Instruction: Generate impression based on findings.

Input: Please evaluate for basal ganglia or other focal lesion: motor and vocal tics for >1 year. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma, including the basal ganglia, 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, and scalp soft tissues are grossly unremarkable. There is mild scattered paranasal sinus mucosal thickening.

Output: The basal ganglia appear grossly unremarkable.


Instruction: Generate impression based on findings.

Input: Female, 33 years old, with five year history of MS presenting with a suspected exacerbation with generalized weakness and burning in the left lower extremity. Brain:Multiple T2 hyperintense lesions are redemonstrated within the juxtacortical and periventricular white matter, the corpus callosum, the brainstem and cerebellum. Accounting for differences in technique, there has been no significant interval change in size or number of lesions when compared to the prior examination.No enhancing lesions are seen. No edema or mass effect is detected. Brain parenchymal volume is well-preserved. No restricted diffusion is seen. No findings to suggest acute intracranial hemorrhage or any abnormal extra-axial fluid collections are demonstrated. The ventricles are normal in size and morphology.Spine:A T2 hyperintense lesion within the ventral spinal cord at the C4 level has diminished in conspicuity when compared to the prior examination.A faint T2 hyperintense lesion within the cord at the T2 level is stable or slightly reduced in conspicuity. A T2 hyperintense lesion within the central cord at T10 is unchanged.No abnormalities of the conus or cauda equina are demonstrated. No pathologic spinal cord or leptomeningeal enhancement is seen.Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. No pathologic marrow edema or enhancement is seen.Mild disc osteophyte formation is seen in the right paracentral region at C3-4. No significant spinal canal or foraminal stenosis results. Elsewhere, the spine is free of significant disc degeneration and there are no areas of high-grade spinal canal or foraminal stenosis.

Output: 1.Multiple lesions in the brain compatible with demyelinating disease are redemonstrated without significant interval change. No new or enhancing lesions are seen.2.Multiple scattered lesions in the spinal cord compatible with demyelinating disease are stable to reduced in conspicuity when compared to prior exams. No new or enhancing spinal cord lesions are detected.


Instruction: Generate impression based on findings.

Input: Secondary glioblastoma on Avastin. There are post-treatment findings in the right frontal lobe related to tumor resection. There is no significant interval change in mildly expansile nonenhancing confluent T2 hyperintensity along the anterior, medial, and posterior margins of the right frontal lobe resection cavity and in the right anterior cingulate gyrus. There is no significant interval change in size of the minimally enhancing ependymal lesion along the lateral aspect of the right frontal horn and the subcentimeter non-enhancing lesion with restricted diffusion along the posteromedial margin of the resection cavity. There is residual gyriform intrinsic T1 hyperintensity in the left cingulate gyrus and paracentral lobule, which likely represents cortical laminar necrosis. There is no evidence of acute territorial infarction. The paranasal sinuses, mastoid air cells, and orbits are unremarkable. The skull and scalp soft tissues appear unchanged.

Output: 1.No significant interval change in presumed residual tumor surrounding the right frontal lobe resection cavity and in the right anterior cingulate gyrus. 2.No significant interval change in size of an ependymal lesion along the lateral aspect of the right frontal horn and along the posteromedial margin of the resection cavity.


Instruction: Generate impression based on findings.

Input: Reason: PSC, eval for strictures History: Abdominal pain, PSC ABDOMEN:LIVER, BILIARY TRACT: There is volume loss of the right lobe, which may reflect underlying cirrhotic morphology. Areas of alternating biliary stricture and dilatation of the intrahepatic ducts appear similar to prior study in degree and distribution. Common bile duct is normal in appearance. There is stable smooth defect in the common hepatic duct, likely reflecting extrinsic compression from crossing vessel. No new areas of stricture or dilatation of the bile duct. No suspicious hepatic lesions is identified.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Alternating biliary stricture and dilation widely throughout both lobes of liver typical of PSC, appearing similar to prior study. No evidence for new strictures or worsening biliary dilatation. NO mass lesions seen.


Instruction: Generate impression based on findings.

Input: Diagnosis: Cerebral infarction, unspecifiedClinical question: rule out ischemic infarct, R MCA distributionSigns and Symptoms: worsening of known dysarthria, left UE, LE weakness There are no foci of diffusion restriction appreciated.There is encephalomalacia involving the right parietal lobe and to lesser degree adjacent right frontal lobe and temporal lobe as well as right insular cortex. This is all in the distribution of the right middle cerebral artery territory predominantly. There is associated loss of volume of the right cerebral peduncle. There is associated ex vacuo effect along the right lateral ventricle.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.There is no evidence for acute infarction.2.Encephalomalacia involving right middle cerebral artery territory structures predominantly centered in the right parietal lobe but also involving the adjacent brain is most likely related to prior cerebrovascular event.3.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: History of carcinoid syndrome and left adrenal mass. Unknown primary. ABDOMEN: The study is limited by the patient's body habitus and suboptimal images on some of the imaging sequences.LIVER, BILIARY TRACT: Significant hepatic steatosis. No focal liver lesion. Status post cholecystectomy. No intra or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: The left and right adrenal gland are essentially normal in morphology size and signal intensity without a focal lesion. KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No discrete adrenal or liver lesion. Hepatic steatosis.


Instruction: Generate impression based on findings.

Input: A patient submitted outside study for review. Submitted for review are MRI dated February 2, 2015, and ultrasound and mammogram dated February 4, 2014 performed at Lutheran General Hospital . For comparison, diagnostic mammogram and left breast ultrasound, images from ultrasound guided left breast biopsy and post biopsy mammogram, and images from left stereotactic biopsy and post biopsy mammogram performed at Lutheran General Hospital dated January 27, 2015 are available. DIAGNOSTIC MAMMOGRAM and LEFT BREAST ULTRASOUND (1/27/2015): Two standard views of the right breast and 3 standard views, one spot compression, and two magnification views of the left breast were obtained. The breast parenchyma is composed of scattered fibroglandular elements, distributes fairly symmetrically in both breasts. Multiple clusters of calcifications are present throughout the left breast, predominating within the central inner aspect. Notably, branching calcifications are present within the central slightly inner left retroareolar breast, mid depth. Total extent of calcifications spans approximately 7.2 cm AP x 5.6 cm transverse x 5.5 cm craniocaudal, extending to the level of the nipple. A 9 mm focal asymmetry is present within the upper inner left breast posteriorly, subjacent to a palpable marker (BB), and persists on spot compression imaging. No dominant mass, suspicious calcifications, or areas of architectural distortion are present in the right breast.Diagnostic ultrasound shows an irregular hypoechoic mass at the 11 o'clock position of the left breast, 8 cm from the nipple measuring 1.1 x 0.8 x 0.8 cm. Mild increased vascularity is present. Other images labeled left axilla show no lymph nodes. STEREOTACTIC GUIDED LEFT BREAST BIOPSY and SPECIMEN RADIOGRAPH (1/27/2015): Images from stereotactic biopsy of linear, branching calcifications within the central left breast are provided. Targeting appears appropriate. Calcifications are noted within the biopsy specimen.ULTRASOUND GUIDED LEFT BREAST BIOPSY and POST-BIOPSY MAMMOGRAM (1/27/2015): Images from ultrasound guided biopsy of the left breast mass at the 11 o'clock position, 8 cm from the nipple are provided. Targeting appears appropriate.Three standard views of the left breast were obtained post stereotactic and ultrasound guided biopsies. An X-shaped biopsy clip is present at the stereotactic biopsy site within the nipple central left breast. Residual calcifications are present extending anteriorly to the nipple. A coil-shaped biopsy marking clip is present within the upper inner left breast, corresponding to the site of ultrasound guided biopsy. Distance between these clips is 6.5 cm on the MLO view.BILATERAL BREAST MRI (2/2/2015): Bilateral breast MRI was performed without and with gadolinium per outside hospital protocol. Susceptibility artifact is present from biopsy clips within the upper inner and mid central left breast. There is diffuse non-mass enhancement within the central and inner left breast extending from the pectoralis muscle posteriorly to the nipple base anteriorly, spanning 10.2 cm AP x 5.3 cm transverse x 8.0 cm craniocaudal. No pectoralis enhancement is present to suggest muscular involvement.Within the outer right breast, there is a circumscribed, enhancing, mass measuring 0.8 x 0.9 x 0.8 cm. No further suspicious areas of morphology or enhancement are present in the right breast. No suspicious axillary nodes. ULTRASOUND RIGHT BREAST (2/4/2015): Targeted right breast ultrasound was performed. At the 10 o'clock position of the right breast, 5 cm from the nipple there is a 0.9 x 0.7 x 1.1 cm circumscribed hypoechoic mass without internal vascularity. This is correlative to the MRI finding. ULTRASOUND GUIDED RIGHT BREAST BIOPSY and POST-BIOPSY MAMMOGRAM (2/2/2015): Images from ultrasound guided biopsy of the right breast mass at the 10 o'clock position are submitted. Targeting appears appropriate. Two standard views of the right breast were obtained post biopsy. A wing shaped clip is present within the upper outer right breast, corresponding to the mass on MRI.PATHOLOGY: Per outside report, pathology results for the ultrasound guided biopsy of the left breast mass resulted invasive ductal carcinoma, grade 2. Pathology results for the stereotactic guided biopsy of left breast calcifications resulted ductal carcinoma in situ, grade 2. Pathology results of the ultrasound guided biopsy of the right breast mass resulted fibroadenoma.

Output: 1. Left breast mass and extensive calcifications status post biopsy revealing invasive ductal carcinoma and DCIS, respectively. There is diffuse non-mass enhancement of the central and inner left breast on MRI, corresponding to calcifications on mammogram, copmpatible with extensive DCIS. Total area of enhancement spans 10.2 x 5.3 x 8.0 cm (AP x ML x CC).2. Right breast biopsy proven fibroadenoma. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: 67-year-old male with elevated PSA, PSA 7.9, prior biopsy revealed Gleason 6, was on active surveillance PELVIS:PROSTATE:Prostate Size: 4.5 x 3.6 x 5.0 cm.Peripheral Zone: Focus of T2 hypointensity measuring 6 x 4 mm in the right mid gland peripheral zone (series 501, image 94) with corresponding asymmetric restriction. ADC restriction measures approximately 6 mm in largest dimension.Central Gland: Moderate degree benign prostatic hypertrophy.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: None.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Focus of T2 hypointensity in the right mid gland peripheral zone as described suspicious for malignancy.


Instruction: Generate impression based on findings.

Input: Clinical question: History of lung cancer. Please evaluate for metastases. Signs and symptoms: Lung cancer. Enhanced CT of brain:There is no definite evidence of metastatic disease to the brain, leptomeninges or the calvarium. This examination is essentially within normal limits for patient's stated age of 73. CAT scan can miss very small metastatic lesions. Please correlate with history and follow-up with an enhanced MRI is recommended.Calvarium, visualized orbits, paranasal sinuses and mastoid air cells are unremarkable.90 cc of Omnipaque 3 350 is administered for above study.

Output: No evidence of metastatic disease and essentially unremarkable enhanced CT of brain for patient's stated age of 73.


Instruction: Generate impression based on findings.

Input: 56Yrs female with a history of breast cancer treated with mastectomy, radiation, and chemotherapy in 2008 found to have atrial arrhythmia and left ventricular dysfunction. Left VentricleThe left ventricle is moderately dilated with mildly reduced systolic function. The overall LV ejection fraction is 41%, the LV end diastolic volume index is 105 ml/m2 (normal range: 65+/-11), the LVEDV is 219 ml (normal range 109+/-23), the LV end systolic volume index is 63 ml/m2 (normal range 18+/-5), the LVESV is 130 ml (normal range 31+/-10), the LV mass index is 63 g/m2 (normal range 67+/-11), and the LV mass is 130 g (normal range 114+/-24). The left ventricular dysfunction is global with regional variation. There is septal bounce of unknown etiology. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is normal in size with moderately reduced systolic function. The overall RV ejection fraction is 37%, the RV end diastolic volume index is 90 ml/m2 (normal range 69+/-14), the RVEDV is 187 ml (normal range 110+/-24), the RV end systolic volume index is 57 ml/m2 (normal range 22+/-8), and the RVESV is 118 ml (normal range 35+/-13). Right AtriumThe right atrium is moderately dilated. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is moderately dilated with mildly reduced systolic function(LVEF 41%). The left ventricular dysfunction is global with regional variation. There is septal bounce of unknown etiology. 2. The right ventricle is normal in size with moderately reduced systolic function. The overall RV ejection fraction is 37%3. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.


Instruction: Generate impression based on findings.

Input: History of ovarian cancer, BRCA1 mutation carrier and family history of breast cancer. There is scattered fibroglandular tissue in both breasts.Minimal parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. Susceptibility artifact is present in the lower lateral right breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: 60 years Male (DOB: 3/14/1956)Reason: 60F with h/o MS, neuro c/s service requesting MRI Javed protocol to further assess History: diffuse pain, joint contractures, poor appetitePROVIDER NAME: IRSK J ANDERSON IRSK J ANDERSON MRI brain:There is a moderate degree of periventricular white matter lesions present associated with some volume loss. These are perpendicularly oriented to the lateral ventricles. They are hyperintense on T2 and FLAIR and hypointense on T1. There is no associated contrast enhancement. Additional similar appearing punctate lesions are identified in the brainstem, left cerebellar hemisphere and subcortical white matter.There is a small focus of encephalomalacia involving the right inferior parietal lobule and postcentral gyrus which involves a portion of the right supramarginal gyrus. Another small focus of encephalomalacia is present along the left temporal lobe posteriorly.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 left vertebral artery flow-void is smaller than the right vertebral artery flow-void. This is nonspecific.The visualized portions of the paranasal sinuses demonstrate scattered opacities.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. There is an old left-sided medial blowout fracture present.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. There is a vague signal hyperintensity within the spinal cord at the C2-3 level. No abnormal enhancing lesions are identified in the cervical spine. There is reversal of the normal cervical curvature presentAt C2-3 there is no significant compromise to the spinal canal or neural foramina. There is a small right paramedian disc protrusion at this level.At C3-4 there is no significant compromise to the spinal canal or neural foramina. There is a minor disc protrusion at this level.At C4-5 there is no significant compromise to the spinal canal or neural foramina. There is a small central disc protrusion present at this level.At C5-6 there is no significant compromise to the spinal canal. There are bilateral uncovertebral osteophytes at this level which are worse on the right side where there is some encroachment on the right-sided exiting nerve roots..At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.There are multiple periventricular, subcortical, brainstem and cerebellar lesions present which are compatible patient's clinical diagnosis of demyelinating disorder. There is no abnormal enhancing lesion within the brain parenchyma to suggest acute plaque formation.2.There is a vague spinal cord lesion present at the C2-3 level. One possibility is that this represents a demyelinating lesion.3.There are small foci of encephalomalacia identified in the right parietal lobe and left temporal lobe as detailed above which are of unknown cause. Is possible they are vascular related or related to other injury.4.There are degenerative changes present in the cervical spine worse at C5-6 where there is some encroachment of the right-sided exiting nerve roots due to osteophytes.


Instruction: Generate impression based on findings.

Input: Paresthesia of skin [R20.2], Reason for Study: ^Reason: please rule out thalamic infarct History: right hemibody numbness Brain MRI.No evidence of acute ischemic or hemorrhagic lesion.Scattered T2/flair high signal intensity lesions on bilateral periventricular white matter and centrum semiovale indicating nonspecific small vessel ischemic disease.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. The paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate slightly ectatic and tortuosity of intracranial vasculature indicating atherosclerotic changes. Otherwise, there is no evidence of intracranial significant luminal stenosis. No evidence of intracranial arterial aneurysm.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. Nonspecific small vessel ischemic disease.3. No evidence of intracranial arterial aneurysm. No evidence of intracranial significant luminal stenosis.


Instruction: Generate impression based on findings.

Input: Clinical question: Aphagia, status post TPA. Signs and symptoms: Aphagia Previously noted on MRI examination from 11 -- 16 left thalamic infarct is again identified with no evidence of hemorrhagic transformation. Subtle mass effect by the edema of the stroke on the third ventricle is noted. There is however no evidence of hydrocephalus. No evidence of hemorrhage is detected. No evidence of new findings. Cortical sulci, ventricular system and all CSF cisterns remain within normal.

Output: Subacute nonhemorrhagic left thalamic stroke.


Instruction: Generate impression based on findings.

Input: Clinical question: Patient hypoechoic, concern for cord paralysis. Signs and symptoms: Hypotonia. Enhanced CT of the soft tissues of the neck:Limited images of intracranial space demonstrated ring enhancing lesions in bifrontal lobes at the site of previously noted large parenchymal hemorrhages. There is complete resolution of head CT of blood product at this site since prior head CT from 10 -- 4 -- 10.Images through the skull base, cavernous sinuses, paranasal sinuses and bilateral petrous bones are within unremarkable.Examination demonstrates edematous changes of the left piriform sinus with partial effacement of sinus and subtle enhancement. There is also evidence of left vocal cord paralysis and thickening. There is no evidence of a mass. The above findings could be result of trauma and extended duration of intubation. There is evidence of a sclerotic changes of left aspect of thyroid cartilage with some irregularity. This finding could represent a healing fracture. Further evaluate an MRI of larynx is recommended. There is no evidence of compromise of the airway. The thyroid lobes are within normal size and density. Trachea is intact. No definitive abnormality of the cervical spine is noted. Limited images of the apices of the lungs and mediastinum are within normal limits.60 cc of Omnipaque 350 is administered.

Output: Edematous changes of the left piriform sinus with asymmetrical enhancement of the mucosal compared to the left may represent inflammatory change. There is evidence of left vocal cord paralysis with soft tissue thickening of the vocal cord. Above changes could be result of long term intubation. The sclerotic changes of the left aspect of thyroid cartilage compared to the right may be an anatomical variation however possibility of a posttraumatic fracture and healing process cannot be ruled out. Follow-up with a dedicated MRI of larynx is recommended if patient's symptoms do not resolve.


Instruction: Generate impression based on findings.

Input: History of relapsed AML status post transplant with back pain. Thoracic Spine: There is diffuse T1 and T2 vertebral bone signal hypointensity. There is degenerative disc disease in the cervical spine seen on sagittal view without evidence of cord compression. There is no intrathecal hematoma, abscess, or tumor deposit. However, there is posterior epidural lipomatosis at multiple levels, measuring up to 10 mm in thickness and resulting in anterior displacement of the spinal cord and marked effacement of the intrathecal cerebrospinal fluid. Nevertheless, there is not convincing spinal cord deformity or signal abnormality. The vertebral column alignment is anatomic. The vertebral body heights are preserved. There is diffuse subcutaneous edema.Lumbar Spine: There are partially-imaged geographic heterogeneous areas in the bone marrow of the bilateral sacral ala and iliac bones. Otherwise, there is a background of diffuse T1 and T2 vertebral bone signal hypointensity. The conus is normal in morphology and terminates at L1 level. There is a posterior disc-osteophyte complex at the L4-5 level without significant spinal canal or neural foraminal stenosis. There is lack of the usual lordosis, but no spondylolisthesis. The vertebral body heights are preserved. There are bilateral renal cysts. There is diffuse subcutaneous edema.

Output: 1. Diffuse bone marrow signal abnormality related to leukemia. Partially-imaged heterogeneous bone marrow of the bilateral sacral ala and iliac bones may also be related to leukemia and/or treatment effects, although osteonecrosis is a potential consideration. Please refer to the separate pelvis MRI report for additional details.2. Epidural lipomatosis in the thoracic spine associated with multilevel spinal canal narrowing.3. Mild degenerative disc disease at the L4-5 level without significant spinal canal or neural foraminal stenosis.


Instruction: Generate impression based on findings.

Input: 68-year-old female with stuttering, right arm and chest heaviness, pain. There is no restricted diffusion to indicate acute infarct. Focal T2 hyperintensity in the right posterior frontal lobe, left thalamus, and the left pons are consistent with chronic prior infarcts. Other scattered small foci of T2 hyperintensity in the cerebral white matter suggest chronic small vessel ischemic disease. Previously seen T2 hyperintensity in the right medullary olives indicative of hypertrophic olivary degeneration is no longer clearly appreciated. There is no acute intracranial hemorrhage, mass effect, or midline shift. The ventricles and sulci are normal in size and configuration. There is no evidence of pathologic enhancement.

Output: 1.No evidence of acute cerebral infarct as clinically questioned.2.Chronic infarcts in the right posterior frontal lobe, left thalamus, and left pons.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Left-sided ataxia. Posterior circulation stroke. Study is mildly limited by patient motion.BRAIN MRI: There is a wedge-shaped area of diffusion restriction and T1-hypointense/T2-hyperintense signal involving the superior aspect of the left cerebellar hemisphere and the left superior cerebellar peduncle and left posterolateral aspect midbrain, with associated mild swelling causing very minimal mass-effect on the fourth ventricle. This is associated with mild, heterogeneous contrast enhancement reflecting the subacute nature of the infarct. Otherwise, there is encephalomalacia in the lateral left occipital lobe extending into the inferior part of the left parietal lobe, with associated ex vacuo enlargement of the left lateral ventricular occipital horn. There are punctate foci of susceptibility effect within these infarcts which probably reflect mineral deposition or minimal hemorrhage. There are also multiple small CSF intensity lesions in the basal ganglia and in the left subinsular region, compatible with chronic infarcts. There is also moderate periventricular and deep T2-hyperintense lesions, which most likely represent chronic microvascular ischemia, superimposed on moderate brain volume loss. There is no midline shift or brain herniation. Caval septum pellucidum and cavum vergae noted and common incidental findings. There is trace mucosal thickening the paranasal sinuses. There is no gross orbital abnormality. There is no destructive skull lesion.CRANIAL MRA:There is moderate narrowing of the terminal part of right V4 segment and mild narrowing involving the mid left V4 segment and distal basilar artery. The left posterior cerebral artery is mildly attenuated. The right A1 segment is hypoplastic. Otherwise, the anterior circulation shows mild irregularity from mild atherosclerosis but no large vessel occlusion. NECK MRA:Accounting for limitation caused by patient motion, there is no significant, flow-limiting stenosis or occlusion of the cervical carotid arteries or vertebral arteries. However, the origin of the right vertebral artery is suboptimally assessed. Also an apparent severe stenosis involving the mid right V2 segment at C4-C5 level is probably artifactual. Otherwise, the vertebral arteries are mildly irregular, reflective of mild atherosclerosis. There are tiny thyroid nodules, the largest measuring up to 4 mm in the right lobe.

Output: 1.Acute to subacute left cerebellar infarct in the territory of the superior cerebellar artery, associated with only minimal mass-effect.2.Chronic left occipital infarct with punctate foci of hemorrhage or mineral deposition. Moderate chronic cerebral white-matter microvascular ischemia and moderate global brain volume loss.3.There is moderate narrowing of the terminal right V4 segment. Otherwise, there is mild atherosclerotic involvement of the intracranial arteries but no large vessel occlusion. Specifically, the superior, anterior inferior and posterior inferior cerebellar arteries are visualized bilaterally.4.Vertebral arteries in the neck are suboptimally evaluated. There is at least mild atherosclerotic disease involving the vertebral arteries in the neck. No long segment occlusion. Repeat MRA neck or CTA can be considered as clinically indicated. No significant stenosis involving the common or internal carotid arteries.


Instruction: Generate impression based on findings.

Input: Reason: mass or old infarct? History: new headache with left-sided numbness. There is no evidence of intracranial hemorrhage, mass, or acute infarct. Increased DWI signal in the anterior medial frontal lobes likely represents artifact. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. Right maxillary mucous retention cyst/polyp.

Output: No acute infarct or other findings to explain patient's symptoms.


Instruction: Generate impression based on findings.

Input: CT of the lumber spine without effusion. The construct parallel to the disks. Finding pedicular screw placement. Fusion at L4 -- L5. Non-infused CT of lumber spine:Axial 1.0-mm CT images of the entire lumbosacral spine were performed. Sagittal and coronal 2-D reformatted images were also acquired.The alignment the vertebral column is unremarkable.Examination demonstrates advanced degenerative disk disease at L1 -- L2 with significant loss of intravertebral disk height and extensive adjacent endplate sclerosis.Minimal degenerative changes of disks at the other levels are noted.There is significant hypertrophic changes of posterior elements in particular of the ligamentum flavum with heavy calcification at multiple levels. This is more severe at L4 -- L5 level with evidence of mass-effect by hypertrophied ligamentum flavum on the thecal sac and results in central spinal stenosis. There is a focus of low attenuation of the bone with internal thick articulation in the left pedicle of L5 vertebrae highly suspected of skeletal hemangioma. This finding a is also visible on prior MRI examination. On the current exam this finding is most noticeable on axial image 43 of series 80228. On prior MRI exam this finding was visible on sagittal T2 weighted image 12 of series 2 and axial T2-weighted image 31 of series 5.

Output: 1.Extensive degenerative changes of posterior elements throughout the lumber spine in particular of the ligamentum flavum with heavy calcification and resultant central spinal stenosis at L4--L5.2.Small hemangioma of left L5 pedicle measuring approximately 9.6 x 8.6-mm in size.


Instruction: Generate impression based on findings.

Input: Memory loss. ? Late-onset Alzheimer dementia. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are a few punctate T2-hyperintense lesions in the cerebral white-matter. The brain parenchyma appear unremarkable otherwise. There is unchanged mild expansion of the sylvian fissures and the sulci, reflecting age-appropriate brain volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The expanded, empty sella remains unchanged. There is also a small CSF-filled invagination into the floor of the left middle cranial fossa anterior to the left foramen ovale which is unchanged since the previous examination. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1.Age-appropriate global brain volume loss without specific distribution, not significantly changed since October 2014. 2.Relatively mild white-matter lesions that are nonspecific but most likely vascular related


Instruction: Generate impression based on findings.

Input: Clinical question: Rule out intracranial bleed. Signs and symptoms: multiple falls. Unenhanced head CT:Findings highly suspected for moderate to advanced small vessel disease of indeterminate age are noted. The large area of low-attenuation in high convexity right frontal lobe white matter with associated mass effect suspected for edema. Recommend further follow-up with an enhanced CT or an MRI with infusion to exclude possibility of malignancy. This is a new finding since prior examination from 2006.There is no evidence of hemorrhage, hydrocephalus or midline shift. Calvarium is intact. Extensive right maxillary sinus opacification and otherwise unremarkable visualized paranasal sinuses.There is also subtle low attenuation of the cortex of the right posterior high convexity frontal lobe suspected for subacute ischemic disease.

Output: 1.High convexity right frontal low attenuation of white matter has the appearance of vasogenic edema and recommend further follow-up with an enhanced study to exclude underlying malignancy.2.Small vessel disease of indeterminate age.3.Subtle low attenuation of the right posterior high convexity frontal cortex may represent a focal area of subacute stroke.4.Recommend follow-up with an enhanced MRI for further evaluation of the above findings.


Instruction: Generate impression based on findings.

Input: Clinical question to be answered: Hydrocephalus. Signs and symptoms: Mental confusion. No definitive appreciable interval change since prior exam. Limited view of cortical sulci remain similar to what was noted on the prior study. Minimal residual blood within the subarachnoid space in high convexity remains stable. No change in the size of ventricular system. No definitive evidence of new bleed, new area of ischemic change or hydrocephalus. Follow-up with an MRI is recommended if patient's clinical symptoms do not improve.

Output: Stable exam.


Instruction: Generate impression based on findings.

Input: Backache, unspecified [724.5] / Malignant neoplasm of breast (female), unspecified site [174.9], Reason for Study: ^Reason: met breast CA, urinary retention, eval for leptomeningeal spread. Also include upper sacrum given known met there. History: met br For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. Again demonstrated multifocal metastatic lesions including right sacral ala (the largest one, 24mm x 25.2mm x 28mm), left sacral ala, left ilium and right ilium lesions. There is also subcutaneous nodule on the left side at the level of obturator foramen. On the L-spine, there are small metastatic lesions on the L4 and L5 vertebral bodies.There is normal lumbar lordosis. The spine alignment is anatomic. The vertebral body height is preserved. The signal of the visualized cord is normal. No evidence of spinal canal/neural foraminal narrowing. The conus medullaris terminates at the L2 level.There is no evidence of abnormal enhancement, cord compression or mass. There are multiple non enhancing low signal intensity lesions on post gadolinium T1 weighted images, no interval change comparing to Jun 20 2015 abdominal CT scan.Degenerative changes are specified by the intervertebral level as follows: T12-L1: no neuroforaminal narrowing or spinal stenosis. L1-L2: no neuroforaminal narrowing or spinal stenosis. L2-L3: no neuroforaminal narrowing or spinal stenosis. L3-L4: no neuroforaminal narrowing or spinal stenosis. L4-L5: minimal bulging of disc, no neuroforaminal narrowing or spinal stenosis. L5-S1: no neuroforaminal narrowing or spinal stenosis.

Output: 1. Multiple various sized vertebral bodies, sacrum, bilateral iliac and subcutaneous metastatic nodules as described above.2. No evidence of spinal canal stenosis or abnormal enhancement indicating spinal canal or spinal cord involvement.


Instruction: Generate impression based on findings.

Input: 38 year old with strong family history of breast cancer and BRCA2 mutation. History of breast cancer in mother diagnosed at the age of 44 and maternal grandmother diagnosed at the age of 63. There is scattered fibroglandular tissue in both breasts.Minimal parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.Focal enhancement of the left breast skin is noted at lower outer aspect.

Output: 1. No MRI evidence for malignancy. 2. Focal skin enhancement in the left breast at lower outer aspect. Clinical correlation is recommended.BIRADS: 2 - Benign finding.RECOMMENDATION: C - Clinical Correlation Needed.


Instruction: Generate impression based on findings.

Input: Reason: stroke History: confusion headacheDOB: 4/30/192788 yearsFemale MRI of the brainNo diffusion weighted abnormalities are appreciated.There is a mild degree of periventricular and subcortical confluent hyperintense white matter lesions present identified on the FLAIR and T2 images. Patchy T2 and FLAIR signal hyperintense foci are present in the brainstem, thalami and internal capsules. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Punctate foci of T2 signal hypointensity are present in the left thalamus as well as periventricular white matter.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. The eyeball lenses are thin.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 no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is small in diameter. The left A1 segment is slightly larger than the right A1 segment. The posterior communicating arteries are intact. The right posterior communicating artery is small. The left posterior communicating artery is tiny. The left vertebral artery is larger than the right vertebral artery. There is mild narrowing along the intracranial right vertebral artery.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. The proximal vertebral arteries are better assessed on the axial MRA of the neck images series #1310 where no stenosis is appreciated along the left vertebral artery course, however, there appears to be narrowing at the origin of the right vertebral artery with a 60%stenosis.

Output: 1.There is no evidence for acute ischemic cerebral infarction.2.There is 60% stenosis at the origin of the right vertebral artery.3.Periventricular and subcortical white matter signal changes are nonspecific. At this age they are most likely vascular related though they could be related to a neurodegenerative process such as nonspecific leukoencephalopathy of aging. 4.Patchy lesions in the brainstem and thalami are likely vascular related.5.There are microhemorrhages present in the periventricular white matter as well as in the thalami.6.There is no evidence for intracranial cerebrovascular occlusive disease appreciated.


Instruction: Generate impression based on findings.

Input: Limited imaging was obtained for surgical localization purposes. Post operative changes are again seen from left frontal parietal temporal craniotomy with minimal underlying scattered dural thickening and enhancement remaining. There is a small CSF signal intensity resection cavity along the anterior/superior left temporal lobe. There is adjacent lesion in posterior to the resection cavity in the left temporal lobe, better previous outside MRI.There is redemonstration of a masslike area of enhancement in the remaining left superior temporal gyrus, as well as additional nodule of enhancement in the inferior anterior left temporal lobe. The larger mass measures 12 x 17 mm in greatest dimensions by 15 mm in greatest CC dimension, enlarged since the previous outside exam (7 x 13 x 11 mm) allowing for differences in technique. The other smaller mass along the anterior/inferior aspect of the resection cavity measures 10 x 11 mm in greatest axial dimensions by 10 mm CC progressed since the previous exam, where the nodule measured 5 mm. It now demonstrates central hypoenhancement. The masses may be contiguous via curvilinear enhancement seen along the inferior margin of the resection cavity on 302/37. Branches of the left middle cerebral artery course in close proximity to these masses.The cisterns remain patent. There is no midline shift or mass effect. There is extensive abnormal T2/FLAIR hyperintensity involving the bilateral cerebral white matter and in near confluent pattern, left greater than right side, with ex vacuo dilatation of the left lateral ventricle. No extra-axial fluid collection is identified. The right cerebellar hemisphere is absent, likely developmental.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits.

Output: 1. Interval progression of left temporal lobe enhancing masses which may be minimally contiguous via curvilinear enhancement, when compared to outside MRI. Findings are consistent with tumor progression.2. Redemonstration of extensive abnormal white matter signal, left greater than right side, which overall likely represents post treatment changes, although the left temporal lobe findings may represent a combination vasogenic edema and/or nonenhancing tumor.3. Right cerebellar hypoplasia.


Instruction: Generate impression based on findings.

Input: 44 years Female (DOB:1/21/1972)Reason: extent of brain damage post MVA History: headaches, post traumatic amnesiaPROVIDER/ATTENDING NAME: ANTHONY T REDER ANTHONY T REDER The CSF spaces are appropriate for the patient's stated age with no midline shift. There is no evidence for intracranial hemorrhage.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 minor opacities. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: MRI of the brain is within normal limits. No MRI visible sequela of traumatic brain injury are appreciated.


Instruction: Generate impression based on findings.

Input: Female, 13 years old. C-spine tenderness after closed head injury There is straightening of the normal cervical lordosis, likely positional. Otherwise, the cervical spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. The epidural space, thecal sac, and spinal cord are preserved with no evidence of spinal canal/neural foraminal narrowing or myelopathy. The intervertebral discs demonstrate normal T2 intensity and height with no evidence of disc herniation. The paraspinal soft tissues are unremarkable. There is no evidence of ligamentous injury.The cerebellar tonsils extend 5-6 mm below the level of the foramen magnum, maintaining a rounded morphology, most compatible with cerebellar tonsillar ectopia.

Output: 1.Normal MR appearance of the cervical spine, without evidence of acute osseous or ligamentous injury. No evidence of cord compression.2.Findings most compatible with cerebellar tonsillar ectopia as above.


Instruction: Generate impression based on findings.

Input: Gait instability. Remote history of right caudate infarct (in 2009). There is focal encephalomalacia involving the right frontal coronal radiata as well as the lateral aspect of the right caudate head and the anterior part of the right external capsule, which is unchanged since previous CT scan. Lacunar infarct involving the posterior aspect of the left caudate head is not definitively seen on prior CT. There are also scattered foci of T2-hyperintensity in the cerebral white-matter which are nonspecific but most compatible with chronic small vessel ischemia. There is tiny focus of susceptibility effect in the central superior aspect of the pons without associated edema, which likely represents chronic microhemorrhage. There is no acute infarct or acute intracranial hemorrhage. There is no mass-effect, midline shift or brain herniation. There is no abnormal intracranial contrast enhancement.The lateral and third ventricles are moderately dilated, which has mildly increased compared to the previous CT scan. There is also focal dilatation involving some of the sulci.There is minimal ethmoid mucosal thickening. The orbits are grossly unremarkable. There is no destructive skull lesion. Sella turcica is partially empty which is usually normal variant in this age group.

Output: 1.There is no acute infarct or intracranial mass. 2.Mild to moderate chronic small vessel ischemic disease with small chronic infarcts as described above. 3.Suggestion of mild disproportionate enlargement of the ventricles compared to the degree of volume loss. Finding may represent communicating hydrocephalus/NPH in the appropriate clinical setting.


Instruction: Generate impression based on findings.

Input: Diffuse neuropathy. There is mild kyphosis centered at C4-5, but no spondylolisthesis. There is an eccentric right disc-osteophyte at C4-5 that abuts the spinal cord and results in moderate right and mild left neural foraminal narrowing. There is also a small eccentric right disc-osteophyte at C5-6 that results in mild right neural foraminal narrowing, but no significant left neural foraminal or spinal canal narrowing. There is no significant left neural foraminal or spinal canal narrowing at C2-3, C3-4, C6-7, or C7-T1. The vertebral body heights are preserved. The vertebral bone marrow signal is unremarkable. The spinal cord displays normal signal. The paravertebral soft tissues are unremarkable.

Output: 1. Mild kyphosis centered at C4-5, but no spondylolisthesis. 2. An eccentric right disc-osteophyte at C4-5 that abuts the spinal cord and results in moderate right and mild left neural foraminal narrowing. 3. A small eccentric right disc-osteophyte at C5-6 that results in mild right neural foraminal narrowing, but no significant left neural foraminal or spinal canal narrowing.


Instruction: Generate impression based on findings.

Input: 54-year-old female with right knee pain. Evaluate for meniscal injury or ligament injury. MENISCI: The menisci appear intact.ARTICULAR CARTILAGE AND BONE: There is a focal full-thickness articular cartilage defect along the medial femoral condyle (image 11; series 901). There is bone marrow signal abnormality in the underlying area of the medial femoral condyle, likely degenerative. There is articular cartilage degeneration affecting the medial and lateral facet of the patella. There is fraying of the articular cartilage of the trochlea. Subcentimeter cystic focus in the proximal tibia likely represents a subchondral cyst.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact. ADDITIONAL

Output: Degenerative changes including a focal full-thickness articular cartilage defect along the medial femoral condyle as described above. No evidence of meniscal injury, as clinically questioned.


Instruction: Generate impression based on findings.

Input: 16-year-old male with pain and swelling, history of ACL repair in 12/2013, with new injury during cheerleading MENISCI: There is a complex tear of the posterior horn of the medial meniscus with a double PCL sign suggestive of a buckle handle tear. The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: The articular cartilage is intact. No marrow edema is evident.LIGAMENTS: Postsurgical changes of a prior ACL reconstruction. The ACL graft fibers are not well visualized suggestive of a rupture. The posterior cruciate ligament is intact. The medial collateral ligament is intact. The lateral collateral ligament complex is intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1.Poor visualization of the ACL graft fibers suggestive of ACL graft rupture.2.Bucket-handle tear of the posterior horn of the medial meniscus.


Instruction: Generate impression based on findings.

Input: 68 year old female who is status post right lumpectomy (1/23/15) for biopsy proven IDC grade 3, presents for MRI assessment. The pathology results for the recent lumpectomy revealed 2 foci of ILC and extensive LCIS within the specimen in addition to the known IDC. There is scattered fibroglandular tissue in both breasts.Minimal parenchymal enhancement is noted bilaterally.There is a post-operative seroma, 74 x 34 x 32 mm (all measurements: AP x LR x CC) at 6 o'clock position in the right breast from the middle depth to immediate anterior of the pectoralis muscle. Anterior to this seroma cavity, there is an extensive non mass enhancement, measuring 53 x 27 x 41 mm, including a small non mass enhancement (11 x 15 x 5 mm), located 1 cm anterior to the seroma, which shows more distinct contrast. This extensive non mass enhancement extends from the anterior edge of seroma to the nipple. Post surgical changes are seen in the right axilla. No abnormal axillary lymph nodes are identified in right axillary regionNo abnormal enhancement is seen in left breast. No abnormal axillary lymph nodes are identified in left axillary region.

Output: 1. Suspicious non mass enhancement in the right breast, extending from the anterior border of seroma to the right nipple. If biopsy is needed for this lesion, MR guided biopsy will be of choice.2. No MR evidence of malignant in the left breast or either axilla.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: 59-year-old female with cellulitis and left great toe ulceration. Evaluate for osteomyelitis. Skin ulceration is noted along the dorsal aspect of the great toe. Surrounding the great toe is a large area of devitalized tissue with interspersed pockets of fluid measuring approximately 2.2 x 1.9 cm in greatest dimensions (series 1101, image 10). These findings extend from the distal tuft of the great toe along the flexor tendon to the level of the tarsometatarsal joint.Foci of low T1 and bright T2 signal involving the bone marrow of the distal tuft of the great toe are suggestive of distal osteomyelitis. There is diffuse subcutaneous edema as well as moderate osteoarthritis involving the first MTP joint.

Output: 1.Findings compatible with osteomyelitis of the distal tuft of the great toe as described above.2.Large area of devitalized tissue and interspersed fluid surrounding the great toe and extending proximally along the flexor and extensor tendon.


Instruction: Generate impression based on findings.

Input: Personal history of right breast lumpectomy for DCIS in 2002 followed by radiation and hormonal therapy. BRCA2 mutation carrier. Family history of breast carcinoma in her mother, maternal first cousin, and paternal aunt; ovarian carcinoma in her maternal aunt diagnosed at age 35. There is scattered fibroglandular tissue in both breasts.Minimal parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. Post-surgical volume loss and distortion of the right anterior breast are stable. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Male 23 years old Reason: PSC, eval for stricturing or lesions History: PSC ABDOMEN:LIVER, BILIARY TRACT: Multifocal biliary ductal stricturing and dilatation appears similar to prior exam, including strictures of the left hepatic and common ducts.T1 and T2 hypointense lesion which enhances and measures 10 mm (series 13/71), unchanged in size consistent with pseudoaneurysm. Segment 8 wedge-shaped T2 hyperintense region consistent with hepatic artery to portal vein fistula, unchanged. No suspicious hepatic lesions.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No evidence of peritoneal carcinomatosis.

Output: 1.Stable biliary tree findings consistent with PSC. No suspicious hepatic lesions.2.Pseudoaneurysm, and likely hepatic artery to portal venous fistula, unchanged in appearance.


Instruction: Generate impression based on findings.

Input: Cystic pineal gland 6 month follow up. There is an unchanged cystic pineal gland that measures up to 11 mm. There is no evidence of intracranial hemorrhage or acute infarct. The brain parenchyma appears unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Unchanged cystic pineal gland.


Instruction: Generate impression based on findings.

Input: Clinical question: Status post pericardial window POD #1. Now with new facial droop. Evaluate for acute stroke, intracranial hemorrhage. Signs and symptoms: Left facial droop, right pronator drift. CT of brain without infusion:Images through posterior fossa demonstrate minimal prominence of the fourth of the cerebellum and vermis and are otherwise unremarkable.Images through supratentorial space demonstrate an area of low attenuation involving the subcortical white matter of right frontal lobe. This appears to apply mass effect on the adjacent cortical sulci and is highly suspected for an acute stroke. If clinically is desired an MRI can further evaluate this area of stroke. There is no evidence of hemorrhage, ventriculomegaly or midline shift. Calvarium, limited view of paranasal sinuses and mastoid air cells are also unremarkable.

Output: 1.Focal area of edema in subcortical right frontal lobe suspected for an acute/subacute stroke considering patients provided clinical data.2.No evidence of hemorrhage, hydrocephalus or midline shift.


Instruction: Generate impression based on findings.

Input: 11-year-old female with a history of MEN I presents with hypoechoic lesions found on endoscopic ultrasound. ABDOMEN:LIVER, BILIARY TRACT: No focal lesions. No intra or extrahepatic biliary ductal dilatation. The gallbladder is normal in appearance.SPLEEN: No significant abnormality noted.PANCREAS: High T2 signal focus in the pancreatic head measures 0.8 x 0.7 cm (series 501, image 11) and does not enhance. Additional high T2 signal focus in the pancreatic tail, abutting the spleen, measures 0.6 x 0.8 cm (series 501, image 20), does not enhance, and follows splenic intensity on all sequences. No pancreatic ductal dilatation. No peripancreatic fluid collections.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No discrete lesion or evidence of hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The bowel is normal in appearance.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: High T2 signal, nonenhancing, foci in the pancreatic head and tail. The focus in the pancreatic tail follows signal intensity of the spleen on all sequences and may reflect an intrapancreatic accessory spleen.


Instruction: Generate impression based on findings.

Input: 24-year-old female patient with FNH. Surveillance imaging. ABDOMEN:LIVER, BILIARY TRACT: Again seen are multiple T2 hyperintense lesions throughout the liver parenchyma, similar compared to prior.In the posterior right hepatic dome there is a T2 hyperintense and arterially enhancing lesion that measures 1.9 x 1.2 cm on arterial enhanced images (series 1002 image 297), unchanged when measured similarly. This lesion does not retain contrast on delayed hepatobiliary phase images and demonstrates trace washout on hepatic phase imaging.There is a lesion in the anterior left lobe of the liver that measures 1 cm and is dark on T1 and T2 and does not demonstrate enhancement and may represent a hemorrhagic cyst.Numerous additional high T2 and arterially enhancing lesions within the liver demonstrate retention of contrast on hepatobiliary phase imaging, compatible with focal nodular hyperplasia. These lesions appear similar compared to prior exam.No intra or extra hepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Peribronchovascular soft tissue thickening in the right lower lobe noted and optimally evaluated on prior CTs of the chest.

Output: 1.Lesion within the posterior right hepatic dome with atypical imaging characteristics may represent an atypical FNH or an adenoma.2.Numerous additional lesions throughout the liver parenchyma with imaging features compatible with FNH appear similar compared to prior.


Instruction: Generate impression based on findings.

Input: 20 yo female with a history of hypopituitarism (central adrenal insufficiency, central hypothyroidism) as well as Chiari malformation, POTS on florinef/midodrine (since 2012), pseudotumor s/p LPS revision most recently 12/16/2014, and MTHFR mutation who presented with acute on chronic refractory headaches, nausea, and vomiting. Urinary incontinence, evaluate for tethering or compression. Brain: Again seen are postsurgical changes of suboccipital craniectomy for Chiari decompression. Low-lying cerebellar tonsils with pointed morphology are unchanged. There are mildly diminished CSF spaces ventrally and dorsally at the foramen magnum but not significantly changed. Biphasic flow is slightly diminished but otherwise preserved ventrally and dorsally. Finding is unchanged. There is a small focus of tenting involving the left dorsal cerebellar surface seen on the high-resolution fiesta sequence which is unchanged since 8/1/2013 and may represent scarring.Compared to MRI dated 5/27/2014, there is slight increase in sagging appearance of the brain with mildly diminished suprasellar cistern compared to prior. There is no restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are unchanged in size and configuration without evidence of hydrocephalus. No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved.There is stable prominence of the pituitary gland measuring up to 11 mm in the craniocaudal dimension and is appropriate for patient's age. Subcentimeter nonenhancing pituitary lesion measuring 3 mm at the junction of the pituitary gland and infundibulum (sagittal postgad series 1801 image 8/15 and axial 3D T1 PG series 1901 image 123/350) remains unchanged since at least 12/31/2013. Mild apparent thickening of the pituitary infundibulum is also unchanged. There is contact of the pituitary gland with the optic chiasm. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits. Complete Spine:No evidence of cervical syrinx or other cord signal abnormality. The spine alignment is anatomic. The vertebral body heights are preserved. Bone marrow signal is within normal limits. No evidence of significant disk disease, spinal canal or neural foramina stenosis. The paraspinal soft tissues and musculature are unremarkable.The conus medullaris normally at mid L1. Filum terminale appear normal in signal intensity, length and caliber. No signal abnormality or masses including lipoma involving the filum terminale. The spinal canal is intact with no evidence of dysraphism. Prone images demonstrate appropriate ventral displacement of the conus.There are several Schmorl nodes of the thoracic spine. There is small disc protrusion at T11-T12 which is stable to minimally minimally more prominent compared to 4/18/2012 and associated with mild indentation of the right ventral cord. No cord signal abnormality.

Output: 1. Postsurgical changes of Chiari decompression with no significant change in appearance of the low-lying cerebellar tonsils. There is mildly diminished CSF space ventrally and dorsally which is not significantly changed. Biphasic flow is slightly diminished but otherwise preserved ventrally and dorsally at the foramina magnum. No significant change. There is a small focus of tenting involving the left dorsal cerebellar surface seen on the high-resolution FIESTA sequence which is unchanged since 8/1/2013 and may represent scarring. Compared to 5/27/2014 there is suggestion of brain sagging and slight interval decrease in size of the suprasellar cistern; finding may be related to some intracranial hypotension possibly related to recent lumbar puncture; correlate with any postural component of headaches or low CSF pressures. 2. Unchanged ventricles without evidence of hydrocephalus. No intracranial mass or mass-effect is seen.3. Unchanged prominence of the pituitary gland which measures up to 11 mm in the craniocaudal dimension is appropriate for the patient's age. Tiny 3-mm focus of non-enhancement in the superior aspect of the pituitary gland is unchanged and may represent a tiny microadenoma.4. No evidence of syrinx or other cord signal abnormality. Conus is in normal position. No findings to suggest tethered cord. Appropriate ventral conus motion on the prone sequence.5. Small disk protrusion at the T12-L1 level is stable to minimally more prominent compared to 4/18/2012 and is associated with mild indentation of the right ventral cord at this level.


Instruction: Generate impression based on findings.

Input: 72-year-old female with adnexal mass seen on CT and ultrasound. Evaluate adnexal mass. ABDOMEN:LIVER, BILIARY TRACT: No suspicious hepatic lesions are noted. Mild intra and extra hepatic biliary prominence. The common bile duct tapers smoothly to the level of the ampulla without evidence of lesion or mass.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Asymmetric prominence of left breast tissue.PELVIS:UTERUS, ADNEXA: There is a large left adnexal nonenhancing lesion demonstrating T2 hyperintensity, T1 hypointensity, and measuring 7.1 x 6.5 x 5.4 cm. There is a thin nonenhancing septation within this adnexal lesion.T2 heterogenous, heterogeneously enhancing subserosal uterine lesion, likely a fibroid.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.Large left adnexal cystic lesion without suspicious features measuring approximately 7 cm. Thus, this favors a benign ovarian neoplasm. Consider gynecological consultation.2.Uterine fibroid.3.Asymmetric prominence of left breast tissue is noted. Correlation with recent mammography is recommended.


Instruction: Generate impression based on findings.

Input: Left hamstring pain There is increased signal at the origin of the hamstring tendons on the left suggesting partial tearing and degeneration. There is no frank tendinous retraction. The sciatic nerve is normal. Similar findings are also noted on the right side however a discrete attachment of the conjoined tendon to the ischium is not well seen which may represent full-thickness tearing without retraction due to the presence of an intact sacrotuberous ligament. The remaining ligamentous structures, muscles, and tendons appear intact.Best seen on radial images is a small focal tear of the left anterior superior labrum at the 2:00 position. The left hip otherwise is unremarkable. There is mild osteoarthritis of the pubic symphysis.

Output: Chronic appearing bilateral degeneration/tearing of the hamstring origins. Additional findings are described above.


Instruction: Generate impression based on findings.

Input: Right sided shaking. Evaluate for central etiology for seizure. There is no evidence of mesial temporal sclerosis, gray matter heterotopia or structural abnormality. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unremarkable.

Output: No evidence of seizure focus.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: A 47 year old male with ventricular tachycardia referred to cardiac MRI for further evaluation. Left VentricleThe left ventricle is in the upper limit of normal range for size with low-normal systolic function. The overall LV ejection fraction is 50%, the LV end diastolic volume index is 94 ml/m2 (normal range: 74+/-15), the LVEDV is 218 ml (normal range 142+/-34), the LV end systolic volume index is 47 ml/m2 (normal range 25+/-9), the LVESV is 110 ml (normal range 47+/-19), the LV mass index is 58 g/m2 (normal range 85+/-15), and the LV mass is 135 g (normal range 164+/-36). There is subtle global hypokinesis with regional variation. There is focal late gadolinium enhancement at the basal inferolateral wall suggesting the presence of an underlying fibrosing, infiltrative, or inflammatory process. Native myocardial T1-times are mildly increased at the base inferolateral wall (~1100ms). These findings are compatible with an old inflammatory process (myocarditis) and not with myocardial infarction.No intracavitary thrombus was seen.Left AtriumThe left atrium is mildly dilated (100ml). Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 51%, the RV end diastolic volume index is 105 ml/m2 (normal range 82+/-16), the RVEDV is 244 ml (normal range 142+/-31), the RV end systolic volume index is 52 ml/m2 (normal range 31+/-9), and the RVESV is 120 ml (normal range 54+/-17). No fatty infiltration of the myocardium, no aneurysm or regional wall abnormalities were seen. No MRI findings to support the diagnosis of ARVD.Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is mildly dilated (33mm).Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac Findings4.2 cm solid lesion within the mid inferior pole of the left kidney.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. 4.2 cm solid lesion within the mid inferior pole of the left kidney, highly worrisome for renal cell carcinoma. 2. The left ventricle is in the upper limit of normal range for size with low-normal systolic function, the LVEF is 50%. There is subtle global hypokinesis with regional variation. 3. There is focal late gadolinium enhancement at the basal inferolateral wall suggesting the presence of an underlying fibrosing, infiltrative, or inflammatory process. Native myocardial T1-times are mildly increased at the base inferolateral wall. These findings are compatible with an old inflammatory process (myocarditis) and not with myocardial infarction.4. The left atrium is mildly dilated. 5. The right ventricle is normal in size with normal systolic function, the RVEF is 51%. No fatty infiltration of the myocardium, no aneurysm or regional wall abnormalities were seen. No MRI findings to support the diagnosis of ARVD.Dr Tung was notified by email about the findings by email.


Instruction: Generate impression based on findings.

Input: A 28 year old female with personal history of mild asthma recently with dyspnea and atypical chest pain during exercise. A recent echocardiography showed mildly reduced right ventricular systolic function with flattened septum. Referred to cardiac MRI for further evaluation. Left VentricleThe left ventricle is severely dilated with low normal systolic function. The overall LV ejection fraction is 52%, the LV end diastolic volume index is 117 ml/m2 (normal range: 65+/-11), the LVEDV is 186 ml (normal range 109+/-23), the LV end systolic volume index is 56 ml/m2 (normal range 18+/-5), the LVESV is 89 ml (normal range 31+/-10), the LV mass index is 58 g/m2 (normal range 67+/-11), and the LV mass is 92 g (normal range 114+/-24). There are no regional wall motion abnormalities present. There is normal wall thickness. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. The native myocardial T1-time are in the upper-normal range (~1060-1080ms). The global relative enhancement (GRE) and extracellular volume fraction are within normal ranges. These findings suggest the absence of an underlying infiltrative, inflammatory, or fibrosis process in the myocardium.Left AtriumThe left atrium is normal in size (97ml).Right VentricleThe right ventricle is severely dilated with low normal systolic function. The overall RV ejection fraction is 50%, the RV end diastolic volume index is 132 ml/m2 (normal range 69+/-14), the RVEDV is 209 ml (normal range 110+/-24), the RV end systolic volume index is 66 ml/m2 (normal range 22+/-8), and the RVESV is 105 ml (normal range 35+/-13). The heart is shifted into the left thorax as a consequence of the decreased sternum to spine dimension. The sternum is extrinsically compressing on the RV free wall, distorting its shape and causing variation in the regional motion. However, there is no evidence that this extrinsic compression is hemodynamically significant. Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC drain normally into the right atrium. IVC is grossly normal. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThere is significant scoliosis and decreased space between the sternum and spine without evidence of a classical pectus deformity. 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 low normal systolic function, the LVEF is 52% without evidence of underlying myocardial fibrosis, inflammation, or infiltration.2. The right ventricle is severely dilated with low normal systolic function, the RVEF is 50%. 3. Significant changes of scoliosis are noted. Although there is no classical pectus deformity of the sternum, the anterior-to-posterior dimension between the sternum and spine is as small as 4.5cm. The reduced space has caused the heart to be shifted into the left thorax and distorted the shape of the right ventricle. This extrinsic compression of the right ventricle does not appear to be causing any hemodynamically significant changes. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: The exam was not performed as a pituitary MRI which somewhat limits evaluation. In addition, there is mild motion degradation of the images. Within these limitations, there is an enhancing pituitary mass measuring 19 CC x 16 ML x 17 AP mm with effacement of the suprasellar cistern, abutting the optic chiasm without significant displacement or mass effect on the optic chiasm. Although evaluation of the cavernous sinuses is limited, the mass appears to the confined within the sella, abutting the cavernous and supraclinoid internal carotid arteries without clear invasion. There are no other areas of suspicious intracranial enhancement. There is no acute infarct, or midline shift. There is patchy T2 signal abnormality adjacent to the trigone of the left lateral ventricle without enhancement, nonspecific, possibly vascular related. There is no hydrocephalus.

Output: 19 x 16 x 17 mm enhancing pituitary mass most likely representing a macroadenoma. Metastatic disease is considered much less likely.No additional intracranial lesions are seen to suggest metastatic 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: Reason: possible meniscus/ligamentous injury MENISCI: There is mild intermediate signal in the medial meniscus, consistent with intrasubstance degeneration without discrete tear. The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: The articular cartilage is intact. There is no abnormal bone marrow signal intensity.LIGAMENTS: The ACL, PCL, LCL, and MCL are intact. EXTENSOR MECHANISM: The quadriceps and patellar tendons are intact.ADDITIONAL

Output: Mild muscle edema involving the popliteus tendon which may represent an underlying sprain without discrete tear.


Instruction: Generate impression based on findings.

Input: Headache and hand numbness. There is mild scattered cerebral white matter T2 hyperintensity. 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, and scalp soft tissues are grossly unremarkable. There are bilateral maxillary sinus retention cysts.

Output: 1. No evidence of acute infarction.2. Mild nonspecific cerebral white matter T2 hyperintensity may represent small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: Female, 68 years old, with psoas abscess undergoing treatment. Compare to prior study to assess for resolution. Findings are again seen reflecting prior posterior instrumented fusion from L3 through L5 as well as interbody fusion at L3-4 and L4-5. Previously seen rim-enhancing fluid collections within the posterior operative soft tissues and within the bilateral psoas muscles are not clearly appreciated and have likely resolved or nearly completely resolved.Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. No evidence of pathologic marrow edema, replacement or enhancement is seen. The visualized distal spinal cord and conus are within normal limits. The cauda equina is unremarkable where not obscured by metallic artifact.L1-2: Facet arthropathy. Minimal disc bulging. No significant spinal canal or foraminal stenosis. No interval changes. L2-3: Facet arthropathy. No significant spinal canal or foraminal stenosis. No interval changes. L3-4: Marked facet arthropathy. Ligamentum flavum thickening. Mild disc bulging. Mild generalized spinal canal stenosis. The left lateral recess remains narrowed. Left foraminal narrowing. No interval changes. L4-5: Marked facet arthropathy. Ligamentum flavum thickening. Mild bulging disc. Mild spinal canal stenosis. Moderate to severe right foraminal narrowing. No interval changes. L5-S1: Facet arthropathy. Minimal disc bulging. No significant spinal canal stenosis. No significant foraminal narrowing. No interval changes.

Output: 1.Redemonstrated is evidence of L3-L5 posterior and interbody instrumented fusion.2.Since the prior examination, abscesses within the posterior operative soft tissues and the psoas muscles have resolved or nearly completely resolved. No new abnormalities are detected.


Instruction: Generate impression based on findings.

Input: Female, 58 years old, with altered mental status status post OLT. No evidence of restricted diffusion, parenchymal edema or mass effect is seen. No pathologic parenchymal or extra-axial enhancement is detected.Mild symmetric T1 hyperintensity of the bilateral globus pallidus may reflect manganese deposition from chronic liver dysfunction. Minimal T2 hyperintense rimming of the lateral ventricles is a nonspecific finding and may be within normal limits.No evidence of significant intracranial hemorrhage is seen. A few scattered foci of susceptibility are seen in the cerebral hemispheres compatible with chronic micro-hemorrhage. No abnormal extra-axial fluid collections are detected. The ventricles are normal in size and morphology.The left maxillary sinus is small showing evidence of mucosal thickening or layering secretions.

Output: 1.No acute intracranial abnormality.2.T1 signal abnormality in the globus pallidus likely reflects the sequelae of chronic liver dysfunction.3.Findings suggestive of chronic left maxillary sinusitis.


Instruction: Generate impression based on findings.

Input: Diagnosis: Headache. Family history of ischemic heart disease and other diseases of the circulatory systemClinical question: headache, family h/o cerebral aneurysm, please evaluate for aneurysmSigns and Symptoms: headache, family h/o cerebral aneurysm 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 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.Incidental note is made of partial empty sella.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 no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. The right A1 segment is small. The posterior communicating arteries are not readily identified. The vertebral arteries are similar in size.

Output: 1.No evidence for cerebrovascular occlusive disease.2.No evidence for intracranial aneurysm.3.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 4.No evidence for intracranial mass lesion or acute ischemic cerebral infarction.


Instruction: Generate impression based on findings.

Input: 83-year-old male patient with grade III oligodendroglioma status post resection, RT, and TMZ. There are stable post-operative changes of a right anterior temporal lobectomy with unchanged T2 signal abnormality surrounding the resection site extending to the right basal ganglia. There is no abnormal enhancement surrounding the right temporal resection cavity. Two new small foci of enhancement within the left paramedian cerebellar hemisphere which demonstrate correlating T2 hyperintensity. No other new or pathologic intracranial enhancement is seen. There is no restricted diffusion. Encephalomalacia involving the left anterior frontal lobe, and to a lesser degree the right inferior frontal lobe, appears similar to the prior study. Scattered periventricular and subcortical abnormal T2 signal may represent chronic small vessel ischemic disease and/or post-treatment related white matter changes. A focus of susceptibility within the left frontal lobe white matter is unchanged. The ventricles are unchanged in size. There is no midline shift or herniation. The major cerebral flow voids are intact. There are scattered tiny maxillary sinus mucous retention cysts.

Output: 1. Stable post-operative changes of a right anterior temporal lobectomy without definite evidence of tumor recurrence.2. Two new foci of enhancement within the left paramedian cerebellar hemisphere are non-specific and could potentially be vascular/ischemic in nature; attention on close follow up imaging is suggested.3. Stable periventricular and subcortical T2 signal abnormality which may represent chronic small vessel ischemic disease and/or post-treatment related white matter changes.4. Areas of frontal lobe encephalomalacia appearing similar to the prior study.


Instruction: Generate impression based on findings.

Input: Diagnosis: Other malaise and fatigueClinical question: r/o acute processSigns and Symptoms: weakness MRI of the brainMultiple small foci of diffusion restriction are present in the territory of the left precentral artery at the left middle frontal and lateral precentral gyri as well as a small portion of the operculum. These are accompanied by FLAIR and T2 signal hyperintensity.A small focus of diffusion restriction is present in the right thalamusThe CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses 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 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. There is extra-cranial origin of the right PICA.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 vertebral arteries. The RVA is larger than the LVA.

Output: 1.Patchy distribution of left precentral artery territory acute cerebral infarction. 2.Small acute cerebral infarction in the right thalamus.3.No evidence for intra-cranial or extra-cranial cerebrovascular occlusive disease is appreciated.


Instruction: Generate impression based on findings.

Input: Male, 15 years old, with seizure-like episodes. Assess for structural abnormalities. The cerebral and cerebellar hemispheres and brainstem show normal signal intensity and morphology. In particular, the mesial temporal structures are symmetric and free of pathologic signal abnormality. No restricted diffusion is seen.No 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 symptoms.


Instruction: Generate impression based on findings.

Input: 13-year-old male with neurofibromatosis. Periorbital neurofibroma causing ptosis. Please provide craniofacial protocol. There is redemonstration of a soft tissue mass located along the right eyelid along the extraconal space on the right side along the superior and temporal aspect of the right orbit which goes as far back as the posterior aspect of the right eye. It does extends into the expected location of the right lacrimal gland. This known to represent a plexiform neurofibroma based on clinical history. This is stable in overall morphology and extent compared to the MRI from 8/15/09. There is associated enophthalmus and inferior displacement of the eye on the right side.There is opacification of the right maxillary sinus. the right maxillary sinus is smaller than its left counterpart and almost completely involuted. Mastoid air cells and middle ears are clear.

Output: 1.Findings consistent with plexiform neurofibroma involving the right eyelid with extending into the right lacrimal fossa and adjacent extraconal space with no intraconal extension. There is associated enophthalmus and inferior displacement of the eye on the right side. In part this displacement and enophthalmos may also be related to right maxillary sinus atelectasis (silent sinus syndrome).2.Small opacified right maxillary sinus consistent with hypoplasia of the right maxillary sinus. Please correlate with clinical history for silent sinus syndrome or prior trauma.


Instruction: Generate impression based on findings.

Input: BRCA2 positive There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. A few scattered enhancing foci are present, none suspicious in appearance. No abnormal lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. Annual MRI screening is recommended based on her history. BIRADS: 1 - Negative.RECOMMENDATION: NS - Routine Screening Mammogram.


Instruction: Generate impression based on findings.

Input: 64 year-old female with a history of metastatic ovarian cancer. Need reevaluation and comparison to previous scans. Suboptimal examination secondary to motion and wraparound artifact.ABDOMEN:LIVER, BILIARY TRACT: Small ventral hernia containing a portion of the liver and a small amount of fluid. Nonspecific thickening of the gallbladder wall may be related to ascites. No evidence of gallstones. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Reference left periaortic lymph node measures 1.5 x 1.4 cm, previously 1.4 x 1.1 cm on prior CT examination dated 12/4/2014 (40; series 13).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Diffuse soft tissue reticulation and subcutaneous edema.OTHER: Note is made of restricted diffusion along the anterior wall of the peritoneal cavity suspicious for peritoneal carcinomatosis.Small ventral hernia containing a portion of the liver and a small amount of fluid. Trace right pleural effusion. Loculated left pleural effusion. Left pleurex catheter in place. Small amount of abdominopelvic ascites. PELVIS:UTERUS, ADNEXA: Status post hysterectomy.BLADDER: No significant abnormality noted.LYMPH NODES: Left external iliac lymph node measures 1.4 x 1.1 cm , previously 1.6 x 1.1 cm (19; series 20).BOWEL, MESENTERY: The previously described mesenteric lymphadenopathy is poorly measured on this examination, secondary to motion artifact.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small amount of free fluid within the pelvis. There is an irregular enhancing mass in the pelvic cul de sac/pouch of Douglas which measures 4.2 x 2.6 cm consistent with pelvic peritoneal metastasis.

Output: 1.Peritoneal carcinomatosis, as detailed above. No significant interval change in the reference abdominopelvic lymphadenopathy consistent with the stated history of metastatic ovarian carcinoma.2.Loculated left pleural effusion. Pleural metastatic disease cannot be excluded. Left lower lobe consolidation is nonspecific. Superimposed infection cannot be excluded. Small right pleural effusion.3.Anasarca and a small amount of abdominopelvic ascites.


Instruction: Generate impression based on findings.

Input: 23 year old female patient with abdominal pain. Question of retroperitoneal mass. ABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis without evidence of acute cholecystitis. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No retroperitoneal mass is identified.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Post-surgical changes to the anterior abdominal wall.OTHER: Trace bilateral pleural effusions, right greater than left, with overlying compressive atelectasis. Free intraperitoneal air within the abdomen is likely related to recent surgery.PELVIS:UTERUS, ADNEXA: There is a 5.2 x 1.8 cm non-enhancing structure within the left adnexa which demonstrates heterogeneous internal T2 signal; this may represent a complicated ovarian or paraovarian cyst. The right ovary is unremarkable.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: Small amount of free fluid in the pelvis.

Output: 1.No evidence of a retroperitoneal mass.2.Non-enhancing, heterogeneously cystic left adnexal lesion may represent a complicated ovarian or paraovarian cyst. 3.Cholelithiasis without evidence of acute cholecystitis. 4.Free intraperitoneal air compatible with recent abdominal surgery.


Instruction: Generate impression based on findings.

Input: 6th and 7th nerve palsy with headache. No evidence of acute ischemic or hemorrhagic lesion on this scan.Multifocal scattered high signal intensities on bilateral hemispheres on FLAIR images indicate minimal non specific small vessel disease.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.3D MRV brain post-gadolinium with maximum intensity projections of the superficial/deep intracranial venous drainage demonstrate normal flow enhancement in the superior sagittal sinus, transverse sinuses, sigmoid sinuses, internal cerebral veins, vein of Galen and straight sinus.

Output: No evidence of acute ischemic or hemorrhagic lesion on this scan.Minimal non specific small vessel disease.Normal brain MRV.


Instruction: Generate impression based on findings.

Input: 60-year-old man with history of Gleason 7 prostate adenocarcinoma in the right lateral apex. PELVIS:PROSTATE:Prostate Size: 57 x 33 mmPeripheral Zone: In the left prostatic apex (401/53, 503/184) there is a poorly defined 6 x 5 mm area of mild T2 hypointensity and ADC signal abnormality. Otherwise, the peripheral zone appears relatively normal.Central Gland: Within the right mid prostate gland anterior transitional zone (503/224, 401/59) there is ADC abnormality and markedly decreased T2 signal measuring 30 x 23 mm which crosses the midline.Seminal Vesicles: The seminal vesicles appear unremarkable.Extracapsular Extension: There are small areas of abnormal signal which may represent extraprostatic extension of tumor from the right anterior transitional zone (503/244).BLADDER: No significant abnormality noted.LYMPH NODES: No significant lymphadenopathy noted.BONES, SOFT TISSUES: In the proximal right femur (2001/13), right juxta-articular ilium (2001/114), and right iliac wing (2001/156), there are areas of abnormal enhancement and marrow signal.Bilateral inguinal hernias noted.OTHER: No significant abnormality noted.

Output: 1.Large area of abnormality in the right mid anterior transitional zone highly suspicious for neoplasm, possibly with a focus of extraprostatic extension.2.Questionable area of signal abnormality in the left apex, indeterminate for tumor. 3.Proximal right femur and right ilium lesions highly suspicious for metastases. The right femur lesion should be evaluated urgently for risk of pathologic fracture. Consider radiographs or bone scan. Findings discussed with Dr. Labbate by phone at 5:19 p.m. on 10/14/2016.4.No lymphadenopathy noted.


Instruction: Generate impression based on findings.

Input: 42 year old with strong family history of breast cancer. Family history of breast carcinoma in her sister (diagnosed at age 36), two aunts (diagnosed at age 40), and a cousin. Family history of ovarian cancer diagnosed in two aunts. BRCA mutation. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

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