Instruction: Generate impression based on findings.

Input: Diagnosis: Abnormal reflex. Other conditions of brain(348.89)Clinical question: left fronto parietal hypodensity on CT headSigns and Symptoms: right leg spastic, mildly weak, Babinski MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No abnormal 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 demonstrate mild 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.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. There is mild reversal of the normal cervical curvature present.At C2-3 there is no significant compromise to the spinal canal or neural foramina. There is disk dessication present at this level. At C3-4 there is no significant compromise to the spinal canal or neural foramina. There is disk dessication present at this level. There is left sided facet hypertrophy at this level associated with mild narrowing of the left neural foramen. At C4-5 there is no significant compromise to the spinal canal or neural foramina. There is disk dessication present at this level. There is loss of disk space height at this level. There is a disk bulge at this level.At C5-6 there is no significant compromise to the spinal canal . There is disk dessication present at this level. There is loss of disk space height at this level. There is a disk bulge at this level. There are right sided uncovertebral osteophytes at this level associated with encroachment of the left exiting nerve roots.At C6-7 there is no significant compromise to the spinal canal or neural foramina. There is disk dessication present at this level. There is loss of disk space height at this level. There is a disk bulge at this level.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.There are multilevel degenerative changes in the cervical spine. There is no significant compromise to the spinal canal and only mild narrowing of the neural foramina 2.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 3.Mild reversal of the normal cervical curvature is a non-specific finding which can be seen with muscle spasm or patient positioning.


Instruction: Generate impression based on findings.

Input: Cervical radiculopathy Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. There is minimal anterolisthesis of C3 on C4, retrolisthesis of C4 on C5, retrolisthesis of C5 on C6, and minimal anterolisthesis of C6 on C7. Bone marrow signal is within normal limits. The cervical spinal cord has normal signal characteristics and overall morphology.Degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal. There is mild left neural foraminal narrowing related to facet arthropathy. Right neural foramen is patent.C3-4: Small disc osteophyte complex. No significant compromise to the spinal canal. There is moderate left neural foraminal stenosis related to uncovertebral hypertrophy and facet arthropathy. Right neural foramen is patent.C4-5: Small disc osteophyte complex. No significant compromise to the spinal canal. There is mild left and minimal right neural foraminal narrowing related to facet arthropathy and uncovertebral hypertrophy.C5-6: Small disc osteophyte complex and ligamentum flavum thickening contributing to mild to moderate spinal canal stenosis. There is moderate left-sided neural foraminal stenosis related to uncovertebral hypertrophy and facet arthropathy. There is also mild to moderate right neural foraminal stenosis.C6-7: Small disc osteophyte complex including small disc protrusion with mild cranial migration. There is also ligamentum flavum thickening. There is resultant mild spinal canal stenosis, relatively worse just superior to the level of the disc space. Minimal bilateral neural foraminal narrowing. Bilateral facet arthropathy.C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: 1. Multilevel degenerative changes in the cervical spine with mild to moderate spinal canal stenosis at the C5-C6 level and to a slightly lesser degree at the C6-C7 level. No cord signal abnormality.2. Multilevel neural foraminal stenosis, relatively worse at the left C3-C4 and left C5-C6 levels.


Instruction: Generate impression based on findings.

Input: New onset lower back pain, evaluate for compression fracture. Five lumbar type vertebral bodies are presumed to be present. Again seen are compression fractures throughout the lumbar spine as well as the partially imaged lower thoracic spine. There is evidence of cement augmentation from the T12 through the L5 levels. Compared to 7/8/2016 there has been development of a mild compression fracture involving the superior endplate of the T11 vertebral body with minimal loss of height involving the mid aspect of the superior endplate. There is mild edema involving the superior aspect of the T11 level. In the interval, there has also been subtle worsening of height loss involving the L3 compression fracture involving the anterior aspect of the superior endplate, better seen on the T1-weighted sequence with bone cement now contacting the superior endplate. There is minimal edema involving the superior anterior endplate of L3 which is slightly decreased in the interval. Bone marrow edema involving the superior aspect of the T11 vertebral body is new. Remainder of the compression fractures are not appreciably changed. As seen before, there is mild retrolisthesis associated with the L4 compression fracture with up to moderate degree of spinal canal stenosis in association with the ligamentum flavum thickening and bilateral facet arthropathy. The degree of spinal canal stenosis is not significantly changed in the interval. Alignment of the lumbar spine is also not significantly changed including grade 1 anterolisthesis of L3 on L4.Multilevel degenerative changes also include mild multilevel disc bulges and moderate facet arthropathy throughout the lumbar spine. Aside from the L3-L4 level there is no high-grade spinal canal stenosis. Mild multilevel neural foraminal stenosis is present at all levels without high-grade foraminal stenoses at any level.Diffusely heterogeneous marrow signal is again noted. STIR hyperintense lesions are noted involving the left aspect of the sacrum and compatible with history of multiple myeloma. These lesions aren't completely imaged on this lumbar spine study.

Output: 1. Compression fractures involving all lumbar vertebral levels and the imaged T11 and T12 thoracic vertebral bodies. The T11 compression fracture involving the superior endplate is new and associated with minimal height loss. There is mild edema at this level, which is new.2. Minimal worsening of L3 compression fracture is also suspected. Remainder of the chronic compression fractures are not significantly changed. Retropulsion at the superior L4 level with moderate spinal canal stenosis at L3-L4 is also not significantly changed.3. Heterogeneous marrow signal abnormality again seen. STIR hyperintense lesions involving the left aspect of the sacrum are partially imaged but present previously and compatible with known multiple myeloma.


Instruction: Generate impression based on findings.

Input: Reason: SRS planning to metastatic resection cavity History: SRS planning to metastatic resection cavity. There has been interval expected evolution of previously seen right sided postoperative changes from previous temporal parietal craniotomy for mass resection. There remains a thin T2 hyperintense extra-axial collection underlying the craniotomy flap, along with mild dural thickening and enhancement. The right periatrial resection cavity appears similar in configuration, measuring 2.1 x 0.9 cm compared to previous 2.3 x 0.8 cm. A rim of hyperintensity remains along the periphery which may represent a combination of nonspecific enhancement enhancement as well as underlying intrinsic T1 signal as precontrast images are not available on the current exam. A focus of T1 hyperintensity is identified extending to the right lateral ventricular margin at the level of the atrium, as seen on 402/170.Surrounding T2 hyperintensity has significantly improved, although remaining present in a faint vasogenic pattern. There is significant improvement in mass effect upon the adjacent right lateral ventricle. The right temporal horn now appears symmetric to the contralateral side. Midline shift is essentially resolved. Overall, susceptibility along the resection cavity margin appears slightly diminished.There is an emerging subtle peripherally enhancing lesion in the right paramedian frontal subcortical white matter on 401/132 in the cingulate gyrus measuring up to 4 mm. There is a small amount of T2 hyperintensity noted in this location.There is mild-moderate fluid opacification of right mastoid air cells.

Output: 1. Emerging tiny 4 mm peripherally enhancing lesion along the right frontal cingulate gyrus with punctate T2 hyperintensity which may represent an additional metastatic lesion.2. Interval expected evolution of previously described postoperative changes with similar configuration of a right posterior temporal resection cavity, with nonspecific peripheral hyperintensity on available T1-weighted images. Minimal extension towards the right lateral ventricular margin.3. Significant interval improvement in extent of vasogenic edema and localized mass effect, as well as resolved midline shift.


Instruction: Generate impression based on findings.

Input: Right hand/thenar pain LIGAMENTS: No significant abnormality noted.TRIANGULAR FIBROCARTILAGE COMPLEX: No significant abnormality noted.TENDONS: No significant abnormality noted. BONES: No significant abnormality noted.ADDITIONAL

Output: Normal appearance of the right hand/thumb.


Instruction: Generate impression based on findings.

Input: 57 year-old woman with history of right hip pain. Moderate to severe osteoarthritis affects the right hip with osteophyte formation and loss of the articular cartilage, particularly along the anterosuperior aspect of the joint. There are also subchondral cysts in the anterior aspect of the femoral head with surrounding edema and subchondral cysts in the anterior acetabulum. There is no joint effusion. Osteoarthritis also affects the left hip to a slightly lesser degree. Prominence of the anterior aspect of the femoral head/neck junction indicates cam deformity with an alpha angle of approximately 60 degrees. The remaining bone marrow signal intensity is within normal limits.Evaluation of the labrum is limited on this non-arthrogram study; however, irregularity and signal abnormality of the anterosuperior labrum suggests extensive tearing.Mild osteoarthritis affects the left sacroiliac joint. There is a small amount of free fluid in the pelvis.

Output: Degenerative arthritic changes of the right hip as described above.


Instruction: Generate impression based on findings.

Input: Other malaise and fatigue [780.79] / Diplopia [368.2], Reason for Study: ^Reason: eval for structural lesions History: weakness No evidence of acute ischemic or hemorrhagic lesion.No evidence of abnormal enhancement.There is a small developmental venous anomaly on the right cerebellar hemisphere mesial aspect which drains toward vein of Gallen.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, 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 are clear. Partial opacifications on bilateral mastoid air cells.

Output: Normal brain MRI.


Instruction: Generate impression based on findings.

Input: 68 years, Female, clear cell renal carcinoma status post right radical nephrectomy in 2014 with brain metastases. Evaluate for radiosurgery planning. Examination is obtained for treatment planning and limited to postgadolinium 3D T1 and VENBOLD sequences. There are multiple small enhancing lesions including the left middle frontal gyrus (series 401, image 126), relatively large lesion in the right parietal lobe, left parietal lobe involving the superior parietal lobule (series 401, image 120), right occipital lobe, and left cerebellar hemisphere (series 41, image 38), many with associated susceptibility, compatible with hemorrhagic metastases. The largest lesion is located within the right posterior parietal lobe measuring up to 1.6 x 1.2 cm. There is associated right parietal, right occipital, and left cerebellar vasogenic edema, relatively greater within the right parietal lobe. There is no midline shift or herniation. There are few additional foci of susceptibility without corresponding enhancement, likely related to previously treated metastases. The ventricles are within normal limits in size and configuration. There is no extra-axial collection. Bone marrow signal and extracranial soft tissues are grossly unremarkable.

Output: 1. At lease 5 intraparenchymal enhancing lesions in the brain including the left frontal lobe, right and left parietal lobes, right occipital lobe, and left cerebellum, compatible with metastases. Some of these lesions demonstrate susceptibility effect consistent with hemorrhage. Vasogenic edema is associated with some of the lesions, particularly in the right parieto-occipital lobes, without midline shift or herniation. 2. Several foci of susceptibility effect without corresponding enhancement presumably representing previously treated metastases.Please note examination is limited to sequences for treatment planning and prior complete brain MRI is not available for comparison.


Instruction: Generate impression based on findings.

Input: Reason: prostate cancer History: elevated PSAProstate biopsy 5/29/2014: Right mid medial prostatic adenocarcinoma, Gleason 6. PELVIS:PROSTATE:Prostate Size: 5.4 x 3.8 x 4.8 cmPeripheral Zone: Lesion in the right mid peripheral zone which is dark on ADC/T2 is suspicious for prosthetic adenocarcinoma. This lesion appears similar to the prior exam. An additional less suspicious triangular appearing lesion in the far lateral right peripheral zone is also stable.Central Gland: No significant abnormality.Seminal Vesicles: No significant abnormality.Extracapsular Extension: NoneBLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Right peripheral zone lesion consistent with biopsy-proven prostatic adenocarcinoma appears similar to the prior exam. No new lesions are evident.2.No lymphadenopathy.


Instruction: Generate impression based on findings.

Input: Recurrent GTC seizures. There is a partially empty sella and the cerebellar tonsils are minimally low-lying. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Findings suggestive of potential pseudotumor cerebri, but no gross evidence of seizure foci.


Instruction: Generate impression based on findings.

Input: History of weight loss. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology, signal intensity and size, measuring 12.4 cm in the craniocaudal dimension. There is small volume perihepatic ascites. No focal suspicious liver lesion. There is mild dilatation of the common bile duct up to 9 mm which tapers at the level of the pancreatic head, likely related to chronic pancreatitis.Normally distended gallbladder without cholelithiasis.SPLEEN: The spleen is normal in size morphology and signal intensity without a focal lesion.PANCREAS: The pancreatic parenchymal calcifications noted on the comparison CT are not well seen on the MRI, but are compatible with chronic pancreatitis. The main pancreatic duct is mildly irregularly dilated. The duct is seen traversing the pancreatic head, speaking against a mass lesion. The findings and morphology favor chronic pancreatitis, although the examination is limited by lack of intravenous contrast..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: Small bilateral pleural effusions with compressive atelectasis.

Output: 1.Limited nonenhanced MRCP.2.Findings of chronic pancreatitis including irregular mild main pancreatic ductal dilatation and narrowing. The duct traverses the masslike pancreatic head, speaking against an underlying mass lesion, and compatible with stigmata of chronic pancreatitis.


Instruction: Generate impression based on findings.

Input: Clinical question: Rule out new CVA. Signs and symptoms: Left upper extremity pain Nonenhanced head CT:There is no evidence of intracranial hemorrhage, edema, mass effect, midline shift or hydrocephalus. Small focal low attenuation in the subcortical and periventricular white matter of right frontal lobe is again identified however it appears larger than prior to study. Possibility of a new overlapping stroke cannot be ruled out and follow-up with an MRI is recommended. The density of area of low attenuation however is suggestive of an old chronic stroke.

Output: Focal area of low-attenuation in the subcortical white matter of right frontal lobe consistent with an old stroke as described above.


Instruction: Generate impression based on findings.

Input: Hand contraction, dystonia left greater than right. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained. Bone marrow signal is within normal limits. The cervical spinal cord has normal signal characteristics and overall morphology.Mild degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: No significant compromise to the spinal canal or neural foramina.C4-5: Small disc osteophyte complex including small left foraminal disc protrusion and uncovertebral hypertrophy. There is partial effacement of the left ventral thecal sac without significant spinal canal stenosis overall. Mild to moderate left neural foraminal stenosis and mild right neural foraminal narrowing.C5-6: No significant compromise to the spinal canal or neural foramina.C6-7: No significant compromise to the spinal canal or right neural foramen. Minimal left neural foraminal narrowing.C7-T1: No significant compromise to the spinal canal or right neural foramen. Mild left neural foraminal narrowing related to uncovertebral hypertrophy.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits. There is a subcentimeter focus of T2 hyperintensity in the left posterior aspect of the left thyroid lobe likely representing thyroid nodule, but not well evaluated.

Output: 1. Mild multilevel degenerative changes without significant spinal canal stenosis at any level or cord signal abnormality.2. Mild to moderate left C3-C4 neural foraminal stenosis. Mild neural foraminal stenosis at additional levels as above.


Instruction: Generate impression based on findings.

Input: A patient submitted outside study for review. Submitted for review are screening and diagnostic mammogram (7/15/2015, 7/21/2015), ultrasound ( 7/21/2015), ultrasound-guided biopsy (7/27/2015), post biopsy mammogram (7/27/2015) and MRI (8/11/2015) performed at Palos Community Hospital, Indiana. For comparison,standard mammogram (6/11/2014 and 3/11/2013) are available. MAMMOGRAMS(7/15/2015, 7/21/2015): Two standard views of both breasts were obtained with tomosynthesis. Additional exaggerated CC lateral views of both breasts were also submitted. The breast parenchyma is heterogeneously dense, which limits the sensitivity of the mammogram . There is very subtle architectural distortion in the right central breast middle depth near 12:00 position, spanning approximately 10 mm. These are likely more evident on the dynamic tomosynthesis views which are not available.No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in the left breast. Benign appearing lymph nodes are projected over both axillae.ULTRASOUND (7/21/2015): Standard images from targeted ultrasound of the right breast shows a 6 x 7 x 3 mm lobulated hypoechoic mass in the right breast 12:00 position 4 cm from the nipple, without internal vascularity. Also in the right breast 4:00 position 6 cm from nipple there is a 7 x 8 x 4 mm anechoic lesion, consistent with a simple cyst.US Bx (7/27/2015): Static images from ultrasound-guided right breast core biopsy show appropriate targeting of the right breast mass 12:00 position 4 cm from the nipple with clip placement. Per the radiology report, pathology results showed invasive ductal carcinoma and DCIS.POST BIOPSY MAMMOGRAM (7/27/2015):Postbiopsy MLO and CC views of the right breast show a percutaneously placed biopsy clip within the medial upper quadrant of the right breast near the 12-1:00 position.MRI (8/11/2015):There is mild background parenchymal enhancement, right greater than left. Within the right breast upper inner quadrant there is a 10 x 12 mm enhancing mass (AP x TV) with clip artifact seen centrally and washout kinetics consistent with biopsy-proven cancer. Post biopsy changes are present adjacent to this mass. There are scattered nonspecific enhancing foci bilaterally, which demonstrate persistent enhancement kinetics and are most consistent with background enhancement. To confirm the stability of those foci, follow up MRI in 6 months is recommended.No additional areas of enhancement in the either breast or axilla to suggest malignancy.Incidental note of right hepatic dome cyst.

Output: Concordant biopsy proven right breast 12:00 position invasive ductal carcinoma and DCIS measuring 10 x 12 mm on MRI. Multiple foci in both breasts on MRI, right greater than left, likely parenchymal enhancement. To confirm the stability of those foci, follow up MRI in 6 months is recommended. Per the outside hospital radiology report, pathology results showed invasive ductal carcinoma and DCIS. No additional suspicious foci of enhancement in either breast or axilla.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Male, 47 years old, with new severe headaches, history of PE and DVTs. No definite restricted diffusion is seen. Small areas of bright diffusion signal along the left paracentral lobule and within the medulla are favored to be artifactual. No edema or mass effect is detected. No evidence of intracranial hemorrhage or any abnormal extra-axial fluid collection is seen. Ventricular size and morphology are within normal limits. A pineal region cystic lesion is evident measuring up to 13 mm. On MRV images, the dural venous sinuses and visualized deep veins are patent.

Output: 1.No definite acute intracranial abnormality or other specific findings which would account for the patient's symptoms.2.No evidence of dural venous thrombosis.3.Incidental note is made of a pineal region cystic lesion. These lesions are most likely benign and do not require specific imaging follow-up.


Instruction: Generate impression based on findings.

Input: Metastatic breast cancer, low back pain, leg weakness, urinary straining. The vertebral bodies are appropriate in the overall alignment and height. The spinal cord displays grossly normal signal characteristics and overall morphology. There is no compromise of the spinal cord or cauda equina. There is a partially imaged lesion within the upper right sacral ala that is T1 hypointense and T2 hyperintense and that appears to impinge upon the exiting nerve roots. An additional lesion with similar signal characteristics is present within the posterior aspect of the T9 vertebral body, as well as a smaller lesion within the L4 vertebral body with no associated extension into the adjacent spinal canal. There are several T2 hyperintense subcutaneous nodules posterior to the spine. For example, a subcutaneous nodule posterior to the upper thoracic spine measures up to 15 mm. There are incompletely imaged lesions in the lungs and abdomen.

Output: 1. No spinal cord or cauda equina compression is identified. This is a limited exam specific for the exclusion of cord compression only and does not exclude more subtle lesions such as intrinsic cord abnormalities. 2. Findings likely represent metastatic disease to the spine, specifically in the right sacral ala, as well as the T9 and L4 vertebral bodies, with likely associated impingement on the exiting nerve roots by the sacral lesion. 3. There are likely additional sites of metastatic disease within the subcutaneous tissues posterior to the spine, as well as known metastatic disease to the mediastinum, lungs, and liver, which are incompletely imaged and characterized. Please refer to prior CT studies for additional findings. Due to the screening nature of this protocol details are not as evident on imaging as dedicated protocols of the spine.Findings were discussed with Dr. Stephen Constantine by phone on 6/19/2015 at 4:50 PM.


Instruction: Generate impression based on findings.

Input: Ms. Jellinek is a 64 year old female with a strong family history of breast cancer including sister (diagnosed at the age of 40), daughter (diagnosed at the age of 24) and ovarian cancer in mother (diagnosed at the age of 49) and paternal grandmother (diagnosed at the age of 63). Personal history of benign left breast MRI guided biopsy x2 in 2003 for fibrocystic changes. She has no current breast related complaints. There is scattered fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary or internal mammary region.

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


Instruction: Generate impression based on findings.

Input: 25-year-old male with lateral joint line pain, rule out lateral meniscal tear MENISCI: There is a thin vertical band of increased signal intensity traversing the inner fibers of body of the lateral meniscus indicating a radial tear, which we suspect spares the most peripheral fibers. There is also a horizontally oriented band of increased signal intensity within the anterior aspect of the body of the lateral meniscus which may be contiguous with the aforementioned radial tear. The posterior horn of the lateral meniscus and medial meniscus are intact.ARTICULAR CARTILAGE AND BONE: No abnormal marrow signal. The articular cartilage is intact.LIGAMENTS: The ACL and PCL are intact. The MCL and lateral collateral ligament complex is intact.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: Thin radial tear of the body of the lateral meniscus.


Instruction: Generate impression based on findings.

Input: PVCs r/o ARVC and infiltrative CM Left VentricleThe left ventricle is normal. The overall LV ejection fraction is 59%, the LV end diastolic volume index is 68 ml/m2 (normal range: 65+/-11), the LVEDV is 122 ml (normal range 109+/-23), the LV end systolic volume index is 28 ml/m2 (normal range 18+/-5), the LVESV is 50 ml (normal range 31+/-10). LV wall thickness is normal. 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. The overall RV ejection fraction is 53%, the RV end diastolic volume index is 73 ml/m2 (normal range 69+/-14), the RVEDV is 131 ml (normal range 110+/-24), the RV end systolic volume index is 34 ml/m2 (normal range 22+/-8), and the RVESV is 62 ml (normal range 35+/-13). No regional wall motion abnormalities noted.Right AtriumThe right atrium is normal. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation, but the severity of aortic regurgitation can be underestimated by the MRI pulse sequence used in this study.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation, but the severity of mitral regurgitation can be underestimated by the MRI pulse sequence used in this study.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation, but the severity of pulmonic regurgitation can be underestimated by the MRI pulse sequence used in this study.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation, but the severity of tricuspid regurgitation can be underestimated by the MRI pulse sequence used in this study.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 drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac Findings . 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 LV systolic function. No wall motion abnormalities. No delayed myocardial enhancement.2. Normal RV with no MRI criteria for ARVC.


Instruction: Generate impression based on findings.

Input: 73-year-old female with history of breast cancer with brain metastases presenting with fulminant hepatic failure. Please evaluate for evidence of increased intracranial pressure. Focal encephalomalacia affecting the left temporal lobe is unchanged in appearance. Patchy low attenuation within the subcortical and periventricular white matter is nonspecific, and may be vascular in etiology. There is no intracranial hemorrhage or abnormal extra-axial fluid collections. There is no midline shift or mass effect. The ventricles are midline, with normal volume and morphology. The basilar cisterns are normal in appearance.Poorly defined lytic lesions affecting the right frontal and left frontal bones may represent metastases. There is also new lytic destruction of the right aspect of the clivus and petrous apex, concerning for metastasis. These were not present on the 4/25/2007 exam. Further evaluation with contrast-enhanced MRI may be considered to evaluate for leptomeningeal extension if clinically indicated. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. No intracranial hemorrhage or evidence of increased intracranial pressure.2. New lytic lesions affecting the frontal bones and skull base are suspicious for metastases. Further evaluation with contrast-enhanced MRI may be considered if clinically indicated.


Instruction: Generate impression based on findings.

Input: 64 years, Male, right hemiparesis and dysarthria.. Please note examination is motion degraded and limited to diffusion-weighted, sagittal T1, and axial T2-weighted sequences. There is restricted diffusion in the left pons consistent with acute infarct. Previously seen infarct involving the right aspect of the pons on prior MRI demonstrates evolution with residual T2 hyperintensity in this region.Volume loss compatible with chronic infarct in the left posterior inferior cerebellar artery territory is again seen. Patchy areas of T2 hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with chronic small vessel ischemic disease. No evidence of intracranial mass effect, midline shift, or herniation. Ventricles remain normal in size.

Output: Patient could not tolerate the full study and limited sequences were obtained. There is evidence of acute infarct involving the left aspect of the pons and evolution of the infarct involving the right aspect of the pons seen on recent MRI from 6/23/2016. Chronic left PICA territory infarct also again seen.


Instruction: Generate impression based on findings.

Input: 33 years, Female, Reason: rule out retained CBD stone post lap chole History: abd pain. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Prominent common bile duct measuring 6 mm with mild intrahepatic biliary ductal dilatation. There are two filling defects within the mid and distal common bile duct which likely represents stones, the largest measuring 3 mm. A small amount of fluid is present in the gallbladder fossa.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Two small stones in the mid to distal common bile duct with mild intrahepatic biliary ductal dilatation.


Instruction: Generate impression based on findings.

Input: Pancreatic ductal dilatation and concern for pancreatic mass. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology, size and signal intensity. Segment VII peripheral subcentimeter hepatic cyst.Cholelithiasis without evidence of acute cholecystitis.No focal suspicious lesion, biliary ductal dilatation or vascular abnormality.SPLEEN: No significant abnormality noted.PANCREAS: No suspicious pancreatic mass. Pancreatic duct is normal in caliber and is again tortuous at the level of the pancreatic tail. Stable subcentimeter T2 hyperintense foci in the pancreatic head and tail some of which appear to communicate with the main pancreatic duct likely represent small branch type IPMNs.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Stable examination with small T2 hyperintense foci in the pancreatic head and tail likely representing very small IPMNs.


Instruction: Generate impression based on findings.

Input: Reason: pre op please call neurosurgery on call to place fiducles 6876 History: pre op for craniotomy today The patient is status post right frontal craniotomy for right frontal lobe surgery. At the tumor resection site there is nodular enhancement present along the medial aspect of the right frontal lobe and medial aspect of the adjacent right cingulate gyrus. This was present on the 3/16/15 exam but is new since exams. There is cystic encephalomalacia present along the anterior aspect of the right frontal lobe with some surrounding T2 signal hyperintensity at the surgical site which remains relatively stable compared to the prior prior exam from march but has progressed over the past year. Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Limited exam for surgical guidance.2.Compared to the prior exam from March there is no significant interval change in the appearance of the right frontal lobe and cingulate gyrus nodular lesions. This is suspicious for local recurrence.3.Status post right frontal lobe surgery.


Instruction: Generate impression based on findings.

Input: Seizure like activity. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. There is no evidence of heterotopia or hippocampal sclerosis. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No evidence of potential seizure foci.


Instruction: Generate impression based on findings.

Input: Female, 22 years old, with weakness and paresthesias. The brain parenchymal morphology and post-contrast T1 signal characteristics are within normal limits. There is no focal enhancing lesion or mass effect detected. The ventricles are normal in size and morphology.

Output: No abnormal intracranial enhancement or other significant abnormality identified on post-contrast images. Please refer to the recent brain MRI without contrast report for additional details.


Instruction: Generate impression based on findings.

Input: 72-year-old female with history of diabetes and hypertension. Presents with slurred speech. Rule out stroke This examination demonstrates no evidence of any acute intracranial abnormality in particular no definite evidence of stroke is detected. If patient's clinical symptoms persist an MRI is recommended.The cortical sulci, ventricular system and all CSF cisterns remain within normal limits. No evidence of hemorrhage, mass-effect, midline shift or hydrocephalus is detected.Calvarial, mastoid air cells are unremarkable.Extensive inflammatory sinus disease of all paranasal sinuses that are visualized on this exam is noted.

Output: 1.No evidence of acute intracranial findings.2.Pansinusitis.3.4.


Instruction: Generate impression based on findings.

Input: Male, 17 years old. Left wrist mass, slowly increasing in size. LIGAMENTS: Absence of intra-articular contrast limits evaluation of the intrinsic ligaments of the wrist, but there is no specific evidence of injury within these limitations.TRIANGULAR FIBROCARTILAGE COMPLEX: No significant abnormality noted.TENDONS: The tendons of the wrist appear unremarkable. BONES: Bone marrow signal intensity is normal.ADDITIONAL

Output: Enhancing multilobulated mass in the lateral soft tissues of the wrist is nonspecific, and benign vs malignant tumors are considered.


Instruction: Generate impression based on findings.

Input: 35-year-old male patient with positive Lachman's and intermittent locking. Question of ACL tear, meniscal tear. MENISCI: Vertical increased signal abnormality within the posterior horn of the lateral meniscus represents a tear. Additionally, there is increased, multidirectional signal within the anterior horn/root of the lateral meniscus which likely represents a complex tear or contusion of the root. The medial meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is slight cortical depression of the weightbearing portion of the lateral femoral condyle without underlying edema which suggests a prior impaction injury. Additionally, the overlying cartilage is thinned. Otherwise the articular cartilage of the medial tibiofemoral compartment and patellofemoral compartment appears intact.LIGAMENTS: There appears to be a avulsion of the anterior cruciate ligament from its tibial attachment with the fracture fragment of the tibial spines lying within the intercondylar notch measuring approximately 8 mm.Edema is also noted within the tibia underlying the site of prior attachment. The posterior cruciate ligament appears intact. The collateral ligaments appear intact.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: Findings compatible with a pivot-shift mechanism of injury with ACL tibial avulsion injury.Recommend plain film radiographs or CT to further evaluate the tibial spine avulsion. Tearing of the lateral meniscus (as above), and evidence of lateral femoral condyle impaction injury.


Instruction: Generate impression based on findings.

Input: Sign and symptoms: Dizziness and dizziness abnormal findings on diagnostic imaging of head.Reason for study: Further evaluation of right periatrial hyperintensity, also rule out CP angle lesion.History: Vertigo, dizziness and weakness.. There is a T2/FLAIR hyperintense focus in the right periatrial white matter with corresponding T1 hypointense signal (image 18, series 701). This is second T2 hyperintense similar focus adjacent to the right frontal horn of the lateral ventricle (image 16, series 701). There is a third focus of T2 hyperintensity along the lateral aspect of the right splenium of corpus callosum (image 17, series 701), which was better appreciated on the prior MRI. None of these lesions demonstrates diffusion restriction, or susceptibility effects or abnormal enhancement. There is no evidence of intracranial hemorrhage or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation.Note that this study is not dedicated for internal auditory meatus /temporal bone. However, no abnormal enhancement in the cerebellar hemispheres or cerebello pontine angles are visualized. Bilateral internal auditory canals show no abnormal enhancement. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1.There are three T2 hyperintense foci in the right periatrial, adjacent to the frontal horn of the lateral ventricle white matter and lateral aspect of the right splenium of corpus callosum. These foci particularly along the corpus callosum is suspicious for demyelinating lesions. Suggested detailed clinical examination as well as correlation with laboratory parameters.2.No evidence of posterior fossa or cerebellopontine angle tumor.


Instruction: Generate impression based on findings.

Input: Assess for abscess versus hematoma of tongue: Left-sided tongue pain and swelling; ESBL E coli of buccal mucosa treated with 3 wks IV ertapenem (9/2015). There is now diffuse T2 hyperintensity and swelling with areas of relatively lower T2 signal within the left oral tongue and tongue base with extension into the submandibular space, floor of the mouth and buccal mucosa region. The mandible bone marrow signal appears to be unremarkable. There does not appear to be significant lymphadenopathy in the upper neck and the imaged portions of the major cervical flow voids appear to be intact. There is a left retinal hemorrhage with a hematocrit level. There is a right lens implant. There is scattered mild paranasal sinus mucosal thickening. The imaged intracranial structures are grossly unremarkable.

Output: 1. Findings suggestive of left oral cavity and tongue base inflammation, such a a form of Ludwig angina, without definite abscess formation, although the assessment is limited due to the lack of intravenous contrast, versus hemorrhage with associated edema.2. Left retinal hemorrhage .


Instruction: Generate impression based on findings.

Input: 33 years Male (DOB:9/8/1983)Reason: preop planning for tumor resection: fiducials 6876 History: preopPROVIDER/ATTENDING NAME: BAKHTIAR YAMINI BAKHTIAR YAMINI Since the previous exam a mass involving the genu of the corpus callosum and adjacent frontal lobe white matter and periventricular white matter and cingulate gyrus has increased in axial dimensions from 49 x 14 mm to 72 x 19 mm. There is associated vasogenic type edema surrounding this mass. There is associated patchy enhancement within the lesion.The patient is status post right frontal craniotomy and right superior frontal gyrus surgery. There is some surrounding T2 and FLAIR signal hyperintensity at the surgical bed. Some enhancement of the dura adjacent to the craniotomy site.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate some minor opacities.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Since the prior exam a mass involving the corpus callosum and adjacent frontal lobes has enlarged.2.The patient is status post right frontal lobe surgery.3.Please note this is a limited exam for the purpose of stereotactic guidance during surgery.


Instruction: Generate impression based on findings.

Input: Effusion. Evaluate for intra-articular pathology. MENISCI: There is complex tearing of the posterior horn and body of the lateral meniscus with both vertical and horizontal components. The medial meniscus is intact. ARTICULAR CARTILAGE AND BONE: Bone marrow signal is within normal limits. The articular cartilage of all three compartments is intact.LIGAMENTS: The collateral ligaments, cruciate ligaments, and popliteus muscle/tendon are intact.EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Complex tear of the posterior horn/body of the lateral meniscus with vertical and horizontal components.


Instruction: Generate impression based on findings.

Input: Female, 54 years old, status post head trauma with possible seizure. Image quality is degraded by motion artifact. In addition, some sequences were not obtained due to patient agitation.No evidence of restricted diffusion is seen. A few scattered foci of FLAIR hyperintensity are seen within the cerebral white matter, a nonspecific finding. No mass effect or parenchymal edema is detected. No evidence of gross intracranial hemorrhage or any abnormal extra-axial fluid collection is seen. The ventricles are normal in size.

Output: 1. No evidence of any posttraumatic sequelae.2. No other specific findings which would account for the patient's seizures.


Instruction: Generate impression based on findings.

Input: Medically refractory epilepsy left side epileptic activity: complex partial with bilateral frontal lobe onset and secondary generalization. There is no evidence of mass or acute infarct. There is a small focus of susceptibility artifact in the superficial right middle frontal gyrus with associated very mild T2 signal abnormality not significantly changed and suggestive of prior insult. There also appear to be terminal zones of myelination. Otherwise, there are no parenchymal signal abnormalities. The corpus callosum appears unchanged from the prior examination, with relative thinning along the posterior body. The ventricles are unchanged in size. There is no midline shift or herniation. The major cerebral flow voids are intact. There is minimal mucosal thickening within the paranasal sinuses as well as dependent secretions within the nasopharynx.

Output: Small focus of susceptibility artifact and parenchymal abnormality involving the right frontal lobe appearing similar to prior and likely the sequela of prior injury.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 43 years, Female, multiple sclerosis, follow-up for progression.. There are approximately 10 T2/FLAIR hyperintense lesions in the periventricular and subcortical white matter with distribution and morphology consistent with known demyelinating disease. Compared to 8/30/2013, there are at least 3 new small lesions including a juxtacortical lesion in the right posterior frontal lobe, axial FLAIR series 403 image 148, right parietal periventricular lesion, image 130, and right inferior parietal lobule juxtacortical lesion, image 133. There is mild burden of T1 hypointense lesions. Small left thalamic lesion again noted. Brain parenchymal volume is preserved. No intracranial mass or mass effect. Ventricles and sulci are within normal limits. Calvarium and extracranial soft tissues are unremarkable.There is suggestion of a small right dorsal C1 lesion, which is not definitively seen on prior remote cervical spine MRI from 2009, which can be better assessed with a follow-up cervical spine MRI.

Output: 1. Compared to 8/30/2013, there are at least 3 new lesions in the supratentorial white matter consistent with progression of demyelinating disease.2. Probable new small right dorsal C1 cervical cord lesion, incompletely assessed.


Instruction: Generate impression based on findings.

Input: Clinical question: 4-year-old female with recurrent parenchymal, status post resection x2. Signs and symptoms: Slight growth on previous MRI scan. Pre and post enhanced thoracic MRI:Examination redemonstrates a small focus of enhancement on the thoracic cord at T8 level. The finding measures approximately 11 mm craniocephalad axis compared to prior study measurement of 8 mm. And T1 weighted images there is a focus of hyperintensity within the cord at this level which may represent mineralization. This finding although was not appreciated on immediate prior exam it was however present on earlier study from 12-20 2-14.Stable extensive postoperative changes of multilevel posterior laminectomies, extensive myelomalacia of the cord and highly suspected cord adhesion since prior exam.There is no detectable additional foci of abnormal enhancement of the cord or the visualized cauda equina.

Output: 1.Small focus of enhancement within the cord at T8 level measuring 11 mm in craniocephalad axis compared to prior study measurement of 8 mm. A small focus of mineralization at this site although was not well appreciated on the immediate prior exam it was noted on earlier study from December 2014.2.Stable postoperative changes of prior laminectomy and including myelomalacia and cord adhesion as detailed.


Instruction: Generate impression based on findings.

Input: Known metastatic prostate cancer, now with question of small cell lung cancer, total whole body screening. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are mild scattered foci of T2 hyperintensity in the cerebral white matter. There is no abnormal intracranial enhancement. There is mild diffuse cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, paranasal sinuses, and scalp soft tissues are grossly unremarkable. However, the bone marrow of the clivus and imaged portions of the upper cervical spine display diffuse low T1 signal and enhancement. There is mild bilateral mastoid air cell fluid.

Output: 1. No evidence of intracranial hemorrhage, mass, or acute infarct. 2. Multiple bone metastases.


Instruction: Generate impression based on findings.

Input: Age : 4 years Gender: Female Indication: Leg length discrepancy Please note that there may be a margin of air due to the fact that the the tibia are not parallel.Measurements are defined as follows: FEMUR -- from the top of the femoral head to the median femoral condyle, TIBIA -- from the median femoral condyle to the tibial plafond, LOWER EXTREMITY -- from the top of the femoral head to the tibial plafond.Measurements are as follows, in centimeters (cm):Left femur: 22.0 cm right femur: 21.5 cmLeft tibia: 16.0 cm right tibia: 17.0 cm Left lower extremity: 38.0 cmRight lower extremity:38.5 cmLeg length discrepancy: 0.5 cm The pelvis is normal in appearance without fracture.

Output: Please note that there may be a margin of air due to the fact that the the tibia are not parallel. Within this limitation, there is a 0.5 cm leg length discrepancy as detailed above.


Instruction: Generate impression based on findings.

Input: 54-year-old male with history of aortic valve replacement (bioprosthetic) for severe aortic regurgitation and a ventricular septal defect with chest pain, syncope, dizziness, diaphoresis. Minimal paravalvular leak on TEE. Referred for cardiac MRI to evaluate for questionable dehiscence. Left VentricleThe left ventricle is normal in size with mildly reduced systolic function. The overall LV ejection fraction is 49%. The LVEDV is 173 ml (normal range 142+/-34), the LV end diastolic volume index is 103 ml/m2 (normal range: 74+/-15), the LVESV is 89 ml (normal range 47+/-19) and the LV end systolic volume index is 53 ml/m2 (normal range 25+/-9). The LV mass is 109 g (normal range 164+/-36) and the LV mass index is 65 g/m2 (normal range 85+/-15). There are no regional wall motion abnormalities present. There is small amount of late gadolinium enhancement in the basal anteroseptal wall possibly due to previous VSD repair.The native T1 myocardial relaxation time is 1110 ms in the ventricular septum and 1147 in the LV free wall.There is no LV thrombus. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 53%. The RVEDV is 133 ml (normal range 142+/-31), RV end diastolic volume index is 79 ml/m2 (normal range 82+/-16), the RVESV is 62 ml (normal range 54+/-17), and the RV end systolic volume index is 37 ml/m2 (normal range 31+/-9).Right AtriumThe right atrium is normal in size.Aortic ValveThe bioprosthetic aortic valve opens opens widely. There is no significant aortic regurgitation. No paravalvular leak is noted.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 drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsScattered subcentimeter pulmonary nodules and mild mediastinal and hilar lymphadenopathy. Correlation with chest CT is suggested. 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: No convincing evidence of aortic perivalvular leak or aortic valvular dysfunction.1.The left ventricle is normal in size with mildly reduced systolic function. LVEF 49%. 2.Small amount of late gadolinium enhancement in the basal anteroseptal wall possibly due to previous VSD repair.3.The right ventricle is normal in size with normal systolic function. RVEF 53%.4.Normally functioning bioprosthetic aortic valve with no regurgitation and no paravalvular leak.5.Scattered subcentimeter pulmonary nodules and mild mediastinal and hilar lymphadenopathy. Correlation with chest CT is suggested. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Pancreatic cancer -- follow-up. CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Infusion port in right anterior chest wall with tip of catheter in the distal superior vena cava unchanged..ABDOMEN:LIVER, BILIARY TRACT: Diffuse fatty infiltration liver again identified -- this obscures the ability to see lesions in the liver and if concern for metastatic disease in liver exists, ultrasound or MRI would be recommended. Pneumobilia seen from prior choledocho jejunostomy..SPLEEN: No significant abnormality noted.PANCREAS: Prior surgery status post Whipple procedure. Remaining pancreas appears normal and unchanged..ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Again noted are multiple small mesenteric lymph nodes along the root of the mesentery. The largest of these measures 1.0 x 2.3 cm (series 5 come image 108) with multiple smaller ones lower inferiorly. These are all unchanged and of uncertain significance. No new lesions are identified. The mild soft tissue cuffing along the posterior SMA remains unchanged with mild narrowing of the origin of the SMA better seen on prior exam and narrowing is less prominent on current examination. BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: Post hysterectomy without other abnormality..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. Status post Whipple procedure with stable exam and no significant change since prior examination. 2. Small lymph nodes at the root of mesentery appear unchanged and are of uncertain significance. 3. Diffuse fatty infiltration the liver -- this can obscure the presence of liver lesions and if concern exists for liver metastases, ultrasound or MR would be recommended.


Instruction: Generate impression based on findings.

Input: BRAIN: There is mild motion degradation of the study. There is no acute infarct, mass effect or midline shift. The cerebellar tonsils remain above the foramen magnum. The rostrum, genu, anterior and midbody of the corpus callosum have formed with hypoplasia of the posterior body and splenium of the corpus callosum. There is mildly colpocephalic appearance of somewhat parallel lateral ventricles. There is no hydrocephalus. There are no definite gray matter heterotopias. The hippocampi are symmetric in signal and volume. There is mild ethmoid and trace sphenoid sinus mucosal thickening. There are small bilateral maxillary sinus air-fluid levels.CERVICAL: There is straightening of the cervical spine with no marrow or cord signal abnormality. There is no suspicious enhancement in the cervical spine. There is no significant disk/endplate degenerative change, spinal canal or neural foraminal stenosis in the cervical spine. The paravertebral soft tissues are unremarkable.THORACIC: The thoracic spine alignment is normal. The bone marrow signal is within normal limits. There is no cord signal abnormality. There is no suspicious enhancement in the thoracic spine. There is mild diffuse epidural lipomatosis in the posterior epidural space essentially throughout the entire thoracic spine with slightly decreased CSF space around the upper and mid thoracic cord. There is no significant disk herniation, or neural foraminal stenosis. There may be trace bilateral pleural effusions.LUMBAR: The last well formed disk space is referred to as S1-2 with the S1 vertebral body lumbarized. There is spina bifida occulta with right-sided hemilamina defect of the L1 vertebral body. The conus terminates at L2, within normal limits and normal ventral motion on prone imaging. There is no meningocele, lipoma or evidence of tethered cord on the prone images. There is no significant spondylolisthesis. The vertebral body and disk heights are preserved. There is no suspicious enhancement within the lumbar spine.There is a nonenhancing 11-mm T2 hyperintense lesion likely consistent with a cyst. There are bilateral extrarenal pelves.

Output: 1.Mildly colpocephalic lateral ventricles with posterior corpus callosum hypoplasia. No definite anatomic abnormality to explain patient's seizure.2.Transitional vertebral anatomy with lumbarized S1, and the last well formed lumbar disk referred to as S1-2. If surgery is to be contemplated, correlation with imaging of the entire spine is recommended.3.No MR evidence of tethered cord.4.Spina bifida occulta at L1.5.Small bilateral maxillary sinus air-fluid levels may represent acute sinusitis in the proper clinical setting.6.Suspect trace bilateral pleural effusions.7.11-mm right renal cyst.


Instruction: Generate impression based on findings.

Input: Left frontal meningioma resection in 1981. Reresection in 1994. Left falcine meningioma RT in 2009. There are postoperative findings related to left frontal meningioma resection with encephalomalacia in the underlying brain parenchyma and a small amount of enhancing tissue overlying the left middle frontal gyrus, which measures up to 5 mm in width. There is an unchanged falcine meningioma that measures up to 32 mm with associated vasogenic edema in the adjacent portions of the bilateral frontal lobes. There is also an unchanged left lateral temporal convexity meningioma that measures up to 7 mm in width. There is no evidence of acute intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is unchanged enhancement within a presumed the left temporal craniotomy gap and within the left frontal craniotomy flap.

Output: 1. Postoperative findings related to left frontal meningioma resection with encephalomalacia in the underlying brain parenchyma and a small amount of enhancing tissue overlying the left middle frontal gyrus, which measures up to 5 mm in width and may represent residual meningioma. 2. Unchanged falcine meningioma that measures up to 32 mm with associated vasogenic edema in the adjacent portions of the bilateral frontal lobes.3. Unchanged left lateral temporal convexity meningioma that measures up to 7 mm in width. 4. Unchanged nonspecific enhancement within a presumed the left temporal craniotomy gap and within the left frontal craniotomy flap.


Instruction: Generate impression based on findings.

Input: 75 year old male with history of MDS, coronary artery disease, reduced systolic function, now with dyspnea and palpitations who presents for stress cardiac MRI to evaluate for myocardia ischemiaMEDICATIONS: atenolol, glimepride, simvastatin First Pass PerfusionDuring hyperemia, no perfusion defects were present. A prominent dark rim artifact is noted on the rest and stress images. Viability/ Myocardial ScarThere is small near transmural late gadolinium enhancement in a pattern of myocardial infarction noted in the apical lateral wall. This small segment is not likely to be viable. There is subtle epicardial late gadolinium enhancement involving the basal inferolateral wall. The pattern is atypical for prior myocardial infarction and suggests the presence of an underlying myocardial fibrosing, inflammatory, or infiltrative process. The viability of this segment is indeterminate. The remainder of the left ventricle is without late gadolinium enhancement and is likely to be viable. Left VentricleThe left ventricle is normal in size with low normal systolic function. The overall LV ejection fraction is 51%, the LV end diastolic volume index is 90 ml/m2 (normal range: 74+/-15), the LVEDV is 161 ml (normal range 142+/-34), the LV end systolic volume index is 44 ml/m2 (normal range 25+/-9), the LVESV is 80 ml (normal range 47+/-19), the LV mass index is 57 g/m2, and the LV mass is 103 g. There is hypokinesis of the apical lateral wall. Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 61%, the RV end diastolic volume index is 77 ml/m2 (normal range 82+/-16), the RVEDV is 138 ml (normal range 142+/-31), the RV end systolic volume index is 30 ml/m2 (normal range 31+/-9), and the RVESV is 54 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is 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 a small pericardial disease.Extracardiac FindingsThere are moderate-large bilateral pleural effusions. There is evidence of iron overload of the liver. Mediastinal lymphadenopathy is noted. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. No perfusion defects/ "ischemia" present during hyperemia.2. There is small near transmural myocardial infarction noted in the apical lateral wall. This small segment is not likely to be viable. There is also subtle epicardial late gadolinium enhancement involving the basal inferolateral wall. The pattern is atypical for prior myocardial infarction and suggests the presence of an underlying myocardial fibrosing, inflammatory, or infiltrative process. The viability of this segment is indeterminate. The remainder of the left ventricle is without late gadolinium enhancement and is likely to be viable. 3. The left ventricle is normal in size with low normal systolic function [LVEF 51%] with apical hypokinesis.4. The right ventricle is normal in size with normal systolic function [RVEF 61%]5. Small pericardial effusion. 6. See extra-cardiac findings.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 25 years Male (DOB:8/30/1990)Reason: communicating hydrocephalus, autism, shunt , new headaches evaluate for changes History: new headaches, aggressive behaviorPROVIDER/ATTENDING NAME: DAVID M. FRIM DAVID M. FRIM The exam is degraded by metal artifact which obscures partial visualization of left hemisphere orbits and paranasal sinuses.The patient status post left-sided ventriculostomy tube placement. The ventriculostomy tube courses in the left frontal lobe into the left lateral ventricle with tip in the third ventricle. It is stable compared to the previous exam.Patient is status post right-sided craniotomy. The patient is status post right anterior temporal lobectomy and There is a defect present along the anterior aspect of the right middle frontal gyrusThe visualized portions of the paranasal sinuses are clear to the extent of visualization possible. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.The exam is limited due to metal artifact. This would obscure more subtle abnormalities. To the extent of visualization there is a no evidence for acute intracranial hemorrhage, mass effect or edema.2.The patient status post ventriculostomy tube placement. The lateral ventricles are not enlarged and are stable compared to the prior exam.3.The patient is status post right-sided craniotomy for right frontal and temporal lobe surgery.


Instruction: Generate impression based on findings.

Input: 22-year-old male with bilateral TMJ clicking and acute pain one month ago Right temporomandibular joint: The meniscus of the right TMJ is appropriately situated between the mandibular condyle and the articular eminence on the closed mouth view. The meniscus remains appropriately situated between the condyle and articular eminence on the open mouth view, which also shows appropriate anterior translation of the condyle.Left temporomandibular joint: The meniscus of the left TMJ is also appropriately situated between the mandibular condyle and articular eminence on the closed mouth view. On the open mouth view there is appropriate anterior translation of the condyle, with the meniscus remaining appropriately situated between the mandibular condyle and the articular eminence.We see no osteoarthritic changes or synovitis.

Output: Unremarkable TMJ joints as described above.


Instruction: Generate impression based on findings.

Input: Female, 40 years old, with vertigo. No evidence of restricted diffusion is seen. Scattered punctate T2 hyperintense foci are seen predominantly within the juxtacortical white matter of the cerebral hemispheres, a nonspecific finding. A 3 mm focus of susceptibility within the right insula is seen likely representing chronic microhemorrhage.No pathologic parenchymal or extra-axial enhancement is seen. No evidence of acute intracranial hemorrhage or any abnormal extra-axial fluid collection is detected. The ventricles are normal in size and morphology.On dedicated MRA imaging, normal flow related signal is seen within the anterior and posterior circulation. No evidence of any significant vascular stenosis or occlusion is seen. No aneurysm or vascular malformation is detected within the limitations of technique.

Output: 1.No acute intracranial abnormality.2.No significant vascular abnormality.3.Scattered small foci of white matter T2 hyperintensity are seen, a nonspecific finding which may reflect sequelae of prior inflammation, demyelination, a vasculitic process or migraine headache.


Instruction: Generate impression based on findings.

Input: 35 year old male with chronic right lower extremity wounds and lymphedema. Evaluate for osteomyelitis. Please note that due to the patient's body habitus, the soft tissues of the leg are not included in their entirety. Right tibia/fibula:There is thickening of the skin and reticulation of the subcutaneous fat compatible with the stated history of lymphedema. Within the anterior subcutaneous fat of the leg, approximately 15 cm proximal to the tibiotalar joint, is an irregular crescentic collection of fluid signal intensity, measuring approximately 5.5 x 1.5 x 4.5 cm (TR x AP x CC) with thin rim enhancement, which presumably corresponds to the fluid collection seen on ultrasound examination performed earlier today. There are small foci of internal low signal intensity which could represent calcification or gas. We see no definite communication with the overlying skin surface. Distal to this collection, the edema becomes more confluent, but we see no additional rim enhancing fluid collections. There is fatty atrophy of the musculature of the leg, particularly affecting the gastrocnemius, soleus, and peroneal musculature. There is mild edema type signal within these muscle groups as well, which may simply reflect underlying atrophy. We see no evidence to suggest intramuscular abscess formation. We see no signal abnormality within the tibia or fibula to indicate osteomyelitis.Right foot:There is reticulation of the subcutaneous fat, particularly dorsally and medially, compatible with the stated history of lymphedema. Although the edema becomes confluent, we see no fluid collection to suggest abscess formation. There is increased signal intensity within the plantar musculature of the foot which may reflect underlying atrophy. There is a small amount of fluid within the flexor hallucis longus tendon sheath, near the knot of Henry, which is nonspecific. There are small subcentimeter lobulated fluid collections adjacent to the tendon sheath with minimal if any enhancement, which may represent ganglia. We see no findings to suggest osteomyelitis.

Output: 1. Lymphedema of the right leg and foot.2. Irregular fluid collection within the anterior subcutaneous fat of the lower leg with thin peripheral enhancement corresponding to that seen on the ultrasound examination performed earlier today which could represent an abscess, but please correlate with physical examination for wounds at this location.3. No findings to suggest osteomyelitis.


Instruction: Generate impression based on findings.

Input: Reason: patient with dementia and gait disorder. assess for NPH History: severe gait instability The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. This remains stable compared to the prior exam Patchy T2 and flair signal hyperintensity is also present in the brain stem. This has mildly progressed compared to the prior examOn susceptibility imaging there is a punctate focus of signal hypointensity in the right pons. Most like represents a microhemorrhage. In isolation this is of little clinical significance.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin.

Output: 1.Periventricular and subcortical white matter and the brainstem changes of a mild degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: 57-year-old male with a history of multiple skin cancers presents with a vocal cord paralysis. There are postoperative findings related to left left lateral temporal bone resection with myocutaneous graft reconstruction. There has been interval increase in the degree of a peripherally enhancing area with scattered foci of susceptibility effect and surrounding edema in the left temporal lobe with effacement of the third and left lateral ventricles, but dilatation of the right lateral ventricle. The defect in the left tegmen with mild herniation of the inferior temporal lobe is unchanged. There is minimal residual fluid extra-axial fluid along the floor of the left middle cranial fossa. There is no evidence of acute territorial infarction. There is a nonspecific punctate focus of susceptibility effect in the right anterior cingulate gyrus. There are denervation changes in the left masticator and facial expression muscles. Low T1 and T2 bone marrow signal in the irregular left mandibular condyle may be attributed to degenerative changes with subchondral sclerosis. There has been interval resolution of the enhancement in the left cochlea and cranial nerves in the left internal auditory canal, but new T1 hyperintensity in the left vestibule and semicircular canal,

Output: 1. Continued evolution of what likely radiation necrosis in the left temporal lobe with increase in localized mass effect and incipient obstructive hydrocephalus of the right lateral ventricle.2. Persistent defect in the left tegmen with mild herniation of the inferior temporal lobe and minimal residual extra-axial fluid collection along the floor of the left middle cranial fossa.3. Resolved enhancement of the left cochlea and cranial nerves in the left internal auditory canal, but new T1 hyperintensity in the left vestibule and semicircular canal, which may be related to proteinaceous debris or hemorrhage.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Reason: evaluate for peroneal brevis tendon rupture History: pain and swelling increased at 5th metacarpal base R after tripping on curb and feeling a pop TENDONS: There is a small amount of fluid within the tendon sheaths of the peroneal tendons which may reflect a very mild tenosynovitis. The tendons themselves appear intact. The flexor and extensor tendons appear intact. The Achilles tendon is normal in appearance.LIGAMENTS: The distal tibiofibular syndesmotic complex appears intact. The lateral collateral ligament complex appears intact. The imaged components of the deltoid ligament appear intact.ARTICULAR SURFACES AND BONE: There is subchondral cyst formation within the lateral aspect of the talar dome and distal fibular tip likely degenerative in etiology. Degenerative osteoarthritic changes affect the calcaneocuboid articulation.ADDITIONAL

Output: 1. Mild peroneal tendon tenosynovitis. 2. Small subtalar joint effusion.3. Osteoarthritis of the ankle and midfoot.


Instruction: Generate impression based on findings.

Input: Reason: evaluate for osteomyelitis in the setting of normal plain film History: chronic non-healing ulcer, PAD, malodorous drainage, elevated ESR/CRP, elevated WBC There is ulceration of the soft tissues anteromedial to the distal tibial metadiaphysis. There is also skin thickening as well as reticulation of the subcutaneous fat indicating edema. There is mild periosteal edema along the medial aspect of the distal tibia which likely corresponds to periosteal reaction seen on the recent radiographs, but we see no abnormal signal or enhancement in the underlying bone to confirm osteomyelitis. We see no rim-enhancing fluid collection to indicate abscess. There is a small amount of fluid in the tibiotalar and subtalar joints which is within normal limits. Osteoarthritis affects the midfoot.

Output: Soft tissue swelling and ulceration with mild periosteal edema along the distal tibia which may be reactive in etiology. We see no abnormal medullary signal to confirm osteomyelitis.


Instruction: Generate impression based on findings.

Input: Reason: evaluation of vaginal disease for brachytherapy planning History: evaluation of vaginal disease for brachytherapy planning. PELVIS:UTERUS, ADNEXA: Postsurgical changes of hysterectomy. BLADDER: No significant abnormality noted.LYMPH NODES: No lymphadenopathy. BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Postsurgical changes with no measurable disease.


Instruction: Generate impression based on findings.

Input: 38-year-old female with new acute leukemia, pancreatic head lesion on ultrasound ABDOMEN:LIVER, BILIARY TRACT: Perfusion abnormality of the posterior right hepatic segments. There is a persistent filling defect within the proximal right hepatic veins that may represent thrombus. Additional smaller foci within the proximal left hepatic veins suspicious for thrombus.SPLEEN: Mottled T2 signal and enhancement of the spleen may reflect known diagnosis of leukemia.PANCREAS: There is a small lymph node adjacent to the pancreatic head that likely represents the hypoechoic lesion identified on prior ultrasound. There is a T2 hyperintense cystic lesion in the distal body of the pancreas measuring 9 x 11 mm (series 9, image 22) with probable communication with the main pancreatic duct favored to represent side branch type IPMN. The main pancreatic duct caliber is normal.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Scattered subcentimeter peripancreatic lymph nodes. No pathologically enlarged lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: T2 hyperintense cyst in the left hemipelvis may be adnexal in origin, incompletely evaluated.

Output: 1.Filling defects within the proximal right and left hepatic veins may represent thrombus. 2.Small lymph node adjacent to the pancreatic head that likely represents the hypoechoic lesion identified on prior ultrasound. 3.T2 hyperintense cystic lesion in the distal body of the pancreas with probable communication with the main pancreatic duct favored to represent side branch type IPMN.4.Mottled enhancement of the spleen may reflect known diagnosis of leukemia. No splenic vein thrombosis is present.Findings discussed with clinical service at 1155 on 11/9/2016.


Instruction: Generate impression based on findings.

Input: Recurrent glomus tumor The exam is slightly limited by motion artifact.Tendons: The extensor tendons are intact. The flexor tendons are intact. There is no tenosynovitis.Ligaments: The scapholunate ligament is intact. The lunotriquetral ligament is intact. The triangular fibrocartilage complex is intact.Joints: There is no dislocation or subluxation. There is no joint effusion. There is no significant arthrosis.Muscles: There is no muscle tear or atrophy of the flexor or extensor compartments.Bone marrow: Small areas of low signal intensity are noted within the heads of the second, third, and fourth metacarpals. These are low on T1 and high on T2 and do not appear to enhance following gadolinium administration. Otherwise of the bone marrow signal is normal. There is no fracture or contusion. Soft tissues: There is mild soft tissue prominence and increased signal intensity overlying the dorsal ulnar wrist at the level of the carpometacarpal articulations which represent area of prior grafting. There is no discrete mass identified.

Output: Soft tissue prominence and increased signal intensity overlying ulnar aspect of the dorsal wrist which likely relates to the area of prior surgical intervention. Mild enhancement in the area may reflect scarring but there is no discrete mass identified.


Instruction: Generate impression based on findings.

Input: 60 year old with personal history of left mastectomy for DCIS in 2006. Family history of breast cancer in maternal sister. There is heterogeneous amount of fibroglandular tissue in the right breast.Minimal parenchymal enhancement is noted in the right breast. Note is made of subcentimeter focus of enhancement in the upper outer quadrant of the right breast at mid depth situated at the 2 to 3:00 position, likely representing an intramammary lymph node, unchanged when compared to the prior studies. Otherwise no abnormal enhancement is seen in right breast. The patient is status post left mastectomy with no suspicious enhancement in the reconstruction. Intact subpectoral left silicone implant. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Malignant melanoma of skin, unspecified [C43.9], Reason for Study: ^Reason: Re-evaluate for new disease due to newly advanced disease and plan for systemic therapy History: Newly advanced stage IV melanoma No evidence of acute ischemic or hemorrhagic lesion.No evidence of abnormal enhancement.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear.Mucosal thickening with retention cysts on bilateral maxillary sinuses.

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


Instruction: Generate impression based on findings.

Input: 55 years Female (DOB:6/20/1961)Reason: postop from resection of right cerebellar tumor History: postopPROVIDER/ATTENDING NAME: BAKHTIAR YAMINI Patient is status post posterior fossa surgery for removal of the right cerebellar mass. There is heterogeneous signal within the tumor bed. No enhancing mass is appreciated currently there is a small fluid collection present at the craniotomy site. There is T2 and FLAIR signal hyperintensity surrounding the tumor bed.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: Status post removal of a right cerebellar mass. There are postoperative changes present at the surgical site. There is no convincing evidence for residual tumor at this time. The fluid collection at the surgical site is most likely related to immediate postoperative change though is nonspecific. A follow-up exam with help further assess this.


Instruction: Generate impression based on findings.

Input: NSCLC brain metastases with progression after WBRT, now on PD1 Ab. There are multiple, at least 25, generally subcentimeter supratentorial and infratentorial cortical and juxtacortical enhancing lesions. Although the enhancing lesions appear to be generally similar in size and number, comparison with the prior study is limited due to the differences in slice thickness. However, there has been markedly decreased vasogenic edema associated with many of the lesions. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Multiple, at least 25, generally subcentimeter supratentorial and infratentorial intracranial metastases. Although the enhancing lesions appear to be generally similar in size and number, comparison with the prior study is limited due to the differences in slice thickness. However, there has been markedly decreased vasogenic edema associated with many of the lesions, which is likely attributable to treatment effects.


Instruction: Generate impression based on findings.

Input: 52-year-old female status post right mastectomy and left breast lift in May 2015 for invasive ductal and lobular carcinoma. Patient also received chemotherapy and hormonal therapy. Three standard views of the left breast and an additional left MLO view were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. Focal asymmetry in the left lower outer quadrant is stable since prior mammogram from February 2015, therefore also stable since mammograms performed before her MRI of April 2015. No suspicious mass, microcalcifications or areas of architectural distortion in the left breast. Benign appearing lymph nodes and port catheter project over the left axilla.

Output: No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, left unilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: Male, 67 years old. Shoulder pain. Previous subscapularis lesion. Some sequences are limited by patient motion artifact.ROTATOR CUFF: There is thickening and increased signal intensity of the supraspinatus tendon indicating moderate tendinosis. At the 12:00 position, there is an insertional tear of the supraspinatus tendon on the greater tuberosity that involves the bursal surface fibers but spares the articular surface fibers. The tear traverses more than 50% of the tendon thickness and continues longitudinally as insertional delamination for approximately 1 cm. The tear is just under 1 cm in AP diameter. The supraspinatus muscle appears normal. There is thickening and increased signal intensity of the infraspinatus tendon, indicating mild tendinosis. There is an approximately 8 mm linear tear of the infraspinatus tendon at its insertion. There is severe fatty atrophy of the infraspinous muscle. The teres minor tendon and muscle appear normal. Linear increased signal intensity within the distal subscapularis tendon suggests insertional tearing. We also suspect that there is undersurface fraying of the distal subscapularis tendon with cyst formation in the underlying humeral head. The subscapularis muscle appears normal.SUPRASPINATUS OUTLET: There is an os acromiale. Mild osteoarthritis affects the acromioclavicular joint. There is trace fluid in the subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Mild osteoarthritis affects the glenohumeral joint. There is a small amount of fluid in the joint. Degeneration/degenerative tearing of the superior labrum appears similar to the prior study.BICEPS TENDON: The tendon of the long head of the biceps is intact.

Output: Partial thickness rotator cuff tearing as above that appears to have progressed slightly when compared to the prior study. Other findings as above.


Instruction: Generate impression based on findings.

Input: 78 years Female (DOB:5/18/1938)Reason: R ICA aneurysm; L sided weakness in April; known aneurysm surveillance for short term stability History: L sided weakness in April; known aneurysm surveillance for short term stabilityPROVIDER/ATTENDING NAME: ISSAM A. AWAD ISSAM A. AWAD MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.There is a mild to moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Additionally there are patchy T2 and FLAIR hyperintense foci in the brainstem and basal ganglia.There is a millimeter-sized focus of susceptibility effect present in the left periventricular white matter adjacent to the trigone of the left lateral ventricle. In isolation this is of unknown clinical significance.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:There is an 8 x 5 mm axial dimension aneurysm present which originates from the distal aspect of the cavernous portion of the right internal carotid artery and extends medially bulging and towards the sella. It is stable and compared to the previous exam.There is 60% stenosis at the right p3 segment of the posterior cerebral artery. This is unchanged since prior exam.Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.The anterior communicating artery is identified. The posterior communicating arteries are small. The vertebral arteries are similar in size.

Output: 1.There is an 8 mm aneurysm at the distal cavernous segment of the right internal carotid artery which is stable.2.There is a 60% stenosis of the the right posterior cerebral artery at the p3 segment. This is stable.3.Periventricular and subcortical white matter lesions of a mild to moderate degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: 47-year-old with multiple sclerosis. 3T CCD MRI Javed MS protocol no DTI. A previous punctate focus of T2 hyperintensity in the right temporal lobe subcortical white matter has slightly decreased in size. There is a second punctate focus of T2 hyperintensity in subcortical left parietal white matter (series 401 image 15, series 501 image 46) which in retrospect was present previously but is unchanged. There is a third small linear T2 hyperintense focus within the right temporal lobe subcortical white matter (series 401 image 57, series 501 image 24) which was obscured on the comparison study secondary to phase artifact. The remaining brain parenchyma is unremarkable. There is no mass, mass effect, or midline shift. The ventricles and basal cisterns are normal in size and configuration. The expected intracranial vascular flow voids are present. The paranasal sinuses are clear. The visualized mastoid air cells are clear. The orbits are unremarkable.

Output: 1.A previous punctate focus of T2 hyperintensity in the right temporal lobe subcortical white matter has slightly decreased in size. 2.There is a second punctate focus of T2 hyperintensity in subcortical left parietal white matter which in retrospect was present previously but is unchanged. 3.There is a third small linear T2 hyperintense focus within the right temporal lobe subcortical white matter which was obscured on the comparison study secondary to phase artifact.


Instruction: Generate impression based on findings.

Input: History of primary sclerosing cholangitis status post transplant 2013. Evaluate for biliary obstruction. Patient is status post total proctocolectomy secondary to ulcerative colitis. ABDOMEN:LIVER, BILIARY TRACT: Status post liver transplant with hepaticojejunostomy. Scattered mild focal intrahepatic biliary ductal dilatation and narrowing is grossly unchanged. No new dominant structure or focal mass. No findings to suggest stenosis at the anastomosis site which is relatively well seen. The liver is normal in morphology size and signal intensity without biliary ductal dilatation vascular abnormality or focal lesion.SPLEEN: Chronic splenic infarct with scarring. The spleen measures 14 cm in craniocaudal dimension, unchanged. Perisplenic collateral vessels.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right renal simple appearing cysts. Trace perirenal fluid, unchanged. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Status post colectomy. Right lower quadrant ileostomy without complication. Esophageal varices.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Stable examination with mild dilatation and irregular narrowing of the biliary tree without a dominant stricture or focal mass.Status post liver transplant and hepaticojejunostomy without complication.Stable chronic splenic infarct.


Instruction: Generate impression based on findings.

Input: Anterolisthesis: radicular low back pain. At T12-L2, there is no significant spinal canal or neural foramen stenosis. At L2-3, there is a slight disc bulge, but no significant spinal canal or neural foramen stenosis. At L3-4, there is a mild disc bulge and ligamentum flavum thickening with mild left neural foramen stenosis, but no significant spinal canal or right neural foramen stenosis. At L4-5, there is 5 mm of anterolisthesis and mild disc space narrowing and loss of fluid signal associated with a disc bulge, which in conjunction with ligamentum flavum thickening results severe spinal canal and mild left neural foramen stenosis. At L5-S1, there is mild disc space narrowing and loss of fluid signal as well as adjacent endplate signal alterations associated a disc bulge, which in conjunction with annular fissure and ligamentum flavum thickening leads to moderate spinal canal and mild bilateral neural foramen stenosis. The imaged portions of the spinal cord are unremarkable. The vertebral body heights are preserved. There paraspinal soft tissues are unremarkable. There is a T2 hyperintense lesion in the right kidney that measures up to 12 mm.

Output: 1. At L4-5, 5 mm of anterolisthesis and a disc bulge and ligamentum flavum thickening result in severe spinal canal and mild left neural foramen stenosis. 2. At L5-S1, a disc bulge with annular fissure and ligamentum flavum thickening result in moderate spinal canal and mild bilateral neural foramen stenosis. 3. Incompletely characterized lesion in the right kidney that measures up to 12 mm, which may represent a cyst. Further evaluation via renal ultrasound may be useful.


Instruction: Generate impression based on findings.

Input: Female 69 years old Reason: knee twisting injury History: right knee injury MENISCI: The menisci are intact.ARTICULAR CARTILAGE AND BONE: There is increased T2 signal indicating edema in the posterior lateral femoral condyle. Within this area of edema there are transverse linear areas of low T1 signal on the coronal view and a linear area of low T1 signal intensity extending craniocaudal on the sagittal view indicating a comminuted, nondisplaced fracture.LIGAMENTS: There is a complete tear of the medial collateral ligament. The lateral collateral ligament complex, the ACL and PCL are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1.Comminuted, nondisplaced fracture of the lateral femoral condyle.2.Complete tear of the medial collateral ligament.Findings discussed with Dr. Mindy Schwartz by phone at 10:16 on 11/16/2015