Instruction: Generate impression based on findings.

Input: New Horner's syndrome with concern for lesion along sympathetic chain: anisocoria. There is no evidence of measurable mass lesions or significant cervical lymphadenopathy based on size criteria. The major salivary glands are unremarkable. The thyroid gland appears unremarkable. There is a disc-osteophyte complex at the C5-6 level with mild narrowing of the spinal canal. The airways are patent. There is a subcentimeter area of restricted diffusion and T2 hyperintensity in the right cerebellar hemisphere without associated enhancement.

Output: 1. No evidence of carotid body tumor or other lesions that might otherwise compromise the sympathetic chain.2. Small recent infarct in the right cerebellar hemisphere.Discussed with ODONNELL, PETER at 4 PM on 2/26/16.


Instruction: Generate impression based on findings.

Input: 41 years Female (DOB:2/27/1975)Reason: low back pain History: low back painPROVIDER/ATTENDING NAME: JAVAD HEKMATPANAH JAVAD HEKMATPANAH Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is loss of disc space height and endplate reactive changes. The endplate reactive changes are bright on T1 and low signal on T2 STIR. There is a broad-based disc protrusion present at this level with some associated partial effacement of fat at the right lateral recess. There is also some mild narrowing of the right neural foramen at this level. Relative to the prior exam this has not significantly changed. Relative to the 11/12/2009 exam this disc extrusion appears to have regressed.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is disc desiccation present at this level. There is a small broad-based central disc protrusion at this level. This central disc protrusion is minimally changed since the prior exam.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: There are degenerative changes present in the lower lumbar spine without significant compromise to the spinal canal or exiting nerve roots. A broad-based disc protrusion at L4-5 affecting the right lateral recess and right neural foramen as remained stable compared to the prior exam from 2011.


Instruction: Generate impression based on findings.

Input: Back pain, fecal incontinence, with history of prostate cancer. There are low signal lesions involving the T8, T9, T11 and L5 vertebrae. While there is mild epidural extension of tumor into the spinal canal at T11 and left neural foramen, as well as paravertebral extension, there is no evidence spinal cord or cauda equina nerve root compression. There is also apparent metastatic disease involving the mediastinal and prevertebral lymph nodes in the lumbar region, as well as pulmonary metastases. The vertebral body heights are preserved. The spinal cord and cauda equina nerve roots appear to be intact.

Output: 1. Metastatic bone lesions involving the T8, T9, T11 and L5 vertebral bodies. While there is mild epidural extension of tumor into the spinal canal at T11 and left neural foramen, there is no evidence spinal cord or cauda equina nerve root compression. However, this is a limited exam specific for the exclusion of cord compression only and does not exclude more subtle lesions such as intrinsic cord abnormalities. Due to the screening nature of this protocol details are not as evident on imaging as dedicated protocols of the spine.2. Apparent metastatic disease involving the mediastinal and prevertebral lymph nodes in the lumbar region, as well as pulmonary metastases. Please refer to the prior body CT reports for additional details.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 57-year-old diabetic with new low back pain with left lower extremity weakness and unable to bear weight. Recent fall. Evaluate for epidural abscess and bony involvement. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is minimal grade 1 anterolisthesis of L4 on L5. Alignment is otherwise maintained. Bone marrow signal is benign including small focus of T1 hyperintensity at the L4 vertebral body compatible with focal fat or small hemangioma. The conus medullaris is normal in position. No abnormal enhancement or epidural or paraspinous collections.Mild degenerative changes are seen, as described 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. Mild facet arthropathy.L3-L4: Mild disk desiccation. No spinal canal or neural foraminal stenosis. Bilateral facet arthropathy, left worse than right.L4-L5: Mild disk desiccation. No spinal canal or neural foraminal stenosis. Advanced bilateral facet arthropathy.L5-S1: Mild disk desiccation. There is a left foraminal and extra foraminal disk protrusion which results in moderate to severe left neural foraminal stenosis. No significant spinal canal or right foraminal narrowing.Paraspinous soft tissues are within normal limits. Multiple cysts are noted in the bilateral kidneys with possible enlargement of the renal calyces, but not well evaluated.

Output: 1. No evidence of epidural hematoma or epidural abscess. No compression fractures.2. Disk protrusion at the left L5-S1 level which results in moderate to severe left neural foraminal stenosis and possible impingement of the left L5 nerve root.3. No significant spinal canal stenosis at any level in the lumbar spine.4. Multiple cysts in the bilateral kidneys with questionable dilatation of renal calyces; these findings are not well evaluated on this study and ultrasound can be considered as clinically indicated.


Instruction: Generate impression based on findings.

Input: Sudden visual loss, bilateral [H53.133], Reason for Study: ^Reason: ich vs contrast extravasation History: ha Brain MRIThere is no evidence of acute ischemic or hemorrhagic lesion on this scan.Specifically, subarachnoid space appears to be clear without evidence of hemorrhage or increased signal intensity indicating blood brain barrier disruption.Underlying brain shows multiple bilateral high signal intensity foci on periventricular white matter and centrum semiovale indicating non specific small vessel ischemic disease.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. The mastoid air cells are clear.There is a retention cyst on the right side of sphenoid sinus and minimal mucosal thickening on the left maxillary sinus.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate subtle luminal irregularities on bilateral distal ICAs and PCAs indicating atherosclerotic changes. Otherwise there is no evidence of intracranial arterial aneurysm. No evidence of intracranial arterial luminal stenosis or occlusion.Right Pcom artery is seen but the left PComA is not visualized.Acom artery is patent.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. Non specific small vessel ischemic disease.3. Minimal atherosclerotic changes of intracranial arterial system.4. No evidence of intracranial arterial occlusion, significant stenosis. No intracranial aneurysm.


Instruction: Generate impression based on findings.

Input: Low back pain [M54.5], Reason for Study: For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. The conus medullaris terminates at the T12-L1 level. The paraspinal soft tissues are unremarkable.There is no evidence of abnormal enhancement, cord compression or mass. Degenerative changes are specified by the intervertebral level as follows: T12-L1: no neuroforaminal narrowing or spinal stenosis. L1-L2: no neuroforaminal narrowing or spinal stenosis. L2-L3: disc dessication, diffuse bulging of disc, no neuroforaminal narrowing or spinal stenosis. L3-L4: no neuroforaminal narrowing or spinal stenosis. L4-L5: disc dessication with evidence of left side partial laminectomy. There is broad based disc protrusion toward left side lateral recess which abuts left side nerve roots. L5-S1: disc dessication, there is broad based disc protrusion toward left side neural foramen and results mild to moderate neural foraminal stenosis.

Output: 1. L4-L5 disc herniations toward left side lateral recess with evidence of partial laminectomy.2. L5-S1 disc herniations toward left neural foramen.3. Disc dessication with diffuse bulging of disc at the level of L23.


Instruction: Generate impression based on findings.

Input: Macrocephaly, developmental delay. Sacral dimple. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The cerebral, cerebellar, and brainstem parenchyma appear unremarkable. There is a normal degree of myelination. The pituitary gland appears to be grossly intact. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are grossly intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Spine: The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The conus medullaris is positioned at the L1-2 level. There is no evidence of tumors or fibrofatty filum. The paravertebral soft tissues are unremarkable.

Output: 1. No evidence of acute intracranial hemorrhage, mass, or ventriculomegaly.2. No gross spinal dysraphism or segmentation anomaly.


Instruction: Generate impression based on findings.

Input: Headache. Likely CVA. Rule out bleed. There is no evidence of intracranial hemorrhage, mass or midline shift. Patchy areas of hypodensity in the right frontal, temporal, and parietal lobes suspicious for ischemia, likely embolic in nature. An MRI is recommended for further evaluation.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: No intracranial hemorrhage. Findings concerning for ischemia, an MRI is recommended for further evaluation.


Instruction: Generate impression based on findings.

Input: 59-year-old female with gallbladder polyp. Follow-up exam. LIVER: Coarse echogenic liver parenchyma. In the anterior left hepatic lobe, there is a 1.5 x 0.7 x 1.2 cm hypoechoic focus with faint posterior acoustic enhancement. This focus correlates with a known cyst seen on the 3/18/2016 MRI abdomen exam. The liver measures 14.2 cm in length. The main portal vein demonstrates normal direction and flow measuring 21.3 cm/s.BILIARY TRACT: The common hepatic duct measures 1.7 mm. The gallbladder is partially distended with no shadowing echogenic stones or wall thickening. The previously described 0.3 x 0.2 cm echogenic focus of the gallbladder wall compatible with a small polyp is unchanged.PANCREAS: The visualized aspect of the pancreas is unremarkable. Incomplete visualization of the distal body and tail due to overlying bowel gas.SPLEEN: The spleen measures 8.4 cm in length. Normal echogenicity.RIGHT KIDNEY: The right kidney measures 11.1 cm in length. Normal echogenicity of the renal parenchyma. No hydronephrosis. OTHER: The left kidney measures 10.4 cm in length. No hydronephrosis. In the left upper renal pole, there is a 0.6 x 0.8 x 0.7 cm well-circumscribed echogenic focus not clearly identified on the prior ultrasound exam.

Output: 1. Coarse echogenic hepatic parenchyma suggestive of chronic parenchymal dysfunction. Stable small cyst of the left hepatic lobe.2. Stable subcentimeter gallbladder polyp.3. Subcentimeter echogenic focus of the left upper renal pole not clearly seen on the prior ultrasound. This could represent a small angiomyolipoma.


Instruction: Generate impression based on findings.

Input: 25 years, Male, intractable epilepsy. Preoperative depth electrode placement.. Examination is obtained for operative planning and intraoperative navigation. The right hippocampus again demonstrates abnormal T2 hyperintensity with loss of internal architecture and volume loss consistent with mesial temporal sclerosis. Findings are better appreciated on prior MRI with epilepsy protocol sequences. Remainder of the brain parenchyma appears unremarkable on the available sequences. No intracranial mass or mass effect is seen. No abnormal parenchymal or meningeal enhancement. No hydrocephalus. No extra-axial collections. Significant mucosal thickening involving the right maxillary sinus is noted. Bone marrow signal and extracranial soft tissues are unremarkable.

Output: Examination for operative planning prior to depth electrode placement. Evidence of right mesial temporal sclerosis again seen and better assessed on prior dedicated epilepsy MRI studies.


Instruction: Generate impression based on findings.

Input: History of rectal cancer status post endoscopic excision. Evaluate for lymph node recurrence. Biopsy dated 1/8/2014 showed rectal polyp which demonstrated invasive moderately differentiated adenocarcinoma. Subsequent transanal excision 2/26/2014 showed residual tubulovillous adenoma measuring 2.5 cm. PELVIS:PROSTATE/SEMINAL VESICLES: Median lobe hypertrophy.BLADDER: No significant abnormality noted.LYMPH NODES: Stable subcentimeter nonspecific lymph nodes in the mesorectal fat. BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Stable nonspecific mesorectal fat subcentimeter lymph nodes.


Instruction: Generate impression based on findings.

Input: BRAIN: Redemonstrated are multiple patchy foci of T2 hyperintensity within the supratentorial white matter. Many of these demonstrate T1 hypointensity. Given differences in technique, there has been no significant interval change. The ventricles are unchanged in size and shape. There is no mass effect or midline shift. Expected vascular flow voids are demonstrated. The paranasal sinuses and mastoid air cells are clear.SPINE: The spinal cord displays normal signal although it is a motion limited exam. There is incompletely characterized thoracolumbar scoliosis. Vertebral body heights are preserved. Vertebral bone marrow signal is unremarkable. The conus terminates at L1. The paravertebral soft tissues are unremarkable.

Output: 1.No discernible spinal cord demyelinating lesions, although the images are motion degraded.2.Redemonstrated are multiple foci of T2 hyperintensity within the supratentorial white matter consistent with the provided history of multiple sclerosis. Given differences in technique, there has been no significant interval change.


Instruction: Generate impression based on findings.

Input: A patient submitted outside study for review. Submitted for review are screening mammogram dated January 22, 2015, right breast diagnostic mammogram and ultrasound dated January 28, 2015, and breast MRI dated February 10, 2015 performed at Advocate Trinity Hospital. No studies are available for comparison. BILATERAL SCREENING MAMMOGRAM (1/22/2015): Two standard views of both breasts were obtained. The breast parenchyma is composed of scattered fibroglandular elements. Asymmetry is present within the lateral right breast, with distortion noted along the anterior aspect of this asymmetry with overall measurement of about 7 x 5 cm. A tiny cluster of calcifications is noted along the medial aspect of the asymmetry. Elsewhere, scattered benign calcifications are present bilaterally. No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in the left breast. Benign morphology lymph nodes are present in the right axilla.RIGHT DIAGNOSTIC MAMMOGRAM (1/28/2015): An ML view and two spot compression views of the right breast are submitted. There is persistent asymmetry and distortion within the anterior upper outer right breast. A tiny cluster of calcifications is noted along the medial aspect of the asymmetry. Elsewhere, scattered benign calcifications are present. RIGHT BREAST ULTRASOUND (1/28/2015): Images labeled right breast 11 o'clock, 4 cm from the nipple reveal an irregular, spiculated hypoechoic mass with posterior acoustic shadowing measuring 2.6 x 2.2 cm. Images labeled "right breast 11 o'clock 4 cm fn axl" which may represent axillary imaging demonstrate a normal morphology lymph node measuring 1.3 cm.ULTRASOUND GUIDED RIGHT BREAST BIOPSY AND POST-PROCEDURAL MAMMOGRAM (1/28/2015): Images from ultrasound guided biopsy of the right breast mass at 11 o'clock were submitted. Targeting appears appropriate. Postprocedural mammogram reveals a rectangular shaped clip within the area of asymmetry and distortion in the upper outer right breast.BILATERAL BREAST MRI (2/10/2015): MRI was performed per outside protocol. There is extensive non-mass enhancement involving the central and lateral aspects of the right breast spanning 8.9 x 6.2 x 4.0 cm. This demonstrates areas of rapid uptake with washout kinetics. Susceptibility artifact from a biopsy clip is noted along the anterior margin of this non-mass enhancement, and resides 2.6 cm posterior to the nipple. The non-mass enhancement extends to near the level of the pectoralis muscle, without evidence for pectoralis involvement. A normal sized probably intramammary lymph node is noted on the right. No suspicious left breast enhancement. A prominent lymph node is visualized within name low right axilla measuring 1.2 cm, and may correspond to the lymph node visualized on ultrasound examination.MRI-GUIDED RIGHT BREAST BIOPSY AND POST-PROCEDURAL MAMMOGRAM (2/10/15): Multiple sequences from reported MRI guided biopsies were submitted. Targeting cannot be evaluated as images currently submitted do not show needle placement. Right CC and MLO mammographic views labeled "post MRI biopsy" demonstrate cylinder shaped clips along the medial aspect of the anterior extent of asymmetry. A second cylinder shaped clip is noted directly posterior to this along the posterior nipple line, and is felt to be too medially located to correspond to biopsy of the posterior extent of non-mass enhancement on MRI. No accompanying procedural report from MRI guided biopsy was available at the time of this dictation. This clip may be displaced, or targeting may have been medial to the non-mass enhancement. PATHOLOGY as per outside hospital reports: -Right breast 11 o'clock 4 cm from nipple; right breast ultrasound guided breast biopsy:Proliferative fibrocystic change with multiple portions of papilloma in florid ductal hyperplasia.-Right breast, more anterior 11 o'clock; MRI guided core biopsy:Atypical ductal hyperplasia in association with a sclerosing intraductal papilloma (atypical papilloma). Florid proliferative fibrocystic changes.-Right breast more posterior 9 o'clock; MRI guided core biopsy:Complex sclerosing lesion (radial scar versus sclerosing papilloma) with florid proliferative fibrocystic changes. Recommend excision.

Output: Extensive non-mass enhancement involving the central and lateral right breast with suspicious mammographic and sonographic findings also noted. Pathology slides should be reviewed at University of Chicago. Incompletely submitted imaging and reports from MRI guided biopsy. Targeting and clip placement/displacement cannot be adequately evaluated.Surgical consultation is advised. BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: There are postoperative findings related to right temporal craniotomy and cystic drainage catheter insertion. Overall, there does not appear to have been significant interval change in size of the mixed cystic and solid tumor centered in the suprasellar cistern with extension into the prepontine, cerebellopontine angle cistern, right ambient and right quadrigeminal cisterns, as well as the right middle cranial fossa, with associated mass effect upon the brainstem, right medial temporal lobe, and hypothalamus-optic apparatus complex. The ventricular system also appears to be unchanged.

Output: No significant interval change in the craniopharyngioma with superimposed treatment findings based on this limited MRI.


Instruction: Generate impression based on findings.

Input: 59-year-old male with intermittent fever status post combined liver and kidney transplantation. ABDOMEN:LUNG BASES: There is some parenchymal scarring in the right lower lobeLIVER, BILIARY TRACT: Normal transplant liver size. Previously seen 6 mm hyperintense nodule in the left lateral segment is not seen on the current exam. No focal hepatic lesions.Mild to moderate right intrahepatic biliary ductal dilation, slightly increased since prior study and measuring up to 6 mm, previously 5 mm. Mild left intrahepatic biliary ductal dilation is not significantly changed and measures up to 3 mm. A short segment stricture is seen of the right common hepatic duct near Klatskin's point. Biliary enteric anastomosis appears patent. Remnant common bile duct appears similar to prior exam.The hepatic and portal veins are patent; the hepatic artery is patent.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Native atrophic kidneys without hydronephrosis. Complex exophytic cyst in the left native kidney midpole with single thin enhancing septation measuring up to 13 mm (series 103/28).RETROPERITONEUM, LYMPH NODES: Marked focal narrowing of the origin of the celiac artery, most likely due to atherosclerotic plaque.BOWEL, MESENTERY: Post operative changes from biliary enteric anastomosis without evidence of bowel obstruction.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Right iliac fossa renal allograft is partially imaged on noncontrast sequences and demonstrates small T2 hyperintense foci, which are not completely characterized but likely due to cysts.

Output: 1. Mild to moderate right and mild left intrahepatic biliary ductal dilation as detailed above. The right-sided biliary ductal dilation has slightly progressed since prior study.2. Marked focal narrowing of the origin of the celiac artery, for which duplex ultrasound is recommended for further characterization.3. 13 mm complex cyst in the left native kidney, for which follow-up is suggested.


Instruction: Generate impression based on findings.

Input: Female, 17 days old, status post ALTE, with abnormal EEG. Assess for structural abnormality or brain lesions. The cerebral and cerebellar hemispheres and brainstem show normal signal intensity and morphology. No restricted diffusion is seen.The pituitary gland and region of the sella are within normal limits. The brainstem, cerebellar vermis and cerebellar hemispheres are normally formed and unremarkable.The corpus callosum is fully formed and intact. The pattern of white matter myelination is appropriate for the stated age.No evidence of parenchymal edema, mass, or mass effect is seen. There is no evidence of intracranial hemorrhage or abnormal extra-axial fluid. The ventricular system is normal in caliber and morphology.

Output: Unremarkable evaluation of the brain without specific findings to account for the patient's presentation.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for shunt malfunction. Signs and symptoms: Headache. Pre-and post-enhanced brain MRI:Immediate images are severely compromised due to extensive metallic artifact overlapping the right hemisphere. Beyond the artifact there is no evidence of restricted diffusion.Stable expected postoperative changes of Chiari decompression without change.Flair and T2 weighted images are also partially obscured secondary to metallic artifact on the right side. Beyond the artifact examination demonstrate shunt the normal size supratentorial ventricular system without interval change since prior exam. A right frontal approach ventricular catheter with the tip in the right frontal horn at the level of foramen of Monro is noted. There is mild interval change in the position of the catheter since prior exam. The tip of the catheter is a slight disorder into the right frontal horn since prior study.The cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination is within normal.Signal void of major intracranial arterial branches are identified.The signal intensity of intracranial venous sinuses are within normal.Post-enhanced images were also extensively obscured by metallic artifact obscuring a large segment right hemisphere. Beyond the artifact there is no evidence of abnormal parenchymal, leptomeningeal or calvarium enhancement.Unremarkable images through the orbits and including axial fat sat post enhanced series.Unremarkable signal intensity of paranasal sinuses, mastoid air cells and middle ear cavities.

Output: 1.Examination is degraded due to metallic hardware artifact resulting in varying degree of obscuration of right hemisphere as detailed.2.Stable normal size of ventricular system. Right frontal approach ventricular catheter with the tip in the right frontal horn as detailed.3.Unremarkable pre-and post enhanced brain MRI otherwise.


Instruction: Generate impression based on findings.

Input: Evaluate for focal area causing repeat seizures, not in the setting of fever. There is no evidence of intracranial hemorrhage, mass, or heterotopia. The brain, including the hippocampi, appears 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 gross seizure foci.


Instruction: Generate impression based on findings.

Input: 56 years Male (DOB:12/19/1959)Reason: evaluate for underlying lesion associated w/ bleed History: as abovePROVIDER/ATTENDING NAME: CHRISTOPHER L KRAMER CHRISTOPHER L KRAMER The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a hemorrhagic focus present in the vermis also identified on recent CT of the head. It is associated with susceptibility effect and some bright signal on T1-weighted imaging. There is no significant contrast enhancement associated with this. No other lesions are identified within the brain parenchyma.Punctate focus of susceptibility in the left cerebellar hemisphere most likely represents a microhemorrhage. In isolation this is a unknown clinical significance.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. There is some leptomeningeal FLAIR signal hyperintensity present along the occipital lobes and medial parietal lobes as well as the high convexities.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 some mild mucosal thickening. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.There is a hemorrhage present in the vermis. Etiology is not clear on the basis of this exam. An underlying vascular lesion such as a cavernoma cannot be excluded. There is no MR evidence to suggest underlying neoplasm or arteriovenous malformation on the basis of information available. A micro-AVM or a dural arteriovenous fistula would not be readily identified on exam like this.2.Findings suggest leptomeningeal reaction adjacent to the occipital and parietal lobes. Differential considerations include subarachnoid blood, hyper oxygenation during the exam (which was done under general anesthesia) as well as a mild form of posterior reversible encephalopathy syndrome. Please correlate with the anesthesia records during the exam.3.Periventricular and subcortical white matter signal changes of a mild degree are present which are nonspecific. They could be vascular related, related to demyelination, trauma, vasculitis, sarcoid. They are nonspecific.


Instruction: Generate impression based on findings.

Input: 40 year old female patient with abnormal LFTs, abdominal pain. Assess for biliary pathology. ABDOMEN:LIVER, BILIARY TRACT: There is cholelithiasis without evidence of acute cholecystitis. The common bile duct is dilated up to 12 mm in diameter to the level of the ampulla. There are multiple round foci of signal void within the distal common bile duct compatible with multiple stones; at least four stones are identified (image 17, series 301). There is mild intrahepatic biliary ductal dictation.SPLEEN: There are accessory splenules.PANCREAS: The main pancreatic duct is not dilated.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. Choledocholithiasis within the distal common bile duct with intra- and extrahepatic biliary ductal dilatation.2. Cholelithiasis without evidence of acute cholecystitis.


Instruction: Generate impression based on findings.

Input: Reason: R hip labral tear History: Right hip pain ACETABULAR LABRUM: There is no evidence of a discrete labral tear or detachment. No significant labral degeneration.ARTICULAR CARTILAGE AND BONE: Bone marrow signal intensity is within normal limits. There is a cam type deformity of the right femoral head-neck junction. There is no evidence of hip dysplasia.SOFT TISSUES: There is no evidence of muscle atrophy or edema. ADDITIONAL

Output: 1. No evidence of labral tear.2. Cam deformity of the right femoral head-neck junction.


Instruction: Generate impression based on findings.

Input: Complex partial seizures starting with right face twitching, history of multiple sclerosis and ischemic stroke. There is extensive scattered periventricular and subcortical white matter T2signal abnormality, as well as scattered posterior fossa signal abnormality, compatible with multiple sclerosis. There is no associated abnormal enhancement. There is no evidence of acute infarct or intracranial hemorrhage. There is mild global parenchymal volume loss. 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: 1.Extensive white matter lesions of multiple sclerosis, without evidence of current active demyelinating lesion.2.No evidence of acute infarct or intracranial hemorrhage.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 40-year-old female with rising bilirubin. Evaluate for obstruction. ABDOMEN: Moderate sized bilateral pleural effusions.LIVER, BILIARY TRACT: Hepatic steatosis without a focal hepatic mass. The common bile duct measuring approximately 8 mm, likely related to cholecystectomy. Mildly dilated intrahepatic biliary ductal system. No evidence of common bile duct stone or lesion.SPLEEN: No significant abnormality noted.PANCREAS: Severe pancreatic atrophy with evidence of calcifications, compatible with sequela of chronic pancreatitis.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Atrophic bilateral native kidneys. Partially visualized left iliac fossa transplant kidney.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Gastric band in appropriate orientation. However, there is persistent severe dilatation of the esophagus with debris. There is additionally a small pulsion diverticulum proximal to the band.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Mild intrahepatic biliary ductal dilatation without evidence of common bile duct stone or lesion.2.Severe esophageal dilatation with debris may be related to tight gastric band.3.Severe pancreatic atrophy and calcifications, compatible with sequela of chronic pancreatitis.4.Status post cholecystectomy.5.Hepatic steatosis without focal lesion.6.Atrophic bilateral native kidneys.


Instruction: Generate impression based on findings.

Input: Clinical question: Follow-up hydrocephalus. Signs and symptoms: Headaches, tachycardia, known to have petroclival meningioma. Non-infused CT of brain:A low density extra axial mass with some bony remodeling measures 37.4-mm x 37-mm at the level of left petroclinoid. Although the density of the lesion is not typical for meningioma on this exam this finding is believed to represent patient's known meningioma. Exclude other possibilities an MRI examination is recommended. This lesion outlines mass effect and deviates the left medial aspect of the temporal lobe laterally. The mass extends into the left cerebellopontine angle and applies mass effect on the left aspect of the pons and left middle cerebellar peduncle. There is no evidence of any edema of the brain parenchyma surrounding the tumor. There is ventriculomegaly of the supratentorial ventricles and effacement of cortical sulci. Findings are suspected for hydrocephalus. Very subtle bifrontal periventricular low attenuation of brain parenchyma is suspected for transependymal exudate of CSF.There is only minimal mass effect on the fourth ventricle however the fourth ventricle is not collapsed and is still widely patent. I see no detectable mass in the quadrigeminal cistern plate or the third ventricle by the tumor. There is no evidence of intracranial hemorrhage. Calvarium is intact.

Output: 1.Obstructive hydrocephalus with suspect that transependymal exudate of CSF.2.Low-attenuation extra-axial mass at the left petroclinoid ligament with bony remodeling and associated mass effect on the left temporal lobe and extension of mass into the left cerebellopontine angle with mass effect on the pons and left middle cerebellar peduncle.3.Follow-up with an infused MRI is recommended.


Instruction: Generate impression based on findings.

Input: There are postoperative changes consistent with C1 and C2 laminectomy for tumor resection at the C1 level bilaterally. Partial resection of the bilateral intradural tumor component is seen, as well as partial resection of bilateral extradural tumor at C1 and C2. Some intradural and extradural tumor does remain at these levels. This residual tumor, along with a post-operative collection of mixed fluid and blood product in the posterior operative bed, contributes to a persistent severe effacement of the thecal sac. In particular, the thecal sac is narrowed in the transverse dimension with significant cord deformation and questionable cord T2 hyperintensity. Additional post-operative findings include dural and pial enhancement in the operative field which are within expected limits. The previously noted enhancing oval mass in the left posterior paraspinal soft tissues at C2 is unchanged in size and measures 26 x 17 mm. A right-sided paraspinal apical pleural space mass which measures approximately 20 mm and is not significantly changed. Likewise, several tumor nodules along the pleural surface of the right lung apex are unchanged. Extensive tumor nodularity in the left paraspinal space at the thoracic inlet is partially visualized, extending into the left hemithorax and depressing the left lung apex. This aggregate lesion is only partially visualized on today's exam, but that portion which is seen does not appear to have changed. From the level of C2 and below, every neural foramen is filled and expanded by tumor, similar to prior. Kyphosis of the cervical spine is again seen, not significantly changed. Vertebral body heights are maintained. No concerning marrow replacement is seen. Except as above, the spinal cord shows normal morphology and signal.

Output: 1. There are postoperative changes consistent with C1 and C2 laminectomy for tumor resection. There has been partial resection of bilateral intradural tumor at C1 as well as bilateral extradural tumor at C1 and C2. Significant bilateral transverse narrowing of the thecal sac does persist, however, due to residual tumor and post-operative fluid. The spinal cord is significantly impinged and may be edematous. 2. Multiple additional paraspinal tumors and tumor aggregates, as well as diffuse foraminal neurofibromas, show no significant interval change.


Instruction: Generate impression based on findings.

Input: Metastatic papular thyroid cancer with single met to L3 vertebral body. Status post RT. Please assess for progression of disease. Unenhanced CT of thoracic spine:Axial immediate CT images of the entire thoracic spine were obtained. Sagittal and coronal 2-D reformatted images were acquired as well.The bony density in the alignment of the vertebral column is within normal limits. There is no evidence of a sclerotic or lytic changes of vertebral column. No minimal degenerative changes of the thoracic spine are noted. There is no evidence of any perispinal soft tissue abnormality. This examination remains stable since prior study.Unenhanced CT of the lumbar spine:Examination again demonstrates a stable findings of the L3 vertebrae. Subtle sclerotic changes of the L3 vertebrae are similar to prior exam. The exact etiology of this finding is not clear. Possibility of a hemangioma or a metastatic disease should be considered. CT exam is not the appropriate test for definitive diagnosis of metastatic bony lesions. MRI examination is recommended. There is however as mentioned above no change in the size, distribution and pattern of this not a specific L3 vertebrae. This lesion however can be further evaluated with biopsy if patient is unable to obtain an MRI examination.

Output: 1.Unremarkable CT of breath.Stable nonspecific sclerotic changes of L3 vertebrae since prior exam.


Instruction: Generate impression based on findings.

Input: Reason: R hip labral re-tear after fall History: pain, catching ACETABULAR LABRUM: There is linear increased signal abnormality which traverses the anterior superior acetabular labrum at the 2 o'clock position which partially fills with intra-articular gadolinium indicating a repeat tear.ARTICULAR CARTILAGE AND BONE: No articular cartilage defects are identified. No bone marrow signal abnormality is seen. No CAM deformity is identified.SOFT TISSUES: The imaged musculature of the right hip is normal in appearance. There is fatty infiltration/atrophy of the right psoas musculature likely related to prior surgical release.ADDITIONAL

Output: Acetabular labral tear, as described.


Instruction: Generate impression based on findings.

Input: Female, 61 years old, with diffuse weakness. Brain:No restricted diffusion is observed. No evidence of parenchymal edema or mass effect is seen. A single small focus of mild T2 hyperintensity is evident within the left superior frontal gyrus, and there may be a few very small foci in the pons as well, a nonspecific finding.A focus of susceptibility is noted within the left temporal lobe just anterior to the temporal horn. On T2-weighted images, the lesion appears to contain a bubbly hyperintense center with a hypointense rim. The lesion induces no edema and there is no associated pathologic enhancement. No pathologic parenchymal or extra-axial enhancement is detected elsewhere. The ventricular system is normal in size and morphology. No evidence of acute intracranial hemorrhage or any abnormal extra axial fluid is seen.Cervical spine:Mild reversal of the normal cervical lordosis is seen. The C4 vertebral body shows a mild retrolisthesis relative to C3 and C5. Vertebral body height and morphology are within normal limits. No pathologic marrow replacement is seen. Mild endplate edema is evident at C4 and C5, likely degenerative. No worrisome marrow enhancement is seen.The spinal cord demonstrates normal signal intensity and morphology throughout. No pathologic cord or leptomeningeal enhancement is seen. No epidural abnormalities are suspected.C2-3: Left greater than right facet hypertrophy. No significant spinal canal stenosis. Mild left foraminal narrowing. C3-4: Facet hypertrophy. Minimal posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Severe right and moderate left foraminal narrowing. C4-5: Mild posterior disc-osteophyte complex formation. Mild generalized spinal canal stenosis. Severe left and moderate right foraminal narrowing. C5-6: Mild posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Severe left and moderate right foraminal narrowing. C6-7: Minimal posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Mild bilateral foraminal narrowing. C7-T1: Left facet hypertrophy. No significant spinal canal or foraminal stenosis.

Output: 1.No definite findings are seen intracranially to account for the patient's symptoms. Specifically, no acute ischemia is detected.2.A susceptibility inducing lesion is seen within the left anterior temporal lobe with imaging characteristics suggestive of a cavernous malformation or a remote hemorrhagic insult. There is no associated parenchymal edema. This lesion is likely incidental and unrelated to the patient's presenting symptoms.3.Degenerative findings are seen in the cervical spine resulting in only mild spinal canal stenosis. Scattered foraminal narrowing is seen, however, severe at some levels. No spinal cord abnormalities are detected to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: 31-year-old female. Left-sided perineal pain. Found to have nonspecific lucencies of bilateral femoral neck and trochanters. Evaluate for cause of perineal pain and/or pelvic mass. Decreased T1 and T2 signal of the bone marrow symmetrically in the proximal femoral metaphysis and diaphysis as well as diffusely of the pelvis, most likely due to red marrow reconversion, which can be seen with anemic patients. No worrisome focal marrow signal abnormality is evident.Multiple small intramural T2 hypointense masses in the uterus consistent with fibroids. IUD is in place. No suspicious pelvic mass is identified.

Output: 1. Findings consistent with red marrow reconversion in the pelvis and proximal femurs, which can be seen with anemia. No focal worrisome marrow signal abnormality. 2. Small fibroids. No pelvic mass suspicious for malignancy.


Instruction: Generate impression based on findings.

Input: Primary sclerosing cholangitis, evaluate for abnormality ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic morphology of the liver. No suspicious hepatic lesion identified. Mild intrahepatic stricturing, with no dominant stricture identified, appearing similar to prior study. The gallbladder is normal in appearance. Portal and hepatic veins are patent. SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted. Status post colectomy. BONES, SOFT TISSUES: No significant abnormality notedOTHER: Small right posterior Bochdalek hernia with fat herniation.

Output: 1. Stable mild intrahepatic ductal stricturing. 2. Cirrhotic morphology of the liver with no suspicious hepatic lesions.


Instruction: Generate impression based on findings.

Input: Left mastoiditis, concern for brain involvement on CT MRI of the brainNo diffusion weighted abnormalities are appreciated.There is abnormal enhancement involving the left temporal bone where there is opacification of the left middle ear and mastoid air cells. There is a ring-enhancing lesion present at the expected location of the mastoid measuring approximately 19 x 12 mm coronal dimensions and another ring-enhancing lesion present within the right middle ear measuring 6 x 8 mm coronal dimensions. There is associated soft tissue swelling superficial to the left temporal bone and infiltration of the subcutaneous fat planes. There is enhancement along the left temporal bone including the squamous portion of the left temporal bone and the petrous portion. There is also extension along the left eustachian tube. The left external auditory canal is narrowed and displaced. There does not appear to be any involvement of the underlying brain. There is no subdural or epidural fluid collection appreciated.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 orbits are intact.MRV brain:The dural venous sinuses are patent. Straight sinus, internal cerebral veins and basal veins are identified and appear patent.

Output: 1.Findings are compatible with otomastoiditis associated with abscess formations and osteomyelitis at the left mastoid and temporal bone. Please refer to CT of the temporal bone for additional comments.2.There is no evidence for intracranial abscess at this time. There is also no evidence for dural venous thrombosis.3.MR venogram of the brain is within normal limits


Instruction: Generate impression based on findings.

Input: 32-year-old male with pituitary cancer, status post chemo and radiation in 2006. Radiation to left sacrum 6/30 through 7/10/2008. December 2008 MRI showed abnormal left hemisacrum, possibly representing disease progression. Please perform CT guided sacral biopsy. Following a discussion of the procedures risks, benefits and alternatives, informed written consent was obtained from the patient's mother.The patient was placed in a prone position. A radiopaque grid was placed over the patient’s left sacrum for needle localization. Using multidetector helical CT, axial 5 mm scans were obtained through the sacrum demonstrating mild irregularity of the left superior sacroiliac joint. A trajectory was plotted into the left hemi-sacrum based on review of pelvis MRI 12/5/2008. The patient's lower back was prepped with Betadine and draped in sterile fashion. The subcutaneous and deeper soft tissues were anesthetized with 1% lidocaine. A 13-gauge Bonopty needle was advanced into the posterior aspect of the left hemisacrum. An inner drill cutting needle was utilized to advance the coaxial Bonopty needle into the posterior lateral aspect of the left hemisacrum. A bone biopsy was performed with an inner bone cutting needle, which yielded a solid bone core. The sample was placed in formalin and sent directly to pathology for diagnostic analysis. The coaxial needle was removed and adequate stasis was achieved with manual compression for 5 minutes.The patient tolerated the procedure well with no immediate complications. The patient remained neurologically intact at baseline at the end of the procedure. The patient was transferred to interventional radiology holding for routine post-procedure monitoring.

Output: Successful CT-guided core bone biopsy of the left hemisacrum.


Instruction: Generate impression based on findings.

Input: Migraine patient now with unrelenting headaches for 3 weeks, family history of intracranial aneurysms. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No suspicious intracranial mass or mass-effect. There is a sub-centimeter pineal cyst measuring 9 x 5 x 5 mm without significant mass-effect or suspicious enhancement. Brain parenchyma is otherwise unremarkable for age. The ventricles are within normal limits in size and configuration. No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits. MRA HEAD: The intracranial internal carotid arteries demonstrate no significant stenosis. The middle and anterior cerebral arteries are also patent. The vertebral arteries, basilar artery, and posterior cerebral arteries also are patent with no significant stenosis. No evidence of aneurysms or vascular malformations.

Output: 1. MRI of the brain is essentially unremarkable. There is a subcentimeter pineal cyst without mass effect and of doubtful clinical significance. No suspicious intracranial masses, mass effect, or abnormal enhancement is appreciated.2. No intracranial aneurysms.


Instruction: Generate impression based on findings.

Input: Male 55 years old Reason: colorectal staging History: occasional brbpr Overall image quality: Satisfactory.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted. LYMPH NODES: Lymph nodes in the perirectal space, within the mesorectal fascia: At least 6 tiny nodes seen (see key images)Lymph nodes outside the mesorectal fascia: Tiny pelvic sidewall nodes, at least 2 (see key images)BOWEL, MESENTERY: Rectal Tumor:Size: 1.6 (axial) x 5 (CC) x 2.9 (AP) cm, image 29 series 1101Tumor appearance on T2-weighted images: IsointenseTumor location: Rectosigmoid colon (For lower rectal tumors):Distance of the lower edge of the tumor to the anal verge (lower edge of the anal canal): n/a Distance of the lower edge of the tumor to the pelvic floor (relationship of the tumor to the anal sphincter complex): n/aCircumference of the colon involved: At least 180 degrees, see image 29 series 1101Relationship and proximity of the tumor to adjacent structures (prostate, seminal vesicles): RemoteMRI T-stage: Tumor Distance to Mesorectal Fascia: 1.7 cm, image 57 series 701BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Adjacent serosal surface slightly indistinct with fat stranding seen, suspicious for tumor involvement.

Output: 1. Rectosigmoid mass with extension to level of serosa and tiny adjacent lymph nodes as above.


Instruction: Generate impression based on findings.

Input: History of hemangiopericytoma (diagnosed 25 years ago) status post mets to brain, salivary gland, right femoral, liver, thoracic spine, presented with fall and intractable back and right hip pain. Thoracic spine:The thoracic spine is in normal alignment. The vertebral body and disk heights are well-maintained. There is a mild dextrocurvature to the thoracic spine. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots. There is redemonstration of a slightly smaller size to the mass located at C7/T1 level. There are pedicle screws present at T3, T4 , T6 and T7 associated with a interconnecting rods. The patient is status post T5 vertebrectomy. The small hemangioma in the left side of T12 vertebral body is unchanged.Lumbar spine:The lumbar spine alignment is within normal limits. The vertebral body and disc space heights are preserved. There is disc desiccation most noted at L1-L2. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable. There are mild degenerative changes involving the lumbar spine with mild disc bulges located from L1-L2 through L5-S1. There is mild facet arthropathy at the L3-4 and L4-5 levels which cause mild neural foraminal stenosis. There is mild central canal stenosis at the L3-4 level. The previous osseous metastatic lesions including left sacral ala and ilium are stable.

Output: 1.Slightly smaller right sided lower cervical and upper thoracic spine mass.2.Stable postsurgical changes of a thoracic vertebrectomy and instrumentation.3.Mild degenerative changes of the lower lumbar spine without significant central canal or neural foraminal compromise.


Instruction: Generate impression based on findings.

Input: Fevers, elevated inflammatory markers, back pain. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal or neural foramen stenosis. There are no mass lesions or abnormal enhancement in the spine. The vertebral column alignment is unchanged with diminished cervical and lumbar lordosis. The spinal cord displays normal signal and morphology. There is diffuse enhancement in the lower back subcutaneous tissues, without evidence of abscess formation.

Output: 1. No evidence of discitis or vertebral osteomyelitis.2. Diffuse enhancement in the lower back subcutaneous tissues is likely related to the previously reported dependent edema versus less likely cellulitis. Please refer to the recent non-contrast spine MRI report for additional details.


Instruction: Generate impression based on findings.

Input: 40 year-old male with history of anoxic encephalopathy. With change in neurological exam. Increased bilateral hypodensities in the area of the basal ganglia consistent with evolving profound ischemic changes. These findings correlate with signal abnormality seen on recent MRI.There is no evidence of intracranial hemorrhage.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. Partial opacification of the sphenoid sinuses and the mastoid air cells.

Output: 1.Evolving bilateral basal ganglia ischemic changes.2.Sphenoid sinus and mastoid air cell opacification.


Instruction: Generate impression based on findings.

Input: History of anaplastic astrocytoma s/p resection and RT/TMZ. Off all treatment now. There are postoperative findings of a right frontal craniotomy. Area of T2 hyperintensity centered in the right superior frontal gyrus consistent with a postoperative cavity is unchanged from the prior exam. Surrounding T2 signal is unchanged in extent. T2 hyperintense signal in the periventricular region, right greater than left, is also unchanged. Susceptibility in the resection cavity likely reflects old blood products. No new areas of abnormal T2 signal. A thin branching focus of enhancement along the resection cavity is stable and likely represents scar tissue. No new areas of abnormal enhancement.No evidence of diffusion restriction. 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: Stable surgical and treatment related changes without evidence of progressive disease.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Diagnosis: Secondary malignant neoplasm of brainClinical question: metastatic melanoma; brain metsSigns and Symptoms: assess for EOD The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a 17 x 19 mm axial dimension ring-enhancing lesion present along the left cuneus associated with susceptibility effect and surrounding T1 hypointensity and T2 hyperintensity compatible with vasogenic edema.

Output: 1.There is a left occipital lobe mass present which is compatible with neoplasm. Given the patient's clinical history of melanoma, metastasis is suspected.2.Please note that this is a limited exam for the purposes of image guidance for treatment planning.


Instruction: Generate impression based on findings.

Input: 47-year-old woman with personal history of right breast DCIS status post mastectomy with implant reconstruction bilaterally and hormonal therapy for screening MRI. No current breast complaints. There is heterogeneous amount of fibroglandular tissue in the left breast.Mild parenchymal enhancement is noted bilaterally.There are postsurgical changes of right mastectomy bilateral retropectoral implant reconstruction. A few scattered enhancing foci in the left breast are unchanged from the prior MRI. There is no abnormal enhancement in the right mastectomy bed or in the left breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: 75 years Male (DOB:7/25/1941)Reason: right mediofrontal scalp wound with exposed cranium, eval for osteomyelitis History: scalp woundPROVIDER/ATTENDING NAME: KEVIN C. CONCORDIA DAVID G. BEISER The calvarial marrow signal appears to be appropriate bilaterally there is not appear to be in the marrow replacement.The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mild mucosal thickening. The visualized portions of the mastoid air cells demonstrate partial opacification of the mastoid air cells on the right side than the left and opacification of the right middle ear. The visualized portions of the orbits are intact.

Output: 1.The patient's right frontal scalp tissues are not associated with marrow replacement. This suggests that underlying osteomyelitis is less likely.2.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related. 3.Opacification of mastoid air cells (right side more than left) and right middle ear is nonspecific and could be simply related to retained secretions. This was also present on the prior CT exam. Early mastoiditis may have a similar appearance however. Please correlate with clinical symptoms


Instruction: Generate impression based on findings.

Input: Clinical question: Glioblastoma multiforme. Signs and symptoms: Vomiting. Pre and post enhanced brain MRI:Examination demonstrates a large heavily necrotic and ring-enhancing mass with large areas of solid enhancing component along the medial aspect of right posterior frontal-parietal lobe which inferiorly extends into the splenium of the corpus callosum. The tumor abuts the right lateral ventricle and with resultant inferior displacement. It measures at least at 38 x 35 x 38 mm and consistent with patient's known GBM. The tumor has white contact with the right lateral ventricle and inseparable from its ependymal lining.There is no detectable surrounding vasogenic edema exception of minimal edema in the splenium of the corpus callosum. There is a large focus of encephalomalacia along the interhemispheric aspect of right frontal lobe immediately anterior to the tumor. There is mild dilatation of the lateral ventricles however with maintained midline. Ventricular system however remains stable in size since prior head CT from 8-26-15.There are no additional foci of parenchymal signal abnormality or parenchymal/meningeal enhancement.There is postoperative changes of a large posterior frontal and parietal craniotomy which traverses the midline to the left. As was noted on prior head CT exam there is a large extracranial fluid signal intensity collection immediately superior to the craniotomy and consistent with a seroma. It measures approximately 82 mm in transverse axis and 34 mm in height which are measured on coronal reformatted post enhanced images.

Output: 1.Large partially solid and necrotic enhancing GBM along the interhemispheric aspect of the right posterior frontal-parietal lobe as detailed/measured above.There is no significant mass effect and midline is maintained.1.Postoperative changes of a wide parietal craniotomy which extends across the midline to the left and with evidence of a seroma immediately above the craniotomy flap as detailed/measured above.


Instruction: Generate impression based on findings.

Input: Hemiplegia, unspecified affecting unspecified side [G81.90], Reason for Study: ^Reason: Evaluate for ischemia History: R hemiparesis, has history of MS Motion artifact degraded exam quality.There is no evidence of acute ischemic lesion.Susceptibility artifacts are seen along the course of left circumflex thalamic stimulator, however, otherwise there is no MR evidence suggesting acute hemorrhagic lesion.Multifocal patch high signal intensity lesions involving bilateral periventricular white matter, centrum semiovale as well as posterior fossa are compatible with demyelinating disease such as multiple sclerosis.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. No evidence of acute ischemic lesion on this scan.2. Susceptibility artifacts are seen along the course of the left thalamic stimulator, however, there is no other MR lesion suggesting acute hemorrhagic lesion on this scan.3. White matter lesions are consistent with multiple sclerosis.


Instruction: Generate impression based on findings.

Input: Sickle cell anemia and right sided facial droop. MRI: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The orbits, skull, and scalp soft tissues are grossly unremarkable. There are secretions and mucosal thickening in the right maxillary sinus. MRA: There is no evidence of significant steno-occlusive lesions in the head and neck arteries. There is no evidence of saccular cerebral aneurysms.

Output: 1. No evidence of acute intracranial hemorrhage, mass, or acute infarct.2. No evidence of significant steno-occlusive lesions in the head and neck arteries.


Instruction: Generate impression based on findings.

Input: History of cervical mass. PELVIS:UTERUS, ADNEXA: Anteflexed anteverted uterus without evidence of a congenital mullerian duct abnormality. The uterus measures approximately 8.0 x 3.4 cm in the sagittal plane.The endometrium/endometrial cavity is normal in thickness measuring 1 to 2 mm.The inner myometrium/junctional zone is normal in thickness and there are no additional specific findings of adenomyosis.Along the posterior lower uterine/cervical segment there is an exophytic/subserosal well-defined T1 and T2 weighted hypointense round mass measuring 4.2 x 3.3 cm in the sagittal plane most compatible with a large fibroid which was present on a 2002 MR in which it measured approximately 5.2 x 4.2 cm in axial plane. The fibroid demonstrates isointense enhancement to the remainder of the myometrium. There are additional small intramural probable fibroids.The right and left adnexa are unremarkable with subcentimeter hyperintense foci in the left ovary, within physiologic limits.The cervical stroma is unremarkable. The parametrial soft tissues are unremarkable.The vaginal canal and perineum is unremarkable.BLADDER: No significant abnormality noted.LYMPH NODES: Small subcentimeter right pelvic wall lymph nodes are also unchanged dating back to 2002.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 4.2 cm posterior lower uterine/cervical segment probable fibroid is unchanged in appearance dating back to 2002 and may correspond to the palpable mass on examination


Instruction: Generate impression based on findings.

Input: Visual loss in the left eye (lateral hemifield>medial) in the setting of recent (corrected) HTN emergency and labile blood sugars. There are bilateral lens implants. The orbital structures are otherwise grossly unremarkable. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mild scattered cerebral white matter T2 hyperintensity and small areas of encephalomalacia in the right cerebellar hemisphere, right thalamus, right pons, and bilateral basal ganglia. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull and scalp soft tissues are grossly unremarkable. There is mild scattered paranasal sinus mucosal thickening.

Output: 1. Aside from bilateral lens implants, the orbital structures are otherwise grossly unremarkable.2. Small chronic lacunar infarcts in the right cerebellar hemisphere, right thalamus, right pons, and bilateral basal ganglia and a background of probable chronic small vessel ischemic disease.3. No evidence of intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: Clinical question: Worst headache of life, posterior headaches, left-sided weakness, slurred speech. Signs and symptoms: Worst headache of her life, posterior headache, left-sided weakness, slurred speech. Nonenhanced CT of brain:Images through posterior fossa are unremarkable.Edema in the right anterior temporal tip with a small amount of hemorrhage is noted. Combination of these findings measures approximately 46 mm x 25 minute periodsmall area of parenchymal edema in the right frontal pole measuring 19 mm times 19-mm. No hemorrhage associated with this finding.Minimal subarachnoid hemorrhage localized to the right anterior parietal region.Suspect a small CSF density extra-axial collection in the left frontal and temporal region. This finding measures approximately 4.5 Mm in size. The gray -- white matter differentiation is preserved. Ventricular system is within normal size and no midline shift.No -attenuation of the white matter of bilateral occipital lobes and is believed to be artifactual.Calvarium is intact. Visualized paranasal sinuses and mastoid air cells demonstrate minimal findings of acute sinusitis in the right maxillary sinus no detectable fracture on this exam. No definitive abnormality of the scalp. For further evaluation MRI examination of brain is recommended.

Output: 1.Foci of edema in the right anterior temporal tip with minimal hemorrhage and right anterior -- inferior frontal lobe without hemorrhage and minimal localized right parietal subarachnoid hemorrhage. Findings are suspected for posttraumatic changes. Follow-up with an MRI is recommended to exclude extent of injury or additional cause for these findings.2.Normal size of ventricular system and no midline shift.3.Negative calvarium.


Instruction: Generate impression based on findings.

Input: Liver cyst, complex. Evaluate for biliary cyst adenoma. Liver ultrasound with enlarging cyst. ABDOMEN:LIVER, BILIARY TRACT: 4.9 x 3.3 cm right hepatic lobe lobulated cystic lesion with multiple thick septations (series 7, image 25), not significantly changed in size from prior US allowing for differences in technique. No calcifications or enhancing solid nodularity in this lesion on post-contrast sequences.Small scattered simple hepatic cysts are 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: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Septated complex cystic lesion in the right hepatic lobe, not significantly changed in size from recent US. This may represent a biliary cystadenoma, other possibility is a complex cyst.


Instruction: Generate impression based on findings.

Input: History of lumbar lipomyelomeningocele repair and hemangioma on the back. Assess for hydrocephalus and cord tethering. BRAIN: The ventricular system is not enlarged. There are foci of susceptibility effect in the posterior right inferior temporal sulcus, left collateral sulcus, and right cerebellar tonsil. There is no evidence of acute intracranial hemorrhage, mass, or acute infarct. There is no midline shift or herniation. In particular, there cerebellar tonsils are not low-lying. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. SPINE: There are postoperative findings related to lipomyelomeningocele surgery with overlying incision plane that may contain a small amount of residual fluid. There is a lipomatous mass in the posterior spinal canal at the L1 through L4 levels, measuring 1.6 AP x 1.5 RL x 3.9 CC cm. The lipomatous mass abuts and mildly deforms the caudal spinal cord. The tip of the conus medullaris is situated at the L4 level. The lower spinal cord does not appear to shift in position from prone to supine. There is a linear high T2 and low T1 signal band in the midline posterior subcutaneous tissues at the L5 level, which extends from the spinal canal to the skin surface, where there appears to be a flat cutaneous lesion. There is no evidence of syrinx. The vertebral column alignment is anatomic. The vertebral body heights are intact, but there is apparent deficiency of the posterior elements at multiple levels of the lumbar spine, which may represent dysraphism or surgical alterations.

Output: 1.No hydrocephalus, acute intracranial hemorrhage, or acute infarct. Tiny foci of susceptibility effect involving the temporal lobes and the right cerebellar tonsil may represent cortical mineralization from previous ischemia, infection, or hemorrhage. 2.Postoperative findings related to repair of the lipomyelomeningocele. The residual lipomatous mass, or caudal lipoma, is attached to the deformed caudal spinal cord and the tip of the conus medullaris lies at the L4 level.3.Suggestion of a possible sinus tract in the posterior subcutaneous tissues at the L5 level, perhaps with associated with a overlying cutaneous hemangioma. Otherwise, no evidence of a residual meningocele.


Instruction: Generate impression based on findings.

Input: 61 years Male (DOB:1/1/1955)Reason: OR prep History: epidermoid tumorPROVIDER/ATTENDING NAME: KRISTINA K SICKER SERVICES ANCILLARY The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a 10 mm lesion present within the left side of the pituitary fossa which bulges into the left cavernous sinus.There is an irregularly-shaped cystic appearing lesion present in the posterior fossa which extends from the fourth ventricle inferiorly and bulges into the posterior aspect of the medulla. It measures approximately 37 x 18 mm axial dimensions.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.The lesion centered in the inferior aspect of the fourth ventricle which extends through foramen of March, and bulges into the medulla. It has a cystic appearance. One possibility is that this represents an epidermoid. Please correlate clinical history and symptoms and prior imaging.2.There is a left sided pituitary fossa lesion present. Please correlate clinical history and symptoms and prior imaging. Most commonly lesions in the pituitary gland represent adenomas.3.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related. 4.Please note that this is a limited exam for the purpose of stereotactic guidance. Please refer to any previous imaging studies that may have been done for further comments


Instruction: Generate impression based on findings.

Input: Male 68 years old with history of hereditary hemorrhagic telangiectasia, evaluate for brain AVMs. MRI:There is no evidence of intracranial hemorrhage, mass, or acute infarct. Few foci of scattered periventricular and subcortical T2/FLAIR hyperintensity, which are nonspecific. The brain parenchyma otherwise appears unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. Trace right maxillary mucosal thickening. The orbits, skull, and scalp soft tissues are grossly unremarkable.MRA:The intracranial internal carotid arteries are normal in course and caliber. The middle and anterior cerebral arteries are unremarkable. The vertebral arteries, basilar artery, and right cerebral arteries are normal in course and caliber. There is a fetal origin of the left posterior cerebral artery. The right posterior communicating artery is not well visualized. There is no evidence of AVM, flow-limiting stenosis, or aneurysm.

Output: 1. No evidence of vascular malformation, high-grade stenosis, or aneurysm.2. No evidence of intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: Reason: s/p R frontal metastatic malignant fibrous histiocytoma resection, planning for post-op radiation History: N/AAdditional history from EMR: Although the reason above reports a RIGH t frontal lobe tumor, pathology corroborates with a LEFT frontal mass. There is been interval expected evolution of postoperative changes from previous left-sided craniotomy for resection of the previous left frontal lobe hemorrhagic lesion, with interval slight decreased size of the resection cavity. There is a complete peripheral rim of susceptibility relating to chronic hemosiderin deposition, slightly more prominent than prior. There is a minimal surrounding halo of T2 hyperintensity remaining, likely relating to posttreatment changes and residual vasogenic edema. Within limitations of only postcontrast imaging, there is mild peripheral intrinsic T1 hyperintensity likely relating to the postoperative blood products, without significant nodular areas of increased signal.Additional hemorrhagic lesion involving the body the right lateral ventricle abutting the septum pellucidum is essentially no longer appreciated on postcontrast images, although there remains significant susceptibility in this location. Overall, the ventricles appear slightly increased in size likely relate to mild global volume loss. Susceptibility in the right occipital horn dependently has resolved.There are additional right temporal lobe rounded enhancing lesions, the larger of which is located laterally, now measuring 5 x 6 mm. A smaller punctate lesion is seen along the mesial right temporal lobe on 301/73. Punctate susceptibility is seen associated with the medial lesion. Additional punctate foci of susceptibility are seen along the superior left temporal lobe, with the more anterior finding not seen previously and stable posterior focus. There is minimal T1 hypointensity in these locations with previous very subtle enhancement questioned now suggesting treated lesions. The more posterior finding demonstrates punctate enhancement along its periphery on 301/103.There remains a prominent mucosal retention cyst within the left maxillary sinus along the floor.

Output: 1. Interval expected evolution from prior left frontal lobe postoperative changes with slight decreased size of hemosiderin stained resection cavity. No evidence of nodular increased signal/enhancement on these postcontrast images to suggest recurrent/residual tumor.2. Previously noted hemorrhagic intraventricular lesion along the right aspect of the septum pellucidum is no longer appreciated on postcontrast images consistent with favorable treatment response.3. Additional right temporal lobe metastases, with slight increased size of the more lateral lateral finding.


Instruction: Generate impression based on findings.

Input: Status post third V-C placement and Rickham reservoir. Rule out ICH. A right frontal ventricular shunt has its tip at the midline. Pneumocephalus and subcutaneous emphysema are likely postprocedural. There is no evidence of intracranial hemorrhage. The lateral and third ventricles are enlarged, and the frontal horns appear more rounded than on the prior MRI. After accounting for differences in technique, this is suggestive of slight interval increase in size of the lateral and third ventricles. The fourth ventricle is within normal limits.The visualized paranasal sinuses and mastoid air cells are within normal limits for the patient's age.

Output: Expected postoperative findings from recent shunt placement. No evidence of intracranial hemorrhage. Slight interval increase in size of lateral and third ventricles.


Instruction: Generate impression based on findings.

Input: Abnormal head CT: newly diagnosed metastatic breast cancer. There is an infiltrative, enhancing mass within the left parietal calvarium that measures up to 50 mm with epidural and subgaleal extension. There is minimal associated mass effect upon the underlying left parietal lobe. There is no evidence of lesions with in the brain, brainstem, or cerebellum. There cerebellar tonsils extend up to 5 mm inferior to the foramen magnum. There is no evidence of acute intracranial hemorrhage or acute cerebral infarction. The orbits and paranasal sinuses are unremarkable.

Output: A lesion in the left parietal lobe with epidural and subgaleal extension is compatible with metastatic disease.


Instruction: Generate impression based on findings.

Input: Other nontraumatic intracerebral hemorrhage [I61.8], Reason for Study: ^Reason: signs of vascular malformation or tumor History: history of right temporal lobe hemorrhage 2/2016 There is a susceptibility area with tissue loss on the right temporal lobe anterior aspect of the superior temporal gyrus indicating chronic hemorrhagic lesion. The area shows linear and somewhat nodular enhancement which could represent remained brain parenchyma. There is some curvilinear signal voids around the lesion which may represent vascular signal voids. There are also a couple of linear and nodular enhancing lesions around the area of encephalomalacia. Therefore, if clinically brain AVM is a possibility, diagnostic catheter angiogram should be considered.There is no evidence of acute ischemic lesion on the scan.The ventricles, sulci and cisterns are unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Chronic hemorrhage with encephalomalacia involving right anterior aspect of superior temporal gyrus.2. Multiple curvilinear signal voids around the area of encephalomalacia (right anterior temporal lobe) which may indicate possibility of underlying brain AVM. Therefore, if clinically indicated, diagnostic catheter angiogram can be considered.3. There is no evidence of acute ischemic lesion on the scan. There is no evidence of abnormal enhancement.


Instruction: Generate impression based on findings.

Input: Clinical question: History of thalamic abscess in the outside hospital. Evaluate resolution. Signs and symptoms: None surveillance scan. Pre-and post-enhanced brain MRI:Unremarkable diffusion weighted series.Examination demonstrates a focus of susceptibility signal change in the right thalamus with hypointensity signal pattern on both flair and T2-weighted images. The finding demonstrate increased T1 hyperintensity and findings are suggestive of a focus of chronic hemorrhage. There is no evidence of surrounding edema or any appreciable mass effect. A thin band of encephalomalacia/gliosis extends from this finding laterally and superiorly to the inner table of the skull in the right posterior frontal and consistent with a surgical tract from prior operation.Post enhanced images demonstrate no enhancement to suggest presence of an infectious process. There are however small linear vascular enhancement within this region which are contiguous with prominent right thalamic. The appearance of the finding is suggestive of a cavernous malformation or a developmental venous anomaly. There are no prior exams for comparison. If such exams are available and are provided the radiology department an addendum to this report was resubmitted after comparison. The findings on this exam are not suggestive of a prior infection/abscess at this site. Comparison to prior exams is important for clarification and is highly recommended. Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination otherwise stated age.The signal void of major intracranial arterial branches are identified.The signal intensity of intracranial venous sinuses are within normal and with normal pattern of enhancement.Unremarkable calvarial, orbit, paranasal sinuses and mastoid air cells.

Output: 1.No diffusion weighted abnormalities.2.Focus of susceptibility signal change in the right thalamus with internal linear vascular (likely venous) enhancement contiguous with a slightly prominent right thalamic vein as detailed above. Constellation of signal changes and pattern of enhancement is highly suggestive of a cavernous malformation with an associated developmental venous anomaly.3.There is no finding on this exam to suggest presence of an infectious or inflammatory process.4.Unremarkable pre-and post enhanced brain MRI otherwise.5.Expected signal changes along the surgical tract from a right frontal burr hole approach.6.Comparison with prior exams are highly recommended considering provided clinical history of right thalamic abscess which does not correlate with any findings on this exam. Please see above comments.


Instruction: Generate impression based on findings.

Input: Postoperative changes are again seen at the L4-S1 levels from previous anterior surgical fusion. The spine is in normal alignment. The vertebral body and disk heights are grossly stable, with mild disc narrowing and desiccation along the lower thoracic spine and cervical spine. However, susceptibility artifact from indwelling hardware limits evaluation of the L4 to S1 vertebra. Prominent endplate degenerative changes are noted at C6-C7. Stable STIR hyperintensity is noted along the superior endplate of L4 extending into the pedicles, as well as involving the L5 pedicles bilaterally. There is also mild stable STIR hyperintensity in the S1 vertebra. The spinal cord is grossly of normal caliber and signal. There is no MR evidence of cord compression. There is suggestion of perhaps moderate central spinal canal stenosis at C5-C6 due to a diffuse posterior osteophyte disc complex, which appears somewhat progressed since previous February 2015 counting image from MRI of the thoracic spine. Prominent ligamentum flavum thickening is noted at T2-T3 and T3-T4.Prevertebral STIR hyperintense collections are noted at the L4-L5 and L5-S1 levels, to be further detailed on the separately dictated dedicated MRI of the lumbar spine. The collection along the mid L4 to L4-L5 level measures 1.7 cm CC x 0.7 cm AP. Collection spanning the L5 level measures 3.6 cm CC x 0.8 cm AP. There is mild adjacent stranding within the fat. There is moderate encroachment upon the L5-S1 foramina bilaterally due to nonspecific soft tissue along the posterior aspect of the interbody spacer at this level, although this does not appear significantly changed since previous exams. A similar appearance is noted at L4-L5 level although to a lesser degree with moderate bilateral foraminal narrowing. There has been interval thickening of the ventral epidural tissue especially spanning the S1 level compared to the prior exam, with mild narrowing of the central spinal canal. This area of soft tissue now measures 9 mm in greatest thickness on 701/9, compared to previous 6 mm.

Output: 1.Interval development of discrete prevertebral collections at the L4-L5 and L5-S1 levels, to be further detailed on a dedicated MRI of the lumbar spine. Given the patient's history, these are suspicious for abscesses.2.Interval thickening of ventral epidural tissue especially at the S1 level, also concerning for infection.3.No MR evidence of cord compression, although there is now mild central spinal canal narrowing at the S1 level.4.Moderate bilateral foraminal narrowing at L4-L5 and L5-S1 secondary to encroachment by nonspecific soft tissue along the dorsal aspects of the interbody spacers.


Instruction: Generate impression based on findings.

Input: Female, 63 years old, with right posterior frontal and right paracentral lobule brain masses. Preoperative planning examination. A rim-enhancing mass is evident within the posterior right frontal lobe with moderate surrounding edema extending superiorly to the vertex and inferiorly to the operculum. There has been no significant interval change in the size of this lesion.A second much smaller enhancing mass is evident within the right paracentral lobule with minimal edema tracking inferiorly. This lesion also shows no significant interval change.Within the limitations of motion degradation, no new enhancing intracranial lesions are detected. There is a generalized midline shift to the left of 5 to 6 mm. Ventricular size and morphology remain within acceptable limits.

Output: Limited sequences for surgical planning redemonstrate two enhancing masses within the right cerebral hemisphere, one in the posterior right frontal lobe and another smaller lesion in the right paracentral lobule. There has been no significant interval change.


Instruction: Generate impression based on findings.

Input: Female 49 years old Reason: Chronic left ankle pain status post sprain 6 months ago History: pain TENDONS: No significant abnormality noted.LIGAMENTS: No significant abnormality noted.ARTICULAR SURFACES AND BONE: Well-corticated ossicle about the distal fibula most likely due to old trauma which abuts the anterior talofibular ligaments appears similar to prior radiograph, with no evidence of inflammation. ADDITIONAL

Output: No findings to account for patient's symptoms.


Instruction: Generate impression based on findings.

Input: Unspecified convulsions [R56.9], Reason for Study: ^Reason: concern for seizure-like activity, neurology service recommendation. Brain parenchyma appears within normal limits. No intracranial mass or mass effect. No evidence of cortical dysplasia, gray matter heterotopia, or other findings to suggest seizure focus are appreciated. No evidence of acute ischemia or hemorrhage. The ventricles and basal cisterns are normal in size and configuration. No abnormal enhancement. There is redemonstration of a prominent focus of T1 shortening in the posterior pituitary gland measuring up to 8 mm, which may represent a prominent neurohypophysis or Rathke's cleft cyst but not significantly changed since 2013. There is mild thickening and T1 hypointensity involving the calvarium compatible with history of sickle cell disease.

Output: Brain parenchyma appears within normal limits. No findings to suggest seizure focus.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for pathology. Signs and symptoms: Bilateral clonus on exam. Nonenhanced cervical MRI:There is normal anatomical alignment of vertebral column. There is however straightening of cervical lordosis which could be positional or due to pain.Foramen magnum is unremarkable.C2-C3 demonstrate minimal degenerative changes with resultant mild left neural foraminal compromise.C3-C4 demonstrate mild degenerative changes with resultant moderate left and mild right neural foraminal compromise.C4-C5 demonstrate a right lateral disc protrusion with resultant effacement of ventral subarachnoid space however without central spinal stenosis or definitive detectable cord signal abnormality. There is moderate to significant bilateral (R>L)neural foraminal compromise.C5-C6 demonstrate mild degenerative changes without central spinal stenosis or definitive neural foraminal compromise.C6-C7 is unremarkable.C7-T1 is unremarkable.Partially visualized paraspinal soft tissues demonstrate enlarged right-sided lower neck pathologic nodes as was mentioned on prior chest CT. The largest node measures at 20 x 19 mm in transaxial dimensions.

Output: 1.Mild degenerative changes with resultant multilevel neural foraminal compromise however without evidence of central spinal stenosis. Please review detailed report per level above.2.Right lateral broad-based disc protrusion at C4-C5 without detectable cord signal abnormality or central spinal stenosis.3.No detectable osseous signal abnormality to suggest metastatic lesions.4.Pathologically enlarged right lower neck lymph nodes largest measuring 20 x 19 mm in transaxial dimensions.


Instruction: Generate impression based on findings.

Input: History of right mastectomy 2/2014 for IDC and DCIS. Patient received chemotherapy and radiation. Pre-surgical MRI demonstrated multiple enhancing foci for which follow-up MRI was recommended. Since the prior MRI, the patient has had a right mastectomy. Heterogeneous fibroglandular tissue is present in the left breast. Mild parenchymal enhancement is noted in the left breast, which has decreased in extent since the prior MRI.Right chest wall: No abnormal enhancement is present within the right chest wall or axilla. A 3.8 x 1.0 cm fluid-filled postsurgical seroma cavity is present in the right axilla.Left Breast: No abnormal enhancing masses, non-mass enhancement or uniquely enhancing foci are present in the left breast. A Port-A-Cath is present in the superior and medial aspect of the left chest wall. No abnormal axillary lymph nodes are identified in the left axilla.

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


Instruction: Generate impression based on findings.

Input: Other general symptoms(780.99) [780.99], Reason for Study: ^Reason: r/o acute ischemia History: word finding difficulty transient No evidence of acute ischemic or hemorrhagic lesion.Patch high signal intensities on periventricular white matter as well as scattered high signal intensities on white matter bilaterally indicating nonspecific small vessel ischemic disease.There are multifocal small tissue losses especially bilateral basal ganglia indicating chronic ischemic lacunar infarcts.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: No evidence of acute ischemic or hemorrhagic lesion.Nonspecific small vessel ischemic disease with multifocal chronic lacunar infarcts.


Instruction: Generate impression based on findings.

Input: Other convulsions [780.39] / Altered mental status [780.97], Reason for Study: ^Reason: ams, concern for PRES on ct head vs demyelinating disease History: confusion Extensive high signal intensity lesion on bihemispheric periventricular white matter as well as deep white matter which are directing perpendicular to ventricular lining indicating demyelinating disease such as multiple sclerosis.Underlying brain shows multifocal tissue losses and linear or nodular high signal intensities on FLAIR and T2 weighted images indicating chronic ischemic infarctions on bilateral external capsule, bilateral basal ganglia, bilateral caudate nucleus, and bilateral thalami. There is no evidence of acute ischemic or hemorrhagic lesion.There is no MR evidence of PRES.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear.The right maxillary sinus shows retention cyst.

Output: 1. Extensive white matter lesions indicating demyelinating disease such as multiple sclerosis.2. Underlying brain shows multifocal chronic ischemic infarctions.3. No acute ischemic or hemorrhagic lesion on this scan.


Instruction: Generate impression based on findings.

Input: Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position. Mild disc desiccation is seen at L2-3, L3-L4, L4-5 and L5-S1 levels. There is prominent epidural fat involving most on the lumbar levels resulting in developmental narrowing of the distal spinal cord. Multilevel degenerative changes are seen, as described below:L1-L2: There is mild ligamentum flavum thickening and left facet hypertrophy. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: There is ligamentum flavum thickening. No spinal canal or neural foraminal stenosis.L4-L5: There is mild disc bulging causing mild to moderate bilateral foraminal stenosis. There is ligamentum flavum hypertrophy. Moderate facet arthropathy is noted. No spinal canal stenosis.L5-S1: There is disc bulge with left more than right causing moderate left foraminal stenosis. There is bilateral facet hypertrophy. No spinal canal stenosis.Paraspinous soft tissues are within normal limits. Partly imaged rounded T2 bright lesion is seen in the upper medial cortex of the right kidney likely related to a cyst as seen on previous abdominal CT.

Output: 1. Mild to moderate multilevel degenerative disc disease predominantly affecting L5-S1 causing moderate left foraminal stenosis. Mild to moderate bilateral foraminal stenosis is seen at L4-L5 level.2. Prominent epidural lipomatosis without definite evidence of spinal canal stenosis.