Instruction: Generate impression based on findings.

Input: Metastatic prostate cancer, increased uptake at T12. Back pain. There is evidence of osseous metastatic disease with multiple lesions noted including the posterior aspect of the T8, T10, T11, and T12 vertebral bodies in the thoracic spine as well as L1, L2, and L3 in the lumbar spine. There is associated abnormal enhancement in most of these lesions. There is mild involvement of the posterior elements at T10 to L1. Vertebral body heights in the thoracic and lumbar spine are normal. Alignment is normal. No evidence of pathologic compression fractures. There is minimal enhancement dorsal to the T11 and T12 vertebral bodies which is favored to be reactive vascular enhancement rather than epidural tumor. No convincing evidence of epidural or leptomeningeal tumor. Postgadolinium images are slightly motion degraded.There is diffuse congenital narrowing of the thoracic and lumbar spine. There is prominence of the epidural fat which contributes to the stenosis. There are is moderate spinal canal stenosis at L3-L4 and L4-L5 related to disk bulge, facet arthropathy, and ligamentum flavum thickening. There is also moderate left and mild right L3-4 neural foramina stenosis. There is moderate left and mild right L4-L5 neural foramina stenosis. There is mild right L5-S1 neural foramina stenosis. There is facet arthropathy throughout the lumbar spine. Sclerotic lesion involving the left iliac wing is noted and was present on prior CT.

Output: 1. Osseous metastatic disease involving multiple levels in the thoracic and lumbar spine, as described above, with relative greatest involvement of the T11, T12, L1, and L3 vertebral bodies. No prior MRI is available for comparison, however, there is sclerosis at these levels dating back to at least CT from 6/6/2014.2. No pathologic compression fracture. There is minimal enhancement dorsal to the T11 and T12 vertebral bodies which is favored to be reactive vascular enhancement rather than epidural tumor. No convincing evidence of epidural or leptomeningeal tumor. 3. Congenital narrowing of the thoracic and lumbar spinal canal with superimposed degenerative changes. There is resulting moderate L3-4 and L4-5 spinal canal stenosis as well as neural foraminal narrowing as detailed above.


Instruction: Generate impression based on findings.

Input: Anesthesia of skin [R20.0] / Radiculopathy, cervical region [M54.12], Reason for Study: ^Reason: eval c-spine due to cervical radiculopathy on EMG History: numbness R RF AND SF, sudden in onset Examination is limited by motion artifact. There is straightening of the cervical spine with mild reversal of the cervical lordosis centered at C4-C5, but no spondylolisthesis. The vertebral body heights are grossly maintained, aside from mild multilevel degenerative endplate irregularities. There is significant developmental narrowing of the cervical spinal canal. The bone marrow signal is unremarkable. There is focal high T2 signal and atrophy of the spinal cord at C3-C4 level.C2-C3: No significant disc herniation or neural foraminal stenosis is noted at this level.C3-C4: There is a diffuse disc bulge and posterior disc osteophyte complex formation resulting in moderate bilateral neural foraminal stenosis and severe spinal stenosis.C4-C5: There is a minimal posterior disc osteophyte without significant neural foraminal stenosis at this level.C5-C6: There are small bilateral paracentral disc protrusions resulting in moderate left and mild right neural foraminal stenosis.C6-C7: There is a diffuse disc bulge/disc osteophyte complex resulting in moderate bilateral neural foraminal stenosis.C7-T1: There is a right paracentral disc protrusion resulting in moderate to severe right lateral recess and bilateral neural foraminal stenosis.

Output: Diffuse developmental narrowing of the cervical spinal canal with superimposed disc degenerative spondylosis, resulting in myelomalacia of the spinal cord at C3-C4 and variable degrees of neural foraminal stenosis, particularly at C5 through C7 levels.


Instruction: Generate impression based on findings.

Input: Metastatic head and neck cancer. Neck CT:The visualized brain demonstrates an enhancing nodule in the right occipital lobe. Post-surgical changes in the right frontal lobe and additional metastatic lesions in the brain are better seen on prior MRI brain dated 7/19/2011.Postsurgical changes of previous laryngectomy is again noted. There is soft tissue thickening at the oropharynx and hypopharynx which is unchanged and presumably represents post treatment granulation.Degenerative changes of the cervical spine is again noted

Output: 1. Postsurgical changes of previous laryngectomy. No evidence of interval change.2. Metastatic brain lesions. Please refer to MRI brain for further details.


Instruction: Generate impression based on findings.

Input: History of hepatocellular carcinoma status post TACE RFA. ABDOMEN:LIVER, BILIARY TRACT: Interval decrease in perihepatic fluid. Cirrhotic liver morphology. The vessels are patent. Esophageal varices.The segment 6 ablation cavity measures approximately 4.5 x 4.4 cm with internal debris/hemorrhage. No abnormal enhancement to suggest residual or recurrent tumor.No new suspicious arterial enhancing focus. Several peripheral wedge shaped areas of arterial enhancement without washout or other signal abnormality are compatible with transient hepatic intensity differences.The vessels are patent.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts are not significantly changed. Mildly T2 hypointense, 1.3 cm minimally enhancing right interpolar region lesion is not significantly changed dating back to 2014.RETROPERITONEUM, LYMPH NODES: Mild atherosclerotic plaque. BOWEL, MESENTERY: Esophageal varices.BONES, SOFT TISSUES: Fat-containing ventral hernia. L1 and L2 vertebral body hemangiomas.OTHER: No significant abnormality noted.

Output: 1.Stable post-ablation changes without evidence of residual or recurrent disease.2.Cirrhotic liver with periesophageal varices.3.Stable minimally enhancing right renal interpolar region 1.3 cm lesion is not significantly changed dating back to 2014 and indeterminate but a papillary sub-type renal cell carcinoma cannot be entirely excluded.


Instruction: Generate impression based on findings.

Input: Ms. Bianchi is a 37 year old female with a family history of breast cancer in her mother (diagnosed at the age of 51) and maternal great aunt. Personal history of bilateral silicone implants and BRCA2 mutation carrier. There is extreme amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.Bilateral retropectoral silicone implants are intact. Focal oval to round area with slight high signal on T2-weighted sequence, minimal fat suppression, nonenhancing on postcontrast sequence measuring up to 11 mm identified in the right breast 11:00 position most likely representing area of fat necrosis.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: 2 - Benign finding.RECOMMENDATION: NS - Routine Screening Mammogram.


Instruction: Generate impression based on findings.

Input: Headache. Acute onset. Hypertensive. Rule out subarachnoid hemorrhage. There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration. The lateral sinuses have higher than normal density which raises the question of sinus thrombosis. MRI/MRV is recommended for further evaluation.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.These findings were discussed with Dr. Adrianne Haggins at the time of interpretation.

Output: 1. No evidence of subarachnoid hemorrhage or edema.2. Increased density in the lateral sinuses raises question of sinus thrombosis. MRI/MRV is recommended for further evaluation


Instruction: Generate impression based on findings.

Input: Male, 32 years old, right-handed, English Spanish bilingual patient who acquired both languages simultaneously as a child, presenting with intractable seizures. Functional MRI requested for surgical planning purposes. Sensorimotor cortical activation of the hand, foot and face maps as expected along the pre- and post-central gyri. Passive visual stimulation elicits robust cortical activation centered on the calcarine sulci bilaterally. Foci of vision related activation are also noted in the posterolateral thalami likely correlating to the lateral geniculate nuclei.Of the tested language paradigms, the most reliable language related cortical activation is seen with the English and Spanish word generation exercises, the Spanish verb generation exercise, and the English sentence completion exercise. Language is consistently left dominant when tested in both English in Spanish. Putative Broca's area activity is seen in its expected location of the left inferior frontal gyri, primarily pars articularis and pars triangularis, on all paradigms. Putative Wernicke's area activity is seen in its expected location along the posterior aspect of the left superior temporal sulcus on the English sentence completion and Spanish verb generation paradigms. Putative Wernicke's area activity is also seen somewhat more posteriorly and inferiorly, within the posterior aspect of the left middle temporal gyrus, on the Spanish and English word generation paradigms.

Output: 1. Adequate functional mapping of the sensorimotor cortex.2. Adequate visual cortical functional mapping with visualization of the lateral geniculate nuclei.3. Language is consistently left dominant when tested in both English and Spanish. Broca's area is identified in its typical location on all tested paradigms. Putative Wernicke's area activity is seen in its typical location on two of the language exercises, but it is also seen in a somewhat more posterior and inferior location on the remaining two language exercises.


Instruction: Generate impression based on findings.

Input: Reason: 61M with NHL with CNS involvement on C5 DA-EPOCH-R. restaging scan History: restaging for CNS involvement. The CSF spaces are appropriate for the patient's stated age with no midline shift. Since the prior exam the patient has developed T2 and flair signal hyperintense lesion centered along the right half of the genu the corpus callosum which measures 27 x 14 mm in axial dimensions and 27 x 10 mm coronal dimensions. This crosses the midline and insinuates itself to the adjacent right frontal lobe somewhat like satellite foci. Contrast enhancement appears to involve perivascular space .There are associated with punctate foci of enhancement along the right orbital gyri.Punctate foci of enhancement associated with T2 and flair signal hyperintensity are identified in the globus pallidus bilaterally, left centrum semiovale and the left internal capsule.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mucosal thickening along the sphenoid sinus and scattered opacities in and the other paranasal sinuses. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The left eyeball lens is thin.

Output: 1.Since the previous examination the patient has developed a lesion centered in the corpus callosum anteriorly as well as several smaller lesions in globus pallidi and a right orbital gyri . Given the patient's clinical history of lymphoma this is suspicious for a recurrence of lymphoma. The possibility that this represents an infectious process cannot be excluded.2.?????3.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: Reason: pain History: pain ACETABULAR LABRUM: There is heterogeneity and increased signal abnormality within the anterior superior acetabular labrum which likely represent combination of postsurgical change, degeneration, and prior tearing. No fluid-filled tear is identified to suggest a re-tear within the limitations of this non arthrogram study.ARTICULAR CARTILAGE AND BONE: No bone marrow signal abnormality is identified. There is a small amount of fluid within the hip joints bilaterally which is not necessarily of any clinical significance. Mild osteoarthritis affects the right hip. Mild osteoarthrosis affects the left hip.SOFT TISSUES: The imaged musculature of the right hip is unremarkable. Note is made of multiple subcentimeter cysts within the left and right adnexa, likely physiologic in a patient of this age.ADDITIONAL

Output: Heterogeneity of the anterior superior acetabular labrum likely representing a combination of postsurgical change, degeneration, and prior tearing. No fluid filled tear is identified within the limitations of this non arthrogram study. Mild osteoarthritis affects the right hip, appearing similar to the prior studies.


Instruction: Generate impression based on findings.

Input: 73-year-old male with elevated PSA. PELVIS:PROSTATE:Prostate Size: 3.2 cm in AP, 5.5 cm in transverse, and 6.3 cm in craniocaudal diameter.Peripheral Zone: Similar appearing ill-defined area of T2 and ADC hypointense signal in the peripheral zone of the right base (axial series 501 image 17, axial series 604 image 304), which could represent the central zone. No dominant lesion is identified.Central Gland: Heterogeneous in appearance.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: No significant abnormality noted.BLADDER: Stable 2 small diverticula of the right posterior bladder wall.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No dominant lesion identified to target for Uronav software.2.Stable T2 and ADC hypointense region of the right base, which may represent the central zone.3.Stable diverticula of the right posterior bladder wall.


Instruction: Generate impression based on findings.

Input: Multiple sclerosis: ataxia, weakness. Brain: There appears to be postoperative findings related to left transfrontal biopsy. There are extensive supratentorial and infratentorial T2 hyperintense lesions, many of which are T1 hypointense as well. There also appear to be T2 hyperintense lesions involving the bilateral optic nerves. There is a small area of encephalomalacia in the right external capsule. There is no evidence of intracranial mass. There is no midline shift or herniation. The major cerebral flow voids are intact. Cervical Spine: There are multiple T2 hyperintense lesions in the imaged portions of the spinal cord. There is reversal of the usual cervical lordosis, but no spondylolisthesis. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The paravertebral soft tissues are unremarkable.

Output: 1. Extensive intracranial and spinal demyelinating lesions related to multiple sclerosis, as well as possible optic nerve lesions.2. Apparent right external capsule chronic lacunar infarct.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for etiology of seizure. Signs and symptoms: Suspected seizures, as is right temporal and parietal hypodensities on CT. Pre-and post-enhanced brain MRI:Negative diffusion weighted images.Examination demonstrates a chronic healed depressed right parietal calvarial fracture as was noted on prior head CT. There is a small focus of underlying cortical and subcortical hemorrhagic encephalomalacia of the right parietal lobe. This finding measures approximately at 19 times 15-mm in largest transaxial dimensions.Additionally there is a larger focus of encephalomalacia in the inferior aspect of right anterior/mid temporal lobe confined primarily to the periventricular white matter of right temporal and extending inferiorly to the cortex. There is no evidence of hemorrhagic changes with this finding. It measures at least at 27 x 19 x 19-mm in size. There is mild ex vacuo dilatation of right temporal horn. This findings are best appreciated on coronal T2 and flair series 901 and 1001. The anatomical morphology of the brain is otherwise within normal and with normal signal intensity on all MRI sequences. The ventricular system and disuse of the spaces remain within normal and with maintained midline. The signal void of major intracranial arterial branches are identified and unremarkable.Post enhanced images demonstrate no detectable abnormal enhancement the brain parenchyma, leptomeninges or the calvarium.Unremarkable images through the orbits and including axial fat sat post enhanced series.Paranasal sinuses demonstrate a single retention cyst in the dependent portion of the left maxillary sinus and unremarkable otherwise.

Output: 1.No acute intracranial process.2.Small focus of right parietal superficial hemorrhagic encephalomalacia under a chronic healed depressed skull fracture as detailed.3.Larger focus of nonhemorrhagic encephalomalacia along the inferior surface of right anterior/mid temporal lobe involving the white matter and the cortex. Finding results in mild expansion of right temporal horn. 4.Unremarkable pre-and post enhanced brain MRI otherwise.


Instruction: Generate impression based on findings.

Input: The spinal cord is of normal caliber and signal. There is mild levocurvature of the mid thoracic spine and dextrocurvature of the lower thoracic spine. Alignment is otherwise maintained. Vertebral body heights are normal. Bone marrow signal is benign. There are mild multilevel degenerative changes with disc desiccation. There are mild disc bulges such as at the T10-T11 and T11-T12 levels without significant spinal canal stenosis. There is moderate facet arthropathy in the lower thoracic spine, relatively worse at the bilateral T10-T11 level and left T11-T12 level. There is no significant spinal canal stenosis at any level. There is mild to moderate right T10-T11 and to a lesser degree right T9-T10 neural foraminal stenosis. There is also moderate left T11-T12 neural foraminal stenosis. Right C7-T1 facet arthropathy is noted, with degenerative changes in the cervical spine better assessed on recent MRI from 11/13/2015.

Output: 1. No evidence of thoracic cord signal abnormality or spinal canal stenosis. 2. Multilevel degenerative changes including facet arthropathy in the lower thoracic spine and up to moderate left T11-T12 and right T10-T11 neural foraminal stenosis.


Instruction: Generate impression based on findings.

Input: Evaluate progression of multiple sclerosis, optic neuritis. Brain:There are innumerable T2 hyperintense lesions throughout the supratentorial and infratentorial white matter compatible with the patient's history of multiple sclerosis. There are several new T2 hyperintense lesions. For example, one is located within the subcortical white matter adjacent to the right central sulcus (series 501, image 50) and another within the left caudothalamic groove (series 501, image 43). Most of the lesions demonstrate low T1 signal, unchanged. A previously seen ring-enhancing lesion in the right superior frontal gyrus has resolved with residual T1 low signal (series 1701, image 65). Nonspecific enhancing foci in the the left caudate head (series 1701, image 41) and subcortical white matter of the left temporal lobe (series 1701, image 35) are nonspecific and may even be potentially artifactual. There is no restricted diffusion to suggest acute ischemia. The ventricles and sulci are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unremarkable.Orbits:The optic nerves and chiasm are normal in caliber and signal without abnormal enhancement. The globes are intact. The extraocular muscles are within normal limits. There is no periorbital soft tissue abnormality.

Output: 1.Innumerable supratentorial and infratentorial white matter lesions compatible patient's history of multiple sclerosis with several new lesions as described above.2.Interval resolution of ring enhancing lesion in the right superior frontal gyrus.3.No imaging evidence of optic neuritis.4.No evidence for an acute intracranial abnormality.


Instruction: Generate impression based on findings.

Input: Injured arm lifting battery ROTATOR CUFF: No significant abnormality noted.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: In the superior labrum there is a SLAP (superior labral anterior posterior) lesion best seen on the axial views. ADDITIONAL

Output: SLAP lesion. Otherwise negative


Instruction: Generate impression based on findings.

Input: There is 3 mm grade 1 anterolisthesis of C7 on T1, T1 on T2, and to a lesser degree at T2 on T3. The remainder of the cervical spine is in normal alignment, with exaggeration of the normal cervical lordosis. There is mild disc narrowing at C3-C4, C5-C6, and C7-T1, as well as moderate disc narrowing at C6-C7. The vertebral body and disk heights are otherwise well-maintained. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal.At C2-C3, there is a shallow central disc protrusion without stenosis.At C3-C4, there is a mild posterior osteophyte disk complex with mild left facet arthropathy as well as uncovertebral hypertrophy. There is mild to moderate left foraminal narrowing.At C4-C5, there is a trace disc bulge diffusely with mild central spinal canal stenosis. There is mild-moderate left and moderate-severe right foraminal narrowing as well.At C5-C6, there is a mild diffuse posterior osteophyte disk complex with right foraminal prominence. There is mild central spinal canal stenosis as well as moderate right and mild-moderate left foraminal narrowing.At C6-C7, there is uncovering of the disc with a diffuse posterior osteophyte disk complex which demonstrates right paracentral/foraminal prominence. There is minimal central spinal canal stenosis. Bilateral ligamentum flavum thickening and right side uncovertebral hypertrophy is noted. There is mild left foraminal narrowing.At C7-T1 and T1-T2, there is uncovering the disc without stenosis.At T2-T3, there is uncovering of the disc with a superimposed shallow central disc protrusion without stenosis.There is moderate right and minimal left mastoid air cell fluid opacification. Extensive postoperative changes are partially visualized along the right neck, with multiple foci of susceptibility which may relate to subcutaneous emphysema, blood products, or metallic clips. A drain is identified along the operative site extending posteriorly.Images are significantly limited by patient motion. In addition, there are areas of prominent susceptibility relating to postoperative change. The cervical plexus and brachial plexus are visualized. There are no masses, focal fluid collections, or significant lymphadenopathy identified. A discrete right level 2A lymph node measures 8 mm in length. There are no compressive masses demonstrated. There is no axillary lymphadenopathy. While the left brachial plexus is unremarkable, there is abnormal STIR hyperintensity and subtle enhancement along the slightly thickened right C5 nerve root, as seen on 4/18 and 17/17-21. The nerve is difficult to follow more distally once in the vicinity of the postoperative change.

Output: 1.Moderate scattered cervical spondylotic changes with up to moderate-severe right foraminal narrowing at C4-C5.2.No focal fluid collection or mass along the brachial plexus bilaterally, although evaluation is limited due to surrounding postoperative changes. Apparent subtle STIR hyperintensity and enhancement along the slightly thickened right C5 nerve root suggesting mild inflammatory changes perhaps in part relating to the distal postoperative change as well as possibly from the foraminal narrowing.


Instruction: Generate impression based on findings.

Input: Neoplasm of unspecified behavior of brain [D49.6], Reason for Study: ^Reason: brain lesion. Preop planning for biopsy History: headaches Extra-axial mass likely represent meningioma on the anterior aspect of falx do not show any significant interval change in terms of MR characteristics as well its size (T:24.4 mm x CC:27.2 mm x AP:30.7 mm).Dural sinuses specialist superior sagittal sinus appears to be intact.Subtle high signal intensity on the left frontal lobe on T2 and FLAIR imaging, does not show any significant interval change since prior scan.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: No change of anterior falx meningioma in terms of size and MR characteristics as well as left inferior frontal lobe white matter lesion since prior scan.


Instruction: Generate impression based on findings.

Input: 52 years, Male, history of renal cell carcinoma and brain metastasis, status post craniotomy for resection. Planning for stereotactic radiosurgery. Examination is obtained for stereotactic radiosurgical planning and limited to SWI and post gadolinium 3-D T1 sequences.Again seen are postoperative findings related to recent right frontotemporal craniotomy for resection of 2 metastatic right frontal lesions. There is interval evolution of postsurgical changes including decreasing blood products in the resection cavity. Again seen is surrounding vasogenic edema with associated mass effect including lateral ventricular effacement and leftward midline shift of 7 mm, which is slightly improved in the interval. The basal cisterns are preserved. There is mildly increased enhancement along the resection cavity margin without discrete mass appreciated. This finding is suboptimally evaluated due to the absence of precontrast T1-weighted images.There is focus of susceptibility effect in the right cerebellar hemisphere (image 50 or series 3) with minimal enhancement, with enhancement better appreciated on prior study from 9/14/2015. There is also a punctate, less than 2 mm enhancing focus in the left inferior cerebellar hemisphere, axial image 21 of series 4. No new lesions.

Output: 1. Interval evolution of postsurgical changes of right frontotemporal craniotomy for resection of two right frontal lesions. No residual tumor in the right frontal lobe is appreciated.2. Unchanged two punctate foci of abnormal enhancement in the bilateral cerebellar hemispheres, with associated susceptibility effect in the right-sided lesion, which may represent additional metastases.


Instruction: Generate impression based on findings.

Input: Reason: Assess status of aneurysms History: h/o migraine, CVA, has eplipesy-takes dilantin MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. A punctate focus of susceptibility effect is present in the left centrum semiovale. In isolation this is of unknown clinical significance.There is redemonstration of a T2 and flair hyperintense lesion in right paraventricular white matter known to represent a prior lacunar infarct currently measuring 18 x 13 mm axial dimensions.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:There is redemonstration of a 1.5 mm aneurysm at the origin of the right A2 segment which is also stable compared to the prior exam.There is redemonstration of a 3 mm right communicating segment internal carotid artery aneurysm directed laterally. This is unchanged compared to the prior exam.Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.The anterior communicating artery and the posterior communicating arteries are identified and are intact. The right posterior communicating artery is small. The left posterior communicating artery is tiny. The anterior communicating artery is small.

Output: 1.Stable right ICA communicating segment laterally directed aneurysm.2.stable right A2 segment aneurysm.3.no new aneurysm is appreciated.4.No evidence for cerebral vascular occlusive disease5.old right centrum semiovale lacunar infarct.6.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: Diabetes insipidus with right ptosis. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is scattered cerebral white matter T2 hyperintensity ,predominantly in a periventricular distribution. There is a punctate focus of susceptibility effect in the left posterior temporal lobe, which may represent chronic microhemorrhage. There is no abnormal intracranial enhancement. There is septum cavum pellucidum and vergae. There is diffuse cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. No evidence of intracranial hemorrhage, mass, or acute infarct. 2. Scattered cerebral white matter T2 hyperintensity ,predominantly in a periventricular distribution is nonspecific, but may represent chronic small vessel disease. 3. Diffuse cerebral volume loss.


Instruction: Generate impression based on findings.

Input: Parkinsonian gait with bradykinesia but no rigidity. Evaluate for structural abnormality. The ventricles and sulci are prominent, consistent with global parenchymal volume loss. The basal cisterns remain patent. There is no midline shift or mass effect. There are scattered punctate foci and confluent areas of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, consistent with chronic small vessel ischemic changes. There is no diffusion abnormality. No extra-axial fluid collection is identified. There is a partially empty sella. There is a small mucous retention cyst in the right maxillary sinus.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits.

Output: 1. Global parenchymal volume loss and chronic small vessel ischemic changes. 2. No evidence of intracranial hemorrhage, mass effect, or acute infarct.


Instruction: Generate impression based on findings.

Input: Pain after fall Note that the examination is limited by the patient's body habitus preventing the use of routine knee coil.MENISCI: The lateral meniscus is intact. There is abnormal morphology and signal intensity of the posterior horn of the medial meniscus reflecting horizontally oriented tearing.ARTICULAR CARTILAGE AND BONE: There is severe, essentially full-thickness loss of the articular cartilage of the medial compartment both along the femoral condyle and tibial plateau. There is moderate diffuse thinning of the articular cartilage of the lateral compartment with areas of full-thickness loss anteriorly. There is severe articular cartilage loss of the patellofemoral compartment as well with full-thickness loss along the lateral patellar facet. Large tricompartmental osteophytes are noted.LIGAMENTS: There is increased intrasubstance signal of the ACL although the ACL itself appears intact. The posterior cruciate ligament and collateral ligaments are intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Tear of the posterior horn of the medial meniscus.2. Severe tricompartmental articular cartilage loss/osteoarthritis most notably within the medial compartment.3. Myxomatous degeneration of the ACL which is otherwise intact.4. Moderate joint effusion with probable mild synovitis.


Instruction: Generate impression based on findings.

Input: Reason: C4-5 disc herniation s/p MVA History: Neck pain The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. Incidental note is made of partial empty sella.At C2-3 there is no significant compromise to the spinal canal or neural foramina. There is a very small central disk protrusion at this level.At C3-4 there is no significant compromise to the spinal canal or neural foramina. There is a small central disk protrusion at this level.At C4-5 there is redemonstration of a central disk extrusion with extrusion of disk material behind of the C3 vertebral body. There is associated effacement of spinal fluid ventral and posterior the spinal cord and compression of the spinal cord. Relative to the prior exam there is no significant change.At C5-6 there is no significant compromise to the spinal canal or neural foramina. There is a minor disk protrusion at this level.At C6-7 there is no significant compromise to the spinal canal or neural foramina.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.There is redemonstration of a large central disk extrusion at C4-5 which compresses the spinal cord and creates spinal stenosis. This has not changed substantially compared to the previous exam.2.There is degenerative disk disease also present at other levels.


Instruction: Generate impression based on findings.

Input: Ms. Smith- Gavin is a 46 year-old woman with a history of diabetes, hypertension, sinus tachycardia, goiter, post-surgical hypothyroidism, asthma, obesity, breast cancer s/p lumpectomy chemotherapy with Taxol (last 10/2015) and radiation (completed 1/2016) presenting for evaluation of left ventricular dysfunction. Left VentricleThe left ventricle is normal in size with mildly-moderately reduced systolic function. The overall LV ejection fraction is 44%, the LV end diastolic volume index is 85 ml/m2 (normal range: 65+/-11), the LVEDV is 165 ml (normal range 109+/-23), the LV end systolic volume index is 48 ml/m2 (normal range 18+/-5), the LVESV is 94 ml (normal range 31+/-10), the LV mass index is 54 g/m2 (normal range 67+/-11), and the LV mass is 106 g (normal range 114+/-24). The LV dysfunction is global. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 60%, the RV end diastolic volume index is 74 ml/m2 (normal range 69+/-14), the RVEDV is 144 ml (normal range 110+/-24), the RV end systolic volume index is 30 ml/m2 (normal range 22+/-8), and the RVESV is 58 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 mild 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 FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with mildly-moderately reduced systolic function. The overall LV ejection fraction is 44%. The LV dysfunction is global. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.2. The right ventricle is normal in size and systolic function. The overall RV ejection fraction is 60%


Instruction: Generate impression based on findings.

Input: Multiple sclerosis and bladder urgency. There is interval increase in the extent of T2 hyperintense lesions in the cervical spine, including at the C3 and C4-5 levels. There is no associated abnormal enhancement, however. The thoracic spinal cord displays normal signal and morphology. However, there appear to be subcentimeter foci of T2 hyperintensity within the brainstem and right middle cerebellar peduncle. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. There is unchanged mild degenerative spondylosis at multiple levels of the cervical spine without significant spinal canal stenosis. There is a Schmorl node in the superior endplate of T11 and a subcentimeter of focal fat versus a hemangioma in the T12 vertebral body. The vertebral bone marrow signal is otherwise unremarkable. The paravertebral soft tissues are unremarkable.

Output: Apparent interval progression of demyelinating disease in the cervical spine without evidence of associated active inflammation. The thoracic spinal cord appears unremarkable. However, there may be new infratentorial demyelinating lesions, which are otherwise incompletely characterized.


Instruction: Generate impression based on findings.

Input: Male 54 years old Reason: elevated psa History: elevated psa PELVIS:PROSTATE:Prostate Size: 5.3 x 3.2 x 4.6 cmPeripheral Zone: The peripheral zone is mildly heterogeneous throughout suggestive of background prostatitis. There is a small focus of T2 hypointense signal with corresponding early enhancement and restricted diffusion. The lesion is in the left peripheral apex and measures 0.9 x 0.4 cm (series 604, image 144). Prostate cancer cannot be excluded for this focus. Central Gland: Heterogeneous due to benign prostatic hyperplasia. A small linear focus measures 0.7 x 0.6 cm (series 604, image 184) in the left transition zone, anteriorly near the apex. Although this focus can represent a BPH nodule, transition zone cancer can not be excluded. Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Two small foci in the left apex transition and peripheral zone which may represent prostate cancer. 2.Imaging features suggestive of background prostatitis.


Instruction: Generate impression based on findings.

Input: Male, 70 years old, with left arm numbness. Assess for stroke. A linear focus of restricted diffusion is seen within the left thalamus. No other restricted diffusion is demonstrated.The above-mentioned thalamic lesion shows corresponding T2 hyperintensity. Within the limitations of a motion degraded examination, no other significant parenchymal signal change is seen.No evidence of mass effect or significant edema is detected. No intracranial hemorrhage or abnormal extra-axial collections are seen. The ventricular system is normal in size and morphology.

Output: 1.Small acute left thalamic stroke.2.No other significant intracranial findings.


Instruction: Generate impression based on findings.

Input: Sciatica, evaluate for disc disease and nerve impingement. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position at the upper L2 level.Multilevel degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: Disk desiccation and minimal bulge. Minimal left neural foraminal narrowing. Otherwise no spinal canal or neural foramina stenosis. L4-L5: Disk desiccation and minimal bulge. No spinal canal or neural foraminal stenosis.L5-S1: Disk desiccation and minimal bulge. No spinal canal or neural foraminal stenosis.Incidentally seen are conjoined left L5 and S1 nerve roots. Mild facet arthropathy is seen at L3-L4, L4-L5, and L5-S1. There is edema and joint distention associated with the right L3-L4 and L4-L5 facet joints. Mild degenerative changes at the sacroiliac joints also noted.

Output: 1. Mild degenerative changes in the lumbar spine including disc bulges as detailed above. Minimal left L3-L4 neural foramina narrowing. Otherwise, no significant spinal canal or neural foramina stenosis is seen at any level in the lumbar spine.2. Facet arthropathy in the lumbar spine. There is edema and joint distention associated with the right L3-L4 and right L4-L5 facet joints, which is favored to be on a degenerative basis.  3. Conjoined left L5 and S1 nerve roots incidentally noted.


Instruction: Generate impression based on findings.

Input: 74-year-old male with severe dizziness with fall from standing. Evaluate for bleed. There is no evidence of intracranial hemorrhage, mass or edema. Recommend correlation with MRI if there is clinical concern for acute stroke.The ventricles and basal cisterns are normal in size and configuration.Multiple diffuse hypo-attenuating lesions in the deep white matter and basal ganglia, likely representing chronic lacunar infarcts. The calvaria and skull base are radiographically normal. Opacification of the right sphenoid sinus is noted. Otherwise, the visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Chronic lacunar infarcts without evidence of acute intracranial abnormality. Recommend correlation with MRI if clinical concern for acute stroke persists.


Instruction: Generate impression based on findings.

Input: Encephalopathy and aphasia. Autoimmune thyroiditis. Assess evolution of brain lesion from prior MRI dated May 8, 2016. The non-territorial swelling and T2 hyperintense signal involving the posterior left cerebral hemisphere including parts of the parietal, occipital and temporal lobes has not changed in overall distribution. The predominantly cortical diffusion restriction is less remarkable than on the prior exam. The smaller superficial inferior right cerebellar lesion shows a similar pattern of evolution. The T2-hyperintense lesion in the posteromedial left thalamus is also unchanged. Mildly increased T2 FLAIR signal centrally within the pons remains unchanged. Single voxel MR spectroscopy with an echo time of 35 ms over the abnormal left parietal lobe shows a prominent lactate doublet peak. The other major metabolite peaks (NAA, Cr, and Cho) are reduced, particularly NAA. Single voxel spectra obtained ovr normal appearing parenchyma, including the basal ganglia, demonstrate normal metabolite peaks with no detectable lactate.

Output: 1.The left posterior hemispheric and the smaller right cerebellar and left thalamic abnormalities show interval evolution with slightly decreased diffusion restriction since May 8, 2016. There is no new lesion.2.MR spectroscopy of the left parietal lesion demonstrates findings compatible with failure of energy metabolism and parenchymal injury. Normal appearing regions of the brain show normal MR spectra, which argues against but does not exclude a global metabolic derangement or inborn error of metabolism. 3.Given that the involved parenchyma spans multiple vascular territories, a conventional vascular etiology is felt to be less likely. However, a regional vasculitis could produce lesions with this distribution. Alternatively, direct parenchymal inflammation, such as might be seen with Hashimoto encephalitis, or some other autoimmune process, can also appear similarly.


Instruction: Generate impression based on findings.

Input: Female, 51 years old, history of breast cancer with metastases to the brain status post SRS. Several (up to four) subcentimeter enhancing lesions are evident within the right cerebellar hemisphere. These were all present on the prior examination and show interval decrease in size. For example, the paramedian lesion now measures 8 x 4 mm, previously 9 x 5 mm. A small enhancing lesion within the anterior left frontal lobe has also decreased in size by a similar degree.None of these lesions is associated with any significant parenchymal edema. No new pathologic intracranial enhancement or signal abnormality is seen. No intracranial hemorrhage or abnormal extra-axial fluid is seen. The ventricles are normal in size and morphology.

Output: 1.Interval decrease in size of several subcentimeter enhancing intracranial lesions.2.No new or progressing lesions are seen.


Instruction: Generate impression based on findings.

Input: Recurrent large conjunctival cysts, proptosis. There is a non-enhancing T2 hyperintense, well-defined lesion associated with the inferior right eyelid, which measures approximately 10 mm in the anteroposterior dimension, 25 mm in the transverse dimension, and 10 mm in the craniocaudal dimension. There are also two additional non-enhancing T2 hyperintense, well-defined lesions associated with the superonasal right eyelid, which each measure up to 5 mm. There is no evidence of retrobulbar lesions in the right orbit and the left orbital contents are unremarkable. There is a small retention cyst in the left maxillary sinus. There is a right maxillary mesiodens. The imaged intracranial structures are unremarkable.

Output: A cystic lesion associated with the inferior right eyelid, which measures up to approximately 25 mm, is compatible with a conjunctival cyst, including inclusion cyst, pterygium with cyst, or lymphatic cyst. Likewise, two additional cystic subcentimeter lesions associated with the superonasal right eyelid may represent conjunctival cysts.


Instruction: Generate impression based on findings.

Input: Clinical question: Status post head first fall. Signs and symptoms: lip laceration. Nonenhanced CT of the brain:There is no evidence of intracranial hemorrhage, edema, mass effect, midline shift or hydrocephalus.Cortical sulci, ventricular system and all CSF cisterns remain within normal.Limited images through the orbits demonstrate no definitive abnormality. No evidence of any soft tissue abnormality in limited view of facial region.On axial image 16 there is a well-demarcated low density in the occipital bone on the left. This is immediately posterior to the left lambdoid suture (image 16 of 40). This finding measures approximately 7 mm in length and 3-mm in thickness. The outer table of the skull at this location is not visualized. There is no associated intracranial abnormality at this location. There may be minimal soft tissue thickening immediately at this level under the scalp. The exact etiology of this finding is not clear. The finding may represent a skull fracture or possibly an intraosseous lesion.Please correlate with physical findings in particular to detect if palpation of this lesion introduces any pain which may indicate a fracture from patient's recent trauma. This finding is visible only on one image and makes precise evaluation very difficult. Follow up exam with an MRI is recommended to evaluate for expansile intraosseous lesion. These findings were relayed to the resident on duty Dr. Yee at the time of interpretation.

Output: 1.No evidence of an acute intracranial finding.2.No definitive evidence of a skull fracture.3.A small foci of lucency within the left occipital bone immediately adjacent to the left lambdoid suture (axial image 16). Please see above comments. Follow up is recommended.


Instruction: Generate impression based on findings.

Input: Ms. Rivers is a 67 year old female with milky right nipple discharge. Recent ultrasound detected multiple intraductal lesions, one of which was associated with linear non-mass enhancement on recent MRI. This will be the target for today's biopsy. Right breast ultrasound re-identified the target lesion for biopsy. The lesion to be targeted is a hypoechoic intraductal mass measuring 0.9 x 0.2 cm at the 7 o’clock position with increased vascularity, 1 cm from the nipple. The lesion was somewhat subtle.PROCEDURE: The procedure and its risks, including bleeding, infection, and failure to diagnose, and expected benefits of ultrasound-guided core biopsy with percutaneous placement of a marking clip and post-procedure unilateral mammogram were discussed with the patient. Questions were answered. Consent was obtained both verbally and in writing. The time-out form was completed to confirm patient identity and side/type of procedure.The right breast was cleansed with chlorhexidine over the target area. Transducer was sterilely sheathed. Local anesthesia was obtained using 2% lidocaine superficially, with 1% lidocaine with 1:100,000 epinephrine at depth. A 3 mm incision was made in the skin with a #11 scalpel blade. Using aseptic technique, continuous ultrasound guidance and a inferior to superior approach, four 14-gauge core needle (Achieve) specimens were obtained of the lesion. Targeting was judged very good. Two specimens sank to the bottom of the prefilled container of 10% formalin. Specimen quality was judged very good.Specimens were sent to Pathology with an accompanying history sheet. Using continuous ultrasound-guidance a Bard ribbon clip was placed into the lesion in the usual manner. Pressure was held over the biopsy site until all bleeding subsided. The skin incision was closed with a Steri-Strip. Post-procedure digital right CC and ML views revealed the percutaneously placed clip to be in the expected location of the target lesion. The clip correlates to the location of non-mass enhancement on MRI. No evidence of hematoma or other complication.A pressure dressing was positioned over the biopsy site and an ice pack positioned over the pressure dressing. Post-procedure instructions were reviewed with the patient both verbally and in writing. She tolerated the procedure well with no evident complications and left the Breast Imaging Department in stable condition.The procedure was performed by Dr. Sheth. Dr. Schacht is was present during the procedure at all times.

Output: Successful ultrasound-guided core biopsy of the right intraductal lesion with clip placement. Pathology is pending at this time.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: 19 year-old female with history of hydrocephalus status post VP shunt placement presenting with headache and vomiting. Evaluate for worsening hydrocephalus. Ventricular shunt catheter enters the right parietal burr hole with catheter tip in the left lateral ventricle, unchanged in position. Stable morphology and increased volume of both lateral ventricles is evident. Previously evident contrast within the left lateral ventricle is no longer seen. There is no evidence of intracranial hemorrhage, abnormal extra-axial fluid collections, or edema. The remainder of the cerebral and cerebellar hemispheres are stable in appearance. The pituitary gland appears mildly prominent, which correlates with convex morphology seen on recent MRI.Postoperative changes status post right parietal burr hole and are unchanged, with the remainder of the calvarium visualized osseous structures intact. Visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Stable hydrocephalus with no additional acute findings to explain headache and vomiting.


Instruction: Generate impression based on findings.

Input: Right shoulder pain The exam is limited by motion artifact.ROTATOR CUFF: No significant abnormality noted. There is a trace amount of of fluid within the subacromial subdeltoid bursa which is of uncertain clinical significance. SUPRASPINATUS OUTLET: Note is made of an os acromiale which is of normal marrow signal intensity. No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: No significant abnormality noted.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: No evidence of rotator cuff tear. Incidental findings described above.


Instruction: Generate impression based on findings.

Input: Female, 69 years old, history of multiple myeloma with new onset hip pain. Cervical:Straightening of the cervical lordosis is seen, likely positional and/or related to disc degeneration. No pathologic marrow enhancement or marrow replacing lesions are seen. Vertebral body heights are preserved. The spinal cord demonstrates normal signal intensity throughout and is free of pathologic enhancement. Disc degeneration is evident at C5-6 and C6-7 where posterior disc osteophyte formation results in mild spinal canal narrowing. The neural foramina are also at least moderately narrowed at these levels.Thoracic:Marrow signal characteristics remain mildly heterogeneous but there are no areas of pathologic enhancement or concerning focal marrow replacement. Alignment is anatomic. Vertebral body heights are preserved. The spinal cord demonstrates normal signal and is free of pathologic enhancement. No significant compromise of the spinal canal or neural foramina is seen.Lumbar:Marrow signal characteristics remain heterogeneous but similar to prior. There are no areas of pathologic marrow enhancement or concerning focal marrow replacement. Alignment is anatomic. Vertebral body heights are preserved. The distal spinal cord, conus and nerve roots of the cauda equina show normal signal and are free of pathologic enhancement.L1-2: Minimal disc bulging. Interval decrease in the size of a left paracentral protrusion. No significant spinal canal or foraminal stenosis. L2-3: Central annular fissure and mild disc bulging. No significant spinal canal stenosis. Mild right foraminal narrowing. L3-4: Facet arthropathy. Ligamentum flavum thickening. Disc bulging. Mild generalized spinal canal narrowing. Moderate bilateral foraminal narrowing. No interval changes. L4-5: Facet arthropathy. Ligamentum flavum thickening. Right foraminal and far lateral disc protrusion. No significant spinal canal stenosis. Mild right foraminal narrowing. No interval changes. L5-S1: Facet arthropathy. Disc bulging. No spinal canal stenosis. Moderate left foraminal narrowing. No interval changes.

Output: 1.No evidence to suggest active myelomatous disease in the spine.2.Degenerative findings in the cervical and lumbar regions are redemonstrated without significant interval worsening.


Instruction: Generate impression based on findings.

Input: 10-year-old female with multiple hereditary exostosis, known osteochondroma on the distal aspect of the tibia and medial aspect of the distal femur. MENISCI: Intact without evidence of tear.ARTICULAR CARTILAGE AND BONE: Articular cartilage is intact without focal chondral defect.Multiple exostoses on the posterior aspect of the proximal fibula extending superiorly. Distal cortical undulations of the femur likely representing multiple exostoses with medium signal cartilaginous cap.There is increased fluid signal along the medial aspect of the fibula likely representing effusion at the tibiofibular articulation. Corresponding increased reactive marrow signal tibiofibular articulation.Posterolateral exostosis of the proximal fibula with cartilaginous cap. Surrounding undulation along the medial aspect of the proximal tibia with cartilaginous cap representing multiple exostoses.LIGAMENTS: Anterior and posterior cruciate ligaments are intact. The MCL and LCL complexes are intact.EXTENSOR MECHANISM: Extensor mechanism is intact.ADDITIONAL

Output: 1. Multiple exostoses as described above.2. Edema within the vastus lateralis secondary to the largest femoral exostosis.3. Joint effusion within the tibiofibular articulation.


Instruction: Generate impression based on findings.

Input: Reason: Metastatic prostate cancer needs re-evaluation and compare to previous scans. Per RECIST 1:1 bi-dimensional measurements where applicable. History: Metastatic prostate cancer needs re-evaluation and compare to previous scans. Per RECIST 1:1 bi-dimensional measurements where applicable. LUNG BASES: Trace bilateral pleural effusions.LIVER, BILIARY TRACT: Liver enhances homogenously without focal lesion. Gallbladder is unremarkable.SPLEEN: No significant abnormality noted.PANCREAS: Pancreas is diffusely atrophic with mild pancreatic ductal dilatation, unchanged.ADRENAL GLANDS: No adrenal nodularity or thickening.KIDNEYS, URETERS: The kidneys enhance symmetrically. Multiple bilateral simple cysts. No hydronephrosis or ureteronephrosis. RETROPERITONEUM, LYMPH NODES: No significant retroperitoneal lymphadenopathy.BOWEL, MESENTERY: Post surgical findings from ileal conduit are present, with ostomy in right lower quadrant. No mesenteric adenopathy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: Status post cystoprostatectomy. Fluid collection in the resection bed in the right hemipelvis measures approximately 4.0 x 3.4 cm, unchanged from the prior exam. No evidence of abnormal enhancement.BLADDER: Status post cystoprostatectomy.LYMPH NODES: No inguinal, iliac chain, or pelvic lymphadenopathy.BOWEL, MESENTERY: Ileal conduit as above.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Postsurgical findings of cystoprostatectomy and ileal conduit. 2.Fluid collection in the right hemipelvis is unchanged, likely postoperative in etiology.3.No specific evidence of disease recurrence or metastasis.


Instruction: Generate impression based on findings.

Input: Worsening low back and hip pain. Five lumbar type vertebral bodies are presumed to be present with the most inferior well-defined disc space labeled L5-S1. Vertebral body heights are within normal limits. There is grade 1 anterolisthesis of L3 on L4 which appears slightly worse than prior study from 6/6/2008. Alignment is otherwise maintained. Bone marrow signal is benign. The conus medullaris is normal in position.Multilevel degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: Disc desiccation and minimal bulge. There is also ligamentum flavum thickening and bilateral facet arthropathy. No significant spinal canal or neural foraminal stenosis.L3-L4: Grade 1 anterolisthesis with disc uncovering. There is also advanced bilateral facet arthropathy and ligamentum flavum thickening. These findings appear mildly progressed since prior study. There is moderate spinal canal stenosis which appears minimally worse since prior. There is also very mild bilateral neural foraminal narrowing.L4-L5: Mild disc bulge and advanced bilateral facet arthropathy. Minimal spinal canal narrowing. There is moderate left and minimal right neural foraminal stenosis. Left-sided neural foraminal stenosis appears slightly worse.L5-S1: No significant disc disease. No spinal canal or neural foraminal stenosis.Paraspinous soft tissues are within normal limits. There is a focus of low T1 and low T2 signal involving the right aspect of the sacrum measuring approximately 11 mm in diameter, previously approximately 4 mm and 2008. Degenerative changes also noted at the sacroiliac joints.

Output: 1. Degenerative changes in the lumbar spine are minimally progressed since 6/6/2008. There is moderate spinal canal stenosis at L3-L4 related to degenerative spondylolisthesis which appears minimally worse. Flexion-extension radiographs may be helpful to assess for instability. There is also moderate left L4-L5 neural foraminal stenosis which appears slightly worse.2. Advanced facet arthropathy at L3-L4 and L4-L5 which may be contributing to patient's low back pain.3. Nonspecific focus of low T1 and low T2 signal involving the right sacrum which is larger since 2008. Finding is favored to represent an enlarging bone island but consider pelvic radiograph for confirmation.


Instruction: Generate impression based on findings.

Input: Pineal parenchymal tumor of intermediate differentiation preoperative planning. There are postoperative findings related to partial resection of a pineal tumor via a posterior approach. The residual tumor measures up to 40 mm and protrudes into the thalami bilaterally. There is encephalomalacia and superimposed edema in the right occipital lobe, with adjacent extra-axial fluid, blood products, and hemostatic agent along the surgical approach. The ventricles have not significantly changed in size, with a right transfrontal ventricular catheter in position. There are unchanged scattered nonspecific foci of T2 hyperintensity in the cerebral white matter. There is a left occipital subcutaneous nodule that measures up to 20 mm. There is fluid within the left mastoid air cells.

Output: 1. Preoperative planning for resection of a residual pineal region tumor.2. No significant change in size of the shunted ventricular system.3. Nonspecific left occipital subcutaneous nodule.


Instruction: Generate impression based on findings.

Input: H/o right frontal meningioma and posterior fossa medulloblastoma. S/p resections. Examination demonstrates postoperative changes status post right frontal craniotomy, including right frontal pneumocephalus, edema and small amount of blood products and extra-axial fluid collection.Imaging through posterior fossa shows postoperative changes status post suboccipital craniotomy and craniectomy. There is a hyperdense mass in the left cerebellum and adjacent meningeal calcification, which is consistent with the finding on the previous MRI. The previously identified lesion in the left cerebellar peduncle is not visualized because of lack of contrast. There is hypoattenuation bilaterally in the periventricular white matter, which likely represents post radiation change. There is no mass effect or midline shift. The ventricles are normal in size and symmetric.The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. Postoperative changes status post right frontal craniotomy, including right frontal pneumocephalus, edema and small amount of blood products and extra-axial fluid collection.2. Left cerebellar mass. Postoperative changes status post suboccipital craniotomy and craniectomy.3. Postradiation change in the periventricular white matter.


Instruction: Generate impression based on findings.

Input: Diagnosis: Malignant neoplasm of brain, unspecifiedClinical question: Eval AA. On CCNU+Avastin.Signs and Symptoms: AAComments: AA on Avastin+CCNU. | The CSF spaces are appropriate for the patient's stated age with no midline shift. The patient is status post left frontal burr hole placement. A track of susceptibility effect courses from the burr hole to the left thalamic lesion suggesting this could be related to prior stereotactic biopsy.There is a left posterior thalamic lesion present with T1 hyperintensity and a focus of susceptibility effect which is stable in appearance when compared to the previous exam. It is associated with ill-defined enhancement which has not significantly changed since previous exam nor the June exam.There is a nonenhancing focus present in the left centrum semiovale with T2 and FLAIR signal hyperintensity which is stable compared to the prior exam from November 6, however, it has mildly progressed since 6/5/2015 and especially since 5/19/2014.A small focus of patchy enhancement is associated T2 and FLAIR signal hyperintensity and is adjacent to the occipital horn of left lateral ventricle. It is stable since the prior exam. It is associated with a punctate focus of susceptibility effect.An ill-defined focus is present along the posterior aspect of the left temporal lobe which was not present in June 2015 and was present on November 2015 appears slightly larger on the current exam. It encompasses an area measuring approximately 30 x 18 mm axial dimensions and demonstrates some gyral enhancement.There is a new ill-defined focus of T2 and FLAIR signal hyperintensity present along the posterior and medial aspect of the right superior frontal gyrus which is associated with a small amount of contrast enhancement.A small lesion in the left paracentral lobule subcortical white matter associated with contrast enhancement is unchanged since the prior exam.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.There are multiple ill-defined lesions scattered in both hemispheres of the brain but predominantly in the left hemisphere some which are associated with ill-defined contrast enhancement and some of which are larger on the current exam and at least one of which is new since the prior exam. Overall there appears to be continued progression. Stereotactic biopsy of the left thalamus demonstrated anaplastic astrocytoma. Because the other lesions have similar imaging characteristics to the thalamic lesion, it is thus reasonable to suggest that these represent a multifocal astrocytic glioma. These lesions are not associated with edema and similar to literature reported recurrent lesions which have been reported to be resistant to Avastin treatment.


Instruction: Generate impression based on findings.

Input: 56-year-old female with HCV cirrhosis. HCC follow-up after surgical resection. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic morphology. Postsurgical changes of a hepatic segment 5 resection. The resection cavity has decreased in size currently measuring 2.4 x 1.9 cm (series 804 image 235) compared to the prior measurement of 3.1 x 2.3 cm. No abnormal enhancement is identified. A decreased extent of restricted diffusion is also noted.In hepatic segment 3, there is a 1.3 x 1.1 cm nonenhancing lesion (series 805 image 216). In retrospect, this lesion shows no significant interval change compared to the 12/18/2013 CT exam.Status post cholecystectomy.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Marked stenosis/occlusion of the proximal celiac trunk (series 803 image 214) with collateralization is again noted.BOWEL, MESENTERY: Small hiatal hernia.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Post surgical changes of a hepatic segment 5 resection. Decreased size of resection cavity and no evidence of local recurrence.2.Nonenhancing segment 3 lesion is nonspecific and not significantly changed from the 2013 CT exam.


Instruction: Generate impression based on findings.

Input: Cellulitis of the left foot with hematoma lateral to fifth metatarsal. Evaluate for osteomyelitis of the remaining portion of the fifth metatarsal. As seen previously, patient has undergone amputations through the proximal phalanges of the first and second toes as well as the fifth metatarsal. These postoperative changes appear similar to that seen on the prior study, without radiographic features of osteomyelitis.Since the prior study, the patient has undergone further resection of the third and fourth metatarsals. The osteotomy margin of the fourth metatarsal is slightly irregular, but we see no definite radiographic features of osteomyelitis. A soft tissue defect however is noted distal to the fourth metatarsal. If further imaging is clinically warranted, MRI may be considered.

Output: Postoperative changes related to amputation of the first through fifth rays, as described above, with no specific radiographic features of osteomyelitis. If further imaging is clinically warranted, MRI may be considered.


Instruction: Generate impression based on findings.

Input: The vertebral body heights are maintained. There is straightening of the lumbar spine, but no spondylolisthesis. There is small area of focal fat in the superior aspect of L3. The conus terminates at T12-L1. The imaged spinal cord is normal in signal and morphology. The T12-L1, L1-L2, and L2-L3 levels are unremarkable, without evidence of central spinal canal stenosis or neuroforaminal narrowing. At the L3-L4, there is slight disc bulge, without significant spinal canal stenosis or neural foraminal narrowing. This is unchanged from prior study. At L4-L5, there is a mild disc bulge, disc desiccation, and mild facet/ligamentum flavum hypertrophy resulting in mild bilateral neural foraminal narrowing, but no evidence of spinal canal stenosis. At L5-S1, there is no central spinal canal stenosis or neural foramina narrowing. The paraspinal soft tissues are unremarkable. There is a right renal cyst.

Output: Mild degenerative spondylosis, most notably at L4-L5, with mild bilateral neural foraminal narrowing, but no evidence of 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: Status post Chiari decompression, follow-up study There are postsurgical changes of Chiari decompression including suboccipital craniectomy and C1 laminectomy. Compared to preoperative study from 8/5/2015, there is improvement in the previously seen crowding of the foramen magnum, with increase in CSF spaces ventrally and dorsally on current study. CSF flow sequence demonstrates preserved biphasic flow both ventrally and dorsally at the foramen magnum; prior CSF flow imaging demonstrated severely diminished flow posteriorly.Again seen at the C2 level in the cord is tiny focus of T2 hyperintensity measuring less than 2 mm in the axial plane and 4 to 5 mm in the craniocaudal dimension, which is not significantly changed allowing for differences in measurement technique and compatible with tiny syrinx. In comparison of the high-resolution 3-D T2 sequences on the current and prior study, there is suggestion of slight decrease in size of the syrinx in the AP dimension. No new cord signal abnormality. Syrinx is relatively more convincingly smaller when compared to 8/20/2013.Vertebral body heights and alignment the cervical spine are normal. Bone marrow signal is benign. There is no significant disc disease at any level. There is no spinal canal or neural foraminal stenosis at any level. Partially empty sella is again noted.

Output: 1. Expected postsurgical changes of Chiari decompression. There is improvement in the CSF spaces and biphasic flow at the foramen magnum.2. Tiny syrinx at the C2 level is stable to slightly decreased in size since preoperative study dated 8/5/2015.


Instruction: Generate impression based on findings.

Input: 35-year-old female with a personal history of left breast lumpectomy in February 2013 for triple negative IDC. Patient did not receive any chemotherapy or radiation therapy. History of benign left MRI guided biopsy. There is scattered fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.A metallic artifact from a marker clip is identified at posterior upper outer quadrant in the left 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: X - No Letter.


Instruction: Generate impression based on findings.

Input: 50-year-old female with history of von Hippel-Lindau and surgery in 2014 for renal cell carcinoma and cysts. Evaluate kidneys and pancreas for lesions. ABDOMEN: Limited examination given motion artifact (per technologist note, patient is claustrophobic).LIVER, BILIARY TRACT: Scattered T2 hyperintense nonenhancing foci consistent with cysts. Hepatic steatosis. No intra or extrahepatic biliary ductal dilatation.SPLEEN: Scattered T2 hyperintense foci consistent with splenic cysts. Additional scattered nonspecific T2 hypointense subcentimeter splenic foci noted. Splenule noted.PANCREAS: Cystic lesions within the pancreas have increased in size; reference pancreatic body/head lesion measures 2.2 x 2.2 cm (series 5, image 18), previously measuring 1.9 x 1.8 cm.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Postoperative changes of right partial nephrectomy. There are 3 T2 heterogeneous cystic and enhancing lesions in the left lower pole. Reference measurements are as follows: 3.0 x 2.5 cm (series 15, image 14), 2.9 x 2.7 cm (series 15, image 16); the third lesion is exophytic, demonstrates peripheral enhancement and measures 2.6 x 1.7 cm (series 15, image 47).There are multiple bilateral T2 hyperintense nonenhancing lesions compatible with cysts; some of these have increased in size and are complex in appearance. For example right upper pole Bosniak 2 lesion measures 5.6 x 4.4 cm (series 5, image 14), previously measuring 5.3 x 4.2 cm.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Within limitations of motion artifact, there are 3 left lower pole renal lesions demonstrating enhancement. These are highly suspicious for renal cell carcinoma, particularly the larger 2 detailed above.2.Partial right nephrectomy. Multiple bilateral cysts.3.Hepatic, splenic, and pancreatic cyst formation.4.Hepatic steatosis.


Instruction: Generate impression based on findings.

Input: Tractography to evaluate the right optical tract, LGN: Right hemianopia. There are postoperative findings related to left medial temporal lobe laser ablation. There are chronic blood products in the ablation zone as well as peripheral T2 hyperintensity that extends into the left lateral genicular nucleus region. There is no evidence of acute intracranial hemorrhage, mass, or acute infarct. 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: Postoperative findings related to left medial temporal lobe laser ablation with gliosis and/or edema that extends into the left lateral genicular nucleus region.


Instruction: Generate impression based on findings.

Input: Multiple sclerosis. There are numerous T2 hyperintense lesions in the supratentorial and infratentorial white matter. Many of the lesions demonstrate T1 hypointensity, but there is no abnormal intracranial enhancement. 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, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No significant interval change in the intracranial demyelinating lesions.


Instruction: Generate impression based on findings.

Input: Intermittent pain and instability. Evaluate for MCL tear. MENISCI: Horizontal tear of the anterior horn of the lateral meniscus, extending from the apex towards the body and to the inferior surface.ARTICULAR CARTILAGE AND BONE: Mild overall loss of cartilage in the lateral compartment, with focal areas of near full thickness loss at the lateral femoral condyle and lateral tibial plateau, with mild associated bone marrow reactive changes. LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Tear of the anterior horn of the lateral meniscus, as above.2. Mild cartilage degeneration, worst in the lateral compartment.


Instruction: Generate impression based on findings.

Input: 43-year-old male with pain with resisted wrist extension. Evaluate for extensor carpi radialis brevis degeneration. LIGAMENTS: Although this examination was not protocoled for detailed evaluation of the intrinsic ligaments of the elbow, the ulnar collateral ligament appears intact. The radial collateral ligament appears intact. The lateral ulnar collateral ligament appears intact.TENDONS: There is intermediate signal intensity and thickening of the common extensor tendon at the level of its insertion on the lateral epicondyle indicating moderate tendinosis. There is a punctate focus of fluid signal intensity within the common extensor tendon at the level of its insertion, indicating a small interstitial insertional tear (image 19; series 901). The common flexor tendon appears intact. The biceps and brachialis tendons appear intact. The triceps tendon is normal in appearance.ARTICULAR SURFACES AND BONE: No bone marrow signal abnormalities are identified. No full-thickness articular cartilage defects are identified. SURROUNDING STRUCTURES: The imaged musculature of the left elbow is normal in appearance.ADDITIONAL

Output: Tendinosis and small interstitial tear of the common extensor tendon as described above.


Instruction: Generate impression based on findings.

Input: Please note that postcontrast images were not obtained as patient could not tolerate further sequences due to pain. MRI thoracic spine and pelvis were not performedThe vertebral column alignment is within normal limits. There is a normal relationship of the dens with the arch of C1. Normal marrow signal. Minimal disc bulges are seen from C2-3 to C5-6 without spinal canal or neuroforaminal stenosis at any level. Normal signal within the visualized cord. . An unfused posterior arch of C1 and partially fused spinous processes of T1 and T2 are again seen. Postsurgical changes of left thyroidectomy. Paraspinous soft tissues are otherwise unremarkable.

Output: No cord signal abnormality. No spinal canal or neural foraminal stenosis at any level.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Female, 20 years old, 27 weeks gestational age, with prenatal ultrasound demonstrating omphalocele and splaying of the sacral vertebrae with suggestion of a mass in this area. A defect is evident within the posterior elements of the lower lumbar and sacral spine. A septated cystic lesion contiguous with the thecal sac projects through this defect at midline and just to the right of midline. The low lying spinal cord enters the cystic lesion and terminates within a network of septations or fibrous strands. The cystic lesion appears to be covered externally by a relatively thick membrane. No evidence of a lipoma or other soft tissue mass is seen.A defect in the ventral abdominal wall is evident with herniation of liver and bowel loops. Most if not all of the liver is extra-abdominal. Numerous dilated bowel loops are present both extra-abdominally and intra-abdominally. Several of the dilated intra-abdominal loops likely represent colon, and these can be followed back to a diminutive rectosigmoid. T1 bright meconium, an expected finding at this gestational age, is not visualized. The kidneys are normal in appearance. The urinary bladder is difficult to accurately visualize but may be present.On incidental views of the brain, the morphology of the frontal horns is suggestive of agenesis or partial agenesis of the corpus callosum. In addition, the right ventricular atrium is top normal in size measuring 10 mm.

Output: 1.Findings are seen compatible with a myelomeningocele of the lumbosacral spine. No evidence is detected to suggest the presence of a lipoma, teratoma or other soft tissue mass.2.A ventral abdominal wall defect is present with herniation of liver and bowel compatible with omphalocele. Most if not all of the liver is extra abdominal. In addition, multiple dilated bowel loops are present which can be followed back to a diminutive rectosigmoid. Normal T1 bright meconium is not identified.3.The combination of myelomeningocele and omphalocele raises the possibility OEIS complex. Furthermore, the presence of multiple dilated bowel loops suggests distal obstruction. Given that the dilated loops can be followed to a diminutive rectosigmoid, Hirschsprung's disease would be a consideration.4.Findings are seen on the incidentally visualized brain suggesting agenesis of the corpus callosum. Please note that this examination was not specifically tailored for assessment of the brain, and therefore, a definitive diagnosis is not possible based on these limited images. Correlation with future sonograms may be helpful.


Instruction: Generate impression based on findings.

Input: Male, 24 years old, with neurofibromatosis status post resection of a cervical lesion, three-month follow-up. Postoperative findings are seen within the posterior paraspinal soft tissue tissues at C1-2. The C2 spinous process has been partially resected. Previously seen large tumors which were centered on the bilateral C1-2 foramina with intraspinal extension have been resected. No evidence of residual or recurrent tumor is seen at the operative site. The previously demonstrated mass effect on the spinal cord has been relieved, though there is some residual cord thinning and myelomalacia.Thickening along the nerve roots at most other cervical levels is again seen without significant interval change. No new or growing lesions are seen. Scattered small subcutaneous and paraspinal nodules are also demonstrated without significant interval change. Bilateral nodules are partially visualized within the carotid space between the common carotid arteries and the jugular veins.Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. No evidence of pathologic marrow replacement or edema is seen. The spinal cord is otherwise unremarkable. No significant disc degeneration, spinal canal or foraminal compromise is detected.

Output: 1.Postoperative findings are seen compatible with resection of large neurofibromas from the C1-C2 foramina . No evidence of residual or recurrent tumor is seen at the operative site.2.The previously demonstrated spinal canal stenosis and cord impingement related to intraspinal extension of the foraminal tumors has been relieved. Focal cord thinning and myelomalacia is now evident.3.Scattered additional neurofibromas are seen within the cervical foramina and in the paraspinal and subcutaneous soft tissues. There are no clearly new or growing lesions.


Instruction: Generate impression based on findings.

Input: 64-year-old male with low risk prostate cancer. Assess for extent of disease.Additional history per EMR: March 2015 PSA 6.88, biopsy confirmed prostate cancer. Most recent PSA 6.92. cT1c, Gleason score 3+3, 6/12 cores. PELVIS:PROSTATE:Prostate Size: 4.5 x 3.1 cm.Peripheral Zone: There are multiple T2/ADC hypointense lesions in the left and right mid gland peripheral zone (series 801, images 17 and 18) with possible associated enhancement. These may represent foci of patient's known prostatic malignancy. There is no evidence of neurovascular bundle invasion or extracapsular extension.Central Gland: Multiple T2/ADC signal hypointense nodules, the largest of which measures 9 x 6 mm in the left mid gland. None demonstrate definite abnormal contrast enhancement and their morphology favors benign etiology. Seminal Vesicles: Seminal vesicles are unremarkable.Extracapsular Extension: None.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Several peripheral zone lesions with findings suggestive of patient's known prostatic malignancy. No evidence of neurovascular bundle invasion or extracapsular extension.


Instruction: Generate impression based on findings.

Input: Female 26 years old Reason: Evaluate for choledocholithiasis History: Ductal dilation seen on RUQ US ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. No suspicious hepatic lesions.Gallbladder contains multiple calculi. There is trace pericholecystic fluid adjacent to the liver.No intra-or extrahepatic biliary ductal dilatation. No choledocholithiasis is evident.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Cholelithiasis without choledocholithiasis.2.Trace pericholecystic fluid between the gallbladder and liver suggests mild early inflammation of the gallbladder.


Instruction: Generate impression based on findings.

Input: 13-year-old male with history of juvenile angiofibroma status post surgery. Evaluate for recurrence. BRAIN: There is no evidence of intracranial hemorrhage, mass or edema. There is no abnormal postcontrast enhancement. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses demonstrate postsurgical changes of the nasopharynx without definitive soft tissue enhancement to suggest tumor recurrence. The left maxillary sinus is near completely opacified which is likely postinflammatory however residual/recurrent tumor cannot be definitively identified and follow a MRI is recommended for further characterization.The surgical cavity and right masticator space gastric postsurgical changes without evidence of abnormal enhancement.The remainder of the soft tissues of the neck are normal in appearance. The oropharynx demonstrates bilaterally enlarged tonsils which are touching however not entirely occluding the airway.

Output: 1. Normal brain CT.2. No postcontrast enhancement to suggest residual or recurrent tumor however left maxillary sinus opacification cannot definitively identify tumor recurrence. A follow-up MRI is recommended for further characterization.


Instruction: Generate impression based on findings.

Input: Ms. Sokol is a 46 year old female with a personal history of right breast lumpectomy in 2010 for IDC treated with radiation, chemotherapy and Aromasin. Bilateral breast reconstruction surgery in 2011. There is scattered fibroglandular tissue in both breasts. Mild background parenchymal enhancement is noted bilaterally.Stable post-lumpectomy changes are identified in the right breast and right axilla. There is no abnormal enhancement seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.

Output: Stable postsurgical changes of the right breast. No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


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: 63-year-old male with history of prostate cancer and rising PSA level ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Nonspecific evidence in the liver on image number 22 measuring less than a centimeter, too small to characterize but most likely a cyst.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Nodular left adrenal gland. 10-mm left adrenal nodule, which cannot be further characterized on this single phase CT but most likely benign. If further evaluation of this lesion is clinically indicated MRI of the adrenal gland may be helpful.KIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Status post prostatectomy. No CT evidence of recurrent disease.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Punctate sclerotic focus in the left iliac bone adjacent to SI joint on image number 100, series number 3.OTHER: No significant abnormality noted

Output: No definite CT evidence of recurrence. Punctate sclerotic focus in the left iliac bone. A small left adrenal nodule which cannot be further characterized on this noncontrast CT but more likely to be a benign adenoma. MRI of the adrenal glands may be helpful if further evaluation of this lesion is clinically indicated.


Instruction: Generate impression based on findings.

Input: Reason: CNS lymphoma History: follow up and compare with previous MRI. The patient is status post transphenoidal hypophysectomy. There is marrow replacement present within the sphenoid bone which has been present since the patient's pituitary surgery and enhances following contrast administration. It has a heterogeneous appearance with cystic appearing components.A small focus of susceptibility effect is present in the right basal ganglia. This is likely related to prior hemorrhagic event.The patient is status post bur hole along the right frontal bone.There is redemonstration of a nodule in the right parotid gland which measures 13 x 13 mm axial dimensions and enhances following gadolinium administration. It is present on prior exams and may 3/24/2008 exam and measured 7 x 4 mm axial dimensions. On the 10/28/14 exam it measured 19 x 10 mm axial dimensions. It is associated with chemical shift artifact. It is of lower signal than the parotid gland on T2 imaging and on T1 imaging.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.No intraparenchymal mass lesions are appreciated to suggest CNS lymphoma.2.Heterogeneous appearance of the sphenoid bone and perisellar region status post transphenoidal hypophysectomy. This is suspected to represent postsurgical change and/or residual pituitary adenoma3.A nodule in the right parotid gland has been present and slowly growing over the past 7 years.4.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: There is no acute cord compression.Chronic cord compression at C3/4 with T2 cord intrinsic changes secondary to a large disc extrusion have improved compared to the 2013 comparison. Degenerative results elsewhere in the cervical spine appear stable. Scattered facet hypertrophy is evident throughout the thoracic and lumbar spine. There is no intrinsic abnormality of the conus. Degenerative disease at L5/S1 including disc degeneration, endplate spurring, and facet hypertrophy result in bilateral foraminal stenosis.

Output: 1.No acute cord compression.2.Chronic cord compression at C3/4 with T2 cord intrinsic changes secondary to a large disc extrusion have improved compared to the 2013 comparison.


Instruction: Generate impression based on findings.

Input: 39-year-old female with history of knee pain and persistent "Bakers cyst". MENISCI: Globular signal within the body and posterior horn of the medial meniscus indicates intrasubstance degeneration. This signal extends to the femoral articular surface compatible with a degenerative tear. The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is moderate degeneration of the articular cartilage of the femoral trochlea particularly along the medial facet with underlying cyst formation. There is also subjective thinning of the articular cartilage of the patella particularly along the lateral facet. We see no fluid-filled defects within the articular cartilage of the medial and lateral tibiofemoral compartments.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1.No evidence of a Baker's cyst.2.Degeneration and degenerative tearing of the medial meniscus.3.Cartilage degeneration affecting the patellofemoral joint and other findings as above.