Instruction: Generate impression based on findings.

Input: 64-year-old male patient with history of prostate cancer status post radical prostatectomy presents with rising PSA. PELVIS:PROSTATE:Prostate Size: Status post radical prostatectomy.Peripheral Zone: Surgically absentCentral Gland: Surgically absentSeminal Vesicles: Surgically absentExtracapsular Extension: Not applicable.BLADDER: There is subtle irregularity at the vesicoureteral anastomosis that is more prominent anteriorly. There is no definitive enhancement seen.LYMPH NODES: There is a right external iliac lymph node that measures 10 x 8 mm (series 701 image 141).BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Subtle irregularity at the vesicoureteral anastomosis without definitive enhancement.2.Right pelvic lymph node measures 10 x 8 mm.


Instruction: Generate impression based on findings.

Input: 64-year-old woman with pain, edema, difficulty walking. Tenderness to palpation over the Achilles. TENDONS: There is intermediate T1 and T2 signal intensity within a longitudinally oriented segment of fusiform swelling within the achilles tendon, consistent with Achilles tendinopathy without evidence of rupture. There is soft tissue edema within the Kager fat pad. The extensor tendons of the ankle are normal, as are the peroneus brevis and longus.LIGAMENTS: The lateral collateral ligament complex is intact. ARTICULAR SURFACES AND BONE: Bone marrow signal intensity is normal. No abnormalities of the articular surfaces of the ankle. ADDITIONAL

Output: Achilles tendinopathy, without rupture.


Instruction: Generate impression based on findings.

Input: 19 years Male (DOB:2/18/1997)Reason: 3T Scanner, CCM Protocol qsm/permeability if possible, no contrast per patient's request History: know CCM please evaluate lesions for changesPROVIDER/ATTENDING NAME: ISSAM A. AWAD ISSAM A. AWAD There is redemonstration of a hemorrhagic focus centered in the right medial temporal lobe and extending into the inferior aspect of the insular cortex and abutting the temporal horn right lateral ventricle. It has a heterogeneous appearance centrally on T2 imaging and dark ring around it and measures approximately 10 mm in diameter. Compared to the prior exam from 7/28/2014 it is similar in size.There are additional hemorrhagic foci with low signal rings compatible with the cerebral cavernous malformations. One is located in the right parietal lobe currently measuring 13 x 19 mm sagittal dimensions and previously measuring similar dimensions. Another is located in the right parietal lobe also not significantly changed and measuring approximately 9 mm. Yet another one is located adjacent to the left lateral ventricle at the junction of the trigone with the body of the left lateral ventricle measuring 9 mm and also is unchanged.Patient is status post left temporal lobe surgery. A portion of the left temporal lobe has been removed. The appearance of the surgical site remains stable. There is a small heterogeneous focus present along the medial left temporal lobe adjacent to the anterior tip of the temporal horn measuring approximately 5 mm in size. It is not clear whether this represents postsurgical effect or residual cavernoma without the preoperative exam.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Multiple lesions in the brain parenchyma are compatible with cerebral cavernous malformations and appear relatively stable.2.Status post left temporal lobe surgery. Differentiation of the postoperative change and residual cavernoma is not entirely clear on this exam. It is unchanged since the prior exams. Comparison to the preoperative exam may be helpful.


Instruction: Generate impression based on findings.

Input: History of Crohn's disease. Abdominal pain vomiting and bloating. Evaluate for active inflammation and stricture. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The small bowel is adequately distended with oral contrast.The small bowel fold pattern is preserved.There is predominantly fibrostenotic disease with mild superimposed active inflammation involving the distal terminal ileum as follows:Mild circumferential wall thickening, postcontrast enhancement and restricted diffusion of 2.5 cm of a persistently moderately narrowed terminal ileum (series 5/18). There is associated proximal/upstream dilated skip segment up to 2.7 cm in caliber involving approximately 8 cm of terminal ileum. Immediately proximal to this skip segment is a long segment of mildly circumferentially thickened, enhancing and restricting small bowel extending 15 to 20 cm proximally which demonstrates moderate fixed luminal narrowing. There is very mild fibrofatty proliferation and mesenteric inflammatory changes surrounding these involved bowel loops.Note is made of a short-segment of circumferential wall thickening of the mid-rectum which appears persistently narrowed without proximal dilatation. This may represent peristalsis, however mild active inflammation is a consideration. No evidence of sinus tract/fistula formation. No significant free fluid or loculated fluid collection to suggest an abscess.BONES, SOFT TISSUES: Left lower lobe multilobular/tubular lesion was better characterized on prior CT and may represent sequestration although superimposed infection and/or bronchial impaction cannot be excluded. Left peri-aortic cystic lesion measuring 3.6 x 2.5 cm has a benign morphology. OTHER: No significant abnormality noted.

Output: Multi-focal fibrostenotic disease involving approximately 30 cm of the distal ileum with mild superimposed inflammation. Persistent mid rectal luminal narrowing and wall thickening may represent peristalsis although mild active inflammation is a consideration.


Instruction: Generate impression based on findings.

Input: Reason: rule out recurrence or metastasis History: hx of urothelial carcinoma, status post left nephrectomy. Evaluation of the solid organs and vasculature is somewhat limited by lack of intravenous contrast.ABDOMEN:LUNG BASES: Subsegmental basilar opacities, likely scarring or atelectasis. Trace right and small amount of left pleural fluid.LIVER, BILIARY TRACT: No focal hepatic lesions within the limits of a noncontrast examination. Cholelithiasis. No biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: There is a cystic structure within the pancreatic uncinate process with most likely reflects a sidebranch IPMN with reference measurements below.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Status post left nephrectomy without evidence of recurrent mass in the surgical bed. Right kidney is mildly atrophic without gross masses within the limits of a noncontrast examination.RETROPERITONEUM, LYMPH NODES: Mildly prominent left periaortic lymph nodes with reference measurement below which are nonspecific but do not appear significantly changed in size compared to pre and postoperative CT examinations. Atherosclerotic disease of the abdominal aorta and its branches.BOWEL, MESENTERY: Left lower quadrant ostomy.BONES, SOFT TISSUES: Mild nonspecific body wall edema.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: Susceptibility artifact related surgical clips in the left hemipelvis. The bladder appears grossly unremarkable.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Left hip arthroplasty device creates artifact which obscures surrounding structures.OTHER: There is redemonstration of a fluid signal structure in left external iliac region slightly decreased in size compared to recent CT with reference measurements below and which most likely represents a lymphocele.INDEX LESION MEASUREMENTS (Current exam date/time: 9/19/2016 12:53:00)LEFT PARA-AORTIC LYMPH NODE: 1.5 x 0.9 cm (Image 24, Series 4); 1.6 x 0.9 cm on prior (3/14/2016) (Image 36, Series 201).LEFT INGUINAL CYSTIC LESION: 1.8 x 1.3 cm (Image 17, Series 11).CYSTIC PANCREATIC UNCINATE PROCESS LESION: 0.9 x 0.7 cm (Image 24, Series 14).

Output: 1.Examination of the solid organs limited by lack of intravenous contrast.2.Surgical changes of left nephrectomy without specific evidence of local recurrence.3.Nonspecific mildly prominent left periaortic lymph nodes are not significantly changed in size. Continued attention to these on subsequent follow-up examinations is recommended.4.Decrease in size of left external iliac lymphocele.5.Incidental note of a probable pancreatic side branch IPMN which can be followed on subsequent examinations.6.Cholelithiasis.


Instruction: Generate impression based on findings.

Input: There are unchanged postoperative findings related to right frontal and paraclinoid meningioma resection. There is high T2 signal along the right frontal lobe surgical approach with foci of susceptibility effect. There is ill-defined curvilinear and dural enhancement without nodular enhancement to suggest recurrent tumor. The cavernous sinuses are intact. There is no evidence of acute cerebral infarction. The ventricles and sulci are unchanged.

Output: Postoperative findings without convincing evidence of tumor recurrence.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: History of breast cancer with brain metastases treated via WBRT, now with altered mental status and seizures. There are several, approximately 10, supratentorial or infratentorial solid or ring enhancing lesions that are predominantly located at grey-white matter interfaces. The largest supratentorial lesion is located in the left thalamus and measures up to 9 mm. The largest infratentorial lesion is located in the superior vermis and measures up to 6 mm. Some of the lesions demonstrate surrounding vasogenic edema, particularly in the posterior fossa. A few of the lesions also demonstrate punctate susceptibility effect, which may represent blood products. There is diffuse bilateral patchy cerebral white matter T2 hyperintensity, which is likely treatment-related. There is no evidence of intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is a subcentimeter T1 and T2 hyperintense lesion in the left parietal skull, which likely represents a hemangioma.

Output: Multiple subcentimeter supratentorial and infratentorial lesions are compatible with metastases.


Instruction: Generate impression based on findings.

Input: 36 year old male with a history of normal exercise SPECT and newly diagnosed left ventricular dysfunction referred for further evaluation with cardiac MRI Left VentricleThe left ventricle is mildly dilated with mildly reduced systolic function. The overall LV ejection fraction is 43%, the LV end diastolic volume index is 116 ml/m2 (normal range: 74+/-15), the LVEDV is 255 ml (normal range 142+/-34), the LV end systolic volume index is 66 ml/m2 (normal range 25+/-9), the LVESV is 147 ml (normal range 47+/-19), the LV mass index is 36 g/m2 (normal range 85+/-15), and the LV mass is 80 g (normal range 164+/-34). There is global hypokinesis with regional variation. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. There is no evidence of myocardial iron overload. The pre-contrast native myocardial T1 relaxation times are 1000-1050 ms (normal). Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal sized with mildly reduced systolic function. The overall RV ejection fraction is 42%, the RV end diastolic volume index is 90 ml/m2 (normal range 82+/-16), the RVEDV is 199 ml (normal range 142+/-31), the RV end systolic volume index is 53 ml/m2 (normal range 31+/-9), and the RVESV is 116 ml (normal range 54+/-17). Right AtriumThe right atrium is mildly dilated. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac 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 mildly dilated with mildly reduced systolic function (LVEF 43%). No evidence of late gadolinium enhancement to suggest presence of underlying fibrosing, infiltrative, or inflammatory process2. The right ventricle is normal sized with mildly reduced systolic function (RVEF 46%). 3. Mild biatrial enlargement. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Reason: pituitary adenoma, sp resection 6 month follow up , eval for changes History: 6 month follow up. Postoperative changes related to transsphenoidal surgery. An enhancing pituitary mass encasing the right cavernous carotid artery without vessel narrowing is unchanged. There is again extension into the suprasellar cistern. The size is stable from the prior exam measuring 2.4 x 2.2 x 3.0 cm, previously 2.4 x 2.1 x 3.2 cm, but again slightly increased since the exam of 7/17/2014. Associated mass effect on the atrophic chiasm and optic nerves is unchanged. The infundibulum remains deviated to the left, similar to the prior exam.There is no evidence of intracranial hemorrhage or acute infarct. Scattered punctate periventricular and subcortical T2 hyperintensities are unchanged. 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 skull and extracranial soft tissues are unchanged, including postoperative findings of the right parotid.

Output: 1.Recurrent pituitary adenoma is stable in size from the prior exam but slightly progressed since 7/17/2014.2.Scattered T2 hyperintensities likely reflect chronic small vessel ischemic disease and are unchanged.


Instruction: Generate impression based on findings.

Input: Walking trouble, right leg weakness, spastic legs and significant sensation loss. Examination is motion degraded. Vertebral body heights in the cervical spine are normal. Alignment is grossly maintained. There is congenital narrowing of the cervical spinal canal with superimposed degenerative changes similar to prior study from 2/6/2015.The cervical cord demonstrates volume loss and T2 hyperintensity at the C4-C5 level consistent with myelomalacia and similar to prior. No new cord signal abnormality.There is ligamentum flavum thickening at the C1-C2 level with effacement of the dorsal thecal sac and mild spinal canal stenosis at this level. Degenerative changes are seen in the cervical spine at additional levels as described below:C2-3: Mild spinal canal stenosis which is predominantly on a congenital basis. No significant neural foraminal stenosis.C3-4: Mild spinal canal stenosis related to central osteophyte. Mild to moderate right neural foraminal stenosis related to uncovertebral hypertrophy. No significant left neural foraminal narrowing.C4-5: There is a disc osteophyte complex, prominent ligamentum flavum thickening, and uncovertebral hypertrophy. There is severe spinal canal stenosis at this level with flattening of the cord. There is T2 hyperintensity in the cord which is also again seen. No significant change allowing for differences related to motion degradation when compared to prior MRI from 2/6/2015. There is moderate to severe right and moderate left neural foraminal stenosis. Prominent right-sided facet arthropathy.C5-6: Small disc osteophyte complex and uncovertebral hypertrophy as well as ligamentum flavum thickening. There is mild to moderate spinal canal stenosis. There is mild to moderate left and mild right neural foraminal stenosis.C6-7: No significant compromise to the spinal canal or neural foramina. Small disc osteophyte complex and uncovertebral hypertrophy. There is mild spinal canal narrowing which is predominantly on a congenital basis. There is mild left and minimal right neural foraminal stenosis.C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: Multilevel degenerative changes in the cervical spine which are not significantly changed since 2/6/2015. There is severe spinal canal stenosis at the C4-C5 level with T2 hyperintensity within the cord and volume loss likely representing myelomalacia. Additional levels as detailed above.


Instruction: Generate impression based on findings.

Input: 39-year-old female with left hamstring pain. There is abnormal fluid signal intensity seen within the left proximal semimembranosus tendon near its insertion at the ischial tuberosity, most compatible with partial tear. No retraction or buckling of the tendon is seen. Small amount of abnormal fluid signal is also seen involving the conjoined tendon of semimembranosus and biceps femoris at the ischial tuberosity. Lastly, a small amount of edema signal is seen within the ischial tuberosity itself near the insertion of the aforementioned tendons. Otherwise, there is normal signal intensity seen within the soft tissues and bones elsewhere in the left thigh.

Output: Findings most compatible with mild avulsion injury and partial tearing of the semimembranosus and conjoined tendon at the ischial tuberosity. The tendons appear intact with no retraction or buckling seen.


Instruction: Generate impression based on findings.

Input: MVA in 8/14. He has worsening pain located mostly lateral to the spine scapular region. Has noted occasional tingling in hands bilaterally. Cervical Spine: The vertebral column alignment is within normal limits. There is slightly deceased T2 signal in the C5-6 disc and minimal disc bulging. Nevertheless, the vertebral body and disc space heights are preserved and there is no significant spinal canal or neural foramen stenosis. The vertebral bone marrow signal is unremarkable. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.Thoracic Spine: 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 spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: Slightly desiccation and disc bulging at C5-6, but no evidence of bone marrow edema or ligamentous injury and no evidence of significant spinal canal stenosis.


Instruction: Generate impression based on findings.

Input: 56 years Female (DOB:1/29/1960)Reason: 56F with AIDS and cryptococcal meningitis, p/w lethargy, found to have lab e/o adrenal insufficiency and metabolic acidosis, ?pituitary pathology History: 56F with AIDS and cryptococcal meningitis, p/w lethargy, found to have lab e/o adrenal insufficiency and metabolic acidosis, ?pituitary pathologyPROVIDER/ATTENDING NAME: SCOTT V STERN SCOTT V STERN MRI pituitary:The pituitary gland is appropriate in overall height and morphology. The infundibulum of the pituitary gland is midline. No suprasellar or intrasellar mass is identified. The cavernous sinuses are intact bilaterally.There is T1 and T2 signal hyperintensity centered in the right basal ganglia.

Output: 1.There is no pituitary mass or other abnormality that is appreciated.2.A lesion is present in the right basal ganglia. It is not clearly defined on this exam. Given the suspicion for cryptococcal meningitis, this may be related to cryptococcal meningitis. An MRI of the brain with gadolinium may help confirm define this better if clinically indicated.


Instruction: Generate impression based on findings.

Input: Diagnosis: Multiple sclerosisClinical question: please do Dr Javed MS protocol and compare to priorSigns and Symptoms: progression MS MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. There are a couple subcortical white matter lesions present without associated contrast enhancement which are high signal on FLAIR and low signal on T1 at the left inferior frontal gyrus and the left superior frontal gyrus. These are stable.There are a couple subcortical white matter lesions present without associated contrast enhancement which are high signal on FLAIR and intermediate signal on T1 at the right inferior frontal gyrus (stable) and the right middle temporal gyrus (new).No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal enhancing lesions are identified in the cervical spine.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina. There is disk dessication and a disk bulge at this level associated with end plate osteophytes. This is stable since the prior exam.At C6-7 there is no significant compromise to the spinal canal or neural foramina. There is disk dessication and a disk bulge at this level. There are end plate reactive changes present. These findings are stable since the prior exam.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.Some subcortical white matter lesions are stable since the prior exam and are non-specific on MRI.2.There are minor degenerative changes in the cervical spine. There are no stigmata of demyelination identified in the cervical spinal cord.


Instruction: Generate impression based on findings.

Input: Clinical question: History of brain metastases with RT, please evaluate stability. Signs and symptoms: Brain metastases. Pre-and post enhanced brain MRI: Examination demonstrate very significant interval increased size of multiple previously known metastatic lesions and with significant interval increased peritumoral vasogenic edema and associated mass effect.A left high convexity paramedian enhancing/necrotic metastatic lesion abutting the falx measures at 18 x 15 x 18 transaxial dimensions compared to prior study measurement of approximately 8.5 x 10.5 x 10 -mm. Significant interval increased surrounding edema.A tiny study patient bone in the intrahemispheric aspect of right anterior frontal lobe measures approximately 4 mm in size compared to prior study measurement of approximately 2.5 mm.A necrotic rim enhancing metastatic lesion in the left thalamus measures at 6 x 7-mm compared to prior study measurement of 5 x 5 mm.a superficially located large necrotic enhancing tumor in the left posterior temporal lobe measures at 20.7 x 24 x 20-mm compared to prior study measurement of 14 x 12 x 12-mm. This lesion also demonstrates fairly significant interval increased surrounding vasogenic edema.An enhancing and centrally necrotic metastatic lesion in the pons is again identified and measuring at 5 x 10-mm without surrounding edema or significant change since prior study.Any right inferior cerebellar paramedian metastatic tumor measuring 7 times 6-mm and without interval change since prior study or any significant surrounding edema/mass effect.There is no evidence of any new metastatic lesions.Increased mass effect from a large left posterior temporal metastatic lesion results in only trace deviation of midline to the right which is new since prior exam.Flair hyperintensity of right hemispheric white matter likely representing post treatment/radiation. The white matter of left hemisphere is widely hyperintense secondary to increased peritumoral edema.Calvarium and orbits are unremarkable and without evidence of metastatic lesions.Paranasal sinuses and mastoid air cells are unremarkable.

Output: 1.Significant interval increase in size and surrounding vasogenic edema of several of the metastatic brain lesions since prior study.2.View of the smaller metastatic lesions demonstrate no significant change.3.Increased peritumoral edema in particular on the left results in trace deviation of midline to the right which is new since prior exam.


Instruction: Generate impression based on findings.

Input: 72 year old female with history of hypertension, now presents with blurred vision and headache. A large area of hyperattenuation is noted in the right occipital and parietal lobes, extending into the right lateral ventricle, basal cisterns and subdural space along the right tentorium. This finding is consistent with an acute intraparenchymal and subdural hemorrhage. The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Acute right occipital/parietal intraparenchymal, intraventricular, and subdural hemorrhage. This finding was discussed with Dr. Nasrallah at 45657.


Instruction: Generate impression based on findings.

Input: 37-year-old female with suspicious enhancing focus within the left central breast on recent MRI study. Family history is positive for breast cancer in mother diagnosed in her late 30s. Patient presents for MRI directed ultrasound evaluation and biopsy. A targeted left ultrasound was performed for the patient’s area of concern within the left central breast. There is no solid or cystic mass identified.Please disregard the two images with annotated measurements in the retroareolar breast. FInding on these two images do not correlate to previously identified left central breast focus on previous MRI breast study of 7/11/2016.

Output: No sonographic evidence for malignancy. No sonographic correlate for suspicious finding on recent MRI breast study of 7/11/2016. Planned ultrasound-guided biopsy was therefore canceled. Findings discussed with the patient, MRI guided biopsy planned on 7/26/2016.BIRADS: 2 - Benign finding.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Ehler Danlos syndrome, rib dislocation, and back pain. There is a small disc herniation at L5-S1 with a punctate annular fissure and loss of disc height, but no spinal canal or neural foraminal stenosis. The vertebral column alignment is within normal limits. The vertebral body 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. Small disc herniation at L5-S1, without spinal canal or neural foraminal stenosis.2. No evidence of scoliosis or vertebral subluxation.


Instruction: Generate impression based on findings.

Input: Mild cognitive impairment, daily marijuana use. There is moderate degree of global parenchymal volume loss with relatively greater involvement of the frontal and parietal lobes. No disproportional volume loss involving the hippocampi seen. No intracranial mass or mass-effect. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No hydrocephalus. Mega cisterna magna incidentally noted. Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild chronic small vessel ischemic changes. No large vascular distribution infarcts. Brain parenchyma is otherwise unremarkable for age. Major flow-voids are preserved.Mild mucosal thickening in the paranasal sinuses with small mucous retention cysts in the left maxillary and left frontal sinuses. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: 1. No intracranial mass or mass effect.2. Moderate global parenchymal volume loss appears appropriate for patient's age. 3. Mild chronic small vessel ischemic changes.


Instruction: Generate impression based on findings.

Input: Male, 69 years old, with right-sided sciatica. Spinal alignment is grossly anatomic. Vertebral body heights are preserved. Fairly substantial endplate edema is seen at L4-5, particularly on the right, with smaller areas of endplate edema noted at L1-2 and L2-3.The visualized distal spinal cord and conus are within normal limits. No significant epidural abnormalities are suspected, though there is a mild generalized prominence of the dorsal epidural fat in the lumbar region.L1-2: Mild loss of disc height and disc bulging. No significant spinal canal or foraminal stenosis. L2-3: Mild disc bulging. Mild spinal canal narrowing with slight crowding of the cauda equina. No significant foraminal narrowing. L3-4: Facet hypertrophy and ligamentum flavum thickening. Disc bulging. Moderate to severe spinal canal narrowing with crowding of the cauda equina and near complete effacement of CSF. Mild bilateral foraminal narrowing.L4-5: Marked facet arthropathy with a large facet effusion on the right. Ligamentum flavum thickening. Disc bulging. Moderate to severe spinal canal narrowing with crowding of the cauda equina and effacement of CSF. Severe right foraminal narrowing with probable nerve root impingement. Mild left foraminal narrowing. L5-S1: Marked facet arthropathy. Disc bulging asymmetric to the left. No significant spinal canal stenosis. Severe left and moderate right foraminal narrowing.

Output: Multilevel degenerative disease is seen, most notably affecting the L4-5 level where facet arthropathy and disc bulging result in a moderate to severe spinal canal stenosis and a severe right-sided foraminal narrowing with nerve root impingement. Fairly significant bilateral foraminal narrowing is also seen at L5-S1.


Instruction: Generate impression based on findings.

Input: 59-year-old male patient with prostate cancer, Gleason 6, and elevated PSA. PELVIS:PROSTATE:Prostate Size: 4.5 x 2.9 x 3.3 cm (transverse by AP by craniocaudal).Peripheral Zone: There is a focus of low T2 signal and ADC hypointensity within the left mid/left base of the peripheral zone measuring 3 x 2 mm (image 17, series 601). An additional focus of low T2 signal and ADC hypointensity is identified within the left mid gland of the peripheral zone measuring 3 x 4 mm (image 74, series 401). Central Gland: The central gland is hyperplastic with multiple BPH nodules.Seminal Vesicles: No definite involvement.Extracapsular Extension: No definite extraprostatic invasion.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.Two foci of signal abnormality within the left peripheral zone which are suspicious for tumor.2.No definite extraprostatic extension.


Instruction: Generate impression based on findings.

Input: Please evaluate for any signs of progressive disease since last MRI scan: Congenital microcephaly, severe intellectual disability, loss of some acquired language since about age 5, altered responsiveness after a fall 4 weeks ago. There is redemonstration microcephaly and marked bilateral colpocephaly with thinning of the brain parenchyma in the posterior cerebral hemispheres and a relatively simplified gyral pattern. The posterior portions of the corpus callosum appear to be deficient or markedly thinned as well. The brainstem and vermis of the cerebellum are mildly hypoplastic. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable. There is diffuse paranasal sinus mucosal thickening and secretions. There is a right frontal scalp contusion.

Output: 1. Redemonstration microcephaly and marked bilateral colpocephaly with thinning of the brain parenchyma in the posterior cerebral hemispheres and a relatively simplified gyral pattern, as well as mild hypoplasia of the vermis and brainstem. 2. Right frontal scalp contusion, but no evidence of acute intracranial hemorrhage.3. Findings suggestive of pansinusitis.


Instruction: Generate impression based on findings.

Input: Clinical question: evaluate tumor. Signs and symptoms: Ataxia Enhanced CT of brain:Examination demonstrate a low attenuation mass in the left cerebellum with significant mass-effect on the fourth ventricle however made no complete collapse of the ventricle. The mass appears to be partially within the fourth ventricle and left lateral recess of the fourth ventricle. There is only questionable subtle enhancement of this mass along its anterior aspect which projects into the left cerebellopontine angle.There is evidence of remodeling of the Petrus bone on the left at the level of its contact with the mass. This is best appreciated on axial image 6 on bony density. This appearance is suggestive of long-standing presence of mass at this location. For better characterization of this mass an MRI exam is recommended.Images through supratentorial space are essentially within normal limits. The ventricular system remain within normal size. There is no abnormal enhancement.

Output: Left inferior cerebellar partially enhancing tumor measuring approximately 36 x 40 mm in transaxial dimensions. Severe mass effect on the fourth ventricle without resultant hydrocephalus. There is mass causes bony remodeling of the petrous bone on the left. Findings were discussed with the referring clinical physician Dr. Sophia Shakur at the time of review of study.


Instruction: Generate impression based on findings.

Input: 33-year-old female with worst headache of her life x 3 days There is no evidence of intracranial hemorrhage, mass or edema. A small focus of mildly increased attenuation in the posterior cranial fossa with possible slight effacement of the right posterior border of the fourth ventricle is seen on a single slice in multiple planes. The remainder of the ventricular system is normal. This is a nonspecific finding and may be artifactual. Recommend MRI if clinically indicated. Slight focal irregularity and waviness of the right lateral ventricle lateral border is nonspecific and may be artifactual or represent isolated remote ischemic event. The remainder of the periventricular white matter is normal. There is a well-demarcated expansile lesion in right supraorbital ridge measuring 2 x 1 x 1.7 cm with no cortical erosion and preservation of the adjacent soft tissue planes. This appearance favors a benign process such as a hemangioma or ossifying fibroma. Left maxillary sinus mucus rentention cyst measuring 1.5 x 1.5 cm is incompletely visualized. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1) No intracranial hemorrhage. 2) Foci of increased attenuation adjacent to the 4th ventricle may represent artifact. Recommend MRI if there is clinical suspicion for mass. 3) Right supraorbital expansile bone lesion, likely benign, such as a hemangioma or ossifying fibroma.


Instruction: Generate impression based on findings.

Input: 56 year old female patient with left temporal interictals. Evaluate for a seizure focus. A few sequences are degraded by motion artifact. There is no evidence of intracranial hemorrhage, mass, or acute infarct. A few scattered foci of white matter T2 signal abnormality are nonspecific and unchanged from the prior examination. There is a partially empty sella, which is unchanged. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. No identifiable seizure focus.2. A few scattered foci of white matter T2 signal are non-specific and unchanged.3. Unchanged partially empty sella.


Instruction: Generate impression based on findings.

Input: Clinical question: History of glioneural tumor. Signs and symptoms: Surveillance scan. Pre-and post enhanced brain MRI:Negative diffusion weighted images.Examination demonstrate extensive postoperative changes of a left anterior frontal partial lobectomy removal of tumor. There is resultant significant ex vacuo dilatation of left frontal and of lateral ventricle similar to prior exam. Minimal flair hyperintensity of left frontal lobe immediately superior to the adjacent surgical cavity remains identical to prior exam and consistent with gliosis.Region of flair hyperintensity containing a well demarcated ovoid focus of susceptibility along the interhemispheric right anterior frontal lobe is also again identified and without convincing evidence of interval change. Right there is a very thin rim enhancement surrounding this focus susceptibility. This finding is nonspecific however could represent small focus of postoperative changes, gliosis and chronic blood.Examination is otherwise unremarkable and demonstrate no convincing evidence of any new findings since prior study.

Output: 1.Stable examination since prior study and without convincing evidence of any new findings.2.Gliosis surrounding a well demarcated focus of susceptibility along the interhemispheric aspect of right anterior frontal lobe with a thin rim of surrounding enhancement demonstrate no convincing evidence of interval change since prior exam.3.Stable extensive postoperative changes of a larger left anterior frontal lobectomy with out abnormal enhancement since prior exam.


Instruction: Generate impression based on findings.

Input: Leukemia. Examination is limited to post contrast sequences which are also motion degraded. Patient did not wish to repeat these sequences. There is suggestion of enhancing ventral epidural tissue from the L4-L5 level to the S3 level.Diffuse marrow signal heterogeneity is noted which is compatible with known leukemia.

Output: Technically very limited study with only postcontrast sequences. Earlier precontrast sequences were also severely degraded. Patient did not wish to repeat the sequences. There is prominence of the ventral epidural soft tissue from the L4-L5 to the S3 levels which may be related to venous plexus although epidural tumor is not excluded. Would recommend repeating pre as well as post contrast lumbar spine sequences, perhaps with sedation.


Instruction: Generate impression based on findings.

Input: Anal pain. Rule anal abscess. PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Colonic diverticulosis.BONES, SOFT TISSUES: There is a 2.7 x 2.6 cm low-density collection adjacent to the anal verge which is suspicious for a small abscess (image 66; series 3). This is difficult to appreciate on this unenhanced study. I would recommend either an enhanced CT or MRI for further evaluation as clinically indicated to confirm this finding.OTHER: No significant abnormality noted

Output: Possible perianal abscess as described above.The ER was notified of this finding at the time of final dictation.


Instruction: Generate impression based on findings.

Input: Migraine No evidence of acute ischemic or hemorrhagic lesion on the scan.There is a small focal high signal intensity on the left precentral gyrus just subcortical white matter over hand motor coordination centimeter (series 1101, image 20/30). This lesion does not show any evidence of restricted diffusion, nor susceptibility artifacts on gradient echo images. Therefore, this likely represent nonspecific in nature.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, 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 paranasal sinuses and mastoid air cells are clear.

Output: Non specific single small high signal intensity on FLAIR image on the left precentral gyrus as described above.Otherwise unremarkable brain MRI.


Instruction: Generate impression based on findings.

Input: Gait disorder, history of radiation therapy for metastatic testicular cancer. Examination is limited by motion artifact, particularly the postcontrast images. The thoracic spine is in normal alignment. There is redemonstration of a mild chronic compression fracture of the L2 vertebral body, predominantly on the left, without significant change from the MRI on 7/20/2016. The thoracic vertebral body heights are otherwise well-maintained. There is an area of increased T1 and T2 signal in the T9 vertebral body most likely representing a hemangioma. No suspicious osseous lesions in the thoracic spine are appreciated. There is T1 shortening in the lumbar spine which is likely related to prior radiation.There are mild degenerative changes in the thoracic spine including a small central disc protrusion at the T7-T8 level and small right paracentral disc protrusion at the T10-T11 level. There is no significant spinal canal or neural foraminal stenosis at any level. There is no gross spinal cord signal abnormality within the limits of mild motion degraded T2 weighted sequences. Degenerative changes in the lumbar spine including disc protrusions in the upper lumbar spine are partially imaged. Please refer to recent MRI lumbar spine report from 7/20/2016 for further details.

Output: 1. Motion degraded exam without gross signal abnormality in the thoracic cord or evidence of significant spinal canal stenosis in the thoracic spine. 2. Postcontrast images are severely motion limited which limits evaluation for small metastases. There is however no gross marrow signal abnormality to suggest metastatic disease.3. Chronic mild compression fracture of the L2 vertebral body without significant change from MRI on 7/20/2016.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Reason: 37 yo F with R knee pain, eval for inflammation, tendon evaluation History: R knee pain. MENISCI: The medial and lateral menisci are intact.ARTICULAR CARTILAGE AND BONE: The articular cartilage is intact.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: Normal appearing knee.


Instruction: Generate impression based on findings.

Input: Female, 62 years old, low back pain and bilateral lower extremity radiculopathy. Degenerative grade 1 anterolisthesis of L4 on L5 is redemonstrated. Spinal alignment is otherwise within normal limits. Vertebral body heights are maintained. A few focal areas of high T1 and T2 signal are present in the bone marrow, stable since prior exam, compatible with intraosseous hemangiomas and/or focal fat. There are degenerative endplate marrow signal changes, most prominent at L3-4.The visualized distal spinal cord and conus medullaris demonstrate normal signal intensity and morphology. There is multilevel disc desiccation signal with loss of intervertebral disc height which is mild in the lower thoracic spine and L5-S1, moderate at L2-3 and L4-5, and marked at L3-4. Additional level specific degenerative findings are as follows:T11-12: Mild disc bulge with superimposed left foraminal disc protrusion. Bilateral facet arthropathy. No significant spinal canal stenosis. Mild right and severe left neural foraminal narrowing. Findings have progressed.T12-L1: No significant disc bulge. Moderate right and mild left facet arthropathy. No significant spinal canal or neural foraminal stenosis.L1-2: No disc bulge or herniation. Mild bilateral, right greater than left, facet arthropathy. No significant spinal canal or neural foraminal stenosis.L2-3: Moderate disc bulge and bilateral facet arthropathy. Prominent dorsal epidural fat. Moderate effacement of the thecal sac. Mild bilateral, left greater than right, neural foraminal narrowing. Degenerative changes have progressed at this level.L3-4: Moderate disc bulge and bilateral facet arthropathy. Mild effacement of the thecal sac. Mild to moderate bilateral, left greater than right, neural foraminal narrowing. Degenerative changes have progressed at this level.L4-5: Anterolisthesis with uncovering of the intervertebral disc and marked bilateral facet arthropathy. Mild spinal canal stenosis. Mild to moderate right and mild left neural foraminal narrowing. Degenerative changes have slightly progressed at this levelL5-S1: Mild disc bulge with a superimposed right foraminal disc protrusion. Marked bilateral facet arthropathy. No significant spinal canal stenosis. Moderate right neural foraminal narrowing. Degenerative changes have slightly progressed at this level. A Tarlov cyst is seen along the right S2 nerve root.

Output: Multilevel lower thoracic and mid to lower lumbar spondylosis, mildly progressed from the examination on 12/1/2005. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: There is no acute infarct, mass effect or midline shift. Previously seen punctate infarct in the right postcentral sulcus region has resolved. On the diffusion images, there are small foci of susceptibility effect in the bilateral thalami with punctate high diffusion signal artifact adjacent to the focus of susceptibility in the right thalamus (series 301 image 211 and 212). There is moderate confluent and patchy T2 hyperintensity, also affecting the central pons, nonspecific but likely representing chronic microvascular ischemic changes which are similar to prior exam. There are multiple unchanged small to punctate foci of susceptibility effect in the cerebellum, brainstem, and bilateral thalami as well as the basal ganglia on the left likely represent chronic microhemorrhages. The ventricles and basal cisterns are normal in size and configuration. The skull and extracranial soft tissues are unremarkable.

Output: Moderate chronic microvascular ischemic changes with no acute infarct, mass effect or midline shift.


Instruction: Generate impression based on findings.

Input: Female 75 years old; Reason: left shoulder pain, severe DJD ROTATOR CUFF: There is a focal high signal intensity vertically traversing the supraspinatus tendon at the 12 o'clock position situated approximately 3 cm proximal to the tendon insertion, suggestive of a full-thickness defect. There is little, if any, frank tendon retraction proximal to the site of this tear, although we suspect that there may be delamination of the undersurface fibers with retraction distally from the greater tuberosity. There is also undersurface insertional tearing more anteriorly, best seen on the sagittal oblique sequences. Additional increased signal within the supraspinatus tendon likely reflects tendinosis. There is associated cyst formation in the underlying humeral head. The supraspinatus muscle is mildly atrophic. Moderate tendinosis is noted of the infraspinatus, with undersurface fraying. Cyst formation along the myotendinous junction is indicative of interstitial tearing. Mild atrophy of the infraspinatus is noted. Mild atrophy of the teres minor is noted, but the teres minor tendon is intact. There is increased signal within and thickening of the distal subscapularis tendon, indicating moderate tendinosis. The subscapularis muscle appears normal.SUPRASPINATUS OUTLET: Moderate osteoarthritis affects the acromioclavicular joint. Trace fluid is seen within the subacromial/subdeltoid bursa. GLENOHUMERAL JOINT AND GLENOID LABRUM: Moderate osteoarthritis affects the glenohumeral joint, with subchondral cysts in the glenoid. Increased signal within the posterior labrum likely reflects tearing, with perhaps minimal posterior translation of the humeral head relative to the center of the glenoid. Blunting of the anterior labrum is likely degenerative. No glenohumeral joint effusion is present.BICEPS TENDON: The tendon of the long head of the biceps is intact.ADDITIONAL

Output: 1. Moderate osteoarthritis of the glenohumeral and acromioclavicular joints.2. Rotator cuff tendinosis and tears, as described above.3. Other findings as described above.


Instruction: Generate impression based on findings.

Input: There are perhaps a couple foci of susceptibility hypointensity along the femoral surface of the left lateral ventricle body. Otherwise, there are no MRI evidence of residua of the patient's documented grade 2 intraventricular hemorrhage. The ventricles are not dilated, although the corpus callosum appears uniformly thinned.There is prominence of the subarachnoid spaces along the anterior hemispheres as well as anterior falx.The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for acute intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. Myelination is appropriate for corrected gestational age. Flow voids are present within the major vessels indicating patency. The mastoid air cells are clear.

Output: 1.There are perhaps a couple foci of susceptibility hypointensity along the femoral surface of the left lateral ventricle body. Otherwise, there are no MRI evidence of residua of the patient's documented grade 2 intraventricular hemorrhage. The ventricles are not dilated, although the corpus callosum appears uniformly thinned.2.There is prominence of the subarachnoid spaces along the anterior hemispheres as well as anterior falx consistent with benign enlarged subarachnoid spaces (aka benign external hydrocephalus) which typically resolves by 2 years of age.


Instruction: Generate impression based on findings.

Input: Lung cancer, metastasis. C-spine:Post a C5 corpectomy status with instrumentation from C4 to C6.Previously noted prevertebral soft tissue thickening has been subsided since prior study. There is no evidence of spinal cord is abnormal signal intensity.Vertebral body signal intensity appear to be normal.There is no abnormal enhancement.The cranial-cervical junction is normal. There is normal cervical lordosis. The cervical spine alignment is anatomic. The epidural space, thecal sac, and spinal cord are preserved with no evidence of spinal canal/neural foraminal narrowing or myelopathy. The intervertebral discs demonstrate normal T2 intensity and height with no evidence of disc herniation. The paraspinal soft tissues are unremarkable.There is no evidence of abnormal enhancement, cord compression or mass. T-spine:T5 and T8 vertebral body show loss of normal bone marrow signal intensity with gadolinium enhancement indicating metastases lesions.Especially for T5 vertebral body shows enhancing soft tissue involvement of vertebral body on the right side as well as right side pedicle extended toward the right-sided neural foramen at this level. Th T8 vertebral body also has enhancing soft tissue confined to vertebral body . No associated soft tissue is seen.There is no evidence of spinal canal stenosis.There is no evidence of other abnormal enhancing lesion.The spinal cord signal intensity appears to be normal.

Output: 1. Metastatic lesions on T5 and T8 as described above.2. T5 lesion extends toward right T5 neural foramen.3. Spinal cord signal intensity appears to be normal.4. No change of C5 coplectomy with C4 to C6 external fixation with instrumentation.


Instruction: Generate impression based on findings.

Input: ORBITS: There is mild thickening and enhancement of the right optic nerve involving the intraorbital, intracanalicular and possibly the intracranial segments. The right optic nerve measures up to 7 mm in thickness while the left optic nerve measures up to 6 mm in thickness. There is no intraorbital or chiasmatic mass and no parasellar abnormality. The extraocular muscles are unremarkable.BRAIN: There is no evidence of intracranial hemorrhage, mass, or acute infarct.There are a few scattered patchy foci of T2 hyperintensity within the supratentorial white matter in a nonspecific pattern. 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 skull and scalp soft tissues are unremarkable. There is minimal paranasal sinus mucosal thickening.

Output: 1.Mild thickening and enhancement of the right optic nerve compatible with optic neuritis.2.Few scattered patchy foci of signal abnormality within the supratentorial white matter are nonspecific and may represent demyelinating lesions, chronic small vessel ischemic disease, among other etiologies.


Instruction: Generate impression based on findings.

Input: Compared to MRI from 7/14/2015 interval decompression of previously seen massively dilated right lateral ventricle is seen. Diffuse thinning of the cortical mantle is again seen. There is development of a large extra-axial collection collection along the right cerebral convexity with mass effect on the right cerebral hemisphere and leftward midline shift which is improved since prior. There is also a small subdural collection along the left cerebral convexity which is new. Small amount of intraventricular blood products are noted layering within the occipital horns. There is also pneumocephalus consistent with recent surgical manipulation. No evidence of acute infarct.Postcontrast images demonstrate abnormal enhancement involving the occipital horns suspicious for ventriculitis. There is also enhancement involving the dura particularly along the left cerebral hemisphere which may be reactive to the adjacent subdural collection or sequela of prior ventricular drainage. No findings to suggest cerebritis or intraparenchymal abscess. Evidence of prior injury with cystic changes involving the left cerebellar hemisphere again noted. The brainstem as well as the cerebellar peduncles are also small.

Output: 1. Abnormal enhancement involving the ventricular walls along the occipital horns. Findings are suspicious for ventriculitis. No findings to suggest intraparenchymal abscess or cerebritis.2. Compared to MRI from 7/14/2015 interval decrease in caliber of the previously seen massively dilated right lateral ventricle and development of a large extra-axial collection along the right cerebral convexity with resulting mass effect on the adjacent parenchyma. Leftward midline shift is overall slightly improved in the interval. There is also a small left sided subdural collection which is new since prior.3. Pneumocephalus, thin left-sided subdural collection, and dural enhancement may all represent postprocedural change related to prior ventricular decompression.5. Severe thinning of the cortical mantle and extensive left cerebellar encephalomalacia again seen.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: History of active perianal Crohn's disease. PELVIS:UTERUS, ADNEXA: 1.6 x 1.0 cm left hemorrhagic cyst. Otherwise unremarkable.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The visualized pelvic bowel is unremarkable. Small amount of pelvic fluid is within physiologic limits.BONES, SOFT TISSUES: Enhancing tract extending from the 12 to 1:00 position to a 1.4 x 1.1 cm rim-enhancing left perianal fluid collection.Additional enhancing tract extending from the 10:00 position anteriorly measuring approximately 3.5 cm in length extending into the perineal soft tissues (image 17 through 33 of series 103). No associated fluid collection.OTHER: No significant abnormality noted.

Output: 1.12 to 1:00 position perianal fistulous tract terminating in a 1.4 x 1.1 cm left perianal fluid collection/abscess.2.Right-sided 3.5 cm tract extending from the 10:00 position anteriorly to the perineal soft tissues.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 51-year-old with biopsy-proven right breast cancer. There is scattered fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally. There are multiple scattered enhancing foci breasts aside from the lesions described below.The index malignancy in the right upper outer breast is seen with hydromark biopsy clip along its anterior aspect. There is a contiguous tail of enhancing tissue projecting away from the main lesion, towards the pectoralis. Pectoralis muscle enhances normally however. The main portion of the index lesion measures 2.0 x 1.5 x 2.6 cm (AP x LM x CC). Inclusive of the contiguous tail of enhancing tissue the AP measurement is up to 3.5 cm. There is an additional mass in the right breast, near the 2:00 position. This measures 10 x 8 x 9 mm. The kinetic pattern is more suggestive of a benign lesion, however the mass appears somewhat irregular in morphology.Within the left breast, the most enhancing focus measures 5-6 mm, though kinetics are not suspicious. No enhancing masses or suspicious areas of nonmass enhancement elsewhere in the left breast. No abnormal lymph nodes are identified in either axillary region.

Output: 1. Index malignancy measures up to 3.5 cm AP inclusive of a contiguous enhancing tail extending posterior from the main portion of the lesion.2. Additional enhancing mass in the medial right breast measuring up to 1.0 cm and should be evaluated with MRI directed ultrasound.3. Left breast 6 mm enhancing area is low suspicion but will also be evaluated on ultrasound. If the left breast focus is negative on ultrasound, then a 12 month MRI follow up should be performed. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Clinical question: Stroke. Signs and symptoms: Left-sided weakness. Nonenhanced brain MRI:Diffusion weighted images demonstrate no evidence of an acute ischemic stroke.FLAIR and T2-weighted images demonstrate a tiny focus of hemorrhagic encephalomalacia involving the cortex and subcortical white matter of left posterior frontal at the site of previously noted focus of low attenuation on prior recent head CT and likely representing a chronic small hemorrhagic stroke.Mild periventricular FLAIR hyperintensity and subtle foci of FLAIR and T2 hyperintensity in left thalamus, right basal ganglia, right anterior temporal cortex and more noticeably in the left paramedian pons without susceptibility signal changes and suggestive of mild chronic small vessel ischemic strokes.Supratentorial ventricular system are slightly prominent for age similar to prior head CT and with maintained midline.The signal void of major intracranial arterial branches are identified.Unremarkable calvarium and soft tissues of the scalp.Unremarkable images through the orbits, paranasal sinuses and mastoid air cells.

Output: 1.No acute intracranial process.2.Findings suggestive of mild chronic nonhemorrhagic small vessel ischemic strokes as detailed.3.Small focus of hemorrhagic encephalomalacia in the left posterior frontal suggestive of a small chronic ischemic stroke.4.Mild prominence of supratentorial ventricular system with maintained midline and stable since prior studies.


Instruction: Generate impression based on findings.

Input: 74-year-old female with recently diagnosed right breast cancer submitted outside breast MRI for review. Outside ultrasound dated 12/8/2015 demonstrated a 5 mm mass in the right breast 3:00 position, which was proven to be IDC and DCIS. On postcontrast images, moderate parenchymal enhancement is seen bilaterally which may reduces the sensitivity of this examination in evaluation of subtle mass or nonmass enhancement.In the right breast, approximately 3:00 position, 6.1 cm from the nipple base, there is some susceptibility artifact from the biopsy marking clip is noted. There is peripheral enhancement surrounding this biopsy clip measuring 1.1 x 1 x 1.5 cm ( LR x AP X SI ), compatible with the known history of biopsy-proven invasive ductal carcinoma and DCIS.In the right breast, medial to the index mass, 3:00 position, 5.3 cm from the nipple base, there is a 5 mm enhancing mass, which is probably benign finding with morphology similar to the additional 2 foci of enhancement in the anterior right breast and central left breast.There is no suspicious enhancement in the left breast.No abnormal axillary lymph nodes are identified in either axillary region.

Output: 1. Unifocal 1.5 cm cancer in the right breast 3:00 position.2. A probably benign 5 mm enhancing focus medial to the index lesion (referred to as retroareolar mass at outside hospital) in the right breast 3:00 position with morphology similar to the additional enhancing foci in the anterior right breast and central left breast. Six-month follow-up of this 5 mm enhancing mass is recommended.BIRADS: 6 - Known cancer.RECOMMENDATION: 3B - Followup at Short Interval (1-11 Months).


Instruction: Generate impression based on findings.

Input: Male, 76 years old. Left wrist pain. Evaluate for TFCC tear. LIGAMENTS: The scapholunate and lunotriquetral ligaments appear grossly intact.TRIANGULAR FIBROCARTILAGE COMPLEX: There is a small central perforation of the TFCC with small amount of fluid and debris within the the distal radioulnar joint consistent with synovitis.TENDONS: There is increased signal within the extensor carpi ulnaris tendon indicating an intrasubstance tear and tenosynovitis. The remaining tendons are grossly intact.BONES: There is increased signal within the bone marrow on T2 sequences without corresponding abnormality on T1 sequences. This may represent either red marrow reconversion or bone resorption. No evidence of fracture. Mild osteoarthritis affects the carpometacarpal articulations.ADDITIONAL

Output: 1. Small central perforation of the TFCC with synovitis of the distal radioulnar joint.2. Diffuse increased signal within the bone marrow likely representing osteopenia/osteoporosis. No evidence of fracture.3. Intrasubstance tear and tenosynovitis of the extensor carpi ulnaris tendon. 4. Soft tissue swelling about the ulnar aspect of the hand.


Instruction: Generate impression based on findings.

Input: 54 year old male patient with stiffness and pain about left long finger. Evaluate for long finger flexor tendon injury. TENDONS: The flexor and extensor tendons of the third digit appear intact with normal signal and orientation.BONES: Bone marrow signal is within normal limits.ADDITIONAL

Output: Intact flexor and extensor tendons of the left long finger.


Instruction: Generate impression based on findings.

Input: Female, 53 years old, pain in the left upper extremity with neck stiffness. Assess for cervical disk disease. Spinal alignment is anatomic. Vertebral body heights and morphology are normal. Scattered degenerative endplate signal alteration is seen. No worrisome marrow replacement is detected.The visualized spinal cord demonstrates normal signal intensity and morphology.C2-3: Unremarkable. C3-4: Mild posterior disk osteophyte formation. Mild spinal canal narrowing. No significant foraminal narrowing. C4-5: Unremarkable. C5-6: Mild posterior disk osteophyte formation with mild spinal canal stenosis. Mild facet hypertrophy. Mild left foraminal narrowing. C6-7: Mild posterior disk osteophyte formation. Mild spinal canal stenosis. Mild facet hypertrophy. Mild left foraminal narrowing. C7-T1: Unremarkable.

Output: Relatively mild multilevel degenerative findings with mild spinal canal stenosis and mild foraminal narrowing as detailed above.No evidence of significant cord impingement seen. No acute abnormalities are detected.


Instruction: Generate impression based on findings.

Input: Female, 91 years old, with pain in the right iliac crest/sciatic region and pain in the right lower extremity. A mild sclerotic curvature of the lumbar spine is demonstrated. Vertebral bodies are otherwise well aligned with respect to each other.Marrow signal characteristics are heterogeneous, particularly at L4-5 where there is superimposed degenerative endplate signal abnormality. No areas concerning marrow replacement are detected.The visualized spinal cord, conus and nerve roots of the cauda equina are unremarkable except as discussed below.Disk degeneration is evident at every level with loss of disk height most severely affecting L4-5. Additional levels specific findings are as follows:L1-2: Facet hypertrophy and ligamentum flavum thickening. Bulging disk. No significant spinal canal stenosis. Moderate left and mild right foraminal narrowing. L2-3: Facet hypertrophy and ligamentum flavum thickening. Bulging disk. Mild spinal canal stenosis. Moderate left and mild right foraminal narrowing. L3-4: Marked facet hypertrophy and ligamentum flavum thickening. Bulging disk. Severe spinal canal stenosis with crowding of the cauda equina. Mild right foraminal narrowing. L4-5: Marked facet hypertrophy and ligamentum flavum thickening. Bulging disk. Severe spinal canal stenosis with crowding of the cauda equina. Severe left and moderate to severe right foraminal narrowing. L5-S1: Marked facet hypertrophy and ligamentum flavum thickening. Bulging disk. No significant spinal canal or foraminal stenosis. A large right renal cyst is demonstrated.

Output: Multilevel degenerative findings are seen involving the disk spaces and posterior elements. The L3-4 and L4-5 levels are most significantly affected with severe spinal canal stenosis and crowding/impingement of the cauda equina. Significant bilateral foraminal narrowing is also evident at L4-5.


Instruction: Generate impression based on findings.

Input: SCLCL, status post treatment with brain lesions, possibly paraneoplastic encephalopathy. There are multiple cerebral cortical foci of high T2 signal with corresponding hypermetabolism on PET, including within the right lateral orbitofrontal gyrus, bilateral inferior temporal gyri, and let occipital and parietal lobe, which have deceased in size since December 2015. There is no discernible corresponding abnormal enhancement, although the post-contrast images are degraded by motion. There are otherwise unchanged scattered areas of cerebral white matter T2 hyperintensity. The limbic system appears unremarkable. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration, with diffuse cerebral volume loss. 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. There are bilateral enlarged parotid and suprahyoid lymph nodes, left larger than right.

Output: 1. Multiple cerebral cortical foci of high T2 signal with corresponding hypermetabolism on PET have deceased in size since December 2015. These lesions may represent a form of paraneoplastic encephalopathy rather than metastases.2. Bilateral enlarged upper neck lymph nodes are compatible metastatic disease.


Instruction: Generate impression based on findings.

Input: Unspecified papilledema [H47.10], Reason for Study: ^Reason: disc swelling History: photosensitivity Brain MRIOn axial scan, bilateral orbital globe show subtle flattening of posterior globe, subtle buckling (tortuosity) of optic nerves (left more prominent than right) and slightly prominent CSF spaces of distal optic nerve sheath. The pituitary gland shows slightly flattened superior aspect of the gland considering the patient's age but there is no evidence of empty sellar. Constellations of these findings indicate possible diagnosis of intracranial hypertension. There is a well circumscribed extra axial lesion at the midline hypothalamus, tuber cinereum area. The lesion is measured about 4.2mm (RL) x 5.6mm (AP) x 2.9mm (CC). The lesion shows high signal intensity on T1, low signal intensity on T2, low signal intensity on Fat saturation T1 and without evidence of enhancement, thus indicating fat containing lesion. On gradient echo images, there are subtle signal loss especially on peripheral and anterior aspect of the lesion indicating possible mineralization. To confirm, head CT with thin section around the hypothalamus can be considered if clinically indicated. Differential diagnosis include hypothalamic lipoma/ osteolipoma or Rathke's clef cyst. Possibility of dermoid or epidermoid cannot be completely excluded but slim. Scattered FALIR/T2 high signal intensity lesions at bilateral frontal lobes and right insular cortex are seen which are non specific.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.Brain MRV3D MRV brain post-gadolinium with maximum intensity projections of the superficial/deep intracranial venous drainage demonstrate normal flow enhancement in the superior sagittal sinus, transverse sinuses, sigmoid sinuses, internal cerebral veins, vein of Galen and straight sinus.

Output: 1. Subtle flattening of posterior globe, slightly prominent CSF spaces around distal optic nerve sheath and subtle buckling of optic nerves especially left side indicate possible intracranial hypertension. 2. Hypothalamic fat containing lesion. Differential diagnosis include lipoma/osteolipoma and Rathke's cleft cyst.3. No evidence of acute ischemic or hemorrhagic lesion.4. Normal brain MRV.


Instruction: Generate impression based on findings.

Input: 71-year-old female ROTATOR CUFF: Increased signal within the distal supraspinatus and infraspinatus tendons, consistent with mild tendinosis. No full-thickness rotator cuff tear is evident. No significant muscle atrophy.SUPRASPINATUS OUTLET: Mild acromioclavicular joint osteoarthritis.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral alignment is within normal limits. There is moderate osteophyte formation and joint space narrowing with near full-thickness articular cartilage degeneration along the glenoid and mild thinning along the humeral head. There is degeneration and likely degenerative tearing of the labrum.BICEPS TENDON: The long head of the biceps tendon is normally situated in the bicipital groove, but thickened with surrounding fluid, which can be seen with tendinosis and tenosynovitis.ADDITIONAL

Output: 1. Mild rotator cuff tendinosis without evidence of tear2. Glenohumeral articular cartilage and labrum degeneration as described above.3. Thickening and fluid along the biceps tendon, which may reflect tendinosis.4. Small joint effusion with debris.


Instruction: Generate impression based on findings.

Input: 62-year-old female with a history of osteoarthritis presents with right knee pain. Please note the study is somewhat suboptimal due to patient's morbid obesity.MENISCI: The lateral meniscus is laterally extruded and the medial meniscus is medially extruded. There is abnormal intermediate signal in the posterior horn of the medial meniscus representing mucoid degeneration. There is also mucoid degeneration within the anterior horn of the lateral meniscus.ARTICULAR CARTILAGE AND BONE: There is marked loss of hyaline cartilage, particularly of the medial tibiofemoral compartment. No underlying abnormal bone marrow signal is identified.LIGAMENTS: The anterior cruciate ligament, posterior cruciate ligament, medial collateral ligament, and lateral collateral ligament complex are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: Severe osteoarthritis of the right knee with marked loss of cartilage.


Instruction: Generate impression based on findings.

Input: Ms. Streicher is a 67 year old female with a personal history of left breast lumpectomy in 2011 for carcinoma. Patient received radiation therapy. She has no current breast complaints. There is scattered fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.Stable post-lumpectomy changes are present in the left upper outer breast. There is no abnormal enhancement seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.

Output: Stable postsurgical changes of the left breast. No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Routine Diagnostic Mammogram.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Right breast IDC; New lytic lesion in the T12 vertebral body seen on CT scan for which bone biopsy recommended Serial CT images obtained during the biopsy procedure demonstrate the needle placement within the lytic T12 vertebral lesion. Post biopsy images demonstrate no complications.

Output: T12 vertebral bone biopsy under CT guidance. A total of two core samples were delivered to pathology for analysis. Touch preps were positive for neoplasm consistent with suspected breast cancer metastasis.


Instruction: Generate impression based on findings.

Input: Posterior fossa epidermoid resection. There are postoperative findings related to posterior fossa epidermoid cyst resection. There are residual punctate foci of somewhat restricted diffusion and high T2 signal along the left lateral aspect of the resection cavity, along the medial margin of the left cerebellar hemisphere and left inferior cerebellar peduncle. There is also a small area of high T2 signal in the posterior medulla. There are also several scattered foci of high T2 signal in the cerebral white matter bilaterally. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are unchanged.

Output: Postoperative findings related to posterior fossa epidermoid cyst resection with residual punctate foci of somewhat restricted diffusion and high T2 signal along the left lateral aspect of the resection cavity, along the medial margin of the left cerebellar hemisphere and left inferior cerebellar peduncle, which may represent post-treatment effects or perhaps a small amount of residual epidermoid components. A small area of high T2 signal in the posterior medulla may represent prior injury related to involvement by epidermoid and/or its resection.


Instruction: Generate impression based on findings.

Input: Progressive headache. MRI: 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 a retention cyst in the right maxillary sinus. There are punctate foci of enhancement in the skin of the cheeks bilaterally, which may represent acne.MRA: There is no evidence of significant steno-occlusive lesions or aneurysms.

Output: 1. No evidence of acute intracranial hemorrhage, mass, or acute infarct.2. No evidence of significant steno-occlusive lesions or aneurysms.


Instruction: Generate impression based on findings.

Input: High risk low grade oligodendroglioma on TMZ. There are postoperative findings related to left parietal craniotomy. There is unchanged confluent T2 hyperintensity surrounding the left parietal lobe resection cavity consistent. There is also scattered bilateral cerebral white matter T2 hyperintensity, which is nonspecific, but perhaps treatment-related. There is no evidence of abnormal enhancement. The ventricles are unchanged in size and configuration. There is no acute territorial infarct. There is no midline shift or herniation. The major cerebral flow voids are grossly intact. The skull and extracranial soft tissues are unchanged.

Output: Post-treatment findings without evidence of tumor progression.


Instruction: Generate impression based on findings.

Input: 18-year-old female with wrist pain. Evaluate for TFC injury versus ECU tendinitis. LIGAMENTS: Evaluation of the intrinsic ligaments of the wrist is limited due to lack of intra-articular contrast. We see no tear of the lunotriquetral or scapholunate ligaments. TRIANGULAR FIBROCARTILAGE COMPLEX: We see no fluid signal intensity within the articular disc of the triangular fibrocartilage. There is intermediate signal intensity within the ulnar fibers of the triangular fibrocartilage that may reflect mild degeneration, however, we see no discrete tear. The meniscal homolog of the triangular fibrocartilage demonstrates mild diffuse increased signal intensity of uncertain significance.TENDONS: The tendons are normal in appearance.BONES: No bone marrow signal abnormality is identified.

Output: Possible minimal degeneration of the fibers of the articular disc of the triangular fibrocartilage near the attachment to the ulnar styloid as well as mild increased signal intensity within the meniscal homolog of uncertain significance. We otherwise see no findings to account for the patient's pain.


Instruction: Generate impression based on findings.

Input: A 71 years old male with previous CABG and cardiopyopathy with severely reduced left ventricular ejection fraction, ICD recently extracted because of infection. Referred to MRI to evaluate etiology Left VentricleThe left ventricle is moderately dilated with severely reduced systolic function. The overall LV ejection fraction is 29%, the LV end diastolic volume index is 120 ml/m2 (normal range: 74+/-15), the LVEDV is 209 ml (normal range 142+/-34), the LV end systolic volume index is 84 ml/m2 (normal range 25+/-9), the LVESV is 147 ml (normal range 47+/-19), the LV mass index is 121 g/m2 (normal range 85+/-15), and the LV mass is 211 g (normal range 164+/-36). There is global hypokinesis with akinesia of the apical 1/2 of the anterior wall. There is late gadolinium enhancement that is near transmural at the apical 1/4 of the anterior wall which is likely nonviable. The anteroseptum is also akinetic and demonstrates intermediate signal abnormality suggestive of near transmural infarct. The apical septum demonstrates subendocardial high signal compatible with infarct, approximately 50% wall thickness, likely viable. There is a focal, transmural infarct involving the inferior wall from mid chamber to apex which is akinetic. The remainder of the inferior wall and lateral wall are severly hypokinetic.There is no intracardiac thrombus.Left AtriumThe left atrium is normal in size. There is leftward bowing of the interatrial septum that does that does not meet criteria for aneurysm. No associated flow jet in either atria is noted.Right VentricleThe right ventricle is small in size with normal systolic function. Because of the small size and limited slices available for postprocessing, the calculation of EF may be inaccurate. However, by visual estimation, the estimated qualitative EF is 60%.There is no evidence infarct.Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve leaflets demonstrate diffuse calcification and thickening. There is limited opening, indicative of a degree of stenosis; flow quantification was not performed above the annulus. There is aortic regurgitation, mild by quantification (15%).Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no pericardial effusion.Extracardiac FindingsSusectibility artifact from sternal wires are present. There is a left chest wall hematoma that contains two components of different signal, most likely due to various age of development. The largest component measures 4.4 x 10.1 cm. The more inferior component measures 4.5 x 6.7 cm (401/6). There is a saline bag resting on the skin of the left superior anterior chest wall, overlying these hematomas. Posterior to the hematomas, there is signal abnormality that is suggestive of a post operative pocket following ICD pulse generator excision.Incidentally, there are several foci of right-sided, nodular pleural thickening (301/ 25,27). The etiology is unclear, possibly postinflammatory or neural in origin. These can be better characterized with CT thorax.There is atherosclerosis of the descending thoracic aorta.

Output: 1. The left ventricle is moderately dilated with severely reduced systolic function, LVEF 29%. There is global hypokinesis with regional akinesis at areas of infarct. There is no MRI evidence of eosinophilic myocarditis.2. The right ventricle is small in size with normal systolic function. No right sided infarct.3. Trileaflet aortic valve with a degree of stenosis which was not quanitfied. Associated aortic regurgitation, mild by quantification (15%).4. Nodular right-sided pleural thickening which can be better characterized with CT thorax.


Instruction: Generate impression based on findings.

Input: Chronic low back pain with bilateral radiation. For the purpose of level numbering, there are 5 lumbar-type, nonrib-bearing vertebrae. The last well-formed disc is at L5-S1.Sagittal alignment is notable for straightening. The vertebral bodies are preserved in height. There is desiccation without significant height loss involving L3-L4, L4-L5 and L5-S1 discs. There is no suspicious marrow abnormality. There is mild right sided degenerative marrow signal subjacent to the L5-S1 endplate. Similar focal changes present along small interbody herniations along the inferior endplates of L3 and L4. Small, focal T1/T2-hyperintense lesions involving the inferior right posterolateral aspect of L1 vertebral body and the base of the right L3 transverse process most likely represent hemangiomas.The conus medullaris is unremarkable. The tip of the conus medullaris lies at mid L2 level.T10-T11 and T11-T12 are only covered on sagittal imaging and there is no significant spinal canal stenosis.T12-L1, L1-L2, and L2-L3: There is no disc herniation. There is no spinal canal or foraminal stenosis.L3-L4: There is mild disc bulge eccentric to the left. There is mild left worse than right facet arthropathy and ligamenta flava thickening. There is mild left foraminal stenosis. There is no spinal canal or right foraminal stenosis.L4-L5: Minimal disc bulge results in no significant spinal canal or foraminal stenosis. Mild bilateral facet arthropathy.L5-S1: Disc bulge with a small central protrusion is associated with mild-to-moderate right facet arthropathy. There is mild right neural foraminal narrowing.Asymmetric, infiltrative fat intensity within the left posterior paraspinal muscles at L2 level is probably an intramuscular lipoma.

Output: 1. Mild degenerative changes in the lumbar spine. There is no significant spinal canal stenosis at any level. There is mild left L3-L4 and right L5-S1 neural foraminal narrowing. No high-grade neural foraminal stenosis. 2. There is facet arthropathy from L3-L4 to L5-S1 levels, relatively worse at the right L5-S1 level.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 46 year old female with new onset dysphagia and dysphonia 4 months status post uneventful ACDF There has been interval ACDF at C5 and C6. There are no postprocedural fluid collections. There are no extraspinal enhancing masses nor is there abnormal intradural enhancement.There is slight reversal of the upper cervical curvature. The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology.A previously demonstrated T2 hyperintense presumed atypical hemangioma along the lateral C5 vertebral body is somewhat obscured secondary to hardware disc artifact, but is otherwise unchanged.Redemonstrated is a 10 mm lesion present within the T2 vertebral body eccentric towards the right side and associated with spiculations within it. This is also a presumed atypical hemangiomaAt C2-3 there is no significant compromise to the spinal canal or neural foramina, unchanged.At C3-4 there is bilateral uncinate hypertrophy, without stenosis, unchanged.At C4-5 there is no significant compromise to the spinal canal or neural foramina, unchanged.At C5-6, a previously demonstrated right lateral disc protrusion has been removed. As before, there is no significant compromise to the spinal canal. Right lateral recess and right neural foraminal stenosis has been relieved.At C6-7 there is no significant compromise to the spinal canal or neural foramina, unchanged.At C7-T1 there is no significant compromise to the spinal canal or neural foramina, unchanged.

Output: 1.There has been interval ACDF at C5 and C6. There are no postprocedural fluid collections. There are no extraspinal enhancing masses nor is there abnormal intradural enhancement.2.At C5-6, a previously demonstrated right lateral disc protrusion has been removed. As before, there is no significant compromise to the spinal canal. Right lateral recess and right neural foraminal stenosis has been relieved.


Instruction: Generate impression based on findings.

Input: 13-year-old female with cerebral cavernous malformation experiencing headache Redemonstrated is a 11 x 11 mm lobulated T2 hyperintense lesion with rim of susceptibility involving the inferior left cerebellar hemisphere abutting the inferior cerebellar vermis measuring 14 x 12 mm in axial plane (previously 11 x 11 mm). There are internal lesional signal changes including new T1 hyperintensity inferiorly as well as 2 foci with a distinctive heme-fluid layering appearance. There is also a tiny amount of new perilesional vasogenic edema. As before, this is associated with a prominent developmental venous anomaly.The remainder of the brain demonstrates no additional cavernous malformations, or other mass or mass effect. There is mild hypoplasia involving the inferior cerebellar vermis. Brain parenchyma is otherwise unremarkable for age. Bilateral hippocampi are unremarkable. No findings to suggest cortical dysplasia or heterotopic gray matter. No restricted diffusion to suggest acute ischemia. The ventricles are within normal limits in size and configuration. No abnormal parenchymal or meningeal enhancement. Sella and orbits are within normal limits. The paranasal sinuses and mastoid air cells are clear.

Output: Slightly enlarged left inferior cerebellar cavernous malformation with adjacent developmental venous anomaly. Internal signal changes as well as a tiny amount of perilesional edema suggest interval new hemorrhage.


Instruction: Generate impression based on findings.

Input: Please note that the exam is somewhat limited by motion artifact. There is no evidence of acute infarction or intracranial hemorrhage. There is a normal degree of myelination. The ventricles and sulci are within normal limits. There is no midline shift or mass effect. No extra-axial fluid collection is identified. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No evidence of acute infarction or intracranial hemorrhage.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain.Coronal images of the temporal lobes demonstrate the temporal horns, hippocampal formations and parahippocampal gyri to be normal in size and symmetric bilaterally without signal abnormalities, masses, or abnormal enhancement identified within the medial temporal lobes on either side. There is no evidence of mesial temporal sclerosis and there are no foci of heterotopic gray matter.

Output: Negative MRI of the brain including gadolinium enhancement. Specifically, there are no MRI findings to explain the patient's seizures.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Multiple sclerosis: paresthesias. There are scattered focal and confluent areas of T2 hyperintensity predominantly involving the periventricular white matter of the bilateral cerebral hemispheres. There also appears to be a T2 hyperintense lesion in the spinal cord at the C1-2 level. The lesions appear to be similar to prior scans. 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 a small right maxillary sinus retention cyst.

Output: Findings compatible with demyelinating lesions in the brain and in the upper spinal cord, which appear similar to prior scans, although comparison is limited by differences in the technical parameters of the scans.


Instruction: Generate impression based on findings.

Input: Female 40 years old with known Crohn's disease (ileum) - reevaluate disease and also history of hip pain. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is a long, 9 cm segment of terminal ileum that demonstrates wall thickening, submucosal fat deposition, apparent decreased distensibility and avid enhancement indicating acute on chronic inflammation (coronal image 18, series 7). Proximal to this is an approximately 3 cm segment of normal-appearing ileum is seen, consistent with a skip area. On initial imaging sequences, region proximal to this skip area was incompletely distended with possible enhancement, suspicious for additional short segment site of disease; however as the exam progressed the lumen expanded allowing for better evaluation and this segment appeared normal (image 382 of series 1700).There is mild tethering of distal ileal loops (image 22 series 7) in lower mid abdomen, may be due in part to nonobstructive adhesive disease. Separation of bowel loops (most pronounced in right lower quadrant) indicative of fibrofatty proliferation.PELVIS:BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Cystic changes are noted bilaterally in the breasts which would be better evaluated with mammography.

Output: 1.Long segment (measuring 9 cm) of acute on chronic inflammation of the terminal ileum.2.Mild tethering of distal ileal loops and evidence of fibrofatty proliferation.3.Cystic changes in both breasts would be better evaluated with mammography.


Instruction: Generate impression based on findings.

Input: 64-year-old man with history of cirrhosis and gallbladder polyp. ABDOMEN:LIVER, BILIARY TRACT: In segment 5 of the liver (6/22) there is a 14 mm T2 hyperintense lobulated lesion which progressively enhances in a nodular, discontinuous fashion. No additional focal hepatic lesions are identified. There is no intra or extrahepatic biliary ductal dilatation. The gallbladder is distended and appears normal.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Tarlov cysts noted.OTHER: There is a 17 mm nodule at the left lung base (11/26), incompletely evaluated.

Output: 1.Hemangioma in the liver.2.Incidental 17 mm nodule at the left lung base. Comparison with prior imaging or further evaluation with CT is warranted. Finding was text paged and messaged via EMR to Dr. Renz at 16:35 on 10/17/16.


Instruction: Generate impression based on findings.

Input: Displacement of lumbar intervertebral disc without myelopathy. History of discectomy. Now with low back pain and difficulty ambulating distance Five lumbar type vertebral bodies are presumed to be present. There is 25% loss of vertebral body height redemonstrated at L2 elated to superior endplate compression and mild anterior subluxation of L4 on L5 redemonstrated. Compared to the February exam there is no significant change in the appearance of either the compression fracture or the subluxation. There is multilevel disk desiccation present.The conus medullaris on sagittal imaging is grossly intact. No abnormal enhancing lesions are appreciated in the lumbar spine.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is a minor disk bulge at this level associated with mild ligamentum flavum and facet hypertrophy.At L4-5 there is diffuse disk bulge associated marked bilateral facet hypertrophy with associated effacement of the fat at the lateral recesses. Since the previous exam the patient has undergone left-sided hemilaminectomy at this level. The thecal sac is enlarged on the current exam relative to the prior. The cerebral spinal fluid surrounding the nerve roots is not effaced though the thecal sac is smaller than at other levels. There is associated narrowing of the neural foramina bilaterally and mild effacement of the fat surrounding the exiting nerve roots within the neural foramina. The exiting nerve roots within the neural foramina are surrounded by fat. There is enhancement of the soft tissues at the lateral recesses and surrounding the thecal sac at this level. There is associated mild anterior subluxation of L4 on L5.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is mild ligamentum flavum hypertrophy present at this level and a minor disk bulge.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 small cyst present in the right kidney measuring 6 mm in diameter.

Output: 1.Since the prior exam the patient has undergone surgery at L4-5. The spinal canal has enlarged. There is less ligamentum flavum hypertrophy at this level now and mild narrowing of the spinal canal which is a significant improvement since the prior exam. There is however some suspicion for scar formation at the lateral recesses at this level involving the nerve roots at the lateral recesses.2.There is a benign-appearing chronic compression fracture at L2.


Instruction: Generate impression based on findings.

Input: Preoperative planning for pituitary cyst via transphenoidal surgery: right side visual defect. There is a cerebrospinal fluid signal intensity lesion within a mildly expanded sella turcica with extension into the suprasellar cistern, which 24 mm measures in height, 16 mm in width, and 16 mm front-to-back. There is marked mass effect upon the optic chiasm and adjacent portions of the bilateral optic nerves, which are stretched, but display normal signal characteristics. The pituitary gland is markedly stretched and mainly displaced anteriorly and superiorly along with the infundibulum. There is minimal mass effect upon the bilateral cavernous sinuses. The internal carotid artery flow voids are intact.

Output: A sellar and suprasellar probable arachnoid cyst measures up to 24 mm and exerts marked mass effect upon the optic apparatus.