Instruction: Generate impression based on findings.

Input: Diagnosis: Other symptoms and signs involving cognitive functions and awarenessClinical question: cognitive declineSigns and Symptoms: memory impairmentComments: Patient doesn't recall whether she has a pin in her foot from a fracture repair. | The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.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.There were several periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Given their small number and the high frequency with which these types of lesions are identified in the general population, they are of little clinical significanceThe visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells demonstrate partial opacification of the right mastoid air cells. The visualized portions of the orbits are intact.

Output: 1.MRI of the brain is within normal limits.2.Opacification of the right mastoid air cells is a nonspecific finding which could relate to inflammation or retained secretions though there is no underlying cause appreciated on this exam.


Instruction: Generate impression based on findings.

Input: 42-year-old male with altered mental status and lethargy There is no evidence of intracranial hemorrhage, mass or edema. Encephalomalacia involving bilateral frontal lobes and bilateral temporal lobes are again noted and not significantly changed from comparison MRI accounting for technical differences. Otherwise symmetric prominence of a ventricular system is in proportion to the diffuse sulcal prominence compatible with generalized brain atrophy. Slight hyperdense lesion extending from the left basal ganglia into the left cerebral peduncle that corresponds to high T1 signal lesion on prior MR is of uncertain clinical etiology and significance.Basal ganglia and right insula calcifications have increased in size, but were likely present on prior MRI. There are atherosclerotic calcifications of the basilar artery as well as bilateral internal carotid arteries and middle cerebral arteries.Hyperostosis frontalis is noted. Otherwise, the calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Accounting for technical differences, there is no significant change compared to prior MRI as described above. Due to multiple abnormalities correlation with MRI should be considered for more definitive comparison.


Instruction: Generate impression based on findings.

Input: 44-year-old female with persistent knee pain, evaluate for lateral collateral ligament tear MENISCI: The medial and lateral menisci are intact.ARTICULAR CARTILAGE AND BONE: A small bone island is present within the tibia, otherwise no abnormal marrow signal. The articular cartilage is intact without full thickness defects.LIGAMENTS: The medial and lateral collateral ligament complexes are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: Normal MRI knee without evidence of lateral collateral ligament tear.


Instruction: Generate impression based on findings.

Input: Male, 54 years old, with cervicalgia. Slight reversal of the cervical adenosis is seen. Sagittal alignment is otherwise anatomic. Vertebral body height and morphology are within normal limits. No evidence of marrow replacement or edema is seen.Multiple areas of patchy abnormal cord signal intensity are seen beginning at approximately the C4 level and continuing down to at least the C7 level (see key images). These lesions appear to involve the dorsal and lateral columns with relative sparing of the central gray matter. No swelling or edema is seen and, if anything, some of the affected areas demonstrate mild volume loss.C2-3: Facet arthropathy. No significant spinal canal or foraminal compromise.C3-4: Left facet arthropathy. Minimal posterior disc-osteophyte complex formation. No spinal canal or foraminal compromise. C4-5: Left facet arthropathy. Mild posterior disc-osteophyte complex formation with central focality. Effacement of the ventral thecal sac but no significant spinal canal compromise. Mild narrowing of the right neural foramen. C5-6: Facet arthropathy. Mild posterior disc-osteophyte complex formation. No significant spinal canal compromise. Mild bilateral foraminal narrowing. C6-7: Facet arthropathy. No significant spinal canal compromise. Mild left foraminal narrowing. C7-T1: Unremarkable.

Output: 1.Relatively mild disc and facet degeneration is seen which does not cause significant spinal canal or foraminal stenosis at any level.2.Multiple small areas of abnormal spinal cord signal are demonstrated involving the lateral and dorsal columns. The cord is not swollen and in some affected areas, there appears to be volume loss which would suggest a chronic process. The differential would include sequelae of prior demyelinating disease, a postinfectious or autoimmune phenomenon, or a metabolic abnormality such as subacute combined degeneration.


Instruction: Generate impression based on findings.

Input: Reason: Is there a new or persistent meniscus tear? Or articular cartilage damage? History: s/p lateral partial meniscectomy with persistent pain MENISCI: There is blunting of the free edge of the body of the lateral meniscus, compatible with history of prior partial lateral meniscectomy. Additionally however, there is vertically oriented increased signal intensity within the peripheral red zone of the body of the lateral meniscus extending to the tibial articular surface, indicating a tear. This may be associated with a very small parameniscal cyst. Medial meniscus is normal in signal characteristics and morphology.ARTICULAR CARTILAGE AND BONE: There is subchondral edema within the lateral tibial plateau, which we suspect is degenerative in etiology, but we see no discrete overlying cartilage defect. Articular cartilage of the medial and patellofemoral compartments are intact.LIGAMENTS: Cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: Quadriceps tendon and patellar tendon are intact.ADDITIONAL

Output: Surgical changes of partial lateral meniscectomy with peripheral tear of the lateral meniscal body and other findings as above.


Instruction: Generate impression based on findings.

Input: Female, 29 years old, with increased trismus and pain to the left parotid region for four months, history of T3 N1 mucoepidermoid carcinoma status post left total parotidectomy. Redemonstrated is evidence of prior left parotidectomy. No masslike lesion is seen in surgical bed. No pathologic adenopathy is detected in the visualized portion of the neck. Scattered lymph nodes are seen in the left neck, some of which demonstrate diffusion restriction, potentially indicating a reactive or inflammatory process. Edema of the left mandibular condyle and surrounding soft tissues is seen with mild superimposed enhancement. The right TMJ is within normal limits. Anatomically anomalous cervical vertebral bodies are redemonstrated with a thoracic scoliosis partially visualized.

Output: 1.No findings are seen to suggest tumor recurrence within the left parotidectomy bed or pathologic adenopathy. 2.Evidence of inflammation is seen centered on the left TMJ which may indicate joint degeneration.


Instruction: Generate impression based on findings.

Input: Reason: s/p R AKA for infected TKA, please evaluate for residual infection History: above Again seen are the surgical changes related to prior above the knee amputation. Although the margins appear relatively sharp, a small amount of heterotopic ossification adjacent to the osteotomy margins, seen on prior examinations, is no longer visible. If there is strong clinical concern for osteomyelitis, MRI may be considered.

Output: Although we see no gross osteolysis of the remaining femur, a small amount of heterotopic ossification along the osteotomy margin seen on the prior study is no longer visible. If there is strong clinical concern for osteomyelitis, MRI could be considered.


Instruction: Generate impression based on findings.

Input: 72 years Female (DOB:1/25/1944)Reason: h/o DM and HTN, now with amnestic syndrome, please assess for CVD and/or focal atrophy History: memory impairmentPROVIDER/ATTENDING NAME: JAMES A. MASTRIANNI JAMES A. MASTRIANNI The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Punctate T2 and FLAIR hyperintense foci are present in the brainstem, basal ganglia and internal capsules.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.There is no evidence for acute cerebral infarction.2.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related. 3.Punctate lesions in the brainstem, internal capsules and basal ganglia are likely vascular related


Instruction: Generate impression based on findings.

Input: Male, 4 years old. Evaluate for possible osteomyelitis. Right knee effusion. Puncture wound. MENISCI AND LIGAMENTS: The medial and lateral menisci are normal. The cruciate and collateral ligaments are normal.BONE AND MARROW: Bone marrow signal is normal.SYNOVIUM: Small joint effusion with synovial enhancementMUSCULATURE: Edema and enhancement involving the medial aspect of the vastus medialis indicates myositis.ADDITIONAL

Output: 1.Cellulitis involving the anteromedial subcutaneous soft tissues with a sinus tract from the skin to the deep soft tissues, and an associated subcentimeter collection, compatible with a small abscess.2.Inflammation extends to the medial aspect of the vastus medialis muscle, compatible with myositis.3.Small joint effusion and enhancing synovium indicating synovitis.4.No evidence of osteomyelitis.


Instruction: Generate impression based on findings.

Input: Heel ulcer There is diffuse subcutaneous edema, skin thickening and subcutaneous gas throughout the hindfoot with ulceration of the soft tissues overlying the calcaneus. The distalmost calcaneus demonstrates low T1/high T2 signal consistent with osteomyelitis. No additional foci of osteomyelitis are identified. There is no evidence of abscess within the limits of a noncontrast examination.Osteoarthritic changes affect the talonavicular and talocalcaneal articulations. Osteoarthritis also affects portions of the midfoot.A mild amount of fluid surrounds the flexor hallucis longus tendons as well as the peroneal tendons otherwise the tendons of the ankle appear intact.

Output: Osteomyelitis of the calcaneus with overlying soft tissue ulcer. Diffuse subcutaneous edema and inflammation without evidence of abscess within the limits of noncontrast exam.


Instruction: Generate impression based on findings.

Input: History of prostate cancer. Biopsy dated 4/10/2015 demonstrated left mid lobe prostatic adenocarcinoma Gleason grade 3+3. PELVIS:PROSTATE:Prostate Size: 3.8 x 5.5 x 5.0 cmPeripheral Zone: 6 x 4 mm T2 weighted hypointense focus in the left base with associated restricted diffusion (series 1001, image 15). 8 x 3 mm T2-weighted hypointense focus in the left mid gland/apex with mild restricted diffusion (series 1001/11).Questionable T2 weighted hypointense focus measuring 7 x 7 mm (series 1001/12) in the right mid gland with associated restricted diffusion.Central Gland: No suspicious foci.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: No evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Suspected 6 mm left base and 8mm left mid gland/apex foci of disease.2. Questionable 7 mm focus of disease in the right mid gland.


Instruction: Generate impression based on findings.

Input: Unspecified persistent mental disorders. Worsening cognition and gaitSigns and Symptoms: history of shunt for possible NPH 15 years ago, now cognitive decline MRI of the brainNo diffusion weighted abnormalities are appreciated.A ventriculostomy tube courses through the right frontal lobe into the right lateral ventricle with tip in the body of the right lateral ventricle. There is signal change surrounding the ventriculostomy tube with high signal on T2 and FLAIR MRI.. The signal changes associated with the ventriculostomy tube have increased compared to the prior exam from 2003. The tube is in stable position compared to the prior exam. Biventricular diameter on coronal imaging at the level of the ventriculostomy tube entry point is currently 36 mm and previously was 31 mm.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Additional small lesions which are hyperintense on T2 and FLAIR are present in the brainstem and thalami and basal ganglia and internal capsules. These lesions appear to not have substantially changed compared to the previous exams.On susceptibility imaging a punctate lesion is present in the medial aspect of the thalamus at the tip of the ventriculostomy tube. This probably represents a microhemorrhage which is only seen on susceptibility imaging.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus. The left vertebral artery is larger than the right vertebral artery.The visualized portions of the paranasal sinuses demonstrate minor opacities.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin.

Output: 1.Since the prior exam the lateral ventricles have mildly enlarged. One possibility is that this is a result of atrophy. 2.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. They appear relatively stable over the past 12 years.3.Lesions in the brainstem thalami and basal ganglia are also likely vascular related. They appear relatively stable over the past 12 years.4.Status post ventriculostomy tube placement. Associated signal change appears to have mildly progressed compared to prior exam. Etiology is uncertain


Instruction: Generate impression based on findings.

Input: Right knee pain MENISCI: The lateral meniscus is intact. There is a small radial tear of the body of the medial meniscus. Additional signal abnormality within the posterior horn of the meniscus is thought to reflect changes of prior repair as opposed to true meniscal tearing.ARTICULAR CARTILAGE AND BONE: There is mild thinning of the articular cartilage of the medial compartment but no evidence of a full-thickness defect. Mild heterogeneity of the signal intensity of the patellofemoral cartilage also likely reflects degenerative change but is otherwise intact. The articular cartilage of the lateral compartment is preserved.LIGAMENTS: There is evidence of prior ACL reconstruction. The ACL graft is intact. The remaining cruciate and collateral ligaments are intact.EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Radial tear of the body of the medial meniscus. Additional signal abnormality within the posterior horn of the medial meniscus is thought to reflect changes of prior repair.2. Prior ACL reconstruction with intact ACL graft.3. Mild cartilage degeneration of the medial patellofemoral compartments without evidence of partial or full-thickness defect.


Instruction: Generate impression based on findings.

Input: 55 year old man with known angiographic left main coronary disease but no ischemic symptoms, referred for repeat cardiac MRI with stress testing.MEDICATIONS: aspirin, atorvastatin, lisinopril First Pass PerfusionDuring hyperemia, no perfusion defects were present. 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 with normal systolic function. The overall LV ejection fraction is 65%, the LV end diastolic volume index is 99 ml/m2 (normal range: 74+/-15), the LVEDV is 230 ml (normal range 142+/-34), the LV end systolic volume index is 34 ml/m2 (normal range 25+/-9), the LVESV is 80 ml (normal range 47+/-19), the LV mass index is 45 g/m2, and the LV mass is 105 g. There are no regional wall motion abnormalities present. Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 55%, the RV end diastolic volume index is 98 ml/m2 (normal range 82+/-16), the RVEDV is 228 ml (normal range 142+/-31), the RV end systolic volume index is 44 ml/m2 (normal range 31+/-9), and the RVESV is 102 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is trivial mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. No perfusion defects/ "ischemia" present during hyperemia.2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and systolic function (LVEF 65%).4. Normal RV size and systolic function (RVEF 55%).No significant change when compared to the previous cardiac MRI of 12/4/2015.


Instruction: Generate impression based on findings.

Input: 37 year old female with strong family history of breast cancer in her mother in her late 30s as well as maternal grandmother. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.In the left breast at posterior central aspect, there is a new enhancing mass measuring 5 x 7 x 8 mm. No abnormal enhancement is seen in right breast. No abnormal axillary lymph nodes are identified in either axillary region.

Output: New enhancing mass in the left breast at posterior central aspect, for which MR directed ultrasound study is recommended. If no sonographic correlate is detected, MR guided biopsy should be considered. BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration.


Instruction: Generate impression based on findings.

Input: New daily persistent headache (ndph) [G44.52], Reason for Study: ^Reason: 57M s/p OLT now with headaches and leukopenia. Donor with ?histoplasmosis. History: Headaches and leukopenia No evidence of acute ischemic or hemorrhagic lesion.There are subtle smooth dural enhancement on postcontrast enhancement T1 axial scan. However, there is no evidence of focal nodular enhancing lesion on the scan. This findings are non specific and differential diagnosis include meningitis or meningeal irritation or intracranial hypotension. If clinically indicated, diagnostic lumbar puncture can be considered.The ventricles, sulci and cisterns are symmetric and unremarkable.There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. Smooth pachymeningeal enhancement, differential diagnosis include meningitis, meningeal irritation and intracranial hypotension.


Instruction: Generate impression based on findings.

Input: History of cirrhosis and ascites. Evaluate for HCC. MRI ABDOMEN UPPER WWO; 7/11/2015 7:10 AMCLINICAL INFORMATION:Evaluate liver lesions, HCC screenTECHNIQUE: MRI abdomen performed with and without IV contrast. Approximately 9 mL of MultiHance administered for study.        COMPARISON: Outside MRI from April 12, 2013.

Output: 1. Cirrhotic liver morphology. Arterially enhancing hepatic dome focus measuring 1.1 x 0.8 cm with washout, suspicious for small hepatocellular carcinoma, attention on follow-up recommended. Additional arterially enhancing foci seen, indeterminate.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Extensive metallic artifact is demonstrated throughout the lumbar spine. The visualized portions of the spinal canal are grossly patent. A diffuse disc bulge is visualized at T10-T11 causing mild effacement of the ventral thecal sac. A multilobulated T2 hyperintense structure is visualized extending from the inferior pole of the left kidney, probably a renal cyst.

Output: 1. Severely limited examination secondary to extensive metal artifact. Portions of the visualized spinal canal appear grossly patent.2. A multilobulated T2 hyperintense structure is visualized extending from the inferior pole the left kidney, probably a renal cyst. Further characterization could be obtained with ultrasound, as clinically indicated.


Instruction: Generate impression based on findings.

Input: Wrist pain, arthritis or synovitis There is a mild amount of enhancement within the distal radioulnar joint indicating mild synovitis. There is also very mild synovial enhancement of the radiocarpal and midcarpal joints which may reflect additional minimal synovitis but this is equivocal. There are foci of signal intensity and enhancement within multiple carpal bones which may reflect a combination of edema and cysts or possibly chronic erosions. There is degeneration of the articular disc of the triangular fibrocartilage complex and signal abnormality within the proximal lunate just distal to the radioulnar articulation which may reflect ulnocarpal abutment. The scapholunate interval appears slightly widened but we see no fluid-filled tear of the scapholunate ligament. Moderate osteoarthritis affects the basilar joint. A multilobulated collection of fluid signal intensity is noted distal and medial to the first carpometacarpal joint which likely represents a ganglion.There is increased signal intensity within the abductor pollicis longus and extensor pollicis brevis as they course along the radial styloid which may reflect the sequela of deQuervain tenosynovitis but we see no frank tenosynovial enhancement at this time. A small slip of tendon is noted between the extensor carpi radialis brevis and longus which may reflect an accessory tendon or the sequela of chronic longitudinal tearing although this is thought to be less likely. There is medial subluxation of the extensor carpi ulnaris from its groove with increased signal intensity noted along the ulnar styloid and adjacent enhancement indicating degeneration/degenerative tearing and focal tenosynovitis.There is poorly defined edema and enhancement volar to the flexor carpi ulnaris tendon with multiple prominent adjacent vessels which is of uncertain etiology but may represent a small vascular malformation or nonspecific inflammation.

Output: Osteoarthritis of the wrist with mild synovitis and other findings described above.Note that the patient developed a reaction to the administered MultiHance which is further detailed above according to hospital policy A03-17/PC 55.


Instruction: Generate impression based on findings.

Input: Status post craniotomy for tumor resection. Assess tumor. Non-infused CT of brain:Extensive postoperative changes of right frontal craniotomy for removal of tumor. A small area of hemorrhage along the most medial aspect of the surgical cavity is a new finding since prior exam. This finding is best appreciated on axial image 12. The hemorrhage measures approximately 7 mm times 8-mm in transaxial dimension. Additional small patchy areas of high density material along the dorsal aspect of the surgical cavity are also believed to represent hemorrhage. I suspect possible minimal increase in these areas of hemorrhage as well. The foci of hemorrhage along the dorsal aspect of the surgical cavity are very small and slice positioning differences between the two studies may contribute to the difference in their appearance. There is interval absorption of air within the epidural space under the craniotomy flap since prior study. Epidural thickening along the inner table of bony flap is within the expected range of postop change.The brain parenchyma immediately posterior to the surgical cavity demonstrates subtle low attenuation this is also new finding since prior exam. I recommend further follow-up with an MRI examination to evaluate for residual/recurrence. Mass-effect and midline shift has improved since prior study. No significant midline shift is detected and ventricular system remains stable.

Output: 1.Subtle small areas of new hemorrhage in the most medial aspect of the surgical cavity.2.New low-attenuation of brain parenchyma surrounding the surgical cavity is concerning for new vasogenic edema or ischemic change.3.Follow-up with an infused MRI examination is recommended.4.Improvement in postoperative changes of right frontal craniotomy.


Instruction: Generate impression based on findings.

Input: Memory deficits, multiple infarcts?. There is encephalomalacia involving the right parietal and right temporal lobes consistent with prior infarcts. These infarcts primarily involve the right inferior parietal lobule, the right superior temporal gyrus, and the adjacent white matter. The bilateral hippocampi demonstrate mild volume loss similar to remainder of the brain. No restricted diffusion to suggest acute ischemia. There is a small pineal cyst measuring 9 x 9 mm. No suspicious intracranial mass or mass-effect. No hydrocephalus. Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild chronic small vessel ischemic changes. There are multiple punctate foci of susceptibility effect involving the bilateral cerebral hemispheres as well as the bilateral cerebellar hemispheres. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. Small left maxillary mucous retention cyst. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: 1. Chronic infarcts involving the right parietal and right temporal lobes.2. Mild chronic small vessel ischemic changes.3. Multiple punctate foci of chronic microhemorrhages involving the bilateral cerebral and cerebellar hemispheres in a nonspecific distribution and may be related to amyloid angiopathy and/or hypertension.


Instruction: Generate impression based on findings.

Input: 42-year-old female with dorsal hand and wrist pain prior remote MVC/ejection. Evaluate for retained glass. LIGAMENTS: The scapholunate and lunotriquetral ligaments appear grossly intact, within the limitations of a non arthrogram study.TRIANGULAR FIBROCARTILAGE COMPLEX: The triangular fibrocartilage complex appears intact, within the limitations of this non arthrogram study.TENDONS: The extensor and flexor tendons appear intact.BONES: No bone marrow signal abnormality is identified.ADDITIONAL

Output: Numerous subcentimeter foci of signal abnormality within the superficial soft tissues along the dorsal and lumbar aspect of the wrist and hand suspicious for retained foreign bodies.


Instruction: Generate impression based on findings.

Input: No significant change in appearance of the resection cavity in the right superior temporal gyrus. No significant change in extent of surrounding T2/FLAIR high signal. The cavity measures 23 x 20 mm, previously 23 x 18 mm. Linear as well as nodular areas of contrast enhancement along the posterior and anteromedial margins of the cavity are not significant changed. Restricted diffusion and intrinsic T1 shortening along the posterior surgical cavity wall are unchanged and compatible with posttreatment change. Dynamic susceptibility-weighted contrast-enhanced imaging shows no significant increase in relative cerebral blood flow in in the tissues surrounding the surgical cavity.The ventricular system remains mildly enlarged. Ex vacuo focal enlargement of the posterior body of the right lateral ventricle is also unchanged. Minimal periventricular T2 hyperintensity is unchanged nor the few tiny scattered foci of deep frontal white matter T2 hyperintensity. Major intracranial vessels are patent. The right parietal craniotomy flap and a minimal underlying extra-axial fluid are unchanged. There is bilateral lens replacement. The orbits are otherwise unremarkable. The paranasal sinuses and mastoid air cells are clear.

Output: Compared to the previous examination of July 29, 2015, there is no evidence of interval disease progression.


Instruction: Generate impression based on findings.

Input: Multiple sclerosis: right sided numbness. Brain: There has been interval increase in the size and number of T2 hyperintense lesions involving the cerebral white matter, including in the unilateral corona radiata, posterior cingulate gyri, and peritrigonal regions. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Cervical Spine: There is a faint patchy area of T2 hyperintensity in the left spinal cord at the C4 level. 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 paravertebral soft tissues are unremarkable.

Output: 1. Interval progression of the intracranial demyelinating lesions.2. Small residual demyelinating lesion in the left spinal cord at the C4 level.


Instruction: Generate impression based on findings.

Input: Reason: pit tumor bleed History: right hemianopsia MRI brain:Since the prior exam a sellar and suprasellar mass has enlarged. Previously measured 14 x 35 mm and coronal dimensions and currently measures 23 x 43 mm coronal dimensions.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. The left eyeball lens is thin.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.MRI pituitary:Since the prior exam a sellar and suprasellar mass has enlarged. Previously measured 14 x 35 mm and coronal dimensions and currently measures 23 x 43 mm coronal dimensions. Is superior aspect there is T1 signal hyperintensity present on the current exam which was not present on the prior exam. This suggests some associated hemorrhage. This mass extends into the left cavernous sinus and surrounds the left carotid artery appeared superiorly it displaces the anterior cerebral arteries and optic chiasm superiorly. It insinuates itself into the interhemispheric fissure and abuts and displaces the adjacent right frontal lobe including the right gyrus rectus and olfactory trigone. The right A1 segment is located behind the mass.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries. The right and to a lesser degree left anterior cerebral arteries are displaced by the patient suprasellar mass. The right A1 segment courses behind the mass. The A2 segments are along the medial aspect of the patient's suprasellar massThere is no evidence for intracranial aneurysm or cerebrovascular occlusion.

Output: 1.Since the prior exam the patient's sellar and suprasellar mass has enlarged and has developed hemorrhage along its superior aspect. The mass surrounds the structures within the left cavernous sinus and displaces the optic chiasm, the right gyrus rectus and olfactory trigone and anterior cerebral arteries right more than left.2.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: Reason: Evaluate for cervical myelopathy History: LE weakness, hyperreflexia, LE numbness Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology.No abnormal enhancing lesions are appreciated in the cervical spine. There is multilevel disk desiccation present.At C2-3 there is no significant compromise to the spinal canal or neural foramina. There is a small central broad-based disk protrusion present at this levelAt C3-4 there is no significant compromise to the spinal canal or neural foramina. There is a minor disk bulge present at this levelAt C4-5 there is no significant compromise to the spinal canal or neural foramina. There is a minor disk bulge present at this levelAt C5-6 there is no significant compromise to the spinal canal or neural foramina. There is a minor disk bulge present at this levelAt C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.MRI thoracic spine:The thoracic vertebral bodies are appropriate in the overall alignment and height. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots. No abnormal enhancing lesions are appreciated in the thoracic spine.

Output: 1.No spinal cord lesions are appreciated.2.There are mild degenerative changes present in the cervical spine.


Instruction: Generate impression based on findings.

Input: 43-year-old man with hypertension, altered mental status in the setting of ESRD. There is no evidence of intracranial hemorrhage or mass. Subtle low attenuation is present in the subcortical white matter. This is nonspecific and most likely signifies age-indeterminate small vessel ischemia. In the proper clinical setting, this finding could also represent sequela of PRES.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are diffusely sclerotic, possibly indicating renal osteodystrophy. There is groundglass opacification and sclerotic bone formation around the left chamber of the frontal sinus. This is most suggestive of fibrous dysplasia but could be better evaluated with MRI.

Output: 1. Widespread subcortical white matter hypoattenuation -- this finding is nonspecific and most likely represents age-indeterminate small vessel ischemic disease. This could also represent sequela of PRES. If clinically indicated, MRI could provide further evaluation.2. Groundglass opacification and bony remodeling involving the left chamber frontal sinus -- possibly representing fibrous dysplasia. This finding could also be better evaluated with MRI.


Instruction: Generate impression based on findings.

Input: Reason: C3 lesion. Osteoblastoma, Osteosarcoma. Dr. Christoforidis performing the case History: Neck pain Serial CT images obtained during the biopsy procedure demonstrate the needle placement within the vertebral lesion.

Output: 1.C3 vertebral bone biopsy under CT guidance. A total of five samples were delivered to pathology for analysis.


Instruction: Generate impression based on findings.

Input: 70-year-old male with history of prostate cancer. PELVIS:PROSTATE:Prostate Size: 4.4 x 5.4 x 5.8 cmPeripheral Zone: The peripheral zone is thinned. In the left apex and mid gland there are several subcentimeter foci of restricted diffusion with very subtle associated T2-weighted signal abnormality. (Series 604, image 264, 304, 324) These may be related to the patient's prostatic adenocarcinoma.Central Gland: Marked BPH enlargement without a discrete suspicious lesion.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: No extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: Left inguinal fullness may reflect inguinal hernia repair or hernia.OTHER: No significant abnormality noted.

Output: Several subcentimeter foci of restricted diffusion within the left apex and mid gland likely correspond to the patient's prostatic adenocarcinoma. No evidence of extraprostatic tumor extension or pelvic lymphadenopathy. Please note that the study is slightly limited by lack of intravenous contrast.


Instruction: Generate impression based on findings.

Input: Ms. Zenk submitted outside study for review. Submitted for review is an MRI dated 2/18/2015 performed at Northwestern Memorial Hospital. She has a recent diagnosis of right breast IDC. There are innumerable foci of enhancement seen in both breasts, compatible with marked background parenchymal enhancement. This finding limits the sensitivity of MRI. Right breast: In the right upper outer breast, 10:00 location, there is 1.9 x 2.4 x 2.0 cm spiculated enhancing mass. Susceptibility artifact from biopsy marker clip is present within the central aspect of this lesion, compatible with biopsy proven malignancy. There are no additional abnormal areas of enhancement identified in the right breast. Left breast: There is no abnormal enhancement seen within the left breast. No abnormal axillary lymph nodes are identified in either axillary region.

Output: (1) 2.4 unifocal biopsy proven malignancy within the right upper outer breast.(2) No MR evidence of malignancy within the left breast.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Diagnosis: Benign neoplasm of brainClinical question: preop MRI for tumor resectionSigns and Symptoms: Lump on Skull/ brain tumor There is a 45 x 51 mm axial dimension extra-axial axial mass adjacent to the falx and visually contiguous with the superior sagittal sinus which is suspected to invade the superior sagittal sinus. It is adjacent to the posterior aspect of the left frontal lobe which should displaces. There is associated involvement of the adjacent calvarium. There are signal voids present within this lesion.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 an extra-axial parasagittal mass along the left frontal convexity which is suspected to invade the adjacent superior sagittal sinus and infiltrate into the the overlying calvarium. This most likely represents a meningioma. 2.Please note that this is a limited exam for the purpose of stereotactic guidance for surgery.


Instruction: Generate impression based on findings.

Input: Neoplasm of unspecified behavior of endocrine glands and other parts of nervous system [D49.7] / Encounter for other preprocedural examination [Z01.818], Reason for Study: ^Reason: Pineal tumor, presurgical MRI STEALTH image guidance for tumor resection. This imaging study was performed under stealth protocol, thus multiple fiducial markers attached on the scalp during the examination.Right occipital craniotomy was seen.Redemonstration of irregular shaped and enhancing pineal tumor which shows evidence of infiltration into bilateral thalami and periaqueductal gray matter, superior colliculi and cranial aspect of tectum unchanged since prior scan.Right frontal approach ventriculostomy tube was inserted and the tip is located at the right lateral ventricle frontal horn, unchanged since prior scan.Unchanged right occipital lobe encephalomalacia since prior scan.The ventricles, sulci and cisterns are unremarkable and stable in size. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Preoperative STEALTH protocol brain MRI imaging with multiple fiducial markers.2. Pineal tumor with local extension into bilateral thalami, periaqueductal gray, cranial aspect of tectum and superior colliculus, unchanged since prior scan.3. Stable ventricle size since prior scan with right frontal approach ventriculostomy catheter.4. Unchanged right occipital craniotomy with right occipital encephalomalacia.


Instruction: Generate impression based on findings.

Input: There is no evidence of acute intracranial hemorrhage, mass, or acute infarct. There are patchy foci of T2 hyperintensity within the supratentorial white matter and brainstem most compatible with chronic small vessel ischemic disease. There are a few punctate foci of susceptibility effect within the supratentorial white matter, including the subcortical white matter and the thalami. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unremarkable. There is a chronic deformity of the left medial orbital wall.

Output: 1.No evidence of acute infarct.2.Moderate supratentorial and infratentorial chronic small vessel ischemic disease.3.A few scattered chronic microhemorrhages within the subcortical white matter and deep gray nuclei.


Instruction: Generate impression based on findings.

Input: 15-year-old male with knee injury MENISCI: The medial and lateral menisci are intact.ARTICULAR CARTILAGE AND BONE: There is an avulsed 1.3 cm fracture fragment of the posterior tibial plateau at the attachment of the PCL. Edema extends within the medial and lateral tibial plateau. The patellofemoral cartilage is intact. The tibiofemoral cartilage is intact.LIGAMENTS: The ACL is intact. The fibers of the PCL are intact with an avulsion fracture of the tibial attachment as described above. The MCL and LCL are intact.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1. Avulsion fracture at the tibial insertion of the PCL. 2. Large hemarthrosis. 3. Intact menisci and collateral ligaments.


Instruction: Generate impression based on findings.

Input: 75-year-old male with cavernous malformation. Redemonstrated is hemosiderin staining associated with the site of prior intraparenchymal hemorrhage involving the left postcentral gyrus. This is unchanged in configuration with a prior examination, as is the closely associated smaller focus of hemosiderin staining and high T2/FLAIR signal within the left precentral gyrus. A left cerebellar hemispheric lesion has also been stable. There are multiple stable foci of high T2/FLAIR scattered within subcortical/ventricular white matter without associated susceptibility abnormality. There are no new lesions including mass, foci of acute hemorrhage, hydrocephalus, enhancement or acute ischemia. The midline is intact. Normal flow-voids are demonstrated within major intracranial vessels. Orbits, sinuses and mastoid air cells are unremarkable.

Output: 1.Stable encephalomalacia and hemosiderin staining involving the left precentral gyrus possibly related to an underlying cavernoma.2.Two other hemosiderin-stained lesions within the left frontal lobe and cerebellar hemisphere are also stable.3.Stable chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: Female, 18 years old. Reason: r/o foreign body History: pain There is bandage material overlying the posterior aspect of the ankle with irregularity of the underlying skin that may reflect a laceration. We see no foreign body or fracture. The anterior margin of the Achilles tendon appears relatively well defined, which argues against a full-thickness tear, but if further imaging evaluation is indicated, MRI can be considered.The ankle joint appears normal. The remainder of the foot appears normal.

Output: Soft tissue laceration without evidence of foreign body.


Instruction: Generate impression based on findings.

Input: 62-year-old male with acute myeloblastic leukemia, echogenic liver mass seen on prior ultrasound, elevated bilirubin ABDOMEN:LIVER, BILIARY TRACT: Normal liver contour. Multiple ill defined poorly marginated, enhancing, T2 hyperintense lesions are scattered throughout the liver. The largest in segment six measures approximately 2.9 x 1.8 cm (series 901, image 57).The gallbladder is within normal limits. Small ascites.SPLEEN: The spleen is enlarged measuring 15.7 cm in longest dimension. Small ascites.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: T2 hyperintense lesion in the T6 vertebral body is incompletely characterized.OTHER: Small bilateral pleural effusions and adjacent atelectasis.

Output: 1.Multiple ill-defined, enhancing lesions scattered throughout the liver as described above. These lesions do not be the criteria of cyst, hemangioma, or primary liver tumor. Differential includes AML involvement of the liver, and less likely infection. Follow-up after chemotherapy treatment is recommended.


Instruction: Generate impression based on findings.

Input: 69-year-old female with suspicious calcifications in the upper inner quadrant of the right breast. Recent bilateral breast MRI demonstrated an enhancing mass in the upper outer quadrant of the right breast. A targeted right ultrasound was performed for the mammographic and MR-detected areas of concern.In the right breast, 2:00, 2 cm from the nipple, there is an ill-defined hypoechoic area with associated calcifications, measuring approximately 0.9 x 0.6 x 1 cm, corresponding to the area of calcifications in the upper inner quadrant seen on prior mammogram.In the right breast, 10:00, 2 cm from the nipple, there is a 0.7 x 0.3 x 0.6 cm hypoechoic mass, corresponding to an enhancing mass seen on breast MRI.

Output: 1. In the right breast, 2:00 position, there is an ill-defined hypoechoic area with associated calcifications, corresponding to the area of calcifications in the upper inner quadrant seen on prior mammogram. Patient is scheduled for stereotactic biopsy of these calcifications later today.2. In the right breast, 10:00 position, there is an indeterminate 0.7 cm hypoechoic mass, corresponding to an enhancing mass seen on breast MRI. Ultrasound-guided core biopsy of this mass will be performed later today.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration.


Instruction: Generate impression based on findings.

Input: Marked patient motion artifact limits sensitivity of examination.Cervical Spine: There is heterogeneous, low T1 bone marrow signal consistent with osseous metastatic disease. The cervical spine alignment is anatomic. The vertebral body heights are preserved. The signal of the spinal cord is normal. The paraspinal soft tissues are unremarkable. There is no evidence of spinal cord compression or mass. Degenerative changes are specified by the intervertebral level as follows: C2-C3: There is a posterior disc osteophyte complex with no significant spinal stenosis. There is no significant neural foraminal narrowing. C3-C4: There is a posterior disc osteophyte complex with uncovertebral hypertrophy, eccentric to the right with mild spinal stenosis and moderate left and severe right foraminal narrowing.C4-C5: There is no significant neuroforaminal narrowing or spinal stenosis. C5-C6: There is a posterior disc osteophyte complex with a superimposed left lateral bulge. There is mild left neural foraminal narrowing. There is no significant spinal stenosis. C6-C7: There is a posterior disc osteophyte complex and uncovertebral hypertrophy with severe left and moderate right neural foraminal narrowing. There is no significant spinal stenosis. C7-T1: There is no neuroforaminal narrowing or spinal stenosis. Thoracic Spine: There is diffuse heterogeneous low T1 signal consistent with osseous metastatic disease. The thoracic spine is in normal alignment. The vertebral body heights are well-maintained. There is mild multilevel disc desiccation. The spinal cord is of normal caliber and signal. There is no pathological enhancement in the spinal cord. There is no significant disk bulge, herniation, or spinal canal or foraminal stenosis within the thoracic spine. The limited localizer images of the lumbar spine demonstrate additional vertebral metastases with epidural extension at L5 and S1.

Output: 1.Widespread osseous metastatic disease. 2.Multilevel cervical spondylosis with mild spinal stenosis at C3-4 and multilevel foraminal narrowing as described above.3.No significant spinal canal or foraminal compromise within the thoracic spine.4. The limited localizer images of the lumbar spine demonstrate additional vertebral metastases with epidural extension at L5 and S1. Please refer to the recent lumbar spine MRI.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 3 months old, 42 week CGA ex 27 week premie, evaluate for abnormality No restricted diffusion to suggest acute infarct. There is punctate focus of susceptibility in the left cerebellum compatible with microhemorrhage. No other foci of hemorrhage. Sulcation and myelination appear within normal limits for age. The ventricles and basal cisterns are normal in size and configuration. No intracranial mass or mass effect. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Punctate focus of susceptibility in the left cerebellum consistent with microhemorrhage. This finding is not uncommon in preterm newborns. Brain MRI appears otherwise within normal limits.


Instruction: Generate impression based on findings.

Input: A 54 year old female with known extrapulmonary sarcoidosis who complaint about palpitations while the echocardiography showed normal systolic left ventricular function. Referred to cardiac MRI to rule out cardiac involvement. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 58%, the LV end diastolic volume index is 73 ml/m2 (normal range: 65+/-11), the LVEDV is 174 ml (normal range 109+/-23), the LV end systolic volume index is 31 ml/m2 (normal range 18+/-5), the LVESV is 73 ml (normal range 31+/-10), the LV mass index is 44 g/m2 (normal range 67+/-11), and the LV mass is 105 g (normal range 114+/-24). There are no regional wall motion abnormalities present. There is no myocardial late gadolinium enhancement to suggest the presence of underlying myocardial fibrosis, inflammation, or infiltration. Normal native myocardial T1-times and global relative enhancement ratio.No intracavitary thrombus.No myocardial iron overload.Global Relative Enhancement1.2Normal <4T1 MOLLI Pre contrast myocardium1006Normal <1050msT1 MOLLI Pre contrast blood pool1718Extracellular volume fraction21.8normal 20-30%Left AtriumThe left atrium is moderately enlarged. The LA volume is 146 ml.Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 54%, the RV end diastolic volume index is 72 ml/m2 (normal range 69+/-14), the RVEDV is 171 ml (normal range 110+/-24), the RV end systolic volume index is 33 ml/m2 (normal range 22+/-8), and the RVESV is 78 ml (normal range 35+/-13). Right AtriumThe right atrium is mildly dilated. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild to moderate mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThere is a left sided aortic arch with a 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 drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsSmall hilar lymph nodes noted. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with normal systolic function, the LVEF is 58% without evidence of underlying myocardial fibrosis, inflammation, or infiltration. No MRI evidence of cardiac sarcoidosis.2. The left atrium is moderately enlarged. 3. The right ventricle is normal in size with normal systolic function, the RVEF is 54%. 4. The right atrium is mildly dilated. 5. There is mild to moderate mitral regurgitation.6. Small hilar lymph nodes notedI personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Reason: pain in right knee No radiologic abnormalities to account for patient's pain.

Output: Normal appearing right knee without radiologic abnormalities to account for patient's pain.


Instruction: Generate impression based on findings.

Input: Female 33 years old Reason: evaluate liver lesions in pt with pancreatic neuroendocrine tumor s/p resection of pancreatic primary with new liver lesions on CT History: abdominal fullness ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. There are 6 hepatic lesions. The largest in the right lobe of the liver in segment 8 measures 6.3 x 5.8 cm with a central scar, has arterial enhancement without washout and is compatible with focal nodular hyperplasia.The 5 other lesions located in segments two (2 lesions) , segment 3, segment 6 and segment 8 also show arterial enhancement and no washout.The segment 3 lesion is T2 hyperintense unlike the rest of the lesions and is favored to be a flash filling hemangioma. The segment 6 lesion is T2 hyperintense and has progressive filling is also favored to be a hemangioma.The remaining three lesions in segment 2 and segment 8 have imaging features suggesting focal nodular hyperplasia but are not diagnostic for the entity given their small size. There are less likely to represent metastatic disease as it have no washout.There is minimal central biliary ductal dilatation with mild focal areas of narrowing in the central left and right hepatic bile ducts. There is thrombosis of the portal vein with cavernous transformation.SPLEEN: Spleen is enlarged. Splenic venous thrombosis.PANCREAS: The postsurgical changes in the head of the pancreas. No pancreatic ductal dilatation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: There are several lymph nodes adjacent to the surgical bed.BOWEL, MESENTERY: Postsurgical changes in the bowel. Soft tissue surrounding the superior mesenteric artery is unchanged.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No ascites.PELVIS:UTERUS, ADNEXA: Bilateral adnexal cysts. Endometrial thickness is normal.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No ascites.

Output: 1.Multiple hepatic lesions with the largest lesion having imaging features of focal nodular hyperplasia.2.Two lesions have imaging features of hemangiomas.3.Remainder of the lesions have imaging findings suggestive of focal nodular hyperplasia but are not definite for the entity due to their small size.4.Postsurgical changes in the pancreas with adjacent lymph nodes.5.Thrombosis of the portal vein with cavernous transformation.6.Mild central biliary duct irregularity of unclear etiology.7.Splenic vein thrombosis with enlarged spleen.


Instruction: Generate impression based on findings.

Input: 50 years Female (DOB: 6/29/1965)Reason: Multiple Sclerosis History: assess progression and new inflammatory activityPROVIDER NAME: ADIL L JAVED ADIL L JAVED MRI brain:There is an extra-axial mass measuring 15 x 10 mm coronal dimensions adjacent to the left central sulcus. It has a broad-based the dura. It is stable compared to the prior exam.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.There are several punctate subcortical white matter lesions present in the parietal lobes bilaterally. There are bright on FLAIR and T2 MRI. There is a punctate FLAIR hyperintense lesion located adjacent to the left orbital gyrus. An additional lesion is present in the subcortical white matter of the right parahippocampal gyrus. These were also present on the prior exam not substantially changed. There is a lesion the subcortical white matter of the anterior aspect of the right temporal lobe which is smaller on the current exam when compared to the prior. It previously measured approximately 6 mm and now measures approximately 3 mm.There is FLAIR signal hyperintensity along the surface of the brainstem as well as the medial aspects of the middle cerebellar peduncles and within the midbrain centrally. There is a vague signal hyperintensity on T2 and FLAIR along the precentral gyri bilaterally and the left middle frontal gyrus subcortical white matter bilaterally. These findings are stable compared to the previous exam.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal enhancing lesions are identified in the cervical spine.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina. There is a disc bulge present this level.At C4-5 there is no significant compromise to the spinal canal or neural foramina. There is a minor disc bulge present at this level.At C5-6 there is loss of disc space height, disc desiccation and diffuse disc bulge associated with mild narrowing of the neural foramina bilaterally and effacement of spinal fluid ventral and posterior the spinal cord. Overall there is a mild degree are spell stenosis at this level.At C6-7 there is loss of disc space height, disc desiccation and diffuse disc bulge associated with mild narrowing of the neural foramina bilaterally and effacement of spinal fluid ventral and posterior the spinal cord. Overall there is a mild to moderate degree are spell stenosis at this level.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 vague patchy lesions present in the subcortical white matter of the postcentral gyri and left middle frontal gyrus associated with some signal changes along the brainstem which were also present on the prior exam. It is conceivable this is related to demyelination. It is stable compared to prior exam.2.There are subcortical white matter lesions scattered within the brain parenchyma which for the most part are stable. One in particular in the right temporal lobe has decreased in size. These are nonspecific. It could be related to demyelination.3.An extra-axial mass adjacent to the left central sulcus most likely represents meningioma.4.There are degenerative changes present in the cervical spine with mild to moderate spinal stenosis at C6-7 and mild spinal stenosis at C5-6..


Instruction: Generate impression based on findings.

Input: 62 year-old male with left shoulder pain. Evaluate for left shoulder injury ROTATOR CUFF: The rotator cuff tendons and muscles appear normal.SUPRASPINATUS OUTLET: Mild degenerative changes affect the acromioclavicular.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint is in anatomic alignment. Mild degenerative changes affect the glenohumeral joint with subchondral cyst formation in the humeral head. There is a small paralabral cyst adjacent to the posterior glenoid labrum indicating an underlying posterior labral tear (series 3, image 14).BICEPS TENDON: The long biceps tendon appears normal.ADDITIONAL

Output: Findings compatible with a posterior glenoid labral tear with adjacent paralabral cyst.


Instruction: Generate impression based on findings.

Input: Metastatic melanoma with a right frontal lesion treated with SRS. There is interval decrease in size of the right frontal lobe lesion, which now measures up to 7 mm, previously 14 mm, and contains susceptibility effect and intrinsic T1 signal. There is minimal residual surrounding T1 hyperintensity. There are unchanged punctate nonspecific foci of susceptibility effect in the right medial temporal lobe and right parietal deep white matter without associated enhancement. There is no evidence of acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull and scalp soft tissues are grossly unremarkable. There is gas in the left globe that likely represents pneumatic retinopexy. There is a right lens implant. There are postoperative findings in the right retromaxillary region with patchy enhancement in the right pterygopalatine fossa. There is mild scattered paranasal sinus mucosal thickening and scattered fluid signal in the bilateral mastoid air cells.

Output: 1. Interval decrease in size of the treated right frontal lobe presumed metastasis.2. Postoperative findings in the right retromaxillary region with nonspecific patchy enhancement in the right pterygopalatine fossa.


Instruction: Generate impression based on findings.

Input: 52-year-old male with pain. Status post right total hip arthroplasty. Evaluation of both hips and the surrounding soft tissue is limited by metallic susceptibility artifact related to the patient's bilateral hip resurfacing arthroplasties. There is a lobulated collection of fluid signal intensity within the right hip joint surrounding the femoral neck in near-circumferential fashion and extending anteriorly into the iliopsoas bursa. The collection has margins of low signal intensity on all sequences which may reflect metal ion deposition. The erosion of the superior aspect of the femoral neck is not as clearly evident on this examination as on recent radiographs and we otherwise see no frank invasion of the bone. The remaining soft tissues of the right hip are within normal limits. There is also a relatively small fluid collection within the left hip which also appears to have a low signal intensity margin which could represent metal ion deposition. We see no frank invasion of bone or surrounding soft tissues. Severe degenerative disc disease affects the level of L4/L5.

Output: 1. Fluid collection within the right hip extending into the iliopsoas bursa with a low intensity rim suggesting metal ion deposition. The erosion of the femoral neck seen on prior radiographs is not as clearly seen on today's examination.2. Smaller left hip fluid collection as described above.


Instruction: Generate impression based on findings.

Input: 91-year-old female patient with gangrene, drainage. Question of osteomyelitis. A marker is placed along the lateral aspect of the hindfoot and toes. The exam is essentially nondiagnostic for evaluation of the phalanges due to motion artifact and susceptibility artifact from air in the soft tissues. Signal abnormality within the proximal phalanx of the great toe could represent osteomyelitis, but this is equivocal. Signal abnormality within the first metatarsal head is probably degenerative in etiology, although we cannot entirely exclude the possibility of osteomyelitis. Otherwise, signal intensity of the remaining metatarsals and bones of the midfoot are within normal limits on T1-weighted images arguing against osteomyelitis. Loss of soft tissue along the posterior and plantar aspects of the heel is noted. There is mild subcortical edema-type signal within the posterior tuberosity of the calcaneus on the T2WI, but signal intensity on T1-weighted images is relatively preserved arguing against osteomyelitis. We see no frank enhancement of the calcaneus. There is diffuse soft tissue edema involving the ankle which extends into the foot. We see no ankle joint effusion or rim-enhancing fluid collection to suggest an abscess

Output: 1. Limited study as described above, particularly with regards to the toes, the phalanges of which are not well visualized on this study. Signal abnormality within the proximal phalanx of the great toe may represent osteomyelitis, but this is equivocal.2. Soft tissue ulceration along the calcaneus with edema type signal is suggestive of reactive osteitis with preservation of T1-weighted signal arguing against osteomyelitis.


Instruction: Generate impression based on findings.

Input: 67-year-old male with a history of non-small cell lung cancer. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are mildly prominent compatible with age-appropriate volume loss.No significant change in small left middle cranial fossa arachnoid cyst which measures 1.4 x 1.3 cm (series 10, image 14) and associated with mild bony remodeling. Brain parenchyma is otherwise unremarkable for age.No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. Note is made of bilateral lens implants. Redemonstration of bilateral mastoid air cell opacification (right greater than left). Also again seen are bilateral maxillary sinus mucus retention. Bone marrow signal and extracranial soft tissues are otherwise within normal limits.

Output: 1. No evidence of intracranial metastases.2. Unchanged small left middle cranial fossa arachnoid cyst without significant mass effect.3. Redemonstration of bilateral mastoid air cell opacification (right greater than left) and bilateral maxillary mucous retention cysts.


Instruction: Generate impression based on findings.

Input: This exam is mildly degraded by motion artifact.MRI BRAIN: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are no areas of abnormal parenchymal signal. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are unremarkable. There is no midline shift or herniation. The major cerebral flow voids are intact. The midline structures and craniocervical junction are within normal limits.MRV HEAD: This portion of the exam is limited by motion artifact and lack of contrast. There is no gross evidence of stenosis or thrombus within the dural venous sinuses.

Output: 1.Normal brain MRI.2.No evidence for venous sinus thrombosis on this limited noncontrast exam.


Instruction: Generate impression based on findings.

Input: History of follicular cell small bowel lymphoma status post resection. Resection dated 2/4/2015 of a jejunal mass. 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: Small simple appearing bilateral renal cortical cysts. No hydroureteronephrosis or suspicious lesion.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postsurgical changes of a side to side jejunal anastomosis. Intermittent regions of jejunal nondistention is likely related to peristalsis. No focal mass is identified. No abnormal distention, bowel wall thickening, T2 weighted signal intensity, restricted diffusion or postcontrast enhancement. No adjacent inflammatory changes. The remainder of the small bowel and colon is unremarkable.No free fluid or loculated fluid collection.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The pelvic small bowel and colon is normal in appearance.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No evidence of small bowel tumor recurrence, active inflammation or lymphadenopathy.


Instruction: Generate impression based on findings.

Input: There is straightening of the cervical spine. There are no fractures. The marrow signal is benign. The cervical and upper thoracic cord are normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable.Heterogeneous, primarily T2 hyperintense, foci are seen within bilateral thyroid lobes, right greater than left. A focus of hypodensity within a right thyroid lobe suggests calcification.C2/3: Posterior osteophyte disc complex and bilateral facet hypertrophy. There is mild right neural foraminal stenosis.C3/4: Trace anterolisthesis C3 on C4, posterior osteophyte disc complex, bilateral uncinate hypertrophy, and left facet hypertrophy. There is flattening of the anterior cord surface without intrinsic cord signal abnormality. There is mild central, severe left neural foraminal and moderate to severe right neural foraminal stenosis.C4/5: Posterior osteophyte disc complex and bilateral uncinate hypertrophy. There is anterior cord flattening without intrinsic cord signal abnormality. There is mild central, mild to moderate left neural foraminal, and severe right neural foraminal stenosis.C5/6: Trace anterolisthesis C5 on C6, posterior osteophyte disc complex and bilateral uncinate hypertrophy. There is anterior cord flattening without intrinsic cord signal abnormality. There is mild central, moderate left neural foraminal, and moderate to severe right neural foraminal stenosis.C6/7: Posterior osteophyte disc complex and bilateral facet hypertrophy. There is minimal anterior cord flattening without intrinsic cord signal abnormality. There is mild left neural foraminal stenosis.C7/T1: Posterior osteophyte disc complex results in mild bilateral neural foraminal stenosis.

Output: 1.Heterogeneous, primarily T2 hyperintense, foci are seen within bilateral thyroid lobes, right greater than left. A focus of hypodensity within a right thyroid lobe suggests calcification. Dedicated thyroid ultrasound is recommended for further characterization.2.C2/3: Mild right neural foraminal stenosis.3.C3/4: Mild central, severe left neural foraminal and moderate to severe right neural foraminal stenosis.4.C4/5: Mild central, mild to moderate left neural foraminal, and severe right neural foraminal stenosis.5.C5/6: Mild central, moderate left neural foraminal, and moderate to severe right neural foraminal stenosis.6.C6/7: Mild left neural foraminal stenosis.


Instruction: Generate impression based on findings.

Input: Laser ablation There are postoperative changes of bilateral frontal lead placement for laser ablation, with the tips at the level of the anterior limbs of the internal capsule bilaterally. There is T1 hyperintensity/enhancement surrounding the distal aspects of the leads which is expected. Expected postsurgical changes also include small amount of pneumocephalus. No large intracranial hemorrhage or significant mass effect is appreciated. No hydrocephalus. Remainder of the brain parenchyma is unremarkable. Major vascular structures are intact. Tiny left maxillary mucus retention cyst.

Output: Expected postsurgical changes of bilateral laser ablation of the anterior limbs of the internal capsules.


Instruction: Generate impression based on findings.

Input: 29-year-old female with thoracic and lumbar tenderness to palpation. Evaluate for a epidural abscess. The vertebral bodies are appropriate in the overall alignment and height. The spinal cord has normal signal characteristics and overall morphology. There is no compromise of the spinal cord. T2 hyperintensity within T10, a majority of the T12 vertebral body, L1, and L3 are of uncertain etiology.

Output: 1.This is a limited exam specific for the exclusion of cord compression only and does not exclude more subtle lesions such as intrinsic cord abnormalities. No cord compression is identified.2.T2 hyperintensity within the T10, a majority of the T12 vertebral body, L1, and L3 are of uncertain etiology. The differential diagnosis would include atypical hemangiomas or other marrow infiltrative lesions.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Chronic HCV cirrhosis, evaluate liver lesion ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic morphology. Moderately T2 hyperintense mass in segment 8 demonstrates central arterial enhancement and distorts the hepatic capsule measuring up to 3.0 x 3.1 cm (series 11, image 29). There is washout on the delayed postcontrast images. The anterior branch of the right portal vein courses towards this lesion and demonstrates internal signal abnormality on arterial and portal venous phase.Additional small arterial enhancing foci are scattered throughout the right hepatic lobe without washout. No intrahepatic biliary ductal dilation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1.3 cm segment 8 hepatic mass, which meets the criteria for HCC.2.Signal abnormality within the anterior branch of the right portal vein; portal venous tumor invasion is suspected.


Instruction: Generate impression based on findings.

Input: Female 25 years old Reason: 25 yo F with hx of liver transplant 2/2 biliary atresia admitted with nausea, vomiting, abdominal pain, elevated lipase, please perform MRCP secretin protocol to r/o pancreatic stricture, pseudocyst, pancreatitis History: epigastric pain, nausea, vomiting, elevated lipase ABDOMEN:LIVER, BILIARY TRACT: Patient is status post partial hepatic lobe transplant. The left hepatic lobe is mildly nodular. There is minimal intrahepatic biliary ductal dilatation. The biliary enteric anastomosis is patent as seen on image 14 of series 6.Hepatic and portal veins are patent. No suspicious hepatic lesions.SPLEEN: Spleen is enlarged with varices.PANCREAS: Pancreas is mildly T1 hypointense on the precontrast T1-weighted imaging. Enhancement is normal without areas of necrosis. Pancreatic duct shows mild narrowing in the pancreatic body for approximately an 8 mm segment.. There is normal physiologic response to secretin. There is minimal surrounding inflammation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Narrowing of the celiac artery better evaluated on the recent CT angiogramBOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Status post left hepatic lobe transplant with minimal intrahepatic biliary ductal dilatation and no suspicious hepatic lesions. Liver is mildly nodular with enlargement of the spleen. Correlate for liver disease.2.Findings suggestive of mild pancreatitis without pseudocyst formation. Mild narrowing of the pancreatic duct in the body. Expected response to secretin.


Instruction: Generate impression based on findings.

Input: History of intermittent abdominal pain. Outside hospital CT questioned small bowel wall thickening. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is adequate distention of the small bowel by oral contrast. The small bowel fold pattern is maintained. The stomach is distended with oral contrast. The jejunal loops are displaced towards the right upper quadrant likely due to stomach distention. No specific evidence of midgut malrotation.The terminal ileum is unremarkable. The small and large bowel loops are normal in caliber, wall thickness, signal intensity and enhancement. No peri-enteric inflammatory changes. No fixed luminal narrowing or restenotic/upstream dilatation to suggest a flow-limiting stricture.No evidence of sinus tract or fistula formation. No free fluid or loculated fluid collection.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No evidence of active inflammation, flow-limiting stricture or sinus tract/fistula formation. No free fluid or loculated fluid collection.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No evidence of bowel inflammation. No specific findings to account for the patient's intermittent abdominal pain.


Instruction: Generate impression based on findings.

Input: Female, 63 years old, with metastatic disease to the brain status post radiosurgery. An enhancing lesion within the left occipital lobe is slightly smaller, now measuring 6 x 3 mm, previously 7 x 4 mm, with reduced edema.A small enhancing lesion within the right inferior cerebellum measures 7 x 6 mm, previously 8 x 6 mm, with minimal if any associated edema.A small focus of enhancement along the inferior vermis is unchanged. An adjacent focus of enhancement within the inferior left cerebellar hemisphere is slightly more conspicuous than on prior (see image 33, series 1301).A 5-mm focus of enhancement within the high right superior frontal gyrus is new. A 3-mm focus of enhancement within the left frontal operculum is new. A 2-mm focus of enhancement within the right superior temporal gyrus is also new. A questionable focus of enhancement along the margin of the left precentral gyrus is unchanged.No evidence of significant brain parenchymal edema or mass effect is seen. No significant intracranial hemorrhage or any abnormal extra-axial fluid collection is detected. The ventricles remain normal in size and morphology.

Output: 1.Lesions within the left occipital lobe and right cerebellum are stable to smaller.2.Two additional small lesions within the cerebellum are stable to minimally more prominent.3.Lesions within the right superior frontal gyrus, left frontal operculum and right superior temporal gyrus are new.


Instruction: Generate impression based on findings.

Input: Reason: right shoulder rotator cuff tear History: right shoulder pain. ROTATOR CUFF: Mild supraspinatus tendinopathy without discrete tear. The infraspinatus, subscapularis and teres minor are intact.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: No significant abnormality noted.BICEPS TENDON: The biceps tendon is intact.ADDITIONAL

Output: Mild supraspinatus tendinopathy without discrete tear.


Instruction: Generate impression based on findings.

Input: Twisted ankle while skateboarding, check for acute injury and fracture Foot: Minimal irregularity observed at the base of the fifth metatarsal at the attachment of the brevis with questionable mild soft tissue swelling. The irregularity appears corticated and most likely correlates with old injury. No definite acute abnormalities observed, however please correlate with patient's specific site of pain. No dislocation or fracture, specifically no discrete associated fracture or defect within the underlying bone to suggest an acute process. MRI may be needed if further characterization is required clinicallyAnkle: Minimal soft tissue swelling overlying the lateral malleolus without additional underlying osseous abnormality A surgical staples projected in the anterior soft tissues overlying the distal tibial diaphysis, of uncertain significance.

Output: Suspected old remote injury without definite acute current osseous abnormality. Please see detail provided


Instruction: Generate impression based on findings.

Input: History of mediastinal lymphangioma. Serial imaging/follow up. Compare to previous MRI. CHEST:LUNGS AND PLEURA: Nonspecific T2 hyperintense lesion along the left lung pleura is unchanged (image 29, series 501). This may represent an intrapulmonary lymph node.MEDIASTINUM AND HILA: Upper anterior mediastinal T2 hyperintense lesion with T2 hypointense septations compatible with known diagnosis of lymphangioma. There is no internal enhancement. This is unchanged in size from the prior study now measuring 3.8 x 1.8 cm (image 22, series 501), previously 3.7 x 1.8 cm.CHEST WALL: Mild scoliosis of the thoracolumbar spine is again noted.UPPER ABDOMEN: T2 hyperintense lesion within the superior aspect of the spleen is unchanged in size now measuring 3.3 x 3.0 cm (image 40, series 501) previously 3.3 x 2.9 cm. There is no significant internal enhancement and likely represents a lymphangioma.

Output: 1. No change in mediastinal lymphangioma.2. No change in splenic lesion, likely a lymphangioma.


Instruction: Generate impression based on findings.

Input: Low back pain and buttock pain, and left calf pain for 3 to 4 weeks. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Severe loss of disc space at the L3-L4 level as well as grade 1 retrolisthesis again seen and similar to prior. There remains bone marrow edema involving the L3 and L4 vertebral bodies as well as the superior L5 endplate, which is slightly worse than 1/27/2016. No evidence of recurrent disc herniation at the L3-L4 level. There is a disc extrusion with inferior migration involving L4-L5 level which is increased since prior. There is effacement of the left lateral recess as well as narrowing of the left L4-L5 foramen. Post gadolinium images demonstrate abnormal diffuse enhancement involving the intrathecal left L5 nerve root likely reflecting inflammation from compression. Additional details of the degenerative changes are 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: Severe loss of disc height and mild retrolisthesis. There is mild narrowing of the left lateral aspect of the spinal canal related to facet arthropathy, otherwise no significant spinal canal stenosis at this level. There is minimal right neural foraminal narrowing and mild left neural foraminal narrowing. Evidence of prior discectomy on the right. No significant change since most recent prior.L4-L5: There is moderate to severe spinal canal stenosis related to combination of facet arthropathy, ligamentum flavum thickening, and disc extrusion with inferior migration. Left lateral recess and foraminal left foraminal disc extrusion as described above is slightly worse since prior. Abnormal enhancement involving the dorsal epidural space at L4-L5 favored to represent granulation tissue and present previously. There is moderate to severe narrowing of the left neural foramen and lateral recess effacement which are slightly worse. Mild right neural foraminal narrowing. Distention of the facet joints is again seen and perhaps minimally worse. There is advanced left-sided facet arthropathy with small synovial cyst suspected posterior to the left facet joint adjacent to a T1 hyperintense, presumable osseous spur, which can be confirmed with CT. Abnormal enhancement is also noted at the left L4-L5 paraspinous region which is favored to represent inflammation with a 9 mm T2 hyperintense possibly representing a synovial cyst within this region. L5-S1: Disc height loss and mild bulge. Mild facet arthropathy. No significant spinal canal stenosis. There is mild right and mild-to-moderate left neural foraminal stenosis.

Output: Moderate to severe central spinal canal stenosis at L4-L5 with mild worsening of left lateral recess stenosis and left foraminal stenosis related to disc extrusion which is worse in the interval. There is suspected impingement of the left L5 nerve root at this level which also demonstrates enhancement in its intrathecal course. There may also be impingement of the left L4 nerve root at the level of the neural foramen at this level.There is advanced facet arthropathy at the left L4-L5 level with abnormal enhancement dorsal and lateral to the left facet joint. There appear to be small presumed synovial cysts in these regions. Findings may be on a degenerative basis but would suggest correlation with clinical findings for the small possibility of infection. These findings have gradually progressed when compared to multiple prior lumbar spine studies.Additional levels as above.


Instruction: Generate impression based on findings.

Input: 43 year old woman with MR detected left breast mass at 12:00 position. MR directed left ultrasound identified a sonographic correlate for an enhancing mass on MRI at 12 o'clock position in the left breast. This is a hypoechoic mass measuring 1.8 x 0.7 cm at the 12 o’clock position with mildly increased vascularity, 1 cm from the nipple. The lesion was readily visible.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 left breast was cleansed with chlorhexidine over the target area. Transducer was sterilely sheathed. Local anesthesia was obtained using 2% lidocaine superficially, with 1% lidocaine with 1:100,000 epinephrine at depth. A 3 mm incision was made in the skin with a #11 scalpel blade. Using aseptic technique, continuous ultrasound guidance and a lateromedial approach, two 14-gauge core needle (InRad) specimens were obtained of the lesion. Targeting was judged very good. All specimens sank to the bottom of the prefilled container of 10% formalin. Specimen quality was judged very good.Specimens were sent to Pathology with an accompanying history sheet. Using continuous ultrasound-guidance a Bard 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 left CC and ML views revealed the percutaneously placed clip to be in the expected location in the peripheral posterior aspect of the lesion. No evidence of hematoma or other complication.A pressure dressing was positioned over the biopsy site and an ice pack positioned over the pressure dressing. Post-procedure instructions were reviewed with the patient both verbally and in writing. She tolerated the procedure well with no evident complications and continued to stereotactic biopsy in stable condition.The procedure was performed by Drs. Abe and Patel. Dr. Abe was present during the procedure at all times.

Output: Successful ultrasound-guided core biopsy of the left breast lesion and ribbon clip placement. Pathology is pending at this time.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Female, 24 years old, with anaplastic astrocytoma currently on Avastin. Postoperative findings are again seen compatible with left parietal craniotomy and prior tumor resection. The resection cavity and several smaller cystic spaces anterior to the main cavity show no significant interval change.Small foci of enhancement within the parenchyma anterior to the resection cavity are slightly more conspicuous when compared to the immediate prior examination. These small foci track anteriorly along the left temporal horn. However, these foci remain significantly reduced when compared to the examination of 07/11/16. T2 FLAIR hyperintensity surrounding the resection cavity has not significantly changed.However, thickening of the splenium of the corpus callosum has progressed from the prior examination. This tissue does not enhance, though it does demonstrate marked diffusion restriction which is also progressed from prior.Ill-defined periventricular FLAIR hyperintensity is unchanged. Minimal FLAIR hyperintensity in the pons along with a probable cavernous malformation are unchanged. Ventricular size morphology are stable as well. Mucosal thickening is unchanged in the right maxillary sinus.

Output: 1.Relatively stable appearance of the left parietal resection cavity and adjacent tissues. There are small foci of enhancement in this area and tracking along the left temporal horn which are slightly more conspicuous than on the immediate prior examination, though they remain significantly improved relative to the examination of 07/11/16.2.However, progressive thickening of the splenium of corpus callosum is seen. This tissue does not enhance but demonstrates marked diffusion restriction. This finding is concerning for progression of nonenhancing tumor in the context of antiangiogenic therapy.


Instruction: Generate impression based on findings.

Input: History of pituitary macroadenoma, evaluate for change: headache and breast tenderness/swelling. Redemonstrated is a mildly heterogeneous pituitary lesion, measuring up to 10 mm in the craniocaudal dimension, which is unchanged. There is no mass effect upon the optic chiasm. The cavernous sinuses sphenoid sinuses are intact.

Output: Unchanged pituitary adenoma.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Stage IV NSCLC. There is a punctate focus of residual enhancement susceptibility effect at the site of the treated anterior right frontal lobe lesion without surrounding edema. There is an unchanged background of scattered T2 hyperintensity without enhancement in the bilateral cerebral hemispheres and pontine white matter, which may represent chronic small vessel ischemic disease. There is no evidence of enhancing intercranial lesions. There is no evidence of acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is a left lens implant.

Output: Marked interval decrease in size of the treated right frontal lobe metastasis.


Instruction: Generate impression based on findings.

Input: 80 years Female (DOB:9/14/1935)Reason: 1 year follow up History: left parietal massPROVIDER/ATTENDING NAME: PETER C. WARNKE PETER C. WARNKE The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a 6 x 9 mm coronal dimension sessile extra-axial lesion adjacent to the left calvarium and adjacent to the left parietal lobeThere is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.There is effacement of spinal fluid posterior the spinal cord at the C1 level with partial effacement of spinal fluid ventral to the spinal cord at this level. There is mild anterior subluxation of C1 relative to C2.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin.

Output: 1.A calcified extra-axial lesion is present adjacent left parietal lobe which is stable. This could represent a burnt out meningioma.2.Findings are suspicious for mild spinal stenosis at the C1 vertebral level associated with mild subluxation at C1-C2. If clinically appropriate, additional imaging of this region may be helpful to further evaluate this.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: Right lower extremity weakness. For the purposes of numbering, there are 5 lumbar type vertebral bodies. The lumbar spine is in normal alignment, with a normal lumbar lordosis. The vertebral body and disk heights are well-maintained. No focal marrow signal abnormality is appreciated. The conus medullaris on sagittal imaging is grossly intact. T12-L1: There is no significant compromise to spinal canal or neural foramina.L1-L2: There is no significant compromise to spinal canal or neural foramina. Bilateral facet arthropathy.L2-L3: The spinal canal has been surgically decompressed with evidence of left-sided laminotomy. Mild disc bulge with minimal effacement of the thecal sac. No significant neural foraminal stenosis. Bilateral facet arthropathy.L3-L4: There is mild spinal canal narrowing, on a predominantly congenital basis. There is minimal prominence of epidural fat and mild right-sided neuroforaminal stenosis. Bilateral facet arthropathy.L4-5: Postsurgical changes of left-sided laminectomy and prior discectomy are noted. There is residual disc protrusion which may represent residual/recurrent disc herniation with associated mild to moderate degree of effacement of the thecal sac. There is no significant compromise to the neural foramina. Bilateral facet arthropathy.L5-S1: There is minimal disc bulge. Bilateral facet arthropathy. There is minimal bilateral neural foraminal stenosis. No significant spinal canal stenosis.There is a partially imaged right hip prosthesis noted.

Output: Postsurgical changes of spinal canal decompression at L2-3 and L4-5 in addition to discectomy at L4-5. There is evidence of residual/recurrent disc herniation at L4-5 with mild to moderate effacement of the thecal sac at this level. There is no high-grade spinal canal or high-grade neuroforaminal stenosis at any level.


Instruction: Generate impression based on findings.

Input: New frontal headaches. There is a partially empty sella. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is minimal nonspecific cerebral white matter T2 hyperintensity. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unremarkable. However, there is fluid signal within the right mastoid air cells.

Output: 1. Nonspecific partially empty sella, which may be associated with pseudotumor cerebri. Otherwise, no evidence of intracranial hemorrhage, mass, or acute infarction.2. Right mastoid fluid, which may indicate mastoiditis in the appropriate clinical setting.


Instruction: Generate impression based on findings.

Input: 42 year-old female with BRCA2 mutation and known left breast fibroadenoma. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally. No suspicious enhancement is seen in either breast. The known fibroadenoma in the left breast near 1:00 shows no appreciable enhancement, most likely due to increased hyalinization. In the left breast anterior depth, multiple enhancing foci in a nonsegmental distribution are not significantly changed. No abnormal lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. Contrast extravasation, as described above.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Routine Diagnostic Mammogram.