Instruction: Generate impression based on findings.

Input: There is no evidence of acute ischemic or hemorrhagic lesion on the scan.There is non enhancing cystic lesion (about 6mm x 7mm) at pineal gland indicating pineal cyst.Bilateral hippocampus appear to be normal in signal intensity, size and shape.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: No acute ischemic or hemorrhagic lesion.No abnormal enhancement.Pineal gland cyst (6mm x 7mm), otherwise unremarkable.


Instruction: Generate impression based on findings.

Input: Female 43 years old Reason: increasing pain in L shoulder and neck after car accident ROTATOR CUFF: Thickening of the distal fibers of the tendon of the supraspinatus as well as mildly increased T2 signal indicates tendinosis of the distal supraspinatus without discrete tearing. The remainder of the rotator cuff is intact. No fluid is present within the subdeltoid bursa.SUPRASPINATUS OUTLET: There is a type II acromion.GLENOHUMERAL JOINT AND GLENOID LABRUM: The humeral head is well-seated glenoid. The glenoid labrum is intact. T2 hyperintensity and T1 hypointensity within the proximal diaphysis of the humerus likely indicates a bone contusion (series 901, image 10; series 1201, image 9).BICEPS TENDON: Biceps tendon is intact and situated within the bicipital groove.ADDITIONAL

Output: Supraspinatus tendinosis and bone contusion in the proximal humeral diaphysis.


Instruction: Generate impression based on findings.

Input: Reason: f/u meniscal tear and bakers cyst History: pain MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: No significant abnormality noted.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Small amount of joint effusion. Otherwise exam within normal limits.


Instruction: Generate impression based on findings.

Input: This 53 old male status post liver transplant with a history of seizures and VZV meningitis as well as a history of intraventricular hemorrhage. Would like to rule out expansion/stroke. Again noted is trace blood in the bilateral lateral ventricles which was seen in the brain MRI dated 7/07/08.There is no evidence of new intracranial hemorrhage.There is asymmetric prominence of the lateral ventricles as well as mild prominence of the third ventricle. This may be due to mild/moderate volume loss. This prominence has increased slightly when compared with the CT scan dated 7/02/08.There are periventricular white matter changes indicative of small vessel disease. There is no evidence of intracranial mass or edema. The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. Trace blood is again seen in the lateral ventricles. There is no evidence of new intracranial hemorrhage.2. There is prominence of the lateral and third ventricles which is slightly increased when compared to the prior CT scan dated 7/2/08.3. There is evidence of small vessel disease.


Instruction: Generate impression based on findings.

Input: 75 years Female (DOB:9/28/1940)Reason: evaluate for ischemia History: vertigo + nystagmusPROVIDER/ATTENDING NAME: RIMAS V. LUKAS RIMAS V. LUKAS MRI of the brainNo diffusion weighted abnormalities are appreciated.A punctate focus of signal loss and susceptibility imaging is present in the left centrum semiovale. In isolation this is of unknown clinical significance. It most likely represents a microhemorrhage.The CSF spaces are appropriate for the patient's stated age with no midline shift. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.Incidental note is made of partial empty sella.Exam is mildly degraded by patient motion.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. The right A1 segment is hypoplastic. The dominant supply to both anterior cerebral arteries at the A2 segments appears to be from the left side. The posterior communicating are very small. The left vertebral artery is very small.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the right vertebral artery. The left vertebral artery is very small. There is a suspected stenosis at the origin of the left vertebral artery but the left vertebral artery is too small to characterize the stenosis on this exam.

Output: 1.No evidence for intracranial aneurysm.2.No evidence for any significant intracranial or extracranial cervicocerebral vascular occlusive disease. The left vertebral artery is very small and it is not clear if there is a significant stenosis present proximally at its origin3.There is no evidence for acute ischemic cerebral infarction.4.Examination is mildly degraded due to patient motion which may obscure more subtle abnormalities.


Instruction: Generate impression based on findings.

Input: 55-year-old man with history of metastatic squamous cell carcinoma of the base of tongue. There are multiple enhancing lesions in the cerebellum bilaterally, which demonstrate increased associated vasogenic edema. Comparison with the prior exam is otherwise limited due to the previous lack of intravenous contrast. There is no evidence of residual enhancing supratentorial or intraocular lesions. There is no evidence of 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 skull and scalp soft tissues are grossly unremarkable. There is a left maxillary sinus retention cyst. There is persistent bilateral tympanomastoid fluid. There is partly imaged right submandibular and cervical lymphadenopathy, base of tongue tumor, and right paraspinal tumor at the craniocervical junction region.

Output: 1.Multiple enhancing lesions in the cerebellum bilaterally with increased associated vasogenic edema may indicate tumor progression. However, comparison with the prior exam is otherwise limited due to the previous lack of intravenous contrast. 2.Partially imaged submandibular and cervical lymphadenopathy, base of tongue tumor, and right paraspinal tumor at the craniocervical junction region. Please refer to the recent neck CT report for additional details.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Ms. Zickau is a 54 year old female with a personal history of right breast mastectomy in 2001 for breast cancer treated with chemotherapy and hormonal therapy. Patient is BRCA1 mutation positive. Family history of breast cancer in paternal aunt and ovarian cancer in paternal grandmother. Patient is status post right breast mastectomy. There is scattered fibroglandular tissue in the left breast. No abnormal enhancement is seen in the right chest wall or left breast. No abnormal axillary lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: There is a punctate diffusion restriction in the midbrain, anterior to the aqueduct, in the region of the left oculomotor nerve nucleus and the left medial longitudinal fasciculus.This focus is consistent with acute ischemia.There are multiple T2/FLAIR hyperintensities in the cerebellum, in the pons, in the thalami, the right external capsule, and in the centrum semiovale. There is a moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.There are punctate focus of signal loss on susceptibility imaging in the left external capsule.Paranasal sinuses and mastoid air cells are clear.The flow-void of the left vertebral artery is not visualized, probably related to hypoplasia vs. Occlusion of the left vertebral artery.

Output: 1. Findings suggest lacunar infarction in the midbrain within the region of the left oculomotor nucleus and the left medial longitudinal fasciculus.2. Periventricular and subcortical white matter lesions of a moderate degree and lesions in the cerebellum, in the pons, in the thalami, and in the right external capsule are nonspecific. At this age they are most likely vascular related. There is associated with mild volume loss in the pons.3. Hypoplasia versus occlusion of the left vertebral artery.


Instruction: Generate impression based on findings.

Input: New upper extremity numbness. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are 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 grossly unremarkable.Spine: There are postoperative findings related to cord detethering and scoliosis surgery. The spinal cord is low lying, with the conus medullaris extending to the level of the inferior L3 vertebra. The previously demonstrated thin linear T1 hyperintensity along the filum terminale is not discernible due to the limited technique. There is no evidence of syringohydromyelia. There is mild thoracolumbar dextroscoliosis. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis.

Output: 1.No acute cerebral infarct or mass.2. Scoliosis and persistently low-lying conus medullaris, but no evidence of spinal cord compression or syringohydromyelia. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: T4N0 adenoid cystic carcinoma of minor salivary gland/maxillary sinus with intracranial extension. There has been interval partial left maxillectomy. There is diffuse mild left maxillary sinus mucosal thickening, with persistent patchy enhancement in the underlying left maxillary alveolus and retromaxillary region. There is also persistent perineural tumor extension involving the left infraorbital nerve, pterygopalatine fossa, Vidian canal, foramen rotundum, foramen ovale, and cavernous sinus, as well as along the cisternal segment of the left trigeminal nerve, but no evidence of intraparenchymal extension. There is also persistent enhancing tumor within the medial left extraconal orbit, which measures up to 6 mm in width. There is no discernible residual right pituitary tumor. There is no evidence of intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There is no evidence of significant cervical lymphadenopathy based on size criteria. The thyroid and major salivary glands are unremarkable.

Output: 1. Interval post-treatment findings in the left sinonasal region with persistent perineural tumor involving the left trigeminal nerve branches with intracranial extension, as well as persistent patchy enhancement in the underlying left maxillary alveolus and retromaxillary region. 2. Persistent left medial orbit extraconal tumor.3. No evidence of brain parenchymal metastases.


Instruction: Generate impression based on findings.

Input: 69-year-old male patient with history of bladder cancer status post robotic radical cystoprostatectomy and pelvic lymph node dissection with extracorporeal ileal conduit urinary diversion on 11/23/2012. Evaluate for metastatic disease. ABDOMEN:LIVER, BILIARY TRACT: Subcentimeter T2 hyperintense liver lesions are too small to characterize and most likely represent cysts.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts, unchanged. No definite suspicious renal lesion seen. The left renal cyst at the mid pole is mildly complex.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postsurgical changes from ileal conduit urinary diversion again noted. Right upper quadrant ostomy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: Status post prostatectomy.BLADDER: Status post cystectomy.LYMPH NODES: No pelvic lymphadenopathy.BOWEL, MESENTERY: Postsurgical changes from ileal conduit urinary diversion again noted.BONES, SOFT TISSUES: Probable Tarlov cysts in the sacrum.OTHER: No significant abnormality noted.

Output: No evidence of recurrent or metastatic disease.


Instruction: Generate impression based on findings.

Input: Speech delay. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mild thinning of the posterior body of the corpus callosum and mildly diminished posterior periventricular white matter bulk, with associated mild prominence of the bilateral lateral ventricle atria. There are punctate foci of susceptibility effect in the bilateral frontal and temporal lobes. The brain parenchyma otherwise appears unremarkable, with an adequate degree of myelination. 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. Mild thinning of the posterior body of the corpus callosum and mildly diminished posterior periventricular white matter bulk, but no partial agenesis of the corpus callosum. 2. Nonspecific scattered punctate foci of susceptibility in the bilateral cerebral hemispheres may represent chronic microhemorrhages or calcifications.


Instruction: Generate impression based on findings.

Input: Clinical question to be answered: Status post foramina magnum shunt revision 6 -- 60. Signs and symptoms: Headaches A catheter is noted entering the subarachnoid space from the level of foramina magnum the catheter extends to the right and is against the bone at the level of foramen magnum. On the first CT image there is suggestion of thickening of the epidural space with compromise of the transverse diameter of the thecal sac. Correlate with clinical findings and if warranted an MRI is recommended. In comparison to the prior exam there is reduction in the size of fourth ventricle. The above-mentioned catheter is not within the fourth ventricle.Images through supratentorial space demonstrate extensive parenchymal volume loss of right hemisphere with no interval change. There is no residual contrast within the subarachnoid space on the right as it was noted on the prior exam. No change in position of bilateral hemispheric catheters. No ventriculomegaly is detected.

Output: New catheter at the level of foramina magnum as detailed. Please see above comments.


Instruction: Generate impression based on findings.

Input: 20 years Female (DOB:7/29/1996)Reason: Evaluate for seizure like episodes and headache. Seizure protocol. History: Evaluate for seizure like episodes and headache.PROVIDER/ATTENDING NAME: SHASHA WU SHASHA WU The CSF spaces are appropriate for the patient's stated age with no midline shift. There are several frontal subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate some mucosal thickening. The visualized portions of the mastoid air cells demonstrate some scattered opacities in the right mastoid air cells and to a lesser degree the left. The visualized portions of the orbits are intact.

Output: Frontal subcortical white matter signal changes of a mild degree are present which are nonspecific. They could be vascular related, related to demyelination, trauma, vasculitis, sarcoid. They are nonspecific.


Instruction: Generate impression based on findings.

Input: Multiple sclerosis, left thalamic stimulator, and altered mental status. The images are degraded by patient motion. There is a left transfrontal approach brain stimulator tip in the left thalamus. There is diffuse prominence of the ventricles and sulci due to cerebral volume loss. There are extensive non-enhancing lesions in the bilateral subcortical and periventricular white matter.

Output: Left thalamic stimulator and extensive demyelinating disease with diffuse cerebral volume loss.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for disk herniation or compression. Signs and symptoms: Abdominal, flank pain and back pain ( R>L) in T9 distribution. Nonenhanced lumbar MRI:There is normal anatomic alignment the vertebral column however a mild exaggeration of thoracic kyphosis.T1 -- T2 is unremarkable.T2 -- T3 is unremarkable.T3 -- T4 is unremarkable. Examination at this level however demonstrate a right-sided intramedullary mass on the right side of the cord measuring approximately at 3.4 x 4-mm in transaxial dimensions. The mass demonstrate a rim of low T2 signal intensity with internal high signal intensity and without evidence of surrounding edema. The finding is highly suggestive of a small cavernoma. Finding is best appreciated on sagittal T2/T2 stir on image 9 and axial T2 series 5 image 16.T4 -- T5 is unremarkable.T5 -- T6 is unremarkable.T6 -- T7 is unremarkable.T7 -- T8 is unremarkable. Incidental note is made of a focus of T2 hyperintensity and T1 isointense in the dorsal right aspect of T8 vertebrae highly suggestive of a benign capillary hemangioma.T9 -- T10 is unremarkable. Incidental note in this level is also made of a focus of T2 hyperintensity and T1 hypointensity along the superior T10 vertebral body as well highly suggestive of a hemangioma.T10 -- T11 is unremarkable.T11 -- T12 is unremarkable.T12 -- L1 is unremarkable.

Output: 1.There is a tiny intramedullary cavernoma in the right aspect of thoracic cord at T4 level as detailed/measured above.2.Examination demonstrates mild exaggeration of thoracic kyphosis.3.There is mild degenerative changes of thoracic spine without evidence of spinal canal or neural foraminal compromise at any level.4.There are multiple small skeletal capillary hemangioma as mentioned above.5.Unremarkable paraspinal soft tissues.6.


Instruction: Generate impression based on findings.

Input: Diagnosis: Lumbago with sciatica, unspecified sideClinical question: lbp, radiculopathySigns and Symptoms: as above Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is loss of disc space height, disc desiccation and a diffuse disc bulge associated with partial effacement of the fat at the right lateral recess and partial effacement of the fat surrounding the exiting nerve roots within the neural foramina.At L3-4 there is loss of disc space height, disc desiccation and diffuse disc bulge associated with moderate facet hypertrophy. There is effacement of the fat at the lateral recess bilaterally at this level and some partial effacement of spinal fluid surrounding the nerve roots at this level. There is narrowing of the neural foramina bilaterally at this level and effacement of fat surrounding the exiting nerve roots. Overall there is moderate spinal stenosis and encroachment of exiting nerve roots bilaterally at this level. There is mild anterior subluxation of L3 on L4 at this level.At L2-3 there is loss of disc space height, disc desiccation and diffuse disc bulge associated with effacement of the fat at the left lateral recess and partial effacement of the fat at the right lateral recess. There is bilateral ligamentum flavum hypertrophy at this level. There is narrowing of the neural foramina with encroachment of the exiting nerve roots within the left neural foramen due to combination of disc bulge and ligamentum flavum hypertrophy. There are endplate reactive changes present at this level which are bright on T2 and low signal on T1 indicating that these are in the subacute stage. There is mild anterior subluxation of L2 on L3 at this level.At L1-2 there is no significant compromise to spinal canal or neural foramina.There is loss of disc space height and disc desiccation associated with a disc bulge at T11-T12.

Output: 1.There is moderate spinal stenosis present at L3-4 associated with encroachment of the exiting nerve roots due to degenerative changes and mild anterior subluxation.2.Degenerative changes and a minor anterior subluxation at L2-3 are associated with acute or subacute endplate reactive changes and some mild encroachment of the nerve roots of the left lateral recess and left neural foramen at this level3.There is some mild encroachment of the nerve roots at the right lateral recess at L4-5 due to a disc bulge with some mild encroachment of the exiting nerve roots at L4-5.4.There are multilevel degenerative changes present in the lumbar spine.


Instruction: Generate impression based on findings.

Input: The vertebral column alignment is within normal limits. The vertebral body heights are preserved. There are focal areas of T1 hyperintensity in the L1 and L5 vertebral bodies, likely representing hemangiomas or focal fat. The vertebral bone marrow signal is otherwise unremarkable. The spinal cord displays normal signal and morphology. The conus terminates at the lower L1 level. The paravertebral soft tissues are unremarkable. However, there is a subcentimeter T1 and T2 hypointense lesions in the body of the uterus. At T12/L1, there is no significant spinal canal or neural foraminal stenosis. At L1/L2, there is mild facet arthropathy and ligamentum flavum hypertrophy without significant spinal canal or neural foraminal stenosis. At L2/L3, there is facet arthropathy and ligamentum flavum hypertrophy without significant spinal canal or neural foraminal stenosis. At L3/L4, there is facet arthropathy and ligamentum flavum hypertrophy and a slight disc bulge with mild spinal canal stenosis. No significant neural foraminal stenosis. At L4/L5, there is a disc bulge with superimposed eccentric right protrusion and facet arthropathy and ligamentum flavum thickening with moderate spinal canal stenosis with apparent impingement of the nerve roots in the right lateral recess and minimal bilateral neural foraminal stenosis. At L5/S1, there is mild facet arthropathy and ligamentum flavum hypertrophy without significant spinal canal or neural foraminal stenosis.

Output: 1. Multilevel degenerative spondylosis, which is most pronounced at the L4/L5 level, where there is moderate spinal canal stenosis with apparent impingement of the nerve roots in the right lateral recess.2. A subcentimeter lesion in the uterus likely represents a fibroid. However, ultrasound of the pelvis may be useful for further evaluation.


Instruction: Generate impression based on findings.

Input: A patient submitted outside study for review. Submitted for review are ultrasound images of right breast and right axilla (12/12/14), Images from ultrasound guided biopsy of right breast (12/30/14) and breast MRI (1/9/15) performed at St Anthony Crown Point. ULTRASOUND IMAGES OF RIGHT BREAST AND RIGHT AXILLA (12/12/14):A round, microlobulated mass, measuring 7 x 5 mm, is visualized at right breast at 10 o'clock position.In the right axilla, one lymph node has 5 x 4 mm focal hypoechoic round mass, suggesting metastatic deposit of the lymph node. In addition, a few normal appearing lymph nodes are visualized.IMAGES FROM ULTRASOUND GUIDED BIOPSY OF RIGHT BREAST (12/30/14):Ultrasound guided vacuum assisted core biopsy was performed for the right breast mass with appropriate needle placement. Per outside radiology report, a marker clip was placed to the biopsy site. The result was malignant.BREAST MRI (1/9/15):The study was performed with a protocol outlined in the outside radiology report. Images could not be processed with our DynaCAD workstation. Because the images cannot be reviewed on the dedicated MRI workstation, limited interpretation is made. A biopsy cavity, measuring 19 x 14 mm (AP x LR) on axial view, is present at upper outer quadrant with rim enhancement. A marker clip is identified in the central portion of this biopsy cavity. Rim enhancement of this cavity is likely due to post biopsy changes. Volume of the remaining tumor cannot be assessed due to the biopsy changes. Mild enhancement is seen around the biopsy cavity, likely due to post biopsy changes.No abnormal enhancing lesions are seen in the left breast.There are no abnormal lymph nodes in either axilla on these limited low resolution MRI.

Output: Status post vacuum assisted biopsy of the right breast cancer. Enhancement seen on the MRI was mostly due to post biopsy changes (interpretation of MRI was limited due to inability of reviewing images on the dedicated MRI workstation). Ultrasound of the right axilla showed possible metastatic deposit within one of the lymph nodes.Mammogram has not been submitted for review. Mammogram will be useful for evaluation of both breasts, and post-biopsy changes of right breast.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: 52-year-old female with a history of uterine fibroids and pelvic pain. PELVIS:UTERUS, ADNEXA: Note is made of numerous masses with associated decreased T2 signal abnormality within the uterus, consistent with uterine fibroids. Some of these masses have an isointense to hyperintense T2 signal abnormality suggestive of cystic degeneration. The largest intramural fibroid is located along the right lateral uterine wall, measures 6.0 x 4.8 x 5.3 cm (26; series 801). The largest pedunculated uterine fibroid situated along the superior aspect of the fundus measures 3.4 x 3.3 x 3.1 cm (35; series 801). All of these masses demonstrate uniform enhancement on post contrast sequences. There are multiple punctate foci of fluid signal abnormality in the endometrium, which appears abnormally thickened, particularly along the anterior wall of the fundus, measuring up to 17 mm in diameter, extending into the myometrium (19; series 1101). These findings are consistent with adenomyosis. Subcentimeter foci of fluid signal intensity in the region of the cervix, consistent with nabothian cysts.Right ovarian follicle. Tubular focus of fluid signal intensity consistent with right-sided hydrosalpinx. BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Heterogeneous bone marrow signal abnormality may represent islands of red marrow.OTHER: No significant abnormality noted.

Output: 1. Numerous uterine fibroids with reference measurements provided above. 2. Uterine adenomyosis, as detailed above. 3. Right-sided hydrosalpinx.


Instruction: Generate impression based on findings.

Input: 20-year-old male with history of syrinx and tethered spinal cord, now experiencing new worsening back pain Cervical spine:Alignment is anatomic. There are no fractures or subluxations. The marrow signal is benign. The cervical and upper thoracic cord are normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable. There are no degenerative changes, disc herniations, or stenoses.Lumbar spine:Redemonstrated is a low-lying conus near the lumbosacral junction with postoperative changes related to prior cord untetherings. The distal thecal sac is ectatic and demonstrates septations. As before, the distal spinal cord abuts and may be adherent to the posterior thecal sac. Cauda equina nerve roots are also peripherally located as seen before which may also be reflective of adhesion. Prone images demonstrate no appreciable ventral motion of the distal cord. As before, a syrinx is present extending from the L1 to the L3-L4 levels and measuring up to 2 x 4 mm in the axial plane. These findings are unchanged.Alignment is anatomic. Vertebral body heights and intervertebral disc spaces are unchanged in morphology. The bone marrow demonstrates normal signal. No spinal canal or neural foraminal stenosis is present.

Output: 1.Negative noncontrast cervical spine MRI.2.No significant change in the appearance of lumbar spine including a small distal cord syrinx.


Instruction: Generate impression based on findings.

Input: Epilepsy laser ablation. There are findings related to recent left medial temporal lobe laser ablation. There are sequelae of removal of bilateral transoccipital and left transtemporal deep brain electrodes from the bilateral anterior temporal lobe regions. There is no evidence of gross acute intracranial hemorrhage. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation.

Output: Findings related to recent left medial temporal lobe laser ablation.


Instruction: Generate impression based on findings.

Input: Clinical question: Spinal stenosis. Signs and symptoms: Left lower back pain with radiating pain to left leg. Nonenhanced lumbar MRI:The lower most visualized thoracic spine demonstrate moderate disc disease and loss of disc height at T10-T11 through T12-L1 levels. There are multiple Schmorl nodes at these levels. There is no spinal stenosis however mild angulation of the spinal column at T11-T12 is noted. This appearance is not greatly different than the study from 9-30-15. The marrow signal intensity of the vertebral column is unremarkable.L1-L2 demonstrate mild degenerative changes. There is a left lateral ventral epidural defect which extend into the left neural foraminal (axial T2 series 601 images 30 through 32 and sagittal T1 series 301 images 6 through 8). Finding demonstrate T1 hyperintense and T2/T2 STIR hyperintense signal pattern. The finding is believed to represent an extruded disc fragment which is often mass effect on the thecal sac and significant compromise of the left neural foramina. Less likely possibility of a mass cannot be entirely excluded. Follow-up with enhanced imaging is recommended. Note however should be made that this finding is not associated with any adjacent marrow signal changes of bone. There is no spinal stenosis and the right neural foramina remains widely patent. This finding retrospectively is identified on prior nondedicated lumbar MRI study (cord compression protocol exam) and without definitive change.L2-L3 demonstrate mild degenerative changes of the disc and the posterior elements without central spinal stenosis or neural foraminal compromise.L3-L4 demonstrate mild degenerative disc disease, mild to moderate bilateral ligamentum flavum hypertrophy and mild facet disease. Constellation of changes results in mild central spinal stenosis and mild bilateral neural foraminal compromise.L4-L5 demonstrate moderate disc disease and loss of disc height, mild grade 1 anterolisthesis, extensive bilateral (L>R) facet hypertrophic changes and mild bilateral ligamentum flavum hypertrophy. Degenerative changes of facet on the left includes a loculated synovial cyst arising from the superior aspect of the left articulating facet (sagittal T2 series 501 image 3). Changes at this level results in moderate central spinal stenosis and with significant right and moderate to significant left neural foraminal compromise.L5-S1 demonstrate mild disc disease and loss of disc height however with extensive left and moderate right facet hypertrophic changes and mild to moderate bilateral ligamentum flavum hypertrophy. There is no spinal stenosis however moderate right neural foraminal compromise is present.

Output: 1.L1-L2 demonstrate a ventral left lateral soft tissue density suspected of an extruded disc which occupies the left neural foramina and with mild mass effect on the thecal sac without central spinal stenosis. This finding is not associated with any adjacent bone marrow signal changes. Possibility of a mass although is considered less likely, however follow-up with postcontrast imaging is recommended for further assessment.2.Mild degenerative changes at other levels however with disproportionate extensive degenerative/hypertrophic changes of the articulating facets in particular at L4-5 and L5-S1 levels as detailed above.3.There is mild central spinal stenosis at L3-L4 and moderate central spinal stenosis at L4-L5.4.Multilevel neural foraminal compromise as detailed per level above.


Instruction: Generate impression based on findings.

Input: 64-year-old male with acute on chronic left hemiparesis. Evaluate for new acute ischemic infarct. Note that this is an incomplete exam as the patient refused to continue. In particular, there are no susceptibility/gradient echo images.Within the right basal ganglia is an area of diffusion restriction compatible with an acute ischemic infarct. There is also restricted diffusion to a lesser degree within the right corona radiata and the left genu of the corpus callosum which likely represent somewhat older acute to subacute infarcts. There are additional patchy areas of periventricular and subcortical T2/FLAIR hyperintensities with additional FLAIR signal abnormalities within the left basal ganglia and diffusely in the brainstem which do not restrict on diffusion-weighted images and are compatible with chronic small vessel ischemic disease. There is no significant mass effect, midline shift or herniation. The ventricles and basal cisterns are normal in size and configuration. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1.Findings compatible with an acute ischemic infarct involving the right basal ganglia. There is no significant mass effect, midline shift or herniation.2.Somewhat lesser degree of restricted diffusion involving the right corona radiata and the left corpus callosum probably represent older late acute to subacute infarcts.3.Additional patchy areas of chronic small vessel ischemic disease elsewhere in a periventricular and subcortical distribution.Findings relayed to the Neurology service physician, Dr. Del Brutto (pager 1706) at the time of this final entry by Dr. Veronesi of the Radiology service.


Instruction: Generate impression based on findings.

Input: Cervical spine:The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable.There is exaggerated lordosis of the cervical spine. Diffuse osseous bone marrow abnormalities are noted within the vertebral bodies and as well as many of the pedicles, compatible with diffuse osseous metastases. No evidence of compression fracture, soft tissue extension into the spinal canal or spinal canal narrowing. The cervical cord is normal in signal without abnormal enhancement. Degenerative changes are noted about the cervical spine most severe in C6-7 level where there is disk height loss and a small posterior disk osteophyte complex which does not cause significant spinal canal stenosis. There is facet hypertrophy at the right C5-6 level but no significant neuroforaminal stenosis.Thoracic spine:There is slightly exaggerated thoracic kyphotic curvature. The vertebral body heights are maintained. There are diffuse osseous bone marrow abnormalities indicating metastases within many of the vertebral bodies and pedicles. No evidence of a compression fracture. No soft tissue extension into the spinal canal or significant spinal canal stenosis. The spinal cord has a smooth contour and is without focal atrophy, edema, or myelomalacia. Lumbar spine:Alignment is anatomic. There are diffuse osseous bone marrow abnormalities indicating metastases within many of the vertebral bodies and pedicles. The right T12/L1 and L1/L2 level demonstrates epidural and neuroforaminal osseous tumor extension from the right L1 pedicle. This causes neuroforaminal stenosis at these levels. No spinal canal stenosis. No evidence of a compression fracture. The visualized intra-abdominal and paraspinal contents are unremarkable.

Output: Widespread osseous metastatic disease with right T12/L1 and L1/L2 epidural and neuroforaminal osseous tumor extension from the right L1 pedicle. However, there is no central canal stenosis or cord, conus or cauda equina compression throughout the spine.


Instruction: Generate impression based on findings.

Input: Reason: sp tumor resection and sp SRS, yearly surveillance History: sp tumor resection and sp SRS, yearly surveillance BRAINThere is a redemonstration of a mass at the left cerebellopontine angle cistern also identified on the preoperative exam. It is identified on the diffusion weighted images as well as T1 weighted images. It currently measures 21x11mm sagittal dimensions and 13x19 mm axial dimensions. It previously measured 11x16 mm axial dimensions and has been enlarging over the past few years.The patient is status post left suboccipital craniotomy and left cerebellar hemisphere surgery. There is a fluid collection present at the surgical site within the muscle tissues and which is extracranial and measures 50 x 30 mm axial dimensions and 65 x 29 mm, coronal dimensions and 59 x 29 mm, sagittal dimensions. It is stable. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.There is a redemonstration of encephalomalacia involving the left cerebellar hemisphere, as well as some shift of the brainstem and cerebellum towards the right side. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. These are stable since the prior 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.Incidental note is made of partial empty sella.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.IACNo abnormal foci of enhancement are appreciated within the internal auditory canals. The cochlea and semicircular canals appear intact. The cochlear nerve can be followed bilaterally tracking into the cochlea within the IAC. The left sided facial and cochlear nerves and the left-sided trigeminal nerves are not readily identified in the posterior fossa but may be retracted due to scarring. The vestibular nerves are not clearly identified.There is redemonstration of a denervation atrophy of the left masticator space musculature.No abnormal enhancing lesions are appreciated at the cerebellopontine angle cisterns nor the internal auditory canals.

Output: 1.The patient is status post surgery for removal of a left cerebellar medullary angle cistern and cerebellar pontine angle cistern lesion. There are attendant post surgical changes with an extracranial fluid collection at the craniotomy site.2.There is a small mass present at the left cerebellopontine angle cistern, which continues to enlarge and could represent an epidermoid3.The left vestibular nerves and left trigeminal are not identified. The left facial and cochlear nerves are suspected to be retracted at the left cerebellomedullary angle cistern due to scar tissue along the dura. Denervation atrophy of left masticator space musculature.


Instruction: Generate impression based on findings.

Input: Swelling, parotid pressure, palate pain. Pillar implants placed and one is still there. Also history of non-Hodgkin's lymphoma in 1998. Troubled by sicca symptoms. The soft palate implant is not readily discernible. The parotid glands and other major salivary glands appear unremarkable. There is no evidence of measurable mass lesions or significant cervical lymphadenopathy based on size criteria. The thyroid gland appears unremarkable. The major cervical flow voids are grossly intact. The osseous structures are unremarkable. The aerodigestive track appears unremarkable. The imaged intracranial structures and orbits are unremarkable.

Output: 1. Unremarkable parotid glands.2. Grossly unremarkable soft palate, although pillar implant is not readily discernible, perhaps due to the small size of the implant and the resolution limits of MRI. 3. Probable fillers in the bilateral nasolabial groove and oral commissure regions.


Instruction: Generate impression based on findings.

Input: Reason: eval for meniscus tear, loose body History: pain MENISCI: The medial meniscus appears intact. There is linear increased signal abnormality within the anterior horn of the lateral meniscus indicating a complex degenerative tearing with a large horizontal component that extends into the body of the meniscus. Low signal intensity debris within the lateral synovial recess, likely represents displaced meniscal fragments. There is superficial fraying/degenerative tearing along the tibial surface of the posterior horn of the lateral meniscus.ARTICULAR CARTILAGE AND BONE: There is a focal near full-thickness to full-thickness articular cartilage defect along the lateral femoral condyle above the posterior horn of the meniscus. There is superficial fraying of the articular cartilage along the weightbearing surface of the lateral femoral condyle as well. There is full-thickness articular cartilage degeneration along the lateral tibial plateau. The medial compartment articular cartilage appears relatively spared. There is full-thickness articular cartilage cleft as well as partial-thickness articular cartilage degeneration along the lateral facet of the patella with underlying subchondral cyst formation and degenerative subchondral signal abnormality. There is superficial fraying of the articular cartilage along the medial facet of the patella. There is increased bone marrow signal abnormality within the lateral femoral condyle and lateral tibial plateau which may reflect a combination of degenerative change and bone contusions. There are tricompartmental osteophytes.LIGAMENTS: There is thickening and increased signal intensity within the proximal fibers of the lateral collateral ligament proper indicating a sprain. The LCL appears intact. The MCL appears intact. The ACL and PCL appear intact.EXTENSOR MECHANISM: The extensor mechanism appears intactADDITIONAL

Output: 1. Complex tearing of the lateral meniscus with a flipped meniscal fragment as described above.2. Focal full-thickness articular cartilage defects/clefts and articular cartilage degeneration as described above. Osteoarthritis of the knee.3. Sprain of the lateral collateral ligament proper.4. Moderate-sized joint effusion with Baker's cyst.5. 11 mm loose body and other findings as described above.


Instruction: Generate impression based on findings.

Input: 53-year-old female patient with history of right kidney mass, evaluate change in size of characteristics. Note that the lack of intravenous contrast limits evaluation of solid organ pathology and lymphadenopathy.ABDOMEN:LIVER, BILIARY TRACT: No intra or extrahepatic biliary ductal dilatationSPLEEN: No significant abnormality noted.PANCREAS: The pancreas is replaced with cystic lesions. No soft tissue lesion identified.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Innumerable complex hemorrhagic, proteinaceous, and simple cysts are noted in both kidneys. There appears to be decreased renal parenchyma compared to examination 9/5/2013, whereas the left kidney cysts and parenchyma appear similar. Susceptibility artifact from partial right nephrectomy noted. The previously identified mass in the posterior midpole of the right kidney measures 3.9 x 2.7 cm (series 3 image 24), previously 1.8 x 2.7 cm.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Limited examination due to the lack of intravenous contrast. Given this limitation, the patient's known solid mass in the right kidney is increased in size compared to prior examination.2.Grossly stable appearance of multiple renal and pancreatic cystic lesions, which are incompletely evaluated on this noncontrast examination.


Instruction: Generate impression based on findings.

Input: History of primary sclerosing cholangitis. Evaluate for stricture or suspicious lesions. ABDOMEN:LIVER, BILIARY TRACT: Redemonstration of multiple areas of intrahepatic biliary ductal dilatation and stricturing appearing similar to the prior exam. Again seen is focal stricturing of the proximal common bile duct as well as the central left main duct. The main common bile duct is nondilated. A nonenhancing focus of increased T2 signal in the hilum presumed to reflect a cystic duct remnant. There is associated susceptibility artifact from cholecystectomy clips.No suspicious enhancing lesions present. Again seen are multiple foci of intrinsic T1 shortening within the biliary tree compatible with inspissated bile or stones. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Stable findings of primary sclerosing cholangitis with areas of biliary stricturing and dilatation. Similar to prior there are areas of inspissated bile within the intrahepatic ducts.2.No focal enhancing liver lesion.


Instruction: Generate impression based on findings.

Input: Reason: assess for L.lumbar radiculopathy and plexopathy History: L.thigh numbness Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. There is multilevel disk desiccation present especially in the lower lumbar spine. No abnormal enhancement is appreciated in the lumbar spine.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is loss of disk space height and diffuse disk bulge at this level. There is very mild ligamentum flavum hypertrophy present at this level.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is loss of disk space height and diffuse disk bulge at this level. There is mild ligamentum flavum hypertrophy present at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: No compromise to lumbar spinal canal or neural foramina.


Instruction: Generate impression based on findings.

Input: Evaluate change in pituitary adenoma. There is no significant interval change in size of the enhancing pituitary mass that measures up to 25 mm with suprasellar extension and associated mass effect upon the optic apparatus. There is also unchanged extension of the tumor into the cavernous sinuses with partial encasement of the right internal carotid artery.

Output: No significant interval change in the pituitary tumor that exerts mass effect upon the optic apparatus, which likely represents a macroadenoma.


Instruction: Generate impression based on findings.

Input: 65-year-old female with knee pain MENISCI: There is an extensive horizontal and vertical signal abnormality within the posterior horn of the medial meniscus extending to both articular surfaces consistent with a complex tear. An adjacent peri-meniscal cyst is noted. The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is mild thinning of the medial tibiofemoral articular cartilage as well as more marked thinning of the articular cartilage along the medial patella facet.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The quadriceps and patella tendons are intact.ADDITIONAL

Output: 1. Complex tear of the posterior horn of the medial meniscus.2. Articular cartilage degeneration as described above, predominantly affecting the medial patella facet.


Instruction: Generate impression based on findings.

Input: Compared to 2/9/2015, interval postsurgical changes of left-sided laminotomy and microdiscectomy at the left L5-S1 level is seen. Again seen is soft tissue involving the left lateral recess and left neural foramen at L5-S1 suspected to represent recurrent disc herniation (best seen on sagittal T1 series 401, image 6). Postcontrast may be helpful to identify component of granulation tissue in this region.Five fully lumbar type vertebral bodies are present. The S1 vertebral body demonstrates a transitional morphology. Numbering is similar to prior. Bone marrow signal is benign. Alignment is grossly maintained with perhaps minimal retrolisthesis of L5 on S1.Individual levels as below:L1-L2: No significant spinal or neural foraminal stenosis.L2-L3: No significant spinal or neural foramina stenosis.L3-L4: There is a small right foraminal disc protrusion resulting in mild right neural foraminal narrowing. No significant left neural foraminal narrowing or significant spinal canal narrowing.L4-L5: Minimal disc bulge eccentric to the right with minimal right neural foraminal narrowing. No significant left neural foraminal narrowing. No significant spinal canal narrowing.L5-S1: Please see above, recurrent left foraminal disc herniation is suspected with moderate narrowing of the left neural foramen and partial effacement of the left lateral recess. No significant central canal stenosis. Bilateral facet arthropathy.No paraspinous fluid collections.

Output: 1. Compared to 2/9/2015, interval postsurgical changes of left-sided laminotomy and microdiscectomy at the left L5-S1 level. Again seen is soft tissue involving the left lateral recess and left neural foramen at L5-S1 which likely represents recurrent disc herniation (best seen on sagittal T1 series 401, image 6). Postcontrast may be helpful to identify component of granulation tissue in this region.2. Additional levels as above including mild right L3-L4 neural foraminal narrowing related to small disc protrusion.


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. Mild mucosal thickening is present within a couple posterior right ethmoid air cells and with minimal mucosal thickening within the single left posterior ethmoid air cell. The remaining paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain. There are no MRI features of the idiopathic intracranial hypertension.

Output: Mild mucosal thickening is present within a couple posterior right ethmoid air cells and with minimal mucosal thickening within the single left posterior ethmoid air cell. The remaining paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain. Otherwise negative MRI of the brain including gadolinium enhancement.


Instruction: Generate impression based on findings.

Input: Chronic tension-type headache, not intractable [G44.229], Reason for Study: ^Reason: r/o venous thrombus History: headache X 6 weeks with change in character and R eye blurriness. Hx of DVT Brain MRINo evidence of acute ischemic or hemorrhagic lesion. The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.Brain MRV2-D TOF MRV and 3D 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. No evidence of acute ischemic or hemorrhagic lesion. No evidence of abnormal enhancement.2. Normal brain MRV


Instruction: Generate impression based on findings.

Input: 70 year-old male with known tonsillar cancer. Evaluate CT scan for staging. HEAD CT:There is an approximately 6-mm focus of enhancement in the left frontal lobe in the region of the corona radiata suspicious for metastatic lesion. No vasogenic edema is seen. An MRI may be obtained for further evaluation if clinically indicated. No additional areas of abnormal enhancement.The remaining cerebral hemispheres, cerebellum and brainstem are normal in structure and attenuation. No abnormal extra-axial fluid collections are identified. The ventricles are normal in volume and are midline.No osseous lesions are identified in the calvarium or skull base. The visualized paranasal sinuses and mastoid air cells are normally aerated.NECK CT:There is an approximately 3.9 x 2.6 cm (image) homogeneously enhancing mass involving the right tonsillar pillar reaching the midline as well as extending posteriorly abutting the oropharynx. There is surrounding lymphadenopathy within the right jugulodigastric region the largest of which appears to be a combination of two nodes measuring 12 x 23 mm (image 41/92) at the level of the angle of the right mandible. Additional suspicious nodes are seen at the level of the hyoid on the right. Subcentimeter nonpathologic nodes are seen on the left.The visualized osseous structures are normal.The visualized lung apices are normal. Please refer to the Chest CT performed on the same day for further details.

Output: 1. Right tonsillar mass with right neck lymphadenopathy.2. Enhancing focus in the left frontal corona radiata without evidence of vasogenic edema. A metastatic focus as the diagnosis of exclusion. An MRI may be considered if clinically indicated.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate head. Signs and symptoms: Dizziness, tinnitus, change in vision and headache. Nonenhanced brain MRI: Negative diffusion-weighted series.Examination demonstrates few nonspecific punctate foci of FLAIR hyperintensity only in the subcortical white matter of cerebral hemispheres.The anatomical morphology as well as the signal intensity of brain parenchyma otherwise remains within normal on all MRI sequences.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination.The signal void of major intracranial arterial branches are identified.Signal intensity of the intracranial venous sinuses are unremarkable.Unremarkable calvarium, soft tissues of the scalp, orbits and well pneumatized bilateral mastoid air cells and middle ear cavities.There is complete opacification of a chamber of the sphenoid sinus in the midline with T1 hyperintense and mixed hypo and hyperintense signal on T2-weighted images. Finding is suggestive of chronic sinus disease of the sphenoid. The rest of the paranasal sinuses remain well pneumatized. The finding could explain patient's headache and follow-up with maxillofacial CT exam is recommended for better assessment.

Output: 1.Minimal scattered nonspecific punctate foci of FLAIR hyperintensity in the subcortical white matter of cerebral hemispheres and unremarkable brain MRI otherwise.2.Complete opacification of a single chamber of the sphenoid sinus suggestive of chronic sinus disease. Follow-up with CT of paranasal sinuses is recommended for further assessment. The rest of the paranasal sinuses as well as bilateral mastoid air cells and middle ear cavities remain well pneumatized.


Instruction: Generate impression based on findings.

Input: Clinical question: L frontal GBM initial Dx 9/2012. s/p RT/TMZ+TMZ. Off all Tx.Signs and Symptoms: GBM.Comments: GBM Dx 9/2012. S/p RT/TMZ+TMZ. Please compare to earlier studies. | The patient is status post left frontal lobe surgery for removal of a left frontal lobe mass. Since the prior exam a new 18mm focus of Flair and T2 signal change has developed along the left fontal lobe at the anterior aspect of the left superior frontal gyrus at the inferior and anterior aspect of the surgical site. This now enhances heterogenously following contrast administration. This associated with increased relative CBV and dilated flow voids on SWI.Flair and T2 signal change adjacent to and inferior and posterior to the surgical site remains stable when compared to the previous exams.Punctate foci of susceptibility on the susceptibility weighted images are present in the subcortical white matter of the supratentorial brain along the frontal and parietal lobesNormal 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: Since the prior exam a new focal lesion has developed at the anterior aspect of the right frontal lobe adjacent to the anterior and inferior margin of the surgical site which is suspicious for local recurrence.


Instruction: Generate impression based on findings.

Input: 59-year-old female with history of perianal fistula status post seton placement. Evaluate for residual collection. PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: 2.2 x 1.7 cm rim-enhancing, air/fluid-containing perirectal collection/abscess at the posterior 6 o'clock position (series 7/35). This collection/abscess extends inferiorly into a small transsphincteric fistula with seton in place in the right medial gluteal cleft.Abnormal osseous signal of the visualized bones diffusely, most suggestive of underlying tumor and/or post therapy changes.OTHER: Small right scrotal hydrocele, partially visualized.

Output: Perirectal collection/abscess with right transsphincteric fistula that has a seton in place.


Instruction: Generate impression based on findings.

Input: Examination is degraded due to patient motion. Lack of contrast also limits evaluation for infection. For the purposes of numbering, the most inferior well-defined disc space is labeled L5-S1. There is abnormal T2/STIR hyperintensity involving the L2-L3 disc space with signal abnormality also involving the inferior and superior aspects of the L2 and L3 vertebral bodies, respectively. There is extensive edema involving the lumbar paraspinous musculature. There is also edema involving the left psoas muscle and probably to a mild degree involving the right psoas muscle. There is a small tubular fluid collection within the left psoas muscle which measures 13 x 18 mm (axial T2 series 1401 image 24/50) in the maximal axial dimensions at the L3 level with smaller components extending from the L2-L3 to the L4-L5 levels, highly suspicious for abscess. No significant destructive changes are appreciated at the endplates.No clear evidence of discitis-osteomyelitis in the thoracic spine. Subtle foci of STIR hyperintensity are seen at multiple levels in the mid thoracic spine involving the disc space and along the left lateral aspects of the endplates which are nonspecific and may be related to degenerative change versus represent early infection. Note, precise levels in the mid thoracic spine is difficult to determine due to motion degradation. Thoracic and lumbar vertebral bodies and alignment are maintained. There is no significant spinal canal stenosis at any level. No cord signal abnormality is appreciated. No evidence of epidural collections within the limits of noncontrast imaging.Degenerative changes in the lumbar spine are suboptimally evaluated due to motion degradation, but there are multilevel disc bulges as well as mild multilevel facet arthropathy. There is associated moderate left L2-L3 neural foraminal stenosis, moderate right and mild left L3-L4 neural foraminal stenosis, and moderate right and mild left L4-L5 neural foraminal stenosis. No significant spinal canal stenosis.There is moderate left pleural effusion and a smaller one on the right.

Output: 1. Examination is motion degraded and limited without contrast. There are findings however highly suspicious for discitis-osteomyelitis at the L2-L3 level with associated abscess involving the left psoas muscle. Measurements of the abscess, which has a tubular morphology, as above.2. Subtle additional areas of signal abnormality are suspected in the mid thoracic spine involving the disc and endplates which are nonspecific but raise possibility of early infection. Would recommend including thoracic spine when follow up spine imaging is considered.3. No significant spinal canal stenosis or evidence of epidural abscess within the limits of noncontrast imaging.


Instruction: Generate impression based on findings.

Input: 69 year old female referred for cardiac MRI to evaluate aortic valve insufficiency. Left VentricleThe left ventricle is severely dilated with mildly reduced systolic function. The overall LV ejection fraction is 46%, the LV end diastolic volume index is 132 ml/m2 (normal range: 65+/-11), the LVEDV is 258 ml (normal range 109+/-23), the LV end systolic volume index is 72 ml/m2 (normal range 18+/-5), the LVESV is 140 ml (normal range 31+/-10), the LV mass index is 61 g/m2 (normal range 67+/-11), and the LV mass is 118 g (normal range 114+/-24). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.No intracardiac thrombus.Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is normal in size with normal sysolic function. The overall RV ejection fraction is 50%, the RV end diastolic volume index is 80 ml/m2 (normal range 69+/-14), the RVEDV is 156 ml (normal range 110+/-24), the RV end systolic volume index is 40 ml/m2 (normal range 22+/-8), and the RVESV is 78 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveTrileaflet aortic valve with thickened leaflets and moderate calcification. Leaflet motion is mildly restricted. Dedicated through-plane imaging demonstrated moderate aortic regurgitation from the central coaptation site with regurgitant fraction 32%. Forward flow is 119 mL, regurgitant volume is 38 mL. Effective orifice area is normal, at 2.8 cm2. Mitral ValveThe mitral valve opens widely and there is mitral regurgitation, visually estimated to be mild. Mitral valve leaflets appear mildly thickened. Dedicated through-plane imaging was not performed. 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 mildly dilated. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no pericardial effusion.Extracardiac FindingsLeft subscapluar intramuscular lipoma.

Output: 1. Thickened and calcified trileaflet aortic valve with moderate aortic regurgitation, quantified as 32%)2. Severely dilated left ventricle with mildly reduced systolic function (LVEF 46%)3. Normal right ventricular size and systolic function.4. Severe left atrial dilation.5. Mitral regurgitation.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Reason: suboptimal MRI CSF flow study on 1/3/2015. Radiologist recommended to repeat flow sequence with no additional change to the patient. History: Chiari malformation. There are mildly low-lying cerebellar tonsils. There is intact CSF flow across the anterior foramen magnum. but blunted CSF flow posteriorly at the level of the cerebellar tonsils.

Output: Intact CSF flow across the anterior foramen magnum. but blunted CSF flow posteriorly at the level of the cerebellar tonsils. Please refer to the prior brain MRI report for additional details.


Instruction: Generate impression based on findings.

Input: 19 year old male with sickle cell anemia with recent septic shock now resolving, referred for cardiac MRI after abnormal ECG and elevated troponins to evaluate for structural heart disease and anomalous coronary arteries. Left VentricleThe left ventricle is mild-moderately dilated with normal systolic function. The overall LV ejection fraction is 60%, the LV end diastolic volume index is 119 ml/m2 (normal range: 74+/-15), the LVEDV is 191 ml (normal range 142+/-34), the LV end systolic volume index is 47 ml/m2 (normal range 25+/-9), the LVESV is 76 ml (normal range 47+/-19), the LV mass index is 53 g/m2 (normal range 85+/-15), and the LV mass is 85 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is mild late gadolinium enhancement in the mid septum which is quite focal and atypical for myocardial infarction. However, the images were of limited diagnostic quality due to respiratory motion.No iron overload of the myocardium. There is no LV thrombus. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is upper normal in size with normal systolic function. The overall RV ejection fraction is 51%, the RV end diastolic volume index is 114 ml/m2 (normal range 82+/-16), the RVEDV is 182 ml (normal range 142+/-31), the RV end systolic volume index is 56 ml/m2 (normal range 31+/-9), and the RVESV is 90 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no obvious aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no obvious mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no obvious pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no obvious tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Coronary ArteriesThe right coronary artery arises normally from the right coronary cusp. The left main coronary artery arises normally from the left coronary cusps and bifurcates to give off the left anterior and left circumflex arteries. Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is a small pericardial effusion present.Extracardiac FindingsThere is a nasogastric tube with associated metal artifact in the stomach. There is a moderate right pleural effusion. There is central venous catheter which terminates at the SVC-RA junction. Improving bilateral opacities consistent with resolving pulmonary edema.This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Mild-moderately dilated left ventricle with normal systolic function (EF 60%).2. Mild, very focal late gadolinium enhancement in the mid septal wall which is atypical for myocardial infarction. Significant motion artifact limits diagnostic certainty of this finding. Would suggest repeat imaging to better delineate this abnormality.3. The right ventricle is upper normal in size with normal systolic function( EF 51%).4. Normal origin of the coronary arteries. 5. Small pericardial effusion.6. Extracardiac findings as noted above.


Instruction: Generate impression based on findings.

Input: History of lung cancer with brain metastasis. The multiple supratentorial brain lesions have decreased in size and are now all subcentimeter. For example, a left parietal lobe lesion measures up to 7 mm, previously 9 mm. The T2 hyperintensity surrounding the metastases has also diminished. There is residual susceptibility effect associated with some of the lesions. However, there is new patchy restricted diffusion in the left parietal lobe with high T2 signal. The ventricles and sulci are stable. Otherwise, patchy and confluent periventricular and subcortical white matter T2 hyperintensity is similar to the prior exam. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is fluid signal in the mastoid air cells bilaterally.

Output: 1.The multiple brain metastases have generally decrease in size since June 2015. Comparison with the brain MRI from July 2015 is otherwise limited due to the extensive motion artifact on that scan.2.Recent infarct involving the left parietal lobe superimposed upon a background of chronic small vessel ischemic disease.Findings discussed with Dr. Salgia by phone at 4:30pm on 10/14/2015.


Instruction: Generate impression based on findings.

Input: RCC, liver lesion surveillance ABDOMEN:LIVER, BILIARY TRACT: Subcentimeter hepatic cysts are unchanged. No suspicious hepatic lesions.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Status post left nephrectomy. No evidence of tumor recurrence within the nephrectomy bed. Right renal cysts. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: Status post left nephrectomy without evidence of tumor recurrence or metastatic disease.


Instruction: Generate impression based on findings.

Input: 53 year old female with alcoholic cirrhosis and HCC status post resection presenting with right upper quadrant pain. Evaluate for recurrence. ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Liver has nodular contours consistent with cirrhosis. New hyperattenuating focus seen only on arterial phase measures 1 x 1 cm on image 39 series 9. Although no definite washout is identified which favors benignity, continued follow up or MRI is suggested for further characterization of this lesion. The patient has undergone interval resection of a portion of the left lateral segment. There is a small perihepatic fluid collection which is likely postsurgical in etiology. No new lesions are identified.Cholelithiasis and pericholecystic fluid. If there is clinical concern for acute cholecystitis, a right upper quadrant ultrasound may be obtained. 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: Borderline enlarged retroperitoneal lymph nodes are stable.BOWEL, MESENTERY: Appearance of intussusception in the duodenum may be transient and is of uncertain clinical significance. Multiple colonic diverticula with retained hyperattenuating foci likely represent retained contrast. No evidence of obstruction, intra-abdominal free air, or abscess is identified.BONES, SOFT TISSUES: Postsurgical changes are identified in the right anterior abdominal wall from the incision.OTHER: Extensive collateral vessels inferior to the spleen at the splenic hilum consistent with portal hypertension.

Output: 1.New 1 cm enhancing focus in the right lobe of liver seen only on arterial phase without definite washout for which continued follow-up or MRI for further characterization is suggested. 2.Cirrhosis and portal hypertension as described above.3.Cholelithiasis and pericholecystic fluid. If there is clinical concern for acute cholecystitis, a right upper quadrant no may be obtained.4.Postoperative and other findings as described above.


Instruction: Generate impression based on findings.

Input: Pain. Evaluate for stenosis. There is straightening of the normal cervical lordosis with minimal anterolisthesis of C7 on T1. The vertebral body heights are preserved. There is mild loss of multiple disc height of the cervical spine. The vertebral bone marrow signal is unremarkable. There is questionable T2 signal abnormality involving the cervical cord at the C1 level ventrally near the midline seen on the sagittal T2 and STIR images although not corroborated on the axial images. Otherwise no definite cord signal abnormality. The paravertebral soft tissues are unremarkable. Incidentally noted is a retrocerebellar arachnoid cyst or a mega cisterna magna and the incompletely evaluated.C1-C2: Mild to moderate spinal canal stenosis superimposed on congenitally narrowed canal.C2-C3: No significant disc bulge, spinal canal or foraminal stenosis. C3-C4: Posterior disc osteophyte complex, bilateral facet degeneration and thickening of the ligamentum flavum, contributing to moderate spinal canal stenosis with mild flattening of the cord and mild right and moderate left foraminal stenosis. C4-C5: Posterior disc osteophyte complex, bilateral facet degeneration and thickening of the ligamentum flavum, contributing to mild to moderate spinal canal stenosis and moderate bilateral foraminal stenosis. C5-C6: Posterior disc osteophyte complex, bilateral facet degeneration and thickening of the ligamentum flavum, contributing to mild spinal canal stenosis and moderate bilateral foraminal stenosis. C6-C7: Posterior disc osteophyte complex, bilateral facet degeneration and thickening of the ligamentum flavum, contributing to mild spinal canal stenosis and moderate bilateral foraminal stenosis. C7-T1: No significant disc bulge, spinal canal or foraminal stenosis.

Output: 1. Advanced degenerative changes of the cervical spine, most prominent at C3-C4, with moderate spinal canal stenosis at this level superimposed upon a congenitally narrow canal. Variable multilevel foraminal stenosis as described.2. Questionable T2 signal abnormality at the C1 level seen on sagittal T2 and STIR sequence and not corroborated on the axial images. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Female, 72 years old. Reason: Primary HPT. Sestamibi shows Right inferior parathyroid adenoma. RIGHT LOBE MEASUREMENTS: 1.7 x 1.3 x 5.6 cmLEFT LOBE MEASUREMENTS: 4.4 x 2.0 x 1.6 cmISTHMUS MEASUREMENTS: 0.2 cmRIGHT LOBE: Heterogeneous echotexture. A right midpole nodule measures 1.2 x 0.7 x 1.0 cm, spongiform, with echogenic foci suggestive of colloid. LEFT LOBE: Heterogeneous echotexture. A left midpole nodule measures 2.0 x 1.7 x 1.8 cm, solid and heterogeneous, with a hypoechoic rim, scattered calcifications, and internal vascularity. ISTHMUS: Heterogeneous echotexture.PARATHYROID GLANDS: Posterior to the right inferior pole, there is an ovoid hypoechoic nodule measuring 0.5 x 0.6 x 0 .8 cm, with minimal internal vascularity. Posterior to the left inferior pole there is an additional ovoid hypoechoic nodule measuring 0.4 x 0.7 x 0 .9 cm.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Bilateral hypoechoic extrathyroidal nodules posterior to the inferior poles may represent hyperplastic parathyroid glands or parathyroid adenomas.2. A 2 cm solid left thyroid nodule has an appearance suspicious for thyroid carcinoma, particularly papillary type. If not already performed, fine needle aspiration of this lesion is recommended for further evaluation.


Instruction: Generate impression based on findings.

Input: Diagnosis: Autistic disorderClinical question: Rule out seizure focusSigns and Symptoms: hx of autism spectrum disorder, behavioral issues The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a T2 and FLAIR hyperintense focus present along the posterior aspect of the right thalamus which measures approximately 3 mm in diameter. There is no associated susceptibility effect.A punctate FLAIR and T2 hyperintense focus is present along the right superior frontal gyrus subcortical white matter. Similar less conspicuous foci are present along the anterior aspects of the temporal lobes.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mucosal thickening throughout the paranasal sinuses as well as opacification of the frontal sinuses and left maxillary sinus.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: A small 3mm lesion in the posterior aspect of the right thalamus and a small 3mm lesion along the right superior frontal gyrus subcortical white matter are nonspecific and of unknown clinical significance. These could simply represent enlarged perivascular spaces, however, the possibility that they are related to demyelination or prior injury cannot be excluded either.


Instruction: Generate impression based on findings.

Input: Upper extremity shooting pain, evaluate for disc herniation Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. There is mild reversal of cervical lordosis with apex at the C4-C5 level. Alignment is otherwise maintained. Bone marrow signal is within normal limits. The cervical spinal cord has normal signal characteristics and overall morphology.Mild degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: Minimal disc bulge without significant spinal canal narrowing. There is minimal bilateral neural foraminal narrowing. C4-5: Disc osteophyte complex with dorsal annular fissure and right-sided uncovertebral hypertrophy resulting in mild right-sided foraminal narrowing. There is mild spinal canal stenosis with effacement of the ventral thecal sac with mild indentation of the right ventral cord. Dorsal thecal sac is preserved. Left neural foramen is patent.C5-6: Small disc osteophyte complex including uncovertebral hypertrophy on the right resulting in mild right neural foraminal narrowing. Mild spinal canal narrowing. No significant left neural foraminal narrowing.C6-7: Small disc osteophyte complex eccentric to the left including uncovertebral hypertrophy. There is mild left neural foraminal narrowing. No significant spinal canal or right neural foraminal narrowing.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. 11 mm right parotid nodule with T1 and T2 hyperintensity which may represent a small lipoma but not well evaluated.

Output: Mild multilevel degenerative changes in the cervical spine. There is mild spinal canal narrowing at C4-C5 and C5-C6. Mild neural foraminal narrowing at multiple levels as detailed above.


Instruction: Generate impression based on findings.

Input: Male 37 years old Reason: 37 y.o. with a h/o ? jejunal inflammation possibly suggesting Crohn's, with recent episode of severe abd and epigastric pain, with constipation alternating with dark stools. History: abd pain, dark stools ABDOMEN:LIVER, BILIARY TRACT: There is normal in morphology. Imaged portions of the hepatic and portal veins are patent. No biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: Pancreas is normal in morphology. Portion of the main pancreatic duct drains via the minor papilla. This causes mild pancreatic ductal dilatation measuring up to 4 mm.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Multiple small mesenteric lymph nodes.BOWEL, MESENTERY: Stomach is well distended and unremarkable. Upper abdominal jejunal loops have a thickened wall with submucosal edema. There is also some thickening of the distal ileum which is suboptimally evaluated due to poor distention.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small amount of upper abdominal ascites.

Output: 1.Abnormal MRI enterography with bowel wall thickening involving the jejunum and some mild inflammation involving the distal ileum. Imaging findings are compatible with an enteritis.


Instruction: Generate impression based on findings.

Input: Female, 16 years old, bilateral leg numbness and pain with walking. Spinal alignment is anatomic. Vertebral body morphology is within normal limits. A transitional morphology of the S1 vertebral body is seen. No concerning marrow replacement or marrow edema is detected.The visualized spinal cord, conus and cauda equina are all within normal limits.There may be a very small central disc protrusion at L5-S1, but this is equivocal. No significant disc degeneration is evident at any level. Moderate facet arthropathy is seen at L5-S1.No evidence of any spinal canal or neuroforaminal stenosis is seen.

Output: 1.Questionable minimal central disc protrusion at L5-S1.2.Moderate facet arthropathy at L5-S1.3.No spinal canal or neuroforaminal stenosis.


Instruction: Generate impression based on findings.

Input: 62 year old female status post lumpectomy for left breast invasive ductal carcinoma in February 2016, presents today for routine follow up. No current breast complaints. Family history of paternal aunt and first cousin diagnosed with breast cancer. Mammogram: Three standard views of both breasts, and additional spot compression views of the right upper outer and left inferior central breast were performed digitally and reviewed with the aid of R2 CAD 9.3 (10 images total). The breast parenchyma is composed of scattered fibroglandular density(BiRads Density Category B). Interval left lumpectomy with expected postsurgical change including architectural distortion, surgical clips and skin thickening. Within the right inferior central breast, mid depth, a focal asymmetry persists on spot compression images. Benign calcifications are noted. No suspicious microcalcifications in either breast. Benign appearing lymph nodes and surgical clips are projected over the left axilla.Ultrasound: Targeted ultrasound was performed of the right breast. At 6:00, 3 cm from the nipple, there is a 1.0 x 0.6 x 1.0 cm isoechoic avascular lesion, that likely represents a solid highly likely benign mass versus complicated cyst, unchanged from prior breast MRI 12/31/2015 (ie. only a 6 month stability).

Output: Right 6:00 mass with ultrasound correlate, stable since MRI 12/31/2015, but may be better evaluated on MRI. Status post left lumpectomy, with expected postoperative changes in the left breast. Given the findings of this exam, and the need to document stability of the findings from the prior MRI, a breast MRI is recommended at this time. BIRADS: 3 - Probably benign finding.RECOMMENDATION: G - Ductography/MRI/Etc.


Instruction: Generate impression based on findings.

Input: Female, 57 years old, status post L2 tumor decompression. Interval postoperative findings are seen compatible with resection of the left L2 lamina, pedicle, and part of the transverse process. The operative bed contains fluid and a bubble of air. Also resected was a portion of the previously demonstrated progressive tumor at L2. There remains enhancing tumor along the left lateral margin of the vertebral body which is at least partially extraosseous, and a small nodule of residual tumor medial to the resection bed. This nodule continues to indent the thecal sac exerting mass effect upon the adjacent cauda equina nerve roots.A severe compression deformity of the L2 vertebral body is redemonstrated with evidence of prior kyphoplasty. A mild compression deformity of the L5 vertebral body is unchanged, also with evidence of prior kyphoplasty. A moderate compression deformity of the L1 vertebral body is unchanged.No new focal marrow space or epidural lesions are identified. The marrow signal characteristics of the lumbar spine are diffusely fatty compatible with prior radiotherapy. The visualized distal spinal cord and conus are within normal limits. As above, there is crowding of the cauda equina at the L2 level, but below this the spinal canal is not significantly compromised.At L1-2, the spinal canal is mildly compromised due to disc degeneration and vertebral body retropulsion. The left neural foramen is mildly narrowed as well.At L2-3, and particularly at the level of the L2 vertebral body, bony retropulsion and the presence of residual tumor contribute to a moderate to severe narrowing of the thecal sac with crowding of the cauda equina. The left neural foramen has been surgically decompressed. The right neural foramen is mildly narrowed.At the remaining levels, mild facet arthropathy is seen without significant spinal canal or foraminal compromise.

Output: 1.Postoperative findings are seen compatible with resection of the left L2 lamina, pedicle and part of the transverse process. The previously demonstrated progressive tumor at this level has also been debulked.2.There remains residual L2 tumor along the left lateral aspect of the vertebral body, and along the medial aspect of the resection bed. This medial tumor component continues to indent and narrow the thecal sac. The left L2-3 neural foramen has been surgically decompressed.3.Multiple compression deformities and evidence of prior kyphoplasty are redemonstrated without significant interval change. No new osseous lesions are suspected.


Instruction: Generate impression based on findings.

Input: No restricted diffusion to suggest acute infarct. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. There is global parenchymal volume loss with slightly greater involvement of the bilateral parietal lobes similar to prior.There are innumerable foci of susceptibility effect throughout the brain compatible with chronic microhemorrhages, with particular preponderance within the basal ganglia and thalami as well as in the cerebellum. Several of these foci also noted in a peripheral lobar distribution. Allowing for differences in technique, no significant change from prior since 10/14/2014.There is moderate degree of T2/FLAIR hyperintensity in the bilateral subcortical and periventricular white matter as well as the pons and thalami which are nonspecific but compatible with moderate small vessel ischemic disease. Prominent perivascular spaces in the the basal ganglia are also seen.No abnormal parenchymal or meningeal enhancement. Specifically no thickening or abnormal enhancement involving the abducens or other cranial nerves is appreciated. There is symmetric enhancement of the cavernous sinuses. Major flow-voids are preserved. Changes of bilateral intraocular lens replacement. Minimal mucosal thickening in the paranasal sinuses. Paranasal sinuses and mastoid cells are otherwise clear. Bone marrow signal and extracranial soft tissues are within normal limits. MRI ORBITS: Changes of bilateral intraocular lens replacement. No intraorbital mass. No abnormal signal involving the optic nerve or chiasm. No evidence of mass effect. Extraocular muscles appear unremarkable. Minimal enhancement is seen along the optic nerve sheaths which is most likely within normal limits.MRA HEAD

Output: 1. No evidence of infarct, intracranial or intraorbital mass, or aneurysm. No lesions along the course of the left abducens nerve are appreciated.2. Moderate chronic small vessel ischemic disease similar to prior. 3. Again seen are numerous foci of chronic microhemorrhages throughout the brain including the basal ganglia, thalami, and cerebellum as well as some in a peripheral lobar distribution. Distribution is consistent with chronic hypertension and/or amyloid angiopathy.4. No significant stenosis in the intracranial or extracranial vasculature in the neck.


Instruction: Generate impression based on findings.

Input: Left forefoot pain under her first and second metatarsal heads. Fracture? There is a bipartite lateral sesamoid bone underneath the first metatarsal head. This is usually a normal variant; however, if there is strong clinical concern for fracture, then MRI may be considered to assess for edema within the bone. The remainder of the foot is unremarkable.

Output: Bipartite lateral sesamoid bone beneath the first metatarsal head is typically a normal variant. However, if there is strong clinical concern for fracture, MRI may be considered.


Instruction: Generate impression based on findings.

Input: Patient with progressive walking problems, evaluate for spinal stenosis. Cervical spine:There is minimal retrolisthesis of C3-C4, C4-C5, and C5-C6 levels, similar to prior exam. Otherwise the alignment is maintained. There is minimal loss of height associated with C4, C5, and C6 vertebral bodies, minimally progressed as compared to prior exam. No cord signal abnormalities are identified. Paraspinal soft tissues are unremarkable.Multilevel degenerative changes, individual levels as below:C2-C3: No significant spinal canal or neural foraminal stenosis.C3-C4: Posterior disc osteophyte complex, facet joint arthropathy and ligamentum flavum thickening results in mild spinal canal stenosis, moderate to severe left neural foraminal stenosis and mild right neural foraminal stenosis.C4-C5: Disc osteophyte complex including uncovertebral hypertrophy results in moderate spinal canal stenosis and moderate to severe bilateral neural foraminal narrowing, left worse than the right.C5-C6: Posterior disc osteophyte complex and uncovertebral hypertrophy results in moderate spinal canal stenosis and moderate bilateral neural foraminal narrowing, worse on the rightC6-C7: Uncovertebral hypertrophy results in mild left neural foraminal narrowing with no significant spinal canal or right neural foraminal stenosis.C7-T1: No significant spinal canal or neural foraminal narrowing.Lumbar spine:For numbering purposes, there are total of 5 lumbar type vertebral bodies. There is grade 1 anterolisthesis of L3 on L4 and L5 on S1. Otherwise the alignment is anatomic. Multilevel Schmorl nodes are noted, with no destructive osseous lesions. There is multilevel disc desiccation and disc height loss, most prominent at the L4-L5 and L5-S1 levels. No signal abnormalities are noted within the spinal cord. Visualized paraspinous soft tissues are unremarkable. Conus medullaris is normal in appearance and terminates at an appropriate level. Multilevel degenerative changes are described level by level, as below:T12-L1: No significant spinal canal or neural foraminal stenosis.L1-L2: No significant spinal canal or neural foraminal stenosis.L2-L3: Diffuse disc bulge and facet joint arthropathy results in mild left neural foraminal stenosis, with no significant spinal canal or right neural foraminal stenosis.L3-L4: Diffuse disc bulge and facet joint arthropathy results in moderate left and mild-to-moderate right neural foraminal stenosis, with partial effacement of the lateral recesses, but no significant central canal stenosis. There is suggestion of prior right laminectomy. L4-5: Disc bulge eccentric to the right resulting in mild to moderate right and moderate left neural foraminal stenosis. No significant spinal canal stenosis.L5-S1: Facet joint arthropathy results in mild to moderate bilateral neural foraminal stenosis, with no significant spinal canal stenosis.

Output: 1.Multilevel degenerative changes in the cervical spine are again seen. There is up to moderate spinal canal stenosis at the C4-C5 and C5-C6 levels which is not significantly changed since 7/15/2014. No cord signal abnormality.2.Multilevel degenerative changes in the lumbar spine without significant spinal canal stenosis at any level. Neural foraminal stenoses as detailed above, which are similar to prior study dated 10/31/2013.


Instruction: Generate impression based on findings.

Input: Wrist pain LIGAMENTS: No significant abnormality noted.TRIANGULAR FIBROCARTILAGE COMPLEX: The TFCC demonstrates mildly increased signal but is otherwise intact.TENDONS: No significant abnormality noted. BONES: Scattered areas of increased signal are noted within the lunate and proximal carpal row fracture of the leakage in nature.ADDITIONAL

Output: Mild degenerative changes of the wrist and TFCC.


Instruction: Generate impression based on findings.

Input: 8-year-old male status post laser ablation, history of seizures including right-sided weakness. Redemonstrated are expected postprocedural findings related to laser ablation of the left medial temporal lobe lesion, where there is volume loss with a small amount of surrounding gliosis. There is a small amount of susceptibility effect along the left frontal and temporal surgical tracks. These findings are unchanged in appearance.The ventricles and basal cisterns are stable in size and configuration. There is no midline shift or herniation. There is scattered paranasal sinus mucosal thickening and secretions, which has improved. The skull and scalp soft tissues otherwise appear unchanged.

Output: Redemonstrated are expected postprocedural findings related to laser ablation of the left medial temporal lobe lesion, where there is volume loss with a small amount of surrounding gliosis, unchanged.


Instruction: Generate impression based on findings.

Input: 70-year-old female with a history of meningioma status post multiple surgeries in 1950s-60s. History of seizures. There is evidence of multiple prior bilateral craniotomies. There are extra-axial enhancing masses along the frontal convexities bilaterally. The mass on the left measures 2.0 x 2.0 x 1.9 cm, and the mass on the right measures 2.3 x to 0.6 x 2.0 cm (series 1501, image 315 and series 1503, image 115). Both of these masses are likely invading the superior sagittal sinus. Mild nodularity elsewhere along the left convexity may represent additional smaller extra-axial masses. The dura is diffusely thickened throughout, left greater than right. In addition, there is a subdural fluid collection along the left cerebral hemisphere measuring up to 7 mm in thickness with susceptibility effect. This was either much smaller or not present on the prior CT examination. There is plaque-like dural thickening along the left pterion which may represent additional dural based tumor. Plaque-like dural thickening along the floor of the right posterior fossa is also seen. The margin of this thickening is somewhat feathered and appears to adhere to or invade the adjacent cerebellum. The right cerebellum is atrophic and demonstrates increased T2 signal. Hemosiderin stained right frontal lobe encephalomalacia and periventricular T2 hyperintensity are noted. There is also encephalomalacia involving the right temporal lobe subjacent to a burr hole and a likely left basal ganglia lacunar infarct. There is a susceptibility inducing lesion in the right inferior frontal gyrus with internal T2 signal which suggests cavernoma. There are a number of additional scattered foci of susceptibility elsewhere which are nonspecific.

Output: 1.Multiple extra-axial masses compatible with meningiomas along the bilateral frontal convexities. A plaque-like area of dural thickening is seen along the left pterion which could also represent a meningioma. Plaque-like dural thickening along the floor of the right posterior fossa with a scirrhous or adhesive appearance relative to the adjacent cerebellum. Given the cerebellar atrophy, this may reflect a chronic treated meningioma with the possibility of an atypical or invasive meningioma considered less likely. Correlation with prior exams would be helpful.2.Subdural collection along the left cerebral hemisphere, which is likely new from the prior CT exams and most likely represents a subacute or chronic subdural hematoma. Asymmetric dural thickening seen in the left hemisphere may therefore be reactive to this collection. 3.Multiple chronic findings are also seen including areas of encephalomalacia and scattered susceptibility inducing lesions which probably represent a combination of cavernomas and chronic microhemorrhage.