Instruction: Generate impression based on findings.

Input: Followup cardiac mass in OHT patientCOMPARISON 8-5-2014. Left VentricleThe left ventricle is normal. The overall LV ejection fraction is 55%, the LV end diastolic volume index is 58 ml/m2 (normal range: 65+/-11), the LVEDV is 107 ml (normal range 109+/-23), the LV end systolic volume index is 26 ml/m2 (normal range 18+/-5), the LVESV is 48 ml (normal range 31+/-10). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is c/w transplant.Right VentricleThe right ventricle is normal. The overall RV ejection fraction is 56%, the RV end diastolic volume index is 53 ml/m2 (normal range 69+/-14), the RVEDV is 99 ml (normal range 110+/-24), the RV end systolic volume index is 23 ml/m2 (normal range 22+/-8), and the RVESV is 43 ml (normal range 35+/-13). Right AtriumThe right atrium is c/w transplant. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation, but the severity of aortic regurgitation can be underestimated by the MRI pulse sequence used in this study.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation, but the severity of mitral regurgitation can be underestimated by the MRI pulse sequence used in this study.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation, but the severity of pulmonic regurgitation can be underestimated by the MRI pulse sequence used in this study.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation, but the severity of tricuspid regurgitation can be underestimated by the MRI pulse sequence used in this study.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 size. Venous AnatomyThe SVC and IVC are normal in size. There is an SVC catheter.PericardiumThere is no obvious pericardial disease.The previously demonstrated cardiac mass has nearly completely resolved. There is a small focal mass in the R sided AV groove / tricuspid annulus, but this has the characteristics of fat and is different from the previously seen mass.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. Normal LV systolic function2. Normal RV systolic function3. Compared to prior MRI 8-2014, there has been a significant improvement in RV and LV systolic function. The previously present cardiac mass has nearly completely resolved.


Instruction: Generate impression based on findings.

Input: 55 year old with bilateral breast calcifications, status post bilateral stereotactic biopsies. Right breast pathology includes focal ADH. Mild parenchymal enhancement is noted bilaterally. There is heterogeneous fibroglandular tissue. There are hematomas in both breasts, much larger on the left than the right. There are two components to the left sided hematoma, with the left breast biopsy clip located along the lateral aspect of the larger hematoma component. The right breast has a smaller hematoma surrounding the biopsy clip near 12:00. Surrounding each hematoma, there is mild non-mass enhancement including thin rim enhancement. No suspicious nodular or mass like enhancement is present. No area of suspicious kinetic analysis is apparent. No abnormal axillary lymph nodes are identified in either axillary region.Hepatic cysts are noted.

Output: Bilateral breast hematomas (left much larger than right). Enhancement surrounding each hematoma may be reactive secondary to the biopsies, given that no distinct mass-like or nodular enhancement is present. Presuming that the patient has surgery for her right ADH, a 6 month MRI follow up of the left breast is recommended to ensure that the enhancement around the hematoma is resolving by that time.Please note that the suggested follow up MRI can be performed as part of the research MRI study in which she is currently participating.BIRADS: 3 - Probably benign finding.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: The lumbar spine displays a normal lordotic curvature. The lumbar vertebral body and disk heights are preserved. There is heterogeneous marrow signal throughout the lumbar vertebrae, which is unchanged and likely related to fatty marrow infiltration. There is a small disc bulge at T11-T12 without significant spinal canal or neural foramen stenosis. There are no significant disc bulges or herniations in the lumbar spine. However, there is mild facet hypertrophy and ligamentum flavum thickening at multiple levels of the lumbar spine bilaterally. There is a subcentimeter right sacral perineural cyst. The spinal cord displays normal signal and morphology. There is diffuse atrophy of the paravertebral muscles.

Output: 1. Small disc bulge at T11-T12 without significant spinal canal or neural foramen stenosis. 2. Mild degenerative facet degenerative changes and ligamentum flavum thickening at multiple levels of the lumbar spine without significant central canal stenosis or neural foraminal narrowing.3. Small right sacral perineural cyst.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: S/p craniotomy. Since the prior examination the patient has undergone suboccipital craniotomy. Air bubbles are identified in the suprasellar cistern and other basal cisterns as well as along the craniotomy site.The cervicomedullary junction is partially obscured by artifact.There is hyperdense thickening of tissues within the left cavernous sinus measuring 20 x 10 mm in axial dimensions identified on the recent MRI of the brain exam extending into the left superior orbital fissure.

Output: 1.Since the prior examination and the patient's undergone suboccipital craniotomy. The cervical medullary junction is not well evaluated. This is the location of the patient's known lesion.2.A mass in the left cavernous sinus is not present which is hyperdense on this CT scan appeared it does not appear substantially different than the exam from July of 2006 or the MRI from September of 2010.


Instruction: Generate impression based on findings.

Input: Female, 33 years old, with burning of both hands and feet and right face numbness. Concern for MS. Follow-up study. Brain:Numerous scattered small foci of T2 hyperintensity are demonstrated within the cerebral hemispheres bilaterally. Lesions are seen in the periventricular and peripheral subcortical regions. Of note, lesions are also present in the high paramedian frontal lobes and within the anterior temporal poles. The corpus callosum is only minimally affected, and the brainstem and cerebellum are spared. No pathologic enhancement is seen. On comparison with the prior examination, no significant change in lesion size or number is demonstrated. None of the lesions causes any significant edema or mass effect. No abnormal fluid collections are seen. The ventricles are normal in size and morphology.Cervical spine:The visualized spinal cord demonstrates normal signal intensity and morphology. No focal lesions are seen. No pathologic enhancement is suspected.Reversal of the cervical lordosis is likely positional. Sagittal alignment is otherwise unremarkable. Vertebral body height and morphology are within normal limits. No pathologic marrow signal abnormality or enhancement is seen. The intervertebral discs are preserved. No compromise of the spinal canal or neural foramina is seen.

Output: Numerous scattered small white matter lesions are demonstrated supratentorially, none of which elicits any associated edema or pathologic enhancement. On comparison with the prior MRI examination, there has been no clear interval change in lesion size or number. No spinal cord lesions are demonstrated in the cervical region.Demyelinating disease would certainly be in the differential diagnosis for findings such as these. However, given the distribution of the lesions, the possibility of a vascular process such as CADASIL or some other form of vasculitis should also be considered.


Instruction: Generate impression based on findings.

Input: Liver lesion noted on prior CT and ultrasound. Characterize lesion. ABDOMEN:LIVER, BILIARY TRACT: Within the right lobe of the liver there are multiple T2 bright foci the largest of which measures 10 mm in diameter corresponding to the lesions seen on prior CT and ultrasound. Some of these lesions are associated with mild local biliary ductal dilatation. The right There is no suspicious arterial enhancement. The largest lesion can be definitively identified as a cyst, while the others are indeterminate but also likely simple cysts. There are no foci of abnormal signal in the left lobe of liver. No extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Scattered parenchymal T2 hyperintensities within the right kidney are too small to characterize but likely benign cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Streaky T2 hyperintense bibasilar opacities compatible with the pulmonary interstitial opacities better seen on recent CT chest.

Output: 1.Numerous small foci of increased T2 signal in clustered in the right lobe of the liver without associated arterial enhancement. The largest lesions are compatible with simple cysts. The smaller lesions are too small to characterize but may also represent additional simple cysts. However given the presence of mild dilatation of some of the adjacent bile ducts, follow-up MRI can be considered for continued evaluation.2.Signal abnormality in the lung bases compatible with the chronic interstitial disease seen on recent CT chest.


Instruction: Generate impression based on findings.

Input: CERVICAL SPINE:Alignment is normal. The marrow signal is benign. The cervical and upper thoracic cord is normal in signal without abnormal enhancement. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. There is diffuse abnormal T2 signal and enhancement of the visualized paraspinal musculature as well as pharyngeal musculature. C2/3: No significant canal stenosis or neural foraminal stenosis.C3/4: Mild disc bulge with mild canal stenosis. Mild uncovertebral hypertrophy bilaterally causes mild bilateral neural foraminal stenosis.C4/5: No significant canal stenosis. Mild left uncovertebral hypertrophy causes mild left neural foraminal stenosis.C5/6: No significant canal stenosis or neural foraminal stenosis.C6/7: No significant canal stenosis or neural foraminal stenosis.C7/T1: No significant canal stenosis or neural foraminal stenosis.LUMBAR SPINE:Alignment is anatomic. There are no fractures or subluxations. Mild degenerative changes affect the lumbar spine with anterior osteophyte formation and reactive changes. The marrow signal is benign. A small T1 and T2 hyperintense lesion in the posterior L1 vertebral body likely represents a hemangioma. The conus is normal in signal and morphology and terminates at an appropriate level. There is diffuse increased T2 signal and enhancement within the visualized musculature. The visualized intra-abdominal are unremarkable.T12/L1: No significant canal stenosis or neural foraminal stenosis.L1/2: No significant canal stenosis. Minimal ligament flavum hypertrophy without significant neural foraminal stenosis.L2/3: No significant canal stenosis. Moderate ligamentum flavum and facet hypertrophy without significant neural foraminal stenosis.L3/4: No significant canal stenosis. Mild ligamentum and facet hypertrophy without significant neural foraminal stenosis.L4/5: No significant canal stenosis. Mild ligamentum and facet hypertrophy causing mild neural foraminal stenosis bilaterally.L5/S1: No significant canal or neural foraminal stenosis.

Output: 1. No abnormal enhancement to suggest discitis/osteomyelitis or evidence of an epidural abscess in the cervical or lumbar spine. 2. Diffuse muscle enhancement and abnormal T2 signal consistent with inflammation and the patient's history of myositis. 3. Mild multilevel degenerative changes of the cervical and lumbar spine.


Instruction: Generate impression based on findings.

Input: Female, 52 years old, with right leg subjective weakness, inability to walk. Cervical:The cervical lordosis is straightened but alignment is otherwise unremarkable. Vertebral body height and morphology are within normal limits. No concerning marrow replacement, edema or pathologic enhancement is seen. The visualized spinal cord shows normal signal intensity and morphology. No pathologic intramedullary or leptomeningeal enhancement is seen.C2-3: Unremarkable. C3-4: Mild posterior disc-osteophyte complex formation which just contacts the ventral surface of the cord. No spinal canal or foraminal stenosis. C4-5: Unremarkable. C5-6: Minimal posterior disc-osteophyte complex formation. No spinal canal or foraminal stenosis. C6-7: Unremarkable. C7-T1: Unremarkable. Thoracic:Alignment is anatomic. Vertebral body height and morphology are within normal limits. No concerning marrow replacement, edema or pathologic enhancement is seen. The visualized spinal cord demonstrates normal signal intensity and morphology throughout. No pathologic intramedullary or leptomeningeal enhancement is detected.A tiny central disc protrusion is evident at T8-9. Otherwise, the intervertebral discs are preserved. No spinal canal or foraminal stenosis is seen.

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


Instruction: Generate impression based on findings.

Input: Pain one month after fall MENISCI: There is extensive globular and branching signal abnormality throughout the posterior horn of the medial meniscus indicating extensive degeneration and complex tearing which propagates into the body of the medial meniscus as well. There is mild attenuation of the anterior horn of the medial meniscus which may reflect additional attritional tearing. There is horizontally oriented linear signal abnormality within the lateral meniscus which extends to both the tibial and femoral articular surfaces indicating horizontal tearing.ARTICULAR CARTILAGE AND BONE: Severe osteoarthritis affects the knee, particularly affecting the patellofemoral joint, the lateral facets of which are devoid of articular cartilage. There is delamination of the articular cartilage along the weightbearing portion of the medial femoral condyle with additional full thickness degeneration of the articular cartilage along the posterior aspect of the condyle with underlying subchondral cyst formation. There is also focal full-thickness degeneration of the articular cartilage of the lateral femoral condyle just above the posterior horn of the lateral meniscus. There are multiple tricompartmental osteophytes. Aside from the subchondral cyst formation, the bone marrow signal intensity is within normal limits. We see no fracture.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact. There is nonspecific edema along the anterior aspect of the patellar tendon.ADDITIONAL

Output: Severe osteoarthritis of the right knee, particularly affecting the patellofemoral joint, with medial and lateral meniscal tears as well as other findings as described above.


Instruction: Generate impression based on findings.

Input: Sickle cell disease. Assess for vascular stenosis or moyamoya. The examination is limited by motion. Several sequences were repeated. A diagnostic perfusion sequence was not obtained because of motion.BRAIN MRI:There is no abnormal brain diffusion restriction or susceptibility artifact. There is no space-occupying or contrast-enhancing brain lesion. There is no midline shift or brain herniation. The ventricles and the other CSF-containing spaces are normal in size.There is minimal anterior ethmoid mucosal thickening, which is nonspecific. There is no destructive skull lesion. There is no significant diploic thickening.CRANIAL MRA:Apparent focal attenuation of signal involving the left internal carotid artery as it enters the skull is related to motion. The intracranial internal carotid arteries show preserved flow-related signal and caliber, and are symmetric. Similarly, the paired anterior and middle cerebral arteries and their major branches are preserved.The intracranial vertebral arteries are preserved, accounting for the right being slightly smaller than the left. The basilar artery and the posterior cerebral arteries are also preserved.

Output: 1.Examination is mildly limited by patient motion. There is no brain abnormality.2.Unremarkable MR angiography.


Instruction: Generate impression based on findings.

Input: History of Crohn's disease status post multiple surgeries at outside hospital with ileostomy and mucous fistula complicated by multiple obstructive episodes. Stricture at anal canal and ileostomy. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The small bowel is relatively well distended with oral contrast. There is a paucity of small bowel compatible with history of multiple small bowel resections. Note is made of a right lower quadrant ileostomy and mucous fistula.In the left hemiabdomen there is an approximately 8 cm (series 401/11) long segment of proximal small bowel which demonstrates mild distention with moderate circumferential wall thickening, mild T2-weighted weighted hyperintensity, restricted diffusion and enhancement compatible with active inflammation. Distally it is associated with a clover-leaf appearance of adjacent small bowel loops which are tethered together suspicious for a complex fistulous network (series 401/12). This also involves the adjacent mucous fistula which demonstrates similar diffuse signal intensity compatible with active inflammation.There is mild circumferential T2-weighted mildly hyperintense wall thickening of the ileostomy loop compatible with active inflammation involving approximately 5 cm.No fixed luminal narrowing or associated upstream/prestenotic dilatation is identified to suggest a flow-limiting stricture. No significant free fluid or loculated fluid collection.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: See discussion above.BONES, SOFT TISSUES: T2-weighted hyperintense peri-anal fistulous tract extending cranially and dorsally towards the coccyx and anteroinferiorly towards the scrotum with probable seton catheter in place. No associated fluid collection. Additionally, there is T2 weighted mildly hyperintense tract extending along the left perianal region in the ischioanal fossa towards the left gluteal cleft without a discrete fluid collection.OTHER: No significant abnormality noted.

Output: Active inflammation of the mucous fistula, an approximately 8 cm proximal small bowel loop in the left hemi-abdomen and approximately 5 cm of the ileostomy loop. No flow-limiting stricture is identified. Complex fistulous network involving the proximal small bowel loop, adjacent small bowel loops and mucous fistula in the left hemi-abdomen.Peri-anal fistulous disease as described above is incompletely evaluated. No associated abscess is seen.


Instruction: Generate impression based on findings.

Input: Allowing for differences in technique, there is been no significant interval change in multiple scattered punctate and oval foci of T2/FLAIR hyperintensity within the periventricular and subcortical white matter, some of which are oriented perpendicular to the long axis of the lateral ventricles, consistent with known demyelinating disease. Pattern is overall similar to prior exam, with some lesions demonstrating corresponding T1 hypointensity. There is redemonstration of peripheral enhancement superimposed upon mild intrinsic T1 hyperintensity along the margins of the previously referenced right parietal subcortical lesion.The ventricles and sulci continue to be prominent, consistent with mild global volume loss slightly greater than expected for the patient's stated age. The cisterns remain patent. There is no midline shift or mass effect. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. Additional lesions are seen in the visualized upper cervical cord, most conspicuous at the mid C2 and C3-C4 levels. These appear grossly unchanged comparing to previous MRI of the cervical spine.

Output: 1.Redemonstration of multiple white matter lesions consistent with known demyelinating disease, without significant interval change when allowing for differences in technique. Overall, mild T1 and T2 burden of disease, with persistent peripheral enhancement of a right parietal subcortical lesion which may suggest more recent changes.2.Partial visualization of additional cervical cord demyelinating lesions, grossly similar to prior exam.


Instruction: Generate impression based on findings.

Input: 76-year-old female with biopsy proven right breast cancer. The patient underwent right and left breast biopsy at outside institution, but no post-biopsy mammogram was submitted. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD, 9.3. The breast parenchyma is heterogeneously dense (BiRADS Density Category C), unchanged in pattern and distribution. There are 2 hydromark clips at upper outer quadrant in the right breast, separating approximately 7 mm. These clips are placed at the malignant lesion (ILC) proven initially. There is another hydromark clip at upper inner quadrant in the right breast. This is the second malignant lesion (DCIS), proven subsequently. Distance between clips at upper outer quadrant and upper inner quadrant is approximately 6 cm.In the left breast, there is a 2 cm round mass at upper outer quadrant, likely a hematoma from recent biopsy. A hydromark clip is present at anterior inner aspect of this hematoma. A lesion on the MRI (11/23/16) which was supposed to be a target for this biopsy is located near 12:00 position . However, the marker clip and hematoma is located upper outer aspect. The biopsy results were ALH, stromal fibrosis. Linear marker overlies 12:00 position in the left breast, denoting the area of prior surgery which shows architectural distortions.

Output: Marker clips are placed to the patient's biopsy sites; 2 clips at right upper outer quadrant for the original malignancy, one clip at right upper inner quadrant for the second malignancy, and one at left upper outer quadrant for the lesion showing non-malignant result. Distance between the 2 clips of original and second malignancy in the right breast is approximately 6 cm.A marker clip in the left breast is laterally located, however the target lesion was centrally located. Submission of biopsy images with report is recommended to determine whether the biopsy was appropriately performed. If there is evidence of mistargeting, repeat MRI guided biopsy may be needed. Final recommendation will be conveyed after all images and reports are reviewed. BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Female 42 years old Reason: Pt with thyroid nodule on OSH imaging. Please eval nodule features as well as for lymphadenopathy to stratify need for FNA. OSH imaging loaded into Epic. History: Thyroid nodule RIGHT LOBE MEASUREMENTS: 5.2 x 2.6 x 2.4 cmLEFT LOBE MEASUREMENTS: 5.3 x 1.8 x 1.8 cmISTHMUS MEASUREMENTS: 3 mmRIGHT LOBE: Diffuse heterogeneous echotexture of the thyroid consistent with thyroiditis. 8mm in diameter well-defined hypoechoic nodule in the right thyroid lobe.LEFT LOBE: Diffuse heterogeneous echotexture of the thyroid consistent with thyroiditis.ISTHMUS: Diffuse heterogeneous echotexture of the thyroid consistent with thyroiditis.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Benign-appearing lymph nodes in the neck.OTHER: No significant abnormality noted.

Output: Single, subcentimeter solid nodule in the right thyroid lobe in the background of thyroiditis


Instruction: Generate impression based on findings.

Input: Reason: hx of prostate cancer s/p prostatectomy in 2012 now with right hip pain x 1.5 months History: right hip pain. ACETABULAR LABRUM: Although this examination was not protocoled for evaluation of the labrum, the labrum is grossly intact. ARTICULAR CARTILAGE AND BONE: No significant abnormality noted. No abnormal bone marrow signal. No abnormal enhancement.SOFT TISSUES: No significant abnormality noted. ADDITIONAL

Output: Normal examination.


Instruction: Generate impression based on findings.

Input: Reason: lower extremity tingling - CNS process? History: tingling Vertebral body heights are intact. Minimal endplate degenerative marrow changes at T12-L1, otherwise no abnormal marrow signal. No abnormal enhancement. Multilevel disc desiccation with disc space loss, most severe at T11-T12, T12-L1 and L1-L2 No abnormal signal within the cord or conus which ends at L1. There is a levocurvature to the lumbar spine present.T12-L2: Moderate loss of disc height with diffuse disc bulge. No spinal canal or neural foraminal stenosis.L1-L2: Mild loss of disc height. Mild ligamentum flavum thickening and facet arthropathy. No spinal or neural foraminal stenosis.L2-L3: Small left lateral protrusion. Mild facet arthropathy and ligamentum flavum thickening. No spinal or neural foraminal stenosis.L3-L4: Mild diffuse disc bulge. Mild facet arthropathy and ligamentum flavum thickening. No spinal or neural foraminal stenosis.L4-L5: Mild diffuse disc bulge. Mild facet arthropathy and ligamentum flavum thickening. Mild anterior subluxation of L4 on L5. Mild spinal canal stenosis. No neural foraminal stenosis.L5-S1: Mild diffuse disc bulge. Mild facet arthropathy. No spinal canal stenosis. Mild left neural foraminal stenosis.Paraspinous musculature is atrophic. A small left renal cyst is present.

Output: Multilevel spondylosis with mild narrowing of the canal at L4-L5 and mild left neural foraminal stenosis at L5-S1.


Instruction: Generate impression based on findings.

Input: Clinical question: Disc degeneration L3-L4. Signs and symptoms: Low back pain. Nonenhanced lumbar MRI:There is normal anatomical alignment of the vertebral column.There is unremarkable signal intensity of vertebral, other than changes related to degenerative disease.T12-L1 is unremarkable.L1-L2 is unremarkable.L2-L3 is unremarkable with the exception of mild ligamentum flavum hypertrophy.L3-L4 demonstrate mild disc desiccation and loss of disc height, mild bilateral ligamentum flavum hypertrophy and facet degenerative changes. Small central shallow disc protrusion results in subtle indentation of thecal sac. Mild compromise of spinal canal however without convincing evidence of central spinal stenosis. Mild bilateral neural foraminal compromise is present. There are no prior exams for comparison.L4-5 is unremarkable with the exception of mild ligamentum flavum hypertrophy and minimal bilateral facet effusion.L5-S1 is unremarkable.Unremarkable prespinal soft tissues.

Output: 1.Mild degenerative disc disease, hypertrophic changes of posterior elements at L3-L4 level and a small central disc protrusion with resultant mild compromise of the spinal canal and bilateral neural foramina.2.Unremarkable images at other levels other than mild degenerative changes as detailed per level.


Instruction: Generate impression based on findings.

Input: 69-year-old postmenopausal woman with history of thickened endometrial stripe. PELVIS:UTERUS, ADNEXA: The uterus is retroflexed. The anterior body uterine wall is thickened focally with areas of increased T2 signal internally (6/27). Additionally, there are small areas of increased T1 and T2 hyperintensity, possibly hemorrhage from recent biopsy. This focal, masslike thickening measures 20 x 19 mm in cross-section and mildly enhances. Additionally, there are smaller, punctate areas of increased T2 signal within the lower uterine segment myometrium. Nabothian cysts noted.There is a 36 mm septated left ovarian cyst without nodularity or areas of enhancement.BLADDER: The bladder appears normal.LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Focal mass in the anterior uterine body with imaging features suggestive of adenomyosis. Although this would be atypical in a postmenopausal patient, there are additional secondary findings in the uterus to suggest this diagnosis. A focal neoplasm can also be considered. Please correlate with the clinical history and hormone use.2.2.6 cm left ovarian cyst, likely a serous inclusion cyst. Please follow as clinically warranted.


Instruction: Generate impression based on findings.

Input: The lumbar spine is in normal alignment, with slight straightening of the normal lumbar lordosis. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated, although there is slight indentation of the superior and inferior endplates of the anterior L1 vertebral body, likely a developmental finding. Trace linear T2 signal is present within the distal central cord, which may represent a terminal ventricle.The distal spinal cord and conus are within normal limits with the conus terminating at the mid L1 level. No abnormal fat signal is seen within the distal thecal sac. No definite spinal dysraphism is appreciated on MRI, although CT would be more subtle. Upon prone positioning, there is appropriate ventral motion of the distal conus as well as cauda equina nerve roots within the thecal sac.There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the lumbar spine.Bladder is significantly distended.

Output: Likely mild developmental irregularity of the anterior L1 vertebral body along the superior and inferior endplate. Otherwise, unremarkable noncontrast MR appearance of the lumbar spine. Significant bladder distention for which clinical correlation is recommended.


Instruction: Generate impression based on findings.

Input: Male, 75 years old, with right upper extremity weakness. Assess for cord compression. Cord compression exam:A scoliotic curvature of the thoracic and lumbar spine is noted. Sagittal alignment of the spine is reasonably anatomic.Vertebral body heights are preserved allowing for mild right lateral wedging of L2 and L3 which is a stable finding likely related to scoliosis.Marrow signal intensity is diffusely and markedly heterogeneous similar to prior. No definite worrisome marrow replacement is seen. Mild edema is evident within the marrow of L2 and L3.Multilevel cervical spondylosis is demonstrated in the cervical spine resulting in significant canal stenoses, but are better assessed in the dedicated exam dictated below.Multilevel thoracic spondylosis is evident without significant spinal canal narrowing. Scattered mild-to-moderate foraminal narrowing is evident.Multilevel spondylosis and posterior element hypertrophy affect the lumbar spine, resulting in mild to moderate canal stenoses, appearing similar to prior. Prominence of the epidural fat also contributes. Scattered foraminal narrowing is also seen most severely affecting the L4-5 level.Although incompletely visualized on this limited study, fat signal intensity is evident along the cauda equina and/or filum terminale suggestive of fatty infiltration of the filum terminale also appearing similar to prior. Findings suggestive of prior surgery are seen in the lumbar region, though the nature of the surgery is uncertain and this appearance may also be due to severe degeneration.Dedicated C-spine exam:Spinal alignment is anatomic allowing for a mild likely positional straightening of the cervical adenosis. Vertebral body heights are grossly preserved except for areas of degenerative endplate irregularity. Bone marrow signal intensity is diffusely heterogeneous but free of worrisome marrow replacement.Severe disc degeneration is evident most conspicuously affecting the C3-4 through C6-7 levels with loss of disc height, bulky anterior osteophyte formation, and posterior disc osteophyte formation. On comparison with a prior examination from 2011, no significant interval change is seen in these findings. Level specific details are as follows:C2-3: Mild facet hypertrophy. Mild posterior disc-osteophyte complex formation. No significant spinal canal stenosis. No significant foraminal narrowing. C3-4: Uncovertebral hypertrophy and posterior disc-osteophyte complex formation. Severe generalized spinal canal stenosis with cord impingement. Mild ill-defined cord T2 hyperintensity is suspected. Mild to moderate bilateral foraminal narrowing.C4-5: Uncovertebral hypertrophy and posterior disc-osteophyte complex formation. Severe spinal canal stenosis with cord impingement. Mild ill-defined cord T2 hyperintensity is suspected. Moderate bilateral foraminal narrowing. C5-6: Uncovertebral hypertrophy and posterior disc-osteophyte complex formation. Mild spinal canal stenosis. No cord impingement. Severe left and moderate right foraminal narrowing.C6-7: Uncovertebral hypertrophy and posterior disc-osteophyte complex formation. Moderate spinal canal narrowing. No cord impingement. Severe left and moderate right foraminal narrowing.C7-T1: Posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Severe bilateral foraminal narrowing.

Output: 1.Severe spinal canal stenosis in the cervical region affecting C3-4 and C4-5 predominantly. The stenoses are degenerative in nature and chronic showing no significant interval change when compared to an exam from 2011. There may be mild abnormal cord signal at the levels of greatest stenosis which could reflect a combination of edema and myelomalacia.2.Degenerative disease is evident elsewhere in the spine resulting in mild to moderate scattered canal stenoses. A significant scoliotic deformity affects the thoracic and lumbar spine. Findings are seen in the lumbar region suggestive of fatty infiltration of the filum terminale, similar to those seen on prior studies.


Instruction: Generate impression based on findings.

Input: Female, 61 years old, bilateral lower extremity radiculopathy. A dextroscoliosis of the lumbar spine is noted. Trace grade 1 anterolisthesis of L4 relative to L5 is also seen. Vertebral body height is preserved.From scattered endplate degenerative signal change and mild marrow heterogeneity, no pathologic marrow replacement is seen. The visualized distal spinal cord, conus and nerve roots of the cauda equina are unremarkable except as discussed below. Multiple perineural root sleeve cysts are seen expanding the sacral foramina.T11-12: Facet arthropathy, right worse than left. Disc bulging with a left central/foraminal protrusion. No significant generalized spinal canal stenosis. No significant foraminal narrowing.T12-L1: Facet arthropathy. Minimal disc bulging. No significant spinal canal or foraminal stenosis.L1-2: Left facet arthropathy. Mild disc bulging. No significant spinal canal stenosis. Moderate left foraminal narrowing. L2-3: Facet arthropathy. Mild disc bulging. Mild spinal canal narrowing. Mild left foraminal narrowing. L3-4: Facet arthropathy. Bulging disc. Moderate spinal canal narrowing with slight crowding of the cauda equina. Moderate to severe bilateral foraminal narrowing. L4-5: Marked facet arthropathy with facet effusion on the left. Bulging disc. Moderate spinal canal narrowing. Severe right foraminal narrowing with possible nerve root impingement. L5-S1: Marked facet arthropathy, right worse than left. Mild disc bulging. No significant generalized spinal canal stenosis. However, a 6 mm probable cystic structure projects into spinal canal from the right facet joint which appears to contact the transiting right S1 nerve root. Significant right foraminal narrowing with possible nerve root impingement.

Output: Multilevel disc and posterior element degeneration is seen. Findings are most severe at L3-4 and L4-5 where there is moderate to severe spinal canal narrowing. Severe foraminal narrowing is evident on the right L4-5, and on the right at L5-S1, with possible associated nerve root impingement. A probable synovial cyst projects medially into the spinal canal from the right L5-S1 facet joint contacting the transiting right S1 nerve root.


Instruction: Generate impression based on findings.

Input: Examination is limited by motion artifact. The cervical lordosis is preserved. There is mild retrolisthesis of C4 on C5 and C5 on C6. Mild inferior endplate compression deformity with low T1/T2 signal involving the C5 vertebral body appears slightly progressed since prior examination. Diffuse heterogeneous marrow signal is demonstrated throughout the cervical spine. The thoracic kyphosis is preserved and the thoracic vertebral bodies appear normally aligned. Diffusely heterogeneous marrow signal of the thoracic spine is again seen with multiple areas of low T1/T2 signal. Multiple thoracic vertebral body compression deformities are demonstrated. Kyphoplasty changes are demonstrated from T10 to L1 levels. Anterior wedging of the T6 vertebral body appears similar to prior examination. Compression deformities of the T11 and T12 vertebral bodies also appear similar to prior examination. There is mild progression of compression involving the T7 and T8 vertebral bodies.The lumbar lordosis lordosis is preserved. The lumbar vertebral bodies are normally aligned. Moderate loss of intervertebral disc space at L2-3, L4-5, and L5-S1 levels are seen. Multifocal areas of low T1 signal are again demonstrated within the lumbar spine. Compression deformity involving the L1 vertebral body status post kyphoplasty changes appear slightly worse since prior examination. The spinal cord demonstrates normal caliber and signal intensity. The conus terminates at L2.Within the limitations of extensive motion artifact, no significant edema or enhancement is visualized throughout the spine.Cervical spine:C2-3: Advanced left facet degenerative changes are demonstrated with significant left neural foraminal stenosis however without central spinal stenosis.C3-4: No significant disc herniation, neuroforaminal stenosis, or spinal stenosis noted at this level.C4-5: There is a small posterior disc osteophyte complex and hypertrophy of the ligamentum flavum resulting in moderate central stenosis and bilateral neuroforaminal stenosis.C5-6: There is loss of intervertebral disc space with small posterior disc osteophyte complex formation and hypertrophy of the ligamentum flavum causing mild to moderate spinal stenosis and moderate bilateral neuroforaminal stenosis.C6-7: There is a posterior disc osteophyte complex formation causing mild bilateral neural foraminal stenosis without central stenosis.C7-T1: Mild diffuse disc bulge with mild bilateral neuroforaminal narrowing. Thoracic spine:T1-2: There is a minimal diffuse disc bulge without significant spinal or neuroforaminal stenosis.T2-3: There is a disc bulge with superimposed central protrusion causing mild to moderate central spinal stenosis without significant neuroforaminal stenosis.T3-4: There is a diffuse disc bulge without significant spinal or neuroforaminal stenosis.T4-5: No significant disc herniation or neuroforaminal stenosis is noted at this level.T5-6: No significant disc herniation, spinal or neuroforaminal stenosis is noted at this level.T6-7: No significant disc herniation, spinal or neuroforaminal stenosis is noted at this level.T7-8: No significant disc herniation, spinal stenosis or neuroforaminal stenosis is noted at this level.T8-9: There is a central disc protrusion resulting in moderate central spinal stenosis without significant neuroforaminal stenosis.T9-10: There is a disc bulge with a left paracentral accentuated component as well as hypertrophy of the ligamentum flavum resulting in moderate left lateral recess stenosis.T10-11: There is mild spinal canal stenosis predominantly on the basis of hypertrophic degenerative change of the ligamentum flavum without significant disc herniation.T11-12: No significant disc herniation or spinal canal stenosis is noted at this level.T12-L1: There is a diffuse disc bulge with hypertrophy of the ligamentum flavum causing mild spinal canal and moderate bilateral neuroforaminal stenosis.Lumbar spine:L1-2: There is a disc bulge resulting in mild central stenosis without significant neuroforaminal stenosis.L2-3: There is a diffuse disc bulge and hypertrophic degenerative changes of the ligamentum flavum/posterior facets resulting in moderate central and bilateral neuroforaminal stenosis.L3-4: There is a diffuse disc bulge resulting in moderate spinal canal and bilateral neuroforaminal stenosis.L4-5. There is a disc bulge with right paracentral protrusion resulting in mild to moderate right neuroforaminal stenosis without significant spinal or left neural foraminal stenosis.L5-S1: There is a diffuse disc bulge and hypertrophic degenerative changes of the ligamentum flavum and facets resulting in mild bilateral neuroforaminal stenosis.

Output: 1. There is redemonstration of heterogeneous marrow signal without evidence for enhancing or edematous lesions to suggest active disease.2. There is mild progression of compression deformities involving the T7, T8, L1, and probably L4 vertebral bodies. Additional compression deformities appears similar to prior examination.3. Multifocal degenerative changes throughout the spine as described above.


Instruction: Generate impression based on findings.

Input: 55-year-old female with strong family history of breast carcinoma. Family history of breast cancer in her sister at age 35, and in a paternal aunt at age 45. There is heterogeneous amount of fibroglandular tissue in both breasts.Minimal parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Neck pain radiating to left trapezius/shoulder. Evaluate for cervical spinal stenosis versus neural foraminal stenosis. Craniovertebral junction appears within normal limits. There is straightening of the cervical spine with lordosis at the C2-C3 level which is likely related to patient position. There appears to be partial fusion involving the right C2-C3 facet joint. There is mild anterolisthesis of C3 on C4 and retrolisthesis of C4 on C5 and C5 on C6. The cervical spinal cord has normal signal characteristics.Degenerative changes are seen in the cervical spine with disc osteophyte complexes and significantly diminished disc space at the C3-C4, C4-C5, C5-C6, and C6-C7 levels, worst at the C3-C4 and C6-C7 levels. There is loss of height involving the C6 level. Vertebral body heights are otherwise grossly maintained. Individual levels as described below:C2-3: Small central disc protrusion and ligamentum flavum laxity without significant spinal canal or neural foraminal stenosis.C3-4: Small central disc protrusion and ligamentum flavum thickening with moderate spinal canal stenosis. There is up to moderate left and no significant right neural foraminal stenosis. There is prominent facet arthropathy on the left.C4-5: There is disc osteophyte complex and ligamentum flavum thickening with moderate spinal canal stenosis. There is mild to moderate left and mild right neural foraminal stenosis related to uncovertebral hypertrophy. C5-6: There is disc osteophyte complex with moderate spinal canal stenosis. There is mild bilateral neural foraminal stenosis related to uncovertebral hypertrophy.C6-7: Small disc osteophyte complex with minimal spinal canal stenosis. There is uncovertebral hypertrophy with mild bilateral neural foraminal stenosis.C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: Advanced multilevel degenerative changes in the cervical spine. There is moderate degree of spinal canal stenosis C3-C4, C4-C5, and C5-C6 levels. There is up to moderate left C3-C4 neural foraminal stenosis and milder degree at additional levels as above.


Instruction: Generate impression based on findings.

Input: Left tongue cancer: left otalgia and left tongue pain. There is an infiltrative left lateral oral tongue and floor of mouth tumor that measures up to approximately 40 mm, with mass effect or possible invasion of the left sublingual gland. There is no gross mandibular or geniohyoid muscle involvement and the tumor does not cross the midline. There is a heterogeneous left level 2A lymph node that measures 10 x 12 mm in axial section and a left level 3 lymph node that measures 10 x 15 mm in axial section. There is no significant right cervical lymphadenopathy. The thyroid, parotid, and submandibular glands are unremarkable. The orbits and imaged intracranial structures also appear unremarkable.

Output: 1. An infiltrative left lateral oral tongue and floor of mouth tumor that measures up to approximately 40 mm is compatible with squamous cell carcinoma.2. Left level 2 and 3 lymphadenopathy likely represent metastatic disease.


Instruction: Generate impression based on findings.

Input: backpain For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. There is focal minimal to mild bulging of L34 intervertebral disc toward left side proximal neural canal just after the isthmus. There is no definitive imaging evidence of direct nerve root compression from this focal disc bulging.Diffuse bulging of disc with minimal ligamentum flavum thickening were seen at the level of L45. No definitive evidence of spinal stenosis at this level. There is normal lumbar lordosis. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. The epidural space, thecal sac, and spinal cord are preserved with no evidence of spinal canal/neural foraminal narrowing. The conus medullaris terminates at the L1-2 level. The intervertebral discs demonstrate normal T2 intensity and height with no evidence of disc herniation. The paraspinal soft tissues are unremarkable.There is no evidence of abnormal enhancement, cord compression or mass. Degenerative changes are specified by the intervertebral level as follows: T12-L1: no neuroforaminal narrowing or spinal stenosis. L1-L2: no neuroforaminal narrowing or spinal stenosis. L2-L3: no neuroforaminal narrowing or spinal stenosis. L3-L4: Focal disc bulging toward left side neural foramen without evidence of direct nerve root compression. no neuroforaminal narrowing or spinal stenosis. L4-L5: diffuse bulging of disc without evidence of spinal canal stenosis. no neuroforaminal narrowing or spinal stenosis. L5-S1: no neuroforaminal narrowing or spinal stenosis.

Output: 1. Focal bulging of disc toward left side neural foramen without direct compression of the nerve root at the level of L34.2. Diffuse bulging of disc at the level of L45.3. Otherwise no remarkable finding.


Instruction: Generate impression based on findings.

Input: Brain MRIMultiple scattered T2/flair high signal intensity lesions on bilateral periventricular white matter and deep white matter including bilateral corpus callosum. There is no evidence of abnormal enhancement on the 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, restricted diffusion/acute ischemia, or abnormal contrast enhancement. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.Cervical spine MRIThere is relatively well defined T2 high signal intensity lesion at the level of foramen magnum-C2 indicating possible demyelinating lesion.Diffuse bulging of discs with associated bilateral ligamentum flavum are seen at the level of C34, C45, C56 and C67 without evidence of spinal canal stenosis. No neuroforaminal stenosis is seen.There is normal cervical lordosis.The vertebral body height is preserved. Constellation of both brain and cervical spine MRI suggest demyelinating disease such as multiple sclerosis involvement of both brain and cervical spine.

Output: 1. White matter lesions and upper cervical spinal cord lesions indicate demyelinating disease such as multiple sclerosis involvement.2. No abnormal enhancement is seen.


Instruction: Generate impression based on findings.

Input: Right buttock ulceration There is a large ulceration along the posteromedial aspect of the proximal left thigh that extends to the ischial tuberosity. The wound contains foci of signal void representing gas and there is enhancement of the surrounding soft tissues indicating inflammation. There is mild marrow edema of the ischium and adjacent inferior pubic ramus on the fat-suppressed T2-weighted images as well as mild enhancement following contrast administration; however the marrow signal intensity on the corresponding T1 sequences is preserved. These findings are more suggestive of a reactive osteitis rather than true medullary osteomyelitis. There is diffuse subcutaneous edema of the visualized proximal left thigh but the marrow signal intensity of the visualized femur is normal. Again noted is a rectocutaneous fistula which is better appreciated on the comparison CT. There also appears to be a defect extending through the subcutaneous fat posterior to the sacrum which is associated with metallic susceptibility artifact from the surgical clip which is also better seen on the CT. The S5 segment as well as the upper coccyx is not well visualized either due to prior surgical resection or destruction from prior infection; however the signal intensity of the remaining sacrum is normal without evidence of osteomyelitis. There is edema within the soft tissues anterior to the sacrum but there is no rim-enhancing fluid collection to confirm an abscess. There is widening of the pubic symphysis and irregularity of its margins with mild alterations in signal intensity within the body of the pubic bones which may reflect prior trauma or chronic degeneration but does not have the typical appearance of infection.

Output: Soft tissue ulceration and inflammation with signal abnormality of the left ischium demonstrating features more suggestive of reactive osteitis rather than true medullary osteomyelitis. Additional findings are described above.


Instruction: Generate impression based on findings.

Input: Right hip pain, prostate cancer The marrow signal of the pelvis is normal without discrete abnormality to suggest bony metastases. There is no fracture or malalignment. Mild osteoarthritis affects the right hip and there may be a small labral tear on the right. Mild osteoarthritis also affects the left hip. Following contrast administration, there is no abnormal enhancing bony or soft tissue lesions. The pelvic musculature is normal in signal and caliber for the patient's age.The prostate is surgically absent. 2 small fluid collections are identified adjacent to the bladder which may represent postsurgical cysts or small lymphoceles. There is thickening of the urinary bladder wall which may be posttreatment in nature.

Output: No specific evidence of bony metastases.


Instruction: Generate impression based on findings.

Input: 42 year-old female history of treated triple negative breast cancer in 2013 with abnormal T5 vertebral body enhancement. Redemonstrated is a small well demarcated focus of increased T2 signal and mild enhancement within the right dorsal aspect of the T5 vertebral body and right pedicle. This lesion measures approximately 8 x 5 mm, previously 8 x 5 mm (image 26/6). There has been no significant change in appearance when compared to two prior exams. There is no evidence of bony erosion. The surrounding structures are unremarkable. The remaining bone marrow signal is normal. No abnormal enhancement to suggest metastasis. Tiny central disk protrusions are unchanged at T4-5 and T5-6. There is no underlying spinal cord signal abnormality. There is no significant spinal cord or neuroforaminal stenosis.

Output: 1.Stable demarcated focus of signal abnormality involving the right pedicle and right posterior aspect of the T5 vertebral body. While the appearance of this lesion is nonspecific, the benign morphology and stability over time are reassuring.2.No additional concerning lesions are present to suggest metastatic disease.


Instruction: Generate impression based on findings.

Input: Abdominal pain ABDOMEN:LUNG BASES: Dependent atelectasis.LIVER, BILIARY TRACT: 8mm nonspecific hypodensity in the liver, most likely benign.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Mild hydronephrosis of the left kidney with associated perinephric fluid. Left ureter is also dilated throughout its course. Two punctate stones in the left UVJ largest measuring 4-mmRight kidney and right ureter are unremarkable.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXAE: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Left UVJ stones causing left-sided hydronephrosis.


Instruction: Generate impression based on findings.

Input: A patient submitted outside study for review. Submitted for review are right breast mammogram 9/9/2015, ultrasound of the right breast 9/8/2015, ultrasound guided biopsy imaging 9/9/2015, right breast mammogram 9/8/2015, MRI breasts 9/4/2015, mammogram of the left breast 8/10/2015 and ultrasound of left breast 8/11/2015 performed at Center for breast care at River Forest, IL. For comparison,mammogram 9/15/2014, ultrasound of the left breast 9/15/2014 are available. Patient initially presented to outside hospital for follow-up of the multiple cysts in the left breast. Mammogram of the left breast on 8/10/2015 demonstrated interval decrease in size of the masses in the medial aspect of the left breast. In addition, there is a focal asymmetry in the far posterior left breast only seen MLO view without a definite sonographic correlate for which breast MRI was recommended. On ultrasound 8/11/2015, there is interval decrease in size of the multiple cysts with the largest cyst at 8:00 in the left breast measuring 9 mm vs 12 mm on the prior. Additionally, there is an another 9 mm indeterminate periareolar hypoechoic mass at the 2:30 o'clock of left breast. MRI was recommended to follow up with the focal asymmetry in the far posterior left breast on the mammogram and the 9 mm indeterminate hypoechoic mass at the 2:30 o'clock left breast. This most likely represents a complicated cyst. MRI BREAST 9/4/2015MR breast was performed as per outside MRI imaging protocol. The breasts are composed of dense fibroglandular tissue bilaterally. There is mild background parenchymal enhancement. A 10 x 11 x 18 mm (LR x AP X SI) mass is present in the posterior right breast, 1:00 location. This mass is abutting the pectoralis muscle without enhancement in the muscle. No additional suspicious mass or nonmass enhancement is noted in either breast. Multiple cysts are noted on the T2-weighted imaging, most prominent on the left breast. Bilateral axillary lymph nodes are unremarkable.DIAGNOSTIC MAMMOGRAM OF THE RIGHT BREAST 9/8/2015:The breast is composed of heterogeneously dense fibroglandular tissue. A small 10 mm partially visualized focal asymmetry is noted in the posterior upper inner right breast, corresponding to the MRI finding.DIAGNOSTIC ULTRASOUND OF THE RIGHT BREAST 9/8/2015:At 1:00 radian, 8 cm from the nipple, there is a 10 x 7 x 9 mm hypoechoic irregular mass, which also corresponds to the MRI and mammogram finding.ULTRASOUND GUIDED BIOPSY 9/9/2015 :Biopsy needle pierces through the hypoechoic mass at the 1:00 location of the right breast. 4 core biopsies were performed as per the provided imaging.POSTPROCEDURE MAMMOGRAM 9/9/2015:CC, ML and exaggerated CC views of the right breast demonstrated a long X shaped clip in the posterior, upper outer right breast, at the site of the biopsied mass.Pathology showed IDC grade 3

Output: Biopsy-proven malignancy in the posterior upper inner right breast. Biopsy clip in the appropriate location. No additional imaging evidence of malignancy.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Clinical question: Rule out bleed. Signs and symptoms: Confusion, altered mental status. No evidence of hemorrhage, edema, mass effect, midline shift or hydrocephalus. Cortical sulci, ventricular system and all CSF cisterns remain within normal. A very small subtle foci of subcortical -- periventricular low attenuation in the left frontal lobe is noted. There is no associated mass effect or parenchymal volume loss. The finding may represent minimal small vessel disease. Please correlate with history and follow up grade a post infusion CT exam or an MRI is recommended. There are no old studies for comparison.

Output: Small nonspecific foci of left frontal subcortical low attenuation as described. The finding may represent minimal small vessel disease of indeterminate age. Follow-up with an MRI is recommended.


Instruction: Generate impression based on findings.

Input: Male, 57 years old, with left hemianesthesia, concern for MCA right thalamic stroke, subacute. A 4 mm focus of restricted diffusion is seen within the right thalamus. Patchy minimal diffusion hyperintensity in the right frontal lobe likely represents T2 shine through artifact. Scattered foci of T2 hyperintensity within the cerebral hemispheres are seen. No evidence of significant edema or mass effect is detected. No acute intracranial hemorrhage or any abnormal extra-axial fluid collection is observed. Numerous foci of susceptibility are evident including within the right frontal lobe, the basal ganglia, right thalamus, brainstem and cerebellum likely indicating chronic microhemorrhage. Ventricular size morphology are within normal limits. A 10 mm cystic structure with a fluid-fluid level is suspected in the right superomedial periorbital soft tissues.Mild to moderate stenosis is detected at the right distal M1 segment and at the bifurcation. A moderate stenosis affects the proximal inferior division of the right MCA. No other significant intracranial stenosis is seen. No aneurysm or vascular malformation is suspected.Common origin of the brachiocephalic and left common carotid arteries is seen. No significant vascular stenosis is detected in the carotid vessels of the neck. The left vertebral artery is dominant. No significant stenosis is seen within the cervical portions of the vertebral arteries.

Output: 1.A small focus of diffusion restriction within the right thalamus is seen compatible with an acute to subacute ischemia.2.Numerous scattered foci of T2 hyperintensity and scattered areas of microhemorrhage are demonstrated likely related to chronic microvascular ischemia.3.Mild to moderate stenoses are evident at the level of the right MCA bifurcation. Elsewhere, no significant intracranial vascular compromise is detected.4.No significant vascular compromise is seen in the neck.5.Incidental note is made of a small cystic structure within the right superomedial periorbital soft tissues.


Instruction: Generate impression based on findings.

Input: 52-year-old female with recurrent acute pancreatitis and pseudocyst, status post ERCP 10/4/2016 with pancreatic duct stricture in head of pancreas. Lack of visualization of the body and tail. Two-week MRCP secretin to evaluate pseudocyst and pancreatic body/tail. ABDOMEN:LIVER, BILIARY TRACT: No intra or extrahepatic biliary ductal dilatation. Layering biliary sludge within the gallbladder.SPLEEN: No significant abnormality noted.PANCREAS: Interval removal of the pancreatic ductal stent. The pancreatic parenchyma demonstrates loss of the normal bright T1 signal intensity on the noncontrast T1 series. Mild parenchymal atrophy and ductal dilatation of the pancreatic tail with a strictured/beaded appearance. The post-secretin series demonstrates an appropriate filling of the duodenum and proximal jejunal loops. There is impaired compliance of the pancreatic duct after secretin administration. No definite side branch ectasia delineated. No evidence for acute inflammation or pseudocyst formation. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Small gastrohepatic lymph nodes (series 7 image 14).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Stricturing of pancreatic duct most notably seen in the distal pancreatic body and tail. No evidence for acute inflammation or pseudocyst formation. Please see above for details.


Instruction: Generate impression based on findings.

Input: Hamstring origin pain. Question of proximal hamstring tear. There is near complete to complete tearing of the conjoined tendon at its origin from the ischial tuberosity. The majority of the fibers are retracted distally 1-2 cm. The semimembranosus tendon appears intact. The hamstring head of the adductor magnus tendon is intact. There is edema within the proximal semitendinosus and biceps femoris muscles as well as fluid and edema in the surrounding soft tissues. Edema is also noted to surround the sciatic nerve as well which otherwise appears intact.The remaining visualized musculature appears normal. Bone marrow signal is within normal limits. There is mild prominence of the lateral femoral head/neck junctions bilaterally suggesting CAM type deformity. The hip joints and sacroiliac joints are normal.

Output: Tear at the origin of the left conjoined tendon as described above.


Instruction: Generate impression based on findings.

Input: Dissection of carotid artery [I77.71], Reason for Study: ^Reason: Evaluate for radiculopathy, myelopathy History: LUE weakness, radiating pain There is straightening of cervical spine.The vertebral body height is preserved.Spinal cord signal intensity is normal.Degenerative changes are specified by the intervertebral level as follows: C2-C3: no neuroforaminal narrowing or spinal stenosis. C3-C4: no neuroforaminal narrowing or spinal stenosis. C4-C5: minimal bulging of disc. no neuroforaminal narrowing or spinal stenosis. C5-C6: Disc desiccation. Diffuse bulging of disc which abuts thecal sac results minimal spinal canal stenosis. C6-C7: Broad-based central to left disc protrusion which abuts thecal sac. Minimal left lateral recess and spinal canal stenosis are seen. C7-T1: no neuroforaminal narrowing or spinal stenosis. T1-2: There is about 6mm sized perineural cyst on the right side. Otherwise unremarkable.

Output: 1. Multilevel disc degenerations as described above (C45, C56 and C67).2. Central to left broad based disc protrusion at C67. 3. Perineural cyst on the right side of T1-T2 level.


Instruction: Generate impression based on findings.

Input: Clinical question: Trauma with neck tenderness. Signs and symptoms: Neck pain. Nonenhanced cervical MRI:There is normal anatomical alignment of cervical spine.There is normal signal intensity of vertebral column and including soft tissue.There is normal signal intensity and caliber of the cervical and upper most visualized thoracic cord.As was noted on prior head CT examinations there is a stable extra-axial hemorrhage along the dorsal aspect of clivus inferiorly and with minimal extension into the upper cervical spine. The finding measures maximum of 5 mm in thickness and approximately 23 mm in cranial cephalad access. This hematoma results in partial effacement of prepontine cistern and the subtle deformity of the cervical medullary junction of the cord. The CSF cistern remains widely patent and there is no detectable signal abnormality of the cord at this level. The upper cervical extension of this finding is very thin and minimal and without mass effect.There is no evidence of a spinal canal compromise of the cervical or upper most visualized thoracic spine. No significant degenerative changes of cervical spine is noted and there is no evidence of neural foraminal compromise at any level.

Output: 1.Normal signal intensity and alignment of the vertebral column.2.Normal signal intensity and caliber of cervical and upper most visualized thoracic cord.3.Subdural hematoma along the inferior-dorsal aspect of clivus as detailed above. This finding demonstrate no interval change since prior study and without significant mass effect on the adjacent cord. Please see above comments.4.No evidence of spinal stenosis or neural foraminal compromise at any level.


Instruction: Generate impression based on findings.

Input: Reason: ro cva History: dizziness, blurry vision Small foci of diffusion restriction are present in the left pons.On susceptibility imaging punctate foci of hypointensity are present in the cerebellar hemispheres, pons, thalami and basal ganglia and to a lesser degree subcortical and periventricular white matter right hemisphere more than left.There is a moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate opacification of the right sphenoid sinus associated with mucosal thickening. Opacification of the right sphenoid sinuses mainly mildly hypointense on T2 and isointense to white matter on T1 The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Findings are compatible with a early subacute lacunar infarct involving the left pons2.Periventricular and subcortical white matter changes of a moderate degree are nonspecific. At this age they are most likely vascular related. 3.Multiple microhemorrhages are appreciated in a pattern predominantly compatible with hypertension.4.Findings suggest chronic sinus obstruction at the right sphenoid sinus. Etiology is uncertain.


Instruction: Generate impression based on findings.

Input: Male 60 years old Reason: eval for lesions, assess hepatic vessel patency History: cirrhosis, s/p OLT 10/94 ABDOMEN:LIVER, BILIARY TRACT: Liver has mildly widened fissures and and hypertrophy of the left hepatic lobe compatible with chronic liver disease.Hepatic artery and portal veins are patent. Hepatic veins are narrowed probably due to central fibrosis but remain patent. No suspicious hepatic lesions identified. Metallic artifact is noted in the right hepatic lobe that partially obscures the right hepatic lobe.Probable cyst in the left hepatic lobe near the dome.No significant intrahepatic biliary ductal dilatation. Common bile duct is normal in caliber.SPLEEN: Spleen is enlarged.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small amount upper abdominal ascites.

Output: 1.Findings of chronic liver disease without suspicious hepatic lesion; patent hepatic vasculature.2.Biliary tree is normal in caliber.3.Findings suggestive of elevated portal pressures with mild upper abdominal ascites and splenomegaly.


Instruction: Generate impression based on findings.

Input: Slurring of the speech. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are scattered areas of high T2 signal in the cerebral white matter bilaterally. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is fluid throughout the paranasal sinuses. There is also a small amount of fluid within the mastoid air cells bilaterally. The orbits, skull, and scalp soft tissues are grossly unremarkable.

Output: 1. Findings suggestive of acute pansinusitis.2. No evidence of acute intracranial hemorrhage, mass, or acute infarct.3. Scattered areas of high T2 signal in the cerebral white matter bilaterally may represent chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: A 68 year old male with history of hypertrophic cardiomyopathy, Crohn's disease, remote colon and bladder cancer status post resection, nephrolithiasis. Referred to cardiac MRI to assess the cardiomyopathy. Left VentricleThe left ventricle is normal in size with hyperdynamic systolic function. The overall LV ejection fraction is 70%, the LV end diastolic volume index is 76 ml/m2 (normal range: 74+/-15), the LVEDV is 152 ml (normal range 142+/-34), the LV end systolic volume index is 23 ml/m2 (normal range 25+/-9), the LVESV is 45 ml (normal range 47+/-19). There is concentric hypertrophy with increased myocardial mass. At end diastole, the antero septum is 18mm. The inferolateral wall is 16mm. There is focal, intermediate signal enhancement at the mid myocardial insertion points of the interventricular septum. There are no cardiac MRI findings to suspect cardiac amyloidosis.No intracardiac thrombus.Left AtriumThe left atrium is dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 64%, the RV end diastolic volume index is 57 ml/m2 (normal range 82+/-16), the RVEDV is 113 ml (normal range 142+/-31), the RV end systolic volume index is 20 ml/m2 (normal range 31+/-9), and the RVESV is 40 ml (normal range 54+/-17).Right AtriumThe right atrium is normal size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mitral regurgitation. This was not quantified but is estimated to be at least moderate in the presence of left atrial chamber dilation. Associated moderate to severe systolic anterior motion of the anterior leaflet of the mitral valve with acceleration of antegrade flow at the subvalvular left ventricular outflow tract.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The thoracic aorta is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is a trace pericardial effusion.Extracardiac FindingsLeft renal atrophy with lesions previously characterized as likely cysts. These are incompletely characterized on this exam.

Output: 1. The left ventricle is normal in size with hyperdynamic systolic function, the LVEF is 70%. There is hypertrophy with increased mass. Mid myocardial enhancement at RV insertion site at interventricular septum. SAM with MR and accelerated flow in the subvalvular outflow tract. Constellation of findings are compatible with hypertrophic cardiomyopathy.2. The right ventricle is normal in size with normal systolic function, the RVEF is 64%.


Instruction: Generate impression based on findings.

Input: 54-year-old male with history of pancreatic cancer, coagulopathy, and liver failure presents with headache, altered mental status, left eye pain with unreactive dilated pupil There is a well demarcated, hyperattenuating sellar mass (image 9, series 2) which is consistent with a pituitary macroadenoma. There also appears to be a separate additional expansile mass in the sella (image 8, series 2) eroding the left posterior clinate and dorsum sella with minimal expansion into the left cerebello-pontine angle and significant extension into the left cavernous sinus with associated lateral expansion of the cavernous sinus. The mass shows hyperattenuation along the periphery with a hypoattenuating center. Although this second mass likely represents extension of the pituitary macroadenoma, an MRI is recommended for further evaluation and to exclude aneurysm. These masses are unlikely to represent metastases. There is no evidence of intracranial hemorrhage. The orbits appear within normal limits.The ventricles and basal cisterns are normal in size and configuration. With the exception of the dorsal sella and posterior clinate, the remaining calvaria and skull base are radiographically normal. A left maxillary retention cyst is noted. The other visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Sellar masses with posterior and left lateral cavernous sinus extension as described above. These masses likely represent pituitary macroadenomas, MRI is recommended for further characterization and to exclude the diagnosis of aneurysm.Left maxillary retention cyst.


Instruction: Generate impression based on findings.

Input: Neck mass concerning for carotid artery invasion with history of T4N2b left oropharyngeal squamous cell carcinoma and concurrent laryngeal squamous cell carcinoma treated with chemo and radiation last in 1/2015), myasthenia gravis, and left internal jugular vein thrombosis (on lovenox). There are post-treatment findings in the upper aerodigestive track related to radiation therapy and tracheostomy tube insertion. There is an ulcerative mass with central hypoenhancing areas and peripheral ill-defined enhancement centered within the left oropharyngeal space that measures up to approximately 4.5 cm. The abnormal enhancement extends to the retropharyngeal space, prevertebral space, left masticator space, and left parapharyngeal space, at least partially surrounding the left internal carotid artery. There is no significant lymphadenopathy in the neck. There is heterogeneous enhancement and ill-defined swelling in the posterior hypopharynx as well, but otherwise no measurable mass in the larynx. There is left tympanomastoid fluid. There is scattered paranasal sinus mucosal thickening. There is deformity and expansion of posterior right ribs, which may be related to prior fracture.

Output: Findings suggestive of tumor progression with substantial areas of necrosis centered within the left oropharyngeal space that measures up to approximately 4.5 cm. Heterogeneous enhancement and ill-defined swelling in the posterior hypopharynx may represent tumor versus treatment effects. Please also refer to the recent prior CTA for additional details regarding the status of the carotid artery.Discussed with Dr. Haraf at 2:30 PM on 6/15/15.


Instruction: Generate impression based on findings.

Input: Acute mental status changes. History of end-stage renal disease. Now with decreased blood pressure. There is no evidence of intracranial hemorrhage, mass or midline shift. An area of low attenuation in the right parieto-occipital region appears slightly larger than on the prior study and is somewhat well defined. This likely represents an infarct of the indeterminate age. An MRI is suggested for further evaluation. The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: No evidence of intracranial hemorrhage. Low attenuation lesion in the right parieto-occipital region is slightly larger than on the prior study. An MRI is recommended for further evaluation.


Instruction: Generate impression based on findings.

Input: Patient used prophylactic antibiotics before and after the procedure as prescribed. The patient received antibiotic prophylaxis with oral Ciprofloxacin 500mg and Vantin 200mg. The patient took 1 tablet of Ciprofloxacin 500mg the night before and morning of the procedure. The patient also took 2 tablets of Vantin 200mg the morning of the procedure. After the procedures, the patient will take 2 tablets of Ciprofloxacin 500mg and 2 tablets of Vantin 200mg.Following the discussion of the risks, benefits, and alternatives of the procedure, informed consent was obtained. DynaCad was used to localize right apical peripheral zone of the prostate at the site of prior ablation. Using the Dynatrim guidance system an 18-gauge MR- compatible needle was inserted into the right of the prostate. Upon confirmation of the tip of the needles close to the suspected lesion, MR guided biopsy using an 18 gauge biopsy needle was performed and two cores were obtained.The cores were hand delivered to the pathology lab.The patient tolerated the procedure well and was discharged without any immediate complications.ESTIMATED BLOOD LOSS: Less than 5 cc.

Output: 1. Successful core-biopsies of the right base of the prostate


Instruction: Generate impression based on findings.

Input: The study is degraded by motion artifact. There are unchanged postoperative findings related to resection of a right superior temporal gyrus lesion. There is a new 5 mm enhancing lesion within the right cerebellar hemisphere with susceptibility effect and surrounding edema. There is also a new punctate focus of susceptibility effect with surrounding edema within the right occipital lobe although contrast enhancement is questionable given the motion degradation on the sequence. There are a few unchanged punctate scattered foci of susceptibility effect supratentorially that likely represent chronic microhemorrhages. The confluent periventricular T2 hyperintensity has minimally increased since the prior exam. There is no evidence of acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is a retention cyst within the left maxillary sinus and minimal fluid within the left mastoid air cells.

Output: 1.Motion degraded exam. 2.New lesions within the right cerebellar hemisphere and the right occipital lobe may represent metastases or possibly acute - subacute microhemorrhages in the setting of prior whole-brain radiation. Given the motion artifact and limitations of the post-contrast sequences, repeating these sequences may be helpful for further characterization and would provide a more sensitive assessment for additional lesions.3.Unchanged postoperative findings related to resection of a right superior temporal gyrus lesion.4.Slightly increased confluent periventricular white matter signal abnormality is likely treatment related.


Instruction: Generate impression based on findings.

Input: 47-year-old male with prior imaging showing 2 collections of gas, one possibly more proximal than ulcer on exam. Evaluate for soft tissue abscess. Diffuse soft tissue swelling within the subcutaneous tissues and musculature of the foot with skin ulceration along the plantar aspect overlying the second and third metacarpal heads and an adjacent collection containing foci of low signal intensity likely gas. There are several small focal collections along the plantar soft tissues which demonstrate rim enhancement suspicious for small abscesses, for example a small collection adjacent to the first metacarpal head measures 12 mm x 6 mm (series 1201, image 56) and an additional collection more laterally overlying the plantar aspect of the third metacarpal head measures 13 mm x 8 mm (series 1201, image 56). There is suggestion of decreased T1 signal intensity affecting the sesamoid bones about the first metacarpal head with no corresponding increased STIR signal or enhancement. The remaining bones of the foot demonstrate normal bone marrow signal intensity.

Output: Diffuse soft tissue swelling with a focal area of ulceration along the plantar aspect of the foot with suspicion for small abscesses as described above. No findings to suggest osteomyelitis.


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 knee 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 22-gauge needle was advanced into the joint. Next, 20 ml of Omnipaque 240 was 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 CT suite for further imaging in stable condition. Please refer to the subsequent MRI report for further information.Exposure time: 1 minute 36 secondsEntrance dose: 7.0 mGy

Output: Successful injection of the left knee under fluoroscopic guidance.


Instruction: Generate impression based on findings.

Input: History of craniopharyngioma and progressive cysts. Status post partial resection of cyst drainage on March 30, 2013. Status post Pegintron and radiation therapy. Allowing for differences in angulation and slice selection, there is overall slight decrease in the size of the peripheral cystic component of the complex suprasellar mass. The central solid part has not changed. For example, the cystic component indenting the undersurface of the right frontal lobe now measures 12 mm compared to 16 mm previously. A similar component deforming the right cerebral peduncle now measures 12 mm compared to 14 mm previously. The component involving the right ambient cistern now measures 19 mm x 13 mm compared to 20 mm x 16 mm previously and now displays more CSF-like intensity. There continues to be involvement of the prepontine, cerebellopontine angle cistern, right ambient and right quadrigeminal cisterns, as well as the right middle cranial fossa, with associated mass effect upon the brainstem, right medial temporal lobe, and hypothalamus-optic apparatus complex. There is asymmetric volume loss of the left cerebellar hemisphere associated with increased T2 signal, which may be attributable to crossed cerebellar diaschisis versus chronic ischemic effects. The basilar artery is tortuous and encased by the mixed cystic and solid mass. There are postoperative findings related to right temporal craniotomy and stable position of right frontal approach drainage catheter with the tip in the right prepontine cyst. The ventricular system also appears to be unchanged. There are foci of susceptibility effect within the right temporal lobe resection cavity, consistent with hemosiderin deposition, and within portions of the tumor, which likely represent calcifications.

Output: 1.Further, slight regression in the peripheral cystic component of the complex suprasellar craniopharyngioma. The tumor has extensive involvement of the adjacent structures as described previously.2.Other postoperative/treatment findings are not significantly changed.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 71 year-old female with hip pain for two months after fall. We see no signal abnormality in the bones to suggest a fracture. Mild osteoarthritis of the right hip. Signal abnormality within the labrum likely a combination of degeneration and tearing. No joint effusion is present.The gluteus minimus tendon on the right appears slightly thickened with mild fatty atrophy of the gluteus minimus muscle. The remaining musculature appears intact. There is small amount of fluid along the soft tissues adjacent to the right greater trochanter which may reflect very mild bursitis.One of the larger field of view images, mild osteoarthritis affects the left hip. There is an elongated and lobulated fluid signal along the the anterior aspect of the hip which extends superiorly along the pelvic side wall posterior to the iliopsoas which may reflect fluid in the iliopsoas bursa or paralabral cyst. There is increased signal intensity at the origin of the hamstrings on the left which may reflect tendinosis and mild tearing but is not necessarily of current clinical significance. Severe degenerative arthritic changes affect the lower lumbar spine.

Output: 1.No fracture is evident.2.Degenerative arthritic changes as above.3.Atrophy of the right gluteus minimus muscle with thickening of the right gluteus minimus tendon which could represent tendinosis or alternatively an old tear that has undergone scarring.4.Small thin collection of fluid along the right greater trochanter may reflect mild bursitis but is not necessarily of current clinical significance.5.Other findings as above.


Instruction: Generate impression based on findings.

Input: 31-year-old male. Persistent pain with running for two months. Calf muscle tear? (most likely soleus). Bone marrow signal intensity is within normal limits without evidence of a fracture. No evidence of edema, atrophy, or hematoma in the muscles of the lower leg.

Output: Unremarkable right tibia/fibula MRI. No evidence of muscle tear or hematoma.


Instruction: Generate impression based on findings.

Input: Clinical question: Rule out structural lesion or ischemia. Signs and symptoms: Right-sided weakness. Pre- and post enhanced brain MRI:Diffusion weighted images demonstrate well-demarcated focus of restricted diffusion in the left caudate head measuring at 16 x 17 mm in transaxial dimensions. Additional focus of restricted diffusion in the left paramedian pons measuring at 8 x 21 mm in transaxial dimensions and consistent with acute nonhemorrhagic ischemic strokes.Above findings are also well visualized on both FLAIR and T2-weighted images as foci of hyperintensity.Additionally examination demonstrate extensive periventricular and to a lesser degree subcortical foci of FLAIR hyperintensity consistent with moderate chronic small vessel ischemic strokes with resultant mild ex vacuo dilatation of lateral ventricles. Post enhanced images demonstrate no detectable abnormal parenchymal or leptomeningeal enhancement.The signal voids of major intracranial arterial branches are identified.The signal intensity of intracranial venous sinuses is normal and mid normal pattern of enhancement.Unremarkable calvarium, paranasal sinuses and mastoid air cells.Images through the orbits demonstrate a chronic blowout fracture of the floor of right orbit with evidence of retro-orbital fat herniation inferiorly of approximately 10 mm.

Output: 1.Acute ischemic stroke of the left caudate head and left paramedian pons as detailed/measured above.2.Extensive chronic small vessel ischemic strokes with resultant mild ex vacuo dilatation of lateral ventricles.3.No detectable abnormal enhancement.4.Chronic blowout fracture of the right orbital floor with 10 mm inferior herniation of retro-orbital fat.


Instruction: Generate impression based on findings.

Input: Female, 51 years old, with history of pituitary adenoma status post resection in 2008. Yearly follow-up for residual. Postoperative findings are redemonstrated compatible with prior transsphenoidal surgery. The sella is partially empty. No new masslike lesion is seen. The pituitary stalk continues to deviate towards the right. No suprasellar lesions are seen. The visualized optic apparatus is unremarkable.

Output: Redemonstration of postoperative findings with no evidence of recurrent sellar tumor.


Instruction: Generate impression based on findings.

Input: Previous stroke, with numbness tingling on left side. Brain MRI: There is linear T2 hyperintensity in the left corona radiata. There is no evidence of intracranial hemorrhage, mass, or acute infarct. 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 orbits, skull, and scalp soft tissues are grossly unremarkable. There is mucosal thickening in the bilateral maxillary sinuses. Brain MRA: There is an unchanged 2 mm outpouching arising from the right posterior communicating artery. There is no evidence of significant steno-occlusive lesions.Cervical Spine MRI: There is no evidence of significant steno-occlusive lesions.

Output: 1. Chronic left corona radiata lacunar infarction, but no evidence of acute infarction.2. Unchanged 2 mm outpouching arising from the right posterior communicating artery, but no evidence of significant steno-occlusive lesions involving the major cerebral arteries.3. No evidence of cervical spinal cord lesions.


Instruction: Generate impression based on findings.

Input: Female 36 years old Reason: Rule out lesion History: Low back pain The vertebral column alignment is within normal limits but shows mild scoliotic deformity of lumbar spine. The vertebral body and disc space heights are preserved. Mild disc desiccation at L5-S1. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and terminates at L1-L2. The paravertebral soft tissues are unremarkable. No abnormal enhancement.Interspace observations:T12-L1: There is no significant compromise to spinal canal or neural foramina.L1-L2: There is no significant compromise to spinal canal or neural foramina.L2-L3: There is no significant compromise to spinal canal or neural foramina.L3-L4: There is no significant compromise to spinal canal or neural foramina.L4-5: There is no significant compromise to spinal canal or neural foramina.L5-S1: There is no significant compromise to spinal canal. Mild bilateral facet hypertrophy and a left foraminal protrusion and osteophyte causes moderate left neural foraminal narrowing. No significant right neural foraminal narrowing.

Output: 1.Moderate left L5-S1 neural foraminal narrowing. No significant spinal canal stenosis or other neural foraminal narrowing is present throughout the lumbar spine.2.Spinal cord itself has normal signal and does not demonstrate abnormal enhancement.


Instruction: Generate impression based on findings.

Input: History of hepatitis and cirrhosis. Evaluate for HCC. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology.Stigmata of portal hypertension including recanalized periumbilical vein and perisplenic collaterals.No focal hepatic lesion. No biliary ductal dilatation.Small periportal lymph nodes are not unexpected and are nonspecific in the setting of cirrhosis.The vessels are patent.SPLEEN: The spleen measures 11 cm in craniocaudal.PANCREAS: Pancreas divisum without acute abnormality. Punctate splenic tail cyst is unchanged and likely represents a small side branch type IPMN without suspicious features. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted. Splenorenal shunt. 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: Cirrhosis and portal hypertension without a suspicious focal hepatic lesion.


Instruction: Generate impression based on findings.

Input: Resection of brain lesion, hemangioblastomas. There are postoperative findings related to suboccipital craniotomy. There are multiple unchanged enhancing nodules in the cerebellum and right posterior cingulate gyrus, some of which have associated cystic components and surrounding vasogenic edema. The largest lesion measures up to 12 mm in the cerebellar vermis. There is also an unchanged punctate enhancing left medial globe lesion. There is an unchanged gliotic tract from prior right transfrontal ventricular shunting. The ventricles are unchanged in size. There is no evidence of acute infarct. There is no midline shift or herniation. The major cerebral flow voids are intact. There is scattered ethmoid sinus mucosal thickening.

Output: 1. No significant interval change in the multiple posterior fossa and right posterior cingular gyrus hemangioblastomas.2. Unchanged punctate enhancing left medial globe lesion, which may represent a retinal capillary hemangioma related to von Hippel Lindau disease.


Instruction: Generate impression based on findings.

Input: Dorsal nasal pit. There appears to be a punctate focus of soft tissue along the midline of the nasal dorsum. There is no evidence of gross sinus tract or connection to the intracranial compartment. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is a patent foramen cecum. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable.

Output: An apparent punctate focus of soft tissue along the midline of the nasal dorsum may be associated with the nasal pit. However, there is no evidence of gross sinus tract or connection to the intracranial compartment. A patent foramen cecum can be a normal variant for age.


Instruction: Generate impression based on findings.

Input: 62-year-old man with history of elevated PSA. Additional history as per chart: Patient with latest PSA of 4.47 ng/mL and biopsy from 12/9/2011 showing high-grade PIN. PELVIS:PROSTATE:Prostate Size: 54 x 42 mm.Peripheral Zone: There is a focus of decreased T2 and ADC map signal in the right paramedian peripheral zone base (series 501, image 83). There is no evidence of extracapsular extension. The remainder of the peripheral zone is unremarkable.Central Gland: No significant abnormality noted.Seminal Vesicles: No evidence of seminal vesicle involvement.Extracapsular Extension: NoneBLADDER: No significant abnormality noted.LYMPH NODES: There are small, bilateral lymph nodes with slight diffusion obstruction. The largest of these (series 801, image 21) measures 14 x 8 mm.BONES, SOFT TISSUES: There is a partially visualized left paralabral cyst measuring 18 x 16 mm.OTHER: No significant abnormality noted.

Output: Focal area of signal abnormality in the right paramedian peripheral zone base suspicious for neoplasm.


Instruction: Generate impression based on findings.

Input: 5-day-old male with history of perinatal acidosis. Evaluate for parenchymal injury. Per chart, patient is an ex 37 2/7 weeks gestational age male born to a 34 year old G4P2012 mother with hypertension, superimposed pre-eclampsia, GDMA1, +HSV but no active lesions. Delivery complicated by non reassuring fetal heart tones and perinatal acidosis prompting hypothermic cooling protocol. Patient is s/p hypothermia cooling protocol and 72 hour EEG, with epileptiform discharges but no clinical or electrographic seizures. Images are limited by patient motion. There is no restricted diffusion on DWI sequences.Normal linear T1 hyperintense and T2 hypointense signal in the the posterior third of the posterior limb of the internal capsules is not optimally visualized bilaterally. The ventral lateral nuclei of the thalamus are well visualized bilaterally. There is no intraparenchymal hemorrhage or mass lesion. There is no extraaxial collection.The CSF spaces are within normal limits. There is an incidental cavum septum pellucidum et vergae. There is no mass effect or midline shift. Midline structures appear intact.There is a T2 hyperintense and T1 hypointense caput succedaneum along the central vertex, slightly greater to the right of midline, measuring up to 8 mm.

Output: Motion limited exam. Poor visualization of normal expected signal associated with myelination in the posterior limb of the internal capsule, concerning for mild hypoxic ischemic injury as described above. Clinical correlation is recommended. No acute infarct.