Instruction: Generate impression based on findings.

Input: Ms. Garibay is a 51 year old female with a personal history of right mastectomy in 2011 for invasive ductal carcinoma. Patient received radiation, chemotherapy, and hormonal therapy. History of left breast mastopexy in 2012 and recent benign left breast biopsy for fat necrosis in 04/2014. The patient is status post right mastectomy with reconstruction. No abnormal enhancement is present within the right reconstructed breast or within the right axilla.Mild background parenchymal enhancement is noted in the left breast. Stable postsurgical changes from prior breast reduction along with susceptibility artifact from biopsy marker clip (at site of prior benign breast biopsy) are stable in the left breast. There is no abnormal enhancement identified. No abnormal left axillary lymph nodes are present.

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


Instruction: Generate impression based on findings.

Input: 53-year-old with history of ALH of the left breast There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. Three metallic artifacts are again seen within left breast; upper inner quadrant, 3 o'clock position, and lower outer quadrant. No abnormal axillary 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: 51-year-old male with pain/avulsion fracture TENDONS: Slight undulation in the Achilles tendon related to retraction. Otherwise the tendon is unremarkable. Mild edema adjacent to the Achilles tendon posteriorly may represent paratenonitis. The remaining tendons are unremarkable.LIGAMENTS: The lateral collateral ligament complex is intact. Distal tibiofibular syndesmotic complex appears intact. Loss of fatty striation in the deltoid ligament with increased signal intensity is compatible with a sprain. Mild edema along the plantar fascia is of questionable clinical significance.ARTICULAR SURFACES AND BONE: As seen on the prior radiograph, there is an avulsion type fracture of the superior aspect of the calcaneus. Edema in the underlying calcaneus presumably represents hemorrhage. Mild osteoarthritis affects the ankle and midfoot.ADDITIONAL

Output: Avulsion-type fracture of the superior aspect of the calcaneus and other findings as described above. The Achilles tendon itself is unremarkable.


Instruction: Generate impression based on findings.

Input: Female, 41 years old. Reason: Characterization of right renal cyst partially seen on MRI of lumbar spine This exam is significantly technically limited due to patient's body habitus.RIGHT KIDNEY: The right kidney measures 10.4 cm, with normal cortical echotexture. A lower pole cystic lesion measures 2.9 x 2.6 x 2.7 cm, with apparent internal echoes and complexity. No shadowing calculi or hydronephrosis.LEFT KIDNEY: The left kidney measures 11.4 cm, with normal cortical echotexture. No shadowing calculi or hydronephrosis.URINARY BLADDER: The bladder is incompletely distended.OTHER: No significant abnormalities noted.

Output: A cystic lesion in the lower pole of the right kidney shows possible internal echoes and complexity, although these findings may represent artifact related to patient body habitus. This lesion is still considered incompletely characterized on this exam, and a dedicated CT exam is recommended for further characterization.


Instruction: Generate impression based on findings.

Input: The risks (including, but not limited to, those of bleeding, infection, allergic reaction, pain and inability to access the joint) and benefits of the procedure were explained to the patient, and informed written consent was obtained. A pre-procedural “time-out” form was completed.The patient was placed supine on the fluoroscopy table. The right elbow was localized fluoroscopically, and a spot radiograph was obtained. The skin was cleansed and covered with a sterile drape. The skin and subcutaneous tissues were anesthetized with 1% lidocaine using a 25-gauge needle.Under fluoroscopic guidance, a 22 gauge needle was advanced into the joint. Attempted aspiration yielded no fluid. Next, 5 cc's of a 50/50 mixture of Omnipaque 240 (to confirm the intra-articular position of the needle) and dilute Multihance (0.1 cc in a 10 cc vial of saline, for subsequent MR imaging) were injected into the joint. Contrast opacified the joint in the expected manner. A spot radiograph was obtained for documentation. The needle was withdrawn. Blood loss was negligible (<1cc), and the patient tolerated the procedure well without immediate complication. An adhesive bandage was placed on the patient’s skin. Routine post procedure instructions were communicated to the patient. The patient was escorted to the MRI suite for further imaging in stable condition. Please refer to the subsequent MRI report for further information.Exposure time: 15 seconds.

Output: Successful fluoroscopic guided right elbow arthrogram.


Instruction: Generate impression based on findings.

Input: 32 year old female with RLQ abdominal pain. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: 4.2 x 3.2 mass in the liver at axial image 39 61 43 with central hypoattenuation displaces adjacent liver parenchyma and vessels. Incompletely characterized on this examination. If clinically indicated, dedicated liver CT or MRI examination may be helpful for further evaluation. This most likely represents focal nodular hyperplasia. No biliary duct dilatation. The hepatic vasculature is intact.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Multiple foci of hypo-attenuation in the right kidney with lower pole striated nephrogram are seen best on coronal image 51/92 and axial image 63/143. These findings are most compatible with pyelonephritis. No hydronephrosis was found.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXAE: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: 4-cm diameter hepatic parenchymal lesion may be due to FNH, but this examination is insufficient for complete characterization. Right pyelonephritis without evidence of abscess or hydronephrosis.


Instruction: Generate impression based on findings.

Input: 35-year-old female with numbness in hands result. Slurred speech resolved. One hour ago. No evidence of hemorrhage, edema, mass-effect, midline shift or hydrocephalus. Cortical sulci, ventricular system and all CSF cisterns remain within normal range for patient's stated age. Slight crowding at the level of the foramen magnum is concerning for ectopic cerebellar tonsils. This can be further evaluated with a dedicated MRI examination.Calvarium, paranasal sinuses and mastoid air cells are also unremarkable.

Output: 1.No evidence of acute findings.2.Minimal crowding at the level foramen magnum is concerning for a slightly ectopic cerebellar tonsils.


Instruction: Generate impression based on findings.

Input: Tinnitus, left ear [H93.12], Reason for Study: ^Reason: r/o avm History: pulsatile tinnitus, slight hand weakness on left Brain MRINo evidence of acute ischemic or hemorrhagic lesion.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.Retention cyst on the right maxillary sinus and mucosal thickening on bilateral ethmoid sinus.Brain MRA:3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal.IAC MRIThe brainstem, cerebellum, vermis and tonsils are normal. The inner ear structures, cochlea, vestibule, semicircular labyrinth are normal. The internal auditory canals are normal with delineation of the facial, cochlear and vestibular nerves. No evidence of signal abnormality, mass or abnormal enhancement is noted.

Output: 1. Normal Brain MRI2. Normal Brain MRA3. Normal Brain IAC


Instruction: Generate impression based on findings.

Input: 68-year-old male with history HNC and CRT, compare to previous measurements. History of RT to the left orbit. Posttreatment findings are again seen in the left supraciliary region. There is persistent enhancement along the left lateral orbital wall and extraconal space extending superiorly through the frontal bone coursing medially adjacent to the left frontal sinus unchanged from prior study. Enhancing tissue also extends to the left frontal dura as before. No new mass lesions or areas of abnormal enhancement are noted to suggest tumor progression. The right orbit is unremarkable.The imaged paranasal sinuses are clear.

Output: Posttreatment changes in the left supraciliary region with unchanged nonspecific enhancing tissue at the site of the treated squamous cell carcinoma.


Instruction: Generate impression based on findings.

Input: 46 year old female with history of right shoulder pain after rotator cuff repair. ROTATOR CUFF: There is a suture anchor present within the greater tuberosity extending towards the superior facet. The supraspinatus tendon can be followed to its insertion on the greater tuberosity. There is intermediate signal intensity within the undersurface of the tendon which suggests fraying, but we see no discrete fluid filled tears. There is perhaps mild undersurface fraying of the anterior fibers of the infraspinatus, but the remainder of the muscle and tendon is unremarkable. The teres minor and subscapularis muscles and tendons are within normal limits.SUPRASPINATUS OUTLET: Mild osteoarthritis affects the AC joint. There is a small amount of fluid located immediately deep to the coracoacromial ligament of doubtful clinical significance. Trace fluid is also seen within the subdeltoid bursa posteriorly.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is mild blunting of the superior labrum which may be due to prior debridement or chronic degeneration. Glenohumeral joint alignment is within normal limits. There is no joint effusion.BICEPS TENDON: The biceps tendon is not seen within the rotator interval or bicipital groove. Best seen on image 15 of series 1001 is a 1.5 cm cylindrical structure of intermediate signal intensity with threaded margins situated longitudinally within the soft tissues anterior to the proximal humeral diaphysis. This may reflect prior biceps tenodesis, but this structure is not currently embedded within the bone and hence may be dislodged. ADDITIONAL

Output: 1. Postoperative changes of prior rotator cuff repair with mild undersurface fraying of the supraspinatus, but no discrete tear is appreciated.2. Cylindrical structure within the soft tissues anterior to the proximal humeral diaphysis may reflect prior biceps tenodesis, however this is not embedded in bone and hence may be dislodged.3. Mild osteoarthrosis affects the AC joint.4. Blunting of the superior labrum may reflect chronic degenerative tearing or surgical debridement but is of questionable clinical significance.


Instruction: Generate impression based on findings.

Input: 24 year old female with seizure history. Again seen is encephalomalacia in the left temporal lobe, compatible with prior temporal lobe resection and unchanged since the prior examination.There is crowding of the foramen magnum. This is compatible with mild cerebellar tonsillar ectopia which was seen on the prior MRI dated 7/3/08No evidence of acute hemorrhage. No evidence of mass or midline shift. The gray-white differentiation is preserved. There are surgical changes compatible with prior left frontotemporal craniotomy. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Postsurgical and other chronic changes as above. No evidence of acute hemorrhage or midline shift.


Instruction: Generate impression based on findings.

Input: 42 year-old female with a history of pituitary adenoma presents with with weight loss, shortness of breath, and heaviness of the neck and upper chest CT HEAD:There is no evidence of intracranial hemorrhage, extra-axial fluid collection, mass or edema. There is no mass effect or midline shift. There is preservation of the gray-white matter interface. There is no evidence of acute territorial ischemia. Limited view of the sella turcica and pituitary gland is unremarkable. The pituitary gland is normal in size. There are sclerotic changes in the sphenoid bone most consistent with postsurgical changes. It should be noted that a dedicated MRI is preferred for evaluating interval changes in pituitary lesions. The ventricles and basal cisterns are normal in size and configuration. There is no effacement of the basal cisterns. The calvaria and skull base are radiographically normal. The visualized mastoid air cells and paranasal sinuses are within normal limits.CT NECK:The thyroid gland, parotid gland, and submandibular glands are within normal limits. The visualized orbits are within normal limits. The visualized paranasal sinuses and mastoid air cells are clear. Bilateral lung apex micronodules. There are small scattered cervical lymph nodes normal in size and shape, which are not enlarged by CT criteria. The major vessels are patent.Mild degenerative disk disease affects the cervical spine. There is preservation of the normal cervical lordosis. There is no evidence of acute fracture or malalignment. The prevertebral soft tissues are within normal limits.

Output: 1. No acute intracranial abnormality. Limited view of the sella turcica and pituitary gland is unremarkable. There are sclerotic changes in the sphenoid bone most consistent with postsurgical changes. It should be noted that a dedicated MRI is preferred for evaluating interval changes in pituitary lesions. 2. No evidence of focal neck mass or other radiographic finding to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: SEGA and cortical tubers for change: Tuberous sclerosis and seizures. There are unchanged supratentorial cortical and subcortical lesion with T2 hyperintensity with a linear configuration. There are also multiple unchanged heterogeneously enhancing subependymal lesions with susceptibility effect, the largest of which is located along the atrium of the left lateral ventricle that measures up to approximately 15 mm. There is no evidence of intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There are small retention cysts in the left maxillary and right sphenoid sinuses.

Output: No significant interval change in the intracranial stigmata of tuberous sclerosis, including the left peritrigonal presumed SEGA and multiple zones of cortical dysplasia.


Instruction: Generate impression based on findings.

Input: Ongoing shoulder pain ROTATOR CUFF: There is marked tendinopathy of the supraspinatus and infraspinatus tendons with a focus less than 1 cm of full-thickness tearing in the anterior most fibers of the supraspinatus. There is a small focus of high-grade partial undersurface tearing with retraction to the level of the acromioclavicular joint. A small focus of high signal intensity is identified along the superior fibers of the infraspinatus seen on series 9 image 7 representing interstitial tearing. There is mild fatty atrophy along the myotendinous junction of the infraspinatus muscle but otherwise the supraspinatus and infraspinatus muscles are preserved. The teres minor and subscapularis tendons and muscles are intact.SUPRASPINATUS OUTLET: Moderate osteoarthritis affects the acromioclavicular joint with degenerative cystic changes noted. There is a small amount of fluid identified within the subacromial subdeltoid bursa containing some areas of intermediate signal intensity.GLENOHUMERAL JOINT AND GLENOID LABRUM: Mild osteoarthritis affects the glenohumeral joint but alignment is normal and the labrum appears grossly intact. There is a small joint effusion containing foci of intermediate signal intensity reflecting a component of synovitis.BICEPS TENDON: Evaluation of the biceps tendon is limited given the internally rotated position of the patient. The intra-articular portion of the biceps tendon demonstrates enlargement and increased signal intensity (series 9 image 8) reflecting tendinosis however the tendon itself appears throughout its course. A small amount of fluid surrounds the biceps tendon reflecting extension from the glenohumeral joint.ADDITIONAL

Output: 1. Tendinosis of the supraspinatus and infraspinatus tendon with a small focus of full-thickness tearing of the distal anterior fibers of the supraspinatus tendon. There is additional high-grade undersurface tearing of the supraspinatus tendon with interstitial tearing of the infraspinatus tendon.2. Moderate osteoarthritis of the acromioclavicular joint.3. Small glenohumeral joint effusion with mild synovitis.4. Biceps tendinosis.


Instruction: Generate impression based on findings.

Input: Ms. O'Hara is a 52 year old female with known left breast malignancy. She presents for MRI evaluation as part of the ISPY-2 protocol. There is scattered fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.In the left upper inner breast, there is an irregular heterogenously enhancing mass identified measuring 3.7 x 2.8 x 3.0 cm (AP x ML x SI). Susceptibility artifact from biopsy marker clip is seen within this mass, compatible with known index malignancy. Expected post-biopsy changes are seen extending antero-superiorly from the malignancy.No abnormal enhancement is seen in the right breast. No abnormal lymph nodes are identified in either axillary or internal mammary region.

Output: (1) 3.7 cm index malignancy in the left upper inner breast with appropriately placed biopsy marker clip. (2) No MRI evidence for malignancy in the right breast. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

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

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


Instruction: Generate impression based on findings.

Input: There are a few scattered punctate foci of T2 hyperintensity within bifrontal subcortical white matter without associated mass effect, restricted diffusion or enhancement. There are no similar appearing lesions in the posterior fossa. The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain.

Output: There are a few scattered punctate foci of T2 hyperintensity within bifrontal subcortical white matter without associated mass effect, restricted diffusion or enhancement. These are nonspecific in appearance and the differential diagnosis would most likely include small vessel disease, migraine sequelae, or residua from previous head trauma.


Instruction: Generate impression based on findings.

Input: Examination is mildly motion degraded. No structural abnormality is appreciated. Myelination is within normal limits. No intracranial mass or mass effect. There is no T2/FLAIR parenchymal signal abnormality. No abnormal enhancement. There is no mass effect on the optic chiasm. Sella and orbits are grossly within normal limits. Ventricular size is normal. No evidence of restricted diffusion or susceptibility abnormalities. T2 flow-voids are preserved.There is mild mucosal thickening scattered in the paranasal sinuses.

Output: Brain MRI appears within normal limits. No intracranial mass or focal parenchymal signal abnormalities are appreciated.


Instruction: Generate impression based on findings.

Input: Evaluate for hypothalamic mass: excessive daytime sleepiness. The pituitary gland is not enlarged, but the visible portions do not appear to enhance as expected and may be more T2 hypointense than usual based on the limited images of this area. Otherwise, the posterior pituitary bright spot appears to be intact and the hypothalamus appears to be unremarkable. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears 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: The pituitary gland is not enlarged, but it does not appear to enhance as expected based on the limited available images of this area, which may be due to partial volume averaging effects or the presence of a cystic lesion, such as a Rathke cyst. Otherwise, the posterior pituitary bright spot appears to be intact and the hypothalamus appears to be unremarkable. Nevertheless, follow up via a dedicated pituitary MRI may be useful.


Instruction: Generate impression based on findings.

Input: Redemonstrated are postoperative findings of the lumbosacral spine for tethered cord repair. There is unchanged appearance of fat signal intensity involving the tip of the conus extending from the L4-L5 level down to the lower S1 level and remains adherent to the dorsal dural margin. The spinal cord displays normal signal and appears to slightly shift anteriorly on prone imaging with respect to supine imaging. The tip of the conus remains approximately at the mid L4 level. There is apparent clumping and a peripheral distribution of the cauda equina nerve roots. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The paravertebral soft tissues are unremarkable, aside from the surgical alterations.

Output: Postoperative findings in the lumbosacral spine with redemonstration of an intradural lipoma and low-lying conus medullaris. Apparent clumping of the cauda equina nerve roots may indicate arachnoiditis.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Intra-articular contrast is identified extending into the distal radioulnar joint indicating a tear of the triangular fibrocartilage complex. No contrast is identified traversing the scapholunate or lunotriquetral ligaments or within the midcarpal joint to suggest a tear. Please refer to the subsequent MRI report for further information.Exposure time: 2 minutes and 20 seconds.

Output: Fluoroscopic guided injection of dilute gadolinium into the radiocarpal joint for subsequent MRI arthrogram examination with findings indicating tear of the triangular fibrocartilage complex. Please refer to the subsequent MRI report for additional details.


Instruction: Generate impression based on findings.

Input: 94 years Female (DOB:1/13/1922)Reason: intracranial lesion History: AMSPROVIDER/ATTENDING NAME: JAMES F AHN JAMES F AHN There is a small focus of diffusion restriction present along the posterior limb of the right internal capsule and adjacent right lentiform nuclei.There are multiple small and punctate foci of signal loss within the basal ganglia, thalami and brainstem and cerebellar hemispheres as well as along the subcortical white matter and periventricular white matter in the supratentorial brain.There is a moderate degree of periventricular and subcortical confluent hyperintense white matter lesions present identified on the FLAIR and T2 images.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus. The right A1 segment appears smaller than the left A1 segment. The left internal carotid artery appears larger than the right internal carotid artery. The right vertebral artery appears larger than the left vertebral.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.There is a subacute lacunar infarct present involving right basal ganglia and adjacent posterior limb of internal capsule.2.There are multiple microhemorrhages present throughout the basal ganglia, thalami, cerebellum, brainstem and subcortical and periventricular white matter. This could be related to hypertension and/or amyloid angiopathy but is nonspecific in etiology.3.Periventricular and subcortical white matter lesions of a moderate degree are nonspecific. At this age they are most likely vascular related. MRI of the brain is within normal limits


Instruction: Generate impression based on findings.

Input: 46 years Female (DOB:5/28/1970)Reason: assess for ischemic infarct History: right sided sensory deficitsPROVIDER/ATTENDING NAME: AASIM I PADELA 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. Additionally there is a punctate T2 and FLAIR hyperintense lesion located in the right pons.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: Periventricular and subcortical white matter punctate lesions of a mild degree as well as a punctate lesion in the right pons are present which are nonspecific. They could be vascular related, related to demyelination, trauma, vasculitis, sarcoid. They are nonspecific.


Instruction: Generate impression based on findings.

Input: There is no acute infarct, mass effect, or cerebral edema. There is stable mild to moderate periventricular and scattered subcortical white matter T2 signal abnormality which is nonspecific, but likely representing chronic microvascular ischemic changes. The ventricles, sulci and basal cisterns are prominent consistent with moderate global volume loss. There is no hydrocephalus or extra-axial collections. No midline shift or herniation is present. The imaged paranasal sinuses and mastoid air cells are clear. Changes of intraocular lens replacement are again noted. The skull and extracranial soft tissues are unremarkable.

Output: 1. No acute infarct or mass effect. 2. Unchanged moderate global parenchymal volume loss.3. Unchanged mild to moderate chronic microvascular ischemic changes.


Instruction: Generate impression based on findings.

Input: Left upper extremity weakness. Endstage renal disease. Assess for extent of small vessel disease. There is no restricted diffusion to suggest acute infarct. In addition to mild periventricular T2-hyperintensity, there are multiple scattered T2/FLAIR hyperintense foci in the cerebral white-matter that are most concentrated in the frontal lobes. These are nonspecific but compatible with mild chronic small vessel ischemic disease. There is a focus of susceptibility artifact involving the lateral aspect of the right thalamus, which may represent chronic microhemorrhage versus mineralization. The ventricles and the other CSF-containing spaces are enlarged, reflecting mild-to-moderate underlying global brain volume loss. The major intracranial vascular flow voids are preserved. There is no mass-effect, midline shift or brain herniation.The orbits are grossly unremarkable. There is mild mucosal thickening in the paranasal sinuses. Partially empty sella is incidentally noted which is a normal variant.

Output: 1.Mild chronic small vessel ischemic disease.2.Focus of susceptibility effect involving the lateral aspect of the right thalamus, which may represent microhemorrhage versus mineralization.


Instruction: Generate impression based on findings.

Input: Male, 54 years old, with thoracic pain with fractures of T4, T5 and T6. Severe comminuted fracturing of the T5 vertebral body is demonstrated. Fracture fragments have been displaced laterally on both sides. There is complete loss of height anteriorly, and approximately 40% loss of height posteriorly.There is a small fracture of the anterior/inferior aspect of the T4 vertebral body. There is also a severe comminuted compression fracture of the T6 vertebral body. A fracture line is seen traversing the spinous process of T4 and to some degree the lamina, but the fracture fragments are not significantly displaced. At T5, the pars interarticularis on the right is fractured. A lucency is also evident within the left T7 pedicle which does not appear to be traumatic in nature and may simply represent fatty deposition or perhaps a hemangioma. There is, however, lucency through the right T6, T7 and T8 transverse processes compatible with fractures. As a result, there is a focal kyphotic angulation of the thoracic spine centered at the T4 through T6 region. The fractured vertebral bodies show mild retropulsion of vertebral body material, mostly at T5 and T6. This does not appear to significantly compromise the spinal canal, though MRI would provide a better assessment.Elsewhere, the bony spinal canal does not appear to be significantly compromised, though CT is insensitive for soft tissue encroachment. Likewise, except at the fractured levels, the bony neural foramina are preserved. At the level of fracturing, there is narrowing of the T5-6 and T6-7 neural foramina.Numerous rib fractures are identified involving at least T1 through T8 on the right and T1 through T6 on the left. These are at variable stages of repair given the presence of callus formation at some fracture sites.Bilateral small pleural effusions are seen.

Output: 1. Vertebral body fractures involving T4, T5 and T6, most severely affecting T5, with mild retropulsion of vertebral body material.2. Posterior element and/or transverse process fractures involving T4 through T8 as discussed above.3. Numerous bilateral rib fractures.


Instruction: Generate impression based on findings.

Input: 52-year-old female with shoulder pain. Evaluate rotator cuff. ROTATOR CUFF: There is full-thickness with near complete to complete rupture of the supraspinatus tendon, which is retracted by approximately 3.9 cm. There is also full-thickness tearing of the anterior fibers of the infraspinatus tendon. There is marked fatty atrophy of the supraspinatus, infraspinatus and teres minor muscles. There is thickening and increased signal abnormality affecting the subscapularis tendon consistent with tendinosis.SUPRASPINATUS OUTLET: Moderate degenerative changes affect the acromioclavicular joint. There is a small amount of fluid within the subacromial subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Note is made of high riding humeral head. Severe degenerative changes affect the glenohumeral joint. There is heterogeneity and signal abnormality affecting the glenoid labrum consistent with degenerative tearing.BICEPS TENDON: There is a small amount of circumferential fluid within the tendon sheath of the long head of the biceps which may represent fluid extension from the glenohumeral joint. ADDITIONAL

Output: Findings consistent with chronic-appearing complete tear of the rotator cuff with retraction and other findings as described above.


Instruction: Generate impression based on findings.

Input: There are postoperative findings related to transphenoidal resection of a pituitary adenoma with partially empty sella configuration, but no evidence of residual or recurrent pituitary mass. The remaining pituitary gland is in the right aspect of the sella and the pituitary stalk is deviated to the right. The suprasellar cistern, optic chiasm, cavernous sinuses, and intracranial portions of the optic nerves appear unremarkable.

Output: Postoperative findings related to transphenoidal pituitary tumor resection without evidence of recurrent tumor.


Instruction: Generate impression based on findings.

Input: 4-year-old male with a history of migraines. Evaluate for abnormal anatomical structures. 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 and scalp soft tissues are grossly unremarkable. There is bilateral maxillary sinus mucosal thickening with question of right greater than left maxillary sinus air-fluid levels.

Output: 1.No evidence of intracranial hemorrhage, mass, or acute infarct. 2.Question of moderate-sized right greater than left maxillary sinus air-fluid levels. Correlate for symptoms of sinusitis.


Instruction: Generate impression based on findings.

Input: 83 years Female (DOB:12/30/1932)Reason: S/p pituitary mass resection on 7/16 History: S/p pituitary mass resection on 7/16- surveillancePROVIDER/ATTENDING NAME: ISSAM A. AWAD ISSAM A. AWAD MRI pituitary:The patient status post pituitary fossa surgery. There is a residual lesion present within the pituitary fossa which measures approximately 17 x 25 mm in coronal dimensions. It has heterogeneous signal on both T1 and T2. It displays a thin rim of enhancement along its periphery as well as some mild heterogeneous enhancement centrally. Coronal dimensions on the prior exam were approximately 17 x 25 mm. The mass bulges into the inferior aspects of the cavernous sinus bilaterallyThe patient is status post right frontal craniotomy. There is extra-axial collection and dural thickening redemonstrated at the craniotomy site which has regressed since the prior exam..There is a focus of encephalomalacia along the right frontal lobe involving gyrus rectus and the medial aspect of the right orbital gyrus which is stable and compared to the prior exam.

Output: 1.The patient status post pituitary fossa surgery. The appearance of the pituitary fossa is relatively stable when compared to the previous exam.2.A focus of encephalomalacia in the right frontal lobe is stable.


Instruction: Generate impression based on findings.

Input: History of non-small cell lung cancer with enlarging right hepatic lobe lesion. ABDOMEN:LIVER, BILIARY TRACT: Right hepatic centrally located necrotic mass measuring approximately 4.9 x 4.1 cm, image 36 series 10. Peripheral lesional enhancement seen. Neoplastic focus seen inferomedially in hepatic segment 5/6 region on image 51 series 11 represents component of aforementioned mass (favored) versus adjacent separate lesion. Associated restricted diffusion seen and occlusion of right hepatic vein and right portal vein, primarily the posterior segment, visualized. Mild mass effect on adjacent IVC laterally. Additional arterially enhancing small 5 mm hepatic segment 6 focus seen on image 61 series 10, no definite corresponding washout seen in subsequent delayed imaging, persistent contrast retention seen (see image 67 series 11 and image 64 series 12), suggesting a tiny hemangioma; additionally, no corresponding restricted diffusion seen and no associated hypermetabolic activity visualized on prior PET/CT imaging. Other punctate T2 hyperintense foci most likely cysts. No biliary duct dilatation. Mildly prominent but nonpathologically enlarged portacaval, periportal lymph and aortocaval nodes. Submitted for reference is 1.5 x 0.9 cm portacaval lymph node, image 53 series 10. SPLEEN: Subcentimeter splenule, image 50 series 9.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Right hepatic centrally located necrotic mass, appearance favoring that of a metastatic lesion.2. Mildly prominent portacaval, periportal lymph and aortocaval nodes, nonspecific.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Metastatic renal cancer, abdominal pain ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesions. Decreased signal on in phase imaging suggests parenchymal iron deposition. Enhancing peritoneal nodule anterior to the left hepatic lobe measures 2.5 x 1.9 cm (series 2002, image 66), previously 2.6 x 1.9 cm.SPLEEN: Splenomegaly. Peripherally enhancing cystic mass in the superior spleen measures 5.1 x 4.3 cm (series 2002, image 77), previously 4.5 x 3.8 cm. Rim enhancing perisplenic lesion measures 3.9 x 1.7 cm (series 2002, image 53), previously 2.3 x 1.6 cm.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Reference enhancing nodule in the superior portion of the left nephrectomy bed measures 2.5 x 1.7 cm (series 2002, image 59), previously 2.0 x 0.8 cm.KIDNEYS, URETERS: Status post left nephrectomy. Ill-defined soft tissue in the left nephrectomy bed measures 3.1 x 2.0 cm (series 2002, image 51), previously 3.2 x 2.1 cm.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Status post left hemicolectomy with right lower quadrant colostomy.Left lateral body wall rim-enhancing lesion in the superior left paracolic gutter measures 4.8 x 2.5 cm (series 2002, image 33), previously 4.6 x 2.4 cm.BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: Avid heterogeneous enhancement of enlarged prostate; correlate with PSA.BLADDER: No significant abnormality noted.LYMPH NODES: Enhancing left inguinal lesion measures 2.5 x 1.5 cm (series 2002, image 37), previously 2.2 x 1.3 cm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1.Multiple enhancing metastases with reference measurements as above.2.No new sites of disease.


Instruction: Generate impression based on findings.

Input: History of diskitis/osteomyelitis of cervical and lumbar spine: back pain. Cervical Spine: There has been interval decrease in the degree of enhancement within the C3 and C4 vertebrae, with resolution of the disc-space fluid collection and the associated epidural and prevertebral soft tissue thickening and enhancement. There is loss of the disc space height at C3-4, as well as perhaps slight low of height of the C4 vertebral body. There is unchanged mild anterior wedging of the C7 vertebral body. There is no spondylolisthesis. There is moderate to severe spinal canal stenosis at C4-5, mild spinal canal stenosis at C5-6, as well as moderate to severe spinal canal stenosis at C6-7 and C7-T1 associated with disc-osteophyte complexes superimposed upon a mild congenitally narrow spinal canal. There is mild bilateral neural foraminal stenosis at C3-4, severe bilateral neural foraminal stenosis at C4-5, moderate to severe bilateral neural foraminal stenosis at C5-6, and mild to moderate bilateral neural foraminal stenosis at C6-7. Apparent linear high T2 signal throughout much of the cervical spinal cord depicted on the sagittal images may be artifactual, since there is no convincing correlate on the axial images. There is patchy T2 hyperintensity in the pons, which may be related to chronic small vessel ischemic disease.Lumbar Spine: There is interval increase in the extent of the enhancement within the L2 and L3 vertebrae and intervening disc space, as well as mildly increased epidural swelling and enhancement at these levels. Furthermore, there is interval increase superior L3 and inferior L2 endplate irregularity and loss of height of these vertebral bodies, with 5 mm of retrolisthesis of L2 on L3 and mild to moderate spinal canal stenosis. In addition, abnormal enhancement extends into the anterior L3-4 disc space and anterosuperior portion of the L4 vertebral body. There also appears to be increase in the degree of enhancement within the anterior L5-S1 disc space and adjacent endplates. However, there are decreased fluid collections in the bilateral psoas muscles, measuring up to 9 mm on the left and 6 mm on the right, along with slightly decreased surrounding diffuse soft tissue enhancement. An intravertebral disc herniation in the inferior L4 endplate with associated enhancement is unchanged. Other manifestations of multilevel degenerative spondylosis in the lumbar spine are also unchanged. The spinal cord and cauda equina nerve roots are unremarkable. The left kidney is atrophic.

Output: 1. Interval improvement of findings related to discitis-osteomyelitis at C4-5.2. Interval increase in the extent of inflammatory changes with erosions in the L2 and L3 vertebrae, intervening disc space, and epidural space, as well as extension into the anterior L3-4 disc space and anterosuperior portion of the L4 vertebral body, and increased enhancement within the anterior L5-S1 disc space and adjacent endplates, which may be infectious or degenerative in nature. However, the bilateral psoas abscesses at L2-3 have decreased in size.3. Decreased fluid collections in the bilateral psoas muscles, measuring up to 9 mm on the left and 6 mm on the right, along with slightly decreased surrounding diffuse soft tissue inflammation. 4. Unchanged multilevel degenerative spondylosis in the cervical and lumbar spine.


Instruction: Generate impression based on findings.

Input: Female 72 years old Reason: confirm cirrhosis History: hx alcoholic hepatitis ABDOMEN:LIVER, BILIARY TRACT: Liver has a cirrhotic morphology with a widened fissures and a slightly nodular contour. No focal lesion with arterial enhancement to suggest hepatocellular carcinoma. There is abnormal perfusional changes near the dome of the of the liver which may be seen in hepatic fibrosis and chronic liver disease.Hepatic and portal veins are patent. No biliary ductal dilatation.SPLEEN: Spleen is enlarged.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: Moderate ascites.

Output: 1.Cirrhotic liver without suspicious hepatic lesion.


Instruction: Generate impression based on findings.

Input: 63-year-old female with pain and limited range of motion with tingling and numbness along the ulnar nerve distribution. LIGAMENTS: The ulnar collateral ligament, radial collateral ligament and lateral ulnar collateral ligament appear intact within the limitations of a non arthrogram examination. TENDONS: There is increased signal intensity within the common extensor tendon at its origin indicating tendinosis. The common flexor tendon appears normal. The biceps and brachialis muscles and tendons are normal in appearance. The triceps tendon appears intact.ARTICULAR SURFACES AND BONE: No bone marrow signal abnormality is identified. No osteochondral defects are seen. SURROUNDING STRUCTURES: The ulnar nerve is within normal limits. The remaining soft tissues are normal in appearance.ADDITIONAL

Output: Mild common extensor tendinosis.


Instruction: Generate impression based on findings.

Input: 59-year-old man with history of HCC, scheduled to undergo TheraSphere treatment Please note that this examination is limited as patient refused intravenous contrast and the images are degraded by respiratory motion.ABDOMEN:LIVER, BILIARY TRACT: There is a 20.6 x 16.6 cm heterogeneous, encapsulated lesion in the right lobe of the liver. Areas of increased T1 signal within this lesion suggest hemorrhage. The right portal vein is not visualized and likely occluded. The right hepatic vein is also not visualized and likely occluded. The middle hepatic vein is markedly attenuated by adjacent mass effect. There is moderate biliary duct dilatation of the left hepatic duct and its branches.No additional focal hepatic lesions are identified. The gallbladder appears normal.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Simple cysts are seen in the kidneys bilaterally with increased T1 signal suggesting hemorrhage but no significant soft tissue component or septations.RETROPERITONEUM, LYMPH NODES: A periportal lymph node (series 11, image 41) measures 29 x 16 mm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Numerous lung base nodules are seen bilaterally. Patient is status post sternotomy with susceptibility artifact noted.

Output: 1.Large, solitary right hepatic mass with adjacent mass effect/occlusion on the portal and hepatic veins as described.2.Enlarged periportal adenopathy.3.Partially visualized lung base nodules suspicious for metastases.


Instruction: Generate impression based on findings.

Input: Cerebral infarction, unspecified [I63.9], Reason for Study: ^Reason: stroke History: left neglect There are restricted diffusion lesions on the right frontal, temporal and parietal lobes including posterior aspect of the right insular cortex. There is no evidence of hemorrhagic conversion.Chronic ischemic infarct lesions worrisome performed on the left parietal lobe, mainly on the inferior parietal lobule with evidence of susceptibility lesions indicating hemorrhagic transformation as well as left frontal lobe and posterior temporal lobe chronic ischemic infarct lesions.Minimal scattered FLAIR/T2 high signal intensity lesions on bilateral periventricular white matter indicate non specific small vessel ischemic disease, unchanged since prior scan.The ventricles, sulci and cisterns are symmetric and unremarkable.The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Acute ischemic infarctions on the right MCA territory without evidence of hemorrhagic transformation as described above.2. Evidence of chronic ischemic infarction with evidence of hemorrhagic transformation on the left MCA distribution.3. Non specific small vessel ischemic disease, unchanged since prior scan.


Instruction: Generate impression based on findings.

Input: Head dropped, and mobility of the cervical spine. There is grade 1 anterolisthesis of C6 on C7. The vertebral body heights are preserved. There is loss of disc height at C3-4, and C5-6 with partial fusion of the posterior C3 and C4 and C5 and C6 vertebrae. There is prominence of the ligamentum flavum and there are small posterior disc-osteophytes at C3-4, C4-5, and C6-7, but no significant spinal canal stenosis. The vertebral bone marrow signal is unremarkable. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: Mild multilevel degenerative spondylosis with grade 1 degenerative anterolisthesis of C6 on C7, but no significant neural foraminal narrowing or spinal canal stenosis.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Pt with BLE hyperreflexia, fasciculations, neck pain, evaluation for radiculopathy or myelopathy Exam is moderately limited by motion artifact.Severe degenerative changes of the cervical spine with bone marrow signal changes in the C3, C4, and C5 vertebral bodies. There is reversal of cervical lordosis centered at C4. Multilevel disc desiccation and mild to moderate disc height loss. There are prominent ventral disc osteophytes from C3 to C5. Right thyroid T2 hyperintense lesion measuring up to 2 cm partially visualized. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. Spinal cord without focal signal abnormality.C1/2: No significant spinal canal stenosis or foraminal narrowing.C2/3: No significant spinal canal stenosis or foraminal narrowing.C3/4: Uncovertebral arthropathy, left greater than right. Moderate to severe bilateral foraminal narrowing. No significant spinal canal stenosis. C4/5: Moderate posterior disc osteophyte complex with left-sided prominence. There is moderate spinal canal stenosis with flattening of the left ventral spinal cord. Bilateral uncovertebral arthropathy with mild to moderate right and moderate to severe left foraminal narrowing.C5/6: Moderate posterior disc osteophyte complex with superimposed right paracentral disc protrusion. There is moderate to severe spinal canal stenosis with deformity of the right ventral spinal cord. Bilateral uncovertebral arthropathy with severe right and moderate to severe left foraminal narrowing.C6/7: Minimal posterior disc osteophyte complex. Bilateral uncovertebral arthropathy with moderate right and moderate to severe left foraminal narrowing. No significant spinal canal stenosis.C7/T1: Shallow disc protrusion. No significant spinal stenosis or foraminal narrowing. T1/T2: No significant spinal canal stenosis or foraminal narrowing.T2/T3: Seen on only the sagittal view, left foraminal disc protrusion without significant spinal canal stenosis. T3/T4: Seen on only the sagittal view, diffuse disc bulge without significant spinal canal stenosis.

Output: 1.Multilevel degenerative disc disease most severe at C5/6 level. There is moderate to severe spinal canal stenosis with deformity of the spinal cord. There is severe right and moderate to severe left foraminal narrowing. Also moderate-severe left foraminal narrowing at C4/5, C6/7 and bilaterally at C3/4.2.2 cm T2 hyperintense right thyroid lesion, partially visualized. Correlation with thyroid function tests is recommended and thyroid ultrasound may be obtained as clinically indicated.


Instruction: Generate impression based on findings.

Input: 73-year-old female with history of partial nephrectomy with positive parenchymal margin. Evaluate for recurrence. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Postoperative changes of partial right nephrectomy without evidence of residual recurrent disease. Punctate left renal cysts and left peripelvic cyst; otherwise, the left kidney is unremarkable.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No evidence of recurrent or metastatic disease.


Instruction: Generate impression based on findings.

Input: Female, 55 years old, with right greater than left leg pain, history of microdiscectomy. Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. Fatty endplate signal change is seen superiorly at T12. No pathologic marrow replacement, edema or enhancement is observed. The visualized spinal cord, conus and nerve roots of the cauda equina are unremarkable. No pathologic intrathecal enhancement is seen.L1-2: No significant spinal canal stenosis or neuroforaminal narrowing. L2-3: Facet hypertrophy and ligamentum flavum thickening. No significant spinal canal or neuroforaminal stenosis. No interval changes. L3-4: Facet hypertrophy and ligamentum flavum thickening. No significant spinal canal or neuroforaminal stenosis. No interval changes. L4-5: Facet hypertrophy and ligamentum flavum thickening. Minimal bulging disc. Minimal spinal canal narrowing. No significant foraminal compromise. No interval changes. L5-S1: Evidence of prior laminotomy on the right is seen. A previously demonstrated right paracentral disc extrusion has essentially resolved. There remains only slight right paracentral disc focality superimposed on a diffusely bulging disc. Mild narrowing of the right lateral recess is improved from prior. No significant generalized spinal canal stenosis. Mild bilateral foraminal narrowing without interval change.

Output: Findings are seen compatible with the stated history of surgery on the right at L5-S1. A right paracentral disc extrusion seen previously at this level has essentially resolved. Effacement of the right lateral recess has improved. No significant generalized spinal canal stenosis is detected. The foramina are only mildly narrowed at this level. Mild degenerative changes are seen elsewhere in the lumbar spine without significant compromise of the spinal canal or neural foramina.


Instruction: Generate impression based on findings.

Input: Right thigh enlargement and pain A mild amount of subcutaneous edema seen within the soft tissues lateral to the right femur. Otherwise there is no evidence of discrete mass or abnormal signal intensity within the thigh musculature or femur itself. Following contrast administration, there is no abnormal enhancement.Limited evaluation of the left thigh also demonstrates no abnormal signal intensity of the musculature or bone.

Output: Mild nonspecific subcutaneous edema within the soft tissues lateral to the distal right femur. There is otherwise no abnormal signal intensity, discrete mass, or enhancement of the right thigh.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate IACs left unilateral hearing loss. Signs and symptoms: 46-year-old female with left unilateral hearing loss. Pre and post enhanced MRI of the IACs:Bilateral internal auditory canals are symmetrical and normal anatomical morphology and size.The signal intensity and overall anatomical morphology of the inner ears structures are within normal limits.The signal intensity of bilateral petrous bones and skull base is within normal.There is normal visualization of bilateral cerebellopontine angle cisterns and bilateral neurovascular bundles traversing through the cerebellopontine angles and within the internal auditory canals.There is normal signal intensity and morphology of pons, medulla and bilateral cerebellar hemispheres.Postcontrast images demonstrate no detectable abnormal enhancement of the pons, cerebellar pontine angles, neurovascular bundles or enhancement of the internal auditory canals or the inner ear structures.There is normal signal intensity and enhancement of bilateral cavernous sinuses. There is normal signal intensity, morphology and size of pituitary stock and with normal pattern of enhancement.

Output: Unremarkable pre and post enhanced MRI of the internal auditory canals as detailed.


Instruction: Generate impression based on findings.

Input: Somnolence [R40.0], Reason for Study: ^Reason: anatomic abnormalities? Chiari? History: LOC concerning for seizure CSF flow study and L-spine prone scan were not performed per the request of ordering service.Extensive syringomyelia starting C2 level to T9 level is seen.The syrinx cavity shows septation in whole length.There is no evidence of associated vertebral body abnormality. There is normal cervical lordosis. There is normal thoracic kyphosis and lumbar lordosis. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The epidural space, thecal sac, and spinal cord are preserved with no evidence of spinal canal/neural foraminal stenosis, cord compression. The conus medullaris terminates at the level of T12-L1. There is no evidence of tethered cord or spinal dysraphism. The filum terminale is normal in size and signal intensity. The intervertebral discs demonstrate normal T2 intensity and height with no evidence of disc herniation. The paraspinal soft tissues and musculature are unremarkable.

Output: 1. Chiari I malformation with extensive syringomyelia from C2 to T9 level as described above.2. Otherwise no remarkable finding.


Instruction: Generate impression based on findings.

Input: 56 year old female patient with Crohn's disease diagnosed in 1988 when had a perianal fistula. Ileocecectomy in 1990 and stricturoplasty in 2006. Assess for active disease. ABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis without evidence of acute cholecystitis. 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: Status post proximal ileocolectomy. There is an approximately 10 cm segment of mildly patulous ileum, which demonstrates wall thickening and mucosal hyperenhancement. This segment corresponds to an abnormal loop on the prior study MRI from 2011. The bowel distal to this segment appears strictured, which is also similar to the prior study. The neoterminal ileum distal to this strictured ileal segment appears distended. No evidence of a bowel obstruction.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: A T2 hypointense lesion within the lower uterine body is compatible with a myometrial fibroid.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: As described above.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Chronic stricturing of the ileum in a region similar to prior studies with signs of active inflammation compatible with acute on chronic disease.


Instruction: Generate impression based on findings.

Input: T2N0 right oral tongue squamous cell carcinoma treated with CRT completed in 6/2009 with right partial glossectomy for salvage in 10/2009 with recurrent right oral tongue tumor treated with chemoradiation. There are post-treatment findings in the oral cavity, including interval post-radiation effects and right neck dissection with radial forearm flap reconstruction. There is interval decrease in size and enhancement of an ill-defined lesion in the right oral tongue along the margins of the glossectomy site that measures up to 14 mm, previously 18 mm. However, there is new patchy high T2 signal and enhancement in the left anterior oral tongue that measures up to approximately 23 mm. There is no evidence of significant lymphadenopathy in the neck. The remaining salivary glands are unremarkable. The thyroid gland also appears unremarkable. There are upper thoracic spinal rods that produce susceptibility effect in the region. There is a right maxillary sinus retention cyst. The major cervical flow voids appear to be intact. The imaged intracranial structures, orbits, and facial soft tissues appear unremarkable.

Output: 1. Interval decrease in size and development of necrosis in the recurrent right oral tongue mass following treatment.2. New patchy high T2 signal and enhancement in the left anterior oral tongue may represent treatment-related effects.


Instruction: Generate impression based on findings.

Input: Diagnosis: Malignant neoplasm of unspecified part of right bronchus or lung Malignant neoplasm of unspecified part of right bronchus or lungClinical question: r/o brain metsSigns and Symptoms: altered mental status, SCLC The CSF spaces are appropriate for the patient's stated age with no midline shift. There are patchy foci of signal hyperintensity on FLAIR and T2 MRI located in the brainstem.There are several punctate FLAIR and T2 hyperintense lesions present within the basal ganglia identified.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 are clear. The visualized portions of the mastoid air cells demonstrate partial opacification of the mastoid air cells. The visualized portions of the orbits are intact. The eyeball lenses are thin.

Output: 1.Patchy lesions in the brainstem and punctate lesions in the basal ganglia are likely vascular related.2.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 3.No evidence for brain metastases.


Instruction: Generate impression based on findings.

Input: 74-year-old male with history of prostate cancer. PELVIS:PROSTATE:Prostate Size: 3.8 x 5.4 x 5.5 cm.Peripheral Zone: Mild T1 hyperintensity bilaterally due to hemorrhage. Low T2 signal lesion with restricted diffusion extending from the right posterolateral base to the inferior mid gland, compatible with prostate cancer and measuring up to 8 x 9 mm (series 604/384). An additional, smaller low T2 signal lesion with restricted diffusion at the left apex is compatible with prostate cancer and measures up to 6 x 9 mm (series 501/57).Central Gland: Heterogeneous.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: Both above-described lesions abut the capsule and may have slight extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No pathologically enlarged lymph nodes by size criteria.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Two lesions most compatible with prostate cancer, as detailed above. Both lesions abut the capsule and may have slight extracapsular extension.


Instruction: Generate impression based on findings.

Input: 72-year-old male patient with history of cholecystitis status post cholecystectomy. Evaluate for biliary stones. ABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy. No intra or extrahepatic biliary ductal dilatation. No suspicious enhancing hepatic lesions. No perihepatic fluid collection. On delayed imaging in the hepatobiliary phase, there is no evidence of bile leak. No filling defects seen in the biliary system.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No pancreatic ductal dilatation or suspicious pancreatic lesions.KIDNEYS, URETERS: Multiple subcentimeter T2 hyperintense lesions in the renal parenchyma bilaterally statistically most likely represent cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Postsurgical changes from cholecystectomy without evidence of complication.2.No evidence of biliary obstruction.


Instruction: Generate impression based on findings.

Input: Patient with one and known tumor and neck with extension towards shoulders and into the skull. Please evaluate extent of plexiform neurofibromas and neck down to level of brachial plexus. There is normal signal intensity and caliber of cervical cord. Kyphotic deformity of cervical spine with congenital dysplastic appearance of the upper cervical vertebral bodies again seen. Postoperative changes are again noted extending from C2 to C5 levels. There is revisualization of mild central spinal stenosis at these levels similar to prior exam.Compared to 8/25/2014 and 3/3/2014, again seen are multiple bilateral neurofibromas within the neural foramina of the upper cervical spine with resultant enlargement of the foraminal appear identical to prior study. There is no detectable mass effect on the cord or compromise of the spinal canal. Multiple (right larger than left) neurofibromas within the soft tissues of neck including bilateral retropharyngeal spaces and along the right brachial plexus demonstrates similar signal intensity, overall morphology and size since prior studies as well. The largest lesion in the right measuring 18 x 24-mm appears identical to prior exam. The largest right-sided retropharyngeal space lesion measuring 10 x 32 mm also demonstrate no significant change since prior exam.Similar appearance of dural ectasia/multiple meningoceles in the upper thoracic spine. Unchanged flattening of the thoracic cord and rightward displacement. Similar appearance of lesions in the right supraclavicular fossa and right upper chest wall. Similar appearance of lesions in the intercostal spaces.

Output: 1.Compared to MRI studies from 8/25/2014 and 3/3/2014, there is no appreciable change in findings of neurofibromatosis including multiple neurofibromas involving the bilateral retropharyngeal space, bilateral upper cervical neural foramina, and along the brachial plexus, larger on the right than the left. Also unchanged kyphotic deformity and mild central spinal stenosis of upper cervical spine. Normal signal intensity and caliber of the cervical cord.2.Similar appearance of dural ectasia/multiple meningoceles in the upper thoracic spine. No appreciable change in appearance of lesions in the right supraclavicular fossa and right upper chest wall. No appreciable change in lesions in the intercostal spaces. Neurofibromas involving the posterior scalp, right larger than left, and right temple are partially imaged.


Instruction: Generate impression based on findings.

Input: Male 60 years old Reason: new CVA History: occipital head numbness. No evidence of diffusion restriction to suggest acute infarct. The areas of minimally increased signal in the bilateral posterior internal capsules do not demonstrate low ADC signal and are not acute infarcts. There are multiple bilateral areas of T2/FLAIR hyperintensity in the brainstem, cerebellar hemispheres, basal ganglia and thalami bilaterally. There is also T2/FLAIR hyperintensity in the periventricular and subcortical white matter. These findings are most compatible with multiple prior lacunar infarcts and chronic small vessel ischemic disease. A new focus of T2/FLAIR hyperintensity in the right temporal lobe likely represents a focus of encephalomalacia of a prior infarct with gliosis. New punctate foci of susceptibility in the right thalamus and left middle cerebellar peduncle may correspond to prior punctate hemorrhage or calcification.There is no evidence of acute intracranial hemorrhage, mass, or acute infarct. The pituitary gland appears unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. Mild mucosal thickening in the left maxillary sinus is again seen.

Output: 1.Extensive abnormal T2/FLAIR hyperintense foci throughout the brain parenchyma compatible with chronic small vessel disease and multiple prior lacunar infarcts, increased from the prior exam in 2015. No evidence of a superimposed acute infarct.2.No evidence of acute intracranial hemorrhage or mass.


Instruction: Generate impression based on findings.

Input: Reason: chronic hand pain and AM stiffness x 1 hour, multiple hx tendinitis - eval for ?RA or autoimmune tendonitis History: as above TENDONS: There is circumferential fluid within the tendon sheath of the flexor digitorum superficialis and profundus at the level of the third MCP joint indicating a tenosynovitis. There is a 3 mm focus of fluid signal abnormality along the ulnar aspect of the third MCP joint which may represent a ganglion formation or a synovial cyst. There is also a small amount of fluid within the tendon sheaths of the flexor digitorum superficialis and profundus of the fourth and fifth digits at the level of the MCP joints and proximal phalanx indicating a tenosynovitis.BONES: No bone marrow signal abnormality is identified. No erosions are evident.ADDITIONAL

Output: Findings indicating a tenosynovitis of the flexor digitorum superficialis and profundus tendons of the third, fourth, and fifth digits of the right hand as described above.


Instruction: Generate impression based on findings.

Input: There is normal alignment of the vertebral bodies. Marrow signal of the vertebral bodies is maintained. The conus medullaris ends at the level of L2. There are no cord signal abnormalities. The filum terminalis appears normal. There are 5 lumbar vertebral bodies with the last rib-bearing vertebra is at T12.T12-L1: No spinal or neural foraminal compromise.L1-L2: There is a trace of disc bulge. No spinal or neural foraminal compromise. L2-L3: There is a trace of disc bulge with no spinal or neural foraminal compromise. L3-L4: Trace of disc bulge with no spinal or neural foraminal compromise. There is bilateral ligamentum flavum thickening which cause minimal bilateral lateral recess narrowing, right more prominent than the left.L4-L5: There is diffuse disc bulge with no spinal stenosis. There is no neural foraminal compromise.L5-S1: Minimal bulging of disc, no spinal or neural foraminal compromise.

Output: There is multilevel trace of disc bulge with no spinal stenosis or neural foraminal compromise as described above.


Instruction: Generate impression based on findings.

Input: A 21 year old male with history of Hodgkin Lymphoma, after chemotherapy and autologous stem cell transplant, on remission the last 2 years. Now hospitalized due to a suspected left atrial mass seen on a routine follow-up echocardiography. Referred to cardiac MRI for further evaluation. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 57%, the LV end diastolic volume index is 70 ml/m2 (normal range: 74+/-15), the LVEDV is 126 ml (normal range 142+/-34), the LV end systolic volume index is 31 ml/m2 (normal range 25+/-9), the LVESV is 55 ml (normal range 47+/-19). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is normal in size. No LA or pulmonary vein mass was seen. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 50%, the RV end diastolic volume index is 76 ml/m2 (normal range 82+/-16), the RVEDV is 136 ml (normal range 142+/-31), the RV end systolic volume index is 38 ml/m2 (normal range 31+/-9), and the RVESV is 68 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium. No PV mass noted.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 FindingsNo lymphadenopathy was seen. 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. The left ventricle is normal in size and systolic function, the LVEF is 57%. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.2. The right ventricle is normal in size and systolic function, the RVEF is 50%. 3. No LA or PV mass was seen.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Diagnosis: Malignant neoplasm of upper-outer quadrant of unspecified female breastClinical question: Hx: metastatic breast cancer, on letrozole therapySigns and Symptoms: dizziness 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.There are couple nonenhancing foci of marrow replacement along C2 one of which is in the odontoid process.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.There is no evidence for brain metastases.2.There are a couple nonenhancing foci of marrow replacement in the visualized C2 vertebra associated with a relatively mottled appearance within the calvarium. These are suspicious for bone metastases which are potentially treated. Please correlate with patient's bone scan for further comments.3.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: 58-year-old female with severe pain in the right foot at the region of the fourth and fifth metatarsal bases. There is a collection of abnormal signal intensity dorsal to the proximal aspect of the third, fourth, and fifth metatarsals measuring approximately 3.3 x 3.4 x 0.9 cm. There is heterogeneous signal intensity of the collection on all pulse sequences, as well as high signal intensity on all pulse sequences, compatible with a hematoma. The underlying extensor tendons and bones appear normal. There is additional edema of the subcutaneous fat of the dorsum of the foot. Mild osteoarthritis affects the first MTP and interphalangeal joint of the great toe. The remaining visualized soft tissues appear normal.

Output: Foot hematoma as described above.


Instruction: Generate impression based on findings.

Input: Female; 20 years old. Reason: please eval for Hepatobiliary/ pancreatic abnormalites. requested by Liver service. Liver MRI also ordered, History: 20 yo F with hx of Biliary obstruction at birth (uncertain dx, got Liver imaging and biopsy here at UC 1995), admitted with gallstone pancreatitis, many GB stones, unusual presentation. ABDOMEN:LIVER, BILIARY TRACT: No suspicious hepatic lesions. No biliary ductal dilation. Multiple gallstones. There is peri-cholecystic fluid which extends as ascites around the liver.SPLEEN: No significant abnormality noted.PANCREAS: No focal pancreatic lesions. No pancreatic ductal dilation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Mild perihepatic ascites, nonspecific.

Output: Cholelithiasis and mild nonspecific perihepatic ascites, but otherwise unremarkable examination.


Instruction: Generate impression based on findings.

Input: History of ethesioneuroblastoma off therapy scan. Face: There are post-operative findings related to right medial maxillectomy and right anterior and posterior ethmoidectomy. There is no significant change in the appearance of the treatment bed without discernible gross tumor. There is persistent mucosal thickening in the right maxillary sinus, right frontal sinus, bilateral ethmoid cavities, and bilateral sphenoid sinuses. There is leftward nasal septal deviation. There are findings related to right dacryocystorhinostomy, but the orbits are otherwise grossly intact. There is a subcentimeter Thornwaldt or nasopharyngeal retention cyst. The lymph nodes in the upper neck are not particularly enlarged.Brain: There is no evidence of intracranial tumor. There is an unchanged prominent perivascular space in the right basal ganglia. The brain parenchyma otherwise appears unremarkable and there is no evidence of acute infection or 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.

Output: 1. Stable post-treatment findings in the sinonasal region without evidence of gross tumor recurrence amidst diffuse mucosal thickening.2. No evidence of intracranial tumor.


Instruction: Generate impression based on findings.

Input: 51 years, Female, possible demyelinating disease. Fatigue, paresthesias. Evaluate for progression. Brain: Again seen are scattered T2/FLAIR hyperintense lesions in the subcortical as well as the periventricular white matter which are not significantly changed since 12/29/2015 although current study is of higher resolution limiting comparison of small lesions. In particular, small lesions are noted along the margins of the right temporal horn as well as along the callososeptal interface. Signal abnormality adjacent to the right temporal horn appears more prominent but this may be related to technique. No significant burden of T1 hypointense lesions. Brain parenchymal volume is preserved.No intracranial mass or mass effect. Ventricles and sulci are within normal limits. Major flow-voids are preserved. Calvarium and extra cranial soft tissues are grossly unremarkable. There is abnormal signal involving the left optic nerve compatible with history of prior optic neuritis and was present on prior study.Cervical spine: Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained. No suspicious osseous lesion. The cervical spinal cord has normal signal characteristics and overall morphology.Degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: There is mild right neural foraminal narrowing related to uncovertebral hypertrophy. Left neural foramen and spinal canal are patent. Findings are unchanged.C4-5: There is a disc osteophyte complex including uncovertebral hypertrophy on the right with moderate right-sided neural foraminal stenosis. Mild effacement of the ventral thecal sac without significant spinal canal stenosis overall. Left neural foramen is patent. Findings are unchanged.C5-6: There is a disc osteophyte complex with partial effacement of the ventral thecal sac. No significant spinal canal stenosis overall. There is mild left neural foraminal narrowing. Right neural foramen is patent. Findings are unchanged.C6-7: Disc osteophyte complex including a left foraminal disc protrusion and uncovertebral hypertrophy. Partial effacement of the ventral thecal sac without significant spinal canal stenosis overall. There is moderate to severe left and mild right neural foraminal stenosis. Mild right neural foraminal narrowing. Findings are not significantly changed.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. Allowing for slight differences in technique with current study of higher resolution, there is no significant change in mild burden of T2/FLAIR hyperintense lesions in the supratentorial white matter compared to 12/29/2015. The distribution and morphology of these lesions is overall nonspecific although few lesions such as along the right temporal horn are suggestive of demyelinating or prior inflammatory process. 2. No signal abnormality in the cervical cord to suggest demyelinating disease.3. Degenerative changes in the cervical spine without significant spinal canal stenosis at any level. There is up to moderate to severe left C6-C7 neural foraminal stenosis and milder neural foraminal stenoses at additional levels as detailed above. These findings are not significantly changed since 2/3/2015.4. Abnormal signal in the left optic nerve compatible with prior optic neuritis.


Instruction: Generate impression based on findings.

Input: MVI with closed head trauma. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma, brainstem, and cerebellum appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and paranasal sinuses are grossly unremarkable. There is minimal fluid within the mastoid air cells. There has been repair of a left frontal scalp laceration, with what may represent embedded foreign body material.

Output: No gross evidence of traumatic brain injury.


Instruction: Generate impression based on findings.

Input: Examination is limited by motion artifact. There is marked progression of T2/FLAIR signal abnormality involving the periventricular and subcortical white matter with thinning of the corpus callosum. A small T2 hyperintense lesion is also visualized in the right cerebellum (series 601, image 23). There is a 1.3 cm T2 hyperintense lesion involving the left palatine tonsil. There is thinning of the corpus callosum. The ventricles and sulci are within normal limits. The basal cisterns remain patent. There is no midline shift or mass effect. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits.

Output: 1.Since 9/2011 there is marked progression of multiple sclerosis plaques involving the supratentorial and infratentorial white matter.2.A 1.3 cm T2 hyperintense lesion involving the left lateral nasopharynx is suspicious for neoplasm. Further evaluation with CT of the neck and or clinical inspection is recommended.3.Findings were reported to Dr. PENYAK CIPRIANI, VERONICA on 8/26/2016 at 4:22 PM


Instruction: Generate impression based on findings.

Input: Clinical question: Stroke, hemorrhage. Signs and symptoms: Weakness and paralysis. Nonenhanced head CT:Examination demonstrates a large area of vasogenic edema in the left mid to high convexity frontal lobe with resultant effacement of all adjacent cortical sulci. Within the region of vasogenic edema there is a suspected mass measuring approximately 17 times 17-mm in size. Recommend further follow-up with an MRI exam. There are also several subcortical areas of low attenuation which may represent a small less ischemic disease although a possibility of additional lesions/metastases cannot be ruled out.Calvarium is intact. There is evidence of an NG tube and with resultant partial opacification of paranasal sinuses.Dr. Susan Lim on pager number 3345 was paged and covering individual Julia Rives from 59215 responded to page and was notified of the above findings.

Output: 1.Left frontal mass with extensive surrounding vasogenic edema. There is focal mass effect and with no evidence of midline shift. Recommend further follow-up with an MRI examination.2.Subcortical and periventricular low-attenuation white matter is suspected of small vessel disease. Possibility of additional masses/metastases cannot be entirely ruled out.3.Calvarium is intact.4.Extensive opacification of paranasal sinuses. Likely result of intubation.


Instruction: Generate impression based on findings.

Input: Reason: hx of IPMN. Needs f/u MRCP. Last ercp 2013 History: Doing well other than recent diarrhea. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: The main pancreatic duct is nondilated. There are multiple cystic lesions within the pancreatic head, neck and body which communicates with the main pancreatic duct, likely representing side branch IPMNs. A lesion in the pancreatic head measures 5 mm (8/27) and is new from the prior exam. A lesion in the pancreatic body measures 5 mm (8/66) and is unchanged. Additional smaller lesions are present within the pancreatic body which are also unchanged. Anteroinferior cystic lesions without definite ductal communication are nonspecific (8/47). No abnormal enhancement.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small hiatal hernia.BONES, SOFT TISSUES: Focus along the crus of the right diaphragm with intrinsic T1 hyperintensity may represent an old focus of hemorrhage from prior surgery.OTHER: Cystic dilatation of multiple nerve roots in the spine.

Output: Multiple sidebranch IPMNs measuring up to 5 mm without suspicious features. A pancreatic head lesion is new from the prior exam. Pancreatic body lesions are not significantly changed.


Instruction: Generate impression based on findings.

Input: Left true vocal cord paralysis. Head CT:There is no evidence of intracranial mass, hemorrhage or infarction. No enhancing abnormality is seen.Neck CT:There is mild dilatation of the left laryngeal ventricle, compatible with history of vocal cord paralysis. No mass, or lymphadenopathy based on radiological criteria is identified. The thyroid gland appears unremarkable.Extensive degenerative disease of cervical spine results in spinal canal and neuroforaminal stenosis at multiple levels. Patchy opacities are seen in the lung apices.There are lytic lesions in C7 and T1 vertebrae. They demonstrate marginated borders, suggesting vertebral hemangiomas. They can be further correlated with MRI if clinically indicated.

Output: 1. Findings compatible with left vocal paralysis, however, no discrete mass or adenopathy is seen in the neck.2. Severe degenerative disease of cervical spine, resulting in spinal canal and neuroforaminal stenosis.3. Lytic lesions within C7 and T1 vertebrae, suggesting hemangiomas. They can be further correlated with MRI if clinically indicated.


Instruction: Generate impression based on findings.

Input: Uterine fibroid and menorrhagia. PELVIS:UTERUS, ADNEXA: Anteverted uterus.The endometrium is normal thickness measuring up to 7 mm.The junctional zone/inner myometrium is distorted by anterior uterine body masses. Dorsally it is well-defined and normal in thickness.Anterior lower uterine body intramural well-defined mass measuring 5.2 x 3.4 x 5.1 cm, compatible with a fibroid.Anterior upper uterine body/fundal intramural well-defined mass measuring 6.3 x 6.8 x 6.8 cm with small cystic components, compatible with a fibroid. Both masses demonstrate significant postcontrast enhancement.Additional subcentimeter intramural masses.Right ovarian 5.6 x 4.6 cm cyst without enhancing components. Otherwise the right ovary and left ovary are normal in morphology and size with numerous follicles.Numerous cervical nabothian cysts. Cystic lesion below the level of pubic symphysis along the posterolateral left wall of the vagina likely representing a Bartholin gland cyst.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative disc disease.OTHER: No significant abnormality noted.

Output: 1. Two large dominant enhancing uterine fibroids as described.2. 5.6 cm right ovarian cyst. Ultrasound follow-up in 6-12 weeks is recommended.


Instruction: Generate impression based on findings.

Input: Bilateral breast cancer with vision changes. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is an enlarged right basal ganglia perivascular space that measures up to 12 mm. The brain parenchyma and pituitary gland otherwise 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: No evidence of intracranial metastases.


Instruction: Generate impression based on findings.

Input: Female, 31 years old, with right-sided ataxia and weakness, new diagnosis of MS, looking for progression from the prior MRI. Brain:Multiple round, oval and linear foci of T2 hyperintensity are demonstrated in the corpus callosum and periventricular tissues. Somewhat confluent signal abnormality is evident in the periatrial regions. Scattered additional focal lesions are demonstrated to a lesser extent in the brainstem, at the left trigeminal root entry zone, and along the right superior cerebellar peduncle. None of the lesions visualized on today's examination demonstrates clear evidence of enhancement.On comparison with the prior study, at least one lesion is new, this in the right frontal subcortical region (image 33 series 401). There may be additional smaller new lesions, but differences in technique between the two studies to make accurate comparison difficult. No evidence of significant mass effect is seen. Brain parenchymal volume is maintained. No abnormal extra axial fluid collections are seen. The ventricles are normal in size and morphology.Cervical spine:No evidence of any focal spinal cord lesion is seen. No pathologic intramedullary or leptomeningeal enhancement is detected. There are no epidural abnormalities.Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. Marrow signal characteristics are remarkable.A posterior disc osteophyte complex at C5-6 effaces the ventral thecal sac but causes no significant generalized spinal canal stenosis. This finding is unchanged. The intervertebral discs are otherwise preserved. No areas of significant spinal canal or foraminal narrowing are detected.

Output: 1.Numerous parenchymal lesions are identified compatible with the history of multiple sclerosis. At least one lesion in the right frontal lobe is clearly new from the prior examination.2.No evidence of any demyelinating lesions in the cervical spinal cord.


Instruction: Generate impression based on findings.

Input: 81-year-old male status post AAA repair, intubated with decreased responsiveness. There is no evidence of intracranial hemorrhage, mass or edema. Small focal decreased hypointensity within the periventricular white matter may represent small vessel ischemic disease, age indeterminate. No evidence of acute intracranial ischemia/infarction; however, CT is insensitive in the early detection of CVA , if there is clinical suspicion for stroke, MRI may be consideredThe ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base demonstrate multiple small ill-defined lucencies concerning for metastatic/metabolic disease. A partial empty sella is present. The visualized paranasal sinuses and mastoid air cells demonstrate mild mucosal thickening.Postsurgical changes of cataract surgery present bilaterally.

Output: No evidence of acute intracranial ischemia/infarction; however, CT is insensitive in the early detection of CVA , if there is clinical suspicion for stroke, MRI may be considered


Instruction: Generate impression based on findings.

Input: Posttraumatic neck pain with left upper extremity radiation. Sagittal alignment is notable for straightening in addition to 2 mm of posterior subluxation of C4 relative to C5. The vertebral bodies are preserved in height. There is mild degenerative marrow signal subjacent to the endplates at C5-C6 and C6-C7. T1/T2-hyperintense lesions in the right aspect of C7 and C4 vertebral bodies probably represent hemangiomata. There is disc desiccation at all levels and mild height loss, most pronounced at C6-C7. There is mild ligamenta flava thickening extending from C4-C5 level through C6-7 level contributing to the below-described canal narrowing. There are anterior disc-osteophytes at C4-C5 through C6-C7 levels. The spinal cord shows normal signal and is only mildly deformed on the left side by the C6-C7 disc-osteophyte complex. Included posterior fossa structures are unremarkable. The paraspinal soft tissues are unremarkable and major cervical vascular flow voids are preserved. There is trace mucosal thickening in the right maxillary sinus.Level-specific findings: C2-C3: There is very minimal uncovertebral and left facet arthropathy but no significant spinal canal or neural foraminal stenosis.C3-C4: Disc-osteophyte complex flattens the ventral thecal sac resulting in mild spinal canal stenosis. Left facet and uncovertebral arthropathy resulting in moderate left neural foraminal stenosis.C4-C5: The retrolisthesis and disc-osteophyte complex result in mild-to-moderate spinal canal stenosis. Uncovertebral and facet arthropathy are more pronounced on the left side and result in severe left and moderate-to-severe right right neural foraminal stenoses.C5-C6: Small, central disc-osteophyte complex indents the thecal sac but causes no significant spinal canal stenosis. There is also mild facet arthropathy but no significant neural foraminal stenosis.C6-C7: The disc-osteophyte complex is associated with a left paracentral component which mildly deforms the spinal cord. Also, uncovertebral and facet arthropathy are associated with severe left and moderate right neural foraminal stenoses.C7-T1: There is no significant spinal canal or neural foraminal stenosis.

Output: 1.Multilevel degenerative cervical spondylosis is most pronounced at C6-C7 resulting in moderate spinal canal stenosis and severe left and moderate right neural foraminal stenoses. 2.At C4-C5, there is also severe left and moderate-to-severe right foraminal stenoses.


Instruction: Generate impression based on findings.

Input: Female, 50 years old, with dizziness and abnormal head CT. Please note that due to patient discomfort, a limited examination was acquired consisting of axial diffusion, FLAIR and T2-weighted images as well as sagittal T1-weighted images.Signal abnormality is evident within the right thalamus consistent with the known hematoma. Accounting for differences in technique, there has been no significant interval change in size. The hematoma demonstrates expected diffusion signal abnormality. However, there are two punctate foci of restricted diffusion in the left periventricular white matter as well as a 1 cm focus of restricted diffusion involving the left cerebellar tonsil. Patchy periventricular FLAIR hyperintensity is seen. No evidence of significant generalized mass effect is detected apart from partial effacement of the right lateral ventricle. The ventricles are otherwise within normal limits

Output: 1.Limited examination due to patient discomfort.2.Redemonstration of a hematoma in the right thalamus without significant interval change.3.Given the presence of multiple foci of acute ischemia including in the left periventricular white matter and in the left cerebellar tonsil, the etiology of the hematoma is favored to be hypertensive in nature.