Instruction: Generate impression based on findings.

Input: Female, 55 years old, with history of basal cell of the nose status post resection and reconstruction, now with mass concerning for recurrence. Mild anatomic distortion is seen along the left nasal ala and nasolabial fold. This is compatible with the history of prior surgery and reconstruction. Signal intensity is seen compatible with small lobules of fatty material and scarring at this location. The appearance is very similar to that seen on the prior MRI examinations. No evidence of nodular STIR hyperintensity or diffusion restricted tissue is seen at the operative site.Mild cutaneous deformity is evident within the scalp of the left forehead, also unchanged. On limited views of the neck, no pathologic adenopathy is detected. Limited intracranial views are significant for perhaps a small chronic lacunar ischemic lesion in the left caudate nucleus. Mild cervical spondylosis is demonstrated without high-grade canal stenosis.

Output: Findings are demonstrated compatible with the history of tumor resection and reconstruction of the left nose. Even without the benefit of IV contrast, the operative site shows no significant interval change, and there are no concerning findings which would suggest recurrent tumor. If postcontrast imaging is deemed necessary for clinical management, this could be performed provided that arrangements are made in advance for anesthesiology monitoring.


Instruction: Generate impression based on findings.

Input: 57-year-old male with elevated PSA. PELVIS:PROSTATE:Prostate Size: 4.9 x 4.7 x 2.8 cm.Peripheral Zone: There is no intrinsic T1 hyperintensity within the peripheral zone. There is asymmetric T2 hyperintensity in the left apex/midgland peripheral zone (series 8, image 16). There is corresponding low signal on ADC. No early arterial enhancement.Central Gland: There is moderate degree benign prostatic hypertrophy.Seminal Vesicles: No significant abnormality noted. Extracapsular Extension: There is no evidence of extracapsular extension.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.Asymmetric T2 hyperintensity in the left apex/midgland peripheral zone may represent malignancy.


Instruction: Generate impression based on findings.

Input: Lesion of uncertain significance. There is no significant interval change in size of the patchy T2 hyperintense lesion that measures up to approximately 14 mm, involving the inferomedial left basal ganglia, with apparent compression of the adjacent optic pathway. There is also an unchanged punctate focus of enhancement in the central portion of the lesion. However, there appears to be an additional punctate focus of enhancement more inferiorly within the lesion. There is no evidence of intracranial hemorrhage 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, and scalp soft tissues are grossly unremarkable. There is scattered paranasal sinus mucosal thickening and retention cyst formation.

Output: No significant interval change in size of the patchy T2 hyperintense lesion with a punctate focus of enhancement involving the inferomedial left basal ganglia, although there appears to be an additional punctate focus of enhancement. A neoplastic remains a salient possibility for this lesion.


Instruction: Generate impression based on findings.

Input: The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain.

Output: Negative MRI of the brain including gadolinium enhancement. Specifically, there are no MRI findings to explain the patient's symptoms.


Instruction: Generate impression based on findings.

Input: 50 year old with family history of breast cancer. History of benign MR guided left breast biopsy in March 2013. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally. Biopsy clip in the left breast from her benign MRI biopsy again noted. No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Diagnosis: Chronic migraine without aura, intractable, with status migrainosusClinical question: intractable headache, daily, nausea , concern for intracranial processSigns and Symptoms: intractable headaches The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate small mucous retention cysts in the maxillary sinuses. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: MRI of the brain is within normal limits


Instruction: Generate impression based on findings.

Input: 41 years Female (DOB:10/7/1975)Reason: metastatic breast CA to brain, choroid of eye History: nonePROVIDER/ATTENDING NAME: PHILIP C HOFFMAN PHILIP C HOFFMAN The CSF spaces are appropriate for the patient's stated age with no midline shift. There are periventricular white matter lesions present which are rather confluent but not significantly changed since the July exam.There are multiple punctate foci of signal loss and susceptibility weighted imaging within the left frontal lobe subcortical white matter and periventricular white matter. Another subcortical punctate focus of susceptibility effect is present in the subcortical white matter of the right orbital gyrus and another couple are present in the right parietal lobe subcortical white matter and periventricular white matter. Another one is present in the right occipital subcortical white matter. A couple more are present in the cerebellum. Many of these were not present on the prior exam.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.No abnormal enhancing lesions are present in the brain parenchyma to suggest new metastatic disease.2.There are multiple microhemorrhages scattered throughout the brain many of which are new since the July exam. These are nonspecific. They could be posttreatment related. Sometimes hemorrhagic metastases can have a subtle appearance such as this.3.Periventricular white matter changes are redemonstrated which are likely treatment related.


Instruction: Generate impression based on findings.

Input: Benign neoplasm of pituitary gland [D35.2], Reason for Study: ^Reason: op planning for pituitary tumor resection History: op planning for pituitary tumor resection Multiple fiducial markers attached on the scalp.Again T2 low and T1 low signal intensity pituitary mass was seen.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: Pituitary gland mass (AP:13.5mm x RL:20.2mm x CC:6mm) was demonstrated.No change since prior scan.Otherwise unremarkable.


Instruction: Generate impression based on findings.

Input: Neck pain. Postop cervical laminoplasty. There are postsurgical changes of cervical laminoplasty, resulting in overall increase of caliber of the spinal canal from C3 to C7. Small pockets of air, fluid density, and soft tissue edema related to the recent surgery are noted.Residual degenerative disease with disk -osteophyte complexes are again noted at C3 - C4 to C6-C7 level. Neuroforaminal narrowing is again noted at C3 - C4 and C4 - C5 level.

Output: Expected postsurgical changes, and residual degenerative disease of cervical spine as described above.


Instruction: Generate impression based on findings.

Input: History of recurrent pancreatitis and known pancreatic divisum. Please perform secretin stimulation test. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in signal and morphology. No focal hepatic lesion. The hepatic arteries, hepatic veins, and portal veins are widely patent. No biliary ductal dilatation. There is an accessory right hepatic duct. The common bile duct measures 6 mm in diameter.SPLEEN: No significant abnormality noted.PANCREAS: There are findings of pancreatic divisum. The main pancreatic duct is nondilated. The duct has a tortuous course once it enters the pancreatic head and is narrowed prior to entering the minor papilla. The ventral duct is also nondilated.Following the administration of secretin, there is no change in duct caliber or extracranial function of the pancreas.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Kidneys are normal in signal and morphology. No hydronephrosis. There is a left inferior pole simple cyst.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.Pancreatic divisum without associated dilatation of the pancreatic ducts. The main pancreatic duct however becomes markedly narrowed prior to entering the minor papilla.2.No change in duct caliber or exocrine function of the pancreas following secretin administration.


Instruction: Generate impression based on findings.

Input: 55 years Female (DOB:2/11/1961)Reason: MS, f/u progression History: paresthesiasPROVIDER/ATTENDING NAME: ADIL JAVED ADIL JAVED The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing lesions are appreciated within the brain parenchyma.There is redemonstration of a mild-to-moderate degree of periventricular white matter lesions which are perpendicularly oriented to the lateral ventricles as well as some subcortical white matter lesions. These are bright on flair and T2 MRI. These are stable when compared to the prior exam.There is redemonstration of a small subdural effusion which is stable compared to the prior exam. Most likely is related to volume loss.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 demonstrates opacification of the left maxillary sinus which has regressed since the prior exam . The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: There is a mild to moderate degree of periventricular white matter lesions present which are suspicious for demyelination and is stable compared to the prior exam.


Instruction: Generate impression based on findings.

Input: ORBITS: There is asymmetric T2 hyperintensity within the left lacrimal gland. The optic nerves are symmetric and normal in size and signal intensity. There is no intraorbital mass or abnormal enhancement. There is no chiasmatic mass or parasellar abnormality. The extraocular muscles are unremarkable.BRAIN: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are no areas of abnormal parenchymal signal. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unremarkable. There is minimal fluid within the left mastoid air cells.

Output: Diffuse signal abnormality within the left lacrimal gland is nonspecific, but is likely treatment related. Otherwise, no evidence of an orbital mass or intracranial metastasis.


Instruction: Generate impression based on findings.

Input: Right knee pain. MENISCI: There is a large complex tear of the periphery of the posterior horn of the lateral meniscus, consisting predominantly of a complete longitudinal tear ("Wrisberg rip") extending into the body of the meniscus along its undersurface. There are punctate foci of increased signal intensity within the anterior horn of the lateral meniscus, near its root, likely representing normal variation. There is also a large complete longitudinal tear through the peripheral fibers of the posterior horn of the medial meniscus that extends into the body of the meniscus.ARTICULAR CARTILAGE AND BONE: There is mild depression of the articular surface of the lateral femoral condyle just above the anterior horn of the lateral meniscus with underlying edema representing a mild impaction fracture. There is also mild edema within the lateral tibial plateau. We see no fluid-filled articular cartilage defects.LIGAMENTS: The anterior cruciate ligament is poorly defined indicating a full-thickness tear. The PCL appears intact. The MCL and LCL appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. ACL rupture with associated mild lateral femoral condyle impaction fracture. The edema of the associated bone contusions is relatively mild, suggesting that this may be a subacute or chronic injury.2. Tears of the posterior horn of the medial and lateral menisci as described above.


Instruction: Generate impression based on findings.

Input: 37 years, Male, Reason: 37 yo male with chronic pancreatitis; please evaluate for abnormalities History: chronic pancreatits. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: The common bile duct is dilated to 9 mm proximal to the intrapancreatic portion which is likely structured. No intrahepatic biliary ductal dilatation. T2 hyperintensity in the left hepatic lobe is too small to characterize but likely represents a cyst or small hemangioma.SPLEEN: No significant abnormality noted.PANCREAS: The main pancreatic duct is irregular and dilated throughout its course measuring up to 1 cm with multiple dilated side branches. There is atrophy of the pancreatic tail with loss of normal signal. Two small stones are seen within the pancreatic duct. 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.Pancreatic atrophy with dilated irregular pancreatic duct. Given the calcifications seen on prior CT, chronic pancreatitis is favored. However, the pancreatic ductal dilatation is rather severe and a main duct IPMN cannot be excluded. It is recommended that the patient return to complete the examination with postcontrast sequences to exclude enhancement within the duct.2.Dilated common bile duct with likely stricturing within the intrapancreatic portion.


Instruction: Generate impression based on findings.

Input: History of congenital hydrocephalus. Rule out shunt malfunction. Fussiness and abdominal pain. There is redemonstration of abnormal cleavage of the forebrain and large associated dorsal cyst, findings consistent with holoprosencephaly. The appearance of the brain parenchyma is unchanged apart from subtle area of apparent mineralization in the right cerebral hemisphere possibly evolving site of prior insult or conceivably artifact. No parenchymal mass lesion or other focus of abnormal attenuation.There is redemonstration of a right posterior approach shunt catheter terminating within the dorsal cyst. There is no visible kinking or discontinuity in the visualized portions of the shunt catheter/reservoir system. Position of the tip is unchanged. There is also unchanged size of the dorsal cysts and rudimentary ventricular system with which it communicates, making allowances for technique differences. No new focal fluid collection or evidence of acute intracranial hemorrhage. There remains some tonsillar descent better seen on prior brain MRI. However, there is no frank brain herniation or gross midline shift.There remains macrocephaly with towering appearance of the cranial vault. Degree of sutural diastases appears to be diminished compared to the prior examination as expected with interval skull growth. There does remain some left-sided posterior plagiocephaly which was present previously.Paranasal sinuses are subtotally opacified and there is also opacification of the left mastoid air cells and middle ear cavities and the right mastoid air cells. Orbital contents are unremarkable.

Output: Stable size of dorsal cyst and rudimentary ventricular system with which it communicates status post ventricular peritoneal shunt. No acute intracranial hemorrhage. Findings are consistent with lobar holoprosencephaly.


Instruction: Generate impression based on findings.

Input: Low back pain, L4-L5, more right-sided symptoms. Five lumbar type vertebral bodies are presumed to be present. There is severely diminished disc height at L5-S1 and to a slightly lesser degree at L4-L5. Alignment is within normal limits. Bone marrow signal is benign with fatty endplate changes at L4-5 and L5-S1. The conus medullaris is normal in position. Mild T12-L1 disc bulge.Multilevel degenerative changes are seen in the lumbar spine, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: No significant disc disease. No spinal canal or neural foraminal stenosis.L4-L5: Severe loss of disc height. Minimal disc bulge with small mall left sided annular fissure. Ligamentum flavum thickening and mild facet arthropathy result in mild narrowing of the thecal sac in the transverse dimension. Minimal left neural foraminal stenosis. No right neural foraminal stenosis.L5-S1: No significant disc disease. No spinal canal stenosis. Mild bilateral neural foraminal stenosis related to endplate osteophytes which contact the exiting L5 nerve roots. Mild facet arthropathy.Paraspinous soft tissues are within normal limits. Tiny perineural cysts incidentally noted. Ectopic right kidney in the pelvis incidentally noted.

Output: Degenerative changes at L4-L5 and L5-S1 with severe loss of disc height at these levels. Mild L4-L5 spinal canal narrowing and mild L5-S1 bilateral neural foraminal stenosis. No high-grade spinal canal or high-grade neural foraminal stenosis at any level.


Instruction: Generate impression based on findings.

Input: Right vestibular schwannoma treated with SRS: surveillance. There is no significant change in size of the right vestibular schwannoma that is extends from fundus of the internal auditory canal to the cerebellopontine angle cistern, now measuring up to 21 AP x 24 RL x 19 SI mm, previously 21 AP x 24 RL x 18 SI. There is associated mass effect upon the right middle cerebellar peduncle and right cerebellar hemisphere, where there appears to be mild edema. There is persistent slightly diminished fluid signal within the right labyrinthine structures. There are unchanged mild scattered foci of cerebral white matter T2 hyperintensity, which likely represent chronic microangiopathy. There is no evidence of acute infarction. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No significant interval change in size of the right vestibular schwannoma.


Instruction: Generate impression based on findings.

Input: 12 year old boy with p53 mutation, cancer screening. 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. There is mildly prominent retrocerebellar cerebrospinal fluid, eccentric to the right. Otherwise, the ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No evidence of intracranial tumors.


Instruction: Generate impression based on findings.

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

Output: No MRI evidence for malignancy. Patient may resume annual diagnostic mammography (with tomosynthesis), due next in May 2017.BIRADS: 1 - Negative.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: Left knee pain MENISCI: There is focal partial-thickness radial tearing of the body of the medial meniscus. Additional faint linear increased signal intensity within the body and both horns appears to extend to this tear and may reflect additional tearing or intrasubstance degeneration.The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is edema within the medial femoral condyle anteriorly surrounding subchondral plaque-like foci of low signal intensity which may be degenerative in nature or represent small subchondral insufficiency fractures. The cartilage overlying these areas appears intact. There is a degenerative subchondral lesion within the medial facet of the femoral trochlea inferiorly with heterogeneity of the overlying articular cartilage likely representing focal full-thickness degeneration. There is additional mild superficial fraying of the articular cartilage of the patella. The articular cartilage of the lateral compartment is relatively spared.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Medial meniscal tear as described above.2. Bone marrow edema in the medial femoral condyle surrounding small subchondral foci of low signal intensity which may be degenerative in nature or represent small subchondral insufficiency fractures.3. Focal cartilage degeneration of the patellofemoral joint.


Instruction: Generate impression based on findings.

Input: Male 68 years old Reason: 68 yo M hx of SBO 2/2 to adhesive disease and alcoholic liver cirrhosis now w/ persistent elevation in LFT's, U/S with cholelithiasis, nondilated CBD, want to r/o possibility of CBD stones History: Abdominal distension and persistently elevated LFTs ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver. Cholelithiasis. No evidence of intra or extrahepatic biliary dilatation. No focal liver lesion suspicious for hepatocellular carcinoma.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Patient's known staghorn calculus is not well seen on MRI due to technical reasons. Minimally complex left renal cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Again noted dilated small bowel loops, partially imaged compatible with patient's previous history of small bowel obstruction.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. No evidence of intra-axial hepatic biliary dilatation. Cirrhotic liver. Cholelithiasis. Dilated small bowel loops.


Instruction: Generate impression based on findings.

Input: A 57 year old male with history of Mantel Cell Lymphoma treated with autologous stem cell transplant and chest radiation, acute pericarditis, hypertension, diabetes, hyperlipidemia and chronic kidney disease. In 2013 a cardiac CT was performed: non-obstructive 25-50% partially calcified plaque in the Mid LAD with non-obstructive calcified plaques in the first diagonal and right coronary arteries. A recent echocardiography showed stable LVEF of 50% with findings concerning of constriction. The patient was referred to cardiac MRI to rule out ischemia and constriction while he complaints about volume overload without chest pain or shortness of breath.MEDICATIONS: atorvastatin, escitalopram, furosemide, lisinopril, testosterone. First Pass PerfusionDuring hyperemia, no perfusion defects were present. Viability/ Myocardial ScarThere is intermediate signal of late gadolinium enhancement in the mid-myocardium which spares the endocardium at the basal and mid inferior wall. This pattern is atypical for prior myocardial infarction and compatible with a previous myocarditis. The rest of the myocardium is free of late gadolinium enhancement and viable. Left VentricleThe left ventricle is normal in size with low normal systolic function. The overall LV ejection fraction is 52%, the LV end diastolic volume index is 67 ml/m2 (normal range: 74+/-15), the LVEDV is 149 ml (normal range 142+/-34), the LV end systolic volume index is 32 ml/m2 (normal range 25+/-9), the LVESV is 72 ml (normal range 47+/-19), the LV mass index is 46 g/m2, and the LV mass is 101 g. There is a diastolic septal bounce noted. Mild LVH at the basal septum (11mm).Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 51%, the RV end diastolic volume index is 69 ml/m2 (normal range 82+/-16), the RVEDV is 153 ml (normal range 142+/-31), the RV end systolic volume index is 34 ml/m2 (normal range 31+/-9), and the RVESV is 75 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely, there is acceleration of flow without obvious stenosis and there is trace aortic regurgitation .Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is mild pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no pericardial effusion. There is mild pericardial thickening most pronounced along the basal to mid right ventricular free wall. This portion of the pericardium also demonstrates contrast enhancement consistent with either fibrosis or inflammation. Based on the myocardial tagging images, the pericardium is tethered to the basal to mid lateral wall and also along the apical RV free wall. 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. Mild pericardial thickening associated with gadolinium enhancement, myocardial tethering, and a diastolic septal bounce. These findings are consistent with pericardial constriction; however, the absence of significant IVC, SVC, or atrial dilation, the severity of the constriction may not be very severe. Hemodynamic correlation with echo or catheterization may be helpful to further define the severity of the constriction. 2. There is an small amount of atypical late gadolinium enhancement involving the basal and mid inferior walls. The pattern is not consistent with prior myocardial infarction and supports the diagnosis of prior myocarditis. 3. No evidence of myocardial ischemia. 4. Normal LV size with low normal systolic function (LVEF 52%). 5. Normal RV size and systolic function (RVEF 51%).


Instruction: Generate impression based on findings.

Input: There are 3 unchanged nonenhancing subcentimeter T2 hyperintensities in the right corona radiata, left parietal periventricular white matter, and adjacent to the left anterior temporal horn. There is no definite lesion the corpus callosum, or the posterior fossa. There are no new white matter T2 hyperintense lesions. There is no suspicious intracranial enhancement, acute infarct, mass effect or midline shift. The ventricles and sulci are normal in appearance. There is mucosal thickening in the bilateral maxillary sinuses.

Output: Three stable nonspecific white matter lesions with no new lesions; at least two of these lesions remain radial in orientation to the ventricles, suggesting demyelinating process. However, they remain nonspecific and other etiologies are not excluded.


Instruction: Generate impression based on findings.

Input: Diagnosis: Aneurysm of unspecified siteClinical question: h/o MCA rupture as newbornSigns and Symptoms: surveillance; head tremor, ataxia MRI of the brainNo diffusion weighted abnormalities are appreciated.There is redemonstration of status post right-sided craniectomy. There is multiseptated cystic encephalomalacia present centered along the right parietal lobe but extending to the adjacent right temporal lobe. A component of this is cystic encephalomalacia protrudes through the craniectomy defect. There is associated ex vacuo effect along the right lateral ventricle. Since the prior exam the septations are somewhat more clearly demarcated and there is a dominant cyst within this multiseptated lesion measuring 45 x 35 mm axial dimensions. Some susceptibility effect is present within the lesion. As a punctate focus of low signal on susceptibility imaging within the right temporal lobe..A previously noted cystic lesion along the left superior frontal gyrus has involuted since the prior examVentriculostomy tube courses through the left parietal lobe into the trigone of the left lateral ventricle and has its tip crossing the midline. There is metal artifact present at centered at the left parietal calvarium which obscures visualization of portions of the left parietal and temporal lobes.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 underdeveloped. The visualized portions of the mastoid air cells are underdeveloped. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries. The right A1 segment is larger than the left A1 segment. The anterior communicating artery is medium-sized. The posterior communicating arteries are identified. The right posterior communicating artery is small to medium sized whereas the left posterior communicating artery is medium-sized. The right vertebral artery is larger than the left vertebral artery.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.

Output: 1.No evidence for cerebrovascular occlusive disease.2.No evidence for intracranial aneurysm.3.There is cystic encephalomalacia centered in the right parietal lobe as detailed above which continues to evolve. This is likely related patient's prior infarction. It currently has a more organized appearance than on the prior exam. Part of the encephalomalacic brain protrudes into the craniectomy defect.


Instruction: Generate impression based on findings.

Input: Right knee pain. Cartilage/meniscus tear? MENISCI: There is marked attenuation of the medial meniscus that I suspect represents a combination of prior partial meniscectomy and chronic attritional tearing. Additionally, however, I see little if any meniscal tissue at the expected site of the root of the posterior horn of the medial meniscus, suggesting a tear. Increased signal intensity within the body of the medial meniscus extending to the tibial articular surface may represent additional tearing.There is also marked attenuation of the body and posterior horn of the lateral meniscus that I suspect represents a combination of prior partial meniscectomy and chronic attritional tearing. Additionally, however, there is branching signal abnormality within the posterior horn of the medial meniscus extending to both articular surfaces, indicating complex tearing.ARTICULAR CARTILAGE AND BONE: There is full-thickness degeneration of the articular cartilage along the posterior aspect of the medial femoral condyle with small foci of degenerative signal abnormality in the underlying subchondral bone. There is also degeneration of the articular cartilage along the posterior aspect of the medial tibial plateau. Heterogeneity of the articular cartilage of the lateral tibiofemoral compartment indicates moderate degeneration, with probable full-thickness cartilage loss posteriorly along the lateral tibial plateau and delamination along the posterior aspect of the lateral femoral condyle. The articular cartilage of the patellofemoral joint appears relatively preserved. There are tricompartment osteophytes.LIGAMENTS: Tunnels and interference screws within the distal femur and proximal tibia indicate prior ACL reconstruction; however no intra-articular graft is seen, indicating chronic rupture. Thinning of the proximal fibers of the posterior cruciate ligament may represent chronic partial-thickness tearing. The superficial band of the medial collateral ligament appears intact. The lateral collateral ligament complex appears intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1.ACL graft rupture.2.Imaging findings of medial and lateral meniscal tearing, and probably surgical changes from prior partial meniscectomy.3.Osteoarthritis with loose bodies and other findings as described above.


Instruction: Generate impression based on findings.

Input: Large soft tissue nodule in midline posterior neck, likely lipoma. Evaluate for infiltration in the spinal column. Patient has a limited neck range of motion. There is a 1.7x2.7x4.1 cm (APxTRVxcraniocaudal) lobulated well-circumscribed T1 hyperintense lesion involving the left paramedian neck subcutaneous soft tissues with low signal on the fat suppressed sequences consistent with lipoma. No deep invasion into the paraspinous musculature or spinal canal is seen, as clinically questioned.There are no other abnormal masses or evidence of pathologic enhancement in the neck. There are scattered subcentimeter lymph nodes which are nonspecific. No pathologically enlarged or necrotic lymph nodes are seen. The airway remains patent. The thyroid and major salivary glands are unremarkable. The major cervical vessels are patent. No suspicion osseous lesions are seen. The imaged intracranial structures are unremarkable. The imaged portions of the lungs are clear.Dedicated cervical spine MRI was not obtained, however, there is evidence of congenital narrowing of the spinal canal with superimposed degenerative changes including mild disk bulge at C3-C4, which partially effaces the ventral and dorsal thecal sac, as well as a relatively larger disk bulge at C5-C6 which effaces the left greater than right ventral thecal sac. No evidence of frank cord compression.

Output: 1. Superficial lipoma involving the left paramedian subcutaneous neck soft tissues. No deep extension into the paraspinous musculature or spinal canal, as questioned. 2. Congenital narrowing of the cervical spinal canal with superimposed mild degenerative changes. There is mild to moderate spinal canal stenosis at C5-C6 related to disk bulge.


Instruction: Generate impression based on findings.

Input: Ms. Kimberly Moreland is a 50 year old female with a personal history of right breast cancer status post the posterior right lumpectomy in 2015 followed by radiation and chemotherapy. History of benign left breast excisional biopsy. There is heterogeneous amount of fibroglandular tissue in both breasts.Post surgical changes in the right superior breast. Moderate parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Bilateral L5 radiculitis. At L5-S1, there is a small annular fissure associated with minimal disc bulging and bilateral facet hypertrophy. There is no significant spinal canal or neural foramen stenosis at this level. At L4-L5, there is annular fissuring, mild disc bulging and bilateral facet hypertrophy with trace effusions. There is resultant mild bilateral neural foramen stenosis, but no significant spinal canal stenosis. At L3-4, there is no significant spinal canal or neural foramen stenosis. At L2-3, there is a small eccentric right dis protrusion with mild narrowing of the right neural foramen, but no significant spinal canal or left neural foramen stenosis. At L1-2, there is mid loss of disc space height and a small posterior disc protrusion without significant spinal canal or neural foramen stenosis. At T12-L1, there is no significant spinal canal or neural foramen stenosis. The vertebral column alignment is within normal limits. The vertebral body are preserved. The vertebral bone marrow signal is unremarkable. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: Mild multilevel degenerative spondylosis, with mild bilateral neural foramen stenosis at L4-5, but no significant spinal canal stenosis at this or the other lumbar spine levels.


Instruction: Generate impression based on findings.

Input: Follow up for residual pituitary tumor. There are postoperative findings related to right frontal craniotomy and transsphenoidal surgery, with right frontal lobe encephalomalacia. There is an unchanged enhancing mass in the left aspect of the sella with suprasellar extension that measures up to 13 mm in the craniocaudal dimension. There is persistent mild protrusion of the lesion into the left cavernous sinus and perhaps slight mass effect upon the adjacent left optic nerve. There is also unchanged mild optic apparatus atrophy. There is persistent partially imaged scattered paranasal sinus mucosal thickening.

Output: Postoperative findings with unchanged residual pituitary tumor.


Instruction: Generate impression based on findings.

Input: Lung cancer. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is a small areas of encephalomalacia in the left thalamus. There is also a small probable perivascular space in the left subinsular region. There is mild scattered T2 hyperintensity in the cerebral white matter, as well. There is no abnormal intracranial enhancement. There is mild diffuse cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is a small left maxillary sinus retention cyst and mild right maxillary sinus mucosal thickening.

Output: No evidence of intracranial metastases.


Instruction: Generate impression based on findings.

Input: Reason: r/o osteomyelitis History: Right wrist cellulitis There is a 1.8 x 1.4 cm focus of increased signal abnormality within the subcutaneous tissue along the dorsal and radial aspect of the wrist which likely represents an early evolving abscess/phlegmon formation, although this is incompletely characterized on this nonenhanced examination. No drainable fluid collection is identified. There is an additional focus of decreased T1 and intermediate T2 signal abnormality along the dorsal and radial aspect of the scaphoid which also may represent phlegmon or early evolving abscess, although this is also incompletely characterized on this noncontrast examination. Again no drainable fluid collection is identified. There is skin thickening along the dorsal aspect of the wrist. There is nonspecific subcutaneous edema and inflammatory change in the surrounding area which extends volarly to involve the lumbrical musculature between the first and second as well as between the second and third metacarpals. No bone marrow signal abnormality is identified to suggest osteomyelitis. There is no frank cortical destruction. There is a linear band of low signal abnormality traversing the scaphoid which may reflect prior remote trauma. There is a trace amount of fluid within the distal radioulnar joint of doubtful current clinical significance. There is subchondral cyst formation within the first metacarpal head. Skin markers overlie the radial aspect of the wrist.

Output: Foci of signal abnormality along the dorsal and radial aspect of the wrist may represent phlegmon/early abscess formation, however, no drainable collection is identified, within the limitations of this noncontrast examination. Subcutaneous and soft tissue inflammatory change, most pronounced along the dorsal aspect of the wrist, as described above without evidence of osteomyelitis.


Instruction: Generate impression based on findings.

Input: Reason: Evaluate for wrist injury History: diffuse wrist pain LIGAMENTS: No significant abnormality noted.TRIANGULAR FIBROCARTILAGE COMPLEX: No significant abnormality noted.TENDONS: No significant abnormality noted. BONES: No significant abnormality noted.ADDITIONAL

Output: Normal MR arthrogram of the right wrist. No evidence of ligamentous or triangular cartilage injury.


Instruction: Generate impression based on findings.

Input: 51-year-old female with epigastric pain and fever. Status post pancreatic abscess with percutaneous drainage. Allergic to IV contrast. Known choledochocyst and cholangitis. Right upper quadrant pain and fever. This examination is limited by the absence of intravenous contrast.ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: This patient is status post percutaneous choledochocyst drainage on 4/17/09 with catheter removal on 5/12/09. Subsequent hepaticojejunostomy was performed. Compared with the MRI examination dated 7/17/09, the previously drained cyst measured 2.3 x 1.8 cm initially and now measures 4.9 x 4.2 cm. There is new increase in the adjacent serpiginous low density tubular structure compatible with new biliary duct dilatation and obstruction which predominantly affects the left hepatic lobe. The expected pneumobilia is seen in this patient who is status post hepaticojejunostomy. Multiple splenic and gastric varices are present. Mild hepatomegaly, the liver measures 18.5 cm overall.SPLEEN: Mild splenomegaly, the spleen measures 12 cm in length.PANCREAS: No definite evidence of pancreatic cyst as clinically questioned. Further examination examination for smaller cysts or abscess would require contrast enhancement.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Small amount of free fluid in the dependent pelvis.

Output: Interval development of enlarged choledochal cyst with probable obstruction of the left biliary tree. Multiple additional findings appear stable since MR examination of 7/17/09.


Instruction: Generate impression based on findings.

Input: Memory loss for 3 years. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mild scattered cerebral and pontine white matter T2 hyperintensity. There are also scattered bilateral cerebral hemisphere mildly prominent perivascular spaces. 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 multilevel degenerative spondylosis of the imaged portions of the cervical spine.

Output: 1. Mild scattered cerebral and pontine white matter T2 hyperintensity is nonspecific, but may represent chronic small vessel ischemic disease, for example.2. No evidence of intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: Reason: Eval for demyelinating disease History: paresthesias Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There is multilevel disk desiccation present.At C2-3 there is no significant compromise to the neural foramina. There is a central disk extrusion present at this level which is stable compared to the previous exam. It effaces spinal fluid ventral but not posterior to the spinal cord and creates a mild degree of spinal stenosisAt C3-4 there is no significant compromise to the spinal canal or neural foramina. There are some mild degenerative changes present at this level.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. The left vertebral artery is larger than the right vertebral artery.MRI thoracic spine:There is abnormal spinal cord signal present from T3 through T6 centered in the left hemicord posteriorly. There is no associated enlargement of the spinal cord .The thoracic vertebral bodies are appropriate in the overall alignment and height. There is no compromise of thoracic spinal canal or exiting nerve roots. Lumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is a broad-based left lateral recess disk protrusion which partially effaces the fat of the left lateral recess.At L3-4 there is loss of disk space height, disk desiccation and a diffuse disk bulge associated with partial effacement of the fat of the lateral recesses left more than right.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.There is a large C2-3 disk extrusion present which is stable compared to the prior exam. It creates a mild degree of spinal stenosis. It is unchanged since 6/12/142.there is a spinal cord lesion extending from T3 through T6 which appears relatively stable when compared to the previous exam. One possibility is that this is related to demyelination. Please correlate with clinical exam findings. It is unchanged since 6/12/14.3.there are disk protrusions present in the lumbar spine with some mild encroachment of the nerve roots at the left lateral recess at L4-5 and L3-4.


Instruction: Generate impression based on findings.

Input: Cervical lesion, 6 month follow-up Again seen is T1 shortening involving the C1-C3 vertebral bodies consistent with prior radiation therapy. There is been slight increase in STIR hyperintensity and enhancement involving the inferior aspect of the odontoid process. Again seen are multiple abnormal foci of enhancement and T2/STIR hyperintensity involving the C3, C4, C5, C6, C7, T1, T2, and T2 vertebral levels consistent with known metastatic disease. Compared to prior, some of these lesions appear minimally more confluent, which may also be in part related to differences in technique. However no major change is appreciated. A C7 transverse process lesion measuring approximately 15 x 14 mm, previously 13 x 11 mm.Vertebral body heights and alignment are grossly unchanged including straightening and minimal anterolisthesis at the C7-T1 level similar to prior. There remains at least moderate spinal canal stenosis at the C3-C4 level related to prominent disc osteophyte complex and ligamentum flavum thickening and not significantly changed. Minimal enhancement along the anterior dura at this level is likely degenerative in etiology. There is T2 hyperintensity and volume loss consistent with myelomalacia at the C3-C4 level also unchanged. Minimal spinal canal narrowing at the C7-T1 level related to disc bulge also appears similar.No evidence of epidural tumor. No abnormal leptomeningeal or intramedullary enhancement.

Output: 1. Compared to 11/19/2015, there is stable to minimal worsening of diffuse metastatic disease involving the cervical and visualized upper thoracic spine. No evidence of pathologic fracture or epidural tumor.2. Moderate spinal canal stenosis at the C3-C4 level on a degenerative basis with cord myelomalacia is unchanged.


Instruction: Generate impression based on findings.

Input: Reason: r/o ligamentous/meniscal injury History: pain MENISCI: The medial meniscus appears intact. There is blunting of the anterior horn of the lateral meniscus which may represent a combination of postsurgical changes from prior partial meniscectomy, degeneration, and prior tearing. No fluid-filled or unstable tear is evident.ARTICULAR CARTILAGE AND BONE: No full-thickness or near full-thickness articular cartilage defects are identified. There is a tiny focus of full-thickness chondromalacia along the anterior aspect of the lateral tibial plateau with underlying subchondral signal abnormality, which may be postsurgical in etiology, particularly if there is a history of microfracture.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: Blunting of the anterior horn of the lateral meniscus may represent a combination of postsurgical changes from prior partial meniscectomy, degeneration and prior tearing. No fluid-filled or unstable meniscal tear is evident. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Paralysis agitans: preoperative planning. There is a 1 cm wide enhancing extra-axial mass overlying the left anterior frontal lobe convexity. There is narrowing and blurring of the pars compacta of the substantia nigra which also loses its expected T2 hyperintensity. There is mild diffuse cerebral volume loss and scattered nonspecific foci of T2 hyperintensity. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is scattered paranasal sinus mucosal thickening.

Output: 1. Preoperative planning MRI demonstrates substantia nigra changes compatible with Parkinson's disease.2. An extra-axial left frontal convexity mass likely represents a meningioma.3. Scattered nonspecific foci of T2 hyperintensity may represent chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: Reason: left shoulder pain History: left shoulder pain Some sequences are limited by patient motion artifact.ROTATOR CUFF: There is mild thickening and increased signal intensity of the supraspinatus tendon indicating mild tendinosis. There is perhaps extension of this tendinosis to involve the anterior fibers of the infraspinatus. The supraspinatus and infraspinatus muscles appear intact. The teres minor tendon appears intact. There is mild fatty atrophy of the teres minor muscle. The subscapularis muscle and tendon appear intact.SUPRASPINATUS OUTLET: There is a trace amount of fluid within the subacromial/subdeltoid bursa which is probably of no clinical significance. The acromioclavicular joint is normal in appearance.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is perhaps minimal posterior subluxation of the humeral head relative to the glenoid. There is intermediate signal intensity within the superior labrum likely reflecting mild degeneration, but we see no fluid-filled tear.BICEPS TENDON: There is increased signal intensity within the tendon of the long head of the biceps as it courses through the rotator interval into the intertubercular groove indicating mild tendinosis. There is also lobulated fluid signal intensity within the biceps tendon sheath suggesting a mild tenosynovitis.ADDITIONAL

Output: Rotator cuff and biceps tendinosis with other findings as described above.


Instruction: Generate impression based on findings.

Input: 54 year old male with a past medical history of dilated cardiomyopathy, syncope, ICD, Ventricular tachycardia. MRI evaluation to rule out infiltrative diseases/scar. Left VentricleThe left ventricle is normal in size with mildly reduced systolic function. The overall LV ejection fraction is 47%. The LVEDV is 210 ml (normal range 142+/-34), the LV end diastolic volume index is 95 ml/m2 (normal range: 74+/-15), the LVESV is 112 ml (normal range 47+/-19) and the LV end systolic volume index is 51 ml/m2 (normal range 25+/-9). The LV mass is 137 g (normal range 164+/-36) and the LV mass index is 62 g/m2 (normal range 85+/-15). There are no regional wall motion abnormalities present. . There is no obvious late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. Left AtriumThe left atrium is probably normal in size. Right VentricleICD lead noted in the right ventricle. The right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 47%. The RVEDV is 221 ml (normal range 142+/-31), RV end diastolic volume index is 100 ml/m2 (normal range 82+/-16), the RVESV is 103 ml (normal range 54+/-17), and the RV end systolic volume index is 53 ml/m2 (normal range 31+/-9). Right AtriumThe right atrium cannot be assessed due to limited views.Tricuspid/ Mitral/ Aortic/ Pulmonary ValvesUnable to assess valves due to lead artifact/ insufficient imagesAortaThere is a left sided aortic arch. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumSmall pericardial effusion. Extracardiac FindingsExtensive artifact from the ICD can. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with mildly reduced systolic function. The overall LV ejection fraction is 47%. No obvious late gadolinium enhancement.2. The right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 47%3. Extensive artifact noted from the ICD lead and battery. Unable to assess valves. 4. Small pericardial effusion.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 56-year-old female with fall with leg pain. Concern for hamstring tear, assess muscle/tendon. Complete avulsion of the hamstring tendons (semimembranosus and conjoint tendon) from their ischial origin. Gap of approximately 3 cm between the retracted tendon edge and the ischium. Edema within the hamstring muscles as well as within the gluteus maximus and adductor magnus muscles and surrounding the sartorius and adductor muscles of the hip, perhaps representing strain.Mass of heterogeneous signal intensity situated between the semimembranous tendon and adductor magnus muscle, representing a hematoma.Edema within the surrounding soft tissues and around the sciatic nerve, although the nerve itself is intact.Bone marrow signal intensity is normal. Mild osteoarthritis affects the knee.

Output: Complete avulsion of the hamstring tendons from their origin on the ischium as described above.


Instruction: Generate impression based on findings.

Input: Female 75 years old Reason: liver lesions and distal pancreas mass on CT History: weight loss, fatigue, light stool ABDOMEN:LUNG BASES: Bilateral pleural effusions, moderate on the right, trace on the left.LIVER, BILIARY TRACT: Innumerable rim enhancing lesions throughout the right and left hepatic lobes are consistent with diffuse metastatic disease. A reference lesion in the posterior right hepatic lobe measures 1.6 x 1.5 cm (series 1101, image 207).Intrahepatic duct dilatation with narrowing of the common bile duct and subtle hyper enhancement at Klatskin point. The appearance is suspicious for infiltrative tumor.SPLEEN: No significant abnormality noted.PANCREAS: Primary tumor: Hypo enhancing mass replacing much of the distal pancreatic body and pancreatic tail measures 4.6 x 7.8 x 3.5 cm (series 1101, image 222).Pancreatic duct: The pancreatic duct is normal in the pancreatic head and poorly visualized in the pancreatic body and tail.Mesenteric Arteries:Arterial tumor abutment or encasement: (1) Proximal celiac artery, SMA, and hepatic artery: The pancreatic mass encases the celiac artery, superior mesenteric artery and the splenic artery which is attenuated(2) Tumor abutment or encasement of additional arteries: There is encasement of the gastroduodenal artery.Mesenteric Veins:Venous anatomy:  (1) Superior mesenteric vein: The superior mesenteric vein is occluded at the level of the mass.Venous tumor abutment or encasement: SMV-PV-splenic vein confluence: The portal vein is patent. The splenic vein is occluded at the confluence.Portal venous system: The right and left portal veins are patent.Inferior vena cava (IVC): Patent.ADRENAL GLANDS: Bulky left adrenal gland which is inseparable from the pancreatic mass, suspicious for invasion.KIDNEYS, URETERS: Multiple T2 hyperintense lesions throughout the kidneys are compatible with renal cysts. A lesion at the upper pole of the left kidney does not meet criteria for a simple cyst however demonstrates no convincing enhancement on subtraction images and is suggestive of a hemorrhagic cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Multiple prominent mesenteric nodules/nodes suspicious for metastatic disease (for example series 1101, image 142).BONES, SOFT TISSUES: No significant abnormality noted.

Output: Pancreatic body/tail mass which is consistent pancreatic adenocarcinoma with metastatic disease to the liver. There is encasement of the celiac artery, superior mesenteric artery and splenic artery. There is superior mesenteric vein and splenic vein occlusion. There is also suspicion for peritoneal involvement and infiltrative tumor at Klatskin point.


Instruction: Generate impression based on findings.

Input: 36-year-old male with history of Crohn's disease presents with fevers, chills, pain; evaluate for abscess. Status post recent fistula repair (on 2/5/2010) with abdominal pain. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Stable hypodense lesions within the liver.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Marked thickening of the terminal ileum and multiple loops of bowel appearing have resolved since the prior exam. The ileosigmoid fistula seen on the prior exam has been resected. There are post-op changes in the right lower quadrant from recent endocsopic procedure. Small amount of intraperitoneal fluid and subcutaneous / intraperitoneal gas are attributed to post-op changes. Contrast is present in the terminal ileum, but not the sigmoid, suggesting that the fistula has been repaired. BONES, SOFT TISSUES: No significant abnormality notedOTHER: New fluid collections with gas bubbles in the rectus muscles near the midline bilaterally, seen best on axial image 93/163 of series 12 and coronal image 67 have enhancing rims, compatible with abscess. These are new since the prior exam. PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Prominent bladder.LYMPH NODES: Borderline enlarged inguinal nodes. No other significant abnormality.BOWEL, MESENTERY: Rectal intramural fistula tract extending to the scrotum is reidentified and is subtle; however, this is incompletely evaluated by CT and may be better seen with MRI, if indicated.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: 1. Ileitis with narrowing of the terminal ileum and fistula between the ileum and the sigmoid colon have resolved since the prior exam. 2. A rectal intramural fistula to the scrotum is less prominent on this exam; however, it is incompletely evaluated on CT and MRI is recommended, if indicated.3. New abscess in the rectal sheath bilaterally.


Instruction: Generate impression based on findings.

Input: A patient submitted outside studies for review. Submitted for review are diagnostic mammogram and ultrasound(6/24/15), stereotactic biopsy and specimen radiographs (6/26/15), and MRI breast (7/1/15)performed at Community Health Care System. For comparison,standard mammogram (9/19/13) are available. Diagnostic mammogram: Three standard views of both breasts were obtained. The breast parenchyma is composed of scattered fibroglandular elements, unchanged in pattern and distribution. Bilateral subpectoral breast implants are present.In the left upper outer breast, there is a 1.8 cm spiculated mass containing minimal calcifications. This lesion extends to the level of the pectoralis muscle.Slightly inferiorly/medially to the aforementioned lesion, there is an additional asymmetry measuring 5 mm.Ultrasound: In the 3:00 position of the left breast, a targeted ultrasound was performed. There is a microlobulated hypoechoic mass with irregular margins arranged in an anti-parallel manner measuring 1.3 x 0.8 x 1.3 cm. There is no increased vascularity. This lesion correlated with mammographic findings.Please note that initially this lesion was labeled as located in the 9 o'clock position, however, a limited ultrasound performed later in the day confirmed that this lesion was in fact located at the 3 o'clock position. This was also reported on a submitted document.Stereotactic biopsy and specimen radiographs: A stereotactic biopsy was performed on the targeted left breast lesion at the 3 o'clock position. Multiple cores were obtained. A biopsy clip was placed. Please note that no postprocedure mammograms were obtained.Specimen radiographs demonstrated multiple cores, some of which may demonstrate faint calcifications.MRI breast: At the 3 o'clock position of the left breast, the known spiculated mass pathologically proven to represent ILC grade 2 is again appreciated. The lesions measures 19 x 16 x 7 mm (AP X ML X CC). The posterior aspect of this lesion extends to the underlying pectoralis muscle. There is no abnormal enhancement of the muscle to suggest involvement. The anterolateral aspect of the lesion is 7 mm from the skin surface. There are adjacent post biopsy changes noted along the lateral aspect of the lesion. Clip artifact is not well visualized. 4 mm inferior to this lesion there is a second round focus of abnormal enhancement with linear anterior extension measuring 10 x 5 x 5 mm. The total extent of both of these lesions is 29 x 15 mm in the CC x AP dimension. The right breast is unremarkable.No abnormal appearing lymph nodes are seen.

Output: 1. Left breast mass with inferior extension as seen on mammogram and MRI with total extent of 29 x 15 mm. This mass has been biopsy proven to represent ILC grade 2.2. Please submit post-stereotactic mammogram to confirm adequate clip placement.3. Unremarkable right breast.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: 29-year-old male status post ski injury. Evaluate left ring finger extensor tendon injury, evaluate left proximal phalanx fracture. LIGAMENTS: Ligaments appear intact.TENDONS: The extensor tendon of the left ring finger is not visualized in its entirety, specifically the course of the extensor tendon abruptly terminates at the level of the proximal phalanx, with surrounding edema suspicious for a tear. The extensor tendon of the remaining imaged fingers appear normal. There is fluidlike signal within the tendon sheath of the flexor compartment overlying the metacarpal of the ring finger. However the flexor tendons of the ring finger appear normal and intact throughout their course. Similarly the flexor tendons of the remaining imaged digits appear normal.BONES: Obliquely oriented low T1, low T2 signal along the proximal phalanx of the ring finger compatible with nondisplaced fracture, better seen on recent radiograph. There is surrounding bone marrow edema. There is a small amount of fluid within the metacarpophalangeal joint of the ring finger. Bone marrow signal in the remaining fourth finger and other imaged digits appears normal.ADDITIONAL

Output: 1. Findings suspicious for a tear of the extensor tendon of the left ring finger.2. Left ring finger proximal phalanx fracture is again seen and better evaluated on recent dedicated radiograph. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Clinical question: myoclonus, including the trunk and Rt leg. Signs and Symptoms: as above MRI THORACIC SPINE WWO:There is normal anatomic alignment and the signal intensity of the vertebral column.There is normal signal intensity and caliber all thoracic cord.There is no evidence of spinal canal compromise or stenosis at any level.There is no appreciable neural foraminal compromise at any level.Small central disk protrusion at C7 -- T1 is noted without spinal stenosis or neural foraminal compromise.There is a right paramedian disk protrusion at T6 -- T7 with resultant flattening deformity of the right ventral aspect of the cord. There is however no signal abnormality of the cord or spinal stenosis at this level.Tiny central disk protrusion at T8 -- T9 with resultant tiny indentation of ventral aspect of the cord.Unremarkable images of all other levels.No detectable paraspinal soft tissue abnormalities.There is no detectable abnormal enhancement of the cord or the leptomeninges. Post-enhanced images however demonstrate expected minimal enhancement of the small disk protrusions as detailed above.MRI LUMBAR SPINE WWO:The signal intensity of the vertebral column is unremarkable other than minimal changes secondary to degenerative disease. There is mild grade 1 anterolisthesis at L5 -- S1 with suspected left sided pars defects and unremarkable alignment of the vertebral column otherwise . At the L5 -- S1 there is mild to moderate facet and ligamentum flavum hypertrophic changes however without spinal stenosis or neural foraminal compromise.There is normal signal intensity and morphology of the conus and cauda equina.There is no evidence of a spinal canal or neural foraminal compromise at any level.Post enhanced images demonstrate no detectable abnormal enhancement of the lower most visualized cord, conus or cauda equina. There is subtle expected enhancement of degenerative changes of posterior elements in the normal lumbar spine.

Output: 1.Pre-and post enhanced MRI of the thoracic spine demonstrate normal signal intensity and caliber the cord and without abnormal enhancement. There are multilevel small disk protrusions more noticeably at the right paramedian T6 -- T7 level which results in slight flattening deformity of the cord without associated cord signal change or central spinal stenosis. No spinal stenosis or neural foraminal compromise at any level.2.Pre-and post enhanced MRI of the lumber spine demonstrate normal signal intensity and morphology Conus and cauda equina without abnormal enhancement. There is a mild grade 1 anterolisthesis with suspected pars defect at L5 -- S1 level as detailed. No central spinal stenosis at any level.


Instruction: Generate impression based on findings.

Input: 33-year-old female patient with Chiari and Ehlers-Danlos. Evaluate for cervical instability. Vertebral body and disc space heights are maintained. Alignment is anatomic. There is no evidence of instability on flexion or extension views.

Output: No evidence of instability.


Instruction: Generate impression based on findings.

Input: 68-year-old male with prostate cancer. The bilateral hip prostheses create artifacts throughout the exam, particularly on the ADC sequence.PELVIS:PROSTATE:Prostate Size: The prostate measures 5.3 cm in transverse, 2.8 cm in AP, and 4.8 cm in craniocaudal length.Peripheral Zone: In the left mid gland peripheral zone, there is a 5 x 3 mm ADC and T2 hypointense focus suspicious for malignancy (series 801 image 17, series 403 image 304). This dominant lesion extends to the capsule, however no definite capsular extension is seen. Abnormal linear/flame-shaped T2 hypointense signal extending from this region anteriorly and medially (series 801 images 17-18) is intermediate suspicion but concerning for tumor extension.Central Gland: Mild nodular changes of BPH.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: As above.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: Artifacts related to the bilateral metallic hip prostheses.OTHER: No significant abnormality noted.

Output: 1.Suspicious focus in the mid gland left lateral peripheral zone measuring 5 x 3 mm (PI-RADS 4).2.Abnormal linear/flame-shaped T2 hypointense signal extending from this region anteriorly and medially is intermediate suspicion but concerning for tumor extension (PI-RADS 3).PI-RADS™ v2 Assessment Categories:PIRADS 1 – Very low (clinically significant cancer is highly unlikely to be present) PIRADS 2 – Low (clinically significant cancer is unlikely to be present)PIRADS 3 – Intermediate (the presence of clinically significant cancer is equivocal)PIRADS 4 – High (clinically significant cancer is likely to be present) PIRADS 5 – Very high (clinically significant cancer is highly likely to be present)https://www.acr.org/~/media/ACR/Documents/PDF/QualitySafety/Resources/PIRADS/PIRADS%20V2.pdf


Instruction: Generate impression based on findings.

Input: 14-year-old male with left knee pain. Assess left knee MPFL, trochlear dysplasia, loose bodies, and measure TT-TG. Per the technologist notes, the patient had left knee surgery in 2014 for anchoring the patella. MENISCI: The medial and lateral menisci are intact.ARTICULAR CARTILAGE AND BONE: There is bone marrow edema within the anterolateral aspect of the medial femoral condyle which appears slightly progressed since prior study. This is nonspecific and may represent a contusion. The previously seen edema within the lateral femoral condyle appears resolved. The articular cartilage of the patella appears intact. The articular cartilage of the trochlea appears intact. There appears to be a moderately deep focal defect within the lateral femoral condyle measuring up to 1.5 cm in AP dimension. This appears more prominent on prior study. The articular cartilage of the medial compartment appears intact.LIGAMENTS: The cruciate and collateral ligaments are intact.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1. No displacement of the patella with respect to the femoral trochlea with measurements as above. 2. No evidence of ligamentous or meniscal injury.3. Small joint effusion with moderately deep focal defect within the lateral femoral condyle.


Instruction: Generate impression based on findings.

Input: Chronic viral hepatitis. Cysts identified on prior ultrasound. ABDOMEN:LIVER, BILIARY TRACT: Scattered subcentimeter T2 hyperintense nonenhancing lesions, compatible with hepatic cysts. No suspicious lesion identified. No intra or extrahepatic biliary duct dilatation. The gallbladder is unremarkable.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: No suspicious hepatic lesion. T2 hyperintense nonenhancing lesions within the liver, compatible with cysts.


Instruction: Generate impression based on findings.

Input: 47 year old female patient with biopsy proven invasive ductal carcinoma grade 3, ER/PR positive, HER 2/neu positive cancer in the left breast 4 o'clock position. There is scattered fibroglandular tissue in both breasts.Minimal parenchymal enhancement is noted bilaterally.In the left breast at the 4 o'clock position there is a spiculated enhancing mass containing clip artifact that measures 8 x 8 x 7 mm (AP x ML x CC). There is non-mass enhancement extending posteriorly and inferiorly with a total extent that measures 4.3 cm in AP dimension. Approximately 4.5 cm medial, anterior, and inferior to the spiculated mass there is a lobulated enhancing mass that measures 8 x 7 x 5 mm (AP x ML x CC) in the 6 o'clock position 7 mm away from the skin. There is a possible correlate seen on recent mammogram that appears more conspicuous compared to mammogram in 2013. No abnormal lymph nodes are identified in either axillary region. No abnormal enhancement noted in the right breast.

Output: 1.Spiculated mass containing biopsy clip in the 4 o'clock position of the left breast compatible with patient's known cancer. There is non-mass enhancement extending posteriorly and inferiorly that measures up to 4.3 cm in maximal extent slightly less in comparison with the calcifications seen on mammogram.2.Lobulated enhancing mass in the 6 o'clock position of the left breast with possible mammographic correlate. Recommend spot compression views and MR directed ultrasound to further evaluate.BIRADS: 6 - Known cancer.RECOMMENDATION: E - Additional Mammo/Ultrasound Workup Required.


Instruction: Generate impression based on findings.

Input: Right craniotomy for subependymal giant cell astrocytoma resection POD 1 in a patient with tuberous sclerosis complex. There are recent postoperative findings related to right foramen of Monro region tumor resection, with crescentic T1 hyperintensity and susceptibility effect in the resection bed, which likely represents blood products, as well as mild surrounding vasogenic edema, but no evidence of gross residual tumor. There is a small amount of hemorrhage in the occipital horns of the lateral ventricles and scattered pneumocephalus. The lateral ventricles are no longer dilated. There is no significant change in the numerous other bilateral lateral ventricular subependymal nodules and appearance of the ventricular system. Likewise, the numerous scattered cortical and subcortical tubers appear unchanged. There is no evidence of acute infarction or hemorrhage. The cerebral flow voids are grossly unremarkable. There are bilateral mastoid effusions. The skull and orbits appear unchanged.

Output: Recent postoperative findings related to right subependymal giant cell astrocytoma resection, with a small amount of blood products in the surgical bed, but no evidence of gross residual tumor. Other stigmata of tuberous sclerosis complex are not significantly changed.


Instruction: Generate impression based on findings.

Input: Reason: right achilles tendon pain, tenderness History: right achilles tendon pain, tenderness TENDONS: There is mild thickening of the distal Achilles tendon just proximal to its insertion on the calcaneus with linear intrasubstance intermediate signal intensity. These findings suggest a mild tendinosis and perhaps interstitial tearing, but we see no surface tear of the Achilles tendon. There is a large retrocalcaneal bursitis. The flexor and extensor tendons appear intact. The peroneal tendons appear intact.LIGAMENTS: The lateral collateral ligament complex appears intact. The distal tibiofibular syndesmotic complex appears intact. The imaged components of the deltoid ligament appear intact.ARTICULAR SURFACES AND BONE: There is no evidence of an osteochondral defect. The bone marrow signal intensity is normal. There is perhaps a minimal Haglund's deformity of the calcaneus. Mild osteoarthritis affects the midfoot articulations.ADDITIONAL

Output: Large retrocalcaneal bursitis with mild tendinosis and perhaps interstitial tearing of the Achilles, but no surface tearing is identified. There is perhaps a very mild Haglund's deformity.


Instruction: Generate impression based on findings.

Input: History of C2-C4 ACDF presenting with C6 radiculopathy. There are postsurgical findings related to C3 through C5 anterior spinal fusion. There is diffuse loss of cervical lordosis. There is multilevel degenerative spondylosis. In particular, at C2-C3, there is a slight disc bulge and mild uncovertebral joint hypertrophy, with mild left neural foraminal stenosis, but no significant spinal canal or right neural foraminal stenosis. At C3-C4, there is considerable spinal canal narrowing due to the altered alignment of the vertebral bodies and what may be an underlying congenitally narrow spinal canal, but no disc-osteophyte complex is present. At C4-C5, facet hypertrophy results in moderate left and mild right neural foraminal stenosis and the altered alignment of the vertebral bodies and what may be an underlying congenitally narrow spinal canal results in considerable spinal canal stenosis. At C5-C6, a disc bulge asymmetric to the left and uncovertebral joint hypertrophy result in severe left and mild right neural foraminal stenosis, as well as compression of the spinal cord. At C6-C7, a disc bulge asymmetric to the left and uncovertebral joint hypertrophy results in severe left and mild right neural foraminal stenosis, as well as severe spinal canal stenosis. There is mild prominence of the central canal at the C7 and T1 levels. The vertebral body heights are intact. The vertebral bone marrow signal is unremarkable, aside from the postoperative alterations. The paraspinal soft tissues are unremarkable.

Output: 1. Postoperative changes from C3 to C5 anterior spinal fusion with spondylitic changes at these level results in considerable spinal canal stenosis at these levels, with contribution from altered alignment and what represent an underlying congenitally narrow spinal canal.2. Spondylitic changes also result in severe spinal canal and neural foraminal stenoses on the left at the C5-6 and C6-7 levels, as well as a mild syrinx inferior to these levels.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Abscess with possible spread to the bone. Patient is status post large hand and forearm abscess incision and drainage. The examination is mildly limited by metal artifact from the orthopedic device at the elbow. Diffuse soft tissue edema/inflammation of the entire forearm with swelling. There is no evidence of underlying bone marrow signal abnormality.

Output: Diffuse soft tissue edema/inflammation consistent with infection. No definite evidence of underlying osteomyelitis.


Instruction: Generate impression based on findings.

Input: Male 54 years old Reason: Please follow protocol IRB # 14-0288. Rectal cancer, please assess for any evidence of disease status post consolidation therapy with Chemo and radiation, in need of post treatment surveillance History: As above PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted. LYMPH NODES: No mesorectal lymphadenopathy.BOWEL, MESENTERY: No significant interval change in low T2 signal along the anterior aspect of the distal rectum continuous with the posterior peripheral zone of the prostate (601:44), likely posttreatment scarring. No intermediate T2 signal or abnormal enhancement to suggest residual disease.BONES, SOFT TISSUES: Bilateral fat-containing inguinal hernias.OTHER: No significant abnormality noted.

Output: 1.Stable post treatment changes in the anterior rectum without measurable disease.


Instruction: Generate impression based on findings.

Input: 13-year-old female who is 7 months status post left hip arthroscopy with labral repair. Patient has continued left hip pain. Evaluate healing of labrum and new labral tear. ACETABULAR LABRUM: No abnormalities are noted in the labrum, specifically no evidence of labral tear.ARTICULAR CARTILAGE AND BONE: There is no bone marrow edema. The articular cartilage appears intact.SOFT TISSUES: There are mildly prominent left inguinal lymph nodes. There is contrast within the anterior soft tissues which is likely iatrogenic in etiology. The remainder of the soft tissues are unremarkable. ADDITIONAL

Output: No evidence of labral tear.


Instruction: Generate impression based on findings.

Input: 15-year-old male. Trauma. CT of brain without infusion.This examination is negative for any post traumatic intracranial findings. No evidence of hemorrhage, edema, mass effect, midline shift or hydrocephalus is detected. The cortical sulci, ventricular system and all CSF cisterns are unremarkable.The bony density of calvarium, pneumatization of mastoid air cells and limited view of paranasal sinuses are unremarkable. Minimal soft tissue swelling in the left preseptal periorbital region is noted.CT of maxillofacial.Large retention cyst within the right maxillary sinus is noted. No evidence of any fracture of the maxillofacial region is present.Swelling of the left preseptal periorbital and minimally retro-orbital is noted.Minimal stranding of retro-orbital fat on the left is detected. This may represent minimal hemorrhage or edema. If clinical concern persist an MRI of orbit may add additional information. The morphology and density of the globe in both anterior and posterior chambers remains within normal limits. The extraocular musculature are intact and the optic nerve from this examination appears to be within normal limits.

Output: 1.Normal CT of brain.2.No meniscal fracture of maxillofacial region.3.Left-sided preseptal periorbital soft tissue swelling.4.Minimal stranding of retro-orbital fat on the left as detailed.


Instruction: Generate impression based on findings.

Input: There is no intracranial mass or abnormal parenchymal or meningeal enhancement to suggest metastatic disease. There are scattered foci of T2/FLAIR hyperintensity in the periventricular and subcortical white matter which are nonspecific but consistent with mild chronic small vessel ischemic changes. No evidence of recent infarct or intracranial hemorrhage. No extra-axial collections. No hydrocephalus. No suspicious lesions are seen within the calvarium. T1 hyperintense lesion within the left occipital calvarium is compatible with small hemangioma.There is a heterogeneous appearing polypoid lesion involving the left maxillary sinus with central enhancement. There is surrounding more inflammatory appearing mucosal thickening in the left maxillary sinus, as well as in the right maxillary sinus.

Output: 1. No evidence of intracranial metastatic disease.2. Enhancing polypoid lesion involving the left maxillary sinus is nonspecific. The central enhancement is atypical for typical inflammatory polyps and consider further ENT evaluation to exclude the possibility of neoplasm.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Drug-resistant epilepsy (complex partial seizures with secondary generalization). Status post VNS placement in 3/2015. History of ependymoma resection in 2002. The presence of VNS device required adjusting the exam parameters resulting in less signal-to-noise ratio and suboptimal quality of the study.Underlying the synthetic right frontoparietal craniotomy graft, there are findings of previous resection from the right frontal lobe with adjacent gliosis and cystic encephalomalacia. This is associated with ex vacuo enlargement of the adjacent parts of the right lateral ventricle and the adjacent sulci. Aside from hemosiderin staining along the resection margin in the right frontal lobe, there is no intracranial hemorrhage. There is no acute infarct. There is no space-occupying or contrast-enhancing brain lesion. There is no mass-effect or brain herniation. Bilateral hippocampi demonstrate preserved internal architecture, volume, and signal without findings to suggest mesial temporal stenosis. The major intracranial vascular flow voids are preserved. There is a small retention cyst in the left maxillary sinus with centrally desiccated secretions. There is trace mucosal thickening in the other paranasal sinuses. A small midline nasopharyngeal mucosal cyst likely represents a Thornwaldt or mucous retention cyst.

Output: 1.Sequela of prior right frontal lobe tumor resection including a resection cavity with adjacent encephalomalacia/gliosis. There is no abnormal enhancement or discrete mass to suggest tumor recurrence. Comparison with prior studies would be helpful if available. 2.Remainder of the brain is otherwise within normal limits.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Reason: posterior fossa stroke History: left sided dysmetria, ataxia The CSF spaces are appropriate for the patient's stated age with no midline shift. On T2 and MRI there are subcentimeter in size foci of T2 and flair signal hyperintensity in the left centrum semiovale as well as the left inferior frontal gyrus subcortical white matter. Additionally there are several punctate subcortical and periventricular white matter lesions in the right and left hemispheres which are hyperintense on T2 and flair MRI.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. Findings suggest a bilateral fetal origins of the posterior cerebral arteries.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.There is no MRI evidence for acute ischemic cerebral infarction.2.A couple lesions present in the left centrum semiovale and subcortical white matter of the left frontal lobe which are nonspecific. Etiology cannot be established on this exam. Periventricular and subcortical white matter signal changes of a mild degree are present which are nonspecific. 3.There is no evidence for acute ischemic cerebral infarction.


Instruction: Generate impression based on findings.

Input: Squamous cell carcinoma of the left base of tongue, T1N2b, status post radiation and chemotherapy. There are recent postoperative findings in the left oropharynx, without evidence of gross residual tumor in the tongue base. There is decrease in size of the left level 2 lymphadenopathy, measuring up to 7 x 9 mm, previously 10 x 11 mm in axial cross-section. The right cervical lymph nodes are unchanged. There is herniation of the left sublingual gland through a mylohyoid defect. The other salivary glands are unremarkable. There is scattered paranasal sinus mucosal thickening. There is mild multilevel degenerative cervical spondylosis. The orbits and imaged intracranial structures are grossly unremarkable.

Output: 1. Postoperative findings in the left oropharynx, without evidence of gross residual tumor.2. Decreased left cervical lymphadenopathy.


Instruction: Generate impression based on findings.

Input: Susceptibility artifact from patient's braces degrades quality of the study. There are punctate foci of subcortical FLAIR hyperintensity in the bilateral frontal lobes, which are nonspecific. The ventricles and sulci are within normal limits. The basal cisterns remain patent. There is no midline shift or mass effect. There is no diffusion abnormality. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits.

Output: 1.Slightly limited study secondary to susceptibility artifact from patient's braces. No intracranial mass or mass effect is identified.2.Punctate foci of subcortical FLAIR signal in the bilateral frontal lobes which are nonspecific but can be seen with migraines. Examination is otherwise unremarkable.


Instruction: Generate impression based on findings.

Input: Reason: Local MRI showed nonspecific hypointense lesions located in the right lobe of the liver, eval for HCC History: NASH cirrhosis. Examination is limited by patient motion and body habitus.ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology. Mild diffuse loss of signal on out of phase images may reflect hepatic steatosis. Within the limitations of patient motion and body habitus, no focal hepatic lesions are identified. The hepatic vasculature appears patent. No biliary ductal dilatation. SPLEEN: Mild splenomegaly.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Subcentimeter renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative changes affect the spine including possible central canal stenosis in the lumbar spine.OTHER: No significant abnormality noted.

Output: Cirrhotic liver without suspicious focal lesions within the limitations described above.


Instruction: Generate impression based on findings.

Input: Female 48 years old with uterine fibroids diagnosed on U/S. She has menorrhagia, bowel and bladder symptoms. MRI needed prior to uterine fibroid embolization procedure. PELVIS:UTERUS, ADNEXA: The uterus has a lobular contour and measures 12.0 x 16.0 x 15.1 cm AP by transverse by craniocaudal (series 701, image 22 and series 601, image 10). There are numerous well defined, enhancing subserosal, intramural and submucosal lesions which are predominantly of low signal intensity on both T1 and T2 weighted images that distort the endometrial canal. The largest lesions include a pedunculated right uterine lesion measuring 5.3 x 5.5 x 6.7 cm (series 501, image 35 and series 601, image 9) and an anterior lesion measuring 5.3 x 7.1 x 7.5 cm (series 701, image 19 and series 601, image 10). The enlarged uterus causes mass effect on the urinary bladder.Fluid signal intensity within the endometrial canal and vagina is likely related to blood products.Functional cysts and follicles are notes in the right ovary, the left ovary is unremarkable.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: There is a small amount of pelvic free fluid.

Output: Enlarged uterus with multiple enhancing leiomyomas.


Instruction: Generate impression based on findings.

Input: history of pelvic rhabdomyosarcoma, six months off therapy. Please evaluate for recurrent disease.EXAMINATION: MR pelvis with and without contrast. PELVIS:UTERUS, ADNEXA: Flow-voids seen within the anterior vaginal wall is unchanged. No focal lesion seen in the uterus.BLADDER: No significant abnormality notedLYMPH NODES: No pelvic or inguinal lymphadenopathy.BOWEL, MESENTERY: Focus of fluid signal intensity along the descending colon is favored to represent fluid in the pericolic gutter.BONES, SOFT TISSUES: Interval decrease in high T2 signal intensity within the marrow of the pubic symphysis. Previously seen focus of mild increased T2 marrow signal in the right S2 body is not well seen on current examination. However, there continues to be subtle mottled signal in the pelvic bones. Persistent, yet decreased, T2 signal intensity within the pelvic musculature compared to prior examination. New nonspecific increase T2 signal in the vaginal introitus and the bilateral labia.OTHER: Small amount of free fluid in the pelvis.

Output: 1.Improved, yet persistent, subtle mottled bone marrow T2 signal hyperintensity in the pelvic bones and improved increased signal in the pelvic musculature. These findings may be related to prior treatment.2.New nonspecific increase T2 signal in the vaginal introitus and the bilateral labia.


Instruction: Generate impression based on findings.

Input: 72-year-old female with history of right greater than left lower extremity radiculopathy. There are multilevel degenerative changes with mild left neural foramen stenosis at L4-5, moderate to severe left L5-S1 neural foramen stenosis, and mild right L5-S1 neural foramen stenosis, but no significant spinal canal stenosis. There is a subcentimeter perineural cyst at S2 with remodeling of the adjacent bone. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. The spinal cord displays normal signal and morphology. There is diffuse paraspinal muscle atrophy.

Output: Multilevel degenerative spondylosis with mild left neural foramen stenosis at L4-5, moderate to severe left L5-S1 neural foramen stenosis, and mild right L5-S1 neural foramen stenosis, but no significant spinal canal stenosis.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Tingling down right arm in C6-7 distribution. There is a congenitally narrow spinal canal. In addition, there are small posterior disc-osteophyte complexes at C3-4 through C7-T1 that at least partial efface the anterior thecal sac cerebrospinal fluid, but do not compress the spinal cord. There is also uncovertebral hypertrophy, which contribute to mild bilateral neural foraminal stenosis at C3-4, C4-5, and C7-T1, and at least mild to moderate neural foraminal stenosis bilaterally at C5-6 and C6-7. The vertebral column alignment is within normal limits. The vertebral body heights are preserved. The vertebral bone marrow signal is unremarkable. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: Congenitally narrow spinal canal and small posterior disc-osteophyte complexes at C3-4 through C7-T1 that at least partial efface the anterior thecal sac cerebrospinal fluid, but do not compress the spinal cord. Uncovertebral hypertrophy, which contribute to mild bilateral neural foraminal stenosis at C3-4, C4-5, and C7-T1, and at least mild to moderate neural foraminal stenosis bilaterally at C5-6 and C6-7.


Instruction: Generate impression based on findings.

Input: 45-year-old female with history of symptomatic uterine fibroids detected on ultrasound. Evaluate fibroids. PELVIS:UTERUS, ADNEXA: The uterus measures 14.7 x 12.1 x 10.6 cm. There are numerous intramural lesions demonstrating T1 isointensity and T2 iso to hypointensity with enhancement. The fundal fibroid demonstrates no significant enhancement. The largest of these measures 7.8 x 5.6 centimeters (series 601, image 22). Findings consistent with fibroleiomyomatous. BLADDER: There is mass effect upon the bladder from the uterine myomas.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is mass effect upon the rectosigmoid from the uterine myomas.BONES, SOFT TISSUES: Trace pelvic ascites.OTHER: No significant abnormality noted.

Output: Findings consistent with uterine myomas with mass effect on the rectosigmoid and the bladder.


Instruction: Generate impression based on findings.

Input: Chiari malformation decompression and shunt, with new symptoms of headache and dysphagia. Brain: There are postoperative findings related to Chiari malformation decompression, with unchanged low-lying cerebellar tonsils to the level of the dens and diminished cerebrospinal fluid flow across the neo-foramen magnum. The brain parenchyma is otherwise unremarkable and the ventricles are not enlarged. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is no midline shift or herniation. The orbits are grossly unremarkable. There is diffuse paranasal mucosal thickening. Cervical Spine: The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: 1. Postoperative findings related to Chiari malformation decompression, with unchanged low-lying cerebellar tonsils to the level of the dens and diminished cerebrospinal fluid flow across the neo-foramen magnum. 2. No evidence of syringohydromyelia. 3. Diffuse paranasal mucosal thickening.