Instruction: Generate impression based on findings.

Input: Male, 59 years old, with urinary retention and lower extremity weakness. Evaluate for lumbar spine disease. Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. Marrow signal characteristics are heterogeneous, but there are no areas of concerning marrow replacement, enhancement or edema. The visualized distal spinal cord, conus and nerve roots of the cauda equina are likewise normal and free of pathologic enhancement. Degeneration of the SI joints is seen.Bilateral hydronephrosis and hydroureter is seen. The renal cortex appears to be thinned. The bladder is not included within the field-of-view of this examination.L1-2: Unremarkable. L2-3: Mild facet arthropathy. Otherwise unremarkable . L3-4: Mild facet arthropathy. Otherwise unremarkable. L4-5: Mild facet arthropathy. Minimal disc bulging. No spinal canal stenosis. Mild bilateral foraminal narrowing. L5-S1: Facet arthropathy. No significant spinal canal or foraminal stenosis.

Output: 1.Relatively mild degenerative findings are seen in the lumbar spine with no areas of significant spinal canal or foraminal stenosis.2.Bilateral hydronephrosis and hydroureter are seen. The lower urinary tract structures are not included within the field-of-view of this examination. Cross-sectional imaging of the pelvis should be considered to assess for the possibility of an obstructing lesion.


Instruction: Generate impression based on findings.

Input: Head: There are no T2/FLAIR signal abnormalities. There is redemonstration of a ventricular catheter with right frontal approach that terminates in the upper third ventricle. The ventricular size is normal. There is no midline shift. Basal cisterns are patent with no evidence of herniation. There is no acute hemorrhage or mass effect. Vascular flow voids are within normal limits. There is no diffusion restriction. There is thickening of the scalp along the right frontal region. There is susceptibility artifact along the right parietal region, perhaps related to a piece of metal in the scalp, as seen in the previous CT. There is opacification of the mastoid air cells. There is partial opacification of the paranasal sinuses.Cervical spine: There is redemonstration of fracture of the base of the dens, which extends obliquely through the right lateral body of C2. Remainder of the vertebral bodies have normal signal. There is a subtle punctate T2 high signal in the left hemicord at the level of C3 on axial imaging, which is not confirmed on sagittal T2 imaging. There is airspace disease in the pulmonary right upper lobe and right-sided pleural effusion.

Output: 1.No acute hemorrhage or mass effect in the brain parenchyma. There is no evidence for acute ischemic cerebral infarction.2.Cervical spine demonstrates fracture of the base of the dens which is better appreciated on recent CT of the cervical spine. 3.There is a subtle punctate T2 high signal in the left hemicord at the level of C3, which is likely artifactual.4.The patient status post ventriculostomy tube placement.5.The patient is known to have temporal bone and skull base fracture. Please refer to CT of the temporal bones for further comments


Instruction: Generate impression based on findings.

Input: 69-year-old male with history of metastatic thyroid cancer. Evaluate response to treatment. Compare to previous, measurements please. ABDOMEN:LIVER, BILIARY TRACT: In hepatic segment 4, there is a stable 1 cm T2 hyperintense lesion again demonstrating peripheral enhancement (series 401 image 25, series 703 image 274) (prior 1.1 cm). The known lesion at the hepatic dome is best seen on the diffusion weighted sequence measuring 1.2 x 0.8 cm (prior 1.8 cm).In the lateral hepatic segment 6, there is a subcentimeter T2 hyperintense and enhancing lesion that is unchanged in size (series 704 image 211, series 401 image 20).The subcentimeter well-circumscribed nonenhancing T2 hyperintense foci in hepatic segment 6 (series 401 image 23) is unchanged and likely a cyst. SPLEEN: No significant abnormality noted.PANCREAS: Stable T2 hyperintense focus in the pancreatic bodyADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Stable T2 hyperintense and enhancing lesion of the L1 vertebral body extending into the right pedicle (series 401 image 17).OTHER: No significant abnormality noted.

Output: 1.Continued decrease size of the hepatic dome lesion. Stable 1 cm lesion in hepatic segment 4 and stable subcentimeter enhancing nodule in the lateral hepatic segment 6.2.Stable size of L1 osseous metastasis.3.Stable cystic lesion the pancreatic body.


Instruction: Generate impression based on findings.

Input: Possible arachnoid cyst and abnormal vessel: right side headache, abnormal CT. MRI: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and brainstem appear unremarkable. There is focal prominence of cerebrospinal fluid spaces along the inferior aspect of the left cerebellar hemisphere, measuring 10 mm in width, 2 mm in height, and 10 mm anteroposteriorly. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.MRA: The vertebrobasilar system is tortuous, but there is no evidence of significant steno-occlusive lesions or cerebral aneurysms.

Output: 1. No evidence of arachnoid cyst in the premedullary space. However, a small areas of focal prominence of the cerebrospinal fluid spaces along the inferior aspect of the left cerebellar hemisphere may be attributable to an arachnoid cyst.2. No evidence of cerebral aneurysms.


Instruction: Generate impression based on findings.

Input: Metastatic NSCLC. Treatment planning MRI for SRS. There is a lesion along the right postcentral sulcus that measures up to 8 mm with a small amount of susceptibility effect. There is no midline shift or mass effect. The ventricles are unchanged in appearance. There is an persistent nonspecific left parietal scalp lesion that measures up to 12 mm.

Output: 1. Pre-treatment planning MRI demonstrates a subcentimeter probable metastases in the right postcentral sulcus. Please refer to the recent brain MRI for additional details.2. Persistent nonspecific left parietal scalp lesion.


Instruction: Generate impression based on findings.

Input: Neurofibromatosis, evaluate tumor mass in right lower pelvis/inguinal area PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Heterogeneously enhancing T2 hyperintense mass between the right iliacus and psoas muscles measures 3.8 x 3.1 x 3.9 cm (series 6, image 16). The mass demonstrates internal restricted diffusion and may invade the adjacent iliacus muscle.

Output: Right pelvic mass suspicious for a peripheral nerve sheath tumor with possible invasion of the right iliacus muscle. This lesion would be amenable to biopsy as clinically warranted to exclude a malignant nerve sheath tumor.


Instruction: Generate impression based on findings.

Input: Female, 57 years old. Left shoulder weakness and pain ROTATOR CUFF: There is a massive tear of the rotator cuff. The supraspinatus and infraspinatus tendons are retracted to the level of the glenohumeral joint, although a few fibers of the infraspinatus tendon appear to extend slightly more distally. There is mild atrophy of the supraspinatus muscle and moderate atrophy of the infraspinatus muscle. The teres minor muscle and tendon are intact. There is a complete tear of the subscapularis tendon with retraction to the level of the glenohumeral joint. There is mild atrophy of the subscapularis muscle.SUPRASPINATUS OUTLET: There is widening of the acromioclavicular joint which may represent prior surgery. There is a small amount of fluid within the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: The humeral head is high riding. Mild to moderate osteoarthritis affects the glenohumeral joint. There is increased signal intensity within the labrum, likely representing a combination of degeneration and degenerative tearing. There is a small to moderate-sized joint effusion with intermediate signal intensity of the fluid, particularly in the axillary recess, presumably representing synovitis.BICEPS TENDON: There is medial dislocation of the tendon of the long head of the biceps from the bicipital groove and increased signal intensity within the tendon likely representing tendinosis.

Output: Massive rotator cuff tear and other findings as described above.


Instruction: Generate impression based on findings.

Input: Finger numbness ROTATOR CUFF: There is partial-thickness articular surface tearing of the supraspinatus tendon. This may also extend slightly into the anteriormost fibers of the infraspinatus. Otherwise infraspinatus is intact. The teres minor and subscapularis tendons are intact. There is no significant fatty atrophy of the rotator cuff musculature.SUPRASPINATUS OUTLET: Mild osteoarthritis affects the acromioclavicular joint. A trace amount of fluid is noted within the subacromial subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Alignment of the glenohumeral joint is normal. There is no evidence of full-thickness labral tear or detachment.BICEPS TENDON: The visualized intra-articular biceps tendon is intact. ADDITIONAL

Output: Partial-thickness articular surface tearing of the supraspinatus tendon with possible slight extension into the anterior fibers of the infraspinatus. There is no evidence of full-thickness rotator cuff tear.


Instruction: Generate impression based on findings.

Input: Female, 65 years old. Reason: r/o growth of nodules, adenopathy History: multiple nodules, one of which was enlarging, but FNA biopsy non-diagnostic. This is 4 month follow up study RIGHT LOBE MEASUREMENTS: 2.0 x 1.5 x 4 . CentimetersLEFT LOBE MEASUREMENTS: 1.1 x 0.9 x 4.7 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: Heterogeneous echotexture. A nodule in the mid right thyroid measures 1.5 x 1.3 x 1 .8 cm, solid and hypoechoic, with coarse peripheral calcification and mild internal vascularity. A nodule in the inferior pole measures 1.3 x 1.2 x 1 .2 cm, homogeneous and significantly hypoechoic, noncalcified, with moderate internal vascularity. If this nodule is extrathyroidal, it may represent a parathyroid adenoma. An additional nodule in the inferior pole measures 0.6 x 0.4 x 1 .0 cm, homogeneous and hypoechoic, noncalcified, with moderate internal vascularity.LEFT LOBE: Heterogeneous echotexture. A nodule in the inferior pole measures 0.4 x 0.4 x 0 .5 cm, solid and hypoechoic, noncalcified, nonvascular.ISTHMUS: Heterogeneous echotexture.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: A right level 3 lymph node measures 0.8 x 0.3 x 0.9 cm, with a fatty hilum. A left level 3 lymph node measures 0.5 x 0.4 x 0.9 cm, unchanged.OTHER: No significant abnormality noted.

Output: Multiple bilateral thyroid nodules as detailed above, unchanged. Stable cervical lymph nodes.


Instruction: Generate impression based on findings.

Input: Male, 43 years old,spinal cord syrinx, follow-up. Thoracic: There is significant volume loss involving the thoracic cord at the level of the syrinx as well as of the mid thoracic cord above the syrinx. Again demonstrated is a syrinx extending from the T8 to T10 levels which is overall not significantly changed since 8/20/2015. At the T8 level there is a locule in the right aspect of the syrinx previously measuring 7.5 x 6.6 mm, now 7.1 x 8.0 mm. At the T9 level a locule measures 6.7 x 7.1 mm, previously 5.6 x 5.9 mm.Exaggerated thoracic kyphosis is redemonstrated with small Schmorl's nodes suggestive of Scheuermann's. Again seen are multilevel laminectomies. Syrinx shunt catheter is poorly visualized. Fatty endplate signal change is seen at the superior endplate of T7, unchanged. No areas of high-grade spinal canal or neuroforaminal stenosis are appreciated.Lumbar:The conus and cauda equina are within normal limits. The conus tip terminates at the upper margin of L2 which is within normal limits.Vertebral body heights are normal. Bone marrow signal is benign. Grade 1 retrolisthesis of L4 relative to L5 is again seen. Alignment is otherwise unremarkable. Edematous endplate marrow signal changes at L5-S1 appear slightly decreased. Disc desiccation at L3-L4, L4-L5, and L5-S1 is again seen with particular loss of disc height at the L5-S1 level. Individual levels as below: L1-2: No spinal canal stenosis or neuroforaminal narrowing. L2-3: No spinal canal stenosis or neuroforaminal narrowing. L3-4: Facet hypertrophy. Mild bulging disk. No significant spinal canal or neuroforaminal stenosis. No interval changes.L4-5: Facet hypertrophy. Disc bulge. No significant spinal canal stenosis. Mild bilateral foraminal narrowing.L5-S1: Facet hypertrophy. Diffuse disc bulge again seen including involvement of the neural foramina. No significant spinal canal stenosis. Mild to moderate bilateral neural foraminal stenosis.

Output: 1. Overall no significant change in size and extent of septated lower thoracic syrinx. There are small loculated areas which demonstrates subtle changes in morphology and perhaps minimal enlargement as detailed above compared to 8/20/2015. 2. Significant parenchymal volume loss involving the thoracic cord at the level of the syrinx as well as above it involving the mid thoracic cord. 3. Mild degenerative changes in the lumbar spine.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for infarct. Signs and symptoms: Left gaze deviation, right face arm and leg weakness, hyperreflexia. Nonenhanced brain MRI:Diffusion weighted images demonstrate a large patchy foci of restricted diffusion extensively involving the left corona radiata, partially involving the left basal ganglia and left insular cortex and left anterior temporal cortex. This finding is not associated with any hemorrhagic changes. This finding is also well visualized on flair and T2 weighted images and consistent with an acute nonhemorrhagic ischemic stroke. Additionally examination demonstrates numerous patchy confluent flair hyperintensity in bilateral subcortical and periventricular white matter consistent with chronic small vessel ischemic strokes without evidence of hemorrhagic changes.Slight prominence of cortical sulci and ventricular system remains within normal for patient stated age of 84. Although not a dedicated vascular imaging there is apparent small caliber and abnormal signal intensity of the left M1 segment of middle cerebral artery. Follow-up with vascular imaging is recommended.Images through the orbits, paranasal sinuses and mastoid air cells are unremarkable. Calvarium and soft tissues of the scalp are also unremarkable.

Output: 1.Large patchy acute nonhemorrhagic ischemic stroke in the left corona radiata, left basal ganglia/left insular cortex and left anterior temporal cortex as detailed. No appreciable mass effect.2.Extensive chronic nonhemorrhagic small vessel ischemic stroke in the supratentorial brain parenchyma.3.Abnormal caliber and signal intensity of the M1 segment of the left middle cerebral artery suspicious for high-grade stenosis or possible thrombus. Recommend follow up with dedicated vascular imaging.


Instruction: Generate impression based on findings.

Input: Right orbital mass with proptosis, diplopia, lateral rectus palsy. There is extensive dental brace artifact, which partly obscures and considerably distorts the appearance of the orbits. There is a partially obscured enhancing T2 hyperintense mass in the right lateral extraconal orbit that measures up to at least 28 mm. There is deformity of the right lateral rectus muscle and right proptosis. There is no evidence of right optic nerve compromise. The left orbit appears to be grossly unremarkable, within the limits of artifact. There is mucosal thickening in the left frontal sinus. The imaged portions of the brain are grossly unremarkable.

Output: Extensive dental brace artifact, which partly obscures and considerably distorts the appearance of the orbits. A partially obscured mass in the right lateral extraconal orbit that measures up to at least 28 mm may represent a hemangioma, but other neoplasms are a consideration.


Instruction: Generate impression based on findings.

Input: The last well formed disk space is referred to as L5-S1. There is minimal grade 1 retrolisthesis of L5 on S1, and minimal grade 1 anterolisthesis of L4 on L5. The remainder of the spine shows normal alignment. There is loss of T2 signal in all visualized disks with moderate loss of disk height at L4-5 and L5-S1. There is diffusely heterogeneous marrow signal which is nonspecific. There are type II endplate degenerative changes at L4-5 and L5-S1. There is minimal edema in the right-sided L4 and L5 articulating facets and pedicles which is nonspecific, likely reflecting degenerative process. The conus terminates at L1-2 and shows normal caliber and signal.T12-L1: No disk herniation, central spinal or neural foraminal stenosis.L1-2: No disk herniation, central spinal or neural foraminal stenosis.L2-3: No disk herniation, central spinal or neural foraminal stenosis.L3-4: Minimal disk bulge and bilateral facet arthropathy contributing to mild to moderate bilateral neural foraminal stenosis. No central spinal stenosis.L4-5: Diffuse disk bulge, bilateral facet arthropathy and ligamentum flavum thickening causing moderate right and mild left neural foraminal stenosis and no significant central spinal stenosis. Disk material encroaches upon the bilateral subarticular zones without significant stenosis.L5-S1: Diffuse disk bulge asymmetric to the left with a left foraminal protrusion causing mild to moderate left and minimal right neural foraminal stenosis. No significant spinal canal stenosis.

Output: 1.Multilevel lumbar spondylosis with no significant central spinal canal stenosis and variable degrees of neural foraminal stenoses as described above.2.At L5-S1, there is mild to moderate left neural foraminal stenosis secondary to left foraminal disk protrusion and may be impinging on the exiting left L5 nerve root.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 50-year-old male with left facial droop. Evaluate the left facial nerve. There is an apparent punctate focus of high signal on the diffusion weighted sequence in the lateral portion of the left internal auditory canal. Otherwise, there is no evidence of a mass or abnormal enhancement. The inner ear structures, including the cochlea, vestibule, endolymphatic duct, and semicircular canals, appear unremarkable. The bilateral mastoid air cells and middle ears also appear unremarkable. There is a left ocular prosthesis.

Output: Apparent punctate focus of high signal on the diffusion weighted sequence in the lateral portion of the left internal auditory canal without evidence of a corresponding abnormality on the other images may represent artifact or perhaps a recent ischemic event involving the left facial nerve. Otherwise, no discernible evidence of a mass or abnormal enhancement. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Patient with low back pain. Rule out sacroiliitis. There is a tiny focus of enhancement along the sacral margin of the right sacroiliac joint anteriorly that may represent a small degenerative cyst, but I see no frank sacroiliitis. I see no abnormal edema or enhancement of the remaining sacrum or iliac bones. There is a subcentimeter ovoid focus of abnormal signal intensity and enhancement along the left inferior articulating facet of L5 that may represent a synovial cyst arising from the facet joint, but this is equivocal and of questionable clinical significance. Low signal intensity within the pars interarticularis of L4 may represent a chronic spondylolysis, but this is equivocal as well.

Output: No frank sacroiliitis. Questionable L4 spondylolysis and facet joint synovial cyst as above. Further evaluation with radiographs and/or lumbar spine MRI may be considered if clinically warranted.


Instruction: Generate impression based on findings.

Input: 54 year old male with ischemic cardiomyopathy, previous percutaneous coronary intervention of left anterior descending artery and left circumflex referred for cardiac MRI prior to consideration of intervention of right coronary artery chronic total occlusion. Viability/ Myocardial ScarThere was subendocardial (< 50% thickness) late gadolinium enhancement noted of the mid to basal inferior / inferoseptum wall that likely represents prior myocardial infarction and is less likely suggestive of fibrosis, inflammation, or infiltration. The entire myocardium is viable by LGE criteria.Left VentricleThe left ventricle is normal in size and moderately reduced in systolic function . The overall LV ejection fraction is 33%, the LV end diastolic volume index is 99 ml/m2 (normal range: 74+/-15), the LVEDV is 217 ml (normal range 142+/-34), the LV end systolic volume index is 66 ml/m2 (normal range 25+/-9), the LVESV is 145 ml (normal range 47+/-19). There is mild hypokinesis of the mid to basal inferior, inferolateral, and inferoseptal walls and basal inferoseptal and inferior walls. At low dose dobutamine (20 mcg) there is augmented contractility of all segments suggesting viability. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and mildly reduced in systolic function. The overall RV ejection fraction is 42%, the RV end diastolic volume index is 63 ml/m2 (normal range 82+/-16), the RVEDV is 139 ml (normal range 142+/-31), the RV end systolic volume index is 37 ml/m2 (normal range 31+/-9), and the RVESV is 81 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is at least mild to moderate aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVCdrain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. There is mild hypokinesis of the mid to basal inferior, inferolateral, and inferoseptal walls and basal inferoseptal and inferior walls. 2. The left ventricle is normal in size and moderately reduced in systolic function (LVEF 33%). 3. The right ventricle is normal in size and mildly reduced in systolic function (RVEF 42%).4. All segments are viable by both LGE and low-dose dobutamine.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Suspect metastatic breast cancer. This patient has a prior history of breast cancer and now presents with an isolated malignant compression fracture at T6. Serial CT images obtained during the biopsy procedure demonstrate the needle placement within the T6 vertebral body and right pedicle lesion.

Output: T6 vertebral bone biopsy under CT guidance. A total of six samples were delivered to pathology for analysis.


Instruction: Generate impression based on findings.

Input: 60-year-old male with prostate cancer. PELVIS:PROSTATE:Prostate Size: The prostate measures 4.6 cm in transverse, 3.1 cm in AP, and 4.3 cm increased caudal diameter.Peripheral Zone: Prominent T1 hyperintense signal intensity of the peripheral zone is compatible with hemorrhage making the exam suboptimal. Background linear heterogeneity is also noted.In the left lateral mid gland, there is a 8 x 9 mm T2 and ADC hypointense focus suspicious for malignancy (series 501 image 51) (series 703 image 284) (series 801 image 85).Central Gland: Mild changes of BPH.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: The described lesion partly abuts the capsule, however there is no definite extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: Bilateral fat-containing inguinal hernias.OTHER: No significant abnormality noted.

Output: In the left lateral mid gland, there is a 8 x 9 mm T2 and ADC hypointense focus suspicious for malignancy. Limitations include background linear heterogeneity and extensive T1 hyperintense signal compatible with hemorrhage making the exam suboptimal.


Instruction: Generate impression based on findings.

Input: Secondary malignant neoplasm of brain [C79.31], Reason for Study: ^Reason: Metastatic Breast with brain lesion to L cerebellar;s/p WBRT 2008-2009 History: headaches, balance issues Redemonstration of the left cerebellar hemisphere which suggests metastatic lesions. Multifocal susceptibility lesions within bilateral frontal lobes and multifocal nodular and somewhat linear enhancing lesions are again seen and unchanged in their number and MR configuration.Previous craniotomy with underlying left frontal lobe encephalomalacia does not show any significant interval change since prior scan.The ventricles, sulci and cisterns are symmetric and unremarkable except ex vacuo changes of the left lateral ventricle frontal horn. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. No change of left cerebellar enhancing lesion (13.7mm x 14.7mm) since prior scan.2. Other multiple enhancing lesions on the left frontal lobe as well as bifrontal susceptibility lesions do not show any significant interval change since prior scan.3. No change of postoperative change of the left frontal craniotomy site.


Instruction: Generate impression based on findings.

Input: 36-year-old female with new onset paresthesias after exercising, history of known cerebral cavernous malformation. Redemonstrated are changes from left subtemporal approach for pontine cavernous reformation resection. Redemonstrated is susceptibility hypointensity with associated T2 hypointensity within the left pons. A central linear focus of T1 hyperintensity, yet with demonstrable enhancement which extends to the adjacent dural thickening may represent postprocedural changes versus a small developmental venous anomaly. Persistent residual T2 hyperintensity is again noted within the middle cerebellar peduncles bilaterally. Postprocedural dural enhancement is again noted. These findings are stable.There is a small focus of ill-defined T2 hyperintensity with associated enhancement just anterior to the left precentral gyrus, in a subcortical location, most consistent with either a tiny developmental venous anomaly or a capillary telangiectasia, unchanged in appearance.Ventricular sizes are normal. Expected vascular flow voids are demonstrated. There is new minimal mucosal thickening within the right sphenoid sinus. The remaining paranasal sinuses and right mastoid air cells are clear. Fat packing is now noted within the expected region of left mastoid air cells.

Output: SRedemonstrated is susceptibility hypointensity with associated T2 hypointensity within the left pons. A central linear focus of T1 hyperintensity, yet with demonstrable enhancement which extends to the adjacent dural thickening may represent postprocedural changes versus a small developmental venous anomaly. Persistent residual T2 hyperintensity is again noted within the middle cerebellar peduncles bilaterally. Postprocedural dural enhancement is again noted. These findings are stable.


Instruction: Generate impression based on findings.

Input: A patient submitted the following outside studies for review.1. Bilateral digital screening mammogram 11/18/20142. Left unilateral digital diagnostic mammogram 12/4/20143. Left breast ultrasound 12/4/20144. Ultrasound guided left breast biopsy 12/11/20145. Post procedure left unilateral digital diagnostic mammogram 12/11/20146. Bilateral breast MRI 12/19/20147. Bilateral digital screening mammogram 10/26/20138. Bilateral digital screening mammogram 10/17/20129. Bilateral digital screening mammogram 10/10/201110. Bilateral digital screening mammogram 9/20/2010 Submitted studies were performed at Palos Community Hospital in Palos Heights Illinois. BILATERAL DIGITAL SCREENING MAMMOGRAM (11/18/2014): Two standard digital views of bothbreasts were obtained and compared to prior studies of 10/26/2013, 10/17/2012, 10/10/2011and 9/20/2010. The breast parenchyma is heterogeneously dense, unchanged in pattern anddistribution. In the posterior depth of the left inferior and slightly medial breast, a 2cm area of architectural distortion with faint calcifications is present. No new masses, suspicious microcalcifications or areas of architectural distortion arenoted in the right breast. LEFT UNILATERAL DIGITAL DIAGNOSTIC MAMMOGRAM (12/4/2014): Digital left ML view and twoopen field spot compression views confirm an area of architectural distortion in theposterior depth of the left medial inferior breast.LEFT BREAST ULTRASOUND (12/4/2014): Static images from a left breast ultrasound weresubmitted. Labeled left breast 6 o'clock 4 cm from nipple, a 1.4 x 1.1 x 0.9 cmhypoechoic mass is present with angular margins and internal vascularity. Images of theleft axilla are unremarkable.ULTRASOUND GUIDED LEFT BREAST BIOPSY (12/11/2014): Static images of a left breastultrasound guided core needle biopsy reveal adequate targeting of the mass at the 6o'clock position of the left breast. Percutaneous clip was placed.POST PROCEDURE LEFT UNILATERAL DIGITAL DIAGNOSTIC MAMMOGRAM (12/11/2014): Left MLO and CCviews were performed after the biopsy. A clip is present at the anterior aspect of thearea of architectural distortion in the left breast. No complication from the procedureis present.BILATERAL BREAST MRI (12/19/2014): Bilateral breast MRI was performed without and withcontrast as per the protocol submitted on the outside report. Heterogeneous fibroglandulardensities are present bilaterally. Minimal parenchymal enhancement is present. A 1.5-cmcyst is present in the right lobe of the liver.Left breast: In the posterior depth of the inferior central left breast, a 1.4 x 2.6 x 1.3cm (all measurements AP x LR x CC) area of heterogeneous enhancement with ill-definedborders is present. Susceptibility artifact is present along the superior and anterioraspect of the mass. Linear enhancement extends from the lateral portion of the mass to theskin surface, most likely related to biopsy changes. Washout kinetics are present. Noadditional abnormal enhancement is present in the left breast. No abnormal left axillarylymph nodes are noted.Right breast: In the mid depth of the superior central right breast, a 2.0 X 1.1 x 1.4 cmarea of linear non-mass enhancement with persistent kinetics is present. No additionalabnormal areas of enhancement are present in the right breast. No abnormal right axillarylymph nodes are present.PATHOLOGY: Pathology slides from Palos Community Hospital dated 12/11/2014 were reviewedat University of Chicago on 12/29/2014. Final pathologic diagnosis of the left breast 6o'clock core needle biopsy is invasive ductal carcinoma grade 2 with DCIS.

Output: Biopsy proven left breast cancer. Non-mass enhancement in the superior rightbreast for which a MR directed ultrasound is recommended. If no ultrasound correlate ispresent, MRI guided biopsy will be needed. Surgical consultation is recommended.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: 45-year-old female with a history of trauma/fall on the left knee and edema in the right ankle. Concern for pseudothrombophlebitis with popliteal cyst. Presents with knee pain. MENISCI: The medial lateral meniscus appear intact.ARTICULAR CARTILAGE AND BONE: No full-thickness or near full-thickness articular cartilage defects. There is increased bone marrow signal abnormality in the lateral patella which may represent a bone contusion. LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact. ADDITIONAL

Output: Soft tissue swelling and probable bone contusion of the patella, without evidence of internal derangement of the knee.


Instruction: Generate impression based on findings.

Input: There is asymmetric enhancement along the left trigeminal nerve in the cisternal portion which extends as a heterogeneously enhancing mass centered in the left Meckel's cave/inferolateral left cavernous sinus measuring 14 x 7 mm on series 20 image 69 with further extension and enhancement along the left foramen ovale (series 22 image 22). There is asymmetric enhancement of the left V2 division of the trigeminal nerve from the Meckel's cave as it courses through the inferior orbital fissure and extends into the left infraorbital foramen.There is a 17 x 9 mm extra-axial dural based mass in the right parietal high convexity without significant internal enhancement (series 19 image 11, series 20 image 178), as well as a similar left high parietal convexity extra-axial dural based mass measuring 15 x 6 mm on series 19 image 19, series 20 image 187. There is no significant surrounding mass effect on the adjacent cortex or vasogenic edema.There is diffuse pachymeningeal enhancement which is smooth and may be reactive to the dural metastases elsewhere.There is no suspicious intra-axial enhancement. There is no acute infarct, mass effect or midline shift. There are scattered T2 signal abnormalities in the periventricular right frontal white matter which are nonspecific. There is no hydrocephalus.There is heterogeneous diffuse low osseous marrow signal and scattered enhancing lesions with restricted diffusion consistent with metastatic disease. There is a retention cyst in the right maxillary sinus.

Output: 1.Findings suspicious for multiple dural-based metastases. There is a heterogeneously enhancing extra-axial mass centered in the left Meckel's cave and inferolateral aspect of the cavernous sinus measuring 14 x 7 mm . Posteriorly mass contacts the cisternal segment of the left trigeminal nerve and anteriorly extends into the left foramen ovale. Asymmetric increased enhancement of the left V2 and V3 nerves is noted. These findings are compatible with patient's left CN V dysfunction. 2.Additional extra-axial masses along the bilateral parietal high convexities. No significant associated mass effect or vasogenic edema. 3.Diffuse osseous metastases.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 77 years Female (DOB:9/11/1938)Reason: history of lumbar stenosis. low back and leg pan History: low back and leg pianPROVIDER/ATTENDING NAME: BEN-ZION ROITBERG BEN-ZION ROITBERG Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There is anterior fusion at C6-7 using metallic hardware..At C2-3 there is no significant compromise to the spinal canal or neural foramina. There is a mild disc bulge and disc desiccation present.At C3-4 there is no significant compromise to the spinal canal. There are some endplate and uncovertebral osteophytes present at this level associated with narrowing of the neural foramina bilaterally and encroachment of the exiting nerve roots within the neural foramina. There is mild narrowing of the spinal canal is level. There is loss of disc space height and disc desiccation at this level. This is stable compared to prior exam.At C4-5 there is no significant compromise to the spinal canal. There are some endplate and uncovertebral osteophytes present at this level associated with narrowing of the neural foramina bilaterally and encroachment of the exiting nerve roots within the neural foramina. There is mild narrowing of the spinal canal is level. There is loss of disc space height and disc desiccation at this level. This is stable compared to prior exam.At C5-6 there is no significant compromise to the spinal canal or neural foramina. There is loss of disc space height and disc desiccation at this level.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.Lumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. There is straightening of the normal lordotic curvature of the lumbar spine which was also the case on the prior exam.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is a disc bulge present at this level. Although the neural foraminal are narrowed, within the neural foramina the exiting nerve roots are surrounded by fat.At L4-5 there is loss of disc space height, disc desiccation and a diffuse disc bulge associated bilateral facet hypertrophy and ligamentum flavum hypertrophy with effacement of the fat at the lateral recess bilaterally. The nerve roots within the thecal sac or crowded. Compared to the prior exam there is some progression of spinal stenosis. There is a moderate to severe degree of spinal stenosis present at this level. The stenosis has progressed since the prior exam. Although the neural foraminal are narrowed, within the neural foramina the exiting nerve roots are surrounded by fat.At L3-4 there is loss of disc space height, disc desiccation and diffuse disc bulge associated with ligamentum flavum hypertrophy. There is effacement of the fat at the lateral recess bilaterally at this level. There is some crowding of the nerve roots within the thecal sac. Overall there is a moderate degree of spinal stenosis at this level. This stenosis has progressed since prior exam. Although the neural foraminal are narrowed, within the neural foramina the exiting nerve roots are surrounded by fat.At L2-3 there is loss of disc space height, disc desiccation and a diffuse disc bulge associated with some mild ligamentum flavum hypertrophy and triangulation of the thecal sac. There is some crowding of the nerve roots present at this level and partial effacement of the fat at the lateral recess bilaterally. Overall there is mild to moderate spinal stenosis at this level. This appears to have progressed compared to the prior exam. Although the neural foraminal are narrowed, within the neural foramina the exiting nerve roots are surrounded by fat.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.There are multilevel degenerative changes in the lumbar spine associated with moderate to marked degree of spinal stenosis at L4-5 and moderate spinal stenosis at L3-4 and mild to moderate spinal stenosis at L2-3. 2.There are degenerative changes present in the cervical spine worse at C3-4 and C4-5-4 there is encroachment of exiting nerve roots within the neural foramina and mild degrees of spinal canal narrowing which are stable compared to the previous exam.


Instruction: Generate impression based on findings.

Input: There is no acute infarct, mass effect, or cerebral edema. There is a chronic right pontine microhemorrhage which is new from prior MRI from April 2013. There is a chronic right cerebellar microhemorrhage which is unchanged from April 2013. There is moderate global sulcal prominence again seen. There is moderate periventricular and subcortical white matter T2 signal abnormalities which are nonspecific, likely representing chronic microvascular ischemic changes (including central pons). The optic nerves are inadequately evaluated on this exam although no gross abnormalities are identified on the axial images. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable.

Output: 1.No acute infarct or mass effect. 2.Moderate global volume loss (advanced for patient age) and moderate chronic small vessel ischemic disease. Please note optic nerves are not adequately assessed on current study and MRI orbit can be considered as clinically indicated.3.Focus of susceptibility likely representing chronic microhemorrhage involving the right pons is new since April 2013.4.Chronic left pontine infarct again seen.


Instruction: Generate impression based on findings.

Input: History of progressive lower extremity weakness and spasticity. Evaluate for myelopathy. Cervical spine:The vertebral body and intervertebral disc heights are maintained. The alignment is anatomic. No bone marrow signal abnormalities. The visualized spinal cord is normal in signal and morphology.C2-C3: No disc bulge, spinal canal stenosis, or neuroforaminal narrowing.C3-C4: Small right paracentral disc osteophyte complex. No significant neural foraminal or spinal canal stenosis.C4-C5: No disc bulge, spinal canal stenosis, or neuroforaminal narrowing.C5-C6: Small generalized disc osteophyte complex eccentric to the right. Mild bilateral neural foraminal stenosis. No spinal canal stenosis.C6-C7: Small generalized disc osteophyte complex. Mild bilateral neural foraminal stenosis. No spinal canal stenosis.C7-T1: No disc bulge, spinal canal stenosis, or neuroforaminal narrowing.Thoracic spine:The vertebral body and intravertebral disc heights are maintained. The alignment is anatomic. Focus of T1 and T2 bright signal within the T9 vertebral body is compatible with an intraosseous hemangioma. The visualized spinal cord is normal in signal and morphology throughout.T1-T2 through T11-12: No disc bulge, spinal canal stenosis, or neuroforaminal narrowing.Lumbar Spine:Vertebral body heights are maintained. There is mild loss of intervertebral disc height at L4-5 and L5-S1 as well as decrease in intervertebral disc signal from L2 to S1 compatible with desiccation. Reactive marrow changes are present in the inferior endplate of L3 and superior endplate of L4. Visualized spinal cord and cauda equina are normal in signal and morphology. The conus medullaris terminates at the L1-2 level.T12-L1: No disc bulge, spinal canal stenosis, or neuroforaminal narrowing.L1-L2: No disc bulge, spinal canal stenosis, or neuroforaminal narrowing.L2-L3: Mild diffuse disc bulge. This creates mild bilateral neural foraminal stenosis. No spinal canal stenosis.L3-L4: Mild diffuse disc bulge, facet arthropathy, and hypertrophy of the ligamentum flavum create moderate left neural foraminal stenosis and mild right neural foraminal stenosis. No significant spinal canal stenosis.L4-L5: Mild diffuse disc bulge, facet arthropathy, and hypertrophy of the ligamentum flavum create severe left and moderate right neural foraminal narrowing.L5-S1: Moderate posterior disc protrusion, facet arthropathy, and hypertrophied ligamentum flavum create moderate to severe right and moderate left neural foraminal stenosis. No central canal stenosis.

Output: 1. Normal signal and morphology of the spinal cord throughout the cervical, thoracic, and lumbar spine. No evidence of myelopathy as clinically queried.2. Multilevel degenerative changes in the cervical and lumbar spine as described. Multilevel neuroforaminal stenoses in the lumbar spine are most severe at the left L4-5 and right L5-S1 levels.


Instruction: Generate impression based on findings.

Input: 75-year-old female with sacral decubitus and foul-smelling. Evaluate for osteomyelitis. Exam is severely limited by motion degradation. There is soft tissue thickening overlying the sacral region without large erosive lesion evident within the limits of motion degradation.The vertebral column alignment is within normal limits. The lumbar vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. Within the lower lumbar spine there is a small disc bulges involving the L4-5 level and L5-S1 levels. There is mild to at most moderate facet arthropathy extending from L3-4 to L5-S1 but there is no significant spinal canal stenosis or neuroforaminal narrowing. The visualized distal spinal cord displays normal signal and morphology.

Output: 1.Severely motion degraded exam without gadolinium. No large osseous lesion is appreciated to indicate osteomyelitis within the limitations of the study. There is soft tissue thickening involving the sacral soft tissues. Suggest repeat examination with sedation or CT.2.Mild degenerative changes involving the lower lumbar spine without significant neural foraminal narrowing or spinal canal stenosis.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Female, 53 years old, with seizures and altered mental status. No evidence of restricted diffusion, edema or mass effect is seen. No focal signal abnormality is observed. There are no structural lesions or parenchymal defects. Postcontrast images are within normal limits. No evidence of intracranial hemorrhage or any abnormal extra-axial fluid collection is seen. Ventricular size and morphology are within normal limits.

Output: Unremarkable evaluation with no specific findings to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: Male 8 years old with left hemiparesis, focal onset epilepsy, right cortical dysplasia, evaluate changes in cortex Again seen is an abnormal gyral pattern in the right cerebral hemisphere involving the right posterior frontal, parietal, and temporal lobes with areas of cortical thickening consistent with polymicrogyria. Findings are most apparent in the right parietal lobe. Myelination is within normal limits. No focal parenchymal signal abnormalities are noted. No evidence of gray matter heterotopia. Bilateral hippocampi appear symmetric and normal in size.There is a minimal amount of rightward midline shift related to the right cerebral hemisphere being smaller than the left. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The pituitary gland appears grossly unremarkable. No hydrocephalus or extra-axial collections. The major cerebral flow voids are intact. The left middle ear cavity and mastoid air cells are opacified as before with improvement in the opacification of the paranasal sinuses.

Output: 1. Again seen is an abnormal gyral pattern in the right cerebral hemisphere involving the right posterior frontal, parietal, and temporal lobes with areas of cortical thickening consistent with polymicrogyria. Findings are most prominent in the right parietal lobe.2. No intracranial mass, infarct, or parenchymal signal abnormalities.3. Mild volume loss in the right cerebral hemisphere.


Instruction: Generate impression based on findings.

Input: Bilateral leg pain radiating from lower back. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable. A spheroid T2 hyperintense lesion in the left kidney likely represents a cyst, bu is incompletely characterized.

Output: No evidence of lumbar spinal canal or neural foraminal stenosis.


Instruction: Generate impression based on findings.

Input: Clinical question: Low back pain, evaluate lumbar spine. Signs and symptoms: Lower back pain and left leg pain. Nonenhanced lumbar MRI:There is normal anatomical alignment of the vertebral column however with straightening of lumbar lordosis. The signal intensity of vertebral column is unremarkable.T11 -- T12 is unremarkable.T12 -- L1 is unremarkable.L1 -- L2 is unremarkable.L2 -- L3 demonstrate mild ligamentum flavum hypertrophy and unremarkable otherwise.L3 -- L4 demonstrate mild degenerative changes however without central spinal stenosis. Moderate bilateral neural foraminal compromise is noted on sagittal T2 weighted images. There is suggestion of congenital anatomical variation of short pedicle causing the neural foraminal compromise.L4 -- L5 demonstrate mild disk disease and loss of disk height and a central and left broad-based disk protrusion. The findings results in moderate central spinal stenosis. There is also moderate bilateral neural foraminal compromise. The degree of neural foraminal compromise appears is disproportionate to the extent of degenerative changes and a component of congenitally short pedicles as a cause of neural foraminal stenosis is highly suspected.L5 -- S1 demonstrate mild disk disease and mild bilateral facet and ligamentum flavum degenerative changes. No spinal stenosis or convincing evidence of neural foraminal compromise.The perispinal soft tissues are unremarkable.

Output: 1.Central and left sided broad-based disk protrusion at L4 -- L5 with resultant central spinal stenosis and moderate bilateral neural foraminal compromise.2.Minimal degenerative changes at other levels with highly suspected congenital anatomical variation of short pedicles results in neural foraminal compromise as detailed per level above.


Instruction: Generate impression based on findings.

Input: Unilateral left sensorineural hearing loss. Reevaluate known vestibular schwannoma.. Again seen is a 3 x 2 x 2 mm (AP x transverse x craniocaudal) enhancing lesion involving the superior lateral aspect of the right internal auditory canal likely representing a schwannoma. The remainder of the bilateral inner ear structures including the cochlea, vestibule, endolymphatic duct, and semicircular canals appear unremarkable. Specifically, no lesions on the left are appreciated. The bilateral mastoid air cells and middle ears also appear unremarkable. Again seen are bilateral maxillary sinus retention cysts, right larger than left.

Output: Unchanged 3 mm enhancing lesion in the lateral aspect of the right internal auditory canal likely representing a schwannoma.


Instruction: Generate impression based on findings.

Input: 64 year old woman with history of pulmonary hypertension, heart failure with preserved EF, atrial fibrillation, sick sinus syndrome with dual chamber pacemaker and worsening shortness of breath, referred for cardiac MRI to evaluate for infiltrative etiologies. Due to renal dysfunction, contrast could not be administered for this study. 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 67 ml/m2 (normal range: 65+/-11), the LVEDV is 129 ml (normal range 109+/-23), the LV end systolic volume index is 19 ml/m2 (normal range 18+/-5), the LVESV is 39 ml (normal range 31+/-10), the LV mass index is 55 g/m2 (normal range 67+/-11), and the LV mass is 113 g (normal range 114+/-24). There is asymmetric hypertrophy of the left ventricle with pronounced hypertrophy of the apical anterior, anterolateral and inferolateral walls (15mm) with normal septal thickness (8-9mm). There is mid cavity obliteration at end-systole but no frank flow acceleration to suggest an intracavitary gradient. Additionally, there appears to be an apical aneurysm which is thinning and akinetic. The native T1 myocardial relaxation time, including for the hypertrophied segments, is 850-950ms which is normal.Left AtriumThe left atrium is severely dilated. There appears to be flow across the interatrial septum (left to right) which could represent a patent foramen ovale.Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 53%, the RV end diastolic volume index is 55 ml/m2 (normal range 69+/-14), the RVEDV is 112 ml (normal range 110+/-24), the RV end systolic volume index is 26 ml/m2 (normal range 22+/-8), and the RVESV is 53 ml (normal range 35+/-13). There is a pacemaker lead visualized in the right ventricle.Right AtriumThe right atrium is moderately dilated. There is a pacemaker lead that terminates in the right atrium. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve leaflet tips are thickened. There is at least mild mitral regurgitation. There is no systolic anterior motion of the mitral valve.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is moderately dilated (34mm).Venous AnatomyThe SVC and IVC drain normally into the right atrium. There are intravascular device leads in the SVC.PericardiumThere is no pericardial effusion. There is pericardial thickening overlying the anterolateral wall. Extracardiac FindingsThere is a pacemaker with associated artifact overlying the left upper chest wall. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Normal size left ventricle with hyperdynamic systolic function. There is asymmetric hypertrophy involving the apical lateral, anterior and inferolateral walls with a maximal thickness of 15-16mm, which could suggest an atypical hypertrophic cardiomyopathy variant. This is supported by a normal septal wall thickness (8-9mm).2. There is an apical aneurysm noted. Evaluation for LV thrombus on this study is limited by inability to administer contrast.3. Normal size right ventricle with normal systolic function. 4. Dual chamber intracardiac device with leads visualized in the right atrium and right ventricle. 5. Left to right flow across the interatrial septum suggestive of patent foramen ovale. 6. Focal thickening of the pericardium overlying the anterolateral wall. 7. At least mild mitral regurgitation, but no evidence of systolic anterior motion of the mitral valve. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 54-year-old female with a personal history of left breast mastectomy in 2007 for IDC followed by chemotherapy and tamoxifen. Status post right breast lift and implant placement and left breast reconstruction. Family history of breast cancer in maternal aunt, diagnosed at the age of 40. Status post left mastectomy with reconstruction. Retropectoral right saline implant is unchanged in position and contour.There is heterogeneous amount of fibroglandular tissue in the right breast.Mild parenchymal enhancement is noted in the right breast.A small enhancing mass is seen in the left lower chest wall, likely a lymph node. Prior MRI did not cover this lower part of the chest wall.In the right 7:00 position, there is a skin lesion, measuring 7 mm.No abnormal lymph nodes are identified in either axillary region.

Output: Benign appearing mass in the left breast and skin lesion in the right breast. Follow up MRI in 6 months is recommended.BIRADS: 3 - Probably benign finding.RECOMMENDATION: 3B - Followup at Short Interval (1-11 Months).


Instruction: Generate impression based on findings.

Input: Male, 56 years old, status post L5-S1 fusion. Assess for proximal nerve root compression as a source of left hip and lower extremity pain. Posterior and interbody instrumented fusion has been performed at L5-S1. A laminectomy defect is also evident on the left at this level. Assessment of the surgical instruments is better made on the accompanying CT examination.Apart from surgical changes at L5-S1, vertebral body height and morphology are within normal limits. No evidence of pathologic marrow replacement is seen. The visualized distal spinal cord, conus and nerve roots of the cauda equina are within normal limits. No epidural abnormalities are suspected.L1-2: Minimal facet arthropathy. No spinal canal or foraminal compromise. L2-3: Mild facet arthropathy. Mild bulging disc with central annular fissuring. No significant spinal canal compromise. Mild bilateral foraminal narrowing. No interval changes. L3-4: Facet arthropathy. Bulging disc with a small central protrusion. No significant spinal canal compromise. Moderate bilateral foraminal narrowing. No interval changes. L4-5: Facet arthropathy. Disc bulging with a central/right paracentral protrusion. No significant spinal canal compromise. Moderate bilateral foraminal narrowing. No interval changes. L5-S1: Facet arthropathy. Disc degeneration with postoperative changes. The fat of the left lateral recess is effaced by T1 and T2 hypointense material which could represent a disc osteophyte complex or perhaps scarring from surgical intervention (see image 19 series 801). This finding contributes to moderate left foraminal narrowing, similar to that seen on prior. The right neural foramen is mildly narrowed. No significant general spinal canal compromise.

Output: 1.Postoperative findings are seen compatible with instrumented fusion from L5 to S1.2.At the L5-S1 level, the left lateral recess and left neural foramen are narrowed by T1/T2 hypointense material which could represent disc osteophyte formation or postoperative scarring. No significant generalized spinal canal compromise is seen at this or any other level.3.Relatively mild degenerative findings are seen at the other lumbar levels without significant interval change.


Instruction: Generate impression based on findings.

Input: Left eyelid swelling and pain rule out orbital cellulitis. There is mild swelling and enhancement of the left preseptal soft tissues, but no evidence of postseptal extension. Indeed, the left globe, extraocular muscles, lacrimal gland, orbital fat, and optic nerve are intact. The right orbit is unremarkable. There is no evidence of mass lesions or drainable fluid collections. There is an unchanged 6 mm diameter high T1 and low T2 signal nodule in the suprasellar cistern along the median eminence of the pituitary stalk. There is a small right maxillary sinus retention cyst. There are partially imaged findings related to apicoectomy at tooth #8 for a periapical granuloma.

Output: 1. Findings compatible with left preseptal cellulitis, but no evidence of postseptal cellulitis or abscess.2. An unchanged 6 mm diameter nodule in the suprasellar cistern along the pituitary stalk may represent a ectopic neurohypophysis or perhaps a Rathke cleft cyst.


Instruction: Generate impression based on findings.

Input: Female 29 years old Reason: r/o CA History: sz \T\ brain tumor CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: There is an enlarged superior mediastinal, right paratracheal lymph node measuring 1.7 x 1.2 cm (series 3, image 10)CHEST WALL: Small axillary lymph nodes all measure less than 1 cm in short axis dimension. Nodular enhancing focus in the right breast (series 6, image 64) is nonspecific and would be better evaluated with mammography/ultrasound.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: 3.2 x 2.6 cm right adrenal mass (series 15, image 27) which does not meet criteria for lipid rich adenoma. There is a 1.5 x 1.2 cm left adrenal nodule (series 15, image 29) which does not meet criteria for lipid rich adenoma. KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Multiple nonenlarged retroperitoneal lymph nodes. A reference aortocaval node measures 1.6 x 1.0 cm (series 6, image 110).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. PELVIS:UTERUS, ADNEXA: Fetus within the uterus. The study was not optimized for evaluation of fetal anatomy. BLADDER: No significant abnormality noted.LYMPH NODES: Pelvic lymphadenopathy. A reference right external iliac node measures 2.2 x 1.3 cm (series 11, image 52).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Mediastinal, retroperitoneal and pelvic lymphadenopathy as well as bilateral adrenal lesions. Findings are suspicious for metastatic disease with no primary malignancy identified although breast or melanoma would be differential considerations. The right adrenal lesion would be amenable to percutaneous biopsy under CT/MRI guidance.


Instruction: Generate impression based on findings.

Input: Diffuse large B-cell lymphoma and PET with possible FDG avid lesion in the right cerebellum. There are small areas of encephalomalacia in the central pons, left periventricular cerebellar hemisphere, and left thalamus. In addition, there are scattered areas of high T2 signal in the bilateral cerebral white matter. However, there is no abnormal intracranial enhancement or mass. There is no evidence of intracranial hemorrhage or acute infarct. There is mild diffuse cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. There are mucosal retention cysts within the maxillary and sphenoid sinuses bilaterally. The orbits, skull, and scalp soft tissues are grossly unremarkable.

Output: 1. No evidence of intracranial mass or abnormal enhancement. 2. Chronic lacunar infarcts in the central pons, left periventricular cerebellar hemisphere, and left thalamus, superimposed upon a background of probable chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: Facial asymmetry since childhood and hyperreflexia here for evaluation of possible multiple sclerosis. There are a few scattered punctate foci of T2 hyperintensity in the cerebral white matter, particularly the frontal lobes. 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 major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is minimal fluid signal in the left mastoid air cells. There is anterior nasal deviation to the left.

Output: 1. A few scattered punctate foci of T2 hyperintensity in the cerebral white matter, particularly the frontal lobes, are nonspecific, but perhaps related to chronic small vessel ischemic disease, but no compelling findings for intracranial demyelinating lesions otherwise.2. Anterior nasal deviation to the left.


Instruction: Generate impression based on findings.

Input: There is straightening of the normal cervical lordosis. The vertebral body heights are well-maintained. There is diffuse disc desiccation and degenerative bone marrow signal changes, but no evidence of tumor. At C3-4, a posterior disc osteophyte complex results in central spinal stenosis with compression of the spinal cord, which displays patchy high T2 signal, as well as at least moderate neural foraminal narrowing bilaterally. At C4-5 and C5-6 posterior disc osteophyte complexes result in moderate spinal canal stenosis and bilateral neural foraminal narrowing. There is no significant disc bulge, herniation, spinal canal or foraminal stenosis within the remainder of the cervical spine. The paravertebral soft tissues are unremarkable. THORACIC SPINE

Output: 1.Degenerative spondylosis in the cervical spine, in which a disc-osteophyte complex at C3-4 compresses the spinal cord, with associated edema or myelomalacia.2.Prominent ligamentum flavum thickening and possible calcification or ossification with associated moderate narrowing of the spinal canal at T10-11. 3.Degenerative spondylosis in the lumbar spine and congenital narrowing of the spinal canal result in compression of the spinal cord at L1-2 with associated edema or myelomalacia and indentation upon the cauda equina nerve roots at L2-3 and L3-4. In addition, the degenerative spondylosis is associated with moderate neural foraminal stenosis on the left at L3-4 and on the right at L4-5, as well as mild left neural foraminal narrowing at L4-5.4.Patchy enhancement surrounding the L4 through S1 spinous processes may be related to Baastrup disease.5.No gross evidence of lymphoma involving the spine.


Instruction: Generate impression based on findings.

Input: Female; 36 years old. Reason: 36 yo female with hx of breast cancer now with lesion in the left rectus abdominis suggestive of desmoid tumor please evaluate for changes and or abnormalities History: desmoid tumor ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, 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: No significant abnormality noted.BONES, SOFT TISSUES: Stable 2.5 x 1.4 cm enhancing lesion in the left rectus abdominis muscle (series 901/for 64), previously 2.5 x 1.4 cm.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Small amount of endometrial fluid is likely physiologic. Tampon device noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: There is a 2.5 x 1.4 cm enhancing lesion in the left rectus abdominis muscle (14/91).OTHER: Trace amount of free fluid in the pelvis is likely physiologic.

Output: Unchanged nonspecific enhancing lesion in the left rectus abdominis muscle, which again may be due to a desmoid and would be amenable to percutaneous biopsy.


Instruction: Generate impression based on findings.

Input: Tuberous sclerosis, evaluate for renal angiomyolipomas. The examination is limited by respiratory motion artifact. The kidneys are normal in size and enhance symmetrically. No focal renal lesion is evident. The previously described ultrasound abnormality in the left upper pole is not present on the current exam. There is no hydronephrosis.The liver is normal without focal lesion or biliary ductal dilation. The spleen, pancreas, and adrenal glands are normal in size and morphology. The lung bases are clear.

Output: Normal appearance of the kidneys. No angiomyolipoma or cyst.


Instruction: Generate impression based on findings.

Input: 53 year old woman with known left breast cancer and metastatic left axillary lymph node, status post neoadjuvant chemotherapy. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.The index cancer in the left breast at 1:00 position now measures 7 x 9 x 7 mm (AP x LR x CC). It is significantly reduced in size when compared to the prior measurement (20 x 20 x 19 mm). A Hydromark clip is present approximately 5 mm lateral to the index cancer. The satellite lesion seen on the prior exam at central left breast is no longer visualized. Only a metallic artifact from marker clip is seen.An enlarged left axillary lymph node becomes smaller, measuring 17 x 8 mm (previous measurement: 34 x 19 mm). A Hydromark clip is identified at the anterior aspect within the lymph node.In the right breast, a benign mass at 9:00 position is unchanged.No new abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in right axillary region.

Output: 1. Interval decrease in size of index cancer in the left breast and left metastatic axillary lymph node, and complete resolution of satellite lesion in the left breast.2. No interval change in the right benign mass.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Female, 18 years old. History of actinomyces infection, off antibiotic therapy; eval progression of disease UTERUS, ADNEXA: The uterus and adnexa are normal in appearance. Multiple physiologicfollicles are seen bilaterally.BLADDER: No significant abnormality noted.LYMPH NODES: No significant lymphadenopathy.BOWEL, MESENTERY: No abnormal bowel wall thickening or evidence of obstruction. The posterior rectal wall abuts the loculated fluid collections, without evidence of involvement of the bowel wall. BONES, SOFT TISSUES: The multiloculated rim-enhancing fluid collection in the presacral space is unchanged from the prior study. The referenced left portion of the collection measures 3.5 x 1.8 cm (series 8, image 20), unchanged. The right portion of the collection measures 1.9 x 0.9 cm (series 8, image 19), unchanged. High T2 signal involving the coccyx without enhancement is unchanged. No other fluid collections are identified. The subcutaneous soft tissues are normal. OTHER: Trace pelvic free fluid.

Output: 1.Unchanged multiloculated, rim-enhancing presacral fluid collections as well as non-enhancing high T2 signal involving the coccyx.2.No new subcutaneous fluid collection or other new acute abnormality.


Instruction: Generate impression based on findings.

Input: 36 years Female (DOB:9/21/1980)Reason: r/o mass History: nonePROVIDER/ATTENDING NAME: SUSAN HONG SUSAN HONG The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.There is redemonstration of a small extra-axial focus of susceptibility effect adjacent to the falx cerebri and right frontal lobe is unchanged compared to prior examsNormal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: There is no evidence for brain metastases. Examination is stable compared to the previous exam.


Instruction: Generate impression based on findings.

Input: History of anal cancer on chemotherapy with history of resection of hepatic metastasis involving the diaphragm, please restage and compare to previous. ABDOMEN:LIVER, BILIARY TRACT: Status post resection of hepatic dome lesion seen on the prior study. No new hepatic lesions are evident. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Punctate T2 hyperintensities in the right kidney are too small to characterize but likely represent small cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: T1 hyperintense lesion is unchanged, likely an endometrioma.There is circumferential wall thickening and increased enhancement involving the vagina with a soft tissue mass along the right posterolateral aspect of the lower vagina and along the right anterolateral aspect of the rectum as described below. The fluid within the upper vagina and cervix has decreased.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is near circumferential bowel wall thickening and increased enhancement involving the anterior, right lateral and posterior aspects of the rectum and anal canal measuring approximately 12 cm in length extending from the anal verge proximally. Circumferential thickening of the rectum has slightly increased now measuring up to 1.2 cm in thickness (series 3, image 29). Soft tissue masses along the right aspect of the rectum in the mesorectal fat and along the right pelvic sidewall have increased in size; for example the previously described soft tissue mass along the right anterolateral of the rectum in continuity with vagina measures 3.6 x 2.7 cm (series 3, image 20), previously 3.1 x 2.8 cm. These masses extend beyond the mesorectal fascia on the right into the ischioanal fossa (series 3, image 15). BONES, SOFT TISSUES: Heterogeneously decreased T1 signal within the bone marrow as well as increased T2 signal within the musculature of the pelvis may be related to radiation changes.OTHER: No significant abnormality noted.

Output: 1.Interval increase in size of pelvic masses involving the rectum and vagina as well as the right pelvic sidewall and ischioanal fossa.2.Surgical changes related to resection of hepatic dome lesion. No new hepatic lesions identified.


Instruction: Generate impression based on findings.

Input: Patient has depth electrodes placed for intracranial EEG monitoring on 10/8/15.Evaluate for depth electrode position. There are two left transfrontal electrodes that extend to the left anterior cingulate and left orbitofrontal region. There are also bilateral transparietal electrodes that extend to the bilateral medial temporal lobes. There is a small amount of pneumoventricle. The ventricular system is otherwise unchanged in size. There is a small amount of high T1 signal in the right parietal sulci adjacent to the electrode, which may represent postoperative enhancement or hemorrhage. There is no midline shift or herniation. There is mild scalp swelling surrounding the electrode insertion sites.

Output: Two left transfrontal electrodes that extend to the left anterior cingulate and left orbitofrontal region and bilateral transparietal electrodes that extend to the bilateral medial temporal lobes.


Instruction: Generate impression based on findings.

Input: 29 years Male (DOB:2/8/1987)Reason: MRI lumbar spine History: back pain PROVIDER/ATTENDING NAME: SERVICES ANCILLARY SERVICES ANCILLARY Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. There is a transitional vertebra present which for the purpose of this exam will be labeled as L5. As a result there is partial sacralization of the L5 vertebra on the left side.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is loss of disc space height, disc desiccation as well as a broad-based right paramedian disc protrusion which impresses on the ventral to the thecal sac and mildly encroaches on the nerve roots at the lateral recess bilaterally.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is loss of disc space height, disc desiccation and some endplate reactive change at this level predominantly on the right side where there is a Schmorl's node along the superior endplate of L4.At L2-3 there is no significant compromise to spinal canal or neural foramina. There is some disc desiccation and Schmorl's nodes at this level.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: There are degenerative changes present in the lumbar spine with a mild degree of spinal stenosis at L4-5 where there is some encroachment of nerve roots at lateral recess is bilaterally worse on the right than the left side.


Instruction: Generate impression based on findings.

Input: Follow-up of brain abnormality that was nonspecific by a previous biopsy. The well-circumscribed lesion involving the left caudate head and the anterior part of the left globus pallidus as well as the intervening anterior limb remains unchanged since July 2015 in size and continues to show relatively angular margins. It is more homogeneously T2-hyperintense and heterogeneously T1-hypointense. The associated contrast enhancement on the medial, subependymal aspect of the lesion is decreased but is associated with mild linear focal diffusion restriction. The remainder of the involved left dorsal striatum is atrophic and there continues to be ex vacuo enlargement of the adjacent portions of the left lateral ventricle. Associated susceptibility effect remains minimal with also a small adjacent traversing vessel. Otherwise, there is no acute infarct, acute hemorrhage or mass-effect. The remainder of the CSF-containing spaces remains normal size. There is no brain herniation.Multiple small T2-hyperintense lesions are present in a subcortical distribution in the left cerebral hemisphere, and to lesser extent the right cerebral hemisphere. The corpus callosum is spared as well as the posterior fossa structures.The major intracranial vascular flow voids are preserved. There is minimal fluid intensity in the left mastoid air cells and trace sphenoethmoid mucosal thickening.

Output: 1.The left dorsal striatum lesion shows less contrast enhancement and probably more cavitation. It continues to show volume loss rather than mass-effect and is well-circumscribed with angular margins. This may reflect slow evolution of an inflammatory lesion but the findings are nonspecific otherwise.2.Few subcortical white-matter lesions involving both cerebral hemispheres, more pronounced on the left, are nonspecific but might be ischemic in nature.


Instruction: Generate impression based on findings.

Input: Male, 68 years old. Low back pain, falls There is severe degenerative disc disease at L3-4 and L5-S1. Vertebral body heights are preserved. There is mild straightening of the lumbar spine.

Output: Degenerative disc disease.


Instruction: Generate impression based on findings.

Input: BRCA mutation and family history of breast cancer. History of benign MR guided biopsy of left breast. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Clinical question: Metastatic breast cancer, baseline study prior to starting on clinical trial. Signs and symptoms: Research required, no symptoms. Pre and post enhanced brain MRI:No diffusion-weighted abnormalities.Examination demonstrates normal anatomical development of brain with normal signal intensity on all MRI sequences.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination.There is no detectable abnormal parenchymal or left meningeal enhancement to suggest metastatic disease.Calvarium and orbits are unremarkable and without evidence of metastatic lesions.All visualized paranasal sinuses and bilateral mastoid air cells and middle ear cavities demonstrate normal pneumatization signal patterns.Intracranial venous sinuses demonstrate normal signal intensity and normal pattern of enhancement.

Output: Unremarkable pre and post enhanced brain MRI.


Instruction: Generate impression based on findings.

Input: Female 50 years old; Reason: evaluate liver mass History: acute on chronic abdominal pain Suboptimal exam secondary to motion artifact.ABDOMEN:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Hepatic steatosis. Corresponding to the largest areas of focal hypoattenuation on the prior CT study are areas of dropout of signal on opposed phase imaging (compared to in phase imaging), consistent with sites of focal fat deposition; examples include subcapsular lesion in hepatic segment 2/3 on image 148 series 1301 as well as in the right hepatic lobe, refer to key images. The hepatic segment 2/3 lesion is best seen on postcontrast imaging as a relatively hypointense focus on image 283 series 1404 measuring up to 1.2 x 0.9 cm in the portal venous phase (appeared larger on prior CT where measured 2.4 x 1.8 cm), possible mild peripheral rim enhancement in arterial phase on image 257 series 1403. No corresponding restricted diffusion visualized. Additional tiny hypoattenuating foci seen on earlier CT study not well delineated on current exam, this may be due in part image degradation to motion artifact. However no suspicious focus of restricted diffusion identified in liver. No imaging evidence of cirrhosis. No significant biliary ductal dilatation. Status post cholecystectomy.SPLEEN: Tiny splenule formation.PANCREAS: Status post resection of pancreatic body and tail for chronic pancreatitis. Small residual head/uncinate process, accounting for differences in technique this is unchanged from August 2016 MRI. Aforementioned residual pancreatic parenchyma demonstrates mild restricted diffusion and mild delayed enhancement. Corresponding mildly increased T2 signal also noted. No drainable fluid collection.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Scattered small retroperitoneal including left para-aortic lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Partially imaged ventral abdominal and dependent subcutaneous edema.OTHER: No significant abnormality noted.

Output: 1. Suboptimal exam secondary to motion artifact.2. Hepatic steatosis. Corresponding to the largest areas of focal hypoattenuation on the prior CT study is dropout of signal on opposed phase imaging (compared to in phase imaging), consistent with sites of focal fat deposition. One of these, a hepatic segment 2/3 lesion containing fat is best seen on postcontrast imaging as a relatively hypointense focus measuring up to 1.2 x 0.9 cm in the portal venous and delayed phases (appeared larger on prior CT where measured 2.4 x 1.8 cm), possible mild peripheral rim enhancement in arterial phase. No corresponding restricted diffusion visualized. No imaging evidence of cirrhosis. Lesion is indeterminate, may be followed up as clinically indicated. Additional tiny hypoattenuating foci seen on earlier CT study not well delineated on current exam, this may be due in part image degradation to motion artifact. 3. Status post resection of pancreatic body and tail for chronic pancreatitis. Small residual head/uncinate process, accounting for differences in technique this is unchanged from August 2016 MRI. Aforementioned residual pancreatic parenchyma demonstrates mild restricted diffusion (newly appearing from earlier MR exam) and mild delayed enhancement. Given patient's provided history, constellation of findings most concerning for early acute on chronic pancreatitis. However correlation with patient's clinical history and laboratory values is also recommended to exclude the possibility of an underlying mass lesion and EUS should be considered as needed.


Instruction: Generate impression based on findings.

Input: Personal history of right breast cancer (IDC/DCIS) status post mastectomy. There is scattered fibroglandular tissue in the left breast.Mild parenchymal enhancement is noted in the left breast. The patient is status post right mastectomy. No new or suspicious enhancement is seen in either the left breast or right chest wall. There are a few scattered areas of focal enhancement in the left breast, but these are unchanged, in fact more clearly stable compared to the older comparison study from 2014. No abnormal axillary lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. The patient is due for annual mammographic follow up. BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: 14-year-old male with history of right knee injury during soccer. Positive Lachman. Evaluate for ACL tear, meniscus tear. Right knee pain. MENISCI: The menisci are intact.ARTICULAR CARTILAGE AND BONE: There is bone marrow edema within the distal femoral metaphysis concentrated along the physis anteriorly. There is poorly defined band like low signal intensity within the anteromedial aspect of the distal femoral metaphysis that is suspicious for a nondisplaced fracture although it is not evident on the T2 weighted images. Furthermore there appears to be periosteal elevation along the lateral aspect of the distal femoral metaphysis and there is a tiny 3 mm linear focus of low signal intensity within the soft tissues along the lateral aspect of the distal femoral physis with surrounding soft tissue edema. The constellation of findings suggests a nondisplaced Salter-Harris type II fracture. There are also subarticular foci of edema within the anterior aspect of the medial and lateral femoral condyles likely representing bone contusions. There is also edema within the anterior aspect of the proximal tibial epiphysis that extends to the tibial tubercle. There also appears to be slight depression of the anterior aspect of the tibial plateau. This pattern of bone contusions may reflect a hyperextension type injury. The articular cartilage appears intact.LIGAMENTS: The anterior cruciate ligament is intact. The posterior cruciate ligament is intact. The medial collateral ligament is intact. The proximal fibers of the lateral collateral ligament proper appear thickened which may represent edema related to the aforementioned suspected Salter-Harris type II fracture. The lateral collateral ligament complex otherwise appears intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1.Bone marrow abnormalities as described above suggesting contusions from hyperextension injury perhaps with mild impaction fracture of the anterior aspect of the tibial plateau as well as what we suspect to be a nondisplaced Salter-Harris type II fracture of the distal femur.2.There is slight swelling of the proximal fibers of the lateral collateral ligament proper but otherwise the ligaments appear intact.3.No evidence of meniscal tear.


Instruction: Generate impression based on findings.

Input: Lung cancer metastasis screening. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are scattered foci of T2 hyperintensity in the cerebral white matter, which are nonspecific. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is mild mucosal thickening in the paranasal sinuses.

Output: No evidence of intracranial metastases.


Instruction: Generate impression based on findings.

Input: There is artifact related to patient's braces involving the anterior upper neck soft tissues. Lack of contrast also limits evaluation for small lesions. There is however no large mass involving the neck soft tissues. Multiple small T2 hyperintense lesions are seen in the neck soft tissues which may represent small lymph nodes and/or small neurofibromas.CERVICAL SPINE

Output: Stigmata of neurofibromatosis type I with multiple neurofibromas involving the cervical, thoracic, and lumbar spine. No intraspinal extension to cause spinal canal stenosis is seen. No cord signal abnormality or expansion to suggest intramedullary tumor. There are multiple neurofibromas involving the paraspinous, subcutaneous, and neck soft tissues as well which are relatively small. Please see details above.


Instruction: Generate impression based on findings.

Input: 16-year-old male with pancreatitis. Evaluate for etiology of pancreatitis.EXAMINATION: MRCP without and with intravenous contrast (7 mL Multihance) 10/10/16 Please note that the exam is markedly limited by magnetic susceptibility artifact.Within these limitations, the pancreas, kidneys and spleen demonstrate a normal MR appearance. A gastrostomy tube is present in the stomach. A right lower quadrant ostomy is partially imaged. There is fat extending into the spinal canal at the level of the pelvis, which is consistent with a lipomyelocele as seen on the MRI.

Output: Normal MRI appearance of the pancreas.


Instruction: Generate impression based on findings.

Input: Reason: evaluate for biliary malignancy History: elevated alk phos and transaminitis, prior RUQ US normal per report. Hx of weight loss concerning for cancer ABDOMEN:LIVER, BILIARY TRACT: Gallbladder is collapsed with diffuse wall thickening which is nonspecific. Common bile duct measures 7 mm, likely within normal limits for age. No intrahepatic biliary ductal dilatation. Cholelithiasis. No evidence of choledocholithiasisSPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Mild bilateral hydronephrosis, right greater than left.RETROPERITONEUM, LYMPH NODES: Prominent portacaval lymph nodes.BOWEL, MESENTERY: Mesenteric stranding, better seen on prior CT. Bowel wall thickening in the ascending colon.BONES, SOFT TISSUES: Lesion in the T7 vertebral body which is hyperintense on T1 and T2 likely represents a hemangioma. L3 T2 hyperintense lesion also likely represents a hemangioma given appearance on prior CT. T2 hypointense lesion in the T9 vertebral body corresponds to sclerotic focus on prior CT.OTHER: Moderate abdominal ascites. Small right pleural effusion.

Output: 1.Patient could not tolerate the exam, which was terminated early. Postcontrast images were not obtained. 2.Cholelithiasis without evidence of cholecystitis or biliary malignancy.3.Moderate abdominal ascites with mesenteric stranding as seen on prior CT.4.Right colonic thickening may represent a nonspecific colitis.


Instruction: Generate impression based on findings.

Input: 34-year-old male with history of autosomal dominant polycystic kidney disease and abdominal pain. Evaluate for hemorrhagic cyst. ABDOMEN:LIVER, BILIARY TRACT: Innumerable hepatic cysts are present with the largest segment 8 measuring 6.2 x 4.5 cm. No evidence of enhancing suspicious hepatic lesion. The liver measures approximately 18 cm in length.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Renal parenchyma bilaterally is replaced by innumerable cysts some of which demonstrate proteinaceous material and hemorrhage. No evidence of an enhancing renal lesion. The right kidney measures 12 cm and the left kidney measures 15 cm in length.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Both kidneys are replaced by numerous cysts, some of which are hemorrhagic and proteinaceous.2.Hepatomegaly with innumerable hepatic cysts with the largest measuring up to 6 cm in segment 8.


Instruction: Generate impression based on findings.

Input: Ms. Linksman is a 63-year-old female with personal history of right breast lumpectomy in June 2009 for multifocal IDC followed by radiation and hormonal therapy. Family history of breast cancer in mother and paternal grandmother. There is heterogeneous amount of fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.Postsurgical changes are identified in the right breast, at site of prior lumpectomy. There is no new abnormal enhancement seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region. Normal size intramammary lymph node in the left upper outer breast is stable.

Output: Stable postsurgical changes of the right breast. No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: Re-evaluate disease status following progression/initiation of new immunotherapy treatment: Stage IV melanoma. There has been interval decrease in size of the right sinonasal mass. The lesion in the left lateral rectus muscle has also decreased in size. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact.

Output: 1. No evidence of intracranial metastases.2. Interval decreased in size of the right sinonasal and left lateral rectus muscle metastases.


Instruction: Generate impression based on findings.

Input: 7 year old female with seizures with febrile illness: focal epileptiform discharges on EEG. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No potential seizure foci are identified.


Instruction: Generate impression based on findings.

Input: Reason: RCT History: pain ROTATOR CUFF: There is increased signal intensity within the supraspinatus indicating moderate tendinosis. Additionally, there is focal fluid signal intensity replacing the undersurface fibers of the supraspinatus at its insertion on the greater tuberosity indicating a partial thickness insertional tear. This tear involves under 50% of the tendon thickness and measures only 3 mm in the AP dimension. There is a cyst within the underlying greater tuberosity. We see no full-thickness rotator cuff tear. The aforementioned tendinosis extends posteriorly to involve the anterior fibers of the infraspinatus, but the infraspinatus otherwise appears normal. The teres minor and subscapularis muscles and tendons appear intact.SUPRASPINATUS OUTLET: Mild osteoarthritis affects the acromioclavicular joint. There is a small amount of fluid within the subacromial/subdeltoid bursa containing foci of low signal intensity that may reflect a chronic synovitis, debris, or perhaps calcification, which could be better visualized on radiographs.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is within normal limits. Given the limitations of a non arthrogram study, the glenoid labrum appears normal.BICEPS TENDON: There is increased signal intensity within the tendon of the long head of the biceps at its transition from the rotator interval to the intertubercular sulcus suggesting tendinosis and partial-thickness tearing.ADDITIONAL

Output: 1. Rotator cuff tendinosis with focal partial-thickness undersurface insertional tear of the supraspinatus as described above.2. Tendinosis and possible partial-thickness tearing of the tendon of the long head of the biceps at its transition from the rotator interval to the intertubercular sulcus.3. Small amount of fluid within the subacromial subdeltoid bursa containing foci of low signal intensity that may reflect debris, chronic synovitis, or calcification.