Instruction: Generate impression based on findings.

Input: Benign neoplasm of meninges, unspecified [D32.9], Reason for Study: ^Reason: grade I meningioma. History: meningioma. Right fronto-parieto temporo-occipital craniectomy extended toward left side across the midline as well as bilateral suboccipital craniectomy are seen, unchanged.Associated encephalomalacia involving right temporal, right occipital, left parietal, left occipital and bilateral cerebellar hemisphere are seen, unchanged.T2 intermediate and T1 iso signal intensity lesions on the right petromastoid area which compresses right inferior temporal lobe is again seen, unchanged in terms of maximum diameter, MR signal intensities and extent of mass effects and edema. The ventricles, sulci and cisterns are unremarkable. There is no evidence of acute ischemic or hemorrhagic lesion. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Post craniectomy status with residual mass on the right petromastoid region, unchanged in terms of the size of residual mass and mass effects against right temporal lobe since prior scan.2. No evidence of acute ischemic or hemorrhagic lesion.


Instruction: Generate impression based on findings.

Input: 55-year-old male with history of prostate cancer. Evaluate for extent of disease. Biopsy 7/16/15. Gleason 3 +4 = 7.PSA history per EMR:January 2013 - 4.3 ng/ml. May 2013 - 5.0 ng/ml April 2015 - 5.9 ng/ml PELVIS:PROSTATE:Prostate Size: 4.3 x 3.7 cm.Peripheral Zone: There are bilateral multifocal ill-defined lesions demonstrating decreased T2/ADC signal abnormality suggestive of patient's known prostatic adenocarcinoma. No definite focal abnormal enhancement. Tumor volume appears larger on the left with largest focus in the left apex. There is no evidence of extracapsular invasion or extension into the seminal vesicles.Central Gland: Numerous well-defined nodular lesions without suspicious characteristics.Seminal Vesicles: No evidence of seminal vesicle invasion of known peripheral zone lesions.Extracapsular Extension: No evidence of extracapsular extension of known peripheral zone lesions.BLADDER: No significant abnormality noted.LYMPH NODES: No significant lymphadenopathy.BONES, SOFT TISSUES: No suspicious focal osseous lesions.OTHER: No significant abnormality noted.

Output: Findings compatible with known multifocal bilateral prostatic adenocarcinoma without evidence of extracapsular invasion, lymph node metastases, or suspicious bone lesions.


Instruction: Generate impression based on findings.

Input: 45-year-old female with a history of optic neuritis. Evaluate for demyelinating lesions. Punctate foci of FLAIR hyperintensity in the left periventricular region are not seen on proton density imaging, favoring artifact. The prior left parasagittal lesion is not demonstrated on today's exam. There is continued optic nerve T2 hyperintensity.There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1.Punctate foci of FLAIR hyperintensity in the left periventricular region are not seen on proton density imaging, favoring artifact. 2.The previously described prior left parasagittal lesion is not demonstrated on today's exam. 3.There is continued optic nerve T2 hyperintensity indicating possible persistent optic neuritis


Instruction: Generate impression based on findings.

Input: Female; 57 years old. Reason: to rule out hcc per protocol ABDOMEN:LIVER, BILIARY TRACT: 1.3 x 1 cm well-circumscribed mildly T2 hyperintense lesion in segment 4A with homogeneous arterial enhancement and no washout on delayed images, most likely reflecting a hemangioma though the appearance is somewhat atypical given the relatively mild T2 hyperintensity and early diffuse arterial enhancement/'flash filling' appearance given the size of the lesion. The lesion does not meet the criteria for hepatocellular carcinoma. No additional focal hepatic lesion. No biliary ductal dilation.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: Segment 4A lesion, most likely benign and a hemangioma, given early arterial enhancement with persistent contrast retention noted on subsequent delayed phase imaging. While a hepatic adenoma is another differential consideration, the homogeneous pattern of enhancement again would favor a hemangioma. The lesion does not meet the criteria for hepatocellular carcinoma. No additional focal hepatic lesion.


Instruction: Generate impression based on findings.

Input: 57-year-old female with previous hip surgery We see no fluid-filled labral tear. The anterosuperior labrum is of mildly heterogeneous signal intensity, including a linear band of increased signal intensity that appears to disrupt the undersurface. We cannot determine whether this represents a new/recurrent labral tear or simply postoperative changes on this non-arthrographic study. The degree of labral tearing seen on the prior exam is not evident on the current study, compatible with interval surgery. Mild osteoarthritis affecting the hip appears similar to that seen on the prior study including cyst formation along the anterior margin of the acetabular dome with mild heterogeneity of the overlying articular cartilage. No frank CAM or pincher deformity is noted. The bone marrow signal is within normal limits. The left hip, pubic symphysis and SI joints appear normal on the large field-of-view images. Severe degenerative disk disease affects L4/5, the evaluation of which would be better on a dedicated lumbar spine MRI.

Output: 1. Although we see no fluid-filled labral tear, there is abnormal signal within the anterosuperior labrum as described above, which may represent a new/recurrent tear or simply postoperative change.2. Osteoarthritis as described above appearing similar to the prior exam.


Instruction: Generate impression based on findings.

Input: ORBITS: This portion of the exam is mildly degraded by motion artifact. The optic nerves are symmetric and normal in size and signal intensity. There is no intraorbital mass or abnormal enhancement. There is no chiasmatic mass or parasellar abnormality. The extraocular muscles are unremarkable.BRAIN: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is a 1 mm focus of T1 (series 301, image 20/37) and FLAIR (series 401, image 20/37) hypointensity just superior to the body of the right corpus callosum in the region of the pericallosal sulcus. On axial T2 image (series 601, image 23/33) and post Gad sagittal image (series 1901, image 18/33) show focal ectatic CSF space with normal sized vascular signal voids from the right pericallosal artery without abnormal enhancement. Therefore, this is most likely represent right pericallosal artery with possible focal azygos variation. The possibility of other vascular lesion such as arteriovenous malformation or aneurysm is less likely and further imaging evaluation such as CT angiography may not be necessary unless clinically indicated. There are a couple of scattered punctate foci of T2 and FLAIR hyperintensity within the supratentorial white matter. These lesions are non specific in nature.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 skull, paranasal sinuses, and scalp soft tissues are unremarkable. There is minimal fluid within left mastoid air cells.

Output: 1.Normal orbital MRI.2.A couple of scattered punctate foci of T2 and FLAIR hyperintensity within the supratentorial white matter which are nonspecific. 3.A small focus of low signal intensity in the region of the right pericallosal artery may simply represent focal azygos variation of the right pericallosal artery. Further characterization may not be necessary unless clinically indicated as described above.


Instruction: Generate impression based on findings.

Input: 62-year-old female with a history of metastatic lung adenocarcinoma status post chemoradiation (8/11/2016- completed whole brain radiation, 8/25/2016- started on Erlotinib 100 mg). There is a rim-enhancing mass in the anterior right superior frontal gyrus with surrounding vasogenic edema. The lesion measures up to 17 mm. There are additional subcentimeter enhancing lesions in the left cerebellar hemisphere. There is no evidence of intracranial hemorrhage or acute infarct. There is mild scattered cerebral white matter and brain stem T2 hyperintensity. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There is mild mucosal thickening in the paranasal sinuses. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable.

Output: 1. Enhancing intracranial metastases in the anterior right superior frontal gyrus and left cerebellar hemisphere. 2. Mild scattered cerebral white matter and brainstem T2 hyperintensity is nonspecific, but may represent chronic small vessel ischemia.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: BRCA 1 mutation carrier. History of breast and ovarian cancer in mother. History of breast cancer in maternal grandmother. There is scattered fibroglandular tissue in both breasts.Moderate 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: Neck pain Examination is mildly degraded by artifact related to patient motion and dental hardware. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained. Bone marrow signal is within normal limits. The cervical spinal cord has normal signal characteristics and overall morphology.Degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: Central disc protrusion with effacement of the ventral thecal sac. Dorsal thecal sac is patent. No significant neural foraminal stenosis.C4-5: Right paracentral disc protrusion with effacement of the ventral thecal sac and minimal deformity of the right ventral cord. Dorsal thecal sac is patent. No significant neural foraminal stenosis.C5-6: There is a small disc osteophyte complex with uncovertebral hypertrophy. There is minimal spinal canal narrowing with effacement of the ventral thecal sac. Dorsal thecal sac is mildly effaced due to ligamentum flavum thickening. There is mild bilateral neural foraminal narrowing. C6-7: Small disc osteophyte complex with effacement of the ventral thecal sac. Dorsal thecal sac is patent. No significant neural foraminal stenosis. C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: Mild multilevel degenerative changes in the cervical spine. There is minimal spinal canal narrowing from C3-C4 to the C6-C7 level with effacement of the ventral thecal sac. Dorsal thecal sac is patent. There is mild bilateral neural foraminal narrowing at C5-6. No high-grade spinal canal or high-grade neural foraminal stenosis at any level. No cord signal abnormality.


Instruction: Generate impression based on findings.

Input: Clinical question: Bleed. Signs and symptoms: Fall. Non-enhanced head CT conalthere is no evidence of intracranial hemorrhage, edema mass-effect, midline shift or hydrocephalus.Cortical sulci, ventricular system, CSF cisterns and gray white matter differentiation is within normal.Calvarium, limited view of paranasal sinuses, mastoid air cells and scalp demonstrate no abnormality.Nonenhanced CT of lumbar spine:There is normal alignment the vertebral column. Diffuse area of thickened bony trabeculation involving the body of L1 vertebrae is believed to represent a hemangioma. This finding is best appreciated on axial image 18. The bony density of the lumbar spine is otherwise unremarkable. No evidence of fracture is identified. There is mild to moderate degenerative disk disease and multilevel bulge of disk material. There is also moderate hypertrophic changes of posterior elements of the ligamentum flavum and facet complexes. There is no measurable central spinal stenosis however this should be further evaluated with an MRI. Hypertrophic changes of posterior elements are most noticeable and prominent at L4 -- L5 level with resultant mass effect on the thecal sac with forward displacement.Nonenhanced CT of cervical spine:Extensive degenerative disk disease more severely at C5 -- C6 is present. Very extensive and prominent anteriorly projecting osteophytes from C2 level to T1 level are noted along the anterior aspect of vertebral column. There is evidence of mass effect on the soft tissues of the neck.There is no evidence of fracture or malalignment. There is normal articulation of occipital condyles with C1 and C1 with C2.

Output: 1.Negative nonenhanced CT of brain.2.CT of the lumbosacral spine demonstrates no evidence of fracture or malalignment.3.CT of cervical spine demonstrates no evidence of fracture or malalignment. Extensive degenerative disk disease and very large hypertrophic spurs project anteriorly into the soft tissues of the neck and there is no significant spur posteriorly within the spinal canal.


Instruction: Generate impression based on findings.

Input: Clinical question: Surgery aborted due to brain swelling. Evaluate for cause of brain swelling? Signs and symptoms: Brain swelling CT of brain without the infusion:The examination demonstrates expected postoperative changes of a left posterior temporal -- parietal craniotomy. There is no evidence of hemorrhage. There is no detectable cerebral edema. Prominence of cortical sulci and underlying encephalomalacia as was noted on prior MRI is again identified. There is no evidence of mass effect, midline shift or hydrocephalus.

Output: 1.Expected postoperative changes of left parietal craniotomy.2.No evidence of underlying hemorrhage, edema, mass effect or midline shift.


Instruction: Generate impression based on findings.

Input: History of brain tumor. Evaluate change. CT of brain without and with contrast:Examination again demonstrates heavily calcified and partially cystic multi-loculated mass in bilateral lateral ventricles. The mass is inseparable from the choroid plexus of the lateral ventricle and is believed to arise from the choroid plexus. On post infusion images there is no enhancement of this mass. The mass is larger in the right lateral ventricle and extends from the trigone of right lateral ventricle and into the body of right lateral ventricle. There is no evidence of hydrocephalus associated with this finding. In comparison with the prior examination there is no definitive evidence of increase in the size of this tumor or any change in its density characteristics. The measurements are minimally smaller than prior study however this could be secondary to slice positioning.Previously described increased signal intensity in the periventricular white matter and corpus callosum (edema) on MRI examination of brain cannot be identified on this CT study.This examination is otherwise unremarkable and also stable.90 cc of Omnipaque 350 was utilized for the study.

Output: 1.Calcified, cystic and multi-loculated mass in the lateral ventricles bilaterally with no enhancement or interval change since prior study.2.Differentials for this tumor include xanthogranuloma, great plexus carcinoma, lymphoma or metastatic lesion.


Instruction: Generate impression based on findings.

Input: 27 years Male (DOB:6/25/1988)Reason: 3 T MRI seizure protocol History: Complex partial seizure since 2010PROVIDER/ATTENDING NAME: SHASHA WU SHASHA WU The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The hippocampi are symmetric and without signal hyperintensity.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: No seizure focus identified on this exam. There is no convincing evidence for mesial temporal sclerosis.


Instruction: Generate impression based on findings.

Input: The left superior parietal lobule enhancing lesion is persistently larger now measuring 7 x 7 mm, previously measured 5 x 4 mm The susceptibility abnormality seen previously is not as conspicuous on this exam which may be due to differences in slice selection. However, the FLAIR hyperintensity is more prominent. An additional punctate enhancing lesion is visualized just posteriorly within the left inferior parietal lobule, which is unchanged. The susceptibility abnormality in this lesion is also unchanged.The left middle frontal gyrus enhancing lesion is stable measuring 3 x 2 mm. This lesion also demonstrates mild susceptibility effect which is unchanged. The punctate focus of enhancement within the left lateral post central gyrus is also unchanged.The left anterior temporal lobe enhancing lesion is stable measuring 6 x 5 mm, but there is now less central enhancement. The susceptibility abnormality is increased compared to the prior exam.The right anterior inferior frontal gyrus enhancing lesion is similar in size measuring 6 x 5 mm. The surrounding FLAIR signal abnormality is also similar to the prior exam. An additional punctate enhancing lesion is noted in the right middle frontal gyrus that was less conspicuous previously and is unchanged.The lesion along the lateral aspect of the junction between the body and frontal horn of the right lateral ventricle, which was less conspicuous on the prior exam, now measures 6 x 6 mm compared to 4 x 5 mm previously.No new lesions. No significant mass effect, midline shift or herniation. There is no diffusion abnormality. There are no extraaxial fluid collections or subdural hematomas. Incidental note is made of a partially empty sella which is a normal variant. Moderate left frontal and anterior ethmoid sinus opacification. Bilateral maxillary retention cysts.

Output: 1.Interval increase in the size of the left superior parietal lobule metastatic lesion with mild increase in the surrounding FLAIR signal abnormality. 2.Interval increase in the size of a right lateral ventricle lesion, and likely represents an additional metastasis.3.Stable size of the remaining six lesions, several of which are punctate. No definite new lesions.


Instruction: Generate impression based on findings.

Input: Female, 57 years old, with acute on chronic worsening of headache. Numerous scattered T2 hyperintense lesions are again seen within the subcortical and per ventricular white matter with particular involvement of the periatrial regions, the subinsular white matter, the subcortical white matter of the paramedian superior frontal gyri and the anterior temporal poles. No new lesions are seen. No diffusion restriction or pathologic enhancement is detected.There is no evidence of edema or mass effect. The findings are seen to suggest acute or chronic intracranial hemorrhage or any abnormal extra axial fluid collection. The ventricles remain normal in size and morphology. Diffuse prominence of the perivascular spaces as a normal variant.

Output: 1.Stable extensive scattered areas of parenchymal signal abnormality are seen. The differential continues to include CADASIL, vasculitis, prior inflammation, or a very atypical presentation of demyelinating disease.2.No definite new or acute intracranial findings are seen to account for the patient's worsening headaches.


Instruction: Generate impression based on findings.

Input: 58-year-old female with headache. Previous electronic medical records indicate history of metastatic colon cancer. The lateral and third ventricles are stable compared to the prior examination suggestive of mild hydrocephalus. The supratentorial gray-white matter differentiation is preserved. There is no midline shift, intra- or extra-axial fluid collection.Abnormally decreased diffuse attenuation involving the right posterior fossa with extension across midline, demonstrates mild anterior mass effect at the level of the fourth ventricle. This is not significantly changed compared to the previous examination and consistent with patient's known metastatic disease at this level as seen on CT dated 4/24/2009.A new foci of subcentimeter hyperdensity within this area of low-attenuation is new compared to exam dated 6/24/2009, best seen on image 4/30, and may represent focal hemorrhage. Further evaluation with contrast-enhanced MRI or postcontrast CT is recommended.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Stable posterior fossa diffuse low-attenuation and edema consistent with known metastatic disease now with new focus of high density which may represent focal hemorrhage. Contrast-enhanced MRI or postcontrast CT is recommended for further evaluation as clinically indicated.


Instruction: Generate impression based on findings.

Input: Chiari malformation, no history of surgery. Minimal central canal prominence at C5-C6. Headaches. MRI brain: Again seen is caudal descent of the cerebellar tonsils which are peg-like in morphology and measuring up to 10 to11 mm below the foramen magnum on the right. Partial effacement of the CSF spaces at the foramen magnum is not appreciably changed. Biphasic CSF flow is present ventrally and dorsally, although diminished slightly posteriorly, as seen before. No parenchymal signal abnormality. No evidence of intracranial mass or mass effect. No evidence of infarct or hemorrhage. Ventricles and sulci are within normal limits. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. Subcentimeter cyst in the pineal gland is unchanged.MRI cervical spine: There is no discrete syrinx in the cervical cord. Minimal prominence of the central canal at the C5-C6 level is unchanged. There is straightening of the cervical spinal curvature which may be in part positional. Alignment is otherwise maintained. Vertebral body heights and disc heights are well-maintained. Bone marrow signal is unremarkable. There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the cervical spine.

Output: 1.Unchanged findings of Chiari I malformation. No new intracranial abnormalities.2.Minimal central canal prominence at C5-C6 without evidence of syrinx.


Instruction: Generate impression based on findings.

Input: Left shoulder pain. Rule out rotator cuff tear ROTATOR CUFF: The rotator cuff appears normal without evidence of tear.SUPRASPINATUS OUTLET: There are small cysts in the distal clavicle which may reflect early osteoarthritis or sequela of prior trauma. The acromioclavicular joint otherwise appears normal. There is no frank fluid within the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral joint alignment is within normal limits. There is a small amount of fluid within the joint but no frank effusion. Linear intermediate signal intensity separates the anterior/inferior labrum from the underlying glenoid and then propagates superiorly through the substance of the anterior labrum and continues posterior through the superior labrum as a SLAP tear. Overall, the tear appears to extend from the from the 12 o'clock to 5 o'clock position anteriorly and from the 12 o'clock to the 10 o'clock position posteriorly.BICEPS TENDON: The tendon of long head of biceps appears normal.

Output: 1.No evidence of rotator cuff tear2.Labral tear as described above.


Instruction: Generate impression based on findings.

Input: 60-year-old male patient with probable metastatic disease in the liver on prior CT. Note that examination is limited by technical malfunction during postcontrast imaging. Examination is also limited by patient motion.ABDOMEN:LIVER, BILIARY TRACT: There are numerous increased T2 and DWI signal lesions throughout the liver parenchyma. A reference left lobe lesion measures 1.9 x 1.3 cm (series 601 image 19). Probable focal biliary ductal dilatation in the left lobe of the liver is noted with associated perfusion anomaly, however, this is incompletely evaluated due to contrast timing.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral probable renal cysts.RETROPERITONEUM, LYMPH NODES: Small retroperitoneal lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Limited examination due to technical malfunction during postcontrast imaging. Patient should return for postcontrast imaging free of charge. An addendum will be made to the report at that time.2.Numerous lesions within the liver parenchyma with increased T2 and DWI signal raise question of metastases, but are incompletely characterized.3.Probable focal biliary ductal dilatation in the left lobe of the liver is noted with associated perfusion anomaly, however, this is incompletely evaluated due to contrast timing.


Instruction: Generate impression based on findings.

Input: Reason: Evaluate left wrist mass . Unspecified fracture of the lower end of left radius, subsequent encounter for closed fracture with routine healing There is extensive artifact caused by the patient’s orthopedic hardware.LIGAMENTS: No acute abnormalities are evident.TRIANGULAR FIBROCARTILAGE COMPLEX: The triangular fibrocartilage cartilage is incompletely visualized, but no abnormalities are evident. TENDONS: The extensors are unremarkable. The flexors and carpal tunnel are grossly intact, where visualized. BONES: There is extensive artifact caused by the patient’s orthopedic hardware. The visualized portions of the wrist demonstrate mild degenerative changes affect the carpus. No fracture is evident. ADDITIONAL

Output: Mild osteoarthritis affects the carpus, but no other acute abnormalities are evident.


Instruction: Generate impression based on findings.

Input: 46-year-old male with severe left hip pain. Evaluate for severity of avascular necrosis or signs of osteoporosis or infection. There is advanced osteonecrosis of the femoral head with collapse and fragmentation as seen on recent radiographs. There is also severe osteoarthritis of the hip with full-thickness cartilage loss superiorly. There is a small amount of fluid within the joint along with synovial enhancement which is nonspecific and could certainly be secondary to the patient's severe avascular necrosis and osteoarthritis, although it is impossible to exclude septic arthritis. Similarly, there is abnormal edema type signal abnormality within the neck and intertrochanteric region of the proximal femur as well as within the acetabulum that is nonspecific and could represent bone ischemia, reactive changes due to severe degenerative osteoarthritis or osteomyelitis. There is mild to moderate edema and enhancement of the musculature of the hip. The large field-of-view sequence of the pelvis shows less advanced osteonecrosis of the right femoral head. There is residual red marrow within the bones of the pelvis and proximal right femur. The sacroiliac joints are within normal limits. The pubic symphysis is within normal limits.

Output: Advanced avascular necrosis and osteonecrosis of the left hip. A small amount of fluid within the joint with enhancement of the synovium, surrounding soft tissues, and adjacent bone marrow may simply be due to the patient's underlying severe avascular necrosis and osteoarthritis, however, we cannot exclude the possibility of a septic joint.


Instruction: Generate impression based on findings.

Input: Malignant pleural effusion [J91.0], Reason for Study: ^Reason: malignant pleural effusion, possibly lung cancer History: cough Motion artifact degraded exam quality.There is no evidence of acute ischemic or hemorrhagic lesion.There is no evidence of abnormal enhancement.Subtle FLAIR high signal intensities around periventricular white matter and a couple of FLAIR high signal lesions on white matter which are nonspecific.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. No abnormal enhancement.3. Non specific FLAIR high signal lesions seen at periventricular white matter.


Instruction: Generate impression based on findings.

Input: Metastatic breast cancer. Leg pain. There are sclerotic lesions in the C4, C6, T4, T5, T10, T12, and L2 vertebral bodies. There is unchanged, mild height loss and posterior retropulsion at T12, but no spinal cord compression. There is otherwise a background of diffuse loss of the normal fatty bone marrow signal throughout the vertebrae, aside from what likely represents a few scattered hemangiomas. The spinal cord shows normal signal and morphology. The vertebral column alignment is within normal limits. The paravertebral soft tissues are unremarkable. There is a partially-imaged right lower lung consolidation and possible left pleural effusion.

Output: 1. Multiple vertebral metastases with mild height loss and posterior retropulsion at T12, but no evidence of spinal cord compression. A background of diffuse loss of the normal fatty bone marrow signal throughout the vertebrae may otherwise represent red marrow conversion.2. Right lower lung consolidation and possible left pleural effusion.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Male 24 years old Reason: evaluate for internal derangement. fell onto shoulder 2/17/15. History: Left shoulder pain, pain with overhead activity There is diffuse signal abnormality within the greater tuberosity consistent with edema related to a known minimally displaced greater tuberosity fracture seen on recent radiographs. A discrete fracture plane is not well seen on this study. There is mild increased signal intensity of the distal fibers of the supraspinatus tendon, likely related to edema secondary to the aforementioned greater tuberosity fracture, but we see no tendon tear. The supraspinatus muscle appears normal. The infraspinatus, teres minor, subscapularis tendons and muscles appear normal.The acromioclavicular joint appears normal. No frank fluid is identified within the subacromial subdeltoid bursa. .Given the limitations of this non-arthrographic study, no labral abnormalities are identified. There is no joint effusion. Glenohumeral joint alignment is normal.The tendon of the long head of the biceps is normal given the limitations of this non-arthrographic study.

Output: Edema within the greater tuberosity reflecting patient's known greater tuberosity fracture, better seen on recent radiographs. The shoulder is otherwise unremarkable.


Instruction: Generate impression based on findings.

Input: There is redemonstration of relative ventral positioning of the thoracic spinal cord with no significant interval change in contour of the cord. Slight differential CSF pulsation is again suggested dorsal to the cord with visualization of traversing vessels and nerve roots along the anterior aspect of the area of differential signal within the thecal sac. This again measures up to 7 mm in greatest thickness on sagittal images. There is again question trace flattening of the dorsal lateral cord bilaterally. The previously seen midline linear possible fibrous strands are not as well delineated on MRI as they were on myelogram.The spine is in normal alignment. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal. The distal spinal cord and conus are within normal limits with the conus terminating at the L1 level.There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the spine. There is again a very large amount of stool within the enlarged rectum, including a large rounded area of low signal intensity measuring 4.5 x 5.0 cm, likely compacted fecal debris.

Output: 1. No significant interval change in appearance of ventral positioning of the thoracic cord with mild contour flattening, with again question of an intradural extramedullary CSF signal intensity collection. Differential remains unchanged, including idiopathic anterior spinal cord herniation/adhesion versus arachnoid cyst, as a cyst could fill in a delayed manner depending on the timing of myelogram following non-radiology service instillation of intrathecal contrast.2. Large amount of fecal debris within the enlarged rectum, including a large stool ball.


Instruction: Generate impression based on findings.

Input: Recent diagnosis of prostate cancer (Gleason 6 at the right lateral mid and Gleason 6 at the left lateral base). PELVIS:PROSTATE:Prostate Size: The prostate measures 4.6 x 2.5 cm.Peripheral Zone: Within the right posterior inferior peripheral zone there is a T2 hypointense, ADC hypointense lesion measuring 0.7 x 0.5 cm (series 701, image 16), suspicious for malignancy. An additional T2 hypointense, ADC hypointense lesion is identified within the left mid posterior peripheral zone measuring 0.8 x 0.8 cm (series 701, image 14), suspicious for malignancy. There are scattered foci of T1 hyperintense signal scattered throughout the peripheral zone, probably corresponding to hemorrhage at prior biopsy sites.Central Gland: There is a symmetric band of T2 hypointense, ADC hypointense signal extending along the anterior central zone, probably fibromuscular stroma. Seminal Vesicles: The seminal vesicles are normal in appearance, without evidence of invasion.Extracapsular Extension: No evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: The external iliac lymph nodes are mildly prominent, nonspecific. A representative right external iliac measures 0.9 x 0.6 cm (series 701, image 31). Scattered subcentimeter pelvic lymph nodes are present.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Multifocal prostatic lesions consistent with biopsy-proven neoplasm. No extracapsular extension or seminal vesicle invasion.2.Nonspecific mildly prominent bilateral external iliac lymph nodes.


Instruction: Generate impression based on findings.

Input: Multiple sclerosis [340], Reason for Study: ^Reason: new ms flare History: BL leg weakness Brain MRIThere is no evidence of acute ischemic or hemorrhagic lesion.There are multiple variable sized FLAIR high signal intensity lesions on subcortical white matter and bilateral corpus callosum consisted with multiple sclerosis.There is no evidence of abnormal enhancement.Comparing to prior scan, there is no significant interval change in terms of the size, number, distribution and signal intensity of identifiable lesions.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.C-SpineThere are multifocal high signal intensities of spina cord on both T2 and STIR images compatible with multiple sclerosis involvement. The lesions were seen on from C2-C3 to C4-C5 level and T1-T2 to T2-T3 level.There is no evidence of abnormal enhancement.The cranial-cervical junction is normal. There is normal cervical lordosis. The cervical spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The epidural space, thecal sac, and spinal cord are preserved with no evidence of spinal canal/neural foraminal narrowing or myelopathy. The intervertebral discs demonstrate normal T2 intensity and height with no evidence of disc herniation. The paraspinal soft tissues are unremarkable.There is no evidence of abnormal enhancement, cord compression or mass.

Output: Multifocal intracranial and spinal cord FLAIR high signal intensity lesions consistent with multiple sclerosis lesions.No significant interval change of intracranial lesions since prior scan.No evidence of abnormal enhancement of those lesions.


Instruction: Generate impression based on findings.

Input: 18-year-old male with acute myeloid leukemia status post double cord stem cell transplant 46 days prior, now with knee pain right greater than left. MENISCI AND LIGAMENTS: The menisci are normal in appearance. The MCL, LCL complex, ACL, and PCL are intact.BONE AND MARROW: The bone marrow signal is normal. There is no evidence of avascular necrosis.SYNOVIUM: No significant abnormality is noted. MUSCULATURE: The musculature is normal in appearance.ADDITIONAL

Output: Normal examination of the knees.


Instruction: Generate impression based on findings.

Input: 52-year-old female with history of pain with activity. ACETABULAR LABRUM: There is severe and extensive mucoid degeneration of the acetabular labrum. This degeneration involves entire superior and anterior labrum with relative sparing of the posterior labrum, but with extension through the transverse acetabular ligament. In addition to the mucoid degeneration, there is extensive tearing of the anterior labrum.ARTICULAR CARTILAGE AND BONE: The superolateral aspect of the femoral head is uncovered suggesting mild developmental dysplasia with resultant hypertrophy the superolateral labrum. There is relative superior positioning of the fovea capitis which is also a marker of development of dysplasia of the hip. There is near-full- to full-thickness articular cartilage loss along the superior femoral head with additional clefts of full-thickness cartilage loss along the superior acetabulum. There is mild edema-type signal within the superolateral acetabulum, likely degenerative in etiology. There is also osteophyte formation along the anterior rim of the acetabulum. There is a slight prominence of the lateral aspect of the femoral epiphysis, but otherwise there is no frank CAM deformity.SOFT TISSUES: There is edema-type signal within the anterior soft tissues related to recent injection. There is mild edema about the greater trochanters bilaterally, which is not necessarily of any clinical significance. The right ligamentum teres appears slightly thickened, which may be degenerative in etiology.ADDITIONAL

Output: 1.Extensive degeneration and tearing of the right acetabular labrum as described above with mucoid degeneration extending through the transverse acetabular ligament.2.Finding suggestive of mild developmental dysplasia of the hip.3.Osteoarthritis and other findings as described above.


Instruction: Generate impression based on findings.

Input: 48 year old female with a history of diastolic dysfunction, secondary pulmonary hypertension, hypertension, hyperlipidemia, gastric bypass surgery, and family history of ischemic cardiomyopathy in father. She is referred for stress cardiac MRI. MEDICATIONS: Aspirin, Furosemide, Insulin, Metolazone, Rosuvastatin, Sildenafil, Spironolactone First Pass PerfusionDuring hyperemia, no perfusion defects were present.Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable.Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 58%, the LV end diastolic volume index is 66 ml/m2 (normal range: 65+/-11), the LVEDV is 125 ml (normal range 109+/-23), the LV end systolic volume index is 28 ml/m2 (normal range 18+/-5), the LVESV is 52 ml (normal range 31+/-10), the LV mass index is 21 g/m2, and the LV mass is 39 g. There are no regional wall motion abnormalities present. No evidence of myocardial iron overload. The pre-contrast native myocardial T1 relaxation times are normal (1044 ms). Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 58%, the RV end diastolic volume index is 66 ml/m2 (normal range 69+/-14), the RVEDV is 125 ml (normal range 110+/-24), the RV end systolic volume index is 27 ml/m2 (normal range 22+/-8), and the RVESV is 52 ml (normal range 35+/-13). Right AtriumThe right atrium is normal. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is trace 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 FindingsThere is evidence of hepatic iron overload. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. No perfusion defects/ "ischemia" present during hyperemia.2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and systolic function (LVEF 58%) without evidence of underlying myocardial fibrosis, inflammation, or infiltration. 4. Normal RV size and systolic function (RVEF 58%).5. Evidence of hepatic iron overload. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Elevated PSA. PELVIS:PROSTATE:Prostate Size: The prostate measures 5.3 cm in transverse, 4.6 cm in AP, and 6.6 cm in craniocaudal diameter.Peripheral Zone: No dominant lesion identified. There are small T2 hypointense foci without definite restricted diffusion.Central Gland: Enlarged central gland consistent with benign prostatic hypertrophy.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: None.BLADDER: Small right posterior diverticulum.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Enlarged central gland compatible with benign prostatic hypertrophy.2. No dominant lesion identified. Follow up can be obtained depending on patient's clinical findings and risk for prostate cancer.


Instruction: Generate impression based on findings.

Input: 52-year-old female status post left breast excisional biopsy for ADH. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.Benign intramammary lymph node is present at anterior upper outer quadrant in the right breast.Multiple small metallic artifacts in the left breast from surgical clips.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: 24-year-old female. Left knee pain and instability. Left patellar dislocation. MENISCI: Medial and lateral menisci are normal in signal intensity and morphology without evidence of a tear.ARTICULAR CARTILAGE AND BONE: Small bone contusion at the anterior aspect of the lateral femoral condyle. The remainder of the bone marrow signal intensity is within normal limits. No patellar contusion is evident. Tibiofemoral and patellofemoral compartment articular cartilage is intact.LIGAMENTS: ACL, PCL, MCL, and lateral collateral ligament complex are intact.EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Small bone contusion in the lateral femoral condyle, which may be sequelae of prior patellar dislocation. 2. Femoral trochlear dysplasia.


Instruction: Generate impression based on findings.

Input: convulsions. Evaluate for underlying structural lesion The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.There is subtle FLAIR signa asymmetry of the hippocampi with more signal on the right hippocampus.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 opacities in the right frontal sinus and right anterior ethmoid air cells. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: Although there is no evidence for hippocampal atrophy there is subtle signal hyperintensity in the right hippocampus relative to the left. This is non-specific. The possibility of mesial temporal sclerosis cannot be excluded.


Instruction: Generate impression based on findings.

Input: 45 year old with FNA proven left breast cancer with left axillary lymph node metastasis presents for MRI study. There is extreme amount of fibroglandular tissue in both breasts.Marked parenchymal enhancement is noted bilaterally.There are multiple enhancing foci and small round masses in both breasts, likely parenchymal enhancement.In the left breast, there is a spiculated mass measuring 24 x 20 x 25 mm (AP x LR x CC) at posterior 4 o'clock position, consistent with FNA proven carcinoma. There is a round enhancing mass, measuring 8 x 9 x 8 mm, located at posterior medial from the index mass. This is likely a fibroadenoma from imaging findings, including round shape, circumscribed margins with dark internal septations. However, MR directed ultrasound is recommended for confirmation, as this mass is located at vicinity of the index tumor. No other suspicious enhancing lesions are present in the left breast.In the left axilla, there is one lymph node with thickened cortex, likely a FNA proven metastatic lymph node. This lymph node measures 15 mm in maximum diameter.In the right breast, there is an oval enhancing mass at middle 6 o'clock position, measuring 17 x 7 x 7 mm, likely fibroadenoma. MR directed ultrasound is recommended for this lesion. Elsewhere, there are multiple enhancing foci and small round masses, likely parenchymal enhancement.No abnormal lymph nodes are identified in right axillary region.

Output: 1. Index cancer is present at posterior 4 o'clock position in the left breast.2. Benign appearing round enhancing mass near the index cancer. MR directed ultrasound was performed later today, and this mass was confirmed as a typical benign fibroadenoma.3. A lymph node with thickened cortex in the left axilla, likely a known metastatic node.4. Benign appearing mass in the right middle 6 o'clock position. Ultrasound guided biopsy was performed for this mass later today.5. No abnormal lymph nodes in right axillary regionBIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Sore on foot for three days. Painful, foul smell, appears that wound may be deep. Evaluate for osteomyelitis. There is diffuse soft tissue swelling. There is ulceration of the plantar soft tissues beneath the calcaneus. I see no osteolysis of the calcaneus to indicate osteomyelitis. The Achilles tendon is indistinct, likely due to surrounding soft tissue swelling. Poorly defined lucency with sclerotic margins in the posterior aspect of the calcaneus may represent a cyst at the Achilles tendon insertion. There are small posterior and plantar calcaneal spurs. Arterial calcifications are noted within the soft tissues of the ankle.On the AP view, the medial margin of the fifth metatarsal is indistinct. I suspect that this is artifactual; however if there is strong clinical concern for osteomyelitis at this location, then MRI may be considered for further evaluation.

Output: Soft tissue swelling and other findings as above without definite radiographic features of osteomyelitis. If there is strong clinical concern for osteomyelitis, MRI may be considered for further evaluation.


Instruction: Generate impression based on findings.

Input: 3-year-old male status post intubation with recent fever; evaluate for cerebral edema. There is a focus of hypoattenuation in the right basal ganglia which is somewhat nonspecific on this nonenhanced CT scan. Additional hypoattenuating regions are seen in the bilateral posterior parietal/occipital lobes with extension to the cerebral cortex. Further imaging with MRI is recommended. There is no evidence of intracranial hemorrhage or midline shift. The gray-white matter differentiation appears somewhat indistinct. There is diffuse loss of the cortical sulci which can be seen as a normal variant in young patients; however this may also suggest diffuse cerebral edema.The ventricles and basal cisterns are normal in size and configuration. The calvaria and skull base are radiographically normal. There is partial opacification of the right mastoid air cells and middle ear cavity.

Output: 1. Findings suspicious for cerebral edema. 2. Nonspecific foci of hypoattenuation in the right thalamus and bilateral posterior parietal/occipital lobes. Further imaging with MRI is recommended. 3. Partial opacification of the right mastoid air cells and middle air cavity is nonspecific, but otomastoiditis cannot be excluded.


Instruction: Generate impression based on findings.

Input: Right shoulder pain Evaluation of the shoulder is limited by metallic susceptibility artifact from orthopedic anchor from prior rotator cuff repair. Evaluation is also limited by patient motion artifact particularly on the sagittal sequences.ROTATOR CUFF: The rotator cuff insertion is obscured secondary to metallic susceptibility artifact. There is fluid signal intensity proximal to the cuff insertion and the distal supraspinatus tendon is ill-defined. These findings are concerning for a full-thickness tear of the supraspinatus near the insertion with retraction and possible scar replacement. Fluid signal intensity is also identified within the intrasubstance of the infraspinatus tendon which likely reflects extension of tearing. Increased signal intensity is also present within the insertional fibers of the subscapularis concerning for interstitial an insertional tearing. The visualized teres minor tendon appears intact. There is severe fatty atrophy of the supraspinatus and infraspinatus muscles. There is also fatty atrophy of the superior fibers of the subscapularis and along the myotendinous junction. The teres minor muscle is normal.SUPRASPINATUS OUTLET: Mild osteoarthritis affects the acromioclavicular joint. There is a small amount of fluid within the subacromial subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: The humeral head is slightly high riding in relation to the glenoid fossa. Moderate osteoarthritis affects the glenohumeral joint and there is degeneration and degenerative tearing of the anterior and superior labrum. There is a small amount of fluid within the glenohumeral joint.BICEPS TENDON: There is fluid signal intensity within the intrasubstance of the biceps tendon within the intertubercular groove. More proximally, the intra-articular portion of the biceps tendon is not well seen which may relate to tearing. ADDITIONAL

Output: 1. Chronic rotator cuff tears and muscle atrophy as detailed above.2. Osteoarthritis of the glenohumeral and acromioclavicular joints.3. Tearing of the intra-articular portion of the biceps tendon.


Instruction: Generate impression based on findings.

Input: History of TIA in 2014 with double vision and possible slurred speech. 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 acute intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: 53-year-old female patient with abdominal pain and cholestatic labs. Evaluate for biliary obstruction. Note that the examination is limited by patient motion artifact.ABDOMEN:LIVER, BILIARY TRACT: There is bilateral intrahepatic biliary ductal dilatation. There is obliteration of the common hepatic biliary duct at the hepatic hilum as well as the secondary biliary ducts bilaterally with an infiltrative mass that measures 5.0 x 4.6 cm (series 901 image 24), which demonstrates delayed enhancement. There is invasion and thrombosis of the portal vein and the left hepatic artery.SPLEEN: No significant abnormality noted.PANCREAS: There is an infiltrative, hypoenhancing lesion in the tail of the pancreas that measures 2.6 x 2.7 cm (series 1401 image 196).ADRENAL GLANDS: There is a small right adrenal adenoma.KIDNEYS, URETERS: Subcentimeter right renal cyst 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: 1.Delayed enhancing lesion at the hepatic hilum is compatible with a cholangiocarcinoma. There is associated intrahepatic biliary ductal dilatation and invasion of the portal vein.2.Hypoenhancing lesion in the pancreatic tail is compatible with malignancy, such as a primary pancreatic adenocarcinoma or a metastatic lesion.3.Right adrenal adenoma.


Instruction: Generate impression based on findings.

Input: 35-year-old male with low back pain. History of previous surgery. There is straightening of the normal lumbar lordosis. There is deformity of the L4 vertebral body with associated superior and inferior endplate depression anteriorly consistent with a chronic vertebral body compression fracture, with loss of less than 50% of the vertebral body height. There is grade 1 retrolisthesis of L4 with respect to L5 with increased T1 signal abnormality affecting the superior and inferior endplates of the L4 vertebral body consistent with type II Modic changes. Additionally, there is endplate irregularity along the inferior endplate of L3. These findings are stable.There is otherwise no abnormal bone marrow signal noted. Note is again made of postoperative changes of prior L4/L5 laminectomy with associated expansion of the thecal sac in the surrounding area. The vertebral bodies are otherwise of normal configuration, size and signal. The spinal cord terminates at L1. The inferior portion of the spinal cord, conus and the cauda equina show no signal abnormality. The visualized portions of the lower thoracic spine are unremarkable. L1-2: Normal intervertebral disk height. There is mild intravertebral disk desiccation. No significant central spinal canal or neuroforaminal stenosis. These findings are unchanged. L2-3: There is mild intervertebral disk space narrowing. There is mild facet joint arthropathy and ligamentum flavum hypertrophy. There is no significant central spinal or neuroforaminal stenosis. These findings are unchanged. L3-4: There is advanced degenerative disk disease with intravertebral disk height loss and desiccation. There is no significant central spinal canal or neuroforaminal stenosis. These findings are unchanged. L4-5: There is intervertebral disk space narrowing as well as disk desiccation. There is no significant central spinal canal stenosis. There is a diffuse disk bulge with associated mild bilateral neuroforaminal stenosis, left greater than right. These findings are unchanged.L5-S1: There is mild degenerative disk disease with intervertebral disk space narrowing and disk desiccation. There is mild ligamentum flavum and facet joint hypertrophy. No significant central spinal canal stenosis. A previously demonstrated left lateral disk extrusion has significantly decreased in size, now resulting in flattening of the left S1 nerve sheath origin (previously displaced and compressed).

Output: 1.Persistent deformity of the of the L4 vertebral body suggestive of a prior chronic vertebral body compression fracture. There are associated type II Modic degenerative changes and retrolisthesis of the L4 vertebral body. There is also irregularity of the inferior endplate of L3. These findings are stable.2.L4-5: Mild bilateral neuroforaminal stenosis, left greater than right, unchanged.3.L5-S1: A previously demonstrated left lateral disk extrusion has significantly decreased in size, now resulting in flattening of the left S1 nerve sheath origin (previously displaced and compressed).


Instruction: Generate impression based on findings.

Input: 55-year-old female history of IPMN abdominal lymphadenopathy, and breast cancer. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: Nonenhancing, cystic pancreatic head lesion appears similar to prior measuring 7 x 6 mm. No enhancing nodularity or septations. No clear communication to the MPD or common bile duct. The main pancreatic duct is unremarkable and measures 2mm.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: Stable probable side-branch IPMN in the pancreatic head without suspicious features. The pancreatic duct is of normal caliber.


Instruction: Generate impression based on findings.

Input: Female, 65 years old, nontraumatic intracranial hemorrhage and history of breast carcinoma. HCT done 10/27 showed an interval slight increase in ICH. MRI done the same day demonstrated 4.5x3x4.6 cm ICH with 5 mm left to right shift with no clear underlying mass. The previously demonstrated large intraparenchymal hemorrhage in the left occipital lobe has decreased in size since the prior examination and now measures up to 3.9 x 3.4 x 4.1 cm (TV by AP by CC). There has been interval evolution of the signal of the blood products with peripheral hemosiderin staining and central high T2 and T1 signal indicating late subacute blood. Mild peripheral enhancement is present, which can be seen with hematoma. No definite masslike enhancement is identified. Mild residual surrounding edema is seen, improved from prior. The atrium of the left lateral ventricle has reexpanded, and there has been interval resolution of previously demonstrated midline shift. Several punctate foci of susceptibility are seen in the tissues surrounding the hematoma but separate from the main collection. Elsewhere in the brain, however, no definite additional hemosiderin staining is demonstrated.There is no diffusion abnormality to suggest acute infarct. No new intracranial mass or mass effect. Numerous scattered foci of T2 hyperintensity are seen within the cerebral white matter, nonspecific and unchanged. The ventricles and sulci are within normal limits for age. No new abnormal extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. A small developmental venous anomaly is noted incidentally in the right cerebellum. The midline structures and craniocervical junction are within normal limits.MRA HEAD

Output: Interval evolution and improvement in size of the intraparenchymal hemorrhage in the left occipital lobe. Improved associated edema and mass effect. No definite underlying enhancing mass or vascular malformation is identified. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 73-year-old man with history of pancreatic cysts seen on outside imaging. ABDOMEN:LIVER, BILIARY TRACT: Liver appears normal without focal hepatic lesion. Patient is status post cholecystectomy and there is no intra or extrahepatic biliary ductal dilatation.SPLEEN: The spleen appears normal.PANCREAS: Numerous tiny cystic lesions are seen within the pancreatic head and tail. Of these, the largest is a round 10 x 8 mm T2 hyperintense lesion which appears to communicate with the pancreatic duct in the neck of the pancreas (5/59). This lesion is hypointense on T1 weighted images, however the postcontrast images are degraded by motion artifact and enhancement cannot be adequately evaluated.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: In the right kidney (8/16) there is a 13 mm, round T2 hypointense lesion arising exophytically from the lower pole. Field-of-view does not extend to cover this lesion on postcontrast images. Multiple bilateral T2 hyperintense renal cysts are noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The small bowel and colon appear normal.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Indeterminate 10 mm cystic lesion in the neck of the pancreas communicating with the duct, likely a sidebranch IPMN. Enhancement of this lesion cannot be determined due to motion artifact.2.Indeterminate right renal inferior pole lesion which was not evaluated on the postcontrast portion of this study. Characterization of this lesion is recommended on subsequent enhanced imaging, otherwise one-year follow-up is recommended.


Instruction: Generate impression based on findings.

Input: Other symptoms and signs involving the musculoskeletal system [R29.898], Reason for Study: ^Reason: evaluate for cervical myelopathy. No contrast given low GFR History: LUE numbness, weakness: intermittent Normal cervical lordosis has been lost straight-end. Instead, there is some minimal kyphotic angulation centered at C4-5 intervertebral disc level.There is no evidence of spinal cord signal abnormality.The cranial-cervical junction is normal. The vertebral body height is preserved. Degenerative changes are as follows: C2-C3: Minimal bulging of disc otherwise unremarkable.C3-C4: Diffuse bulging of disc which abuts thecal sac. C4-C5: Broad-based disc extrusion central to right which abuts thecal sac as well as minimal to moderate narrowing of the right neural foramen.C5-C6: Focal central extrusion of the disc which abuts thecal sac and cause minimal to mild spinal canal stenosisC6-C7: Broad-based central to left disc bulging otherwise unremarkable. C7-T1: no neuroforaminal narrowing or spinal stenosis.

Output: 1. No evidence of spinal cord signal abnormality.2. Multifocal intervertebral disc herniations as described above.


Instruction: Generate impression based on findings.

Input: Female 41 years old with right knee pain. Evaluate for meniscal tear. MENISCI: The medial and lateral menisci are intact and unremarkable other than very minimal intrasubstance degeneration of the posterior horn of the medial meniscus, less than on the left.ARTICULAR CARTILAGE AND BONE: No significant abnormality noted, specifically no focal discrete cartilage defects as observed on the left.LIGAMENTS: The cruciate and collateral ligaments are intact. The MCL and LCL complex are intact. EXTENSOR MECHANISM: The extensor mechanism is intactADDITIONAL

Output: No acute or sub acute abnormality.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Elevated PSA, evaluate for disease, had 3 previous negative biopsies, does not want endorectal coil PELVIS:PROSTATE:Gland measures 5.3 cm in transverse dimension x 5.1 cm in AP dimension x 4.8 cm in craniocaudal dimension.Thinning of bilateral peripheral zones, making assessment suboptimal.Severe BPH, with some associated obscuration of left peripheral zone at mid gland and apex.Small scattered foci of T1 hyperintensity likely small postbiopsy hemorrhage.BLADDER: No significant abnormality noted.LYMPH NODES: No enlarged lymph nodes by size criteria.BONES, SOFT TISSUES: Heterogeneous marrow signal.OTHER: Partially imaged right greater than left hydroceles.

Output: Exam performed without endorectal coil. No suspicious lesion identified. Thinning of peripheral zones bilaterally, making assessment suboptimal, severe BPH noted.Heterogeneous marrow signal, likely degenerative in etiology; if there is concern for metastatic disease, please note that evaluation would be more sensitive with dedicated nuclear medicine bone scan.


Instruction: Generate impression based on findings.

Input: 80 years Female (DOB:10/7/1935)Reason: hx of cirrhosis of liver. Thoracic lesion seen on Liver MRI. Eval dedicated spine imaging for lesion History: none- surveillance PROVIDER/ATTENDING NAME: EDWIN RAMOS EDWIN RAMOS MRI thoracic spine:The thoracic vertebral bodies are appropriate in the overall alignment and height. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots. Adjacent to the left T10 vertebral body and overlying the left T10-T11 neural foramen there is a 12 x 17 mm axial dimension mass. Lesions within the neural foramina of T10-T11 bilaterally and the right side at T9-T10 neural foramen as well as the right neural foramen of T8-T9 are present which are bright on STIR T2 imaging, do not enhance following contrast administration and are dark signal on T1 imaging. This implies that they are cystic in nature. Most likely representing perineural cysts.There are multiple lesions which are bright signal on T2 and T1 imaging measuring up to 14 mm in diameter located at T11, T9 and T8. These suppress on inversion recovery and fat suppressed imaging. Most likely this represents a hemangioma.There are degenerative changes in the visualized portions cervical spine worse at C5-6 where there is some narrowing of the spinal canalLumbar spine:Five lumbar type vertebral bodies are presumed to be present The conus medullaris on sagittal imaging is grossly intact.There is a compression fracture present at L1 with approximately 40% loss of vertebral body height. There is mild retropulsion. The L1 vertebral body is bright on T1 it has a Schmorl's node superiorly. Most likely this represents a benign compression fracture.No abnormal enhancing lesions are appreciated in the lumbar spine.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is mild anterior subluxation of L5 on S1 associated with bilateral pars interarticularis defects. There is elongation of the AP dimension of the spinal canal. There is mild narrowing of the neural foramina at this level, associated with partial effacement of the fat surrounding the exiting nerve roots.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is a mild disc bulge and disc desiccation at this level as well as loss of disc space height and mild facet hypertrophy.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is a mild disc bulge and disc desiccation at this level as well as loss of disc space height and mild facet hypertrophy.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.There is a cystic lesion along the left kidney which was also present on the prior liver MRI. It measures 18 x 12 mm axial dimensions. It has not substantially changed

Output: 1.There is a left paraspinous mass present adjacent to the T10 vertebral body overlying the left T10-T11 neural foramen. It was also present on the liver MRI exam from 10/6/2015. Given its location differential considerations include nerve sheath tumor. Follow-up exams would help confirm this.2.There is a compression fracture present at L1 which has a benign appearance.3.There are spondylolysis with spondylolisthesis grade one at L5-S1. There is mild encroachment of the exiting nerve roots within the neural foramen at this level.4.There are some degenerative changes present in the lumbar spine without significant compromise to the spinal canal or exiting nerve roots.


Instruction: Generate impression based on findings.

Input: Redemonstrated is patchy ill-defined enhancement and increased T2/FLAIR signal in the anterior temporal lobes with no significant change from the prior exam. Perfusion imaging in this area is unreliable due to susceptibility effect from the skull base. MR spectroscopy is also complicated by the enhancing tissue being in close proximity to the skull base. A small voxel was utilized and, by necessity, only partially included the enhancing tissue. Nevertheless, the spectrum does contain diagnostic information and shows a reduction of the major metabolic peaks (choline, creatinine, and NAA). In addition, there are features suggestive of a small amount of lipid and possibly a lactate doublet.The ventricles and sulci are prominent, consistent with mild age-related volume loss. The basal cisterns remain patent. There is no midline shift or mass effect. There is a similar pattern of scattered punctate foci and confluent areas of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, which are nonspecific but may represent mild chronic small vessel ischemic changes and/or post treatment changes. There is no new pathological enhancement. A left frontal developmental venous anomaly is again incidentally noted. There is no diffusion abnormality. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. Again seen is a left maxillary sinus mucosal retention cyst.

Output: Stable patchy ill-defined areas of enhancement in bilateral temporal lobes. The location, symmetry, and information obtained from spectroscopy favor radiation treatment-related tissue injury rather than metastatic involvement.


Instruction: Generate impression based on findings.

Input: Similar to prior outside study, again seen is caudal descent of the cerebellar tonsils to the mid to lower C2 level, measuring approximately 19 mm below the foramen magnum. Cervical tonsils are peglike in configuration. There is associated crowding at the foramen magnum and C1-C2 levels. Biphasic CSF flow is mildly diminished ventrally at the foramen magnum and diminished to a greater degree posteriorly. There are ill-defined T2 hyperintensity in the cervical cord at the C2 level, which was present previously, without discrete syrinx.The cervical spine is in normal alignment. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated.There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the cervical spine. THORACIC SPINE

Output: 1. Findings consistent with Chiari I malformation with caudal descent of the cerebellar tonsils measuring up to 19 mm below the foramen magnum. There is associated crowding and diminished biphasic CSF flow at the foramen magnum and C1-C2 levels, particularly posteriorly.2. Ill-defined T2 hyperintensity in the cervical cord at the C2 level is compatible with a "pre-syrinx" and was also present on prior outside study. There is a small syrinx at the T11 level.3. No evidence of tethered cord.


Instruction: Generate impression based on findings.

Input: 30-year-old female with right lower quadrant pain with prior history of Crohn's disease and resection. Evaluate for Crohn's disease. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.CALCIFICATIONS IN ABDOMINAL AORTA AND ITS BRANCHES: NoneBOWEL, MESENTERY: There is proximal cecal and neoterminal ileum wall thickening with associated submucosal edema and enhancement involving approximately 4 cm the terminal ileum. Colon is normal in appearance.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: As above.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Findings consistent with acute on chronic inflammatory bowel disease involving the terminal ileum and the proximal cecum.


Instruction: Generate impression based on findings.

Input: Male 58 years old PELVIS:PROSTATE:Prostate Size: The prostate measures 5.3 x 4.0 x 6.2 cmPeripheral Zone: There is a dominant focus of T2 signal abnormality posteriorly in the midline within the mid gland/apex. This is dark on ADC map. This measures approximately 0.9 x 0.6 cm (series 703, image 124). A second focus of signal abnormality is identified in the right paracentral mid gland/base posteriorly measuring 1.2 x 0.6 cm (series 703, image 264). These are suspicious for foci of prostatic adenocarcinoma.Central Gland: Enlarged and heterogeneous.Seminal Vesicles: No seminal vesicle invasion.Extracapsular Extension: No convincing extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Two foci of signal abnormality within the peripheral zone suspicious for foci of prostatic adenocarcinoma. The largest measures 1.2 cm in maximum dimension. No extracapsular extension or seminal vesicle invasion.


Instruction: Generate impression based on findings.

Input: Male, 75 years old. Reason: eval for further mets History: thoracic spine with lytic lesion, bx with plasmacytoma SKULL: Tiny lucencies in the calvarium may simply represent vascular markings. We see no definite myelomatous lesions.CERVICAL SPINE: The lower cervical spine is not well-seen on the lateral view due to overlying anatomy. Given these limitations, we see no lytic lesions. Severe degenerative disc disease affects the lower cervical spine. There is moderate multifocal facet joint osteoarthritis.THORACIC SPINE: The left pedicle of T9 is indistinct, corresponding to the lesion seen within the T9 vertebra on prior MRI. We see no additional lesions within the thoracic spine. There is multilevel degenerative disc disease. LUMBAR SPINE: The bones appear demineralized diffusely, but focal vertebral body lesions are much better seen on recent MRI study. Severe degenerative disc disease affects the lumbar spine.RIBS: Rib lesions seen on recent CT scan are not clearly evident on this study. The lower ribs are partially obscured by enteric contrast in the colon. Surgical clips and stents are noted in the mediastinum.PELVIS: Portions of the pelvis are obscured by overlying enteric contrast. Myelomatous lesions are better visualized on recent CT scan. Surgical clips overlie the left groin region.UPPER EXTREMITY: Two views of the right humerus show multiple lucent lesions concentrated in the proximal diaphysis compatible with myeloma. One view of the right forearm shows small lucencies in the proximal radial and ulna that may represent foci of myeloma. Two views of the left humerus show multiple lucent lesions within the diaphysis, compatible with myeloma. One view of the left forearm shows no definite myeloma lesions.LOWER EXTREMITY: Two views of the right femur show poorly defined lucencies in the proximal diaphysis, compatible with myeloma. Moderate osteoarthritis affects the right knee. Two views of the left femur show poorly defined lucencies within the femoral diaphysis, compatible with myeloma. AP views of the lower legs show no definite myelomatous lesions. Surgical clips are noted within the soft tissues of the right leg.

Output: Widespread multiple myeloma as described above.


Instruction: Generate impression based on findings.

Input: Reason: cuff tear History: pain. ROTATOR CUFF: Mild supraspinatus tendinopathy but no full thickness tear. Mild infraspinatus tendinopathy with no full thickness tear. The subscapularis and teres minor are intact. No muscle atrophy.SUPRASPINATUS OUTLET: Mild AC joint osteoarthritis. No fluid within the subacromial subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral alignment is within normal limits. Mild glenohumeral joint osteoarthritis. The labrum is grossly intact.BICEPS TENDON: The biceps tendon is intact. ADDITIONAL

Output: Mild rotator cuff tendinopathy with no full thickness tear.


Instruction: Generate impression based on findings.

Input: 47 year old woman with history of abnormal nuclear scan, LV dysfunction, stroke and previously suspected LV thrombus who presents for cardiac MRI. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 19%, the LV end diastolic volume index is 168 ml/m2 (normal range: 65+/-11), the LVEDV is 382 ml (normal range 109+/-23), the LV end systolic volume index is 136 ml/m2 (normal range 18+/-5), the LVESV is 309 ml (normal range 31+/-10), the LV mass index is 47 g/m2 (normal range 67+/-11), and the LV mass is 106 g (normal range 114+/-24). There is global hypokinesis with regional variation. There is a small rounded thrombus in the apex of the left ventricle . There is late gadolinium enhancement in the mid-inferior wall and basal anterior wall suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. The late gadolinium enhancement involves the endocardial surface so the pattern is typical for prior myocardial infarction. The native T1 myocardial relaxation time is mildly 1101ms, which is abnormal. Left AtriumThe left atrium is severely dilated. The interatrial septum is bowed to the right, suggestive of elevated left atrial pressure.Right VentricleThe right ventricle is moderately dilated with severely reduced systolic function. The overall RV ejection fraction is 20%, the RV end diastolic volume index is 114 ml/m2 (normal range 69+/-14), the RVEDV is 258 ml (normal range 110+/-24), the RV end systolic volume index is 91 ml/m2 (normal range 22+/-8), and the RVESV is 206 ml (normal range 35+/-13). Right AtriumThe right atrium is moderately dilated. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve leaflets are tethered and there is moderate mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild-moderate tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is mildly dilated.Venous AnatomyThe SVC and IVC and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThere are multiple large hepatic cysts noted. There is a substernal thyroid tissue on the right. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 19%. 2. The right ventricle is moderately dilated with severely reduced systolic function. The overall RV ejection fraction is 20%. 3. There is a small rounded apical thrombus in the left ventricle. 4. There is \late gadolinium enhancement in the mid-inferior wall which is suggestive of underlying fibrosis, inflammation or infiltration. The pattern is typical for small myocardial infarctions because the late gadolinium enhancement involves the endocardium.5. There is moderate mitral regurgitation. 6. There is mild-moderate tricuspid regurgitation. 7. The main pulmonary artery is mildly dilated. 8. See extracardiac findings. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 64-year-old female with a history of a nasal mass. Limited examination for preoperative planning purposes.Again seen is a polypoid lesion in the posterior right nasal cavity which measures approximately 3.3 cm in the axial plane, 1.4 cm in the transverse dimension, and approximate 4 cm in the craniocaudal dimension. The lesion demonstrates low T2 signal and homogeneous enhancement. Lesion extends posteriorly into the nasopharynx. The lesion is noted to extend into the anterior aspect of the right sphenoid sinus with widening at the right sphenoethmoidal recess. Subtle foci of thinning along the floor of the anterior cranial fossa are better appreciated on the prior CT examination. There is no evidence of intracranial extension.There is mild mucosal thickening in the bilateral maxillary sinuses as well as a mucous retention cyst in the right sphenoid sinus. There is also minimal opacification involving the anterior and posterior ethmoid air cells.The ventricles and sulci are prominent compatible with age-related volume loss. Several foci of T2 hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with chronic small vessel ischemic changes. Brain parenchyma is otherwise grossly unremarkable on these limited sequences with no abnormal parenchymal or meningeal enhancement.

Output: 1. Limited examination done for preoperative planning purposes. Right-sided polypoid lesion in the posterior right nasal cavity with protrusion into the nasopharynx. The lesion demonstrates low T2 signal and homogeneous enhancement, signal features which are suspicious for neoplasm although not specific.2. Lesion appears to extend into the right sphenoid sinus through what appears to be widened sphenoethmoid recess. Subtle foci of thinning along the floor of the anterior cranial fossa are better appreciated on the prior CT. There is no evidence of intracranial extension.3. Mild chronic small vessel ischemic changes.


Instruction: Generate impression based on findings.

Input: 65 year old woman with chest pain/dyspnea, referred for evaluation of underlying ischemia. MEDICATIONS: ASA, pravastatin, insulin First Pass PerfusionDuring hyperemia, no perfusion defects were present.Viability/ Myocardial ScarThere is no late gadolinium enhancement noted to suggest myocardial infarction. The entire myocardium is viable.Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 68%, the LV end diastolic volume index is 73 ml/m2 (normal range: 65+/-11), the LVEDV is 150 ml (normal range 109+/-23), the LV end systolic volume index is 23 ml/m2 (normal range 18+/-5), the LVESV is 48 ml (normal range 31+/-10), the LV mass index is 38 g/m2, and the LV mass is 78 g. There are no regional wall motion abnormalities present. There is no evidence of underlying myocardial fibrosis, inflammation, or infiltration. Native myocardial T1 time is within normal limits.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 64%, the RV end diastolic volume index is 64 ml/m2 (normal range 69+/-14), the RVEDV is 132 ml (normal range 110+/-24), the RV end systolic volume index is 23 ml/m2 (normal range 22+/-8), and the RVESV is 48 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation. There is moderate mitral annular calcification extending onto the posterior leaflet.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is moderately dilated. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is a trivial pericardial effusion.Extracardiac FindingsThe esophagus is patulous. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. No perfusion defects/ "ischemia" present during hyperemia.2. Normal LV size and systolic function (LVEF 68%) without evidence of prior myocardial infarction or other infiltrative, inflammatory, or fibrosing process. There is mild concentric left ventricular hypertrophy.3. Normal RV size and systolic function (RVEF 64%).4. Moderate dilation of the main pulmonary artery.5. Patulous esophagus.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: History of right mastectomy for breast cancer. There is heterogeneous amount of fibroglandular tissue in the left breast. Status post right mastectomy. The implant on the right is intact.Moderate parenchymal enhancement is noted in the left breast. No abnormal enhancement is seen in either the left breast or right reconstruction. There are a few scattered foci and areas of non-mass enhancement in the left breast, though these are not significantly changed compared to prior MRIs. 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: The evaluation for leptomeningeal metastatic disease is nondiagnostic given the lack of intravenous contrast.Cervical spine:Artifact limits evaluation of the lower cervical spine axial T2 sequence. There is straightening of the normal cervical lordosis. The vertebral body heights are grossly preserved. The bone marrow demonstrates heterogeneous marrow signal. There is no evidence of acute fracture. Mild degenerative spondylosis affects the cervical spine. A Schmorl's node is noted along the inferior endplate of C4. Disc osteophyte complexes are noted at C3-4 through C6-7 without significant spinal canal stenosis or neural foraminal narrowing. The cervical cord is normal in caliber and signal. The thyroid is incompletely assessed only on the sagittal images and appears heterogeneous as well as slightly prominent.Thoracic spine:There is signal dropout limiting evaluation of the STIR sequence cranially. The axial T2 images of the lower thoracic spine are nondiagnostic. Alignment of the thoracic spine is within normal limits. Vertebral body height is grossly preserved. The bone marrow signal is mildly heterogeneous. No evidence of acute fracture. Mild degenerative spondylosis affects the thoracic spine. Schmorl's nodes are present at the T8 and T9 superior endplates and T10 inferior endplate. No significant spinal canal stenosis or neural foraminal narrowing. The spinal cord is normal in caliber and signal.Lumbar spine:The axial T1, T2, and sagittal STIR sequences were not performed. Alignment of the lumbar spine is anatomic. The vertebral body heights are preserved. The bone marrow signal is within normal limits. Minimal disc protrusions affect the lower lumbar spine. There is no significant spinal canal stenosis or neural foraminal narrowing at any level. The visualized distal cord and conus medullaris are normal in caliber and signal. The cord terminates at L2-3.

Output: 1. Nondiagnostic evaluation for leptomeningeal metastatic disease given the lack of intravenous contrast.2. No evidence of abnormal cord signal or spinal canal stenosis.3. Incompletely assessed, but mildly prominent and possibly heterogeneous thyroid gland. Please correlate with physical exam.


Instruction: Generate impression based on findings.

Input: Male 46 years old with recently diagnosed high risk prostate cancer. Staging exam. PELVIS:PROSTATE:Prostate Size: 4.9 x 3.3 cmPeripheral Zone: There are multiple T2 hypointense lesions involving the peripheral zone. The dominant lesion is predominantly anterior from the mid gland to the apex with involvement of the central gland and anterior extracapsular extension (series 901, images 12 and 16). There are additional lesions in the right posterior apex involving the neurovascular bundle (series 901, image 11) and in the mid peripheral zone at the apex with extracapsular extension (series 901, image 12). The lesions are hyperintense on DWI, dark on ADC and demonstrate early contrast enhancement.Central Gland: The central gland is involved by the anterior peripheral zone lesion as described above.Seminal Vesicles: No evidence of disease extension into the seminal vesicles.Extracapsular Extension: There is extracapsular extension from the anterior lesion as well as from the lesion in the mid peripheral zone at the apex.BLADDER: No significant abnormality noted.LYMPH NODES: There is a 6 x 5 mm enhancing left pelvic node at the sacrosciatic notch (series 901, image 29)BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Multiple lesions consistent with prostate carcinoma. The dominant lesion is predominantly anterior, involved the central zone and has extracapsular extension. A second lesion in the mid posterior apex also demonstrates extracapsular extension.2.A lesion at the right post apex involved the neurovascular bundle.3.Left pelvic lymph node is suspicious for metastatic disease.Findings discussed by phone with Dr. Zagaja at 8:35 am on 11/22/2016


Instruction: Generate impression based on findings.

Input: Male 44 years old Reason: ankle pain, swelling History: swelling. We have 3 views of the left ankle which show an ossicle posterior to the talus. Relatively little edema in the pre-Achilles fat suggests this is a normal variant os trigonum, however, CT/MRI is recommended if there is strong clinical concern for fracture. Mild osteoarthritis affects the ankle joint and there is mild soft tissue swelling.We have 3 views of the left foot which show the aforementioned ankle findings and possibly a small tibiotalar joint effusion.

Output: Ossicle posterior to talus is favored to represent a normal variant os trigonum. However, if there is strong clinical concern for fracture, CT or MRI may be considered.


Instruction: Generate impression based on findings.

Input: Visual hallucination. 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, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There are bilateral mastoid effusions.

Output: 1. No evidence of intracranial hemorrhage, mass, or acute infarct. 2. Nonspecific bilateral mastoid effusions.


Instruction: Generate impression based on findings.

Input: Brain: Postsurgical changes are present related to decompression including suboccipital craniectomy and C1 laminectomy. The CSF spaces at the foramen magnum ventrally and dorsally have significantly increased in size, and the cerebellar tonsils are no longer flattened. There is persistent mild cerebellar tonsillar ectopia with the left cerebellar tonsil extending to the C1 level. There is no evidence of intracranial hemorrhage or acute infarct. A small pineal cyst is unchanged in size. There are no areas of abnormal parenchymal signal. 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, paranasal sinuses, and scalp soft tissues are unremarkable. 3-D T2 Fiesta and CSF flow images are severely degraded due to technical limitations. Cervical Spine: Postsurgical changes are present including C1 laminectomy. There is mild straightening of the normal cervical lordosis which may be due to positioning. The vertebral body heights and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. The spinal cord displays normal signal and morphology. There is no evidence of syrinx of the cervical or upper most visualized thoracic cord. The paravertebral soft tissues are unremarkable.Mild disc protrusions are present at C3-C4, C4-C5, and C5-C6 without significant central canal stenosis or foraminal stenosis.

Output: Interval postsurgical changes related to Chiari decompression with significant enlargement of CSF spaces ventrally and dorsally at the foramen magnum.


Instruction: Generate impression based on findings.

Input: 56-year-old male with right hand/arm pain and swelling for one week. Evaluate for infection. No bone marrow signal abnormality is identified. There is no evidence to suggest osteomyelitis. There is extensive diffuse increased signal abnormality in the soft tissues of the right forearm and wrist, most pronounced along the dorsal aspect of the wrist and forearm, consistent with edema/inflammation. There is a moderate amount of fluid within the radiocarpal joint. There are multiple fluid collections about the wrist. There is a 2.2 x 1.4 cm collection about the dorsal aspect of the extensor carpi ulnaris and extensor digiti minimi tendons. There is an additional fluid collection deep to the flexor digitorum tendons measuring approximately 3.1 x 1.3 cm. It should be noted that evaluation for abscess formation is limited due to lack of intravenous contrast.

Output: Multiple focal fluid collections about the wrist, suspicious for abscess formation, with associated extensive soft tissue swelling about the wrist and forearm, as described above.


Instruction: Generate impression based on findings.

Input: Male, 43 years old, with cervical radiculopathy to the left shoulder. Alignment is anatomic. Vertebral body morphology is within normal limits. No evidence of marrow replacement seen. Mild degenerative marrow edema is evident along the inferior endplate of T4.C2-3: Left facet hypertrophy. No significant spinal canal or neuroforaminal stenosis. C3-4: Facet hypertrophy. Posterior disk osteophyte formation with a superimposed left paracentral extrusion which migrates superiorly. This results in effacement of the left ventral spinal canal and slight impingement of the spinal cord without cord signal abnormality. The left neural foramen is mildly narrowed. The right neural foramen is patent. C4-5: Posterior disk osteophyte complex with a small superimposed central extrusion. This results in effacement of the ventral spinal canal with minimal ventral cord flattening but no cord signal abnormality. The neural foramina are patent. C5-6: Posterior disk osteophyte formation resulting in effacement of the ventral spinal canal and minimal ventral cord flattening. No cord signal abnormality. The right neural foramen is mildly narrowed and the left neural foramen is severely narrowed. C6-7: Posterior disk osteophyte formation resulting in mild central spinal canal effacement but no significant cord impingement. The left neural foramen is mildly narrowed and the right neural foramen is severely narrowed.C7-T1: Unremarkable.

Output: Degenerative disk disease is seen from C3-4 through C6-7 with disk osteophyte formation at all levels.At C3-4, there is a superimposed left paracentral disk extrusion, migrating superiorly, which results in left ventral spinal canal effacement and mild cord impingement.At C4-5 and C5-6, disk osteophyte formation results in mild ventral cord flattening.Significant foraminal narrowing is evident on the left at C5-6 and on the right at C6-7.