Instruction: Generate impression based on findings.

Input: Increase seizures and headaches. There are subcentimeter foci of high T2 signal in the anterior right subinsular and adjacent inferior right frontal lobe white matter. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. However, there is fluid within the left mastoid air cells and middle ear.

Output: 1. Nonspecific subcentimeter foci of high T2 signal in the anterior right subinsular and adjacent inferior right frontal lobe white matter. Otherwise, no evidence of acute intracranial hemorrhage, mass, or acute infarct.2. Nonspecific fluid within the left mastoid air cells and middle ear may represent otomastoiditis.


Instruction: Generate impression based on findings.

Input: 66 year old male with a history of pulmonary hypertension status-post thromboendarterectomy who is referred for cardiac MRI Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 58%, the LV end diastolic volume index is 91 ml/m2 (normal range: 74+/-15), the LVEDV is 188 ml (normal range 142+/-34), the LV end systolic volume index is 39 ml/m2 (normal range 25+/-9), the LVESV is 79 ml (normal range 47+/-19), the LV mass index is 31 g/m2 (normal range 85+/-15), and the LV mass is 63 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement present to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. The native myocardial T1 relaxation times range between 900-970 ms (normal limits). No evidence of myocardial iron overload. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and mildly reduced systolic function. The overall RV ejection fraction is 46%, the RV end diastolic volume index is 95 ml/m2 (normal range 82+/-16), the RVEDV is 196 ml (normal range 142+/-31), the RV end systolic volume index is 52 ml/m2 (normal range 31+/-9), and the RVESV is 107 ml (normal range 54+/-17).Right AtriumThe right atrium is moderately dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is trace tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is mildly dilated (35 mm). Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size and systolic function (LVEF 58%) without evidence of underlying myocardial fibrosis, inflammation, or infiltration.2. The right ventricle is normal in size and mildly reduced systolic function (RVEF 46%).3. The main pulmonary artery is mildly dilated (35 mm). 4. The right atrium is moderately 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: Alignment is normal. The marrow signal is benign. The cervical and upper thoracic cord is normal in signal without abnormal enhancement. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable.Mild inflammatory changes are noted in the mastoid air cells bilaterally.C2/3: UnremarkableC3/4: UnremarkableC4/5: UnremarkableC5/6: Uncinate hypertrophy and ligamentum flavum thickening without stenosis.C6/7: There is a left paramedian disc herniation which abuts the cord surface causing anterior left hemicord flattening, without intrinsic cord signal abnormality and no cord compression.C7/T1: Unremarkable

Output: C6/7: There is a left paramedian disc herniation which abuts the cord surface causing anterior left hemicord flattening, without intrinsic cord signal abnormality and no cord compression.


Instruction: Generate impression based on findings.

Input: 47-year-old female with biopsy proven DCIS in the left breast There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.In the left breast at posterior 5:00 position, there is a clip artifact from the recent biopsy of DCIS. There is a small linear non-mass enhancement anterior and posterior from this clip artifact. AP measurement of the enhancement is 21 mm, which is approximately the same AP measurement of calcifications on the mammogram.In the right breast at the central aspect, there is a benign appearing enhancing focus.No abnormal lymph nodes are identified in either axillary region.

Output: 1. Non-mass enhancement with a clip artifact at posterior 5:00 position in the left breast, at the site of proven DCIS. Single wire localization can be performed for a breast conservation surgery. 2. Benign appearing enhancing focus in the right central breast. Follow up MRI in 6 months is recommended. 3. No abnormal lymph nodes are identified in either axillary region.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: 56-year-old male with metastatic small cell lung carcinoma status post radiation therapy. Neck mass. Headache. There is a 1.7 x 1.5 cm ring enhancing mass within the right high parietal convexity, with surrounding hypodensity consistent with a metastatic lesion with surrounding vasogenic edema. There are also questionable punctate enhancing lesions within the left frontal lobe and the left high parietal convexity. Brain MRI with contrast is recommended for more sensitive evaluation of these lesions. No midline shift or intra-cranial hemorrhage is seen. 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.The neck demonstrates a 2.8 x 2.7 x 3.1 cm enhancing mass within the right neck, with mass effect and compression of the right internal jugular vein. This likely represents a deep cervical nodal metastasis. In addition, there are multiple sclerotic lesions within the C3, T1, T3, T5, and T6 vertebral bodies, as well as the right posterior elements of C5. Within the visualized lung, there is bilateral pleural thickening and left-sided fibrosis and focal calcification. Please refer to dedicated chest CT for further discussion.

Output: Multiple intracranial, osseous, and deep cervical metastatic lesions as described above. Brain MRI with contrast is recommended for more sensitive characterization of intracranial lesions.


Instruction: Generate impression based on findings.

Input: 65-year-old male with an acute knee injury presents with left knee pain and swelling. MENISCI: There is horizontally oriented signal within the posterior horn and body of the medial meniscus extending to the tibial articular surface indicating a horizontal tear. This tear extends through the peripheral fibers of the posterior horn of the medial meniscus and is associated with small parameniscal cysts, posteriorly. There is additional globular signal replacing much of the root of the medial meniscus which extends to the free edge of the meniscus likely representing mucoid degeneration and additional tearing. There is blunting of the free edge of the posterior horn of the lateral meniscus indicating degeneration/radial tearing. There is additional intrasubstance degeneration noted within the body of the lateral meniscus.ARTICULAR CARTILAGE AND BONE: There is superficial degeneration of the articular cartilage of the patella with small subchondral cysts noted inferiorly. There is focal degeneration of the articular cartilage of the medial facet of the femoral trochlea, inferiorly. There is heterogeneity of the articular cartilage of the medial femoral condyle posteriorly indicating mild degeneration. LIGAMENTS: The ACL appears intact. The proximal fibers of the PCL appears thickened with foci of increased signal intensity internally. This likely represents chronic degeneration with acute interstitial tearing considered less likely. The MCL and LCL appear intact.EXTENSOR MECHANISM: There is a tear of the quadriceps tendon and its patellar insertion. The tear involves predominantly the middle and posterior components of the tendon (tendons of the vastus musculature) with approximately 1 cm of retraction. The anterior fibers of the rectus femoris can be traced to the patella, although there is increased signal intensity within the rectus femoris fibers approximately 3 cm proximal to its insertion, suggesting partial thickness tearing. There is heterotopic ossification within the proximal patellar tendon indicating chronic tendinosis. The patellar tendon otherwise appears intact. ADDITIONAL

Output: 1. Insertional quadriceps tear as described above.2. Medial and lateral meniscus degeneration and tears as described above.3. Thickening and increased signal intensity of the proximal fibers of the PCL likely representing chronic degeneration rather than acute tearing.4. Small joint effusion and Baker's cyst.5. Cartilage degeneration and other findings as described above.


Instruction: Generate impression based on findings.

Input: 32-year-old female with cerebral cavernous malformation. There is persistent stability in size and signal characteristics of a small focus of T2/FLAIR hypointensity in the subcortical white matter of the left posterior cingulate gyrus with associated susceptibility abnormality. As before, there is no lesional edema or mass effect. There may be a tiny associated vein representing a small associated DVA, however no definite findings of an associated developmental venous anomaly. There are several additional lesions demonstrated on susceptibility weighted sequences within the bilateral cerebral hemispheres which are unchanged. There are no lesions demonstrated within the posterior fossa or brainstem. Within differences of technique these correlate with those on the prior exam and there are no new lesions identified.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, midline shift, intra or extra-axial fluid collection/hemorrhage, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1.Stable left posterior cingulate gyrus subcortical lesion compatible with a cerebral cavernous malformation and deposition of subacute blood products. There may be a tiny associated vein representing associated DVA.2.Stable additional punctate foci of susceptibility throughout the brain consistent with multiple cavernous malformations.3.No definite new lesions.


Instruction: Generate impression based on findings.

Input: Male, 11 months old, with staring spells x 2. The cerebellar tonsils are pointed and descend approximately 5 mm below the level of the foramen magnum. The CSF space is effaced through the foramen magnum.Brain morphology is otherwise unremarkable. No evidence of restricted diffusion or any other signal abnormality is detected. No edema or mass effect is seen.The pituitary region is unremarkable. The corpus callosum is fully formed and normal. The brainstem and cerebellar vermis are unremarkable.No evidence of intracranial hemorrhage or any abnormal fluid collection is seen. The ventricles are normal in size and morphology.

Output: 1.Findings compatible with Chiari I malformation.2.No other specific abnormalities are detected.


Instruction: Generate impression based on findings.

Input: Reason: labral tear History: pain and locking ROTATOR CUFF: There is a small concealed insertional tear of the supraspinatus tendon at its insertion, measuring just under 1 cm in the AP dimension, involving less than 50% of the thickness of the tendon. The remainder of the supraspinatus tendon and muscle appear normal. There is perhaps mild insertional tendinosis of the infraspinatus, but otherwise the infraspinatus appears normal. The subscapularis and teres minor muscles and tendons appear normal. There is gadolinium infiltration within the subscapularis muscle which is likely iatrogenic.SUPRASPINATUS OUTLET: Mild to moderate osteoarthritis affects the acromioclavicular joint. There is spurring of the anterior aspect of the acromion process with perhaps mild impression upon the superior fibers of the supraspinatus. There is a trace amount of fluid within the subacromial/subdeltoid bursa, but no gadolinium is identified to indicate a full-thickness rotator cuff tear.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is anatomic. There is increased signal intensity within the anterior aspect of the superior labrum, appearing more prominent than a typical sublabral sulcus and we suspect that this represents a tear, but the clinical significance of this is uncertain. We also suspect that this signal abnormality extends into the biceps anchor. The anterior inferior labrum appears slightly blunted, but there is no convincing inferior labral tear.BICEPS TENDON: The remainder of the visualized tendon of the long head of the biceps appears normal.

Output: 1. Findings suspicious for a tear of the anterior superior labrum with probable extension into the biceps anchor.2. Concealed interstitial tear within the supraspinatus at its insertion.3. Osteoarthritis of the acromioclavicular joint.


Instruction: Generate impression based on findings.

Input: Stage IV neuroblastoma, off therapy since 3 months. Evaluate for progression of disease. No abnormal mass or enhancement is appreciated within the lumbar spinal canal to suggest tumor recurrence. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position. No spinal canal or neural foraminal stenosis is seen.Paraspinous soft tissues appear within normal limits. No obvious mass within the retroperitoneum is appreciated, but can be better assessed with dedicated abdominal imaging.

Output: No evidence of tumor recurrence within the lumbar spine.


Instruction: Generate impression based on findings.

Input: 57-year-old male with periorbital swelling. Please evaluate for signs of orbital cellulitis. Limited intracranial images show no evidence of intracranial hemorrhage or edema. Ill-defined focus of increased attenuation within the sella seen throughout the noted images may be related to volume averaging. With appropriate clinical history a dedicated pituitary 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.ORBITS: Mild preseptal and periorbital soft tissue inflammatory changes are noted without evidence of discrete focal fluid collection to suggest abscess. The retro-orbital fat remains intact without evidence of infiltration. Optic nerve sheath complex appears unremarkable.

Output: Preseptal and periorbital mild soft tissue swelling without evidence of retro-orbital extension.


Instruction: Generate impression based on findings.

Input: 27-year-old male with history of primary sclerosing cholangitis, now with elevated total bilirubin, jaundice, pruritus. Evaluate for a dominant stricture. ABDOMEN:LIVER, BILIARY TRACT: Common bile duct is dilated to 1 cm, proximal to an approximately 2 cm segment of narrowing and irregularity of the distal common bile duct, unchanged compared to the previous examination. There are multiple regions of narrowing and dilatation involving the intrahepatic bile ducts giving beaded appearance, stable. Persistent narrowing of the right common bile duct at the confluence.SPLEEN: Multiple stable splenic cysts. Again noted is a large T2 hyperintense complex cystic lesion in the anterior spleen with multiple enhancing septations measuring approximately 2.7 x 2.1 cm (series 401, image 36) not significantly changed.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: Ahuastration of the colon again with colon measuring up to 6 cm. BONES, SOFT TISSUES: Fluid attenuating focus in the epidural space in the upper thoracic spine partially imaged.OTHER: No significant abnormality noted.

Output: 1.No significant change in the intra and extrahepatic biliary stricturing consistent with history of primary sclerosing cholangitis.2.Multiple stable splenic cysts, including a larger nonspecific complex cyst. 3.Ahaustration of the colon consistent with inflammatory bowel disease with persistent dilatation measuring up to 6 cm. 4.Fluid draining focus in the epidural space and upper thoracic spine is partially imaged. If patient has symptoms further evaluation can be obtained by MRI of the T-Spine


Instruction: Generate impression based on findings.

Input: High risk for breast cancer screening, strong family history of breast and ovarian cancer. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

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

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


Instruction: Generate impression based on findings.

Input: 56 years, Female, left weakness and numbness presenting a stroke code status post TPA. No restricted diffusion to suggest acute ischemia. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. Multiple confluent areas and scattered foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild to moderate chronic small vessel ischemic disease. There are also scattered foci of susceptibility compatible with chronic microhemorrhage including the right temporal lobe as well as along the left periatrial white matter. Major flow-voids are preserved. There is mild to moderate opacification throughout the paranasal sinuses including the anterior and posterior ethmoid air cells, left worse than right, as well as mild mucosal thickening involving the maxillary sinuses, left greater than right. There is also mild opacification of the mastoid air cells, left greater than right. There is deformity involving the right medial orbital wall compatible with remote blowout fracture, with medial herniation of fat and slight contour deformity involving the right medial rectus muscle.

Output: 1. No evidence of acute infarct.2. Scattered foci of T2/FLAIR hyperintensity in the white matter are nonspecific but compatible with mild to moderate chronic small vessel ischemic disease. There are also few scattered foci of chronic microhemorrhage in a nonspecific distribution.3. Chronic right medial orbital wall fracture.


Instruction: Generate impression based on findings.

Input: 25-year-old with history of Hodgkin's lymphoma, status post chest wall radiation. High-risk for breast cancer. There is scattered fibroglandular tissue in both breasts.Minimal parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Evaluate for residual flair signal change and for hemorrhage History: s/p right side craniotomy for resection of temporal lesion Postsurgical changes of anterior right temporal craniotomy and resection of the mesial temporal lesion. There is small amount of diffusion restriction along the posterior margin of the resection cavity compatible with cytotoxic edema and blood products. At least most of the previously seen masslike FLAIR hyperintensity has been resected. In comparison with preoperative images, however, there is a focus of FLAIR signal abnormality (series 801 image 15) involving the right medial temporal lobe adjacent to the temporal horn, which is suspicious for minimal residual lesion. The right anterior temporal resection cavity is filled with postoperative fluid/blood products which extend along the right cerebral convexity. There is parenchymal intrinsic T1 hyperintensity related to the right anterior temporal blood products without definite residual enhancement previously seen with the lesion. No midline shift or herniation. No hydrocephalus. There is edema of the overlying scalp extending to the periorbital region. There is diffuse nonspecific opacification of the bilateral mastoid air cells and paranasal sinuses.

Output: Postsurgical changes involving the right anterior temporal lobe. There appears to be near total resection of the right temporal lesion with small focus of residual FLAIR signal abnormality involving the right medial temporal lobe adjacent to temporal horn, which may represent minimal residual tumor.


Instruction: Generate impression based on findings.

Input: Rule out a volar plate or collateral ligament injury to the right SF PIP joint. Evaluation of the fifth finger on several sequences is limited by excessive noise.The PIP joint is held in slight flexion. There is edema likely representing bone contusion from prior injury in the head of the proximal phalanx and the base of the middle phalanx. There is also a small amount of fluid in the PIP joint. The collateral ligaments of the PIP joint appear intact. The volar plate appears intact. The flexor tendon apparatus appears normal. The extensor tendon is difficult to see dorsal to the middle phalanx but its attachment to the middle and distal phalanges appear intact. Although the A2 pulley is difficult to visualize, we suspect that it is intact.

Output: Bony contusions in the head of the proximal phalanx and the base of the middle phalanx of the right fifth digit. We see no findings to indicate collateral ligament injury or volar plate injury.


Instruction: Generate impression based on findings.

Input: Low back pain [M54.5], Reason for Study: ^Reason: lumbar pain concerning for spondylosis vs HNP History: lumbago For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. There is a focal endplate defects on the at the level of T12-L1 disc. Specifically, inferior endplate of T12 and superior endplate of L1 shows smooth margin defect with associated bone marrow edema. This finding suggests acute Schmorl's node. This can be symptomatic.Overall, T1 images of lumbar vertebrae, sacrum and bilateral iliac bones show relatively low signal intensity. However, since those signal intensities are brighter than those of intervertebral discs and adjacent muscle, these relatively lower T1 signal intensity can be seen as within normal range. There is normal lumbar lordosis. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. The epidural space, thecal sac, and spinal cord are preserved with no evidence of spinal canal/neural foraminal narrowing. The conus medullaris terminates at the T12-L1 level.The intervertebral discs demonstrate normal T2 intensity and height with no evidence of disc herniation. The paraspinal soft tissues are unremarkable.

Output: 1. Acute Schmorl's node, at the level of T12-L1 with surrounding edema.2. Otherwise no remarkable finding.


Instruction: Generate impression based on findings.

Input: The study is mildly motion degraded limiting evaluation, especially of the axial sequences. There is persistent anterolisthesis of C3 on C4 measuring up to 5 mm. There is loss of cervical lordosis with interval progression of multilevel degenerative spondylotic changes. There is no evidence of acute fracture. There is no prevertebral soft tissue swelling.C2-3: Disk desiccation, minimal loss of disk height and disk osteophyte complex and left greater than right uncovertebral hypertrophy no significant spinal stenosis.C3-4: Disk desiccation, loss of disk height. Anterolisthesis of C3 on C4 with uncovering of the disk, kinking of the spinal cord, with moderate to severe spinal canal stenosis and no cord signal changes. Severe bilateral neural foraminal stenosis.C4-5: Disk desiccation, loss of disk height and disk osteophyte complex, bilateral uncovertebral and facet hypertrophy causing mild spinal canal stenosis and bilateral right greater than left neural foraminal stenosis.C5-6: Disk desiccation, loss of disk height and disk osteophyte complex, bilateral uncovertebral and facet hypertrophy causing mild spinal canal stenosis and moderate bilateral neural foraminal stenosis.C6-7: Disk desiccation, loss of disk height and disk osteophyte complex and bilateral facet hypertrophy causing no significant spinal canal stenosis and moderate left neural foraminal stenosis.C7-T1: Disk desiccation, loss of disk height and disk osteophyte complex with left uncovertebral hypertrophy causing moderate left neural foraminal stenosis and spinal canal or right neural foraminal stenosis.On the sagittal images, T1-2 and T2-3 show minimal disk bulges with no significant disk herniation or spinal stenosis.

Output: 1.Moderate to severe spinal canal stenosis with kinking of the cord at C3-4 without cord signal abnormality. Findings felt to be due to degenerative anterolisthesis of C3 on C4.2.Mild to moderate cervical spondylotic changes as described above.3.No evidence of acute fracture.


Instruction: Generate impression based on findings.

Input: 75 years, Female, Reason: 74 yo female with hx of pancreas mass; please evaluate for changes and or abnormalities History: pancreas mass. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Diffuse loss of signal on out of phase images suggest steatosis. No focal hepatic lesion.Common bile duct appears normal.SPLEEN: No significant abnormality noted.PANCREAS: Cystic lesion in the pancreatic tail measuring 7 x 5 mm (6/97) and communicating with the pancreatic duct is unchanged and likely represents a sidebranch IPMN, or intraductal papillary mucinous neoplasm. Pancreatic duct appears normal.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral atrophic kidneys with small renal cysts. Right iliac fossa renal transplant.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Stable subcentimeter cystic lesion in the pancreatic tail, likely a sidebranch IPMN.


Instruction: Generate impression based on findings.

Input: BRAIN: There are postoperative findings related to posterior fossa tumor resection without evidence of recurrent tumor. There is an unchanged peripherally-enhancing subcentimeter cystic pineal gland. There is no evidence of acute infarction. The ventricular system is unchanged in size and configuration. There is no midline shift. The major cerebral flow voids are intact. The skull and extracranial structures appear unchanged.SPINE: There is no abnormal enhancement within the thecal sac and the spinal cord displays normal signal. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. The paravertebral soft tissues are unremarkable.

Output: 1. Postoperative findings related to suboccipital craniectomy without evidence of intracranial recurrent tumor 2. No evidence of drop metastases in the spine.


Instruction: Generate impression based on findings.

Input: Reason: left eye ptosis, reduced visual field left eye, neck pain History: progressive bilateral upper extremity weakness MRI Brain: No intracranial mass or mass-effect. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. The ventricles are within normal limits in size and configuration. Multiple patchy areas and scattered foci of T2/FLAIR hyperintensity are again seen in the bilateral subcortical and periventricular white matter as well as the pons, which are nonspecific, but most compatible with chronic small vessel ischemic disease. Brain parenchyma is otherwise unremarkable for age. No abnormal parenchymal or meningeal enhancement. Specifically no abnormal enhancement or masses are seen associated with the cranial nerves, cavernous sinuses, or skull base foramina. Major flow-voids are preserved.Outpouching of the posterior globes again seen which may suggest staphyloma. Small right maxillary mucous retention cysts and minimal paranasal sinus mucosal thickening again noted.MRI Soft Tissue Neck: Examination slightly motion degraded. No masses or abnormal enhancement is appreciated within the oral cavity, pharynx, or parapharyngeal soft tissues. Minimal asymmetric fullness noted at the left fossa of Rosenmuller without evidence of underlying mass. Scattered small cervical lymph nodes are seen which are nonspecific without significant lymphadenopathy.There are moderate degenerative changes in the cervical spine with up to moderate spinal canal and moderate to severe neural foraminal narrowing as described on recent MRI cervical spine study. Diffuse heterogeneity of the bone marrow signal is again seen which is nonspecific.

Output: 1. Moderate chronic small vessel ischemic disease. No evidence of intracranial mass or mass effect. No abnormal enhancement.2. No abnormal masses within the neck soft tissues are appreciated.3. Moderate degenerative changes in the cervical spine which may be contributing to patient's neck pain and better assessed on recent MRI cervical spine study.


Instruction: Generate impression based on findings.

Input: 56-year-old female patient status post liver transplant presents with inability to place biliary drain. Note that the examination is limited due to the lack of intravenous contrast and vasculature cannot be fully evaluated.ABDOMEN:LIVER, BILIARY TRACT: There is interval resolution of left lobe abscess. Left-sided biliary ductal dilatation is stable to mildly increased compared to prior examination. There is also mild to moderate irregular biliary ductal dilatation in the right lobe liver, stable to slightly increased compared to prior. There is anastomosis of the left hepatic biliary duct to the jejunum and separate anastomosis of the right hepatic biliary duct to the jejunum. Both of the anastomotic sites are patent. Porta hepatic lymphadenopathy again noted.SPLEEN: Splenomegaly again noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Right-sided pleural effusion.

Output: 1.Irregular intrahepatic biliary structures are unchanged to slightly increased compared to prior examination. There are patent right and left duct anastomoses to the jejunum. Lack of intravenous contrast limits evaluation of liver parenchyma and hepatic vasculature.2.Interval resolution of left lobe of the liver abscess.3.Right-sided pleural effusion.


Instruction: Generate impression based on findings.

Input: 61-year-old male with left knee pain. Rule out ligamentous/meniscal injury. Somewhat suboptimal examination secondary to patient motion artifact.MENISCI: There is increased linear branching signal abnormality within the posterior horn of the medial meniscus which extends to the femoral and tibial articular surface consistent with a complex tear. There is deformity of the posterior horn extending to the body of the meniscus. There is associated subcentimeter foci of fluid signal intensity along the posteromedial aspect of the meniscus consistent with meniscal cyst formation. The anterior horn appears intact. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is a focal full-thickness articular cartilage defect along the lateral femoral condyle. There is bone marrow edema in the underlying area as well as subchondral cyst formation. There is fraying and irregularity of the articular cartilage along the lateral facet of the patella.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism is intact. ADDITIONAL

Output: 1. Complex tearing of the posterior horn of the medial meniscus with associated parameniscal cyst formation.2. Articular cartilage degeneration as described above.


Instruction: Generate impression based on findings.

Input: Lung cancer with brain metstases status post SRS and chemotherapy. There is a persistent subcentimeter focus of residual T2 hyperintensity at the grey-white matter junction of the left superior frontal gyrus. Otherwise, there is no evidence of residual or new abnormal intracranial enhancement. There is unchanged scattered mild nonspecific cerebral white matter T2 hyperintensity, particularly in the periventricular regions. There is no evidence of intracranial hemorrhage or acute infarct. The ventricles are unchanged in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unchanged.

Output: Persistent subcentimeter focus of residual T2 hyperintensity in the left superior frontal gyrus without evidence of recurrence of the treated brain metastases otherwise.


Instruction: Generate impression based on findings.

Input: 30-year-old female with lumbar back pain status post epidural anesthesia, evaluate for a epidural abscess There is transitional lumbosacral anatomy. There is sacralization of L5 with a rudimentary disk at L5-S1. For the purposes of this exam, the last fully formed disk is at L4-L5.Alignment is anatomic. No abnormal marrow signal. Vertebral body heights and disk spaces are maintained. Normal signal of the distal cord and conus, ending at L1. No evidence of epidural abscess. T1 hyperintense normal caliber fatty filum is incidentally noted extending from L2 to L5.T12-L1: No significant spinal canal or neural foramina stenosis.L1-L2: No significant spinal canal or neuroforaminal stenosis.L2-L3: No significant spinal canal or foraminal stenosis.L3-L4: No significant spinal canal or neuroforaminal stenosis.L4-L5: No significant spinal canal or foraminal stenosis.L5-S1: Sacralization of the L5 vertebral body. No significant spinal canal or foraminal stenosis.

Output: 1.No evidence of epidural abscess or collection.2.Fatty filum is incidentally noted with normal conus termination. This is a normal variant, but can be seen associated with tethered cord. Please correlate clinically.3.Transitional spinal anatomy. If surgery is to become contemplated, correlation with imaging of the entire spine is recommended.


Instruction: Generate impression based on findings.

Input: 66-year-old male with history of hemophilia now with right flank pain ABDOMEN:LUNG BASES: Significant interval increase in the size and number of bilateral lung nodules. These are incompletely imaged with this CT of abdomen and pelvis. New small bilateral pleural effusions.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Interval increase in the size of the lytic lesion involving T8 vertebral body. There is cathodic fracture of the T 8 vertebral body secondary to this metastatic lesion. MRI may be helpful for further evaluation of the metastatic lesion and spinal canal. Small lytic lesions are also present in the lumbar vertebral bodies, suspicious for metastatic disease.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Interval increase in the size of the right iliac bone lytic lesion, best seen on image number 113, series number 3.. New left iliac bone lesion, best seen on image number 104, series number 3.OTHER: No significant abnormality noted

Output: Interval increase in the size of the T8 and right iliac bone lytic lesions and interval development of a new left iliac bone lytic lesion consistent with metastatic disease. Smaller lytic lesions are also present in the lumbar vertebral bodies. MRI of the thoracic and lumber spine may be helpful for better evaluation of these lesions.Interval increase in the size and number of lung lesions suspicious for metastatic disease.Dr. Bhatt was notified and acknowledged by the findings at the time of dictation.


Instruction: Generate impression based on findings.

Input: History of hepatocellular carcinoma status post TACE/RFA. ABDOMEN:LIVER, BILIARY TRACT: Liver is cirrhotic in morphology with atrophy of the right lobe, widening of the intrahepatic fissures, and surface nodularity. Recanalized umbilical vein and other portosystemic collaterals indicate portal hypertension.Within hepatic segment 8, anterior to the right hepatic vein the previously described arterially enhancing lesion with washout has been replaced by an ablation cavity which measures 12 x 20 mm (series 904, image 194). There is equivocal thin rim enhancement surrounding the ablation cavity which may be a posttreatment change. Otherwise, the ablation cavity does not enhance. There is a new wedge-shaped area of arterial enhancement in the periportal aspect of segment 8 (series 901, image 252) which does not washout and may represent a posttreatment transient hepatic intensity difference. No new suspicious arterial enhancing lesions are identified in the liver.There is cholelithiasis and mild gallbladder wall thickening which is nonspecific in the setting of chronic liver disease appearing similar to prior. No intra or extrahepatic biliary ductal dilatation.SPLEEN: Moderate splenomegaly with spleen measuring up to 18.5 cm in the craniocaudal dimension. Perisplenic collaterals.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple renal cysts the largest of which arises from the inferior pole of the left kidney measuring up to 6.4 cm. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: There is a 1.7 x 3.4 cm focus of non mass-like enhancement within the left breast (series 901, image 412) which demonstrates T2 hyperintensity as well as restricted diffusion.OTHER: Trace amount of ascites is seen along the inferior aspect of the liver.

Output: 1.Interval ablation of segment 8 hepatocellular carcinoma without evidence of residual or recurrent disease. Continued follow-up is recommended.2.Cirrhosis with splenomegaly and portal hypertension and trace amount of ascites.3.Cholelithiasis with gallbladder wall thickening appearing similar to prior; in the absence of symptomatology suggesting acute gallbladder disease, gallbladder wall thickening is common in patients with cirrhosis and not indicative of acute disease.4.Findings suggestive of gynecomastia of the left breast; correlation with mammography can be considered as clinically warranted.


Instruction: Generate impression based on findings.

Input: There is a focus of T1 hyperintensity and T2/FLAIR hyperintensity involving the posterior limb of the internal capsule on the left abutting the lateral aspect of the thalamus. No associated susceptibility effect. Remainder of the brain parenchyma appears unremarkable without findings to suggest traumatic encephalomalacia or hemosiderin deposition in the brain related to prior trauma. No evidence of recent infarct or hemorrhage. No intracranial mass or mass effect. No extra-axial collections. No hydrocephalus. The major cerebral flow voids are intact. There is small focus of T2 hyperintensity and restricted diffusion involving the subcutaneous soft tissues in the left temporal occipital region which may represent a sebaceous cyst. The orbits, skull, paranasal sinuses, and scalp soft tissues are otherwise grossly unremarkable.

Output: There is a focus of T1 and T2 hyperintensity involving the posterior limb of the internal capsule on the left which is nonspecific and of uncertain etiology. Finding may represent mineralization related to prior trauma if there was history of prior injury in this region. Prior inflammation or other toxic metabolic injury also remain a possibility. Comparison with prior studies is suggested if available.Remainder of the brain appears otherwise unremarkable without evidence of traumatic encephalomalacia or hemosiderin deposition related to chronic hemorrhage.


Instruction: Generate impression based on findings.

Input: Evaluate for degenerative disc disease and look for lytic lesions from multiple myeloma. There are T2 hyperintense and T1 hypointense lesions within the left iliac bone and sacrum, the largest of which measures up to approximately 3 cm. There is also a T1 and T2 hyperintense lesion within the T12 vertebral body that suppressed on STIR, which likely represents a hemangioma. At L1-L2, there is facet hypertrophy, but no spinal canal or neural foraminal stenosis. At L2-L3, there is a mild disc bulge and moderate facet hypertrophy without significant spinal canal or neural foraminal stenosis. At L3-L4, there is extensive facet arthropathy, with a new right extradural centrally T2 hyperintense lesion with T2 hypointense rim that measures up to approximately 2 cm and impinges upon cauda equina nerve roots. At L4-L5, there is facet arthropathy and a disc bulge without significant neural foraminal or spinal stenosis. At L5-S1, there is loss of disc space height and a disc bulge associated with effacement of the left lateral recess, as well as moderate right and severe left neural foraminal stenosis. There is grade 1 anterolisthesis at L4-5 and grade 1 retrolisthesis at L5-S1. There is a Schmorl node in the superior L1 vertebral body. The vertebral body heights are otherwise preserved. The paraspinous soft tissues are unremarkable.

Output: 1.A new right extradural lesion at the level of the L3 vertebral body likely represents a facet cyst associated with severe facet arthropathy and resulting in cauda equina nerve root compression.2.Multilevel degenerative spondylosis, which is most pronounced at L3-4 and L5-S1.3.Lesions within the left iliac bone and sacrum likely represent myelomatous involvement, although these are incompletely characterized due to the lack of intravenous contrast.


Instruction: Generate impression based on findings.

Input: Evaluate for abnormality/metastatic disease; history ovarian cancer. Brain: There is a peripherally enhancing mass in the medial left occipital lobe that measures up to 24 mm, with extensive surrounding vasogenic edema. There is also a heterogeneously enhancing mass in the right cerebellar hemisphere, which measures up to 15 mm, also with extensive surrounding vasogenic edema. There cerebellar tonsils extend up to 6 mm inferior to the foramen magnum. There is no evidence of intracranial hemorrhage or acute infarct. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Complete Spine: There is fatty bone marrow signal in the lumbosacral spine related to radiation effects. There is also irregular linear low T1 signal and enhancement that traverses the right sacral ala. There are prominent sacral perineural cysts with remodelling of the sacrum. Otherwise, there is no evidence of mass lesions in the spine. There are mild degenerative changes in the lower cervical spine and at L5-S1 without significant spinal canal stenosis. The vertebral body heights are preserved. There is no significant spondylolisthesis. The spinal cord signal and morphology is normal. There is a right pleural effusion.

Output: 1. Metastases in the right cerebellar hemisphere and left occipital lobe with associated vasogenic edema.2. Radiation effects in the lumbosacral spine bone marrow with probable right sacral insufficiency fracture versus less likely an infiltrative metastasis.3. Low-lying cerebellar tonsils may represent Chiari 1 malformation.4. Right pleural effusion.


Instruction: Generate impression based on findings.

Input: 66 year-old male with history of cholangiocarcinoma. ABDOMEN:LIVER, BILIARY TRACT: There is a large heterogeneous T2 hyperintense/T1 hypointense mass centered within the hepatic hilum with maximal axial dimensions of 10.1 x 7.6 cm (image 19 of series 4). After contrast administration, there is irregular enhancement particularly about the right anterior aspect of the lesion extending to the liver periphery which fills in on delayed series most compatible with cholangiocarcinoma. Large area of central nonenhancement indicates necrosis. There are innumerable other smaller lesions scattered about the liver parenchyma which also demonstrate progressive enhancement compatible with metastatic disease. There is significant intrahepatic biliary ductal dilatation, particularly within the left hepatic lobe. The left portal vein and anterior branch of right portal veins are thrombosed. The right posterior portal vein is intact.There are necrotic appearing portal lymph nodes, the largest measuring 2.9 x 1.8 cm (image 166 of series 12).A right biliary stent is in place.Cholelithiasis.SPLEEN: No significant abnormality noted.PANCREAS: No suspicious pancreatic lesions. The pancreatic duct is unremarkable.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral nonenhancing renal cysts.RETROPERITONEUM, LYMPH NODES: Extensive confluent retroperitoneal lymphadenopathy with reference left para-aortic conglomerate measuring 3.8 x 2.5 cm (image 98 of series 10).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: There are small enhancing retrocrural lymph nodes, the largest measuring 15 x 9 mm.There is a right lower lobe pulmonary nodule measuring 8 mm.

Output: 1. Findings compatible with metastatic intrahepatic cholangiocarcinoma with reference measurements and other findings as above.2. Right lower lobe pulmonary nodule is indeterminant. Chest CT is recommended when clinically appropriate.


Instruction: Generate impression based on findings.

Input: Right shoulder pain ROTATOR CUFF: There is high-grade partial-thickness tearing of the supraspinatus tendon along the bursal surface fibers. This is superimposed upon diffuse tendinopathy of the supraspinatus tendon. The infraspinatus tendon appears intact. The subscapularis and teres minor tendons are normal there is no significant atrophy of the rotator cuff musculature.SUPRASPINATUS OUTLET: Moderate osteoarthritis affects the acromioclavicular joint. There is a small amount of fluid within the subacromial subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Evaluation of the glenoid labrum is limited absent intra-articular contrast. Within these limits, there is age-related degeneration of the superior labrum without evidence of full-thickness detachment.BICEPS TENDON: Both the intra-articular and extra-articular portions of the biceps tendon are not seen, likely secondary to rupture.ADDITIONAL

Output: 1. High-grade partial-thickness to near full-thickness tearing of the supraspinatus tendon.2. Nonvisualization of the biceps tendon representing rupture.3. Moderate osteoarthritis of the acromioclavicular joint.


Instruction: Generate impression based on findings.

Input: 59-year-old male. Patient with pain, swelling, febrile, changes on XR, gram positive cocci bacteremia. Evaluate for osteomyelitis. Exam is motion degraded, limiting evaluation. Bone marrow signal intensity is within normal limits without evidence for osteomyelitis. Diffuse subcutaneous edema. No focal fluid collection is evident within limits of noncontrast exam. Severe osteoarthritis of the talonavicular joint. Small degenerative cysts are seen in the midfoot.

Output: Limited study due to motion artifact and lack of IV contrast. No evidence of osteomyelitis. Diffuse subcutaneous edema.


Instruction: Generate impression based on findings.

Input: Clinical question: History of pituitary lesion. Evaluate for change. Signs and symptoms: Breast discharge. Pre- and post enhanced pituitary MRI:Similar to prior exam there is no evidence of a pituitary adenoma.Pituitary gland demonstrate normal signal intensity and morphology and uniform pattern of enhancement. It measures maximum of 3.2 mm in height similar to prior exam from 2014.Pituitary stalk demonstrate normal uniform pattern of enhancement and with midline position.No detectable abnormality of the basal cistern, suprasellar visual complex or hypothalamic region.Unremarkable signal intensity, size and overall pattern of enhancement of cavernous sinuses.Indication cyst in the sphenoid sinus and larger retention cyst in right maxillary sinus are noted.

Output: 1.No evidence of a pituitary mass or interval change since prior exam from 2014.2.Retention cysts in the right and sphenoid sinuses is present.


Instruction: Generate impression based on findings.

Input: AML status post allo transplant complicated by GVHD, with new altered mental status. There is a focus of blooming effect in the right cerebellar hemisphere, which may represent hemosiderin deposition or mineralization. There is scattered periventricular and subcortical white matter T2 hyperattenuation. Otherwise, there is no evidence of tumors or acute infarction. The ventricles and sulci are mildly prominent diffusely due to cerebral volume loss. There is no midline shift or herniation. The pituitary gland appears unremarkable. There is fluid within the bilateral mastoid air cells. There is mild mucosal thickening in the right maxillary sinus and scattered ethmoid air cells. The orbits and calvarium are unremarkable.

Output: 1. No abnormal diffusion restriction or acute intracranial hemorrhage.2. Scattered periventricular and subcortical white matter hyperattenuation is nonspecific, but may represent chronic small vessel ischemic disease3. Nonspecific focus of blooming effect in the right cerebellar hemisphere, which may represent hemosiderin deposition or mineralization. 4. Bilateral fluid-filled mastoid air cells, which may represent mastoiditis.


Instruction: Generate impression based on findings.

Input: Hodgins Lymphoma s/p ABVD x 1cycle - persistent dysphagia / nausea / vomiting - vocal cord paralysis/ right facial weakness. Furthermore, there is apparent increase in size of portions of the right skull base tumor with enlargement of the portions in the right cerebellomedullary angle cistern, and new extension of tumor into the right Meckel cave. Otherwise, the soft tissue components in the right prevertebral and paravertebral spaces, with extension in the right middle ear, jugular foramen, hypoglossal canal, and foramen lacerum, and portions of the facial nerve path, including the greater superficial petrosal nerve and in the region of the stylomastoid foramen, have not significantly changed. There is persistent fluid within the right middle ear and mastoid air cells with extensive mucosal thickening. There is persistent diffuse enhancement of the bone marrow in the right lateral and central skull base, with mild overlying dural enhancement diffusely, including within the right internal auditory canal. There is protrusion of the bilateral optic nerve discs and prominence of the optic nerve sheaths.

Output: Apparent increase in size of portions of the right skull base tumor with enlargement of the portions in the right cerebellomedullary angle cistern, and new extension of tumor into the right Meckel cave. Otherwise, the soft tissue components in the right prevertebral and paravertebral spaces, with extension in the right jugular foramen, hypoglossal canal, and foramen lacerum, and portions of the facial nerve segments, have not significantly changed. Persistent right tympanomastoid opacification, which may be related to Eustachian tube obstruction and/or otomastoiditis. Protrusion of the bilateral optic nerve discs and prominence of the optic nerve sheaths may indicate elevated cerebrospinal fluid pressure.


Instruction: Generate impression based on findings.

Input: Cervicalgia, post concussive syndrome. MVA one month ago, flashbacks since, memory loss, headaches, foggy brain. Brain: Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with chronic small vessel ischemic changes. No focal area of traumatic encephalomalacia. There is punctate focus of susceptibility effect involving the left occipital lobe compatible with chronic microhemorrhage and nonspecific. Brain parenchyma is otherwise unremarkable for age. There is mild global parenchymal volume loss which appears appropriate for age. No restricted diffusion to suggest acute ischemia. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved. Paranasal sinuses and mastoid air cells are clear. Bone marrow signal is within normal limits. Cervical Spine:Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. There is mild loss of cervical lordosis and mild retrolisthesis of C4 on C5. Alignment is otherwise grossly maintained. Bone marrow signal is benign. The cervical spinal cord has normal signal characteristics and overall morphology. No evidence of cord edema, hemorrhage, or focal volume loss to suggest prior cord injury. Degenerative changes are seen in the cervical spine with disc osteophyte complexes at C3-C4, C4-C5, C5-C6. Individual levels as below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: Small disc osteophyte complex and uncovertebral hypertrophy on the right. No significant compromise to the spinal canal or neural foramina.C4-5: Small disc osteophyte complex and ligamentum flavum thickening. There is minimal spinal canal narrowing. There is mild to moderate right neural foraminal stenosis related to uncovertebral hypertrophy and no significant left neural foraminal stenosis. C5-6: Small small disc osteophyte complex and ligamentum flavum thickening with minimal spinal canal narrowing. There is mild to moderate right and moderate left neural foraminal stenosis.C6-7: Minimal disc bulge. No significant spinal canal or neural foraminal stenosis.C7-T1: No significant compromise to the spinal canal or neural foramina. Mild left-sided facet arthropathy.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: 1. No evidence of traumatic encephalomalacia or definitive evidence of traumatic brain injury. No intracranial mass or mass effect. There is a punctate focus of chronic microhemorrhage in the left occipital lobe which is nonspecific and may be related to prior trauma, for example, but other etiologies like amyloid angiopathy should also be considered. Additional scattered foci of T2/FLAIR hyperintensity in the periventricular and subcortical white matter are also nonspecific but favored to be related to mild chronic small vessel ischemic disease. Brain MRI is otherwise unremarkable for age.2. No evidence of traumatic cord injury. There are degenerative changes in the cervical spine without significant spinal canal stenosis. There is mild to moderate right C4-C5 neural foraminal stenosis and mild to moderate right and moderate left C5-C6 neural foraminal stenosis.


Instruction: Generate impression based on findings.

Input: Ms. Wesley is a 47-year-old female with known right breast IDC with lobular features/DCIS and a metastatic right axillary lymph node. She presents today for I-SPY research MRI (#4). There is scattered fibroglandular tissue in both breasts. Mild background parenchymal enhancement is noted bilaterally.RIGHT BREAST: There has been slight interval decrease in size of biopsy-proven malignancy in the right retroareolar region now measuring 3.2 x 1.4 x 3.0 cm, previously measuring 3.2 x 2.7 x 3.3 cm (AP x ML x SI). The biopsy-proven malignancy demonstrates less avid enhancement on postcontrast sequences when compared to the prior study. Again seen is a biopsy marker clip located centrally within this malignancy. There continues to be minimal persistent periareolar skin thickening. Multiple benign enhancing masses in the right breast are unchanged. Biopsy-proven metastatic right axillary lymph node now measures 1.5 x 0.9 cm, previously 1.8 x 1.1 cm. Biopsy marker clip is located centrally within this lymph node. No new abnormal enhancement is identified in the right breast. LEFT BREAST:No abnormal enhancement is seen in the left breast. No abnormal axillary lymph nodes are identified in the left axillary region. Vascular port again present in the left medial chest wall.

Output: (1) Slight interval decrease in size and marked decrease in enhancement pattern of patient's known right breast malignancy. Slight interval decrease in size of known metastatic right axillary lymph node.(2) No MRI evidence of malignancy in the left breast. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Male 63 years old Reason: evaluate for metastasis History: hx of renal cell carcinoma, high risk, sp nephrectomy, CKD Evaluation of solid and hollow abdominal viscera is limited without intravenous contrast.ABDOMEN: LIVER, BILIARY TRACT: Liver is normal in morphology. Probable hepatic cysts. No biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Status post right nephrectomy.Duplicated left renal collecting system. The left upper pole moiety is dilated was previously shown to drain into the prostatic urethra. The lower pole moiety is normal in caliber.RETROPERITONEUM, LYMPH NODES: No retroperitoneal lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Status post right nephrectomy without definite evidence of recurrent or metastatic disease.


Instruction: Generate impression based on findings.

Input: 32 year old with history of left breast cancer. Extensive suspicious calcifications in the left breast. Mammographic asymmetry in the right inferior breast with questionable ultrasound correlate also seen. There is heterogeneous amount of fibroglandular tissue in both breasts.Marked parenchymal enhancement is noted bilaterally, a limitation to the exam.In the left upper breast 12:00 anterior depth, near the biopsy site and associated with Hydromark biopsy clip artifact, is an area of mass like enhancement with associated foci/non-mass enhancement that is somewhat more enhancing than her extensive background. This measures 5.0 x 4.3 x 2.4 cm. A more faint area of non-mass enhancement that corresponds to the location of additional calcifications in the left outer breast measures 2.9 x 0.6 x 0.6 cm. In the right inferior breast there are three adjacent areas with low T2 signal and mild enhancement that likely correspond to the mammographic asymmetry. The largest two are located in mid to posterior depth and measure 1.5 x 0.9 x 1.2 cm and 0.9 x 0.7 x 0.5 cm. No abnormal lymph nodes are identified in either axillary region.

Output: 1. Extensive background enhancement limits the exam.2. Large abnormal area of enhancement in the left upper breast corresponding to the biopsy proven malignancy measures up to 5.0 cm.3. Additional equivocal area of enhancement laterally in the left breast. If mastectomy is not already planned on the left, then an additional stereotactic biopsy for the left outer breast calcifications should be performed.4. Right inferior breast enhancement corresponds to the mammographic asymmetry. Though more likely benign, suggest correlation with targeted ultrasound given the limitations of the supplied outside ultrasound images of the right breast. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: 88-year-old male with bilateral shoulder pain. Right shoulder: The humeral head is high riding indicating a rotator cuff tear as seen on the prior MRI. Mild osteoarthritis affects the glenohumeral joint. Moderate osteoarthritis affects the acromioclavicular joint with spurring anteriorly of the acromion process. The bones appear diffusely demineralized. There is a lobulated focus of calcification noted along the posteriolateral aspect of the humeral head and neck, perhaps within the subdeltoid bursa.Left shoulder: Mild osteoarthritis affects the glenohumeral joint. Mild osteoarthritis affects the acromioclavicular joint with spurring anteriorly of the acromion process. The bones appear diffusely demineralized. The acromiohumeral interval is preserved.

Output: Bilateral shoulder osteoarthritis and other findings as described above.


Instruction: Generate impression based on findings.

Input: Male, 38 years old. Neck pain The cranial-cervical junction is normal. There is mild loss of the normal cervical lordosis, but the cervical spine alignment is otherwise anatomic. Vertebral body and disc space heights are preserved. There is endplate marrow edema at C6-7, likely degenerative in etiology. Otherwise, the bone marrow and end plates demonstrate normal MR signal. The signal of the visualized cord is normal, without evidence of cord compression or mass. The paraspinal soft tissues are unremarkable.Degenerative changes are specified by the intervertebral level as follows: C2-C3: There is no significant neuroforaminal narrowing or spinal stenosis. C3-C4: There is bilateral uncovertebral joint hypertrophy and posterior osteophyte disc complex formation with flattening of the left hemicord without intrinsic cord abnormality there is moderate left foraminal narrowing.C4-C5: There is bilateral uncovertebral joint hypertrophy, posterior osteophyte disc complex formation, and minimal ligamentum flavum thickening with moderate bilateral neural foraminal narrowing and mild spinal canal stenosis.C5-C6: There is left greater than right uncovertebral joint hypertrophy, posterior osteophyte disc complex formation, and minimal ligamentum flavum thickening with moderate to severe left neuroforaminal narrowing, mild to moderate right neural foraminal narrowing, and mild to moderate spinal canal stenosis.C6-C7: There is posterior osteophyte disc complex formation and uncovertebral joint hypertrophy with moderate left and mild right foraminal narrowing and minimal spinal canal stenosis.C7-T1: There is no significant neuroforaminal narrowing or spinal stenosis.

Output: Multilevel degenerative changes involving the cervical spine as detailed above with up to mild-to-moderate spinal canal narrowing at C5-6, up to moderate-to-severe left neural foraminal narrowing at C5-6, and up to moderate right neural foraminal narrowing at C4-5.


Instruction: Generate impression based on findings.

Input: Bone marrow lymphoma. There is a heterogeneous appearance of the calvarial bone marrow. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable. There are a few small retention cysts in the bilateral maxillary sinuses.

Output: 1. A heterogeneous appearance of the calvarial bone marrow is compatible with lymphoma.2. No evidence of intracranial mass.


Instruction: Generate impression based on findings.

Input: 56-year-old male with history of renal cell carcinoma. Evaluate for recurrence or metastases. ABDOMEN:LIVER, BILIARY TRACT: Scattered subcentimeter benign cysts.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Postoperative changes of left upper pole partial nephrectomy.Left mid pole T2 hypointense lesion with mild enhancement measuring 1.8 x 1.4 cm (image 34 series 3). Two additional T2 hypoattenuating lesions with mild contrast enhancement are seen in the left lower pole measuring 11 and 8 mm and are indeterminant.Right upper pole T2 hypoattenuating lesion has increased in size measuring 7 mm, previously 3 mm (image 22 of series 3). Right midpole complex cyst with enhancing septations measures 1.9 x 1.3 cm, previously 1.9 x 1.6 cm (image 21 of series 13).Additional benign-appearing cysts are present bilaterally.RETROPERITONEUM, LYMPH NODES: Nonspecific right paraaortic soft tissue thickening is stable to slightly smaller when compared to prior and is nonspecific.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Left mid pole solid lesion concerning for papillary RCC, not significantly changed from prior. Additional smaller lesions in the left lower pole are indeterminant, but stable in size. 2. Interval increase in size of small right upper pole lesion which is too small to accurately characterize.3. Right sided complex cyst is stable in size and appearance.4. Stable to slight decrease in size of right paraaortic nonspecific soft tissue thickening.


Instruction: Generate impression based on findings.

Input: 63-year-old man with a history of CVA and intermittent left frontotemporal headaches. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is confluent increased FLAIR signal in the periventricular and patchy areas in the subcortical white matter, bilateral basal ganglia and bilateral thalami. The sulci are prominent and there is ex vacuo dilatation of the ventricles. The brain parenchyma and pituitary gland appear unremarkable, and there are no areas of abnormal parenchymal enhancement. There is no midline shift or herniation. No areas of susceptibility artifact are present to suggest prior hemorrhage. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1.No evidence of intracranial hemorrhage, mass, or acute infarct.2.Moderate to advanced chronic small vessel ischemic disease 3.Global volume loss greater than expected for age.


Instruction: Generate impression based on findings.

Input: 64-year-old male with prostate cancer Gleason 7 (3+4) PELVIS:PROSTATE:Prostate Size: 4.7 x 2.4 x 3.7 cm.Peripheral Zone: Heterogenous foci in the left aspect of the peripheral zone without discrete or dominant nodule. Central Gland: T2 hypointense lesion measuring 1.2 x 1.2 cm (series 601, image 15) is noted within the right of the central/ transitional region anteriorly. This lesion demonstrates diffusion restriction and early enhancement. Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: No extracapsular extension is evident.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: Susceptibility artifact from a right hip arthroplasty. Mild asymmetric atrophy of the right obturator internus.OTHER: No significant abnormality noted.

Output: 1.Lesion in the right central/transitional region with early enhancement and diffusion restriction may represent the known prostate cancer. 2.Additional heterogenous foci in the left aspect of the peripheral zone is nonspecific without discrete or dominant nodule.


Instruction: Generate impression based on findings.

Input: Sagittal T2 weighted sequence was performed and, due to extensive artifact from surgical hardware, the exam was terminated.

Output: Aborted nondiagnostic examination due to extensive artifact from surgical metallic hardware.


Instruction: Generate impression based on findings.

Input: 54-year-old with Crohn's disease, back/hip pain, evaluate for sacroiliitis or other abnormalities There is low intramedullary signal intensity on T1-weighted images and increased signal intensity on fat-suppressed T2-weighted images along the sacroiliac joints bilaterally, an active inflammatory sacroiliitis. Moderate-severe degenerative disc disease affects L5/S1. Osteoarthritis affects the facet joints of the visualized lower lumbar spine. Evaluation of the hip joints is limited due to metallic susceptibility artifact resulting from the patient's total hip arthroplasties.

Output: Osteoarthritis of the sacroiliac joints without findings to suggest active inflammatory sacroiliitis. Degenerative disc disease and facet joint osteoarthritis of the lower lumbar spine.


Instruction: Generate impression based on findings.

Input: Evaluate for cause of diplopia and dizziness. History of craniotomy, meningioma. Nonenhanced head CT:Examination again demonstrate encephalomalacia in the left posterior parietal lobe as was noted on prior MRI exam. Slightly high density mass at the level of the superior sagittal sinus and right parafalcine region in the parietal region is consistent with patient's known residual meningioma which extends slightly to the left. This finding is also similar to prior exam. Subtle periventricular low attenuation of brain parenchyma in the parietal region is also similar to prior exam and may represent post therapy changes. Minimal small vessel disease of indeterminate age is also present.There is no evidence of acute intracranial hemorrhage, edema, mass-effect, midline shift or hydrocephalus.Calvarium is intact and only reveals evidence of a wide biparietal craniotomy. Visualized paranasal sinuses are well pneumatized and unremarkable. Partial opacification of right mastoid air cells and minimally of the right middle ear cavity. This finding was observed on prior MRI examination of brain.

Output: 1.No evidence of acute intracranial findings.2.Postoperative changes of biparietal craniotomy for removal of patient's known meningioma is noted.3.Residual encephalomalacia and small residual right parafalcine parietal meningioma similar to prior MRI from 2 -- 17 -- 11.


Instruction: Generate impression based on findings.

Input: 68 year old female with history of coronary artery disease diagnosed during stress test, now status post TECAB with LIMA to LAD (known to be atretic) and RCA stenting in 12/2013 x 2 presenting with abnormal stress echocardiogram. MEDICATIONS: metoprolol succinate, clopidogrel, aspirin, rosuvastatin First Pass PerfusionDuring hyperemia, no perfusion defects were present; however, acquisition of the stress images was significantly delayed and mild to moderate severity defects may not have been seen.Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 62%, the LV end diastolic volume index is 85 ml/m2 (normal range: 65+/-11), the LVEDV is 136 ml (normal range 109+/-23), the LV end systolic volume index is 33 ml/m2 (normal range 18+/-5), the LVESV is 52 ml (normal range 31+/-10), the LV mass index is 41 g/m2, and the LV mass is 65 g. There are no regional wall motion abnormalities present. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 67%, the RV end diastolic volume index is 76 ml/m2 (normal range 69+/-14), the RVEDV is 121 ml (normal range 110+/-24), the RV end systolic volume index is 25 ml/m2 (normal range 22+/-8), and the RVESV is 41 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. No perfusion defects/ "ischemia" present during hyperemia; however, a technical error occurred during image acquisition and defects of mild to moderate severity may have been missed. 2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and systolic function (LVEF 62%).4. Normal RV size and systolic function (RVEF 67%).When compared to the prior study, the perfusion defect previously noted is no longer seen; however, the above mentioned caveat exists.


Instruction: Generate impression based on findings.

Input: Reason: evaluating for adenomyosis. h/o multiple uterine fibroids and UFE History: menorrhagia, polymenorrhea, pelvic pain PELVIS:UTERUS, ADNEXA: The uterus is enlarged with multiple fibroids measuring 10.6 x 12.7 cm in transverse dimension and 13.3 cm in craniocaudal dimension. There are multiple large enhancing fibroids, including an anterior intramural fibroid measuring 6.7 x 6.0 cm (501/40) and a right-sided lower subserosal fibroid measuring 5.8 x 5.8 cm (501/28). The right-sided lower subserosal fibroid is avidly enhancing on arterial phase images. The remaining fibroids demonstrate progressive enhancement. There is an enhancing submucosal fibroid measuring 1.9 x 1.2 cm in transverse dimension (501/44), and 2.0 cm in craniocaudal dimension (601/46). There is an additional small submucosal fibroid near the fundus (901/20). The junctional zone is within normal limits measuring 6 mm. Multiple nabothian cysts are present.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Small fat-containing umbilical hernia.OTHER: Small amount of free fluid is present within the pelvis.

Output: 1.Multiple large enhancing fibroids with differential enhancement pattern as detailed above, with two smaller submucosal fibroids.2.No evidence of adenomyosis.


Instruction: Generate impression based on findings.

Input: H/o breast cancer. S/p Ommaya removal. Examination demonstrates diffuse right frontoparietal edema which was detected on the prior MRI exam. The fluid collection within the area of the edema appears smaller. The catheter has been removed. There is no intracranial hemorrhage, extraaxial fluid collection or midline shift. The ventricles are normal in volume. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Stable head CT exam with decrease in size of the right frontal fluid collection. No intracranial hemorrhage, extraaxial fluid collection or midline shift.


Instruction: Generate impression based on findings.

Input: Intermittent dysphagia. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain, brainstem, and cerebellum appear unremarkable. There is mild diffuse cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is a small right maxillary sinus retention cyst. There is a small amount of fluid in the right maxillary sinuses.

Output: No evidence of acute intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: Status post fall with subdural hematoma. Evaluate presence of subdural hematoma. Nonenhanced head CT:Examination again demonstrates a thin acute subdural hematoma in the left posterior parietal region. Compared to prior exam there is evidence of reduction in density and size of these subdural. In the current exam the thickest portion of subdural measures approximately 4.7 mm compared to prior measurements of 5.8-mm.Small amount of acute subdural blood is also present along the posterior aspect of falx on the left in the occipital region. This finding was present on prior study and is believed to represent continuation of left parietal subdural as was noted on prior MRI exam. There is no evidence of new hemorrhage. A minute amount of blood in the dependent portion of occipital horn is again identified.Prominence of lateral ventricles is similar to prior study. Area of vasogenic edema in the right posterior frontal is again identified and unchanged.The left posterior temporal cortical stroke is again identified.

Output: 1.No evidence of new hemorrhage since prior exam.2.Smaller size of left parietal subdural. No significant change in the left parafalcine component of subdural.3.Stable right frontal -- parietal vasogenic edema.4.Left posterior temporal lobe cortical stroke.5.Stable prominent size of the lateral ventricles.


Instruction: Generate impression based on findings.

Input: 53 year old woman with right shoulder pain. ROTATOR CUFF: There is a small amount of fluid in the subacromial-subdeltoid bursa, consistent with mild bursitis. There is a less than 50% thickness articular surface fraying of the supraspinatus. The remaining structures of the rotator cuff appear intact. SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is moderate degeneration in the posterior superior labrum, but no evidence of a SLAP tear. Chondral surfaces are intact.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: Articular surface fraying of the supraspinatus tendon. Degeneration in the posterior superior labrum.


Instruction: Generate impression based on findings.

Input: Headache that wakes her up from sleep and history of renal cell carcinoma. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are mild scattered cerebral white matter, which is nonspecific, but may represent chronic small vessel ischemic disease. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is minimal fluid within the right mastoid air cells. There appears to be a partially imaged fluid-signal lesion in the left mandible.

Output: 1. No evidence of acute intracranial tumors, within the limits of a non-contrast exam.2. An apparent partially imaged fluid-signal lesion in the left mandible may represent a periapical cyst. Dedicated imaging of this region may be useful for further characterizing this.


Instruction: Generate impression based on findings.

Input: 3T scannerReason: 3T scanner, aneurysm follow up History: L side headaches starting at temple and radiating back, started 3 weeks ago8/13/194174 yearsFemale 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. There is no optic nerve enhancement appreciated. The suprasellar cistern is intact .IACThe patient status post left temporal bone surgery including mastoidectomy. There is a fat graft present within the surgical site at the left temporal bone.No abnormal foci of enhancement are appreciated within the internal auditory canals. The cochlea and semicircular canals appear intact. The cochlear nerve can be followed bilaterally tracking into the cochlea. The modiolus is well formed bilaterally.No abnormal enhancing lesions are appreciated at the cerebellopontine angle cisterns nor the internal auditory canals.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is a 5 mm wide neck aneurysm along the distal left internal carotid artery originating at the level of the clinoid process which is directed laterally and slightly superiorly and abuts the left gyrus rectus and adjacent left orbital gyrus.The anterior communicating artery is identified and is medium size. The posterior communicating arteries are intact. There is fenestration of the basilar artery present. The left vertebral artery is larger than the right vertebral artery.

Output: 1.There is a 5 mm wide neck aneurysm along the distal left internal carotid artery originating at the level of the clinoid process which is directed laterally and slightly superiorly and abuts the left gyrus rectus and adjacent left orbital gyrus. This is stable compared to the previous exam.2.The patient status post left temporal bone surgery.3.There is no evidence for internal auditory canal mass.4.There is no evidence for an intraorbital mass.


Instruction: Generate impression based on findings.

Input: 31-year-old female with history of Crohn's disease with fistula/abscess in the past who presents for follow-up ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Again noted is narrowing of the bowel loops in the left lower quadrant. Long segment of distal ileum demonstrates loss of normal folds with evidence of fibrostenotic disease and associated fibrofatty proliferation compatible with chronic disease; this segment measures approximately 13 cm in length. Very small segment of terminal ileum is again noted to demonstrate contrast enhancement (series 7, image 22).No evidence of a mass or a fistula.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Detailed above.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Long segment of chronic disease affecting the distal and terminal ileum. Very small segment of terminal ileum demonstrates contrast enhancement consistent with active disease.2.No evidence of abscess or fistula.


Instruction: Generate impression based on findings.

Input: Evaluate for cord compression or cord contusion: fall with L2 fracture. There is mild anterior wedging and bone marrow edema affecting the L2 vertebral body, but no evidence of retropulsion. The spinal cord displays normal signal and morphology. There is no evidence of intraspinal hematoma. The vertebral column alignment remains nearly anatomic. There is no significant spinal canal stenosis. The paravertebral soft tissues are unremarkable.

Output: Mild acute compression fracture of the L2 vertebral body without evidence of spinal cord contusion or intraspinal hematoma.


Instruction: Generate impression based on findings.

Input: There is mild straightening of the cervical spine, which may be positional. Multilevel degenerative changes of the cervical spine are noted, including multilevel disc desiccation from C2-3 to C6-7. There is mild loss of intervertebral disc space, most prominent at the C3-4 level. At the C3-4 level, there is a disc protrusion with associated moderate to severe spinal canal stenosis and associated increased STIR signal in the spinal cord at this level. Cervical spinal canal is patent at the remaining levels.In the thoracic and lumbar spine, alignment is grossly within normal limits. Vertebral body heights are preserved. There is mild loss of intervertebral disc space and disc desiccation at the L4-5 level. Otherwise, there is no evidence of cord compression or significant spinal canal stenosis in the thoracic and lumbar spine. Mild L4-5 neural foraminal narrowing bilaterally.

Output: 1. Examination limited to sequences per cord compression protocol. There is disc protrusion with resulting moderate to severe spinal canal stenosis at the C3-4 level with associated cord signal abnormality. This finding is better assessed on dedicated cervical spine MRI, which was obtained subsequently.2. No evidence of spinal canal stenosis in the thoracic or lumbar spine.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 67-year-old male with newly diagnosed low-grade prostate cancer. Right apex, grade 6; left base grade 6 PELVIS:PROSTATE:Prostate Size: 2.2 x 4.7 x 3.4 cm.Peripheral Zone: There is an 8 x 8 mm T2 hypointense lesion with corresponding restricted diffusion and early arterial enhancement (series 1001, image 11) in the anterior prostate. There is probable urethral invasion. Additional 5 x 5 mm T2 hypointense lesion in the right midgland peripheral zone with corresponding appreciable restricted diffusion.Central Gland: Mild degree benign prostatic hypertrophy.Seminal Vesicles: No significant abnormality.Extracapsular Extension: Not present.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Suspicious lesion in the anterior prostate with probable urethral invasion as described above.2.Indeterminate lesion in the right midgland peripheral zone as described above.


Instruction: Generate impression based on findings.

Input: MRI: There is no suspicious intracranial enhancement, acute infarct, mass effect, or cerebral edema. There are two tiny foci of T2 signal abnormality in the left centrum semiovale, nonspecific. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable. The extraocular muscles are not thickened and enhance symmetrically. There is no proptosis or evidence of intraorbital mass.MRV: The superior sagittal sinus, inferior sagittal sinus, transverse sinuses, sigmoid sinuses, straight sinus, vein of Galen, internal cerebral veins, and several visualized cortical veins are patent. There is no evidence of venous thrombosis.

Output: 1.No acute intracranial infarct or mass, dural venous sinus thrombosis or intraorbital mass.2.Few nonspecific left centrum semiovale white matter T2 signal abnormalities.


Instruction: Generate impression based on findings.

Input: Pain instability of left knee MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: No significant abnormality noted.LIGAMENTS: The anterior and posterior cruciate ligaments are normal. The medial and lateral collateral ligaments are normal.EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Normal MR examination of the left knee.


Instruction: Generate impression based on findings.

Input: 5 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 evaluation of rejection. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 57%, the LV end diastolic volume index is 58 ml/m2 (normal range: 74+/-15), the LVEDV is 138 ml (normal range 142+/-34), the LV end systolic volume index is 25 ml/m2 (normal range 25+/-9), the LVESV is 59 ml (normal range 47+/-19), the LV mass index is 52 g/m2 (normal range 85+/-15), and the LV mass is 125 g (normal range 164+/-36). There is mild concentric left ventricular hypertrophy (11-12mm). There are no regional wall motion abnormalities present. T2 edema ratio is <2, which is normal. Global relative enhancement value is 2.4, which is normal and decreased when compared to the study from May 2016. The myocardial native T1 time is 1106 ms in the mid ventricle, which is borderline elevated but improved from the previous study. Additionally, the extracellular volume fraction is not elevated. There is a small area of patchy late gadolinium enhancement in the mid inferoseptum, which is similar to the previous contrast study (MRI dated 5/3/2016). It is atypical of myocardial infarction and suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process. Left AtriumThe left atrium is enlarged consistent with transplant. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 52%, the RV end diastolic volume index is 56 ml/m2 (normal range 82+/-16), the RVEDV is 133 ml (normal range 142+/-31), the RV end systolic volume index is 27 ml/m2 (normal range 31+/-9), and the RVESV is 64 ml (normal range 54+/-17).Right AtriumThe right atrium is enlarged consistent with transplant.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThere is a left sided aortic arch with a "pseudo-bovine" brachiocephalic branching pattern (normal variant). The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumNo residual pericardial inflammation noted. Extracardiac FindingsSternotomy wires are present. Interval resolution of small left pleural effusion. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Normal size left ventricle with normal systolic function (EF 57%) with mild left ventricular hypertrophy which is stable compared to the previous study. There is the stable appearance of mild late gadolinium enhancement in the basal inferoseptum which has been previous observed. Otherwise, there is no evidence of acute myocardial edema on T2-STIR imaging, and the native T1 myocardial relaxation times and the ECV fractions have decreased when compared to the previous study of 5/3/2016.2. Normal size right ventricle with normal systolic function (EF 52%).3. No residual pericardial inflammation or evidence of respirophasic septal shift on this study. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Right hip pain Note that the exam is significantly limited given the presence of a total hip arthroplasty.There is no obvious underlying bony destruction. There is a large amount of soft tissue and muscle edema about the right hip reflecting recent surgical intervention. Within the posterior soft tissues of the hip is a 5.1 cm fluid collection which appears to communicate with the joint (postcontrast image 14/26 on series 8). An additional small collection is seen within the gluteal musculature (image 21/26 on series 8).

Output: Significantly limited exam secondary to metallic artifact. There is a nonspecific fluid collection within the posterior soft tissues which appears to communicate with the joint itself end is likely postoperative in nature. Additional postoperative findings described above.


Instruction: Generate impression based on findings.

Input: Ms.Joo Lee, 44 years old, submitted outside studies for review. Images performed at Edward Hospital submitted for review: Screening mammogram 12/19/2015Diagnostic mammogram of left breast 12/30/2015Stereotactic guided biopsy imaging and postprocedure mammogram 1/6/2016MRI breast 1/14/2016Images submitted for comparison:None MAMMOGRAM 12/19/2015 and 12/30/2015: Standard views of both breasts and 3 additional views of the left breast were obtained. The breast parenchyma is composed of scattered fibroglandular elements. 3 adjacent clustered microcalcifications are present in the left upper outer breast together measuring 3 x 4.4 cm. No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in the right breast or elsewhere in the left breast. STEREOTACTIC GUIDED BIOPSY OF THE LEFT BREAST 1/6/2016: Previously identified calcifications in the left upper outer breast at 2:00 and 1:00 position are the targets for the biopsy. Targeting appears appropriate. Calcifications are noted on both specimen radiograph. POST PROCEDURE MAMMOGRAM 1/6/2016: A bow tie shaped clip is placed in the the left breast breast 2:00 position.A U shaped clip is placed in the the left breast breast 1:00 position. The distances between the 2 clips is at least 3.6 cm. A few residual calcifications are best seen on the ML view.MRI breast 1/14/2016:Multiplanar and multisequence MR breast with and without contrast was performed as per outside MRI protocol. The breasts are composed of scattered fibroglandular tissue. There are mild background parenchymal enhancement in both breasts. Images are reviewed without the benefit of kinetic data, a limitation. Left breast:Susceptibility artifact from the 2 biopsy clips are noted in the left breast 2:00 and 1:00 position, respectively. There are nonmass enhancement surrounding 2 clips with a total span of 4.0 x 3.7 x 3.0 cm (AP x ML X SI). The anterior most of this enhancement is approximately 2.3 cm from the nipple base. Small area of enhancement in the far posterior central breast likely represents the background enhancement as symmetric enhancement is also present in the contralateral breast.Right breast:No suspicious enhancement is noted.Axillary lymph nodes:Two prominent lymph nodes are noted in the high left axilla measuring up to 14 and 15 mm, respectively. One of the lymph node is immediately lateral to the pectoralis muscle.The right axillary lymph nodes are unremarkable.PER OUTSIDE PATHOLOGY:A. left breast lesion, 2:00 position; stereotactic guided core needle biopsy:- DCIS, grade 2, cribriform type with the associated dystrophic calcifications.B. left breast lesion, 1:00 position; stereotactic guided core needle biopsy:- DCIS with focal apocrine feature and lobular cancerization, grade 2.

Output: Biopsy proven DCIS in the left upper-outer breast corresponding to the 4.4 cm calcifications on the mammogram and 4 cm non mass enhancement on MRI. Prominent lymph nodes in the left axilla could be reactive and related to her biopsies.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Left salivary duct carcinoma ex pleomorphic adenoma status post chemotherapy and left deep lobe parotidectomy and neck dissection with pathology showing metastatic carcinoma in 4/19 lymph nodes. There are post-treatment findings in the neck, including left deep lobe parotidectomy and neck dissection. There is diffuse edema in the remaining portions of the left parotid gland, likely related to treatment effects, but no measurable tumor in the parotidectomy bed. The left submandibular gland also appears to be mildly edematous. The right-sided salivary glands are unremarkable. There is no residual significant cervical lymphadenopathy. The thyroid gland is unremarkable. The osseous structures are intact. There is mild ethmoid and left maxillary sinus mucosal thickening. The imaged intracranial structures are unremarkable.

Output: Post-treatment findings in the neck without evidence of measurable residual left parotid tumor or significant cervical lymphadenopathy.


Instruction: Generate impression based on findings.

Input: Reason: rule out ligamentous/tendon injury or AVN History: pain in right knee with swelling after a fall \R\2 weeks ago MENISCI: The menisci are intact.ARTICULAR CARTILAGE AND BONE: There is moderate thinning of the cartilage in addition to full-thickness cartilage loss along the lateral femoral condyle. Medullary infarcts are seen in the distal femur as noted on the prior radiograph.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Cartilage loss in the femoral trochlea and patella as described above. No evidence of ligamentous or tendon disruption as clinically questioned.