Instruction: Generate impression based on findings.

Input: 35-year-old female status post cerebral cavernous reformation resection. Redemonstrated are changes from left subtemporal approach for pontine cavernous reformation resection. Pneumocephalus has resolved. Redemonstrated is susceptibility hypointensity with associated T2 hypointensity within the left pons contain a few foci of internal T1 hyperintensity. Perilesional vasogenic edema has decreased, with a small amount of residual within the middle cerebellar peduncles bilaterally (left more than right). Compared to the presurgical images, there is now significantly less mass effect and anatomic deformation. Postprocedural dural enhancement is again noted.There is a small focus of ill-defined T2 hyperintensity with associated enhancement just anterior to the left precentral gyrus, in a subcortical location, most consistent with either a tiny developmental venous anomaly or a capillary telangiectasia.Ventricular sizes are normal. Expected vascular flow voids are demonstrated. The paranasal sinuses and right mastoid air cells are clear. Fat packing is now noted within the expected region of left mastoid air cells.

Output: Susceptibility hypointensity with associated T2 hypointensity within the left pons contain a few foci of internal T1 hyperintensity. Perilesional vasogenic edema has decreased, with a small amount of residual within the middle cerebellar peduncles bilaterally (left more than right). Compared to the presurgical images, there is now significantly less mass effect and anatomic deformation. These findings are consistent with the postprocedural appearance of a cerebral cavernous reformation.


Instruction: Generate impression based on findings.

Input: 61-year-old female with unilateral posttraumatic osteoarthritis of the left hip. There is mild degeneration of the articular cartilage particularly along the posterosuperior aspect of the femoral head. Although evaluation of the acetabular labrum is limited due to the lack of intra-articular contrast, there is increased signal intensity throughout much of the labrum that likely represents degeneration and degenerative tearing. There is a small amount of fluid within the joint but no large effusion. There is fatty atrophy of the gluteus minimus muscle, but the remaining musculature of the left hip is unremarkable. Osteoarthritis also affects the right hip as seen on the large field-of-view images. There is also fatty atrophy of the right gluteus minimus muscle. Severe degenerative disc disease affects the level of L4/L5. Although incompletely imaged on this study, there appears to be focal disc protrusion, to the left of the midline at this level, which would be better evaluated with a dedicated lumbar spine MRI examination.

Output: 1. Osteoarthritis of the left hip.2. Severe degenerative disc disease at the level of L4/L5 with what we suspect is a protrusion of disc material at this level, however, this is incompletely imaged and could be better evaluated with a dedicated lumbar spine MRI exam if clinically warranted.


Instruction: Generate impression based on findings.

Input: Clinical question: Worsening back pain and lower extremity radiculopathy. Signs and symptoms: Same. Nonenhanced lumbar MRI:T12 -- L1 is unremarkable.L1 -- L2 is unremarkable.L2 -- L3 demonstrate moderate bilateral ligamentum flavum hypertrophy and unremarkable otherwise.L3 -- L4 demonstrate mild to moderate bilateral ligamentum flavum hypertrophy without spinal stenosis or neural foraminal compromise or interval change.L4 -- L5 demonstrate bilateral transpedicular screw placement since prior exam. Mild to moderate disk disease and loss of disk height with mild interval progression. There is evidence of laminectomy with resultant expansion of thecal sac and no spinal stenosis or neural foraminal compromise. Tiny focus of T2 increase signal intensity within the annulus of the disk suspected of an annular fissure.L5 -- S1 demonstrate metallic hardware artifact posteriorly from prior fusion. There is moderate disk disease and loss of disk height with interval progression since prior exam. There is however no spinal stenosis or neural foraminal compromise. Bilateral transpedicular screws at S1 level is also noted.

Output: 1.Interval post operative changes of laminectomy at L4 -- L5 level, posterior fixating wires and bilateral transpedicular screws at L4 and S1 levels as detailed.2.Mild progression of degenerative disk disease at L4 -- 5 and L5 -- S1 levels and a tiny annular fissure at L4-L5 level.3.No spinal stenosis or neural foraminal compromise at any level.


Instruction: Generate impression based on findings.

Input: 24-year-old with anaplastic astrocytoma status post proton RT and on TMZ. Again seen are postoperative changes from left parietal craniotomy and remote ependymoma resection. Resection cavity is CSF filled and appears to communicate with the atrium of the left lateral ventricle. Again seen is a cystic focus anterior to the resection cavity related to recent biopsy with susceptibility artifact indicating postbiopsy blood products.Compared to most recent MRI from 1/17/2016 and dating back to 9/30/2015, there is slight further interval decrease in the extent of abnormal T2 signal within the white matter of the left parietal, temporal, and frontal lobes. The masslike thickening of the posterior corpus callosum and cingulate gyrus has resolved. Slight decrease in signal abnormality involving the left thalamus with T1 and T2 hyperintensity also noted. Slight decrease in signal abnormality involving the posterior callosum/splenium extending into the right also noted.A more nodular area of increased T2 signal in the subcortical white matter of the left inferior parietal lobule is not significantly changed. Most recent comparison study was obtained without gadolinium however when compared to MRI brain from 9/30/2015, there is interval development of nodular enhancement in the left inferior parietal lobule which measures 9 x 7 mm associated with the nodular T2 hyperintense focus mentioned above. Enhancement involving the left posterior thalamus is again seen. Punctate nodular enhancement more laterally in the subcortical left temporal white matter was also present previously. Punctate enhancement lateral to the left parietal resection cavity is no longer seen. Mild increase in enhancement medial and lateral to the posterior body of the left lateral ventricle also noted.A cavernous malformation within the central pons is not significantly changed from prior. There are additional punctate foci of susceptibility related to chronic microhemorrhages involving the left parietal, and temporal lobes.The ventricles and basal cisterns are normal in size and configuration. The expected intracranial vascular flow voids are present. There has been significant increase in opacification of the left maxillary sinus as well as increased opacification of the right maxillary sinus. Right sphenoid sinus opacification appears improved. Opacification of the left greater than right ethmoid air cells is slightly worse. The visualized mastoid air cells are clear.

Output: 1. Compared to 1/7/2016 and 9/30/2015, there is continued decrease in T2/FLAIR signal abnormality within the white matter of the left temporal and parietal lobes, more noticeable when compared to study from 9/30/2015. There remain areas of abnormal increased T2/FLAIR signal centered within the left periatrial white matter and inferior parietal lobule related to known tumor. When compared with post gadolinium sequences from 9/30/2015, there is interval increase in nodular enhancement associated with the nodular lesion in the left inferior parietal lobule. Additional adjacent nodular areas of enhancement described above demonstrate stability, slightly increased, or slightly decreased compared to 9/30/2015. As such these findings may represent posttreatment changes but suggest attention on follow-up, particularly of the inferior parietal lobule lesion with nodular T2/FLAIR signal.2. Again seen is a separate left parietal resection cavity related to prior ependymoma resection without findings to suggest ependymoma recurrence.3. No significant change in pontine cavernous malformation.4. Increased paranasal sinus opacification.


Instruction: Generate impression based on findings.

Input: Headaches, ventricular shunt, hydrocephalus, and prior resection of a colloid cyst. There are postoperative findings related to right transfrontal resection of a colloid cyst with susceptibility from chronic blood products along the surgical approach, but no evidence of colloid cyst recurrence. There is a right transparietal ventricular catheter that termites in the posterior left lateral ventricle. The lateral ventricles remain disproportionately dilated with respect to the rest of the ventricular system. The brain parenchymal signal is otherwise unremarkable and there is no evidence of acute infarct. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable.

Output: 1. Persistent disproportionate dilatation of the shunted lateral ventricles. 2. No evidence of recurrent colloid cyst.


Instruction: Generate impression based on findings.

Input: Focal seizures with secondary generalization, most likely temporal semiology. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma, including the hippocampi, appears unremarkable. There is no evidence of grey matter heterotopia. 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 are grossly unremarkable. There is a subcutaneous lipoma that measures up to 20 mm associated with the right lipoma. There is fluid and mucosal thickening in the bilateral maxillary, right ethmoid, and right frontal sinuses.

Output: 1. No gross structural intracranial abnormality.2. FIndings suggestive of acute sinusitis.


Instruction: Generate impression based on findings.

Input: Male, 68 years old, with weakness, hoarseness and dysphagia. Brain:No restricted diffusion is seen. Scattered foci of T2 hyperintensity are seen in the periventricular white matter bilaterally. No edema or mass effect is detected. No intracranial hemorrhage or abnormal extra-axial fluid is seen. Ventricular size and morphology are within normal limits.C-spine:The cervical lordosis is slightly exaggerated but sagittal alignment is otherwise unremarkable. Vertebral body height and morphology are within normal limits. No evidence of marrow edema or marrow replacement is seen. The visualized spinal cord shows normal signal intensity and morphology throughout. No epidural abnormalities are suspected. Minimal posterior disc-osteophyte complex formation is seen at C4-5, C5-6 and C6-7, without significant spinal canal stenosis. Likewise, no evidence of significant foraminal compromise is seen.L-spine:Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. No evidence of marrow edema or marrow replacement is seen. The visualized distal spinal cord, conus and nerve roots of the cauda equina are within normal limits. No epidural abnormalities are seen. The intervertebral discs are preserved with no significant bulging or herniation. Mild facet arthropathy is seen at lower lumbar levels. No compromise of the spinal canal or neural foramina is detected.

Output: 1.Scattered nonspecific foci of T2 hyperintensity are seen in the brain. No findings are detected which could account for the patient's symptoms.2.Minimal degenerative disease in the cervical lumbar spine, without findings which would account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: Persistent knee pain MENISCI: There is mild increased signal within the posterior horn of the medial meniscus without clear extension to either articular surface. There is otherwise no evidence of tear within the medial lateral meniscus.ARTICULAR CARTILAGE AND BONE: There is mild signal heterogeneity and loss of the articular cartilage of the lateral patellar facet with with a small focus of marrow edema in the underlying patella. There is no discrete fracture line. Articular cartilage of the medial and lateral compartments is preserved.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Intact ACL.2. Mildly increased signal within the posterior horn of the medial meniscus evidence of discrete tear.3. Articular cartilage loss with underlying marrow edema in the lateral patellar facet.


Instruction: Generate impression based on findings.

Input: 64 years Female (DOB:8/5/1951)Reason: eval for brain lesion History: eval for brain lesionPROVIDER/ATTENDING NAME: PETER C WARNKE PETER C WARNKE There is an extra-axial contrast enhancing mass present which abuts the falx and is medial to the right frontal lobe. It has a broad-based the dura and measures 46 x 39 mm axial dimensions. It is heterogeneous on signal intensity on all pulse sequences. It has a low signal center. There is susceptibility effect within much of the lesion. Within the white matter in the adjacent right frontal lobe there is T2 and FLAIR signal hyperintensity suggestive of vasogenic edema. There is mass effect present with distortion of the right lateral ventricle and corpus callosum. There is also shift of the falx to the left of midline x 10 mm. An 8 mm component of the mass protrudes across midline along the anterior and superior aspect of the mass.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: There is a large right parafalcine extra-axial mass present adjacent to the right frontal lobe associated with compression of adjacent brain parenchymal structures as well as some vasogenic edema. Most likely this represents a meningioma.


Instruction: Generate impression based on findings.

Input: Male 33 years old Reason: 32 yo with cirrhosis small perfusional defect on prior scans please evaluate History: none ABDOMEN:LIVER, BILIARY TRACT: Liver has a smooth contour. There is a focal area of fatty deposition in segment 4 of the liver with associated perfusional changes. No hypervascular lesion is identified.A shunt connecting the right hepatic vein to the right portal vein is well opacified and is patent.Artifact from coils in the left upper abdomen possibly obscure the left hepatic lobe.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.No focal lesion that meets criteria for HCC.2.Focal fatty deposition in segment 4 of the liver causing focal perfusional changes.


Instruction: Generate impression based on findings.

Input: Other alteration of consciousness [780.09], Reason for Study: ^Reason: Eval for ischemia, septic emboli, other acute abnormalities History: 5-6 days AMS-- waxing/waning alertness and orientation, transient aphasia Motion artifact degraded the examination quality.There is no evidence of acute ischemic or hemorrhagic lesion.Several localized tissue losses involving right external capsule, bilateral basal ganglia and mid Pons area indicating age indeterminate likely chronic lacunar infarcts.Minimal patch high signal intensities on periventricular white matter on FLAIR imaging indicate 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, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: No evidence of acute ischemic or hemorrhagic lesion on the scan.Several chronic lacunar infarcts involving right external capsule, pons and bilateral basal ganglia as described above.


Instruction: Generate impression based on findings.

Input: Left thalamic hemorrhage. Also, history of fall with neck injury. BRAIN MRI:The left thalamic hematoma has not changed since the CT scan from yesterday, measures in the axial plane 2.1 cm x 1.3 cm. It shows signal characteristics that are compatible with its early subacute nature (peripherally T1-hyperintense and T2-hypointense). It is surrounded by moderate degree of vasogenic edema resulting in mass-effect on the third ventricle and the posterior limb of the left internal capsule as well as lentiform nucleus, which is not significantly changed also compared to the previous scan. Susceptibility weighted imaging shows multiple other scattered foci of hemosiderin staining in the cerebrum indicative of previous hemorrhages. Many of these are in periventricular and central in distribution.There is multifocal diffusion restriction involving the left external capsule, the parafalcine posterior frontal lobes (left more than right) as well as the right inferior frontal gyrus. In addition, there is diffusion restriction just deep to the posterior aspect of the right cingulate sulcus. There are foci of diffusion restriction in the left cerebellar hemisphere. A tiny focus of diffusion restriction is present in the left hemipons as well. There is diffusion restriction in the inferior fibers of the splenium of the corpus callosum, which likely reflects acute Wallerian generation. In addition, there is symmetric bright T2 and diffusion signal within the middle cerebellar peduncles which shows relatively isointense ADC signal. This may reflect metabolic injury or drug toxicity.Confluent cerebral white-matter T2/FLAIR hyperintense signal without diffusion restriction is compatible with chronic microvascular ischemia. Similar changes are present in the midbrain and pons. The right occipital chronic infarct and the associated leukomalacia as well as cortical laminar necrosis remain unchanged. Multiple scattered chronic lacunar infarcts involving the thalami, basal ganglia, and cerebellum are also not significantly changed. Accounting for mass effect caused by the left thalamic hematoma, the remainder of the ventricular system is mildly dilated reflective of diffuse brain volume loss. There is no brain herniation.There is mild mucosal thickening in the mastoid air cells and paranasal sinuses. There are secretions in the posterior nasopharynx. An esophagogastric tube traverses the right nasal cavity. There is an endotracheal tube through the oral cavity. There is bilateral proptosis without significant orbital abnormality otherwise.CRANIAL MRA:The intracranial internal carotid arteries become irregular in caliber and attenuated in their cavernous segments which probably reflects atherosclerotic involvement. This is more pronounced at the anterior genu of the cavernous segment of the right internal carotid artery which is significantly attenuated. Similar irregularity is present throughout the anterior and middle cerebral arteries and the major branches. This is most pronounced at the proximal A2 segment. A small anterior communicating artery is probably present.The left intradural vertebral artery is very attenuated with segmental complete loss of flow-related signal. The basilar artery and the right vertebral artery show irregularly narrowed caliber but no not flow limiting stenoses, reflective of atherosclerotic involvement. Both posterior-inferior cerebellar arteries are not definitively visualized. The anterior inferior and the superior cerebellar arteries are patent although atherosclerotically narrowed, especially the origin of the right anterior-inferior cerebellar artery. The posterior cerebral arteries are very small, more on the right. The left posterior communicating artery is larger than the associated P1 segment, with a fetal-type PCA. The right posterior communicating artery is not well visualized.Overall appearance has not significant change compared to the previous MRA.CERVICAL SPINE MRI:Alignment is notable for 2 mm of posterior subluxation of C5 relative to C6. The vertebral bodies are preserved in height. Anterior osteophytes are most pronounced at C5-C6 and C6-C7 levels. The intervertebral discs are unremarkable for mild height loss at C5-C6 and relative preservation of the other levels. The spinal canal is moderately to markedly narrowed at C4-C5 and C5-C6 levels. The spinal cord shows no abnormal signal although it is indented by the C5-C6 degenerative disc-osteophyte complex. There is increased T2 signal within and in between the paraspinal muscles along the cervical spines, which is more pronounced on the left, and may represent muscle sprain.C2-C3 and C3-C4: There is shallow anterior indentation of the thecal sac by degenerative disc-osteophyte complex but no significant spinal canal or foraminal stenosis.C4-C5: The disc-osteophyte complex partially effaces the CSF around the spinal cord resulting in mild spinal canal stenosis. There is no significant foraminal stenosis.C5-C6: Disc-osteophyte complex mildly deforms the spinal cord at this level causing moderate spinal canal stenosis. There is mild-to-moderate right and minimal left neuroforaminal stenoses by uncovertebral and to a lesser extent facet arthropathy. C6-C7 and C7-T1: There is no significant spinal canal or foraminal stenosis.There is an incidental finding of a 2.4 cm right thyroid lobe nodule which is heterogeneously T2-hyperintense. The endotracheal tube and esophagogastric catheter are included.

Output: 1.Stable appearance of evolving subacute left thalamic hematoma with surrounding vasogenic edema and localized mass-effect. Multiple other foci of hemosiderin staining are present centrally in the brain reflective of previous hemorrhage as, probably hypertensive in nature.2.Multiple scattered cerebral, left pontine and cerebellar recent infarcts, probably embolic given the multifactorial distribution. Diffusion restriction in the splenium of the corpus callosum is probably acute neuronal degeneration. 3.Symmetric T2 signal in the middle cerebellar peduncles is nonspecific and may reflect metabolic injury or drug toxicity. Alternatively, it may relate to chronic small vessel ischemia.4.Changes of chronic microvascular ischemia, chronic infarcts and global brain volume loss are unchanged.5.Essentially stable MRA head demonstrating multifocal attenuation of the intracranial arteries are reflective of atherosclerotic involvement. The diminutive left vertebral artery might be congenital variation or may reflect severe atherosclerosis.6.Disc-osteophyte complex at C5-C6 mildly deforms the spinal cord but without abnormal signal, reflecting moderate spinal canal stenosis.7.Right thyroid lobe nodule. If further assessment is clinically warranted, thyroid ultrasound is recommended.Dr. Monther Qandeel discussed the above findings with Dr. Tania Rebeiz over the phone on January 3, 2016 at 1505 hours.


Instruction: Generate impression based on findings.

Input: Chiari malformation, thoracic lesion, syrinx, follow up. There is slight dilatation of the central canal in the thoracic spinal cord at T4 and T9 to T11, measuring up to 1 mm in diameter. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The paravertebral soft tissues are unremarkable. The cerebellar tonsils appear to be mildly low-lying on the localizer images.

Output: Minimal syringohydromyelia in the thoracic spinal cord.


Instruction: Generate impression based on findings.

Input: 43 years Female (DOB: 7/19/1972)Reason: Please do CSF flow study at foramen magnum, s/p Chiari Decompression Jan 7th History: follow up s/p Chiari DecompressionPROVIDER/ATTENDING NAME: ISSAM A. AWAD ISSAM A. AWAD The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There is disc desiccation present at multiple levels.The patient is status post decompression for Chiari I malformation. There is no obstruction at the foramen magnum. There is normal biphasic flow at the level of foramen magnum.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: Status post surgery for Chiari decompression. There is no obstruction to CSF flow at the level of the foramen magnum appreciated.


Instruction: Generate impression based on findings.

Input: Right hand weakness which started 2 weeks ago with prior history of stroke. There is interval appearance of a punctate T2 hyperintense lesion in the left precentral gyrus involving the putative hand center without discernible restricted diffusion. There is unchanged encephalomalacia in the right middle cerebral artery territory involving the frontal, parietal, and temporal lobes. There is also encephalomalacia within the bilateral cerebellar hemispheres, left larger than right. There is scattered patchy high T2 signal in the cerebral and pontine white matter. There are probable enlarged perivascular space in the bilateral basal ganglia. There is no evidence of an acute infarct. There is ex vacuo dilatation of the lateral ventricles superimposed on a background of diffuse cerebral volume loss. There is unchanged susceptibility effect in the left superior frontal gyrus, which is compatible with chronic hemorrhage. There is no evidence of mass, midline shift or mass effect. The imaged paranasal sinuses and mastoid air cells are unremarkable. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Interval appearance of a punctate lesion in the left precentral gyrus involving the putative hand center may represent a subacute infarct. Otherwise, extensive areas of chronic infarcts in multiple vascular territories.


Instruction: Generate impression based on findings.

Input: 8 days, Male, Reason: is there intracranial hemorrhage? white matter injury? is structure WNL? History: 36 4/7 week with H/O perinatal depression S/P whole body cooling.. Examination is nondiagnostic as only sagittal T1-weighted sequence was obtained. No obvious intracranial mass effect, hydrocephalus, or herniation is appreciated.

Output: Examination was prematurely terminated after a single sagittal T1-weighted sequence as patient could not tolerate the study. No obvious intracranial mass effect, hydrocephalus, or herniation is appreciated. If clinically indicated suggest obtaining complete study with sedation.


Instruction: Generate impression based on findings.

Input: History of meningioma, status post resection. There are stable postoperative findings related to right parietal craniotomy. There is unchanged encephalomalacia in the right parietal lobe along the margins of the resection cavity. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues appaer grossly unchanged.

Output: Stable post-treatment findings without evidence of tumor recurrence.


Instruction: Generate impression based on findings.

Input: Female, 21 years old, history of GBM. A right parietal resection cavity is again seen without significant change in size or morphology. Mild T2 hyperintensity within the tissues surrounding cavity is unchanged. No pathologic enhancement is seen adjacent to the cavity or elsewhere intracranially. A few scattered small foci of T2 hyperintensity are seen in the cerebral white matter without significant interval change. A small suspected arachnoid cyst is redemonstrated along the left inferior frontal lobe. Ventricular size and morphology are within normal limits.

Output: Stable postoperative findings with no evidence of tumor recurrence.


Instruction: Generate impression based on findings.

Input: L knee pain, evaluate for MPFL disruption or other intra-articular pathology, meniscal tear, ACL tear. BONES: The osseous alignment is within normal limits. There is no acute fracture. There is increased bone marrow signal in the lateral femoral condyle compatible with contusion (series 6 image 12).MENISCI: The medial and lateral menisci are normal in morphology and signal.ARTICULAR CARTILAGE AND BONE: Deep fissuring of the medial facet of the patellar cartilage (series 4 image 7), new from prior study. Grade 2/3 chondromalacia of the lateral compartment.LIGAMENTS: The cruciate ligaments and collateral ligaments are unremarkable. There is mildly increased signal on the medial patellofemoral ligament suggestive of sprain (series 4 image 12). The lateral patellofemoral ligament is within normal limits. EXTENSOR MECHANISM: Quadriceps mechanism and patellar ligament are within normal limits.ADDITIONAL

Output: Deep fissuring of the medial facet of the patellar cartilage, new from prior study.Mild medial patellofemoral ligament sprain.Small joint effusion.Lateral femoral condyle bone contusion.


Instruction: Generate impression based on findings.

Input: Female, 4 years old. Sickle cell disease with osteomyelitis of the sacrum, 6 week therapy repeat scan. Edema and enhancement of the right sacral ala and right aspect of the sacral promontory are again seen, compatible with osteomyelitis, appearing slightly decreased in this area from the prior study. The right lateral sacrum and vertebral body at the S2 level are homogeneously involved, with decreased involvement on the left at S2. Additional involvement of the bilateral lateral aspects of the sacrum at the S3 level appears similar to prior. Persistent enhancement of the right sacroiliac joint.Edema and enhancement of the medial aspect of the right iliac bone adjacent to the sacroiliac joint.Small volume free pelvic fluid. No discrete fluid collection within the pelvis or soft tissues

Output: Sacral osteomyelitis with decreased involvement on the left at the S2 level, but otherwise grossly unchanged sacral involvement. New involvement of a small area of the right iliac bone adjacent to the SI joint. Persistent right sacroiliitis.


Instruction: Generate impression based on findings.

Input: Numbness in feet. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is a perineural cyst in the left C7-T1 neural foramen that measures up to 9 mm with mild indentation upon the thecal sac. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: 1. Subcentimeter perineural cyst in the left C7-T1 neural foramen.2. No evidence of significant spinal canal stenosis.3. No evidence of cervical spinal cord lesions.


Instruction: Generate impression based on findings.

Input: 74-year-old female with cavernous malformation. Redemonstrated is a patchy subcentimeter area of enhancement in the lateral right putamen associated with a small anomalous vein. There is also a nonenhancing focus of 4 mm susceptibility effect in the medial right putamen. There is no evidence of acute intracranial hemorrhage or acute infarct. As before, there are a few scattered punctate to small foci of T2 hyperintensity within subcortical white matter locations without susceptibility abnormality. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable.

Output: 1.Findings suggestive of a subcentimeter right putamen cavernous malformation and associated developmental venous anomaly which are unchanged in appearance. 2.Probable minimal chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: Reason: r/o retear ACL graft History: pain and instability Exam is slightly limited secondary to artifact from femoral and tibial tunnels.MENISCI: There is evidence of prior partial medial meniscectomy. There is superimposed abnormal proton density and T2 signal hyperintensity signal in the anterior aspect of the posterior horn of the medial meniscus, which is more pronounced than on the prior study, suggesting a more acute oblique tear, which contacts the inferior articular surface (series 6, image 25). There is persistent abnormal signal hyperintensity in the anterior horn of the lateral meniscus, which was also seen previously, compatible with fibrosis.ARTICULAR CARTILAGE AND BONE: There is grade II chondromalacia in the posterior aspect of the medial femoral condyle. Otherwise, the articular cartilage is intact.There is a 14 x 13 mm osteochondral defect in the posterior aspect of the medial femoral condyle with near complete underlying T2 signal hyperintensity, and evidence of previous repair.LIGAMENTS: There is indistinctness of the anterior cruciate ligament graft along its midportion, which suggests at least partial tear (series 5, image 17).The posterior cruciate ligament is intact. The medial collateral ligament and lateral collateral ligament complexes are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1.Indistinctness of the ACL graft along its midportion suggesting at least partial tearing.2.Status post repair of an osteochondral defect in the medial femoral condyle with near complete underlying T2 signal abnormality which suggests there may be a component of partial instability.3.Prior partial medial meniscectomy with evidence of superimposed tear.


Instruction: Generate impression based on findings.

Input: 66-year-old with two recent right breast biopsies showing invasive mammary carcinoma and invasive lobular carcinoma. A patient submitted outside study for review. Submitted for review are breast MRI (7/20/2015) performed at Valparaiso Medical Center. For comparison,standard mammogram (6/29/2015 and 7/8/2015) and ultrasound (7/8/2015) are available. MRI

Output: Nondiagnostic exam due to artifact resulting in loss of signal in large portions of each breast. A repeat MRI is recommended as clinically indicated.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: 64 year old male. Chronic hepatitis C. HCC status post resection. Evaluate for recurrence. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology. Cholelithiasis.No suspicious hepatic mass. Previously noted segment 8 arterially enhancing lesion is no longer visualized.Patent hepatic vasculature with a replaced right hepatic artery, representing normal variant anatomy. No biliary ductal dilatation.Small perigastric varices, similar to prior.SPLEEN: Mild splenomegaly measuring 13.8 cm.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Atrophic right kidney.RETROPERITONEUM, LYMPH NODES: Calcific atherosclerotic disease of the abdominal aorta with an ectatic distal aorta that measures 2.3 cm in AP dimension, similar to prior.Mildly enlarged left periaortic lymph nodes and multiple small gastrohepatic ligament lymph nodes, unchanged.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Multilevel small perineural cysts at neural foramina in the thoracic spine. Mild degenerative changes of the lumbar spine with rightward curve.Post-surgical findings in the anterior abdominal wall.OTHER: No significant abnormality noted.

Output: Cirrhotic liver morphology with no evidence of recurrence or new suspicious lesion.


Instruction: Generate impression based on findings.

Input: Male, 62 years old, history of nasopharyngeal carcinoma status post CRT with cranial nerve 12 palsy. Concern for recurrence. Brain:Two or three scattered small foci of nonspecific T2 hyperintensity are evident within the cerebral hemispheres.No restricted diffusion is seen. No evidence of parenchymal edema or mass effect is detected. On postcontrast images, no pathologic parenchymal or extra-axial enhancement is observed.No significant intracranial hemorrhage or any abnormal extra axial fluid collection is seen. Ventricular size and morphology are within normal limits.Neck:Imaging of the neck is somewhat degraded by motion artifact. Within this limitation, the following observations are made.Mild pooling secretions are evident in the nasopharynx, but no mucosal lesion is seen.Mild atrophy of the intrinsic tongue and floor of mouth muscles is suspected on the left. No tongue or tongue base mass is demonstrated. No clear evidence of any focal lesion is seen along the expected course of the hypoglossal nerves.Volume loss in the left neck is likely related to prior therapy, as is infiltration of the fascial planes and scarring, particularly along the left carotid space.No pathologic adenopathy is detected by size criteria. No mass lesion is seen. The visualized salivary glands and thyroid are free of focal lesions.Vertebral body marrow signal characteristics are unremarkable. Mild cervical spondylosis is evident without significant spinal canal stenosis. The visualized spinal cord is unremarkable.

Output: 1.No evidence of intracranial metastases.2.Mild atrophy of the left tongue is suspected.3.No evidence of tumor recurrence, pathologic adenopathy, or any other specific findings are seen in the neck to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: Benign neoplasm of brain, unspecified [D33.2], Reason for Study: ^Reason: follow up meningioma resection History: routine imaging following meningioma resection. Post left fronto temporal craniotomy status.Rim enhancing lesions on the left middle cranial fossa with restricted diffusion are again demonstrated. Measured size of each lesion on Gad enhanced axial scan are 14mm x 12mm and 9.9mm x 10.7mm, certainly there is no evidence of growth but no significant interval change since prior scan. Diagnostic possibilities include organized blood products, post-operative changes and the possibility of residual or regrowth of tumor is less likely. High signal intensity lesion on FLAIR/T2 at the right cingulate gyrus with subtle enhancement most evident on sagittal post enhancement scan appears to be stable, no change since prior scan.Encephalomalacia of the left lateral orbital gyrus and the left temporal lobe tip also appear to be stable, no change since prior scan. The ventricles, sulci and cisterns are symmetric and unremarkable. There is no evidence of acute ischemic or hemorrhagic lesion. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Re-demonstration of the left middle cranial fossa rim enhancing lesions. No significant interval change of their size and MR signal characteristics since prior scan. Differential diagnosis include organizing and evolving hematoma, postoperative changes. Possibility of residual or regrowth of tumor would be slim.2. No change of FLAIR/T2 high signal intensity lesion with subtle enhancement on the right cingulate gyrus since prior scan.3. No change of left lateral orbital gyrus and left temporal tip encephalomalacia since prior scan.4. No evidence of acute ischemic or hemorrhagic lesion.


Instruction: Generate impression based on findings.

Input: History of brain biopsy, third ventricle and removal of EVD 3/31. Evaluate ventricles. Interval removal of right-sided ventricular catheter. A defect in the right calvarium from prior catheter placement is noted. There is stable enlargement of the lateral, third and fourth ventricles. The previously described mass in the pineal gland is of increased attenuation and measures 2.4 x 2 cm (image 13/36, series 2). When accounting for differences in technique, there is no significant change compared to the prior MRI. Calcification is seen along the superior and left anterolateral aspect of the mass.No evidence of intracranial hemorrhage or edema. No midline shift.The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Pineal region mass with associated hydrocephalus. Size of ventricles appears stable compared to the prior MRI.


Instruction: Generate impression based on findings.

Input: 62 year old who is BRCA mutation carrier, with family history of breast cancer There is heterogeneous amount of 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.


Instruction: Generate impression based on findings.

Input: 46-year-old man with left shoulder pain, history of rotator cuff repair in 2008 ROTATOR CUFF: There is a full-thickness tear of the supraspinatus with at least 3 cm of retraction. There is at least a partial, and likely full-thickness, tear of the subscapularis tendon with mild retraction and thickening at the attachment, although a few fibers may remain attached. A small amount of fluid tracks along the infraspinatus tendon, which may relate to the injection of contrast material prior to the MRI. No definite abnormality of the infraspinatus is identified. The teres minor is unremarkable.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: Globular signal abnormality in the superior and anterior aspect of the labrum is seen, with an associated linear SLAP tear.BICEPS TENDON: Degenerative changes affect the biceps tendon with internal fluid signal.ADDITIONAL

Output: Probable SLAP tear and degenerative changes of the labrum. Complete tear of the supraspinatus and subscapularis as detailed above.


Instruction: Generate impression based on findings.

Input: Hip pain, evaluate for labral tear. ACETABULAR LABRUM: There is an abnormal focus of increased signal within the anterior superior aspect of the labrum compatible with a small tear (series 1201, image 3). The remainder of the labrum is intact.ARTICULAR CARTILAGE AND BONE: The bone marrow signal intensity is within normal limits. A small defect within the acetabular articular cartilage at approximately the 3:00 position is thought to represent a pseudodefect rather than a true defect. The remaining acetabular cartilage is intact.SOFT TISSUES: The visualized musculature and soft tissues are within normal limits. ADDITIONAL

Output: Small tear of the anterior superior labrum.


Instruction: Generate impression based on findings.

Input: 4-year-old male status post chiari decompression January 2016 with syrinx. BRAIN: Postsurgical changes of the posterior suboccipital craniectomy compatible with a Chiari decompression and left cerebellar tonsillar resection. There is now ample CSF space in the neo-foramen magnum. There is now biphasic CSF flow across the ventral and dorsal aspect of the neo-foramen magnum, as well as along the dorsal upper cervical canal.There is no evidence of intracranial hemorrhage, mass, or acute infarct. Focus of asymmetric T2/FLAIR signal abnormality in the periventricular white matter along the posterior body the right lateral ventricle region of the right lateral ventricle, in the area of a terminal zone of myelination, may represent asymmetric variation of myelination versus more likely gliosis given the possible mild volume loss. 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.CERVICAL SPINE: A syrinx is noted at the C5-C7 levels slightly decreased craniocaudal extent now measuring 1.5 cm and measuring 3 mm in AP dimension, previously 8 mm AP. The cervical spine is in normal alignment, with a normal cervical lordosis. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal.There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the cervical spine. THORACIC SPINE: Trace residual prominence of the central spinal canal is noted at the T8 level measuring 1.0 mm in diameter, significantly improved since the prior exam, where the thoracic syringohydromyelia was only partially visualized.The thoracic spine is in normal alignment, with a normal thoracic kyphosis. The vertebral body and disk heights are well maintained. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is otherwise of normal caliber and signal.There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the thoracic spine.

Output: 1.Expected postoperative changes following Chiari decompression, with patent neoforamen magnum and restoration of dorsal biphasic CSF flow at this level.2.Interval decrease in size and craniocaudal extent of a cervical spine syrinx.3.Significant interval improvement of previously partially visualized lower thoracic syringohydromyelia, with trace prominence of the canal at the T8 level.


Instruction: Generate impression based on findings.

Input: Male, 12 years old, with involuntary abnormal movement. The cerebral and cerebellar hemispheres and brainstem show normal signal intensity and morphology. 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. An incidental developmental venous anomaly is present within the right centrum semiovale.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: Clinical question: Cervical spine disease. Signs and symptoms: Left facial numbness. Pre and post enhanced cervical MRI:There is normal anatomical alignment of the vertebral column however with mild straightening of lordosis without change since prior exam.There is normal signal intensity and caliber of the cervical cord and upper most visualized thoracic cord.Foramen magnum is unremarkable.C2-C3 is unremarkable.C3-C4 demonstrate mild degenerative changes and unremarkable otherwise.C4-C5 demonstrate mild degenerative changes with resultant moderate left neural foraminal compromise with subtle interlobar progression and no central spinal stenosis.C5-C6 demonstrate mild to moderate disc disease and loss of disc height, asymmetric left-sided uncovertebral hypertrophy, mild facet and ligamentum flavum hypertrophy. There is no spinal stenosis or neural foraminal compromise and no significant change since prior exam. There is tortuosity of the left dominant vertebral artery which abuts the left neural foraminal at this level similar to prior exam.C6-C7 demonstrate mild degenerative changes without spinal stenosis or neural foraminal compromise. No change since prior exam.C7-T1 is unremarkable.Post enhanced images demonstrate no detectable abnormal enhancement of the vertebral column, cervical and upper visualized thoracic cord or the leptomeninges.

Output: 1.Mild degenerative changes of cervical spine with minimal progression since prior exam as detailed.2.No evidence of central spinal stenosis and single level neural foraminal compromise on the left at C5-C6 as detailed.3.Normal signal intensity and caliber of cervical and upper most visualized thoracic cord without abnormal enhancement.


Instruction: Generate impression based on findings.

Input: Clinical question: 62-year-old female with metastatic Phyllodes tumor to spine. Signs and symptoms: Back pain. Non-enhanced CT lumbar spine:Examination demonstrate a large destructive lytic lesion involving the vertebral body of L5 on the right with involvement and extension across the right pedicle into the right facet complex and transverse process of L5 vertebrae. The overall length of this lesion measures 56-mm in transverse axis and 37-mm in AP axis. This lesion also partially involve the right lamina. There is partial extra osseous extension of tumor into the right neural foramina at L5 -- S1 and minimally at L4 -- L5. There is no distinct evidence of extension of mass into the spinal canal. For detailed evaluation an MRI is significantly more sensitive for detection of extent of tumor. Minimal bulge of disk, degenerative change and vacuum phenomenon of L4 -- L5 disk is noted. The a small additional separate foci of low-attenuation in the left paramedian of L5 vertebrae is also present. This finding also could represent a small additional metastatic lesion and measures 7-mm times 11-mm in size. Minimal sclerotic changes along the inferior endplate of L2 is believed to be secondary to degenerative changes. No additional lytic or sclerotic metastatic lesions are identified. The alignment of the lumbosacral spine remains within normal.CT of cervical spine:A large lytic / sclerotic destructive bony lesion is noted involving the left aspect of vertebral body of C6 with involvement of left transverse process, pedicle, facet complex and left lamina. The overall transverse axis of this tumor measures 34-mm and 22.5-mm in AP axis. There is small extra osseous spread of tumor into the left paraspinal space. There is shallow epidural spread of tumor along the ventral aspect of the canal on the left and along the lamina on the left. This tumor also appears to involve the left foramina transversarium. The normal alignment of vertebral column is maintained. A very small entirely intraosseous a foci of low density within the anterior aspect of body of C4 vertebrae may also in indicate a second metastatic foci. This lesion measures on the 3.5 x 2.5-mm in size.

Output: 1.Large destructive lytic metastatic lesions of vertebral bodis, pedicles, transverse process and lamina of C6 and L5 as detailed above. There is a small extra osseous spread of tumor into the soft tissues of cervical spine and epidural space of the lumbar spine. Please see above detailed report.2.Possible two very small entirely intraosseous additional metastatic foci.3.The alignment of vertebral column and cervical and lumbosacral spine remains within normal.


Instruction: Generate impression based on findings.

Input: Male, 37 years old, history of MS, with new right face weakness, left third nerve palsy, left ptosis and bilateral internuclear ophthalmoplegia for two days. Brain:Scattered T2 hyperintense lesions are redemonstrated within the white matter of the bilateral cerebral hemispheres. As before, the largest lesion is present in the right parietal periatrial white matter. There has been no significant interval change in the size and number of these lesions when compared to the prior exams.As before, a very small focus of T2 hyperintensity and questionable restricted diffusion is again seen within the dorsal pons, just to the right of midline along the floor of the fourth ventricle. No significant interval change is seen.No evidence of parenchymal edema or mass effect is seen. No pathologic parenchymal or extra-axial enhancement is observed. There are no abnormal extra axial fluid collections or evidence of intracranial hemorrhage. The ventricular system remains normal in size and morphology.IACs:The visualized cranial nerves demonstrate normal morphology and are free of pathologic enhancement. The fluid-filled structures of the inner ears demonstrate normal morphology.Orbits:The globes are round and symmetric. The extraocular muscles demonstrate normal morphology and signal characteristics. The optic nerves are normal in course morphology and show no evidence of pathologic focal signal abnormality. Postcontrast images are motion degraded, but within this limitation, no definite pathologic intraorbital enhancement is seen.

Output: 1.Multiple scattered cerebral white matter lesions are redemonstrated, appearing similar to prior examinations and consistent with demyelinating disease.2.A small area of T2 and diffusion signal abnormality is redemonstrated along the dorsal pons, in the location of the medial longitudinal fasciculus. Given the history of MS, this may represent a small demyelinating lesion which could potentially account for the patient's internuclear ophthalmoplegia.3.Within the limitations of imaging artifact, no definite abnormalities of the cranial nerves or orbits are seen.


Instruction: Generate impression based on findings.

Input: 28 year old with history of left ventricular systolic dysfunction and hypertension presenting for evaluation of cardiac function and scar. Left VentricleThe left ventricle is normal in size with mildly reduced systolic function. The overall LV ejection fraction is 52%, the LV end diastolic volume index is 86 ml/m2 (normal range: 74+/-15), the LVEDV is 193 ml (normal range 142+/-34), the LV end systolic volume index is 42 ml/m2 (normal range 25+/-9), the LVESV is 93 ml (normal range 47+/-19), the LV mass index is 59 g/m2 (normal range 85+/-15), and the LV mass is 132 g (normal range 164+/-36). The left ventricular dysfunction is global. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 51%, the RV end diastolic volume index is 82 ml/m2 (normal range 82+/-16), the RVEDV is 184 ml (normal range 142+/-31), the RV end systolic volume index is 40 ml/m2 (normal range 31+/-9), and the RVESV is 90 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.OtherIn some views, there appears to be a small patent ductus arteriosus but it is not well visualized. Of note, no PDA flow is noted on his echocardiograms. Correlation with physical exam suggested.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. Mildly reduced left ventricular systolic dysfunction (LVEF 52%) without evidence of scar, infarct or inflammation. The LV dysfunction is global. 2. Normal right ventricular size and function (RVEF 51%)3. There is mild mitral and tricuspid regurgitation. 4. In some views, there appears to be a small patent ductus arteriosus but it is not well visualized. Of note, no PDA flow is noted on his echocardiograms. Correlation with physical exam suggested.


Instruction: Generate impression based on findings.

Input: 71 years Male (DOB:11/1/1944)Reason: persistent headache History: headachePROVIDER/ATTENDING NAME: HALINA BRUKNER HALINA BRUKNER 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 patient status post paranasal sinus and nasal cavity surgery with removal of middle turbinates. The maxillary sinuses are relatively small. There is some mucosal thickening present within the maxillary sinuses and ethmoid air cells. 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 intracranial mass lesion or intracranial hemorrhage. 2.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related. 3.Patient status post paranasal sinus surgery.


Instruction: Generate impression based on findings.

Input: History of prostate cancer. 3+3 right mid medial, 3+3 right Apex medial dated 6/25/2013. PELVIS:PROSTATE:Prostate Size: 2.8 x 5.3 x 5.0 cmPeripheral Zone: No discrete T2-weighted hypointense or restricting lesion to suggest neoplasm. Non-specific linear foci of T2-weighted and ADC hypointensity.Central Gland: There is a large T2 hypointense lesion in the transition zone extending from the apex to the base with abnormal restricted diffusion and avid enhancement with washout. The lesion is best delineated on the restricted diffusion images were measures 2.0 x 2.6 cm (series 604/284). Using similar measurement technique the lesion previously measured 1.7 x 2.6 cm (series 902/324). The lesion appears to extend into a prominent median lobe.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: The lesion bulges the anterior margin of the prostate.BLADDER: No significant abnormality noted.LYMPH NODES: Small nonspecific external iliac lymph nodes measuring less than 1 cm in short axis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Large transition zone lesion has not demonstrated significant interval change. Carcinoma cannot be ruled out. This lesion would be amenable to MRI/TRUS fusion biopsy.


Instruction: Generate impression based on findings.

Input: Traumatic hemorrhage of left cerebrum with loss of consciousness of unspecified duration, initial encounter [S06.359A], Reason for Study: ^Reason: eval vasculature History: likely traumatic left splenium ICH Brain MRIThere is linear T1 high signal intensity lesion at the left corpus callosum splenium which is corresponding to the CT high attenuation lesion. The lesion does not show evidence of enhancement and does not show significant susceptibility artifacts either. Surrounding edema cannot be evaluated due to limited image sequences. There is no other hemorrhagic lesion on this scan. Constellation of above findings indicate early subacute parenchymal hemorrhage.There is no evidence of acute ischemic infarction.There is no evidence of abnormal enhancement.The left cerebellar hemispheric DVA is again seen, unchanged since prior scan. The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal.No evidence of intracranial arterial aneurysm. No arterial stenosis.Brain MRV3D Phase contrast MRV brain 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: 1. Linear left corpus callosum splenium lesion most likely represent early subacute parenchymal hemorrhage. No other hemorrhagic lesion is seen.2. No evidence of acute ischemic lesion.3. Normal brain MRA and MRV.Comment: unusual location, unusual shape parenchymal hemorrhage may need further imaging investigation such as catheter angiography.


Instruction: Generate impression based on findings.

Input: Male, 4 years old, with tongue fasciculations and left leg weakness status post gunshot wound to the abdomen with extensive blood loss. Concern for hypoperfusion of the medulla. No diffusion restriction is seen. No evidence of edema or mass effect is detected. There are no findings to suggest acute or chronic intracranial hemorrhage or any abnormal extra axial fluid collection. The ventricles are normal in size and morphology. The brainstem shows normal signal intensity and morphology.

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


Instruction: Generate impression based on findings.

Input: bilateral sensorineural hearing loss, developmental delay, and OSA, presenting with a shaking episode. There are multiple scattered foci of T2 hyperintensity in the bilateral cerebral white matter, predominantly in periventricular and subcortical distributions. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Multiple scattered foci of T2 hyperintensity in the bilateral cerebral white matter are nonspecific, but may represent a sequela of prior ischemia, a demyelinating process, sequela of prior infection, or vasculitis process, for example. Otherwise, no evidence of acute intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: 44-year-old female with personal history of left breast cancer, status post lumpectomy and radiation and hormonal therapy in 2008. Benign right breast biopsy in 2011 with pathology of PASH. There are moderate parenchymal enhancement in right breast and mild in the left breast.RIGHT BREAST:There is no new or abnormal enhancement. There is redemonstration of multiple cysts scattered throughout the right breast. Biopsy clip in the upper inner right breast is again noted. A few nonspecific enhancing foci in the right breast are stable. LEFT BREAST:There is no suspicious enhancement. Postsurgical changes from prior lumpectomy are noted in the left breast. Decreased background parenchymal enhancement is likely from prior radiation therapy.Prominent right axillary lymph nodes are stable. No abnormal lymph nodes are identified in the left axillary region.

Output: No MRI evidence for malignancy. Postsurgical changes of the left breast.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: Elevated PSA. Additional history per EMR: PSA 4.1 in April of 2015 and it was 4.6 in June of 2015. It has varied between 2.5 and 3.5 over the last few years. No prior biopsy. PELVIS:PROSTATE:Prostate Size: 5.5 x 4.2 cm.Peripheral Zone: There is a 11 x 5 mm focus of decreased T2 and ADC signal demonstrating mild early enhancement, located in the mid to apical medial portion of the right peripheral zone (series 1201, image 12). No evidence of extracapsular extension.Central Gland: Hypertrophy of the median zone is noted. There are few well-defined nodules, some of which demonstrate decreased ADC and enhancement on postcontrast images, though given well-circumscribed morphology with smooth, round margins, would favor benign nodules (series 1201, image 14). Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: None.BLADDER: No significant abnormality noted.LYMPH NODES: Few prominent subcentimeter right external iliac and inguinal lymph nodes are nonspecific.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 11 mm right peripheral zone lesion suspicious for neoplasm as described above.Benign prostatic hypertrophy with associated nodules.


Instruction: Generate impression based on findings.

Input: A patient submitted outside study for review. Submitted for review are digital mammographic images (5/24/16), images from ultrasound guided biopsy of right breast with specimen radiograph and postprocedural right mammographic images (5/27/2016), breast MRI (6/3/16), ultrasound images (6/9/16) performed at outside institution. DIGITAL MAMMOGRAPHIC IMAGES (5/24/16):The breast parenchyma is extremely dense (BiRADS Density Category D), which limits the sensitivity of the mammogram . A BB marker is placed at upper outer quadrant of right breast, denoting the area of palpable lump.There is a cluster of pleomorphic calcifications at the site of palpable lump in the right breast at upper outer quadrant. The cluster measures approximately 18 mm in AP dimension.No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in left breast. IMAGES FROM ULTRASOUND GUIDED BIOPSY OF RIGHT BREAST WITH SPECIMEN RADIOGRAPH AND POSTPROCEDURAL RIGHT MAMMOGRAPHIC IMAGES (5/27/2016):An irregularly-shaped, ill-defined hypoechoic mass is detected at 11:00 position in the right breast, measuring 21 x 11 mm. This lesion likely corresponds to the area of pleomorphic calcifications on the mammogram., In addition, there is an ill-defined hypoechoic mass measuring 12 x 7 mm at 10:00 position. This mass is annotated as "area of pain/area of palp." There are a few benign-appearing lymph nodes in the right axilla.Ultrasound guided biopsy for the mass at 11:00 position and 10:00 position in the right breast were performed with an appropriate needle placement. Specimen radiograph demonstrates a single calcification within one of the cores.Postprocedural mammographic images demonstrate a coil clip at 11:00 position, near the cluster of calcifications, and a ribbon clip at 10:00 position in the right breast. Distance between these 2 clips is 23 mm on CC view, and 17 mm on ML view.Per outside radiology report, the pathology results for both sites were malignant.BREAST MRI (6/3/16):MR images were submitted with non-DICOM format, and this could not be processed at our workstation. We tried to upload the images from the original DVD, but again images could not be uploaded to our workstation.Pre and post contrast MR images uploaded to PACS are not interpretable, because only axial images are available and no subtraction images are available. On T2 weighted images and non-contrast T1 weighted images, there are two metallic artifacts, at posterior upper outer quadrant, corresponding to the biopsy clips. There are a few small cysts in the right breast.ULTRASOUND IMAGES (6/9/16):This study was performed for MR directed ultrasound after abnormal findings on the MRI performed 6/3/2016. Per outside radiology report, there was a small focal area of masslike enhancement in the retroareolar region in the right breast. On the provided ultrasound images, there is a simple cyst at retroareolar region, and a complicated cyst next to it. There are no suspicious findings in the ultrasound images.

Output: Biopsy proven malignancy in the right breast at upper outer quadrant. MRI provided from outside institution is not interpretable. MR directed ultrasound for the right retroareolar region demonstrated a simple cyst with a complicated cyst.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Left shoulder pain. ROTATOR CUFF: There is increased signal intensity within the distal fibers of the supraspinatus muscle compatible with mild tendinopathy. The rotator cuff tendons are otherwise intact. There is no muscle atrophy.SUPRASPINATUS OUTLET: There is minimal osteoarthritis of the acromioclavicular joint. No fluid is noted in the subacromial/subdeltoid bursa. GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral joint alignment is within normal limits. There are mild degenerative changes of the glenohumeral joint with subchondral cyst formation in the humeral head.The labrum is grossly intact on this non-augmented examination.BICEPS TENDON: The biceps tendon is intact. ADDITIONAL

Output: Mild supraspinatus tendinopathy.


Instruction: Generate impression based on findings.

Input: Reason: h/o lumbar stenosis History: back pain, leg pain, leg numbness Five lumbar type vertebral bodies are presumed to be present. The conus medullaris on sagittal imaging is grossly intact. There is approximate 25% loss of vertebral body height at L2 related to superior endplate compression with a mild retropulsion and there is mild intra-subluxation of L4 on L5. There is multilevel disk desiccation isAt L5-S1 there is no significant compromise to spinal canal or neural foramina. There is a minor disk bulge at this level associated with mild ligamentum flavum and facet hypertrophy.At L4-5 there is diffuse disk bulge associated marked bilateral facet and ligamentum flavum hypertrophy with associated effacement of the fat at the lateral recesses and a moderate to severe degree of spinal stenosis. There is associated narrowing of the neural foramina bilaterally are partial effacement of the fat surrounding the exiting nerve roots within the neural foramina. There is associated mild anterior subluxation of L4 on L5.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is mild ligamentum flavum hypertrophy present at this level and a minor disk bulge.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.There is a small cyst present in the right kidney measuring 6 mm in diameter.

Output: 1.There is moderate to severe spinal stenosis at L4-5 related to degenerative changes.2.There is a benign-appearing chronic compression fracture at L2.


Instruction: Generate impression based on findings.

Input: 90 year-old female with acute mental status changes. Diffuse periventricular and subcortical white matter hypodensity indicates diffuse small vessel ischemic disease. Prominence of the sulci and ex vacuo dilatation of the ventricles indicates moderate to severe corticomedullary volume loss.Hypodense focus in the left cerebellar hemisphere with an adjacent area of increased attenuation is nonspecific but could represent infarction, tumor, or even blood. A contrast-enhanced CT or preferably an MRI is indicated for further evaluation of this area.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. Hypodense left cerebellar focus with adjacent area of increased attenuation is nonspecific. A contrast enhanced CT or preferably an MRI is indicated for further evaluation of this lesion.2. Diffuse small vessel ischemic disease and volume loss.


Instruction: Generate impression based on findings.

Input: 41-year-old female with a history of transverse myelitis, presenting with back pain, numbness/tingling in left leg, imbalance. Assess for demyelination. MRI Brain:Since the prior exam there has been development of multiple new foci of T2/FLAIR signal abnormality in the bilateral subcortical and periventricular white matter, including periventricular lesions perpendicular to the callosum highly suggestive of demyelinating disease. There is no evidence of brain parenchymal enhancement, intracranial hemorrhage, mass, acute infarct, midline shift or herniation. The ventricles and basal cisterns are unchanged in size and configuration. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.MRI T-Spine:The thoracic spine is in normal alignment. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. There is a subtle T2/FLAIR signal abnormality involving the posterior aspect of the spinal cord at the T11-12 level which was present previously. There are no new lesions and no pathological enhancement in the thoracic cord. There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the thoracic spine.

Output: 1.Interval increase in the number of foci of T2/FLAIR signal abnormality in the subcortical and periventricular brain parenchymal white matter including lesions with morphology and distribution highly suspicious for demyelinating disease. 2.Subtle T2/FLAIR signal abnormality within the posterior aspect of the spinal cord at the T11-12 level, most compatible with a chronic demyelinating plaque. No new lesions in the thoracic cord are appreciated.3.No abnormal enhancement in the brain or thoracic cord to suggest active demyelination.


Instruction: Generate impression based on findings.

Input: A 76 year old male with history of hypertension, hyperlipidemia and coronary artery disease: in a recent hospitalization a left cath showed chronic total occlusion of the left circumflex and 95% of the right coronary artery, a stent was implanted to the RCA. The echocardiography showed normal left ventricular function. Now referred to stress cardiac MRI for further evaluation due to fatigue.MEDICATIONS: aspirin, ticagrelor, metoprolol, ramipril, atorvastatin, tamsulosin. First Pass PerfusionDuring hyperemia, a moderate perfusion defects was present at the base and mid level of the lateral, inferolateral and inferior walls and within the apical lateral wall. The ischemia score is 4/32 (12.5%). Viability/ Myocardial ScarThere was late gadolinium enhancement at the base and mid level of the inferolateral walls, suggesting a prior myocardial infarction. This finding affects more than 50% of the thickness of the myocardium suggesting that is a transmural defect. The rest of the myocardium is viable.Left VentricleThe left ventricle is normal size with normal systolic function. The overall LV ejection fraction is 67%, the LV end diastolic volume index is 59 ml/m2 (normal range: 74+/-15), the LVEDV is 129 ml (normal range 142+/-34), the LV end systolic volume index is 20 ml/m2 (normal range 25+/-9), the LVESV is 43 ml (normal range 47+/-19), the LV mass index is 52 g/m2, and the LV mass is 112 g. There is mild hypokinesis of the basal and mid segments of the inferolateral wall. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal size with normal systolic function. The overall RV ejection fraction is 55%, the RV end diastolic volume index is 74 ml/m2 (normal range 82+/-16), the RVEDV is 162 ml (normal range 142+/-31), the RV end systolic volume index is 34 ml/m2 (normal range 31+/-9), and the RVESV is 73 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no 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. During hyperemia, a moderate perfusion defects was present at the base and mid level of the lateral, inferolateral and inferior walls and within the apical lateral wall. The ischemia score is 4/32 (12.5%). 2. There was late gadolinium enhancement at the base and mid level of the inferolateral wall, suggesting a prior myocardial infarction. This finding affects more than 50% of the thickness of the myocardium suggesting that is a transmural defect. The rest of the myocardium is viable.3. Normal LV size and systolic function (LVEF 67%).4. Normal RV size and systolic function (RVEF 55%).I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Clinical question: Seizure, etiology seen? Signs and symptoms: Seizure. Pre and post enhanced brain MRI:Diffusion weighted images are negative.Examination demonstrates scattered tiny nonspecific foci of FLAIR hyperintensity only in the subcortical and periventricular white matter of the lateral cerebral hemispheres. Findings demonstrate no evidence of hemorrhagic changes or abnormal enhancement and considering patient's stated age of 61 could represent mild chronic nonhemorrhagic small vessel ischemic strokes.The anatomical morphology and the signal intensity of brain parenchyma otherwise remains within normal on all MRI sequences. Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and myelination of the brain.There is no detectable abnormal parenchymal or meningeal enhancement.Unremarkable images through the orbits and calvarium without abnormal enhancement.All the paranasal sinuses and bilateral mastoid air cells and middle ear cavities demonstrate normal pneumatization signal pattern.

Output: 1.Negative diffusion weighted series.2.Scattered tiny nonspecific foci of FLAIR hyperintensity only in the subcortical and periventricular white matter which could represent mild chronic small vessel ischemic strokes.3.Unremarkable pre and post enhanced brain MRI otherwise.


Instruction: Generate impression based on findings.

Input: Please evaluate for basal ganglia or temporal lesion: Tics and episodes of somatosensory hallucinations. There is no evidence of intracranial hemorrhage, mass, or acute infarct. However, there are multiple punctate scattered cerebral white matter T2 hyperintense foci, with relative sparing of the temporal lobes. The basal ganglia are unremarkable. There is mild cavum septum pellucidum. The ventricles and basal cisterns are otherwise normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. Multiple scattered cerebral white matter T2 hyperintense foci are nonspecific, but may represent sequela of prior infection, vasculitis, toxic substance exposure, or perhaps demyelinating lesions, for example.2. No evidence of acute intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: 39 year old male with an atrial septal defect and pulmonary hypertension, referred for cardiovascular MRI to evaluate shunt, Qp:Qs, and possible anomalous pulmonary venous return. Left VentricleThe left ventricle is moderately dilated with severely reduced systolic function. There is global hypokinesis, and diastolic septal flattening suggestive of volume overload. The overall LV ejection fraction is 28%, the LV end diastolic volume index is 125 ml/m2 (normal range: 74+/-15), the LVEDV is 227 ml (normal range 142+/-34), the LV end systolic volume index is 60 ml/m2 (normal range 25+/-9), the LVESV is 165 ml (normal range 47+/-19), the LV mass index is 70 g/m2 (normal range 85+/-15), and the LV mass is 126 g (normal range 164+/-36). There is no late gadolinium enhancement to suggest inflammatory or infiltrative disorder.Coronary ArteriesRight and left coronary artery origins are normal.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is severely dilated with severely reduced systolic function. The overall RV ejection fraction is 17%, the RV end diastolic volume index is 277 ml/m2 (normal range 82+/-16), the RVEDV is 504 ml (normal range 142+/-31), the RV end systolic volume index is 230 ml/m2 (normal range 31+/-9), and the RVESV is 417 ml (normal range 54+/-17).Right AtriumThe right atrium is severely enlarged.Atrial SeptumThere is a large secundum atrial septal defect (30mm x 40mm). There is predominantly left-to-right shunting seen on the first pass perfusion imaging. Velocity-encoded imaging suggestive of bidirectional shunting although net shunt flow could not be reliably quantified. Of note, patient was on supplemental home oxygen. ASD rims: SVC rim = 12 mmIVC rim = 0-1 mmAortic rim = 11 mmPosterior rim = 11 mmAortic ValveThe aortic valve is trileaflet, opens widely, and there is trace aortic regurgitation. Aortic forward flow is 46 mL.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. It is trileaflet. There is mild pulmonic regurgitation. Pulmonary forward flow is 75 mL.Tricuspid ValveThe tricuspid valve opens widely. There is at least moderate tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium. No anomalous pulmonary venous drainage noted.Pulmonary ArteryThe main pulmonary artery is severely dilated.MPA measures 38 x 40 mmRPA measures 41 x 42 mmLPA measures 32 x 32 mmVenous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Left ventricle is moderately enlarged with severely reduced systolic function (LVEF 28%). There is septal flattening in diastole suggestive of RV volume overload2. Right ventricle is severely enlarged with severely reduced systolic function (RVEF 14%)3. Large secundum atrial septal defect measuring 30mm x 40mm with rims as specified above. 4. Predominantly left to right shunting seen. Qp:Qs = 1.6:15. There is at least moderate tricuspid regurgitation6. No anomalous pulmonary venous drainage appreciated. 7. The main pulmonary artery and both branch PAs were severely dilated.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 patient submitted outside study for review. Submitted for review are breast MRI dated 6/27/2016 performed at Palos community Hospital. Outside hospital MRI uploaded to Dyna CAD for postprocessing and interpretation. As per the report from outside hospital 20 cc of MultiHance was administered intravenously.Fatty breast tissue noted bilaterally. Mild parenchymal enhancement is present.Lobulated enhancing mass at the site of proven right central breast malignancy measures 2.1 x 1.1 cm. Clip artifact is identified within the lobulated mass. Predominantly superior to the enhancing mass, there is an area of fat density with peripheral thin enhancement, compatible with postbiopsy fat necrosis/hematoma. A somewhat nodular area of enhancement at the superior aspect of the fat necrosis is seen though this may represent post biopsy changes rather than tumor. Additionally, about 3 cm lateral and posterior to the known malignancy is a 6 mm intramammary lymph node, with a normal fatty hilum on the fat sensitive sequence and expected enhancement. Within the inferior breast, there are 2 several millimeter sized foci of enhancement that do not meet threshold for kinetic analysis on our system. No suspicious axillary lymph node in either axilla. Normal parenchymal enhancement is noted in the left breast.

Output: 1. Biopsy-proven malignancy in the right breast measures up to 2.1 cm. Adjacent hematoma/fat necrosis is noted.2. Normal sized intramammary lymph node in the right upper outer quadrant has expected MRI appearance on contrast enhanced and fat sensitive sequences.3. A few scattered foci in the inferior right breast do not meet threshold for kinetic analysis and are probably benign. Suggest a 6 month MRI and mammogram follow-up to ensure stability.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Right lower extremity focal seizure and left paracentral lesion on imaging. Preoperative planning. There is no significant interval change in the extent of gyriform and subcortical swelling of the left paracentral lobe without abnormal intracranial enhancement. There is no evidence of intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Preoperative planning MRI for a left paracentral lobe lesion.


Instruction: Generate impression based on findings.

Input: Altered mental status, unspecified [R41.82], Reason for Study: ^Reason: eval for vascular abnormality History: syncope, gait instability Brain MRIMotion artifacts degraded exam quality.Especially gradient echo images (venbold) are non diagnostic/There is no evidence of acute ischemic lesion.Patchy FLAIR high signal intensity lesions on bilateral periventricular white matter indicate non specific 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 MRAMotion artifacts significantly degraded image quality.3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate patent ICAs, MCAs and ACAs. Vertebrobasilar system appears to be patent.Due to significant motion artifacts, precise evaluation of intracranial arterial system for atherosclerotic changes, mild to moderate luminal stenosis or arterial aneurysm cannot be evaluated.Neck MRA3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate about 80% or higher degree of luminal stenosis on the left carotid bulb and distal left CCA.Bilateral distal vertebral arteries at the level of C1 show about 50% luminal stenosis.Left vertebral artery ostium appears to have more than 70% luminal stenosis. The right CCA and extracranial ICA do not show any significant luminal stenosis.

Output: 1. Motion artifacts degraded exam quality.2. No evidence of acute ischemic lesion. 3. Non specific small vessel ischemic disease.4. More than 80% stenosis of the distal left CCA and left CCA bulb as described above.5. Various degree luminal stenosis of bilateral distal vertebral arteries and left vertebral artery ostium as described above.


Instruction: Generate impression based on findings.

Input: 65 years, Male, ataxia, rule out new ischemic event.. No restricted diffusion to suggest acute ischemia. No evidence of acute intracranial hemorrhage. No intracranial mass or mass-effect. There is extensive encephalomalacia involving the right frontal lobe extending into the right anterior temporal lobe. Minimal encephalomalacia involving the left inferior frontal lobe also noted. There is mild ex vacuo dilatation of the right lateral ventricle. No hydrocephalus. Minimal foci of susceptibility compatible with chronic blood products are noted in the right frontal and anterior temporal lobes. There are foci of T2 hyperintensity with volume loss involving the globi pallidi which may be related to prior ischemic or metabolic injury. Additional scattered foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild chronic small vessel ischemic changes. There is cystic change/volume loss involving the left lateral aspect of the cervicomedullary junction compatible with prior injury. There is also mild to moderate generalized volume loss involving the cerebral hemispheres as well as of the cerebellar vermis and hemispheres.Paranasal sinuses are grossly clear. There is minimal opacification involving the bilateral mastoid air cells. Major flow-voids are preserved. There is mild deformity involving the bilateral medial orbital walls with medial herniation of fat and slight contour deformity involving the medial recti muscles which is suspected to be related to remote trauma.

Output: 1. No evidence of acute infarct.2. Extensive encephalomalacia in the right frontotemporal lobes favored to be related to prior trauma. Additional foci of signal abnormality and volume loss are seen in the bilateral globi pallidi which may be related to prior ischemic or toxic-metabolic injury. Additional focus of volume loss is seen involving the left lateral medulla/upper cervical cord junction also likely related to remote injury.3. Mild to moderate volume loss involving the cerebellar vermis and hemispheres and to a lesser degree the bilateral cerebral hemispheres. Finding is nonspecific and may be related to antiepileptic medications and/or chronic alcohol use, for example.


Instruction: Generate impression based on findings.

Input: 63 year old male with medial sided left knee pain. MENISCI: There is attenuation of the body and most of the posterior horn of the medial meniscus presumably reflecting changes related to the patient's history of partial meniscectomy. Best seen on coronal image 22 of series 1001, is linear increased signal intensity within the body of the medial meniscus extending to the tibial articular surface, suspicious for a tear. There is also globular increased signal intensity more anteriorly within the body of the medial meniscus that extends to the tibial articular surface, suggestive of degenerative tearing/fraying. Please note, however, it is difficult to determine whether or not these represent tears that existed prior to the patient's surgery without prior imaging for comparison. There is also diffuse signal abnormality within the remainder of the truncated posterior horn with extension to the femoral and tibial articular surfaces. Once again we cannot determine if this represents new or pre-existing tearing, but we see no fluid signal intensity within this portion of the posterior horn to indicate a large unstable tear. Finally, there is a relatively abrupt contour change between the truncated posterior horn and the remainder of the posterior horn near its root, as seen on images 21 and 22 of series 601. While we suspect this is postoperative in etiology , we cannot exclude a tear. There is mild medial extrusion of the body of the medial meniscus. There are parameniscal cysts seen along the posterior aspect of the meniscal body. The anterior horn of the medial meniscus appears intact. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is moderate diffuse degeneration of the articular cartilage of the weightbearing portion of the medial femoral condyle with several superimposed small near full-thickness and full-thickness articular cartilage defects. There is also mild to moderate thinning of the articular cartilage of the medial aspect of the tibial plateau. There is a subchondral cyst situated centrally and inferiorly within the femoral trochlea with associated near full-thickness degeneration of the overlying articular cartilage. Articular cartilage of the patella appears intact.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Abnormalities of the medial meniscus as described above in large part likely reflect postoperative changes, however, there is signal abnormality within the body of the meniscus that extends to the tibial articular surface which is suspicious for tearing. Other findings as described above.2. Degeneration of the articular cartilage of the medial compartment and femoral trochlea.3. Subcutaneous mass along the lateral aspect of the distal thigh that is incompletely imaged on this study and could be further evaluated with a contrast-enhanced MRI.


Instruction: Generate impression based on findings.

Input: History of inflammatory pseudotumor: worsening headache. There is no significant interval change in the high T2 signal lesion involving the periaqueductal portion of the midbrain, with extension into the bilateral posterior thalami. There is no associated abnormal enhancement. There is a right transfrontal ventricular catheter with mild surrounding gliosis. The ventricles and basal cisterns are unchanged in size and configuration. There are scattered punctate foci of susceptibility effect in the ventricles, which may be related to prior hemorrhage. There is no evidence of acute infarction. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are unremarkable. There is a left maxillary sinus retention cyst.

Output: 1. No significant interval change in the lesion involving the periaqueductal portion of the midbrain, with extension into the bilateral posterior thalami.2. Unchanged appearance of the shunted ventricular system.


Instruction: Generate impression based on findings.

Input: Renal mass. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Mild diffuse thickening of the adrenal glands bilaterally, without focal masses.KIDNEYS, URETERS: Unchanged size of the 2.1 x 1.5 cm complex T1 hyperintense, T2 hyperintense lesion (series 801, image 15) in the midpole of the left kidney. The multiple thick enhancing septations are unchanged. Additional subcentimeter simple and hemorrhagic cysts are noted in both kidneys.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted. No lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: Unchanged appearance of the complex cystic lesion in the left midpole kidney, again suspicious for a cystic renal cell carcinoma.


Instruction: Generate impression based on findings.

Input: History of thoracic astrocytoma treated with chemotherapy: off therapy evaluation. There are postoperative findings in the lower thoracic and upper lumbar spine. There unchanged diffuse expansion and T2 hyperintensity without corresponding abnormal enlacement. There is also persistent significant narrowing of the lower thoracic spinal canal with flattening of the lower thoracic spinal cord. There is unchanged considerable thoracolumbar levoscoliosis and exaggerated kyphosis in the lower thoracic region related to mild wedging of the T7 through T12 vertebral bodies.

Output: 1. Unchanged post-treatment findings and tumor involving the lower thoracic spinal cord.2. Severe stenosis of the lower thoracic spinal canal.3. Unchanged considerable thoracolumbar levoscoliosis.