Instruction: Generate impression based on findings.

Input: There is abnormal T2 hyperintensity at the dorsal paramedian cord at the C7-T1 level extending to the T1-T2 level. There is associated abnormal enhancement. The signal abnormality appears to be present on prior cervical MRI study. Dorsal paramedian cord T2 hyperintensity is also seen from the lower T3 to the lower T4 level with minimal enhancement. No signal abnormality is seen in the remainder of the thoracic cord.The thoracic spine is in normal alignment, with a normal thoracic kyphosis. The vertebral body heights are well maintained. No worrisome focal marrow signal abnormality is appreciated. There is a small left central disc extrusion at the T6-T7 level with minimal cranial extension abutting the ventral aspect of the cord. There is otherwise no significant disk bulge, herniation, spinal canal or foraminal stenosis within the thoracic spine.There are multiple cysts in the bilateral kidneys, some of which demonstrate T1 hyperintensity compatible with proteinaceous or hemorrhagic cysts.1. LUMBAR SPINE

Output: T2 signal abnormality with enhancement in the cervical cord is partially imaged and appears to extend in an interrupted fashion into the dorsal aspect of the upper thoracic cord to the T1-T2 level. There is additional, but similar signal abnormality extending from the T3 to T4 levels. Given the multifocal dorsal distribution, differentials include metabolic processes such as B12 deficiency, inflammatory processes such as neurosarcoid, infection such as varicella zoster or HIV, demyelinating lesion such as NMO, and less likely neoplasm.


Instruction: Generate impression based on findings.

Input: Female, 82 years old, with 15 mm pituitary adenoma found incidentally on 06/22/15 after falling and striking her head. Evaluate for interval change in size. A pituitary mass is redemonstrated which fills and slightly expands the sella. The lesion measures up to 15 mm in maximal dimension and shows no significant interval change in size or morphology. The pituitary infundibulum deviates toward the left of the lesion. No impingement of the optic apparatus is suspected. Multiple scattered white matter T2 hyperintense lesions are again seen in the context of moderate parenchymal volume loss.

Output: No change in the size or morphology of the pituitary mass.


Instruction: Generate impression based on findings.

Input: post deep brain electrode insertion follow up. Right hippocampal volume loss. There are multiple electrodes inserted on this scan.Specifically, one electrode through the right occipital burr hole and the tip is located at the right hippocampus.There are three more electrodes and the tip locations are anterior middle and posterior aspect of the right hippocampus, through the right temporal burr hole. There is another electrode inserted through the left occipital burr hole and the tip of the electrode is located at the left hippocampus.There are significant metallic artifacts from the electrodes which prevents precise evaluation of electrode track changes. However, there are a couple of changes shown on today's scan.First, there is ovoid shape signal void (series 301, image 97/176) in the frontal horn of left lateral ventricle which corresponds well to intra-ventricular air. This could related to operation related considering one of the right temporal approach electrodes especially toward middle portion of the right hippocampus appears to be traversing right lateral ventricle temporal horn and the right occipital approach electrode traverse right lateral ventricle occipital horn. Second, there is tubular high signal intensity on T2 weighted axial scan which follows the most posteriorly located electrode through the right temporal burr hole. This may represent electrode track edema or fluid collection.A bit prominent enhancement seen on the area of the right side choroidal fissure may represent choroidal plexus enhancement and due to associated electrode related metallic artifact, it appears to be a bit prominent enhancing area. The ventricles size is symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Post multiple deep brain electrodes insertion status.2. Intraventricular air was seen which is operation related.3. Likely electrode track edema along with right temporal burr hole approach posterior electrode.4. No abnormal enhancement.


Instruction: Generate impression based on findings.

Input: The craniocervical junction is unremarkable. Vertebral body heights are normal. Alignment is grossly maintained. Bone marrow signal is benign. No abnormal signal in the cervical or upper thoracic cord.There are multilevel degenerative changes throughout the cervical spine, as described below:C2/3: There is a mild posterior disc bulge without significant spinal canal stenosis. No neural foraminal stenosis. C3/4: There is a mild posterior disc bulge with minimal spinal canal stenosis. No significant neural foraminal stenosis. C4/5: There is a small disc osteophyte complex which effaces the ventral thecal sac and results in mild spinal canal stenosis. There is mild right and minimal left neural foraminal stenosis related to uncovertebral hypertrophy. C5/6: There is small disc osteophyte complex without significant spinal canal stenosis. There is minimal bilateral neural foraminal stenosis.C6/7: There is small disc osteophyte complex with minimal spinal canal stenosis. There is minimal bilateral neural foraminal stenosis.C7/T1: No significant spinal canal or neural foraminal stenosis. There is mild bilateral facet arthropathy.

Output: Mild multilevel degenerative changes in the cervical spine without high-grade spinal canal or high-grade neural foraminal stenosis at any level. Specifically, no significant neural foraminal narrowing at the C7-T1 level is appreciated. Please see additional levels as above.


Instruction: Generate impression based on findings.

Input: 70-year-old man with history of bladder cancer status post cystectomy. ABDOMEN:LIVER, BILIARY TRACT: The visualized portions the liver are normal in signal and morphology. Scattered subcentimeter hepatic cysts are noted. The gallbladder is normal and there is no intra or extrahepatic biliary ductal dilatation.SPLEEN: Partially visualized spleen appears normal.PANCREAS: The pancreas is atrophic but the pancreatic duct is normal in caliber.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple simple cortical cysts are seen in the kidneys bilaterally. No suspicious renal masses and no hydronephrosis. The patient is status post cystectomy and ileal conduit formation withRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: Patient status post prostatectomy.BLADDER: Patient is status post cystectomy and ileal conduit formation.LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Postoperative changes from cystectomy and ileal conduit formation without evidence of recurrent or metastatic disease.


Instruction: Generate impression based on findings.

Input: Newly diagnosed tongue mass, eval extent of lesion. There is a heterogeneously enhancing mass in the right floor of mouth with possible involvement of the overlying right mylohyoid muscle and oral tongue. The tumor extends across the midline measures up to approximately 35 mm. In addition, there is surrounding ill-defined T2 hyperintensity and enhancement that extends towards the tongue base, which also appears diffusely enlarged. However, the overlying mandible appears to be intact. Although not particularly enlarged based on size criteria, right level 1B and 2B lymph nodes appear hyperenhancing. There is a heterogenous right level 3 lymph node that measures 11 x 13 mm. There is also a prominent left level 1B lymph node that measures 12 x 15 mm in axial cross section. The thyroid and salivary glands appear to be intact. The larynx appears to be unremarkable. The orbits and intracranial structures are grossly unremarkable. There is multilevel degenerative spondylosis of the cervical spine, including a disc-osteophyte complex at C5-6 that mildly impinges upon the spinal cord.

Output: 1. A heterogeneously enhancing mass in the right floor of mouth and oral tongue with extension across the midline measures up to 35 mm likely represents a squamous cell carcinoma. Ill-defined enhancement that extends towards a prominent, likely hyperplastic lingual tonsil may represent peritumoral inflammation rather than tumor infiltration.2. Bilateral cervical lymphadenopathy likely, at least in part, represents metastatic disease.


Instruction: Generate impression based on findings.

Input: Clinical question: History of breast cancer in right breast. Signs and symptoms: Evaluate for progression of disease. Nonenhanced head CT:Examination demonstrates diffuse subtle subcortical and periventricular foci of low attenuation which are nonspecific although concern patient's age are highly suspected for minimal small vessel ischemic disease of indeterminate age.There is no evidence of intracranial hemorrhage, edema, mass effect, midline shift or hydrocephalus. This non-infused examination demonstrate no evidence of any findings to suggest metastatic lesions however lack of intravenous contrast significantly reduces the sensitivity of the exam for detection of small metastatic disease to the brain or leptomeninges. Falloff in infuse the study or an enhanced MRI should be considered.The cortical sulci, ventricular system and CSF cisterns remain already normal.Visualized mastoid air cells and paranasal sinuses are unremarkable.Images through the orbit demonstrate evidence of prior cataract surgery.Calvarium is intact.

Output: 1.Negative non-infused head CT for metastatic disease. Recommend further studies will an enhanced CT or an enhanced MRI is recommended.2.Small vessel disease of indeterminate age.3.Negative calvarium, paranasal sinuses and mastoid air cells.


Instruction: Generate impression based on findings.

Input: There has been interval evolution of the disease burden involving the sacrum, with some areas that appear to be smaller with less enhancement , but some areas have enlarged with cystic and enhancing components, particularly within the left sacral ala and expanded spinal canal at S2, causing compression of the left S1 and S2 nerve roots and bilateral S3 nerve roots within the neural foramina. Otherwise, the previously demonstrated lesions in the lumbar vertebrae no longer enhance, suggestive of treatment response. The vertebral column alignment is within normal limits. The vertebral body heights are preserved. The spinal cord displays normal signal and morphology. There are hepatic cysts. There appears to be diffuse mural hyperenhancement of the bowel in the posterior pelvis.

Output: 1. Interval evolution of the disease burden involving the sacrum, with some areas that appear to be smaller with less enhancement in response to treatment, but some areas have enlarged with cystic and enhancing components, suggestive of tumor progression versus less likely superimposed infection, particularly within the left sacral ala and spinal canal, causing compression of the left S1 and S2 nerve roots and bilateral S3 nerve roots within the neural foramina. Otherwise, the previously demonstrated lesions in the lumbar vertebrae no longer enhance, suggestive of treatment response. 2. Diffuse mural hyperenhancement of the bowel in the posterior pelvis may represent inflammation.These findings were discussed with Dr. Kourosh Rezania at 4:40 PM on 7/28/2016.


Instruction: Generate impression based on findings.

Input: 38 year old man with history of a mechanical aortic valve replacement in 2009, recent TIA like symptoms and discordant left ventricular function on recent transthoracic echocardiogram versus transesophageal echocardiogram. He was referred for cardiac MRI to evaluate LV function. Left VentricleThe left ventricle is moderately dilated with mildly reduced systolic function. The overall LV ejection fraction is 50%, the LV end diastolic volume index is 120 ml/m2 (normal range: 74+/-15), the LVEDV is 222 ml (normal range 142+/-34), the LV end systolic volume index is 61 ml/m2 (normal range 25+/-9), the LVESV is 112 ml (normal range 47+/-19), the LV mass index is 57 g/m2 (normal range 85+/-15), and the LV mass is 105 g (normal range 164+/-36). Wall motion appears mildly hypokinetic with no regional wall motion abnormalities.Left AtriumThe left atrium is stable in size. Right VentricleThe right ventricle is upper normal in size with mildly reduced systolic function. The overall RV ejection fraction is 40%, the RV end diastolic volume index is 113 ml/m2 (normal range 82+/-16), the RVEDV is 209 ml (normal range 142+/-31), the RV end systolic volume index is 68 ml/m2 (normal range 31+/-9), and the RVESV is 126 ml (normal range 54+/-17).Right AtriumThe right atrium is mild-moderately dilated.Aortic ValveThere is a prosthesis in the aortic position consistent with the patient's history of valve replacement. There is an interposition graft with the anastomosis at the level of the PA.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. No interval aneurysm.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no pericardial effusion.

Output: When compared to the previous MRI of 4/23/2009:1. LV function remains dilated with mildly reduced systolic function. The LVEF =50%, compared to 59%, previously. 2. The right ventricle systolic function has somewhat worsened, with an EF of 40%, compared to 49%.3. A mechanical valve is now located in the aortic position. 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: Evaluate for structural changes or other reasons for cognitive impairment. Signs and symptoms: As above. Nonenhanced brain MRI:Negative diffusion-weighted series.Examination demonstrates extensive patchy and confluent foci of FLAIR hyperintensity in the subcortical and periventricular white matter of bilateral cerebral hemispheres, extensively in bilateral basal ganglia and thalami as well as pons which although nonspecific however considering patient's stated age likely representing advanced age indeterminate small vessel ischemic strokes. This finding demonstrate no associated susceptibility signal changes.There is mild prominence of cortical sulci however with normal size of ventricular system for stated age.No detectable cortical abnormality and the CSF spaces remain unremarkable.Signal void of major intracranial arterial branches are identified and unremarkable.The signal intensity of intracranial venous sinuses remain within normal.Unremarkable images through the orbits and unremarkable calvarium.

Output: 1.No acute intracranial process.2.Findings suggestive of extensive chronic nonhemorrhagic small vessel ischemic strokes as detailed.


Instruction: Generate impression based on findings.

Input: Motion degrades sensitivity. For the purpose of this study the most inferior level is defined as L5-S1. The vertebral column alignment is within normal limits. The vertebral body heights are preserved. The vertebral bone marrow signal is unremarkable. The spinal cord terminates at the T12 inferior endplate and displays normal signal and morphology. Atrophy of the lower lumbar paraspinal musculature noted. Partially imaged left renal cysts.Multilevel degenerative changes are seen, as describe below:T12-L1, L1-L2: No significant spinal canal or foraminal stenosis.L2-3: Minimal disc bulging with mild bilateral facet arthropathy. No significant spinal canal or foraminal stenosis.L3-4: Disc bulge and bilateral facet arthropathy as well as prominence of the dorsal epidural fat contribute to mild to moderate spinal canal stenosis, slightly worse since prior exam. There is mild bilateral neural foraminal stenosis, not significantly changed from prior exam. Widening of the facet joints again noted. L4-5: Post-surgical changes of a remote laminectomy with areas of osseous fusion involving the posterior elements from L4-S1. No evidence of significant central or neural foraminal stenosis.L5-S1: No significant spinal canal stenosis. Minimal narrowing of the neural foramina. Prior right-sided laminectomy.

Output: 1. Post-surgical changes in the lumbar spine with laminectomies at L4-L5 and L5-S1 and solid osseous fusion involving the posterior elements from L4 through S1 better seen on prior CT. 2. Mild to moderate spinal canal stenosis at L3-4, which appears slightly worse since prior exam from 9/5/2012. 3. Mild L3-L4 and minimal L5-S1 bilateral neural foraminal narrowing. Neural foramina are otherwise patent.


Instruction: Generate impression based on findings.

Input: 49-year-old female with rotator cuff SLAP repair in 2008. ROTATOR CUFF: Postsurgical changes about the lateral humeral head with 3 fixation screws affixing tendons of presumably the supraspinatus, infraspinatus, and subscapularis. There is distal degenerative fraying of the tendon complexes, but no frank tear is visualized.SUPRASPINATUS OUTLET: Degenerative fraying and signal abnormality within the distal supraspinatus tendon, but no complete tear.GLENOHUMERAL JOINT AND GLENOID LABRUM: The superior glenoid labrum appears right irregular with areas of subchondral cysts, indicative of known history of SLAP pathology. No single large tear is evident.BICEPS TENDON: Biceps tendon appears well seated without tearing.ADDITIONAL

Output: 1. Postsurgical findings related to orthopedic fixation of multiple rotator cuff muscles as outlined above. No complete tear of the rotator cuff.2. Glenoid labrum degenerative changes consistent with SLAP pathology.


Instruction: Generate impression based on findings.

Input: 27-year-old female with positive Apley grind and McMurray after twisting injury MENISCI: The posterior horn of the medial meniscus is approximately the same size as the anterior horn which is abnormal. Vertically oriented tear of the posterior horn of the medial meniscus. Lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: Bone marrow edema within the lateral femoral condyle and posterolateral tibial plateau compatible with contusion from a varus injury. Mild bone marrow edema within the posterior medial tibial plateau. A bone island is noted in the posterior medial tibial plateau. Articular cartilage is within normal limits.LIGAMENTS: Abnormal signal within the anterior cruciate ligament with nonvisualization of fibers compatible with rupture. The posterior cruciate ligament is intact. The collateral ligaments are intact.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1.Rupture of the anterior cruciate ligament.2.Vertical tear of the posterior horn of the medial meniscus.3.Other findings as above.


Instruction: Generate impression based on findings.

Input: History of right cheek melanoma, and headache with pontine mass seen on cervical spine MRI. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are scattered punctate foci and confluent areas of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter and the pons, which are nonspecific, but most likely related to chronic microvascular disease. There is a non enhancing cystic focus in the pons as well as a smaller similar lesion in the left thalamus. There is a developmental venous anomaly in the right frontal lobe. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. Partially imaged is an enhancing lesion at the right C2-3 foramen on sagittal images. The skull and extracranial soft tissues are otherwise unremarkable.

Output: 1. Scattered T2 abnormalities in the periventricular and subcortical white matter and the pons, most likely representing chronic microvascular disease. Cystic focus in the pons as well as the left thalamus, which may represent cavitary foci related to ischemic lesions, less likely perivascular spaces, and very unlikely to be metastases. 2. No definite evidence of intracranial metastasis or acute intracranial abnormality.3. Partially imaged enhancing lesion at the right C2-3 foramen, as previously described.


Instruction: Generate impression based on findings.

Input: 52-year-old female with history of HIV, history of left shoulder abscess, x-ray with gas in left shoulder, worsening pain, swelling, erythema of left shoulder. Evaluate for abscess, osteomyelitis. There is a collection in the subcutaneous soft tissues lateral to the proximal humerus extending from the level of the humeral head to the mid humeral diaphysis and centered within the deltoid musculature. The mass demonstrates a heterogeneously hyperintense signal to skeletal muscle on T2-weighted images, intermediate to slightly hyperintense signal to skeletal muscle on T1-weighted images with rim as well as internal multiloculated enhancement after intravenous contrast demonstration. The mass contains internal foci of low signal intensity on T1 and T2-weighted images most likely gas. The mass measures 4.5 cm (anteroposterior) x 3.2 cm (mediolateral) by at least 7 cm (craniocaudal). There is a smaller mass with similar imaging features anterior to the subscapularis tendon measuring 8 mm x 5 mm. There are multiple masses in the right axilla which demonstrate low signal intensity to skeletal muscle on T1-weighted images, hyperintense signal to skeletal muscle T2-weighted images and enhances after intravenous contrast administration; these are most compatible with lymphadenopathy as seen on prior CT study overall appearance grossly similar in size allowing for differences in imaging technique.ROTATOR CUFF: Intermediate signal intensity of the supraspinatus tendon indicating tendinosis. The supraspinatus muscle appears normal. The remaining rotator cuff tendons and muscles appear normal.SUPRASPINATUS OUTLET: No significant abnormality noted. GLENOHUMERAL JOINT AND LABRUM: Glenohumeral joint alignment is anatomic. The glenoid labrum appears grossly normal on this nonarthrogram study. There are no MRI findings to suggest underlying osteomyelitis. Heterogeneous signal intensity of the bone marrow of the proximal humerus most compatible with residual red marrow.BICEPS TENDON: The long head of the biceps tendon appears normal.ADDITIONAL

Output: 1. Findings compatible with abscesses within the soft tissues adjacent to the left humerus, the largest of which is located lateral to the humerus with measurements provided above. No MRI findings to suggest osteomyelitis.2. Glenohumeral joint effusion with associated synovitis.3. Marked left axillary lymphadenopathy overall appearing grossly similar to prior CT study allowing for differences in imaging modality.4. Tendinosis of the supraspinatus tendon.


Instruction: Generate impression based on findings.

Input: The cervical spine alignment is anatomic with a normal cervical lordosis. The vertebral body and disk heights are preserved. No focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal. There is no pathological enhancement. There is no significant disk bulge, herniation, central or foraminal stenosis within the cervical spine. THORACIC SPINE

Output: 1.No evidence for cord compression.2.There is a small T6-7 central disc protrusion without significant central or foraminal stenosis.3.There is no compromise to the lumbar spinal canal or exiting nerve roots.


Instruction: Generate impression based on findings.

Input: Muscle weakness (generalized) [M62.81] / Cerebral infarction, unspecified [I63.9], Reason for Study: ^Reason: stroke eval History: as above Brain MRIThere is a focal restricted diffusion area on the right periventricular white matter and the right side basal ganglia without evidence of hemorrhagic conversion.Underlying brain shows multifocal small lacunar infarcts in bilateral basal ganglia and thalami, unchanged.Nonspecific small vessel ischemic disease are again seen, unchanged since prior scan.The ventricles, sulci and cisterns are unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage. The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate multifocal various degree irregularities and narrowings of intracranial vasculature including bilateral PCAs and distal M1 segment of left MCA which appear to have more than 50% of luminal stenosis. Comparing to prior scan, no significant interval change is seen.There is no occlusion of the major intracranial artery. There is no evidence of intracranial arterial aneurysm.Neck MRA3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate There is less than 20% of luminal stenosis of right proximal internal carotid artery just after the bifurcation. The left common carotid artery and extracranial internal carotid artery appear to be unremarkable. Otherwise no significant arterial luminal stenosis on craniofacial arterial system although it shows tortuosity and ectasia of common carotid arteries and extracranial internal carotid arteries indicate atherosclerotic changes.Left vertebral artery is hypoplastic and appears to be finish with the left PICA.

Output: 1. Acute ischemic infarct on the left periventricular white matter and basal ganglia as described above without evidence of hemorrhagic transformation.2. Mild to moderate atherosclerotic changes of intracranial arterial system, unchanged since prior scan.3. Atherosclerotic changes of extracranial craniofacial arterial system, grossly unchanged since prior scan. No significant luminal stenosis (more than 50%).


Instruction: Generate impression based on findings.

Input: Reason: Syrinx and tethered cord, status post repair, yearly follow up for changes , please do with tethered cord protocol History: yearly follow up Again seen is prominence of the central canal in the distal cervical and upper thoracic cord. More discrete dilatation with T1 hypointensity consistent with syringohydromyelia begins at approximately the T7 level and continues inferiorly to the T12 levelnear the conus. The craniocaudal extent of this abnormality is unchanged. Likewise, the maximal caliber of the syrinx is also not significantly changed, for example measuring 5 x 6 mm at the T9-T10 level, previously also 5 x 6 cm.Cervical tonsils are again imaged only on the sagittal counting sequence and appear low-lying but without clear evidence of Chiari I. Dedicated brain imaging can be considered as clinically appropriate.The conus tip terminates at the L1 level which is normal. Findings are again seen compatible with surgical tethered cord release at the L2-3 level. No evidence of fatty infiltration of the filum terminale, lipoma, or other lesions within the lumbar spinal canal. On prone imaging, there is appropriate anterior motion of the conus and cauda equina. Spinal alignment is anatomic. Vertebral body heights and disc spaces are maintained. No significant spinal canal or foraminal stenosis is present at any level. As on the prior examination, the urinary bladder is fluid distended. There is atelectasis in the right lower lobe.

Output: 1.No significant change in syringohydromyelia involving the mid to lower thoracic cord.2.No evidence of spinal cord re-tethering.


Instruction: Generate impression based on findings.

Input: GBM, status post RT/TMZ, now 2 cycles of TMZ. Again seen are postsurgical changes of right temporoparietal craniotomy for partial tumor resection involving the right temporal lobe. Compared to most recent outside MRI from 7/24/2015, there is decrease in T2/FLAIR hyperintensity surrounding the resection cavity, particularly involving the right inferior frontal and superior temporal lobes. There is significant decrease in associated mass effect with reexpansion of the right lateral ventricle and resolution of previously seen leftward midline shift. There is also significant interval decrease in enhancement surrounding the resection cavity with area of nodular enhancement previously measuring approximately 15 mm in thickness now measuring 8 mm in thickness. Again noted is enhancement extending along the right periatrial white matter towards the splenium, also improved in the interval. Separate focus of enhancement involving the right temporal lobe cortex more anterolaterally previously measuring 15 mm in the AP dimension now measures 13 mm. There is mild increase in FLAIR hyperintensity along the bilateral frontal horns and adjacent to the body of the lateral ventricles likely reflective of posttreatment change. Thicker T2/FLAIR hyperintensity surrounding the left occipital horn is not significantly changed in the interval.

Output: 1. Posttreatment changes related to right temporal GBM. Compared to most recent outside MRI from 7/24/2015, there is significant decrease in FLAIR hyperintensity and enhancement surrounding the right temporal resection cavity likely related to Avastin therapy.2. Improvement in mass effect and resolution of midline shift.3. Slight decrease in size of enhancing right lateral temporal lobe satellite lesion.


Instruction: Generate impression based on findings.

Input: 40 year old with new onset heart failure presenting for evaluation of etiology. Left VentricleThe left ventricle is severely dilated with mild to moderately reduced systolic function. The overall LV ejection fraction is 42%, the LV end diastolic volume index is 183 ml/m2 (normal range: 74+/-15), the LVEDV is 310 ml (normal range 142+/-34), the LV end systolic volume index is 106 ml/m2 (normal range 25+/-9), the LVESV is 180 ml (normal range 47+/-19), the LV mass index is 85 g/m2 (normal range 85+/-15), and the LV mass is 144 g (normal range 164+/-36). The left ventricular systolic dysfunction is global with regional variation. There is mid myocardial interventricular septal late gadolinium ("mid-wall stripe") enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. This finding has been described in nonischemic cardiomyopathy and is atypical for prior myocardial infarction. Native T1 times are normal at 1025 ms. No evidence of iron overload. Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is severely dilated with mildly reduced systolic function. The overall RV ejection fraction is 45%, the RV end diastolic volume index is 155 ml/m2 (normal range 82+/-16), the RVEDV is 264 ml (normal range 142+/-31), the RV end systolic volume index is 85 ml/m2 (normal range 31+/-9), and the RVESV is 145 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.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 mildly dilated (30 mm).Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Severe LV dilation with mild to moderately reduced systolic function (LVEF 42%) with evidence of late gadolinium enhancement involving the mid-wall of the septum. The pattern most likely represents myocardial fibrosis and is commonly described in dilated cardiomyopathy. The pattern is not typical for prior myocardial infarction.2. Severe RV dilation with mildly reduced systolic function (RVEF 45%).3. Mild biatrial dilation.4. Mild dilation of the main pulmonary artery. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 58-year-old female with HCC, cirrhosis, portal vein thrombus. Evaluate liver lesions, masses, HCC screen, vessel patency. Status post TACE/RFA, coronary calcifications. ABDOMEN:LIVER, BILIARY TRACT: Nodular cirrhotic morphology of the liver. Diffuse low T2 signal intensity compatible with hemosiderin deposition. Hazy increased T2 signal of the hepatic hilum is unchanged and compatible with reticular fibrosis.The known ablation cavity of the hepatic dome measures 2 x 1.6 cm and again demonstrates peripheral T1 precontrast hyperintense signal (series 14 image 81). The cavity has slightly decreased in size (prior 2.2 x 2.2 cm). No associated abnormal enhancement is seen to suggest recurrent/residual tumor. No new arterially enhancing lesions are identified.Portal vein is patent and again noted to be attenuated in size.The gallbladder is mildly distended, and there is a stable large gallstone.SPLEEN: Splenomegaly measuring 17.8 cm in length. Large perisplenic varices are again noted including a prominent splenorenal shunt.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: Trace perihepatic ascites.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Stable small right pericardial cyst.

Output: 1.Ablation cavity of the hepatic dome has slightly decreased in size. No evidence of residual or recurrent disease.2.Cirrhotic morphology with sequelae of portal hypertension including splenomegaly and prominent perisplenic varices and a splenorenal shunt. Trace perihepatic ascites. Stable attenuated portal vein.3.Stable large gallstone.


Instruction: Generate impression based on findings.

Input: Stroke. MRI: There are right posterior frontal lobe subcortical white matter T2 hyperintense foci, between the superior and frontal gyri in a linear distribution. There are prominent perivascular spaces in the bilateral basal ganglia. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is nonspecific left tympanomastoid fluid. There is a small left maxillary sinus retention cyst.Brain MRA: There is a focal high-grade stenosis of the distal M1 segment of the right middle cerebral artery. There is mild decrease in caliber of the left vertebral artery after the origin of the left PICA. The other major cerebral artery flow voids are intact. There is no evidence of cerebral saccular aneurysms.Neck MRA: There is no evidence of significant steno-occlusive lesions.

Output: Right posterior frontal lobe subcortical white matter T2 hyperintense foci, between the superior and frontal gyri in a linear distribution are suggestive of chronic watershed ischemia, perhaps related to the high-grade stenosis of the distal M1 segment of the right middle cerebral artery. Otherwise, no evidence of acute infarction or hemorrhage and no significant steno-occlusive lesions in the cervical arteries.


Instruction: Generate impression based on findings.

Input: Reason: evaluate s/p bolt removal- evaluate for DAI History: TBI MRI brain:There are multiple foci of diffusion restriction with associated susceptibility effect consistent with intraparenchymal hemorrhage and associated edema at the gray-white junction. These foci are most prominent in the left frontal lobe but also involve the anterior and posterior right frontal lobe, medial left occipital lobe and left temporal lobe. There are additional adjacent smaller foci of susceptibility without restricted diffusion. Punctate foci of susceptibility are noted in the most dependent portion of the occipital horn suggestive of minimal intraventricular blood products.There is been interval removal of a right frontal approach intracranial pressure monitoring bolt. A trace right parieto-occipital subdural hematoma measures 3 mm in thickness and is unchanged from recent CTs. Multiple maxillofacial fractures, including the bilateral nasal bones, bilateral orbital floors, maxilla, bilateral pterygoid processes and bony nasal septum, are better evaluated on dedicated maxillofacial CT. There is increased T1 signal within the bilateral maxillary and ethmoid sinuses which likely represents blood products. There is also associated moderate mucosal thickening. Blood products and secretions are present within the nasal cavity and nasopharynx bilaterally. An orogastric tube is present.No hydrocephalus. No midline shift or evidence of herniation. The major cerebral flow voids are intact. Fluid is present in the mastoid air cells bilaterally which may be related to intubation. MRI cervical spine:The vertebral column alignment is within normal limits. There is a normal relationship of the dens with the arch of C1. Fragmentation of the dens as seen on prior CT likely represents incomplete ossification, as no abnormal T2 signal is present. No surrounding edema. Normal marrow signal. No abnormal signal within the visualized cord. No epidural hematoma. No significant spinal canal or neural foraminal stenosis at any level.

Output: 1.Multiple foci of intraparenchymal hemorrhage as described above, many of which are at the gray-white junction and suggestive of diffuse axonal injury. Mild associated edema without midline shift or herniation. Trace right subdural hematoma as seen before. Minimal blood products within the occipital horns of the lateral ventricles are also noted. 2.Multiple facial fractures are better evaluated on recent CT.3.No evidence of fracture or subluxation in the cervical spine. There is incomplete fusion of the dens as noted on prior CT and within normal limits for age. No evidence of epidural or paraspinous hematoma or ligamentous injury.


Instruction: Generate impression based on findings.

Input: Multiple sclerosis [340], Reason for Study: ^Reason: MS, f/u progression History: paresthesias There is interval progression of the right frontal white matter lesion comparing to prior scan.Other scattered white matter lesions on bilateral hemispheres including bilateral frontal, parietal, temporal and occipital lobes, The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Interval aggravation of the right frontal white matter lesion since prior exam.2. Other multiple scattered white matter lesions do not show any significant interval change since prior exam.


Instruction: Generate impression based on findings.

Input: 20-year-old female with right knee pain. Evaluate for right knee ACL tear and bucket-handle medial meniscus tear. MENISCI: The medial and lateral meniscus appear intact.ARTICULAR CARTILAGE AND BONE: Note is made of increased bone marrow signal abnormality within the posterior aspect of the medial and lateral tibial plateau consistent with a bone contusions. There is increased signal abnormality on fluid sensitive sequences within the lateral femoral condyle, underlying a lateral notch sign, indicating an impaction fracture/contusion. There is a partial-thickness articular cartilage cleft along the medial facet of the patella with underlying subchondral signal abnormality.LIGAMENTS: There is complete rupture of the ACL through its mid substance fibers. The PCL appears intact. There is increased signal abnormality within the proximal fibers of the lateral collateral ligament proper which may represent a sprain. The LCL appears intact. The MCL appears intact. EXTENSOR MECHANISM: The extensor mechanism appears intact. There is a small amount of fluid within the deep infrapatellar bursa.ADDITIONAL

Output: 1. Complete rupture of the ACL with bone contusions as described above.2. Large joint effusion.3. Partial-thickness articular cartilage cleft along the medial facet of the patella.


Instruction: Generate impression based on findings.

Input: Redemonstrated is the levorotoscoliosis centered at approximately L2/3. There are no fractures or subluxations. The marrow signal is benign. The conus is normal in signal and morphology and terminates at an appropriate level. The visualized intra-abdominal and paraspinal contents are unremarkable.T12/L1: Unremarkable and unchangedL1/2: There has been near complete regression of the previously identified shallow midline disc protrusion. There are no stenoses.L2/3: Mild disc bulge now appears more eccentric to the right with new right mild neural foraminal stenosis.L3/4: Unremarkable and unchanged.L4/5: Mild disc bulge containing a small posterior midline annular fissure without stenosis, unchanged.L5/S1:Disc disease including mild disc bulge, without stenosis, unchanged.

Output: 1.L1/2: There has been near complete regression of the previously identified shallow midline disc protrusion. There are no stenoses.2.L2/3: Mild disc bulge now appears more eccentric to the right with new right mild neural foraminal stenosis.


Instruction: Generate impression based on findings.

Input: 55-year-old woman with ER positive IDC of the right breast. I-Spy 2 research MRI performed. There is relatively extensive non-mass enhancement, new since the 8/31/2016 comparison examination, presumably related to the biopsy performed on 9/8/2016. Within the limitation created by this enhancement, the following observations can be made:There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.Within the right outer breast, the patient's biopsy-proven malignancy is seen as an enhancing mass measuring up to 220 mm. The biopsy clip is again noted within this mass. Immediately anterolateral to the index mass is 6 mm mm satellite mass. Medial to the index lesion there are 3 additional small enhancing masses, 2 of which are immediately anterior to and abut the pectoralis major muscle. An enhancing mass is again noted within the anterior chest wall musculature, posteromedial to the index lesion and presumed satellites. The other areas of chest wall muscular enhancement are less prominent on today's examination, which may relate to differences in technique.The previously described 9 mm area of non-mass enhancement is not definitively seen on today's examination, also possibly due to technique and effect of yesterday's biopsy.The overall extent of masses, inclusive of the mass suspicious for pectoralis involvement is up to 6.2 cm. The nonspecific focus of increased T2 signal within a midthoracic vertebral body has been evaluated using other imaging modalities and is of doubtful clinical significance given those results.There are scattered foci of increased T2 signal within the liver, likely representing cysts or hemangiomas, without corresponding hypermetabolic activity on the PET scan dated 9/9/2016.No abnormal enhancement is seen in the left breast. A few scattered foci and areas of edge parenchymal enhancement are not suspicious. No abnormal axillary lymph nodes are identified in either axillary region.

Output: Biopsy proven right breast cancer with multiple additional enhancing masses within the right breast and the right anterior chest wall musculature. The overall extent of masses, inclusive of the mass suspicious for pectoralis involvement is up to 6.2 cm. Presumed biopsy related non-mass enhancement is a limitation of this study compared to the recent MRI exam. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Right shoulder pain ROTATOR CUFF: There is increased signal within the supraspinatus tendon indicating moderate tendinosis. There is also a more focal full-thickness tear of the anterior fibers of the supraspinatus at its insertion upon the greater tuberosity. The tear measures approximately 8 to 9 mm in the AP dimension and results in approximately 7 mm of retraction of the anterior fibers. There is mild fatty atrophy of the supraspinatus muscle along the myotendinous junction. The tendinosis of the supraspinatus tendon extends posteriorly to involve the anterior fibers of the infraspinatus tendon and there is suggestion of bursal surface fraying although no full-thickness infraspinatus tear is appreciated. There is also mild fatty atrophy along the myotendinous junction of the infraspinatus tendon. Small cysts are noted in the underlying greater tuberosity which are likely degenerative in nature. The teres minor muscle and tendon are normal. There appears to be tearing of the superficial fibers of the subscapularis tendon from its insertion on the humeral head although the deeper fibers appear intact. The subscapularis muscle is normal.SUPRASPINATUS OUTLET: Moderate osteoarthritis affects the acromioclavicular joint. There is a small amount of fluid within the subacromial subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Mild osteoarthritis affects the glenohumeral joint and there is a small of fluid within the joint. There is increased signal within the superior labrum likely representing degenerative tearing. There is a rounded contour to the anterior labrum which may be degenerative in etiology. Glenohumeral alignment is normal.BICEPS TENDON: The tendon of the long head of the biceps appears slightly subluxed medially, coursing along the torn superficial fibers of the subscapularis tendon.

Output: 1. Focal full-thickness tearing of the anterior fibers of the supraspinatus tendon with additional degenerative tendinopathy of the supraspinatus and infraspinatus tendons.2. Tearing of the superficial fibers of the subscapularis tendon with medial subluxation of the long head of the biceps tendon.3. Osteoarthritis and labral degeneration as described above.


Instruction: Generate impression based on findings.

Input: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mild diffuse cerebral white matter T2 hyperintensity, predominantly in a periventricular distribution. There is a punctate focus of susceptibility effect in the right thalamus, which likely represents a chronic microhemorrhage. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Findings suggestive of chronic microvascular ischemic disease without evidence for acute abnormality.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Female, 66 years old, with extensive history of multiply recurrent head and neck cancers, initially diagnosed as tongue cancer in 1991, status post multiple recurrences, including in 2011 at the tongue treated with left partial glossectomy, left neck dissection and radial forearm free flap reconstruction, and again in May 2015 at the right tongue, status post composite hemiglossectomy, marginal mandibulectomy, mandibular splitting, right neck dissection and ALT free flap. Patient now presents with rapidly growing dermal nodules in the neck and upper chest, biopsy proven as squamous cell carcinoma. Sequelae of extensive prior surgery are seen including right hemiglossectomy and floor of mouth dissection with soft tissue flap reconstruction; mandibular surgery with orthopedic fixation instruments in place; and bilateral neck dissection.A large enhancing mass with central necrosis is evident centered in the right floor of mouth, along the right lateral margin of the flap construct. This lesion measures up to 64 mm in the coronal plane, and up to 40 x 39 mm in the axial plane (see image 64 series 18, and image 26 series 16).This lesion extends superiorly along the medial surface of the mandible to the level of the retromolar trigone. There is questionable anterior extension from here into the right buccal space. The lesion extends inferiorly from the floor of mouth along the superficial cutaneous and subcutaneous tissues of the right neck. There may be infiltration of the sternocleidomastoid muscle and some of the strap muscles of the neck. Tumor extends deep to at least the level of the hyoid bone and thyroid cartilage.The soft palate and supraglottic mucosa is thickened and enhancing which may be inflammatory in nature. The supraglottic airway is displaced towards the left. No definite pathologic lymph nodes are seen within the neck, though scattered subcutaneous nodules are noted in the right lower neck which could represent metastatic lymph nodes. The right-sided neck vessels course along the posterior margin of the tumor and are not clearly encased by it.Marrow replacement and enhancement of the right mandible are nonspecific findings. Elsewhere, marrow signal characteristics are relatively unremarkable. A significant thoracic scoliotic curvature is partially visualized.

Output: 1.Extensive surgical findings are seen including evidence of hemiglossectomy and floor of mouth dissection with flap reconstruction, mandibular surgery, and bilateral neck dissection.2.A large centrally necrotic tumor is seen centered on the right floor of mouth. This lesion extends superiorly along the medial margin of the right mandible, reaching the retromolar trigone and potentially extending anteriorly into the buccal space. The tumor extends inferiorly along the cutaneous and subcutaneous tissues of the right lower neck, with deep invasion at least to the level of the hyoid bone and thyroid cartilage.3.Marrow replacement and enhancement of the right mandible is nonspecific but concerning for tumor involvement. The possibility of a treatment related or inflammatory process can also be considered.


Instruction: Generate impression based on findings.

Input: Metastatic mesothelioma to brain, MRI for SRS planning: visual field deficit. There is a heterogeneous mass in the right occipital lobe that measures up to 4 cm, with extensive surrounding vasogenic edema. There is effacement of the right occipital horn of the lateral ventricle. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are unremarkable.

Output: Pretreatment planning MRI for a right occipital lobe mass.


Instruction: Generate impression based on findings.

Input: Altered mental status, unspecified [R41.82], Reason for Study: ^Reason: altered mental status History: altered mental status No evidence of acute ischemic or hemorrhagic lesion. 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: No evidence of acute ischemic or hemorrhagic lesion.No abnormal enhancement.


Instruction: Generate impression based on findings.

Input: Right upper extremity weakness and right lower extremity numbness for 1 day There are scattered restricted diffusion lesions on the left side precentral and postcentral gyri without evidence of hemorrhagic transformation. Previously seen left precentral gyrus restricted diffusion lesion is probably embedded in the present restricted diffusion lesions. Left paramedian pontine restricted diffusion lesion is not seen anymore.No change of extensive nonspecific small vessel ischemic disease.No change of multifocal susceptibility lesions on gradient echo images indicating multifocal small bowel hemorrhagic foci since prior scan.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, 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: New restricted diffusion lesion on the left pre and post central gyri without evidence of hemorrhagic transformation.No change of extensive nonspecific small vessel ischemic disease with the multifocal small hemorrhagic foci since prior scan is described above.


Instruction: Generate impression based on findings.

Input: History of seizures. Evaluate for structural abnormality, specifically in the occipital region. No abnormal signal is seen on the T2, FLAIR or diffusion weighted images. Myelination is normal for age. No foci of heterotopic gray matter or evidence of cortical dysplasia.There is no evidence of intracranial hemorrhage, mass or edemaThe ventricles and basal cisterns are normal in size and configuration.The expected intracranial vascular flow voids are present.The ethmoid sinuses and left mastoid air cells are opacified. The orbits are unremarkable.

Output: No structural abnormality or mass lesion is identified to suggest an epileptogenic focus.


Instruction: Generate impression based on findings.

Input: Reason: patient w/ known cholelithiasis, here with lipase elevation, abdominal pain, concern for gallstone pancreatitis, evaluate for stone. ABDOMEN:LIVER, BILIARY TRACT: Scattered subcentimeter T2 hyperintense foci compatible with cysts. No intra or extrahepatic biliary ductal dilatation. Distended gallbladder containing large intraluminal stones.SPLEEN: No significant abnormality noted.PANCREAS: There is restricted diffusion of the pancreas suggestive of acute pancreatitis, which is most evident at the pancreatic head (axial series 12 image 26). No drainable fluid collection.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right parapelvic cyst. 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: 1.Restricted diffusion of the pancreas suggestive of acute pancreatitis. No drainable fluid collection. The exam is limited due to the lack of intravenous contrast.2.Cholelithiasis.


Instruction: Generate impression based on findings.

Input: History of choledochocyst and recurrent cholelithiasis status post right hepatic lobectomy with hepaticojejunostomy and enterolithotomy in 2009. ABDOMEN:LIVER, BILIARY TRACT: Postsurgical changes from right hepatic lobectomy and hepaticojejunostomy. Progressive compensatory hypertrophy of the left hepatic lobe.Demonstrated again is segmental dilatation of the segment 4 intrahepatic bile ducts, unchanged.No discrete mass lesion. The vessels are patent.SPLEEN: Postsurgical changes from partial pancreatectomy. No focal lesion or pancreatic ductal dilatation.. 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: Stable postoperative appearance.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Stable post right hepatectomy surgical changes with mild segmental biliary ductal dilatation. No findings to suggest biliary ductal dilatation, a focal mass or flow-limiting stricture.


Instruction: Generate impression based on findings.

Input: 31 year old with BRCA mutation, screening MRI. A patient submitted outside study for review. Submitted for review is a breast MRI performed at Parkview Outpatient Service Center on 6/6/2016. For comparison, a breast MRI from 4/30/2015 also performed at Parkview Outpatient Service Center is available, this exam was performed with the patient was postpartum and is limited due to postpartum and lactation changes. Outside hospital MRI pre and post contrast images were processed by DynaCad for interpretation.There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.There is a 5 x 4 x 7 mm enhancing focus in the right breast at the 12:00 position with a thin septation which most likely represents a benign fibroadenoma unchanged compared to the prior MRI. A benign intramammary lymph node is identified in the right breast at the 10:00 position and has a T2 and STIR correlate. Small enhancing foci in both breasts are noted, none of which are uniquely enhancing. No abnormal axillary lymph nodes are identified in either axillary region. No abnormal enhancement noted in the left breast.

Output: 1.No MRI evidence for malignancy. 2.Benign morphology stable lesion in the 12:00 position in the right breast most likely a fibroadenoma for which no further intervention is recommended given its stability and benign features. Ultrasound may be performed for confirmation but if no definite correlate is found, annual screening mammogram and MRI is recommended.3.Benign intramammary lymph node in the right breast at the 10:00 position.BIRADS: 2 - Benign finding.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: 52-year-old female with back and leg pain The signal intensity of vertebral column demonstrate changes related to degenerative disk disease and is unremarkable otherwise. There are no fractures or subluxations. The conus is normal in signal and morphology and terminates at appropriate level. The visualized paraspinal contents are unremarkable.Examination at T12/L1, L1/L2, and L2/L3 levels demonstrate no central spinal stenosis or neural foraminal compromise. Mild degenerative disk disease and hypertrophic changes of posterior elements however are again noted. There has been no significant interval change.At L3/L4 there is new asymmetric bulge to the left causing new mild left neural foraminal stenosis.At L4/L5 there is advanced degenerative disk disease with loss of intervertebral disk height, broad based bulge of disk with new asymmetric prominence to the right and mild to moderate hypertrophic changes of the posterior elements. There is mild central, mild left lateral recess, moderate right lateral recess, mild left neural foraminal, and moderate right neural foraminal stenosis. Right lateral recess and neural foraminal stenosis has progressed, whereas the other stenoses are stable.L5/S1 demonstrates mild degenerative changes with mild left neural foraminal stenosis, unchanged.

Output: 1.At L3/L4 there is new asymmetric bulge to the left causing new mild left neural foraminal stenosis.2.At L4/L5 there is mild central, mild left lateral recess, moderate right lateral recess, mild left neural foraminal, and moderate right neural foraminal stenosis. Right lateral recess and neural foraminal stenosis has progressed, whereas the other stenoses are stable.3.L5/S1 demonstrates mild mild left neural foraminal stenosis, unchanged.


Instruction: Generate impression based on findings.

Input: Female 47 years old Reason: 47F h/o fascioscapulohumerol dystrophy p/w numbness/tingling/weakness of right thumb, forefinger. Pain originates at shoulder and goes doesn through forearm. Eval for plexopathy/nerve impingement at level of shoulder. Some sequences are degraded by motion.ROTATOR CUFF: Mild supraspinatus tendinopathy is present. No tear or retraction of the supraspinatus tendon. Remainder of the rotator cuff is intact.SUPRASPINATUS OUTLET: There is a type I acromion. Mild osteoarthritis at the AC joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: Small subchondral cysts are present in the humeral head indicating osteoarthritis. The glenoid labrum is intact. Irregularity in the anterior superior labrum is likely normal variant.BICEPS TENDON: Biceps tendon is intact and situated in the bicipital groove. ADDITIONAL

Output: 1.No evidence of nerve impingement as clinically questioned.2.Mild supraspinatus tendinopathy without rotator cuff tear or retraction. Mild osteoarthritis of the acromioclavicular and glenohumeral joints.


Instruction: Generate impression based on findings.

Input: Female, 78 years old, with history of lung cancer complaining of dizziness and unsteady gait. No restricted diffusion is seen. Extensive patchy parenchymal T2 hyperintensity is redemonstrated appearing similar in terms of lesion number and lesion distribution. As before, lesions are evident in the periventricular and subcortical regions as well as the brainstem and deep gray nuclei. However, lesions are also noted symmetrically affecting the bilateral frontal convexities and the far anterior temporal lobes. No definite evidence of parenchymal edema or mass effect is seen. No abnormal extra-axial collections are detected. A punctate focus of susceptibility in the right cerebellum is unchanged. No other evidence of acute or chronic hemorrhage is seen. An exostosis off the left occipital bone is unchanged.

Output: There has been no significant interval change in the quantity or distribution of rather extensive T2 hyperintense parenchymal lesions. Although this could represent small vessel ischemic disease, lesion morphology and distribution are somewhat atypical. The possibility of CADASIL or some other arteriopathy or vasculitic process should also be considered.Within the limitations of a noncontrast examination, there is no evidence to suggest any acute parenchymal lesion. No brain metastases are suspected.


Instruction: Generate impression based on findings.

Input: Female; 68 years old. Reason: Rotator cuff tear History: pain Exam is somewhat optimal secondary to patient body habitus.ROTATOR CUFF: There is generalized atrophy of the supraspinatus and infraspinatus muscles. Mild increased signal at the supraspinatus tendinous insertion, compatible with tendinopathy. No frank rotator cuff tear is visualized.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenoid labrum is grossly normal. Mild thinning and loss of the glenohumeral articular cartilage secondary to degenerative disease.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: 1.Supraspinatus tendinopathy as well as supraspinatus/infraspinatus atrophy without frank rotator cuff tear.2.Moderate degenerative changes as described above.


Instruction: Generate impression based on findings.

Input: Reason: 68 yo female with pancreatic cancer that abutted the CHA as well as main PV without encasement. There was soft tissue infiltration of the porta hepatitis. Pt rec'd adjuvant Chemo. Restaging CT Scan here 2 htypodense lesion of liver. Needs MRI History: none ABDOMEN:LIVER, BILIARY TRACT: Diffuse loss of signal on out of phase sequence compatible with hepatic steatosis. Linear hypointense signal compatible with pneumobilia as seen on CT. Mild intrahepatic biliary ductal dilatation. Biliary stent in place. Innumerable punctate T2 hyperintense, T1 hypointense, nonenhancing lesions compatible with cysts. Left lobe T2 hyperintense, T1 hypointense lesion with progressive nodular peripheral enhancement compatible with a hemangioma, unchanged.Two lesions with T2 and T1 hyperintense signal and homogeneous enhancement measuring 1.0 x 0.7 cm along the gallbladder (series 1303 image 49) and 1.2 x 0.7 cm in the hepatic dome (series 1303 image 15).SPLEEN: No significant abnormality noted.PANCREAS: Pancreatic head mass has decreased in size, measuring 1.6 x 1.1 cm (series 1/3/2002 image 61), previously 2.1 x 1.5 cm. Pancreatic ductal dilatation up to the level of the pancreatic head again noted. No evidence of SMA or celiac trunk invasion. The mass abuts the SMV by less than 180 degrees. Tumor abuts the common hepatic artery and main portal vein.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: Mildly prominent periportal lymph nodes. Normal variant retroaortic course of the left renal vein.BOWEL, MESENTERY: Moderate hiatal hernia. Colonic diverticulosis.BONES, SOFT TISSUES: Dextroscoliosis of the lumbar spine. Multiple Tarlov cysts are noted.OTHER: Right breast implant.

Output: 1.Interval decrease in size of patient's known pancreatic head mass.2.Indeterminate small hepatic lesions on recent CT demonstrate benign signal characteristics and could possibly represent flash filling hemangiomas.


Instruction: Generate impression based on findings.

Input: Clinical question: 69-year-old female with back/trunk pain and intermittent incontinence. Signs and symptoms: As above. Pre and postcontrast enhanced thoracic MRI:Examination demonstrates normal signal intensity and the alignment of vertebral column.Examination demonstrates mild degenerative changes of disc and the posterior elements are present.There is no evidence of a spinal canal or neural foraminal compromise or stenosis at any level.There is normal signal intensity and caliber of the thoracic cord.There is no detectable abnormal enhancement of the vertebral column, cord or the meninges.No detectable. Spinal soft tissue abnormalities.Pre- and post enhanced lumbar MRI:There is normal anatomical alignment of vertebral column.T12-L1 is unremarkable.L1-L2 demonstrate mild degenerative changes and which shallow bulging disc however without spinal stenosis or neural foraminal compromise.L2-L3 demonstrate mild disc disease and loss of disc height, shallow broad-based bulging disc, moderate ligamentum flavum and mild facet hypertrophic changes. There is a tiny right perimedian disc protrusion with expected minimal enhancement.Constellation of changes results in moderate central spinal stenosis however without neural foraminal compromise.L3-L4 demonstrate moderate disc disease and loss of disc height, moderate ligamentum flavum and mild bilateral facet hypertrophic changes. Constellation of changes results in moderate central spinal stenosis without neural foraminal compromise.L4-L5 demonstrate moderate disc disease and loss of disc height, mild to moderate left ligamentum flavum hypertrophy and mild bilateral facet hypertrophic changes. There is evidence of a right-sided prior laminectomy with resultant expansion of thecal sac and no central spinal stenosis. There is a large right lateral disc osteophyte at this level which results in right lateral recess compromise however without neural foraminal compromise.L5-S1 demonstrates significant loss of disc height and suggestion of fusion of L5 and S1. There is evidence of prior laminectomy with resultant expansion of thecal sac and without spinal stenosis or neural foraminal compromise.Unremarkable post enhanced images.

Output: 1.Pre- and post enhanced thoracic MRI demonstrate mild degenerative changes without spinal stenosis or neural foraminal compromise. Normal signal intensity of the cord. No detectable abnormal enhancement.2.Pre- and post enhanced MRI of lumbar spine demonstrate degenerative changes at L2-L3 and L3-L4 levels with resultant moderate central spinal stenosis (worse at L2-L3) without neural foraminal compromise. Postoperative changes of laminectomy at L4-L5 and L5-S1 levels without evidence of central spinal stenosis. Right lateral disc-osteophyte complex at L4-L5 with resultant right lateral recess compromise.


Instruction: Generate impression based on findings.

Input: Closed head injury, new tremor, gait disorder. There is an area of T2/flair hyperintensity in the right frontal lobe involving the right superior and middle frontal gyri extending to the cortical surface. There is associated susceptibility compatible with chronic blood products. Finding may be related to prior ventriculostomy catheter with chronic blood products along the surgical tract. Mild associated ex vacuo dilatation of the right frontal horn. There is also evidence of chronic hemorrhage involving the left superior parietal lobule. No restricted diffusion to suggest acute ischemia. No intracranial mass or mass-effect. There is mild global parenchymal volume loss, commensurate with age. There is prominence of the ventricular system which appear slightly out of proportion to the degree of volume loss. Additional scattered foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild chronic small vessel ischemic changes. No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. Paranasal sinuses are clear. Minimal opacification of the mastoid air cells. Bone marrow signal is within normal limits.

Output: 1. No acute findings. No intracranial mass or mass effect.2. T2/flair hyperintensity in the right frontal lobe extending from the cortical surface to the ventricle, presumably related to prior ventriculostomy catheter and associated gliosis. Correlate with prior surgical history. There is associated susceptibility effect compatible with chronic blood products and mild associated volume loss. Focus of chronic hemorrhage is also noted in the left superior parietal lobule.3. Prominence of the ventricular system which appears slightly out of proportion to the degree of mild global parenchymal volume loss. Component of communicating hydrocephalus cannot be excluded; correlate with clinical findings.4. Mild chronic small vessel ischemic changes.


Instruction: Generate impression based on findings.

Input: 41 year old male with history of repaired Tetralogy of Fallot who presents for cardiac MRI to evaluate for pulmonary regurgitation severity and right heart dysfunction. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 62%, the LV end diastolic volume index is 76 ml/m2 (normal range: 74+/-15), the LVEDV is 134 ml (normal range 142+/-34), the LV end systolic volume index is 29 ml/m2 (normal range 25+/-9), the LVESV is 51 ml (normal range 47+/-19), the LV mass index is 50 g/m2 (normal range 85+/-15), and the LV mass is 87 g (normal range 164+/-36). Abnormal septal motion consistent with prior sternotomy is noted. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process of the LV myocardium.There is no evidence of interventricular (or interatrial) shunt by first pass perfusion.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is severely dilated in size and moderately reduced in systolic function. The overall RV ejection fraction is 37%, the RV end diastolic volume index is 155 ml/m2 (normal range 82+/-16), the RVEDV is 273 ml (normal range 142+/-31), the RV end systolic volume index is 97 ml/m2 (normal range 31+/-9), and the RVESV is 171 ml (normal range 54+/-17). The RVOT is aneurysmal with evidence of late gadolinium enhancement, most likely representing a patch-repair.Right AtriumThe right atrium is moderately dilated.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 ValveThere is severe pulmonic regurgitation (regurgitant volume is 65ml, regurgitant fraction is 48%)Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThere is an over-riding aorta. There is a right sided aortic arch with mirror imaging brachiocephalic branching pattern. The proximal portion of the left subclavian artery is not seen but the remainder of the vessel fills via collaterals, suggesting that the patient may have had a Blaylock-Taussig shunt. The aortic root is mildly dilated (sinus of Valsalva 41mm).Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. There is mild narrowing of the proximal left (15x17mm) and right (13x17) pulmonary artery; however, there is no evidence of flow acceleration suggesting that the narrowing is not hemodynamically significant.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size and systolic function (LVEF 62%) without evidence of underlying myocardial fibrosis, inflammation, or infiltration. 2. The right ventricle is severely dilated in size and moderately reduced in systolic function (RVEF 37%). The RVOT is aneurysmal with evidence of late gadolinium enhancement, consistent with a patch repair. 3. There is severe pulmonic valve regurgitation.4. There is no evidence of residual ventricular septal defect. 5. There is mild stenosis of the right and left branch pulmonary arteries.6. The aortic root is mildly dilated. 7. There is an over-riding right sided aortic arch with mirror imaging. The proximal left subclavian artery is not seen and the vessel fills via collaterals. This suggests the patient may have had a BT shunt at one point.


Instruction: Generate impression based on findings.

Input: Headaches. Rule-out tumor or mass. Neck pain. Brain: Brain parenchyma appears within normal limits for age. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved. Partially empty sella incidentally noted. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits. Cervical Spine:Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate height. Alignment is maintained. Bone marrow signal is within normal limits. The cervical spinal cord has normal signal characteristics and overall morphology.Minimal 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. There is mild left neural foramina narrowing related to uncovertebral hypertrophy and mild facet arthropathy. No significant right foraminal narrowing.C5-6: There is mild bilateral neural foraminal narrowing. No significant spinal canal narrowing.C6-7: Mild ligamentum flavum thickening. There is mild bilateral neural foramina narrowing, relatively worse on the left. There is mild spinal canal narrowing. C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: 1. MRI of the brain is within normal limits. No intracranial mass or abnormal enhancement is appreciated.2. Mild degenerative changes in the cervical spine without high-grade spinal canal or neural foramina stenosis at any level.


Instruction: Generate impression based on findings.

Input: Clinical question: Status post brain tumor resection. Signs and symptoms: Status post brain tumor resection. Pre- and post enhanced brain MRI:Indication is status post left posterior temporal-frontoparietal craniotomy with expected postoperative changes.There is a surgical resection cavity at the site of removed tumor in the left frontal lobe measuring approximately 32 x 37 mm in transaxial dimensions. There is serosanguineous fluid as well as a small amount of air within the surgical cavity which is within expected postoperative finding. Very extensive surrounding vasogenic edema demonstrate no significant change since prior exam.On post enhanced images there is an ill-defined focus of enhancement along the anterior and superior aspect of surgical cavity measuring 10 x 20 mm in transaxial dimensions (axial post enhanced series 1001 image 20) and approximately 14 x 13 mm size measured on sagittal post enhanced series 1/1/2001 image 9. Region of enhancement is believed to represent a focus of residual tumor and further follow-up is recommended.Increased mass effect on the left results in rightward deviation of midline of approximately 4 mm which has a slightly decreased since prior exam. The ventricular system however remain within normal size.Multiple additional necrotic rim enhancing metastatic lesions in bilateral cerebral hemispheres and right cerebellum are again identified without significant change since prior exam from 6-5-15.

Output: 1.Expected postoperative changes of a left-sided craniotomy for removal of tumor as detailed.2.Focus of enhancement along the anterior superior aspect of surgical cavity measuring at 10 x 20 mm in transaxial and 14 x 13 mm on sagittal post enhanced images is highly suspected of residual tumor.3.Slight interval decreased rightward deviation of the midline since prior exam and with stable normal size of ventricles.4.Stable multiple bilateral hemispheric and right cerebellar metastatic lesion since prior exam.5.Extensive vasogenic edema in bilateral hemispheres (left greater than right) remains fairly similar to preoperative study.


Instruction: Generate impression based on findings.

Input: 70-year-old male patient with history of left RCC now with right adrenal recurrence. Assess for IVC involvement. ABDOMEN:LIVER, BILIARY TRACT: There are scattered subcentimeter foci of arterial enhancement within the liver which do not demonstrate washout on more delayed images and may be perfusional in etiology (image 101 and 108, series 11). No suspicious hepatic lesions are identified. The hepatic veins and portal veins are patent.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: A normal right adrenal gland is not identified. There is a 5.8 x 6.5 cm mass within the right adrenal gland which demonstrates heterogeneous peripheral enhancement, central low intensity, and numerous enhancing septations on post-contrast images.The left adrenal gland is absent. KIDNEYS, URETERS: The left kidney is absent. There is no suspicious mass in the right kidney. The right kidney is enlarged, likely secondary to hypertrophy. There is the suggestion of two right renal veins with appear patent. RETROPERITONEUM, LYMPH NODES: There is mass effect along the right aspect of the infrahepatic inferior vena cava secondary to a large right adrenal mass. The IVC appears to opacify normally with contrast. A fat plane is delineated between a majority of the mass and the IVC. There is no definite direct invasion of tumor within the IVC. BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Centrally necrotic right suprarenal mass, compatible with an adrenal metastasis given history, without definite extension into the IVC.


Instruction: Generate impression based on findings.

Input: 41 years Female (DOB:9/27/1975)Reason: Yearly surveillance for previously operated pituitary microadenoma History: SurveillancePROVIDER/ATTENDING NAME: ISSAM A. AWAD ISSAM A. AWAD MRI pituitary:The patient is status post pituitary surgery. The infundibulum of the pituitary is shifted towards the left and is mildly thickened but unchanged since the previous exam. The general configuration of the pituitary gland is stable.There is a 2mm hyperintense T1 focus present within the infundibulum and mid portion of the pituitary gland which is stable compared with prior exams and may represent a Rathke's cleft cyst.A small nonenhancing focus along the superior aspect of the left pituitary gland is approximately 3 mm in size and is stable.The cavernous sinuses are intact bilaterally.

Output: 1.Status post pituitary surgery. The appearance of the pituitary gland is stable when compared to prior exams. Small nodule along the superior aspect of the left pituitary gland remains stable.2.Findings are consistent with a Rathke's cleft cyst which appears stable when compared to prior exams.


Instruction: Generate impression based on findings.

Input: An apparent area of linear high signal in the left cerebellum on the post-contrast 3D T1-weighted images is likely artifactual. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mild bilateral basal ganglia mineralization. The brain parenchyma and pituitary gland otherwise appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is fluid within the bilateral mastoid air cells. There is minimal paranasal sinus mucosal thickening. The skull and scalp soft tissues are grossly unremarkable. The left lens has been replaced.

Output: 1. No convincing evidence of intracranial metastases. Indeed, an area of linear high signal in the left cerebellum on the post-contrast 3D T1-weighted images is likely artifactual rather than actual neoplasm. Nevertheless, a short interval follow up MRI may be useful.2. Nonspecific within the bilateral mastoid air cells.


Instruction: Generate impression based on findings.

Input: Male, 69 years old, with history of brain metastasis, status post SRS. The treated right frontal lobe lesion is again seen showing susceptibility effect, intrinsic T1 hyperintensity and a curvilinear area of enhancement. The enhancing area continues to measure approximately 7 mm in length, unchanged from the prior examination. No associated edema is detected.No additional enhancing lesions are seen. There are a few scattered foci of parenchymal susceptibility showing no significant interval change. No abnormal extra axial fluid collections are seen. The ventricles are normal in size and morphology. Again seen is evidence of extensive sinonasal surgery. Patchy fluid remains within the bilateral mastoid air cells.

Output: 1.No change in the appearance of the treated right frontal lobe lesion.2.No new intracranial lesions are detected.


Instruction: Generate impression based on findings.

Input: 53-year-old female with knee pain Due to the patient's body habitus a high-definition knee coil could not be used. Use of the alternative coil results in slightly suboptimal image qualityMENISCI: There is mild intrasubstance signal within the medial and lateral menisci with perhaps mild fraying along the undersurface of the posterior horn of the medial meniscus, but no discrete tear.ARTICULAR CARTILAGE AND BONE: There is moderate articular cartilage thinning along the undersurface of the lateral patellar facet without focal defect. There is perhaps mild subjective thinning of the articular cartilage of the tibiofemoral joint compartment.LIGAMENTS: The cruciate and collateral ligaments are intact.EXTENSOR MECHANISM: The quadriceps and patella tendons are intact.ADDITIONAL

Output: Degeneration of the articular cartilage of the patella and mild meniscal degeneration without discrete tear. Small loose bodies within the posterior aspect of the knee joint.


Instruction: Generate impression based on findings.

Input: Benign intracranial hypertension [348.2] / Encounter for other specified aftercare [V58.89] / Compression of brain [348.4], Reason for Study: ^Reason: Chiari malformation , please do with CSF flow study post Chiari decompression. Brain MRI:There is evidence of suboccipital craniectomy. No evidence of acute ischemic or hemorrhagic lesion on this scan.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.C-Spine MRI:Suboccipital craniectomy is again seen.There is normal cervical lordosis. The cervical spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. There are minimal central focal bulging of discs at the level of C34, 45, 56 and C67 without evidence thecal sac compression.CSF Flow study:The brain CSF flow study does not include phase imaging sets. On magnitude images which might include some of phase images, demonstrated normal craniofugal and cranio petal flow of the CSF through the foramen magnum. However, there is minimal craniofugal flow on the posterior aspect of the foramen magnum including upper cervical level CSF flow. There are however, minimal cranio petal flow on the posterior aspect of the cerebellar hemisphere. Above findings suggest the CSF flow of the posterior aspect of foramen magnum and upper cervical cord appears to be restricted but the anterior aspect of foramen magnum and upper cervical cord appears to be maintained and the magnitude of the flow appears to be slightly decreased comparing to that of the anterior aspect of the brain stem.

Output: 1. Post suboccipital craniectomy status due to Chiari malformation.2. No evidence of acute ischemic or hemorrhagic lesion. Ventricle size appears to be normal.3. CSF study shows decreased flow but maintaining pulsatile flow on the anterior aspect of the foramen magnum and upper cervical cord. However, posterior aspect of the foramen magnum and upper cervical cord level appears to be restricted.


Instruction: Generate impression based on findings.

Input: There is mild cerebellar tonsillar ectopia with pointed morphology of the right cerebellar tonsil which extends up to 6 mm below the foramen magnum. There is no evidence of suspicious intracranial enhancement, acute infarct, mass effect, or cerebral edema. The ventricles and basal cisterns are normal in size and unchanged. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable.

Output: Findings suggesting Chiari I malformation. No other significant intracranial findings.


Instruction: Generate impression based on findings.

Input: Low back pain; knee pain Knee: Again seen is broadening of the proximal tibial metaphysis which may reflect the sequela of old trauma or a sessile exostosis. This appears similar to the prior exam. There are tricompartmental osteophytes reflecting mild osteoarthritis. Poorly defined sclerosis within the proximal fibular metaphysis represents bone infarct as seen on prior MRI. Ossification along the medial condyle of the left knee likely reflects old trauma to the MCL.Lumbar spine: There is mild degenerative disc disease at L4-5 with mild to moderate facet joint osteoarthritis of the lower lumbar spine, similar to the prior exam. There is normal alignment of the lumbar spine with preservation of the vertebral body heights.

Output: Osteoarthritis of the knee and lumbar spine with other findings described above.


Instruction: Generate impression based on findings.

Input: 75 year old male patient with hepatic lesion on CT. ABDOMEN:LIVER, BILIARY TRACT: There is a 1.6 cm lesion within segment eight of liver which demonstrates nodular, peripheral, discontinuous enhancement with progressive filling in with contrast on delayed imaging; this compatible with a hemangioma. No suspicious hepatic lesion is identified. There is no intra or extrahepatic biliary ductal dilatation. The hepatic vascular structures patent.SPLEEN: There is a 2.4 x 1.6 cm cystic lesion within the anterior spleen with peripheral rim of low signal on T2-weighted imaging compatible with calcium. An additional 2.2 x 0.9 cm region of susceptibility within the posterior spleen is also compatible with calcification. These correlate to calcified and/or peripherally calcified cystic lesions on the prior CT.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts with additional subcentimeter T2 hyperintense foci which are too small to characterize, but also likely representing cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. A segment eight hepatic lesion has imaging characteristics compatible with a hemangioma. No suspicious hepatic lesion is identified.2. Partially calcified splenic granulomas.


Instruction: Generate impression based on findings.

Input: Altered mental status [780.97], Reason for Study: ^Reason: new onset seizure History: new onset seizure No evidence of acute ischemic or hemorrhagic lesion.There is no evidence of hippocampal sclerosis of or abnormal signal intensity.There is no evidence of abnormal enhancement.Bihemispheric scattered high signal intensities on periventricular white matter on FLAIR images indicate nonspecific small vessel ischemic disease.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, 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.About 16 mm x 22 mm sized well-circumscribed right temporo-occipital scalp lesion is again seen. The lesions show mixed are slightly high signal intensity on T1 weighted image with low signal intensity on T2 weighted image indicating high protein content cystic structure such as sebaceous cyst.

Output: No evidence of acute ischemic or hemorrhagic lesion.No evidence of hippocampal sclerosis or abnormal signal intensity.No abnormal enhancement or mass lesion.Nonspecific small vessel ischemic disease as described above.Right temporo-occipital scalp sebaceous cyst most likely.


Instruction: Generate impression based on findings.

Input: Clinical question: Mass-effect. Signs and symptoms: Syncope. Has known brain cancer of unclear etiology. Non-infused CT of brain:There is no evidence of hemorrhage, edema mass-effect, midline shift or hydrocephalus.Cortical sulci, ventricular system and all CSF cisterns remain within normal limits. Sinusitis of the right maxillary sinus is noted and the rest of the paranasal sinuses are essentially unremarkable.Mastoid air cells and middle ear cavities are well pneumatized and unremarkable. Calvarium is intact.There is no evidence of a mass on this examination as clinically indicated. If clinical concern persist a follow-up with an MRI examination is recommended.

Output: 1.Essentially unremarkable non-infused CT of brain.2.Calvarium is unremarkable.3.Minimal sinusitis as detailed.4.No evidence of mass is detected as clinically is indicated. Porter follow-up with an MRI is recommended.


Instruction: Generate impression based on findings.

Input: Clinical question to be answered: Evaluate for epidural hematoma in an anticoagulated patient can't get an MRI. Signs and symptoms: Myelopathy. This examination was performed with contrast to evaluate for possible epidural process (abscess, hematoma). This examination is not the appropriate test and it may not visualize any of these abnormalities on this exam. This exam however was performed due to patient's inability to obtain an MRI. Advanced degenerative disk disease at C3 -- C4 and C4 and C5 levels are again identified. There is grade 1 retrolisthesis of C4 in respect to C5. There is reversal of cervical lordosis into kyphotic deformity centered at C3 -- C4 level.Axial and sagittal reformatted images demonstrate no definitive evidence of any abnormal enhancement within the epidural space in the cervical region from C2 through C7. Images below this level are even further obscured due to shoulder artifacts and nondiagnostic for any of the above clinical question concerns.Foramina magnum.Examination at this level is unremarkable.C2 -- C3. No central spinal stenosis or neural foramina compromise.C3 -- C4.Minimal compromise of bilateral neural foramina. Flattening and posterior displacement of the cord secondary to ventral hypertrophic changes. Borderline central spinal stenosis of 7.9-mm is suspected.C4 -- C5. Advanced degenerative disk disease and retrolisthesis. Central spinal stenosis of 6.6-mm is suspected. Compromise of bilateral neural foramina secondary to degenerative changes.C5 -- C6. Minimal degenerative changes. Suspected minimal left neural foramina compromise. No central spinal stenosis.C6 -- C7.No central spinal stenosis or neural foramina compromise.C7 -- T1.Examination at this level is unremarkable.100 cc of Omnipaque was utilized for the above study.

Output: 1.Extensive degenerative changes of cervical spine with multilevel neural foramina compromise and central spinal stenosis as detailed.2.Limited value examination for detection of epidural hematoma or abscess however no definitive finding to suggest either one of the above suspected clinical questions.A


Instruction: Generate impression based on findings.

Input: History of cervical cancer. Evaluate tumor burden. History of invasive moderately differentiated squamous cell carcinoma. PELVIS:UTERUS, ADNEXA: The uterus is markedly distorted in its mural contour with numerous T2-weighted very hypointense masses and T2-weighted intermediate signal intensity masses which are submucosal, intramural and subserosal in distribution. The uterus is approximately 20.5 x 8.9 cm in sagittal cross section (series 901/45). Many of these masses demonstrate peripheral heterogeneous enhancement with central non-enhancement, suspicious for extensive tumor involvement. The endometrial cavity is abnormally dilated measuring up to 2 cm with an ill-defined endometrial/inner myometrial junction.There is suspected tumor invasion into the bilateral adnexa. Tumor extends to the right lateral pelvic side wall (series 701/41). Tumor invades the proximal vagina. BLADDER: Foley catheter within a partially collapsed urinary bladder. The fat plane between the cervix and inferior dorsal bladder wall is obliterated with suspected tumor invasion into the base of the bladder (series 1002/49).LYMPH NODES: There is extensive periaortic lymphadenopathy best seen on the coronal series #401, image 21 and 19 as well as common iliac lymphadenopathy (series 401 image 24). The right periaortic lymph node measures approximately 3.7 x 2.4 cm in the coronal plane.BOWEL, MESENTERY: There is a moderate volume of pelvic ascites with nodular peritoneal thickening with enhancement suspicious for carcinomatosis (series 1604/64).Peripheral enhancing nodule at the umbilicus suspicious for tumoral deposit measuring 1.8 x 1.5 cm (series 1604/image 121). Additional tumoral deposits are suspected but are incompletely evaluated in the lower abdomen/upper pelvis. Tumor involves the right ureter with moderate hydroureter. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Extensive tumoral involvement of an enlarged and distorted uterus, proximal vagina and bilateral adnexa. Probable tumoral invasion into the base of the bladder. 2.Extensive pelvic and lower abdominal retroperitoneal lymphadenopathy.3.Right ureteral involvement resulting in hydroureter.4. Pelvic ascites and additional findings as described above.


Instruction: Generate impression based on findings.

Input: 68 year old with history of right lumpectomy in 2006 followed by radiation therapy, and right mastectomy in 2014 for IDC with DCIS. Status post right mastectomyThere is scattered fibroglandular tissue in the left breast.Mild parenchymal enhancement is noted in the left breast.Stable intramammary lymph node in the lower outer left breast.No abnormal enhancement is seen in left breast or right mastectomy bed. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Rule out tethered cord, spinal dysraphisms, and cauda equina syndrome. History of intermittent bowel and bladder incontinence, bilateral leg pain. The conus medullaris is situated at the L2 level. The imaged-portion of the spinal cord displays normal signal and morphology. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal or neural foramen stenosis. The paravertebral soft tissues are unremarkable.

Output: 1. The conus medullaris is situated at the L2 level, which is within normal limits.2. No evidence of significant spinal canal stenosis in the lumbar spine.