Instruction: Generate impression based on findings.

Input: Ms. Dazzena is a 60-year-old female with known right breast cancer IDC and metastatic right axillary lymph node. She presents today for MRI #3 per ISPY-2 protocol. There is scattered fibroglandular tissue in both breasts. Minimal parenchymal enhancement is noted bilaterally.RIGHT BREAST:There is no residual enhancement identified in the right upper inner breast, at site of biopsy-proven malignancy. Susceptibility artifact from biopsy marker clip is seen within the central aspect of a normal-appearing right axillary lymph node, now measuring 1.1 cm, compared to 1.1 cm.LEFT BREAST:No abnormal enhancement is seen in the left breast. No abnormal axillary lymph nodes are identified in the left axillary region. Vascular port identified in the left medial chest wall.

Output: (1) No residual abnormal enhancement identified in the right upper inner breast, at site of biopsy-proven malignancy. If breast conservation therapy is desired, a repeat post-therapy mammogram is recommended at this time to delineate the presence and extent of previously mammographically-seen calcifications in the right upper inner breast. A bracketed wire localization may be required depending on the mammographic findings.(2) No MR evidence of malignancy in the left breast.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Evaluate for scoliosis, side bending left and right In neutral position, there is approximately 24 degrees of levoscoliosis of the thoracic spine from superior endplate of T4 to inferior endplate of T12. In neutral position, there is approximately 30 degrees of dextroscoliosis from superior endplate of L1 to inferior endplate of L4.With leftward bending, there is approximately 9 degrees of levoscoliosis of the thoracic spine from superior endplate of T4 endplate of T12. With leftward bending, there is approximately 38 degrees of dextroscoliosis from superior endplate of L1 to inferior endplate of L4.With rightward bending, there is approximately 22 degrees of levoscoliosis of the thoracic spine from superior endplate of T4 endplate of T12. With rightward bending, there is approximately 23 degrees of dextroscoliosis from superior endplate of L1 to inferior endplate of L4.

Output: Levoscoliosis of the thoracic spine and dextroscoliosis of the lumbar spine as above.


Instruction: Generate impression based on findings.

Input: Multiple sclerosis [G35], Reason for Study: ^Reason: Multiple Sclerosis History: follow up progression Brain MRIFLAIR/T2 high signal intensity lesions are seen at the left frontal white mater, bilateral corpus callosum, bilateral parietal white mater, right posterior temporal white mater and right cerebellar white mater. These lesions are consistent with lesions of demyelinating disease such as multiple sclerosis. The ventricles, sulci and cisterns are symmetric and unremarkable.There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear.There is a retention cyst on the right maxillary sinus.Cervical spine MRIThere are T2 high signal intensity spinal cord lesions involving C2, C4, C5, C6 and C7 level. Some of those lesions involving hemi spinal cord and some involves posterior aspect of the cord. Comparing to prior scan, especially lesions at the level of C6 and C7 appear to be slightly more prominent than prior. On the other hand, the lesions at the level of C2 to C5 lesions show less conspicuous especially on axial T2 images than prior. These finding can represent some improvement and some aggravation. However, considering the difference in scanning machine and imaging technique, these lesion signal intensity variation could be related to artifacts related to the difference in imaging machine and technique.There is normal cervical lordosis. The cranial-cervical junction is normal. There is no evidence of spinal canal stenosis.There is no evidence of neuroforaminal stenosis.Thoracic spine MRIAgain T2, T10, T11 and T12 spinal cord lesions are seen.Among them, the T11 lesion appears to be more prominent and slightly bulging posterior which was flat patchy lesion on prior indicating possible aggravation of this lesion. There is normal thoracic kyphosis. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The cord signal is normal. The epidural space, thecal sac, and spinal cord are preserved with no evidence of spinal canal/neural foraminal stenosis, cord compression or myelopathy. The conus medullaris terminates at the level of T12-L1.There is T2 high signal intensity lesion within the T11 vertebral body indicating possible hemangioma, unchanged since prior scan.

Output: 1. Multifocal white mater FLAIR high signal intensity lesions are seen bilateral periventricular white mater, consistent with demyelinating disease such as multiple sclerosis.2. Multifocal cervical spinal cord lesions are again seen. Some of them appears to be slightly more conspicuous and some are less conspicuous. These could represent local aggravation and improvement. But could also be related to artifacts related to different scanner and imaging technique.3. Multifocal thoracic spinal cord lesions are seen which are consistent with demyelinating disease. Especially T10-T11 spinal cord lesion shows more prominent and conspicuous indicating possible aggravation. Other lesions appear to be grossly unchanged since prior scan.


Instruction: Generate impression based on findings.

Input: Exam is limited due to lack of contrast. There is also patient motion. The cervical spine is in normal alignment, with a normal cervical lordosis. There is slight exaggeration of the normal upper thoracic kyphosis The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal.There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the cervical spine. Patient's known leptomeningeal disease within the posterior fossa is not well appreciated on this noncontrast exam.

Output: Unremarkable noncontrast MRI of the cervical spine. Limited evaluation for metastatic disease, especially leptomeningeal, given lack of contrast. No evidence of abnormal marrow signal abnormality or space-occupying lesion within the spinal canal.


Instruction: Generate impression based on findings.

Input: 36-year-old male with headache and weakness. This exam is limited secondary to artifact from the ventriculoperitoneal shunt system. The shunt enters through a right parietal burr hole, courses through the right parietal lobe and enters the atrium of the right lateral ventricle. It then crosses midline and terminates in the left lateral body of the left lateral ventricle. Hardware is also visualized overlying the sagittal suture anteriorly. The lateral ventricles appear prominent in comparison to the third and fourth ventricles, however without prior imaging one cannot determine if this is a acute finding or chronic in this patient. Further, there is no obvious pathology within the cerebral aqueduct or fourth ventricle. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect.No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. There is a retained mucous cyst within the left sphenoid sinus. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: 1. No evidence of intracranial hemorrhage, mass, or acute infarct.2. The lateral ventricles appear prominent compared to the third and fourth ventricles. However, there is no obvious pathology within the cerebral aqueduct or fourth ventricle. Comparison with prior imaging is recommended to determine if this is an acute finding.


Instruction: Generate impression based on findings.

Input: 47-year-old female with pain in the AC joint. Evaluate for meniscal tear and potential other pathology. ROTATOR CUFF: There is intermediate signal intensity within the supraspinatus indicating mild tendinosis. The supraspinatus muscle and tendon appear intact. The infraspinatus muscle and tendon appear intact. The subscapularis and teres minor muscles and tendons appear intact.SUPRASPINATUS OUTLET: There is trace fluid within the subacromial subdeltoid bursa. Mild to moderate osteoarthritic changes affect the acromioclavicular joint. There is fluid within the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is anatomic. There is a small amount of fluid within the joint without evidence of a large effusion. There is increased signal abnormality within the posterior superior labrum indicating degeneration. No fluid-filled tear is evident, within the limitations of this non arthrogram studyBICEPS TENDON: There is a small amount of fluid within the tendon sheath of the long head of the biceps which likely represents fluid extension from the joint. The tendon of the long head of the biceps appears intact.ADDITIONAL

Output: 1. Acromioclavicular joint osteoarthritis. 2. Findings suggestive of adhesive capsulitis. Other findings as described above.


Instruction: Generate impression based on findings.

Input: 33 years Female (DOB:12/15/1982)Reason: STEALTH MRI, IN CCD at 6:00am pre-operative, PLEASE PAGE NEUROSURGERY RESIDENT TO PLACE FIDUCIALS History: Pituitary macroadenomaPROVIDER/ATTENDING NAME: ISSAM A. AWAD ISSAM A. AWAD The CSF spaces are appropriate for the patient's stated age with no midline shift. The pituitary gland is large and heterogeneous in signal intensity. It measures approximately 11 mm in height. It is unchanged compared to the prior exam from 4/18/2016No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate some mucous retention cysts. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.The pituitary gland is large and heterogeneous. One possibility is that this represents sequela of necrosis.2.This examination was performed the purpose of stereotactic guidance


Instruction: Generate impression based on findings.

Input: Neuroblastoma with relapse x 2; progression of disease. Extensive diffuse marrow abnormality is seen in the bilateral frontal bones with probable extension into the bilateral parietal bones. Exact extent of tumor is best evaluated with MRI, if clinically indicated. There is a thick band of epidural enhancement in the bifrontal region which measures 7 mm in maximum dimension consistent with epidural spread of tumor (best seen image 15-22). There is minimal mass effect on the superior sagittal sinus which is mildly displaced posteriorly. There is no evidence of intraparenchymal mass or edema. No abnormal leptomeningeal enhancement is seen. The ventricles and basal cisterns are normal in size and configuration.The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Extensive marrow abnormality in the bilateral frontal bones, probably extending to the bilateral parietal bones consistent with osseous metastases. Thick band of epidural enhancement in the bifrontal region consistent with epidural spread of tumor. Extent of disease may be better evaluated with MRI, if indicated clinically.


Instruction: Generate impression based on findings.

Input: Male, 70 years old, with spasticity in the bilateral upper extremities, lower extremities and with left lower extremity weakness. Also with episodes of decreased consciousness. Brain:Artifact is seen from presumed dystrophic calcifications along the left middle frontal gyrus. No restricted diffusion is seen. Fairly extensive patchy T2 hyperintensity within the periventricular regions, the subcortical white matter, the basal ganglia and brainstem show no significant interval change. Also unchanged is a small region of encephalomalacia and surrounding T2 hyperintensity within the right temporal lobe. No acute intracranial hemorrhage or any abnormal extra axial fluid collection is suspected. The ventricles and sulci are mildly prominent compatible with underlying parenchymal volume loss.C-spine:Motion artifact significantly degrades image quality. Within this limitation, the following observations are made.A slight reversal of the cervical lordosis is seen, likely degenerative in nature. Vertebral body heights are grossly preserved. Endplate degenerative signal abnormality is noted, but no worrisome marrow replacement or marrow edema is detected.Visualized spinal cord demonstrates normal signal intensity throughout.C2-3: No spinal canal stenosis or neuroforaminal narrowing. C3-4: Left facet hypertrophy. Minimal posterior disc-osteophyte complex formation. No spinal canal stenosis. Mild to moderate left foraminal narrowing. C4-5: Bilateral facet hypertrophy. Posterior disc-osteophyte complex formation asymmetric to the right which effaces the right lateral recess and causes a mild generalized spinal canal stenosis with ventral cord flattening. Moderate left and severe right foraminal narrowing. C5-6: Facet hypertrophy. Mild posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Moderate to severe bilateral foraminal narrowing. C6-7: Facet hypertrophy. Mild posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Mild left and moderate right foraminal narrowing. C7-T1: No spinal canal stenosis or neuroforaminal narrowing.

Output: 1.Sequelae of extensive chronic microvascular ischemic disease, with perhaps a small area of territorial ischemia in the right temporal lobe, are unchanged.2.No definite acute intracranial abnormality is seen.3.Relatively mild degenerative findings are noted in the cervical spine without significant spinal canal stenosis or cord impingement. Scattered foraminal narrowing is seen, most severely affecting the C4-5 and C5-6 levels.


Instruction: Generate impression based on findings.

Input: History of prostate cancer. Multifocal prostatic adenocarcinoma. PELVIS: Please note that this study did not extend to the aortic bifurcation.PROSTATE:Prostate Size: 3.6 x 4.2 x 4.0 cmPeripheral Zone: Multiple small foci of T2 weighted hypointensity and restricted diffusion in the left greater than right peripheral zone compatible with multifocal prostatic adenocarcinoma.Central Gland: Benign prostatic hyperplasia. There is a dominant well-defined focus of T2 hypointensity and restricted diffusion measuring 1.2 x 0.9 cm in the mid gland left transition zone (series 1204/284) demonstrating postcontrast enhancement and washout.Seminal Vesicles: No specific evidence of seminal vesicle invasion.Extracapsular Extension: No significant evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: Nonspecific prominent bilateral external iliac and inguinal lymph nodes.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Multifocal prostatic adenocarcinoma involving the peripheral zone. Dominant 1.2 cm lesion within the left mid gland transitional zone is suspicious for prostatic adenocarcinoma.Nonspecific enlarged external iliac and inguinal lymph nodes.


Instruction: Generate impression based on findings.

Input: Left foraminal narrowing. Left arm weakness. MS versus radiculopathy. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. There is mild retrolisthesis of C4 on C5 and C5 on C6 as well as mild anterolisthesis of C7 on T1 similar to prior. Bone marrow signal is benign with mildly edematous appearance of the C4 and C5 vertebra likely probably on a degenerative basis. Bone marrow signal is benign with fatty marrow signal changes from C5 to C7 as well as mild edema involving the C4 and C5 vertebral bodies which is likely on a degenerative basis. The cervical spinal cord has normal signal characteristics. No findings to suggest demyelinating disease in the cervical cord.Degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: Small disc osteophyte complex and uncovertebral hypertrophy. Mild facet arthropathy. No significant spinal canal or neural foraminal stenosis.C4-5: Small disc osteophyte complex and uncovertebral hypertrophy. There is moderate to severe left neural foraminal stenosis and mild right neural foraminal stenosis, which appears minimally worse since prior. No significant spinal canal stenosis.C5-6: Small disc osteophyte complex and uncovertebral hypertrophy. There is moderate to severe left neural foraminal stenosis. There is mild right neural foraminal stenosis. Findings are similar to prior. There is mild spinal canal narrowing with partial effacement of the ventral and dorsal thecal sac. C6-7: Disc osteophyte complex and uncovertebral hypertrophy. There is severe bilateral neural foraminal stenosis, left slightly greater than right. There is mild to moderate spinal canal stenosis.C7-T1: Mild anterolisthesis and small disc osteophyte complex. There is uncovertebral hypertrophy and bilateral facet arthropathy. There is moderate spinal canal stenosis with mild deformity of the cord which is narrowed in the transverse dimension. There is severe bilateral neural foraminal stenoses. Findings are similar to prior.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: 1. No cord signal abnormality or findings to suggest demyelinating disease in the cervical cord.2. Multilevel degenerative changes in the cervical spine with up to moderate spinal canal stenosis at the C7-T1 level, similar to prior. There is multilevel neural foraminal stenoses, severe at the bilateral C6-C7 and C7-T1 levels. Moderate to severe left C5-C6 and C4-C5 neural foraminal stenoses also noted. Overall degenerative changes are stable to minimally worse since MRI 2/21/2015.


Instruction: Generate impression based on findings.

Input: Reason: Left triceps hyperreflexia, c/f cervical myelopathy History: LUE hyperreflexia in patient with infectious endocarditis and L4 osteo and septic emboli in the brain - history of cervical neck injection for pain 1 month ago Cervical: There is moderate degree of edema involving the C6 and C7 vertebral bodies with mild extension into the prevertebral region. There is severe loss of intervening C6-C7 disc space. Mild erosive changes are noted at the C6 and C7 endplates. There is mild enhancement involving the prevertebral and right paravertebral soft tissues including the right neural foramen. No discrete fluid collection or abscess is appreciated.Vertebral body heights are normal. Bone marrow signal is benign. No focal suspicious osseous lesions are evident. There are multilevel degenerative changes with levocurvature of the cervical spine. No significant spondylolisthesis. The cervical spinal cord has normal signal characteristics and overall morphology.Degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: No significant compromise to the spinal canal or neural foramina.C4-5: No significant compromise to the spinal canal or neural foramina.C5-6: Small disc osteophyte complex including uncovertebral hypertrophy and bilateral facet arthropathy. There is mild spinal canal stenosis. There is moderate to severe right and moderate left neural foraminal stenosis. C6-7: There is no significant spinal canal stenosis. There is bilateral uncovertebral hypertrophy contributing to mild to moderate bilateral neural foraminal stenosis.C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Bilateral pleural effusions are again seen. There is a T2 hyperintense nodule measuring 11 x 21 mm in the right thyroid lobe.Thoracic: The thoracic spine is in normal alignment aside from minimal anterolisthesis of T2 on T3. The vertebral body heights are well maintained. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal.Mild multilevel degenerative changes are present including a central disc extrusion at the T7-T8 level which contacts the ventral cord without significant spinal canal stenosis overall. There is minimal cranial migration of the disc material. There is no significant disk bulge, herniation, spinal canal or foraminal stenosis elsewhere within the thoracic spine.

Output: 1. Edema and enhancement involving the C6 and C7 vertebral bodies with mild extension into the paravertebral region is suspicious for C6-C7 discitis-osteomyelitis. No discrete fluid collection to suggest abscess. No findings to suggest osteomyelitis in the thoracic spine.2. Degenerative changes in the cervical spine as detailed above including neural foraminal stenoses at the C5-C6 and C6-C7 levels. There is also mild spinal canal stenosis at C5-C6. No high-grade spinal canal stenosis or cord signal abnormality at any level. 3. Small central disc extrusion at the T7-T8 level which contacts the ventral thoracic cord but without significant spinal canal stenosis overall at this level. 4. Bilateral pleural effusions as seen on recent CT. Approximately 2 cm right thyroid nodule also again seen.


Instruction: Generate impression based on findings.

Input: Altered mental status [780.97], Reason for Study: ^Reason: evaluate for metastasis, stroke History: new left sided weakness, seizure No evidence of acute ischemic or hemorrhagic lesion.There are multifocal encephalomalacia including right parietal temporal occipital lobe, left occipital lobe and bilateral cerebellar hemisphere indicating chronic ischemic infarct. In addition, there are multiple lacunar infarcts involving bilateral thalami and basal ganglia.Underlying brain also shows patch high signal intensities on periventricular white matter on FLAIR imaging indicating nonspecific small vessel ischemic disease.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. No evidence of abnormal enhancement.3. Multifocal chronic ischemic infarct with the encephalomalacia seen.4. Moderate degree nonspecific small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: Reason: severe frontal sinus headaches after sinus surgery 2.5 years ago, DM2 History: severe recurrent week long presssure headaches, new onset in 62 y/o The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate small frontal sinuses and opacification of the anterior ethmoid air cells and frontal sinuses is also scattered opacities in the left sphenoid sinus and mucosal thickening in the maxillary sinuses. Patient appears to be status post paranasal sinus surgery. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 2.There is paranasal sinus opacification present. Etiology cannot be established on this exam. There is no associated lesion within the brain parenchyma appreciated on this exam


Instruction: Generate impression based on findings.

Input: Reason: eval for TFCC tear History: above LIGAMENTS: No contrast is seen within the midcarpal space, indicating that the lunotriquetral and scapholunate ligaments are intact.TRIANGULAR FIBROCARTILAGE COMPLEX: Contrast injected into the radiocarpal joint is seen within the distal radioulnar joint, consistent with a full thickness tear of the triangular fibrocartilage complex. TENDONS: No significant abnormality noted. BONES: Ossicles adjacent to the ulnar styloid are consistent with prior trauma. No acute fractures are identified.ADDITIONAL

Output: Full-thickness tear of the triangle fibrocartilage complex and old fracture of the ulnar styloid.


Instruction: Generate impression based on findings.

Input: Profound bilateral sensorineural hearing loss. Internal Auditory Canal: There is an arachnoid cyst in the right cerebellomedullary cistern that measures up to 20 mm and abuts the vestibular nerve without appreciable displacement. The bilateral vestibular nerves are otherwise unremarkable. The cochlear and facial nerves are intact bilaterally. The bilateral inner ear structures are intact. Brain: The brain parenchyma and pituitary gland appear unremarkable. There is no evidence of intracranial hemorrhage 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 and scalp soft tissues are grossly unremarkable. There is mild scattered paranasal sinus mucosal thickening. There is plagiocephaly.

Output: A right cerebellomedullary cistern arachnoid cyst that measures up to 20 mm and abuts the vestibular nerve without appreciable displacement. Otherwise, no evidence of cochlear nerve deficiency or inner ear anomalies.


Instruction: Generate impression based on findings.

Input: Reason: R distal tibia abnormality with persistent pain, evaluate for AVN, neoplasm vs insufficiency fx History: above. TENDONS: The tendons are intact with no evidence of tendinosis or tenosynovitis. Previously seen fluid within the flexor analysis longus tendon sheath just proximal to the ninth Henry has resolved. Previously seen increased signal within the peroneus brevis tendon is no longer visualized.LIGAMENTS: The lateral collateral ligament complex is intact. The distal tibiofibular syndesmotic complex is intact. The deep fibers of the deltoid ligament have lost their normal striations and there is an ossicle distal to the medial malleolus. These findings suggest old trauma. The superficial components of the deltoid ligament appear unusually thickened which may likewise reflect old injury.ARTICULAR SURFACES AND BONE: Edema within the distal tibia has decreased compared to prior with residual subchondral edema likely degenerative in etiology. Additional foci of signal abnormality within the foot are similar to prior and likely reflect mild osteoarthritis. New diffuse edema within the medial cuneiform. New edema within the sinus tarsi and the overlying talus. Metallic artifact within the head and neck of the first metatarsophalangeal joint represents arthroplasty which is incompletely imaged on this study. ADDITIONAL

Output: 1.New edema within the medial cuneiform bone, sinus tarsi and overlying talus, suggestive of transient osteoporosis, which can manifest as transient bone marrow edema.2.Resolution of previously seen stress fracture involving the distal tibia. 3.Resolution of previously seen ankle tendinosis.


Instruction: Generate impression based on findings.

Input: There is no mass, mass-effect, or midline shift. There are no abnormal foci of enhancement. There is no diffusion abnormality to suspect acute stroke. There is no susceptibility weighted abnormality. The ventricles and sulci are within normal limits. The basal cisterns remain patent. The major intracranial vascular structures enhance normally. The midline structures and craniocervical junction are within normal limits. There is moderate mucosal thickening in the left maxillary sinus.

Output: 1. No evidence of intracranial mass, Chiari malformation, white matter lesions, or signs of hydrocephalus.2. Moderate left maxillary sinus opacification may represent sinusitis.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 67-year-old female with fatty liver, abnormal liver imaging. Unclear if OSH scan shows hemangioma versus malignancy. Consider using Eovist. ABDOMEN:LIVER, BILIARY TRACT: In hepatic segment 6, there is a 1 x 0.9 cm mild T2 hyperintense focus demonstrating nodular peripheral enhancement that fills in on delayed imaging compatible with a benign hemangioma (series 801 image 19, series 1104 image 199, series 1105 image 208).In hepatic segment 2, there is a 4.6 x 3.7 cm mildly T2 hyperintense (coronal series 701 image 13) T1 hypointense (series 1102 image 305) lesion with a gentle lobulated border. This lesion demonstrates right-sided unilateral linear enhancement (series 1103 image 290) that fills in during the venous and delayed phases (series 1104 image 303, series 1105 image 312). No washout is identified.Additional small cysts are seen scattered throughout the liver.No biliary ductal dilatation. Normal gallbladder.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Punctate T2 hyperintense focus of the left upper renal pole is too small to fully characterize, favor cystic.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Compression deformity of the T12 vertebral body is of indeterminate age (series 201 image 12).OTHER: No significant abnormality noted.

Output: 1.Hepatic segment 2 lesion measuring 4.6 x 3.7 cm with enhancement characteristics most suggestive of an atypical hemangioma. Consider follow-up imaging for stability. 2.Small typical hemangioma in hepatic segment 6.


Instruction: Generate impression based on findings.

Input: There is widening of the scapholunate interval with contrast extending from the mid carpal joint through the scapholunate articulation into the radiocarpal joint compatible with a scapholunate ligament disruption. Additionally contrast extends from the radiocarpal joint into the distal radioulnar joint compatible with disruption of the triangular fibrocartilage complex. Please refer to the subsequent MRI report for further information.Exposure time: 00:50

Output: Successful left wrist arthrogram for MRI study. There is disruption of the scapholunate ligament and triangular fibrocartilage complex. Please refer to the subsequent MRI report for further information.


Instruction: Generate impression based on findings.

Input: Neurofibromatosis, type 1 [Q85.01] / Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with complex partial seizures, intractable, without status epilepticus [G40.219] / Moyamoya disease [I67.5], Reason for Study: ^Reason Brain MRI:There is no evidence of acute ischemic or hemorrhagic lesion.There are extensive likely chronic ischemic stroke related encephalomalacia involving right frontal, right parietal, right temporal, right occipital lobe, left temporal and left occipital lobes with ex vacuo changes of bilateral lateral ventricle. No change since prior scan.There is no mass, mass effect, edema, midline shift, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.Brain MRA:3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate complete occlusion of bilateral distal ICAs, the right ICA occluded after the origin of the right ophthalmic artery and the right Pcom artery, and the left ICA is occluded after the left Pcom artery origin. The left ophthalmic artery is not clearly visualized.Bilateral ECA branches likely superficial temporal arteries cross through the bilateral temporal bone craniotomy site and appear to be connected to bilateral MCA M3 segments. Bilateral distal M1 segment of MCAs were visualized likely through retrograde fashion. Bilateral distal ACAs are visualized but bilateral ACA A1 segments are not seen.Vertebrobasilar system including bilateral PCAs were seen and the left distal Vertebral artery appears to be hypoplastic.No evidence of intracranial aneurysm.Comparing to prior MRA, there is no significant interval change.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. Extensive bihemispheric encephalomalacia likely due to prior ischemic infarctions with ex vacuo changes, no change since prior scan.3. Post EC-IC bypass surgery status with patent bypass grafts.4. No change of MRA findings since prior scan.


Instruction: Generate impression based on findings.

Input: 42-year-old male with mental status change There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Normal brain CT.


Instruction: Generate impression based on findings.

Input: Knee instability MENISCI: There is mild irregularity of the free edge of the anterior horn of the medial meniscus with similar but more conspicuous findings noted in the anterior horn of the lateral meniscus near the root. This may reflect degeneration/degenerative tearing, but is of questionable significance.ARTICULAR CARTILAGE AND BONE: There is redemonstration of an oblique nondisplaced fracture through the patella that involves the underlying articular cartilage. Additionally, there is subchondral cystic change and focal full-thickness degenerative cartilage loss of the lateral tibial plateau.LIGAMENTS: No significant abnormality noted. Specifically, the anterior and posterior cruciate ligaments and the collateral ligaments are intact.EXTENSOR MECHANISM: The quadriceps tendon is normal. There is mild increased signal and thickening of the patellar tendon reflecting mild tendinosis.ADDITIONAL

Output: 1. Redemonstration of nondisplaced patellar fracture.2. Intact cruciate and collateral ligaments.3. Additional findings described above.


Instruction: Generate impression based on findings.

Input: 63-year-old female with family history of breast cancer and personal history of uterine cancer presents for breast MRI surveillance examination. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.Stable enhancing foci correspond to benign intramammary lymph nodes identified in the right breast.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.Stable small high T2 signal left hepatic lesion most likely a cyst or hemangioma.

Output: No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Routine Screening Mammogram.


Instruction: Generate impression based on findings.

Input: Block to extension, supination. Assess for intra-articular chondral lesion, possible physeal fracture (olecranon or medial epicondyle). There is a full-thickness tear of the posterior component of the distal triceps tendon (combined tendon of the lateral and long heads) from the olecranon with mild (1 cm) retraction. There is mild edema within the retracted muscle. A few intact fibers of the lateral aspect of the posterior component may extend to the lateral aspect of the olecranon. The anterior/deep component of the triceps tendon (medial head) can be traced to its insertion on the olecranon although there is edema within its medial fibers which may represent a strain. The lateral aponeurotic expansion appears intact. There is mild edema in the flexor carpi radialis compatible with a strain. The remaining musculature is unremarkable. The biceps and brachialis tendons are intact. The common flexor and extensor tendons are intact.Gadolinium separates the distal aspect of the anterior bundle of the ulnar collateral ligament from the sublime tubercle of the coronoid process, indicating at least a partial thickness undersurface tear, and probably a complete tear of the distal attachment of the ligament. The proximal fibers of the ligament appear intact. The lateral collateral ligament proper and lateral ulnar collateral ligament appear intact.There is edema within the olecranon at the site of triceps avulsion. A small amount of edema is also noted within the tip of the olecranon process corresponding to the site of a small ossicle seen on radiographs; I am not certain if this represents a normal variant accessory ossification center or a small nondisplaced fracture. Additional mild edema is seen more distally within the olecranon as well as in the coronoid process. Edema is also noted within the capitate and radial head which may represent bone contusions. There is a 4 to 5 mm ovoid focus of intermediate signal intensity situated within the joint just distal to the lateral aspect of the humeral trochlea suggestive of a small loose body. It is possible that this arises from a tiny defect in the adjacent trochlea, but this is equivocal; I see no additional cartilage defects.The remaining visualized soft tissue structures are within normal limits.

Output: 1.Insertional tear of the triceps tendon as described above.2.Ulnar collateral ligament tear as described above.3.Probable small loose body within the joint.4.Other findings as described above.


Instruction: Generate impression based on findings.

Input: A 49 year old male with personal history of viral pericarditis on 2010 with tamponade that required pericardiocentesis and drainage. Recently an echocardiography was performed due to dyspnea and showed a left ventricular ejection fraction of 31%. Referred to cardiac MRI for further evaluation Left VentricleThe left ventricle is normal size with mildly reduced systolic function. There is a significant diastolic bounce of the interventricular septum. The overall LV ejection fraction is 47%, the LV end diastolic volume index is 86 ml/m2 (normal range: 74+/-15), the LVEDV is 192 ml (normal range 142+/-34), the LV end systolic volume index is 46 ml/m2 (normal range 25+/-9), the LVESV is 102 ml (normal range 47+/-19), the LV mass index is 44 g/m2 (normal range 85+/-15), and the LV mass is 98 g (normal range 164+/-36). There is epicardial late gadolinium enhancement involving the basal inferolateral wall which suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process. The pattern is not typical for prior myocardial infarction.Left AtriumThe left atrium is normal in size (87ml). Right VentricleThe right ventricle is normal size with normal systolic function. The overall RV ejection fraction is 50%, the RV end diastolic volume index is 73 ml/m2 (normal range 82+/-16), the RVEDV is 163 ml (normal range 142+/-31), the RV end systolic volume index is 37 ml/m2 (normal range 31+/-9), and the RVESV is 82 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant 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.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is mild thickening of the pericardium with evidence of pericardial late gadolinium enhancement but not increased T2-signal. Additionally there is significant respiratory variation in the position of the interventricular septum. These findings suggest the diagnosis of constrictive pericarditis in the fibrotic stage.Extracardiac FindingsThe esophagus is dilated with significant thickening of the esophageal wall. Mediastinal lymphadenopathy is noted. 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 LV size with mildly reduced systolic function (LVEF 47%) with epicardial late gadolinium enhancement in the basal inferolateral wall, consistent with the patients history of known prior myocarditis.2. There is mild thickening of the pericardium with evidence of pericardial late gadolinium enhancement without increased T2-signal. Additionally there is a prominent diastolic bounce of the interventricular septum which is associated with significant respiratory variation in the septal position. These findings suggest the diagnosis of constrictive pericarditis in the fibrotic stage.3. Normal RV size and systolic function (RVEF 50%).4. The esophagus is dilated with significant thickening of the esophageal wall. Mediastinal lymphadenopathy is noted. 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 33 years old Reason: Hx of gastric GIST in 2006 s/p partial gastrectomy, Follow-up please History: None ABDOMEN:LIVER, BILIARY TRACT: Nonspecific nonenhancing focus in the left hepatic lobe, may represent a cyst. 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. In particular, no evidence of gastric mass.BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Trace pelvic free fluid.

Output: 1.Status post partial gastrectomy for GIST. No specific evidence of tumor recurrence in the abdomen or pelvis.


Instruction: Generate impression based on findings.

Input: Male 11 years old Reason: left knee injury/patellar dislocation History: knee pain and swelling MENISCI: The menisci are intact.ARTICULAR CARTILAGE AND BONE: There is a bone contusion of the medial patella as well as the lateral femoral condyle in a pattern consistent with transient patellar dislocation. The medial patellofemoral ligament is partially torn from the medial facet of the patella. No patellofemoral articular cartilage or other articular cartilage defects are present.LIGAMENTS: The ACL, PCL, MCL, and LCL complex are intact. EXTENSOR MECHANISM: Extensor mechanism is intact.ADDITIONAL

Output: 1.Transient patellar dislocation bone contusion pattern with associated partial medial patellofemoral ligament tear.2.Moderate to large joint effusion.


Instruction: Generate impression based on findings.

Input: DDD, HNP: History of low back sprain 10/13/16. There are small central disc protrusions at L4-5 and L5-S1 with loss of disc space height and fluid signal and mild spinal canal, as well as mild neural foraminal stenosis bilaterally at L5-S1. There is no significant spinal canal or neural foramen stenosis at T12 through L4. There are bilateral L5-S1 pars interarticularis defects and approximately 5 mm of L5 upon S1 anterolisthesis. The vertebral body heights are preserved. The vertebral bone marrow signal is unremarkable. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: 1. Degenerative spondylosis at L4-5 and L5-S1 with mild spinal canal. 2. Bilateral L5-S1 pars interarticularis defects and approximately 5 mm of L5 upon S1 anterolisthesis, which contributes to bilateral neural foraminal narrowing at this level.


Instruction: Generate impression based on findings.

Input: Cervicalgia. Rule out spinal cord compression. Per technologist note, patient was claustrophobic and had difficulty tolerating the study. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. There is minimal retrolisthesis of C5 on C6. Alignment is otherwise maintained. Bone marrow signal is heterogeneous which is nonspecific but without discrete suspicious lesion demonstrated. Small T1 hyperintense focus at C5 is compatible with small hemangioma or focus of fat.The cervical spinal cord has normal signal characteristics and overall morphology.Mild degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: Minimal disc bulge. No significant compromise to the spinal canal or neural foramina.C4-5: Small right foraminal disc protrusion. No significant compromise to the spinal canal or neural foramina.C5-6: Mild disc bulge. No significant compromise to the spinal canal or neural foramina.C6-7: Minimal right paracentral disc protrusion. No significant compromise to the spinal canal or neural foramina.C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: Mild degenerative changes in the cervical spine without spinal canal or neural foraminal stenosis at any level.


Instruction: Generate impression based on findings.

Input: 58-year-old male with diabetic foot ulcer, cellulitis and elevated inflammatory markers evaluate for left fifth toe osteomyelitis. There is ulceration of the soft tissues along the dorsolateral aspect of the fifth toe. There is a biphalangeal fifth toe with abnormal signal intensity and enhancement of the tuft of the distal phalanx, highly suggestive of osteomyelitis. There is mild edema on fluid sensitive sequences within the base of the distal phalanx with preserved fat signal intensity on T1-weighted images likely representing reactive osteitis. We see no additional foci of osteomyelitis. There is swelling of the soft tissues of the little toe. There is soft tissue edema along the dorsum of the foot. There is increased signal intensity within the plantar musculature of the foot which may reflect mild inflammation and atrophy, but is commonly seen in diabetic patients. We see no rim-enhancing fluid collection to indicate abscess formation.

Output: Findings highly suggestive of osteomyelitis of the tuft of the distal phalanx of the fifth toe. These findings are related to Dr. Natelborg, Christina at 5149, via text page at 6:00 PM on 11/3/2015.


Instruction: Generate impression based on findings.

Input: No evidence of nerve root avulsion or pseudomeningocele. No abnormal signal involving the brachial plexus nerve roots, trunks, divisions or cords.No evidence of masses in the neck to suggest extrinsic compression. Limited evaluation of the cervical spine demonstrates preservation of the vertebral body heights and alignment, and no evidence of spinal canal or neural foraminal stenosis.

Output: No evidence of nerve root avulsion. No abnormal signal involving the brachial plexus.


Instruction: Generate impression based on findings.

Input: Back pain, L4-L5 spondy noted on x-ray, evaluate for stenosis, abnormality. History of prior lumbar epidural abscess and laminectomy. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is grade 1 anterolisthesis of L4 and L5 which is much more apparent on the radiographs from 9/8/2015. Alignment is otherwise maintained. Again seen is diffuse low T1 marrow signal which is nonspecific and can be seen with marrow reconversion related to anemia or chronic illness for example. There is particular heterogeneity of the bone marrow signal at the L5 level without edema and probably related to remote osteomyelitis. No significant bone marrow or disc space edema at any level on the current study or evidence of fluid collection to suggest residual or recurrent infection--although lack of contrast slightly limits evaluation.Evidence of prior laminectomies at L4-L5 and L5-S1. There is disc desiccation at L4-L5 and L5-S1 as before. Individual levels as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: No significant disc disease. No spinal canal or neural foraminal stenosis.L4-L5: Evidence of prior laminectomy and grade 1 anterolisthesis. Disc bulge is minimally more prominent than prior, eccentric to the right with effacement of the right lateral recess. No significant central canal stenosis. There is advanced bilateral facet arthropathy. There is moderate right and minimal left neural foraminal narrowing.L5-S1: Evidence of prior laminectomy. Disc bulge eccentric to the right without significant spinal canal stenosis. There is mild right and minimal left neural foraminal stenosis. There is bilateral facet arthropathy.

Output: 1. Degenerative changes in the lumbar spine at the L4-L5 and L5-S1 levels including disc bulges and facet arthropathy. There is grade 1 anterolisthesis of L4 and L5 which is much more apparent on recent upright/flexion radiographs.2. Moderate right L4-L5 neural foraminal stenosis. Additional levels as above.3. Prior laminectomies at L4-L5 and L5-S1 related to prior epidural abscess drainage. No findings to suggest recurrent infection or abscess within limitations of noncontrast study.


Instruction: Generate impression based on findings.

Input: 69 year-old male with history of prostate cancer in the left peripheral zone. Patient used prophylactic antibiotics before and after the procedure as prescribed. The patient received antibiotic prophylaxis with oral Ciprofloxacin 500 mg bid starting the night before the procedure. He took 2 tablets of Ciprofloxacin 500 mg before the procedure and will take two tablets after the procedure. Following the discussion of the risks, benefits, and alternatives of the procedure, informed consent was obtained for the research study. The procedure was performed under moderate conscious sedation.MRI focus in the left mid peripheral zone suspicious for patient's known cancer was localized with T2 weighted MR images. Following preparation, Medtronic laser ablation template was placed in the perineum on the patient and localized on MR images and registered to the MR images where prostate lesion could be visualized.Following local anesthesia with lidocaine, 14-gauge MR- compatible needles were inserted into the left side of the prostate to stabilize the prostate. Upon confirmation of the tip of the needle on the left side close to the known lesion, two laser ablations with 15-W, 92 % power was performed within the left base and two ablations were performed within the left mid and left apical peripheral zone of the prostate. The patient tolerated the procedure well without any immediate complications.Pre-and postcontrast axial MR images are obtained before and after administration of 5 cc MultiHance, upon completion of the procedure. On MR images of ablation defect was noted within the left peripheral zone in the location of the biopsy proven prostate cancer.

Output: MR guided laser ablation of the lesions in the left peripheral zone lesion.


Instruction: Generate impression based on findings.

Input: Question of Crohn's disease. Evaluate for active Crohn's disease or fistulous tract. Questionable Crohn's disease of the ileocecal valve on biopsy. History of left hip pain. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted. No focal hepatic lesions. No cholelithiasis. No biliary ductal dilation.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 bowel dilation, wall thickening, or abnormal wall enhancement. The ileocecal valve is within normal limits. No mesenteric fibrofatty changes are noted.BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No bowel dilation, wall thickening, or abnormal wall enhancement. The ileocecal valve is within normal limits. No mesenteric fibrofatty changes are noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: No evidence of active Crohn's disease or specific findings otherwise to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: Clinical question: Preop planning. Signs and symptoms: Seizures. Pre- and post enhanced fusion brain MRI:Examination is performed as a surgical/treatment planning study and is not a true diagnostic exam.Examination demonstrate placement of electrodes in the left anterior temporal lobe. Electrodes enter the calvarium via a left posterior temporal-occipital burr hole as well as a left frontal burr hole. Electrodes are noted along the medial aspect of the left anterior temporal lobe and extending posteriorly along the medial aspect of the left mid and posterior temporal. Additional electrodes traverses the left anterior temporal. The appropriateness of the placement of the electrodes should be decided by the referring clinical physician. There is a small focus of T2 hyperintensity of the brain parenchyma at the site of entry of an electrode in the left posterior temporal-occipital region measuring approximately 14 x 20 mm and believed to represent a focus of edema.Examination is performed for surgical planning and does not include axial T1 nonenhanced series and there is also metallic streak artifact secondary to electrodes which makes precise assessment for detection of abnormal enhancement difficult. Within this limitation however no definitive evidence of abnormal enhancement is detected.Ventricular system remains within normal size and with maintained midline.

Output: 1.Surgical planning exam demonstrate a series of electrodes in the left temporal lobe as detailed.2.No convincing evidence hemorrhage or of abnormal enhancement.3.Tiny focus of parenchymal edema at the site of entry of the electrodes in the left posterior temporal lobe measuring at 14 x 20 mm in size.


Instruction: Generate impression based on findings.

Input: Male; 77 years old. Reason: Probable renal cell carcinoma by prior MRI. Please evaluate progression History: As above ABDOMEN:LIVER, BILIARY TRACT: T2 hyperintense lesions in both lobes of the liver do not demonstrate enhancement and are consistent with cysts, similar to prior study. No suspicious hepatic lesions. Mild diffuse hepatic steatosis. Portal and hepatic veins are patent.SPLEEN: T2 hyperintense splenic lesion has slightly increased in size and measures up to 15 x 10 mm (series 805/300), previously 13 x 8 mm; the lesion demonstrates gradual internal enhancement on delayed phase images, most suggestive of a benign hemangioma, which can grow. Additional nonspecific, smaller T2 hyperintense splenic lesions are not significantly changed, likely due to additional benign lesions.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable small exophytic, peripherally enhancing lesion arising from medial aspect of lower pole which measures 9 mm, previously 9 mm, which again may be due to a renal cell carcinoma (series 801/132). Additional nonenhancing simple and hemorrhagic cysts in both kidneys, not significantly changed.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Stable levoscoliosis lumbar spine.OTHER: No significant abnormality noted.

Output: Unchanged enhancing 9 mm lesion arising from the inferomedial right kidney, which again may be due to a small renal cell carcinoma.


Instruction: Generate impression based on findings.

Input: Possible right buccal mass. There is a right lateral cheek skin marker. There is an asymmetrically prominent right accessory parotid gland, which appears to be unchanged. There is no evidence of tumors, parotitis, or ductal dilatation. The buccal space contents are otherwise unremarkable. There is herniation of the bilateral sublingual glands via boutonierre defects. The submandibular glands are unremarkable. There is no significant lymphadenopathy in the upper neck. The orbits, paranasal sinuses, and imaged intracranial structures are unremarkable. There may be plaque at the bilateral carotid bifurcations. There is mild multilevel degenerative cervical spondylosis.

Output: Asymmetrically prominent right accessory parotid gland, without evidence of tumors or findings to suggest Sjogren disease otherwise.


Instruction: Generate impression based on findings.

Input: Male, 16 years old, with abnormal movements. Evaluate for structural abnormality. Brain:Parenchymal morphology is within normal limits. No structural abnormality or evidence of dysplasia is detected. No focal signal abnormality, restricted diffusion, edema or mass effect is detected. There are no findings to suggest acute or chronic intracranial hemorrhage. No abnormal extra-axial fluid collections are seen and the ventricular system is within normal limits. On postcontrast images, the pattern of intracranial enhancement is unremarkable.Spine:A full complement of normally formed vertebral bodies is evident. Spinal alignment is anatomic with mild straightening of the cervical lordosis likely due to positioning. Vertebral body signal characteristics are within normal limits. No pathologic marrow edema, replacement or enhancement is seen. The visualized spinal cord, conus and nerve roots of the cauda equina are within normal limits. No epidural abnormalities are suspected. No significant compromise of the spinal canal or neural foramina is seen.

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


Instruction: Generate impression based on findings.

Input: 55 year-old female. Two masses in the right breast, 3:00 and 9:00 position that are highly suspicious for malignancy. Participating in Allen Penn, MRI research study. Right ultrasound re-identified the target lesions for biopsy. The two lesions to be targeted are a hypoechoic 2 x 1.8 x 2.4 cm mass at the 3 o’clock position 1 cm from the nipple and a 2.1 x 1.1 mass at the 9 o'clock position 4 cm from the nipple. The lesions were readily visible. Targeted ultrasound was also done of the 12 o'clock position 1 cm from the nipple in the area of the irregular enhancing mass seen on same day MRI. This corresponded to a 0.9 x 0.5 x 0.9 cm hypoechoic mass, suspicious for a malignancy.PROCEDURE: The procedure and its risks, including bleeding, infection, and failure to diagnose, and expected benefits of ultrasound-guided core biopsy with percutaneous placement of a marking clip and post-procedure unilateral mammogram were discussed with the patient. Questions were answered. Consent was obtained both verbally and in writing. The time-out form was completed to confirm patient identity and side/type of procedure.The right breast was cleansed with chlorhexidine over the target area. Transducer was sterilely sheathed. The 3 o'clock position lesion was first targeted. Local anesthesia was obtained using 2% lidocaine superficially, with 1% lidocaine with 1:100,000 epinephrine at depth. A 3 mm incision was made in the skin with a #11 scalpel blade. Using aseptic technique, continuous ultrasound guidance and a inferior to superior approach, three 12-gauge core needle (Celero) specimens were obtained of the 3 o'clock position lesion. Targeting was judged excellent. All specimens sank to the bottom of the prefilled container of 10% formalin. Specimen quality was judged excellent.Following this, a second skin entry was made for the 9 o'clock position lesion. Local anesthesia was obtained using 2% lidocaine superficially, with 1% lidocaine with 1:100,000 epinephrine at depth. A 3 mm incision was made in the skin with a #11 scalpel blade. Using aseptic technique, continuous ultrasound guidance and a inferior to superior approach, three 12-gauge core needle (Celero) specimens were obtained of the 9 o'clock position lesion. Targeting was judged excellent. All specimens sank to the bottom of the prefilled container of 10% formalin. Specimen quality was judged excellent.Specimens were sent to Pathology with an accompanying history sheet. Using continuous ultrasound-guidance two Hydromark clips were placed into the two lesions in the usual manner. Pressure was held over the biopsy site until all bleeding subsided. The skin incision was closed with a Steri-Strip. Post-procedure digital right CC and ML views revealed the two percutaneously placed clips to be in the expected location within the two lesions. No evidence of hematoma or other complication.A pressure dressing was positioned over the biopsy site and an ice pack positioned over the pressure dressing. Post-procedure instructions were reviewed with the patient both verbally and in writing. She tolerated the procedure well with no evident complications and left the Breast Imaging Department in stable condition.The procedure was performed by Dr. Xiong and Dr. Abe, who was present during the procedure at all times.

Output: Successful ultrasound-guided core biopsy of the two right breast lesions and clip placement. This is most likely a malignancy. Pathology is pending at this time.BIRADS: 5 - Highly suggestive of malignancy.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: 53 year-old female. Right calcaneal osteomyelitis ? progression of disease. History of PVD and DM2. No loculated drainable fluid collection is evident. Small heel and plantar forefoot soft tissue ulcers are redemonstrated. Diffuse subcutaneous edema. Refer to recent MRI right foot and ankle regarding additional findings.

Output: Post-consequences only. No drainable fluid collection. Refer to recent MRI right foot and ankle report for additional findings.


Instruction: Generate impression based on findings.

Input: 2 prior negative biopsies. Elevating PSA. PELVIS:PROSTATE:Prostate Size: 4.8 x 3.2 x 5.2 cmPeripheral Zone: Minimal T1-weighted hyperintense blood product in the paramedial mid gland. Mild T2 weighted hypointense linear stranding in the right hemi-prostate.In the anterior left base/mid-gland there is a wedge-shaped region of T2-weighted hypointensity measuring up to 1 cm (series 801/22) with mild associated restricted diffusion (series 604/424), favored to be benign but amenable to TRUS-MRI-guided fusion biopsy.No suspicious dominant/index lesion is evident.Central Gland: In the right apex there is a vague T2-weighted mildly hypointense region of signal abnormality measuring up to 1.0 x 0.9 cm. No associated restricted diffusion. There may be associated early dynamic-contrast enhancement and wash-out (series 1401/973) in this region but this is equivocal. Changes of benign prostatic hyperplasia.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: No evidence of extracapsular extension.BLADDER: The bladder is partially distended with resulting moderate apparent trabeculation and wall thickening. LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Two indeterminate lesions as described above, in the left anterior mid-gland/base peripheral zone and in the right apex near the anterior fibromuscular stroma are somewhat suspicious and are amenable to TRUS-MRI-guided fusion biopsy.2.Changes of benign prostatic hyperplasia.3.Bladder wall trabeculated thickening likely in part due to underdistention.


Instruction: Generate impression based on findings.

Input: 65 years Male (DOB:7/7/1951)Reason: eval for stroke History: R facial droop, R hip flexor weakness and RLE numbness x3 weeksPROVIDER/ATTENDING NAME: JEFFREY T JACOBS JEFFREY T JACOBS A focus of diffusion restriction is present in the left thalamus and another one in the left cerebral peduncle. This associated with T2 and FLAIR hyperintensity.There is a moderate to marked degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images as well as to a lesser degree similar lesions in the brainstem and cerebellum. Small uptake T2 and FLAIR hyperintense lesions are also present in the basal ganglia and thalami..Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate some mucosal thickening. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Findings are compatible with acute lacunar infarcts involving the left thalamus and left cerebral peduncle.2.Findings are compatible with old lacunar infarcts in the thalami and basal ganglia.3.Periventricular and subcortical white matter lesions of a moderate to marked degree as well as some lesions in the brainstem and cerebellum are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: Reason: HCC screening, follow up of biliary stricture History: cryptogenic cirrhosis ABDOMEN:LIVER, BILIARY TRACT: Widening of the hepatic fissures and the left hepatic lobe hypertrophy is compatible with chronic liver disease and unchanged. Status post cholecystectomy.Mild intrahepatic biliary ductal dilatation with stricturing of the proximal common bile duct and distal right and left intrahepatic ducts is unchanged.SPLEEN: Splenomegaly and splenic varices, unchanged.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No suspicious hepatic lesions.2.Biliary stricturing and intrahepatic biliary ductal dilatation is unchanged.


Instruction: Generate impression based on findings.

Input: Female, 29 years old, with history of nasopharyngeal carcinoma status post treatment with chemotherapy and radiation. Asymmetry of the nasopharyngeal mucosa is again seen appearing similar to the prior examination and perhaps related to therapy. Likewise, a thin layer of T2 hyperintense material along the left aspect of the nasopharynx is also similar to prior and may simply represent adherent secretions. No evidence of any recurrent aerodigestive tumor is seen. No pathologic adenopathy is detected in the neck by size criteria. The glandular tissues are unremarkable. The bone marrow signal characteristics are within normal limits. A new focus of susceptibility is evident within the brainstem at the level of the obex (see image 17 series 8) which is present on all sequences and not likely to be artifactual. There does not appear to be any associated parenchymal edema or mass effect.

Output: 1.Treatment related findings in the neck with no evidence to suggest recurrent nasopharyngeal tumor or pathologic adenopathy.2.A small focus of susceptibility within the brainstem at the level of the obex is new when compared to prior examinations. This could represent chronic microhemorrhage of uncertain etiology. If clinical concern warrants, dedicated brain imaging can be obtained to better assess this lesion and to evaluate for the presence of additional lesions.


Instruction: Generate impression based on findings.

Input: 38-year-old female who presents with lumbar radiculopathy. For the purposes of numbering, there are 5 lumbar type vertebral bodies. The lumbar spine is in normal alignment, with a normal lumbar lordosis. The vertebral body and disk heights are well-maintained. No focal marrow signal abnormality is appreciated. The conus medullaris on sagittal imaging is grossly intact. Incidentally noted is a small right adrenal nodule which is not well assessed on the current study.T12-L1: There is no significant compromise to spinal canal or neural foramina.L1-L2: There is no significant compromise to spinal canal or neural foramina.L2-L3: There is no significant compromise to spinal canal or neural foramina.L3-L4: There is disc desiccation and mild bulge eccentric to the right and extending into the neural foramina without significant central spinal canal stenosis. There is moderate right neuroforaminal stenosis with possible impingement of the L3 exiting nerve root. There is also mild left neuroforaminal stenosis. L4-5: There is no significant compromise to spinal canal or neural foramina.L5-S1: There is mild disc protrusion without significant central spinal canal or neuroforaminal stenosis.

Output: Mild degenerative changes of the lumbar spine with disc bulge at L3-4. There is associated moderate right and mild left neural foraminal stenosis. There may be impingement of the exiting L3 nerve roots at this level, particularly on the right.


Instruction: Generate impression based on findings.

Input: Reason: Evaluate right hip for labral tear History: Right hip pain ACETABULAR LABRUM: The labrum overall appears similar to prior. There is no gadolinium seen entering the substance of the labrum to confirm a discrete tear. However, much of the anterior/superior labrum is replaced with intermediate signal intensity that may reflect degenerative tearing and/or fraying; the extent to which this represents postoperative change is uncertain. The posterior labrum appears normal.ARTICULAR CARTILAGE AND BONE: There is no evidence of avascular necrosis. There is mild cartilaginous heterogeneity and osteophyte formation noted at the superior acetabulum. No focal fluid-filled cartilaginous defects are identified. There is postsurgical scalloping along the antero-lateral femoral head/neck junction. Sacroiliac joints are unremarkable.SOFT TISSUES: There is gadolinium within the anterior musculature of the hip, likely related to injection. Ligamentum teres and transverse ligament are intact. Iliopsoas tendon is intact with normal signal and morphology. Adductor, gluteal, and hamstring insertions are unremarkable. ADDITIONAL

Output: The labrum appears similar to prior exam. Intermediate signal intensity again replaces most of the anterior/superior labrum suggesting degenerative tearing and/or fraying, but no discrete gadolinium filled defects are identified.


Instruction: Generate impression based on findings.

Input: Wrist pain following injury, multiple prior surgical interventions Despite multiple attempts at metal reduction, evaluation of the wrist, including the triangular fibrocartilage complex, is extremely limited due to susceptibility artifact from an orthopedic screw affixing the scaphoid and lunate. There are new surgical changes relating to prior TFCC repair with the small areas of signal void within the soft tissues overlying the ulna. Additionally, there are small foci of low T1 signal seen between the triquetrum and ulnar styloid which are thought to represent areas of suture material. The triangular fibrocartilage complex is not well visualized on the fluid sensitive sequences on account of the aforementioned metallic susceptibility artifact. There is low T1 signal intensity within the region of the TFCC thought to represent the area of repair. Within this structure are areas of ill-defined signal abnormality (best appreciated on series 9 images 10 and 11 and series 3 images 7 and 8) suspicious for areas of tearing. Evaluation of the intrinsic ligaments is limited due to metallic susceptibility artifact. A mild amount of increased marrow signal is seen along the ulnar styloid which may be reactive in nature.The median nerve is normal in caliber.

Output: 1. Markedly limited study due to extensive metallic susceptibility artifact. 2. Postsurgical changes of TFCC repair. What is seen of the TFCC demonstrates areas of ill-defined signal abnormality suspicious for partial tears with or without scarring.3. Normal appearance of the median nerve.


Instruction: Generate impression based on findings.

Input: 59 years Male (DOB: 7/30/1956)Reason: c/f R cervical radiculopathy History: painPROVIDER/ATTENDING NAME: HELENE G RUBEIZ HELENE G RUBEIZ The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There is straightening of the normal cervical curvature present.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is a right lateral recess broad-based disc protrusion present which extends into the right neural foramen and encroaches on the right-sided exiting nerve roots within the neural foramen. There is also a disc bulge present at this level. There is some partial effacement of spinal fluid ventral to the spinal cord at this level. There are right-sided uncovertebral osteophytes present this level.At C5-6 there is some loss of disc space height and a diffuse disc bulge associated with effacement of the fat surrounding the exiting nerve roots within the neural foramina and encroachment of the exiting nerve roots. There are bilateral uncovertebral osteophytes present this level.At C6-7 there is no loss of disc space height, disc desiccation and diffuse disc bulge, right-sided uncovertebral osteophytes and encroachment of the exiting nerve roots within the left neural foramen. There is some effacement of the spinal fluid ventral and posterior the spinal cord and some mild flattening of the spinal cord this level. Overall there is moderate spinal stenosis at this level.At C7-T1 there is no significant compromise to the spinal canal. There are some encroachment of the left-sided exiting nerve roots at this level due toThe vertebral artery flow voids appear to be intact.There is some ill-defined lesion present within the right thyroid lobe which is not adequately imaged on this exam.

Output: 1.There are multilevel degenerative changes present in the cervical spine worse at C6-7 where there is a moderate degree of spinal stenosis. There is also encroachment of the left-sided exiting nerve roots at C6-7, the right-sided exiting nerve roots at C4-5 and bilateral exiting nerve roots at C5-6.2.There is some ill-defined lesion present within the right thyroid lobe which is not adequately imaged on this exam. Please note that MR is not accurate in evaluation of thyroid lesions.


Instruction: Generate impression based on findings.

Input: There is no diffusion abnormality. No intracranial mass or mass effect. The ventricles and sulci are within normal limits for age. Again seen are scattered foci of T2/FLAIR hyperintensity in the periventricular and subcortical white matter which are nonspecific but consistent with chronic small vessel ischemic disease. There appears to be a small cortical/subcortical infarct involving the left middle frontal gyrus and also present previously. No extra-axial fluid collection is identified. Multiple scattered punctate foci of susceptibility throughout the brain are again seen and compatible with chronic microhemorrhages, grossly similar to prior. There is mild mucosal thickening in the maxillary sinuses with small bilateral mucus retention cysts.MRI PITUITARY

Output: 1. No evidence of residual or recurrent pituitary tumor within the limits of noncontrast study.2. Unchanged right paraophthalmic aneurysm compared to 12/16/2015 and 11/1/2014.


Instruction: Generate impression based on findings.

Input: Evaluate for myelitis: Pain on back and right-sided numbness. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: No evidence of spinal cord lesions.


Instruction: Generate impression based on findings.

Input: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are no areas of abnormal parenchymal signal. The midline structures and craniocervical junction are within normal limits. The hippocampi are symmetric and normal in appearance. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull and scalp soft tissues are unremarkable. There is mild paranasal sinus mucosal thickening.

Output: Normal brain MRI.


Instruction: Generate impression based on findings.

Input: Right leg pain (buttocks to behind the right knee), numbness and tingling. For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. There is about 13 mm sized well-circumscribed vertebral body lesion, showing high signal intensity on both T1 and T2 weighted images indicating possible vertebral body hemangioma, this lesion wasn't seen on prior scan and demonstrate no interval change in terms of shape, size and MR characteristics.There is normal lumbar lordosis. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. The conus medullaris terminates at the T12-L1 level. The paraspinal soft tissues are unremarkable.Degenerative changes are specified by the intervertebral level as follows: T12-L1: Disc desiccation, no neuroforaminal narrowing or spinal stenosis. L1-L2: Disc desiccation, no neuroforaminal narrowing or spinal stenosis. L2-L3: Diffuse bulging of disc with disc desiccation. Minimal spinal canal stenosis.L3-L4: Diffuse bulging of disc with disc desiccation. There is associated central to slightly left focal protrusion of disc which indents anterior thecal sac. There is no interval change since prior scan about this finding.L4-L5: Diffuse bulging of disc with bilateral ligamentum flavum thickening at this level creating mild to moderate spinal canal stenosis. There is associated central focal protrusion of disc which indents the thecal sac. Again no change since prior scan.L5-S1: Diffuse bulging of disc with disc desiccation. There is a focal central to right disc protrusion. Again no significant interval change since prior scan.

Output: 1. Multifocal disc degeneration with the herniation as described above (L3-4: Central to left, L4-5: Central, L5-S1: Central to right). No change since prior scan.2, multifocal various degree spinal canal stenosis from L2-3 to L4-5, no significant interval change since prior scan.3. Vertebral body hemangioma, T12.


Instruction: Generate impression based on findings.

Input: Female 52 years old Reason: primary hyperparathyroidism and Graves' disease History: high calcium and PTH Both thyroid lobes are heterogeneous.RIGHT LOBE MEASUREMENTS: 6.1 x 2.4 x 2.1 cmLEFT LOBE MEASUREMENTS: 5.2 x 2.1 x 1.6 cmISTHMUS MEASUREMENTS: 4 mmRIGHT LOBE: Subcentimeter hypoechoic nodule measuring 9 mm in diameter at the inferior aspect of the right lobe of the thyroid.LEFT LOBE: No significant abnormality noted.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Heterogeneous echotexture of bilateral thyroid lobes. Subcentimeter nodule in the right inferior thyroid lobe. No evidence of parathyroid adenoma.


Instruction: Generate impression based on findings.

Input: 70-year-old male with shoulder pain, weakness, rule out rotator cuff tear Exam of mildly limited due to motion artifact. ROTATOR CUFF: Increased T2 signal within the distal anterior supraspinatus tendon and infraspinatus tendon near its insertion on the greater tuberosity indicating tendinosis without evidence of tear. No fluid is present within the subacromial- subdeltoid bursa.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral alignment is within normal limits. The labrum appears grossly intact.BICEPS TENDON: Fluid extends along the tendon of the long head of the biceps which appears otherwise intact.ADDITIONAL

Output: 1. Tendinosis of the supraspinatus and infraspinatus without evidence of tear.2. Findings suggestive of adhesive capsulitis as detailed above.


Instruction: Generate impression based on findings.

Input: Reason: History of esophageal ca, now with hyponatremia. rule out metastatic disease History: Hyponatremia, nausea, vomiting The CSF spaces are appropriate for the patient's stated age with no midline shift. There is leptomeningeal enhancement present along the cerebellar hemispheres bilaterally associated with flair signal hyperintensity along the cerebellar folia bilaterally. There is also some leptomeningeal enhancement present along the surface of the brainstem especially at the quadrigeminal plate.Punctate foci of flair signal hyperintensity are present in the right basal ganglia .No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.There are a couple of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Leptomeningeal involvement of the posterior fossa structures is present which could be a result of leptomeningeal carcinomatosis though meningitis may have a similar appearance.2.A punctate lesion in the right basal ganglion could be a result of a prior lacunar infarct .3.A couple subcortical white matter lesions are likely of little clinical significance.4.An alphanumeric page and an email with the results were sent to Emeka Anyanwu on the date of the exam.


Instruction: Generate impression based on findings.

Input: 59-year-old female with multiple right lumpectomies, followed by right skin sparing mastectomy with flap reconstruction in May 2005 for IDC and DCIS. Minimal parenchymal enhancement is noted in the left breast. There is heterogeneous fibroglandular tissue in the left breast.No suspicious enhancement is seen in the right reconstructed breast or left breast. A few scattered enhancing foci in the skin of the left breast near the nipple are stable. No abnormal axillary lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Reason: Eval Index Finger MCP History: s/p dislocation LIGAMENTS: There is disruption of the proximal fibers of the ulnar collateral ligament of the MCP joint of the index finger (image 12; series 701). The radial collateral ligament appears intact.TENDONS: The flexor and extensor tendons appear intact. There is fluid within the tendon sheath of the flexor tendon of the index finger indicating a mild tenosynovitis. There is subcutaneous edema along the volar aspect of the tendon as well which may reflect a strain injury.BONES: No bone marrow signal abnormality is identified. The alignment is anatomic.ADDITIONAL

Output: Findings indicating disruption of the ulnar collateral ligament of the MCP joint of the index finger as well as a mild tenosynovitis of the flexor tendon of the index finger as described above.


Instruction: Generate impression based on findings.

Input: 50-year-old female with left knee pain. MENISCI: Note is made of linear signal abnormality which traverses the posterior horn of the medial meniscus and extends to the tibial and femoral articular surfaces, consistent with a vertical tear. The anterior horn appears intact. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is focal full-thickness articular cartilage degeneration along the weightbearing surface of the medial femoral condyle above the posterior horn of the meniscus. There is subjective thinning of the articular cartilage of the lateral compartment. There is full-thickness articular cartilage degeneration along the medial facet of the patella with underlying subchondral signal abnormality. There is a near full-thickness articular cartilage fissure along the median eminence of the patella.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: Tearing of the medial meniscus and articular cartilage degeneration as described above. Small joint effusion.


Instruction: Generate impression based on findings.

Input: Infant born at 37 1/7 weeks with respiratory distress. Please evaluate corpus callosum: possible agenesis of corpus callosum on ultrasound. Dysmorphic features (redundant skin folds, edema, micrognathia with recessed jaw). There are several subcentimeter foci of restricted diffusion in the left frontal lobe periventricular white matter. There is a lesion in the left caudothalamic groove with cerebrospinal fluid signal characteristics that measures up to 5 mm. There is diffuse paucity of cerebral white matter with apparent deficiency of myelination in the bilateral corticospinal tracks. There is no evidence of intracranial hemorrhage or mass. There is no midline shift or herniation. The major cerebral flow voids are grossly intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Subcentimeter acute infarcts in the left frontal lobe periventricular white matter, persistent ventriculomegaly that appears to be associated with diffuse cerebral white matter deficiency with severe thinning of the corpus callosum diffusely, as well as apparent delayed myelination, a subcentimeter lesion in the left caudothalamic groove, which may represent a germinolytic cyst, and cerebellar vermis hypoplasia may represent stigmata of an underlying disorder of metabolism or other congenital anomaly. Follow up with MR spectroscopy of the brain may provide additional insights.Discussed with Dr. Singh at 12 PM on 9/23/15.


Instruction: Generate impression based on findings.

Input: There multiple small foci of decreased diffusion within the deep right frontal white matter and right occipital cortex. There are also additional unchanged small foci of T2 hyperintensity within the supratentorial white matter compatible with chronic small vessel ischemic disease and a chronic left occipital infarct. There is no evidence of intracranial hemorrhage or mass. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull and scalp soft tissues are unremarkable. There is minimal paranasal sinus mucosal thickening and fluid within the mastoid air cells bilaterally.

Output: 1.Multiple small foci of acute infarction within the deep right posterior frontal white matter and right occipital cortex, likely within a watershed distribution.2.Mild unchanged chronic small vessel ischemic disease and a chronic left occipital infarct.3.Nonspecific mild paranasal sinus mucosal thickening and mastoid air cell fluid.


Instruction: Generate impression based on findings.

Input: Small cancer in the left maxillary mucosa. There is a subcentimeter nodular lesion along the gingiva of the posterior left maxillary alveolus. There is no evidence of disruption of the buccopharyngeal fascia and the rest of the upper aerodigestive tract structures appear to be grossly unremarkable. There is no significant cervical lymphadenopathy. There is multilevel degenerative cervical spondylosis. There is a small right maxillary sinus retention cyst. There are bilateral lens implants. There is scattered nonspecific cerebral white matter T2 hyperintensity.

Output: A subcentimeter nodular lesion along the gingiva of the posterior left maxillary alveolus corresponds to the known squamous cell carcinoma. No significant cervical lymphadenopathy to suggest metastatic disease.


Instruction: Generate impression based on findings.

Input: Clinical question to be answered: Possible bleed. Signs and symptoms: Blunt head trauma. Images through posterior fossa and the straight a subtle area of low attenuation along the interhemispheric aspect of left cerebellum. This is concerning for an acute cerebellar stroke. No clinical data regarding neurological deficit is however given. Please correlate and follow-up with an MRI is recommended.This examination is otherwise unremarkable and in particular no evidence of any acute post traumatic finding is detected. Calvarium remains intact. Mastoid air cells and paranasal sinuses are unremarkable.The findings were relayed to the ER resident at pager number 2659.

Output: 1.No evidence of acute posttraumatic finding.2.Left cerebellar nonhemorrhagic acute stroke.


Instruction: Generate impression based on findings.

Input: Reason: 55 y/o F with positive Neer's test, tenderness of L shoulder, fall 3 months ago, eval for rotator cuff tear History: as above Some sequences are suboptimal secondary to patient motion artifact.ROTATOR CUFF: There is thickening and intermediate signal intensity within the supraspinatus indicating moderate tendinosis. The supraspinatus muscle and tendon appear intact. There is thickening and intermediate signal intensity within the infraspinatus indicating moderate to severe tendinosis. There is interstitial tearing of the infraspinatus at the level of the myotendinous junction. No full-thickness tear or retraction is identified. The subscapularis and teres minor muscles and tendons appear intact.SUPRASPINATUS OUTLET: There is no significant fluid within the subacromial subdeltoid bursa. Mild osteoarthritis affects the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is anatomic. The glenoid labrum appears intact within the limitations of a non arthrogram study.BICEPS TENDON: The tendon of the long head of the biceps appears intact. There is thickening and intermediate signal intensity within the intra-articular portion of the tendon of the long head of the biceps indicating a mild tendinosis. ADDITIONAL

Output: 1. Rotator cuff tendinosis and interstitial tearing without evidence of a full-thickness rotator cuff tear or retraction.2. Infiltration of the subcoracoid fat is nonspecific but can be seen in patient's with adhesive capsulitis.


Instruction: Generate impression based on findings.

Input: 33 year old female with genetic cardiomyopathy s/p transplant 10/24/16 admitted for concern for acute rejection. Patient referred to cardiac MRI for further evaluation. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 60%, the LV end diastolic volume index is 100 ml/m2 (normal range: 65+/-11), the LVEDV is 150 ml (normal range 109+/-23), the LV end systolic volume index is 40 ml/m2 (normal range 18+/-5), the LVESV is 60 ml (normal range 31+/-10), the LV mass index is 77 g/m2 (normal range 67+/-11), and the LV mass is 115 g (normal range 114+/-24). There is mild concentric left ventricular hypertrophy (~12-13 mm myocardial thickness at the mid wall). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. The pre-contrast native myocardial T1 relaxation time (of the septal and lateral wall) is mildly elevated (~1100 ms). The T2-STIR edema ratio is elevated (2.14, normal <2) and the extracellular volume fraction is normal (19%, normal <30%). The global relative enhancement ratio is within normal limits (<4). Left AtriumThe left atrium is consistent with transplant. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 50%, the RV end diastolic volume index is 87 ml/m2 (normal range 69+/-14), the RVEDV is 130 ml (normal range 110+/-24), the RV end systolic volume index is 43 ml/m2 (normal range 22+/-8), and the RVESV is 65 ml (normal range 35+/-13). Right AtriumThe right atrium is consistent with transplant.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve suboptimally assessed, but there is no gross pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsSternal wires present. 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. The left ventricle is normal in size and systolic function (LVEF 60%).2. The right ventricle is normal in size and systolic function (RVEF 50%). 3. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.4. The pre-contrast native myocardial T1 relaxation time (of the septal and lateral wall) is mildly elevated (~1100 ms). The T2-STIR edema ratio is elevated (2.14, normal <2) and the extracellular volume fraction is normal (19%, normal <30%). The global relative enhancement ratio is within normal limits (<4).


Instruction: Generate impression based on findings.

Input: Other specified disorders of bladder [N32.89] / Unspecified urinary incontinence [R32], Reason for Study: ^Reason: Evaluate for tethered cord History: day time and night time enuresis For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. There is normal lumbar lordosis. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. The conus medullaris terminates at the L1 level. The filum terminale is normal in size and signal intensity. There is no evidence of tethered cord or spinal dysraphism. The paraspinal soft tissues are unremarkable.On prone scan, mobility of the filum and cauda equina are demonstrated.There are minimal diffuse bulging of intervertebral discs at the level of L45 without evidence of disc degeneration. Otherwise unremarkable.

Output: 1. No evidence of tethered cord.2. Minimal diffuse bulging of disc at the level of L45. Otherwise unremarkable.


Instruction: Generate impression based on findings.

Input: 3 years, Male, new seizure with EEG abnormality. Seizure episode described as upper extremity shaking in patient's clinical notes. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. The sulci are normal in configuration, with no evidence of heterotopia. The hippocampi are symmetric. The corpus callosum is normal in appearance. No abnormal parenchymal or meningeal enhancement. Major flow-voids are preservedThere are retained secretions within the mastoid air cells and middle ear, left greater than right. This results in asymmetry of blooming artifact on susceptibility weighted sequences at this level. Sella and orbits are grossly within normal limits. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: 1. No abnormality to account for seizure history.2. Significant left mastoid air cell and middle ear fluid opacification as compared to right, which is nonspecific. Please correlate clinically.