Instruction: Generate impression based on findings.

Input: Possible TIA. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mild diffuse patchy cerebral white matter T2 hyperintensity. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Mild diffuse patchy cerebral white matter T2 hyperintensity may represent chronic small vessel ischemic disease. Otherwise, no evidence of acute intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: Male 52 years old Reason: Assess for labral tear, loose body History: Left shoulder instability ROTATOR CUFF: There is fluid signal along the undersurface of the supraspinatus tendon reflecting partial undersurface tearing. No full-thickness tear is identified. The remaining rotator cuff tendons are normal. There is no associated muscle atrophy.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is a superior labral tear extending from the level of the biceps anchor the posterior superior labrum. The tear does not definitely extend into the biceps tendon.There is some degeneration of the anterior and posterior glenoid labrum.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: 1. Type II SLAP tear of the labrum. There is no extension into the biceps anchor.2. Partial undersurface tearing of the supraspinatus tendon.


Instruction: Generate impression based on findings.

Input: Female, 63 years old, with meningioma, follow-up exam. A 10 x 8 mm enhancing extra-axial lesion is evident along the right lateral aspect of the spinal canal at the C1 level. This lesion effaces the CSF space, contacting and deforming the adjacent spinal cord. On comparison with the prior noncontrast C-spine MRI this lesion has probably not changed significantly in size.No other extra-axial or intra-axial lesions are appreciated. Brain parenchymal morphology is within normal limits. No evidence of concerning signal abnormally, edema or mass effect is detected. No abnormal extra-axial fluid or intracranial hemorrhage is observed. The ventricular system is normal in size and morphology.

Output: 1.A 10 x 8 mm extra-axial enhancing lesion is seen within the right lateral spinal canal at the C1 level compatible with the stated history of meningioma. This lesion impinges on the adjacent spinal cord. No significant interval change is suspected when compared to a prior examination from August 2015.2.The remainder of the examination is within normal limits. No additional intra-axial or extra-axial lesions are appreciated.


Instruction: Generate impression based on findings.

Input: 62-year-old female with pain along the lateral femoral condyle MENISCI: Globular intermediate signal within the posterior horn of the medial meniscus is suggestive of mild intrasubstance degeneration. Lateral meniscus is within normal limits.ARTICULAR CARTILAGE AND BONE: Marked thinning of the articular cartilage with subchondral cyst and reactive edema in the medial femoral condyle. Intermediate signal within the articular cartilage is compatible with degeneration without focal fluid-filled defect.Marked thinning of the patellar articular cartilage, primarily along the lateral facet, with combination of underlying subchondral cyst and bone marrow edema. There is fluid-filled laminar tearing of the articular cartilage along the medial aspect of the lateral facet.LIGAMENTS: The cruciate and collateral ligaments are intact.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1.Articular cartilage defects along the lateral facet of the patella and medial femoral condyle as described above.2.Mild intrasubstance degeneration of the posterior horn of the medial meniscus.


Instruction: Generate impression based on findings.

Input: Other specified malignant neoplasm of skin, unspecified [C44.99] / Encounter for follow-up examination after completed treatment for conditions other than malignant neoplasm [Z09], Reason for Study: ^Reason: History of Brain metastases post resection, ass Motion artifact degraded exam quality.Redemonstration of post resection status of right anterior temporal lobe metastatic nodule with postoperative changes.In particular, linear and slightly irregular shaped enhancements on the posterior margin of the resection cavity appear to be unchanged since prior scan.Partially visualized left side paraspinal soft tissue mass which shows iso or slightly high on T2, low on T1 with diffuse relatively homogeneously enhancement is again seen and unchanged since prior scan.Scattered non specific FLAIR high signal intensity lesions on periventricular white matter, unchanged. 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 midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. No evidence of recurrent tumor at the right anterior temporal resection cavity.2. No evidence of new abnormal enhancement on this scan.3. Unchanged left paraspinal soft tissue mass.4. No evidence of new acute ischemic or hemorrhagic lesion.


Instruction: Generate impression based on findings.

Input: 53-year-old male with history of necrotizing cholecystitis now with apparent hernia on surgical site. Increased pain. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Subcentimeter hypodensities in the right and caudate lobe of the liver which are too small to characterize but most likely represent cysts.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Right upper quadrant. Incisional hernia containing nonobstructed colon and small bowel segments.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Subtle focal enhancement in the left posterior peripheral zone of the prostate. Correlation with PSA level and/or MRI of the prostate may be helpful.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Large right upper quadrant incisional herniaSubtle focal enhancement in the left posterior peripheral zone of the prostate. Correlation PSA level is recommended.


Instruction: Generate impression based on findings.

Input: The internal auditory canals are symmetrical and normal in size and signal intensity. The inner ears are normal, with normal T2 signal and no pathological enhancement. No abnormal mass or abnormal enhancement is seen within the cerebellopontine angle, cisterns bilaterally or within the internal auditory canals. The seventh and eighth cranial nerves are visualized bilaterally, although the left cochlear nerve is slightly better visualized than the contralateral side, which may be technical in nature. Please note that evaluation is limited sagittal obliques through the IACs were not submitted for review.There is mild nonspecific prominence of the ventricles, especially the lateral and third ventricles. There is only minimal prominence of the anterior subarachnoid space, greater on the right side. The cisterns remain patent. There is no midline shift or mass effect. There are no areas of abnormal signal or pathological enhancement. There is no diffusion abnormality. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits.

Output: 1. Unremarkable contrast-enhanced MR appearance of the IACs. Seventh and eighth cranial nerves are visualized bilaterally, with better visualization of the left cochlear nerve likely technical in nature. Evaluation somewhat limited due to lack of sagittal obliques through the IACs.2. Nonspecific mild prominence of the ventricles with less conspicuous prominence of the anterior subarachnoid spaces, greater on the right side. Findings could relate to benign enlargement of subarachnoid spaces of infancy we should resolve by two years of age. Follow-up imaging may be obtained as clinically indicated.


Instruction: Generate impression based on findings.

Input: 46-year-old woman with history of pancreatitis and choledocholithiasis. ABDOMEN:LIVER, BILIARY TRACT: The liver appears normal. There is mild intrahepatic biliary duct dilatation. The gallbladder is distended and there are multiple layering stones. There is no gallbladder wall thickening or pericholecystic fluid. The common bile duct is dilated up to 9 mm and tiny stones are seen in the distal common bile duct (series 501, images 22/23). SPLEEN: The spleen appears normal.PANCREAS: There is mildly increased signal in the pancreatic parenchyma suggesting edema. The pancreatic duct is mildly prominent to the level of the ampulla.ADRENAL GLANDS: The adrenal glands are normal.KIDNEYS, URETERS: A right upper pole parapelvic cyst is noted. The kidneys are otherwise normal and enhance symmetrically.RETROPERITONEUM, LYMPH NODES: No significant lymphadenopathy noted. Of note, a strut of the IVC filter is seen in the aorta.BOWEL, MESENTERY: Partially visualized small bowel and colon are normal.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Tiny gallstones in the distal common bile duct with mild intrahepatic and pancreatic duct dilatation.2.IVC filter strut in the aorta.3.Findings discussed with Dr. Chapman and Kathleen Tepe, PA by phone at 17:16 on 10/27/15.


Instruction: Generate impression based on findings.

Input: New lung cancer diagnosis. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are numerous scattered foci of T2 hyperintensity in the bilateral cerebral hemisphere, which are nonspecific and may represent chronic small vessel ischemic disease. There is no abnormal intracranial enhancement. There is mild diffuse cerebral volume loss. There is no midline shift or herniation. There appears to be a 6 mm diameter left paraclinoid aneurysm. The skull and scalp soft tissues are grossly unremarkable. There are secretions in the left anterior ethmoid sinus. There are bilateral lens implants.

Output: 1. No evidence of intracranial metastases. 2. Apparent 6 mm diameter left paraclinoid aneurysm. Dedicated cerebrovascular imaging may be useful for further evaluation.Discussed with Dr. Olugbile at 4:40 PM on 5/16/16.


Instruction: Generate impression based on findings.

Input: A 45 year old male with no known medical problems until about one month ago when he was hospitalized because of heart failure and his clinical condition improved with diuretics. The echocardiography showed a severely decreased systolic function of the left ventricle and suspected non-compaction cardiomyopathy. A normal EKG and troponin levels was seen. He suffers from mildly reduced kidney function. Referred now to cardiac MRI for further evaluation. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 20%, the LV end diastolic volume index is 239 ml/m2 (normal range: 74+/-15), the LVEDV is 510 ml (normal range 142+/-34), the LV end systolic volume index is 191 ml/m2 (normal range 25+/-9), the LVESV is 408 ml (normal range 47+/-19), the LV mass index is 83 g/m2 (normal range 85+/-15), and the LV mass is 177 g (normal range 164+/-36). There is severe global hypokinesis with akinesia of the entire inferior wall. The lateral wall is mildly dyskinetic. There is intermediate signal that is transmural from the base to the apical two thirds of the lateral wall. In addition, there is a high signal, linear epicardial enhancement involving the apex that extends from the apical one third of the septum to the apical one third of the lateral wall. This epicardial enhancement is atypical for myocardial infarct. Given the pattern of enhancement and disproportionate wall abnormality relative to regions of enhancement, a global process such as inflammation may be present. In the presence of wall thinning, this may represent a subacute or chronic myocarditis. Per clinical history, the EKG and troponins were normal; therefore, ischemic etiology is considered much less likely.There is no intracavitary thrombus.There is no iron overload in the myocardium. There is no MRI findings compatible with non-compaction cardiomyopathy.Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is mildly dilated with moderately reduced systolic function. The overall RV ejection fraction is 36%, the RV end diastolic volume index is 117 ml/m2 (normal range 82+/-16), the RVEDV is 249 ml (normal range 142+/-31), the RV end systolic volume index is 74 ml/m2 (normal range 31+/-9), and the RVESV is 158 ml (normal range 54+/-17). No definite right ventricular wall enhancement is identified; however, this may be limited because a single dose of gadolinium was utilized due to limited renal function.Right AtriumThe right atrium is moderately dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is at least moderate 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 mild pericardial effusion.

Output: 1. The left ventricle is severely dilated with severely reduced systolic function, the LVEF is 20%. 2. There is no MRI findings compatible with non-compaction cardiomyopathy. There is severe global hypokinesia with areas of akinesia and wall thickening with associated enhancement as described above. The enhancement is not typical of myocardial infarct; therefore, other etiologies such as inflammation may be considered.3. The right ventricle is mildly dilated with moderately reduced systolic function, the RVEF is 36%. 4. The right and left atrium are moderately dilated. 5. There is at least moderate mitral regurgitation.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: Foot drop, right footClinical question: hx back and leg pain. Now with Foot drop x 4months. Eval for abnormalitySigns and Symptoms: foot drop, back and leg pain 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 a disc bulge present at this level which minimally effaces the fat at the left lateral recess. There is no compromise to the exiting nerve roots.At L4-5 there is no significant compromise to spinal canal or neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: There is a disc bulge and L4-5 which minimally encroaches on the nerve roots at the left lateral recess.


Instruction: Generate impression based on findings.

Input: Prominent susceptibility is seen along the right frontal region from indwelling shunt catheter which limits evaluation of surrounding structures. Grossly, the right frontal approach catheter is in stable position, with its tip just across midline in the interhemispheric region. Overall, the interhemispheric cystic spaces are reduced since the remote MRI and perhaps even slightly reduced since the more recent CT comparison. However, there has been overall interval fluctuation of the extra-axial cystic areas of the convexity. For example, a cyst along the posterior right parietal region has increasing convexity of its margins, now measuring 3.0 x 2.0 cm on 601/22, compared to previous 2.4 x 1.1 cm. However, there has been interval reduction of the overlying percent shaped cystic structure. Identifiable portions of the ventricular system do not appear significantly changed accounting for distorted anatomy since the previous MRI.Severe disordered gray matter with a nodular appearance replaces the majority of the superior right cervical hemisphere consistent with a migration abnormality of polymicrogyria. There is additional abnormal appearance of the gray matter along the left posterior parietal lobe consistent with additional polymicrogyria. There appears be complete absence of the corpus callosum. There is slight distorted appearance of the cerebellum with perhaps mild dysplasia.There are no areas of abnormal signal other than scattered minimal areas of marginal FLAIR hyperintensity consistent with areas of gliosis. There is no diffusion abnormality.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits.

Output: 1.Overall, no significant interval change in dysmorphic ventricular size, with stable decreased interhemispheric and fluctuating size of convexity extra-axial cystic structures. Right frontal approach drainage catheter remains in grossly stable position.2.Redemonstration of extensive developmental abnormalities including multifocal polymicrogyria and absence of the corpus callosum.


Instruction: Generate impression based on findings.

Input: Dizziness, gait problems, evaluate for structural lesions The evaluation for structural lesions is limited by lack of intravenous contrast.Alignment of the cervical spine is anatomic. The cervical vertebral body heights and intervertebral disc spaces are grossly preserved. The bone marrow signal is within normal limits. Within the spinal cord, there is a 4 mm syrinx just to the left of midline at the level of C7-T1. Otherwise, the cord signal is within normal limits. Limited evaluation of the intracranial contents is within normal limits. The cerebellar tonsils are normal in position.C2/3: No canal stenosis or neural foraminal narrowing.C3/4: No canal stenosis or neural foraminal narrowing. C4/5: No canal stenosis or neural foraminal narrowing. C5/6: No canal stenosis or neural foraminal narrowing. C6/7: There is a mild central disc protrusion without significant canal stenosis. No neural foraminal narrowing. C7/T1: No canal stenosis or neural foraminal narrowing.

Output: 1.Focal syrinx at the C7-T1 level without cord expansion is likely chronic. 2.Minimal degenerative spondylosis of the cervical spine.


Instruction: Generate impression based on findings.

Input: 57-year-old female evaluate for abdominal abscess ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Mild biliary prominence and dilatation of the common bile duct. The patient is status post cholecystectomy.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Left adrenal nodule measuring 2 cm in diameter. Further evaluation with adrenal MRI may be helpful.KIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postsurgical changes involving the bowel.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: There is a 8.1 x 5.5 cm air, stool, fluid containing, oval shaped area in the pelvis. Due to poor opacification of the colon it's not clear whether this represents a redundant cecum located in the pelvis versus an extraluminal collection.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Postsurgical changes involving the bowel. Mild biliary prominence. Redundant cecum located in the pelvis versus less likely an extraluminal collection in the pelvis. Further evaluation with repeat CT with rectal contrast or MRI may be helpful for differentiation.


Instruction: Generate impression based on findings.

Input: Ataxia. There is no evidence of intracranial hemorrhage or acute infarct. There are mild areas of periventricular white matter T2 hyperintensity, which may represent terminal zones of myelination. The brain, brainstem, and cerebellum otherwise appear unremarkable, with a normal of myelination. There is a cystic pineal gland that measures 9 mm in diameter. There is no abnormal intracranial enhancement. There right lateral ventricle frontal horn is slightly small than the left frontal horn. The ventricles are not enlarged. There is mild prominence of the anterior cerebral convexity subarachnoid spaces. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is mild plagiocephaly.

Output: No evidence of specific findings to account for ataxia.


Instruction: Generate impression based on findings.

Input: 50-year-old man with pain and locking of left knee. Evaluate for torn meniscus. MENISCI: There is globular signal within the medial meniscus indicating intrasubstance degeneration, but we see no frank tear. There is also globular signal within the lateral meniscus indicating intrasubstance degeneration, without a discrete tear. There is slight prominence of the body of the lateral meniscus, which may reflect a mild discoid morphology. ARTICULAR CARTILAGE AND BONE: There is a focal near-full-thickness to full-thickness defect involving the articular cartilage of the weightbearing portion of the medial femoral condyle, which measures approximately 1.5cm in AP dimension. There is perhaps mild fraying of the articular cartilage of the medial tibial plateau. The articular cartilage of the lateral tibiofemoral joint appears relatively intact. There is moderate to severe degeneration of the articular cartilage of the trochlea, particularly inferiorly, with multiple subchondral cysts. There is superficial degeneration of the articular cartilage of the patella. LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1.Osteoarthritis, most severely affecting the femoral trochlea, with a loose osteochondral fragment within the joint posteriorly, which may be the source of the patient’s joint locking.2.Joint effusion with edema extending inferiorly from the Baker’s cyst which may reflect edema or recent rupture.


Instruction: Generate impression based on findings.

Input: Male 49 years old; Reason: Left achilles tendon avulsion, tx'd w/o surgery, evaluate pain along Achilles insertion Three views of the left ankle again show marked thickening of the Achilles tendon compatible with tendinosis and tearing, as seen on prior MRI.Small foci of ossification posterior to the calcaneus appear similar to those seen in the prior study, and may represent avulsed fragments. A small focus of heterotopic ossification is again seen along the anterior margin of the Achilles tendon.

Output: Findings compatible with Achilles tendinosis and tearing, appearing similar to the prior study.


Instruction: Generate impression based on findings.

Input: Metastatic melanoma treated with SRS for brain metastasis. Surveillance exam. There is an enhancing mass arising from the right lateral occipital bone with paraspinal soft tissue extension, measuring up to 30 mm. There also appear to be an enhancing lesions in the mandibular condyles, left larger than right. The right superior frontal gyrus enhancing lesion measures up to 4 mm, previously 7 mm. There are multiple new subcentimeter lesions, including within the right middle frontal gyrus, right superior frontal sulcus, right hippocampus, right lateral occipital lobe, right precuneus, bilateral basal ganglia, left fusiform gyrus, left orbitofrontal region, left inferior frontal sulcus, left inferior parietal lobule, left anterior cingulate gyrus, and bilateral cerebellar hemispheres. A few of the lesions display a small amount of susceptibility effect, which may represent hemorrhage. There is generally trace vasogenic edema associated with the lesions. There is scattered cerebral white matter T2 hyperintensity and encephalomalacia in the left basal ganglia. There is no evidence of acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, paranasal sinuses, and mastoid air cells are grossly unremarkable. There is a punctate nodule in the left parietal scalp.

Output: 1. Interval decrease in size of the right superior frontal gyrus, but interval appearance of numerous subcentimeter intracranial metastases.2. An enhancing mass arising from the right lateral occipital bone with paraspinal soft tissue extension, measuring up to 30 mm, likely represents a metastasis. Likewise, lesions in the mandibular condyles, left larger than right, may also represent metastases.3. Chronic lacunar infarct in the left basal ganglia, but no evidence of acute infarction.4. Nonspecific punctate nodule in the left parietal scalp.


Instruction: Generate impression based on findings.

Input: Known 2.5 cm pancreatic head neuroendocrine tumor. ABDOMEN: LIVER, BILIARY TRACT: The liver is normal in size and morphology. There are numerous bilobar cysts. No suspicious liver lesion. The vessels are patent. The common bile duct measures up to 6 mm and tapers smoothly distally without a filling defect.SPLEEN: No significant abnormality noted.PANCREAS: There is significant main pancreatic ductal dilatation up to 8 mm with an abrupt transition at the level of the pancreatic head. There is moderate distal pancreatic parenchymal atrophy. At the transition point there is a faint region of restricted diffusion measuring approximately 1.4 x 1.2 cm (series 4/147). No definite associated signal abnormality is identified on T2-weighted images. There may be associated mild relative hyperenhancement to the remainder of the pancreatic parenchyma on subtraction images (series 100/30). This corresponds to the faintly enhancing lesion seen on the outside hospital CT (series 6/56).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: Significant main pancreatic ductal dilatation and moderate pancreatic parenchymal atrophy with a 1.4 cm focus of restricted diffusion corresponding to the faintly enhancing lesion seen on outside hospital CT and compatible with the stated history of pancreatic neuroendocrine tumor. No definite liver metastases or other sites of disease.


Instruction: Generate impression based on findings.

Input: 57-year-old female with a deep coccygeal pressure ulcer presenting with sepsis. Evaluate for osteomyelitis. Note is made of soft tissue irregularity along the dorsal aspect of the sacrum consistent with the stated history of ulceration. There is increased signal abnormality within the subcutaneous tissue with associated enhancement on postcontrast sequences extending to the level of the posterior aspect of the sacrum extending laterally along the sacroiliac joints bilaterally. There are multiple foci of signal void along the posterior aspect of the sacrum likely representing foci of gas. Additionally, note is made of increased signal abnormality and fluid sensitive sequences with corresponding decreased signal abnormality on T1-weighted images within the S3 segment of the sacrum indicating osteomyelitis. There is also soft tissue irregularity along the posterior aspect of the left posterior hemipelvis which extends anterior to the level of the hip musculature. Note is made of increased signal abnormality on fluid sensitive sequences within the left iliacus muscle, and vastus musculature of the left hip. There is irregular lobulated enhancement within the soft tissues along the left anterior femoral head/neck junction suggestive of phlegmon formation or early pyomyositis. There is increased bone marrow signal abnormality on fluid sensitive sequences within the left greater trochanter with associated decreased signal abnormality on T1-weighted images indicating osteomyelitis. There is also signal abnormality within the proximal left femoral metadiaphysis which is also suspicious for osteomyelitis. There is no definite drainable collection identified. There is nonspecific subcutaneous edema along the lateral aspect of the thighs bilaterally. Foley catheter in place. There is a small amount of fluid within the left hip joint which may be of no clinical significance.

Output: Soft tissue ulceration with associated osteomyelitis of the left femur and sacrum as described above. Inflammatory changes within the musculature of the left hip with findings suggestive of phlegmon formation/early pyomyositis about the anterior aspect of the left femoral head/neck as described above. No definite drainable collection is identified. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Aneurysm CTA of intracranial circulation:60 cc of Omnipaque 350 was administered for this study.Axial 0.9 contiguous CT images of head after administration of contrast were obtained. 3-D reformatted images were acquired utilizing an independent workstation.Axial, coronal and sagittal 2-D MIP images are also rendered.Examination demonstrates an aneurysm of anterior communicating artery which involves the entire length of the anterior communicating artery. The aneurysm extends from the junction of the right A1 with anterior communicating artery to the junction of the left A1 with the anterior communicating artery. It also appears to incorporate the origins of the A2 segments of anterior cerebral arteries. The aneurysm measures 8.2 mm in transverse axis, 7.2-mm in AP axis and 7.7-mm in cranial -- cephalad axis. The aneurysm is smooth and rounded and with no evidence of any intraluminal defect.The bilateral A1 segments of anterior anterior cerebral arteries are symmetrical in size. There is also normal visualization of bilateral A2 segments and distal branches of the anterior cerebral arteries with no additional abnormality.There is normal visualization of bilateral middle cerebral arteries without evidence of aneurysm.Normal appearing bilateral supraclinoid internal carotid arteries and a single dominant right posterior communicating artery without aneurysm.Intracondylar components of vertebral arteries are normal bilaterally and the normal visualization of bilateral pica branches.Vaso-artery, superior cerebellar arteries and posterior cerebral arteries are also well visualized and without evidence of pathology.In comparison with MRA of intracranial circulation from Ingalls open MRI study dated 8 -- 3 -- 11 there is no appreciable interval change.Nonenhanced head CT:Examination demonstrates no evidence of intracranial hemorrhage, edema, mass effect, midline shift or hydrocephalus.New patchy subcortical and periventricular foci of increased signal intensity in bilateral cerebral hemispheres as was noted on prior MRI are brief to represent small vessel ischemic disease of indeterminate age.The cortical sulci and ventricular systems as well as CSF cisterns remain within normal for patient's stated age of 73.Calvarium is intact. Visualized mastoid air cells and paranasal sinuses are unremarkable.Incidental note is made of bilateral soft tissue density within the external auditory canals with no evidence of any bony changes. Findings are believed to represent debris within the external auditory canals. Recommend And further evaluation by direct inspection.

Output: 1.Single locule anterior communicating artery aneurysm which appears to incorporate the entire length of anterior communicating artery. The aneurysm has a smooth round configuration and measures 8.2 x 7.2 X 7.7 mm in three dimensional measurements. There is no evidence of hemorrhage, vasospasm or mass effect.2.Negative CTA of intracranial circulation otherwise.3.Nonenhanced head CT demonstrates moderate findings of small vessel ischemic disease of indeterminate age.


Instruction: Generate impression based on findings.

Input: Reason: evaluate for osteo History: edema, r/o osteo There is soft tissue irregularity along the plantar aspect of the calcaneus consistent with known history of ulceration. There is decreased signal abnormality on T1 and T2 along the plantar aspect of the calcaneus likely representing scarring/granulation tissue. Although this signal abnormality extends to the level of the plantar aspect of the calcaneus, no bone marrow signal abnormalities are identified to suggest osteomyelitis. There is additional ulceration along the dorsal and lateral aspect of the midfoot. There is low signal intensity internally which may represent packing material or granulation tissue. There is no evidence of osteomyelitis of the underlying bones of the midfoot/ankle. There is nonspecific increased signal abnormality and fluid sensitive sequences within the plantar musculature of the foot as can be seen in diabetic patients or in myositis/inflammatory change. There is circumferential fluid within the tendon sheath of the extensor digitorum longus indicating acute synovitis. There is an apparent fluid collection within the subcutaneous tissue along the anterior aspect of the extensor tendons measuring approximately 3.4 x 1.0 x 5.5 cm which is suspicious for abscess formation, although this is incompletely characterized on this noncontrast examination. This collection extends distally along the dorsal and lateral aspect of the midfoot.Osteoarthritis affects the tarsometatarsal articulations with degenerative subchondral signal abnormality. There is a small amount of fluid within the tibiotalar and subtalar joints but no evidence of a large effusion. There is nonspecific increased signal abnormality within the muscle belly of the flexor hallucis longus at the level of the myotendinous junction. The lateral collateral ligament complex appears intact. The distal tibiofibular syndesmotic complex appears intact. Imaged components of the deltoid ligament appear intact.

Output: 1. Ulceration and subcutaneous inflammatory change about the plantar aspect of the calcaneus as well as along the dorsolateral aspect of the ankle/midfoot, without evidence of osteomyelitis. Fluid collection within the subcutaneous tissue along the anterior and lateral aspect of the ankle extending along the dorsal and lateral aspect of the midfoot is suspicious for abscess formation, although this is incompletely characterized on this noncontrast examination.2. Findings indicating extensor digitorum longus tenosynovitis. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Right-sided acoustic neuroma, which was re-resected in a second operation about 5 years ago. There are stable postoperative findings related to suboccipital craniotomy for resection of a right vestibular schwannoma, including right cerebellar hemisphere and middle cerebellar peduncle encephalomalacia. There is no evidence of recurrent vestibular schwannoma. There is disruption of the right cranial nerve 7 and 8 complex as well as volume loss of the right trigeminal nerve. There is also unchanged loss of fluid signal within the right cochlea. The left internal auditory canal contents and inner ear structures are unremarkable. There is no evidence of intracranial hemorrhage or acute infarct. The brain parenchyma appears unremarkable. The ventricles are stable in size and configuration. There is no midline shift or herniation. The major cerebral vessels are grossly intact. The skull and extracranial soft tissues are unchanged, including asymmetric loss of bulk of the right mimetic muscles.

Output: Stable postoperative findings without evidence of recurrent vestibular schwannoma.


Instruction: Generate impression based on findings.

Input: Chronic lifelong headaches due to aqueductal stenosis that was surgically corrected in October 2011 by third ventriculostomy. There are postoperative findings related to third ventriculostomy. There appears to be a jet of CSF across the floor of the third ventricle. There is unchanged mild prominence of the third and lateral ventricles. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appears unchanged. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues appear unchanged.

Output: 1. Postoperative findings related to third ventriculostomy, which appears to be patent2. Unchanged supratentorial ventriculomegaly.


Instruction: Generate impression based on findings.

Input: Worsening gait difficulty, evaluate for myelopathy, cord compression, etc. Craniovertebral junction appears within normal limits. There is mild exaggeration of cervical lordosis which may be positional. Minimal C5 on C6 anterolisthesis similar to prior. Alignment of the cervical spine is otherwise maintained. Vertebral body heights are normal. Bone marrow signal is benign. There is some congenital narrowing of the cervical spinal canal with superimposed degenerative changes. No abnormal cord signal is seen. Individual levels as below: C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: Minimal disc osteophyte complex and ligamentum flavum thickening. Left-sided facet arthropathy. No significant spinal canal or neural foraminal stenosis. C4-5: Minimal disc osteophyte complex as well as uncovertebral hypertrophy and ligamentum flavum thickening. There is mild to moderate spinal canal stenosis with effacement of the ventral and dorsal thecal sac. No significant neural foraminal narrowing.C5-6: Minimal anterolisthesis. There is mild to moderate spinal canal stenosis with effacement of the ventral and dorsal thecal sac. There is mild bilateral neural foraminal stenosis.C6-7: Small disc osteophyte complex with effacement of the ventral thecal sac. Mild spinal canal stenosis. No significant neural foraminal narrowing.C7-T1: No significant compromise to the spinal canal or neural foramina.Enlarged and nodular left thyroid lobe again seen similar to 2008. The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: 1. There is congenital narrowing of the spinal canal with superimposed degenerative changes. There is effacement of the ventral and dorsal thecal sac resulting in mild to moderate spinal canal narrowing at C4-C5, C5-C6, and C6-C7. No evidence of frank cord compression or cord signal abnormality. 2. Mild anterolisthesis is again seen at C5-6 similar to prior CT from 2008. Flexion-extension radiographs can be considered to evaluate for instability. Exaggeration of cervical lordosis with apex at C4-C5 is also seen, which may be in part positional.


Instruction: Generate impression based on findings.

Input: Stage IIIB (cT3N3) lung adenocarcinoma. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is unchanged minimal scattered nonspecific cerebral white matter T2 hyperintensity. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No evidence of intracranial metastases.


Instruction: Generate impression based on findings.

Input: 57-year-old male with prostate cancer status post prostatectomy (2013) with rising PSA PELVIS:PROSTATE:Prostate Size: Status post prostatectomy. T2 hyperintense 4 mm cystic lesion in the midline posterior to the urethra is likely postsurgical.Peripheral Zone: Status post prostatectomy.Central Gland: Status post prostatectomy.Seminal Vesicles: Surgically absent.Extracapsular Extension: Not applicable.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: T2 dark focus measuring 5 mm in the left femoral head is unchanged since CT dated 11/23/2013. Right fat-containing inguinal hernia.OTHER: No significant abnormality noted.

Output: 1.Status post prostatectomy without identifiable evidence of recurrent or residual disease.


Instruction: Generate impression based on findings.

Input: There are postoperative changes related to left frontal craniotomy for resection of a left frontal lobe mass. There is marginal susceptibility along the resection cavity as well as along the residual anterior left frontal lobe parenchyma, consistent with chronic hemosiderin deposition likely from the prior surgery. There is also diffuse smooth dural enhancement in the left frontal region with mild thickening, also likely postoperative in etiology. There is no significant interval change in the extent of the T2 hyperintense infiltrative process in the left frontal lobe surrounding the resection cavity with extension across the corpus callosum into the right frontal lobe. There is also unchanged patchy T2 hyperintensity in the white matter of the bilateral cerebral hemispheres, which may be treatment related. There is mild mucosal thickening in the right frontal sinus and left ethmoid air cells. The orbits are unremarkable.

Output: Postoperative findings related to left frontal mass resection and radiation without evidence of interval tumor progression.


Instruction: Generate impression based on findings.

Input: 53-year-old male with spiking fevers. Evaluate for worsening perianal abscess/fistula. PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Redemonstration of small rim-enhancing fluid collection posterior to the internal sphincter which measures 1.6 x 0.8 cm (series 1/4/2001, image 19), previously measuring 1.8 x 1.1 cm. There is surrounding soft tissue edema and thickening of the adjacent rectal wall. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Stable to mild decrease in size of perianal abscess with persistent adjacent soft tissue edema/proctitis.


Instruction: Generate impression based on findings.

Input: 70 year old female with a history of hypertension, left ventricular hypertrophy, heart failure with preserved ejection fraction, prior stroke, and lupus who is referred for stress cardiac MRI for further evaluation. MEDICATIONS: Furosemide, Hydralazine, Lisinopril, Metoprolol, Rivaroxaban, Allopurinol, Symbicort, Calcitrol, Ergocalciferol. First Pass PerfusionDuring hyperemia, no perfusion defects were present.Viability/ Myocardial ScarThere is mid-myocardial late gadolinium enhancement present in the mid to basal inferoseptum and lateral wall. Additionally there is patchy subepiocardial late gadolinium enhancement present. Images are limited by breathing artifact. This pattern of late gadolinium enhancement is atypical for myocardial infarction and may suggest the presence of fibrosis, inflammation, or infiltration. The entire myocardium is viable. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 60%, the LV end diastolic volume index is 83 ml/m2 (normal range: 65+/-11), the LVEDV is 172 ml (normal range 109+/-23), the LV end systolic volume index is 33 ml/m2 (normal range 18+/-5), the LVESV is 68 ml (normal range 31+/-10), the LV mass index is 107 g/m2, and the LV mass is 205 g. There is severe concentric left ventricular hypertrophy - at the mid to basal segment, the septum measures 15-16 mm and the lateral wall measures 14-15 mm. There are no regional wall motion abnormalities present. The pre-contrast native T1 myocardial relaxation times are elevated (1180 ms). Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 61%, the RV end diastolic volume index is 86 ml/m2 (normal range 69+/-14), the RVEDV is 163 ml (normal range 110+/-24), the RV end systolic volume index is 34 ml/m2 (normal range 22+/-8), and the RVESV is 64 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 at least mild to moderate mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC drain normally into the right atrium. PericardiumThere is a moderate sized circumferential pericardial effusion.Extracardiac Findings This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. No perfusion defects/ "ischemia" present during hyperemia. 2. No prior myocardial infarction. The entire myocardium is viable. There is mid-myocardial late gadolinium enhancement present in the mid to basal inferoseptum and lateral wall. Additionally there is patchy subepiocardial late gadolinium enhancement present. Images are limited by breathing artifact. This pattern of late gadolinium enhancement is atypical for myocardial infarction and may suggest the presence of fibrosis, inflammation, or infiltration.3. The left ventricle is normal in size with normal systolic function. (LVEF 60%). The pre-contrast native T1 myocardial relaxation times are elevated (1180 ms) which could be suggestive of diffuse myocardial fibrosis. 4. The right ventricle is normal in size and systolic function (RVEF 61%).5. There is severe, concentric left ventricular hypertrophy (see above measurements).6. The left atrium is severely dilated. The right atrium is mildly dilated. 7. The mitral valve opens widely and there is at least mild to moderate mitral regurgitation.8. There is a moderate sized circumferential pericardial effusion. Hemodynamic assessment of pericardial effusion not evaluated. Suggest alternate imaging such as echocardiography. 9. Overall the findings are not typical for cardiac amyloid. Previous history of myocarditis is possible given pattern of late gadolinium enhancement. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: MRA Brain: The intracranial internal carotid arteries demonstrate no significant stenosis. The middle and anterior cerebral arteries are also patent. The vertebral arteries, basilar artery, and posterior cerebral arteries also are patent with no significant stenosis. No evidence of aneurysms.MRA Neck:There is a separate origin of the left subclavian artery, left common carotid artery, and brachiocephalic artery from the arch. The common carotid arteries and cervical internal carotid arteries are normal in course and caliber. Both vertebral artery origins are patent. There is no evidence of stenosis or occlusion.

Output: No abnormalities are visualized involving the major intracranial arteries or arteries of the neck.


Instruction: Generate impression based on findings.

Input: Dizziness. Neck pain. There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration.Trace amount of low attenuation are present in the periventricular and subcortical white matter. Gray-white differentiation is preserved. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: No acute intracranial abnormality.


Instruction: Generate impression based on findings.

Input: History of heart and kidney transplantation in September 2014. Possible CNS Nocardia infection. There is no evidence of acute ischemic or hemorrhagic lesion on the scan.There is patchy high signal intensity especially on the subcortical white matter on the right inferior frontal gyrus, in particular pars opercularis on FLAIR imaging. The lesion is non enhancing and shows low signal intensity on T1 with subtle evidence of volume loss. Therefore, this lesion is likely represent localized chronic ischemic lesion.Patch periventricular white matter high signal intensity on FLAIR imaging indicates nonspecific small vessel ischemic disease.Scattered small signal void areas especially on bilateral cerebellar hemisphere and left temporal lobe superficial area without evidence of surrounding edema indicate possible parenchymal calcification or chronic hemorrhagic foci.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear. Bilateral maxillary sinus shows mucosal thickening

Output: No evidence of acute ischemic or hemorrhagic lesion.No evidence of abnormal enhancement.Minimal nonspecific small vessel ischemic disease.Possible chronic ischemic lesion on the right inferior frontal gyrus, pars opercularis as described above.


Instruction: Generate impression based on findings.

Input: Male, 59 years old, with history of T4 N2 WHO type III nonkeratinizing EBV+ nasopharyngeal cancer. Orbits:No orbital masses are seen. The globes are round and symmetric. The extraocular muscles demonstrate normal caliber and signal characteristics. The optic nerves are free of pathologic signal abnormality and enhancement.Neck:Posttreatment findings are redemonstrated in the nasopharyngeal region without evidence of recurrent mucosal tumor. The marrow of the central skull base remains heterogeneous similar to prior. No pathologic adenopathy is detected. Mucosal thickening and secretions are demonstrated in the bilateral maxillary and ethmoid sinuses as well as the tympanic cavities and mastoid air cells.

Output: 1.No findings to suggest recurrent primary tumor or pathologic adenopathy in the neck.2.Persistent mucosal inflammation and secretions in the paranasal sinuses, mastoid air cells and tympanic cavities.


Instruction: Generate impression based on findings.

Input: Meningioma status post laser ablation on 6/30/2016. There is slight interval decrease in size of a nodular component of the petroclival dural-based mass that projects into the left pons, where laser ablation had been performed. There is resultant mildly diminished mass effect upon the pons. However, there is now more confluent enhancement of the treated portion of the tumor. Nevertheless, there is diffuse vasogenic edema within the brainstem and left cerebellar hemisphere. The rest of the tumor, including the portion that extends into the left cavernous sinus is unchanged. There are postoperative findings related to prior left temporal craniotomy with encephalomalacia in the left anterior temporal lobe and left retrosigmoid craniotomy with left cerebellar hemisphere and left pons encephalomalacia. There is a right transfrontal ventricular catheter. The ventricles are unchanged in size and configuration. There is no evidence of acute territorial infarction.

Output: Slight interval decrease in size of a nodular component of the petroclival dural-based mass that projects into the left pons, where laser ablation had been performed. However, there is now more confluent enhancement of the treated portion of the tumor. In addition, there is diffuse vasogenic edema within the brainstem and left cerebellar hemisphere.


Instruction: Generate impression based on findings.

Input: Male 20 years old Reason: Evaluate the Small Bowel History: Crohn's Disease ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. No suspicious hepatic lesions. Hepatic and portal veins are patent. Biliary tree is normal in caliber.SPLEEN: Spleen is top normal in size.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: Small bowel is normal in caliber and course. Postsurgical changes are present near the terminal ileum. No evident inflammatory change. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Postsurgical changes without evident inflammation.


Instruction: Generate impression based on findings.

Input: 24 year old woman in third trimester of pregnancy who presents with LV dysfunction in the setting of recent sepsis, as well as widened mediastinum of CXR, referred for cardiac MRI. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 59%, the LV end diastolic volume index is 79 ml/m2 (normal range: 65+/-11), the LVEDV is 157 ml (normal range 109+/-23), the LV end systolic volume index is 32 ml/m2 (normal range 18+/-5), the LVESV is 64 ml (normal range 31+/-10), the LV mass index is 63 g/m2 (normal range 67+/-11), and the LV mass is 125 g (normal range 114+/-24). There are no regional wall motion abnormalities present. 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 50%, the RV end diastolic volume index is 93 ml/m2 (normal range 69+/-14), the RVEDV is 186 ml (normal range 110+/-24), the RV end systolic volume index is 47 ml/m2 (normal range 22+/-8), and the RVESV is 93 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is at least mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild-moderate tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size. There is no evidence for a dissection flap or aortic aneurysmal disease of the aortic root, thoracic aorta and visualized portions of the abdominal aorta.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThere is residual thymic tissue in the anterior mediastinum. Cholelithiasis. 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. Normal LV size and function (EF 59%). 2. Normal RV size and function (EF 50%). 3. At least mild mitral regurgitation, and mild-moderate tricuspid regurgitation. 4. There is no evidence for aortic dissection or aneurysmal disease on limited.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Male 55 years old with intractable epilepsy, cognitive slowing No evidence of diffusion restriction to suggest acute infarction. No evidence of intracranial hemorrhage or mass. Right frontal lobe encephalomalacia appears unchanged from prior exam. Patchy areas of subcortical and periventricular T2/FLAIR hyperintensity, appearing similar to prior exam and suggestive of chronic white matter small vessel ischemic disease. Stable thinning of the corpus callosum. The ventricles and basal cisterns are normal in size and configuration. No midline shift or herniation. The major cerebral flow voids are intact. The sinuses are almost completely opacified with progression noted in the sphenoid. The mastoid sinuses are relatively clear. The orbits, skull, and scalp soft tissues are grossly unremarkable.

Output: 1. No evidence of acute intracranial hemorrhage, mass, or acute infarct.2. Right frontal lobe encephalomalacia likely secondary to chronic infarct, unchanged from prior exam. 3. Stable chronic white matter small vessel ischemic disease.4. The sinuses are almost completely opacified with progression noted in the sphenoid.


Instruction: Generate impression based on findings.

Input: Headache. Hemorrhagic sellar lesion on previous MRI. BRAIN:There is nodular heterotopia along the frontal horn of the right lateral ventricle, best seen on the coronal T2 sequence. The remainder of the brain shows normal signal and morphology. There is no acute infarct or brain hemorrhage. There is no midline shift or brain herniation. The ventricles and other CSF-containing spaces are normal in size. There is trace mucosal thickening in the paranasal sinuses. The orbits are unremarkable. The major intracranial vascular flow voids are preserved. There is no gross skull or scalp abnormality.PITUITARY:The well-circumscribed, homogeneously intensely T1/T2 hyperintense lesion involving the pituitary gland has increased in size. In height, it measures 8 mm compared to 4 mm previously and extends slightly into the suprasellar cistern but still separate from the optic chiasm. There is a thin rim of pituitary tissue which normally contrast enhances surrounding this lesion. There is suggestion of a layering fluid level with susceptibility, axial image 482 series 901 although artifact from the bony sella and sphenoid sinus limit assessment of this region. The normal posterior pituitary T1 hyperintensity is preserved. The pituitary infundibulum is midline and there is no hypothalamic abnormality. The sella turcica is not expanded and the cavernous sinuses are unremarkable.

Output: Homogeneous, well-circumscribed, intensely T1/T2 hyperintense lesion within the anterior pituitary has increased in size since August 2015. There appears to be layering of debris or blood products. Rathke's cleft cyst is favored. Cystic microadenoma with layering fluid or hemorrhage or small craniopharyngioma are possible but seem less likely given the well-circumscribed, homogenous nature of the lesion and the lack of perceptible contrast enhancement except in the displaced pituitary tissue. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Status post thoracolumbar fusion. Signs and symptoms: See above. Nonenhanced CT of thoracolumbar spine:Examination demonstrates severely compressed L1 vertebral body with significant posterior protrusion of fractured vertebrae into the spinal canal. There is evidence of interval laminectomy at L1 and L2 levels. There is also evidence of posterior fixating rods and fusion utilizing transpedicular screws bilaterally at T11, T12, L2 and L3 levels. In comparison with prior MRI examination there is slight interval improvement in the alignment of vertebral column and good minimal residual anterolisthesis of T12 in respect to L2. There is no evidence of fracture of any of the rods or transpedicular screws. The appropriateness of their positioning should be decided by the referring physician. Note is made of a surgical drain extending posterior to the spinal canal in the lower thoracic and upper lumbar region. Examination also demonstrate mild compression fracture of the superior endplate of L3.

Output: 1.Severely compressed fracture of L1 vertebrae with significant extension posteriorly into the spinal canal.2.Interval bilateral laminectomy at L1 and L2 levels. 3.Posterior fixating rods and multilevel transpedicular bilateral screw placement of T11, T12, L2 and L3 levels.4.Mild residual anterolistheses of T12 with interval improvement since prior MRI exam.


Instruction: Generate impression based on findings.

Input: High risk breast cancer screening. History of breast cancer in mother, maternal second cousin and maternal aunt. There is heterogeneous amount of fibroglandular tissue in both breasts. Bilateral cysts are again seen.Mild parenchymal enhancement is noted bilaterally.No suspicious enhancement is seen in either breast. Bilateral enhancing foci are not significantly changed.No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: A patient submitted outside study for review. Submitted for review are specimen radiograph of left breast and post-procedural left digital mammographic images (2/20/15), digital mammographic images (1/29/15), ultrasound images of both breasts (1/29/15, 11/10/14) and breast MRI (10/8/14) performed at Rush University Medical Center. For comparison, digital mammographic images (1/22/13, 1/22/14) are available. BREAST MRI (10/8/14):The study was performed with a protocol outlined in the outside radiology report. The study was performed for screening purposes. There is extreme amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.There is a focal non mass enhancement in the left breast at 12 o'clock position, measuring 8 x 6 x 7 mm (AP x LR x CC).In the right breast, there are scattered enhancing foci are seen , but no abnormal enhancement is present.ULTRASOUND IMAGES OF BOTH BREASTS (11/10/14):This study was performed for second look ultrasound of non specific focus in the right breast at 10 o'clock position and an enhancing lesion in the left breast at 12 o'clock position seen on MRI. In our interpretation, the focus in the right breast is a part of parenchymal enhancement, which is benign. On ultrasound, no sonographic correlates are detected in either breast.DIGITAL MAMMOGRAPHIC IMAGES (1/29/15):The breast parenchyma is extremely dense, unchanged in pattern and distribution. A cluster of amorphus calcifications, measuring 5 mm, is present at 12 o'clock position in the left breast. This cluster of calcifications likely corresponds to the non mass enhancement seen on MRI.No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in right breast. ULTRASOUND IMAGES OF BOTH BREASTS (1/29/15):Normal appearing lymph node is present in the right axilla. No abnormal findings are visualized in the provided sonographic images.SPECIMEN RADIOGRAPH OF LEFT BREAST AND POST-PROCEDURAL LEFT DIGITAL MAMMOGRAPHIC IMAGES (2/20/15):Per outside radiology report, patient underwent stereotactic biopsy for left breast calcifications.Specimen radiographs reveal target calcifications within some specimens.A marker clip is present at the site of the cluster of calcifications (12 o'clock) in the left breast on post-procedural left digital mammographic images. No residual calcifications are seen.Per outside pathology report, the biopsy result was malignant, DCIS grade 2.

Output: Biopsy proven DCIS in the left breast. Breast MRI demonstrates unifocal lesion in the left breast at 12 o'clock position.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: History of pituitary adenoma, with recent blurred vision in both eyes over last month. Pituitary: There appears to be a punctate focus of hypoenhancement in the posterior right pituitary lobe. Otherwise, the pituitary gland is not enlarged and there is no evidence of pituitary macroadenoma. The infundibulum and optic apparent are intact. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. Apparent punctate focus of hypoenhancement in the posterior right pituitary lobe may represent artifact or perhaps a microadenoma, but no evidence of macroadenoma or other mass lesions compromising the optic apparatus.2. No evidence of intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: 22 year old man with bicuspid aortic valve, referred for further evaluation of aortic regurgitation and aortic root size. Left VentricleThe left ventricle is moderately dilated with low normal systolic function. The overall LV ejection fraction is 53%, the LV end diastolic volume index is 129 ml/m2 (normal range: 74+/-15), the LVEDV is 247 ml (normal range 142+/-34), the LV end systolic volume index is 61 ml/m2 (normal range 25+/-9), the LVESV is 116 ml (normal range 47+/-19), the LV mass index is 62 g/m2 (normal range 85+/-15), and the LV mass is 118 g (normal range 164+/-36). 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 normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 51%, the RV end diastolic volume index is 109 ml/m2 (normal range 82+/-16), the RVEDV is 208 ml (normal range 142+/-31), the RV end systolic volume index is 53 ml/m2 (normal range 31+/-9), and the RVESV is 102 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and is bicuspid with fusion of the right and left aortic leaflets. There is moderate aortic regurgitation (regurgitant fraction 25%) eccentrically directed towards the anterior mitral valve leaflet. Mitral ValveThe mitral valve opens widely and there is trace mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. No aortic coarctation noted. Aorta dimensions as below:SOV: 32mm x 35mm x 33mmSTJ: 32mm x 32mmAscending Aorta: 34mm x 33mmAortic Arch: 22mm x 21mmDescending Thoracic Aorta: 18mm x 18mmPulmonary 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 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 moderately dilated with low normal systolic function. The overall LV ejection fraction is 53%. No underlying myocardial fibrosis, inflammation, or infiltration. 2. The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 51%.3. The aortic valve is bicuspid. There is moderate aortic regurgitation without aortic valve stenosis.4. Normal thoracic aorta size without evidence of coarctation, aneurysm, or dissection.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: View for chronic and acute subdural hematoma: fall from bed. There is a mildly T1 hyperintense and T2 hyperintense right frontoparietal subdural collection that measures up to 8 mm in thickness. There is also a globular area of high T1 and low T2 signal with susceptibility effect in the right superior frontal convexity subdural space that measures up to 15 mm. There is cerebrospinal fluid signal intensity left frontoparietal subdural fluid collection that measures up to 4 mm in thickness. There is an epidural fluid collection with high T1 and low T1 signal that measures up to 3 mm in thickness along the left parietal convexity. There is a punctate focus of susceptibility effect along a cortical vein corresponding to the subarachnoid hyperattenuation on the prior CT. There is minimal prominence of the bilateral anterior frontal subarachnoid spaces. There is no evidence of acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is a normal degree of myelination. 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. There is right posterior subgaleal hematoma that measures up to 5 mm in thickness with an underlying linear defect in the right parietal bone and perhaps the right occipital bone, which correspond to the non-displaced fractures. The orbits are grossly unremarkable.

Output: 1. A small focus of acute subdural hemorrhage is present in the right superior frontal convexity superimposed upon what likely corresponds to a late frontoparietal convexity subdural hematoma.2. A left frontoparietal convexity fluid collection may represent a subdural hygroma versus a chronic subdural hematoma with superimposed small parietal convexity epidural hematoma.3. A punctate focus of susceptibility effect along a cortical vein corresponding to the subarachnoid hyperattenuation on the prior CT may represent subarachnoid hemorrhage.4. Minimal prominence of the bilateral frontal subarachnoid spaces.5. The known non-displaced posterior right skull fractures are better depicted on the prior CT.


Instruction: Generate impression based on findings.

Input: Brachial neuritis or radiculitis. Left-sided radiculopathy. Backache. Cervical: Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained. Bone marrow signal is within normal limits. Degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: Small central disc protrusion and ligamentum flavum thickening with mild spinal canal narrowing. No significant neural foraminal stenosis.C4-5: Disc osteophyte complex with bilateral uncovertebral hypertrophy and ligamentum flavum thickening. There is resulting moderate to severe spinal canal stenosis with mild flattening of the cord. There is mild to moderate bilateral neural foraminal stenosis.C5-6: Disc osteophyte complex and bilateral uncovertebral hypertrophy with moderate to severe spinal canal stenosis including flattening of the cord. Subtle T2 hyperintensity suspected in the cervical cord bilaterally at this level. There is moderate to severe right and moderate left neural foraminal stenosis.C6-7: Small disc osteophyte complex with minimal spinal canal narrowing. There is mild right and minimal left neural foraminal narrowing.C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.Lumbar: Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is mild loss of lumbar lordosis and minimal retrolisthesis of L5 on S1. Alignment is otherwise within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position.Multilevel degenerative changes are seen including disc desiccation throughout and mild loss of disc height, relatively greater at the L5-S1 levels. Individual levels as below:L1-L2: Minimal disc bulge eccentric to the right with minimal right-sided neural foraminal narrowing. Otherwise no significant spinal canal or left neural foraminal stenosis. Mild bilateral facet arthropathy.L2-L3: Disc bulge and ligamentum flavum thickening without significant spinal canal stenosis. Minimal neural foraminal narrowing bilaterally.L3-L4: Disc bulge, mild facet arthropathy, and ligamentum flavum thickening. No significant spinal canal stenosis. There is moderate left neural foraminal stenosis which may be impinging on the left L3 nerve root. No significant right neural foraminal narrowing.L4-L5: Disc bulge, ligamentum flavum thickening, and bilateral facet arthropathy with mild spinal canal stenosis including partial effacement of the right greater than left lateral recesses. There is also mild, left greater than right neural foraminal narrowing bilaterally.L5-S1: Mild disc bulge and small right foraminal protrusion without significant spinal canal stenosis. Mild facet arthropathy. There is moderate right neural foraminal stenosis and mild left neural foraminal narrowing. There is contact of the right L5 nerve root.Paraspinous soft tissues are within normal limits. Mild disc bulges in the partially imaged lower thoracic spine are also noted. Renal cysts again incidentally noted.

Output: 1. Multilevel degenerative changes in the cervical spine, worst at the C4-C5 and C5-C6 levels where there is moderate to severe spinal canal stenosis. Subtle foci of T2 hyperintensity in the cord are suspected at the C5-C6 level bilaterally. Neural foraminal stenosis is also seen at C5-C6, individual levels as detailed above.2. Multilevel degenerative changes in the lumbar spine are minimally progressed since 11/19/2007. There is partial effacement of the lateral recesses at L4-L5. No significant central canal stenosis at any level in the lumbar spine. There is moderate left L3-L4 and moderate right L5-S1 neural foraminal stenosis.


Instruction: Generate impression based on findings.

Input: Female, 60 years old. Swelling and pain TENDONS: The tendons of the ankle are normal in appearance.LIGAMENTS: The anterior talofibular ligament is not well visualized, and there may be a few small fibers intact. The posterior talofibular ligament, calcaneofibular ligament, and the tibiofibular ligaments are intact.ARTICULAR SURFACES AND BONE: There is mild marrow edema involving the lateral malleolus. Bone marrow signal elsewhere is normal. There are small-moderate tibiotalar and subtalar joint effusions. ADDITIONAL

Output: 1.At least partial tearing of the anterior talofibular ligament. The remaining ligaments of the ankle appear intact.2.Small to moderate ankle joint effusion.


Instruction: Generate impression based on findings.

Input: Reason: Abnml Brain MRI. Please compare to all the prior studies. Bx revealed no definite evidence of tumor. Please perform MR Perfusion. History: Abnml MRI brain.. Lesion in the left basal ganglia is decreased in size with a decreased extent of T2 signal measuring 2.3 x 1.5 cm (601/17), previously 2.7 x 1.8 cm. There is markedly decreased enhancement with residual enhancement along the lateral margin of the left frontal horn. Intrinsic T1 shortening is similar to the prior exam. Diminished cerebral blood volume within the lesion is again demonstrated. Ex vacuo dilatation of the adjacent left frontal horn has increased suggesting local volume loss. No new enhancing lesions are present.Focus of restricted diffusion in the right mesial temporal lobe has resolved with a punctate residual focus of T2 hyperintensity in this region. There are additional scattered punctate subcortical T2 hyperintensities which are nonspecific and appear similar to the prior exam. A left frontal burr hole is patent with a small amount of encephalomalacia along the biopsy tract.There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Continued decreased in size and enhancement of left basal ganglia lesion with increased local volume loss. Findings likely represent evolution of an ischemic injury.


Instruction: Generate impression based on findings.

Input: 60 year old male with right lower quadrant abdominal pain referred to testes. Rule out appendicitis. US exam negative for testicular torsion. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: 1.9 cm diameter right upper pole renal cortical lesion appears uniloculated and may be a mass or atypical cyst. Contents measure approximately 60 HU. Further evaluation with non-contrast CT scan or dedicated renal MRI is recommended to distinguish a solid renal mass, if indicated. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Appendix is normal. BONES, SOFT TISSUES: Small gas bubble in right pubic symphysis may be due to osteoarthritis, seen best on axial image 125/142 and coronal image 66/131. OTHER: No significant abnormality noted

Output: No appendicitis. Small gas bubble in right pubic symphysis, may be due to osteoarthritis. Hyperdense 1.9 cm diameter right upper pole renal mass, may be further evaluated with non-contrast CT scan or dedicated renal MRI, if indicated.


Instruction: Generate impression based on findings.

Input: Status post colloid cyst resection. There has been interval evolution of postoperative findings related to transcallosal resection of a colloid cyst with resolution of the previously demonstrated perioperative acute infarction along the surgical approach. There is no discernible intraventricular lesions and the ventricles are unchanged in size. There is unchanged patchy cerebral white matter T2 hyperintensity, which may represent chronic small vessel ischemic disease. There is no midline shift or herniation. There are postoperative findings related to rhinoplasty. There is hypertrophy of the right inferior turbinate.

Output: Interval evolution of postoperative findings related to colloid cyst resection without evidence of recurrent colloid cyst.


Instruction: Generate impression based on findings.

Input: BRAIN: There is no evidence of intracranial hemorrhage or acute infarct. There is mild global volume loss and patchy regions of T2 hyperintensity within the periventricular white matter that are most compatible with mild chronic small vessel ischemic disease. 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 unremarkable. There are bilateral staphylomas.MRA HEAD: The intracranial internal carotid arteries are normal in course and caliber. The middle and anterior cerebral arteries are unremarkable. The vertebral arteries, basilar artery, and posterior cerebral arteries are normal in course and caliber. There is no evidence of flow-limiting stenosis or aneurysm.

Output: 1.No evidence of intracranial aneurysm.2.Mild global volume loss and mild chronic small vessel ischemic disease.3.Bilateral staphylomas.


Instruction: Generate impression based on findings.

Input: Ms. Riddering is a 49-year-old woman with a strong family history of breast cancer presenting for screening MRI. There is heterogeneous amount of fibroglandular tissue in both breasts. Minimal parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. A few subcentimeter bilateral breast cysts are noted.No abnormal lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: 51 year old with large right breast cancer. There is heterogeneous amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally, somewhat of a limitation to the exam.There is abnormal enhancement throughout much of the right upper and inner breast, spanning 7.9 x 5.3 x 4.6 cm. There are associated fluid component areas within this abnormal enhancement suggesting areas of infection and or necrosis. Associated skin thickening of the medial breast is also noted. A Hydromark clip from the recent biopsy is seen within this area of enhancement. There are at least 3 abnormal right axillary lymph nodes, the largest measuring 1.9 x 1.3 cm. This includes an abnormal subpectoral node. No suspicious enhancement is seen in the left breast. Multiple enhancing foci and small benign morphology masses are present scattered through the left breast, but none are uniquely suspicious. No abnormal lymph nodes are identified in the left axillary region.

Output: 1. Large region of abnormal enhancement in the right breast measures up to 7.9 cm and is compatible with malignancy with possible superimposed infection. Associated skin thickening is noted.2. Multiple abnormal right axillary lymph nodes.3. Extensive background enhancement. Follow up MRI in 12 months is suggested to ensure stability and because her mammograms are limited by breast density. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: No evidence of acute ischemic or hemorrhagic lesion.No evidence of abnormal enhancement.Subtle thinning of right hippocampus comparing to left side indicating minimal volume loss, unchanged.Diffuse cerebellar volume loss, unchanged.Subtle high signal intensity on the right cerebellar hemisphere superior aspect, unchangedThere is developmental venous anomaly on the right middle temporal gyrusThe ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. No evidence of abnormal enhancement.3. Unchanged, minimal volume loss of the right hippocampus, T2/flair high signal intensity lesions on right cerebellar hemisphere superior aspect and diffuse cerebellar volume loss since prior scan.


Instruction: Generate impression based on findings.

Input: 12 years, Male, daily episodes of visual "black-out" and hearing "vibration" in his ears, and headaches. Differential dx include migraine vs. seizures vs. Chiari malformation Examination is moderately motion degraded which may obscure small lesions. Brain parenchyma appears however grossly unremarkable. There is no intracranial mass or mass-effect. No findings to suggest seizure focus are definitively appreciated. There is nodular/bulging contour along the posterior aspect of the left lateral ventricle with FLAIR signal grossly similar to the adjacent white matter. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. The ventricles are within normal limits in size and configuration. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are grossly clear. There is T2 hyperintensity along the right lateral aspect of the sphenoid sinus which is not well assessed but presumably represents a small mucous retention cyst. Bone marrow signal and extracranial soft tissues are grossly unremarkable.

Output: 1. Brain parenchyma appears grossly unremarkable. Note there is moderate motion degradation on the current study which may obscure subtle lesions. There is no evidence of Chiari malformation, as questioned.2. Subtle nodular contour irregularity along the posterior aspect of the left lateral ventricle which is favored to be related to asymmetric bulging of the white matter and less likely subependymal heterotopia. If seizures remain in the differential, consider repeat study.


Instruction: Generate impression based on findings.

Input: 45 year old with history of left breast cancer, status post left mastectomy and right prophylactic mastectomy, with implant placement. Now with palpable mass in the left breast. Status post bilateral mastectomy and retropectoral silicone implants, which appear intact.Remaining tissue in both breasts are almost fatty with no parenchymal enhancement.No masses or remaining parenchymal tissue is noted.No abnormal enhancement is seen in either reconstructed breast. No abnormal lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Evidence of stroke or metastasis: Altered mental status. There are several punctate foci of restricted diffusion and high T2 signal in the bilateral cerebral and cerebellar hemisphere watershed zones, without evidence of associated hemorrhage or enhancement. There are postoperative findings related to left parietal craniotomy, with intrinsically T1 hyperintense material within the resection cavity and patchy enhancement along the margins of the cavity. There is a 5 mm diameter enhancing lesion in the right anterior cingulate gyrus and a 4 mm diameter enhancing lesion in the right superior frontal gyrus. There is a background of scattered cerebral white matter high T2 signal without enhancement or restricted diffusion, which may represent chronic small vessel ischemic disease. 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 are grossly unremarkable. There is fluid signal in the mastoid air cells.

Output: 1. Multiple punctate recent infarcts in the bilateral cerebral and cerebellar hemisphere watershed zones, without evidence of associated hemorrhage.2. Postoperative findings related to left parietal craniotomy, without definite evidence of gross residual tumor in this location.3. Subcentimeter enhancing lesions in the right anterior cingulate gyrus and right superior frontal gyrus are compatible with metastases. Discussed with Dr. Gajewski at 11 AM on 8/7/15.


Instruction: Generate impression based on findings.

Input: Female, 68 years old, with general weakness, and known non-small cell lung cancer. Patchy periventricular T2 hyperintensity is again seen without significant change. Also unchanged is patchy T2 hyperintensity in the pons along with a slitlike central pontine defect.No definite evidence of any new intracranial lesion is seen. No parenchymal edema or mass effect is detected. No evidence of intracranial hemorrhage or any abnormal extra-axial fluid collection is observed. The ventricular system is within normal limits for size.

Output: 1.Stable findings compatible with chronic microvascular and lacunar ischemic disease.2.No new or acute intracranial findings.3.No specific findings to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: Female, 40 years old, with numbness and tingling in the hands and feet, history of C5-6 transverse myelitis in October 2014. Assess for demyelination. A 5-mm round focus of T2 hyperintensity is evident just lateral to the corpus callosum in the right frontal lobe. No additional parenchymal lesions are seen.Diffusion weighted images are normal. No evidence of parenchymal edema or mass effect is seen. No pathologic parenchymal or extra-axial enhancement is detected. The ventricular system is normal in size and morphology.

Output: A single 5-mm nonenhancing focus of signal abnormality is seen within the white matter lateral to the corpus callosum in the right frontal lobe. While such a lesion could represent demyelinating disease, in the absence of other lesions or more definitive findings, it is nonspecific.


Instruction: Generate impression based on findings.

Input: Sickle-cell disease without crisis [D57.1] / Moyamoya disease [I67.5], Reason for Study: ^Reason: hx of pial synangiosis. Eval vasculature History: none- surveillance imaging Brain MRI:There is no evidence of acute ischemic or hemorrhagic lesion on this scan. The right hemispheric sulci appear to be more prominent and gyri appear to be atrophic comparing to those of left hemisphere. These findings do not show significant interval change since prior scan.On FLAIR imaging, there are patchy high signal intensity on the right frontal lobe superior frontal gyrus which indicate chronic ischemic infarction. As well, there are multiple scattered and a bit confluent high signal intensities on bilateral periventricular white matter indicating possible non specific small vessel ischemic disease. Comparing to prior scan, the extent and approximate number of those high signal intensity lesions do not show any significant interval change.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.Brain MRA:3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate near total occlusion of the distal right ICA at the level of ICA terminus, without showing appreciable right MCA M1 segment. The left distal ICA also appears to be occluded with multiple small in-flow signals indicating collateral vessels. However, the left MCA M1 segment is reconstituted and the luminal diameter appears to be normal range. Comparing to prior scan, there is no significant interval change since prior scan.Bilateral posterior communicating arteries are patent and vertebrobasilar system appears to be normal

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. Multifocal chronic ischemic lesions and non specific ischemic lesions as described above, no change since prior scan.3. No significant interval change of bilateral distal ICA occlusion/near total occlusion with collateral vessels including the reconstitution of the left MCA with reasonable lumen size and non visualization of the right MCA M1 segment. Vertebrobasilar system appears to be within normal range.


Instruction: Generate impression based on findings.

Input: There is no abnormal intracranial enhancement, including leptomeningeal or pachymeningeal enhancement. Redemonstration of a right cerebellar hemisphere developmental venous anomaly. The left frontal sinus, maxillary sinus, and sphenoid sinus are fluid-filled with mucosal enhancement. There is mucosal thickening and enhancement within the remaining paranasal sinuses.

Output: 1. No abnormal intracranial enhancement. Specifically, there is no reliable evidence of neurosarcoidosis.2. Chronic sinusitis. 3. Please refer to recent MRI brain without contrast report for other findings.


Instruction: Generate impression based on findings.

Input: 57-year-old male with seizure-like activity. Evaluate for mass or stroke. There is no evidence of intracranial hemorrhage, mass, or acute infarct. No findings to suggest seizure focus are appreciated. The bilateral hippocampi are symmetric in size, signal characteristics, and with preserved internal architecture. There is scattered periventricular and subcortical white matter T2/FLAIR hyperintensity which is nonspecific. A focus of susceptibility abnormality in the medial left midbrain is seen only on susceptibility weighted images. A small T1 and T2 bright lesion is seen conforming to the undersurface of the right medial tentorium. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. Left greater than right maxillary sinus mucosal thickening is seen. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable.

Output: 1.There is no evidence of a mass, infarct, hemorrhage or seizure focus.2.Scattered mild chronic likely small vessel ischemic disease.3.Focus of susceptibility abnormality in the medial left midbrain may represent a vascular lesion such as a developmental venous anomaly or focus of capillary telangiectasia for which a contrasted MRI exam may provide further information if clinically warranted.


Instruction: Generate impression based on findings.

Input: Enlargement of his lateral and third ventricles in the setting of aqueduct stenosis, caused by a small glioma: yearly follow up. There is a non-enhancing, slightly T2 hyperintense lesion in the left periaqueductal region of the midbrain that measures up to approximately 5 mm. There is associated narrowing of the superior cerebral aqueduct and dilation of the third and lateral ventricles, which is unchanged. Indeed, there is no discernible cerebrospinal fluid flow across the aqueduct of Sylvius. There is unchanged mild periventricular T2 hyperintensity. There is no evidence of intracranial hemorrhage or acute infarct. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable.

Output: Unchanged subcentimeter lesion in the left periaqueductal region of the midbrain with associated narrowing of the superior cerebral aqueduct and obstructive hydrocephalus.


Instruction: Generate impression based on findings.

Input: Female, 70 years old, with low back pain radiating into both lower extremities. Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. A focus of fatty signal is seen within the L4 vertebral body likely representing a benign hemangioma. No pathologic marrow replacement or marrow edema is detected.The visualized distal spinal cord, conus and nerve roots of the cauda equina are unremarkable except as discussed below. No epidural abnormalities are suspected.Advanced osteoarthritis of the sacroiliac joints is seen. Level specific degenerative findings are as follows:T12-L1: Minimal disc bulging. No significant spinal canal or foraminal stenosis.L1-2: Facet arthropathy, left worse than right. Minimal disc bulging. No significant spinal canal or foraminal stenosis. L2-3: Facet arthropathy, right worse than left. Ligamentum flavum thickening. Minimal disc bulging. Moderate generalized spinal canal stenosis with some crowding of the cauda equina nerve roots. No significant foraminal narrowing. L3-4: Facet arthropathy. Ligamentum flavum thickening. Bulging disc. Moderate generalized spinal canal stenosis with crowding of the cauda equina nerve roots. No significant foraminal narrowing. L4-5: Facet arthropathy. Ligamentum flavum thickening. Bulging disc. Severe generalized spinal canal narrowing with crowding and possible mild compression of nerve roots. Mild left foraminal narrowing. L5-S1: Facet arthropathy. Bulging disc with central annular fissure. No significant generalized spinal canal stenosis. Moderate bilateral foraminal narrowing.

Output: Multilevel disc degeneration and posterior element hypertrophy is seen. At L2-3, L3-4 and L4-5, these findings result in spinal canal narrowing, most severely affecting the L4-5 level. At L5-S1, the neural foramina are moderately narrowed. Fairly advanced osteoarthritis of the sacroiliac joints is also seen.


Instruction: Generate impression based on findings.

Input: Clinical question: Eval for growth of lesions in temporal lobe and for growth of retinal mets from NSCLC. Pt s/p recent RT to orbits. Please obtain orbital cuts/.Signs and Symptoms: Retinal mets. Parenchymal brain mets. Probable RT-related changes in brain. S/p recent orbital RT. NSCLC. Pre-and post enhanced brain MRI:Examination demonstrates slight interval decreased size of the left posterior temporal hemorrhagic metastatic lesion. It measures approximately at 24 x 18 x 21-mm compared to prior study measurements of 26 x 23 x 23 millimeters. A second small enhancing metastatic lesion in the left anterior temporal lobe also demonstrates subtle interval decreased size. It measures at 10 x 8.5-mm compared to prior study measurements of 12.5 x 8mm.there is no detectable additional foci of parenchymal or leptomeningeal enhancement.A tiny focus of susceptibility in the right anterior temporal tip without enhancement demonstrate no change. Extensive white matter flair hyperintensity without mass effect also remains identical to prior study and likely representing post treatment/radiation related finding. Prominence of cortical sulci and mild prominence of lateral ventricles similar to prior exam and suspect of underlying parenchymal volume loss.Pre-and post enhanced MRI of orbits:Examination demonstrates no convincing evidence of a visible metastatic lesion in this exam. This is a similar observation is prior to exam and could be secondary to very small size of the lesions .

Output: 1.Pre-and post enhanced brain MRI demonstrate interval decreased size of a hemorrhagic metastatic lesion in the left superior temporal gyrus and left anterior temporal tip since prior exam as detailed/measured above.2.There is no detectable metastatic lesions on MRI of orbits.3.Stable tiny focus of susceptibility without enhancement in the right anterior temporal lobe.4.Diffuse white matter flair hyperintensity of cerebral hemispheres likely treatment related also remains stable since prior exam.