Instruction: Generate impression based on findings.

Input: Female, 46 years old, with lumbar radicular pain, stool incontinence, subjective right lower extremity weakness. Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. Endplate edema is seen at L4-5, progressed from prior. Elsewhere, no pathologic marrow replacement or edema is demonstrated. Marrow signal characteristics on T1 and T2-weighted images are slightly dark which may reflect dense bones.The visualized distal spinal cord, conus and nerve roots of the cauda equina are within normal limits. No epidural lesions are detected.At L1-2 through L3-4, no significant spinal canal or foraminal compromise is seen. At most there may be mild facet arthropathy. At L4-5, disc degeneration has progressed with further loss of disc height and progressive endplate edema. However, a large previously demonstrated disc protrusion has significantly regressed with a small residual protrusion in the right paracentral location. This causes focal effacement of the right ventral thecal sac and posterior displacement of the right L5 and S1 nerve roots. Prior generalized spinal canal stenosis has been relieved. The neural foramina are mildly narrowed.At L5-S1, mild facet arthropathy is seen without significant spinal canal or foraminal stenosis.

Output: Although progressive disc degeneration is seen at L4-5 in the form of reduced disc height and worsened endplate edema, a large disc protrusion which previously caused significant spinal canal stenosis has regressed. There is only a small residual right paracentral protrusion which may slightly impinge the right L5 and S1 nerve roots.


Instruction: Generate impression based on findings.

Input: Hemiplegic migraine, not intractable, without status migrainosus [G43.409], Reason for Study: ^Reason: Eval for mass History: R sided persistent tinnitus and headache 28 years Female (DOB:2/10/1988)Reason: Eval for mass History: R sided persistent tinnitus and headachePROVIDER/ATTENDING NAME: ANTHONY T. REDER ANTHONY T. REDER No evidence of acute ischemic or hemorrhagic lesion.No evidence of abnormal enhancement.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.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: MRI of the brain is within normal limits


Instruction: Generate impression based on findings.

Input: Female, 8 years old, with neurofibromatosis type I who is having signs of premature puberty and vomiting. Assess for any evidence of a hypothalamic tumor or hydrocephalus. An oval, nonenhancing focus of T2 hyperintensity is seen within the right globus pallidus. The lesion exerts no mass effect but does closely approach the right hypothalamus. A smaller but otherwise similar-appearing lesion is seen within the left globus pallidus.The hypothalamic tissues are otherwise unremarkable. Likewise, the pituitary gland shows normal size and morphology on this non-dedicated examination. Brain parenchymal morphology is within normal limits and no other areas of pathologic signal abnormality are seen. No abnormal intracranial enhancement is observed. The ventricular system is normal in size and morphology. No definite optic pathway lesions are seen on this non-dedicated examination.

Output: Nonenhancing T2 hyperintense lesions are seen within the globus pallidus bilaterally compatible with foci of abnormal signal intensity (FASI) characteristic of NF1. The lesion on the right does approach the hypothalamic region. The pituitary is unremarkable and the ventricles are not dilated.


Instruction: Generate impression based on findings.

Input: 58-year-old man with history of new left lower pole renal cyst seen on ultrasound and chronic renal disease. ABDOMEN:LIVER, BILIARY TRACT: There is a subcentimeter cyst in the left lobe of the liver The liver appears otherwise normal. There is no intrahepatic biliary duct dilatation. The gallbladder is normal.SPLEEN: The spleen is normal.PANCREAS: There is mild prominence of the pancreatic duct in the pancreatic head. The pancreatic parenchyma is normal.ADRENAL GLANDS: The adrenal glands are normal.KIDNEYS, URETERS: There is a 17 x 16 mm simple renal cyst in the inferior pole of the left kidney. Innumerable additional bilateral renal cysts are identified.RETROPERITONEUM, LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: Partially visualized small bowel and colon are normal.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Limited study with simple left lower renal pole cyst. Along with innumerable additional cysts bilaterally is likely related to hemodialysis.


Instruction: Generate impression based on findings.

Input: Female, 91 years old, with left trigeminal neuralgia and left facial asymmetry. Please note that although a complete brain examination was ordered and protocoled, patient discomfort prevented completion of the full study. As a result, a shortened examination tailored to the cranial nerves was performed.T2 hyperintensity and gyral thickening are seen in the left anterior temporal lobe in a pattern suggesting vasogenic edema. There are several small foci of hypointense signal or susceptibility along the anteriormost temporal lobe with adjacent ill-defined enhancement. No associated diffusion restriction is seen.The brain is only partially included within the field-of-view of this examination. These images do show evidence of periventricular T2 hyperintensity and mild generalized parenchymal volume loss. No clear pathologic enhancement is seen along the course of the cranial nerves though evaluation is limited. Incidental note is made of a fatty lesion superficial to the right sternocleidomastoid muscle in the upper neck which likely represents a lipoma. Mild scattered fluid is seen in the right mastoid air cells.

Output: Vasogenic edema is seen in the left anterior temporal lobe with ill-defined associated enhancement and scattered foci of low signal which could represent blood product, mineralization or vascular structures. Due to exam limitations as above, this abnormality is incompletely evaluated on the present study. The patient will be called back to complete standard imaging sequences of the brain. These findings were discussed with Dr. Bernard at 1:00 PM on 07/22/16.


Instruction: Generate impression based on findings.

Input: Male, 14 years old, with ganglioglioma of the spinal cord with growth, six month follow-up exam. Evidence of laminectomy is again seen from C6 to T3. A cavity within the posterior aspect of the spinal cord is redemonstrated beginning at C5-6 and continuing down to T3-4 likely representing the site of resected tumor. A 2 mm focus of enhancement within the cavity at the T2 level appears to be new from the prior examination. No other significant interval changes are seen.The remainder of the spinal cord is within normal limits. A focal kyphosis of the upper thoracic spine is unchanged. Otherwise, vertebral body morphology and spinal alignment are within normal limits. No significant compromise of the spinal canal or neural foramina is seen.

Output: 1.Postoperative findings are redemonstrated compatible with prior resection of a ganglioglioma from the upper thoracic spinal cord.2.A 2 mm focus of enhancement within the spinal cord resection cavity at the T2 level appears to be new when compared to the prior examination. The lesion is too small to characterize accurately and is therefore considered nonspecific. Continued attention on follow-up exams is recommended.3.The resection bed and the remainder of the spinal cord are otherwise unchanged.


Instruction: Generate impression based on findings.

Input: 59-year-old female with recurrent neuroendocrine tumor, nausea ABDOMEN:LIVER, BILIARY TRACT: Large segment eight liver cyst and additional subcentimeter T2 hyperintense foci are unchanged likely a benign etiology. There is unchanged intrinsic T1 signal within the segment eight lesion which measures 3.9 x 2.0 cm when using similar measurement techniques to the prior exam. At the posterior margin is an arterial enhancing nodule measuring 1.5 x 1.1 cm suspicious for recurrence. The nodule measures venous and three minute delayed sequences. This similar appearing when compared to the prior exam.SPLEEN: No significant abnormality noted.PANCREAS: Pancreatic divisum anatomy.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: Unchanged enhancing L2 hyperintense lesion a representative hemangioma.OTHER: No significant abnormality noted.

Output: 1.Hepatic segment eight cavity/lesion as described above with enhancing nodule at the posterior margin of the segment eight cavity suspicious for recurrence. Findings are similar in appearance when compared to the prior noncontrast examination.


Instruction: Generate impression based on findings.

Input: 10-year-old male with sickle cell disease, ACS now with history of seizures and mental status change. There is no evidence of intracranial hemorrhage. Diffuse area of low density seen within the posterior aspect of the right temporal lobe and correlates with subacute ischemic changes and edema seen on brain MRI performed same day.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Blurring of the gray-white junction and low density seen in the posterior aspect of the right temporal lobe consistent with focal edema due to subacute ischemic process as correlated on an MRI performed same day.


Instruction: Generate impression based on findings.

Input: Abdominal pain, nausea, vomiting, evaluate liver nodule on CT ABDOMEN: LUNG BASES: Right basilar scarring/atelectasis.LIVER, BILIARY TRACT: Evaluation is limited by respiratory artifact. T2 hyperintense lobulated mass in segment VII adjacent to the intrahepatic IVC measures 3.4 x 1.9 cm (series 8, image 34). There is peripheral enhancement anteriorly with progressive central enhancement. No evidence of intralesional fat. The common bile duct measures up to 10 mm in diameter. Status post cholecystectomy.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:

Output: T2 hyperintense segment VII hepatic lesion with an enhancement pattern consistent with a hemangioma.


Instruction: Generate impression based on findings.

Input: 34 years Female (DOB: 10/26/1981)Reason: Evidence of cervical radiculopathy History: Radicular pain down R arm after accidentPROVIDER/ATTENDING NAME: TODD STERN TODD STERN The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina. There is a minor disk bulge at this level which appears chronic.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: There is no compromise to the cervical spinal canal or exiting nerve roots.


Instruction: Generate impression based on findings.

Input: 2-year-old male with history of syncope and falls. Please amount of The density and morphology brain parenchyma remains within normal limits. No evidence of hemorrhage, edema, mass effect, midline shift or hydrocephalus.Prominence of lateral ventricles (left greater than right) is noted. Further evaluation with an MRI examination is recommended to evaluate the cause of this discrepancy in the size of lateral ventricles which CT may not be able to determine.Calvarial, mastoid air cells and limited view of paranasal sinuses are unremarkable.

Output: 1.No evidence of acute intracranial process.2.Expansion of left lateral ventricle although may be anatomical variation it is concerning for underlying parenchymal volume loss of left hemisphere and should be further evaluated with an MRI examination.


Instruction: Generate impression based on findings.

Input: Secondary malignant neoplasm of brain [C79.31], Reason for Study: ^Reason: eval for tumor resection History: left weakness Post right fronto-parietal craniotomy status.Previously seen right parietal lobe intra-axial enhancing masses (one at the right inferior parietal lobule and another at the precuneus) are not demonstrated on this scan with minimal tumor bed enhancement indicating near complete or complete resection status. Susceptibility lesions on tumor bed indicate operation related blood products. Minimal enhancement on the tumor bed may indicate postoperative changes, but may need follow up scan.The degree of brain edema and midline shift toward left do not show any significant interval change since prior scan.There is no evidence of acute ischemic or hemorrhagic lesion except resection bed blood products on this scan.The ventricles, sulci and cisterns are unremarkable and unchanged since prior scan. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Near total or complete resection status of the right parietal metastatic lesions, postoperative no unusual finding.2. Subtle enhancement of tumor beds are likely represent postoperative changes but needs follow up scan.3. Unchanged the degree of brain edema and midline shift toward left side since prior scan.


Instruction: Generate impression based on findings.

Input: Clinical question: R hemiparesis s/p R + L vert clipping / sacrifice for basilar fusiform aneurysmSigns and Symptoms: R hemiparesis s/p R + L vert clipping / sacrifice for basilar fusiform aneurysm MRI of the brainThere are several millimeter sized foci of diffusion restriction in the left inferior cerebellum and the left inferior tip of the vermis. No diffusion weighted abnormalities are appreciated in the medulla. However, artifact from the clips obscures visualization immediately adjacent to the clips.On T2 imaging there is a subtle 5mm focus of mild signal hyperintensity along the left posterior aspect of the medulla at the expected location of the left hypoglossal nucleus and left nucleus intercalatus.The flow voids of the intracranial vertebral arteries are not present. The proximal portion of the fusiform basilar aneurysm has heterogeneous but relatively high signal on T2 and intermediate signal on T1. The mid portion and superior portions of the aneurysm have a combination of signal void and T1 and T2 signal hyperintensity.There is artifact on T2 and FLAIR MRI overlying the lower pons suspected to be a result of the metallic clips.The patient is status post distal vertebral artery clipping with suboccipital craniotomy and C1 laminectomy.The CSF spaces are appropriate for the patient's stated age with no midline shift. Normal vascular flow voids are present in the distal carotid arteries 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.MRA brain:Artifact obscures visualization of the distal vertebral arteries and the proximal left PICA. A small portion of the right vertebral artery and right PICA can be subtly but questionably discerned.Bilateral PICA cannot be identified. Portions of the right and left AICA are identified. The distal basilar artery opacify.Antegrade flow is present in the distal internal carotid arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.The anterior communicating artery is identified. The posterior communicating arteries are not readily identified. The vertebral arteries are similar in size.

Output: 1.There are several punctate foci of microinfarction in the left inferior cerebellum. There is no convincing evidence for cerebral infarction involving the brainstem, however, part of the medulla is obscured by artifact. There is, however, some signal change in the posterior aspect of the left medulla which may represent ischemic damage involving the area of hypoglossal nucleus and nucleus intercalatus. This would not explain right hemiparesis, however. Please note that metal artifact may obscure or exaggerate visualization of subtle findings in the territories adjacent to the metal clips.2.The aneurysm, AICA, PICA and distal vertebral arteries may be better evaluated on a contrast enhanced imaging study such as a CTA. Metal artifacts and slowed flow in patulous vessels may obscure visualization on this 3DTOF1.5 T MRA. As a result interpretation as to the status of these vessels on 3DTOF1.5T MRA may be limited. 3.Findings were discussed with Dr Awad at the time of the exam.4.Status post distal vertebral artery clipping with suboccipital craniotomy and C1 laminectomy.


Instruction: Generate impression based on findings.

Input: 61 years, Female, Reason: Pancreatic IPMN History: Cysts, abdominal pain. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: HepatomegalySPLEEN: No significant abnormality noted.PANCREAS: Cystic lesions communicating with the main pancreatic duct in the tail of the pancreas are unchanged measuring 1.5 x 0.6 cm (4/35) and 1.0 x 0.3 cm (4/37), previously 1.8 x 0.5 cm and 0.9 x 0.3 cm respectively. A punctate lesion in the pancreatic head (4/52) which communicates with the common pancreatic duct also likely represents a sidebranch IPMN, unchanged. No new lesions are identified.Normal response to secretin administration.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small amount of pelvic fluid.

Output: Pancreatic lesions compatible with sidebranch IPMN's are unchanged.


Instruction: Generate impression based on findings.

Input: Status post resection for CCM; post-op follow up; 3T Scanner, CCM Protocol, QSM/Permeability The patient is status post left-sided craniotomy for a left parietal lobe lesion which has been removed. There is associated dural thickening and enhancement underneath the craniotomy flap. Cortically based lesion has been removed. There still some susceptibility effect along the adjacent brain tissues which is likely related to hemosiderin deposition.There are several periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. These are nonspecific and likely of little clinical significance. They have been present since previous exams and are not changedNormal 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.There is a 5x8mm enhancing lesion present along the superficial portion of the right frontal bone the right frontal scalp soft tissues associated with the skin deformation. This is also evident on the prior head CT as well as old MRI scans dating back to 2011.

Output: 1.Status post removal of left parietal lobe cerebral cavernous malformation. There is some local postoperative change and residual hemosiderin deposition related to the previous CCM but no convincing evidence for residual of recurrent CCM.


Instruction: Generate impression based on findings.

Input: Knee pain and swelling MENISCI: There is no discrete medial or lateral meniscal tearARTICULAR CARTILAGE AND BONE: There is a focal depressed osteochondral defect of the medial femoral condyle just above the free edge of the anterior horn of the medial meniscus measuring approximately 1 cm in its greatest diameter. There is edema type signal in the underlying bone likely representing the sequela of focal avascular necrosis. There is an additional focus of subchondral avascular necrosis of the lateral femoral condyle posteriorly without overlying articular surface collapse.There appears to be delamination of the articular cartilage along the anterior aspect of the lateral femoral condyle with a small focus of degenerative signal abnormality in the underlying marrow.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Osteochondral lesion of the medial femoral condyle with underlying marrow edema likely representing the sequela of avascular necrosis. An additional focus of avascular necrosis is noted in the lateral femoral condyle but without overlying articular collapse.2. Delamination of the articular cartilage of the lateral femoral condyle anteriorly.3. Moderately sized joint effusion and synovitis.4. Edema along the head of the gastrocnemius which may be the result of a leaking or ruptured Baker's cyst.5. No evidence of ligamentous or meniscal tear.


Instruction: Generate impression based on findings.

Input: Dextroscoliosis is evident involving the thoracic spine with its apex at approximately T9/10 with compensatory levoscoliosis of the lumbar spine with its apex at approximately L2/3.There are no osseous dysplasias.Fluid is present within a few right mastoid air cells. Otherwise the visualized paraspinal contents are unremarkable.The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. Biphasic CSF flow is identified posteriorly at the level of the foramen magnum and cerebellar tonsils.There are no fractures or subluxations. The marrow signal is benign. The cord and conus are normal in signal without evidence of syrinx.Linear T1 signal within the lumbar canal exits the left S1 nerve root sheath consistent with flow identified within a vestigial vessel. There is no MRI evidence of fatty filum.There are no stenoses.

Output: 1.Dextroscoliosis is evident involving the thoracic spine with its apex at approximately T9/10 with compensatory levoscoliosis of the lumbar spine with its apex at approximately L2/3.2.Fluid is present within a few right mastoid air cells. 3.No MRI evidence for Chiari malformation, tethered cord, or syrinx.


Instruction: Generate impression based on findings.

Input: History of left cavernous sinus aneurysm. The examination demonstrates expansion of the left cavernous sinus. In comparison with a prior brain MRI, it remains stable. The cerebral and cerebellar hemispheres are normal in attenuation and morphology. There is no intracranial hemorrhage, edema, midline shift or abnormal extra-axial fluid collection. The ventricles are normal in volume and symmetric.Visualized paranasal sinuses mastoid air cells are normally pneumatized. The bony density of the calvarium and skull base is radiographically normal.CTA shows a gigantic aneurysm in the anterior aspect of the left internal carotid artery, which is mostly within the cavernous sinus with little expansion into the supraclinoid segment. It measures 14.4 x 19.2 mm on the sagittal view and 19.9 x 12.0 mm on the coronal view. In addition, little ectasia of the right internal carotid artery is noted. The right internal carotid, vertebral, basilar and their intracranial major branches are patent with no evidence of aneurysm or significant stenosis.

Output: Grossly stable left cavernous sinus fusiform aneurysm as detailed above.


Instruction: Generate impression based on findings.

Input: Male, 2 days old, with unilateral hydrocephalus. Assess for evidence of pressure on brain or vascular issues. A large, multilocular cystic lesion is evident situated between the cerebral hemispheres, the larger part of which resides to the left of midline. The loculations are formed by thin septations which enhance minimally if at all. No solid nodular enhancement is seen. Most of the locules are variably T1 hyperintense relative to CSF, though one or two are fairly close in signal to CSF. No evidence of susceptibility effect is seen within or adjacent to the cysts to suggest hemorrhage.The presence of the cystic lesion causes significant deformity of the brain parenchyma. The thalami are formed but inferiorly and laterally displaced, particularly on the left. The interhemispheric fissure is present and seems to be fully formed. Both cerebral hemispheres are somewhat compressed and there may be a component of edema versus transependymal CSF flow in the temporal lobes, left more than right.No definite corpus callosum or cavum septum pellucidum is visualized. In addition, the morphology of the frontal horns and apparent colpocephaly of the right lateral ventricle are suggestive of agenesis of the corpus callosum. Both temporal horns are dilated, left side more than right, suggesting entrapment.The pituitary region is within normal limits. The brainstem appears to be normally formed and intact. The cerebellum is likewise normally formed but it does experience mass effect from deformity of the supratentorial structures.

Output: A large multiloculated cystic lesion is evident situated between the cerebral hemispheres with the majority of the lesion residing to the left of midline. No solid enhancing components are seen to suggest that this lesion is neoplastic in nature. Rather, the location and features of the lesion, along with additional findings suggesting agenesis of the corpus callosum, suggest an underlying diagnosis of type II callosal agenesis with interhemispheric cyst. Based on their variable signal characteristics, it is unlikely that the individual cystic locules communicate with each other or with the ventricular system. Findings suggestive of ventricular entrapment are seen, particularly affecting the temporal horns.


Instruction: Generate impression based on findings.

Input: 17 years old, Female, Reason: Evaluate for medial retinaculum tear History: knee pain with instability for a year MENISCI: No significant abnormality noted. No meniscal tear is present.ARTICULAR CARTILAGE AND BONE: No significant abnormality noted. The articular cartilage appears intact throughout the femoral condyles, tibial plateau, and patella.LIGAMENTS: Cruciate ligaments are intact. No significant abnormality within the other tendinous structures.EXTENSOR MECHANISM: The extensor mechanism is intact without significant abnormality. The medial retinaculum is normal in appearance as clinically questioned.ADDITIONAL

Output: Normal examination of the knee. The medial retinaculum is normal in appearance as clinically questioned.


Instruction: Generate impression based on findings.

Input: 52-year-old with arm pain and frequent falls. Cervical: Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate height. Mild degenerative changes are seen in the cervical spine with small disk osteophyte complexes and ligamentum flavum thickening. There is mild retrolisthesis of C3 on C4. Alignment is otherwise maintained. Bone marrow signal is within normal limits. The cervical spinal cord has normal signal characteristics and overall morphology. Mild degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: Minimal disk osteophyte complex. There is mild to moderate left neural foramina stenosis related to uncovertebral hypertrophy. There is partial effacement of the ventral thecal sac. No significant compromise to the spinal canal or right neural foramina.C4-5: No significant compromise to the spinal canal or neural foramina.C5-6: No significant compromise to the spinal canal or neural foramina.C6-7: No significant compromise to the spinal canal or neural foramina.C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.Lumbar: Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Minimal loss of lumbar lordosis. Alignment is otherwise within normal limits. Bone marrow signal is benign. The conus medullaris is at the lower limits of normal at the inferior L2 level. No fatty filum or other lesions along the cauda equina nerve roots or filum terminalis.Individual levels as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: No significant disc disease. No spinal canal or neural foraminal stenosis.L4-L5: No significant disc disease. No spinal canal or neural foraminal stenosis.L5-S1: No significant disc disease. No spinal canal or neural foraminal stenosis.Mild facet arthrosis. Paraspinous soft tissues are within normal limits. Incidentally seen is ectopic right kidney within the pelvis.

Output: 1. Mild degenerative changes in the cervical spine including at C3-4 where there is minimal retrolisthesis, minimal spinal canal narrowing, and mild to moderate left neural foraminal stenosis related to uncovertebral hypertrophy. Otherwise no significant spinal canal or neural foraminal stenosis in the cervical spine. 2. No significant spinal canal or neural foramina stenosis in the lumbar spine. No compression fractures.3. Pelvic kidney incidentally noted.


Instruction: Generate impression based on findings.

Input: Reason: Evaluate for seizure focus and for abnormalities to explain CP. History: Intractable epilepsy with staring and stiffening spells. R temporal/parietal, bifrontal, and generalized epileptiform discharges. Diplegic cerebral palsy. Global developmental delay. The CSF spaces are appropriate for the patient's stated age with no midline shift. No foci of diffusion restriction are appreciated.There is a 9 x 10 mm coronal dimension extra-axial cyst adjacent to the left superior frontal sulcus and mildly displacing adjacent veins which is associated with some subtle bone remodeling. It follows spinal fluid on all pulse sequences.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.Following the pharyngeal mucosal space there are couple small cystic lesions present at the level of the adenoids. These are likely of little clinical significance

Output: 1.Small arachnoid cyst adjacent to the left superior frontal sulcus.


Instruction: Generate impression based on findings.

Input: Knee pain for two years with clicking MENISCI: No significant abnormality noted. The menisci are intact and normal in appearance.ARTICULAR CARTILAGE AND BONE: No significant abnormality noted. No focal areas of chondromalacia. Normal bone marrow signal throughout.LIGAMENTS: The cruciate and collateral ligaments are intact.EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: No specific findings to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: Ms. Winston is a 77 year old female with disease positive left axillary lymph nodes and no definite breast primary. She presents for MR evaluation to identify a possible breast primary. There is scattered fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.In the left breast, there is a subtle area of linear non-mass enhancement identified in the left lower outer breast, anterior depth, that may be a possible candidate for primary breast malignancy. This linear non-mass enhancement measures approximately 3.4 cm in the AP dimension and extends up to the anterior skin surface. There is minimal left breast skin thickening, particularly along the antero-medial aspect of the left breast. There is also a focal area of enhancement seen in the supero-anterior left breast skin, which correlates with history of recent skin punch biopsy.There are numerous (> 6) abnormal morphology lymph nodes located in the left axillary region, the largest of which measures approximately 3.8 x 1.6 cm. No susceptibility artifact is identified in any of these lymph nodes to indicate presence of biopsy marker clip. In addition, it is not apparent on this MRI as to which of these nodes were biopsied due to lack of obvious surrounding post-biopsy changes. There is no abnormal enhancement seen in the right breast. There are no abnormal axillary lymph nodes located in the right axillary region.

Output: (1) Multiple abnormal left axillary lymph nodes, one of which has been biopsied and is malignant. No biopsy marker clip was placed at time of biopsy and it is unclear from MRI which specific node was biopsied. An US-guided clip placement can certainly be performed for one of these abnormal nodes if clinically desired.(2) Subtle area of linear non-mass enhancement in the left lower inner breast, spanning 3.4 cm in the AP dimension. This may be a possible candidate for the primary breast malignancy. An MR guided biopsy with clip placement can be performed if clinically warranted.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Reason: evaluate for recurrent MPNST History: history of malignant peripheral nerve sheath tumor s/p surgery Note is made of postsurgical changes with interval resection of the reference mass within the posterior compartment of the left thigh. Note is made of multiple foci of enhancement within the subcutaneous tissues along the posterior aspect of the thigh adjacent to multiple foci of metallic susceptibility artifact which likely represent granulation tissue related to prior surgery, however, follow-up examination is recommended to evaluate for interval change (image 38 and 41; series 18). There is a 2.5 x 1.8 cm lobulated heterogeneous mass interposed between the semimembranosus and long head of the biceps femoris along the posterior aspect of the distal femoral metaphysis with foci of increased signal intensity on fluid sensitive sequences, with multiple target signs, as well as minimal, if any, enhancement on postcontrast sequences (image 19; series 13) consistent with neurofibromas. There is a vitamin E capsule overlying the mass presumably corresponding to the patient's surgical scar. There is no involvement of the surrounding musculature of the posterior compartment of the thigh. The reference heterogeneous enhancing mass within the superficial soft tissues along the medial aspect of the left knee measures 4.0 x 1.7 cm, previously 3.9 x 1.6 cm (23; series 19), not significantly changed. There are multiple additional foci of signal abnormality along the course of the sciatic nerve consistent with the patient's known history of neurofibromas. There are subcutaneous nodules about the thigh also consistent with the patient's history of neurofibromatosis.

Output: Interval resection of the large reference mass within the posterior compartment of the left thigh. Multiple punctate foci of enhancement within the subcutaneous tissues along the posterior aspect of the thigh likely represent granulation tissue from prior surgery, however, follow-up examination is recommended to evaluate for interval change. Otherwise no findings to suggest residual or recurrent tumor. Other findings consistent with the patient's history of neurofibromatosis as described above.


Instruction: Generate impression based on findings.

Input: Other amnesia [R41.3], Reason for Study: ^Reason: memory difficulties History: memory difficulties There is no evidence of acute ischemic or hemorrhagic lesion.Patchy confluent FLAIR/T2 high signal intensity lesions on bilateral periventricular white matter and centrum semiovale. The white matter lesions are non specific thus could indicate extensive non specific small vessel ischemic disease (leukoaraiosis) , however, cannot completely exclude possibility of demyelinating disease.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. Extensive white matter lesions on FLAIR/T2 images indicate possible advanced non specific small vessel ischemic disease or demyelinating disease.


Instruction: Generate impression based on findings.

Input: Altered mental status. Evaluate for brain edema or midline shift. A small focus of increased density in the right cerebellar hemisphere is unchanged from the prior CT. Please note that the previously described small enhancing lesions seen on the prior MRI are not visualized on this noncontrast head CT. There is no evidence of intracranial hemorrhage, mass, edema, or midline shift. The ventricles and basal cisterns are normal in size and configuration. The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: No acute intracranial abnormality.


Instruction: Generate impression based on findings.

Input: 55 years Female (DOB:7/29/1960)Reason: h/o R sided weakness and aphasia, eval for stroke History: see abovePROVIDER/ATTENDING NAME: IMRE M NOTH IMRE M NOTH MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. 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 demonstrates mucosal thickening.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.The exam is significantly degraded due to patient motion. Susceptibility imaging is significantly limited.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal right vertebral artery, the basilar artery and the proximal anterior, middle and posterior cerebral arteries. The left vertebral artery is not identified intracranially.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. Anterior communicating artery cannot be excluded based on a general appearance of the anterior communicating artery region. The right posterior communicating artery is relatively small but can be identified. The left posterior cerebral artery has fetal origin. The vertebral arteries are similar in size. The exam is significantly degraded due to patient motion.MRA neck: On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. The left vertebral artery is not identifiedThe exam is significantly degraded due to patient motion. The origins of the great vessels from the aortic arch are not included.MRI neck:Soft tissues of the neck exam is severely limited due to patient motion. No obvious mass lesion is identified in the soft tissues of the neck.

Output: 1.The exam is significantly degraded due to patient motion. This may obscure more subtle abnormalities on the MRI of the brain, the MRA of the brain, soft tissues of the neck study and the MRA of the neck.. 2.There is some suspicion that the anterior communicating artery aneurysm may or may not exist. If clinically appropriate a CT angiogram when the patient is able to tolerate exams are an MR angiogram of the patient is able to tolerate may be of further benefit in evaluating.3.The left vertebral artery is not readily identified. The possibility of left vertebral artery disease cannot be excluded. Please note that motion artifact limits evaluation. It is possible the left vertebral artery is simply hypoplastic.4.There is no evidence for acute ischemic cerebral infarction.


Instruction: Generate impression based on findings.

Input: Female 23 years old Reason: chronic abdominal pain; mesenteric adenitis History: generalized abdominal pain worse in lower quadrants ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. No suspicious hepatic lesions. Hepatic and portal veins are patent.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No hydronephrosis in either kidney. Renal parenchyma enhances homogeneously.RETROPERITONEUM, LYMPH NODES: No retroperitoneal or mesenteric lymphadenopathy.BOWEL, MESENTERY: Small bowel is normal in caliber and course. Terminal ileum is normal in caliber. No hyperenhancement to suggest acute inflammation. No focal strictures or fistulous connections identified.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: Please see aboveBONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No specific evidence of inflammatory bowel disease.


Instruction: Generate impression based on findings.

Input: History of HCC status post TACE/RFA presents for follow-up. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology with T2 weighted reticulation consistent with fibrosis. The patient experienced contrast extravasation during the examination and was unable to continue with the examination, severely limiting the sensitivity for evaluation of hepatocellular carcinoma. No T2 hyperintense or diffusion restricting lesion is identified.Previously the patient has been ablated in segment 2/3.No biliary ductal dilatation.SPLEEN: Status post splenectomy.PANCREAS: No significant abnormality noted. Note is made of a bifid pancreatic duct with a persistent Duct of Santorini.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable probable subcentimeter cyst in the lower pole of the right kidney.RETROPERITONEUM, LYMPH NODES: Tortuous thoracic aorta.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Nondiagnostic examination as there was extravasation during contrast administration and the patient was unable to continue. The patient will be called back for postcontrast imaging.2.Cirrhosis without a discrete T2 hyperintensity or diffusion restricting lesion.Contrast extravasation description:Supervising radiologist: Dr. ShethMinor or major extravasation: MinorContrast type:16 cc of Multihance were administered. Amount extravasated: 16 ccLocation of extravasation: Left antecubital fossaSigns and symptoms: Pain.Treatment given: Cold compress.Discharge instructions given: Yes


Instruction: Generate impression based on findings.

Input: 17 years Female (DOB:2/14/1999)Reason: 3 t scanner ccm protocol qsm/permialbility History: surveillancePROVIDER/ATTENDING NAME: ISSAM A. AWAD ISSAM A. AWAD The CSF spaces are appropriate for the patient's stated age with no midline shift. There are multiple lesions identified on susceptibility imaging present in both hemispheres of the supratentorial brain as well as the brainstem. The largest one is located in the left side of the brainstem at the junction of the pons and the left middle cerebellar peduncle and measures 12 mm on T2 imaging. It appears stableOne in the right periventricular white matter in the right parietal lobe measures 7 mm on the current exam and the 10 mm on the prior exam.One in the right postcentral gyrus is smaller. A smaller one in the right precuneus is stable . One in the left periventricular white matter is also stable. A very small lesion in the left occipital lobe is also stable.On susceptibility imaging many small punctate foci of susceptibility effect are identified in the frontal lobes and periventricular white matter which are also identified on the prior exams unchanged.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: There are multiple cavernous hemangiomas present. Compared to the previous exam the lesion in the right periventricular white matter in the right parietal lobe is small. The rest of the lesions do not appear to have changed substantially.


Instruction: Generate impression based on findings.

Input: History of meningioma and breast cancer; subacute development of vertigo, imbalance, diplopia, and subjective coordination issues. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are a few scattered nonspecific punctate foci of T2 hyperintensity in the cerebral white matter. The cerebellum appears unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is an arrested pneumatization variant of the sphenoid. There is mild scattered paranasal sinus mucosal thickening. There are bilateral lens implants.

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


Instruction: Generate impression based on findings.

Input: Female 19 years old; Reason: Evaluate for proximal hamstring tear History: hamstring pain for months at insertion pain 12 cm from insertion MUSCLES/TENDONS: Normal muscle signal intensity. The hamstring musculature and tendons appear normal. No significant abnormality is seen. BONES: Normal bone marrow signal for the patient's age. OTHER: No significant abnormality seen.

Output: Normal appearance of the left hamstring muscles and tendons. No specific findings to account for the patient's pain.


Instruction: Generate impression based on findings.

Input: 63-year-old female with severe left shoulder pain with limited range of motion. Evaluate for rotator cuff tear. Motion artifact slightly limits evaluation.ROTATOR CUFF: There is discontinuity of the fibers of the subscapularis tendon near its insertion with associated high signal intensity on proton density and T2-weighted images consistent with a full-thickness tear. The subscapularis muscle appears normal. There is thickening of the supraspinatus tendon with associated intermediate signal intensity indicating tendinosis. The supraspinatus muscle appears normal. The infraspinatus tendon appears normal. There is mild fatty infiltration of the infraspinatus muscle. The teres minor tendon and muscle appear normal.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint is in anatomic alignment. There is a small amount of fluid in the glenohumeral joint without frank effusion. The glenoid labrum appears grossly normal on this nonarthrogram study.BICEPS TENDON: Small amount of fluid within the tendon sheath of the long head of the biceps tendon communicating with the glenohumeral joint fluid. The tendon of the long head of the biceps appears normal.ADDITIONAL

Output: 1. Full-thickness tear of the subscapularis tendon.2. Tendinosis of the supraspinatus tendon.3. Thickening of the coracohumeral ligament raising the possibility of adhesive capsulitis ('frozen shoulder').


Instruction: Generate impression based on findings.

Input: 82-year-old male with left frontal intracranial hemorrhage and intraventricular extension. Acute left frontal parenchymal hemorrhage is new with adjacent edema and mass effect. No definite underlying mass is seen, but if suspicion is high, further imaging evaluation with MRI may be obtained. Hemorrhage extends intraventricularly layering dependently within the posterior horns of the lateral ventricles. Scattered foci of periventricular and subcortical low attenuation likely represent small vessel ischemic disease of indeterminate age. Dystrophic cortical calcification is evident within the right posterior parietal lobe with adjacent low attenuation suggesting a prior ischemic event. This finding is unchanged. The ventricles are prominent and slightly asymmetric. Complete opacification of the frontal and ethmoid sinuses is unchanged. The visualized mastoid air cells appear well pneumatized. Calvarial bones are grossly unremarkable.

Output: No interval change.


Instruction: Generate impression based on findings.

Input: 55-year-old male with a history of elevated PSA and small volume Gleason 3+ 3 prostate cancer, evaluate for disease. Prostate biopsy to follow. PELVIS:PROSTATE:Prostate Size: 5.0 x 3.5 x 3.3 cm (TR x AP x CC)Peripheral Zone: There is a 10 x 4 mm focus of decreased T2 signal abnormality in the right paramedian base of the peripheral zone of the prostate gland with associated restricted diffusion and equivocal enhancement on dynamic contrast-enhanced sequences, suspicious for prostate carcinoma (image 23; series 801). No additional foci of signal abnormality are identified.There is an additional focus of decreased T2 signal abnormality with associated restricted diffusion which is also suspicious for prostate carcinoma (series 604; image 224). Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: No evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No lymphadenopathy.BONES, SOFT TISSUES: Heterogeneous bone marrow signal abnormality is nonspecific, but can be seen in anemia or other myeloproliferative disorders.OTHER: No significant abnormality noted.

Output: Foci of signal abnormality in the posterior right paramedian base and posterior left apex of the peripheral zone of the prostate gland, which are suspicious for prostate carcinoma.


Instruction: Generate impression based on findings.

Input: Right nasopharyngeal carcinoma, treated with and radiation and chemotherapy. There are post-treatment findings in the right nasopharynx with mild right asymmetric pharyngeal mucosal space thickening without measurable residual mass. Rather, there is paucity of enhancement in a large area of the right nasopharyngeal treatment bed and adjacent prevertebral and parapharyngeal spaces, extending towards the internal carotid artery. There is no evidence of significant cervical lymphadenopathy based on size criteria. There are denervations changes in the right masticator muscles. The thyroid and major salivary glands are unchanged. There is persistent asymmetric enhancement within the right mandibular ramus and right parotid gland, which is likely related to treatment effects. There is mild anterolisthesis of C3 on C4 and C4 on C5, as well as cervical spondylosis with at least moderate spinal canal stenosis at C5 and C6 and retrolisthesis of C6 on C7. There are bilateral maxillary sinus retention cysts. There are degenerative changes in the right temporomandibular joint with an associated trace effusion. There is mild diffuse prominent intracranial dural enhancement, including along the clivus.

Output: 1. Post-treatment findings in the right nasopharynx and central skull base without measurable residual tumor. Rather, there is necrotic tissue in the right nasopharyngeal treatment bed and adjacent prevertebral and parapharyngeal spaces, extending towards the internal carotid artery.2. Degenerative spondylosis of the cervical spine with spinal canal stenosis at C5 and C6.3. Findings suggestive of right Eustachian tube dysfunction.


Instruction: Generate impression based on findings.

Input: Female, 25 years old, with paresthesias and headaches. Evaluate for demyelinating disease. Also with low back pain. Evaluate for spinal stenosis. Brain:Parenchymal morphology is within normal limits. No areas of focal signal abnormality, edema or mass effect are detected. No abnormal extra-axial collections are seen. Ventricles are normal in size and morphology. Non-expansile FLAIR hyperintense and T1 intermediate intensity material is evident within the left petrous apex.Lumbar:Alignment is anatomic. Vertebral body height and morphology are within normal limits. No marrow replacement or marrow edema is detected. The visualized distal spinal cord, conus and nerve roots of the cauda equina are within normal limits. No epidural abnormalities are suspected. The intervertebral discs are preserved. No significant compromise of the spinal canal or neural foramina is seen. Mild facet arthropathy develops at lower lumbar levels.

Output: 1.Unremarkable evaluation of the brain with no findings to suggest evaluating disease or any other specific abnormality.2.Asymmetric signal abnormally is seen within the left petrous apex. The absence of bony expansion favors this to represent trapped secretions in the petrous apex air cells rather than a more aggressive process. This is likely an incidental finding but correlation with the timing and laterally of the patient's headaches is suggested.3.Apart from mild facet arthropathy at lower lumbar levels, no specific lumbar spine abnormalities are identified.


Instruction: Generate impression based on findings.

Input: 50 years Male (DOB:11/18/1965)Reason: eval for nerve root impingement History: severe R sciatica refractory to outpatient treatmentPROVIDER/ATTENDING NAME: GREGG M HELLAND MADHU C YARLAGADDA Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is mild loss of disc space height and disc desiccation. There is mild facet hypertrophy at this level. There is mild ligamentum flavum hypertrophy at this level. There is some narrowing of the neural foramina bilaterally with mild encroachment on the exiting nerve roots on the left side and moderate encroachment of the exiting nerve roots on the right side.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is mild loss of disc space height and disc desiccation at this level. There is a mild disc bulge at this level and mild facet and ligamentum flavum hypertrophy.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina. There is loss of disc space height, disc desiccation and a disc bulge present at this level.

Output: There are degenerative changes present in the lumbar spine worse at L5-S1 where there is some encroachment of the right-sided exiting nerve roots within the neural foramen.


Instruction: Generate impression based on findings.

Input: Nausea, vomiting, and abdominal pain ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Ill-defined, hypodense lesion near the dome of the liver, measuring 11 x 9 mm. The etiology is unknown. This represents a focal lesion or focal fat. MRI of the liver may be helpful for further evaluation as clinically indicated.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Distal small bowel loops are slightly dilated, measuring up to 3 cm. Terminal ileum is decompressed. On image number 94, series number 3 there is a transition point between the mildly dilated small bowel loops in decompressed bowel loops. Mild fat stranding and small amount of free fluid is present in the pelvis. There are slightly enlarged lymph nodes in the right lower quadrant.Appendix is normal. No evidence of abscess or free air.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Nonspecific punctate sclerotic foci in the lumber vertebral bodies.PELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Mildly distended distal small bowel loops with transition point in the mid pelvis. These findings likely represent an early, mild, partial distal small bowel obstruction.


Instruction: Generate impression based on findings.

Input: There is persistent inferior herniation with rounded contour of the cerebellar tonsils. Given the limitations of technique and measurement error, the herniation measures up to 4 mm below the foramen magnum when measured at the same position as on the prior exam and is unchanged. There is no acute infarct, mass effect, or cerebral edema. There is no hydrocephalus. The ventricles are unchanged, normal in size and configuration. There is no midline shift. The skull and extracranial soft tissues are unremarkable.

Output: Mild inferior cerebellar tonsillar herniation without significant change. No hydrocephalus or change in ventricular caliber.


Instruction: Generate impression based on findings.

Input: Non-traumatic intracranial hemorrhage, follow up of enhancement around old hemorrhage. There is redemonstration of prior parenchymal hemorrhage with encephalomalacia in the left posterior parietal lobe and areas of associated susceptibility effect. There is an unchanged subcentimeter focus of associated enhancement within the area of encephalomalacia. There is an unchanged background of scattered foci of T2 hyperintensity in the periventricular and subcortical white matter. There is no evidence of new intracranial hemorrhage, mass, or acute infarct. The ventricles are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is mild mucosal thickening in the bilateral maxillary and right ethmoid sinuses.

Output: 1. Redemonstration of left posterior parietal area of encephalomalacia related to previous hemorrhage with an unchanged nonspecific punctate focus of enhancement, which may represent an organizing hematoma or granulation tissue, for example.2. No evidence of new intracranial hemorrhage, mass, or acute infarct. 3. Unchanged probable chronic small vessel ischemic changes. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 20 years Female (DOB:8/10/1996)Reason: history of seizures. Evaluate for structural cause History: seizuresPROVIDER/ATTENDING NAME: SANDRA LYNN ROSE SANDRA LYNN ROSE 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.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 pituitary gland measures 9 mm in height

Output: 1.No abnormal mass lesions are appreciated intracranially to explain patient's seizures.2.The pituitary gland is at the upper limits of normal in height and is borderline abnormal..


Instruction: Generate impression based on findings.

Input: Mild motion degradation slightly limits evaluation for cord signal abnormality; however, no cord signal abnormality is appreciated. There is mild straightening of the cervical spine. The vertebral body heights are preserved. There are type II degenerative marrow changes at endplates of C5-6, and C6-7. There is disk desiccation at essentially all levels of the cervical spine, with mild loss of height loss relatively more prominent at C5-6 and C6-7.C2-3: No significant spinal canal or neural foraminal stenosis.C3-4: Minimal disk osteophyte complex without significant spinal canal or neural foraminal stenosis.C4-5: Minimal disk osteophyte complex without significant spinal canal or neural foraminal stenosis.C5-6: Small disk osteophyte complex, mild ligamenta flavum thickening and bilateral uncovertebral hypertrophy causing mild spinal canal stenosis and moderate bilateral neural foraminal stenosis.C6-7: Small disk osteophyte complex, mild ligamenta flavum thickening and bilateral uncovertebral hypertrophy causing no significant spinal canal stenosis and mild to moderate right and mild left neural foraminal stenosis. C7-T1: No significant spinal canal or neural foraminal stenosis.

Output: Mild degenerative changes in cervical spine as detailed above. There is mild spinal canal stenosis at C5-C6. Otherwise no high-grade spinal canal stenosis or cord signal abnormality is appreciated. There is moderate bilateral neural foraminal narrowing at C5-C6 and mild to moderate on the right at C6-C7.


Instruction: Generate impression based on findings.

Input: Male, 9 years old, with motor and vocal tics. Assess for basal ganglia abnormality. The cerebral and cerebellar hemispheres and brainstem show normal signal intensity and morphology. No restricted diffusion is seen. No pathologic intracranial enhancement is detected.No evidence of parenchymal edema, mass, or mass effect is seen. There is no evidence of intracranial hemorrhage or abnormal extra-axial fluid. The ventricular system is normal in caliber and morphology. Signal intensity of the bone marrow is unremarkable. No significant abnormalities of the paranasal sinuses are detected.

Output: Unremarkable evaluation of the brain.


Instruction: Generate impression based on findings.

Input: Hypotonia and developmental delay. Evaluate for structural abnormality. No abnormal signal is seen on the T2, FLAIR or diffusion weighted images. There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration. The expected intracranial vascular flow voids are present.Mild bilateral maxillary sinus mucosal thickening. The visualized mastoid air cells are clear. The orbits are unremarkable.

Output: Normal unenhanced brain MR.


Instruction: Generate impression based on findings.

Input: Known cavernoma patient, follow-up Right frontal and left parietal small cavernous malformations as well as right frontal developmental venous anomaly were redemonstrated. No evidence of enhancement on post gadolinium enhancement scan.There is no evidence of interval change in terms of size and MR characteristics since prior scan.There is no evidence of acute ischemic or hemorrhagic lesion on the scan.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses are clear.No change of small amount of left mastoid air cell fluids.Multiple subcutaneous epidermal inclusion cyst, again do not show any significant interval change in terms of size and MR characteristics.

Output: 1. Stable right frontal and left parietal cavernous malformations with right frontal developmental venous anomaly since prior scan.2. No evidence of acute ischemic or hemorrhagic lesion.


Instruction: Generate impression based on findings.

Input: Female 40 years old with a history of endometriosis status post TAH, BSO and resection of endometrial implants on bladder/ureteral reanastomosis and reimplantation. Now with pelvic pain, pelvic mass, pain and incontinence with intercourse. PELVIS:UTERUS, ADNEXA: A T2 hypointense mass extending from the vaginal cuff and invading the bladder wall measures 5.3 x 2.6 cm (series 5, image 19) and is compatible with endometriosis. An additional cystic lesion (series 5, image 28) and numerous other peritoneal implants of endometriosis are seen with the most prominently between the rectum and sigmoid colon (series 5, image 39) and in the dependent portions of the pelvis.Status post hysterectomy and bilateral salpingo-oophorectomy.BLADDER: The bladder is invaded by endometriosis as described above.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: The largest focus of endometriosis extends from the vaginal cuff and invades the urinary bladder. Multiple additional endometrial implants are also seen.


Instruction: Generate impression based on findings.

Input: Search for structural abnormality that may cause intellectual disability. There is no evidence of intracranial hemorrhage or mass. The grey-white matter differentiation appears to be intact. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No evidence of potential seizure foci.


Instruction: Generate impression based on findings.

Input: Reason: pt with biopsy confirmed recurrent endometrial cancer at vaginal cuff, assess for extent of recurrent disease. Please place lubricant vaginally to better delineate vaginal tumor. Requesting wide bore MRI. History: vaginal bleeding PELVIS:UTERUS, ADNEXA: There is a polyploid enhancing mass at the vaginal cuff projecting into the lumen measuring 3.6 x 2.7 cm in transverse dimension and 3.5 cm in craniocaudal dimension (401/30, 501/35). The lesion abuts the adjacent sigmoid colon with likely serosal involvement.BLADDER: No significant abnormality noted.LYMPH NODES: No lymphadenopathy.BOWEL, MESENTERY: Diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: There is a enhancing presacral lesion measuring 1.3 x 2.2 cm (401/37) with subtle cortical involvement of the anterior sacrum. A large enhancing lesion within the left iliacus muscle measures 3.8 x 2.9 cm.OTHER: No significant abnormality noted.

Output: 1.Enhancing mass at the vaginal cuff likely represents recurrent endometrial cancer.2.Enhancing presacral and left iliacus lesions likely metastases.


Instruction: Generate impression based on findings.

Input: History thyroid cancer with memory difficulties, imbalance, and word-finding difficulties. There is motion artifact on several of the sequences. There is an area of encephalomalacia and gliosis involving the left parietal lobe high convexity with associated hemosiderin deposition related to prior intraparenchymal hemorrhage, which measures up to approximately 3 cm. There is slight interval increase in the extent of surrounding confluent T2 hyperintensity. There is no evidence of acute intracranial hemorrhage, mass, or acute infarct. The remaining brain parenchyma appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There is a partially empty sella. The major cerebral flow voids are grossly intact. There is minimal mucosal thickening within the maxillary sinuses and a small amount of fluid within the bilateral mastoid air cells. The orbits, skull, and scalp soft tissues are grossly unremarkable. However, there is an enlarging low T1 and high T2 signal lesion in the left parotid gland.

Output: 1. Interval evolution of the prior left parietal lobe hemorrhage with increased surrounding presumed gliosis.2. An enlarging low T1 and high T2 signal lesion in the left parotid gland is incompletely characterized, but may represent a cystic neoplasm or focally dilated duct, for example. Dedicated imaging of this region may be useful.3. Nonspecific partially empty sella.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Clinical question: Seizure versus embolic stroke. Signs and symptoms: Right arm jerking 5 minutes. Nonenhanced brain MRI:There is excessive motion artifact throughout the images. Study is suboptimal however diagnostic.Diffusion-weighted images are negative and no evidence of acute ischemic stroke is detected.Examination demonstrates patchy nonspecific foci of flair hyperintensity in the subcortical and periventricular white matter of bilateral cerebral hemispheres which considering patient's stated age of 87 likely representing chronic microvascular ischemic changes. The signal intensity of brain parenchyma is otherwise unremarkable.There is slight prominence of cortical sulci and ventricular system which may be at the upper limits of normal for patient stated age.Signal void of major intracranial arterial branches are identified.Unremarkable images through the orbits, paranasal sinuses and mastoid air cells.Calvarium and soft tissues of the scalp are unremarkable.

Output: 1.No acute intracranial process.2.Findings suggestive of mild chronic non-hemorrhagic small vessel ischemic strokes.3.Unremarkable suboptimal motion degraded exam otherwise.


Instruction: Generate impression based on findings.

Input: Distal tibia pain. Stress fracture? A marker was placed along the anteromedial aspect of the lower leg approximately 13 cm above the medial malleolus. Mild focal increased signal intensity is seen within the medial aspect of the medullary cavity of the distal tibial diaphysis at the site of this marker on T2-weighted images, suggesting a mild stress reaction. Minimal if any signal abnormality is noted on the T1-weighted images. There is perhaps minimal periosteal edema at this level as well, but this is equivocal, and I see no cortical signal abnormality or discrete fracture line. The remainder of the tibia is unremarkable. The fibula is unremarkable. The signal intensity of the musculature is within normal limits.

Output: Mild focal stress reaction ("grade 2") of the medial aspect of the distal tibial diaphysis; I see no fracture line.


Instruction: Generate impression based on findings.

Input: Shoulder pain. Humerus lesion on MRI. Evaluate proximal humerus. There is a 2 cm ossific fragment situated anterior to the inferomedial aspect of the humeral head. On the basis of the outside MRI examination, I suspect that this represents a displaced fracture of the lesser tuberosity. I see no underlying lesion. The distal humerus appears normal. Shoulder joint alignment is normal.

Output: Mildly displaced lesser tuberosity fracture.


Instruction: Generate impression based on findings.

Input: The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. Opacification is noted in a single posterior left ethmoid air cell. Otherwise the paranasal sinuses and mastoid air cells are clear.Coronal images of the temporal lobes demonstrate the temporal horns, hippocampal formations and parahippocampal gyri to be normal in size and symmetric bilaterally without signal abnormalities or masses identified within the medial temporal lobes on either side. There is no evidence of mesial temporal sclerosis and there are no foci of heterotopic gray matter.

Output: Negative MRI of the brain. Specifically, there are no MRI findings to explain the patient's seizures.


Instruction: Generate impression based on findings.

Input: History of interhemispheric cyst seen on ultrasound. 19 weeks gestational age. Large field-of-view images demonstrate mild maternal right hydroureteronephrosis, not unexpected in pregnancy.Small field-of-view images of the fetal brain demonstrate that the fetal ventricles are normal in size. There is a normal cavum septum pellucidum and possible small cavum vergae. There is prominence of the CSF space posterior to the cavum septum pellucidum situated between the hemispheres and superior to the tectum which could represent a normal variant prominent cistern or a cyst of the cavum vellum interpositum.The degree of cortical development appears within normal limits for age. No focal parenchymal abnormalities are identified. The corpus callosum and cerebellum appear appropriately formed.

Output: Prominent CSF space posterior to the cavum septum pellucidum which could represent a normal variant prominent cistern or cyst of the cavum vellum interpositum. Sonographic follow-up and/or dedicated postnatal imaging can be considered as clinically warranted.


Instruction: Generate impression based on findings.

Input: 30 years, Female, seizures with right upper extremity shaking. Brain parenchyma appears within normal limits. No findings suggest a seizure focus are appreciated. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. There is mild opacification of the bilateral anterior ethmoid air cells and minimal maxillary sinus mucosal thickening. Mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: Brain MRI appears within normal limits.


Instruction: Generate impression based on findings.

Input: Clinical question: Preop planning. Signs and symptoms: Preop planning. Nonenhanced head CT:Stealth nonenhanced head CT for surgical planning is performed. Halo is secured to patient's calvarium.Examination demonstrates a well demarcated cystic lesion in the right cerebellum measuring approximately 33.3 x 15-mm in size.There is no appreciable interval change since prior exam in the size or density of this is. The overall mass effect on the fourth ventricle with slight deviation across the midline to the left is also similar to prior study.Images through supratentorial space demonstrate small less ischemic disease of indeterminate age as was noted on prior MRI study.

Output: 1.Steath enhanced preoperative surgical planning CT the reidentifies a stable right cerebellar cyst.2.Small vessel ischemic disease of indeterminate age.


Instruction: Generate impression based on findings.

Input: 43-year-old female with right knee pain and popping, rule out meniscal tear MENISCI: The menisci are intact.ARTICULAR CARTILAGE AND BONE: Although we see no fluid-filled defects within the articular cartilage, there is mild heterogeneity of the articular cartilage of the patella centrally and slight subjective thinning of the articular cartilage within the medial compartment, suggesting minimal degeneration. There are small foci of signal abnormality within the subchondral bone of the patella which are also likely degenerative.LIGAMENTS: The ACL and PCL are intact. The MCL and lateral collateral ligament complex is intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: Minimal degeneration of the articular cartilage as described above is of questionable clinical significance. We see no meniscal tear or other findings to account for the patient's pain or popping.


Instruction: Generate impression based on findings.

Input: 55-year-old female with history of recent orthotopic liver transplant now with persistent headaches. There is no evidence of acute infarction or intracranial hemorrhage. There are minimal punctate foci of increased T2 signal within the periventricular white matter. There is no abnormal intracranial enhancement. The basal ganglia appear unremarkable bilaterally. There is an arachnoid cyst that measures up to 10 mm in thickness inferior to the left medial temporal lobe with associated remodeling of the skull base. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is minimal fluid within the right mastoid air cells.

Output: 1. Minimal punctate foci of increased T2 signal within the periventricular white matter, which is nonspecific, but likely related to chronic small vessel ischemic disease.2. No evidence of acute ischemic infarction or intracranial hemorrhage.3. Small arachnoid cyst inferior to the left medial temporal lobe with associated remodeling of the skull base. 4. Minimal fluid within the right mastoid air cells.


Instruction: Generate impression based on findings.

Input: Female, 26 years old, 31 weeks gestational age with holoprosencephaly suspected on ultrasound. A generalized failure of midline brain separation is evident. Cerebral parenchyma is underdeveloped and represented predominantly by a smooth cortical mantle which spans both sides of the cranium. A rudimentary interhemispheric fissure is seen anteriorly and inferiorly, but the interhemispheric fissure is largely absent elsewhere.The cortical mantle enwraps a single monoventricle. The thalami are fused. Posterior fossa structures are relatively unremarkable. No evidence to suggest intracranial hemorrhage is seen.The left fetal globe appears to be normally formed. The right fetal globe is either absent or hypoplastic and malformed, though the bony orbit does seem to be present. A normally positioned nose appears to be present.A subjective overabundance of amniotic fluid is seen. Prominence of the left maternal renal collecting system is likely physiologic.

Output: Constellation of findings compatible with alobar holoprosencephaly.


Instruction: Generate impression based on findings.

Input: Male 62 years old; Reason: +Ku antibody, elevated aldolase. UIP on lung biopsy. Evaluate for myositis History: weakness Thin linear vertically oriented high STIR signal with associated enhancement is present in the proximal medial triceps extending approximately 5 cm in CC dimension, compatible with myositis. The imaged soft tissues are otherwise unremarkable. The bone marrow signal is normal. No significant abnormality is otherwise identified.

Output: Findings compatible with myositis, as described above.


Instruction: Generate impression based on findings.

Input: 28-year-old female with pain and locking. Evaluate for meniscus tear (per history patient has medial joint tenderness) MENISCI: The medial meniscus appears normal with no evidence of tear. There is no adjacent edema. The lateral meniscus also appears normal with no adjacent edema.ARTICULAR CARTILAGE AND BONE: Bone marrow signal is within normal limits. The articular cartilage is unremarkable.LIGAMENTS: The anterior cruciate ligament is intact. The posterior cruciate ligament is intact. The lateral collateral and medial collateral ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: No findings to account for the patient's symptoms. Specifically there is no evidence of meniscal tear as clinically questioned.


Instruction: Generate impression based on findings.

Input: Clinical question: Rule out multiple sclerosis. Signs and symptoms: Spasticity. Pre- and post enhanced brain MRI:No prior exams.Negative diffusion weighted series.Examination demonstrates very few small primarily periventricular foci of FLAIR hyperintensity which are nonspecific. On sagittal FLAIR images however few of these lesions demonstrate linear perpendicular appearance to the ventricular age is suggestive of demyelinating disease.There are no distinct lesions in the corpus callosum or the pons and cerebellar peduncles. None of the lesions demonstrate enhancement.Unremarkable anatomical morphology and with normal signal intensity of brain parenchyma otherwise on all MRI sequences. Unremarkable post enhancement series.Unremarkable images through the orbits, paranasal sinuses and mastoid air cells.Pre- and post enhanced cervical MRI:Examination is severely degraded due to motion artifact which precludes precise assessment for subtle findings.Within the severe limitation there is no convincing lesion within the cervical cord.Post enhanced images also demonstrate no convincing evidence of abnormal enhancement however this sequence is also degraded due to motion artifact.There is uniform smaller than expected caliber of the spinal canal and highly suggestive of congenitally small canal/short pedicles. Mild degenerative changes of cervical spine is noted and with suggestion of mild left neural foraminal compromise at C3-C4, C4-C5 and moderate right neural foraminal stenosis at C6/C7.Pre- and post enhanced thoracic MRI:Patient examination demonstrates only a suspected focus of T2 hyperintensity in the dorsal aspect of thoracic cord extending from mid T4 to upper T5 level. Finding is best appreciated on sagittal T2 stair image 12 and axial T2 series 35 images 27-29 without evidence of abnormal enhancement. This finding is retrospectively detected on prior thoracic MRI exam from 3-12-15 on sagittal T2 STIR series 8 image 9 which also demonstrate decreased cord caliber at this site.No convincing evidence of any additional foci of cord signal abnormality. Mild degenerative changes however without evidence of central spinal stenosis are noted.

Output: 1.Pre and post brain MRI demonstrates primarily periventricular tiny foci of FLAIR hyperintensity some with perpendicular relation to the ventricular wall however without enhancement and suggestive of mild demyelinating disease. Unremarkable pre and postcontrast enhanced brain MRI otherwise.2.Pre- and post enhanced cervical MRI is degraded due to motion artifact. Within this location there is no convincing evidence of demyelinating plaque or abnormal enhancement. Uniformly small caliber of the spinal canal consistent with congenitally small canal/short pedicles. Mild degenerative changes with resultant neural foraminal compromise as detailed.3.Pre- and post enhanced thoracic MRI demonstrates a focus of T2 hyperintensity with decreased cord caliber and without enhancement extending from mid T4 to mid T5 levels as detailed above. Please see comments.


Instruction: Generate impression based on findings.

Input: 50 year old female for brachial plexus injury evaluation ROTATOR CUFF: Intermediate signal within and thickening of the distal tendon of the supraspinatus is compatible with tendinosis. Mild fatty atrophy is noted along the distal myotendinous junction of the supraspinatus. No discrete fluid-filled tear is evident. The infraspinatus tendon also appear intact. The teres minor tendon and muscle appear intact. The subscapularis tendon and muscle appear intact. Collection that is isointense to muscle on all sequences with increased T2 rim appearing to be within the subcoracoid bursa presumably represent blood products. SUPRASPINATUS OUTLET: The acromioclavicular joint is within normal limits.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral alignment is within normal limits. Multiple anchor sutures are noted within the glenoid. The anterior inferior labrum appears slightly rounded but otherwise intact. There is blunting and fraying of the superior labrum that may reflect prior surgery and degenerative changes without a discrete fluid-filled tear. The posterior labrum appears similar to that seen on the prior exam.BICEPS TENDON: Status post long head of the biceps tenodesis into the proximal humeral diaphysis. ADDITIONAL

Output: 1.Findings compatible with supraspinatus tendinosis with mild fatty atrophy as described above.2.Blunting and narrowing of the superior labrum that may reflect prior surgery and degenerative changes without a discrete fluid-filled tear.3.Status post long head of the biceps tenodesis.4.Soft tissue edema, air, and blood products reflect recent surgery as described above.


Instruction: Generate impression based on findings.

Input: 43 year old woman with history of breast cancer s/p chemotherapy referred for cardiac MR to delineate ventricular function. Left VentricleThe left ventricle is normal in size with mildly reduced systolic function. The overall LV ejection fraction is 50%, the LV end diastolic volume index is 84 ml/m2 (normal range: 65+/-11), the LVEDV is 163 ml (normal range 109+/-23), the LV end systolic volume index is 42 ml/m2 (normal range 18+/-5), the LVESV is 82 ml (normal range 31+/-10), the LV mass index is 26 g/m2 (normal range 67+/-11), and the LV mass is 50 g (normal range 114+/-24). There is global hypokinesis. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.The native T1 myocardial relaxation time is within normal limits. There is no evidence for myocardial edema.There is no myocardial iron overload. There is no LV thrombus. Left AtriumThe left atrium is mildly dilated.Right VentricleThe right ventricle is normal in size with lower normal systolic function. The overall RV ejection fraction is 49%, the RV end diastolic volume index is 83 ml/m2 (normal range 69+/-14), the RVEDV is 162 ml (normal range 110+/-24), the RV end systolic volume index is 42 ml/m2 (normal range 22+/-8), and the RVESV is 82 ml (normal range 35+/-13). Right AtriumThe right atrium is upper normal. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is upper normal (28mm).Venous AnatomyThe SVC and IVC drain normally into the right atrium. PericardiumThere is a trivial pericardial effusion. Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The LV is normal in size with mildly reduced systolic function (EF 50%).2. There is no evidence of late gadolinium enhancement to suggest infiltrative, inflammatory or fibrotic disease of the myocardium.3. The RV is normal in size with lower normal systolic function (EF 49%).4. Mildly dilated left atrium. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 29 years, Female, preoperative planning for tumor resection. There is an ill-defined T1 hypointense and T2 hyperintense mass in the right frontal lobe without enhancement. The margins of the mass are not well-defined but measures approximately 5.5 x 4.7 x 4.2 cm in the AP, transverse, and craniocaudal dimensions. Signal abnormality extends to the right frontal horn margin and the anterior body of the corpus callosum. Mass is associated with mild leftward subfalcine herniation. There is effacement of the lateral ventricles. No uncal herniation. No hydrocephalus. No additional lesions elsewhere in the brain.

Output: Examination for operative planning demonstrating a right frontal lobe mass most compatible with a glioma. No enhancement, necrosis, or evidence of hemorrhage to suggest a high-grade lesion by imaging.


Instruction: Generate impression based on findings.

Input: Ms. Casey submitted outside studies for review.Submitted for review are:-Bilateral breast MRI dated 7/12/2016 performed at Silver Cross Hospital-Bilateral mammogram dated 7/12/2016 performed at Silver Cross Hospital-Images from stereotactic core biopsy of the right breast including specimen radiograph and postprocedure right breast mammogram performed at Silver Cross HospitalFor comparison, bilateral mammogram dated 8/15/2014, left breast ultrasound dated 2/6/2015, bilateral breast MRI dated 2/9/2015, and images from a left breast ultrasound-guided biopsy dated 2/17/2015 are available. Older exams from this institution are also available. BILATERAL BREAST MRI:Multiple enhanced MR sequences are submitted per outside institution's protocol.There is scattered fibroglandular tissue bilaterally. There is minimal background parenchymal enhancement.No abnormal enhancement in either breast. There are postsurgical changes in the upper outer posterior left breast with stable mild enhancement near the surgical site. Biopsy clip artifact is seen within the area of postsurgical changes. No abnormal enhancement in either breast. No axillary or internal mammary lymphadenopathy. Post surgical changes noted in the left axilla. BILATERAL MAMMOGRAM:Bilateral CC and MLO views and spot magnification views of the right breast are submitted.The breast parenchyma is composed of scattered fibroglandular density (BiRads Density Category B).There is a suspicious 11 mm cluster of pleomorphic calcifications in the upper outer quadrant of the right breast at posterior depth. There is a smaller 3 mm cluster of calcifications 6 mm posterosuperior to this cluster. When measured together, the calcifications span approximately 1.2 x 1 x 1 cm (AP x TV x CC).There are expected postsurgical changes in the upper outer quadrant of the left breast at posterior depth. Biopsy clip is seen in the upper left breast at posterior depth on the MLO view. Scattered benign calcifications are present in the left breast. No new mass, suspicious microcalcifications, or nonsurgical architectural distortion in the left breast.STEREOTACTIC CORE BIOPSY, RIGHT BREAST:Images from stereotactic core biopsy of the right breast including specimen radiograph and postprocedure CC and ML view mammograms of the right breast are submitted.A suspicious cluster of pleomorphic calcifications in the upper outer quadrant of the right breast are targeted for biopsy. Targeting appears appropriate. Specimen radiograph demonstrates calcifications within one of the cores. Postprocedure mammograms demonstrate a dumbbell-shaped clip in the upper outer quadrant of the right breast that is displaced inferiorly by 1.3 cm. There are residual calcifications 8 mm posterosuperior to the biopsy site.OUTSIDE PATHOLOGY (per report):The core specimens samples of the 10 o'clock RIGHT breast demonstrate ductal carcinoma in situ, cribriform type with necrosis and microcalcifications, nuclear grade 2.

Output: 1. Biopsy proven right breast DCIS. The biopsy clip is displaced 1.3 cm inferiorly. There are residual calcifications posterosuperior to the biopsy site. Continued surgical management is recommended.2. Expected postsurgical changes of the left breast are not changed. No mammographic or MR evidence of malignancy in the left breast.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Brain parenchyma is within normal limits. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. No intracranial hemorrhage or infarct. No extra-axial collections. No abnormal parenchymal or meningeal enhancement. Cerebellar tonsils are borderline low measuring up to 3 mm below the foramen magnum with normal rounded morphology and without convincing evidence of Chiari 1. There is opacification of a single right ethmoid air cell. Paranasal sinuses are otherwise clear. Flow-voids are preserved. Sella and orbits are grossly unremarkable. The skull and extracranial soft tissues are unremarkable.

Output: MRI of the brain is within normal limits. No intracranial mass or evidence of mass-effect.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Evaluate right perianal mass and location to sphincter muscles, preoperative consideration Suboptimal study secondary to patient's body habitus.PELVIS:UTERUS, ADNEXA: Evidence of adenomyomatosis with thickened junctional stone (measuring up to 30 mm) and associated scattered cystic spaces. Multiple uterine fibroids seen with dominant fundal fibroid visualized measuring 7.8 x 5.3 cm and directed into left lower quadrant. Endometrial stripe normal in size for perimenopausal patient. Nabothian cyst formation. Normal-appearing ovaries, left ovary appears to be superiorly located on image 45 series 1401.BLADDER: Mass effect on bladder by enlarged fibroid uterus, bladder deviated rightward.LYMPH NODES: Pelvic lymphadenopathy suggested. Left pelvic sidewall nodular focus measuring 2.1 x 1.7 cm, image 38 series 501, this focus lies alongside the left uterus and alternatively may represent a subserosal fibroid, lesion mildly heterogeneously enhances, also located near left ovary. Additional left pelvic ovoid soft tissue focus measures 2.2 x 1.3 cm, image 33 series 601, abuts but appears to be separate from the uterus on image 33 series 601, minimal rim to no enhancement visualized. BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Heterogeneously enhancing soft tissue mass involving internal and external sphincter with mild invasion into right ischioanal fossa fat. The base of the mass extends from the 6:00 to the 9:00 position. Lesion measures 3.2 x 2.6 cm, image 79 series 1603. Trace pelvic free fluid.

Output: 1. Heterogeneously enhancing soft tissue perianal mass demonstrating restricted diffusion, lesion involves internal and external sphincter with mild invasion into right ischioanal fossa fat, appearance worrisome for necrotic neoplasm; abscess formation another consideration but considered less likely, there is absence of a significant internal fluid component, correlation with patient's clinical history/physical exam recommended. 2. Findings suspicious for pelvic lymphadenopathy as above.3. Fibroid uterus with evidence of adenomyosis as well.


Instruction: Generate impression based on findings.

Input: There are scattered nonspecific punctate foci of T2/FLAIR hyperintensity in the bilateral frontal subcortical and periventricular white matter. Ventricular size is normal for age with no midline shift. Basal cisterns are patent. There are no diffusion or susceptibility abnormalities. There is no abnormal enhancement. There is partially empty sella. There is mild left maxillary sinus mucosal thickening.

Output: Unremarkable MRI of the brain.


Instruction: Generate impression based on findings.

Input: The lumbar spine is in normal alignment, with a normal lumbar lordosis. There is minimal disc narrowing and desiccation at L5-S1. The vertebral body and disk heights are otherwise well-maintained. No worrisome focal marrow signal abnormality is appreciated. The distal spinal cord and conus are within normal limits with the conus terminating at the mid L2 level.At L5-S1, there is a mild diffuse disc bulge with right paracentral annular fissure. The disc approaches the descending S1 nerve roots bilaterally without abutment. There is mild bilateral facet arthropathy. There is no significant stenosis.There is mild lateral facet arthropathy throughout the lumbar spine, with overall mild to moderate developmental narrowing of the L3-L4 and L4-L5 foramina bilaterally. There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the lumbar spine. There is slight narrowing and sclerosis along the anterior left sacroiliac joint.

Output: Minimal lower lumbar spondylosis with mild to moderate bilateral femoral narrowing which is developmentally at L3-L4 and L4-L5 exacerbated by mild facet arthropathy.


Instruction: Generate impression based on findings.

Input: Evaluate for focal lesion to explain dysarthria and eye movement abnormality: Myasthenia Gravis. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain, brainstem, cerebellum, and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. There a small choroid plexus glomus cysts. The ventricles and basal cisterns are otherwise normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

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