Instruction: Generate impression based on findings.

Input: Drowsy with slurred speech. Evaluate for stroke or structural abnormality. Examination is motion degraded. There is restricted diffusion in the right occipital lobe. There is no evidence of intracranial hemorrhage or mass effect. There are scattered punctate foci and confluent areas of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, consistent with chronic small vessel ischemic changes. There is volume loss which is prominent for patient's age. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable.

Output: 1. Acute infarct in the right occipital lobe.2. Mild chronic small vessel ischemic disease.3. Global parenchymal volume loss which appears mildly advanced for patient's age.Findings discussed with Dr. Reid on 3/28/2015 at 5:50 pm.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Chiari decompression: headache and adrenal insufficiency. Brain: There are postoperative findings related to Chiari decompression, with an unchanged configuration of the cerebellum, which remains low-lying. There appears to be partly impeded flow of cerebrospinal fluid across the neo-foramen magnum, both anteriorly and posteriorly. There is increased patchy T2 hyperintensity in the pons. 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. The major cerebral flow voids are intact. The orbits are grossly unremarkable. There are small bilateral ethmoid sinus retention cysts.Pituitary: There is unchanged appearance of the pituitary gland, which measures up to 10 mm in height. The infundibulum is intact and there is no mass effect upon the optic apparatus or cavernous sinuses.Cervical Spine: The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology.

Output: 1. Postoperative findings related to Chiari decompression, with an unchanged configuration of the cerebellum and apparent partly impeded flow of cerebrospinal fluid across the neo-foramen magnum. 2. Increased nonspecific patchy T2 hyperintensity in the pons. 3. Unchanged appearance of the pituitary gland, which measures up to 10 mm in height. 4. No evidence of syringomyelia.


Instruction: Generate impression based on findings.

Input: Female 52 years old with left lateral hip pain. Evaluate for gluteus medius tear. ACETABULAR LABRUM: No significant abnormality noted on this nonarthrogram exam.ARTICULAR CARTILAGE AND BONE: There is abnormal, somewhat linear increased T2 and decreased T1 signal within the left acetabular roof that may represent a bone contusion or occult fracture. Bone marrow signal intensity is otherwise within normal limits for patient's age. There are small acetabular osteophytes bilaterally indicating mild osteoarthritis. SOFT TISSUES: The hip musculature is intact, there is no evidence of gluteus muscular tear or avulsion. ADDITIONAL

Output: Abnormally increased T2 and decreased T1 signal in the roof the acetabulum may represent a bone contusion or occult fracture. If the patient's symptoms persists follow-up with CT is suggested.


Instruction: Generate impression based on findings.

Input: Male 27 years old Reason: Crohn's of SB and colon, s/p 4/2014 jejunal perforation with SB resection. Evaluate for recurrent Crohn's disease. History: Crohn's disease, loose bowel movements ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Scattered prominent mesenteric lymph nodes.BOWEL, MESENTERY: Multiple abnormal distal jejunal/proximal ileal bowel segments demonstrating asymmetric mural thickening, increased on the mesenteric side, and mural hyper enhancement most marked on delayed phases of imaging. There are two areas of luminal narrowing in the mid bowel which persists on multiple sequences (for example series 4, image 27 and 28; series 19, image 55 and 57). The proximal segment measures 4.3 cm. The more distal segment measures at least 7.9 cm. There is focal dilatation of the segment of bowel between these two stenoses. There is no associated diffusion restriction. The appearance suggests chronic stenotic disease. There is a short segment of mural hyperenhancement and luminal narrowing involving the terminal ileum (series 14, image 76). There is no associated diffusion restriction. The appearance is suggestive of chronic stenotic disease.There is early mural hyperenhancement involving the descending/sigmoid colon (series 19, image 53 through 57) which persists on delayed phases of imaging. The appearance is suggestive of stenotic disease with a degree of acute inflammation.Multiple areas of closely apposed small bowel loops in the mid abdomen raising the possibility of adhesions. No definite evidence of fistula.There is moderate fibrofatty proliferation, particularly in the region of the jejunum.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Areas of chronic stenosis predominantly involving the mid small bowel and terminal ileum. Acute on chronic inflammation of the descending/sigmoid colon.


Instruction: Generate impression based on findings.

Input: 58-year-old male with history of chronic osteomyelitis and medication noncompliance presents with altered mental status and elevated white blood cell count, evaluate for progression of chronic osteomyelitis. Again seen is ulceration of the soft tissues posterior and inferior to the calcaneus. The margin of the posterior calcaneus is less distinct on the current study compared to the prior compatible with stated history of osteomyelitis which was confirmed on MRI study dated 9/10/2015. Additionally, there has been development of a new pathologic fracture through the superior aspect of the posterior calcaneal tuberosity with approximately 1 cm anterosuperior displacement of the retracted fracture fragment. There is thickening of the adjacent Achilles tendon. The bones appear demineralized suggestive of osteopenia. Arterial calcifications are noted in the soft tissues.

Output: Soft tissue ulceration with osteomyelitis at the calcaneus and a new pathologic fracture through the superior aspect of the posterior calcaneal tuberosity.The above findings were communicated via telephone to Mark Belkin, MD at 09:13 AM on 11/03/2015.


Instruction: Generate impression based on findings.

Input: 5-year-old female status post VP shunt and subdural shunts. No evidence of acute intracranial abnormality, including no hemorrhage or midline shift.Interval removal of right frontal subdural catheter. Remaining bilateral subdural catheters and ventriculostomy catheter appear unchanged. Bilateral subdural collections are unchanged in size, with decrease in amount of gas in the left subdural collection.Mild interval decrease in size of common lateral ventricular chamber, which now measures approximately 6.7 cm in transverse dimension, previously measured 7.5 cm. Abnormal morphology of ventricles is unchanged.Stable displacement of cerebellar tonsils below foramen magnum by 9 mm, previously this measured 9 mm.Persistent abnormal morphology of brain parenchyma consistent with severe periventricular leukomalacia and areas of porencephaly in superior frontal and right occipital lobes, as described on recent MRI. Persistent abnormal morphology of the calvarium and burr holes noted. The visualized paranasal sinuses and mastoid air cells unremarkable.

Output: 1.No acute intracranial abnormality.2.Mild interval decrease in ventricular size.3.Interval removal of right subdural catheter, without significant change in bilateral subdural collections size.4.Stable Chiari I malformation.5.Stable abnormal morphology of brain parenchyma and calvarium.


Instruction: Generate impression based on findings.

Input: The risks (including, but not limited to, those of bleeding, infection, temporary nerve block, pain) and benefits of the procedure were explained to the patient, and informed written consent was obtained. A pre-procedural “time-out” form was completed.The patient was placed supine on the fluoroscopy table. The right 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, 15 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 lidocaine, 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: 28 seconds

Output: Successful fluoroscopic guided injection of the right hip.


Instruction: Generate impression based on findings.

Input: 61 year old male patient history of renal cell carcinoma status post nephrectomy. Evaluate for recurrence of RCC. ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesion.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Status post right nephrectomy. No evidence of tumor recurrence in the nephrectomy bed. A prominent left extrarenal pelvis and left upper pole simple renal cyst are unchanged.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: Status post right nephrectomy without evidence of tumor recurrence or metastatic disease in the abdomen.


Instruction: Generate impression based on findings.

Input: 19 year old male with prior transthoracic echo consistent with possible bicuspid valve presents for cardiac MRI to evaluate for aortic valve and aortic anatomy. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 61%, the LV end diastolic volume index is 88 ml/m2 (normal range: 74+/-15), the LVEDV is 158 ml (normal range 142+/-34), the LV end systolic volume index is 34 ml/m2 (normal range 25+/-9), the LVESV is 61 ml (normal range 47+/-19), the LV mass index is 48 g/m2 (normal range 85+/-15), and the LV mass is 80 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 56%, the RV end diastolic volume index is 95 ml/m2 (normal range 82+/-16), the RVEDV is 171 ml (normal range 142+/-31), the RV end systolic volume index is 42 ml/m2 (normal range 31+/-9), and the RVESV is 74 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve is trileaflet, opens widely, and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Aortic sinus of valsalva 33mAortic sino-tubular junction 23.6 mmAscending aorta 22.2 mmDescending aorta 19 mm.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac 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. The left ventricle is normal in size with normal systolic function [61%]2. The right ventricle is normal in size with normal systolic function {RVEF 56%] 3. Aortic valve has trileaflet anatomy. No aortic root or ascending aortic dilatation. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Reason: Evaluate for spinal cord pathology to explain diffuse hyperreflexia and some leg weakness History: Episodes of non rhythmic tremor; hyperreflexia, wheelchair MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a developmental venous anomaly present along the posterior aspect of the left temporal lobe and adjacent left inferior parietal lobule. This is associated with a ringlike low signal lesion left central T2 hyperintensity measuring 10 x 10 mm axial dimensions adjacent to the left lateral ventricle near the trigone.There is some abnormal signal associated with contrast enhancement along the subcutaneous and cutaneous tissues along the left for head. This associated with an underlying venous structure which appears to extend to the calvarium.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.Thoracic spine:The thoracic vertebral bodies are appropriate in the overall alignment and height. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots. There is a small right paramedian disk protrusion present at T7-T8 and to some multilevel disk desiccation.

Output: 1.There is a 10mm cavernous malformation present adjacent to the trigone of the left lateral ventricle which is associated with a developmental venous anomaly.2.There are mild degenerative changes present in the thoracic spine.3.No abnormal lesions are appreciated within the cervical or thoracic spinal cord. If there is clinical suspicion for leptomeningeal disease.4.There is a left for head lesion present. Please correlate with physical findings on clinical exam


Instruction: Generate impression based on findings.

Input: Female 53 years old Reason: knee arthritis? History: knee pain. Four views of the right knee show mild joint space narrowing of the medial compartment on weight bearing views and small tricompartmental osteophytes.Frontal views of the left knee demonstrate an incompletely cartilaginous lesion involving the proximal tibial diaphysis, which is better imaged on MRI from January of 2015.

Output: Mild osteoarthritis with slight medial joint space narrowing. Note is made of an incompletely imaged cartilaginous lesion within the left proximal tibial diaphysis, which is evaluated better on prior exams.


Instruction: Generate impression based on findings.

Input: New diagnosed prostate cancer. Biopsy dated 10/13/2014. Several foci of 3+3 disease in the right mid medial and lateral gland. 3+4 disease in the right apex lateral. 3+3 disease in late left base medial. The study is limited by patient motion and peristalsis. PELVIS:PROSTATE:Prostate Size: 3.6 x 5.3 x 4.4 cmPeripheral Zone: Approximately 4 mm T2-weighted hypointense foci (series 401/63) in the right and left apex without associated restricted diffusion or enhancement. 4 mm T2 weighted hypointense focus in the paramedial mid gland measuring 2 mm (series 401/86) without associated restricted diffusion or enhancement.Central Gland: Mild BPH changes.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: No evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small volume free fluid in the pelvis.

Output: 1.Punctate T2 weighted hypointense foci in the apices and paramedial mid gland may reflect sites of prostatic adenocarcinoma. No lesion measuring greater than 1 cm is identified. No evidence of extraprostatic extension.2.Trace pelvic ascites of uncertain etiology.


Instruction: Generate impression based on findings.

Input: 40 year-old female with trauma and neck pain. Evaluate for bleed. There is no evidence of intracranial hemorrhage or abnormal extra-axial fluid collections. There is asymmetric low attenuation within the left temporal lobe, which may represent contusion versus artifact from beam hardening. Repeat CT or MRI is recommended for further evaluation if clinically indicated.The remainder of the cerebral and cerebellar hemispheres and brain stem demonstrate normal morphology and attenuation. Ventricles are midline, with normal volume and morphology. The basilar cisterns are normal in appearance.The calvaria are intact, with no evidence of fracture. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Asymmetric low attenuation within the left temporal lobe, which may represent contusion versus beam hardening artifact. Repeat CT or MRI is recommended for further evaluation if clinically indicated.


Instruction: Generate impression based on findings.

Input: Atypical meningioma status post resection on 7/14/2015. There are postsurgical findings related to left frontal craniotomy for resection of a left frontal convexity meningioma. There is a small amount of scattered blood products and trace confluent T2 hyperintensity surrounding the resection cavity. There is mild dural thickening and enhancement overlying the resection cavity, as well as a few punctate foci of enhancement along the margins of the surgical cavity. There is minimal ex vacuo dilatation of the frontal horn of the left lateral ventricle. Otherwise, the ventricles and basal cisterns are normal in size and configuration. There is unchanged mild predominantly periventricular nonspecific cerebral white matter T2 hyperintensity. There is no midline shift or mass effect. There is no evidence of acute infarction. There is scattered fluid signal in the mastoid air cells, right greater than left. There are bilateral lens implants.

Output: Postoperative findings related to gross total left frontal meningioma resection with a few nonspecific punctate foci of enhancement along the margins of the surgical cavity.


Instruction: Generate impression based on findings.

Input: Known brain metastases. There are four supratentorial ring-enhancing mass lesions with surrounding vasogenic edema. The right parietal lobe tumor measures up to 42 mm, the right occipital lobe tumor measures up to 12 mm, the left temporal lobe tumor measures up to 8 mm, and the left superior frontal gyrus tumor measures up to 7 mm. There is susceptibility effect along the walls and layering within the right parietal lobe tumor. There is also a nonspecific punctate focus of enhancement in the right lateral pons. There is no evidence of acute infarct. There is effacement of the right lateral ventricle, but no evidence of hydrocephalus. There is trace midline shift to the left and perhaps minimal subfalcine herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Multiple brain metastases, the largest of which measures up to 42 mm in the right parietal lobe, with associated intratumor hemorrhage.


Instruction: Generate impression based on findings.

Input: Male; 56 years old. Reason: evaluate for interval change in dysplastic nodules History: hcv cirrhosis, high AFP ABDOMEN:LIVER, BILIARY TRACT: Nodular, cirrhotic changes. Increased reticular T2 signal with delayed enhancement, compatible with areas of confluent fibrosis. No ductal dilatation. Cholelithiasis. Mild ascites. Patent portal venous system. Scattered siderotic nodules are similar to prior study. Previously described segment 8 lesion is not discretely visualized. No enhancing lesion suspicious for hepatocellular carcinoma.SPLEEN: Splenomegaly, similar to prior study.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Esophageal varices, similar to prior study.BONES, SOFT TISSUES: Small fat-containing ventral hernia.OTHER: Moderate ascites, mildly increased since prior study.

Output: Cirrhosis with sequela of portal hypertension with mildly increased ascites. Multiple siderotic nodules. No enhancing lesion suspicious for hepatocellular carcinoma.


Instruction: Generate impression based on findings.

Input: 85 years Female (DOB: 8/1/1931)Reason: Evaluate for cervical spinal stenosis or neuroforaminal stenosis causing cervical radiculopathy. History: Left upper extremity radicular pain with neck painPROVIDER/ATTENDING NAME: DIONNE J. BLACKMAN DIONNE J. BLACKMAN Cervical spine:There is reversal of the normal cervical curvature centered at C3-4 and C4-5. There is osseous bridging across the C3 and C4 vertebral bodies. To a lesser degree there is some osseous bridging present at C4-5 and C5-6. There appears to be some loss of vertebral body height at C4.At C2-3 there is a diffuse disc bulge associated with thickening of the ligamentum flavum and effacement of spinal fluid ventral and posterior the spinal cord. This appears to have mildly progressed since 5/13/2014. There is associated hypertrophy of the right facet and encroachment of right-sided exiting nerve roots is also present on the prior examAt C3-4 there are large endplate osteophytes present and uncovertebral osteophytes associated with effacement of spinal fluid ventral to the spinal cord but not posterior the spinal cord. There is redemonstration of encroachment of left-sided exiting nerve roots related to endplate osteophytes and uncovertebral osteophytes this level.At C4-5 there is no significant compromise to the spinal canal. There are endplate uncovertebral osteophytes present this level with narrowing of the neural foramina bilaterallyAt C5-6 there is no significant compromise to the spinal canal. There are endplate uncovertebral osteophytes present this level with narrowing of the neural foramina bilaterally but worse on the right side.At C6-7 there is no significant compromise to the spinal canal. There are endplate uncovertebral osteophytes present this level with narrowing of the neural foramina bilaterally. There is some encroachment of the exiting nerve roots at this level. This appears to have been present on the prior exam as wellAt C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.There is redemonstration of multilevel degenerative changes in the cervical spine with findings compatible with mild to moderate spinal stenosis at C2-3 as well as neural foraminal encroachment of exiting nerve roots worse at C2-3 and C6-7 bilaterally as well as the left side at C3-4. The C2-3 stenosis appears to have progressed relative to the prior exam.2.There is reversal of the normal cervical curvature in the upper cervical spine with some loss of vertebral body height at C4 and some osseous bridging along some of the upper cervical spine vertebrae.


Instruction: Generate impression based on findings.

Input: Female, 24 years old, with sarcoma status post resection x2. Postoperative changes are again seen compatible with resection of a large right frontal intracranial and orbital tumor. An epidural collection along the craniotomy has become smaller. Encephalomalacia of the right frontal lobe appears relatively similar to the prior exam. Intracranially, there are scattered nonspecific foci of enhancement along the dura as well as epidural thickening and enhancement along the craniotomy favored to be postoperative in nature.Proptosis of the right globe has improved. A fluid collection previously seen within the superior right orbit has resolved. An enhancing nodule is present within the superior right orbital apex which measures approximately 18 x 12 x 12 mm. It is difficult to discern if this lesion was present on the prior examination. Scattered smaller nodules are also seen along the superior orbit including along the lateral and medial margins (see images 71 through 74, series 1002).Elsewhere no new intracranial or orbital enhancing lesions are seen. Scattered foci of cerebral white matter T2 hyperintensity are nonspecific. Apart from mild ex vacuo dilatation of the right frontal horn, the ventricular system remains within normal limits.

Output: Expected evolution of postoperative findings are seen compatible with resection of a prior large tumor involving both the right orbit and intracranial space. No definite residual or recurrent intracranial tumor is seen. However, a soft tissue nodule within the superior aspect of the right orbital apex is concerning for tumor. It is difficult to determine whether this lesion was present on the prior examination. Smaller nodules within the superior orbit are nonspecific but could also potentially represent tumor.


Instruction: Generate impression based on findings.

Input: History of cirrhosis presents for HCC screening. History of Crohn's disease. LUNG BASES: Gynecomastia.ABDOMEN:LIVER, BILIARY TRACT: Mild left lobe hypertrophy and contour nodularity compatible with history of cirrhosis. A small cyst is noted. No focal suspicious hepatic lesion. No biliary ductal dilatation. Partially contracted gallbladder. Trace perihepatic fluid.The portal vein is patent. A TIPS catheter obscures evaluation of the right hepatic vein.SPLEEN: The spleen is normal in size.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is chronic dilatation of left upper quadrant small bowel, appearing similar to the prior. Overall paucity of small bowel. These findings are compatible with history of Crohn's disease.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No suspicious liver lesion.


Instruction: Generate impression based on findings.

Input: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is a punctate focus of high T2 signal in the right frontal white matter, in the vicinity of the frontal horn. The brain parenchyma otherwise appears unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. The proximal portions of the bilateral trigeminal and facial nerves are intact. There is a persistent flattened appearance of the pituitary gland.

Output: 1. Nonspecific punctate focus of high T2 signal in the right frontal white matter, in the vicinity of the frontal horn. Otherwise, no evidence of intracranial hemorrhage, mass, or acute infarct. 2. Persistent flattened appearance of the pituitary gland, which may be due to atrophy.


Instruction: Generate impression based on findings.

Input: Male 22 years old Reason: s/p sacral removal History: decubitus ulcer Patient is status post surgical distal sacrum removal. A surgical drain is in place. No definite evidence of osteomyelitis, however there is continued clinical concern for osteomyelitis an MRI is recommended.

Output: Postsurgical changes of a distal sacrum removal.


Instruction: Generate impression based on findings.

Input: Left popliteal mass A complex predominantly cystic mass is noted within the posterolateral compartment of the leg lying below the fascial plane of the medial head of the gastrocnemius. There is mass effect upon the muscle itself but no direct invasion. The mass measures approximately 18 cm in the craniocaudal dimension and is heterogeneous in signal on both T1 and T2 sequences. The more superior aspect of the mass is heterogeneous in nature but contains a large T1 hyperintense component likely reflecting hemorrhagic contents. There is soft tissue enhancement both proximal and distal to the mass although there is no discrete nodular enhancement of the mass itself. The marrow signal of the tibia and fibula there is normal. The remaining muscles are normal in caliber and signal as well.

Output: Large complex hemorrhagic mass within the posterior lateral component of the leg. This could represent an old hematoma with other differentials including complex Baker's cyst and or discrete soft tissue mass are also possible but thought to be less likely.


Instruction: Generate impression based on findings.

Input: Headaches In comparison with the prior examination no evidence of any interval change in the size of the lateral ventricles which contain a right-sided ventricular catheter is noted. The fourth ventricle is not visualized and also remains similar to prior exam. Widening of the posterior fossa at the level from in magnum and low positioning of the cerebellar tonsils (left greater than right) is consistent with Chiari malformation. All these findings remain stable since prior exam. There are no prior MRI examination.

Output: Stable CT of brain since prior examination from 2007.


Instruction: Generate impression based on findings.

Input: Clinical question: Aberration of smell. Signs and symptoms: Dysosomia. Pre-post-enhanced brain MRI:No diffusion weighted abnormalities.The anatomic lung morphology as well as the signal intensity of brain parenchyma remains reading normal on all MRI sequences. There is also no detectable abnormal enhancement the brain parenchyma or leptomeninges detected. The cortical sulci, ventricular system, CSF and spaces and myelination the brain is unremarkable.The signal void of major intracranial arterial branches are identified.The signal intensity of the intracranial venous sinuses are within normal and with normal pattern of enhancement.Calvarium and soft tissues of the scalp are unremarkable and without abnormal enhancement.Unremarkable images through the orbits, paranasal sinuses and mastoid air cells without abnormal enhancement.

Output: Negative pre-and post enhanced brain MRI.


Instruction: Generate impression based on findings.

Input: Clinical question: L4 -- L5 disk disease? Signs and symptoms: Weakness dorsi flexion of great toe and ankle with LBP. Nonenhanced lumbar MRI:There is normal anatomical alignment the vertebral column however mild straightening of lordosis is noted which may be positional or pain related.Examination at T11 -- T12 through L2 -- L3 levels are unremarkable.L3 -- L4 demonstrate mild disk disease and loss of disk height/signal, mild bilateral ligamentum flavum hypertrophy and minimal facet disease. There is a short horizontal band of T2/T2 stir hyperintensity in the annulus of the disk in the midline consistent with an annular fissure (axial T2 series 701 image 12 and sagittal T2, T2 stir image 8. There is no spinal stenosis or neural foraminal compromise.L4 -- L5 demonstrate moderate disk disease with loss of T2 signal intensity and height. Mild bilateral ligamentum flavum and facet degenerative and hypertrophic changes are present. There is a large right-sided disk extrusion with significant mass effect on the thecal sac, significant right lateral recess compromise and mild central spinal stenosis. Patent neural foraminal bilaterally.L5 -- S1 demonstrate mild disk disease and loss of disk height, mild bilateral ligamentum flavum hypertrophy and minimal facet disease. There is a linear T2 hyperintensity in the annulus of the disk in the midline suggestive of annular fissure is present. There is no spinal stenosis, neural foraminal or lateral recess compromise.Perispinal soft tissues including bilateral kidneys are identified and without gross evidence of abnormality.

Output: 1.Large right lateral disk extrusion at L4 -- L5 with resultant significant right lateral recess compromise and mild central spinal stenosis.2.No spinal stenosis or neural foraminal compromise at any other level.3.Mild degenerative changes including annular fissures at L3 -- L4 and L5 -- S1 levels as detailed.4.Unremarkable exam at all other levels.


Instruction: Generate impression based on findings.

Input: Meningioma, WHO grade I, status post resection: 3 month follow up. There are postoperative findings related to right anterior cranial fossa extra-axial tumor resection via subfrontal osteotomy with removal of the anterior wall of the right frontal sinus with confluent enhancement in the right frontal bone resection bed and persistent trace nodular dural enhancement along the floor of the resection cavity. There is minimal high T2 signal and apparent mild volume loss in the right frontal lobe white matter adjacent to the resection cavity, which is consistent with encephalomalacia. There are scattered nonspecific foci of high T2 signal elsewhere in the cerebral white matter. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is a subcentimeter retention cyst in the left maxillary sinus.

Output: Evolution of postoperative findings related to right subfrontal osteotomy with persistent trace small enhancement along the floor of the resection bed, which may represent minimal residual meningioma, but otherwise with gross total tumor resection.


Instruction: Generate impression based on findings.

Input: 48 year old woman with recent URI and elevated troponins without significant coronary disease, referred for cardiac MR to evaluate for possible myocarditis. Left VentricleThe left ventricle is normal in size with hyperdynamic systolic function. The overall LV ejection fraction is 69%, the LV end diastolic volume index is 81 ml/m2 (normal range: 65+/-11), the LVEDV is 172 ml (normal range 109+/-23), the LV end systolic volume index is 25 ml/m2 (normal range 18+/-5), the LVESV is 53 ml (normal range 31+/-10), the LV mass index is 70 g/m2 (normal range 67+/-11), and the LV mass is 149 g (normal range 114+/-24). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. Her myocardial T2-times are within normal limits, as was her global relative enhancement ratio.The native T1 myocardial relaxation time is mildly elevated, with an overall ECV of 36% which is also mildly elevated. This suggest diffuse mild underlying interstitial fibrosis. There is no myocardial iron overload. Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 51%, the RV end diastolic volume index is 76 ml/m2 (normal range 69+/-14), the RVEDV is 123 ml (normal range 110+/-24), the RV end systolic volume index is 37 ml/m2 (normal range 22+/-8), and the RVESV is 79 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation which is eccentric. There is mild thickening of the leaflet tips.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is a small pericardial effusion.Extracardiac FindingsThere is hilar lymphadenopathy. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Normal size left ventricle with hyperdynamic systolic function (EF 69%).2. No There is no late gadolinium enhancement to suggest the presence of an underlying focal/ replacement fibrosing, infiltrative, or inflammatory process. The native T1 myocardial relaxation time and extra-cellular volume fraction (ECV) are both mildly elevated suggesting the presence of mild diffuse interstitial fibrosis. 3. Normal size right ventricle with normal systolic function (EF 51%).4. Mild eccentric mitral regurgitation. 5. Small pericardial effusion. 6. See extra-cardiac findings. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: History of liposarcoma. Evaluate sciatic nerve in size of the mass. PELVIS:UTERUS, ADNEXA: Displaced towards the left by the large right hemipelvis mass. Otherwise unremarkable.BLADDER: Displaced towards the left by the large right hemipelvis mass. Otherwise unremarkable.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Demonstrated again is the heterogeneous enhancing mass in the right hemipelvis measuring up to 11.5 x 7.8 cm (series 9/25) in maximal cross-section. The lesion has fat and solid enhancing components. In the craniocaudal dimension the lesion measures up to 13.7 cm (series 11/21). The mass displaces the pelvic organs to the left specifically the bladder, uterus and the mesorectal fascia. The fat planes between the mass and the right piriformis muscle, uterus and bladder are indistinct which may represent tumoral involvement.The mass partially encases the right common and external iliac artery and vein. The lesion engulfs the right internal iliac artery and vein and its branches. The lesion has a component extending through the sacrosciatic notch to the level of the ischial tuberosity and encases the sciatic nerve to this level as well as the more proximal sacral nerve roots. The tumor extends tracks along the sacral plexus to the level of the right L5 and S1 neuroforamen. The lesion abuts the right sacral ala without discrete osseous invasion. OTHER: No significant abnormality noted.

Output: 1.Right pelvic liposarcoma with extensive mass effect and soft tissue involvement as described.2.The lesion engulfs the sciatic nerve to the level of the ischial tuberosity and tracks along the sacral plexus to the L5 and S1 right neural foramen.


Instruction: Generate impression based on findings.

Input: Female; 23 years old. Reason: PSC, evaluate for cholangiocarcinoma ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesions.Scattered areas of mild intrahepatic biliary stricturing in the right hepatic lobe, including a tight focal stenosis of the right hepatic duct at Klatskin's point. Dominant biliary stricture is seen of the left hepatic duct at Klatskin's point. Axial images demonstrate mild biliary wall thickening of the left hepatic duct and proximal common hepatic duct, not there are no focal masses.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Biliary tree abnormalities as detailed above, compatible with primary sclerosing cholangitis, with dominant stricture of the left hepatic duct at Klatskin's point. No focal masses.


Instruction: Generate impression based on findings.

Input: Reason: r/o intracranial pathology History: papilledema No diffusion abnormality. No intracranial hemorrhage. No mass, mass effect, or midline shift. Gray-white matter differentiation is preserved. No extra-axial fluid collection. Flow-voids are present within major vessels indicating patency. Paranasal sinuses and mastoid air cells are clear. Visualized orbits are intact. Osseous structures are unremarkable.

Output: 1.Normal examination of the MRI brain. 2.Severe allergic reaction to the gadolinium contrast with vomiting, hypotension, tachycardia, and tongue and laryngeal swelling. RRT was called. Patient received 0.3 mg of subcutaneous epinephrine and 0.3 mg of IV epinephrine as well as racemic epinephrine. Breathing improved and patient returned to the room.


Instruction: Generate impression based on findings.

Input: Occlusion and stenosis of right vertebral artery [I65.01] / Dizziness and giddiness [R42] / Muscle weakness (generalized) [M62.81], Reason for Study: ^Reason: evaluate for stroke History: vertigo, L sided leg > arm weakness, gait instability, slurred speech Brain MRIMotion artifact degraded image quality.No evidence of acute ischemic or hemorrhagic lesion on the scan.Multiple scattered T2/flair high signal intensities on bilateral periventricular white matter indicate nonspecific small vessel ischemic disease. The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear. Bilateral lens signal is not seen indicating postoperative status with bilateral buphthalmos.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 significant arterial luminal stenosis. No intracranial arterial aneurysm is seen.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion on the scan.2. Minimal nonspecific small vessel ischemic disease.3. Normal brain MRA


Instruction: Generate impression based on findings.

Input: Left modified radical mastectomy in November 2007 for IDC, ER/PR negative, HER-2 positive, status post chemotherapy and radiation therapy presents for follow-up. Young age of the time of diagnosis.History of benign right breast biopsy revealing fibroadenoma. No current breast complaints. Status post left mastectomy. There is heterogeneous amount of fibroglandular tissue in the right breast.Moderate parenchymal enhancement is noted in the right breast.Several cysts are seen in the right breast, few of which are new from prior exams. Two benign stable masses are present at 12:00 position; laterally located mass measuring 10 x 12 mm, previously measured 13 x 12 mm and medially located mass measures 6 x 4 mm, previously measured 8 x 7 mm. A new cystic lesion identified in the right breast 7:00 position posterior depth measures 8 x 9 mm with corresponding T2 high signal intensity.No abnormal enhancement is seen in right breast or in the left mastectomy bed. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Thyroid toxicosis. Low TSH RIGHT LOBE MEASUREMENTS: 4.0 x 1.2 x 2.1 cmLEFT LOBE MEASUREMENTS: 5.5 x 1.9 x 2.5 cmISTHMUS MEASUREMENTS: 0.5 cmRIGHT LOBE: Numerous tiny mostly hypoechoic nodules in the right lobe with the largest measuring 0.4 x 0.4 x 0.3 cm. These are nonspecific due to small size.LEFT LOBE: Numerous hypoechoic and slightly complex nodules in the left lobe. These are also nonspecific due to small size. The largest measures 0.9 x 0.9 x 1.3 cm.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Multiple subcentimeter nodules which are too small to characterize. No dominant nodules.


Instruction: Generate impression based on findings.

Input: 57 years Male (DOB: 11/6/1958)Reason: h/o H\T\N cancer s/p chemoradiation History: R shoulder, biceps weaknessPROVIDER/ATTENDING NAME: DANIEL HARAF DANIEL HARAF The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There is mild disc desiccation present.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: There are minor degenerative changes present in the cervical spine without significant compromise to spinal canal or neural foramina.


Instruction: Generate impression based on findings.

Input: Reason: 47 year old female with known FNH, follow up imaging with Eovist for re-evaluation. Also, pt with right hepatic vein possible thrombus. follow up imaging for re-eval. History: FNH ABDOMEN:LIVER, BILIARY TRACT: The reference arterial enhancing lesion, with a central T2 hyperintense scar, within segment 5/6 of the liver measures 4.0 x 3.8 cm, previously 3.6 x 3.6 cm (image 51, series 100). This lesion is nearly isointense with the liver on all other sequences and demonstrates homogeneous restricted diffusion. The additional apparently enhancing reference lesion within segment 4B measures 1.7 x 1 .1 cm, previously 1.6 x 1.1 cm (image 53, series 100). Both of these lesions retain contrast on delayed post Eovist contrast enhanced sequences consistent with the stated history of FNH. The right hepatic vein is again noted to be narrowed and thrombosed with associated collateral vessels suggesting that this thrombosis is chronic.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No significant interval change in the reference hepatic lesions most compatible with focal nodular hyperplasia, with measurements provided above.2.Persistent chronic right hepatic vein thrombosis.


Instruction: Generate impression based on findings.

Input: Clinical question: History of left temporal/sphenoid meningioma status post XRT. Signs and symptoms: As above. Pre-and post-enhanced brain MRI:No diffusion weighted abnormalities.The examination redemonstrates an expansile enhancing mass arising from the left greater wing of the sphenoid consistent with a previous known meningioma. There is extension of tumor into the left anterior middle cranial fossa similar to prior exam and with a meniscal adjacent left anterior temporal lobe encephalomalacia/edema. The tumor extends into the apex of the left orbit with enhancement and subtle thickening of the left lateral rectus muscle and without convincing evidence of interval change.There is inferior extension of tumor into the left pterygopalatine fossa edema. Several measurements of tumor in various axis demonstrate no convincing evidence of change. The largest component of tumor measures 21.6-mm in transverse axis at the level of the skull base which is identical to prior exam. The left anterior middle cranial component the tumor measuring approximately 21 mm in length is also identical to prior study.Stable expected for chronic postoperative changes of left pterional craniotomy since prior exam. Similar to prior exam there are a few tiny foci of flair hyperintensity in the periventricular and subcortical white matter bilateral cerebral hemispheres which likely representing chronic small vessel ischemic strokes. Possibility of possible overlapping of postradiation change cannot be entirely excluded.There is no detectable or new foci of parenchymal signal abnormality or abnormal parenchymal/leptomeningeal enhancement.

Output: 1.No evidence of an acute or new finding since prior study.2.Stable left greater wing of the sphenoid meningioma in size and extent and pattern of enhancement since prior study. Tumor involves the left greater wing of the sphenoid, left anterior aspect of the middle cranial fossa, left orbital apex and left skull base and pterygopalatine fossa similar to prior exam.3.Findings suggestive of mild chronic nonhemorrhagic ischemic strokes.


Instruction: Generate impression based on findings.

Input: Recent CVA, hypertension and gait abnormality. The exam is somewhat limited due to motion configuration. There is no evidence of intracranial hemorrhage, mass, or acute infarct. Scattered punctate foci of abnormal T2 hyperintensity is seen in the periventricular and subcortical white matter consistent with minimal chronic small vessel ischemic changes. There is demonstration of empty sella. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is mild opacification of the left posterior ethmoid cells. There is left maxillary mucosal retention cyst or polyp. The orbits, skull and scalp soft tissues are grossly unremarkable.

Output: No evidence of acute intracranial hemorrhage, mass, or acute infarct. Mild chronic small vessel ischemic changes are present.


Instruction: Generate impression based on findings.

Input: Clinical question to be answered: Status post foramina magnum shunt revision 6 -- 60. Signs and symptoms: Headaches A catheter is noted entering the subarachnoid space from the level of foramina magnum the catheter extends to the right and is against the bone at the level of foramen magnum. On the first CT image there is suggestion of thickening of the epidural space with compromise of the transverse diameter of the thecal sac. Correlate with clinical findings and if warranted an MRI is recommended. In comparison to the prior exam there is reduction in the size of fourth ventricle. The above-mentioned catheter is not within the fourth ventricle.Images through supratentorial space demonstrate extensive parenchymal volume loss of right hemisphere with no interval change. There is no residual contrast within the subarachnoid space on the right as it was noted on the prior exam. No change in position of bilateral hemispheric catheters. No ventriculomegaly is detected.

Output: New catheter at the level of foramina magnum as detailed. Please see above comments.


Instruction: Generate impression based on findings.

Input: 64-year-old female with left-sided bloody nipple discharge found to have a focal asymmetry in the upper outer quadrant of right breast on recent mammogram with a negative ultrasound examination. There is scattered fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally, somewhat of a limitation. There are a few high T2 signal cysts scattered in each breast and a high T1 signal complicated cyst in the left central breast. Note is made of linear increased T1 signal abnormality in the retroareolar region of the left breast compatible with intraductal blood products. No periductal or intraductal enhancement or mass lesions are identified. The high T1 signal within the duct is seen on subtraction images due to slight motion. Note is made of bilateral subcentimeter benign morphology masses in the outer breast compatible with intramammary lymph nodes. No suspicious enhancement is seen in either breast, including at the site of right breast mammographic focal asymmetry. No abnormal lymph nodes are identified in either axillary region.

Output: T1 signal abnormality in the left retroareolar region compatible with intraductal blood products. No suspicious periductal or intraductal enhancement or mass lesions are identified.BIRADS: 2 - Benign finding.RECOMMENDATION: C - Clinical Correlation Needed.


Instruction: Generate impression based on findings.

Input: Ms. Catalano is a 55 year old female with a personal history of left breast lumpectomy in 1997 for mucinous carcinoma. Patient had a biopsy for enlarged right axillary lymph nodes in 2004 which showed benign reactive changes. She has no current breast complaints. There is heterogeneous amount of fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.Expected postoperative volume loss and scarring in the left breast is unchanged. Few scattered foci of enhancement are seen in the right breast, all of which appear stable when compared to prior examination. No new abnormal enhancement is seen in either breast. Multiple enlarged right axillary and subpectoral lymph nodes are stable. No new abnormal axillary lymph nodes are identified in either axillary region.

Output: Stable postsurgical changes of the left breast and stable right axillary/subpectoral lymph nodes. No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: The risks (including, but not limited to, those of bleeding, infection, allergic reaction, temporary nerve block, pain, and inability to access the joint) and benefits of the procedure were explained to the patient, and informed written consent was obtained. A pre-procedural “time-out” form was completed.The patient was placed supine on the fluoroscopy table. The right 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, 15 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: 27 seconds

Output: Successful MR arthrogram of the right hip.


Instruction: Generate impression based on findings.

Input: SMA presenting with concern for new seizures: new onset "drop attacks". There is no evidence of intracranial hemorrhage, mass, or infarct. The brain, brainstem, and cerebellum appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, mastoid air cells, and scalp soft tissues are grossly unremarkable. There is a small right maxillary sinus retention cyst.

Output: No evidence of seizure foci.


Instruction: Generate impression based on findings.

Input: Reason: prostate cancer History: prostate cancerBiopsy 10/19/2015: Gleason 6, right lateral base PELVIS:PROSTATE:Prostate Size: 5.3 x 3.8 x 4.8 cmPeripheral Zone: No significant abnormality.Central Gland: BPH nodules.Seminal Vesicles: No significant abnormality.Extracapsular Extension: No significant abnormality.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No suspicious lesions are identified.


Instruction: Generate impression based on findings.

Input: assess for cause of memory lossSigns and Symptoms: memory loss, complicated medical history including chemotherapy , NHL in 2001 The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of punctate foci of susceptibility weighted imaging signal loss located in the cerebellar hemispheres, brainstem , left thalamus, left basal ganglia, left frontal subcortical white matter and bilateral periventricular white matter.There is a punctate periventricular white matter lesion present which is high signal on T2 and FLAIR. It is located in the right frontal lobe. In isolation it is of little clinical significance.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 are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: There is a mild degree of punctate micro hemorrhages located in the cerebellar hemispheres, brainstem , left thalamus, left basal ganglia, left frontal subcortical white matter and bilateral periventricular white matter. The pattern is somewhat non-specific but could be related to prior radiation, chemotherapy or hypertension.


Instruction: Generate impression based on findings.

Input: Clinical question:syncope. Signs and symptoms: Syncope with altered mental status. Nonenhanced head CT:Examination demonstrate a well demarcated area of low attenuation in the left caudate and globus pallidus highly suspect that of an acute left basal ganglial infarct. There is no appreciable mass effect but this finding. Recommend follow-up with an MRI. There is no evidence of hemorrhage. Examination also demonstrate mild bilateral patchy areas of low attenuation of subcortical white matter highly suspected for small vessel ischemic disease of indeterminate age.Ventricular system and the CSF cisterns remain within normal.There is mild calcification and tortuosity of bilateral cavernous carotid.There is severe tortuosity and aneurysmal dilatation of the basilar artery (dolichoectatic basilar) representing atherosclerotic disease. Follow up with an MRA or a CTA is recommended.

Output: 1.Highly suspected acute nonhemorrhagic lacunar infarct of left caudate and globus pallidus. 2.Mild small vessel ischemic strokes of indeterminate age in the supratentorial brain parenchyma.3.Dolichoectatic basilar artery with calcification.4.Recommend follow-up with an MRI and MRA.


Instruction: Generate impression based on findings.

Input: There are no findings of diffusion restriction.There are no T2 and FLAIR abnormalities.There is soft tissue prominence that is noted in the midline in the nasopharynx which may represent lymphoid tissue hypertrophy, but discrete soft tissue mass or neoplasm cannot be excluded.Ventricular size is normal. There is no midline shift. No evidence of bleed, mass effect, or edema. There is a normal gray-white matter differentiation.Paranasal sinuses are normal. There are no osseous abnormalities.Flow void of the cerebral arteries and the visualized carotid arteries are within normal limits.

Output: 1.No restricted diffusion to suggest the presence of acute ischemia.2.There is soft tissue prominence that is noted in the midline in the nasopharynx which may represent lymphoid tissue hypertrophy, but discrete soft tissue mass or neoplasm cannot be excluded. Further evaluation is recommended.3.Dr. Christine Babcock was notified on 8/3/2015 at 9:45 AM.


Instruction: Generate impression based on findings.

Input: Headache. The exam is mildly limited by motion artifact. There is no evidence of intracranial hemorrhage or acute infarct. There appears to be a 4 mm wide T1 hyperintense nodule superior to the pituitary gland, which appears to be separate from the posterior pituitary. The brain parenchyma and pituitary gland otherwise appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. No evidence of acute intracranial hemorrhage, ventriculomegaly, sinus disease, or acute infarction.2. An apparent 4 mm wide T1 hyperintense nodule superior to the pituitary gland, which appears to be separate from the posterior pituitary may represent a Rathke cleft cyst. A dedicated pituitary MRI without and with contrast may be useful for further characterization.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Reason: history of breast cancer and multiple brain mets; received prior whole brain radiation, now s/p radiosurgery; please evaluate for response History: brain metastases. Prior surgery (2/2011), WBRT(3/2011) SRS (R cerebellum, R parietal on 6/4/15)(cerebellar vermis on6/8/15) Postoperative findings of left parieto-occipital craniotomy. Confluent T2 hyperintensity in the treatment bed appears similar to the prior exam. Diffuse volume loss as well as ex vacuo dilatation of the left occipital horn is unchanged.Enhancing nodule in the right parietal lobe is unchanged measuring 5 mm (1 101/56), previously 6 mm. Enhancing focus along the inferior surface of the right cerebellum is unchanged measuring 7 x 5 mm (1101/12). Two adjacent punctate enhancing foci in the right cerebellum are unchanged (1102/147). A 6 mm lesion in the cerebellar vermis is unchanged (1101/29). An enhancing focus in the right sylvian fissure seen on the coronal views likely represents a vessel. No new enhancing lesions are evident. There may be slightly increased T2 signal adjacent to the vermian lesion, however the remaining T2 signal is unchanged including periventricular, right parietal and left parietal hyperintensities.There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and paranasal sinuses are unremarkable. Enhancement within the right internal auditory canal is unchanged. A DVA with adjacent foci of susceptibility within the pons is unchanged.

Output: Multiple metastatic lesions are overall stable without evidence of new metastases.


Instruction: Generate impression based on findings.

Input: Secondary malignant neoplasm of brain [C79.31] / Malignant neoplasm of prostate [C61], Reason for Study: ^Reason: 67 yo M with metastatic prostate cancer, prior cavernous sinus XRT, now with worsening aphasia/apraxia and right lower extremity spasms. Interval progression of enhancing bi-convexity and left frontal dural based masses in terms of size and extent since prior scan. In addition, underlying brain edema in particular bilateral frontal and parietal lobes are shown. On gradient echo images, peripheral aspects of the left parietal dural lesion show some susceptibility artifacts, however, these lesions could represent compressed adjacent cortical veins but can also represent intralesional hemorrhages.Irregular diffuse bihemispheric dural enhancements indicate diffuse dural involvement of metastatic lesions.Previously shown left Meckel's cave and trigeminal ganglion lesions are not conspicuous on today's scan. Normal fatty marrow signal intensities of clivus, skull and upper cervical vertebral bodies appear to be replaced with low signal intensity lesions suggesting diffuse bone marrow metastasis. However, this could also represent early changes of radiation. There is no evidence of acute ischemic lesion.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear.Retention cyst in the right maxillary sinus.

Output: 1. Interval progression of bihemispheric dural metastatic lesions with underlying brain edema since prior scan.2. Interval decrease size of the left Meckel's cave and left trigeminal ganglion lesion since prior scan.


Instruction: Generate impression based on findings.

Input: 73-year-old male with elevated ferritin concern for primary hemachromatosis. Evaluate for hepatocellular carcinoma. ABDOMEN:LIVER, BILIARY TRACT: Hepatic parenchyma demonstrates mild dropout on the in phase relative to the out of phase sequences. No arterially enhancing or washing out hepatic lesions. No intra or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: There is a nonenhancing T2 hyperintense focus in the pancreatic body most compatible with a side branch IPMN.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral nonenhancing T2 hyperintense lesions compatible with cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Mild hepatic iron deposition. Otherwise, no suspicious hepatic lesion.2.Pancreatic body side branch IPMN.


Instruction: Generate impression based on findings.

Input: Shoulder pain ROTATOR CUFF: The supraspinatus, infraspinatus, and teres minor tendons and muscles are intact. There is increased signal intensity along the undersurface of the distal subscapularis tendon which may reflect mild undersurface fraying/tearing but this is equivocal. The subscapularis muscle is normal. SUPRASPINATUS OUTLET: The acromioclavicular joint is normal and there is no fluid within the subacromial subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Alignment of the glenohumeral joint is normal. The labrum appears normal. There is no joint effusion or frank osteoarthritic changes. There is a small cyst in the greater tuberosity which is not necessarily of any clinical significance.BICEPS TENDON: No significant abnormality noted.

Output: Increased signal intensity along the undersurface of the distal subscapularis which may reflect mild fraying but this is equivocal. There is otherwise no evidence of rotator cuff tear or other specific findings to account for the patient's pain.


Instruction: Generate impression based on findings.

Input: Male, 54 years old, with lancinating left facial pain that occurs 100 times per day waking the patient from sleep. Evaluate for structural lesions. Several scattered small discrete foci of T2 hyperintensity are seen within the periventricular and subcortical white matter, a nonspecific finding. More ill-defined T2 hyperintensity just above the right frontal horn is also seen.There is no restricted diffusion or significant parenchymal edema. No mass or mass effect is observed. No pathologic parenchymal or extra-axial enhancement is identified. There are no findings to suggest acute intracranial hemorrhage or any abnormal extra axial fluid collection. The ventricles are normal in size and morphology.Although not a dedicated cranial nerve examination, the trigeminal nerves as visualized show no gross abnormality. No abnormal enhancement is detected along the cisternal portions of the cranial nerves.Dedicated vascular imaging illustrates normal flow related signal within the anterior and posterior circulations. No significant vascular stenosis or occlusion is seen. No aneurysm or vascular malformation is identified. The left superior cerebellar artery and the left petrosal vein course in proximity to the cisternal left fifth cranial nerve, but this is not an atypical finding.

Output: 1.Scattered nonspecific white matter signal abnormality is seen. No acute intracranial abnormality is detected.2.Although not a dedicated cranial nerve examination, no specific abnormalities of the visualized portions of the left trigeminal nerve are seen.3.No significant vascular abnormalities are detected intracranially.


Instruction: Generate impression based on findings.

Input: Goiter. Enlarged thyroid. RIGHT LOBE MEASUREMENTS: 0.7 x 1.3 x 2.0 cmLEFT LOBE MEASUREMENTS: 5.5 by 0.9 x 2.0 cmISTHMUS MEASUREMENTS: 2.0 cmRIGHT LOBE: No significant abnormality noted.LEFT LOBE: No significant abnormality noted.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: A few small benign-appearing lymph nodes are noted on the left.OTHER: No significant abnormality noted.

Output: No evidence of thyroid goiter.


Instruction: Generate impression based on findings.

Input: 80 year woman with chest pain and non-sustained ventricular tachycardia referred to rule out ischemia and evaluate for myocardial damage.MEDICATIONS: aspirin, atorvastatin, azilisartan, carvedilol, torsemide. First Pass PerfusionDuring hyperemia, the patient has a mild, small perfusion defect in the mid septum and in the mid inferolateral wall. The overall ischemia score is 2 out of 32 and involves 6% of the myocardium.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 hypertrophied but normal in size and systolic function. The overall LV ejection fraction is 68%, the LV end diastolic volume index is 77 ml/m2 (normal range: 65+/-11), the LVEDV is 139 ml (normal range 109+/-23), the LV end systolic volume index is 24 ml/m2 (normal range 18+/-5), the LVESV is 44 ml (normal range 31+/-10), the LV mass index is 85 g/m2, and the LV mass is 153 g. There are no regional wall motion abnormalities present. Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 53%, the RV end diastolic volume index is 79 ml/m2 (normal range 69+/-14), the RVEDV is 143 ml (normal range 110+/-24), the RV end systolic volume index is 37 ml/m2 (normal range 22+/-8), and the RVESV is 67 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild to moderate mitral regurgitation. The posterior mitral valve is thickened and has restricted motion. Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease. A trace pericardial effusion is noted.Extracardiac FindingsThere is a large hiatal hernia with proximal dilation of the esophagus. Trace bilateral pleural effusions are present. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. There is a mild, small burden of the ischemia involving the mid inferolateral and mid septal walls.2. No prior myocardial infarction. The entire myocardium is viable.3. Mild left ventricular hypertrophy with normal LV size and systolic function (LVEF 68%) without evidence of underlying myocardial fibrosis, inflammation, or infiltration.4. Normal RV size and systolic function (RVEF 53%).5. Severe left atrial dilation.6. Mild to moderate mitral regurgitation with restricted motion of the posterior leaflet.7. Large hiatal hernia with proximal esophageal dilation. Of note, patient was significantly hypertensive (systolic BP 210mmHg) but improved somewhat after taking her medications (systolic BP 160mmHg).


Instruction: Generate impression based on findings.

Input: 53-year-old female with undifferentiated connective tissue disease, recurrent myalgia and weakness. Evaluate for myositis. Signal intensity of the musculature of the right thigh appears normal. We see no enhancement, edema, or frank atrophy. Intermediate signal intensity within the proximal femora and obturator rings bilaterally likely represents residual red marrow. On the large field-of-view coronal STIR sequence, there is edema-type signal in the left obturator internus muscle which is nonspecific.

Output: 1.Normal-appearing right thigh musculature.2.Mild edema-type signal of the left obturator internus muscle is nonspecific.


Instruction: Generate impression based on findings.

Input: ROTATOR CUFF: No significant abnormality noted. The intra-articular contrast does not communicate with the subacromial and subdeltoid bursae.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is a cleft in the posterior labrum that fills with contrast, best seen on the axial views . This most likely represents a posterior labral tear. ADDITIONAL

Output: Probable posterior labral tear


Instruction: Generate impression based on findings.

Input: Female 58 years old left hip pain ACETABULAR LABRUM: The acetabular labrum is torn anteriorly.ARTICULAR CARTILAGE AND BONE: Moderate to severe osteoarthritis affects the left hip with osteophyte formation and joint space narrowing. Generalized thinning of the articular cartilage with focal defects posteriorly (series 301, image 17 through 19)SOFT TISSUES: No significant abnormality noted. ADDITIONAL

Output: Osteoarthritis and degenerative changes including cartilage defects and labral tear as detailed above.


Instruction: Generate impression based on findings.

Input: Brain mapping for a stereotactic biopsy. Enhanced head CT:80 cc of Omnipaque 350 is administered for this exam.Stealth infused head CT with 1 mm slice thickness is obtained. Reformatted images are also acquired. This exam is performed with patient with stereotactic frame on head.Examination again demonstrates a large area of CSF collection in the right posterior frontal -- parietal region (likely result of prior partial lobectomy) with suggestion of subtle enhancing mass along its anterior edge similar to prior MRI exam from 4 -- 29 -- 2011. Extensive vasogenic edema in the left posterior frontal -- parietal is also again noted. There is an internal focus of enhancement measuring 14.9 x 19.5-mm in size.No evidence of an additional focus of enhancement.Stable size of ventricular system and no midline shift.

Output: Stereotactic Stealth pulse infused T2 of the brain demonstrate two foci of enhancement one along the anterior aspect of right posterior temporal -- parietal lobectomy and a second one in the right posterior parietal similar to prior MRI exam.


Instruction: Generate impression based on findings.

Input: Redemonstrated is complete absence of the corpus callosum with bilateral resultant colpocephaly and parallel orientation of the lateral ventricles. The lateral and third ventricles again dilated, with the atrium of the right lateral ventricle being the most dilated although slightly decreased from the last exam. The fourth ventricle remains normal in size. Myelination pattern appears appropriate for age on T2 images. There is no midline shift or mass effect or acute infarct. There is unchanged mild prominence of the intra-axial space along the inferior aspect of the posterior fossa probably representing a magna cisterna magna versus small cerebellar tonsils. There is an unchanged 8-mm subcutaneous soft tissue nodule probably representing a superficial lymph node in the right occipital region.

Output: Complete absence of the corpus callosum redemonstrated with third and lateral ventriculomegaly, most prominent in the right atrium. Compared to prior exam, there is slight decreased dilatation of right atrium with the remaining ventricles overall unchanged.


Instruction: Generate impression based on findings.

Input: Acute-onset numbness down both legs. The lumbar spine is in normal alignment, with a normal lumbar lordosis. The vertebral body heights are intact. The lower spinal cord and cauda equina have normal morphology and signal characteristics. A small disc protrusion at L5-S1 is unchanged, extending into the lateral recess, without significant associated neural foraminal or spinal canal narrowing. There is no significant neural foraminal or spinal canal stenosis at the other lumbar spine levels either. The vertebral bone marrow signal is unremarkable. There is a small left renal cyst. The uterus is heterogeneous with several low T2 signal nodules and blurring of the junctional zone, as well as complex adnexal lesions. There may also be a small amount of free fluid in the pelvis.

Output: 1. Unchanged small left paramedian disc protrusion at L5-S1, but no significant spinal canal or neural foraminal stenosis at any lumbar spine level. 2. Partially imaged uterine fibroids and/or adenomyosis and probable complex adnexal cysts. A pelvic ultrasound may be useful for further evaluation.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 68-year-old male with metastatic lung cancer to the brain There is a hypodense area in the right occipital lobe extending into the temporal lobe but most likely represents an acute ischemic event. This area is in the region of the hyperdense focus in the right occipital region representing metastatic disease with surrounding vasogenic edema. This can be further evaluated with an MRI. No evidence of midline shift, new hemorrhage, or significant 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: Hypodense area in the right occipital lobe extending into the temporal lobe in the region of the hyperdense metastatic focus. Appearance most likely represents an acute ischemic event and can be further evaluate with an MRI. No evidence for new hemorrhage or mass-effect.


Instruction: Generate impression based on findings.

Input: Reason: PLEASE INCLUDE POPLITEAL FOSSA leiomyosarcoma of left thigh s/p excision who has left thigh nodularity in the distal thigh and proximal left leg History: see above A skin marker is present over the posterior aspect of the left calf presumably corresponding to the patient's palpable area of concern. Immediately underlying this area is a focus of fat signal intensity on all pulse sequences within the medial head of the gastrocnemius, which likely represents focal fatty atrophy, although an intramuscular lipoma could also be considered. No enhancing mass lesions are identified. There is fatty atrophy of the imaged musculature of the left leg. There is skin thickening and enhancement in the surrounding area which is nonspecific but may reflect a cellulitis in the correct clinical context. There is nonspecific subcutaneous edema in the surrounding area. No bone marrow signal abnormality is identified. The imaged musculature of the left leg are otherwise unremarkable.

Output: No enhancing mass lesions are identified. Focal fatty atrophy of the medial head of the gastrocnemius. Skin thickening along the posterior aspect of the left leg may reflect a cellulitis or post therapy changes in the correct clinical context.


Instruction: Generate impression based on findings.

Input: Female 58 years old Reason: patient presents with left plantar foot ulcer; evaluate for osteomyelitis History: left foot ulcer There is ulceration of the soft tissues of the ball of the foot beneath the first metatarsophalangeal joint. Best seen on postcontrast sequences there is what appears to be a nonenhancing tract extending from the ulcer toward both hallux sesamoid bones. There is edema and enhancement of adjacent soft tissues indicating inflammation. There is abnormal signal and enhancement in the medial sesamoid bone consistent with osteomyelitis although we see no frank cortical destruction. There is also low signal intensity within the lateral sesamoid on T1 images which may also represent osteomyelitis although this is less likely as there is no edema seen on the STIR sequence. Signal intensities of the metatarsals is normal. Signal intensity of the first through third toe phalanges is normal. Evaluation of the fourth and fifth toes is limited due to metallic susceptibility artifact, likely from foreign body in the fifth toe.There is enhancement of the sheath of the flexor hallucis longus as it courses beneath the first proximal phalanx and first metatarsal indicating tenosynovitis with a tiny amount of fluid, particularly distally. Atrophy of the plantar muscles of the foot is noted. There is mild increased STIR signal in the muscles which may represent mild edema.

Output: 1.Ulceration of the base of the great toe with underlying inflammatory changes in the soft tissues.2.Signal abnormality of the hallux sesamoid bones, with changes compatible with osteomyelitis in the medial sesamoid bone, and findings equivocal for osteomyelitis in the lateral sesamoid bone.3.Tenosynovitis of the flexor hallucis longus tendon which could represent infection.


Instruction: Generate impression based on findings.

Input: Preterm newborn, gestational age 28 weeks with parenchymal hemorrhage. There is predominantly T1 and T2 hyperintense with surrounding circumferential effect in the bilateral medial parietal and occipital lobes, perhaps with slight extra-axial extension. There also appears to be T1 hyperintensity in the overlying superior sagittal sinus. There are small scattered areas of susceptibility effect in the bilateral temporal lobes, ventricular system, posterior fossa, and right caudothalamic groove. The degree of myelination is within expected limits accounting for prematurity. There is no evidence of acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral artery flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are grossly intact. There is mild dilatation of the left lacrimal sac.

Output: 1. Subacute hemorrhages within the bilateral medial parietal and occipital lobes, perhaps with slight extra-axial extension. Apparent T1 hyperintensity in the overlying superior sagittal sinus may represent artifact versus thrombus and dedicated vascular imaging is recommended for further evaluation. 2. Small scattered areas of chronic hemorrhage in the bilateral temporal lobes, ventricular system, posterior fossa, and right caudothalamic groove.3. Small left lacrimal sac mucocele.


Instruction: Generate impression based on findings.

Input: 40 year-old male with large left retroperitoneal mass per history discussed with Dr. Rogan additional or new catheter proof of current tumor is required prior to additional therapy. History of resection with this tumor representing either incomplete resectional possible recurrence. Written informed consent was obtained. Patient was prepped and draped in sterile fashion. Skin was anesthetized with lidocaine. A posterior approach was used to avoid bowel. Using coaxial technique two 18G core samples were obtained from the central portion of the mass just above iliac crest. Samples were placed in both in formalin and submitted for pathologic analysis.Procedure was complicated by shooting pain down the leg and groin during the biopsy which slowly subsided following the procedure. The patient was discharged to the floor in good condition with some mild persistent discomfort.

Output: Two 18-gauge core biopsies left retroperitoneal mass with CT guidance.


Instruction: Generate impression based on findings.

Input: 75 years, Female, Reason: hx of colorectal cancer History: hx of colorectal cancer. PELVIS: UTERUS, ADNEXA: Right sided Bartholin's gland cyst.BLADDER: No significant abnormality notedLYMPH NODES: No lymphadenopathy.BOWEL, MESENTERY: Postsurgical changes of prior colonic resection with artifact related to surgical clips seen on CT.Presacral edema and inflammatory changes are slightly decreased in the prior exam. There is also edema within the piriformis muscles bilaterally. There is diffuse circumferential rectal wall thickening, diffusion restriction and mucosal enhancement without a discrete enhancing mass.BONES, SOFT TISSUES: There are bilateral regions of linear decreased T1 and increased T2 signal within the sacrum which are most suggestive of sacral insufficiency fractures.OTHER: No significant abnormality noted

Output: 1.Abnormal signal within the sacrum bilaterally is suggestive of sacral insufficiency fractures.2.Diffuse circumferential rectal wall thickening, diffusion restriction and enhancement may suggest a nonspecific inflammatory process, however no discrete enhancing mass is identified.3.Presacral edema and inflammation may be related to posttreatment changes.


Instruction: Generate impression based on findings.

Input: Clinical question: Preop planning study. Signs and symptoms: Brain tumor. Preoperative planning study. Pre- and post enhanced Stealth brain MRI:Examination is performed utilizing surgical planning protocol and is not a true complete diagnostic study.Examination redemonstrates a partially solid and cystic enhancing intra-axial in the right anterior and mid temporal lobe. The well-demarcated superficial solid component of the mass demonstrate inhomogeneous enhancement and measuring maximum of 19 x 38 x 44 mm in size. Immediately medial to the solid component of the mass there is a large minimally septated cystic and nonenhancing component measuring at least at 47 x 40 mm in transaxial dimensions. There is resultant significant mass effect on the temporal horn of lateral ventricle. Posteriorly the mass reaches the trigone of right lateral ventricle and with bulge of the cystic component of tumor into the right trigone of the lateral ventricle which is best appreciated on prior noncontrast study. There is also subtle mass effect on the right lateral ventricle however without evaluation of midline and widely patent basal cisternsA punctate focus of enhancement noncontiguous with the tumor in the right temporal lobe (axial post enhanced series 501 image 103 coronal post enhanced series 701 image 20. Images through posterior fossa on post enhanced series demonstrate a multi branch vascular enhancement in the right cerebellum consistent with a developmental venous anomaly

Output: 1.Partially solid and enhancing with a large nonenhancing cystic component mass in the right anterior and mid temporal lobe as detailed above.2.There is bulge of the cystic component of tumor into the trigone of right lateral ventricle as detailed.3.Small developmental venous anomaly in the right cerebellum as detailed.4.A noncontiguous punctate focus of enhancement immediately anterior to the mass in the right anterior temporal lobe as mentioned.


Instruction: Generate impression based on findings.

Input: Female 25 years old Reason: Multiple right hip dislocation, history of hip arthroscopy, labral repair, evaluate labrum ACETABULAR LABRUM: Small cleft in the right superior labrum could be due to prior surgery, or perhaps a re-tear. The superior labrum is diminutive, likely post surgical in etiology.ARTICULAR CARTILAGE AND BONE: Bony prominence of the head neck junction of the right femoral head consistent with cam deformity.SOFT TISSUES: No significant abnormality noted. ADDITIONAL

Output: 1.Small cleft in the superior labrum which could be due to prior surgery or perhaps a re-tear.2.Diminutive superior labrum, likely postsurgical in etiology.3.Cam deformity of right femur.


Instruction: Generate impression based on findings.

Input: Clinical question: Rule out multiple infarcts. Signs and symptoms: Memory loss, left carotid stenosis. Nonenhanced brain MRI:Negative diffusion weighted series.Images through posterior fossa are unremarkable and in particular without evidence of stroke and stable since prior study.Images through the supratentorial space demonstrate scattered small foci of FLAIR hyperintensity in the periventricular white matter of bilateral cerebral hemispheres and to a lesser degree in bilateral subcortical white matter with no convincing evidence of any significant change since prior exam from 2011. Although nonspecific this appearance often represent microvascular ischemic changes of mild degree in this patient.There is mild prominence of supratentorial ventricular system with slight interval progression since prior exam from 2011.Cortical sulci and ventricular system as well as CSF spaces remain within normal for age.The signal void of major intracranial arterial branches are identified.Unremarkable calvarium, soft tissues of the scalp, paranasal sinuses, mastoid air cells/middle ear cavities and orbits.

Output: 1.No acute intracranial process.2.Findings suggestive of mild chronic nonhemorrhagic small vessel ischemic strokes without convincing evidence of interval progression since prior exam from 2011.3.Supratentorial ventriculomegaly with slight interval progression since prior study from 2011.


Instruction: Generate impression based on findings.

Input: History of cervical schwannoma, status post resection. Evaluate for recurrence. Surveillance imaging. Again seen are postsurgical changes of C1 and partial C2 for resection of right C2 nerve schwannoma. Again seen is an area of enhancement measuring approximately 9 x 7 mm at the level of the right C2 nerve root in the neural foramen and unchanged. The cervical vertebral bodies are appropriate in overall alignment and height. No abnormal signal in the cervical cord.No significant change in multilevel degenerative changes including mild to moderate spinal canal stenosis at the C6-C7 level related to left paracentral disc extrusion and ligamentum flavum thickening. There is mild flattening of the left ventral cord at this level without cord signal abnormality. Mild degree of spinal canal stenosis is also evident at C3-C4, C4-C5, and C5-C6 and also similar to prior. No abnormal cord signal. Neural foramina are not well evaluated but there is up to moderate neural foraminal stenoses at the right C4-C5 level, right worse than left C5-C6 level, and left worse than right C6-C7 level.

Output: 1.Postsurgical changes related to schwannoma involving the right C2 nerve root. There is no significant change in small focus of enhancement at the level of the right C2 nerve root in the neural foramen which may represent minimal residual tumor versus postsurgical change. No evidence of interval enlargement. No abnormal enhancement within the spinal canal to suggest intradural extension.2.No significant change in multilevel degenerative changes in the cervical spine with up to mild to moderate spinal canal stenosis at the C6-C7 level without cord signal abnormality. There is also moderate degree of neural foraminal stenoses at the right C4-C5 level, right worse than left C5-C6 level, and left worse than right C6-C7 level.


Instruction: Generate impression based on findings.

Input: Female 2 years old History: congenital cutaneous and subcutaneous lesion of the L buttock, possible plexiform neurofibroma BONE MARROW: No significant abnormality noted.SOFT TISSUES: Subtle cutaneous enhancement of the left buttock without soft tissue mass deep to the enhancement. Hyperintense cutaneous T2 signal along the left buttock. JOINTS: No significant abnormality noted.ADDITIONAL

Output: Cutaneous lesion of the left buttock without deep soft tissue mass.


Instruction: Generate impression based on findings.

Input: History of previous bilateral nipple sparing mastectomies for right DCIS and left DCIS found in the specimen with a very close margin now with new onset nipple discharge. A technical repeat exam is performed today due to signal loss on last week's study. Status post bilateral nipple sparing mastectomies with retropectoral silicone implants.Implants appear intact, with no evidence of rupture or herniation.There are two small high T2 signal areas in the right nipple that likely represent simple fluid within the nipples ducts. The enhancement of the nipples is symmetric and the degree of enhancement within each nipple is within normal limits. Note that the small amount of color shown on the color map is artifactual due to slight changes in nipple position throughout the dynamic sequence. No abnormal lymph nodes are identified in either axillary region.

Output: Expected post operative findings of nipple sparing mastectomies. No suspicious enhancing lesion is noted. BIRADS: 2 - Benign finding.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Signs and symptoms: left facial droop and altered mental status. Clinical question: Stroke? Non-enhanced CT brain:There is evidence of a large right temporal craniotomy with diffuse area of encephalomalacia in the right anterior and mid temporal. There is ex vacuo dilatation of right temporal horn and trigone of right lateral ventricle.Encephalomalacia of the right occipital lobe of unknown etiology. This finding could represent an old stroke or cytotoxic views the treated metastatic lesion. Clinical information on MRI of brain head was performed after this CT indicated patient's history of metastatic lung cancer.There is no evidence of intracranial hemorrhage, edema, mass-effect, midline shift or hydrocephalus.Calvarium demonstrate changes of right frontal temporal craniotomy and is otherwise unremarkable. Visualized mastoid air cells and middle ear cavities and paranasal sinuses are unremarkable.

Output: 1.No evidence of acute intracranial findings.2.Encephalomalacia of in the right temporal lobe under a craniotomy flap are present postoperative change.3.Right occipital encephalomalacia of unknown etiology. Please see above comments.4.Calvarium demonstrate right sided craniotomy and he is otherwise intact.5.Visualized paranasal sinuses, mastoid air cells are unremarkable.


Instruction: Generate impression based on findings.

Input: 39 year old female with right breast cancer and gene mutation, status post neoadjuvant chemotherapy and mastectomy. There is heterogeneous amount of fibroglandular tissue in the left breast.Mild parenchymal enhancement is noted in the left breast. The patient is status post right mastectomy. No abnormal enhancement is seen in either the left breast or right chest wall. No abnormal lymph nodes are identified in either axillary region. Right axillary post operative change including two adjacent simple fluid collections is noted.

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


Instruction: Generate impression based on findings.

Input: History of grade II oligodendroglioma status post resection, radiation and chemotherapy, now with progression. This is a limited MRI of the brain for presurgical planning. There are postoperative findings related to right craniotomy with confluent high T2 signal surrounding the resection cavity. In particular, there is interval enlargement of an ovoid T2 hyperintense lesion in the anterior right frontal lobe, which measures 24 x 16 mm, previously 15 x 9 mm. In addition, there is an associated cluster of ring enhancing components. The ventricles are unchanged in size and configuration. There are skin-based fiducial markers.

Output: Pre-treatment planning MRI for an enlarging right frontal lobe lesion.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.