Instruction: Generate impression based on findings.

Input: Female, 35 years old, with low back and left leg pain and back spasms. Thoracic:Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. No pathologic marrow replacement or marrow edema is observed.The visualized spinal cord demonstrates normal morphology and signal characteristics. No epidural abnormalities are detected.The intervertebral discs are preserved with no evidence of significant disc bulging or disc herniation. The spinal canal and neural foramina are patent.Lumbar:Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. No pathologic marrow replacement or marrow edema is seen.The visualized distal spinal cord, conus and nerve roots of the cauda equina are unremarkable. No epidural abnormalities are suspected.The intervertebral discs are preserved with no evidence of significant disc bulging or disc herniation. The spinal canal and neural foramina are patent.

Output: Unremarkable evaluation of the thoracic and lumbar spine with no specific findings to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: Female 69 years old; Reason: third ventriculostomy,suspected aqueductal stenosis History: 6 month follow up. No acute intracranial hemorrhage. No intra- or extra-axial fluid collections. Again seen is a recumbent AP paramedian frontal burr hole. Linear low attenuation traversing the right frontal lobe and terminating into the right lateral ventricle likely result of prior instrumentation. Punctate focus of air within the right frontal horn has resolved.Redemonstration of enlargement of the lateral and third ventricles, which are unchanged compared to previous exam. Periventricular low attenuation of white matter is similar to prior exam corresponding to regions of small vessel ischemic strokes on prior MRI study and are unchanged. Possibility of underlying periventricular exudate of CSF should also be considered.The visualized osseous structures and soft tissue extracranial components are without abnormalities.

Output: 1.No significant interval change in the size of the supratentorial enlarged ventricular system.


Instruction: Generate impression based on findings.

Input: 52 year old female; rule out intracranial hemorrhage. No abscess identified.Patchy low attenuation in the subcortical white matter compatible with small vessel disease of indeterminate age.More focal low attenuation in the right high parietal region represents edema given subsequent contrast enhanced examination that revealed a metastatic focus at this location. This lesion is visible on the MRI dated 3/29/2008.There is no evidence of intracranial hemorrhage. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. No intracranial hemorrhage.2. Metastatic lesion with surrounding edema in the high right parietal region adjacent to the cerebral falx; please see recent contrast enhanced examination for further details. If further workup is necessary, recommend MRI.


Instruction: Generate impression based on findings.

Input: 67 year-old female with confusion. There is no evidence of intracranial hemorrhage, mass or edema. Confluent periventricular and subcortical areas of hypoattenuation are consistent with chronic small vessel ischemic disease, which was present on 2010 MRI.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.Atherosclerotic calcifications in both internal carotid arteries.

Output: 1.No acute intracranial abnormality. However, CT is not sensitive in detecting acute ischemic change and MRI is recommended if clinical suspicion for nonhemorrhagic stroke persists.2.Chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: Soft, nonmobile, nontender right hand mass. There is a 10 x 4 mm intermediate T1 and T2 signal lesion which appears to be centered within the palmar aponeurosis of the right hand. The lesion enhances on post-contrast imaging suggesting a degree of vascularity. The underlying tendons and muscles appear distinct from this mass. Note is also made of enhancing synovium within the wrist. A cyst is noted in the proximal pole of the scaphoid. The TFCC is incompletely visualized on this examination.

Output: Non-specific palmar mass which appears to have enhancement suggesting some degree of vascularity.


Instruction: Generate impression based on findings.

Input: Mr. Brinkley is a 57-year-old female with biopsy proven malignancy in the right breast. She presents for MR-directed ultrasound for the focal non-mass enhancement in the left breast at 3:00 position found on the MRI dated 9/19/2015. Ultrasoud for left retroareolar region is also requested by Dr. Jaskowiak, as the patient reports a history of brownish nipple discharge on the left. A targeted left ultrasound was performed for the MRI area of concern. In the left breast, 3:00 location, 4 cm from the nipple, there is a 10 x 7 x 8 mm hypoechoic mass, which corresponds to the MR findings. The mass is centered in a dilated duct, which extends to the nipple. There are no abnormal findings other than dilated ducts in the left retroareolar region. At 5:00 location, 3 cm from the nipple, there is a 17 x 8 x 11 mm simple cyst, which correlates with the cyst on the MRI.

Output: 10 mm hypoechoic mass with dilated duct in the left breast, correlating with the nonmass enhancement on the MRI and likely representing a papilloma. Ultrasound guided biopsy of this mass was performed after this study.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration.


Instruction: Generate impression based on findings.

Input: Reason: evaluate for subdural cyst History: s/p fenestration of thoracic subdural cyst Alignment is anatomic. Marrow signal is normal for age. There is been interval fenestration of the arachnoid cysts with laminoplasty from T2 to T9. There are postsurgical changes including edema within the posterior epidural space and paraspinous tissues, particularly along the spinous processes from T2 to T5. Increased T1 signal at these levels posterior to the thecal sac likely reflects some postsurgical blood products. However, there is no significant mass effect on the posterior thecal sac. A small amount of T1 hyperintensity along the left aspect of the spinous process T3 also likely represents postsurgical blood. The arachnoid cysts seen on the prior myelogram at the T3-T4 level and T7-T8 level are not specifically visualized, however mass effect on the cord has resolved. For example, the dorsal thecal sac at T2-T3 measures 3 mm, previously 5 mm. At T8, the dorsal thecal sac measures 2 mm, previously 5 mm. The lower thoracic cord and conus is slightly deviated rightward with mild clumping of the nerve roots abutting the right lateral dural margin; findings likely related to adhesions/mild arachnoiditis. Scattered increased signal is seen in the lungs, likely atelectasis.

Output: 1.Expected postsurgical findings related to fenestration of two thoracic arachnoid cysts with resolution of previously seen mass effect and deformity of the thoracic cord.2.Mild rightward deviation of the distal thoracic cord with mildly clumped nerve roots abutting the right lateral dural margin, findings likely related to adhesions/mild arachnoiditis.


Instruction: Generate impression based on findings.

Input: Reason: Newly diagnosed multiple myeloma; recently found to have plasmacytoma to L hip; please evaluate for myeloma lesions History: Newly diagnosed multiple myeloma; recently found to have plasmacytoma to L hip; please evaluate for myeloma lesions Evaluation of left hip and the surrounding soft tissues is limited by metallic susceptibility artifact related to the patient's total hip arthroplasty device. There is a crescentic collection of fluid along the posterolateral aspect of the greater trochanter with associated rim enhancement on postcontrast sequences. We suspect that this represents a postoperative seroma, although we cannot entirely exclude the possibility of an infected fluid collection. There is a band of low signal intensity and enhancement which extends from this collection through the lateral subcutaneous fat, although this is not included in its entirety in the field-of-view of this study. There are small foci of signal abnormality and enhancement noted within the first sacral segment, coccyx, L4 vertebral body, and right ilium. The largest of these lesions within the sacrum is approximately 10 mm in diameter. Osteoarthritis affects the sacroiliac joints. There is bandlike enhancing signal abnormality within the right sacral wing likely representing a site of prior bone marrow biopsy. Note is made of low signal intensity masses within the uterus which are partially obscured by the aforementioned metallic susceptibility artifact, but likely represent uterine fibroids.

Output: Multiple myeloma and other findings as described above.


Instruction: Generate impression based on findings.

Input: 43-year-old man with history of paraplegia. Evaluate for osteomyelitis Again seen is heterogeneous signal intensity and enhancement within the subcutaneous fat posterior to the sacrum, favored to represent a combination of edema, scar tissue and heterotopic ossification. There is irregularity of the overlying skin, presumably reflecting ulceration. The signal intensity of the underlying sacrum appears normal and we see no findings to suggest osteomyelitis of the sacrum.Again seen is a deep ulcer along the left gluteal fold extending to the left ischium, which was present on the prior MRI as well as a CT scan from 2014. There is mild decreased signal intensity of the left ischial tuberosity on T1-weighted images, as well as mild increase in signal intensity on the fat suppressed T2-weighted images. This appearance is consistent with chronic osteomyelitis. Increased signal intensity within the ischial tuberosity on the fat suppressed T2-weighted sequence appears slightly more prominent on the current study when compared to the prior study, but it is uncertain whether this represents a slight increase in bone marrow edema, or if this simply represents differences between the two MRI scanners. We are not convinced that there has been any further bone destruction when compared to the March 2016 study. Heterogeneous signal intensity adjacent to the left ischium presumably represents edema, scar tissue and heterotopic ossification, similar to the prior study.An additional sinus tract is again seen extending from the right gluteal fold to the right ischium, but we see no signal abnormalities to suggest osteomyelitis in this region.Postsurgical changes of a right Girdlestone procedure are again seen. We see no abnormal signal intensity in the proximal right femur to suggest osteomyelitis.Again seen is deformity of the left proximal femur with adjacent heterotopic ossification, which appears unchanged from the prior MRI. Osteoarthritis of the left hip appears similar to prior. Heterogeneous signal intensity in the soft tissues surrounding the left hip likely represents scar tissue and additional heterotopic ossification, and appears similar to prior.There is ankylosis of the sacroiliac joints, particularly on the right. There is diffuse muscle atrophy. Again noted is mild edema and enhancement of the gluteal musculature, but we see no findings to suggest an abscess. Increased T2 signal intensity within the adductor musculature may represent atrophy or mild edema, and appears similar to prior. There is a Foley catheter within the bladder.

Output: 1. Pelvic soft tissue ulcers as describe above, with findings suggesting chronic osteomyelitis of the left ischium. Although the degree of edema within the ischium appears to have increased slightly when compared to the prior study, this may simply reflect differences between the two MRI scanners. We see no findings to confirm progression destruction of the ischium.2. Other findings as detailed above, appearing similar to the prior study.


Instruction: Generate impression based on findings.

Input: 64 years, Male, History of prostate cancer status post biopsy 1.5 years ago. Rising score PELVIS:PROSTATE:Prostate Size: 4.0 x 2.9 x 3.0 cmPeripheral Zone: Right apical lesion which is dark on ADC/T2 measuring 3 x 5 mm (804/24) is suspicious for adenocarcinoma.Central Gland: Transitional zone lesion in the left mid gland measuring 9 x 8 mm (804/224) is also suspicious for adenocarcinoma.Seminal Vesicles: No involvement.Extracapsular Extension: NoneBLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Lesions in the left mid gland transitional zone and right apex are suspicious for prosthetic adenocarcinoma.


Instruction: Generate impression based on findings.

Input: Reason: evaluate for placental implantation, previous MRI with concern for increta History: abnormal placentation PELVIS:UTERUS, ADNEXA:An intrauterine pregnancy is present with its head positioned caudally. The fetus is grossly within normal limits. Amniotic fluid is grossly within normal limits.There are postsurgical changes along the lower anterior abdominal wall, likely from prior cesarean sections. The placenta is positioned along the right anterior aspect of the uterus, low-lying with respect to the cervical os (5/20). Again seen is irregularity within the myometrium adjacent to the anterior aspect of the placenta, immediately left of midline (4/27). There is no definite extension of the placenta through the myometrium. Underlying cystic change within the placenta at the myometrium is new from the prior exam. Overall these findings raises suspicion of placenta increta.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Findings suggestive of placenta increta, although placenta percreta cannot be excluded.2.Low-lying placenta.


Instruction: Generate impression based on findings.

Input: 34-year-old female with pain. MENISCI: The medial and lateral meniscus appear intact.ARTICULAR CARTILAGE AND BONE: There are focal near full-thickness to full-thickness articular cartilage defects along the medial facet of the patella.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: Findings suggestive of patellofemoral instability including articular cartilage degeneration affecting the patellofemoral joint as well as an elevated tibial tubercle to trochlear groove distance as described above.


Instruction: Generate impression based on findings.

Input: Reason: eval for spondylolysis History: lbp with hockey for months with significant LLD--left sided pain; right leg long Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. The conus medullaris is normal in position. Bone marrow signal is benign. There appear to be bilateral L5 pars defects with mild fluid along the defect and mild adjacent edema. There is also mild fluid in the L4-L5 and L5-S1 facet joints, left relatively greater than right. Paraspinous soft tissues are otherwise unremarkable.There are minimal disc bulges in the lumbar spine at L4-L5 and L5-S1 with minimal narrowing of the neural foramina. There is no significant spinal canal or neural foraminal stenosis at any level.

Output: Likely bilateral L5 spondylolysis without spondylolisthesis. CT can be considered for optimal visualization of the pars defects. There is small amount of fluid at the site of the pars defects with mild surrounding edema and mild fluid extending into the L4-L5 and L5-S1 facet joints, left relatively greater than right.


Instruction: Generate impression based on findings.

Input: Multifocal bilateral subtle high signal foci are seen in FLAIR and in T2 sequences in the white matter of the trigone bilaterally, less prominent than in the previous study. Note is made that this subtle difference may be due to difference in technical imaging factors.The ventricles and sulci are within normal limits. The basal cisterns remain patent. There is no midline shift or mass effect. There is no diffusion abnormality. 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: Multifocal bilateral subtle high signal foci in the FLAIR and in T2 sequences in bilateral periventricular white matter including trigone area. These are less prominent than in the previous study of 7/8/2014; however, difference in technical imaging factors should be taken into account.


Instruction: Generate impression based on findings.

Input: New lung cancer. 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 mild mucosal thickening in the left maxillary sinus.

Output: No evidence of intracranial metastases.


Instruction: Generate impression based on findings.

Input: 44-year-old female patient with shoulder pain. ROTATOR CUFF: Slight thickening and increased signal within the distal fibers of the supraspinatus tendon indicate mild tendinosis, but there is no full-thickness tear. The supraspinatus muscle is within normal limits. The muscle and tendons of the infraspinatus, teres minor, and subscapularis are within normal limits.SUPRASPINATUS OUTLET: No significant fluid is identified in the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral joint alignment is within normal limits. The glenoid labrum is grossly intact. Degenerative cysts are noted in the humeral head at the rotator cuff insertion.BICEPS TENDON: The long head of the biceps tendon is intact. ADDITIONAL

Output: Mild tendinosis of the supraspinatus tendon without full thickness rotator cuff tear.


Instruction: Generate impression based on findings.

Input: Increasing low back pain. Abdominal aortic aneurysm repair with a stent graft one month ago. THORACIC SPINE:Alignment is anatomic. While overall vertebral body height is preserved, there is minimal multilevel endplate concavity in the upper/mid thoracic spine, most pronounced at T7. This is not associated with marrow edema. There are foci of T1/T2-hyperintense signal anteriorly subjacent to the superior and inferior endplates of T7, which can be degenerative in nature or may reflect hemangiomas. Similar but more central signal abnormality in the right side of T12 vertebral body is compatible with a hemangioma. There is no suspicious marrow signal abnormality otherwise. The intervertebral discs show desiccation but relatively preservation of height. The spinal canal is preserved. The thoracic spinal cord shows normal shape and signal characteristics. There is no significant spinal canal or neural foraminal stenosis at all levels. Following contrast administration, there is no abnormal spinal cord, leptomeningeal, or epidural contrast enhancement. The thyroid gland is enlarged. Well-circumscribed, T1/T2-hyperintense, non-contrast-enhancing nodules in the left thyroid lobe may represent colloid cysts. The largest measures 14 mm in diameter.Multilevel degenerative cervical spine spondylosis associated with disc-osteophyte complexes that minimally indent the ventral aspect of the spinal cord without intrinsic spinal cord signal abnormality. These are not completely evaluated on this examination.LUMBOSACRAL SPINE:Alignment is anatomic apart from 2 mm of anterior subluxation of L5 relative to S1, which is probably degenerative in nature. The vertebral bodies are preserved in height. Marrow signal is notable for degenerative change along the inferior L3 and superior S1 endplates. There is also degenerative signal in the right-sided articulating pillars related to the severely osteoarthritic L5-S1 facet. There is partial disc desiccation but heights are fairly preserved. The spinal canal is preserved. The tip of the conus medullaris lies at the mid/lower L1 vertebral level. The conus medullaris shows normal shape and signal. Following contrast administration, there is no abnormal spinal cord, leptomeningeal, epidural or osseous contrast enhancement. T12-L1, L1-L2, and L2-L3: There is no significant disc herniation. There is mild facet arthropathy and ligamenta flava thickening. There is no spinal canal or foraminal stenosis. L3-L4: There is minimal disc bulge and mild facet arthropathy. There is moderate ligamenta flava thickening. There is no significant spinal canal and only mild left foraminal stenosis.L4-L5: There is mild disc bulge along with moderate facet arthropathy and negative flat thickening. There is no significant spinal canal stenosis and only mild right foraminal stenosis.L5-S1: Disc uncovering along with severe, right more than left, facet arthropathy and ligamenta flava thickening result in transverse narrowing of the spinal canal and relative preservation of the anteroposterior diameter. There is mild narrowing of the subarticular recesses and the neural foramina.The endograft through the lower abdominal aortic aneurysm is partially included. There is also severe osteoarthritic changes of the sacroiliac joints with osteophytes and subarticular sclerosis. There is a small, narrow neck umbilical hernia, containing fat but not completely imaged.

Output: 1.There are no imaging findings to suggest thoracolumbar spinal infection.2.No significant degenerative disease of the thoracic spine. 3.Thyroid nodules are incompletely assessed on this examination. If further assessment is clinically warranted, thyroid ultrasound can be considered.4.Degenerative disease of the lumbar spine is most pronounced at L5-S1, where severe facet arthropathy and ligamentous thickening result in mild bilateral neural foraminal and subarticular recess stenoses.


Instruction: Generate impression based on findings.

Input: 53 old female with acute altered mental status. There is a hypodense region in the left frontal lobe which is unchanged from yesterday, but new compared to CT from 12/20/08. MRI is recommended for further evaluation of this lesion.The ventricles and basal cisterns are normal in size and configuration.There is a lytic lesion in the right parietal calvarium which was seen on the prior scan and may represent metastases. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1- Hypodense lesion in the left frontal lobe unchanged from yesterday. MRI is recommended for further evaluation.2- Right parietal calvarial lesion doesn't appear to have significantly changed from prior and likely represent metastases.


Instruction: Generate impression based on findings.

Input: Thoracic spine: There has been interval approximately 50% height loss T8 vertebral body, which demonstrates abnormal bone marrow signal. There is also 4 mm of retropulsion with partial effacement of the ventral thecal sac. However, there is no evidence of spinal cord compression or abnormal spinal cord signal. There is mild overall spinal canal stenosis at the T8 level. There is moderate narrowing of the left neural foramen at T8-T9. Lumbar spine: There is normal alignment of the lumbar spine, with a normal lumbar lordosis. The vertebral body heights are well-maintained. There is no abnormal bone marrow signal. There is moderate loss of intervertebral disc height at L4-L5 and mild loss of intervertebral disc height at the remaining levels of the lumbar spine. There are disc bulges at L2-L3, L3-L4, L4-L5 and L5-S1. There is bilateral facet arthropathy and mild ligamentum flavum thickening from L2-L3 to L5-S1. There is resultant moderate spinal canal stenosis at L3-L4 and L4-L5. There is mild bilateral neural foraminal narrowing at L3-L4 through L5-S1. There is unchanged nodularity of the left adrenal gland. There is a left renal cyst.

Output: 1. Pathologic compression fracture of the T8 vertebral body with 50% loss of vertebral body height and mild retropulsion with mild resultant spinal canal stenosis, but no spinal cord compression or abnormal signal.2. Multilevel lumbar spondylosis with up to moderate spinal canal stenosis at L3-4 and L4-L5.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Chiari malformation. Torticollis and gait issues. 6 month follow-up. BRAIN: The cerebellar tonsils again extend up to approximately 21 mm inferior to the foramen magnum and display a pointed configuration with crowding of the foramen magnum in association with a relatively small posterior fossa. There is mildly narrowed column of cerebrospinal fluid flow across the foramen magnum ventrally especially at C1 level which is slightly more pronounced than on the previous examination but this likely relates to different head positions, as the patient's neck is much more flexed on today's examination. Dorsal flow, however, has slightly improved since the prior examination. There continues to be mismatch of synchronicity between ventral and dorsal flow. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift. The major cerebral flow voids are intact. The orbits are grossly unremarkable. There is scattered paranasal sinus mucosal thickening.CERVICAL SPINE: There is mild retroflexion of the dens. The cervical vertebral column is otherwise unremarkable, without evidence of subluxation. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: 1. Stable Chiari type 1 malformation. Compared to previous examination, CSF flow shows increased attenuation of the ventral flow at and below the level of foramen magnum which likely relates to differences in head position as described above. 2. No cervical syringohydromyelia.


Instruction: Generate impression based on findings.

Input: Headache [R51], Reason for Study: ^Reason: new onset headaches History: new onset headaches, lightheadedness No evidence of acute ischemic or hemorrhagic lesion on the scan.No evidence of abnormal enhancement.There are multifocal lacunes on bilateral thalami (right worse than left), periventricular white matter and bilateral pons with evidence of susceptibility artifacts indicating possible prior petechial hemorrhages.There are bihemispheric periventricular FLAIR/T2 high signal intensity lesions indicating non specific small vessel ischemic disease.The ventricles, sulci and cisterns are symmetric and unremarkable. 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.The sphenoid sinus and frontal sinus especially right side show fluid collections.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. No evidence of abnormal enhancement.3. Multiple lacunar infarctions involving bilateral thalami, pons and periventricular white matter with evidence of associated chronic petechial hemorrhages.4. Non specific small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: Reason: 31M with wrist pain, eval for TFCC injury History: wrist pain LIGAMENTS: The scapholunate and lunotriquetral ligaments appear intact within the limitations of a non arthrogram examination.TRIANGULAR FIBROCARTILAGE COMPLEX: There is increased fluid signal abnormality within the articular disc of the triangular fibrocartilage at the level of its insertion on the ulnar styloid indicating partial thickness tearing. Some of the fibers of the articular disc can be traced to their insertion on the ulnar styloid. Additionally, there is increased fluid signal intensity within the triangular fibrocartilage complex at the level of its foveal attachment also indicating a partial thickness tear. Some of the fibers can be traced to their foveal attachment. Note is made of a 3 mm linear ossific density along the distal aspect of the ulna corresponding to the findings seen on recent radiographs which may reflect prior remote trauma. There is no bone marrow edema or other findings to suggest acute fracture. There is a trace amount of fluid within the distal radial ulnar joint.TENDONS: The flexor and extensor tendons appear intact. There is perhaps minimal intermediate signal intensity within the extensor carpi ulnaris indicating minimal tendinosis of questionable clinical significance. BONES: No bone marrow signal abnormality is identified.ADDITIONAL

Output: Partial thickness tearing of the triangular fibrocartilage complex involving its insertion on the ulnar styloid as well as its foveal attachment. Other findings as described above.


Instruction: Generate impression based on findings.

Input: 57-year-old male. Evaluate for prostate cancer. PSA was 3.6 ng/mL on 6/16/2016.Prostate biopsy from 7/18/2016:Right mid medial: Adenocarcinoma, Gleason 3+3Left base lateral: Atypical small acinar proliferation adjacent to high-grade prostatic intraepithelial neoplasm.Left mid medial: Adenocarcinoma, Gleason 3+3Left apex medial: Adenocarcinoma, Gleason 3+3Left apex lateral: Adenocarcinoma, Gleason 3+3 PELVIS:PROSTATE:Prostate Size: The prostate measures 5.8 cm in transverse, 3.3 cm in AP, and 5.2 cm in craniocaudal diameter.Peripheral Zone: In the left mid gland, there is a 4 x 4 mm ADC and T2 hypointense focus suspicious for malignancy (series 201 image 51, series 303 image 304).Central Gland: In the left transitional zone, there is a well-defined T2 and ADC hypointense focus measuring 4 x 6 mm (series 303 image 224, series 701 image 12, series 201 image 41). The ADC appearance is particularly low in signal intensity.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: None.BLADDER: No significant abnormality noted.LYMPH NODES: No suspicious pelvic lymphadenopathy.BONES, SOFT TISSUES: A well-defined T2 and T1 hypointense focus adjacent to the right pelvic sidewall demonstrates dense calcification on the 12/20/2016 abdominal radiograph and is compatible with a benign phlebolith (series 201 image 68).OTHER: No significant abnormality noted.

Output: 1.In the left mid gland, there is a 4 x 4 mm ADC and T2 hypointense focus concerning for malignancy (PI-RADS 4).2.Suspicious well-defined T2 hypointense and very low ADC hypointense focus in the left transitional zone measuring 4 x 6 mm (PI-RADS 3).PI-RADS™ v2 Assessment Categories:PI-RADS 1 – Very low (clinically significant cancer is highly unlikely to be present) PI-RADS 2 – Low (clinically significant cancer is unlikely to be present)PI-RADS 3 – Intermediate (the presence of clinically significant cancer is equivocal)PI-RADS 4 – High (clinically significant cancer is likely to be present) PI-RADS 5 – Very high (clinically significant cancer is highly likely to be present)https://www.acr.org/~/media/ACR/Documents/PDF/QualitySafety/Resources/PIRADS/PIRADS%20V2.pdf


Instruction: Generate impression based on findings.

Input: Chiari malformation, worsening symptoms, headache. Brain: There are postoperative findings related to Chiari decompression. The cerebellar tonsils assume a rounded configuration and extend to the level of the tip of the dens. There is biphasic flow of cerebrospinal fluid across the neo-foramen magnum, both anteriorly and posteriorly. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Cervical Spine: The spinal cord displays normal signal and morphology. 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.

Output: Expected postoperative findings related to Chiari decompression without evidence of ventriculomegaly or syringohydromyelia.


Instruction: Generate impression based on findings.

Input: Loss of vision for 4 mins, MVR and AVR. MRI: There is no evidence of intracranial mass or acute infarct. There are mild scattered foci of white matter T2 hyperintensity in the anterior frontal lobes bilaterally. There are also numerous scattered foci of susceptibility effect in the bilateral cerebral hemispheres, midbrain, and cerebellum. 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 are small bilateral maxillary sinus retention cysts. MRA: The left vertebral artery is diminutive. Otherwise, there is no evidence of significant steno-occlusive lesions. There is no evidence of saccular aneurysms.

Output: 1. Nonspecific mild scattered foci of white matter T2 hyperintensity in the anterior frontal lobes bilaterally, but no evidence of acute infarct or significant steno-occlusive lesions in the cerebral arteries.2. Numerous scattered supratentorial and infratentorial foci of susceptibility effect are nonspecific, but may represent cavernous malformations or chronic microhemorrhages.


Instruction: Generate impression based on findings.

Input: History of metastatic small cell lung cancer. There are multiple bilateral supratentorial and infratentorial enhancing lesions have overall decreased in size. For example, the largest lesion is located in the left frontal lobe and measures up to 22 mm, previously 35 mm. Likewise, the associated vasogenic edema has generally diminished. There is no significant residual midline shift and effacement of the ventricular system. There is a background of mild cerebral white matter T2 hyperintensity, which may represent chronic small vessel ischemic disease. There is no evidence of acute cerebral infarction. There is minimal mucosal thickening of the left maxillary sinus. The orbits, skull, and scalp soft tissues are grossly unremarkable.

Output: Interval decrease in size of multiple supratentorial and infratentorial metastatic lesions and diminished associated vasogenic edema, indicating treatment response.


Instruction: Generate impression based on findings.

Input: History of atypical meningioma prior resection and radiation therapy. Follow-up examination. The MRI exam was a scheduled to have pre and post gadolinium enhancement. However, due to patient's left-sided severe pain, the patient wanted to abort the exam prior to gadolinium enhancement. There is no evidence of acute ischemic lesion on the scan.Again there is evidence of tissue loss on right frontal lobe and left frontal lobe with frontal craniotomy and overlying extra axial fluid collections. Encephalomalacia on bifrontal lobes are also shown.Above findings do not show any significant interval change since April 17, 2014.There is no evidence of postoperative unusual signal intensity on the scan. There is no evidence of recurrence of the tumor on this limited scan.The ventricles, sulci and cisterns are symmetric and unremarkable. No change since prior scan. There is no mass, mass effect, edema, midline shift, or restricted diffusion/acute ischemia. 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 left maxillary sinus.

Output: No evidence of acute ischemic lesion.Post surgical resection status of bi-frontal atypical meningioma, no interval change since prior study and no evidence of recurrence on this limited scan.Postgadolinium enhancement study was not performed due to patient pain.


Instruction: Generate impression based on findings.

Input: Female, 28 years old, with myoclonic jerking in the right upper extremity, history of motor vehicle accident in 2011, history of melanoma. Rule out MS or other lesion. Brain:The cerebral and cerebellar hemispheres and brainstem show normal signal intensity and morphology. No restricted diffusion is seen. No pathologic enhancement is detected. Incidental note is made of a developmental venous anomaly in the left inferior parietal lobule, and another in the left cerebellum.No evidence of parenchymal edema, mass, or mass effect is seen. There is no evidence of intracranial hemorrhage or abnormal extra-axial fluid. The ventricular system is normal in caliber and morphology. Signal intensity of the bone marrow is unremarkable. No significant abnormalities of the paranasal sinuses are detected.Cervical spine:Alignment is anatomic. Vertebral body height and morphology are within normal limits. No pathologic marrow replacement or enhancement is seen.The visualized spinal cord demonstrates normal signal intensity and morphology. No focal lesions are seen. No pathologic intramedullary or leptomeningeal enhancement is detected. No epidural lesions are seen.There may be a very small central disc protrusion at C6-7. Elsewhere the intervertebral discs are preserved. No significant spinal canal or foraminal stenosis is observed.

Output: No specific findings are seen to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: Metastatic apocrine adenocarcinoma status post brain tumor resection. There are recent postoperative findings related to right temporal craniotomy for resection of a right anterior temporal lobe tumor. There is an area of restricted diffusion along the posterior aspect of the resection cavity that measures up to 25 mm and a small amount of blood products within the cavity, but no evidence of gross residual enhancing tumor. There is extensive confluent T2 hyperintensity surrounding the resection cavity. There is associated 6 mm of midline shift to the left and partial effacement of the third and right lateral ventricles. There is mild prominence of the left lateral ventricle. There is swelling of the scalp tissues overlying the craniotomy site. There is a partially-imaged large left paraspinal tumor adjacent to the craniocervical junction with compression of the left internal jugular vein and slow flow in the ipsilateral dural venous sinuses. There also appears to be an enlarged left preauricular lymph node.

Output: 1. No evidence of gross residual enhancing tumor in the anterior right temporal lobe status post recent resection, although surrounding vasogenic edema with mild midline shift persists.2. Partially-imaged large left paraspinal metastasis adjacent to the craniocervical junction.3. Apparent enlarged left preauricular lymph node, which may also represent metastatic disease.


Instruction: Generate impression based on findings.

Input: History of prostate cancer. No pathology report available. PELVIS:PROSTATE:Prostate Size: 3.6 x 5.3 x 5.4 cmPeripheral Zone: In the right apex there is a 5.0 x 5.0 mm focus of T2 weighted hyperintensity (series 901/7) with associated restricted diffusion (series 503/104) suspicious for prostatic adenocarcinoma. No additional discrete lesion.Central Gland: Benign prostatic hyperinflation.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: No evidence of extraprostatic extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.5 x 5 mm focus in the right apical peripheral zone suspicious for prostatic adenocarcinoma.2.No evidence of seminal vesicle invasion, extraprostatic extension or pelvic lymphadenopathy.


Instruction: Generate impression based on findings.

Input: Intracranial hemorrhage. 63-year-old female. There is a left parietal extra-axial mass present currently measuring 15 x 22 mm and previously measuring 13 x 19 mm on head CT. This has been followed on MRI exams.The CSF spaces are appropriate for the patient's stated age with no midline shift. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.No evidence for acute intracranial hemorrhage mass effect or edema.2.CT is insensitive for the early detection of nonhemorrhagic CVA3.There is an extra-axial mass which is compatible with a meningioma with a little interval change. There may be slight enlargement of this mass since 2005 as described above.


Instruction: Generate impression based on findings.

Input: Male, 48 years old, with grade 2 oligodendroglioma. The left superior frontal resection cavity is redemonstrated showing no significant change in size or confirmation. Nodular enhancement projecting into the cavity from the midline falx, and linear enhancement along the posterior inferior cavity margin, are unchanged and nonspecific. A rim of T2 hyperintensity around the cavity margins is seen which coalesces to a more bandlike area of hyperintensity along the roof of the left lateral ventricle. The extent of this signal abnormality shows very slight interval progression over the last two exams.Elsewhere in the brain, a few scattered small foci of nonspecific T2 hyperintensity are seen without significant change. No additional areas of pathologic parenchymal or extra-axial enhancement are seen. No significant generalized mass effect is detected. The ventricles are normal in size and morphology.

Output: No definite concerning interval changes are seen. A very mild slow progression of T2 hyperintensity is seen over recent prior exams along the resection cavity margin and below the resection cavity which is nonspecific but may very well represent a treatment related effect. Continued follow-up is advised.


Instruction: Generate impression based on findings.

Input: Status post debridement for right proximal tibial osteomyelitis. Evaluate for healing. Again seen is a rounded lucent defect in the proximal tibial metaepiphysis compatible with debridement of osteomyelitis. The volume of visible antibiotic beads has decreased, and portions of the cavity are slightly less distinct and less lucent, suggesting some interval healing. Widespread osteonecrosis is better seen on prior MRI.

Output: Surgical changes of right proximal tibial osteomyelitis debridement with suggestion of healing as above


Instruction: Generate impression based on findings.

Input: History of cirrhosis. Presents for HCC screening. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology. The liver is normal in size and signal intensity. No suspicious lesion. No biliary ductal dilatation. Normally distended gallbladder. Small volume perihepatic ascites. SPLEEN: Mild splenomegaly measuring 13 cm in craniocaudal dimension. Note is made of a 2.3 splenic artery pseudoaneurysm.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right renal simple cyst.RETROPERITONEUM, LYMPH NODES: IVC filter is noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Cirrhosis without suspicious liver lesion.2.Approximately 2.3 cm splenic artery pseudoaneurysm. Endovascular evaluation for possible treatment is recommended.


Instruction: Generate impression based on findings.

Input: 69 years Male (DOB:8/5/1947)Reason: S/p SRS for brain metastasis, surveillance exam History: S/p SRS for brain metastasis, surveillance examPROVIDER/ATTENDING NAME: STEVEN J. CHMURA TODD STERN There is a 9 x 8 mm enhancing mass in the left cerebellar hemisphere which previously measured 8 x 9 mm. Centrally there are some susceptibility effect associated with this lesion. In July 2015 this same lesion measured 14 mm in size and in March 2016 measured approximately 11 mm in size.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 a minor opacity in the right mastoid air cells. The visualized portions of the orbits are intact.

Output: There is a left cerebellar mass present which is similar in size relative to the prior exam.


Instruction: Generate impression based on findings.

Input: Posttraumatic left hand paresthesia. History of spinal fusion. Patient demonstrates evidence of previous C3-C5 anterior fusion and C3-C7 laminoplasties. The vertebral body osseous fusion is solid. The thecal sac is decompressed at the operated levels. The soft tissue on the laminoplasty bed is enhancing but does not impinge on the thecal sac. The spinal cord is notable for focal T2 hyperintense focus involving the cord bilaterally at the upper C5 vertebral level. It is associated with mild cord thinning. This is may be related to prior compressive myelopathy. The spinal cord otherwise shows no significant signal or morphologic abnormality (down to T4-T5 level). The included lower brainstem/cerebellum also shows no abnormality.Cervical alignment is notable for straightening which is expected given the multilevel fusion. There is mild, symmetric height loss at the C6 vertebral body but without associated edema or retropulsion. This is probably chronic. The other included vertebral bodies (down to T4) are normal. There is no suspicious marrow abnormality. Mild ossification along the posterior longitudinal ligament better seen on CT.C2-C3: There is no spinal canal or foraminal stenosis.C3-C4: There is mild left uncovertebral proliferative change causing minimal left foraminal stenosis. There is no spinal canal or right foraminal stenosis.C4-C5: There is mild uncovertebral proliferative change causing mild left and minimal right foraminal stenosis. There is no spinal canal stenosis.C5-C6: Uncovertebral and facet proliferative change are associated with moderate biforaminal narrowing. There is no spinal canal stenosis.C6-C7: Uncovertebral and facet proliferative change are associated with moderate left and minimal right foraminal narrowing. There is no spinal canal stenosis.C7 T1: There is mild left foraminal narrowing by proliferative facet/endplate disease. There is no spinal canal narrowing.

Output: 1.Prior C3-C5 solid osseous anterior fusion and C3-C7 laminoplasties with well-decompressed thecal sac. 2.Focal cord signal abnormality at C5 level is consistent with myelomalacia. No evidence of cord edema or traumatic contusion. No findings to suggest ligamentous injury. No epidural hematoma. 3.Degenerative changes with foraminal narrowing, moderate bilateral at C5-C6 and on the left at C6-C7.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 84 years Male (DOB:8/23/1931)Reason: worsening pain, h/o stenosis History: painPROVIDER/ATTENDING NAME: STACIE KAYE LEVINE STACIE KAYE LEVINE Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina. There are small uncovertebral osteophytes at this levelAt C4-5 there is loss of disc space height, disc desiccation and a diffuse disc bulge associated with ligamentum flavum hypertrophy and bilateral uncovertebral osteophyte formation. The osteophyte formation is worse on the left compared to the right side. It is encroachment of left-sided exiting nerve roots. There is partial effacement of spinal fluid ventral and posterior the spinal cord at this level. The spinal cord is not flattened. Overall compared the prior exam there is greater narrowing of the spinal canal at this level and greater encroachment of the exiting nerve roots in the left side.At C5-6 there is no significant compromise to the spinal canal. There is disc desiccation, uncovertebral osteophyte formation and a disc bulge at this level which is similar to the prior exam. There is narrowing of the neural foramina at this level with encroachment of left-sided exiting nerve roots which has not significantly progressed relative to the prior exam.At C6-7 there is no significant compromise to the spinal canal. There is disc desiccation and a disc bulge at this level associated with endplate and uncovertebral osteophytes and narrowing of the neural foramina bilaterally. These findings were also present on the prior exam. There is a hypointense lesion on all pulse sequences located along the posterior inferior aspect of the 6 vertebral body which was not readily depicted on the prior exam. It measures approximately 6 mm.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.MRI thoracic spine:The thoracic vertebral bodies are appropriate in the overall alignment and height. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots. There is multilevel loss of disc space height present associated with disc desiccation and minor disc bulges.There are small pleural effusions present.Lumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is loss of disc space height, disc desiccation and a diffuse disc bulge at this level as well as facet hypertrophy. There are some mild encroachment of the nerve roots of the right lateral recess at this level as a result of combination of disc bulge and facet hypertrophy.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is loss of disc space height, disc desiccation and facet hypertrophy at this level associated with mild anterior subluxation of L4 on L5. The patient appears to be status post right hemilaminectomy at.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is some disc desiccation and a minor disc bulge at this level.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.There is a large left-sided cystic lesion along the left kidney at this level which is not entirely included on this exam. It measures 64 x 51 mm coronal dimensions on the scout images.

Output: 1.There are multilevel degenerative changes present in the cervical spine which have mildly progressed compared to the 2012 exam. There is a mild to moderate degree of spinal stenosis present at C4-5 and encroachment of left-sided exiting nerve roots at C4-5 and C5-6 and bilateral exiting nerve roots at C6-7.2.There is a new lesion present within the C6 vertebral body which was not present on prior exams. I suspect this is degenerative in nature. A CT of the cervical spine with help further assess this.3.There are degenerative changes present in the lumbar spine with some mild encroachment of the nerve roots at the right lateral recess at L5-S1 and some minor subluxation at L4-5.4.There is some mild degenerative changes present in the thoracic spine without significant compromise spinal canal or neural foramina.5.There are very small pleural effusions present.6.There is a cystic lesion in the left kidney measuring just over 6 cm in diameter. It is not completely included on this exam.7.Status post lumbar spine surgery.


Instruction: Generate impression based on findings.

Input: Reason: Rule out tear, eval for osteoarthritis History: chronic L shoulder pain ROTATOR CUFF: Heterogeneous signal within the supraspinatus and infraspinatus tendons indicates mild tendinopathy with additional high grade and questionably full thickness tearing of the supraspinatus underlying the acromion. This accounts for a small amount of fluid underlying the deltoid. The subscapularis and teres minor tendons are intact and demonstrate normal signal intensity.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: The labrum appears grossly intact. Moderate osteoarthritis affects the acromioclavicular joint and less extent the glenohumeral.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: Partial moderate grade tearing of the supraspinatus and mild tendinopathy of the infraspinatus tendons. See additional details above


Instruction: Generate impression based on findings.

Input: Male, 63 years old, with newly diagnosed lung cancer. Evaluate for brain metastases. No evidence of restricted diffusion, edema or mass effect is seen. Scattered small foci of T2 hyperintensity are evident within the periventricular white matter bilaterally. No intracranial hemorrhage or any abnormal extra-axial fluid collections are detected. Ventricular size and morphology are within normal limits.

Output: 1.Scattered T2 hyperintense foci likely reflect chronic microvascular ischemia.2.Within the limitations of a noncontrast examination, no definite evidence of intracranial metastatic disease is seen.


Instruction: Generate impression based on findings.

Input: Patient with vertigo possible cerebral infarction. 82 years old male. Foci of encephalomalacia are present in the left parietal lobe along the left superior parietal lobule and left pre-central gyrus in the left middle frontal gyrus. These correspond to recent foci of infarction identified on the recent MRI exam.A focal hypodensity is present along the left to caudate nucleus corresponding to a prior infarction. Another focus of hypodensity is present left external capsule appearedPeriventricular and subcortical white matter hypodensities are present of a moderate degree.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.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.Mild atherosclerotic calcifications are present along the distal internal carotid arteries.

Output: 1.No evidence for acute intracranial hemorrhage mass effect or edema.2.There is a moderate to marked degree of periventricular and subcortical white matter hypodensity is present which are likely vascular related in a patient this age.3.Foci of encephalomalacia in the left middle cerebral artery distribution correspond to recent foci of infarction identified on the October 2009 exam and the acute phase at that time.


Instruction: Generate impression based on findings.

Input: Uterine fibroids. Evaluation for uterine fibroid embolization. PELVIS:UTERUS, ADNEXA: Lobular enlargement of the uterus containing numerous fibroids. The uterus measures 22.9 x 11.8 cm in craniocaudal dimension.The endometrium/residual cavity is normal in thickness and signal intensity. It is moderately distorted numerous fibroids which are mostly intramural. There is a small fundal subserosal fibroid. The fibroids demonstrate predominantly very low T2-weighted signal intensity with some fibroids demonstrating intermediate signal intensity. The largest is in the lower uterine segment measuring 8.8 x 7.3 cm. Most of the fibroids demonstrate moderate to avid postcontrast enhancement.Near the fundus some of the fibroids do not demonstrate significant enhancement.Small nabothian cysts are noted. The right and left ovaries are normal in size and morphology.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Enlarged myelomatous uterus with numerous moderate to avidly enhancing intramural fibroids.


Instruction: Generate impression based on findings.

Input: 45 years, Female, ovarian cancer with brain metastasis, status post resection and SRS. Again seen are postsurgical changes of right occipital craniotomy for tumor resection. No residual or recurrent enhancing tumor is identified. There is minimal FLAIR hyperintensity and volume loss involving the right occipital cortex compatible with encephalomalacia. There is increased enhancement at the craniotomy site favored to represent granulation tissue. There is decrease in postoperative dural enhancement within this region. No new parenchymal or meningeal enhancing lesion is appreciated in the brain. No suspicious calvarial lesions.No evidence of recent ischemia or hemorrhage. No intracranial mass effect, midline shift, or herniation. Vascular flow-voids are preserved. No hydrocephalus. No extra-axial collections. Diffuse right maxillary sinus opacification/sinusitis again seen.

Output: Postoperative changes of resection of right occipital metastasis. No residual or recurrent tumor in the surgical bed is appreciated. No new lesions to suggest metastatic disease elsewhere in the brain are appreciated.


Instruction: Generate impression based on findings.

Input: 69 years Male (DOB:6/14/1946)Reason: eval tumor resection History: seizuresPROVIDER/ATTENDING NAME: BAKHTIAR YAMINI BAKHTIAR YAMINI The patient has undergone parietal craniotomies and cranioplasty for removal of a meningioma which involve the superior sagittal sinus. There are associated postoperative changes with intracranial air and subcutaneous air and soft tissue swelling. There is an extra-axial collection present at the craniotomy site measuring up to 13 mm in thickness. This collection is associated with some mild displacement of the adjacent brain. There is redemonstration of white matter T2 and FLAIR corresponding to T2 and FLAIR hyperintensities on the prior MR located within the left frontal and parietal lobes as well as the right parietal lobe, left external capsule, left posterior limb of internal capsule and the small portion of the posterior medial aspect of the right frontal lobe white matter. There is associated midline shift with shift of the septum pellucidum approximately 5 mm to the right of midline.There is contrast enhancement along the surface of the brain at the surgical resection site. No convincing evidence for residual tumor.There is a focus of diffusion restriction present centered in the right caudate nucleus measuring 16 x 18 mm axial dimensions. This associated with FLAIR signal hyperintensity. There are multiple punctate foci of diffusion restriction scattered throughout both hemispheres of the brain and along the left occipital lobe and to a lesser degree right occipital lobe. These are associated with FLAIR signal hyperintensity.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. The anterior aspect of the superior sagittal sinus is identified but not the posterior aspect of the superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate only minor opacities. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Status post craniotomy and cranioplasty for removal of a meningioma. There is no convincing evidence for residual meningioma is appreciated. There are associated postoperative changes with intracranial air and subcutaneous air and soft tissue swelling.2.There is an extra-axial collection with mild mass effect at the craniotomy site. The white matter edema associated with a meningioma identified on the prior exam persists.3.Subacute infarction involving the right caudate nucleus4.Multiple microinfarcts scattered in both hemispheres of the brain.


Instruction: Generate impression based on findings.

Input: Reason: ? Worsening of listening upon standing History: back and bilateral leg pain Please note that exam could not be performed with patient standing due to inability to stand. Service notified at the time of the exam.Again seen is grade 1 anterolisthesis of L3 and L4. Exaggerated lordosis appears similar to the prior MRI. Moderate degenerative disc disease at L3-L4 with vacuum phenomenon and mild degenerative disc disease at L4-L5 is present. Vertebral body heights are intact. Small anterior osteophytes and severe facet arthropathy of the lower lumbar levels is present. There are large calcified fibroids in the pelvis.

Output: Degenerative changes of the lumbar spine with anterolisthesis appearing similar to the prior MRI. Please note that patient was unable to perform exam while standing as requested by service.


Instruction: Generate impression based on findings.

Input: Reason: eval for peroneal tendon tear, cuboid fracture History: lateral foot pain following inversion injury to ankle TENDONS: The flexor and extensor tendons appear intact. There is interstitial tearing of the peroneus longus tendon immediately proximal to the cuboid bone. Fibers of the peroneus longus tendon can be traced to the level of its insertion. The peroneus brevis tendon appears intact. The Achilles tendon appears intact.LIGAMENTS: The distal tibiofibular syndesmotic complex appears. The lateral collateral ligament complex appears intact. The imaged components of the deltoid ligament appear intact.ARTICULAR SURFACES AND BONE: There is increased signal abnormality within the cuboid bone with associated linear decreased signal abnormality indicating a nondisplaced comminuted fracture with extension to the tarsometatarsal joint. The peroneal tendons appear intact. ADDITIONAL

Output: Nondisplaced comminuted fracture of the cuboid. There is interstitial tearing of the peroneus longus tendon. The peroneus brevis tendon appears intact.


Instruction: Generate impression based on findings.

Input: Reason: concern for meniscal tear, please evaluate History: see above MENISCI: There is a horizontal tear through the body and posterior horn of the medial meniscus. There is a small parameniscal cyst along the medial aspect of the body of the medial meniscus. The lateral meniscus is normal in appearance.ARTICULAR CARTILAGE AND BONE: There is thinning of the articular cartilage along the medial facet of the patella. There is no bone marrow edema. LIGAMENTS: There is mild increased signal within the MCL, consistent with a sprain. There is a full thickness tear of the ACL, with no fibers completing their attachment upon the femur. The PCL and LCL complex appear intact. EXTENSOR MECHANISM: The quadriceps and patellar tendons appear intact.ADDITIONAL

Output: 1. Complete ACL tear and findings consistent with MCL sprain.2. Horizontal tear through the body and posterior horn of the medial meniscus.


Instruction: Generate impression based on findings.

Input: Patient has undergone craniotomy with debulking of the mass is in the right cerebellopontine angle cistern. There is residual enhancement in the right proximal internal auditory canal. No significant hemorrhage identified.Multiple additional enhancing masses are identified and appear similar to the prior examination:*Mass in the left cerebellomedullary angle cistern, likely a cranial nerve schwannoma.*Mass in the left geniculate ganglion, likely a facial nerve schwannoma.*Bilateral Meckel's cave and involving the bilateral foramen ovale, likely V3 schwannomas*masslike enhancement in the left cavernous sinus, likely cranial nerve schwannoma*mass along the left tentorium, possibly a meningioma or schwannoma*multiple masses along the carotid sheath extending into the neck and partially imaged, likely cranial nerve schwannomas*broad-based mass on the planum sphenoidale, likely a meningioma*mass in the left lateral rectus muscle, possible an abducens schwannoma*peripherally enhancing mass at the cervicomedullary junction, corresponding to a treated ependymoma.Additional postoperative findings are noted including craniotomy with postsurgical change from meningioma resection in the left frontal lobe and the interhemispheric fissure. There is stable increase in the CSF space along the left lateral cerebellar hemisphere. There is abnormal enhancement and thickening in the right suboccipital and the left parietal scalp. The ventricles and sulci are normal in size. There is no evidence for postoperative hemorrhage. No diffusion-weighted abnormalities are identified. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear.Images of the right internal auditory canal demonstrate residual tumor occupying the entire proximal canal. Postsurgical changes are noted in the proximal left internal auditory canal.

Output: 1.Post operative findings from debulking of right cerebellopontine angle masses with residual enhancing tumor in the internal auditory canal.2.Redemonstration of multiple extra-axial masses at the left cerebellomedullary angle cistern, left geniculate ganglion, bilateral Meckel's caves, bilateral foramen ovale, left cavernous sinus, along the left tentorium, and the planum sphenoidale.3.Multiple masses seen in the neck and partially imaged along the carotid sheath.4.Stable appearance of enhancing tumor at the cervicomedullary junction.5.Postoperative findings of left frontal and interhemispheric fissure meningioma resection without evidence of recurrence.


Instruction: Generate impression based on findings.

Input: Clinical question: Hoarseness, visual changes and with history of breast cancer. Rule out intracranial disease/metastases. Signs and symptoms: Visual changes and hoarseness. Pre and post enhanced brain MRI:No acute intracranial process and negative diffusion weighted series.Examination demonstrates to tiny foci of FLAIR/T2 hyperintensity in the subcortical white matter of right frontal lobe without hemorrhagic changes or abnormal enhancement. Findings are nonspecific and of no clinical significance.The anatomical morphology and signal intensity of brain parenchyma is otherwise within normal on all MRI sequences. The cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination is unremarkable.Post enhanced images demonstrate no detectable abnormal enhancement of brain parenchyma or the leptomeninges to suggest metastatic disease.A tiny right frontal developmental venous anomaly is however detected at the level of right frontal horn of lateral ventricle of no clinical significance.Calvarium and soft tissues of the scalp as well as images through the orbits and including axial fat sat post enhanced series are unremarkable.All paranasal sinuses and bilateral mastoid air cells and middle ear cavities demonstrate normal pneumatization signal patterns.

Output: Unremarkable pre and post enhanced brain MRI.


Instruction: Generate impression based on findings.

Input: Female 16 years old Reason: MRCP to check bile ducts for abnormalities in view of persistently elevated GGT in patient 15 years post transplant. and no evidence of rejection or autoimmune hepatitis on most recent liver biopsy. History: Elevated GGT. ABDOMEN:LIVER, BILIARY TRACT: Changes related to orthotopic liver transplant. The signal and morphology of the liver is within normal limits. No intrahepatic biliary ductal dilatation is present. No gallbladder is seen. SPLEEN: No significant abnormality noted.PANCREAS: The pancreatic duct is not visualized.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Innumerable subcentimeter cysts are present in both kidneys. Mild prominence of the left renal collecting system. A single varix arises off the left renal vein and extends inferiorly out of the field of view.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.No evidence of intrahepatic biliary ductal dilatation.2.Surgical changes related to orthotopic liver transplant.


Instruction: Generate impression based on findings.

Input: 42 year-old female with a strong family history of breast cancer, including breast cancer in her mother, maternal grandmother, and maternal and paternal great grandmothers. There is heterogeneous amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.No suspicious enhancement is seen in either breast. Numerous areas of focal parenchymal enhancement are unchanged. No abnormal axillary lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: 79-year-old male with weakness, inflammatory myopathy, recurrent symptoms. Suboptimal examination secondary to patient motion artifact and inability to optimally position the patient.Right femur:There is diffuse and extensive fatty atrophy of the musculature of the right thigh, particularly affecting the vastus musculature. There is diffuse increased signal abnormality within the musculature of the thigh particularly affecting the vastus lateralis and abductor musculature. There are foci of fluid signal intensity along the anterolateral aspect of the vastus lateralis musculature which is nonspecific and may represent confluent edema. Nonspecific subcutaneous edema most pronounced along the lateral and posteromedial aspect of the thigh. No bone marrow signal abnormality is identified. There is a large knee joint effusion which is incompletely imaged.Left femur:There is diffuse and extensive fatty atrophy of the musculature of the left thigh particularly affecting the quadriceps and hamstring musculature. There is diffuse increased signal abnormality within the musculature of the thigh particularly affecting the vastus and abductor musculature. There are foci of fluid signal intensity along the lateral aspect of the vastus lateralis musculature which is nonspecific and may represent confluent edema. Nonspecific subcutaneous edema most pronounced along the posterior and medial aspect of the left thigh. No bone marrow signal abnormality is identified. There is a large knee joint effusion which is incompletely imaged.

Output: 1. Nonspecific inflammatory changes of the imaged musculature of the thighs, right greater than left, as well as diffuse musculature fatty atrophy and subcutaneous edema, as described above.2. Bilateral knee joint effusions, left greater than right.


Instruction: Generate impression based on findings.

Input: Evaluate for meniscus tear, unable to bear weight or flex knee without pain. Injury on 9/1/15. MENISCI: The medial and lateral menisci appear intact.ARTICULAR CARTILAGE AND BONE: No articular cartilage or bony defects noted.LIGAMENTS: Anterior cruciate ligament and posterior cruciate ligament are intact. No other significant abnormalities noted. EXTENSOR MECHANISM: Extensor mechanism is intact.ADDITIONAL

Output: Normal MRI of the left knee with no evidence of meniscal tear.


Instruction: Generate impression based on findings.

Input: Per EPIC, recent diagnosis of acute mixed lineage (T/myeloid) leukemia c/b hyperleukocytosis s/p leukophoresis at OSH, DIC (resolved) who received debulking dexamethasone/vincristine and now receiving induction chemo with CALGB, presents with lethargy and altered mental status concerning for CNS involvement or meningitis. There is redemonstration of ependymal enhancement along the right frontal horn, and right greater than left occipital horns of the bilateral ventricles with associated diffusion restriction, most likely representing ependymitis/ventriculitis with debris/pus in the right ventricle. There is increased T2/FLAIR signal hyperintensity associated with the right periventricular white matter. There is a peripheral nodular enhancing lesion in the left cerebellar hemisphere measuring 11 x 7 mm with associated central restricted diffusion and decreased surrounding T2/FLAIR signal hyperintensity, most likely representing an abscess. There is leptomeningeal enhancement involving the surface of the bilateral left greater than right cerebellar hemispheres. There are scattered punctate foci of susceptibility artifact, likely representing hemosiderin deposition from chronic microhemorrhages. Direct comparison to prior MRI is limited due to motion artifact, but they appear to be present.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 skull and extracranial soft tissues are unremarkable.

Output: 1. Peripheral nodular enhancing lesion within the left cerebellar hemisphere with central restricted diffusion, most favored to represent an abscess, with less prominent surrounding edema. Additional prominent enhancement of the bilateral ventricular walls containing debris/pus, most suggestive of ventriculitis, although some of this enhancement may be related to leukemic involvement. Leptomeningeal enhancement of the left greater than right cerebellum surfaces, which may be related to meningitis although again some of this may be related to leukemia. Sampling of the CSF may be considered for further evaluation. 2.Multiple chronic microhemorrhages, which are also present on prior motion degraded exam, are nonspecific but given history can be seen with DIC.


Instruction: Generate impression based on findings.

Input: History of liver mass on outside CT, possible hemangioma. Also history of rectal cancer 15 cm from anal verge, evaluate whether rectal mass above or below the peritoneal reflection. Per electronic medical record, also history of obstructive uropathy (as reported on 8/28/16 clinic note). ABDOMEN:LIVER, BILIARY TRACT: There is a T2 hyperintense lesion within hepatic segment 5 measuring 3.9 x 3.1 cm which demonstrates peripheral nodular enhancement and progressive centripetal and likely represents a benign hemangioma. There are several additional scattered subcentimeter T2 hyperintense lesions, some of which demonstrate trace peripheral enhancement (for example segment 7, series 27 image 270) which are nonspecific but suspicious for metastases.The hepatic vasculature appears patent. The gallbladder is nondilated. No biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral mild-moderate hydroureteronephrosis. Mild perinephric stranding. A few subcentimeter renal 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.PELVIS:PROSTATE/SEMINAL VESICLES: The prostate is mildly enlarged measuring 5.4 x 3.8 x 3.4 cm.BLADDER: Markedly distended. The bilateral ureterovesical junctions appear patent. No definite bladder wall masses are identified.LYMPH NODES: Lymph nodes in the perirectal space, within the mesorectal fascia: Several lymph nodes are present within the mesorectal fascia. The largest is on the left and measures 1.3 x 1.6 cm (series 14, image 11).Lymph nodes outside the mesorectal fascia: No abnormally enlarged lymph nodes identified.BOWEL, MESENTERY: Rectal Tumor:Size: 3.3 x 3.2 x 5.8 cm (image 20/series 14; image 30, series 15)Tumor appearance on T2-weighted images: Predominantly solid lesion with intermediate signal intensityTumor location: Approximately 12 cm from the lower edge of the tumor to the anal verge and centered at the junction of the peritoneal reflection with Denonvilliers fascia.Circumference of the rectum involved: 360 degrees. Relationship and proximity of the tumor to adjacent structures (prostate, seminal vesicles): The tumor appears to abut the posterior wall the bladder.MRI T-stage: T3c - Tumor invades >1cm into perirectal fat or extramuralTumor Distance to Mesorectal Fascia: The tumor on the right is within 1.4 cm the mesorectal fascia. On the left, an enlarged perirectal lymph node is within 1.0 cm the mesorectal fascia.BONES, SOFT TISSUES: Degenerative changes affect the hip joints. OTHER: No significant abnormality noted.

Output: 1.Rectal cancer with circumferential wall involvement and greater than 1 cm invasion into the perirectal fat which abuts the posterior bladder.2.Mild-moderate hydroureteronephrosis and markedly enlarged bladder suggesting bladder outlet obstruction. No definite bladder lesion are identified on this nondedicated exam. 3.Hepatic segment 5 lesion compatible with a benign hemangioma. 4.Several additional subcentimeter hepatic lesions which are nonspecific but suspicious for metastases.


Instruction: Generate impression based on findings.

Input: 84-year-old female with right buttock/ischium pain, history of breast cancer. There are numerous T1 hypointense, T2 hyperintense lesions demonstrating enhancement scattered throughout the proximal imaged left femur and right femoral neck. No joint effusion is present. There are additional lesions with similar imaging characteristics in bilateral ischium. There is a large right iliac wing lesion that is again noted, appearing similar to that seen on prior PET. Additional lesions are also noted within the sacrum and visualized lower lumbar vertebral bodies. The S2 vertebral body is near completely replaced by tumor. Many of the aforementioned lesions correspond with mildly sclerotic PET/CT. There is high T2, edema type signal within the right iliacus muscle.There is leftward curvature of the visualized lower lumbar spine. There is 13 mm of anterolisthesis of L5 on S1, grade 1/2 with uncovering of the intervertebral disc. There is severe neural foramen stenosis at L5-S1, right greater than left. A fat-containing umbilical hernia is present. A cystic lesion in the left hemipelvis is likely adnexal in origin and measures 1.4 x 1.1 cm.

Output: 1.Numerous enhancing lesions scattered throughout the osseous structures as described above consistent with diffuse metastases. 2.13 mm of anterolisthesis of L5 on S1, grade 1/2, with uncovering of the intervertebral disc. There is severe neural foramen stenosis at L5-S1, right greater than left. 3.Edema type signal within the right iliacus muscle may be reactive from reported radiation therapy.4.Cystic lesion in the left hemipelvis is likely adnexal in origin. Given its size greater than 1 cm, follow up in one year with ultrasound may be considered. A serous inclusion cyst is favored.


Instruction: Generate impression based on findings.

Input: The risks (including, but not limited to, those of bleeding, infection, allergic reaction, temporary nerve block, pain, and inability to access the joint) and benefits of the procedure were explained to the patient, and informed written consent was obtained. A pre-procedural “time-out” form was completed.Sedation was provided by the pediatric sedation service. The patient was placed supine on the fluoroscopy table. The right hip was localized fluoroscopically, and a spot radiograph was obtained. The course of the femoral artery was noted on the patient's skin using an ink marker. The skin was cleansed and covered with a sterile drape. The skin and subcutaneous tissues were anesthetized with 1% lidocaine using 25-gauge and 22-gauge needles.Under fluoroscopic guidance, a 20-gauge spinal needle was advanced into the joint. Attempted aspiration yielded no fluid. Next, 15 ml of a 50/50 mixture of Omnipaque 240 (to confirm the intra-articular position of the needle) and dilute Multihance (0.1 cc in a 10 cc vial of saline, for subsequent MR imaging) were injected into the joint. Contrast opacified the joint in the expected manner. A spot radiograph was obtained for documentation. Next, 1 ml of Kenalog was injected into the joint. The needle was withdrawn. Blood loss was negligible (<1cc), and patient tolerated the procedure well without immediate complication. An adhesive bandage was placed on the patient’s skin. The patient was escorted to the MRI suite for further imaging in stable condition by the pediatric sedation service. Please refer to the subsequent MRI report for further information.Exposure time: 0:30

Output: Technically successful right hip injection under fluoroscopic guidance without complication.


Instruction: Generate impression based on findings.

Input: 64-year-old male with follicular lymphoma. A status post fall this a.m. landed on left side of face. Swelling over left mandible. Pain with opening jaw. Evaluate for hematoma CT of brain without infusion.CT examination of brain is negative in particular no evidence of an acute post traumatic finding is detected.No evidence of hemorrhage, edema, mass effect, hydrocephalus or midline shift is detected.CT of maxillofacial.No evidence of fracture is detected in particular no evidence of fracture of mandible is detected. The fascial planes of the soft tissues of the maxillofacial region are preserved.Images at the level of C2 demonstrates extensive loculated area of lucency in a well demarcated fashion involving the left aspect of the body of C2 and extending posteriorly to the posterior elements. There is no evidence of destruction of the bone or cortical break. This finding is believed to represent a hemangioma. Likelihood of metastatic disease is considered less likely however cannot be entirely ruled out. This area would be best evaluated with an MRI examination if clinically desired.

Output: 1.Unremarkable CT of brain and in particular with evidence of post traumatic findings.2.No evidence of fracture in the CT of maxillofacial.3.Findings likely representing hemangioma involving C2 all were to exclude less likely possibility of metastatic disease an MRI would be helpful.


Instruction: Generate impression based on findings.

Input: 9 years Female (DOB:11/22/2006)Reason: Please evaluate for brainstem malformation or aneurysm History: Episodic vertigoPROVIDER/ATTENDING NAME: MICHAEL H KOHRMAN CHARLES J MARCUCCILLI MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mild mucosal thickening. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The nasopharyngeal and oropharyngeal tonsils are symmetric and large as can often be seen at this age. MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. The posterior communicating arteries are medium-sized. The right vertebral artery slightly larger left vertebral artery. The right anterior inferior cerebellar artery and the left posterior inferior cerebellar artery are dominant.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries.

Output: 1.There is no evidence for cerebral infarction or mass.2.No evidence for intracranial cerebrovascular occlusive disease.3.No evidence for extracranial cerebrovascular occlusive disease.4.Large tonsils in a child are best evaluated on a clinical basis.


Instruction: Generate impression based on findings.

Input: Follow up ultrasound performed based on MRI findings of enlarging right axillary lymph nodes. A targeted right ultrasound was performed for the axilla. In the deep right axilla, a 1.1 cm hypoechoic area compatible with a deep lymph node is present. There is internal vascularity within this finding. Additionally, several nonsuspicious lymph nodes are also noted more superficially, correlating with the MRI.

Output: Suspicious right axillary lymph node for which ultrasound-guided biopsy is recommended. Biopsy was performed today after this diagnostic examination.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration.


Instruction: Generate impression based on findings.

Input: A 74 year old female with personal history of coronary artery disease (VF arrest in 1998 with PCI to prox LAD), left ventricular systolic dysfunction (LVEF 43% by last echo from 2013), mild mitral regurgitation and indolent multiple myeloma. Left VentricleThe left ventricle is normal in size with mildly reduced systolic function. The overall LV ejection fraction is 46%, the LV end diastolic volume index is 86 ml/m2 (normal range: 65+/-11), the LVEDV is 147 ml (normal range 109+/-23), the LV end systolic volume index is 46 ml/m2 (normal range 18+/-5), the LVESV is 79 ml (normal range 31+/-10). There is an extensive apical aneurysm with a thin myocardium. There is late gadolinium enhancement in all the segments of the apex affecting the entire wall (transmural). This finding represents fibrosis and has a pattern of old myocardial infarction and non-viability. There is a mural thrombus in the apex with a maximal thickness of 4.5mm.No myocardial iron overload was noted.Left AtriumThe left atrium is normal in size. The LA volume is 86 ml.Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 58%, the RV end diastolic volume index is 65 ml/m2 (normal range 69+/-14), the RVEDV is 111 ml (normal range 110+/-24), the RV end systolic volume index is 27 ml/m2 (normal range 22+/-8), and the RVESV is 46 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve is trileaflet, opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is at least mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a "pseudo bovine" pattern (normal variant). The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with mildly reduced systolic function, the LVEF is 46%. There is an extensive apical aneurysm with a thin myocardium. 2. There is late gadolinium enhancement in all the segments of the apex affecting the entire wall (transmural). This finding represents fibrosis and has a pattern of old myocardial infarction and non-viability. 3. There is a mural thrombus in the apex with a maximal thickness of 4.5mm.4. The right ventricle is normal in size and systolic function, the RVEF is 58%. 5. There is at least mild mitral regurgitation. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Abnormal cerebellum and myelomeningocele on antenatal ultrasound. Patient is 22 weeks 4 days gestational age. Please note that imaging is tailored for assessment of the fetal brain and lower spine. The fetal abdomen is not specifically addressed on this study.Dedicated evaluation of the fetal brain demonstrates a small posterior fossa with a small and inferiorly displaced cerebellum which appears to partially enwrap the brainstem (best seen on image #12 of series #9). The appearance is similar to the ultrasound "banana" sign. The fourth ventricle in not clearly visualized which may indicate some compression, and there is a lack of CSF in the posterior fossa. The lateral ventricles are not dilated. However, the occipital horns of the lateral ventricles are angled inferiorly and medially, towards the posterior fossa, and it appears that the occipital poles are inferiorly positioned and possibly encroaching on the posterior fossa. The frontal region of the skull is narrowed due to bilateral frontal bone concavity, similar to the ultrasound "lemon" sign.The corpus callosum is too small to definitively assess at this point. A cavum septum pellucidum is present suggesting that the corpus callosum is present anteriorly. The posterior corpus callosum may be dysgenetic or agenetic. The gyral pattern is within range for reported gestational age. There is no parenchymal signal alteration or intracranial hemorrhage.Dedicated evaluation of the fetal spine demonstrates a dorsal vertebral defect involving the lower lumbar and upper sacral segments (starting at the L3 or L4 level and continuing into the sacrum, measuring 15 mm craniocaudally and 3 mm in transverse). There is suggestion of a neural placode extending across this lumbosacral defect with no clear soft tissue covering, compatible with an open myelomeningocele.

Output: 1. The constellation of small posterior fossa with inferior displacement/tethering of its contents, as well as the lumbosacral myelomeningocele, are compatible with Chiari II malformation.2. Abnormal morphology especially involving the posterior part of the lateral ventricles is probably related to medial and inferior displacement by the tethered posterior fossa structures. A partially dysgenetic or partially agenetic corpus callosum could also be contributing to this appearance. 3. Due to technical limitations, some of the more subtle features of Chiari II may not be detected on this exam. However, the ventricles are not dilated, and the brain otherwise shows a relatively normal volume and normal gyration.


Instruction: Generate impression based on findings.

Input: Male, 40 years old, with ataxia. Scattered small foci of FLAIR hyperintensity have become more numerous when compared to the prior examination. No diffusion restriction is seen. No edema or mass effect is detected. There are no findings to suggest intracranial hemorrhage or any abnormal extra-axial fluid collection. The ventricles are normal in size. Questionable mild volume loss and FLAIR hyperintensity of the hippocampi is unchanged. On postcontrast imaging, no pathologic parenchymal or extra-axial enhancement is observed.

Output: 1.No evidence of acute ischemia or any other definite acute intracranial abnormality.2.Scattered small foci of FLAIR hyperintensity have increased in number when compared to the prior examination but these remain nonspecific.3.There may be a mild degree of volume loss and signal abnormality affecting the hippocampi but this is unchanged.


Instruction: Generate impression based on findings.

Input: Clinical question: 49-year-old with cervical neck pain. Signs and symptoms: Tenderness in the spine especially with extension. Nonenhanced cervical MRI:There is normal anatomical alignment of vertebral column.There is unremarkable signal intensity of vertebral column.There is normal caliber and signal intensity of cervical and upper most visualized thoracic cord.Foramen magnum is unremarkable.C2-C3 is unremarkable.C3-C4 is unremarkable.C4-C5 demonstrate mild degenerative disc disease with mild loss of disc height. There is bilateral uncovertebral hypertrophy with resultant moderate right neural foraminal compromise and mild on the left. Mild central spinal stenosis is also suspected.C5-C6 demonstrate mild to moderate degenerative disc disease and mild loss of disc height without significant degenerative or hypertrophic changes of posterior elements. There is shallow broad-based bulging disc which is a slightly more prominent on the right compared to left. Osteophytes from uncovertebral hypertrophic changes are also present at this level and more prominent on the right. Constellation of changes at this level results in effacement of ventral subarachnoid space, subtle flattening and posterior displacement of the cord and mild central spinal stenosis. Moderate left neural foraminal compromise and mild right.C6-C7 demonstrate mild degenerative changes without central spinal stenosis. Mild left neural foraminal compromise is suspected.C7-T1 through T3-T4 levels are unremarkable.

Output: 1.Degenerative changes at C5-C6 and to a lesser degree at C4-C5 results in mild central spinal stenosis and neural foraminal compromise as detailed above.2.Unremarkable images at other levels. Please review detailed report above.3.The caliber and signal intensity of the visualized cervical/upper thoracic cord remains within normal.


Instruction: Generate impression based on findings.

Input: Male, 58 years old, with history of nasopharyngeal carcinoma and oral cavity squamous cell carcinoma status post CRT. Posttreatment findings are redemonstrated in the neck. Diffuse mucosal edema and hyperenhancement of the tonsils, pharynx and supraglottic larynx persists, similar to prior. No pathologic adenopathy is detected on either side of the neck. The previously referenced left level II lymph node cannot be accurately identified on the present study. The salivary glands and thyroid are unremarkable. Bone marrow signal characteristics are within normal limits. Mucosal thickening has progressed in the left maxillary sinus and minimally on the right.

Output: Redemonstration of posttreatment findings with no evidence to suggest recurrent mucosal tumor or pathologic adenopathy.


Instruction: Generate impression based on findings.

Input: 33-year-old male with nocturnal diarrhea. Evaluate for small bowel inflammation. ABDOMEN:LIVER, BILIARY TRACT: There are multiple liver lesions that are T1 hypointense (axial series 14 images 18, 19, 30, 31, 38, 45), T2 hyperintense, and demonstrate restricted diffusion, located relatively peripherally. A thin rim of enhancement with central hypoechoic enhancement are noted on the early/arterial phase imaging on the dynamic series (coronal series 19 images 300, 307, 312). These findings are concerning for multifocal hepatic abscess formation.SPLEEN: Mild splenomegaly measuring 14 cm in craniocaudal length. The timing of the IV contrast injection for the enterography exam poorly evaluated the splenic vein and main portal vein.PANCREAS: In the expected region of the pancreatic neck/proximal body, there is a 5.1 x 3.2 cm centrally T1 hypointense masslesion suggested with suspected peripheral enhancement expanding the lesser sac and causing mass effect on the distal gastric body and antrum (axial series 20 image 51). Normal contours of the pancreas are not clearly seen. This raises the question for a pancreatic phlegmon. There is poor visualization of the distal pancreatic body and tail.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No abnormal wall thickening or significant contrast enhancement. Trace free fluid in the dependent pelvis. Mild apparent thickening of the terminal ileum (coronal series 11 image 25) is likely related to underdistention, as appearance resolves on later imaging sequences. There is no significant upstream dilatation and no abnormal wall enhancement at this level. The stomach is distended with oral contrast, and there is suboptimal distention of the small bowel loops (especially proximally), and a partial gastric outlet obstruction cannot be excluded.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.BOWEL, MESENTERY: As above.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Unremarkable appearance of small and large bowel, please refer to details above.2.Multiple peripherally based rounded hepatic lesions with imaging findings suspicious for multifocal hepatic abscess formation. Correlation with patient's clinical history and laboratory values recommended.3.Findings concerning for necrotizing pancreatitis, centered at level of pancreatic neck/proximal body, with superimposed infection and phlegmon. This finding causes mass effect on the stomach with upstream gastric dilatation noted, appearance concerning for underlying partial gastric outlet obstruction. Correlation with symptomatology and laboratory data is needed. A CT abdomen with pancreas protocol may provide a more detailed assessment, with CT being less prone to image degradation secondary to artifacts including motion artifact.Findings were discussed with Dr. Leslie Yang of gastroenterology on 9/7/2016 at 17:14.