Instruction: Generate impression based on findings.

Input: 73 year old man with history of heart transplant for nonischemic cardiomyopathy in 2005, PPM placement, CKD with worsening TR and RV function referred for cardiac MRI to evaluate for rejection. Of note, given the patient's renal function no contrast was administered. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 58%, the LV end diastolic volume index is 76 ml/m2 (normal range: 74+/-15), the LVEDV is 130 ml (normal range 142+/-34), the LV end systolic volume index is 32 ml/m2 (normal range 25+/-9), the LVESV is 55 ml (normal range 47+/-19). There are no regional wall motion abnormalities present. Left AtriumThe left atrium is dilated consistent with previous transplant. Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 48%, the RV end diastolic volume index is 63 ml/m2 (normal range 82+/-16), the RVEDV is 138 ml (normal range 142+/-31), the RV end systolic volume index is 33 ml/m2 (normal range 31+/-9), and the RVESV is 72 ml (normal range 54+/-17). There is a pacemaker lead noted within the RV.Right AtriumThe right atrium is dilated.Aortic ValveThe aortic valve is not well seen.Mitral ValveThe mitral valve opens widely and there is at least mild mitral regurgitation.Pulmonic ValveThe pulmonic valve is not well seenTricuspid ValveThe tricuspid valve opens widely. There is at least mild tricuspid regurgitation, which appears eccentrically directed but was not fully evaluated due to the abbreviated study.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 upper normal in size.Venous AnatomyThe SVC and IVC drain normally into the right atrium. There are transvenous device leads noted in the SVC.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThere are sternotomy wires present. There is a left chest wall pacemaker with associated artifact. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Normal size LV with normal systolic function (EF 58%). 2. Normal size RV with mildly reduced systolic function (EF 48%).3. Biatrial dilation consistent with history of cardiac transplant. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Headache(784.0) [784.0], Reason for Study: ^Reason: evaluate for infarct; Head CT showing possible R lacunar infarct History: Head CT with possible R lacunar infarct; persistent headaches No evidence of acute ischemic or hemorrhagic lesion on the scan.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, 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 are clear.Bilateral mastoid air cells are opacified.

Output: Normal brain MRI.


Instruction: Generate impression based on findings.

Input: Clinical question: Bleed. Signs and symptoms: Fall. Non-enhanced head CT conalthere is no evidence of intracranial hemorrhage, edema mass-effect, midline shift or hydrocephalus.Cortical sulci, ventricular system, CSF cisterns and gray white matter differentiation is within normal.Calvarium, limited view of paranasal sinuses, mastoid air cells and scalp demonstrate no abnormality.Nonenhanced CT of lumbar spine:There is normal alignment the vertebral column. Diffuse area of thickened bony trabeculation involving the body of L1 vertebrae is believed to represent a hemangioma. This finding is best appreciated on axial image 18. The bony density of the lumbar spine is otherwise unremarkable. No evidence of fracture is identified. There is mild to moderate degenerative disk disease and multilevel bulge of disk material. There is also moderate hypertrophic changes of posterior elements of the ligamentum flavum and facet complexes. There is no measurable central spinal stenosis however this should be further evaluated with an MRI. Hypertrophic changes of posterior elements are most noticeable and prominent at L4 -- L5 level with resultant mass effect on the thecal sac with forward displacement.Nonenhanced CT of cervical spine:Extensive degenerative disk disease more severely at C5 -- C6 is present. Very extensive and prominent anteriorly projecting osteophytes from C2 level to T1 level are noted along the anterior aspect of vertebral column. There is evidence of mass effect on the soft tissues of the neck.There is no evidence of fracture or malalignment. There is normal articulation of occipital condyles with C1 and C1 with C2.

Output: 1.Negative nonenhanced CT of brain.2.CT of the lumbosacral spine demonstrates no evidence of fracture or malalignment.3.CT of cervical spine demonstrates no evidence of fracture or malalignment. Extensive degenerative disk disease and very large hypertrophic spurs project anteriorly into the soft tissues of the neck and there is no significant spur posteriorly within the spinal canal.


Instruction: Generate impression based on findings.

Input: MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: No significant soft-tissue swelling anterior to the tibial tuberosity or loss of the sharp inferior angle of the infrapatellar fat pad. No thickening and edema of the inferior patellar tendo. No findings to suggest an infrapatellar bursitis. Cartilage is intact.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Small uncomplicated baker's cysts without specific findings to support Osgood Schlatter's


Instruction: Generate impression based on findings.

Input: CT of the head and right paracervical spine. 56-year-old male with daily headaches x 2 years. Also mass right neck, positive cervical radiculopathy. CT of brain without infusion:No evidence of hemorrhage, edema, mass effect, midline shift or hydrocephalus is detected. Cortical sulci, ventricular system and all CSF cisterns remain within normal limits. Calvarium, limited via paranasal sinuses, mastoid air cells and middle ear cavities are also within normal limits.CT of cervical spine without the infusion:The bony density and the alignment of cervical spine remains within normal limits. Degenerative disk disease including anteriorly projected bridging osteophytes, calcification and hypertrophic changes of posterior longitudinal ligament and bulging disks throughout the cervical spine are not. Degenerative changes at C3 -- C4 causes significant left neural foramina compromise and to a lesser degree of right neural foramina. A ventral hypertrophic spur at C5 -- C6 appears to be in contact with the cord with minimal posterior displacement of the cord. Heavy calcification of hypertrophy posterior longitudinal ligament posterior to C6 is noted. There is compromise of the left neuroforamina at C6 -- C7 level.There is no evidence of any destructive bony lesions. No evidence of any sclerotic bony changes. This examination is tailored primarily for CT of cervical spine and is not the appropriate test for evaluation of soft tissue masses ending at. Bilateral coarse soft tissue mass in the neck CT of the soft tissues of the neck with infusion or an MRI of the soft tissues of the neck is recommended.

Output: 1.Normal CT brain and calvarium without infusion.2.Degenerative changes of cervical spine with resultant multilevel neural foramina compromise as detailed.3.No evidence of any acute or sclerotic bony changes.4.This examination cannot evaluate for soft tissues of the neck since its tailored primarily for evaluation of cervical spine.5.If there is history of mass in the neck a dedicated CT of the soft tissues of the neck with infusion is recommended. 6.The findings were discussed with the clinical service pager # 4146( DR. Cathleen Mulcahy). Because a stated to the clinical service that this exam is not the appropriate test for detection of soft tissue mass in the neck. CT of the soft tissues of the neck with infusion is recommended for evaluation of possible mass in neck.


Instruction: Generate impression based on findings.

Input: Male 60 years old Reason: acute lower back pain Alignment is normal. Vertebral body heights are maintained. No acute fracture. Lesion involving the sacrum seen on MRI is not well seen due to overlying bowel gas.

Output: No fracture or malalignment.


Instruction: Generate impression based on findings.

Input: Seizure. ?Previous tumor resection. There is an anterior, interhemispheric resection bed that is CSF-filled. There is increased T2 signal, volume loss and parenchymal distortion involving the adjacent anteromedial aspect of the frontal lobes. There is an overlying bifrontal craniotomy. Frontal sinuses are opacified which may reflect postsurgical change and/or secretions. Smooth dural enhancement is present which is likely postsurgical. No suspicious nodular nodular enhancement is seen.Multiple foci of susceptibility are seen involving the bilateral cerebellar hemispheres compatible with chronic microhemorrhages. The remainder of the brain is notable for mild volume loss. No evidence of intracranial mass or mass effect. There is ex vacuo dilatation involving the bilateral frontal horns. No hydrocephalus. The major intracranial flow voids are patent (including the anterior cerebral arteries).Mastoid air cells are clear. Two well-circumscribed, T2 hyperintense lesions involving the maxillary alveolar ridge are probably related to the periodontal cysts but not well assessed.

Output: 1.Postsurgical changes of bifrontal craniotomy with resection cavity and gliosis involving the bilateral anterior inferior frontal lobes. There is smooth dural enhancement consistent with postsurgical change. No findings to suggest recurrent tumor.2.Multiple small foci of susceptibility involving the cerebellum are compatible with chronic microhemorrhages.3.No evidence of acute infarct, intracranial mass, or mass effect.4.Opacified bilateral frontal sinuses are at least in part related to postsurgical change with areas of T2 hyperintensity reflecting obstructed secretions or possibly CSF.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: L sided weakness and sensory deficit, r/o stroke MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. There are several foci of susceptibility effect centered in the pons and lower midbrain best seen on susceptibility images..Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There is multilevel disc desiccation present and straightening of the normal cervical curvature.At C2-3 there is no significant compromise to the spinal canal. There is narrowing of the left neural foramen resulting from disc material at this level with some encroachment of the left-sided exiting nerve rootsAt C3-4 there is loss of disc space height, diffuse disc bulge, bilateral uncovertebral osteophytes and some small endplate osteophytes. There is effacement of spinal fluid ventral and posterior to spinal cord at this level with a mild to moderate degree of spinal stenosis. There is also encroachment of the exiting nerve roots within the neural foramina bilaterally due to disc material and osteophytes - worse on the left side compared to the right.At C4-5 there is no significant compromise to the spinal canal. There is a disc bulge present at this level associated with some narrowing of the neural foramina and some mild encroachment of exiting nerve roots at this level.At C5-6 there is no significant compromise to the spinal canal . There is a right lateral recess broad-based disc protrusion present at this level which encroaches on the nerve roots at the right lateral recess.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.There are multiple old microhemorrhages present within the brain stem. 2.There are multilevel degenerative changes present in the cervical spine with encroachment of the right-sided exiting nerve roots at C5-6 and the left-sided exiting nerve roots at C3-3 and C3-4 and a mild to moderate degree of spinal stenosis at C3-4.3.There is no evidence for acute ischemic cerebral infarction.


Instruction: Generate impression based on findings.

Input: Prostate neoplasm. Plan to biopsy. PSA of 9.77 ng/ml. Right and left Gleason 6. PELVIS:PROSTATE:Prostate Size: The prostate measures 5.2 x 2.9 cm.Peripheral Zone: Within the mid gland, there is a 0.8 x 0.7 cm T2 hypointense lesion with restricted diffusion (series 1001, image 50), but no definite contrast enhancement, suspicious for carcinoma. Within the right mid gland there is T1 and T2 hyperintense signal, compatible with blood products.Central Gland: The central gland is nodular in appearance, compatible with benign prostatic hyperplasia.Seminal Vesicles: There is no seminal vesicle invasion.Extracapsular Extension: Questionable extracapsular extension is present.BLADDER: No significant abnormality noted.LYMPH NODES: Few subcentimeter external iliac lymph nodes are identified.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Left mid gland peripheral lesion suspicious for carcinoma. Questionable extracapsular extension.


Instruction: Generate impression based on findings.

Input: known brainstem lesion interval change, projectile vomiting. No evidence of acute ischemic or hemorrhagic lesion.Multifocal scattered high signal intensities on FLAIR images on bilateral periventricular white matter and centrum semiovale indicate non specific small vessel ischemic disease.There is ovoid shaped lesion on the left dorsal medulla (6mm x 5mm x 5mm) with subtle enhancement on Gad infusion. There is no evidence of surrounding edema. Possible diagnosis of the lesion is likely low grade glioma.There is no other abnormal enhancement on this scan.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Ovoid subtle enhancing left dorsal medullar lesion without surrounding edema, comparing to out side MR scan on Nov 18 2014, the size and MR characteristics do not show any significant interval change.2. Underlying non specific small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: 49-year-old male with history of urothelial cancer status post nephroureterectomy and cystectomy with neobladder formation. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Status post left nephrectomy. Exophytic T2 hyperintense cyst in the right superior pole. No hydronephrosis.T1 hyperintense focus measuring 9 mm in the right superior pole favored to represent a renal sinus cyst containing hemorrhage or proteinaceous debris. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postsurgical changes in the midline abdominal wall.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Stable index nodule in the left pelvis. 2.No new sites of disease.


Instruction: Generate impression based on findings.

Input: 38 years Female (DOB: 10/25/1978)Reason: MS, f/u progression History: pain and gait issuesPROVIDER NAME: ADIL JAVED ADIL JAVED MRI brain: There is redemonstration of multiple periventricular and subcortical white matter lesions as well as lesions in the thalami, internal capsules, brainstem and cerebellum which were also present on the previous exam. These lesions appear to be similar in size and distribution number compared to the previous exam from 1/22/2015. Many of the lesions are perpendicularly oriented to the lateral ventricles. There are some lesions extending into the corpus callosum bilaterally. 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.Lumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The distal spinal cord demonstrates some subtle T2 hyperintense lesions. They are not confirmed on axial imaging.. No abnormal lesions are identified in the lumbar spine. A T1 hyperintense lesion is identified in the L4 vertebral body and most likely represents a vertebral body hemangioma. It suppresses on the inversion recovery images.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is facet hypertrophy at this level.At L4-5 there is no significant compromise to spinal canal or neural foramina. Some subchondral cysts are present at the facet joints at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.There are periventricular subcortical white matter lesions present as well as lesions in the brainstem and cerebellum and deep gray nuclei and internal capsules which are stable and compared to prior exam. These are compatible patient's diagnosis of multiple sclerosis.2.There appear to be lesions in the distal thoracic spinal cord demonstrates some subtle lesions which are compatible with demyelinating disorder. If clinically indicated additional imaging of the thoracic spinal cord may help further assess these and confirm their presence.


Instruction: Generate impression based on findings.

Input: Numbness and tingling of the right upper extremity with concern for demyelinating disease. There is no evidence of acute intracranial hemorrhage or mass effect. There is a punctate focus abnormal T2 hyperintensity within the white matter of the left inferior frontal lobe and left aspect of the cerebellar vermis, which are nonspecific. There diffusion hyperintensity associated with the left inferior frontal lobe T2 hyperintensity without clear low ADC values. There is an additional nonspecific left frontal lobe punctate T2 hyperintensity. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable. There is mild mucosal thickening of the left maxillary and right sphenoid sinuses.

Output: Punctate T2 hyperintense foci within the white matter of the left inferior frontal lobe and left aspect of the cerebellar vermis, with mild restricted diffusion associated with the left inferior frontal lobe lesion. The left inferior frontal lobe lesion may represent an acute to subacute infarct versus an active demyelinating lesion which can also show restricted diffusion. Postcontrast sequence would be helpful, but were not be obtained due to inability of gaining intravenous access. Patient will reschedule for the postcontrast sequences. Please note however there is no specific evidence of chronic demyelinating disease on this study although remains a possibility. Further evaluation with CSF analysis may be helpful.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Follow-up for multiple sclerosis. There are multiple T2 hyperintense lesions cerebral white matter and perhaps in the right superior cerebellar peduncle. There has been interval increase in size of a lesion in the right superior frontal gyrus and in the left temporal horn periventricular white matter. The other lesions have not significantly changed. Many of the lesions demonstrate T1 hypointensity. 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: Interval increase in size of demyelinating lesions in the right superior frontal gyrus and in the left temporal horn periventricular white matter. The other lesions have not significantly changed. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: BRAIN: There is abnormal enhancement in the left posterior nasopharynx soft tissues. There is abnormal enhancement along with innumerable foci of non-enhancement representing extensive infection with innumerable abscesses extending into the clivus. There is a low marrow T1 signal with enhancement in the left occipital condyle, inferior aspect of the left occipital bone (opisthion), left lateral mass of C1. There is epidural enhancement with small central abscess and the left cervical spinal epidural space at the foramen magnum extending inferiorly to the C1-2 level. There is extensive enhancement with multiple abscesses in the left prevertebral, paravertebral and the paraspinal left postero-lateral neck soft tissues. There is involvement of the sella surrounding the pituitary gland. There are erosive changes at the posterior cortex of the clivus with extension into the right prepontine cistern as noted previously. These findings are grossly unchanged from the prior examination.There is increased signal abnormality with somewhat bulky appearance and enhancement of the bilateral cavernous sinuses with multiple small abscesses, consistent with bilateral cavernous sinus thrombophlebitis, similar to prior examination. However, there remains no abnormal superior ophthalmic vein enlargement or proptosis. There is persistent enhancement of the walls of the cavernous carotid arteries bilaterally without significant narrowing of the internal carotid arteries.There is contiguous infection extension along the right temporal leaflet from the right cavernous sinus, with a thin subdural empyema in the right tentorial leaflet which is best appreciated on the 3-D postcontrast T1 coronal images. There is asymmetric signal abnormality with heterogeneous enhancement in the left jugular tubercle and left hypoglossal canal. The left proximal internal jugular vein appears occluded and infectious process surrounds the left jugular canal as on the prior examination. These findings are also grossly unchanged from the prior examination. The dural venous sinuses appear patent. There is no acute infarct, mass effect or midline shift. There is no evidence of infection involving the brain parenchyma, or suspicious brain parenchymal enhancement. The ventricles and sulci are normal for patient's age. The flow-voids of the skull base are patent. There are mucus retention cysts in the bilateral maxillary sinuses. There is inflammatory mucosal thickening involving the right sphenoid sinus.CERVICAL: Compared to the prior exam, there is overall slightly decreased infection involvement in the neck. Representative measurements are described below:1.Abscess in the left posterior lateral neck soft tissues previously measured 28 mm compared to 25 mm today on series 21 image 4.2.Soft tissue thickening and enhancement along the left lateral neck measured up to 47 mm previously in short axis, now measuring up to 41 mm in short axis on series 23 image 1. This process extends from the skull base inferiorly to C5-6 level, unchanged in overall extent.3.There is persistent left anterolateral epidural enhancement with foci of central non-enhancement measuring up to 7 mm at the foramen magnum extending to C1-2, compared to 9 mm previously. There is effacement of the ventral CSF space with the epidural component abutting the ventral medulla/cord at C1 level without stenosis.4.There is contiguous left anterolateral epidural infection spreading inferiorly to the C3 level measuring up to 7 mm in thickness with tiny central abscess, similar to prior examination.5.There is asymmetric enhancement in the left neural foramina down to C5-6 which may be reactive to adjacent soft tissue infection, similar to prior examination.There are postoperative findings in the left neck including scattered foci of susceptibility which appear new from prior examination.There is no cord signal abnormality or suspicious enhancement within the cord. There is no restricted diffusion in the cervical cord. Aside from the skull base and C1, there is no osseous signal abnormality or suspicious osseous enhancement in the cervical spine. There is no significant disk herniation, significant spinal canal or neural foraminal stenosis in the cervical spine.

Output: 1.No evidence of infection or abscess within the brain parenchyma.2.Extensive transspatial infection with innumerable abscesses centered in the skull base with extension into the sella with findings suggesting infectious involvement of the pituitary gland. There is thrombophlebitis of the bilateral cavernous sinuses, with contiguous extension of infection into the right tentorial leaflet resulting in a small subdural empyema. These findings are similar to prior outside MRI from January 2015.3.Extensive infectious involvement of the left sided deep neck/paraspinous and prevertebral soft tissue with multiple abscesses extending inferiorly to C5-6 level. Overall, infectious findings in the neck appears slightly decreased from the prior examination, although the overall extent of involvement appears similar to the prior examination. Please see details above.4.Left anterolateral epidural phlegmon/abscess extending from the foramen magnum to C3 level, slightly decreased from prior examination. Please see details above.5.Extensive erosive changes in the clivus with extension of infection into the pre-pontine cistern on the right, similar to prior study. Infectious marrow involvement of the left sphenoid and occipital bone as well as left lateral mass of C1, similar to prior study.6.Infectious process surrounding the left jugular and hypoglossal canals, similar to prior study.7.Left proximal internal jugular vein appears occluded, similar to prior study.Findings were discussed with Neurology resident Dr. Ali Mansour in person at the time of initial interpretation.


Instruction: Generate impression based on findings.

Input: 45-year-old with known left breast cancer. There is scattered fibroglandular tissue in both breasts.Marked parenchymal enhancement is noted bilaterally, with large patchy areas of marked parenchymal enhancement bilaterally, somewhat of a limitation to the study in those regions. At the site of biopsy-proven malignancy in the left breast, there is an irregularly enhancing mass with biopsy clip artifact. Correlating with the mammogram, a smaller satellite projects immediately inferior and medial to the main mass. The overall extent is 2.4 x 2.1 x 3.4 cm. No abnormal enhancement is seen in the right breast, within the limitation described above. In the left axilla, there are several lymph nodes with mildly thickened cortices. These are non-specific in appearance, with etiologies including reactive change (given the recent biopsy) and tumor involvement possible. No abnormal axillary lymph nodes are identified in the right axillary region.

Output: 1. Index lesion in the left posterior breast measures up to 3.4 cm. 2. Asymmetric, non-specific left axillary lymph nodes. Depending on planned management of the axilla, an axillary ultrasound with possible biopsy could be considered. 3. Marked background enhancement distributes in a similar pattern to her parenchyma and limits the evaluation. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Diagnosis: Unspecified epilepsy without mention of intractable epilepsyClinical question: h/o epilepsy s/p hippocampal laser ablation The patient is status post bilateral parietal bone and right temporal bone burr hole placement. There are T2 and FLAIR hyperintense tracts extending from the burr holes into the brain parenchyma.There is redemonstration of abutting irregularly shaped ring-enhancing lesions located in the right hippocampal head together measuring 15 x 20 cm in axial dimensions. This was also present on prior exam from 6/2/2015. On T1-weighted imaging and is bright and intermediate signal. On T2-weighted imaging it is predominantly low signal. On FLAIR MRI imaging it is low signal centrally and high signal peripherally. There is no evidence for diffusion restriction associated with it.The CSF spaces are appropriate for the patient's stated age with no midline shift. Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.There is a ring-enhancing lesion present in the right hippocampus. Most likely this is related to blood products at the prior treatment site. Please correlate with surgical findings.


Instruction: Generate impression based on findings.

Input: 59-year-old female presents with altered mental status an lethargy. There is no evidence of acute intracranial hemorrhage or midline shift. There is redemonstration of areas of encephalomalacia involving the right insular cortex, right temporal and right frontal lobes in the distribution of the right middle cerebral artery. There is also encephalomalacia in the left posterior cerebral artery involving the left occipital lobe.The ventricles and basal cisterns are unchanged in appearance compared to prior exam, including small right frontal horn.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1.No acute intracranial hemorrhage or midline shift.2.Stable multiple areas of encephalomalacia.3.CT is insensitive for the early detection of non-hemorrhagic CVA. MRI should be considered if clinical suspicion for CVA persists.


Instruction: Generate impression based on findings.

Input: Right knee pain and MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: Again seen is a near full-thickness defect of the lateral facet of the patella which slightly progressed compared to the prior exam.. Partial-thickness defects of the medial patellar facet are also noted which appears similar to the prior exam as well. There is also heterogeneous signal within the patellar cartilage relating to degeneration. The femoral trochlea is shallow suggesting dysplasia. The articular cartilage of the lateral compartment is thinned but otherwise intact. The articular cartilage of the medial compartment is intact.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: Metallic susceptibility artifact is again noted along the proximal tibia relating to prior fixation and osteotomy. No significant abnormality noted.ADDITIONAL

Output: Slightly worsening patellofemoral cartilage loss. There are no additional acute findings.


Instruction: Generate impression based on findings.

Input: Patient with pain, evaluate for fracture. Right hip:Severe degenerative changes, including joint space narrowing, subchondral cyst formation, and subchondral sclerosis affect the right hip. There is no discrete evidence of fracture or dislocation, however if there is continued clinical concern for fracture, MRI or CT could be considered.Pelvis:Mild degenerative changes affect the left hip. Severe degenerative changes of the lower lumbar spine are partially imaged. There is moderate degenerative changes of the bilateral sacroiliac joints and pubic symphysis.

Output: Severe osteoarthritis of the right hip without evidence of fracture. However, if there is continued clinical concern for fracture, CT or MRI may be considered.


Instruction: Generate impression based on findings.

Input: 2-year-old male with right knee pain and swelling, eval for osteomyelitis MENISCI AND LIGAMENTS: The menisci, cruciate and collateral ligaments are normal in appearance.BONE AND MARROW: No evidence of marrow edema or abnormal decreased T1 signal to suggest osteomyelitis. The distal femoral and proximal tibial epiphyses are normal for patient age.SYNOVIUM: No significant abnormality noted. MUSCULATURE: The extensor tendons are normal in appearance. ADDITIONAL

Output: Normal MRI knee for patient age without evidence of osteomyelitis.


Instruction: Generate impression based on findings.

Input: 65-year-old man with history of orthotopic liver transplant, evaluate for HCC. Please note that this study is markedly limited due to susceptibility artifact from the IVC/porta hepatis.ABDOMEN:LIVER, BILIARY TRACT: The partially visualized liver has nodular contour and widened fissures suggestive of cirrhosis. There is a geographic area of increased T2 signal in the right hepatic lobe along with delayed enhancement of this region. There is an approximately 16 x 14 mm round focus of arterial enhancement with washout on delayed phase images (series 103, image 51) in segment 6 of the liver. Restricted diffusion suggested by this focus. Additionally, there is a 10 x 10 mm focus of arterial enhancement with washout on delayed phase images (series 13, image 23) in the dome of the liver.SPLEEN: The spleen appears normal.PANCREAS: The pancreas appears normal.ADRENAL GLANDS: The left adrenal gland appears normal. The right adrenal gland is not visualized.KIDNEYS, URETERS: The left kidney has uniformly increased T2 signal and diffusion restriction. There is no hydronephrosis. The right kidney appears normal. The kidneys enhance symmetrically with normal nephrograms bilaterally.RETROPERITONEUM, LYMPH NODES: There are two large para-aortic masses which are heterogeneous in appearance but predominantly isointense to liver on T1 and T2 sequences. The left-sided mesenteric mass (series 4, image 27) measures 102 x 94 mm. This mass appears nodular, has small areas of high T1 signal suggesting hemorrhage, nonenhancing areas suggestive of necrosis, and peripheral enhancement. The right-sided mesenteric mass (series 4, image 27) measures 117 by 102 mm. This mass also appears nodular with nonenhancing areas suggestive of necrosis and demonstrates peripheral enhancement.The superiormost intrahepatic IVC and the intrahepatic IVC are not visualized.BOWEL, MESENTERY: Loops of small bowel are displaced by the retroperitoneal masses, otherwise the partially visualized small bowel and colon appear normal. The SMV courses anterior to the right retroperitoneal mass and is attenuated in caliber.BONES, SOFT TISSUES: There are multiple small ventral hernias, most of which contain fat, although one of which contains a portion of the transverse colon without evidence of obstruction. The patient is status post median sternotomy.OTHER: Right lung base pleural nodule (series 3, image 6) measures 12 x 11 mm.

Output: 1.Examination markedly limited by susceptibility artifact as described above, patient motion artifact noted on several sequences as well. Given the findings below, a contrast-enhanced liver protocol CT should be considered.2.Cirrhotic morphology of the liver with geographic increased T2 signal and delayed enhancement of the right lobe which may represent fibrosis or may be perfusional.3.Foci of enhancement in segments 6 and 8 of the liver as described suspicious for HCC.4.Large retroperitoneal masses which may represent necrotic nodal metastatic disease or PTLD or lymphoma (however these latter conditions considered less likely given the heterogeneous appearance).5.Abnormal signal of the left kidney nonspecific but may be related to an early obstructive process. No hydronephrosis.6.Nonspecific right pleural based lung nodule.


Instruction: Generate impression based on findings.

Input: 57-year-old male with HCV cirrhosis. Evaluate for hepatocellular carcinoma. Due to contrast injector malfunction, no precontrast images were obtained. Initially 15 mL of MultiHance was administered obtaining a portal venous phase. After approximately 20 minutes, an additional 12 mL was injected obtaining the arterial, portal venous, and delayed phases.ABDOMEN: LIVER, BILIARY TRACT: Severely cirrhotic hepatic morphology with caudate hypertrophy. There is been progression of confluent fibrosis and retraction. There are no arterially enhancing lesions. The delayed images demonstrate heterogeneous appearance of the hepatic parenchyma consistent with delayed enhancement within the fibrous bands rather than washout. Cholelithiasis.Gastroesophageal varices are noted.SPLEEN: Splenomegaly is 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: Large volume ascites.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Sequela of severe cirrhosis without evidence of arterially enhancing lesions. The delayed images demonstrate heterogeneous appearance consistent with delayed enhancement within the confluent fibrosis rather than washout.


Instruction: Generate impression based on findings.

Input: History of NF 1. New right thigh/buttock pain and twitching. Evaluate for hamartomas and neurofibromas. Brain: Examination is slightly motion degraded. No intracranial mass or mass effect is appreciated. No abnormal parenchymal signal abnormality is seen. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. The ventricles are within normal limits in size and configuration. No extra-axial collections. Cerebellar tonsils are borderline low-lying measuring up to 3.5 mm below the foramen magnum without clear evidence of Chiari I malformation.Sella and orbits are grossly within normal limits. There is minimal mucosal thickening involving the paranasal sinuses. Bone marrow signal and extracranial soft tissues are within normal limits. There is a small cervical syrinx which is noted at the C5 level and extends inferior, outside the field-of-view, (sagittal STIR series 25 image 16).Lumbar spine:Examination is motion degraded. The lumbar spine is in normal alignment. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. The distal spinal cord and conus are within normal limits with the conus terminating at the lower L1level. There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the lumbar spine. Incidentally seen is a small focus of CSF intensity measuring 9 x 8 mm at the L4-L5 level which may represent a small arachnoid cyst or diverticulum, and of doubtful clinical significance. Specifically no masses within the lumbar spinal canal or neural foramina are appreciated within the limits of noncontrast study. Please refer to separate report for findings in the pelvis. Small subcutaneous nodules are noted in the posterior paraspinous soft tissues compatible with superficial neurofibromas.

Output: 1. MRI of the brain without contrast is within normal limits. Cerebellar tonsils are borderline low-lying without clear evidence of Chiari I malformation.2. Incidentally seen on the brain MRI study is a small cervical syrinx at the C5 level which extends inferiorly, outside the field-of-view. Prior cervical spine MRI from 8/24/2012 also demonstrates a small cervical syrinx. Follow-up dedicated cervical and thoracic spine MRI can be considered for further evaluation as clinically indicated.3. No masses within the lumbar spinal canal or neural foramina are appreciated within the limits of noncontrast study. Please refer to separate report for findings in the pelvis.


Instruction: Generate impression based on findings.

Input: Female 59 years old Reason: r./o hydro History: signs RIGHT KIDNEY: Mild increased echogenicity. 7.3 cm in length. Septated upper pole cyst measures 1.7 x 2 x 2.7 cm no hydronephrosis.LEFT KIDNEY: 8.5 cm length.As well seen due to body habitus. No definite lesions. Central area of irregularity felt to be vasculature.URINARY BLADDER: : No significant abnormality noted.OTHER: No significant abnormalities noted.

Output: No hydronephrosis or hydroureter. Echogenic kidneys. Septated cyst right upper pole unchanged from MRI of 10/13. Left kidney not well seen no evidence of hydronephrosis.


Instruction: Generate impression based on findings.

Input: 36 years, Male, Reason: Please assess for brain AVMs, has HHT, hx of stroke related to large pulmonary AVMs. MRI BRAIN: There are at least five punctate foci of susceptibility effect which are seen on the susceptibility weighted sequence in the bilateral frontal lobes as well as the left thalamus. There may be an additional punctate focus in the left temporal lobe adjacent to the left temporal horn. No significant associated edema, gliosis, or enhancement. No restricted diffusion to suggest acute ischemia. No clear evidence of prior infarct. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. No abnormal parenchymal or meningeal enhancement. Sella and orbits are grossly within normal limits. There is a right maxillary sinus mucus retention cyst and minimal bilateral maxillary sinus mucosal thickening. Bone marrow signal and extracranial soft tissues are grossly unremarkable.MRA HEAD: The intracranial internal carotid arteries demonstrate no significant stenosis. The middle and anterior cerebral arteries are also patent. The vertebral arteries, basilar artery, and posterior cerebral arteries also are patent with no significant stenosis. No evidence of aneurysms or vascular malformations. There is mild ectasia at the left A1-A2 junction without discrete aneurysm.

Output: 1. Multiple (at least 5) punctate foci of susceptibility effect involving the bilateral frontal lobes as well as the left thalamus are compatible with chronic microhemorrhages or possibly tiny cavernous malformations. 2. Mild ectasia at the left A1 A2 junction without discrete aneurysm. No findings to suggest arteriovenous malformation.


Instruction: Generate impression based on findings.

Input: 58-year-old male with elevated PSA PELVIS:PROSTATE:Prostate Size: 3.8 x 3.5 x 5.1 cm.Peripheral Zone: Focus of T2 hypointensity in the right mid gland peripheral zone with corresponding restricted diffusion measuring 7 x 4 mm. Hypointensity reaches up to the capsule, suggestive of extracapsular extension.Additional focus of T2 hypointensity in the left apical peripheral zone measuring 6 x 7 mm with corresponding restricted diffusion.No definite corresponding suspicious enhancement pattern is evident.Central Gland: Moderate degree of benign prostatic hypertrophy.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: Findings suggestive of extracapsular extension in the right mid gland peripheral zone.BLADDER: No significant abnormality noted.LYMPH NODES: 6 mm right inguinal lymph node.BONES, SOFT TISSUES: Fat-containing patulous left inguinal canal.OTHER: No significant abnormality noted.

Output: 1.Two foci suspicious for prostate malignancy in the left apical and right mid gland peripheral zone. Findings suggestive of extracapsular extension the right mid gland peripheral zone.2.6 mm right inguinal node noted.


Instruction: Generate impression based on findings.

Input: Female, 36 years old. Reason: left knee pain History: left knee pain Views of the left knee appear normal for age without specific findings to account for the patient's pain.

Output: No specific radiographic findings to account for the patient's pain.


Instruction: Generate impression based on findings.

Input: Reason: eval rot cuff, extent of OA History: shoulder pain Study is limited by patient motion artifact.ROTATOR CUFF: Thickening and increased signal of the distal supraspinatus tendon consistent with moderate to marked tendinopathy. No discrete signal change to indicate tear. Fraying of the undersurface of the supraspinatus and infraspinatus tendons at the greater tubercle insertion site. No muscle atrophy.SUPRASPINATUS OUTLET: Moderate degenerative changes of the AC joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: Moderate degenerative changes of the glenohumeral joint with multiple subchondral cysts in the humeral head. Labrum is grossly normal.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: 1.Findings consistent with moderate to marked supraspinatus distal tendinopathy. No discrete tear is evident.2.Moderate degenerative changes of the AC joint and glenohumeral joint.


Instruction: Generate impression based on findings.

Input: Female, 31 years old, status post craniotomy for tumor resection. Postoperative findings are seen compatible with recent right frontal craniotomy and right frontal lobe resection. The right-sided dura is mildly thickened and enhancing. The resection cavity is roughly wedge shaped and contains fluid and air.Restricted diffusion is seen along the margins of the resection cavity. A small amount of ragged-appearing tissue is evident within the anterior aspect of the resection cavity but this is nonspecific. Most of the nodular enhancing tissue seen on the preoperative examination has been resected, especially superiorly. Along the inferior posterior aspect of the cavity, however, there remains a region of thickened tissue which contains patchy foci of enhancement appearing similar to prior.Elsewhere in the brain, periventricular T2 hyperintensity, predominantly at the level of the frontal horns, is again seen, a finding which may be related to prior therapy. No new signal abnormality or pathologic enhancement is detected. No new abnormal extra-axial fluid collections are seen. The right frontal horn remains partially effaced similar to prior, while the remainder of the ventricular system is unremarkable.

Output: Expected findings are seen status post right frontal resection. Most of the nodular enhancing tissue evident on the preoperative examination has been resected, particularly along the superior aspect of the cavity. Along the posterior inferior aspect of the cavity, there does remain some nodular parenchymal thickening which contains patchy foci of enhancement.


Instruction: Generate impression based on findings.

Input: Female, 41 years old, with back pain. 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 and conus are within normal limits. The nerve roots of the cauda equina are generally somewhat crowded which likely reflects a congenitally slender spinal canal. Additional superimposed degenerative findings are as follows:L1-2: Unremarkable. L2-3: Mild facet arthropathy. No significant spinal canal or foraminal stenosis. L3-4: Mild disc bulging, slightly progressed from prior. Mild generalized spinal canal narrowing. Mild bilateral foraminal narrowing. L4-5: Facet arthropathy, ligamentum flavum thickening, and disc bulging, progressed from prior. Mild generalized spinal canal stenosis, progressed from prior. Mild bilateral foraminal narrowing. L5-S1: Facet arthropathy, ligamentum flavum thickening, and mild spinal canal stenosis, progressed from prior. Moderate bilateral foraminal narrowing.

Output: Relatively mild but progressive disc and posterior element degeneration is seen from L3-4 through L5-S1. Superimposed upon a congenitally narrow spinal canal, these findings contribute to mild spinal canal and foraminal stenosis as detailed above.


Instruction: Generate impression based on findings.

Input: Squamous cell lung cancer. There is a linear area of high T2 signal that extends from the posterior limb of the left internal capsule into the corona radiata without associated restricted diffusion. There are also mild scattered foci of T2 hyperintensity in the cerebral white matter elsewhere without restricted diffusion. There is no evidence of acute intracranial hemorrhage, mass, or acute infarct. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unremarkable.

Output: Linear area of high T2 signal that extends from the posterior limb of the left internal capsule into the corona radiata without associated restricted diffusion may represent a prior lacunar infarct. Otherwise, no evidence of intracranial metastases, hemorrhage, or acute infarction.


Instruction: Generate impression based on findings.

Input: Alignment is anatomic. No loss of vertebral body height. The marrow signal is benign. The conus is normal in signal and morphology and terminates at an appropriate level. The visualized intra-abdominal and paraspinal contents are unremarkable. L1/2: No evidence foraminal narrowing or spinal canal stenosis. L2/3: Mild hypertrophy of the ligamentum flavum and disk dessication. No evidence of neuroforamina or central canal stenosis.L3/4: Mild hypertrophy of the ligamentum flavum and disk dessication. No evidence of neuroforamina or central canal stenosis.L4/5: Mild hypertrophy of the ligamentum flavum and disk dessication. No evidence of neuroforamina or central canal stenosis. L5/S1: Ligamentum flavum hypertrophy, right greater than left. Mild disk desiccation and loss of disk height. Moderate right neural foraminal narrowing. No evidence of left neural foraminal narrowing or central canal stenosis. Sacrum: Expansion of the thecal sac with bony remodeling of the neuroforamina bilaterally, right greater than left. There is extension to the S2 neuroforamina with mild mass effect with forward displacement and flattening of the right S2 nerve root. There is lesser mass effect on the left S2 nerve root. There is no abnormal signal of the nerve roots.

Output: 1.Expansion of the thecal sac with bony remodeling of the sacral neuroforamina bilaterally, right greater left. There is mild mass effect on the S2 nerve roots bilaterally, right greater than left. The differentials include prominent Tarlov cysts, perineural cyst, or arachnoid cyst. Myelogram with delayed imaging will be helpful for further evaluation.2.Degenerative disk disease as above, without significant central canal stenosis.


Instruction: Generate impression based on findings.

Input: 67 year old female pre-vertebroplasty procedure scan There is normal lumbar spine lordosis. Examination again shows mild collapse of the L5 vertebral body with sclerotic change, more prominent on the left side. Axial images show soft tissue density intra-osseous mass on the left with posterior extension to the left hepatic lobe and transverse process, and extending into the neural foramen and adjacent paraspinal space (axial image 60/105, sagittal image 28). There is vacuum phenomenon at L5-S1 intervertebral disk space.There is no vertebral body destruction in the residual lumbar spine. No bony destruction is identified in other segments of posterior elements.Disk bulge is noticed at L2-3, L3-4 and L4-5 level. Please refer to the dedicated lumbar spine MRI examination for more details on degenerative change findings.

Output: L5 vertebral column metastatic lesion as detailed above.


Instruction: Generate impression based on findings.

Input: Neoplasm of unspecified behavior of brain [D49.6], Reason for Study: ^Reason: 42 yo M with recurrent GBM enrolled on clinical trial of re-irradiation, eval extent of disease pre-treatment History: left arm weakness Previously seen right frontal lobe and corpus callosum genu mass which extended toward left frontal lobe with enhancement show more intra tumoral enhancement especially corpus callosum genu area mass on today's scan.There are also more conspicuous enhancements of the right frontal mass especially posterior aspect. However, the maximum diameter of the lesion as well as mass effects toward adjacent ventricle and extents of surrounding edema do not show any significant interval change.Therefore, these interval changes may indicate super imposed effects of Avastin therapy but cannot exclude possibility of tumor progression.Previously seen postoperative changes of the right temporal lobe, insular and the right frontal lobe inferior parietal gyrus with associated overlying dural enhancement are again seen, unchanged. The ventricles, sulci and cisterns are unremarkable.Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: Interval increase of the extent of enhancing portion of postoperative tumor especially corpus callosum genu portion mass and posterior aspect of right frontal mass. However, these findings are not associated with identifiable interval tumor size increase, nor evidence of increasing mass effects. Differential diagnosis include interval tumor progression and post Avastin therapy effects.


Instruction: Generate impression based on findings.

Input: Well-controlled HIV, treated syphilis, admitted for confusion, dizziness, unsteady gait. Had a fall 1 week ago and again 1 day before admission. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mild scattered cerebral white matter T2 hyperintensity. There is moderate diffuse cerebral volume loss. There is a developmental venous anomaly in the posterior right perisylvian region. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There are bilateral lens implants.

Output: Diffuse cerebral volume loss and probable chronic mild cerebral white matter disease. No evidence of acute intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: Male 58 years old Reason: prostate cancer History: prostate cancer PELVIS:PROSTATE:Prostate Size: 3.7 x 4.1 x 4.0 cm.Peripheral Zone: Diffuse intrinsic T1 hyperintense signal throughout the prostate, particularly the peripheral zone suggestive of hemorrhage. Multiple foci of abnormal T2 hyperintense signal within the peripheral zone. A dominant focus of signal abnormality measures 0.7 x 1.2 cm in the right posterior basal/mid gland. A second dominant focus measures 0.6 x 1.1 cm in the left posterolateral base/mid gland. Central Gland: Heterogeneous.Seminal Vesicles: No significant abnormality, in particular no evidence of seminal vesicle invasion. Extracapsular Extension: There is suspicion for bilateral extracapsular extension. This is in the region of the expected location of the neurovascular bundles.BLADDER: No significant abnormality noted.LYMPH NODES: Mildly prominent external iliac chain lymph nodes are nonspecific.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Two dominant foci of signal abnormality in the peripheral zone suspicious for prostatic carcinoma. There is suspicion for bilateral extracapsular extension.


Instruction: Generate impression based on findings.

Input: Left optic disc swelling and vision loss. History of venous tributary occlusion of retina on the right and breast cancer. Brain: There is a homogeneously enhancing extra-axial mass overlying the left lateral temporal convexity that measures up to 15 mm in width with associated hyperostosis. 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.Orbits: There is diffuse enhancement and prominent high T2 signal along the left optic nerve sheath and protrusion of the left optic nerve disc. The left optic nerve itself displays high signal on diffusion-weighted imaging, perhaps due to pressure effects, but displays normal T2 signal and no associated enhancement. There is no discrete mass lesion in the right orbit. The left extraocular muscles and lacrimal gland are unremarkable. The right optic nerve appears to be relatively atrophic. The right orbit is otherwise unremarkable.

Output: 1. Findings suggestive of left optic perineuritis versus perhaps an infiltrative neoplastic process.2. Unchanged left lateral temporal convexity probable meningioma.


Instruction: Generate impression based on findings.

Input: Evaluate left facial mass concerning for left sinonasal malignancy. There is a heterogeneous and infiltrative mass centered in the left sinonasal region, completely obliterating the left maxillary sinus and much of the left nasal cavity and ethmoid sinuses, with extension into the inferior and medial extraconal orbit, abutting the left inferior rectus muscle, and into the overlying left facial subcutaneous tissues with surrounding fat stranding and into the retromaxillary space. There is also compression of the left nasolacrimal duct, with dilatation of the lacrimal sac. Overall, the mass measures up to approximately 7 cm. There are secretions and mucosal thickening in the left frontal sinus and right ethmoid sinuses. The right orbit and paranasal sinuses are unremarkable. There is a mildly enlarged left level 1B lymph node that measures 10 x 17 mm in axial section. There is no significant cervical lymphadenopathy elsewhere in the neck. The salivary glands appear to be grossly intact. There is no evidence of gross intracranial tumor. There is no evidence of acute cerebral infarction, hemorrhage, or ventriculomegaly. There is minimal nonspecific periventricular T2 hyperintensity.

Output: 1. An aggressive mass centered in the left sinonasal region with extension into the extraconal orbit, the overlying left facial subcutaneous tissues, and the retromaxillary space is compatible with a malignant neoplasm. 2. A mildly enlarged left level 1 lymph node may represent metastatic disease.


Instruction: Generate impression based on findings.

Input: 35 years Female (DOB:12/30/1980)Reason: Prior MRI shows lesions consistent with MS but no findings= RIS. Today has a babinski on the right so now CIS. Burden change? Activity? History: right Babinski Lhermitte's signPROVIDER/ATTENDING NAME: BARRY G. ARNASON BARRY G. ARNASON The CSF spaces are appropriate for the patient's stated age with no midline shift. There are multiple periventricular white matter lesions present some which are perpendicularly oriented to the lateral ventricles as well as some lesions extending towards the orbits callosum along the colossocingulate junction. These are identified on the prior exam in have not changed to any significant degree. There is no associated contrast enhancement with these lesions current exam. Additionally there are white matter lesions present in the posterior fossa including the left middle cerebellar peduncle and medulla where there are stable lesions, however, there is a new lesion along the left superior semilunar lobule of the left cerebellar hemisphere which lesion has developed since the prior exam.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: Since the prior exam patient developed a new lesion along the left cerebellar hemisphere. The rest of the study appears stable. Is omental patient's known clinical history of demyelinating disorder


Instruction: Generate impression based on findings.

Input: 43-year-old male with chronic pancreatitis and new onset right lower quadrant pain ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: Numerous calcifications are scattered throughout the pancreas, compatible with chronic pancreatitis.A 14 x 9 cm cystic lesion is seen at the junction of the body/tail of the pancreas (series 3, image 41) with possible associated calcifications, unchanged from recent MRI.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The appendix is not definitively visualized. No right lower quadrant inflammatory changes are visualized.A tubular, blind ending structure (series 3, image 114) arises off the distal ileum, compatible with a Meckel's diverticulum. No adjacent inflammatory changes are visualized.Mild diffuse haziness of the mesentery is seen, not significantly changed.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Trace free fluid in the pelvis, unchanged.

Output: Meckel's diverticulum without adjacent inflammatory changes. Nonvisualized appendix without inflammatory changes in the ileocecal region to suggest appendicitis.Cystic lesion in the pancreas, unchanged from MRI from 7/15/09. In retrospect, this is compatible with a side branch IMPN. Follow-up MRI may beneficial.


Instruction: Generate impression based on findings.

Input: Reason: Evaluate left knee for lateral meniscus tear, loose body. History: left knee pain MENISCI: We see no discrete lateral meniscal tear. There is attenuation of the posterior horn of the medial meniscus with increased signal intensity throughout its substance likely reflecting extensive degeneration and tearing. The root of the posterior horn of the meniscus is not clearly identifiable. There is poorly defined increased signal intensity within the body of the meniscus also likely representing degeneration and perhaps degenerative tearing. The body of the meniscus is extruded medially. Additionally, there is low signal intensity beneath the extruded meniscus which could represent displaced meniscal tissue or a thickened meniscotibial ligament.ARTICULAR CARTILAGE AND BONE: There is severe degeneration of the articular cartilage of the medial tibiofemoral compartment with areas along the weightbearing portion of the medial femoral condyle and medial tibial plateau essentially devoid of articular cartilage with associated degenerative subchondral signal abnormality and cyst formation. There is also heterogeneity of the articular cartilage of the lateral compartment indicating relatively mild degeneration. There is also near full-thickness to full-thickness fissuring of the articular cartilage of the femoral trochlea, centrally. There are tricompartmental osteophytes.LIGAMENTS: There is thickening and increased signal intensity of the ACL and PCL likely representing mucoid degeneration. The collateral ligaments appear intact.EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Severe osteoarthritis of the knee particularly affecting the medial tibiofemoral compartment with extensive tearing of the medial meniscus. We see no discrete lateral meniscal tear or loose body.2. Mucoid degeneration of the cruciate ligaments and other findings as described above.


Instruction: Generate impression based on findings.

Input: Fasciculations and vertigo. There is no evidence of intracranial hemorrhage or acute infarct. There is a fat-signal intensity lesion along the pituitary stalk that measures up to 6 mm. The brain parenchyma and pituitary gland otherwise appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There are subcentimeter nasopharyngeal retention cysts.

Output: 1. Incidental subcentimeter lipoma or dermoid along the pituitary stalk.2. No evidence of intracranial hemorrhage or acute infarct.


Instruction: Generate impression based on findings.

Input: 20-year-old female with history of hemoglobin SS with lower back pain, shooting down leg. Diffuse hypointensity of the bone marrow again seen without abnormal enhancement or evidence of bone marrow edema. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The conus medullaris is normal in signal and morphology and terminates at an appropriate level. There is no significant spinal canal or neural foraminal stenosis at any level. The paravertebral soft tissues are unremarkable. There is diffuse low signal in the partially imaged liver and also present previously.

Output: 1. No significant disc disease, spinal canal or neural foraminal stenosis at any level.2. Diffuse marrow signal hypointensity as well as low signal in the partially imaged liver consistent with known sickle cell anemia and iron overload.


Instruction: Generate impression based on findings.

Input: Multiple myeloma and CML BONE MARROW: Subtle areas of intermediate to low signal intensity are identified within the left posterior ilium on series 501 images 34 and 35 and these demonstrate slight hyperintensity on corresponding T2 fat saturated sequences. Additional areas are identified within the right iliac wing (series 501 image 42) and the right proximal femur (series 501 image 9)SOFT TISSUES: No significant abnormality noted. JOINTS: There is mild osteoarthritis of the hips with a small amount of fluid identified within each hip joint but no sizable effusion.ADDITIONAL

Output: Subtle areas of intermediate to low signal intensity within the pelvis particularly in the left posterior ilium suspicious for early myelomatous involvement.


Instruction: Generate impression based on findings.

Input: Reason: New pelvic mass, presumed vaginal carcinoma. Need further evaluation with MRI prior to chemoradiation. History: As above PELVIS:UTERUS, ADNEXA:Patient is status post hysterectomy.There is a circumferential mass centered at the vaginal cuff involving the mid and upper vagina, extending cranially 6.8 cm and measuring approximately 8.3 x 5.2 cm in transverse dimension (501/44, 81/25). There are multiple parametrial soft tissue nodules in the pelvis. Nodules on the left extend to within 1 to 2 mm of the adjacent sidewall (601/41). There are multiple perirectal and retrorectal soft tissue implants within the mesorectal fascia with a large mass measuring 4.5 x 3.7 cm. Perirectal soft tissue implants abut and and are intermittently associated with the rectosigmoid colon (801/34) without definite invasion. A portion of the dominant mass abuts the left aspect of the posterior bladder wall. BLADDER: No significant abnormality noted.LYMPH NODES: Multiple enlarged pelvic lymph nodes with a left external iliac iliac node measuring up to 3.3 x 3.6 cm which compresses the left external iliac vein. Para-aortic lymphadenopathy is seen on coronal views and demonstrated on recent CT (701/18).BOWEL, MESENTERY: Multiple perirectal implants abutting the rectosigmoid as above. No mass is seen within the colon to indicate a colon cancer.BONES, SOFT TISSUES: Multiple enhancing osseous lesions likely represent metastases including the bilateral sacrum, bilateral inferior pubic rami and proximal left femoral diaphysis.OTHER: Partially thrombosed aneurysmal and normal in all all dilatation of the right common iliac artery measuring 3.2 cm

Output: 1.Vaginal cuff mass involving the upper vagina and extending into the parametrial tissues with multiple soft tissue nodules within the pelvis. A gynecological malignancy is favored including endometrial or upward extension of a vaginal or possibly cervical cancer. Correlate with history, as this also could represent a recurrent tumor.2.Retroperitoneal and pelvic lymphadenopathy.3.Multiple enhancing osseous lesions, likely metastases.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for progression of lumbar disease. Signs and symptoms: Back pain. Nonenhanced lumbar MRI:The signal intensity of the vertebral column demonstrate changes secondary to degenerative disease and are unremarkable otherwise.The alignment of vertebral column remains anatomical however there is mild straightening lumbar lordosis.Normal visualized thoracic spine and thoracic cord from T10 inferiorly is unremarkable.T12 -- L1 is unremarkable.L1 -- L2 is unremarkable.L2 -- L3 demonstrate mild disk disease and subtle loss of disk height and moderate bilateral (left greater than right) facet hypertrophic changes and including the left facet effusion. Mild to moderate bilateral (right greater than left) ligamentum flavum hypertrophy is also noted. There is resultant mild central spinal stenosis and no neural foraminal compromise. There is a slight progression of degenerative changes since prior exam.L3 -- L4 demonstrate mild disk disease and loss of disk height, moderate bilateral ligamentum flavum hypertrophy and mild bilateral facet hypertrophic changes. There is no spinal stenosis and no neural foraminal compromise. There is no significant change in extent of changes since prior study.L4 -- L5 demonstrate mild disk disease, moderate to severe (left greater than right) ligamentum flavum hypertrophic changes and mild bilateral facet hypertrophic changes. Constellation of changes results in moderate central spinal stenosis. There is no appreciable change in the extent of degenerative changes since prior study.L5 -- S1 demonstrate moderate disk disease and loss of disk height, mild to moderate symmetrical bilateral ligamentum flavum hypertrophy and mild bilateral facet disease and facet effusion. There is no central spinal stenosis or neural foraminal compromise. There is however mild compromise of the lateral recess of the canal bilaterally. Although there is no significant change in the extensive of degenerative changes at this level there is interval decreased size of broad-based disk protrusion far laterally on the left since prior exam.

Output: 1.Degenerative changes of disks and the posterior elements demonstrate mild progression since prior exam as detailed.2.At L2 -- L3 mild central spinal stenosis again noted without significant change.3.Moderate central spinal stenosis at L4 -- L5 without significant change.4.At L5 -- S1 there is interval decreased size of far left lateral disk protrusion since prior exam.5.No significant neural foraminal compromise at any level.


Instruction: Generate impression based on findings.

Input: Right orbitozygomatic craniotomy for orbital schwannoma resection. There has been interval evolution of postoperative findings related to orbital tumor resection with minimal residual fluid in the anterior superior extraconal right orbit. There is interval resolution of the edema in the inferior right frontal lobe gyrus along the surgical approach and resolution of dural enhancement along the floor of the right anterior cranial fossa. There is mild protrusion of the right orbitofrontal gyri into the right orbit through a defect in the superior orbital wall and mild deformity of the right superior rectus-levator complex. The right orbital contents are otherwise intact and the left orbit appears unremarkable.

Output: Interval evolution of postoperative findings orbitozygomatic craniotomy without evidence of recurrent tumor.


Instruction: Generate impression based on findings.

Input: 32 year old with history of left breast cancer on neoadjuvant chemotherapy. Extensive suspicious calcifications in the left breast. On recent MRI, asymmetry in the right inferior breast was also identified, and further evaluation was recommended. LEFT BREAST:A targeted left ultrasound was performed patient's known left upper outer quadrant cancer. In the upper outer quadrant at the 1:00 position 3 cm from nipple there is a hypoechoic mass with biopsy clip seen centrally measuring approximately 7 x 3 x 12 mm (CC x AP x LR), consistent with biopsy-proven cancer. This mass measured up to 3 cm per report from outside hospital. There is an elongated geographic mixed echogenicity area with echogenic calcifications extending from the mass along the 1:00 radian. The mass and the adjacent strip measures approximately 18 mm long, and is 6 mm thick. There is an adjacent parallel elongated hypoechoic, geographic area with calcification at the 1:00-2:00 position approximately 4 cm from nipple, inferior and lateral to the biopsy proven cancer which measures approximately 12 x 2 x 11 mm (CC by AP by TV). These likely correlate to areas of non-mass enhancement seen on recent MRI.Targeted ultrasound of the left breast outer lower quadrant from 3:00 to 6:00 was also performed. No abnormalities are identified.RIGHT BREAST:A targeted right ultrasound was performed for the area of concern in the right inferior breast identified on MRI breast 6/1/2015 spanning 3:00 through 9:00 positions. Unremarkable sonographically dense fibroglandular tissue is present throughout the inferior breast. No discrete solid or cystic masses are identified. No correlates to the MRI findings are seen.

Output: Interval decrease in size of known left breast cancer measuring 7 x 3 x 12 mm, previously measured up to 3 cm. Adjacent mixed echogenicity areas with calcifications are noted as described and likely correlate to areas of non-mass enhancement seen on recent MRI.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: 24-year-old male status post anterior shoulder dislocation now with pain, evaluate for labral tear. ROTATOR CUFF: The rotator cuff is within normal limits. The acromioclavicular joint is normal and we see no fluid within the subacromial/subdeltoid bursa.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is within normal limits. There is slight deformity of the anterior inferior glenoid from the three o'clock to six o'clock position that we suspect represents a thin crescentic healing Bankhart fracture. There is deformity of the anterior inferior labrum along the suspected fracture that likely represent injury to the labrum; however, we see no fluid separating the labrum from the underlying bone, even on the ABER sequence. There is a small cleft in the articular cartilage of the anterior glenoid as well as a 7 mm linear focus of intermediate signal intensity along the surface of the anterior inferior glenoid which may represent a cartilage flap or fragment. Gadolinium partially separates the anterior superior labrum from the underlying bone and we are uncertain if this represents a tear or sublabral foramen. There is a full-thickness chondral defect along the posterior superior aspect of the humeral head. Small foci of intermediate signal intensity layering dependently in the glenohumeral joint likely represent cartilage fragments. BICEPS TENDON: The long head of the biceps is intact. There is a 5 mm focus of intermediate signal intensity in the biceps tendon sheath, likely representing an additional cartilage fragment.

Output: Findings indicating prior anterior dislocation as detailed above, including deformity of the anterior inferior glenoid and labrum likely representing a healing Bankhart fracture with additional cartilage defects and fragments as described above.


Instruction: Generate impression based on findings.

Input: Diagnosis: Neoplasm of unspecified nature of brainClinical question: s/p brain tumor resectionSigns and Symptoms: s/p brain tumor resection There is a 61x56mm sagittal dimension heterogenously enhancing mass in involving the deep white matter of the right frontal lobe and the adjacent subcortical white matter of the right parietal lobe . There is adjacentT2/FLAIR signal hyperintensity compatible with vasogenic edema in an area measuring 91x64 mm axial dimensions. There are satellite foci of enhancement in the adjacent brain. There is susceptibility effect within the mass. Since the prior exam there are more blood products within the mass.The patient is status post recent right sided craniotomy. There is an underlying subdural collection measuring up to 9mm thickness. There is mass effect with 10 mm right sided shift of the septum pellucidum at the level of the internal cerebral veins. This midline shift has increased compared to the prior exam. There is mild uncal herniation present and subfalcine herniation. The right lateral ventricle is compressed.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Since the prior exam the patient's right hemispheric mass has developed more hemorrhage and mass effect with slightly greater midline shift. There is mild uncal herniation present.2.Since the prior exam the patient has undergone craniotomy. There is a small extra-axial fluid collection at the craniotomy site.


Instruction: Generate impression based on findings.

Input: The pituitary gland measures up to 5 mm in craniocaudal thickness. The pituitary gland displays mildly heterogeneous enhancement, although no discrete mass is apparent. The pituitary stalk lies in the midline. The suprasellar cistern, optic chiasm, cavernous sinuses and intracranial portions of the optic nerves appear unremarkable. There is a small retention cyst in the right sphenoid sinus. There may be a small arachnoid cyst in the medial right middle cranial fossa.

Output: The pituitary gland measures up to 5 mm in craniocaudal thickness, which is smaller than average, but does not meet the criteria for partially empty sella.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 46-year-old female with right frontal mass a slight soft tissue/abscess. Rule out bleed. Examination demonstrates an irregularly shaped bony defect of right frontal bone. Soft tissue density mass externally over this bony defect is present. Very minimal epidural thickening also within the intracranial space at this level is present. There is no evidence of edema, mass effect or midline shift secondary to this finding. Further evaluation with an MRI is recommended for possibility of tumor or an infectious process. No additional bony defect is detected. Paranasal sinuses and mastoid air cells are unremarkable. Images through intracranial space demonstrate no definitive evidence of any additional abnormality. No evidence of hemorrhage, edema, mass-effect, midline shift or hydrocephalus is present.

Output: 1.Irregular bony defect with large extracranial soft tissue component that is concerning for tumor or an abscess and should be further evaluated with dedicated MRI.2.Unremarkable CT examination of intracranial space.


Instruction: Generate impression based on findings.

Input: Index finger laceration. Patient unable to bend finger. The bone marrow signal of the phalanges appears within normal limits. The tendons in the index finger are normal in signal and size. The remaining soft tissues of the finger are unremarkable.

Output: No specific findings to account for the patient's decreased function.


Instruction: Generate impression based on findings.

Input: History of breast cancer on a clinical trial. Evaluate for metastases. There is subtle heterogeneous signal abnormality within the central pons that does not demonstrate enhancement. The appearances is nonspecific and possibly vascular in etiology. There is no associated diffusion restriction.Otherwise, no abnormal signal is seen on the T2, FLAIR or diffusion weighted images. No abnormal enhancement on the postcontrast images. There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration. The expected intracranial vascular flow voids are present.The paranasal sinuses are clear. The visualized mastoid air cells are clear. The orbits are unremarkable.

Output: 1.No evidence of intracranial metastatic disease.2.There is a patchy lesion present within the pons which is nonspecific. One possibility is that this is vascular related.


Instruction: Generate impression based on findings.

Input: CERVICAL SPINE: There is mild kyphosis of the cervical spine, unchanged from the prior radiograph. There is no evidence of fractures or subluxations. The vertebral bone marrow signal is unremarkable. The cervical and upper thoracic spinal cord are normal in signal. The cerebellar tonsils are in normal position. There is no significant spinal canal stenosis or neural foraminal narrowing. The imaged paraspinal contents are unremarkable, including the imaged portions of the cervical arterial flow voids. LUMBER SPINE: For the purposes of numbering five lumbar type vertebral bodies are assumed. There is slight straightening of the lumbar spine in the sagittal plane. There is no evidence of fractures or subluxations. The vertebral bone marrow signal is unremarkable. The vertebral body heights and intervertebral disc spaces are preserved, although there appears to be minimal loss of fluid signal in the L5-S1 disc. The conus is normal in signal and morphology and terminates at an appropriate level. There are no significant posterior disc bulges or herniations. There is no significant spinal canal or neural foraminal stenosis. The imaged intra-abdominal and paraspinal contents are unremarkable.

Output: 1.No evidence of cervical and lumbar spine fractures or subluxations, within the limits of MRI.2. No evidence of cervical spinal cord injury.3. Nonspecific mild kyphosis of the cervical spine and slight straightening of the lumbar spine in the sagittal plane. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Secondary malignant neoplasm of brain [C79.31] / Secondary malignant neoplasm of other parts of nervous system [C79.49], Reason for Study: ^Reason: S/p SRS for brain metastasis. Surveillance exam. History: S/p SRS for brain metastasis. Surveillance exam. 58 years Female (DOB:10/11/1958)Reason: S/p SRS for brain metastasis. Surveillance exam. History: S/p SRS for brain metastasis. Surveillance exam.PROVIDER/ATTENDING NAME: STEVEN J. CHMURA SERVICES ANCILLARY Interval decrease of the size of resection cavity on the right middle temporal gyrus reaching to the periventricular white matter of right lateral ventricle occipital horn. In addition, enhancing portion of the lesion is also decreased since prior scan.There is no other abnormal enhancement is seen.No evidence of acute ischemic or hemorrhagic lesion. Right temporoparietal craniotomy is seen, unchanged since prior scan.No intracranial hemorrhage is identified. 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 right mastoid air cells opacified, unchanged since prior scan. The visualized portions of the orbits are intact.

Output: 1. Interval decreased size of the resection cavity as well as decreased extent of enhancing portion of the right middle temporal gyrus lesion extended toward the right lateral ventricle periventricular white matter.2. No evidence of new abnormal enhancing lesion.3. No evidence of acute ischemic or hemorrhagic lesion.


Instruction: Generate impression based on findings.

Input: Critical question: Evaluate for bleed or mass. Signs and symptoms: Hypertension and headaches. Non-enhanced head CT:There is no evidence of intracranial hemorrhage, edema, mass, mass effect or midline shift or hydrocephalus.Questionable foci of low-attenuation in the subcortical white matter of both hemispheres are noted. These may represent small vessel ischemic disease. The common follow-up with an MRI exam. Cortical sulci, ventricular system and all CSF cisterns are otherwise unremarkable. Calvarium, visualized paranasal sinuses and mastoid air cells are unremarkable.

Output: 1.No evidence of acute intracranial finding.2.Questionable small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: Trauma. The ventricles and basal cisterns are normal in size and configuration. The gray-white matter differentiation is preserved. There is subtle hypoattenuation seen in the subcortical and deep white matter of the superior frontal gyri subcortical white matter and possible expansion of the gyrus. This is unusual for a patient of this age and further assessment with an MRI is advised.There is no mass-effect or midline shift, intra-extra axial fluid collection, or acute hemorrhage.The calvaria and skull base appear normal, no evidence of a skull fracture or diastases of the calvarial sutures. No pneumocephalus.The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. No acute intracranial abnormality.2. Subtle low attenuation in the in the high convexity bifrontal deep white matter unlikely traumatic and may represent congenital leukomalacia, further assessment with MRI may be helpful.


Instruction: Generate impression based on findings.

Input: Pain. Sprain involving the medial collateral ligament MENISCI: No abnormality noted and are well visualized.ARTICULAR CARTILAGE AND BONE: No significant abnormality noted. Normal marrow signal observed throughout. Cartilage well visualized without focal defectsLIGAMENTS: The ACL, PCL and LCL are well visualized and intact. Stranding in adjacent soft tissue inflammatory changes are observed with the MCL, however the MCL ligament demonstrates minimal thickening towards its superior aspect with fibers that are otherwise intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Moderate MCL sprain without additional abnormality


Instruction: Generate impression based on findings.

Input: 18-year-old male with right knee pain and swelling, please rule out for MCL tear or meniscal injury. MENISCI: Predominantly transverse, near complete meniscal tear of the posterior lateral meniscus. ARTICULAR CARTILAGE AND BONE: T2 hyperintense signal is visualized within the lateral aspects of the distal anterior femur and proximal posterior tibia. Further, T2 hyperintense signal is visualized medially within the posterior tibia.LIGAMENTS: The MCL and LCL complex remain intact. High T2 signal is visualized within the ACL, though some ligamentous fibers appear intact throughout the course of the ligament.EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Predominantly transverse near complete meniscal tear of the lateral meniscus posteriorly.2. Partial ACL tear. No specific evidence to indicate MCL tear, as clinically queried.3. Bone contusions within the distal aspect of the femur and proximal aspect of the tibia.


Instruction: Generate impression based on findings.

Input: 62 years Male (DOB:11/14/1954)Reason: evaluate for blood versus laminar necrosis History: h/x GBMPROVIDER/ATTENDING NAME: JAMES A. MASTRIANNI The CSF spaces are appropriate for the patient's stated age with no midline shift. The patient is status-post right-sided craniotomy. There is a focus of encephalomalacia centered in the right temporal lobe. There is associated T2 and flair signal change within and temporal lobe and enlargement of the trigone of the right lateral ventricle. There is some T1 hyperintensity as well as some patchy contrast enhancement in the right temporal lobe. This appearance was also present on the prior exam from March and does not appear to have changed significantly. There is relatively decreased cerebral blood volume on perfusion maps within this region. Cerebral blood volume maps do not demonstrate any foci of increased perfusion, however, susceptibility imaging demonstrates some small serpiginous signal voids.There is a mild degree of periventricular and subcortical confluent hyperintense white matter lesions present identified on the FLAIR and T2 images. This is likely treatment related.There are punctate foci of signal loss and susceptibility imaging involving left thalamus and right temporal lobe. These are stable compared to prior exam.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate minor mucosal thickening. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.The patient is status post right temporal lobe surgery for removal of a neoplasm.2.There is abnormal signal within the right temporal lobe and decreased perfusion to the right temporal lobe. Since the prior exam there has been no significant interval change.


Instruction: Generate impression based on findings.

Input: Evaluate for brainstem abnormality: Speech apraxia, frequent aspiration. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brainstem, cerebellum, and brain parenchyma appear unremarkable, including patchy areas of bilateral parietal terminal zones of myelination. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is a 10 mm diameter, well-defined, cystic lesion in the left sphenoid triangle. There is fluid within the bilateral mastoid air cells and scattered paranasal sinus fluid and mucosal thickening, which may be attributable to intubation. The orbits are grossly unremarkable.

Output: 1. The brainstem is unremarkable. No evidence of intracranial hemorrhage, mass, or acute infarct. 2. A 10 mm diameter, well-defined, cystic lesion in the left sphenoid triangle likely represents an inclusion cyst.


Instruction: Generate impression based on findings.

Input: Somnolence [R40.0], Reason for Study: ^Reason: eval for mass or stroke History: diffuse weakness No evidence of acute ischemic or hemorrhagic lesion on the scan.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, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: No evidence of acute ischemic or hemorrhagic lesion.


Instruction: Generate impression based on findings.

Input: New onset seizures and ESRD due to renal agenesis, inflammatory myopathy, APLS, Raynaud's, HTN, and colitis. There are scattered areas of subcortical white matter T2 hyperintensity predominantly involving the left parietal and occipital lobes, and to a lesser extent portions of the right cerebral hemisphere. There are also scattered foci of T2 hyperintensity in the deep white matter. The hippocampi are unremarkable and there is no evidence of heterotopia. 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 appear to be grossly intact. There are artifacts related to dental braces.

Output: Scattered white mater lesions in the bilateral cerebral hemisphere predominantly involving the left parietal and occipital lobes likely represent a posterior reversible encephalopathy syndrome versus less likely a demyelinating or infectious process, although characterization is limited by the lack of intravenous contrast (acknowledging the patient's renal failure).


Instruction: Generate impression based on findings.

Input: 62-year-old male with history of CNS lymphoma. Pre-surgical planning study. Stealth infused head CT:Nonenhanced 1 mm head CT examination with 2-D reformatted images for surgical planning is obtained.There is no evidence of intracranial hemorrhage, edema, mass effect or midline shift or hydrocephalus.Cortical sulci, ventricular system, CSF cisterns and gray -- white matter differentiation remains normal. Previously noted minimal small vessel disease on prior brain MRI examination is not identified on this study.Visualized paranasal sinuses, mastoid air cells are unremarkable. Calvarium is intact.New since prior exam is bilateral paramedian high convexity parietal subcutaneous scalp soft tissue thickening which is best appreciated on axial images 27 through 29. Please correlate with history.

Output: 1.No evidence of any intracranial abnormality. Stable exam since prior study.2.Subgaleal soft tissue thickening in high convexity paramedian parietal region is new since prior exam. 3.Unremarkable calvarium, paranasal sinuses and mastoid air cells.


Instruction: Generate impression based on findings.

Input: 45-year-old woman with history of portal vein occlusion and worsening LFTs. ABDOMEN:LIVER, BILIARY TRACT: The liver is small and cirrhotic in morphology. No focal hepatic lesion is identified. The portal vein is not visualized beyond the confluence of the SMV and splenic vein. There are numerous, large collateral vessels in the upper abdomen. The gallbladder appears normal.SPLEEN: Spleen is mildly enlarged.PANCREAS: The pancreas is normal.ADRENAL GLANDS: The adrenal glands appear normal.KIDNEYS, URETERS: The kidneys are normal and enhancement symmetrically.RETROPERITONEUM, LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: Partially visualized small bowel and colon are normal.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: There is a large right pleural effusion.

Output: 1.Cirrhotic liver with nonvisualization of the portal vein suggesting thrombosis with large portosystemic collaterals.2.Large right pleural effusion.


Instruction: Generate impression based on findings.

Input: Left shoulder pain, possible rotator cuff/biceps pathology. ROTATOR CUFF: There is thickening with increased signal intensity indicating moderate tendinosis of the supraspinatus tendon with mild undersurface fraying. There is also focal linear increased signal intensity within the tendon extending to the insertion which may represent interstitial tearing, but we see no full thickness tear. The supraspinatus muscle is normal for age. There is mild to moderate insertional tendinosis of the infraspinatus muscle and perhaps a thin interstitial tear more proximally, but we see no surface tear. There is mild fatty atrophy along the myotendinous junction of the infraspinatus muscle. The teres minor muscle and tendon is intact. There is perhaps mild tendinosis of the subscapularis tendon but otherwise the muscle and tendon appear normal for age.SUPRASPINATUS OUTLET: There is mild to moderate osteoarthritis of the acromioclavicular joint with anteroinferior spurring of the acromion process. There is trace fluid in the subacromial/subdeltoid bursa. The coracoacromial ligament appears normal. The coracohumeral ligament appears slightly thickened.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral alignment is within normal limits. There is a small glenohumeral joint effusion. There is increased signal intensity within the labrum both anteriorly and posteriorly which likely represents degeneration/tearing.BICEPS TENDON: There is increased signal intensity within the intra-articular portion of the long head of the biceps indicating mild tendinosis. Fluid within the biceps tendon sheath likely represents extension of fluid from the glenohumeral joint. ADDITIONAL

Output: 1. Edema within the greater tuberosity that is suspicious for a healing nondisplaced fracture.2. Rotator cuff tendinosis and interstitial tearing as described above without full thickness tear.3. Mild tendinosis of the long head of the biceps tendon.4. Osteoarthritis of the acromioclavicular joint and the labral degeneration/tearing as described above.5. Small glenohumeral joint effusion as well as fluid in the subcoracoid bursa suggesting bursitis.