Instruction: Generate impression based on findings.

Input: Newly diagnosed prostate cancer, considering focal therapy or active surveillance. PSA 13.5. Prostate biopsy revealing Gleason 3+3 in the left lobe, one out of 12 cores. PELVIS:PROSTATE:Prostate Size: 5.3 x 4.3 x 3.8 cm.Peripheral Zone: Within the right mid peripheral zone, there is a 5 x 8 mm focus of abnormally decreased T2 and ADC signal (series 601, image 17) suspicious for neoplasm. There is an additional small focus of abnormally decreased ADC signal within the medial left mid peripheral zone (series 704, image 244) measuring 5 mm also suspicious for neoplasm.Central Gland: No significant abnormality.Seminal Vesicles: No significant abnormality.Extracapsular Extension: The right mid peripheral zone lesion appears to abut the capsule adjacent to the right neurovascular bundle but does not appear to extend beyond the capsule or to invade the neurovascular bundle.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Left and right peripheral zone lesions suspicious for neoplasm as described above without specific evidence of extracapsular extension.


Instruction: Generate impression based on findings.

Input: History of meningioma status post resection and radiation therapy now with new headache. There is evidence of prior left-sided craniotomy for biopsy or partial resection of tumor. There is redemonstration of a homogeneously enhancing extra-axial mass in the left superior cerebellopontine angle cistern measuring 22 x 22 x 28 mm (AP x TR x CC), previously 22 x 21 x 29 mm. The lesion abuts the dorsal aspect of petrous bone with resultant hyperostosis, with mass effect on the left aspect of superior pons. There is mass effect with effacement of the left Meckel's cave at this level. The enhancing dural tail of tumor extends along the left cerebellopontine angle inferiorly to the level of foramen magnum. There are scattered punctate foci and confluent areas of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, consistent with chronic small vessel ischemic changes. There is unchanged extensive T2/FLAIR hyperintensity of the left middle cerebellar peduncle, which could represent a combination of edema and encephalomalacia from tumor and surgery. There is no evidence of acute intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. There is a partially empty sella. The skull and extracranial soft tissues are otherwise unremarkable. There is mild scattered mucosal thickening of the paranasal sinuses.

Output: 1. No significant interval change in size of a homogeneously enhancing extra-axial mass in the upper left cerebellopontine angle cistern, consistent with known petrous apex meningioma. There is unchanged mass effect on the left aspect of the pons. Unchanged diffuse T2/FLAIR hyperintensity of left middle cerebellar peduncle with volume loss.2. No acute infarct. Mild to moderate chronic small vessel ischemic changes. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Chiari malformation, concern for syrinx. The cerebellar tonsils have a pointed morphology and extend up to 20 mm inferior to the foramen magnum. There is interruption of cerebrospinal fluid flow across the foramen magnum. However, the spinal cord displays normal signal and morphology. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The paravertebral soft tissues are unremarkable.

Output: Low-lying cerebellar tonsils compatible with Chiari I malformation, but no evidence of cervical syrinx.


Instruction: Generate impression based on findings.

Input: Diagnosis: Abnormal reflex. Other conditions of brain(348.89)Clinical question: left fronto parietal hypodensity on CT headSigns and Symptoms: right leg spastic, mildly weak, Babinski MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mild mucosal thickening in the right maxillary sinus. 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. No abnormal enhancing lesions are identified in the cervical spine. There is mild reversal of the normal cervical curvature present.At C2-3 there is no significant compromise to the spinal canal or neural foramina. There is disk dessication present at this level. At C3-4 there is no significant compromise to the spinal canal or neural foramina. There is disk dessication present at this level. There is left sided facet hypertrophy at this level associated with mild narrowing of the left neural foramen. At C4-5 there is no significant compromise to the spinal canal or neural foramina. There is disk dessication present at this level. There is loss of disk space height at this level. There is a disk bulge at this level.At C5-6 there is no significant compromise to the spinal canal . There is disk dessication present at this level. There is loss of disk space height at this level. There is a disk bulge at this level. There are right sided uncovertebral osteophytes at this level associated with encroachment of the left exiting nerve roots.At C6-7 there is no significant compromise to the spinal canal or neural foramina. There is disk dessication present at this level. There is loss of disk space height at this level. There is a disk bulge at this level.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 multilevel degenerative changes in the cervical spine. There is no significant compromise to the spinal canal and only mild narrowing of the neural foramina 2.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 3.Mild reversal of the normal cervical curvature is a non-specific finding which can be seen with muscle spasm or patient positioning.


Instruction: Generate impression based on findings.

Input: Disturbance of skin sensation [782.0], Reason for Study: ^Reason: r/o ischemia History: transient RLE numbness, reflex asymmetry Brain MRINo evidence of acute ischemic or hemorrhagic lesion.Focal tissue loss on the left cerebellar hemisphere indicating small chronic ischemic infarction.Scattered multifocal periventricular white matter high signal intensity lesions on FLAIR images indicate non specific small vessel ischemic disease. The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal.Neck MRA3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The vertebral artery origins are normal. There is normal flow enhancement through the bilateral common carotid, carotid bifurcations, internal/external carotid, and vertebral arteries.

Output: 1. Non specific small vessel ischemic disease.2. No acute ischemic or hemorrhagic lesion.3. Normal brain MRI and neck MRA.


Instruction: Generate impression based on findings.

Input: There is no evidence of intracranial hemorrhage or acute infarct. There appears to be patchy high signal on the thin-section postcontrast T1 images along the right internal auditory canal. There are also minimal scattered punctate foci of T2 hyperintensity within the cerebral white matter. The brain, brainstem, and cerebellar parenchyma 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.

Output: 1.Apparent patchy high signal on the thin-section postcontrast T1 images along the right internal auditory canal may be artifactual, vascular, inflammatory, or represent leptomeningeal metastatic disease. Follow up via a temporal bone MRI may be useful if there is clinical concern. Otherwise, no evidence of intra-axial metastases.2.Punctate foci of T2 hyperintensity in the cerebral white matter are nonspecific, but may represent chronic microvascular ischemic disease. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 51-year-old female, please evaluate mass on superolateral patella. MENISCI: The menisci appear intact without significant tearing.ARTICULAR CARTILAGE AND BONE: Tiny osteophytes affect the lateral and medial tibiofemoral compartments. A large osteophyte is seen off the superior aspect of the patella. There is a small amount of patellar edema with general thinning of the patellar cartilage.LIGAMENTS: The ACL, PCL, MCL, and LCL complex appears intact. EXTENSOR MECHANISM: Extensor mechanism appears intact.ADDITIONAL

Output: 3 cm lesion anterior to the patella as outlined above. These findings are nonspecific. The lesion is favored to be inflammatory in etiology, soft tissue mass is not excluded, especially on only noncontrast examination. Biopsy is recommended if clinically warranted for further evaluation.


Instruction: Generate impression based on findings.

Input: 42-year-old male, NF 2, status post resection of schwannoma and meningioma. Evaluate for new tumor. The patient is experiencing weakness. Brain and internal artery canal MRI:There is a focus of enhancement within the left sylvian fissure which appears to correlate with vascular structures when compared to T2 and susceptibility techniques. Although not described previously, this was present and unchanged on the most recent comparison of 12/3/2015. When comparing to the oldest, outside MRI dated 4/2/2015 (from Freeport Memorial Hospital), it appears to have enlarged.Redemonstrated is a contrast-enhancing left acoustic schwannoma, filling the left IAC, extending to involve the vestibule and a portion of the proximal semicircular canals. The largest portion within the left cerebellopontine angle measures 12 mm. These findings are unchanged in appearance.Redemonstrated is a contrast-enhancing right acoustic schwannoma, filling the right porous acusticus, extending to involve the vestibule, semicircular canals, as well as the geniculate ganglion and the right facial nerve (extending along its entirety to the parotid gland). The largest portion within the right cerebellar pontine angle measures 28 mm, which is unchanged in size. There remains mass effect upon the adjacent pons, middle cerebellar peduncle, and cerebellum, however without associated edema and unchanged in extent.There is a dural based enhancing mass underlying the left rectus gyrus which extends inferiorly into the superior-most left ethmoid air cells and adjacent inferior frontal sinus, most likely representing a meningioma. Given differences in technique, there has been no significant interval change.Also redemonstrated are a few, very small foci of enhancing prominence along the falx, probably anteriorly, which are unchanged in appearance. These likely represent very small meningiomas. There are a few foci of T2 hyperintensity within the within the white matter, predominantly subcortical in location, without associated restricted diffusion. Encephalomalacia involving the lateral left cerebellar hemisphere is stable.The ventricles and sulci are normal in size. The cerebellar tonsils are in appropriate position. There are no parenchymal masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The right mastoid air cells are completely opacified by fluid intensity material, unchanged. There has been prior retinal banding.Cervical spine MRI:Redemonstrated are postsurgical changes of suboccipital craniectomy and resection of the posterior arch of C1. Laminoplasties are also noted from C3 to C6. Again seen are multiple enhancing lesions throughout the cervical spine including nodular intramedullary lesions involving the cervical cord within the medulla and at the C1 and C2 levels which may represent ependymomas, unchanged in appearance. These are associated with T2 hyperintensity.Enhancing masses seen involving the right C2 nerve root and a smaller one on the left compatible with schwannomas, unchanged.C2-C3: Enhancing left nerve root with mild expansion of the neural foramina likely represents a schwannoma. There is mild intraspinal extension without significant cord deformity. These findings are unchanged.C3-C4: No enhancing lesions. No spinal or neuroforaminal stenosis. These findings are unchanged.C4-C5: Expansile lesion involving the right neural foramen again seen with intraspinal extension and mild residual mass effect on the right aspect of the cord. Partial resection as described previously. T2 hyperintensity within the right aspect of the cord. These findings are unchanged. C5-C6: Large, predominantly extraforaminal lesion on the right. Small enhancing extra foraminal lesion on the left. No spinal canal stenosis. These findings are unchanged. Previously demonstrated heterogeneous enhancement, posterior to the thecal sac has decreased in conspicuity. Indentation upon the posterior cord is again noted, unchanged, and still without intrinsic cord signal abnormality.C6-C7: Small, predominantly extraforaminal enhancing lesions bilaterally without expansion of the foramina. No spinal canal stenosis. These findings are unchanged.C7-T1: Small predominantly enhancing extraforaminal enhancing bilaterally lesions without expansion of the foramina. No spinal canal stenosis. These findings are unchanged.There is a relatively large lesion involving the peripheral aspect of the right C6 nerve root extending to the brachial plexus, unchanged.Vertebral body heights are normal. Mild focal kyphotic angulation at the C5-C6 level is again seen appearing more exaggerated, although this may be positional.

Output: 1.There is a focus of enhancement within the left sylvian fissure which appears to correlate with vascular structures when compared to T2 and susceptibility techniques. Although not described previously, this was present and unchanged on the most recent comparison of 12/3/2015. When comparing to the oldest, outside MRI dated 4/2/2015 (from Freeport Memorial Hospital), it appears to have enlarged. This constellation of imaging features may suggest an aneurysm which is stable compared to last December, however enlarged when compared to the prior April. CTA or catheter directed angiography could better characterize this finding and confirm an aneurysmal etiology.2.Stable bilateral acoustic schwannomas.3.Stable presumed meningioma underlying the left rectus tremors.4.Stable probable small meningiomas involving the falx.5.The right mastoid air cells remain completely opacified by fluid intensity material. 6.Again seen are multiple enhancing lesions throughout the cervical spine including nodular intramedullary lesions involving the cervical cord within the medulla and at the C1 and C2 levels which may represent ependymomas, unchanged in appearance.7.C4-C5: Expansile lesion involving the right neural foramen again seen with intraspinal extension and mild residual mass effect on the right aspect of the cord with associated T2 hyperintensity, unchanged. 8.C5-C6: Previously demonstrated heterogeneous enhancement, posterior to the thecal sac has decreased in conspicuity. Indentation upon the posterior cord is again noted, unchanged, and still without intrinsic cord signal abnormality.9.The remaining stigmata of NF 2 within the cervical spine MRI are stable in appearance as described in detail above.


Instruction: Generate impression based on findings.

Input: 46 year old woman with history of OHT, referred for annual evaluation for CAV.MEDICATIONS: ASA, Lipitor, Lasix, Toprol XL, Cellcept, Rapamune, Prednisone First Pass PerfusionWas not performed per patient request.Viability/ Myocardial ScarWas not performed per patient request.Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 65%, the LV end diastolic volume index is 65 ml/m2 (normal range: 65+/-11), the LVEDV is 143 ml (normal range 109+/-23), the LV end systolic volume index is 23 ml/m2 (normal range 18+/-5), the LVESV is 51 ml (normal range 31+/-10), the LV mass index is 39 g/m2, and the LV mass is 85 g. There are no regional wall motion abnormalities present. Left AtriumThe left atrium is consistent with transplant. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 58%, the RV end diastolic volume index is 55 ml/m2 (normal range 69+/-14), the RVEDV is 121 ml (normal range 110+/-24), the RV end systolic volume index is 23 ml/m2 (normal range 22+/-8), and the RVESV is 50 ml (normal range 35+/-13). Right AtriumThe right atrium is consistent with transplant. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsProbable right renal cyst. 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. Limited study for size/function performed due to patient request.2. The left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 65%.3. The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 58%.


Instruction: Generate impression based on findings.

Input: History of left parotid space rhabdomyosarcoma, off therapy. Brain: There is no evidence of intracranial mass. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The cerebellar tonsil remains low lying especially on the left. There is left parieto-occipital plagiocephaly. There is scattered paranasal sinus mucosal thickening. There is trace fluid in the left mastoid air cells. The orbits and scalp soft tissues are grossly unremarkable.Neck: There are post-treatment findings in the left parotid space region, but no evidence of underlying measurable mass lesions. The cervical lymph nodes are unchanged. The thyroid and major salivary glands are unchanged, including an asymmetrically small left submandibular gland. The major cervical flow voids are intact. The airways are patent. The osseous structures are unremarkable.

Output: 1. Post-treatment findings in the left parotid gland without discernible recurrent tumor.2. No significant change in the cervical lymph nodes.3. No evidence of intracranial mass.


Instruction: Generate impression based on findings.

Input: Brain lesion and cyst, abnormal MRI in the past, 3 month post surgical follow up. There has been interval evolution of postoperative findings related to left frontal convexity cyst fenestration, with a small amount of high T1 and low T2 signal extra-axial blood products along the anteromedial left frontal convexity and collapse of the cyst cavity. There is minimal residual T2 hyperintensity in the underlying brain parenchyma and no significant mass effect upon the underlying brain parenchyma. There is no evidence of acute territorial cerebral 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. There is bilateral otomastoid fluid.

Output: Interval evolution of postoperative findings related to left frontal convexity cyst fenestration, with a small amount of late subacute extra-axial blood products along the anteromedial left frontal convexity and collapse of the cyst cavity.


Instruction: Generate impression based on findings.

Input: Slurred speech, dizziness, concern for TIA There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Normal brain CT.


Instruction: Generate impression based on findings.

Input: History of rising PSA. Evaluate for prostate cancer. PELVIS:PROSTATE:Prostate Size: 4.4 x 5.6 x 4.2 cm (AP by transverse by CC)Peripheral Zone: Within the posterior mid to superior aspect of the left peripheral zone there is confluent low T2 signal with associated restricted diffusion and early arterial enhancement extending to both the internal and peripheral capsule compatible with tumor. This measures 1.5 x 1.1 cm the axial plane. No extracapsular extension is evident.Central Gland: There is marked hypertrophy of the central gland with cystic changes compatible with benign prostatic hypertrophy. There is a focus of low T2 signal and restricted diffusion in the anterolateral right aspect of the central zone which measures 1.3 x 1.3 cm in axial dimension. On the postcontrast images however this does not demonstrate early arterial enhancement and is therefore likely a hyperplastic nodule.Seminal Vesicles: The seminal vesicles are unremarkable. No evidence of tumor involvement.Extracapsular Extension: NoneBLADDER: The bladder wall appears diffusely thickened and trabeculated compatible with chronic outlet obstruction.LYMPH NODES: There are multiple mildly prominent bilateral external iliac as well as retroperitoneal lymph nodes which are not pathologically enlarged by size criteria.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.1.5 x 1.1 cm focus of abnormal signal within the left posterior peripheral zone compatible with tumor. No evidence of extracapsular extension. No pathologic lymphadenopathy within the visualized abdomen.2.Central zone findings of benign prostatic hypertrophy with associated bladder wall thickening suggestive chronic urinary tract outflow obstruction.


Instruction: Generate impression based on findings.

Input: DLBCL recurrent in CSF. Now receiving IT rituximab. Brain: There is increased patchy T2 hyperintensity and enhancement in the medial right basal ganglia region. There is increase in size of a lesion in the right basal ganglia region with enhancement along the margin of the right frontal horn. There also appears to be new T2 hyperintensity along the bilateral cerebellar tonsils. There is persistent infiltrative abnormal enhancement involving the optic apparatus. There are unchanged nonspecific foci of T2 hyperintensity without corresponding enhancement in the cerebral white matter. There is no evidence of acute infarction or intracranial hemorrhage. There is a right transfrontal Ommaya catheter that terminates in the right lateral ventricle. There is no significant interval change in the size of the ventricular system. There is no midline shift or herniation. There is moderate right maxillary sinus mucosal thickening and an apparent fluid level in the left maxillary sinus. There is mild fluid signal within the mastoid air cells.Spine: There is no evidence of mass lesions or abnormal leptomeningeal enhancement in the spine. There is loss of the usual cervical and lumbar lordosis, but the thoracic vertebral column alignment is within normal limits. The vertebral body heights are preserved. There is degenerative spondylosis at multilevel levels of the cervical spine with mild spinal canal stenosis. The vertebral bone marrow signal is unremarkable, aside from degenerative endplate signal alterations. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: 1. Persistent infiltrative abnormal enhancement involving the optic apparatus likely related to involvement by lymphoma. 2. Increase in size of a lesion in the right basal ganglia region with enhancement along the margin of the right frontal horn and involving the cerebellar tonsils also likely represent involvement by lymphoma. 3. No evidence of leptomeningeal disease in the spine.4. Findings suggestive of acute sinusitis.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for hemorrhage. Signs and symptoms: Headaches and dysarthria. CT of brain without infusion:High density material within the right internal carotid artery is consistent with prior embolization and coil placement.A slightly high density loculated and calcific tissue surrounding the basal cistern and within the cavernous sinuses is consistent with patient's known significant atherosclerotic disease with ectasia and tortuosity of the vasculature. These findings appear similar to prior CT and MRI examinations.Extensive areas of encephalomalacia of the right cerebral hemisphere with ex vacuo dilatation of the right lateral ventricle remain identical to prior studies. Few small foci of low-attenuation likely small vessel strokes in the left hemisphere are also noted and stable.No evidence of hemorrhage, edema, mass-effect, midline shift or hydrocephalus.

Output: No evidence of acute findings and stable exam since prior study.


Instruction: Generate impression based on findings.

Input: Female, 25 years old, with history of prolactinoma, outside hospital records and images pending, evaluate size mass effect. A hypoenhancing nodule is evident within the right aspect of the pituitary gland measuring up to 7 x 5 x 7 mm. The right aspect of the gland is slightly enlarged by this process, but no evidence of significant suprasellar extension is seen. Likewise, there is no evidence of cavernous sinus invasion. The gland is otherwise unremarkable. The pituitary stalk enhances normally and enters the gland at midline.

Output: A subcentimeter hypoenhancing nodule in the right aspect of the pituitary gland is seen compatible with the stated history of prolactinoma. No evidence of suprasellar or cavernous sinus encroachment is seen.


Instruction: Generate impression based on findings.

Input: 54-year-old female with pain. Evaluate for rotator cuff tear. ROTATOR CUFF: The supraspinatus muscle and tendon appear intact. The infraspinatus muscle and tendon appear intact. The teres minor and subscapularis muscles and tendons appear intact. The rotator cuff is within normal limits for age.SUPRASPINATUS OUTLET: There is no significant fluid within the subacromial/subdeltoid bursa. The acromioclavicular joint is within normal limits.GLENOHUMERAL JOINT AND GLENOID LABRUM: Mild to moderate osteoarthritis affects the glenohumeral joint with cartilage degeneration and small osteophytes. The anterior superior labrum appears detached from the underlying glenoid and while this may represent a normal variant sublabral foramen, heterogeneous signal abnormality of the anterior labrum, more inferiorly, raises the possibility of a degenerative tear. There is no glenohumeral joint effusion. There are small subchondral cysts within the inferior glenoid.BICEPS TENDON: The tendon of the long head of the biceps appears intact. ADDITIONAL

Output: 1. Normal appearing rotator cuff.2. Glenohumeral joint osteoarthritis and probable degenerative tearing of the anterior labrum.


Instruction: Generate impression based on findings.

Input: 21-year-old male with medial knee pain after valgus injury. MENISCI: The medial and lateral meniscus appear intact.ARTICULAR CARTILAGE AND BONE: No full-thickness or near full-thickness articular cartilage defects are identified. Note is made of bone marrow signal abnormality within the anterior aspect of the lateral tibial plateau as well as within the lateral aspect of the lateral femoral condyle consistent with contusions. Additionally, note is made of linear decreased signal abnormality within the lateral aspect of the proximal tibial plateau, as well as cortical irregularity, suspicious for a nondisplaced subchondral fracture of the tibial plateau (image 14 and 15; series 701).LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: Findings consistent with a nondisplaced subchondral fracture of the anterior aspect of the lateral tibial plateau. Bone contusion affecting the lateral femoral condyle.


Instruction: Generate impression based on findings.

Input: There is no acute cord compression. No gross change in the MRI appearance of the cervical and lumbar spine.

Output: No acute cord compression.


Instruction: Generate impression based on findings.

Input: Female, 51 years old, history of lung cancer with brain metastases, presenting with dizziness, assess for progression. Brain MRI:Extensive metallic artifact is seen due to the placement of aneurysm clips along the right sylvian fissure and suprasellar region, and due to shunt apparatus in the posterior fossa. Diffusion-weighted images are particularly degraded, but within this limitation, no definite restricted diffusion is seen.Small bilateral subdural collections are again seen, predominantly along the frontal lobes, stable on the right and improved on the left. Diffuse dural thickening is also noted along both frontal lobes but particularly on the left where it is thicker than that seen on the prior exam.New small patches of parenchymal T2 hyperintensity are seen within the left and right middle frontal gyri of uncertain significance. Multiple scattered small foci of white matter T2 hyperintensity are also seen in the periventricular and subcortical white matter. Some of these may be new or perhaps just better visualized due to imaging at 3T. No evidence of any significant parenchymal edema or mass effect is observed.The left posterior fossa catheter system remains in stable position. Amorphous enhancement and T2 hyperintensity along the distal end of the catheter tip, at the level of the left foramen of Luschka, have not significantly changed from the prior examination. No additional or new pathologic enhancement is seen within the posterior fossa or in the cerebral hemispheres.The ventricular system is normal in size. A subcentimeter pineal region cystic lesion is again visualized. No evidence of new intracranial hemorrhage is detected. A few scattered punctate foci of susceptibility in the cerebral hemispheres are better visualized than on prior, likely due to imaging at 3T.Sequelae of right pterional craniotomy and multiple bilateral burr holes are again seen.Brain MRA:The distal right ICA and most of the proximal MCA is not visualized due to metallic artifact. The regions of the right PCOM and the ACOM arteries are also obscured. There is a relative paucity of right MCA distribution vessels. Elsewhere, no significant vascular stenosis is suspected. A 2.0 x 2.5 mm outpouching is evident from the left MCA bifurcation directed anteriorly and inferiorly. This appears similar to the prior CTA examination. There is also a 1 mm medially directed outpouching off of the left cavernous ICA which appears similar to the prior CTA. No additional aneurysms are suspected.Neck MRA:MRA image quality is slightly suboptimal but still diagnostic. No evidence of any significant vascular stenosis or occlusion is seen within the carotid or vertebral vessels of the neck.

Output: 1.No definite evidence of acute ischemia or any other definite acute intracranial abnormality allowing for substantial artifact related to prior surgical interventions.2.Small bilateral subdural collections are again seen, primarily along the frontal lobes. These are stable on the right and improved on the left relative to the prior MRI examination. Significant dural thickening is also seen along both frontal lobes but particularly on the left which is likely reactive to the long-standing subdural collections.3.New patches of T2 hyperintensity are seen within the left and right middle frontal gyri. These are of uncertain significance but could reflect the sequelae of prior parenchymal injury related to the previously seen large subdural collections.4.Numerous scattered small white matter lesions are also seen which are nonspecific but may reflect chronic microvascular ischemic disease.5.A left posterior fossa catheter system is in stable position. Amorphous signal abnormality and enhancement along the distal aspect of the catheter shows no significant interval change from the prior examination.6.No new parenchymal enhancing lesions are seen.7.On MRA imaging of the brain, there is a relative paucity of right MCA vessels which may be related to prior treatment of numerous aneurysms. Otherwise, no significant vascular stenosis is suspected.8.A 2.0 x 2.5 mm aneurysm arising at the left MCA bifurcation is unchanged relative to the prior CTA. Similarly, a 1 mm outpouching from the left cavernous ICA is also unchanged.9.Unremarkable MRA evaluation of the neck.


Instruction: Generate impression based on findings.

Input: Pancreatitis. Please evaluate for gallstones. Per medical record, history of renal cell cancer status post left nephrectomy and right clavicular mass resection. Please note numerous sequences are limited by extensive motion artifact. ABDOMEN:LUNG BASES: Patchy bilateral lung opacities seen on the large field of view sequences, right greater than left, which may represent aspiration or multifocal infection, better evaluated on the prior CT.LIVER, BILIARY TRACT: Ring-enhancing left hepatic lesion, measuring 1.1 x 1.1 cm (series 1902, image 297), suspicious for metastatic disease. Mild biliary ductal dilation, similar to prior CT. Distended gallbladder with biliary sludge. No choledocholithiasis evident, though further evaluation on MRCP images is limited by motion artifact.SPLEEN: Prominent, suggestive of splenomegaly. Splenule noted.PANCREAS: No loculated peripancreatic fluid collections. No pancreatic ductal dilation. No pancreatic mass evident. No differential parenchymal enhancement to suggest necrosis.ADRENAL GLANDS: The left adrenal gland is not seen. Right adrenal gland is within normal limits.KIDNEYS, URETERS: Patient is status post left nephrectomy. Right kidney with cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Large heterogenous collection without internal enhancement, compatible with hematoma, at the resected right clavicular head is partially imaged on the large field-of-view images, better seen on the prior CT.Subcentimeter foci of increased T2 signal in multiple vertebral bodies, without CT correlate, likely represent hemangiomas. OTHER: The mesenteric nodule seen on the prior CT is not included on the field of view of this exam.

Output: 1.Limited examination due to extensive motion artifact.2.No choledocholithiasis evident. 3.No peripancreatic fluid collections.


Instruction: Generate impression based on findings.

Input: 75 year-old female with abnormal spells daily, abnormal EEG consistent with seizures, evaluate temporal lobes versus atrophy. There is no evidence of intracranial hemorrhage, mass, or acute infarct. Ventricular sizes and sulci are within acceptable limits for a patient of age 75 years. There are mild scattered foci of high T2 signal within periventricular and subcortical white matter, consistent with sequela of chronic small vessel ischemic disease, unchanged in extent. The ventricles and basal cisterns are normal in size and configuration. The skull and extracranial soft tissues are unremarkable. There are no abnormal enhancing foci.Dedicated coronal FLAIR imaging demonstrates a suggestion of increased T2 hyperintensity within bilateral hippocampi, however internal hippocampal architecture is preserved and hippocampal size is within normal limits. There is no preferential mesial temporal lobe atrophy.

Output: 1.Stable chronic small vessel ischemic disease.2.Dedicated coronal FLAIR imaging demonstrates a suggestion of increased T2 hyperintensity within bilateral hippocampi, however internal hippocampal architecture is preserved and hippocampal size is within normal limits. Given this nonspecific appearance, it is of uncertain clinical significance.


Instruction: Generate impression based on findings.

Input: Sclerotherapy of the right mandibular hemangioma. There is no significant interval change in the predominantly T2 hyperintense and enhancing right mandibular lesion, measuring up to approximately 55 mm. There is no evidence of significant cervical lymphadenopathy. There are multiple right thyroid nodules, the largest of which measures up to 16 mm and contains a punctate calcification. There also appear to be several punctate left thyroid nodules. The major salivary glands are unremarkable. There is scattered patchy cerebral white matter T2 hyperintensity. There are bilateral lens implants. There is a hemangioma in the C4 vertebral body and multilevel degenerative cervical spondylosis. There is also a hemangioma within the occipital bone.

Output: No significant interval change in the previously treated right mandibular hemangioma.


Instruction: Generate impression based on findings.

Input: 66 years, Female, stage IV melanoma with brain metastases on treatment. Again seen is a hemorrhagic lesion in the right paramedian occipital lobe measuring approximately 11 x 6 mm, which is not significantly change in size on the T1 weighted sequences since prior MRI from 9/16/2015 (measured11x7 mm), but clearly smaller than 6/1/2015 (measured 16x13 mm). There is intrinsic T1 shortening without clear enhancement. There is mild increase in surrounding FLAIR hyperintensity without mass effect. No midline shift or herniation. No abnormal parenchymal or meningeal enhancement is seen elsewhere in the brain to suggest a new lesion. There are multiple nonspecific foci of scattered T2/FLAIR hyperintensity similar to prior. No hydrocephalus. No extra-axial collections. Diffuse low T1 marrow signal is again noted, which is nonspecific. No destructive calvarial lesions.

Output: 1. No new or enlarging lesions to suggest progression of metastatic disease. 2. Treated hemorrhagic right occipital lesion is not significantly changed in size compared to 9/16/2015. There is increase in surrounding FLAIR hyperintensity which may represent mild edema or gliosis from prior treatment.


Instruction: Generate impression based on findings.

Input: Cerebral infarction, unspecified [I63.9], Reason for Study: ^Reason: left facial droop History: left facial droop Brain MRIThere is restricted diffusion lesion on the right internal capsule posterior limb without evidence of hemorrhagic conversion. Scattered multifocal T2/flair high signal intensity lesions on bilateral periventricular white matter and centrum semiovale indicating nonspecific small vessel ischemic disease are seen.The ventricles, sulci and cisterns are unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear. Mucosal thickening on the left maxillary sinus.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate focal luminal stenosis at the proximal basal artery (about 60-70%).Otherwise, there is no evidence of intracranial arterial aneurysm. No other intracranial arterial luminal stenosis is seen.

Output: 1. Acute ischemic infarct involving right internal capsule posterior limb without evidence of hemorrhagic conversion.2. Nonspecific small vessel ischemic disease.3. Focal luminal stenosis of proximal basal artery (60-70%).


Instruction: Generate impression based on findings.

Input: Pain. Question of cuff tear. ROTATOR CUFF: The supraspinatus, infraspinatus, teres minor, and subscapularis muscles and tendons appear normal, other than minimal enthesopathic changes along the humerus at the supraspinatus/infraspinatus insertionSUPRASPINATUS OUTLET: Moderate osteoarthritis affects the acromioclavicular joint. No fluid is seen within the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is mild osteoarthritis of the glenohumeral joint with loss of articular cartilage along the superolateral aspect of the humeral head. Also, signal abnormality is seen within the superior labrum extending into the anterior labrum which likely represents tearing. The inferior labrum appears intact. A small amount of fluid is noted in the glenohumeral joint but no frank effusion.BICEPS TENDON: The long head of the biceps tendon is intact.

Output: 1. No evidence of rotator cuff tear.2. Osteoarthritis of the acromioclavicular joint.3. Osteoarthritis of the glenohumeral joint with labral tearing as described above.


Instruction: Generate impression based on findings.

Input: Reason: 42 yo F with history of sphincter of Oddi dysfunction s/p biliary sphincterotomy in 2007, with persistent abdominal pain. MRI/MRCP with gadolinium and secretin to assess for biliary or pancreatic stricture as cause of pain, also pancreatic parenchyma History: abdominal pain in setting of history of sphincter of Oddi dysfunction ABDOMEN:LIVER, BILIARY TRACT: Punctate hepatic dome T2 hyperintensity, likely a cyst. No suspicious enhancing lesions. No intrahepatic or extrahepatic biliary ductal dilatation. Status post cholecystectomy.Common bile duct is normal in caliber measuring 4 mm. No intrahepatic biliary ductal dilatation. Mild narrowing at the distal right hepatic duct without proximal dilatation may be technical. Incidentally noted is a draining branch from the right liver into the left hepatic duct.SPLEEN: No significant abnormality noted.PANCREAS: Main pancreatic duct appears normal. Pancreatic parenchyma is normal appearing. No suspicious pancreatic lesions. Normal response to secretin administration.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There are multiple dilated jejunal loops measuring up to 3.1 cm. There is apparent mass within the cecum at the level of the ileocecal valve which measures 3.8 x 2.6 cm which appears to enhance on postcontrast images (8/29).BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small amount of free fluid is present within the pelvis.

Output: 1. Multiple dilated jejunal loops. Small bowel obstruction may be considered although this is not well evaluated on this study. Recommend CT enterography for further evaluation.2.Suspected enhancing mass in the cecum can be further evaluated on subsequent CT.3.Apparent narrowing of the distal right hepatic duct is most likely technical, no upstream dilatation seen to suggest flow-limiting stricture. The biliary system and pancreas are otherwise unremarkable.


Instruction: Generate impression based on findings.

Input: Asymmetrical SNHL, right more than left and right tinnitus. The bilateral cranial nerve 7 and 8 complexes are intact. There is no evidence of mass lesions. The inner ear structures, including the cochlea, vestibule, endolymphatic duct, and semicircular canals, appear unremarkable. The bilateral mastoid air cells and middle ears also appear unremarkable. There is partially imaged probable small area of encephalomalacia in the right basal ganglia, which may represent a chronic lacunar infarct.

Output: No evidence of retrocochlear or inner ear lesions.


Instruction: Generate impression based on findings.

Input: Assess for seizure focus: 2 GTCs. There is a subcentimeter focus of high T1 signal with susceptibility effect in the left posterior basal ganglia. There is mild scattered cerebral white matter T2 hyperintensity bilaterally. The hippocampi are unremarkable and there is no evidence of heterotopia. There is also no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The paranasal sinuses and scalp soft tissues are grossly unremarkable. There is deformity of the nasal skeleton related to prior trauma. There are bilateral lens implants.

Output: 1. Nonspecific subcentimeter focus of mineralization in the left posterior basal ganglia, but otherwise no evidence of potential seizure foci. 2. Mild scattered cerebral white matter T2 hyperintensity bilaterally is nonspecific, but may represent chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: Breast cancer staging, known right breast cancer. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.In the right lower inner breast at anterior depth, the known cancer measures 4.3 x 3.8 x 3.8 cm. There is additional mass like and non-mass enhancement extending laterally and anteriorly from the main mass. Total extent is 8.4 x 6.6 cm. Some of the most lateral enhancement is non-specific in appearance. There are foci near the nipple and an anterior satellite mass that measures 1.2 x 0.8 x 0.8 cm. This anterior satellite lesion and the anterior foci are all within 0.5 cm of the nipple. Skin thickening measuring 0.5 cm is noted in the medial right breast.In the left breast, a typically benign enhancing lesion correlates to the focal asymmetry seen on mammography. This measures 1.0 x 0.5 x 0.3 cm. In the short term between the outside mammograms and this study (3 months) this size appears stable. No abnormal lymph nodes are identified in either axillary region.

Output: 1. Known right breast cancer measures up to 4.3 cm. Additional mass like and non-mass like enhancement in the right breast and skin thickening, with anterior satellite lesions that approach to within 0.5 cm of the nipple. 2. Normal axillary lymph nodes. 3. In the left breast, a typically benign enhancing area measures up to 1.0 cm and correlates to the mammographic focal asymmetry. Given the typically benign appearance, and how readily visible the finding is on mammography, a 6 month mammogram follow up is recommended. If the patient had any older mammograms and the finding could be proven stable, short term follow up would not be needed.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Left VentricleThe left ventricle is normal in size. The overall LV ejection fraction is 56%, the LV end diastolic volume index is 92 ml/m2 (normal range: 65+/-11), the LVEDV is 142 ml (normal range 109+/-23), the LV end systolic volume index is 42 ml/m2 (normal range 18+/-5), the LVESV is 62 ml (normal range 31+/-10). There are no regional wall motion abnormalities present. . There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is enlargedRight VentricleThe right ventricle is normal. The overall RV ejection fraction is 59%, the RV end diastolic volume index is 66 ml/m2 (normal range 69+/-14), the RVEDV is 113 ml (normal range 110+/-24), the RV end systolic volume index is 31 ml/m2 (normal range 22+/-8), and the RVESV is 76 ml (normal range 35+/-13). Right AtriumThe right atrium is enlarged. Aortic ValveThere is a bi-leaflet mechanical prosthesis which appears well-seated. Ao Qflow analysis reveals a RF of 4-6%.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation, but the severity of mitral regurgitation can be underestimated by the MRI pulse sequence used in this study.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation, but the severity of pulmonic regurgitation can be underestimated by the MRI pulse sequence used in this study.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation, but the severity of tricuspid regurgitation can be underestimated by the MRI pulse sequence used in this study.AortaThere is evidence of a prosthetic ascending aortic graft. There is a left sided aortic arch with a normal brachiocephalic branching pattern.AO measurementsGraft 29mmAsc Ao above graft 30x32 mmMid Ao arch 29x32 mmDesc 19x19 mmPulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsPost sternotomy. 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. Lower normal LV systolic function2. Normal RV3. Mechanical bioprosthetic AV without evidence for significant AR4. Prosthetic ascending aortic graft with aortic measurements as above.Unchanged from 2013.


Instruction: Generate impression based on findings.

Input: History of uterine fibroids status post uterine artery embolization, follow-up examination. PELVIS:UTERUS, ADNEXA: The uterus is lobular in morphology and contains numerous fibroids. The uterus measures approximately 22 x 10 x 15 Ccm (CC by AP by TR), previously 24 x 11 x 17 cm when analogous measurement technique used.The endometrial stripe is normal in thickness and is distorted by numerous fibroids. Several nabothian cysts are again noted.There are numerous fibroids, most of which are intramural. Most of the fibroids demonstrate very low T2 signal with a few demonstrating more intermediate T2 signal. The largest fibroid is in the lower uterine segment on the right measuring up to approximately 6 x 7.5 cm in the axial plane, previously 7.3 x 8.8 cm. Overall, the fibroids have decreased in size. There is redemonstration of the small subserosal fibroid at the fundus. On postcontrast images, the majority of the fibroids no longer avidly enhance (as they did previously).The ovaries are normal in size and morphology and contain several follicles or small cysts.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Interval decrease in size and loss of enhancement enhancement involving the majority of the uterine fibroids following uterine artery embolization.


Instruction: Generate impression based on findings.

Input: 50 year old presents for MRI research scan before her right breast biopsy. The study is performed for the Alan Penn research study. There is extreme amount of fibroglandular tissue in both breasts.Moderate to marked parenchymal enhancement is noted bilaterally. This includes prominent parenchymal edge enhancement and is a limitation to this study. There are a few scattered cysts in the breasts, right greater than left. In the right breast 12:00 position posteriorly, a bilobed irregular enhancing mass measures 0.8 x 0.8 x 1.3 cm and correlates to the mammogram and ultrasound. There is a thin fat plane between the mass and the pectoralis and the pectoralis enhances normally. No suspicious enhancement is seen in the left breast. No abnormal lymph nodes are identified in either axillary region.A few scattered high T2 signal hepatic lesions are highly likely benign such as cysts or hemangiomas.

Output: Suspicious enhancing mass in the right 12:00 position. This will be biopsied for clinical purposes today after this research MRI.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Malignant neoplasm of brain, unspecified [C71.9], Reason for Study: ^Reason: Eval GBM. History: GBM. Prior ICH. Right temporal intra axial mass with peripheral enhancement is again demonstrated. Comparing to prior scan, maximum diameter of the mass appears to be slightly decreased in size (for example, previously 54mm of AP diameter on axial post contrast scan and now 49.4mm). However, the degree of mass effects appear to be unchanged.In addition, the enhancing rim of the lesion appears to be slightly smoother than before. However, this could also be related to the scan position and slice thickness differences.The enhancement pattern especially regarding ependymal enhancement is again seen, but unchanged since prior scan (lessen than Jan 29, 2016 scan).The right inferior parietal ICH appears to be unchanged in size and MR characteristics since prior scan. The other lesion located in the right parietal lobe just mesial aspect of ICH does not show any significant difference in size and enhancing characteristics.Multifocal periventricular and deep white matter confluent bihemispheric FLAIR high signal intensities are again seen, unchanged.There is no new enhancing lesion or new abnormal FLAIR or T2 signal intensity on this scan. The ventricles, sulci and cisterns are unchanged. 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. Measurement of the right temporal lobe mass appears to be slightly decreased in size and the pattern of peripheral enhancement has slightly changed since prior scan as described above. 2. However, the degree of mass effects toward adjacent brain parenchyme has not been changed. Right parietal ICH and another enhancing lesion do not show any interval change since prior scan.3. Confluent bihemispheric FLAIR high signal intensity lesions are redemonstrated, unchanged. 4. No new enhancing lesion is seen.


Instruction: Generate impression based on findings.

Input: 88 year old with cardiomyopathy presenting for evaluation of left ventricular systolic dysfunction. Left VentricleThe left ventricle is moderately dilated with moderately reduced systolic function. There is a mild sigmoid septum. The overall LV ejection fraction is 40%, the LV end diastolic volume index is 104 ml/m2 (normal range: 65+/-11), the LVEDV is 176 ml (normal range 109+/-23), the LV end systolic volume index is 62 ml/m2 (normal range 18+/-5), the LVESV is 106 ml (normal range 31+/-10), the LV mass index is 58 g/m2 (normal range 67+/-11), and the LV mass is 98 g (normal range 114+/-24). There is hypokinesis of the mid to apical anterior and anteroseptal walls. There is a mid myocardial "stripe" of late gadolinium enhancement involving the basal septum. This is seen as a typical finding in nonischemic cardiomyopathy (dilated or previous myocarditis). Additionally, the native T1 times are elevated at 1150 ms (normal < 1050 ms) which suggests mild diffuse underlying myocardial fibrosis or edema. Left AtriumThe left atrium is mildly to moderately enlarged. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 52%, the RV end diastolic volume index is 65 ml/m2 (normal range 69+/-14), the RVEDV is 110 ml (normal range 110+/-24), the RV end systolic volume index is 31 ml/m2 (normal range 22+/-8), and the RVESV is 52 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is trace aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is mild pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size. There is mild to moderate atherosclerosis in the descending thoracic aorta.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is a trivial pericardial effusion. There is pericardial fat present. Extracardiac FindingsThere is a large pleural-based, heterogenous, mass (35 x 32 mm) on the right lateral mid lung and another smaller mass in right lung field. There is a right renal complex exophytic mass. 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. Lung and renal mass as above, recommend dedicated imaging if clinically indicated. 2. Moderate left ventricular dilation with moderately reduced systolic function (LVEF 40%) with mid to apical hypokinesis of the anterior and anteroseptal walls. There is additionally late gadolinium enhancement of the basal septum in the mid-wall stripe pattern, which is suggestive myocardial fibrosis or inflammation. The pattern has been described in both myocarditis and non-ischemic cardiomyopathy. 3. Normal right ventricular size and systolic function (RVEF 52%).4. Mild to moderate left atrial dilation.


Instruction: Generate impression based on findings.

Input: Chronic knee pain MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: No significant abnormality noted.LIGAMENTS: The cruciate ligaments are normal. The medial and lateral collateral ligaments are normal.EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Normal examination of the right knee.


Instruction: Generate impression based on findings.

Input: MRI Brain:There is a small area of restricted diffusion involving the left corona radiata which is compatible with an acute infarct, just cranial to a smaller old lacunar infarct. There is no associated mass effect or susceptibility. Again seen are scattered punctate foci and confluent areas of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, consistent with moderate to severe chronic small vessel ischemic changes. This includes patchy abnormal signal within the pons and scattered chronic lacunar infarcts.There are numerous scattered punctate foci of susceptibility abnormality throughout the cerebral hemispheres bilaterally with perhaps a few new foci compared to the prior exam. The ventricles and sulci are prominent but unchanged, consistent with moderate age-related volume loss. The basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. Mucous retention cysts or polyps are seen in the maxillary sinuses bilaterally. There is patchy mucosal thickening involving the ethmoid air cells.MRA Brain: The intracranial internal carotid arteries are normal in course with mild dolichoectasia. There is mild focal narrowing of the left proximal M1 segment, unchanged. There is also scattered focal narrowing of bilateral M2 segments, just before entering the sylvian fissure, unchanged. The middle and anterior cerebral arteries are otherwise unremarkable. There is mild multifocal irregularity and narrowing of the left P2 segment, unchanged. The right posterior cerebral artery distal to the P1 segment is mildly diminutive compared to the contralateral side but this is stable. The vertebral arteries, basilar artery, and posterior cerebral arteries are otherwise normal in course and caliber. There is no evidence of flow-limiting stenosis or aneurysm.MRA Neck: There is a separate origin of the left subclavian artery, left common carotid artery, and brachiocephalic artery from the arch. There is a medialized right carotid bifurcation and bulb, and moderate plaque along the left carotid bifurcation, minimal on the right. There is some tortuosity of the distal right cervical internal carotid artery. The remainder of the common carotid arteries and cervical internal carotid arteries are otherwise unremarkable. Both vertebral arteries are tortuous but patent. There is no evidence of stenosis or occlusion.

Output: 1.Acute infarct involving the left corona radiata but without significant mass effect or associated susceptibility.2.Moderate-severe chronic small vessel ischemic disease, unchanged. 3.Scattered foci of susceptibility likely relating to chronic hemosiderin deposition possibly from amyloid angiopathy or hypertensive microhemorrhages are similar in appearance.4.No significant flow limiting stenosis involving the intracranial or neck arteries.


Instruction: Generate impression based on findings.

Input: 75 years, Male, Reason: eval pancreatic mass vs cyst History: noted on ERCP. Study limited due to patient motionABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: Pancreatic duct is diffusely dilated to the ampulla. No cystic lesion is seen as there is extensive respiratory motion. No solid enhancing pancreatic masses are identified.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Limited study due to patient motion. There is diffuse dilatation of the pancreatic duct, however previously seen cystic lesion is not identified, likely due to motion. Within the limitations of this exam, no solid enhancing pancreatic mass is identified.


Instruction: Generate impression based on findings.

Input: Cervical spine:The cervical spine that demonstrates no abnormal signal in the vertebral bodies. There is normal alignment of the vertebral bodies.The intervertebral disc space at C2-C3 is normal with no significant spinal stenosis.At the level of C3-C4 there is a disk bulge associated with loss of disc height and disc desiccation. There is associated posterior ligamentous hypertrophy. There is effacement of the spinal fluid ventral and dorsal to the spinal cord. Overall there is moderate spinal stenosis is seen. There are bilateral uncovertebral osteophytes present at this level associated with disc material and associated with encroachment of the exiting nerve roots bilaterally.At the level of C4-C5 there is a disk bulge associated with loss of disc height and disc desiccation. There is associated posterior ligamentous hypertrophy. There is effacement of the spinal fluid ventral and dorsal to the spinal cord. Overall there is moderate spinal stenosis is seen. There are bilateral uncovertebral osteophytes present at this level associated with disc material and associated with encroachment of the exiting nerve roots on the right side.At the level of C5-C6 there is a disk bulge associated with loss of disc height and disc desiccation. There is associated posterior ligamentous hypertrophy. There is partial effacement of the spinal fluid ventral and dorsal to the spinal cord. Overall there is mild to moderate spinal stenosis is seen. There are bilateral uncovertebral osteophytes present at this level associated with disc material and associated with encroachment of the exiting nerve roots on the right side.At the level of C6-C7 there is a disk bulge associated with loss of disc height and disc desiccation. There is associated posterior ligamentous hypertrophy. There is partial effacement of the spinal fluid ventral and dorsal to the spinal cord. Overall there is mild spinal stenosis is seen. There are bilateral uncovertebral osteophytes present at this level associated with disc material and associated with encroachment of the exiting nerve roots bilaterally.At the level of C7-T1 there is loss of disc space height, disc desiccation and a mild disc bulge. There is mild narrowing of the neural foramina bilaterally at this level as a result of disc material with some mild encroachment of the exiting nerve roots. There is no significant compromise to the spinal canal.MRI thoracic spine:The thoracic spine is in normal alignment, with a normal thoracic kyphosis. The vertebral body and disk heights are well-maintained. Mild disc bulges are seen in the intervertebral disc spaces of T1-T2 and T2-T3. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal.There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the thoracic spine. Lumbar spine:The lumbar spine demonstrates loss of the normal lumbar lordosis. A 25 mm axial dimension well-circumscribed lesion in the left half of the C2 vertebral body most likely represents a vertebral body hemangioma it is bright on T1-weighted imaging and suppresses signal on the fat suppressed images.At the level of T12-L1 there is no significant disc abnormalities.At the level of L1-L2 there is loss of disc space height, diffuse disc bulge, disc desiccation and bilateral ligamentum flavum hypertrophy. Overall there is a moderate degree of spinal stenosis present at this level. This is at theAt the level of L2-L3 there is loss of disc space height, disc desiccation, endplate reactive changes of a chronic stage and a diffuse disc bulge. Overall there is a mild to moderate degree of spinal stenosis at this level and there is narrowing of the neural foramina bilaterally at this level.At the level of L3-L4 there is loss of disc space height, disc desiccation and diffuse disc bulge associated with endplate osteophytes. There is bilateral facet hypertrophy and ligamentum flavum hypertrophy at this level. There is partial effacement of the fat within the neural foramina at this level. Overall there is a mild to moderate degree of spinal stenosis at this level.At the level of L4-L5 there is loss of disc space height, diffuse disc bulge and bilateral ligamentum flavum hypertrophy. There is fluid identified within the facet joints at this level. There is effacement of the fat at the lateral recesses sees at this level and mild narrowing of the neural foramina bilaterally at this level. Overall there is a mild degree of spinal stenosis at this level.At the level of L5-S1 there is loss of disc space height, disc desiccation and a diffuse disc bulge associated with the mild ligamentum flavum hypertrophy. There is encroachment of the nerve roots at the right lateral recess at this level as a result of disc material. There is encroachment of the exiting nerve roots within the neural foramina bilaterally at this level as a result of the disc material

Output: 1.There are multilevel degenerative changes present in the lumbar spine with mild to moderate spinal stenosis at L45, L3-4 and L2-3 and moderate spinal stenosis at L1-2.2.There are multilevel degenerative changes present in the cervical spine with moderate spinal stenosis at C2-3 and C3-4 and mild to moderate spinal stenosis at C5-6 and C6-7. There is multilevel neural foramen encroachment of exiting nerve roots in the cervical spine as detailed above3.There are mild degenerative changes present in the thoracic spine.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, nausea, preoperative planning for craniotomy for tumor resection. Examination is limited to sequences for operative planning and intraoperative navigation. Again seen is an enhancing, predominantly solid fourth ventricular mass measuring approximately 3.6 x 4.2 x 4.2 cm in the AP, transverse, and craniocaudal dimensions. Mass demonstrated restricted diffusion on prior study. Again noted is obstructive hydrocephalus with dilated lateral, third, and upper aspect of the fourth ventricles similar to prior. Periventricular T2 hyperintensity is consistent with transependymal CSF flow. Distended optic nerve sheaths also again seen. No additional foci of parenchymal or meningeal enhancement are appreciated. No midline shift or uncal herniation. Mild inferior cerebellar tonsillar herniation again seen. Major flow-voids are preserved. Mucosal thickening in the maxillary sinuses, right worse than left again noted. Calvarium and extracranial soft tissues are otherwise unremarkable.

Output: Examination for operative planning again demonstrates a fourth ventricular mass which is favored to represent a medulloblastoma. Associated obstructive hydrocephalus again seen.


Instruction: Generate impression based on findings.

Input: There are stable post surgical findings related to left parietal craniotomy. There is an avidly enhancing dural based mass along the left greater wing of the sphenoid that measures 1.3 x 1.2 cm, previously 1.3 x 1.3cm. There is minimal mass effect upon the inferior left frontal lobe and minimal surrounding edema. There are unchanged scattered nonspecific foci of cerebral white matter T2 hyperintensity. The ventricles and sulci are unchanged. There is no midline shift. The imaged portions of the paranasal sinuses and mastoid air cells are clear.

Output: No significant interval change in the left greater wing of sphenoid meningioma with superimposed treatment effects.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Male 66 years old s/p OLT for HCC, 1.5 lesion with enhancement on CT but no washout, evaluate further with HCC. ABDOMEN:LIVER, BILIARY TRACT: Postsurgical changes of liver transplant.The previously described segment 6 lesion measures 1.3 x 1.3 cm (series 1203, image 2). It is hypointense on both T1 and T2-weighted images with avid arterial enhancement, mild venous enhancement and no washout. On the arterial phase there appears to be a right hepatic artery branch vessel leading into the lesion. Amorphus low T2 signal is also seen posterior to the lesion and on delayed postcontrast images only an amorphus hypointense artifact is seen in this same area. This artifact may be related to turbulent/pulsatile flow within the lesion.A tubular focus of hypointensity along the fissure is of uncertain significance. It may be related to artifact from surgery.No intra or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: The pancreas enhances normally. There is no pancreatic ductal dilatation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.The previously described segment 6 lesion is favored to represent a vascular anomaly, for example an aneurysm.2.No evidence of recurrent hepatocellular carcinoma.


Instruction: Generate impression based on findings.

Input: Reason: r/o repeat meniscus tear History: pain MENISCI: There is linear increased signal abnormality within the body of the meniscus which extends to the tibial articular surface indicating a longitudinal tear, new from prior examination (image 28; series 701 and image 27; series 501). There is blunting and deformity of the posterior horn of the lateral meniscus. The medial meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is a focal full-thickness articular cartilage cleft with delamination along the weightbearing surface of the medial femoral condyle above the body of the meniscus. Note is made of a lesion along the medial aspect of the distal femoral metaphysis with sclerotic margins likely representing a benign nonossifying fibroma, appearing similar to the prior study.LIGAMENTS: There is thickening and foci of fluid signal intensity internally within the ACL likely representing mucoid degeneration. There are also foci of fluid signal intensity about the anterior and posterior aspect of the PCL which may represent mucoid degeneration as well. The ACL and PCL appear intact. The LCL and MCL appear intact.EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Findings indicating a new tear of the body of the lateral meniscus as described above. There is blunting and deformity of the posterior horn of the lateral meniscus which also likely represents a re-tear, although some of this may be related to the patient's history of prior partial meniscectomy.2. Full-thickness articular cartilage cleft with delamination along the medial femoral condyle. 3. Moderate-sized joint effusion. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Female, 51 years old. Constant right knee pain with no hx of trauma. MENISCI: There is thickening and increased signal intensity of the anterior horn of the lateral meniscus, particularly at its root, indicating moderate to severe degeneration and degenerative tearing. The body and posterior horn of the lateral meniscus appear normal. The medial meniscus appears normal.ARTICULAR CARTILAGE AND BONE: There is moderate degeneration of the articular cartilage of the patella particularly along the medial facet. There is a full thickness fissure at the median eminence with underlying subchondral cysts. There is focal degeneration of the femoral trochlea inferiorly. The remainder of the articular cartilage appears relatively normal.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism appears normal.ADDITIONAL

Output: 1.Patellofemoral osteoarthritis.2.Degeneration and degenerative tearing of the anterior horn of the lateral meniscus.


Instruction: Generate impression based on findings.

Input: Male, 35 years old, with history of grade 2 oligodendroglioma status post partial resection. A heterogeneous tumor is evident within the left frontal lobe spanning from the cortical surface to the lateral ventricular margin. Abnormal signal also spreads into the genu of the corpus callosum and along the margin of the left caudate nucleus.Evidence of interval partial tumor resection is seen with a small resection cavity in the central portion of the tumor. The margins of this cavity demonstrate a thin rim of discrete enhancement. Anterior to the cavity, there is a blush of mild enhancement within the tumor which appears similar to prior exams. Apart from the resection cavity, the overall size and morphology of the lesion have not significantly changed from prior exams.Mass effect from the lesion results in partial effacement of the left frontal horn and a very slight midline shift to the right. No other parenchymal lesions are seen. No other abnormal intracranial enhancement is detected. The ventricular system is otherwise normal in size and morphology.

Output: Findings are seen compatible with partial resection of a left frontal lobe tumor. Apart from the resection cavity, there has been no significant interval change in the size of the lesion when compared to prior exams.


Instruction: Generate impression based on findings.

Input: Ms. Kanoy is a 55-year-old female presenting for short term 6 month follow-up of a benign-appearing 4 mm lesion in the right breast seen on outside MRI. Family history of breast cancer in father, maternal grandmother, maternal uncle, two maternal aunts, and one maternal cousin. There is heterogeneous amount of fibroglandular tissue in both breasts. Mild background parenchymal enhancement is noted bilaterally.Scattered foci of enhancement are seen bilaterally in both breasts, all of which appear similar in size and distribution when compared to prior examinations. Specifically, a focus seen in the right medial retroareolar breast, is stable when compared to prior examination from 11/17/2015, now measuring 0.4 x 0.4 cm, previously measuring 0.3 x 0.4 cm. No new abnormal enhancement is seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.

Output: Stable benign focus of the right breast. No MRI evidence of malignancy.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Routine Diagnostic Mammogram.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Episodes of left sided weakness and occasional slurred speech. Family reports a stress test with triple vessel disease. Brain MRI: There is an area of high T2 signal and restricted diffusion in the right thalamocapsular junction that measures up to 25 mm. There is also a subcentimeter focus of high T2 signal and restricted diffusion in the right posterior putamen. There is no evidence of intracranial hemorrhage or mass. 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.Brain MRA: There is no evidence of significant steno-occlusive lesions or aneurysm.Neck MRA: There is no evidence of significant steno-occlusive lesions.

Output: 1. Acute infarcts in the right thalamocapsular junction and putamen without evidence hemorrhagic transformation or midline shift.2. No evidence of significant steno-occlusive disease in the major head and neck arteries, within the limits of MRA.Discussed with nurse Valerio at 5PM on 9/21/15.


Instruction: Generate impression based on findings.

Input: Reason: 57 y/o with seizure disorder, recently diagnosed cervical cancer and new cerebellar lesions on MRI. Study for biopsy planning Exam was obtained for surgical localization purposes. There is redemonstration of a 1.9 x 1.0 cm enhancing lesion in the left cerebellum with a small amount of surrounding vasogenic edema. Additionally, a 0.6 cm lesion in the anterior inferior right cerebellum also appears similar to prior examination.Redemonstrated are scattered areas of T1 hypointensity and T2 hyperintensity are demonstrated in the periventricular and subcortical white matter correlating to areas of T2/FLAIR hyperintensity seen on prior examination, likely secondary to chronic microvascular ischemic change. The cortical sulci are in proportion to the cerebral ventricles. No midline shift or mass effect is appreciated. Incidental empty sella is noted.

Output: Stable left greater than right enhancing cerebellar lesions concerning for metastatic disease.


Instruction: Generate impression based on findings.

Input: 44 years, Female, follow-up of a left retrocerebellar arachnoid cyst. Again seen is a left posterior fossa CSF signal lesion measuring approximately 7.0 x 3.3 x 5.5 cm (TV x AP x CC), which is unchanged when measured with a similar technique. Mild associated mass effect on the adjacent cerebellum. Mild scalloping of the occipital calvarium is also again noted. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. Unchanged 4 mm pineal cyst. No suspicious intracranial mass. The ventricles are within normal limits in size and configuration. No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: Compared to outside MRI from 12/2/2013, left retrocerebellar arachnoid cyst is unchanged.


Instruction: Generate impression based on findings.

Input: Vertigo. MRI: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma, brainstem, cerebellum, and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.MRA: There is no evidence of significant cerebral steno-occlusive lesions or saccular aneurysms, within the limits of MRA. In particular, the posterior circulation appears to be intact. The major arteries in the neck also appear to be intact.

Output: 1. No evidence of acute intracranial hemorrhage, mass, or acute infarct.2. No evidence of significant steno-occlusive lesions of the head and neck arteries.


Instruction: Generate impression based on findings.

Input: Clinical question: Rule out cord compression; known lung cancer. Signs and symptoms: As above. Pre-and post enhanced lumbar MRI:The field of exam spans from the T10 through S3 levels. External there are multiple foci of marrow signal changes with subtle varying degree of enhancement and consistent with multiple foci of osseous metastatic disease. These findings were all present on prior CT of chest from February 11.There is no evidence of the spinal canal compromise or stenosis from T10 through L2 levels and without evidence of cord /conus/cauda equina compression.Metastatic T11 vertebrae demonstrate less than 50% compression deformity and mild expansion into the spinal canal however without central spinal stenosis.No evidence of any additional vertebral body fracture. There is no evidence of extension of metastatic lesion into the epidural space or the paraspinal soft tissues at any level.At L2 -- L3 there is a broad based central and rightward shadow disk protrusion with subtle mass effect on the thecal sac and mild central spinal stenosis.Extensive degenerative changes and L3 -- L4 however results in moderate central spinal stenosis and right neural foraminal compromise. Extensive degenerative changes at L4 -- L5 and including mild grade 1 anterolisthesis also results in significant central spinal stenosis and moderate left neural foraminal compromise.The signal intensity and caliber are normal as visualized thoracic cord, conus and cauda equina is within normal and without detectable abnormal enhancement.

Output: 1.Multiple osseous metastatic lesions involving multiple vertebral bodies from T10 through S2 as detailed with subtle varying degree of enhancement.2.Less than 50% compression fracture of metastatic T11 vertebrae with mild expansion into the spinal canal however without spinal compromise.3.There is no evidence of stapedial spread of tumor at any level and no evidence of spinal canal compromise secondary to metastatic disease.4.Degenerative changes at L3 -- L4 and L4 -- L5 levels results in moderate to severe central spinal stenosis at these levels. 5.No evidence of signal abnormality or enhancement of the lower most visualized thoracic cord, conus or the cauda equina.


Instruction: Generate impression based on findings.

Input: Clinical question: Further evaluation for disc herniation. Signs and symptoms: Myelopathy, preop planning. Nonenhanced cervical MRI:Foramen magnum is unremarkable.C2-C3 demonstrate mild degenerative changes and unremarkable otherwise.C3-C4 demonstrate mild degenerative disc disease with resultant moderate left and mild right neural foraminal compromise and no central spinal stenosis.C4-C5 demonstrate moderate disc disease and loss of disc height and mild bilateral facet and ligamentum flavum hypertrophic changes. Shallow mental hypertrophic spur on the left results in slight flattening and posterior displacement of the cord and moderate central spinal stenosis. Moderate bilateral neural foraminal compromise is also present.C5-C6 demonstrate a large disc extrusion extending superiorly to mid C5 level and inferiorly to mid C6. Although the prior exam was incomplete there is no significant change of this finding which results in significant central spinal stenosis. The extruded disc is more prominent to the left of midline. Significant bilateral neural foraminal compromise is also present. On sagittal T2 STIR there is evidence of increased T2/T2 STIR signal intensity of the cord at this level suggestive of myelitis.C6-C7 demonstrate moderate disc disease, loss of disc height, mild hypertrophic changes of facet and ligamentum flavum. There is a shallow bulging disc with resultant subtle flattening the ventral aspect of the cord and mild central spinal stenosis.C7-T1 is unremarkable.Upper most visualized thoracic spine and thoracic cord to T3 level is unremarkable.

Output: 1.C5-C6 demonstrate a large disc extrusion with resultant significant central spinal stenosis and increased T2 signal intensity of the cord/myelitis.2.C4-C5 demonstrate degenerative changes with resultant moderate central spinal stenosis and neural foraminal compromise as detailed.3.C6-C7 demonstrate degenerative changes with resultant mild central spinal stenosis and neural foraminal compromise.4.See detailed report per level above.


Instruction: Generate impression based on findings.

Input: 72-year-old male with new onset tremor and gait disorder, concern for atherosclerotic Parkinson's disease. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. There is diffuse prominence of the ventricles and sulci indicating mild global atrophy.Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with chronic small vessel ischemic changes. Normal flow-voids are demonstrated in the major intracranial vascular structures.The sella and orbits appear within normal limits. There is partial opacification of the right posterior ethmoidal air cells, right frontal sinus as well as the right mastoid air cells. Chronic appearing opacification of the right sphenoid sinus. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: .1. Mild chronic small vessel ischemic disease involving the periventricular and subcortical white matter.2. Prominence of the ventricles and sulci compatible with mild global atrophy. 3. Chronic appearing paranasal sinus disease as described above.


Instruction: Generate impression based on findings.

Input: Female, 60 years old, with dysarthria and gait disorder. Evaluate for cerebellar disease. One or two curvilinear, nonspecific foci of T2 hyperintensity are seen within the subcortical white matter of the right superior parietal lobule. No other focal lesions are detected. No edema or mass effect is observed. There are no diffusion restricting lesions. Cerebral volume is generally well preserved. However, the cerebellar fissures are disproportionately prominent, particularly along the vermis, suggesting underlying volume loss. The brainstem is within normal limits. No evidence of intracranial hemorrhage or any abnormal extra-axial fluid is seen. The ventricular system is within normal limits.

Output: Prominence of the cerebellar fissures, predominantly along the vermis, is out of proportion to sulcal caliber elsewhere and likely reflects underlying volume loss. The etiology for this finding is broad and includes inherited disorders, medication effect, toxic exposures and metabolic abnormalities.


Instruction: Generate impression based on findings.

Input: Female, 4 years old, with history of JPA, follow-up three month evaluation. Evidence of occipital craniotomy is again seen. A resection cavity centered on the cerebellar vermis has decreased in size from the prior exam. No evidence of surrounding edema or any significant T2 signal abnormality is seen. On postcontrast images, previously seen curvilinear enhancement along the cavity margins has diminished. There remains a small focus of curvilinear enhancement at the anterior margin of the cavity. No additional new intracranial lesions are seen. The fourth ventricle has reexpanded and the ventricular system has resumed normal caliber and morphology. Supratentorial parenchymal morphology and signal are within normal limits.

Output: Expected postoperative findings compatible with resection of tumor from the posterior fossa. The resection cavity has decreased in size along with decreasing nonspecific curvilinear enhancement along the cavity margins. No evidence of any new or recurrent lesion is seen.


Instruction: Generate impression based on findings.

Input: Severe headaches with semiology consistent with migraine with aura and suspicion of autoimmune disease: bilateral nystagmus and peripheral neuropathy. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are several, at least 15, punctate foci of high T2 signal in the white matter of the bilateral frontal lobes, which may have progressed slightly since 2011. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is a subcentimeter left posterior nasopharyngeal retention cyst. There are partially imaged postoperative findings in the cervical spine.

Output: Punctate foci of T2 hyperintensity in the bilateral frontal lobe white matter are nonspecific, but may represent sequela of migraine, autoimmune, or chronic small vessel ischemic disease. Otherwise, no evidence of intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: 30-year-old female with right femur Ewing's with retroperitoneal metastases receiving chemotherapy, evaluate disease status. Patient underwent right proximal femoral resection with right total hip arthroplasty on December 2015. Components of a total hip arthroplasty with adjacent metal artifact limiting evaluation of the immediate surrounding structures. The previously seen mass in the right anterior thigh is not definitively visualized. There are postsurgical changes in the lateral soft tissues of the right upper thigh with a linear tract extending from the skin to the thigh musculature, specifically the vastus lateral and intermedius, which demonstrates low signal intensity on T1 and bright signal on T2 and heterogeneous enhancement. There is generalized mild fatty atrophy of the thigh musculature. Small enhancing right inguinal lymph nodes are unchanged.

Output: Surgical changes related to a right total hip arthroplasty with likely postsurgical and mild inflammatory changes in the right lateral soft tissues and thigh musculature. Adjacent metal artifact limits evaluation of the immediate surrounding tissues, however there is no discrete mass identified.


Instruction: Generate impression based on findings.

Input: 43 year-old female with pituitary adenoma, assess interval change after discontinuing cabergolinr. There has been no significant interval change in the all size of the patient's pituitary lesion measuring 8 mm AP by 10 mm transverse by 9 mm craniocaudal. However, there has been slight decrease in thickness of a small hypointense portion located along its anterior aspect. The infundibulum remains deviated slightly to the left. There is no mass effect upon the optic apparatus or cavernous sinuses. Fluid is present in left mastoid air cells, which has been present dating back to 6/5/2013.

Output: There has been no significant interval change in the all size of the patient's pituitary lesion. However, there has been slight decrease in thickness of a small hypointense portion located along its anterior aspect.


Instruction: Generate impression based on findings.

Input: MRI brain:There has been interval resolution of previously seen multiple areas of bilateral T2/FLAIR hyperintensity predominantly involving the cortex and subcortical white matter. There are no areas of abnormal signal or pathologic enhancement. The ventricles and sulci are prominent, consistent with mild global volume loss greater than expected for the patient's stated age. The cisterns remain patent. There is no midline shift or mass effect. There is no diffusion abnormality. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. There is mild mucosal thickening of the frontal sinuses, ethmoid air cells and bilateral maxillary sinuses. MRA brain:The intracranial internal carotid arteries are normal in course and caliber. Slightly inhomogeneous areas of flow related enhancement in the cavernous carotids likely relates to turbulence and flow related artifact. The middle and anterior cerebral arteries are unremarkable. The vertebral arteries, basilar artery and posterior cerebral arteries are normal in course and caliber. There is no evidence of flow-limiting stenosis or aneurysm.

Output: 1. Interval complete resolution of previously seen scattered prominent areas of abnormal cortical and subcortical abnormal signal, presumably related to PRES as well as possible superimposed areas of seizure activity given history of status epilepticus.2. No evidence of acute infarct.3. Unremarkable MRA of the head.


Instruction: Generate impression based on findings.

Input: Aphasia [R47.01], Reason for Study: ^Reason: eval for pathology, s/p crani for R MCA and L ICA aneurysms. History: aphasia Due to metallic artifact, precise evaluation with diffusion-weighted imaging and gradient-echo imaging are limited.However, there is no evidence of acute ischemic lesion on the scan.There are localized and somewhat gyral pattern FLAIR/T2 high signal intensity lesions at the left anterior temporal lobe surface area (series 6, image 12,13,14). There are also associated FLAIR/T2 high signal intensity lesions at the left anterior and mesial temporal area. This lesion is likely to be intra axial and indicate possible hemorrhagic lesions as well as associated parenchymal edema likely related to prior operation.There is also extra dural fluid collection extending from the left frontal lobe 2 to temporal lobe and the maximum diameter was measured about 11 mm on axial T2 images with subtle effacement of underlying brain parenchyme. The maximum diameter measured on prior CT scan was about 10.1 mm, thus, considering different imaging modality, there is no significant interval change of extradural fluid collections.There is also scalp fluid collections with air signal intensities which are related to prior operation, unchanged since prior scan.Minimal (about 1-2mm) midline shift toward right side is again seen but unchanged since prior scan.The ventricles, sulci and cisterns are symmetric.There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Left temporal lobe likely hemorrhagic lesion and edematous lesions, likely represent prior surgery related lesions as described above (series 6, image 12,13,14).2. No evidence of acute ischemic lesion.3. Unchanged extra dural fluid and air collections since prior scan with subtle effacement of underlying brain parenchyme since prior scan.4. Unchanged subgaleal fluid and air collection since prior CT scan.


Instruction: Generate impression based on findings.

Input: 27 years Female (DOB:8/7/1988)Reason: 3T scanner, qsm/permeabiltiy, CCM Protocol History: yearly surveillancePROVIDER/ATTENDING NAME: ISSAM A. AWAD ISSAM A. AWAD There are multiple lesions which have a ring of low signal compatible with hemosiderin ring and smaller central area of T2 signal hyperintensity present which appear to be stable compared to the prior exam. The largest one appears to be in the left basal ganglia and internal capsule and measures 14 x 11 mm axial dimensions and is unchanged. Other smaller lesions evident on T2 imaging are located in the left hippocampus left fusiform gyrus right inferior temporal lobe gyrus, right anterior medial temporal lobe left isthmus of the cingulate gyrus left frontal lobe subcortical white matter, right frontal lobe subcortical white matter and a right paracentral lobule subcortical white matter and another one in the gray matter in that location and right superior frontal gyrus. Additional lesions are also identified on susceptibility weighted imaging which are not clearly identified on the T2 and FLAIR images..Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: The patient has multiple cerebral cavernous malformations scattered in both hemispheres which are stable compared to the prior exam.