Instruction: Generate impression based on findings.

Input: 51-year-old female with knee pain. Evaluate for meniscal tear. Suboptimal evaluation secondary to artifact and patient inability to tolerate further imaging, particularly affecting the coronal PD fat saturated sequence.MENISCI: The medial and lateral meniscus appear intact.ARTICULAR CARTILAGE AND BONE: No bone marrow signal abnormalities are identified. There is superficial fraying of the articular cartilage along the lateral facet of the patella. There is a full-thickness cleft along the medial facet of the femoral trochlea, centrally.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Borderline tibial tubercle to trochlear groove distance with a full-thickness articular cartilage cleft along the femoral trochlea as described above.2. Small knee joint effusion.


Instruction: Generate impression based on findings.

Input: History of prostate cancer. Evaluate extent of disease. PSA 5.86. Prostate biopsy from January 2014 revealed 1 core of Gleason 3+3 involving less than 2% of tissue. PELVIS:PROSTATE:Prostate Size: 3.9 x 5.3 x 4.8 cmPeripheral Zone: The peripheral zone is homogeneous hyperintense on T2-weighted imaging without a discrete lesion.Central Gland: Changes of benign prostatic hyperplasia.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: No evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: Medial to the right external iliac artery is a region fibrous tissue versus fat necrosis, benign. OTHER: No significant abnormality noted.

Output: No dominant lesion is evident.


Instruction: Generate impression based on findings.

Input: 81-year-old female status post fall; evaluate for fracture/dislocation BRAIN:There is no evidence of acute intracranial hemorrhage, mass or edema. Several bilateral lacunar infarctions in the basal ganglia. Multiple nonspecific foci of attenuation are seen in the periventricular and subcortical white matter which may represent small vessel ischemic disease, appearing similar to the previous MRI.Ventriculomegaly out of portion with age-related volume loss and may represent normal pressure hydrocephalus, unchanged. Prominence of the cortical sulci consistent with age-related volume loss. Atherosclerotic calcifications are seen in the internal carotid arteries, most prominently at the carotid bifurcations.The calvaria and skull base are radiographically normal without evidence of depressed skull fracture. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.CERVICAL SPINE:There is reversal of the normal cervical lordosis with grade 1-2 anterolisthesis of C3 on C4. There is also grade 1 retrolisthesis of C4 on C5 and of C5 on C6. The vertebral body heights are grossly maintained. Prevertebral soft tissues are grossly unremarkable.Multilevel extensive degenerative changes are seen throughout the cervical spine with uncal vertebral joint hypertrophy, osteophyte formation, disk space narrowing, and neuroforamina narrowing. If high clinical concern for cord or ligamentous injury, MRI may be obtained for further evaluation.

Output: 1. No acute intracranial hemorrhage. No evidence of acute fracture.2. Stable ventriculomegaly. 3. Bilateral lacunar infarcts and likely small vessel ischemic disease of indeterminate age, appearing similar to the previous exam.4. Reversal of normal cervical lordosis extensive multilevel degenerative changes. If high clinical concern for spinal cord or ligamentous injury, MRI may be obtained for further evaluation.


Instruction: Generate impression based on findings.

Input: Female, 6 years old, with C2 fracture and concern for vertebral dissection. Evaluate for ischemia. MRI brain:The external contour of the brain conforms to the dysmorphic calvarium, similar to prior exams. No evidence of restricted diffusion is seen. No parenchymal edema or mass effect is detected.A small area of encephalomalacia in the right frontal lobe related to prior ischemia is unchanged. Likewise, scattered foci of T2 hyperintensity in the bilateral cerebral watershed zones, in the periventricular tissues, the right greater than left occipital lobes, and the cerebellum are unchanged compatible with chronic ischemic lesions. A curvilinear area of cystic encephalomalacia involving the superior right thalamus related to prior ischemia is unchanged.No definite evidence of any new intracranial lesion is seen. No acute intracranial hemorrhage or any abnormal extra axial fluid collection is observed. The lateral and third ventricles remain prominent, similar to prior. A cavum septum pellucidum et vergae is redemonstrated.MRA neck:Although MRA images are degraded by motion artifact, the cervical intervertebral arteries of the neck appear to show normal caliber throughout. In particular, no evidence of significant narrowing or dissection is seen at any point in the vertebral arteries.MRI C-spine:Known bilateral fractures through the dysmorphic pedicles of C2 are better visualized on prior CT. However, the fractures are vaguely identified with edema in the adjacent marrow.The anterior prevertebral tissues are significantly thickened showing heterogeneous T1 isointense and T2 hyperintense signal suggesting a combination of edema and blood product. No evidence of injury of the adjacent intervertebral discs is seen which reduces concern for an anterior longitudinal ligament injury.The anterior atlantooccipital and atlantoaxial ligaments are visualized and appear intact. The apical ligament and tectorial ligament are both visualized and appear intact. No injury to the posterior longitudinal ligament is suspected. The posterior atlantooccipital ligament does not appear to be injured. However, between the posterior arch of C1 and the fused posterior elements of C2-4, extensive soft tissue edema is seen. The posterior atlantoaxial ligament appears attenuated and may have been avulsed from its attachment at the spinous process and laminae at C2. The nuchal ligament appears to be intact, though there is likely some injury of the interspinous connective tissue.There is minimal if any effacement of the dorsal thecal sac by edema or fluid posterior to the injured atlantoaxial ligament. However, no large or significant epidural collections are seen. The spinal canal is not compromised at any level. No evidence of spinal cord edema or intramedullary hemorrhage is seen.Multiple cervical anomalies are redemonstrated likely related to Crouzon syndrome. Briefly these include a bulbous and dysmorphic odontoid process; hypoplasia of the C2, C3 and C4 vertebral bodies; fusion of the C2-C4 posterior elements; and partial anterior midline clefting of the cervical vertebrae from C3 down.

Output: 1.No acute intracranial abnormality is seen. Multiple chronic ischemic lesions are redemonstrated scattered through the cerebral hemispheres and cerebellum without significant interval change.2.Findings are seen compatible with bilateral fractures through the C2 pedicles. Prevertebral edema and/or hemorrhage is noted, but there is no evidence of any additional vertebral body or disc injury.3.Findings are seen concerning for strain or tear of the posterior atlantoaxial ligament. The remaining craniocervical ligamentous attachments appear to be intact. There is likely interspinous connective tissue injury between C1 and C2.4.Within the limitations of a motion degraded examination, no findings are seen to suggest vertebral artery dissection or occlusion.


Instruction: Generate impression based on findings.

Input: Reason: r/o seizure focus and stroke History: facial twitching, weakness The CSF spaces are appropriate for the patient's stated age with no midline shift. There is redemonstration of an extra-axial mass located the level of the foramen magnum and premedullary cistern, anterior to the medulla and cervicomedullary junction an eccentric towards the left which measures 11 x 32 mm sagittal dimensions on the current exam and previously measured 11 x 32 mm sagittal dimensions. It is associated with mild displacement of the cervicomedullary junction posteriorly. It abuts, partially surrounds and displaces the left vertebral artery.There are T2 and flair signal hyperintensities present in the cerebellar hemispheres, pons and midbrain as well as the thalami and basal ganglia bilaterally. These are associated with a similar distribution but lesser in number of signal hypointensities on susceptibility imaging.There is a mild degree of periventricular and subcortical confluent hyperintense white matter lesions present identified on the FLAIR and T2 images.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate minor mucosal thickening in the right maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Since the prior examination an extra-axial mass at the level of the foramen magnum has not changed substantially in dimensions. This mass partially encases the left vertebral artery.2.Microhemorrhages in the brainstem, thalami and basal ganglia are in a distribution suggestive of hypertension.3.Periventricular and subcortical white matter changes of a moderate degree are nonspecific. At this age they are most likely vascular related. 4.Lesions are also present in the basal ganglia, thalami, brainstem and cerebellar hemispheres. These are suspected to be related to prior vascular insults.


Instruction: Generate impression based on findings.

Input: 45-year-old male with maxillary sinus cancer. To status post chemo. Evaluate disease compared to the prior study. CT of the soft tissues of the neck.A very large destructive mass within the bilateral ethmoid sinuses with extension bilaterally into the orbits (right greater than left with significant mass-effect on the optic nerve), sphenoid sinus, nasal cavity, right maxillary sinus with extensive bony destruction is again identified. The mass at the level of skull base causes erosion and extends into bilateral subfrontal extra-axial space. No definitive evidence of any parenchymal edema is detected. In comparison with the prior exam no appreciable interval change in the size of this tumor is detected. The mass on the right involves the right pterygopalatine fossa. No abnormality of the cavernous sinus can be detected on this exam. If this area needs to be further evaluated an MRI examination is recommended.Images through the rest of the soft tissues of the neck demonstrate no pathologic adenopathy.No evidence of spinal column abnormality is detected.Limited images through the apices of the lungs are negative. Limited view of mediastinum is negative for lymphadenopathy. Please review the dictated report of CT of chest performed the same date.CT of brain with infusion.Enhancing mass in bilateral subfrontal region secondary to spread of tumor into the intracranial spaces noted. No areas of vasogenic edema of the frontal lobes is detected. No evidence of enhancement of the brain parenchyma or the leptomeninges is identified. The brain parenchyma remains essentially within normal limits.

Output: 1.No definitive evidence of any appreciable change in in the size, morphology or pattern of enhancement of a large destructive mass in bilateral ethmoid air cells, sphenoid sinus, skull base, nasal cavity and right maxillary sinus.2.Bilateral subfrontal tumor spread with no evidence of edema or leptomeningeal enhancement all frontal lobes.3.Unremarkable CT I examination of brain parenchyma and leptomeninges.


Instruction: Generate impression based on findings.

Input: 65 year-old male with multi-valve disease and possible pulmonary sarcoidosis on CT. CMR to rule out cardiac involvement. Left VentricleThe left ventricle is normal in size and hyperdynamic. The overall LV ejection fraction is 78%, the LV end diastolic volume index is 57 ml/m2 (normal range: 74+/-15), the LVEDV is 117 ml (normal range 142+/-34), the LV end systolic volume index is 13 ml/m2 (normal range 25+/-9), the LVESV is 27 ml (normal range 47+/-19), the LV mass index is 50 g/m2 (normal range 85+/-15), and the LV mass is 104 g (normal range 164+/-36). 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.Left AtriumThe left atrium is normal in size. Flow disturbance seen at the level of the fossa ovalis in the inter-atrial septum suspicious for PFO. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 57%, the RV end diastolic volume index is 76 ml/m2 (normal range 82+/-16), the RVEDV is 157 ml (normal range 142+/-31), the RV end systolic volume index is 32 ml/m2 (normal range 31+/-9), and the RVESV is 66 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThere is an aortic bioprosthesis. Flow acceleration noted. Quantification of flow not performed. Mild aortic regurgitation.Mitral ValveThere is significant mitral annular calcification with flow acceleration in keeping with significant mitral stenosis. Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is at least moderate tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered. Refer to recent CT for pulmonary findings.

Output: 1. The left ventricle is normal in size and hyperdynamic. The overall LV ejection fraction is 78%. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.2. The right ventricle is normal in size and systolic function. The overall RV ejection fraction is 57%.3. There is significant mitral annular calcification with flow acceleration in keeping with significant mitral stenosis. These findings should be correlated with recent echocardiography. 4. There is an aortic bioprosthesis with flow acceleration. 5. The tricuspid valve opens widely. There is at least moderate tricuspid regurgitation.6. Flow disturbance seen at the level of the fossa ovalis in the inter-atrial septum suspicious for PFO. Unable to confirm on MRI. Suggest confirmation on intra-opertative TEE if patient is going to the OR.7. No evidence for cardiac sarcoid on this study.


Instruction: Generate impression based on findings.

Input: Cisternogram for assessment of ventricles. Hydrocephalus, VP shunt infection status post removal and EVD placement on 9 -- 11. Comparison with the prior examination of the same date which was performed at 16:59:44 hours there is evidence of increase in the size of the supratentorial ventricular system. The fourth ventricle remains stable and normal. No additional findings.

Output: Increase in the size of supratentorial ventricular system since prior study of the same date.


Instruction: Generate impression based on findings.

Input: 49-year-old female with strong family history of breast cancer. Family history of breast cancer in her mother x 4 times. Personal history of bilateral benign breast biopsies (left breast 2:00-fibroadenoma). She has no current breast related complaints. There is heterogeneous amount of fibroglandular tissue in both breasts.Marked parenchymal enhancement is noted bilaterally.Scattered cysts are identified in both breasts. Previously biopsied left breast fibroadenoma in the left lateral breast is unchanged.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: A counting sequence was not provided. Correlating with previous MRI cervical spine, the last fully visualized vertebra on the sagittal images is designated as T12, with significant disc degeneration at C6-C7 as noted previously. Axial T2-weighted images through the thoracic cord are somewhat inhomogeneous secondary to technical factors.The thoracic spine is in normal alignment, with a normal thoracic kyphosis. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. A rounded area of T1/T2 hyperintensity is seen in the T5 vertebral body inferiorly which appears to represent a hemangioma.The spinal cord is of normal caliber. There are questioned areas of patchy abnormal T2/STIR hyperintensity scattered along the thoracic cord, most conspicuous at the T2-T3 level. Additional questioned findings are seen on the right dorsal lateral aspect of the cord at T6-T7 and along the dorsal midline cord at the lower T10 level, perhaps affecting the conus at the mid T12 level.There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the thoracic spine. There are incidental rounded T2 hyperintense lesions associated with the kidneys, which are nonspecific but most likely represent small cysts.

Output: 1. Questioned scattered areas of patchy abnormal signal along the thoracic cord, which given the previous cervical cord findings, may represent additional demyelinating plaques. Relation is somewhat limited due to inhomogeneity of the thoracic cord signal secondary to technical factors.2. No significant thoracic spondylotic changes. Redemonstration of focal degenerative changes at C6-C7.


Instruction: Generate impression based on findings.

Input: 65-year-old woman with pressure ulcer of the sacrum, evaluate extent of wound. There has been suspected interval removal of the coccyx given an apparent osteotomy line, although destruction is not excluded. There is soft tissue irregularity with broad ulceration and gas extending to the sacrum, with abnormal signal intensity at the underlying distalmost segments of bone. The ulceration traverses nearly the width of the sacrum. There is enhancement of the soft tissues in this region, as well as of the distalmost osseous segments. Evaluation of the pelvis is otherwise within normal limits.

Output: Ulceration with suspected partial surgical resection of the coccyx, and osteomyelitis of the distalmost sacral segments.


Instruction: Generate impression based on findings.

Input: Female, 29 years old, with abnormal prenatal ultrasound, 23 weeks gestational age. Failure of hemispheric separation is seen with a smooth band of cortex which spans the midline anteriorly. The interhemispheric falx has not developed anteriorly, though there may be a partial falx posteriorly. Neither the corpus callosum nor the septum pellucidum have developed. A single communicating ventricle is seen. The deep nuclei including the basal ganglia and thalami are at least partially if not completely fused. Partial temporal lobe development is seen. The cortical mantle thins posteriorly where there is prominence of the CSF space. The cerebellum appears to have developed normally. No definite evidence to suggest intracranial hemorrhage is seen.

Output: Findings are seen compatible with holoprosencephaly. Based on the specific imaging features, the severity appears to fall somewhere between the semilobar and alobar variants.


Instruction: Generate impression based on findings.

Input: New onset headaches with dizziness and giddiness. The brain parenchyma appears within normal limits. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. Pituitary gland appear unremarkable. There is minimal mucosal thickening involving right frontal and anterior ethmoid sinuses as well as probable small retention cyst in the left maxillary sinus. The orbits, skull, and scalp soft tissues are grossly unremarkable.

Output: MRI of the brain is within normal limits.


Instruction: Generate impression based on findings.

Input: 51 years Female (DOB: 12/7/1964)Reason: Evaluate for metastases, known metastatic synovial sarcoma with known spinal lesion at T4. History: LE paresthesiaPROVIDER NAME: HARVEY M GOLOMB HARVEY M GOLOMB MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. There are a couple of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. One located in the left frontal lobe subcortical white matter is associated with an adjacent punctate focus of signal loss on susceptibility imagingNo abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal enhancing lesions are identified in the cervical spine.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.Thoracic spine:There is a 21 x 10 mm sagittal dimension mass centered in the thoracic spinal cord at the T4-5 disc space level. It appears to be intra-axial with an exophytic component. There is associated T2 signal hyperintensity within the spinal cord extending up to the T2 vertebral body level and down to the T5-6 disc space level. It is well-circumscribed. It is slightly hyperintense to the spinal cord on T1-weighted imaging and hyperintense relative to the spinal cord at T2-weighted imaging.There is an airspace opacity present along the right upper lobe associated with streak-like opacities. It measures approximately 12 mm in size.There is right-sided pleural thickening present associated with loss of volume in the right chest cavity indication of prior chest surgery.There is a T1 hyperintense lesion measuring 10 mm located within the T1 vertebral body which suppresses on the fat suppressed images and most likely represents a hemangioma.The thoracic vertebral bodies are appropriate in the overall alignment and height. Lumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. No abnormal enhancing lesions are identified in the lumbar spine.At L5-S1 there is a right lateral recess disc protrusion present which mildly impresses on the nerve roots of the right lateral recess and effaces the fat ventral and posterior to the nerve roots of the right lateral recess.At L4-5 there is some loss of disc space height, disc desiccation mild disc bulge and some mild ligamentum flavum hypertrophy. There is no significant compromise to the spinal canal or exiting nerve roots at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.There is a mass centered in the thoracic spinal cord at the T4-5 disc space level associated with some adjacent edema in the spinal cord. This is suspicious for neoplasm which could either be primary or secondary.2.There is a 12 mm right upper lobe lung lesion suspicious for round atelectasis. Please refer to CT scan of the same date for further comments.3.The patient is status post right lung surgery. 4.There is right-sided pleural thickening present. Please refer to CT scan of the same date for further comments.5.There is some mild degenerative change in the lower lumbar spine with some mild encroachment of the nerve roots of the right lateral recess at L5-S1 due to a disc protrusion


Instruction: Generate impression based on findings.

Input: 67 year-old female with left arm tingling and numbness. There is no evidence of intracranial hemorrhage, mass or edema. Diffuse areas of hypodensity in the periventricular and subcortical white matter distribution consistent with small vessel disease, age indeterminate but grossly overall unchanged from the previous examination. Focal area of hypodensity adjacent to the right thalamus and basal ganglia unchanged from the previous study. No new cortical stroke is noted. If there is clinical concern for acute ischemia, an MRI may be considered.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized mastoid air cells are normally pneumatized. Limited view of the paranasal sinuses are unremarkable.

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


Instruction: Generate impression based on findings.

Input: Non-traumatic intracranial hemorrhage. Seizures. Follow-up. There is symmetric, diffuse cortical diffusion restriction involving both cerebral hemispheres. This is associated with increased cortical T1 and T2 FLAIR signal. The increased cortical T1 signal may reflect early laminar necrosis. There is also diffusion restriction diffusely involving the corpus callosum and the corticospinal tracks, the later best seen at the level of the internal capsules and cerebral peduncles, which is probably either from acute Wallerian degeneration secondary to the cortical injury. The deep gray nuclei and the cerebellum are fairly preserved. There is no brain herniation.There are bilateral subdural effusions that are more FLAIR hyperintense to the intraventricular CSF overlying both cerebral convexities, with a maximum thickness of 6 mm. More T1-hyperintense subdural effusions are present in the posterior fossa. There is only mild apparent mass-effect on the underlying brain. There are foci of susceptibility artifact reflecting the presence of blood products within the subarachnoid and subdural spaces. This is most pronounced in the subarachnoid spaces near the vertex and the subdural collections in the posterior fossa. There is no definite intraparenchymal hemorrhage. There are thin multifocal subgaleal effusions. Major intracranial vascular flow voids are preserved. There are secretions along the posterior pharyngeal wall.

Output: 1.Diffuse cerebral cortical diffusion restriction is most compatible with severe, global anoxic injury. The deep gray nuclei and the cerebellum are spared.2.Diffusion restriction along the cortical spinal tracts and corpus callosum is most likely reflective of acute Wallerian degeneration secondary to the severe cortical injury.3.Small subdural collections are present over both cerebral and both cerebellar convexities. There are blood products within the subarachnoid space and the subdural collections as described above.


Instruction: Generate impression based on findings.

Input: Asymptomatic female presents for routine screening mammography. She has BRCA mutation and a family history of breast cancer in two maternal and an ovarian cancer in a maternal aunt. Personal history of oophorectomy. Two standard digital views of both breasts were performed with tomosynthesis and reviewed with the aid of R2 CAD. The breast parenchyma is heterogeneously dense, which may obscure small masses (BiRads Density Category C). A 7 mm circumscribed benign mass in the right breast at the 12:00 position is stable when compared to the prior MRIs. Stable fibroadenolipoma of the right breast. No suspicious masses, microcalcifications or areas of architectural distortion are present.

Output: Stable masses of the right breast. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 2 - Benign finding.RECOMMENDATION: NSC - Screening Mammogram.


Instruction: Generate impression based on findings.

Input: Male; 66 years old. Reason: urothelial cancer, s/p chemoradiation, restage History: urothelial cancer, s/p chemoradiation, restage ABDOMEN:LUNG BASES: Large right and small left pleural effusions, partially visualized. See report from CT chest performed on the same day.LIVER, BILIARY TRACT: No focal hepatic lesions. Distended gallbladder, which may be due to fasting state. No biliary ductal dilation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable atrophic right kidney. No hydronephrosis. MR urogram images are limited in the upper abdomen due to pleural effusions and motion artifact. However, the distal ureteroenteric anastomosis is well-visualized and appears patent with no definite recurrent disease.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.CALCIFICATIONS IN ABDOMINAL AORTA AND ITS BRANCHES: Moderate.BOWEL, MESENTERY: Small hiatal hernia. Mild dilation of proximal small bowel loops, similar to prior study and suggestive of persistent partial distal small bowel obstruction.BONES, SOFT TISSUES: Right mid anterior abdominal wall ileal conduit. Mild body wall anasarca.OTHER: Mild abdominopelvic ascites.PELVIS:PROSTATE, SEMINAL VESICLES: Status post cystoprostatectomy.BLADDER: Status post cystoprostatectomy.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: As above.BONES, SOFT TISSUES: Mild body wall anasarca.OTHER: Mild abdominopelvic ascites.

Output: 1. No evidence of recurrent or metastatic disease in the abdomen and pelvis.2. Findings suggestive of persistent partial distal small bowel obstruction.3. See report from CT chest performed on the same day.


Instruction: Generate impression based on findings.

Input: Multiple sclerosis [340], Reason for Study: ^Reason: multiple sclerosis flare History: left leg motor and/or sensory cortex. Also occular symptoms, ataxia Brain MRI:There is no evidence of acute ischemic or hemorrhagic lesion on this scan.Multifocal somewhat patchy high signal intensity lesions on FLAIR images on bilateral periventricular white matter extending toward subcortical white matter with perpendicular to ventricular wall appear to be consistent with multiple sclerosis lesion. Since most of those lesions show tissue losses on T1 weighted images, high signal intensity lesions on FLAIR images could represent burn out lesions.There is no evidence of abnormal enhancement.There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.C-Spine:There are multifocal various sized some linear and some nodular high signal intensity lesions (most prominent on C3 level) on cervical spinal cord as well as brain stem on T2 and STIR images indicating demyelinating lesions.There is minimal bulging of disc at the level of C34, otherwise unremarkable.No abnormal enhancement.Thoracic Spine:There are linear and slightly patchy increased signal intensities especially mid to lower thoracic spinal cord indicating demyelinating lesions.Intervertebral discs are unremarkable.Neural foramen and spina canal are unremarkable.No abnormal enhancement.Lumbar Spine:There is patchy high signal intensity lesion on the conus on T2 weighted image indicating demyelinating lesion. The spinal cord completed at the level of T12-L1.There is intervertebral disc dessication at the level of L5S1 with minimal central protrusion which abuts thecal sac.Small (5.5mm) perineural cyst on the right side of likely S4 root.No abnormal enhancement.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. Multiple non enhancing high signal intensity lesions on FLAIR images with evidence of corresponding tissue losses indicate possible burn out lesions of multiple sclerosis. Comparison of prior scan might be helpful for more precise evaluation of each lesion activity. 3. Multifocal patchy and some nodular high signal intensity lesions involving thoracic and lumbar spinal cords on T2 images indicating demyelinating lesions.4. Disc protrusion with disc dessication at the level of L5S1.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Visual disturbance. Word-finding difficulties. There is a punctate focus of restricted diffusion in the posterior left putamen. There is a background of mild cerebral white matter T2 hyperintensity, which is nonspecific, but may represent chronic small vessel disease. There is no evidence of intracranial hemorrhage or mass. The brain parenchyma otherwise appears unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable. There are scattered subcentimeter paranasal sinus retention cysts.MRA

Output: 1. A punctate focus of restricted diffusion in the posterior left putamen is compatible with an acute lacunar infarct. 2. No evidence of significant steno-occlusive arterial lesions.3. Fusiform dilatation of the left V4 vertebral artery with a superimposed 5 wide mm wide based aneurysm. 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: nurse aide who lifts pts suffered incr pain R shoulder after lifting heavy pt last week; pls eval persistent/worsened shoulder pain Some sequences are limited by patient motion artifact.ROTATOR CUFF: Intermediate signal intensity and thickening of the posterior fibers of the supraspinatus tendon and anterior fibers of the infraspinatus tendon indicating mild-to-moderate tendinosis. Relatively focal high signal intensity within the bursal surface fibers of the rotator cuff at the junction of the supraspinatus and infraspinatus, indicating interstitial tearing with possible extension to the bursal surface. This is situated approximately 1 cm proximal to the tendinous insertion on the greater tuberosity and is approximately 1 cm in longitudinal dimension and 5 mm in AP dimension. This tear involves less than 50% of the tendon thickness. We see no full-thickness rotator cuff tear. Supraspinatus and infraspinatus muscles appear normal without edema to suggest acute strain. Teres minor and subscapularis tendons and muscles are intact. SUPRASPINATUS OUTLET: AC joint appears normal. No frank fluid in the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral joint alignment is normal. No glenohumeral joint effusion. Evaluation of the labrum is limited on some sequences due to patient motion artifact. Given this limitation, we see no fluid-filled labral tear. There is a defect centrally within the glenoid with thinning of the overlying cartilage, which may represent an unusually large anatomic variant (bare area) or be degenerative in etiology as previously suggested. This appears similar to the prior study.BICEPS TENDON: Long head of the biceps tendon is intact. ADDITIONAL

Output: 1.Slightly limited study due to patient motion artifact.2.Rotator cuff tendinopathy and partial-thickness likely interstitial tear as described above.3.Defect centrally of the glenoid may represent an unusually large anatomic variant (bare area) or be degenerative in etiology as previously suggested. This appears similar to prior study.


Instruction: Generate impression based on findings.

Input: Reason: 27 y/o lady w/ a hx of liver transplant and now w/ RUQ pain and fever History: RUQ pain ABDOMEN: Susceptibility artifact at the porta hepatis likely due to cholecystectomy clips limits examination.LUNG BASES: Small left and trace right pleural effusions, new compared to prior outside CT. LIVER, BILIARY TRACT: Postsurgical changes of a liver transplant and cholecystectomy. No intrahepatic biliary ductal dilatation. See below in pancreas.SPLEEN: Perisplenic varices.PANCREAS: In the pancreatic head, there is a multiloculated fluid collection/cystic lesion measuring approximately 6.2 x 4.6 x 5.7 cm (series 301 image 20, series 401 image 12), not significantly changed. Within this collection/lesion, there is polypoid ill-defined hypointense signal that enhances after gadolinium administration (series 401 image 13). Associated upstream pancreatic ductal dilatation up to 6 mm in the body and tail (series 301 image 17). The pancreatic duct appears to communicate with the fluid collection/cystic lesion (series 301 image 18).This also appears to communicate with a collection/lesion that is within the liver parenchyma or subcapsular region that measures approximately 3.3 x 4.4 x 4.7 cm (series 301 image 29, series 401 image 16), not significantly changed. The polypoid hypointense signal within the pancreatic collection/lesion also appears to communicate with a hypointense nodular focus (series 301 image 26) within the liver collection/lesion (series 401 image 16). Adjacent hyperemia in the surrounding liver parenchyma.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: Multiple additional multiloculated collections/cystic lesions throughout the abdomen. The largest in the mid abdomen measures 3.2 x 5.1 x 3.5 cm (series 301 image 6, series 401 image 10), not significantly changed. Small amount of perihepatic and perisplenic free fluid.

Output: Multiloculated fluid collection/cystic lesion within the pancreatic head, which appears to communicate with dilated pancreatic duct and with a multiloculated fluid collection/cystic lesion within/abutting the liver. These collections/lesion have internal enhancing components which may represent granulation tissue or tumor. The size has not significantly changed compared to outside CT. Additional multiloculated collections throughout the abdomen. The constellation of findings most likely represent pancreatic/peripancreatic complex fluid collections related to pancreatitis with upstream pancreatic ductal dilatation from mass effect. Also included in the differential diagnosis is a pancreatic solid and cystic neoplasm.


Instruction: Generate impression based on findings.

Input: 19 year old male patient with left ankle pain. Evaluate for deltoid ligament pathology. TENDONS: The visualized tendons are intact.LIGAMENTS: The anterior talofibular and posterior talofibular ligaments are intact. The deltoid ligament is intact but demonstrates increased signal intensity on T2 weighted images.ARTICULAR SURFACES AND BONE: There is minimal increased T2 signal within the medial malleolus which may reflect edema. ADDITIONAL

Output: 1. Intact deltoid ligament with increased signal intensity likely representing a sprain.2. Bone edema within the medial malleolus.


Instruction: Generate impression based on findings.

Input: The risks (including, but not limited to, those of bleeding, infection, allergic reaction, temporary nerve block, pain, and inability to access the joint) and benefits of the procedure were explained to the patient, and informed written consent was obtained. A pre-procedural “time-out” form was completed.The patient was placed supine on the fluoroscopy table. The right hip was localized fluoroscopically, and a spot radiograph was obtained. The course of the femoral artery was noted on the patient's skin using an ink marker. The skin was cleansed and covered with a sterile drape. The skin and subcutaneous tissues were anesthetized with 1% lidocaine using 25-gauge and 22-gauge needles.Under fluoroscopic guidance, a 20-gauge spinal needle was advanced into the joint. Attempted aspiration yielded no fluid. Next, 10 ml of a 50/50 mixture of Omnipaque 240 (to confirm the intra-articular position of the needle) and dilute Multihance (0.1 cc in a 10 cc vial of saline, for subsequent MR imaging) were injected into the joint. Contrast opacified the joint in the expected manner. A spot radiograph was obtained for documentation. Subsequently, 40 mg of Kenalog was injected into the joint. The needle was withdrawn. Blood loss was negligible (<1cc), and patient tolerated the procedure well without immediate complication. An adhesive bandage was placed on the patient’s skin. Routine post procedure instructions were communicated to the patient. The patient was escorted to the MRI suite for further imaging in stable condition. Please refer to the subsequent MRI report for further information.Exposure time: 1:24

Output: Successful intra-articular injection of contrast material for a right hip MR arthrogram, and intra-articular injection of 40 mg Kenalog.


Instruction: Generate impression based on findings.

Input: Reason: assess for recurrent disease History: high risk testis cancer s/p right orch 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: A right periaortic lymph node is slightly increased in size measuring 1.0 x 0.7 cm (12/29), previously0.8 x 0.7 cm on the CT dated 10/1/2015.This is located near the right gonadal vein along the anterior aspect of the IVC.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Mildly enlarged retroperitoneal lymph node is slightly increased in size from prior. This is located near the right gonadal vein along the anterior aspect of the IVC


Instruction: Generate impression based on findings.

Input: Reason: ro tumor, RF and LF PIP History: above The flexor and extensor tendons appear intact. The PIP joints appear normal. The soft tissues of the right hand are unremarkable. No focal signal abnormality is identified. No enhancing mass lesions are identified. No bone marrow signal abnormality is identified. The alignment is anatomic.

Output: Normal appearing right hand without findings to account for the patient's symptoms. No enhancing mass lesions are identified.


Instruction: Generate impression based on findings.

Input: 83 year old with coronary artery disease s/p TECAB (LIMA to LAD) and RCA stents in 2008. He presents with recurrent angina. MEDICATIONS: aspirin, Omega-3, atorvastatin, fenofibrate, lisinopril, metoprolol, niacin, and NTG First Pass PerfusionDuring hyperemia, 2 distinct perfusion defects were noted. The first is mild to moderate in severity and involves the basal inferior inferolateral walls, the mid inferolateral wall, and the apical inferior wall. The second is severe and involves the mid anteroseptum. The overall ischemic burden of the left ventricle is 18%.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 normal in size and overall systolic function. There is tardokinesis of the basal inferior wall. The overall LV ejection fraction is 61%, the LV end diastolic volume index is 61 ml/m2 (normal range: 74+/-15), the LVEDV is 121 ml (normal range 142+/-34), the LV end systolic volume index is 24 ml/m2 (normal range 25+/-9), the LVESV is 47 ml (normal range 47+/-19), the LV mass index is 65 g/m2, and the LV mass is 129 g. Left AtriumThe left atrium is mildly dilated. There is lipomatous hypertrophy of the interatrial septum. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 68%, the RV end diastolic volume index is 63 ml/m2 (normal range 82+/-16), the RVEDV is 124 ml (normal range 142+/-31), the RV end systolic volume index is 20 ml/m2 (normal range 31+/-9), and the RVESV is 40 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve is mildly calcified and has mild 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 are 2 distinct regions of ischemia as described above. Approximately 18% of the myocardium is ischemic. 2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and systolic function (LVEF 61%). There is tardokinesis of the basal inferior wall.4. Normal RV size and systolic function (RVEF 68%).5. Mild aortic valve calcification with mild aortic regurgitation. 6. Lipomatous hypertrophy of the interatrial septum.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Clinical question: 60 years old female with probable meningioma. Need to evaluate carotid anatomy in relation to tumor. Signs and symptoms: Headaches CTA of intracranial circulation:65 cc of Omnipaque 350 is administered for this exam.Previous reformatted images of the intracranial vasculature were obtained utilizing an independent workstation.Right internal carotid:There is a normal appearing right internal carotid artery across the skull base. There is also normal-appearing right internal carotid artery across the cavernous sinus and to its supraclinoid component. There is no evidence of any encasement of the right internal carotid artery from patient's known right-sided subfrontal meningioma. The right middle cerebral artery appears to traverse direct D. posterior to the tumor and the no evidence of direct contact with the tumor or any evidence of encasement. On reformatted images there is suggestion of slight bowing of the right M1 posteriorly due to tumor immediately anterior to the right MCA. There is normal appearing bifurcation of right middle cerebral artery. The right MCA branches distal to M1 are unremarkable. The right and right ophthalmic artery is also well visualized and unremarkable. A small right posterior communicating artery is also identified.Left internal carotid.There is normal appearing left internal carotid artery across the skull base, cavernous sinus and in its supraclinoid component. There is no posterior communicating artery present. There is normal bifurcation the left internal carotid artery and normal visualization of both anterior and middle cerebral arteries and their branches. Anterior communicating artery is unremarkable. No evidence of vascular abnormality in particular no aneurysm or stenosis is detected. Incidental note is made of a large empty sella. There is inferior herniation of the suprasellar visual complex partially into the sella. This finding was also noted on prior MRI examination.Vertebral -- basilar system:Patent bilateral intracranial vertebral arteries. Normal basilar artery, posterior cerebral is and superior cerebellar arteries. There is a normal-appearing right pico however no visualization of left pico. There is a prominent left aica branch which is believed to supply the left pituitary. This is in normal anatomical variation.Nonenhanced head CT:There is a poorly visualized patient's known right anterior clinoid/subfrontal meningioma. There is no evidence of intracranial edema, hemorrhage, mass-effect, midline shift or hydrocephalus.Cortical sulci, ventricular system, CSF cisterns and gray to white matter differentiation remains within normal

Output: 1.Unremarkable CTA of intracranial circulation and in particular no evidence of encasement of right internal carotid artery, right ophthalmic artery, right middle or anterior cerebral artery with patient's known right anterior clinoid/subfrontal meningioma.2.Unremarkable nonenhanced CT of brain. Very poorly visualized patient's known right sided meningioma.


Instruction: Generate impression based on findings.

Input: Back pain, radicular pain, evaluate for lumbar nerve root involvement. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is dextro curvature of the upper lumbar spine better evaluated on recent radiographs. There is also minimal retrolisthesis of L1 on L2 and mild grade 1 anterolisthesis of L4 on L5. Bone marrow signal is benign with T1 hyperintense lesion involving L5 consistent with hemangioma. The conus medullaris is normal in position.Multilevel degenerative changes are seen including significant loss of disc height at the L1-L2 and L5-S1 levels and associated fatty endplate marrow signal changes. Individual levels as below: L1-L2: Disc bulge eccentric to the left and left-sided facet arthropathy result in mild left-sided neural foraminal stenosis. No significant spinal canal or right neural foraminal narrowing.L2-L3: Disc bulge and bilateral facet arthropathy with minimal spinal canal stenosis. No significant neural foraminal stenosis.L3-L4: Disc bulge with central protrusion, facet arthropathy, and ligamentum flavum thickening result in moderate to severe central spinal canal stenosis. There is minimal right and mild to moderate left neural foraminal stenosis.L4-L5: Grade 1 anterolisthesis, disc covering and mild bulge, ligamentum flavum thickening, and advanced bilateral facet arthropathy. There is moderate to severe spinal canal stenosis. There is also moderate to severe bilateral, right worse than left neural foraminal stenosis which may be impinging on the bilateral L4 nerve roots.L5-S1: Disc bulge and mild facet arthropathy. No significant spinal canal stenosis. There is mild bilateral neural foraminal narrowing.Paraspinous soft tissues are within normal limits.

Output: Multilevel degenerative changes in the lumbar spine, worst at the L4-L5 level where there is degenerative grade 1 anterolisthesis, moderate to severe spinal canal stenosis, and moderate to severe bilateral, right worse than left, neural foraminal stenosis. There is also moderate to severe spinal canal stenosis at the L3-L4 level. Additional levels as detailed above.


Instruction: Generate impression based on findings.

Input: Patient with pain with eye movements: evaluate for orbital inflammation. Orbits: The bilateral globes and ocular adnexa are unremarkable. There is no evidence of abnormal intraorbital enhancement or mass lesions.Brain: There is no evidence of intracranial hemorrhage or acute infarct. There is minimal nonspecific periventricular T2 hyperintensity adjacent to the bilateral frontal horns of the lateral ventricles. There is a punctate low T1 signal focus in the pituitary. 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, mastoid air cells, and scalp soft tissues are grossly unremarkable. There is mild mucosal thickening within the bilateral maxillary and ethmoid sinuses.

Output: 1. No evidence of intraorbital inflammation or tumors.2. Minimal nonspecific periventricular T2 hyperintensity adjacent to the bilateral frontal horns of the lateral ventricles may represent chronic small vessel ischemia. 3. Punctate probable pars intermedia cyst.4. Mild mucosal thickening within the bilateral maxillary and ethmoid sinuses.


Instruction: Generate impression based on findings.

Input: 38 years, Male, headache. Evaluate for structural lesion. Brain parenchyma appears within normal limits. No intracranial mass or evidence of mass effect. No parenchymal signal abnormality. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. The ventricles are within normal limits in size and configuration. Mega cisterna magna is incidentally noted, which is a normal variant. Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: Noncontrast MRI of the brain is within normal limits.


Instruction: Generate impression based on findings.

Input: Female 53 years old Reason: hx lung CA, recent PET suggest MRI of liver ABDOMEN:LUNG BASES: Moderate-sized right pleural effusion. Postsurgical changes in the right chest wall.LIVER, BILIARY TRACT: There is a lobulated, markedly T2 hyperintense/T1 hypointense lesion within the posterior right hepatic lobe. This measures 7.3 x 6.9 cm (7, image 15). Post contrast, this demonstrates incomplete peripheral nodular enhancement with progressive fill-in. A superior lesion, contiguous with the above described lesion measures 6.8 x 5.7 cm (series 7, image 9) and also demonstrates incomplete peripheral nodular enhancement. There is some fill-in on delayed images. These lesions are most consistent with hemangiomas.A third T2 hyperintense lesion within segment 4a measures 1.2 x 0.9 cm (series 6, image 8). This is indeterminate however it is unchanged in size compared to prior studies.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.

Output: 1. Two contiguous hepatic lesions as detailed above, with imaging appearance suggestive of hemangiomas. 2. A third lesion within segment 4 A. is indeterminate however it is uncharged in size compared to prior studies.3. Postsurgical changes within the right chest wall. 4. Large right pleural effusion.


Instruction: Generate impression based on findings.

Input: Male; 66 years old. Reason: prostate cancer History: prostate cancer PELVIS:PROSTATE:Prostate Size: 3.7 x 4.7 x 3.2 cm.Peripheral Zone: Scattered T1 hyperintensity due to hemorrhage. Multifocal prostate cancer with dominant lesion in the right posteromedial mid to apical peripheral zone with low T2 signal and restricted diffusion, measuring up to 1 x 1.8 cm (series 903/204). A smaller focus of prostate cancer is seen in the left posteromedial mid gland (series 903/204).Central Gland: Heterogeneous.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: No extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Multifocal prostate cancer with dominant lesion in the left mid to apical peripheral zone. No evidence of extracapsular extension.


Instruction: Generate impression based on findings.

Input: Reason: eval for meniscal tear History: knee pain for months with crepitus; clicking; pain with ADL's; no swelling; some instability; history of trauma MENISCI: Bucket handle tear of the medial meniscus. There is perhaps an additional horizontally oriented tear through the posterior horn of the medial meniscus. Lateral meniscus is normal in morphology and signal characteristics. ARTICULAR CARTILAGE AND BONE: There is mild heterogeneity of the patellar cartilage consistent with minimal degeneration. The cartilage of the trochlea, lateral compartment, and medial compartment are within normal limits.LIGAMENTS: The cruciate ligaments and collateral ligaments are intact. There is mild edema between the IT band and lateral femoral condyle, which conceivably reflects mild IT band friction syndrome.EXTENSOR MECHANISM: The patellar tendon and quadriceps tendon are intact.ADDITIONAL

Output: Bucket handle tear of the medial meniscus and other findings as above.


Instruction: Generate impression based on findings.

Input: Ms. Lee is a 46-year-old female who is BRCA1 positive. She has a strong family history of breast cancer including maternal grandmother, maternal aunt, cousins and great grandmother. Personal history of benign left breast MR guided biopsy in 2012. 8/21/2009Minimal parenchymal enhancement is noted bilaterally. Breast parenchyma is almost entirely fat.There is a 4 mm focus of enhancement identified in the right upper inner breast, which may have a questionable correlate to prior MR examination from 08/21/2009 (particularly on the T2 weighted images). The kinetic pattern is typically benign at this site. Given the presence of calcified oil cysts in this region mammographically, it may represent a focus of fat necrosis. No abnormal enhancement is seen in the left breast. There are several stable intramammary lymph nodes seen bilaterally. No abnormal axillary lymph nodes are identified in either axillary region.Images were also reviewed with Dr. Abe, who concurred with the management plan below.

Output: High probability benign focus of enhancement in the right upper inner breast, with an appearance favoring fat necrosis. Given the strong family history, recommend a short term 6 month MRI examination to confirm stability of these findings.BIRADS: 3 - Probably benign finding.RECOMMENDATION: 3B - Followup at Short Interval (1-11 Months).


Instruction: Generate impression based on findings.

Input: Reason: evaluate for meniscal tear, ligament tear, etc. Had a fall about 6 weeks ago with subsequent persistent swelling History: right knee pain MENISCI: There is complex, multidirectional tearing of the medial meniscus involving the body and posterior horn, with a prominently oblique component, which contacts the superior and inferior articular surfaces, and has progressed from the prior study in 2013. Additionally, there is a complex, multidirectional tear of the lateral meniscus with lateral extrusion and redundancy of the fragmented meniscus into the posterior intercondylar notch. There is a posterior lateral parameniscal cyst. Overall, the tearing is likely degenerative, and has progressed from the prior study.ARTICULAR CARTILAGE AND BONE: Again seen is severe tricompartmental osteoarthritis including near total chondral loss in the weightbearing aspects of the joint, particularly in the lateral tibiofemoral compartment, slightly progressed from the prior study in 2013. There is diffuse grade 3 chondral loss in the patellofemoral compartment. There are exuberant tricompartmental osteophytes.LIGAMENTS: The cruciate and collateral ligaments are intact. The posterior corner structures appear to be intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1.Complex, multidirectional degenerative type tearing/maceration of the medial and lateral menisci, which has progressed from the prior study in 2013.2.Tricompartmental osteoarthritis with exuberant osteophyte formation and multifocal complete chondral loss.3.Moderate joint effusion.


Instruction: Generate impression based on findings.

Input: 67 years Female (DOB:9/20/1948)Reason: R/O CAUSE OF COGNITIVE DECLINE History: COGNITIVE DECLINEPROVIDER/ATTENDING NAME: ADIL JAVED ADIL JAVED The patient is status post craniotomy adjacent and above the lambdoid suture eccentric towards the right side for a mass previously centered in the region of the right precuneus. There is adjacent T2 and FLAIR signal hyperintensity at the surgical site. No contrast enhancing lesion is appreciated on the current exam. Adjacent posterior falx dural enhancement remains stable and compared to prior exams.There is redemonstration of periventricular and subcortical white matter T2 and FLAIR hyperintense lesions present which are stable when compared to the prior exams.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate partial opacification of the left maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.There is no evidence for recurrence of the prior known meningioma. There are stable postoperative changes present.2.There is redemonstration of periventricular and subcortical white matter lesions present which are stable when compared to the prior exams. This most likely vascular related


Instruction: Generate impression based on findings.

Input: 62-year-old female with bradycardia, slurred speech, and right facial droop. Please evaluate for intracranial process. There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration.Small osseous deformity at the right lamina papyracea is likely from old trauma and appears similar to prior studies from 2009. Otherwise, the calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Normal brain CT.


Instruction: Generate impression based on findings.

Input: Effusion, medial jointline pain. Evaluate medial meniscus. MENISCI: There is a complex tear of the posterior horn and body of the medial meniscus with both horizontal and vertical components. The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is perhaps mild thinning and increased signal intensity within the articular cartilage of the medial femoral condyle above the posterior horn of the medial meniscus. Otherwise, the articular cartilage of the lateral and patellofemoral compartments is intact.LIGAMENTS: The collateral and cruciate ligaments are intact.EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Complex tearing of the posterior horn and body of the medial meniscus.


Instruction: Generate impression based on findings.

Input: Malignant neoplasm of right ciliary body [C69.41] / Malignant melanoma of skin, unspecified [C43.9], Reason for Study: ^Reason: METASTATIC MELANOMA , lesion identified to thoracolumbar spine area, initial staging to determine tx options. History: HX melanoma. There are multiple enhancing lesions at T10 and L4 vertebral bodies which show ill defined high signal intensity on T2 and low signal intensity on T1 indicating possible metastatic lesions.Similar lesions (low T1, ill defined high T2 and peripheral enhancement on post Gad T1) are seen on the right ilium (series 24, image 34) and the right side ala of S1(series 24, image 37). Another two smaller lesions are seen on the left side ilium (series 24, image 37).Relatively well defined vertebral body lesions with high T1 and high T2 with enhancement at T6, T9, and L3 bodies are likely represent vertebral hemangiomas.T1 low, T2 high with enhancement at T11 and T12 endplates could represent disc degeneration related endplate change but cannot completely exclude possibility of metastatic lesion.There is normal thoracic kyphosis and lumbar lordosis. The spine alignment is anatomic. The vertebral body height is preserved. The signal of the visualized cord is normal. The conus medullaris terminates at the T12-L1 level.There is no evidence of abnormal enhancement of spinal cord, there is no evidence of cord compression or mass. Degenerative changes are specified by the intervertebral level as follows: Diffuse bulging of discs with abuts thecal sac at the level of T10-11 and T11-12. There is no evidence of spinal canal stenosis or neuroforaminal stenosis.T12-L1: Minimal bulging of disc. No neuroforaminal narrowing or spinal stenosis. L1-L2: Minimal bulging of disc. No neuroforaminal narrowing or spinal stenosis. L2-L3: Diffuse bulging of disc with associated with bilateral ligamentum flavum thickening result in bilateral lateral recess minimal stenosis. No spinal stenosis. L3-L4: Broad-based disc protrusion which abuts thecal sac in association with bilateral ligamentum flavum thickening result moderate spinal canal stenosis.L4-L5: Diffuse bulging of disc with bilateral ligamentum flavum thickening causing moderate spinal canal stenosis at this level. L5-S1: Diffuse bulging of disc. No spinal stenosis.

Output: 1. Multiple metastatic lesions involving T10 and L4 including right S1 ala as well as bilateral ilium.2. Degenerative spinal stenosis at the level of L3-4, and L4-5.3. No evidence of spinal cord compression, abnormal signal intensity of spinal cord, nor abnormal enhancement.


Instruction: Generate impression based on findings.

Input: Male 53 years old Reason: right knee OA History: right knee pain . Four views of the right knee show a large joint effusion, sharpening of the tibial spines, small osteophytes of the medial and lateral compartments, and nonspecific chondrocalcinosis of the lateral meniscus. Frontal views of the left knee show mild tibial spine sharpening compatible with osteoarthritis.

Output: Moderate osteoarthritis of the right knee with nonspecific lateral meniscal chondrocalcinosis


Instruction: Generate impression based on findings.

Input: History of split tear of the tibialis posterior, patient still having pain and swelling. Please revaluate TENDONS: Persistent enlargement of the tibialis posterior with internal signal and split tear as previously observed in 2013. Abnormal changes are again most pronounced at the level of the tibiotalar junction and associated with mild surrounding fluid. Changes again traverse approximate over a 4 cm length. It is difficult to determine if this represents a recent injury or chronic finding given the appearance, however it also may represent a mild combination. Increased signal within the tibialis posterior is largely central without discrete evidence of retraction or new abnormalities either more proximally or distally.The remaining tendons are otherwise intactLIGAMENTS: ATFL and PTFL and the calcaneofibular ligaments are otherwise intact. The deltoid is grossly intact.ARTICULAR SURFACES AND BONE: Underlying osseous structures are otherwise similar with minimal degenerative changes and normal marrow signal throughout. The previously observed minimal changes suggesting synovitis again cannot entirely be excluded and may account for mild diffuse signal changes within the sinus tarsus, unchanged. ADDITIONAL

Output: Overall residual or recurrent longitudinal split tear of the tibialis posterior. Appearance similar to prior study


Instruction: Generate impression based on findings.

Input: 58-year-old male with enteritis/small bowel wall thickening noted on CT. ABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis is is present.SPLEEN: No significant abnormality noted.PANCREAS: Previously noted cystic focus in the tail of the pancreas is not well seen on the current study. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Hydronephrosis or perinephric inflammation. Punctate T2 hyperintensities likely reflect small cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is no evidence of small bowel obstruction. There is no focus of abnormal enhancement. Previously noted segment of small bowel wall thickening is not appreciated on the current study. 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: 1.Previously noted segment of small bowel wall thickening is not appreciated on the current study. No additional sites of abnormal bowel enhancement.2.Previously noted cystic focus in the tail of the pancreas is not well seen on the current study. Consider dedicated MRCP for further evaluation.


Instruction: Generate impression based on findings.

Input: Male 52 years old left knee "popping" post twisting weeks x-ray with mild OA MENISCI: There is mild intrasubstance degeneration involving the posterior horn of medial meniscus. No discrete tear is evident.There is linear signal involving the posterior horn of lateral meniscus that extends to the periphery as seen on image 9/701 and is suspicious for a small peripheral tear.ARTICULAR CARTILAGE AND BONE: There is full-thickness cartilage loss involving the central weightbearing zone of the medial femoral condyle and tibial plateau. There is reactive marrow edema involving the medial tibial plateau and medial femoral condyle adjacent to the site of cartilage loss.There is diffuse chondral thinning involving the lateral compartment.There is surface irregularity and chondral fibrillation with some undersurface mining involving the medial and lateral facets of the patella.LIGAMENTS: Anterior and posterior cruciate ligaments are intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Moderate osteoarthritis involving the medial femoral tibial compartment with full-thickness cartilage loss.2.Mild osteoarthritis involving the extensor compartment.


Instruction: Generate impression based on findings.

Input: 20 year old female with episodes of syncope, etiology unclear. Subsequent ECHO reported with globally reduced EF. Left VentricleThe left ventricle is normal in structure and function. The overall LV ejection fraction is 57%. The LVEDV is 147 ml (normal range 109+/-23), LV end diastolic volume index is 93 ml/m2 (normal range: 65+/-11), LVESV is 63 ml (normal range 31+/-10), and LV end systolic volume index is 40 ml/m2 (normal range 18+/-5). The LV mass is 89 g (normal range 114+/-24) and the LV mass index is 56 g/m2 (normal range 67+/-11). 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.Left AtriumThe left atrium is normal.Right VentricleThe right ventricle is normal in size and structure. The overall RV ejection fraction is 47%, the RV end diastolic volume index is 93 ml/m2 (normal range 69+/-14), the RVEDV is 146 ml (normal range 110+/-24), the RV end systolic volume index is 50 ml/m2 (normal range 22+/-8), and the RVESV is 78 ml (normal range 35+/-13). Right AtriumThe right atrium is normal. Aortic ValveThe aortic valve is trileaflet, 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. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsProbable ingested material within the stomach. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Normal left ventricular structure with ejection fraction calculated at 57%2. Normal right ventricular structure with ejection fraction calculated at 47%3. No late gadolinium enhancement noted in left ventricular myocardium. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Systemic sclerosis. New onset bilateral lower extremity pain. The patient is also immunosuppressed. Thoracic Spine:There is exaggeration of the upper thoracic kyphosis though without significant anterior compression at any single level. Alignment is otherwise anatomic. There is no suspicious marrow focality. There is mild multilevel disc height and T2 signal loss. The discs at T2-T3, T3-T4, and T7-T8 cause shallow ventral thecal sac indentations as well as minimal indentation of the spinal cord. Less significant ventral thecal sac indentations are caused by the T8-T9 and T10-T11 discs without morphologic spinal cord abnormality. T10-T11 disc is associated with small interbody herniations but no edema. There is facet arthropathy multiple levels but without significant foraminal stenosis.The spinal cord shows normal signal. Following contrast administration, there is no abnormal spinal cord or leptomeningeal contrast enhancement.C7-T1 and T1-T2: There is no signal spinal canal or foraminal stenosis.T2-T3: There is a central component to the disc which minimally indents the spinal cord. There is no foraminal stenosis.T3-T4: There is a focal right paracentral component to the disc-osteophyte complex which minimally indents the spinal cord. There is no significant foraminal stenosis.T4-T5, T5-T6, and T6-T7: There is no significant spinal canal or foraminal stenosis.T7-T8: The disc-osteophyte complex is slightly more pronounced on the left causing minimal left paracentral indentation on the thecal sac. There is no significant foraminal stenosis.T8-T9: The disc-osteophyte complex has a very small central component minimally indenting the thecal sac. There is no central or foraminal stenosis.T9-T10, T10-T11, T11-T12 and T12-L1: There is no spinal canal or foraminal stenosis.Dependent lung opacities may represent atelectasis. The esophagus is more thick-walled and more open than expected which may reflect involvement by systemic sclerosis.Lumbar Spine:Alignment is notable for straightening which may reflect patient positioning. The vertebral bodies are preserved in height. Marrow signal is also without suspicious focality. The intervertebral discs are notable for mild T2 signal loss at L4-L5 and moderate height and T2 signal loss at L5-S1. Tip of the conus medullaris is at the L1-L2 level. The conus medullaris shows normal morphology and signal characteristics. The cauda equina nerve roots are normally distributed in the thecal sac. There are small anterior indentations of the thecal sac at L4-5 and L5-S1 due to discs as described below. Following contrast injection, there is no abnormal contrast enhancement along the conus or cauda equina roots.T12-L1, L1-L2 and L2-L3: There is no significant disc herniation. There is no spinal canal or foraminal stenosis. There is mild facet arthropathy.L3-L4: Disc bulge flattens the anterior aspect of thecal sac. There is also mild facet arthropathy. There is no significant spinal canal or foraminal stenosis.L4-5: Disc bulge is slightly eccentric to the left narrowing the left subarticular recess and abutting the traversing left L5 nerve root. There is left more than right facet arthropathy causing mild foraminal stenoses.L5-S1: There is a central disc extrusion which causes moderate left worse than right subarticular recess stenosis abutting traversing S1 nerve roots. There is also mild central spinal canal stenosis. This is associated with mild left worse than right foraminal stenoses. The disc extrusion is associated with contrast enhancement which is probably reactive.

Output: 1.Mild multilevel degenerative disease of the thoracic spine is present as described above. There is no significant spinal canal or foraminal stenosis.2.Lower lumbar degenerative spondylosis is most pronounced at L5-S1, where disc extrusion is abutting the S1 nerve roots. Please correlate with S1 radiculopathy, especially on the left. Milder degenerative disease is present at L4-5 as described above. Please correlate with left L5 radiculopathy.3.There is no abnormal spinal cord signal to suggest myelitis.


Instruction: Generate impression based on findings.

Input: Previous scoliosis x-ray demonstrated levoscoliosis of the lower thoracic spine with a Cobb angle measuring 50 degrees as well as a compensatory dextroscoliosis at the thoracolumbar junction with a Cobb angle measuring 61 degrees.The patient's scoliosis is redemonstrated, as better demonstrated on the previous x-ray.There appear to be 13 rib bearing segmental units. Thus, C7 is presumed to be the upper-most level containing cervical ribs, and utilizing this nomenclature there are 6 lumbar type vertebral bodies. However, the presence of hemivertebrae as described below magnum are difficult. If a spinal procedure is contemplated, CT may be of benefit for better osseous interpretation.Multiple osseous dysplasias are present including:Narrowed vertebral bodies with partial fusion across C4, C5, C6, and C7.A large anterior bridging osteophyte at C7/T1.A very small left-sided hemivertebra at T2/3.Right lateral wedge deformity of T10.A small right-sided hemivertebra of L2.Foraminal stenoses are as follows:Moderate left neural foraminal stenosis at C4/5.Mild right neural foraminal stenosis at T2/3.The spinal cord is normal in signal throughout. The conus terminates at L2/3.There is a tiny focus of T1 hyperintensity in the region of the presumed filum (although the axial T1 is motion degraded)(best seen series 2801, image 25). This same region on axial T2 demonstrates a small hypointense focus with an inferiorly located linear hyperintense periphery, suggestive of chemical shift artifact, which can be seen from fat (best seen series 2401, image 25). Lastly, the same focus appears to be present on the sagittal T1 (series 2901, image 8, although this sequences also motion degraded). The constellation of these features are suggestive of a tiny portion of fatty filum.There are no fractures. The marrow signal is benign. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable.

Output: 1.Scoliosis with osseous dysplasias including vertebral body fusion and hemivertebrae as described in detail above.2.Moderate left neural foraminal stenosis at C4/5, and mild right neural foraminal stenosis at T2/3.3.The spinal cord is normal in signal throughout.4.There is a tiny focus of T1 hyperintensity in the region of the presumed filum (although the axial T1 is motion degraded). This same region on axial T2 demonstrates a small hypointense focus with an inferiorly located linear hyperintense periphery, suggestive of chemical shift artifact, which can be seen from fat. Lastly, the same focus appears to be present on the sagittal T1 (although this sequences also motion degraded). The constellation of these features are suggestive of a tiny portion of fatty filum.


Instruction: Generate impression based on findings.

Input: History of primary sclerosing cholangitis with increasing alkaline phosphatase. Cholangiocarcinoma screening. ABDOMEN:LIVER, BILIARY TRACT: Diffuse multifocal stricturing with associated dilatation of the biliary tree with marked atrophy and fibrosis of the right lobe of the liver, appearing similar to the prior study and compatible with PSC. Again seen is long segment narrowing of the distal common bile duct which demonstrates thickening and mild enhancement, grossly unchanged.No new dominant stricture or focal enhancing mass.Normally distended gallbladder without significant gallbladder wall thickening pericholecystic fluid or other specific evidence of gallbladder inflammation. No gallstones.Stable hepatomegaly. Attenuated patent intrahepatic portal veins.SPLEEN: Moderate splenomegaly, unchanged. Splenic varices.PANCREAS: Mild main pancreatic ductal dilatation, slightly improved from the prior. No focal lesion is evident.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Gastroesophageal varices are again noted. Trace pelvic ascites.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Multifocal stricturing and dilatation of the pancreatic and biliary tree appearing similar to the prior without a new dominant stricture or focal lesion.2.Stable long segment stricture of the distal common bile duct.


Instruction: Generate impression based on findings.

Input: Male; 74 years old. Reason: intermediate risk prostate cancer with cT2a disease (palpable nodule in right lobe). Please evaluate History: prostate cancer PELVIS:PROSTATE:Prostate Size: 5 x 6.6 x 5.9 cm. Peripheral Zone: 1 x 0.9 cm lesion in the right mid prostate gland peripheral zone medially with low T2 signal and restricted diffusion, compatible with prostate cancer (series 904/244).Central Gland: Heterogeneous.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: None.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Right mid prostate gland peripheral zone in prostate cancer as detailed above.


Instruction: Generate impression based on findings.

Input: 45 years Female (DOB:12/1/1970)Reason: Hx pituitary germinoma. Also cavernous malformation. History: HA.PROVIDER/ATTENDING NAME: RIMAS V. LUKAS RIMAS V. LUKAS Since prior exam patient is undergone right frontal craniotomy for right frontal lobe surgery. There is redemonstration of a lesion centered in the right half of the corpus callosum along the genu measuring 16 x 16 mm axial dimensions previously measured similar dimensions. It has a popcorn-like appearance on T2 and T1 imaging. There is a focus of encephalomalacia within the adjacent right frontal lobe.Incidental note is made of partial empty sella.Small foci of signal loss and susceptibility imaging are present along the superior aspect of the vermis and the superior aspect of the right cerebellar hemisphere. One of these is visible on the T2 imaging. On the prior exam these were less conspicuous.There is redemonstration of a focus of low signal on susceptibility imaging along the anterior and left paramedian aspect of the pons. This was present on prior exams and is unchanged.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Findings are compatible with the cerebral cavernous malformation in the genu of the corpus callosum. This does not appear to be significantly different than the prior exam.2.Since prior exam the patient is undergone right frontal craniotomy. There is encephalomalacia present along the right frontal lobe.3.There is no evidence for germinoma on this exam.4.There is redemonstration of a hemorrhagic focus in the pons which is unchanged prior exam. This is nonspecific given its small size. Differential considerations include include cavernous malformation is also causes of microhemorrhage.5.There is redemonstration of some small hemorrhagic lesions in the cerebellum. These are more conspicuous on the current versus the prior exam. It is possible that these represent small cavernous malformations they are nonspecific and could represent other types of lesions including radiation effect


Instruction: Generate impression based on findings.

Input: 62-year-old female patient with penetrating injury and complicated soft tissue infection of the right leg. Evaluate for osteomyelitis. There is a wound along the anterior aspect of the lower leg that extends through the subcutaneous fat to the underlying anterior compartment musculature. There is thickening and enhancement of the adjacent skin as well as enhancement of the adjacent subcutaneous fat, indicating inflammation. There are thin, nonenhancing tracts extending from the wound into the anterior compartment musculature, but we see no drainable fluid collection in this area. There is inter- and intramuscular edema involving the anterior compartment musculature as well as a small amount of edema and enhancement involving the adjacent deep posterior compartment musculature. There is a 4 mm rim-enhancing collection between the distal fibula and the posterior tibialis tendon that may represent a small phlegmon, but we see no drainable abscess. The bone marrow signal intensity is normal and we see no evidence of osteomyelitis.

Output: Anterior soft tissue ulceration with inflammatory changes of the underlying soft tissues, including peripherally enhancing tracts extending from the wound into the anterior compartment musculature that could represent intramuscular extension of infection. We see no drainable abscess or findings of osteomyelitis.


Instruction: Generate impression based on findings.

Input: 53 years Female (DOB:5/1/1963)Reason: Discussed high priority of study (goal w/in 24 hours) with Neuro-Rad Fellow, Veronesi p3854. Please evaluate for abscess in spine, epidural space, paraspinal muscles as well as any interval change in osteomyelitis given recurrent fevers. History: as above PROVIDER/ATTENDING NAME: ANNA VOLERMAN BEASER ANNA VOLERMAN BEASER Cervical spine:The patient is status post anterior fusion using metal plate and screws at C4, C5, C6 and C7.The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology.No abnormal enhancing lesions are appreciated in the cervical spine.At C2-3 there is no significant compromise to the spinal canal or neural foramina. There is a small central disc protrusion at this level.At C3-4 there is no significant compromise to the spinal canal or neural foramina. There is a broad-based disc protrusion present at this level which impresses on the ventral aspect of thecal sac and is associated with hypertrophy of the ligamentum flavum. Overall there is a mild degree of spinal stenosis at this level.At C4-5 there is no significant compromise to the spinal canal or neural foramina. There are some endplate osteophytes at this level.At C5-6 there is no significant compromise to the spinal canal or neural foramina. There are some endplate osteophytes at this level.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.MRI thoracic spine:The patient status post laminectomies from T7 through T11. Since the prior exam the patient is developed destruction of the endplates at T8-T9. There is continued enhancement within the T7, T8 and T9 vertebral bodies. There is epidural enhancement present at the T7, T8 and T9 levels which is not changed in thickness anteriorly. Posteriorly the epidural enhancement is present at the levels of laminectomy however, spinal canal is not as narrow was on the prior exam. There is no spinal fluid can be identified ventral and posterior to the spinal cord. There is circumferential epidural thickening present at T7, T8 and T9 which appears to be worse at the T8 level and is predominantly on the left hemicanal. On the prior exam it appears that the spinal canal was smaller and narrowed down to approximately 6 x 6 mm whereas on the current exam than narrowest component spinal canal is approximately 10 x 7 mm. A fluid collection behind the thecal sac at the site of the laminectomy has a filled in with contrast enhancing tissue with the exception of a small component measuring 10 mm x 10 mm in axial dimensions.There is paravertebral soft tissue thickening and pleural thickening bilaterally but more on the right pleural space compared to the left. This was also present on the prior exam and has regressedThe thoracic vertebral bodies are appropriate in the overall alignment and height. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots. No abnormal enhancing lesions are appreciated in the thoracic spine.Lumbar spine:Please note that counting from C2 there are 6 lumbar vertebrae present.The patient is status post posterior fusion including L5, L6 and S1 using pedicle screws at L5 and S1 bilaterally a and interconnecting rods. There is a disc spacer present at L6-S1 the one at L5-L6. There are associated reactive changes at the adjacent endplates. These is been present on the prior exam from 7/30/2016 and have not changed substantially.Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. No abnormal enhancing lesions are appreciated in the lumbar spine.At L6-S1 there is no significant compromise to spinal canal or neural foramina.At L5-6 there is effacement of the fat at the lateral recess bilaterally with encroachment of nerve roots of the lateral recesses sees as well as mild narrowing of neural foramina. There is bilateral facet hypertrophy at this level as well as a disc bulge. Effacement of fat at the lateral recesses developed since the 5/18/2012 exam.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is bilateral facet hypertrophy at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: Please note that there are 6 lumbar vertebrae present.1.Anterior fusion of the cervical spine, multilevel laminectomies in the midthoracic spine and anterior and posterior fusion in the lower lumbar spine as detailed above.2.Since prior exam with greater destruction of the T8-T9 endplates. This suspicious for discitis osteomyelitis.3.There is epidural thickening at the mid thoracic spine which has somewhat regressed relative to the prior exam but is worse at the T8-T9 level. There is continued evolution of postoperative changes at the laminectomy sites. The possibility this represents a regressing phlegmon cannot be excluded.4.The patient is undergone anterior and posterior fusion in the lumbar spine. Since prior exam there is greater encroachment of nerve roots at the lateral recesses at L5-L6 compared to the prior exam from 2012.5.There are degenerative changes present cervical spine worse at C3-4 without significant compromise spinal canal or neural foramina.6.Bilateral pleural thickening has regressed relative to the prior exam.


Instruction: Generate impression based on findings.

Input: Images of the internal auditory canals demonstrate the seventh and eighth nerves to be normal in size and symmetric bilaterally without masses or enhancing lesions along the course of these nerves or in the cerebellopontine angle cisterns bilaterally. The inner ear structures are normal in appearance and symmetric bilaterally without congenital inner ear anomalies identified on either side. There are no vascular anomalies.

Output: Negative MRI of the internal auditory canals including gadolinium enhancement.


Instruction: Generate impression based on findings.

Input: Left retromolar trigone/hard palate low-grade mucoepidermoid carcinoma status post wide local excision 2011, with possible scar tissue versus mass in surgical field due to asymmetric fullness of left maxillary tuberosity. There is no evidence of measurable mass lesions or significant cervical lymphadenopathy based on size criteria. The thyroid and major salivary glands are unremarkable. The major cervical flow voids are intact. The osseous structures are unremarkable, aside from mild thoracic scoliosis. There are bilateral maxillary sinus retention cysts. The imaged intracranial structures are unremarkable.

Output: No evidence of measurable tumor recurrence in the left retromolar trigone region.


Instruction: Generate impression based on findings.

Input: History of allergic conjunctivitis with chronic left upper lid swelling recalcitrant to topical therapy: exam showing an enlarged lacrimal gland. There is asymmetric diffuse enlargement of the left lacrimal gland, without evidence of discrete mass lesions. There also appears to be mild thickening of the left upper eyelid, along with conjunctival enhancement. The rest of the left orbital contents are unremarkable and the right orbit is unremarkable. There is mild mucosal thickening in the anterior right ethmoid sinuses. The imaged intracranial structures are grossly unremarkable.

Output: Asymmetric diffuse enlargement of the left lacrimal gland, without evidence of discrete mass lesions, and mild thickening of the left upper eyelid with signs of conjunctivitis. The findings may be related to an allergic etiology, as clinically suggested, although a lymphoproliferative process is a consideration based on imaging.


Instruction: Generate impression based on findings.

Input: Recent L4-L5 fusion with radicular pain and bowel incontinence. Five lumbar type vertebral bodies are presumed to be present. There are postsurgical changes related to recent extension of spinal fusion with hardware now extending from the L4 to the S1 levels. Hardware is better assessed on recent CT and includes bilateral paraspinous rods and pedicle screws at L5 and S1 as well as a unilateral right pedicle screw at the L4 level. There is high T2 signal within the L4-L5 disc space related to recent interbody implant placement. There is also edema involving the L4 and L5 vertebral bodies which is also nonspecific in this postoperative period.Vertebral body heights in the lumbar spine are normal. There is loss of lumbar lordosis as seen before. Alignment is otherwise grossly maintained. There is moderate to severe thecal sac effacement at the L4-L5 level related to fluid in the dorsal epidural space with intermediate T1 signal and T2 hyperintensity indicating at least some blood products. Large right-sided laminectomy defect and facetectomy at this level are better seen on recent CT.There is mild to moderate spinal canal stenosis at the L3-L4 level related to disc bulge with small dorsal annular fissure, ligamentum flavum thickening, and facet arthropathy. Spinal canal in the lumbar spine is otherwise patent. Right L4-L5 neural foramen is surgically decompressed. There is fairly mild multilevel neural foraminal narrowing in the remainder of the lumbar spine as seen previously but suboptimally evaluated due to artifact at the level of the pedicle screws.There is also a hematoma/fluid collection in the subcutaneous soft tissues from the L4 to S1 levels on the right with T1 shortening.

Output: 1. Recent postsurgical changes related to extension of spinal fusion which now extends from L4 to S1. There is moderate to severe thecal sac effacement at the L4-5 level related to postoperative epidural fluid and blood products. The bony spinal canal is surgically decompressed at this level.2. Subcutaneous postoperative hematoma/fluid collection at the right L4 to S1 levels.3. Mild to moderate spinal canal stenosis at the L3-L4 level which is unchanged and on a chronic degenerative basis.