Instruction: Generate impression based on findings.

Input: Lower extremity weakness. Cervical spine:Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. There is mild loss of cervical lordosis with minimal anterolisthesis of C3 on C4 and C4 on C5 and minimal retrolisthesis of C5 on C6. The cervical spinal cord has normal signal characteristics and overall morphology. Bone marrow signal is benign with no suspicious osseous lesions.Degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: No significant compromise to the spinal canal or right neural foramen. Mild to moderate left neural foraminal stenosis related to uncovertebral hypertrophy and facet arthropathy.C4-5: No significant compromise to the spinal canal or right neural foramen. Mild left neural foraminal narrowing.C5-6: No significant compromise to the spinal canal. Moderate bilateral neural foraminal stenosis, left worse than right, related to uncovertebral hypertrophy and facet arthropathy.C6-7: No significant compromise to the spinal canal or neural foramina.C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.Thoracic Spine:There is abnormal T2 signal involving the ventral aspect of the cord bilaterally from the upper T7 upper T9 levels. No additional cord lesions or cord mass is appreciated.Thoracic vertebral body heights are maintained. Alignment is maintained. Mild degenerative changes are seen including small Schmorl's nodes, disc height loss, as well as small disc bulge at the T6-T7 level. There is no significant spinal canal or neural foraminal stenosis. Bone marrow signal is benign with no suspicious lesions. Scattered foci of T1 hyperintensity are compatible with small hemangiomas or foci of fat. Paraspinous soft tissues are grossly unremarkable.

Output: 1. Abnormal T2 hyperintensity involving the ventral thoracic cord bilaterally from the upper T7 to the upper T9 levels. Findings are suspicious for infarct in the anterior spinal artery territory, although inflammatory myelitis remains a possibility. Diffusion sequence may be attempted of the thoracic cord for further evaluation if clinically indicated.2. No significant cervical spinal canal stenosis or cervical cord signal abnormality. Mild degenerative changes as detailed above.


Instruction: Generate impression based on findings.

Input: Diagnosis: Low back painSigns and Symptoms: RLE neuropathy Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal . There is a left lateral recess disk protrusion at this level which mildly encroaches on the nerve roots at the left lateral recess.At L4-5 there is a right paramedian broad based disk extrusion which effaces the fat at the right lateral recess and compresses the thecal sac. It is associated with bilateral facet and ligamentum flavum hypertrophy as well as moderate spinal stenosis. There is loss of disk space height at this level. There is disk dessication at this level.At L3-4 there is a focal central disk extrusion associated with bilateral facet and ligamentum flavum hypertrophy as well as moderate spinal stenosis. Some disk material tracks behind the L3 inferior endplate and vertebral body There is loss of disk space height at this level. There is disk dessication at this level.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.There is spinal stenosis at L4-5 affecting the nerve roots at the right lateral recess more than the left lateral recess as described above.2.There is spinal stenosis at L3-4 as described above.3.There is mild encroachment of the nerve roots at the left lateral recess at L5-S1 due to a disk protrusion.


Instruction: Generate impression based on findings.

Input: 49 year old man with history of previous pulmonary sarcoidosis, coronary disease with previous PCI, and worsening LV dysfunction who was referred for cardiac MRI to evaluate for possible sarcoidosis. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 8%, the LV end diastolic volume index is 120 ml/m2 (normal range: 74+/-15), the LVEDV is 204 ml (normal range 142+/-34), the LV end systolic volume index is 110 ml/m2 (normal range 25+/-9), the LVESV is 188 ml (normal range 47+/-19), the LV mass index is elevated at 125 g/m2 (normal range 85+/-15), and the LV mass is 214 g (normal range 164+/-36). There is global hypokinesis with regional variation. For example, akinesia is demonstrated by the anterior and basal two thirds of the inferior walls, severe hypokinesia of the septum and apical two thirds of the lateral wall. There is no evidence of myocardial edema. There is no late gadolinium enhancement to suggest myocardial fibrosis, infiltration or inflammation. The global relative enhancement ratio is normal. No intracardiac thrombus.Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is normal in size with moderately reduced systolic function. The overall RV ejection fraction is 40%, the RV end diastolic volume index is 81 ml/m2 (normal range 82+/-16), the RVEDV is 138 ml (normal range 142+/-31), the RV end systolic volume index is 48 ml/m2 (normal range 31+/-9), and the RVESV is 82 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is trace mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.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 evidence of pericardial inflammation or effusion.Extracardiac FindingsA right adrenal mass is present which measures 4.2 x 4.4 cm on the coronal view. This is a heterogeneous mass with areas of enhancement, better characterized on the MR abdomen performed 12/8/2015.

Output: 1. Severely dilated left ventricle with severely reduced systolic function (EF = 8%). 2. Normal sized RV with moderately reduced systolic function (EF = 40%). 3. Moderately dilated left atrium. 4. No evidence of late gadolinium enhancement to suggest myocardial inflammation, infiltration or fibrosis. 5. Heterogeneous right adrenal mass, better characterized by dedicated abdominal imaging to be performed today. 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 adrenal lesion. History of neoplasm of uncertain behavior with atypical lymphocytes on bone marrow biopsy. Schwannomatosis. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology, signal intensity and size. It contains numerous punctate T2 weighted hyperintensities and larger hyperintensities compatible with numerous cysts. 2.2 x 1.8 cm segment 6 lesion with imaging characteristics consistent with a benign hemangioma.SPLEEN: The spleen is normal in size, morphology and signal intensity without a focal lesion.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: The right adrenal lesion measures 1.8 x 1.8 cm. The lesion demonstrates T2-weighted hyperintensity and mildly heterogeneous postcontrast enhancement. It demonstrates no loss of signal loss on out of phase imaging to confirm an adrenal adenoma. No macroscopic fat is evident to suggest a myelolipoma.KIDNEYS, URETERS: Multiple bilateral punctate T2 hyperintensities, likely cysts. 1.3 cm right renal superior pole cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Heterogeneous marrow signal intensity including postcontrast enhancement and restricted diffusion, with several focal lesion in the pelvic osseous structures. The largest lesion measures 2.8 x 1.7 cm (series 19, image 23). Post bone marrow biopsy changes are noted of the left iliac bone. OTHER: No significant abnormality noted.

Output: 1.Non-specific right adrenal lesion does not have imaging characteristics of a lipid-rich adrenal adenoma or myelolipoma. Differential considerations include a metastatic lesion, a neurogenic tumor such as Schwannoma or lipid-poor adrenal adenoma, amongst others.2.Abnormal focal signal abnormality in the osseous structures, the largest of which is in the right iliac bone; suspicious for neoplastic disease.


Instruction: Generate impression based on findings.

Input: Evaluate for soft tissue abnormality of the left foot. There is an oval enhancing soft tissue mass with sharp discrete margins in between the third and fourth distal metatarsal bones, extending from the articulation of the metatarsophalangeal joints to the metatarsal necks with mild tracking under the metatarsal heads. The mass appears to have lower signal than muscle on T1 sequence and increased T2 signal and demonstrates pronounced enhancement on postcontrast images. The metatarsal bones are distinct and there is no evidence of abnormal signal and adjacent osseous structures. There is mild adjacent soft tissue edema. The remainder of the osseous and soft tissue structures are unremarkable.

Output: Soft tissue mass between the third and fourth distal metatarsal bones with sharply discrete margins and pronounced enhancement on postcontrast imaging. No significant secondary findings such as adjacent osseous destruction or infiltration is present. This is most suggestive of a Morton's neuroma or intermetatarsal bursitis, with other differential considerations such as infection and neoplasm less likely given the absence of secondary findings.


Instruction: Generate impression based on findings.

Input: 64-year-old female. Evaluate for pancreatic cyst discovered on CT. ABDOMEN:LIVER, BILIARY TRACT: In hepatic segment 6, there is a 1.8 x 1.1 cm T2 hyperintense focus that demonstrates peripheral nodular enhancement that fill in on delayed imaging compatible with a benign hemangioma (series 7 image 22, series 15 image 418). Additionally, a subcentimeter cyst of the inferior right hepatic lobe is also noted.SPLEEN: No significant abnormality noted.PANCREAS: In the uncinate process, there is a 3.5 x 2.2 cm unilocular cystic lesion (series 7 image 21, series 9 image 27) with lobulated margins demonstrating connections with the proximal and distal aspect of the pancreatic duct (series 7 image 23, series 4 image 25). No upstream pancreatic ductal dilatation is seen. There is no associated postcontrast enhancement or other suspicious features.ADRENAL GLANDS: Bilateral adrenal nodules demonstrate loss of signal on the out of phase sequence compatible with benign adenomas (series 14 images 157, 145).KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Levoscoliosis of the lumbar spine with multilevel compression deformities.There is nonspecific postcontrast enhancement of the right posterior iliac bone extending to the SI joint (series 15 image 193). No signal abnormality is appreciated on the coronal T2 or precontrast T1 fat-saturated sequence.OTHER: No significant abnormality noted.

Output: 1.Unilocular cystic lesion centered in the uncinate process measuring 3.5 x 2.2 cm demonstrating lobular margins and communicating with the main pancreatic duct proximally and distally. MPD normal in size. Findings are most suggestive of a sidebranch IPMN. No associated abnormal wall nodularity or postcontrast enhancement seen. However based on size criteria (greater than 3 cm), follow-up endoscopic ultrasound is recommended for cyst aspiration.2.Bilateral adrenal nodules with loss of signal on the out of phase sequence confirming intravoxel fat and compatible with benign adenomas.3.Benign hepatic hemangioma of hepatic segment 6.4.Nonspecific postcontrast enhancement of the right posterior iliac bone extending to the SI joint, similar signal characteristics noted to a lesser extent in left iliac bone. No signal abnormality on the precontrast T1 or coronal T2 sequences, and this is of uncertain clinical significance.


Instruction: Generate impression based on findings.

Input: Recurrent papillary thyroid carcinoma status post multiple recent biopsies. There are postoperative findings related to thyroidectomy and neck dissection. There is a persistent infiltrative mass situated in the right tracheoesophageal groove, which measures 19 x 29 mm in axial cross-section. The mass infiltrates the party wall and mildly narrows the tracheal lumen. There is otherwise no evidence of other mass lesions of cervical lymphadenopathy. The salivary glands appear unchanged. The imaged intracranial structures are unremarkable. The osseous structures are unchanged. There are bilateral maxillary sinus retention cysts. There are bilateral lens implants.

Output: Postoperative findings related to thyroidectomy, with a persistent infiltrative mass situated in the right tracheoesophageal groove.


Instruction: Generate impression based on findings.

Input: Flank pain. History of polycystic kidney disease. ABDOMEN:LIVER, BILIARY TRACT: Multiple T2-weighted hyperintense foci throughout the liver are noted may represent hepatic cysts and/or hamartomas.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: The kidneys are enlarged and the parenchyma is replaced with numerous T2 weighted hyperintense foci and several intermediate T2-weighted foci presumably containing proteinaceous/hemorrhagic contents. The proximal ureters are well seen and are not dilated.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Note is made of small breast cystic foci.OTHER: No significant abnormality noted.

Output: 1.Findings of polycystic kidney disease without evidence of hydronephrosis. Evaluation for renal cell carcinoma is limited without intravenous contrast. Several lesions likely represent proteinaceous/hemorrhagic minimally complex cysts.2.Multiple T2 hyperintense foci in the liver likely represent hepatic cysts and/or biliary hamartomas.3.Incidental cystic foci in the breast parenchyma.


Instruction: Generate impression based on findings.

Input: Male 74 years old with history of adenoid cystic carcinoma of palate and CRT Enhancing perineural lesion along the maxillary nerve within the right pterygopalatine fossa and foramen rotundum with extension into the cavernous sinus is redemonstrated. The lesion measures approximately 6 mm (1601/38), and is not significantly changed from prior exam. Areas of increased T2/FLAIR signal most prominent in the subcortical areas suggestive of white matter ischemic degenerative changes. There is no evidence of intracranial hemorrhage or acute infarct. 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. Right maxillary sinus mucosal thickening and diffusion restriction appears similar to prior exam. The orbits, skull, and scalp soft tissues are grossly unremarkable.

Output: 1. Perineural tumor involving the maxillary nerve within the foramen rotundum and pterygopalatine fossa, appearing similar to prior exam. 2. Stable right maxillary sinus mucosal thickening.


Instruction: Generate impression based on findings.

Input: New frequent headaches. The brain appears unremarkable with no signal abnormality. There is no intracranial mass or evidence of mass effect, midline shift, or herniation. No evidence of infarct or hemorrhage. The CSF-containing spaces are normal in size. Cerebellar tonsils are normal in position. Vascular flow-voids are preserved.Orbits and sella are grossly unremarkable. Paranasal sinuses and mastoid are cells are clear. Decreased pneumatization of left mastoid air cells is probably developmental.

Output: Brain parenchyma is within normal limits.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Nausea and dizziness and history of TIA. There are numerous scattered cerebral white matter T2 hyperintense foci. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unremarkable. However, there is mild nonspecific prominence of the adenoids.

Output: Nonspecific numerous scattered cerebral white matter T2 hyperintense foci, which may represent demyelinating lesions, vasculitis, or small vessel ischemic disease, for example, Otherwise, no evidence of intracranial hemorrhage or mass.


Instruction: Generate impression based on findings.

Input: Clinical question: Pontobulbar hyperintensity in evaluation. Signs and symptoms: Cerebellar ataxia. Pre and post enhanced cervical MRI:There is normal signal intensity and caliber of the cervical and uppermost visualized thoracic cord and without abnormal enhancement. There is normal anatomical alignment of the cervical spine, mild reversal of cervical lordosis which could be positional or due to pain/spasm.The signal intensity of the vertebral column is unremarkable and without abnormal enhancement.Foramen magnum is unremarkable.C2-C3 is unremarkable.C3-C4 demonstrate mild degenerative disease, small central shallow disc protrusion with expected subtle enhancement and without spinal stenosis. There is mild right neural foraminal compromise secondary to right uncovertebral hypertrophic spur.C4-C5 demonstrate mild degenerative disease without spinal stenosis or neural foraminal compromise.C5-C6 demonstrate mild disc disease and loss of disc height, there is a shallow central disc protrusion with expected enhancement and with resultant partial effacement of ventral subarachnoid space, subtle flattening deformity of the cord without spinal stenosis or neural foraminal compromise.C6-C7 demonstrate mild degenerative changes and unremarkable otherwise.C7-T1 is unremarkable.Incidental note is made of partially visualized foci of T2 hyperintensity in the anterior medulla as reported on prior brain MRI study

Output: 1.Normal signal intensity and caliber of cervical and upper most visualized thoracic cord without abnormal enhancement.2.Mild degenerative changes of cervical spine, small central disc protrusions with expected enhancement at C3-C4 and C5-C6 levels without spinal stenosis or neural foraminal compromise at any level. Normal anatomic alignment of the vertebral column however with mild reversal of cervical diagnosis which could be positional or secondary to pain/spasm.


Instruction: Generate impression based on findings.

Input: 48 year old with known left breast cancer on chemotherapy. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.In the left outer breast, surrounding the biopsy clip, there is faint non-mass enhancement and a focus of enhancement, but no residual enhancing mass is seen. The overall extent of residual enhancement is 5.9 x 3.7 x 2.5 cm. No abnormal enhancement is seen in the right breast. A few scattered foci are present elsewhere in each breast, none suspicious. No abnormal lymph nodes are identified in either axillary region.

Output: At the site of a previously avidly enhancing left breast mass, mild residual non-mass enhancement currently measures up to 5.9 cm AP. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Ms. Balstrode is a 47 year old female with a recent diagnosis of right breast invasive lobular carcinoma and right breast ADH. She presents for MRI for further evaluation. There is heterogeneous amount of fibroglandular tissue in both breasts. Moderate parenchymal enhancement is noted bilaterally.In the right upper outer breast, posterior depth, there is a spiculated enhancing mass identified measuring approximately 2.1 x 2.1 x 2.4 cm (AP times mL times SI). Susceptibility artifact from biopsy marker clip is seen within this lesion, compatible with biopsy-proven malignancy. Located approximately 0.6 cm infero-posteriorly is an additional oval enhancing mass which measures approximately 1.0 cm. This is suspicious for a satellite lesion. Total span of enhancement (index lesion + satellite lesion) measures approximately 2.7 cm in the AP dimension and 3.1 cm in the SI dimension. This satellite lesion can be seen in retrospect on the original diagnostic workup (particularly on the C-view on the right MLO).In the right upper inner breast, there is an additional oval enhancing mass identified measuring 2.3 x 1.3 x 1.4 cm. Susceptibility artifact from biopsy marking clip is seen within this lesion, compatible with biopsy-proven atypia. In the left breast, there is no abnormal enhancement. No abnormal axillary lymph nodes are identified in either axillary region.In the right midlung, there is a T2 hyperintense, enhancing lesion identified, that measures approximately 1.4 cm in maximal dimension.

Output: (1) Biopsy proven malignancy along with suspected satellite lesion seen in the right upper outer breast. Total span of enhancement measures up to 3.1 cm. Clip is within the index malignancy. (2) 2.3 cm enhancing mass in the right upper inner breast corresponding to biopsy proven atypia. Clip is within the mass. If breast conservation therapy is desired, patient may need a bracketed wire localization for the index+satellite masses along with a single wire targeting the clip at site of atypia. (3) 1.4 cm enhancing lesion in the right mid-lung of indeterminate significance. If a patient has had prior cross-sectional imaging, that should be submitted in order to aid further characterization. Otherwise, patient should get a contrast-enhanced CT scan for further evaluation. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Clinical question: Metastatic breast cancer, baseline prior to starting on clinical trial. Signs and symptoms: No clinical signs of brain metastases. Pre-and post enhanced brain MRI:Negative diffusion weighted images.Examination demonstrate normal anatomical morphology and signal intensity to brain parenchyma on all MRI sequences. Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination.No detectable abnormal parenchymal or leptomeningeal enhancement.Normal signal intensity calvarial gland without detectable abnormal enhancement.Unremarkable images through the orbits and including axial fat sat post enhanced series.Normal signal intensity of paranasal sinuses and bilateral mastoid air cells and middle ear cavities.

Output: Negative pre-and post enhanced brain MRI.


Instruction: Generate impression based on findings.

Input: 28 years, Female, multiple sclerosis, follow-up for progression. Brain: There are several scattered foci of T2/FLAIR hyperintensity in the periventricular and subcortical white matter as well as one involving the left aspect of the pons, some of which are very nonspecific in distribution. Lesions include however a juxtacortical left superior frontal gyrus lesion as well a few pericallosal and periventricular lesions which are more suggestive of demyelinating disease. Current study is of higher resolution and this difference may limit comparison of small lesions. There is a small left lateral pontine lesion which is not appreciable on prior study. There is otherwise no definite evidence of progression of demyelinating disease in the brain. There is no significant burden of T1 hypointense lesions. Brain parenchymal volume is preserved. There is no intracranial mass or mass effect. Ventricles and sulci are within normal limits. Calvarium and extracranial soft tissues are grossly unremarkable.Cervical cord: There is an intramedullary lesion at the dorsal C2 level involving the bilateral, right greater than left, aspects of the cord. This lesion was slightly more conspicuous previously and also demonstrated enhancement. There is also a more subtle lesion involving the left lateral aspect of the cord at the upper C6 level which was also present previously. No new cervical cord lesions are demonstrated. Cord parenchymal volume is preserved.Vertebral body heights and alignment in the cervical spine are normal. Bone marrow signal is benign. Minimal disc osteophyte complexes are present at the C3-C4 and C5-C6 levels which were present previously. There is no significant spinal canal or neural foraminal stenosis.

Output: 1. There is a single small focus of T2 hyperintensity involving the left lateral aspect of the pons which is not seen on prior MRI study from 11/23/2015, which was of slightly lower resolution. There is otherwise no evidence of progression of demyelinating disease in the brain. 2. No evidence of progression of demyelinating disease in the cervical spinal cord.


Instruction: Generate impression based on findings.

Input: Anterolateral ankle pain TENDONS: No significant abnormality noted.LIGAMENTS: No significant abnormality noted. Specifically, the calcaneofibular ligament is intact (series 701 image 22) and the ATFL is intact (series 301 image 21)ARTICULAR SURFACES AND BONE: No significant abnormality noted. ADDITIONAL

Output: Unremarkable MRI of the left ankle.


Instruction: Generate impression based on findings.

Input: Right hip pain, evaluate for labral pathology. ACETABULAR LABRUM: There is a superior labral tear best seen on the radial images, (series 1101 image 6), which appears similar to the prior study. In addition, there are new articular cartilage defects adjacent to the labrum which are new on this study when compared to prior (series 1101 image 4).ARTICULAR CARTILAGE AND BONE: No significant abnormality of the bone noted. Articular cartilage defects adjacent to the labrum as described above.SOFT TISSUES: No significant abnormality noted. ADDITIONAL

Output: Superior labral tear with new adjacent articular cartilage defects.


Instruction: Generate impression based on findings.

Input: Right hand basilar and MCP joint pain. Evaluate for ligamentous disruption. A marker was placed on the skin along the thenar eminence. The musculature deep to this marker appears normal. Mild osteoarthritis affects the basilar joint, and there is slight dorsoradial subluxation of the first metacarpal relative to the trapezium. Portions of the anterior oblique ligament are poorly defined which may represent chronic degeneration and/or tearing. The dorsoradial ligament and what I believe to be the posterior oblique ligament appear intact. Increased signal intensity within the intermetacarpal ligament suggests mild degeneration. There is a small amount of fluid between the dorsoradial ligament and abductor pollicis longus tendon containing a small focus of low signal intensity corresponding to a small ossicle seen on recent radiographs. Additional small collections of fluid signal intensity are noted along the volar margin of the radioscaphoid articulation, perhaps representing ganglia arising from the long radiolunate and radioscaphocapitate ligaments. This study was not protocoled for detailed evaluation of the ligaments of the wrist, however.The proximal fibers of the ulnar collateral ligament of the first metacarpophalangeal joint are of intermediate signal intensity relative to the normal low signal intensity of the radial collateral ligament. This may reflect degeneration or probably perhaps a chronic partial-thickness tear. A small focus of fluid signal intensity superficial to the ligament may represent a small ganglion.The interphalangeal joint of the thumb appears normal. The flexor and extensor tendons of the thumb are unremarkable. Bone marrow signal intensity is within normal limits except for small tiny degenerative cysts in the base of the first metacarpal.

Output: 1.Osteoarthritis and subluxation of the first carpometacarpal joint, with poor definition of portions of the anterior oblique ligament that may represent chronic degeneration and/or tearing.2.Findings suggestive of degeneration or perhaps a chronic partial-thickness tear of the proximal fibers of the ulnar collateral ligament of the first metacarpophalangeal joint, with a small adjacent ganglion.3.Other findings as above.


Instruction: Generate impression based on findings.

Input: Demyelinating lesions. Left leg weakness. There are numerous, greater than 10, foci of supratentorial and infratentorial white matter T2 hyperintensity. In addition, a few of the lesions demonstrate enhancement, particularly in the right frontal lobe, including an open-ring enhancement pattern. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Findings compatible with demyelinating disease, particularly multiple sclerosis with areas of active demyelination.


Instruction: Generate impression based on findings.

Input: Clinical question: Baseline scan prior to new treatment start following disease progression. Signs and symptoms: History of stage IV metastatic melanoma. Enhanced CT of soft tissues of neck:60 cc of Omnipaque 350 is administered for this exam.Limited view of intracranial space demonstrate a large area of vasogenic edema in the right mid and posterior temporal lobe. There is a partially visualized enhancing mass in the right posterior temporal lobe measuring 13 x 14.2-mm in size.This finding was reported on prior MRI examination of brain from 6 -- 28 -- 11.Images through the skull base including cavernous sinuses are unremarkable.A right-sided nasopharyngeal mass is again identified. In comparison to prior study from 5 -- 16 -- 11 there is interval decrease in the size of the tumor. This mass extends along the posterior wall of the nasopharynx across the midline to the left paramedian left side of nasopharynx. The largest AP axis of this tumor is 18.6 and the largest transverse axis is 32.6-mm. These measurements are smaller since prior study. On the prior exam note was also made of extension of this tumor into the right posterior choana of the right nasal cavity which is no longer present on current study.A small subcutaneous metastatic nodule or on the left at C4 level demonstrate interval increase in its size to 18.6 x 20.6-mm in size while it measured only 9 x 6-mm on prior study.A small necrotic node in the left submandibular region remains identical to prior study and measures approximately 6.5 mm.No additional foci of metastatic lesions are identified.There is no definitive evidence of any osseous metastatic lesions. Please review dedicated studies for detection of osseous metastases.

Output: 1.Interval decrease in the size of right-sided nasopharyngeal mass since prior study. The largest dimensions of this mass are 18.6 x 32.6 millimeter.2.Interval increase in the size of a left posterior upper neck subcutaneous metastases lesion from 9 x 6-mm to 18.6 x 20.6-mm on current exam. 3.No evidence of neoplastic lesions.4.Large area of vasogenic edema in the right mid to posterior temporal lobe surrounding an enhancing tumor measuring 13 x 14.2-mm in size.


Instruction: Generate impression based on findings.

Input: Female 35 years old Reason: evaluate for pancreatic mass History: P53 ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. No suspicious hepatic lesions. Hepatic and portal veins are patent. Biliary tree is without diagnostic abnormality.SPLEEN: No significant abnormality noted.PANCREAS: Pancreas is normal in morphology. No suspicious pancreatic lesions. Pancreatic duct is normal in caliber.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No retroperitoneal lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Small fat-containing umbilical hernia.OTHER: No significant abnormality noted.

Output: 1.No measurable pancreatic mass.


Instruction: Generate impression based on findings.

Input: 74-year-old male with history of rectal cancer. Surveillance exam for rectal cancer, status post radiation and chemotherapy. PELVIS:PROSTATE/SEMINAL VESICLES: Changes secondary to transurethral resection. There is persistent loss of a normal fat plane between the residual prostate tissue and the anterior rectal wall in the midline (axial series 601 image 33). BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No recurrent measurable mass is identified. In the region of the prior known tumor, there is mild wall thickening and minimal wall enhancement.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No recurrent measurable mass is identified in the rectum.2.No discrete mass in the prostate. A fat plane between the prostate and the rectum is not well seen focally. This study is not a dedicated prostate exam, and therefore prostate cancer cannot be optimally evaluated. If there is clinical concern for prostate cancer, further evaluation with dedicated prostate MRI with endorectal coil is recommended.


Instruction: Generate impression based on findings.

Input: Spells of peripheral loss of vision bilaterally, but normal EEG. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. In particular, the hippocampi are intact and there is no evidence of heterotopia. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift. However, the cerebellar tonsils extend up to 5 mm inferior to the foramen magnum. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is mild mucosal thickening in the right maxillary sinus.

Output: 1. No potential seizure focus is identified.2. Borderline low-lying cerebellar tonsils.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Autism intellectual disability and seizures. There is a T1 hypointense and T2 hyperintense subcortical lesion in the pars orbital region of the inferior left frontal gyrus that measures up to 5 mm. There is no evidence of intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is dolichocephaly. The orbits are grossly unremarkable.

Output: Nonspecific subcortical lesion in the pars orbital region of the inferior left frontal gyrus that measures up to 5 mm. Differential considerations include a prominent perivascular space, a congenital cyst, or perhaps a cystic neoplasm. However, the lesion incompletely characterized due to the lack of intravenous contrast.


Instruction: Generate impression based on findings.

Input: Right shoulder pain Note that the examination is significantly limited by motion artifact.ROTATOR CUFF: There is a massive tear of the supraspinatus and infraspinatus tendons with associated retraction of the infraspinatus tendon to the level of the glenohumeral joint and lesser retraction of the anterior fibers of the supraspinatus. There is mild fatty infiltration along the myotendinous junctions of both the supraspinatus and infraspinatus tendons. The teres minor tendon and muscle are normal. The subscapularis demonstrates mild undersurface fraying but is otherwise intact and the subscapularis muscle is normal.SUPRASPINATUS OUTLET: There is mild osteoarthritis of the acromioclavicular joint. A small amount of fluid is present within the subacromial subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: The humeral head is high riding. Evaluation of the labrum is limited by motion artifact although it appears that there is partial detachment of the anterior labrum. There is a small glenohumeral joint effusion.BICEPS TENDON: The extra-articular portion the biceps tendon appears intact. The intra-articular portion of the biceps tendon is difficult to visualize on account of patient motion.

Output: Limited examination due to patient motion which demonstrates the presence of a massive rotator cuff tear and additional findings detailed above.


Instruction: Generate impression based on findings.

Input: BRAIN: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are no areas of abnormal parenchymal signal. 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. Mild mucosal thickening is present within the maxillary and ethmoid sinuses. The skull and scalp soft tissues are unremarkable.MRA HEAD: The intracranial internal carotid arteries are normal in course and caliber. The left A1 segment is hypoplastic. The middle and anterior cerebral arteries are unremarkable. The vertebral arteries, basilar artery, and posterior cerebral arteries are normal in course and caliber. There is no evidence of flow-limiting stenosis or aneurysm.MRA NECK: There is a separate origin of the left subclavian artery, left common carotid artery, and brachiocephalic artery from the arch. The common carotid arteries and cervical internal carotid arteries are normal in course and caliber. Both vertebral artery origins are patent. The vertebral arteries are co-dominant. There is no evidence of flow-limiting stenosis or occlusion.MRV was partially performed. The images give the appearance of decreased flow in the left sigmoid sinus. This could be artifactual. 2-D time-of-flight oblique images were not performed which could help further assess this.The right sigmoid sinus, transverse sinus and jugular bulb are significantly smaller relative to the left-sided counterparts based on the recent CT exam.

Output: 1.No evidence of ischemic infarction or other acute intracranial abnormality.2.Patent arteries within the head and neck without evidence of aneurysm or flow-limiting stenosis.3.Please note that the MRV portion of this examination will be reported separately following acquisition of additional images. Specifically the left sigmoid sinus is not adequately imaged on this exam.


Instruction: Generate impression based on findings.

Input: Male, 67 years old, with history of metastatic thyroid cancer with brain metastases. No significant interval change in size is seen in a rim-enhancing left paracentral lobule lesion. The degree of associated T2 hyperintensity is also unchanged.At least 3 additional lesions within the bilateral frontal lobes (see image 62 series 12), have not significantly changed from the prior examination, and remain less conspicuous than on older exams.No new intracranial lesions are seen. No evidence of any new parenchymal edema, mass effect or pathologic enhancement is seen. The ventricles are stable in size and morphology.

Output: Stable intracranial lesions. No new or progressing lesions are seen.


Instruction: Generate impression based on findings.

Input: History of invasive breast carcinoma progressed after aromatase inhibitor status post right radical mastectomy 12/14/2015 at outside hospital with bulky tumor left behind close margins positive nodes and direct skin extension. Evaluate for distant metastases. CHEST:LUNGS AND PLEURA: Numerous bilateral pulmonary nodules compatible with metastatic disease, see reference left apical nodule and right apical nodule measurements below. Left lung base paramedial mass, see measurements below.Right hilar mass/conglomerate lymphadenopathy and extensive soft tissue paramediastinal soft tissue thickening. The dominant right hilar/mediastinal mass measurement is provided below.There is nodular soft tissue pleural thickening and enhancement of the right hemi-thorax, suspicious for pleural metastatic disease.Small left pleural effusion.MEDIASTINUM AND HILA: Right hilar/mediastinal mass. Paratracheal lymphadenopathy measuring approximately. The right hilar/mediastinal lesion partially encases the SVC which is mildly narrowed. Small pericardial effusion.CHEST WALL: Postsurgical changes from right mastectomy. Abnormal restricted diffusion in the right axillary region may represent residual tumor. There is abnormal postcontrast enhancement which appears to involve several right lateral ribs such as on image 51 of series 100 which reflect metastatic osseous disease and less likely healing fractures.ABDOMEN:LIVER, BILIARY TRACT: Numerous liver metastases. Reference right hepatic dome segment 8 lesion measurement is provided below. No biliary ductal dilatation. The vessels are patent. Porta hepatis lymphadenopathy.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral simple appearing and minimally complex cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.INDEX LESION MEASUREMENTS (Current exam date/time: 2/2/2016 13:00:00)LEFT APICAL NODULE: 1.5 x 1.1 cm (Image 15, Series 7).RIGHT APICAL NODULE: 1.4 x 1.3 cm (Image 14, Series 7).LEFT LUNG BASE PARAMEDIAL MASS: 5.2 x 3.9 cm (Image 38, Series 7).RIGHT HILAR MASS/CONGLOMERATE LYMPHADENOPATHY: 5.5 x 4.4 cm (Image 17, Series 10).PARATRACHEAL LYMPH NODE: 2.5 x 1.6 cm (Image 12, Series 10).RIGHT HEPATIC DOME SEGMENT 8 LESION: 1.6 x 1.3 cm (Image 8, Series 20).

Output: Multiple bilateral pulmonary metastatic nodules/mass, right hilar mass/conglomerate lymphadenopathy and numerous liver metastases. Suspected metastatic right hemi-thorax pleural disease. Suspected right lateral rib metastases; consider bone scan for a more sensitive evaluation of bone metastases. Right axillary signal abnormality may be post-surgical or residual tumor.


Instruction: Generate impression based on findings.

Input: Low back pain, leg numbness, hip weakness. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Minimal L2 on L3 retrolisthesis. Alignment is otherwise maintained. Bone marrow signal is benign. The conus medullaris is normal in position.Sagittal images demonstrate an epidural collection measuring at least 12 mm in the AP dimension and at least 4 cm in the craniocaudal dimension and extending outside of the field-of-view. This lesion is not well evaluated, but there appears to be effacement of the dorsal thecal sac. This collection demonstrates predominantly fluid density with possible low T2 signal inferiorly.Multilevel degenerative changes are seen, as described below:L1-L2: There is dorsal annular fissure with small left paracentral protrusion. No significant spinal canal or neural foraminal stenosis at this level.L2-L3: There is loss of disc height, associated endplate marrow signal changes, and mild diffuse disc bulge. There is no significant spinal canal stenosis. There is minimal bilateral neural foraminal narrowing.L3-L4: Minimal disc bulge. No spinal canal or neural foraminal stenosis.L4-L5: Minimal disc bulge. Minimal left neural foraminal narrowing. No spinal canal or right neural foraminal stenosis.L5-S1: Minimal disc bulge. No spinal canal or neural foraminal stenosis.There is mild facet arthropathy in the lumbar spine, relatively worse at L4-L5 and L5-S1. Small perineural cysts are incidentally seen at the S2 level. Paraspinous soft tissues are within normal limits.

Output: 1. Mild degenerative changes in the lumbar spine as detailed above without significant spinal canal or neural foraminal stenosis at any level.2. There is an epidural collection in the lower thoracic spine which is seen on the sagittal images and not included on the axial lumbar spine images. There appears to be at least mild narrowing of the thecal sac posteriorly. Recommend dedicated thoracic spine MRI for better evaluation.Findings were communicated to Dr. Roitberg at 1230 pm on 6/16/2015.


Instruction: Generate impression based on findings.

Input: Since prior MRI from 11/3/2015, there has been increase in edema and enhancement involving the occipital condyles, C1, as well as the C2 vertebra, primarily involving the odontoid process. Remainder of the previously seen marrow signal abnormality with low T1 signal and enhancement in the skull base is not significantly changed. There are no new fluid collections or discrete masses in the adjacent soft tissues.There are post-treatment findings in the left nasopharyngeal region with soft tissue deficiency involving the pharyngeal mucosal and left parapharyngeal spaces. No mass to suggest residual or recurrent tumor. No significant cervical lymphadenopathy. Postoperative findings related to left-sided mastoidectomy again seen with fluid in the residual left mastoid air cells. There is also partial right mastoid air cell opacification. Moderate mucosal thickening involving most of the paranasal sinuses again seen. These findings are similar to prior from 11/3/2015.Multilevel degenerative changes are present in the cervical spine with small disc osteophyte complexes and up to moderate spinal canal stenosis at the C3-C4 level. There is also a prominent disc osteophyte complex with ventral indentation of the cord at the C5-C6 levels. These findings are grossly similar to prior. Chronic left cerebellar infarct again seen. Also has seen on recent brain MRI, there are small cysts involving the lacrimal glands.

Output: 1. Posttreatment findings in the left nasopharyngeal region without evidence of tumor recurrence.2. No recent neck MRI is available for comparison. Previously seen marrow signal abnormality involving the central skull base with edema and enhancement has progressed compared to 11/3/2015, with new or worsened signal abnormality involving the occipital condyles, C1, and C2 levels. Findings are compatible with progressive osteoradionecrosis/osteomyelitis. No associated fluid collections or masses.


Instruction: Generate impression based on findings.

Input: There are 4 new enhancing lesions which are identified:*a heterogeneously enhancing mass in the posterior left temporal lobe which measures 45 x 38 x 37 mm. This mass is heterogeneous on T1 and T2 sequences with susceptibility artifact consistent with hemorrhage and small areas of necrosis.*a heterogeneously enhancing mass in the left anterior lingual gyrus which measures 15 x 10 x 8 mm. This mass demonstrates susceptibility artifact suggesting hemorrhage.*a heterogeneously enhancing mass in the inferior left frontal lobe which measures 15 x 11 x 11 mm.*5 mm enhancing nodule in the left superior temporal gyrus.There is extensive vasogenic white matter edema in the left cerebral hemisphere. There is mass effect upon the left lateral and third ventricles with approximately 13 mm rightward midline shift. There may be mild entrapment of the right lateral ventricle. There is mild left uncal herniation.Scattered areas of T2 and FLAIR hyperintensity in the subcortical white matter are again noted and likely related to small vessel ischemic disease. There is no diffusion weighted abnormality to suggest infarct. The major intracranial vascular structures enhance normally. No destructive lesions in the calvarium are appreciated.

Output: 1.Multiple new enhancing lesions with hemorrhage in the left cerebral hemisphere, compatible with intracranial metastases. Largest hemorrhagic posterior left temporal mass measures 45 x 38 x 37 mm. 2.There is associated vasogenic edema and mass effect with 13 mm rightward midline shift, effacement of the left lateral and third ventricles, and mild left uncal herniation.Findings were discussed with Dr. Salgia by phone at 1536 hrs on 3/18/2015.


Instruction: Generate impression based on findings.

Input: History of cirrhosis, HCC screening. ABDOMEN:LIVER, BILIARY TRACT: The liver is cirrhotic in morphology. A TIPS device is again noted which generates susceptibility artifact. No suspicious focal intrahepatic lesions are identified. The hepatic arteries, veins, and portal venous system appear patent.SPLEEN: The spleen is enlarged and measures up to 20.0 cm in length. A small splenule is present anterior to the spleen.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: The kidneys are atrophic. Subcentimeter renal cysts are present bilaterally.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Cirrhosis without suspicious liver lesion.2.Splenomegaly.


Instruction: Generate impression based on findings.

Input: 2-year-old female with swelling and pain at the right distal thigh Edema type signal is present predominantly within the vastus intermedialis and portions of the biceps femoris and vastus medialis. Small amount of fluid tracks along the fascial planes around the vastus intermedius. Subcutaneous edema is noted along the anteromedial thigh with small amount of fluid tracking along the fascia over the vastus medialis. Circumferential periosteal reaction and subperiosteal fluid is present with surrounding edema signal extending from the proximal femoral metaphysis to the distal femoral metaphysis. Along the lateral aspect of the distal femoral diaphysis is a T2 bright peripherally enhancing subperiosteal collection measuring 10 x 3 mm (1401/48) with underlying cortical indistinctness. There is increased T2 marrow signal with postcontrast enhancement may represent areas of infarct or osteomyelitis. Serpiginous foci of T1 and T2 hypointensity within the mid femoral diaphysis.Increased T2 signal along the posterior right ischium that demonstrates enhancement. The hip joint appears within normal limits without abnormal signal or joint effusion.

Output: 1.Osteomyelitis or infarct of the right femoral diaphysis with subperiosteal abscess along the lateral aspect of the distal femoral diaphysis. Surrounding myositis as described above.2.Serpiginous T1 and T2 hypointensity within the mid femoral diaphysis compatible with areas of bone infarct.


Instruction: Generate impression based on findings.

Input: 64-year-old man with history of Gleason 7 prostate adenocarcinoma at the left mid gland and left apex. PELVIS:PROSTATE:Prostate Size: 42 x 38 mm.Peripheral Zone: There is a vague, approximately 6 x 5 mm focus of T2 hypointensity and diffusion restriction in the left anterolateral apex (501/19).Central Gland: Normal in appearance.Seminal Vesicles: Seminal vesicles appear normal.Extracapsular Extension: No evidence of extraprostatic extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant lymphadenopathy noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Small area of left apical prostatic signal abnormality suspicious for tumor.


Instruction: Generate impression based on findings.

Input: 21 year old woman with headache. There is no evidence of intracranial hemorrhage, mass or edema. There is possible Chiari malformation, however, head positioning is not ideal to evaluate for this abnormality. Recommend MRI.The ventricles and basal cisterns are normal in size and configuration.The foramen magnum appears slightly enlarged. Otherwise, the calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. Possible Chiari malformation. Recommend evaluation with MRI.


Instruction: Generate impression based on findings.

Input: 59 year old male with hypertension, dyslipidemia, and obesity referred for stress cardiac MRI for further risk stratification.MEDICATIONS: None First Pass PerfusionDuring hyperemia, no perfusion defects were present. Viability/ Myocardial ScarThere was no obvious late gadolinium enhancement noted; however, the lateral wall is not well visualized due to the presence of significant artifact. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 54%, the LV end diastolic volume index is 50 ml/m2 (normal range: 74+/-15), the LVEDV is 130 ml (normal range 142+/-34), the LV end systolic volume index is 23 ml/m2 (normal range 25+/-9), the LVESV is 59 ml (normal range 47+/-19), the LV mass index is 29 g/m2 (normal range 85+/-15), and the LV mass is 76 g (normal range 164+/-36). 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 54%, the RV end diastolic volume index is 52 ml/m2 (normal range 82+/-16), the RVEDV is 134 ml (normal range 142+/-31), the RV end systolic volume index is 24 ml/m2 (normal range 31+/-9), and the RVESV is 62 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.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.2. There was no obvious late gadolinium enhancement noted; however, the lateral wall is not well visualized due to the presence of significant artifact which could not be resolved despite significant effort during image acquisition. 3. Normal LV size and systolic function (LVEF 54%).4. Normal RV size and systolic function (RVEF 54%).I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Reason: Evaluate for ischemia History: LUE weakness, loss of vision in the L eye The CSF spaces are appropriate for the patient's stated age with no midline shift. 5-8 punctate foci of diffusion restriction are present between the right anterior, middle and posterior cerebral artery territories in the subcortical and periventricular white matter.On susceptibility imaging there is a punctate focus of signal loss present in the right inferior frontal gyrus. In isolation this is of unknown clinical significance.There is a moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Punctate foci of a cerebral infarction are present between vascular territories in the right cerebral hemisphere suggesting watershed distribution. Please correlate with a possible history of vascular stenosis in the right carotid distribution.2.Periventricular and subcortical white matter changes of a moderate degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: 31 year old female with family history of breast and ovarian cancer, presents for screening MRI. 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: Lymphangioma status post treatment. There are multiple cystic lesions in the right face, the parapharyngeal, carotid, masticator, parotid, buccal, submandibular, and submental spaces, as well as the floor of mouth and pterygopalatine fossa. There has been interval resection of the previously demonstrated nasopharyngeal components that protruded into the nasopharynx and oropharynx. Otherwise, some of the components have increased in size, such as the dominant component in the right cheek, which measures up to 43 mm, previously 35 mm. A fluid level in another component has resolved. Otherwise, some of the lesions contains septations and display peripheral enhancement. There is mild narrowing of the pharyngeal airway and mass effect upon the right submandibular and parotid glands. There is a cleft palate. The orbits and imaged intracranial structures appear to be grossly unremarkable, aside from mild prominence of the anterior cerebral subarachnoid spaces bilaterally.

Output: 1. Interval resection of the components of lymphatic malformation protruding into the nasopharynx and oropharynx, but increase in size of some of the components of in the right side of the face.2. Cleft palate.


Instruction: Generate impression based on findings.

Input: 57-year-old male with pain. MENISCI: There is a complex tear of the medial meniscus consisting of a horizontal component within the posterior horn that extends to the tibial articular surface. There is also increased signal intensity within the body of the medial meniscus replacing most of its cross section as seen on coronal image 18, suggesting a radial component to the tear as well. There is also mild medial extrusion of the body of the medial meniscus. The anterior horn appears relatively intact. There is parameniscal cyst formation along the posterior half of the meniscus. There is intrasubstance degeneration of the posterior horn of the lateral meniscus. The anterior horn appears intact.ARTICULAR CARTILAGE AND BONE: There is a small near full-thickness to full-thickness cleft of the articular cartilage of the patella, centrally, with additional moderate thinning of the cartilage along the lateral facet. There is also moderate diffuse degeneration of the articular cartilage of the femoral trochlea with central osteophytes. Subjectively, the articular cartilage of the medial femoral condyle appears thinned and heterogeneous indicating degeneration, particularly along the posterior aspect of the condyle. There is also heterogeneous signal of the articular cartilage of the lateral tibial plateau beneath the posterior horn of the meniscus indicating focal full-thickness articular cartilage degeneration. There are tricompartmental osteophytes. There is a prominent osteophyte projecting from the posterior aspect of the medial tibial plateau. A separate ossicle is seen posterior to the PCL immediately lateral to this osteophyte which could represent a loose body within the joint. There is intermediate signal intensity within the adjacent soft tissues suggesting a synovitis.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The patellar tendon is slightly thickened which may reflect a mild tendinosis, but the extensor mechanism appears intact. ADDITIONAL

Output: 1. Medial meniscus tear as described above.2. Osteoarthritis with tricompartmental cartilage degeneration as described above.3. Slight thickening of the patellar tendon may reflect a mild tendinosis.4. Small Baker's cyst and possible loose body within the posterior aspect of the joint.5. Lobulated focal near fluid signal intensity collection which probably represents a ganglion as described above.


Instruction: Generate impression based on findings.

Input: 66 years Female (DOB:11/1/1950)Reason: rule out History: rule outPROVIDER/ATTENDING NAME: KWANG JIN CHOI The vertebral bodies are appropriate in the overall alignment and height. There are multiple nodules within the thecal sac in the lower thoracic spinal canal and lumbar spinal canal coding the cauda equina and distal spinal cord.There is some T2 signal hyperintensity within the cervical spinal cord extending from C2 inferiorly additionally there appears to be thoracic spinal cord central T2 signal hyperintensity.There are multilevel degenerative changes present in the cervical spine with narrowing of the spinal canal. There are also multilevel degenerative changes present in the thoracic spine worse at T10-T11 related to disc bulge associated with ligamentum flavum hypertrophy and spinal stenosis. There are also degenerative changes present in the lumbar spine with narrowing of the spinal canal at L4-5 and L5-S1.There is a pleural effusion present on the right side associated with the nodules within the right pleural space and there is a mediastinal nodules present.There is patchy marrow replacement throughout many of the visualized spinal vertebrae.

Output: 1.Multiple nodular lesions are present throughout the cauda equina and distal spinal cord compatible with the metastatic disease. If clinically appropriate additional imaging may help further evaluate this2.There is abnormal signal within the cervical spinal cord and thoracic spinal cord. Possibility of a cervical cord lesions and thoracic spinal cord lesions and syrinx cannot be excluded. If clinically appropriate additional imaging may help further evaluate this.3.There are multilevel degenerative changes present in the thoracic and cervical spine associated with findings suspicious for spinal stenosis at T10-T11.4.There are multiple nodular lesions throughout the right pleural space and mediastinum. The possibility that these represent neoplasm is suggested is suspected as significantly progressed since prior exams. If clinical appropriate CT of the chest may be of further benefit in evaluating this.5.There is patchy marrow replacement throughout many of the visualized spinal vertebrae. This a nonspecific finding which can be seen with chronic disease, lymphoproliferative disorder, myeloproliferative disorder, anemia, metastases.Findings were reported to the hospitalist service: Dr KWANG JIN CHOI at 8126Due to the screening nature of this protocol details are not as evident on imaging as dedicated protocols of the spine.


Instruction: Generate impression based on findings.

Input: 45-year-old female with metastatic breast cancer and weakness, rule out cord compression Vertebral body heights are intact. Nonenhancing foci of increased signal within the L1 vertebral body likely represents focal fat. No osseous enhancing lesions. Alignment is anatomic. Normal signal within the distal cord, which ends at L1. Mild multilevel facet arthropathy.Multiple enhancing intrathecal nodules are present, the largest at L1-L2 measuring 1.5 x 1.6 cm (1001/27), likely representing metastases. This lesion causes moderate to severe central canal narrowing, compressing the cauda equina and extending into the right lateral recess of L3-L4 along the nerve root. Several additional smaller nodules are also evident along the conus and nerve roots of the cauda equina. In addition, there is diffuse mild thickening and enhancement cauda equina, indicating diffuse leptomeningeal spread of tumor.T12-L1: No central or neuroforaminal stenosis.L1-L2: No central or neuroforaminal stenosis. L2-L3: Large aforementioned metastatic deposit in the right lateral recess causing moderate to severe central canal narrowing. L3-L4: Large enhancing lesion extends inferiorly into the L3-L4 nerve root on the right. No central canal or neural foramina stenosis.L4-L5: Small enhancing lesion in the left lateral recess along L4. No central or neuroforaminal stenosis.L5-S1: No central or neuroforaminal stenosis.

Output: Extensive intrathecal metastatic disease with gross nodules, including a 1.6-cm nodule at L1-L2 causing moderate to severe compression of the canal, as well as a finer leptomeningeal pattern disease.


Instruction: Generate impression based on findings.

Input: Back pain, L1 compression fracture and multiple mets. RCC. Evaluate for metastases and cord compression. Exam is limited due to lack of contrast. Marrow signal is overall heterogeneous in appearance. There is evidence of abnormal signal in the thoracic spine with relatively diffuse tumor infiltration involving the T9 vertebral body where there is osseous retropulsion into the ventral epidural space and extension of tumor into bilateral pedicles and right lamina. There is right paravertebral extension of tumor. Abnormal signal is also noted within the superior T10 vertebral body also compatible with metastatic disease.There is complete effacement of the ventral thecal sac at the T9 level with moderate-severe central spinal canal stenosis. Cord signal remains within normal limits without evidence of cord compression. No epidural tumor is seen elsewhere in the thoracic spinal although absence of contrast limits evaluation. There is mild-moderate narrowing of the right T9-T10 neural foramina. At T1-T2, there is a minimal right paracentral disk protrusion with annular fissure indents the ventral thecal sac. There is scattered facet arthropathy throughout the thoracic spine, especially along the mid to lower portions. No significant spinal canal or neural foramina stenosis is seen in the remainder of the thoracic spine.3.6 x 2.7 cm destructive mass is also noted involving the posterior medial aspect of the left third rib extending to the costovertebral junction. There is mild left foraminal narrowing at this level.Vertebral body heights in the thoracic spine are maintained. Alignment is within normal limits although there is straightening of the normal thoracic kyphosis.There is partial visualization of osseous metastatic disease involving the L1 vertebral body with suggestion of involvement of the right pedicle, and mild-moderate narrowing of the right T12-L1 foramen. There is indentation of the right ventral thecal sac.There is incomplete characterization of several nodules associate with the both adrenal glands, better visualized on prior abdominal CT. However, these are suspicious for metastases.

Output: 1. Osseous metastatic disease in the thoracic spine as seen on recent CT studies and prior bone scan, predominantly involving T9 extending into the posterior elements. Associated osseous retropulsion into the ventral epidural space with effacement of the ventral thecal sac and moderate-severe central spinal canal stenosis, although without cord compression.2. Left third costovertebral junction destructive metastatic mass.3. Additional partially visualized L1 vertebral metastatic disease.4. Partially visualized bilateral adrenal masses also likely metastatic in origin.


Instruction: Generate impression based on findings.

Input: Female, 69 years old, with new imbalance, history of breast cancer. No enhancing intracranial lesions are seen. No evidence of parenchymal edema or mass effect is detected. There are numerous scattered foci of T2 hyperintensity within the cerebral hemispheres and pons. However, no diffusion restricting lesions are seen. No evidence of intracranial hemorrhage or any abnormal extra-axial fluid collection is seen. Ventricular size and morphology are within normal limits. Fluid levels are evident in the maxillary sinuses.

Output: 1.No evidence of intracranial metastases.2.Extensive scattered T2 hyperintense lesions are seen which statistically most likely represent chronic microvascular ischemia.3.No acute or specific findings are seen which would account for the patient's symptoms.4.Paranasal sinus inflammation.


Instruction: Generate impression based on findings.

Input: 77 year old female with biopsy-proven IDC grade 3 with DCIS in the right breast 10:00 position. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.There is an enhancing mass with small anterior non-mass enhancement, measuring 22 x 10 x 14 mm (AP x LR x CC), corresponding to the proven cancer with anterior calcifications. A clip artifact is present between the mass and the non-mass enhancement. Fat plane is present between the mass and pectoralis muscle. No other abnormal enhancement is seen elsewhere in the right breast.No abnormal enhancement is seen in left breast. No abnormal lymph nodes are identified in either axillary region.

Output: 1. Biopsy proven cancer with small anterior extension in the right breast.2. No abnormal enhancement in left breast3. No abnormal lymph nodes in either axillary regionIf conservation surgery is planned, a single wire localization can be performed for anterior aspect of the calcifications located anterior to the proven cancer. An excision should be made of the whole posterior breast tissue from the wire.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: 81-year-old male status post fall. Hit head. Evaluate for bleeding. There is no evidence of intracranial hemorrhage, mass or edema. Diffuse patchy hypodensities in the periventricular and subcortical white matter distribution consistent with microangiopathic changes. Right MCA distribution hypodensity consistent with previous infarct. No acute cortical strokes are noted. If there is clinical concern for acute ischemia, an MRI may be considered.Proportional prominence of the ventricles and sulci.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: No evidence of intracranial hemorrhage.


Instruction: Generate impression based on findings.

Input: CNS lymphoma; restaging scan following chemotherapy. There are left transfrontal post-biopsy findings, including intrinsic T1 hyperintensity and susceptibility effect related to chronic blood products. There are also patchy areas of enhancement in the left frontal lobe periventricular white matter region, posterior left corpus callosum, as well as in the left basal ganglia. There are also numerous scattered nonspecific punctate foci of T2 hyperintensity in the cerebral white matter. There is no evidence of acute intracranial hemorrhage or acute infarct. There is diffuse cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. Artifacts related to dental implants obscures portions of the face.

Output: 1. Periventricular areas of enhancement in the left frontal lobe and posterior corpus callosum, as well as in the left basal ganglia, are compatible with central nervous system lymphoma superimposed upon prior left transfrontal post-biopsy effects. 2. Numerous scattered nonspecific punctate foci of T2 hyperintensity in the cerebral white matter may represent chronic small vessel ischemic disease, for example.


Instruction: Generate impression based on findings.

Input: Male; 63 years old. Reason: biochemically recurrent prostate cancer. Please evaluate the prostate bed and regional nodes. History: biochemically recurrent prostate cancer. PELVIS:PROSTATE:Prostate Size: Status post prostatectomy. No evidence of residual or recurrent disease in the surgical bed.Seminal Vesicles: Not visualized likely due to surgical removal.Extracapsular Extension: Status post prostatectomy.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Status post prostatectomy without evidence of residual or recurrent disease.


Instruction: Generate impression based on findings.

Input: Female 73 years old status post History of Roux-en-Y hepaticojejunostomy with new transaminitis and elevated bilirubin. Evaluate for biliary obstruction. ABDOMEN:LIVER, BILIARY TRACT: No focal liver lesion or ascites. Status post Roux-en-Y hepaticojejunostomy. The common duct measures up to 7 mm in diameter. There is mild intrahepatic biliary ductal dilatation which has improved slightly compared to the prior outside exam. No biliary stones or other obstructing lesions identified. There are no intrahepatic biliary strictures. The hepaticojejunostomy is widely patent.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: There are numerous simple appearing bilateral renal cysts. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Status post Roux-en-Y hepaticojejunostomy.BONES, SOFT TISSUES: T10 vertebral body hemangioma.OTHER: No significant abnormality noted.

Output: Status post Roux-en-Y hepaticojejunostomy with no evidence of choledocholithiasis or biliary stricture.


Instruction: Generate impression based on findings.

Input: 57-year-old female with history of headache and speech disturbance. Evaluate for CVA. There are no areas of restricted diffusion to suggest an acute infarction. There are minimal scattered foci of T2/flair hyperintensity within the periventricular and subcortical white matter which are nonspecific findings. The basal cisterns are intact. The ventricles and sulci are normal and symmetric. There are no intra-or extra-axial fluid collections. Normal flow voids are appreciated within the cerebral vasculature. The calvarium and soft tissues of the scalp are unremarkable.

Output: 1. No evidence of CVA as clinically queried.2. Mild nonspecific scattered foci of T2/flair hyperintensity within the periventricular and subcortical white matter most likely compatible with chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: There is straightening of the cervical spine which is likely positional. There are no fractures or subluxations. The marrow signal is benign. The cervical and upper thoracic cord are normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable.C2/3: Unremarkable and unchangedC3/4: Minimal disc bulge without significant stenosis, unchanged.C4/5: There is a new right paracentral disc protrusion which causes slight anterior right hemicord flattening without intrinsic cord signal abnormality. There is no significant central or foraminal stenosis.C5/6: Redemonstrated is a focal right paracentral disc protrusion causing slight anterior hemicord flattening without intrinsic cord signal abnormality. There is no significant central or foraminal stenosis. These findings are unchanged.C6/7: Progressive mild disc bulge without cord encroachment, cord deformation, or resulting stenosis.C7/T1: Unremarkable and unchanged.

Output: 1.C4/5: There is a new right paracentral disc protrusion which causes slight anterior right hemicord flattening without intrinsic cord signal abnormality. There is no significant central or foraminal stenosis.2.C5/6: Redemonstrated is a focal right paracentral disc protrusion causing slight anterior hemicord flattening without intrinsic cord signal abnormality. There is no significant central or foraminal stenosis. These findings are unchanged.3.C6/7: Progressive mild disc bulge without cord encroachment, cord deformation, or resulting stenosis.


Instruction: Generate impression based on findings.

Input: Assess for encephalitis: intermittent seizure-like activity, catatonia, and delusions. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. Scattered areas of sulcal T2-FLAIR hyperintensity are likely attributable to supplemental oxygen. 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.

Output: No imaging manifestations of encephalitis or other potential sources of seizures.


Instruction: Generate impression based on findings.

Input: 46-year-old male with recurrent headaches The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.There is a punctate left frontal periventricular white matter lesion present a similar but smaller lesion is present in the subcortical white matter of the left insular cortex. These are bright on FLAIR and T2 MRI. There is no associated diffusion restriction or contrast enhancement.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate minor scattered opacities. The visualized portions of the mastoid air cells demonstrate minor opacities in the right mastoid air cells. The visualized portions of the orbits are intact.

Output: 1.Minor subcortical white matter lesions in isolation are nonspecific and likely of little clinical significance.


Instruction: Generate impression based on findings.

Input: Status post motor vehicle collision. Evaluate for stroke, acute pathology or intracranial hemorrhage. The patient experienced loss of sensation and neck pain. Evaluate for cervical instability. MRI brain:Redemonstrated is a minimally enhancing lobular mass involving the right frontal periventricular region which measures 10 x 11 mm (series 7, image 21). This demonstrates susceptibility abnormality with an accompanying prominent venous structure. There is no surrounding edema and the lesion has not changed in size compared to the previous CT. No other lesions are detected elsewhere. 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.MRI C-spine:The cervical spine alignment is maintained. The vertebral bodies are appropriate in height. The bone marrow signal is within normal limits. The cervical spinal cord has normal signal characteristics and overall morphology.Degenerative changes are seen in the cervical spine as described below:C2-3: There is a mild disc osteophyte complex but no significant compromise to the spinal canal or neural foramina.C3-4: There is a mild disc osteophyte complex and mild uncovertebral and facet hypertrophy, which causes mild bilateral neural foraminal stenosis but no central canal stenosis.C4-5: There is a mild disc osteophyte complex and mild facet and uncovertebral hypertrophy, which cause mild bilateral neuroforaminal stenosis. No central spinal canal stenosis. C5-6: There is a mild disc osteophyte complex and mild to moderate uncovertebral and facet hypertrophy, which causes mild bilateral neuroforaminal stenosis. No central spinal canal stenosis.C6-7: There is mild uncovertebral and mild to moderate facet hypertrophy which causes mild left neural foraminal stenosis. No right neural foraminal or central canal stenosis.C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. The paraspinous soft tissue structures appear within normal limits.

Output: 1.Findings compatible with a 10 x 11 mm cavernous malformation in the right frontal periventricular region which is unchanged compared to the previous exam.2.Mild degenerative changes involving the cervical spine without evidence of significant spinal canal or neural foraminal compromise.


Instruction: Generate impression based on findings.

Input: Unspecified open wound of unspecified part of head, initial encounter [S01.90XA], Reason for Study: ^Reason: rule out intraparenchymal infection History: abscess There is no evidence of acute ischemic or hemorrhagic lesion on the scan.There is evidence of right frontal parietal craniotomy with bilateral frontal encephalomalacia with evidence of blood products as well as right occipital lobe encephalomalacia.There are diffuse thick enhancements of the right fronto-parietal bone flap with surrounding fluid collections and soft tissue swelling of the overlying scalp indicating possible infected bone flap. On the posterior aspect of the bone flap, there is defect of the scalp with about 18.3mm x 9.5mm irregular shaped peripheral enhancing lesion (series 1201, image 115/175) indicating possible focal abscess formation. Underlying dura shows diffuse thick enhancement which could represent associated infection/inflammation but could also represent reactive inflammatory changes. There is no evidence of intracranial abnormal enhancement suggesting possible intracranial abscess on this scan.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear.Mucosal thickening of the left maxillary sinus.

Output: 1. Diffuse peripheral enhancement with some fluid collection on the left fronto-parietal bone flap and focal overlying scalp defect especially on the posterior aspect indicating possible infected bone flap.2. Underlying dura and overlying scalp of the bone flap show diffuse thick dural and subgaleal enhancement indicating possible reactive inflammatory changes or could represent involvement of infection.3. No evidence of intracranial abscess formation.4. No evidence of acute ischemic or hemorrhagic lesion. 5. Bifrontal encephalomalacia with hemosiderin deposition as well as right occipital encephalomalacia.


Instruction: Generate impression based on findings.

Input: 32-year-old female with newly diagnosed extensive left breast carcinoma presents for MRI for staging and surgical planning. There is heterogeneous amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.At the approximate 4 o'clock position of the left breast, posterior depth, there is enhancing, spiculated mass which contains susceptibility artifact from a biopsy clip measuring 1.5 x 1.4 x 1.6 cm with 3 immediately adjacent satellite lesions for total measurement of 2.1 x 2.7 x 1.8 cm. This area corresponds to the patient's known malignancy. Approximately 2.7 cm superior to the aforementioned mass, at the 1 o'clock position of the left breast, there is a second spiculated, enhancing mass which contains susceptibility artifact from a biopsy clip measuring 1.2 x 0.7 x 1.3 cm, corresponding to the patient's known malignancy. Approximately 1 cm anterolateral to the second mass, is a third enhancing mass measuring 0.4 x 0.4 x 0.7 cm. Total area of enhancement in the left breast is 2.5 cm AP x 3.1 cm transverse x 5.6 cm CC.At the approximate 11 o'clock position of the right breast, anterior depth, there is a 2.1-cm hematoma which corresponds to the site of prior benign biopsy. Within the upper outer quadrant of the right breast, mid depth, there is a masslike area of enhancement with washout kinetics measuring 1.4 x 0.7 x 1.0 cm.No abnormal lymph nodes are identified in either axillary region.

Output: 1. Multiple enhancing masses within the outer left breast. Total area of enhancement is 2.5 x 3.1 x 5.6 cm. Two of these masses contain susceptibility artifact from biopsy clips, and are compatible the patient's known malignancy.2. Area of masslike enhancement within the upper outer right breast measuring up to 1.4 cm. MR guided ultrasound is recommended for further characterization.3. Hematoma measuring 2.1 cm at the approximate 11 o'clock position of the right breast, corresponding to site of prior benign biopsy.Findings conveyed to Dr. Chhablani at the time of dictation. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: The risks (including, but not limited to, those of bleeding, infection, allergic reaction, temporary nerve block, pain, and inability to access the joint) and benefits of the procedure were explained to the patient, and informed written consent was obtained. A pre-procedural “time-out” form was completed.The patient was placed supine on the fluoroscopy table. The left wrist was localized fluoroscopically, and a spot radiograph was obtained. The skin was cleansed and covered with a sterile drape. The skin and subcutaneous tissues were anesthetized with 1% lidocaine using 25-gauge and 22-gauge needles.Under fluoroscopic guidance, a 20-gauge spinal needle was advanced into the radio scaphoid joint. Attempted aspiration yielded no fluid. Next, 3 ml of a 50/50 mixture of Omnipaque 240 (to confirm the intra-articular position of the needle) and dilute Multihance (0.1 cc in a 10 cc vial of saline, for subsequent MR imaging) were injected into the joint. Contrast opacified the joint in the expected manner. A spot radiograph was obtained for documentation. The needle was withdrawn. Blood loss was negligible (<1cc), and patient tolerated the procedure well without immediate complication. An adhesive bandage was placed on the patient’s skin. Routine post procedure instructions were communicated to the patient. The patient was escorted to the MRI suite for further imaging in stable condition. Please refer to the subsequent MRI report for further information.Exposure time: 89 seconds

Output: Successful fluoroscopic guided wrist arthrogram.


Instruction: Generate impression based on findings.

Input: new onset headache, sensory disturbances and tremor No evidence of acute ischemic or hemorrhagic lesion.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: No evidence of acute ischemic or hemorrhagic lesion.Normal brain MRI.


Instruction: Generate impression based on findings.

Input: Pituitary lesion and Chiari one malformation: yearly follow up. Brain: There are unchanged low lying cerebellar tonsils that extend to the level of the tip of the dens with mildly blunted cerebrospinal fluid flow across the posterior foramen magnum and intact flow anteriorly. 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. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Pituitary: There is a cystic lesion within the pituitary that measures up to 13 mm in width and 8 mm in height, which is unchanged. There is unchanged slight deviation of the infundibulum to the right. The cavernous sinuses and optic apparatus are intact.

Output: 1. Unchanged stigmata of Chiari 1 malformation.2. Unchanged pituitary cyst.


Instruction: Generate impression based on findings.

Input: 52-year-old female with history of paroxysmal atrial fib with intermittent vision changes, facial numbness, evaluate for stroke, mass or other There is no restricted diffusion on DWI sequences. The CSF spaces are appropriate for patient's age. There is faint vascular enhancement traversing the white matter from the left frontal horn of the left lateral ventricle anteriorly to the left frontal cortex consistent with a development vascular anomaly of no clinical significance. Otherwise no areas of abnormal intraparenchymal enhancement, mass lesions or mass effect are noted. There are very few punctate foci of FLAIR hyperintensity in the subcortical white matter, nonspecific. There is mild prominence of the cerebellar and vermin folia for age which are of unknown clinical significance.There is a tiny focus of T2 and FLAIR hyperintensity in the mid pons posteriorly which on post enhanced images demonstrates diffuse ill-defined faint enhancement and definite susceptibility signal changes. This focus measures 6 mm x 5 mm on sagittal post enhanced images (series1203, image 95) and most likely represents a form of vascular malformation such as a capillary telangiectasia.The visualized paranasal sinuses are clear. The visualized orbits are unremarkable. The mastoid air cells are well-pneumatized.

Output: 1. Overall unremarkable examination. 2. Findings most likely represent a capillary telangiectasia at the mid pons and likely a developmental vascular anomaly in the left frontal cortex as described above. 3. Other findings as above.


Instruction: Generate impression based on findings.

Input: Reason: Persistent hematospermia History: Persistent hematospermia PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Unremarkable MRI pelvis study.


Instruction: Generate impression based on findings.

Input: This limited planning MRI reveals unchanged postsurgical findings related to left parietal craniotomy including subjacent volume loss and gliosis. There is a small left frontal lobe developmental venous anomaly. There is also unchanged volume loss and signal abnormality within the medial left temporal lobe. There are grossly unchanged dysplastic left A1 and M1 segments without evidence of aneurysm. There is fluid within left mastoid air cells. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation.

Output: 1.Unchanged findings suggestive of left mesial temporal sclerosis.2.Unchanged post surgical changes within the left parietal lobe.3.Grossly unchanged dysplastic left A1 and M1 segments.4.Nonspecific fluid within the left mastoid air cells.


Instruction: Generate impression based on findings.

Input: Right hip pain There is abnormal degenerative signal and cystic change within the right pubic bone to the level of the pubic symphysis. The marrow signal of the remaining bones of the pelvis is otherwise normal and there is no evidence of fracture.Although the evaluation of the labrum is limited given the lack of intra-articular contrast, there is intermediate to high signal traversing the superior labrum, suspicious for a labral tear. There are no articular cartilage defects and no evidence of synovitis of the hip joint.The musculature of the pelvis and hip is intact with normal signal intensity.Nabothian cysts noted within the cervix.

Output: 1. No evidence of fracture or synovitis.2. Findings suggestive of superior labral tear. This can be better evaluated with MR arthrography if clinically warranted.


Instruction: Generate impression based on findings.

Input: Clinical question: Patient was transferred from an outside institution for respiratory failure. Found down at trauma on paralytics and sedated at outside hospital. Now lie attending sedation and off paralytic agents. Still minimally responsive. Non-enhanced CT of brain:There is lower than expected hypoattenuation of the white matter of bilateral cerebral hemispheres. There is however no evidence of effacement of cortical sulci, mass effect midline shift or hydrocephalus. The density of cortex and basal ganglia and thalami remain within normal limits. Considering provided clinical date of possibly two underlying diffuse cerebral edema cannot be entirely ruled out and follow-up with an MRI is recommended. It is also possible that this appearance may be technique related. Images through posterior fossa are essentially unremarkable.

Output: Suspected cerebral edema of bihemispheric white matter as detailed. Considering patient's provided clinical date of follow-up with an MRI is recommended. There is no evidence of hemorrhage, mass-effect, midline shift or hydrocephalus. Please see above comments.


Instruction: Generate impression based on findings.

Input: There is a partially empty sella. There is no associated optic nerve sheath ectasia, optic nerve sheath dilatation, optic nerve disc flattening, or a "pinched" appearance of the frontal horns.The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. Other than minimal mucosal thickening within the inferior right maxillary sinus and a single right ethmoid air cell, the paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain.

Output: There is a partially empty sella which can be seen in the setting of idiopathic intracranial hypertension (a.k.a. pseudotumor) versus idiopathic partially empty sella. As is no associated optic nerve sheath ectasia, optic nerve sheath dilatation, optic nerve disc flattening, or a "pinched" appearance of the frontal horns, idiopathic partially empty sella is favored.


Instruction: Generate impression based on findings.

Input: 37-year-old male with a salivary cancer. Status post 4 cycles of treatment. Compare and provide measurement. CT of soft tissues of the neck with infusion:Large destructive mass involving the left ethmoid air cells and with extension into the left orbit is again noted. In comparison with the prior exam there may be slight increase in the size of tumor in the retro-orbital space. Extensive tumor across the midline into the right ethmoid air cells with extensive bony erosion is also noted. This section of tumor demonstrates no definitive interval change. Erosion of the anterior wall of the sphenoid sinus with extension of tumor remains a stable. Increased soft tissue density on the lateral aspect of right orbit and right infratemporal fossa also remains a stable. Extensive posttherapy/surgical changes remains stable. No evidence of pathologic adenopathy in the neck. Limited images of the apices of the lungs are negative. Limited images of the mediastinum are negative on this study. Please review the dictated report of CT of chest that visualizes both these sections with more accuracy.CT of brain with infusion.No evidence of hemorrhage, edema, mass effect, midline shift or hydrocephalus. No evidence of abnormal enhancement of brain parenchyma or leptomeninges. To better evaluate patient's known tumor at the skull base in particular for epidural spread into the intracranial space an MRI is recommended.

Output: 1. With the exception of possible minimal increase in the left the retro-orbital tumor this is study remains a stable.2.Unremarkable CT of brain. Three see above comments.


Instruction: Generate impression based on findings.

Input: 22 years, Female, multiple sclerosis, worsening symptoms. Visual problems. Again seen are multiple T2/FLAIR hyperintense lesions in the periventricular and subcortical white matter with morphology and distribution consistent with known demyelinating disease. Compared to 7/22/2016 there are multiple new lesions evident with interval development of greater than 10, T2/FLAIR hyperintense lesions which demonstrate peripheral enhancement consistent with active demyelination. These lesions are seen in the bilateral frontal and parietal lobes, predominantly in the periventricular region, left temporal lobe, as well as a relatively large one in the right occipital lobe. There is relatively mild posterior fossa involvement as before although there is a right inferior cerebellar lesion which is new since prior.Previous present relatively larger left frontal lesion demonstrates mild decrease in size and decrease in peripheral enhancement consistent with evolution.No intracranial mass effect, midline shift, or herniation. Ventricles are normal in size. Brain parenchymal volume is preserved. There is abnormal signal involving the cervical cord at the C2 level which was grossly present on prior although not well evaluated on the current brain MRI.

Output: Continued progression of demyelinating disease with greater than 10 new lesions with enhancement consistent with active demyelination.