Instruction: Generate impression based on findings.

Input: Evaluate for cortical tubers, some ependymal giant cell astrocytoma. Compared to MRI for -- 13 -- 07. 2-year-old male with tuberous sclerosis. Pre-and post infusion CT of brain:Small area of calcific density at the level of left foramina of Monro several enhancement is noted. This lesion measures approximately 4.5-mm times 4 1/2 mm in transaxial dimension. This finding cannot be properly compared with prior MRI due to technique difference and pattern of enhancement as well as a slice thickness. The lesion however appears grossly stable.A heavily calcified lesion in the subependymal lining of the left lateral ventricle at the level of the trigone is consistent with a calcified tuber with no appreciable enhancement due to is heavy calcification. This lesion appeared as an area of low signal intensity on T2-weighted images of MRI of brain and measured approximately 8 mm times 6-mm in transaxial dimension. On the current CT examination this lesion measures 7.6 mm x 8 0.1-mm. multiple additional small punctate calcific lesions of the subependymal lining of the lateral ventricles are also present with no enhancing component. The A. minimally cortical based calcific tumor in the right frontal lobe is also present. This lesion demonstrates no definitive enhancement the overall appearance of this lesion is similar to what was noted on prior MRI examination. 20 cc of Omnipaque was utilized for the above study.

Output: Although comparison to the prior MRI is not accurate due to difference in technique, the overall appearance of patient's calcific tubers in the left ventricle as well as the cortex of the right frontal lobe remain essentially stable.


Instruction: Generate impression based on findings.

Input: Diffuse mucocutaneous hemangiomas and possible involvement of the liver requiring further evaluation. Brain: There are several scattered subcentimeter enhancing nodular lesions in the scalp and face. There are also several subcentimeter enhancing lesions with susceptibility effect in the bilateral cerebellar hemispheres. There is no evidence of acute infarct. The supratentorial brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact, without evidence of steno-occlusive lesions, vascular malformations, or aneurysms. The orbits, skull, paranasal sinuses, and mastoid air cells are grossly unremarkable.Neck: There are several scattered subcentimeter enhancing nodular lesions in the neck. There is no evidence of mass lesions or significant cervical lymphadenopathy. The thyroid and major salivary glands are unremarkable. The osseous structures appear to be intact.

Output: 1. Several scattered subcentimeter nodular lesions in the skin of the scalp, face, and neck likely correspond to the reported diffuse mucocutaneous hemangiomas. 2. Several subcentimeter posterior fossa lesions may represent metastases from the probable liver hemangioendotheliomas or a spontaneous manifestation of diffuse hemangiomatosis.3. No evidence of deep neck space tumors.


Instruction: Generate impression based on findings.

Input: Reason: known large sacral decubitus ulcer, arrived with fever and AMS, r/o OM History: see above There is soft tissue irregularity along the posterior aspect of the coccyx consistent with the stated history of ulceration. The ulceration extends anteriorly to the level of the coccyx. There is increased signal abnormality within the coccyx on fluid sensitive sequences without decrease signal abnormality on T1-weighted images. These findings are most consistent with a reactive osteitis. There is no convincing evidence of osteomyelitis. The remainder of the bone marrow signal is within normal limits. There are foci of signal void within the subcutaneous tissue along the left gluteal crease and left perianal region suspicious for subcutaneous gas density/sinus tract formation. There is apparent extension of increased signal abnormality/inflammation from the level of the ulceration into the presacral space and left perianal area. There is diffuse subcutaneous edema about the pelvis most pronounced posteriorly, which is nonspecific. Some of this edema becomes more confluent, posteriorly, however, there is no encapsulated fluid collection to suggest abscess formation. No enhancing mass lesions are identified. There is increased signal abnormality within the gluteal musculature bilaterally and adductor musculature which is nonspecific, but may represent a myositis. There is a small amount of fluid within both hips, left greater than right, without evidence of a large effusion. There is a small amount of fluid in the right peritrochanteric region which may represent trochanteric bursitis. There is a Foley catheter in place.

Output: 1. Soft tissue ulceration with extension anteriorly to involve the perianal and presacral space with associated inflammatory changes. 2. Reactive osteitis of the coccyx. No convincing evidence of osteomyelitis.3. Findings indicating a right trochanteric bursitis.4. Nonspecific inflammatory change within the subcutaneous tissue and gluteal musculature as described above. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Male, 87 years old, with history of a right cavernous sinus lesion and progressive dysfunction of cranial nerves III, V, VI, and VII. Since the prior examination, progression of the previously demonstrated enhancing lesion centered on the right cavernous sinus is seen. The cavernous sinus and Meckel's cave components of the lesion have become notably bulkier. In addition, the lesion appears now to extend medially, encasing but not yet occluding the right ICA, and invading the sella. New marrow replacement within the right aspect of the clivus may also reflect tumor invasion. New enhancing tissue is also evident within the right sphenoid sinus.Abnormal enhancing tissue at the level of the right orbital apex is unchanged. Enhancement within the right pterygopalatine fossa has progressed. Enhancement and thickening of V2 at the foramen rotundum and V3 at the foramen ovale appear relatively similar to prior.The component of the lesion centered on the right cisternal trigeminal nerve has significantly progressed. There is now a rim-enhancing soft tissue lesion at this location which appears to grow into the pons and extends inferiorly along the ventral surface almost to the level of the medulla. There is significant associated pontine and right middle cerebellar peduncle edema. From this lesion, new dural thickening and enhancement extends into the right IAC. Enhancement at the right geniculate ganglion and greater petrosal nerve appear similar to prior.No areas of diffusion restriction are seen within the brain. Numerous scattered small foci of FLAIR hyperintensity within the cerebral hemispheres are nonspecific and unchanged. No evidence of acute intracranial hemorrhage or any abnormal extra axial fluid collection is seen. The ventricles and sulci are mildly prominent compatible with parenchymal volume loss.

Output: Interval progression of the enhancing infiltrative lesion centered on the right cavernous sinus is seen. The cavernous sinus component of the lesion has become notably bulkier with local extension into the sella, the right sphenoid sinus and perhaps into the bone of the clivus. The lesion has also progressed along the cisternal right trigeminal nerve with the development of rim-enhancing tissue which invades the pons and induces significant edema.The differential diagnosis remains broad and would include infiltrative malignancy such as lymphoma or perineural spread from a head and neck primary. Alternately, this could represent malignant degeneration of a peripheral nerve sheath tumor, a higher grade meningioma, or perhaps a hemangiopericytoma. The possibility of a nonneoplastic granulomatous or inflammatory condition is not excluded but considered less likely.


Instruction: Generate impression based on findings.

Input: Right parietal ischemic stroke and a 60-year-old female. Images through posterior fossa demonstrates a focal area of low attenuation in the right aspect of pons with a small calcification. This is believed to represent an old lacunar infarct and dystrophic calcification. This finding was present on the prior exam and demonstrates no definitive interval change. To exclude other pathologies at this location an MRI exam is recommended.Images through the supratentorial brain parenchyma demonstrate no definitive evidence of stroke, hemorrhage, mass-effect or midline shift. A very subtle questionable lucency however overlapping the cortex of the operculum of the right parietal lobe is suspected on axial image 14 which was not present on the prior study. Further dilation with an MRI is recommended. This finding may represent a very small area of new cortical stroke.

Output: 1.Likely old lacunar infarct of the pons with calcification.2.Only suspect small lucency involving the cortex of the proximal right frontal lobe.3.Both these findings can be better evaluated with an MRI exam.


Instruction: Generate impression based on findings.

Input: Female, 20 years old. History of lateral meniscal tear s/p repair in June. Recent injury with decreased extension. MENISCI: There is a complex tear of the lateral meniscus predominantly involving the anterior horn and anterior root, with abnormal signal and disruption at the junction of the body and anterior horn. Horizontally oriented signal abnormality is noted in the body of the lateral meniscus. The posterior horn also has an abnormal rounded configuration, likely reflecting re-tearing. These findings appear progressed from the prior study. The medial meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is mild diffuse articular cartilage loss of the lateral femoral condyle. There is a full-thickness articular cartilage defect posteriorly along the lateral tibial plateau just anterior to the meniscal remnant. There is generalized thinning of the patellar cartilage, without focal defect identified. Bone marrow signal is normal.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1.Complex tear of the lateral meniscus, greater than seen on the prior study, compatible with re-tearing.2.Full-thickness articular cartilage defect posteriorly along the lateral tibial plateau


Instruction: Generate impression based on findings.

Input: Male 47 years old Reason: 47 with history of recurrent acute pancreatitis, MRI with gadolinium to rule out tumor, MRCP with secretin to r/o PD stricture and fluid collection History: history of steatorrhea, abdominal pain, and acute pancreatitis ABDOMEN:LIVER, BILIARY TRACT: Diffuse hepatic steatosis. No focal hepatic lesion. No intra-or extrahepatic duct dilatation.SPLEEN: No significant abnormality noted.PANCREAS: The pancreas is severely atrophic, in particular the body and tail where there is associated loss of normal intrinsic T1 hyperintense signal. There is blunted physiologic response to secretin consistent with severe pancreatic atrophy. There is no focal pancreatic lesion evident. Conventional pancreatic ductal anatomy and normal duct caliber. 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.

Output: 1.The pancreas demonstrates blunted physiologic response to secretin consistent with severe pancreatic atrophy.2.Diffuse hepatic steatosis.


Instruction: Generate impression based on findings.

Input: Metastatic melanoma. Neck CT:Again seen is soft tissue mass in the right nasopharynx which measures 24 mm in largest dimension on coronal images (series 80564, image 54) compared to prior measurement of 19 mm on prior study (series 80324, image 46). On axial plane, it measures 19 x 17 mm (series 6, image 34) compared to prior measurement of 17 x 13 mm (series 4, image 18). There is no lymphadenopathy of pathological size.As seen before there is a left sided 6 -mm nodule in the left dorsal subcutaneous fat at level of C3 showing no significant interval change in size or appearance.There are enhancing lesions in the right cerebral hemisphere. These lesions were also present on prior MRI brain of 2/23/2011.There are degenerative changes in the cervical spine. No definite bone metastasis is identified in the cervical spine.

Output: 1. Slight increased size of right nasopharynx soft tissue lesion.2. Brain lesions partially visualized. Please refer to dedicated brain study.


Instruction: Generate impression based on findings.

Input: Unspecified foreign body in respiratory tract, part unspecified causing other injury, initial encounter [T17.908A], Reason for Study: ^Reason: Clinical concern for aspiration for unknown reason, assess for prior CVA History: aspiration There is no evidence of acute ischemic lesion on the scan.Multifocal scattered susceptibility lesions without associated with surrounding edema or mass effect on both supra and infratentorial brain parenchyma indicate chronic petechial hemorrhage or calcification.Scattered FLAIR/T2 high signal intensity lesions on bilateral periventricular white matter and centrum semiovale are nonspecific, most likely represent 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 mastoid air cells are clear. Bilateral maxillary sinuses appear to be small with the minimal cortical thickening.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. Minimal nonspecific small vessel ischemic disease.3. Multifocal susceptibility lesions are nonspecific, diagnostic possibilities include multiple parenchymal chronic hemorrhage or calcification.


Instruction: Generate impression based on findings.

Input: Diagnosis: Heart transplant status Heart transplant statusClinical question: s/p OHT now w/ delirium and confusionSigns and Symptoms: delirium and confusionComments: With Gadolinium please | The CSF spaces are appropriate for the patient's stated age with no midline shift. There are no foci of diffusion restriction identified. There are small foci of T2 shine through however.On susceptibility imaging there are multiple punctate foci of hypointensity scattered throughout the subcortical white matter of the supratentorial brain as well as in the cerebellar hemispheres. Additionally there is more patchy like gyriform susceptibility effect along the right middle temporal gyrus along its posterior aspect which is associated with loss of volume and T2 and FLAIR signal hyperintensity compatible with encephalomalacia.Foci of encephalomalacia are present in the right middle frontal gyrus and the right middle temporal gyrus. There are T2 and FLAIR hyperintense subcentimeter foci present along the gray matter adjacent to the left postcentral sulcus, and scattered in the left parietal lobe, right parietal lobe and in the frontal lobes.Several punctate foci of the T2 and FLAIR signal hyperintensity are present in the left thalamus as well as the cerebellar hemispheres.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.There are multiple small foci of either encephalomalacia and subcentimeter cortically based lesions which are suspicious for prior foci of infarction in multiple locations. The largest ones are in the right middle temporal gyrus in the right middle frontal gyrus.2.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. They're most likely vascular related.3.Findings suggest prior lacunar infarct involving the left thalamus. Additionally some lacunar infarcts are present in the cerebellar hemispheres.4.There are multiple microhemorrhages scattered in the subcortical white matter which are nonspecific.5.There is no evidence for acute ischemic cerebral infarction at this time.


Instruction: Generate impression based on findings.

Input: 53-year-old female with history of hepatic hemangioma and adrenal adenoma who presents for follow-up evaluation. ABDOMEN:LIVER, BILIARY TRACT: Stable T2 hyperintense lesion in the right hepatic lobe measuring 6.5 x 5.0 cm (series 9, image 41) is unchanged. There is peripheral, discontinuous nodular enhancement with incomplete centripetal fill in over time compatible with joint hemangioma.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Stable left adrenal gland nodule.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.Stable right hepatic lobe giant hemangioma.2.Stable left adrenal adenoma.


Instruction: Generate impression based on findings.

Input: Subdural hematomas. 73-year-old female Patient is status-post of left and right craniotomies.There is redemonstration of bilateral subdural hematomas which have decreased in density since previous exam.. These are unchanged in thickness since the prior exam measuring approximately 9 mm in the right and 13 mm on the left. There is an intracranial pressure monitor present.Along the left inferior frontal gyrus and anterior temporal lobe. There is hypodensity present. This was also present on the prior CT exam. It is suspicious for infarction.Some blood products are present in the occipital horn of the right lateral ventricle. The temporal horns the lateral ventricles are mildly dilated. The sulci are not effaced. In general, the lateral ventricles are larger on the current exam versus the prior CT exam. They are similar in size to the recent MRI exam of 12/30/09.There is opacification of the mastoid air cells and middle ears status-post intubation.There is mucosal thickening along the sphenoid sinus and ethmoid air cells.Opacification of a mastoid air cells is and partial opacification of paranasal sinuses is associated with intubation. Atherosclerotic calcifications of a moderate to marked degree are present in the distal internal carotid arteries.

Output: 1.The bilateral subdural hematomas have gradually decreased in size since exams dating back to 12/16/09.2.The lateral ventricles are mildly dilated, as described above.3.Findings are compatible with a foci of infarction in the left frontal lobe and temporal lobe.


Instruction: Generate impression based on findings.

Input: Memory problems. There is no evidence of intracranial hemorrhage, mass, or acute infarct. Aside from minimal nonspecific bilateral periventricular T2 hyperintensity diffusely, the signal characteristics of the brain, brainstem, cerebellum, and pituitary appear to be unremarkable. There is no abnormal intracranial enhancement. There is mild diffuse cerebral volume loss, which appears to be most pronounced in the bilateral medial temporal lobes. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull and scalp soft tissues are grossly unremarkable. There is a left lens and scleral buckle. There is mild bilateral anterior ethmoid sinus mucosal thickening. There is left mastoid fluid.

Output: 1. Mild diffuse cerebral volume loss, which appears to be most pronounced in the bilateral medial temporal lobes, may represent Alzheimer dementia. Otherwise, no evidence of intracranial hemorrhage, mass, or acute infarct. 2. Nonspecific left mastoid effusion.


Instruction: Generate impression based on findings.

Input: Male; 57 years old. Reason: assess extent of known prostate cancer History: PSA >100; 4+3 disease in biopsy but CT and bone scan reportedly negative PELVIS:PROSTATE:Prostate Size: 3.8 x 4.4 x 3.9-cm.Peripheral Zone: Multifocal, extensive prostate cancer extending from the base bilaterally through the mid gland, right greater than left, with sparing at the left apex. Central Gland: Heterogeneous.Seminal Vesicles: Bilateral seminal gland invasion (series 401/66).Extracapsular Extension: Extracapsular extension is seen at the right lateral mid gland.BLADDER: No significant abnormality noted.LYMPH NODES: Prominent, nonspecific right iliac chain lymph node measures 18 x 8 mm (series 1802/88).BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Multifocal, diffuse prostate cancer with bilateral seminal gland invasion and mild right extracapsular extension.


Instruction: Generate impression based on findings.

Input: Transient vision loss. MRI Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is a right cerebellar hemisphere developmental venous anomaly. The brain parenchyma otherwise appears 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, and paranasal sinuses are grossly unremarkable. There is a well-circumscribed mass in the right parotid gland that measures up to 18 mm.MRA Brain: There is apparent focal stenosis of the left vertebral artery just distal to the origin of the left PICA. The right vertebral artery is diffusely hypoplastic. Otherwise, there is no evidence of significant other cerebral steno-occlusive lesions or aneurysms.MRA Neck: The right vertebral artery is diffusely hypoplastic. Otherwise, there is no evidence of significant steno-occlusive lesions.

Output: 1.No evidence of acute intracranial hemorrhage or infarct.2.Apparent focal stenosis of the left vertebral artery just distal to the origin of the left PICA. The remaining major intracranial and cervical vessels are patent without aneurysm or significant stenosis.3.A well-circumscribed mass in the right parotid gland may represent a benign mixed tumor, but is incompletely characterized.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 74 year old female with a history of breast cancer, venous insufficiency, presents with right knee pain and swelling for the past few months with medial joint tenderness on exam. Concern for meniscal injury. MENISCI: There is globular increased signal abnormality in the posterior horn of the medial meniscus consistent with intrasubstance degeneration. The medial and lateral meniscus appear intact.ARTICULAR CARTILAGE AND BONE: There is near full-thickness to full-thickness articular cartilage degeneration along the medial facet of the trochlea with underlying bone marrow signal abnormality. There is full-thickness articular cartilage degeneration along the medial and lateral facets of the patella with underlying bone marrow edema type signal, likely degenerative in etiology. LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Multilobulated collection along the posterior aspect of the knee most consistent with popliteal cyst formation. 2. Articular cartilage degeneration and other findings as described above.


Instruction: Generate impression based on findings.

Input: Ms Greco is a 37-year-old female with known right triple negative breast cancer and metastatic right axillary lymphadenopathy. She presents for MRI evaluation to assess for response during neoadjuvant chemotherapy. There is heterogeneous amount of fibroglandular tissue in both breasts. Moderate background parenchymal enhancement is noted bilaterally, limiting the sensitivity of this examination.RIGHT BREAST:In the right upper outer breast, there is revisualization of the index malignancy, now measuring 3.0 x 2.2 x 1.9 cm, previously measuring 3.0 x 2.5 x 2.3 cm (AP x ML x SI). Susceptibility artifact from biopsy marker clip is seen within this lesion, compatible with index malignancy.Extending postero-inferiorly from this index malignancy are multiple additional enhancing masses, the posterior-most one of which is biopsy-proven to be malignant. Total span of enhancement (index malignancy + additional satellite lesions) now measures approximately 5.8 x 2.7 x 5.2 cm, previously measuring 5.8 x 3.1 x 5.4 cm. The total span in the AP oblique dimension continues to be approximately 6.3 cm. The two biopsy marker clips (index + satellite) are separated by approximately 4.1 cm in the AP dimension. In the right axilla, there are three abnormal morphology lymph nodes with eccentric cortical thickening. The largest one is biopsy proven to be metastatic with biopsy marker clip, now measuring 1.7 cm, previously measuring 1.7 cm.LEFT BREAST:In the left retroareolar region, there is a stable oval circumscribed mass, which is biopsy proven to be benign. Few enhancing foci are seen in the left breast, none of which are more suspicious than the rest. There is no abnormal enhancement seen elsewhere in the left breast. No abnormal axillary lymph nodes are identified in the left axillary region.

Output: (1) Stable to minimal interval decrease in size of known multicentric right breast cancer. Detailed measurements as above.(2) No MRI evidence of malignancy in the left breast. BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Ms. Jackson is a 50-year-old female with biopsy-proven breast cancer on the left 3:00 location and metastatic left axillary lymph node. She presents today for MR-directed ultrasound and possible ultrasound-guided biopsy of the lesion found on the recent MRI dated 9/18/2015, and a marker clip placement into the proven metastatic left axillary lymph node. Left breast ultrasound was performed over the lower inner quadrant. At the 6:00 location, 4 cm from the nipple, there is a 9 x 10 x 9 mm hypoechoic mass with irregular margin and increased blood flow. In addition, at the 6:30 location, 3 cm from the nipple, there is another 4 x 5 x 7 mm hypoechoic mass with irregular margin and increased blood flow. These 2 lesions correspond to the two abnormal enhancement found on the MRI dated 9/18/2015. It was decided to sample the mass at 6:00 position in the left breast.On discussion with Dr. Jaskowiak, we decided to place an additional marker clip (Hydromark) in the proven metastatic lymph node in the left axilla, to make sure the marker clip would be seen on ultrasound after completion of chemotherapy. Left axillary ultrasound identified the target lymph node for clip placement. It was in the medial part of the axilla. Bipolar maximum dimension was 25 mm, complete fatty hilar replacement and mild non-hilar cortical blood flow was seen on color flow imaging. The procedure and its risks, including bleeding, infection, and failure to diagnose, and expected benefits of ultrasound-guided core biopsy with percutaneous placement of a marking clip and post-procedure unilateral mammogram were discussed with the patient. Questions were answered. Consent was obtained both verbally and in writing. The time-out form was completed to confirm patient identity and side/type of procedure.ULTRASOUND EVALUATION AND ULTRASOUND-GUIDED BIOPSY OF THE INFERIOR LEFT BREAST MASSES:The left breast and left axilla were cleansed with chlorhexidine over the target area. Transducer was sterilely sheathed. Local anesthesia was obtained using 2% lidocaine superficially, with 1% lidocaine with 1:100,000 epinephrine at depth. A 3 mm incision was made in the skin with a #11 scalpel blade. Using aseptic technique, continuous ultrasound guidance and a mediolateral approach, three 14-gauge core needle (Inrad) specimens were obtained of the lesion. Targeting was judged very good. All specimens sank to the bottom of the prefilled container of 10% formalin. Specimen quality was judged very good.Specimens were sent to Pathology with an accompanying history sheet. Using continuous ultrasound-guidance a Bard wing clip was placed into the lesion in the usual manner. Pressure was held over the biopsy site until all bleeding subsided. The skin incision was closed with a Steri-Strip. ULTRASOUND GUIDED CLIP PLACEMENT IN THE LEFT AXILLARY LYMPH NODE:Subsequently, ultrasound guided clip placement in the metastatic left axillary lymph node was performed.Local anesthesia was obtained using 2% lidocaine superficially, with 1% lidocaine with 1:100,000 epinephrine at depth. A 3 mm incision was made in the skin with a #11 scalpel blade. Using aseptic technique, continuous ultrasound guidance and inferior to superior approach, a Hydro mark clip was directed into the target node in the usual manner.No evidence of hematoma or other complication on post procedure ultrasound. The skin incision was closed with a Steri-Strip. Post-procedure instructions were reviewed with the patient both verbally and in writing. She tolerated the procedure well with no evident complications and left the Breast Imaging Department in stable condition.Post-procedure digital left CC and ML views revealed the percutaneously placed clip to be in the expected location in the central aspect of the lesion at 6:00 position. No evidence of hematoma or other complication.A pressure dressing was positioned over the biopsy site and an ice pack positioned over the pressure dressing. Post-procedure instructions were reviewed with the patient both verbally and in writing. She tolerated the procedure well with no evident complications and left the Breast Imaging Department in stable condition.The procedure was performed by Drs. Abe and Wang Dr. Abe was present during the procedure at all times.

Output: 1. Successful ultrasound-guided core biopsy of the left breast 6:00 lesion, and clip placement. Pathology is pending at this time.2. Ultrasound-guided clip placement to the known metastatic left axillary lymph node.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: 63-year-old male with an upper extremity mass. Evaluate for soft tissue mass/possible lipoma. There is a marker along the anterior aspect of the arm at the level of the mid humeral diaphysis. There is slight prominence of the fat immediately medial to the marker which may represent a lipoma, but this is equivocal. A second marker was placed more distally along the medial aspect of the arm, approximately 4 cm above the level of the medial epicondyle. Once again, there is slight prominence of the subcutaneous fat proximal to this marker, which could represent a lipoma. Measurements of the aforementioned fatty prominences is limited due to the lack of inherent contrast with the surrounding fat. We see no mass or signal abnormality within the underlying musculature. The bone marrow signal intensity is within normal limits. Mild osteoarthritis affects the acromioclavicular joint. Degenerative disc disease affects the visualized thoracic and lumbar spine.

Output: Mild prominence of the subcutaneous fat as described above which may represent subcutaneous lipomas. We otherwise see no soft tissue abnormality.


Instruction: Generate impression based on findings.

Input: 33 year old presents for research MRI on Alan Penn Study. Research scanning of both breasts was performed with the research protocol. There is heterogeneous amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.Two enhancing masses are present in the left breast. The known lobulated mass at the 7:00 position measures 2.5 x 1.9 x 1.8 cm. An additional smaller mass at the left 6:00 position that is oval, circumscribed and has a dark internal septation measures 7 x 6 x 7 mm. This is most likely a fibroadenoma. No abnormal enhancement is seen in the right breast. The parenchymal enhancement in each breast aside from the two masses mentioned above is symmetric. No abnormal lymph nodes are identified in either axillary region.

Output: 1. Known left breast mass at 7:00 measures up to 2.5 cm. This will be biopsied today.2. Additional mass typical for a fibroadenoma in the left 6:00 position measures up to 0.7 cm. As long as today's biopsy is benign, this additional mass can be followed on ultrasound in 6-12 months. BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: 67-year-old male with gallbladder lesion invading into the liver. History of hepatitis C. ABDOMEN:LUNG BASES: Small hiatal hernia.LIVER, BILIARY TRACT: Mild gallbladder wall thickening and enhancement with nodular appearance at the fundus (e.g. series 102/56), decreased when compared to prior CT. Few small gallstones. No biliary ductal dilation. No focal hepatic lesions. SPLEEN: Previously seen hypoattenuating lesion in the spleen demonstrates dark T2 signal with delayed enhancement, most suggestive of sclerosing angiomatoid nodular transformation (SANT) lesion.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: Previously seen nonspecific prominent portacaval lymph node has decreased in size and appears within normal limits.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Mild gallbladder wall thickening with nodular appearance at the fundus has decreased when compared to prior CT with no focal liver lesions seen on the current MRI. Overall, the findings favor chronic cholecystitis with reactive changes in the adjacent liver on prior CT. Follow-up imaging with ultrasound can be obtained as clinically indicated to ensure resolution.


Instruction: Generate impression based on findings.

Input: Male, 51 years old, status post T10-L2 posterior spinal fusion and strut graft, now with loose stools. Assess for cord compression. Please note that only the lower half of the spine was imaged as the patient was unable to tolerate completion of the full exam.Findings are seen compatible with recent posterior spinal fusion from T10 through L2. Edema and fluid within the posterior subcutaneous tissues is within expected limits for the recent postoperative period.Although there is some signal loss in the operative region due to the presence of the orthopedic instruments, the area in question does appear to be at least partially visualized on at one or two slices of the T1-weighted sagittal sequence (see image 13 series 3). Within the limitations of this artifact, there is no evidence to suggest any large intracanalicular assess for significant canal compromise.

Output: 1.Evaluation is limited to the lower spine due to patient tolerance, though the operative region is fully included in the field-of-view.2.Within the limitations of artifact induced by the orthopedic instruments, which does result in some signal loss, the spinal canal is at least partially visualized through the operative region, and there is no evidence of any large intracanalicular process or significant canal compromise.


Instruction: Generate impression based on findings.

Input: Male, 57 years old, with right bicep and shoulder weakness, history of right tonsil cancer status post treatment. Ill-defined edema is seen within the paraspinal soft tissues of the right neck encompassing the roots, trunks and divisions of the brachial plexus. No masslike lesion or fluid collection is seen. Also noted is extensive right-sided muscular atrophy including the sternocleidomastoid muscle, scalene muscles, and muscles of the shoulder girdle, all of which demonstrate some degree of edema as well.

Output: Although no focal lesions are identified, there is evidence of edema within the right neck which does encompass the proximal portion of the brachial plexus. Extensive muscular atrophy is seen at least as far distally as the shoulder girdle. These findings favor brachial plexitis perhaps related to prior radiotherapy with associated denervation muscular edema and atrophy.


Instruction: Generate impression based on findings.

Input: 32 years Female (DOB:1/1/1984)Reason: chiari with new vision changes and headaches/dizziness, sp decompression, please do with csf flow History: vision changes, Chiari, headaches ,dizzinessPROVIDER/ATTENDING NAME: DAVID M FRIM DAVID M FRIM MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. There appears to be some bidirectional flow at the level of foramen magnum.The patient status post suboccipital craniotomy and C1 posterior arch surgery for Chiari decompressionNo abnormal enhancing mass lesions are appreciated within the brain parenchyma. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate a small mucous retention cyst. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI orbits:The eyeballs are intact. No intraconal or extraconal space mass is identified. The extraocular muscles are intact. The lacrimal glands are symmetric and within normal limits in size and configuration. The suprasellar cistern is intact .

Output: 1.There is no evidence for an intraorbital mass.2.Some bidirectional flow present at the level of the foramen magnum which may suggest that there is some mild impedance to CSF flow at the level of the foramen magnum. There is no evidence for ventriculomegaly on this exam.3.Status post Chiari I decompression.


Instruction: Generate impression based on findings.

Input: Brain MRI:There are innumerable, multifocal, T2 hyperintense abnormalities throughout the supratentorial and infratentorial brain. Within the supratentorial compartment these are primarily located in subcortical white matter locations, although lesions can be found within the corpus callosum and internal capsules. A lesion within the genu of the corpus callosum appears hemorrhagic, measuring 22 x 13 mm in axial dimension, accounting for the new right frontal horn compression. Within the posterior fossa, cerebellar hemispheres as well as the pons and pontomedullary junction are involved. To a lesser extent, several of these abnormal foci are associated with contrast enhancement. Susceptibility weighted image also demonstrates multifocal petechial hemorrhages throughout the involved areas.The basilar cisterns are maintained and there is no midline shift. The cerebellar tonsils are in normal position. The pituitary gland is normal in size. There is no evidence for acute cerebral, brainstem or cerebellar infarction. There are no extraaxial fluid collections or subdural hematomas.Brain MRV: There is normal venous flow demonstrated within the internal cerebral veins, vein of Galen, straight sinus, superior sagittal sinus and within the bilateral transverse and sigmoid sinuses. No dural venous sinus thromboses or occlusions are identified. Neck MRA:There are no stenoses of the bilateral common, internal or external carotid arteries or of the bilateral carotid bifurcations. There is no evidence for fibromuscular dysplasia or dissection of the carotid or vertebral arterial systems within the neck. There are no vascular masses identified.

Output: 1.There are multifocal T2 hyperintense abnormalities involving both supratentorial and infratentorial brain with associated enhancement and microhemorrhage as described in detail above. This constellation of imaging findings has been described in the literature for hemophagocytic lymphohistiocytosis. Cerebritis and/or lupus vasculitis is felt to be a less likely etiology for these lesions. PRES is not considered within the differential diagnosis.2.Negative MRV of the brain.3.Negative MRA of the neck.


Instruction: Generate impression based on findings.

Input: History of multiple myeloma, now with pain with flexion and extension of spine. Thoracic spine: Diffuse osteopenia likely secondary to multifocal tumor involvement seen on MRI from 5/12/2016. Multilevel degenerative disease. Superior endplate compression deformity of T11 vertebral body with approximately 10% height loss. This study was seen on prior study is likely chronic. No acute fractures or malalignment.Ribs: No acute fractures. Left central venous catheter terminates near midline.

Output: No acute abnormalities. Redemonstration of degenerative changes and mild compression deformity of T11 vertebral body.


Instruction: Generate impression based on findings.

Input: 54 years, Female, pancreatic cancer, surveillance after SRS There is a 2 mm enhancing lesion in the left cerebellar hemisphere, series 10 image 42, which is suspicious for metastasis and not appreciably changed since 4/26/2016. No associated edema or hemorrhage. No new parenchymal or meningeal enhancement is seen. Again seen is a small resection cavity involving the left inferior parietal lobule without mass or enhancement to suggest recurrent tumor. There is susceptibility related to chronic blood products in this region. Surrounding FLAIR hyperintensity compatible with gliosis is also not significantly changed in the interval. Minimal additional scattered T2/FLAIR hyperintense foci are nonspecific and not appreciably changed in the interval.A cavernoma with an associated developmental venous anomaly is again seen in the right parietal lobe showing no significant interval change. No evidence of hydrocephalus, intracranial mass effect, midline shift, or herniation.There is a 6 x 9 mm enhancing lesion involving the squamous portion of the right temporal bone, which in retrospect measures 3 x 5 mm on prior MRI from 4/26/2016. No significant osseous intracranial mass effect.

Output: 1. Compared to 4/26/2016, there is no significant change in size of 2 mm left cerebellar enhancing lesion likely representing metastasis. No new parenchymal or meningeal enhancement.2. Enlarging right temporal calvarial lesion, likely representing metastasis, measures 6 x 9 mm, previously 3 x 5 mm on 4/26/2016. No associated intracranial mass effect.3. Evidence of left parietal tumor resection without evidence of local recurrence.4. Stable right parietal cavernous malformation.


Instruction: Generate impression based on findings.

Input: There are numerous bilateral foci of increased T2/FLAIR signal in the brainstem, periventricular white matter, and deep white matter of bilateral hemispheres, left slightly greater than right. Multiple of these larger lesions in the periventricular white matter demonstrate low T1 signal centrally. The largest of these lesions, in the left frontal white matter measures 22 x 22 mm (series 801, image 17). These lesions are not associated with diffusion-restriction or abnormal enhancement. There are no extra-axial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain otherwise. The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for acute cerebral, brainstem, or cerebellar infarction. CERVICAL SPINE

Output: 1. Extensive T2 hyperintense lesions throughout the cerebral white matter, brainstem, and cervical spine compatible with multiple sclerosis. No abnormal enhancement is identified in these lesions. 2. Moderate degenerative changes at the C5/6 level.


Instruction: Generate impression based on findings.

Input: Ms. Elizabeth Gaylord is a 41 years old female with calcifications in the right breast and breast MRI for research purposes performed today which showed an additional probably benign finding in the left breast. A second look ultrasound is performed for the left breast 6:00 position. A targeted left ultrasound was performed for the area of concern detected on today's breast MRI. In the left breast, 6:00 position, 4 cm from the nipple, there are multiple small simple and complicated cysts, including a few adjacent cysts which measure up to 5 mm in maximum diameter. This likely corresponds to the MRI findings.

Output: No sonographic evidence for malignancy. Multiple small cysts in the left breast 6:00 position likely corresponding to the MRI finding. Results and recommendations were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: A 50 year old man with a history of ischemic cardiomyopathy, s/p heart transplant (4/30/2015) and antibody mediated rejection, hypertension and diabetes. Referred for follow-up cardiac MRI . Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 55%, the LV end diastolic volume index is 75 ml/m2 (normal range: 74+/-15), the LVEDV is 164 ml (normal range 142+/-34), the LV end systolic volume index is 34 ml/m2 (normal range 25+/-9), the LVESV is 74 ml (normal range 47+/-19), the LV mass index is 57 g/m2 (normal range 85+/-15), and the LV mass is 124 g (normal range 164+/-36). There is mild abnormal septal wall motion consistent with prior sternotomy. There are no regional wall motion abnormalities present. There is focal subepicardial late gadolinium enhancement in the mid-apical inferoseptal wall. This finding suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. This finding could be consistent with underlying myocarditis. The myocardial native T1 time is 1282ms (previously 1167ms on 12/11/15 and 1231ms on 12/2/15). This is elevated and can suggest the presence of an intra-myocardial process. It has increased compared to the last 2 prior MRIs. The myocardial to skeletal T2 ratio is normal (below 2).By method of disks, the cardiac output is 7.36L/min and the cardiac index is 3.83L/min/m2.By phase contrast velocity encoded imaging, the cardiac output is 6.89L/min and the cardiac index is 3.39L/min/m2.Left AtriumThe left atrium is moderately dilated (134 ml). Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 53%, the RV end diastolic volume index is 69 ml/m2 (normal range 82+/-16), the RVEDV is 150 ml (normal range 142+/-31), the RV end systolic volume index is 32 ml/m2 (normal range 31+/-9), and the RVESV is 70 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly dilated.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 at least mild tricuspid regurgitation.AortaThere is a left sided aortic arch with a combined right innominate and left common carotid or "pseudo bovine" branching pattern, which is a normal variant. The aortic root is normal in size (20 x 23 mm).Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size (24mm).Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThe pericardium is thickened (5-6 mm maximal). The pericardium is bright on LGE images as well on T2-weighted imaging suggesting that it is edematous/ inflamed with possible fibrosis. There is no obvious pericardial to myocardial tethering noted on the current study. On real-time cine imaging, there is no evidence of respirophasic septal shift. There is a small loculated pericardial effusion adjacent to the right atrium. There is a significant amount of pericardial fat present. All these findings are similar to those found in the last MRI (12/11/2015), with the exception that contrast was given on today's study.Extracardiac FindingsSternal wires noted. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with normal systolic function, the LVEF is 55%. There are no regional wall motion abnormalities present. 2. There is focal subepicardial late gadolinium enhancement in the mid-apical inferoseptal wall which could represent the presence of an underlying fibrosing, infiltrative, or inflammatory process. It is not typical of myocardial infarction but could represent underlying myocarditis. 3. The myocardial native T1 time is 1282ms (higher than noted previously). This could suggest the presence of an intra-myocardial process. 4. The right ventricle is normal in size with normal systolic function, the RVEF is 53%. 5. There is thickening of the pericardium with evidence of inflammation and possible fibrosis. These findings suggest that there is ongoing pericarditis. Despite these findings, however, there is no evidence of constrictive physiology. 6. There is a small loculated pericardial effusion adjacent to the right atrium, without significant change compared to previous MRI.5. 7. The left atrium is moderately dilated. 8. The right atrium is mildly dilated.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 14-year-old female with left knee pain. Evaluate for medial meniscus or ACL tear. MENISCI: The lateral and medial menisci are intact.ARTICULAR CARTILAGE AND BONE: Bone marrow signal intensity is normal. The articular cartilage is intact. No fracture.LIGAMENTS: Anterior and posterior cruciate ligaments are intact. Medial collateral ligament and lateral collateral complex are intact. EXTENSOR MECHANISM: Quadriceps tendon and patellar tendon are intact.ADDITIONAL

Output: Normal examination.


Instruction: Generate impression based on findings.

Input: There has been interval near total resolution of previously demonstrated innumerable, multifocal, T2 hyperintense abnormalities throughout the supratentorial and infratentorial brain. Susceptibility weighted imaging redemonstrates multifocal petechial hemorrhages throughout the involved areas, with a few new scattered punctate lesions (for example a cluster in the left parietal subcortical white matter locations), and some retraction in size of the largest corpus callosal genu lesion. There is no residual pathologic enhancement.The basilar cisterns are maintained and there is no midline shift. The cerebellar tonsils are in normal position. The pituitary gland is normal in size. There is no evidence for acute cerebral, brainstem or cerebellar infarction. There are no extraaxial fluid collections or subdural hematomas. Expected vascular flow-voids are demonstrated. Mastoid air cells are clear.

Output: There has been interval near total resolution of previously demonstrated innumerable, multifocal, T2 hyperintense abnormalities throughout the supratentorial and infratentorial brain. Susceptibility weighted imaging redemonstrates multifocal petechial hemorrhages throughout the involved areas, with a few new scattered punctate lesions, and some retraction in size of the largest corpus callosal genu lesion. There is no residual pathologic enhancement.


Instruction: Generate impression based on findings.

Input: Sciatica, rule out progression of DJD Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is grade 1 anterolisthesis of L4 on L5 similar to prior. Alignment is otherwise within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position.Small disc bulges at T11-T12 and T12-L1 again partially imaged. Multilevel degenerative changes are seen in the lumbar spine, as described below, which are not significantly changed since prior lumbar spine MRI from 7/9/2014.L1-L2: Disc desiccation with mild ligamentum flavum thickening and mild facet arthropathy. No spinal canal or neural foraminal stenosis.L2-L3: Disc desiccation with mild ligamentum flavum thickening and mild facet arthropathy. No spinal canal or neural foraminal stenosis.L3-L4: Disc desiccation with mild ligamentum flavum thickening and mild facet arthropathy. No spinal canal or neural foraminal stenosis.L4-L5: There is grade 1 anterolisthesis, advanced bilateral facet arthropathy, and ligamentum flavum thickening with resulting moderate spinal canal stenosis at this level similar to prior. There is mild bilateral neural foraminal stenosis, similar to prior.L5-S1: Severe disc height loss as before. There is mild disc bulge eccentric to the right and moderate bilateral facet arthropathy. There is no central spinal canal stenosis. There is however effacement of the right lateral recess similar to prior. There is also severe bilateral, right worse than left neural foraminal stenosis, also similar to prior. There may be impingement of the bilateral exiting L5 and possibly descending right S1 nerve roots at this level.

Output: 1. Degenerative changes in the lumbar spine, particularly at the L4-L5 and L5-S1 levels, are not significantly changed since 7/9/2014. 2. Grade 1 anterolisthesis, advanced facet arthropathy, and moderate spinal canal stenosis at L4-L5 similar to prior. Instability at this level is demonstrated on prior flexion-extension radiographs.3. Again seen at L5-S1 is severe bilateral, right worse than left, neural foraminal stenosis. There is also effacement of the right lateral recess at this level as before. 4. Additional levels as above.


Instruction: Generate impression based on findings.

Input: Ms. Warren is a 43 year old female with a strong family history of breast cancer in sister (diagnosed at the age of 36) and maternal aunt (diagnosed at the age of 40) and ovarian cancer in maternal grandmother (diagnosed in her 40s). She has no current breast related complaints. There is scattered fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.In the left central to medial breast, there are several new enhancing masses with interspersed non-mass enhancement identified. The total span of abnormal enhancement measures 5.2 x 3.7 x 4.4 cm (AP x ML x SI). The two largest enhancing masses are located in the left medial and left central breast, measuring approximately 2.1 x 0.9 and 1.2 x 0.5 cm respectively.No abnormal enhancement is seen in the right breast. No abnormal lymph nodes are identified in either axillary or internal mammary region.Bilateral small pleural effusions are identified.

Output: (1) New enhancing masses/nonmass enhancement identified in the left central to medial breast, the two largest lesions of which are located in the left medial and left central breast, respectively. An MR directed ultrasound with possible biopsy is recommended for further evaluation.(2) No MRI evidence of malignancy in the right breast. BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: E - Additional Mammo/Ultrasound Workup Required.


Instruction: Generate impression based on findings.

Input: 88 year old female with pain. Evaluate for type II dens fracture. Again seen is a type II dens fracture better evaluated on recent CT and MRI study. There is mild widening of the fracture fragment on the extension view. The fracture fragment abuts the inferior aspect of the clivus. No prevertebral soft tissue swelling. Multilevel severe degenerative changes of the cervical spine most pronounced at C5-C6. There is grade 1 anterolisthesis of C4 on C5.

Output: Type II dens fracture better evaluated on recent CT and MRI study. The fracture fragment abuts the inferior aspect of the clivus and there is mild widening of the fracture fragment on the extension view.


Instruction: Generate impression based on findings.

Input: History of breast cancer with liver metastasis. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are numerous scattered foci of T2 hyperintensity in the cerebral white matter. 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 skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There are bilateral lens implants. There are partially-imaged findings related to right parotidectomy. There is mild fluid signal in the right mastoid air cells.

Output: 1. No evidence of intracranial metastases. 2. Numerous scattered cerebral white matter lesions are nonspecific, but likely represent chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: Female, 58 years old, with blurry vision, vertigo and headaches. Scattered foci of T2 hyperintensity are evident in the periventricular white matter, most notably in the periatrial regions. No restricted diffusion is seen. No edema or mass effect is detected. There is no evidence to suggest intracranial hemorrhage or any abnormal extra-axial fluid collection. The ventricles are normal in size and morphology.

Output: 1.Mild white matter signal abnormality which is nonspecific but probably represents chronic microvascular ischemic disease.2.No evidence of any acute intracranial abnormality or other specific findings which would account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: Clinical question: Patient with spinal metastases, neck pain. Signs and symptoms: Neck pain Nonenhanced CT of the cervical spine:Previously described on prior MRI of the cervical spine with the study the lesion to the vertebral body of C5 is not identified on this study. There is subtle low attenuation of C7 vertebral body consistent with patient's known metastatic lesion. There is no evidence of fracture of this vertebrae and the alignment of vertebral column is unremarkable.Nonenhanced CT of thoracic spine:The alignment the vertebral column is within normal limits. Examination identifies previously detected metastatic lesion to T1 with mild compression deformity and minimal bulge of vertebrae into the spinal canal. There is no involvement of the pedicle of T1. The alignment remains intact. Mild compression deformity of vertebral body of T5 along its superior aspect and the internal lytic changes. There is no definitive involvement of the pedicles of T5. No definitive evidence of any additional lytic changes of vertebral column is detected.No definitive metastatic lesion to the facets of the pedicles of vertebral column.Nonenhanced CT of the lumber spine:The alignment of vertebral column is unremarkable. No definitive for the study kidneys to the lumber spine is detected.No evidence of central spinal stenosis or neural foramina compromise.There is very subtle low-attenuation involving S2 vertebral body however been no distinct destruction of the cortex or any perispinal soft tissue abnormality. Possibility of metastatic disease cannot be entirely ruled out.

Output: 1.Multiple metastatic disease to the thoracic spine and a suspected metastatic lesion to as to as detailed.2.There is mild compression fracture of T1 and T5 and mid no involvement of the pedicles of T1 or T5.3.The alignment of the vertebral column throughout the spine remains normal.


Instruction: Generate impression based on findings.

Input: 67 year-old female with seizure today. No history of seizure. History of CVA and encephalopathy, mental retardation. There is no evidence of intracranial hemorrhage, mass or edema. Extensive carotid calcification. Dystrophic calcifications within the bilateral basal ganglia. Multiple hypodensities in periventricular distribution consistent with extensive small vessel disease, age indeterminate. Multifocal old cerebellar strokes. No evidence of supratentorial cortical stroke. If there is clinical concern for acute ischemia an MRI may be considered. Prominent sulci with proportionally enlarged ventricles.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Small vessel disease, age indeterminate. If there is clinical concern for acute ischemia an MRI may be considered.


Instruction: Generate impression based on findings.

Input: Female, 38 years old, receiving radiotherapy for craniopharyngioma, evaluate cystic lesions. A predominantly cystic, rim-enhancing lesion is redemonstrated centered on the suprasellar cistern and third ventricle. The inferior aspect of the lesion has not significantly changed in size. However, that portion of the lesion which extends through the left foramen of Monro to enter the left frontal horn has increased. There is, as a result, a greater degree of left lateral ventricular dilatation with transependymal CSF flow. A midline shift to the right of up to 14 mm is seen with subfalcine herniation. Evidence of left frontal approach biopsy is seen. There appears to be a small amount of brain parenchyma which herniates into the burr hole defect.

Output: Continued expansion in size of the cystic suprasellar and third ventricular region lesion. In particular, that portion of the lesion which herniates through the left foramen of Monro to invade the left lateral ventricle has increased in size. Left lateral ventricular dilatation has also increased from prior. There is generalized mass effect in the form of midline shift and subfalcine herniation.


Instruction: Generate impression based on findings.

Input: History of elevated PSA.Additional history per electronic medical record:TRUS 3/14/2014, performed for PSA 3.5.3 cores of Gleason 6 prostate cancer totalling 7 mm. This included four mm at the right mid, two mm at the rightapex and one mm at the left space. PELVIS:PROSTATE:Prostate Size: 2.3 x 4.4 x 3.5 cm.Peripheral Zone: There is a focus of decreased T2 and ADC signal within the left apex (series 501, image 52) measuring 7 x 7 mm which is suspicious for neoplasm. There is an additional focus of decreased T2 and ADC signal within the right apex (series 501, image 52) measuring 7 x 15 mm which is also suspicious for neoplasm.Central Gland: No significant abnormality noted.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: No definite evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Signal abnormality within the bilateral peripheral zone apices suspicious for neoplasm, please see discussion above.


Instruction: Generate impression based on findings.

Input: Left parotid fullness, hx of tongue cancer. PER EPIC note: revision left partial glossectomy on 1/28/2016 for microinvasive SCC/severe dysplasia with positive margins from surgery on 12/22/2015 in an outside hospital. Wife notes left parotid fullness today, states that the fullness was present prior to surgery. The left parotid tail is longer than on the right side, but there is no discernible tumor or associated inflammatory changes. The masticator spaces are unremarkable. The submandibular glands are also unremarkable. There are postoperative findings related to left partial glossectomy, but there is no evidence of measurable mass lesions or significant cervical lymphadenopathy based on size criteria. The thyroid is unremarkable. There is multilevel degenerative cervical spondylosis. The airways are patent. The imaged intracranial structures are unremarkable.

Output: 1. The left parotid tail is longer than on the right side, but there is no discernible tumor or associated inflammatory changes. This may represent an anatomic variant versus much less likely neoplasm. 2. No evidence of measurable oral tongue tumor.


Instruction: Generate impression based on findings.

Input: 55 years Male (DOB:12/27/1960)Reason: R/o neurodegenerative process History: Abnormal ocular movements w/ delirium, h/o EtOH abusePROVIDER/ATTENDING NAME: WEI WEI LEE SACHIN DILIP SHAH MRI brain:There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Multiple Punctate T2 and FLAIR hyperintense foci are present in the thalami and basal ganglia. Patchy T2 and FLAIR hyperintense lesions are present in the brainstem.No foci of diffusion restriction are appreciated.There several punctate foci of signal loss on susceptibility weighted imaging present in the midbrain and basal ganglia and the left thalamus.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.Postcontrast imaging is mildly degraded patient motion artifact which may obscure more subtle abnormalities.Marrow signal in the visualized cervical spine and calvarium is rather low. There is patchy areas of marrow replacement present.Lumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment. The conus medullaris on sagittal imaging is grossly intact. No abnormal enhancing lesions are identified in the lumbar spine. There is superior endplate compression present at T12 associated with a Schmorl's node. There is no associated T2 signal hyperintensity with this compression fracture to suggest that it is acute. There is a 12 x 9 mm well-circumscribed T1 hyperintense lesion along the posterior aspect of the T12 vertebral body which suppresses on the STIR sequence and most likely represents a vertebral body hemangioma. Marrow signal in the lumbar spine is rather low with patchy marrow replacement in the lumbar spine. There is multilevel disc desiccation present.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is mild loss of disc space height, diffuse disc bulge and some ligamentum flavum hypertrophy associated with effacement of the fat at the right lateral recess. Overall there is mild to moderate encroachment of the nerve roots of the right lateral recess at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is a mild disc bulge present at this level associated with some mild loss of disc space height. There is also mild ligamentum flavum hypertrophy at this level.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.Chronic superior endplate compression at T12.2.There is a disc bulge at L4-5 associated with some mild to moderate encroachment of the nerve roots at the right lateral recess.3.Findings are compatible with multiple old lacunar infarcts in the thalami and basal ganglia.4.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related. 5.Patchy signal hyperintensity within the brain stem is present especially in the central portion of the pons and midbrain. This is a nonspecific finding. It is possible that it is vascular related though it is nonspecific. It is also not classic for central pontine myelolysis, however, it may represent a milder form of CPM.6.There are several microhemorrhages present in the upper brainstem and deep gray nuclei. Most likely these are related to hypertension based on the distribution.7.There is marrow replacement present which is a nonspecific finding. It can be associated with chronic disease, anemia, lymphoproliferative disorder. It is nonspecific.


Instruction: Generate impression based on findings.

Input: 39 years Male (DOB:2/5/1977)Reason: Cervical stenosis evaluation History: Neck pain and numbnessPROVIDER/ATTENDING NAME: RIMAS V. LUKAS SERVICES ANCILLARY The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal enhancing lesions are identified in the cervical spine. There is mild reversal of the normal cervical curvature present. There is mild multilevel 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. The right vertebral artery is larger than the left vertebral.

Output: 1.There are minor degenerative changes present cervical spine spine. There is no significant compromise to spinal canal or exiting nerve roots.2.There is reversal of the normal cervical curvature present which is a nonspecific finding and could be related to patient positioning or muscle spasm.


Instruction: Generate impression based on findings.

Input: Clinical question: evaluate for PRESSSigns and Symptoms: hypertension, headacheUnspecified essential hypertension . S/p allogeneic bone marrow transplant The CSF spaces are appropriate for the patient's stated age with no midline shift. No foci of diffusion restriction are appreciated intracranially.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: MRI of the brain is within normal limits. There is no evidence for posterior reversible encephalopathy syndrome appreciated.


Instruction: Generate impression based on findings.

Input: Pulsating left upper quadrant pain. History of drained right hepatic cyst. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology size and signal intensity. Several simple cysts. No suspicious lesion, biliary ductal dilatation or vascular abnormality.SPLEEN: The spleen is normal in size morphology, signal intensity and enhancement without a focal lesion. Small splenule anterior to the anterior splenic pole.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: Postsurgical changes of the anterior abdominal wall.OTHER: No significant abnormality noted.

Output: No significant abnormality or specific findings to account for the patient's reported left upper quadrant pulsatile mass.


Instruction: Generate impression based on findings.

Input: There is a new focus of restricted diffusion with associated abnormal T2 signal within the right putamen adjacent to the posterior limb of the right internal capsule. This focus has faint enhancement on postcontrast imaging.There are post-surgical changes of a right temporoparietal craniotomy for partial tumor resection involving the right temporal lobe. Nodular enhancement surrounding the right temporal resection cavity as well as the right periatrial white matter is not significantly changed compared to the prior study. There is similar T2/FLAIR hyperintensity surrounding the resection cavity, but overall increased T2/FLAIR subcortical and periventricular hyperintensity, right greater than left. The ventricular size is unchanged. There is no midline shift.

Output: 1. Focus of restricted diffusion within the right putamen/posterior limb of the internal capsule with associated T2 signal abnormality and enhancement is suggestive of a subacute infarct.2. No significant change in enhancement surrounding the right temporal resection cavity. Increased white matter hyperintensity is favored to represent posttreatment change.Findings communicated via telephone to O. Kamson at 1244 hrs on 1/16/2016.


Instruction: Generate impression based on findings.

Input: Optic neuritis and history of type 2 diabetes, TIA one seizure episode associated with her TIA, hypertension, and smoking. Orbits: There is diffuse atrophy of the left optic nerve, without associated signal abnormality or enhancement. The right optic nerve appears unremarkable. There is no evidence of mass lesions in the bilateral orbits. The globes, lacrimal glands, and extraocular muscles are unremarkable. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mild scattered cerebral white matter T2 hyperintensity. There are subcentimeter foci of encephalomalacia in the right caudothalamic groove and left caudate. There is no abnormal intracranial enhancement. The ventricles and sulci are mildly prominent diffusely due to cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull and scalp soft tissues are grossly unremarkable. There is mild scattered paranasal sinus mucosal thickening. There are also several subcentimeter nasopharyngeal mucosal retention cysts.

Output: 1. Left optic nerve atrophy, without evidence of acute optic neuritis.2. No evidence of intracranial hemorrhage, mass, or acute infarct. 3. Subcentimeter foci of encephalomalacia in the right caudothalamic groove and left caudate likely represent chronic lacunar infarcts, superimposed upon a background of mild chronic cerebral white matter small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: 78 years Female (DOB:1/1/1938)Reason: r/o meningeal irritation; evaluate brain structure History: new onset headaches with dizzinessPROVIDER/ATTENDING NAME: AUDREY L. TANKSLEY AUDREY L. TANKSLEY The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.There appears to be some subtle T2 and FLAIR signal hyperintensity along the subcortical white matter of the temporal lobes and medial aspects of the temporal lobes including hippocampi and along the subependymal space and insular cortex.There appear to be dilated perivascular spaces present. This could represent normal variant.No abnormal 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: 1.There is a subtle signal abnormality involving the limbic system, subependymal region and some of the subcortical white matter of the temporal lobes is nonspecific. This could represent a limbic encephalitis or a paraneoplastic syndrome. It is nonspecific. If clinically appropriate MRI with gadolinium may be of further benefit to further delineate this.2.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related. 3.Findings were discussed with Dr Tanksley at the time of this dictation.


Instruction: Generate impression based on findings.

Input: 69-year-old male with altered mental status. There is no evidence of intracranial hemorrhage, mass or edema. Hypodensities in periventricular white matter most consistent with small vessel ischemic disease, which were present on prior MRI.The ventricles and basal cisterns are normal in size and configuration.Several small, round bony excrescences are seen arising from outer table of skull, of unclear etiology but doubtful clinical significance (sagittal series 80475, image 26). The calvaria and skull base are otherwise radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: No acute intracranial abnormality.


Instruction: Generate impression based on findings.

Input: 46-year-old female with increased ICP and history of SAH status post right craniotomy with PCOM aneurysm clipping. Increased ICP? Postoperative changes status post right frontal craniotomy for clipping of an aneurysm is again noted without interval changes. Right-sided ventricular catheter with no interval change in its course and position with its tip located in the frontal horn of the right lateral ventricle. Small amount of hemorrhage is again noted in the dependent portion of the occipital horn of the right lateral ventricle, unchanged.Ventricular system and basal cisterns appear unchanged. No evidence of acute hemorrhage, edema or mass effect.Multiple prior studies were reviewed and demonstrate persistent low positioned cerebellar tonsils with crowding of the foramen magnum, raising a question of Chiari malformation. If clinically indicated, MRI with flow study may be considered.

Output: 1. Stable postoperative changes.2. Persistently low positioned cerebellar tonsils with crowding of the foramen magnum are noted raising a question of Chiari malformation. If clinically indicated, MRI with flow study may be considered.


Instruction: Generate impression based on findings.

Input: 47-year-old male with knee pain. Evaluate lateral meniscus. MENISCI: The medial and lateral meniscus appear intact.ARTICULAR CARTILAGE AND BONE: There is focal degeneration of the articular cartilage of the patella along the medial and lateral facets involving greater than 50% of the cartilage thickness. The medial and lateral compartment articular cartilage appears relatively spared. There is a focus of low signal intensity in the anterior aspect of the femur likely representing a benign bone island.LIGAMENTS: The IT band appears slightly thickened with inflammation of the soft tissues between the IT band and the lateral femoral condyle, suggesting a "friction syndrome". The lateral collateral ligament proper and biceps femoris tendon appear intact. The ACL, PCL and MCL appear intact.EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. MR findings compatible with an IT band "friction syndrome". We see no meniscal tear.2. Degeneration of the articular cartilage of the patella as described above.


Instruction: Generate impression based on findings.

Input: 60 years Female (DOB:5/2/1956)Reason: S/p brain RT. Surveillance exam. History: S/p brain RT. Surveillance exam.PROVIDER/ATTENDING NAME: STEVEN J. CHMURA SERVICES ANCILLARY The CSF spaces are appropriate for the patient's stated age with no midline shift. Punctate focus of enhancement is identified in the right paracentral lobule which is associated with susceptibility effect. It has not changed since the prior.There is a punctate focus of susceptibility effect in the left inferior parietal lobule which is not associated with contrast enhancement. It was also present on the prior exam and is unchangedNormal 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: 1.Punctate lesion in the right paracentral lobule is stable compared to the prior exam.2.A microhemorrhage is present in the left inferior parietal lobule which is also stable.


Instruction: Generate impression based on findings.

Input: 38-year-old male with knee pain, patellar tendon pain. MENISCI: There is globular intrasubstance signal within the body and posterior horn of the medial meniscus indicating intrasubstance degeneration. The root of the posterior horn of the medial meniscus is essentially replaced with abnormal signal intensity and does not definitively contact the tibial articular surface, presumably representing a root avulsion tear. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is subjective thickening of the articular cartilage of the medial compartment. The articular cartilage of the lateral compartment appears relatively spared. The articular cartilage of the patellofemoral compartment also appears relatively spared. The bone marrow signal intensity is within normal limits.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: There is minimal increased signal intensity within the undersurface fibers of the proximal patellar tendon which may represent mild tendinosis but is of questionable clinical significance. The extensor mechanism appears intact.ADDITIONAL

Output: 1. Root avulsion tear of the medial meniscus as described above.2. Articular cartilage degeneration as described above.3. Findings suggestive of minimal patellar tendinosis of questionable clinical significance.4. Nonspecific subcutaneous edema along the anterior aspect of the patellar tendon.5. Findings suggestive of a mild synovitis and joint effusion.


Instruction: Generate impression based on findings.

Input: Myeloma with new right-sided T7/T8 and chronic pain L1. L1 site of known compression fracture. There is greater than 50% loss of height of the T12 vertebral body and near complete loss of height of the L1 vertebral body, as seen on prior MRI. The vertebral heights otherwise appear maintained.

Output: Compression deformities of the T12 and L1 vertebral bodies, as seen on prior MRI.


Instruction: Generate impression based on findings.

Input: Female, 45 years old. Severe knee pain in SLE patient on chronic corticosteroids. Inability to bear weight. Due to the patient's body habitus, the high-resolution coil could not be used. An alternative coil was used instead, which results in slightly suboptimal image quality. Furthermore, several images are limited by artifact.MENISCI: There is an obliquely oriented tear involving the junction of the body and posterior horn of the medial meniscus, extending from the femoral articular surface through the peripheral fibers of the meniscus. This is best seen on images 27 and 28 of series 5 and 7. Poorly defined intermediate signal intensity in the adjacent soft tissues may reflect extrusion of mucoid material. There is slight medial extrusion of the body of the medial meniscus. The anterior horn of the medial meniscus as well as the lateral meniscus appear intact.ARTICULAR CARTILAGE AND BONE: Evaluation of the articular cartilage is limited on this study, but subjectively there is thinning of the articular cartilage of the patellofemoral and medial tibiofemoral compartments. There are also small tricompartmental osteophytes. Bone marrow signal intensity is normal. We see no findings to suggest osteonecrosis.LIGAMENTS: The anterior cruciate ligament appears intact, although slightly thickened, which may represent mucoid degeneration. The PCL and collateral ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1.Limited study as described above.2.Normal appearing bone marrow without avascular necrosis.3.Mild osteoarthritis.4.Tear of the medial meniscus as described above.5.Small collections of fluid signal intensity along the popliteus probably represent ganglia with nonspecific edema in the adjacent soft tissues.


Instruction: Generate impression based on findings.

Input: Adenoid cystic carcinoma of the right parotid gland (T4aN0), underwent right total parotidectomy and a right selective neck dissection with a rotational skin flap closure on 2/16/12. There are partially imaged findings related to right parotidectomy without definite evidence of mass lesions in this region. There is unchanged nonspecific enhancement in the left petrous apex region. Otherwise, there is no evidence of intracranial hemorrhage, mass, or acute infarct. The cavernous sinuses appear to be intact, albeit mildly asymmetric. There are a few scattered nonspecific foci of cerebral white matter T2 hyperintensity. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. There is persistent fluid signal within the right mastoid air cells. There is mild scattered paranasal sinus mucosal thickening. There are bilateral lens implants. There is a right maxillary periapical cyst. There is an unchanged 8 mm diameter left parotid cystic lesion. There is diffuse T2 hyperintensity and enhancement in the left masticator muscles. There are left temporomandibular joint degenerative changes.

Output: 1. Stigmata of denervation effects in the left trigeminal nerve distribution.2. Unchanged subcentimeter cyst lesion in the left parotid gland without evidence of associated enhancing mass, although the images are not optimized for assessment of this region.3. Postoperative findings related to right parotidectomy without discernible evidence of gross tumor, although this region is incompletely imaged.4. Persistent nonspecific enhancement in the left petrous apex region.5. Left temporomandibular joint degenerative changes.


Instruction: Generate impression based on findings.

Input: Intracranial hemorrhage with altered mental status. There are postoperative findings related to right PCOM aneurysm coiling and stenting. There is a small amount of scattered subarachnoid hemorrhage and hemorrhage within the ventricular system with evidence of superficial siderosis. There is a predominantly T1 and T2 hyperintense hematoma in the right frontal lobe surrounding the path of the prior right transfrontal ventricular catheter that measures up to approximately 25 mm with surrounding vasogenic edema. There is also a small amount of hemorrhage along the left transfrontal shunt catheter path. The ventricular system appears to be stable to minimally more distended. There are small areas of recent infarction in the corpus callosum, posterior left insular cortex, and bilateral frontal lobe white matter. There is also mild scattered cerebral white matter T2 hyperintensity and more confluent T2 hyperintensity in the periventricular regions. There appears to be a small amount of encephalomalacia in the right cerebellar hemisphere. There is no midline shift or herniation. There is fluid signal within the bilateral mastoid air cells and middle ears.

Output: 1. Small amounts of residual scattered subarachnoid hemorrhage and hemorrhage within the ventricular system, with evidence of superficial siderosis. 2. Subacute hemorrhage along the bilateral transfrontal ventricular catheter paths, right larger than left. 3. The shunted ventricular system appears to be stable to minimally more distended.4. Small areas of recent infarction in the corpus callosum, posterior left insular cortex, and bilateral frontal lobe white matter.


Instruction: Generate impression based on findings.

Input: Clinical question: Assess lumbar spine for possible stenosis, disc pathology, foraminal stenosis, cause of symptoms of the spinal stenosis. Signs and symptoms: Bilateral buttock to knee pain, worse with standing. Nonenhanced lumbar MRI:The signal intensity of vertebral column is unremarkable and the anatomic alignment is within normal.T12-L1 is unremarkable.L1-L2 is unremarkable.L2-L3 demonstrate mild degenerative changes and unremarkable otherwise. Incidental note is made of multiple bilateral large renal cysts which are partially visualized. Recommend follow-up with dedicated imaging.L3-L4 demonstrate moderate disc disease and loss of disc height, mild broad base bulging disc and mild ligamentum flavum hypertrophy. No spinal stenosis however mild bilateral neural foraminal compromise is noted.L4-L5 demonstrate mild disc disease and loss of disc height, moderate asymmetric right-sided facet hypertrophic changes and mild facet and ligamentum flavum hypertrophy on the left. There is no spinal stenosis however moderate the right and mild left neural foraminal compromise are present.L5-S1 demonstrate moderate disc disease and loss of disc height and mild bilateral hypertrophic changes of posterior elements. No spinal stenosis or neural foraminal compromise. Examination at this level however demonstrate a linear increased T2/T2 STIR signal intensity within the annulus of the disc in the midline and bilateral paramedian consistent with an annular fissure which is best appreciated on axial T2 series 5 image 22 and sagittal T2, T2 STIR image 10.

Output: 1.Mild to moderate degenerative changes of lumbar spine without spinal canal compromise or stenosis at any level.2.Midline and bilateral paramedian annular fissure at L5-S1 is noted.3.Mild to moderate neural foraminal compromise as detailed per level above.4.Bilateral multiple large renal cysts are identified. Follow-up with dedicated imaging is recommended.


Instruction: Generate impression based on findings.

Input: 56-year-old male status post syncope. There is no evidence of intracranial hemorrhage, mass or edema. Periventricular and deep white matter diffuse hypodensities consistent with small vessel ischemic disease, age indeterminate. If there is clinical concern for stroke, an MRI may be considered.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: Periventricular and deep white matter diffuse hypodensities consistent with small vessel ischemic disease, age indeterminate. If there is clinical concern for stroke, an MRI may be considered.


Instruction: Generate impression based on findings.

Input: Left vestibular schwannoma resection. Internal Auditory Canal: There has been interval evolution of postoperative findings related to left translabyrinthine surgery with fat graft in the mastoid bowl. There is a heterogeneously enhancing, well-defined, extra-axial mass within the left cerebellopontine angle cistern and skeletonized internal auditory canal that measures 15 AP x 32 RL x 20 SI mm. There is persistent mass effect upon the adjacent left cerebellar hemisphere and pons.Brain: There is no evidence of intracranial hemorrhage or acute infarct. There is unchanged left cerebellar hemisphere encephalomalacia. The ventricles and basal cisterns are unchanged in size and configuration.

Output: Postoperative findings related to left translabyrinthine surgery with residual vestibular schwannoma.


Instruction: Generate impression based on findings.

Input: Redemonstration of left intracranial/cisternal optic nerve and optic chiasm mass. The mass demonstrate regions of solid and enhancing tumor, foci of solid and partially enhancing tumor as well as cystic component. The tumor extends from the cisternal component of left optic nerve superiorly along the anterior aspect of supraclinoid internal carotid artery, superiorly into the basal cistern/hypothalamic region and posteriorly into the interpeduncular cistern and laterally into the proximal horizontal segment of left sylvian fissure. The tumor also has a small subfrontal component similar to prior exam. There is intrinsic T1 hyperintensity at the region of hypothalamus compatible with calcification. There is stable to minimal decrease in the size of the left paraclinoid enhancing component now measuring 13 x 14 x 13 mm in AP, transverse, and CC dimensions. It previously measured 13 x 17 x 16 mm. There is slight increase in the size of the cystic components just anterior to the interpeduncular cistern measuring 8 x 9 mm in AP and CC dimensions, previously 6 x 7 mm. Separate adjacent enhancing nodular component is without significant change from prior study.There is cystic collection in the middle cranial fossa, which follows near CSF characteristics. This collection has minimally decreased in size.No diffusion-weighted abnormalities are identified. There is no evidence for intracranial hemorrhage. The ventricles and sulci are normal in size. Flow voids re present within the major vessels indicating patency. Left maxillary mucous retention cyst.

Output: 1.Redemonstration of mixed signal intensity and pattern of enhancement of an irregular mass arising from the cisternal component of the left optic nerve and with involvement of the optic chiasm, extension into the interpeduncular cistern/hypothalamic region and minimally into the left subfrontal region and laterally into the proximal sylvian fissure. Left paraclinoid enhancing component is slightly decreased in size. Slight increase in the size of the cystic component anterior to the interpeduncular cistern. Adjacent nodular enhancing component is stable in size. 2.Cystic collection in the left medial middle cranial fossa follows near CSF characteristics and slightly decreased in size.3.No evidence of any additional new lesions since prior exam.


Instruction: Generate impression based on findings.

Input: Male, 62 years old, with history of GBM status post recent fall with pain in the lower back. Brain:Again seen is a rim-enhancing, centrally necrotic tumor in the right paramedian frontal lobe with evidence of biopsy. Since the prior examination, the overall size of the enhancing lesion has expanded and now measures 44 x 28 x 35 mm, previously 35 x 23 x 24 mm. Most of the enhancing rim correlates with elevated rCBV. T2 hyperintensity in the surrounding right frontal and parietal lobes is also significantly expanded with progressive regional sulcal effacement.Elsewhere, no new enhancing or nonenhancing lesions are identified. No evidence is seen to suggest acute intracranial hemorrhage or any abnormal extra-axial fluid collection. No acute ischemia is detected. Ventricles remain normal in size and morphology allowing for mild mass effect upon the right lateral ventricle.Lumbar:A compression deformity of the T12 vertebral body is seen with approximately 25% loss of vertebral body height. The marrow is edematous with reactive enhancement. No significant retropulsion is seen.The remaining vertebral bodies demonstrate preservation of height. No additional areas of edema or marrow replacement are seen. Spinal alignment is anatomic.The visualized distal spinal cord, conus and nerve roots of the cauda equina are within normal limits. No pathologic spinal cord or leptomeningeal enhancement is seen within the limitations of motion degraded images.Enhancement and mild edema is seen within the interspinous spaces of the lumbar spine. No obvious hematoma or fluid collection is seen.At L5-S1, there is a shallow central disc protrusion with annular fissuring but no significant spinal canal or foraminal stenosis. Elsewhere, the intervertebral discs are preserved.

Output: 1.Findings are seen concerning for interval progression of the right paramedian frontal lobe tumor. Treatment effect is a less likely consideration.2.A recent compression deformity of the T12 vertebral body is seen with approximately 25% loss of vertebral body height. No associated retropulsion or spinal canal stenosis is detected.3.Mild edema and enhancement within the interspinous spaces of the lumbar spine may represent soft tissue injury/ligamentous strain related to the patient's fall. However, it could also be an unrelated manifestation of interspinous impingement (Baastrup disease).


Instruction: Generate impression based on findings.

Input: Reason: metastatic Prostate cancer, right sided lower thoracic spine predominantly sclerotic lesions amenable to biopsy (per Dr Christoforidis) History: Requiered per Protocol 12-0109 Serial CT images obtained during the biopsy procedure demonstrate the needle placement within the vertebral lesion. Incidental note is made of calcific gallstones which have moved to a dependent position on the prone position scan relative to the prior supine position CT of the abdomen from 8/27/13.

Output: 1.T10 vertebral bone biopsy under CT guidance. A total of six samples were delivered to pathology for analysis.2.Gallstones


Instruction: Generate impression based on findings.

Input: Neck pain. Osteoarthritis? There are tiny posterior vertebral body osteophytes noted at multiple levels, but the intervertebral disc spaces are appear normal for age. Alignment is within normal limits. Vertebral body heights are preserved. There is perhaps mild narrowing of the neural foramina bilaterally, but this would be better assessed with MRI if clinically warranted.

Output: Minimal degenerative arthritic changes as described above, essentially within normal limits considering the patient's age.