Instruction: Generate impression based on findings.

Input: Male, 63 years old, with GBM, no longer on PDL1 antibody trial, now receiving Avastin plus CCNU. No significant change is seen in the size or morphology of the resection cavity which incorporates the right anterior temporal lobe, a portion of the right insula, and the right inferior frontal lobe. Likewise, the degree of surrounding T2 signal abnormality has not substantially changed.Thin nonspecific enhancement seen along the medial margin of the right frontal lobe resection cavity appears similar to prior exams. Contiguous with this is a rim of ependymal enhancement along the right frontal horn which has become slightly thinner. Nodular enhancement along the left frontal horn ependyma has also diminished, as have several additional small patches of ependymal enhancement along the body and atrium of the right lateral ventricle. Many of these areas of decreasing ependymal enhancement show a corresponding interval increase in restricted diffusion.No new enhancing lesions are seen. No new parenchymal signal abnormality is detected. A mild degree of periventricular FLAIR hyperintensity along the left lateral ventricle is not significantly changed and may be treatment related. The size and morphology of the ventricular system are unchanged including ex vacuo dilatation of the right lateral ventricle.

Output: 1.Stable appearance of the resection cavity involving the right anterior temporal lobe, insula and inferior frontal lobe. No concerning new enhancement is seen along the margins of the cavity.2.Since the prior examination, scattered areas of ependymal enhancement along both lateral ventricles show decreased intensity of enhancement and progressive diffusion restriction. Findings may reflect a true response to therapy or pseudoresponse related to antiangiogenic therapy.


Instruction: Generate impression based on findings.

Input: 66-year-old female with biopsy-proven left breast invasive ductal carcinoma presents for MR guided ultrasound of bilateral breasts and left axilla. Recent MRI dated 10/11/2016 demonstrated enhancing masses at the 9:00 position posterior to the index mass in the left breast, at the 2:00 and 4:00 positions in the left breast, and in the subareolar region of bilateral breast. Abnormal morphology left lower axillary lymph nodes were also identified on MRI. On physical examination of both breasts, the patient has bilateral inverted nipples.A targeted LEFT breast ultrasound was performed for the areas of concern seen on MRI.In the left breast, 9:00, 4 cm from the nipple, again seen is the biopsied index mass measuring approximately 1.9 x 1.6 x 1.8 cm, corresponding to known malignancy.Immediately posteromedial and adjacent to the index mass in the left breast, 9:00, 3 cm from the nipple, there is a 7 x 4 x 7 mm oval circumscribed hypoechoic mass, corresponding to the enhancing oval mass seen on MRI.In the left breast, 2:00, 3 cm from the nipple, there is a 6 x 4 x 6 mm oval circumscribed hypoechoic mass, corresponding to the MRI finding.In the left breast, 4:00, 3 cm from the nipple, there is no sonographic correlate for the MRI finding.In the left breast, subareolar region, there is no solid or cystic mass identified.In the left axilla, there is an abnormal left axillary lymph node with an area of focal cortical thickening measuring 1.3 x 0.6 x 1 cm.Targeted RIGHT breast ultrasound was performed in the area of concern seen on MRI.In the right breast, subareolar region, there is no solid or cystic mass identified.

Output: 1. Known biopsied malignancy in the left breast at the 9:00 position, measuring up to 1.9 cm.2. Abnormal left axillary lymph node, for which ultrasound-guided biopsy is recommended.3. In the left breast, 9:00 position, adjacent to the index mass, there is a probably benign 7 x 4 x 7 mm oval circumscribed hypoechoic mass, corresponding to the MRI finding. Six month follow-up bilateral breast MRI is recommended to evaluate for stability.4. In the left breast, 2:00 position, there is a probably benign 6 mm oval circumscribed hypoechoic mass, corresponding to the MRI finding. Six month follow-up bilateral breast MRI is recommended to evaluate for stability.5. No sonographic correlate for the left breast 4:00 lesion seen on MRI. This can be reevaluated on six-month follow-up bilateral breast MRI.6. No sonographic findings in the subareolar region in both breasts. Bilateral subareolar enhancement seen on MRI is compatible with inverted nipples.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: 69-year-old female with drainage from groin wound and associated induration. Evaluate for bilateral groin seromas versus abscess. ABDOMEN:LUNG BASES: Bibasilar atelectasis. No acute infiltrates or effusions. Mild cardiomegaly.LIVER, BILIARY TRACT: Cholelithiasis. The multiple ill-defined hepatic hypodensities. The small at the hepatic dome on image 14 of series 3. The largest is adjacent to the hepatic hilum in the medial segment of the left lobe measuring 2 cm in greatest dimension at axial image 37 of series 3. A second lesion in the medial segment of the left hepatic lobe measures 1.6 cm in greatest dimension on axial image 36 of series 3. These hepatic lesions could be better characterized with a multiphase dedicated liver CT or MRI examination.SPLEEN: No significant abnormality noted. Splenule at the hilum. PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: There are multiple bilateral renal cortical cysts. There is a nonobstructing punctate left upper pole renal calculus. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Aortobifemoral bypass graft is in expected position and appears widely patent. Diffuse atherosclerotic changes with vascular calcifications.PELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Multiple bilateral borderline enlarged inguinal lymph nodes, probably reactive.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Bilateral groin fluid collections, largest on the left. Both fluid collections appear uniloculated with mildly thickened enhancing wall. No gas bubbles. Both of these collections lie superficial to the distal aortobifemoral bypass graft anastomotic sites. Small amount of free fluid in the pelvis. The smaller right-sided fluid collection and has a maximum diameter of approximately 2.5 cm. The left sided collection extends craniocaudally for 13 cm and has a transverse dimension of 5.5 cm.

Output: Bilateral uniloculated groin fluid collections at the distal anastomoses of aortobifemoral bypass graft. Enhancing rims suggest these are more likely abscess than seroma.. Multiple hepatic hypodensities are better characterized with dedicated liver CT or MR examination, if indicated.


Instruction: Generate impression based on findings.

Input: 86 years, Male, memory and language decline, assess for lobar atrophy. Word finding difficulty, poor word generation, and difficulty with repetition.. There is global parenchymal volume loss without a clear lobar distribution, but perhaps affecting minimally more the frontal and parietal lobes and not significantly changed since prior study from 12/16/2009. No disproportional volume loss involving the hippocampi. Multiple foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild to moderate chronic small vessel ischemic disease and minimally progressed since prior. There is a focus of volume loss in the right cerebellar hemisphere compatible with a small chronic infarct but new since prior study dated 12/16/2009. No evidence of acute ischemia. No evidence of hemorrhage. No intracranial mass or mass-effect. There is ossification along the falx which is within normal limits. No hydrocephalus. No extra-axial collections. Mild scattered opacification is evident in the paranasal sinuses.

Output: 1. Global parenchymal volume loss without a particular lobar distribution and not significantly changed since prior from 12/16/2009. No intracranial mass or mass effect.2. Mild to moderate chronic small vessel ischemic disease which is minimally worse since prior. There is also a small right cerebellar infarct which appears chronic but is new since prior.


Instruction: Generate impression based on findings.

Input: 50-year-old female with right ankle pain. TENDONS: There is circumferential fluid about the posterior tibialis tendon and flexor hallucis longus suggesting a tenosynovitis. The flexor and extensor tendons appear intact. The peroneal tendons appear intact. The Achilles tendon is normal in appearance.LIGAMENTS: The lateral collateral ligament complex appears intact. The distal tibiofibular syndesmotic complex appears intact. The visualized components of the deltoid ligament appear intact.ARTICULAR SURFACES AND BONE: There is subchondral cyst formation and subchondral signal abnormality within the medial cuneiform consistent with degenerative osteoarthritic changes. ADDITIONAL

Output: 1. Findings suggestive of posterior tibialis and flexor hallucis longus tenosynovitis.2. 2.0 cm lobulated collection of fluid signal intensity along the posteromedial aspect of the talus, which appears most consistent with ganglion cyst formation.


Instruction: Generate impression based on findings.

Input: Clinical question: Is there evidence of occult bleed. Signs and symptoms: Headaches Nonenhanced CT of brain:Examination demonstrates a focal area of increased signal intensity in the right periventricular white matter of frontal lobe. This finding measures 6.2-mm x 8.9-mm on axial image 15. This finding was not reported on prior exam and likely represent a new finding. Differentials for this lesion includes a small area of hemorrhage or a hemorrhagic tumor. There is no evidence of any surrounding vasogenic edema but this finding. Follow-up with an MRI is recommended. This nonenhanced CT of brain is otherwise entirely within normal limits.

Output: 1.6.2 x 8.9-mm hemorrhage in the right periventricular white matter of frontal lobe with no surrounding edema as detailed above.2.Follow-up with an MRI is recommended.3.Negative nonenhanced CT brain otherwise.


Instruction: Generate impression based on findings.

Input: 89 year-old male status post fall. Examination shows patchy hypoattenuation in the cerebral white matter. The ventricles, sulci and cisterns are symmetric and prominent, consistent with brain volume loss. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. No acute intracranial abnormality. 2. Small vessel ischemic disease of indeterminate age.


Instruction: Generate impression based on findings.

Input: Cerebral aneurysm, nonruptured [I67.1], Reason for Study: ^Reason: Dural AVF hemorrhage, s/p embolization and occlusion in Lebanon and VP shunt placement. Please evaluate status of dural AVF. 3T scanner. History: Neurological deficits s/p hemorrhage Brain MRIThere is no evidence of acute ischemic or hemorrhagic lesion. However, there are multiple hemosiderin depositions with associated tissue losses indicating prior hemorrhagic lesions. Those lesions involving left middle cerebellar peduncle, left side lower pons, left midbrain especially lateral aspect and the right side pars marginalis. Especially, the mesial aspect of the left middle cerebellar peduncle shows subtle Gad enhancement, but other lesions do not show any evidence of contrast enhancement.High signal intensities on the left side of medullar on T2/FLAIR indicate Wallerian degeneration.Scattered high signal intensity lesions on bilateral periventricular white matter are non specific.The ventricles, sulci and cisterns are unremarkable. There is no mass effect, edema, midline shift, intra or extra-axial fluid collection, restricted diffusion/acute ischemia. The mastoid air cells are clear.Retention cysts on bilateral maxillary sinuses.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal.No evidence of intracranial arterial aneurysm. No evidence of intracranial arterial luminal stenosis.

Output: 1. Multifocal hemosiderin depositions but mainly focused on the left side middle cerebellar peduncle extends through the left side of pons to the level of the left side midbrain with associated encephalomalacia as well as the right side pars marginalis as described above. 2. Normal brain MRA.


Instruction: Generate impression based on findings.

Input: Female, 10 years old, altered mental status and intractable seizures. Areas of T2 hyperintensity are seen involving both thalami, right side more than left. These areas are bright on diffusion weighted images but there is no ADC correlate to verify diffusion restriction. Some questionable mild T2 hyperintensity may exist within the caudate nuclei as well, but this is equivocal.On T2 weighted images, the corticospinal tracts at the level of the posterior limb of the internal capsule and cerebral peduncles are slightly brighter than what is typically seen though this could potentially be normal. Within the medulla, very distinct slitlike areas of T2 hyperintensity are present at the level of the olives. Small T2 hyperintense, T1 hypointense defects are also present within the splenium of the corpus callosum.Although on axial images, there are some areas of apparent gyral/cortical thickening involving the right parietal and posterior temporal lobes, on close inspection of thin section images in 3 planes, this finding probably represents volume averaging of the gyral convolutions. No definite parenchymal structural defects are seen.No evidence of intracranial hemorrhage or any abnormal extra-axial fluid is detected. Ventricles are normal in size and shape. Brain parenchymal volume is normal as well.On postcontrast imaging, a large developmental venous anomaly is evident in the right frontal lobe. No other pathologic enhancement is seen.

Output: Multiple areas of signal abnormality are detected including in the thalami, right side more than left, and questionably in the caudate nuclei and portions of the corticospinal tracts. Distinct signal abnormality is seen within the medullary olives, and there are also small lesions noted in the splenium of the corpus callosum. The pattern of these findings, although not exactly specific for any single etiology, is suggestive of a mitochondrial disorder, a lysosomal storage disorder or some other metabolic derangement. While a profound ischemic insult could potentially produce the findings in the thalami and basal ganglia, it would not necessarily account for the other findings.On some axial images, there is the suggestion of cortical/gyral thickening involving areas of the right parietal and posterior temporal lobes. On close inspection of thin section images, however, no unequivocal findings of a cortical dysplasia or malformation are seen.


Instruction: Generate impression based on findings.

Input: Ms. Selvie-Brown is a 50 year old female with biopsy proven malignancy of the left breast (ILC). She presents today for MRI evaluation for staging purposes. There is scattered fibroglandular tissue in both breasts. Marked background parenchymal enhancement is noted bilaterally, limiting the sensitivity of this examination.Left breast - There is a large conglomerate of enhancing masses identified in the left superior breast measuring approximately 10.7 x 8.1 x 5.9 cm (AP x ML x SI) and 10.0 cm in the AP oblique dimension. This corresponds in distribution and span to the mammographically detected area of architectural distortion. Susceptibility artifact from biopsy marker clip is seen at the inferolateral aspect of this enhancement, compatible with biopsy-proven malignancy.Right breast - There is no abnormal enhancement seen in the right breast. Scattered foci of enhancement are seen diffusely throughout the right breast, none of which are more suspicious than the rest.Axillae - A single lymph node with uniformly thickened cortex is identified in the left axilla, measuring approximately 1.7 cm in maximal dimension. No abnormal lymph nodes are identified in the right axillary region.

Output: (1) 10.7 cm of abnormal enhancement in the left superior breast, corresponding in distribution and span to the mammographically detected area of architectural distortion. Biopsy marker clip present at the infero-lateral aspect of this enhancement.(2) Uniformly thickened cortex of a single left axillary lymph node. Recommend MR-directed ultrasound with possible biopsy of this lymph node.(3) No MRI evidence for malignancy in the right breast. BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: E - Additional Mammo/Ultrasound Workup Required.


Instruction: Generate impression based on findings.

Input: 61 years Female (DOB:2/21/1954)Reason: evaluate for mets History: pain. shootingReferring Attending: SUSAN HONG Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. No abnormal enhancing lesions are appreciated in the lumbar spine.At L5-S1 there is loss of disc space height, disc desiccation and a broad-based left lateral recess disc protrusion which impresses on the nerve roots of the left lateral recess. The exiting nerve roots within the neural foramina are surrounded by fat. There is partial effacement of the fat surrounding the left-sided exiting nerve roots within the neural foramen.At L4-5 there is marked loss of disc space height, diffuse disc bulge and partial effacement of fat at the lateral recess bilaterally.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is loss of disc space height and disc desiccation at this level.At L2-3 there is no significant compromise to spinal canal or neural foramina. There is loss of disc space height and disc desiccation at this level. There is a left far lateral disc protrusion present at this level which displaces the left-sided exiting nerve after it exits foramen.At L1-2 there is no significant compromise to spinal canal or neural foramina.The uterus appears enlarged and heterogeneous with multiple T2 hypointense lesions.

Output: 1.There is no evidence for metastases to the lumbar spine.2.There are multilevel degenerative changes in the lumbar spine worse at L5-S1 where there is some mild encroachment of the nerve roots of the left lateral recess and the left neural foramen due to a broad-based disc protrusion. There is a left far lateral disc protrusion at L2-3 displacing the left-sided exiting nerve root after it exits the neural foramen.3.Multiple uterine fibroids are suspected. Please correlate with clinical history and exam.


Instruction: Generate impression based on findings.

Input: Patient with history of benign left breast biopsy with pathology demonstrating ALH and PASH. Patient with strong family history of breast cancer. There is heterogeneous amount of fibroglandular tissue in both breasts.Moderate to marked parenchymal enhancement is noted bilaterally.There are a few scattered subcentimeter cysts bilaterally. Additionally, there are scattered enhancing foci without suspicious enhancement in either breast. No abnormal lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. Routine high risk screening follow-up is recommended.BIRADS: 1 - Negative.RECOMMENDATION: NS - Routine Screening Mammogram.


Instruction: Generate impression based on findings.

Input: 52-year-old male status post cervical spine fusion, with neck pain The alignment of the cervical spine is preserved. Again noted are post surgery change statu post C1/2 fusion and stabilization change. Stabilization screws and plates runs between the occipital bone and C2 laminar are stable in position when compared to previous MRI study. The ends of both occipital screws seem crossing through the inner table of the calvarium. The cross-axial screws at C2 seems crossing through the inner table of the right lamina. No radio lucency is observed surrounding all the hardwares.Coronal images again demonstrate tilting of the dens. The joint space between the left occipital condyle and C1 arch and between the C1 and C2 have been fused by dense material. The degree of the tilting of the dens has been stable when compared to previous study dated 9/9/2011. The hardware obscures full emaculation of the cervical spine at this level, however, no apparent bony canal or neural foramina compromise is observed.Stable mild degenerative change at other level of cervical spine with no evidence of bony canal or neural foramina compromise.

Output: 1. Post C1/2 fusion and stabilization change. Stabilization screws and plates runs between the occipital bone and C2 laminar are stable in position when compared to previous MRI study. The ends of both occipital screws seem crossing through the inner table of the calvarium. The cross-axial screws at C2 seems crossing through the inner table of the right lamina. No radio lucency is observed surrounding all the hardwares.2. Stable C1/2 position. No evidence of bony canal or neural foramina compromise at any level.


Instruction: Generate impression based on findings.

Input: Female, 51 years old, with persistent back pain three months after ceiling fell on her. Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. No evidence of marrow replacement or marrow edema is observed. The distal spinal cord, conus and nerve roots of the cauda equina are within normal limits. No epidural abnormalities are suspected.T12-L1 through L3-4: The intervertebral discs are preserved with no evidence of spinal canal or foraminal stenosis. Mild facet arthropathy is seen at L3-4.L4-5: Moderate facet arthropathy is noted. Slight loss of disc T2 signal and minimal right foraminal annular fissuring. No significant disc herniation is seen. The spinal canal and neural foramina are not significantly narrowed. L5-S1: Moderate facet arthropathy noted. Disc bulging with a small central disc protrusion. No significant generalized spinal canal stenosis. The left neural foramen is mildly narrowed.

Output: 1.No evidence of any posttraumatic lumbar spine injury.2.Facet arthropathy develops at lower lumbar levels.3.Findings related to mild disc degeneration are seen at L4-5 and L5-S1 without significant spinal canal stenosis.


Instruction: Generate impression based on findings.

Input: 24-year-old woman with left knee pain MENISCI: The medial and lateral menisci appear normal.ARTICULAR CARTILAGE AND BONE: Mild tricompartmental osteoarthritis.LIGAMENTS: The cruciate and collateral ligaments appear intact.EXTENSOR MECHANISM: The quadriceps tendon and patellar tendon appear intact.ADDITIONAL

Output: Post-arthroscopic changes and a small joint effusion without other acute findings.


Instruction: Generate impression based on findings.

Input: 73-year-old female with right facial numbness. Evaluate for ischemia. There is no evidence of intracranial hemorrhage, mass or edema. Focus of decreased attenuation is present in a wedge-shaped distribution in the right posterior cerebellum reflecting prior infarct in a posterior inferior cerebellar artery distribution. There are multifocal regions of low attenuation throughout the subcortical and deep white matter periventricular distribution, nonspecific, however most likely representing small vessel ischemic disease, age indeterminate. If there is clinical concern for acute ischemia, an MRI may be considered.No areas of acute cortical ischemia identified.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. There is near complete opacification of the left maxillary sinus which represents a retention cyst, unchanged. The remaining visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. No evidence of acute cortical ischemia.2. Multifocal regions of low attenuation white matter which most likely represent small vessel ischemic disease, age indeterminate. If there is clinical concern for acute ischemia, an MRI may be considered.


Instruction: Generate impression based on findings.

Input: Male 42 years old Reason: eval for neurocompressive pathology History: LUE radiculopathy, prior C6/7 acdf The craniovertebral junction appears within normal limits. The cervical spine alignment is maintained. There are postsurgical changes of anterior cervical discectomy and fusion at the C6-7 level with degenerative loss of height of the C5 vertebral body. There is variable disc desiccation within the cervical spine with mild loss of disc height and anterior disc osteophyte formation at the C5-6 level. The cervical spinal cord has normal signal characteristics and overall morphology. The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.Degenerative changes are seen in the cervical spine as described below:C2-3: Tiny disc protrusion. No spinal canal or neuroforaminal stenosis.C3-4: Small disc osteophyte complex and tiny disc protrusion. Mild facet arthropathy. No spinal canal or neural foraminal stenosis.C4-5: Small right greater than left disc-osteophyte complex. Mild facet arthropathy. Mild right neuroforaminal narrowing. No left neuroforaminal or spinal canal stenosis.C5-6: Moderate left greater than right disc osteophyte complex and moderate left uncovertebral hypertrophy. Moderate facet arthropathy. Moderate to severe left and mild to moderate right neuroforaminal stenosis. Mild spinal canal stenosis. C6-7: Postsurgical changes of the ACDF without significant spinal canal or neural foraminal stenosis.C7-T1: Small disc osteophyte complex and central disc protrusion without significant spinal canal or neural foraminal stenosis.Sagittal T1-T2 and T2-T3: No spinal canal nor foraminal stenosis.

Output: Postsurgical changes of a prior ACDF at the C6-7 level with degenerative changes most prominent at the C5-6 level where there is moderate to severe left and mild-to-moderate right neural foraminal stenosis as well as mild spinal canal stenosis.


Instruction: Generate impression based on findings.

Input: There is a punctate focus of restricted diffusion and high T2 signal in the left corona radiata. There are also scattered punctate foci and confluent areas of T2 hyperintensity within the periventricular and subcortical white matter, right cerebellar hemisphere, as well as in the pons without restricted diffusion. In addition, there also appear to be scattered prominent perivascular spaces. There is linear and branching susceptibility effect in the right parietal lobe, which likely represent developmental venous anomaly. The ventricles and sulci are within normal limits. The basal cisterns are patent. There is no midline shift or mass effect. The major cerebral flow voids are intact. The midline structures and craniocervical junction are within normal limits. There are nasopharyngeal Thornwaldt and/or mucous retention cysts.

Output: A punctate focus of acute microvascular infarct in the left corona radiata. Other areas of white matter abnormality likely represent chronic small vessel ischemic disease and lacunar infarcts.


Instruction: Generate impression based on findings.

Input: Parkinson tremors. Inactive deep brains electrode leads in place in head. There are postoperative findings related to prior bilateral deep brain stimulators. There are a small foci of susceptibility effect in the left frontal lobe. There is mild patchy cerebral white matter T2 hyperintensity. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is mild diffuse cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact.

Output: Postoperative findings related to prior bilateral deep brain stimulators.


Instruction: Generate impression based on findings.

Input: Female 61 years old Reason: Evaluate right shoulder for recurrent rotator cuff tear History: Recurrent right shoulder pain and weakness. 15+ years s/p rotator cuff repair. ROTATOR CUFF: There is partial-thickness undersurface tearing of the anterior supraspinatus tendon near its insertion extending from approximately 10-11 o'clock (series 9, image 4). There is also greater than 50% undersurface tearing of the supraspinatus near its insertion extending from approximately 11-12 o'clock (series 9, image 7). The infraspinatus, teres minor, and subscapularis are intact. No significant muscle atrophy. No retraction of muscle fibers. There is mild atrophy of the supraspinatus and infraspinatus muscles.SUPRASPINATUS OUTLET: There is a type I acromion.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenoid labrum is intact.BICEPS TENDON: Long head of the biceps tendon is situated in the bicipital groove. No significant abnormality.ADDITIONAL

Output: Greater than 50% undersurface tearing of the anterior and superior supraspinatus tendon. Mild supraspinatus and infraspinatus muscle atrophy.


Instruction: Generate impression based on findings.

Input: Clinical question: Assess for lumbar spinal stenosis. Signs and symptoms: Lower extremity pain and weakness. Nonenhanced lumbar MRI:T11-T12, T12-L1 and L1-L2 levels are unremarkable.L2-L3 demonstrate a tiny right lateral small disc protrusion which projects into the inferior aspect of the right L2-L3 neural foraminal without detectable neural foraminal compromise or mass effect on the right L2 nerve root (sagittal T2 and T2 stair image 6 as well as axial T2 series 701 imaging 9). Unremarkable exam otherwise.L3-L4 demonstrate mild disc desiccation and mild bilateral ligamentum flavum hypertrophy with mild facet disease. No spinal stenosis or neural foraminal compromise.L4-L5 demonstrate moderate to advanced disc disease and loss of disc height, moderate bilateral facet and moderate to severe bilateral ligamentum flavum hypertrophy as well as mild grade 1 anterolisthesis. Constellation of findings results seen significant central spinal stenosis and significant bilateral (R>L) neural foraminal compromise. Facet disease at this level is associated with mild bilateral facet space T2 hyperintensity suggestive facet effusion.L5-S1 demonstrate moderate disc desiccation, mild bilateral facet and ligamentum flavum degenerative/hypertrophic changes however without the spinal stenosis or neural foraminal compromise.

Output: 1.L4-L5 demonstrate extensive degenerative/hypertrophic changes and including grade 1 anterolisthesis with resultant significant central spinal stenosis and significant bilateral (R>L) neural foraminal compromise. Mild bilateral facet effusion at this level is also noted.2.Tiny right far lateral disc protrusion at T2-L3 level without spinal stenosis or neural foraminal compromise as.3.Unremarkable images at other levels and without spinal stenosis or neural foraminal compromise.


Instruction: Generate impression based on findings.

Input: Redemonstrated is superior endplate compression deformity of L2, unchanged in extent compared to the recent CT with only a mild amount of adjacent marrow edema. The remainder of the vertebral body heights are maintained.At L5-S1 there is asymmetric bulge to the left with endplate spurring as well as left facet hypertrophy causing mild left neural foraminal stenosis, unchanged.At L4-5 there is asymmetric bulge to the right with endplate spurring, right ligamentum flavum thickening, and mild bilateral facet hypertrophy. There is mild central, mild left lateral recess, moderate right lateral recess, moderate left neural foraminal, and severe right neural foraminal stenosis. These findings are unchanged.At L3-4 there is diffuse disc bulge, a superimposed left paramedian extrusion, ligamentum flavum thickening, and mild bilateral facet hypertrophy. There is mild-to-moderate central, moderate left lateral recess, mild right lateral recess, and mild to moderate bilateral neural foraminal stenosis. These findings are unchanged. At L2-3 there is disc bulge, ligamentum flavum thickening, and mild bilateral facet hypertrophy. There is mild central, mild bilateral lateral recess, and mild bilateral neural foraminal stenosis, unchanged.At L1-2 there is no significant compromise to spinal canal or neural foramina, unchanged.

Output: 1.Redemonstrated is superior endplate compression deformity of L2, unchanged in extent compared to the recent CT with only a mild amount of adjacent marrow edema. The remainder of the vertebral body heights are maintained.2.Stable degenerative stenoses.


Instruction: Generate impression based on findings.

Input: 92 year-old male left retro-orbital mass. Lymphoma is suspected please. CT soft tissues of the neckimages at the level of skull base are unremarkable. The cavernous sinuses are within normal limits. Retention cyst within the left maxillary sinus is detected.Images through the soft tissues of the neck demonstrate no evidence of any masses or adenopathy. Extensive degenerative disk disease is noted. The bony density of area of the study is otherwise unremarkable.Limited images through the apices of the lung demonstrate a very small focal area of anemia are and loculated soft tissue density in the left lung field that may represent a focal area of scarring.CT of the maxillofacial region. Image is through the orbit demonstrate no evidence of any abnormality. Specifically no definitive evidence of any left-sided retro-orbital mass is identified. The retro-orbital contents including optic nerves, extraocular musculature and retro-orbital fat remains entirely within normal limits. The morphology and density of both globes in anterior and posterior chambers are normal. The lacrimal glands are within normal size. The bony structure of the orbits are also normal.The paranasal sinuses demonstrate a small retention cyst within the left maxillary sinus and are otherwise unremarkable. No abnormality within the nasal cavity or nasopharynx is detected.Previously described abnormality within the left orbit on prior MRI is likely an artifactual finding.

Output: 1.Unremarkable CT examination of soft tissues of the neck and in particular no evidence of any masses or pathologic adenopathy is detected.2.Unremarkable CT of the maxillofacial region and in particular no evidence of masses within the retro-orbital space is detected.


Instruction: Generate impression based on findings.

Input: Headache and seizures. There are postoperative findings related to right temporal craniotomy. There is unchanged encephalomalacia in the right temporal lobe. There are also unchanged scattered foci of cerebral white matter T2 hyperintensity. The hippocampi appears to be intact. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. There is mild fusiform bulbous enlargement of the azygos anterior cerebral artery. The orbits, skull, paranasal sinuses, and scalp soft tissues are unchanged.

Output: Postoperative findings with extensive right temporal lobe encephalomalacia and mild scattered probable chronic small vessel ischemic disease, but no evidence of acute intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: 52-year-old man with history of renal cell carcinoma with brain metastases status post craniotomy and resection on 9/16/2015 now with right facial swelling. Evaluate for postoperative changes or infection. There are postoperative findings related to right frontotemporal craniotomy. There is a heterogeneous subdural collection underlying the craniotomy site and in the subgaleal space. The fluid collections demonstrate diffusion restriction and there is avid linear enhancement along the resection cavity, increased when compared to the prior MRI. There is extensive surrounding edema results in mild mass effect, right lateral ventricle effacement and approximately 7 mm of leftward midline shift are unchanged. The basal cisterns are patent. There is also been an increase in the collection overlying the scalp. There is interval increase in size of two subcentimeter cerebellar lesions. The focus in the right cerebellar hemisphere is associated with susceptibility artifact. The major cerebral flow voids are intact. The orbits and paranasal sinuses are grossly unremarkable.

Output: 1.Postoperative findings related to right frontal lobe metastasis resection with extensive enhancement in the surgical bed and overlying scalp suggests a wound infection with possible abscess formation.2.Interval increase in size of the subcentimeter cerebellar metastases.


Instruction: Generate impression based on findings.

Input: Female; 55 years old. Reason: further characterization of heptic biliary duct dilatation seen in CT scan. Etiology of obstruction? History: 55yo F with OLT in 2011 c/b biliary stricture who presents with hepatic abscess s/p IR drain 4/30 and noted chronic biliary dilation on prior CT scans; question of cause of this dilation. MRCP images are limited due to body wall anasarca and ascites. ABDOMEN:LUNG BASES: Small right pleural effusion and moderate right lower lobe nonspecific atelectasis/consolidation similar to prior CT. Cardiomegaly.LIVER, BILIARY TRACT: Mild right and moderate left intrahepatic biliary ductal dilation, presumably due to stricturing near Klatskin's point as the confluence of the main right and left hepatic ducts is not well seen, all similar to prior MRI on 8/6/13. Small filling defects within dilated left intrahepatic biliary ducts noted, likely due to stones and/or debris.Findings suspicious for multiple left hepatic microabscesses with confluent abscess in the posterior left hepatic lobe status post placement of percutaneous drain, not significantly changed since prior CT on 4/30/15.SPLEEN: Splenomegaly with left upper abdominal varices.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Enlarged cardiophrenic, porta hepatis, and gastrohepatic lymph nodes, likely reactive in the setting of infection.BOWEL, MESENTERY: Mild abdominal ascites.BONES, SOFT TISSUES: Body wall anasarca.OTHER: No significant abnormality noted.

Output: 1. Mild right and moderate left intrahepatic biliary ductal dilation presumably due to stricturing just proximal to the anastamotic site with the small bowel.2. No significant interval change in findings suspicious for multiple left hepatic lobe abscesses since prior CT on 4/30/15.


Instruction: Generate impression based on findings.

Input: Other visual disturbances [H53.8], Reason for Study: ^Reason: Evaluate for sudden onset R eye blindness History: as above Brain MRINo evidence of acute ischemic or hemorrhagic lesion on this scan.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. The mastoid air cells are clear.Mucosal thickening of paranasal sinuses, no change since prior scan.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal. There is no evidence of intracranial arterial aneurysm. No intracranial arterial luminal stenosis or irregularity. Bilateral ophthalmic arteries are patent.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion on the scan.2. Normal brain MRA


Instruction: Generate impression based on findings.

Input: Refractory knee pain. Evaluate for meniscal pathology. MENISCI: The medial and lateral menisci are intact.ARTICULAR CARTILAGE AND BONE: There is heterogeneity and superficial delamination of the medial facet articular cartilage of the patella with minimal underlying subchondral edema of the patella. There is thinning of the lateral femoral trochlear articular cartilage. No full-thickness chondral defect is identified. The articular cartilage of the medial and lateral compartments is intact.LIGAMENTS: The collateral and cruciate ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: Patellar chondromalacia as described above.


Instruction: Generate impression based on findings.

Input: Clinical question: Worsening headache; rule out any structural lesions. Signs and symptoms: Worsening headaches. Nonenhanced brain MRI:Negative diffusion weighted series.Examination demonstrates normal anatomical morphology of the brain. There is normal signal intensity of brain parenchyma on all MRI sequences.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination.The signal void of major intracranial arterial branches are identified.The signal intensity of the intracranial venous sinuses is "normal.Unremarkable calvarium and soft tissues of the scalp.Unremarkable images through the orbits.All the paranasal sinuses and bilateral mastoid air cells and middle ear cavities demonstrate normal pneumatization signal pattern.

Output: Unremarkable nonenhanced brain MRI.


Instruction: Generate impression based on findings.

Input: Reason: hx of uterine fibroids/imaging prior to Uterine Artery Embolization History: fibroid bulk symptoms PELVIS:UTERUS, ADNEXA: The uterus is enlarged with multiple subserosal and intramural fibroids. Along the fundus, there is an avidly enhancing subserosal fibroid measuring 8.8 x 9.3 cm (5/36),. There is an additional large conglomerate of subserosal fibroids along the left aspect of the fundus measuring 11.9 x 7.9 cm (9/10) which is avidly enhancing but contains a centrally necrotic region. Additional fibroids are mostly avidly enhancing. No submucosal fibroids are evident.Follicles are identified in the left adnexa. A T1 hyperintense lesion is present in the right adnexa with low T2 signal measuring 2.3 x 2.7 cm, likely an endometrioma.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: No significant abnormality noted.

Output: 1.Multiple uterine fibroids, most of which are avidly enhancing.2.Right adnexal endometrioma.


Instruction: Generate impression based on findings.

Input: Reason: Elevated PSA, evaluate for prostate cancer History: see aboveBiopsy 9/17/2015: Right base, right mid, right apex, left base, left mid, left apex positive for Gleason 6 adenocarcinoma PELVIS:PROSTATE:Prostate Size: 5.2 x 3.2 x 4.7 cmPeripheral Zone: Multiple lesions throughout the prostate are suspicious for prostatic adenocarcinoma. A lesion in the apex, immediately right of midline measures 0.5 x 0.3 cm (701/12). Bilateral lesions in the mid gland peripheral zone measure 1.0 x 0.8 cm and 1.0 x 0.7 cm (701/15). A lesion in the left base measures 0.5 x 0.8 cm (701/19). There is an ill-defined lesion in the right base with possible invasion into the seminal vesicles.Central Gland: There is a large lesion in the anterior transitional zone of the right apex measuring 1.8 x 1.8 cm which is T2/ADC hypointense and hyperintense on DWI, suspicious for tumor. Seminal Vesicles: Ill-defined T2/ADC hypointense lesion in the right base with possible seminal vesicle invasion.Extracapsular Extension: Equivocal extracapsular extension of right apical lesion.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Multifocal lesions lesions throughout the prostate with a large anterior apical lesion, suspicious for prostatic adenocarcinoma. There is possible seminal vesicle involvement at right base.2.No pelvic lymphadenopathy.


Instruction: Generate impression based on findings.

Input: 70 years, Male, new right hand and arm weakness.. Brain: 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. Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild chronic small vessel ischemic disease. Brain parenchyma is otherwise unremarkable for age. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits. Cervical spine: Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. There is loss of normal cervical lordosis with minimal anterolisthesis of C4 on C5, minimal retrolisthesis of C5 on C6 and C6 on C7, and minimal C7-T1 anterolisthesis. 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: There is disc osteophyte complex and uncovertebral hypertrophy resulting in mild spinal canal narrowing. There is moderate bilateral neural foraminal stenosis.C4-5: Small disc osteophyte complex with mild spinal canal narrowing. Mild right-sided neural foraminal stenosis. Minimal left neural foraminal narrowing.C5-6: Small disc osteophyte complex and uncovertebral hypertrophy. Minimal spinal canal stenosis. There is mild to moderate bilateral neural foraminal narrowing.C6-7: No significant spinal canal stenosis. Minimal neural foraminal narrowing bilaterally.C7-T1: No significant compromise to the spinal canal. Minimal bilateral neural foraminal narrowing.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: 1. No evidence of acute infarct. No intracranial mass effect.2. Mild chronic small vessel ischemic disease.3. Mild to moderate multilevel degenerative changes in the cervical spine. No cord signal abnormality. There is mild spinal canal stenosis from C3-C4 to C5-C6. Neural foraminal narrowing is worst at the C3-C4 level and relatively worse on the right than the left.


Instruction: Generate impression based on findings.

Input: 13-year-old female with left foot pain, evaluate for calcaneal fracture status post injury. TENDONS: The Achilles tendon has an abnormal morphology, having lost its normal crescent-shaped, now appearing rounded with associated high signal consistent with a partial tear. There is fluid within the retrocalcaneal bursa. The remaining imaged portions of the tendons of the ankle appear intact.LIGAMENTS: No significant abnormality noted.ARTICULAR SURFACES AND BONE: There is an approximately 2.0 cm long crescent shaped signal void along the posterior superior aspect of the calcaneus, which may represent an avulsion fracture fragment, possibly from the apophysis. . Bone marrow edema is noted within the calcaneus, particularly the posterior portion as well as the talus.ADDITIONAL

Output: Partial thickness tear of the Achilles tendon with an associated avulsion of fracture of the superior portion of the calcaneal apophysis;


Instruction: Generate impression based on findings.

Input: Female, 35 years old, with medically intractable right hemisphere epilepsy. Functional MRI is requested as part of epilepsy presurgical evaluation. Sensorimotor cortical activation of the hand, foot and face maps as expected along the pre- and post-central gyri. Visual cortical activation is seen extensively within the occipital lobes. Statistical thresholding on the visual paradigm is adjusted to reveal the lateral geniculate nuclei bilaterally.Most of the tested language paradigms produced reliable language related cortical activation. In general, language laterality and relative dominance varied with the language paradigm administered and the language in which the patient generated her responses. For example, in the object naming paradigm, Broca's area activation is seen bilaterally involving the pars orbitalis and to a lesser degree the pars triangularis and opercularis. When this paradigm is performed in English, a slight right-sided preference is noted, and when in Cantonese, a slight left-sided preference is seen. Wernicke's area is not specifically elicited during this paradigm, and strong symmetric bilateral secondary language activation in the middle frontal gyri and the parietal lobes is demonstrated in both languages. During the verb generation paradigm, fairly symmetric Broca's area activation is seen bilaterally in both English and Cantonese. Wernicke's area is identified in both English in Cantonese along the posterior aspect of the superior temporal sulcus. No right-sided Wernicke's activity is noted.The word generation paradigm produces a relative Broca's dominance on the right with English, and on the left with Cantonese. No definite Wernicke's area activity is seen.When the sentence completion paradigm is performed in English, a strong left dominance of Broca's and Wernicke's areas is seen. However, when performed in Cantonese, Broca's area activity was slightly right dominant, while Wernicke's area is only seen on the left.

Output: Sensorimotor cortical activation maps as expected along the pre- and post-central gyri. Visual cortical stimulation is evident extensively in the occipital lobes, with symmetric foci of activity visualized in the dorsolateral thalami likely indicating the location of the lateral geniculate nuclei.As the patient is multi-lingual, a hybrid approach to the language paradigms was adopted such that both English and her native Cantonese were tested. Broca's and Wernicke's areas are reliably identified in their expected locations as detailed above. However, no clear hemispheric language dominance is observed. Rather, in most cases, a mild right or left hemispheric Broca's dominance is seen depending on the paradigm and language utilized. Wernicke's area is not visualized on all paradigms, but when it is seen, it is most convincingly detected on the left. Findings suggest substantial language processing in both hemispheres, with a preference for receptive language (Wernicke's) on the left.


Instruction: Generate impression based on findings.

Input: Male 9 years old Reason: concern for splenic vein thrombus; please evaluate splenic vein with MRV History: grade 2 esophageal varices on EGD, past evidence of splenic infarct on imaging ABDOMEN:Motion artifact limits sensitivity of examination.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: The spleen is markedly enlarged, with multiple small, subcentimeter foci of decreased signal intensity.PANCREAS: Pancreas is normal in appearance.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No evidence of bowel obstruction.BONES, SOFT TISSUES: No significant abnormality noted.MRV: The portal vein, splenic vein, hepatic veins, and IVC are patent with no evidence of thrombus.OTHER: Small to moderate amount of ascites is present.

Output: 1.Patent vasculature with no evidence of thrombus, specifically no splenic vein thrombus.2.Splenomegaly.3.Small to moderate ascites.


Instruction: Generate impression based on findings.

Input: Female, 53 years old, with altered mental status and hypertension. Assess for PRES, cerebral edema. Image quality is compromised by motion artifact. A relatively linear region of encephalomalacia is redemonstrated within the right aspect of the pons with associated pontine volume loss. The pontine parenchyma, and to a lesser degree the midbrain parenchyma, show mild ill-defined T2 hyperintensity. There may also be some T2 hyperintensity within the right middle cerebellar peduncle.Elsewhere, only a few scattered punctate foci of white matter T2 hyperintensity are seen. No evidence of cortical or subcortical edema is detected. No restricted diffusion is evident. There are no findings to suggest acute or chronic intracranial hemorrhage. No abnormal fluid collections are seen. The ventricular system is normal in size and morphology.

Output: 1.No change in the appearance of a chronic right pontine infarct.2.Ill-defined signal within the remainder of the pons and the midbrain may reflect chronic microvascular ischemic disease or sequelae of degenerating fibers related to pontine infarction.3.No acute intracranial abnormality is suspected. No evidence of cerebral edema is seen. In particular, no findings to suggest PRES are noted.


Instruction: Generate impression based on findings.

Input: Clinical question: History epilepsy and drop attacks. Signs and symptoms: Preoperative planning for laser ablation callosotomy. Pre-and post-enhanced fusion brain MRI:Similar to prior exam there is generalized prominence of cortical sulci and cerebellar -- vermian folia for stated age of 29 and consistent with underlying parenchymal volume loss. Large focus of encephalomalacia in the right anterior temporal and with evidence of a right temporal craniotomy is noted. Smaller focus of primary cortical encephalomalacia in the left anterior temporal lobe under a left temporal craniotomy is also noted. There is no detectable abnormal enhancement the brain parenchyma or the pia- meninges. Examination is performed as surgical planning study and is not a true and complete diagnostic exam.

Output: 1.Large right anterior temporal and a smaller left anterior temporal foci of encephalomalacia and evidence of prior craniatomy.2.Generalized prominence of the cortical sulci and cerebellar -- vermian folia consistent with underlying parenchymal volume loss.3.No detectable abnormal enhancement.


Instruction: Generate impression based on findings.

Input: Sagittal T2 technique suggests the presence of a CSF intensity focus within the anterior right middle cranial fossa which is only partially characterized.The left cerebellar tonsil extends 6-7 mm below the level of the foramen magnum and demonstrates a pointed morphology with partial effacement of the posterior CSF space. There is also associated deformation of the leftward cervicomedullary junction secondary to the tonsillar herniation. There is a flash of biphasic CSF flow posteriorly at the level of the cerebellar tonsils. The odontoid tip is retroflexed abutting the cervicomedullary junction with mild deformation.A prominent syrinx is present within the cervical and thoracic spinal cord extending from the C4 level to the T12 level demonstrating multiple septations and measuring up to 8-9 mm in maximal AP dimension as well as 10-11 mm in maximal transverse dimension at several locations. The conus extends below L1 (below the field of view acquired for thoracic spine acquisition).There are no fractures, subluxations, or developmental osseous dysplasias.

Output: 1.Sagittal T2 technique suggests the presence of a CSF intensity focus within the anterior right middle cranial fossa which is only partially characterized. This may represent a partially imaged arachnoid cyst. Correlation with prior brain exams could help confirm.2.The left cerebellar tonsil extends 6-7 mm below the level of the foramen magnum and demonstrates a pointed morphology with partial effacement of the posterior CSF space consistent with Chiari I information. 3.A prominent syrinx is present within the cervical and thoracic spinal cord extending from the C4 level to the T12 level demonstrating multiple septations and measuring up to 8-9 mm in maximal AP dimension as well as 10-11 mm in maximal transverse dimension at several locations.


Instruction: Generate impression based on findings.

Input: Right knee pain MENISCI: There is truncation and blunting of the posterior horn and body of the medial meniscus suggesting the presence of a radial tear. The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is moderate diffuse articular cartilage loss of the medial compartment with areas of full-thickness loss along the medial femoral condyle and medial tibial plateau (Series 4 image 23/38). The articular cartilage of the lateral meniscus is diffusely thin but relatively preserved otherwise. There is severe articular cartilage loss of the patellofemoral compartment with full-thickness loss along both the medial and lateral patellar facets. There is loss of the articular cartilage of the femoral trochlea as well.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Radial tear of the medial meniscus.2. Marked articular cartilage loss of the patellofemoral compartment with additional areas of full-thickness loss of the medial compartment.3. Large joint effusion.


Instruction: Generate impression based on findings.

Input: 70 year old male patient with history of elevated PSA, negative biopsy in 2013, and gross hematuria. Evaluate for prostate tumor, pending biopsy. PELVIS:PROSTATE:Prostate Size: 7.2 x 5.1 x 6.8 cm. Peripheral Zone: The peripheral zone is thinned secondary to an enlarged central gland. There are linear areas of T2 hypointensity and mild ADC hypointensity within the right mid-gland (image 15, series 501) and left mid-gland (image 16, series 501) which are indeterminate. Central Gland: The central gland is hyperplastic with BPH nodules. Confined with the anterior and left apical central gland, there is a 1.1 x 2.2 cm region of T2 hypointensity and ADC hypointensity which demonstrates early enhancement; this is suspicious for tumor. Furthermore, this lesion appears to abut the prostatic urethra. Seminal Vesicles: No definite involvement.Extracapsular Extension: No definite extraprostatic extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Signal abnormality confined to the left central gland which is suspicious for tumor.2.Linear signal abnormality within the mid-gland of the peripheral zone bilaterally which is indeterminate.


Instruction: Generate impression based on findings.

Input: The last well formed disk space is referred to as L5-S1. There is normal alignment of the lumbar spine. There is disk desiccation and loss of disk height at L3-4 and L4-5. The osseous marrow signal is benign. The vertebral body heights are preserved. The conus shows normal signal and caliber and terminates at L1.T11-12: No disk herniation or spinal stenosis.T12-L1: No disk herniation or spinal stenosis.L1-2: No disk herniation or spinal stenosis.L2-3: Minimal disk bulge and bilateral facet arthropathy with no significant spinal stenosis.L3-4: Diffuse disk bulge, facet arthropathy and ligamentum flavum thickening causing mild to moderate bilateral neural foraminal stenosis and no significant spinal canal stenosis. There may be impingement of the exiting L3 nerve roots.L4-5: Diffuse disk bulge with left foraminal protrusion component. There is bilateral facet arthropathy. There is resulting moderate to severe bilateral left worse than right neural foraminal stenosis. No significant spinal canal stenosis. There may be impingement of the exiting L4 nerve roots, particularly on the left.L5-S1: Mild disk bulge and facet arthropathy with no significant spinal canal or neural foraminal stenosis.

Output: Multilevel degenerative changes as detailed above with moderate to severe L4-L5 and moderate L3-L4 neural foraminal stenosis as above. No significant spinal canal stenosis.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: The risks (including, but not limited to, those of bleeding, infection, allergic reaction, temporary nerve block, pain, and inability to access the joint) and benefits of the procedure were explained to the patient, and informed written consent was obtained. A pre-procedural “time-out” form was completed.he patient was placed supine on the fluoroscopy table. The left hip was localized fluoroscopically, and a spot radiograph was obtained. The course of the femoral artery was noted on the patient's skin using an ink marker. The skin was cleansed and covered with a sterile drape. The skin and subcutaneous tissues were anesthetized with 1% lidocaine using 25-gauge and 22-gauge needles.Under fluoroscopic guidance, a 20-gauge spinal needle was advanced into the joint. Attempted aspiration yielded no fluid. Next, 12 ml of a 50/50 mixture of Omnipaque 240 (to confirm the intra-articular position of the needle) and dilute Multihance (0.1 cc in a 10 cc vial of saline, for subsequent MR imaging) were injected into the joint. Contrast opacified the joint in the expected manner. A spot radiograph was obtained for documentation. The needle was withdrawn. Blood loss was negligible (<1cc), and patient tolerated the procedure well without immediate complication. An adhesive bandage was placed on the patient’s skin. Routine post procedure instructions were communicated to the patient. The patient was escorted to the MRI suite for further imaging in stable condition. Please refer to the subsequent MRI report for further information.Exposure time: 55 seconds

Output: Successful fluoroscopic-guided left hip arthrogram injection.


Instruction: Generate impression based on findings.

Input: Diagnosis: Multiple sclerosisClinical question: disease activity on GilenyaSigns and Symptoms: steroid side effects taper ending in one week MS--L sensory and weaknessComments: ? Interval change and activity on Gilenya | Do on Mon AM | There is redemonstration of a mild degree of periventricular and subcortical white matter lesions some of which are perpendicularly oriented to the lateral ventricles. Many of these are smaller on the current exam. There is also a right posterior medulla lesion which is bright on T2 and FLAIR MRI measuring about 8 mm in size which was also present on the prior exam but measured approximately 10 mm. There are small white matter lesions bright on FLAIR imaging located in the middle cerebellar peduncles which are smaller on the current exam. No abnormal enhancing lesions are appreciated in the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mucosal thickening in the right maxillary sinus there is a small air-fluid level present. The visualized portions of the mastoid air cells are clear. There is mild mucosal thickening in the ethmoid air cells. The visualized portions of the orbits are intact.

Output: 1.There is redemonstration of multiple white matter lesions as well as brainstem lesions which are stable in number compared to the previous exam. Please note that many of the lesions identified and appear smaller in volume. There is no convincing evidence for an acute lesion at this time.2.There is right maxillary sinus opacification with an air fluid level. This could represent retained secretions or acute sinusitis.


Instruction: Generate impression based on findings.

Input: 41-year-old female with right knee pain and swelling. Evaluate for meniscus tear. Due to the patient's body habitus, an HD coil was not able to be utilized resulting in slightly suboptimal image quality.MENISCI: There is globular signal abnormality within the anterior horn of the lateral meniscus indicating intrasubstance degeneration. The signal also extends to both the tibial and femoral articular surfaces indicating degenerative tearing. There is a heterogeneous collection of signal abnormality along the anterior aspect of the lateral meniscus representing a parameniscal cyst. There is additional branching signal abnormality within the body of the lateral meniscus which extends to the free edge, representing additional tearing. There is horizontally oriented signal abnormality within the posterior horn of the lateral meniscus which extends to the tibial articular surface, representing additional tearing. There is perhaps minimal undersurface fraying of the posterior horn of the medial meniscus, but we see no discrete tear. The anterior horn appears intact.ARTICULAR CARTILAGE AND BONE: There is full-thickness cartilage loss along the inferior aspect of the lateral facet of the patella. There is also a full-thickness defect of the articular cartilage along the medial facet of the patella with what appears to be a dislodged cartilaginous fragment within the patellofemoral joint. There is also a full-thickness defect of the articular cartilage of the femoral trochlea superiorly. Additional full-thickness cartilage loss is identified along the lateral facet of the femoral trochlea with small underlying subchondral cysts. There is full-thickness cartilage loss along the lateral tibial plateau with underlying degenerative subchondral signal abnormality. There is relatively mild degeneration of the articular cartilage of the lateral femoral condyle. There is near full-thickness degeneration of the articular cartilage of the weightbearing portion of the medial femoral condyle above and anterior to the posterior horn of the medial meniscus. There are tricompartmental osteophytes.LIGAMENTS: The cruciate and collateral ligaments appear intact.EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Extensive degenerative tearing of the lateral meniscus as described above.2. Tricompartmental osteoarthritis as described above.3. Large joint effusion.


Instruction: Generate impression based on findings.

Input: Alignment is anatomic. There are no fractures or subluxations. The marrow signal is benign. The cord signal is normal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable. C1/2: No significant spinal canal stenosis or neuroforaminal narrowing.C2/3: No significant spinal canal stenosis or neuroforaminal narrowing.C3/4: No significant neuroforaminal narrowing or spinal canal stenosis. There is linear T2 and T2 STIR hyperintensity within the annulus of the disk just left of the midline with enhancement which is consistent with an annular fissure.C4/5: There is a small disk protrusion which minimally indents the thecal sac. There is also disk height. Mild central spinal canal stenosis. Moderate right neuroforaminal narrowing with uncovertebral hypertrophy. There is also mild left neuroforaminal narrowing.C5/6: There is loss of disk height and uncovertebral hypertrophy. Moderate right and mild to moderate left neuroforaminal narrowing. There is mild central canal stenosis secondary to shallow central disk protrusion.C6/7: No significant spinal canal stenosis or neuroforaminal narrowing.C7/T1: No significant neuroforaminal narrowing or spinal canal stenosis.

Output: 1. Multilevel degenerative changes of the cervical spine worse at C4-C5 and C5-C6 as detailed above.2. Annular fissure is present at C3-C4.2. No mass lesion or evidence of infection as clinically questioned.


Instruction: Generate impression based on findings.

Input: History of breast cancer with left rectus abdominis muscle lesion. PELVIS:UTERUS, ADNEXA: The endometrial thickness is normal. The junctional zone is within normal limits. There is an intramural anterior lower uterus segment fibroid measuring up to 1.7 cm. The adnexa are unremarkable.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: The left rectus abdominis muscle lesion is best seen on the postcontrast imaging and measures approximately 1.9 x 1.5 cm (series 1 303/518), compared to 2.5 x 1.4 cm previously.OTHER: No significant abnormality noted.

Output: Minimal decrease in size of the nonspecific enhancing lesion in the left rectus abdominis muscle.


Instruction: Generate impression based on findings.

Input: 63 year old female with a history of fat malabsorption and decreased fecal elastase level. Assess for chronic pancreatitis. ABDOMEN:LIVER, BILIARY TRACT: No evidence of intra- or extra-hepatic biliary ductal dilation. Fluid signal intensity lesion in segment 6 of the liver with associated discontinuous peripheral nodular enhancement and progressive enhancement on delayed sequences, consistent with a benign hemangioma. SPLEEN: No significant abnormality noted.PANCREAS: There is mild atrophy of the pancreas without evidence of focal mass lesion. The main pancreatic duct is normal in size and appearance without evidence of significant narrowing or stricture.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: Mild atrophy of the pancreas. Otherwise, unremarkable MRI/MRCP of the abdomen.


Instruction: Generate impression based on findings.

Input: Back pain Tendons: The gluteus medius and gluteus minimus tendinous insertions on the greater trochanter are intact. The iliopsoas tendon is intact. The hamstring tendon origin is intact.Joints: The hip joints are normal. The sacroiliac joints appear unremarkable and without evidence of erosion, fluid, degenerative change, or abnormal enhancement. The pubic symphysis is unremarkable.Joint effusion/Bursa: No evidence of joint effusion. No trochanteric bursitis present.Muscles: No muscle atrophy or tear seen.Bone marrow: No focal marrow replacing lesions are identified. There is no fracture.

Output: Normal MRI of the pelvis/sacroiliac joints.


Instruction: Generate impression based on findings.

Input: Female, 67 years old, with weakness in the left arm and leg, worsening gait. Evidence for anterior instrumented fusion is seen from C4 through C6. Spinal alignment is anatomic. Vertebral body heights are preserved. No worrisome marrow replacement or pathologic marrow enhancement is seen.The visualized spinal cord demonstrates normal signal intensity throughout. No pathologic intramedullary or leptomeningeal enhancement is seen. No epidural abnormalities are suspected.C2-3: Unremarkable. C3-4: Mild posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Mild bilateral foraminal narrowing. C4-5: Obliteration of the disc space. No significant spinal canal or foraminal stenosis. C5-6: Near obliteration of the disc space. No significant spinal canal or foraminal stenosis. C6-7: Ligamentum flavum thickening. Minimal posterior disc-osteophyte complex formation. Mild spinal canal stenosis. No significant foraminal narrowing. C7-T1: Unremarkable.

Output: 1.Evidence of anterior instrumented fusion from C4 through C6.2.Mild disc degeneration and ligamentum flavum thickening result in mild spinal canal stenosis at C6-7.3.Elsewhere, no high-grade spinal canal or foraminal narrowing is detected.


Instruction: Generate impression based on findings.

Input: The ventral epidural soft tissue thickening that was seen in the previous study along the L5 and S1 vertebral bodies is still visualized and slightly increased in size from 11.5 mm in previous study to approximately 13-14 mm currently. The immediate prior exam was obrained without contrast, but on comparison to the initial study, the enhancement is more uniform and solid. Only a single small locule of fluid is seen on the present exam within the enhancing tissue.There is a slight increase in the degree of retrolisthesis of L5 on S1 than the previous study and the L5-S1 disk space has progressively lost height. The L5 and S1 vertebral bodies are also more intensely enhancing with increased T2 signal abnormality. The spinal canal remains significantly narrowed by the epidural process at L5-S1 but similar to the prior exams.Ventral epidural thickening extends superiorly to the L4-L5 disc space with some enhancement within the L4-5 disk peripherally, but this finding is unchanged.There are irregularities of the anterior inferior vertebral body L3, related to degenerative changes and are stable since the previous study.No new disc space or vertebral body involvement.Inflammatory changes are seen in the anterior paraspinal soft tissue along L5 and S1, not significant changed since the previous study.There are mild to moderate degenerate changes seen, unchanged. The visualized spinal cord and conus are unremarkable.

Output: 1. Since previous studies the ventral epidural thickening along L5-S1 is slightly increased in size with progressive uniform pattern of enhancement and small persistence loculation of fluid. The spinal canal remains in this area significantly narrowed. The thickened soft tissue may represent expected granulation in the context of resolving epidural infection.2. Progressive destruction of the L5-S1 disc and progressive signal abnormalities and enhancement of the vertebral bodies L5 and S1. This possibly of ongoing or even progressive osteomyelitis cannot be excluded. It should be noted, though, that the changes seen on imaging in osteomyelitis can lag behind the clinical improvement by several months or more. Correlation with the clinical and laboratory parameters is recommended to interpret this finding.3. No evidence of infectious involvement of any new disc or vertebral body levels.


Instruction: Generate impression based on findings.

Input: Female, 65 years old, with imbalance and question of midline lesion seen on prior exam. The cerebellar fissures are more prominent than what is typically seen suggesting underlying parenchymal volume loss, similar to the prior examination. Pacchionian granulations are evident along the right occipital bone.A focus of encephalomalacia is evident within the posterior right cingulate gyrus, again appearing similar to the prior exam. No other parenchymal signal abnormality is seen. There is no evidence of edema or mass effect. The pattern of intracranial enhancement is within normal limits.No abnormal extra-axial collection or intracranial hemorrhage is seen. The ventricular system is normal in size and morphology.

Output: 1.Moderate cerebellar atrophy is seen, similar to that noted on the prior examination from 2007. This finding caries a broad differential diagnosis including sequelae of prior infection/inflammation, effect of certain medications and toxic exposures, and inherited syndromes.2.A small focus of chronic encephalomalacia is evident within the posterior right cingulate gyrus, also unchanged. The etiology for this finding is uncertain.3.No acute intracranial abnormality or other significant intracranial findings are seen. In particular, no evidence of any midline lesion is detected.


Instruction: Generate impression based on findings.

Input: 52 year old man with history of fluctuating LV dysfunction, hypertension and recent chest pain referred for cardiac MR with vasodilator stress perfusion imaging.MEDICATIONS: aspirin 81mg daily, atorvastatin 20mg daily, lasix 40mg daily, irbesartan 300mg daily First Pass PerfusionDuring hyperemia, no perfusion defects were present. Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable. Left VentricleThe left ventricle is mildly dilated with lower normal systolic function. The overall LV ejection fraction is 51%, the LV end diastolic volume index is 109 ml/m2 (normal range: 74+/-15), the LVEDV is 230 ml (normal range 142+/-34), the LV end systolic volume index is 53 ml/m2 (normal range 25+/-9), the LVESV is 116 ml (normal range 47+/-19), the LV mass index is 52 g/m2, and the LV mass is 113 g. There are no regional wall motion abnormalities present. Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 45%, the RV end diastolic volume index is 107 ml/m2 (normal range 82+/-16), the RVEDV is 235 ml (normal range 142+/-31), the RV end systolic volume index is 59 ml/m2 (normal range 31+/-9), and the RVESV is 128 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly dilated.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 no significant tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal variant brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. No perfusion defects/ "ischemia" present during hyperemia.2. No prior myocardial infarction. The entire myocardium is viable.3. Mildly dilated LV with lower normal systolic function (LVEF 51%) without evidence of underlying myocardial fibrosis, inflammation, or infiltration. 4. Normal RV size and mildly reduced systolic function (RVEF 45%).I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 79-year-old male with altered mental status on anticoagulation. Evaluate for intraventricular hemorrhage. Minimal hypoattenuation in the periventricular white matter is consistent with chronic small vessel ischemic disease.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: 1. No acute intracranial abnormality.2. Minimal small vessel ischemic disease in the periventricular white matter.


Instruction: Generate impression based on findings.

Input: Multiple sclerosis with paresthesias. There is no significant interval change in the scattered cerebral white matter T2 hyperintense lesions. Many of the lesions demonstrate T1 hypointensity, but no associated enhancement. The ventricles and sulci are unchanged in size and configuration, with focal volume loss assocated with a right postcentral gyrus lesion. There is no midline shift or herniation. The major cerebral flow voids are grossly intact. The skull and extracranial soft tissues are unchanged. There are bilateral maxillary sinus retention cysts.

Output: No significant interval change in the intracranial demyelinating lesions.


Instruction: Generate impression based on findings.

Input: A patient submitted outside study for review. Submitted for review are breast MRI (3/28/2016) performed at Porter Regional Hospital. For comparison,breast imaging studies 3/29/2016 and priors dating back to 11/13/2008 are available. MRI 3/28/2016:Scout, axial T1, axial T1 postcontrast, axial T2 and axial T2 fat sat images were submitted for evaluation. Images were uploaded into PACS and reviewed with DynaCAD software.There is moderate heterogeneous fibroglandular tissue and mild background parenchymal enhancement in both breasts.Left Breast: In the upper outer quadrant near the 1:00 position, posterior depth, there is a heterogeneously enhancing mass with irregular margins, areas of necrosis and central clip artifact, consistent with the biopsy-proven malignancy. This mass measures 2.0 x 1.9 x 2.9 cm (AP x TV x CC) and demonstrates mixed kinetics. Immediately anterior to the mass, there is a clip artifact seen at the site of known prior benign biopsy. There is no abnormal enhancement surrounding this second biopsy clip, however a hematoma measuring 2.7 x 2.1 x 1.2 cm (AP x TV x CC) is seen near this biopsy clip. No abnormal enhancement identified elsewhere in the left breast. Right Breast: There a few nonspecific foci of enhancement which are likely related to background parenchymal enhancement. Specifically, no suspicious enhancement is seen in the lateral right breast at the area of mammographically identified indeterminate calcification or elsewhere in the right breast. Axilla: No abnormal lymph nodes are identified in either axillary region.

Output: (1) Unifocal left breast 1:00 position, posterior depth biopsy-proven malignancy measuring 2.0 x 1.9 x 2.9 cm.(2) Small hematoma measuring up to 2.7 cm in the left breast 1:00 position, anterior depth, near the site of benign biopsy. Clip noted within the hematoma. No abnormal enhancement seen at that site. (3) No MR evidence of malignancy in the right breast. Stereotactic biopsy is still recommended for the indeterminate right lateral breast calcifications previously evaluated on diagnostic mammogram.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: 28-year-old male with right shoulder instability ROTATOR CUFF: The muscles and tendons of the rotator cuff are intact. Contrast is contained within the glenohumeral joint.SUPRASPINATUS OUTLET: The acromioclavicular joint is within normal limits.GLENOHUMERAL JOINT AND GLENOID LABRUM: Normal glenohumeral alignment. There is a small defect within the mid posterior labrum containing contrast consistent with a nondisplaced labral tear. There is flattening of the posterior humeral head with bone marrow edema consistent with contusion from prior dislocation. BICEPS TENDON: Normally situated within the bicipital groove. ADDITIONAL

Output: 1. Hill-Sachs deformity with associated marrow edema.2. Small nondisplaced tear of the mid posterior labrum.


Instruction: Generate impression based on findings.

Input: New diagnosis of cirrhosis, ascites, elevated LFTs ABDOMEN:LIVER, BILIARY TRACT: Micronodular liver contour, suggesting cirrhosis. Minimal intrahepatic biliary duct prominence. Dilated proximal common bile duct, measuring up to 11 mm, with gradual distal tapering seen. No focus of intraluminal signal void seen to suggest choledocholithiasis. Distended cystic duct. Findings suggestive of underlying benign stricture, no definite obstructing masslesion seen. However, evaluation suboptimal due to inability to perform dynamic postcontrast imaging. Suboptimal evaluation of liver parenchyma secondary to lack of dynamic postcontrast imaging, no suspicious liver lesion seen within these limitations.SPLEEN: No significant abnormality noted.PANCREAS: Mildly prominent pancreatic duct, measuring up her limits of normal, 3 mm. Mildly decreased intrinsic T1 signal pancreas, may be sequela of chronic pancreatitis.ADRENAL GLANDS: Bilateral diffusely enlarged adrenal glands, may reflect underlying adenomatous hyperplasia. KIDNEYS, URETERS: T2 hyperintense renal foci, most likely cysts. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: Flattened configuration of the IVC.BOWEL, MESENTERY: Thickened small bowel, likely reactive in the setting of ascites.BONES, SOFT TISSUES, OTHER: Small pleural effusions. Large ascites.

Output: 1. Minimal intrahepatic biliary duct prominence and dilated proximal common bile duct, measuring up to 11 mm, with gradual distal tapering seen. No focus of intraluminal signal void seen to suggest choledocholithiasis. These findings favor underlying benign stricture, no definite obstructing masslesion seen. However, evaluation suboptimal due to inability to perform dynamic postcontrast imaging. Per MRI technologist, patient was claustrophobic and unable to tolerate dynamic series acquisition. Correlation with patient's clinical history/laboratory values recommended and confirmation of benign findings with ERCP should be considered.2. Underdistended and thick walled sludge-containing gallbladder, nonspecific in setting of ascites. 3. Micronodular liver contour, suggesting cirrhosis.4. Mildly decreased intrinsic T1 signal pancreas, may be sequela of chronic pancreatitis.5. Paraaortic and retrocaval soft tissue thickening, may reflect small adenopathy or chronic scarring, further evaluation with CT imaging recommended. 6. Large ascites, small pleural effusions.


Instruction: Generate impression based on findings.

Input: 26-year-old with scoliosis and backache. Redemonstrated is pronounced thoracic kyphosis (apex at T7) as well as dextroscoliosis similar to prior. There is mild anterior wedging of the T6-T8 vertebral bodies with endplate Schmorl nodes which are unchanged. The remainder of the vertebral body heights are preserved. No thoracic vertebral malformation is present. The signal of the visualized cord is normal. There is a small disc protrusion with dorsal annular fissure at the T4-T5 level which mildly indents the right ventral cord, unchanged. Mild T5-T6 protrusion with minimal cord flattening, unchanged. Right T7-T8 protrusion which causes mild anterior hemicord flattening, unchanged. Mild T8-T9 bulge is unchanged. Dorsal thecal sac is widely patent. No evidence of cord signal abnormality. The paraspinal soft tissues are unremarkable.

Output: 1.Pronounced thoracic kyphosis and dextroscoliosis with apex at T7 similar to prior MRI.2.Unchanged mild anterior wedging of the T6-T8 vertebral bodies with endplate Schmorl nodes. No bone marrow edema.3.There is a small disc protrusion with dorsal annular fissure at the T4-T5 level which mildly indents the right ventral cord, unchanged.4.Mild T5-T6 protrusion with minimal cord flattening, unchanged. 5.Right T7-T8 protrusion which causes mild anterior hemicord flattening, unchanged.


Instruction: Generate impression based on findings.

Input: Reason: 6-month follow up of IPMNs History: none ABDOMEN:LIVER, BILIARY TRACT: Stable subcentimeter hemangioma in the right hepatic lobe (series 20/221). No biliary ductal dilation.SPLEEN: No significant abnormality noted.PANCREAS: Multiple unchanged small cystic foci throughout the pancreas, most compatible with IPMNs. Reference largest focus in the pancreatic body/tail measures up to 10 x 10 mm, previously 10 x 10 mm (series 17/22). Reference largest focus in the pancreatic head measures 6 x 6 mm, previously 6 x 6 mm (series 17/28). No suspicious enhancement or mural nodularity.Main pancreatic duct is normal in caliber, though there is stable mild relative dilation of the pancreatic duct in the tail upstream from the reference pancreatic body/tail lesion described above.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: Stable pancreatic cystic lesions most consistent with intraductal papillary mucinous neoplasms measuring up to 10 x 10 mm. No suspicious features. Continued follow-up is recommended.


Instruction: Generate impression based on findings.

Input: Clinical question: 61 yo with h/o CML, assess for CVA, assess for interval change in chloromaSigns and Symptoms: ataxia, aphasia. There are several punctate foci of diffusion restriction present in the left centrum semiovale and subcortical white matter. These are associated with T2 and FLAIR signal hyperintensity. They were not present on the 10/20/2008 examOn FLAIR imaging there is serpiginous signal hyperintensity present in the sulci of the left temporal lobe extending to the left inferior parietal lobule suggestive of signal hyperintensity within the left angular artery.The caliber of the left internal carotid artery appears smaller than its right-sided counterpart on on the postcontrast fat-sat axial T1 images as well as the post gadolinium SPGR T1 images.The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a burr hole present in the right parietal bone just lateral to the right some central lobule . There is a small focus of encephalomalacia present at the right some centrilobular anteriorly,There are punctate foci of signal loss on susceptibility weighted imaging in the right periventricular white matter with a larger focus of susceptibility effect in the right frontal lobe involving the anterior aspect of the subcentral lobule and the adjacent subcortical white matter. There are additional punctate foci of signal loss and susceptibility weighted imaging in the subcortical white matter of the right temporal lobe.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mucous retention cysts in the maxillary sinuses.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Findings are suspicious for punctate foci of acute cerebral infarction involving the left centrum semiovale which could intensely suggest vascular compromise in the left hemispheric territory.2.Findings raise the question of slow flow along the left angular artery (which could affect the left inferior parietal lobule). Please correlate with potential relevant clinical symptoms. If clinically appropriate a perfusion study and an the MRA of the brain or a CTA of the brain may be helpful to further evaluate this.3.The caliber of the left internal carotid artery appears smaller than its right-sided counterpart on some of the images. If clinically appropriate MRA of the neck or CTA of the neck may be of benefit to further evaluate this for possible carotid stenosis..4.Small focus of encephalomalacia and surrounding microhemorrhages in the adjacent right temporal lobe and frontal lobe white matter is probably related to the patient's prior history of chloroma and associated treatment.5.An alphanumeric page was with callback was sent to pager 1551 at the time of this dictation. Ashley called back at 9:15 am and the findings were discussed.


Instruction: Generate impression based on findings.

Input: 67-year-old female. Backache numbness in right leg and left shoulder pain. ROTATOR CUFF: Intermediate increased signal of the supraspinatus, infraspinatus, and subscapularis tendons consistent with tendinosis. No discrete tear is evident. Mild atrophy of the rotator cuff muscles diffusely, within normal limits for patient age.SUPRASPINATUS OUTLET: Large os acromiale. Severe acromioclavicular joint osteoarthritis with fluid in the joint and osteophytes. There is associated fluid in the subacromial/subdeltoid bursa and a tiny pocket of fluid above the AC joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: Severe osteoarthritis of the glenohumeral joint with marked joint space narrowing and subchondral cysts in the glenoid. There is fraying and irregular shape of the anterior labrum, likely representing degenerative tearing. Small cysts in the greater tuberosity of the humeral head, most likely related to aforementioned rotator cuff pathology.BICEPS TENDON: The biceps tendon is intact and in the bicipital groove. ADDITIONAL

Output: 1. Severe glenohumeral joint osteoarthritis. Severe acromioclavicular joint osteoarthritis with associated subdeltoid/subacromial bursitis.2. Rotator cuff tendinosis without evidence of a discrete tear.


Instruction: Generate impression based on findings.

Input: 56 year-old the female with lumbago There is straightening of the lumbar alignment. A intraosseous hemangioma is noted in the L1 vertebral body. There is no evidence of compression fracture or joint subluxation.T11-12, T12-L1: There is no central canal or neural foramen stenosis.L1-2, L2-3: There is no central canal or neural foramen stenosis.L3-4: There is diffuse disk bulge and bilateral mild facet degenerative change. There is no central canal or neural foramen stenosis. L4-5: Vacuum phenomena in L4-5 intervertebral disk. There is diffuse disk bulge. A large soft tissue density lesion is noted along the dorsal side of the L5 vertebral body, causing compression to the thecal sac and left side exiting nerve root. It is measuring 17 x 8 x 24mm. No associated bone destruction. On sagittal images, it is contiguous with the L4/5 intervertebral disk (image 31 series 80269). However, other etiology such as meningioma can not be completely excluded given relative poor soft tissue contrast on CT images. A MRI study may help further evaluate. L5-S1: there is no central canal or neural foramen compromise.

Output: 1. L4/5 canal soft tissue density lesion, most likely extruded disk with inferior migration. However, other etiology such as meningioma can not be completely excluded given relative poor soft tissue contrast on CT images. A MRI study may help further evaluate. It causes central canal stenosis and nerve root impingement on the left.2. Mild degenerative disk disease in the lumbar spine. See details above.


Instruction: Generate impression based on findings.

Input: Bilateral vocal cord paralysis. Assess for intracranial cause. History of T3N1M0 left tonsil squamous cell carcinoma that was treated with CRT completed in September 2007. Endoscopy showed immobile vocal cords in paramedian position, with marginal airway patency. Artifact significantly limits the 3-D T1 postcontrast acquisition. There is confluent and patchy T2/FLAIR hyperintensity involving the periventricular and deep cerebral white-matter which has increased slightly since the previous examination from 2011 and most probably reflect chronic microvascular ischemia. There is development of a 7 mm CSF intensity lesion involving the right para median central pons which is compatible with chronic infarct. Subtle T2-hyperintensity extends caudally from this presumed infarct into the medulla. Small foci of CSF intensity just lateral to the left frontal horn (including the head of the caudate nucleus) and the right atrium remain unchanged and likely represent chronic lacunar infarcts.There is no acute infarct, intracranial hemorrhage or mass. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are mildly expanded reflecting underlying mild brain volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. Subtle asymmetry between the petrous apices probably reflects asymmetric pneumatization, and fluid/mucosal thickening on the left.

Output: 1.Post contrast images are limited by artifact as described above.2.No evidence of intracranial hemorrhage, mass, or acute infarct. 3.Moderate changes of cerebral white-matter chronic microvascular ischemia and small chronic lacunar infarcts, as described above. A dedicated skull base MRI without and with contrast may provide better assessment of the cranial nerves, if clinically warranted.


Instruction: Generate impression based on findings.

Input: Ms. Trivunovic is a 72 year old female with recent biopsy-proven malignancy of the left upper outer breast. She presents for MR evaluation. There is scattered fibroglandular tissue in both breasts. Mild background parenchymal enhancement is noted bilaterally.LEFT BREAST: In the left upper outer breast, posterior depth, there is an irregular, peripherally enhancing mass identified measuring 3.6 x 4.0 x 3.8 cm (AP x ML x SI). Susceptibility artifact from biopsy marker clip is seen within the central aspect of this necrotic mass, compatible with biopsy-proven malignancy. Extending anteromedially from this index malignancy is an area of nonmass enhancement. Total span of abnormal enhancement (index malignancy + nonmass enhancement) measures approximately 6.2 cm in the oblique AP dimension.There is no additional abnormal enhancement seen in the left breast.RIGHT BREAST:There is no abnormal enhancement seen in the right breast.AXILLA:A biopsy marker clip is seen within a left axillary lymph node, which was proven to be a benign lymph node. No abnormal axillary lymph nodes are identified in the right axillary region.OTHERS:Note is made of a small hiatal hernia and subcentimeter hepatic cyst.

Output: (1) Biopsy-proven malignancy + additional nonmass enhancement extending anteromedially from the index malignancy measures approximately 6.2 cm in maximal dimension in the left breast. Clip is in appropriate position.(2) No MRI evidence of malignancy in the right breast. BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.