Instruction: Generate impression based on findings.

Input: History of glioblastoma with left-sided weakness and in a 56-year-old female. Now with right facial droop x 4 days since anesthesia for colonoscopy. Very large area of encephalomalacia involving the right frontal lobe with ex vacuo dilatation of the right frontal horn and right lateral ventricle is identified. There is evidence of an extra-axial high density mass abutting the right temporal and parietal bone with mass effect and medial deviation of brain parenchyma. There is extensive surrounding calcification. This finding was noted on prior MRI examination dated 2 -- 15 -- 2008 and with no definitive evidence of interval change. The finding may represent a meningioma or an organized old calcified hematoma.No evidence of hemorrhage, midline shift is detected. The overall appearance of this is study is similar to the prior MRI exam.

Output: No evidence of acute findings.Stable exam since prior MRI.


Instruction: Generate impression based on findings.

Input: 52 year old with biopsy proven DCIS in the left breast. Mild parenchymal enhancement is noted bilaterally.Extensive abnormal segmental enhancement is present occupying much of the left upper breast. This extends from near the pectoralis muscle to within 1.2 cm of the nipple, and includes the locations of previous malignant biopsies. The overall extent of abnormal enhancement measures 8.0 x 4.3 x 4.9 cm. No suspicious enhancement is seen in the right breast. There are a few scattered enhancing foci with typically benign kinetic patterns, including a 4 mm focus in the outer breast that may represent a normal morphology lymph node versus very small fibroadenoma. No abnormal axillary lymph nodes are identified in either axillary region.

Output: 1. Extensive enhancement in the left breast compatible with DCIS measures up to 8.0 cm. 2. No suspicious axillary adenopathy or suspicious enhancing lesion in the right breast.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Clinical question: History of metastatic ovarian cancer with brain metastases. Evaluate for radiosurgery planning. Signs and symptoms: Metastatic brain lesions. Pre and post enhanced brain MRI is performed:Examination is performed utilizing treatment planning protocol and is not a true diagnostic study. Examination demonstrate a right frontal extra-axial hematoma measuring 15.6 mm in thickness and 44 mm in length and with no convincing evidence of significant change since prior exam in its size or associated regional mass effect.Multiple enhancing metastatic lesions in bilateral cerebral hemisphere and in the right cerebellum are again noted.A left anterior frontal enhancing metastatic lesion measures approximately at 12 x 14 mm and not significantly changed since prior exam.An enhancing mass projecting immediately lateral to the trigone of right lateral ventricle with internal areas of necrosis measures at least 14 x 11 mm and appears slightly larger than prior study.A right posterior cerebellar enhancing metastatic lesion measuring get 6 x 7 mm in transaxial dimensions which is minimally larger than prior study measurements.There is a large right frontal surgical cavity with CSF internal CSF-like signal intensity and multiple petechial hemorrhage. This cavity measures approximately 22 x 33 mm in transaxial dimensions and is smaller in size compared to prior exam. There is an irregular however thin rim of enhancement surrounding the surgical cavity. This is significantly more conspicuous compared to prior exam which was of very poor quality due to extensive motion artifact. Possibility of small residual tumor along the cavity wall cannot be entirely excluded.Stable normal size of ventricular system and with maintained midline.

Output: 1.Multiple supratentorial and infratentorial metastatic lesions as detailed/measured above.2.There is suggestion of subtle interval increased size of metastatic lesions since prior exam. Please see above comments.3.A right frontal surgical cavity with interval decreased size however more conspicuous pattern of rim enhancement since prior exam.


Instruction: Generate impression based on findings.

Input: Clinical question: 43-year-old female with pseudotumor cerebri, CRS with associated left anterior ethmoid encephalocele versus mucocele. Evaluate for encephalocele involving paranasal sinuses. Signs and symptoms: As above. Pre- and postenhanced brain MRI:Negative diffusion weighted series.Examination demonstrate a small bony defect of the left fovea ethmoidalis with evidence of herniation of the left frontal lobe and minimally of the CSF through the defect into the left anterior ethmoid air cells. There is also a bony defect along the posterior wall of left frontal sinus inferior with resultant herniation of the left frontal lobe into the left frontal sinus and with slight extension across the midline to the right. The herniated left frontal lobe extends approximately 22 mm inferiorly into the left anterior ethmoid. The encephalocele in the left anterior ethmoid measures approximately 23 x 13 mm (axial T2 series 601 image 15) and 15 x 19 mm in transaxial dimensions in the frontal sinuses (axial T2 series 601 image 17).There is no detectable signal abnormality of the frontal lobe intracranially or its herniated segment within the left frontal and left ethmoid air cells. There is no convincing evidence of any mass effect/remodeling of the left lamina papyracea.The anatomical morphology and signal intensity of brain parenchyma is otherwise within normal on all MRI sequencesUnremarkable sacral cortex, cortical sulci, ventricular system and CSF spaces otherwise and with normal brain myelination. Post enhanced images demonstrate no abnormal enhancement of brain parenchyma or the meninges.Unremarkable images through the orbits and including axial fat sat post enhanced series.Normal signal intensity of the calvarium and soft tissues of the scalp without abnormal enhancement.Paranasal sinuses are well pneumatized and there is evidence of a small focus of mucosal thickening in the dorsal aspect of the right maxillary sinus. Bilateral mastoid air cells and middle ear cavities demonstrate normal pneumatization signal patterns.

Output: 1.Evidence of left anterior ethmoid and left frontal encephalocele as detailed. The herniated left frontal lobe into the left frontal sinus demonstrate slight extension across the midline to the right frontal sinus. Encephalocele extends approximately 22 mm inferiorly into the left anterior ethmoid. Bony defects inferiorly along the posterior wall of left frontal sinus as well as left fovea ethmoidalis.2.Unremarkable pre and post enhanced brain MRI otherwise.


Instruction: Generate impression based on findings.

Input: 7 years, Male, cerebral cavernous malformation There is a 10 x 15 x 16 mm lesion in the right frontal lobe involving the cingulate gyrus and to a mild extent, body of the corpus callosum, with heterogeneous T1 and T2 hyperintensity and rim of susceptibility consistent with cavernous malformation. There is an additional relatively more prominent lesion involving the cortex and subcortical white matter in the left parietal lobe measuring approximately 12 mm in diameter, measured on the axial T2-weighted sequence. There are at least 10 additional lesions which are smaller and scattered throughout the bilateral cerebral hemispheres as well as in the right cerebellar hemisphere. There is no significant intracranial mass effect, midline shift, or herniation. Ventricles and sulci are within normal limits aside from nonspecific mild asymmetric enlargement of the right lateral ventricle and minimal contour deformity involving the superior aspect of the right lateral ventricle related to minimal local mass effect associated with the right cingulate gyrus lesion. No evidence of hydrocephalus.Postgadolinium images are significantly motion degraded but are grossly unremarkable. Major flow-voids are preserved indicating patency of the major intracranial vasculature. Borderline low cerebellar tonsils are incidentally noted measuring approximately 5 mm below the foramen magnum without significant crowding at the foramen magnum. Brain parenchyma is otherwise unremarkable.There is a partially empty sella which is nonspecific. Paranasal sinuses and mastoid air cells are grossly clear. Calvarium and remainder of the extracranial soft tissues are unremarkable.

Output: 1. Multiple cerebral cavernous malformations in the bilateral cerebral and right cerebellar hemispheres as described above. The largest lesion is centered in the right cingulate gyrus and demonstrates heterogeneous T1 signal, which may indicate relatively recent hemorrhage although there is no surrounding edema to support this finding. No prior studies are available for comparison, and addendum can be issued if made available.2. Borderline low cerebellar tonsils are incidentally noted. There is also a partially empty sella which can be normal variant or associated with intracranial hypertension in the appropriate clinical setting.


Instruction: Generate impression based on findings.

Input: Multiple myeloma SKULL: There are no discrete myelomatous lesions.CERVICAL SPINE: The bones are demineralized and there is degenerative disc disease and facet osteoarthritis of the cervical spine but there are no discrete myelomatous lesions.THORACIC SPINE: There is mild anterior wedging of the T12 vertebral body which appears chronic in nature. The bones are demineralized but we see no discrete myelomatous lesions. Mild multilevel degenerative disc disease affects the remaining thoracic spine. LUMBAR SPINE: The bones are demineralized but we see no discrete myelomatous lesions. There are mild chronic appearing compression deformities of L2 and L4 which were evident on the recent MRI. Severe degenerative disc disease affects L5-S1 with bilateral spondylolysis and grade 1 anterolisthesis of L5.RIBS: There are no discrete myelomatous lesions.PELVIS: The bones are demineralized but we see no discrete myelomatous lesions. Mild osteoarthritis affects the hips.UPPER EXTREMITY: The bones are demineralized. There are tiny lucencies within the proximal diaphysis which may represent small myelomatous deposits but this is equivocal. There are no discrete myelomatous lesions within the left humerus or left or right forearm.LOWER EXTREMITY: The bones are demineralized but we see no discrete myelomatous lesions

Output: Diffusely demineralized bones with tiny lucencies in the proximal right humeral diaphysis that may represent myelomatous involvement but this is equivocal. Otherwise there are no discrete myelomatous lesions; additional findings are described above.


Instruction: Generate impression based on findings.

Input: Male 57 years old Reason: Patient with nephrotic range proteinuria, R hydronephrosis seen on US during biopsy, repeat US to better evaluate hydronephrosis RIGHT KIDNEY: Right kidney measures 11.8 cm. There is a right renal sinus cyst measuring 8.8 x 5.46 x 7.6 cm. No hydronephrosis or shadowing calculusLEFT KIDNEY: Difficult to visualize left kidney, however the left kidney measures 11.1 cm. No shadowing calculus or hydronephrosis.URINARY BLADDER: Bladder is distended.OTHER: Incidentally noted cholelithiasis.

Output: 1.Large right renal sinus cyst. No hydronephrosis.2.Incidental note is made of cholelithiasis.


Instruction: Generate impression based on findings.

Input: There are postoperative findings related to T3-T4 laminotomy/hemilaminectomy for fenestration of a dorsal cyst. There is a 12 x 24 mm well defined fluid collection within the epidural space in the surgical bed at the level of T3. There is a grossly unchanged loculated cystic lesion dorsal to the spinal cord extending from the T3-T8 levels. This lesion is somewhat heterogeneous although mainly follows CSF on all pulse sequences. It results in ventral displacement of the spinal cord and also widens the left neural foramina at the C4-C7 levels and the right neural foramen at the T4-T8 levels. There is unchanged thin enhancement of some of the septa. The spinal cord displays normal signal and morphology. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis.There are small bilateral pleural effusions. There are multiple hepatic masses as well as a left pulmonary nodule that are not well assessed on this exam.

Output: 1.Postoperative findings related to T3-T4 laminotomy/hemilaminectomy for fenestration of a dorsal cyst that appears essentially unchanged with ventral displacement of the spinal cord. 2.No cord signal abnormality. 3.12 x 24 mm fluid collection within the epidural space at the level of T3 may represent seroma or CSF.4.Small bilateral pleural effusions.5.Multiple hepatic and pulmonary metastases that were better assessed on the prior CT.


Instruction: Generate impression based on findings.

Input: 70-year-old woman with history of diarrhea and weight loss. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in signal and morphology. The gallbladder is normal. There is no intra or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: There is age-related pancreatic atrophy but the pancreatic duct appears normal. There is no focal pancreatic parenchymal lesion.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: There is a small hiatal hernia. There is no evidence of bowel wall thickening, abnormal enhancement, or obstruction.BONES, SOFT TISSUES: Scoliosis.OTHER: No significant abnormality noted.

Output: No abnormality to explain the patient's symptoms.


Instruction: Generate impression based on findings.

Input: 16 year-old girl with pseudoseizures and generalized EEG discharges. Increased frequency of shaking episodes. Rule out structural reason for the seizures. The brain demonstrates normal structure and signal. No evidence of gray matter heterotopia or cortical malformation. The hippocampi are symmetric in size and signal with preserved internal architecture. The ventricles and other CSF-containing spaces are normal in size. No intracranial hemorrhage, infarct, mass or mass effect. The major vascular flow voids are preserved. There is very minimal mucosal thickening in the sphenoid sinus.

Output: Normal brain MR examination without findings to suggest seizure focus.


Instruction: Generate impression based on findings.

Input: Dysarthria [784.51], Reason for Study: ^Reason: Stroke workup History: Dysarthria There are scattered restricted diffusion lesions on bilateral frontal lobes including the left precentral gyrus, bilateral frontal lobe deep white matter indicating acute ischemic stroke. There is no evidence of hemorrhagic transformation.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage. 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: Multifocal bifrontal acute ischemic infarction without hemorrhagic transformation as described above.


Instruction: Generate impression based on findings.

Input: 2-year-old female patient with complex febrile seizure. Evaluate for anatomic abnormality. The brain parenchyma appears unremarkable. There are no findings to suggest cortical dysplasia, heterotopia, or other abnormality to suggest a seizure focus. There is no evidence of intracranial hemorrhage or mass. Myelination is within normal limits. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Normal examination of the brain without abnormality to suggest a seizure focus.


Instruction: Generate impression based on findings.

Input: 53-year-old male with sepsis and history of osteomyelitis with a rectal exam concerning for sacral osteomyelitis. The coccyx is absent, presumably related to prior resection. There is ulceration of the soft tissues posterior to the distal sacrum to the left of midline which courses distally along the gluteal crease toward the perineum. There is a thin collection of rim-enhancing fluid along the ulceration which contains gas and may communicate with the skin surface. The inflammation abuts the fifth sacral segment and extends anterior to the S5 segment and also into the spinal canal to the level of S2/S3 as well as along the right S2 and S3 nerve roots. The S5 segment shows low signal intensity on T1-weighted images, increased signal intensity on T2-weighted images, and enhances after contrast administration compatible with the suspected history of osteomyelitis. There is relatively mild signal abnormality and enhancement within the S4 segment that could reflect osteomyelitis or simply reactive edema. The bone marrow signal intensity of the remainder of the sacrum appears normal, as does the signal intensity of the remainder of the bones of the pelvis. Note is made of multiple sinus tracts within the perineum compatible with the patient's history of perineal fistulas related to the patient's known history of Crohn's disease. There is also a linear focus of T2 signal abnormality extending to the bladder concerning for fistula formation. Again seen are postoperative changes of proctectomy with a right lower quadrant colostomy, appearing similar to the prior study. A Foley catheter is in place. A pigtail catheter is identified within the bladder. There is gas density within the pelvis, particularly along the right iliopsoas muscle, better seen on the patient's recent CT examination. There is an ovoid collection of high signal intensity on both T1 and T2-weighted images, posterior to the psoas muscle at the level of the lumbosacral transition, which may represent a small hematoma. There is edema within the subcutaneous fat of the right flank which is nonspecific. Overall the subcutaneous edema has improved when compared to the prior study. There is mild intramuscular edema within the right proximal hip musculature that does not enhance following contrast administration. There is mild nonspecific and nonenhancing edema of the abductor musculature of the left hip. A small amount of fluid is identified within both hips, within normal limits.

Output: 1. Soft tissue ulceration as described above with inflammation extending along the anterior aspect of the lower sacrum as well as into the sacral spinal canal. Signal abnormality and enhancement of the S5 segment is compatible with osteomyelitis with possible osteomyelitis of the S4 segment as well.2. Gas density within the pelvis is better seen on the patient's recent abdomen/pelvis CT examination. Please see the discussion above for additional details.


Instruction: Generate impression based on findings.

Input: 33 years, Female, brain lesion. Examination is limited to sequences for operative planning and intraoperative navigation. Again seen is an enhancing mass involving the right aspect of the midbrain and thalamus. The mass measures approximately 2.5 x 2.2 x 2.3 cm in the AP, transverse, and craniocaudal dimensions. Placement of right transfrontal laser fiber is seen for ablation which extends into the deep aspect of the lesion at the level of the midbrain. Central areas of nonenhancement are noted compatible with postsurgical change. No new mass effect. Leftward displacement of the third ventricle is again noted. Ventricles remain unchanged in size. Minimal T1 hyperintensity and enhancement is evident at the laser fiber insertion site. No significant hemorrhage or extra-axial collections are evident.

Output: Examination for operative planning and intraoperative guidance. Expected postsurgical changes of laser ablation of right midbrain/thalamus mass are seen.


Instruction: Generate impression based on findings.

Input: Severe headache after exertion, including sex Diffusion-weighted images demonstrate no areas of restricted diffusion. Normal signal intensity and morphology of the cerebral hemispheres, cerebellum, and brainstem. No intracranial hemorrhage, mass, abnormal extra-axial fluid, or edema. No abnormal enhancement of the parenchyma or leptomeninges. The ventricles and basal cisterns are normal in size and configuration. There is a partially empty sella which is slightly more prominent than on prior. This finding may be a normal variant or associated with intracranial hypertension in the appropriate clinical setting.There is a mucus retention cyst in the inferior aspect of the right maxillary sinus which appears slightly smaller than on prior study. The remaining paranasal sinuses and mastoid air cells are grossly clear. There is a diffuse nonspecific T1 hypointensity in the bone marrow without focal suspicious lesions.

Output: 1. Brain parenchyma is unremarkable.2. Partially empty sella which is more prominent than on prior. This finding can be normal variant or associated with intracranial hypertension in the appropriate clinical setting.3. Diffuse T1 hypointense marrow signal which is nonspecific and can be seen with entities such as marrow reconversion related to chronic anemia or lymphoproliferative disorders.


Instruction: Generate impression based on findings.

Input: 25-year-old female who is BRCA2 positive presents for screening bilateral breast MRI. There is extreme amount of fibroglandular tissue in both breasts. Minimal parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary or internal mammary region.

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


Instruction: Generate impression based on findings.

Input: Malignant neoplasm of esophagus, unspecified [C15.9], Reason for Study: ^Reason: esophageal CA with L1 soft tissue met and new LLE pain/weakness History: new LLE pain/weakness For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. There is an enhancing intramuscular lesion at the level of L1,32.9mm (CC) x 14.5mm (AP) x 22.2mm (RL) indicating metastatic lesion.There is about 17.8mm sized subcutaneous well circumscribed lesion without evidence of enhancement but with evidence of suppression on fat suppression scan. This is more likely represent fat containing benign lesion such as focal fat necrosis or inclusion cyst.There is no evidence of vertebral body metastasis.There are multifocal Schmorl's nodes at the level of L4 and L5 vertebral bodies with degenerative changes.The disc height of L45 is decreased indicating disc degeneration.The vertebral body height is preserved. The signal of the visualized cord is normal. The conus medullaris terminates at the T12-L1 level. Degenerative changes are specified by the intervertebral level as follows: T12-L1: Disc desiccation, no neuroforaminal narrowing or spinal stenosis. L1-L2: Disc desiccation, no neuroforaminal narrowing or spinal stenosis. L2-L3: Mild to moderate spinal canal stenosis due to disc bulging with bilateral ligamentum flavum thickening. No neuroforaminal narrowing or spinal stenosis. L3-L4: Disc desiccation with disc degeneration decreased disc height. No neuroforaminal narrowing or spinal stenosis. L4-L5: Disc desiccation, diffuse bulging of disc. No neuroforaminal narrowing or spinal stenosis. L5-S1: no neuroforaminal narrowing or spinal stenosis.

Output: 1. Left paraspinal muscle intramuscular metastatic lesion as described above.2. No evidence of vertebral body metastatic lesion.3. Multifocal disc degenerations especially at the level of L34 and L45 with the Schmorl's malformation as described above.4. Mild spinal canal stenosis at the level of L23.


Instruction: Generate impression based on findings.

Input: Status post ependymoma resection Interval postsurgical changes of C4 to C7 laminectomy, myelotomy, and resection of enhancing intramedullary lesion (which extended from upper C5 to lower C7 levels) are seen. Posterior spinal fusion hardware with paraspinous rods and lateral mass screws are seen extending from C4 to C7. Susceptibility artifact slightly limits evaluation; there is however no evidence of residual tumor. T2 hyperintensity is seen within the cord reflecting resection cavity with mild surrounding edema. T2 hypointensity at the C7 level is compatible with hemosiderin deposition related to remote hemorrhage. There is mild intrinsic T1 hypointensity without definite enhancement.Expected postsurgical changes include fluid and blood products in the surgical bed. No large hematoma or evidence of significant mass effect on the cord is appreciated. There is effacement of the ventral and dorsal thecal sac from C4 to C7 levels which was present on the preoperative study. Small disc osteophyte complexes with disc bulges are noted at C5-C6 and C6-C7 levels with mild thickening along the posterior longitudinal ligament. Neural foramina are patent. Vertebral body heights and alignment are maintained. Bone marrow signal is unremarkable.

Output: 1. Expected postsurgical changes of cervical intramedullary tumor resection as described above. There is hemosiderin deposition related to remote hemorrhage associated with the ependymoma at the C7 level but without abnormal enhancement on the current study. No convincing evidence of residual tumor.2. Posterior spinal fusion hardware from C4 to C7 appears well-positioned but can be better assessed with radiographs or CT.


Instruction: Generate impression based on findings.

Input: Dysphagia, globus sensation, and occasional aspiration. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears unremarkable. There is no abnormal intracranial enhancement. In particular, the brainstem and jugular foramen regions appear unremarkable. The lateral ventricles are asymmetric, in which the right is larger than the left, which can represent a developmental variant. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unremarkable.

Output: No evidence of intracranial hemorrhage, mass, or acute infarction.


Instruction: Generate impression based on findings.

Input: Reason: eval liver lesions, masses, HCC screen, S/P TACE/RFA History: cirrhosis, HCC, TACE/RFA ABDOMEN:LUNG BASE: Small right pleural effusion,LIVER, BILIARY TRACT: Cirrhotic morphology with sequelae of portal hypertension including splenomegaly and splenic varices. There are multiple arterially enhancing subcentimeter foci, which are new or more prominent from prior study. One lesion is adjacent to the segment 8 lesion cavity (series 14 image 21). One lesion is in the left lobe of the liver (series 14 image 21). There are 2 lesions in segment 5 (series 14 image 32 and 40). There is also faint arterial enhancing focus in the hepatic dome (series 14 image 9). These lesions show restricted diffusion. The portal and hepatic veins are patent. Scattered subcentimeter nonenhancing T2 hyperintense foci compatible with cysts.SPLEEN: Spleen measures 15.1 cm and is mildly enlarged.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: Small rounded foci of T2 hyperintense signal of the T7, T8, and T9 vertebral bodies (coronal series 11 images 5, 6). These are statistically benign hemangioma, but given the multiple hepatic lesions, bone scan is recommended.OTHER: No significant abnormality noted.

Output: 1.Multiple arterially enhancing subcentimeter foci as above, new or more prominent on current study.2.Small rounded foci in thoracic spine, which statistically favor benign hemangioma, but given multiple hepatic lesions, bone scan is recommended.


Instruction: Generate impression based on findings.

Input: 52 years, Female, metastatic renal cell cancer status post SRS to right cerebellum. Evaluate for progression. Compared to prior post gadolinium MRI brain study dated 9/22/2015, hemorrhagic metastatic lesion involving the right cerebellar hemisphere measures 2.0 x 2.3 x 2.0 cm previously 2.0 x 2.3 x 1.9 cm. There is mild enlargement when compared to 8/14/2015.Right lateral basal ganglia/subinsular white matter is not also significantly changed measuring 5 x 5 mm similar to 5 x 5 mm on 9/22/2015. There is however mild enlargement compared to 8/14/2015.T2/FLAIR hyperintensity compatible with vasogenic edema surrounding the right cerebellar lesion is not significantly changed since 9/22/2015 and 10/17/2015. Mild vasogenic edema associated with the subinsular/lateral basal ganglia lesion appears decreased since 9/22/2015 but similar to 10/17/2015. No new enhancing lesion, mass effect, or edema is appreciated. No evidence of infarct or new hemorrhage. No hydrocephalus. No extra-axial collections. No destructive lesions within the calvarium are appreciated. There are small bilateral maxillary mucosal retention cysts.

Output: Compared to prior post gadolinium study dated 9/22/2015, there is no significant change in size of two enhancing metastatic lesions involving the right cerebellar hemisphere and right lateral basal ganglia/subinsular white matter. No new lesions. There remains vasogenic edema surrounding the right cerebellar lesion which is not significantly changed.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate CSF flow. Signs and symptoms: Left ear pain, status post foramen magnum to the atrial shunt. Nonenhanced brain MRI:Diffusion weighted images are severely compromised due to extensive metallic artifact. The images and the artifact demonstrate no abnormalities.Examination demonstrates extensive postoperative changes of Chiari decompression without appreciable change since prior study. There is prolapse of the cerebellum into the expanded thecal sac and neo foramen magnum similar to prior exam without visible CSF signal. A stent is noted extending from the fourth ventricle posteriorly and abutting the craniectomy site similar to prior exam.There is interval increased size of the fourth ventricle superiorly and extending into distal aqueduct with resultant elevation of the quadrigeminal plate posteriorly. It measures at approximately 11.5 x 14 mm in transaxial dimensions compared to prior study measurement of approximately 7 mm in transaxial. There is however no evidence of supratentorial ventriculomegaly. The normal size of supratentorial ventricles remain stable since prior study and with maintained midline. Cerebral cortex and cortical sulci and the supratentorial CSF spaces remain within normal and stable since prior exam. Signal void the major intracranial arterial branches are identified. The signal intensity of intracranial venous sinuses appear normal.Unremarkable images through the orbits, paranasal sinuses and mastoid air cells.CSF flow study:Demonstrate presence of biphasic flow anteriorly through the foramen magnum however significantly compromised at the level of the dens and with suggestion of interval worsening since prior. There is no detectable flow posteriorly through the foramen magnum.Previously noted flow through the fourth ventricle is significantly less conspicuous compared to prior exam.Nonenhanced cervical MRI:Stable postoperative changes of Chiari decompression as detailed in MRI of brain is again identified.A non-expansile syrinx involving the entire cervical cord demonstrate no interval change since prior exam. Straightening of cervical lordosis similar to prior study.Nonenhanced thoracic MRI:There is revisualization of a mildly expansile syrinx of the thoracic cord superiorly contiguous with syrinx of cervical cord and inferiorly terminating at T10 level similar to prior exam. The most expansile component of syrinx extends from approximately T2 inferiorly to T5 level and measuring maximum of 4.5-mm in transverse axis at T2 level similar to prior exam.There is normal signal intensity and anatomical alignment the vertebral column similar to prior study. No spinal stenosis or neural foraminal compromise is detected at any level.

Output: 1.Nonenhanced brain MRI demonstrate interval increased size of the superior aspect of the fourth ventricle and the distal aqueduct with resultant mass-effect and superior displacement of the quadrigeminal plate as detailed/measured. Stable exam otherwise and with revisualization of extensive Chiari decompression postoperative changes detailed above. CSF flow study demonstrate diminished flow through the foramen magnum anteriorly compared to prior exam and significantly less conspicuous flow through the fourth ventricle and the aqueduct since prior study.2.Nonenhanced MRI of the cervical spine demonstrate no evidence of an acute or new finding since prior study. Stable non-expansile syrinx involving the entire cervical cord since prior exam.3.Nonenhanced MRI of the thoracic spine demonstrate no evidence of an acute or new finding since prior study. Stable mildly expansile syrinx of thoracic cord extending from cervical spine inferiorly to T10 level similar to prior exam.


Instruction: Generate impression based on findings.

Input: Questionable lucency observed on plain film. Pain Severe osteoarthritic changes are observed with bone on bone narrowing with extensive subchondral cysts in both the femoral head and acetabulum. Changes are more pronounced along the superior margin with associated flattening of the femoral head. Minimal protrusio abnormality. Associated edema-like changes are observed in the immediate adjacent marrow extending into the acetabulum and pelvis without deep extension or additional changes. No findings to suggest associated fracture.Inflammation involving the joint capsule with small fluid collection. Surrounding vasculature, muscles and soft tissues are all otherwise unremarkable. No lymphadenopathy. No additional suspicious areas of enhancement.Partial visualization of the lower pelvis is unremarkable. Incompletely visualized

Output: Severe osteoarthritis of the left hip without additional superimposed new additional abnormality


Instruction: Generate impression based on findings.

Input: 33-year-old male with many prior arthroscopies and possible tibial tubercle osteotomy. Evaluate for patellofemoral disease or meniscal tear. Metallic susceptibility artifact from orthopedic screws in the proximal tibia somewhat limited examination.MENISCI: The medial and lateral meniscus appear intact.ARTICULAR CARTILAGE AND BONE: There is focal near full-thickness to full-thickness articular cartilage defect along the medial facet of the patella with subchondral marrow signal abnormality likely degenerative in etiology. Irregularity and signal heterogeneity of the articular cartilage along the medial facet of the patella may reflect degeneration although it is uncertain if this is postoperative in etiology given the patient's history of chondroplasty. There is also a near full-thickness to full-thickness articular cartilage fissure with probable focal articular cartilage delamination along the lateral facet of the patella. There is relative sparing of the articular cartilage of the lateral and medial compartments.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: Near full-thickness to full-thickness articular cartilage defect along the medial facet of the patella as well as full-thickness articular cartilage fissuring and focal articular cartilage delamination along the lateral facet of the patella as described above.


Instruction: Generate impression based on findings.

Input: Sickle cell disease. Right arm numbness/weakness today that is resolving. Evaluate for CVA. Multiple subcortical and periventricular white matter hypodensities in the bilateral frontal and parietal lobes are compatible with small vessel ischemic disease. Most of these areas were present on the prior examination. However, an MRI would be helpful in evaluating for an acute infarct. There is no evidence of intracranial hemorrhage, mass or edema. Prominence of the sulci and ventricles consistent with corticomedullary volume loss. No midline shift.The calvarium is thickened, likely reflecting extramedullary hematopoiesis in a patient with sickle cell disease. This appears similar to the prior examination. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Moderate small vessel ischemic disease, similar in appearance to the prior examination. However, an MRI would be helpful in evaluating for an acute infarct as clinically indicated.


Instruction: Generate impression based on findings.

Input: There is no suspicious intracranial enhancement, acute infarct, mass effect, or cerebral edema. There is moderate soft tissue crowding at the foramen magnum with slightly pointed cerebellar tonsillar morphology, without true peg-like appearance. There is a single small nonenhancing white matter T2 hyperintense signal abnormality in the right frontal white matter, nonspecific. There is punctate focus of susceptibility effect in the left basal ganglia, nonspecific probably representing calcification. There is mild to moderate volume loss.There is no hydrocephalus. There is no midline shift or herniation. There is a mucus retention cyst in the right maxillary sinus. There is a small nonenhancing rounded lesion in the scalp by the vertex of the skull which is nonspecific, and likely representing a small sebaceous cyst. The skull and extracranial soft tissues are otherwise unremarkable.

Output: 1.No intracranial mass, mass effect or suspicious enhancement.2.Moderate soft tissue crowding at the foramen magnum with slightly pointed cerebellar tonsillar morphology, but not fitting the strict criteria for Chiari I malformation. Clinical correlation is advised.


Instruction: Generate impression based on findings.

Input: Chiari decompression with worsening headache and difficulty swallowing. Brain: There are postoperative findings related to Chiari decompression surgery. There is persistent tenting of the posteroinferior cerebellum to the overlying dura associated with intervening hypointense bands. There is also blunted cerebrospinal fluid flow across the posterior aspect of the neo-foramen magnum. Otherwise, there is intact cerebrospinal fluid flow across the anterior neo-foramen magnum and the inferior cerebellum extends to the level of tip of the dens, which is unchanged. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles are slightly smaller in size. There is no midline shift. The major cerebral flow voids are intact. The orbits and paranasal sinuses are grossly unremarkable.Cervical Spine: The spinal cord displays normal signal and morphology, without evidence of syrinx. The vertebral column alignment is unchanged, with paucity of the usual cervical lordosis. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis.

Output: 1. Postoperative findings related to Chiari decompression surgery with persistent evidence of adhesion formation along the posteroinferior cerebellum.2. No evidence of syringohydromyelia in the cervical spinal cord.


Instruction: Generate impression based on findings.

Input: Reason: Sickle-cell disease without crisis [D57.1] / Moyamoya disease History: surveillance Postoperative changes are again seen from previous bilateral pial synangiosis.There is slight asymmetric right-sided cerebral volume loss, as previously noted, similar to prior exams. There is a similar pattern of T2/FLAIR hyperintensity scattered in the frontal lobe white matter predominantly consistent with chronic small vessel ischemic changes, with additional gadolinium punctate foci. A prominent focus is seen in the posterior aspect of the posterior limb of the right internal capsule on the right side, unchanged.The ventricles and sulci are within normal limits. The basal cisterns remain patent. There is no midline shift or mass effect. There are no new areas of abnormal signal. There is likely a prominent perivascular space along the right basal ganglia. Chronic lacunar infarct is noted in the left caudate, with slightly progressed ex vacuo dilatation of the adjacent left frontal horn. There is no diffusion abnormality. No extra-axial fluid collection is identified.The midline structures and craniocervical junction are within normal limits. Prominent mucous retention cysts are noted in the posterior nasopharyngeal soft tissues.MRA HEAD: Images are somewhat limited by patient motion. There is redemonstration of complete or near complete occlusion of the distal right internal carotid artery, along its supraclinoid portion and terminus. A right M1 segment is again not identified, with numerous serpentine vessels along its expected course consistent with collaterals. Asymmetrically diminished flow related enhancement is identified in the M2 segments and distally. On the left, the carotid terminus and proximal left M1 segment are not well visualized, although there are persistent serpentine vessels along the expected proximal M1 location. The remainder of the left middle cerebral artery appears relatively unremarkable. There is a large right and small left P-comm with relatively large caliber posterior cerebral arteries bilaterally. A1 segments are also not visualized, although diminutive A1 segments are suggested bilaterally. Posterior circulation is relatively unremarkable.There is a similar appearance of thin flow related enhancement traversing the site of right sided synangiosis, at the site of EC-IC bypass. On the left, flow related enhancement associated with the site of EC-IC bypass is not as well visualized as on prior exam, although this in part could be due to artifact.

Output: 1. No evidence of acute infarct. Similar pattern of mild to moderate scattered chronic small vessel ischemic changes, most prominent along the frontal lobes bilaterally relating to underlying moyamoya disease, without significant progression.2. Similar appearance of bilateral bilateral distal ICA occlusion/near total occlusion compatible with moyamoya, with resultant collateral vessels including the reconstitution of the left MCA and more distal right MCA.3. Grossly stable appearance of right synangiosis site with decreased delineation of left synangiosis site, which may in part be technical in nature.


Instruction: Generate impression based on findings.

Input: Mechanical fall, outside hospital CT/MRI head with concern for bleed/lesion. Per chart, history of cavernous malformations. Patient is status post ground-level fall, tenderness to palpation along the cervical spine. Partially imaged is a T1 and T2 hyperintense mass with rim of susceptibility involving the right aspect of the pons compatible with history of cavernous malformation and seen on prior CT from 2012. Examination of the spine is mildly motion degraded. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained. Bone marrow signal is grossly benign. There is a T1 and T2 hyperintense lesion involving the C7 vertebral body which may represent sclerotic lesion such as bone island and can be correlated with outside CT.The cervical spinal cord has normal signal characteristics. Degenerative changes are seen in the cervical spine, worst at the C4-C5 level where there is severe loss of disc height and mild nonspecific T2 hyperintensity within the disc space. Individual levels as below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: No significant compromise to the spinal canal or neural foramina.C4-5: Disc osteophyte complex and ligamentum flavum thickening. There is moderate spinal canal stenosis including mild deformity of the cord. There is bilateral uncovertebral hypertrophy with moderate to severe left and mild to moderate right neural foraminal stenosis.C5-6: Small disc osteophyte complex and ligamentum flavum thickening. There is mild narrowing of the spinal canal. Uncovertebral hypertrophy is associated with moderate bilateral neural foraminal stenosis. C6-7: Minimal disc bulge and ligamentum flavum thickening. There is minimal narrowing of the spinal canal. There is mild narrowing of the bilateral neural foramina.C7-T1: No significant compromise to the spinal canal or neural foramina.Ligamentous structures appear intact. The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: 1. No evidence of traumatic injury to the cervical spine. Specifically, no cord signal abnormality, hematoma within the spinal canal, or evidence of ligamentous injury,2. Multilevel degenerative changes changes, worst at the C4-C5 level, where there is moderate spinal canal stenosis. There is also significant neural foraminal stenoses at the left C4-C5 and bilateral C5-C6 levels.3. Large right pontine cavernous malformation is partially imaged and also evident on prior CT from 8/18/2012.4. T1 and T2 hypointense focus involving the C7 vertebral body may represent a sclerotic focus such as bone island and can be correlated with prior outside CT cervical spine.


Instruction: Generate impression based on findings.

Input: Female, 36 years old, with worsening headaches. The cerebral and cerebellar hemispheres and brainstem show normal signal intensity and morphology. No restricted diffusion is seen.No evidence of parenchymal edema, mass, or mass effect is seen. There is no evidence of intracranial hemorrhage or abnormal extra-axial fluid. The ventricular system is normal in caliber and morphology. Signal intensity of the bone marrow is unremarkable. No significant abnormalities of the paranasal sinuses are detected.

Output: Unremarkable evaluation of the brain with no specific findings to account for the patient's worsening headaches.


Instruction: Generate impression based on findings.

Input: T4aN2b base of tongue squamous cell carcinoma status post treatment. There is no measurable tumor in the right tongue region. Likewise, there is no evidence of residual significant lymphadenopathy in the neck. For example, a necrotic right level 2B lymph node measures 4 mm in short axis and an ill-defined right level 2A lymph node measures 6 mm in short axis. The thyroid salivary glands are unremarkable. The larynx appears to be intact. There is multilevel degenerative cervical spondylosis with mild spinal canal narrowing at C3-4 and C4-5. The orbits and imaged intracranial structures are unremarkable.

Output: No evidence of measurable tumor in the right tongue base and no evidence of significant lymphadenopathy in the neck.


Instruction: Generate impression based on findings.

Input: History of lung cancer, evaluate for metastases No diffusion restriction is seen to suggest acute ischemia. No susceptibility weighted artifact is seen to suggest intracranial hemorrhage. T2/FLAIR hyperintense foci are seen throughout the periventricular and subcortical white matter compatible with mild chronic small vessel ischemic disease. Prominent perivascular spaces are seen within the inferior left basal ganglia. No mass lesion is seen within the brain parenchyma. No abnormal areas of enhancement are seen. The CSF spaces are appropriate for the patient's stated age with no midline shift. Normal vascular flow voids are present in the major intracranial vasculature. 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: Mild chronic small vessel ischemic disease without evidence of intracranial metastases.


Instruction: Generate impression based on findings.

Input: 75 year old male with history of aortic valve disease and coronary artery disease with aortic valve replacement and 3 vessel coronary artery bypass grafting in 2004 with known dilated thoracic aorta presenting for evaluation of aortic dilation and cardiac function. Left VentricleThe left ventricle is normal in size and with low normal systolic function and mild to moderate left ventricular hypertrophy. The overall LV ejection fraction is 54%, the LV end diastolic volume index is 70 ml/m2 (normal range: 74+/-15), the LVEDV is 135 ml (normal range 142+/-34), the LV end systolic volume index is 32 ml/m2 (normal range 25+/-9), the LVESV is 62 ml (normal range 47+/-19), the LV mass index is 56 g/m2 (normal range 85+/-15), and the LV mass is 108 g (normal range 164+/-36). There is basal inferior hypokinesis. Septal wall dyssynergy likely consistent with previous surgery. There are areas of subendocardial late gadolinium enhancement in the basal inferior and basal lateral wall consistent with previous myocardial infarction. These areas were noted on the previous study in 01/2015.Left AtriumThe left atrium is mild to moderately dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 51%, the RV end diastolic volume index is 65 ml/m2 (normal range 82+/-16), the RVEDV is 125 ml (normal range 142+/-31), the RV end systolic volume index is 32 ml/m2 (normal range 31+/-9), and the RVESV is 62 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve has been replaced with a bioprosthetic valve. There is no significant aortic regurgitation. Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The ascending aorta is dilated (see measurements below). There is mild aortic tortuosity in the descending thoracic aorta without significant dilation. Ascending aorta (largest portion): 44 x 40 mmAscending aorta (just proximal to right innominate): 37 x 35 mmAorta (mid arch): 29 mmDescending Thoracic Aorta: 26 mmPulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThe right hemidiaphragm is elevated. Sternotomy wires are present. 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 and with low normal systolic function and mild to moderate left ventricular hypertrophy. The overall LV ejection fraction is 54%2. There are areas of subendocardial late gadolinium enhancement in the basal inferior and basal lateral wall consistent with previous myocardial infarction. 3. The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 51%4. Dilated ascending aorta. See above for specific measurements.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 56 years Male (DOB:5/2/1959)Reason: history of metastatic NSCLC to brain s/p RT History: nonePROVIDER/ATTENDING NAME: RENUKA MALIK VICTORIA M VILLAFLOR The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a moderate degree of periventricular and subcortical confluent hyperintense white matter lesions present identified on the FLAIR and T2 images. This is stable compared to the prior exam.The patient is status post left frontal craniotomy for left frontal lobe surgery.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mild mucosal thickening. The visualized portions of the mastoid air cells are partly opacified but not significantly different compared to the prior exam. The visualized portions of the orbits are intact. The right eye lens is thin.

Output: 1.There is no evidence for local recurrence or new metastasis to the brain.2.Periventricular and subcortical white matter signal changes are nonspecific but in this case most likely treatment related.


Instruction: Generate impression based on findings.

Input: 61 years Female (DOB:5/25/1955)Reason: eval for stenosis or abnormality History: neck painPROVIDER/ATTENDING NAME: EDWIN RAMOS The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal enhancing lesions are identified in the cervical spine. There is straightening of the normal cervical curvature which could be related to muscle spasm or patient positioning.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina. There is a minor disc bulge at this level which is stable relative to the prior exam.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina. There is a minor disc bulge at this level which is stable relative to the prior exam.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: There are minor degenerative changes in the cervical spine without significant compromise to spinal canal or neural foramina.


Instruction: Generate impression based on findings.

Input: Epilepsy. There are postoperative findings in the right temporal lobe. There is no significant interval change in the residual non-enhancing, T2 hyperintense right temporal lobe mass. There is no evidence of acute intracranial hemorrhage or acute infarct. The ventricles are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable. There is minimal fluid signal within the bilateral mastoid air cells.

Output: No significant interval change in the residual tumor in the right temporal lobe.


Instruction: Generate impression based on findings.

Input: Female, 33 years old. Reason: Thyromegaly History: Thyromegaly RIGHT LOBE MEASUREMENTS: 5.7 x 2.1 x 2.5 cmLEFT LOBE MEASUREMENTS: 5.8 x 2.0 x 2.3 cmISTHMUS MEASUREMENTS: 0.4 cmRIGHT LOBE: Mildly heterogeneous echotexture, without focal lesion.LEFT LOBE: Mildly heterogeneous echotexture, without focal lesion.ISTHMUS: Mildly heterogeneous echotexture, without focal lesion.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Benign-appearing cervical lymph nodes are identified. A left cervical lymph node measures 1.3 x 0.4 x 0.8 cm, with a fatty hilum, favoring benignity.OTHER: No significant abnormality noted.

Output: Normal appearance of the thyroid, with benign appearing cervical lymph nodes.


Instruction: Generate impression based on findings.

Input: 65-year-old male left shoulder pain, evaluate for rotator cuff tear ROTATOR CUFF: There is intermediate signal intensity within the supraspinatus and infraspinatus tendons, indicating tendinosis. There is also poorly defined, higher signal intensity within the distal supraspinatus and infraspinatus tendons that is suggestive of a network of tearing that appears to disrupt the articular surface and bursal surface fibers of the cuff, indicating full thickness involvement of the tendon although we see no discrete fluid-filled gap. This presumed network of tearing extends from the insertion of the supraspinatus tendon at approximately the 12 o'clock position into the infraspinatus tendon over an AP dimension of approximately 2 cm, and propagates proximally along the infraspinatus tendon as interstitial tearing. There is mild atrophy of the supraspinatus and infraspinatus muscles. The teres minor muscle and tendon appear intact. The subscapularis muscle and tendon appear intact.SUPRASPINATUS OUTLET: Mild osteoarthritis affects the acromioclavicular joint. Small amount of fluid is noted in the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is within normal limits. We see no joint effusion. There is perhaps mild fraying of the superior labrum, but otherwise the labrum appears intact given the limitation of this non-arthrogram study.BICEPS TENDON: The tendon of the long head of the biceps appears normal. ADDITIONAL

Output: Heterogeneous signal intensity of the supraspinatus and infraspinatus tendons likely represents a combination of degenerative tendinosis and a poorly-defined network of tearing that extends to the bursal and articular surface of the cuff, with other findings as described above.


Instruction: Generate impression based on findings.

Input: 60-year-old male with pain over the left knee. MENISCI: There is a horizontal tear of the anterior horn of the lateral meniscus extending to the femoral articular surface. The tear is noted on multiple images extending from the attachment of the transverse meniscal ligament into the body of the meniscus. The posterior horn appears intact. There is intermediate signal abnormality consistent with intrasubstance degeneration of the medial meniscus, which otherwise appears intact.ARTICULAR CARTILAGE AND BONE: There is mild to moderate degeneration of the articular cartilage of the lateral facet of the patella with underlying degenerative subchondral foci of signal abnormality. There is focal signal abnormality within the inferior aspect of the femoral trochlea likely reflecting full-thickness degeneration. The trochlear groove is flattened suggesting dysplasia. There is focal near full-thickness degeneration of the articular cartilage of the medial femoral condyle above the posterior horn of the medial meniscus. There is a lobulated lesion of increased signal intensity in the distal femoral metaphysis compatible with a benign enchondroma. LIGAMENTS: There is thickening of and increased signal intensity of the proximal fibers of the lateral collateral ligament proper suggesting degeneration or sequela of an old injury. The ACL, PCL, and MCL appear intact.EXTENSOR MECHANISM: There is mild increased signal intensity within the undersurface fibers of the proximal patellar tendon suggesting tendinosis. The extensor mechanism appears intact.ADDITIONAL

Output: 1. Horizontal tear of the lateral meniscus.2. Osteoarthritis with cartilage degeneration as described above.3. Thickening and increased signal intensity of the lateral collateral ligament proper may reflect degeneration or the sequela of prior injury.4. Mild proximal patellar tendinosis.5. Baker's cyst.6. Femoral trochlear dysplasia.


Instruction: Generate impression based on findings.

Input: History of cirrhosis. Evaluate for HCC. ABDOMEN:LIVER, BILIARY TRACT: Liver contour: Mild fissural prominence compatible with chronic liver disease/cirrhosis.Features of portal hypertension: Splenomegaly and gastroesophageal varices. Perisplenic collaterals. Recannulated umbilical vein. Splenorenal shunt.Portal vein: Patent. Hepatic veins: Patent.Hepatic artery: Patent.Lesions: No suspicious lesion.Cholelithiasis within a normally distended gallbladder without wall thickening or pericholecystic fluid.SPLEEN: Splenomegaly measuring 19 cm in craniocaudal dimension. No focal suspicious lesion.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Numerous bilateral renal cysts. No hydronephrosis.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: Cirrhosis with stigmata of portal hypertension without a suspicious liver lesion.


Instruction: Generate impression based on findings.

Input: 86-year-old female with syncope and history of CVA. Rule out CVA There is no evidence of intracranial hemorrhage, mass or edema. Diffuse hypodensity in a periventricular distribution consistent with small vessel ischemic disease, age indeterminate. If there is clinical concern for acute ischemia, an MRI may be considered. 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: Small vessel ischemic disease, age indeterminate. If there is clinical concern for acute ischemia, an MRI may be considered.


Instruction: Generate impression based on findings.

Input: 38 year old male with history of anti-phospholipid antibody syndrome, CKD s/p kidney transplant, CAD s/p DES x3 in 11/2014 now with recurrent angina who presents for stress CMR to evaluate for ischemia.MEDICATIONS: asa 81mg, plavis 75mg, lipitor 80mg, coreg 25mg bid, benazepril 20mg daily, imdur 60mg daily, amlodipine 10mg daily First Pass PerfusionDuring hyperemia, there are two perfusion defects noted. The first is a mild subendocardial perfusion defect involving the basal to mid inferior wall. The second is a moderate subendocardial perfusion defect involving the mid to apical anterior wall. Viability/ Myocardial ScarThere is a small, focal transmural infarct in the mid anterior wall. The amount of ischemia in the anterior wall is out of proportion to the amount of infarct; there is concern for peri-infarct ischemia in the LAD territory.There is also a small non-transmural infarct in the basal to mid inferior wall that is viable. This area of infarct coincides with the inferior perfusion defect described above. The remainder of the myocardium is viable.Left VentricleThe left ventricle is moderately enlarged with normal systolic function. The overall LV ejection fraction is 55%, the LV end diastolic volume index is 126 ml/m2 (normal range: 74+/-15), the LVEDV is 282 ml (normal range 142+/-34), the LV end systolic volume index is 57 ml/m2 (normal range 25+/-9), the LVESV is 128 ml (normal range 47+/-19), the LV mass index is 88 g/m2, and the LV mass is 198 g. There are no regional wall motion abnormalities present. There is mild hypokinesis seen in the basal to mid inferior wall and in the mid anterior wall.There is no LV thrombus. Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 60%, the RV end diastolic volume index is 112 ml/m2 (normal range 82+/-16), the RVEDV is 250 ml (normal range 142+/-31), the RV end systolic volume index is 45 ml/m2 (normal range 31+/-9), and the RVESV is 101 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch. The right subclavian artery arises aberrantly from the proximal descending aorta with a retroesophageal course. Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is a trace pericardial effusion.Extracardiac FindingsThere are small bilateral pleural effusions and bilateral renal atrophy with cysts.

Output: 1. There are two perfusion defects/ "ischemia" as described above in the LAD and RCA territory. The inferior perfusion defect is in the area of a subendocardial basal to mid non-transmural inferior infarct. This area is viable. There is a very small, focal mid transmural anterior infarct with peri-infarct ischemia noted in the mid to apical anterior wall. There is mild hypokinesis noted in the both territories. The remainder of the myocardium is viable.2. Moderately dilated LV size with normal systolic function (LVEF 55%)3. Normal RV size and systolic function (RVEF 60%).4. In comparison to the study performed 8/27/2014, there is now ischemia in the LAD territory. There is now a non-transmural infarct in the area of inferior ischemia noted on the last exam.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Clinical question: Prominent central spinal canal with tethered cord, 6 month follow. Signs and symptoms: Six month follow-up. Nonenhanced lumbar MRI:Examination redemonstrate a stable there cord without evidence of change since prior exam. Fatty density in the distal filum terminalis is again identified. There is abrupt angulation of the filum and sacrum nerve roots extending from the dorsal aspect of thecal sac at S2 level anteriorly and inseparable from the anterior wall of the thecal sac at S2 level. This appearance is identical to prior exam and highly suggestive of adhesion.There is visualization of minimally prominent central canal of the tethered cord without interval change since prior exam and with questionable clinical significance.There is no detectable anterior movement of the cord on prone sagittal T2 weighted series compared to supine sagittal T2.There is larger than expected caliber of the spinal canal (dural ectasia) with very subtle flattening as well as scalloping deformity of the posterior aspect of vertebral bodies of the lower lumbar and sacral spine identical to prior study.Nonenhanced thoracic MRI:Examination similar to prior study demonstrate slightly smaller caliber of the cord and likely secondary to tethering. Similar to prior exam there is visualization of a tiny central canal of questionable clinical significance.The signal intensity and alignment the vertebral column is unremarkable and stable since prior study. Mild prominence of subarachnoid space however less conspicuous compared to lumbosacral scanal is again noted without change since prior study.

Output: 1.No evidence of acute or new finding since prior study.2.Stable findings of tethered cord.3.No detectable anterior movement of the cord on prone sagittal T2 weighted images.4.Visualization of a punctate size central canal without change since prior exam and with questionable clinical significance.


Instruction: Generate impression based on findings.

Input: 15-year-old male status post blunt head trauma with loss of consciousness. Evaluate for intracranial hemorrhage. Preseptal and periorbital soft tissue swelling on the left. Minimal fat stranding of the retro-orbital fat on the left appear stable. If further evaluation is clinically warranted, an MRI is suggested. The globe appears normal in morphology and density in the anterior and posterior chambers. Extraocular muscles appear intact. There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration.There is soft tissue swelling overlying the left orbit. There is minimal opacification of bilateral maxillary sinuses. The calvaria and skull base are radiographically normal. The remaining visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Preseptal and periorbital soft tissue edema on the left with minimal fat stranding a left retro-orbital fat unchanged from prior exam. If further evaluation is clinically warranted, an MRI may be obtained.


Instruction: Generate impression based on findings.

Input: 56-year-old female presents with right knee pain, swelling, and a "knee pop"; evaluate for ligament tear. MENISCI: There is full-thickness avulsion of the posterior horn of the medial meniscus from its root associated with mild medial extrusion of the body of the medial meniscus. Intrasubstance increased signal within the posterior horn and body of the medial meniscus suggests mucoid degeneration. Within the body of the medial meniscus, this signal extends to the tibial articular surface perhaps representing degenerative fraying/tearing. The lateral meniscus appears normal for age.ARTICULAR CARTILAGE AND BONE: There is moderate degeneration of the articular cartilage of the patellofemoral joint, particularly along the lateral facet of the patella. There is perhaps a small focus of partial thickness degeneration of the articular cartilage along the weightbearing surface of the medial femoral condyle. The articular cartilage of the lateral compartment appears intact.LIGAMENTS: The cruciate and lateral ligaments are intact.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1. Avulsion of the root of the posterior horn of the medial meniscus.2. Moderate-sized joint effusion and a Baker's cyst with edema along the medial head of the gastrocnemius which may reflect leakage or rupture of the Baker's cyst.3. Cartilage degeneration, most pronounced at the patellofemoral joint.


Instruction: Generate impression based on findings.

Input: 51-year-old male with chronic tinnitus and dizziness. Evaluate ventricular size. There is no restricted diffusion or abnormal enhancement. Scattered T2/FLAIR hyperintense nonenhancing foci within the subcortical and periventricular white matter unchanged. Diffuse cerebral volume loss and prominence of the ventricles unchanged from prior study. No midline shift or herniation.The internal auditory canals are symmetric with no abnormal lesions or enhancement.

Output: 1. No interval change in age appropriate minimal to mild diffuse cerebral volume loss and prominence of the ventricles. The cerebellopontine angles and internal auditory canals are unremarkable.2. Unchanged T2/hyperintense nonenhancing foci of the white matter likely small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: 24 year old male with crushing injury of the hand. Rule out 1st dorsal interosseous injury or 2nd intermetacarpal ligament injury. Presents with pain in the 2nd MPJ. LIGAMENTS: No significant abnormality noted.TENDONS: The flexor and extensor tendons appear intact. BONES: There is increased signal abnormality within the second metacarpal which is most pronounced in the diaphysis and may represent stress reaction/fracture. No discrete fracture line is identified. Otherwise no bone marrow signal abnormality is identified.ADDITIONAL

Output: 1. Increased signal abnormality within the second metacarpal indicating stress reaction/fracture.2. There is increased signal/edema within the 2nd lumbrical muscle at the level of the third MCP joint which is nonspecific and may be post traumatic in etiology, although subacute denervation could also be considered in the correct clinical setting.


Instruction: Generate impression based on findings.

Input: 19-year-old female with left knee pain and instability, assess medial patellofemoral ligament, tibial tuberosity to trochlear groove distance, trochlear dysplasia, cartilage, loose bodies MENISCI: Lateral and medial menisci are intact.ARTICULAR CARTILAGE AND BONE: There is edema type signal within the medial aspect of the patella and associated lateral aspect of the lateral femoral condyle. Near fluid signal intensity within the medial patellofemoral ligament is suggestive of at least a partial tear. Patella alta is noted. The femoral trochlea appears shallow. Small ossicles measuring up to 5 mm are seen medial to the patella correlates with those seen on prior radiographs. Mild soft tissue swelling along the anterior soft tissues over the patella. The TT-TG distance measures approximately 8 mm. LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The patellar tendon is intact. The quadriceps tendon is intact.ADDITIONAL

Output: 1.At least partial tearing of the medial patellofemoral ligament with edema type signal along the medial aspect of the patella and lateral aspect of the femoral condyle consistent with a recent lateral dislocation and reduction. 2.Patella alta and findings suggestive of trochlear dysplasia. Findings are associated with predisposition to patellar instability.3.Small joint effusion.


Instruction: Generate impression based on findings.

Input: 5 year old male patient with developmental delay and focal epilepsy. Evaluate for structural abnormalities. There is abnormal T2/FLAIR signal involving the subcortical white matter of the left posterior frontal lobe, with blurring at the gray-white junction, and linear signal abnormality extending from the cortex to the lateral ventricle (transmantle sign). Portion of the signal abnormality appears to involve the lateral aspect of the left precentral gyrus.Remainder of the brain parenchyma including the hippocampi appear unremarkable. No intracranial mass or mass effect. No evidence of ischemia or hemorrhage. Ventricles are within normal limits. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Evidence of focal cortical dysplasia within the posterior left frontal lobe as described above.


Instruction: Generate impression based on findings.

Input: Altered mental status, parietal subgaleal hematoma, pronator drift, anisocoria. Motion artifact degraded image quality.There is no evidence of acute ischemic or hemorrhagic lesion on the scan.Multifocal scattered patch high signal intensities on FLAIR imaging on bilateral periventricular white matter and deep white matter indicate nonspecific small vessel ischemic disease.Right parietal subgaleal hematoma still seen, comparing to the CT scan, no significant interval change since prior scan performed on June 17, 2015.There are about 3.7 mm thickness bilateral subdural fluid collections with evidence of linear susceptibility artifacts on gradient echo images indicate chronic subdural hemorrhage. There is no evidence of mass effect towards brain parenchyma and from these fluid collection.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. No evidence of acute ischemic or hemorrhagic lesion.2. Non specific small vessel ischemic disease.3. Bihemispheric subdural fluid collections without mass effects toward brain parenchyma possibly represent chronic subdural hematoma.4. No change of right parietal subgaleal hematoma since prior CT scan.


Instruction: Generate impression based on findings.

Input: Right acoustic neuroma, MRI for SRS treatment planning: right hearing loss and imbalance. There is a mass within the right internal auditory canal that measures up to 11 mm. The tumor protrudes slightly into the right cerebellopontine angle cistern. There is nonspecific patchy cerebral white matter T2 hyperintensity bilaterally. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There appears to be an azygous ACA. There is mild mucosal thickening in the bilateral maxillary sinuses. There are bilateral lens implants.

Output: Preoperative planning MRI demonstrates a right vestibular schwannoma that measures up to 11 mm.


Instruction: Generate impression based on findings.

Input: Painless subacute blurred vision and visual disturbance of the right eye. The bilateral optic nerves are intact. There is no evidence of intraorbital mass lesions or abnormal enhancement. There are bilateral lens implants. The lacrimal glands and extraocular muscles are unremarkable. The paranasal sinuses and imaged intracranial structures are also unremarkable.

Output: No discernible orbital lesions.


Instruction: Generate impression based on findings.

Input: History of hepatitis presents for HCC screening. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology.Nonspecific punctate subcentimeter enhancing focus in segment 8 (series 10/22) is unchanged and demonstrates no washout on delayed imaging. This may represent a perfusion anomaly, attention to this on subsequent surveillance imaging is recommended.Stable segment 5 completion cavity measuring 3.6 x 2.5 cm (series 9/128).Stable segment 6 ablation cavity measuring 5.8 x 4.8 cm (series 9/129). Internal T1 hyperintensities compatible with blood products.The vessels are patent.Cholelithiasis within a normally distended gallbladder. No intra or extrahepatic biliary ductal dilatation.SPLEEN: Borderline splenomegaly without a focal lesion, unchanged.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple subcentimeter bilateral renal cysts. No hydroureteronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Site of previously seen right-sided Spigelian hernia demonstrates postsurgical changes and 3.3 x 1.6 cm fluid collection, likely postsurgical.OTHER: No significant abnormality noted.

Output: Cirrhotic liver with stable postablation zones without a suspicious lesion. Enhancing focus in segment 8 (series 10/22) is unchanged and demonstrates no washout on delayed imaging. This may represent a perfusion anomaly; attention to this on subsequent surveillance imaging is recommended.


Instruction: Generate impression based on findings.

Input: 57 year old female with right gluteal nodules and history of stem cell transplant. Note is made of a lobulated collection within the subcutaneous tissues along the posterior aspect of the right gluteus maximus measuring approximately 3.8 x 2.5 cm. An additional collection is identified within the subcutaneous tissues along the posterior aspect of the right hemipelvis just lateral to the gluteal crease, measuring 1.9 x 1.7 cm. Additionally, there is a smaller subcentimeter collection identified along the right gluteal crease with an apparent sinus tract extending to the level of the skin surface (image 38; series 4). There is diffuse nonspecific subcutaneous edema about the pelvis most pronounced along the lateral aspect of the hips. Heterogeneous bone marrow signal abnormality is nonspecific but can be seen in patients with anemia or myeloproliferative disorders. The imaged musculature of the pelvis is within normal limits. There are multiple prominent inguinal lymph nodes identified bilaterally. There is a small amount of free fluid within the pelvis. Evaluation of the pelvic viscera is limited on this noncontrast examination.

Output: Diffuse nonspecific subcutaneous edema as described above. Multiple lobulated collections within the subcutaneous tissue along the posterior aspect of the right hemipelvis as described above. Superimposed infection/abscess formation cannot be excluded on this noncontrast examination. Other findings as described above.


Instruction: Generate impression based on findings.

Input: The risks (including, but not limited to, those of bleeding, infection, allergic reaction, temporary nerve block, pain, and inability to access the joint) and benefits of the procedure were explained to the patient, and informed written consent was obtained. A pre-procedural “time-out” form was completed.The patient was placed supine on the fluoroscopy table. The right hip was localized fluoroscopically, and a spot radiograph was obtained. The course of the femoral artery was noted on the patient's skin using an ink marker. The skin was cleansed and covered with a sterile drape. The skin and subcutaneous tissues were anesthetized with 1% lidocaine using 25-gauge and 22-gauge needles.Under fluoroscopic guidance, a 20-gauge spinal needle was advanced into the joint. Attempted aspiration yielded no fluid. Next, 12 ml of a 50/50 mixture of Omnipaque 240 (to confirm the intra-articular position of the needle) and dilute Multihance (0.1 cc in a 10 cc vial of saline, for subsequent MR imaging) were injected into the joint. Contrast opacified the joint in the expected manner. A spot radiograph was obtained for documentation. The needle was withdrawn. Blood loss was negligible (<1cc), and patient tolerated the procedure well without immediate complication. An adhesive bandage was placed on the patient’s skin. Routine post procedure instructions were communicated to the patient. The patient was escorted to the MRI suite for further imaging in stable condition. Please refer to the subsequent MRI report for further information.Exposure time: 30 seconds.

Output: Successful fluoroscopic guided injection of dilute gadolinium into the right hip for subsequent MRI arthrogram examination.


Instruction: Generate impression based on findings.

Input: 51 year old female with a personal history of benign right breast biopsy and a history of a right thigh liposarcoma. She has a family history of breast cancer in her mother, two maternal aunts, and maternal grandmother. There is heterogeneous amount of fibroglandular tissue in both breasts.Marked parenchymal enhancement is noted bilaterally.There are cysts in both breasts.There is stability of benign enhancing areas in each breast, including the left lower inner breast mass and thin peripheral enhancement around some cysts. No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Brain: There are postoperative findings related to Chiari decompression. There has been interval resolution of the fluid collection overlying the duraplasty. There is persistent mild deformity of the left inferior cerebellum, which contacts the duraplasty material. There is CSF flow across the anterior and posterior portions of the foramen magnum, but persistent focal narrowing of the column of CSF flow through the posterior spinal canal at C2. There is an unchanged T1 hyperintense lesion in the pituitary gland that measures up to 7 mm. The ventricles are unchanged in size and configuration. There is no evidence of acute infarction. Spine: There has also been interval decrease in the caliber of the diffuse cervicothoracic syringohydromyelia, now measuring up to 4 mm in width, previously 7 mm. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis.

Output: 1. Postoperative findings related to Chiari decompression with interval resolution of the fluid collection overlying the duraplasty and interval decrease in the caliber of the diffuse cervicothoracic syringohydromyelia. 2. Persistent mild deformity of the left inferior cerebellum, which contacts the duraplasty material, is suggestive of adhesion formation.3. A subcentimeter lesion in the pituitary gland likely represents a Rathke cleft cyst.


Instruction: Generate impression based on findings.

Input: Malignant neoplasm of the prostate. PELVIS:PROSTATE:Prostate Size: 4.8 x 6.3 x 4.9 cmPeripheral Zone: There is a focus of signal abnormality in the peripheral aspect of the base of the left peripheral zone (series 801, image 15) measuring 5 x 8 mm which demonstrates decreased T2 signal and decreased ADC signal. There is an additional focus of signal abnormality in the base of the right peripheral zone (series 801, image 16) measuring 2 x 3 mm which demonstrates decreased T2 signal and decreased ADC signal. There is an additional focus of signal abnormality in the left mid gland peripheral zone (series 801, image 10) measuring 4 x 4 mm which demonstrates decreased T2 signal and decreased ADC signal. These lesions are suspicious for prostate cancer.Central Gland: There is marked benign prostatic hypertrophy. The median lobe impresses upon the bladder.Seminal Vesicles: No significant abnormalities.Extracapsular Extension: No definite extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: Small retroperitoneal lymph nodes are not pathologically enlarged by size criteria.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Three subcentimeter foci of abnormal signal within the peripheral zone with imaging characteristics (low ADC and T2 hypointense signal) suspicious for prostate carcinoma.


Instruction: Generate impression based on findings.

Input: Other malaise and fatigue [780.79] / Aneurysm of unspecified site [442.9], Reason for Study: ^Reason: STROKE History: WEAKNESS, post clipping status of right paraophthalmic aneurysm. Post right pterional craniotomy with clipping on the right para ophthalmic aneurysm with a significant susceptibility artifacts.There is no acute ischemic lesion on the scan.Again seen postoperative hemorrhage contusion of right frontal operculum and the inferior frontal lobe with a some subarachnoid blood products, however, there is no other hemorrhagic lesion seen 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: 1. No evidence of acute new ischemic or hemorrhagic lesion. 2. No change of right frontal hemorrhagic contusion with scattered subarachnoid blood products since prior scan.


Instruction: Generate impression based on findings.

Input: Female, 55 years old. Reason: is there a cause of the lumbar radiculopathy? History: lumbar radiculopathy For the purposes of numbering, five lumbar type vertebral bodies are presumed to be present. There is unchanged mild retrolisthesis of L5 over S1. Lumbar spine is in normal alignment, with a normal lumbar lordosis. The vertebral body and disk heights are well-maintained. Advanced endplate degenerative changes are seen at L5-S1, similar to prior. Otherwise, bone marrow signal intensity is within normal limits. There is disc desiccation at L2-3 through L5-S1, with severe loss of disc height at L5-S1 and to a lesser degree at L4-5. The conus medullaris on sagittal imaging is grossly intact, terminating at approximately the L1-2 level.L1-L2: There is ligamentum flavum and facet hypertrophy with no significant compromise to spinal canal or neural foramina.L2-L3: There is ligamentum flavum and facet hypertrophy and mild disc bulge with mild bilateral neuroforaminal narrowing and minimal spinal canal stenosis.L3-L4: There is ligamentum flavum and facet hypertrophy and mild disc bulge with mild central canal stenosis and partial effacement of the left lateral recess.L4-5: There is facet hypertrophy and ligamentum flavum hypertrophy as well as disc bulge with superimposed right foraminal and extraforaminal disc protrusion. There is mild central canal stenosis, mild to moderate left neural foraminal narrowing, and severe right neuroforaminal stenosis. There may be impingement on the exiting right L4 nerve root.L5-S1: There is mild retrolisthesis, facet joint hypertrophy, and disc bulge causing moderate to severe left neural foraminal narrowing, moderate right neural foraminal narrowing, and effacement of the left lateral recess. There may be impingement of the exiting left L5 nerve root and the descending left S1 nerve root.

Output: Multilevel degenerative changes throughout the lumbar spine, relatively worse at the L4-5 and L5-S1 levels. There may be impingement of the right L4 nerve root at the L4-5 neural foramen, impingement of the left L5 nerve root at the L5-S1 neural foramen, and impingement of the left S1 nerve root at the L5-S1 lateral recess. These findings are mildly progressed from the prior study dated 02/05/2013.


Instruction: Generate impression based on findings.

Input: The conus terminates at approximately the lower L4 level, the determination including an expansile CSF signal intensity cystic structure along the distal conus, which measures 4 x 5 mm in greatest axial dimensions, x 1.8 cm CC. This scan the L2-L3 to the lower L4 level. In addition, there is a prominent rounded area of fat signal intensity just distal to this cystic structure which measures up to 5 x 4 mm which extends from the lower L4 level to at least S1-S2, consistent with a filar lipoma. On prone imaging, there is only slight ventral motion of the distal cord and conus.A skin surface marker is identified in the L5-S1 level down to the upper aspect of the gluteal cleft which presumably designates a sacral dimple. At the mid S3 level, there is a minimal underlying linear T1/T2 hypointensity (1701/34), although no clear patent tract is identified. The linear abnormality extends deep to the superficial aspect of the gluteal musculature without definite direct connection to the spinal canal contents. There is questioned linear T1 hypointense signal along the midline of the L5 posterior elements which could suggest a minimal occult dysraphism. No definite significant spinal dysraphism is appreciated on this MRI.The thoracic and lumbar spine are in normal alignment. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal.There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the spine. A few rounded T2 hyperintense structures within the pelvis bilaterally likely relate to the ovaries.

Output: 1.Approximate conus termination at the the lower L4 level, although exact level is difficult to determine secondary to the associated conus cyst. This most likely represents an associated conus syrinx, less likely a terminal ventricle or cystic neoplasm, although postcontrast images through the conus is recommended for complete evaluation.2.Additional finding of focal filar/intraspinal lipoma measuring up to 5 mm with only mild ventral motion of the distal cord and conus on prone imaging. Please correlate clinically for possible tethered cord.3.Small subcutaneous sinus tract suggested just deep to the caudal aspect of the skin surface marker presumably in the location of the sacral dimple at the approximate mid S3 level, without definite connection to the spinal canal contents. Questioned linear cleft in the midline of the posterior elements of L5. CT would better delineate any possibility of occult dysraphism.4.Unremarkable MRI of the thoracic spine.


Instruction: Generate impression based on findings.

Input: 43 year old female with BRCA 1 mutation. Personal history of benign right breast biopsy in 2003 as well as an FNA aspiration of a right breast nodule at 7 o'clock in 2009 compatible with a fibroadenoma. Family history of breast carcinoma in her sister at age 36, in two paternal aunts in their 40s, and a grandmother. Extremely dense breast tissue is present. On postcontrast images, moderate parenchymal enhancement is seen bilaterally.RIGHT BREAST: There is an ovoid homogeneously enhancing mass in the posterior right breast, approximately 7:00 position. This mass measures 2.0 x 1.3 x 1.5 cm and is not associated with a biopsy clip. However, it corresponds to ultrasound findings from 2014 and the reported site of FNA aspiration biopsy in 2009 confirming a fibroadenoma. Located just anterior to this mass, there is another smaller lesion compatible with fibroadenoma, also seen on prior ultrasound from 2014.At approximately the 10 to 11:00 position, posterior depth there is a 1.6 x 0.9 x 1.8 cm circumscribed mass that demonstrates slow but homogeneous enhancement. This mass is also most likely a fibroadenoma and was seen on prior ultrasound exam, mostly unchanged.LEFT BREAST:No abnormal enhancement is identified. No abnormal axillary lymph nodes are identified in either axillary region. Multiple T2-hyperintense lesions in the liver may represent cysts or hemangiomas but are incompletely characterized.

Output: Multiple benign morphology masses in the right breast with sonographic correlates as described above. These most likely represent fibroadenomas, and the largest of these at the 7:00 position is an FNA biopsy-proven fibroadenoma. No MRI evidence for malignancy. Annual surveillance with diagnostic mammogram and ultrasound is recommended.Annual surveillance MRI is also recommended given the patient's genetic susceptibility. BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: MRI obtained yesterday demonstrated a small focus of restricted diffusion with matching ADC hypointensity located in right parietal subcortical white matter without associated mass effect or susceptibility are normally. It was T1 hypointense and T2 hyperintense.The current exam demonstrates no abnormal enhancement. Specifically, the aforementioned focus of restricted diffusion does not enhance.

Output: There is no abnormal enhancement. The differential diagnosis most likely includes acute ischemia or post-ictal abnormality. An isolated focus of encephalitis could have this nonenhancing appearance and inflammation is felt to be unlikely.


Instruction: Generate impression based on findings.

Input: 60 year old man with 4-day history of instability, double vision, mild aphasia. There are no CT findings of hemorrhage, mass, or edema. There are no CT findings of stroke. However, if stroke is of clinical concern recommend MRI.The ventricles and basal cisterns are normal in size and configuration.There is plagiocephaly. The skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Unremarkable brain CT.


Instruction: Generate impression based on findings.

Input: Male, 72 years old, history of right MCA stroke, now with possible lacune and seizures. No restricted diffusion is seen to suggest the presence of acute ischemia. Encephalomalacia is again seen involving the right perirolandic cortex and the underlying white matter compatible with a chronic MCA distribution stroke. Patchy periventricular T2 hyperintensities are noted, a nonspecific finding but most likely representative of chronic microvascular ischemic disease. Mild chronic hemosiderin staining of the right MCA infarct region is seen. Otherwise, no significant intracranial hemorrhage is detected. No abnormal collections are seen. The ventricles are mildly prominent but stable in size and morphology.

Output: 1.No acute ischemia or other acute intracranial process.2.Chronic right MCA distribution stroke involving the perirolandic gyri and underlying white matter.3.No additional findings are seen to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: Dissection of carotid artery [I77.71], Reason for Study: ^Reason: bilateral carotid dissection yearly follow up, h/ort hemispheric stroke 2013 History: stabile, yearly follow up. Brain MRIThere is no evidence of acute ischemic or hemorrhagic lesion on this scan.Focal encephalomalacia on the right insular posterior aspect and posterior right parietal operculum appear to be stable.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Right ACA A1 segment is hypoplastic. Vertebrobasilar system appears to be normal. Neck MRA3D MRA neck pre and post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate irregularities of the right extracranial ICA cervical segment and proximal petrous segment without evidence of luminal narrowing.Otherwise normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The vertebral artery origins are normal. There is normal flow enhancement through the bilateral common carotid, and left internal carotid, and vertebral arteries.

Output: 1. No change of right extracranial ICA luminal irregularity since prior scan. Otherwise unremarkable Neck MRA.2. No change of chronic ischemic stroke on the right posterior insular and posterior aspect of right parietal operculum.3. No evidence of acute ischemic or hemorrhagic lesion.4. Normal brain MRA.