Instruction: Generate impression based on findings.

Input: Clinical question: Mass? Intracranial hemorrhage? Signs and symptoms: Central vertigo x 1 month history of metastatic melanoma to brain and with status post RT Non-enhanced head CT:A there is no evidence of intracranial hemorrhage, edema, mass-effect or midline shift or hydrocephalus.The cortical sulci, ventricular system, CSF cisterns are essentially minimal for patient's stated age of 74.Diffuse patchy areas of subcortical and periventricular low-attenuation are nonspecific however they are suspected for small vessel ischemic disease of indeterminate age. Similar findings were present on prior MRI examination from 12 -- 13 -- 2010.Calvarium is intact. Limited view of paranasal sinuses and mastoid air cells as well as middle ear cavities are unremarkable.Limited images through the orbit demonstrate ptosis bulbi of the right globe as was noted on multiple prior studies.

Output: 1.No evidence of any acute new findings in particular no evidence of hemorrhage or acute cortical stroke.2.Findings of small vessel ischemic disease of indeterminate age.3.Ptosis bulbi of right globe.4.Unremarkable calvarium, paranasal sinuses and mastoid air cells.


Instruction: Generate impression based on findings.

Input: Female, 36 years old, history of multiple sclerosis, with paresthesias, assess for progression. Multiple small T2 hyperintense lesions are redemonstrated involving the subcortical and periventricular white matter as well as the corpus callosum itself. Many of these are linear and oriented radially with respect to the ventricles consistent with known demyelinating disease. There appears to be a new small lesion involving the right inferior aspect of the corpus callosum body which is not seen on prior study. There is minimal burden of T1 hypointense lesions. Brain parenchymal volume is maintained.Evaluation of the remainder of the brain with limited sequences demonstrates no intracranial mass or mass effect. No midline shift or herniation. No hydrocephalus. No extra-axial collections. There is an 11 x 6 mm T2 hyperintense lesion involving the right frontal bone, with questionable punctate focus of signal abnormality on the prior study in this location. Remainder of the calvarium and extracranial soft tissues are grossly unremarkable.

Output: 1. Findings consistent with known demyelinating disease with one new lesion involving the body of the corpus callosum since 7/14/2014.2. 11 x 6 mm T2 hyperintense lesion involving the right frontal bone which is new or significantly larger since prior study. Differential includes benign and aggressive processes. Consider CT for further evaluation.


Instruction: Generate impression based on findings.

Input: Mild residual cortical thickening of the right insula is redemonstrated, similar to prior examination. No other areas of significant residual parenchymal thickening or abnormal signal are seen in the areas which had previously been affected including the right frontal lobe, thalamus and temporal lobe. No evidence of significant edema or mass effect is detected. Although postcontrast images are motion degraded, no definite pathologic intracranial enhancement is observed. Postoperative changes are seen from a previous right frontal approach biopsy of the thalamus.

Output: Stable exam compared to 7/29/2016 with only minimal residual parenchymal thickening.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, 11 years old, with arachnoid cyst, presenting with recurrence of dizziness, assess for changes. A nonenhancing extra-axial cystic lesion is demonstrated interposed between the left frontal lobe and calvarium. This lesion continues to measure approximately 32 x 27 mm and shows no significant change in size.Newly seen on this examination is a vague, 5 mm focus of soft tissue which appears to be situated at the most dependent portion of the cyst given supine positioning of the patient (see image 11 series 10 and image 11 series 8). This structure is not discretely visualized on the prior examinations, though this could reflect differences in technique.As before, no part of the cystic lesion enhances. The cyst exerts mass effect upon the adjacent left frontal lobe parenchyma but without pathologic parenchymal signal abnormality. The remainder of the examination is within normal limits.

Output: 1.No significant change in the overall size of an extra-axial cystic lesion along the left frontal lobe.2.Newly visualized on this examination is a small quantity of nonenhancing ill-defined soft tissue which appears to be layering in the most dependent portion of the cyst given supine positioning. Although this tissue was not clearly evident on prior exams, differences in technique may have prevented its identification. 3.Given that this tissue is nonenhancing and located dependently, it may simply represent a small quantity of layering debris. The possibility of a growing nodule is considered less likely at this point. If further imaging evaluation is warranted, repeat imaging could be considered with sequences obtained in prone or lateral decubitus positions in an attempt to demonstrate mobility of this tissue within the cyst.


Instruction: Generate impression based on findings.

Input: Female, 8 years old, with history of arachnoid cyst status post cyst fenestration in June 2015. Evaluate for changes. The fenestrated arachnoid cyst located at midline just above the cerebellar vermis shows no significant interval change when compared to the prior examination. There is no mass effect upon the tectum or the vermis, and the cerebral aqueduct remains well visualized and patent.No evidence of significant parenchymal signal abnormality is seen. There are no areas of edema or mass effect. No pathologic parenchymal or extra-axial enhancement is seen. Sequelae of prior suboccipital craniectomy are redemonstrated without significant interval change. The ventricles are normal in size and morphology.

Output: Stable size of the fenestrated arachnoid cyst.


Instruction: Generate impression based on findings.

Input: Crohn disease, evaluate areas of inflammation ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: 1.1 x 0.8 cm cystic lesion in the region of the pancreatic head (series 4, image 20). No associated pancreatic ductal dilation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Wall enhancement and thickening involving approximately 10 cm of the terminal ileum. The more proximal aspect of this bowel segment demonstrates focal stricturing over a 3 cm course (series 3, image 17). Angulation of several small bowel loops in the lower abdomen and pelvis compatible with adhesions. The cecum and appendix are normal in appearance. No evidence of fistula. Mildly prominent ileocolic lymph nodes are noted.BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1.Acute on chronic inflammation of the terminal ileum with focal stricturing as described above compatible with inflammatory bowel disease.2.Cystic lesion in the region of the pancreatic head with associated pancreatic ductal dilation. While this finding may represent an ampullary or duodenal diverticulum, follow-up MRI / MRCP with attention to the pancreas is recommended in 6 months.


Instruction: Generate impression based on findings.

Input: Male, 33 years old, with epilepsy status post depth electrode placement. Findings compatible with recent placement of depth electrodes are seen including bilateral scalp thickening and subgaleal fluid as well as creation of multiple bilateral burr holes.Bilateral parietal burr holes are in place through each of which passes a depth electrode coursing anteriorly through the bilateral medial temporal lobes.A left frontal burr hole is in place through which pass two depth electrodes which traverse posteriorly and inferiorly through the frontal lobe to terminate just below the basal ganglia.A left temporal burr hole is in place through which pass three depth electrodes traversing medially across the anterior left temporal lobe.Intracranial air is compatible with recent surgery. No unexpected extra-axial collections or significant intracranial hemorrhage is seen. No significant parenchymal edema or mass effect is observed. The ventricular system is normal in size and morphology.

Output: Expected findings status post recent placement of a single right-sided and multiple left-sided depth electrodes.


Instruction: Generate impression based on findings.

Input: Right L3-4 nerve pain. There is 5 mm of anterolisthesis of L4 on L5. At L4-5, there is also a disc bulge, facet arthropathy with effusions, and ligamentum flavum thickening, which result in mild bilateral neural foraminal narrowing and moderate spinal canal narrowing. At L5-S1, there is a disc bulge, facet arthropathy, and ligamentum flavum thickening, which result in moderate right and mild left neural foraminal narrowing and mild spinal canal narrowing. There is a small disc bulge at T12-L1, without significant spinal canal or neural foraminal narrowing. There is no significant disc bulge, spinal canal narrowing or neural foraminal compromise at L1 through L4. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: Mild anterolisthesis of L4 on L5 and degenerative spondylosis at L4-5 and L5-S1.


Instruction: Generate impression based on findings.

Input: Brainstem glioma: increased dysarthria and ataxia. There is no appreciable change in the heterogeneous upper brainstem mass, measuring up to approximately 23 mm, with a small cystic area along the right aspect of the mass. The mass protrudes into the inferior portion of the third ventricle and there is unchanged mild prominence of the bilateral lateral ventricles. There are unchanged punctate foci of susceptibility effect in the brainstem and surrounding areas, which may be related to prior radiation therapy. There is unchanged encephalomalacia in the medial right cerebellar hemisphere. There is also a punctate focus of encephalomalacia at the site of the previously demonstrated acute right external capsule infarct. There is an unchanged small cystic area in the left basal ganglia, which may represent a chronic lacunar infarct or prominent perivascular space. There are unchanged mild nonspecific scattered areas of high T2 signal in the periventricular white matter. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. No appreciable change in the treated brainstem glioma.2. Unchanged encephalomalacia in the medial right cerebellar hemisphere. 3. Chronic right external capsule lacunar infarct.


Instruction: Generate impression based on findings.

Input: Metastatic cancer to the brain. Treatment planning. Punctate residual contrast enhancement in the left cerebellar hemisphere related to treated lesion is unchanged. There are several contrast enhancing nodules involving the left parietal and occipital white-matter, which appears slightly increased in size since the previous examination. The largest one measures 7 mm compared to 5 mm previously, and is in the left parietal lobe. On the axial 3D postgadolinium series 1201, there are two left parietal lobe lesions, images 123 and 118. There is a left temporal occipital lesion, image 89. Lesions are associated with minimal surrounding edema, which is increased. Given their size, there is no significant mass-effect. There are questionable additional foci of enhancement such as in the right anterior temporal lobe, axial image 78 and right frontal lobe image 138, possibly artifactual. The significance of these may be better assessed on follow-up studies.There is no midline shift or brain herniation. There is no acute intracranial hemorrhage or infarct. The major vascular flow voids are preserved. There is mild mucosal thickening in the anterior ethmoid sinuses and right maxillary sinus. There is no gross orbital abnormality.

Output: 1.There are at least 3 well-defined subcentimeter enhancing lesions involving the left parietal lobe and at the left temporal-occipital junction as described above, which are consistent with metastatic disease. There is minimal surrounding edema.2.Punctate residual contrast enhancement in the left cerebellar hemisphere related to treated lesion is unchanged. 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: follow-up: FHLH s/p multiple areas of ischemic necrosis at diagnosis in 2007; currently stable spastic quadriparesis and global delay and seizures History: spastic quadriparesis and global delay and seizures There is redemonstration of extensive loss of parenchymal volume with accompanying signal FLAIR signal abnormality consistent with gliosis, most conspicuous in the hemispheric white matter, and in some locations extending through the cortex (for example in the left perirolandic region). Signal abnormality and volume loss involves the brainstem and cerebellar hemispheres to a lesser extent. Ventricles remain enlarged related to the volume loss more pronounced in the bilateral frontal and temporal lobes. No findings to suggest hydrocephalus. These findings are unchanged from the prior examination and consistent with sequela of remote insult, possibly due to reported hemophagocytic disorder.No new parenchymal signal abnormality is appreciated compared to 10/5/2011. There is diffuse thinning of the corpus callosum which may be related to Wallerian degeneration but unchanged from prior. There is no intracranial mass effect, midline shift, or basal cistern effacement. There is no diffusion abnormality. There is no evidence of intracranial hemorrhage or extra-axial collection. There is no abnormal enhancement following injection of intravenous contrast.The major intracranial flow-voids are present. Visualized orbital contents are unremarkable. There is mild opacification involving the right sphenoid sinus as well as small right maxillary mucosal retention cyst.

Output: Sequela of extensive prior insult including severe supratentorial and to a lesser degree infratentorial parenchymal volume loss but remains unchanged since 10/5/2011. No new parenchymal lesion or area of abnormal enhancement.


Instruction: Generate impression based on findings.

Input: Clinical There is replacement of the marrow signal involving the coccygeal segments with a fracture through the coccyx. The marrow signal is hypointense on T1, hyperintense on T2 and enhances. There is an adjacent fluid pocket inferiorly measuring 1.9 x 1.5 cm contiguous with the bone. No intrapelvic extension.There is some soft tissue loss involving the right posterior thigh adjacent to the greater trochanter however, no signal abnormalities noted within the femur.There is some subcutaneous edema.There is some mild edema involving the left hamstring tendons.

Output: Findings of osteomyelitis of the coccyx with a soft tissue abscess.


Instruction: Generate impression based on findings.

Input: Reason: assess for fracture, new bony mets History: non weight bearing, L hip pain, new bony mets to R sacrum, b/l ilium, R femur head w pathologic fracture in L ilial crest Pelvis: There is a mixed sclerotic and lytic lesion in the left ilium with a nondisplaced small pathological fracture in the nonweightbearing portion of the left ilium. The right ilial, right sacral and the right femoral metastatic lesions are better characterized on the MRI from today.Right hip: The right intertrochanteric femoral metastatic lesion is subtly seen with no associated pathological fracture.

Output: Multiple metastatic lesions as described above, with a nondisplaced small pathological fracture in the nonweightbearing portion of the left ilium.


Instruction: Generate impression based on findings.

Input: The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. The imaged spinal cord displays normal signal and morphology with the conus terminating at L1. There is mild enhancement of the cauda equina nerve roots without evidence of epidural abscess.There is mild unchanged T2 hyperintensity and enhancement within the L3-L4 interlaminar space, likely related to prior lumbar punctures. There is minimal disc desiccation and disc bulge at L3-L4 and mild disc desiccation and disc bulge at L4-L5 there is also mild facet arthropathy and mild posterior annular fissure. These findings are unchanged and do not result in significant spinal canal or neural foramen stenosis.

Output: 1.Mild cauda equina enhancement compatible with nonspecific arachnoiditis of uncertain etiology. This may be infectious, inflammatory, neoplastic, or post lumbar puncture in nature and is likely related to the brain findings. Imaging of the cervical and thoracic spine may be helpful to exclude lesions in this location.2.Unchanged mild degenerative changes at L3-L4 and L4-L5 without significant spinal canal or neural foramen stenosis.


Instruction: Generate impression based on findings.

Input: Peroneal tendinitis TENDONS: There is thickening and abnormal signal of the peroneal tendons, particularly the longus just distal to the peroneal tubercle. There is no evidence of a full-thickness tear. Mild fluid surrounds both the peroneal tendons reflecting a component of mild tenosynovitis.LIGAMENTS: No significant abnormality noted.ARTICULAR SURFACES AND BONE: Abnormal marrow signal and irregularity of the peroneal tubercle is noted although a discrete fracture line is not visualized. Additional abnormal marrow signal is noted within the metatarsal of the visualized fourth metatarsal again with no discrete fracture line identified. Severe osteoarthritis affects the third and fourth MTP joints with associated reactive marrow and degenerative cystic change.ADDITIONAL

Output: 1. Abnormal thickness and signal of the peroneal tendons with surrounding fluid representing a combination of tendinosis and possible split tearing with associated mild tenosynovitis. There is no evidence of full-thickness tear. The remaining tendons of the ankle are intact.2. Abnormal signal within the peroneal tubercle without discrete fracture line likely representing stress injury. Similar abnormal marrow edema is noted within the base of the fourth metatarsal which is incompletely visualized but also likely represent stress injury.3. Severe degenerative changes of the third and fourth MTP joints.


Instruction: Generate impression based on findings.

Input: Ms. Edens is a 58 year old female presenting for MRI evaluation of screen detected calcifications in the left breast. There is heterogeneous amount of fibroglandular tissue in both breasts. Mild background parenchymal enhancement is noted bilaterally.LEFT BREAST: Spanning the entire left superior breast is a segmental distribution of clumped nonmass enhancement spanning approximately 9.0 x 2.3 x 3.4 cm (AP x ML x SI). This clumped nonmass enhancement extends to within 1 cm from the left nipple base and approximates the distribution of the mammographically detected calcifications. There are a few additional foci of enhancement seen in the left inferior and left lower outer breast, none of which are more suspicious than the rest.RIGHT BREAST: Slight motion artifact limits sensitivity of the right breast. However, there is no abnormal enhancement seen in the right breast.AXILLA: There are two abnormal morphology lymph nodes identified in the left axilla, the largest one of which measures approximately 2.1 cm. There are no abnormal lymph nodes identified in the right axillary region.

Output: (1) 9.0 cm of clumped nonmass enhancement in a segmental distribution in the left superior breast, approximating the distribution of the mammographically detected calcifications. A two site ultrasound-guided biopsy with clip placement is recommended for further evaluation.(2) Abnormal morphology lymph node in the left axilla. An MR directed ultrasound with ultrasound-guided biopsy is recommended for further evaluation.(3) No MRI evidence of malignancy in the right breast.BIRADS: 5 - Highly suggestive of malignancy.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration.


Instruction: Generate impression based on findings.

Input: Ms. Tsoutsias is a 44 year old female with known multifocal left breast IDC currently on neoadjuvant therapy. She presents today for MRI evaluation as part of ISPY2 trial. There is heterogeneous amount of fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally. Bilateral retropectoral silicone implants are present.Left breast: In the left lower inner breast, the index malignancy now measures approximately 1.3 x 1.0 x 1.3 cm, previously measuring 2.8 x 1.4 x 2.1 cm (AP x ML x SI). Susceptibility artifact from biopsy marker clip continues to be seen in the mass. The index mass continues to abut against the pectoralis muscle, with no obvious enhancement or abnormal contour of the pectoralis muscle itself.In the left inferior breast, the linear nonmass enhancement surrounding a cyst now measures approximately 5.1 x 1.4 x 1.4 cm, previously measuring 5.1 x 2.3 x 2.8 cm. The total span of abnormal enhancement (index malignancy + nonmass enhancement) measures approximately 5.1 x 3.4 x 3.9 cm, previously measuring 5.2 x 4.4 cm.Right breast: There is no abnormal enhancement seen in the right breast.Axillae: A total of four abnormal lymph nodes continue to be seen in the left axilla. Representative lymph node now measures 1.0 cm in the axial plane, previously measuring 1.1 cm. No abnormal axillary lymph nodes are identified in the right axillary region. Extra-mammary: A port-a-cath is present in the right upper chest wall. A high T2 signal hepatic lesion is partially visualized, likely a benign cyst.

Output: (1) Continued interval decrease in index malignancy and malignant non-mass enhancement in the left breast, with residual enhancement measuring up to 5.1 cm. Stable metastatic left axillary lymph node.(2) No MRI evidence for malignancy in the right breast.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: 47 year old female patient with hepatic cysts seen on OSH 12/2015. ABDOMEN:LIVER, BILIARY TRACT: There are multiple lesions non-enhancing, T2 hyperintense lesions throughout the liver which are compatible with simple hepatic cysts. The largest is within the left hepatic lobe measuring 6.1 x 5.3 cm (image 249, series 12). Some lesions are mildly complex with enhancing internal septae. Additionally, a segment VIII lesion measuring approximately 2.5 x 2.1 cm (image 47, series 12) with peripheral, discontinuous, nodular enhancement is compatible with a hemangioma. Overall, the lesion appears similar in size to the prior outside hospital CT. No new hepatic lesion is identified. No intra or extra hepatic biliary ductal dilatation. The hepatic vasculature is patent.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small right peripelvic cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Enlarged myomatous uterus.

Output: 1.Multiple cystic hepatic lesions representing simple and mildly complex hepatic cysts, appearing grossly stable in size to an OSH CT.2.Segment VIII hemangioma.3.Enlarged myomatous uterus.


Instruction: Generate impression based on findings.

Input: 55 year-old female with endometrial cancer. Now with supraclavicular lymph nodes and cough. Images through the skull base including cavernous sinuses, petrous bones and paranasal sinuses remain within normal limits.Images through the soft tissues of the neck demonstrate a small midline cystic structure in the nasopharynx which is believed to represent a Tornwaldt cyst with questionable clinical significance.There is suggestion of a cyst within the right tonsil suspect that of a retention cyst with no enhancement.Images the level of the left supraclavicular region demonstrate minimal soft tissue thickening immediately posterior to the left scalene muscle. There is no evidence of enhancement of this soft tissue prominence. This finding may represent a lymph node. This area is somewhat obscured by contrast material that was injected from the left side. Further evaluation with an MRI is recommended. This finding is best appreciated on axial image 66 to 71. No evidence of any additional area of suspected lymph node is present. Extensive degenerative changes of cervical spine with multilevel neuroforamina compromise is noted.

Output: Only minimal soft tissue fullness in the left supraclavicular region with no distinct lymph node or enhancement as detailed above. Further follow-up with an MRI is recommended to exclude lymphadenopathy.


Instruction: Generate impression based on findings.

Input: Cervical radiculopathy Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained. Bone marrow signal is within normal limits. The cervical spinal cord has normal signal characteristics and overall morphology.There is mild congenital narrowing of the spinal canal. Individual levels as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: No significant compromise to the spinal canal or neural foramina.C4-5: Minimal disc bulge. No compromise to the spinal canal or neural foramina.C5-6: Minimal disc bulge. No compromise to the spinal canal or neural foramina.C6-7: No significant compromise to the spinal canal or neural foramina.C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: Examination of the cervical spine is essentially unremarkable for age. No significant spinal canal or neural foraminal stenosis is evident at any level.


Instruction: Generate impression based on findings.

Input: Female 16 years old Reason: please evaluate for structural abnormality History: possible seizure There is prominence of the lateral ventricles, left greater than right, similar to prior exam, with colpocephalic configuration. The third ventricle and fourth ventricle as well as the basal cisterns are also enlarged, similar to prior exam. There is dysgenesis of the corpus callosum. There are a few nonspecific small FLAIR signal abnormalities in the periventricular white matter. There is a 3 mm probable lipoma in the cerebellomedullary cistern on the left. Possible inferior vermian hypoplasia is noted.There is no evidence of intracranial hemorrhage, mass or edema. No abnormal extra-axial fluid collection is identified. There is no midline shift or mass effect. There is no diffusion abnormality to suggest acute infarction. Normal flow-voids are demonstrated in the major intracranial vascular structures.There is mucosal thickening in the maxillary sinuses, the anterior ethmoids, sphenoid sinus and the frontal sinuses. There is fluid signal in the mastoid air cells, left greater than right. The left lens is dislocated. Evidence of left choroidal detachment is also noted.

Output: 1.Callosal dysgenesis with colpocephalic configuration of the lateral ventricles.2.Paranasal sinus disease.3.Left lens dislocation and evidence of choroidal detachment.


Instruction: Generate impression based on findings.

Input: Pituitary lesion and Chiari one malformation: yearly follow up. Brain: There are unchanged low lying cerebellar tonsils that extend to the level of the tip of the dens with mildly blunted cerebrospinal fluid flow across the posterior foramen magnum and intact flow anteriorly. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Pituitary: There is a cystic lesion within the pituitary that measures up to 13 mm in width, which is unchanged. There is unchanged slight deviation of the infundibulum to the right. The cavernous sinuses and optic apparatus are intact.

Output: 1. Unchanged stigmata of Chiari 1 malformation.2, Unchanged pituitary cyst.


Instruction: Generate impression based on findings.

Input: 61 years Male (DOB:1/27/1955)Reason: brain lesion: preop planning for craniotomy and resection History: headachesPROVIDER/ATTENDING NAME: BAKHTIAR YAMINI BAKHTIAR YAMINI There is a 30 x 40 mm axial dimension mass centered in the left trigone of the lateral ventricle. It is predominantly low signal on T2-weighted imaging. It enhances following gadolinium administration. It is well-circumscribed. It is not changed substantially since the 2/23/2016 exam.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.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.

Output: There is a mass in the trigone of the left lateral ventricle. One possibility is that this represents a meningioma. Examination was performed for the purpose of stereotactic guidance.


Instruction: Generate impression based on findings.

Input: Reason: Evaluate for aneurysm or vascular abnormality and etiology of SAH History: SAH, ICH, seizures. MRI of the brainNo diffusion weighted abnormalities are appreciated.There a multiple punctate foci of signal loss on susceptibility imaging in the deep gray nuclei and to a lesser degree subcortical white matter and in the right cerebellar hemisphere and brainstemThere is a hemorrhagic lesion in the right frontal subcortical white matter.There is subarachnoid susceptibility effect along the ambient and quadrigeminal plate cisterns.There is a mild degree of periventricular and 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 mild mucosal thickening. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.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 sized. The posterior communicating arteries are not readily identified. The vertebral arteries are similar in size.

Output: 1.No evidence for cerebrovascular occlusive disease.2.No evidence for intracranial aneurysm.3.Subarachnoid blood in the ambient and quadrigeminal plate cisterns4.Small right frontal hematoma5.Multiple microhemorrhages are present throughout in the deep gray nuclei, cerebellum and subcortical white matter. The pattern is suggestive of hypertension.6.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 7.The exam is degraded due to patient motion. This may obscure more subtle abnormalities.


Instruction: Generate impression based on findings.

Input: There is a solitary, nonenhancing, 4-5 mm focus of T2 hyperintensity within the left paramedian frontal subcortical white matter (series 501, image 21/29) which was present on the comparison study and is unchanged. There is no associated mass effect or susceptibility abnormality. The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain. Incidental note is made of a small developmental venous anomaly within the right frontal white matter draining medially.

Output: There is a solitary, nonenhancing, 4-5 mm focus of T2 hyperintensity within the left paramedian frontal subcortical white matter which was present on the comparison study and is unchanged.


Instruction: Generate impression based on findings.

Input: Seizure disorder. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are a few subcentimeter prominent perivascular spaces in the superior bilateral cerebral hemispheres. The brain parenchyma and pituitary gland otherwise appear unremarkable. In particular, there is no evidence of heterotopia, hamartomas, or medial temporal sclerosis. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There are bilateral maxillary sinus retention cysts.

Output: No evidence of seizure foci.


Instruction: Generate impression based on findings.

Input: History of pancreatic cyst. Evaluate for interval change. ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in pathology, size and signal intensity. No focal suspicious lesion, biliary ductal dilatation or vascular abnormality. Mild CBD intraluminal heterogeneity favored to be artifactual. Status post cholecystectomy. SPLEEN: No significant abnormality noted.PANCREAS: At the junction of the pancreatic head and uncinate process there is a 1.8 x 1.7 cm unilocular somewhat lobulated cystic lesion (series 4/21), previously measuring 1.6 x 1.3 on CT from 2012. It does not clearly communicate with the main pancreatic duct. There is no abnormal postcontrast wall thickening or mural nodularity. The main pancreatic duct is normal in caliber. There are scattered punctate cystic foci in the pancreatic parenchyma suggestive of sidebranch IPMNs.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Minimal interval increase in the size of the unilocular lobulated cystic lesion at the pancreatic head and uncinate process without definite communication with the main pancreatic duct or suspicious imaging characteristics. Continued surveillance imaging is suggested.


Instruction: Generate impression based on findings.

Input: 18-year-old male with right hip pain status post right hip labral tear. Evaluate for recurrening labral tear. ACETABULAR LABRUM: Again seen is linear increased signal intensity and intra-articular gadolinium traversing the anterior superior acetabular labrum unchanged in extent from prior study extending from the 10 o'clock to 1 o'clock position compatible with a tear. There is a CAM deformity along the anterior superior femoral head with elevated alpha angle measuring 80 similar to prior. ARTICULAR CARTILAGE AND BONE: No articular cartilage defect is identified. Bone marrow signal intensity is normal.SOFT TISSUES: There is extravasation of contrast material within the anterior soft tissues along the tract of injection. Otherwise the soft tissue tissues are unremarkable. ADDITIONAL

Output: 1. Persistent anterior superior labral tear unchanged in extent from prior study.2. CAM deformity similar to prior study.


Instruction: Generate impression based on findings.

Input: Again seen are postoperative changes of suboccipital decompressive craniectomy and C1 laminectomy with resection of small meningioma at the C1-C2 level. Compared to postoperative study from 4/1/2015, there is significant increase in fluid collection involving the suboccipital soft tissues extending to the lower C2 level and measuring approximately 2.6 x 3.6 x 3.6 cm in the AP, transverse, and craniocaudal dimensions, likely representing a pseudomeningocele.The expansile mass involving the medulla and upper cervical cord appears similar in size and configuration. The other known intracranial masses also are not significantly changed including a left cavernous sinus meningioma which extends slightly into the suprasellar cistern and bilateral vestibular schwannomas. Evaluation of the orbits again demonstrates an enhancing mass in the left orbit extending from the orbital apex to just posterior to the globe likely representing an optic nerve sheath meningioma. No abnormal signal within the optic nerve is demonstrated. No significant change in diffuse thickening, T2 hyperintensity and enhancement involving the left upper eyelid.No evidence of acute ischemia or hemorrhage. No new mass effect. No hydrocephalus. There is a small left maxillary sinus mucosal retention cyst.

Output: 1. Evolution of postsurgical changes of suboccipital decompression and resection of small C1-C2 meningioma. Interval increase in size of fluid collection in the surgical bed is noted which likely represents a pseudomeningocele.2. Evaluation of the orbits demonstrates no appreciable change in size of left orbital mass which likely represents an optic nerve sheath meningioma when compared to most recent study. There is mild enlargement when compared to more remote study dating back to 6/15/2012. There appears to be mild compression of the left optic nerve. 3. Stigmata of neurofibromatosis type 2 with additional masses including a cervicomedullary ependymoma, left cavernous sinus meningioma, and bilateral vestibular schwannomas which are not significantly changed.


Instruction: Generate impression based on findings.

Input: Check for ACL and MCL injury. Laxity on exam and pain MENISCI: No significant abnormality noted. Specifically no findings to suggest associated tear or degeneration. Minimal extrusion questionably observed in the medial meniscus.ARTICULAR CARTILAGE AND BONE: Minimal bone contusion observed in the lateral and medial femoral condyle with moderate associated thinning of the cartilage, again more pronounced than lateral compartment. No discrete underlying focal defects observedLIGAMENTS: ACL is disrupted and torn with suspected adherent to the PCL with a remaining distal component. PCL and LCL are otherwise intact, however minimal inflammatory changes observed surrounding the medial collateral ligament, raises concern for mild inflammation however fibers are preserved throughout their entirety and remain intact. No discrete tears observed. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: ACL disruption with associated large effusion and mild sprain of the MCL. Menisci intact, and details are provided


Instruction: Generate impression based on findings.

Input: Dizziness and weakness. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are minimal scattered nonspecific punctate foci of cerebral white matter T2 hyperintensity. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unremarkable.

Output: No evidence of intracranial hemorrhage, mass, or cerebral edema.


Instruction: Generate impression based on findings.

Input: Right hip pain. Evaluate for labral tear. Several sequences are limited by patient motion artifact.ACETABULAR LABRUM: Although I see no gadolinium entering the substance of the labrum, a thin linear band of intermediate signal intensity traverses the labrum at approximately the 2:00 position likely representing a chronic tear present on the prior study. There is blunting and fraying of the labrum more superiorly toward the 12:00 position. I see no displaced labral fragment.ARTICULAR CARTILAGE AND BONE: Subjectively, the posterior articular cartilage of the hip joint appears slightly thinned; I see no focal fluid-filled defect. Bone marrow signal intensity is normal. I see no frank CAM deformity.SOFT TISSUES: There is mild edema lateral to the greater trochanter which may reflect mild inflammation, but this is of uncertain clinical significance. I see no tears of the hip abductors. There is also mild edema at the origin of the adductor magnus on the right which may reflect a mild strain, but this is equivocal. ADDITIONAL

Output: Small non-fluid-filled tear of the anterosuperior labrum with additional blunting/fraying of the superior labrum, of questionable clinical significance. Other findings as above.


Instruction: Generate impression based on findings.

Input: 35-year-old female with cervical bleeding and concern for cervical cancer. Lack of intravenous contrast limits sensitivity for solid organ pathology. Please note that multiple sequences are also limited or not completed, as the patient was unable to tolerate positioning within the scanner.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: 2.5 x 3.4 cm slightly thick-walled, lobulated T2 hyperintense cystic lesion with few peripheral, thin septations in the pancreatic body, most likely due to mucinous cystic neoplasm given the appearance and patient's age. Normal caliber of the main pancreatic duct.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: Mild nonspecific edema-like signal seen tracking along the left iliopsoas muscle, which may be due to strain.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Gravid uterus with anterior placenta. Small to moderate amount of subchorionic hemorrhage is present posteriorly (series 1201/44). Limited evaluation of the fetus due to motion.Intermediate T2 hyperintensity cervical mass measuring up to 5.1 x 7 x 5.9 cm (series 1301/36 and series 1501/35), highly suspicious for cervical cancer. Probable mild invasion into the left vaginal cuff (series 1301/31). No definite parametrial invasion or rectal/bladder invasion. Packing material within the vagina noted.BLADDER: Air within the bladder due to Foley catheter being in place.LYMPH NODES: Mild bilateral pelvic lymphadenopathy. For future reference, an enlarged right external iliac lymph node measures 14 x 14 mm (series 1201/45), and an enlarged left common iliac lymph node measures 14 x 11 mm (series 1201/67).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Gravid uterus with subchorionic hemorrhage present. Correlation with pelvic ultrasound is recommended.2.Cervical mass, highly suspicious for cervical cancer.3.Mild pelvic lymphadenopathy, suspicious for metastatic disease.4.Cystic pancreatic body mass, most likely due to mucinous cystic neoplasm given the appearance and patient's age. Short interval follow-up contrast enhanced MRI/MRCP can be obtained for further catheterization.


Instruction: Generate impression based on findings.

Input: Right upper quadrant pain ABDOMEN:LUNG BASES: Cardiomegaly. No pleural effusions.LIVER, BILIARY TRACT: Prominent hepatic veins and intrahepatic IVC, likely representing a component of cardiac congestion. No focal hepatic lesions are seen. No biliary ductal dilation is present.Cholelithiasis without choledocholithiasis. A small amount of fluid about the gallbladder is nonspecific, though similar to prior CTs dating back to 3/12/2015 and is likely secondary to cardiac congestion.SPLEEN: No significant abnormality noted.PANCREAS: Punctate T2 hyperintensity in the inferior pancreatic head likely represents a very small side branch IPMN. Otherwise, no abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Subcentimeter renal cysts noted. No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Thoracic dextroscoliosis and lumbar levoscoliosis.OTHER: Small Tarlov cysts noted.

Output: 1.Cholelithiasis without specific evidence of cholecystitis.2.No specific findings otherwise to account for the patient's right upper quadrant abdominal pain.


Instruction: Generate impression based on findings.

Input: Spinal stenosis, lumbar region, with neurogenic claudication [724.03], Reason for Study: ^Reason: eval for epidural hematoma History: s/p spinal fusion For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. There are evidence of external fixation using rods and screws from L2 to L5 with bilateral total laminectomies from L4 to L5.There are also interbody spacer in the L23 and L34 disc spaces.The L4 and L5 vertebral bodies appears to be fused.At the level of L34, there is disc-osteophyte complex which shows broad based central to left protrusion and abuts thecal sac.There is also bony structure on the left side of the left L34 lateral recess indicating left L3 inferior articular process of facet joint. There is no definitive evidence of fluid collection or blood product at the left lateral recess area of L34 disc space on this MRI, though those possibilities cannot be excluded completely due to adjacent screw related metallic artifacts.On the right side lateral recess of the L34, there is mild foraminal stenosis. At the level of L23, bilateral mild to moderate foraminal stenosis are seen.Conus medullaris terminate at the level of L12 and the signal intensity of the spinal cord appears to be normal.There is subcutaneous fluid collection with air-fluid level which corresponds to postoperative changes.

Output: 1. External fixation using rods and screws from L2 to L5 with interbody spacer at L23 and L34 as described above.2. Left side lateral recess stenosis of L34 level likely related to both disc-osteophyte complex of L34 disc and inferior articular process of facet joint of L3. The likelihood of epidural blood products around the level of the L34 disc space is slim.3. Other postoperative changes do not show significant interval change since prior CT scan.


Instruction: Generate impression based on findings.

Input: 47 year old man with history of congenital heart block s/p pacemaker and pes excavatum s/p surgery, now with worsening LV EF and referred for cardiac MRI to assess function. Left VentricleThe left ventricle is moderately dilated with moderately reduced function. The overall LV ejection fraction is 36%, the LV end diastolic volume index is 119 ml/m2 (normal range: 74+/-15), the LVEDV is 246 ml (normal range 142+/-34), the LV end systolic volume index is 76 ml/m2 (normal range 25+/-9), the LVESV is 157 ml (normal range 47+/-19). LV mass index is 58g/m2, and LV mass is 120g. As seen on the previous MRI, there is a muscular band at the LV apex which alters the apical contours and causes apical dyskinesis. The apex is aneurysmal; however, it is not well seen due to artifact and the finding could potentially represent a diverticulum or also be a extreme normal variant. Left AtriumThe left atrium is normal. Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 48%, the RV end diastolic volume index is 99ml/m2 (normal range 82+/-16), the RVEDV is 205 ml (normal range 142+/-31), the RV end systolic volume index is 52 ml/m2 (normal range 31+/-9), and the RVESV is 107 ml (normal range 54+/-17). There is a pacemaker lead in the right ventricle. Right AtriumThe right atrium is mildly dilated. There is a pacemaker lead in the right atrium.Aortic ValveThe aortic valve opens widely and there is at least mild regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is trace pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is grossly normal in size.Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThere is a pacemaker in the left chest wall with associated artifact. 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. Moderately dilated left ventricle with moderate reduced systolic function (EF 36%). This has worsened since the previous MRI of 10/2013. The apex is not well seen due to severe artifact from the pacemaker can (see above for details).2. Normal sized RV with normal systolic function (EF 48%). 3. Dual chamber pacemaker with significant associated artifact. 4. At least mild aortic 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: 75-year-old male with right arm weakness and slurred speech. Evaluate for acute stroke. Reidentified is a focal area of hypoattenuation involving the left temporoparietal region compatible with encephalomalacia secondary to prior infarct. No new hemorrhage identified. There is mild ex vacuo dilation of the left occipital horn secondary to adjacent volume loss. No evidence of hydrocephalus.No evidence of acute ischemia, however, CT is insensitive for the evaluation of early ischemic change; if there is clinical concern for acute ischemia, an MRI may be considered.There is no evidence of intracranial hemorrhage, mass or edema. The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. No acute intracranial abnormalities are present including hemorrhage, mass-effect, or edema.2. No evidence of acute ischemia, however, CT is insensitive for the evaluation of early ischemic change; if there is clinical concern for acute ischemia, an MRI may be considered.


Instruction: Generate impression based on findings.

Input: Concern for spine osteomyelitis on chest CT. Please note lack of contrast and motion degradation limiting evaluation. There are erosive endplate changes involving the T4-T5 vertebral body endplates as seen on recent CT. There is T2/STIR hyperintensity compatible with edema involving the disc and adjacent vertebral body segments as well as posteriorly at the interspinous level to a mild degree. There is ankylosis involving the T5-T6 vertebral bodies and nonspecific T2 hyperintense foci involving the T6 vertebral body.There is diffuse T1 hypointensity involving the bone marrow which is nonspecific but favored to be related to renal osteodystrophy.There is mild to moderate loss of height associated with the T4 and T5 lytic changes and mild associated kyphotic angulation at this level. Vertebral body heights and alignment are otherwise maintained. Mild degenerative changes are evident including small disc bulge at the T4-T5 level with mild spinal canal stenosis. No high-grade spinal canal stenosis is evident at any level in the thoracic spine. There is moderate to severe neural foraminal stenosis at T4-T5.T2 hyperintensity involving the L1-L2 endplates are favored to represent Schmorl's nodes.Lumbar spine MRI sequences are severely motion degraded. Vertebral body heights and alignment are grossly maintained. Multilevel degenerative changes are seen including endplate marrow signal changes and disc bulges in the lower lumbar spine. No significant spinal canal stenosis is present at any level. No obvious epidural collection displacing the distal cord or cauda equina is demonstrated within the limits of noncontrast study.

Output: 1. Endplate destructive changes involving the T4-T5 level as seen on recent CT. No epidural or paraspinous collections to suggest abscess are appreciated within the limits of noncontrast MRI. There is also loss of disc space inferiorly at T5-T6 with bony ankylosis at this level. These findings suggest possibility that the T4-5 findings are chronic. Discitis-osteomyelitis cannot be excluded at this level. Dialysis-related arthropathy is also a possibility. 2. Severely motion degraded lumbar spine study demonstrating no large epidural collections. No findings to suggest significant spinal canal stenosis in the thoracic or lumbar spine.3. Diffuse T1 hypointensity involving the bone marrow which is nonspecific but favored to be related to renal osteodystrophy.4. Endplate changes at L1-L2 level which are suboptimally evaluated but likely represent Schmorl's nodes.


Instruction: Generate impression based on findings.

Input: Please note lack of contrast significantly limits evaluation for leptomeningeal disease. Within this limitation, no cord signal abnormality or mass within the cervical, thoracic, or lumbar spinal canal is appreciated to suggest drop metastases. Postsurgical changes in the posterior fossa are partially imaged with T2 hyperintensity along the resection cavity not appreciably changed since MRI dated 1/27/2016.Vertebral body heights in the cervical spine are grossly normal aside from minimal endplate deformities affecting the C3-C7 vertebral bodies. No suspicious osseous lesions are demonstrated. Mild degenerative changes are seen with small multilevel disc osteophyte complexes and ligamentum flavum thickening, but without significant spinal canal stenosis or neural foraminal stenosis at any level.In the thoracic spine, there is extensive T2 hyperintensity and mild T1 hyperintensity involving the T7 and T8 vertebral bodies extending into the posterior elements, particularly on the right. Smaller and more T1 hyperintense lesions are seen at the T5 and T6 vertebral bodies and the T12 vertebral bodies most compatible with hemangiomas. No abnormal flow-voids in the spinal canal. Subtle T2 hyperintensity and deformity of the posterior aspect of the cord is noted at the T7-T8 level which may be sequela of prior treatment with possible adhesions in the thecal sac. There is mild narrowing of the right T7-T8 and T8-T9 right-sided neural foraminal narrowing related to bony expansion of the right-sided pedicles. There is otherwise no significant spinal canal or neural foraminal stenosis in the thoracic spine. There is a small Schmorl's node involving the superior endplate of T6 level. Minimal generalized deformity of the thoracic endplates is noted, as in the cervical spine, but without significant overall loss of height at any level. There is evidence of prior laminectomies from T6 to T8.In the lumbar spine and partially imaged pelvis, there also multiple T1 hyperintense lesions most compatible with hemangiomas. Minimal degenerative changes are present without significant spinal canal or neural foraminal stenosis. Vertebral body heights are grossly maintained. Alignment is maintained. There is no significant spinal canal or neural foraminal stenosis at any level.

Output: 1. Please note lack of contrast significantly limits assessment of leptomeningeal disease and postcontrast sequences should be considered as clinically indicated. No obvious nodularity along the surface of the cord or cauda equina to suggest drop metastases. There are also no intramedullary or epidural masses.2. Evidence of multiple hemangiomas in the spine and visualized pelvis. There are particularly large T2 hyperintense lesions involving the T7 and T8 vertebral bodies with mild osseous expansion and extension into the posterior elements. These would be compatible with more vascular/aggressive hemangiomas/venous malformations but suggest comparison with prior imaging and pathology if available. There is evidence of prior T6-T8 laminectomies. Subtle cord signal abnormality and dorsal cord deformity at the T7-T8 level may be related to myelomalacia and adhesions in the thecal sac.


Instruction: Generate impression based on findings.

Input: Pain. Evaluate for internal derangement, possible slap tear. ROTATOR CUFF: The rotator cuff tendons and muscles are intact. No evidence of muscle atrophy.SUPRASPINATUS OUTLET: There are small osteophytes at the acromioclavicular joint compatible with mild osteoarthritis. No fluid is seen in the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral joint alignment is within normal limits. The articular cartilage is intact. There are small subchondral cysts along the posterior humeral head which are likely degenerative in etiology.There is a linear area of high signal intensity along the superior labrum at the 12 o'clock position which does not fill with contrast and likely represents a normal variant sulcus. No definite evidence of a labral tear. BICEPS TENDON: The biceps tendon is intact. ADDITIONAL

Output: 1. Intact labrum.2. Mild AC joint osteoarthritis and posterior humeral head degenerative cysts.


Instruction: Generate impression based on findings.

Input: 68 years, Female, metastatic leiomyosarcoma. Evaluate for metastasis. No intracranial mass or abnormal enhancement to suggest metastatic disease. Patchy foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild to moderate chronic small vessel ischemic changes. There is mild parenchymal volume loss and possible mild disproportional enlargement of the ventricular system for the degree of volume loss which along with focal expansion of the CSF spaces, particularly in the parieto-occipital region, raises possibility of communicating hydrocephalus in the appropriate clinical setting. Mega cisterna magna incidentally noted. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. Major flow-voids are preserved. There is osseous protuberance involving the left temporal inner table which represent osteoma. Rightward nasal septal deviation. Calvarium and extracranial soft tissues are otherwise grossly unremarkable.

Output: 1. No evidence of intracranial metastatic disease.2. Mild to moderate chronic small vessel ischemic changes.3. Suspected mild disproportionate enlargement of the ventricular system for the degree of volume loss, which raises possibility of communicating hydrocephalus/NPH in the appropriate clinical setting.


Instruction: Generate impression based on findings.

Input: Female 20 years old; Reason: Evaluate for possible right labral tear. ACETABULAR LABRUM: Abnormal signal in the anterior superior acetabular labrum is consistent with a labral tear, this is best seen on the radial view (Series 11, Image 15).ARTICULAR CARTILAGE AND BONE: No significant abnormality noted.SOFT TISSUES: No significant abnormality noted. ADDITIONAL

Output: Anterior superior labral tear.


Instruction: Generate impression based on findings.

Input: Diagnosis: Malignant neoplasm of brain, unspecifiedClinical question: increased tumor burdenSigns and Symptoms: lethargy There is redemonstration of a multiple foci of enhancement scattered throughout the brain. The largest one is located in the right frontal lobe which includes part of the prefrontal gyrus and measures 44 x 30 mm in axial dimensions and has a irregular ring-enhancing pattern. It is high signal on FLAIR and T2 and low signal on T1. This is stable and compared to the prior exam.There is punctate enhancement present within the corpus callosum associated T1 signal hyperintensity and ring enhancement as well as some susceptibility artifact. These are stable and compared to the prior exam.A left occipital lobe focus of abnormal enhancement is present which measures 36 x 24 axial dimensions on postcontrast imaging and 24 x 39 mm on FLAIR imaging. It is slightly larger on the current exam when compared to the prior exam where it measured approximately 20 x 37 mm axial dimensions on FLAIR imaging and 18 x 36 mm on postcontrast imaging.There is a lesion located at the left thalamus and posterior limb of internal capsule extending to the centrum semiovale measuring 18 x 12 mm which appears stable and enhances subtly following gadolinium administration. A similar lesion is present at the right globus pallidus and Jan of internal capsule and measures 16 x 11 mm and is also unchanged but does not enhance following gadolinium administration.There is redemonstration of a calvarial-based focus of ring enhancement located in the right frontal bone which measures 14 mm axial dimension and previously measured the same. It is best seen on the prior head CTs and appears like a burr hole.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.The current exam is compromised due to patient motion.

Output: 1.Since the prior examination multiple brain parenchymal lesions appear similar in dimensions. Some of the corpus callosum lesions are hemorrhagic. A left occipital lesion appears slightly larger on the current exam when compared to the prior exam. These lesions are suspicious for malignancy.2.There is a calvarial-based lesion present at the right frontal bone just anterior to the coronal suture. This most likely represents a prior burr hole.3.Exam is somewhat compromised due to patient motion which may obscure more subtle abnormalities.


Instruction: Generate impression based on findings.

Input: 66 year old with history of active smoking, hypertension and SLE with recent onset pericardial effusion requiring drainage and LV dysfunctionMEDICATIONS: carvedilol, furosemide, Bidil First Pass PerfusionDuring hyperemia, no perfusion defects were present.Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable.Left VentricleThe left ventricle is severely dilated with moderately reduced systolic function. The overall LV ejection fraction is 38%, the LV end diastolic volume index is 110 ml/m2 (normal range: 65+/-11), the LVEDV is 243 ml (normal range 109+/-23), the LV end systolic volume index is 68 ml/m2 (normal range 18+/-5), the LVESV is 150 ml (normal range 31+/-10), the LV mass index is 70 g/m2, and the LV mass is 243 g. There is global hypokinesis with regional variation. Native myocardial T1 relaxation times are within normal limits. Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 46%, the RV end diastolic volume index is 76 ml/m2 (normal range 69+/-14), the RVEDV is 167 ml (normal range 110+/-24), the RV end systolic volume index is 41 ml/m2 (normal range 22+/-8), and the RVESV is 90 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is mild to moderately aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in mildly dilated.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is a trivial pericardial effusion without significant pericardial thickening or obvious increased T2-signal.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. No perfusion defects/ "ischemia" present during hyperemia.2. No prior myocardial infarction. The entire myocardium is viable.3. Severe LV dilation with moderately reduced systolic function (LVEF 38%) without evidence of underlying myocardial fibrosis, inflammation, or infiltration.4. Normal RV size with mildly reduced systolic function (RVEF 46%).5. Moderate left atrial dilation. 6. Mild to moderate aortic regurgitation. 7. Trivial pericardial effusion without significant pericardial thickening or obvious increased T2-signal. 8. Mild main pulmonary artery dilation. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 42 year old with history of BRCA2, status post prophylactic mastectomies with history of incidental left DCIS at time of mastectomies. New palpable area of concern in the left lateral breast, not well characterized on ultrasound. The patient is status post bilateral mastectomies with implant reconstructions, and no clear residual fibroglandular breast tissue. No suspicious enhancement is seen in either breast reconstruction. There are bilateral circumscribed mixed T2 signal lesions in each medial breast compatible with bilateral oil cysts. The larger of these have central high signal compatible with fat. No suspicious enhancing lesion is seen laterally in the left breast at the area of clinical concern or elsewhere.No abnormal lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. Bilateral oil cysts. BIRADS: 2 - Benign finding.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Hx of prostate cancer, evaluate for further disease, biopsy to follow, considering active surveillance.Additional history per EMR:PSA history:2014: 4 ng/mLJanuary 2015: 5 ng/mLFeb 17, 2015: 7.07 ng/mLProstate biopsy 4/20/2015:Right apex Gleason 3+3, 1mm PELVIS:PROSTATE:Prostate Size: 5.7 x 4.9 cm.Peripheral Zone: Single focus of T2/ADC hypointense signal abnormality is seen in the mid gland/apex in the midline (series 901, image 19). No definite pathologic enhancement is seen on postcontrast sequences. This lesion is indeterminate. No other lesions suspicious for known prostatic adenocarcinoma are identified.Central Gland: Transitional zone is enlarged with multiple nodules demonstrating benign morphology without suspicious characteristics.Seminal Vesicles: Seminal vesicles are unremarkable.Extracapsular Extension: No evidence of extracapsular extension of a prostatic lesion.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Questionable small midline lesion in the mid gland/apex, as above.


Instruction: Generate impression based on findings.

Input: 75-year-old male with nearly diagnosed high-grade prostate cancer; Gleason 8 right mid lateral PELVIS:PROSTATE:Prostate Size: 4.5 x 3.3 x 5.0 cm.Peripheral Zone: Suboptimal evaluation due to diffuse hemorrhage. Thinning and scarring of the left peripheral zone. T2 hypointense lesion with corresponding ADC restriction measuring 10 x 8 mm in the right mid gland peripheral zone highly suspicious for malignancy. Additional adjacent smaller T2 hypointense foci with corresponding restriction on ADC also seen and suspicious, e.g., measuring 7 mm in the right mid gland peripheral zone (series 301, image 65). T1 hyperintense striations in the peripheral and transitional zones suspicious for hemorrhage.T2 hypointense focus in the midleft peripheral zone with no corresponding low ADC signal and T1 bright signal favoring to be blood products. Central Gland: Marked benign prostatic hypertrophy.Seminal Vesicles: No significant abnormality.Extracapsular Extension: No specific evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: T2 hyperintense lesion in the right femoral head, may be degenerative in etiology/subcortical cyst formation.OTHER: Diverticulosis without evidence of diverticulitis.

Output: 1.Suboptimal examination due to diffuse postprocedural hemorrhage (especially pronounced throughout peripheral zones) as described above.2.T2 hypointense lesion with corresponding ADC restriction in the right mid gland peripheral zone compatible with prostate malignancy.3.Additional smaller T2 hypointense/low ADC signal lesions seen, suspicious for neoplasm, e.g., smaller adjacent focus in right mid gland peripheral zone.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for progression of metastatic breast cancer status post RT. Signs and symptoms: Breast cancer with brain metastases status post RT. Negative cytology. Pre and post enhanced brain MRI:Extensive for the hyperintensity in the left cerebellum and its associated mass effect on the fourth ventricle demonstrate no definitive interval change. Within this region a cystic hemorrhagic focus with extensive enhancement demonstrate no convincing evidence of interval change in overall appearance. Findings represent site of a previous surgical intervention. It remains unclear whether there is residual tumor at this site or the extent of findings are demonstrated postoperative findings. Further follow-up is recommended.There is revisualization of a well-demarcated uniformly enhancing mass in the right temporal lobe measuring 10 x 9 mm in transaxial dimensions which is larger than prior study measurement of 6.7 x 6.7 mm. There is no surrounding vasogenic edema or appreciable mass effect with this finding.There is no evidence of any new abnormal foci of parenchymal or leptomeningeal enhancement. Calvarium demonstrate normal signal intensity and without abnormal enhancement.Unremarkable images through the orbits and including axial fat sat post enhanced series.All paranasal sinuses and bilateral mastoid air cells and middle ear cavities demonstrate normal pneumatization signal pattern.

Output: 1.Stable extensive FLAIR hyperintensity, internal foci of hemorrhage, extensive enhancement and subtle mass effect in the left cerebellum since prior exam. It remains unclear whether there is residual tumor within this region or findings represent post surgical changes. Follow-up is needed. 2.Interval increased size of a superficially located right temporal enhancing mass measuring at 10 x 8.5 mm compared to prior study measurement of 6.7 x 6.7 mm.3.No detectable new foci of parenchymal, leptomeningeal, calvarial or orbital enhancement.


Instruction: Generate impression based on findings.

Input: Female, 64 years old, with cervicalgia and spinal stenosis, history of cervical fusion. Preoperative evaluation for corpectomy. Again demonstrated is partial osseous fusion of the C6 and C7 vertebrae. Spinal alignment is anatomic. Vertebral body heights are preserved allowing for endplate degeneration. No evidence of marrow edema or pathologic marrow replacement is seen.The visualized spinal cord shows normal signal throughout. No epidural lesions are suspected.C2-3: Bilateral facet arthropathy. No spinal canal stenosis. Mild right foraminal narrowing. No interval changes. C3-4: Advanced facet arthropathy on the left. No spinal canal stenosis. Moderate left foraminal narrowing. No interval changes. C4-5: Bilateral facet arthropathy. Posterior disc-osteophyte complex formation. Mild effacement of the ventral thecal sac. Mild right foraminal narrowing. No interval changes. C5-6: Broad posterior disc-osteophyte complex formation causing at least moderate spinal canal stenosis with some deformation of the spinal cord but no evidence of cord edema. Moderate left and mild right foraminal narrowing. No interval changes. C6-7: No significant spinal canal or foraminal stenosis. C7-T1: No significant spinal canal or foraminal stenosis.

Output: 1.Fusion of the C6 and C7 vertebrae is redemonstrated compatible with prior surgery.2.A broad disc osteophyte at C5-6 continues to produce moderate spinal canal stenosis and mild deformation of the cord, similar to prior.3.Scattered additional degenerative changes, including mild-to-moderate foraminal narrowing as above, show no significant interval change.


Instruction: Generate impression based on findings.

Input: Abnormal results of other function studies of central nervous system [R94.09], Reason for Study: ^Reason: 6 month repeat MRI looking for hyperintensities to compare History: as above There is no evidence of acute ischemic or hemorrhagic lesion on this scan.There is no evidence new high signal intensity lesion on FLAIR/T2 images.Previously found multifocal high signal intensity lesions on FLAIR/T2 images including the right middle cerebellar peduncle, left posterior temporal lobe periventricular white matter (just underneath of the left lateral ventricle occipital horn), and right parietal lobe (right parietal operculum) appear to be stable or slightly not as conspicuous as it was.About 4.5mm downward herniation of cerebellar tonsils through the foramen magnum, no change since prior scan. The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear. Minimal mucosal thickening on ethmoid sinuses and sphenoid sinus.

Output: 1. Stable or slightly decreased signal intensity of previously noted lesions on FLAIR/T2 images including right middle cerebellar peduncle, left periventricular white matter especially inferior aspect of the lateral lateral ventricle occipital horn and the right parietal operculum since prior scan.2. No evidence of acute ischemic or hemorrhagic lesion on this scan.


Instruction: Generate impression based on findings.

Input: Compared to 7/1/2015 there is slight increase in prominence of the hypoenhancing pituitary lesion involving the left anterior aspect of the pituitary gland measuring 7 x 7 x 7 mm, previously 7 x 6 x 6 mm in the AP, transverse, and craniocaudal dimensions. Lesion is isointense on T1 and hyperintense on T2-weighted sequences. The pituitary stalk remains midline. There is no suprasellar extension or optic chiasm abutment. Cavernous sinuses are unremarkable. Limited evaluation of the visualized brain parenchyma is unremarkable.

Output: Stable to minimal interval increase in size of hypoenhancing nodule involving the left anterior aspect of the pituitary gland which is favored to represent a microadenoma. T1 hyperintense blood products within the sella seen on remote prior studies are no longer evident.


Instruction: Generate impression based on findings.

Input: The risks (including, but not limited to, those of bleeding, infection, allergic reaction, temporary nerve block, pain, and inability to access the joint) and benefits of the procedure were explained to the patient, and informed written consent was obtained. A pre-procedural “time-out” form was completed.The patient was placed supine on the fluoroscopy table. The left shoulder was localized fluoroscopically, and a spot radiograph was obtained. The skin was cleansed and covered with a sterile drape. The skin and subcutaneous tissues were anesthetized with 1% lidocaine using 25-gauge and 22-gauge needles.Under fluoroscopic guidance, a 21-gauge needle was advanced into the joint. Attempted aspiration yielded no fluid. Next, 10 ml of a 50/50 mixture of Omnipaque 240 (to confirm the intra-articular position of the needle) and dilute Multihance (0.1 cc in a 10 cc vial of saline, for subsequent MR imaging) were injected into the joint. Contrast opacified the joint in the expected manner. A spot radiograph was obtained for documentation. The needle was withdrawn. Blood loss was negligible (<1cc), and patient tolerated the procedure well without immediate complication. An adhesive bandage was placed on the patient’s skin. Routine post procedure instructions were communicated to the patient. The patient was escorted to the MRI suite for further imaging in stable condition. Please refer to the subsequent MRI report for further information.Exposure time: 55 seconds

Output: Successful left shoulder arthrogram.


Instruction: Generate impression based on findings.

Input: Shoulder pain and sciatica. Cervical spine:There are degenerative changes in the cervical spine, with level-specific findings as follows:C2-C3: There is mild disk-osteophyte complex, degenerative changes of uncovertebral joints and facet joints. Spinal canal and neuroforamina remain patent.C3-C4: There is mild disk-osteophyte complex, degenerative changes of uncovertebral joints and facet joints. Spinal canal remains patent. There is minimal left neuroforaminal narrowing.C4-C5: There is mild disk-osteophyte complex, degenerative changes of uncovertebral joints and facet joints. There is mild narrowing at the left lateral recess and left neuroforamen. C5-C6: There is mild disk-osteophyte complex, degenerative changes of uncovertebral joints and facet joints. There is mild narrowing at the spinal canal. Moderate bilateral neuroforaminal narrowing is also seen.C6-C7: There is moderate disk-osteophyte complex, degenerative changes of uncovertebral joints and facet joints. There is mild to moderate narrowing at the spinal canal. Moderate bilateral neuroforaminal narrowing is also seen.C7-T1: Spinal canal and neuroforamina are patent.Lumbar spine:For the purpose of labeling, 5 lumbar vertebral bodies are assumed to be present, with the most superior intervertebral level on the sagittal images assumed to be T12 - L1.Degenerative disease is seen in the lumbar spine. The degenerative changes at individual levels are as follows:T12-L1: There is central disk protrusion, with calcification. There is indentation of thecal sac. Neural foramina at this levels are patentL1-L2: Vacuum disk phenomenon is seen. There is disk bulging. Spinal canal and neural foramina remain patent.L2-L3: Vacuum disk phenomenon is seen. There is disk bulging, facet arthropathy changes and ligamentum flavum hypertrophy. Spinal canal and neural foramina remain patent.L3-L4: There is mild grade 1 anterolisthesis of L3 over L4, with disk bulging, facet arthropathy changes and ligamentum flavum hypertrophy, resulting in spinal canal stenosis and neural foraminal narrowing. L4-L5: There is disk bulging with calcification, facet arthropathy changes and ligamentum flavum hypertrophy, resulting in spinal canal. There is stenosis of the lateral recess with probably mild L5 nerve impingement bilaterally. There is neural foraminal stenosis greater on the left, with likely impingement of exiting left L4 nerve. L5-S1: There is disk bulging, posterior osteophytes, facet arthropathy changes and ligamentum flavum hypertrophy, resulting in spinal canal stenosis. There is latera recess and neural foraminal stenosis, with likely impingement of the S1 nerves at the lateral recesses.In the right iliac wing, there is a 14 mm lesion with fine internal matrix. Its imaging characteristics are of indeterminate significance. At a similar location, there is a subtle lesion seen on T1 weighted images on prior MRI of 12/07/07, suggesting this is likely a chronic lesion.There are fine calcifications in the left kidney with punctate calcification in the lower pole suggesting calculus.

Output: 1. Degenerative disease of the cervical and lumbar spine resulting in multilevel spinal canal and neuroforaminal stenosis as described above. There is likely multi-level nerve impingement. Further correlation with MRI will be helpful.2. Left renal calculus.3. Nonspecific lesion at right iliac wing, of indeterminate significance. Continued follow-up is recommended to confirm its stability.


Instruction: Generate impression based on findings.

Input: Decreased vision acuity. Headache with conjunctival injection and tearing The bilateral globes, optic nerves, extraocular muscles, orbital fat, lacrimal glands, and preseptal tissues are unremarkable. There is no evidence of intraorbital tumors. There is scattered paranasal sinus mucosal thickening and fluid levels in the bilateral maxillary sinuses, The intracranial structures are unremarkable.

Output: 1. No evidence of orbital lesions.2. Findings suggestive of acute sinusitis.


Instruction: Generate impression based on findings.

Input: Female 49 years old Reason: H/o Ovarian cancer s/p resection 1 year ago. Pt found on OSH to have a appendix thickening needs a a peritoneal protocol MRI ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. Segment 7 mildly T2 hyperintense lesion has peripheral nodular enhancement and progressive fill-in and is compatible with a hemangioma. There are scattered small T2 hyperintense foci in the liver compatible with cysts. Hepatic and portal veins are patent. Gallbladder contains sludge. Biliary tree is normal in caliber.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small bowel is normal caliber and course. The colon is nondistended. The appendix is located within the pelvis. It is dilated measuring 11 mm. It has a thick enhancing wall with restricted diffusion. No discrete measurable lesion along the peritoneum.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Status post hysterectomy.BLADDER: No significant abnormality noted. LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Please see aboveBONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Mildly dilated appendix with a thick enhancing wall. Differential considerations include chronic appendicitis or serosal disease. While acute appendicitis is also possibility there is no surrounding fluid to suggest acute inflammation.


Instruction: Generate impression based on findings.

Input: Malignant neoplasm of endometrium [C54.1] / Lumbago with sciatica, right side [M54.41] / Lumbago with sciatica, left side [M54.42], Reason for Study: ^Reason: Hx: recurrent endometrial cancer with worsening back pain. Please eval for cord compression. For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. There is acute compression fracture of L4 vertebral body with about 30% height reduction associated with bone marrow edema. On Gad enhanced scan, there is diffuse relatively homogenous enhancement of the L4 vertebral body which is matching with bone marrow edema extent. There is also relatively smooth enhancement surrounding the L4 vertebral body.There is no evidence of spinal canal stenosis or cord compression.There is grade 1 anterolisthesis of L5 on S1, but no evidence of spinal canal stenosis, nor neural foraminal stenosis.There is normal lumbar lordosis. The spine alignment is anatomic. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. The conus medullaris terminates at the T12-L1 level.

Output: 1. About 30% of compression fracture with bone marrow edema at the level of L4 vertebral body with enhancement. Most likely diagnosis would be osteoporotic compression fracture, however, considering the patient's history of endometrial cancer, metastatic compression fracture cannot be completely excluded.2. Grade 1 anterolisthesis of L5 on S1 without evidence of spinal stenosis.Comment: Neurointerventional evaluation and possible kyphoplasty with bone biopsy is recommended. I have discussed with Dr.Fleming and we both agreed on above plan.


Instruction: Generate impression based on findings.

Input: 49-year-old male with cavernous malformation The CSF spaces are appropriate for the patient's stated age with no midline shift. Redemonstrated is a 7 x 9 mm axial dimension lesion centered in the midbrain with heterogeneous signal centrally on T1 and T2 and a low signal ring. It has a popcorn-like appearance, and other than some minimal intrinsic signal changes, there has been no significant interval change in size or morphology. There is no perilesional edema. There is no associated DVA appreciated.Also redemonstrated is a well-circumscribed heterogeneous mass in the left half of the genu of the corpus callosum measuring 18 x 13 mm axial dimensions It is heterogeneous with predominantly high signal on T1 weighted imaging within its central portion. It has multiple septations and a low signal rim on all pulse sequences. There is extensive susceptibility effect associated with this. It protrudes into the frontal horn of the left lateral ventricle. Other than some minimal intrinsic signal changes, there has been no significant interval change in size or morphology. There is no perilesional edema. There is no associated DVA appreciated.As demonstrated previously, there are multiple punctate lesions scattered in both hemispheres of the brain as well as in the brainstem which are low signal on susceptibility weighted imaging.Redemonstrated are multiple foci of marrow replacement and enhancement scattered throughout the calvarium. Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Cerebral cavernous malformations in the genu of the corpus callosum and midbrain which are essentially stable.2.Punctate lesions throughout the supratentorial brain and brainstem are nonspecific but could represent small cerebral cavernous malformations.3.Multiple small calvarial lesions are present. These are nonspecific though they most likely represent hemangiomas.


Instruction: Generate impression based on findings.

Input: 71-year-old female with numbness. Evaluate expansion of subdural fluid collection. Redemonstrated are the findings from a previous left-sided craniotomy for aneurysm clip placement along the anterior communicating artery region. A previously demonstrated hypodense focus in region of the anterior limb of the left internal capsule, into aspect of the left lentiform nuclei and the left globus pallidus is again seen. There is associated ex vacuo dilatation of the anterior horn of the left lateral ventricle. Note is made of a small hypodensity within the anterior limb of the right internal capsule, unchanged. Note is made of a mixed density fluid collection along the right frontoparietal region, most consistent with an extra-axial hematoma. Note is made of mass effect with associated sulcal effacement of the right hemisphere in the surrounding area. No evidence of intraparenchymal hemorrhage. The remainder of the CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially.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. Redemonstrated is a hyperdense, bone density lesion along the inner table underlying left-sided periorbital gyri, without significant parenchymal mass effect.

Output: 1. Mixed density fluid collection overlying the left frontoparietal lobes consistent with a extra-axial hematoma, corresponding to the findings seen on recent MRI performed on 4/15/2013. No evidence of intraparenchymal hemorrhage.2. Status post aneurysm clipping of anterior communicating artery region aneurysm. 3. Expected evolution of prior infarct in region of the anterior limb of the left internal capsule with development of encephalomalacia and associated ex vacuo dilatation of the anterior horn of the left lateral ventricle.4. Small hypodensity within the anterior limb of the right internal capsule may represent prior remote lacunar infarct.5. Stable calvarial osteoma.


Instruction: Generate impression based on findings.

Input: History of cirrhosis and ascites. Evaluate liver lesions, masses, HCC screen, coronary calcification. ABDOMEN:LIVER, BILIARY TRACT: Widening of fissures consistent with cirrhosis. TIPS shunt. No suspicious hepatic mass. No biliary ductal dilatation.Scattered small hepatic cysts.Patent portal vein proximal to the shunt; patency within the TIPS shunt cannot be assessed due to metal artifact. No ascites or varices.SPLEEN: Borderline splenomegaly.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: Bilateral cystic foci at the bilateral sacral foramina suggestive of Tarlov cysts.

Output: Cirrhosis with no suspicious hepatic masses.


Instruction: Generate impression based on findings.

Input: Reason: L knee pain, evaluate for meniscus tear MENISCI: There is globular intrasubstance increased signal intensity within the lateral and medial menisci suggestive of intrasubstance degeneration. However, we see no meniscal tear.ARTICULAR CARTILAGE AND BONE: There is severe loss of cartilage at the undersurface of the patella. There is also focal degeneration of articular cartilage at the anterior aspect of the medial trochlea. Articular cartilage of the femorotibial compartments appears normal for age.LIGAMENTS: ACL appears normal. PCL is thickened with intermediate signal intensity, which may reflect mucoid degeneration or partial thickness tearing. Collateral ligaments are intact. EXTENSOR MECHANISM: There is minimal increased signal of the proximal fibers of the patellar tendon, which may represent tendinosis, but this is equivocal. Insall Salvati ratio measures 1.4-1.5, indicating patella alta. Femoral trochlea subjectively appears slightly shallow.ADDITIONAL

Output: 1. Intrasubstance degeneration of the lateral and medial menisci without tear.2. Severe loss of articular cartilage along the undersurface of the patella with sparing of the femorotibial compartments.3. Moderate to large joint effusion.4. Thickening and increased signal intensity of the PCL with adjacent lobular intermediate to high signal intensity in the posterior aspect of the joint, which may represent mucoid degeneration of the ligament with adjacent synovitis or partial thickness tearing of the ligament if there is history of trauma.5. Other findings as above.


Instruction: Generate impression based on findings.

Input: 40 year old 5 month pregnant female with history of heroine use and cocaine use with two days of left-sided weakness/numbness. There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: No acute intracranial abnormalities.


Instruction: Generate impression based on findings.

Input: 86 year old female with a repeat head CT secondary to worsened mental status change. There is no evidence of intracranial hemorrhage, mass or edema. Small lacunae in the right basal ganglia. Few diffuse hypodensities consistent with minimal small vessel disease, age indeterminate, essentially within normal limits for the patient's age. If there is clinical concern for acute ischemia an MRI may be considered. Overall, there is no change when compared to the previous study.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Stable exam.


Instruction: Generate impression based on findings.

Input: Cholangiocarcinoma status post resection and chemotherapy. Possible recurrence in 2014 status post repeat chemotherapy. ABDOMEN:LIVER, BILIARY TRACT: Postsurgical changes from a left hepatectomy and biliary enteric anastomosis. There is mild intrahepatic biliary ductal dilatation to the level of the anastomosis, appearing similar to the prior study. No discrete mass lesion is identified. The subtle peribiliary and ductal wall enhancement seen on the 8/6/2014 MR study is not evident on today's study suggesting an infectious/inflammatory in etiology.The portal vein appears patent.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral simple and minimally complex renal cysts, unchanged. No hydronephrosis or suspicious renal lesion.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Stable ductal dilatation in the remnant right hepatic lobe appearing similar to the prior study to the level of the biliary enteric anastomosis without a discrete mass lesion.


Instruction: Generate impression based on findings.

Input: Knee pain Right: There is mild sharpening of the tibial spines but the knee otherwise appears normal for the patient's age.Left: Moderate to severe osteoarthritis affects the knee with narrowing of the medial tibiofemoral compartment and tricompartmental osteophytes. There is there is a geographic lucent lesion within the fibular head and neck which extends into the proximal diaphysis. There is no cortical destruction or other particularly aggressive features but further evaluation with MRI is recommended.

Output: 1. Moderate to severe osteoarthritis of the left knee.2. Radiographic lucent lesion within the proximal fibula which is nonspecific and may represent an intraosseous ganglion but a more aggressive lesion such as a giant cell tumor cannot be excluded on the basis of this imaging exam alone. MRI of the knee with and without contrast is recommended to further evaluate this finding.These findings were communicated to the ordering clinician Dr. M. Cheng via telephone at the time of dictation.


Instruction: Generate impression based on findings.

Input: 41-year-old female with STUMP (Smooth muscle Tumor of Uncertain Malignant Potential) tumor in fibroid. Please evaluate for potential residual disease. PELVIS:UTERUS, ADNEXA: Uterus containing multiple T2 hypoattenuating rounded foci compatible with history of fibroids.Left ovary contains a 2.1 cm follicle/cyst (coronal series 7 image 14). Unremarkable right ovary.In the left adnexa, there is a 1.2 x 1.4 x 1.4 cm round structure (axial series 11 image 23, sagittal series 9 image 28) that is hypointense on T2 and demonstrates peripheral contrast enhancement similar to that of the uterine myometrium (axial series 1302 image 63).BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Rounded T2 hypointense structure in the left adnexa measuring 1.2 x 1.4 x 1.4 cm that demonstrates peripheral contrast enhancement similar to uterine myometrium. This could represents a fallen fragment from prior myomectomy, however a drop metastasis cannot be excluded.2.Leiomyomatous changes of the uterus. No abnormal contrast enhancement is seen.