Instruction: Generate impression based on findings.

Input: 26 years, Female, Reason: 26 yo F with newly dx von hippel-lindau disease (VHL) and family history of renal cell carcinoma; r/o renal/pancreatic lesions including cysts and pheochromocytoma History: 26 yo F with newly dx von hippel-lindau disease (VHL) and family history of renal cell carcinoma; r/o renal/pancreatic lesions including cysts and pheochromocytoma. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: There are a few nonspecific cystic lesions within the pancreas without definite communication to the pancreatic duct. No suspicious enhancing lesions. Main pancreatic duct appears normal.ADRENAL GLANDS: No suspicious adrenal lesions.KIDNEYS, URETERS: No hydronephrosis. No suspicious renal masses.RETROPERITONEUM, LYMPH NODES: Scattered small retroperitoneal lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Simple appearing left ovarian cysts measuring 3.3 cm (6/19).BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.There are a few subcentimeter nonenhancing pancreatic cysts, the etiology and significance of which is uncertain.2.No suspicious renal or adrenal lesions.3.Simple appearing left ovarian cyst. Recommend 3 month follow-up ultrasound to confirm stability.


Instruction: Generate impression based on findings.

Input: Male, 58 years old, with altered mental status. New onset seizure. History of HIV on HAART with strokes. Extensive signal abnormality and encephalomalacia affects the right cerebral hemisphere. Encephalomalacia is most notable in the right parietal lobe (both precuneus and inferior parietal lobule), the cingulate gyrus, the opercular parenchyma and insula, and the superior temporal lobe.Extensive subcortical and periventricular T2 hyperintensity is seen on the left without significant encephalomalacia. Patchy T2 hyperintensities are also evident within the brainstem and the cerebellum. The right cerebral peduncle is atrophic and there is evidence of Wallerian degeneration through the right brainstem.No evidence of restricted diffusion is seen to suggest acute ischemia. Many of the areas of encephalomalacia demonstrate hemosiderin staining on susceptibility weighted images. No evidence of acute intracranial hemorrhage is seen. The right lateral ventricle demonstrates ex vacuo dilatation. The remainder of the ventricular system is relatively unremarkable.On postcontrast images, no pathologic parenchymal or extra-axial enhancement is seen.

Output: 1.Sequelae of extensive chronic microvascular and territorial ischemic injury in the right cerebral hemisphere. Large areas of parenchyma demonstrate encephalomalacia, with signal abnormality suggesting gliosis throughout the remainder of the hemisphere.2.Findings compatible with advanced chronic microvascular ischemic disease in the left cerebral hemisphere.3.No evidence is seen to suggest an active or acute intracranial process.


Instruction: Generate impression based on findings.

Input: persistent symptom of dizziness, history of seizure and VP shunt. No evidence of acute ischemic or hemorrhagic lesion on this scan.VP shunt inserted via right posterior temporal lobe and the tip is located right lateral ventricle frontal horn area. Especially on the right temporal approached through the right parietal white matter, VP shunt track shows high signal intensity on FLAIR indicating localized encephalomalcia through the VP shunt track.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal distal ICAs, MCAs, and ACAs.Acom artery is patent but bilateral Pcom arteries are not seen. Vertebrobasilar system appears to be normal.There is no evidence of intracranial arterial aneurysm or arterial luminal stenosis.3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The vertebral artery origins are normal. There is normal flow enhancement through the bilateral common carotid, carotid bifurcations, internal/external carotid, and vertebral arteries.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion on this scan.2. Ventriculostomy tube through the right posterior temporal lobe via parietal white matter and located in the right lateral ventricle. No significant interval change since prior exam.3. Normal brain MRA and neck MRA.


Instruction: Generate impression based on findings.

Input: 57-year-old female with history of pain. ROTATOR CUFF: There is perhaps mild tendinosis and minimal surface fraying of the supraspinatus tendon, but we see no discrete tear. The supraspinatus muscle is intact. The infraspinatus, teres minor, and supraspinatus muscles and tendons are unremarkable.SUPRASPINATUS OUTLET: Mild osteoarthritis affects the acromioclavicular joint. There is no frank fluid within the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is a small amount of fluid within the subscapular recess. There is a focal linear lucency along the anterior/superior labrum which may represent a small tear although this may not be of any clinical significance. There may also be mild degenerative fraying of the superior labrum. The inferior labrum is intact. Tiny osteophytes indicate mild osteoarthritis. Tiny cysts are present in the posterior aspect of the humeral head.BICEPS TENDON: The biceps tendon is unremarkable. There is a small amount of fluid in the biceps tendon sheath which may simply represent extension from the glenohumeral joint rather than representing a tenosynovitis.

Output: Minimal degenerative changes as above; we see no discrete rotator cuff tear.


Instruction: Generate impression based on findings.

Input: 47-year-old female with shoulder pain. Evaluate right shoulder. ROTATOR CUFF: The supraspinatus and infraspinatus muscles and tendons appear intact. The subscapularis and teres minor muscles and tendons appear intact.SUPRASPINATUS OUTLET: There is a small amount of fluid within the subacromial subdeltoid bursa. No intra-articular gadolinium is identified within the subacromial subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Severe degenerative changes affect the glenohumeral joint. There is full-thickness articular cartilage degeneration along the central and inferior aspect of the glenoid with subchondral signal abnormality and subchondral cyst formation, which is likely degenerative. There is a 13 mm oval focus of low signal intensity within the inferior aspect of the axillary recess likely representing a loose body within the joint. There is an additional 12 mm focus of low signal abnormality along the posterior aspect of the glenohumeral joint also consistent with a loose body. The glenoid labrum appears intact.BICEPS TENDON: The tendon of the long head of the biceps appears normal. ADDITIONAL

Output: Severe degenerative changes affecting the glenohumeral joint with multiple loose bodies within the joint space as described above.


Instruction: Generate impression based on findings.

Input: Sacrococcygeal decubitus ulcer. Evaluate for osteomyelitis. There is soft tissue edema, fluid, and enhancement posterior to the sacrum with a 7 cm wide right paramedian gas-filled defect compatible with ulceration. This region of abnormal signal extends to the sacrum, with a focus of low T1 signal and enhancement of the medial crest of the sacrum near the sacral hiatus, compatible with osteomyelitis. No drainable fluid collection is noted. Small bilateral hip joint effusions are noted. The pelvic musculature is atrophic. A bladder catheter is in place. A small amount of non-specific pelvic free fluid is noted. There is partially visualized enhancement about the anus.

Output: Sacral osteomyelitis, as described above.


Instruction: Generate impression based on findings.

Input: Female, 26 years old, with history of temporal lobe cyst. Evaluate for size and for other lesions. A cyst is present in the left middle cranial fossa, sitting just superior to the temporal lobe, which measures 24 mm AP, 22 mm TV, and 20 mm SI. The cyst follows CSF signal characteristics on all sequences. There is slight mass effect upon the adjacent anterior temporal lobe.The cerebral and cerebellar parenchyma is otherwise within normal limits. No edema or focal signal abnormality is seen. No restricted diffusion is demonstrated. There are no findings to indicate intracranial hemorrhage. Ventricular size morphology are within normal limits. Prominence of the CSF space posterior to the cerebellum could represent a magna cisterna magna or an additional CSF cyst.

Output: Findings are seen compatible with an arachnoid cyst in the left middle cranial fossa. The lesion causes mild mass effect on the adjacent parenchyma. Findings are also seen compatible with mega cisterna magna or perhaps an additional arachnoid cyst in the posterior fossa. The brain parenchyma itself is within normal limits.


Instruction: Generate impression based on findings.

Input: 65 year-old male with unclear cardiomyopathy status-post dual chamber ICD with recent ICD discharges for ventricular tachycardia who is referred for cardiac MRI for further evaluation. The risks of cardiac MRI were discussed with the patient and consent was obtained to proceed. Left VentricleThe left ventricle is severely dilated and qualitatively appears to have severely reduced systolic function (LVEF 20-25%). Quantitative measurements are not possible due to artifact from ICD. There is global hypokinesis with regional variation There are two distinct areas of late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. The first is mid-wall and involves the basal anterior wall. The second is epicardial and involves the basal to mid inferior wall (near the right ventricular insertion point). Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is normal in size and function. The overall RV ejection fraction is 52%, the RV end diastolic volume index is 62 ml/m2 (normal range 82+/-16), the RVEDV is 153 ml (normal range 142+/-31), the RV end systolic volume index is 29 ml/m2 (normal range 31+/-9), and the RVESV is 73 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly dilated.Aortic ValveDue to ICD artifact, unable to accurately assess the valve. Mitral ValveDue to ICD artifact, unable to accurately assess the valve.Pulmonic ValveDue to ICD artifact, unable to accurately assess the valve.Tricuspid ValveDue to ICD artifact, unable to accurately assess the valve.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is severely dilated with severely reduced systolic function (LVEF 20-25%).2. The right ventricle is normal in size and function. 3. There are two distinct areas of late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. The first is mid-wall and involves the basal anterior wall. The second is epicardial and involves the basal to mid inferior wall (near the right ventricular insertion point). I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Back pain wrapping around to sternum. Evaluate for acute changes, myelopathy, foraminal stenosis, known thoracic disc bulge with mild canal stenosis previously. At T5/6, there is mild right paracentral disc bulge with mild flattening of the right spinal cord. At T7/8, there is right paracentral disc bulge with mild flattening of the right spinal cord. The vertebral column alignment is within normal limits. The vertebral body heights are preserved. There is mild loss of disc height at multiple levels from T2/3 through T7/8. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal or foraminal stenosis. The spinal cord displays normal signal. The paravertebral soft tissues are unremarkable.

Output: Right paracentral disc bulges at T5/6 and T7/8 with mild flattening of the right spinal cord at 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: 81-year-old female with primary sclerosing cholangitis. Screening exam for cholangiocarcinoma and hepatocellular carcinoma. ABDOMEN:LIVER, BILIARY TRACT: Multiple biliary strictures are redemonstrated. There are strictures of the common bile duct at the level of the ampulla, the mid portion, and at Klatskin's point. A stricture of the main left hepatic duct is noted, and left-sided intrahepatic ductal dilatation has worsened in the interval. Atrophy of the left hepatic lobe is unchanged. There is a stricture at the cystic duct where it joins the common hepatic duct with distention of the gallbladder. Multiple intrahepatic strictures are again noted on the right.No obvious mass is identified, however due to technical factors the patient needs to be recalled for a repeat postcontrast exam. A mass in the left hepatic lobe cannot be excluded.SPLEEN: No significant abnormality noted.PANCREAS: Stable appearance compared to prior study with mild prominence of the 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.Biliary strictures redemonstrated as described above. Left-sided ductal dilatation has slightly worsened since the prior 2014 MRI exam.2.No obvious mass is identified, however a mass in the left hepatic lobe cannot be excluded due to technical factors. The patient should be recalled for repeat postcontrast imaging.


Instruction: Generate impression based on findings.

Input: History of known pancreatic cyst. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal morphology, size and signal intensity. Two subcentimeter punctate cysts. Status post cholecystectomy. No intra or extra hepatic biliary ductal dilatation. No common bile duct filling defect.Several small nonspecific periportal lymph nodes.SPLEEN: No significant abnormality noted.PANCREAS: There are several punctate cystic foci in the pancreatic tail best seen on the thin MRCP images. The largest measures approximately 4 mm (series 4/16), communicates with the main pancreatic duct which is normal in caliber. No suspicious imaging features of this lesion. Additional punctate focus in the pancreatic head measures 4 mm.The pancreatic parenchyma is normal in intrinsic T1-weighted signal intensity and demonstrates normal contrast enhancement. No peripancreatic inflammatory changes.Normal excretory response to secretin administration. ADRENAL GLANDS: Right adrenal lipid rich adenoma measuring 2.2 x 1.3 cm (series 1102/45). KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Susceptibility artifact from lumbar spinal fusion hardware.OTHER: No significant abnormality noted.

Output: Punctate cystic pancreatic foci, the largest of which measures approximately 4 mm and communicates with a normal caliber main pancreatic duct, compatible with a side-branch IPMN without suspicious imaging features.


Instruction: Generate impression based on findings.

Input: Diagnosis: Headache(784.0)Unspecified transient cerebral ischemiaClinical question: 57 yo lady with blurry vision and ataxia, evaluate for potential TIASigns and Symptoms: lightheadedness, blurry vision, ataxia MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.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. There is bilateral fetal origin of the PCA with small p1 segments bilaterally.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. The posterior communicating arteries are intact. The vertebral arteries are similar in size.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the left vertebral artery. The proximal right vertebral artery appears significantly narrowed, however, artifact partially obscures this area. A CTA of the chest from 4/21/2010 did not demonstrate any significant stenosis at the proximal RVA.

Output: 1.The proximal right vertebral artery appears significantly narrowed, however, it is possible that this appearance is related to artifact. A CTA may be able to better evaluate this vessel. A CTA of the chest from 4/21/2010 did not demonstrate any significant stenosis at the proximal RVA.2.There is no evidence for acute ischemic cerebral infarction.3.There is no evidence for intracranial aneurysm or intracranial cerebrovascular occlusive disease.


Instruction: Generate impression based on findings.

Input: Female, 21 years old, blurry vision for 6 months with Chiari I malformation on MRI, CSF flow study recommended. The cerebellar tonsils descend below the level of the foramen magnum, approximately 5 mm on the left and 7 mm on the right. The tonsils do, however, maintain their round morphology, and there is preservation of the CSF space posterior to the tonsils and anterior to the brainstem. CSF flow imaging is suboptimal despite an attempt to correct this by adjusting the technical parameters of the sequence. Given this limitation, there does seem to be robust flow anterior to the brainstem through the foramen magnum. There may be some degree of flow posterior to the spinal cord and along the cerebellar tonsils but this is difficult to assess with certainty.The remainder of the examination is unremarkable. Parenchymal morphology and attenuation are within normal limits. No areas of signal abnormality are suspected. No intracranial hemorrhage or abnormal extra-axial fluid is seen. The ventricles are normal in size.

Output: Descent of the cerebellar tonsils as described above is compatible with Chiari I malformation. However, the cerebellar tonsils maintain a round morphology, and there is little if any actual crowding at the foramen magnum with preservation of CSF space both anterior to the brainstem and around the cerebellar tonsils. Therefore, the relevance of the Chiari malformation to the patient's presenting symptoms is unclear. CSF flow imaging is compromised by technical difficulties which could not be corrected at the time of scanning. The sequence, therefore, contributes little diagnostic information. If this information is felt to be necessary for clinical management, the patient may return to repeat the flow sequence only at no additional charge.


Instruction: Generate impression based on findings.

Input: Left knee pain MENISCI: There is marked attenuation of the anterior horn and body of the lateral meniscus compatible with chronic attrition and degenerative tearing (in the absence of prior meniscectomy). There is linear intrasubstance signal within the posterior horn which extends to the tibial articular surface, indicating additional tearing. This is superimposed upon mild attenuation of the posterior horn.There is globular intrasubstance degeneration of the body and posterior horn of the medial meniscus with additional vertically oriented intermediate signal within the posterior horn. This intermediate signal extends to both the femoral and tibial articular surfaces, indicating a vertical tear. There is a small parameniscal cyst adjacent to the posterior horn and body and there is blunting of the inner free edge of the posterior horn and body which indicates fraying. The anterior horn is intact.ARTICULAR CARTILAGE AND BONE: There is near full-thickness to full-thickness articular cartilage degeneration of the lateral femoral condyle and lateral tibial plateau with numerous intra-articular osteophytes present. There is thinning of the articular cartilage of the posterior aspect of the medial femoral condyle with numerous intra-articular osteophytes present in the medial compartment as well. Multiple focal full-thickness defects affect the patellofemoral joint with subchondral cystic changes in the underlying patella. A small cyst is noted within the lateral femoral condyle just posterior to the origin of the popliteal tendon.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Medial and lateral meniscal tears with tricompartmental osteoarthritis. Additional findings are detailed above.


Instruction: Generate impression based on findings.

Input: Female, 58 years old, with unspecified convulsions, status post laser ablation. Compared to 3/25/2016, there has been slight further evolution of postsurgical changes in the medial right temporal lobe related to prior depth electrode placement and laser ablation. There is susceptibility effect related to chronic blood products involving the right hippocampus with slight retraction/evolution since prior. Minimal surrounding FLAIR hyperintensity is seen which may represent gliosis. No significant parenchymal edema or mass effect is appreciated. Mild global parenchymal volume loss including of the left hippocampus again seen. No extra-axial collections. No hydrocephalus. Aside from postsurgical changes, calvarium and extracranial soft tissue structures are grossly unremarkable.

Output: 1. Slight evolution of postsurgical changes related to depth electrode placement and laser ablation of the right hippocampus. Chronic blood products in the right hippocampus are again seen with slight evolution.2. Please note patient had a minor contrast extravasation as detailed in the technique section and post gadolinium images could not be obtained. Patient may return for postgadolinium sequences following placement of a new IV line.


Instruction: Generate impression based on findings.

Input: 54 year old man with history of non-Hodgkin's lymphoma with previous chest radiation, coronary disease with multivessel CAD with worsening LV function and exertional dyspnea, referred for cardiac MRI stress test.MEDICATIONS: aspirin, plavix, crestor, diovan, lasix, coreg First Pass PerfusionDuring hyperemia, there was a moderate to severe perfusion defect noted in the basal inferoseptum, basal inferior and mid inferior wall. The perfusion defect extends beyond the below described myocardial infarction.Viability/ Myocardial ScarThere was subendocardial late gadolinium enhancement noted in the basal inferior and inferoseptal walls in a pattern suggestive of previous myocardial infarction. It involves 50% or less of the myocardial wall, suggesting intermediate probability of viability. The remaining myocardium is viable.Left VentricleQualitatively, there is moderate left ventricular dilation with mild to moderate reduction in systolic function. There is thinning and hypokinesis of the basal and mid inferior wall.Left AtriumThe left atrium is mildly dilated. Right VentricleQualitatively, the right ventricle is normal in size and systolic function. Right AtriumThe right atrium is small, with extrinsic compression from the elevated right hemidiaphragm.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsSternotomy wires are present. The right hemidiaphragm is elevated. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. There is a non-transmural myocardial infarction involving the basal inferoseptum and inferior walls which is associated with a significant amount of peri-infarct ischemia and hibernating myocardium. The infarcted territories have an intermediate probability of viability. The remaining myocardium is free of myocardial infarction and likely to be viable. 2. Moderate LV dysfunction with mild to moderate reduction in systolic function. 3. Normal RV size and systolic function.4. See extra-cardiac findings.5. Quantification of ventricular size and function to follow as an addendum.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Male, 9 years old, with new onset seizures, evaluate for structural abnormality. The cerebral and cerebellar hemispheres and brainstem show normal signal intensity and morphology. No restricted diffusion is seen. The mesial temporal lobe structures are symmetric and normal. No pathologic signal abnormality is seenNo evidence of parenchymal edema, mass, or mass effect is seen. There is no evidence of intracranial hemorrhage or abnormal extra-axial fluid. The ventricular system is normal in caliber and morphology. Signal intensity of the bone marrow is unremarkable. No significant abnormalities of the paranasal sinuses are detected.

Output: Unremarkable evaluation with no specific findings to account for the patient's seizures.


Instruction: Generate impression based on findings.

Input: Disorientation, unspecified [R41.0], Reason for Study: ^Reason: New onset confusion \T\ word finding difficulties, r/o PRES or other cause History: Confusion \T\ word finding difficulties There is no evidence of acute ischemic or hemorrhagic lesion on the scan.There is no evidence of abnormal enhancement.Focal susceptibility artifacts on the left posterior temporal lobe without evidence of surrounding edema or enhancement is seen which indicate either parenchymal calcification or chronic petechial hemorrhagic lesion.There are various sized lacunar infarcts on the bilateral basal ganglia and thalami.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. Multifocal lacunar infarcts as described above.3. Nonspecific small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: Female 54 years old Reason: Hx of Rectal Cancer, restaging History: Hx of Rectal Cancer, restaging PELVIS:UTERUS, ADNEXA: The uterus is enlarged with multiple T2 hypointense well-defined enhancing nodules compatible with leiomyomata. The endometrium/endometrial cavity is distorted.BLADDER: Urinary bladder is normally distended without focal abnormality. There is abnormal marked symmetric circumferential thickening of the urethra extending from the bladder base for approximately a 2.6 cm segment.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: In comparison with the study of 3/25/2015 the lesion involving the distal rectum has resolved. There is new circumferential wall thickening involving the anorectal junction/anus with the wall measuring up to 8 mm in thickness. The segment of in rectum/anus measures 4 cm. The rectum proximal to this is mildly distended. There is slight hyperenhancement in this region.BONES, SOFT TISSUES: Post radiation changes with replacement of the normal red marrow.OTHER: No significant abnormality noted.

Output: 1.Resolution of the distal rectal mass.2.Circumferential thickening of the anal rectal region which is nonspecific and may be due to underdistention of the segment.


Instruction: Generate impression based on findings.

Input: Clinical question: Rule out dural sinus thrombosis and assess Chiari. Signs and symptoms: Headaches and postural lightheadedness. CT of brain without the infusion:No evidence of hemorrhage, edema, mass-effect, midline shift or hydrocephalus is detected. Cortical sulci, ventricular system and all CSF cisterns remain within normal for patient stated age. Redemonstration of slight crowding of the cerebellar tonsils at the level of foramen magnum. No change since prior exam.CTA of intracranial circulation:Vertebral -- basilar system.There is normal visualization of bilateral vertebral arteries across the skull base (dominant left vertebral). Basilar artery, posterior cerebral arteries and superior cerebellar arteries are all within normal limits. No evidence of vascular lesion in particular aneurysm or any atherosclerotic stenosis is detected.Carotid system.Patent normal appearing internal carotid arteries across to skull base and in their supraclinoid portions. Anterior and middle cerebral arteries and their branches are well visualized and no evidence of vascular lesions of aneurysm or atherosclerotic disease is detected.CTV of the intracranial venous sinuses.Superior sagittal sinus, confluence of sinuses, bilateral transverse sinuses, sigmoid sinuses, jugular bulbs and proximal portion of bilateral internal jugular veins are within normal limits.There is normal visualization of bilateral internal cerebral veins, vein of Galen and straight sinus.On the reformatted MIP images both on sagittal and coronal plane low positioning of the cerebellar tonsils with effacement of subarachnoid space is noted. This is believed to represent ectopia of the cerebellar tonsil and not Chiari malformation due to its minimal protrusion through the foramina magnum. This finding can be further evaluated if clinically is indicated with an MRI of cervical spine and cranial/cervical junction as well as CSF flow study65 cc of Omnipaque 350 with the injection rate of 4.5 CC/sec was utilized for the above studies.

Output: 1.Unremarkable CTA of the intracranial circulation.2.Unremarkable CT of the of intracranial venous sinuses.3.Minimally ectopic cerebellar tonsils. Correlate with history and neurological findings and if clinically indicated further follow-up with MRI of cranial cervical junction and with CSF the study across the foramen magnum.4.Negative CT of brain without the infusion and stable since prior study.


Instruction: Generate impression based on findings.

Input: 60 year-old male with history of left nasal vestibule is squamous cell carcinoma involving left lateral nasal wall. Now status-post left medial maxillectomy and ethmoidectomy. Has granulation tissue, possible requirements left superior/anterior nasal area. Please evaluate and stage. Enhanced CT of soft tissues of neck:In comparison with prior examination there is interval resolution of previously noted soft tissue densities within the left frontal sinus and left ethmoid sinus region which is leave to have represented mucosal thickening and inflammatory changes. There is no definitive evidence of interval new bony changes.Images through the nasal cavity demonstrate overall decrease in the amount of soft tissue density that was present in the left nasal cavity. On coronal reformatted image 14 in the most anterior aspect of the left nasal cavity the soft tissue within the nasal cavity demonstrate subtle enhancement. This finding measures approximately 12 mm in cranial cephalad access and 7-mm in transverse axis. Although this finding may represent postop scarring considering the provided clinical data it may represent recurrence of tumor. This finding could be better evaluated with a dedicated MRI of maxillofacial region. On axial image 16 this tissue appears to extend beyond the confinement of nasal cavity and into the soft tissues of the nose. There is no detectable new bony changes since prior study.Residual mucosal thickening within the left maxillary sinus.Images through the skull base remain unremarkable.Images through the neck demonstrate multiple small nonenhancing and not pathologic by CT size criteria lymph nodes which were present and read no detectable change since prior study from 2009. There is no evidence of any pathologic lymph nodes in the neck.No evidence of osseous or cartilaginous erosion.Heterogeneously enlarged right lobe of thyroid is consistent with goiter. This finding was also present on prior study.Limited images of the apices of the lungs and mediastinum are negative.Enhanced CT of brain:There is no evidence of intracranial metastatic lesion. Calvarium is intact.Findings consistent with small vessel disease are again identified and made no gross interval change since prior study from 2009.80 CT of Omnipaque 350 was administered for the above studies.

Output: 1.Interval decrease in the amount of soft tissue within the left nasal cavity compared to prior nonenhanced CT of the maxillofacial region. A small enhancing tissue in the anterior aspect of the left nasal cavity may represent recurrence of tumor as detailed above. Further evaluation with a dedicated enhanced MRI is recommended since this finding could also conceivably represent postoperative scarring. This finding is not associated with any new bony changes.2.Stable CT examination through the rest of soft tissues of neck and with no evidence of pathologic adenopathy.3.No evidence of metastatic disease to the brain or calvarium. Findings of small vessel disease remains grossly stable since prior study.


Instruction: Generate impression based on findings.

Input: 85 years Male (DOB:9/10/1930)Reason: cognitive impairment History: memory lossPROVIDER/ATTENDING NAME: JAMES A MASTRIANNI JAMES A MASTRIANNI MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.A punctate focus of signal loss and susceptibility weighted imaging is present in the left orbital gyrus subcortical white matter.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate some mucosal thickening. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin.Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there are endplate and uncovertebral osteophytes at this level associated with ligamentum flavum hypertrophy. There is partial effacement of spinal fluid ventral and posterior the spinal cord at this level. There is encroachment of the exiting nerve roots within the neural foramina bilaterally at this level. Overall there is a mild degree of spinal stenosis at this levelAt C4-5 there is no significant compromise to the spinal canal or neural foramina. There are some disc desiccation at this level. There is mild facet hypertrophy at this level.At C5-6 there is endplate and uncovertebral osteophytes present associated with mild ligamentum flavum hypertrophy. There is encroachment of the exiting nerve roots bilaterally within the neural foramina. There is partial effacement of spinal fluid ventral and posterior the spinal cord at this level.At C6-7 there is a disc bulge associated with endplate and uncovertebral osteophytes and encroachment of the exiting nerve roots within the neural foramina bilaterally.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.Periventricular and subcortical white matter lesions of a moderate degree are nonspecific. At this age they are most likely vascular related. 2.There is mild ventriculomegaly present which is a nonspecific finding. One possibility is that it is related to normal pressure hydrocephalus in the appropriate clinical setting.3.There is a microhemorrhage present along the left orbital gyrus.4.There are multilevel degenerative changes present in the cervical spine with mild-to-moderate spinal stenosis C3-4 and bilateral encroachment of exiting nerve roots within the neural foramina at C3-4 and C5-6 and C6-7. There is mild spinal stenosis at C5-6.


Instruction: Generate impression based on findings.

Input: 66-year-old male with history of HCC in a transplanted liver. Please restage. ABDOMEN:Study is limited by extensive susceptibility artifact from the patient's surgical hardware.LIVER, BILIARY TRACT: Orthotopic liver transplant. A large portion of the liver cannot be evaluated due to extensive susceptibility artifact from the patient's IVC stent.Stable segment 5 reference lesion measuring 0.9 x 0.9 cm, and washout is again noted. Other small T1 hyperintense foci are similar in size and number.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable small cyst of the left lower renal pole. No acute abnormality.RETROPERITONEUM, LYMPH NODES: Similar-appearing heterogenous lesions in the periaortic distribution measuring approximately 10.1 x 11.7 cm on the right and 9.4 x 10.2 cm on the left.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Stable ventral midline incisional fat-containing hernias.OTHER: Right pleural effusion, and a 1.4 x 1.2 cm right posterior pleural-based lesion is unchanged.

Output: 1.Stable large heterogenous masses of periaortic lymphadenopathy.2.Multiple liver lesions not significantly changed in size or number. These lesions are again suspicious for multiple dysplastic nodules and/or multifocal HCC. Reference lesion in hepatic segment 5 is stable in size. The exam is markedly limited due to extensive susceptibility artifact from the patient's IVC stent. Consider CT evaluation of follow-up exams for more optimal visualization of hepatic parenchyma, portal veins, and/or hepatic veins.3.Stable right pleural effusion and approximately 1.4 x 1.2 cm right pleural-based nodule.


Instruction: Generate impression based on findings.

Input: Clinical question: Weakness and pain in UE. Signs and symptoms: As above. Nonenhanced cervical MRI:There is normal anatomical alignment of cervical spine however with mild grade 1 anterolisthesis at C7-T1.There is moderate degenerative changes of the discs and posterior elements throughout the cervical spine and including uniform and diffuse hypertrophic changes of posterior longitudinal ligament.Constellation of above findings results in moderate to severe central spinal stenosis at C3-C4, C4-C5, C5-C6 levels and mild central spinal stenosis at C6-C7 level. No spinal stenosis and C7-T1 level.Degenerative changes also results in moderate right neural foraminal compromise at C3-C4, severe right and mild left neural foraminal compromise at C4-C5, significant left and mild right neural foraminal compromise at C5-C6 and significant left and moderate to significant right neural foraminal compromise at C6-C7 levels. Although there is mass effect and flattening deformity of the cord at the levels of spinal stenosis there is no detectable signal abnormality of the cervical or the upper most visualized thoracic cord.Unremarkable images at the level of foramen magnum and mild degenerative changes at C2-C3 level.

Output: 1.Extensive degenerative changes of cervical spine and including diffuse posterior longitudinal ligament hypertrophy results in moderate to severe central spinal stenosis at C3-C4, C4-C5, C5-C6 levels and mild stenosis at C6-C7 level.2.Multilevel moderate to significant bilateral neural foraminal compromise as detailed per level above.3.No detectable cervical or upper most visualized thoracic cord signal abnormality.4.Mild grade 1 anterolisthesis at C7-T1 level likely due to degenerative disease.


Instruction: Generate impression based on findings.

Input: 52-year-old female with history of renal transplant, pancreatic transplant with chronic diarrhea and weight loss. Evaluate for small bowel inflammation. ABDOMEN:LIVER, BILIARY TRACT: Significant intrahepatic and extra hepatic biliary ductal dilatation, which is stable. Subcentimeter polypoid mass at the ampulla which was identified on the CT 2010 examination is not well appreciated on this nondedicated MR examination.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Marked atrophy of the native kidneys bilaterally. Allograft kidney is identified in the left iliac fossa with interval increase in size of 3 cysts. No evidence of hydronephrosis in the transplant kidney.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No evidence of small bowel wall thickening or inflammation. No evidence of small bowel obstruction or colitis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No evidence of small bowel wall thickening or inflammation. No evidence of small bowel obstruction or colitis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No evidence of small bowel or colonic inflammatory changes as clinically questioned.2.Persistent severe intrahepatic and extra hepatic biliary ductal dilatation suggestive of a choledochal cyst.3.Left iliac fossa transplant kidney with interval increase in size of 3 cysts without evidence of hydronephrosis.


Instruction: Generate impression based on findings.

Input: History of pancreas cyst. Hx of chronic necrotizing pancreatitis and duct obstruction. Per service patient has a CBD stent. ABDOMEN:LIVER, BILIARY TRACT: Postsurgical changes from hepaticojejunostomy. There is significant intra and extrahepatic biliary ductal dilatation with the common duct measuring up to 2 cm. It tapers smoothly to the level of the anastomosis. The appearance is similar to that seen on the CT dated 3/5/2015. A tubular filling defect likely reflects the reported CBD stent. There appears to be a long-segment smooth walled stricture of the distal CBD at the level of the pancreatic head. No discrete lesion is evident. Mild hepatomegaly measuring 22 cm in craniocaudal dimension.No suspicious liver lesion. There is chronic occlusion of the distal SMV, splenic vein and portal vein confluence with reconstitution of the main portal vein by numerous dilated collaterals. Status post cystectomy with cystic duct noted. SPLEEN: Splenomegaly measuring 18 cm. No focal lesion. Minimal perisplenic fluid.PANCREAS: The pancreas is markedly atrophic with decreased intrinsic T1-weighted signal intensity, likely stigmata of chronic pancreatitis. There is scarring in the pancreatectomy bed, compatible with chronic necrotizing pancreatitis. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left pelvic kidney is not visualized. RETROPERITONEUM, LYMPH NODES: Prominent periportal lymph node is unchanged, likely reactive.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Stigmata of chronic pancreatitis including marked pancreatic parenchymal atrophy. No discrete mass lesion is identified.2.Biliary ductal dilatation with stent in place with distal CBD stricture without a discrete lesion evident. Correlate with EUS/ERCP findings.


Instruction: Generate impression based on findings.

Input: Male, 66 years old, right leg pain, history of left diskectomy. A mild scoliotic curvature is seen but otherwise alignment is anatomic. Vertebral body height is preserved. Endplate edema is seen at L5-S1 similar to the prior exam. Edema is also evident in the L5 spinous process and the soft tissues surrounding the left-sided posterior elements. Bilateral pars interarticularis defects are suspected at L5-S1 and these were present previously.The visualized spinal cord and conus demonstrate normal signal intensity and morphology. Details of the cauda equina will be discussed below.Generalized loss of disk height is seen through the lumbar spine. In addition, there is prominence of the dorsal epidural fat from T12-L1 through L3-4 which contributes to areas of canal narrowing as discussed below.T12-L1: Mild facet hypertrophy and ligamentum flavum thickening. Mild bulging disk. No significant spinal canal or neuroforaminal stenosis. No changes. L1-2: Moderate facet hypertrophy and ligamentum flavum thickening. Mild bulging disk with perhaps a small left paracentral protrusion. Along with epidural fat, findings contribute to a moderate spinal canal stenosis, perhaps mildly progressed. There is mild left foraminal narrowing, unchanged. L2-3: Moderate facet hypertrophy and ligamentum flavum thickening. Bulging disk. Along with epidural fat, findings contribute to a moderate to severe spinal canal stenosis and crowding of the cauda equina, perhaps slightly progressed relative to the prior exam. Mild bilateral neuroforaminal narrowing, unchanged.L3-4: Moderate facet hypertrophy and ligamentum flavum thickening. A subcentimeter left ligamentum flavum cyst has decreased in size. Bulging disk. Along with epidural fat, findings contribute to a moderate spinal canal stenosis, perhaps slightly progressed. Moderate bilateral foraminal narrowing, unchanged. L4-5: Severe facet hypertrophy. Ligamentum flavum thickening. Bulging disk. Mild progression of epidural fat. Mild spinal canal stenosis, slightly progressed. Severe right and mild left foraminal narrowing, unchanged. L5-S1: Left-sided laminectomy which is new from the prior exam. Facet hypertrophy. Bulging disk asymmetric to the left. Epidural fat is prominent in the right aspect of the canal and absent on the left aspect of the canal. The thecal sac is deviated towards the left and may be mildly narrowed. Severe bilateral foraminal narrowing is unchanged.

Output: 1. Evidence of interval left-sided laminectomy at L5-S1 is seen. The epidural fat is prominent on the right of the spinal canal at this level resulting in slight leftward displacement of the thecal sac and perhaps mild thecal sac narrowing. Severe bilateral foraminal narrowing is unchanged.2. Chronic bilateral pars interarticularis fractures at L5. Significant endplate edema at L5-S1 is seen with edema also seen in the L5 spinous process and the surrounding soft tissues.3. Multilevel degenerative findings as above with a mild degree of interval progression. For example, there are stenoses at L1-2 through L4-5 which seem slightly worse than on the prior examination which may represent slight progression of either the bulging disks or epidural fat.


Instruction: Generate impression based on findings.

Input: Clinical question: Stage IV melanoma brain metastases. Status post treatment. Signs and symptoms: Restaging. Pre and post enhanced brain MRI:Examination demonstrates a previously known right paramedian occipital lobe metastatic enhancing lesion with interval decrease in size since prior study. The finding measures approximately 9 x 6 mm in transaxial dimensions compared to prior study measurement of approximately 15 x 11 mm. Similar to prior exam there is extensive internal susceptibility signal changes of tumor. There is no detectable surrounding vasogenic edema and no appreciable mass effect.There is no convincing evidence of any additional foci of parenchymal, leptomeningeal or calvarial enhancement suggest metastatic lesions.Unremarkable cerebral cortex, cortical sulci, ventricular system and CSF spaces. There are multiple tiny periventricular and subcortical foci of FLAIR hyperintensity without significant change since prior exam and suspected of mild chronic nonhemorrhagic small vessel ischemic strokes.Pre and post enhanced cervical MRI:The signal intensity of the vertebral column is unremarkable other than minimal changes secondary to degenerative disease.The alignment of vertebral column is anatomical.There is no detectable abnormal enhancement or vertebral column to suggest metastatic disease.There is normal signal intensity and caliber of cervical and upper most visualized thoracic cord without abnormal enhancement.Foramen magnum is unremarkable.C2-C3 is unremarkable.C3-C4 demonstrate mild asymmetric left-sided facet hypertrophic changes with mild left neural foraminal compromise and unremarkable otherwise.C4-C5 demonstrate moderate disc disease and loss of disc height, mild bilateral facet and minimally of ligamentum flavum hypertrophy is noted. There is shallow broad-based origin disc. Constellation of above changes results in significant right and mild left neural foraminal compromise and mild central spinal stenosis.C5-C6 demonstrate mild disc disease and loss of disc height, mild bilateral facet (left greater than right) hypertrophy. No spinal stenosis or neural foraminal compromise.C6-C7 demonstrate advanced disc disease and loss of disc height, shallow ventral broad-based bulge and hypertrophic spur, moderate bilateral facet hypertrophy changes and mild ligamentum flavum hypertrophy. Constellation of changes results in mild bilateral neural foraminal compromise and without convincing evidence of central spinal stenosis.C7-T1 is unremarkable.

Output: 1.Interval decreased size of a right paramedian occipital metastatic lesion to 9 x 6 mm compared to prior study measurements of 15 x 11 mm. No surrounding edema or mass effect.2.Negative diffusion weighted images and findings suggestive of mild chronic nonhemorrhagic small vessel ischemic strokes.3.Pre and post enhanced MRI of cervical and upper most visualized thoracic spine demonstrate no evidence of osseous, cord or meningeal metastases. Degenerative changes of cervical spine results in mild central spinal stenosis at C4-C5. Multilevel neural foraminal compromise (some significantly) as detailed per level above.


Instruction: Generate impression based on findings.

Input: Vertebral body heights are well-maintained. Again noted is a significant signal abnormality of the vertebral bodies of C5, C6, and C7, likely related to the underlying degenerative changes. No evidence of acute fracture or traumatic subluxation. No abnormal cervical spinal cord signal or lesions. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable.C1/2: No significant central spinal canal stenosis.C2/3: No significant central spinal canal stenosis.C3/4: Mild facet arthropathy without evidence of significant foraminal or central spinal canal stenosis.C4/5: Mild to moderate facet arthropathy and uncovertebral hypertrophy results in moderate bilateral neural foraminal narrowing. No significant central spinal canal stenosis.C5/6: Mild central disk bulge as well as facet arthropathy resulting in severe left neural foraminal narrowing and moderate right neural foraminal narrowing. No significant central spinal canal stenosis. C6/7: Facet arthropathy resulting in severe bilateral neural foraminal narrowing without significant central spinal canal stenosis.C7/T1: Persistent grade 1 anterolisthesis of C7 over T1. Facet arthropathy results in moderate bilateral neural foraminal narrowing. No significant central spinal canal stenosis.T1/T2: Facet arthropathy and uncovertebral hypertrophy results in moderate left neural frontal narrowing. No significant central spinal canal stenosis.

Output: 1.No evidence of lesions within the cervical spine to suggest multiple sclerosis as clinically questioned.2.Multilevel degenerative changes with neural foraminal narrowing as above.


Instruction: Generate impression based on findings.

Input: History of IPMN, re-evaluate. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: Subcentimeter splenic cysts, unchanged.PANCREAS: The pancreatic parenchyma demonstrates normal signal intensity and enhancement. The pancreatic duct is nondilated. There is redemonstration of a 4 mm cyst in the pancreatic head (series 7, image 23) unchanged in size since 10/25/2013, without definite communication with the pancreatic duct, and which most likely represents a side branch intraductal papillary mucinous neoplasm.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Subcentimeter renal cysts, unchanged.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: 4 mm pancreatic head sidebranch IPMN stable since 10/25/2013.


Instruction: Generate impression based on findings.

Input: Evaluate for stress fracture TENDONS: No significant abnormality noted.LIGAMENTS: No significant abnormality noted.ARTICULAR SURFACES AND BONE: No significant abnormality noted. ADDITIONAL

Output: Bone infarction in the distal tibia. No evidence of stress fracture


Instruction: Generate impression based on findings.

Input: History of left breast cancer, status post surgery and radiation. Complains of headaches. Rule out metastases. CT of brain without and with infusion:A well demarcated low-density in the left basal ganglia remains stable since prior study. Prior MRI examination from 10 -- 3 -- 2006 is also reviewed which demonstrates the same finding which is believed to represent a lacunar infarct.No evidence of any additional foci of abnormal density of brain parenchyma is detected. No evidence of hemorrhage, edema, mass-effect, midline shift or hydrocephalus.Post infusion images demonstrate no evidence of any abnormal enhancement the brain parenchyma or the leptomeninges and in particular no evidence of metastatic lesion is detected.Calvarium is intact. Limited view of paranasal sinuses and mastoid air cells are also within normal limits.120 cc of Omnipaque 350 was utilized for the above study.

Output: Normal pre-and post infusion CT examination of brain and calvarium.


Instruction: Generate impression based on findings.

Input: Evaluate for etiology of left temporal lobe seizures. Possible tumor on previous MRI. MRI Brain: There is stable to minimal increase in size of the abnormal increased T2/FLAIR signal and cortical thickening of the anterior and medial left temporal lobe, the left insular cortex and the posterior left thalamus. There is no associated enhancement or restricted diffusion. There is no evidence of intracranial hemorrhage. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There are multiple punctate foci susceptibility artifact of the supra- and infratentorial compartments, consistent with hemosiderin deposition from chronic microhemorrhage. At the posterior aspect of the left parotid gland, there is a lobulated T1 hyperintense lesion with incomplete fat suppression on T1 post contrast fat saturation, but with fat attenuation on CT head dated 11/14/12014, may represent a lipoma. The skull and extracranial soft tissues are otherwise unremarkable. MR spectroscopy: Single voxel MR spectroscopy over the thickened, abnormal tissue in the posteromedial left temporal lobe demonstrates an elevated choline peak with decreased NAA peak relative to the contralateral normal side, suspicious for the presence of tumor. Single voxel MR spectroscopy over the abnormal tissue in the left insular cortex is somewhat more indeterminate and demonstrates only mildly elevated choline and decreased NAA relative to the contralateral normal side.MR perfusion: While there is suggestion of elevated relative cerebral blood volume corresponding to the abnormal tissue in the left temporal lobe, suboptimal bolus delivery makes interpretation unreliable.

Output: 1. Stable to slightly increased size of abnormal tissue in the anterior and medial left temporal lobe, left insular cortex and posterior left thalamus. 2. The spectroscopic pattern of the left posteromedial temporal lobe component of the lesion is concerning for the presence of tumor.


Instruction: Generate impression based on findings.

Input: Reason: paraprotein weakness in thighs History: weakness with repetitive use: fatigue low grad CPK. No abnormal signal within the musculature.Bone marrow signal within normal limits.

Output: No signal abnormality of the musculature.


Instruction: Generate impression based on findings.

Input: 75-year-old female with pancreatic ductal dilatation and history of pancreatic cancer. Patient is status post Whipple in 2006. Most recent surveillance imaging in May 20, 2016 showed dilated pancreatic duct. EUS on 7/11/2016 with a dilated pancreatic duct and some changes in the residual pancreas of lobularity, no mass. Follow-up 3 month MRCP exam. ABDOMEN:LIVER, BILIARY TRACT: Status post hepaticojejunostomy. Minimal left biliary ductal dilatation. There is a subcentimeter nonenhancing T1 hypointense focus in the left hepatic lobe (axial series 11 image 136) that is too small to characterize.SPLEEN: No significant abnormality noted.PANCREAS: Status post Whipple procedure. There is a hypoenhancing lesion in the distal-most aspect of the residual pancreatic body (axial series 11 image 130) measuring 1.7 x 1.2 cm with upstream ductal dilatation of 4.5 mm. This lesion also demonstrates increased signal intensity on diffusion-weighted imaging (axial series 4 image 98).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: Broad-based supraumbilical ventral hernia containing a segment of transverse colon and omental fat (axial series 8 image 34). A more inferior ventral hernia contains a loop of small bowel (axial series 8 image 47). No bowel obstruction. No ascites.Incidental note is made of an intramuscular lipoma of the right lateral abdominal wall (axial series 8 image 28).OTHER: No significant abnormality noted.

Output: 1.Obstructing mass of the proximal-most aspect of the residual pancreatic body with associated upstream ductal dilatation.2.Too small to characterize nonenhancing T1 hypointense lesion of the left hepatic lobe. A larger hypodense lesion in this location was noted on the 2006 CT exam. This could be a residual small cyst, however attention on follow-up imaging is recommended.


Instruction: Generate impression based on findings.

Input: 41 years Female (DOB:4/19/1975)Reason: ? nerve impingement History: painPROVIDER/ATTENDING NAME: LEWIS L SHI LEWIS L SHI The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal enhancing lesions are identified in the cervical spine.Examination is somewhat degraded due to patient motion which may obscure more subtle abnormalities.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina. There is mild disc bulge at this level associated with some disc desiccation.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: There are minor degenerative changes present in the cervical spine without significant compromise to spinal canal or neural foramina.


Instruction: Generate impression based on findings.

Input: History of pancreatic adenocarcinoma. Staging MRI. ABDOMEN:LIVER, BILIARY TRACT: No focal suspicious liver lesion. Probable cyst in the left hepatic lobe. Moderate intra and extrahepatic biliary ductal dilatation to the level of the pancreatic head.SPLEEN: No significant abnormality noted.PANCREAS: 2.7 x 2.4 cm pancreatic head hypoenhancing mass (series 1 302/36) with associated pancreatic ductal dilatation and parenchymal atrophy. The lesion abuts and mildly deforms the adjacent superior mesenteric vein involving less than 180 degrees of the vessel. There may be focal non-occlusive marginal thrombus in the SMV. There is loss of fat plane with the adjacent superior mesenteric artery with less than 180 degrees of involvement.1.4 x 1.1 cm periportal heterogeneously enhancing lymph node (series 1 302/49).ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral small renal cysts.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: 2.7 x 2.4 cm pancreatic head hypoenhancing mass with associated pancreatic and biliary ductal dilatation is compatible with FNA proven adenocarcinoma. Periportal adenopathy. The mass abuts less than 180 degrees of the superior mesenteric vein and artery as described above.


Instruction: Generate impression based on findings.

Input: 2 week history of headaches that wake her up at night and last 1-3 1/2 hours (crying and upset). There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. Myelinization appears normal. Cerebellar tonsils are normally positioned without ectopia. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No evidence of intracranial hemorrhage, mass, or infarct. No specific findings to account for the patient's symptoms.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: left eye proptosis with hx of CNS lymphoma History: left eye proptosis and pain Exam is severely degraded by motion artifact.There is interval progression of the circumferential soft tissue thickening involving the left intraorbital optic nerve measuring up to 6-mm in thickness. There is also increase in T2 signal abnormality of this lesion. There is interval improvement of the previously seen pre-chiasmatic and chiasmatic component with mild residual enhancement of the right prechiasmatic optic nerve centered at the optic canal and left optic nerve just anterior to the chiasm and intracanalicular portion. There is worsening of left orbital proptosis. Additional lesions of the brain seen on prior studies are suboptimally evaluated on this study.There is moderate diffuse paranasal mucosal thickening, similar to prior study. There is no significant interval change in the size of the ventricular system. There is no midline shift or herniation. The skull and scalp soft tissues are unremarkable.

Output: 1.Compared to MRI 2/11/2015, there is interval increase in circumferential soft tissue surrounding the left intraorbital optic nerve suspicious for some disease progression. There is worsening proptosis. 2.Limited exam from motion artifact. There is interval improvement of prechiasmatic and chiasmatic abnormal enhancement with residual disease as described above. Consider dedicated MRI of the brain with contrast to follow up intracranial extent of disease as clinically indicated.3.Moderate diffuse paranasal mucosal thickening similar to prior study.


Instruction: Generate impression based on findings.

Input: Clinical question: Stroke. Signs and symptoms: Baseline dysarthria and slurred speech with acute worsening in ED. Nonenhanced brain MRI:Examination demonstrates a tiny 6 mm cortical focus of restricted diffusion in the left occipital lobe, additional linear focus of 18 x 6 mm in the periventricular white matter of the left hemisphere, a focus of approximately 11 mm in the subcortical white matter of right posterior frontal lobe and a punctate focus in the cortex of the left anterior parietal lobe. Findings demonstrate no evidence of hemorrhagic changes and without any mass effect.Additionally examination demonstrates a large focus of FLAIR hyperintensity involving the cortex and subcortical white matter of the left frontal lobe and including the left basal ganglia consistent with a large chronic left MCA territory cortical stroke. Findings suggestive of mild chronic nonhemorrhagic small vessel ischemic strokes are also noted. Small focus of left occipital chronic cortical stroke and multiple tiny foci in bilateral cerebellar hemispheres consistent with chronic small ischemic strokes.There is significant ex vacuo dilatation of left hemispheric cortical sulci secondary to large chronic stroke and mild bilateral (left greater than right) expected dilatation of lateral ventricles however with maintained midline.Findings and concerns on this exam were discussed by phone with the referring physician Sridharan, Aadhavi # 1071 at the time of review of exam.

Output: 1.Multiple foci of acute ischemic strokes in the left occipital, left hemispheric periventricular white matter, left anterior parietal cortex and subcortical white matter of right posterior frontal lobe. Findings are nonhemorrhagic and produces no mass effect.2.Large chronic left MCA ischemic stroke, moderate chronic small vessel ischemic strokes, small chronic right frontal cortical stroke, a small left occipital chronic stroke and tiny bilateral cerebellar chronic strokes are also noted.


Instruction: Generate impression based on findings.

Input: 60 years, Male, Reason: hx of elevated PSA and 3 previous negative biopsies, most recent biopsy revealing 4 cores suspicious for carcinoma, biopsy to follow History: see above. PELVIS:PROSTATE:Prostate Size: 5.6 x 4.5 x 4.8 cmPeripheral Zone: There is an ill-defined lesion in the left peripheral zone, mid gland to base.Central Gland: Multiple well-defined heterogeneous nodules, likely BPH nodulesSeminal Vesicles: No involvementExtracapsular Extension: No extensionBLADDER: No significant abnormality noted.LYMPH NODES: No lymphadenopathyBONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Ill-defined lesion in the left peripheral zone, mid gland to base.2.No lymphadenopathy.


Instruction: Generate impression based on findings.

Input: Left-sided numbness. Evaluate for acute ischemic infarct. There is no evidence of acute infarct, hemorrhage, mass, or mass effect. There are scattered punctate and confluent areas of abnormal T2 signal in the periventricular and subcortical white matter. The ventricles and basal cisterns are unchanged in size and configuration. No hydrocephalus. No extra-axial collections. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable.

Output: 1.No evidence of acute infarct.2.Scattered areas of abnormal T2 signal in the periventricular and subcortical white matter, which are nonspecific, but most consistent with mild chronic small vessel ischemic disease.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Symptomatic contents partial seizures. History of intraventricular hemorrhage. Evaluate for focal, structural abnormality. EEG from Jan 2011 was abnormal; focal slowing over the left parietal region. There are also sharp waves in this left parietal region but no seizures. Areas of susceptibility effect are present at midline, partly in the third ventricle and partly along the medial aspect of the left thalamus, which also shows volume loss. Additional punctate foci of susceptibility effect are present in the occipital horn of the right lateral ventricle and in the trigone of the left lateral ventricle. These are related to previous intraventricular hemorrhage. There is no acute intracranial hemorrhage or acute infarct. There is no mass-effect or midline shift. The biparietal periventricular white-matter is mildly decreased in volume and of slightly increased T2 signal, which reaches to the lateral ventricular surface. These findings are unchanged since the prior examination and most probably reflect prior ischemic injury. The left thalamus is small in size as described above. Otherwise, there is no definite sign of malformation of cortical development. However, the left hippocampus shows asymmetric volume loss and increased T2 signal affecting its head, body and tail, consistent with mesial temporal sclerosis. Volume loss is also noted in the left fornix.Slight asymmetry in the size of the lateral ventricles is unchanged, right being slightly larger than the left. Major intracranial vascular flow voids are preserved. The orbits are unremarkable. There is trace mucosal thickening in the paranasal sinuses which is nonspecific. The mastoid air cells and the middle ear cavities are clear. There is no destructive skull lesion or gross scalp abnormality.

Output: 1.Unchanged mild biparietal white-matter volume loss and increased T2 signal, probably reflective of prior ischemic injury. 2.No definite sign of malformation of cortical development. However, the left hippocampus shows asymmetric volume loss and increased T2 signal, consistent with mesial temporal sclerosis. There is associated volume loss of the left fornix.3.Hemosiderin staining in the lateral ventricles and in the third ventricle/left thalamus reflecting prior intraventricular hemorrhage.


Instruction: Generate impression based on findings.

Input: 75 years Female (DOB:11/22/1940)Reason: low back pain with left sided sciatica History: as abovePROVIDER/ATTENDING NAME: KAMALA GULLAPALLI COTTS KAMALA GULLAPALLI COTTS Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment . There is a superior endplate compression at L4 which was also present on the prior exam, however, it appears to have mildly progressed in the Schmorl's node at the superior endplate of L4 is larger on the current exam. There is a inferior endplate compression at L3 which is new since the 10/6/2007 exam. T2 signal hyperintensity with within the inferior half of the L3 vertebral body suggests acute or subacute compression. There is a compression fracture present at T12 with 50% loss of vertebral body height. This appears to be chronic and unchanged since the 10/6/2007 exam. There is mild kyphotic deformity at this level. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is disc desiccation and broad-based right far lateral disc protrusion at this level which extends into the right neural foramen and encroaches the exiting nerve roots within the neural foramen. There is some ligamentum flavum hypertrophy at this level. These findings were also present on the prior exam but have mildly progressed.At L4-5 there is a disc bulge associated with ligament flavum hypertrophy and facet hypertrophy. There is narrowing of the spinal canal at this level with mild degree of spinal stenosis. These findings were also present on the prior exam but have mildly progressed.At L3-4 there is loss of disc space height, disc desiccation and diffuse disc bulge associated with some ligamentum flavum hypertrophy, effacement of the fat at the lateral recesses and crowding of the nerve roots. Overall there is moderate spinal stenosis at this level. This hasn't significantly progressed since the prior examAt L2-3 there is no significant compromise to spinal canal or neural foramina. There is disc desiccation, Schmorl's node and a diffuse disc bulge at this level.At L1-2 there is no significant compromise to spinal canal or neural foramina. There is mild loss of disc space height and a diffuse disc bulge at this level.

Output: 1.Since the previous examination the patient has developed a new subacute compression at the inferior endplate of L3. There is redemonstration of a compression fracture at T12 which is stable and some mild progression of the superior endplate of L4 compression fracture.2.Since the prior exam, the patient has developed a moderate degree of spinal stenosis at the L3-4 level.3.There are multilevel degenerative changes present in the lumbar spine.


Instruction: Generate impression based on findings.

Input: Hearing loss and poor balance. Internal Auditory Canals: The bilateral cranial nerve 7 and 8 complexes are intact. There is no evidence of mass lesions. The inner ear structures, including the cochlea, vestibule, endolymphatic duct, and semicircular canals, appear unremarkable. The bilateral mastoid air cells and middle ears also appear unremarkable.Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. No evidence of inner ear anomalies or cochlear nerve deficiency.2. No evidence of acute intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: Male, 59 years old, with history of lung cancer with rib and spine pain. Assess for the presence of a neoplastic process. Cervical:A trace degenerative retrolisthesis of C3 relative to C4 is demonstrated. Spinal alignment is otherwise unremarkable. No areas of worrisome marrow replacement or marrow edema are seen.No definite cord signal abnormality is seen. Questionable ill defined increased signal in the mid cervical cord, seen on the sagittal STIR and axial T2 sequences, but not the sagittal T2 sequence, may be artifactual and/or related to motion artifact.On post constrast images, no pathologic marrow space, epidural, or intradural enhancement is seen.C2-3: Right facet hypertrophy. No significant spinal canal or foraminal stenosis.C3-4: Facet hypertrophy. Disk osteophyte formation. Mild generalized spinal canal stenosis. Mild to moderate left foraminal stenosis.C4-5: Facet hypertrophy. Disk osteophyte formation. No significant spinal canal stenosis. Moderate left and mild right foraminal narrowing. C5-6: Left facet hypertrophy. Disk osteophyte formation with a focal component at the right subarticular/foraminal zone. No significant generalized parenchymal canal stenosis, but the right lateral thecal sac is effaced. Mild right foraminal narrowing. C6-7: Disk osteophyte formation, particularly along the left uncovertebral joint. No significant spinal canal stenosis. Mild left neuroforaminal narrowing.C7-T1: Facet hypertrophy. Otherwise, unremarkable.Thoracic:There is a slight curvature in the coronal plane, but alignment is otherwise unremarkable.A mild alteration of the marrow signal intensity in the upper and mid thoracic region may reflect radiation related change. Some of the upper thoracic vertebral bodies demonstrate a very subtle non uniform pattern of enhancement which is also favored to be treatment related. There is no definite evidence of any marrow space metastatic disease.The spinal cord demonstrates normal signal intensity and morphology. On postcontrast images, no concerning epidural or intradural enhancement is seen.Mild disk bulging is seen at T11-12 without significant spinal canal stenosis. A small left paracentral disk protrusion is present at T12-L1, again without significant stenosis.Elsewhere, the intervertebral disks are preserved with no compromise of the spinal canal or neural foramina.Partially visualized are numerous pulmonary nodules, some of which may be larger than on the prior exam. Volume loss and scarring is demonstrated in the right upper lung.Lumbar:The lumbar lordosis is straightened and there is a mild degenerative retrolisthesis of L5 relative to S1. A nonspecific, low signal, presumably sclerotic lesion is seen within the right iliac bone. No concerning marrow replacement or pathologic marrow enhancement is seen.The visualized spinal cord, conus and cauda equina are unremarkable. No pathologic epidural or intradural enhancement is seen.L1-2: Mild facet hypertrophy and ligamentum flavum thickening. Loss of disk height and bulging disk with a small left paracentral disk protrusion. No significant spinal canal stenosis. No significant foraminal narrowing. L2-3: Mild facet hypertrophy and ligamentum flavum thickening. No significant spinal canal or neuroforaminal stenosis. L3-4: Moderate facet hypertrophy and ligamentum flavum thickening. Mild laterally bulging disk. No significant spinal canal or neuroforaminal stenosis. L4-5: Mild facet hypertrophy and ligamentum flavum thickening. Mild bulging disk, particularly in the foraminal zones. Mild generalized spinal canal stenosis. Mild bilateral foraminal narrowing. L5-S1: Moderate facet hypertrophy. Loss of disk height with mild bulging and perhaps a very small central protrusion. No significant spinal canal stenosis. Mild bilateral foraminal narrowing.

Output: 1.No definite evidence of metastatic disease in the spine.2.Mildly altered signal intensity and pattern of enhancement within the mid to upper thoracic vertebral bodies is favored to represent a radiation related change.3.Questionable ill defined T2 signal abnormality is noted within the cervical spinal cord. This could be artifactual, as it is not confirmed on every sequence, and as there is some motion degradation on this exam. Follow-up imaging can be considered if clinical symptoms persist.4.Mild to moderate degenerative findings as discussed by level above.5.Numerous pulmonary nodules are partially visualized. Please consider dedicated chest imaging to assess for the possibility of interval growth.


Instruction: Generate impression based on findings.

Input: 64-year-old female with a 9 mm hypoattenuating liver lesions seen on the March 2016 scan. ABDOMEN:LIVER, BILIARY TRACT: Liver with normal morphology. Multiple well-circumscribed T2 hyperintense foci scattered throughout the liver are most compatible with cysts.In hepatic segment 8, there is a 0.9 x 0.8 cm focus that is faintly T2 hyperintense (axial series 3 image), T1 hyperintense (axial series 9 image 87), and no enhancement after contrast administration (axial series 103 image 86).SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right mid/lower pole renal cysts. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Multiple pulmonary nodules.

Output: 1.The 0.9 cm nonenhancing T1 hyperintense focus in hepatic segment 8 could represent a proteinaceous/mucinous cyst. No suspicious features identified. Attention on follow-up imaging is recommended.2.Multiple pulmonary nodules compatible with metastatic disease. Please see the same day CT chest exam for further details.


Instruction: Generate impression based on findings.

Input: EBV-associated nasopharyngeal cancer treated with chemoradiation. There is no measurable tumor in the nasopharyngeal region. There are secretions within the nasopharynx, however. There are no significantly enlarged lymph nodes in the imaged portions of the neck. The major salivary glands appear to be unchanged. There is scattered paranasal sinus mucosal thickening and retention cyst formation. The skull base appears to be intact. The imaged portions of the intracranial structures and orbits are unremarkable. There is multilevel degenerative cervical spondylosis.

Output: No measurable tumor in the nasopharyngeal region.


Instruction: Generate impression based on findings.

Input: 69-year-old male with atypical meningioma status post resection and radiation therapy, history of partial seizures, surveillance imaging. Redemonstrated are postoperative findings related to left parietal convexity meningioma resection. Expected evolution of post procedural changes are noted including near total resolution of postoperative blood products, resolution of mass effect, better definition of a postoperative cavity, and only a small residual extradural collection. There remains mild diffuse linear enhancement along the margins of the operative cavity. Previously demonstrated nodular enhancement adjacent to the superior sagittal sinus has not significantly changed, measuring up to 23 mm in maximal dimension (best seen series 1101, image 77/192 as well as series 11 image 137/148), present on prior studies. Mild effacement of the left lateral ventricle has resolved. There are no new abnormal enhancing foci. Mucosal thickening is now present within bilateral ethmoid air cells (right greater than left). Mucosal of thickening is again noted within the inferior maxillary sinuses. The mastoid air cells are clear. Expected vascular flow voids are demonstrated.

Output: Redemonstrated are postoperative findings related to left parietal convexity meningioma resection. Expected evolution of post procedural changes are noted including near total resolution of postoperative blood products, resolution of mass effect, better definition of a postoperative cavity, and only a small residual extradural collection. There remains mild diffuse linear enhancement along the margins of the operative cavity. Previously demonstrated nodular enhancement adjacent to the superior sagittal sinus has not significantly changed, measuring up to 23 mm in maximal dimension


Instruction: Generate impression based on findings.

Input: 18 year old woman with LV dysfunction diagnosed post partum, referred for cardiac MRI for further evaluation of underlying etiology. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 29%, the LV end diastolic volume index is 137 ml/m2 (normal range: 65+/-11), the LVEDV is 284 ml (normal range 109+/-23), the LV end systolic volume index is 98 ml/m2 (normal range 18+/-5), the LVESV is 203 ml (normal range 31+/-10), the LV mass index is 58 g/m2 (normal range 67+/-11), and the LV mass is 121 g (normal range 114+/-24). LV dysfunction is global. There is epicardial late gadolinium enhancement in the basal inferior wall, which is not in a typical infarct pattern and may suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. The region with late gadolinium enhancement also demonstrates increased native myocardial T1 times and extra-cellular volume fraction.Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 53%, the RV end diastolic volume index is 64 ml/m2 (normal range 69+/-14), the RVEDV is 133 ml (normal range 110+/-24), the RV end systolic volume index is 30 ml/m2 (normal range 22+/-8), and the RVESV is 62 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely. There is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild to moderate tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is mildly dilated. Venous AnatomyThe SVC and IVC drain normally into the right atrium. PericardiumThere is a small to moderate sized pericardial effusion, without evidence of obvious hemodynamic compromise.Extracardiac FindingsThere are small bilateral pleural effusions. Right lower lung nodule is noted (correlation with chest CT recommended). Atelectesis/ infiltrate in left lower lung. 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 severely dilated with severely reduced systolic function. The overall LV ejection fraction is 29%.2. There is epicardial late gadolinium enhancement in the basal inferior wall, which is not in a typical infarct pattern and may suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.3. The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 53%.4. Mild to moderate tricuspid regurgitation.5. Small to moderate sized, non-hemodynamically significant pericardial effusion.6. Severe left atrial dilation.7. See extra-cardiac findings. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 61-year-old male with an acute ischemic stroke. Is there chronic right carotid occlusion? There are numerous foci of restricted diffusion within a watershed distribution in the right cerebral hemisphere. The largest area is in the right frontoparietal corona radiata. There are a few foci of restricted diffusion in the occipital lobe in the MCA/PCA watershed as well. Many of these areas are associated with increased T2 signal. Additional areas of increased T2 signal within the periventricular and subcortical white matter are not associated with diffusion restriction and are compatible with mild chronic small vessel ischemia. There is a punctate focus of susceptibility effect within the white matter of the right frontal lobe compatible with chronic hemorrhage.The intracranial right ICA flow void is absent related to slow or retrograde flow with the extent of ICA occlusion better seen on the recent CTA. There is no evidence of acute intracranial hemorrhage or mass. There is asymmetric increased enhancement within the right cerebral hemisphere related to collateral blood flow. No abnormal parenchymal enhancement is present. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There is moderate mucosal thickening within the left maxillary sinus and posterior ethmoid air cells on the left. There is partial opacification of the mastoid air cells on the right. The orbits, skull, and scalp soft tissues are grossly unremarkable.On perfusion images the cerebral blood volumes in the right cerebral hemisphere are preserved, and in fact, there are areas with increased blood volume in the right frontal white matter, finding which can be seen with chronic stenosis. There is prolongation of mean transit time throughout the right cerebral hemisphere. Cerebral blood flow images also demonstrate areas of increased flow in the right frontal lobe adjacent to the areas of infarct.

Output: 1.Multiple foci of acute infarct in the right cerebral hemisphere in a watershed distribution.2.Right internal carotid artery occlusion, extent of which was better delineated on the recent CTA. 3. Preserved cerebral blood volume in the right cerebral hemisphere with areas of elevated cerebral blood volumes in the right cerebral hemisphere compared to the left. These findings can be seen with chronic stenosis/occlusion with preserved perfusion through collaterals. There are foci of acute infarct however indicating acute decompensation of collateral flow or possibly acutely developed complete occlusion on a background of chronic high-grade stenosis.


Instruction: Generate impression based on findings.

Input: Low back pain, weakness, numbness in the left foot The vertebral bodies are appropriate in the overall alignment and height. The spinal cord has grossly normal signal characteristics and overall morphology. There is no compromise of the spinal cord.At the T9-T10 level, there is effacement of the posterior thecal sac related to ligamentum flavum thickening and/or facet arthropathy without evidence of high-grade spinal canal stenosis at this level.In the lumbar spine, there is disc desiccation at the L3-L4, L4-L5, and L5-S1 levels. There is developmental narrowing of the lumbar spinal canal with superimposed disc herniations/bulges with dorsal annular fissures at L4-L5 and L5-S1 contributing to severe spinal canal stenosis at these levels. There is mild facet arthropathy at these levels. There is also up to moderate narrowing of the neural foramina at these levels which can be better assessed with axial sequences. Upper lumbar spinal canal is patent.

Output: This is a limited exam specific for the exclusion of cord compression only and does not exclude more subtle lesions such as intrinsic cord abnormalities. No cord compression is identified.There is severe spinal canal stenosis at L4-L5 and L5-S1 related to combination of developmental narrowing and superimposed disc herniations/bulges. Recommend dedicated lumbar spine MRI for further evaluation.Dr. Ali discussed findings with Dr. Adjei-Twum in the ED at 0840 hours on 4/23/2016.


Instruction: Generate impression based on findings.

Input: Follicular lymphoma, unspecified, unspecified site [C82.90], Reason for Study: ^Reason: assess for brain mets- concern for paraneoplatic syndrome History: symptomatic hypotension No evidence of acute ischemic or hemorrhagic lesion.Multiple scattered patchy bihemispheric T2/FLAIR high signal intensity lesions on periventricular white matter and centrum semiovale indicate non specific small vessel ischemic disease.Minimal diffuse brain atrophy is age appropriate.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: Nonspecific small vessel ischemic disease.No evidence of acute ischemic or hemorrhagic lesion.


Instruction: Generate impression based on findings.

Input: Reason: cervical radiculopathy versus carpal tunnel History: neck pain numbness/tingling to hands, greater to the left The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology.At C2-3 there is no significant compromise to the spinal canal or neural foramina.This has minimally changed when compared to the prior exam.At C3-4 there is no significant compromise to the spinal canal or neural foramina. There is a disk bulge associated with uncovertebral osteophytes more prominent on the left versus the right side at this level but no significant compromise to the spinal canal exiting nerve roots.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: There mild degenerative changes present in the cervical spine worse at C3-4 which are stable when compared to prior exam.


Instruction: Generate impression based on findings.

Input: Other malformations of cerebral vessels [Q28.3] / Other specified postprocedural states [Z98.89], Reason for Study: ^Reason: vein of Galen aneurysmal malformation, coiled, 6 month follow up History: 6 month follow up Brain MRIThere is no evidence of acute ischemic or hemorrhagic lesion.The prominent median prosencephalic vein is again seen and the maximum diameter of the vein is slightly increased (18.8mm, was measured about 17.5mm on T2 axial scan).However, there is no evidence of brain parenchymal edema or abnormal signal intensity indicating possible venous congestive encephalopathy.Otherwise signal intensity of brain as well as the myelination appears to be within normal limits and ventricle size is also within normal limits.Susceptibility lesions on bilateral lateral ventricle occipital horns are still seen which indicate possible prior hemorrhage related hemosiderin deposition, unchanged since prior scan.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. The paranasal sinuses are clear.Opacification of the right mastoid air cell is seen, slightly decreased in size comparing to prior scan which indicate immature status.Brain MRA 3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate prominent and significant in-flow enhancement of median prosencephalic vein indicate still patent so called vein of Galen malformation. Vertebrobasilar arterial system appears to be enlarged in diameter indicate major feeding arterial system.Bilateral ICAs appear to be normal range diameter. There is no evidence of arterial aneurysm.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion. In particular, there is no evidence of venous congestive encephalopathy. Ventricle size remains normal.2. Persistent filling of median prosencephalic vein which shows slightly increased in maximum diameter. However, there is no evidence of outlet occlusion or stenosis on this scan.3. Unchanged bilateral lateral ventricle occipital horn susceptibility lesions since prior scan. Otherwise brain parenchymal signal intensity and myelination appear to be within normal range.4. Brain MRA shows enlarged vertebrobasilar system luminal diameter indicate main feeding arterial system to the shunt toward median prosencephalic vein.


Instruction: Generate impression based on findings.

Input: 65-year-old female with known right breast cancer, with a satellite lesion detected on outside MRI. Ultrasound study is requested to look for the satellite lesion. Focused ultrasound is performed for the right lower outer breast. The index lesion, measuring 7 x 7 mm, is again detected at 7:00 position, 5 cm from the nipple. Immediate anterior and superior to the index lesion, there is a hypoechoic lesion measuring 5 x 4 mm with increased blood flow, consistent with a satellite lesion. The total measurement of index lesion with satellite lesion is approximately 1.2 cm in AP dimension. AP distance of index plus satellite lesion on MRI is 1.8 cm, and the shorter ultrasound measurement is probably due to patient's supine position. A marker clip is detected at inferoanterior to the index lesion.

Output: MR-directed ultrasound successfully detected anterior satellite in the right breast. Ultrasound-guided wire localization for index lesion and satellite lesion can be performed for breast conservation surgery.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.