Instruction: Generate impression based on findings.

Input: Hemangioma of intracranial structures [D18.02], Reason for Study: ^Reason: Please page neurosurgery resident to place fiducials, PRE-OP STEALTH MRI, DO IN CCD History: PRE-OP STEALTH MRI FOR BRAINSTEM CAVERNOMA REMOVAL Multiple fiducial markers attached on the scalp per Stealth protocol.There is lobulating contoured pontine cavernous malformation which is located left posterior aspect and extends from midbrain to the level of left side middle cerebellar peduncle. The size of the lesion is about 28.3mm (RL) x 17.7mm (AP) x 28.2mm (CC).Surrounding edema seen on the midbrain as well as left middle cerebellar peduncle indicate possible recent hemorrhagic event. Comparing to prior scan, the extent of surrounding edema appears to be slightly lessen since prior scan.Otherwise, the ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: Preoperative stealth protocol MRI has been performed.Large pontine cavernous malformation centered at the posterior and left lateral aspect of pons with evidence of recent hemorrhagic event, redemonstrated, slightly decreased extent of edema since prior scan.


Instruction: Generate impression based on findings.

Input: Leg and arm weakness, severe back pain shooting to legs Cervical: Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. There is loss of cervical lordosis with mild kyphotic angulation of the apex at the C3-C4 level. There is minimal anterolisthesis of C3 on C4. Bone marrow signal is benign. Examination is motion degraded but demonstrates no convincing cord signal abnormality. Degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: There is disc osteophyte complex and uncovertebral hypertrophy with partial effacement of the ventral thecal sac. No significant spinal canal stenosis. There is moderate right neural foraminal stenosis. Mild left neural foraminal stenosis. Prominent facet arthropathy on the right.C4-5: No significant spinal canal stenosis. Mild uncovertebral hypertrophy on the left with mild left and no significant right neural foraminal stenosis. C5-6: Uncovertebral hypertrophy with mild to moderate left and mild right neural foraminal stenosis. No significant spinal canal stenosis. C6-7: Disc osteophyte complex and uncovertebral hypertrophy. There is no significant spinal canal stenosis. There is mild bilateral, left worse than right, neural foraminal stenosis. Facet arthropathy, worse on the left.C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.Lumbar: 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 with T1 hyperintense lesion at L1 compatible with hemangioma. The conus medullaris is normal in position.Multilevel degenerative changes are seen, as described below:L1-L2: Minimal disc bulge. No spinal canal or neural foraminal stenosis.L2-L3: Minimal disc bulge. No spinal canal or right neural foraminal stenosis. Minimal left neural foraminal narrowing.L3-L4: Mild disc bulge. No spinal canal stenosis. Mild right and minimal left neural foraminal stenosis.L4-L5: Mild disc bulge. There is bilateral facet arthropathy. No significant spinal canal stenosis. There is mild left neural foraminal stenosis.L5-S1: Mild disc bulge. There is advanced facet arthropathy on the left. There is moderate to severe left neural foraminal stenosis where there may be impingement of the left L5 nerve root. No significant right neural foraminal narrowing.Paraspinous soft tissues are within normal limits. Bilateral renal cysts are noted.

Output: 1. Multilevel degenerative changes in the cervical spine without high-grade spinal canal stenosis at any level. No cord signal abnormality. Multilevel neural foraminal stenosis, worst at the right C3-C4 level. Additional levels as above.2. Multilevel degenerative changes in the lumbar spine. There is moderate to severe left L5-S1 neural foraminal stenosis where there is suspected impingement of the left L5 nerve root. No significant spinal canal stenosis. Additional levels as above.


Instruction: Generate impression based on findings.

Input: The patient's lytic defect involving the right anterior mandibular body has better osseous characterization on the recent CT. Within the lytic defect proper, the MRI demonstrates ill-defined T2 hyperintensity and enhancement which extends into adjacent soft tissues. A central masslike portion measures 20 x 14 mm in axial dimension, yet signal and enhancement abnormality extends beyond this. There is an adjacent right-sided 14 x 10 mm rounded enhancing submandibular lymph node. A previously described small lucency within the left fibular condyle also demonstrates enhancement and T2 hyperintensity, which may indicate another myelomatous lesion, especially given the lack of degenerative findings of the left TMJ. The remainder of the mandible demonstrates a benign marrow signal.Redemonstrated is a left torus mandibularis. Previously identified lucencies within the cervical spine, particularly anterior aspects of the C4 and C5 vertebral bodies, are not well characterized on the current study given MRI face acquisition technique, although there is a suggestion of enhancement on the sagittal THRIVE sequence at these aforementioned levels.Minimal sporadic mucosal thickening in the paranasal sinuses is again noted. Redemonstrated are intraocular lens implants and a right scleral buckle.

Output: 1.Within a right anterior mandibular lytic defect, there is ill-defined T2 hyperintensity and enhancement which extends into adjacent soft tissues. A central masslike portion measures 20 x 14 mm in axial dimension, yet signal and enhancement abnormality extends beyond this. 2.There is an adjacent right-sided 14 x 10 mm rounded enhancing submandibular lymph node. 3.A lesion within the left mandible condyle is suspicious for a myelomatous lesion.4.There are findings suggestive that C4 and C5 lytic lesions identified on CT demonstrate enhancement. However, these are not well characterized on the current study given MRI face acquisition technique.


Instruction: Generate impression based on findings.

Input: Ms. Booth is a 40-year-old female with known left breast cancer and metastatic left axillary lymph node. She presents today for MR imaging to evaluate response to neoadjuvant chemotherapy. Minimal parenchymal enhancement is noted bilaterally.Left breast: There has been an interval decrease in size of the biopsy proven malignancy within the left upper outer breast, 2 o'clock position. This malignancy now measures 1.4 x 0.7 x 0.7 cm, compared to 2.0 x 2.0 x 1.9 cm. Previously identified satellite lesions along with linear non-mass enhancement is no longer seen to enhance on today's examination. There has also been an interval decrease in size of previously visualized abnormal lymph nodes in the left axillary and left subpectoral regions. Previously measured left axillary lymph node now measures 0.6-cm, compared to 1.8-cm. The left subpectoral lymph node now measures 0.5-cm, compared to 0.9-cm.Right breast: There is no new abnormal enhancement seen in the right breast. No abnormal axillary lymph nodes are identified in the right axillary region.

Output: 1.Interval decrease in size of the primary malignancy with complete imaging response of the satellite lesions and non-mass enhancement in the left breast.2.Interval decrease in size of left axillary lymph nodes.3.No MR evidence of malignancy in the right breast.BIRADS: 6 - Known cancer. RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Male, 88 years old, with right lower extremity weakness and speech difficulty. Several small scattered foci of mild diffusion restriction are seen involving the left corona radiata and left insular cortex with questionable additional foci in the left middle frontal gyrus and frontal operculum.No evidence of parenchymal mass effect is seen. No intracranial hemorrhage or any abnormal extra-axial fluid collection is detected. Patchy periventricular T2 hyperintensity is seen, a nonspecific finding which most likely reflects chronic microvascular ischemic disease. The ventricles and sulci are mildly prominent compatible with volume loss.The marrow signal characteristics are unremarkable. Mucosal thickening and secretions are evident within the left maxillary sinus. The mastoid air cells show evidence of opacification.

Output: Scattered foci of mild restricted diffusion are seen involving the left corona radiata and insular cortex, with a few additional questionable foci as above. This is compatible with late acute or perhaps subacute ischemic injury.Discussed with Dr. Cejas at 8:50 AM on 2/9/15.


Instruction: Generate impression based on findings.

Input: Pain, check for ligamentous injury MENISCI: Multiple bilateral medial and lateral abnormalities. A largely vertical tear through the posterior horn of the medial meniscus extends to the superior articular surface and runs more horizontally into the body. Questionable extension to the inferior margin. The lateral meniscus is significant for 2 linear tears, with one oblique tear extending to both the superior and inferior margins involving the anterior horn and a vertical tear through the posterior horn. Mild extrusion of both menisci are also observedARTICULAR CARTILAGE AND BONE: Mild thinning diffusely of the cartilage with heterogeneous signal observed in both the medial and lateral compartments, largely involving the condylar surfaces. No distinct focal defects. Underlying suspected contusion throughout the tibial plateau and lateral femoral condyle, greater involving the lateral compartment overall.LIGAMENTS: ACL is torn and demonstrates considerable retraction, questionable appearance partially to the PCL and tibial spines. The PCL, patellar and extensor complex are otherwise intact. The LCL is intact. The short component appears mildly thickened with minimal nonlinear internal signal, representing a partial strain . MCL is grossly intact EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: ACL tear with bilateral medial and lateral meniscal tears. See detail provided


Instruction: Generate impression based on findings.

Input: Male 65 years old with left posterior shoulder mass. Evaluate for interval change. There is a lobulated mass confined within the posterior subcutaneous fat overlying the scapula. It has high T1 signal and areas of high T2 signal on fat-saturated images. Mild enhancement is again seen on the postcontrast images with the majority of enhancement along the periphery and within septations similar to the previous exam. The lesion measures approximately 12.1 x 3.2 cm in transverse and AP dimension (series 6, image 25) and 14.0 cm in craniocaudal dimension (series 8, image 18). This is minimally increased in size but stable in imaging characteristics compared to the prior studies. Differences in size may be due to differences in plane of imaging and measurement techniques.This exam was not tailored for evaluation of the rotator cuff however there is increased signal intensity within the anterior fibers of the supraspinatus tendon suggesting a articular sided partial-thickness tear. There are small degenerative cysts in the underlying humeral head.

Output: Slight increase in size but stable imaging appearance of the predominantly fatty mass in the posterior subcutaneous tissues overlying the scapula. Differential considerations again include hypernephroma, atypical lipoma and atypical lipomatous tumor.


Instruction: Generate impression based on findings.

Input: History of metastatic renal cancer status post RFA of a liver lesion. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology size and signal intensity.There is a 5 mm focus of arterial enhancement in segment 4A (series 1002/577), new from the priors. Minimal associated restricted diffusion.Post ablation changes of the inferior right hepatic lobe with associated perfusion anomaly. The ablation zone measures approximately 9 mm without definite enhancement.No intra or extrahepatic biliary ductal dilatation. Normally distended gallbladder.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Status post left nephrectomy. No evidence of residual or recurrent tumor in the nephrectomy bed. The right kidney is unremarkable.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Incompletely imaged ventral abdominal wall diastases/hernia.OTHER: No significant abnormality noted.

Output: 1.New segment IVa 5 mm arterially-enhancing focus is suspicious for metastatic disease.2.Stable post-ablation changes of the inferior aspect of the right hepatic lobe.3.Stable postsurgical changes from left nephrectomy.


Instruction: Generate impression based on findings.

Input: Head and neck cancer with brain metastasis status post SRS: 3 month follow up. There has been decrease in size of the left cerebellar hemisphere lesion with susceptibility effect, which measures up to 8 mm, as opposed to 18 mm in October 2014. There is no discernible surrounding vasogenic edema. There is no evidence of acute infarct. There are a few nonspecific scattered punctate foci of T2 hyperintensity in the white matter. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There are bilateral lens implants. There appears to be fluid within the right maxillary sinus. There are post-treatment findings in the partially-imaged upper neck and denervation atrophy of the right tongue.

Output: 1. Interval decrease in size of the treated left cerebellar metastasis.2. Findings suggestive of right maxillary acute sinusitis.


Instruction: Generate impression based on findings.

Input: Back pain with radicular pain. Rule out lumbar stenosis. Five lumbar type vertebral bodies are presumed to be present. There is a chronic appearing compression fracture involving the superior endplate of the L4 vertebral body with approximately 30% loss of height involving the right aspect of the vertebral body. No edema involving the bone marrow. Remainder of the vertebral body heights are within normal limits. There is minimal anterolisthesis of L3 on L4 and L4 on 5. Alignment is otherwise within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position at the L1-L2 level. There is fatty infiltration involving the filum terminale from the L2 level to the sacrum measuring 1 to 2 mm.There is developmental narrowing of the lumbar spinal canal and epidural lipomatosis resulting in moderate L2-L3, severe L3-L4, and moderate to severe L4-L5 spinal canal stenosis. There are additional multilevel degenerative changes as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: Mild disc bulge, ligamentum flavum thickening, and facet arthropathy. There is moderate spinal canal stenosis primarily related to developmental narrowing and epidural lipomatosis. Neural foramina are patent.L3-L4: Disc bulge, ligamentum flavum thickening, and moderate bilateral facet arthropathy. There is severe spinal canal stenosis related to developmental narrowing and epidural lipomatosis with superimposed aforementioned degenerative changes. Mild bilateral neural foraminal narrowing, relatively worse on the right.L4-L5: Disc bulge with advanced facet arthropathy and prominent ligamentum flavum thickening. There is also prominence of the epidural fat. There is resulting moderate to severe spinal canal stenosis. Mild right and mild to moderate left neural foraminal stenosis. Distention of the facet joint on the right.L5-S1: Mild disc bulge, ligamentum flavum thickening, and bilateral facet arthropathy. Mild spinal canal stenosis. Mild to moderate bilateral neural foraminal stenosis.

Output: 1. There is severe L3-L4 and moderate to severe L4-L5 spinal canal stenosis related to combination of developmental narrowing, epidural lipomatosis, and superimposed degenerative changes. There is no high-grade neural foraminal stenoses at any level although there is mild or mild-to-moderate multilevel foraminal stenoses. Please see additional details above.2. Prominent facet arthropathy from L3-L4 to L5-S1. Minimal anterolisthesis of L3 on L4 and L4 and 5.3. Fatty infiltration of the filum terminale with normal conus position.4. Chronic mild compression fracture involving the L4 vertebral body without bone marrow edema.


Instruction: Generate impression based on findings.

Input: 52-year-old female presents with right lateral knee pain after an injury. MENISCI: There is a tiny focus of intermediate signal intensity along the undersurface of the free edge of the body of the lateral meniscus that may represent fraying or perhaps a tiny inner-edge tear. No fluid-filled defect or other specific findings to suggest an unstable tear. The anterior and posterior horns of the lateral meniscus appear normal. The body of the medial meniscus appears slightly small, but no medial meniscal tear is identified.ARTICULAR CARTILAGE AND BONE: There is partial-thickness degeneration of the articular cartilage along the medial facet of the femoral trochlea as well as small subchondral cysts in the lateral tibial plateau indicating mild osteoarthritis. The bone marrow signal intensity is otherwise normal.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: Small focus of intermediate signal intensity along the free edge of the body of the lateral meniscus suggests mild fraying or perhaps a tiny inner-edge tear. No fluid-filled defect or other specific findings to suggest an unstable tear.


Instruction: Generate impression based on findings.

Input: Rule-out ligamentous tear versus osteoarthritis. Pain ROTATOR CUFF: Marked atrophy of the supraspinatus and subscapularis with associated complete tendonous full-thickness tear with associated marked retraction. Fibers of the infraspinatus are observed to insert with only mild tendinopathy. Teres minor is grossly intactSUPRASPINATUS OUTLET: Bone-on-bone narrowing superiorly with moderate superimposed osteoarthritic changes with a mildly downward sloping acromion.GLENOHUMERAL JOINT AND GLENOID LABRUM: The labra is grossly intact in the absence of an augmented exam. Extensive degenerative changes including scattered subchondral cysts, osteophytes and cortical thickening/irregularity.BICEPS TENDON: The biceps tendon is grossly intact yet not well visualized. Central signal suggest a longitudinal intrasubstance tear with mild to moderate tendinopathy.ADDITIONAL

Output: Extensive marked rotator cuff tear involving the supraspinatus and subscapularis along with changes of the biceps tendon and other less pronounced changes. See detail provided.


Instruction: Generate impression based on findings.

Input: Ms. Herrera is a 61 year old female with newly diagnosed left breast cancer with metastatic left axillary lymph node. Ultrasound examination from OSH suggested additional satellite lesions in the same breast. She presents today for MRI evaluation for staging. There is heterogeneous amount of fibroglandular tissue in both breasts. Marked nodular background parenchymal enhancement is noted bilaterally, which limits the sensitivity of this examination.LEFT BREAST: In the left upper inner breast, there is an irregular enhancing mass identified measuring approximately 2.8 x 2.1 x 2.6 cm (AP x ML x SI). Susceptibility artifact from biopsy marker clip is seen at the superolateral aspect, compatible with biopsy-proven malignancy.Seen just superior to this index malignancy is an additional irregular enhancing mass measuring approximately 1.5 x 1.4 x 1.3 cm. This was seen on the outside hospital ultrasound from 10/2016, and is highly suspicious for satellite lesion. In addition, seen just inferior to the index malignancy is an additional irregular enhancing mass (seen on the outside hospital ultrasound from 10/2016 labeled as 9:00 lesion) suspicious for additional satellite lesion, measuring approximately 1.0 x 1.4 x 1.2 cm. The total span of abnormal enhancement (index malignancy + 2 additional suspicious satellite lesions) measures approximately 3.1 x 2.6 x 4.8 cm.In the left lower outer breast, there is an irregular enhancing mass identified measuring approximately 0.7 x 1.0 x 1.4 cm. Susceptibility artifact from biopsy marker clip is seen at the inferior aspect of this lesion, compatible with biopsy proven radial scar.In the left breast, there are several oval enhancing lesions identified, the largest one of which is located in the far posterior depth measuring up to 1.1 cm. These are compatible with benign fibroadenomata. RIGHT BREAST: No suspicious enhancement is identified within the right breast.AXILLAE: In the left axilla, there is a single abnormal morphology lymph node identified measuring approximately 1.9 x 1.5 x 1.5 cm. This likely represents the biopsy-proven metastatic left axillary lymph node with no associated biopsy marker clip.There are no abnormal lymph nodes identified in the right axillary region.

Output: (1) Biopsy-proven index malignancy of the left upper inner breast with two associated satellite lesions. Total span of abnormal enhancement measures approximately 4.8 cm in the SI dimension. Ultrasound-guided biopsy with clip placement can be performed for these 2 additional satellite lesions as clinically warranted.(2) Biopsy-proven radial scar of the left lower outer breast with associated enhancement. If this area is to be excised, please note that the biopsy marker clip is seen inferior and lateral to the area of abnormal enhancement.(3) Metastatic left axillary lymph node with no associated biopsy marker clip. A biopsy marker clip can be placed into this lymph node if clinically warranted.(4) No MRI evidence of malignancy of the right breast.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Ms. Kohut is a 47 year old female with a personal history of right breast lumpectomy in 2010 for DCIS treated with radiation. She has no current breast complaints. There is heterogeneous amount of fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.Expected postsurgical changes are seen in the right upper inner breast. Few scattered foci of enhancement are seen bilaterally, none of which are more suspicious than the rest. No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary or internal mammary region.

Output: Expected postsurgical changes of the right breast. No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: 63 year old female with history of compression fracture and kyphoplasty. Recent fall. Evaluate for compression fracture. Additional history per EMR: Bilateral lower extremity weakness. Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.There has been interval kyphoplasty at T12, L1, and L3. There is new L2 superior endplate depression as well as compression deformity seen at L4 with approximately 40% loss of height. No associated retropulsed fragments are identified.At L1-2 there is no significant compromise to spinal canal or neural foramina, unchanged.At L2-3 there is no significant compromise to spinal canal or neural foramina, unchanged.At L3-4 there is mild facet hypertrophy, ligamentum flavum hypertrophy and minimal disk bulge with minimal central canal stenosis and no significant neuroforaminal narrowing, unchanged.At L4-5 there is moderate facet hypertrophy, ligamentum flavum hypertrophy and mild disk bulge with mild central canal stenosis and mild bilateral neuroforaminal narrowing, unchanged.At L5-S1 there is eccentric, left greater than right disk bulge, mild facet hypertrophy and ligamentum flavum hypertrophy. These findings result in mild central canal stenosis, as well as mild right and moderate left neuroforaminal narrowing, unchanged.

Output: 1.New L2 and L4 compression deformities.2.Interval kyphoplasty of T12, L1, and L3 vertebrae.3.Degenerative changes of the lumbar spine, with mild central canal stenosis at L4-5 and moderate left L5-S1 neuroforaminal narrowing, not significantly changed.


Instruction: Generate impression based on findings.

Input: 62 years, Male, GBM, 4 week post RT. Again seen are postsurgical changes related to biopsy of paramedian right frontal lobe mass which measures approximately 3.5 x 2.3 cm in the AP and transverse dimensions, previously 2.9 x 1.7 cm, measured similarly in the axial plane. In particular, there has been significant increase in masslike nodular thickening involving the right lateral aspect of the lesion. More medial necrotic component is slightly increased in size as well, and there appears to be more necrosis involving the previously more solid component medially. Lesion again extends to the dural surface and associated with mild adjacent leptomeningeal enhancement which was seen previously and suspicious for leptomeningeal involvement. There is surrounding T2/FLAIR hyperintensity in the adjacent right posterior frontal lobe which is significantly increased since prior studies. There is no midline shift or herniation. Blood products within the lesion are similar to prior. No new lesions elsewhere in the brain are appreciated. There is increased linear enhancement along the biopsy tract compatible with evolution. Ventricles remain stable in size without evidence of hydrocephalus.

Output: 1. Mild interval increase in size of right paramedian frontal lobe lesion related to known high-grade glioma. There is more pronounced increase in surrounding FLAIR hyperintensity, much of which which likely represents vasogenic edema. Given history of recent radiation these findings may represent superimposed post treatment change but recommend continued close follow-up. 2. Adjacent leptomeningeal enhancement is again seen and was present pretreatment and suspicious for leptomeningeal spread.


Instruction: Generate impression based on findings.

Input: 57-year-old female with acute left hip pain and radiculopathy down the left leg Vertebral body heights are within normal limits. Alignment is within normal limits. Mild/moderate type I discogenic endplate changes are present along the inferior aspect of L5. Minimal multilevel disc desiccation without significant disc space loss. No abnormal signal within the cord or conus which ends at L1.T12-L1: No significant disc disease. No spinal canal or neural foraminal stenosis.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. Mild facet arthropathy and effusions.L3-L4: No significant disc disease. No spinal canal or neural foraminal stenosis. Mild facet arthropathy and effusions.L4-L5: Diffuse disc bulge and mild ligamentum flavum thickening. No significant disc disease. No spinal canal or neural foraminal stenosis. Mild facet arthropathy and effusionsL5-S1: Diffuse disc bulge and mild ligamentum flavum thickening. No significant disc disease. No spinal canal or neural foraminal stenosis.Paraspinous soft tissues are within normal limits. There is no abnormal enhancement.

Output: Mild degenerative changes without stenosis of the spinal canal or neural foramina.


Instruction: Generate impression based on findings.

Input: Reason: S/P fall. ASSESS for medial meniscal tear right knee. Locking. History: pain Patient motion artifact limits multiple sequences.MENISCI: There is linear increased signal abnormality within the posterior horn of the medial meniscus which extends to the tibial and femoral articular surfaces consistent with complex tear with a large radial component. This tear extends to involve the body of the meniscus as well. The anterior horn appears intact. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is partial-thickness articular cartilage degeneration along the weightbearing surface of the medial femoral condyle above the posterior horn of the meniscus. The lateral tibiofemoral compartment articular cartilage appears relatively spared. There is partial-thickness articular cartilage degeneration along the lateral facet of the patella. There are tricompartmental osteophytes. There are bone contusions within the medial tibial plateau and medial femoral condyleLIGAMENTS: The cruciate and collateral ligaments appear intact. There is increased signal abnormality and fluid sensitive sequences about the superficial band of the MCL which may represent a sprain EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Complex tear of the posterior horn of the medial meniscus including a large radial component. Bone contusions of the medial femoral condyle and medial tibial plateau.2. Osteoarthritis of the knee with articular cartilage degeneration affecting the medial tibiofemoral and patellofemoral compartments.3. Sprain of the MCL.


Instruction: Generate impression based on findings.

Input: Right knee swelling MENISCI: There is complex tearing of the anterior horn and body of the lateral meniscus with a perimeniscal cyst noted in the intercondylar notch. The medial meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There are scattered areas of cartilage loss and degeneration although no full-thickness defects are appreciated. This is most evident in the patellofemoral compartment where a near full-thickness defect is noted in the medial patellar facet (series 6 image 12/32). Additionally, there is edema of the medial patellar facet and lateral femoral condyle consistent with a pattern of patellar subluxation. The medial patellofemoral retinaculum is at least partially torn as a result. There is also dysplasia of the femoral trochlea.LIGAMENTS: The lateral collateral ligament is torn. The medial collateral ligament, ACL, and PCL are intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Findings consistent with transient patellar subluxation including at least partial tearing of the medial patellofemoral retinaculum, dysplasia of the femoral trochlea, and contusions of the inferomedial patella and lateral femoral condyle.2. Complex tearing of the lateral meniscus involving the body and anterior horn.3. Strain of the vastus intermedius muscle.4. Moderate joint effusion with associated synovitis.


Instruction: Generate impression based on findings.

Input: Reason: Hypervascular pancreatic tail lesion History: see above. History of kidney cancer status post nephrectomy and bilateral adrenalectomy ABDOMEN:LIVER, BILIARY TRACT: Right hepatic subcentimeter T2 hyperintense lesion is too small to characterize but unchanged.SPLEEN: No significant abnormality noted.PANCREAS: Lesion in the pancreatic tail measuring 2.6 x 2.3 cm is hypointense on T1 and mildly hyperintense on T2 without diffusion restriction. This lesion demonstrates patchy enhancement on postcontrast images. Of note, signal intensity differs from that of the spleen.ADRENAL GLANDS: Status post bilateral adrenalectomy.KIDNEYS, URETERS: Status post right nephrectomy. Retroaortic left renal vein. No enhancing tissue in the nephrectomy bed.RETROPERITONEUM, LYMPH NODES: No retroperitoneal lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Enhancing lesion within the pancreatic tail is likely neoplastic. A metastatic lesion is favored, with a neuroendocrine tumor considered less likely.


Instruction: Generate impression based on findings.

Input: Male 85 years old Reason: evaluate for osteomyelitis History: chronic ankle ulcers, superimposed cellulitis A vitamin E marker was placed over the area of interest along the medial ankle.Bone: There is minimally increased T2 signal within the medial malleolus without corresponding T1 signal abnormality compatible with mild bone marrow edema. The marrow signal is otherwise unremarkable. There is no abnormal enhancement after the administration of contrast. Metal artifact is present adjacent to the lateral malleolus.Soft tissues: There is diffuse mild soft tissue edema. No discrete fluid collections are identified. There is marked muscle atrophy. The Achilles and flexor tendons are intact.

Output: No evidence of osteomyelitis.


Instruction: Generate impression based on findings.

Input: Female 57 years old asymptomatic patient with a lipoma in the head of the pancreas. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in size and smooth in contour. There is a subcentimeter cyst in left hepatic lobe. No suspicious hepatic lesion. The hepatic vasculature is patent.There is thickening of the gallbladder wall at the fundus as well as multiple multiple T2 hyperintense, nonenhancing foci within the wall consistent with adenomyomatosis. No intra or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: The pancreatic tail is slightly foreshortened, normal variant. There is a 1 hyperintense focus in the head of the pancreas loses signal on out of phase images. The pancreatic parenchyma enhances normally and the duct is not dilated. There is no suspicious pancreatic lesion.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: There is a 6.6 cm T2 hyperintense, circumscribed, nonenhancing left upper pole renal lesion consistent with a cyst. Additional smaller bilateral renal cysts are also seen. There is no hydronephrosis.RETROPERITONEUM, LYMPH NODES: No retroperitoneal lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Presumed subcentimeter lipoma in the head of the pancreas.2.Gallbladder adenomyomatosis.


Instruction: Generate impression based on findings.

Input: 43-year-old female runner. Rule out stress fracture. Lucency on plain films. There is focal cortical and endosteal thickening along the posterior aspect of the tibial diaphysis as seen on recent radiographs. There is mild edema within the underlying marrow as well as along the cortical surface compatible with a stress fracture. Of note, there is minimal edema seen within the contralateral tibial diaphysis, which may also represent stress reaction/fracture. There is a tiny amount of fluid within the semimembranosus/gastrocnemius recess. The imaged musculature is normal in appearance.

Output: Stress fracture of the mid tibial diaphysis as described above.


Instruction: Generate impression based on findings.

Input: Unspecified convulsions [R56.9], Reason for Study: ^Reason: Possible new seizures vs autonomic dysfunction History: numbness, staring, twitching Brain MRI:No evidence of acute ischemic or hemorrhagic lesion.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.L spine MRI:For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. 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 epidural space, thecal sac, and spinal cord are preserved with no evidence of spinal canal/neural foraminal narrowing. The conus medullaris terminates at the L1-L2 level. The intervertebral discs demonstrate normal T2 intensity and height with no evidence of disc herniation. The paraspinal soft tissues are unremarkable.There is 32.7mm x 29.4mm sized right renal cystic looking mass lesion likely located at renal hilum. Further imaging evaluation using renal ultrasound examination or CT scan can be considered if clinically indicated. T12-L1: no neuroforaminal narrowing or spinal stenosis. L1-L2: no neuroforaminal narrowing or spinal stenosis. L2-L3: no neuroforaminal narrowing or spinal stenosis. L3-L4: no neuroforaminal narrowing or spinal stenosis. L4-L5: no neuroforaminal narrowing or spinal stenosis. L5-S1: no neuroforaminal narrowing or spinal stenosis.

Output: 1. Normal brain MRI scan.2. Normal lumbar spine MRI scan 3. About 30mm sized right renal hilar cystic lesion. Further imaging evaluation using ultrasound or CT examination can be considered if clinically indicated.


Instruction: Generate impression based on findings.

Input: Posterior fossa ependymoma, status post treatment, now with worsening ataxia, difficulty breathing. There are postoperative findings related to suboccipital craniotomy. There is no significant change in size of the somewhat infiltrative tumor with irregular peripheral enhancement in the right inferior fourth ventricle, cerebellopontine angle, right premedullary cistern, which measures up to approximately 5 cm. There is a right trans-cerebellar catheter that terminates within the tumor, along the medial aspect of a cystic space extrinsic to the tumor in the right cerebellopontine angle that measures up to 20 mm. There is associated mass effect upon the adjacent right cerebellar hemisphere, brainstem, and upper spinal cord. There is associated high signal diffusely within the cerebellum, right much more than left, pons, right middle cerebellar peduncle, and within the central portion of the upper spinal cord. There is a left transfrontal ventricular catheter that terminates in near the left foramen of Monro. The third and lateral ventricles nearly effaced. There is no midline shift or herniation. Although there is mass effect and perhaps encasement of the vertebrobasilar system, the flow voids are otherwise intact. There is no evidence of acute infarction or intracranial hemorrhage. There is persistent bilateral tympanomastoid fluid. There is diffuse paranasal sinus mucosal thickening.

Output: 1. Residual tumor in the posterior fossa with edema in the surrounding parenchyma is not significantly changed since March 2016.2. A cystic space extrinsic to the tumor in the right cerebellopontine angle is also not significantly changed since March 2016.3. The third and lateral ventricles nearly effaced, with a left transfrontal ventricular shunt catheter in position.


Instruction: Generate impression based on findings.

Input: 31-year-old woman with history of uterine adenomyomatosis, C-section in 2006, now with left inguinal mass. PELVIS:UTERUS, ADNEXA: The margins of the uterine junctional zone are ill-defined and measures approximately 20 mm in thickness. Additionally, multiple small cysts are seen within the junctional zone. Postoperative findings of prior C-section are seen. The endometrial stripe appears normal. Prominent pelvic vasculature is noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: A well marginated T2 hyperintense, T1 hypointense lesion in the lesser trochanter of the left femur is noted (series 5, image 32) measuring 13 mm. No soft tissue mass or lesion is identified in the visualized left inguinal region.OTHER: A small amount of pelvic free fluid is seen, likely physiologic.

Output: 1. Findings compatible with uterine adenomyomatosis.2. Nonvisualization of reported left inguinal mass.3. Probable aneurysmal bone or simple cyst of the left lesser trochanter.4. Prominent pelvic vasculature which may be seen in setting of pelvic congestion syndrome and/or multiparity, correlation with patient's clinical history and symptoms recommended.


Instruction: Generate impression based on findings.

Input: Clinical question: r/o transverse myelitis and cord lesionSigns and Symptoms: b/l LE weakness. L>RComments: Thoracic, Lumbar, and Sacral. Will require sedation. | MRI thoracic spine:There is a 53x42 axial dimension and 53x64mm sagittal dimension mass located in the right posteromedial thoracic cavity abutting the right side of the T1 through T8 vertebral bodies which insinuates into the right sided neural foramina foramina from T1-2 through T6-7 especially at T3-4, T4-5 and T5-6 which it extends through the neural foramina into the spinal canal where ir compresses the thecal sac from the right side and flattens the spinal cord.The mass also extends along the posterior aspect of the mediastinum and displaces and compresses the trachea and bronchi and abuts and compresses the venous structures of the upper mediastinum and displaces the heart and aorta and great vessels.The thoracic vertebral bodies are appropriate in the overall alignment and height. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots. No abnormal enhancing lesions are identified in the thoracic spine.Lumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. There is a well formed disk at S1-S2. The bladder is large.No abnormal enhancing lesions are identified in the lumbar spine.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is no significant compromise to spinal canal or neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.Large intrathoracic mass abutting he T1 through T8 vertebral bodies extends into the spinal canal through the T3-4, T4-5 , T5-6 right neural foramina behind the T2-T6 vertebral bodies where it markedly compresses the spinal cord. Differential consideration includes neuroblastoma as well as other neoplasms.2.The same mass compresses and narrows mediastinal airway structures and mediastinal vascular structures (especially veins). A CT chest would be of further benefit to evaluate this.3.Enlarged bladder may be neurogenic given the above findings.4.There is no compromise to the lumbar spinal canal.


Instruction: Generate impression based on findings.

Input: Assess for compression, need DWI, suspicion for cord ischemia. Acute loss of lower extremity function. Evaluation of the cervical and thoracic spine is somewhat limited due to motion degradation, however no evidence of cord compression is identified. Please note this exam is inadequate to assess for cord signal abnormality in the cervical and upper/mid thoracic cords.There is abnormal T2 hyperintensity involving the lower thoracic cord from the mid T10 level and extending inferiorly to the conus at the L1-L2 level. There is associated restricted diffusion (sag DWI series 801, image 88; sag ADC series 803 image 84).Mild degenerative changes are seen in the lumbar spine including mild L4-L5 disc bulge and small disc protrusion at L5-S1 level. There is no significant spinal canal or neural foraminal stenosis at any level in the lumbar spine. Vertebral body heights and alignment in the lumbar spine are maintained. There is edema involving the bilateral paraspinous musculature as well as the right iliac is and psoas muscles.Motion degraded cervical spine images demonstrate small disc osteophyte complexes with mild degree of spinal canal stenosis, particularly at C3-C4.Innumerable cysts in the bilateral kidneys.

Output: No evidence of extrinsic cord compressionAbnormal T2 hyperintensity with restricted diffusion involving the lower thoracic cord from the mid T10 level to the conus at the lower L1 level. Finding is most consistent with cord infarct.Nonspecific edema involving the bilateral paraspinous musculature as well as the right iliacus and psoas muscles.


Instruction: Generate impression based on findings.

Input: Papilledema, headache No evidence of acute ischemic or hemorrhagic lesion on the scan.There is no evidence of venous congestive encephalopathy.Major venous sinuses appear to be patent and demonstrated normal enhancement pattern.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.3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion on the scan.2. No evidence of venous congestive encephalopathy. No abnormal enhancement.


Instruction: Generate impression based on findings.

Input: 19 year-old male with headache, sudden onset. Evaluate for intracranial hemorrhage. Electronic medical records provided history of sickle cell disease. There is no evidence of intracranial hemorrhage, mass or edema. A single focus of low attenuation is present along the anterior aspect of the left frontal horn which represents a focus of encephalomalacia. This is present on prior CT and MRI examinations compatible with a focus of encephalomalacia most likely secondary to sequela of sickle cell disease and appears unchanged. No new foci are appreciated.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: No acute intracranial abnormalities.


Instruction: Generate impression based on findings.

Input: 64 years Male (DOB:7/12/1952)Reason: r/o posterior fossa infarct/lesion History: gait imbalancePROVIDER/ATTENDING NAME: HELENE G. RUBEIZ HELENE G. RUBEIZ There is patchy and T2 and FLAIR signal hyperintensity present within the brainstem.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.There are 10-15 punctate foci of signal loss and susceptibility imaging is present in the right centrum semiovale. In isolation this is of unknown clinical significance.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Periventricular and subcortical white matter lesions of a mild degree and patchy lesions in the brainstem are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: New diagnosis of lung cancer. Evaluate for brain metastasis. There is a well-circumscribed 11 mm tiny region mass which shows solid contrast enhancement. There is minimal cerebral white matter T2 hyperintensity. The brain parenchyma and pituitary gland appear unremarkable. Otherwise, there is no evidence of brain parenchymal enhancing lesions, intracranial hemorrhage, or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is minimal maxillary sinus mucosal thickening. There is also minimal fluid within the left mastoid air cells.

Output: 1.A pineal mass with solid enhancement that measures up to 11 mm may represent a perineal parenchymal tumor versus an isolated lung cancer metastatic lesion. Follow-up imaging is recommended to confirm stability.2.Minimal cerebral white-matter T2 hyperintensity is nonspecific, but may reflect chronic microvascular ischemia.3.No evidence of intracranial hemorrhage or acute infarct. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 66 year old woman with recent hemorrhagic pericardial effusion referred to evaluate for constriction and myocarditis. Left VentricleThe left ventricle is normal LV size and systolic function. The overall LV ejection fraction is 57%, the LV end diastolic volume index is 62 ml/m2 (normal range: 65+/-11), the LVEDV is 136 ml (normal range 109+/-23), the LV end systolic volume index is 27 ml/m2 (normal range 18+/-5), the LVESV is 59 ml (normal range 31+/-10), the LV mass index is 54 g/m2 (normal range 67+/-11), and the LV mass is 120 g (normal range 114+/-24). 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. Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 49%, the RV end diastolic volume index is 68 ml/m2 (normal range 69+/-14), the RVEDV is 77 ml (normal range 110+/-24), the RV end systolic volume index is 35 ml/m2 (normal range 22+/-8), and the RVESV is 77 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is a small, heterogenous appearing, loculated pericardial effusion along the posterior wall. There is mild, circumferential thickening of the pericardium with evidence of increased T2 signal and early gadolinium enhancement, suggesting the presence of active inflammation. There is additionally late gadolinium enhancement of the visceral and parietal pericardium, which can represent both inflammation or fibrosis. Based on myocardial tagging, there is tethering of the pericardium to the posterior wall of the myocardium. There is no respiratory variation in the interventricular septal position suggesting that the pericardial changes are not causing constriction at the current LV volume load. Extracardiac FindingsModerate bilateral pleural effusions. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. There is a small, heterogenous appearing, loculated pericardial effusion along the posterior wall. There is mild, circumferential thickening of the pericardium with evidence of acute inflammation; however, there is no respiratory variation in the interventricular septal position suggesting that the pericardial changes are not yet causing constriction at the current LV volume load. 2. Normal left ventricular size and systolic function (LVEF 57%) without evidence of underlying myocardial fibrosis, infiltration, or inflammation. 3. Normal right ventricular size with mildly reduced systolic function (RVEF 49%).4. Moderate bilateral pleural effusions.


Instruction: Generate impression based on findings.

Input: Cholangitis. Evaluate for stricture/suspicious lesion. History of primary sclerosing cholangitis. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic morphology of the liver. No suspicious hepatic lesion identified. Mild intrahepatic stricturing, with no dominant stricture identified. The gallbladder is normal in appearance.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted. Status post colectomy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Mild intrahepatic stricturing. No dominant stricture or suspicious hepatic lesion.


Instruction: Generate impression based on findings.

Input: Redemonstrated is evidence of the patient's known multifocal anaplastic astrocytoma. A dominant expansile infiltrating T1 hypointense and T2 hyperintense tumor involving much of the left pons, left midbrain, left cerebral peduncle and left thalamus is again noted. Based on multiple measurements on T2 sequences, this lesion appears somewhat decreased in size. For instance, on series 501, image 14 the lesion measures 19 x 32 cm compared to 23 x 36 cm previously. There are interval postoperative changes from a small craniotomy as well as a small area of encephalomalacia along the right lateral cerebellum which probably reflects site of prior biopsy. Abnormal T2 signal within this right lateral cerebellar hemisphere is smaller than before likely related to the biopsy. T2/flair signal abnormality within the left lateral cerebellar hemisphere has decreased in size. Questionable very subtle tumor infiltration involving the right ventral pons and the right ventral midbrain are not as well appreciated on this study. There appears to be no significant enhancement or restricted diffusion. A few scattered small foci of susceptibility weighted abnormalities are noted elsewhere which is nonspecific and may be related to microhemorrhage secondary to radiation therapy.The ventricles and sulci are unchanged. There is no midline shift or herniation. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear.

Output: 1.Decrease in size of the known multifocal anaplastic astrocytoma as described above.2.Post-operative changes from a right lateral cerebellar biopsy.


Instruction: Generate impression based on findings.

Input: Recent memory changes and numbness and tingling in the upper extremities. Known to have Chiari malformation with syrinx. Annual follow up BRAIN:There is no acute infarct or intracranial hemorrhage. Aside from low lying cerebellar tonsils related to Chiari I malformation which are not appreciably changed, the brain is unremarkable. The ventricles are normal in size as well as the sulci. There is no midline shift. The major intracranial vascular flow voids are preserved. There is trace mucosal thickening in the nasal sinuses. There is no gross orbital abnormality. Prominent pharyngeal tonsils and upper cervical lymph nodes, including nodes of Rouvière, are probably reactive in this age group.The cerebellar tonsils extend up to 8 mm below the level of foramen magnum. There is relative crowding at the level of foramen magnum but without complete obliteration of the CSF space. The CSF flow study, though mildly limited by patient motion, shows preserved, pulsatile ventral CSF flow. However, dorsally the CSF flow is attenuated and delayed.WHOLE SPINE:Cervical spine: Alignment is anatomic. The vertebral bodies are preserved in height. Marrow signal is benign. There is disc desiccation at C5-C6 and C6-C7 associated with very shallow ventral indentations of the thecal sac. Otherwise, there is no significant spinal canal or neural foraminal stenosis in the cervical spine. Also, the cervical spinal cord shows normal signal and morphology. There is no cervical syrinx. Prominent pharyngeal tonsils and upper cervical lymph nodes, as described above, are probably reactive.Thoracic and lumbosacral spine: Alignment is anatomic. Of note, there is partial lumbarization of S1. The vertebral bodies are preserved in height. Marrow signal is benign. The discs show preserved height and T2 signal. The spinal canal and neural foramina are preserved. The central canal remains minimally prominent from mid T6 level through T7-T8 level, axially measuring 1-2 mm at maximum. The spinal cord shows normal morphology and signal. The tip of the conus medullaris lies at T12-L1 level which is normal.

Output: 1.Chiari 1 malformation with mildly diminished CSF flow dorsally at the foramen magnum similar to prior. The brain is otherwise unremarkable.2.Persistent mild prominence of the central canal in the mid thoracic spine compared to 2014 although less prominent when compared to 11/17/2012. Spine imaging is otherwise normal.


Instruction: Generate impression based on findings.

Input: Clinical question: Back strain 7 7-2015. Signs and symptoms: Rule out disc disorder or lumbar stenosis. Nonenhanced lumbar MRI:There is normal signal intensity and clinical alignment of vertebral column.There is no detectable posttraumatic findings of spine or the perispinal soft tissues.Unremarkable lower most visualized thoracic spine and thoracic cord from T10 inferiorly.T12-L1, L1-L2 and L2-L3 levels are unremarkable.L3-L4 demonstrate mild symmetrical bilateral ligamentum flavum hypertrophy and minimal bilateral facet effusion and unremarkable otherwise.L4-L5 is unremarkable.L5-S1 demonstrate mild disc desiccation and loss of disc height, a central shallow broad-based disc protrusion is noted at this level (axial T2 series 801 image 6 and sagittal T2 and T2 STIR images 8 and 9). No spinal stenosis, neural foraminal or lateral recesses compromise.

Output: 1.Mild degenerative changes at L5-S1 and a small shallow central disc protrusion without spinal stenosis, neural foraminal or lateral recess compromise as detailed.2.Unremarkable nonenhanced lumbar MRI otherwise.3.Incidental note is made of a limited view of a loculated cystic lesion in the midline and to the right in the pelvis and follow-up with dedicated imaging is recommended. Findings could represent adnexal cyst.


Instruction: Generate impression based on findings.

Input: Female 78 years old Reason: follow up of renal cysts History: none ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: There are multiple bilateral renal cysts some with layering hemorrhage and debris. The conglomerate cysts in the right kidney that is exophytic measures 4.5 cm previously, 4.4 cm. No hydronephrosis in either kidney. The lack of intravenous contrast limits evaluation for solid renal lesions.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Multiple bilateral cysts some which are hemorrhagic or contain proteinaceous debris without significant interval change from prior.


Instruction: Generate impression based on findings.

Input: A patient submitted outside study for review. Submitted for review are diagnostic bilateral mammogram and targeted bilateral retroareolar ultrasound dated 3/30/2014 and breast MRI dated 4/2/2015 performed at Future Diagnostics Group. No comparisons were available at the time of dictation. Diagnostic mammogram dated 3/30/2015: Three standard views of both breasts, additional left XCC, and 2 right spot magnification views were obtained. The breast parenchyma is composed of scattered fibroglandular elements. There is right breast skin thickening. Calcifications are noted in the right retroareolar area. No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in either breast. Targeted bilateral breast ultrasound dated 3/30/2015: Targeted bilateral retroareolar ultrasound (2 images) was submitted. No cysts or masses seen.Breast MRI dated 4/2/2015: There is moderate background parenchymal enhancement. Focally enhancing nipple and periareolar tissue without underlying suspicious mass or non mass enhancement. Skin thickening measures up to 6 mm in the nipple area.

Output: Right nipple and periareolar thickening and enhancement seen on mammogram and MRI without underlying mass. Recommend surgical consultation and skin biopsy.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: 47-year-old female patient with left finger pain. Evaluate for glomus tumor of left small finger. Bone marrow signal is within normal limits. No abnormal soft tissue mass or enhancement is identified on postcontrast imaging of the left fifth digit. The visualized ligamentous and tendinous structures appear intact.

Output: Normal examination of the left fifth digit and remaining visualized structures.


Instruction: Generate impression based on findings.

Input: Male, 81 years old, with uvula cancer with soft palate extension. Present with throat pain. The mucosa overlying the posterior aspect of the hard palate, the soft palate and uvula is thickened and enhancing. In the coronal plane, this abnormal tissue measures up to 32 x 20 mm (image 25 series 901).The remainder of the aerodigestive mucosa is unremarkable. Please note that artifactual failure of fat suppression is seen within the right sublingual/submental space likely due to dental amalgam.No pathologic adenopathy is detected by size criteria. The salivary glands and the thyroid are free of focal lesions. Bone marrow signal characteristics are unremarkable.

Output: 1.Thickening and pathologic enhancement of the mucosa of the palate and uvula are seen compatible with the stated history.2.No evidence of any pathologic adenopathy is detected.


Instruction: Generate impression based on findings.

Input: 64 years Male (DOB:2/9/1952)Reason: LE weakness History: as abovePROVIDER/ATTENDING NAME: KOUROSH REZANIA NINA SANTOS 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.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina. There is a disc bulge at this level. Some endplate reactive changes are also present.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is a broad-based right lateral recess disc protrusion present which encroaches on the right sided exiting nerve root within the neural foramen. There are associated endplate reactive changes present.At C6-7 there is a broad-based left paramedian disc protrusion present which mildly encroaches on the left-sided exiting nerve roots within the neural foramen. There are some associated ligamentum flavum hypertrophy at this level.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.There is a T2 hyperintense lesion present within the pons which is low signal on T1. There is abnormal T2 hyperintense signal along the superior aspect of the right cerebellar hemisphere compatible with infarction.

Output: 1.There are degenerative changes present in the cervical spine associated with encroachment of the right-sided exiting nerve roots at C4-5 and the left-sided exiting nerve roots at C6-7.2.Right cerebellar infarction in the subacute stage. Please refer to MRI of the brain from 11/30/2016 for further comments.3.Old lacunar infarct in the pons.


Instruction: Generate impression based on findings.

Input: Reason: Evaluate hepatobiliary and pancreatic abnormalities seen on CT scan. Known ascending carcinoma of the colon. History: As above ABDOMEN:LIVER, BILIARY TRACT: Subcentimeter T2 hyperintense lesions in the hepatic dome and left hepatic lobe without enhancement likely represent cysts. No suspicious hepatic lesions. No extrahepatic biliary ductal dilatation. Minimal intrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: Cystic lesion in the pancreatic tail measures 2.2 x 1.4 cm (601/33) and appears to communicate with the main pancreatic duct, which is not dilated. No enhancement is evident.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral simple appearing renal cysts measuring up to 5.7 cm in the left lower pole.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Extensive colon diverticulosis without evidence of diverticulitis. Apparent soft tissue signal in the cecum/ascending colon on axial T2-weighted images with possible corresponding restricted diffusion, image 48 series 706. However please note that this study is not protocoled for adequate evaluation of bowel.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Small subcentimeter T2 hyperintensities within the liver likely represent cysts. No suspicious hepatic lesion evident.2.Cystic lesion in the pancreatic tail likely represents a side branch IPMN.3.Reported ascending colon adenocarcinoma not seen with certainty (please note that this study is not protocoled for adequate evaluation of bowel). 2.5 cm area of apparent restricted diffusion along dependent aspect of proximal ascending colon/cecum, no definite corresponding postcontrast enhancement seen on subtraction imaging sequences. Correlation with patient's colonoscopy recommended.


Instruction: Generate impression based on findings.

Input: Clinical question: Stroke. Signs and symptoms: Stroke. Nonenhanced CT of brain:The examination demonstrates fairly extensive supratentorial periventricular and subcortical low-attenuation with no associated mass effect. There is also suspected low-attenuation of corpus callosum. Although the above findings are nonspecific they could represent very advanced to small vessel disease of indeterminate age. Findings remain identical to prior study from 6 -- 2 -- 2010. Follow-up with an MRI examination is recommended to exclude other possibilities. Multiple prior studies and including patient MRI examination from 2009 demonstrated similar findings.An old right posterior temporal -- parietal cortical stroke is again identified and no change.Images through posterior fossa demonstrate suspected low-attenuation in the pons consistent with old lacunar strokes.There is no evidence of hemorrhage or acute cortical stroke. The ventricular system remains within normal range of size.

Output: 1.Stable exam since prior study.2.Extensive White matter findings likely secondary to advanced to small vessel disease of indeterminate age.3.Old right posterior parietal -- temporal cortical stroke. Local nor strokes of pons.


Instruction: Generate impression based on findings.

Input: Evaluate bone lesion. ABC versus UBC. There is a fairly circumferentially expansile lesion within the proximal humerus extending from the proximal metaphysis to diaphysis over a 7 cm length. The lesion has slightly heterogeneous intermediate T1 signal and high T2 signal with a fluid-fluid level. There is no significant surrounding edema. There cortex appears discontinuous mid-lesion which likely reflects the non-displaced fracture seen on the prior radiograph. There is central low signal and rim enhancement on post-contrast imaging. The remaining bone marrow signal is within normal limits. The musculature and soft tissues appear normal.

Output: Findings most likely represent a unicameral bone cyst in the proximal humerus given location, signal characteristics, and enhancement pattern. An aneurysmal bone cyst is considered less likely.


Instruction: Generate impression based on findings.

Input: A patient submitted outside study for review. Submitted for review are digital mammographic images (3/31/15, 4/6/15, 10/9/15, 11/2/15), ultrasound images of right breast (10/12/15), images from ultrasound guided biopsy and postprocedural right mammographic images (11/2/2015), breast MRI (11/10/2015), ultrasound images of right breast (11/12/2015), images from stereotactic needle biopsy of right breast and postprocedural right mammographic images (11/19/2015) performed at Presence St. Joseph Medical Center. For comparison, digital mammographic images (1/11/14) are available. DIGITAL MAMMOGRAPHIC IMAGES (3/31/15, 4/6/15, 10/9/15, 11/2/15): The breast parenchyma is composed of scattered fibroglandular elements (BiRADS Density Category B), unchanged in pattern and distribution.In the right breast at lateral aspect around 9:00 position, there are pleomorphic calcifications, including fine linear type with a developing focal asymmetry. The calcifications are extending segmentally in discontiguous fashion, measuring 60 x 40 mm (AP x LR). The focal asymmetry is present at posterior aspect of these calcifications, measuring 11 mm. There is another asymmetry seen best on CC view at medial anterior aspect of the right breast measuring 7 mm.A circumscribed oval mass with multiple coarse benign-appearing calcifications is present at 12:00 position in the right breast, likely a fibroadenoma.No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in left breast. ULTRASOUND IMAGES OF RIGHT BREAST (10/12/15):Ill-defined hypoechoic mass measuring 7 x 9 mm at 9:00 position with echogenic rim is detected, corresponding to the focal asymmetry seen on the mammogram at posterior aspect of the segmentally distributed calcifications.IMAGES FROM ULTRASOUND GUIDED BIOPSY AND POSTPROCEDURAL RIGHT MAMMOGRAPHIC IMAGES (11/2/2015):Ultrasound guided biopsy was performed for the mass at 9:00 position with an appropriate needle placement. Postprocedural mammograms demonstrate a marker clip (Hydromark) at the site of the focal asymmetry at 9:00 position in the right breast.Per outside radiology report, the result was malignant.BREAST MRI (11/10/2015):The study was performed with a protocol outlined in the outside report.There are 2 enhancing masses in the right breast, one at 9:00 position measuring 19 x 13 x 12 mm (AP x LR x CC), and the other at 3:00 position measuring 14 x 21 x 11 mm. The one at 9:00 position is proven carcinoma and the marker clip is present at the anterior aspect of this mass. Non-mass enhancement is present between the two masses, measuring 49 x 71 x 20 mm.No abnormal enhancement is seen in the left breast.No abnormal lymph nodes are present in either axilla.ULTRASOUND IMAGES OF RIGHT BREAST (11/12/2015):The study was performed as second look ultrasound to look for a correlate of MR detected mass at 3:00 position in the right breast. No sonographic correlate was detected in this study.IMAGES FROM STEREOTACTIC NEEDLE BIOPSY OF RIGHT BREAST AND POSTPROCEDURAL RIGHT MAMMOGRAPHIC IMAGES (11/19/2015):Stereotactic biopsy was performed for the asymmetry best seen on CC view at medial right breast, because the asymmetry is likely correlating to the MR detected mass at 3:00 position. Postprocedural mammograms demonstrate a marker clip at upper inner aspect of the right breast, near the site of the enhancing mass seen on the MRI. Distance between 2 clips is 135 mm on CC view.Per outside radiology report, the biopsy result was malignant; invasive ductal carcinoma.

Output: 1. Biopsy proven carcinoma in the right breast, 2 sites; one at 9:00 position and the other at 3:00 position. Mammograms demonstrate suspicious calcifications segmentally at lateral right breast and MRI demonstrates extensive non-mass enhancement between the two malignant masses in the right breast.2. No mammographic or MR evidence of malignancy in the left breast.3. No MR evidence of abnormal lymph nodes in either axilla.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Lung adenocarcinoma with brain metastasis. Status post metastectomy and stereotactic radiosurgery. There are changes related to the resection of right frontal paramedian metastasis. The resection cavity is smaller and the adjacent white-matter T2-hyperintensity is remarkably improved with resolved mass-effect. Susceptibility artifact is present along the resection margin as well as contrast enhancement. This contrast enhancement is slightly thicker and more nodular than usual, especially along the superior and lateral margins. This likely reflect posttreatment change. There is no acute infarct or other foci of brain hemorrhage. There is no new contrast enhancement in the brain. Mild contrast enhancing dural thickening underneath the right frontal craniotomy flap is probably reactive. The overlying scalp postoperative changes are improved. The major intracranial vascular flow voids are preserved, including the superior sagittal sinus. There is minimal mucosal thickening in the paranasal sinuses. The mastoid air cells are clear. There is no gross orbital abnormality.

Output: 1.Expected post resection/stereotactic radiosurgery changes are present in the right frontal lobe. 2.The contrast enhancement along the resection margin is mildly thick and nodular, especially along the superior and lateral borders. This still may represent posttreatment change but residual/recurrent tumor can also look similar. Follow-up is recommended.3.No new brain metastasis.


Instruction: Generate impression based on findings.

Input: The risks (including, but not limited to, those of bleeding, infection, allergic reaction, temporary nerve block, pain, and inability to access the joint) and benefits of the procedure were explained to the patient, and informed written consent was obtained. A pre-procedural “time-out” form was completed.The patient was placed supine on the fluoroscopy table. The right hip was localized fluoroscopically, and a spot radiograph was obtained. The course of the femoral artery was noted on the patient's skin using an ink marker. The skin was cleansed and covered with a sterile drape. The skin and subcutaneous tissues were anesthetized with 1% lidocaine using 25-gauge and 22-gauge needles.Under fluoroscopic guidance, a 20-gauge spinal needle was advanced into the joint. Attempted aspiration yielded no fluid. Next, 16 ml of a 50/50 mixture of Omnipaque 240 (to confirm the intra-articular position of the needle) 0.9% sterile saline, and 1% lidocaine were injected into the joint. Contrast opacified the joint in the expected manner. Gadolinium was not utilized due to the patient's prior contrast reaction. A spot radiograph was obtained for documentation. The needle was withdrawn. Blood loss was negligible (<1cc), and patient tolerated the procedure well without immediate complication. An adhesive bandage was placed on the patient’s skin. Routine post procedure instructions were communicated to the patient. The patient was escorted to the MRI suite for further imaging in stable condition. Please refer to the subsequent MRI report for further information.Exposure time: 25 seconds.

Output: Successful fluoroscopic-guided injection of dilute Omnipaque, with 1% lidocaine and 0.9% normal saline into the right hip for subsequent MRI arthrogram examination.


Instruction: Generate impression based on findings.

Input: CERVICAL SPINE: There is subtle T2 hyperintensity which is seen in the left lateral cervical cord at the C3-C4 level and in the right C5-C6 level (axial T2 images 19/34 and 11/34) and which also appears to be present on prior MRI from 12/6/2014. These are not definitive seen on the sagittal sequence. There is artifact related to the field inhomogeneity from dental hardware.The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is slightly heterogeneous but otherwise unremarkable. There is no evidence of intraspinal mass or abnormal enhancement. The paravertebral soft tissues are unremarkable. There is multilevel disc desiccation and loss of disc height as well as endplate degenerative changes. C2-C3: There is mild grade 1 anterolisthesis of C2 on C3 without significant spinal canal, or neural foraminal narrowing.C3-C4: There is mild grade 1 retrolisthesis of C3 on C4 as well as mild disc bulge with effacement of ventral thecal sac. There is mild bilateral neural foramen stenosis.C4-C5: No significant spinal canal, or neural foraminal narrowing.C5-C6: There is a small central disc osteophyte complex without significant spinal canal, or neural foraminal narrowing.C6-C7: There is a small central disc osteophyte complex without significant spinal canal, or neural foraminal narrowing.C7-T1: No significant spinal canal or neural foraminal narrowing.THORACIC SPINE: There are unchanged chronic compression deformities involving the T7 vertebral body (anterior wedging with 40% height loss) and the superior endplate of T5 (without significant height loss). The vertebral column alignment is within normal limits. The disc space heights are preserved. There is mild thoracic spondyloarthropathy with multilevel disc desiccation and mild posterior ligamentous thickening. There is no significant spinal canal or neural foramen stenosis. The vertebral bone marrow signal is unremarkable. The spinal cord displays normal signal and morphology. There is no evidence of intraspinal mass or abnormal enhancement. The paravertebral soft tissues are unremarkable.

Output: 1.There is subtle T2 hyperintensity which is seen in the left lateral cervical cord at the C3-C4 level and at the right lateral C5-C6 level (axial T2 images 19/34 and 11/34). These also may be present on prior MRI from 12/6/2014. Although artifact from dental hardware makes evaluation difficult, these may possibly represent true lesions and etiologies such as old inflammatory or demyelinating lesions may be considered. No abnormal enhancement, cord swelling, or cord masses in the spinal cord.2.Unchanged mild cervical degenerative disease that is relatively worse at the C3-C4 level where a grade 1 retrolisthesis and a disc bulge result in mild ventral thecal sac effacement and mild bilateral neural foramen stenosis.3.Mild thoracic degenerative disease without significant spinal canal or neural foramen stenosis.4.Chronic unchanged mild compression deformities of T5 and T7 vertebral bodies.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Status post left DBS; now planning for right DBS. There are postoperative findings related to left transfrontal deep brain stimulator insertion, which terminates in the region of the left cerebral peduncle. 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.

Output: Expected postoperative findings related to left transfrontal deep brain stimulator insertion.


Instruction: Generate impression based on findings.

Input: 9-year-old female with history of Crohn's disease. PELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Persistent sigmoid and rectal wall thickening is again noted with mild inflammatory changes in the presacral fat. Previously described intramural and perirectal abscesses have significant decreased in size and are no longer measurable. No evidence of significant mucosal enhancement to suggest active disease. No drainable fluid collections are present.There is a enhancing tubular structure arising from the 6:00 position of the lower rectum extending to the skin surface which likely represents a rectocutaneous fistula.BONES, SOFT TISSUES: Probable small intraosseous lipoma in the left sacral ala.OTHER: No significant abnormality noted

Output: 1. Persistent sigmoid and rectal wall thickening with mild adjacent inflammatory changes in the presacral space. Interval decrease in size of intramural and perirectal abscesses.2. Enhancing tubular structure arising from the 6 clock position of the lower rectum extending to the skin surface may represent a rectocutaneous fistula, however correlation with physical exam is recommended.


Instruction: Generate impression based on findings.

Input: Clinical question: History of suprasellar meningioma status post resection and left frontal cystic mass. Signs and symptoms: Surveillance scan. Pre and post enhanced brain MRI:Negative diffusion weighted series.Examination redemonstrate stable postoperative changes of a right frontal and temporal craniotomy.Underlying right frontal focus of encephalomalacia and gliosis without detectable abnormal enhancement to suggest recurrence of tumor similar to prior exam.Also stable since prior exam is a round well-demarcated isointense T1 and mildly hyperintense on FLAIR and T2-weighted images and with a thick uniform rim of T2 hypointensity in the left paramedian floor of the anterior cranial fossa. The finding measures approximately 17 mm in transaxial dimensions similar to prior study. It demonstrate thick rim of enhancement similar to prior study. It applies regional mass effect on the left inferior frontal lobe without detectable surrounding edema or encephalomalacia. The finding is suggestive of a organized hematoma.There is no detectable associated bony abnormality with this finding an underlying ethmoid air cells and sphenoid sinus remain well pneumatized.Multiple scattered periventricular and subcortical foci of FLAIR hyperintensity without enhancement are again noted. Some of the lesions demonstrate perpendicular axis to the ventricular wall and also demonstrate a halo of T1 hyperintensity on axial nonenhanced T1-weighted images. The appearance of the findings are more suggestive of a demyelinating disease and less likely representing small vessel ischemic strokes.

Output: 1.Stable postoperative changes of a right frontal and anterior temporal craniotomy for removal of meningioma without detectable recurrence of tumor.2.Stable well demarcated extra axial mass like lesion along the floor of the left anterior cranial fossa with thick rim of enhancement suggestive of an organized hematoma. 3.Stable multiple nonenhancing foci of FLAIR hyperintensity several with morphology highly suggestive of demyelinating disease as detailed above. Unremarkable exam otherwise.


Instruction: Generate impression based on findings.

Input: Diagnosis: Multiple sclerosisClinical question: CNS demyelinationSigns and Symptoms: Numb legs Cervical spine:There is T2 signal hyperintensity within the cervical spinal cord along the long segment along the posterior and left paramedian aspect of the spinal cord extending from the cervical medullary junction down to the C4-5 level. There is smaller T2 hyperintense lesions in the cervical spinal cord one measuring a couple millimeters in size along the left posterior lateral aspect of the spinal cord at the C6-7 level additional T2 hyperintense lesions are present in the thoracic spinal cord.There is patchy T2 signal hyperintensity present within the visualized portion of the pons and medulla.The cervical vertebral bodies are appropriate in overall alignment and height. There is loss of disc space height at C4-5, C5-6 and C6-7 and to some degree at C3-4. There is disc desiccation present throughout the cervical spine.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina. There is a disc bulge as well as endplate and uncovertebral osteophytes at this level and mild ligament flavum hypertrophy.At C4-5 there is no significant compromise to the spinal canal. There is a disc bulge as well as endplate and uncovertebral osteophytes at this level and mild ligament flavum hypertrophy. There is encroachment of the right-sided exiting nerve roots within the neural foramina. There are some subacute acute endplate reactive changes at this level.At C5-6 there is no significant compromise to the spinal canal or neural foramina. There is a disc bulge as well as endplate and uncovertebral osteophytes at this level and mild ligament flavum hypertrophy.At C6-7 there is no significant compromise to the spinal canal or neural foramina. There is a disc bulge as well as endplate and uncovertebral osteophytes at this level and mild ligament flavum hypertrophy.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.MRI thoracic spine:Multiple patchy T2 hyperintense lesions are present in the thoracic spinal cord. There is a generalized spinal CORD atrophy present. There is T2 and T1 signal hyperintensity present within the T5 vertebral body with the CT findings on 6/27/2012 suggestive of vertebral body hemangioma.There is anterior compression fracture present T2 12 which can also be identified on the CT scan from 6/27/2012 and does not appear to have changed substantially. Additionally there is compression fracture at L1 and L2 with exaggeration of the normal lumbar lordosis which is also stable.The thoracic vertebral bodies are appropriate in the overall alignment. There is no compromise of thoracic spinal canal or exiting nerve roots.

Output: 1.There are multiple lesions scattered in the cervical and thoracic spinal cord associated with cord atrophy. This may be suggestive of demyelination. Additionally there are signal changes within the visualized brainstem which are also suggestive of demyelination.2.There are compression fractures present in the upper lumbar and lower thoracic spine which have been stable since prior CT exam from 2012.3.There is encroachment of the right-sided exiting nerve roots at C4-5 due to degenerative changes. The multilevel degenerative changes present in the cervical spine.


Instruction: Generate impression based on findings.

Input: 24 years, Female, Reason: determine if crohns active, small bowel and colonic disease. also determine if renal stone present. History: left-sided CVA tenderness. LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No bowel thickening or dilatation. No abnormal enhancement or diffusion restriction.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS: FemaleUTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Normal examination without evidence of active disease or complication.


Instruction: Generate impression based on findings.

Input: 67 year old woman with possible sarcoidosis, referred for evaluation of cardiac involvement and interval changes since prior CMR. Left VentricleThe left ventricle is normal in size with low normal systolic function. The overall LV ejection fraction is 51%, the LV end diastolic volume index is 77 ml/m2 (normal range: 65+/-11), the LVEDV is 146 ml (normal range 109+/-23), the LV end systolic volume index is 37 ml/m2 (normal range 18+/-5), the LVESV is 71 ml (normal range 31+/-10), the LV mass index is 65 g/m2 (normal range 67+/-11), and the LV mass is 124 g (normal range 114+/-24). There is moderate concentric left ventricular hypertrophy (13mm). There is hypokinesis of the apical inferior wall and the mid anterior wall. There is late gadolinium enhancement that is multifocal and patchy, that is atypical for an infarct pattern. It is present in the apical inferior and lateral walls, basal inferior, inferoseptal, and inferolateral walls, and basal to mid antero wall. There is additionally evidence of early gadolinium enhancement involving the apical inferior and lateral walls. Together these findings support the presence of acute or subacute myocardial inflammation. The overall LGE burden since prior MRI in 2013 has increased. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 51%, the RV end diastolic volume index is 72 ml/m2 (normal range 69+/-14), the RVEDV is 137 ml (normal range 110+/-24), the RV end systolic volume index is 35 ml/m2 (normal range 22+/-8), and the RVESV is 67 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is mildly dilated. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumSmall pericardial effusion is noted.Extracardiac FindingsPulmonary opacities noted, please see dedicated chest CT imaging for further description. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with low normal systolic function. Regional wall motion abnormalities as described above are noted. The overall LV ejection fraction is 51%.2. There is extensive late gadolinium enhancement which is associated with early gadolinium enhancement. These findings support the presence of acute or subacute myocardial inflammation. The pattern of late gadolinium enhancement is not typical for prior myocardial infarction. The extent of late gadolinium enhancement has increased when compared to the prior study from 2013. Given the associated lung findings, the diagnosis of cardiac sarcoidosis should be considered. 3. The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 51%.4. Small pericardial effusion. 5. See extra-cardiac findings. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Cerebral infarction, unspecified [I63.9], Reason for Study: ^Reason: assess for strokes History: right sided weakness Brain MRI:No evidence of acute ischemic or hemorrhagic lesion on this scan.There are focal tissue losses on the left basal ganglia and periventricular white matter with surrounding high signal intensities on FLAIR images indicating gliotic changes. Scattered high signal intensity lesions on bilateral periventricular white matter on FLAIR indicate minimal non specific small vessel disease.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. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.Brain MRA:3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal.Bilateral PCAs are fetal origin.There is no evidence intracranial arterial aneurysm. No significant (more than 50%) luminal stenosis.Neck MRA:3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The vertebral artery origins are normal. There is normal flow enhancement through the bilateral common carotid, carotid bifurcations, internal/external carotid, and vertebral arteries.

Output: 1. No acute ischemic or hemorrhagic lesion.2. Focal tissue losses on the left basal ganglia and periventricular white matter with surrounding gliotic changes.3. Minimal non specific small vessel ischemic disease.4. Normal brain MRA and neck MRA.


Instruction: Generate impression based on findings.

Input: Ms. Bianchi is a 37 year old female with a family history of breast cancer in her mother (diagnosed at the age of 51) and maternal great aunt. Personal history of bilateral silicone implants and BRCA2 mutation carrier. There is extreme amount of fibroglandular tissue in both breasts. There are multiple enhancing foci seen bilaterally, compatible with moderate background parenchymal enhancement. No one focus is more suspicious than the rest. Bilateral retropectoral silicone implants are intact. There is no abnormal enhancement seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for abnormality; history of sarcoma. Signs and symptoms: None Pre and post enhanced brain MRI:Diffusion weighted images are unremarkable.Examination demonstrates normal anatomical morphology of the brain parenchyma. There is normal signal intensity of brain parenchyma on all MRI sequences. Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination.There is no detectable abnormal enhancement of brain parenchyma or the leptomeninges and post enhanced images.Normal visualization of signal void of major intracranial arterial branches.Normal signal intensity of the intracranial venous sinuses and with normal pattern of enhancement.Unremarkable calvarium, soft tissues of the scalp and orbits without abnormal enhancement.All paranasal sinuses and bilateral mastoid air cells and middle ear cavities demonstrate normal motility position signal patterns.

Output: Unremarkable pre and post enhanced brain MRI.


Instruction: Generate impression based on findings.

Input: 25-year-old with kyphosis and new onset lower extremity numbness.. Thoracic:There is pronounced thoracic kyphosis (apex at T7) as well as dextroscoliosis similar to prior. Please refer to recent radiography for degree of the abnormality. There is mild anterior wedging of the T6-T8 vertebral bodies with endplate Schmorl nodes which are unchanged. The remainder of the vertebral body height is preserved. No thoracic vertebral malformation is seen. The signal of the visualized cord is normal. There is a small disc protrusion with dorsal annular fissure at the T4-T5 level which mildly indents the right ventral cord. This appears slightly more rounded but otherwise not significantly changed. Mild T5-T6 protrusion also unchanged. Right T7-T8 protrusion appears less prominent. Mild T8-T9 bulge is also not significantly changed. Dorsal thecal sac is widely patent. No evidence of frank cord compression. The paraspinal soft tissues are unremarkable.Lumbar:There are 5 lumbar type vertebral bodies with most inferior well-defined disc space labeled L5-S1. Vertebral body heights in the lumbar spine are normal. There is exaggerated lumbar lordosis. Alignment is otherwise maintained. Individual levels as 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: Disk desiccation with dorsal annular fissure and small central protrusion again seen. There is no spinal canal or neural foraminal stenosis.L4/L5: Minimal disk bulge. There is bilateral facet arthropathy which is again seen. No spinal canal or neural foraminal stenosis.L5/S1: Disk desiccation with a small disk protrusion centrally. No spinal canal or neural foraminal stenosis. Paraspinous soft tissues unremarkable.

Output: 1. Pronounced thoracic kyphosis and dextroscoliosis with apex at T7 similar to prior MRI. There is also exaggerated lumbar lordosis.2. Unchanged mild anterior wedging of the T6-T8 vertebral bodies with endplate Schmorl nodes. No bone marrow edema.3. Multilevel mild disc bulges and small protrusions are again seen in the mid thoracic spine, relatively worse at T4-5 with mild indentation on the right ventral cord. No significant change since prior. No evidence of frank cord compression, high grade canal stenosis, or cord signal abnormality. 4. Mild degenerative changes in the lumbar spine without spinal canal or neural foramina stenosis at any level in the lumbar spine. There is facet arthropathy at the L4-L5 level.