Instruction: Generate impression based on findings.

Input: 17 years Female (DOB:4/21/1998)Reason: headache History: headachePROVIDER/ATTENDING NAME: MICHELE R MCKEE SANGHYUN MARGARET PAIK MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. 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 are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium sized. The posterior communicating arteries are medium-sized. The vertebral arteries are similar in size.

Output: 1.No evidence for cerebrovascular occlusive disease.2.No evidence for intracranial aneurysm.3.There is no evidence for acute ischemic stroke or intracranial mass lesion to explain the patient's headache.


Instruction: Generate impression based on findings.

Input: Back pain. There are unchanged syrinxes in the lower portions of the spinal cord, including at the T7-8 through T12 and L1-2 levels, which measure up to 2 mm in diameter. There are several small disc-osteophyte complexes at multiple levels of the thoracic spine without significant spinal canal stenosis. There are postoperative findings related to posterior rod and screw fusion and intervertebral spacer insertion. There is no significant spinal canal or neural foraminal stenosis at any level of the lumbar spine. The vertebral column alignment is within normal limits. The vertebral body heights are preserved. The vertebral bone marrow signal is unremarkable.

Output: 1. Unchanged syrinxes in the lower portions of the spinal cord, which measure up to 2 mm in diameter. 2. Several small disc-osteophyte complexes at multiple levels of the thoracic spine without significant spinal canal stenosis. 3. Postoperative findings related to posterior rod and screw fusion and intervertebral spacer insertion without residual or new significant spinal canal or neural foraminal stenosis at any level of the lumbar spine.


Instruction: Generate impression based on findings.

Input: Reason: evaluate brainstem chronic infarct History: vertigo No abnormal diffusion restriction. No acute intracranial hemorrhage is identified. No evidence of intracranial mass, mass-effect, or midline shift. No extra-axial fluid collections. The ventricles, sulci, and cisterns are normal in size without evidence of hydrocephalus. Nonspecific scattered subcortical white matter FLAIR hyperintensities. These lesions are not seen in the brainstem or posterior fossa. Gray-white matter differentiation is preserved. The imaged paranasal sinuses and mastoid air cells are clear. The imaged orbits are intact. The osseous structures are unremarkable.

Output: Nonspecific scattered subcortical white matter FLAIR hyperintensities. These are most likely related to chronic small vessel ischemic disease. The differential diagnoses would most likely include migraine sequelae or past axonal injury. Given the lesion locations and appearance demyelination is considered unlikely.


Instruction: Generate impression based on findings.

Input: Newly diagnosed multiple, T2 signal hyperintensities in brain and c-spine: numbness in upper extremities. There is a punctate focus of high T2 signal in the left aspect of the lower thoracic spinal cord. The rest of the thoracic and upper lumbar portions of the spinal cord display normal signal and morphology. There is no evidence of enhancing lesions or tumors in the thoracic or lumbar spine. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved, aside from mild loss of disc fluid signal and height at L4-5 and L5-S1. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The paravertebral soft tissues are unremarkable, aside from dependent edema in the lower back subcutaneous tissues. There are nodules in the uterus.

Output: 1. A punctate focus of high T2 signal in the left aspect of the lower thoracic spinal cord may represent a demyelinating lesion.2. Nodules in the uterus may represent fibroids. Dedicated pelvic ultrasound may be useful for further evaluation.


Instruction: Generate impression based on findings.

Input: Newly diagnosed non-small cell lung cancer. Initial staging. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are multiple punctate defects in the brainstem, cerebellum, and basal ganglia, which likely represent chronic lacunar infarcts and/or prominent perivascular spaces. There is a punctate focus of susceptibility effect in the right thalamus, which likely represents a chronic microhemorrhage. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is a cystic lesion in the midline of the nasopharynx that measures up to 12 mm, which may represent a Thornwaldt cyst or retention cyst.

Output: No evidence of intracranial metastases.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Diagnosis: CervicalgiaClinical question: Chronic neck pain The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina. There is a mild disc bulge present at this level.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.There are number of lymph nodes identified in the upper neck which are not unusual at this age and don't meet size criteria for lymphadenopathy

Output: 1.There is no compromise cervical spinal canal or exiting nerve roots. There are minimal degenerative changes in the cervical spine


Instruction: Generate impression based on findings.

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

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


Instruction: Generate impression based on findings.

Input: Unspecified infectious and parasitic diseases [136.9] / Infectious acute disseminated encephalomyelitis (ADEM)(323.61) [323.61], Reason for Study: ^Reason: f/u ADEM, NMO spectrum disorder History: f/u ADEM, NMO spectrum disorder C-spine:Redemonstration of the high signal intensity lesions on T2 and STIR images at the level of C3 and C6, the MR characteristics and the extent of the lesion do not show any significant interval change since prior scan. There is no evidence of abnormal enhancement. The basal.The cranial-cervical junction is normal. There is normal cervical lordosis. The cervical spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The paraspinal soft tissues are unremarkable.There is no evidence of significant spinal canal stenosis or neural foraminal stenosis.Brain MRI:No evidence of acute ischemic or hemorrhagic lesion on the scan.Mild (about 3 mm) low lying of cerebellar tonsil, no change since prior scan.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. No interval change of some cervical spinal cord high signal intensity lesions since prior scan.2. No evidence of acute ischemic or hemorrhagic lesion.3. No change of mild low lying cerebellar tonsil as described above since prior scan.


Instruction: Generate impression based on findings.

Input: Male, 32 years old, with bilateral lower extremity and low back pain. Grade 1 retrolisthesis of L5 relative to S1 is seen. Spinal alignment is otherwise unremarkable.Vertebral body morphology is unremarkable. No concerning marrow replacement is seen. Endplate edema is demonstrated at L5-S1.The visualized distal spinal cord, conus and cauda equina nerve roots are within normal limits. No epidural abnormality is seen.L1-2: Unremarkable. L2-3: Unremarkable. L3-4: Unremarkable. L4-5: Mild facet arthropathy. Loss of disc height and T2 signal. Disc bulging with a right paracentral annular fissure. No significant spinal canal stenosis. Mild bilateral foraminal narrowing. L5-S1: Mild facet arthropathy. Loss of disc height and T2 signal. Disc bulging with a superimposed central/right paracentral protrusion. No significant spinal canal stenosis or clear nerve root impingement is seen. The neural foramina are moderately narrowed.

Output: 1.Disc degeneration at L4-5 is seen with mild bilateral foraminal narrowing but no significant spinal canal stenosis.2.Spondylolisthesis and disc degeneration is seen at L5-S1. The neural foramina are moderately narrowed at this level, but again, no significant generalized spinal canal stenosis is seen.


Instruction: Generate impression based on findings.

Input: Clinical question: Head and neck cancer. Signs and symptoms: Headache cancer. Enhanced CT of soft tissues of the neck:70 cc of Omnipaque 350 is administered for the exam. Images through the skull base including cavernous sinuses, bilateral petrous bones are unremarkable.Images through the neck again demonstrate postoperative changes of partial mandibulectomy in the midline anteriorly with a bony graft. There is interval change with a new bony graft compared to prior study. There is no definitive evidence of fusion of bony graft and the native bone. There are bilateral sonolucencies of the marrow space immediately at the level of mandibulectomy and without appreciable change since prior examination.Subtle soft tissue thickening surrounding the mandibulectomy size and the bony graft are within expected range for postop changes. There is however more soft tissue density anterior to the mandible on the right since prior exam which may be present at it postop changes. No definitive evidence of tumor. Recommend MRI for follow it on physical exam there is suspected tumor recurrence at this site.Extensive postoperative changes of bilateral neck is noted. No detectable cervical adenopathy.Multiple small varying sized cysts within an enlarged right lobe of thyroid and the isthmus of thyroid appears similar to prior exam. Limited images of the apices of the lungs demonstrate emphysematous changes however without metastatic lesions. However these reviewed dedicated reports of CT of chest performed on this date.Enhanced head CT:There is no evidence of metastatic disease to the brain, leptomeninges or the calvarium.The cortical sulci, ventricular system, CSF cistern and the gray -- white matter differentiation remains within normal.Calvarium is intact. Minimal chronic pansinusitis.

Output: 1.Evidence of interval further surgery at the site of anterior mandibulectomy in the midline with a new bony graft and increased soft tissue density anterior to the mandible on the right. No definitive recurrence of tumor at this site. There is no fusion of bone graft with the mandible. There is no evidence of recurrence of tumor or lymphadenopathy in the neck. Please see above comments there2.negative enhanced CT of brain and calvarium.


Instruction: Generate impression based on findings.

Input: Status post craniotomy for tumor resection. There are postoperative changes related to a right parietotemporal craniotomy for partial tumor resection from the right temporal lobe. There is a resection cavity filled with fluid and blood products. A small amount of intracranial air is also seen. There is significant residual tumor around the resection cavity as demonstrated by post contrast imaging. There are several small satellite lesions, including within the right insula, the anterior right temporal lobe, and along the splenium of the corpus callosum, which are unchanged. Enhancing tumor extends up to and projects into the right vertricular atrium. There is associated restricted diffusion along the rim of the cavity as well as a lobulated finger-like area of restricted diffusion at the posterior and medial aspect. An additional, separate focus of restricted diffusion is noted at the right occipital pole. There are also multiple punctate foci of susceptibility artifact throughout the bilateral cerebral hemispheres, consistent with hemosiderin deposition. There remains generalized right cerebral mass effect, which is minimally improved. There is edema tracking through the temporal and parietal lobes and into the right basal ganglia. A midline shift to the left of approximately 9 mm is not significantly changed from the prior examination where it measured up to 10 mm. The right lateral ventricle is partly effaced.

Output: Expected postoperative findings following partial resection of tumor from the right temporal lobe with significant tumor remaining around the margin of the cavity as well as several small satellite lesions.


Instruction: Generate impression based on findings.

Input: Worsening clinical symptoms of C6 bilateral weakness. Please evaluate for cervical myelopathy and compare to old outside MRI's from 2013. There is straightening of the cervical spine with mild retrolisthesis of C3 on C4. The vertebral body heights are preserved. There is loss of disc height at C3-C4 through C6-C7 with endplate degenerative changes. The vertebral bone marrow signal is mildly heterogeneous with increased STIR signal at the anterior inferior aspect of the C6 vertebra, which is unchanged from 2013. The spinal cord displays normal signal characteristics. The paravertebral soft tissues are unremarkable.C2-C3: No significant disc bulge, spinal canal or foraminal stenosis.C3-C4: Disc bulge, uncinate spurs, thickening of the ligamentum flavum and facet arthropathy, contributing to flattening of the ventral cord, severe spinal canal and mild right and moderate left foraminal stenosis, without significant interval change.C4-C5: Posterior disc-osteophyte complex, uncinate spurs, thickening of the ligamentum flavum and facet arthropathy, contributing to flattening of the ventral cord, mild spinal canal and mild bilateral foraminal stenosis, without significant interval change.C5-C6: Posterior disc-osteophyte complex, uncinate spurs, thickening of the ligamentum flavum and facet arthropathy, contributing to flattening of the ventral cord, severe spinal canal and severe bilateral foraminal stenosis, without significant interval change.C6-C7: Posterior disc-osteophyte complex, uncinate spurs, thickening of the ligamentum flavum and facet arthropathy, contributing to mild spinal canal and mild bilateral foraminal stenosis, without significant interval change.C7-T1: Small central disc protrusion and bilateral uncinate spurs, contributing to mils bilateral foraminal stenosis. No significant spinal canal stenosis. T1-T2: Small central disc protrusion with slightly increased left foraminal disc protrusion, contributing to moderate left foraminal stenosis. No significant spinal canal or right foraminal stenosis.

Output: 1. Advanced degenerative cervical spondylosis, most prominent at C3-C4 and C5-C6 with severe spinal canal stenosis and flattening of the ventral cord at these levels without definite abnormal spinal cord signal. 2. Slightly increased left foraminal disc protrusion at T1-T2, contributing to moderate left foraminal stenosis. Otherwise, no significant interval change since 9/19/2013.3. Nonspecific increased STIR signal at the anterior inferior aspect of the C6 vertebra is unchanged and likely represents degenerative endplate edema. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Acute pancreatitis. Evaluate pancreas and biliary tree further. ABDOMEN:LIVER, BILIARY TRACT: The liver is smooth in contour and normal in morphology. Within segment 7, there is a 5 mm T2 hyperintense, nonenhancing lesion, too small to characterize but probable cyst (series 701, image 24). No additional lesion is identified. The gallbladder is unremarkable. No intra or extrahepatic ductal dilatation is identified.SPLEEN: No significant abnormality noted.PANCREAS: Pancreatic parenchymal and peripancreatic (mild) edema, compatible with acute pancreatitis. Pancreas divisum seen. Nondilated pancreatic duct. No evidence of organizing fluid collection.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Diffuse colonic wall thickening, better identified on recent CT.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No evidence of sclerosing cholangitis.Findings consistent with acute pancreatitis, no organizing fluid collection. Pancreas divisum seen. Diffuse colonic wall thickening better visualized on recent CT, consistent with history of ulcerative colitis.


Instruction: Generate impression based on findings.

Input: Paraclinoid meningioma status post RT: surveillance MRI. There are postoperative findings related to left temporal craniotomy with a substantial defect in the anterior left temporal lobe and confluent T2 hyperintensity in the surrounding brain parenchyma, mainly related to encephalomalacia. The extra-axial enhancing tumor in the left paraclinoid region, appears to be slightly smaller, measuring up to 14 mm, previously 16 mm. The mass partially surrounds the internal carotid artery, without apparent significant narrowing of the flow void. The tumor also continues to abut the prechiasmatic segment of the left optic nerve. There are unchanged mild nonspecific foci of cerebral and brainstem white matter T2 hyperintensity, which may represent chronic small vessel ischemic disease. There is no evidence of acute intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unchanged, including a left temporal scalp lipoma.

Output: Apparent slight interval decrease in size of the treated residual left paraclinoid region meningioma.


Instruction: Generate impression based on findings.

Input: There is no definite cortex above the bilateral superior semicircular canals which can be seen in the setting of superior canal dehiscence. Images of the internal auditory canals demonstrate the seventh and eighth nerves to be normal in size and symmetric bilaterally without masses or enhancing lesions along the course of these nerves or in the cerebellopontine angle cisterns bilaterally. The inner ear structures are normal in appearance and symmetric bilaterally without congenital inner ear anomalies identified on either side. There are no vascular anomalies. Fluid is present within right mastoid air cells.

Output: 1.There is no definite cortex above the bilateral superior semicircular canals which can be seen in the setting of superior canal dehiscence, although MRI is relatively insensitive for characterization of this cortex compared to CT. If there is clinical suspicion for superior canal presence, a temporal bone CT would be recommended for confirmation.2.Otherwise negative contrast enhanced MRI of the internal auditory canals.3.Fluid is present within right mastoid air cells.


Instruction: Generate impression based on findings.

Input: Metastatic melanoma status post 4 cycles of chemotherapy please assess response to therapy and compare to previous imaging. There are postoperative findings in the left temporal lobe with persistent confluent T2 hyperintensity diffusely along the margins of the resection cavity patchy enhancement along the medial aspect of the resection cavity. There is no evidence of acute intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues appear unchanged.

Output: Postoperative findings in the left temporal lobe with persistent patchy enhancement along the medial aspect of the resection cavity, which is nonspecific. Otherwise, no new intracranial metastases are identified.


Instruction: Generate impression based on findings.

Input: Altered mental status. History of CAD and diabetes. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are punctate and confluent T2 hyperintensities in the subcortical and periventricular white matter, in the left caudate, in the bilateral thalami, in the brainstem, and in both cerebellar hemispheres, consistent with extensive chronic small vessel ischemic findings and chronic lacunar infarcts. Global volume loss is also greater than expected for the patient's age.There are mild diffusion hyperintensity with ADC isointensity along the right periatrial white matter, and along the medial left peri-atrial white matter adjacent to an area of chronic lacune (3/17-19), likely representing evolving subacute lacunar infarctions. There is mild associated FLAIR hyperintensity in these locations. There is no midline shift or herniation. The major cerebral flow voids are intact.

Output: 1. There are findings suggestive of a few subacute lacunar infarctions in the peri-atrial white matter bilaterally.2. There are extensive underlying chronic small vessel ischemic changes with chronic lacunar infarcts, affecting both supratentorial and infratentorial structures.


Instruction: Generate impression based on findings.

Input: Lumbar pain with right-sided radiculopathy Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position.Degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: No significant disc disease. No spinal canal or neural foraminal stenosis.L4-L5: There is a disc desiccation with a right paracentral disc protrusion which partially effaces the right lateral recess and contacts the right L5 nerve root. No significant central spinal canal stenosis or neural foraminal stenosis.L5-S1: There is disc desiccation with central and bilateral paracentral disc extrusion with minimal cranial and caudal migration. The extruded disc material measures 8 x 16 x 11 mm in the AP, transverse, and craniocaudal dimensions, respectively, and mildly contacts the bilateral S1 nerve roots, left greater than right. There is mild central spinal canal stenosis at this level. No significant neural foraminal stenosis.Paraspinous soft tissues are within normal limits. There is a simple appearing cystic structure measuring at least 4 cm in diameter in the pelvis which is partially imaged but likely benign in a woman of reproductive age.

Output: 1. Disc herniations at the L4-L5 and L5-S1 levels. The L4-L5 disc protrusion contacts the right L5 nerve root and may be source of patient's described right-sided radiculopathy. The L5-S1 disc extrusion slightly contacts the S1 nerve roots, left greater than right.2. 4 cm adnexal cyst is partially imaged and likely benign in this age group.


Instruction: Generate impression based on findings.

Input: Pelvic pain. Patient with uterine window at old C-section scar possibly involving the bladder on pelvic ultrasound. PELVIS:UTERUS, ADNEXA: The uterus is anteverted and anteflexed. It is normal in size. The visualized endometrium and junctional zones are normal in thickness. There is a small defect in the lower uterine segment, compatible with a c-section defect/scar. Immediately adjacent to the defect is a 1.7 x 1.0 cm well-defined non-enhancing focus with intrinsic high T1- and low T2-weighted signal intensity with a possible fluid-fluid level. There may be a thin communication to this collection at the level of the c-section defect/scar, best seen on series 1402 image 81. The focus may represent a post-procedural hemorrhagic/proteinaceous collection or endometrioma. This abuts the left posterior dome of the bladder and the fat plane is poorly visualized. Otherwise, the fat plane between the uterus and bladder is preserved. The bladder wall contour is unremarkable.There is a well defined 2.6 x 2.6 cm left mural/submucosal uterine mass which is very low signal intensity on T1- and T2-weighted images demonstrating postcontrast enhancement compatible with a fibroid.Right corpus luteal cyst is noted. Otherwise, several bilateral adnexal follicles. The ovaries are normal in size.Small nabothian cysts.BLADDER: See discussion above. Partially collapsed bladder with normal wall thickness.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.1.7 cm post-procedural hemorrhagic/proteinaceous collection or endometrioma adjacent to lower uterine segment c-section scar with a suspected thin communication to the endometrial cavity. 2.The fat plane between the collection/lesion with the adjacent posterior left urinary bladder is poorly defined, however there is no specific evidence of bladder communication. If clinically warranted a fluoroscopic study, such as a cystogram or HSG, to evaluate for a communication between the collection and uterus or collection and bladder may be considered.3.2.6 x 2.6 cm left mural/submucosal uterine mass, likely a fibroid.


Instruction: Generate impression based on findings.

Input: History of cirrhosis, evaluate regenerative nodules seen on 10/8/2015 CT. ABDOMEN:LIVER, BILIARY TRACT: The liver is cirrhotic morphology with diffuse nodularity and hypertrophy of the left lateral segment. Out of phase images demonstrate diffuse mildly decreased signal intensity suggesting fatty infiltration. There is an approximately 2 cm area of increased arterial phase enhancement at the junction of segments 1 and 8 (series 11, image 57) which demonstrates isointense enhancement on portal venous phase images and does not washout. This pattern is compatible with a transient hepatic intensity difference due to perfusional variation. No focal suspicious hepatic lesions are identified. The hepatic vasculature and portal venous system are patent.SPLEEN: The spleen measures 12.0 cm in length.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Cirrhotic appearing liver without suspicious focal lesions.


Instruction: Generate impression based on findings.

Input: 25 year-old woman with history of knee pain following motor vehicle accident. MENISCI: The medial and lateral menisci are intact.ARTICULAR CARTILAGE AND BONE: There is no abnormality of the cortical or marrow signal. The articular cartilage of the knee appears normal.LIGAMENTS: The ACL, PCL, MCL, and no complex are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: Normal examination of the right knee without finding to explain the patient's pain.


Instruction: Generate impression based on findings.

Input: The 62-year-old male with seizures. Minimal small vessel disease of indeterminate age is noted.High density tissue prominence along the medial aspect of left temporal lobe which obscures the left perimesencephalic cistern is noted. This lesion may contain calcification and it overlaps the edge of the tentorium. The finding may represent a small meningioma with a small amount of vasogenic edema within the left temporal lobe. Possibly tilt primary tumor of the brain parenchyma cannot be entirely however ruled out. Further evaluation with an infused MRI examination is highly recommended. This finding is best appreciated on axial image 5 through 7. No evidence of hemorrhage, mass-effect, midline shift or hydrocephalus.

Output: 1.Minimal small vessel disease.2.Mass along the medial aspect left temporal lobe or along the edge of the tentorium with minimal vasogenic edema as detailed above.3.Follow-up with a dedicated posterior diffuse MRI of brain is recommended.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for growth of grade 3 oligodendroglioma with 1P19q deletion. Off all treatments since 2012. Signs and symptoms: As above. Pre-and post enhanced brain MRI:There is a focus of cortical and subcortical hemorrhagic encephalomalacia in the right posterior superior temporal gyrus without appreciable change in size or signal intensity since prior exam. Additional underlying white matter flair hyperintensity at this site also remains nearly identical to prior exam. There is mild ex vacuo dilatation of the trigone of right lateral ventricle similar to prior exam. There is no evidence of associated mass effect with this finding which is a similar observation is prior study. The involved cortex at this site demonstrated thin linear T1 hyperintensity consistent with mineralization similar to prior exam. Post enhanced images demonstrate no convincing evidence of abnormal enhancement. This is a similar observation is prior study. Findings consistent with stable treated tumor without change since prior exam.Unremarkable pre-and post enhanced brain MRI otherwise.

Output: 1.Stable post operative/treatment of a right posterior temporal mass without initial interval change as detailed.2.Unremarkable pre-and post enhanced brain MRI otherwise and stable since prior study.


Instruction: Generate impression based on findings.

Input: 59-year-old female with intractable complex partial seizures, without status epilepticus. There is mildly increased T2/FLAIR signal involving the bilateral hippocampi. The left hippocampus is asymmetrically smaller. The internal architecture of both hippocampi is grossly preserved within the limits of technique. No gray matter heterotopia, cortical dysplasia, or other lesion to suggest seizure focus is appreciated. A small focus of volume loss in the posterior right cerebellar hemisphere may relate to tiny remote infarct. Minimal scattered foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with very mild chronic small vessel ischemic changes. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. No abnormal enhancement. The ventricles are within normal limits in size and configuration. Major flow-voids are preserved.Empty sella which is expanded is incidentally noted. The orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: Nonspecific findings in the bilateral hippocampi as described above, raising question of mesial temporal sclerosis. No additional findings to suggest seizure focus. Consider high resolution coronal T2/FLAIR sequences at 3 Tesla.


Instruction: Generate impression based on findings.

Input: Colon cancer and left T8 pedicle lesion with spinal canal involvement. There is an infiltrative mass centered in the T8 vertebra with extension into the adjacent vertebrae, paraspinal space, and epidural space, where there is moderate spinal canal stenosis and involvement of the left T7-8, T8-9, and T9-10 neural foramen and right T8-9 neural foramen. Although displaced slightly anteriorly by the tumor, the spinal cord displays normal signal and morphology. There are also enhancing lesions within the posterior elements of T10 and the T11 vertebral body. The vertebral column alignment is within normal limits and the vertebral body heights are preserved. There is a left hilar mass.

Output: 1. Metastatic disease to the imaged axial skeleton, including involvement of the T8 vertebra with extension into the adjacent vertebrae, paraspinal space, and epidural space, with resultant moderate spinal canal stenosis and involvement of the left T7-8, T8-9, and T9-10 neural foramen and right T8-9 neural foramen.2. A mass in the left hilar region is also compatible with metastatic disease. Please refer to the prior body CT report for additional details.


Instruction: Generate impression based on findings.

Input: Male, 17 years old, with history of pineal region tumor, status post chemotherapy and radiation, 4 weeks post radiation scan. Irregular enhancement in the pineal region is again seen measuring approximately 10 x 10 mm (image 14 series 1001), not significantly changed from the prior examination accounting for technical differences between scans.No new areas of pathologic parenchymal enhancement or signal abnormality are seen. Evidence of a prior right frontal approach biopsy tract is redemonstrated similar to prior. Patchy T2 hyperintensity within the bilateral parietal periventricular white matter is stable from prior, perhaps representing white matter thinning or prominent perivascular spaces in association with previous transependymal CSF flow. Ventricular caliber and morphology remain within normal limits and are significantly improved from earlier exams. No acute intracranial hemorrhage or any abnormal extra-axial fluid collection is seen.

Output: Stable irregular enhancing lesion in the pineal region compatible with a treated germinoma. As noted on prior exams, this lesion is much improved when compared to older studies. No new intracranial lesions are seen.


Instruction: Generate impression based on findings.

Input: Clinical question: Metastatic cancer of the parotid gland; follow-up from abnormal head CT. Signs and symptoms: As above. Pre- and post enhanced brain MRI:Examination demonstrate a ring-enhancing metastatic lesion in the left cerebellum measuring 11 x 8 x 12 mm in size. It demonstrates mild surrounding vasogenic edema without significant mass effect. A separate punctate focus of enhancement immediately to the left lateral aspect of this metastatic lesion is also noted and concerning for additional tiny metastases.There are bilateral posterior parietal necrotic ring-enhancing enhancing metastatic lesions measuring at 17 x 16 x 17 mm on the right and 16 x 10 x 8 mm on the left. Both lesions demonstrate surrounding vasogenic edema and the resultant regional mass effect/effacement of cortical sulci. A second left posterior parietal enhancing metastases measures at 4 mm on sagittal post enhanced series 13 image 21.Diffusion-weighted images also demonstrate a punctate/linear focus of restricted diffusion in the left cerebellum and a punctate focus of cortical restricted diffusion in the right high convexity posterior frontal lobe consistent with small acute nonhemorrhagic ischemic strokes.Slight prominence of cortical sulci for patient's stated age of 68 is noted. Ventricular system is slightly prominent however likely within normal range for age and with maintained midline. The signal void of major intracranial arterial branches are identified.The signal intensity of intracranial venous sinuses is within normal and without detectable abnormal enhancement.Unremarkable images through the orbits and including axial fat sat post enhanced series.Unremarkable calvarium, soft tissues of the scalp, paranasal sinuses and mastoid air cells.

Output: 1.Small foci of restricted diffusion in the left cerebellum and high convexity right posterior frontal consistent with small acute ischemic strokes.2.Multiple supratentorial and infratentorial necrotic/rim-enhancing metastatic lesions as detailed/measured above.3.Regional mass effect by metastatic lesions and surrounding edema however without mass effect on the ventricular system or deviation of midline.4.Unremarkable calvarium, orbits, paranasal sinuses and mastoid air cells.


Instruction: Generate impression based on findings.

Input: 69-year-old man with fall and head trauma. Questionable loss of consciousness. There is no evidence of intracranial hemorrhage or edema. Scattered areas of hypoattenuation are present in the subcortical, periventricular, and basal ganglia regions. These are consistent with age determined small vessel ischemic disease. No CT findings of acute stroke are present. Large vessel calcifications are noted in the carotid arteries.Fullness of the sella is noted. MRI is recommended to evaluate for the presence of a sellar mass.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base reveal no CT evidence of fracture. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. No CT evidence of intracranial hemorrhage or fracture.2. Sellar fullness is present. Recommend pituitary protocol MRI tube evaluate for presence of sella mass.3. Age-indeterminate small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: 15-year-old male with left knee pain, evaluate for ligamentous/meniscal injury MENISCI: The lateral and medial menisci are intact.ARTICULAR CARTILAGE AND BONE: There is a bony contusion injury involving the anterior aspect of the medial tibial plateau and the medial femoral condyle with no underlying fractures. There is also an edema-type signal at the posterior aspect of the femoral condyle and the fibular head. The possibility of a small fracture through the fibular head cannot be ruled out. Edema at the lateral femoral physis is also noted.The articular cartilage remains intact.LIGAMENTS: There is edema at the proximal attachment of the ACL within the intercondylar notch, but the ACL remains intact. The PCL and collateral ligaments are also intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1. High-grade partial-thickness tear of the lateral head of the gastrocnemius at its femoral attachment, associated with a small adjacent hematoma.2. Edema type signal at the posterior aspect of the femoral condyle and fibular head. The possibility of a small fracture through the fibular head cannot be ruled out.3. Bony contusion injury involving the anterior aspect of the medial tibial plateau and the medial femoral condyle (hyperextension injury) without evidence of underlying fractures.4. The collateral and cruciate ligaments remain intact.


Instruction: Generate impression based on findings.

Input: The lateral ventricles and the third ventricle are enlarged, not significantly changed since the previous study. The fourth ventricle appears normal size. In the mid to distal aqueduct there is a focal low signal area on 3D sagittal BFFE sequence (series 301, image 20/51) that may represent point of narrowing, but it could also represent partial volume artifact.Flow images demonstrates bidirectional flow signal anterior and posterior to the brainstem thorough the foramen magnum. However, there is no identifiable flow signal across the aqueduct.There are no diffusion abnormalities. There are scattered susceptibility signals throughout the brain, most likely due to old blood products.

Output: 1. Low signal intensity is seen in the mid to distal aqueduct on 3D BFFE sagittal scan. This may represent the point of narrowing of the aqueduct; however, it could also represent partial volume artifact.2. There is no flow signal across the aqueduct on phase contrast MRA.


Instruction: Generate impression based on findings.

Input: Left hand weakness. There is mild left and moderate right narrowing of the internal carotid artery origins. There also appears to be moderate focal narrowing of the origin of the right vertebral artery. There is a three vessel aortic arch.

Output: Mild left and moderate right narrowing of the internal carotid artery origins and apparent moderate focal attenuation at the origin of the right vertebral artery. Doppler ultrasound may be useful for further characterization.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Brain: Again seen are postoperative findings related to Chiari decompression. Unchanged mild patchy T2 hyperintensity in the inferior right cerebellar hemisphere compatible with gliosis. Neo-foramen magnum is widely patent. CSF flow is preserved across the anterior and posterior aspects of the neo-foramen magnum, although the anterior flow column remains minimally constricted due to the retroflexed dens. The third and lateral ventricles are mildly prominent. Cerebral aqueduct is patent most evident on 3-D T2 as well as CSF flow sequences. There is no midline shift or mass effect. There is no evidence of acute infarct or hemorrhage. Spine: There is trace prominence of the central canal from C3 to C5 levels as before. Again seen is a syrinx extending from the lower C6 level into the thoracic cord. Syrinx measures approximately 2 x 3 mm at the T1 level which is not significantly changed since cervical spine MRI 9/17/2015. Compared to the examination from 4/23/2015 when the thoracic spine was completely evaluated, there is clear decrease in the caliber and extent of the syrinx. For example at the T4 level, syrinx currently measures 4 x 3 mm, previously 10 x 7 mm on examination from 4/23/2015. Decreased cranial extent of the syrinx in the cervical spine was also noted on more recent MRI dated 9/17/2015. Caudally in the thoracic spine, the syrinx tapers inferiorly to the T11-12 level which was the inferior extent on prior study from 4/23/2015, although the caliber of the syrinx was larger at that time throughout the thoracic cord. 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 or neural foraminal stenosis at any level. Conus terminates normally at the L1-L2 level. No evidence of tethered cord.

Output: 1.Postoperative findings related to Chiari I decompression with preserved ventral and dorsal CSF flow at the foramen magnum.2. Compared to prior complete spine MRI from 4/23/2015 when the cord was completely imaged, there is significant decrease in size and extent of the cervicothoracic syrinx. The improvement was partially evident on more recent MRI cervical spine exam from 9/17/2015.3. Unchanged mildly dilated lateral and third ventricles with patent cerebral aqueduct.


Instruction: Generate impression based on findings.

Input: 30 year-old female with multifocal giant cell tumor. Now with right-sided chest wall pain. Evaluate for thoracic spine or rib lesions. Nonenhanced CT of thoracic spine:Axial 3-mm images of entire thoracic spine with zero degree angulation of the gantry were obtained. Sagittal and coronal 2-D reformatted images were obtained.Examination demonstrates normal density and alignment of vertebral column. There is no detectable lytic or sclerotic lesions of the vertebral column. No definite acute abnormality of perispinal soft tissues is identified. Very minimal degenerative disk disease throughout the thoracic spine is present. No evidence of central spinal stenosis or definitive neural foramina compromise on this exam is detected. Recommend follow-up with an MRI examination.Limited view of the proximal thoracic ribs are negative for any osseous abnormalities.

Output: Negative nonenhanced CT of thoracic spine. Follow-up with dedicated MRI of thoracic spine likely more helpful for detecting the cause of patient's right sided chest wall pain.


Instruction: Generate impression based on findings.

Input: 63 years, Male, Reason: right PSA with previously negative previous biopsy History:. PELVIS:PROSTATE:Prostate Size: 6.2 x 3.9 x 4.4 cmPeripheral Zone: Lesion in the right base with low T2/ADC signal and noncontributory enhancement characteristics measuring 1.6 x 1.1 cm (804/284) is suspicious for prostatic adenocarcinoma. This lesion abuts the seminal vesicles without definite invasion.There is a lesion in the left base with low T2/ADC signal and noncontributory enhancement characteristics measuring 1.3 x 1.0 cm which is also suspicious for prostatic adenocarcinoma, lesion again extends to the seminal vesicle level.Central Gland: Lesion in the left anterior mid gland with low ADC signal and ill-defined margins on T2 weighted images raises suspicion for an additional focus of prostatic adenocarcinoma.Additional well-circumscribed heterogeneous nodules throughout the central gland likely reflect benign prostatic hypertrophySeminal Vesicles: Abutment as above.Extracapsular Extension: No definite extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: Enlarged right external iliac node measuring 1.3 x 1.0 cm (1501/38). Prominent inguinal nodes.BONES, SOFT TISSUES: Heterogeneous marrow signal.

Output: 1. Lesions in the right and left base peripheral zones are suspicious for prostatic adenocarcinoma. There is an additional lesion in the left anterior mid gland central zone which is also suspicious.2. Enlarged right pelvic lymph node, nonspecific but metastatic disease not excluded.3. Heterogeneous marrow signal.


Instruction: Generate impression based on findings.

Input: Left orbit/sinus solitary fibrous tumor status post subtotal resection twice. There is no significant interval change in size of the mass centered within the left orbit with extension into the adjacent paranasal sinuses, premaxillary space, and masticator space. Overall, the tumor measures approximately 45 mm in width, 50 mm in height, and 40 mm in length. There is marked left proptosis and compression of the optic nerves and most of the extraocular muscles, with relative sparing of the superior rectus. There are postoperative findings in the left maxillary sinus, with moderate mucosal thickening and new secretions. The right orbit is unremarkable. There is no evidence of intracranial extension of tumor.

Output: 1. No appreciable change in size of the solitary fibrous tumor involving the left orbit with extension into the adjacent paranasal sinuses, premaxillary space, and masticator space. 2. Findings suggestive of acute sinusitis.


Instruction: Generate impression based on findings.

Input: 23 years Female (DOB:4/27/1993)Reason: s/p AVM resection and SRS, please evaluate for changes, 3T scanner History: yearly surveillance, seizuresPROVIDER/ATTENDING NAME: ISSAM A. AWAD SERVICES ANCILLARY MRI of the brainNo diffusion weighted abnormalities are appreciated.The patient is status post left-sided craniotomy for removal of an arteriovenous malformation. Some signal changes at the surgical bed likely represent gliotic changesThere is a small tangle of flow voids present in the right perimesencephalic cistern and in the right geniculate nucleus. There is associated enhancement at the right geniculate nucleus which has decreased compared to the prior exam. This focus of enhancement currently measures 9 x 4 mm axial dimensions and previously measured 13 x 6 mm axial dimensions on the 11th/2/15 exam. On susceptibility imaging there is signal loss at the area of contrast enhancement. Associated FLAIR signal hyperintensity is also regressedA punctate microhemorrhage is present in the left middle frontal gyrus. This is stable when compared to the prior examThe visualized portions of the paranasal sinuses demonstrate a small mucus retention cyst in the right maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is a small tangle of vascular structures centered in the expected location of the right geniculate nucleus associated with mild enlargement of the the thalamogeniculate branches of the right posterior cerebral artery. These are less prominent than on the previous exams. The right medial atrial vein is asymmetrically larger than the left medial atrial vein.The anterior communicating artery is medium-sized. The posterior communicating arteries are small. The vertebral arteries are similar in size.

Output: 1.Status post removal of left temporal lobe arteriovenous malformation with expected post treatment change.2.A previously identified and treated arteriovenous malformation centered in the right geniculate nucleus continues to regress. Given some asymmetry in the size of the medial atrial veins this may represent indirect evidence that it hasn't resolved completely. Contrast enhancement and T2 to signal hyperintensity within the radiation bed continues to regress and is likely related to posttreatment change.


Instruction: Generate impression based on findings.

Input: Neutropenic fever. History of leukemia.IMAGE ACQUISITIONS: 1.5-mm contiguous axial images of the brain without contrast infusion.2.Thin section axial and reformatted coronal images of paranasal sinuses without contrast infusion. Low-attenuation in involving right internal capsule and periatrial white matter and small portion of right medial temporal lobe is consistent with infarct, likely in the right anterior choroidal artery territory, as previously described on MRI. There is no acute intracranial hemorrhage, mass effect or shift of midline structures. Small white matter infarcts over the cerebral convexities that were present on the previous MRI are not as well demonstrated on CT due to decreased sensitivity CT compared MRI.On previous CT of sinuses the March 11, 2009, there was mild mucosal thickening in the right side of the sphenoid sinus. On the current scan, there is some frothy or bubbly secretion in the right side of the sphenoid sinus, which is new compared with the previous scan. Minimal mucosal thickening is again noted in the right maxillary antrum. There are no other areas of mucosal thickening. There are no fluid levels. There is no bone obstruction or sinus expansion.. Ostiomeatal complexes are structurally normal. Mastoids are mostly included in the field of view and are well aerated.Bilateral proptosis is again noted.

Output: 1.Chronic right anterior choroidal artery infarct is again noted. CT of the brain is otherwise negative.2.There is some frothy secretion in the sphenoid sinus on the right. This has developed since the previous scan and could indicate early acute inflammation.


Instruction: Generate impression based on findings.

Input: Male 14 years old Reason: Partial anomalous pulmonary venous drainage and sinus venosus ASD History: Asymptomatic CARDIAC FUNCTION \T\ MORPHOLOGY:Heart size is normal. LV wall motion, thickness and thickening are normal.RV myocardium wall thickness is normal with no dysfunction. No evidence of VSD.Patent ASD AORTA MEASUREMENTS: aortic valve ring: 14.5 mmsinuses of Valsalva: 25.8 mmsinotubular junction: 15.2 mmascending aorta: 15.7 mmaortic arch: 20 mmdescending aorta: 17.5 mmdiaphragmatic hiatus: 15.5 mmPULMONARY ARTERY MEASUREMENTS:MAIN: 25.4 mmRIGHT: 19 mmLEFT: 18 mmLeft VentricleThe left ventricle is normal in size. The overall LV ejection fraction is 47.3%, the LV end diastolic volume index is 77 ml/m2 (normal range: 74+/-15), the LVEDV is 130.89 ml (normal range 142+/-34), the LV end systolic volume index is 40.6 ml/m2 (normal range 25+/-9), the LVESV is 69.02 ml (normal range 47+/-19), the LV mass index is 64.43 g/m2 (normal range 85+/-15), and the LV mass is 109.54 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is normal in size. The right upper pulmonary veins connects to the superior vena cava.Right VentricleThe right ventricle is normal in size. The overall RV ejection fraction is 61.4%, the RV end diastolic volume index is 135.20 ml/m2 (normal range 82+/-16), the RVEDV is 229.96 ml (normal range 142+/-31), the RV end systolic volume index is 52.11 ml/m2 (normal range 31+/-9), and the RVESV is 88.68 ml (normal range 54+/-17). Right AtriumThe right atrium is normal in size. Question of 6 mm. ASD noted. Aortic ValveThe aortic valve opens widely. There is no significant dephasing inferior to the aortic valve to suggest significant aortic regurgitation. Dedicated through plane imaging of the aortic valve was not performed.Mitral ValveThe mitral valve opens widely. There is no significant mitral regurgitation. Dedicated through plane imaging of the mitral valve was not performed.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation visualized. Dedicated through plane imaging of the pulmonic valve was not performed.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation visualized. Dedicated through plane imaging of the tricuspid valve was not performed.AortaThe ascending thoracic aorta is normal in size. There is a left sided aortic arch.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 pericardial thickening or effusion.Extracardiac Findings: No focal lung opacities, effusions or pneumothorax. Partial visualization of solid organs and hollow viscus of the upper abdomen are normal.

Output: 1. Partial abnormalities pulmonary venous return of the right upper pulmonary vein connecting to the SVC with possible ostium secundum type atrial septal defect.2. Dilation of the right ventricle with volume over flow.Dr. Peter Varga was present during the elaboration of this report and agrees with the findings.


Instruction: Generate impression based on findings.

Input: Right toe pain and ulcer There is diffuse soft tissue swelling with mild osteoarthritis of the forefoot and moderate osteoarthritis of the midfoot. There is a posterior calcaneal spur and large Haglund deformity. There is relative lucency of the posterior calcaneal soft tissues which may be artifactual in nature but if there is ulceration or clinical concern for osteomyelitis, MRI can be considered.

Output: Soft tissue swelling and osteoarthritis of the foot.


Instruction: Generate impression based on findings.

Input: 53-year-old female with history of right breast cancer status post right lumpectomy and sentinel node biopsy for IDC in 2011. Family history of breast cancer in maternal aunt, maternal great aunt, and paternal aunt. No new breast complaints. There is scattered fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted in the right breast and minimal enhancement in the left breast. Postsurgical/treatment changes are appreciated in the right breast and right axilla from lumpectomy and sentinel node biopsy.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

Output: Postsurgical/treatment changes in the right breast with no MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: Female, 80 years old, with syncope. Evaluate for stroke. No restricted diffusion is seen. Patchy areas of periventricular white matter T2 hyperintensity are demonstrated, particularly along the right frontal horn and the left atrium, showing no significant interval change. Also unchanged are scattered small focal lesions in the basal ganglia compatible with chronic lacunar infarcts. Encephalomalacia and gliosis of the right occipital lobe are unchanged.No new parenchymal lesions are seen. No evidence of edema or mass effect is detected. No acute intracranial hemorrhage or any abnormal extra-axial fluid collection is seen. The ventricles and sulci are slightly prominent compatible with underlying volume loss.

Output: 1.No evidence of acute ischemia or any other acute intracranial abnormality.2.Evidence of chronic small vessel and lacunar ischemia is again seen without significant interval change. A probable chronic right occipital territorial infarct is unchanged.


Instruction: Generate impression based on findings.

Input: Pulmonary nodules and brain tumor with left numbness not correlated with left side brain tumor, also hyperreflexic LUE and BLE. There is a peripherally enhancing masa that measures up to approximately 5 cm in the anterior left temporal lobe with surrounding T2 hyperintensity, which may represent vasogenic edema or tumor infiltration. There is mild left uncal herniation and effacement of the left temporal horn. There is mild midline shift to the left. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is a nasopharyngeal retention cyst that measures up to 19 mm in length.Spine: There is degenerative spondylosis at C3 through C6, with mild to moderate spinal canal narrowing. There is also extensive posterior thoracic epidural lipomatosis that markedly narrows the thecal sac and mildly compresses the spinal cord at T6-7. However, the spinal cord signal is within normal limits. There is also degenerative spondylosis at L3 through L5, but no significant spinal canal stenosis. There is scattered fatty infiltration of the vertebral bone marrow and degenerative endplate signal alterations at L4-5, but no evidence of enhancing lesions within the imaged spinal column. The vertebral body heights are preserved. There are nodules in the partially imaged right lung. There is also a partially imaged left hepatic cyst. There are postoperative findings related to aortoiliac bypass.

Output: 1. Left anterior temporal lobe mass measuring up to approximately 5 cm may represent a primary glial neoplasm.2. Degenerative spondylosis at C3 through C6, with mild to moderate spinal canal narrowing. 3. Extensive posterior thoracic epidural lipomatosis that markedly narrows the thecal sac and mildly compresses the spinal cord at T6-7.4. Degenerative spondylosis at L3 through L5, but no significant spinal canal stenosis. 5. No evidence of spine lesions.6. Partially imaged right lung nodules. Please refer to dedicated chest imaging for further assessment.7. Partially imaged left hepatic cyst.8. Aneurysmal dilatation of the infrarenal aorta, measuring up to approximately 25 mm in width.


Instruction: Generate impression based on findings.

Input: Reason: evulsion fx on hip xray, eval chronicity and soft tissue History: hip pain, radiculopathy ACETABULAR LABRUM: Abnormal signal within the left anterior superior labrum is suspicious for an underlying labral tear.ARTICULAR CARTILAGE AND BONE: There is slight over coverage noted at the acetabulum as can be seen with a pincer deformity. There is no evidence of avulsion fracture or bursitis at the lesser trochanter.SOFT TISSUES: No significant abnormality noted. ADDITIONAL

Output: 1. Findings suspicious for a labral tear and possible pincer deformity as above. No avulsion fracture as clinically questioned.2. Disc extrusion at the level of L5-S1 is better evaluated on the recent MRI.


Instruction: Generate impression based on findings.

Input: Male 69 years old Reason: evaluate for cholangiocarcinoma History: abnormal CT scan ABDOMEN:LIVER, BILIARY TRACT: Liver morphology is normal with mild atrophy of the left hepatic lobe. There is a T2 hypointense mass at the confluence of the left and right hepatic ducts with greater extension into the left hepatic ducts. The mass shows restricted diffusion and enhancement on delayed imaging. It measures 1.7 x 2.1 cm. The lesion extends more into the left hepatic ducts causing more proximal ductal obstruction. The lesion obstructs the central right hepatic lobe common duct.There is moderate to severe intrahepatic biliary ductal dilation. There is an accessory right hepatic duct The lesion obstructs the left portal vein which is thrombosed. Right portal vein is patent.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Small peripancreatic and hilar nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.2.0 cm Klatskin point tumor with predominant extension into the left hepatic ducts with imaging features compatible with a cholangiocarcinoma with predominant fibrous stroma.2.Moderate to severe intrahepatic biliary ductal dilatation. The left hepatic lobe ducts are obstructed more to the periphery of the liver leading to isolated areas of ductal obstruction. The right hepatic lobe ducts are obstructed more centrally.3.Invasion of the left portal vein by tumor.


Instruction: Generate impression based on findings.

Input: 24 year old male with a history of MVA causing left shoulder injury still with persistent pain after 6 weeks. ROTATOR CUFF: The supraspinatus and infraspinatus muscles and tendons appear intact.SUPRASPINATUS OUTLET: No fluid is identified within the subacromial subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is a small amount of fluid within the glenohumeral joint and subscapular recess. Although this is a non arthrogram study, the glenoid labrum appears grossly intact.BICEPS TENDON: The tendon of the long head of the biceps is normal. ADDITIONAL

Output: No evidence of rotator cuff tear. Evaluation of the glenoid labrum is limited on this non arthrogram study.


Instruction: Generate impression based on findings.

Input: Malignant melanoma of skin, unspecified [C43.9], Reason for Study: ^Reason: Evaluate for metastatic disease History: Stage IV melanoma with increased frequency of pain For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. Focal enhancement at anterior superior aspect of L2 vertebral body with STIR high signal intensity indicate focal degenerative changes.There is no evidence of vertebral body compression fracture. There is no evidence of focal mass or enhancing mass.There is normal lumbar lordosis. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. The conus medullaris terminates at the L1 level. The paraspinal soft tissues are unremarkable.There is no evidence of abnormal enhancement, cord compression or mass. Degenerative changes are specified by the intervertebral level as follows: T12-L1: no neuroforaminal narrowing or spinal stenosis. L1-L2: Minimal bulging of disc. No neuroforaminal narrowing or spinal stenosis. L2-L3: Diffuse bulging of disc. No neuroforaminal narrowing or spinal stenosis. L3-L4: Disc desiccation. Diffuse bulging of disc which abuts thecal sac. Associated with bilateral ligamentum flavum thickening, there is minimal to mild spinal canal stenosis. L4-L5: Disc desiccation. Diffuse bulging of disc with broad based disc bulging through the left side neuroforamen which results mild to moderate left side neuroforaminal stenosis. L5-S1: Disc desiccation. No neuroforaminal narrowing or spinal stenosis.

Output: 1. No evidence to compression fracture. No evidence of spinal cord compression.2. Focal abnormal enhancement of anterosuperior aspect of the L2 vertebral body indicating degenerative changes. Otherwise, no abnormal enhancing lesion.3. No evidence of spinal cord compression.4. Minimal to mild spinal canal stenosis at the level of L34.5. Mild to moderate L45 left side neuroforaminal stenosis.


Instruction: Generate impression based on findings.

Input: ataxia and spasticity No evidence of acute ischemic or hemorrhagic lesion.There is focal high signal intensity on the left frontal lobe pre central gyrus without evidence of diffusion restriction indicate non specific focal encephalomalacia.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: No evidence of acute ischemic or hemorrhagic lesion.Nonspecific focal encephalomalacia on the left frontal lobe pre central gyrus, otherwise unremarkable.


Instruction: Generate impression based on findings.

Input: ESRD on HD presenting with MRSA bacteremia and low back pain. The vertebral bone marrow signal is unremarkable. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. There are mild degenerative changes involving the lower lumbar spine facet joints, but no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. There is extensive mediastinal lymphadenopathy and atrophic and cystic kidneys.

Output: 1. No evidence of discitis-osteomyelitis in the thoracic and lumbar spine, although assessment is somewhat limited without intravenous contrast.2. Extensive mediastinal lymphadenopathy and atrophic and cystic kidneys. Please refer to the prior body CT report for additional details.


Instruction: Generate impression based on findings.

Input: Numbness and tingling in left fifth digit after basketball injury. Suspect hamate fracture. Evaluation of ulnar nerve neuropathy. Evaluation of the wrist is limited on some sequences by patient motion artifact. There is a minimally displaced fracture through the hook of the hamate with edema in the adjacent marrow. I see no additional fractures. Tiny rounded foci of signal abnormality within the lunate, triquetrum, and capitate, best seen on the T1 weighted sequences, are of doubtful current clinical significance.Evaluation of the intrinsic ligaments of the wrist and triangular fibrocartilage is limited by patient motion artifact and noise; given these limitations, I see no defects.The tendons of the wrist are unremarkable. There is mild edema within the soft tissues volar to the distal ulna which extends both superficial and deep to the distal flexor digitorum musculature. The ulnar nerve can be followed along its course and is unremarkable. The median nerve is unremarkable. The remaining visualized soft tissue structures are unremarkable.

Output: Fracture through the hook of the hamate. The ulnar nerve is unremarkable.


Instruction: Generate impression based on findings.

Input: Worsening balance, endometrial cancer. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are mild scattered nonspecific foci of high T2 signal in the cerebral white matter bilaterally. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are unchanged.

Output: No evidence of intracranial metastases.


Instruction: Generate impression based on findings.

Input: 63 years Female (DOB:5/27/1953)Reason: Cervical spondylosis History: paresthesiasPROVIDER/ATTENDING NAME: ADIL JAVED ADIL JAVED 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 reversal of the normal cervical curvature present. There is an 11 mm T1 hyperintense lesion within the T3 vertebral body most likely representing a vertebral body hemangioma.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is a small central disc protrusion present associated with endplate osteophytes and uncovertebral osteophytes. There is effacement of spinal fluid ventral to the spinal cord and some mild deformity of the spinal cord at this level. This appears to have progressed. Overall there is a mild to moderate degree of spinal stenosis at this level and mild encroachment of exiting nerve rootAt C4-5 there is loss of disc space height, disc desiccation, diffuse disc bulge, endplate and uncovertebral osteophytes associated with effacement of spinal fluid ventral and posterior the spinal cord and mild flattening of the spinal cord. There is bilateral encroachment of exiting nerve roots at this level within the neural foramina due to osteophytes and disc material. This has progressed since 2009 but is not changed substantially since October 2014. Overall there is moderate spinal stenosis at this level.At C5-6 there is loss of disc space height, disc desiccation, diffuse disc bulge, endplate and uncovertebral osteophytes associated with effacement of spinal fluid ventral and posterior the spinal cord and mild flattening of the spinal cord. There is bilateral encroachment of exiting nerve roots at this level within the neural foramina due to osteophytes and disc material. This has progressed since 2009 but is not changed substantially since October 2014. Overall there is moderate spinal stenosis at this level. There is bilateral encroachment of exiting nerve roots within the neural foramina at this level.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.There are multilevel degenerative changes present in the cervical spine with moderate spinal stenosis at C4-5 and C5-6 and mild to moderate spinal stenosis at the C3-4. There is bilateral encroachment of exiting nerve roots at the C3-4, C4-5 and C5-6. Since 2014 there has been some mild progression at C3-4 relative stability at C5-6 and C4-5. Over the years since 2009 there is been some slow overall progression at these levels.


Instruction: Generate impression based on findings.

Input: History of cirrhosis and hepatocellular carcinoma status post TACE RFA. Interval follow-up exam. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic morphology liver with surface nodularity and fissural widening. There is diffuse reticular increased T2 signal compatible with fibrosis. Unchanged ablation defect in segment 6/7.There is a focus of arterial enhancement in segment 6 which measures 1.3 x 0.9 cm. There is no definite washout, restricted diffusion, or associated T2 signal abnormality, however this lesion remains suspicious as it has approximately doubled in size compared to the prior exam.No focal lesions meeting diagnostic criteria for hepatocellular carcinoma.The hepatic artery, hepatic veins, and portal veins are patent. No intrahepatic or extrahepatic biliary ductal dilatation.SPLEEN: Borderline splenomegaly with the spleen measuring 13 cm in length.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Large gastroesophageal varices.

Output: 1.Segment 6 arterial enhancing 1.3 cm lesion as described above. While not meeting definitive criteria for hepatocellular carcinoma, this lesion remains suspicious as it has doubled in size since the prior exam. Short interval follow-up is recommended.2.Hepatic cirrhosis with borderline splenomegaly and prominent gastroesophageal varices formation.


Instruction: Generate impression based on findings.

Input: 50 year old man with heart/kidney transplant on 10/22/15, referredfor serial MRI as part screening for cardiac allograft rejection Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 57%, the LV end diastolic volume index is 78 ml/m2 (normal range: 74+/-15), the LVEDV is 152 ml (normal range 142+/-34), the LV end systolic volume index is 34 ml/m2 (normal range 25+/-9), the LVESV is 66 ml (normal range 47+/-19), the LV mass index is 32 g/m2 (normal range 85+/-15), and the LV mass is 63 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is consistent with cardiac transplant. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 51%, the RV end diastolic volume index is 85 ml/m2 (normal range 82+/-16), the RVEDV is 167 ml (normal range 142+/-31), the RV end systolic volume index is 42 ml/m2 (normal range 31+/-9), and the RVESV is 82 ml (normal range 54+/-17).Right AtriumThe right atrium is consistent with cardiac transplant.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size. Evidence of aortic anastomosis at approximately 6 cm above the aortic valve. Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is mildly dilated (30 mm).Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is a small pericardial effusion. There is no apparent hemodynamic compromise from pericardial effusion. Extracardiac FindingsSternotomy wires are present consistent with previous cardiac surgeries. Bilateral gynecomastia is present.

Output: 1. The left ventricle is normal in size and systolic function. The overall LV ejection fraction is 57%. This LVEF is slightly lower than previous study, however, still within normal range. There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.2. The right ventricle is normal in size and systolic function. The overall RV ejection fraction is 51%3. Small pericardial effusionAddendum to follow with calculations of ECV and T1 times


Instruction: Generate impression based on findings.

Input: Male, 5 years old. History of neuroblastoma now with bruising around left eye. The new lobular, T1 hypointense, T2 heterogeneous mass within the left masticator space and infratemporal fossa measuring approximately 4.0 cm has diffuse heterogeneous enhancement and diffusion restriction. There is a small enhancing lobule extending cranially into the posterior aspect of the left lateral extraconal space with mild mass effect on the lateral rectus muscle (series 801, image 8). There is focal narrowing of the proximal optic canal with decreased visualized fluid within the optic nerve sheath at this level, but the nerve does not appear invaded by tumor.There is a cordlike area of enhancement along the left V2 nerve through the foramen rotundum. There is loss of the lateral wall cortex of the vidian canal with nodular enhancement superomedially. There is diminished caliber of the left pterygomaxillary fissure and pterygopalatine fossa without frank enhancement within the structures. There is extension of the tumor through the widened left foramen ovale into the extradural space in the middle cranial fossa inferior to the temporal lobe (series 701, image 5). There is an extradural enhancing nodule measuring 7 x 6 cm adjacent to the inferior left frontal lobe laterally (series 801, image 3), compatible with tumor extension, with subtle FLAIR abnormality in the adjacent brain parenchyma seen on prior noncontrast MRI. There is a an additional small enhancing lobulation anterior to the left temporal lobe (series 801, image 9).Additionally, there is new/increased masslike enhancing soft tissue surrounding the mandibular rami, right greater than left (series 701, image 4) which is favored to represent additional tumor, although there may be a component of adjacent local lymphadenopathy as well. These areas of soft tissue demonstrate diffusion restriction. The vestibular rami marrow signal is now STIR hyperintense, further suggesting osseous involvement. Additional small cervical lymph nodes are partially imaged. There is scattered mild paranasal sinus mucosal thickening.There is no evidence of intracranial hemorrhage or acute infarct. There is mild mega cisterna magna. Otherwise, the ventricles and basal cisterns are normal in size and configuration. There is no midline shift. The midline structures and craniocervical junction are within normal limits. Normal flow-voids are demonstrated in the major intracranial vascular structures. There is scattered mild paranasal sinus mucosal thickening as well as scattered mastoid air cell opacification bilaterally.

Output: 1. An enhancing 4 cm mass in left masticator space/infratemporal fossa with extension into the left orbit, along the V2 and V3 cranial nerves as detailed above. There is extradural extension into the left middle cranial fossa, with mild mass effect on the adjacent inferior temporal lobe, consistent with neuroblastoma. Dedicated skull base CT imaging can be obtained for further evaluation of skull base osseous involvement.2. Additional enhancing soft tissue surrounding the STIR hyperintense mandibular rami, right greater than left, is consistent with additional tumor, although there may be a component of adjacent local lymphadenopathy as well.


Instruction: Generate impression based on findings.

Input: 56-year-old male with elevated PSA. Evaluate.3/24/16- PSA 9.4 with free 20%. negative prostate biopsy at Rush PELVIS:PROSTATE:Prostate Size: 4.7 x 5.5 x 3.4 cmPeripheral Zone: There is low T2 signal throughout the posterior peripheral zone at the level of the base which may represent prostatitis. No definite suspicious for prostatic nodule.Central Gland: Heterogeneous and nodular appearance compatible with benign prostatic hypertrophy.Seminal Vesicles: No seminal vesicles extension.Extracapsular Extension: No extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: Nonspecific mildly enlarged inguinal lymph nodes.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Diffuse low T2 signal in the peripheral zone at the base may be secondary to prostatitis. 2.No suspicious lesions identified.


Instruction: Generate impression based on findings.

Input: Female, 30 years old, with history of lumbar fusion and stenosis, presenting with back and leg pain. Evidence of anterior instrumented and interbody fusion is seen at L5-S1. At least partial laminectomy is also evident at this level. No marrow replacement or marrow edema is seen. The remaining vertebral bodies are normal in morphology and signal. The distal spinal cord, conus and nerve roots of the cauda equina are within normal limits. No epidural abnormalities are suspected.The intervertebral disc at L5-S1 has been surgically extirpated. The intervertebral discs at the remaining lumbar levels are preserved. Moderate facet arthropathy is seen at L4-5 and L5-S1. No significant spinal canal or foraminal compromise is detected at any level. There is perhaps a grade 1 retrolisthesis of L5 relative to S1. Spinal alignment elsewhere is anatomic.

Output: Findings are seen compatible with anterior and interbody fusion at L5-S1. A partial laminectomy has also been performed bilaterally at this level. No marrow abnormalities are seen. In addition, the spinal canal and neural foramina are patent throughout. The remaining intervertebral discs are preserved.


Instruction: Generate impression based on findings.

Input: The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Incidental small parafalcine calcification is again noted. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. The optic nerves, chiasm, and tracts appear normal. There is no optic nerve sheath dilatation. The extraocular muscles are normal and symmetric. The globes appear normal. No retinal detachment or vitreous clouding. The lacrimal glands are symmetric and within normal limits for size. No orbital mass lesion.

Output: Although pre-and postcontrast MRI was ordered of the brain and orbits, the patient refused to continue. Several repeat sequences were obtained to attempt to acquire a diagnostic study. The patient became nauseous before contrast could be administered. Thus, contrast could not be administered which limits the sensitivity of the study. Given these caveats, negative noncontrast MRI of the brain and orbits. Specifically, there are no noncontrast MRI findings to explain the patient's symptoms.


Instruction: Generate impression based on findings.

Input: 34 years, Female, Reason: pt with pelvic mass vs. pedunculated fibroid seen on previous scan, check for increase size, adenopathy History: abdominal pain/distension. PELVIS: FemaleUTERUS, ADNEXA: Large exophytic lesion arising from the fundus of the uterus is increased in size measuring 20.1 x 8.8 x 19.0 cm (4/26 and 5/26), previously 17.7 x 9.1 x 18.0 cm. This lesion is primarily low signal on T2 weighted images with areas of increased areas of increased T2 signal, likely representing cystic degeneration. There is displacement but no evidence of invasion of surrounding structures.Normal ovarian follicles are present bilaterally.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small amount of free fluid in the pelvis.

Output: Large exophytic lesion arising from the uterus is increased in size and most likely represents a pedunculated fibroid. However, while there is no invasion of surrounding structures or lymphadenopathy, a leiomyosarcoma cannot be excluded.


Instruction: Generate impression based on findings.

Input: History of ADEM most prominently involving her brainstem several months prior, who finished her steroids 3 weeks prior, and 2 weeks after steroid cessation, started having a bad throbbing frontal and all over headache, as well as sensitivity to light/ sound, with nausea and vomiting. There has been interval evolution of postsurgical findings related to right frontal approach stereotactic biopsy of the right pons, with a small focus of susceptibility effect at the biopsy site. There is now only a residual punctate focus of enhancement in the left anterior pons. There are no new lesions. There is no evidence of acute intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits and paranasal sinuses are grossly unremarkable.

Output: Interval evolution of postsurgical findings related to right frontal approach stereotactic biopsy of the right pons, with near-interval resolution of the pontine inflammatory process and no new lesions.


Instruction: Generate impression based on findings.

Input: Evaluate for primary sclerosing cholangitis and Crohn's disease. Abnormal LFTs. ABDOMEN:LIVER, BILIARY TRACT: Mild steatosis. Mild fissural prominence. Borderline hepatomegaly measuring 22.5 cm in length. No focal lesion, biliary ductal dilatation or vascular abnormality. The biliary system is unremarkable. Normally distended gallbladder.SPLEEN: The spleen measures 12.8 cm in length without a focal lesion.PANCREAS: Pancreas divisum with sidebranch ectasia. No specific findings of acute pancreatitis.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Multiple large porta hepatis lymph nodes. An anterior lymph node measures 2.1 x 1.4 cm (series 3/20).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Mild hepatic steatosis with hepatomegaly. Fissural prominence raising possibility of chronic liver disease. Porta hepatis lymph nodes may be related to acute and/or chronic liver disease.2.No focal liver lesion or specific findings of PSC.3.Pancreas divisum with side branch ectasia, which can be seen in early chronic pancreatitis. No findings of acute pancreatitis.


Instruction: Generate impression based on findings.

Input: AML status post allo transplant complicated by GVHD, with new altered mental status. There is focus of blooming effect in the right cerebellar hemisphere, which may represent hemosiderin deposition or mineralization. There is scattered periventricular and subcortical white matter T2 hyperattenuation. Otherwise, there is no evidence of tumors or acute infarction. The ventricles and sulci are mildly prominent diffusely due to cerebral volume loss. There is no midline shift or herniation. The pituitary gland appears unremarkable. There is fluid within the bilateral mastoid air cells. There is mild mucosal thickening in the right maxillary sinus and scattered ethmoid air cells. The orbits and calvarium are unremarkable.

Output: 1. No abnormal diffusion restriction or acute intracranial hemorrhage.2. Scattered periventricular and subcortical white matter hyperattenuation is nonspecific, but may represent chronic small vessel ischemic disease3. Nonspecific focus of blooming effect in the right cerebellar hemisphere, which may represent hemosiderin deposition or mineralization. 4. Bilateral fluid-filled mastoid air cells, which may represent mastoiditis.


Instruction: Generate impression based on findings.

Input: Female, 34 years old, with history of p53 mutation, Li-Fraumeni syndrome, bilateral breast cancer with increasing right sided level 1 lymph nodes. A cluster of small lymph nodes is evident at level Ib bilaterally. None of these is large enough to meet imaging criteria for pathologic enlargement. However, the cluster on the right does correlate with increased FDG uptake on prior PET scanning.Multiple prominent cervical lymph nodes are identified elsewhere on both sides of the neck including at level II bilaterally and level III on the left. For reference, one of the left level II nodes measures 15 x 14 mm (image 22 series 8). The aggregate at level III contains foci of susceptibility which may reflect calcifications or surgical clips. Although the CT portion of the prior PET/CT is inadequate for accurate comparison, these nodes do seem to have been present on that exam.The aerodigestive tract is unremarkable. The salivary glands and thyroid are free of suspicious focal lesions. The marrow signal characteristics are unremarkable.

Output: A cluster of small lymph nodes is evident at level Ib on the right. Although none of these reaches imaging criteria for pathologic enlargement, the cluster does correlate with increased FDG uptake on a prior PET scan.Pathologically enlarged lymph nodes and nodal aggregates are detected elsewhere, particularly in the left neck, but these were likely present on prior PET/CT where they showed only mild FDG uptake.


Instruction: Generate impression based on findings.

Input: Right shoulder pain, history of rotator cuff repair 12 years ago. Evaluate for rotator cuff arthropathy. Tubular foci of signal abnormality are noted in the humeral head extending to the greater tuberosity anteriorly and laterally presumably representing suture anchor tracks from prior rotator cuff repair.ROTATOR CUFF: There is a complete tear of the supraspinatus tendon with retraction to the glenohumeral joint. There is mild fatty atrophy of the supraspinatus muscle. This tear extends posteriorly to involve the majority of the infraspinatus tendon, although there are perhaps a few posterior fibers that extend to the greater tuberosity. There is severe fatty atrophy of the infraspinatus muscle. The teres minor muscle and tendon are intact. There is also tendinosis and interstitial tearing of the subscapularis tendon, although we are not convinced that there is a full-thickness tear. There is mild atrophy of the superior portion of the subscapularis muscle.SUPRASPINATUS OUTLET: Moderate osteoarthritis affects the acromioclavicular joint. There is a mild deformity that likely represents a combination of prior surgery and osteoarthritis. There is a small amount of fluid in the subacromial space as a result of the patient's large rotator cuff tear. Little if any fluid is present in the subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is elevation of the humeral head with narrowing of the acromiohumeral interval to 1 to 2 mm. There is mild acetabularization of the acromion as well as mild subchondral sclerosis along the superior aspect of the humeral head. Moderate to severe osteoarthritis affects the glenohumeral joint with portions of the glenoid appearing to be devoid of articular cartilage. There is heterogeneity of the glenoid labrum circumferentially likely representing degenerative tearing. A small amount of fluid is present in the glenohumeral joint. Intermediate signal intensity in the axillary recess likely represents synovitis.BICEPS TENDON: The tendon of the long head of the biceps is not well visualized in the bicipital groove nor within the rotator interval and we suspect it is ruptured.

Output: Large rotator cuff tear and associated moderate to severe osteoarthritis of the shoulder with other findings as above.


Instruction: Generate impression based on findings.

Input: Male, 54 years old, with recurrent T2 N2b squamous cell carcinoma of the base of the tongue, on protocol 12-1554 finished 4.5 cycles of TFHX on 5/4/16. Please evaluate and compare to previous scans. Since the prior examination, evidence of interval resection and soft tissue flap reconstruction are demonstrated involving the left oral tongue, floor of mouth and part of the left pharynx. Within this distorted postoperative background, no definite evidence of residual or recurrent tumor is seen. The residual native mucosa, and particularly that of the soft palate, is edematous likely related to surgery and treatment.Artifact related to orthopedic fixation is seen along the left paramedian mandible. Evidence of interval left neck dissection is seen including a very small seroma tracking through the surgical plane. No evidence of pathologic adenopathy is detected. No other masslike lesions are seen. The marrow signal characteristics are unremarkable.

Output: Postoperative findings are demonstrated compatible with interval resection and reconstruction of the left oral tongue, floor of mouth and pharynx. Sequelae of left neck dissection are also noted. Within this postoperative background, no evidence of residual or recurrent primary tumor or pathologic adenopathy is seen.


Instruction: Generate impression based on findings.

Input: 61-year-old female with rectovaginal fistula, hypertension, CAD PELVIS:UTERUS, ADNEXA: Small amount of fluid within the endometrial canal. Marked thickening and enhancement of the vaginal walls diffusely. The ovaries are not definitely identified. T2 cystic lesion left of the uterus may be a paraovarian cyst.BLADDER: Bladder wall thickening may be partially secondary to under distention.BOWEL, MESENTERY: A large colovaginal fistula with gas and fluid is identified extending from the sigmoid colon to the posterior wall of the vagina. At a more proximal level, there is mild T2 linear signal extending from the anterior wall of the sigmoid colon to the posterior wall of the upper vagina/cervix raising question of a second fistula (series 6, image 21). There is marked diffuse sigmoid colon and rectum wall thickening and enhancement. Bilateral, enhancing and necrotic exophytic soft tissue lesions are noted extending into the adjacent ischioanal fat compatible with necrotic tumor.Focal mildly T2 hyperintense sigmoid colon wall thickening is noted on the right.A left lower quadrant ostomy is identified.BONES, SOFT TISSUES: Asymmetric edema type signal is noted within the pelvic musculature including the iliacus, right greater than left obturator internus, and piriformis musculature. Edema signal is also noted in the gluteal cleft and perineal regions.OTHER: Small amount of free fluid within the pelvis. Partially imaged mild right hydroureter.

Output: 1.Large colovaginal fistula with gas and fluid is identified extending from the sigmoid colon to the posterior wall of the vagina. Additional 2nd more proximally located fistula suggested near level of cervix.2.Multiple exophytic enhancing and necrotic appearing lesions arising from the rectosigmoid colon compatible with necrotic tumor invading the adjacent soft tissues.3.Asymmetric edema type signal is noted within the pelvic musculature, e.g., the iliacus, right greater than left obturator internus, and piriformis musculature.4.Partially imaged mild right hydroureter may reflect an element of associated urinary obstruction.


Instruction: Generate impression based on findings.

Input: New onset of dizziness and history of metastatic breast cancer. There is a heterogenously enhancing mass with small areas of susceptibility effect in the right cerebellar hemisphere that measures up to 35 mm, with extensive surrounding edema and marked effacement of the fourth ventricle, as well as mild inferior cerebellar herniation. There is also a 5 mm wide left cerebellar hemisphere enhancing lesion with associated vasogenic edema. There is a punctate enhancing lesion at the grey white matter junction of the left posterior occipital lobe. There appears to be a small developmental venous anomaly in the left inferior frontal gyrus. There is dilatation of the third and lateral ventricle with diffuse periventricular T2 hyperintensity. There is no evidence of acute infarct. There is dilatation of the bilateral optic nerve sheaths, which attests to elevated intracranial cerebrospinal fluid pressure. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. Bilateral cerebellar hemisphere metastases, right larger than left with extensive vasogenic edema associated with effacement of the fourth ventricle, acute obstructive hydrocephalus and mild inferior cerebellar herniation.2. A punctate enhancing lesion at the grey white matter junction of the left posterior occipital lobe likely represents a metastasis as well. Discussed with Dr. Nanda at 10:30 AM on 1/28/16.