Instruction: Generate impression based on findings.

Input: The vertebral column alignment is within normal limits. The vertebral body heights are preserved. The vertebral bone marrow signal is unremarkable. The imaged spinal cord displays normal signal and morphology and the conus terminates at T12-L1. There is no evidence of intraspinal mass or abnormal enhancement. The paravertebral soft tissues are unremarkable.L1-L2: Unremarkable.L2-L3: Unremarkable.L3-L4: Unremarkable.L4-L5: There is disc desiccation, minimal disc height loss, and a mild disc bulge with central annular fissure, as well as mild ligamentum flavum thickening. These findings result in mild spinal canal stenosis and mild posterior displacement of the descending left L5 nerve root and encroachment upon the subarticular zone but no significant neural foramen stenosis.L5-S1: There is disc desiccation, mild loss of disc height, mild Modic type I endplate degenerative changes, and a mild disc bulge with a superimposed mild central disc protrusion. Findings result in moderate right neural foramen stenosis and mild spinal canal stenosis with mild posterior displacement of the descending left S1 nerve root and encroachment upon the subarticular zone.

Output: 1.Mild degenerative changes with mild spinal canal stenosis at L4-L5 and L5-S1 as well as moderate right neural foramen stenosis at L5-S1. Minimal posterior displacement of the descending descending left L5 and S1 nerve roots.2.No evidence of intraspinal mass or abnormal enhancement.


Instruction: Generate impression based on findings.

Input: There is no appreciable change in the syrinx the extends from approximately the T5 level to the T10 level, with a maximum diameter of approximately 2 mm. Otherwise, there is no evidence of mass lesions in the thoracic spine. There appears to be mild apex right thoracic scoliosis. The vertebral body and disc heights are intact. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The paravertebral soft tissues are unremarkable.

Output: 1. No appreciable interval change in narrow caliber thoracic spinal cord syrinx.2. Mild apex right thoracic scoliosis.


Instruction: Generate impression based on findings.

Input: 24-year-old female with a prior episode of right hip osteomyelitis in 2012 with new right hip pain and fever for 2 days. The right hip appears normal. There is a trace amount of fluid seen within the joint, appearing similar to the other side, but no joint effusion is evident. There is no enhancement to suggest a synovitis nor is there edema/enhancement of the surrounding soft tissues of the right hip. The bone marrow signal intensity of the right hip is normal. There is decreased signal intensity along the right sacroiliac joint corresponding to sclerosis seen on radiographs which may be degenerative in etiology or reflect prior inflammatory arthritis, but currently there is no fluid within the sacroiliac joint or within the adjacent soft tissues. There is edema within the paraspinal musculature, left greater than right, which is nonspecific. We see no fracture or intramuscular fluid collections. There is also edema within the subcutaneous fat, posteriorly, which is not necessarily of any current clinical significance. There is a right adnexal cyst which is likely physiologic in a patient of this age.

Output: 1. No evidence of septic arthritis or osteomyelitis of the right hip.2. Osteoarthritis of the right sacroiliac joint which may reflect prior inflammatory arthritis, but this is equivocal. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Reason: pain, posterior lateral knee; previous small lipoma that was excised History: pain MENISCI: Posterior to the posterior horn of the medial meniscus, the previously seen lipoma has been resected. Scarring is noted at the margin of the resection bed. The underlying medial meniscus and lateral meniscus are intact. ARTICULAR CARTILAGE AND BONE: There is cartilage degeneration of the medial femoral condyle and diffuse chondral thinning within the lateral compartment but no full-thickness defects are seen. A benign appearing sclerotic focus is noted within the proximal fibula, unchanged. No fracture.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Postsurgical changes adjacent to the posterior horn of the medial meniscus with scarring. The underlying meniscus is intact.


Instruction: Generate impression based on findings.

Input: Rule out bleed or acute change. Signs and symptoms: Encephalopathy. No evidence of hemorrhage, edema, mass-effect, midline shift or hydrocephalus. Cortical sulci, ventricular system and all CSF cisterns remain within normal range for patient's stated age of 69. Large vessel intracranial vascular calcification. Calvarium, paranasal sinuses and mastoid air cells are unremarkable. If clinical concern persist an MRI is recommended.

Output: Negative CT of brain without infusion.


Instruction: Generate impression based on findings.

Input: Reason: H/o multiple hepatic cysts. Assess for stability. Now w/ nonspecific abdominal bloating History: H/o multiple hepatic cysts. Assess for stability. Now with nonspecific abdominal bloating ABDOMEN:LIVER, BILIARY TRACT: Lesions in the right hepatic lobe measuring 2.2 cm and 1.4 cm with peripheral nodular enhancement, suggestive of hemangiomas. These lesions are grossly similar to the prior ultrasound accounting for differences in technique. No suspicious 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: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Right hepatic lesions correspond to lesions identified on ultrasound and are suggestive of hemangiomas.


Instruction: Generate impression based on findings.

Input: Spinal stenosis, lumbar region [M48.06], Reason for Study: ^Reason: back pain History: back pain For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. Spinal cord diminished at the level of L3-4 level, unchanged since prior scan. L5 vertebrae showed spina bifida, unchanged.Vertebral heights are preserved.Vertebral body signal intensity appears to be normal.There is normal lumbar lordosis. The spine alignment is anatomic. The signal of the visualized cord is normal. The right side renal cysts are again seen, grossly unchanged.Degenerative changes are specified by the intervertebral level as follows: T12-L1: no neuroforaminal narrowing or spinal stenosis. L1-L2: No evidence of spinal canal stenosis. No neuroforamen stenosis.L2-L3: Minimal bulging of disc, more prominent toward left side with left side mild to moderate neuroforaminal narrowing.L3-L4: Diffuse bulging of disc with bilateral ligamentum flavum thickening results moderate to severe spinal canal stenosis as well as bilateral lateral recess narrowing. Slightly advanced since prior scan.. L4-L5: Diffuse bulging of disc with bilateral ligamentum flavum thickening results moderate to severe spinal canal stenosis as well as bilateral lateral recess narrowing. Slightly advanced since prior scan. Unchanged since prior scan. L5-S1: Minimal bulging of disc with prominent right side facet joint, unchanged since prior scan.

Output: 1. Lower lying conus at the level of L34 without evidence of spinal cord signal abnormality, unchanged.2. Slightly progressed L34 spinal canal stenosis since prior scan.3. Multilevel degenerative changes of lumbar spine, grossly unchanged since prior scn.


Instruction: Generate impression based on findings.

Input: Reason: cuff tear History: pain over biceps tendon and pain with specialized manuevers ROTATOR CUFF: Mildly increased signal within the supraspinatus tendon is consistent with tendinopathy. There is no evidence of a tear and the supraspinous muscle is within normal limits without significant atrophy. The infraspinatus, teres minor and subscapularis muscles and tendons are intact.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: No significant abnormality noted.BICEPS TENDON: There is a fair amount of fluid surrounding the tendon of the large head of the biceps, which may reflect to tenosynovitis. ADDITIONAL

Output: 1. Tendinopathy of the supraspinatus tendon without tear. The rotator cuff is otherwise intact.2. Findings suggestive of tenosynovitis of the tendon of the large head of the biceps.3. Subdeltoid and subacromial bursitis.


Instruction: Generate impression based on findings.

Input: Cellulitis Note that the examination is limited by the presence of overlying casting material and patient's body habitus.There is a small joint effusion of the distal radioulnar joint with mild enhancement of the surrounding synovium indicating mild synovitis. The effusion causes mild displacement of the extensor carpi ulnaris tendon which is otherwise intact. There is a minimal amount of fluid surrounding the tendon (series 6 image 9/33) suggesting minimal tenosynovitis. There is a mild amount of soft tissue and edema and inflammation within the dorsal lateral compartment of the wrist.Bone marrow signal of the wrist is normal and there are no focal erosions identified. Mild negative ulnar variance is noted.

Output: 1. Small joint effusion of the distal radioulnar joint with mild associated synovitis.2. Minimal tenosynovitis of the extensor carpi ulnaris tendon.3. Normal bone marrow signal without focal erosions.


Instruction: Generate impression based on findings.

Input: Acute midbrain hemorrhage. New vertical gaze palsy. Many of the images are at least mildly limited by patient motion.MRI: The left midbrain hemorrhage that extends into the posterior medial aspect of the left thalamus has not significantly changed in size since the previous examination. The associated vasogenic edema along T2 hyperintense signal has slightly increased compared to the CT scan, accounting for differences in techniques. There is trace hemorrhage within the occipital horns of the lateral ventricles. There is encephalomalacia in the right basal ganglia and corona radiata, as well as the left corona radiata. In addition, moderate to extensive periventricular confluent T2 hyperintensity, as well as small patches of subcortical T2 hyperintensity are compatible with chronic microvascular ischemia. There is no contrast-enhancing brain lesion. There is no evidence of acute territorial infarct. The pituitary gland appears unremarkable. The ventricles and sulci are enlarged diffusely, reflecting a combination of ex vacuo dilatation from previous infarcts and global cerebral volume loss, but there is no evidence of hydrocephalus otherwise. There is no midline shift or herniation. A left nasal cavity polypoid lesion, a retention cyst in the left maxillary sinus, and secretions in the right posterior ethmoid sinuses are unchanged. The orbits, skull, and scalp soft tissues are grossly unremarkable.MRA: The included upper cervical, petrous, cavernous and supraclinoid internal cleft arteries show preserved flow-related signal and caliber with no flow-limiting lesion or aneurysm. The paired anterior and middle cerebral arteries are also unremarkable. An anterior communicating artery is present. The left vertebral artery is small (both its intracranial and included upper extracranial segments). This is associated with small osseous foramina, which is probably developmental/congenital. The basilar artery is predominantly supplied by the right vertebral artery. The right P1 segment is either absent or very small. The right posterior cerebral artery is supplied through an enlarged right posterior communicating artery (fetal origin; normal variation). The left posterior cerebral artery is conventional in anatomy. Both posterior cerebral arteries are otherwise unremarkable.

Output: 1. Left midbrain and thalamic hemorrhage has not significantly changed since the previous CT scan, although the associated vasogenic edema has slightly increased, accounting for differences in technique. Minimal intraventricular extension of the hemorrhage is present as well.2. Extensive chronic small vessel disease and chronic infarcts are unchanged.3. No hemodynamically significant cerebrovascular lesions.


Instruction: Generate impression based on findings.

Input: Abnormal facial movements of the right face with eye blinking and right lower facial contraction. Rule out intracranial cause (CN VII abnormality?). MRI: The cranial nerve 7 and 8 complexes and labyrinthine structures are unremarkable. There is no evidence of intracranial hemorrhage or mass. The grey-white matter differentiation appears to be intact. The ventricles are normal in size and configuration. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. The skull and scalp soft tissues are unremarkable. MRA: There is no evidence of significant steno-occlusive lesions or aneurysms.

Output: 1. Unremarkable intracranial and intratemporal portions of the facial nerves and facial nerve nuclei.2. No evidence of intracranial hemorrhage, mass, or cerebral edema.3. No evidence of significant steno-occlusive lesions or aneurysms.


Instruction: Generate impression based on findings.

Input: Male, 37 years old. Reason: evaluate for rotator cuff tear History: subscapularis weakness on exam ROTATOR CUFF: The rotator cuff tendons and muscles appear normal. No evidence of tear or other acute injury.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenoid labrum appears grossly intact in the absence of an augmented exam. Small degenerative cysts are noted at the humeral head and along the glenoid.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: 1.No tear or other acute abnormality involving the rotator cuff tendons and muscles.2.Degenerative changes involving the glenohumeral joint as described above. Although these findings are moderate in extent, given the patient's age, they are considered relatively severe. Correlate with occupational history or other history of chronic repetitive trauma.


Instruction: Generate impression based on findings.

Input: Reason: eval for acute rtc tear History: weak pain 3d after overhead injury Suboptimal evaluation secondary to patient motion artifact and inability to optimally position the patient.ROTATOR CUFF: There is intermediate signal intensity within the supraspinatus indicating mild tendinosis. There is perhaps mild superficial fraying of the articular surface fibers of the supraspinatus. The supraspinatus muscle and tendon otherwise appear intact. The infraspinatus and teres minor muscles and tendons appear intact. The subscapularis muscle and tendon appear intact. There are irregular foci low signal intensity along the anterior aspect of the bicipital groove which may represent a calcific tendinopathy of the subscapularis tendon (image 5; series 4).SUPRASPINATUS OUTLET: There is a trace amount of fluid within the subacromial subdeltoid bursa. Mild degenerative changes affect the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is anatomic. The glenoid labrum appears intact within the limitations of a non arthrogram study. BICEPS TENDON: The tendon of the long head of the biceps appears intact ADDITIONAL

Output: 1. Rotator cuff tendinosis and superficial fraying without evidence of a full-thickness rotator cuff tear or retraction.2. Findings suggestive of calcific tendinopathy affecting the subscapularis as described above.3. Osteoarthritis of the shoulder.


Instruction: Generate impression based on findings.

Input: 28 year old man with second degree AV block who presents for cardiac MRI to evaluate for structure, function, and scar. Left VentricleThe left ventricle is mildly enlarged with lower limits of normal systolic function. The overall LV ejection fraction is 53%, the LV end diastolic volume index is 117 ml/m2 (normal range: 74+/-15), the LVEDV is 242 ml (normal range 142+/-34), the LV end systolic volume index is 56 ml/m2 (normal range 25+/-9), the LVESV is 115 ml (normal range 47+/-19), the LV mass index is 51 g/m2 (normal range 85+/-15), and the LV mass is 104 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. Area of curvilinear hyperintensity at the LV apex is shown to not represent delayed enhancement in the myocardium as this was not present on any other planes.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is moderately enlarged with mildly reduced systolic function. The overall RV ejection fraction is 45%, the RV end diastolic volume index is 142 ml/m2 (normal range 82+/-16), the RVEDV is 294 ml (normal range 142+/-31), the RV end systolic volume index is 79 ml/m2 (normal range 31+/-9), and the RVESV is 162 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is mildly enlarged with lower limits of normal systolic function. [LVEF 53% ]2. The right ventricle is moderately enlarged with mildly reduced systolic function.[RVEF 45%]3. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.


Instruction: Generate impression based on findings.

Input: Male 64 years old with a pancreatic neuroendocrine tumor since 2011 with hepatic metastatic resection July 2015. The exam is limited as the top 1-2 cm of the liver are not included in the field-of-view on axial images.ABDOMEN:LIVER, BILIARY TRACT: Posttreatment changes are again seen in segment 8. There is stable very faint, ill-defined enhancement superior to the cavity (series 903, image 357) without T2 hyperintensity. The nonenhancing hypointense segment 3 focus is unchanged and likely postsurgical in etiology.There are multiple foci of restricted diffusion with associated ill-defined arterial enhancement and washout increased in size and number compared to the previous exam and suspicious for metastatic disease. For reference, a segment 7 lesion measures 9 x 7 mm (series 3, image 372).Cholelithiasis without evidence of acute cholecystitis. No biliary ductal dilatation or ascites. The hepatic vasculature is patent.SPLEEN: Status post splenectomy.PANCREAS: Status post distal pancreatectomy. The remaining pancreas enhances homogeneously. The pancreatic duct is not dilated.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Juxtaphrenic lymph nodes on the right are stable to mildly increased in size.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Increase in size and number of multiple arterially enhancing hepatic lesions with washout concerning for new and progressive metastatic disease.2.Stable post treatment changes in segment 8 with likely treatment related faint enhancement (similar in appearance to prior imaging).


Instruction: Generate impression based on findings.

Input: Ischial tuberosity pain There are mild, chronic appearing enthesopathic changes of the hamstring origins bilaterally with small enthesophytes and mild increased signal intensity of the hamstring tendons at their origins suggesting tendinosis, left greater than right. There is linear intermediate signal intensity at the origin of the conjoined tendon which may indicate additional chronic partial insertional tearing but we see no fluid signal intensity within the tendon or frank rupture. There is no evidence of ischial bursitis.The bone marrow signal intensity is normal. There is minimal osteoarthritis of the hips with severe degenerative disc disease of L5-S1.

Output: Mild chronic enthesopathic changes at the hamstring origins bilaterally, left greater than right. There is no evidence of ischial bursitis.


Instruction: Generate impression based on findings.

Input: 79-year-old female with meningioma, 3 month follow-up evaluation Redemonstrated is a T2 hypointense minimally enhancing extra-axial mass along the left parietal convexity that measures up to 8 mm without significant mass effect upon the brain, unchanged in appearance. There remain scattered foci of T2 hyperintensity in the cerebral white matter without mass effect, restricted diffusion, or susceptibility abnormality. There is no evidence of acute intracranial hemorrhage. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There are bilateral lens implants. The paranasal sinuses and mastoid air cells are clear. Expected vascular flow voids are demonstrated.

Output: 1.Stable subcentimeter extra-axial calcified/ossified mass along the left parietal convexity that measures up to 8 mm without significant mass effect upon the brain which may represent a meningioma or osteoma.2.Stable chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: 59 years, Female, with bilateral lower extremity myoclonus. There are foci of restricted diffusion in the left frontal lobe, predominantly in the middle left frontal gyrus, with a small focus also including the lateral aspect of the precentral gyrus. Additional tiny foci of restricted diffusion are present in the left parietal lobe. There is associated T2/FLAIR signal hyperintensity in these regions. A tiny focus of gradient susceptibility is present within the left frontal lobe infarct, which may represent thrombus versus minimal petechial hemorrhage. No frank intraparenchymal hemorrhage or additional intracranial hemorrhage is identified. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. Several scattered foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with chronic small vessel ischemic changes. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: Acute infarcts in the left frontal and left parietal lobes. Tiny focus of susceptibility within a left frontal infarct may be related to minimal petechial hemorrhage versus thrombus within a distal middle cerebral artery branch. No frank intraparenchymal hematoma. No intracranial mass effect.Dr. Sorensen discussed the above findings with Dr. Liu at 1345 hours on 8/7/2016.


Instruction: Generate impression based on findings.

Input: History of hypodense pancreatic head mass. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology size and signal intensity. Scattered small subcentimeter cysts. No focal suspicious lesion. The vessels are patent. No biliary ductal dilatation. Normally distended gallbladder without gallstones.SPLEEN: The spleen is normal in morphology and size.PANCREAS: The pancreas is normal in morphology without parenchymal atrophy. The main pancreatic duct is normal in caliber and inserts into the major ampulla. It demonstrates a looped morphology, a normal variant. No focal suspicious lesion.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No discernible discrete lesion is evident at the level of the ampulla as described on the recent CT. This is felt to likely represent a normal ampulla given the lack of upstream biliary and pancreatic ductal dilatation as well as no corresponding restricted diffusion.


Instruction: Generate impression based on findings.

Input: 46-year-old female with enlarged uterus, bulk symptoms. Evaluate for uterine fibroids, fertility preservation. Operative planning. PELVIS:UTERUS, ADNEXA: The uterus has a lobulated contour and is markedly enlarged measuring up to 19.4 cm in transverse, 11.6 cm in AP, and 23.7 cm in length. The enlarged uterus causes deviation of the urinary bladder and sigmoid colon anteriorly and to the right.Numerous T2 hypointense urine fibroids are noted, and the 2 largest uterine fibroids are listed for reference:The fibroid in the left lateral uterine fundus measures 8.4 cm in AP, 8.2 cm in transverse, and a 10.8 cm in craniocaudal diameter (axial series 5 image 17, coronal series 6 image 25). This fibroid is primarily subserosal in location, and internal degenerating components are noted on postcontrast sequences (series 11 image 259).The fibroid in the posterior lower uterine segment measures 8.1 cm in AP, 9 cm in transverse, and 8.2 cm in craniocaudal diameter (axial series 5 image 34, coronal series 6 image 24). This fibroid is favored to have submucosal and intramural components.The bilateral ovaries are difficult to reliably visualized.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Trace free fluid in the dependent pelvis is likely physiologic.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Markedly enlarged uterus containing multiple fibroids as described above.


Instruction: Generate impression based on findings.

Input: Female, 28 years old, 32 weeks gestational age, with fetal brain abnormality on ultrasound. The lateral ventricles are markedly dilated. As a result, the cerebral cortex is severely thinned and somewhat dysmorphic. The septum pellucidum is not visualized and may have degenerated. The third ventricle is mildly dilated and the fourth ventricle is within normal limits. The cerebral aqueduct is not visualized.The interhemispheric falx is normally formed. The thalami are not fused. The corpus callosum is probably present but it is markedly thinned secondary to ventricular enlargement. The cerebellum appears mildly small for gestational age. No specific parenchymal signal abnormality is seen. No acute intracranial hemorrhage or any other abnormal extra-axial collections are suspected.

Output: Marked lateral ventriculomegaly is seen which may be secondary to aqueductal stenosis as the cerebral aqueduct is not visualized. As a result, the cerebral cortex is markedly thinned and somewhat dysmorphic. However, there are no findings to suggest holoprosencephaly.


Instruction: Generate impression based on findings.

Input: 50-year-old female with chronic abdominal pain 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: The jejunum is not well assessed due to underdistention. Small bowel caliber is within normal limits without evidence of obstruction. The appendix is well visualized and within normal limits. Previously seen mildly prominent ileal loop is not present on the current exam. No abnormal enhancement is present. Appearance of terminal ileum within normal limits. Scattered right lower quadrant subcentimeter mesenteric lymph nodes.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Status post hysterectomy.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: As above.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Previously seen focally prominent ileal loop is not present on the current exam. In retrospect findings may have been related to focal peristalsis. No abnormal enhancement or findings to account for the patient's pain. Terminal ileum is normal in appearance.


Instruction: Generate impression based on findings.

Input: Acute altered mental status. Evaluate for intracranial hemorrhage. There is no evidence of intracranial hemorrhage, mass or edema. A moderate amount of diffuse hypodensity within the periventricular and subcortical white matter is consistent with small vessel disease, age indeterminate. If there is clinical concern for acute ischemia, an MRI may be considered.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Small vessel disease, age indeterminate, without intracranial hemorrhage. An MRI has been obtained subsequent to this exam.


Instruction: Generate impression based on findings.

Input: A patient submitted outside study for review. Submitted for review are digital mammographic images of left breast (5/23/16), breast MRI (5/23/16) performed at outside institution. For comparison, digital mammographic images (5/18/15), breast MRI (10/8/14) are available. Per outside radiology report, the patient had right mastectomy in 2014 for invasive ductal carcinoma. DIGITAL MAMMOGRAPHIC IMAGES OF LEFT BREAST (5/23/16):The breast parenchyma is heterogeneously dense (BiRADS Density Category C), unchanged in pattern and distribution. No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in left breast. BREAST MRI (5/23/16):The study was performed per a protocol outlined in the outside radiology report.Status post right mastectomy and a retropectoral silicone implant placement.There is heterogeneous amount of fibroglandular tissue in the left breast.Mild parenchymal enhancement is noted in the left breast.There are stable enhancing foci in the left lower inner quadrant.No abnormal enhancement is seen in left breast or in the right remaining tissue. No abnormal lymph nodes are identified in either axillary region.

Output: No mammographic or MRI evidence of malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: 18-year-old with history of stroke status post pial synangiosis at outside hospital. MRI: There is near extensive encephalomalacia throughout the vast majority of the right side cerebral hemisphere with relative sparing of the inferior frontal and anterior mesial temporal lobes. There is associated right brainstem Wallerian degeneration, ex vacuo dilatation of the right lateral ventricle, right Dyke-Davidoff-Masson, as well as approximately 7 mm of rightward midline shift. There is mild periventricular T2 hyperintensity in the left cerebral hemisphere. There is no evidence of acute intracranial hemorrhage, mass, or acute infarct. The orbits are unremarkable. MRA: There is a patent anastomosis between the bilateral superficial temporal arteries and distal branches of the middle cerebral arteries. Otherwise, there is extensive steno-occlusive diease of the anterior circulation, right more than left. There is also proliferation of lenticulostriate collateral vessels within the basal ganglia. Right dominant vertebrobasilar. There is a right posterior communicating artery that communicates with collateral vessels. The right posterior cerebral artery is diminutive, while the left right posterior cerebral artery, basilar artery, and vertebral arteries are intact.

Output: 1. Extensive chronic infarction of the right cerebral hemisphere, but no evidence of acute infarction.2. Patent bilateral pial synangiosis, but extensive steno-occlusive disease involving the anterior circulation with moyamoya, right more severe than left.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Clinical question: 71-year-old female with stage IV non-small cell lung cancer and known brain metastases. Restaging CT. Signs and symptoms: Same Enhanced head CT:No contrast was given for this study. This examination was performed after an enhanced CT of chest abdomen and pelvis.Examination again demonstrates an enhancing high convexity left anterior parietal metastatic lesion measuring 12.8 x 13.2-mm in size. This is associated with extensive surrounding vasogenic edema and effacement of adjacent cortical sulci. Very subtle mass effect on the left lateral ventricle is also present. There is approximately 3 mm midline shift to the right. Precise comparison to prior exam is not possible due to severely degraded images on prior MRI exam secondary to motion. Within this limitation however there is suggestion of possible minimal reduction in the size of tumor. Compared to prior nonenhanced head CT the degree of vasogenic edema on overall mass effect remains similar.There is no evidence of any additional foci of parenchymal or leptomeningeal enhancement to suggest additional metastatic lesions. Calvarium is also intact.There is a focus of vascular enhancement at the level of the supraclinoid right internal carotid artery suggestive of atherosclerotic aneurysmal dilatation or an aneurysm of the supraclinoid right internal carotid. This finding was noted on prior MRI exam. This finding measures approximately 9.6 x 6.6-mm in size. Recommend further follow-up with a CTA or MRA of intracranial circulation.Multiple attempts to contact with the referring clinical physician failed. Findings were relayed to Dr. Rhee Charles (pager 2869) via paging system at time of review of the exam.

Output: 1.Revisualization of a left parietal metastatic focus with extensive surrounding edema. The overall surrounding vasogenic edema and mass effect remain similar to prior study. There may be slight interval decrease in the measurement of tumor.2.Either atherosclerotic aneurysmal dilatation or a berry aneurysm of the proximal right supraclinoid internal carotid artery.


Instruction: Generate impression based on findings.

Input: Male, 41 years old, with problems walking and history of multiple sclerosis. Assess for changes from prior MRI. Brain:Numerous patchy areas of T2 hyperintensity are seen within the periventricular and juxtacortical white matter of the cerebral hemispheres. The cerebellum is also involved to a lesser degree. Since the prior examination, and accounting for differences in imaging technique, no significant interval change in the size or number of these lesions is appreciated.The above-mentioned lesions exert no significant mass effect. They are associated with no susceptibility effect or pathologic enhancement. No abnormal extra-axial collections are seen. The ventricular system is stable and within normal limits for size and morphology.Cervical spine:Abnormal T2 signal intensity is again observed at several locations in the cervical spinal cord. At C2, this signal abnormality is predominantly dorsal and extends for about 10 mm in the craniocaudal dimension. An additional area of signal abnormality is seen spanning from approximately C3 where the signal abnormality is holocord, down to approximately C4-5 where it is more right-sided. Evidence of cord volume loss is also seen at the C3 level. There has been no significant or convincing change in the appearance of these findings relative to the prior examination, again accounting for differences in imaging technique.Spinal alignment is anatomic. Vertebral body heights are preserved. No worrisome marrow signal replacement or marrow edema is seen. No significant disc herniation, spinal canal or neuroforaminal stenosis is identified.Thoracic spine:Areas of cord T2 signal abnormality are again observed on the right at T1, on the left at T3, on the right at T7-8, on the right at T9-10, and centrally at T11-12. Accounting for differences in imaging technique, and motion artifact on the present examination, no significant or convincing interval change is seen.Spinal alignment is anatomic. Vertebral body heights are preserved. Vertebral body hemangiomas are seen at T8 and T9. Marrow signal characteristics are otherwise unremarkable. No significant disc herniation, spinal canal or neuroforaminal stenosis is seen.

Output: Numerous periventricular and juxtacortical white matter lesions are reidentified in the brain compatible with the stated history of multiple sclerosis. There has been no significant interval change in the size, number or distribution of these lesions.Multiple areas of pathologic spinal cord signal abnormality are identified in the cervical and thoracic regions, again without significant or convincing interval change.


Instruction: Generate impression based on findings.

Input: Reason: assess for masses or abnormalities that may be causing lower abdominal pain. PELVIS:UTERUS, ADNEXA: The uterus is anteverted and anteflexed and is normal in size. Normal variant nabothian cysts are noted. There is poor definition of the endometrial-myometrial junction. The ovaries appear within normal limits including several small follicles and/or cysts, some of which may contain a small amount of hemorrhage. However there is no significant associated intrinsic T1 shortening to suggest endometriosis.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Poor definition of the endometrial-myometrial junction which can be seen with adenomyosis.2.No abnormal mass lesions are identified within the pelvis to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: 44-year-old female. Right upper quadrant abdominal pain. Evaluate for choledocholithiasis. ABDOMEN:LIVER, BILIARY TRACT: Gallstones including impacted stone at gallbladder neck (series 401, image 18) with edematous wall thickening and pericholecystic fluid consistent with acute cholecystitis. No evidence of abscess or gallbladder perforation.No choledocholithiasis.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: Trace abdominal ascites.

Output: Findings consistent with acute cholecystitis. No choledocholithiasis.


Instruction: Generate impression based on findings.

Input: Hyperprolactinemia with 3mm adenoma years ago: elevated prolactin. There is a 4 mm wide apparently hypoenhancing focus in the posterior adenohypophysis. The rest of the pituitary gland, including the posterior pituitary bright spot are unremarkable. The infundibulum is intact and situated in the midline. The cavernous sinuses and optic apparatus are unremarkable.

Output: A 4 mm lesion in the pituitary gland may represent a microadenoma.


Instruction: Generate impression based on findings.

Input: 47-year-old female with pain and stiffness. Evaluate for rotator cuff tear versus labral tear versus frozen shoulder. ROTATOR CUFF: There is thickening and increased signal abnormality in the supraspinatus tendon consistent with mild tendinosis. The supraspinatus muscle and tendon appear intact. The infraspinatus muscle and tendon appear intact. The subscapularis and teres minor muscle and tendon appear intact. SUPRASPINATUS OUTLET: There is a small amount of fluid within the subacromial subdeltoid bursa which extends into the acromioclavicular joint, however, no intra-articular gadolinium extends into the bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Intra-articular contrast distends the glenohumeral joint. The glenohumeral joint alignment is anatomic. No labral tears are evident.BICEPS TENDON: The long head of the biceps tendon is normal in size and appearance. ADDITIONAL

Output: Small amount of fluid within the subacromial subdeltoid bursa suggestive of a bursitis. No evidence of rotator cuff tear or glenoid labrum pathology, as clinically questioned.


Instruction: Generate impression based on findings.

Input: History of prostate cancer and renal cancer status post right open partial nephrectomy. Evaluate for recurrent or metastatic disease. Papillary renal cell carcinoma dated 5/8/2008. Status post prostatectomy with 3+3 tumor. ABDOMEN:LIVER, BILIARY TRACT: Small liver cyst is again noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Postsurgical changes from a right partial nephrectomy without evidence of recurrent disease in the nephrectomy bed. Dorsal to the right kidney is a stable encapsulate fat containing focus most compatible with treatment related fat necrosis. There are several bilateral renal cysts. No hydroureteronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small hiatal hernia. Right lateral abdominal wall broad-based hernia containing small and large bowel without evidence of complication.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Postoperative findings of partial nephrectomy without evidence of recurrent or metastatic disease.


Instruction: Generate impression based on findings.

Input: The patient was placed in a prone position. A radiopaque grid was placed over the patient’s mid back neck for needle localization. Using multidetector helical CT, axial 3 mm scans were obtained through the thoracic spine demonstrating osteolytic lesion in the T6-T7 vertebral body and disk space suspicious for osteomyelitis/diskitis as seen on the patient's recent MRI study.A trajectory was plotted into the T6-T7 vertebral bodies using a left transpedicular approach. The patient's back was prepped with Betadine and draped in sterile fashion. The subcutaneous and deeper soft tissues were anesthetized with 1% lidocaine. A 13-gauge Bonopty needle was advanced into the posterior aspect of the left T6 pedicle. An inner drill cutting needle was utilized to advance the coaxial Bonopty needle into the posterior lateral aspect of the T6 vertebral body projecting medially and inferiorly toward the disk space. Aspiration through the coaxial technique 13- gauge Bonopty needle yielded approximately 2 ml of viscous sanguinous fluid. Next, a 22-gauge x 15-cm Chiba needles was utilized to perform fine needle aspiration which yielded another 1 ml of serosanguineous aspirate. Finally, the inner bone cutting needle was utilized to obtain a core tissue biopsy. Therefore, 3 fine needle aspirations were performed with 20 and 22-gauge x 15-cm . The samples were placed in two vials mixed with normal saline to facilitate microbiology analysis. The sample was sent directly to microbiology for infectious analysis (viral /bacterial/fungal, and mycobacterial cultures).The coaxial needle was removed and adequate hemostasis was achieved with manual compression for 5 minutes.The patient tolerated the procedure well with no immediate complications. The patient remained neurologically at baseline at the end of the procedure. The patient was transferred back to the inpatient unit in stable condition.

Output: Successful CT-guided fine-needle aspiration and core needle biopsy of the T6 vertebral body


Instruction: Generate impression based on findings.

Input: Personal history of left breast skin sparing mastectomy in 2011 for DCIS. Family history of breast cancer in paternal grandmother, paternal great aunt, and paternal cousins. Patient is status post left mastectomy with reconstruction. There is mild parenchymal enhancement and a heterogeneous amount of fibroglandular tissue in the right breast.No abnormal enhancement is seen in the right breast or the reconstructed left breast. Scattered enhancing foci in the right breast are similar to prior studies dating back multiple years. A few high T2 signal cysts are present on the right as well. No abnormal axillary lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Reason: Pt w/ GBM, s/p RT/TMZ and now only on Optune. History: GBM. Postoperative changes are again seen from previous right frontal craniotomy for resection of a right frontal lobe mass. There are section cavity along the high anterior right frontal lobe appears similar in configuration, with slight decreased marginal susceptibility relating to postoperative blood products.There has been interval development of a few scattered punctate foci of diffusion restriction along the medial right lateral ventricular margin at the level of the body, in addition to nodular appearing diffusion restriction along the body of the corpus callosum. Corresponding nodular enhancement is seen along the areas of new callosal abnormality. There is now ill-defined T2/FLAIR hyperintensity across the corpus callosum, with slight increased extent of periventricular FLAIR hyperintensity along the lateral ventricles, and now extension into the right lateral temporal lobe periventricular white matter as well. There is focal nodular enhancement now along the right temporal lobe periventricular white matter measuring up to 1.4 cm. Persistent nodular enhancement is also seen along the margins of the resection cavity extending towards the ventricular wall. Other more punctate foci of enhancement are seen within the intervening white matter, for example on 1300/114 in the right lateral frontal deep white matter.

Output: Progression of nodular enhancement and abnormal ill-defined signal across the body of the corpus callosum as well as now into the right temporal periventricular white matter suggestive of tumor progression.


Instruction: Generate impression based on findings.

Input: Headache, lupus cerebritis No evidence of acute ischemic lesion.There is localized high signal intensity on T1 weighted image on the left side of posterior pons (series 801, image 12/32) which shows susceptibility artifact on gradient echo images. There is no evidence of surrounding edema. The lesion is associated with linear enhancement which likely represent venous structure. Therefore, the diagnosis of cavernoma associated with developmental venous anomaly is most likely.On FLAIR images, multifocal scattered subcortical white matter high signal intensities on bilateral hemisphere.There is no evidence of abnormal enhancement. Considering the patient age, these lesions may represent inflammatory origin including lupus and multiple sclerosis.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, or midline shift. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Left posterior pons cavernous malformation with associated developmental venous anomaly.2. Multiple scattered bihemispheric subcortical white matter high signal lesions on FLAIR images indicate inflammatory lesions such as lupus or multiple sclerosis. Follow up study is recommended.


Instruction: Generate impression based on findings.

Input: Left knee pain There are tricompartmental osteophytes and moderate joint space narrowing, especially in patellofemoral compartment, indicative of moderate osteoarthritis. No joint effusion is seen. The contralateral right knee demonstrates mild to moderate osteoarthritis as seen on frontal view.

Output: Moderate osteoarthritis.


Instruction: Generate impression based on findings.

Input: History of end-stage renal disease status post parathyroidectomy. Past medical history significant for previous cerebrovascular accident now with worsening altered mental status, concern for repeat cerebrovascular accident versus seizure. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is extensive subcortical and deep cerebral white matter T2 hyperintensity bilaterally. There are small areas of encephalomalacia in the bilateral basal ganglia, thalami, and cerebellar hemispheres. There is mild diffuse cerebral volume loss. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is mucosal thickening and fluid in the bilateral sphenoid sinuses. There is a small posterior disc-osteophyte complex at C3-4 that abuts the spinal cord.

Output: 1. DIffuse cerebral white matter abnormality bilaterally may represent small vessel ischemic disease and/or toxic-metabolic encephalopathy.2. Chronic lacunar infarcts in the bilateral basal ganglia, thalami, and cerebellar hemispheres, but no acute infarcts. 3. Findings suggestive of acute sphenoid sinusitis.4. A small posterior disc-osteophyte complex at C3-4 abuts the spinal cord.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Reason: Evaluation for prostate cancer. History: Elevated PSA 8.19. Two distant negative prior biopsies. PELVIS:PROSTATE:Prostate Size: 6.2 x 4.8 x 6.0 cmPeripheral Zone: Lesion in the right peripheral zone measuring 7 x 3 mm (703/304) demonstrates hypointensity on T2/ADC with diffusion restriction and early enhancement, suspicious for prostate adenocarcinoma.There is additional patchy low T2 signal throughout the peripheral zone with areas of intermediate to low signal intensity on ADC but without enhancement.Central Gland: Multiple BPH nodules.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: No evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Mural hyperenhancement of the sigmoid colon may reflect mild inflammation.

Output: 1.Small lesion in the right mid peripheral zone measuring up to 7 mm is suspicious for process adenocarcinoma.2.Additional patchy areas of low T2 signal with intermediate to low ADC and no enhancement may reflect chronic pancreatitis, although neoplasm is also possible.3.No pelvic lymphadenopathy.4.Mural hyperenhancement in the sigmoid colon may reflect mild inflammation.


Instruction: Generate impression based on findings.

Input: 64 year old male with history of atypical mycobacterial infection within the right wrist. Abnormal signal intensity and enhancement within the distal ulna is compatible with the stated history of osteomyelitis. On large field-of-view images, this signal abnormality and enhancement appears to extend from the distal end of the ulna into the diaphysis over a length of at least 8 cm. Signal abnormality and enhancement is most prominent within the distal aspect of the ulna, where it is associated with several cortical defects / sinus tracts.There is a heterogeneously enhancing soft tissue mass surrounding the distal ulna, perhaps containing tiny pockets of fluid, but with no large drainable collection is identified. Overall, the circumferential mass measures approximately 4 cm in greatest diameter and presumably represents extension of infection into the soft tissues. There is also enhancement of the distal radioulnar joint indicating inflammation/infection, with a small cortically-based erosion along the medial aspect of the distal radius.Enhancement appears to extend through a defect in the triangular fibrocartilage into the radiocarpal joint, and there is abnormal signal and enhancement within the medial aspect of the triquetrum that may represent early osteomyelitis. This inflammation extends further distally along the dorsal aspect of the wrist and into the dorsal soft tissues of the hand, although the remaining carpal bones are of normal signal. Inflammation within the dorsal soft tissues of the hand is incompletely evaluated on today's MRI, but signal abnormality and enhancement along the length of the third metacarpal and within the distal half of the second metacarpal are also suspicious for osteomyelitis. Additional enhancement is seen in the soft tissues between the second and third metacarpals as well as third and fourth metacarpals. The signal intensity of the first, fourth, and fifth metacarpals appears normal.Diffuse subcutaneous edema involves the wrist and dorsum of the hand. Small foci of signal void in the soft tissues medial to the distal ulna likely represent metallic susceptibility artifact from prior surgery.There is medial subluxation of the extensor carpi ulnaris tendon as it courses through the aforementioned inflammatory mass. Mild generalized tenosynovial enhancement of the extensor tendons of the wrist indicates mild inflammation. There is perhaps minimal tenosynovial enhancement of the flexor tendons but this is of uncertain clinical significance.

Output: 1.Extensive soft tissue inflammation as described above, extending from the distal ulna into the wrist and dorsal soft tissues of the hand. This presumably represents infection with possible tiny foci of fluid along the ulna, although no large drainable fluid collection is seen.2.Signal abnormality within the distal ulna represents osteomyelitis that has likely progressed when compared to radiographs from May 2015. Additional foci of signal abnormality within the triquetrum and second and third metacarpals is also concerning for osteomyelitis.3.Enhancement of the radiocarpal joint and distal radioulnar joint, suggestive of septic arthritis.


Instruction: Generate impression based on findings.

Input: History of optic neuritis: visual decline. Orbits: There is diffuse high T2 signal involving the intraorbital, canalicular, and cisternal segments of the left optic nerve. There is also enlacement along the cisternal segment of the left optic nerve. The right optic nerve is intact. There are bilateral lens implants. The bilateral globes and ocular adnexa are otherwise unremarkable. There is no evidence of intraorbital mass lesions.Brain: There is no evidence of intracranial hemorrhage or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is a 10 mm diameter pineal gland cyst. 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, mastoid air cells, and scalp soft tissues are grossly unremarkable. There is mild mucosal thickening in the bilateral frontal and ethmoid sinuses.

Output: 1. Findings compatible with left optic neuritis.2. No evidence of acute intracranial hemorrhage or acute infarct.


Instruction: Generate impression based on findings.

Input: 50 year old with family history of breast cancer. History of benign MR guided left breast biopsy in March 2013. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally. Biopsy clip in the left breast from her benign MRI biopsy again noted. No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: History of halo for cervical instability after injury. Evaluate C1-C2 alignment, evaluate for changes. There is faint residual focal T2 hyperintensity within the spinal cord at the level of the dens. There is slight widening of the atlanto-dens interval, measuring up to 6 mm, where there also appears to be a small effusion. There is also slight asymmetry in distance between the lateral masses of C1and odontoid process, without evidence of rotatory subluxation. The vertebral column alignment is straightened in the sagittal plane. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The paravertebral soft tissues are unremarkable.

Output: Faint residual spinal cord contusion at the level of the dens and slight widening of the atlanto-dens interval. Evaluation for dynamic instability is otherwise limited without flexion and extension scans.


Instruction: Generate impression based on findings.

Input: Adenoid cystic carcinoma of the left floor of mouth. There is an enhancing mass centered the left floor of mouth that measures up to approximately 50 mm. The tumor has eroded into the lingula aspect of the left mandible and extends into the left submandibular space with mass effect upon the glossotonsillar sulcus. The tumor does not extend across the midline. There are denervation changes in the left tongue, but there is no evidence of perineural tumor in the region of the skull base. There is an enlarged left level 1B lymph node that measures 12 x 19 mm in axial section. The right submandibular gland and bilateral parotid glands are unremarkable. There is a right palatine tonsillary crypt retention cyst. The thyroid gland in unremarkable. The imaged orbits and intracranial structures are unremarkable. There is mucosal thickening in the bilateral ethmoid and maxillary sinuses. There is multilevel degenerative cervical spondylosis.

Output: 1. The adenoid cystic carcinoma of the left floor of mouth measures up to approximately 50 mm and has eroded into the lingula aspect of the left mandible and extends into the left submandibular space. 2. An enlarged left level 1B lymph node may represent metastatic disease.


Instruction: Generate impression based on findings.

Input: Acral melanoma: Re-evaluate disease status status post liver wedge resection and hold on immunotherapy. 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 unchanged. The orbits, skull, paranasal sinuses, and scalp soft tissues are unremarkable.

Output: No evidence of intracranial metastases.


Instruction: Generate impression based on findings.

Input: Compression of brain. Other specified postprocedural states. Other specified diseases of spinal cord Compression of brain. Assess Chiari decompression There have been interval surgical changes related to Chiari decompression. There appears to be decreased mass effect upon the brainstem anterior to the tonsils. CSF flow is demonstrated anteriorly and posteriorly, at the level of the cerebellar tonsils and through the foramen magnum.The cervical vertebral bodies are appropriate in overall alignment and height. The C1 vertebral body appears to be fused to the skull base. The posterior arch of C1 is not readily identified laminectomy changes from C2 through C6 are demonstrated. The previously identified T2 signal involving the upper cervical spinal cord is unchanged.At C2-3 there is no significant compromise to the spinal canal. There is a disc bulge present at level associated with some uncovertebral osteophytes and narrowing of the neural foraminal encroachment of left-sided exiting nerve roots..At C3-4 there is no significant compromise to the spinal canal. There is a disc bulge present this level associated with uncovertebral osteophytes and narrowing of the neural foramina bilaterally and encroachment of the exiting nerve roots.At C4-5 there is no significant compromise to the spinal canal or neural foramina. There is a disc bulge at this level. There are some right-sided uncovertebral osteophytes at this level.At C5-6 there is no significant compromise to the spinal canal. There is a disc bulge at this level associated with uncovertebral osteophytes bilaterally worse on the right side. There is encroachment of the right exiting nerve roots within the neural foramen.At C6-7 there is no significant compromise to the spinal canal. There are endplate and uncovertebral osteophytes present this level associated with encroachment of the exiting nerve roots within the neural foramina bilaterally.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.Chiari I malformation status post decompression.2.There is biphasic CSF flow present at the level of the cerebellar tonsils.3.Stable T2 signal abnormality involving the upper cervical spinal cord.4.Multilevel degenerative changes similar to prior examination.


Instruction: Generate impression based on findings.

Input: History of Crohn's disease with a J-pouch excision presenting with deep perineal pain. PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Status post proctocolectomy. Interval J-pouch resection. In the resection/surgical bed there is a small amount of fluid measuring 2.8 x 1.9 cm (series 501/61) in maximal cross-section extending 10 cm in the craniocaudal dimension (series 901/27). On the sagittal images the fluid appears space-occupying without mass effect, however there is questionable peripheral rim enhancement on postcontrast imaging. No restricted diffusion or adjacent inflammatory changes to suggest inflammation/infection.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Fluid in the proctectomy/surgical bed appears space-occupying without mass effect, however there is questionable peripheral rim enhancement on postcontrast imaging which may be surrounding peritoneal reflection enhancement as opposed to an organizing capsule. No restricted diffusion or adjacent inflammatory changes to specifically suggest inflammation/infection.


Instruction: Generate impression based on findings.

Input: 63-year-old male with a history of lymphoma and positivity in the duodenum on PET/CT scan who presents with elevated LFTs. ABDOMEN:LIVER, BILIARY TRACT: There is marked extrahepatic and moderate intrahepatic biliary ductal dilation most pronounced involving the common bile duct to the level of an enhancing distal common bile duct mass which appears to extend minimally beyond the level of the ampulla into the 2nd portion of the duodenum, lesion measures 1.5 x 1.1 cm (36; series 9) and correlates to the FDG avid focus seen on prior PET imaging. Simple cyst in segment IVB of the liver.SPLEEN: No significant abnormality noted.PANCREAS: Mildly prominent pancreatic duct.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Exophytic simple cysts in interpolar region of the left kidney.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Enhancing distal common bile duct mass, which appears to extend minimally beyond the level of the ampulla into the 2nd portion of the duodenum, measuring 1.5 x 1.1 cm (36; series 9). BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1.5 cm distal common bile duct mass, with associated marked extrahepatic and mild to moderate intrahepatic biliary ductal dilation. Lesion extends to level of ampulla with apparent minimal extension into the second portion of the duodenum with mild dilation of the duodenum proximally. These findings are suspicious for a primary cholangiocarcinoma with differential considerations including an ampullary malignancy or duodenal neoplasm. Further characterization with ERCP/histologic sampling recommended.


Instruction: Generate impression based on findings.

Input: At L5-S1, there is desiccation of the intervertebral disc with mild loss of intervertebral disc height and a disc bulge causing moderate to severe right and moderate left compression of the traversing S1 nerve roots, but no significant neural foraminal narrowing. Otherwise, there is no significant disc bulge, herniation, spinal canal, foraminal stenosis or facet disease at T12 through L5. The lumbar spine displays a normal lordosis. The vertebral body heights are maintained. The bone marrow signal is unremarkable. The distal spinal cord and conus medullaris are within normal limits. The paravertebral soft tissues are unremarkable.

Output: A disc bulge at L5-S1 results in bilateral lateral recess stenosis with nerve root compression, right more than left.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: T1 and T2 hyperintense lesions are noted involving the right cerebellar hemisphere and vermis extending to the middle cerebellar peduncle and adjacent posterior lateral pons. Postcontrast images demonstrate multilobular, and multifocal enhancement of lesions involving the right cerebellar hemisphere, right middle cerebellar peduncle, the right posterolateral pons, as well as the left pontomedullary surface. The largest cerebellar focus of enhancement measures approximately 27 x 22 mm in axial dimension. These are associated with surrounding vasogenic edema. Additionally, there is nodular enhancement along the tentorium with additional enhancing nodules along the left anterior paramedian falx, involving the optic apparatus and adjacent inferior left rectus dry wrist, right occipital horn minimal surface, filling the right internal auditory canal, along the right occipital craniectomy site, and coating several cranial nerves..Craniotomy changes involving the right frontal bone near the convexity suggest the presence of a previous biopsy site.Redemonstrated is marked lateral and third ventricular enlargement with periventricular T2 hyperintensity suggesting transependymal flow. Although, white matter abnormality is diffuse, and there may also be a component of underlying treatment response.Susceptibility hypointensity is noted along a previous left frontal approach ventriculostomy catheter tract. Susceptibility also demonstrates tiny foci of hemorrhage within bilateral occipital horns.Fluid is again noted within the sphenoid sinuses and bilateral mastoid air cells. Expected vascular flow voids are demonstrated.

Output: Extensive metastatic disease involving supratentorial and infratentorial brain, the intraventricular spaces, extra-axial CSF spaces, the dura, and the tentorium.


Instruction: Generate impression based on findings.

Input: 75 year-old female with altered mental status and lethargy. Evaluate for ICH or mass. There is no evidence of intracranial hemorrhage, mass or edema. Multifocal areas of patchy hypoattenuation in the subcortical and deep white matter distribution, nonspecific, however most likely related to small vessel ischemic disease, age indeterminate. No evidence of acute cortical stroke is noted. If there is clinical concern for acute ischemia, an MRI may be considered.The ventricles and basal cisterns appear enlarged secondary to volume loss.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. Multifocal white matter hypoattenuation most likely representing small vessel ischemic disease, age indeterminate. 2. No evidence of acute cortical stroke. If there is clinical concern for acute ischemia, MRI may be considered.3. No evidence of mass or intracranial hemorrhage as clinically questioned.


Instruction: Generate impression based on findings.

Input: Newly diagnosed bilateral optic disc edema, mild headaches. Brain MRI: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles are mildly prominent diffusely. 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.Orbit MRI: The bilateral globes, optic nerves, orbital fat, extraocular muscles, and superior ophthalmic veins are unremarkable. There is Brain MRV: There is narrowing of portions of the bilateral transverse sinuses, but no evidence of thrombosis.

Output: 1. No evidence of acute intracranial hemorrhage, mass, or acute infarct.2. No evidence of orbital lesions.3. Narrowing of portions of the bilateral transverse sinuses may represent a normal variant or a manifestation of pseudotumor cerebri.4. Mild nonspecific diffuse prominent of the ventricles.


Instruction: Generate impression based on findings.

Input: No evidence of acute ischemia or hemorrhage. Encephalomalacia of left occipital lobe and left medial temporal lobe compatible with prior infarct. There is also focal T2/FLAIR hyperintensity along the posterior left cerebellum with hemosiderin deposition, new from prior study but chronic and nonenhancing. This lesion is linear in appearance and does not have the appearance of a mass. Stable signal abnormalities in the subcortical and periventricular white matter compatible with chronic small vessel ischemic disease. 3-D T1 post contrast images are limited by motion artifact but no definite abnormal brain enhancement is identified. No evidence of mass, mass effect, or hydrocephalus. Major intracranial vessels with flow voids. Paranasal sinuses and mastoid air cells are clear. Bilateral orbits are unremarkable. Diffuse nonspecific heterogeneity of the bone marrow signal, stable from prior study.

Output: 1.No acute intracranial abnormality.2.Evidence of prior left temporooccipital lobe infarct, with interval small area of gliosis in the left posterior cerebellum with trace hemosiderin deposition suggesting prior hemorrhage.3.No definite evidence of intracranial metastasis.


Instruction: Generate impression based on findings.

Input: 57-year-old male with right knee pain. Meniscal tear medial? MENISCI: There is a complex tear of the medial meniscus involving the body and posterior horn. This includes truncation of the free edge of the body and posterior horn, indicating a radial tear, with an additional horizontal tear of the posterior horn extending to the tibial articular surface. Furthermore, there is extrusion of degenerated meniscal tissue into the medial gutter of the knee, beneath the body of the meniscus. The anterior horn appears intact. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is mild bone marrow edema type signal within the far medial aspect of the medial tibial plateau and weightbearing surface of the medial femoral condyle adjacent to the torn meniscus. There is tapering of the articular cartilage at this site, suggesting chronic degeneration. There is focal increased signal intensity of the articular cartilage of the weightbearing surface of the lateral tibial plateau suggesting near full thickness degeneration. There is full-thickness degeneration of the articular cartilage of the median eminence of the patella, superiorly, as well as along the far medial aspect of the patella. There is superficial degeneration of the remainder of the patellar cartilage as well as the articular cartilage of the femoral trochlea. Thickened trabeculae within the lateral femoral condyle are not associated with edema and probably of no clinical significance.LIGAMENTS: The cruciate and collateral ligaments appear intact.EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: Complex tear of the medial meniscus and other findings as described above.


Instruction: Generate impression based on findings.

Input: Glioblastoma. Status post prior re-irradiation and Avastin therapy. Presenting with progressive abnormality of gait, generalized weakness, and incoordination over the past 2 days. Additional clinical history from electronic medical records: Underwent craniotomy with complete radiographic resection (7/22/14, Dr. Lesniak). She lacked EGFRv3 mutation. She received RT/TMZ and then TMZ. This was for a total of 6 cycles of TMZ. When there was progression of disease she enrolled in RTOG1205 for which she received re-RT, as well as additional bevacizumab. She had then been continuing bevacizumab off study under the care of Dr. Nicolau in Florida. More recently, she returned to Chicago and received a dose of bevacizumab on 05/18/2016 with Dr. Narula. The right temporal surgical cavity is not significantly changed nor the associated contrast enhancement along its posterior margin. However, T1 and T2 hypointense lesions along the anterior and superior surgical margins have increased in size and shows peripheral contrast enhancement and mild diffusion restriction. The anterior one measures up to 2.3 cm, on postcontrast sagittal T1, compared to 1.7 cm previously. The superior one measures up to 1.7 cm on same image compared to 1.2 cm previously. Dynamic susceptibility contrast-enhanced perfusion imaging shows no prominent CBV increase in the treatment bed or adjacent parenchyma. The confluent white-matter T2-hyperintensity surrounding the surgical cavity has slightly increased, with more extension along the right internal and external capsules. There is no acute infarct or acute intracranial hemorrhage. There is no midline shift or brain herniation. The lateral ventricles are slightly less enlarged than before. Nonspecific periventricular T2-hyperintensity and mild global brain volume loss are not significantly changed. Major intracranial vascular flow voids are preserved. There are findings of prior bilateral cataract surgery. The right parietal craniotomy flap and the small underlying extra-axial fluid collection are not significantly changed. There is an unchanged subcentimeter nonspecific enhancing lesion in the left parietal bone.

Output: 1.Enlarging lesions with peripheral contrast enhancement and mild diffusion restriction along the anterior and superior surgical margins are suggestive of tumor progression despite the discernible contrast enhancement or hyperperfusion, perhaps due to superimposed treatment effects.2.There is no acute infarct, acute hemorrhage, mass-effect or brain herniation.3. Unchanged subcentimeter nonspecific enhancing lesion in the left parietal bone.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 47 years, Male, with multiple sclerosis. Paresthesias. Evaluate for progression. There are approximately 20 periventricular and subcortical supratentorial as well as infratentorial T2/FLAIR hyperintense lesions in the white matter with morphology and distribution consistent with known demyelinating disease. Multiple lesions are seen along the corpus callosum. Infratentorial lesions include the pons, right middle cerebellar peduncle, and right cerebellar hemisphere. Several apparent foci of hyperintensity in the cerebellum are most likely artifactual. Compared to 6/21/2013, no new lesion is definitively appreciated. Multiple lesions with T1 hypointensity are again seen. There is minimal global brain parenchymal volume loss including thinning of the corpus callosum. No intracranial mass or mass effect. No hydrocephalus. Bone marrow signal and extracranial soft tissues are unremarkable. Patchy opacification of the ethmoid sinuses again seen.

Output: No convincing evidence of progression of chronic demyelinating disease in the brain compared to 6/21/2013.


Instruction: Generate impression based on findings.

Input: Female 50 years old with Hx of multifocal GBM s/p reRT 3mo ago, on TMZ and Avastin Post-surgical changes of a right frontal craniotomy and tumor resection with associated ex vacuo of the right lateral ventricle. The resection cavity is multiseptated with areas of subtle enhancement along the posterosuperior aspect, some of which appears to be intra-axial, overall appearing stable in terms of enhancing pattern and configuration. An additional lenticular area of enhancement anteromedial and adjacent to the resection cavity just right of the falx appears unchanged from prior exam. No associated perfusion abnormality, edema or mass effect. Increased T2/FLAIR signal is noted along the resection margin as well as the left centrum semiovale, which appears stable from prior exams and likely represents gliotic changes.There is redemonstration of a non-enhancing T2/FLAIR hyperintensity within the right cerebellum, which causes mild effacement of the posterolateral aspect of the fourth ventricle, and measuring 12 x 18 mm (501/8), unchanged from prior exam.Subtle nodular enhancement of the right frontal horn, which abuts the anteromedial ependymal surface, is less conspicuous and measures up to 6 x 4 mm (1301/19), decreased from prior 13 x 9 mm accounting for technical differences.No evidence of restricted diffusion to suggest acute infarct. The ventricles and basal cisterns are patent. There is no midline shift or herniation. The major cerebral flow voids are intact.

Output: 1. Post-surgical changes of right frontal craniotomy with tumor resection. Mildly enhancing right frontal horn nodular lesion appears less conspicuous than prior exam. Subtle enhancement along the posterosuperior and anteromedial aspects of the resection bed appear stable from prior exam. No new lesions identified.2. Stable non-enhancing right paramedian cerebellar lesion.


Instruction: Generate impression based on findings.

Input: Ms. Jones is a 28-year-old female with biopsy-proven left breast invasive carcinoma. Diffuse disease is suspected. MRI is needed for further evaluation due to dense breast tissue. There is extreme amount of fibroglandular tissue in both breasts. Moderate background parenchymal enhancement is noted bilaterally, which limits the sensitivity of this examination.LEFT BREAST:The entire left breast demonstrates diffuse, markedly abnormal enhancement with associated skin thickening (measuring up to 0.7 cm) and nipple retraction. The enhancement extends up to and into the left nipple itself. Susceptibility artifact from a biopsy marker clip is seen in the left lower inner breast, far posterior depth, consistent with biopsy proven malignancy. There are multiple enlarged left axillary lymph nodes present, the largest one of which measures 2.2 x 1.0 cm. RIGHT BREAST:There is a linear segment of clumped non-mass enhancement identified in the medial right breast, far posterior depth, that measures up to 2.6 cm in the AP dimension. There is a right-sided chest port.There is a prominent right axillary lymph node identified that measures approximately 1.6 x 1.0 cm.

Output: (1) Diffuse abnormal enhancement affecting the entire left breast with associated skin thickening and nipple retraction. Findings are highly suspicious for inflammatory breast cancer. Recommend correlation with recent skin punch biopsy. If skin punch biopsy is negative, then an additional biopsy can be performed to confirm extent of disease.(2) Bilateral enlarged axillary lymph nodes. An ultrasound-guided biopsy with clip placement can be performed if clinically warranted.(3) 2.6 cm linear segment of clumped nonmass enhancement in the medial right breast. An MR guided biopsy with clip placement is recommended for further evaluation. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. There is some loss of cervical lordosis, alignment is otherwise maintained. Bone marrow signal is benign. The cervical spinal cord has normal signal characteristics and overall morphology.Degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: No significant compromise to the spinal canal or neural foramina.C4-5: No significant compromise to the spinal canal or neural foramina.C5-6: There is a disc osteophyte complex including a right central disc extrusion. There is also ligamentum flavum thickening. There is resulting moderate spinal canal stenosis including mild cord deformity. No cord signal abnormality. There is moderate to severe right and mild left neural foraminal stenosis related to uncovertebral hypertrophy. Mild facet arthropathy.C6-7: There is a disc bulge with small extrusion component as well as ligamentum flavum thickening. There is mild to moderate spinal canal stenosis. There is mild right and minimal left neural foraminal stenosis. Mild facet arthropathy.C7-T1: No significant compromise to the spinal canal or neural foramina. Mild facet arthropathyThe vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.THORACIC SPINE

Output: 1. Degenerative changes in the cervical spine at the C5-C6 and C6-C7 levels. There is moderate spinal canal stenosis at C5-C6 and to a lesser degree at the C6-C7 level. There is moderate to severe right C5-C6 neural foraminal stenosis this level. No cord signal abnormality. Additional levels as above.2. Minimal degenerative changes in the thoracic spine with no significant spinal canal or neural foraminal stenosis at any level in the thoracic spine. No cord signal abnormality.3. Mild degenerative changes in the lumbar spine including mild left L3-L4 and L4-L5 neural foraminal narrowing. No high-grade neural foraminal stenosis at any level in the lumbar spine.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for acute abnormality. Signs and symptoms: Worsening chronic neck pain with soft tissue inflammation at the base of neck. Nonenhanced cervical MRI:Examination demonstrates no evidence of fracture or malalignment.Normal signal intensity and caliber of cervical cord.Unremarkable foramen magnum.C2-C3 is unremarkable.C3-C4 is unremarkable.C4-C5 is unremarkable.C5-C6 demonstrate mild degenerative changes, tiny right median disc protrusion (axial T2 series 701 image 10) results in subtle flattening deformity of the ventral aspect of the cord. No detectable signal abnormality of the cord. No convincing evidence of spinal stenosis or neural foraminal compromise.C6-C7 demonstrate advanced disc disease and significant loss of disc height, moderate (left greater than right) neural foraminal compromise and no central spinal stenosis.C7-T1 demonstrate mild degenerative changes without spinal stenosis or neural foraminal compromise.Nonenhanced thoracic MRI:Examination demonstrates no detectable fracture or malalignment.The signal intensity of vertebral column is unremarkable.The signal intensity and caliber of thoracic cord is unremarkable.Examination at T7-T8 demonstrate a right lateral small disc protrusion resulting in subtle flattening deformity of right lateral aspect of the cord without detectable cord signal abnormality, spinal stenosis or neural foraminal compromise.At T8-T9 there is also evidence of a right lateral disc protrusion without mass effect on the cord, spinal stenosis or neural foraminal compromise and with normal signal intensity of the cord.Unremarkable images at other levels and without intravenous or spinal stenosis or neural foraminal compromise. No detectable perispinal soft tissue abnormalities.

Output: 1.Nonenhanced MRI of cervical spine demonstrate advanced degenerative disc disease at C6/C7, tiny right perineum disc protrusion at C5-C6, no spinal stenosis or neural foraminal compromise at any level and no detectable paraspinal soft tissue abnormalities. There is normal signal intensity and caliber of cervical cord.2.Nonenhanced MRI of the thoracic spine demonstrate normal signal intensity of the vertebral column, cord and the perispinal soft tissues. No spinal stenosis or neural foraminal compromise at any level. Small right lateral disc protrusions at T7-T8 and T8-T9 levels as detailed.


Instruction: Generate impression based on findings.

Input: Clinical question: Rule out brain metastases. Signs and symptoms:N/A Pre-and post-enhanced brain MRI:No diffusion weighted abnormalities.Flair and T2-weighted images demonstrate scattered foci of hyperintensity in the in the periventricular and subcortical white matter cerebral hemispheres and consistent with mild chronic nonhemorrhagic small vessel ischemic strokes. Unremarkable renal cortex, cortical sulci, ventricular system the CSF spaces for age.Post enhanced images are negative for any abnormal enhancement the brain parenchyma, leptomeninges, calvarial or the orbits to suggest metastatic disease. There however visualization of a small right occipital calcarine fissure developmental venous anomaly.Unremarkable orbits, paranasal sinuses, mastoid air cells and middle ear cavities

Output: 1.No evidence of metastatic disease.2.Negative diffusion weighted images.3.Mild chronic nonhemorrhagic small vessel ischemic strokes only in the subcortical and periventricular hemispheric white matter and normal signal intensity of brain parenchyma otherwise.4.A small right occipital calcarine fissure developmental venous anomaly is detected


Instruction: Generate impression based on findings.

Input: left side facial palsy No evidence of acute ischemic or hemorrhagic lesion on this scan.No evidence of abnormal enhancement.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: Normal brain MRI scan.


Instruction: Generate impression based on findings.

Input: Right thalamus glioblastoma status post recent partial resection. There has been partial resection of the right thalamic mass via a right parietal approach. The residual tumor measures up to approximately 6 cm. There are blood products along the surgical tract and in the occipital horn of the right lateral ventricle, as well as within the right thalamic mass. There is a right parietal ventriculostomy catheter that traverses the right lateral ventricle and indents the anterior corpus callosum. There is perhaps a small amount of restricted diffusion related to ischemic tissue along the surgical approach, but no evidence of territorial infarction. There is also a small amount of linear enhancement along the surgical approach, which may represent granulation tissue. There is decreased dilatation of the right lateral ventricle, while the left lateral ventricle remains dilated and the third ventricle is partially effaced. The cortical swelling and high T2 signal in the inferior right parietal lobule has diminished. There is minimal extra-axial fluid underlying right parietal craniotomy flap and swelling and fluid in the overlying scalp. There is a maxillary retention cyst and sphenoethmoidal mucosal thickening. The orbits are unremarkable.

Output: 1.Interval partial resection of the large right thalamic glioblastoma with intratumor hemorrhage and a small amount of hemorrhage along the surgical path and ventricular system. The residual tumor measures up to approximately 6 cm.2.Decreased dilatation of the shunted right lateral ventricle.3.Decreased right parietal cortical edema, which may represent transient seizure-related effects.


Instruction: Generate impression based on findings.

Input: There is significant decrease in confluent T2 signal abnormality in the right superior and middle frontal gyri. Many of these lesions show low signal on T1 images, although more lesions are visible on T2 images. Numerous (greater than 15) remaining periventricular and subcortical white matter lesions in the supratentorial brain are without significant change, most of which remain rather confluent. There are white matter T2 hyperintense lesions in pons and left cerebral peduncle which are also unchanged. Stable lesion are also likely present in the right brachium pontis. There is a single area of enhancement along the right corona radiata on 901/54 although it has a minimally curvilinear figuration. It is not identified on the prior postcontrast images. There is no other definite pathologic intracranial enhancement. The ventricles and sulci are main unchanged.There is an unchanged 23 x 22 x 6 mm lipoma along the high left paramedian scalp. There is redemonstration of a lobulated area of T1 hypointensity and T2/FLAIR hyperintensity when correlating with prior exams along the paramedian anterior frontal calvarium. Previous sagittal T1 postcontrast images demonstrated mass effect upon the adjacent superior sagittal sinus which is narrowed at this location, possibly representing focal prominence of arachnoid attenuation.Artifact limits evaluation of the visualized upper cervical cord, although there is questioned focal FLAIR hyperintensity at the C4-C5 level within the cord, as well as dorsally at the C3 level.

Output: 1. Significant decrease in confluent T2 signal abnormality in the right superior and middle frontal gyri with numerous other stable white matter lesions both in the supratentorial and infratentorial brain. Overall, mild to moderate T1 and moderate T2 burden of disease.2. Single area of apparent enhancement along the right corona radiata which may indicate a small active plaque, given its absence on prior post contrast imaging. This is not favored to represent a vascular structure despite its minimally curvilinear appearance.3. Questioned focal FLAIR hyperintensity in the cord at the C3 and C4-C5 levels versus artifact. Dedicated MRI of the cervical spine may be obtained as clinically indicated.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Male, 44 years old, with back pain. Assess L4 pathologic fracture secondary to lung cancer, one month follow-up. A pathologic compression fracture of the L4 vertebral body status post vertebroplasty is redemonstrated. There has been further collapse of vertebral body height with complete loss of height centrally. Retropulsion results in a mild generalized spinal canal narrowing and effacement of the left lateral recess which is similar to the prior examination. Moderate to severe narrowing of the left L3-4 neural foramen is unchanged, while severe narrowing of the left L4-5 neural foramen has progressed.Since the prior examination, a large cystic space containing a blood fluid level within the left posterior paraspinal soft tissues adjacent to L4 has significantly decreased in size. However, a septated or loculated pattern of apparent cystic spaces within the left L4 pedicle and transverse process has become more conspicuous.The epidural tissues and the ligamentum flavum are thickened and enhancing at L3-4, similar to prior. The compressed L4 vertebral body is diffusely enhancing, similar to prior. No definite evidence of any significant epidural tumor is seen.A 1 cm sclerotic focus within the T12 vertebral body is unchanged. A T1 and T2 hypointense, partially sclerotic lesion within the L1 vertebral body seems to have increased slightly in size with a mild increase in surrounding marrow edema. No entirely new osseous lesions are seen.

Output: 1.Continued interval collapse of the pathologic L4 compression fracture is seen. Retropulsion at this level continues to result in mild spinal canal narrowing and effacement of the left lateral recess. Severe left foraminal narrowing at L4-5 has progressed.2.Since the prior examination, a large presumed hemorrhagic cavity within the left posterior paraspinal soft tissues at L4 has significantly decreased in size. However, there is a new pattern of apparent cystic spaces within the left L4 pedicle and transverse process. This could represent the development of osseous hemorrhagic cysts related to the fracture or prior instrumentation. The possibility of underlying tumor involvement must also be considered.3.A sclerotic lesion within the T12 vertebral body is unchanged. A partially sclerotic lesion within the L1 vertebral body seems to have increased mildly in size. No entirely new osseous metastases are seen.


Instruction: Generate impression based on findings.

Input: Evaluate for lumbar disc disease: low back pain. There is mild degenerative spondylosis at L3 through S1 with disc dessication, facet hypertrophy, and slight disc bulging at these levels. There is at most mild neural foraminal stenoses bilaterally at these levels, but no significant spinal canal stenosis. There is also edematous endplate bone marrow alteration at L5-S1. There is no significant degenerative spondylosis at the other lumbar spine levels. The vertebral column alignment is within normal limits. The vertebral body heights are preserved. There is a hemangioma or focal fat within the L2 vertebral body. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: Mild degenerative spondylosis at L3 through S1 with disc dessication, facet hypertrophy, and slight disc bulging at these levels. There is at most mild neural foraminal stenoses bilaterally at these levels, but no significant spinal canal stenosis.


Instruction: Generate impression based on findings.

Input: Ovarian cancer with brain metastases treated with SRS. There are postoperative findings related to right frontal craniotomy for resection of a right frontal lobe metastases. There is persistent confluent T2 hyperintensity surrounding the resection cavity, but no evidence of enhancing tumor in this region. There is no significant interval change in size of the enhancing lesion in the right peritrigonal white matter that measures up to 6 mm in width, with associated vasogenic edema. The punctate left periventricular frontal lobe white matter and left inferior temporal gyrus punctate lesions are now more apparent. There is no discernible lesion in the cerebellum. There is unchanged scattered non-enhancing mild cerebral white matter T2 hyperintensity, which is nonspecific. There is no evidence of acute intracranial hemorrhage or infarction. There is no midline shift. The major cerebral flow voids are intact. The orbits are unremarkable.

Output: 1. Post-treatment findings in the right frontal lobe without evidence of recurrent tumor in this region.2. No significant interval change in size of the subcentimeter right peritrigonal metastasis.3. The punctate left periventricular frontal lobe white matter and left inferior temporal gyrus punctate metastases are now more apparent.


Instruction: Generate impression based on findings.

Input: Reason: adrenal insufficiency History: short gut, TPN dependence, poor growth, normal GLT stim test and centreal adrenal insufficiency MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images, predominantly on the left side.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI pituitary:The pituitary gland is appropriate in overall height and morphology. The infundibulum of the pituitary gland is midline. No suprasellar or intrasellar mass is identified. The cavernous sinuses are intact bilaterally.

Output: 1.No abnormal lesion is identified in the pituitary gland. The pituitary is normal in overall size and morphologic appearance.2.Punctate periventricular white matter lesions of a mild degree are present which are nonspecific. Given the patient's PMH, they are most likely are perinatal in origin.


Instruction: Generate impression based on findings.

Input: 35 year-old female with headache, recent delivery via c/s. Evaluate for bleed. There is no evidence of intracranial hemorrhage, mass 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. The orbital contents are within normal limits.

Output: No acute intracranial abnormality.


Instruction: Generate impression based on findings.

Input: History of left lumpectomy for IDC in 04/2010. Patient is status post radiation. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.No suspicious enhancement is seen in either breast. Stable post surgical changes in the left axillary tail and axilla. Stable benign enhancing foci in the right breast. No abnormal axillary lymph nodes are identified in either axillary region.

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