Instruction: Generate impression based on findings.

Input: The last well formed disk space is referred to as L5-S1. The osseous marrow signal appears benign but is mildly heterogeneous on T1 and T2 images. There is no osseous marrow edema. The vertebral body heights are intact. There is loss of T2 disk signal in the L3-4 and L4-5 disks with loss of disk height. There is mild grade 1 anterolisthesis of L4 on L5 with mild uncovering of the L4-5 disk. The conus terminates at the inferior aspect of L1 and has normal signal.T12-L1: No spinal canal or neural foraminal stenosis.L1-2: No spinal canal or neural foraminal stenosis.L2-3: No spinal canal or neural foraminal stenosis.L3-4: Minimal disk bulge and bilateral facet arthropathy with ligamenta flava thickening. Mild right neural foraminal stenosis. No significant spinal canal or left neural foraminal stenosis.L4-5: Mild disk bulge with uncovering of the disk secondary to anterolisthesis of L4 on L5. Moderate bilateral facet arthropathy and ligament flava thickening. Moderate to severe spinal canal stenosis and mild bilateral neural foraminal stenosis. There is mild soft tissue T2 hyperintense signal surrounding the facets of L4-5 probably representing mild reactive soft tissue edema from degenerative facets.L5-S1: Mild disk bulge with bilateral facet arthropathy and ligament flava thickening. Mild bilateral neural foraminal stenosis. No spinal canal stenosis.

Output: Multilevel lumbar spondylosis worst at L4-5 where there is mild anterolisthesis of L4 on L5 with uncovering of the disk, facet arthropathy and ligamenta flava thickening combining to cause moderate to severe spinal canal stenosis and mild bilateral neural foraminal stenosis.


Instruction: Generate impression based on findings.

Input: 62 years, Male, Reason: newly diagnosed Gleason 6 prostate cancer, needs repeat MRI fusion biopsy if clear lesions are found History: newly diagnosed Gleason 6 prostate cancer, needs repeat MRI fusion biopsy if clear lesions are found. PELVIS:PROSTATE:Prostate Size: 4.8 x 4.9 x 4.8 cmPeripheral Zone: Lesion in the left peripheral zone extending from the mid gland to base measures 1.1 x 0.57 m (704/264) and has low signal on T2/ADC, suspicious for prostatic adenocarcinoma.Central Gland: Multiple well defined lesions likely represent BPH nodules.Seminal Vesicles: No extensionExtracapsular Extension: No extracapsular extensionBLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Lesion in left peripheral zone, mid gland to base, is suspicious for prostatic adenocarcinoma.2.No lymphadenopathy.


Instruction: Generate impression based on findings.

Input: 51 year old female with shoulder pain. Rule out SLAP tear. Suboptimal examination secondary to patient motion artifact.ROTATOR CUFF: There is increased signal abnormality and thickening consistent with moderate tendinosis of the supraspinatus tendon. The supraspinatus muscle and tendon appear intact. The infraspinatus muscle and tendon appear intact. The teres minor muscle and tendon appear intact. The subscapularis muscle and tendon appear intact.SUPRASPINATUS OUTLET: Mild degenerative changes affect the acromioclavicular joint. No gadolinium is identified within the subacromial subdeltoid bursa. No fluid is identified within the subacromial subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Intra-articular gadolinium is identified within a heterogeneous and fragmented posterior superior labrum, consistent with degenerative tearing. There is additional linear increased signal abnormality within the anterior superior labrum consistent with tearing. There is no definite extension to involve the biceps anchor. BICEPS TENDON: The long head of the biceps tendon is unremarkable. ADDITIONAL

Output: Tearing of the glenoid labrum, as described above.


Instruction: Generate impression based on findings.

Input: Evaluate for metastasis and recurrent tumor. Again seen is a scarlike deformity involving the right lower thorax paraspinous soft tissues similar to prior. No discrete mass is seen to suggest recurrent tumor.No suspicious osseous lesions within the thoracic spine are appreciated. No evidence of epidural tumor. No abnormal signal within the thoracic cord.The vertebral column alignment is within normal limits. The vertebral body heights are preserved. There is a T1 and T2 hyperintensity in the left third and seventh ribs compatible with small hemangiomas. Degenerative changes with mild disc bulges are again seen throughout the thoracic spine. There is mild spinal canal stenosis at T11-T12 related to facet arthropathy and prominent ligamentum flavum thickening. There is mild right and moderate left neural foraminal stenosis at T11-T12. levels. Mild bilateral foraminal narrowing at T9-T10 and T10-T11 also again noted.Moderate degenerative changes in the cervical spine related to multiple disc osteophyte complexes at C3-C4, C4-C5, and C5-C6 with associated moderate cervical spinal canal stenosis suspected on the sagittal counting sequences covering the cervical spine.

Output: 1. Post-surgical changes of thoracic right paraspinous soft tissue tumor excision without evidence of recurrent tumor. No evidence of metastatic disease in the thoracic spine.2. Degenerative in the thoracic spine as above as well as involving the partially imaged cervical spine with up to moderate spinal canal stenosis suspected from C3-C4 to C5-C6.


Instruction: Generate impression based on findings.

Input: Reason: 39 y/o lady w/ a hx of HIV and high fevers. History: 39 y/o lady w/ a hx of HIV and high fevers.. There is no evidence of intracranial hemorrhage, mass, or acute infarct. Scattered punctate subcortical (10-20 per hemisphere) and to a lesser degree periventricular T2 and FLAIR hyperintensities are nonspecific and not associated with diffusion restriction. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is deformity of the medial wall of the right orbit with tethering of the medial rectus, appearing similar to prior CT. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There are enhancing lesions along the anterior aspect of the parotid gland bilaterally, likely lymph nodes.Metal artifact from dentition partially degrades imaging at orbits and distorts DWI and SWI imaging anteriorly.

Output: Scattered periventricular and subcortical T2 hyperintensities are nonspecific. Differential diagnosis includes chronic migraines, small vessel ischemic disease, demyelinating disease and other inflammatory etiologies.


Instruction: Generate impression based on findings.

Input: There are scattered punctate foci of T2 hyperintensity within the periventricular and subcortical white matter, and to a lesser extent within the pons, without associated mass effect, restricted diffusion, susceptibility and dramatic, or enhancement. The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain. There is a suggestion of a 5 mm saccular aneurysm arising from the post-ophthalmic left cavernous internal carotid artery directed laterally.

Output: 1.There are scattered punctate foci of T2 hyperintensity within the periventricular and subcortical white matter, and to a lesser extent within the pons, as described in detail above. Given patient age 57 years, as well as a history of hypertension, hyperlipidemia, and diabetes, this most likely represents chronic small vessel ischemic change.2.There is a suggestion of a 5 mm saccular aneurysm arising from the post-ophthalmic left cavernous internal carotid artery directed laterally. Please note conventional MRI is insensitive for the detection and characterization of aneurysms; if deemed clinically beneficial, MRA of the circle of Willis could better define the presence of aneurysms as well as their characterization.


Instruction: Generate impression based on findings.

Input: Please refer to the subsequent MRI report for further information.Exposure time: 44 seconds

Output: Successful fluoroscopically guided right wrist arthrogram for MRI.


Instruction: Generate impression based on findings.

Input: 33 years, Male, intractable epilepsy. Preoperative planning for depth of electrodes. The brain parenchyma, including the temporal lobes, are unchanged from prior MRI. The ventricles and sulci are also unchanged in appearance. There is no evidence of intracranial mass lesions. Major flow voids are preserved. There is no midline shift or herniation. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Grossly unremarkable preoperative brain MRI.


Instruction: Generate impression based on findings.

Input: 15 year old male with history of gunshot wound, now with cellulitis. Evaluate for osteomyelitis, soft tissue infection.EXAMINATION: MRI left tibia/fibula with and without contrast 12/14/2016 15:25 Diffuse swelling and reticulation of the soft tissues with enhancement overlying the entire left tibia/fibula. No loculated/rim enhancing collection is present. Marked soft tissue defect posterior to the proximal tibia and fibula compatible with known debridement.The deeper muscular compartments are normal. Bone marrow signal intensity is normal.

Output: Cellulitis without osteomyelitis or abscess.


Instruction: Generate impression based on findings.

Input: 51 years, Male, status post craniotomy for tumor resection. Compared to MRI dated 4/19/2016, there are interval postsurgical changes of left temporoparietal craniotomy for partial resection of the previously seen area of enhancement surrounding the prior resection cavity. There remains residual areas of heterogeneous enhancement in the left temporal lobe extending to the ependymal surface of the left lateral ventricle. There is minimal rind of restricted diffusion along the resection cavity margin compatible with cytotoxic edema. Extent of T2/FLAIR hyperintensity involving the left temporal, parietal, and occipital lobes is similar to prior. Ventricular system is not significantly changed in size, without evidence of hydrocephalus. No significant midline shift or uncal herniation. Expected postsurgical changes include blood products in the posterior temporal resection cavity, minimal extra-axial fluid, as well as fluid collection in the left scalp. Evidence of prior endoscopic sinonasal surgery again noted as well as partial paranasal sinus opacification, primarily including the bilateral frontal and bilateral anterior ethmoid air cells.

Output: Expected postsurgical changes of craniotomy for repeat GBM resection. There has been partial resection of the previously seen area of heterogeneous enhancement in the left temporal lobe, which may represent combination of recurrent tumor and posttreatment change.


Instruction: Generate impression based on findings.

Input: Clinical question: New symptoms, evaluate for syrinx and tethered cord. Signs and symptoms: Numbness pelvic area and occasional incontinence, stool. Nonenhanced lumbar MRI:Comparison of sagittal T2 on prone and supine demonstrate anterior movement of the lower thoracic cord, conus and proximal cauda equina on prone series.The signal intensity of vertebral column is unremarkable other than mild changes secondary to degenerative disease.There is normal signal intensity of the lowermost visualized thoracic cord and conus and with normal termination of the cord at the L1 -- L2 disk level.The signal intensity of the cauda equina is within normal and in particular no areas of fatty deposition is detected.T12 -- L1, L1 -- L2 and L2 -- L3 levels are unremarkable with the exception of mild degenerative changes of posterior elements.L3 -- L4 demonstrate moderate bilateral ligamentum flavum hypertrophy and mild facet disease without spinal stenosis or neural foraminal compromise.L4 -- L5 demonstrate mild disk disease, moderate to severe bilateral ligamentum flavum hypertrophy and mild facet disease. Constellation of changes result seen mild central spinal stenosis and bilateral neural foraminal compromise.L5 -- S1 demonstrate advanced disk disease, loss of disk height, associated adjacent endplate Modic signal changes, mild facet and ligamentum flavum hypertrophic changes. No spinal stenosis or significant neural foraminal compromise.Limited lower thoracic spine demonstrate moderate disk disease and loss of disk height at T10 and T11 levels without spinal stenosis are mild bilateral neuroforaminal compromise at T10 -- T11 is present.

Output: 1.No evidence of tethered cord.2.Degenerative changes at L4 -- L5 results in mild central spinal stenosis and bilateral neural foraminal compromise.3.Advanced disk disease and to a lesser degree hypertrophic changes of posterior elements at L5 -- S1 without spinal stenosis or neural foraminal compromise.


Instruction: Generate impression based on findings.

Input: Male, 18 years old. Posteromedial left leg and knee pain. Evaluate for stress reaction. Focal bone marrow edema and signal abnormality within the cortex of the mid tibial diaphysis compatible with a stress reaction. No corresponding abnormality on T1 imaging to indicate acute fracture. The remainder of the bone marrow signal is unremarkable. The overlying soft tissues and musculature are unremarkable. The contralateral leg is grossly normal.

Output: Findings compatible with a stress reaction with microfracture of the mid left tibial diaphysis.


Instruction: Generate impression based on findings.

Input: Clinical question: Right-sided numbness in face/arm/leg. Signs and symptoms: Same. CTA of intracranial circulation:55 cc of Omnipaque 350 is administered for this exam.3-D reformatted images were obtained from an independent workstation.There is patent bilateral internal carotid arteries across the skull base and in their supraclinoid components. The source and MIP images demonstrate presence of bilateral ophthalmic arteries. Proximal bilateral anterior and middle cerebral arteries are well visualized and unremarkable. The anterior communicating artery is identified and unremarkable. There are patent bilateral normal appearing posterior communicating arteries.There is a hypoplastic right vertebral artery and with a normal appearing right pica branch.A dominant and normal appearing left vertebral artery is identified. Right pica branch and including its origin is unremarkable.Basilar artery is patent. Excellent Normal visualization of bilateral superior cerebellar arteries. There is hypoplastic left P1 secondary to a dominant left posterior communicating artery. Posterior cerebral arteries are unremarkable.CTA of neck:Limited view of the aortic arch and the origins of the major vessels are unremarkable.Right brachial cephalic, origin of right common carotid artery, right common carotid artery are within normal limits. A small smooth and minimally calcific plaque at the origin of right internal carotid artery is noted. There is no hemodynamically significant lumen compromise. The right internal carotid artery is otherwise unremarkable.The left common carotid artery and including its origin are unremarkable. A shallow smooth and minimally calcified plaque at the origin of the left internal carotid artery is also present and bleed no evidence of compromise of lumen. The left internal carotid artery is otherwise unremarkable.Bilateral proximal external carotid arteries are unremarkable.Nonenhanced head CT:Examination demonstrates very subtle suspect that periventricular low attenuation of white matter concerning for possible minimal small vessel ischemic disease of indeterminate age. Recommend further follow-up with a dedicated MRI of brain.There is no evidence of hemorrhage, edema, mass effect, midline shift or hydrocephalus.

Output: 1.Non-enhanced CT of brain demonstrates suspected minimal small vessel disease of indeterminate age. Recommend follow-up with a dedicated MRI of brain.2.Unremarkable CTA of intracranial circulation.3.Unremarkable CTA of neck.


Instruction: Generate impression based on findings.

Input: Craniotomy defect is noted in the right temporal bone with some underlying volume loss and encephalomalacia which was seen on prior MRI. The gray-white matter differentiation is normal. There is no mass effect, midline shift, or acute intracranial hemorrhage. The ventricles, and cisterns are symmetric and unremarkable. Limited views of the paranasal sinuses and mastoid air cells are unremarkable.

Output: Postsurgical changes in the right temporal bone and underlying temporal lobe. No acute intracranial abnormalities. For evaluation of new masses MRI with contrast is recommended.


Instruction: Generate impression based on findings.

Input: 23-year-old male with a history of Crohn's disease. Unable to scope proximal to the ileocolonic anastomosis. Evaluate for active inflammation in neoterminal ileum. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postoperative changes of small bowel resection with patent anastomosis. There is no bowel wall thickening or signal abnormality to suggest active disease/inflammation. No focal fluid collection to suggest abscess formation. No fistula is identifed.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.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: Postoperative changes without evidence of active inflammatory bowel disease.


Instruction: Generate impression based on findings.

Input: History of alcoholic cirrhosis and hepatitis C. ABDOMEN: The study is suboptimal due to respiratory motion.LIVER, BILIARY TRACT: Cirrhotic liver morphology with diffuse nodularity and increased reticular T2-weighted signal intensity suggestive of fibrosis.Stable segment 2 lesions demonstrating mild T2 weighted hyperintensity and T1 weighted hypointensity without arterial enhancement. These measure approximately 1.9 and 1.6 cm.Stable segment 7 peripheral 2.0 cm lesion (series 8/50) with similar imaging characteristics.Stigmata of portal hypertension including mild perihepatic ascites, splenomegaly, retroperitoneal and ventral varices.The vessels appear patent. No biliary ductal dilatation.SPLEEN: Splenomegaly measuring 27 cm in craniocaudal dimension without a focal lesion.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: Suboptimal study due to patient motion artifact.Cirrhosis with stigmata of portal hypertension.Stable hepatic lesions do not demonstrate arterial enhancement and hence do not fulfill imaging criteria for hepatocellular carcinoma. These may represent cirrhosis associated nodules (regenerative and/or dysplastic) versus atypically mildly hyperintense cysts.


Instruction: Generate impression based on findings.

Input: 34-year-old male with recurrent pancreatitis and pancreas disease and. Status post multiple treatments. MR examination showed mass in pancreatic body. Please evaluate for extent of disease. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Status post cholecystectomy. Subcentimeter arterial enhancing focus in the left lateral hepatic segment on arterial phase axial image 41 of series 8 is probably due to a flash filling hemangioma. Periportal hepatic parenchymal hypodensity is faintly seen on portal venous phase image 35/154. In retrospect, this was present on the recent MRI examination with signal loss between in and out of phase images, most likely due to focal fat infiltration. Multiple other subcentimeter hepatic hypodensities are too small to characterize.SPLEEN: No significant abnormality notedPANCREAS: Diffuse pancreatic calcifications compatible with history of chronic pancreatitis. No definite evidence of a pancreatic mass was found. The pancreas is diffusely atrophic with dilated duct, better seen on the recent M.R.C.P. exam.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Multiple bilateral renal cortical hypodensities measures subcentimeters in size and are probably due to simple cysts.RETROPERITONEUM, 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: No significant abnormality noted.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Chronic pancreatitis. No definite evidence of pancreatic mass.No significant change since the recent M.R.C.P. examination.


Instruction: Generate impression based on findings.

Input: 64-year-old man with history of alcohol cirrhosis, please evaluate for HCC. ABDOMEN:LIVER, BILIARY TRACT: The liver is nodular in contour with widening hepatic fissures. Additionally, there is increased T2 signal in the right lobe of the liver with mild retention of contrast on the delayed phase images. There is a 13 x 11 mm, T2 hyperintense, nonenhancing cyst at the porta hepatis (series 701, image 25). No arterially enhancing lesions are identified.The gallbladder appears normal. There is no intra or extrahepatic biliary duct dilatation.SPLEEN: The spleen is enlarged at 14.3 cm. Susceptibility artifact near the splenic hilum is likely secondary to vascular clip.PANCREAS: The pancreas appears normal.ADRENAL GLANDS: The adrenal glands are normal.KIDNEYS, URETERS: Innumerable, subcentimeter T2 hyperintense lesions are seen in the kidneys bilaterally, likely cysts.RETROPERITONEUM, LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: There is a trace amount of perihepatic ascites.BONES, SOFT TISSUES: Bilateral gynecomastia.OTHER: No significant abnormality noted.

Output: Cirrhotic and fibrotic liver without lesions suspicious for malignancy.


Instruction: Generate impression based on findings.

Input: Chiari malformation decompression follow up. Brain: There are stable postoperative findings related to Chiari decompression and fourth ventricular stenting. The cerebellum displays an unchanged morphology and signal characteristics. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits and paranasal sinuses are grossly unremarkable.Spine: There is a posterior disc-osteophyte complex, eccentric to the right at C6-7, which has increased in size and indents the spinal cord. Otherwise, there is no evidence of spinal cord signal abnormality or syrinx. There is no significant neural foramen stenosis. The vertebral column alignment is within normal limits. The vertebral body heights are preserved. The vertebral bone marrow signal is unremarkable. The paravertebral soft tissues are unchanged.

Output: 1. Stable postoperative findings related to Chiari decompression and fourth ventricular stenting without evidence of syringohydromyelia.2. A posterior disc-osteophyte complex has increased in size and indents the spinal cord.


Instruction: Generate impression based on findings.

Input: Re-do untethering of spinal cord. Additional history from electronic medical record: Ex-31 week preemie. Untethered in 2007 in Madison, Wisconsin, again in 2011. Status post 5 different surgeries to drain abscess in the prior discovered normal sinus tract involving the left buttock. Most recent surgery on 4/4/2016 with untethering of spinal cord by detachment and resection of intradural extent of previously resected subcutaneous dermal sinus track. Completion of laminectomies at L3-L5, and complex wound reconstruction. There has been interval repeat spinal cord untethering surgery. There is no appreciable change in the appearance of the lower spinal cord and conus medullaris, which lies at the L4 level. Likewise, the lipoma along the filum terminale extending from the L5 and S2 is unchanged. The more plaque-like lipomatous mass in the posterior sacral spinal canal is partially-imaged. There is also a partially-imaged band of low T1 signal in the midline posterior sacral soft tissues. The alignment of the lumbar spinal column is normal, with expected lordosis. The vertebral body heights and disc heights are preserved. The vertebral bone marrow signal intensity is normal. There is no evidence of disc herniation or bulge. The right kidney is absent and the left kidney is prominent, likely related to compensatory hypertrophy.

Output: 1. Interval repeat spinal cord untethering surgery without appreciable change in the appearance of the lower spinal cord and conus medullaris, which lies at the L4 level. Likewise, the lipoma along the filum terminale extending from the L5 and S2 is unchanged. The more plaque-like lipomatous mass in the posterior sacral spinal canal is partially-imaged. 2. Partially-imaged band of low T1 signal in the midline posterior sacral soft tissues, which may correspond to a residual sinus tract.3. The right kidney is absent and the left kidney is prominent, likely related to compensatory hypertrophy.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 15-year-old male with swelling. Status post ACL reconstruction. MENISCI: There is increased linear branching signal abnormality within the posterior horn of the medial meniscus which extends to involve the body and anterior horn of the meniscus and extends to the tibial and femoral articular surfaces indicating complex tearing. Some of these findings may represent prior tearing or be postoperative in etiology, although this is difficult to ascertain without prior examinations for comparison. There is also increased signal abnormality within the anterior horn medial meniscus which extends to the femoral articular surface consistent with fraying/tearing.There is increased signal abnormality within the posterior horn of the lateral meniscus which extends to the tibial articular surface consistent with undersurface fraying/tearing.ARTICULAR CARTILAGE AND BONE: The lateral compartment appears relatively spared. There is focal partial-thickness articular cartilage degeneration along the medial facet of the patella with a tiny foci of underlying subchondral signal abnormality. Note is made of postsurgical changes consistent with prior ACL graft repair.LIGAMENTS: Postsurgical changes from prior ACL graft repair. There is increased signal abnormality within the graft likely related to revascularization. The fibers of the graft appear intact. The PCL appears intact. The medial and lateral collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Postsurgical changes of prior ACL graft repair as described above. 2. Complex tearing of the medial meniscus and articular cartilage degeneration of the patellofemoral compartment as described above. 3. Small joint effusion.


Instruction: Generate impression based on findings.

Input: 58 year-old man with a history of diabetes and hypertension and recurrent syncope/palpitations. MRI ordered to assess for hypertrophic cardiomyopathy. Left VentricleThe left ventricle is normal in size with hyperdynamic function. The overall LV ejection fraction is 68%, the LV end diastolic volume index is 72 ml/m2 (normal range: 74+/-15), the LVEDV is 179 ml (normal range 142+/-34), the LV end systolic volume index is 23 ml/m2 (normal range 25+/-9), the LVESV is 57 ml (normal range 47+/-19), the LV mass index is 76 g/m2 (normal range 85+/-15), and the LV mass is 189 g (normal range 164+/-36). Maximum thickness of the myocardial wall on short-axis views 13 mm. There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. Myocardial T1 is 943 -1060 ms (normal range).Left AtriumThe left atrium is mild-moderately dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 65%, the RV end diastolic volume index is 76 ml/m2 (normal range 82+/-16), the RVEDV is 190 ml (normal range 142+/-31), the RV end systolic volume index is 27 ml/m2 (normal range 31+/-9), and the RVESV is 67 ml (normal range 54+/-17). Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. 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 (26 mm)Venous AnatomyThe SVC and IVC 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 hyperdynamic function. The overall LV ejection fraction is 68%. Maximum thickness of the myocardial wall on short-axis views 13 mm2. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.3. The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 65%.


Instruction: Generate impression based on findings.

Input: Palpable guided lumpectomy of left breast IDC for specimen review. Orthogonal digital specimen radiographs revealed the mass and clip to be within the specimen. The dense tissue with few spiculations are noted reaching the margins.

Output: Successful specimen radiograph of the left breast mass.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Melanoma. Right frontal lesion treated with laser ablation on 7/22/2014. Left occipital lesion treated with SRS on 10/22/2014. Again seen is a heterogeneous enhancing lesion in the right superior frontal gyrus that measures 12 x 7 mm similar to prior from 10/7/2014 and has been previously treated via laser ablation. Enhancing nodule within the left occipital lobe with intrinsic T1 hyperintensity at the grey-white matter junction is stable to minimally smaller compared to prior, measuring 3mm, previously approximately 4 mm. There is a right precentral gyrus developmental venous anomaly. There are scattered punctate foci and confluent areas of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, consistent with minimal chronic small vessel ischemic changes. There is no midline shift or herniation. The ventricles and basal cisterns are normal in size and configuration. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unremarkable.

Output: 1. No significant change in size of enhancing right superior frontal gyrus lesion measuring up to 12 mm and consistent with treated metastasis (via laser ablation).2. Stable to slight decrease in size of enhancing left occipital lesion measuring 3 mm and consistent with treated metastasis (via radiation therapy).3. No new lesions or evidence of intracranial mass effect.


Instruction: Generate impression based on findings.

Input: Reason: eval TFCC History: ulnar sided wrist pain The exam is limited by motion artifact.LIGAMENTS: The scapholunate and lunotriquetral ligaments are intact.TRIANGULAR FIBROCARTILAGE COMPLEX: TFCC complex is intact.TENDONS: Flexor and extensor tendons are intact. BONES: No evidence of acute fracture. There is mild nonspecific edema in the bone marrow of the dorsal ulna.ADDITIONAL

Output: 1.TFCC is intact.2.Small radioscaphoid ganglion.3.Mild nonspecific edema in the marrow of the distal ulna, with small amount of fluid in the distal radioulnar joint.


Instruction: Generate impression based on findings.

Input: Non-Hodgkin lymphoma, unspecified, unspecified site [C85.90], Reason for Study: ^Reason: Non Hodgkins Lymphoma History: Non Hodgkins Lymphoma There is normal thoracic kyphosis and lumbar lordosis. The spine alignment is anatomic. The vertebral body height is preserved. Subtle increased signal intensity of vertebral bodies especially involving L3 superior aspect and L2 posterior and inferior aspect with enhancement. These findings may indicate compression fracture or cold represent partial involvement with tumor. The signal of the visualized cord is normal. The conus medullaris terminates at the L1-L2 level. There is no evidence of cord compression or mass. Degenerative changes are specified by the intervertebral level as follows: T12-L1: no neuroforaminal narrowing or spinal stenosis. L1-L2: no neuroforaminal narrowing or spinal stenosis. L2-L3: no neuroforaminal narrowing or spinal stenosis. L3-L4: disc dessication, diffuse bulging of disc, no neuroforaminal narrowing or spinal stenosis. L4-L5: diffuse bulging of disc, disc dessication, no neuroforaminal narrowing or spinal stenosis. L5-S1: diffuse bulging of disc, disc dessication,no neuroforaminal narrowing or spinal stenosis.

Output: 1. Normal thoracic spine MRI2. Possible compression fracture on the L3 and L2 vertebral bodies as described above. Lymphoma involvement cannot be completely excluded.3. Disc degenerations without evidence of spinal canal stenosis or neuroforaminal stenosis on lower lumbar spine.


Instruction: Generate impression based on findings.

Input: 24-year-old female patient with history of PSC. ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesions.Scattered mild intrahepatic biliary stricturing in the bilateral hepatic lobes. Tight focal stenosis the right hepatic duct at Klatskin's point appears similar compared to prior examination. Dominant left hepatic duct stricture at Klatskin's point appears similar to prior exam. Again noted is mild biliary wall thickening of the left hepatic duct and proximal hepatic duct. Left lobe atrophy.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: Trace free fluid in the pelvis.

Output: Stable biliary tree abnormalities compatible with primary sclerosing cholangitis with dominant stricture at the left hepatic duct at Klatskin's point. No focal masses.


Instruction: Generate impression based on findings.

Input: Clinical question: Stability of bleed. Signs and symptoms: Altered mental status. Portable CT exam time in the mid or slices were obtained. Images through posterior fossa are compromised due to extensive artifact and patient motion however no gross abnormalities detected. Fourth ventricle is normal in size and in midline position.Images through supratentorial space demonstrate large hematoma likely secondary to hemorrhagic tumor in the left basal ganglia and extensive surrounding echogenic edema. A ring of low density within the hematoma is suspected of tumor. The hematoma measures 43.2-mm times 40-mm in transaxial dimension (axial image 19 of 34). There is significant mass effect on the left lateral ventricle and minimal extension of blood into the ventricle. Multiple small satellite hemorrhagic lesions are also noted. The midline shift of approximately 4.3 mm is noted. A small cortically based high convexity right posterior frontal hemorrhagic lesion is also present on axial image 24.In comparison with the prior MRI examination from 10 to 26/2009 no gross interval change in the size of hematoma is detected.

Output: Multiple hemorrhagic intracranial lesions. Largest within the left basal ganglia remains stable since prior MRI.


Instruction: Generate impression based on findings.

Input: A patient submitted outside study for review. Submitted for review are digital mammographic images (8/24/16), images from stereotactic biopsy of right breast with specimen radiograph and postprocedural right mammographic images (9/16/2016), breast MRI (9/27/2016) performed at outside institution. DIGITAL MAMMOGRAPHIC IMAGES (8/24/16):The breast parenchyma is composed of scattered fibroglandular elements (BiRADS Density Category B). A cluster of pleomorphic calcifications is present at posterior lower outer quadrant in the right breast, measuring 13 x 10 mm.No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in left breast. IMAGES FROM STEREOTACTIC BIOPSY OF RIGHT BREAST WITH SPECIMEN RADIOGRAPH AND POSTPROCEDURAL RIGHT MAMMOGRAPHIC IMAGES (9/16/2016):Stereotactic biopsy of the right breast calcifications at lower outer quadrant was performed by lateral approach. Specimen radiograph demonstrates multiple target calcifications in at least 6 samples. Postprocedural right mammographic images show a marker clip is placed approximately 18 mm medially from the target.Per outside pathology report, the result was malignant; invasive ductal carcinoma grade 3 with ductal carcinoma in situ grade 2 and 3.BREAST MRI (9/27/2016):Breast MRI was performed with a protocol outlined in the outside report. There is a linear non-mass enhancement corresponding to the biopsy-proven carcinoma at posterior lower outer quadrant in the right breast measuring 19 x 18 x 22 mm (AP x LR x CC). A marker clip is present at medial aspect of this non-mass enhancement. There is a linear enhancement from this lesion to lateral side of the skin, consistent with biopsy changes. Multiple slowly enhancing foci and masses are seen in the left breast, likely parenchymal enhancement and benign lesions. No abnormal lymph nodes are identified in either axillary region.

Output: Biopsy proven invasive and in situ carcinoma at posterior lower outer quadrant in the right breast. Although a marker clip is displaced medially on mammogram, MRI demonstrates a marker clip is located within the enhancing lesion.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: 24-year-old female with abdominal pain. Evaluate for placenta accreta and cesarean section scar. PELVIS:UTERUS, ADNEXA: Intrauterine gestation is present. Mild subchorionic hemorrhage is present. Findings of placenta accreta and probable increta located anteriorly along the lower uterine body, likely in site of prior cesarean section scar. No evidence of placenta percreta.Myometrial contractions make evaluation of the uterus difficult, but within this limitation, there is ill-defined low T2 signal anteriorly within the myometrium of the mid uterine body, for which adenomyosis is a consideration.BLADDER: No significant abnormality noted.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.Findings of placenta accreta and probable increta as above. No evidence of placenta percreta.2.Mild subchorionic hemorrhage is present.3.Possible adenomyosis of the mid uterine body.


Instruction: Generate impression based on findings.

Input: Malignant neoplasm of frontal lobe [C71.1], Reason for Study: ^Reason: 34 yo M with recurrent GBM s/p prior surgeries and chemoRT, planning scan for re-RT planning History: none Previously seen tissue defect on the left frontal lobe appears to be slightly shr inked since prior scan.Enhancing lesions on the left frontal lobe adjacent to the excision cavity as well as caudate nucleus is again seen, grossly unchanged since prior scan.Prominent dural enhancement on the right frontal and part of the left frontal lobe reflects postoperative changes.There is no other abnormal enhancing lesion on this scan.The ventricles, sulci and cisterns are unremarkable. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: Postoperative expected changes with residual enhancing lesions along the resection margin, no gross interval changes since prior scan.


Instruction: Generate impression based on findings.

Input: 55 year old female with family history of breast cancer in her sister, mother, maternal grandmother, maternal great aunt, and maternal cousin. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Left optic neuritis with scotoma. Orbits: The globes and optic nerves appears unremarkable. The ocular adnexa are intact. There is no evidence of mass lesions or abnormal intraorbital enhancement.Brain: There is a T2 hyperintense enhancing lesion in the right pituitary lobe that measures up to 6 mm. There is also a non-enhancing focus in the right lateral pituitary lobe that measures up to 4 mm. There is no mass effect upon the optic apparatus. There is no evidence of intracranial hemorrhage or acute infarct. There are a few punctate foci of T2 hyperintensity in the cerebral white matter, without associated enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unremarkable.

Output: 1. An enhancing lesion in the right pituitary lobe that measures up to 6 mm may represent a microadenoma. A non-enhancing focus in the right lateral pituitary lobe that measures up to 4 mm may represent a cystic microadenoma.2. A few punctate foci of T2 hyperintensity in the cerebral white matter are nonspecific.3. The orbits are unremarkable.Discussed with Dr. Reder at 8:40 AM on 1/9/15.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: History of Crohn's disease status post surgery in 2007 presenting with obstructive symptoms. ABDOMEN:LIVER, BILIARY TRACT: Gallstones without acute cholecystitis. Normal liver.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: Very small as mesenteric lymph nodes are noted.BOWEL, MESENTERY: Postsurgical changes from an ileocecectomy. The neoterminal ileum is normal in caliber, wall thickness and enhancement. There is a tiny strand of soft tissue along the mesenteric aspect just proximal to the neoterminal ileum which demonstrating delayed enhancement likely represents postsurgical scarring. There is no proximal bowel dilatation. No significant fibrofatty infiltration. No discrete fluid collection.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Apparent short segment enhancement likely related to contracted segments of the sigmoid colon.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Postsurgical changes from an ileocecectomy without evidence of acute inflammation. No evidence of bowel obstruction.


Instruction: Generate impression based on findings.

Input: Clinical question: 17-year-old male with Chiari malformation. Status post shunt placement. Now with mental status change, concerned for stroke. Signs and symptoms: Altered mental status. Non-enhanced CT of brain:A catheter traversing the midline at the level of the foramina magnum and enters the foot ventricle which is nearly completely collapsed. The catheter extends superiorly to the level of quadrigeminal plate. This is believed to be within the aqueduct. No change since prior exam.Images through supratentorial space demonstrate normal size of lateral ventricles and with no change since prior examination. 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.Two punctate area of subcortical low attenuation symmetrically and bilateral posterior frontal lobes are again identified and are believed to represent prominent perivascular spaces as were noted on prior MRI exam.

Output: No evidence of acute new findings and stable exam since prior study.


Instruction: Generate impression based on findings.

Input: Intra-articular contrast extends from the radiocarpal joint into the distal radioulnar joint consistent with disruption of the triangular fibrocartilage complex. Please refer to the subsequent MRI report for further information.Exposure time: 1 minute and 38 seconds.

Output: Left wrist arthrogram with injection of dilute gadolinium for subsequent MRI arthrogram examination demonstrating tear of the triangular fibrocartilage complex as described above. Please refer to the subsequent MRI report for additional details.


Instruction: Generate impression based on findings.

Input: Female 21 years old with acute liver failure due to Tylenol overdose. AST/ALT improving but the bilirubin is elevating and she has abdominal pain. ABDOMEN:LIVER, BILIARY TRACT: The liver is smooth in contour. There is heterogeneous perfusion of the liver parenchyma which is non-specific. Mild periportal edema. No focal liver lesion is identified. The gallbladder is collapsed. There is no intra or extrahepatic biliary ductal dilatation. There is trace perihepatic fluid.The hepatic vasculature is patent.SPLEEN: No significant abnormality noted.PANCREAS: The pancreas enhances homogeneously. There is no pancreatic ductal dilatation.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.Heterogeneous hepatic perfusion and mild periportal edema can be seen in the setting of acute hepatitis.2.No biliary dilatation.


Instruction: Generate impression based on findings.

Input: Male; 39 years old. Reason: 39 with suspect lesion in the head of pancreas that is too small to characterize on CT scan; please evaluate for any abnormalities History: pancreas lesion ABDOMEN:LIVER, BILIARY TRACT: Hepatic steatosis. Stable segment 6/7 hemangioma measuring up to 2.8 x 2.6 cm (series 13/37). No biliary ductal dilation.SPLEEN: No significant abnormality noted.PANCREAS: No corresponding lesion is seen for previously described subcentimeter hypoattenuating focus in the inferior pancreatic head. A small area of signal dropout on out of phase images in the uncinate process is most likely due to focal fat deposition. No suspicious pancreatic lesions. No pancreatic ductal dilation.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: No suspicious pancreatic lesion to correspond to the abnormality seen on CT.


Instruction: Generate impression based on findings.

Input: 26-year-old female with MENISCI: No significant abnormality noted. No significant meniscal tears are visualized.ARTICULAR CARTILAGE AND BONE: The articular cartilage of the tibia, femur, and patella appear intact.LIGAMENTS: The ACL, PCL, and MCL appear intact. The LCL complex also appears within normal limits. EXTENSOR MECHANISM: No significant pathology is visualized within the extensor mechanism.ADDITIONAL

Output: There is a small joint effusion, however no significant findings to account for patient's pain. Specifically, no evidence of LCL or meniscal tear as clinically queried.


Instruction: Generate impression based on findings.

Input: 53 year old man with history of CAD, with multiple PCI, referred for cardiac MRI for evaluation of chest pain and shortness of breath.MEDICATIONS: ASA, Plavix, lisinopril, Toprol XL, amlodipine, Cellcept, prednisone, methotrexate. First Pass PerfusionDuring hyperemia, has a severe perfusion defect involving the basal inferolateral, mid anterolateral and inferolateral, and apical inferior and lateral walls. The overall ischemia score is 8 out of a possible 32 and 25% of the myocardium is ischemic. Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable. Left VentricleThe left ventricle is moderately dilated with mildly reduced systolic function. The overall LV ejection fraction is 45%, the LV end diastolic volume index is 139 ml/m2 (normal range: 74+/-15), the LVEDV is 278 ml (normal range 142+/-34), the LV end systolic volume index is 77 ml/m2 (normal range 25+/-9), the LVESV is 154 ml (normal range 47+/-19), the LV mass index is 97 g/m2, and the LV mass is 195 g. Abnormal septal wall motion due to patient's underlying left bundle branch block. There is mild LVH. Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 57%, the RV end diastolic volume index is 90 ml/m2 (normal range 82+/-16), the RVEDV is 180 ml (normal range 142+/-31), the RV end systolic volume index is 39 ml/m2 (normal range 31+/-9), and the RVESV is 78 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. There is a large severe perfusion defect in the usual territory of the left circumflex artery. 2. No prior myocardial infarction. The entire myocardium is viable.3. The left ventricle is moderately dilated with mildly reduced systolic function. The overall LV ejection fraction is 45%4. The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 57%I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Male, 44 years old, with heat sensitivity, right facial numbness recurrent, and spasms. The cerebral and cerebellar hemispheres and brainstem show normal signal intensity and morphology. No restricted diffusion is seen.No evidence of parenchymal edema, mass, or mass effect is seen. There is no evidence of intracranial hemorrhage or abnormal extra-axial fluid. The ventricular system is normal in caliber and morphology. Signal intensity of the bone marrow is unremarkable. No significant abnormalities of the paranasal sinuses are detected.

Output: Unremarkable evaluation of the brain with no specific findings to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: Female, 80 years old, with right cranial nerve VI palsy. Periventricular and scattered subcortical foci of white T2 hyperintensity are seen. Patchy foci of T2 hyperintensity are also seen within the pons including relatively asymmetric involvement of the right dorsal pons at the level of the sixth cranial nerve nucleus. However, no diffusion restricting lesions are detected. A more well-circumscribed 2-mm T2 hyperintense focus is also seen at midline in the dorsal pons at the level of the facial colliculi.No evidence of significant parenchymal edema or mass effect is observed. No acute intracranial hemorrhage or any abnormal extra axial fluid collection is seen. The ventricles are normal in size and morphology. No pathologic parenchymal or extra-axial enhancement is detected.The globes are round and symmetric. The extraocular muscles demonstrate normal signal intensity and morphology. The intraorbital fat is clean. No signal abnormality of the optic nerves is detected. A fine pattern of enhancement is noted along the bilateral optic nerve sheaths which is of uncertain significance.The cranial nerves as visualized are within normal limits. Specifically, the left abducens nerve is only vaguely discerned, and the right abducens nerve is not clearly seen. However, no evidence of pathologic cisternal enhancement is detected. The IACs and CP angles are unremarkable.

Output: 1.Evidence of chronic microvascular ischemic disease is seen within the brain and brainstem. This includes lesions within the dorsal pons and, specifically, in the region of the right abducens nucleus. A small T2 hyperintense focus is also demonstrated at midline within the dorsal pons at the level of the facial colliculi which may also reflect chronic ischemic disease.2.On dedicated imaging, no definite orbital or cranial nerve abnormalities are seen. The sixth cranial nerves are not well visualized due to technical limitations, though no pathologic cisternal enhancement is appreciated. 3.There is, however, a fine pattern of enhancement along the bilateral intraorbital optic nerve sheaths which is of uncertain significance. The enhancement is more than typically seen in normal individuals, though there is no evidence of optic nerve signal abnormality or any other pathologic intracranial enhancement to support this finding. This may reflect normal variation, but clinical assessment for an inflammatory process of the optic apparatus should be considered.


Instruction: Generate impression based on findings.

Input: 57 year old female with multifocal invasive cancer of the right breast, undergoing neoadjuvant chemotherapy. History of left mastectomy in 1998. Status post left mastectomy and bilateral retropectoral silicone implants.There is scattered fibroglandular tissue in the right breast.Mild parenchymal enhancement is noted in the right breast.Silicone implants appear intact bilaterally.There are two irregularly-shaped enhancing masses in the right breast, consistent with proven carcinoma. The larger mass is located at 3 o'clock position, measuring 23 x 32 x 27 mm (all measurements: AP x LR x CC), and the smaller mass is located at 9 o'clock position, measuring 17 x 21 x 21 mm. Surrounding these two masses, there is an extensive non-mass enhancement, measuring 48 x 70 x 69 mm, predominantly in the lower half, but extending all four quadrants of the right breast.No abnormal enhancement is seen in left post-mastectomy breast. No abnormal lymph nodes are identified in either axillary region.

Output: 1. Known right multicentric cancer.2. No MRI evidence for malignancy in the left post-mastectomy breast.3. No abnormal lymph nodes in either axillary region.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Please note, there is significant patient motion during the examination degrading the image quality of the contrast enhanced neck MRI. Within the constraints of motion deterioration, the right common carotid artery demonstrates luminal narrowing approximately 32% at the proximal segment. There is minimal narrowing at the distal left common carotid artery approximately 10% without significant stenosis.On the Neck MRA performed using TOF technique, there is demonstration of long segment of luminal narrowing at the proximal left internal carotid artery just beyond the bifurcation. The lesion extends to involve 11.5 mm craniocaudally. However, this long segment luminal narrowing is likely related to TOF MRA related artifacts.Contrast enhanced MRA was not optimal either due to patient's motion, however, based on source image analysis and measurement, the degree of right extracranial ICA stenosis by NASCET criteria is about 60%.The prior CT angiogram dated 9/7/2015, showed moderate wall irregularity and luminal narrowing of about 60% at the same location. Direct comparison was also made with prior MR angiogram there was demonstration of at least 50% stenosis of the right ICA just above the right CCA bifurcation. Therefore, there is no MRA evidence of the degree of luminal stenosis of the right extracranial ICA just above the right CCA bifurcation since prior MRA performed in 2013.There is a separate origin of the left subclavian artery, left common carotid artery, and brachiocephalic artery from the arch. There is luminal narrowing the origin of the right vertebral artery with at least 40% stenosis, which is also similar to previous exam. Remaining right vertebral artery and the left vertebral artery shows normal flow and patency.

Output: 1.This study is significantly motion degraded. There is at least 60% stenosis at the origin of the right extracranial internal carotid artery with no significant progression compared to previous CT dated 9/7/2015 and MRI dated 2/25/2013.2. 40% stenosis at the origin of the right vertebral artery, unchanged from previous.


Instruction: Generate impression based on findings.

Input: Right knee pain, history of microfracture MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: Small full-thickness cartilage loss is seen involving the medial femoral condyle. There is associated underlying reactive marrow signal. The lateral compartment is normal. Mild degenerative signal is also evident within the patellofemoral compartment involving the medial patellar facet but no full-thickness defect is seen.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Articular cartilage loss involving the medial compartment with associated underlying reactive marrow signal. These changes may in part be related to prior intervention and the remaining internal structures of the knee are otherwise intact.


Instruction: Generate impression based on findings.

Input: 56-year-old man with history of hepatitis C and liver lesion seen on CT. ABDOMEN:LIVER, BILIARY TRACT: Multiple round markedly T2 hyperintense lesions are seen scattered throughout the liver (4/8 and 11). These lesions appear to begin enhancing peripherally in arterial phase (12/24 and 30) and become isointense and homogenous with blood pool by the delayed phase of imaging (13/26). The largest of these lesions in segment 4A measures 29 x 23 mm.The background liver is normal in signal and morphology. There is no intra or extrahepatic biliary ductal dilatation. The gallbladder appears normal.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: Multiple liver lesions (including the lesion seen on prior CT and ultrasound) compatible with hemangiomata.


Instruction: Generate impression based on findings.

Input: 43 year old female with BRCA 1 positive, history of ovarian cancer Minimal motion artifact in the left breast. There is heterogeneous amount of fibroglandular tissue in both breasts. Bilateral intact retroglandular saline implants. Mild parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.At least 4 high signal intensity oval circumscribed lesions on T2 sequence in the left and right lobe of liver could represent cysts or hemangiomas but given history of ovarian cancer, cystic metastases remains in the differential.

Output: No MRI evidence for malignancy in the breast. At least 4 high signal intensity oval circumscribed lesions on T2 sequence in the left and right lobe of liver could represent cysts or hemangiomas but given history of ovarian cancer, cystic metastases remains in the differential. If patient has obtained prior liver imaging in the form of CT or MRI that can be helpful for comparison. If not, further evaluation can be performed with a liver MRI with contrast for confirmation. Annual screening mammogram is also recommended if patient has not obtained one in the recent year. BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Routine Screening Mammogram.


Instruction: Generate impression based on findings.

Input: Left lower back pain/buttock pain. Additional history includes known renal cell carcinoma metastases. Five lumbar type vertebral bodies are present. There is diffuse enhancement and edema in the left sacral ala, which has increased in extent since 7/28/2016. Although there is some linear signal abnormality in the anterior aspect of the left sacroiliac, the degree of increased edema and enhancement is suggestive of underlying increasing tumor infiltration. Edema and enhancement surrounds the extraforaminal left L5 nerve root as well as left sacral foraminal nerve roots, without evidence of significant compression.There is redemonstration of a large mass involving the right aspect of the sacrum centered at the right S2 level. Decreased central enhancement of the lesion and now predominantly peripheral enhancement suggests necrosis. The tumor surrounds the right S2 nerve root and to a lesser degree S3 and S1 roots. The previously demonstrated epidural extension is no longer evident. Small enhancing lesions at the anterior superior aspect of the L2 vertebral body is slightly increased, measuring 9 mm on today's examination. A smaller lesion in the posterior aspect of the L2 vertebral body is slightly smaller. The enhancing lesion in the right articular process of L4 has minimally increased in size. The small T12 spinous process enhancing lesion appears grossly stable. Enhancing lesions in both iliac bones were better assessed on prior MR of the pelvis. Elsewhere in the lumbar spine, no large lesions are evident. Vertebral body heights are within normal limits. There is trace anterolisthesis of L5 on S1. Alignment is otherwise within normal limits. The conus medullaris is normal in position.Multilevel degenerative changes are seen, as described below:L1-L2: There is mild disc bulge, ligamentum flavum thickening, and bilateral facet arthropathy. There is no significant spinal canal stenosis. No significant neural foraminal stenosis.L2-L3: There is mild disc bulge, ligamentum flavum thickening, and bilateral facet arthropathy. There is no significant spinal canal stenosis. No significant neural foraminal stenosis.L3-L4: There is mild disc bulge, ligamentum flavum thickening, and bilateral facet arthropathy. There is no significant spinal canal stenosis. There is minimal bilateral neural foraminal narrowing.L4-L5: There is loss of disc height, disc bulge, ligamentum flavum thickening, and advanced bilateral facet arthropathy. There is resulting moderate to severe spinal canal stenosis. There is moderate bilateral neural foraminal narrowing, worse on the left.L5-S1: Grade 1 anterolisthesis with disc uncovering. There is advanced bilateral facet arthropathy. There is partial effacement of the lateral recesses. No significant central canal stenosis. There is minimal right and mild to moderate left neural foraminal stenosis.A large left renal cortical cyst is visualized.

Output: 1. Decreased central enhancement and epidural spread of the large right sacral metastatic lesion is compatible with interval treatment changes.2. Increasing edema and enhancement in the left sacral wing with small linear signal changes in the anterior portion suggest developing stress fracture with findings suspicious for underlying infiltrating tumor. Enhancement and edema surrounding the L5 and sacral nerve roots on the left without significant compression.3. Additional small lesions in the lumbosacral spine overall appear relatively stable with some lesions slightly smaller and some slightly larger. No large new lesion in the lumbar spine or evidence of new epidural tumor extension.4. Redemonstrated multilevel degenerative changes in the lumbar spine with moderate to severe spinal canal stenosis at the L4-L5 level, without significant change since 2/22/2016. Additional details as above.


Instruction: Generate impression based on findings.

Input: Reason: brain and spine mets History: gait ataxia, RUE weakness, lung CA. MRI Brain: Please note lack of intravenous contrast limits evaluation for metastatic disease. There is a 1.2 x 0.9 cm lesion, measured on the axial T2/FLAIR sequences, in the right parietal lobe with susceptibility effect indicative of blood products. There is extensive adjacent vasogenic edema involving portions of the the right frontal, parietal, and superior temporal lobes. There is significant mass effect with 5.4 mm midline shift to the left, not significantly changed compared to recent CT. There is no restricted diffusion to suggest acute ischemia. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.MRI cervical spine:Vertebral body heights in the cervical spine are normal. There is mild reversal of cervical lordosis. Mild degenerative changes are seen throughout the cervical spine without high-grade spinal canal stenosis at any level. Postcontrast images are motion degraded however do not demonstrate suspicious enhancement to suggest osseous metastasis, epidural tumor, or cord lesion.Multilevel degenerative changes, as described below: At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina. Minimal disc osteophyte complex.At C4-5 there is a small disc osteophyte complex with effacement of the ventral thecal sac. No significant spinal canal stenosis. Mild bilateral neural foraminal narrowing.At C5-6 there is a small disc osteophyte complex with effacement of the ventral thecal sac. No significant spinal canal or neural foraminal stenosis. 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 right neural foramen. There is uncovertebral hypertrophy on the left and facet arthropathy resulting in mild left neural foraminal narrowing.Paraspinal soft tissues are unremarkable.

Output: 1. Please note lack of postcontrast brain MRI sequences limits evaluation for metastatic disease. There is a 12x9 mm hemorrhagic lesion in the right parietal lobe with extensive surrounding vasogenic edema presumably representing metastasis given history. Suggest post contrast brain MRI for further evaluation including evaluation for additional lesions. There is mass effect related to the extensive edema with 5 mm leftward midline shift.2. Postcontrast images of the cervical spine are motion degraded but demonstrate no evidence of metastatic disease. There are mild degenerative changes without significant spinal canal stenosis at any level. No cord signal abnormality. Individual levels as above.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Reason: ? Biceps tear History: pain ROTATOR CUFF: There is thickening and intermediate signal intensity within the supraspinatus indicating moderate tendinosis. There is an interstitial tear of the supraspinatus at the level of the myotendinous junction. The infraspinatus muscle and tendon appear intact. The subscapularis and teres minor muscles and tendons appear intact.SUPRASPINATUS OUTLET: There is a trace amount of fluid within the subacromial subdeltoid bursa. Moderate osteoarthritis affects the acromioclavicular joint. GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is anatomic. There is heterogeneity and increased signal abnormality within the superior, anterior and posterior labrum most likely representing a combination of degeneration and degenerative tearing, within the limitations of this non arthrogram study. There are cysts within the posterior superior humeral head. There is osteophyte formation and articular cartilage degeneration affecting the glenohumeral joint indicating moderate osteoarthritis.BICEPS TENDON: The tendon of the long head of the biceps appears intact. There is circumferential fluid as well as foci of low signal intensity within the tendon sheath of the long head of the biceps indicating a tenosynovitis.ADDITIONAL

Output: 1. Rotator cuff tendinosis without evidence of a full-thickness tear or retraction. Interstitial tearing of the supraspinatus. 2. Findings indicating a tenosynovitis of the long head of the biceps tendon, which appears intact.3. Osteoarthritis of the shoulder. Other findings as described.


Instruction: Generate impression based on findings.

Input: 20 years, Male, headache. Brain parenchyma appears within normal limits. No parenchymal signal abnormality. No intracranial mass or mass-effect. No intracranial hemorrhage. No restricted diffusion to suggest acute ischemia. The ventricles are within normal limits in size and configuration. Cerebellar tonsils are borderline low without evidence of Chiari I malformation.No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved. Sella and orbits are grossly within normal limits. There is moderate degree of mucosal thickening involving the left frontal sinus, frontoethmoidal recesses, and left anterior ethmoid air cells. There is also minimal left maxillary sinus mucosal thickening. Bone marrow signal and remainder of the extracranial soft tissues are within normal limits.

Output: 1. Brain parenchyma appears within normal limits.2. Moderate degree of opacification involving the left frontal sinus and left anterior ethmoid air cells.


Instruction: Generate impression based on findings.

Input: Reason: osteomyelitis at based of proximal phalanx based on XR, evaluate for additional source of infection (abscess, additional foci of osteomyelitis) History: as above Note is made of soft tissue irregularity along the plantar aspect of the fifth MTP joint consistent with patient's known history of ulceration. There is increased subcutaneous and soft tissue signal abnormality/inflammatory change in the surrounding area which extends to the level of the base of the proximal phalanx of the fifth toe and also extends posteriorly to the level of the fifth MTP joint. There is increased signal abnormality within the base of the proximal phalanx on fluid sensitive sequences with corresponding decreased signal abnormality on T1-weighted images indicating osteomyelitis. There is increased signal abnormality within the head of the fifth metatarsal on fluid sensitive sequences without corresponding decreased T1 signal abnormality likely reflecting reactive osteitis. There is fluid within the fifth MTP joint which may represent a very mild synovitis. No encapsulated fluid collection is identified to suggest abscess formation. There is increased signal abnormality within the base of the fourth metatarsal which likely represents degenerative change and subchondral cyst formation. There is increased signal abnormality within the distal phalanx of the great toe without corresponding decreased T1 signal abnormality, likely representing reactive osteitis or degenerative change. There is nonspecific subcutaneous edema about the imaged portions of the midfoot/forefoot most pronounced along the dorsal aspect of the tarsals and metatarsals. There is fluid within the first MTP joint which may represent a mild synovitis.

Output: Findings indicating osteomyelitis of the proximal phalanx of the fifth toe of the left foot and other findings as described above. No drainable abscess is identified.


Instruction: Generate impression based on findings.

Input: Left sided weakness. Disorientation, unspecified [R41.0], Eval for thromboembolic stroke. Limited examination was performed to evaluate for acute ischemia. The examination is also limited by motion artifact.There is encephalomalacia in the right occipital lobe in the region of previously identified right posterior cerebral artery territory ischemia. There is a small new area of diffusion restriction and likely FLAIR hyperintensity in the right occipital pole as well as a punctate area of diffusion restriction in the left thalamus, also with FLAIR hyperintensity. In addition, there is a cortical patchy diffusion signal with isointense signal on ADC maps present within the right greater than left splenium of the corpus callosum. There is suggestion of equivocal increased FLAIR signal within this area as well. Multiple scattered foci of FLAIR hyperintensity are demonstrated in the periventricular and subcortical white matter. Patchy FLAIR signal is again seen within the pons. There is no midline shift or mass effect appreciated. No definite gross intra-axial or extra-axial fluid collections are visualized.

Output: 1. Limited MRI of the brain demonstrates small area of acute to subacute ischemia in the right occipital pole as well as a punctate area of acute to subacute ischemia in the left thalamus.2. There is a equivocal diffusion restriction involving the right greater than left splenium of the corpus callosum which may relate to early ischemia.2. Right PCA territory encephalomalacia.3. Periventricular and subcortical white matter as well as brainstem T2/FLAIR signal abnormality likely relates to chronic microvascular ischemic change and appears similar to prior examination.


Instruction: Generate impression based on findings.

Input: Male; 66 years old. Reason: 2.9 cm left adrenal mass identified on CTA abdomen. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Left adrenal nodule measures 3.2 x 2.5 cm on series 9, image 14 and demonstrates heterogeneous enhancement and heterogeneous loss of signal on out-of-phase imaging, the latter of which is indicative of microscopic fat within the lesion. KIDNEYS, URETERS: Numerous bilateral renal cysts. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: Large abdominal aortic aneurysm measures 5.2 x 4.3 cm status post open repair, unchanged (series 9, image 28).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Left adrenal lesion meets criteria for a lipid-rich adenoma as described above. 2.Unchanged abdominal aortic aneurysm.


Instruction: Generate impression based on findings.

Input: Diagnosis: Memory lossClinical question: memory lossSigns and Symptoms: repetition of stories 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.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. The left eye lens is thin.There is hypertrophy of the cruciate ligaments at C1-2 with mild narrowing of the spinal canal.

Output: 1.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 2.There is no evidence for an intracranial mass lesion.


Instruction: Generate impression based on findings.

Input: 44-year-old female with altered mental status. Evaluate for intracranial abnormalities or interval change. There are multiple oval-shaped focal T2-hyperintense, T1-hypointense lesion in the cerebral white-matter that are somewhat perpendicularly oriented relative to the long axis of the lateral ventricles. There is multifocal punctate susceptibility effect in the cerebrum and cerebellum without associated edema, may reflect hemosiderin staining. These microbleeds may be related to end-stage renal disease-associated microangiopathy. Otherwise, there is no acute intracranial hemorrhage or acute infarct. Without contrast, meningitis cannot be evaluated but there is no empyema, parenchymal abscess and no obvious findings of cerebritis. There is no mass-effect, midline shift or brain herniation. The ventricles, sulci and basal cisterns are mildly to moderately enlarged, reflecting underlying global brain volume loss. The major intracranial vascular flow voids are preserved.There are retention cysts in the maxillary sinuses. There has been bilateral eye lens placement. There is no gross destructive skull lesion or gross scalp soft tissue abnormality.

Output: No appreciable interval change compared to the MRI brain from 5/30/2016. The multifocal cerebral white-matter lesion remain nonspecific with differentials including demyelinating disease or prior ischemia or inflammation.


Instruction: Generate impression based on findings.

Input: Reason: fracture? History: osseous mets. Evaluate for ortho surgery. Lumbar spine:Alignment is anatomic. Vertebral body heights are preserved. Intervertebral disc spaces are maintained. Diffuse osseous metastases better seen on recent MRI. Pelvic surgical clips.Pelvis:Lucencies seen within the pelvis compatible with known diffuse osseous metastases.Right hip:Faint lucencies within the proximal femur compatible with known diffuse osseous metastases better seen on recent MRI. No evidence of pathologic fracture.Left hip:Faint lucencies within the proximal femur compatible with known diffuse osseous metastases better seen on recent MRI. No evidence of pathologic fracture.Right femur:Subtle lucencies compatible with known diffuse osseous metastases, better seen on recent MRI. No pathologic fracture.Left femur:Subtle lucencies compatible with known diffuse osseous metastases, better seen on recent MRI. No pathologic fracture.

Output: Known diffuse osseous metastases better seen on recent MRIs. No pathologic fractures.


Instruction: Generate impression based on findings.

Input: Hydrocephalus. Ataxia. There is persistent dilatation of the third and fourth ventricles. There is also downward displacement of the hypothalamus. However, there is patency of the foramina of Monro, sylvian aqueduct and the fourth ventricular outflow. In fact, there appears to be hyperdynamic flow across the sylvian aqueduct, with a prominent cerebrospinal fluid flow jet into the third ventricle. There is multilevel degenerative cervical spondylosis, with mild spinal canal stenosis at C5-C6.

Output: 1. Hyperdynamic cerebrospinal fluid flow through the sylvian aqueduct and disproportionate dilatation of the third and lateral ventricles is compatible with the previously suggested diagnosis of normal pressure hydrocephalus. Please refer to the prior brain MRI report for additional details.2. Multilevel degenerative cervical spondylosis.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Neoplasm of unspecified behavior of bone, soft tissue, and skin [D49.2] / Radiculopathy, lumbar region [M54.16], Reason for Study: ^Reason: hx neuroblastoma with lumbar spine tumor. eval for change History: RLE pain For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. Paraspinal mass seen on the right side of lumbar vertebral body extending from T12 to the level of L34 disc is again seen.Especially the mass from the level of L23 to L34 where the mass extends retrocaval area and retroperitoneal space, appear to increase in thickness since prior scan. For example, the retrocaval enhancing mass is measured about 20.1mm which was about 14mm.Other level of the mass lesions including L12 level lesion which extends toward right side L12 neuroforamen and right side psoas muscle, as well as retropleural space mass on the right side at the level of T12 appear to be stable in size and the extent.The right kidney is smaller than that of the left and minimal mass effects from the L1 level paraspinal mass is seen, unchanged. Mild remodelling of the right L2 transverse process is also seen, unchanged.Unchanged inhomogenous vertebral body signal intensity, mild disc dessication and central disc protrusion at the level of L5S1. The right L34 and left L45 neuroforaminal minimal to mild narrowing is again seen, unchanged since prior scan.Spinal cord signal intensity is normal.There is normal lumbar lordosis. The spine alignment is anatomic. The vertebral body height is preserved. The conus medullaris terminates at the L1 level.

Output: 1. Localized increase in size of retroperitoneal mass and retrocaval mass between the level of L23 and L34 since prior scan.2. Otherwise, no significant interval change of right side paraspinal mass since prior scan.3. Unchanged minimal neuroforaminal stenosis at the level of L34 and L45 as well as disc protrusion at the level of L5S1.


Instruction: Generate impression based on findings.

Input: Ms. Simeran is a 52-year-old female with known left breast cancer with positive lymph nodes status post neoadjuvant chemotherapy. She presents today for imaging evaluation to assess for treatment response. There is heterogeneous amount of fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally. Bilateral prepectoral silicone implants are identified. There has been an interval increase in size of all previously measured left breast reference lesions:-Interval increase in size of index malignancy in the left retroareolar breast, now measuring 3.7 x 2.6 x 2.8 cm (AP x ML x SI), previously measuring 2.6 x 1.9 x 2.5 cm. This mass now invades and includes the entire left nipple.-Interval increase in size of mass located postero-inferior to the index malignancy, at site of mammographically detected asymmetry with calcifications, now measuring 0.9 x 0.6 x 0.9 cm, previously measuring 0.5 x 0.7 x 0.4 cm.-Interval increase in size of left intramammary lymph node, now measuring 0.9 x 0.7 cm, previously measuring 0.6 x 0.6 cm.-In addition, there are two new enhancing foci seen lateral to the left retroareolar index malignancy, suspicious for additional disease.-The total span of enhancement (index malignancy + postero-inferior mass + two new enhancing foci) measures approximately 3.6 x 4.0 cm (AP x ML).In the axillary regions, reference measurements are as follows:-Interval increase in size of previously identified left axillary lymph node, now measuring 5.0 x 3.0 cm, previously measuring 3.0 x 2.2 cm. This node is now centrally necrotic.-Interval increase in size of previously identified right axillary lymph node, now measuring 1.9 x 0.9 cm, previously measuring 1.4 x 0.9 cm. No abnormal enhancement is seen in the right breast.

Output: Interval progression of disease in the left breast and bilateral axillary regions. Continued surgical consultation is recommended for further evaluation at this time. All results and recommendations were discussed with the patient.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Ms. Jaeger is a 53 year old female with a personal history of right breast mastectomy in 2013 for IDC treated with radiation and chemotherapy. No family history of breast cancer. RIGHT BREAST: Patient is status post right breast mastectomy. There is no abnormal enhancement seen in the right chest wall. LEFT BREAST:There is scattered fibroglandular tissue in the left breast. Mild background parenchymal enhancement is noted. There is no abnormal enhancement seen in the left breast. AXILLA:No abnormal axillary lymph nodes are identified in either axillary region.EXTRAMAMMARY:Stable right hepatic cyst.

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


Instruction: Generate impression based on findings.

Input: Left upper extremity radiculopathy, C6-C7 distribution. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained aside from minimal retrolisthesis of C5 on C6. Bone marrow signal is within normal limits. Examination is motion degraded and in adequate to assess for cord signal abnormality. No definite cord signal abnormality however is appreciated. Degenerative changes are seen in the cervical spine as described below:C2-3: Minimal disc bulge and ligamentum flavum thickening. No significant compromise to the spinal canal or neural foramina.C3-4: Mild disc bulge and ligamentum flavum thickening. No significant compromise to the spinal canal or neural foramina.C4-5: Small central disc protrusion and ligamentum flavum thickening with mild spinal canal stenosis. Minimal right neural foraminal narrowing related to uncovertebral hypertrophy. Otherwise no significant neural foraminal stenosis.C5-6: Disc osteophyte complex including a small central disc extrusion which along with ligamentum flavum thickening contributes to mild to moderate spinal canal stenosis. There is mild impression on the ventral cord. There is mild to moderate right and mild left neural foraminal stenosis related to uncovertebral hypertrophy.C6-7: Disc osteophyte complex including disc bulge and bilateral uncovertebral hypertrophy. Mild ligamentum flavum thickening. There is mild spinal canal stenosis. There is moderate left and mild right neural foraminal stenosis.C7-T1: Minimal disc bulge without significant spinal canal stenosis. There is mild left neural foraminal narrowing related to uncovertebral hypertrophy. Right neural foramen is patent. The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: 1. Mild to moderate degenerative changes throughout the cervical spine relatively worse at the C5-C6 and C6-C7 levels. There is moderate left neural foraminal stenosis at C6-C7 where there may be impingement of the left C7 nerve root.2. Motion degradation limits evaluation for cord signal abnormality. No definite cord signal abnormality however is appreciated within this limitation. Additional details as above.


Instruction: Generate impression based on findings.

Input: Female, 4 months old, previously healthy, with new vertical metastatic mass noted in both eyes, with suprasellar lesion seen on imaging. A lobular mass is evident centered in the suprasellar cistern measuring 51 x 38 mm in the axial plane (image 5 series 2301), and up to 23 mm in the coronal plane (image 8 series 2201). The lesion is slightly T1 hypointense to brain parenchyma and uniformly T2 hyperintense. The lesion is solidly enhancing on all postcontrast sequences, though on the early acquired postcontrast images (series 1901), the lesion shows a marginal rind of hyperenhancement which eventually equilibrates with internal enhancement on more delayed images. The lesion contains no internal susceptibility to suggest the presence of blood products or mineralization. The lesion does not diffusion restrict.The lesion encases the ICAs and the M1 and A1 segments, and may potentially narrow these vessels, though flow voids are seen compatible with preservation of patency. The lesion protrudes superiorly, elevating the thalami and frontal lobes as well as deforming the contour of the third ventricle. The lesion extends laterally to slightly displace the left medial temporal lobe. Posteriorly, the lesion extends into the prepontine cistern, particularly on the left where there is some slight mass effect on the left cerebral peduncle.The orbital structures are unremarkable. The lesion engulfs the optic chiasm and optic tracts which are therefore not evaluated. The lesion extends down and may compress the pituitary gland to some degree, though it is distinct from the pituitary gland. Both the anterior and posterior portions of the pituitary gland are visualized and appear otherwise unremarkable.The remainder of the brain demonstrates normal morphology and signal characteristics. The pattern of white matter myelination is appropriate for age. No evidence of restricted diffusion or any parenchymal edema is seen. No acute intracranial hemorrhage is detected. The ventricular system, despite deformation of the third ventricle by tumor, is not dilated. No additional pathologic intracranial enhancement is seen.

Output: A lobular, solid enhancing tumor is evident centered on the suprasellar cistern with mass effect upon the thalami, inferior frontal lobes, left medial temporal lobe and left cerebral peduncle. The lesion encases the terminal ICAs, as well as the A1 and M1 segments, with possible vascular narrowing but with preserved patency.Given the morphology and location of the lesion, a glioma of the optic chiasm or hypothalamus is favored, with pilocytic astrocytoma as the most common histology. By location, craniopharyngioma and germinoma would also be in the differential, but these are considered less likely based on other imaging features.


Instruction: Generate impression based on findings.

Input: Mother diagnosed with breast cancer at 48 years old. History of right breast benign biopsy. There is heterogeneous amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.Within the right retroareolar breast, anterior/mid depth, there is a T1 hyperintense, T2 hypointense lesion with rim enhancement, compatible with a proteinaceous cyst. Within the right upper outer quadrant, mid depth, there is a subcentimeter benign-appearing lymph node. A ribbon biopsy clip within the right breast identified on same day mammogram, is not well visualized on MRI.No suspicious 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: Left renal complex cyst. ABDOMEN:LIVER, BILIARY TRACT: Normal morphology without a focal lesion or biliary ductal dilatation. Normally distended gallbladder.SPLEEN: T2 hyperintense splenic septated cystic nonenhancing lesion is unchanged, most likely benign.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right renal cyst with minimal proteinaceous/hemorrhagic components. Exophytic left renal inferior pole intrinsically T1 hyperintense lobular lesion measures 2.1 x 1.4 cm, essentially unchanged in size. Accounting for subtraction misregistration artifact there is no significant postcontrast enhancement.There is a smaller likely proteinaceous/hemorrhagic cyst in the superior pole of the left kidney measuring 1.1 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: Stable hemorrhagic/proteinaceous cysts in the left kidney.


Instruction: Generate impression based on findings.

Input: Male, 46 years old, ischemic stroke workup. Patient has aphasia, right arm hemiplegia and left-sided neglect. Status post embolectomy and recanalization of the left middle cerebral artery. There is diffusion restriction compatible with acute stroke in the left middle cerebral artery territory prominently affecting the left temporal lobe, basal ganglia, and minimally the insula. There are also small areas of acute infarct in the posterior left frontal and anterior parietal lobes, including the lateral post central gyrus. There is no evidence of hemorrhagic conversion. T2/FLAIR signal abnormality is associated with these regions. There is evidence of remote infarcts with small areas of encephalomalacia redemonstrated in the right frontal and occipital lobes. No significant mass effect or midline shift is present. There are no abnormal extra-axial fluid collections. Paranasal sinuses and mastoid air cells grossly clear.

Output: 1. Findings compatible with acute infarct in the left middle cerebral artery territory correlating with CTA findings of left middle cerebral artery occlusion. No evidence of hemorrhagic conversion.2. Small areas of encephalomalacia in the right frontal and occipital lobes likely related to remote ischemic events.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Reason: stiffness of the L.arm, H/O L.elbow fracture History: contracture of the L. Elbow LIGAMENTS: The ulnar collateral and radial collateral ligaments appear intact. The lateral ulnar collateral ligament appears intact.TENDONS: The common flexor tendon appears intact. There is minimal intermediate signal intensity within the common extensor tendon indicating mild tendinosis. The common extensor tendon appears intact. The biceps and brachialis tendon appear intact. The triceps tendon appears intact.ARTICULAR SURFACES AND BONE: There is deformity of the medial aspect of the radial head with near full-thickness to full thickness articular cartilage degeneration and underlying subchondral signal abnormality best seen on the axial T2 fat saturated sequence (series 6; image 16 and series 14; image 12). This appears most consistent with the sequela of a prior radial head fracture although the possibility of an osteochondral defect cannot be completely excluded. There is also irregularity of the capitellum with full-thickness articular cartilage degeneration also likely related to prior trauma. There is osteophyte formation indicating mild osteoarthritis. No definite loose body is identified.SURROUNDING STRUCTURES: The remainder of the imaged musculature and soft tissues are unremarkable.ADDITIONAL

Output: 1. Deformity of the medial aspect of the radial head with radiocapitellar articular cartilage degeneration that appears most consistent with the sequela of prior remote trauma. However, an osteochondral defect cannot be completely excluded. There is also irregularity of the capitellum with full-thickness articular cartilage degeneration which may also likely related to prior trauma. 2. Osteoarthritis of the elbow. Other findings as described.


Instruction: Generate impression based on findings.

Input: patient with posterior epidural fluid collection. Please aspirate sample. 61 yo female Serial CT images obtained during the aspiration procedure demonstrate the needle placement within the fluid collection. Following needle removal images obtained demonstrate no complications . Air was present in the remaining cavity.

Output: Epidural fluid collection aspiration under CT guidance.