Instruction: Generate impression based on findings.

Input: 52-year-old male with high-grade sarcoma of the left tibia. Evaluate prior to surgery.IMAGE ACQUISITIONS: CT of the left tibia/fibula without intravenous contrast. As seen on the recent MRI, there is a lytic lesion involving the anterolateral proximal tibial diaphysis and the anterior tibial tuberosity with associated partially mineralized soft tissue component that is consistent with the given history of high grade sarcoma. The lesion appears to be predominantly cortically based.Lack of intravenous contrast limits accurate measurement of the mass. However, it is approximately 3.7 x 5.1 cm in axial dimension (image 325, series 7) and 7.4 cm in craniocaudal dimension (image 87, series 80773). Edema and stranding in the subcutaneous fat anterior to the mass is again noted.There is mild osteoarthritis of the knee. The remainder of the leg is within normal limits.Multiple markers along the leg are presumably presurgical.

Output: Destructive, predominantly cortically based lesion of the proximal tibia, as described above.


Instruction: Generate impression based on findings.

Input: 66-year-old male patient with epigastric abdominal pain, weight loss, pancreatitis, suspected pancreatic neoplasm status post EUS 6/29/2016 with a cystic lesion in pancreatic tail and diffuse echogenicity in pancreas. Study limited as multiple sequences are degraded by motion artifact.ABDOMEN:LIVER, BILIARY TRACT: The gallbladder is absent. There is mild intrahepatic biliary ductal dilatation which is presumably due to a postcholecystectomy state. No filling defects are identified within the common bile duct. No suspicious hepatic lesion is seen. The hepatic vasculature is patent. SPLEEN: No significant abnormality noted.PANCREAS: There are no signs of acute pancreatitis. No obvious pancreatic head lesion is seen. A lobulated cystic lesion in the pancreatic tail likely represents a sidebranch IPMN without complicated features. A few other scattered cystic lesions in the pancreas also likely represent punctate branch type cystic lesions. A 2.2 x 1.7 cm air and fluid containing structure near the ampulla is favored to represent an ampullary/duodenal diverticulum. 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: A subcutaneous cystic structure in the posterior right abdominal wall is again noted. There is thoracic lumbar orthopedic hardware.OTHER: No significant abnormality noted.

Output: 1.No suspicious pancreatic head mass. A cystic lesion in the tail of the pancreas likely represents a lobulated sidebranch IPMN with other punctate cystic branch type lesions elsewhere.2.An air/fluid containing structure near the ampulla is favored to represent an ampullary/duodenal diverticulum.


Instruction: Generate impression based on findings.

Input: Left knee pain following fall one year ago The examination is limited by patient motion artifact. Furthermore, due to the patient's body habitus, the high-resolution coil could not be used; an alternative coil was used which results in slightly suboptimal image quality. The sagittal PD sequence was not obtained secondary to extensive patient motion.MENISCI: Evaluation of the menisci is limited due to reasons provided above. Within the limits of the exam, there are no findings to suggest an unstable meniscal tear.ARTICULAR CARTILAGE AND BONE: Evaluation of the articular cartilage is limited due to the reasons provided above. Subjectively, there is mild diffuse thinning of the articular cartilage of the medial compartment although we see no fluid-filled articular cartilage defects. Mild subchondral degenerative marrow signal is also noted within the medial condyle anteriorly. There appears to also be slight lateral subluxation of the patella in relation to the femoral trochlea.LIGAMENTS: The mid to distal fibers of the anterior cruciate ligament are poorly defined, with intermediate signal intensity. Although this could reflect mucoid degeneration, it could also reflect sequela of an old tear which has undergone subsequent scarring. There are no bony contusions to suggest an acute ACL tear. There is also thickening and longitudinally-oriented increased signal within the PCL which we suspect reflects the sequela of prior injury. The lateral collateral ligament proper appears slightly thickened which may reflect prior sprain. The remaining collateral ligaments are intact.EXTENSOR MECHANISM: A small focus of increased signal is noted within the quadriceps tendon at its insertion on the patella, suggesting mild tendinosis. There is no fluid filled tear identified. The patellar tendon is intact. There is linear low signal intensity within the subcutaneous fat anterior to the patella which may reflect the sequela of chronic bursitis/scarring.ADDITIONAL

Output: 1. Abnormalities of the both the ACL and PCL thought to represent the sequela of old tears. We see no bone contusions to suggest acute ligamentous tears.2. Mild degeneration of the articular cartilage of the medial compartment.3. Small joint effusion and Baker's cyst.


Instruction: Generate impression based on findings.

Input: 90 year-old female with past medical history of ESRD on hemodialysis, end hypertension. Presents with new, right lid ptosis and concern for TIA. There is no evidence of intracranial hemorrhage, mass or edema. Multiple patchy areas of hypodensity in a periventricular and subcortical distribution consistent with small vessel disease, age indeterminate. If there is clinical concern for acute ischemia, an MRI may be considered.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Small vessel disease as described above. If there is clinical concern for acute ischemia, an MRI may be considered.


Instruction: Generate impression based on findings.

Input: Clinical question: Reevaluate enhancing focus in the left thalamus. Signs and symptoms: Headache and memory disturbance. Pre and post enhanced brain MRI:No acute intracranial process and negative diffusion weighted series.Examination demonstrates stable small focus of susceptibility in the left thalamus without interval change in size or morphology since prior study. Similar to prior exam there is no associated FLAIR or T2 signal abnormality with this finding and no detectable surrounding edema or mass effect. Differential diagnosis of a capillary hemangioma or a cavernous malformation should be considered.The signal intensity and morphology of the brain parenchyma is otherwise is within normal limits and without detectable abnormal enhancement otherwise. Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination.Unremarkable calvarium, orbits, paranasal sinuses and mastoid air cells.

Output: 1.Subtle well-demarcated focus of enhancement in the left thalamus with minimal susceptibility associated signal changes remains stable since prior exam. Differential diagnosis of capillary telangectasia or a cavernous malformation should be considered. This finding is not associated with any surrounding edema or mass effect.2.Stable and unremarkable pre and post enhanced brain MRI otherwise.


Instruction: Generate impression based on findings.

Input: 66 years Female (DOB:2/5/1950)Reason: dizziness History: dizzinessPROVIDER/ATTENDING NAME: DIANE B CHANEY DIANE B CHANEY The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. These are asymmetrically more numerous in the left frontal lobe compared to the right. There are approximately 10 or 15 and the left frontal lobe and approximately 5 or 6 and the right frontal lobe subcortical white matter. Several additional subcortical white matter lesions are present in the parietal lobes.The periaqueductal gray matter appears hyperintense on T2 and FLAIR imaging. There is no associated contrast enhancement also appears to be a subtle hyperintensity along the mamillary bodies and adjacent inferior hypothalamus.There is a 13 x 15 mm arachnoid cyst in the left middle cranial fossa.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Findings suggest some subtle increased signal in the periaqueductal gray matter and mammillary bodies. This is somewhat nonspecific. The possibility of a metabolic disturbance such as Wernicke’s encephalopathy due to thiamine deficiency cannot be excluded. Please correlate with patient's clinical history. Findings were reported to Dr Heyer at the time of this dictation.2.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related. 3.There is no evidence for acute ischemic cerebral infarction.4.Small arachnoid cyst in the left middle cranial fossa.


Instruction: Generate impression based on findings.

Input: Dizziness. The bilateral labyrinthine structures, internal auditory canals, and cranial nerve 7 and 8 complexes appear unremarkable. There is no evidence of intracranial hemorrhage or mass. There are prominent perivascular spaces in the left cerebral peduncle. The grey-white matter differentiation appears to be intact. The ventricles are normal in size and configuration. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. The skull and scalp soft tissues are unremarkable.

Output: No evidence of retrocochlear lesions.


Instruction: Generate impression based on findings.

Input: Headache [R51] / Viral meningitis, unspecified [A87.9], Reason for Study: ^Reason: please r/o structural abnormality vs infiltrate History: Headache There is no evidence of acute ischemic or hemorrhagic lesion.There are ill defined subtle increased a bit patchy confluent signal intensities on bilateral periventricular white matter especially on FLAIR images. Those lesions do not show any evidence of enhancement on Gad infusion. There is no evidence of susceptibility artifact either. These MR findings are non specific but the pattern could represent early CADASIL (cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy) although there is no evidence ischemic lesion. On previous scan performed on Feb 25 2011, the FLAIR images also show similar findings. Therefore, considering the different MR scanner and improved signal to noise ration with 3T imager, above findings can be seen as stable lesion. The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear. The left maxillary sinus show retention cyst.

Output: 1. Ill defined subtle, a bit confluent and patchy high signal intensity lesions on bilateral periventricular white matter especially on FLAIR images. These lesions are non specific but could represent an early manifestation of white matter disease such as CADASIL as described above. Imaging follow up using MRI can be considered.2. No evidence of acute ischemic or hemorrhagic lesion.3. No abnormal enhancement.


Instruction: Generate impression based on findings.

Input: 45 years Male (DOB:10/6/1970)Reason: Evaluate for disc herniation, nerve root compression History: RLE radiculopathy + lumbar back painPROVIDER/ATTENDING NAME: JAMES M MOK JAMES M MOK Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is no significant compromise to spinal canal or neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: No compromise to lumbar spinal canal or neural foramina.


Instruction: Generate impression based on findings.

Input: 37 years, Female, metastatic cervical cancer, referred for SRS. Examination is obtained for treatment planning with limited sequences obtained. Multiple enhancing lesions are seen in the brain as below:1) Right occipital lesion measuring 3x4 mm, image 89 series 401.2) Right posterior cerebellar hemispheric lesion measuring 4x5 mm, image 40 series 401.3) Left inferior cerebellar lesion measuring 9x9 mm, image 37 series 401.4) Left inferior cerebellar lesion measuring 5x6 mm, image 38 series 401. 5) Left inferior cerebellar lesion measuring 3x2 mm, image 41, series 401No associated hemorrhage on the susceptibility sensitive sequence. There is mild degree of vasogenic edema involving the left cerebellar hemisphere.Enhancing right occipital calvarial lesion measuring 9 x 7 mm also seen with some intrinsic T1 hyperintensity noted on the prior study .

Output: 1. Five subcentimeter enhancing lesions involving the right occipital lobe and bilateral cerebellar hemispheres as detailed above consistent with metastatic disease.2. Enhancing right occipital calvarial lesion is nonspecific; osseous metastasis not excluded.


Instruction: Generate impression based on findings.

Input: Bilateral knee pain and osteoarthritis. Sclerosis in distal femurs on knee radiographs of unclear etiology. Evaluation is somewhat limited by motion artifact.MENISCI: There is globular high T2 signal within the body of the medial and lateral menisci compatible with degeneration. In addition, there is linear high signal within the posterior horn of the medial meniscus compatible with a horizontal tear that does not extend to the articular surface.ARTICULAR CARTILAGE AND BONE: There is mild thinning of the articular cartilage of the medial patellar facet and within the medial and lateral compartments but no full-thickness cartilage defects are identified.The bone marrow signal throughout the distal femoral and proximal tibial and fibular diaphyses is markedly low on T1-weighted images with heterogeneous high T2 signal throughout. There is relative sparing of the epiphyses. No evidence of bone infarct.LIGAMENTS: The anterior cruciate and collateral ligaments are intact. There is thickening and ill-defined increased T2 signal in the PCL however the fibers are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: Abnormal marrow signal with relative sparing of the epiphyses. This finding can be seen in marrow replacement and infiltrative marrow processes. Although less likely, a malignant process cannot be entirely excluded.


Instruction: Generate impression based on findings.

Input: Seizure and worsening headaches. Evaluate for structural lesion. Some of the sequences are degrade by patient motion. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is minimal nonspecific periventricular white matter T2 hyperintensity. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There are bilateral lens implants. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is fluid signal in the left mastoid air cells.

Output: 1. No evidence of acute intracranial hemorrhage, mass, or acute infarct.2. Fluid signal in the left mastoid air cells may represent mastoiditis.


Instruction: Generate impression based on findings.

Input: Scattered small foci of FLAIR hyperintense signal in the periventricular and subcortical white matter, with no significant interval change. No corresponding pathological enhancement. Right parietal development of venous anomaly is again noted. The ventricles and sulci are within normal limits. The cisterns remain patent. There is no midline shift or mass effect. No extra-axial fluid collection is identified. The midline structures and craniocervical junction are within normal limits.

Output: No significant interval change in scattered demyelinating lesions. No enhancing lesions.


Instruction: Generate impression based on findings.

Input: 79-year-old female with left-sided numbness and dysarthria. There is effacement of the gray-white matter differentiation involving the cortex of right insula and portion of the right temporal lobe which is highly concerning for an acute cortical stroke. Further follow-up with an MRI is highly recommended. Minimal small vessel disease is present. No evidence of hemorrhage, midline shift or mass effect is detected.

Output: 1.Highly suspected acute right MCA stroke. Further evaluation with an MRI.2.A small vessel disease of undetermined age.3.No evidence of hemorrhage.


Instruction: Generate impression based on findings.

Input: Ms. Lau is a 32 year old female with known right breast IDC. She presents for MRI imaging evaluation. There is heterogeneous amount of fibroglandular tissue in both breasts. Moderate background parenchymal enhancement is noted bilaterally, which limits the sensitivity of this examination.RIGHT BREAST:Spanning the entire right lower inner breast, there is an irregular enhancing mass identified measuring 3.4 x 1.9 x 3.6 cm (AP times ML times SI). This mass measures 3.7 cm in AP oblique dimension. This corresponds in distribution and location to the mammographically detected calcifications, which span approximately 4.8 cm. Susceptibility artifact from biopsy marker clip is seen within this mass, compatible with biopsy-proven malignancy.LEFT BREAST:There is no abnormal enhancement seen in the left breast. AXILLAE:There is a prominent right axillary lymph node identified with eccentric cortical thickening, measuring approximately 1.4 cm in dimension.There are no abnormal axillary lymph nodes identified in the left axillary region.

Output: (1) 3.7 cm irregular mass in the right lower inner breast, corresponding in distribution and location to the mammographically detected calcifications, which span approximately 4.8 cm. Of note, the calcifications in the right breast do extend into the nipple.(2) Prominent right axillary lymph node with eccentric cortical thickening. An MR-directed ultrasound with possible biopsy is recommended for further evaluation.(3) No MRI evidence for malignancy in the left breast.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: E - Additional Mammo/Ultrasound Workup Required.


Instruction: Generate impression based on findings.

Input: New onset headache. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles are unchanged l in size and configuration, including septum cavum pellucidum and vergae and choroid plexus cysts, which are anatomic variants. 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 extensive paranasal sinus mucosal thickening.

Output: 1. No evidence of acute intracranial hemorrhage, mass, or Chiari malformation.2. Findings suggestive of sinusitis.


Instruction: Generate impression based on findings.

Input: History of seizures, headaches, and lesion on MRI. There is an unchanged T2 hyperintense cortical lesion in the right middle frontal gyrus with apparent associated enhancement that measures up to 9 mm. There is also an unchanged adjacent subcortical T2 hyperintense lesion that measures up to 5 mm. There is no evidence of intracranial hemorrhage 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. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Unchanged small contiguous lesions in the right temporal lobe.


Instruction: Generate impression based on findings.

Input: 6-year-old male with history of brain abscess related to mastoiditis, status post resection. There are unchanged postoperative findings related to prior right tympanomastoidectomy and temporal craniotomy. There is unchanged high signal within the mastoidectomy bowl consistent with fluid. There is an unchanged T2 hypointense rim-enhancing lesion in the right inferior temporal lobe along the mastoid roof, which measures up to 14 mm. There is confluent high T2 signal in the adjacent white matter, which is also unchanged. No new lesions are identified. 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 are grossly unremarkable. There are skin-based fiducial markers.

Output: Postoperative findings related to right mastoidectomy and temporal craniotomy without significant change in size right temporal lobe chronic abscess or granuloma and associated vasogenic edema.


Instruction: Generate impression based on findings.

Input: Male, 49 years old, with left facial numbness and pain. Brain:No restricted diffusion is seen. One or two very small foci of T2 hyperintensity are seen within the right frontal subcortical white matter. No other parenchymal signal abnormality is detected. No abnormal intracranial enhancement is appreciated. No evidence of intracranial hemorrhage or any abnormal extra-axial fluid collection is detected. The ventricles are normal in size pathology.A small mucous retention cyst is seen within the right maxillary sinus. The marrow signal characteristics are unremarkable.C-spine:The cervical spine is straightened, likely positional. Sagittal alignment is otherwise unremarkable.Vertebral body height and morphology are within normal limits. No evidence of any pathologic marrow signal abnormality or enhancement is seen.The visualized spinal cord demonstrates normal signal intensity and morphology. No pathologic spinal cord or leptomeningeal enhancement is seen. No epidural abnormalities are suspected.Very mild disc osteophyte disease is seen at C2-3, C3-4 and C4-5. No significant spinal canal or foraminal stenosis is observed.

Output: 1.No significant intracranial findings are seen and in particular, nothing to account for the patient's symptoms.2.Very mild degenerative findings in the cervical spine without spinal canal or foraminal stenosis. The spinal cord is unremarkable.


Instruction: Generate impression based on findings.

Input: Left face and arm numbness. MRI: There is no evidence of intracranial hemorrhage or acute infarct. There are multiple nonspecific foci of high T2 signal in the periventricular white matter. The brain parenchyma otherwise appears unremarkable. There is a small extra-axial T2 hypointense lesion along the left parietal convexity. 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.MRA: The intracranial internal carotid arteries are normal in course and caliber. The middle and anterior cerebral arteries are unremarkable. There is a hypoplastic T1 segment of the right posterior cerebral artery with a relatively prominent right posterior communicating artery. The vertebral arteries, basilar artery, and posterior cerebral arteries are normal in course and caliber. There is no evidence of flow-limiting stenosis or aneurysm.

Output: 1. No evidence of acute intracranial hemorrhage, mass, or acute infarct. Nonspecific foci of T2 hyperintense signal in the supratentorial white matter may represent mild chronic small vessel ischemic disease.2. No evidence of flow-limiting stenosis, occlusion, or aneurysm in the major intracerebral arteries.3. A small extra-axial T2 hypointense lesion along the left parietal convexity may represent a meningioma, but is incompletely characterized.


Instruction: Generate impression based on findings.

Input: Female, 13 years old, with seizures. Findings related to prior left-sided craniotomy are redemonstrated. Sequelae of partial left temporal lobe resection are seen including the anterior portion of the left hippocampus. The surgical resection cavity, and the tissues immediately surrounding the cavity, are unchanged in appearance. In addition, the posterior aspect of the left hippocampus remains T2 hyperintense similar to prior.The right mesial temporal lobe structures are unremarkable. No additionally new lesions are detected. No pathologic parenchymal or extra-axial enhancement is seen. There is no evidence of intracranial hemorrhage or any new abnormal extra-axial fluid collection. Some sequences are substantially degraded by metallic artifact from presumed orthodontic braces. In particular, the susceptibility weighted sequence is significantly degraded and the diffusion-weighted sequence is nondiagnostic.The paranasal sinuses are poorly visualized due to this artifact, but significant mucosal inflammation is suspected within the right frontal sinus, the right sphenoid sinus, and the ethmoid air cells.

Output: Sequelae of partial left temporal lobe resection are redemonstrated without significant change. Signal abnormality within the residual left hippocampus is also unchanged.No new or acute intracranial findings are detected.


Instruction: Generate impression based on findings.

Input: 44 years Female (DOB:6/12/1971)Reason: please do dr Javed MS protocol compare to prior History: progression MSPROVIDER/ATTENDING NAME: JACQUELINE T. BERNARD JACQUELINE T. BERNARD The cervical vertebral bodies are appropriate in overall alignment and height. No abnormal enhancing lesions are identified in the cervical spine. There are small foci of T2 signal hyperintensity present within the cervical spinal cord along the posterior aspect of the cervical spinal cord at C2-3 which have not changed substantially along the left hemicord at the C4 vertebral level and a smaller lesion along along the right hemicord at the C4 vertebral level. Additional small lesions are present along the right hemicord at C6-7 and left hemicord at C6-7. These lesions appear to have been present on the prior exam are better visualized on current exam mainly due to differences in image acquisition technique. No abnormal enhancing lesions are identified within the cervical spinal cord.Additional lesions are identified in the visualized brainstem and cerebellum.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.There are multiple lesions scattered throughout the cervical spinal cord which are compatible with demyelinating disorder. Accounting for differences in image acquisition technique these do not appear to have changed substantially when compared to the previous exam.2.There are lesions identified in the brainstem and visualized cerebellum which have been previously present. These also are compatible with the patient's diagnosis of demyelinating disorder.


Instruction: Generate impression based on findings.

Input: Reason: 42 yo female with von hippel lindau disease (VHL); no abdominal imaging since 2012; evaluate for new renal, adrenal, pancreatic lesions and ovarian cysts History: 42 yo female with von hippel lindau disease (VHL); no abdominal imaging since 2012; evaluate for new renal, adrenal, pancreatic lesions and ovarian cysts ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No suspicious lesions. No cysts.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: There is a minimally complex cyst in the right kidney measuring 2.9 x 2.1 cm (5/21) with a thin septation and no nodular or enhancing components.. A simple cyst is present within the left kidney.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.PELVIS:UTERUS, ADNEXA: There is diffuse thickening of the junctional zone measuring 2.2 cm posteriorly (20/27), suggestive of adenomyosis.Normal-appearing follicles. Small nabothian cysts.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Right femoral impingement cyst.OTHER: No significant abnormality noted.

Output: 1.Minimally complex cyst in the right kidney.2.Thickening of the uterine junctional zone is suggestive of diffuse adenomyosis.


Instruction: Generate impression based on findings.

Input: Female, 20 years old, with prominent soft tissue along the bilateral ventricular atria on a prior CT examination, presenting with nausea and vomiting. Several anatomic anomalies are identified to account for the findings on prior CT. To begin, it appears that there may be some deficiency of the tentorium which allows a portion of the bilateral cingulate gyrus and the precuneus to prolapse into what would be the posterior fossa. This otherwise normal-appearing parenchyma flattens the superior aspect of the cerebellum to some degree. Also noted is the presence of a prominent posterior superior vermian vein which contributes to the anomalous appearance in this region.No mass or parenchymal edema is identified. No evidence of pathologic parenchymal or extra-axial enhancement is seen. There is no evidence of intracranial hemorrhage or any abnormal extra-axial fluid collection. The ventricular system is within normal limits for size.

Output: The unusual appearance of the posterior fossa on prior CT is accounted for by several congenital anomalies. These include presence of a prominent posterior superior vermian vein, and apparent deficiency of the tentorium which allows downward prolapse of parts of the bilateral cingulate gyrus and precuneus. It is considered very unlikely that these findings would be symptomatic or otherwise related to the patient's presenting complaints.No other significant or acute intracranial abnormalities are identified.


Instruction: Generate impression based on findings.

Input: Reason: Rule out osteomyelitis History: pain swelling Right toe:There is a focus of gas density overlying the tuft of the distal phalanx on the AP and oblique views which we suspect reflects air trapped between the upper toenail bed but we cannot entirely exclude focal bone erosion. If there is strong clinical concern for osteomyelitis, MRI could be obtained. Mild osteoarthritis affects the first MTP joint. Arterial vascular calcifications are noted.Left toe:There is irregularity of the soft tissues dorsal to the distal phalanx but we see no frank osteolysis to confirm osteomyelitis. Mild osteoarthritis affects the first MTP joint. Arterial vascular calcifications are noted.

Output: 1. Focus of gas density overlying the tuft of the distal phalanx of the right great toe. While we suspect this represents air trapped between the toenail bed, we cannot entirely exclude focal bone erosion. If there is strong clinical concern for osteomyelitis, MRI could be obtained.2. Soft tissue irregularity of the soft tissues dorsal to the distal phalanx of the left great toe without specific radiographic evidence of osteomyelitis.


Instruction: Generate impression based on findings.

Input: Reason: eval for scapholunate tear History: pain after fall LIGAMENTS: The scapholunate and lunotriquetral ligaments appear intact. No intra-articular gadolinium traverses the ligaments to suggest a tear. There is no intra-articular gadolinium is identified within the radiocarpal joint.TRIANGULAR FIBROCARTILAGE COMPLEX: There is a subcentimeter focus of fluid signal intensity within the triangular fibrocartilage complex of the level of its foveal attachment which may represent ganglion formation. The triangular fibrocartilage complex otherwise appears intact. There is a small amount of fluid within the distal radioulnar joint.TENDONS: The flexor and extensor tendons appear intact. BONES: There is subcentimeter cyst formation within the trapezoid. Otherwise no bone marrow signal abnormality is identified.

Output: No evidence of scapholunate or lunotriquetral ligament disruption.


Instruction: Generate impression based on findings.

Input: Living-related donor kidney transplant complicated by PTLD (DLBCL - type) involving the CNS, LN and gut. There is unchanged extensive diffuse cerebral white matter T2 hyperintensity. There are also unchanged punctate foci of susceptibility effect in the bilateral frontal lobes. There is also an unchanged focus of susceptibility effect in the medial right cerebellar hemisphere with mild peripheral enhancement and diffuse confluent T2 hyperintensity. There is a milder degree of T2 hyperintensity in the left cerebellar hemisphere. There is no evidence of acute infarct. The ventricles and sulci are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is mild scattered paranasal sinus mucosal thickening. There is a small amount of fluid within the bilateral mastoid air cells. There are bilateral lens implants. There is unchanged diffuse T1 hyperintensity of the clivus and imaged portions of the cervical spine, likely related to radiation therapy.

Output: Unchanged extensive diffuse cerebral white matter T2 hyperintensity likely related to treatment effects and unchanged treated right cerebellar lesion. No evidence of new intracranial lesions.


Instruction: Generate impression based on findings.

Input: Transient alteration of awareness [R40.4], Reason for Study: ^Reason: eval for CVA as part of TIA workup History: transient amnesia and RUE weakness No evidence of acute ischemic or hemorrhagic lesion.Redemonstration of chronic left frontal and parietal chronic ischemic infarct with encephalomalacia, no change since prior scan.Multifocal scattered high signal intensities on bilateral periventricular white matter on FLAIR imaging indicate nonspecific small vessel ischemic disease, no change since prior scan.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.No change of left frontal parietal chronic ischemic infarct as well as nonspecific small vessel ischemic disease since prior scan.


Instruction: Generate impression based on findings.

Input: 54 year old with history of pleomorphic LCIS status post excision in 2010. History of benign phyllodes tumor and multiple benign bilateral breast biopsies. Strong family history of malignancy; breast cancer in sister, paternal aunt and paternal first cousin, and several other types of cancer in multiple relatives. There is scattered fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.Enhancing foci and a few masses are unchanged in both breasts.T1 high signal fluid in the both retroareolar ducts are again seen.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Fracture, concern for osteomyelitis The exam is limited by the presence of an intramedullary rod within the tibia. As a result, detection of abnormal marrow signal within the tibia is severely impaired.Within the limits of the exam, there is focal areas of normal marrow signal intensity of the proximal tibia to the level of the metadiaphysis. Remaining evaluation of the tibia is otherwise obscured. There is mild diffuse subcutaneous edema and mild muscular edema of the posterior compartment. There is no focal fluid collection. There is a comminuted fracture of the distal tibia with lobulated areas of increased T1 signal along the fracture sites likely representing areas of hemorrhage.

Output: 1. Detection of osteomyelitis is severely limited given the presence of an intramedullary rod within the tibia. There is no surrounding fluid collection or ulceration however evaluation of abnormal bone marrow of the tibia is severely limited. 2. Comminuted fracture of the distal tibia with associated hemorrhage.Findings were discussed with ordering physician Dr. Murray at the time of dictation.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for structural lesions. Signs and symptoms; worsening headaches. Nonenhanced brain MRI:No diffusion weighted abnormalities.There is normal anatomical morphology of the brain patent with normal signal intensity on all MRI sequences.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination.The signal void of major intracranial arterial branches are identified and unremarkable.The signal intensity joint intracranial venous sinuses are beginning normal.The calvarium and soft tissues of the scalp demonstrate no abnormalities.Unremarkable images through the orbits, paranasal sinuses and mastoid air cells.

Output: Negative nonenhanced brain MRI.


Instruction: Generate impression based on findings.

Input: 46 show man with dental x-rays showing "left maxillary cyst." Patient is status post left upper molar extraction about one year ago -- since that time swelling in left cheek. Patient appears to be status post left temporal craniectomy and mastoidectomy with a large defect in the tectum of the petrous bone. There is inferior herniation of the temporal lobe through this bony defect to the expected level of the external auditory canal and middle ear. The inner ear structures are visualized and appear grossly normal. Middle ear structures are not visible and the external auditory canal is not visible. There is soft tissue density present in the expected position of the external auditory canal. Correlate with physical examination and medical history and consider evaluation with MRI.The left maxillary sinus is completely opacified and expanded with bony remodeling extending anteriorly into the soft tissues of the left cheek, medially into the left nasal cavity, inferiorly into the left alveolar process of the maxilla and posteriorly into the pterygopalatine fossa. The left ostiomeatal unit is not visible. The bony floor of the left orbit has normal contour and the orbital contents have normal appearance. This lesion is consistent with a mucocele.There is minimal mucosal thickening in the inferior portion of the right maxillary sinus. The right ostiomeatal unit is not clearly seen to be patent on this study. The frontal sinuses, ethmoid air cells, and sphenoid sinuses are normal in appearance. The right orbit is unremarkable. Limited examination of the soft tissues of the face is normal.The right mastoid air cells and middle ear cavity has normal CT appearance. The right external auditory canal is not clearly patent on this study, however, this may be due to soft tissue compression by the InstaTrak device.

Output: 1. Expansile lesion in the left maxillary sinus causing extensive bony remodeling. The appearance of this lesion is consistent with a mucocele. 2. Postsurgical changes of left temporal craniectomy and mastoidectomy with absence of middle ear structures and EAC. Inferior herniation of temporal lobe through bony defect and soft tissue at expected position of the external auditory canal. Consider evaluation with MRI.The ordering physician was not available by pager at the time of study interpretation and no additional contact information was available.


Instruction: Generate impression based on findings.

Input: Dizziness and facial asymmetry. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mild bilateral periventricular T2 hyperintensity. There are also several punctate foci of T2 hyperintensity in the posterior corpus callosum. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. However, there is prominence of the left retrocerebellar cerebrospinal fluid. There is no midline shift or herniation. The major cerebral flow voids are intact. There is mild mucosal thickening in a small right maxillary sinus. The calvarium appears unremarkable. There is a right lens implant. There is nonspecific prominence of the adenoids.

Output: 1. No evidence of acute intracranial hemorrhage, mass, or acute infarct. 2. Several punctate foci of T2 hyperintensity in the posterior corpus callosum are nonspecific, but may represent chronic microhemorrhages. 3. Mild bilateral periventricular T2 hyperintensity is nonspecific, but may represent chronic small vessel ischemic disease. 4. Hypoplastic right maxillary sinus, which may account for facial asymmetry.


Instruction: Generate impression based on findings.

Input: Surveillance of CCM. There is interval decrease in size of the T1 and T2 hyperintense lesion in the inferior aspect of the right basal ganglia, now measuring up to 4 mm, previously 9 mm. There is persistent extensive surrounding susceptibility effect, which extends into the adjacent right optic tract. There is a small left frontal developmental venous anomaly. There is no evidence for new hemorrhage or recent infarct. There is no midline shift. The ventricles and sulci are unchanged in size and configuration. The orbits, skull, paranasal sinuses, and mastoid air cells are unremarkable.

Output: 1.Interval decrease in size of the cavernous malformation in the right basal ganglia.2.Small left frontal developmental venous anomaly.


Instruction: Generate impression based on findings.

Input: 76 year old male with history of coronary artery disease, hypertension, diabetes and dyslipidemia presenting with increasing chest pain with exertionMEDICATIONS: aspirin, rosuvastatin, carvedilol, isosorbide mononitrate, irbesartan First Pass PerfusionDuring hyperemia, there are perfusion defects associated with the below described transmural myocardial infarction. None of the other territories have clear evidence of ischemia.Viability/ Myocardial ScarThere is extensive transmural late gadolinium enhancement noted likely from prior myocardial infarction in the entire septum, anterior and anteroseptal the apex and these segments are not viable. The remaining myocardium is free of myocardial infarction and these segments are viable. There is fat deposition in the septal infarct consistent with old myocardial infarction. Left VentricleThe left ventricle is mildly enlarged in size with moderate reduced systolic function. There is akinesis in the LAD territory. The overall LV ejection fraction is 35%, the LV end diastolic volume index is 111 ml/m2 (normal range: 74+/-15), the LVEDV is 249 ml (normal range 142+/-34), the LV end systolic volume index is 72 ml/m2 (normal range 25+/-9), the LVESV is 163 ml (normal range 47+/-19), the LV mass index is 37 g/m2, and the LV mass is 83 g. No LV thrombus is noted. Left AtriumThe left atrium is mild to moderately enlarged. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 63%, the RV end diastolic volume index is 81 ml/m2 (normal range 82+/-16), the RVEDV is 183 ml (normal range 142+/-31), the RV end systolic volume index is 30 ml/m2 (normal range 31+/-9), and the RVESV is 67 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly enlarged.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is trace mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.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 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. There is a large transmural myocardial infarction in the LAD territory, which is not viable. The remainder of the myocardium is free of myocardial infarction and likely to be viable.2. No evidence of ischemia in viable territories.3. Mildly enlarged LV size with moderately reduced systolic function (LVEF 35%) with akinesis of the LAD territory.4. Normal RV size and systolic function (RVEF 63%).Compared to previous study, no significant change.


Instruction: Generate impression based on findings.

Input: 68-year-old male. HCC, cirrhosis, HCV. Status post TACE/RFA. Evaluate liver lesions. ABDOMEN:LIVER, BILIARY TRACT: Ablation cavity in segment 5 has mildly increased in size status post recent re-ablation and now measures up to 2.2 x 4.7 cm (13/50), previously 1.8 x 3.6 cm. No evidence residual or recurrent tumor.New ablation cavity in segment 6 measures up to 4.3 x 2.9 cm. No evidence of residual or recurrent tumor.Intrinsic high T1 signal within both ablation cavities, most likely due to hemorrhage.No biliary ductal dilatation. Patent hepatic artery, hepatic vein, and portal vein. Cirrhotic liver morphology.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Mildly atrophic kidneys.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small hiatal hernia.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Two right hepatic lobe ablation cavities without evidence of residual or recurrent tumor.


Instruction: Generate impression based on findings.

Input: Acute back pain, rule out metastases Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign. The conus medullaris is at the lower limits of normal at the lower L2 level. There is fatty infiltration of the filum terminale measuring 1 to 2 mm in thickness and extending from the mid L4 to the S2 levels. Mild 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: Disc desiccation and minimal bulge. No spinal canal or neural foraminal stenosis.L4-L5: Disc bulge eccentric to the right and small right central disc extrusion with cranial migration. No spinal canal stenosis. Mild right and minimal left neural foraminal narrowing. Mild facet arthropathy.L5-S1: No significant disc disease. No spinal canal or neural foraminal stenosis. Mild facet arthropathy.Paraspinous soft tissues are within normal limits.

Output: 1. No evidence of metastatic disease.2. Mild multilevel degenerative changes including a small disc extrusion at the L4-L5 level. No high-grade spinal canal or neural foraminal stenosis at any level. Mild right L4-L5 neural foraminal stenosis. Additional details as above.3.Fatty infiltration of the filum terminale with borderline low conus at the inferior L2 level. These findings may be incidental but would suggest correlation for signs of spinal cord tethering.


Instruction: Generate impression based on findings.

Input: History of FNH and secondary hemosiderosis. ABDOMEN:LIVER, BILIARY TRACT: There is a loss of signal intensity of the liver on out of phase imaging most suggestive of steatosis.Multiple faintly T2 weighted hyperintense foci are noted in both lobes of the liver, unchanged in size. These lesions are faintly T1 hyperintense. Following contrast administration these lesions demonstrate relatively homogeneous arterial phase enhancement and become iso-intense to mildly hyperintense on portal venous and equilibrium phase imaging. On hepatobiliary phase imaging the lesions are relatively hypointense to the liver.The index right hepatic lobe peripheral lesion measures 2.8 x 2.0 cm (series 8/35), compared to 2.1 x 1.5 cm previously.The index segment 4B lesion measures 3.8 x 3.9 cm (series 3/68) compared to 3.1 x 2.8 cm previously.Previously seen segment II heterogeneous lesion appears to have involuted (03/15/2015 series 401/82).Status post cholecystectomy.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: Mild increase in size of several of the bilobar liver lesions, previously characterized as FNHs. However, on today's hepatobiliary phase imaging the lesions are relatively hypointense to the liver, contrary to what would be expected in a typical FNH and changed from prior hepatobiliary phase imaging. These may represent multiple adenomas versus atypical FNHs.Hepatic steatosis.


Instruction: Generate impression based on findings.

Input: Female 54 years old Reason: h/o HNC, completed CRT, abnormality found on CT History: New intra-and extrahepatic biliary ductal dilatation, cause not identifiable. ABDOMEN:LIVER, BILIARY TRACT: No focal liver lesion. There is intra-and extrahepatic biliary duct dilatation. The common bile duct measures 1.0 cm in maximum dimension. This smoothly tapers toward the ampulla. No discrete measurable lesion is identified. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted. The pancreatic duct is mildly smoothly dilated to the ampulla. It measures approximately 5 mm.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is moderate gastric distention, unchanged compared to recent CT chest.BONES, SOFT TISSUES: No significant abnormality noted.

Output: Persistent intra-and extrahepatic biliary duct dilatation. Smooth dilatation of the common bile duct and pancreatic duct without discrete measurable mass lesion at the ampulla/duodenum. However, particularly given associated mild gastric distension, consideration should be given to ERCP/EUS.


Instruction: Generate impression based on findings.

Input: Diagnosis: Other convulsionsClinical question: assess for ischemic changesSigns and Symptoms: seizure/altered mental status8 months old MRI of the brainNo diffusion weighted abnormalities are appreciated. Myelination pattern is appropriate for a months ageThe CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. The posterior communicating arteries are not readily identified. The vertebral arteries are similar in size.MRV brain:The dural venous sinuses are patent. Straight sinus, internal cerebral veins and basal veins are identified and appear patent.

Output: 1.No abnormal lesions are appreciated within the brain parenchyma to explain the patient's seizure. 2.There is no evidence for acute ischemic cerebral infarction.3.MR venogram of the brain is within normal limits


Instruction: Generate impression based on findings.

Input: 74-year-old male with fatigue, weight loss, and proximal muscle weakness. Evaluate for myositis or other abnormality. MRI left femur: Moderate diffuse atrophy of the thigh musculature with edema signal, most compatible with myositis. No focal soft tissue lesion such as hematoma or abscess. Normal bone marrow signal.MRI right femur: Moderate diffuse atrophy of the thigh musculature with edema signal, most compatible with myositis. No focal soft tissue lesion such as hematoma or abscess. Normal bone marrow signal.

Output: Moderate, symmetric atrophy and edema of the bilateral thigh musculature, most compatible with myositis.


Instruction: Generate impression based on findings.

Input: Ms. Nodiff is a 58 year old female with a personal history of left breast lumpectomy in 2002 followed by radiation treatment and tamoxifen therapy. BRCA carrier. There is heterogeneous amount of fibroglandular tissue in both breasts. Minimal parenchymal enhancement is noted bilaterally.Stable postlumpectomy changes are identified in the left upper outer breast. No abnormal enhancement is seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.

Output: Stable post-lumpectomy changes of the left breast. No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Routine Diagnostic 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: Female 51 years old Reason: History metastatic renal cancer, assess for progression ABDOMEN:LIVER, BILIARY TRACT: The liver is enlarged secondary to innumerable rim enhancing, T2 hyperintense, diffusion restricting lesions which are consistent with metastatic disease. The reference lesion anterior to the IVC in the right hepatic lobe measures 2.9 x 2.5 cm (series 3, image 14), previously 1.4 x 1.3 cm demonstrating an interval increase in size. Additional non reference lesions are also subjectively increased in size. SPLEEN: Signal drop out within the spleen on in phase images, again suggesting iron deposition.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Status post right nephrectomy. T2 hyperintense lesion within the left kidney is consistent with a renal cyst.RETROPERITONEUM, LYMPH NODES: The intrahepatic-IVC is attenuated, secondary to mass effect from adjacent metastatic deposits. Prominent gastrohepatic, retroperitoneal and juxtaphrenic lymph nodes demonstrate an internal increase in size suggestive of worsening metastatic disease.BOWEL, MESENTERY: Small hiatal hernia.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1.Hepatomegaly with diffuse hepatic metastatic deposits, significantly increased in size compared to prior study.2.Increasing gastrohepatic, retroperitoneal and juxtaphrenic nodes suggesting worsening metastatic disease.3.Post surgical changes of right nephrectomy without evidence of recurrent disease in the nephrectomy bed.


Instruction: Generate impression based on findings.

Input: History of Crohn's ileitis. Evaluate extent of disease. 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: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The bowel is adequately distended with oral contrast. Approximately 8 cm of the distal and terminal ileum demonstrates two fixed strictures of T2-weighted hypointense circumferential wall thickening with intervening skipped segments of small bowel demonstrating normal wall thickening and mild pseudosacculation (series 5, image 19 through 21). Along the dorsal aspect of this segment of bowel (series 5 image 21) the focal outpouching may represent pseudosacculation and less likely tethered adjacent small bowel. There is no significant associated postcontrast enhancement, adjacent mesenteric inflammatory changes or restricted diffusion to suggest acute inflammation. The proximal small bowel is normal in caliber, wall thickness and enhancement. No free or loculated fluid collection.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Suspected chronic fibro-stenotic disease affecting approximately 8 cm of the distal and terminal ileum with focal strictures and intervening pseudosacculated spared bowel segments without evidence of acute inflammation.


Instruction: Generate impression based on findings.

Input: 3 years, Female, seizure, follow-up previous study. Again seen is asymmetric enlargement of the right lateral ventricle. There is also suggestion of subtle asymmetrically increased parenchymal volume in the right cerebral hemisphere, as compared to the left. The right caudate head and putamen also appears slightly larger. There is evidence of mild diffuse loss of white matter volume, particularly in the right cerebral hemisphere. There is also diffuse thinning of the corpus callosum as seen before. Myelination has progressed since prior study. Subtle areas of subcortical FLAIR hyperintensity however persist including the left frontal and right greater than left temporal subcortical white matter presumably related to incomplete myelination. Hippocampi are symmetric and grossly unremarkable. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. Major flow-voids are preserved. Moderate opacification of the paranasal sinuses is noted and nonspecific.

Output: 1. Again seen is diffuse thinning of the corpus callosum as well as mild diffuse white matter volume loss, particularly in the right cerebral hemisphere. The right cerebral hemisphere appears overall asymmetrically larger in volume. The right lateral ventricle is also larger, which is in part related to ex vacuo dilatation from white matter volume loss. However combination of these findings is suggestive of hemimegalencephaly.2. There has been progression of myelination since last study. Minimal areas of FLAIR hyperintensity persist in the subcortical white matter, including the left frontal and bilateral temporal lobes, which may be related to mildly delayed myelination given patient's age of 3.


Instruction: Generate impression based on findings.

Input: 34-year-old male with recurrent pancreatitis and pancreas disease and. Status post multiple treatments. MR examination showed mass in pancreatic body. Please evaluate for extent of disease. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Status post cholecystectomy. Subcentimeter arterial enhancing focus in the left lateral hepatic segment on arterial phase axial image 41 of series 8 is probably due to a flash filling hemangioma. Periportal hepatic parenchymal hypodensity is faintly seen on portal venous phase image 35/154. In retrospect, this was present on the recent MRI examination with signal loss between in and out of phase images, most likely due to focal fat infiltration. Multiple other subcentimeter hepatic hypodensities are too small to characterize.SPLEEN: No significant abnormality notedPANCREAS: Diffuse pancreatic calcifications compatible with history of chronic pancreatitis. No definite evidence of a pancreatic mass was found. The pancreas is diffusely atrophic with dilated duct, better seen on the recent M.R.C.P. exam.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Multiple bilateral renal cortical hypodensities measures subcentimeters in size and are probably due to simple cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS: PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Chronic pancreatitis. No definite evidence of pancreatic mass.No significant change since the recent M.R.C.P. examination.


Instruction: Generate impression based on findings.

Input: 67-year-old man with history of prostate cancer. Additional history as per chart: Biopsy on 8/24/2015 identified Gleason 3+4 disease, last PSA of 4.8 PELVIS:PROSTATE:Prostate Size: 44 x 32 mmPeripheral Zone: In the right anterior prostatic base (series 601, image 87) there is an area of low T2 and ADC map signal measuring 28 x 12 mm. This lesion extends into the transition zone and anterior fibromuscular stroma.A second lesion in the left mid/apex of the prostate (series 601, image 67) has low T2 and ADC map signal with enhancement measuring 13 x 8 mm.A third lesion in the left prostatic base (series 601, image 92) also has low T2 and ADC map signal measuring 8 x 7 mm.T1 hyperintensity in the left peripheral zone is suggestive of postbiopsy hemorrhage.Central Gland: No significant abnormality noted.Seminal Vesicles: Possible small tumoral invasion of the anterior inferior portion of the right seminal vesicle (series 603, image 93).Extracapsular Extension: Extracapsular extension suggested on the let side and with tumor abutting the neurovascular bundle.BLADDER: The bladder appears normal.LYMPH NODES: No significant lymphadenopathy noted.BONES, SOFT TISSUES: Bilateral hip prostheses noted.OTHER: No significant abnormality noted.

Output: Multifocal prostate cancer described above with possible involvement of the right seminal vesicle and left neurovascular bundle.


Instruction: Generate impression based on findings.

Input: Diagnosis: Disorder of brain, unspecifiedClinical question: preop planning for Brain biopsySigns and Symptoms: left hand weakness There is a 27 x 26 mm axial dimension mass centered in the posterior aspect of the right frontal lobe associated with surrounding vasogenic edema which has heterogeneous enhancement. On 12/5/2015 and measured 15 x 17 mm axial dimensions. It involves part of the right precentral gyrus. The septum pellucidum is now shifted approximately 5 mm to the left of midline.There is T2 signal hyperintensity present along the right insular cortex and right anterior and medial temporal lobe as well as right basal ganglia and internal capsule. There is also T2 hyperintensity present along the medial aspects of the frontal lobes and along the gyrus rectus. It is not associated with contrast enhancement. It has not changed substantially since the prior exam.The uncus is displaced medially but not different than on the prior exam.There are patchy T2 hyperintense periventricular white matter lesions present.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 a small mucous retention cyst in the right maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Since the prior exam a mass centered in the right frontal lobe has enlarged and is associated with more vasogenic edema. Given the significant enlargement over a short period of time, in addition to neoplastic process, an infectious process should be considered in differential. There is mild midline shift associated with this now.2.There is abnormal thickening and abnormal signal involving the right anterior and medial temporal lobe and insular cortex , right inferior frontal gyrus, bilateral medial frontal lobes as well as periventricular white matter in the internal capsule. This is nonspecific. One possibility is that this represents an encephalitis. Another possibility is that this is paraneoplastic3.This is a limited exam performed for the purpose of the stereotactic guidance.


Instruction: Generate impression based on findings.

Input: 60-year-old female with altered mental status. Assess for structural lesions. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are nonspecific scattered T2 hyperintensities in the periventricular and subcortical white matter. There are prominent perivascular spaces in the left basal ganglia. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1.No evidence of intracranial hemorrhage, mass, or acute infarct. 2.Scattered probable chronic small vessel white matter ischemic disease.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 51-year-old female with family history of breast cancer in her mother and sister and personal history of cervical cancer. There is scattered fibroglandular tissue in both breasts.Minimal parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Metastatic breast cancer. Baseline exam prior to enrolling in a clinical trial. Evaluate for brain metastasis.. There is a peripherally enhancing T1 hypoattenuating and T2 hyperattenuating mass in the right frontal lobe measuring up to 42 mm with surrounding vasogenic edema and mass effect upon the frontal horn of the right lateral ventricle. There is susceptibility effect within the dominant mass, likely related to hemorrhage. In addition, there is an enhancing lesion in the left frontal lobe up to 5 mm, an enhancing lesion in the right anterior parietal lobe that measures up to 7 mm, and a right cerebellar enhancing lesion that measures up to 4 mm. There leftward midline shift measuring up to 3 mm anteriorly with slight subfalcine herniation. Thre is also effacement of the frontal horn of the right lateral ventricle. Within the posterior aspect of the pons, there appears to be a punctate focus of diffusion restriction. The major cerebral flow voids are intact. There appears to be a punctate focus of enhancement in the right posterior globe. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There are bilateral nasolabial fold cosmetic fillers.

Output: 1. A total of four supratentorial and infratentorial lesions likely represent metastases, the largest of which measures up to 42 mm in the right frontal lobe with vasogenic edema, possible intratumoral hemorrhage, and 3 mm of midline shift. 2. A punctate focus of enhancement in the right posterior globe may also represent a metastasis. 3. Possible punctate recent infarct in the right pons.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Clinical question: hx transphenoidal. f/u 3 months post op eval for change. Signs and Symptoms: surveillance imaging. Pre and post enhanced pituitary MRI:Examination demonstrate stable post operative changes of pituitary without change or residual or recurrence of tumor.Mild thickening of the pituitary stalk with normal pattern of enhancement similar to prior study.Stable residual atrophic pituitary or post operative scar on the left which the pituitary stock terminates into and similar to prior exam.Unremarkable bilateral cavernous sinuses. Basal cistern is unremarkable.Orbits, visualized paranasal sinus and mastoid air cells are unremarkable.

Output: Stable post operative changes of transphenoidal pituitary hypophysectomy without residual or recurrence of tumor.


Instruction: Generate impression based on findings.

Input: Numbness and pain in the legs with upgoing toes on examination. Examination is limited by patient motion.CERVICAL SPINE:Sagittal alignment is notable for partial straightening which may relate to patient positioning. Disc desiccation is present at all levels. There is minimal disc height loss at C5-C6 and C6-C7, which is associated with minimal ventral indentations of the thecal sac as described below. There is no abnormal signal within the spinal cord within the limits of mild motion degradation. The vertebral bodies are preserved in height. There is no suspicious marrow signal abnormality. Following contrast administration, there is no abnormal contrast enhancement.C2-C3: Very minimal disc bulge but no spinal canal or foraminal stenosis.C3-C4 and C4-C5: Eccentric to the right disc-osteophyte complex and uncovertebral arthropathy. No significant spinal canal or foraminal stenosis.C5-C6: Disc-osteophyte complex is associated with a narrow based right paracentral disc protrusion/osteophyte which minimally indents the spinal cord without signal abnormality. There is no significant foraminal stenosis.C6-C7: Disc-osteophyte complex is mildly eccentric to the left mildly narrowing the spinal canal and mildly narrowing the left neural foramen.C7-T1: No spinal canal or neural foraminal stenosis. Small left neural foraminal cystic structure on the left likely represents an incidental perineural cyst.THORACIC SPINE:Sagittal alignment is anatomic. An incompletely imaged right ward convex curvature in the lower thoracic spine is present. The vertebral bodies are preserved in height. Fat-containing lesions in T6, T7 and T10 vertebral bodies are probably hemangiomas. There is no suspicious marrow lesion. There is disc desiccation associated with small disc bulges indenting the ventral aspect of thecal sac as described above. There is no significant spinal canal stenosis. The thoracic spinal cord shows normal signal and shape. The conus medullaris is imaged and is normal.T1-T2: Small left foraminal spurring causes mild left foraminal stenosis. There is no spinal canal or right foraminal stenosis.T2-T3: No spinal canal or foraminal stenosis.T3-T4: Minimal central disc protrusion causing very shallow ventral indentation thecal sac. No foraminal stenosis.T4-T5, T5-T6 and T6-T7: No spinal canal or foraminal stenosis.T7-T8 and T8-T9: Small central disc protrusion causing very shallow ventral indentation of the thecal sac. No foraminal stenosis.T9-T10: No disc herniation. Moderate facet arthropathy. No central canal stenosis. Minimal foraminal stenosis.T10-T11: There is suggestion of a small right foraminal disc protrusion which along with facet arthropathy moderately narrow the right neural foramen. There is no spinal canal or left foraminal stenosis.T11-T12: Minimal disc bulge and right more than left facet arthropathy. There is mild bilateral foraminal stenosis. No spinal canal stenosis.T12-L1: No spinal canal or foraminal stenosis. Mild left more than right facet arthropathy.

Output: 1.Examination is motion degraded, which limits evaluation for subtle abnormalities. No abnormal cord signal or enhancement however is appreciated. 2.Degenerative changes in the cervical spine with mild spinal canal stenosis at the C5-C6 and C6-C7 levels. No higher grade spinal canal stenosis.3.Mild multilevel degenerative changes throughout the thoracic spine. There is mild deformity of the left ventral aspect of the cord at T8-T9 related to a small disc protrusion without cord signal abnormality. No high-grade spinal canal stenosis at any level in the thoracic spine or cord signal abnormality. Please see additional details above.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 17-year-old female with VP shunt, hydrocephalus, myelomeningocele, syrinx, yearly follow up. Brain MRI:The examination again demonstrates stable appearing ectopia of the cerebellar tonsils with associated deformity of the inferior poles of the tonsils. Findings of Chiari II malformation as well as corpus callosal dysgenesis are again seen. There is no evidence of hydrocephalus and shunt catheter terminating in the right lateral ventricle shows no interval change. Expansion of the tip of the left temporal horn is unchanged. No new hemorrhage, infarct, intracranial mass or mass effect.MRI complete spine:Examination redemonstrates stable segmentation anomaly of C2 and C3 level with fusion. There is effacement of ventral and dorsal subarachnoid space at the level of foramen magnum secondary to herniation of cerebellar tonsils and slight posterior projection of the dens. At the mid C2 level, anterior CSF space is reconstituted however there remains loss of the posterior CSF space. An expansile syrinx of cervical cord extends from C4 level inferiorly to T4 level, with a less expanded syrinx portion extending from T4 inferiorly to the T8 level on the left aspect of the cord, not significant changed since prior. Diffuse volume loss involving the cord appears similar to prior.The cord terminates at the approximate L5/S1 level level with a small covered meningomyelocele extending posteriorly through midline dysraphism of L5 and S1 level. Again seen is extensive scoliosis of the upper thoracic spine and levoscoliosis with apex at the thoracolumbar junction as well as exaggerated lumbar lordosis.

Output: 1.Compared to 9/11/2014, there is no significant change in brain MRI findings including Chiari malformation with tonsillar ectopia and dysgenesis of the corpus callosum. Stable caliber of the shunted ventricular system which remains decompressed.2.No significant change in size and extent of expansile syrinx of the cervical cord which extends from C4 level inferiorly to the T4 level as well as a less expanded syrinx portion extending from T4 inferiorly to the T8 level.3.No significant change in volume loss involving the spinal cord which terminates at the L5-S1 level and findings of myelomeningocele.


Instruction: Generate impression based on findings.

Input: Reason: 13 yo with Klippel Trenaunay malformation of left buttock, thigh, lower leg. ?Macrocysts v microcystic, ?persistent embryonic vein of Servelle, ?normal deep venous system - please evaluate. History: Multiple prior procedures to debulk, repeated episodes of cellulitis There is a complex capillary-lymphaticovenous malformation in the right lower extremity extending from the level of the right hip joint to the proximal tibia (approximately 12 cm below the mean). There also appears to be extension proximally into the retroperitoneum. This results in asymmetric enlargement of the right lower extremity as well as multifocal muscular atrophy, most markedly the right gluteal musculature. The malformation is predominantly microcystic in appearance. Several focal superficial varicosities are identified (series 5, image 14). There is no significant enhancement observed on postcontrast imaging. An abnormal lateral marginal vein is not observed. The normal femoral artery and vein as well as the deep and superficial femoral vessels are patent with a normal configuration. The right pelvic veins and multiple superficial veins in the lower extremity are enlarged and tortuous. Oval, circumscribed lesion in the neurovascular bundle between the semitendinosus and semimembranosus in the distal femur measures 1.7 x 1.1 cm with T1 hyperintensity and T2 hypointensity, indicative of blood products and a possible draining vein, which may reflect a partially thrombosed AVF.There is a right hydrocele, which is likely secondary to poor venous/lymphatic drainage on the right. The bladder is distended, but appears normal. Mildly prominent inguinal lymph nodes are nonspecific. The known leg length discrepancy is not well evaluated on this study.

Output: 1.Complex capillary lymphaticovenous malformation of the right pelvis and lower extremity, predominantly microcystic.2.An abnormal lateral marginal vein is not identified.3.There is a normal deep venous system in the thigh but multiple enlarged and tortuous superficial vessels are also present in the pelvis and lower extremity.4.Possible partially thrombosed AVF in the neurovascular bundle of the posterior distal right thigh.


Instruction: Generate impression based on findings.

Input: Female 40 years old Reason: r/o growth of nodules, r/o suspicous features, r/o adenopathy History: multiple thyroid nodules, subjective increase in size of nodule RIGHT LOBE MEASUREMENTS: 4.7 x 1.9 x 2.7 cmLEFT LOBE MEASUREMENTS: 5.9 x 1.8 x 2.2 cm a there is a the aISTHMUS MEASUREMENTS: 8mmRIGHT LOBE: Multiple nodules in the right lobe of the liver. Largest nodule in the midportion measures 1.8 x 1 .1 cm, not significantly changed from previous study. Other nodules are also grossly unchangedLEFT LOBE: Multiple nodules in the left lobe of the liver. Largest nodule measures 1.1 by 1.3 cm, not significantly changed from previous study. Other nodules are also grossly unchanged.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Multinodular goiter. No significant change from previous study.


Instruction: Generate impression based on findings.

Input: Reason: meningeal process History: memory disturbance. Limited exam as only postcontrast images were obtained. Findings were compared to recent nonenhanced MRI of 7/21/2015.There is no evidence of intracranial hemorrhage or mass. In the region of siderosis seen on the prior exam along the right frontal lobe, the sulci are prominent consistent with volume loss. There is no abnormal intracranial enhancement. Specifically, no leptomeningeal enhancement is identified. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation.

Output: No evidence of abnormal intracranial enhancement.


Instruction: Generate impression based on findings.

Input: There has been overall interval decrease in size of the numerous supratentorial and infratentorial metastatic lesions and associated vasogenic edema. For example, a lesion in the anterior left temporal lobe now measures up to 6 mm, previously 12 mm, and a lesion in the superior vermis measures up to 4 mm, previously 8 mm. There is diffuse subcortical and periventricular deep white matter T2 hyperintensity, which has slightly progressed. The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There is no midline shift. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem, or cerebellar infarction. The skull and orbits are unremarkable.

Output: 1.Interval decrease in size of the numerous supratentorial and infratentorial metastatic lesions and associated vasogenic edema.2.Diffuse subcortical and periventricular deep white matter abnormality has slightly progressed. This is nonspecific and may be related to whole brain radiation superimposed on small vessel chronic ischemic changes.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Headache. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

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


Instruction: Generate impression based on findings.

Input: Redemonstrated are numerous patchy foci of T2 hyperintensity within the supratentorial and infratentorial white matter. The supratentorial foci are mainly clustered in a periventricular distribution with extensive involvement of the entire corpus callosum. There is also involvement of the bilateral basal ganglia and thalami extending into the brainstem which is extensively involved. There is no evidence of intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull and scalp soft tissues are unremarkable. The paranasal sinuses and mastoid air cells are clear.

Output: 1.Extensive supratentorial and infratentorial non-enhancing T2 hyperintense lesion burden consistent with patient's diagnosis of multiple sclerosis.2.No restricted diffusion to suggest the presence of acute ischemia.


Instruction: Generate impression based on findings.

Input: Metastatic germ cell tumor: headache. There is an enhancing lesion in the occipital bone, which measures up to 10 mm. There is also an enhancing lesion in the right parietal bone 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. The orbits are unremarkable. There are small bilateral maxillary and left frontal sinus retention cysts.

Output: Small skull lesions likely represent metastases. Otherwise, no evidence of intracranial metastases.


Instruction: Generate impression based on findings.

Input: Male, 32 years old, with neurofibromatosis and diffuse scalp neurofibroma status post resection and skin grafting two years ago, with new occipital swelling and intense pain. Redemonstrated is evidence of right parietal and occipital scalp surgery and grafting. The scalp soft tissues are scarred and mildly redundant, similar to prior. No definite evidence of any scalp tumor recurrence is seen, and no erosion of the underlying calvarium is evident. Incidentally noted is area of marked thinning of the left parietal bone. This finding is unchanged when compared to examinations dating back to 2011, and there is no definite masslike or enhancing lesion in the overlying scalp.Thickening of the optic chiasm, left side more than right, is unchanged. As before, this lesion does not enhance. No lesions of the intraorbital optic nerves are suspected on this nondedicated examination. Brain parenchymal morphology and signal characteristics are otherwise unremarkable. No pathologic intracranial enhancement is seen. No abnormal fluid collections are detected. The ventricles are normal in size and morphology.

Output: 1.Sequelae of prior scalp resection and skin grafting are redemonstrated without significant interval change. In particular, no evidence of any recurrent scalp tumor is seen.2.Presumed optic chiasm glioma shows no significant interval change as well. No other concerning intracranial findings are seen.3.Chronic thinning of the left parietal bone is incidentally noted. Given stability over many years and lack of any apparent aggressive lesion in this location, a congenital or developmental etiology is favored.


Instruction: Generate impression based on findings.

Input: Male 15 years old; Reason: left knee pain and swelling after Leland surgery MENISCI: The posterior horn of the lateral meniscus is now identified in its normal location compared to the prior exam. The posterior horn is attenuated with abnormal signal extending to both the femoral and tibial articular surfaces. Given the extensive tearing seen on the prior study, it is difficult to determine to what degree this represents expected postoperative changes versus interval tearing. Increased signal within the body and anterior horn of the lateral meniscus may reflect resolving meniscal "contusions"..Vertically oriented increased signal traverses the peripheral fibers of the posterior horn of the medial meniscus, indicating a longitudinal tear. Currently, this tear is of intermediate signal intensity, which may indicate some interval healing, however this is equivocal. There is slight medial extrusion of the body of the medial meniscus. The meniscofemoral coronary ligament is not well seen and may be torn. The meniscotibial coronary ligament appears thickened.ARTICULAR CARTILAGE AND BONE: Again seen is mild depression of the lateral femoral condyle, representing sequelae of prior impaction fracture, likely sustained at the time of the initial injury. There is mild thinning of the overlying cartilage, without full-thickness fluid-filled defect seen. There is minimal fraying of the superficial articular cartilage of the patella, without fluid-filled defect.LIGAMENTS/TENDONS: The ACL has been reconstructed and the graft appears intact. Edema in the bone marrow adjacent to the intercondylar notch is nonspecific. The PCL is intact. The superficial band of the MCL is intact. Intermediate signal between the superficial band of the MCL and underlying medial meniscus may represent synovitis or scarring. The LCL complex appears intact. Edema signal is seen within the popliteus muscle indicating strain, however the tendon is intact.EXTENSOR MECHANISM: The quadriceps tendon is intact. The patellar tendon is intact, however there is focal thickening of the proximal medial aspect of the tendon indicating scarring, likely postoperative in etiology.ADDITIONAL

Output: 1. ACL reconstruction. Moderate joint effusion with a rind of intermediate to low signal intensity likely representing a combination of synovitis and arthrofibrosis. Globular signal abnormality anterior to the ACL graft likely represents additional arthrofibrosis (cyclops lesion).2. Deformity and abnormal signal intensity of the posterior horn of the lateral meniscus likely in part represents meniscal surgery, however, we cannot exclude the possibility of interval tearing.3. Longitudinal tear of the peripheral fibers of the posterior horn of the medial meniscus, which in is now of intermediate signal intensity, perhaps representing interval healing, however this is equivocal.4. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Secondary malignant neoplasm of brain and spinal cord(198.3)Other malignant neoplasm without specification of site The CSF spaces are appropriate for the patient's stated age with no midline shift. The patient is status post right occipital craniotomy.A 3-mm enhancing nodule is present at the right occipital lobe along the cuneus. This is also identified on the prior exam and does not appear to have changed substantially.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1. Stable small right occipital lobe lesion. Differential considerations include post operative change and metastatic focus. Between the two postoperative change is favored based on stability.


Instruction: Generate impression based on findings.

Input: 65 years Female (DOB:1/7/1951)Reason: lower back pain, rule adjacent segment disease and possible stenosis History: abovePROVIDER/ATTENDING NAME: MICHAEL J LEE MICHAEL J LEE Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.The patient is status post laminectomy and posterior and anterior fusion at L4-5 with pedicle screws and interconnecting rods at these levels as well as disc spacer. There appears to be osseous bridging at the L4-5 disc level.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is facet hypertrophy present at this level which is worse on the left compared to the right side which has only slightly progressed since the prior exam from 2006.At L4-5 there is no significant compromise to spinal canal or neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is mild ligamentum flavum hypertrophy at this level which is stable. There is a diffuse disc bulge present at this level which has developed since the prior exam mildly narrowing the neural foramina bilaterally. There is associated disc desiccation.At L2-3 there is no significant compromise to spinal canal or neural foramina. There is loss of disc space height at this level which has developed since the prior exam which is associated with endplate reactive changes and Schmorl's nodes as well as some mild T2 signal hyperintensity adjacent to the endplates within the L2 and L3 vertebral bodies.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.The patient is status post L4-5 surgery. There is no significant compromise to the spinal canal or neural foramina. Since the previous exam degenerative disc changes have progressed at L2-3 and L3-4 with some findings that suggest subacute inflammatory changes at L2-3. Although there is some further narrowing of the neural foramina at these levels the exiting nerve roots are not significantly compromised.


Instruction: Generate impression based on findings.

Input: 44 year-old female with history of breast cancer status post neoadjuvant chemotherapy, partial mastectomy and sentinal node biopsy. There is heterogeneous amount of fibroglandular tissue in both breasts.Minimal parenchymal enhancement is noted bilaterally.There is post-surgical volume loss and artifact from surgical clips in the right medial breast.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: 19-year-old male status post reduction of an acute anterior dislocation. Is there an associated labral tear? Some sequences are limited by patient motion artifact.ROTATOR CUFF: The supraspinatus muscle and tendon appear intact. The infraspinatus muscle and tendon appear intact. The subscapularis and teres minor muscles and tendons appear intact.SUPRASPINATUS OUTLET: There is no significant fluid within the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is within normal limits. There is a glenohumeral joint effusion. There is a large anterior/inferior labral tear extending from approximately the 2 o'clock position, anteriorly, to the 6 o'clock position, inferiorly, with detachment of the capsule from the inferior aspect of the glenoid. Additionally, there is abnormal signal intensity within the superior labrum indicating a SLAP tear which we suspect extends into the biceps anchor. There is also a Hill Sachs deformity with edema within the underlying humeral head.BICEPS TENDON: As stated above, we suspect there is a SLAP tear with extension into the biceps anchor, but the remainder of the long head of the biceps tendon appears normal. Fluid within the tendon sheath of the long head of the biceps likely represents extension from the glenohumeral joint.

Output: 1. Large anterior/inferior labral tear as well as a SLAP tear that we suspect extends into the biceps anchor.2. Hill-Sachs deformity and glenohumeral joint effusion.


Instruction: Generate impression based on findings.

Input: 50 years Male (DOB:12/25/1965)Reason: history of RCC to brain s/p resection. History: headachePROVIDER/ATTENDING NAME: STEVEN J CHMURA STEVEN J CHMURA There is redemonstration of status post right-sided craniotomy for right parietal lobe lesion which is associated with susceptibility effect . Compared to the prior exam there is some retraction of the enhancing lesion in the right parietal lobe and evolution of blood products. There is associated contrast enhancement. Since the prior exam associated. Lesional T1 signal hypointensity has regressed but not resolved. Currently the enhancing lesion measures 12 mm whereas previously it measured 18.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.There is a hemorrhagic lesion present in the right parietal lobe. Changing MR appearance may be attributed to evolution of blood products. A lesion appears smaller in volume on the current versus the prior exam. Continued retraction of the lesion suggests this lesion most likely represents scar formation rather than residual tumor.2.Examination is limited and was performed for treatment planning purposes.


Instruction: Generate impression based on findings.

Input: History of tuberous sclerosis and renal angiomyolipomas. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: Stable nonspecific subcentimeter focus in the distal pancreatic body/tail.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Demonstrated again are multiple bilateral T1 and T2 hypointense renal masses demonstrating mild postcontrast enhancement. No macroscopic fat is apparent. The largest is a right superior pole lesion measuring 3.9 x 3.3 x 3.9 cm in maximal cross-section. This is increased from the prior study remeasured using similar technique. The remaining lesions measure less than 2.5 cm in maximal dimension. The largest left renal lesion measures 2.2 x 1.4 cm.No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Bilateral renal lesions compatible with multiple lipid poor angiomyolipomas given the clinical history. The largest measures 3.9 cm in maximum dimension in the right superior pole, increased from the prior study.


Instruction: Generate impression based on findings.

Input: 25-year-old male with history of ulcerative colitis, elevated LFTs. Evaluate for PSC. ABDOMEN:LIVER, BILIARY TRACT: No suspicious hepatic lesions. No intra or extra hepatic biliary ductal dilation.SPLEEN: No significant abnormality noted.PANCREAS: The pancreatic duct is not well-visualized.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: No imaging features of primary sclerosing cholangitis or any other findings to account for the patient's elevated LFTs.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.