Instruction: Generate impression based on findings.

Input: 71 year old female with left lower extremity pain. Evaluate for new blood.IMAGE ACQUISITIONS: Helical non-contrast enhanced CT of the legs with transverse, coronal, and sagittal reformatted images provided. No hematoma evident. Overall musculature of the left leg shows moderate fatty atrophy compared to right leg. Visualized femur, tibia, and fibula are more demineralized on the left compared to the right. These findings are presumably due to disuse. Although no large mass lesion is identified, multiple small masses of soft tissue density are seen in the lower leg and ankle as described on an accompanying MRI study. These are of uncertain etiology and could represent nerve sheath tumors if patient has a history of neurofibromatosis. Additionally, review of the patient's electronic medical history indicates that the patient has a history of resected glomus tumors and rarely multiple glomus tumors can occur in the leg. A 1 cm nodular soft tissue density posterior to the femur may represent a lymph node.

Output: 1.No evidence of hematoma.2.Diffuse muscular atrophy and bony demineralization on the left relative to the right as described above.3.Multiple nonspecific soft tissue masses as described above.


Instruction: Generate impression based on findings.

Input: Clinical question: GBM. Signs and symptoms: Injury. Pre and post enhanced brain MRI:Examination demonstrates a large focus of vasogenic edema in the right hemisphere with significant extension into the corpus callosum consistent with patient's known peritumoral edema. There are small foci of susceptibility changes in the corpus callosum consistent with hemorrhage with subtle interval increase since prior exam.Within the edema and there are multiple noncontiguous foci of necrotic rim-enhancing tumor within the right hemisphere and the corpus callosum. The largest focus of tumor enhancement is in the right frontal lobe measuring maximum of 51 x 38 mm in transaxial dimensions which is significantly larger than prior study.Multiple loculated necrotic enhancing tumor in the corpus callosum with mild extension into the left hemisphere demonstrate mild interval increased necrosis without significant change since prior study. Note should be made that very irregular shape of tumor makes precise assessment difficult.Constellation of findings results in mild deviation of midline to the left of approximately 8mm at the level of corpus callosum/foramen of Monro with interval progression. Minimal interval increased size of mildly dilated left lateral ventricle is also noted.There is no detectable new foci of parenchymal signal abnormality or parenchymal/meningeal enhancement.

Output: 1.Interval significant increased size of a right frontal lobe glioblastoma since prior exam.2.Multiple loculated enhancing foci of tumor in the corpus callosum and with extension into the left hemisphere demonstrate no significant change in their size.3.Constellation of findings results in 8 mm leftward of midline which is new since prior exam and there is minimal interval increased size of left lateral ventricle.


Instruction: Generate impression based on findings.

Input: History of right lumpectomy for breast cancer. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally. Postsurgical volume loss of the right breast is noted.No abnormal enhancement is seen in either breast. Postsurgical changes are again noted in the right outer breast, but no suspicious nodular enhancement is seen surrounding the surgical site. Normal intramammary lymph node again noted in the left outer breast posteriorly. No abnormal axillary lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: 20-year-old female with left shoulder injury presents with pain and decreased range of motion. ROTATOR CUFF: There is thickening and intermediate signal intensity within the supraspinatus tendon at the level of its insertion on the greater tuberosity indicating mild tendinosis. The supraspinatus muscle and tendon appear intact. Infraspinatus muscle and tendon appear intact. The subscapularis and teres minor muscles and tendons appear intact.SUPRASPINATUS OUTLET: No significant fluid is identified within the subacromial subdeltoid bursa. Mild osteoarthritis affects the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is anatomic. There is a small amount of fluid within the joint without evidence of a large effusion.BICEPS TENDON: The tendon of the long head of the biceps is normal in appearance. ADDITIONAL

Output: Mild rotator cuff tendinosis without evidence of a full-thickness rotator cuff tear. Mild osteoarthritis affects the acromioclavicular joint.


Instruction: Generate impression based on findings.

Input: Macroadenoma without history of surgery. There is redemonstration of T1 hypointense and T2 hyperintense tissue within the enlarged sella consistent with macroadenoma. This is located in the interim left lateral aspects of the sella, with relative hypoenhancement as compared to adjacent normal enhancing glandular tissue tissue. The lesion again invades the clivus along the inferior and posterior margins of the sella. The medial aspect of the left cavernous sinus is likely involved. The mass again measures 13 x 10 mm on 3/7, not significantly changed even dating back to 2003.The native pituitary gland is displaced to the right superior aspect of the sella where it enhances normally and appears stable compared to multiple prior exams. The pituitary stalk demonstrates normal enhancement and is very minimally deviated to the right. The optic chiasm and visualized portions of the optic nerves bilaterally are unremarkable. Flow-voids are visualized in the cavernous carotid arteries without significant narrowing.Incidental note is made of fluid within a degenerated right temporomandibular joint.

Output: Continued stable appearance of macroadenoma with invasion of the clivus and the left cavernous sinus.


Instruction: Generate impression based on findings.

Input: 40 years Female (DOB:1/24/1976)Reason: please evaluate for expansion of diffusion changes in the affected area History: epilepsia partialis continua manifesting as RLE twitching refractory to 6 AEDs, has diffusion restriction in the mesial part of the left precentral regionPROVIDER/ATTENDING NAME: JAMES A MASTRIANNI JAMES A MASTRIANNI There is a gyriform T2 and FLAIR hyperintense lesion involving the anterior aspect of the left paracentral lobule which was smaller on the 5/19/2016 exam when it measured 8 x 7 mm axial dimensions. It is hyperintense on diffusion-weighted imaging but does not display diffusion restriction.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: A left paracentral lobule lesion has enlarged relative to the prior exam from 5/19/16. It does not appear to be related to ischemia but rather may represent an inflammatory lesion and may represent encephalitis given the rapid enlargement. Although neoplasms may have similar appearance one would not expected a neoplasm to enlarge this rapidly. Therefore neoplasm is less likely.


Instruction: Generate impression based on findings.

Input: 30-year-old male with knee pain. Rule out ligamentous or meniscal injury. MENISCI: The medial and lateral meniscus appear intact.ARTICULAR CARTILAGE AND BONE: No full-thickness or near full-thickness articular cartilage defects are identified. There are tiny patellar osteophytes, but the articular cartilage is within normal limits. The bone marrow signal intensity is within normal limits. LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The patellar tendon appears slightly thickened with intermediate signal intensity within its proximal fibers compatible with tendinosis. There are small spurs projecting from the proximal tibial metaepiphysis that result in mild mass effect on the undersurface fibers of the patellar tendon just proximal to its insertion on the tibial tubercle. We see no fluid signal intensity within the tendon itself to confirm a tear. The quadriceps tendon appears intact.ADDITIONAL

Output: Patellar tendinosis of the left knee and other findings as described above.


Instruction: Generate impression based on findings.

Input: Headache and ataxia. Possible aneurysm on head CT. Brain MRI:There is no acute infarct or intracranial hemorrhage. Confluent periventricular and patchy deep and subcortical white-matter T2/FLAIR hyperintense lesions are most pronounced in the frontal and parietal lobes. Similar changes are present in the deep gray nuclei and the brainstem. There is no space-occupying or contrast-enhancing brain lesion. The ventricles and other CSF-containing spaces are moderately expanded, reflecting underlying global brain volume loss. There is no extra-axial fluid collection, otherwise. There is no midline shift or brain herniation. There is asymmetry at the level of the left anterior clinoid, most typical of osseous overgrowth or possibly an ossified meningioma.There is no destructive skull lesion and scalp soft tissues are unremarkable. The sella is partially empty, which is of doubtful significance at this age. There is mild mucosal thickening in the paranasal sinuses, also of doubtful significance. There are changes of bilateral eye lens replacement.Cranial MRA:There is mild attenuation of flow-related signal in the anterior genu of the right internal carotid artery. Otherwise, the intracranial internal carotid arteries as well as the paired anterior and paired middle cerebral arteries and their major branches show preserved flow-related signal without significant stenosis or aneurysm. The right A1 segment is congenitally hypoplastic, with a large anterior communicating artery artery and preserved downstream flow in both anterior cerebral arteries.The right V4 segment is diffusely, slightly smaller than the left which might be congenital. Otherwise, the vertebral basilar arteries show no significant stenosis.Neck MRA:The cervical arteries are tortuous but show no significant stenosis.

Output: 1.No acute infarct or intracranial hemorrhage. Moderate brain changes of chronic microvascular ischemia and volume loss. No abnormal contrast enhancement.2.The asymmetry in the region of the left anterior clinoid is most likely to represent an osseous overgrowth or perhaps an ossified meningioma. 3.Cervical and cranial MRA images show no significant stenosis or aneurysm.


Instruction: Generate impression based on findings.

Input: Evaluate for leptomeningeal carcinomatosis versus metastases: Weakness and prostate cancer. The lack of contrast limits the assessment for neoplasm. The vertebral bone marrow appears to be unremarkable. There is no evidence of gross intraspinal mass lesions, within the limits of the technique. There is no evidence of abnormal signal in the spinal cord. There is multilevel degenerative spondylosis in the cervical spine with moderate spinal canal stenosis. There is also lower lumbar spine degenerative spondylosis with moderate spinal canal stenosis at L4-5.

Output: 1. No evidence of metastases involving the imaged axial skeleton, although the assessment is limited by the lack of intravenous contrast. Likewise, assessment for leptomeningeal carcinomatosis is vastly limited without contrast.2. Multilevel degenerative spondylosis in the cervical spine with moderate spinal canal stenosis and lower lumbar spine degenerative spondylosis with moderate spinal canal stenosis at L4-5.


Instruction: Generate impression based on findings.

Input: 81-year-old female with left hand numbness and neck pain. Evaluate for cervical stenosis. There is slightly exaggerated cervical lordosis compared with the previous exam, but there is no spondylolisthesis. The vertebral body heights are maintained. There is disc height loss most prominently involving the C4-5, C5-6 and C6-7 levels. The bone marrow signal is within normal limits. The cervical spinal cord displays normal signal characteristics. The vertebral artery flow voids appear to be intact. At C2-3, there is a small central disc protrusion without spinal canal or neuroforaminal stenosis. At C3-4, there is a small disc osteophyte complex with facet hypertrophy, which contributes to mild spinal canal stenosis. There is also mild right neuroforaminal narrowing. At C4-5, there has been interval progression of the posterior disc osteophyte complex and superimposed central disc protrusion, which contributes to moderate spinal canal stenosis. There is right greater than left facet and uncovertebral hypertrophy at this level which contributes to moderate right and mild left neural foraminal stenosis. At the C5-6 level, there has been interval progression of the posterior disc osteophyte complex, as well as facet hypertrophy, which contributes to moderate spinal canal stenosis. There is facet and uncovertebral hypertrophy, which causes moderate bilateral neural foraminal narrowing at this level. At the C6-7 level is a small posterior disc osteophyte complex, uncovertebral joint hypertrophy, and facet hypertrophy with mild to moderate bilateral neural foraminal stenosis, as well as slight spinal canal narrowing. At the C7-T1 level, there is significant compromise to the spinal canal or neural foramina.The paraspinous soft tissue structures appear within normal limits.

Output: Multilevel degenerative spondylosis with some progression compared to previous exam, most notably involving the C4-5, C5-6, and C6-7 levels.


Instruction: Generate impression based on findings.

Input: 56-year-old female with pain in the right shoulder, evaluate for rotator cuff pathology. ROTATOR CUFF: There is increased signal intensity of the supraspinatus tendon indicating moderate tendinosis. There is also more focal high signal intensity within the distal supraspinatus tendon anteriorly at its insertion on the greater tuberosity that may represent a concealed tear, with cyst formation in the underlying humerus. The supraspinatus muscle appears normal. The tendinosis extends posteriorly to involve the infraspinatus tendon as well, but we see no frank infraspinatus tendon tear. The infraspinatus muscle appears normal. The teres minor and subscapularis tendons and muscles appear normal.SUPRASPINATUS OUTLET: Moderate osteoarthritis affects the acromioclavicular joint. There is a small amount of fluid within the subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral humeral joint alignment is within normal limits. There is trace fluid within the glenohumeral joint, but no large effusion. The glenoid labrum appears normal for age.BICEPS TENDON: The tendon of the long head of the biceps appears normal.

Output: 1. Rotator cuff tendinosis with focal insertional tearing of the anterior distal fibers of the supraspinatus that may represent a concealed tear.2. Acromioclavicular joint osteoarthritis and a small amount of fluid in the subdeltoid bursa could be associated with impingement.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate left-sided numbness/weakness. Signs and symptoms: Left-sided numbness and weakness. Nonenhanced head CT:There is no detectable intracranial hemorrhage, edema, mass effect, midline shift or hydrocephalus. The cortical sulci, ventricular system, CSF cisterns and gray -- white matter differentiation is within normal. CT is insensitive for detection of early ischemic stroke. If clinical concern persists recommend MRI examination.Calvarium, paranasal sinuses, mastoid air cells and limited views of the orbits are unremarkable

Output: Negative head CT.


Instruction: Generate impression based on findings.

Input: A nonspecific area T2 and FLAIR hyperintensity is again seen in the white matter of the inferior frontal lobe. There is no diffusion abnormality to suspect acute stroke. The ventricles and sulci are within normal limits. The basal cisterns remain patent. There is no midline shift or mass effect. There are no areas of abnormal signal or enhancement. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures on noncontrast images. The midline structures and craniocervical junction are within normal limits. Bone marrow signal is heterogenous and nonspecific; finding may be related to history of leukemia.

Output: No specific findings to explain patient's symptoms. No evidence of infarct, intracranial mass, or abnormal enhancement. No focal lesions in the cerebellum or disproportionate volume loss.


Instruction: Generate impression based on findings.

Input: Right vestibular schwannoma treated with SRS: surveillance. There is no significant change in size of the right vestibular schwannoma that extends from fundus of the internal auditory canal to the cerebellopontine angle cistern, now measuring up to 21 AP x 24 RL x 19 SI mm, previously 21 AP x 24 RL x 18 SI. There is associated mass effect upon the right middle cerebellar peduncle and right cerebellar hemisphere, where there appears to be mild edema. There is persistent slightly diminished fluid signal within the right labyrinthine structures. There are unchanged mild scattered foci of cerebral white matter T2 hyperintensity, which likely represent chronic microangiopathy. There is no evidence of acute infarction. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No significant interval change in size of the right vestibular schwannoma.


Instruction: Generate impression based on findings.

Input: 28 year-old female with pain and swelling, evaluate for meniscal tear Evaluation is markedly limited due to metallic artifact from hardware within the proximal tibia, despite changes in exam parameters.MENISCI: Evaluation of the medial meniscus is extremely limited with the anterior horn rendered essentially invisible due to metallic susceptibility artifact. The visualized portion of the posterior horn of the medial meniscus appears intact, although the posterior horn near its root is distorted, presumably due to metallic artifact. The visualized portion of the body appears intact given the aforementioned limitations.The lateral meniscus is slightly better visualized than the medial meniscus and appears intact.ARTICULAR CARTILAGE AND BONE: The articular cartilage of the patellofemoral joint appears grossly intact. No fluid filled cartilage defects are visualized, although evaluation of the tibiofemoral cartilage is markedly limited due to metallic artifact.LIGAMENTS: The cruciate ligaments are intact. The lateral collateral ligament is intact. The medial collateral ligament is not fully visualized, but the visualized portions appear intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: Limited exam as detailed above due to metallic artifact from hardware within the proximal tibia. Given these limitations, no specific findings are identified to account for the patient's pain.


Instruction: Generate impression based on findings.

Input: Ms. Ryan is a 58 year old female presenting for high risk MRI screening. Strong family history of breast cancer in 3 sisters and maternal grandmother. She is currently on tamoxifen therapy. There is heterogeneous amount of fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.There is a stable enhancing subcentimeter mass identified in the left superior breast with internal nonenhancing septation and high T2 signal intensity, likely representing a fibroadenoma. This is stable in size and appearance when compared to multiple prior MRIs dating back to 2013. There is no new abnormal enhancement seen in either breast.No abnormal axillary lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: 51 year old with biopsy proven right and left breast cancers There is heterogeneous amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.Strong motion artifacts are seen in the subtraction images, limiting the quality of the study.In the left breast, there are two irregularly shaped masses located back to back in the posterior upper outer quadrant, measuring 18 x 20 x 12 and 20 x 18 x 19 mm (all measurements: AP x LR x CC), consistent with biopsy proven cancer. Clip artifact is seen within both masses. In addition, there is a spiculated mass at left retroareolar region abutting the retracted nipple, measuring 18 x 13 x 21 mm, and there are multiple enhancing small masses and foci in the left upper outer quadrant. A segmental non-mass enhancement in the left upper outer quadrant is encompassing those masses and foci. Overall size of the lesions is 115 x 34 x 58 mm.In the right breast, a metallic artifact from a marker clip placed at the site of proven malignancy is identified at posterior 10 o'clock position. No abnormal enhancement is present around the clip or elsewhere in the right breast. No abnormal lymph nodes are identified in either axillary region.

Output: 1. Limited study due to strong motion artifacts.2. Extensive non-mass enhancement with multiple masses and foci, including biopsy proven malignancy, in the left upper outer breast.3. No abnormal enhancement at the site of proven malignancy in the right breast.4. No abnormal lymph nodes in either axillary region.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: 30-year-old female with pain status post motor vehicle collision to the left shoulder. ROTATOR CUFF: The rotator cuff appears intact. There is mild fraying of the undersurface of the distal supraspinatus/infraspinatus tendon complex.SUPRASPINATUS OUTLET: The supraspinatus outlet appears without significant abnormality.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is a complete SLAP tear of the labrum with distraction of the labrum from the underlying glenoid extending anteriorly. Further, the distracted labral fragment demonstrates internal tearing anteriorly.BICEPS TENDON: The biceps tendon appears intact. Small amount of contrast within the occipital groove is expected finding after arthrogram.ADDITIONAL

Output: SLAP tear with distraction of the labrum from the underlying glenoid. Intrinsic tearing is also visualized within the anterior distracted portion of the labrum. The rotator cuff appears intact.


Instruction: Generate impression based on findings.

Input: Reason: 7-year-old female with treatment related ALL, s/p bone marrow transplant. Having fevers as well as apneic/breath holding episodes. Please assess for fungal infection of brain. The ventricles and sulci are within normal limits. The basal cisterns remain patent. There is no midline shift or mass effect. There is diffusely increased T2 signal within the white matter, sparing the subcortical white matter, which is nonspecific but favored to reflect treatment effect. There is no associated diffusion abnormality. No pathological enhancement is identified. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. The partially developed frontal, ethmoid, sphenoid, and maxillary sinuses as well as the bilateral mastoid air cells remain partially opacified. There is also persistent partial opacification of the bilateral middle ears. An endotracheal tube is partially visualized.

Output: 1.Increased T2 signal within the periventricular white matter which is nonspecific but favored to reflect treatment effect.2.No evidence of acute ischemic infarction, hemorrhage, or abnormal meningeal enhancement.3.Persistent opacification of the paranasal sinuses, mastoid air cells, and middle ears.


Instruction: Generate impression based on findings.

Input: Reason: 22M with anterior dislocation x 2, eval ligaments, labrum ROTATOR CUFF: No significant abnormality noted.SUPRASPINATUS OUTLET: AC joint is normal. There is no fluid in the subdeltoid/subacromial bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: The labrum along the anteroinferior glenoid is attenuated with intermediate signal intensity along the anterior margin of the scapula (series 6 image 13), likely representing medially displaced scarred labral tissue. These findings are suggestive of an ALPSA-type lesion. There is also small amount of contrast between the superior labrum and adjacent articular cartilage (series 3 image 9), which may represent a small SLAP tear or conceivably a normal variant sublabral sulcus. We see no loose bodies in the joint. There is a Hill Sachs deformity of the humeral head posteriorly.BICEPS TENDON: The tendon of the long head of the biceps is normal.

Output: Findings indicating prior anterior shoulder dislocation with medialization of the anterior inferior labrum (ALPSA-type lesion) and Hill-Sachs deformity.


Instruction: Generate impression based on findings.

Input: 55 year old man on dialysis referred for assessment of LV size and function, given abnormal echo. Left VentricleThe left ventricle is severely dilated with moderately reduced systolic function. The overall LV ejection fraction is 35.3%, the LV end diastolic volume index is 135 ml/m2 (normal range: 74+/-15), the LVEDV is 203 ml (normal range 142+/-34), the LV end systolic volume index is 87 ml/m2 (normal range 25+/-9), the LVESV is 131 ml (normal range 47+/-19), the LV mass index is 120 g/m2 (normal range 85+/-15), and the LV mass is 178 g (normal range 164+/-36). There is thinning and hypokinesis of the basal to mid inferior and inferolateral wall, consider prior myocardial infarction. There is otherwise circumferential mild left ventricular hypertrophy (IVSd=11mm). Based on SSFP scout imaging (not T2-star), there is probably no myocardial iron overload.Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 56%, the RV end diastolic volume index is 83 ml/m2 (normal range 82+/-16), the RVEDV is 125 ml (normal range 142+/-31), the RV end systolic volume index is 37 ml/m2 (normal range 31+/-9), and the RVESV is 55 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThere is likely significant hepatic and splenic iron overload. Thyroid enlargement is noted. Esophageal dilation is noted. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Severe LV dilation, mild LVH, and moderately reduced systolic function (LVEF 35.2%). There is thinning and hypokinesis of the basal to mid inferior and inferolateral wall, consider prior myocardial infarction or hibernating myocardium. 2. Normal RV size and systolic function (RVEF 56%).3. Severe left atrial dilation.4. See extra-cardiac findings.


Instruction: Generate impression based on findings.

Input: Weakness [R53.1], Reason for Study: ^Reason: r/o compression History: weakness The vertebral bodies are appropriate in the overall alignment and height. The spinal cord has normal signal characteristics and overall morphology. There is no compromise of the spinal cord.

Output: 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. No cord compression is identified.Due to the screening nature of this protocol details are not as evident on imaging as dedicated protocols of the spine.


Instruction: Generate impression based on findings.

Input: Diagnosis: Localization-related (focal) (partial) epilepsy and epileptic syndromes with complex partial seizures, without mention of intractable epilepsy.Clinical question: Evaluate for cortical dysplasiaSigns and Symptoms: localization-related epilepsy; DiGeorge SyndromeComments: Please perform with Seizure II protocol. May try without sedation first. 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 at the left frontal lobe.The hippocampi are symmetric in size. The temporal horn of the right lateral ventricle is slightly larger than the left. There is no convincing evidence for mesial temporal sclerosis present.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 demonstrates mucosal thickening in the right sphenoid sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Some punctate subcortical lesions along the left frontal lobe are non-specific.2.There is no convincing evidence for mesial temporal sclerosis present.


Instruction: Generate impression based on findings.

Input: Reason: eval RCT History: pain Examination is severely limited due to patient motion artifact. ROTATOR CUFF: Minimally increased signal within the supraspinatus tendon may indicate mild tendinopathy, but there is no rotator cuff tear evident.There is no significant muscle atrophy. SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: Mild osteoarthritis affects the glenohumeral joint, with a few subchondral cysts of the humeral head. The labrum is grossly normal. BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: Osteoarthritis of the glenohumeral and acromioclavicular joints. No evidence of rotator cuff tear.


Instruction: Generate impression based on findings.

Input: The ventricles and sulci are within normal limits. The basal cisterns remain patent. There is no midline shift or mass effect. There are no areas of abnormal signal. There is no diffusion abnormality. The myelination pattern is appropriate for age. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. There are partially-imaged enlarged bilateral cervical lymph nodes. There is right-sided plagiocephaly. There are secretions in the right maxillary sinus and mild mucosal thickening within the left mastoid air cells.

Output: 1. No acute infarct, intracranial hemorrhage, intracranial mass, or hydrocephalus.2. Partially-imaged nonspecific bilateral cervical lymphadenopathy, which is likely reactive.3. Right-sided plagiocephaly.4. Secretions in the right maxillary sinus and mild mucosal thickening within the left mastoid air cells.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 5 year old female with subdural fluid collection. Postoperative exam. Right-sided shunt ventriculostomy catheter is unchanged in position. Right frontal catheter terminating in subdural collection unchanged. There is a new right parietal catheter terminating in subdural collection. The left frontal catheter terminating in subdural collection unchanged in position.There is new air in the right subdural collection. The right subdural collection is not significantly changed in size, measuring approximately 3.9 cm and greatest thickness, previously measured 4.1 cm (series 80498, image 43).The left subdural collection with internal air is not significantly changed, measuring 1.7 cm in greatest thickness, previously measured 1.8 cm (series 80498 on image 29). No evidence of acute hemorrhage.The common lateral ventricular chamber is unchanged in morphology or size, measuring approximately 8.0 cm in maximal transverse dimension, previously measured 8.2 cm (series 8 stroke 498, image 30).There is stable displacement of cerebellar tonsils below foramen magnum by 9 mm, previously this measured 9 mm.There is persistent abnormal morphology of the brain parenchyma and sulci, consistent with severe periventricular leukomalacia and areas of porencephaly in superior frontal and right occipital lobes, as described on recent MRI and unchanged. Abnormal morphology of calvarium, with bilateral burr holes unchanged.The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1.Stable ventricular size.2.Stable size of bilateral subdural collections, with new air and new catheter in right subdural collection.3.Abnormal brain parenchyma, calvarium, and ventricular configuration; findings are unchanged and most consistent with severe periventricular leukomalacia and porencephaly, as described on recent MRI. 4.Stable inferior displacement of cerebellar tonsils, consistent with Chiari I malformation.


Instruction: Generate impression based on findings.

Input: 67-year-old female with pelvic pain PELVIS:UTERUS, ADNEXA: Extremely large fibroid uterus is noted extending to the inferior edge of the liver. Numerous T2 hypointense fibroids are noted primarily in the lower uterine segment. The largest fibroids are noted in the uterine fundus both within the anterior and posterior walls. The largest fibroids demonstrate contrast enhancement. Many submucosal fibroids distort the endometrial canal.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: T2 isointense round focus in the spinal canal, likely intradural, extra medullary is seen at the T12 level.OTHER: Partially imaged T2 hyperintense minimally complex renal cysts are noted bilaterally.

Output: 1.Extremely large fibroid uterus as described above. 2.Probable intradural, extra medullary lesion is seen at the T12 level. A lumbar spine MRI with and without contrast is suggested for further evaluation. 3.Minimally complex renal cysts are noted bilaterally, incompletely imaged.Findings could not be text paged to the ordering physician GOODALL, PERPETUA, T. so an EPIC INBOX message was sent to GOODALL, PERPETUA T and VAUGHAN, ERIN F. at 1629 on 11/04/2016.


Instruction: Generate impression based on findings.

Input: Diffuse right upper extremity pain with history of multiple shoulder surgeries, evaluate for brachial plexopathy There are postsurgical changes of anterior cervical fusion at the C5-C6 level. Small disc osteophyte complexes are seen without significant spinal canal or neural foraminal stenosis.Postsurgical changes including scalenectomy and right first rib resection are noted. There is minimal asymmetric increased T2 signal without enhancement involving the proximal aspect of the right C8 nerve root beyond the neural foramen, which may be reactive to the surrounding postsurgical changes. Asymmetric increased enhancement is noted near the right lung apex surrounding the right T1 nerve root; no abnormal signal or enhancement within the nerve root however is appreciated; finding may represent postsurgical change. Otherwise no abnormal signal or enhancement is definitively seen within the right brachial plexus. No masses or extrinsic compression is appreciated.

Output: Postsurgical changes related to decompression for thoracic outlet syndrome are seen including resection of the right first rib. There is minimal asymmetric T2 hyperintensity involving the proximal aspect of the right C8 nerve root beyond the neural foramen which may be reactive to the surrounding postsurgical changes. No convincing signal abnormality is seen in the brachial plexus to suggest residual compression or plexitis.


Instruction: Generate impression based on findings.

Input: Worsening headaches with vision changes. Neck pain and weakness. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is a punctate focus of high T2 signal in the subcortical white matter of the right inferior frontal gyrus. The brain parenchyma otherwise 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 are grossly unremarkable. There is a low signal nodule in the right parietal scalp, which may represent an inclusion cyst. There is a small retention cyst in the right maxillary sinus. Cervical 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 a small posterior disc-osteophyte complex at C5-6, but no significant spinal canal or neural foraminal stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: 1. Nonspecific punctate focus of high T2 signal in the subcortical white matter of the right inferior frontal gyrus. Otherwise, no evidence of acute intracranial hemorrhage, mass, or acute infarct.2. No evidence of spinal cord lesions or significant spinal canal stenosis.


Instruction: Generate impression based on findings.

Input: The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. Minimal mucosal thickening is present within the right sphenoid sinus. The remaining paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain.

Output: Negative MRI of the brain including gadolinium enhancement. Specifically, there are no MRI findings of PRES clinically questioned.


Instruction: Generate impression based on findings.

Input: Reason: Eval for progression, cervical stenosis History: arm numbness and weakness Cervical spine:The cervical vertebral bodies are appropriate in overall height. The patient is status post laminectomies at C2, C3, C4, C5, C6 and C7. There is anterior fusion of C5, C6 and C7. There is reversal of the normal cervical curvature in the upper cervical spine especially at C3-4 and C4-5. There is mild anterior subluxation of C3 on C4 of approximately 4 mm with resultant spinal stenosis. There is myelomalacia present along the lower cervical spinal cord .At C2-3 there is no significant compromise to the spinal canal or neural foramina. There is bilateral facet hypertrophy present at this level.At C3-4 there is 4 mm subluxation of C3 on C4 associate bilateral facet hypertrophy and narrowing of the spinal canal with effacement of spinal fluid ventral posterior the spinal cord. There are uncovertebral osteophytes present at this level as well as disk bulge. There is bilateral neural foramen encroachment of the exiting nerve roots at this level.At C4-5 there is disk desiccation as well as uncovertebral osteophytes and a disk bulge associated with bilateral facet hypertrophy. There is encroachment of the exiting nerve roots within the neural foramina bilaterally at this level.At C5-6 there is no significant compromise to the spinal canal. There are uncovertebral osteophytes present at this level with some narrowing of the neural foramina bilaterally.At C6-7 there is no significant compromise to the spinal canal. There are uncovertebral osteophytes present at this level with some narrowing of the neural foramina bilaterally.At C7-T1 there is no significant compromise to the spinal canal. There are uncovertebral osteophytes present at this level with some narrowing of the neural foramina bilaterally.The vertebral artery flow voids appear to be intact.Lumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall height. The conus medullaris on sagittal imaging is grossly intact. There is a levocurvature to the lumbar spine.There is a heterogeneously hyperintense lesion present within the distal sacral spinal canal was also present on the prior exam as well as an exam from 2/8/13 that does not appear to have changed substantially. This is associate with some expansion of the sacral spinal canal. At L5-S1 there is a redemonstration of anterior subluxation of L5 on S1 associated with a diffuse disk bulge and bilateral facet hypertrophy. There is effacement of the fat at the lateral recesses bilaterally at this level and mild narrowing of the neural foramina bilaterally. The exiting nerve roots within the neural foramina are surrounded by fat. Overall there is moderate to severe spinal stenosis at this level.At L4-5 there is a redemonstration of anterior subluxation of L4 on L5 associated with a diffuse disk bulge and bilateral facet hypertrophy. There is effacement of the fat at the lateral recesses bilaterally at this level. There is obliteration of spinal fluid surrounding the nerve roots at this level. There is mild narrowing of the neural foramina bilaterally. The exiting nerve roots within the neural foramina are surrounded by fat. Overall there is severe spinal stenosis at this level.At L3-4 there is loss of disk space height, disk desiccation and diffuse disk bulge associated with a moderate degree of facet hypertrophy there is partially effacement of the fat at the lateral recesses at this level with triangulation of the thecal sac. The exiting nerve roots within the neural foramina are surrounded by fat. Overall there is a mild to moderate degree of spinal stenosis at this levelAt L2-3 there is no significant compromise to spinal canal or neural foramina. There is disk desiccation and a disk bulge at this level.At L1-2 there is no significant compromise to spinal canal or neural foramina. There is disk desiccation and a disk bulge at this level.There is mild retropulsion of T12 on L1. There is no significant compromise to the spinal cord at this level

Output: 1.The patient is status post multilevel laminectomies from C2 down to C7 and anterior fusion from C5 through C7.2.There is subluxation with spinal stenosis associated degenerative changes at C3-4 which appears stable when compared to the prior exam.3.There are multilevel degenerative changes present with neural foramen encroachment at multiple levels.4.There is reversal of the normal cervical curvature present. There is a mild levocurvature to the lower cervical spine .5.There is myelomalacia present in the lower cervical spinal cord.6.There are multilevel degenerative changes in the lumbar spine due to disk disease and facet disease resulting in severe spinal stenosis at L4-5 associated with mild subluxation and moderate to severe spinal stenosis at L5-S1 associated with mild subluxation. These findings are stable when compared to the previous exam.7.There is a lesion present in the distal sacral spinal canal centered at the S3 level which appears to be long-standing and associated with expansion of the spinal canal. It appears to be partly hemorrhagic in nature. It affects the nerve roots in the distal sacral spinal canal.


Instruction: Generate impression based on findings.

Input: 41 years Female (DOB: 3/3/1975)Reason: MS? History: legs weak R loss vibration in leg bladder incontinence Lhermitte's fatiguePROVIDER NAME: ANTHONY T. REDER ANTHONY T. REDER MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal lesions are identified in the cervical spine. There is multilevel disc desiccation present.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina. There is a disc bulge present at this level.At C6-7 there is no significant compromise to the spinal canal or neural foramina. There is a diffuse disc bulge present at this level.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.No abnormal lesions are identified within the brain parenchyma or the cervical spinal cord to suggest demyelination.2.There are mild degenerative changes present in the cervical spine


Instruction: Generate impression based on findings.

Input: 63 year old with history of diabetes, coronary disease s/p LAD PCI, and HTN presenting for evaluation of coronary artery diseaseMEDICATIONS: amlodipine, aspirin, atorvastatin, valsartan, HCTZ, metoprolol First Pass PerfusionDuring hyperemia, there are perfusion defects in the mid to basal infero-septal, inferior, inferolateral walls and a defect in the apical lateral wall. This corresponds to ischemia of approximately 44% of the myocardium. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 67%, the LV end diastolic volume index is 80 ml/m2 (normal range: 65+/-11), the LVEDV is 149 ml (normal range 109+/-23), the LV end systolic volume index is 26 ml/m2 (normal range 18+/-5), the LVESV is 49 ml (normal range 31+/-10), the LV mass index is 46 g/m2, and the LV mass is 85 g. There is mid to basal inferior and inferolateral hypokinesis. There is small area of late gadolinium enhancement noted in the proximal apical septum (non-transmural, less than 50%) in a pattern consistent with myocardial infarction. Additionally, there is an small area in the mid infererolateral wall with nontransmural (<50%) LGE which likely consistent with myocardial infarction and is intermediate probability of being viable. The remaining myocardium is viable. Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 64%, the RV end diastolic volume index is 80 ml/m2 (normal range 69+/-14), the RVEDV is 149 ml (normal range 110+/-24), the RV end systolic volume index is 29 ml/m2 (normal range 22+/-8), and the RVESV is 54 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. There are perfusion defects in the mid to basal infero-septal, inferior, inferolateral walls and a defect in the apical lateral wall. This corresponds to ischemia of approximately 44% of the myocardium. 2. The left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 67%.There is mid to basal inferior and inferolateral hypokinesis. There is small area of late gadolinium enhancement noted in the proximal apical septum (non-transmural, less than 50%) in a pattern consistent with myocardial infarction. Additionally, there is an small area in the mid infererolateral wall with nontransmural (<50%) LGE which likely consistent with myocardial infarction and is intermediate probability of being viable. The remaining myocardium is viable. 3. The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 64%.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Persistent headache, awaking the patient from sleep. Associated double vision, nausea and vomiting. The post contrast images are mildly limited by patient motion.BRAIN:There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Prominent lymph nodes in the included upper neck are nonspecific in this age group. There is trace mucosal thickening in the ethmoid sinuses, which is also nonspecific.BRAINSTEM/CRANIAL NERVES:There is no brainstem or root entry zone lesion. There is no abnormal contrast enhancement in the brainstem or along the cranial nerve roots. There is no skull base destructive lesion. The cavernous sinuses are symmetric. Carotid arterial flow voids are preserved.

Output: Normal examination. Specifically, there is no brainstem or cranial nerve abnormality.


Instruction: Generate impression based on findings.

Input: There is no evidence of acute infarction, intracranial hemorrhage, or mass, although the exam is degraded by patient motion. There are unchanged scattered T2 hyperintense foci in the cerebral white matter. There is a punctate focus of encephalomalacia in the inferior left cerebellar hemisphere. There is also unchanged high T2 signal in the left anterior temporal lobe with focal dilatation of the adjacent left anterior temporal horn and mild volume loss including the left hippocampus. There is otherwise mild diffuse cerebral volume loss. There is no midline shift. The major cerebral flow voids are preserved. There is a small retention cyst in the left maxillary sinus.

Output: 1. No evidence of acute infarction, intracranial hemorrhage, or mass, although the exam is degraded by patient motion.2. Mild probable chronic small vessel cerebral white matter ischemic disease and a punctate left cerebellar infarct, which appear to be unchanged.3. Unchanged encephalomalacia in the anterior and medial left temporal lobe.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Personal history of LCIS and ALH, family history of breast cancer. There is heterogeneous amount of fibroglandular tissue in both breasts.Minimal parenchymal enhancement is noted bilaterally.In the right central 3:00 position, there is a new 1.1 cm area of linear non-mass enhancement. This does not meet threshold for kinetic analysis, however based on the appearance and change compared to prior studies, further evaluation with MR guided biopsy is recommended. Second look/MRI directed ultrasound would be highly unlikely to find a correlate for this small subtle finding.No abnormal enhancement is seen in the left breast. No abnormal lymph nodes are identified in either axillary region.

Output: New linear non-mass enhancement in the right breast. Further evaluation with MR guided biopsy is recommended. If the patient is on blood thinning medications, these should be held prior to biopsy. The finding and need for biopsy were emailed to Dr. Romero.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration.


Instruction: Generate impression based on findings.

Input: 46 year old with family history of breast cancer, BRCA 2 mutation carrier. Prior benign MRI guided biopsy of the right breast. There is heterogeneous amount of fibroglandular tissue in both breasts.Minimal parenchymal enhancement is noted bilaterally.Susceptibility artifact from biopsy clip is present within the posterior central right breast. No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: 16 years Male (DOB:11/10/1999)Reason: chiari malformation, syrinx , follow up syrinx evaluate for changes History: syrinx , follow upPROVIDER/ATTENDING NAME: DAVID M. FRIM DAVID M. FRIM MRI thoracic spine:There is central cord T2 signal hyperintensity present identified on the scout views in the cervical spine extending from the C3-4 disc space level down to C6-7 level which has a diameter of approximately 6 mm in the AP dimension. Some the axial imaging extends bottom of the cervical cord or the width is approximately 9 mm.. It measures approximately 5.5 cm in length. It is not imaged adequately on this exam. Additionally there appears to be a Chiari I malformation with pointed cerebellar tonsils which extend approximately 5 mm below the level of foramen magnum but not adequately imaged on this examThe thoracic vertebral bodies are appropriate in the overall alignment and height. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots. At T5-6 there is a disc bulge present at. At T6-7 there is a right paramedian disc protrusion presentLumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is disc desiccation at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.There is central cord T2 hyperintensity in the cervical spinal cord. One possibility is that this represents a syrinx. It is only seen on the scout images. An MRI of the cervical spine help further evaluate this.2.Findings there is a question of a Chiari I malformation. If clinically appropriate MRI of the cervical spine may be of further benefit in evaluating this.3.There are mild disc degenerative changes present in the thoracic spine and lumbar spine.


Instruction: Generate impression based on findings.

Input: Occipital fibrous dysplasia with headaches. 13-year-old male. There is redemonstration of thickening of the left occipital bone with a ground glass appearance consistent with the patient's clinical history of fibrous dysplasia extending from the foramen magnum along its posterior and left lateral aspect and its left lateral aspect of a left occipital condyles and of the left clivus involving the left hypoglossal canal completely and the left the jugular foramen partially. The left condylar canal is also involved. The left hypoglossal canal is a little bit smaller than the right. The right hypoglossal canal measures 3.5 mm in diameter. The left and measures 2.9 mm in diameter. Along the midline the bidimensional measures of fibrous dysplasia of the occipital bone measures at 28 x 68 mm on sagittal imaging. There is an MRI from 9/4/09 which had sagittal imaging. It appears that dimensions at that time were 28 by 68 mm on sagittal imaging as well. It is not possible to make a fair comparison on the in between the prior CT and the current CT due to differences in slice thickness and angulation on imaging. Overall I get the impression that it is larger on the current versus the prior exam. On the scout image a lateral dimensions are 24 x 63 mm indicating interval growth.There is a 15 x 11 mm in sagittal dimension ground glass appearing lesion within the odontoid process. The rest of the cervical or vertebral bodies are probably normal alignment and height.

Output: 1.Large area of ground glass appearance of the occipital bone consistent with fibrous dysplasia as described above with diameters hypoglossal canals as described above. A fair comparison the prior CT scan cannot be made as indicated above I suspect it appears larger in the overall thickness. The left jugular foramen is only partially involved.2.Focus of ground glass appearance of bone at the odontoid process consistent with fibrous dysplasia.


Instruction: Generate impression based on findings.

Input: Metastatic lung cancer, brain metastases status post right cerebellar lesion resection and RT and AP26113 therapy. There are postoperative findings in the posterior fossa without evidence of right cerebellar tumor recurrence. There is an unchanged subcentimeter partially cystic and partially enhancing lesions with mild surrounding T2 hyperintensity in the right middle frontal gyrus. There is also an unchanged punctate intrinsically T1 hyperintense lesion in the left superior frontal gyrus. There is no evidence of new intracranial lesions. There is no evidence of intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are unchanged. There is moderate mucosal thickening in the bilateral maxillary sinuses and a retention cyst in the right sphenoid sinus.

Output: 1. Unchanged postoperative findings in the posterior fossa without evidence of right cerebellar tumor recurrence. 2. Unchanged small bilateral frontal lobe treated metastases.


Instruction: Generate impression based on findings.

Input: Neurofibromatosis type II variant. Severe low back pain radiating to the right foot. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is mild loss of lumbar lordosis. There is mild retrolisthesis of L2 on L3 and L3 on L4 as well as L5 on S1. There is severe loss of disc space at the L4-L5 level with fatty endplate marrow signal changes similar to prior study from 5/17/2008. Bone marrow signal is benign. The conus medullaris is normal in position.There are tiny nodular foci of enhancement along the surface of the visualized distal thoracic cord as well as a focus involving the cauda equina nerve roots at the right L4 level (sagittal series 13 image 9 and axial series 12, image 33). There is no clear evidence of enlargement compared to prior MRI from 10/6/2014 as well as 5/17/2008.Multilevel degenerative changes are seen in the lumbar spine which are not significantly changed. Individual levels as described below:L1-L2: Minimal disc bulge. No spinal canal or neural foraminal stenosis.L2-L3: Minimal disc bulge. No spinal canal or neural foraminal stenosis. Mild facet arthropathy with small joint effusions.L3-L4: Minimal disc bulge. No spinal canal or neural foraminal stenosis. There is moderate bilateral facet arthropathy.L4-L5: Mild disc bulge with small central protrusion. No significant spinal canal stenosis. Minimal neural foraminal narrowing without evidence of impingement. Mild bilateral facet arthropathy.L5-S1: Mild disc bulge with small protrusion. There is moderate left worse than right facet arthropathy. No significant spinal canal stenosis or neural foraminal narrowing.Paraspinous soft tissues are within normal limits.

Output: 1. Tiny enhancing nodules are suspected involving the surface of the lower thoracic cord as well as at the L4 level of the spinal canal slightly to the right of the midline. These may represent tiny schwannomas. No clear evidence of enlargement when compared to prior MRI from 2014 as well as 2008.2. Multilevel degenerative changes in the lumbar spine without significant spinal canal stenosis or nerve root impingement to explain provided history. There is multilevel facet arthropathy which may be contributing to patient's low back pain.


Instruction: Generate impression based on findings.

Input: Cerebral infarction due to unspecified occlusion or stenosis of right posterior cerebral artery [I63.531], Reason for Study: ^Reason: assess for stenosis History: right PCA ischemic infarct 54 years Female (DOB:7/9/1962)Reason: assess for stenosis History: right PCA ischemic infarctPROVIDER/ATTENDING NAME: THOMAS L. FISHER Brain MRIThere are diffusion restriction lesions involving the right posterior temporal and occipital lobes. On gradient echo images, there are susceptibility lesions within the right occipital lobe lesion indicating petechial hemorrhagic transformation.Subtle enhancement within the diffusion restricted lesions indicate luxury perfusion, again indicating acute to subacute ischemic infarction.Multiple scattered T2/FLAIR high signal intensity lesions on bilateral periventricular white matter and centrum semiovale indicate non specific small vessel ischemic disease.The ventricles, sulci and cisterns are unremarkable. The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Bilateral PCAs are fetal origin. Basilar artery is small and the left vertebral artery ends up with the left PICA. There is no evidence of intracranial arterial aneurysm. There is no evidence of significant (more than 50%) intracranial arterial luminal stenosis. Neck MRA4D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The vertebral artery origins are normal. There is normal flow enhancement through the bilateral common carotid, carotid bifurcations, internal/external carotid, and vertebral arteries.

Output: 1. Right posterior temporal and occipital lobe acute or subacute ischemic infarction, right PCA, with petechial hemorrhagic conversion.2. Bilateral fetal origin PCAs. Small basilar artery with the left vertebral artery ends up with PICA. No aneurysm. No significant (more than 50%) intracranial arterial stenosis.3. Normal Neck MRA.


Instruction: Generate impression based on findings.

Input: 55 year-old female with left-sided numbness. There is no evidence of intracranial hemorrhage, mass or edema. Multiple patchy areas of hypoattenuation consistent with small vessel disease, age indeterminate. If there is clinical concern for acute ischemia, an MRI may be considered. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

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


Instruction: Generate impression based on findings.

Input: A patient submitted outside study for review. Submitted for review are digital mammographic images (3/31/15, 4/6/15, 10/9/15, 11/2/15), ultrasound images of right breast (10/12/15), images from ultrasound guided biopsy and postprocedural right mammographic images (11/2/2015), breast MRI (11/10/2015), ultrasound images of right breast (11/12/2015), images from stereotactic needle biopsy of right breast and postprocedural right mammographic images (11/19/2015) performed at Presence St. Joseph Medical Center. For comparison, digital mammographic images (1/11/14) are available. DIGITAL MAMMOGRAPHIC IMAGES (3/31/15, 4/6/15, 10/9/15, 11/2/15): The breast parenchyma is composed of scattered fibroglandular elements (BiRADS Density Category B), unchanged in pattern and distribution.In the right breast at lateral aspect around 9:00 position, there are pleomorphic calcifications, including fine linear type with a developing focal asymmetry. The calcifications are extending segmentally in discontiguous fashion, measuring 60 x 40 mm (AP x LR). The focal asymmetry is present at posterior aspect of these calcifications, measuring 11 mm. There is another asymmetry seen best on CC view at medial anterior aspect of the right breast measuring 7 mm.A circumscribed oval mass with multiple coarse benign-appearing calcifications is present at 12:00 position in the right breast, likely a fibroadenoma.No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in left breast. ULTRASOUND IMAGES OF RIGHT BREAST (10/12/15):Ill-defined hypoechoic mass measuring 7 x 9 mm at 9:00 position with echogenic rim is detected, corresponding to the focal asymmetry seen on the mammogram at posterior aspect of the segmentally distributed calcifications.IMAGES FROM ULTRASOUND GUIDED BIOPSY AND POSTPROCEDURAL RIGHT MAMMOGRAPHIC IMAGES (11/2/2015):Ultrasound guided biopsy was performed for the mass at 9:00 position with an appropriate needle placement. Postprocedural mammograms demonstrate a marker clip (Hydromark) at the site of the focal asymmetry at 9:00 position in the right breast.Per outside radiology report, the result was malignant.BREAST MRI (11/10/2015):The study was performed with a protocol outlined in the outside report.There are 2 enhancing masses in the right breast, one at 9:00 position measuring 19 x 13 x 12 mm (AP x LR x CC), and the other at 3:00 position measuring 14 x 21 x 11 mm. The one at 9:00 position is proven carcinoma and the marker clip is present at the anterior aspect of this mass. Non-mass enhancement is present between the two masses, measuring 49 x 71 x 20 mm.No abnormal enhancement is seen in the left breast.No abnormal lymph nodes are present in either axilla.ULTRASOUND IMAGES OF RIGHT BREAST (11/12/2015):The study was performed as second look ultrasound to look for a correlate of MR detected mass at 3:00 position in the right breast. No sonographic correlate was detected in this study.IMAGES FROM STEREOTACTIC NEEDLE BIOPSY OF RIGHT BREAST AND POSTPROCEDURAL RIGHT MAMMOGRAPHIC IMAGES (11/19/2015):Stereotactic biopsy was performed for the asymmetry best seen on CC view at medial right breast, because the asymmetry is likely correlating to the MR detected mass at 3:00 position. Postprocedural mammograms demonstrate a marker clip at upper inner aspect of the right breast, near the site of the enhancing mass seen on the MRI. Distance between 2 clips is 135 mm on CC view.Per outside radiology report, the biopsy result was malignant; invasive ductal carcinoma.

Output: 1. Biopsy proven carcinoma in the right breast, 2 sites; one at 9:00 position and the other at 3:00 position. Mammograms demonstrate suspicious calcifications segmentally at lateral right breast and MRI demonstrates extensive non-mass enhancement between the two malignant masses in the right breast.2. No mammographic or MR evidence of malignancy in the left breast.3. No MR evidence of abnormal lymph nodes in either axilla.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Male, 44 years old. Left knee pain The left knee appears normal without findings to account for the patient's pain. Please refer to the MRI exam report from yesterday for further information.

Output: Normal-appearing left knee without findings to account for the patient's pain. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Brain lesion on PET; done w/o contrast 2/2 creatinine. There are mildly expansive confluent areas of subcortical high T2 signal in the right precentral gyrus and right superior frontal gyrus. The right postcentral gyrus lesion also contains a punctate focus of susceptibility effect. There are a few scattered foci of punctate high T2 signal deeper in the cerebral white matter, which are nonspecific. There is no evidence of an acute infarct. There is diffuse prominence of the right cerebellar hemisphere folia. There is no midline shift or herniation. There is mild maxillary sinus mucosal thickening. The skull, paranasal sinuses, and scalp soft tissues are unremarkable.

Output: 1.Mildly expansive confluent areas of subcortical high T2 signal in the right precentral gyrus and right superior frontal gyrus may be related to metastatic disease, although the lesions are incompletely characterized due to the lack of intravenous contrast. 2.Right cerebellar hemisphere volume loss may represent a developmental phenomenon, remote ischemic insult, a post-infectious state, or a neurodegenerative process, for example.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 17-year-old female with history of scoliosis, tethered cord with voiding dysfunction. Evaluate for hydronephrosis. BLADDER  Wall Thickness: Normal  Contents: Distended and normal. Distal Ureter -- SFU Grade**  Right: 0  Left: 0   Ureteral Jets Right: Not observed  Left: Not observedKIDNEYS  Cortical Echogenicity: Normal   Medullary Echogenicity: Normal   Pelvicaliceal System -- SFU Grade*  Right: 0 Left: 0  Length*** Right: 9.0 cm Left: 9.5 cm   Mean for age: 10.3 cm  Range for age: 9 - 11.5 cmADDITIONAL OBSERVATIONS: There is a bulge in the left renal midpole cortex which is similar in appearance to the MRI lumbar spine examination.

Output: Normal examination.*SFU grading system: Grade 0: No hydronephrosis. Grade 1: The renal pelvis is visualized. Grade 2: A few but not all of the calices are identified in addition to the renal pelvis. Grade 3: Virtually all the calices are seen. Grade 4: Grade 3 and parenchymal thinning. **SFU grading system retrovesical ureter: Grade 0: No ureteral dilatation. Grade 1: Ureter less than 7 mm. Grade 2: Ureter is 7-10 mm. Grade 3: Ureter is over 10 mm. Fernbach SK, Maizels M, Conway JJ. Ultrasound Grading of Hydronephrosis: Introduction to the System used by the Society for Fetal Urology. Pediatric Radiology (1993) 23: 478-480.***Rosenbaum DM, Korngold E, Teele RL. Sonographic Assessment of Renal Length in Normal Children. AJR Am J. Roentgenol (1984) 142:467-469


Instruction: Generate impression based on findings.

Input: 52 year old female with a personal history of biopsy-proven left breast intraductal papilloma with focal atypia. There is heterogeneous amount of fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally. Scattered bilateral enhancing foci are noted, none of which are uniquely enhancing.Within the medial aspect of the left breast, 2 cm from nipple, there is a 4 x 4 x 3 mm (AP x transverse X CC) enhancing focus adjacent to the medial aspect of the clip artifact corresponding to the patient's biopsy-proven papilloma. No significant ductal fluid or dilatation is noted. No additional masses or abnormal enhancement lesions is noted.No abnormal lymph nodes are identified in either axillary region.

Output: Left breast lesion corresponding to the patient's biopsy-proven papilloma without additional mass or suspicious enhancement identified.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Reason: Gastric cancer, OSH bony lesions on PET Scan and supposedly negative Bone scan. Needs MRI to further w/u bone lesions. History: weight loss. The imaged musculature of the pelvis is normal in appearance. There is a small right-sided fat-containing inguinal hernia. Although this examination was not protocoled for detailed evaluation of the pelvic viscera, no acute abnormality is identified. Note is made of multiple foci of decreased signal abnormality within the iliac bones bilaterally as well as within the right acetabulum and superior pubic ramus which are associated with cortical thickening corresponding to the findings of suspected Paget's disease seen on recent CT examination. Otherwise no bone marrow signal abnormality is identified. There are no enhancing lesions to suggest osseous metastatic disease. Severe degenerative disc disease affects the imaged lower lumbar spine.

Output: Findings indicating Paget's disease affecting the bones of the pelvis as described above. No convincing osseous metastases are identified.


Instruction: Generate impression based on findings.

Input: Female 54 years old with left shoulder pain. There are 2 osseous fragments superior to the greater tubercle, the largest measures 9 mm. There is no dislocation.

Output: Acute supraspinatus avulsion fracture.


Instruction: Generate impression based on findings.

Input: Brain MRI:There is a small focus of restricted diffusion with matching ADC hypointensity within the left centrum semiovale consistent with small vessel acute to subacute infarction. It demonstrates T2 hyperintensity, mild T1 hypointensity, and no susceptibility hypointensity.The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Scattered foci of mucosal thickening can be found within the paranasal sinuses without air-fluid levels. The mastoid air cells are clear. Brain MRA: Images are motion degraded. Given this caveat:There is a small 2-3 mm aneurysm at the junction of the left A1/A2 ACA segments with the anterior communicating artery. There is antegrade flow within the distal bilateral internal carotid arteries and carotid siphons and bilateral anterior, middle and posterior cerebral arteries without occlusion. The distal right vertebral artery appears to end in PICA and is diminutive (please see MRA neck discussion below). Artifact is noted through the mid basilar artery which is otherwise intact with antegrade flow. Intact antegrade flow is also noted within bilateral PCA vessels.Neck MRA:There is conventional takeoff of the great vessels from the aortic arch without evidence for stenosis of the origin of the great vessels. There are no significant stenoses of the bilateral common, internal or external carotid arteries or of the bilateral carotid bifurcations. The right vertebral artery is diminutive in its entirety and appears to end in PICA. However, significant stenosis appears to involve the left vertebral artery origin, and there is irregularity of the lumen at several locations throughout its length, suggesting there may have been previous dissection. Mild stenosis is noted at the origin of the left vertebral artery which is otherwise unremarkable.

Output: 1.There is a small focus of restricted diffusion with matching ADC hypointensity within the left centrum semiovale consistent with small vessel acute to subacute infarction.2.There is a small 2-3 mm aneurysm at the junction of the left A1/A2 ACA segments with the anterior communicating artery. 3.The right vertebral artery is diminutive in its entirety and appears to end in PICA. However, significant stenosis appears to involve the left vertebral artery origin, and there is irregularity of the lumen at several locations throughout its length, suggesting there may have been previous dissection. 4.Mild stenosis is noted at the origin of the left vertebral artery which is otherwise unremarkable.


Instruction: Generate impression based on findings.

Input: 89-year-old man with history of pressure ulcer, evaluate for osteomyelitis of the coccyx. SOFT TISSUES: There is a soft tissue ulcer just superficial to the right lateral margin of the coccyx. Additionally, there is enhancement of the surrounding subcutaneous tissues, however there is no fluid collection suggestive of abscess.BONE MARROW: There is increased STIR signal intensity along with loss of normal T1 signal and enhancement of the coccyx and S5 vertebrae indicating osteomyelitis. There is a small bone island in the left femoral head. The remainder of the bone marrow signal appears normal.JOINTS: The hip joints are unremarkable.ADDITIONAL

Output: Findings of osteomyelitis involving the inferior sacrum and coccyx.


Instruction: Generate impression based on findings.

Input: There is a stable 16x10mm parenchymal hemorrhage within the left midbrain/thalamus with mild extension into the third ventricle. The hemorrhage involves the medial aspect of the left thalamus, the left quadrigeminal plate and the left periaqueductal gray. There is associated compression of the aqueduct of Sylvius. Biventricular diameter is identified on coronal imaging at the level of foramen of Monro is 50 mm on the current exam and unchanged since the 7/9/2015 exam. The third ventricle measures 12 mm in width and is unchanged. The temporal horns of the lateral ventricles appear similar to the prior exam.There are multiple hypodense foci present in the basal ganglia and centrum semiovale bilaterally right more than left. There is associated ex vacuo effect upon the right lateral ventricle. There are periventricular white matter hypodensities of a moderate to marked degree.Atherosclerotic calcifications are present along the distal internal carotid arteries. Atherosclerotic calcifications are present along the distal vertebral arteries.There is opacification of the left maxillary sinus with air-fluid level. There is partial opacification of the left ethmoid sinus. The left mastoid air cell is partially opacified.

Output: 1.Stable CT of the head with no change in the focal hemorrhagic lesion centered in the left thalamus and quadrigeminal plate. There is mass effect associated with this. Underlying cause is not established on this exam2.Periventricular and subcortical white matter changes of a moderate to marked degree are nonspecific. At this age they are most likely vascular related. 3.There is redemonstration and no change in multiple old lacunar infarcts in the basal ganglia and centrum semiovale bilaterally.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 66-year-old female with CT finding of pancreatic ductal dilatation concerning for ampullary lesion. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in size and morphology. There is no suspicious hepatic lesion. The hepatic vasculature is patent.Common duct measures 7 mm in diameter. There is no intrahepatic biliary ductal dilatation. The gallbladder is normally distended without cholelithiasis.SPLEEN: No significant abnormality noted.PANCREAS: As on the prior CT the pancreatic duct is diffusely dilated to the level of the ampulla measuring up to 7 mm in diameter. At the level of the ampulla there is a 10 x 7 mm T2 hypointense soft tissue focus (series 5, image 11) that may represent normal ampulla although a small mass is not excluded. There is mild diffuse pancreatic atrophy. No suspicious pancreatic parenchymal lesion.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: The smoothly marginated right renal pelvis lesion is T1 isointense, T2 hypointense and demonstrates mild enhancement and washout. It is unchanged in size compared to the prior day's CT.Multiple nonenhancing subcentimeter T2 hyperintense lesions within the left kidney are too small to accurately characterize but are favored to represent cysts given the degree of T2 hyperintensity.RETROPERITONEUM, LYMPH NODES: No retroperitoneal lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.The pancreatic duct duct is dilated to the level of the ampulla, a soft tissue focus at this level may represent a prominent ampulla however a small mass is not excluded. Further evaluation with EUS is recommended.2.Mildly enhancing, slowly growing right upper renal pelvis lesion is unchanged from the prior day's CT and is suspicious for a small papillary neoplasm.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for MS progression. Signs and symptoms: Multiple sclerosis. Pre and post enhanced brain MRI:Negative diffusion weighted images.Examination demonstrates interval increase in number of demyelinating plaques in bilateral cerebral hemispheres and without significant change of the finding in the posterior fossa. Few of the new lesions are best appreciated on axial FLAIR series 901 on images 21 and 22 on the left, images 17 and 18 on the right and image 15 on the left.Few of the new lesions demonstrate enhancement. There is also interval minimal decrease size of few of previously noted demyelinating plaques.The cortical sulci and ventricular systems remain within normal size and without deviation of midline. The signal voids of major intracranial arterial branches are identified. Signal intensity of intracranial venous sinuses are within normal and the normal pattern of enhancement.Unremarkable images through the orbits demonstrate enhancement along the dorsal aspect of the left optic nerve (axial fat sat post enhanced series 1101 image 10).

Output: 1.Interval progression of demyelinating disease in the supratentorial brain parenchyma and with enhancement of few of the new demyelinating lesions.2.Few of the previously seen demyelinating lesions demonstrate interval decreased size.


Instruction: Generate impression based on findings.

Input: 65-year-old female patient with spinal stenosis status post anterior cervical discectomy at C5-6 and C6-7. Assess hardware. There is an anterior plate with screws entering the C5, C6, and C7 vertebral bodies. The tips of the C7 screw overly the inferior endplate of the vertebral body without specific features of hardware complication. There are intervertebral spacer devices at C5-C6 and C6-C7. There is straightening of the cervical spine. There are calcifications in the soft tissues lateral to the cervical spine, likely within the carotid vasculature. Note is made of poor dentition.

Output: Orthopedic fixation of the lower cervical spine.


Instruction: Generate impression based on findings.

Input: Clinical question: Small cell lung cancer status post WBRT and 2 cycles of SC 16 D6.5. IRB 13-0726. Signs and symptoms: Small cell lung cancer. Pre and post enhanced brain MRI:Examination demonstrate a small focus of enhancement along the medial aspect of right anterior temporal lobe measuring approximately at 4.5 x 3.5 mm in transaxial dimensions. There is subtle FLAIR and T2 hyperintensity at the site as well and finding is highly suspected of a small metastatic lesion. This finding is best appreciated on axial post enhanced, axial flair and T2 series on image 11.Additionally there is a punctate focus of enhancement in the right subcortical white matter of the occipital lobe (coronal reformatted post enhanced series 1202, axial post enhanced series 1201 image 79) which could represent a vessel or a tiny metastatic lesion.None of above lesions were identified with certainty on prior exam.A focus of chronic hemorrhage and encephalomalacia in the right parietal lobe without detectable abnormal enhancement is again noted. The findings remain stable and demonstrate no abnormal enhancement. There is an overlapping craniotomy and this finding could represent post surgical change.Patchy cortical and subcortical/periventricular FLAIR hyperintensity without enhancement demonstrate interval progression since prior study and could represent posttreatment change. One of the foci of FLAIR hyperintensity in the left frontal lobe without demonstrated internal punctate focus of chronic hemorrhage however without enhancement which measured approximately 7.5 x 5.5 mm in size on prior exam has a slightly increased and measures at 7.5 x 11.5 mm. Finding is believed to represent post treatment change.

Output: 1.New 4.5 x 3.5 mm focus of enhancement in the medial aspect of the right anterior temporal lobe with subtle associated FLAIR/T2 hyperintensity is suspicious for a new metastatic lesion however less likely possibility of posttreatment change cannot be excluded. Punctate focus of enhancement in the right occipital lobe could represent a vascular structure or a punctate metastatic lesion. Please see above comments.2.Stable focus of hemorrhagic encephalomalacia in the right parietal lobe without interval change since prior exam.3.Focus of T2 hyperintensity and internal focus of minimal chronic hemorrhage without enhancement in the left frontal lobe as detailed. 4.Interval increased patchy foci of FLAIR and T2 hyperintensity in the periventricular and subcortical white matter since prior study likely representing posttreatment change. Please see above comments.


Instruction: Generate impression based on findings.

Input: BRAIN: There are minimal punctate foci of T2 hyperintensity in the cerebral white matter, as in the posterior right putamen. There are also punctate foci of susceptibility effect in the right cerebellar hemisphere and right thalamus. There are no abnormal enhancing lesions. 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.CERVICAL SPINE: The vertebral body heights and intervertebral disc spaces are well-maintained. There is straightening of the cervical spine. There is disc desiccation at C2-3, C3-4, and C5-6. There is mild disc osteophyte complex formation at C3-4 and C5-6, eccentric to the left, with mild left neuroforaminal stenosis at C3-4. There is also a minimal disc osteophyte complex is at C4-5, but no significant neuroforaminal or spinal canal stenosis. There is no spinal cord signal abnormality or enhancing lesions. There is no abnormal marrow signal. The paravertebral soft tissues are unremarkable.

Output: 1. Nonspecific minimal punctate foci of T2 hyperintensity in the cerebral white matter, as in the posterior right putamen. 2. Punctate foci of susceptibility effect in the right cerebellar hemisphere and right thalamus are also nonspecific and may represent chronic microhemorrhages or mineralization.3. Mild spondylotic changes affect cervical spine without significant neuroforaminal or spinal canal stenosis.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Headache [R51], Reason for Study: ^Reason: evaluate for ischemic etiology of intractable headache in patient with HgbSS History: persistent headache No evidence of acute ischemic or hemorrhagic lesion. No evidence of abnormal enhancement.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, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: No evidence of acute ischemic or hemorrhagic lesion. No abnormal enhancement.


Instruction: Generate impression based on findings.

Input: 53-year-old male with positive Thompsons test There is a complete rupture of the distal Achilles tendon at its insertion with proximal retraction of the tendon by approximately 1.8 cm.. There is extensive edema within the calf musculature, and susceptibility artifact consistent with blood product proximally within the gastrocnemius. The underlying osseous structures appear unremarkable.

Output: Achilles tendon rupture and high grade muscle strain with hematoma as described above.


Instruction: Generate impression based on findings.

Input: Male 68 years old with renal cell carcinoma and liver lesions seen on CT. ABDOMEN:LIVER, BILIARY TRACT: There is a T2 hyperintense focus with wall enhancement within the left liver dome that has decreased in size when compared to the prior CT. The previous described lesion in the right liver dome seen on the prior MRI was not visible on the prior CT and is not clearly defined on today's MRI. An additional T2 hyperintense lesion in the left lobe of liver (series 8, image 33) demonstrates no enhancement but was not seen on the previous exam.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Right adrenal gland nodule measures 14 x 13 mm (series 12, image 63), previously 13 x 13 mm. The left adrenal nodule is unchanged in size. Both nodules are bright on T1-weighted images and have signal loss centrally on out of phase imaging suggesting adenoma.KIDNEYS, URETERS: Status post right nephrectomy. T2 hyperintense cysts in the left kidney are unchanged from the prior exams.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Colonic diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.A T2 hyperintense focus within segment 2 of the liver is stable in size with nonspecific imaging features however it is suspicious for an atypical cystic metastasis.2.Stable bilateral adrenal nodules with features suggestive of adenomas.


Instruction: Generate impression based on findings.

Input: Diagnosis: Aphasia following cerebral infarctionClinical question: cause for confusion and aphasiaSigns and Symptoms: aphasia, poor memory The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Incidental note is made of partial empty sella.There is signal change involving the left middle temporal gyrus with high signal on T2 and FLAIR in the area measuring 10 x 25 mm axial dimensions and involving both gray and white matter. There is some associated volume loss. This suggests this represents encephalomalaciaAnother similar focus is present in the right precentral gyrus and is associated with punctate foci of susceptibility effect.There are punctate foci of signal hypointensity in the subcortical white matter bilaterally of a mild to moderate degree on SWI.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 near complete opacification of the right maxillary sinus and mucous retention cysts in the left maxillary sinus.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Small focus of encephalomalacia is present in the left temporal lobe centered in the left middle temporal and inferior temporal gyri.2.Another small focus of encephalomalacia is present in the right precentral gyrus3.Subcortical microhemorrhages are suspicious for amyloid angiopathy.4.Periventricular and subcortical white matter changes of a moderate degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: Avascular necrosis of the humerus, evaluate rotator cuff prior to shoulder arthroplasty ROTATOR CUFF: There is mild increased signal intensity along the articular surface of the supraspinatus tendon suggesting tendinosis and fraying although we see no discrete tear. There is minimal fatty atrophy along the myotendinous junction but otherwise the supraspinatus muscle is normal. The infraspinatus, teres minor, and subscapularis tendons and muscles are intact.SUPRASPINATUS OUTLET: The acromioclavicular joint is unremarkable. There is a trace amount of fluid in the subacromial subdeltoid bursa which is of questionable clinical significance.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is flattening and fragmentation of the superomedial aspect of the humeral head with underlying signal abnormality indicating advanced avascular necrosis. Severe osteoarthritis affects the glenohumeral joint with full-thickness cartilage loss and degenerative edema type signal within the glenoid. There is deformity of the posterior labrum likely the result of tearing. There is a joint effusion with intermediate signal intensity present in the axillary and subscapular recesses which likely represents a combination of synovitis and debris.BICEPS TENDON: There is fluid and tenosynovitis within the biceps tendon sheath likely the result of extension from the glenohumeral joint however the biceps tendon itself appears intact.

Output: 1. Advanced avascular necrosis of the humeral head and secondary osteoarthritis of the glenohumeral joint.2. Mild supraspinatus tendinosis and undersurface fraying but no discrete fluid-filled rotator cuff tear is seen.3. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Sensorineural hearing loss. Internal Auditory Canals: The bilateral cochlear nerves are not well-defined on the DRIVE sequence, which appears blurry due to a low matrix size selection by the technologist. However, the cochlear nerves appear to present on sequences with higher slice thickness. The vestibular and facial nerves otherwise appear to be intact. There is no evidence of mass lesions. The inner ear structures, including the cochlea, vestibule, endolymphatic duct, and semicircular canals, appear unremarkable. The bilateral mastoid air cells and middle ears also appear unremarkable.Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. The bilateral cochlear nerves do not appear well-defined on the DRIVE sequence and may be mildly deficient. However, technical factors may limit the visibility of the structures, since there is suggestion that they are present on sequences with higher slice thicknesses, which are otherwise not optimized for delineation of the cranial nerves. Follow up MRI using a DRIVE sequence with higher matrix size for the internal auditory canals may be useful and this can be performed at no additional charge.2. The brain and brainstem appear unremarkable.


Instruction: Generate impression based on findings.

Input: 49-year-old woman with history of left arm numbness and weakness. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. There is grade 1 retrolisthesis of C5 on C6 and C6 on C7, otherwise alignment is normal. Bone marrow signal is within normal limits. The cervical spinal cord has normal signal characteristics and overall morphology.Degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: No significant compromise the spinal canal or neural foramina.C4-5: There is a disc osteophyte complex with effacement of the anterior thecal sac but no significant spinal canal or neural foraminal stenosis.C5-6: There is a disc osteophyte complex and uncinate hypertrophy, left greater than right. This results in moderate to severe left neural foraminal stenosis and mild to moderate right neural foraminal stenosis. There is minimal spinal canal stenosis.C6-7: There is a disc osteophyte complex and uncinate hypertrophy, left greater than right. This results in severe left neural foraminal stenosis and moderate right neural foraminal stenosis. There is mild central canal stenosis.C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: Degenerative disc disease and retrolisthesis, worst from C5 to C7 with significant neural foraminal narrowing, left greater than right. No severe spinal canal stenosis.