Instruction: Generate impression based on findings.

Input: CERVICAL SPINE:The marrow signal is benign. The cervical cord is normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. Multilevel degenerative changes are noted about the cervical spine with diffuse disc dessication. The visualized paraspinal contents are unremarkable.C2/3: No significant spinal canal stenosis or neuroforaminal narrowing. C3/4: Shallow central disc protrusion. Mild right uncovertebral hypertrophy. No significant spinal canal stenosis or neuroforaminal narrowing.C4/5: Left greater than right facet hypertrophy. 1 mm of anterolisthesis of C4 on C5 with mild disc uncovering and mild central spinal canal stenosis. Mild left neuroforaminal narrowing. No right neuroforaminal narrowing. C5/6: Posterior disc-osteophyte complex and ligamentum flavum hypertrophy with resultant moderate central spinal canal stenosis. Moderate facet and uncovertebral hypertrophy with moderate right and mild left neuroforaminal stenosis.C6/7: Posterior disc-osteophyte complex and ligamentum flavum hypertrophy with resultant moderate central spinal canal stenosis. Moderate uncovertebral and facet hypertrophy with resultant moderate bilateral neuroforaminal narrowing.C7/T1: No significant spinal canal stenosis or neuroforaminal narrowing.Nonspecific pleuroparenchymal opacities are noted in the lung apices, left greater than right, possibly related to scarring.THORACIC SPINE:There is a smooth, physiologic thoracic kyphotic curve. The vertebral body heights and disc spaces are maintained. Marrow signal intensity is benign throughout. The spinal cord has a smooth contour and is without focal atrophy, edema, or myelomalacia. There are no masses.A somewhat lobulated T2 hyperintense lesion is partially visualized in the liver measuring at least 2.5 cm.

Output: 1.Multilevel degenerative disease of the cervical spine as described above.2.Moderate spinal canal stenosis of C5-6 and C6-7 levels.3.Grade 1 anterolisthesis of C4 on C5.4.Unremarkable MR of the thoracic spine.5.A somewhat lobulated possibly cystic lesion is partially visualized in the liver, which can be further evaluated with ultrasound if clinically warranted.


Instruction: Generate impression based on findings.

Input: Draining sinus tract, calcaneal fracture Evaluation of the ankle joint is limited given metallic susceptibility artifact from prior surgical intervention.Best seen on series 13 images 20 through 22 is a sinus tract extending from the body of the calcaneus to the skin surface. A small focus of signal void is identified on the distal and of this tract which likely represents a small focus of gas. This sinus tract arises from the calcaneus where there is an ill-defined multilobulated peripherally enhancing collection. This measures approximately 4.4 x 2.6 cm in the greatest AP and craniocaudal dimensions. This extends into the body of the calcaneus with the anterior process relatively preserved. There is no joint effusion. There is fragmentation and deformity of the calcaneus which is at least posttraumatic in nature but may also reflect the sequela of chronic infection. There is intermediate T1 marrow signal of the calcaneus and slightly increased marrow edema but no discrete low T1 marrow signal intensity. There is no tibiotalar effusion.Note that the exam was not tailored for the evaluation of the ligaments and tendinous structures. The distal Achilles tendon demonstrates abnormal signal intensity and thickening representing tendinopathy. The sinus tract described above courses through the intrasubstance of the distal Achilles tendon but more proximally, the tendon appears relatively normal. There is otherwise no obvious tendinous or ligamentous disruption. Mild osteoarthritis also affects the midfoot.

Output: 1. Deformity of the calcaneal body which is at least in part posttraumatic in nature but may also represent the sequela of chronic infection and/or posttraumatic change.2. Draining sinus tract extending through the distal Achilles tendon to the skin surface which arises from an ill-defined fluid collection within the calcaneal body. Findings are concerning for an intraosseous abscess. The surrounding bone marrow demonstrates slight edema but no discrete low T1 signal intensity focus.


Instruction: Generate impression based on findings.

Input: History of tethered cord, new worsening symptoms, leg weakness. There are postoperative findings related to posterior lumbar spine surgery for attempted dethetering. There is a fluid collection in the posterior lumbar paraspinal soft tissues that measure up to 75 mm in length. The conus medullaris is bulbous and terminates at L3-4, where it is posteriorly deviated alongside the duraplasty. In addition, the cauda equina nerve rots appear to be clumped and deviated peripherally to the overlying dura. Posterior fusion hardware is present in the upper thoracic, lower thoracic, and at L2-L4, with associated metallic artifact. There is thoracolumbar dextroscoliosis. The bone marrow signal is unremarkable. The vertebral body heights are preserved.

Output: 1. Postoperative findings related to posterior lumbar spine surgery for attempted dethetering, with a fluid collection in the posterior lumbar paraspinal soft tissues that measure up to 75 mm in length, which may represent cerebrospinal fluid leakage or seroma. In addition, there are persistent signs of tethered cord and suggestion of arachnoiditis involving the cauda equina.2. Thoracolumbar dextroscoliosis with fixation hardware in position. Discussed with Dr. Frim at 2:10 PM on 6/11/16.


Instruction: Generate impression based on findings.

Input: Secondary malignant neoplasm of brain [C79.31], Reason for Study: ^Reason: met NSCLC to brain s/p SRS to R frontal and L temporal lesions, WBRT most recently History: treatment planning for radiosurgery Multifocal enhancing intra axial lesions with surrounding edema indicate metastatic lesions are again seen including left posterior inferior temporal gyrus, anteromesial aspect of the left cerebellar hemisphere adjacent to the left IAC, left posterior cingulate gyrus, periventricular or ependymal surface or the left lateral ventricle occipital horn, right precentral gyrus, and right middle frontal gyrus. No change in number, size and location since prior scan. The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: Multifocal various sized intra axial enhancing lesions with surrounding edema as described above.The size, number and locations of these lesions do not show any interval change since prior scan.


Instruction: Generate impression based on findings.

Input: 49-year-old female with newly diagnosed triple negative IDC in the left breast. History of left breast IDC status post neoadjuvant chemotherapy and lumpectomy in 2013, followed by radiation therapy. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.There is an irregularly shaped enhancing mass at 11:00 position in the left breast, measuring 26 x 18 x 18 mm (AP x LR x CC). This is a proven cancer, and a marker clip is identified within this mass.Post surgical scar is seen in the left posterior upper inner quadrant and left axilla.Mild skin thickening of the left breast is likely due to prior radiation therapy.No abnormal enhancement is seen in right breast. No abnormal lymph nodes are identified in either axillary region.

Output: 1. Proven left breast cancer2. No MR evidence of malignancy in the right breast3. No abnormal lymph nodes in either axillary regionBIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Refractory multiple myeloma, now status post left hip hemiarthroplasty and L4 kyphoplasty. SKULL: Two views of the skull show numerous lytic lesions of various sizes compatible with multiple myeloma.CERVICAL SPINE: Two views of the cervical spine are provided. Evaluation of the cervical spine is limited due to the inability to optimally position the patient. The lower cervical spine is not well seen on the lateral view due to overlying anatomy. The C2 vertebra/dens is likewise not well seen which we suspect is artifact of suboptimal positioning, but we cannot exclude possibility of myelomatous involvement. This can be further evaluated with MRI if clinically warranted. There is mild multilevel facet joint osteoarthritis.THORACIC SPINE: Single view of the thoracic spine shows multiple compression fractures with near complete loss of height of the T9 vertebral body. The bones appear demineralized.LUMBAR SPINE: Two views of the lumbar spine show multiple compression fractures with cement in L4. Moderate to severe facet joint osteoarthritis affects the lower lumbar spine. The bones appear demineralized.RIBS: Rib radiographs show multiple healing/healed fractures presumably due to underlying myelomatous lesions. Note is made of multiple splenic granulomas and surgical clips in the right upper quadrant.PELVIS: Single view of the pelvis shows small poorly defined lucencies in the obturator rings which may represent myelomatous deposits but this is equivocal. The bones appear demineralized.UPPER EXTREMITY: Right humerus: Two views of the right humerus show poorly defined lucencies in the humerus which may represent myelomatous deposits. The bones appear demineralized.Left humerus: Two views of the left humerus show poorly defined lucencies in the humerus and distal clavicle which likely represent myelomatous deposits. The bones appear demineralized.Right forearm: One view of the right forearm shows poorly defined lucencies which may represent myeloma. The bones appear demineralized.Left forearm: One view of the left forearm shows poorly defined lucencies which may represent myeloma. The bones appear demineralized.LOWER EXTREMITY: Right femur: Two views of the right femur show several small lucent lesions consistent with multiple myeloma in the diaphysis. Moderate osteoarthritis affects the hip and knee.Left femur: Two views of the left femur show hardware components of a left total hip arthroplasty situated in near anatomic alignment. Skin staples are noted in the lateral soft tissues. Small lucent lesions in the distal diaphysis are consistent with multiple myeloma. Moderate to severe osteoarthritis affects the knee.Right tibia/fibula: One view is provided. Tiny scattered lucencies may represent multiple myeloma but this is equivocal. The bones appear demineralized.Left tibia/fibula: One view is provided. Tiny scattered lucencies may represent multiple myeloma but this is equivocal. The bones appear demineralized.

Output: Findings compatible with multiple myeloma as described above.


Instruction: Generate impression based on findings.

Input: Female, 54 years old, with history of neuromyelitis optica and worsening weakness and numbness. Follow-up exam. Cervical:The previously seen long segment cervical spinal cord signal abnormality and edema has significantly improved. Mild residual signal abnormality is evident within the left ventral cord at C2 and in the right lateral cord at C7. No areas of cord expansion are seen and cord volume is preserved.Spinal alignment is anatomic. Vertebral body heights are preserved. No concerning marrow signal abnormality is detected. The intervertebral discs demonstrate loss of height and there is disc osteophyte formation at all levels. Mild spinal canal stenosis is seen at C3-4, C4-5 and C5-6, without significant interval change. Moderate bilateral foraminal narrowing is seen at C4-5, with severe left and mild right foraminal narrowing at C5-6, unchanged. Thoracic:Minimal T2 signal abnormality is seen in the right lateral cord extending from T1 down to approximately T6. This was not clearly evident on prior examinations, though the finding is quite subtle and may not have been visualized previously due to differences in technique. No evidence of cord expansion or cord volume loss is seen.The thoracic kyphosis is mildly exaggerated but sagittal alignment is otherwise unremarkable. Vertebral body height and morphology are within normal limits. No concerning marrow replacement or marrow edema is observed. Minimal degenerative disc disease is seen with no significant spinal canal or foraminal stenosis.

Output: 1.Significant improvement in the severity of cervical spinal cord T2 hyperintensity when compared to prior examinations. Only two small areas of residual cord signal abnormality are demonstrated.2.Very mild T2 hyperintensity is seen within the right lateral cord in the thoracic spine as above. This finding was not clearly evident on prior examinations, though differences in MRI technique may contribute.


Instruction: Generate impression based on findings.

Input: 19-year-old female presents with right knee pain. MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: No focal articular cartilage defects are identified. Bone marrow signal intensity is normal. Note is made of a bone island in the lateral femoral condyle.LIGAMENTS: There is intermediate signal intensity on T1-weighted images with high signal intensity on T2-weighted images in the anterior cruciate ligament compatible with a tear, however, some fibers remain intact. The posterior cruciate ligament, medial collateral ligament, and lateral collateral ligament complex are intact.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: Findings compatible with a partial tear of the anterior cruciate ligament.


Instruction: Generate impression based on findings.

Input: Firm nodule in the left medial eyelid. There is a T1 and T2 hyperintense cystic lesion in the subcutaneous tissues of the medial left upper eyelid, which measures 7 mm in diameter. The orbital contents are otherwise unremarkable bilaterally. The imaged intracranial structures and paranasal sinuses are unremarkable.

Output: A cystic lesion in the subcutaneous tissues of the medial left upper eyelid, which measures 7 mm in diameter, likely represents a form of inclusion cyst.


Instruction: Generate impression based on findings.

Input: Breast cancer with diffuse bony metastasis, declining function and ability to walk. Left lower extremity weakness. There is diffuse osseous metastatic disease throughout the cervical, thoracic, and lumbar spine involving the anterior and posterior elements. Vertebral body heights are maintained. There is most likely epidural tumor at the L4 level dorsal to the vertebral body measuring up to 1 cm in thickness and is associated with mild spinal canal stenosis. There is otherwise no high-grade spinal canal stenosis in the cervical, thoracic, or lumbar spine. No evidence of acute cord compression or cauda equina compression. Alignment is maintained. No gross cord signal abnormality is evident. Mild degenerative changes are also evident including multilevel small disc osteophyte complexes and ligamentum flavum thickening in the cervical spine, but again without high-grade spinal canal stenosis.

Output: 1. Numerous osseous metastatic lesions throughout the spine without evidence of acute cord compression or cauda equina compression.2. Epidural tumor at the L4 level without high-grade spinal canal stenosis.3. This is a limited exam specific for the exclusion of cord compression only and does not exclude more subtle lesions such as intrinsic cord abnormalities. Due to the screening nature of this protocol details are not as evident on imaging as dedicated protocols of the spine.


Instruction: Generate impression based on findings.

Input: Female, 63 years old, with history of endometrial cancer presenting with right hand numbness and persistent leg pain. Evaluate for cord compression. Cervical:Spinal alignment is anatomic. Vertebral body heights are preserved. Degenerative endplate signal abnormality is seen primarily at C5-6 and C6-7. Otherwise, no pathologic marrow replacement is observed. The visualized spinal cord shows normal signal intensity and morphology. No epidural abnormalities are detected.C2-3: No spinal canal stenosis or neuroforaminal narrowing. C3-4: No spinal canal stenosis or neuroforaminal narrowing. C4-5: Facet arthropathy. Minimal posterior disc-osteophyte complex formation. No significant spinal canal or foraminal stenosis. C5-6: Loss of disc height with posterior disc-osteophyte complex formation. Mild spinal canal narrowing. Moderate right and mild left foraminal narrowing. C6-7: Loss of disc height with posterior disc-osteophyte complex formation. Moderate spinal canal narrowing without significant cord impingement. Mild bilateral foraminal narrowing. C7-T1: No spinal canal stenosis or neuroforaminal narrowing.  Thoracic:The thoracic kyphosis is slightly exaggerated but sagittal alignment is otherwise unremarkable. Vertebral body heights are preserved. No pathologic marrow replacement or edema is seen. Degenerative endplate signal alteration is noted in the mid thoracic levels. The visualized spinal cord shows normal signal intensity throughout. Slight cord deformation is evident at T7-8 and T8-9 due to disc degeneration. No epidural abnormalities are suspected.At T7-8, bilateral paracentral disc protrusions are seen which slightly indent the cord but which cause no significant generalized canal stenosis. The neural foramina are patent.At T8-9, a central disc protrusion mildly indents the ventral cord but causes no significant generalized spinal canal stenosis. The neural foramina are patent.Lumbar:Five fully lumbar type vertebral bodies are present with a transitional S1. Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. No areas of concerning marrow replacement or edema are seen. The distal spinal cord, conus and nerve roots of the cauda equina are within normal limits. No epidural abnormalities are detected.L1-2 and L2-3: The intervertebral discs are preserved with no significant spinal canal or foraminal compromise.L3-4: Facet arthropathy. Minimal disc bulge. No significant spinal canal stenosis. The neural foramina are mildly narrowed.L4-5: Facet arthropathy. Minimal disc bulging. No significant spinal canal or foraminal stenosis.L5-S1: Advanced facet arthropathy. No significant spinal canal or foraminal stenosis.

Output: 1.No findings are seen to suggest metastatic disease or cord compression.2.Multilevel degenerative findings are evident in the cervical region resulting in mild spinal canal narrowing at C5-6 and moderate spinal canal narrowing at C6-7. Scattered variable foraminal narrowing is also seen.3.Mild degenerative findings are seen in the thoracic region with slight cord impingement at T7-8 and T8-9 but no significant generalized canal stenoses.4.Minimal disc degeneration is seen in the lumbar region without significant spinal canal or foraminal compromise. However, advanced facet arthropathy is noted at L5-S1.


Instruction: Generate impression based on findings.

Input: 70-year-old male with neck pain and numbness in left arm Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. There is loss of normal cervical lordosis with minimal retrolisthesis of C4 and C5 and minimal anterolisthesis of C5 on C6. There is also mild anterolisthesis of C7 on T1. Alignment is maintained. Multilevel vertebral body endplate degenerative changes are noted.Focal signal abnormality within the spinal cord at C4/5 with volume loss.Degenerative changes are seen in the cervical spine as described below:C2-3: Small disk bulge without significant compromise to the spinal canal or neural foramina.C3-4: Disk osteophytes complex, bilateral uncovertebral hypertrophy and facet hypertrophy, resulting in mild spinal canal narrowing and severe bilateral neuroforaminal narrowing. C4-5: Disk osteophytes complex, bilateral uncovertebral hypertrophy and facet hypertrophy, resulting in severe left and moderate to severe right neuroforaminal narrowing. Moderate ligamentum flavum hypertrophy. There is moderate to severe spinal canal stenosis.C5-6: Disk osteophytes complex, bilateral uncovertebral hypertrophy, facet hypertrophy, and ligamentum flavum hypertrophy. Moderate to severe right and severe left neuroforaminal narrowing. Severe spinal canal stenosis.C6-7: Uncovertebral joint hypertrophy with moderate to severe right and moderate left neuroforaminal narrowing. No significant spinal canal stenosis.C7-T1: Uncovertebral hypertrophy and facet arthropathy, with moderate left and mild right neuroforaminal narrowing. No significant spinal canal narrowing. The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: Advanced degenerative changes with moderate to severe multilevel neuroforaminal narrowing and moderate to severe spinal canal stenosis as detailed above. At C4/5 there is focal cord signal abnormality consistent with myelomalacia.


Instruction: Generate impression based on findings.

Input: 57-year-old female with intraductal papilloma with ADH and columnar cell change in right breast lesion, status post terminal duct excision in November 2015 presents for bilateral diagnostic mammogram. Mammogram: Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density(BiRads Density Category B), unchanged in pattern and distribution. Multiple surgical clips identified in the right retroareolar region. An oval circumscribed benign morphology mass in the lower medial posterior right breast is increased since 2015, new from prior exams and persist on spot compression views. This most likely represents a proteinaceous cyst on MRI dated 2/17/2015No dominant mass, suspicious microcalcifications or areas of architectural distortion in either breast. Ultrasound: Targeted right lower inner quadrant ultrasound was performed. At 5:00 position there is a 8 x 4 mm circumscribed hypoechoic mass without peripheral blood flow most consistent with a simple cyst.

Output: Simple cyst in the right breast on mammogram and ultrasound. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: Stage IV non-small cell lung adenocarcinoma. There are numerous T1 hypointense lesions through the imaged axial skeleton. However, the vertebral body heights are preserved and there is no significant associated narrowing of the spinal canal. There is a background of high T1 signal in the lower thoracic spine bone marrow suggestive of prior radiation therapy effects. The spinal cord signal and morphology is unremarkable. There is degenerative spondylosis in the lumbar spine with small posterior disc bulges and facet hypertrophy with resultant moderate to severe neural foraminal stenosis at L5-S1 bilaterally. There is a left pleural effusion with consolidation in a portion of the left lung.

Output: 1. Numerous metastatic lesions involving the axial skeleton without evidence of associated significant spinal canal stenosis.2. Degenerative spondylosis in the lower lumber spine with moderate to severe neural foraminal stenosis at L5-S1 bilaterally.3. Left pleural effusion with consolidation in a portion of the left lung that likely corresponds to the lung adenocarcinoma. Please refer to the recent chest CT for additional details.


Instruction: Generate impression based on findings.

Input: Diagnosis: Other specified disorders of muscleClinical question: Evaluate for Disc diseaseSigns and Symptoms: Left arm and leg numbness and weakness and hyporeflexia MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.Incidental note is made of a developmental venous anomaly located in the left centrum semiovale.There is a punctate focus of signal hypointensity in the subcortical white matter of the right frontal lobe. In isolation this is probably of little clinical significance.The visualized portions of the paranasal sinuses demonstrate some mild mucosal thickening. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There is mild reversal of the normal cervical curvature present.. There is multilevel disc desiccation presentAt C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina. There is a small left lateral recess disc protrusion at this levelAt C4-5 there is no significant compromise to the spinal canal. There is a broad-based left lateral recess disc protrusion at this level which narrows the left neural foramenAt C5-6 there is no significant compromise to the spinal canal. There is a left lateral recess disc protrusion present at this level which encroaches on the left-sided exiting nerve roots within the neural foramen at this level. This is associated with uncovertebral osteophytes.At C6-7 there is no significant compromise to the spinal canal. There are uncovertebral osteophytes and a left lateral recess disc protrusion which encroaches on the left-sided exiting nerve roots at this level.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.There are left-sided lateral recess disc protrusions associated with uncovertebral osteophytes at C5-6 and C6-7 which encroach on the left-sided exiting nerve roots. To a lesser degree there is some narrowing of the left neural foramen.2.There is no evidence for cerebral infarction.3.There is a developmental venous anomaly in the left centrum semiovale. This is an incidental finding.


Instruction: Generate impression based on findings.

Input: 58 year old female with a suspicious lesion seen on mammogram and ultrasound at right 12:30 position. Additional suspicious lesion was seen on the breast MRI performed earlier today at right 12 o'clock position. Right ultrasound re-identified the target lesion (lesion #1) for biopsy. This is a hypoechoic mass measuring 10 x 8 mm at the 12:30 position with slightly vascularity, 5 cm from the nipple. The lesion was somewhat subtle.MR directed ultrasound was performed for the additional suspicious lesion seen on the MRI. Detected is an elongated intraductal lesion with increased vascularity measuring 14 x 3 mm at 12 o'clock position, 1 cm from the nipple (lesion #2). This lesion corresponds to the additional enhancing lesion on MRI.PROCEDURE: The procedure and its risks, including bleeding, infection, and failure to diagnose, and expected benefits of ultrasound-guided core biopsy with percutaneous placement of a marking clip and post-procedure unilateral mammogram were discussed with the patient. Questions were answered. Consent was obtained both verbally and in writing. The time-out form was completed to confirm patient identity and side/type of procedure.The right breast was cleansed with chlorhexidine. Transducer was sterilely sheathed. Biopsy for lesion #1 (12:30 position, 5-cm from nipple):Local anesthesia was obtained using 2% lidocaine superficially, with 1% lidocaine with 1:100,000 epinephrine at depth. A 3 mm incision was made in the skin with a #11 scalpel blade. Using aseptic technique, continuous ultrasound guidance and a mediolateral approach, three 14-gauge core needle (Inrad) specimens were obtained of the lesion. Targeting was judged very good. One specimen sank to the bottom of the prefilled container of 10% formalin. Two specimens partially sank. Specimen quality was judged very good. Using continuous ultrasound-guidance a Hydromark clip was placed into the lesion in the usual manner. Pressure was held over the biopsy site until all bleeding subsided. The skin incision was closed with a Steri-Strip. Biopsy for lesion #2 (12:00 position, 1-cm from nipple):Local anesthesia was obtained using 2% lidocaine superficially, with 1% lidocaine with 1:100,000 epinephrine at depth. A 3 mm incision was made in the skin with a #11 scalpel blade. Using aseptic technique, continuous ultrasound guidance and a mediolateral approach, three 14-gauge core needle (Inrad) specimens were obtained of the lesion. Targeting was judged very good. All specimens sank to the bottom of the prefilled container of 10% formalin. Specimen quality was judged very good. Using continuous ultrasound-guidance a Bard ribbon clip was placed into the lesion in the usual manner. Pressure was held over the biopsy site until all bleeding subsided. The skin incision was closed with a Steri-Strip. Specimens were sent to Pathology with an accompanying history sheet. Post-procedure digital right CC and ML views revealed the percutaneously placed Hydromark clip to be at the peripheral superior aspect of the lesion and the ribbon clip to be at expected location at anterior 12 o'clock position. No evidence of hematoma or other complication.A pressure dressing was positioned over the biopsy site and an ice pack positioned over the pressure dressing. Post-procedure instructions were reviewed with the patient both verbally and in writing. She tolerated the procedure well with no evident complications and left the Breast Imaging Department in stable condition.The procedure was performed by Dr. Abe.

Output: Successful ultrasound-guided core biopsy of the right breast lesion (2 sites) and clip placement. Pathology is pending at this time.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Female 61 years old Reason: alcoholic cirrhosis, please evaluate for HCC. Non-infused images completed yesterday History: As above ABDOMEN:LIVER, BILIARY TRACT: Liver has a cirrhotic morphology with extensive T2 reticular changes compatible with fibrosis.No focal hypervascular lesion is evident. Hepatic and portal veins are patent.Gallbladder contains innumerable small stones.SPLEEN: Spleen is enlarged.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No retroperitoneal lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: There is upper abdominal ascites. There is moderate esophageal and paraesophageal varices.

Output: 1.Cirrhotic liver without suspicious hepatic lesion.2.Sequelae of portal hypertension including gastroesophageal varices, ascites and splenomegaly.3.Routine follow-up is recommended.


Instruction: Generate impression based on findings.

Input: Dizziness and giddiness [R42], Reason for Study: ^Reason: vertigo, history of CVA, please eval History: vertigo, history of CVA, please eval There is no evidence of acute ischemic or hemorrhagic lesion.There are multifocal tissue losses involving bilateral basal ganglia and thalami indicating chronic lacunar infarctions.Multifocal patchy scattered high signal intensity lesions on bilateral periventricular white matter and centrum semiovale indicate non specific small vessel ischemic disease. Unchanged since prior scan.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear.Mucosal thickenings on bilateral maxillary sinuses and a retention cyst in the right maxillary sinus.

Output: No evidence of acute ischemic or hemorrhagic lesion.Mild to moderate non specific small vessel ischemic disease, no change since prior scan.


Instruction: Generate impression based on findings.

Input: Male, 14 years old. Abdominal pain and EGD significant for gastritis and duodenitis, concerning for potential Crohns diseaseEXAMINATION: MR enterography without and with IV contrast 07/14/2016, 1240 hrs. ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesions. No intrahepatic or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: The kidneys enhance symmetrically, without focal lesion or hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No abnormal bowel wall thickening, abnormal enhancement, or dysmotility. No surrounding inflammatory changes about the bowel. The cecum is somewhat capacious and debris-filled.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: As aboveBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: No evidence of bowel inflammation, abnormal motility, or other acute abnormality.


Instruction: Generate impression based on findings.

Input: Altered mental status, unspecified [R41.82], Reason for Study: ^Reason: Concern for intracranial change compared to prior MRI History: Altered mental status No evidence of acute ischemic or hemorrhagic lesion.Postsurgical changes from prior frontal craniotomy are seen (including bifrontal encephalomalacia, hemosiderin deposition around interhemispheric fissure and frontal small extra-axial fluid collections), unchanged since prior scan.Subtle increased FLAIR high signal intensities on the right middle cerebellar peduncle and right cerebellum are again seen, unchanged.The ventricles, sulci and cisterns are unremarkable. 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. Postoperative changes related to prior frontal craniotomy for tumor removal are again seen, unchanged since prior scan.


Instruction: Generate impression based on findings.

Input: Right trigeminal neuralgia evaluate for demyelination or vascular compression. A venous structure appears to impress upon the inferior aspect of the root entry zone of the right trigeminal nerve, while the posterior cerebral artery abuts the superior aspect of the root entry zone of the right trigeminal nerve. 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 orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. A venous structure appears to impress upon the inferior aspect of the root entry zone of the right trigeminal nerve, while the posterior cerebral artery abuts the superior aspect of the root entry zone of the right trigeminal nerve, which may represent a vascular loop syndrome. 2. No evidence of demyelinating or mass lesions.


Instruction: Generate impression based on findings.

Input: 45-year-old female with persistent leukocytosis and abdominal pain This study is limited due to lack of IV contrast.ABDOMEN:LUNG BASES: Bilateral small pleural effusions. Cardiomegaly. Dependent atelectasis in the left lung base. Trace pericardial effusion.LIVER, BILIARY TRACT: Nonspecific 1 cm hypodense lesion in the right lobe of the liver on image number 36 on series number 3. SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral mild calyectasis. This is likely secondary to distended bladderRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: There is a large lobulated mass arising from the pelvis and extending superiorly to the level of the kidneys. The mass is heterogeneous and measures 27 by 15 cm. This represent a large leiomyomatous uterus, however, possibility of an ovarian carcinoma cannot be entirely excluded with this noncontrast CT. Further evaluation with MRI is recommended.BLADDER: Bladder is displaced to the left and superiorly by the mass. Bladder is also distended. The mass likely causes bladder outlet obstruction.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Bilateral IVC filter is in the common iliac veins.

Output: Large pelvic mass extending superiorly to the level of the kidneys. This likely represents leiomyomatous uterus versus ovarian carcinoma. Further evaluation with pelvic MRI is recommended.Bladder obstruction and bilateral mild calyectasis.Cardiomegaly and bilateral small pleural effusions.


Instruction: Generate impression based on findings.

Input: Evaluate for stenosis. Low back pain. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is grade 1 retrolisthesis at L5-S1, unchanged from prior. Alignment is otherwise within normal limits. Bone marrow signal is benign. There is mild disc desiccation at L4-5 and L5-S1, unchanged. The conus medullaris is normal in position terminating at L1-2. There is fibrofatty infiltration of the filum, which measures less than 2 mm, unchanged from prior study and of doubtful clinical significance. There is congenital narrowing of the spinal canal particularly inferiorly. Multilevel degenerative changes are seen, as described below:L1-L2: There is no spinal canal or neural foraminal stenosis.L2-L3: There is minimal disc bulge. There is no spinal canal or neural foraminal stenosis.L3-L4: There is a mild broad-based disc bulge, with mild narrowing of the spinal canal. There is no neural foraminal stenosis.L4-L5: There is mild disc bulge, epidural lipomatosis, facet arthropathy and congenital narrowing resulting in moderate narrowing of the thecal sac. There is mild bilateral neuroforaminal stenosis, left greater than right.L5-S1: There is prominent epidural fat. There is mild spinal canal stenosis with associated disc bulge. There is mild bilateral neuroforaminal stenosis.Paraspinous soft tissues are within normal limits.

Output: 1.No significant change in degenerative changes compared to 12/17/2014 with moderate spinal canal stenosis at L4-L5 and to a slightly lesser degree at L5-S1 related to combination of mild disc bulge, epidural lipomatosis, and congenital narrowing of the spinal canal. 2.Unchanged disc desiccation at L4-5 and L5-S1 and mild facet arthropathy.3.Grade 1 retrolisthesis at L5-S1, unchanged from prior.4.Fatty filum terminale incidentally noted measuring less than 2 mm and of doubtful clinical significance. Conus is in normal position without finding to suggest tethered cord.


Instruction: Generate impression based on findings.

Input: Migraine without aura. 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.

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


Instruction: Generate impression based on findings.

Input: Status post resection of skull based meningioma on 4/8/14. There are postoperative findings related to right pterional craniotomy for resection of a planum sphenoidal tumor. There is a small amount of persistent residual dural enhancement in the right paraclinoid region. There is no evidence of intracranial hemorrhage or acute infarct. There are a few scattered nonspecific foci of cerebral white matter T2 hyperintensity. The ventricles are unchanged in size and configuration. There is no midline shift or herniation. The orbital contents are unremarkable.

Output: Postoperative findings with what may appears to be approximately unchanged small amounts of residual tumor in the right paraclinoid region.


Instruction: Generate impression based on findings.

Input: History of prostate cancer treated with RT, now with rising PSA, prostate biopsy negative. This study is limited the to patient's inability to complete the study at one session and lack of intravenous contrast.PELVIS:PROSTATE:Prostate Size: 4.6 by 3.2 by 3.3-cm.Peripheral Zone: Prostate gland is atrophic due to radiation therapy. There are multiple radiotherapy seeds throughout the prostate. In the right basal the prostate there is a 1.3 x 1.1 cm hypointense mass involving both the right transition zone and peripheral zone anteriorly.Central Gland: Hypointense focus involving the right transition zone near the base as described above.Seminal Vesicles: Unremarkable.Extracapsular Extension: Not seen.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Changes secondary to radiation therapy. Right anterior basal lesion involving the peripheral and transition zones compatible with prostate cancer.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 male experiencing groin pain, history of L3 compression fracture as well as lipomyelomeningocele. Redemonstrated is a severe compression fracture involving the L3 vertebral body with near complete height loss involving the anterior mid aspect of the vertebral body similar to prior, without residual marrow edema. As before, there is evidence of cement augmentation at the L3 vertebral body is again seen. Enhancement within the disc spaces above and below this compression deformity is felt to be reactive as there is no disc fluid. There is no pathologic enhancement elsewhere.Remainder of the vertebral body heights are normal. Alignment is grossly maintained in the lumbar spine. There are diminished posterior osseous elements from L3-L4 to the sacrum reflecting combination of prior laminectomies and dysplasia, stable in appearance.Abnormal T2 signal likely reflecting myelomalacia in the spinal cord at the L2-L3 level again seen, which is unchanged. The spinal cord remains low-lying with the distal neural tissue/conus extending to the L5 level. Septations/adhesions are again again noted in the thecal sac from the L5 to S1 levels similar to prior. Lipoma within the thecal sac at the right lateral S1 level is again seen as well as along the distal aspect of the filum in the midline at the S2 level. These findings are stable in appearance.Degenerative changes are specified by the intervertebral level as follows and unchanged since 3/31/2016:T12-L1: No spinal canal or neural foraminal stenosis, unchanged.L1-L2: There is bilateral facet hypertrophy and ligamentum flavum thickening. There is minimal disc bulge. There is unchanged mild central canal stenosis and bilateral mild to moderate neural foraminal stenosis. These findings are unchanged, and are best visualized on sagittal T2 technique.L2-L3: There is bilateral facet hypertrophy and ligamentum flavum thickening. There is diffuse disc bulge with central protrusion component resulting in moderate to severe spinal canal stenosis and moderate bilateral foraminal stenosis. These findings are unchanged.L3-L4: There is bilateral facet hypertrophy and ligamentum flavum thickening. There is also mild disc bulge with unchanged mild to moderate spinal canal stenosis and mild to moderate bilateral foraminal stenosis. These findings are unchanged.L4-L5: There is bilateral facet hypertrophy. There is central disc protrusion. No significant spinal canal stenosis. There is unchanged mild bilateral foraminal narrowing, relatively worse on the left. These findings are unchanged.L5-S1: There is bilateral facet hypertrophy without neuroforaminal narrowing or spinal stenosis, unchanged.Bridging marginal osteophytes as well as joint space fusion is noted involving the sacroiliac joints (right greater left), unchanged in appearance.Fatty atrophy involving the paraspinous musculature again seen, which is predominantly on the right. Left renal cysts again seen.

Output: 1.No significant change in moderate to severe spinal canal stenosis at the L2-L3 level. Unchanged T2 hyperintensity within the cord and volume loss at the this level consistent with myelomalacia.2.Severe chronic compression fracture of the L3 vertebral body with evidence of cement augmentation is unchanged in appearance. Enhancement within the disc spaces above and below this compression deformity is felt to be reactive as there is no disc fluid.3.Unchanged appearance of the low-lying conus which extends to the L5 level with adhesions within the distal thecal sac as well as residual lipoma involving the right lateral aspect of the thecal sac at the S1 level and to a minimal degree along the distal filum terminale at the S2 level. Re-tethering can be considered in the appropriate clinical setting. 4.Degenerative changes at additional levels as detailed above which are unchanged.


Instruction: Generate impression based on findings.

Input: 38 years, Female, epilepsy since age 18 and history of headache. Brain parenchyma appears within normal limits. No appreciable cortical abnormalities or evidence of gray matter heterotopia. The 3-D T1 sequence is motion degraded. No intracranial mass or mass-effect. No diffusion abnormality. No intracranial hemorrhage. The ventricles are within normal limits in size and configuration. Bilateral hippocampi demonstrate normal signal characteristics, preserved internal architecture, and are symmetric in size. Paranasal sinuses and mastoid cells are clear. Calvarium and remainder of the extracranial soft tissues are grossly unremarkable.

Output: Brain MRI appears within normal limits. No intracranial mass or other structural lesion to suggest seizure focus is appreciated.


Instruction: Generate impression based on findings.

Input: 50-year-old female with shoulder pain. ROTATOR CUFF: There is a full-thickness insertional tear of the supraspinatus with minimal retraction measuring approximately 13 mm in the AP dimension. There is mild edema extending along the superficial fibers of the supraspinatus muscle suggesting that this may represent an acute tear. There is also thickening and increased signal intensity within the remainder of the supraspinatus tendon indicating moderate tendinosis. There are subchondral cysts within the underlying greater tuberosity. There is minimal fatty infiltration along the myotendinous junction. There is thickening and increased signal intensity within the infraspinatus indicating moderate tendinosis, but we see no discrete tear. There is minimal fatty infiltration along the myotendinous junction, otherwise the infraspinatus muscle appears normal. There may be a couple of tiny interstitial tears of the distal subscapularis tendon, but otherwise the subscapularis muscle and tendon appear normal. The teres minor muscle and tendon appear intact.SUPRASPINATUS OUTLET: Moderate osteoarthritis affects the acromioclavicular joint with osteophytes that result in mild impression upon the superior fibers of the supraspinatus. There is a small amount of fluid within the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is within normal limits. Minimal osteoarthritis affects the glenohumeral joint. There is a small amount of fluid within the joint with no frank effusion.BICEPS TENDON: There is increased signal intensity within the tendon of the long head of the biceps as it enters the bicipital groove from the rotator interval suggestive of a partial thickness tear, although this may be of no current clinical significance as there is minimal, if any, fluid within the tendon sheath. ADDITIONAL

Output: 1. Full-thickness but minimally retracted tear of the supraspinatus with additional rotator cuff tendinosis as described above.2. Moderate osteoarthritis of the acromioclavicular joint.3. Findings suggesting a partial thickness tear of the long head of the biceps tendon, although this may not be of any current clinical significance.


Instruction: Generate impression based on findings.

Input: 70 years, Female, Reason: evaluate for ?subacute ischemia, change in SDH or meningioma History: AMS. MR BRAIN: Since the prior brain MRI from 5/20/2016, there has been development of area of T2/FLAIR hyperintensity involving the left occipital lobe. There is T1 shortening with susceptibility effect and enhancement in this region. Findings are most compatible with a hemorrhagic infarct in the left PCA territory. There is no evidence of acute infarct. Again seen is a small subdural collection along the left frontal convexity which is decreased in size from approximately 14 mm to 5 mm; residual subdural collection demonstrates no significant mass effect.Again seen is evidence of multiple prior bilateral craniotomies. There are extra-axial enhancing masses along the frontal convexities bilaterally consistent with meningiomas. The posterior high right frontal convexity mass measures 23 x 26 x 21 mm which is unchanged. The anterior left frontal convexity mass measures 22 x 20 x 17 mm which is also unchanged allowing for slight differences in measurement technique. Both of these masses are invading the superior sagittal sinus. Mild nodularity elsewhere along the left convexity is also related to small meningiomas and unchanged. More diffuse dural enhancement and thickening also not significantly changed.There is plaque-like dural thickening along the left pterion measuring 8 to 9 mm in thickness likely representing en plaque meningioma. Similar en plaque meningioma is evident along the right inferior cerebellar hemisphere measuring 6 mm in thickness and also similar to prior. There is feathery enhancement in this region which may be reflective parenchymal invasion and/or postradiation change. The right cerebellum is atrophic and demonstrates increased T2 signal as before which may reflect posttreatment change. Hemosiderin staining associated with right frontal lobe encephalomalacia again noted. There is also a small area of encephalomalacia with susceptibility involving the right temporal lobe. Small left basal ganglia infarct with chronic hemorrhage also noted. Additional small cortical infarct is noted involving the left postcentral gyrus. There are multiple foci of susceptibility compatible with chronic microhemorrhage throughout the brain as before. A rounded 7 mm lesion with susceptibility in the right inferior frontal lobe is also unchanged and may represent a cavernous malformation. No midline shift or herniation. There is ex vacuo dilatation of the frontal horns related to encephalomalacia. No hydrocephalus. Unchanged empty sella which may be postsurgical.MR venogram: There is invasion with occlusion of the anterior and mid aspects of the superior sagittal sinus by the bilateral frontal meningiomas. The posterior superior sagittal sinus remains patent as does the remainder of the venous system.

Output: 1. Compared to 5/20/2016, there has been development of a hemorrhagic infarct in the left occipital lobe which appears subacute.2. Left sided subdural collection has decreased in size.3. No significant change in multiple meningiomas.4. Multiple foci of chronic hemorrhage in the brain, some of which are related to areas of encephalomalacia and may reflect prior hemorrhagic infarcts and/or postsurgical change. Multiple parenchymal microhemorrhages may also be related to prior radiation. Unchanged relatively larger 7 mm inferior frontal hemorrhagic lesion which may represent a cavernous malformation, possibly also related to remote radiation if there is such history.5. MR venogram demonstrates invasion and occlusion of the anterior and middle thirds of the superior sagittal sinus. The posterior aspect of the superior sagittal sinus and remainder of the major venous system remains patent.


Instruction: Generate impression based on findings.

Input: 37-year-old status post right mastectomy for right breast cancer in 08/2014, presents for follow up MRI of the left breast enhancement. Status post right mastectomy.There is extreme amount of fibroglandular tissue in left breast.Mild parenchymal enhancement is noted in the left breast.No abnormal enhancement is seen in left breast or right mastectomy bed. The enhancing area in the left posterior 3:00 position seen on the prior MRI must be a part of parenchymal enhancement. No abnormal lymph nodes are identified in either axillary region.Port-A-Cath is present within the left upper medial chest wall.

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


Instruction: Generate impression based on findings.

Input: 56-year-old male with back pain. Evaluate T12-L1 disc herniation. At T12-1, there is a disc herniation eccentric to the right with mild to moderate neural foraminal narrowing, but no significant spinal canal stenosis. The patient is status post left-sided hemilaminectomy at L5. At L5-S1, there is loss of disc space height, disc desiccation, and disc bulge associated with bilateral neural foraminal narrowing, moderate on the right and severe on the left. There is effacement of the left lateral recess. There is no significant compromise to spinal canal. At L4-5, there is loss of disk space height, disk bulge, disk desiccation and ligamentum flavum hypertrophy with apparent impingement of nerve roots in the left lateral recess and mild neural foraminal narrowing bilaterally. At L1-4, there is no significant narrowing of the spinal canal or neural foramina. The vertebral column alignment is within normal limits. The imaged portions of the spinal cord are unremarkable. There are incompletely characterized bilateral renal T2 hyperintense lesions, which likely represent cysts.

Output: 1. A disc herniation eccentric to the right at T12-L1 results in mild to moderate neural foraminal narrowing.2. Postsurgical findings and persistent degenerative spondylosis in the lower lumbar spine, most pronounced at L5-S1.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 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, and scalp soft tissues are grossly unremarkable. There is a small left maxillary sinus retention cyst.

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


Instruction: Generate impression based on findings.

Input: Partially imaged on the sagittal scout sequence is unchanged mildly low-lying cerebellar tonsils extending 3 mm below the foramen magnum with a slightly pointed morphology. There is also mild retroflexion of the dens. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology with the conus terminating at T12-L1. There is no evidence of spinal mass or abnormal enhancement. The paravertebral soft tissues are unremarkable.

Output: 1.No evidence of thoracic or lumbar spine abnormality. 2.Partially imaged, unchanged, foramen magnum crowding secondary to dens retroflexion, and mildly low lying cerebellar tonsils that have a slightly pointed morphology.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for structural lesions. Signs and symptoms: Worsening headaches. Nonenhanced brain MRI:Negative diffusion weighted series.Flair and T2 weighted images demonstrate few tiny foci of hyperintensity in the subcortical and periventricular white matter of cerebral hemispheres, tiny foci in the left external capsule which are nonspecific however in proper clinical setting they could represent mild chronic small vessel ischemic strokes. No prior exams available for comparison. There is also very mild prominence of vermian folia for age. The cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination is otherwise unremarkable.The signal void of major intracranial arterial branches are identified.The signal intensity of intracranial venous sinuses is within normal.Paranasal sinuses and bilateral mastoid air cells and middle ear cavities are well pneumatized. Unremarkable images through the orbits.

Output: 1.No acute intracranial process.2.Findings suggestive of mild chronic nonhemorrhagic small vessel ischemic strokes as detailed.3.Unremarkable exam otherwise.4.Paranasal sinuses and bilateral mastoid air cells and middle ear cavities remain well pneumatized.


Instruction: Generate impression based on findings.

Input: 21 year old w/ history of myxopapillary ependymoma status post radiation therapy; history of cavernous malformations Redemonstrated are innumerable punctate foci of susceptibility throughout the brain which are not appreciably changed since prior brain. No enlarging lesions are present. No new edema or acute or subacute blood products to suggest new hemorrhage. Prominent hemosiderin staining involving the left precuneus is again seen related to prior hematoma. No evidence of acute infarct. A few nonspecific scattered punctate foci of FLAIR hyperintensity are again seen. No abnormal enhancement. No intracranial mass effect, midline shift, or herniation. Ventricles are normal in size. Visualized calvarium and extracranial soft tissues are grossly unremarkable.

Output: Innumerable foci of susceptibility effect throughout the brain likely related to microhemorrhages from radiation therapy as well as a larger area of hemosiderin deposition in the left precuneus appear similar to prior examination.


Instruction: Generate impression based on findings.

Input: 50 year-old female with pancreatic cancer on chemotherapy (gemcitabine). Additional history reveals patient is status post Whipple and radiation treatment. Please evaluate disease status. CHEST:LUNGS AND PLEURA: Bilateral pleural effusions with compressive atelectasis. Mild emphysema. No lung nodules identified.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Right-sided Port-A-Cath tip is in the SVC. No evidence of osseous metastatic disease. Bilateral thyroid nodules.ABDOMEN:LIVER, BILIARY TRACT: The liver is diffusely low-attenuation, due to fatty infiltration. In the posterior inferior right lobe of the liver the hypervascular lesion is grossly stable in size, measuring 2.4 x 1.9 cm (image 94/11 of series 4). This avid enhancement is unusual for a adenocarcinoma metastasis to the liver; however, enhancement on this study may appear exaggerated given the degree of fatty infiltration. The adjacent lesion in the lateral aspect of the liver is also grossly stable in size, currently measuring 1.1 x 0.8 cm (image 96/211 of series 4). This hypodense lesion in the left lobe liver near the falciform ligament is unchanged and had characteristics of a simple cyst on the patient's recent MRI. Attenuation differences within the liver elsewhere are likely due to transient differences due to phase of enhancement.There is a subcapsular fluid collection anterior to the right lobe of the liver. This measures 4.0 x 1.9 cm (image 68/211 series number 4).Extensive postsurgical changes are identified in the porta hepatis. There is fluid attenuation throughout the porta hepatis which may be postsurgical in etiology. Extrahepatic portal vein occlusion noted. Numerous varices are identified throughout the abdomen.SPLEEN: Stable mild splenomegaly. The splenic vein appears to drain inferiorly into the inferior mesenteric vein and there are splenic vein collaterals.PANCREAS: Patient status post Whipple with pancreatic head removal.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: The azygos and hemiazygos systems are dilated due to collateral blood flow.BOWEL, MESENTERY: Multiple collateral vessels are identified in the lack of flow through the portal vein. Diffuse ascites. There is diffuse infiltration of the mesentery as well as multiple soft tissue nodules which may be due to ascites. BONES, SOFT TISSUES: No significant abnormality noted. The osseous abnormalities identified on the patient's recent MRI are not seen on this exam.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The well-defined lesion identified medially to the right of the rectum measures 2.0 x 1.4 cm (image 29/211). This has peripheral calcification. Diffuse ascites.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Gross stability of the two enhancing lesions in the right lobe of the liver. While the hypervascularity of these lesions is unusual for pancreatic adenocarcinoma, enhancement may be exaggerated given the degree of fatty infiltration throughout the remainder of the liver. Both should be followed to confirm stability.2. Multiple collateral vessels and ascites likely secondary to portal vein occlusion.


Instruction: Generate impression based on findings.

Input: There are unchanged multiple foci of T2 hyperintensity within the supratentorial white matter. There multiple unchanged foci susceptibility effect throughout the cerebral and cerebellar hemispheres, mostly likely secondary to radiotherapy. There is minimal unchanged punctate enhancement within the previously treated left precentral gyrus lesion. There is otherwise no appreciable corresponding abnormal enhancement . There is no evidence of acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are grossly intact. The skull, paranasal sinuses, and scalp soft tissues are unremarkable.

Output: No significant change in the post-radiotherapy appearance of the brain, including treated brain metastases.


Instruction: Generate impression based on findings.

Input: Bilateral upper extremity weakness. Additional patient history includes Chiari malformation, treated surgically in 1997. Many of the images are degraded by motion. Postoperative changes related to suboccipital craniectomy and posterior C1 arch resection is redemonstrated. The cerebellar tonsils are stable in morphology and again extend down to the level of C1, consistent with patient's Chiari I malformation. The cervical vertebral bodies are appropriate in height. Alignment is maintained. Anterior flowing osteophytes are present throughout the cervical spine, compatible with DISH and most prominent at C3-C4 with bulging into the aerodigestive tract. There are mild vertebral body endplate degenerative changes throughout the cervical spine. Bone marrow signal is otherwise within normal limits. The cervical spinal cord has normal signal characteristics and overall morphology.Mild developmental narrowing of the spinal canal is again noted. Superimposed degenerative changes include small disc osteophyte complexes and uncovertebral hypertrophy with stenoses as described below:C2-3: Mild right neural foraminal stenosis. No significant spinal canal or left neural foraminal stenosis.C3-4: Mild bilateral neural foraminal stenosis. No significant spinal canal stenosis.C4-5: Mild to moderate right and mild left neural foraminal stenosis. No significant spinal canal stenosis.C5-6: Moderate to severe bilateral neural foraminal stenosis. No significant spinal canal stenosis.C6-7: Mild right neural foraminal stenosis. No significant spinal canal or left neural foraminal stenosis.C7-T1: Mild spinal canal narrowing and minimal bilateral neural foraminal stenosis.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: 1. No cord signal abnormality or high-grade spinal canal stenosis at any level. Multilevel degenerative changes as detailed above are not significantly changed since prior MRI from 6/19/2012. 2. Postsurgical changes of Chiari decompression with unchanged position and configuration of the low-lying cerebellar tonsils.


Instruction: Generate impression based on findings.

Input: Male 63 years old Reason: fall History: swelling There is a large joint effusion as well as moderate osteoarthritis. There is a curvilinear focus of increased density within the weight-bearing portion of the medial femoral condyle which may be degenerative but could conceivably represent a nondisplaced subchondral fracture in the correct clinical context. If further imaging evaluation is clinically warranted, MRI may be considered.

Output: 1. Large joint effusion. 2. Curvilinear focus of increased density within the weight-bearing portion of the medial femoral condyle is nonspecific but could conceivably represent a nondisplaced subchondral fracture in the correct clinical context. If further imaging evaluation is clinically warranted, MRI may be considered.


Instruction: Generate impression based on findings.

Input: 23-year-old female with history of Crohn's disease status post small bowel resection with primary anastomosis now off Crohn's medications who presents with abdominal pain, nausea, and vomiting. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Portions of the proximal small bowel are incompletely distended and suboptimally evaluated. The bowel is normal in caliber without evidence of high-grade obstruction. Postsurgical changes of neoterminal ileum anastomosis are present. No evidence of hyperemic, thickened mucosa. No mesenteric fat stranding. No free or loculated intraperitoneal fluid.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Portions of the proximal small bowel are incompletely distended and suboptimally evaluated. The bowel is normal in caliber without evidence of high-grade obstruction. Postsurgical changes of neoterminal ileum anastomosis are present. No evidence of hyperemic, thickened mucosa. No mesenteric fat stranding. No free or loculated intraperitoneal fluid.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Expected postsurgical changes. No specific evidence of active Crohn's disease.


Instruction: Generate impression based on findings.

Input: Medial left elbow pain Tendons: The common extensor tendon origin is intact. The common flexor tendon origin is intact. The triceps tendon insertion is intact. The biceps tendon is not completely visualized upon its insertion on the radial tuberosity but the visualized portion is intact. Ligaments: There is tearing of the ulnar collateral ligament with mild contrast extravasation into the medial gutter. The lateral ulnar collateral ligament is intact. The radial collateral ligament is intact.Joints: The bone marrow signal is normal. There is no dislocation. The articular cartilage is intact. There is no osteochondral defect.Muscles: The muscles about the elbow are normal in caliber and signal.

Output: Tear of the ulnar collateral ligament. Remaining internal structures of the elbow are otherwise intact.


Instruction: Generate impression based on findings.

Input: History of HCC treated with radiofrequency ablation x 2. Study is slightly limited by patient's body habitus and inability to place arms above the head.ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology with findings of segment V/VIII focal confluent fibrosis. Stigmata of portal hypertension including splenomegaly, gastroesophageal varices and recannulized periumbilical vein.The liver parenchyma demonstrates loss of signal on in phase imaging compatible with iron deposition.In segment 3, inferior lateral segment of the left hepatic lobe there is a 2.7 x 1.7 cm postablation halo (series 9/41) which is intrinsically T1 hyperintense. No residual arterial enhancing lesion is evident.Several scattered arterial enhancing foci become isointense on the delayed imaging likely representing perfusional anomalies.No new suspicious arterially enhancing lesion demonstrating washout.Segment 7 and segment 8 simple cyst.The hepatic vessels appear patent. Portal vein enlargement compatible portal hypertension.Cholelithiasis within a normally distended gallbladder. No biliary ductal dilatation.SPLEEN: Marked splenomegaly with the spleen measuring 22 cm in craniocaudal dimension. Splenic hilar collateral vessels. PANCREAS: Multiple T2 hyperintense lesions within the pancreas most of which appear to communicate with the main pancreatic duct and likely represent side branch IPMNs. The main pancreatic duct is normal in caliber. The largest lesion is in the pancreatic body/tail measuring 1.6 x 1.1 cm (series 5/17), not significantly increased in size. No suspicious enhancing imaging features. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small right renal exophytic simple cyst. No hydronephrosisRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small right pleural effusion with compressive atelectasis. Rate recanalized periumbilical vein.

Output: Interval re-ablation of the segment 3 hepatic lesion without evidence of residual or recurrent disease. No new suspicious lesion. Cirrhosis with portal hypertension. Small right pleural effusion.


Instruction: Generate impression based on findings.

Input: 72-year-old woman with history of urothelial cancer, new liver lesion on recent CT. ABDOMEN:LIVER, BILIARY TRACT: In segment 8 of the liver (1101/29) there is a 21 x 18 mm lobular, T2 hyperintense lesion which demonstrates nodular, progressive enhancement through the perfusion sequences. On the delayed phase (1205/254), this lesion is homogenous in appearance and isointense to the blood pool. The liver is otherwise normal in signal and morphology.The gallbladder appears normal. There is no intra or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Patient is status post left nephrectomy. Subcentimeter right renal cysts noted.RETROPERITONEUM, LYMPH NODES: Multiple enlarged retroperitoneal lymph nodes are noted (1205/169), characterized on recent CT. BOWEL, MESENTERY: Enhancing soft tissue is seen predominantly in the left upper quadrant mesentery. A previously described serosal T2 hyperintense lesion along the greater curvature of the stomach (1101/23) does not have definite imaging characteristics for metastasis. For reference purposes, peritoneal disease in the left lower abdomen (1204/48) measures 31 x 30 mm. Partially visualized small bowel and colon appear normal.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Mildly enlarged cardiophrenic lymph node noted.

Output: 1.Liver lesion compatible with hemangioma.2.Retroperitoneal lymphadenopathy and peritoneal carcinomatosis as seen on recent CT.


Instruction: Generate impression based on findings.

Input: Corresponding to the area of abnormal signal predominantly in the L4 vertebral body posteriorly extending into the left pedicle, there is prominent stippled enhancement. More ill-defined enhancement also involves the superior endplate of L5 on the left, also extending into the left pedicle. There is severe disk space narrowing at this level with enhancement within the posterior disk space on the left side, as well as along the left facet. No definite associated paravertebral or epidural soft tissue mass is identified. Concurrent left hip MRI images demonstrate mild ill-defined T2 hyperintensity and enhancement extending into the left paraspinal soft tissues. No other areas of abnormal enhancement are seen.Correlation with previous PET/CT demonstrates a prominent sclerotic area involving this portion of the L4 vertebral body with extra vertebral bone formation extending along the left anterolateral aspect. There is a small focal lucency along the very left lateral aspect of the posterior L4 vertebral body. Severe bilateral facet arthropathy is noted at L4-L5. There is also a prominent left lateral osteophyte at L5-S1. Review of the outside PET/CT images demonstrates and oval area of increased uptake along the left L5 level, although not beyond the confines of the vertebral body.There is redemonstration of a large nonenhancing partially visualized cyst off the lower pole the left kidney. There are additional partially exophytic lesions of both kidneys, some of which demonstrate intrinsic T1 hyperintensity suggestive of blood products, especially as there is some layering.

Output: Corresponding enhancement involving the left posterior L4 vertebral body and to a lesser degree the left L5 superior endplate extending into the left pedicles, in areas of previously noted abnormal signal. Given severe degenerative changes and lack of epidural/paravertebral soft tissue, findings are more favored to represent severe degenerative changes with adjacent reactive changes rather than metastatic disease or infection. However, outside PET/CT demonstrates a small area of corresponding increased uptake along the left L5 vertebral body in addition to corresponding significant sclerosis and osteophyte formation. Biopsy is recommended for further evaluation, to exclude metastatic involvement. Bone scan could also be considered to evaluate for other osseous metastatic disease.


Instruction: Generate impression based on findings.

Input: NMO: weakness in legs. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are a few punctate foci of white matter T2 hyperintensity in the bilateral frontal lobes. 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 and scalp soft tissues are grossly unremarkable. There is mild scattered paranasal sinus mucosal thickening.Orbits: There is diffuse volume loss of the left orbital segment of the left optic nerve with associated high T2 signal. The right optic nerve appears to be unremarkable. The globes, extraocular muscles, lacrimal glands, and orbital fat also appear to be intact bilaterally. There is no evidence of intraorbital mass lesions.Spine: There has been marked interval decrease in the degree of upper spinal cord edema with residual patchy high T2 signal and enhancement measuring up to 35 mm in length at the C2-3 to C4-5 levels. The thoracic spinal cord is unremarkable. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. There is a hemangioma in the T5 vertebral body. The vertebral bone marrow signal is otherwise unremarkable. There is no significant spinal canal stenosis. The paravertebral soft tissues are unremarkable. However, there are multiple thyroid nodules, the largest of which measures up to approximately 15 mm.

Output: 1. Marked interval decrease in the degree of upper spinal cord edema patchy high T2 signal and enhancement measuring up to 35 mm in length at the C2-3 to C4-5 levels, which may be a manifestation of NMO. 2. Left optic nerve atrophy, which may a chronic sequela of NMO involvement.3. Nonspecific bilateral punctate frontal lobe white matter lesions. 4. Multiple nonspecific thyroid nodules.


Instruction: Generate impression based on findings.

Input: 67-year-old female with history of small cell lung cancer status post chemo/RT. History brain metastases status post resection and whole brain RT. There is a questionable focus of mild enhancement or intrinsic high density along the superior aspect of the left lateral ventricle approximately at the location of the corpus callosum. This finding is slightly more conspicuous than was seen on prior study dated 7/2/2008. This is suspicious for metastatic focus. MRI is recommended to evaluate this finding.Patchy areas of low attenuation in the subcortical and periventricular white matter reflect small vessel ischemic disease. Stable area of encephalomalacia is seen in the left parietal lobe vertex adjacent to the craniotomy site.There is no evidence of intracranial hemorrhage or edema.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Questionable area of enhancement above the roof of the left lateral ventricle. MRI pre-and post contrast is recommended to further evaluate.


Instruction: Generate impression based on findings.

Input: Female 61 years old Reason: Evaluate the Ileum History: Pathology showed quiescent disease- ileum unable to visualized. ABDOMEN:LIVER, BILIARY TRACT: Cholecystectomy. The common duct is dilated and measures 1.4 cm in maximum transverse dimension, which can be seen in the setting of prior cholecystectomy.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Post surgical changes of prior ileocecectomy and side to side ileocolonic anastomosis. The new terminal ileum is patulous but there is no evidence of bowel wall thickening, diffusion restriction or abnormal enhancement. There is a stool ball in the region of the anastomosis and multiple additional stool balls throughout the sigmoid colon.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: There has been interval resolution of the previously noted right lower quadrant multiloculated fluid collection. Signal void in the right lower quadrant corresponds to surgical clips on prior CT.PELVIS:UTERUS, ADNEXA: Fibroid uterus.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: See above.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Postsurgical changes of prior ileocecectomy and side to side ileocolonic anastomosis without evidence of active disease.


Instruction: Generate impression based on findings.

Input: History of recurrent acute pancreatitis in the setting of pancreas divisum presenting with chronic abdominal pain. ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology and size. There is diffuse fatty infiltration with focal periportal sparing. No biliary ductal dilatation with the common bile duct measuring 5 mm.Normally distended gallbladder.SPLEEN: No significant abnormality noted.PANCREAS: Findings of pancreas divisum. The main pancreatic duct is normal in caliber. The pancreas parenchyma demonstrates normal transit T1 weighted signal intensity and postcontrast enhancement. No peripancreatic inflammatory changes. No peripancreatic fluid collections. The peripancreatic vessels are unremarkable without evidence of pseudoaneurysm or thrombosis.Normal excretory response to secretin administration. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Colonic diverticulosis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Pancreas divisum without evidence of acute pancreatitis. Normal excretory response to secretin.


Instruction: Generate impression based on findings.

Input: Chronic ulcer. Evaluate for osteomyelitis. There is mildly increased signal intensity in the soft tissues in the postcontrast sequence.Bone marrow signal intensity is within normal limits throughout the right tibia and fibula.There is circumferential skin thickening and diffuse inflammation in the soft tissues, with no evidence of osteomyelitis.

Output: Soft tissue swelling with no evidence of osteomyelitis.


Instruction: Generate impression based on findings.

Input: History of alcoholic cirrhosis. Evaluate for HCC. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology. The liver measures 12.6 cm in craniocaudal dimension. No biliary ductal dilatation.TIPS catheter is noted with associated susceptibility artifact. Previously described punctate hepatic dome intrinsically T1-weighted lesion is unchanged (Series 11/10) with no arterial enhancement or washout. No suspicious arterial enhancing lesion.SPLEEN: The spleen measures 10.9 cm in length. No focal lesion. Stable 1.8 cm distal splenic artery aneurysm (series 7/21).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. Small duodenal diverticulum noted. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Cirrhosis with stable non-specific subcentimeter right hepatic dome intrinsically hyperintense lesion which does not meet imaging criteria for HCC.2.Stable splenic artery aneurysm.


Instruction: Generate impression based on findings.

Input: Altered mental status, unspecified [R41.82], Reason for Study: ^Reason: evaluation of possible septic emboli seen on previous head ct History: encephalopathy There are multifocal bihemispheric high signal intensity lesions on DWI which most likely represent T2 shine through indicating chronic lesion such as encephalomalacia. However, there are several mildly restricted diffusion lesions especially on bilateral centrum semiovale could represent evolving ischemic infarctions likely late subacute stage. There is a focal susceptibility lesion which does not show restricted diffusion on this scan on the right superior frontal gyrus (series 10, image 26) which may indicate parenchymal petechial hemorrhage or calcification. However, there is evidence of discrete brain parenchymal hemorrhage with surrounding edema indicating acute hemorrhagic lesion.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. Mucosal thickenings on bilateral maxillary and sphenoid sinuses.Bilateral mastoid air cells show opacifications.

Output: 1. Chronic ischemic lesions on bilateral hemisphere with several evolving late subacute ischemic lesions as described above.2. Focal susceptibility lesion on the right superior frontal gyrus may indicate focal petechial hemorrhage otherwise no remarkable finding.Rec: if clinically suspicious for septic emboli, please consider gadolinium enhanced MRI scan.


Instruction: Generate impression based on findings.

Input: Female; 31 years old. Reason: Eval hepatic lesions: RUQ pain worse with movement, recent chole @ OSH noted liver ahderent to peritoneal cavity as time of procedure. History: abdominal pain ABDOMEN:LIVER, BILIARY TRACT: In the lateral aspect of segment 8, there is focal area of capsular retraction with underlying geographic, wedge-shaped area of T2 hyperintensity demonstrating delayed contrast enhancement and measuring up to 3.9 x 2.3 cm (series 11/31). Trace adjacent perihepatic ascites.In the lateral aspect of segment 6, there is smaller but similar-appearing lesion (series 11/53). Trace adjacent perihepatic ascites.In segment 2, there is a round focus of arterial hyperenhancement measuring 1.3 x 1.6 cm without corresponding abnormality on T2-weighted sequences or delayed images, most likely due to transient hepatic arterial differences (series 10/25).Status post cholecystectomy. 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: Prominent to mildly enlarged right pericardial lymph nodes measuring up to 1.3 x 0.7 cm (series 10/13).

Output: 1. Segment 8 and segment 6 focal areas of capsular retraction with underlying signal and enhancement changes as detailed above. These findings are nonspecific, and differential considerations include mass lesions such as hemangioendotheliomas versus fibrosis/scarring from prior infection or inflammation. Ultrasound or CT-guided biopsy could be performed as clinically indicated.2. Nonspecific prominent to mildly enlarged right pericardial lymph nodes.


Instruction: Generate impression based on findings.

Input: Right arm numbness and tingling, dexterity issues with right arm Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate height. Alignment is maintained. Bone marrow signal is within normal limits. The cervical spinal cord has normal signal characteristics and overall morphology.There is congenital narrowing of the cervical spinal canal with superimposed degenerative changes, as described below: C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: Minimal disc bulge and uncovertebral hypertrophy on the right. No significant spinal canal stenosis. There is minimal right neural foraminal narrowing. No significant left neural foraminal narrowing.C4-5: Minimal disc bulge. No significant spinal canal or neural foraminal stenosis.C5-6: There is a right central disc extrusion which mildly indents the ventral cord. There is also uncovertebral hypertrophy with moderate right neural foraminal stenosis and mild left neural foraminal narrowing. There is low T2 signal extending from C5-C6 to C6-C7 along the posterior longitudinal ligament which is likely related to subligamentous disc extrusion.C6-7: There is central disc extrusion which indents the ventral cord. There is 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: 1. There are disc extrusions at the C5-C6 and C6-C7 levels which indent the ventral cord. There is also low T2 signal extending from C5-C6 to C6-C7 along the posterior longitudinal ligament which is likely related to subligamentous disc extrusion originating from either of the 2 levels. No cord signal abnormality.2. Moderate right C5-C6 neural foraminal stenosis related to disc extrusion and mild uncovertebral hypertrophy. There may be associated impingement of the right C6 nerve root.


Instruction: Generate impression based on findings.

Input: Clinical question: Rule out hemorrhage. Signs and symptoms: Post op. Nonenhanced CT of brain:Examination demonstrates expected postoperative changes of left suboccipital craniotomy. There is minimal residual fluid and air under the craniotomy flap, minimal residual air within the subarachnoid space in both supra-and infratentorial space. Minimal punctate high density at the expected level of the left foramina of Luschka is noted. There was tumor at this site on prior exam. This findings has the appearance of calcification and or hemorrhage which may be a postop change or represent residual tumor. This finding measures approximately 7 mm times 14-mm in size and should be further followed with an MRI examination. Subtle mass effect on the fourth ventricle with minimal deviation to the right is similar to prior study. There is no evidence of any opacification of mastoid air cells although the craniotomy line traverses the posterior mastoid air cells. Middle ear cavities are well pneumatized and unremarkable. A retention cyst within the left chamber of the sphenoid sinus is noted.

Output: 1.Expected postoperative changes of left suboccipital craniotomy for removal of left cerebellopontine angle tumor.2.Suspect small residual tumor in the left cerebellopontine angle and follow-up with an MRI is recommended.3.No evidence of acute hemorrhage or cerebral edema.


Instruction: Generate impression based on findings.

Input: Reason: lumbar stenosis History: leg pain with walking Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is no significant compromise to spinal canal or neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.A small amount of fluid is present in the uterus which is not an unusual finding in a normally menstruating woman.

Output: 1.No compromise to lumbar spinal canal or neural foramina.2.A small amount of fluid is present in the uterus which is not an unusual finding in a normally menstruating woman but would have significance if this is a non-menstruating woman.


Instruction: Generate impression based on findings.

Input: Clinical question: History of PXA status post ablation with residual cyst. Signs and symptoms: Preop planning for cyst fenestration. Pre-and post-enhanced fusion brain MRI:Examination he demonstrate a previously known partially cystic partially solid and enhancing mass in the posterior fossa consistent with xanthoastrocytoma.Compared to prior exam there is interval decreased size of the cystic component of the tumor on the left. There is also suggestion of a slight interval decrease solid component of the tumor on the left. This appearance however may be as a result of decreased left cystic component rather than a true interval decreased size. The large right sided cystic component of tumor however demonstrate no convincing evidence of interval change in its size however the enhancement of its rim is more conspicuous compared to prior study. This however may be technique related. The overall transaxial dimensions of tumor measures at 33.7 x 42.6-mm compared to prior study measurements of 35 x 22.8mm.The craniocephalad axis of tumor measures a maximum of 52-mm compared to prior study measurement of 49.Supratentorial ventriculomegaly demonstrate no appreciable change. The right frontal approach ventricular catheter with the tip in the body of right lateral ventricle similar to prior exam. Gliosis along the course of right ventricular catheter in the right frontal lobe is again noted.

Output: 1.Revisualization of a pleomorphic xanthoastrocytoma with slight interval decrease in cystic component on the left and otherwise without significant change. Please see above comments.2.Shunted enlarged supratentorial ventricular system and a right frontal approach ventricular catheter remains stable since prior exam.


Instruction: Generate impression based on findings.

Input: 5 months Male (DOB:4/18/2016)Reason: evaluate for tethered cord (tethered cord protocol) History: evaluate for tethered cord (tethered cord protocol)PROVIDER/ATTENDING NAME: ICY A. CADE-BELL ICY A. CADE-BELL Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris ends at the L2-3 level. Going from supine to prone position the conus medullaris does not move anteriorly.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is no significant compromise to spinal canal or neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: Findings are suggestive of a tethered cord. The conus medullaris does not move adequately anteriorly in the prone position relative to the supine position.


Instruction: Generate impression based on findings.

Input: 16-year-old male with history of knee pain, concern for fractureVIEWS: Right knee AP, lateral (two views) 3/13/15 Flabella is present. Apparent osseous defect in the superior medial aspect of the patella is a normal variant, seen on the prior MRI. Moderate knee joint effusion is present.

Output: Knee joint effusion without evidence of fracture.


Instruction: Generate impression based on findings.

Input: 60 year-old male with pain and constipation. Rule-out obstruction. The the patient has cholangiocarcinoma, status post Roux-en-Y resection and cholecystectomy. ABDOMEN:LIVER, BILIARY TRACT: The circumferential mass encasing the common hepatic duct at the confluence of the main, right and left ducts is smaller with resolution of the intrahepatic biliary ductal dilatation since the MRI examination in September 2010. No new or additional hepatic lesions were identified.SPLEEN: Not seen. Presumed splenectomy. PANCREAS: No pancreatic ductal dilatation is identified. No significant abnormality is seenADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Enlarged periportal and portacaval lymph nodes are identified. The largest of which is portocaval measuring 2 x 1.5 cm. (image number 39; series number 3.). ABOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Status post mesh reconstruction of the abdominal wall with large numbers of surgical staples.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: The rectosigmoid is markedly dilated with inspissated stool compatible with constipation. There is a 3-cm long segment of sigmoid which appears markedly narrowed with increased wall thickness and coronal image 65 and axial image 90 - 92 of series 3. This could represent spasm or a colonic lesion not seen on the 9/29/2010 MR examination.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: 1.Hepatic findings are consistent with cholangiocarcinoma, status post Roux-en-Y resection. Severe constipation. Questionable lesion in sigmoid colon.2.Periportal and portacaval lymphadenopathy.


Instruction: Generate impression based on findings.

Input: 28 years Female (DOB:11/5/1987)Reason: Cysts in brain History: HA,PROVIDER/ATTENDING NAME: DAVID M FRIM DAVID M FRIM The patient is status post right hemispherectomy. Since the prior exam a ventriculostomy tube has been placed through the right parietal bone into the right cranial vault fluid cavity and into a complex of abutting cystic cavities along the left hemisphere.There is redemonstration of T2 white matter signal hyperintensities adjacent to the left lateral ventricle which are stable compared to the prior examThe upper spinal cord is angulated posteriorly at the level of C1 where there is a prior surgery.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Since the prior exam patient's undergone placement of a ventriculostomy type catheter has been placed.2.The patient status post right hemispherectomy3.The patient is status post surgery along the upper cervical spine. The upper cervical spinal cord is deformed but not changed since prior exam.