Instruction: Generate impression based on findings.

Input: Diagnosis: Other intervertebral disc degeneration, lumbosacral regionClinical question: low back pain radiating down her legs, eval for stenosisSigns and Symptoms: low back pain Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is mild loss of disc space height, disc desiccation and a mild disc bulge at this level. There is mild facet hypertrophy present at this level.At L4-5 there is loss of disc space height, disc desiccation as well as a broad-based right lateral recess disc protrusion which effaces the fat at the right lateral recess and partially effaces the fat at the left lateral recess. There is mild to moderate facet ligamentum flavum hypertrophy at this level associated with a subtle anterior subluxation of L4 and L5. There is mild encroachment of the nerve roots at the right lateral recess at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is a small right far lateral disc protrusion present at this level.At L2-3 there is no significant compromise to spinal canal or neural foramina. There is a broad-based left far lateral disc protrusion at this level.At L1-2 there is no significant compromise to spinal canal or neural foramina.There appears to be enlargement of the right common bile duct where measures up to 8 mm in diameter.

Output: 1.There are degenerative changes present in the lumbar spine which are worse at L4-5 where there is encroachment of the nerve roots of the right lateral recess due to a disc protrusion.2.There appears to be enlargement of the right common bile duct. This is not entirely imaged on this exam. If clinically appropriate correlation with clinical history and additional imaging may be of benefit to further evaluate this.3.An email was sent to Dr Omar Qureshi regarding the above findings. Pager 3153 was paged at the time of this dictation.


Instruction: Generate impression based on findings.

Input: Following a discussion of the procedure with the patient and/or family, including its risks, benefits, alternatives and steps to prevent infection, informed written consent was obtained and documented in the patient's chart. The time-out form was completed to confirm patient identity and side/type of procedure. All operators present for the case performed standard preprocedural prep including hand washing, sterile gloves, mask and cap. The patient was prepped and draped in the usual aseptic fashion. Local anesthesia over the target area was obtained by 1% lidocaine. Localizing CT examination demonstrates a homogeneous 2 cm soft tissue mass along the posterior aspect of the greater trochanter corresponding to the findings seen on recent MRI examination. Using CT guidance, a 14-gauge Achieve core biopsy needle was advanced into the lesion. Four 14-gauge core biopsy specimens were obtained and placed in 10% formalin. Touch preparations were performed and handed to cytopathology to confirm specimen adequacy.The core biopsy specimens were hand carried to the Surgical Pathology labThe patient tolerated the procedure well without immediate complication. Routine post procedure instructions were communicated to the patient.ESTIMATED BLOOD LOSS: Less than 5cc. An adhesive bandage was placed on the patient’s skin.

Output: CT-guided biopsy of right hip soft tissue mass.


Instruction: Generate impression based on findings.

Input: Ms. McAllister is a 41 years year old female with a family history of breast cancer in mother diagnosed in late 50s. She presents today for the evaluation the calcifications in the left outer breast on the screening mammogram 9/21/2015. An ML and 2 spot magnification compression views of left breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. The previously noted calcification in the left outer breast, posterior depth, persists on the spot magnification views. No suspicious mass or areas of architectural distortion are present. Please note that our department has a research MRI available for patient's such as this (dense breasts and will have biopsy) but that due to the patient's complicated schedule, she is not sure if she will be interested in the study.

Output: Suspicious calcifications in the left outer breast. Stereotactic biopsy is recommended.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration.


Instruction: Generate impression based on findings.

Input: 36-year-old female with sclerosis experiencing paresthesias, evaluate for progression Due to patient claustrophobia, she was unable to hold still during the exam, even with immobilization. Repeated sequences were attempted. For this reason, the patient requested that the cervical spine MRI (originally ordered to coincide with the brain MRI) be rescheduled at a later date.Redemonstrated are multiple T2/FLAIR hyperintensity in the periventricular and subcortical white matter with morphology and distribution consistent with known demyelinating disease. Small infratentorial T2 hyperintense lesion involving the left middle cerebellar peduncle again seen. No new lesions are definitively appreciated. None demonstrate contrast enhancement. Brain parenchymal volume appears within normal limits. No evidence of intracranial mass or mass effect. No extra-axial collections or hydrocephalus. Paranasal sinuses and mastoid air cells are clear. Major arterial flow voids are preserved.

Output: Redemonstrated are multiple T2/FLAIR hyperintense, nonenhancing, lesions in the supratentorial or infratentorial white matter consistent with known demyelinating disease. There are no new lesions to suggest disease progression.


Instruction: Generate impression based on findings.

Input: Status post Chiari decompression 7/9/2015, follow-up examination There are postsurgical changes of suboccipital craniectomy and posterior C1 arch resection for Chiari decompression with interval improvement in subarachnoid spaces at the level of the foramen magnum. There is good CSF present ventrally and dorsally at the level of the foramen magnum. CSF flow sequence demonstrates preserved biphasic flow at the craniocervical junction with heterogeneous flow dorsal to the inferior cerebellum most likely artifactual. Limited visualization of the brain is unremarkable without evidence of hydrocephalus or intracranial mass effect. The cervical spinal cord has normal signal characteristics and overall morphology.Minimal changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: No significant compromise to the spinal canal or neural foramina.C4-5: No significant compromise to the spinal canal or neural foramina.C5-6: Minimal disc bulge. 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. Small suboccipital fluid collection measuring 9 mm in thickness and 2 cm in the craniocaudal dimension is noted at the level of the suboccipital craniectomy which may represent a tiny pseudomeningocele.

Output: Postsurgical changes of Chiari decompression with preserved CSF spaces and biphasic flow at the foramen magnum.


Instruction: Generate impression based on findings.

Input: History of PSC. ABDOMEN:LIVER, BILIARY TRACT: Demonstrated again is markedly irregular beaded dilatation and narrowing of the intra and extrahepatic biliary system. The common bile duct measures up to 8 mm, unchanged. No new dominant stricture or focal lesion is identified. Normally distended gallbladder without gallstones or choledocholithiasis. No abnormal bile duct enhancement.The vessels are patent.SPLEEN: The spleen is normal in morphology and size without a discrete lesion.PANCREAS: The accessory duct is directed towards the main pancreatic duct (series 8 image 24 and series 9 image 18) suggesting normal variant ansa pancreatica. The pancreatic parenchyma is normal in morphology and signal intensity. Normal pancreatic duct caliber.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right renal superior pole simple cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No significant change in the multifocal biliary ductal dilatation and stricturing of PSC without evidence of a dominant stricture, thickened biliary ductal walls or focal hepatic mass.


Instruction: Generate impression based on findings.

Input: Male, 70 years old. Reason: left thyroid uptake on PET/CT recently-exam uploaded in our system-please evaluate History: see 1.Treated lymphoma years ago-left neck site then RIGHT LOBE MEASUREMENTS: 4.7 x 2.0 x 1.7 cmLEFT LOBE MEASUREMENTS: 5.2 x 1.7 x 1.5 cmISTHMUS MEASUREMENTS: 0.2 cmRIGHT LOBE: Mildly heterogeneous echotexture, without focal lesion.LEFT LOBE: Mildly heterogeneous echotexture. A left lower pole nodule measures 1.9 x 1.5 x 1 .8 cm, solid and heterogeneous, noncalcified, hypervascular.ISTHMUS: Mildly heterogeneous echotexture, without focal lesion.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Benign-appearing cervical lymph nodes are identified. A left level 5 lymph node measures 0.7 x 0.3 x 0.5 cm.OTHER: No significant abnormality noted.

Output: A 1-2 cm solid left lower pole thyroid nodule has significant internal vascularity. Given a history of lymphoma and increased metabolic activity in PET imaging, biopsy of this lesion is recommended for further evaluation.


Instruction: Generate impression based on findings.

Input: 66-year-old male with headache, nausea, vomiting. There is no evidence of acute intracranial hemorrhage, mass or edema. Right parieto-occipital cortical hypodensity may represent subacute infarction. MRI is recommended for further evaluation. Left parietal subcortical white matter hypodensity is likely due to small vessel ischemic disease.The ventricles and basal cisterns are normal in size and configuration.There is a benign-appearing round ossific density in the right frontal bone.The visualized paranasal sinuses and mastoid air cells are normally pneumatized. There is a fluid attenuation structure anterior to the left globe, incompletely imaged.

Output: Right parieto-occipital cortical hypodensity, which may represent subacute infarction. MRI is recommended if clinical concern for acute ischemia remains.


Instruction: Generate impression based on findings.

Input: Male; 56 years old. Reason: evaluate size of HCC History: HCC ABDOMEN:LIVER, BILIARY TRACT: Arterially enhancing lesion with washout in segment 8 measures 11 x 10 mm, unchanged (series 1001/362). No new suspicious hepatic lesions. Stable subcentimeter left hepatic cyst.Cirrhotic liver morphology.Patent hepatic vasculature. No biliary ductal dilatation. Cholelithiasis. Subcentimeter sessile enhancing polypoid lesion in the gallbladder fundus (series 1001/235), unchanged from 2013 CT. Paraumbilical and esophageal varices, unchanged.SPLEEN: Mild splenomegaly.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable subcentimeter bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Segment 8 lesion consistent with HCC, unchanged.


Instruction: Generate impression based on findings.

Input: Right knee pain; patellofemoral arthroplasty Note that the exam is limited by metallic artifact from prior patellofemoral arthroplasty.MENISCI: Within the limits of the exam, no discrete meniscal tear is identified.ARTICULAR CARTILAGE AND BONE: Evaluation of the patellofemoral compartment is limited given surgical changes of the trochlea. There is mild thinning of the articular cartilage of both the medial and lateral compartments however no discrete full-thickness tear is appreciated.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Limited exam secondary to metallic artifact from prior patellofemoral arthroplasty.2. Within the limits of the exam, no discrete meniscal tear is appreciated.3. Mild thinning of the articular cartilage of both the medial and lateral compartments without discrete full-thickness defect.


Instruction: Generate impression based on findings.

Input: There are 5 lumbar type vertebral bodies. Compared to 9/9/2015, interval postsurgical changes of L1-L3 partial laminectomy and laminoplasties are seen. Again seen are multiple expansile lesions involving the distal thoracic cord with enhancement likely representing multiple ependymomas as well as multiple extramedullary lesions compatible with schwannomas along the cauda equina nerve roots. There appears to be total or near total resection of the previously described L2-L3 level mass previously measuring 13 x 12 x 17. There may have been partial debulking of additional lesions and can be correlated with surgical history. Expected postsurgical changes are seen in the paraspinous soft tissues without fluid collections. No new signal abnormality involving the conus.Vertebral body heights in the lumbar spine are normal. Alignment is grossly maintained. Additional nerve sheath tumors are evident in the neural foramina which are relatively small. There is a relatively larger one involving the left L5 nerve root measuring approximately 13 x 20 mm in the AP and transverse dimensions. Nerve sheath tumors involving the sacral foramina are partially visualized involving the left S1 nerve root. There is also an enhancing lesion at the level of the L3-L4 facet joint on the left, also likely a nerve sheath tumor. These are not appreciably changed since 9/9/2015. Large retroperitoneal, suprarenal mass is again seen and partially imaged.

Output: Again seen is stigmata of NF 2 with multiple intramedullary enhancing masses involving the distal cord, which likely represent ependymomas, as well as multiple extramedullary lesions compatible with meningiomas as well as schwannomas involving the cauda equina nerve roots. Interval total or near total resection of the previously seen large schwannoma which occupied majority of the spinal canal at the L2-L3 level is noted. Additional debulking may have been performed of the lesions along the surface of the conus which appear slightly smaller but difficult to precisely compare, and can be correlated with surgical history.


Instruction: Generate impression based on findings.

Input: 87-year-old female status post fall loss of consciousness. Evaluate for bleed There is no evidence of intracranial hemorrhage, mass or edema. Diffuse periventricular white matter hypodensities are consistent with small vessel disease, age indeterminate. If there is clinical concern for acute ischemia and MRI may be consideredThe 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: 1. Diffuse periventricular white matter hypodensities are consistent with small vessel disease, age indeterminate. If there is clinical concern for acute ischemia and MRI may be considered.2. No evidence of intracranial hemorrhage.


Instruction: Generate impression based on findings.

Input: 40 year old woman with history of orthotopic heart transplant in 2009, referred for annual evaluation of allograft vasculopathy. MEDICATIONS: Cellcept, Prograf, Pravastatin, Synthroid, Lyrica First Pass PerfusionDuring hyperemia, no definite perfusion defects were present. Apparent area of decreased enhancement during hyperemia and rest images within the interventricular septum in the mid and apical portions of the LV is likely artifactual.Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable.Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 63%, the LV end diastolic volume index is 63 ml/m2 (normal range: 65+/-11), the LVEDV is 106 ml (normal range 109+/-23), the LV end systolic volume index is 23 ml/m2 (normal range 18+/-5), the LVESV is 39 ml (normal range 31+/-10), the LV mass index is 18 g/m2, and the LV mass is 31 g. There are no regional wall motion abnormalities present. Left AtriumThe left atrium is consistent with transplant. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 69%, the RV end diastolic volume index is 65 ml/m2 (normal range 69+/-14), the RVEDV is 110 ml (normal range 110+/-24), the RV end systolic volume index is 20 ml/m2 (normal range 22+/-8), and the RVESV is 34 ml (normal range 35+/-13). Right AtriumThe right atrium is consistent with transplant. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveTrace mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsSternal wires are present. Nonspecific renal hyperintense T2 lesions. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. No convincing evidence of perfusion defects/ "ischemia" present during hyperemia. Apparent area of decreased enhancement during hyperemia and rest images within the interventricular septum in the mid and apical portions of the LV is likely artifactual. Consider MRI follow-up imaging in 6 months for reevaluation.2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and systolic function (LVEF 63%).4. Normal RV size and systolic function (RVEF 69%).


Instruction: Generate impression based on findings.

Input: There is redemonstration of a extensive absence of the majority of the upper right cerebral hemisphere, including much of the right frontal lobe and majority of the right parietal lobe. There is associated mild ex vacuo dilatation of the distorted right lateral ventricle. However, there is suggestion of post extra-axial CSF signal intensity collection which has progressively increased size and density of the right hemicranium compared to multiple prior exams. There is also evidence of mass effect upon the residual right cerebral parenchyma as well as the right lateral ventricle areas the right lateral ventricle maintains at differentiating margin from this collection. In 2008, this collection measured 2.8 cm transverse x 4.1 cm the x 6.0 cm AP, and now measures 5.7 cm transverse x 6.8 cm CC x 14.3 cm AP.The left lateral ventricle is within normal limits, as are the third and fourth ventricles. A thin strip of brain parenchyma remains along the right aspect of the falx inferiorly. There is suggestion of very mild FLAIR hyperintensity along the margins of the residual right cerebral parenchymal tissue which may relate to gliosis. There is slight expansion of the right hemicranium as compared to the contralateral side. The right cerebral peduncle is small, as well as the right aspect of the brainstem, likely relating to Wallerian degeneration. There is slight rightward bowing of the medial aspect of the left thalamus.No mass effect or midline shift. There is increased prominence of the left cerebral convexity subarachnoid space with widening of the associated sulci to asymmetric volume loss. The left cerebellum remains diminutive in size which is favored to relate to crossed cerebellar diaschisis, given normal appearance at birth.The cisterns remain patent. There is no diffusion abnormality. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. Corpus callosum is severely thinned, with sparing of the anterior and posterior portions. The midline structures and craniocervical junction are within normal limits.Mastoid air cells are underpneumatized with fluid on the left side.ORBITS

Output: 1.Redemonstration of absence of the majority of the right cerebral hemispheric parenchyma, with associated right-sided Wallerian degeneration and left crossed cerebellar diaschisis.2.Right hemispheric cavity/collection, with previous peripheral hemosiderin deposition in the collection, consistent with previous large hematoma which may been parenchymal in location, resulting in extensive cystic encephalomalacia of the right cerebral hemisphere. The collection is progressively increasing in size given the associated expansion of the right hemicranium and mass effect upon the residual right cerebral structures. No MR sequelae of its hypoxic ischemic injury present as previously questioned.3.Unremarkable contrast enhanced MR appearance of the orbits. No definite elevation of optic nerve heads.


Instruction: Generate impression based on findings.

Input: Male, 71 years old. Shoulder pain, painful arc, decreased rom, weakness. ROTATOR CUFF: There is increased signal intensity within the anterior fibers of the supraspinatus tendon at its insertion indicating a tear. The tear appears to involve the bursal surface fibers extending across the majority of the thickness of the tendon but sparing the articular surface fibers. The tear is just under 1 cm in AP diameter, and there is no frank retraction of the tendon. More proximally, there appears to be undersurface fraying as well as tendinosis of the supraspinatus tendon. The supraspinatus muscle appears normal. There also appears to be undersurface fraying of the infraspinatus tendon with small cysts in the underlying humeral head but no full-thickness tear. The infraspinatus muscle appears normal. The teres minor tendon and muscle appear normal. There is mild subscapularis tendinosis but no discrete tear. The subscapularis muscle appears normal.SUPRASPINATUS OUTLET: Moderate osteoarthritis affects the acromioclavicular joint. We see no frank fluid in the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Mild osteoarthritis affects the glenohumeral joint. There is a small amount of fluid in the joint, particularly in the subscapular recess containing small intermediate signal intensity foci indicating synovitis or debris. There is mild degeneration of the labrum with linear foci of intermediate signal intensity traversing the superior, anterior, and posterior labrum, likely representing degenerative tearing.BICEPS TENDON: Increased signal intensity within the tendon of the long head of the biceps at its transition from the rotator interval to the bicipital groove represents tendinosis.

Output: 1.Partial-thickness bursal surface tear of the anterior fibers of the supraspinatus tendon with additional rotator cuff tendinosis and fraying as described above.2.Osteoarthritis and other findings as described above.


Instruction: Generate impression based on findings.

Input: 26 years Female (DOB:7/6/1990)Reason: assess for MS History: as abovePROVIDER/ATTENDING NAME: DAVID M. LIEBOVITZ DAVID M. LIEBOVITZ MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated within the brain parenchyma. 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 demonstrate some mild mucosal thickening in the right maxillary sinus The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI orbits:The eyeballs are intact. No intraconal or extraconal space mass is identified. The extraocular muscles are intact. The lacrimal glands are symmetric and within normal limits in size and configuration. There is no optic nerve enhancement appreciated. The suprasellar cistern is intact .MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal enhancing lesions are identified in the cervical spine.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.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.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.There are no abnormal lesions are appreciated within the brain or cervical spinal cord to suggest demyelinating disorder.2.No evidence for optic neuritis is appreciated on this exam.


Instruction: Generate impression based on findings.

Input: Pain and numbness, left hand second finger. Rule out cervical radiculopathy, C7. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is 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: No significant compromise to the spinal canal or neural foramina.C4-5: Tiny central disc protrusion. No significant compromise to the spinal canal or neural foramina.C5-6: Mild disc bulge including small bilateral foraminal components. No significant compromise to the spinal canal. There is mild bilateral neural foraminal stenosis. C6-7: Mild disc bulge and mild uncovertebral hypertrophy contribute to mild left neural foraminal stenosis. Minimal right neural foraminal narrowing. Spinal canal is patent. 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.

Output: Mild degenerative changes in the cervical spine as described above. There is mild bilateral C5-C6 and mild left greater than right C6-C7 neural foraminal stenosis. No significant spinal canal stenosis at any level.


Instruction: Generate impression based on findings.

Input: 20 year old male with a history of IBD. Assess for perianal fistula. PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Again seen is wall thickening involving the distal sigmoid colon and proximal rectum. Again seen are foci of increased T2 signal abnormality within the bowel wall as well as increased mesenteric vascularity, compatible with active inflammation. Redemonstrated transsphincteric perianal fistulae arising at the 5 o'clock and 7 o'clock positions extending to the skin surface with bilateral setons in place, appearing similar to the prior study. There is interval increase in size of the fluid collection along the right gluteal crease, measuring 11 mm in diameter, consistent with abscess formation (64; series 4). Additionally, note is made of an intersphincteric fistula extending from the 6 o'clock position of the which extends to the skin surface along the left gluteal crease and may communicate with the aforementioned left transsphincteric fistula, which appears more pronounced when compared to the prior examination. BONES, SOFT TISSUES: Heterogeneous lesion within the medial right iliac bone has high T1 and high T2 signal with mild peripheral enhancement consistent with a hemangioma. Heterogeneous bone marrow signal likely represents islands of red marrow.OTHER: Bilateral testicular hydroceles.

Output: 1.Persistent bilateral perianal fistula formation, as detailed above. There is slight interval increase in size of a 11-mm fluid collection along the right gluteal crease consistent with abscess formation. Additionally, a right intersphincteric fistula appears more pronounced when compared to the prior study.2.Acute on chronic inflammatory changes involving the sigmoid colon and rectum compatible with known inflammatory bowel disease.


Instruction: Generate impression based on findings.

Input: Ms. Heth is a 67 year old female with a personal history of left breast lumpectomy x2 in 2006 for DCIS/ADH treated with tamoxifen therapy and a right breast excisional biopsy in 2015 for periductal chronic inflammation. Family history of breast cancer in paternal aunt, diagnosed at the age of 50. She recently had biopsy of an enlarged left axillary lymph node, which was positive for breast primary. There is scattered fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.LEFT BREAST: Spanning the entire left central to inferior breast are numerous enhancing masses/nonmass enhancement measuring approximately 13.2 x 7.8 x 7.3 cm (AP x ML x SI). This enhancement extends up to within 1 cm of the left nipple base. The enhancement is greater than 2 cm from the pectoralis muscle border.RIGHT BREAST: There is no abnormal enhancement seen in the right breast.AXILLAE: In the left axillary region, there are 4 abnormal axillary lymph nodes identified, the largest of which measures approximately 2.0 cm and is biopsy-proven to be malignant. Hydromark clip is seen within this lymph node.No abnormal axillary lymph nodes are identified in the right axillary region.

Output: (1) Numerous enhancing masses/nonmass enhancement spanning the entire left central to inferior breast, measuring up to 13.2 cm, highly suspicious for malignancy. If tissue sampling of this abnormal area is warranted, an MR directed ultrasound with biopsy can be performed.(2) Biopsy-proven metastatic left axillary lymph node with appropriate clip placement.(3) No MRI evidence for malignancy in the right breast. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Female 39 years old Reason: seizure focus There is no evidence of acute infarct or hemorrhage. Extra-axial focus of susceptibility along the right anterior frontal convexity measuring 6 mm may represent a small calcified meningioma, but not well assessed without gadolinium. No significant mass effect on the underlying brain parenchyma. No appreciable evidence of cortical dysplasia, gray matter heterotopia, or suspicious intracranial mass. Bilateral hippocampi are symmetric and grossly unremarkable. No midline shift or herniation.There is abnormal T2 hyperintensity involving the bilateral cerebellar hemispheres as well as the vermis with associated moderate volume loss. No significant swelling of the cerebellum or mass effect. Punctate nonspecific focus of T2/FLAIR hyperintensity in the right frontal lobe is nonspecific.Mild prominence of the pituitary gland which can be seen with pregnancy. Calvarium and extracranial soft tissues are grossly unremarkable.

Output: 1.No evidence of acute infarct, hemorrhage, or mass effect.2.There is abnormal T2 hyperintensity involving the bilateral cerebellar hemispheres as well as the vermis with associated moderate volume loss. The volume loss may be related to chronic epileptic medications for seizures but given T2 hyperintensity raises the possibility of gliosis from prior inflammation or other injury. Comparison with prior MRI, if available, may be helpful.3.Subcentimeter anterior frontal extra-axial focus of susceptibility is nonspecific and not well evaluated with contrast, but may represent a small calcified meningioma. No significant associated mass effect.


Instruction: Generate impression based on findings.

Input: 15-year-old male with left hip/pelvis soft tissue Ewing's sarcoma-evaluation prior to surgical local control.EXAMINATION: MRI pelvis with and without contrast 12/10/2016 10:29 Normal bone marrow signal intensity.Small amount of free pelvic fluid similar to prior exam.No pelvic lymphadenopathy.The previously described lesion in the soft tissues lateral to the left iliac wing is not included in the field-of-view. Otherwise the soft tissues are normal.

Output: Previously described lesion in the soft tissues lateral to the left iliac wing is not included in the field of view on the current exam. The patient has been called back for repeat imaging.


Instruction: Generate impression based on findings.

Input: Reason: eval for osteomyelitis in patient with chronic ulcer and xray concerning for osteo History: see above There is diffuse thickening of the skin of the ankle particularly medially, laterally, and anteriorly with mild enhancement following contrast administration. There is ulceration of the skin both medially and laterally. Heterogeneous intermediate low signal intensity of the underlying subcutaneous fat likely represents a combination of scarring and calcification. We see no fluid collection to suggest abscess and we see no abnormal signal intensity within the bone to suggest osteomyelitis. There is chronic periosteal bone formation along the distal tibia and fibula as seen on recent radiographs. There is ankylosis of the syndesmosis of the distal tibia and fibula. There is also a large bony excrescence projecting posteriorly from the medial malleolus. Mild osteoarthritis affect the ankle and midfoot. There is diffuse muscular atrophy but the visualized tendons appear normal for age. This study was not protocoled for detailed evaluation of the ankle ligaments.

Output: Ulceration and other findings as described above without evidence of osteomyelitis.


Instruction: Generate impression based on findings.

Input: A patient submitted outside study for review. Submitted for review are digital mammographic images (1/6/15), ultrasound images of right breast (1/6/15), images from stereotactic biopsy of right breast with specimen radiographs and post procedural right digital mammographic images (1/22/15) and breast MRI (1/22/15) performed at DuPage Medical Group. DIGITAL MAMMOGRAPHIC IMAGES (1/6/15):The breast parenchyma is heterogeneously dense, which limits the sensitivity of the mammogram. Highly suspicious pleomorphic type calcifications distribute segmentally in the lower outer quadrant of the right breast. These calcifications measure 55 x 34 x 37 mm (AP x LR x CC).No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in the left breast. ULTRASOUND IMAGES OF RIGHT BREAST (1/6/15):There is an irregularly shaped hypoechoic area with internal multiple hypoechoic spots in the right breast at 7 o'clock position, corresponding to the mammographic findings. The sonographic images suggest intraductal lesion with calcifications.One abnormal lymph node with cortical thickening is present in the right axilla. Cortical thickness measures 4.4 mm.IMAGES FROM STEREOTACTIC BIOPSY OF RIGHT BREAST WITH SPECIMEN RADIOGRAPHS AND POST PROCEDURAL RIGHT DIGITAL MAMMOGRAPHIC IMAGES (1/22/15):Stereotactic core biopsy of the right breast calcifications was performed. Two sites of these calcifications were targeted; at posterior and anterior aspect. Specimen radiographs of both biopsies reveal multiple calcifications in the obtained cores.Post procedural right digital mammographic images show that a marker clip for the anterior biopsy site (dumbbell shaped) is displaced 2.5 cm medially. A marker clip for the posterior biopsy site (top hat) is at the posterior aspect within the group of calcifications.Per outside pathology report, the results for the posterior biopsy site were invasive ductal carcinoma, grade 3 associated with high-grade ductal carcinoma in situ, and the results for the anterior biopsy site were high-grade ductal carcinoma in situ.BREAST MRI (1/22/15):The study was performed with a protocol outlined in the outside radiology report.Segmental non mass enhancement is demonstrated at lower outer right breast at mid depth to posterior aspect, corresponding to the abnormal calcifications on the mammogram. This lesion measures 54 x 29 x 51 mm (AP x LR x CC). A marker clip is identified within the lesion at posterior aspect, located at 17 mm anterior from the posterior border. Another marker clip is identified at the central breast, mid-depth, displaced from the non-mass enhancement.An enlarged lymph node is present in the upper right axilla. It measures 15 mm in maximum diameter.No abnormal enhancing lesion in the left breast.

Output: Biopsy proven invasive and in situ carcinoma in the right breast, with an enlarged right axillary lymph node.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: 23-year-old female with right knee instability. Evaluate for right knee ACL tear. Somewhat suboptimal examination secondary to patient motion artifact.MENISCI: There is linear increased signal abnormality within the posterior horn of the lateral meniscus which extends to the femoral articular surface consistent with a small horizontal tear (image 22; series 701). There is also linear increased signal abnormality which extends to the femoral and tibial articular surfaces within the anterior horn of the lateral meniscus consistent with a radial tear (image 17; series 601). The medial meniscus appears intactARTICULAR CARTILAGE AND BONE: There is subchondral signal abnormality within the posterior lateral tibial plateau underlying the posterior horn of the lateral meniscus consistent with a bone contusion. No full-thickness or near full-thickness articular cartilage defects are identified.LIGAMENTS: The proximal and mid substance fibers of the ACL are indistinct with increased signal abnormality on fluid sensitive sequences suggesting a tear. The PCL appears intact. The LCL and MCL appear intact.EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Tearing of the ACL.2. Tearing of the lateral meniscus and bone contusion as described above.


Instruction: Generate impression based on findings.

Input: 64 y ear old male with history of ischemic cardiomyopathy, diabetes and atrial fibrillation presenting prior to planned AF ablation. Left VentricleThe left ventricle is normal in size with mildly reduced systolic function. The overall LV ejection fraction is 47%, the LV end diastolic volume index is 94 ml/m2 (normal range: 74+/-15), the LVEDV is 174 ml (normal range 142+/-34), the LV end systolic volume index is 50 ml/m2 (normal range 25+/-9), the LVESV is 93 ml (normal range 47+/-19), the LV mass index is 62 g/m2 (normal range 85+/-15), and the LV mass is 114 g (normal range 164+/-36). The LV dysfunction is global with regional variation . There is are two distinct transmural myocardial infarctions. The first involves the mid anterior and anterolateral walls and the apical anterior, lateral, and inferior walls. The second involving the entire inferior wall and the basal inferolateral wall. No LV thrombus seen. Left AtriumThe left atrium is mildly dilated (93ml). The interatrial septum is aneurysmal.Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 57%, the RV end diastolic volume index is 65 ml/m2 (normal range 82+/-16), the RVEDV is 120 ml (normal range 142+/-31), the RV end systolic volume index is 28 ml/m2 (normal range 31+/-9), and the RVESV is 52 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a "pseudo-bovine" brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium. A right middle pulmonary vein is noted. Pulmonary vein ostia are as below: LUPV: 17x21mmLIPV: 17x13mmRUPV 19x\18mmRMPV: 10x11mmRLPV: 17x12mmPulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsSternotomy wires and bypass graft clips present. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Normal LV size with mildly reduced systolic function (LVEF 47%).2. Two large transmural myocardial infarctions are noted in the usual territory of the left anterior descending artery and the right coronary artery.3. Normal RV size and systolic function (RVEF 57%).4. Mild left atrial dilation with aneurysmal interatrial septum.5. Normal pulmonary vein anatomy. A small right middle pulmonary vein is additionally noted. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Unsteadiness. Increased tone and hyperreflexia in the lower extremities. Assess for myelitis. Cervical Spine: The vertebral column alignment is within normal limits. The vertebral body heights are preserved. The vertebral bone marrow signal is unremarkable apart from minimal type I degenerative signal subjacent to the C5-C6 endplates on the right, which also contrast enhances. There is multilevel disc desiccation and mild height loss. Disc-osteophyte complexes at C4-C5, C5-C6 and C6-C7 result in mild spinal canal stenosis. The cervical spinal cord displays normal signal and morphology. Uncovertebral and, to a lesser extent, facet arthropathy result in neural foraminal stenoses that is moderate to severe on the right and mild to moderate on the left at at C4-C5 and C5-C6, as well as the on the right at C3 C4. There is no abnormal intrathecal contrast enhancement. The paravertebral soft tissues are unremarkable. Thoracic Spine: The vertebral column alignment is within normal limits. The vertebral body heights are preserved. The vertebral bone marrow signal is unremarkable. There is multilevel disc desiccation and height loss causing very shallow ventral indentations of the thecal sac but no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable. There is mild mild neuroforaminal stenoses on the right at T4-T5, T10-T11, T11-T12, and on the left at T7-T8, T10-T11, and T11-T12. There is no abnormal spinal cord contrast enhancement. There is prominent lower esophageal contrast enhancement and diffuse mural thickening.

Output: 1.No definite evidence of spinal cord lesions.2.Multilevel degenerative cervical and thoracic spondylosis results in neural foraminal stenoses, but no significant spinal canal stenosis.3.Prominent lower esophageal contrast enhancement and diffuse mural thickening is nonspecific but may represent esophagitis. Endoscopy may be useful for further evaluation.


Instruction: Generate impression based on findings.

Input: Hepatitis C and cirrhosis. HCC screening. Motion artifact markedly grades multiple sequences.ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology. Stable subcentimeter T2 hyperintense focus in the anterior left hepatic lobe, likely representing a cyst. No suspicious lesions or foci of enhancement evident. 15 mm gallstone noted, without evidence of cholecystitis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left renal cysts noted. Otherwise 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: No significant abnormality noted. No ascites.

Output: No evidence of hepatocellular carcinoma.


Instruction: Generate impression based on findings.

Input: 47-year-old female status post fall with shoulder pain ROTATOR CUFF: There is a tear of the distal supraspinatus tendon near its insertion on the greater tuberosity with associated fluid extending within the subacromial subdeltoid bursa consistent with a full-thickness component. There is no retraction of the tendon or atrophy of the muscle. There is surrounding tendinopathy of the supraspinous tendon. The remaining muscles and tendons of the rotator cuff appear intact.SUPRASPINATUS OUTLET: Mild acromioclavicular joint osteoarthritis.GLENOHUMERAL JOINT AND GLENOID LABRUM: The labrum is grossly intact. Glenohumeral alignment is within normal limits.BICEPS TENDON: Intact and appropriately situated within the bicipital groove. ADDITIONAL

Output: Tear of the distal supraspinous tendon near its insertion on the greater tuberosity with fluid extending within the subacromial-subdeltoid bursa, consistent with a full-thickness component without tendinous retraction.


Instruction: Generate impression based on findings.

Input: 6-year-old female with left neck mass. Assess after treatment. Images through the skull base including cavernous sinuses remain within normal limits. Mastoid air cells and middle ear cavities are well pneumatized and unremarkable. Chronic inflammatory sinus disease of all paranasal sinuses are noted.Images through the soft tissues of the neck demonstrate an enhancing mass superficial to the left sternocleidomastoid muscle and immediately posterior and inferior to the left parotid gland. This lesion measures 15.7-mm in AP access and 12 mm in transverse axis (axial image 75 of 171). On coronal image 109 of 229 the mass measures 13.4-mm x 9.8-mm. the mass is well demarcated and demonstrates no evidence of any surrounding edema. The mass appears to be external to the parotid call her on coronal images the mass appears to be at least partially within the superficial lobe of left parotid. A pleomorphic adenoma or a lymph node are the most likely etiology however further evaluation with an MRI is recommended. There is no evidence of inflammatory changes surrounding the mass or the parotid gland.Several bilateral cervical lymph nodes with no enhancement are believed to be within normal range for patient's stated age of 6 years. The bony density at the area of the exam is unremarkable. The vasculature remains intact. Limited images of the apices of the lungs and mediastinum are unremarkable.

Output: 1.Enhancing lesion likely within the left parotid gland as detailed.2.There are no old films available for comparison.3.Unremarkable examination of soft tissues of the neck otherwise.4.Extensive chronic sinus disease.


Instruction: Generate impression based on findings.

Input: Female, 40 years old. Cervical radiculopathy in C6-7 distribution in R arm; new weakness in R tricep, 4/5 strength. The cranial-cervical junction is normal. There is straightening of the normal cervical lordosis. The cervical spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal and caliber of the visualized cord are normal. There is no evidence of cord compression or mass. The paraspinal soft tissues are unremarkable.At C5-6, there is posterior disc osteophyte complex formation, with mild to moderate left neural foraminal narrowing. No significant right neural foraminal narrowing or spinal canal stenosis.At C6-7, there is mild uncovertebral joint hypertrophy, disc height loss and posterior disc osteophyte complex formation with a superimposed right paracentral/proximal foraminal disc protrusion. This results in impingement on the right ventral C7 nerve root. There is associated moderate right and moderate to severe left neural foraminal stenosis as well as mild spinal canal narrowing.At the other cervical levels, there is no significant spinal canal or neural foraminal narrowing.

Output: 1.Diffuse degenerative changes at C6-7 with a superimposed disc protrusion resulting in impingement on the right ventral C7 nerve root as well as moderate right and moderate-to-severe left neural foraminal stenosis at this level.2.Mild-to-moderate left neural foraminal narrowing at C5-6.


Instruction: Generate impression based on findings.

Input: Vision loss, optic neuropathy both eyes. History of optic atrophy and glaucoma. Brain: There is diffuse bilateral optic nerve and optic chiasm atrophy. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is unchanged nonspecific mild scattered cerebral white matter T2 hyperintensity. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull and scalp soft tissues are grossly unremarkable. There is mild scattered paranasal sinus mucosal thickening. There is periapical enhancement associated with teeth # 2 and 10. There is a nonspecific 3 mm wide enhancing nodules in the right preauricular region.Orbits: There is diffuse bilateral optic nerve atrophy. There is no evidence of intraorbital mass lesions. The bilateral globes and extraocular muscles are unremarkable.

Output: 1. Diffuse bilateral optic apparatus atrophy, which may be attributable to chronic ischemic optic neuropathy or glaucoma.2. No evidence of intracranial hemorrhage, mass, or acute infarct. 3. Dental disease.


Instruction: Generate impression based on findings.

Input: New onset of MZL (left conjunctiva), assess for additional foci of disease. The left conjunctive abnormality cannot be resolved. The bilateral globes, optic nerves, extraocular muscles, orbital fat, and lacrimal glands are unremarkable. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull and scalp soft tissues are grossly unremarkable. There is a small left maxillary sinus retention cyst.

Output: No evidence of orbital or intracranial mass lesions.


Instruction: Generate impression based on findings.

Input: 70 years Female (DOB:11/4/1945)Reason: Speech change, ams? History: Speech change, ams?PROVIDER/ATTENDING NAME: PETER C WARNKE PETER C WARNKE MRI of the brainNo diffusion weighted abnormalities are appreciated.There is a moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Additional patchy T2 and FLAIR signal hyperintensity is present in the basal ganglia, thalami and brainstemA mild degree of punctate foci of signal loss on SWI are identified in the subcortical white matter . There is a left sided subependymal focus of susceptibility. Additional foci o punctate sized susceptibility are present in the thalamiThe 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 demonstrate minor mucosal thickening. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. The posterior communicating arteries are intact. The right PCOMA is large. The left PCOMA is small. The vertebral arteries are similar in size. MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is 40% stenosis at the LICA origin by NASCET criteria.There is no significant stenosis along the course of the vertebral arteries. Lumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is facet hypertrophy at this level (left more than right).At L4-5 there is no significant compromise to spinal canal or neural foramina. There is disk dessication and a disk bulge at this level associated with 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.

Output: 1. 40% stenosis at the LICA origin by NASCET criteria.2.Periventricular and subcortical white matter lesions of a moderate degree and lesions in the basal ganglia, thalami and brainstem are nonspecific. At this age they are most likely vascular related. 3.Mild degree of predominantly thalamic and subcortical microhemorrhages. This is a non-specific pattern which may imply combination of more than one cause (i.e. amyloid angiopathy and hypertension)4.Mild degenerative are present in the lumbar spine without significant compromise to the spinal canal or exiting nerve roots.


Instruction: Generate impression based on findings.

Input: Female, 34 years old, with breast cancer and known lung metastases, now with syncope. Assess for brain metastases. The cerebral and cerebellar hemispheres and brainstem show normal signal intensity and morphology. No restricted diffusion is seen.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. On postcontrast images, no pathologic parenchymal or extra-axial enhancement is detected.Bone marrow signal intensity is limits. A small area of mucosal thickening or secretion is evident in the left maxillary sinus.

Output: No evidence of intracranial metastases or any other finding which would account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: Splenic mass. Pelvic pain. Consultation with Dr. Peabody reveals an additional history of prior breast cancer.IMAGE ACQUISITIONS: Nonenhanced computed tomography of the pelvis with transverse, coronal, and sagittal reformatted images provided. There is sclerosis of the left ischium and supraacetabular left ilium that appears similar to prior studies and corresponds to abnormal signal intensity seen on an outside MRI examination. Subtle abnormal density of the L5 vertebral body is also noted, but the corresponding lesion is better visualized on the prior lumbar spine MRI examination. There are also chronic fractures of the superior ramus and body of the left pubic bone. A fracture of the left sacral wing is new when compared to prior studies. Moderate osteoarthritis affects both hip joints. Severe degenerative disk disease affects the visualized lower lumbar spine.There is atherosclerotic calcification of the distal abdominal aorta and common iliac arteries. The pelvic viscera are unremarkable given the limitation imposed by lack of intravenous or enteric contrast.

Output: 1. Sclerotic lesions in the left ischium and supra-acetabular ilium as described above which correspond to areas of abnormal signal intensity on MRI. Given the patient's history of breast cancer, metastases cannot be excluded.2. Fractures and degenerative arthritis as described above.


Instruction: Generate impression based on findings.

Input: Neck tightness and left side pulsatile tinnitus. Brain MRI: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. However, there appears to be subcentimeter protrusion of CSF into the right cavernous sinus. There is no midline shift or herniation. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Brain MRA: There is no evidence of significant steno-occlusive lesions. There is minimal outpouching at the origin of the left superior cerebellar artery.Cervical Spine MRI: There is a posterior disc-osteophyte complex at C5-6 that indents the spinal cord and results in bilateral moderate neural foramen narrowing. There are also posterior disc-osteophyte complexes at C4-5 and C6-7 without significant spinal canal stenosis. There is perhaps mildly increased T2 signal within the spinal cord at this level versus artifact. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. The paravertebral soft tissues are unremarkable.

Output: 1. No evidence of intracranial mass lesions.2. A posterior disc-osteophyte complex at C5-6 indents the spinal cord and results in bilateral moderate neural foramen narrowing at this level, as well as possible signal abnormality within the spinal cord at this level versus artifact. Posterior disc-osteophyte complexes are also present at C4-5 and C6-7, but without significant spinal canal stenosis. 3. Minimal outpouching at the origin of the left superior cerebellar artery likely represents a prominent infundibulum rather than a true saccular aneurysm. Otherwise, no evidence of significant intracranial steno-occlusive lesions or vascular malformations within the limits of MRA.


Instruction: Generate impression based on findings.

Input: 20 year-old male, question of ACL tear MENISCI: The medial and lateral menisci are intact.ARTICULAR CARTILAGE AND BONE: There is edema consistent with contusions in the anterior lateral and femoral condyles and the medial and lateral posterior tibial plateau.LIGAMENTS: There is complete rupture of the ACL. The PCL is intact. The lateral collateral ligament complex and medial collateral ligament are intact.EXTENSOR MECHANISM: The quadriceps and patella tendons are intact.ADDITIONAL

Output: 1. Complete rupture of the ACL with bone contusions in the anterior femoral condyles and along the posterior tibial plateau.2. Moderate joint effusion and hemarthrosis.


Instruction: Generate impression based on findings.

Input: Right brain tumor with left sided weakness: preoperative planning for biopsy. There is a dominant heterogeneous mass in the right perirolandic region that measures up to approximately 4 cm. There are also several subcentimeter lesions adjacent to the mass. The ventricles are normal in size and configuration. There is no midline shift. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. Fiducial markers are present.

Output: Preoperative planning MRI shows a dominant heterogeneous mass in the right perirolandic region that measures up to approximately 4 cm and several subcentimeter satellite lesions.


Instruction: Generate impression based on findings.

Input: Reason: arachnoid cyst , with hydrocephalus , lumbar peritoneal shunt, Evaluate for changes History: headache. There are postoperative findings related to right pterional craniectomy with apparent deficiency of the calvarial bone flap and mild depression of the scalp flap. There is no evidence of underlying lesions. However, there is a subcentimeter right choroid fissure cyst. There are linear areas of gliosis in the bilateral frontal lobes related to tracts from prior ventricular catheterization. There is no midline shift. There is no evidence for intracranial hemorrhage or acute infarction. The orbits and paranasal sinuses are unremarkable.

Output: 1. Postoperative findings related to right pterional craniectomy with apparent deficiency of the calvarial bone flap and mild depression of the scalp flap, but no evidence of underlying arachnoid cyst.2. Subcentimeter right choroid fissure cyst. 3. No evidence of ventriculomegaly.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Back pain and right lower extremity pain status post TLIF. Postsurgical changes from L5-S1 posterior spinal fusion with bilateral pedicle screws and posterior stabilization rods. Susceptibility artifact from metallic hardware limits evaluation at this level. There is mild anterior wedging of the T12 vertebral body, focally increased kyphosis, and advanced degenerative disc disease with a central disc protrusion at T11-12. This is associated with effacement of the ventral thecal sac and mass effect on the cord. This level is only imaged on the sagittal views, but appears slightly progressed compared to prior.The remaining vertebral body and intervertebral disc heights are maintained. Alignment is likewise otherwise maintained. The spinal cord has normal signal throughout. The conus medullaris terminates at the L1 level.Level by level findings are as follows:T12-L1: No disc bulge, spinal canal stenosis, or neuroforaminal narrowing.L1-L2: No disc bulge, spinal canal stenosis, or neuroforaminal narrowing.L2-L3: No disc bulge, spinal canal stenosis, or neuroforaminal narrowing.L3-L4: No disc bulge, spinal canal stenosis, or neuroforaminal narrowing.L4-L5: Small right paracentral disc protrusion, facet hypertrophy, and hypertrophy of the ligamentum flavum creates moderate subarticular foraminal narrowing on the right which appears mildly progressed compared to prior. No spinal canal or left neural foraminal stenosis.L5-S1: Metallic susceptibility artifact markedly limits evaluation. There is marked narrowing of the right neural foramen by low signal tissue corresponding to the soft tissue density seen on recent CT. No definite enhancement is noted, but evaluation is markedly limited by metallic artifact.

Output: 1. Postsurgical changes from L5-S1 posterior spinal fusion. There is a low signal tissue obliterating the right L5-S1 neural foramen corresponding to the soft tissue density seen on prior CT. Although evaluation is limited by metallic artifact, the lack of definite enhancement favors fibrotic postsurgical change.2. Moderate right L4-5 neural foraminal stenosis which appears slightly progressed compared to preoperative MRI.3. Partially imaged central disc protrusion at T11-12 with effacement of the ventral thecal sac and mass effect on the underlying cord also appears slightly progressed compared to the preoperative MRI. No abnormal signal is identified within the cord.


Instruction: Generate impression based on findings.

Input: Male, 5 years old, with optic nerve atrophy. The optic nerves are thinned, more so in the middle and posterior orbital segments than at the optic nerve heads. The optic chiasm and cisternal optic nerves are also poorly visualized and probably thinned as well.The globes are round and symmetric. The extraocular muscles demonstrate normal morphology. The intraconal fat shows normal homogeneous signal intensity.Brain parenchymal morphology is within normal limits. No evidence of any migrational anomalies are seen. The septum pellucidum is intact.No evidence of edema or mass effect is seen. No intracranial hemorrhage or abnormal extra-axial fluid is detected. The ventricles are normal in size.

Output: 1.Thinning of the optic nerves is seen without associated findings.2.Evaluation of the brain is otherwise within normal limits.


Instruction: Generate impression based on findings.

Input: Reason: PTT rupture History: Pain TENDONS: There is abnormal T2 signal hyperintensity surrounding the posterior tibialis tendon at the level of the medial malleolus, indicating tenosynovitis, but the tendon remains intact throughout its course. There is a split tear of the peroneal brevis tendon. The remainder of the flexor and extensor tendons are intact.LIGAMENTS: The ligaments are intact.ARTICULAR SURFACES AND BONE: Bone marrow signal is within normal limits. There is a type II accessory navicular. The ankle mortise is intact. There is mild degenerative spurring at the tibiotalar and subtalar joints.ADDITIONAL

Output: 1.Mild tenosynovitis of the posterior tibialis tendon which remains intact throughout its course.2.Split tear of the peroneal brevis tendon.3.Mild degenerative changes in the hindfoot.4.Small joint effusion and mild edema in the subcutaneous tissues.


Instruction: Generate impression based on findings.

Input: Clinical question: Preop for biopsy of brain lesion. Signs and symptoms: Headache. Pre-and post enhanced stealth brain MRI:Examination is performed as a treatment/surgical planning study and is not a complete diagnostic test. There are also not prior exams for comparison.Within the indication a large irregular, necrotic and with irregular homogeneous pattern of enhancement superficially in the right posterior temporal lobe measuring at least at 40 x 38-mm in transaxial dimensions. The mass grossly extensive surrounding vasogenic edema and mass-effect resulting in mild deviation of the midline to the left. No evidence of ventriculomegaly.A second slightly smaller similar type mass is also present in the left posterior parietal measuring at least at 30 x 32-mm. This lesion also demonstrates fairly extensive surrounding vasogenic edema and resultant lesion or mass effect. Findings are suggestive of metastatic lesions. No additional foci of parenchymal, leptomeningeal or calvarial enhancement.

Output: 1.Enhancing necrotic metastatic lesion measuring at 40 x 38-mm in the right posterior temporal lobe.2.Enhancing necrotic metastatic lesion in the right posterior parietal lobe measuring at 30 x 32-mm.3.Metastatic lesions and surrounding vasogenic edema results in subtle leftward deviation of midline without ventriculomegaly.


Instruction: Generate impression based on findings.

Input: Right foot drop, lower extremity pain. Patient has MRI compatible spinal cord stimulator device. For the purposes of numbering, there are 7 cervical, 12 thoracic, and 4 lumbar type vertebral bodies, which is consistent with prior CT lumbar spine reports. The last rib-bearing vertebra is labeled T12.Partially imaged cervical spine demonstrates a disc herniation at the C3-C4 level on the sagittal images with mass effect on the ventral cervical cord which is not well evaluated. Small disc osteophyte complexes at the C4-C5 and C5-C6 levels are also present.Thoracic: There is a central disc protrusion at the T7-T8 level which effaces the ventral thecal sac and is associated with impression on the ventral aspect of the thoracic cord. There is overall mild to moderate degree of spinal canal stenosis at this level with some residual CSF space dorsally.Vertebral body heights and alignment of the thoracic spine are otherwise normal. Bone marrow signal is benign. No significant herniation, spinal canal stenosis, or neural foraminal stenosis is evident at the remainder of the thoracic spine levels. There is mild to moderate multilevel facet arthropathy in the lower thoracic spine.Lumbar: As mentioned above, there are 4 lumbar type vertebral bodies, which is consistent with prior CT lumbar spine reports. The last rib-bearing vertebra is labeled T12. Vertebral body heights are within normal limits. There is grossly unchanged appearance of the grade 1 anterolisthesis of L3 on L4 with evidence of interspinous fixation device at this level as seen on prior CT. Bone marrow signal is benign. Multilevel degenerative changes are seen, as described below:L1-L2: Minimal disc bulge, ligamentum flavum thickening, and facet arthropathy. No significant spinal canal or neural foraminal stenosis.L2-L3: Minimal disc bulge, ligamentum flavum thickening, and facet arthropathy. There is mild to moderate left neural foraminal stenosis. No significant spinal canal or right neural foraminal stenosis.L3-L4: Postoperative changes with interspinous fixation device better seen on prior CT. There is advanced facet arthropathy and bony proliferation along the ligament of flavum which contributes to mild to moderate spinal canal stenosis. There is disc uncovering and disc bulge which extends into the right neural foramen. There is associated moderate degree of right-sided neural foraminal stenosis. Left neural foramen is patent. L4-S1: Mild disc bulge and facet arthropathy. No spinal canal stenosis. Minimal narrowing of the neural foramina.

Output: 1. For the purposes of numbering, there are 7 cervical, 12 thoracic, and 4 lumbar type vertebral bodies, which is consistent with prior CT lumbar spine reports. The last rib-bearing vertebra is labeled T12.2. T7-T8 central disc extrusion with minimal craniocaudal extension. There is effacement of the ventral thecal sac and mild impression on the ventral thoracic cord. No cord signal abnormality. Otherwise no significant spinal canal or neural foraminal stenosis in the thoracic spine.3. Postoperative changes of interspinous fusion at L3-L4 with unchanged grade 1 anterolisthesis. There is mild to moderate degree of spinal canal stenosis at this level related to facet arthropathy and bony proliferation along the ligamentum flavum. There is also moderate right-sided neural foraminal stenosis where there may be impingement of the exiting right-sided nerve root.4. Mild to moderate left L2-L3 neural foraminal stenosis.5. C3-C4 disc herniation partially imaged on the sagittal localizer sequence with suggestion of mass effect on the ventral cord at this level.


Instruction: Generate impression based on findings.

Input: MENISCI: No significant abnormality noted. Specifically menisci are intact, no findings to suggest acute tear and both menisci are properly inserted posteriorly.ARTICULAR CARTILAGE AND BONE: Moderate edema is observed throughout the lateral compartment, both within the distal femur and proximal tibia. Cartilage is intact throughout.LIGAMENTS: Abnormal signal within the ACL with small amount of fluid suggesting intrasubstance tear, however fibers are intact throughout. Additionally the MCL demonstrates marked abnormal inflammation and strain involving the proximal insertion with mild adjacent inflammatory changes and minimal fluid. Suspected subacute abnormality, please correlate patient injury.PCL, LCL and retinaculum are otherwise intactEXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Acute tendinosis and mild intrasubstance tear of the ACL and proximal MCL. The constellation along with bone edema and contusion correlate with a clipping injury.


Instruction: Generate impression based on findings.

Input: Multiple sclerosis with left side numbness. There are several, greater than 10, foci of cerebral white matter T2 hyperintensity, the largest of which is in the right posterior periventricular region. There is also patchy high T2 signal in the pons. While many of the lesions demonstrate T1 hypointensity, there is no associated abnormal enhancement. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is a nasopharyngeal mucosal retention cyst.

Output: Findings compatible with multiple sclerosis.


Instruction: Generate impression based on findings.

Input: h/o spondylolysis. Examination demonstrates a spondylolysis of the left L4 pars interarticularis. The lumbar spine alignment and vertebral body height appear normal. No spinal stenosis or neuroforaminal compromise is identified.

Output: Spondylolysis of the left L4 pars interarticularis.


Instruction: Generate impression based on findings.

Input: 43 years Male (DOB:11/26/1972)Reason: left BG ICH History: left BG ICHPROVIDER/ATTENDING NAME: CHRISTOPHER L KRAMER CHRISTOPHER L KRAMER There is a hemorrhagic mass present involving the right thalamus and adjacent white matter which is associated with intraventricular blood. His blood products are dark on T2 and heterogeneous on T1 with mixed peripheral T1 signal and lower signal centrally. There is associated susceptibility effect with this. There is minimal enhancement around the hematoma. There is T2 and FLAIR signal hyperintensity surrounding the hematoma which is compatible with edema.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images..The right lateral ventricle is larger than the leftNormal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate opacities in the left and right maxillary sinus is compatible with mucous retention cysts.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: There is a hematoma centered in the right thalamus and extending into the adjacent white matter and associated with intraventricular blood. There is not appear to be an underlying mass associated with it. Its location suggests that it may be a hypertensive hemorrhage. No microhemorrhages are associated with this. If clinically appropriate when the hematoma recedes, an MRI evaluation may help exclude the possibility of an underlying abnormality obscured by the current blood products.


Instruction: Generate impression based on findings.

Input: Female 70 years old Reason: assess for ischemia History: altered mental status, h/o 2 prior CVAs. MRI is somewhat limited by patient motion.There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is periventricular and subcortical white matter T2/FLAIR hyperintensity which is nonspecific but likely related to chronic small vessel ischemic disease. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. Incidental note is made of a persistent cavum septum pellucidum. 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: 1.No evidence of acute intracranial hemorrhage, mass, or acute infarct.2.Moderate chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: Provided history of uterine fibroids. PELVIS:UTERUS, ADNEXA: Markedly enlarged uterus replaced with heterogeneous well-defined masses compatible with numerous large fibroids. The uterus measures 10.8 x 21.2 cm in the sagittal plane.A representative intramural fibroid in the posterior uterine body measures 6.7 x 6.0 cm (series 1 104/162) in axial dimension. In the anterior fundus the largest discrete fibroid measures 9.4 x 7.5 cm (series 1 104/310).The fibroids demonstrate moderate to marked arterial enhancement.The endometrium is markedly distorted by marked mass effect but is not thickened.Fluid-filled tubular structure in the left adnexa likely represents a hydrosalpinx. No significant surrounding inflammatory changes.In the region of the right adnexa physiologic cyst formation is suggested, less likely insinuating small bowel.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Markedly enlarged lobular fibromatous uterus. The fibroids demonstrate moderate to marked arterial enhancement.2. Left sided hydrosalpinx without significant inflammatory changes.


Instruction: Generate impression based on findings.

Input: Cervicalgia Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. There is mild anterolisthesis of C4 on C5 C5 on C6. Alignment is otherwise maintained. Bone marrow signal is benign. There is multilevel disc desiccation with particular loss of disc height at the C3-C4, C5-C6, and C6-C7 levels.The cervical spinal cord has normal signal characteristics and overall morphology.Degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina. Right-sided facet arthropathy.C3-4: No significant compromise to the spinal canal or neural foramina. There appears to be ankylosis of the right-sided facet joints.C4-5: Minimal disc osteophyte complex and ligamentum flavum thickening. There is no significant spinal canal stenosis. There is mild to moderate right neural foraminal stenosis related to uncovertebral hypertrophy and prominent facet arthropathy. No significant left neural foraminal narrowing.C5-6: Disc osteophyte complex and ligamentum flavum thickening. There is mild left neural foraminal narrowing related to uncovertebral hypertrophy and facet arthropathy. No signal right neural foraminal narrowing. Bilateral facet arthropathy.C6-7: Minimal disc osteophyte complex. No significant compromise to the spinal canal or neural foramina. Bilateral facet arthropathy.C7-T1: No significant compromise to the spinal canal or left neural foramen. Bilateral facet arthropathy. Minimal right neural foraminal narrowing.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: Multilevel degenerative changes in the cervical spine as described above. There is no significant spinal canal stenosis at any level or cord signal abnormality. Neural foraminal narrowing is relatively worst at the right C4-C5 level. There is also multilevel facet arthropathy, relatively worst at the C4-C5 level on the right, which may also be contributing to patient's neck pain.


Instruction: Generate impression based on findings.

Input: Patient used prophylactic antibiotics before and after the procedure as prescribed. The patient received antibiotic prophylaxis with oral Ciprofloxacin 500mg and Vantin 200mg. The patient took 1 tablet of Ciprofloxacin 500mg the night before and morning of the procedure. The patient also took 2 tablets of Vantin 200mg the morning of the procedure. After the procedures, the patient will take 2 tablets of Ciprofloxacin 500mg and 2 tablets of Vantin 200mg. Following the discussion of the risks, benefits, and alternatives of the procedure, informed consent was obtained. DynaCad was used to localize the right mid peripheral zone of the prostate (marked container 2) and the posterior gland at the base in the midline (marked container 1) at the site of the T2 hypointense enhancing lesions. Using the Dynatrim guidance system an 18-gauge MR- compatible needle was inserted into the target areas of the prostate gland. Upon confirmation of the tip of the needles close to the suspected lesion, MR guided biopsy using an 18 gauge biopsy needle was performed and 3 cores of each target were obtained.The cores were hand delivered to the pathology lab.The patient tolerated the procedure well and was discharged from the IR holding area without any immediate complications after a period of observation.ESTIMATED BLOOD LOSS: Less than 5 cc.

Output: 1. Successful core-biopsies of two prostate gland target lesions as detailed above.


Instruction: Generate impression based on findings.

Input: Again noted is a circumscribed homogeneously enhancing mass in the left retrobulbar space, encasing the diminutive and medially displaced left optic nerve. The mass measures 2.3 x 1.3 x 1.5 cm, not significant changed since the previous study; however, the mass is decreased in size compared to remote studies, consistent with expected post-treatment change. The mass fills the left orbital apex with complete encasement of the left superior ophthalmic vein. There is stable extension of enhancing tissue into the superior orbital fissure with minimal invasion of the lateral left cavernous sinus. Mild relative left proptosis is unchanged. The right orbit is unremarkable. Extraocular muscles are unremarkable.Scattered the nonspecific T2 hyperintensity is seen in the basal ganglia, which most likely represents prominent perivascular spaces. Again, seen stable plaque like area of dural based enhancement along the right inferior frontal gyrus, unchanged in size since previous study.

Output: 1. Stable enhancing left orbital mass encasing the left optic nerve which is diminutive in size and displaced medially. No changes since previous study.2. Also stable appearance of a plaque-like area of enhancement along the right gyrus rectus which likely represents a small intracranial meningioma, seen on multiple prior remote exams.


Instruction: Generate impression based on findings.

Input: Diagnosis: Neoplasm of unspecified behavior of unspecified siteClinical question: preop planning for tumor biopsySigns and Symptoms: preop planning The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a cystic appearing mass measuring 29 x 16 mm axial dimensions and located underneath the right half of the genu of the corpus callosum involving the right gyrus rectus and rostral anterior cingulate gyrus. It is associated with some local mass effect. It is unchanged in size when compared to the August exam.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.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: A cystic mass adjacent and inferior to the genu of the corpus callosum involving the subcallosal cingulate gyrus and posterior aspect of the gyrus rectus is stable compared to the prior exam.


Instruction: Generate impression based on findings.

Input: Evaluate for lesion, inflammatory changes: concern for transverse myelitis, decreased lower extremity sensation, wide based gait. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct, within the limits of artifact, from what may be dental hardware. The brain parenchyma and pituitary gland appear unremarkable. 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, although metal artifact obscures portions of the right face region.Spine: The spinal cord displays normal signal and morphology. The tip of the conus medullaris is positioned at the L1 level and the cauda equina nerve roots are unremarkable. There is no evidence of abnormal enhancement or tumors. There is mild straightening of the cervical spine alignment in the sagittal plane. The vertebral column alignment is otherwise within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The paravertebral soft tissues are unremarkable.

Output: No evidence of intracranial or spine lesions to suggest and inflammatory process.


Instruction: Generate impression based on findings.

Input: Evaluation of this study is significantly limited by the absence of thin-section sequences, which were inadvertently not acquired. Postcontrast images are limited by significant vascular pulsation artifact especially through the posterior fossa.The cystic structure described on fetal ultrasound and seen on 1-day-old outside hospital MRI is subtly suggested at the left cerebellopontine angle at the level of the right cisternal trigeminal nerve on the current study only on the axial T2-weighted sequence. It is occult on other sequences, with prominent flow artifact in this area on FLAIR imaging. The margins are not delineated sufficiently to permit measurement. This structure may be associated with the left trigeminal nerve, or alternatively may displace the trigeminal nerve as it is not well visualized, similar to prior. There is no significant change in contour of the adjacent pons to suggest significant interval growth. There is no significant mass effect or midline shift. There is no evidence of intracranial hemorrhage.The myelination pattern is appropriate for age. There is mild nonspecific prominence of the ventricles diffusely and anterior sulci.

Output: 1. The previously described cystic structure at the left cerebellopontine angle is not sufficiently visualized for measurement, although a significant interval increased size is suggested as there is no obvious new mass effect upon or contour deformity of the left ventral pons. Follow-up contrast enhanced imaging should include acquisition of a 3D-T1 sequence, an axial high-resolution or 3D-T2 sequence, and possibly a 3D FLAIR sequence through the area of the abnormality, for complete evaluation. Thin section coronal T2-weighted imaging could be obtained to better evaluate for the left trigeminal nerve location and morphology.2. There is nonspecific mild prominence of the ventricles and anterior sulci suggestive of benign enlargement of the subarachnoid spaces. This is a common finding in infants and should resolve by the age of 2 years. Follow-up imaging as clinically warranted.


Instruction: Generate impression based on findings.

Input: Rectal cancer staging post radiation treatment. PELVIS:UTERUS, ADNEXA: Status post hysterectomy.BLADDER: Partially distended urinary bladder without a focal abnormality.LYMPH NODES: The reference lymph node in the mesorectal fat adjacent to the left aspect of the upper rectum measures 4 x 4 mm (series 3/19) compared to 1.0 x 0.9 cm previously. No additional prominent lymphadenopathy.BOWEL, MESENTERY: Corresponding to the site of the previously seen upper rectal tumor there is a region of intermediate T2 weighted hypointensity (series 4/29) which likely predominantly represents collapsed mildly edematous bowel has there are additional regions of similar signal intensity throughout the rectosigmoid. This is associated with minimal restricted diffusion and postcontrast enhancement. No proximal obstructive dilatation. Sigmoid diverticulosis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Residual intermediate T2 weighted hypointensity at the site of the previously characterized upper rectal tumor is likely predominantly collapsed mildly edematous bowel associated with mild restricted diffusion and postcontrast enhancement without a measurable discrete lesion, compatible with near complete treatment response. Residual 4 mm left mesorectal lymph node, significantly decreased from prior.


Instruction: Generate impression based on findings.

Input: A patient submitted outside study for review. Submitted for review are digital mammographic images with tomosynthesis of left breast (2/23/15), ultrasound images of left breast (2/23/15) and breast MRI (3/4/15) performed at Edward Hospital. DIGITAL MAMMOGRAPHIC IMAGES WITH TOMOSYNTHESIS OF LEFT BREAST (2/23/15):The breast parenchyma is composed of scattered fibroglandular elements. Mild skin thickening is noted.No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in the left breast. Port-A-Cath is present in the left upper chest wall.ULTRASOUND IMAGES OF LEFT BREAST (2/23/15):Skin thickening with edema is seen at lower inner - lower outer left breast.No suspicious solid or cystic lesions are present in the provided images.BREAST MRI (3/4/15):The study was performed with a protocol outlined in the outside radiology report.Limited interpretation is made as MR images could not be transferred to our dedicated MR workstation.Status post right mastectomy.Significant artifact is noted at upper part of left breast, by Port-A-Cath.Diffuse edema and mild skin thickening is present within the lower half of left breast.No abnormal enhancing lesions are seen in the left breast or right mastectomy bed.

Output: 1. Diffuse skin thickening and edema in the lower half of left breast. Clinical correlation is recommended.2. No mammographic, sonographic evidence for malignancy in the left breast. Within the limited breast MRI study due to significant artifact, no definite evidence of malignancy in left breast or right mastectomy bed.3. Status post right mastectomy.BIRADS: 2 - Benign finding.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Dizziness and giddiness [R42], Reason for Study: ^Reason: R/o posterior stroke History: dizziness Brain MRIMotion artifact degraded image quality of some exams.No evidence of acute ischemic or hemorrhagic lesion on the scan. The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate irregular lumen on bilateral MCA bifurcation or distal, however, these findings are more likely artifactual mainly due to patient's motion. Bilateral ICAs, MCAs and ACA appear to be within normal limits. No evidence of significant luminal stenosis, no intracranial arterial aneurysm.Vertebrobasilar system appears to be normal. Neck MRAArterial bolus timing was missed, thus venous phase was used for this interpretation thus cannot be precise. If needed, the Neck MRA can be performed without additional charge.3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. There is normal flow enhancement through the bilateral common carotid, carotid bifurcations, internal/external carotid, and vertebral arteries. Proximal bilateral CCAs and bilateral vertebral artery origins cannot be evaluated.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. Normal brain MRA3. Extracranial craniocervical arterial system appears to be normal, however, since arterial phase examination is not available, precise evaluation is not possible. Neck MRA can be performed without additional charge if requested.


Instruction: Generate impression based on findings.

Input: 76 year old female status-post fall. There is no evidence of intracranial hemorrhage, mass or edema. Diffuse hypodensity in a periventricular and subcortical white matter distribution is consistent with small vessel disease, age indeterminate. Right frontal encephalomalacia. Left middle carotid artery appears slightly dense which in light of lack of adjacent ischemic changes may simply represent atherosclerotic calcifications, however if, there is clinical concern for acute ischemia, an MRI may be considered. Vascular calcifications affect the cavernous carotid bilaterally.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: Diffuse hypodensity in a periventricular and subcortical white matter distribution consistent with small vessel disease, age indeterminate. If there is clinical concern for acute ischemia, an MRI may be considered.


Instruction: Generate impression based on findings.

Input: CCM disease: please evaluate for changes and lesion burden. There is a partially enhancing multiloculated cavernous malformation in the anterior left superior frontal gyrus that measures up to 23 mm. While the lesion has not significantly changed in size, the signal characteristics of the lesion have evolved, with more high T1 and low T2 signal components and decreased fluid-fluid levels. There is surrounding hemosiderin deposition diffusely, but no vasogenic edema. There is a newly apparent high T2 and intermediate T1 signal intense lesion in the subcortical white matter of the anterior temporal lobe, with susceptibility effect. There is no evidence of acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable.

Output: 1. No significant interval change in size of the cavernous malformation within the anterior left superior frontal gyrus, although the hemorrhagic contents within the lesion have evolved. 2. A newly apparent subcentimeter lesion in the anterior left temporal lobe may represent an additional cavernous malformation.


Instruction: Generate impression based on findings.

Input: Lower extremity weakness and urinary incontinence There are multiple metastatic lesions in the visualized spine involving the anterior and posterior elements, most prominent in the thoracic spine at the T1, T7, and T8 levels and L4 and L5 levels in the lumbar spine. There is pathologic compression fractures involving the T7 and T8 vertebral bodies as well as the L5 vertebral body. Mild osseous retropulsion at the T8 level results in mild indentation of the ventral thoracic cord at this level with overall mild spinal canal stenosis.There is mild to moderate multilevel spinal canal stenosis in the cervical spine which is on a degenerative basis. No findings to suggest acute cord compression. Epidural tumor from L4-L5 to L5-S1 is better seen on same-day lumbar spine MRI with contrast. Multiple metastatic lesions in the partially imaged pelvis are also noted.

Output: 1. Diffuse osseous metastatic disease without evidence of acute cord compression.2. Pathologic compression fractures involving the T7, T8, and L5 vertebrae as seen on recent CT dated 8/31/2016. There is mild osseous retropulsion at the T8 level with overall mild spinal canal stenosis.3. There is epidural tumor from L4-L5 to L5-S1 levels which is better assessed on dedicated lumbar spine MRI with gadolinium study from same day.


Instruction: Generate impression based on findings.

Input: History of metastatic testicular cancer with brain metastases, treatment planning for SRS. There is redemonstration of two enhancing masses within the left frontal lobe. The larger mass measures approximately 19 x 28 x 23 mm and straddles the central sulcus with significant adjacent vasogenic edema and appears not significantly changed. There is some adjacent dural thickening which is likely reactive. There is an additional smaller and slightly inferiorly located subcentimeter enhancing lesion within the left centrum semiovale with surrounding mild adjacent vasogenic edema. There is susceptibility abnormality within the two lesions indicating intratumoral hemorrhage/hemosiderin. No additional intracranial lesions are identified.The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. Mild relatively uniform enhancement of the clivus and central skull base is seen, nonspecific. No other definite osseous lesions are detected.

Output: Limited treatment planning images again demonstrate two enhancing hemorrhagic masses within the left frontal lobe compatible with metastases, with the larger lesion straddling the central sulcus and causing significant local edema, not significantly changed compared to 8/13/2016.


Instruction: Generate impression based on findings.

Input: Syrinx, yearly follow up. There is no significant interval change in the long segment syringohydromyelia that measures up to 2 mm in width. The conus medullaris tip is located at L2. The vertebral column alignment is unchanged. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The paravertebral soft tissues are unremarkable.

Output: No significant interval change in the long segment syringohydromyelia that measures up to 2 mm in width.