Instruction: Generate impression based on findings.

Input: 62-year-old male with history of prostate cancer scheduled for surgery. Evaluate for disease and assess for nerve sparing. PELVIS:PROSTATE:Prostate Size: The prostate measures 4.6 cm in transverse, 3.7 cm in AP, and 3.9 cm in craniocaudal length.Peripheral Zone: In the right mid gland, there is a 1.7 x 1.3 cm ADC and T2 hypointense lesion (series 301 image 12). There is a extracapsular extension along the right posterior-lateral border close to the neurovascular bundle, and involvement is not excluded (series 301 image 11). The lesion extends from the right mid gland to the apex.Central Gland: Nodular appearance of BPH.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: As aboveBLADDER: No significant abnormality noted.LYMPH NODES: Subcentimeter external iliac lymph nodes are not enlarged by criteria. Evaluation of the lymph nodes at the aortic bifurcation is significantly limited due to artifact. Consider CT exam.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.In the right mid gland peripheral zone extending to the apex, there is a 1.7 x 1.3 cm ADC and T2 hypointense with extracapsular extension along the right posterior-lateral border close to the neurovascular bundle, and involvement is not excluded. PI-RADS-5 PI-RADS™ v2 Assessment Categories:PI-RADS 1 – Very low (clinically significant cancer is highly unlikely to be present) PI-RADS 2 – Low (clinically significant cancer is unlikely to be present)PI-RADS 3 – Intermediate (the presence of clinically significant cancer is equivocal)PI-RADS 4 – High (clinically significant cancer is likely to be present) PI-RADS 5 – Very high (clinically significant cancer is highly likely to be present)https://www.acr.org/~/media/ACR/Documents/PDF/QualitySafety/Resources/PIRADS/PIRADS%20V2.pdf


Instruction: Generate impression based on findings.

Input: 70-year-old female patient with right upper quadrant abdominal pain, fatty liver. Noted hypoechoic change in the proximal body of the pancreas on outside hospital ultrasound. ABDOMEN:LIVER, BILIARY TRACT: There is a 2.0 x 1.6 cm lesion within segment V of the liver which demonstrates T2 hyperintensity and discontinuous, peripheral, nodular enhancement with filling in on more delayed images (image 46, series 12). An additional 1.3 x 1.4 cm lesion within segment VIII demonstrates similar imaging characteristics (image 72, series 12). These are compatible with hemangiomata. There is no intra or extrahepatic biliary ductal dilatation. The hepatic and portal veins are patent. The gallbladder is absent.SPLEEN: No significant abnormality noted.PANCREAS: There is a 1.1 x 0.6 cm ovoid, well demarcated region within the pancreatic body which demonstrates signal characteristics of fat without enhancement; this likely represents an intrapancreatic lipoma. Multiple scattered foci of T2 hyperintensity measuring no more than a few millimeters which do not enhance likely represent sidebranch IPMNs. No suspicious pancreatic lesion is identified. The main pancreatic ductal diameter is within normal limits.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Scattered subcentimeter T2 hyperintense foci within both kidneys likely represent cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Intrapancreatic lipoma within the body of the pancreas and several subcentimeter cystic foci compatible with sidebranch IPMNs. No suspicious pancreatic lesion is identified. 2.Two hepatic lesions with imaging characteristics compatible with hemangiomas.


Instruction: Generate impression based on findings.

Input: Male, 62 years old. Right shoulder pain/weakness ROTATOR CUFF: There is a full-thickness tear of the supraspinatus tendon with retraction of the tendon fibers to the level of the glenohumeral joint and advanced atrophy of the supra spinous muscle. The infraspinatus tendon is intact, but there is severe atrophy of the infraspinatus muscle. There is advanced tendinopathy of the subscapularis tendon. The teres minor tendon and muscle are intact.SUPRASPINATUS OUTLET: There is a small amount of fluid within the subacromial/subdeltoid bursa. Mild to moderate osteoarthritis affects the acromioclavicular, with a small subchondral cyst within the acromion.GLENOHUMERAL JOINT AND GLENOID LABRUM: Moderate osteophytosis affects the glenohumeral joint with mild chondral thinning. There is diffuse degenerative tearing of the labrum.BICEPS TENDON: The intra-articular biceps tendon appears torn. The extra-articular biceps tendon is normal in course ADDITIONAL

Output: 1.Full-thickness tear of the supraspinatus tendon with advanced atrophy of the supraspinatus and infraspinatus muscles.2.Tear of the intraarticular biceps tendon, degenerative tearing of the labrum, and other findings as above.


Instruction: Generate impression based on findings.

Input: 67 years Female (DOB:2/10/1949)Reason: lue radiculopathy History: samePROVIDER/ATTENDING NAME: RICHARD W KANG RICHARD W KANG The cervical vertebral bodies are appropriate in overall height. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal enhancing lesions are identified in the cervical spine. There is mild anterior subluxation of C4 on C5.At C2-3 there is no significant compromise to the spinal canal. There is left-sided facet hypertrophy at this level. There is narrowing of the left neural foramen at this level.At C3-4 there is no significant compromise to the spinal canal. There is left-sided facet hypertrophy at this level. There is narrowing of the left neural foramen at this level.At C4-5 there is mild facet hypertrophy at this level. There is mild anterior subluxation of C4 on C5. At C5-6 there is a right paramedian disc extrusion present at this level which is broad-based. It extends behind the adjacent endplates and impresses on the ventral aspect of thecal sac partially patient's spinal fluid ventral and posterior the spinal cord. Mild-to-moderate degree of spinal stenosis.At C6-7 there is no significant compromise to the spinal canal or neural foramina. There is a disc bulge present at this level associated partial effacement of spinal fluid ventral and posterior the spinal cord.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.There are multilevel degenerative changes present cervical spine with a mild to moderate degree of spinal stenosis C5-6 related to a disc extrusion. There is also multilevel encroachment of neural foramina involving the left neural foramen at C2-3, left neural foramen at C3-4, bilateral neural foramina at C5-6 and bilateral neural foramina at C6-7. There is mild subluxation at C4-5.


Instruction: Generate impression based on findings.

Input: 71 years, Male, with tremor, preoperative planning. Examination is limited to sequences for operative planning and intraoperative navigation. There are focal areas of volume loss involving the posterior cerebellar hemispheres bilaterally likely related to chronic infarcts but new since prior from 10/13/2011. There is also mild generalized volume loss supra and infratentorially. There are scattered foci of susceptibility effect consistent with chronic microhemorrhages including the left posterior frontal lobe, left posterior temporal lobe, bilateral parieto-occipital lobes as well as the left cerebellar hemisphere. No intracranial mass or mass effect. Specifically no lesions are abnormal vascular structures are seen along the expected trajectory of DBS leads. No hydrocephalus or extra-axial collections. No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved. There is mild opacification throughout the paranasal sinuses including multiple small bilateral maxillary mucus retention cysts.

Output: 1. Examination for operative planning and intraoperative navigation. No masses or abnormal vascular structures are seen along the expected trajectory of DBS leads.2. Focal areas of volume loss involving the posterior cerebellar hemispheres bilaterally likely related to chronic infarcts and new since prior from 10/13/2011. 3. Mild generalized volume loss supra- and infratentorially. 4. Multiple foci of chronic microhemorrhage which are predominantly in a peripheral lobar distribution and favored to represent amyloid angiopathy.


Instruction: Generate impression based on findings.

Input: 46-year-old male with history of seminoma. Evaluate for recurrence. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No retroperitoneal lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted. LYMPH NODES: New pelvic lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No evidence of metastatic disease.


Instruction: Generate impression based on findings.

Input: Reason: knee pain, unable to bear weight/ambulate History: as above MENISCI: There is globular increased signal abnormality within the posterior horn of the lateral meniscus indicating intrasubstance degeneration. There is a small radial tear of the posterior horn of the lateral meniscus with a flipped meniscal fragment situated medial to the body of the meniscus (coronal image 19: series 9). Some of the signal extends to the tibial and femoral articular surface consistent with superficial fraying and degenerative tearing. There is globular increased signal abnormality within the posterior horn of the medial meniscus consistent with intrasubstance degeneration. No fluid-filled tear is evident.ARTICULAR CARTILAGE AND BONE: There are tricompartmental osteophytes. There is near full-thickness to full-thickness articular cartilage degeneration along the medial tibial femoral compartment. There is relative sparing of the lateral tibiofemoral compartment. There is decreased signal abnormality within the articular cartilage along the weightbearing surface of the lateral femoral condyle likely representing chondrocalcinosis. There is full-thickness articular cartilage degeneration along the patellofemoral articulation with large areas of the lateral facet of the patella and femoral trochlea completely devoid of articular cartilage with underlying subchondral signal abnormality, likely degenerative in etiology. There is near full-thickness to full-thickness articular cartilage degeneration along the medial facet of the femoral trochlea and patella.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Severe degenerative changes affecting the right knee most pronounced along the patellofemoral articulation with findings suggesting CPPD arthropathy.2. Radial tear of the posterior horn lateral meniscus with a small flipped meniscal fragment as well as intrasubstance degeneration as described above.


Instruction: Generate impression based on findings.

Input: Gas in midfoot. Evaluate for infection. There are chronic appearing changes in the cuboid and lateral cuneiform at the joint line. There is no cortical destruction or evidence of osteomyelitis. Scattered foci of signal void are compatible with gas as seen on prior CT.There is skin thickening and edema particularly affecting the dorsolateral aspect of the mid and forefoot. There is also extensive increased signal affecting the muscles of the foot consistent with edema. No discrete drainable fluid collection is identified. The ligaments and tendons of the ankle appear intact.

Output: 1. Extensive edema of ankle and midfoot without specific evidence of osteomyelitis. Gas is again noted adjacent to multiple bones in the foot. No drainable fluid collection is identified.2. Signal abnormality within the medial cuboid/lateral cuneiform is likely degenerative in etiology or post-traumatic, infection is considered less likely.


Instruction: Generate impression based on findings.

Input: History of cirrhosis, preliver transplant evaluation, evaluate for HCC. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology. No suspicious focal hepatic lesions are identified. The hepatic vasculature appears patent. No significant biliary ductal dilatation. The gallbladder is mildly distended without wall thickening.SPLEEN: Mild splenomegaly.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple subcentimeter renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Perigastric/gastroesophageal varices.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Mild to moderate ascites.

Output: Cirrhosis and sequela of portal hypertension without suspicious hepatic lesion seen.


Instruction: Generate impression based on findings.

Input: Reason: Evaluate posterior knee schwannoma History: Left knee pain and mass MENISCI: There is blunting and deformity of the posterior horn of the medial meniscus indicating complex degenerative tearing extending to involve the body of the meniscus. There is also linear signal abnormality within the anterior horn of the medial meniscus which extends to the femoral articular surface indicating a horizontal tear. There is minimal increased signal abnormality within the anterior and posterior horns of the lateral meniscus indicating intrasubstance degeneration. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is severe articular cartilage degeneration affecting the patellofemoral articulation with large areas of the medial and lateral facet of the patella and femoral trochlea completely devoid of articular cartilage. There are tricompartmental osteophytes. There is full-thickness articular cartilage degeneration along the weightbearing surface of the medial femoral condyle with areas completely devoid of articular cartilage above the posterior horn of the meniscus. There is underlying subchondral signal abnormality. There is full-thickness articular cartilage degeneration along the anterior aspect of the lateral femoral condyle with areas completely devoid of articular cartilage with underlying subchondral signal abnormality.LIGAMENTS: There is increased signal abnormality and irregularity of the mid substance fibers of the PCL indicating a tear, unchanged. This may be chronic in etiology. The ACL appears intact. The LCL and MCL appear intact.EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Nonspecific 4 cm mass which courses along the bifurcation of the tibial and peroneal nerves, posterior to the knee, with nodular and septal enhancement on postcontrast sequences. While this may represent a peripheral nerve sheath tumor, a malignant peripheral nerve sheath tumor cannot be completely excluded by this examination.2. Osteoarthritis of the knee most pronounced along the patellofemoral articulation.3. Disruption of the PCL which may be chronic in etiology.4. Small joint effusion with findings suggestive of a synovitis as well as multiple loose bodies within the joint. 5. Tearing of the medial meniscus as described above. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Male 69 years old Reason: hx of prostate cancer, scheduled for ablation History: see above PELVIS:PROSTATE:Prostate Size: Prostate measures 5.1 x 3.4 x 4.4 cmPeripheral Zone: In the left mid gland there is a small focus of suspected cancer measuring 8 x 5 mm along the periphery of the gland lesion is hypointense on T2-WI with restricted diffusion. At the left base there is a second small focus of suspected cancer measuring 4 x 4 millimeters which is hypointense on T2-WI with restricted diffusion..There are additional foci of signal abnormality involving the apex of the right gland. The lesion has mild signal abnormality on ADC map but no significant corresponding abnormality on T2-WICentral Gland: Heterogeneous central gland.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: No definite extracapsular extension.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Foci of suspected prostate cancer in the gland.


Instruction: Generate impression based on findings.

Input: Female, 64 years old, with stage III recurrent non-small cell lung cancer presenting with vague neurologic symptoms (weakness) rate assess for brain metastases. Image quality on several sequences, including the postcontrast sequences, is degraded by motion artifact. Within this limitation, the following observations are made.No definite pathologic parenchymal or extra-axial enhancement is observed. No focal edema or mass effect is seen. Diffusion-weighted images are within normal limits. A small nonspecific focus of FLAIR hyperintensity is seen within the right inferior parietal lobule. A small slitlike defect is also seen in the left cerebellum.No evidence of acute intracranial hemorrhage or any abnormal extra axial fluid collection is seen. The ventricles are normal in size and morphology.

Output: 1.Within the limitations of a motion degraded exam, no evidence of metastatic disease is seen.2.A small chronic left cerebellar infarct is noted.


Instruction: Generate impression based on findings.

Input: 74-year-old female with architectural distortion in the right breast identified on screening mammogram, subsequent ultrasound identified 2 suspicious areas in the right breast. Subsequent MRI identified additional lesions in the right breast, 12 o'clock position, 6:00 position, and left breast 9-10 o'clock position and 5:00 position. Right ultrasound re-identified the target lesion for biopsy. Lesion to be targeted for biopsy in the right breast at the 7:00 position 4 cm from the nipple (labeled #1) is hypoechoic and ill-defined and measures 1.9 x 1.0 cm. 2 masses identified at the at the 7:00 position 2 cm from the nipple in the right breast, with the largest lesion measuring 6 x 4 mm (labeled #2 and 3) which will be targeted to biopsy. No correlate was identified with MR finding in the right breast 6:00 position. Oval hypoechoic lesion in the right breast at the 12:00 position 4 cm from the nipple measures 4 x 3 mm, thought to correspond to the MRI finding, was chosen for biopsy.Targeted left breast second look ultrasound in the 9:00 position in the area of the enhancing mass identified at MR was not identified on ultrasound. Enhancing focus in the left breast at the 4-5 o'clock position identified on MRI had no ultrasound correlate.PROCEDURE: The procedure and its risks, including bleeding, infection, and failure to diagnose, and expected benefits of ultrasound-guided core biopsy with percutaneous placement of a marking clip and post-procedure unilateral mammogram were discussed with the patient. Questions were answered. Consent was obtained both verbally and in writing. The time-out form was completed to confirm patient identity and side/type of procedure.The right breast lesion 7:00 position #1 biopsy was cleansed with chlorhexidine over the target area. Transducer was sterilely sheathed. Local anesthesia was obtained using 2% lidocaine superficially and at depth. A 3 mm incision was made in the skin with a #11 scalpel blade. Using aseptic technique, continuous ultrasound guidance and a mediolateral approach, three 14-gauge core needle (Inrad) specimens were obtained of the lesion. Targeting was judged excellent. No specimens sank to the bottom of the prefilled container of 10% formalin. All specimens partially sank. Specimen quality was judged very good.Specimens were sent to Pathology with an accompanying history sheet. Using continuous ultrasound-guidance a Hydromark clip was placed into the lesion in the usual manner. Pressure was held over the biopsy site until all bleeding subsided. The skin incision was closed with a Steri-Strip. The right breast lesion 7:00 position #2 biopsy was cleansed with chlorhexidine over the target area. Transducer was sterilely sheathed. Local anesthesia was obtained using 2% lidocaine superficially and at depth. A 3 mm incision was made in the skin with a #11 scalpel blade. Using aseptic technique, continuous ultrasound guidance and a mediolateral approach, three 14-gauge core needle (Inrad) specimens were obtained of the lesion. Targeting was judged excellent. No specimens sank to the bottom of the prefilled container of 10% formalin. All specimens partially sank. Specimen quality was judged very good.Specimens were sent to Pathology with an accompanying history sheet. Using continuous ultrasound-guidance a Hydromark clip was placed into the lesion in the usual manner. Pressure was held over the biopsy site until all bleeding subsided. The skin incision was closed with a Steri-Strip. The right breast 12:00 position biopsy was cleansed with chlorhexidine over the target area. Transducer was sterilely sheathed. Local anesthesia was obtained using 2% lidocaine superficially and at depth. A 3 mm incision was made in the skin with a #11 scalpel blade. Using aseptic technique, continuous ultrasound guidance and a mediolateral approach, three 14-gauge core needle (Inrad) specimens were obtained of the lesion. Targeting was judged excellent. No specimens sank to the bottom of the prefilled container of 10% formalin. All specimens partially sank. Specimen quality was judged very good.Specimens were sent to Pathology with an accompanying history sheet. Using continuous ultrasound-guidance a Bard ribbon clip was placed into the lesion in the usual manner. Pressure was held over the biopsy site until all bleeding subsided. The skin incision was closed with a Steri-Strip. Post-procedure digital right CC and ML views revealed the percutaneously placed clips to be in the expected location in the central anterior aspect of the lesion. No evidence of hematoma or other complication. Distance between the 2 Hydro mark clips is 2.2 cm.A pressure dressing was positioned over the biopsy sites and an ice pack positioned over the pressure dressing. Post-procedure instructions were reviewed with the patient both verbally and in writing. She tolerated the procedure well with no evident complications and left the Breast Imaging Department in stable condition.The procedure was performed by Dr. Kulkarni and Dr. Jahangir. Dr. Kulkarni was present during the procedure at all times.

Output: Successful ultrasound-guided core biopsy of the right breast lesions ( 7:00 (#1 and satellite) and 12:00 position) and clip placement. This is most likely a malignancy. Pathology is pending at this time.No sonographic correlate identified to the lesions seen on MRI in the left breast.No sonographic correlate identified to the lesion seen on MRI in the right breast 6:00 position.BIRADS: 5 - Highly suggestive of malignancy.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Lumbar radiculopathy Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is mild dextrocurvature of the upper thoracic spine and mild levocurvature of the lower lumbar spine. There appears to be minimal anterolisthesis of L4 and L5. Bone marrow signal is benign. The conus medullaris is normal in position.Multilevel degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: No significant disc disease. No spinal canal or neural foraminal stenosis.L4-L5: There is mild disc bulge and advanced bilateral facet arthropathy with minimal anterolisthesis. There is also ligamentum flavum thickening. There is resulting mild spinal canal stenosis. There is mild bilateral, right relatively worse than left, neural foraminal stenosis.L5-S1: There is a disc bulge which is eccentric to the right with suggestion of a right lateral osteophyte component. There is advanced bilateral facet arthropathy. There is no significant central canal stenosis. However, there is partial effacement of the right lateral recess. There is mild right neural foraminal stenosis as well as contact of the right L5 nerve root extraforaminally with the right lateral disc osteophyte complex.Paraspinous soft tissues are within normal limits.

Output: 1. Mild degenerative changes in the lumbar spine, particularly at the L4-L5 and L5-S1 levels. There is mild spinal canal stenosis at the L4-L5 level. Otherwise no significant spinal canal stenosis in the lumbar spine.2. Neural foraminal narrowing is relatively worse at the right L4-L5 and right L5-S1 levels. There is also contact of the right L5 nerve with a laterally projecting disc osteophyte complex extraforaminally at the L5-S1 level as well as partial effacement of the lateral recess at the right L5-S1 level where there is contact of the right S1 nerve root. No high-grade neural foraminal stenosis at any level.3. Advanced bilateral facet arthropathy at L4-L5 and L5-S1. There is grade 1 anterolisthesis of L4 on L5.


Instruction: Generate impression based on findings.

Input: Reason: recent multiple strokes. increased wandering and memory loss. recent 25 lb weight loss. evaluate for new strokes or malignancy History: weight loss There is redemonstration of a large focus of encephalomalacia involving the right parietal lobe. Another focus of encephalomalacia is present along the medial aspect of the right occipital lobe and unchanged compared to the prior exam. A smaller focus of encephalomalacia is present in the right middle and inferior frontal gyri. This is also stable compared to the previous exam. A smaller focus of encephalomalacia is present along the posterior aspect of the right superior frontal gyrus. This is also stable compared to the previous exam.No foci of diffusion restriction are appreciated on the current exam.The punctate focus of high signal on T2 and flair MRI is present in the right cerebral hemisphere which is new since the prior exam. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.There is a small parafalcine focus of susceptibility which is bright on T1 imaging measuring 17 x 6 mm axial dimensions and 17 x 12 mm sagittal dimensions. It is located adjacent to the right cingulate sulcus.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.Multiple foci of encephalomalacia in the right hemisphere compatible prior vascular insults are stable compared to the previous exam.2.There is a small hemorrhagic focus present adjacent to the falx cerebri which is suspected to be in the subacute stage.3.Findings were discussed with Dr Neda Laiterapong


Instruction: Generate impression based on findings.

Input: 62-year-old male status post C3, C4, C5, C6, and partial C7 laminectomy as well as bilateral C3, C4, C5, and C6 lateral mass fusion exhibiting drainage at wound. Surgery performed 12/4/2015 There has been interval laminectomy at C3, C4, C5, and C6. Bilateral pedicle screws are now present at C3, C4, C5, and C6. Posterior to the resection site, within the operative tract, underlying the skin, there is a 4 cm craniocaudal by 1.5 cm AP x 2.5 cm transverse fluid collection demonstrating peripheral enhancement.Craniovertebral junction appears within normal limits. Redemonstrated is osseous fusion involving the C3-C4 vertebral bodies and the C5-C6 vertebral bodies. There is minimal retrolisthesis of C5 on C6. Alignment is otherwise grossly maintained. Bone marrow signal is benign.C2-3: There is mild right neural foraminal narrowing related to uncovertebral hypertrophy and facet arthropathy. No significant compromise to the spinal canal or left neural foramen. These findings are unchanged.C3-4: Secondary to laminectomy, the central canal has been decompressed and central stenosis is no longer evident. As before, there Is questionable subtle T2 hyperintensity within the cord at this level.C4-5: Fusion at the intervertebral discs level is again noted. Secondary to laminectomy, the central canal has been decompressed and central stenosis is no longer evident. Mild left and minimal right neural foraminal narrowing is unchanged.C5-6: Secondary to laminectomy, the central canal has been decompressed and central stenosis is no longer evident. There is persistent deformity of the cord particularly in its right aspect. Redemonstrated is T2 hyperintensity in the cord and volume loss consistent with myelomalacia. There is severe right and moderate left neural foraminal stenosis related to uncovertebral hypertrophy and to a lesser degree facet arthropathy, unchanged.C6-7: Secondary to laminectomy, the central canal has been decompressed. As before, there is no significant spinal canal stenosis. There is mild left and minimal right neural foraminal stenosis, unchanged. C7-T1: There is a disc osteophyte complex and bilateral uncovertebral hypertrophy. There is mild spinal canal stenosis at this level. There is mild to moderate bilateral neural foraminal stenosis. These findings are unchanged.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: There has been interval laminectomy at C3, C4, C5, and C6. Bilateral pedicle screws are now present at C3, C4, C5, and C6. Posterior to the resection site, within the operative tract, underlying the skin, there is a 4 cm craniocaudal by 1.5 cm AP x 2.5 cm transverse fluid collection demonstrating peripheral enhancement. Given the length of time since surgery, and the clinical provided history of drainage occurring at the wound site, these findings are most suggestive of abscess.


Instruction: Generate impression based on findings.

Input: 65-year-old man with right shoulder pain and fever. Evaluate for abscess. ROTATOR CUFF: The rotator cuff is intact. There is moderate fatty atrophy of the supraspinatus, infraspinatus and teres minor muscles. There is a small amount of fluid within the subdeltoid bursa.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is severe joint space narrowing, osteophyte formation and cartilage loss with reactive marrow change in the humeral head and glenoid. The glenoid labrum is irregular consistent with degeneration.BICEPS TENDON: The biceps tendon is not seen within the biceps groove and may be torn. The extra-articular portion of the tendon is unremarkable in appearance. ADDITIONAL

Output: 1.Moderate joint effusion with synovitis. These findings are nonspecific but can be seen in a septic joint. This is incompletely evaluated due to the lack of IV contrast.2.The biceps tendon is not seen within the biceps groove and may be torn.3.There are severe degenerative changes of the glenohumeral joint and moderate osteoarthritis at the acromioclavicular joint.4.No evidence of osteomyelitis.5.No discrete extra-articular fluid collection to suggest abscess.


Instruction: Generate impression based on findings.

Input: History of CVA x 2, complaining of weakness and acute mental status changes. Rule out CVA. There is no evidence of intracranial hemorrhage, mass or midline shift. Areas of subcortical and periventricular white matter hypodensity and an area of lacunar infarction in the left basal ganglia indicate advanced small vessel ischemic disease of indeterminate age. This appears slightly more prominent than on the prior examination. If there is concern for an acute stroke, an MRI may be considered for further evaluation.Prominence of the ventricles and sulci indicate corticomedullary volume loss.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.Foci of increased density of the right globe are identified. These may represent dystrophic calcification or may be artifactual. The right eye is only partially included in the field of view.

Output: Advanced small vessel ischemic disease of indeterminate age. If there is concern for an acute stroke, an MRI may be considered for further evaluation.


Instruction: Generate impression based on findings.

Input: Optic nerve gliomas, now off therapy. Orbits: There is no significant interval change in the peripherally-enhancing right orbital segment optic nerve glioma with a central cystic component, which measures up to 7 mm in diameter. The other right orbital contents and left orbit are otherwise unremarkable. Brain: There is no significant interval change in the non-enhancing T2 hyperintense lesion centered within the left optic chiasm and hypothalamus that measures up to 10 mm. Additional nonenhancing T2 hyperintense foci that localize to the more posterior portions of the bilateral optic tracks are also unchanged. There is no evidence of intracranial hemorrhage or acute infarct. The ventricles are unchanged in size and configuration. There is no midline shift or herniation. The skull and scalp soft tissues are unremarkable. There is mild scattered paranasal sinus mucosal thickening.

Output: Unchanged bilateral optic pathway gliomas.


Instruction: Generate impression based on findings.

Input: 25-year-old status post excisional biopsy of left breast mass with pathology revealing DCIS and positive margins presents for bilateral staging breast MRI. There is extreme amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally. Bilateral saline implants are intact.Left breast: In the upper inner breast near the 11:00 position, there is enhancement consisting of three adjacent areas of focal and non-mass enhancement together measuring 1.7 x 1.6 x 1.9 cm, suspicious for malignancy. This approaches to within 4 mm of the skin surface. There is some distortion of the adjacent breast parenchyma likely related to post excisional biopsy changes near this site of enhancement. Additionally, in the left retroareolar region, there is a round enhancing focus measuring 4 mm, which enhances similarly to the area mentioned above. This focus is 1.0 cm from the nipple. Patchy areas of enhancement are noted elsewhere throughout the breast, likely related to background parenchymal enhancement. There is no abnormal enhancement involving the nipple itself or the skin of the left breast.Right breast: Patchy areas of enhancement are noted throughout the breast, likely related to background parenchymal enhancement. There is no discretely enhancing mass, or suspicious focus of enhancement. Right nipple enhancement is symmetric with respect to the left. No abnormal lymph nodes are identified in either axillary region.

Output: Areas of suspicious enhancement in the left breast, one in the superior 11:00 position near the site of excisional biopsy measuring up to 1.9 cm and another in the retroareolar region measuring 4 mm. No suspicious enhancement in the right breast or either axilla. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: 40 years Male (DOB:11/21/1975)Reason: eval hemorrhagic mets, hydro, preop shunt History: headachePROVIDER/ATTENDING NAME: JEFFREY D. JACOBS JEFFREY D. JACOBS The patient status post left frontal craniotomy for left frontal lobe lesion.Since the prior examination the patient is developed new hemorrhagic lesions within the brain parenchyma and previous hemorrhagic lesions within the brain parenchyma have enlarged. There is a new hemorrhagic focus in the right frontal lobe which on T2 imaging measures approximately 7 mm in diameter. Another one in the right medial frontal lobe is approximately 3 mm in size. It was not previously present. A lesion located in the right thalamus was not clearly present on the prior exam and measures 34 x 14 mm axial dimensions. It protrudes into the right lateral ventricle. The lesion is present in the left cerebellar hemisphere which measures approximately 1 mm in size. Another lesion adjacent to the occipital horn of the right lateral ventricle was present on the prior exam and demonstrates a fluid fluid level. It measures 11 x 8 mm axial dimensions. Another one in the right occipital lobe in the cuneus measures 2 mm. Another one in the right occipital L adjacent to the temporal lobe measures 7 mm and was not clearly demonstrated on the prior exam. One in the right temporal lobe medially measures 13 mm on the current exam and previously was not readily visualized. One in the left temporal lobe could only be seen on susceptibility weighted imaging on the prior exam and now can be seen on rest of the pulse sequences and measures 7 x 4 mm. The enhancement pattern with these lesions is predominantly heterogeneous.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.Since the previous examination, the patient has developed multiple new hemorrhagic lesions while previously noted hemorrhagic lesions have enlarged. This is compatible with metastatic disease throughout the brain.


Instruction: Generate impression based on findings.

Input: Status post femoral access attempts. Rule out retroperitoneal bleeding. ABDOMEN: Bilateral small pleural effusions. Cardiomegaly. Independent atelectasis lung bases.LIVER, BILIARY TRACT: Liver is nodular in contour with hypertrophic left lobe suggestive of chronic liver disease. Cholelithiasis without evidence of cholecystitis. No biliary dilatation.SPLEEN: No significant abnormality noted.PANCREAS: Pancreas is atrophic. Lack of IV contrast severely limits evaluation of the pancreas. If there is any clinical concern for pancreatic pathology MRI is recommended.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Both kidneys demonstrate retained contrast likely from previous contrast enhanced study. Bilateral large stones mostly in the lower pole of the collecting system of the kidneys are again noted. Large left-sided renal cyst and small bilateral renal 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, ADNEXAE: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Small left-sided inguinal hematoma. No extension to the retroperitoneum.OTHER: Right-sided femoral venous catheter extends to the right ventricle.

Output: No evidence of retroperitoneal hemorrhage. Cholelithiasis and bilateral nephrolithiasis unchanged.Cardiomegaly bilateral small pleural effusions. Possible chronic liver disease. If there is a clinical concern for pancreatic pathology MR of the liver is recommended. This study is extremely limited for evaluation of the pancreas.


Instruction: Generate impression based on findings.

Input: Neurofibromatosis, type 2 with cerebrospinal fluid leak after surgery. Fluctuation of a sense of pressure in the head. There are postoperative findings related to bilateral middle cranial fossa cerebrospinal fluid leak leak repairs and right superior canal dehiscence repair. There is bone graft overlying the dehiscent right superior semicircular canal. The inner ear structures otherwise appear unremarkable. There is fluid within the left mastoid air cells. The bilateral cranial nerve 7 and 8 complexes appear to be intact, without evidence of mass lesions. There are unchanged bilateral petrous apex cephaloceles associated with enlarged Meckel caves and cystic dilatation of bilateral hypoglossal canal contents. There is also a partially empty sella.

Output: 1. Postoperative findings related to bilateral middle cranial fossa cerebrospinal fluid leak leak repairs and right superior canal dehiscence repair with persistent nonspecific fluid in the left mastoid air cells.2. Unchanged bilateral petrous apex cephaloceles and cystic dilatation of bilateral hypoglossal canal contents, which may be a sequela of elevated intracranial pressure, along with a partially empty sella.


Instruction: Generate impression based on findings.

Input: Aphasia [R47.01], Reason for Study: ^Reason: stroke History: slurred speech, R face and R arm wkness There are restricted diffusion areas on the left basal ganglia, internal capsule genu and posterior limb which extend cranially to the level of centrum semiovale indicating acute/subacute ischemic infarct. There is no evidence of hemorrhagic conversion.Scattered FLAIR/T2 high signal intensity lesions on periventricular bihemispheric white matter are seen, indicating nonspecific small vessel ischemic lesions.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage. 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. Fluid collection with ovoid well circumscribed low signal intensity lesion is seen at sphenoid sinus indicating focal accumulation of high protein content secretion.

Output: 1. Left basal ganglia, internal capsule and centrum semiovale acute ischemic infarct without evidence of hemorrhagic transformation.2. Underlying nonspecific small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: Pituitary adenoma. The intrinsically T1 hyperintense lesion in the right pituitary gland has further decreased in size, now measuring up to 5 mm, previously 9 mm. The normal pituitary tissue and infundibulum remain deviated to the left. There is no mass effect upon the optic apparatus or cavernous sinuses. The internal carotid artery flow voids are intact.

Output: Interval decrease in size of the right pituitary gland lesion.


Instruction: Generate impression based on findings.

Input: Medial ankle pain, check for sprain and failed PT TENDONS: The flexor and extensor tendons along with the peroneal longus and brevis appear intact and uniform throughout. Specifically no focal signal abnormalities. Sheaths are unremarkable. Of note however is mild minimal thickening of the distal Achilles approximately 3 cm from the attachment with minimal faint signal representing mild tendinopathy and/or a more remote injury.LIGAMENTS: No significant abnormality noted, specifically all are intact and well visualized.ARTICULAR SURFACES AND BONE: Focal signal abnormality is observed in the anterior calcaneus with small associated cystic component. Probable and suspected contusion related to a possible small enchondroma related to subacute prior injury. No discrete fractures or healing fractures observed. Specifically the calcaneal facets and medial aspects of the osseous structures are unremarkable. Marrow signal otherwise unremarkable.ADDITIONAL

Output: Anterior calcaneal focal signal abnormality representing possible subacute contusion adjacent to a small antidromic. See detailed provided


Instruction: Generate impression based on findings.

Input: Mass in 4th ventricle: headache and emesis. Brain: There is a heterogeneous mass that contains patchy enhancement and multiple small cystic components within the fourth ventricle. The mass measures up to approximately 4 cm and results in marked compression of the brainstem and cerebellum with mild inferior cerebellar herniation. In addition, there is marked dilatation of the third and lateral ventricles with diffuse periventricular white matter T2 hyperintensity, which is compatible with transependymal cerebrospinal fluid flow. There is no evidence of acute intracranial hemorrhage or acute infarct. There is no midline shift. The major cerebral flow voids are intact. There is dilatation of the bilateral optic nerve sheaths. The skull is intact.Spine: There is no evidence of mass lesions or abnormal enhancement within the spinal canal. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology and cauda equina appears to be intact. The paravertebral soft tissues are unremarkable.

Output: 1. A fourth ventricular mass measuring up to approximately 4 cm with associated obstructive hydrocephalus likely represents a medulloblastoma.2. No evidence of drop metastases in the spinal canal.


Instruction: Generate impression based on findings.

Input: 16 year old female with history of internal knee derangement. MENISCI: The medial and lateral menisci are intact.ARTICULAR CARTILAGE AND BONE: Bone marrow signal intensity is within normal limits. The articular cartilage is unremarkable.LIGAMENTS: The ACL, PCL, MCL, and LCL are intact. EXTENSOR MECHANISM: There is mild thickening and focal increased signal intensity of the proximal fibers of the patellar tendon particularly along its medial aspect suggesting tendinosis (jumper's knee). The distal patellar tendon and quadriceps tendon appear normal.

Output: Mild proximal patellar tendinosis.


Instruction: Generate impression based on findings.

Input: Assess prepontine cistern for tuberculosis: history of potential TB meningitis, incompletely treated meningitis recently finished therapy. Now persistent headaches and photophobia. There is interval progression of leptomeningeal enhancement along the surface of the pons, along the surface of the medulla, within the basal cisterns, and along the surface of the cerebellum. There is also interval progression of high T2 signal with punctate foci of enhancement and mild susceptibility effect in the medial left thalamus. There are also scattered punctate foci in the white matter of the bilateral cerebral hemispheres, which are stable to perhaps slightly more conspicuous in some cases. Otherwise, there is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits and paranasal sinuses are grossly unremarkable. There is redemonstration of an ovoid enhancing lesion in the right frontal calvarium that measures up to 12 mm, without associated soft tissue swelling.

Output: 1. Interval progression of leptomeningeal enhancement along the surface of the pons, medulla, basal cisterns, and along the surface of the cerebellum, which may represent tuberculous meningitis.2. Interval progression of high T2 signal with punctate foci of enhancement in the medial left thalamus may represent evolving tuberculous cerebritis. 3. Mild bilateral cerebral white matter hyperintensities are nonspecific.4. A right frontal calvarial lesion is nonspecific, but may also represent a manifestation of tuberculosis versus an atypical hemangioma.


Instruction: Generate impression based on findings.

Input: Left periventricular parietoccipital white matter lesion, re-evaluate for progression: transient left hemisensory syndrome, with persistent left retro-orbital headache. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is an unchanged T2 hyperintense periventricular parietoccipital white matter lesion that measures up to 25 mm. There is no abnormal intracranial enhancement. There is asymmetry of the lateral ventricles, right larger than left. There is no midline shift or herniation. The major cerebral flow voids are intact. There is mild plagiocephaly. The orbits, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is left greater than right tympanomastoid fluid.

Output: A periventricular parietoccipital white matter lesion may represent the sequela of remote ischemic injury. No evidence of intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: Female, 19 years old. Hx of ACL reconstruction in 2012. Pain MENISCI: The posterior horn of the medial meniscus is small and fragmented with vertical and horizontal tears. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: Postsurgical changes in the bone ACL graft. There is cartilage irregularity of the medial compartment, with slight underlying marrow edema along the medial most aspect of the medial tibial plateau but no definite focal full-thickness cartilage defect identified.LIGAMENTS: Surgical findings status post ACL grafting. The fibers of the ACL graft are intact. The PCL and collateral ligaments are unremarkable. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1.The ACL graft appears intact.2.Complex tearing of the medial meniscus.


Instruction: Generate impression based on findings.

Input: Multiple myeloma The examination is limited by motion artifact.There is diffuse intermediate marrow signal throughout the bones of pelvis reflecting residual red marrow. There are no focal marrow abnormalities to suggest the presence of multiple myeloma. A collection of fat is noted within the left sciatic notch likely representing a lipoma. There is mild displacement of the sciatic nerve posteriorly as a result. The remaining soft tissues are normal. There is perhaps mild osteoarthritis of the sacroiliac joints and hips. There are degenerative changes of the lower lumbar spine; please refer to the spine MRI report from the same day.There are prominent inguinal lymph nodes and multiple nabothian cysts.

Output: No focal lesions or marrow changes to suggest multiple myeloma. Additional findings are described above.


Instruction: Generate impression based on findings.

Input: Female 14 years old Reason: eval pancreatic mass History: abdominal pain, emesis, mass on CT ABDOMEN:LIVER, BILIARY TRACT: No intrahepatic or extrahepatic biliary ductal dilatation. No focal mass lesion is evident within the hepatic parenchyma.SPLEEN: No significant abnormality noted.PANCREAS: 3.9 x 3.9 cm heterogeneous T1 hypointense, slightly T2 hyperintense mass is present within the tail of the pancreas, with progressive continuous circumferential enhancement of its rim. An approximately 2 cm wide defect is noted along the anterior aspect of this mixed solid/cystic mass, with the contents spilling into the peritoneal cavity.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No hydronephrosis or hydroureter.RETROPERITONEUM, LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small volume ascites.

Output: Ruptured mixed solid/cystic neoplasm in the tail of the pancreas, most likely a solid pseudopapillary tumor.


Instruction: Generate impression based on findings.

Input: A 68 year old male with history of coronary artery disease, s/p coronary artery bypass surgery (LIMA to LAD, RIMA to RCA, SVG to OM), s/p PCI to LAD. Recently the patient complaint of progressive dyspnea on exertion. After review of last coronary angiogram, the patient is referred to stress cardiac MRI to evaluate ischemia.MEDICATIONS: Aspirin, Atorvastatin, Clopidogrel, Metoprolol, Levothyroxine, Nitro as needed. First Pass PerfusionDuring hyperemia, perfusion abnormalities were noted in the basal anteroseptum, inferoseptum, inferior, inferolateral, and anterolateral walls; the mid anteroseptum, inferoseptum, and inferior walls; and the apical inferior and septal walls. The overall ischemia score is 10 out of a possible 32 and 31% of the myocardium is ischemic. Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable.Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 55%, the LV end diastolic volume index is 71 ml/m2 (normal range: 74+/-15), the LVEDV is 147 ml (normal range 142+/-34), the LV end systolic volume index is 32 ml/m2 (normal range 25+/-9), the LVESV is 66 ml (normal range 47+/-19), the LV mass index is 42 g/m2, and the LV mass is 87 g. There are no regional wall motion abnormalities present. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 54%, the RV end diastolic volume index is 84 ml/m2 (normal range 82+/-16), the RVEDV is 174 ml (normal range 142+/-31), the RV end systolic volume index is 37 ml/m2 (normal range 31+/-9), and the RVESV is 80 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 no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is mild pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsSternal wires were noted. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. There is a large burden of "ischemia" as described above.2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and systolic function (LVEF 55%) without evidence of underlying myocardial fibrosis, inflammation, or infiltration.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: Clinical question: Evaluate for possible aneurysms seen on MRI. Signs and symptoms: Possible aneurysm seen on MRI. CTA of intracranial circulation:Source images, MIP and 3-D reformatted images were obtained.Vertebral basilar system:Patent bilateral intracranial vertebral arteries and bilateral pica branches. Patent basilar artery and its branches and with no pathology.Carotid system:Right internal carotid artery across the skull base and through the cavernous sinus remains normal. Right supraclinoid internal carotid artery is unremarkable. Hypoplastic left A1.Right middle cerebral artery is normal in its M1 segment. There is an aneurysm at the bifurcation of right middle cerebral artery which measures 11.2-mm in transverse axis and 8.5-mm in cranial cephalad axis (coronal reformatted image 120). This aneurysm projects directly laterally and shows uniform enhancement. The aneurysm sac appears to incorporate the distal tip of right middle cerebral artery and the origins of superior and inferior divisions of the right middle cerebral artery. There is no detectable internal defect to suggest presence of clot. The distal branches of right MCA beyond this aneurysm remain normal.The left internal carotid artery across the skull base and in its cavernous component are within normal limits. The left missing or free and its branches are within normal limits. The left A1 is prominent and fills both anterior cerebral arteries through a patent anterior communicating artery. There is slight ectasia of the distal left A1 immediately proximal to its junction to the anterior communicating artery. There is no distinct aneurysm.CTA of the vasculature of the neck:Right common carotid artery, right internal carotid artery and including their origins are normal thereleft common carotid, left external carotid artery and their origins are within normal.Right vertebral artery and including its origin is unremarkable.Left vertebral artery and including its origin is normal.Nonenhanced CT of brain:Focal area of increased density along the superior aspect of the vermis a left paramedian location is again identified. There is no associated mass effect with this finding and no change in its size since prior CT and MRI exam. Findings could represent area of calcification or a cavernoma. On coronal reformatted image number 53 this lesion measures 14.2 times 10.5-mm.Well demarcated high density lesion at the expected level of right MCA bifurcation measures 9.3 x 9.7-mm and is believed to represent an aneurysm. This examination is otherwise essentially unremarkable.60 cc of Omnipaque 350 is administered problem study.

Output: 1.Aneurysm of right MCA bifurcation with no internal thrombus. Aneurysm measures 11.2 x 8.5-mm in size and has a direct lateral projection. The aneurysm sac appears to incorporate distal right M1 and the origins of M2 segments of the middle cerebral artery. There is hypoplastic right A1 with minimally ectatic distal left A1 however no distinct aneurysm. The CTA of intracranial circulation is otherwise unremarkable.2.Unremarkable CTA of the vasculature of the neck.3.Stable CT examination of brain with partially thrombosed right MCA aneurysm and focal area of calcification or cavernoma in the superior vermis in left paramedian location.


Instruction: Generate impression based on findings.

Input: Male, 73 years old, with altered mental status and encephalopathy. Evaluate for intracranial metastases. History of pancreatic cancer. Multiple scattered areas of gyriform restricted diffusion are seen within both cerebral hemispheres, predominantly in the MCA distributions. The most severely affected regions are the right posterior parietal and temporal lobes and the insula. Several scattered areas of restricted diffusion are also seen in the cerebellum.Corresponding T2 hyperintensity is seen with these areas of restricted diffusion with minimal local edema, but no significant generalized mass effect is seen. No masslike lesions or pathologic enhancement are seen. No evidence of intracranial hemorrhage or any abnormal extra axial fluid collection. The ventricles are normal in size and morphology.

Output: Multiple scattered areas of restricted diffusion are noted in both cerebral hemispheres and on both sides of the cerebellum. An embolic phenomenon is favored. No evidence of intracranial metastases is seen.


Instruction: Generate impression based on findings.

Input: Other disturbances of skin sensation [R20.8], Reason for Study: ^Reason: suspect for thalamic lacunar stroke, but autoimmune disorder has some suspicion too, eval pls History: 4d h/o left hemibody hypoesthesia Brain MRIThere is focal restricted diffusion lesion on the right thalamus as well as left side paramedian mid-pons without evidence of hemorrhagic conversion indicating acute/subacute ischemic infarction. There is no evidence acute hemorrhagic lesion.There is no abnormal enhancement.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal.Neck MRA3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The vertebral artery origins are normal. There is normal flow enhancement through the bilateral common carotid, carotid bifurcations, internal/external carotid, and vertebral arteries.

Output: 1. Acute/Subacute ischemic infarctions on the right thalamus and paramedian mid-pons without hemorrhagic transformation.2. Normal brain MRA and Neck MRA.


Instruction: Generate impression based on findings.

Input: Bilateral thigh pain and numbness. Evaluate for disc disease. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position.Mild disc bulges at the lower thoracic spine at T10-T11 and T11-T12. There is mild prominence of the dorsal epidural fat. Multilevel degenerative changes are seen in the lumbar spine, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: No significant disc disease. No spinal canal or neural foraminal stenosis.L4-L5: There is mild disc desiccation, ligamentum flavum thickening, and moderate bilateral facet arthropathy, which contribute to minimal central canal stenosis. Neural foramina are patent. There is a tiny synovial cyst posterior to the facet jointL5-S1: Moderate bilateral facet arthropathy. No spinal canal or neural foraminal stenosis.Paraspinous soft tissues are within normal limits. There is mild enhancement associated with the facet arthropathy, particularly at the L4-L5, and is likely on a degenerative basis. Otherwise no abnormal enhancement within the spine or paraspinous soft tissues is appreciated.

Output: Degenerative changes in the lumbar spine with moderate facet arthropathy at the L4-L5 and L5-S1 levels. There is very mild narrowing of the spinal canal at the L4-L5 level. Spinal canal and neural foramina are otherwise patent.


Instruction: Generate impression based on findings.

Input: Mid and low back pain now with saddle anesthesia. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. There are scattered focal fatty deposits in the vertebral bone marrow. There is also a subcentimeter area of high T2 signal in the T3 vertebral body. There are mild posterior disc-osteophyte complexes at C7-T1 and T8-9. In addition, there are minimal disc bulges at L3-4 and L4-5 without significant neural foraminal stenosis. There is also a disc bulge at L5-S1 and facet hypertrophy with mild left and moderate right neural foraminal stenosis. However, there is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: 1. No evidence of spinal cord or cauda equina compression.2. A disc bulge at L5-S1 and facet hypertrophy is associated with mild left and moderate right neural foraminal stenosis.3. A subcentimeter area of high T2 signal in the T3 vertebral body is nonspecific, but may represent an atypical hemangioma, for example. Nevertheless, follow up via MRI with contrast may be useful.


Instruction: Generate impression based on findings.

Input: Enhancing nodules with adjacent cystic components are again seen from C7 to T2 as described on MRI cervical spine study from 6/1/2016 and are not appreciably changed since prior study from 5/31/2015.There is an additional 2 x 3 mm nodule involving the left ventral aspect of the cord at the T5 level which is not appreciably changed. T2 signal abnormality at the left ventral T5 level appears stable to minimally more prominent. 2 mm nodule involving the ventral T6-T7 level is also unchanged. A larger lesion more inferiorly at the right T11-T12 level is slightly larger measuring 8 x 10 mm previously 7 x 7 mm. There is an additional enhancing nodule at the left dorsal T12-L1 level measuring up to 5 mm in the craniocaudal dimensions and unchanged. Extent of T2 signal abnormality and syrinx in the lower thoracic cord is not significantly changed and extends from the T10 to the upper L1 levels. Evidence of prior resection of lower thoracic lesions again seen.Vertebral body heights and alignment in the thoracic spine are maintained. No spinal canal or neural foraminal stenosis is evident. LUMBAR SPINE

Output: Multiple hemangioblastomas consistent with known diagnosis of VHL. Multiple lesions involving the cervicothoracic junction, at the T5 level, at the T6-T7 level, and left dorsal T12-L1 level are not appreciably changed since 5/31/2015. A lesion involving the right T11-T12 level is larger measuring 8 x 10 mm, previously 7 x 7 mm.


Instruction: Generate impression based on findings.

Input: 77 years Female (DOB:4/14/1938)Reason: Cognitive decline. Please assess for cerebrovascular disease and volume loss History: cognitive impairmentPROVIDER/ATTENDING NAME: JAMES A. MASTRIANNI JAMES A. MASTRIANNI There is abnormal T2 hyperintense and T1 hypointense signal present at the splenium of the corpus callosum.There is T2 hyperintense signal present along the subcortical white matter of the posterior aspect of the right middle temporal gyrus.The lateral ventricles are dilated. The temporal horns are relatively large. The third ventricle is wide measuring 9 mm with. Biventricular diameter at the level of foramen of Monro is 41 mm.There are punctate FLAIR and T2 hyperintense lesions present in the thalami bilaterally and to a lesser degree in the brainstem.There is a peripherally height O intense and centrally hyperintense lesion on T2-weighted imaging measuring 7 mm in diameter associated with susceptibility effect and located in the right parietal lobe adjacent to the medial aspect of the intraparietal sulcus.There is a mild 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.There is a hemorrhagic focus present in the right parietal lobe measuring 7 mm in size which is suspected to represent a cerebral cavernous malformation.2.Findings suggest myelomalacia along the splenium of the corpus callosum.3.Findings suggest mild ventriculomegaly of unknown cause. At this age and most likely related to brain atrophy but is nonspecific and the possibility of normal pressure hydrocephalus in the appropriate clinical setting cannot be excluded.4.Periventricular and subcortical white matter lesions as well as a few punctate lesions in the brainstem and thalami are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: 63-year-old female with fullness in the left kidney seen on ultrasound and outside Hospital noncontrast CT ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: Small T2 hyperintense, T1 isointense lesion in the spleen is likely benign.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Atrophic left kidney. No hydronephrosis or perinephric inflammation bilaterally. No masses evident. Small cyst in the interpolar left kidney. Left renal artery stent. RETROPERITONEUM, LYMPH NODES: Infrarenal aortic stent.BOWEL, MESENTERY: Small bowel caliber is within normal limits without evidence of obstruction. The appendix is well visualized and within normal limits.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Atrophic left kidney without suspicious mass or hydronephrosis.


Instruction: Generate impression based on findings.

Input: Knee pain MENISCI: Signal intensity and morphology of the menisci are normal, without evidence of discrete meniscal tear.ARTICULAR CARTILAGE AND BONE: The articular cartilage in the medial, lateral, and patellofemoral compartments appears preserved without evidence of chondromalacia or focal cartilage defect.LIGAMENTS: The cruciate and collateral ligaments are intact without evidence of rupture.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: No findings to account for left knee pain.


Instruction: Generate impression based on findings.

Input: 45 years, Female, Reason: Visual hallucination and loss of consciousness. Recurrent syncope with history of penetrating cerebellar injury. Brain MRI: Again seen are postsurgical changes of Chiari 1 decompression with suboccipital craniectomy and resection of posterior arch of C1. There is improved CSF space at the neo foramen magnum. Brain parenchyma appears otherwise within normal limits. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits with cavum septum pellucidum incidentally noted. No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. Trace mucosal thickening involving the paranasal sinuses. Bone marrow signal is within normal limits.Brain MRA: The intracranial internal carotid arteries demonstrate no significant stenosis. The middle and anterior cerebral arteries are also patent. The vertebral arteries, basilar artery, and posterior cerebral arteries also are patent with no significant stenosis. No evidence of aneurysms or vascular malformations. Left posterior cerebral arteries is predominantly fetal in origin with small left P1 segment incidentally noted.

Output: 1. Postsurgical changes related to Chiari I decompression. Examination is otherwise within normal limits with no intracranial mass or mass effect. No evidence of infarct or hemorrhage. No abnormal enhancement.2. MRA of the head is within normal limits.


Instruction: Generate impression based on findings.

Input: 44 year old woman MENISCI: There is a complex tear of the posterior horn of the medial meniscus with a radial component. The lateral meniscus appears intact. ARTICULAR CARTILAGE AND BONE: There is a large area of full thickness cartilage loss in the central weightbearing portion of the lateral femoral condyle as well as the tibial plateau in the corresponding territory. There is fissuring greater than 50% in thickness along the lateral tibial plateau. The articular cartilage of the lateral joint space appears otherwise intact. There is full thickness cartilage loss of the lateral facet of the patella and lateral trochlea. The trochlea is shallow. LIGAMENTS: The ACL and PCL are intact. The medial collateral ligament and lateral collateral ligament complex appear intact. EXTENSOR MECHANISM: The quadriceps and patellar tendons appear normal.ADDITIONAL

Output: Moderate to severe extensor compartment osteoarthritis and moderate medial compartment osteoarthritis with a complex tear of the posterior horn of the medial meniscus.


Instruction: Generate impression based on findings.

Input: Head and neck cancer. Dry mouth. Head CT:There is no evidence of intracranial mass, hemorrhage or acute infarction. The enhancing focus in the left parietal lobe reported on the prior CT study is no longer well visualized. In this same area, there is subtle hypodensity, consistent with encephalomalacia, possibly from previous infarction. There are scattered areas of chronic infarction in the left cerebellum, left parietal lobe, right frontal lobe and right basal ganglia which are unchanged compared to prior study. There are new areas of hypodensity seen in the right frontal periventricular region, and at the left basal ganglia, with low density compatible with old infarctions that have evolved since the prior CT study. The lesion at the left basal ganglia was also seen on prior MRI brain of 9/26/2009. Scattered ill-defined cerebral white matter hypoattenuation is consistent with small vessel ischemic changes.Neck CT:The soft tissue thickening and asymmetry at the laryngeal region are unchanged compared to prior study. No pathological size lymph nodes, or necrotic lymph node is identified. Again noted is a diverticulum at the anterior aspect of the esophagus. There is degenerative disease of cervical spine. There is interval development of near-complete opacification of the right maxillary sinus, with mucosal thickening also seen in the left maxillary sinus.There are postsurgical changes in bilateral mastoid regions.

Output: 1. Multiple chronic infarctions in the brain as described above.2. Stable soft tissue asymmetry in the laryngeal region. No evidence of adenopathy.3. New bilateral maxillary sinus disease.


Instruction: Generate impression based on findings.

Input: Reason: Hx of Gleason 6 prostate cancer. Eval for suspcious lesion in anticipation of uronav biopsy History: As above PELVIS:PROSTATE:Prostate Size: 5.2 x 3.2 x 4.3 cmPeripheral Zone: No suspicious lesions are evident.Central Gland: Small BPH nodules.Seminal Vesicles: No significant abnormality notedExtracapsular Extension: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No suspicious lesions are identified.2.No pelvic lymphadenopathy.


Instruction: Generate impression based on findings.

Input: Male, 59 years old, with cervical radiculopathy. Spinal alignment is anatomic. Vertebral body morphology is normal. No concerning marrow replacement or marrow edema is seen.The visualized spinal cord demonstrates normal signal intensity. Cord morphology is discussed below.C2-3: Left greater than right facet hypertrophy. No significant spinal canal stenosis. Mild left foraminal narrowing. C3-4: Left greater than right facet hypertrophy. Mild disc osteophyte formation. No significant spinal canal stenosis. Mild bilateral foraminal narrowing. C4-5: Left facet hypertrophy. Mild disc osteophyte formation. No significant spinal canal stenosis. Mild right and moderate left foraminal narrowing.C5-6: Facet hypertrophy. Mild disc osteophyte formation. Mild spinal canal stenosis without significant cord deformation. Moderate bilateral foraminal narrowing. C6-7: Facet hypertrophy. Moderate disc osteophyte formation and thickening of the PLL. Mild flattening of both the ventral and dorsal spinal cord with a moderate generalized canal stenosis. No significant foraminal narrowing. C7-T1: Facet hypertrophy. Mild disc osteophyte formation and thickening of the PLL. No significant spinal canal or neuroforaminal stenosis.

Output: Multilevel cervical spondylosis most severely affecting C5-6 where there is a mild generalized spinal canal stenosis, and C6-7 where there is a moderate generalized spinal canal stenosis and mild impingement of the spinal cord. No evidence of cord edema is seen.


Instruction: Generate impression based on findings.

Input: 56-year-old male with shoulder pain. ROTATOR CUFF: There is mild increased signal intensity along the undersurface fibers of the supraspinatus tendon suggesting fraying, but we see no discrete tear. A tiny focus of increased signal intensity within the tendon at its insertion on the greater tuberosity may reflect focal insertional tendinosis. The infraspinatus tendon appears intact. The teres minor tendon appears intact. There is mild increased signal intensity along the undersurface of the subscapularis tendon near its insertion likely reflecting fraying. On the fat saturated T2-weighted sequences, there is mild increased signal intensity of the supraspinatus, teres minor and posterior deltoid muscles, which could reflect subacute atrophy. We see no masses in the quadrilateral space or suprascapular notch. The subscapularis muscle and infraspinatus muscle are within normal limits.SUPRASPINATUS OUTLET: Mild osteoarthritis affects the acromioclavicular joint. We see no fluid in the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is within normal limits. There is no evidence of joint effusion. There is intermediate signal intensity within the superior labrum which likely represents degenerative tearing. There is attenuation of the anterior superior labrum which may represent extension of the degenerative tearing.BICEPS TENDON: The long head of the biceps tendon is within normal limits. ADDITIONAL

Output: 1. Mild increased signal intensity within the teres minor, posterior deltoid muscle, and to a lesser degree the supraspinatus muscle which may reflect subacute atrophy. We see no masses within the quadrilateral space or suprascapular notch.2. There is mild undersurface tendinosis/fraying of the supraspinatus and subscapularis tendon but no discrete rotator cuff tear.3. Osteoarthritis of the acromioclavicular joint.4. Findings suggestive of degenerative tearing of the superior labrum.5. Subcentimeter focus of signal abnormality in the scapular spine which is nonspecific.


Instruction: Generate impression based on findings.

Input: 63-year-old male with known lesions in the body of the pancreas. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: There is a T2 hyperintense lesion noted within the pancreatic body measuring 4 x 4 mm series 8, image 16), not significantly changed. No evidence of enhancement. An additional pancreatic body T2 hyperintense focus measuring 7 x 5 mm (series 3, image 60), previously measuring 6 x 5 mm. No evidence of enhancement. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: In the visualized right lung base, there are 2 subcentimeter T2 hyperintense foci. When compared to the CT examination from July 2009, these likely represent bronchiolitis/mucous plugging.

Output: Findings consistent with two small sidebranch IPMNs, not significantly changed.


Instruction: Generate impression based on findings.

Input: 37-year-old male with bruising and swelling MENISCI: The medial and lateral menisci are intact.ARTICULAR CARTILAGE AND BONE: No significant abnormality noted.LIGAMENTS: The cruciate and collateral ligaments are intact.EXTENSOR MECHANISM: Extensor mechanism is intact.ADDITIONAL

Output: Findings compatible with Morel Lavallée injury over the lateral aspect of the knee.


Instruction: Generate impression based on findings.

Input: 47-year-old female with strong family history of breast cancer. Family history of breast cancer in her mother 4 times. Personal history of benign biopsy of a left breast mass two o'clock (fibroadenoma). Patient has also undergone two benign stereotactic biopsies in the left breast at an outside institution There is heterogeneous amount of fibroglandular tissue in both breasts.There is a cyst in the right breast.Mild parenchymal enhancement is noted bilaterally.Again seen is the patient's previously biopsied left breast fibroadenoma at the 3 o'clock position of the left breast with faint enhancement.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: 2 - Benign finding.RECOMMENDATION: NS - Routine Screening Mammogram.


Instruction: Generate impression based on findings.

Input: 31 year old healthy male presenting with chest pain and positive troponins without evidence of coronary obstruction. Left VentricleThe left ventricle is normal in size with low normal systolic function. There is mild hypokinesis of the apical inferior and septal walls. There is concentric mild left ventricular hypertrophy (IVSd=11-12mm). The overall LV ejection fraction is 53%, the LV end diastolic volume index is 103 ml/m2 (normal range: 74+/-15), the LVEDV is 189 ml (normal range 142+/-34), the LV end systolic volume index is 49 ml/m2 (normal range 25+/-9), the LVESV is 90 ml (normal range 47+/-19), the LV mass index is 55 g/m2 (normal range 85+/-15), and the LV mass is 101 g (normal range 164+/-36). On T2-weighted imaging, there is increased signal involving the basal anteroseptum, mid anterior, anteroseptum, inferoseptal, and inferior walls, and the apical septum. These findings correspond to the presence of myocardial edema. There is no obvious late gadolinium enhancement to suggest underlying myocardial fibrosis or scar.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with mildly reduced systolic function . The overall RV ejection fraction is 45%, the RV end diastolic volume index is 104 ml/m2 (normal range 82+/-16), the RVEDV is 191 ml (normal range 142+/-31), the RV end systolic volume index is 57 ml/m2 (normal range 31+/-9), and the RVESV is 86 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 no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease. A small pericardial cyst is noted near the left atrial appendage. 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. Normal LV size, mild left ventricular hypertrophy, and low normal systolic function (LVEF 53%). There is mild hypokinesis of the apical inferior and septal walls. 2. There is significantly increased T2-signal involving the basal anterior wall; mid anterior, septum, and inferior walls, and the apical septum. There is no or global late gadolinium enhancement. These findings support the diagnosis of Takotsubo cardiomyopathy (especially given the rapid improvement in LVEF when compared to echo from a few days ago); however, the differential diagnosis also includes myocarditis. 3. Normal RV size with mildly reduced systolic function (RVEF 45%).4. A small pericardial cyst is noted near the left atrial appendage. When compared to the echo from 10/8/2015, the LVEF is significantly improved, as is the regional wall motion abnormality. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Male, 76 years old, history of GBM with recurrence. Preoperative planning for resection. Evidence of prior left temporal craniotomyis again seen. A small resection cavity within the anterior left temporal lobe remains visible.Surrounding the resection cavity is a thick rim of heterogeneous but predominantly solidly enhancing tissue which extends through the entire lateral aspect of the temporal lobe. Superiorly it reaches as far as the operculum and insula. Since the prior examination, this lesion has increased in overall size now measuring up to 46 x 32 mm (image 81 series 301), previously 37 x 28 mm. Extensive T2 hyperintensity surrounds this lesion essentially filling the left temporal lobe with extension posteriorly into the occipital lobe and superiorly into the operculum, insula, internal capsule and parietal lobe. The geographic extent of this signal abnormality is also progressed.No areas of pathologic enhancement are suspected discontiguous with the above-mentioned dominant lesion. The left lateral ventricle is partially effaced. The right lateral ventricle remains of normal caliber. Elsewhere, scattered foci of white matter T2 hyperintensity are seen, a nonspecific finding which may reflect microvascular ischemic disease.

Output: Interval increase in size of a large enhancing lesion within the left temporal lobe.


Instruction: Generate impression based on findings.

Input: 52-year-old man with history of liver lesion seen on abdominal ultrasound prior to heart transplant. ABDOMEN:LIVER, BILIARY TRACT: 1.4 cm mildly T2 hyperintense lesion corresponding to sonographic finding. This lesion has questionable progressive filling in of contrast, although is difficult to definitively characterize. No other hepatic lesions are seen. No suspicious hepatic lesions are seen.SPLEEN: No significant abnormality noted.PANCREAS: Pancreatic duct is normal in caliber and no focal parenchymal lesion identified.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Simple bilateral renal cysts noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.1.4 cm lesion corresponding to sonographic finding likely represents a hemangioma when taken sonographic appearance into context. The enhancement pattern of this lesion is not definitive, but favors hemangioma. Thus, ultrasound follow-up of this lesion in 6 months is suggested to ensure stability.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Female, 59 years old, with metastatic lung adenocarcinoma to the brain, cerebellar mass, history of herniation, altered mental status. Greater than 20 solid and rim-enhancing lesions are evident within the brain and cerebellum. These lesions range in size from punctate up to 2.5 cm in diameter with the largest lesion present in the left cerebellum. The lesions are peripheral and in most cases associated with a sulcus. Along with potential enhancement of the left cisternal trigeminal nerve, this distribution would suggest that at least some of the lesions represent leptomeningeal involvement. Several of the larger lesions demonstrate susceptibility effect and or T1 hyperintensity suggesting trace blood product.Lesions in the bilateral frontal lobes and in the cerebellar hemispheres induce moderate local edema. However, no significant generalized mass effect or brain herniation is seen. The ventricular system remains within normal limits for size and morphology. Scattered T2 hyperintense foci without correlating enhancement are nonspecific but may reflect chronic microvascular ischemia. An enhancing focus is evident within the left aspect of the clivus potentially representing an osseous metastasis.

Output: Greater than 20 intracranial lesions are demonstrated compatible with metastases. The distribution of the lesions, along with enhancement of the left cisternal trigeminal nerve, suggesting that at least some of these lesions are leptomeningeal in nature. Moderate local edema is seen in association with larger lesions in the bilateral frontal lobes and the bilateral cerebellar hemispheres. However, no significant generalized mass effect or brain herniation is seen. One osseous metastasis is suspected in the clivus.


Instruction: Generate impression based on findings.

Input: Male, 55 years old, with diplopia, facial weakness, multifocal cranial neuropathy, and cervical myelopathy. Brain:Again seen are minimal scattered periventricular foci of T2 hyperintensity. These have not significantly changed from the prior examination.No evidence of restricted diffusion is seen. No parenchymal edema or mass effect is detected. Postcontrast images are degraded by motion artifact which limits the ability to detect subtle abnormalities. Given this caveat, however, no definite pathologic parenchymal or extra-axial enhancement is seen.No intracranial hemorrhage or any abnormal extra axial fluid is detected. The ventricular system is normal in size and morphology.C-spine:Image quality is degraded both by motion artifact and artifact induced by orthopedic instrumentation. Within these limitations, the following observations are made.Since the prior examination, decompressive laminectomy has been performed at least partially at C2, then from C3 down to C6. Fusion instrumentation has been placed on the left from C2 through C6, and on the right from C2 through C5.Soft tissue surrounding the odontoid process, likely representing pannus, has increased in size since the prior examination. This results in progressive narrowing of the spinal canal at the C1-2 level but with only mild mass effect upon the spinal cord.The normal cervical lordosis is mildly reversed, a new finding which may at least in part reflect spinal fusion. The vertebral bodies are otherwise well aligned with respect to each other.Vertebral body height and morphology are normal. No concerning marrow space lesions are detected.C2-3: Postoperative findings. Disc osteophyte formation. Mild spinal canal stenosis, but improved from prior. No significant foraminal narrowing. C3-4: Postoperative findings. Disc osteophyte formation. No significant spinal canal stenosis which is an improvement from prior. Mild bilateral foraminal narrowing. C4-5: Postoperative findings. Disc osteophyte formation asymmetric towards the right. Mild residual spinal canal stenosis, improved from prior. Questionable faint T2 hyperintensity versus artifact within the spinal cord. The foramina are not well assessed but mild to moderate stenosis is suspected bilaterally. C5-6: Postoperative findings. Disc osteophyte formation. No significant spinal canal stenosis, improved from prior. The foramina are not well assessed, but at least mild-to-moderate stenosis is suspected bilaterally. C6-7: Postoperative findings. Mild disc osteophyte formation. Perhaps mild spinal canal stenosis, similar to prior. The foramina are not well assessed, but mild to moderate stenosis is suspected bilaterally.C7-T1: Facet hypertrophy. Disc osteophyte formation. Mild spinal canal stenosis without cord impingement. Mild foraminal stenosis is seen bilaterally. Allowing for significant motion degradation and artifact related to orthopedic instrumentation, no definite pathologic enhancement is seen within the osseous elements of the spine or within the visualized portion of the spinal canal.The paraspinal soft tissues are unremarkable. In particular, a nodule which was previously seen in the left parotid gland is no longer evident.

Output: 1.Examination of the brain is slightly limited by motion artifact. Allowing for this, no acute or significant intracranial abnormalities are appreciated.2.Evaluation of the C-spine is degraded both by motion artifact and the presence of orthopedic instrumentation. Multiple areas of tight spinal canal stenosis seen on the prior examination have been relieved secondary to surgery.3.Of note, however, is progressive pannus formation at the level of the odontoid process which does result in increasing stenosis at the C1-2 level, but with only mild mass effect on the spinal cord.


Instruction: Generate impression based on findings.

Input: Female 54 years old with history of pain in the left knee, evaluate bone length There is 7 degrees of valgus angulation within the left lower extremity. Again seen is a stable appearing lesion within the left proximal tibial diaphysis with subtle inner cortex scalloping, likely representing a low-grade chondral lesion.

Output: There is 7 degrees of valgus angulation within the left lower extremity. Low-grade chondral lesion involving the proximal diaphysis of the tibia, which is better characterized on MRI (1/31/2015).


Instruction: Generate impression based on findings.

Input: Reason: index finger mass History: same A marker was placed along the skin surface dorsal to the DIP joint of the index finger. There is prominence of the underlying proximal nail fold of the index finger which appears partially separated from the underlying nailbed and plate, but we otherwise see no discrete mass. There is perhaps minimal enhancement of this enlarged proximal nail fold. The underlying soft tissues and bone are unremarkable.

Output: Enlargement of the proximal nail fold is nonspecific and may be inflammatory in nature. We see no discrete mass.


Instruction: Generate impression based on findings.

Input: Neurofibromatosis 1 with lesions on right forearm Multiple nodules are within the subcutaneous tissues of the forearm particularly within the radial portion. These nodules are iso to slightly hyperintense on T1 relative to skeletal muscle and hyperintense to muscle on T2 sequences. The largest of these is seen within the posterolateral forearm approximately 6.5 cm from the elbow with several others delineated on PACS. The majority of the lesions demonstrate faint homogeneous enhancement following of gadolinium administration. These lesions do not demonstrate aggressive or invasive features.The underlying muscle and bone marrow signal is normal.

Output: Multiple subcutaneous nodules of the forearm which do not demonstrate aggressive characteristics but enhance slightly following contrast administration. Given the subcentimeter size of these lesions, characterization of their relationship with surrounding nerve bundles is unreliable however given the patient's known history of NF-1, these most likely represent small neurofibromas.


Instruction: Generate impression based on findings.

Input: Motion degraded examination, specifically affecting the axial pre and post T1 sequences and the axial and coronal T2 sequences. Brain parenchymal morphology is within normal limits. Several scattered small foci of nonspecific FLAIR hyperintensity within the cerebral hemispheres which were not definitively seen on the prior examination. No edema or mass effect is detected. Diffusion-weighted images are within normal limits. There is no evidence to suggest intracranial hemorrhage or any abnormal extra-axial fluid collection. The ventricles are normal in size and morphology. Curvilinear enhancing structure in the right cerebellar hemisphere likely reflects a small developmental venous anomaly.

Output: 1. No evidence of an intracranial lesion.2. Scattered nonspecific foci of FLAIR hyperintensity may be seen in the setting of migraines. However, the differential considerations are numerous including prior inflammation, chronic small vessel ischemic disease, gliosis, etc.


Instruction: Generate impression based on findings.

Input: Reason: 69 y/o female with DLCBL and lucency right femur head and neck on XRAy and PET. Is NOT FDG avid on PET. Looks like fatty deposit per radiology, Need MRI to characterize History: right femur lucency Note is made of heterogeneous bone marrow signal abnormality which may represent residual islands of red marrow. Note is made of heterogeneous marrow signal abnormality corresponding to findings seen on recent CT examination and hip radiographs which is iso to hyperintense to skeletal muscle on T1-weighted images, slightly hyperintense on fluid sensitive sequences and demonstrates no definite enhancement on postcontrast sequences. There is a subcentimeter focus of increased bone marrow signal abnormality within the left sacral wing which is nonspecific and too small to characterize. There is nonspecific subcutaneous edema along the lateral aspect of the right hip. There is a small amount of fluid within the hip joints bilaterally which is not necessarily of any clinical significance. Mild osteoarthritis affects the hips.

Output: Lesion within the right femoral head/neck corresponding to the findings seen on recent PET/CT examination and radiographs without definite enhancement. These findings appear most consistent with a benign fibrous lesion including fibrous dysplasia or perhaps a liposclerosing myxofibrous tumor, with an intraosseous lipoma also is a differential consideration. A lymphomatous deposit is considered exceedingly unlikely given the imaging characteristics, lack of definite enhancement, and lack of hypermetabolic activity on the recent PET/CT examination.


Instruction: Generate impression based on findings.

Input: There are multiple foci of susceptibility abnormality throughout both infratentorial and supratentorial brain, including at the cervicomedullary junction, with imaging features consistent with innumerable cavernous malformations. The largest of these is centered in the right thalamus measuring 16 mm AP x 15 mm transverse x 12 mm craniocaudal (as measured on T2 images). This larger lesion demonstrates heterogeneous internal signal characteristics, with a hypointense rim. There is no associated mass effect or perilesional edema. There are no associated developmental venous anomalies.The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There is no midline shift. The pituitary gland is normal in size. There is no evidence for acute cerebral, brainstem or cerebellar infarction. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain.

Output: 1.There are multiple cerebral cavernous malformations throughout the supratentorial and infratentorial brain, including at the cervicomedullary junction.2.The largest of these is centered in the right thalamus measuring 16 mm AP x 15 mm transverse x 12 mm craniocaudal (as measured on T2 images). This larger lesion demonstrates heterogeneous internal signal characteristics, with a hypointense rim. There is no associated mass effect or perilesional edema.