Instruction: Generate impression based on findings.

Input: 57-year-old male with history of chronic heart failure abdominal pain The study is limited due to poor perfusion secondary to patient's heart failure. Focal lesions and distal organs cannot be optimally evaluated.ABDOMEN:LUNG BASES: Significant cardiomegaly, bilateral pleural effusions, more prominent on the right compared to the left with dependent atelectasis consistent with patient's known heart failure.LIVER, BILIARY TRACT: Liver is enlarged with dilated hepatic veins and IVC secondary to heart failure. Focal, peripheral increased attenuation in the right lobe of the liver likely represents a perfusion abnormality. Focal lesions in the liver cannot be excluded.SPLEEN: No significant abnormality notedPANCREAS: Pancreas is atrophic with dilated duct and numerous parenchymal intraductal calcifications consistent with chronic pancreatitis.ADRENAL GLANDS: Slightly thickened left adrenal gland.KIDNEYS, URETERS: Perfusion of the kidneys is limited. Extensive atherosclerotic disease involving the aorta and renal arteries. Right renal cyst. Calcifications in the kidneys are likely vascular, however, small stones cannot be excluded.RETROPERITONEUM, LYMPH NODES: Extensive atherosclerotic calcifications involving the entire vasculature atherosclerotic plaques and stenosis involving most of the visceral branches of the abdominal aortaBOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Small amount of ascites. Generalized anasarca.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: The tip of the left femoral venous catheter is in the right ventricle.Ill-defined enhancing lesions lateral to the right psoas muscle in the pelvis. On image number 79, series number 3, at the inferior aspect of this lesion, the lesion measures 2.4 x 2 cm. The etiology is unknown. MRI of the abdomen and pelvis may be helpful for further evaluation.

Output: Limited study due to poor perfusion secondary to patient's congestive heart failure.Cardiomegaly, bilateral pleural effusions, hepatomegaly, ascites, generalized anasarca secondary to patient's known heart failure.Severe and extensive atherosclerotic disease involving the entire vasculature.The tip of the left femoral venous catheter is in the right ventricle.Severe chronic pancreatitis.Enhancing soft tissue density lesions in the right retroperitoneum, adjacent to the psoas muscle. There etiology is unknown. They may represent neoplasm versus abscess. Further evaluation with MRI may be helpful.Bilateral renal calcifications, most of the more vascular, however, small stones cannot be excluded.Dr. Anveroy (3123) was notified and acknowledged about these findings at the time of dictation.


Instruction: Generate impression based on findings.

Input: 67-year-old female with endometrial cancer. Compared to last MRI and measure vaginal cuff mass, left inguinal lymph node, and right common iliac node. Status post immunotherapy 4 cycles. PELVIS:UTERUS, ADNEXA: The known vaginal cuff mass has slightly decreased in size with reference measurements listed below. Extension through the parametrial fat is again noted. The mass is associated with satellite nodules and peritoneal extension, and there are persistent areas of the peritoneal implants compatible with carcinomatosis. Large volume ascites is again partially visualized. Tumor is present along the peritoneal reflection of the bladder. The posterior aspect of the tumor abuts the rectosigmoid colon. Enhancing tumor is again identified along the anterior surgical scar.BLADDER: As above.LYMPH NODES: Decreased size of the right common iliac lymph node. Stable size of the left inguinal lymph node. Reference measurements listed below.BOWEL, MESENTERY: As above.BONES, SOFT TISSUES: Mild anasarca.OTHER: No significant abnormality noted.INDEX LESION MEASUREMENTS (Current exam date/time: 11/2/2016 14:15:00)LEFT INGUINAL LYMPH NODE: 0.9 x 0.4 cm (Image 30, Series 401); 0.9 x 0.5 cm on prior (8/10/2016) (Image 23, Series 1301).RIGHT COMMON ILIAC LYMPH NODE: 0.7 x 0.7 cm (Image 55, Series 401); 1.2 x 1.0 cm on prior (8/10/2016) (Image 48, Series 1301).VAGINAL CUFF MASS: 6.4 x 3.8 cm (Image 43, Series 401); 7.9 x 4.6 cm on prior (8/10/2016) (Image 38, Series 1301).

Output: 1.The known infiltrative soft tissue mass at the vaginal cuff with extension into the parametrial soft tissue, along the peritoneum, and abutment above the bladder and rectum and sigmoid colon has decreased in size. Reference measurements listed above.2.Decreased size of the right common iliac lymph node and stable size of the subcentimeter left inguinal lymph node. Reference measurements listed above.


Instruction: Generate impression based on findings.

Input: Dementia. There are small areas of encephalomalacia in the bilateral basal ganglia and cerebellar hemispheres. There is scattered cerebral white matter T2 hyperintensity as well. In addition, there are numerous scattered punctate foci of susceptibility effect in the bilateral cerebral hemispheres, basal ganglia, and pons. There is mild diffuse cerebral volume loss. There appears to be a defect in a portion of the septum pellucidum. There is no evidence of intracranial mass or acute infarct. 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: Probable chronic lacunar infarcts in the bilateral basal ganglia and cerebellar hemispheres, chronic small vessel ischemic white matter disease, probable chronic hypertensive microhemorrhages, as well as mild diffuse cerebral volume loss, but no evidence of acute infarct.


Instruction: Generate impression based on findings.

Input: Evaluate right liver dome lesion seen on CT. ABDOMEN:LIVER, BILIARY TRACT: The right hepatic dome lesion measuring 1.3 x 1.1 cm is moderately T2 weighted hyperintense and demonstrates peripheral nodular discontinuous enhancement which gradually fills in on delayed phase imaging compatible with a benign hemangioma. No additional liver lesion, biliary ductal dilatation or vascular abnormality.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: The right hepatic dome lesion most likely represents a benign hepatic hemangioma.


Instruction: Generate impression based on findings.

Input: 36-year-old female with history of right breast cancer status post neoadjuvant chemotherapy, partial mastectomy, sentinel lymph node biopsy and management radiation therapy. Now with new mammographic evidence of left focal asymmetry and new left nipple inversion. Please evaluate for new suspicious lesions. There is scattered fibroglandular tissue in both breasts. Postsurgical changes noted in the right upper-outer quadrant and axillary region.Mild parenchymal enhancement is noted bilaterally. New linear oriented area of non mass enhancement is seen in the left central breast at approximately 9:00 position measuring 32 x 7 x 7 mm (AP X ML X SI).No abnormal enhancement is seen in right breast. No abnormal lymph nodes are identified in either axillary region.

Output: New linear oriented area of non mass enhancement in the left central breast at approximately 9:00 position needs further evaluation with MRI guided biopsy. Findings conveyed to Joly Raju RN, at the time of dictation. BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: H - Percutaneous Biopsy/Aspiration.


Instruction: Generate impression based on findings.

Input: Diagnosis: Lumbago with sciatica, unspecified sideClinical question: lumbar spine pain. LLE radicular symptomsSigns and Symptoms: LLE radicular symptoms Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is bilateral facet hypertrophy present at this level.At L4-5 there anterior subluxation of L4 on L5, disc desiccation and diffuse disc bulge associated with marked bilateral facet and ligamentum flavum hypertrophy. There is partial effacement of spinal fluid within the thecal sac at this level with a moderate degree of spinal stenosis. There is partial effacement of fat surrounding the exiting nerve roots within the neural foramina at this level. Compared to the previous exam from 5/17/2008 there is been clear progression.At L3-4 there is no significant compromise to spinal canal or neural foramina. There are some ligamentum flavum hypertrophy present at this level.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.There is a 32mm right renal cyst which previously measured . The left kidney is not entirely included exam and appears to have associated enlargement of the renal cysts and appear smaller than the right kidney.There is some disc desiccation and minor disc bulges at T11-T12, T10 - T11 and T9-T10.

Output: 1.Degenerative changes are present which are worse at L4-5 where there is mild subluxation as well as marked facet hypertrophy, disc bulge and moderate spinal stenosis as well as mild encroachment of exiting nerve roots. Compared to the prior exam from 2008, there significant progression.2.Interval enlargement of renal cysts over the past 7 years. There appears to be some atrophy of the left kidney which to some degree is also present on the prior exam


Instruction: Generate impression based on findings.

Input: Cervical spondylosis. Hand paresthesias and leg spasticity. The vertebral column is mildly straightening in the sagittal plane. The vertebral body heights are preserved. There is moderate spondylosis with disc-osteophyte complexes from C3/4 to C6/7 with Modic type II endplate signal changes. Otherwise, the vertebral bone marrow signal is unremarkable. There is overall moderate spinal canal and bilateral neural foramen stenosis from C3/4 to C6/7, with mild indentation of the spinal cord at some of these levels, but no abnormal spinal cord signal. The paravertebral soft tissues are unremarkable. There appear to be a Thornwaldt cyst and an adenoid retention cyst. There is a T2 hyperintense ovoid lesion in the right tracheoesophageal groove that measures up to 12 mm. There is an occipital scalp lipoma that measures up to 5 mm in thickness. There are punctate defects in the inferior right cerebellar hemisphere, which may represent chronic infarcts.

Output: 1. Multilevel degenerative cervical spondylosis with overall moderate spinal canal and bilateral neural foramen stenosis from C3/4 to C6/7.2. An ovoid lesion in the right tracheoesophageal groove that measures up to 12 mm may represent an exophytic thyroid nodule or parathyroid adenoma. A thyroid ultrasound may be useful for further characterization.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Dear male loss of consciousness and head laceration. A scalp laceration in the right frontal region is noted.A very small cortical based lucency in involves the cortex of high convexity right parietal lobe this is highly suspected of a very small cortical stroke. This is best demonstrated on axial image 22 and 23. Further follow-up with an MRI is recommended.No additional areas of hemorrhage, edema, mass effect, midline shift or hydrocephalus is detected.

Output: Very small area of vertical low-attenuation in the right high convexity parietal suspected a very small cortical stroke.


Instruction: Generate impression based on findings.

Input: There is redemonstration of multiple punctate subcortical and periventricular white matter lesions which are hyperintense in FLAIR. There is no significant change in the size and number of the lesion with no evidence of enhancement.

Output: No evidence of progression of the known MS disease. No evidence of enhancement to suggest acute exacerbation.


Instruction: Generate impression based on findings.

Input: 66 year old female with cognitive impairment, altered mental status, evaluate for stroke or brain injury MRI Brain: No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. There is global parenchymal volume loss, relatively greater in the bilateral frontal and parietal lobes. There is hippocampal volume loss which is not disproportionate to the remainder of the brain. 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. Small foci of volume loss and FLAIR hyperintensity along the left lateral ventricle margin are compatible with lacunar infarcts. Brain parenchyma is otherwise unremarkable for age. 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. MRA Brain: There is irregularity and moderate narrowing involving the bilateral cavernous internal carotid arteries likely related to atherosclerotic disease. There is diminished flow-related enhancement involving the left distal vertebral artery with reconstitution distally. The bilateral ACAs, MCAs, basilar artery, and PCAs demonstrate no significant stenosis. No aneurysms are appreciated.

Output: 1. No evidence of acute infarct, mass or mass effect. 2. Mild chronic small vessel ischemic disease. 3. Global parenchymal volume loss relatively greater in the bilateral frontal and parietal lobes.3. Intracranial atherosclerotic disease with moderate narrowing involving the cavernous internal carotid arteries and V3 segment of the left vertebral artery. These stenoses can be better visualized with CTA if clinically indicated.


Instruction: Generate impression based on findings.

Input: Reason: Evaluate for PSC History: Recent MRI/MRCP with narrowing of the proximal common bile duct. ABDOMEN:LIVER, BILIARY TRACT: Diffuse hepatic steatosis, unchanged. Geographic areas of T2 hyperintense signal and hyperenhancement likely due to fibrosis, unchanged. Previously seen hemangioma is not visualized on today's exam. Focal stricturing at the proximal common bile duct is unchanged. No intrahepatic or extrahepatic biliary ductal dilatation. The right hepatic duct again is poorly visualized. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Stable minimal narrowing of the proximal common bile duct and poor visualization of the right hepatic duct. No new areas of stricturing or dilatation. 2.Hepatic steatosis and fibrosis without suspicious focal lesion. Previously seen probable hemangioma is not visualized on today's examination.


Instruction: Generate impression based on findings.

Input: Reason: Assess for rotator cuff tear - concern for supraspinatus and infraspinatus; acute injury 5/15 with new weakness and shoulder pain History: Right shoulder pain, supraspinatus and infraspinatus weakness after acute injury (fall) ROTATOR CUFF: Again seen is a full-thickness tear of the anterior fibers of the supraspinatus at the level of its insertion on the greater tuberosity measuring approximately 2.2 cm in the AP dimension. There is associated retraction of the proximal tendon fragment by approximately 4 cm. There is thickening and intermediate signal intensity within the proximal tendon fragment indicating tendinosis. There is moderate fatty atrophy of the supraspinatus. The infraspinatus muscle and tendon appear intact. There is thickening and intermediate signal intensity within the subscapularis indicating moderate tendinosis. There is linear fluid signal intensity within the tendon indicating interstitial tearing. The teres minor muscle and tendon appear intact.SUPRASPINATUS OUTLET: There is a small amount of fluid within the subacromial subdeltoid bursa with foci of low signal intensity internally which may reflect a bursitis or debris. Severe osteoarthritis affects the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is anatomic. There is heterogeneity and increased signal abnormality within the inferior labrum likely representing a combination of degeneration and degenerative tearing.BICEPS TENDON: There is a small amount of fluid within the tendon sheath of the long head of biceps tendon which may represent fluid extension from the joint. The tendon itself appears intact. ADDITIONAL

Output: 1. Full-thickness tear of the anterior fibers of the supraspinatus with retraction which appears increased in size when compared to the prior study. Interstitial tearing of the subscapularis. Rotator cuff tendinosis.2. Osteoarthritis of the shoulder.3. Findings suggestive of a subacromial subdeltoid bursitis and possible glenohumeral joint synovitis. Other findings as described above.


Instruction: Generate impression based on findings.

Input: History of long-standing endometriosis with known pelvic mass since 2012. Presenting with menorrhagia. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology, size, and enhancement without a focal suspicious lesion, biliary ductal dilatation or vascular abnormality. Loss of signal on out of phase imaging compatible with diffuse fatty infiltration. Normally distended gallbladder without cholelithiasis.SPLEEN: Normal size spleen without a focal lesion.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Few bilateral cystic lesions are not completely characterized without contrast. One in the right interpolar region appears at least minimally complex. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Normal small and large bowel caliber. No significant free or loculated fluid collection. Small fat-containing umbilical hernia without evidence of complication.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Minimal basilar atelectasis.PELVIS:UTERUS, ADNEXA: The endometrial thickness is 10 mm, within normal limits. The inner myometrium/junctional zone is not well-defined with diffuse low signal intensity thickening of the uterine body particularly anteriorly with scattered T2 hyperintense foci compatible with diffuse adenomyosis.Small nabothian cysts.Well-defined 4.9 x 5.2 cm right uterine body subserosal mass is unchanged and likely a fibroid.In the rectouterine space there is a well-defined predominantly homogeneously T1 weighted hyperintense lesion with mild shading on T2-weighted imaging sequences. It is bilobed and measures 10.0 x 10.2 cm (series1501/38), not significantly changed from the prior study. However, it contains a large peripheral heterogeneous focal component which is partially exophytic measuring 6.9 x 4.5 cm (series 1601/40), increased from the prior study.The right and left adnexa are unremarkable in morphology size and signal intensity.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The rectouterine mass causes leftward mass effect on the sigmoid colon without evidence of invasion or obstruction.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No significant change in the overall size of the large cul-de-sac mass. However, the complex heterogeneous focal component of this lesion demonstrates interval increase in size. No postcontrast images were obtained due to the patient's contrast allergy. The lesion appears distinct from the ovaries which are otherwise unremarkable. A large endometrioma remains on the differential. Although uncommon, malignant transformation cannot be excluded especially given the limitation of a nonenhanced examination and the interval increase in size a focal component of the dominant. Without the provided history of endometriosis, a hemorrhagic cystic neoplasm could not be excluded.2.Diffuse adenomyosis.3.Fatty liver.4.Incompletely characterized renal cystic lesions.


Instruction: Generate impression based on findings.

Input: Reason: ganglioglioma. Status post left-sided temporoparietal craniotomy for sub dural hematoma History: 6 month follow up, eval for changes.. Postsurgical findings of left temporal ganglioglioma resection with left-sided craniotomy. A large left cerebral convexity subdural fluid collection with multiple adhesions is unchanged in size from the prior exam measuring 27 mm, previously 28 mm. Ventricular asymmetry with partial effacement of the left lateral ventricle and mild right ventricular enlargement is unchanged. 8 mm of left to right midline shift is unchanged. Subtle increased FLAIR signal in the left temporal lobe is unchanged. Volume loss in the left anterior temporal lobe is unchanged. Mild enhancement along the left anterior medial aspect of the resection cavity is unchanged with no new or enlarging enhancing lesions. Tenting of the left frontal lobe to the overlying dura is unchanged. No acute intracranial infarction or hemorrhage. No new enhancing lesions to suggest recurrence or metastases.

Output: Stable examination including large chronic left subdural hematoma with midline shift.


Instruction: Generate impression based on findings.

Input: Metastatic NSCLC to bone with new symptoms concerning for brain metastases. There are multiple, at least 10, supratentorial and infratentorial intraparenchymal and leptomeningeal enhancing lesions. For example, a heterogeneously enhancing dominant tumor with central foci of susceptibility effect in the left thalamic region with focal effacement of the third and lateral ventricles measures up to 36 mm, an irregular right anterior superior frontal gyrus lesion measures up to 11 mm, a peripherally enhancing left lateral orbitofrontal gyrus lesion measures 8 mm in diameter, an enhancing nodular along the superior vermis measures 6 mm in diameter, an enhancing focus in the interpeduncular cistern measures 4 mm in diameter, a focus of enhancement along the ependymal margin of the left occipital horn measures 4 mm, and there are enhancing foci along multiple cranial nerves. Many of the lesions are associated with vasogenic edema. There is an enhancing 5 mm wide left frontal convexity lesion without substantial mass effect upon the underlying brain parenchyma. There is a background of nonspecific mild scattered cerebral white matter T2 hyperintensity without associated enhancement. There is no evidence of intracranial hemorrhage or acute infarct. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. Multiple supratentorial and infratentorial intraparenchymal and leptomeningeal metastases, with a dominant left thalamic region tumor that measures up to 36 mm and may contain small areas of hemorrhage.2. A 5 mm wide left frontal convexity lesion may represent a meningioma.


Instruction: Generate impression based on findings.

Input: Female, 42 years old, with history of lung cancer and wobbly gait, assess for metastatic disease. Findings are seen related to prior right parietal craniotomy.A 10 mm rim-enhancing nodule is evident within or adjacent to the cortex of the right superior frontal gyrus with modest local edema. Thick irregular subarachnoid enhancement is also seen within the right central sulcus and to a lesser degree the right precentral sulcus, also with modest local edema. Very mild subarachnoid enhancement is also seen along the right paracentral lobule.Pathologic enhancement is evident within both IAC's. Minimal pathologic enhancement is also seen scattered throughout the cerebellar fissures without significant parenchymal edema.No evidence of significant generalized mass effect is seen. No evidence of acute intracranial hemorrhage or any abnormal extra-axial fluid collection is seen. The lesion along the right superior frontal gyrus demonstrates internal susceptibility compatible with chronic blood product.

Output: 1.Findings compatible with leptomeningeal carcinomatosis involving the right central sulcus and surface of the right paracentral lobule, the IACs, and the cerebellar fissures.2.An enhancing lesion along the right superior frontal gyrus may be either cortical or subarachnoid in location.


Instruction: Generate impression based on findings.

Input: History of HCC status post TACE/RFA of 3 hepatic lesions. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology with a nodular contour, left hepatic lobe hypertrophy and fissural widening.Segment 5 ablation cavity measures 3.9 x 1.9 cm) (series 9/249). Adjacent to the anterolateral cranial aspect of this ablation cavity is a residual focus of arterial enhancement measuring 1.7 x 1.4 cm (series 9/35). This associated with restricted diffusion without definite washout.Segment 6 ablation cavity measures 2.8 x 1.0 cm (series 9/247). Adjacent to the medial cranial aspect of this ablation cavity is a 1.3 x 1.2 cm residual focus of arterial enhancement (series 9/30), increased in size from the prior where it measured 1.1 x 1.0 cm (series 10/44). This is associated with restricted diffusion without definite washout.Additional punctate subcentimeter enhancing focus in segment 8 (series 9/29) is unchanged, measuring 7 x 6 mm.Segment 3 ablation cavity measures 2.6 x 1.1 cm (series 9/242). SPLEEN: Splenomegaly measuring 18 cm in craniocaudal dimension. Numerous siderotic nodules.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Post-ablation changes of the liver. There are residual arterially enhancing lesions adjacent to the segment 5 and segment 6 ablation cavities. The segment 6 enhancing focus demonstrates interval mild increase in size. Stable non-specific enhancing subcentimeter focus in segment 8.


Instruction: Generate impression based on findings.

Input: Diagnosis: Disturbance of skin sensationClinical question: radiculopathy, numbness, right hip tightnessSigns and Symptoms: right sided lower extremity tightness, numbness diffusely Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. There is a 27 mm predominantly T1 hyperintense lesion with a spiculated appearance located within the left side of the L3 vertebral body which most likely represents a vertebral body hemangioma.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is a minor disc bulge present at this level.At L4-5 there is no significant compromise to spinal canal or neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.No significant compromise to lumbar spinal canal or neural foramina. There is a minor disc bulge present at L5-S1 without significant compromise to the adjacent nerve roots.2.There is a lesion within the L3 vertebral body which most likely represents a vertebral body hemangioma.


Instruction: Generate impression based on findings.

Input: 55 year old female with PMHx of alcoholic cirrhosis admitted for abdominal pain, diarrhea, found to have an IVC mass. Referred for cardiac MRI to evaluate for RA mass. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 65%. The LVEDV is 125 ml (normal range 142+/-34), the LV end diastolic volume index is 78 ml/m2 (normal range: 74+/-15), the LVESV is 44 ml (normal range 47+/-19) and the LV end systolic volume index is 27 ml/m2 (normal range 25+/-9). The LV mass is 82 g (normal range 164+/-36) and the LV mass index is 51 g/m2 (normal range 85+/-15). There are no regional wall motion abnormalities present. There is no obvious late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. Artifact over the basal inferior and inferolateral walls preclude accurate assessment of late gadolinium enhancement in these areas. The native T1 myocardial relaxation time is normal at 1060 ms. This value is suggestive off no underlying diffuse fibrosis or inflammation. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 66%. The RVEDV is 130 ml (normal range 142+/-31), RV end diastolic volume index is 81 ml/m2 (normal range 82+/-16), the RVESV is 44 ml (normal range 54+/-17), and the RV end systolic volume index is 28 ml/m2 (normal range 31+/-9).Right AtriumThe right atrium is upper normal in size. No right atrial mass appreciated. Aortic ValveThe aortic valve is trileaflet, 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 mild tricuspicd regurgitation.AortaThere is a left sided aortic arch with pseudo-bovine branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC drain normally into the right atrium. Turbulence noted at the level of the IVC/RA junction but a mass could not be appreciated. However, image quality is suboptimal at this level.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsModerate right and small left-sided pleural effusion. Atelectasis noted in the right lung base. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1.The left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 65%.2.The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 66%.3.No right atrial mass/thrombus appreciated. 4.IVC mass not well seen on this study. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Left shoulder pain acute, persistent pain and immobility for 4 weeks. Unable to externally rotate or laterally abduct above horizontal. Evaluate for rotator cuff tear. ROTATOR CUFF: There is a partial thickness tear of the distal fibers of the supraspinatus tendon. The supraspinatus muscle appears normal for age. The infraspinatus tendon is intact and the muscle is normal in appearance for age. The teres minor muscle/tendon are intact. There is thickening and increased signal intensity within the subscapularis tendon compatible with tendinosis. Additionally, there is a full thickness insertional tear of the subscapularis without tendon retraction. The subscapularis muscle appears normal for age.SUPRASPINATUS OUTLET: Moderate to severe osteoarthritis affects the acromioclavicular joint. There is a small amount of fluid within the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is thinning of the articular cartilage of the superior glenoid. The labrum is grossly intact.BICEPS TENDON: There is thickening and increased signal intensity within the proximal portion of the long head of the biceps tendon compatible with tendinosis. ADDITIONAL

Output: 1. Rotator cuff tears and tendinopathy as described above.2. Biceps tendinopathy.3. Bone edema of the posterolateral humeral head.


Instruction: Generate impression based on findings.

Input: 53 years Female (DOB:10/13/1962)Reason: please do dr javed MS protocol compare to prior History: leg weakness, fatigue, dysequilibriumPROVIDER/ATTENDING NAME: JACQUELINE T. BERNARD JACQUELINE T. BERNARD The CSF spaces are appropriate for the patient's stated age with no midline shift. There are periventricular and subcortical white matter lesions present within the brain parenchyma. These were also present on the prior exam. They have not significantly changed in number relative to the prior exam. No new lesions are appreciated. There are also several lesions present in the cerebellum and brainstem which are also unchanged. No abnormal enhancing lesions are appreciated within the brain parenchyma in association with these.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: There is redemonstration of multiple white matter lesions present within the subcortical and periventricular white matter as well as in the posterior fossa which are stable when compared to the prior exam.


Instruction: Generate impression based on findings.

Input: Abdominal pain. ABDOMEN:LIVER, BILIARY TRACT: Patchy hepatic steatosis. No intrahepatic or extra hepatic biliary ductal dilatation. Simple right hepatic dome cyst. No suspicious liver lesion.SPLEEN: No significant abnormality noted.PANCREAS: In the dorsal aspect of the pancreatic body there is a unilocular 3.2 x 2.0 cm cystic lesion demonstrating no internal enhancement or enhancing papillary projections. Lesion demonstrates very thin wall enhancement. The lesion does not clearly communicate with the main pancreatic duct which is normal in caliber.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral T2 hyperintense foci compatible with hepatic cysts and too small to characterize hyperintensities. Intrinsically hyperintense right renal formation/hemorrhagic cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Bilateral breast prostheses.OTHER: No significant abnormality noted.

Output: 3.2 cm pancreatic body cystic lesion without definite communication with the main pancreatic duct which is normal in caliber. Differential considerations include a mucinous cystic neoplasm.Hepatic steatosis.


Instruction: Generate impression based on findings.

Input: Unspecified cerebral artery occlusion with cerebral infarction [434.91], Reason for Study: ^Reason: STROKE History: R SIDE WEAKNESS Scattered restricted diffusion lesions on the left PCA territory including left occipital lobe, left side corpus callosum splenium, left thalamus, and left periventricular white matter. In addition, there are scattered restricted diffusion lesions on the right parietal lobe and bilateral cerebellar hemispheres.There is no evidence of hemorrhagic transformation.Underlying brain shows extensive patchy high signal intensities on periventricular white matter, cerebellar hemisphere and pons indicating non specific small vessel disease.In addition, there are multifocal tissue losses on bilateral basal ganglia and pons indicating chronic lacunar infarctions with encephalomalacia.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Multifocal acute/subacute ischemic infarctions mainly on the left PCA territory but also involves right parietal lobe and bilateral cerebellar hemispheres.2. There is no evidence of hemorrhagic transformation.3. Underlying brain demonstrated multifocal lacunar infarctions with tissue losses as well as extensive non specific small vessel disease.


Instruction: Generate impression based on findings.

Input: 64-year-old male, evaluation of exposed hardware, left orbit, history of meningioma status post resection 2003 There are postsurgical changes of left anterior frontotemporal craniotomy with underlying encephalomalacia involving the anterior inferior frontal lobe and anterior temporal lobe presumably related to resection of prior meningioma. There is thickening of the left zygoma and left sphenoid wing which may be related to prior surgery and radiation, although this could represent residual hyperostosis as well. There may be some enhancement and thickening of the cutaneous tissues lateral to the left orbit which is nonspecific; inhomogeneous fat suppression could also account for these findings. There are no fluid collections or findings to suggest osteomyelitis. The surgical hardware is better assessed on recent CT study.There is no intraparenchymal restricted diffusion to suggest acute ischemia. There is no evidence of intraparenchymal hemorrhage. There are no extra-axial collections. There are no discrete intraparenchymal masses. There is no mass effect.There is scattered periventricular and subcortical T2/FLAIR hyperintense foci compatible with chronic small vessel ischemic disease.The left maxillary sinus is completely opacified with what may represent secretions or a large mucous retention cyst. There is near complete opacification of the left sphenoid sinus as well. The mastoid air cells and middle ear cavities are unremarkable. There are normal flow voids within the intracranial carotid and vertebral vasculature.

Output: 1. Postoperative changes of left anterior frontotemporal meningioma resection with encephalomalacia at the resection cavity.2. There maybe some cutaneous enhancement and thickening lateral to the left orbit which is nonspecific. Inhomogeneous fat suppression could also account for the findings. There are no fluid collections or findings to suggest osteomyelitis.


Instruction: Generate impression based on findings.

Input: There is slight reversal of normal cervical curvature centered at C5. There are no fractures or subluxations. The marrow signal is benign. The cervical and upper thoracic cord are normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable.C2/3: Left facet hypertrophy and slight ligamentum flavum thickening. There is mild left neural foraminal stenosis.C3/4: Mild posterior osteophyte disc complex, slight ligamentum flavum thickening, and mild bilateral facet hypertrophy. There are no significant stenoses.C4/5: Posterior osteophyte disc complex, bilateral uncinate hypertrophy, ligamentum flavum thickening, and minimal bilateral facet hypertrophy. There is mild anterior cord flattening without intrinsic cord signal abnormality. There is mild central, mild left neural foraminal, and mild to moderate right neural foraminal stenosis.C5/6: Posterior osteophyte disc complex, bilateral uncinate hypertrophy, and ligamentum flavum thickening. There is mild anterior cord flattening without intrinsic cord signal abnormality. There is mild central and mild bilateral neural foraminal stenosis.C6/7: Posterior osteophyte disc complex, bilateral uncinate hypertrophy, and ligamentum flavum thickening. There is mild central and mild bilateral neural foraminal stenosis.C7/T1: Unremarkable

Output: 1.C2/3: Mild left neural foraminal stenosis.2.C4/5: Mild central, mild left neural foraminal, and mild to moderate right neural foraminal stenosis.3.C5/6: Mild central and mild bilateral neural foraminal stenosis.4.C6/7: Mild central and mild bilateral neural foraminal stenosis.


Instruction: Generate impression based on findings.

Input: Pain and swelling 1 month after injury. MENISCI: No significant abnormality noted. Specifically menisci are well visualized, intact and anchored posteriorlyARTICULAR CARTILAGE AND BONE: No abnormal marrow signal, however mild osteoarthritic changes are observed. Small osteophytes and minimal narrowing. Cartilage is preserved throughout the medial and lateral compartments however moderate thinning of the patellofemoral surface with mild irregularity without focal cartilaginous defect, however small underlying small cysts are observed under the medial facet.LIGAMENTS: ACL and PCL are intact. Anterior extensor complex, LCL and patella are also unremarkable. The MCL however demonstrates minimal surrounding fluid and although intact in uniform throughout its entirety, a mild sprain is observed. Minimal waviness of the medial patellar retinaculum is observed, this may represent an old injury, however please correlate with physical exam for patellar stability.EXTENSOR MECHANISM: As aboveADDITIONAL

Output: 1. Questionable mild MCL sprain2. Mild degenerative changes involving the patella with retinacular minimal irregularity concerning for prior and likely remote dislocation, correlate with history.3. Moderate Baker's cystI personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Known solitary cavernoma. Surveillance examination. Within the peripheral right pons there is a mixed T1 and T2 bright lesion with foci of internal and peripheral susceptibility compatible with the stated history of a cavernous malformation. This measures 1.7 x 1.0 x 1.5 cm (AP by transverse by CC). There is no adjacent edema or other findings to suggest acute hemorrhage. Postcontrast images demonstrate adjacent serpiginous vessels likely representing an associated developmental venous anomaly.No additional cavernomas are identified. Punctate focus of increased T2 signal in the left parietal lobe subcortical white matter without associated susceptibility or enhancement may represent a small focus of small vessel ischemic change. The ventricles and basal cisterns are normal in size and configuration. The expected intracranial vascular flow voids are present.The paranasal sinuses are clear. The visualized mastoid air cells are clear. The orbits are unremarkable.

Output: Single cavernous malformation in the right lateral pons measuring 1.7 x 1.0 x 1.5 cm with an associated developmental venous anomaly. No additional cavernomas are identified.


Instruction: Generate impression based on findings.

Input: Thyrotoxicosis with toxic multinodular goiter without thyrotoxic crisis or storm [E05.20], Reason for Study: ^Reason: staging, newly diagnosed lung cancer History: newly diagnosed lung cancer There is about 5 mm sized ring-enhancing lesion on the right corpus callosum body without significant mass effect. The lesion shows restricted diffusion with FLAIR high signal intensity. There are also multiple FLAIR high signal intensity lesions located on subcortical white matter and deep white matter but those lesions do not show any evidence of enhancement.Diagnostic possibilities include demyelinating disease such as multiple sclerosis with active plaque, subacute ischemic infarction and considering the patient history of primary malignancy (lung cancer), the diagnosis of metastatic lesion cannot be excluded. There is no other abnormal enhancing lesion is seen.There is no evidence of acute hemorrhagic or ischemic lesion on the scan.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: Single ring enhancing lesion with restricted diffusion at the right corpus callosum body with multiple FLAIR high signal intensity lesions as described above. Diagnostic possibilities include demyelinating disease such as multiple sclerosis, subacute ischemic infarction and metastatic lesion.No evidence of acute hemorrhagic lesion.


Instruction: Generate impression based on findings.

Input: Complains of headaches. On Coumadin. Rule out chronic subdural? Nonenhanced head CT:There is no evidence of intracranial hemorrhage, edema, mass effect, midline shift or hydrocephalus.The pituitary gland appears a slightly enlarged and with apparent extension into the basal cistern. This is concerning for a pituitary adenoma and follow-up with an MRI exam is recommended. This finding measures approximately 15.2 mm in cranial cephalad access on sagittal reformatted images.The cortical sulci, ventricular system, cisterns cisterns and gray -- white matter differentiation is within normal limits.Calvarium is intact.Paranasal sinuses and mastoid air cells are well pneumatized and unremarkable.

Output: 1.Pituitary adenoma as described above. Follow-up with an MRI is recommended.2.Unremarkable non-infused CT of brain and calvarium.3.Visualized paranasal sinuses and mastoid air cells are unremarkable.


Instruction: Generate impression based on findings.

Input: Right medullary thyroid now with rising calcitonin, possible left level 4/5 nodes. There are postoperative findings related to total thyroidectomy without evidence of measurable locoregional tumor or abnormal lymph nodes in the neck. The major salivary glands are unremarkable. There is atherosclerotic plaque at the bilateral carotid bifurcations and left vertebral artery origin. There is multilevel degenerative spondylosis. The imaged intracranial structures are unremarkable.

Output: Postoperative findings related to total thyroidectomy without convincing evidence of measurable locoregional tumor recurrence or lymph node metastases in the neck.


Instruction: Generate impression based on findings.

Input: Male, 57 years old, with history of nasopharyngeal cancer, status post induction, evaluate response. Neck:The previously demonstrated nasopharyngeal mass has significantly decreased in size and definition. A discretely measurable lesion separate from the adenoids is no longer identified.Substantial decrease in the size of multiple metastatic lymph nodes is seen. The large aggregate at level II on the right now measures approximately 21 x 12 mm (image 30 series 20), previously 55 x 54 mm. A left level II node measures 23 x 13 mm (image 30 series 20), previously 37 x 18 mm. A left lateral retropharyngeal node now measures up to 19 x 11 mm (image 24 series 20), previously 21 x 12 mm.The salivary glands are within normal limits. The visualized airway is patent. Bone marrow signal characteristics are unremarkable. Disc herniations are seen at several levels in the visualized cervical spine with perhaps mild spinal canal stenosis at C4-5.Brain:No evidence of parenchymal edema, mass effect or pathologic intracranial enhancement is observed. Diffusion-weighted images are within normal limits. No intracranial hemorrhage or any abnormal extra-axial fluid collections are seen. A few very small scattered foci of T2 hyperintensity within the cerebral hemispheres are nonspecific. Ventricular size and morphology are within normal limits.

Output: 1.Significant interval decrease in the size of a nasopharyngeal mass, such that there is no longer any discretely measurable lesion.2.Significant interval decrease in size of multiple pathologic lymph nodes and nodal aggregates in the neck.3.No evidence of intracranial metastasis.


Instruction: Generate impression based on findings.

Input: 67 years Male (DOB:12/21/1948)Reason: assess limited MRI of head History: AMSPROVIDER/ATTENDING NAME: SHANNON K MARTIN HEMAL M. NAYAK MRI of the brainThere is redemonstration of diffusion restriction involving the right centrum semiovale and right periventricular white matter at the trigone and right occipital lobe. There is no evidence for hemorrhagic conversion. The extent has not changed since the prior exam, however, the signal intensity on DWI has decreased.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. There is fetal origin of the PCA bilaterally associated with a hypoplastic p1 segment on the right and a small to medium sized p1 segment on the left. The right SCA is predominantly supplied via the anterior circulation. The RVA is hypoplastic intracranially

Output: 1.There is redemonstration and continued evolution of foci of subacute infarction involving the right centrum semiovale and right periventricular white matter at the trigone and right occipital lobe. These have not changed in extent compared to the prior exam. There is no evidence for hemorrhagic conversion at this time.2.There is bilateral fetal origin. The right SCA is predominantly supplied via the anterior circulation. The RVA is hypoplastic


Instruction: Generate impression based on findings.

Input: 40 year old with history of congenital cleft tricuspid valve requiring tricuspid valve repair presenting for evaluation of heart function. Left VentricleThe left ventricle is moderately dilated with normal systolic function. The overall LV ejection fraction is 60%, the LV end diastolic volume index is 105 ml/m2 (normal range: 65+/-11), the LVEDV is 173 ml (normal range 109+/-23), the LV end systolic volume index is 42 ml/m2 (normal range 18+/-5), the LVESV is 69 ml (normal range 31+/-10), the LV mass index is 35 g/m2 (normal range 67+/-11), and the LV mass is 57 g (normal range 114+/-24). There are no regional wall motion abnormalities present. There is small area of late gadolinium enhancement in the mid inferior wall of unknown signficance. This was seen on previous CMR exams. This may represent a previous fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is severely dilated with normal systolic function. The overall RV ejection fraction is 52%, the RV end diastolic volume index is 133 ml/m2 (normal range 69+/-14), the RVEDV is 219 ml (normal range 110+/-24), the RV end systolic volume index is 63 ml/m2 (normal range 22+/-8), and the RVESV is 105 ml (normal range 35+/-13). Right AtriumThe right atrium is moderately dilated. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThere is evidence of tricuspid valve repair. There is qualitatively moderate tricuspid regurgitation(appears slightly worse than previous study). AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsSternal wires are noted. 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. Moderate LV dilation with normal systolic function (LVEF 60%) with evidence of a small atypical pattern of late gadolinium enhancement seen in the basal inferior wall. 2. Severe RV dilation with normal systolic function (RVEF 52%).3. Moderate right atrial dilation.4. Moderate tricuspid regurgitation.When compared to the prior study, the patient's LV and RV are larger and the amount of tricuspid regurgitation is a little more. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Status post brain tumor resection. Assess extent of resection. There are expected changes related to the recent resection on the left temporal mass. Accounting for T1 hyperintensity along the surgical margin, which probably reflects the presence of blood products, there is a small area of contrast enhancement along the anterior-inferior-lateral surgical margin. Even smaller foci of contrast enhancement are present along the lateral aspect of the superior surgical margin. These may represent residual tumor tissue but may also reflect early post resection enhancement. Contrast enhancement along the posterior-superior surgical margin, which abuts the temporal horn of the left lateral ventricle, is likely reactive enhancement in the choroid plexus. There is hemorrhage in the anterior inferior lateral aspect of the left temporal lobe anterior to the surgical, likely within the anterior aspect of the fusiform gyrus. There is minimal volume of blood products in the occipital horn of the left lateral ventricle. The T2-hyperintensity surrounding the left temporal treatment bed is not significantly changed. While midline shift is slightly improved, now 4 mm compared to 6 mm at the level of the lower aspect of the septum pellucidum, impingement on the suprasellar cistern has slightly increased. There is no sign of perioperative infarct. There continues to be no other focus of brain enhancement. Noncontrast enhancing, non-diffusion-restricted foci of T2-hyperintensity in the cerebral white-matter probably reflect chronic microvascular ischemia. Major intracranial vascular flow voids are preserved, reflecting gross patency.The relatively large right nasopharyngeal mucosa retention cyst is unchanged. Focal T2-hyperintensity in the posterior aspect of the right masseter cells is unchanged and nonspecific.

Output: 1.The left temporal mass has been resected. Small foci of contrast enhancement along the surgical margin, especially along the anterior-inferior-lateral surgical margin, may reflect residual tumor or may reflect early post surgical contrast enhancement. Follow-up MRI imaging may better characterize the significance of these foci of contrast enhancement. 2.There is small hemorrhage extending from the anterior-inferior surgical margin into the anterior aspect of the left fusiform gyrus. There is also minimal hemorrhage in the occipital horn of the left lateral ventricle.


Instruction: Generate impression based on findings.

Input: There is slight prominence of lobulated soft tissue along the base of the tongue projecting into the vallecula, more prominent on the left side. The oral tongue is unremarkable. The right submandibular gland is slightly more prominent than the left with overlying prominent right level 1B lymph node measuring 1.4 cm.There is no abnormal enhancement. Nasopharynx, oropharynx, hypopharynx and the larynx are otherwise unremarkable.There is mild T1 and T2 hyperintense lesion in the upper pole of the right lobe of the thyroid gland which is nonspecific.There is no evidence of diffusion restriction.

Output: 1. Mildly prominent right greater than left submandibular gland with overlying prominent right level 1B lymph node, which may correlate with palpable area of concern.2. Mild prominent lobulated soft tissue along the base of the tongue which projects into the vallecula, more prominent on the left side, most likely reactive lymphoid tissue. Please correlate with findings from direct inspection.3. Mild T1 and T2 hyperintense lesion in the upper pole of the right lobe of the thyroid gland, which is a nonspecific finding, but may represent a small hemorrhagic or proteinaceous lesion. Correlation with thyroid function tests is recommended and thyroid ultrasound may be obtained as clinically indicated.


Instruction: Generate impression based on findings.

Input: History of metastatic prostate cancer status post recent left frontal region tumor resection. There are postoperative findings related to recent resection of a left frontal convexity mass, along with overlying cranioplasty. There is no evidence of gross residual tumor. There is diffuse left cerebral convexity dural enhancement and a extra-axial fluid collection that measures up to 6 mm in thickness. There is no evidence of acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is are small bilateral mastoid air cell effusions. There are bilateral lens implants. There is a small right maxillary sinus retention cyst.

Output: Recent resection of a left frontal convexity tumor resection, without evidence of gross residual tumor.


Instruction: Generate impression based on findings.

Input: History of spinous process fractures of T10, T11, T12 and pelvic bones with worsening mid-lower back pain. Three views of the thoracic spine are provided. The bones appear perhaps slightly demineralized. Mild degenerative disc disease affects T12-L1. The previously described suspected T11-T12 spinous process fractures are not clearly evident on this study.Three views of the lumbar spine demonstrate mild degenerative disc disease at L5-S1. The L1 spinous process fracture described on prior MRI is not clearly evident on this study. Alignment is within normal limits. Vertebral body heights are preserved.A single AP view of the pelvis demonstrates mild deformity of the right superior pubic ramus and bilateral inferior pubic rami which may reflect the healing fractures seen on prior MRI. We see no acute fractures. Evaluation of the lower sacrum is limited by overlying bowel gas. The sacral and iliac fractures seen on prior MRI are not clearly visualized.Three views of the sacroiliac joints demonstrate minimal osteoarthritis of the bilateral sacroiliac joints.

Output: Bilateral obturator ring deformities likely representing old healed fractures. We see no acute fractures. Mild degenerative disc disease of the lower thoracic and lumbar spine.


Instruction: Generate impression based on findings.

Input: Low back pain, history of herniated disk and lumbar radiculopathy. There is an eccentric left disc protrusion at L5-S1 that results in mild-to-moderate left neural foraminal stenosis, but no significant right neural foraminal or spinal canal stenosis. There is a slight disc bulge at L4-5 with minimal left neural foraminal stenosis. There are fatty and edematous degenerative endplate signal alterations at L4-5 and L5-S1 with loss of fluid signal and loss of height of the discs. There is no significant degenerative spondylosis at the other lumbar spine levels. The vertebral column alignment is within normal limits. The vertebral body are preserved. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable, aside from mild dependent edema in the posterior subcutaneous tissues.

Output: Mild-to-moderate left L5-S1 neural foraminal stenosis related to a disc protrusion.


Instruction: Generate impression based on findings.

Input: Mental portion: Rule out hemorrhage. Signs and symptoms: Altered mental status, gaze deviation. Unenhanced head CT:Since prior CT examination from 9 -- 16 -- 2011 and MRI examination from 9 -- 19 -- 2011 there is interval noticeable increase in the size of the supratentorial ventricular system. There is also resultant partial effacement of cortical sulci throughout bilateral cerebral hemispheres. Finding is consistent with acute hydrocephalus. There is no definitive evidence of periventricular low attenuation to suggest transependymal CSF exudate. There is low attenuation and thickening of the posterior aspect of septum pellucidum when compared with prior two studies. This finding appears to extend posteriorly along the roof of the third ventricle and likely in the velum interpositum. Review post shunted the study demonstrate absence of this finding which is suggestive of exudate of CSF into the septum pellucidum and cisternal velum interpositum. This finding is best appreciated on axial images 13 and 14 and coronal reformatted image 32. Findings were discussed with referring clinical physician Dr Hadipour pager # 3068 at the time of review exam.

Output: 1.Interval development of hydrocephalus with resultant partial effacement of bilateral cerebral cortical sulci.2.Low-density soft tissue fullness at the level of septum pellucidum and cisternal velum interpositum likely representing CSF leakage into the cisterns due to patient's hydrocephalus. This finding has resolved on immediate follow-up exam to this study.3.No evidence of periventricular transependymal exudate, hemorrhage or midline shift.


Instruction: Generate impression based on findings.

Input: Female 38 years old 10 weeks from repeat cesarean delivery with persistent left lower quadrant abdominal pain; evaluate for abscess, fluid collection or ventral hernia. PELVIS:UTERUS, ADNEXA: Susceptibility artifact along the anterior lower uterine segment and ventral wall soft tissues is consistent with the history of recent cesarean section. The uterus is normal in size and contour. A few follicles are seen within each ovary. No adnexal mass.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy.BOWEL, MESENTERY: No free or loculated pelvic fluid. The visualized bowel is normal in caliber. Normal appendix.BONES, SOFT TISSUES: Susceptibility artifact in the lower anterior pelvic wall is related to recent cesarean section. No hernia is seen.OTHER: Note is made of a sacral Tarlov cyst.

Output: MRI pelvis study showed:1.No pelvic fluid collection or abscess.2.No abdominal wall hernia.3.Expected postsurgical changes of recent cesarean section.


Instruction: Generate impression based on findings.

Input: Tingling/paresthesia in the left finger and the groin. Evaluate for demyelinating disease. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma is unremarkable. Specifically, there are no lesions suggestive of multiple sclerosis or other demyelinating disease. There is no abnormal intracranial enhancement. Slight asymmetric prominence of the posterior right lateral ventricle without significant abnormality in the adjacent parenchyma is probably a normal variation. Otherwise, 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 pituitary gland appears unremarkable. There are small retention cysts in the maxillary sinuses.

Output: 1.No evidence of intracranial hemorrhage, mass, or acute infarct. 2.There is also no brain abnormality to suggest multiple sclerosis or other demyelinating disease.


Instruction: Generate impression based on findings.

Input: Unspecified fall [E888.9], Reason for Study: ^Reason: better define intracranial lesion History: S/P fall; s/p R craniotomy 2013; R proptosis Motion artifact degraded exam quality.There is no evidence of acute ischemic or hemorrhagic lesion on the scanThere is evidence of right frontal parietotemporal craniotomy with right temporal occipital encephalomalacia. Approximately 12 mm in thickness of dural thickening and enhancement are seen. No significant interval change since prior scan. There is no other abnormal enhancement.Patchy high signal intensities on bilateral periventricular white matter indicate mixed age indeterminate ischemic infarct and nonspecific small vessel ischemic disease. Again no change since prior scan.Susceptibility artifact lesion on the left parieto-occipital sulcus as well as right frontal parietal subdural space indicate prior hemorrhage related blood products. No change since prior scan.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear. Bilateral inguinal lens is not seen, no change since prior scan.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. Prior right frontal parietotemporal craniotomy with the underlying dural thickening with enhancement, no significant interval change in terms of dural thickening and enhancement pattern since prior scan.3. No change of right temporal occipital encephalomalacia with periventricular white matter changes since prior scan.


Instruction: Generate impression based on findings.

Input: Male, 74 years old, with progressive gait deterioration. Grade 1 anterolisthesis of C4 relative to C5 is seen, progressed from the prior examination. A mild reversal of the normal cervical lordosis has developed as well.Progressive disc degeneration is seen between C4 and C7 with further loss of disc height and endplate integrity and degenerative loss of vertebral body height. No significant marrow edema is detected. Ventral epidural thickening from C4 through C7 has also progressed, likely secondary to degeneration of the adjacent discs.Sequelae of prior laminectomy are again seen from C3-C7. The spinal canal remains decompressed in this region similar to prior. The spinal cord is thinned in the area of laminectomy and there is superimposed focal signal abnormality at the C5 level compatible with myelomalacia. Elsewhere, the cord is unremarkable.C2-3: Right facet arthropathy. Minimal posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Mild right foraminal narrowing. No interval changes. C3-4: Facet arthropathy. Mild posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Moderate to severe bilateral foraminal narrowing. No interval changes. C4-5: Bilateral facet arthropathy. Posterior disc-osteophyte complex formation asymmetric to the right paracentral and foraminal zones. No spinal canal stenosis. Severe bilateral foraminal narrowing. No interval changes. C5-6: Facet arthropathy. Progressive disc and endplate degeneration with disc osteophyte formation. No significant spinal canal stenosis. Severe bilateral foraminal narrowing, likely progressed. C6-7: Facet arthropathy. Progressive disc and endplate degeneration with disc osteophyte formation. No significant spinal canal stenosis. Severe left foraminal narrowing, unchanged. C7-T1: Progressive disc and endplate degeneration with disc osteophyte formation. Moderate generalized spinal canal narrowing which has slightly progressed. Severe bilateral foraminal narrowing, similar to prior.

Output: 1.Multilevel disc degeneration has progressed between C4 and C7. Although most of these levels have been surgically decompressed, a moderate canal narrowing is evident at C7-T1.2.The spinal cord remains thinned between C4 and C7 with focal chronic myelomalacia at the C5 level. No other cord abnormalities are identified.3.Evidence of prior laminectomy for spinal canal decompression is seen between C3 and C7.


Instruction: Generate impression based on findings.

Input: Diagnosis: Neoplasm of unspecified behavior of respiratory system Neoplasm of uncertain behavior of brain, unspecified. Encounter for other preprocedural examinationClinical question: growth of sphenoid sinus/posterior fossa tumor, MRA and a MRI STEALTH for presurgery planning. No fiducials neededSigns and Symptoms: imaging for image guidance during surgery, and details of anatomy MRI of the brainThere is a mass centered in the left cavernous sinus involving the left sphenoid sinus involving the left sphenoid bone which displaces the cavernous LICA laterally. It extends into the left sphenoid sinus and left pterygomaxillary fossa. It protrudes into the lateral aspect of the pituitary fossa. It appears very vascular with multiple flow voids. It has significantly enlarged relative to the prior exam from 8/13/12.The CSF spaces are appropriate for the patient's stated age with no midline shift. Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:There is a vascular mass centered in the left cavernous sinus. Arterial supply can be identified from the LICA, RICA and left internal maxillary artery branches including the left middle meningeal artery.Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries. There is no stenosis of the left ICA at the level of the known cavernous sinus mass.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. The right posterior communicating arteries are intact and medium size. The vertebral arteries are similar in size.

Output: 1.There is a vascular mass centered in the left cavernous sinus which appears to erode into the adjacent sphenoid bone and extend into the sphenoid sinus, pterygomaxillary fossa and pituitary fossa,. Arterial supply can be identified from the LICA, RICA and LECA branches. It has significantly enlarged relative to the prior exam from 8/13/12.2.The MRI of the brain is a limited exam for the purpose of stereotactic guidance during surgery.


Instruction: Generate impression based on findings.

Input: Enlarging brain metastases. MRI for treatment planning. Redemonstrated are multiple subcentimeter enhancing lesions with susceptibility effect in the bilateral cerebral hemispheres at the grey-white matter junctions and right caudate subependymal surface. There is no midline shift or herniation. The ventricles are unchanged in size and configuration. There are inflammatory changes in the paranasal sinuses. The skull appears diffusely heterogeneous, but is incompletely characterized.

Output: Limited treatment planning brain MR with redemonstration of multiple brain metastases.


Instruction: Generate impression based on findings.

Input: Thoracic spine:At the T9/10 level, there is apparent lesion within the right lung measuring up to 16 mm in AP dimension (of its visualized aspects), best seen series 16 image 18.There is minimal anterior wedge deformity of T5, T6, and T7 without marrow edema. The remaining vertebral body heights are maintained. Marrow signal intensity is benign throughout. Degenerative changes are noted of the lower cervical spine with grade 1 anterolisthesis C5 and C6. Osteophyte disc complex, ligamentum flavum thickening, and facet hypertrophy result in mild central stenosis at C5/C6 as well as bilateral neural foraminal stenosis at C5/6 and C6/7.T1/2 demonstrates no significant disc bulge or cord encroachment.T2/3 demonstrates no significant disc bulge or cord encroachment. T3/4 demonstrates a small right paracentral disc protrusion with minimal anterior right hemicord flattening and no intrinsic cord signal abnormality. T4/5 demonstrates no significant disc bulge or cord encroachment. T5/6 demonstrates no significant disc bulge or cord encroachment.T6/7 demonstrates asymmetric bulge to the left causing minimal anterior left hemicord flattening and no intrinsic cord signal abnormality. T7/8 demonstrates no significant disc bulge or cord encroachment. T8/9 demonstrates a small right paracentral disc protrusion causing minimal anterior right cord flattening and no intrinsic cord signal abnormality. T9/10 demonstrates a small right paracentral disc protrusion without cord encroachment.T10/11 demonstrates asymmetric bulge to the right causing mild right neural foraminal stenosis. T11/12 demonstrates a left paracentral disc protrusion without cord encroachment. There is also bilateral facet hypertrophy.T12/L1 demonstrates no significant disc bulge or cord encroachment. Small Schmorl's nodes are present involving T11 and T12.Lumbar spine:There is partial lumbarization of S1 with a rudimentary S1/2 disc.Small Schmorl's nodes involving L1 and L2. Disc desiccation is present throughout.Mild superior endplate deformity is noted of L4 without marrow edema representing a chronic finding. The remaining vertebral body heights are maintained. The marrow signal is benign. The conus is normal in signal and morphology and terminates at an appropriate level. The visualized intra-abdominal and paraspinal contents are unremarkable.L1/2: Mild disc bulge and mild bilateral facet hypertrophy without stenosis.L2/3: Mild disc bulge, ligamentum flavum thickening, mild to moderate left facet hypertrophy, and mild right facet hypertrophy without stenosis.L3/4: Trace anterolisthesis L3 on L4, asymmetric bulge to the right, ligamentum flavum thickening, severe bilateral facet hypertrophy, and a small left facet effusion. There is moderate central, mild to moderate left neural foraminal, and moderate right neural foraminal stenosis.L4/5: Trace anterolisthesis L4 on L5, asymmetric bulge to the right, ligamentum flavum thickening, and severe bilateral facet hypertrophy. There is mild central and mild right neural foraminal stenosis.L5/S1:Mild disc bulge, severe left facet hypertrophy, moderate right facet hypertrophy, and bilateral facet effusions (left greater than right). There are no significant stenoses.,S1/2: Unremarkable

Output: 1.At the T9/10 level, there is apparent lesion within the right lung measuring up to 16 mm in AP dimension (of its visualized aspects). Recommendations are made to obtain a dedicated chest CT for verification of this lesion. The differential diagnosis would include phase encoding artifact.2.Multilevel degenerative changes of the thoracic spine. Specifically, there are multilevel disc bulges and disc herniations.3.Multilevel degenerative changes of the lumbar spine, worse at L3/4 were there is moderate central, mild to moderate left neural foraminal, and moderate right neural foraminal stenosis.4.Findings were discussed with Dr. Hekmat-panah on 9/26/2016 at approximately 1:40 PM.


Instruction: Generate impression based on findings.

Input: Left renal mass. History of orthotopic liver transplant for PSC. ABDOMEN:LIVER, BILIARY TRACT: Postsurgical changes from orthotopic liver transplant. The liver is normal in morphology size and signal intensity without a focal lesion. No intrahepatic biliary ductal dilatation.SPLEEN: Normal size without a focal lesion.PANCREAS: 9 mm cystic focus in the pancreatic tail without definite communication with the main pancreatic duct is unchanged. No main pancreatic ductal dilatation or focal lesion.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral T2 weighted hyperintense simple and minimally complex cysts. Several too small to characterize foci.In the left renal interpolar region there is a T2 weighted hypointense lesion measuring 1.7 x 1.4 cm, previously this measured 1.3 x 1.3 cm. The lesion is isointense to the medulla on precontrast images. The lesion demonstrates mild postcontrast enhancement relative to the cortex.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Status post colectomy. Right lower lower quadrant ileostomy with moderate-sized parastomal prolapse which is partially imaged.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Slowly growing 1.7 cm left interpolar solid mildly enhancing T2 weighted hypointense lesion suspicious for renal cell carcinoma, specifically papillary subtype.2.Postsurgical changes from orthotopic liver transplant without complication.3.Subcentimeter pancreatic tail focus may represent a branch type IPMN without suspicious imaging features.


Instruction: Generate impression based on findings.

Input: 4 month old male with history of cerebrovascular accident; please evaluate for interval change. Low attenuation and loss of gray-white differentiation within the left temporal lobe extending to the occipital lobe, bilateral frontal lobes and right temporal lobe extending to the parietal lobe compatible with CVA. When compared to the MRI performed on 12/5/2008, the extent of these infarcts is increased.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: Increasing extent of bilateral, large infarcts as described above.


Instruction: Generate impression based on findings.

Input: Lumbosacral radiculitis with radiation down left leg. Re-assess lumbar degenerative disk disease. Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is redemonstration of loss of disc space height, disc desiccation and a diffuse disc bulge associated with effacement of the fat at the left lateral recess and extension of disc material into the neural foramina bilaterally. There are associated endplate osteophytes as well. There is redemonstration of mild facet and ligamentum flavum hypertrophy at this level. Overall there is no significant interval change when compared to the previous exam.At L4-5 there is redemonstration of bilateral facet hypertrophy and ligamentum flavum hypertrophy which has mildly progressed since the prior exam. There is no significant compromise to spinal canal or exiting nerve roots at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is mild facet hypertrophy present at this level which has not changed substantially compared to the previous examAt L2-3 there is no significant compromise to spinal canal or neural foramina. There is mild ligamentum flavum hypertrophy at this level which has not changed substantially compared to the previous. There are new endplate reactive changes present at this level associated with a disc bulge and some mild narrowing of th neural foramina. The endplate reactive changes are heterogeneous signal on T2 and low signal on T1.At L1-2 there is no significant compromise to spinal canal or neural foramina.There is a new Schmorl's node present at T12-L1 associated with some adjacent marrow signal changes which are low signal on T1 and high signal on T2There is a left renal lesion which is bright on T2 and low signal on T1 which suspect was present on the prior exam but is only included on the very top image of this exam as well as a prior exam. Most likely this represents a renal cyst but is incompletely evaluated on this exam.

Output: 1.There is mild encroachment of the nerve roots at the left lateral recess at L5-S1 due to degenerative changes which is stable compared to the previous exam. 2.There is redemonstration of multilevel degenerative changes present in the lumbar spine which are not associated with compromise to spinal canal or exiting nerve roots. There is some progression of facet hypertrophy at L4-5 but otherwise no substantial change. There is also endplate reactive change at L2-3 as well as Schmorl's node at T12-L1 which has progressed since the prior exam and appears to be in a somewhat subacute stage.


Instruction: Generate impression based on findings.

Input: Daily headache obesity and sleep apnea. There is a partially empty sella. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The lateral ventricles are perhaps relatively narrow. 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: Findings compatible with pseudotumor cerebri.


Instruction: Generate impression based on findings.

Input: Reason: Evaluate lumbar pathology History: Low back pain radiating down right leg Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is loss of disk space height, disk desiccation and diffuse disk bulge as well as bilateral facet hypertrophy and a mild anterior subluxation of L5 on S1. There are bilateral pars interarticularis defects present at this level and the narrowing of the neural foramina bilaterally. There is effacement of the fat surrounding the exiting nerve roots within the neural foramina bilaterally at this level. This appears to be worse on the right versus the left side.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is a minor disk bulge at this level and there is bilateral facet hypertrophy at the mild/moderate degree at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.There are degenerative changes present in lumbar spine with spondylolysis with spondylolisthesis at L5-S1 where there is encroachment of the exiting nerve roots within the neural foramina bilaterally right worse than left.


Instruction: Generate impression based on findings.

Input: 52 year-old female with history of injury while shoveling snow. Evaluate for tendon rupture or fracture of left ankle. TENDONS: The tendons of the ankle are intact with no evidence of tendon rupture.LIGAMENTS: The visualized components of the deltoid ligament are intact. The ligaments of the sinus tarsus are intact.ARTICULAR SURFACES AND BONE: There is moderate edema within the head of the talus particularly in its medial aspect. In retrospect, the medial aspect of the talus appears demineralized on recent radiographs. We see no discrete fracture line. The remainder of the bone marrow signal intensity is unremarkable. ADDITIONAL

Output: Edema within the head of the talus most pronounced along the medial aspect. The differential diagnosis includes a stress fracture/stress reaction (we see no discrete fracture line), a bony contusion or perhaps a small impaction fracture that is below the resolution of this study, or transient migratory edema. If there was an acute traumatic injury to this location, CT may be considered to evaluate for a fracture.


Instruction: Generate impression based on findings.

Input: Brain lesions concerning for pancreatic cancer metastasis: work finding difficulties. There is a heterogeneously enhancing mass in the posterior left inferior frontal gyrus that measures up to 35 mm. There is a small amount of susceptibility effect within the tumor, which may represent blood products. There is extensive surrounding vasogenic edema with partial effacement of the left posterior lateral ventricle. However, there is minimal midline shift and no herniation. There is a lobulated lesion in the right parietal white matter that measures up to 12 mm with circumferential susceptibility effect and an associated developmental venous anomaly. There is also a punctate focus of susceptibility effect in the right pons, with corresponding calcification on the prior CT. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is a small left maxillary sinus retention cyst.

Output: 1. A lesion in the left inferior frontal gyrus that measures up to 35 mm likely represents a metastasis.2. A lesion in the right parietal white matter that measures up to 12 mm with circumferential susceptibility effect and an associated developmental venous anomaly likely represents a cavernous malformation.3. A punctate focus of susceptibility effect in the right pons may also represent a cavernous malformation.


Instruction: Generate impression based on findings.

Input: 48 years, Male, possible parkinsonism, gait difficulty. Question of hypoxic brain injury during birth. Per chart, patient also has history of recent fall with bruising on neck and back. Brain: No appreciable area of gliosis or volume loss to suggest prior ischemic injury. Mild hypoplasia of the inferior cerebellar vermis is suspected. Mild volume loss is also noted involving the cerebellar hemispheres. There is possible T1 hyperintensity along bilateral frontal dura which may be artifactual versus related to mineralization; finding is of doubtful clinical significance but can be correlated with prior CT if available. No corresponding signal abnormality is appreciated on the T2 or FLAIR sequences. There is no intracranial mass or mass effect. No focal parenchymal signal abnormality. No evidence of infarct or hemorrhage. No intracranial mass or mass effect. No hydrocephalus. No extra-axial collections. No volume loss, focal lesions, or abnormal iron deposition is evident within the basal ganglia, brainstem, or cerebellum. Major flow-voids are preserved. Trace mucosal thickening is evident in the paranasal sinuses. Calvarium and remainder of the extracranial soft tissue structures are unremarkable. Cervical spine: Some of the cervical spine sequences are motion degraded slightly limiting evaluation. There is mild edema involving the posterior soft tissues at the C5-C6 level at the level of the interspinous and supraspinous ligaments. Anterior and posterior longitudinal ligaments as well as ligamentum flavum demonstrate no disruption or signal abnormality. Vertebral body heights and alignment are maintained. Craniovertebral junction also appears within normal limits. The cervical spinal cord has normal signal characteristics and overall morphology. No evidence of hematoma within the spinal canal.There is mild congenital narrowing of the cervical spinal canal with pedicle hypoplasia and superimposed mild degenerative changes as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: Mild congenital narrowing of the spinal canal with superimposed thickening of the ligamentum flavum and small disc bulge. Mild left neural foraminal stenosis related to facet arthropathy and uncovertebral hypertrophy. No significant right neural foraminal narrowing.C4-5: Mild spinal canal stenosis related to congenital narrowing and superimposed mild disc bulge. There is moderate to severe right and moderate left neural foraminal stenosis related to uncovertebral hypertrophy. C5-6: There is mild to moderate narrowing of the spinal canal on a congenital basis as well as superimposed disc bulge and ligamentum flavum thickening. There is moderate to severe right and moderate left neural foraminal stenosis related to uncovertebral hypertrophy.C6-7: Mild spinal canal narrowing. There is moderate to severe bilateral neural foraminal narrowing related to disc bulge and uncovertebral hypertrophy.C7-T1: No significant compromise to the spinal canal or right neural foramen. Mild left neural foraminal narrowing related to facet arthropathy..The vertebral artery flow voids appear to be intact.

Output: 1. No imaging findings to suggest sequela of prior hypoxic-ischemic injury. No intracranial mass or mass effect. No focal lesions involving the basal ganglia, brainstem, or cerebellum are appreciated.2. Mild volume loss involving the cerebellar hemispheres which is nonspecific and may be related to chronic antiepileptic medications for example. Mild hypoplasia involving the inferior cerebellar vermis also suspected.3. Images of cervical spine demonstrates mild edema involving the posterior soft tissues at the C5-C6 level which may represent mild ligamentous injury involving the interspinous and supraspinous ligaments at C5-C6. The anterior and posterior longitudinal ligaments and ligamentum flavum are intact. No cord signal abnormality, evidence of fracture, or hematoma within the spinal canal.4. Congenital narrowing of the cervical spinal canal with superimposed degenerative changes. There is up to mild to moderate spinal canal stenosis at the C5-C6 level. Relatively mild spinal canal narrowing at additional levels without cord signal abnormality. There is also high-grade neural foraminal stenosis at multiple levels. Please see details above.


Instruction: Generate impression based on findings.

Input: 35-year-old male patient with left shoulder pain. No definitive history of trauma. ROTATOR CUFF: There is mild supraspinatus tendinopathy at its insertion on the humeral head. No rotator cuff tear is identified.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: The labrum is intact without evidence of tearing.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: 1.Subchondral degenerative cysts at the insertion of the supraspinous tendon on the humeral head.2.Mild supraspinatus tendinopathy at its insertion.3.No evidence of labral tear.


Instruction: Generate impression based on findings.

Input: Male 72 years old with prostate cancer, evaluate for disease, fusion biopsy to follow. PELVIS:PROSTATE:Prostate Size: 5.1 x 3.0 x 4.3 cmPeripheral Zone: The previously described lesion in the left mid apex measures 4 x 3 mm (series 901, image 16), previously 3 x 3 mm. The reference lesion in the right peripheral zone measures 5 x 4 mm (series 901, image 16), previously 5 x 5 mm. The lesion in the midline left apex measures 6 x 4 mm (series 901, image 13), previously 6 x 4 mm. These lesions are hypointense on T2 and ADC. No new suspicious lesions are identified.Central Gland: Benign prostatic hypertrophy.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: No extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Stable size of bilateral small lesions suspicious for prostate adenocarcinoma.2.No new lesions, extracapsular extension or pelvic lymphadenopathy.


Instruction: Generate impression based on findings.

Input: 67-year-old male with vertigo and left-sided fullness. Evaluate for mass. Asymmetric fullness of the left cavernous sinus and left intracranial internal carotid and middle cerebral arteries raises the question of left cavernous-carotid fistula. MRI/MRA could be performed to help exclude this possibility.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: Asymmetric fullness of the left cavernous sinus and proximal internal carotid and middle cerebral arteries and raises the question of cavernous carotid fistula. MRI/MRA could be obtained to further evaluate as clinically indicated.


Instruction: Generate impression based on findings.

Input: Female 54 years old s/p craniotomy (6/8/2016) for meningioma resection Post-surgical changes of a left frontoparietal craniotomy and underlying tumor resection with associated dural thickening/enhancement. No residual tumor is definitively identified. Expected areas of increased susceptibility artifact underlying the craniotomy consistent with blood products. Vasogenic edema within the left frontoparietal lobes with mild mass effect causing downward effacement of the left lateral ventricle appears similar to prior exam.The ventricles remain normal in size. There is no midline shift or herniation. The major cerebral flow voids are intact.

Output: Post-operative changes of a left parasagittal meningioma resection without evidence of residual tumor.


Instruction: Generate impression based on findings.

Input: 76 years Female (DOB:4/8/1940)Reason: eval pituitary mass History: strokePROVIDER/ATTENDING NAME: ANUBHA C GANJOO ANUBHA C GANJOO MRI of the brainThere is diffusion restriction present along the corpus callosum including the genu of the corpus callosum in the body of the corpus callosum eccentric to the left side. There is associated T2 and FLAIR signal ofA small focus of encephalomalacia in the left precentral gyrus..The CSF spaces are appropriate for the patient's stated age with no midline shift. 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 opacification of the left maxillary sinus with a T2 hypointense lesion in the infundibulum of the left maxillary sinus extending into the left hiatus semilunaris. There is associated loss of volume within the left maxillary sinus and thickening of the walls of the left maxillary sinus. There is also mild mucosal thickening in the sphenoid sinuses.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.The exam is mildly degraded due to patient motion which can obscure more subtle abnormalities.MRI pituitary:There is redemonstration of a 25 x 21 mm sagittal dimension T1 hyperintense mass centered in the sella which extends into the suprasellar cistern This mass has heterogeneous signal on T2 and has not changed significantly since the previous exam. The optic chiasm drapes over the mass. The mass abuts the internal carotid arteries bilaterally. The left internal carotid artery appears narrowed.MRA brain:There is 70% stenosis present along the distal left internal carotid artery along the ophthalmic segment between the pituitary mass in the anterior clinoid. There is a 1 mm x 1.5 mm aneurysm at the ophthalmic segment of the right internal carotid artery which is directed medially.Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. The posterior communicating arteries are intact. The vertebral arteries are similar in size.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries.

Output: 1.There is a large pituitary mass with suprasellar extension which displaces the optic high as in an internal carotid arteries.2.There is an acute infarction present along the corpus callosum.3.There is 70% stenosis present at the ophthalmic segment of the left internal carotid artery adjacent to the pituitary mass.4.Small focus of encephalomalacia is present along the left precentral gyrus5.Findings are compatible with an obstructive lesion at the left maxillary sinus antrum and hiatus semilunaris. The possibility of the obstructing lesion cannot be excluded. There additional findings suggestive of silent sinus syndrome and chronic sinusitis involving the left maxillary sinus.6.Some of the images are degraded due to motion artifact.


Instruction: Generate impression based on findings.

Input: The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. Note is made of a partially empty sella without other imaging features suggestive of idiopathic intracranial hypertension. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are otherwise negative contrast enhanced MRI of the brain and orbits. Specifically, there are no MRI findings to explain the patient's visual symptoms. Present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain. The optic nerves, chiasm, and tracts appear normal. There is no optic nerve sheath dilatation. The extraocular muscles are normal and symmetric with physiologic, homogeneous, and intense contrast enhancement. The globes appear normal with physiologic enhancement of the ciliary bodies and choroid. No retinal detachment or vitreous clouding. The lacrimal glands are symmetric and within normal limits for size. No orbital mass lesion. No enhancing pathology.

Output: Note is made of a partially empty sella without other imaging features suggestive of idiopathic intracranial hypertension. Otherwise negative contrast-enhanced MRI of the brain and orbits. Specifically, there are no MRI findings to explain the patient's visual symptoms.