Instruction: Generate impression based on findings.

Input: Trigeminal nerve entrapment versus CNS demyelinating lesion: right facial pain. Internal Auditory Canals: A small venous structures courses along the superior and medial aspects of the root entry zone of the right trigeminal nerve. The bilateral trigeminals nerves are otherwise intact. There is no evidence of mass lesions. The bilateral cavernous sinuses and Meckel caves appear unremarkable. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear 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. There is hypertrophy of the posterior left inferior turbinate. There is cosmetic filler material in the bilateral cheeks, but not near the infraorbital foramen. There are postoperative findings related to maxillary reconstruction, with metal susceptibility artifact that obscures surrounding structures.

Output: 1. A small venous structures courses along the superior and medial aspects of the root entry zone of the right trigeminal nerve, which is nonspecific and may be indicative of a vascular loop syndrome or represent an incidental anatomical variant. Otherwise, no evidence of tumor or demyelinating lesions.2. Postoperative findings related to maxillary reconstruction and cosmetic fillers in the bilateral cheeks.


Instruction: Generate impression based on findings.

Input: Female, 24 years old, with anaplastic astrocytoma currently on Avastin. The left parietal lobe resection cavity is unchanged in size and morphology. Small cystic spaces anterior to the main cavity are not significantly changed in size, though their internal signal no longer suppresses on FLAIR images suggesting a change in the fluid consistency.Ill-defined periventricular T2 hyperintensity surrounding the treatment bed has increased in geographic extent, particularly within the superior parietal lobule. The posterior left thalamus and posterior medial temporal lobe are also affected to a greater degree. Signal abnormality and thickening of the splenium of corpus callosum is grossly unchanged, though signal abnormality within the overlying cingulate white matter has progressed.The previously seen small foci of enhancement anterior to the resection cavity have evolved into a more rim-enhancing, confluent, centrally diffusion restricting lesion. The splenium of the corpus callosum is incorporated in this lesion with new rim enhancement to the right of midline. Ependymal enhancement along the left ventricular atrium has increased. Small foci of periventricular enhancement extending along the left temporal horn appear grossly similar to the prior examination.Ventricular size and morphology are within normal limits. No new abnormal fluid collections are seen. A cavernous malformation with associated developmental venous anomaly in the pons is unchanged. A punctate focus of enhancement within the left IAC is unchanged dating back to 2013, a nonspecific finding but perhaps representing an incidental schwannoma.

Output: Since the prior examination, small enhancing foci anterior to the left parietal lobe cavity have evolved into a more confluent rim-enhancing lesion which incorporates the splenium of corpus callosum. Scattered additional foci of enhancement are stable to slightly more prominent as described above. Ill-defined T2 hyperintensity has progressed in the left cerebral hemisphere and to a lesser degree in the right cerebral hemisphere. While the findings do at least in part reflect posttreatment changes in the context of antiangiogenic therapy, the slowly progressive enhancing components are concerning for persistent tumor growth.


Instruction: Generate impression based on findings.

Input: The lobulated enhancing mass with areas of susceptibility effect and cystic components in the left lateral ventricle, appears minimally more prominent when compared to prior examination, measuring 33 mm, previously 32 mm. There is persistent mild vasogenic edema in the surrounding brain parenchyma. There is also an enhancing mass within the right lateral ventricle, which measures up to approximately 10 mm, previously 8 mm. The lateral ventricles remain mildly prominent, unchanged from prior examination. There is no significant interval change in numerous foci of subcortical T2 hyperintensity, some of which demonstrate enhancement. There is no evidence of intracranial hemorrhage or acute infarct. There is a right cerebellar hemisphere developmental venous anomaly. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable.

Output: 1. There is minimal increase in size of the bilateral lateral ventricular subependymal giant cell astrocytomas. 2. Other stigmata of tuberous sclerosis are not significantly changed.3. Interval resolution of the left tympanomastoid fluid.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Medial elbow pain and weakness LIGAMENTS: The radial and ulnar collateral ligaments are normal.TENDONS: The common flexor tendon appears normal. There is mild intermediate signal intensity within the common extensor tendon suggesting very mild tendinosis which is of questionable current clinical significance.ARTICULAR SURFACES AND BONE: The bone marrow signal is normal. Specifically, there is no abnormal signal within the medial epicondyle. SURROUNDING STRUCTURES: There is mild edema within the subcutaneous fat superficial to the medial condyle which may reflect mild soft tissue inflammation.ADDITIONAL

Output: Mild edema within the subcutaneous fat superficial to the medial epicondyle which may reflect mild soft tissue inflammation however the common flexor tendon and underlying bone marrow are normal. Possible mild brachialis strain.


Instruction: Generate impression based on findings.

Input: Migraine headaches. History of congenital cavernous malformation. Redemonstration of a very small focus of susceptibility artifact within the mesial right precentral gyrus seen primarily on the gradient echo images compatible with a small congenital cavernous malformation. There is perhaps subtle associated T2 signal abnormality associated with lesion, but no significant perilesional vasogenic edema. There is no associated enhancement. No additional lesions are identified.The T2, FLAIR and diffusion weighted images are otherwise normal.There is no evidence of intracranial hemorrhage, mass or edemaThe ventricles and basal cisterns are normal in size and configuration.The expected intracranial vascular flow voids are present.The paranasal sinuses are clear. The visualized mastoid air cells are clear. The orbits are unremarkable.

Output: Stable findings compatible with a small suspected cavernous malformation in the mesial aspect of the right precentral gyrus. No additional lesions are identified.


Instruction: Generate impression based on findings.

Input: Metallic artifact There are surgical changes overlying the right parietal lobe with multiple metallic devices affixing the prior biopsy site. No additional abnormal metallic densities are identified overlying the calvarium.

Output: Surgical changes overlying the right parietal lobe.


Instruction: Generate impression based on findings.

Input: 58 years Female (DOB:9/18/1958)Reason: fu on GBM (previous loaded into isite under her name) History: GBMPROVIDER/ATTENDING NAME: BROOKE E PHILLIPS RIMAS V. LUKAS There is a 30 x 21 mm axial dimension mass present centered in the right frontal lobe involving the right precentral gyrus along its lateral aspect. There is an adjacent craniotomy defect products. This associated with peripheral enhancement.There is a 22 x 21 mm axial dimension mass centered in the medial aspect of the right temporal lobe is a hemosiderin tract extending from the right occipital lobe to this lesion. This associated with peripheral enhancementThere is a vasogenic pattern of edema involving the right temporal lobe and right frontal lobe as well as right parietal lobe associated with the above described lesions. There is associated mild uncal herniation.There is T2 and FLAIR signal hyperintensity to a lesser degree are present in the left hemisphere.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: There are mass lesions present in the centered right medial temporal lobe and the right postcentral gyrus which are associated with vasogenic edema and mass effect and mild uncal herniation.. The patient is status post surgical intervention with regards to both masses. The patient is known to have glioblastoma based on the clinical history.


Instruction: Generate impression based on findings.

Input: Ms. Turner is a 60-year-old female with a family history of ovarian cancer in maternal aunt. She has no current breast related complaints. There is heterogeneous amount of fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.Few scattered enhancing foci are seen bilaterally, none of which are more suspicious than the rest. No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary or internal mammary region.

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


Instruction: Generate impression based on findings.

Input: 71-year-old male with a small mass in the right posterior lateral knee. Presents with right lower leg pain. MENISCI: There is increased signal abnormality which extends to the femoral and tibial articular surfaces and is associated with deformity of the posterior horn of the medial meniscus consistent with radial and degenerative tearing. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is thinning of the articular cartilage most pronounced along the medial tibiofemoral compartment without evidence of full-thickness or near full-thickness articular cartilage defect. No bone marrow signal abnormality is identified.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Slight interval increase in size of the reference mass along the posterolateral aspect of the left knee which may represent a peripheral nerve sheath tumor such as a schwannoma.2. Tearing of the posterior horn of the medial meniscus, as described above.


Instruction: Generate impression based on findings.

Input: Redemonstrated are postoperative changes related to resection of the posterior lumbar spine canal lipoma with a minimal residual fat-containing lesion in the operative bed. The residual lesion measures approximately 10 x 4 x 10 mm (TR x AP x CC), previously 10 x 4 x 10 mm. There is an unchanged low-lying conus medullaris terminating at the L4-L5 level. On prone sequence, there is no anterior translation of the cord, suggestive of residual tethering. The vertebral column alignment is otherwise within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. There is persistent linear T2 hypointensity along the surface of the distal conus medullaris, which likely represents chronic blood products. The spinal cord otherwise is unchanged in signal and morphology. There are postoperative changes of the lower lumbar paravertebral soft tissues.

Output: Postoperative findings related to posterior lumbar spinal canal lipoma resection with a small residual lipomatous lesion in the operative bed. The lack of anterior translation of the spinal cord on prone images is unchanged and suggestive of persistent tethering. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 62-year-old female with history of cirrhosis. Evaluate for hepatocellular carcinoma. ABDOMEN:LIVER, BILIARY TRACT: Diffuse nodular hepatic contour compatible with cirrhosis. No suspicious arterially enhancing and washing out hepatic lesions. No intra or extra hepatic biliary ductal dilatation. The hepatic and portal veins are patent.SPLEEN: Splenomegaly. PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable left mid pole renal cyst.RETROPERITONEUM, LYMPH NODES: Mild persistent gastrohepatic lymphadenopathy, likely reactive.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Cirrhosis with sequela of portal hypertension. 2.No suspicious hepatic lesion.


Instruction: Generate impression based on findings.

Input: Male 42 years old; Reason: evaluate for achilles tendon rupture or fx History: pain to achilles tendon, cannot weight bear The Achilles tendon is thickened with edema in Kager's fat pad, which could indicate a tear of the Achilles tendon. Further evaluation with MRI may be considered if clinically warranted. A small spur projects from the dorsal aspect of the talar head. We see no fracture or malalignment.

Output: Thickening of the Achilles tendon with edema in Kager's fat pad, which may represent an Achilles tendon tear and may be further evaluated with MRI if clinically warranted. Findings were discussed with the attending physician in the emergency department, Dr. Hogan, at 0945 on 2/21/15.


Instruction: Generate impression based on findings.

Input: 69 years, Female, evaluate mass. History of meningioma. Again seen are postsurgical changes related to prior left parietal parasagittal meningioma resection. There remains an approximately 7 mm focus of enhancement in the surgical bed with associated susceptibility compatible with chronic blood products and/or mineralization. No new or enlarging lesion is seen. There is T2/FLAIR hyperintensity with volume loss in the left parietal lobe related to encephalomalacia with adjacent gliosis. Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild chronic small vessel ischemic changes. Mild cerebellar tonsillar ectopia is again seen. No evidence of acute ischemia or hemorrhage. No extra-axial collections. No hydrocephalus. Major flow-voids are preserved. Calvarium and remainder of the extra-axial soft tissues are unremarkable.

Output: Postoperative changes related to left parietal meningioma resection with unchanged gliosis in the left parietal lobe. There remains a subcentimeter nodular focus of enhancement in the left parietal surgical bed without interval enlargement. There is associated susceptibility which may be related to chronic blood products or mineralization. This finding is again favored to represent posttreatment change. No definite evidence of residual or recurrent meningioma.


Instruction: Generate impression based on findings.

Input: Pituitary tumor surveillance and history of prior infarcts. Pituitary: There are postoperative findings related to transsphenoidal surgery. There is an unchanged enhancing mass arising from the pituitary that measures up to 19 mm in craniocaudal dimension, previously 16 mm. The tumor protrudes into the left cavernous sinus, but there is no encasement of the carotid artery flow voids. There is also thickening of the infundibulum, which measures up to 6 mm in width. The tumor abuts the right prechiasmatic optic nerve. There is mild mucosal thickening in the sphenoid sinuses.Brain: There are subcentimeter foci of encephalomalacia in the right pons and basal ganglia. There is also an area of encephalomalacia in the right cerebellar hemisphere. There is a background of scattered T2 hyperintense foci in the cerebral white matter. There is no evidence of intracranial hemorrhage or acute infarct. The ventricles are unchanged in size and configuration, with a cavum septum pellucidum and vergae. There is no midline shift or herniation. The major cerebral flow voids are grossly intact. The orbits, skull, and scalp soft tissues are grossly unremarkable.

Output: 1. Interval increase in size of the pituitary macroadenoma.2. Chronic right pons, right cerebellar hemisphere, and right basal ganglia lacunar infarcts superimposed upon a background of chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: 47-year-old male with history of hepatitis B and hepatocellular carcinoma status post resection/RFA. Patient presents for surveillance. ABDOMEN:LUNG BASES: Interval resolution of bilateral pleural effusions.LIVER, BILIARY TRACT: There has been interval RFA and lateral wedge resection for hepatocellular carcinoma when compared to the prior MRI examination. When compared to the previous CT examination, there has been interval improvement in the large areas of hypoattenuation with T2 hyperintensity on the current examination consistent with postablation changes. No evidence of arterially enhancing nodular lesions to suggest residual carcinoma. No evidence of hepatic or portal venous thrombus. No intra or extrahepatic biliary ductal dilatation. Postoperative changes of cholecystectomy.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Postsurgical and post RFA changes without evidence of nodular arterially enhancing hepatic lesions.2.Interval improvement in bilateral pleural effusions.


Instruction: Generate impression based on findings.

Input: There are numerous punctate foci of susceptibility artifact within the bilateral cerebral and cerebellar hemispheres, left pons and midbrain. There is unchanged T2 hyperintensity associated with a lesion in the left insula. There is no evidence of acute hemorrhage, hydrocephalus, or acute ischemia. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No appreciable interval change in the numerous intracranial cavernous malformations. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 75-year-old male with elevated PSA PELVIS:PROSTATE:Prostate Size: 6.6 x 7.0 x 5.1 cm, previously 6.7 x 4.9 x 4.9 cm Peripheral Zone: There are scattered T2 hypointensities that are favored to be benign. No suspicious foci are identified.Central Gland: Severe degree of benign prostatic hypertrophySeminal Vesicles: No significant abnormality noted.Extracapsular Extension: Not applicable.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.There is no credible target identified for biopsy.2.Severe degree benign prostatic hypertrophy.


Instruction: Generate impression based on findings.

Input: Female, 38 years old, with headaches and intraventricular brain lesion seen on prior imaging. An oval, T2/FLAIR hyperintense nodule is redemonstrated within the left lateral ventricle. The lesion measures 11 x 6 mm in the axial plane and shows no significant interval change in size over the two prior examinations. As before, the lesion sits along the floor of the frontal horn and is in contact with both the septum pellucidum and the caudate head but does not clearly arise from either surface. On T2-weighted images, the center of the lesion is brighter than the rim which raises the possibility of a thick-walled cyst. No portion of the lesion demonstrates enhancement. Spectroscopic assessment of the lesion shows absence of NAA and relatively reduced metabolite peaks overall. No convincing evidence of lipid or lactate is seen. Brain parenchymal morphology is otherwise unremarkable. No new lesions are identified. No parenchymal edema or mass effect is observed. The ventricles are stable and normal in size. No evidence of acute intracranial hemorrhage is seen.

Output: An oval lesion is redemonstrated within the left lateral ventricle showing no significant interval change in size or morphology. This lesion may represent either a solid nodule or a cyst with a thickened rim.The interval stability, imaging features and spectroscopic assessment argue against an aggressive or highly proliferative neoplastic process. A low-grade neoplastic process is not excluded, however the imaging features are not typical for the common low-grade intraventricular neoplasms. The differential diagnosis would continue to include a cyst related to prior cysticercosis infection, or perhaps an ependymal or developmental cyst with changes related to prior inflammation.There may be some benefit to further evaluation with noncontrast CT. For example, the presence of additional small calcific lesions would support the possibility of cysticercosis.


Instruction: Generate impression based on findings.

Input: 48-year-old female patient with idiopathic myopathy; hereditary with cramps and weakness. Question of myositis. Bone marrow signal is within normal limits. No abnormal signal or enhancement is noted within the visualized musculature. No discrete mass is identified. The visualized tendons are intact. The subcutaneous tissues are unremarkable.Imaging of the left knee is suboptimal, however, there does appear to be a small effusion and minimal enhancement of the synovium which may represent synovitis. The visualized pelvic structures are unremarkable.

Output: 1. No signal abnormality within the visualized musculature to suggest myositis. 2. Suboptimal evaluation of the knee though with minimal enhancement of the synovium which may represent synovitis; please refer to prior dedicated MR knee report.


Instruction: Generate impression based on findings.

Input: 63-year-old female with history of nasopharyngeal carcinoma and liver lesion, history of chemoradiation ABDOMEN:LIVER, BILIARY TRACT: Interval resection of the left lateral segment of the liver. No suspicious liver lesion is evident. The remainder hepatic vessels are patent.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral extrarenal pelves. Subcortical right renal cortical cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Tarlov cyst in the sacrum. T2 hyperintense lesion demonstrating fat saturation in the T12 vertebral body, unchanged, likely represents a hemangioma. OTHER: No significant abnormality noted.

Output: 1.Interval resection of left lateral segment of the liver. No suspicious liver lesion is evident on the current study.


Instruction: Generate impression based on findings.

Input: Male, 45 years old, with myelopathy. The cervical lordosis is reversed. Sagittal alignment is otherwise unremarkable. Vertebral body height and morphology are within normal limits. No pathologic marrow replacement or edema is seen.The spinal canal is diffusely narrowed beginning at C2 and continuing down to C6 with specific details as follows. The spinal cord through this region shows no areas of focal signal abnormality. No epidural abnormalities are suspected.C2-3: Left facet arthropathy. Posterior disc-osteophyte complex formation with thickening of the PLL. Moderate spinal canal stenosis with slight flattening of the ventral cord. Mild left foraminal narrowing.C3-4: Left facet arthropathy. Posterior disc-osteophyte complex formation. Moderate generalized spinal canal stenosis without significant cord deformation. Moderate left foraminal narrowing. C4-5: Left facet arthropathy. Posterior disc-osteophyte complex formation asymmetric to the right. Moderate generalized spinal canal stenosis without significant cord deformation. No significant spinal canal stenosis. C5-6: Left facet arthropathy. Posterior disc-osteophyte complex formation. Mild generalized spinal canal stenosis without cord deformation. No significant spinal canal stenosis. C6-7: Left facet arthropathy. No significant spinal canal or foraminal stenosis. C7-T1: Unremarkable.

Output: Disc osteophyte disease is evident at multiple levels resulting in spinal canal stenosis from C2-3 through C5-6. C2-3 is the most severely affected level where there is a moderate stenosis and some deformation of the spinal cord. Moderate left foraminal narrowing is also seen at C3-4.


Instruction: Generate impression based on findings.

Input: 45-year-old woman with worsening daily left frontal headaches. Please evaluate for intracranial/anatomic etiology. A large, isodense, apparently extra-axial mass is seen in the right frontal region which measures 31 x 48 mm (image 17/36). The peripheral aspect of the mass appears low density which probably represents multiple superficial cysts. The overlying bony cortex is slightly irregular and appears to be partially absorbed. Findings are most consistent with a cystic meningioma however, the associated bony irregularity is atypical for a meningioma and further evaluation with MRI is recommended to exclude primary brain malignancy or metastases. There is significant associated vasogenic edema in the right frontal parenchyma with minimal, approximately 2 mm, midline shift at the level of the septum pellucidum. No additional mass lesions are seen. No intracranial hemorrhage is present. The ventricles and basal cisterns are normal in size and configuration. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Large, probable extra axial mass with significant associated vasogenic edema which may represent a cystic meningioma, however further evaluation with MRI is necessary to exclude primary brain malignancy or metastases. Findings were discussed with Dr. M. Glather at 10:30am on 3/25/2008.


Instruction: Generate impression based on findings.

Input: Reason: syrinx, yearly follow up History: yearly eval for changes. History of Chiari decompression. Cervical spine:Expansion of the subarachnoid space at the level of the midline from suboccipital decompression and removal of the posterior arch of C1 appears similar to the prior exam. Alignment is anatomic. Vertebral body heights are intact. No abnormal marrow signal. Disc spaces are intact. Subtle trace prominence of the central canal from C6-C7 to C7-T1 without syrinx formation appears similar to the prior exam. Minimal broad-based disc bulges at C4-C5, C5-C6 and C6-C7 without significant spinal or neural foraminal narrowing at any level.Thoracic spine:There is a small syrinx extending from T2-T3 to T5-T6 which appears similar in size and extent to the prior exam. It measures a maximum of 3.0 x 1.5 mm, unchanged. There is mild dextroscoliosis of the thoracic spine, otherwise alignment is anatomic. Vertebral body heights and disc spaces are intact. No abnormal marrow signal. No new areas of abnormal signal within the cord.Lumbar spine:Alignment is anatomic. No abnormal marrow signal. No abnormal signal within the distal cord or conus which ends at T12-L1. Vertebral body heights and disc spaces are intact. There are broad-based disc bulges at L3-L4, L4-L5 and L5-S1 without significant spinal or neural foraminal stenosis.

Output: Small syrinx of the upper thoracic cord is stable. Stable post-operative appearance from prior Chiari decompression.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for lesion. Signs and symptoms: Seizures. Nonenhanced CT of brain:Large area of right cerebellar encephalomalacia is again identified as was noted on prior MRI examinations.Focal area of encephalomalacia in the left frontal lobe and left basal ganglial is consistent with old stroke and remains stable.There is no evidence of intracranial hemorrhage, edema, mass-effect, midline shift or hydrocephalus.

Output: No evidence of acute new findings since prior study. Multiple areas of encephalomalacia likely old strokes in the right cerebellum and the left frontal lobe/basal ganglia is again identified.


Instruction: Generate impression based on findings.

Input: NF1: hands lock at times and can't grasp things. Cervical Spine: There is apparent mild thickening of multiple cervical nerve roots traversing the neural foramina. There is otherwise no mass effect upon the spinal cord or abnormal spinal cord signal. There are multiple subcentimeter T2 hyperintense nodules in the skin and subcutaneous tissues of the neck. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. There are partially imaged T2 hyperintense lesions in the cerebellum.Lumbar Spine: There is an unchanged fusiform lesion within the right L3-4 neural foramen with a targetoid appearance that measures up to 10 mm in width. There is also an unchanged fusiform lesion in the T12-L2 neural foramen that measures up to 8 mm in width. In addition, there appears to be enlargement of multiple sacral neural foramina. There are numerous T2 hyperintense nodules in the thoracic and lumbar paraspinous muscles, psoas muscles and subcutaneous fat. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is mild facet hypertrophy in the lower lumbar spine, but no significant spinal canal stenosis. The spinal cord displays normal signal and morphology.

Output: 1. Apparent mild thickening of multiple cervical nerve roots traversing the neural foramina, as well as mild enlargement of multiple sacral nerve roots, are compatible with stigmata of NF1. 2. Unchanged neurofibroma in the right L3-L4 and left T12-L1 neural foramina. 3. Numerous neurofibromas in the cervical and lumbar paraspinous muscles, subcutaneous tissues, and skin. 4. Partially imaged T2 hyperintense lesions in the cerebellum are compatible with stigmata of NF1, but are better depicted on the prior brain MRI.


Instruction: Generate impression based on findings.

Input: Male 54 years old Reason: neuroendocrine CA with pancreatic lesion and high bili. evaluate for obstruction History: Hyperbilirubinemia ABDOMEN:LIVER, BILIARY TRACT: There are two hemangiomas in the liver located in segments 3 and 7. There are a few scattered hepatic cysts. No suspicious hepatic lesions.The hepatic and portal veins are patent. There is new moderate intrahepatic biliary ductal dilatation due to obstruction of the common bile duct at the level of the pancreatic head. The common bile duct measures approximately 9 mm in diameter. Gallbladder is distended with sludge.SPLEEN: The spleen is enlarged.PANCREAS: The pancreatic parenchyma has been replaced by multiple enhancing lesions. The dominant lesion located in the head of the pancreas measures 5.5 x 4.5 cm (image 19/series 701). This lesion obstructs the pancreatic duct and the common bile duct. There is severe narrowing of the main portal vein and splenic vein the head of the pancreas due to the mass.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small bilateral cysts. Subcentimeter lesion at the upper pole of the right kidney is complex.RETROPERITONEUM, LYMPH NODES: Left cardiophrenic lymph node measures 2.5 x 1.8 cm (image 33/series 701). BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Metastatic disease to the L1 vertebral body.OTHER: Trace pelvic ascites.

Output: 1.Biliary obstruction due to pancreatic head mass.2. Metastatic disease to the spine and nodes.


Instruction: Generate impression based on findings.

Input: History of osteoarthritis with joint pain. Sacroiliac joints: The sacroiliac joints appear unremarkable without evidence of sacroiliitis.Right hip: Small osteophyte formation and mild acetabular sclerosis compatible with mild osteoarthritis.Left hip: Small osteophyte formation and mild acetabular sclerosis compatible with mild osteoarthritis.Right knee: Small osteophytes and mild narrowing of the medial tibiofemoral joint space compatible with mild osteoarthritis.Left knee: Small osteophytes and mild narrowing of the medial tibiofemoral joint space compatible with mild osteoarthritis.

Output: Mild osteoarthritis.


Instruction: Generate impression based on findings.

Input: Diagnosis: Unspecified hearing lossClinical question: Unilateral Hearing Loss RIghtSigns and Symptoms: Tinnitus, And Right ear hearing loss IACNo abnormal foci of enhancement are appreciated within the internal auditory canals. The cochlea and semicircular canals appear intact. The cochlear nerve can be followed bilaterally tracking into the cochlea. The modiolus is well formed bilaterally.No abnormal enhancing lesions are appreciated at the cerebellopontine angle cisterns nor the internal auditory canals.

Output: MRI of the IACs are within normal limits


Instruction: Generate impression based on findings.

Input: Clinical question: Rule out spinal abscess and single bacteremia and candidemia. The skull hematocrit radiologist, with it DWI imaging of any concerning areas. Nonenhanced complete spine MRI:Examination demonstrate unremarkable signal intensity of vertebral column and with normal anatomical alignment.There is no evidence of the spinal canal compromise or stenosis at any level and no detectable mass effect on the cord. There is no detectable epidural abnormality at this exam. Unremarkable perispinal soft tissues.There is right-sided pleural effusion measuring at maximum of 15-mm on this exam.Multiple loculated low attenuation masses in the uterus are concerning for fibroids. Follow for dedicated studies is recommended.

Output: 1.Normal signal intensity and caliber of cervical/thoracic cord and conus and without evidence of mass effect.2.Normal signal intensity and alignment of the vertebral column and without detectable epidural abnormalities as detailed.3.No evidence of spinal canal or neural foraminal compromise at any level.4.Pleural effusion on the right as detailed.


Instruction: Generate impression based on findings.

Input: Female 63 years old Reason: Patient with large right renal mass. Eval for IVC involvement and surgical planning History: as above ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. There is fatty infiltration of the liver. No suspicious hepatic lesions. Hepatic and portal veins are patent. Gallbladder is mildly distended.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: There is a large right anterior renal enhancing mass measuring 9.6 x 7.8 cm (image 294/series 1404) . Enhancing tumor thrombus extends into the renal vein and into the IVC . Tumor thrombus extends to the level of the L1 and L2 vertebral bodies. The intrahepatic IVC appears free of thrombus.The mass contacts the lateral aspect of the second portion of the duodenum with loss of the fat plane.There is extension into the perinephric fat. The mass also abuts the inferior aspect of the liver with a thin fat plane between the mass and the liver edge.There is hemorrhage in the right renal collecting system.No focal mass in the left kidney.RETROPERITONEUM, LYMPH NODES: Small aortocaval lymph nodes with a reference lymph node measuring 0.9 x 0.7 cm (image 16/series 1101). BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: Foley catheter noted within the urinary bladder.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Right renal mass with tumor thrombus extension into the IVC.2.The renal mass abuts the second portion of the duodenum with loss of a fat plane.


Instruction: Generate impression based on findings.

Input: C7 right upper extremity paresthesias Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained. Bone marrow signal is within normal limits. The cervical spinal cord has normal signal characteristics and overall morphology.Degenerative changes are seen in the cervical spine including multilevel disc desiccation. Individual levels as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: Mild disc bulge and uncovertebral hypertrophy on the right result in minimal right-sided neural foraminal narrowing. No significant spinal canal or left neural foraminal stenosis.C4-5: Mild disc bulge and uncovertebral hypertrophy result in mild right-sided neural foraminal narrowing. No significant spinal canal or left neural foraminal narrowing. C5-6: There is a central disc protrusion which results in effacement of the ventral thecal sac. There is mild overall narrowing of the spinal canal at this level. There is mild to moderate right-sided neural foraminal stenosis. No significant left neural foraminal narrowing. C6-7: There is a central disc extrusion and mild ligamentum flavum thickening resulting in effacement of the ventral and dorsal thecal sac and mild to moderate spinal canal stenosis. Disc material demonstrates approximately 7 mm subligamentous superior extension. There is moderate right right-sided neural foraminal stenosis. There is minimal left-sided neural foraminal narrowing.C7-T1: No significant compromise to the spinal canal or neural foramina.Paraspinous soft tissue structures appear within normal limits.

Output: Multilevel degenerative changes in the cervical spine, worst at the C6-C7 level, where there is a disc extrusion and uncovertebral hypertrophy resulting in mild to moderate spinal canal stenosis and moderate right-sided neural foraminal stenosis. No cord signal abnormality. Additional details as above.


Instruction: Generate impression based on findings.

Input: Male, 20 years old, history of Chiari malformation status post decompression surgery with chronic daily headaches. Brain:Evidence of Chiari decompressive surgery is again seen with expansion of the foramen magnum and a stable appearance of the cerebellar tonsils. The CSF space at the level of the foramen magnum is well expanded with the exception of slight narrowing ventrally due to a mild retroflexion of the dens, all stable findings. Adequate biphasic flow is seen both anteriorly and posteriorly through the foramen magnum.Brain parenchymal morphology is otherwise unremarkable. No evidence of restricted diffusion or other signal abnormality is seen. No intracranial hemorrhage or any abnormal extra axial fluid collection is detected. The ventricular system is patent and normal in size. No pathologic enhancement is seen.Spine:The spinal cord demonstrates normal signal intensity and morphology. No evidence of six formation is seen. The conus terminates normally at the L1 level. The nerve roots of the cauda equina dispersed evenly. No evidence of any intraspinal fatty lesion is seen. No evidence pathologic enhancement is seen.Spinal alignment is anatomic. Vertebral body morphology is normal. No worrisome marrow signal changes are seen. A nonspecific subcentimeter focus of T2 hyperintensity within the C5 vertebral body stable. No significant degenerative disc disease is seen. No spinal canal or neuroforaminal stenosis is detected.

Output: 1.Stable findings compatible with Chiari decompressive surgery. The CSF space at the foramen magnum remains well-expanded and adequate CSF flow is seen both dorsally and ventrally.2.Unremarkable evaluation of the spine. Particular, no evidence of any syrinx or other spinal cord abnormality is seen.


Instruction: Generate impression based on findings.

Input: Reason: pancreatic cancer with elevated T-bili which continues to rise s/p biliary stent at OSH (6/6, 6/9) History: as above ABDOMEN:LIVER, BILIARY TRACT: Multiple enhancing lesions, likely reflecting metastases. Right hepatic lobe lesion measures 2.2 x 2.6 cm for reference (1103/64). There is a biliary stent. Ill-defined tissue is present within the hepatic hilum which restricts on diffusion-weighted imaging and surrounds the stent, likely representing tumor. The main portal vein is narrowed but remains patent.There hyperenhancement and wall thickening of the gallbladder. Increased T1 signal within the lumen likely represents hemorrhage. Metastatic lesions are present within the liver immediately adjacent to the gallbladder.SPLEEN: No significant abnormality noted.PANCREAS: There is an enhancing mixed solid and cystic lesion in the pancreatic tail measuring 5.1 x 4.7 cm (5/18). The main pancreatic duct is nondilated and there is fatty atrophy within the majority of the body and neck of the pancreas. There is ill-defined soft tissue in the pancreatic head surrounding the common bile duct which demonstrates enhancement and diffusion restriction measuring 4.0 x 2.4 cm (1104/70), suspicious for pancreatic adenocarcinoma. This tissue extends along the course of the common bile duct into the hepatic hilum.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: There is an enlarged portacaval lymph node measuring 2.5 x 1.7 cm (1104/56). Enlarged para-aortic lymphadenopathy with an enlarged left periaortic node measuring 1.6 x 1.1 cm (1101/94).BOWEL, MESENTERY: Perihepatic peritoneal nodule measures 0.9 x 0.4 cm (1104/61).BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small right pleural effusion with thickened adjacent pleura which may suggest an empyema.

Output: 1.Ill-defined tissue in the pancreatic head extending along the course of the common bile duct into the hepatic hilum is suspicious for a primary pancreatic adenocarcinoma.2.There is an additional mixed solid and cystic lesion in the pancreatic tail which is also likely neoplastic. 3.Multiple hepatic metastases. There is hemorrhage within the gallbladder lumen, which may be due to an adjacent metastases or prior intervention.4.Peritoneal nodularity raises the suspicion of early carcinomatosis.5.Retroperitoneal lymphadenopathy.6.Small right pleural effusion with a thickened pleura likely represents empyema.


Instruction: Generate impression based on findings.

Input: Thigh mass. Sarcoma status post radiation. The lobulated predominantly T2 hyperintense cystic-solid irregularly-enhancing soft tissue mass centered at the anterior mid to distal right thigh measures 14.1 cm AP x 12.3 cm TV x 27.1 cm CC, previously 12.6 AP x 10.2 cm TV x 22.5 cm CC. The mass appears encapsulated and lies deep to the quadriceps tendon and muscles, which are atrophic, and drapes along the lateral aspect of the femur. There is edema in the adjacent subcutaneous fat and in the musculature of the posterior compartment. The mass is in close proximity to the vasculature of the thigh, though remains separate. The mass contacts the right femur with mild periosteal reaction at the distal medial aspect without areas of osseous destruction. No inguinal lymphadenopathy is evident. The mass terminates approximately 2 cm cranial to the superior pole of the patella. There is no evidence of invasion into the knee joint. No knee joint effusion is seen.

Output: Enlarged right thigh mass compatible with malignancy, as described above.


Instruction: Generate impression based on findings.

Input: Left-sided lesion that was visible on only the FLAIR and T2, seizures. There is no evidence of intracranial hemorrhage or acute infarct. There is no significant interval change in the T2 hyperintense lesion in the posterior limb of the left internal capsule that extends superiorly into the corona radiata, accounting for differences in technique. There is perhaps faint patchy associated enhancement, but no discernible hyperperfusion. The ventricles and basal cisterns are unchanged in size and configuration. There are unchanged minimally low-lying cerebellar tonsils. There is no midline shift. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is mucosal thickening within the right frontal and anterior ethmoid sinuses.

Output: No significant interval change size of the lesion involving the posterior limb of the left internal capsule with extension into the corona radiata.


Instruction: Generate impression based on findings.

Input: 81 years, Female, weakness, history of non-small cell lung cancer. There is a 15 x 11 x 15 mm (AP x transverse x craniocaudal dimensions) expansile enhancing mass in the right aspect of the medulla. There is surrounding vasogenic edema involving the bilateral aspects of the medulla and extending slightly into the right pons. There is minimal susceptibility effect suggesting minimal hemorrhage within the lesion.There is a 3 mm enhancing nodule in the right internal auditory canal.There is an area of susceptibility effect along the gyri in the left paramedian parietal lobe involving the precuneus, with mild enhancement and increased vascularity in this region, indicating prior subarachnoid hemorrhage. There is also intraparenchymal focus of hemorrhage involving the posterior aspect of the left cingulate gyrus. There is a 3 mm focus of enhancement along the cortical surface in this region but otherwise no discrete mass is appreciated.No restricted diffusion to suggest acute ischemia. Aside from the right medullary lesion there is no large intracranial mass or evidence of mass effect, midline shift, or herniation. No hydrocephalus. There is prominence of the extra-axial spaces along the bilateral cerebral convexities likely reflecting volume loss and perhaps small chronic subdural effusions, relatively larger on the right, without focal mass effect and similar to prior CT from 6/14/2012. Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild chronic small vessel ischemic changes. Major flow-voids are preserved. No discrete enhancing lesions are seen in the calvarium or extracranial soft tissues.

Output: 1. 15 x 11 x 15 mm enhancing mass in the right aspect of the medulla with surrounding vasogenic edema suspicious for metastasis.2. 3 mm enhancing nodule in the right internal auditory canal may represent an incidental vestibular schwannoma although additional focus of metastasis is not excluded.3. Evidence of subacute to chronic intraparenchymal and subarachnoid hemorrhage in the left paramedian parietal lobe. There is a 3 mm focus of enhancement along the cortical surface in this region which may be secondary to the hemorrhage or represent an underlying lesion. There is increased vascularity in this region and underlying vascular lesion is not excluded.Dr. Ali communicated findings to Dr. Patel via email on 10/8/2016 at the time of this report.


Instruction: Generate impression based on findings.

Input: 51-year-old female with gastrocnemius strain. There is mildly T2 signal within the medial head of the gastrocnemius, consistent with mild edema. The Achilles tendon is intact. There is mild diffuse bilateral subcutaneous fat stranding of both lower extremities, consistent with edema. The imaged bone marrow signal is within normal limits.

Output: 1.Mildly increased T2 signal within the medial head of the gastrocnemius consistent with muscular sprain.2.Diffuse bilateral infiltration of subcutaneous fat of both lower extremities, also consistent with edema.


Instruction: Generate impression based on findings.

Input: Multiple foci of diffusion signal abnormality with only minimal corresponding signal abnormality on the flair consistent with small foci of acute ischemia which are new from the prior exam. Foci of acute diffusion abnormality include two foci in the left occipital cortex, a slightly larger focus in the left insular cortex as well as the adjacent white matter, a single focus in the right frontal lobe, and small focus in the right cerebellar hemisphere. There is a chronic appearing infarct is present in the subcortical white matter of the inferior frontal gyrus (series 303, image 172).Again seen is the posterior parietal lesion, very similar in size the prior exam measuring 2.5 x 2.1 cm (series 501, image 22). Surrounding vasogenic edema is similar to the prior exam dated 1/28/15. No significant mass effect or midline shift. The cerebellar tonsils are in normal position. No appreciable hemorrhage. The ventricles and sulci are normal in size. Flow voids are present within the major vessels indicating patency. Posterior parietal lesion shows enhancement. Postoperative changes are seen secondary to a biopsy of this lesion. No new lesion is identified. Motion limits sensitivity facial MRI. Sinonasal windows present on the right as well is evidence of left chronic sinus disease. There is an air-fluid level in left maxillary sinus, recommend correlation with symptoms of sinusitis. No abnormal enhancement is seen in the face.

Output: 1. Multiple foci of diffusion abnormality indicating acute infarct in multiple lobes. There is also a single focus of chronic infarction that is new from the prior exam in the left frontal lobe.2. Right posterior parietal PTLD lesion is not significantly changed. No new lesion is identified.3. Evidence of chronic left sinus disease. Recommend correlation with symptoms of sinusitis. No abnormal enhancement in the face.


Instruction: Generate impression based on findings.

Input: History of prostate cancer. Evaluate for high risk features. Left base medial and lateral 3+4 disease. Left mid gland 3+4 disease. PELVIS:PROSTATE:Prostate Size: 5.9 x 3.2 x 4.3 cmPeripheral Zone: Diffuse patchy intrinsic T1 weighted signal hyperintensity in the peripheral zone related to proteinaceous/hemorrhagic products likely related to recent biopsy. This limits evaluation of the peripheral zone.In the left base extending into the left seminal vesicle there is a region of restricted diffusion measuring 2.0 x 1.5 cm (series 603/424) associated with decreased T2 weighted signal intensity (series 1001/23) and marked relative hyperenhancement (series 1 601/2 252).6 mm focus of restricted diffusion (series 603/3 64) in the right lateral mid gland with associated low T2 weighted signal intensity (series 901/19).Central Gland: Changes of benign prostatic hyperplasia.Seminal Vesicles: There is abnormal signal extending into the left seminal vesicle including postcontrast enhancement compatible with seminal vesicle invasion.Extracapsular Extension: The left base lesion is broadly based and there is spiculated enhancement beyond the capsule margin (series 1601/2572).BLADDER: No significant abnormality noted.LYMPH NODES: No enlarged pelvic lymphadenopathy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Dominant lesion in the left base measuring up to 2.0 x 1.5 cm with findings most compatible with seminal vesicle invasion and extracapsular extension. No enlarged pelvic lymphadenopathy evident.Additional suspicious focus in the lateral right mid gland measuring 6 mm.


Instruction: Generate impression based on findings.

Input: Hypercalcemia. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is a persistent flattened appearance of the pituitary gland. The brain parenchyma appears unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. No evidence of acute intracranial hemorrhage, mass, or acute infarct.2. A persistent flattened appearance of the pituitary gland may be due to atrophy.


Instruction: Generate impression based on findings.

Input: History of a renal lesion. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology, signal intensity and size. No focal suspicious lesion, biliary ductal dilatation or vascular abnormality. The gallbladder is normally distended.SPLEEN: 3.0 x 2.8 x 2.6 cm T1 hypointense and T2 hyperintense lesion in the superior spleen with multiple internal septations which enhance on postcontrast imaging. No additional splenic lesion.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left inferior pole exophytic T1 hyperintense and T2 isointense lesion measuring 2.2 x 2.0 cm (series 6/43) demonstrating no definite postcontrast enhancement suggesting a proteinaceous/hemorrhagic cyst. However evaluation for enhancement is limited by lack of subtraction images and the lesions intrinsic T1-weighted hyperintensity. The renal vessels are unremarkable. No regional lymphadenopathy.Left inferior pole parapelvic T1-weighted intermediate and T2-weighted mildly hyperintense lesion measuring 1.1 cm without post-contrast enhancement, compatible with a hemorrhagic/proteinaceous cyst.Bilateral nonenhancing T2 hyperintense and T1 hypointense lesions, the largest on the right measuring 2.6 x 1.9 cm and 1.1 x 1.4 cm on the left compatible with cysts without internal complexity.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Probable complex hemorrhagic/proteinaceous cyst in the lower pole of the left kidney without definite enhancement, although this is limited by lack of subtraction images and its intrinsic T1 hyperintensity. A repeat MRI with subtraction images is recommended to assess for enhancement.2.Left parapelvic hemorrhagic/proteinaceous cyst.3.Multiseptated 3.0 cm splenic lesion without internal enhancement may reflect a complex splenic cyst or lymphangioma.


Instruction: Generate impression based on findings.

Input: Examination is limited to sequences for treatment planning. There are numerous, greater than 30, enhancing lesions throughout the brain which have overall decreased in size and number as noted on recent MRI brain dated 4/19/2016. There are a few lesions which demonstrates slight enlargement compared to 2/2/2016. For example a right lateral inferior frontal lobe lesion, series 401 image 101, measures 6 mm, previously 4 mm. A right posterior medial temporal lesion, series 401 image 83, measures 6 mm previously 3 mm. A left occipital lesion, series 401 image 55 measures 8 mm, previously 6 mm. There is an unchanged calcified left posterior frontal parafalcine mass with mild peripheral enhancement which is unchanged and may represent a meningioma. No evidence of significant intracranial mass effect, midline shift, or herniation. No hydrocephalus. No evidence of hemorrhage.

Output: As noted on recent brain MRI from 4/19/2016 there is been interval decrease in size and number of the numerous intracranial metastases when compared to 2/2/2016. Few lesions demonstrate slight enlargement as detailed above.


Instruction: Generate impression based on findings.

Input: 81 years Male (DOB:3/5/1935)Reason: assess for stenosis History: history of lumbar decompression in April, still having leg and back painPROVIDER/ATTENDING NAME: BEN-ZION ROITBERG BEN-ZION ROITBERG Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall height. The conus medullaris on sagittal imaging is grossly intact.There is T2 signal hyperintensity present along the superior anterior aspect of the L4 vertebral body adjacent to the endplates and eccentric to the right side. This may represent subacute inflammatory change.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is mild facet hypertrophy present at this level.At L4-5 there is a diffuse disc bulge present associated with loss of disc space height, disc desiccation and bilateral facet and ligamentum flavum hypertrophy. There is mild anterior subluxation of L4 and L5. The patient is status post right-sided hemilaminotomy at this level. There is effacement of the fat at the lateral recess bilaterally at this level but worse in the right compared to the left side. Compared to the prior exam there is no nerve root crowding on the current exam when compared to the prior. There is narrowing of the neural foramina bilaterally at this level. The nerve root exiting the left neural foramen are surrounded by fat whereas the right-sided exiting nerve root is encroached upon by a combination of facet hypertrophy and disc material.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.There are large cysts present along the kidneys bilaterally which were also present on the prior exam and do not appear to have changed severe not entirely included on this exam in the assessment of their size cannot be adequately done on this exam.

Output: 1.Since the prior examination the patient is undergone lumbar spine surgery at L4-5 there is no significant spinal stenosis at this level. Currently however, there is encroachment of the nerve roots within the right neural foramen and at the right lateral recess at this level as a result of disc disease and facet disease. A contrast enhanced exam may help differentiate scar from disc protrusion.2.Some subacute inflammatory changes are present along the anterior superior aspect of the L4 vertebral body eccentric towards the right side.3.Multiple large renal cystic lesions are not completely evaluated on this exam. There are present on prior exams and to the extent of visualization have not changed significantly


Instruction: Generate impression based on findings.

Input: Clinical question: History of meningioma status post resection; also with history of multiple sclerosis. Signs and symptoms: Surveillance scan for meningioma. Pre and post enhanced brain MRI:Unremarkable diffusion weighted series.Examination demonstrate stable postoperative changes of a left frontal and temporal craniotomy without evidence residual or recurrence of tumor/meningioma. Expected subtle dural thickening and enhancement along the inner table of craniotomy flap is again noted.Extensive periventricular and to lesser degree subcortical and corpus callosum foci of flair hyperintensity consistent with patient's diagnosis of multiple sclerosis is again identified. There is no evidence of any appreciable interval change since prior study and without evidence of an enhancing plaque. There is revisualization of a small left anterior frontal development of venous anomaly without evidence of an associated cavernoma.Mildly prominent supratentorial ventricular system and with maintained midline remains similar to prior exam.The signal void of major intracranial arterial branches are identified.The intracranial venous sinuses demonstrate normal signal intensity and with normal pattern of enhancement.Unremarkable images through the orbits, paranasal sinuses and mastoid air cells.

Output: 1.No evidence of acute or new finding since prior study. 2.Stable postoperative changes of the left frontal and temporal craniotomy without evidence of residual or recurrence of tumor/meningioma.3.Extensive findings of demyelinating disease without significant change since prior exam or detectable enhancing plaque.


Instruction: Generate impression based on findings.

Input: Low back pain. The vertebral column alignment is within normal limits. There is increased T2 signal and low T1 signal at the endplates of L3-4 likely related to degenerative changes. There is multilevel disc desiccation and moderate loss of height of the L3-4 disc, with what appears to be herniation of disc into the posterior L3 vertebral body. The spinal cord displays normal signal and morphology. There is a partially imaged right renal cyst. There is a large well-circumscribed T1 and T2 hyperintense lesion within the right iliacus muscle, which likely represents a lipoma.Interspace observations:T11-12: There is no significant compromise to spinal canal or neural foramina.T12-L1: There is no significant compromise to spinal canal or neural foramina.L1-L2: There is no significant compromise to spinal canal or neural foramina.L2-L3: There is no significant compromise to spinal canal or neural foramina.L3-L4: There is disc bulge, facet hypertrophy with effusions and possible small synovial cysts, and ligamentum flavum thickening, as well as mild epidural lipomatosis, causing moderate central canal and moderate right and moderate to severe left neural foraminal narrowing.L4-5: There is disc bulge, facet hypertrophy with effusions, and ligamentum flavum thickening cause mild central canal stenosis, as well as moderate to severe right and moderate left neural foraminal narrowing.L5-S1: There is a minimal disc bulge, facet hypertrophy, and ligamentum flavum thickening with mild bilateral neural foraminal narrowing, but no significant spinal canal narrowing.

Output: Degenerative spondylosis with moderate central canal and moderate right and moderate to severe left neural foraminal narrowing at L3-4 and mild central canal stenosis, as well as moderate to severe right and moderate left neural foraminal narrowing at L4-5.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Focal weakness and hip flexors and medial thighs, known iliopsoas abscess but recently drained Examination slightly motion degraded.Thoracic: Thoracic vertebral body heights are maintained. Alignment is maintained. Thoracic spinal canal is mildly narrow on a congenital basis. There are minimal degenerative changes without significant spinal canal or neural foraminal stenosis. Thoracic cord is normal in signal and contour. Bone marrow signal is benign with no suspicious lesions. T1 hyperintense focus at T10 is compatible with focal fat or hemangioma.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. Alignment is otherwise within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position.There is moderate loss of disc height at the L5-S1 level with associated endplate changes. The spinal canal appears congenitally narrow, worse inferiorly, with superimposed degenerative changes as described below: L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: There is mild spinal canal stenosis, predominantly on a congenital basis. No significant disc disease. No neural foraminal stenosis.L3-L4: There is mild spinal canal stenosis, predominantly on a congenital basis and prominence of the epidural fat. There is mild disc desiccation with small right foraminal disc protrusion which contacts the exiting right L3 nerve root without clear impingement. No significant left neural foraminal stenosis.L4-L5: There is moderate spinal canal stenosis, predominantly on a congenital basis, prominence of the epidural fat, as well as a superimposed ligamentum flavum thickening, mild disc bulge with annular fissure. Minimal bilateral foraminal narrowing.L5-S1: There is narrowing of the spinal canal which is predominantly on a congenital basis with superimposed prominence of the epidural fat and mild degenerative changes including disc desiccation, ligamentum flavum thickening, mild disc bulge and endplate osteophytes. No significant foraminal stenosis.Fluid collections along the bilateral iliopsoas musculature are noted. There is a discrete approximately 3 x 3 cm fluid collection on the right.

Output: 1. No significant spinal canal stenosis in the thoracic spine or thoracic cord signal abnormality.2. Moderate stenosis of the lumbar spinal canal at L4-L5 and L5-S1 which is predominantly on a congenital basis with mild superimposed degenerative changes and prominence of the epidural fat. There is mild narrowing of the right L3-L4 neural foramen. Otherwise no significant neural foraminal stenosis is appreciated.3. Fluid collections along the bilateral iliopsoas musculature are partially visualized. There is an approximately 3x3 cm right iliopsoas fluid collection which may be impinging on the peripheral course of the lumbar nerve roots on the right. Please note evaluation for infection can be better obtained with postcontrast sequences; however no obvious evidence of discitis-osteomyelitis or epidural extension of infection is demonstrated.


Instruction: Generate impression based on findings.

Input: Male, 78 years old, history of renal cell carcinoma and metastatic prostate cancer with asymptomatic brain lesions. Evaluate for stability or growth. Scattered small foci of enhancement are redemonstrated including a 5 mm lesion in the right insula and smaller lesions along the paramedian right frontal lobe, the right superior frontal gyrus and in the left pons. These lesions have not increased in size and may even be slightly less conspicuous than on the prior examination. As before, there are associated with mild susceptibility effect suggesting chronic blood product.No definite evidence of any new parenchymal lesion is seen. No significant edema or mass effect is detected. No abnormal extra-axial collections are observed. Ventricles are normal in size and morphology.Multiple enhancing skull lesions are identified, some of which may be slightly increased in size. However accurate comparison is difficult and most of the lesions are unchanged.

Output: 1.Several small enhancing parenchymal lesions are stable to slightly smaller.2.No new intracranial lesions.3.Multiple skull lesions are demonstrated, most which show no significant change. A few may be slightly larger but accurate comparison is difficult.


Instruction: Generate impression based on findings.

Input: 52-year-old with history of T8 with Patchy areas of periventricular hypodensity are present in the subcortical white matter, right side greater than left. Findings are consistent with small vessel ischemic disease These are present on the prior study and do not appear significantly changed.If there is clinical concern for acute ischemic changes MRI with diffusion weighted imaging would allow more sensitive evaluation.

Output: Small vessel ischemic disease without significant change from prior.


Instruction: Generate impression based on findings.

Input: Female, 10 years old, with right leg spasticity and weakness, syrinx. Brain:Small areas of subcortical T2 hyperintensity are seen within the left superior frontal, left middle frontal gyrus, and the anterior left temporal lobe. These lesions produce no mass effect and the overlying cortex shows normal signal intensity.No additional areas of focal signal abnormality, restricted diffusion or susceptibility effect are seen. Cerebral and cerebellar morphology is otherwise within normal limits. No evidence of intracranial hemorrhage or any abnormal extra-axial fluid collections are seen. Ventricular size and morphology are within normal limits.The left sphenoid sinus is completely opacified along with scattered ethmoid air cells. There is trace fluid signal in the mastoid air cells.Spine:Expansion of the central canal of the spinal cord is seen beginning at T10-11 and continuing down to T12-L1. The maximum caliber of the central canal measures 3 x 3 mm. Above the T10-11 level, there is minimal prominence of the central canal which can be normal.The spinal cord is otherwise normal in morphology and signal characteristics. The conus tip terminates at L1-2. No evidence of fatty filum terminale or other intrathecal fatty lesion is seen. On prone imaging, there is clear anterior shifting of the conus and cauda equina.Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. There is a normal complement of intact vertebral bodies. The intervertebral discs are preserved with no areas of significant spinal canal or foraminal stenosis.

Output: 1.Scattered small areas of signal abnormally are seen in the subcortical white matter of the left frontal lobe and the anterior left temporal lobe. These lesions are nonspecific but could potentially represent areas of gliosis related to prior traumatic injury, or prior inflammation/infection. No acute intracranial abnormalities are detected.2.Syringohydromyelia of the lower spinal cord is seen with a maximum caliber of 3 x 3 mm. The spinal cord is otherwise unremarkable, and there are no findings to suggest tethered cord. The osseous spine is within normal limits.


Instruction: Generate impression based on findings.

Input: New left sixth nerve palsy, rule out cavernous sinus process. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intraparenchymal mass or mass-effect. The ventricles are within normal limits in size and configuration. Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild chronic small vessel ischemic changes. Brain parenchyma is otherwise unremarkable for age. Minimal mucosal thickening in the paranasal sinuses. Major flow-voids are preserved.There is a 9 x 6 x 9 mm (APxTRVxCC) extra-axial enhancing lesion in the right petro clival region compatible with meningioma. This lesion appears larger compared to 8/28/2007 when it measured 3 mm in the transverse dimension, currently 6 mm. No masses are seen along the course of the left sixth nerve. Cavernous sinuses are within normal limits without evidence of thrombosis or other masses. Prominent vascular calcifications involving the cavernous carotid arteries which are better seen on recent CT. Bilateral orbits appear within normal limits.

Output: 1. No evidence of acute infarct. 2. No evidence of cavernous sinus thrombosis or other pathology involving the cavernous sinuses as questioned.3. There is an extra-axial enhancing lesion most compatible with a petroclival meningioma on the right measuring 9 x 6 x 9 mm and has enlarged since prior MRI dated 8/28/2007. No significant mass effect.


Instruction: Generate impression based on findings.

Input: Prostate cancer. Elevated PSA. EPIC history: G 3 + 3 disease right mid gland. PSA 3.9 10/2014. PELVIS:PROSTATE: Prostate Size: 5.4 x 4.1 x 4.2 (TR x AP x CC) Peripheral Zone: Heterogeneous T2 hypointensity of the peripheral zone with increased enhancement suggestive of prostatitis, unchanged. This limits evaluation for focal lesions. Scattered nonspecific subcentimeter ADC hypointense foci in the right mid/apex of the peripheral zone are unchanged. Central Gland: Well defined heterogeneous nodules consistent with benign prostatic hypertrophy.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: No evidence of extracapsular extension. BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: Mild inflammatory changes in the muscles lateral to the left acetabulum, unchanged. OTHER: No significant abnormality noted.

Output: Scattered nonspecific ADC hypointense foci in the right mid/apex peripheral zone of the prostate, unchanged. No evidence of extraprostatic extension or local metastatic disease.


Instruction: Generate impression based on findings.

Input: 36 years Male (DOB:12/3/1979)Reason: preoperative planning for OR 2/14 History: preoperative planning for OR 2/14PROVIDER/ATTENDING NAME: IRA J BLUMEN ISSAM A AWAD There is redemonstration of a hemorrhagic focus centered in the right optic tract and adjacent basal ganglia involving the right optic tract, right side of the optic chiasm and posterior most aspect of the right optic nerve. The component that extended into the right optic tract and optic nerve has an exophytic appearance and extends into the suprasellar cistern. The optic nerve component is adjacent to the right A1 segment. There are fluid-fluid levels present within 2 components of this cavernous malformation. One fluid fluid level which is located at the optic tract measures approximately 7 mm diameter the other one is located in the right basal ganglia and measures 5 mm.There is redemonstration of a developmental venous anomaly in the left frontal lobe.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: Right optic tract and basal ganglia cerebral cavernous malformation.


Instruction: Generate impression based on findings.

Input: BRAIN MRI There is normal left ventricular size with normal patency of all the basal cisterns. There is no evidence of hemorrhage or infarction. There are no mass effect. No abnormal signal is seen in T2 or FLAIR. There are no abnormal enhancements. No midline shift. No extra-axial fluid collection.There are no foci of diffusion restriction. There are no abnormalities seen in the susceptibility images.BRAIN MRAThe brain MRA demonstrates wide neck cavernous aneurysm of the left internal carotid artery measuring 11 x 7 mm axial dimensions which originates from the lateral wall of the horizontal segment of the left cavernous internal carotid artery. The neck of the aneurysm measures 7 mm. The aneurysm is extends laterally to the left cavernous sinus lateral wall. There is no change in the size of the aneurysm since the previous study. The aneurysm drapes around the adjacent left anterior clinoid processNo other aneurysms are appreciated intracranially. There is no evidence for intracranial cerebrovascular arterial stenosis. Note is made that the posterior communicating arteries are small bilaterally. The anterior communicating artery is small to medium sized. The left vertebral artery is larger than the right vertebral artery. Basilar artery is of normal caliber.

Output: 1. 11mm left internal carotid artery cavernous segment wide neck aneurysm with a 7 mm neck. The aneurysm is unchanged in size since the previous study of 6/27/2015.2. No evidence for intracranial mass lesion.


Instruction: Generate impression based on findings.

Input: Female, 12 years old, with rapidly changing scoliosis, headaches and syncopal events. Evaluate for Chiari malformation, syringohydromyelia, and tethered cord. Brain:Brain parenchymal morphology is within normal limits. No evidence of Chiari malformation or any other structural abnormality is seen. No parenchymal signal abnormality, edema or mass effect is observed. No intracranial hemorrhage or any abnormal extra axial fluid collection is seen. The pineal gland is slightly prominent though it measures less than 1 cm in diameter and if anything this simply represents a benign pineal region cyst. The left lateral ventricle is slightly larger than the right, but this is within the limits of normal variation.Spine:A scoliotic curvature of the spine is seen, though this is better assessed on prior radiographs. The sagittal alignment of the spine is otherwise unremarkable. A normal complement of vertebral bodies is present. Vertebral body morphology and signal characteristics are within normal limits. The intervertebral discs are preserved. No spinal canal or foraminal stenosis is detected.The spinal cord demonstrates normal signal intensity and morphology. The conus tip terminates at the L1 level which is normal. The nerve roots of the cauda equina disperse evenly through the thecal sac. No fatty filum terminale or other intraspinal fatty lesion is seen. No epidural abnormality is suspected. On prone imaging, there is anterior displacement of the conus and cauda equina.

Output: 1.Unremarkable evaluation of the brain. At most there may be a mild pineal region cyst which requires no specific follow-up.2.Apart from scoliosis, unremarkable evaluation of the spine. No evidence of Chiari malformation, syringohydromyelia or tethered cord.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate disc for herniation. Signs and symptoms: Right thoracic pain. Nonenhanced thoracic MRI:There is normal anatomical morphology and alignment of the vertebral column.There is normal signal intensity and caliber of the thoracic cord.There is no evidence of spinal stenosis at any level.Mild degenerative changes at T10-T11 level results in moderate to severe right neural foraminal compromise (sagittal T2 series 501 image 12 and axial T2 series 801 image 11). No evidence of neural foraminal compromise at any other level.Unremarkable perispinal soft tissues.Nonenhanced lumbar MRI:There is normal anatomical development, morphology and alignment of vertebral column.Degenerative changes are noted only in the lower lumbar spine at L4-L5 and L5-S1 levels are noted and unremarkable at other levels.At L4-L5 there is mild disc disease and loss of disc height, mild facet and ligamentum flavum hypertrophy without spinal or neural foraminal compromise. There is a linear T2/T2 STIR hyperintense lesion in the annulus of the disc in the midline consistent with an annular fissure.L5-S1 demonstrate advanced disc disease and loss of disc height, mild bilateral facet and ligamentum flavum hypertrophy with resultant mild left neural foraminal compromise and unremarkable otherwise.

Output: 1.Nonenhanced thoracic MRI demonstrate mild degenerative changes at T10-T11 with resultant moderate to severe right neural foraminal compromise and unremarkable exam otherwise as detailed.2.Nonenhanced MRI of lumbar spine demonstrate moderate to advanced disc disease at L5-S1 and mild degenerative changes at L4-L5 levels only. There is resultant mild left neural foraminal compromise at L5-S1 and unremarkable exam otherwise


Instruction: Generate impression based on findings.

Input: 66-year-old man with cirrhosis, please evaluate for HCC. ABDOMEN:LIVER, BILIARY TRACT: The liver is cirrhotic in morphology with nodular contour, prominent hepatic fissures, and mild caudate hypertrophy. Increased reticular T2 signal is seen in the right lobe of the liver (series 4, image 12) with retention of contrast suggestive of fibrosis. A number of wedge-shaped areas of arterial enhancement are seen without washout on delayed images, likely perfusion abnormalities. A T2 hyperintense focus adjacent to the gallbladder is again noted, probably a benign cyst.The gallbladder appears normal.SPLEEN: The spleen appears normal.PANCREAS: The pancreas appears normal.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: The kidneys appear normal and enhance symmetrically.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Numerous perigastric varices are noted. The visualized small bowel and colon are unremarkable.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Cirrhotic morphology of liver without suspicious focal hepatic lesion.


Instruction: Generate impression based on findings.

Input: 69-year-old female with a personal history of left breast lumpectomy in 2005 for DCIS followed by radiation and Arimidex therapy. Family history of breast cancer in her paternal cousin and ovarian cancer in her mother. She has no current breast complaints. There is heterogeneous amount of fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.Stable postsurgical changes from prior lumpectomy are noted in the left retroareolar region. Stable enhancing focus in the left lower outer breast.No abnormal enhancement is seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.Incidental note is made of a 1.2 x 1.1 cm area in the spleen which has high T2 signal intensity and has remained stable since 2013. This likely represents a benign etiology such as a cyst or hemangioma.

Output: No MRI evidence for malignancy. Stable postsurgical change in the left breast.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Routine Screening Mammogram.


Instruction: Generate impression based on findings.

Input: Malignant neoplasm of base of tongue [C01] / Secondary and unspecified malignant neoplasm of lymph nodes of head, face and neck [C77.0] / Encounter for follow-up examination after completed treatment for conditions other than malignant neoplasm [Z09] Redemonstration of the left cerebellar tonsilar enhancing lesion which does not show MR evidence of surrounding edema or mass effects, no change since prior scan in terms of size and enhancement pattern. Left posterior globe lesion is also again seen and shows slightly decreased in size (thickness: about 2.5mm, length: 11mm) since prior scan (thickness: 3mm, length 14mm).There is no evidence of retinal detachment on this scan.There is no evidence of acute ischemic or hemorrhagic lesion.There is no evidence of another 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 mastoid air cells are clear.There is a retention cyst on the left maxillary sinus.

Output: 1. Interval decrease (slightly) of the left posterior globe enhancing lesion since prior scan.2. No interval change of the left cerebellar tonsil lesion since prior scan.3. No evidence of acute ischemic or hemorrhagic lesion. 4. No other abnormal enhancing lesion.4.


Instruction: Generate impression based on findings.

Input: There is an unchanged enhancing 9 mm lesion within the right centrum semiovale with unchanged surrounding T2 hyperintensity and unchanged susceptibility effect. There are no new lesions identified. There is no evidence of acute infarct. There are scattered unchanged punctate foci of T2 hyperintensity within the supratentorial white matter and brainstem that are most compatible with chronic small vessel ischemic disease. There is an unchanged punctate chronic infarct within the right cerebellar hemisphere. 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 skull, paranasal sinuses, and scalp soft tissues are unremarkable. There is fluid within the right mastoid air cells. There are bilateral lens implants. The partially imaged degenerative changes of the upper cervical spine are not well assessed on this exam.

Output: Unchanged treated right frontal lobe metastasis. No new lesion. Reidentified fluid within the right mastoid air cells, a nonspecific finding.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: MRI brain:There are areas of diffusion restriction compatible with acute infarcts involving the following regions: bilateral frontal corona radiata, right frontal lobe cortex in the middle and inferior frontal gyri extending to the operculum, right insular cortex, left caudate body, left putamen, superior aspect of the left thalamus and right inferior medial cerebellar hemisphere. There is corresponding hyperintense T2/FLAIR signal abnormality.Mild global cerebral volume loss. Partially empty sella is noted. The basal cisterns remain patent. There is no midline shift or mass effect. No extra-axial fluid collection is identified.The midline structures and craniocervical junction are within normal limits. Bilateral lens implants.MRA brain:The intracranial internal carotid arteries are normal in course and caliber. There is abrupt termination of a branch of the distal right M2 segment with associated susceptibility artifact indicating thrombus. The left middle and bilateral anterior cerebral arteries are unremarkable. A small right posterior communicating artery is identified. The left posterior communicating artery is not well seen. The vertebral arteries, basilar artery, and posterior cerebral arteries are normal in course and caliber. There is no evidence aneurysm.MRA neck:Images are technically degraded due to motion artifact, as per technologist note, patient was moving during MRA neck portion despite attempting restraint.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 grossly patent.The left vertebral artery origin is patent. Proximal right vertebral artery is not well seen, which may reflect artifact and/or high-grade stenosis. The left vertebral artery is dominant. There is no evidence of occlusion of the remainder of the cervical vertebral arteries.

Output: 1.Multiple acute infarcts in the bilateral cerebral hemispheres and right cerebellum, as described above. 2.Occlusion of a branch of the distal right M2 segment with suggestion of thrombus. Major intracranial vasculature is otherwise patent.3.MRA neck images are significantly motion-degraded. Right vertebral artery origin not well seen, likely in part due to artifact though high-grade stenosis cannot be excluded. Major neck vasculature is otherwise grossly patent. If further detailed evaluation is desired, repeat MRI or CTA may be considered.Findings communicated via telephone with Dr. Loggini at 9:22 AM on 8/26/2016.


Instruction: Generate impression based on findings.

Input: CCM: Migraines. There is a 5 mm diameter T1 and T2 hyperintense lesions with complete peripheral susceptibility effect in the posterior right medial orbitofrontal gyrus. There is an adjacent anterior right frontal lobe developmental venous anomaly. There is no evidence of intracranial hemorrhage, vasogenic edema, or 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, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Unchanged small posterior right medial orbitofrontal gyrus cavernous malformation with an associated developmental venous anomaly, but no evidence of acute intracranial hemorrhage.


Instruction: Generate impression based on findings.

Input: Male, 67 years old. Reason: 67yo with ?h/o Afib on chronic amiodarone. now TSH <0.01. Requesting thyroid US w/dopplers to assess bloodflow and r/o thyroid nodules. RIGHT LOBE MEASUREMENTS: 7.2 x 2.8 x 4.0 cmLEFT LOBE MEASUREMENTS: 7.5 x 3.0 x 3.5 cmISTHMUS MEASUREMENTS: 0.4 cmRIGHT LOBE: Heterogeneous echotexture. A nodule in the mid to lower right lobe measures 6.1 x 3.5 x 4.0 cm, predominantly solid with cystic component, hypoechoic, with questionable small internal calcifications, non-vascular.LEFT LOBE: Heterogeneous echotexture. A nodule in the mid to lower left lobe measures 3.9 x 2.3 x 2.5 cm, predominantly solid with cystic component, hypoechoic, noncalcified, nonvascular.ISTHMUS: Heterogeneous echotexture.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No cervical lymphadenopathy.OTHER: Calcified plaque noted in the left common carotid artery, with mild resultant narrowing.

Output: 1.Enlarged, multinodular thyroid gland as detailed above. A large right thyroid nodule with internal calcifications is amenable to biopsy. Additionally, given the clinical picture, nuclear medicine thyroid scan may be beneficial for functional evaluation of these nodules.2.Calcified atherosclerotic plaque in the left common carotid artery, with mild resultant narrowing.


Instruction: Generate impression based on findings.

Input: NF type 1, optic glioma and medullary mass. Brain: There is no significant interval change in the enhancing mass involving the cisternal portion of the left optic nerve, although the tumor has gradually increased in size since 2012, now measuring up to approximately 16 mm. However, there appears to be overall decrease in size of the multiple foci of T2 hyperintensity in the bilateral basal ganglia and cerebellar hemisphere. The non-enhancing expansile lesion in the right posterior medullar has not significantly changed. There is no evidence of acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. Orbits: The bilateral globes and ocular adnexa are unremarkable. There is no evidence of abnormal intraorbital enhancement or mass lesions.

Output: 1. No significant interval change in the left optic nerve glioma, although the tumor has gradually increased in size since 20122. Apparent overall decrease in size of the multiple bilateral basal ganglia and cerebellar hemisphere lesions.3. The non-enhancing expansile lesion in the right posterior medullar has not significantly changed.


Instruction: Generate impression based on findings.

Input: Slurred speech. Brain MRI: The examination is motion degraded. There is no evidence of acute infarct or hemorrhage. There is mild diffuse nonspecific T2 hyperintensity in the periventricular and subcortical white matter. There is also encephalomalacia in the left middle frontal gyrus and multiple defects in the bilateral inferior cerebellar hemispheres. There is no evidence of mass lesions or midline shift. The ventricles and sulci are unchanged in size and configuration, with mild diffuse cerebral volume loss. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Brain MRA: There is no evidence of significant steno-occlusive lesions or saccular aneurysms without the limits of MRA. There is a right fetal posterior cerebral artery, which is an anatomic variant.Neck MRA: The origin of the right vertebral artery is not well depicted and there appears to be significant stenosis of the brachiocephalic artery origin. There is also mild narrowing of the right common carotid artery just proximal to the bifurcation. The other major cervical arteries appear to be patent. There appears to be a 6 mm outpouching along the dorsal aspect of the aortic arch adjacent to the brachiocephalic artery origin.

Output: 1. Chronic small vessel ischemic disease and infarcts in the left middle frontal gyrus and inferior cerebellar hemispheres, but no evidence of acute intracranial hemorrhage, mass, or acute infarcts.2. The origin of the right vertebral artery is not well depicted and there appears to be significant stenosis of the brachiocephalic artery origin. 3. Apparent 6 mm outpouching along the dorsal aspect of the aortic arch adjacent to the brachiocephalic artery origin, which may represent a pseudoaneurysm or ulcerative plaque. A CTA may be useful for further evaluation.4. No significant steno-occlusive lesions intracranially.Discussed with Dr. at 11:40 AM on Maryam Mohammed.


Instruction: Generate impression based on findings.

Input: 56 years, Male, Reason: etiology for elevated liver enzymes, intrahepatic ductal dilation, abnormal abdominal US History: as above. ABDOMEN:LUNG BASES: Trace effusions.LIVER, BILIARY TRACT: Subcentimeter left hepatic simple cysts.Common bile duct appears normal measuring up to 7 mm in diameter. No cholelithiasis or choledocholithiasis. No obstructing mass.SPLEEN: 1.3-cm nonenhancing splenic lesion with T2 hyperintensity, likely a cyst.PANCREAS: Pancreatic duct is normal in caliber. There is diffusion restriction noted throughout the pancreas, with mildly decreased T1 signal.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Subcentimeter left renal cysts. An exophytic left mid pole lesion with high T1 signal measures 2.4 x 1.9 cm, previously 2.1 x 1.8 cm on the MRI from 7/29/2014.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small amount of free fluid in the pelvis.

Output: 1.Normal appearing common bile duct and pancreatic duct.2.Left renal lesion with increased T1 signal is slightly increased in size, likely a hemorrhagic/proteinaceous cyst.3.Diffusion restriction throughout the pancreas with low T1 signal area. This is nonspecific and may be related to age or inflammatory changes, either acute or chronic pancreatitis. Correlation with clinical presentation and serum lipase levels is recommended.


Instruction: Generate impression based on findings.

Input: 31 years Female (DOB:4/20/1984)Reason: signs of MS History: left weakness, fatiguePROVIDER/ATTENDING NAME: JACQUELINE T BERNARD JACQUELINE T BERNARD MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. There are approximately 15 periventricular and subcortical white matter lesions present which are high signal on T2 and FLAIR sequences. Some of these are perpendicularly oriented to the lateral ventricles and several extends to the colossal cingulate junction. On T1-weighted imaging the appear somewhat hypointense but less conspicuous. There is no associated susceptibility effect with these lesions.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal lesions are appreciated within the cervical spinal cord.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.There is a mild degree of periventricular and subcortical white matter lesions which are suspicious for demyelinating disorder and compatible with patient's clinical history of multiple sclerosis. 2.No cervical spinal cord lesions are appreciated.


Instruction: Generate impression based on findings.

Input: 37 year old male with hypertrophic cardiomyopathy, referred for cardiovascular MRI to evaluate function, hypertrophy, and scar. Left VentricleThe left ventricle has severe asymmetric hypertrophy involving the mid and distal ventricular septum, anterior, and anterolateral walls with sparing of the basal-mid inferior and lateral walls. There is mid-cavitary obstruction. The overall systolic function is normal, The apex is akinetic. The overall LV ejection fraction is 57%, the LV end diastolic volume index is 85 ml/m2 (normal range: 74+/-15), the LVEDV is 199 ml (normal range 142+/-34), the LV end systolic volume index is 37 ml/m2 (normal range 25+/-9), the LVESV is 86 ml (normal range 47+/-19), the LV mass index is 117 g/m2 (normal range 85+/-15), and the LV mass is 273 g (normal range 164+/-36). There is extensive late gadolinium enhancement in the mid and distal anterior and anterolateral walls and basal anterior wall. There is transmural circumferential enhancement in the apex and distal lateral wall. Left AtriumThe left atrium is normal in moderately dilated.Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 55%, the RV end diastolic volume index is 61 ml/m2 (normal range 82+/-16), the RVEDV is 143 ml (normal range 142+/-31), the RV end systolic volume index is 28 ml/m2 (normal range 31+/-9), and the RVESV is 65 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation. No obvious SAM.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 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 has severe asymmetric hypertrophy involving the mid and distal ventricular septum, anterior, and anterolateral walls with sparing of the basal-mid inferior and lateral walls. Maximal wall thickness (anterior wall) was 21-22 mm.2. The overall LV systolic function is normal.3. The apex is akinetic. 4. There is extensive late gadolinium enhancement in the mid and distal anterior and anterolateral walls and basal anterior wall. ALthough the endocardium is more heavily involved, the pattern of enhancement is clearly more than endocardial and in many segments diffuse.5. There is transmural circumferential enhancement in the apex and distal lateral wall. These segments are also thinned suggestive of infarction.6. Normal RV systolic function.