Instruction: Generate impression based on findings.

Input: Unspecified cerebral artery occlusion with cerebral infarction [434.91] / Cerebral aneurysm, nonruptured [437.3] / Aphasia [784.3] / Memory loss [780.93], Reason for Study: ^Reason: hx of therapeutic carotid artery occlusion for aneurysm, chronic ischemia. Significant metallic artifacts on the left skull base which reflects prior coil embolization of the left ICA and aneurysm.There is no MR evidence of acute ischemic or hemorrhagic lesion on this scan.There is evidence of focal parenchymal chronic hemorrhage on the right centrum semiovale and tissue losses indicating chronic ischemic lesions on the left centrum semiovale. Underlying brain shows multiple scattered high signal intensity lesions on FLAIR images around periventricular white matter indicating non specific small vessel ischemic disease.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal right ICA, bilateral MCAs and ACAs. Distal left ICA from the origin of the left ophthalmic artery is visualized. Vertebrobasilar system appears to be normal.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion on this scan.2. The left distal ICA is reconstituted through both Acom and left Pcom arteries, no evidence arterial luminal stenosis or evidence of intracranial arterial aneurysm.3. Chronic hemorrhagic lesion on the right centrum semiovale and chronic ischemic lesion on the left centrum semiovale as described above.


Instruction: Generate impression based on findings.

Input: Weakness and paresthesia, new diagnosis neuroendocrine small cell lung cancer with metastasis. Rule out cord compression. Again seen is patchy marrow replacement involving many of the vertebral bodies of the spine concerning for diffuse metastatic disease. However, there is no significant loss of vertebral body height. At the C5-6 and C6-7 level there is substantial T2 hypointensity within the ventral epidural space which causes displacement and compression of the spinal cord. There is evidence of a small amount of cord signal abnormality at the C7 level which is confirmed on the recent previous outside hospital MRI exam of the spine. The signal characteristics involving the ventral epidural space at the C5-6 and C6-7 level suggests disc extrusion although the adjacent vertebral bodies are infiltrated by metastatic disease and therefore the possibility of disc mixed with tumor can be considered. Dedicated contrast enhanced exam of the cervical spine may provide additional information on this.Prominent disc herniation at the L5-S1 level with degenerative endplate changes causes moderate spinal canal stenosis at that level. There is no other significant spinal canal stenosis elsewhere in the cervical, thoracic or lumbar spine. Incidental note is made of thyroid gland enlargement and a left thyroid nodule.

Output: 1.This is a limited exam specific for the exclusion of cord compression only and does not exclude more subtle lesions such as intrinsic cord abnormalities. Due to the screening nature of this protocol details are not as evident on imaging as dedicated protocols of the spine.2.Extensive patchy marrow replacement involving the majority of the spine consistent with extensive osseous metastatic disease.3.Low T2 intensity material in the anterior epidural space at the C5-6 and C6-7 level causing cord compression and possibly cord edema. The signal characteristics suggest disc extrusion although the adjacent vertebral bodies are infiltrated by metastatic disease and this could possibly be due to disc mixed with tumor. Dedicated contrast enhanced cervical spine imaging is pending which may provide additional information.4.Prominent disc herniation at the L5-S1 level with endplate degeneration causes moderate spinal canal stenosis at that level.


Instruction: Generate impression based on findings.

Input: Patient has a strong family history of breast cancer in her mother and sister and personal history of benign MR guided left breast biopsy in March 2013. No current breast related complaints. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region. Stable bilateral enhancing foci, none suspiciously enhancing.High T2 signal right hepatic lobe lesion is likely a cyst or hemangioma.

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


Instruction: Generate impression based on findings.

Input: Migraine without aura, intractable, without status migrainosus [G43.019], Reason for Study: ^Reason: secondary causes of migraine History: bilateral frontal pressure like headache No evidence of acute ischemic or hemorrhagic lesion.There are a couple of high signal intensity lesions on the right parietal lobe subcortical white matter which are non specific.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.

Output: Normal brain MRI


Instruction: Generate impression based on findings.

Input: Prostate cancer on active surveillance, stable urinary side effects PELVIS:PROSTATE:Prostate Size: Measures 7.2 cm in craniocaudal dimension x 6.9 cm in transverse dimension x 4.9 cm in AP dimension.Peripheral Zone: Relative atrophy of right peripheral zone particularly at level of base with focus of T2 hypointense and low ADC signal measuring 7 x 7 mm on image 127 series 501, previously measured 6 x 6 mm, focus extends to level of capsule.Central Gland: Enlarged, including median lobe hypertrophy with indentation of adjacent urinary bladder.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Stable to mildly increased size of right peripheral zone T2 hypointense/low ADC signal focus at level of base as described, suspicious for focus of prostatic malignancy.


Instruction: Generate impression based on findings.

Input: There is normal lumbar lordosis. The spine alignment is anatomic. The vertebral bodies, 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. The conus medullaris is normal at the L1 level. The paraspinal soft tissues are unremarkable.Degenerative changes are specified by the intervertebral level as follows: At T12-L1: No evidence of disc herniation. The neural foramina and spinal canal are patent. At L1-L2: No evidence of neural foraminal narrowing or spinal stenosis. Normal disc is visualized.At L2-L3: Disc desiccation is seen. No evidence of herniation. The neural foramina appears normal with no evidence of stenosis.At L3-L4: No evidence of herniation. No evidence of neural foramina narrowing or spinal stenosis. There is moderate facet hypertrophy. There are no changes since the previous study.At L4-L5: Disc desiccation is seen. Minimal disc bulge. There is a minimal effacement of the anterior thecal sac. There is a bilateral mild neural foramina narrowing that is unchanged since the previous study. There is minimal spinal stenosis. There is facet hypertrophy that is worse than in the previous study. Hypertrophy of the ligamentum flavum is seen. The synovial cyst that was seen in the previous study along the left facet joint is not visualized and probably regressed.At L5-S1: There is minimal disc bulge with no evidence of neural foramina narrowing or spinal stenosis. There is facet hypertrophy. No changes since the previous study.

Output: 1. There is progression of facet hypertrophy at the level of L4-L5.2. No evidence of high-grade spinal stenosis or neural foraminal narrowing.3. The synovial cyst that was seen in the previous study in the left neural foramina of L4-L5 is no longer visualized, probably regressed.


Instruction: Generate impression based on findings.

Input: Wrist swelling and pain LIGAMENTS: No significant abnormality noted.TRIANGULAR FIBROCARTILAGE COMPLEX: No significant abnormality noted.TENDONS: There is a small amount of fluid surrounding the extensor carpi radialis longus tendon. The remaining extensor tendons are unremarkable. The flexor tendons are unremarkable.BONES: Minimal degenerative changes of the proximal carpal noted. There is no fracture or malalignment.ADDITIONAL

Output: 1. Small lesion between the second and third extensor compartments demonstrate signal characteristics consistent with a ganglion cyst.2. Small amount of fluid surrounding the extensor carpi radialis longus tendon which may reflect minimal tenosynovitis.


Instruction: Generate impression based on findings.

Input: Ms. Winkler is a 26 year old female with BRCA2 mutation. There is heterogeneous amount of fibroglandular tissue in both breasts. Mild to moderate background parenchymal enhancement is noted bilaterally, which limits the sensitivity of this examination.No abnormal enhancement is seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Headache, evaluate for structural abnormality. There is cavum septum pellucidum and vergae with convex borders, measuring up to approximately 25 mm. There is what may represent a fine adhesion between the two compartment. The rest of the ventricles are unremarkable. There is no evidence of intracranial hemorrhage or infarct. The brain parenchyma signal appears unremarkable. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Cystic cavum septum pellucidum and vergae.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: seizure, known right temporal lesion. Re demonstration of right parahippocampal gyrus lesion (16mm x 16mm x 19mm).The lesion appears to be exophytic nature and a bit expansile arising from mesial superior aspect of the parahippocampal gyrus likely involving subiculum and abuts dentate gyrus superiorly. On Gad infusion, the lesion shows minimal or no enhancement. Specifically, there is no nodular or mural enhancement.Mesial aspect of the lesion shows large tubular signal void which indicates right PCA passes by which is a fetal origin.Diagnostic possibilities include ganglioglioma, low grade glioma. Possibility of extra axial lesion would be less likely.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no 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.

Output: 1. Minimally or no enhancing right parahippocampal gyrus mass lesion as described above. Diagnostic possibilities include gangioglioma, low grade astrocytoma or other low grade intra axial tumor. 2. No change of the lesion's MR characteristics and size since prior exam.


Instruction: Generate impression based on findings.

Input: Major depressive disorder, recurrent, moderate [F33.1], Reason for Study: ^Reason: vascular dementia History: htn and cognitive impairment No evidence of acute ischemic or hemorrhagic lesion.Scattered T2/flair high signal intensity lesions on subcortical white matter and periventricular white matter are nonspecific but may indicate small vessel ischemic disease.The ventricles, sulci and cisterns are unremarkable. 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.

Output: 1.No evidence of acute ischemic or hemorrhagic lesion.2. Minimal nonspecific small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: Reason: Evaluate for ischemic stroke or mass lesion History: sudden onset of confusion and unresponsiveness, nonverbal but eyes open, not following any commands MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.There is a mild to moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. This is stable since prior exam.There is a mild degree of brainstem punctate hyperintense lesions present identified on the FLAIR and T2 images. This is stable since prior exam.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries. It is suspected that an apparent narrowing of the right internal carotid artery at the petrous segment is in part exaggerated due to artifact from adjacent air interface.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. The posterior communicating arteries are intact. The vertebral arteries are similar in size. The right A1 segment is hypoplastic. The posterior communicating arteries are very small. The right vertebral artery is larger than the left vertebral artery.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries.

Output: 1.No evidence for acute ischemic cerebral infarction.2.No convincing evidence for significant intracranial or extracranial cerebrovascular occlusive disease. There is apparent narrowing of the right internal carotid artery at the petrous segment which may be exaggerated due to artifact.3.Periventricular and subcortical white matter changes of a mild to moderate degree are nonspecific. At this age they are most likely vascular related. This is stable since prior exam.4.A mild degree of brainstem lesions are also suspected to be vascular related. This is stable since prior exam.


Instruction: Generate impression based on findings.

Input: 51-year-old man with right biceps pain. Evaluate for partial tear. The biceps muscle is normal in appearance, with no atrophy. There is no evidence of retraction to suggest a tear. The distalmost attachment of the biceps tendon on the radial tuberosity is not included in the field of view. If there is high clinical suspicion of a distal tendon abnormality, then an elbow MR would be appropriate.

Output: No evidence of biceps retraction to suggest a tear. The distalmost attachment of the biceps tendon on the radial tuberosity is not included in the field of view. If there is high clinical suspicion of a distal tendon abnormality, then an elbow MR would be appropriate.


Instruction: Generate impression based on findings.

Input: BRCA 1 positive. Nodularity on physical exam at left breast at 8:00. Breast parenchyma is almost entirely fat in both breasts.Mild parenchymal enhancement is noted bilaterally.No suspicious enhancement is seen within either breast. A peripherally enhancing dermal lesion in the left 6:00-7:00 position is present, likely an inflamed epidural inclusion cyst. This was confirmed on ultrasound performed today. No abnormal axillary lymph nodes are identified in either axillary region.A few probable hepatic cysts are again noted.

Output: No MRI evidence for malignancy. Left breast skin lesion compatible with an inflamed epidermal inclusion cyst. Today's other diagnostic imaging will be separately dictated. BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Routine Screening Mammogram.


Instruction: Generate impression based on findings.

Input: Male; 81 years old. Reason: 81 y/o male with HCC. Chemo has been on hold for 1m- GIB. Restaging CT- compare to prior History: see above ABDOMEN:LIVER, BILIARY TRACT: Nodular liver contour compatible with cirrhosis. No biliary ductal dilatation. Patent hepatic vasculature. No significant interval change in the size of segment 4 ablation cavity with high intrinsic T1 signal due to residual blood products. Area of enhancement along the postero-lateral wall of the ablation cavity measures 1.8 x 1 cm (series 11/23), previously 1.7 x 1.4 cm. Again, this area demonstrates T2 hyperintensity, restricted diffusion, arterial enhancement, and washout, compatible with marginal recurrence. Abutment and probable invasion of the middle hepatic vein are again noted. No additional suspicious hepatic lesions are seen.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Findings compatible with marginal recurrence along the posterolateral aspect of the segment 4 ablation cavity are not significantly changed.


Instruction: Generate impression based on findings.

Input: Female, 61 years old, with left-sided weakness and numbness. No restricted diffusion is seen to suggest acute ischemia. Scattered small foci of T2 hyperintensity are demonstrated in the periventricular and subcortical white matter. No evidence of parenchymal edema or mass effect is seen. No intracranial hemorrhage or abnormal extra-axial fluid is detected. The ventricular system is normal in size and morphology.

Output: 1.No evidence of acute ischemia.2.Numerous scattered small white matter lesions are nonspecific but most commonly reflect chronic microvascular ischemic disease.


Instruction: Generate impression based on findings.

Input: There is 4 mm of anterolisthesis of L3 upon L4. The vertebral body heights are well maintained. There are diffuse T1 and T2 hyperintense foci within the vertebral bodies likely hemangiomas or focal fat. The conus is normal in signal and morphology and terminates at an appropriate level. The visualized intra-abdominal and paraspinal contents are unremarkable. There is disc space narrowing and desiccation affecting L2/3 and L3/4. Additional findings by level.L1/2: Disc bulge with mild left neural foramen stenosis, but no significant spinal canal stenosis.L2/3: Disc bulge, ligamentum flavum thickening, and facet hypertrophy result in severe spinal canal stenosis and mild, left greater than right, neural foramen narrowing.L3/4: Disc bulge, ligamentum flavum thickening, and facet hypertrophy result in severe spinal canal stenosis and minimal neural foramen narrowing.L4/5: Ligamentum flavum thickening and facet hypertrophy result in mild spinal canal stenosis and neural foramen narrowing.L5/S1: Facet hypertrophy, but no significant central spinal canal stenosis or neural foramen narrowing.

Output: Multilevel degenerative spondylosis, which is most pronounced at L2/3 and L3/4, where there is severe spinal canal stenosis.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Male; 67 years old. Reason: Hx of prostate cancer on active surveillance with lesion on MRI Patient used prophylactic antibiotics before and after the procedure as prescribed. The patient received antibiotic prophylaxis with oral Ciprofloxacin 500mg and Vantin 200mg. The patient took 1 tablet of Ciprofloxacin 500mg the night before and morning of the procedure. The patient also took 2 tablets of Avantin 200mg the morning of the procedure. After the procedures, the patient will take 2 tablets of Ciprofloxacin 500mg and 2 tablets of Avantin 200mg.Following the discussion of the risks, benefits, and alternatives of the procedure, informed consent was obtained. DynaCad was used to localize dominant anterior apical T2 hypointense lesion. Using the Dynatrim guidance system an 18-gauge MR-compatible needle was inserted into the anterior prostate. Upon confirmation ofthe tip of the needle within the suspected lesion, MR guided biopsy using an 18 gauge Bard biopsy needle was performed and three cores were obtained.The cores were hand delivered to the pathology lab.The patient tolerated the procedure well and was discharged without any immediate complications.ESTIMATED BLOOD LOSS: Less than 5 cc.

Output: Successful core-biopsies of the dominant anterior apical prostate gland lesion.


Instruction: Generate impression based on findings.

Input: A 74 year old female with history of hear transplant on 5/26/2011, last echocardiography showed normal left ventricular function and a dobutamine stress test showed adequate response and no evidence for inducible ischemia.MEDICATIONS: Baclofen, calcium, vitamin B, D, folic acid, magnesium, levothyroxine, omeprazole, pravastatin, prednisone, tacrolimus. First Pass PerfusionDuring hyperemia, no perfusion defects were present.Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 65%, the LV end diastolic volume index is 53 ml/m2 (normal range: 65+/-11), the LVEDV is 96 ml (normal range 109+/-23), the LV end systolic volume index is 19 ml/m2 (normal range 18+/-5), the LVESV is 34 ml (normal range 31+/-10), the LV mass index is 41 g/m2, and the LV mass is 74 g. There are no regional wall motion abnormalities present. There is mild basal septal hypertrophy measuring up to 14 mm on the 3 chamber view end diastole.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 67%, the RV end diastolic volume index is 49 ml/m2 (normal range 69+/-14), the RVEDV is 89 ml (normal range 110+/-24), the RV end systolic volume index is 16 ml/m2 (normal range 22+/-8), and the RVESV is 29 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 pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no pericardial effusion.Extracardiac FindingsSternal wires.

Output: 1. No perfusion defects/ "ischemia" present during hyperemia.2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and systolic function (LVEF 65%).4. Normal RV size and systolic function (RVEF 67%).I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 54-year-old male with right shoulder pain. Rule out rotator cuff tear. ROTATOR CUFF: Note is made of a full-thickness tear of the supraspinatus tendon measuring approximately 11 mm in the AP dimension with minimal retraction. There is also partial thickness insertional tearing of the anterior fibers of the infraspinatus and posterior fibers of the supraspinatus tendon at their insertion on the greater tuberosity. The supraspinatus and infraspinatus muscles appear intact. There is mild fatty atrophy of the infraspinatus at the level of the myotendinous junction. The teres minor and subscapularis muscles and tendons appear intact.SUPRASPINATUS OUTLET: There is a small amount of fluid within the subacromial subdeltoid bursa. Mild degenerative changes affect the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: Minimal degenerative changes affect the glenohumeral joint. The glenohumeral joint alignment is anatomic. The glenoid labrum appears intact within the limitations of this non arthrogram study.BICEPS TENDON: The tendon of long head of the biceps appears intact. Circumferential fluid within the tendon sheath of the long head of the biceps may represent fluid extension from the glenohumeral joint versus a tenosynovitis. ADDITIONAL

Output: Full-thickness tearing of the rotator cuff with minimal retraction as described above. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Question of meniscal or ACL injury with reduced range of motion and tenderness to palpation. MENISCI: There is a vertical, peripheral partial tear of the posterior, medial meniscus (series 3, image 9).ARTICULAR CARTILAGE AND BONE: Bony contusions of the lateral femoral condyle and lateral tibial plateau.LIGAMENTS: Nonvisualization of ACL fibers is compatible with near complete ACL tear. The PCL, MCL, and LCL complex appear within normal limits. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Bony contusions of the lateral femoral condyle and lateral tibial plateau and findings compatible with near complete ACL tear. Moderate joint effusion.


Instruction: Generate impression based on findings.

Input: Previously noted restricted diffusion lesions are not seen anymore.Multiple signal voids on Gradient echo images on bilateral hemispheres may indicate petechial hemorrhage, calcification or amyloid angiopathy, no significant interval change since prior exam.On Gad enhanced images, there are diffuse uniform but pachymeningeal enhancement without evident leptomeningeal enhancement. This finding is likely represent benign nature but the differential diagnosis should include intracranial hypotension, postoperative status, lymphoma involvement, pachymeningeal metastasis such as breast cancer. Since the patient's sagittal images do not show evidence of tonsilar herniation and the shape of ventricular system appear to be within normal limits, the chance of intracranial hypotension could be remote.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion on this scan.2. Diffuse enhancement of pachymeninges, differential diagnosis include intracranial hypotension, postoperative status, lymphoma involvement, pachymeningeal metastasis such as breast cancer.


Instruction: Generate impression based on findings.

Input: Reason: right shoulder tendinopathy and OA, now limited ROM, assess for rotator cuff tear History: as above. ROTATOR CUFF: Partial thickness bursal tearing of the distal supraspinatus tendon. Infraspinatus tendinosis without discrete tear. The teres minor and subscapularis tendons are intact. Diffuse fatty muscle atrophy. SUPRASPINATUS OUTLET: Mild AC joint osteoarthritis. Small amount of fluid within the subacromial subdeltoid bursa, similar to prior.GLENOHUMERAL JOINT AND GLENOID LABRUM: The labrum is small and irregular likely representing degeneration. Subcortical cysts along the superior humeral head.BICEPS TENDON: The long head of the biceps tendon is intact. ADDITIONAL

Output: 1.Partial thickness bursal surface tearing of the supraspinatus tendon.2.Mild AC joint osteoarthritis.


Instruction: Generate impression based on findings.

Input: Knee pain. MENISCI: There is undulation of the free edge of the body of the medial meniscus likely representing meniscal flounce. The medial and lateral meniscus appear intact.ARTICULAR CARTILAGE AND BONE: The medial and lateral tibiofemoral articular cartilage appears intact. The patellofemoral articular cartilage appears intact.LIGAMENTS: The cruciate and collateral ligaments appear intact.EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: Patella alta and edema within the superolateral aspect of Hoffa's fat-pad can be seen in patient's with patellofemoral instability. Otherwise no findings to account for the patient's pain.


Instruction: Generate impression based on findings.

Input: Mitral regurgitation Left VentricleThe left ventricle is normal. The overall LV ejection fraction is 59%, the LV end diastolic volume index is 80 ml/m2 (normal range: 65+/-11), the LVEDV is 120 ml (normal range 109+/-23), the LV end systolic volume index is 34 ml/m2 (normal range 18+/-5), the LVESV is 51 ml (normal range 31+/-10). There are no regional wall motion abnormalities present. . There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is normal. Right VentricleThe right ventricle is normal . The overall RV ejection fraction is 57%, the RV end diastolic volume index is 87 ml/m2 (normal range 69+/-14), the RVEDV is 130 ml (normal range 110+/-24), the RV end systolic volume index is 40 ml/m2 (normal range 22+/-8), and the RVESV is 50 ml (normal range 35+/-13). Right AtriumThe right atrium is normal. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation, but the severity of aortic regurgitation can be underestimated by the MRI pulse sequence used in this study.Mitral ValveThe MV appears structurally normal, no prolapse. The mitral valve opens widely and there is mild mitral regurgitation, but the severity of mitral regurgitation can be underestimated by the MRI pulse sequence used in this study.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation, but the severity of pulmonic regurgitation can be underestimated by the MRI pulse sequence used in this study.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation, but the severity of tricuspid regurgitation can be underestimated by the MRI pulse sequence used in this study.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis 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. Structurally normal MV without evidence for prolapse. The is MR , however by visual estimation and quantitative regurgitant fraction it is mild.2. Upper normal LV size with normal LA size.3 Normal RV systolic function.


Instruction: Generate impression based on findings.

Input: Complicated endocrine issue, headache. The pituitary is not enlarged and there is no evidence of pituitary lesions. The pituitary stalk and hypothalamus are intact. There is no compromise do the optic apparatus or cavernous sinuses.

Output: No evidence of pituitary lesions.


Instruction: Generate impression based on findings.

Input: Male 69 years old with known CBD dilatation and pancreatic duct dilatation to level of ampulla since 2013. Evaluate for any new lesions or changes. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in size and contour. There are scattered, subcentimeter T2 hyperintense foci which are too small to accurately characterize but unchanged. No suspicious hepatic lesion is identified.Mild, smooth, and bile duct dilatation up to 9 mm in diameter to level of the ampulla not significantly changed since 2013. No intrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: The pancreatic duct is irregular and dilated with areas of focal narrowing in the body and head however the appearance is not significantly changed compared to the prior exam. Normal postcontrast appearance of the pancreatic parenchyma with no focal, suspicious lesion.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable bilateral subcentimeter renal cysts.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: No significant change in mild common bile duct dilatation. Irregularity and dilation of the pancreatic duct with areas of focal narrowing in the head and body is also unchanged. No obstructing mass or stone seen.


Instruction: Generate impression based on findings.

Input: New left tongue cancer. There is an ill-defined patchy hyperintense, enhancing lesion in the posterior left oral tongue that measures up to approximately 10 mm. The extrinsic tongue muscles and floor of mouth appear to be intact. There is no evidence of significant cervical lymphadenopathy based on size criteria. However, there is partially imaged right supraclavicular lymphadenopathy. The thyroid and major salivary glands are unremarkable. The major cervical flow voids are intact. There is multilevel degenerative cervical spondylosis. The airways are patent. The imaged intracranial structures are unremarkable. The imaged portions of the lungs are clear.

Output: 1. An ill-defined patchy hyperintense, enhancing lesion in the posterior left oral tongue that measures up to approximately 10 mm corresponds to the known tongue cancer. 2. No evidence of significant cervical lymphadenopathy based on size criteria. However, there is partially imaged right supraclavicular lymphadenopathy. Please refer to the separate PET report for additional details.


Instruction: Generate impression based on findings.

Input: 75-year-old male patient with history of PSC and lymphadenopathy. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology with mildly irregular biliary ducts are again noted. There is questionable nonspecific delayed enhancement in a heterogeneous area of the right lobe of the liver (series 13 image 27) without corresponding diffusion signal abnormality. Attention should be paid to this area on subsequent imaging. Portal venous system is patent. Multiple gallbladder stones and sludge.SPLEEN: Splenomegaly, measuring up to 17 cm in craniocaudal dimension.PANCREAS: Evaluation of the pancreas is limited due to intra-abdominal ascites. Multiloculated cystic lesion in the uncinate process appear similar compared to prior examination and currently measures 1.1 x 1.4 cm (coronal series 5 image 65), previously 1.1 x 1.5 cm.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Reference upper abdominal retroperitoneal lymph node measures 3.9 x 1.3 cm (series 3 image 18), previously 3.9 x 1.5 cm. Other nonindex retroperitoneal lymph nodes appear unchanged compared to prior.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Bilateral gynecomastia is noted.OTHER: No significant abnormality noted.

Output: 1.No significant interval change in retroperitoneal lymphadenopathy.2.Questionable delayed enhancement in a heterogeneous area of the right lobe of the liver without definitive liver lesion. Attention should be paid to this area on subsequent examinations.3.Stable appearance of the biliary tree, compatible with history of sclerosing cholangitis, without new dominant stricture evident or new intrahepatic biliary dilatation.4.Stable multiseptated uncinate process probable pancreatic IPMN.


Instruction: Generate impression based on findings.

Input: Reason: intractable headache, recently postpartum concern for PRES History: intractable headache, recently postpartum concern for PRES. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. Dural sinuses are patent. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Normal MRI brain without evidence of PRES.


Instruction: Generate impression based on findings.

Input: 30-year-old male with a left wrist cyst and history of De Quervain's tenosynovitis. LIGAMENTS: No significant abnormality noted.TRIANGULAR FIBROCARTILAGE COMPLEX: No significant abnormality noted.TENDONS: There is increased signal abnormality is the soft tissues and well as circumferential fluid within the tendon sheath of the extensor pollicis brevis, and to a lesser extent along the abductor pollicis longus, consistent with the stated history of De Quervain's tenosynovitis.BONES: No bone marrow signal abnormality is identified.ADDITIONAL

Output: 1. Findings consistent with the stated history of De Quervain's tenosynovitis.2. 1.0 cm cystic lesion along the dorsal aspect of the capitate most consistent with a ganglion cyst.


Instruction: Generate impression based on findings.

Input: Female 8 years old Reason: eval for sacro ileitis History: lbp and HLA B27 + for months BONE MARROW: No significant abnormality noted.SOFT TISSUES: No significant abnormality noted. JOINTS: No significant abnormality noted.ADDITIONAL

Output: Normal examination.


Instruction: Generate impression based on findings.

Input: Abdominal painEXAMINATION: MR enterography without and with IV contrast date ABDOMEN:LIVER, BILIARY TRACT: Normal hepatic size and enhancement without focal lesion. No intrahepatic or extrahepatic biliary ductal dilatation. The gallbladder is normal.SPLEEN: Normal size and enhancement.PANCREAS: Normal enhancement.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Symmetric enhancement without focal lesion or significant hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant lymphadenopathy.BOWEL, MESENTERY: Increased enhancement of the descending colon, without significant bowel wall thickening or abnormal motility. No surrounding fat stranding. No other areas of abnormal enhancement, wall thickening, dilation, or abnormal motility. No evidence of obstruction.BONES, SOFT TISSUES: No focal osseous lesion.OTHER: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Distended and normalLYMPH NODES: No significant lymphadenopathy.BOWEL, MESENTERY: Increased enhancement of the descending colon, without significant bowel wall thickening or abnormal motility. No surrounding fat stranding. No other areas of abnormal enhancement, wall thickening, dilation, or abnormal motility. No evidence of obstruction.BONES, SOFT TISSUES: No focal osseous lesions.OTHER: No significant free pelvic fluid.

Output: Descending colonic wall enhancement, inflammatory in nature, without significant bowel wall thickening or surrounding fat stranding.


Instruction: Generate impression based on findings.

Input: Found down, non-responsive, and hypoglycemic. There is extensive diffuse bilateral symmetric cerebral cortex restricted diffusion and T2 hyperintensity, with a posterior predominance. There is also restricted diffusion and high T2 signal in the bilateral posterior limbs of the internal capsules and to a lesser extent in the anterior left putamen. There is mild diffuse cerebral volume loss. There is a punctate focus of susceptibility effect in the anterior left frontal lobe, which may represent a chronic microhemorrhage. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, mastoid air cells, and scalp soft tissues are grossly unremarkable. There is a small left maxillary sinus retention cyst.

Output: Extensive cytotoxic edema involving the cortex of the bilateral cerebral hemispheres, with a posterior predominance, bilateral posterior limbs of the internal capsules, and to a lesser extent the left putamen. The constellation of findings and clinical setting are most compatible with acute hypoglycemic encephalopathy.


Instruction: Generate impression based on findings.

Input: The risks (including, but not limited to, those of bleeding, infection, allergic reaction, 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 left elbow was localized fluoroscopically, and a spot radiograph was obtained. The skin was cleansed and covered with a sterile drape. The skin and subcutaneous tissues were anesthetized with 1% lidocaine using a 25-gauge needle.Under fluoroscopic guidance, a 22 gauge needle was advanced into the joint. Next, 7 mL Omnipaque 240 mixed with dilute Multihance (0.1 cc in a 10 cc vial of saline, for subsequent MR imaging) were injected into the joint. Contrast opacified the joint in the expected manner. A spot radiograph was obtained for documentation. The needle was withdrawn. Blood loss was negligible (<1cc), and the 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: 1 minute 2 seconds

Output: Successful left elbow arthrogram.


Instruction: Generate impression based on findings.

Input: Cirrhosis of liver, HCV, evaluate for blockage of biliary ducts, elevated alkaline phosphatase and GGT ABDOMEN:LIVER, BILIARY TRACT: Nodular liver contour and diffusely heterogeneous hepatic parenchymal signal. No suspicious arterially enhancing hepatic focus delineated. Mildly enlarged perihepatic and periportal lymphadenopathy, stable to mildly decreased in size compared to earlier exam and most likely reactive in etiology. Status post cholecystectomy. Not significantly changed from prior study is mild intrahepatic biliary duct dilatation. Common bile duct normal in size, distalmost CBD not well seen, similar in appearance to prior study. SPLEEN: Stable nonenhancing hypointense foci in spleen, may reflect sequela of prior ischemic insult.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Decreasing residual T1 hyperintensity seen in left adrenal region, for example, component measuring 3.8 x 2.1 cm on prior exam now measures 0.9 x 0.5 cm, persistent left adrenal nodularity, image 61 series 10.KIDNEYS, URETERS: Bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Spinal degenerative disease and scoliosis.OTHER: Status post sternotomy. Cardiomegaly.

Output: 1. Not significantly changed from prior study is mild intrahepatic biliary duct dilatation. Common bile duct normal in size, distalmost CBD not well seen, similar in appearance to prior study. Findings may reflect combination of postcholecystectomy state/benign stricturing. No definite enhancing lesion seen.2. Cirrhotic liver. No suspicious liver lesion. Mildly enlarged perihepatic and periportal lymphadenopathy, stable to mildly decreased in size compared to earlier exam and most likely reactive in etiology. 3. Decreasing left adrenal hemorrhage, persistent left adrenal nodularity.


Instruction: Generate impression based on findings.

Input: Left finger numbness. Brain: There are several, at least 10, punctate cerebral white matter T2 hyperintense lesions. Some of these appear to be slightly larger than in 2010, although this may be attributable to differences in technique. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Cervical Spine: The spinal cord displays normal signal. There is lack of the usual cervical lordosis and a posterior disc-osteophyte complex at the C5-6 level that results in mild spinal canal stenosis. There are also smaller posterior disc-osteophytes at C4-5 and C6-7. There is a punctate perineural cyst in the left C5-6 neural foramen. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. The paravertebral soft tissues are unremarkable. However, there is a left thyroid nodule that measures up to 15 mm, which is unchanged.

Output: 1. Some of the presumed intracranial demyelinating lesions appear to be slightly larger than in 2010, although this may be attributable to differences in technique. 2. No evidence of demyelinating lesions in the cervical spine.3. Lack of the usual cervical lordosis and a posterior disc-osteophyte complex at the C5-6 level that results in mild spinal canal stenosis. 4. Nonspecific left thyroid nodule, which is unchanged.


Instruction: Generate impression based on findings.

Input: 59-year-old male with cirrhosis who presents for hepatocellular carcinoma screening ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver contour and morphology without evidence of a suspicious hepatic lesion. No intrahepatic biliary ductal dilatation. Gallbladder wall thickening is nonspecific and likely related to cirrhosis.SPLEEN: Mild splenomegaly. No suspicious splenic lesion. Punctate siderotic nodules are again noted. Splenic collaterals including splenorenal shunt. PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Retroaortic left renal vein.RETROPERITONEUM, LYMPH NODES: Nonspecific subcentimeter retroperitoneal lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Cirrhosis without a suspicious liver lesion. Stigmata of portal hypertension.


Instruction: Generate impression based on findings.

Input: Disorientation, unspecified [R41.0], Reason for Study: ^Reason: CT head with acute versus subacute infarct in the right occipital lobe History: see above Brain MRIRestricted diffusion lesions on bilateral frontal and parietal lobes as well as the right occipital lobe. Especially the right occipital lobe lesion show susceptibility artifacts indicating hemorrhagic conversion.There are scattered FLAIR/T2 high signal intensity lesions on periventricular white matter indicating non specific small vessel ischemic disease.The ventricles, sulci and cisterns are unremarkable. The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. The right distal PCA is not clearly visualized. Otherwise basilar artery and the left PCA appear to be normal.

Output: 1. Right occipital, bilateral frontal and bilateral parietal subacute ischemic infarction with evidence of hemorrhagic conversion on the right occipital lobe lesion.2. Non visualization of the distal right PCA which corresponding to the right occipital ischemic infarction.3. Minimal non specific small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: 54-year-old man with history of Budd-Chiari syndrome, evaluate for HCC. ABDOMEN:LIVER, BILIARY TRACT: The liver is cirrhotic in morphology. There is an enhancing focus in the caudate lobe measuring 9 x 9 mm (9/42), previously 10 x 10 mm. An additional, punctate focus of enhancement is also unchanged.Cholelithiasis without wall thickening or pericholecystic fluid.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: Partially visualized small bowel and colon appear normal.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Arterially enhancing foci in the caudate lobe likely represent regenerative nodules and are unchanged.2.Cirrhotic liver compatible with given history of Budd-Chiari.


Instruction: Generate impression based on findings.

Input: 72 years, Male, Reason: 72M with history of sigmoid colon cancer. treated with 3 courses of radiation therapy, most recently 7/2014, to a presacral recurrence. now with moderate pain in the left pelvis and left leg. evaluate for tumor recurrence vs radiation toxicity. History: left leg pain along L4 distrubution.. PELVIS: PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Diffuse bladder wall thickening may be secondary to radiation change..LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: There is significant patchy enhancement, diffusion restriction and increased T2 signal throughout the sacrum, which is also low signal on precontrast T1 images of lumbar spine performed on the same day. This corresponds to region of minimally increased uptake on prior PET/CT. Overall, the signal changes mostly confined to the sacrum and only minimally extends to the left iliac bone. No definite fractures are evident in these images.There is also edema and enhancement which extends along the left piriformis and is thought to be reactive.OTHER: No significant abnormality noted.

Output: 1.Patchy enhancement and edema throughout the sacrum. Radiation changes are favored, however on the basis of these images, neoplasm cannot be excluded. It should be noted that it would be considered highly unlikely to have an isolated sacral metastases in the setting of colon cancer without other more common metastatic lesions.2.Edema and enhancement extending along the left piriformis thought to be reactive, unlikely to represent tumor.


Instruction: Generate impression based on findings.

Input: 45-year-old female with history of left breast MR guided biopsy with pathology result of focal ALH underwent an outside hospital MRI at outside hospital on 3/13/2015 that demonstrated new nonmass enhancement in the right upper inner breast with overlying skin augmentation for which MR directed ultrasound is recommended. A targeted right upper inner quadrant ultrasound was performed. There is no solid or cystic mass identified. Patient denies any surgical procedure or biopsy in that area. The skin indentation probably could've been due to the coil placement at the time of the MRI at outside hospital.

Output: No sonographic evidence for malignancy corresponding to the area of enhancement seen on MRI. 6 month follow up MRI is recommended to confirm stability of the area of non mass enhancement seen in the right breast. Findings conveyed to Dr. Jaskowiak at 10 am . BIRADS: 3 - Probably benign finding.RECOMMENDATION: 3B - Followup at Short Interval (1-11 Months).


Instruction: Generate impression based on findings.

Input: 83 years Female (DOB:2/11/1933)Reason: stroke work up History: as abovePROVIDER/ATTENDING NAME: TERESITA M. HOGAN MRI of the brainNo diffusion weighted abnormalities are appreciated. Incidental note is made of partial empty sella.The CSF spaces are appropriate for the patient's stated age with no midline shift. There are several periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate some scattered opacities. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries. Incidental note is made of azygos A2 segment.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The posterior communicating arteries are very small and intact. MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There are weblike defects present along the distal internal carotid arteries. The distal internal carotid arteries are highly tortuous.There is no significant stenosis along the course of the vertebral arteries. The left vertebral artery significantly larger than the right vertebral artery. There are weblike defect present along the distal left vertebral artery.

Output: 1.There is no evidence for acute ischemic cerebral infarction.2.Periventricular and subcortical white matter lesions of a minor degree are nonspecific. At this age they are most likely vascular related. 3.Weblike defects along the internal carotid arteries and left vertebral artery are present. It is possible that these are related to fibromuscular dysplasia.4.There is no evidence for intracranial or extracranial cerebrovascular occlusive disease.


Instruction: Generate impression based on findings.

Input: 37-year-old female with known right triple negative breast cancer and metastatic right axillary lymphadenopathy. She presents for I-SPY 2 research MRI #3. There is heterogeneous amount of fibroglandular tissue in both breasts. Mild background parenchymal enhancement is noted bilaterally.RIGHT BREAST:The index malignancy at upper outer quadrant shows a significant reduction of its size. Although the index mass measured 3.0 x 2.2 x 1.9 cm on the prior study, there are only two enhancing foci remaining at the site of prior index mass. Multiple additional enhancing masses are still present, but they become significantly smaller. Total extent of these lesions is 5.0 x 1.7 x 3.7 cm (previously 5.8 x 2.7 x 5.2 cm).In the right axilla, the proven metastatic lymph node with marker clip measures 1.3 cm (previously 1.7 cm). No other abnormal lymph nodes are seen.LEFT BREAST:A stable oval circumscribed mass, which is biopsy proven to be benign, is again seen in the retroareolar region. No abnormal enhancement seen elsewhere in the left breast. No abnormal axillary lymph nodes are identified in the left axillary region.

Output: 1. Significant reduction in the size of the index mass and additional multiple masses in the right breast.2. Interval reduction in the size of metastatic right axillary lymph node3. No MRI evidence of malignancy in the left breast. BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Ms. Schnitz is a 48-year-old female with family history of breast cancer in a paternal aunt. Patient is a known BRCA mutation carrier. Personal history of benign MR-guided biopsy of right breast in 04/2014 for columnar cell change. Quality of this examination is slightly limited due to presence of motion artifact and aliasing.There is heterogeneous amount of fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.Focal susceptibility artifact from biopsy marker clip is reidentified in the right breast, at site of prior benign MR guided biopsy. There is no abnormal enhancement seen in either breast. No axillary or internal mammary lymphadenopathy.

Output: No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Routine Screening Mammogram.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Male 58 years old Reason: eval for lesions in liver/ pancreas, f/u biliary strictures, s/p OLT 4/11 History: elevated liver tests ABDOMEN:LIVER, BILIARY TRACT: Status post liver transplant with a biliary enteric anastomosis. Mild intrahepatic biliary ductal dilatation is present without significant change. Hepatic and portal veins are patent. No suspicious hepatic lesions. Hypoenhancing focus in segment 7 is unchanged. There is mild scattered intrahepatic biliary ductal dilatation. SPLEEN: Spleen is enlarged with upper abdominal portosystemic varices.PANCREAS: Cystic lesion in the pancreatic body measures 1.8 cm as seen on image 22 of series 5. Small cystic foci in the pancreatic tail and head are unchanged. No pancreatic ductal dilatation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small right renal cysts. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Mild dilatation of the small bowel in the right hemiabdomen likely postsurgical given the roux limb for the biliary enteric anastomosis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No suspicious hepatic lesions. Mild intrahepatic biliary ductal dilatation persists.2.No significant change in the cystic pancreatic body lesion.


Instruction: Generate impression based on findings.

Input: 63 year-old male with left-sided weakness. No evidence of acute intracranial hemorrhage or midline shift. Again seen is extensive bilateral vasogenic edema due to patient's known metastatic disease. Metastatic foci in the right frontal and left frontal lobes have increased attenuation compared to prior CT, likely corresponding to hemorrhage; however, this is likely unchanged from more recent MRI (series 4, image 23 and image 21).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: 1.No evidence of acute intracranial abnormality.2.Metastatic foci bilaterally have increased attenuation, most consistent with hemorrhage; although this appears increased since CT done 1/1/2012, this is likely unchanged from more recent MR done 1/25/2012. Extensive bilateral vasogenic edema associated with metastases not significantly changed.


Instruction: Generate impression based on findings.

Input: Shortness of breath [R06.02], Reason for Study: ^Reason: chronic memory issues History: rule out occult vascular disease Significant metallic susceptibility artifacts on bilateral temporalis muscle area degraded intracranial evaluation.No evidence of acute ischemic or hemorrhagic lesion.Scattered patchy FLAIR/T2 high signal intensity lesions on bilateral periventricular white matter and centrum semiovale indicating nonspecific small vessel ischemic disease.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, 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.

Output: No evidence of acute ischemic or hemorrhagic lesion.Nonspecific small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: There are scattered punctate foci of T2 hyperintensity within the white matter without associated mass effect, restricted diffusion, susceptibility abnormality, or enhancement. There are no similar appearing foci in the posterior fossa.There is a 2-3 mm focus of relative hypoenhancement within the mid aspect of the anterior pituitary which is slightly T2 hyperintense. The pituitary gland height remains normal, and there is no involvement of the adjacent optic apparatus.The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. Mucosal thickening is present within the maxillary sinuses. Scattered foci of mucosal thickening can be found in bilateral ethmoid air cells. The remainder of the paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain.

Output: 1.There are scattered punctate foci of T2 hyperintensity within the white matter without associated mass effect, restricted diffusion, susceptibility abnormality, or enhancement. There are no similar appearing foci in the posterior fossa. This is nonspecific in appearance and the differential diagnosis would most likely include migraine sequela, small vessel disease, residua from prior head trauma, or demyelination.2.There is a 2-3 mm focus of relative hypoenhancement within the mid aspect of the anterior pituitary which is slightly T2 hyperintense. The pituitary gland height remains normal, and there is no involvement of the adjacent optic apparatus. This is suggestive of a pituitary microadenoma, which could be confirmed with dedicated pituitary MRI imaging and/or correlation with thyroid hormone levels.


Instruction: Generate impression based on findings.

Input: 14-year-old male with familial hemophagocytic lymphohistiocytosis and cerebral palsy with epilepsy now experiencing increased somnolence with EEG changes. There is extensive diffuse cerebral, brainstem, and cerebellum volume loss with white matter T2 hyperintensity, representing gliosis, is not significantly changed. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is no abnormal intracranial enhancement. 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 a small right maxillary sinus retention cyst.

Output: No significant interval change of both supratentorial and infratentorial abnormalities without enhancement.


Instruction: Generate impression based on findings.

Input: Right lower quadrant pain status post ileocecectomy with prior fistulae seen disease. Concern for stricture at anastomotic site. 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: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postsurgical changes from a ileocecectomy. The neoterminal ileum demonstrates fixed narrowing and moderate circumferential wall thickening measuring approximately 7.1 cm (series 3 image 26) with surrounding fibrofatty proliferation, restricted diffusion, reactive right lower quadrant lymph nodes and vascular engorgement. More proximally there is approximately 10 cm of mild circumferential wall thickening with hyperenhancement (series 16/370).No free or loculated fluid collection. No discrete sinus tract or fistulous tract is identified. No significant proximal bowel dilatation.The remainder of the small bowel and colon shows no discrete abnormality.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Fixed narrowing, suspicious for chronic stricture, with superimposed moderate acute mural and mesenteric inflammation involving approximally 7 cm of the neoterminal ileum. There is mild to moderate acute inflammatory changes of 10 cm of the immediately upstream small bowel.


Instruction: Generate impression based on findings.

Input: 79-year-old female with back pain. Evaluate for lumbar spinal stenosis. Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall height. There is grade 1 anterolisthesis at L4-5 which appears slightly worse since 12/9/2009 MRI. Alignment is otherwise maintained. Degenerative changes are seen as describe below:At L1-2 there is no significant compromise to spinal canal or neural foramina. Mild facet arthropathy.At L2-3 there is no significant compromise to spinal canal or neural foramina. Mild facet arthropathy.At L3-4 there is no significant compromise to spinal canal or neural foramina. Bilateral facet arthropathy.At L4-5 there is grade 1 anterolisthesis, disc dessication, disc uncovering as well as mild extrusion superimposed on disc bulge. There is also advanced facet arthropathy and evidence of prior decompressive left hemi-laminectomy. There is mild left worse than right neural foraminal stenosis and progressed since 2009. No significant spinal canal stenosis. At L5-S1 there is mild disc extrusion superimposed on diffuse disc bulge, ligamentum flavum thickening, and advanced facet arthropathy particularly on the right. There is moderate right neural foraminal stenosis, which has progressed in the interval. No significant left neural foraminal or spinal canal stenosis. A solid 2 cm lesion along the anterior margin of the right kidney with low T2 signal is noted. Additional left renal cystic lesion is noted.

Output: 1. Grade 1 degenerative spondylolisthesis at L4-5 has slightly progressed since 12/9/2009. Interval left decompressive hemi-laminectomy is noted at this level. No significant spinal canal stenosis is appreciated at this level or elsewhere in the lumbar spine.2. Mild left worse than right L4-5 and moderate right L5-S1 neural foraminal stenosis have progressed since 2009. Advanced L4-5 and L5-S1 facet arthropathy again seen. 3. Right renal lesion is again seen and better characterized on prior post-contrast abdominal CT.


Instruction: Generate impression based on findings.

Input: Clinical question: Chest pain, cervical radiculopathy. Signs and symptoms: As above. Nonenhanced cervical MRI:There is normal anatomical alignment of vertebral column.There is however mild straightening normal cervical lordosis.Foramen magnum is unremarkable.C2-C3 is unremarkable.C3-C4 is unremarkable.C4-C5 is unremarkable.C5-C6 demonstrate mild disc disease and minimal facet/ligamentum flavum hypertrophy. There is a shallow broad-based disc protrusion along the entire ventral epidural space (left greater than right). Findings is also seen effacement of ventral subarachnoid space, mild flattening deformity and posterior displacement of the cord and resultant moderate central spinal stenosis. There is no detectable associated cord signal abnormality with this finding. This finding results in mass effect on the exiting nerve roots at this level which is more conspicuous on the left.C6/C7 is unremarkable.C7-T1 is unremarkable.Unremarkable upper most visualized thoracic spine and thoracic cord to T4 level.

Output: 1.Shallow broad-based disc protrusion at C5/C6(L>R) on good with resultant moderate central spinal stenosis and mass effect on bilateral exiting nerve roots (L>R).2.Unremarkable MRI of cervical spine otherwise.


Instruction: Generate impression based on findings.

Input: 47-year-old male with right shoulder pain, no improvement with physical therapy ROTATOR CUFF: Supraspinatus is intact. Infraspinatus is intact. The teres minor is intact. The subscapularis is intact. Normal muscle bulk. No evidence of tear.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: No significant abnormality noted.BICEPS TENDON: Small amount of fluid within the biceps tendon sheath, normal.ADDITIONAL

Output: No evidence of rotator cuff tear.


Instruction: Generate impression based on findings.

Input: Reason: evaluate for osteomyelitis History: pain, redness and swelling Note is made of postsurgical changes of transmetatarsal amputation. There are foci of susceptibility artifact along the distal aspect of the metatarsal remnants likely postsurgical in etiology. Severe osteoarthritis affects the tibiotalar joint with full-thickness articular cartilage degeneration and subchondral signal abnormality, also likely degenerative in etiology. Otherwise no bone marrow signal abnormality to suggest osteomyelitis. Note is made of subcutaneous edema along the dorsal aspect of the fourth and fifth metatarsal remnants which enhances on postcontrast sequences likely representing a cellulitis. The visualized tendons appear intact. The distal tibiofibular syndesmotic complex appears intact. The ATFL is poorly visualized and likely disrupted. The PTFL and calcaneofibular ligaments appear intact. There is loss of the normal fatty striation of the image components of the deltoid ligament likely representing degeneration or prior injury. There is increased signal abnormality within the plantar musculature which is nonspecific but can be seen in diabetic patients. No focal fluid collection is identified to suggest abscess formation.

Output: Postsurgical changes of the foot with osteoarthritis of the ankle. Findings suggestive of a mild cellulitis without findings to suggest osteomyelitis. No focal fluid collection is identified to suggest abscess formation. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Metastatic colon cancer, neck pain radiating. Is there metastatic disease? There is evidence of osseous metastatic disease with diffuse low T1 marrow signal, STIR hyperintensity, and enhancement involving the C5 vertebral body, as well as the right posterior aspect of the T3 vertebral body, pedicle, and transverse process extending into the right posterior third rib. Motion degradation limits evaluation for small lesions; there are tiny foci of T1 hypointensity and enhancement involving the C2 and C3 levels which are favored to represent vascular structures and less likely metastatic foci. Please note bone scan or PET may better assess the burden of osseous metastatic disease. There is no evidence of epidural tumor in the cervical spine. Vertebral body heights are normal. There is minimal retrolisthesis of C4 on C5. Alignment is otherwise grossly maintained.Degenerative changes are evident as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: Disc osteophyte complex. Minimal spinal canal narrowing. No significant neural foraminal stenosis.C4-5: Central disc osteophyte complex. Minimal spinal canal narrowing. Mild right and minimal left neural foraminal narrowing.C5-6: Left paracentral disc osteophyte complex and ligamentum flavum thickening with mild spinal canal stenosis. Mild narrowing of the neural foramina bilaterally related to uncovertebral hypertrophy.C6-7: Small disc osteophyte complex and uncovertebral hypertrophy. No significant spinal canal stenosis. Mild left neural foraminal narrowing. No significant right neural foraminal narrowing.C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Lung masses related to known metastasis noted and better assessed on recent chest CT. There is long segment enhancement involving the esophageal wall.

Output: 1. Edema and enhancement involving the C5 vertebral body likely related to metastatic disease. There is also a larger destructive metastatic lesion involving the right posterior aspect of the T3 vertebral body extending into the posterior elements and third rib which was also noted on chest CT from 11/9/2015.2. No evidence of epidural tumor or pathologic fracture in the cervical spine. There are mild degenerative changes involving the cervical spine from the C3-C4 to the C6-C7 levels with mild spinal canal and mild multilevel neural foraminal stenosis. Please see details above. 3. Long segment enhancement is noted involving the esophageal wall/mucosa which may represent treatment-related esophagitis.


Instruction: Generate impression based on findings.

Input: Female, 71 years old. Right shoulder pain radiating in median nerve distribution with associated hypoesthesia over anterior deltoid. Per Epic note, the patient is also experiencing shoulder stiffness. ROTATOR CUFF: There is a full thickness tear of the supraspinatus tendon without retraction. The infraspinatus, teres minor, and subscapularis tendons appear intact. SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is within normal limits. The glenoid labrum is intact.BICEPS TENDON: The biceps tendon appears intact. ADDITIONAL

Output: 1. Full-thickness tear of the supraspinatus without retraction.2. Findings consistent with adhesive capsulitis.


Instruction: Generate impression based on findings.

Input: Status post fusion, left radicular pain. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is minimal anterolisthesis of L5 on S1 which is similar to prior. Alignment is otherwise within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position. Compared to MRI 6/16/2015, interval postsurgical changes of spinal fusion at L5-S1 is seen. Paraspinous rods, pedicle screws, and interbody spacer have been placed which are better seen on recent lumbar spine CT from 6/22/2015.Multilevel degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: Mild disc bulge again seen without significant spinal canal or neural foraminal stenosis.L4-L5: Minimal disc bulge. No spinal canal or neural foraminal stenosis.L5-S1: Previously seen disc bulge is decreased in prominence. The spinal canal and right neural foramen are patent. Left neural foramen is suboptimally visualized due to susceptibility artifact from the hardware but appears surgically decompressed. Evaluation for scar tissue in the left neural foramen is very limited due to artifact. No obvious epidural scar tissue is appreciated in the spinal canal. Facet arthropathy is better seen on recent postoperative CT.Paraspinous soft tissues are grossly unremarkable. No hematomas within the spinal canal or fluid collections within the paraspinous soft tissues. No MRI evidence of arachnoiditis.

Output: Postsurgical changes of spinal fusion at L5-S1. There is no significant spinal canal or neural foraminal stenosis which is evident. The left L5-S1 neural foramen, which was previously narrowed, is suboptimally assessed due to artifact but appears surgically decompressed.


Instruction: Generate impression based on findings.

Input: There are multiple metastatic lesions within the cervical and thoracic vertebral column. In particular, there has been interval increase in size of the lesions within the C2 through C4, and C7, where there is now epidural extension into the right spinal canal that results in mild spinal canal stenosis, but no spinal cord compression. However, there is obliteration of the right C2-3 neural foramen by the tumor. Nevertheless, the vertebral body heights are preserved. There are an unchanged probable hemangioma in the T1 and T2 vertebral bodies. There is unchanged loss of the usual cervical lordosis. There is degenerative spondylosis with minimal spinal canal stenosis at C3-4, C4-5, and C6-7, mild left neural foraminal stenosis at C3-4, mild-to-moderate right neural foraminal stenosis at C4-5, severe left and moderate right neural foraminal stenosis at C6-7, and mild right neural foraminal stenosis at C7-T1. There is a probable Thornwaldt cyst, which is unchanged.THORACIC SPINE

Output: 1.Post-operative and post-radiation treatment findings in the spine with overall increase in the vertebral metastases in the cervical spine and in T1 through T5 and T9. The tumor involving the T6 through T8 vertebrae appears similar, although precise comparison is limited due to the presence of hardware artifacts and there still appears to be severe spinal canal stenosis with compression of the spinal cord. 2.Interval decrease in the marrow signal and tumor enhancement in the lower lumbosacral spine related to radiation treatment.3.An unchanged subcentimeter lesion in the cauda equina nerve roots at the L3 level may represent a peripheral nerve sheath tumor.4. Interval increase in size of an upper mediastinal lymph node metastasis.5. Unchanged degenerative spondylopyosis in the cervical spine and lower lumbar spine.


Instruction: Generate impression based on findings.

Input: 73-year-old male patient with acute pancreatitis. Evaluate for common bile duct stones. Evaluation is limited secondary to lack of IV contrast.ABDOMEN:LIVER, BILIARY TRACT: No intra or extrahepatic ductal dilatation. There is cholelithiasis without specific evidence of acute cholecystitis. No foci of signal void identified within the common bile duct to suggest choledocholithiasis. There is a heterogeneous mixed signal collection measuring 7.0 x 3.2 cm within the right hepatic lobe posterior to and displacing the posterior branch of the right portal vein adjacent to a large right suprarenal mass; this is new compared to the prior OSH MRI. The collection is septated, has a thin peripheral rim of T1 hyperintensity, and foci of susceptibility artifact, which may represent calcification or hemorrhage. This is favored to represent an intraparenchymal hematoma. SPLEEN: There is an accessory splenule. PANCREAS: The main pancreatic duct is not dilated with variant pancreatic ductal anatomy.ADRENAL GLANDS: There is a large right suprarenal mass measuring approximately 9.0 x 10.6 x 10.4 cm, appearing similar in size to the prior study, which causes mass effect on the adjacent liver and right kidney. The mass is heterogeneous in T2 signal with increased T2 hyperintensity centrally presumably representing necrosis, however, is incompletely characterized without IV contrast. The mass appears to compress the inferior vena cava anteriorly, but there is no definite invasion as best seen on the axial fiesta images. The right renal vein appears patent.The left adrenal gland is unremarkable.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Large right pleural effusion and small left pleural effusion with overlying compressive atelectasis.

Output: 1.No intra- or extrahepatic biliary ductal dilatation. Cholelithiasis without evidence of acute cholecystitis.2.Large right suprarenal mass compatible with provided history of pheochromocytoma, though incompletely characterized without IV contrast.3.Interval development of a heterogeneous 7cm collection within the right hepatic lobe which is favored to represent an intraparenchymal hematoma given history of surgery since the prior OSH MRI.


Instruction: Generate impression based on findings.

Input: Right lower facial droop and aphasia. MRI: There is extensive patchy T2 hyperintensity involving the cerebral and pontine white matter. There is no evidence of acute infarct. There is diffuse cerebral volume loss. There is no evidence of acute intracranial hemorrhage. There is no midline shift or mass effect. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There are bilateral lens implants.MRA: There is mild irregularity of the right cavernous internal carotid artery likely secondary to atherosclerotic calcifications. There is also mild focal narrowing of the P1-P2 junction of the right posterior cerebral artery. The rest of the major cerebral vessels are unremarkable. There is no evidence of cerebral aneurysms.

Output: 1. No evidence for acute ischemia.2. Cerebral and pontine white matter abnormalities may represent chronic small vessel ischemic disease.3. Mild irregularity of the right cavernous internal carotid artery likely secondary to atherosclerotic calcifications and mild focal narrowing of the P1-P2 junction of the right posterior cerebral artery, but no evidence of significant cerebral artery steno-occlusive disease otherwise.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 56 year old female with metastatic left axillary lymph nodes and palpable left breast mass presents for MRI evaluation. There is heterogeneous amount of fibroglandular tissue in both breasts.Several cysts are noted in the left breast.Mild parenchymal enhancement is noted bilaterally.There is an irregularly shaped enhancing mass in the left breast at posterior 2 o'clock position, measuring 19 x 12 x 11 mm, which is suspicious for malignancy.There is an additional enhancing mass, measuring 9 x 6 x 9 mm, at posterior 12 o'clock position in the left breast.Surgical changes are seen in the left axilla. Multiple enlarged lymph nodes are present in the left axilla, mainly in level one and two. The largest lymph node measures 28 mm in maximum diameter.No abnormal enhancement is seen in right breast. No abnormal lymph nodes are identified in right axillary region.

Output: 1. Suspicious mass in the left posterior 2 o'clock position and additional enhancing mass in the left posterior 12 o'clock position.2. Multiple abnormal lymph nodes in the left axilla.3. No abnormal enhancement in right breast. 4. No abnormal lymph nodes in right axillary region.BIRADS: 5 - Highly suggestive of malignancy.RECOMMENDATION: X - No Letter.


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 left 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, 10 ml of a 50/50 mixture of Omnipaque 240 (to confirm the intra-articular position of the needle) and dilute Multihance (0.1 cc in a 10 cc vial of saline, for subsequent MR imaging) were injected into the joint. Contrast opacified the joint in the expected manner. A spot radiograph was obtained for documentation. The needle was withdrawn. Blood loss was negligible (<1cc), and patient tolerated the procedure well without immediate complication. An adhesive bandage was placed on the patient’s skin. Routine post procedure instructions were communicated to the patient. The patient was escorted to the MRI suite for further imaging in stable condition. Please refer to the subsequent MRI report for further information.Exposure time: 17 seconds

Output: Successful fluoroscopic guided left hip arthrogram.


Instruction: Generate impression based on findings.

Input: Diagnosis: Altered mental status. Personal history of other disorders of nervous system and sense organsClinical question: unclear hx of seizure disorder, SDH, CVA, residual R hemiparesis Arm > LSigns and Symptoms: transferred from OSH for AMS There is encephalomalacia involving the left inferior frontal gyrus as well as portions of the left middle frontal gyrus and in the left pre and postcentral gyri and left insular cortex within the left middle cerebral artery territory. There is associated atrophy of the left cerebral peduncle with signal change compatible with Wallerian degeneration. There is associated susceptibility effect within the area of infarction. There is ex vacuo effect on the left lateral ventricle. There are associated flow voids within the left sylvian fissure middle cerebral artery vasculature.No foci of diffusion restriction are appreciated to suggest acute ischemic cerebral infarction.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Normal vascular flow voids are present in the distal right 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 left internal carotid artery lumen has high signal within it at the petrous segment..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.Findings are suspicious for old infarction with encephalomalacia in the left middle cerebral artery territory as detailed above with associated Wallerian degeneration.2.Occlusion or near occlusion of the left internal carotid artery.3.Periventricular and subcortical white matter changes of a mild degree are nonspecific.4.There is no evidence for acute ischemic cerebral infarction.


Instruction: Generate impression based on findings.

Input: 31 year old male patient with history of ileal Crohn's disease. Blood in stool. ABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis without evidence of acute cholecystitis. No focal hepatic lesion.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: There is an extrarenal pelvis on the right.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postsurgical changes of an ileocecectomy. The ileocolonic anastomosis appears narrowed, but patent and not significantly changed in caliber compared to the prior MRI in 2010. There is mild associated wall enhancement of the anastomosis and neo-terminal ileum as well (image 61, series 15). There is no associated small bowel wall thickening, abnormal enhancement, or restricted diffusion to suggest acute inflammation elsewhere. There is however multifocal short segment narrowing and enhancement of the distal descending colon and rectosigmoid colon, which is new from the prior study. There is fibrofatty proliferation.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Narrowing and enhancement of the ileocolonic anastomosis compatible with acute on chronic disease.2.Multifocal narrowing and enhancement of the descending/sigmoid colon compatible with active inflammation.


Instruction: Generate impression based on findings.

Input: Known extensive DVA, tremor, off balance, speaking difficulty. There is an unchanged brainstem and right cerebellar hemisphere developmental venous anomaly, with multiple surrounding foci of susceptibility effect and patchy enhancement. There is no evidence of acute infarct. The supratentorial brain parenchyma appears unremarkable. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral artery flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No appreciable change in the brainstem and right cerebellar hemisphere developmental venous anomaly, with multiple surrounding cavernous malformations, telangiectasias, and/or microhemorrhages.


Instruction: Generate impression based on findings.

Input: Left leg pain Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment of the lumbar spine is grossly maintained aside from mild straightening and trace retrolisthesis at L2-L3, L3-L4, L4-L5, and L5-S1. There is mild progression of degenerative disease with a T1 hypointense and T2/STIR hyperintense lesion involving the superior endplate, which is favored to represent an acute Schmorl's node and new since prior. Small Schmorl's node involving the superior L3 endplate also noted which is new but without significant edema. Endplate changes/Schmorl's nodes involving L3-L4 endplates are unchanged. Disc space narrowing at multiple levels is again seen, worst at L5-S1. The conus medullaris is normal in position.Individual levels as described below:L1-L2: Minimal disc bulge. No significant spinal canal or neural foraminal stenosis.L2-L3: Disc bulge without significant spinal canal or neural foraminal stenosis. L3-L4: Diffuse disc bulge without significant spinal canal stenosis. There is mild bilateral neural foraminal stenosis. L4-L5: Diffuse disc bulge with a left foraminal protrusion component which effaces the left lateral recess and results in moderate to severe left foraminal stenosis, minimally worse since prior study from 11/9/2012. Moderate central canal stenosis appears similar. There is minimal right neural foraminal narrowing. Bilateral facet arthropathy.L5-S1: Minimal disc bulge and endplate osteophytes without significant spinal canal stenosis. There is mild to moderate and minimal right left and mild right neural foraminal stenosis similar to prior. Mild left facet arthropathy.Paraspinous soft tissues are within normal limits.

Output: Mild progression of multilevel degenerative changes compared to 11/9/2012. There is a disc protrusion at the left L4-L5 level involving the left lateral recess and left neural foramen. There may be impingement of the exiting left L4 and descending left L5 nerve roots at this level. There is also mild to moderate left L5-S1 neural foraminal stenosis which is similar to prior. Please see details above.


Instruction: Generate impression based on findings.

Input: 36-year-old female with history of pancreatic cysts ABDOMEN:LIVER, BILIARY TRACT: Hepatomegaly. The liver and spleen are diffusely decreased in signal on T2-weighted images, suggesting hemosiderosis. On T1-weighted images, the liver loses signal on out of phase images, suggesting steatosis. Gallbladder wall thickening appears similar to the prior exam. No cholelithiasis. No intra or extrahepatic biliary ductal dilatation.SPLEEN: Splenomegaly.PANCREAS: Cystic lesion in the pancreatic tail is stable measuring 2.2 x 1.2 cm (1 701/22), previously 2.2 x 1.2 cm. Adjacent pancreatic tail lesion measures 0.7 x 0.6 cm (1 701/24), previously 0.9 x 0.7 cm. Pancreatic head lesion measures 1.3 x 0.9 cm (1701/13), previously 1.3 x 1.1 cm. These appear to communicate with the main pancreatic duct which is nondilated. There are also smaller cystic lesions (1 901/61) which are unchanged. Hepatomegaly measuring 22.2 cm in craniocaudal dimension.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts are unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Large amount of abdominal ascites is unchanged. Cardiomegaly.

Output: 1.Multiple cystic pancreatic lesions are stable and likely represent side branch IPMN's.2.Hemosiderosis, hepatomegaly and ascites appear prior exam.3.Gallbladder wall thickening is nonspecific and appears similar to the prior exam.


Instruction: Generate impression based on findings.

Input: Headache [R51] / Systemic lupus erythematosus, unspecified [M32.9], Reason for Study: ^Reason: h/o neuropsych lupus, off lupus meds, here with concern for flare History: headache Brain MRINo evidence of acute ischemic or hemorrhagic lesion.No evidence of abnormal enhancement.There are scattered T2/flair high signal intensities on bilateral subcortical white matter. These are nonspecific.The ventricles, sulci and cisterns are unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal. Left ACA A1 segment is hypoplastic.Brain MRVMotion artifact degraded image quality.3D MRV brain post-gadolinium with maximum intensity projections of the superficial/deep intracranial venous drainage demonstrate normal flow enhancement in the superior sagittal sinus, transverse sinuses, sigmoid sinuses, internal cerebral veins, vein of Galen and straight sinus.

Output: 1. Nonspecific T2/FLAIR high signal intensity lesions on bilateral subcortical white matter.2. No evidence of acute ischemic or hemorrhagic lesion. No abnormal enhancement.3. Normal brain MRA.4. Normal brain MRV


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for cause of double vision, intraocular lens implant bilaterally. Signs and symptoms: Double vision for 12 days. Pre and post enhanced cervical MRI:Unremarkable diffusion-weighted series.Examination demonstrate scattered numerous foci of FLAIR and T2 hyperintensity in the subcortical and periventricular white matter of bilateral cerebral hemispheres and minimally in the basal ganglia and pons. Findings are nonspecific, nonhemorrhagic and demonstrate no abnormal enhancement. However considering patient's stated age of 83 this appearance is often result of microvascular ischemic changes.The signal intensity of the renal cortex and cerebellum remains within normal.There is mild generalized prominence of cortical sulci which are likely within normal for patient's stated age. The ventricular system remains within normal for age and with maintained midline.The signal voids of major intracranial arterial branches are all identified.Postcontrast images demonstrate no abnormal enhancement of brain parenchyma or the leptomeninges. However expected enhancement of a small developmental venous anomaly in the left median pons is detected.There is a focus of signal void abutting the inner table of the skull in the right frontal skull with subtle mass effect on the adjacent right frontal lobe however without detectable parenchymal signal change or abnormal enhancement. Finding is believed to represent hyperostosis of the inner table of the skull on the right and of no clinical significance.Pre- and post enhanced MRI of orbits:Images through the orbits demonstrate symmetrical bilateral lobes without detectable lenses. Signal intensity at the expected site of lenses consistent with lens implant is however detected. There is no abnormal enhancement of the globes. The retro-orbital fat remains within normal and without abnormal enhancement.Extraocular musculature are within normal size, morphology and signal intensity and without abnormal enhancement.Bilateral optic nerves demonstrate normal signal intensity and without abnormal enhancement.Bilateral lacrimal glands demonstrate normal signal intensity and without abnormal enhancement.Bilateral cavernous sinuses are within normal size and pattern of enhancement.The suprasellar visual complex demonstrate normal signal intensity and without abnormal enhancement.

Output: 1.Brain MRI demonstrate no acute intracranial process. Finding consistent with chronic nonhemorrhagic small vessel ischemic strokes in the subcortical and periventricular white matter and minimally in the basal ganglia and pons as detailed. No abnormal parenchymal or leptomeningeal enhancement. Tiny left paramedian pontine developmental venous anomaly however is noted on post enhanced series. Hyperostosis frontalis interna of right frontal bone.2.Unremarkable pre and post enhanced MRI of orbits. Please see above comments.


Instruction: Generate impression based on findings.

Input: 55 -year-old female with family history of pancreatic cancer. Evaluate for pancreatic cancer. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: The pancreatic parenchyma demonstrates normal intrinsic T1 hyperintensity without a suspicious pancreatic lesion.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Mild prominence of subcentimeter periportal and aortocaval lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No suspicious pancreatic lesion.