Instruction: Generate impression based on findings.

Input: Female 43 years old Reason: history of cholecystectomy, with subsequent retained stone in choledocholithiasis s/p ERCP, now w/ recurrent right sided abdominal pain and pneumobilia on OSH CT ABDOMEN:LIVER, BILIARY TRACT: Normal hepatic morphology and contour without signal abnormalities. No suspicious hepatic lesions. No intra or extrahepatic biliary ductal dilatation. The gallbladder is absent. No evident choledocholithiasis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Status post cholecystectomy without evidence of choledocholithiasis.2.No focal hepatic lesion.


Instruction: Generate impression based on findings.

Input: Elevated PSA, evaluate for prostate cancer. PELVIS:PROSTATE:Prostate Size: 5.8 x 4.1 x 5.7 cm.Peripheral Zone: The previously described area of decreased signal within the left aspect of the mid gland is less conspicuous, appears more symmetrical, and is compatible with normal central zone. No suspicious focal lesions are identified within the peripheral zone.Central Gland: Central zone is hypertrophic with numerous hyperplastic nodules compatible with BPH.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: Not applicable.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small fat-containing bilateral inguinal hernias are noted.

Output: No suspicious focal prostate lesions are identified.


Instruction: Generate impression based on findings.

Input: 39-year-old man with history of epigastric abdominal pain and family history of pancreatic cancer. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in signal and morphology. There is no intrahepatic or extrahepatic biliary ductal dilatation. The gallbladder is normal.SPLEEN: The spleen is enlarged measuring 13.5 cm in length. PANCREAS: Punctate T2 hyperintense lesions within the pancreatic head, which is nonspecific but may represent a side branch IPMN (series 4/21). ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Focal lateral left midpole cortical scar. Kidneys are otherwise normal in appearance.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is mild dilatation of a short length of small bowel in the right upper quadrant.BONES, SOFT TISSUES: Vertebral body hemangioma noted in L1, L2 and L3.OTHER: No significant abnormality noted.

Output: 1.Mild dilatation of a short length of small bowel in the right upper quadrant, which may represent focal ileus.2.Splenomegaly.3.Subcentimeter cystic lesion in the pancreatic head may represent a sidebranch IPMN.


Instruction: Generate impression based on findings.

Input: 39-year-old male with significant ankle pain for 2 years and associated inflammation. TENDONS: No significant abnormality noted.LIGAMENTS: The anterior talofibular ligament appears slightly elongated and thin. The calcaneofibular ligament appears thickened. There are small foci of near-fluid signal intensity along the posterior talofibular ligament. This constellation of findings may represent prior injury to the lateral collateral ligament complex. The distal tibiofibular syndesmotic complex appears intact. There is loss of the normal fatty striation of the deep component of the deltoid ligament which may reflect prior trauma. There is a 1 cm ossicle along the anterior inferior margin of the medial malleolus likely reflects old trauma as well.ARTICULAR SURFACES AND BONE: There are 1.5-2 cm ossicles along the dorsal aspect of the talonavicular joint which may reflect old trauma. There is severe osteoarthritis of the talonavicular joint. Relatively mild osteoarthritis affects the tibiotalar joint. ADDITIONAL

Output: Findings suggestive of prior trauma to the ankle as described above with severe osteoarthritis of the talonavicular joint and relatively mild osteoarthritis of the tibiotalar joint.


Instruction: Generate impression based on findings.

Input: Clinical question: Rule out intracranial bleed. Signs and symptoms: Stroke. CT of brain without infusion:Crowding of the cerebellar tonsils at the level from the magnum is again identified. Images through posterior fossa demonstrates minimal encephalomalacia along the medial aspect of right cerebellum. This area demonstrated acute stroke on prior MRI examination off January 29 of 2010. There is no evidence of any hemorrhage within the posterior fossa. Fourth ventricle remains normal and in midline. Images through the supratentorial space are essentially unremarkable and no evidence of hemorrhage, edema, mass-effect, midline shift or hydrocephalus.Paranasal sinuses, mastoid air cells, middle ear cavities and calvarium are unremarkable.

Output: 1.Small area of low attenuation likely encephalomalacia or edema in the distribution of the right pica is consistent with patient's known prior right pica stroke.2.No evidence of any new area of stroke or hemorrhage is detected.


Instruction: Generate impression based on findings.

Input: 65-year-old male with history of cirrhosis and pancreatic cyst seen on CT. Evaluate. ABDOMEN:LIVER, BILIARY TRACT: Nodular hepatic contour with widening of the fissures consistent with cirrhosis. Previously seen arterially enhancing lesions are not evident on the current examination. There is a linear arterially enhancing focus in segment 4A near the liver capsule which does not demonstrate washout and is likely a perfusion defect.SPLEEN: Multiple subcentimeter hypointense foci throughout the spleen, most likely secondary to iron deposition.PANCREAS: No pancreatic ductal dilatation. There is a minimally complex T2 hyperintense lesion in the pancreatic head that measures 1.2 x 0.9 cm (series 10, image 26), previously measuring 1.6 x 1.2 cm; this lesion has a small enhancing septation. Multiple subcentimeter T2 hyperintense foci within the pancreas, likely side branch type IPMN.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Paraesophageal varices are noted.

Output: 1.Minimally complex pancreatic head lesion as above. Follow-up is recommended.2.Multiple pancreatic side branch type IPMNs.3.Cirrhosis without evidence of nodular arterially enhancing suspicious lesion.


Instruction: Generate impression based on findings.

Input: Diagnosis: Secondary malignant neoplasm of brain and spinal cord Malignant neoplasm of thyroid glandClinical question: history of papillary thyroid carcinoma previously treated with radiosurgery; please evaluate response (particular attention to enlarging L superior parietal region)Signs and Symptoms: brain metastases. The CSF spaces are appropriate for the patient's stated age with no midline shift. The patient is status post left-sided craniotomy. There is adjacent dural thickening present and blood products. A previously noted mass in the left inferior parietal lobule is not readily identified on the current exam. Instead there is a small amount of enhancement associated with the susceptibility effect indicative of postsurgical change.There is a 6 mm ring-enhancing lesion present along the left superior parietal lobule just behind the left postcentral gyrus. This measured 8 mm on 5/29/2015 and 6 mm on the 6/23/2015 exam.There is redemonstration of a 3 mm enhancing longitudinal along the lateral aspect of the right orbital gyrus. This area is obscured on susceptibility weighted imaging.A 2 mm minimal nodule is redemonstrated at the frontal horn of the right lateral ventricle. It is barely visible on the current exam and was more conspicuous on the prior exam. It is associated with the susceptibility effect and is more conspicuous on the susceptibility weighted images on the current exam.A 2 mm nodule is present along the right inferior frontal gyrus. It is associated with the susceptibility effect.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate scattered opacities. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.The patient has undergone surgical removal of a left inferior parietal lobule mass.2.There are multiple small nodules scattered in the right frontal lobe, left parietal lobe and left frontal lobe. There appear to be blood products associated with these lesions which make the somewhat more conspicuous on susceptibility weighted imaging in areas where there is less artifact from the skull base. In general these lesions appear stable compared to the 6/23 exam but slightly smaller compared to the 5/29 exam.


Instruction: Generate impression based on findings.

Input: Reason: concern for polymyositis History: complains for polymyositis Left femur:There is a moderate amount of diffuse increased signal abnormality on fluid sensitive sequences within the gluteal, quadriceps, hamstring, and adductor musculature. No focal fluid collection is identified. There is mild fatty atrophy of the hamstring and gluteal musculature. There is nonspecific subcutaneous edema most pronounced along the anterior and medial aspect of the thigh. No definite abscess is identified within the limitations of this noncontrast examination. No bone marrow signal abnormality is identified. There is a small amount of fluid within the left hip and knee which is not necessarily of any clinical significance.Right femur:There is a moderate amount of diffuse increased signal abnormality on fluid sensitive sequences within the gluteal, quadriceps, hamstring, and abductor musculature. There is mild fatty atrophy of the hamstring and gluteal musculature. No focal fluid collection is identified. There is nonspecific subcutaneous edema most pronounced along the lateral aspect of the thigh. Some of this edema becomes more confluent along the lateral aspect of the vastus lateralis at the level of the mid diaphysis of the femur, however, no definite capsulated collection is identified. However, evaluation for abscess is limited on this noncontrast examination. No bone marrow signal abnormality is identified. There is a small amount of fluid within the left hip and knee which is not necessarily of any clinical significance.

Output: Diffuse bilateral signal abnormality/inflammatory change within the musculature of the left and right thigh which is nonspecific but consistent with the patient's history of polymyositis. Nonspecific bilateral subcutaneous edema.


Instruction: Generate impression based on findings.

Input: Reason: r/o bleed History: s/p fall None infused head CT:There is no intracranial hemorrhage, edema, mass effect, midline shift or hydrocephalus.Bilateral extra-axial CSF density collections in frontal and anterior parietal regions are concerning for old subdural hematomas. Recommend follow-up with an MRI examination. The collection on the left at the level of frontal horn of lateral ventricle measures approximately 9 mm in size and results in very minimal flattening of the cortex. The smaller right-sided subdural measures approximately 6.4 mm. Minimal patchy foci of periventricular white matter is concerning for mild small vessel disease of indeterminate age.

Output: 1.No evidence of acute intracranial hemorrhage, edema, mass effect, midline shift or hydrocephalus.2.Small bilateral frontal CSF density subdural collections (left greater than right) with very subtle mass effect on the brain parenchyma.3.Mild small vessel disease of indeterminate age.


Instruction: Generate impression based on findings.

Input: 80-year-old female patient with pancreatic adenocarcinoma and liver lesion seen on outside CT. ABDOMEN:LIVER, BILIARY TRACT: There are two T2 hyperintense, arterially enhancing foci in the right lobe of the liver corresponding to the lesions seen on prior CT. A lesion in the dome of the liver measures 7 x 7 mm and contains minimal enhancement on venous phase imaging. The peripheral, mildly wedge shaped focus in segment seven measures 10 x 7 mm and does not enhance on venous or delayed phase imaging. There is mild perihepatic fluid.SPLEEN: There is mild perisplenic fluid.PANCREAS: Corresponding to the prior CT findings, again seen is an ill-defined soft tissue lesion in the body of the pancreas with soft tissue encasement of the celiac axis and the superior mesenteric artery. The superior mesenteric vein was attenuated on the prior CT and is not well seen on the current study, likely representing occlusion. There are at least five peripancreatic fluid and hemorrhage containing collections about the tail of the pancreas. The largest collection anteriorly is mildly increased in size compared to prior CT and measures 8 x 4.4 cm (series 601 image 186), previously 7.6 x 3.6 cm.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Lesion in the dome of the liver most likely represents a hemangioma, while the posterior peripheral focus in the liver most likely represents a perfusional anomaly. No metastatic hepatic lesions are seen.2.Soft tissue mass in the body of the pancreas compatible with known adenocarcinoma. 3.There is peripancreatic soft tissue encasement of the celiac axis and superior mesenteric artery as well as likely interval focal occlusion of the superior mesenteric vein.4.Multiple fluid and hemorrhage containing collections about the distal pancreas, the largest of which has slightly increased in size compared to prior CT.


Instruction: Generate impression based on findings.

Input: Bladder cancer with new left lower extremity weakness Cervical: Craniocervical junction is unremarkable. Vertebral body heights in the cervical spine are normal. Alignment is maintained aside from straightening. No cord signal abnormality. There is moderate disc height loss at the C5-C6 level, particularly anteriorly. There is abnormal signal involving the left aspect of the C7 vertebral body with extension into the posterior elements suspicious for metastasis. No gross evidence of epidural tumor within the limits of noncontrast study.There is developmental narrowing of the cervical spinal canal with superimposed degenerative changes as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: Mild spinal canal stenosis which is on a developmental basis. Neural foramina are patent.C4-5: Developmental narrowing of the cervical spinal canal with superimposed small central disc protrusion. Mild facet arthropathy. There is moderate spinal canal stenosis. Neural foramina are patent.C5-6: Disc osteophyte complex with bilateral uncovertebral hypertrophy as well as ligamentum flavum thickening. There is moderate spinal canal stenosis and mild to moderate bilateral neural foraminal stenosis.C6-7: Disc osteophyte complex and uncovertebral hypertrophy as well as ligamentum flavum thickening. There is moderate spinal canal stenosis and mild to moderate bilateral neural foraminal stenosis.C7-T1: No significant compromise to the spinal canal or neural foramina.There is a 14 x 17 mm right lower cervical/level 4 lymph node which is also present on recent chest abdomen pelvis CT from 10/4/2016.Limited thoracolumbar spine evaluation on the cord compression protocol MRI: Scattered foci of osseous signal abnormality are seen including a 14 mm focus involving the L2 vertebral body as well as a lesion involving the spinous process of L5. There is also signal abnormality involving the posterior superior aspect of the T6 vertebral body.Vertebral bodies heights are maintained. Alignment in the thoracolumbar spine is maintained. There is T1 shortening involving the bone marrow of the pelvis and L5 level consistent with prior radiation. No large infiltrating lesions, pathologic fractures, or gross evidence of epidural tumor. No obvious cord signal abnormality. There are fairly mild multilevel degenerative changes with mild to moderate neural foraminal stenosis at the L4-L5 level. There is nonspecific edema involving the posterior paraspinous musculature from L3 to L5 level.

Output: 1. Examination of the spine includes sequences per acute cord compression protocol with additional noncontrast sagittal and axial T2-weighted sequences of the cervical spine. There is no evidence of acute cord or cauda equina compression.2. Scattered likely osseous metastatic lesions, relatively more prominent involving the C7 and L2 levels. No large destructive osseous lesions, pathologic fractures, or gross evidence of epidural tumor is appreciated.3. Developmental narrowing of the cervical spinal canal with superimposed degenerative changes resulting in moderate spinal canal stenosis at the C4-C5, C5-C6, and C6-C7 levels. No cord signal abnormality. 4. Enlarged lymph node in the right lower neck likely representing metastatic disease.5. Note due to the screening nature of the cord compression protocol details are not as evident on imaging as dedicated protocols of the spine.


Instruction: Generate impression based on findings.

Input: Low back pain Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits aside from minimal retrolisthesis of L4 on L5 which is unchanged. Bone marrow signal is benign with small T1 hyperintense focus at the left superior T12 level compatible with a focus of fat or hemangioma. The conus medullaris is at the lower limits of normal in position at the inferior L2 level as before.There is developmental narrowing of the mid to lower lumbar spinal canal with superimposed mild degenerative changes. There is disc desiccation at the L4-L5 and L5-S1 levels, mildly worse at L4-L5 compared to prior from 1/20/2014. Individual levels as below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: Mild disc bulge, facet arthropathy, and ligamentum flavum thickening. There is mild central spinal canal stenosis as before. There is mild left-sided neural foraminal stenosis which appears slightly worse in the interval. Right neural foramen is patent.L4-L5: There is slight worsening of disc bulge at this level with small central protrusion component. Bilateral facet arthropathy and ligamentum flavum thickening again seen. There is moderate spinal canal stenosis which appears slightly worse. There is mild bilateral neural foraminal stenosis, left slightly worse than right. There is mild distention of the facet joints which has increased since prior.L5-S1: There is minimal disc bulge, mild facet arthropathy, and ligamentum flavum thickening with mild effacement of the lateral recesses sees similar to prior. No significant central canal stenosis. There is mild left and minimal right neural foraminal stenosis. Paraspinous soft tissues are within normal limits.

Output: 1. Mild progression of degenerative changes in the lumbar spine compared to 1/20/2014. There is up to moderate spinal canal stenosis at the L4-L5 level which has slightly progressed, related to increase in disc bulge and mild progression of facet arthropathy superimposed on a developmentally narrow lumbar spinal canal. 2. Fairly mild multilevel neural foraminal stenoses as detailed above.


Instruction: Generate impression based on findings.

Input: 59-year-old male with wrist pain. Evaluate TFCC. LIGAMENTS: Given the limitations of a non arthrogram study, we see no findings to suggest scapholunate or lunotriquetral ligament tear.TRIANGULAR FIBROCARTILAGE COMPLEX: Although we see no fluid-filled tear of the triangular fibrocartilage complex, there is intermediate signal intensity along the distal surface of the articular disc that likely reflects degenerative fraying/tearing as well as mild increased signal intensity centrally that likely represents intrasubstance degeneration. There is also thinning of the styloid and foveal attachments of the articular disc that as well as linear increased signal intensity within the dorsal radioulnar ligament suggesting degeneration. TENDONS: The extensor carpi ulnaris appears slightly enlarged with minimal intrasubstance signal that may represent mild tendinosis. There are multiple slips of the first and second extensor compartment tendons which may reflect normal variation for this patient. BONES: There is abnormal signal intensity within the proximal and medial aspect of the lunate bone adjacent to the aforementioned surface degeneration/tearing of the triangular fibrocartilage disc, likely representing small cysts and adjacent edema. We see no positive ulnar variance.ADDITIONAL

Output: 1. Although we see no fluid-filled tear of the triangular fibrocartilage complex, there appears to be degeneration of the articular disc as described above. Furthermore, there are cysts within the proximal lunate. These findings may represent the sequela of ulnar impaction syndrome, although we see no positive ulnar variance.2. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Foot pain, left and right. Open wound of left foot. Drainage, pus, warmth. History of osteomyelitis. Evaluate for osteomyelitis. Left foot: Surgical changes of transmetatarsal amputation appear similar to those seen on the prior study. Overall, the margins are sharp, although there is wispy bone formation along the distal end of the remaining fifth metatarsal that corresponds approximately to signal abnormality seen on an MRI examination from July 27. While this could represent osteomyelitis, it appears similar to that seen on the radiographs from July 26, without evidence of progression.Right foot: Surgical changes of transmetatarsal amputation appear similar to those seen on the prior study. I see no frank osteolysis to suggest osteomyelitis. There is a defect in the soft tissues beneath the tarsometatarsal joint on the lateral view that likely represents ulceration that appears smaller than that seen on the prior study.

Output: Surgical changes of bilateral transmetatarsal amputation appearing similar to the prior study. Mild irregularity of the distal margin of the remaining left fifth metatarsal could represent sequela of osteomyelitis, but appears similar to that seen on the prior study without evidence of progression. Right foot soft tissue ulceration without specific radiographic features of osteomyelitis.


Instruction: Generate impression based on findings.

Input: 16 year old female with hypertensive crisis, seizure. Rule out edema. There is no evidence of intracranial hemorrhage, mass or edema. Low-attenuation within the right posterior parietal lobe along the high convexity is consistent with patient's given history of prior stroke. Intra-sulcal punctate calcification may be related to prior hemorrhage or leptomeningeal calcifications. No acute cortical stroke is seen. If there is clinical concern for acute ischemia, MRI may be considered.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Right posterior parietal encephalomalacia consistent with previous stroke. No acute cortical stroke is seen, however, if there is clinical concern for acute ischemia, an MRI may be considered.


Instruction: Generate impression based on findings.

Input: Clinical question: Acute hemorrhage. Signs and symptoms: Altered mental status x 24 hours. Nonenhanced head CT:No detectable acute intracranial process. CT however it is insensitive for early detection of acute nonhemorrhagic ischemic stroke. The clinical concern persist recommend follow-up with an MRI examination.Mild degree of small vessel ischemic strokes of indeterminate age are evident by subtle periventricular and subcortical low attenuation white matter.The cortical sulci, ventricular system and the CSF cisterns are within normal for patient stated age.Mild large vessel intracranial vascular calcification of the cavernous carotid and bilateral routine post is present.Calvarium, visualized paranasal sinuses and orbits and mastoid air cells are unremarkable.

Output: Mild small vessel ischemic strokes of indeterminate age. CT however it is insensitive for early detection of acute nonhemorrhagic ischemic stroke.


Instruction: Generate impression based on findings.

Input: 86-year-old female with syncope and history of CVA. Rule out CVA There is no evidence of intracranial hemorrhage, mass or edema. Diffuse hypodensity in a periventricular distribution consistent with small vessel ischemic disease, age indeterminate. If there is clinical concern for acute ischemia, an MRI may be considered. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Small vessel ischemic disease, age indeterminate. If there is clinical concern for acute ischemia, an MRI may be considered.


Instruction: Generate impression based on findings.

Input: Bilateral severe-profound hearing loss. Internal Auditory Canals: There is marked deficiency of the bilateral cochlear and inferior vestibular nerves associated with stenosis of the cochlear apertures. The bilateral facial and superior vestibular nerves appear to be intact. There is fluid within the bilateral mastoid air cells and middle ears. The bilateral semicircular canals, vestibules, and endolymphatic ducts are otherwise grossly unremarkable.Brain: There mild prominence of the subarachnoid spaces anteromedial to the bilateral temporal lobes. Otherwise. there is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is an expected degree of myelination. There is no abnormal intracranial enhancement. The ventricles 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 scattered paranasal sinus mucosal thickening.

Output: 1. Bilateral cochlear and inferior vestibular nerve deficiency.2. Nonspecific bilateral otomastoid fluid.3. No evidence of acute intracranial hemorrhage, mass, or infarct.


Instruction: Generate impression based on findings.

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

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


Instruction: Generate impression based on findings.

Input: Brain: There are several enhancing lesions in the skull. For example, the largest in the right frontal calvarium measures up to approximately 20 mm. There are associated defects in the cortex, but no mass effect upon the underlying brain. There is no evidence of intraparenchymal mass lesions. However, there is diffuse cerebral white matter T2 hyperintensity and a chronic lacunar infarct in the right pons. There is no evidence of intracranial hemorrhage or acute cerebral 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.Cervical spine: There are multiple enhancing lesions in the cervical spine and upper thoracic spine. In particular, there is epidural extension of tumor involving the C3 and C4 vertebrae with negligible spinal canal stenosis, but substantial encroachment upon the neural foramina at those levels. There is no evidence of spinal cord compression or signal abnormality. There is mild endplate deformity of several cervical vertebral bodies, which may represent pathologic fractures. There is underlying multilevel degenerative spondylosis, which is most pronounced at C5-6, with mild spinal canal stenosis.

Output: Multiple metastases involving the imaged axial skeleton without evidence of metastatic lesions in the brain parenchyma or spinal cord compression.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Redemonstrated are postoperative changes of a right parietal craniotomy with resection of a previously demonstrated enhancing tumor along the resection cavity. The subadjacent epidural fluid collection confined to the right parietal-occipital flap with mild mass effect on the adjacent parenchyma has decreased slightly in size now measuring 14 mm in thickness compared to 16 mm previously. The resection cavity itself has become slightly FLAIR hyperintense relative to the prior examination which may reflect accumulated debris or blood product. Restricted diffusion surrounding the resection cavity has diminished.There has been interval development of nodular peripheral enhancement along the resection cavity and involving the ependyma of the occipital and temporal horn of the right lateral ventricle. This ependymal enhancement first becomes apparent back on the 7/21/2015 MRI. Parts of the new nodular rim enhancement show increased relative cerebral blood volume. Again seen is persistent T2/Flair signal surrounding the resection cavity in the right temporal, parietal and occipital lobes. This FLAIR signal has slightly progressed in the inferior right temporal gyrus. Also redemonstrated is thickening and T2 hyperintensity of the right medial temporal lobe structures, similar to prior, and concerning for disease involvement.An equivocal small focus of restricted diffusion in the left periventricular region adjacent to the occipital horn is nonspecific. The ventricles may be mildly larger than on the prior exam. There is no midline shift.There is minimal mucosal thickening in the bilateral maxillary sinuses. The rest of the paranasal sinuses are unremarkable. There is fluid in the right mastoid air cells.

Output: Post-surgical changes of a right parietal craniotomy for resection of recurrent GBM are seen. Progressive nodular peripheral enhancement within the parenchyma along the resection cavity is evident on today's exam. Given that these areas of new nodular enhancement demonstrate elevated rCBV, and in the context of slowly progressive ependymal enhancement, the findings are concerning for progression of disease.


Instruction: Generate impression based on findings.

Input: Breast cancer, evaluate for cord compression The vertebral bodies are appropriate in the overall alignment and height. There is multifocal abnormal marrow signal related to osseous metastatic disease, relatively more prominent at the T10, L1, L3, L5, and sacral vertebrae. There is diffuse marrow infiltration involving the L1 vertebra as well as multiple sacral vertebrae. There is suspected narrowing of the left sacral neural foramina related to the tumor. The spinal cord has grossly normal signal characteristics and overall morphology. There is no compromise of the spinal cord or significant stenosis involving the cauda equina in the lumbar spine.Large right pleural effusion partially imaged.

Output: 1. Extensive osseous metastatic disease without evidence of pathologic compression fracture or associated cord compression.2. This is a limited exam specific for the exclusion of cord compression only and does not exclude more subtle lesions such as intrinsic cord abnormalities. 3. Due to the screening nature of this protocol details are not as evident on imaging as dedicated protocols of the spine. There is suspected narrowing of the sacral neural foramina related to the extensive tumor infiltration of the sacrum, particularly on the left. Additional imaging with contrast can be considered as clinically indicated.


Instruction: Generate impression based on findings.

Input: Knee pain and swelling. Check for ligamentous tear MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: Cartilage is well visualized without focal defects. Pronounced red marrow is also observed in the distal femur incompletely, may represent potential anemia given patient age.LIGAMENTS: Mild thickening of the MCL with surrounding inflammation, mild strain cannot be excluded. Fibers however appear intact. The LCL is grossly intact and similar increased signal in the ACL is also observed with fibers extending in the expected location; moderate sprain suspected. The PCL is intact EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Moderate ACL sprain without evidence of definite tear or retraction. Additional moderate sprain of the MCL must also be considered. Please correlate with patient's symptoms. Moderate knee effusion


Instruction: Generate impression based on findings.

Input: Female, 31 years old. Outside podiatry eval and x-ray with abnormality of mid-shaft area of 2nd metatarsal and separately a possible neuroma in the same foot. Right foot pain The imaged soft tissue structures of the foot are normal, without solid mass lesion, discrete fluid collection, or foci of abnormal enhancement. The imaged muscles and tendons are grossly normal. The underlying osseous structures are unremarkable, with normal cortical thickness and marrow signal. Specifically, there is no evidence of metatarsal stress injury.

Output: Normal examination, without evidence of mass lesion or stress injury.


Instruction: Generate impression based on findings.

Input: BRAIN: There is no abnormal diffusion weighted signal to suggest acute ischemic infarction. Mild prominence of the cortical sulci and supratentorial ventricles is compatible with age-related volume loss appearing similar to prior. There is no midline shift or herniation. Scattered punctate foci of increased T2/FLAIR signal within the supratentorial white matter are compatible with chronic small vessel ischemic changes appearing similar to the 10/17/2012 exam. There is a 6 x 6 mm intraparenchymal focus of signal abnormality adjacent to the left hippocampal head which demonstrates internal T2 hyperintensity and T1 hypointensity without associated edema or mass effect appearing similar to the prior examination. Scattered punctate foci of decreased signal on susceptibility weighted images are present within the bilateral cerebral and cerebellar hemispheres appearing similar to prior. There is once again a chronic blowout fracture left lamina papyracea. Postcontrast images do not demonstrate any abnormal areas of intraparenchymal enhancement.MRA HEAD: The intracranial internal carotid arteries are normal in course and caliber. The middle and anterior cerebral arteries are unremarkable. The right P1 is hypoplastic. The left PCOM is poorly visualized. The vertebral arteries, basilar artery, and posterior cerebral arteries are normal in course and caliber. There is no evidence of flow-limiting stenosis or aneurysm.MRA NECK: There is a separate origin of the left subclavian artery, left common carotid artery, and brachiocephalic artery from the arch. The common carotid arteries are normal in course and caliber. There is a short segment of approximately 30% stenosis involving the origin of the right internal carotid artery. The left internal carotid artery is normal in course and caliber. Both vertebral artery origins are patent. There is no evidence of flow-limiting stenosis or occlusion.

Output: 1.No acute ischemic infarction. 2.Mild age-related volume loss and chronic small vessel ischemic disease, unchanged.3.MRA of the head and neck without aneurysms or flow-limiting stenosis. Mild (approximately 30%) narrowing of the origin of the right internal carotid artery.4.Redemonstration of a 6 mm focal signal abnormality adjacent to the left hippocampal head which likely represents a cavernous malformation appearing similar to prior and without significant associated edema or mass effect.5.No new intracranial masses to suggest metastatic disease.6.Scattered punctate susceptibility artifacts in the cerebellum and cerebral hemispheres which are nonspecific but may represent microhemorrhage, cavernomas, or microcalcifications appearing similar to prior.7.Chronic blowout fracture left lamina papyracea.


Instruction: Generate impression based on findings.

Input: New left-sided 7th nerve palsy, history of DLBCL, melanoma, breast cancer. There is new diffuse left facial nerve enhancement. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are a few nonspecific punctate foci of T2 hyperintensity within the cerebral white matter. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There are bilateral lens implants.

Output: New diffuse left facial nerve enhancement is suggestive of Bell's palsy rather than neoplastic involvement and there is otherwise no evidence of brain metastases.


Instruction: Generate impression based on findings.

Input: 40-year-old male with severe knee pain and history of amyloidosis. Evaluate for involvement by amyloid. Evaluation of several sequences is limited by motion artifact.MENISCI: Given the above limitations, there is no evidence of meniscal tear.ARTICULAR CARTILAGE AND BONE: There is linear low signal intensity traversing the articular cartilage of the trochlea centrally. This finding has been found to be associated with cartilage fissuring. The remainder of the articular cartilage appears normal given the aforementioned limitations.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: There is intermediate signal intensity at the insertion of the quadriceps on the patella which may represent focal tendinosis but this is equivocal and of questionable clinical significance. There also appear to be very mild inflammatory changes within the subcutaneous fat along the anterior aspect of the patella, of questionable significance.ADDITIONAL

Output: 1. Limited study due to patient's motion artifact.2. Focal cleft of the articular cartilage of the femoral trochlea.3. Small joint effusion.4. Scarring of Hoffa's fat pad which may represent prior surgery.5. Mild inflammatory changes within the prepatellar subcutaneous fat, of questionable clinical significance.


Instruction: Generate impression based on findings.

Input: Pain in unspecified limb [M79.609], Reason for Study: ^Reason: R/O syrinx and or Tethered cord History: leg pain There is normal cervical lordosis. The cranial-cervical junction is normal. There is normal thoracic kyphosis and lumbar lordosis. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The cord signal is normal. The epidural space, thecal sac, and spinal cord are preserved with no evidence of spinal canal/neural foraminal stenosis, cord compression or myelopathy. The conus medullaris terminates at the level of L1-L2.The intervertebral discs demonstrate normal T2 intensity and height with no evidence of disc herniation. The paraspinal soft tissues and musculature are unremarkable.

Output: Normal spine MRI


Instruction: Generate impression based on findings.

Input: Check for rotator cuff. Pain Evaluation of the right shoulder is limited secondary to moderate artifact from underlying hardware and multiple anchoring screws. Please note correlation with a plain film if available would increase sensitivity.ROTATOR CUFF: Full-thickness tear of the supraspinatus is observed with retraction of the more anterior fibers. Diffuse signal and thickening are observed more mild changes of the infraspinatus and subscapularis tendons. Teres minor is intactSUPRASPINATUS OUTLET: No significant abnormality noted given limitations..GLENOHUMERAL JOINT AND GLENOID LABRUM: Labrum is only grossly intact and diminutive along the anterior aspect as well as a suspected small SLAP tear. Consider dedicated augmented imaging if further detail and characterization is needed. Moderate degenerative changes involving the AC jointBICEPS TENDON: The biceps tendon is less well visualized given the artifact, however the visualized portions otherwise demonstrate mild changes compatible with tendinosis, specifically within the horizontal component. ADDITIONAL

Output: Limited exam secondary to artifact and prior surgery with residual hardware. Underlying recurrent and/or residual supraspinatus tear is observed as described with more mild to moderate changes involving the remaining rotator cuff and articulation. See details provided


Instruction: Generate impression based on findings.

Input: Avascular necrosis The examination is limited by motion artifact.There is abnormal marrow signal intensity and significant collapse of the femoral heads bilaterally consistent with avascular necrosis. There is marked secondary osteoarthritic changes of the hips bilaterally as a result. There is no malalignment. There is no definite fracture.Following contrast administration, there is no abnormal enhancement soft tissue enhancement or significant enhancement of the femoral heads.

Output: Advanced avascular necrosis of the hips with femoral head collapse and marked secondary osteoarthritis.


Instruction: Generate impression based on findings.

Input: Male, 44 years old. Left wrist pain. LIGAMENTS: After injection of contrast into the intercarpal joint space, contrast also opacified the radiocarpal joint space on MR images. The scapholunate ligament appears intact. The lunotriquetral ligament however is not visualized and is most likely torn.TRIANGULAR FIBROCARTILAGE COMPLEX: Contrast within the radiocarpal space does not communicate with the distal radioulnar joint, indicating an intact triangular fibrocartilage complex. There is no fluid within the distal radioulnar joint.TENDONS: The tendons of the wrist are intact. BONES: Bone marrow signal intensity is normal.ADDITIONAL

Output: 1.Findings compatible with a tear of the lunotriquetral ligament.2.The triangular fibrocartilage complex is intact.


Instruction: Generate impression based on findings.

Input: Reason: HCC screening History: NASH and alpha-1 antitrypsin cirrhosis, hemosiderosis. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology. There are innumerable, diffusely distributed subcentimeter foci of decreased signal within the liver more prominent on out of phase images compatible with siderotic nodules. There are several subcentimeter arterially enhancing foci for example within the left hepatic lobe (series 1101, image 602) and right hepatic lobe (series 1101, images 497, 542, and 562) which lack definite associated washout.Replaced hepatic artery arising from the superior mesenteric artery which provides arterial flow to both the right and left lobes of the liver. Hepatic veins and portal vein appear patent.The gallbladder is normal in morphology. No biliary ductal dilatation is identified.There is evidence of portal hypertension including extensive portosystemic collaterals and a patent periumbilical vein.SPLEEN: No significant abnormality noted.PANCREAS: The pancreas demonstrates mildly decreased T1 signal. No focal pancreatic lesions are identified. The pancreatic duct is nondilated.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Nodular, cirrhotic liver with evidence of portal hypertension.2.Several subcentimeter foci of hepatic arterial enhancement which are too small to accurately characterize but without definite washout to suggest hepatocellular carcinoma.


Instruction: Generate impression based on findings.

Input: 60 years, Male, multiple myeloma. Numbness in face, V3 There is smooth thickening and enhancement of the dura along the bilateral cerebral convexities with suggestion of associated small bilateral subdural effusions. No associated intracranial mass effect. Brain parenchyma appears otherwise within normal limits. No abnormal parenchymal or meningeal enhancement to suggest metastatic disease. No evidence of acute infarct or hemorrhage. Ventricles are normal in size without evidence of hydrocephalus. There is mild nonspecific opacification of the bilateral mastoid air cells. Bone marrow signal is heterogeneous which is nonspecific. No destructive calvarial lesions.

Output: 1. No intracranial mass or abnormal enhancement to suggest neoplastic disease. Specifically no lesions along the intracranial course of the trigeminal nerves. No destructive lesions within the calvarium to suggest myeloma. 2. Diffuse dural enhancement with suggestion of small bilateral subdural effusions. No associated mass effect. Finding is nonspecific with a broad differential including prior lumbar puncture, associated with intracranial hypotension, reactive to tiny subdural effusions, or represent a mild inflammatory pachymeningitis for example.


Instruction: Generate impression based on findings.

Input: Reason: eval rc History: shoulder pain ROTATOR CUFF: There is thickening and intermediate signal intensity within the distal supraspinatus tendon indicating mild tendinosis, but we see no discrete tear. The supraspinatus muscle appears normal. The infraspinatus muscle and tendon appear normal. The teres minor and subscapularis muscles and tendons appear intact.SUPRASPINATUS OUTLET: Moderate osteoarthritis affects the acromioclavicular joint. There is a small amount of fluid within the subacromial/subdeltoid bursa which may reflect a mild bursitis.GLENOHUMERAL JOINT AND GLENOID LABRUM: Mild osteoarthritis affects the glenohumeral joint. The anterior superior labrum may be partially detached from the glenoid, but this may represent a normal variant sublabral foramen. We see no fluid-filled labral tears. BICEPS TENDON: The tendon of the long head of the biceps appears intact.

Output: 1. Mild tendinosis of the supraspinatus without discrete rotator cuff tear.2. Acromioclavicular joint osteoarthritis.3. Small amount of fluid within the subacromial/subdeltoid bursa suggesting a mild bursitis.


Instruction: Generate impression based on findings.

Input: History of basilar migraines. New episodes involving the left eye blurriness, left arm and leg paresthesias and numbness, persistent left arm and leg proximal weakness since yesterday associated with left thigh and back pain. Evaluate for new ischemic or inflammatory lesion. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable.

Output: No acute intracranial abnormality.


Instruction: Generate impression based on findings.

Input: Clinical question: Post op Chiari malformation decompression, meningitis, 4 months follow evaluate for change. Signs and symptoms: Headache, fever and neck pain. Nonenhanced cervical spine MRI:Negative diffusion weighted images.Examination is to status post suboccipital midline craniectomy for Chiari decompression. Compared to prior exam there is significant reduction in size of a pseudomeningocele/seroma posterior to the craniectomy site. The remaining epidural fluid collection at the site measures approximately 8 mm in thickness and 24-mm in AP axis measured on sagittal T2 weighted cervical spine MRI exam.There is posterior tenting of the cervical medullary junction of the cord at the surgical site and without visible subarachnoid space inferior to cerebellar and vermis. Although the findings may be within expected postop changes possibility of adhesion cannot be entirely excluded.There is no detectable signal abnormality of adjacent brain parenchyma on any of the MRI sequences.The cortical sulci, ventricular system, CSF spaces and myelination of brain is within normal on all MRI sequences.Unenhanced cervical MRI:Examination demonstrate significant improvement in postoperative changes of suboccipital Chiari decompression as detailed above.There is normal signal intensity and caliber of the cervical and uppermost visualized thoracic cord and without evidence of syrinx.Fiesta 3-D images demonstrate a normal appearing aqueduct and quadrigeminal plate.CSF flow study demonstrate presence of biphasic flow through the neo-foramen magnum anteriorly however without detectable probe posteriorly. There is also no detectable flow through the fourth ventricle or the aqueduct.There is normal signal intensity and alignment of vertebral column.

Output: 1.Nonenhanced brain MRI demonstrate improvement of postoperative changes of Chiari decompression with significant decreased size of pseudomeningocele/seroma at the surgical site since prior study. Unremarkable nonenhanced brain MRI otherwise. Please see above comments.2.MRI of the cervical spine demonstrate improved post operative changes of Chiari decompression. No evidence of syrinx of the cervical or uppermost visualized thoracic cord.3.CSF flow study demonstrate presence of biphasic flow anteriorly through neo-foramen magnum and without detectable flow posteriorly. There is also no detectable flow through the fourth ventricle or the aqueduct .


Instruction: Generate impression based on findings.

Input: Ankle pain and swelling TENDONS: There is redemonstration of enlargement and increased signal of the peroneus tendons, the extent of which appears similar to the prior exam. Further distally, the peroneus brevis tendon continues to appear thickened with increased signal although the peroneal longus tendon appears normal in caliber. Trace amount of fluid is seen within the peroneal sheath, similar to the prior exam.The Achilles tendon appears normal in caliber and signal. The medial ankle tendons appear normal; a small amount of fluid in the tibialis posterior tendon sheath is of doubtful significance. There is a type I accessory navicular. The anterior ankle tendons appear normal.LIGAMENTS: The anterior talofibular and calcaneofibular ligaments appear slightly thickened which may reflect prior sprain injury, however this is similar to the prior exam. The posterior talofibular ligament appears normal. The remaining ligaments appear similar to the prior exam.ARTICULAR SURFACES AND BONE: There is mild deformity of the posterior aspect of the distal tibial meta-epiphysis, likely representing an old healed fracture. Small osteophytes indicate mild osteoarthritis at the ankle and midfoot however there is no osteochondral defect of the talar dome. ADDITIONAL

Output: Essentially unchanged exam when compared to the prior study of 7/3/2014. There is persistent enlargement and increased signal of the peroneus tendons reflecting tendinopathy although no full-thickness tear is identified. Additional findings are described above.


Instruction: Generate impression based on findings.

Input: MRI: There are small areas of acute infarction involving the right insular cortex, and right parietal cortex. There is subarachnoid hemorrhage in the right sylvian fissure, and scattered along the right temporal and occipital lobe sulci as well hemorrhage in the right occipital horn, not as well appreciated on CT. There is moderate diffuse volume loss and scattered T2 signal abnormalities in the periventricular and subcortical white matter most consistent with chronic microvascular ischemic changes. There is a small old right cerebellar hemispheric infarct. There are old pontine infarcts as well with significant encephalomalacia.MRA: There is a short segment of focal severe luminal irregularity and narrowing in the cavernous right internal carotid artery which is favored to represent atherosclerotic disease, much less likely aneurysmal dilatation (series 301 image 61). Only one major branch of the right MCA bifurcation is seen with the other expected large branch or branches presumed to be occluded. A paucity of right MCA vessels is seen more distally. There is luminal irregularity of the right M1 branch without high-grade stenosis. The anterior cerebral arteries are patent. There is no flow related enhancement at the expected location of the distal vertebral arteries. There is a prominent right posterior communicating artery and perhaps a hypoplastic left posterior communicating artery. There is flow related enhancement in both posterior cerebral arteries, right greater than left which may be in part due to decreased caliber of the left posterior cerebral artery as compared to the right. There is probable retrograde filling of the basilar artery tip. The basilar artery is markedly attenuated more proximally.

Output: 1.Small areas of acute infarction involving the right insular cortex and right parietal cortex. Occlusion of one or more of the branches off the right MCA bifurcation is suspected with paucity of distal right MCA branch vessels as compared to the left. Given the mismatch between the large vessel occlusion and few small infarcts, question is raised as to the chronicity of the vessel occlusion.2.Subarachnoid hemorrhage in the right sylvian fissure, right temporal and occipital sulci as well as intraventricular hemorrhage layering in the right occipital horn.3.Short segment high-grade focal stenosis of the distal right cavernous carotid artery with aneurysmal dilatation much less likely.4.Chronic microvascular ischemic changes and old cerebellar and pontine infarcts.5.Occlusion of bilateral vertebral arteries, proximal to mid basilar artery with retrograde filling of the basilar tip predominantly via a patent and large right posterior communicating artery. Again chronicity of these findings is uncertain particularly given the history of a chronic pontine infarct.


Instruction: Generate impression based on findings.

Input: Recurrent Ewing sarcoma, restaging following adjuvant chemotherapy for relapse There has been significant interval reduction in size of the mixed solid and cystic mass previously noted to encase the left inferior pubic ramus. A discrete soft tissue component is not well seen with an estimated residual tumor in the area of less than 5 cm. Within the adductor musculature below the superior pubic ramus are pockets of fluid thought to represent areas of necrosis which are best appreciated on axial postcontrast images 12 and 14 of 44. Additionally, the focus of enhancement within the left ilium is again seen but has decreased in size suggesting response to therapy.There is redemonstration of decreased T1 signal within the proximal aspect of the right inferior pubic ramus. Additionally, there is decreased T1 signal throughout the left inferior pubic ramus. There is increased extent of low T1 signal within the left iliac wing which extends to the level of the SI joint. Patchy areas of low marrow signal are also seen in the proximal femora and sacrum which also appear more conspicuous on the current exam.There is redemonstration of postsurgical changes relating to prior resection of the right iliac bone with associated superior migration and flattening of the femoral head. There is an old surgical tract through the femoral head.There is similar high T2 signal and enhancement within the pubic/adductor musculature, likely reactive in nature. There is generalized atrophy of the muscle on the right.At the request of the clinical service, the current study was briefly compared to a outside MRI study from March 11, 2016. The left pubic mass and suspected metastatic foci appear slightly smaller on the current study than on this prior outside study as well.

Output: 1. Significant interval reduction in size and extent of pelvic recurrence particularly surrounding the left inferior pubic ramus. Small amount of residual necrosis is evident.2. Patchy areas of intermediate and low marrow signal throughout the pelvis, femora, and lower spine. This are thought to be posttreatment-related with progression of disease thought to be less likely given the findings above.3. Additional chronic findings described above.


Instruction: Generate impression based on findings.

Input: Ms. Webb is a 66 year old female with a history of recurrent left breast malignancy. She has a personal history of left breast lumpectomy at the age of 42 years. She presents for MR imaging evaluation after new right chemotherapy. There is heterogeneous amount of fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.In the left lateral breast, far posterior depth, the biopsy proven malignancy demonstrates peripheral enhancement with central necrosis, now measuring approximately 4.1 x 2.4 x 3.2 cm (AP x ML x SI), previously measuring 2.2 x 1.4 x 1.7 cm (on ultrasound from 04/04/2016). Although the mass is quite posteriorly located, there is a discrete fat plane between the mass and pectoralis muscle. The muscle itself is of normal contour and enhancement. Susceptibility artifact from biopsy marker clip is seen centrally within this malignancy.There is no abnormal enhancement seen in the right breast. Postsurgical changes are identified in the left axilla. No abnormal axillary lymph nodes are identified in either axillary region.A right chest wall port is present.

Output: (1) Interval growth of known left breast malignancy while on neoadjuvant therapy, now measuring up to 4.1 cm. (2) No MRI evidence for malignancy in the right breast. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Nasopharyngeal carcinoma, status post treatment. Neck: There is no gross residual left nasopharyngeal mass. There is no evidence of intracranial extension or skull base erosion. There are secretions in the right lateral nasopharyngeal recess. There is no residual cervical lymphadenopathy. For example, a right level 2B lymph node measures 5 x 10 mm in axial section. The salivary glands are unremarkable. There is fluid within the bilateral mastoid air cells. The orbits are unremarkable. The cervical spine is intact. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There is mild mucosal thickening in the maxillary sinuses.

Output: 1. No gross residual left nasopharyngeal tumor or significant cervical lymphadenopathy.2. No evidence of intracranial metastases.


Instruction: Generate impression based on findings.

Input: Female 59 years old Reason: evaluate for meniscus tear History: reports catching and instability. MENISCI: There is marked loss of the posterior horn of the medial meniscus with a small fragment seen compatible with a complete tear of the meniscus. The anterior horn of the medial meniscus appears intact. There is marked loss of the posterior horn of the lateral meniscus with complete tearing and degeneration, only a small residual fragment is seen. The anterior horn of the medial meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is an approximately 1.5 cm defect of the articular cartilage of the lateral femoral condyle with associated bone marrow edema. The articular cartilage of the medial femoral condyle is intact. Evaluation of the patella and femoral articular cartilage shows marked loss of the cartilage along the lateral facet with an underlying subchondral cyst. There is markedly thin articular cartilage along the medial facet. The proximal tibial articular cartilage is intact.LIGAMENTS: The cruciate and collateral ligaments appear intact.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1.Complete tears of the medial and lateral menisci as described above.2.Osteoarthritic changes of the knee with osteophyte formation and degenerative changes in the articular cartilage as described above.


Instruction: Generate impression based on findings.

Input: 57-year-old male with lateral ankle pain, episodic effusions x3 months. Evaluate for occult fracture or osteochondral defect. TENDONS: The Achilles tendon is within normal limits. The flexor tendons appear intact. The peroneal tendons appear intact. The extensor tendons are within normal limits.LIGAMENTS: The lateral collateral ligament complex is intact. The distal tibiofibular syndesmotic complex appears intact. There is loss of the normal fatty striation in the deep fibers of the deltoid ligament which may represent an old sprain.ARTICULAR SURFACES AND BONE: There is a nondisplaced fracture through the anterior process of the calcaneus with edema within the adjacent bone marrow. There is mild edema within the medial aspect of the cuboid that may represent a contusion. There is a subchondral focus of decreased signal intensity within the cuboid, beneath the anterior process of the calcaneus, which could conceivably represent a nondisplaced impaction fracture, but this is equivocal. There are small foci of signal abnormality within the lateral cuneiform and base of the third metatarsal which are likely degenerative in etiology. ADDITIONAL

Output: Nondisplaced fracture through the anterior process of the calcaneus and other findings as described above.


Instruction: Generate impression based on findings.

Input: 44 years Female (DOB:12/8/1971)Reason: Stroke w/u History: R thalamic hemorrhagePROVIDER/ATTENDING NAME: JAMES A MASTRIANNI JAMES A MASTRIANNI MRI of the brainThere is a right thalamic hematoma present measuring 15 x 20 mm in axial dimensions. There is a surrounding halo of edema present.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma. MR characteristics include bright on T1, dark on T2 and susceptibility effect.There are punctate foci of signal loss on susceptibility imaging present within the cerebellum, brainstem, right putamen and the left thalamus.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The left A1 segment is larger than the right A1 segment. The anterior communicating artery is not readily identified. The posterior communicating arteries are medium-sized. The vertebral arteries are similar in size.

Output: 1.There is a right thalamic hematoma present which is not appear to be significantly different in size when compared to the 6/11/2016 exam.2.There are multiple microhemorrhages present in the cerebellum, left thalamus and right putamen. This pattern is suggestive of hypertensive microhemorrhages. 3.No evidence for cerebrovascular occlusive disease.4.No evidence for intracranial aneurysm.


Instruction: Generate impression based on findings.

Input: Reason: Small bowel CD S/P SBR and ileocectomy, re assess disease History: diarrhea ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There are 2 regions of small bowel hyperenhancement. A region of small bowel in the left upper quadrant, likely represents jejunal loops and measures approximately 10 to 15 cm. These bowel loops are collapsed and did not change in orientation throughout the exam, likely representing some degree of chronic stenosis.An additional region of collapsed hyperenhancing bowel loops in the right lower quadrant, likely representing ileum, measures approximately 10 cm. These regions also do not change throughout the exam and are likely stenotic.No evidence of obstruction. There are postsurgical changes of ileocecectomy with a neoterminal ileum in the right upper quadrant. The terminal ileum itself is unremarkable. There is significant fibrofatty perforation.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: There are 2 segments of hyperenhancing small bowel loops which are mildly stenotic, further described above, likely representing acute on chronic disease. No evidence of obstruction.


Instruction: Generate impression based on findings.

Input: 36 years Female (DOB:2/10/1980)Reason: eval for osteo vs neoplasm History: Chronic osteo on CT, persistent CRP elevation patient is status post recent tooth extraction.PROVIDER/ATTENDING NAME: REASHEAL M LEHMANN MADHU C YARLAGADDA There is an infiltrating and contrast enhancing lesion which involves the right alveolar ridge centered along the right-sided maxillary premolar which extends up into the inferior aspect of the right maxillary sinus including the inferior aspects of the lateral wall of the right maxillary sinus. Additionally there is extension into the adjacent soft tissues surrounding the right alveolar ridge. There is infiltration of fat planes and muscles of mastication associated with some contrast enhancement.The visualized intracranial structures which include the posterior fossa are intact. The visualized orbits appear to be intact.The parotid and the submandibular glands appear intact.The carotid and vertebral vasculature visualized on this exam appears intact. There are mild disc bulges present in the cervical spine.The cervical vertebral bodies in general are intact with no evidence for canal stenosis.

Output: There is an infiltrating lesion present centered in the right alveolar ridge which extends into the surrounding soft tissues including the right masticator space in the soft tissues superficial to the right maxillary sinus including the subcutaneous fat. It also involves the lateral wall of the right maxillary sinus. This is suspected to represent osteomyelitis and cellulitis.


Instruction: Generate impression based on findings.

Input: 84-year-old female with severe right shoulder pain ROTATOR CUFF: There is intermediate signal within the supraspinatus tendon at its myotendinous junction without extension to the articular or bursal surface, favored to represent tendinopathy. There is fatty atrophy of the supraspinatus, infraspinatus, subscapularis, and teres minor muscles. No discrete full thickness tear is evident. SUPRASPINATUS OUTLET: Moderate osteoarthritis of the acromioclavicular joint with osteophytes. The humeral head is high riding.GLENOHUMERAL JOINT AND GLENOID LABRUM: Severe narrowing of the glenohumeral joint with osteophytosis compatible with severe osteoarthritis. The glenoid labrum is blunted with osteophytes arising from the glenoid rim compatible with degenerative fraying and fragmentation.BICEPS TENDON: The long head of the biceps tendon is intact.ADDITIONAL

Output: 1.Supraspinatus tendinopathy with fatty atrophy of the rotator cuff muscles and deltoid muscle. No discrete fluid-filled tear is evident. 2.Severe osteoarthritis affects the glenohumeral joint and moderate osteoarthritis affects the acromioclavicular joint.3.Other findings as above.


Instruction: Generate impression based on findings.

Input: 9-year-old male with bilateral knee pain on chronic steroids, concern for AVN MENISCI AND LIGAMENTS: The menisci are intact. The ACL, PCL, MCL, and lateral collateral complex are intact. The extensor mechanism is intact.BONE AND MARROW: The bones are diffusely demineralized consistent with an osteoporosis likely secondary to chronic steroids. In the proximal tibial diaphysis is a focal area of more severe osteoporosis. This focal area severe osteoporosis occupies nearly the entire volume of the proximal tibial diaphysis. No avascular necrosis or osteochondral defects are present. Focal area of low T1 signal along the medial aspect of the distal femoral metaphysis with corresponding high T2 signal likely represents a focal paraphyseal edema, which can be normal.SYNOVIUM: No significant joint effusion. The articular cartilage is intact.MUSCULATURE: Musculature appears moderately atrophic.ADDITIONAL

Output: Diffuse demineralization with a focal area of more severe osteoporosis in the proximal tibial diaphysis without evidence of avascular necrosis or osteochondral defect.


Instruction: Generate impression based on findings.

Input: 22-year-old female with a history of neuroblastoma. Baseline pre-stem cell transplant. CHEST:LUNGS AND PLEURA: The innumerable bilateral pulmonary nodules have increased in size and number. No significant pleural effusion is identified. Many of the metastatic nodules are pleural based.MEDIASTINUM AND HILA: The heart size is normal. The pre-vascular, subcarinal and right hilar lymphadenopathy has increased in size in the interval. The lymph nodes are in a conglomeration are not amenable to reproducible measurement.CHEST WALL: The previously described right axillary lymph node now measures 4.4 x 2 cm (image 13/2 a one). On the most recent exam this measured 3.6 x 2 centimeters.There is new sclerosis of the T5 and T6 vertebral bodies. The T6 vertebral body shows a loss of height of approximately 50%. While no involvement of the spinal canal is identified on this examination, if there is clinical concern for involvement, an MRI may be obtained. Multiple sclerotic metastatic lesions are seen in the ribs.ABDOMEN:LIVER, BILIARY TRACT: There are multiple hypodense lesions in both lobes of the liver. The phase of enhancement is different on today's examination and therefore reproducible measurement is not possible. However, it appears to these lesions have all increased in size. No biliary ductal dilatation is present.SPLEEN: No significant abnormality noted.PANCREAS: Multiple hypodense lesions are identified within the body and tail of the pancreas. Lesions in the tail of pancreas have increased slightly in size. Lesions in the body of the pancreas are not as clearly seen on this examination. This may be due to phase of contrast enhancement rather than actual decrease in size.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: The right kidney is atrophic. No abnormalities are identified within the left kidney itself. However multiple nodules are identified surrounding the left kidney which likely represent metastatic nodules.RETROPERITONEUM, LYMPH NODES: Multiple retroperitoneal lymph nodes are increased in number but not enlarged by CT criteria.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Subtle sclerotic lesions are identified within the thoracic and lumbar spine. These correlate with the areas of increased uptake on recent bone scan likely represent metastatic disease.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: The uterus is small for age.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: See discussion of bones in the abdomen above.OTHER: No significant abnormality noted.

Output: Interval worsening of metastatic disease in the chest, abdomen and pelvis as described above. Specifically new collapse of the T6 vertebral body is identified.


Instruction: Generate impression based on findings.

Input: History of lumbar spinal fusion, evaluate sagittal balance. Views of the spine demonstrate posterior stabilization rods with screws entering L4, L5, and S1. There is rightward curvature of the lumbar spine (though precise angles are difficult to measure due to partial obscuration of the lumbar spine on the frontal view). At least mild-moderate multilevel degenerative changes are present most prominent in the lumbar spine. The coronal balance measures approximately -6 cm. The sagittal balance measures approximately +16 cm.

Output: Postoperative changes and balances as described above.


Instruction: Generate impression based on findings.

Input: 13-year-old male with history of Rathke's cyst and pituitary cyst. Evaluate cystic structures. MRI Brain:There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears unremarkable. There is no evidence of abnormal 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. Minimal diffuse paranasal sinus mucosal thickening. Mildly enlarged bilateral cervical lymph nodes are likely reactive in etiology. The AP dimension of the globes remain elongated but are unchanged.MRI Pituitary:Interval significant decrease in the size of the non-enhancing focal lesion between the anterior and posterior pituitary gland which now appears as a thin slitlike area of nonenhancement. The pituitary gland is otherwise within normal limits. Suprasellar cistern, optic chiasm, cavernous sinuses and intracranial portions of the optic nerves appear unremarkable.

Output: Interval significant decrease in the size of a likely Rathke's cleft cyst located between the anterior and posterior pituitary gland.


Instruction: Generate impression based on findings.

Input: New lung squamous cell carcinoma. There is mild scattered cerebral white matter T2 hyperintensity bilaterally and several punctate foci of susceptibility effect in the bilateral thalami, basal ganglia, temporal lobes, and occipital lobes. There is no evidence of enhancing mass lesions, although the postcontrast images are somewhat degraded by patient motion. There is no evidence of acute infarct. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is degenerative spondylosis in the imaged upper cervical spine with indentation of the spinal cord at C3-4.

Output: 1. No definite evidence of enhancing metastases.2. Several punctate foci of susceptibility effect in the bilateral thalami, basal ganglia, temporal lobes, and occipital lobes are nonspecific, but may represent chronic hypertensive microhemorrhage.3. Mild scattered cerebral white matter T2 hyperintensity bilaterally is nonspecific, but may represent chronic small vessel ischemic disease.4. Degenerative spondylosis in the imaged upper cervical spine with indentation of the spinal cord at C3-4.


Instruction: Generate impression based on findings.

Input: Status post meningioma resection: surveillance. There are postoperative findings related to right parietal craniotomy for resection of an extra-axial tumor. There is mild dural thickening and enhancement in the resection bed. Otherwise, no gross mass lesion is identified. There is a small amount of encephalomalacia in the superior right parietal lobule. There is no midline shift. The ventricles are stable in size and configuration. There is fluid and mucosal thickening in the left maxillary sinus.

Output: 1. Postoperative findings related to right parietal craniotomy for resection of a right parasagittal meningioma without evidence of gross residual tumor.2. Findings suggestive of acute left maxillary sinusitis.


Instruction: Generate impression based on findings.

Input: 14-year-old male with pain. Evaluate for meniscus pathology. MENISCI: The medial and lateral menisci are intact with no tears.ARTICULAR CARTILAGE AND BONE: Articular cartilage is intact with no defects. Bone marrow signal is normal. No fractures.LIGAMENTS: Cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: Extensor mechanism is intact.ADDITIONAL

Output: Normal appearing knee.


Instruction: Generate impression based on findings.

Input: Transient cerebral ischemic attack, unspecified [G45.9] / Muscle weakness (generalized) [M62.81], Reason for Study: ^Reason: r/o acute stroke History: alterations and weakness There is no evidence of acute ischemic or hemorrhagic lesion on this scan.Patchy FLAIR/T2 high signal intensities on periventricular white matter and centrum semiovale are again seen, unchanged since prior scan.Focal tissue losses indicating multifocal lacunar infarctions are seen on the right cerebellar hemisphere, bilateral basal ganglia and bilateral external capsules.The ventricles, sulci and cisterns are 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. The paranasal sinuses and mastoid air cells are clear.Non visualization of bilateral lenses indicating postoperative status.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. Non specific chronic ischemic disease, unchanged since prior scan.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for encephalitic changes. Signs and symptoms: Nausea, vomiting, intermittent confusion, dizziness, neck pain. Diagnosis of viral meningitis. Pre and post enhanced brain MRI:No acute intracranial process and negative diffusion weighted series.Examination demonstrates normal anatomical development and morphology of brain parenchyma and great normal signal intensity on all MRI sequences.There is no detectable foci of parenchymal, leptomeningeal or CSF space signal abnormality. There is no detectable abnormal parenchymal or leptomeningeal enhancement. No detectable findings to suggest inflammatory intracranial process.There is mild low positioning of the cerebellar tonsils at the level of foramen magnum however without associated signal abnormality or significant effacement of subarachnoid space. Finding is not consistent with urinary malformation is believed to represent a normal anatomical variation.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and gray-white matter differentiation.Images through the orbits demonstrate a tiny chronic left lamina papyracea blowout fracture and unremarkable otherwise. The signal void of major intracranial arterial branches are identified.The signal intensity of the calvarium and soft tissues of the scalp are unremarkable and without abnormal enhancement.Evidence of sinusitis more noticeable in maxillary sinuses and including a large retention cyst in the left maxillary sinus measuring approximately at 17 x 34 mm.

Output: 1.No acute intracranial process.2.Mild low positioning of cerebellar tonsil representing an anatomical variation and not consistent with Chiari malformation.3.Unremarkable pre and post enhanced brain MRI as detailed.4.Tiny left lamina papyracea chronic blowout fracture and unremarkable orbits otherwise.5.Chronic sinusitis and including a retention cyst in the left maxillary sinus as detailed/measured above.


Instruction: Generate impression based on findings.

Input: Reason: MMT History: right knee pain Evaluation is limited on some sequences due to motion artifact.MENISCI: Near complete or complete tear through the body of the medial meniscus, which is new when compared to prior study. Lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: Again seen is moderate degeneration of the articular cartilage of the weightbearing portions of the medial femoral condyle with small foci of full-thickness degeneration and delamination, slightly more pronounced on current study than on prior study. There is also focal degeneration of articular cartilage of the medial tibial plateau beneath the medial meniscal radial tear which is new. Mild degenerative subchondral bone marrow signal abnormality seen in the medial femoral condyle and the medial tibial plateau. Lateral compartment and patellofemoral compartment cartilage is relatively well preserved.LIGAMENTS: Anterior cruciate ligament, posterior cruciate ligament, medial collateral ligament, and lateral collateral ligament are intact.EXTENSOR MECHANISM: There is minimal tendinosis of the proximal patellar tendon. Otherwise patellar tendon and quadriceps tendon are intact.ADDITIONAL

Output: 1. New radial tear of the body of the medial meniscus as above.2. Slight progression of the osteoarthritis of the medial compartment.3. Other findings as above.


Instruction: Generate impression based on findings.

Input: NSCLC, evaluate for intracranial involvement. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is nonspecific, mild, predominantly periventricular cerebral white matter and pontine T2 hyperintensity. There is no abnormal intracranial enhancement. There is coaptation of the frontal horn of the right 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 grossly unremarkable.

Output: No evidence of intracranial metastases.


Instruction: Generate impression based on findings.

Input: Urinary incontinence, decreased bladder capacity, thick-walled bladder, detrusor sphincter dyssynergia. The conus medullaris is located at the L1-2 level and appears to translate anteriorly with prone positioning. The inferior spinal cord signal is intact and there is no evidence of fibrofatty filum terminale. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The inferior spinal cord and cauda equina nerve roots appear unremarkable. The paravertebral soft tissues are unremarkable.

Output: No evidence of lumbar spine anomalies.


Instruction: Generate impression based on findings.

Input: 46-year-old male with elevated PSA. Evaluate for malignancy. PELVIS:PROSTATE:Prostate Size: The prostate measures 5 cm in transverse, 3.1 cm in AP, and 4.2 cm in craniocaudal diameter.Peripheral Zone: In the left apex, there is a 0.8 x 0.6 cm lesion that is hypointense on ADC (axial series 804 image 204) and less well visualized on the T2 series. The lesion also demonstrates focal contrast enhancement (axial series 1501 image 976).Central Gland: Heterogeneous appearance.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: None.BLADDER: No acute abnormality.LYMPH NODES: No pelvic lymphadenopathy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Indeterminate but suspicious lesion in the left apex peripheral zone.


Instruction: Generate impression based on findings.

Input: Reason: bladder cancer- s/p cystoprostatectomy- creation of orthotopic neobladder - October 2013 History: see above ABDOMEN:LIVER, BILIARY TRACT: PunctateT2 hyperintensity in the right hepatic lobe is too small to characterize but likely represents a cyst.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left renal cysts are unchanged. Mild bilateral hydronephrosis and ureteral dilatation, increased since the prior exam.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.No evidence of recurrent or metastatic disease.2.Increased mild bilateral hydronephrosis as well as distention of the neobladder. A urethral anastomotic stenosis cannot be excluded. Short-term ultrasound follow-up may be considered.


Instruction: Generate impression based on findings.

Input: Ms. Smith is a 52 year-old female presenting for an MR biopsy of the right breast. She has a personal history of LCIS/ALH and a strong family history of breast cancer. Upon evaluation of the post-contrast images, the previously visualized area in the right central breast is no longer appreciated. Therefore, the procedure was aborted and plan to perform a short term 6 month follow-up was made in order to confirm that this area of prior enhancement simply represented background parenchymal enhancement. The MR procedure was performed by Dr. Sheth.

Output: Cancellation of MR guided core needle biopsy of the right breast due to non-visualization of target enhancement in the right central breast. A short term 6 month follow-up MRI is recommended in order to confirm that this area of prior enhancement simply represents background parenchymal enhancement. BIRADS: 3 - Probably benign finding.RECOMMENDATION: 3B - Followup at Short Interval (1-11 Months).


Instruction: Generate impression based on findings.

Input: 24-year-old woman, 16 weeks pregnant and with history of lupus, now with severe headache. There are a few, scattered foci of punctate diffusion restriction and increased T2/FLAIR signal in the bilateral cerebral and cerebellar hemispheres at the gray-white junction (601/19 and 21). There is no intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. Several additional foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with chronic small vessel ischemic changes. The brain parenchyma is otherwise unremarkable for age. The major flow voids are preserved.Sella and orbits are grossly within normal limits. The paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits. MRV BRAIN

Output: 1.Scattered punctate white matter foci of diffusion and T2 signal abnormality which are nonspecific but likely represent bihemispheric subacute small vessel ischemia.2.Additional nonspecific punctate foci of increased T2 signal in the centrum semiovale, probably prior small vessel ischemic disease.3. No evidence of venous congestive encephalopathy.4. Poor visualization of the inferior sagittal sinus, likely technical. No evidence of venous infarct or hemorrhage.


Instruction: Generate impression based on findings.

Input: Again noted is a large destructive lesion of the left ilium which extends from the left sacroiliac joint to the left iliac crest, with associated heterogeneous T1 and T2 prolongation, consistent with the patient's diagnosis of plasmacytoma. Again seen is osseous destruction, appearing similar to the prior study. The lesion appears similar to minimally decreased in size and extent when compared to the prior study, however, direct comparison is suboptimal due to lack of intravenous contrast. The previously described soft tissue enhancement within the iliacus muscle is not able to be assessed on this noncontrast examination, however, there is increased signal abnormality on fluid sensitive sequences within the muscle that appears similar to the prior study. There is nonspecific subcutaneous edema along the lateral aspect of the iliac crest appearing similar to the prior study. No additional osseous lesions are identified.

Output: Persistent left iliac lesion as described above appearing similar to minimally decreased in size when compared to the prior examination, compatible with the clinical history of plasmacytoma. No new osseous lesions are identified. Please see the dedicated MRI spine examination report for additional details.


Instruction: Generate impression based on findings.

Input: Syncope and collapse [R55], Reason for Study: ^Reason: r/o ischemia or structural lesion History: syncopal episodes with LOC Brain MRINo evidence of acute ischemic or hemorrhagic lesion.The ventricles, sulci and cisterns are 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.C-spine MRIThere are T2 high signal intensity lesions within the spinal cord at the level of C2-3 and C3-4 indicating cervical cord myelopathy. On axial scan, at the level of C2-3 and C3-4 there are broad-based central disc extrusion which compresses thecal sac as well as spinal cord. Another disc protrusion is seen at the level of C6-7 which compresses thecal sac and spinal cord.The cranial-cervical junction is normal. The spine alignment is anatomic. The vertebral body height is preserved. Degenerative changes are as followsC12: Within normal limitsC2-3: Mild to moderate bulging of disc which abuts thecal sac. No evidence of spinal cord compression.C3-4: Globular shaped central disc extrusion with broad-based which compresses the thecal sac and spinal cord results severe spinal canal stenosis and T2 high signal intensity within the spinal cord indicating compressive myelopathy.C4-5: broad-based disc protrusion compresses thecal sac and spinal cord results severe spinal canal stenosis and T2 high signal intensity within the spinal cord indicating compressive myelopathy.C5-6: Diffuse bulging of disc which abuts thecal sac. No evidence of spinal cord signal abnormality. C6-7: Central to left broad-based disc protrusion which compresses thecal sac results in moderate spinal canal stenosis. No evidence of spinal cord signal abnormality.C7-T1: Within normal limits

Output: 1. Unremarkable brain MRI.2. Severe spinal canal stenosis with compressive myelopathy due to cervical disc herniation at the level of C34 and C45 level.3. Disc protrusion at the level of C56 and C67 without evidence of spinal cord signal abnormality.


Instruction: Generate impression based on findings.

Input: The patient is a 57-year-old male with atrial fibrillation he presents for a pulmonary vein and left atrial CT prior to radiofrequency Atrial fibrillation ablation. The left atrium is normal in morphology. There are 4 distinct pulmonary veins each with its own separate ostium. The left atrial volume and pulmonary vein dimensions at the ostia are as follows:left atrial volume: 160 ccright superior pulmonary vein: 27 x 24 mmright inferior pulmonary vein: 29 x 24 mmleft superior pulmonary vein: 26 x 19 mmleft inferior pulmonary vein: 26 x 17 mm

Output: Normal left atrial and pulmonary vein morphology.Please refer to the separate radiologist report for interpretation of the lungs and other soft tissues of the thorax.


Instruction: Generate impression based on findings.

Input: 43-year-old female. Crohn's disease, status post complete colectomy with ileostomy. Report from outside hospital shows a 3 x 3 cm mass containing gas adjacent to ileostomy compatible with probable abscess. Evaluate for abscess versus bowel wall thickening due to Crohn's flare. CHEST: LUNGS AND PLEURA: Minimal bibasilar atelectasis. No pulmonary nodules. No pleural effusions or focal airspace consolidation. MEDIASTINUM AND HILA: No mediastinal or hilar adenopathy. The heart size is normal. No left ventricular hypertrophy. No pericardial effusion. CHEST WALL: No significant abnormality noted. ABDOMEN: LIVER, BILIARY TRACT: No significant abnormalities seen within the liver or gallbladder. SPLEEN: No significant abnormality noted. KIDNEYS, URETERS: No significant abnormality noted. ADRENAL GLANDS: No significant abnormality noted. PANCREAS: No significant abnormality noted. RETROPERITONEUM, LYMPH NODES: Small retroperitoneal nodes. Small mesenteric nodes identified as well. BOWEL, MESENTERY: There is a 3.9 x 4 cm rim enhancing loculated fluid collection with internal gas at axial image 98/157 extending from the rectal sheath into the subcutaneous fat at the site of the ileostomy. This is compatible with a uniloculated abscess.BONES, SOFT TISSUES: No significant abnormality noted. OTHER: No significant abnormality noted. PELVIS: UTERUS, ADNEXAE: Patient is status post hysterectomy. There is a 4.8 x 3 cm mass in the right adnexa (image 120/157 series number 3). This is this was present on the prior examination it appears slightly smaller. If indicated the mass may be further evaluated with transvaginal ultrasound or MRI. The left adnexa is unremarkable. BLADDER:Unremarkable LYMPH NODES: No significant abnormality noted. BOWEL, MESENTERY: Right lower quadrant ileostomy is present compatible with patient's known Crohn's disease and total colectomy. Cyst present in the subcutaneous tissues just lateral to the ostomy site. See both. In addition, multiple loops of small bowel have wall thickening in the pelvis which is new since the prior CT examination of 1/6/08. The wall thickening is best seen at axial image 121/157 of series 3 and is compatible with a Crohn's flare. No intraperitoneal abscess and no bowel obstruction.BONES, SOFT TISSUES: No significant abnormality noted. OTHER: No other significant abnormality was found.

Output: 1. Status post colectomy with right lower quadrant ileostomy. New abscess lateral to ostomy site. Crohn's flare involving pelvic small bowel loops. See above.2. Large right adnexal mass which is not completely evaluated on this examination. The mass appears slightly smaller since 1/6/07. If indicated, transvaginal ultrasound or MRI would be helpful in further evaluating this lesion.


Instruction: Generate impression based on findings.

Input: 17-year-old male with history of neurofibromatosis type II. Brainstem ependymoma, spinal tumors, acoustic neuroma. Six-month follow up. Brain / Internal Auditory Canal:Numerous extracranial enhancing lesions are not significantly changed in size or number. The left frontal scalp lesion measures 12 mm and the right tongue lesion measures 7 mm, previously measuring 12 and 7 mm, respectively.Bilateral enhancing lesions in the internal auditory canals are compatible with vestibular schwannomas and stable from the previous exam. Again seen is abnormal enhancement of the right facial nerve canal, unchanged.Lesion arising from the left cavernous sinus is also unchanged, measuring 21 x 18 mm from previously 21 x 17 mm, and may represent a schwannoma of the trigeminal nerve versus meningioma. An enhancing nodular lesion anterior to the right midbrain is again unchanged at 4 mm and may represent a right oculomotor nerve schwannoma. Enhancement of the left oculomotor is also unchanged.Plaque-like area of dural enhancement along the left frontal lobe likely represents a meningioma, unchanged.No extra-axial fluid collection is identified. There is no diffusion restriction to suggest acute infarct. The ventricles and sulci are within normal limits. The cerebellar tonsils are in normal position. Pituitary gland is unremarkable. Normal flow-voids are demonstrated in the major intracranial vascular structures. Paranasal sinuses and mastoid air cells are clear. Complete spine:Cervical spine:Post surgical findings related to midline suboccipital craniectomy are redemonstrated. There is an enhancing brainstem mass in the caudal medulla extending to the upper cervical spinal cord, measuring 17 mm in craniocaudal dimension. There are at least 4 nearly confluent, enhancing lesions of the upper cervical spinal cord spanning 37 mm from the C2 to C4 levels. Two small dural-based lesions extend from the posterior dura at T2 and T2-3. Bilateral cervical neuroforaminal enhancing lesions at nearly every level are grossly unchanged; the largest measures 16 mm in craniocaudal dimension at the C4-5 left neural foramen. Multiple scattered enhancing cervical soft tissue lesions, including in the carotid sheaths bilaterally. These findings are all stable in size and appearance. Thoracic spine:In the thoracic spine, three small dural based enhancing masses are redemonstrated posteriorly at the right T2 and left T2-3 levels and anteriorly at the left T6-7 level. Patchy T2 hyperintensity with associated cord expansion at T8, T9-10, and T11 is again noted with associated enhancement at T11. Multiple enhancing foraminal, paraspinal lesions, intercostal, and chest wall lesions are again noted. These findings are not significantly changed from the previous exam.Lumbar spine:Again seen is transitional lumbosacral anatomy, with lumbarization of the sixth rib-free lumbar appearing vertebra, designated S1. Spinal cord terminates at the upper L1 level with intact conus medullaris. Numerous enhancing lesions within the lumbar thecal sac are grossly unchanged in size and number. Again seen at the mid L2 level is an extramedullary intradural enhancing mass, also unchanged measuring approximately 8 mm. Numerous enhancing lesions in the neural foramina are stable in size and number, the largest measuring 15 mm in the right S1-2 neural foramen and 12 mm in the left L4-5 neural foramen. Multiple paraspinal enhancing lesions are also unchanged.A large T1 dark/T2 bright mass inferior to the right adrenal gland demonstrates continued growth, markedly increased in size since exam dated 10/2/2013. There has been interval change in signal characteristics from the last exam; lesion was previously solidly enhancing and is now cystic with a thick enhancing rim and enhancing internal septations. The mass measures 4.0 x 3.0 cm axially from previously 2.7 x 2.0 cm.

Output: 1.Large mass inferior to the right adrenal gland demonstrates continued growth and interval change in signal characteristics. Findings are concerning for malignant degeneration of a nerve sheath tumor.2.No significant interval change in numerous suspected intracranial nerve sheath tumors and/or meningiomas.3.No significant interval change in enhancing parenchymal tumors of the brainstem and cervical spinal cord.4.Multiple stable thoracic and lumbar dural based enhancing lesions probably representing meningiomas.5.Numerous neuroforaminal and innumerable extraspinal enhancing nodules probably representing nerve sheath tumors, not significantly changed in size or number.6.Enhancing nodules along the cauda equina nerve roots also likely representing nerve sheath tumors.