Instruction: Generate impression based on findings.

Input: 46 year old female presenting with recent biopsy-proven intraductal papillary proliferation and focal ADH in the right breast inner quadrant presents for preoperative wire localization. On review of the prior studies, there are multiple oval masses in the lower inner right breast in a ductal distribution confirmed on ultrasound. One of the masses subsequently biopsied showed intraductal papillary proliferation and focal ADH. On MRI similar findings are seen within a large area of abnormal segmentally distributed clumped non-mass enhancement, spanning approximately 13 cm. Upon discussion with Dr. Jaskowiak, plan is to perform a bracket localization targeting the biopsy clip and additional asymmetry anteriorly.Target biopsy clip with adjacent masses are in the right breast in the lower inner quadrant region located posteriorly at 3 o’clock (site 1). Target asymmetric density is located in the right breast in the lower inner quadrant region located in mid-breast (site 2), anterior to site 1.The procedure, risks including bleeding, mis targeting and infection, and benefits of needle-wire localization were discussed with the patient. Questions were answered. Consent was obtained both verbally and in writing. The time out form was completed to confirm patient identity and site of procedure. Right breast wire localization site 1:The right breast was placed in an alphanumeric grid using medial to lateral approach. When the target was positioned in the aperture of the grid, the skin was cleansed with chlorhexidine. Local anesthesia was obtained using 2% Lidocaine. Using coordinates from the grid, a 5 cm Kopans needle was placed adjacent to the lesion. On orthogonal mammography, adequate positioning of the needle was confirmed after adjusting depth so the needle tip was approximately 2cm deep to the center of the target. A spring wire was then deployed. Repeat two view orthogonal mammograms reveal the spring wire to be in excellent position.Right breast wire localization site 2:The right breast was placed in an alphanumeric grid using medial to lateral approach. When the target was positioned in the aperture of the grid, the skin was cleansed with chlorhexidine. Local anesthesia was obtained using 2% Lidocaine. Using coordinates from the grid, a 5 cm Kopans needle was placed through the lesion. On orthogonal mammography, adequate positioning of the needle was confirmed after adjusting depth so the needle tip was approximately 2cm deep to the center of the target. A spring wire was then deployed. Repeat two view orthogonal mammograms reveal the spring wire to be in excellent position. The mammogram was annotated and reviewed with Dr. Jaskowiak prior to the patient's procedure. Patient tolerated the procedure well and was sent to the holding area in stable condition. Dr. Udoji performed the procedure under direct supervision of Dr. Abe, who was present during the procedure at all times.Orthogonal digital specimen radiographs revealed the clip, multiple small masses, and both wires to be within the specimen.

Output: Successful needle localization of the right breast, two sites.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Evaluate for biliary abnormality and hepatic vessel patency. ABDOMEN:LIVER, BILIARY TRACT: Postsurgical changes from liver transplant. Mild prominence of the biliary tree with patent anastomosis and smooth tapering of the CBD distally without an obstructing stone or lesion. Cholecystectomy.The hepatic artery is patent. The portal and hepatic veins are patent. The hepatic vein IVC anastomosis is suboptimally visualized due to susceptibility artifact but the vessels opacify normally and are normal in caliber. Scattered hepatic cysts without a suspicious lesion.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted. Punctate left renal 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: Orthotopic liver transplant without evidence of complication. Mild prominence of the biliary tree with patent anastomosis and distal tapering of the CBD without an obstructing stone, mass or stricture.


Instruction: Generate impression based on findings.

Input: 67-year-old female with history of pancreatic lesions seen on EGD/US. ABDOMEN:LIVER, BILIARY TRACT: There is mild intrahepatic biliary ductal dilatation. The common bile duct measures 9 mm. There are multiple tiny T2 hyperintense foci scattered throughout the liver which are too small to actually characterize.SPLEEN: No significant abnormality noted.PANCREAS: There is a poorly defined T2 hypointense mass arising from the pancreatic body/head junction measuring 3.0 x 1.8 cm (image 18 of series 8). There is abrupt cut off of the pancreatic duct along with distal atrophy. This lesion abuts the SMV and main portal vein. The proximal main portal vein is markedly attenuated. The splenic vein is thrombosed. There is soft tissue stranding surrounding the proximal SMA. There is hypertrophy of the common hepatic artery. The celiac trunk is not visualized.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Subcentimeter bilateral simple cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Nonenhancing T2 hyperintense lesions located within the right aspect of the sacrum and T11 vertebral body are nonspecific.OTHER: No significant abnormality noted.

Output: Pancreatic body mass as above with no convincing evidence of distant metastatic disease. Marked attenuation of the proximal main portal vein, splenic vein occluded. The celiac trunk is poorly visualized, most likely secondary to motion and technique. There is soft tissue stranding surrounding the SMA which may represent tumor involvement. A CTA is recommended for further evaluation of the vasculature.


Instruction: Generate impression based on findings.

Input: Lumbar polyradiculopathy with bilateral calf pain. There is transitional lumbar anatomy with lumbarization of the S1 vertebral body with a rudimentary S1-S2 intervertebral disc. For the purposes of numbering, the inferior most fully formed intervertebral disc space is considered to be the L5-S1 disc space.There is mild left curvature of the lumbar spine. The lumbar lordosis is preserved. The vertebral bodies are normally aligned. The vertebral body heights and intervertebral disc spaces are maintained. There is mild desiccation of the L2-3 and L3-4 intervertebral discs. The spinal cord and cauda equina demonstrate normal signal intensity and morphology. The conus is located at L2. A sacral Tarlov cyst is incidentally noted.T12-L1: No significant disc herniation, neuroforaminal stenosis or spinal stenosis is noted.L1-2: No significant disc herniation, neuroforaminal stenosis or spinal stenosis is noted.L2-3: There is a mild diffuse disc bulge without significant spinal or neuroforaminal stenosis.L3-4: There is a mild diffuse disc bulge without significant spinal or neuroforaminal stenosis.L4-5: No significant disc herniation, neuroforaminal stenosis or spinal stenosis is noted.L5-S1: No significant disc herniation, neuroforaminal stenosis or spinal stenosis is noted.

Output: 1. There is transitional lumbar anatomy with lumbarization of the S1 vertebral body and a rudimentary S1-S2 intervertebral disc. Please correlate with imaging of the entire spine if lumbar surgery is contemplated.2. Mild degenerative changes of the lumbar spine as described above.


Instruction: Generate impression based on findings.

Input: Clinical question: No acute intracranial abnormality. Bleed, metastases. Signs and symptoms: history of metastatic prostate cancer. New onset of headaches for one week associated with eye pain and balance problems Nonenhanced head CT:There is no evidence of intracranial hemorrhage, edema, mass-effect, midline shift or hydrocephalus. A very subtle area of low-attenuation with apparent involvement of cortex and subcortical white matter of left frontal lobe is present. The exact etiology of this finding is not clear however the finding could represent small ischemic stroke. The age of this is stroke cannot be determined due to small size. On this non-infused exam there is no evidence of metastatic disease. Recommend an MRI for further evaluation. Calvarium is intact. Mastoid air cells and paranasal sinuses are unremarkable.

Output: 1.Small focus of low-attenuation in the left frontal lobe likely result of ischemic stroke. Recommend further follow-up with MRI since the small size of this lesion makes precise determination of its age difficult.2.No evidence of metastatic disease on this non-infused study.3.Calvarium is intact.


Instruction: Generate impression based on findings.

Input: Grade II meningioma, s/p surgery and SRS. There are post-treatment findings related to right parietal craniotomy and radiation therapy. There is no significant interval change in size of an enhancing dural based lesion deep to the craniotomy, with extension to the superior sagittal sinus. There is also no significant interval change in size of the enhancing dural-based lesion along the right lateral parietal convexity with infiltration of the craniotomy flap margin. There are also small tumors along the posterior and lateral occipital convexities. There is persistent high T2 signal and scattered areas of gyriform enhancement in the posterior parietal lobes near the midline. There is no evidence of acute cerebral infarction. The ventricles are unchanged in size and configuration. There is no midline shift or herniation. There is a partially-empty sella. The skull and extracranial soft tissues are unchanged.

Output: 1. No significant interval change in size of the residual tumor in the right parasagittal surgical bed and lateral right parietal convexity. There are also small tumors along the posterior and lateral occipital convexities. 2. Persistent treatment effects in the bilateral posterior cerebral hemispheres, likely related to radiation necrosis.


Instruction: Generate impression based on findings.

Input: History of breast cancer and bloating, evaluate for mass ABDOMEN:LIVER, BILIARY TRACT: Hepatic steatosis.SPLEEN: Multiple small splenules, unchanged from prior PET/CT imaging.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Reference right external iliac lymph node measures 0.9 x 0.7 cm, image 38 series 13, unchanged.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Trace pleural fluid suggested bilaterally.PELVIS:UTERUS, ADNEXA: Status post hysterectomy and bilateral salpingo-oophorectomy. Scattered foci susceptibility artifact consistent with postsurgical sequela.BLADDER: No significant abnormality noted.BONES, SOFT TISSUES: Diastases of rectus abdominous muscles.

Output: 1. Stable reference right external iliac lymph node.


Instruction: Generate impression based on findings.

Input: Recurrent adenoid cystic carcinoma, status post radiation and surgery. There is no evidence of intracranial hemorrhage or infarction. There are scattered hypoattenuating foci in bilateral cerebral white matter, which may represent small vessel ischemic changes.Extensive post-treatment changes are again present involving the left orbit, maxillary region and upper neck. Again noted are enhancing soft tissue lesion involving the left orbit, extending to the orbital apex, superior and inferior orbital fissure. There is extension into the region of the left pterygopalatine fossa and left cavernous sinus. There is lesion involving the left nasopharyx and sphenopalatine foramen, with bony destruction at the floor of the sphenoid sinus and bone destruction of the left basisphenoid. There is soft tissue lesion overlying and lateral to the ramus of the left mandible. The lesion at the left lacrimal fossa measures slightly larger as 21 x 7 mm (image 12, series 3) compared to prior measurement of 19 x 5 mm (image 33, series 10). There is increased erosion of the lateral wall of the left orbit, with soft tissue lesion involving also the left temporalis muscle. The lesion overlying the ramus of the left mandible is also slightly increased.The enhancing lesions involving the anterior pole of the left temporal lobe, and enhancement in the left foramen ovale seen on prior MRI are not as well appreciated on this CT study and may be related to technical difference.There is patchy opacity in the right lung apex, which may represent inflammatory change. Degenerative disease of cervical spine is noted.

Output: 1. Enhancing lesions involving the left maxillary region and left orbit with extension into the left nasopharynx, left masticator space, sphenoid sinus, skull base, and left cavernous sinus as described above. There is subtle interval increase of the lesions as evident at lateral aspect of the left orbit and left masticator space.2. Enhancing lesion in anterior pole of the left temporal lobe seen on prior MRI study is not well-visualized and may be related to technical difference. This could potentially represent post radiation necrosis versus tumor brain parenchymal involvement. This can be further evaluated with MRI brain using skull base protocol.


Instruction: Generate impression based on findings.

Input: Reason: rule out PRES History: double vision Examination is limited to postcontrast sequences. Precontrast study was performed earlier same day. There is no abnormal parenchymal or meningeal enhancement. Major vascular structures are patent.

Output: Examination limited to postcontrast sequences. No abnormal enhancement. Please refer to separate MRI brain without contrast report from same day regarding additional findings.


Instruction: Generate impression based on findings.

Input: Reason: assess for brainstem/parietal lesion History: numb tongue. negative dental evaluation The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses and demonstrate mild mucosal thickening in the maxillary sinuses.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.No intracranial lesions are appreciated which would be able to explain the patient's tongue numbness.


Instruction: Generate impression based on findings.

Input: Prior multiple bowel surgeries with a chronic TPN, altered mental status. There are multiple small focal susceptibility artifacts on bihemispheric periventricular white matter. These lesions are not associated with surrounding edema or evidence of T1 or T2 signal intensity abnormality indicating nonacute nature. Therefore the possibilities include small parenchymal calcifications or chronic hemorrhagic foci.On FLAIR imaging, patch or nodular bihemispheric scattered high signal intensity lesions indicating nonspecific small vessel ischemic disease.There is no evidence of acute ischemic or hemorrhagic lesion on this 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, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. Nonspecific small vessel ischemic disease as described above.3. Multiple scattered susceptibility artifact lesions indicate possibility of parenchymal calcification or chronic hemorrhagic foci, possibility of acute focal hemorrhage is unlikely.


Instruction: Generate impression based on findings.

Input: 64-year-old male presents with left-sided facial droop. MRI Head: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is global parenchymal volume loss. Mild scattered periventricular and subcortical white matter T2 hyperintensity. There is no midline shift or herniation. The major cerebral flow voids are intact. There is a partially empty sella. There is patchy opacification of the left anterior ethmoid air cells. The orbits, skull, and scalp soft tissues are grossly unremarkable.MRA Brain: The intracranial internal carotid arteries demonstrate no significant stenosis. The middle and anterior cerebral arteries are also patent. The vertebral arteries, basilar artery, and posterior cerebral arteries also are patent with no significant stenosis. The right A1 segment of the anterior cerebral artery is hypoplastic No evidence of aneurysms or vascular malformations.MRA Neck: There is a separate origin of the left subclavian artery, left common carotid artery, and brachiocephalic artery from the arch. The common carotid arteries and cervical internal carotid arteries are normal in course and caliber. Both vertebral artery origins are patent. There is no evidence of stenosis or occlusion.

Output: 1. Mild scattered periventricular and subcortical white matter T2 hyperintensity may represent chronic small vessel ischemic disease, but no evidence of acute infarct.2. Mild scattered likely chronic small vessel ischemic disease.3. No high-grade stenosis involving the intracranial or neck arteries.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Female, 55 years old, with a left temporal tumor, fMRI requested for language lateralization prior to surgery. All tested language paradigms produced reliable language related activity. The highest quality images were obtained with the sentence completion, word generation, and verb generation paradigms. Language cortical activation was strongly right dominant with all paradigms. Putative Broca's area activity localized to the right inferior frontal gyri, and putative Wernicke's area activity localized along the posterior aspect of the right superior temporal sulcus. Strong secondary language related activity was elicited in the right middle frontal gyri, along with robust right SMA activation.

Output: Language related cortical activity is strongly right dominant.


Instruction: Generate impression based on findings.

Input: 51 years Female (DOB:9/14/1964)Reason: MS, follow up progression History: paresthesiasPROVIDER/ATTENDING NAME: ADIL JAVED ADIL JAVED MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. There are multiple periventricular white matter lesions present which are high signal on T2 and FLAIR imaging. These are perpendicularly oriented to the lateral ventricles. There are subcortical T2 and FLAIR hyperintense lesions present cerebellar hemispheres bilaterally. There is also a T2 and FLAIR hyperintense focus present in the lower medulla.. There are a few supratentorially located subcortical white matter lesions present as well. Total number of cerebral white matter lesions is approximately 15.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.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. There are multiple patchy T2 hyperintense foci present in the thoracic spinal cord. One is located the C1 vertebral level centered in the left hemicord. Another is at the right hemicord at the C2 level; another is at the left hemicord at the C4-5 disc level. Another one is located along the posterior central aspect of the spinal cord at the C5-6 level and another one along the left anterolateral aspect of the spinal cord at the C6 level. There is no associated mass effect with these lesions.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. There is a disc bulge present at this level associated with uncovertebral osteophytes and encroachment of the exiting nerve roots more on the left than the right side.At C5-6 there is no significant compromise to the spinal canal. There is a disc bulge present at this level associated with uncovertebral osteophytes and encroachment of the exiting nerve roots more on the left than the right side.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.Thoracic spine:The thoracic vertebral bodies are appropriate in the overall alignment and height. There is no compromise of thoracic spinal canal or exiting nerve roots. A T2 hyperintense focus is present along the right hemicord at the T9-T10. There is no associated mass effect.There is a left paramedian disc protrusion present at T8-9 which effaces spinal fluid ventral to the left hemicord. Smaller disc protrusions without significant CSF effacement are present at the right paramedian region at T7-8 and T9-T10.

Output: 1.There are multiple white matter lesions present within the brain and cervical spinal cord. These are suspected to be related to demyelination. 2.A spinal cord lesion located at the T9-10 level is associated with a disc protrusion that could also be related to demyelination.


Instruction: Generate impression based on findings.

Input: 47 year old woman with progressive systemic sclerosis and pulmonary sarcoidosis now referred for cardiac MRI to evaluate for any cardiac involvement of her sarcoidosis. Left VentricleThe left ventricle is mildly dilated with normal systolic function. The overall LV ejection fraction is 56%, the LV end diastolic volume index is 97 ml/m2 (normal range: 65+/-11), the LVEDV is 183 ml (normal range 109+/-23), the LV end systolic volume index is 43 ml/m2 (normal range 18+/-5), the LVESV is 81 ml (normal range 31+/-10), the LV mass index is 34 g/m2 (normal range 67+/-11), and the LV mass is 64 g (normal range 114+/-24). There is no increase in T2-STIR signal in the myocardium or pericardium to suggest the presence of edema. There no evidence of early gadolinium enhancement on T1 black blood imaging. Native myocardial T1 time 1033ms. There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 51%, the RV end diastolic volume index is 92 ml/m2 (normal range 69+/-14), the RVEDV is 172 ml (normal range 110+/-24), the RV end systolic volume index is 45 ml/m2 (normal range 22+/-8), and the RVESV is 84 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThere is pretracheal lymphadenopathy. Esophagus is dilated. 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. Mildly dilated LV with normal systolic function (EF 56%) without evidence of underlying myocardial fibrosis, inflammation, or infiltration. No CMR evidence of cardiac sarcoidosis. 2. Normal size RV with normal systolic function (EF 51%). 3. See extra-cardiac findings.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: The vertebral column alignment is within normal limits. The vertebral body heights are preserved. There is loss of disc height with disc desiccation and endplate degenerative changes throughout the cervical spine. There is mild heterogeneity of the marrow signal. The spinal cord displays normal signal and morphology. Mild mucosal thickening is present in the bilateral maxillary sinuses.C2-C3: No significant disc bulge, spinal canal or foraminal stenosis.C3-C4: Disc osteophyte complex, bilateral facet arthropathy and uncinate spurs, contributing to moderate left foraminal stenosis and encroachment of the left-sided exiting nerve roots. No significant spinal canal or right foraminal stenosis.C4-C5: Disc osteophyte complex, bilateral facet arthropathy and uncinate spurs, contributing to mild spinal canal stenosis and mild right and moderate left foraminal stenosis and encroachment of the exiting nerve roots.C5-C6: Disc osteophyte complex, bilateral facet arthropathy and uncinate spurs, contributing to mild bilateral foraminal stenosis and encroachment on exiting nerve roots. No significant spinal canal stenosis.C6-C7: Disc osteophyte complex, bilateral facet arthropathy and uncinate spurs, contributing to mild spinal canal stenosis and mild right and moderate left foraminal stenosis and encroachment on the left exiting nerve roots.C7-T1: Disc osteophyte complex, bilateral facet arthropathy and uncinate spurs, contributing to moderate right and mild left foraminal stenosis and encroachment on exiting nerve roots. No significant spinal canal stenosis.

Output: No significant interval change in degenerative spondylosis of the cervical spine, with mild spinal canal stenosis at C4-C5 and C6-C7, as well as multilevel foraminal stenosis and encroachment on exiting nerve roots as described above.


Instruction: Generate impression based on findings.

Input: 62-year-old female with pain and stiffness, progressive ring and small finger flexion contracture, possible mechanically locked trigger finger versus other pathology. LIGAMENTS: The ligaments are intact.TENDONS: There is abnormal volar displacement of the flexor tendon of the fourth digit with associated increased STIR signal interposed between the proximal phalanx and the tendon. In addition, at the level of the proximal phalanx there is indistinctness of the flexor tendon with intermediate signal intensity on T1-weighted sequences suggesting at least a partial thickness tear. Further distally however the flexor digitorum superficialis and profundus tendons are visualized and demonstrate normal signal intensity. At the level of the metacarpal there is fluid signal within the tendon sheath of the flexor tendons suggesting tenosynovitis. The remaining flexor tendons of the other digits are intact and appear normal. The extensor tendons are intact and appear normal. BONES: Bone marrow signal intensity is normal. The visualized erosions described on the subsequent radiograph are not well-defined on the current study.ADDITIONAL

Output: Findings are suggestive of at least a partial thickness tear of the flexor tendon of the fourth digit with possible tenosynovitis.


Instruction: Generate impression based on findings.

Input: Wrist pain, prior osteomyelitis A ball arthroplasty of the first carpometacarpal joint is noted with areas of susceptibility artifact overlying the surgical site.There is diffusely increased T2 signal with fragmentation and cystic changes throughout the carpal bones particularly involving the lunate. There is corresponding low signal throughout the carpal bones as well with areas of further decreased T1 signal involving the proximal pole of the scaphoid and the majority of the lunate. Following contrast administration, there is enhancement of the majority of the carpal bones excluding the proximal pole of the scaphoid and the majority of the lunate. There is no evidence of a focal fluid collection. There is diffuse soft tissue edema and enhancement following contrast representing inflammation.The flexor tendons appear unremarkable. The median nerve is enlarged. There is mild fluid surrounding the e fourth extensor compartment.

Output: Abnormal marrow signal throughout the majority of the carpal bones with areas of further decreased signal involving the proximal pole of the scaphoid and portions of the lunate. Given these changes, the possibility of chronic osteomyelitis cannot be excluded. Alternatively, this may be the result of severe degenerative change with areas of avascular necrosis involving the scaphoid and lunate.


Instruction: Generate impression based on findings.

Input: 63 years, Male, numbness. Dizziness and giddiness. Rule out old stroke. Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild chronic small vessel ischemic disease. No evidence of a prior large vascular territory infarct. Brain parenchyma is otherwise unremarkable for age. No restricted diffusion to suggest acute infarct. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. Major flow-voids are preserved. Sella and orbits are grossly unremarkable. There is minimal paranasal sinus mucosal thickening; sinuses are otherwise clear. Mastoid air cells are clear. Calvarium and extracranial soft tissues are grossly unremarkable.

Output: 1. Mild chronic small vessel ischemic disease. No findings to suggest a prior large vascular territory infarct.2. No evidence of acute infarct or intracranial mass effect.


Instruction: Generate impression based on findings.

Input: Biochemical recurrence of prostate cancer. PELVIS:PROSTATE: Status post prostatectomy. No discrete lesion is seen in the prostatectomy bed. The cystourethral anastomosis is unremarkable.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: Severe right hip arthropathy.OTHER: No significant abnormality noted.

Output: No specific findings of residual or recurrent tumor in the pelvis.


Instruction: Generate impression based on findings.

Input: Status post craniotomy with worsening headache. Evaluate for bleed. The patient is status post frontal craniotomy. Pneumocephalus and subcutaneous emphysema are likely postsurgical. In the left frontal high convexity an area of hypodensity with surrounding air represents the surgical bed. Foci of high attenuation likely represent a small amount of blood within the surgical bed. No large intracranial hemorrhage is identified. No midline shift. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Expected postoperative findings of a recent craniotomy. No large intracranial hemorrhage.


Instruction: Generate impression based on findings.

Input: 68 year old man with history of pericarditis, coronary disease and recurrent chest pain, referred for evaluation of continued pericarditis. 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 74 ml/m2 (normal range: 74+/-15), the LVEDV is 152 ml (normal range 142+/-34), the LV end systolic volume index is 28 ml/m2 (normal range 25+/-9), the LVESV is 57 ml (normal range 47+/-19), the LV mass index is 42 g/m2 (normal range 85+/-15), and the LV mass is 86 g (normal range 164+/-36). The myocardial:skeletal T2 ratio is normal (=2). There is late gadolinium enhancement in the basal inferior wall which involves the subendocardium and is in a pattern consistent with prior myocardial infarction. This was seen on prior cardiac MRI and is better visualized on today's study. The native T1 relaxation time is normal (1020ms). Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with low normal systolic function. The overall RV ejection fraction is 49%, the RV end diastolic volume index is 68 ml/m2 (normal range 82+/-16), the RVEDV is 139 ml (normal range 142+/-31), the RV end systolic volume index is 35 ml/m2 (normal range 31+/-9), and the RVESV is 71 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 trivial tricuspid regurgitation.AortaThere is a left sided aortic arch with a pseudo-bovine branching pattern. The aortic root is mildly dilated (ascending aorta 42mm).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 a small pericardial effusion. When compared to the previous study of 12/2015, there is focal thickening overlying the inferior, inferolateral and lateral walls of the left ventricle and there is prominently increased T2 signal, suggestive active pericarditis. There is also prominent late gadolinium enhancement in this same region. There is mild pericardial to myocardial tethering without evidence of variation in the septal position during respiration. These changes suggest recurrent active pericarditis without constrictive physiology.Extracardiac FindingsPreviously reported nodule located between the LV and pulmonary artery is a surgical clip from LIMA anastomosis site. Trivial left pleural effusion. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. There is pericardial thickening with evidence of active inflammation and mild tethering to the myocardium but no evidence of constrictive physiology. These changes have worsened when compared to the prior MRI study from 12/2015.2. Normal LV size with systolic function (LVEF 63%) with evidence of a small, non-transmural myocardial infarction which is unchanged from before.3. Normal RV size with low normal systolic function (RVEF 49%).4. Mild aortic root dilation. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: History of craniopharyngioma, status post 2 resections in 2002 and 2001. Stable vision loss and panhypopituitarism. There are postoperative findings related to left frontal craniotomy. There is redemonstration of a heterogeneous mass in the suprasellar region that measures up to approximately 15 mm, which has not significantly changed in size. There is persistent deformity of the adjacent optic apparatus. The pituitary gland itself is unremarkable. There are small mucous retention cysts are again noted in the maxillary and right sphenoid sinuses.

Output: No significant interval change in the residual suprasellar craniopharyngioma.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Reason: resolution of meningeal enhancement? History: headaches The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical confluent hyperintense white matter lesions present identified on the FLAIR and T2 images. Some of these signal changes extend into the thalami and midbrain are additional confluent signal hyperintensities are present in the deep white matter of the cerebellum. When compared to the previous exam these white matter signal hyperintensities have progressed.Since the prior exam right-sided leptomeningeal vascular enhancement has mildly regressed but has not resolved.There are small foci of enhancement present on the prior exam the right middle frontal gyrus and right parietal lobe which are not as conspicuous on the current exam.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits demonstrates a bright signal within the left eyeball.Incidental note is made of empty sella.

Output: 1.There is continued progression of diffuse white matter, thalamic, brainstem and deep cerebellar signal change. Etiology is uncertain.2.Since the prior exam leptomeningeal intravascular enhancement - suspected to be related to collateral flow - has a regressed. This change is non-specific. The patient is known to have a occlusion of the right middle cerebral artery.3.Ocular abnormalities are present. Please correlate with visual exam findings and history.


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. The patient took 1 tablet of Ciprofloxacin 500mg the night before and morning of the procedure. After the procedures, the patient will take 2 tablets of Ciprofloxacin 500mg.Following the discussion of the risks, benefits, and alternatives of the procedure, informed consent was obtained. DynaCad was used to localize two foci of signal abnormality within the prostate gland. One anteriorly in the mid gland and a second in the left peripheral zone posteriorly at the apex. Using the Dynatrim guidance system an 18-gauge MR- compatible needle was inserted into the anterior aspect and left side of the prostate. Upon confirmation of the tip of the needles close to the suspected lesions, MR guided biopsy using an 18 gauge biopsy needle was performed and 3 cores were obtained from each lesion.The cores were hand delivered to the pathology lab.The patient tolerated the procedure well and was discharged without any immediate complications.ESTIMATED BLOOD LOSS: Less than 5 cc.

Output: 1. Successful core-biopsies of the prostate gland as detailed above.


Instruction: Generate impression based on findings.

Input: 13-year-old with history of Chiari malformation status post decompression as well as pituitary microadenoma status post transsphenoidal resection. Follow-up exam. Pituitary: Expected postoperative findings from prior transsphenoidal pituitary resection. There is about 4mm sized non enhancing foci on the right anterior aspect of the pituitary fossa on dynamic pituitary imaging (series 1401, image 22/40). Since the scan parameter especially slice thickness of the delayed coronal and sagittal scan was different (3mm) from that of dynamic scan (2.5mm), it was difficult to determine the nature of the lesion. In particular, it is not clear if the lesion shows no enhancement or enhancement on delayed scan. Especially on delayed post contrast sagittal scan, the lesion appears to be located on the anterior aspect of pituitary fossa which could raise possibility of partial volume artifacts with sphenoid sinus wall. Comparing to prior scan on Jan 8 2015 dynamic MRI scan, the lesion has not been changed in term of MR characteristics and size (series 1401, image 21/40). Constellation of these findings indicate the lesion could suggest partial volume artifacts of sphenoid sinus wall, postoperative scar or changes or less likely residual pituitary lesion. Clinical and laboratory correlation would help the differential diagnosis.There is no focal enhancement or discrete underlying mass lesion to suggest recurrent microadenoma. The infundibulum is intact and not significantly deviated. There is no mass effect on the adjacent structures. The cavernous sinus is intact.Brain: Postoperative findings related to prior suboccipital decompression. There is a stable appearance of the cerebellar tonsils. No evidence of intracranial hemorrhage, mass, or acute infarct. There is stable asymmetry of the lateral ventricles with the right slightly larger than the left. The major cerebral flow voids are intact. CSF flow imaging at the level of the foramen magnum shows robust bidirectional flow along the ventral aspect of the cord. No significant flow is appreciated along the dorsal aspect of the cord, however this may be technical as this region appears widely patent.

Output: 1. Postoperative changes from transsphenoidal pituitary resection without evidence of recurrent pituitary mass.2. Non enhancing lesion on the dynamic pituitary imaging on the anterior and slightly right lateral aspect of the pituitary fossa was seen, unchanged since prior scan. 3. Postoperative changes from suboccipital decompression. CSF flow imaging at the level of the foramen magnum shows robust bidirectional flow along the ventral aspect of the cord. No significant flow is appreciated along the dorsal aspect of the cord, however this may be technical as this region appears widely patent.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Reason: rule out evidence of recurrent disease History: s/p pelvic exenteration. PELVIS:UTERUS, ADNEXA: Postsurgical changes of an anterior pelvic exenteration. No evidence of recurrence. BLADDER: Postsurgical changes of a cystectomy. LYMPH NODES: No lymphadenopathy.BOWEL, MESENTERY: Right lower quadrant ileal conduit.BONES, SOFT TISSUES: Right sacral insufficiency fracture, not significantly changed. Stable nonspecific subcentimeter focus of hyperintense T2 signal intensity in the left sacral ala without enhancement. Postradiation changes of the bones. OTHER: Trace free fluid.

Output: Posttreatment changes with no definite evidence of recurrence or metastatic disease.


Instruction: Generate impression based on findings.

Input: There is a new 13x12 mm mass-like focus of intense enhancement in the right lateral occipital lobe slightly inferior and lateral to the postoperative cavity with associated mild restricted diffusion and increased relative CBV. Surrounding hyperintensity couldThere is minimal enhancement along the resection cavity margin which is compatible with treatment change. There are postoperative findings related to right occipital mass resection with resolved pneumocephalus and decreased intrinsic T1 shortening along the surgical cavity and subjacent dural thickening with linear enhancement. There is persistent nonspecific and nonenhancing confluent T2 hyperintensity and mild mass effect in the right parietal and occipital lobes which is stable to slightly decreased.

Output: 1.New 12x13 mm solid enhancing nodule in the right lateral occipital lobe inferolateral to the resection cavity. There is mild restricted diffusion and some elevation in CBV. Although this patient has had recent radiation treatment, findings are suspicious for tumor progression. Suggest close follow-up.2.Evolution of right occipital resection cavity with mild enhancement in the resection bed which may represent treatment change.


Instruction: Generate impression based on findings.

Input: 63-year-old female with cervical cancer and seizures, concern for metastasis. There is no evidence of intracranial hemorrhage, mass, or acute infarct. Scattered punctate foci of increased T2 signal within the periventricular and subcortical white matter, do not appear substantially changed compared from the prior examination, when accounting for differences in acquisition technique. The hippocampi are normal in signal and morphology. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1.No evidence of intracranial hemorrhage, mass, or acute infarct.2.Grossly stable scattered foci of high T2 signal in the periventricular and subcortical white matter are nonspecific, but may reflect chronic small vessel ischemic disease.3.Normal appearance of the bilateral hippocampi.


Instruction: Generate impression based on findings.

Input: 63-year-old male patient with elevated PSA. PELVIS:PROSTATE:Prostate Size: The prostate measures 4.6 x 3.3 x 3.3 cm (transverse by AP by craniocaudal).Peripheral Zone: There is a region of signal abnormality within the right mid/right base of the peripheral zone which demonstrates T2 hypointensity. Within this region of T2 signal abnormality, there is a more focal 9 x 9 mm region of corresponding ADC hypointensity and early enhancement suspicious for carcinoma (image 136, series 806). The overlying capsule is indistinct compatible with extraprostatic extension.There is another region of T2 and ADC signal hypointensity with equivocal early enhancement within the left mid gland of the peripheral zone measuring 12 x 11 mm (image 14, series 401), which is suspicious for carcinoma.Central Gland: The is unremarkable.Seminal Vesicles: No definite involvement.Extracapsular Extension: As described above. BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Outside exam read:1. Two regions of signal abnormality within the right mid/base and left mid gland of the peripheral zone suspicious for tumor. 2. Extraprostatic extension of tumor on the right.


Instruction: Generate impression based on findings.

Input: 52-year-old male with groin pain. Evaluate for labral tear. ACETABULAR LABRUM: There is heterogeneity and increased signal abnormality affecting the anterior superior acetabular labrum, extending from the level of the 9 o'clock position to the 11 o'clock position, indicating a tear. There is a CAM deformity along the anterior superior femoral head/neck junction with an elevated alpha angle measuring approximately 61 degrees.ARTICULAR CARTILAGE AND BONE: There is a CAM deformity along the anterior superior femoral head/neck junction with an elevated alpha angle measuring approximately 61 degrees. There is osteophyte formation affecting the right hip indicating mild osteoarthritis. No bone marrow signal abnormality is identified. No full-thickness articular cartilage defects are seen.SOFT TISSUES: The imaged musculature is normal in appearance.ADDITIONAL

Output: 1. CAM deformity and anterior superior acetabular labral tear.2. Nonspecific 3 cm focus of fluid signal intensity along the inferior aspect of the apex of the prostate gland is incompletely imaged and characterized on this examination but may represent a urethral diverticulum.


Instruction: Generate impression based on findings.

Input: Recent spells of ataxia, headache possible visual loss and history of colon cancer. MRI: There is a 6 mm diameter lesion with extensive peripheral susceptibility effect and punctate central T1 and T2 hyperintensity in the white matter anterior to the frontal horn of the left lateral ventricle. There is perhaps a small adjacent developmental venous anomaly. There is no evidence of intracranial hemorrhage or acute infarct. The brainstem and cerebellum 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 skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. The right globe is elongated with a scleral buckle and lens implant.MRA: There is no evidence of significant steno-occlusive lesions or aneurysms.

Output: 1. A 6 mm diameter lesion in the white matter anterior to the frontal horn of the left lateral ventricle likely represents a cavernous malformation. 2. No evidence of acute acute infarct.3. No evidence of significant steno-occlusive lesions or aneurysms.


Instruction: Generate impression based on findings.

Input: A patient submitted outside study for review. There are two biopsy proven IDC (12:30 position and 1:00 position) in the left breast. Submitted for review are breast MRI (8/16/16) performed at outside institution. For comparison, digital mammographic images (6/14/16), ultrasound images of left breast (7/8/16), images from ultrasound guided biopsy of left breast and postprocedural left mammographic images (8/2/16) are available. Breast MRI was performed with a protocol outlined in the outside radiology report.There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.LEFT BREAST:There are two marker clips in the left breast from recent biopsy at 12:30 position and 1:00 position (12:30 clip is superior to 1:00 clip). Inferior to the 1:00 clip, there is a 17 mm hematoma. On the post-contrast images, there is an enhancing mass measuring 8 x 9 x 8 mm (AP x LR x CC) at immediately anterior to the 12:30 clip, and another enhancing mass around the 1:00 clip, measuring 9 x 10 x 6 mm, located just superior to the hematoma. Both correspond to the proven carcinoma. Overall measurement of these two masses is 15 x 15 x 24 mm.In addition, there is a linear non-mass enhancement extending anteriorly from the masses, measuring 30 x 12 x 12 mm. Overall AP measurement of the masses and the non-mass enhancement is 43 mm.RIGHT BREAST:No abnormal enhancement is seen in right breast. AXILLAE:No abnormal lymph nodes are identified in either axillary region.

Output: 1. Two proven carcinoma with clip associated with hematoma at 12:30 - 1:00 position in the left breast. Suspicious non-mass enhancement extending anteriorly from the proven cancer. MR guided biopsy of the non-mass enhancement should be considered if breast conservation surgery is planned.2. No abnormal enhancement in right breast. 3. No abnormal lymph nodes are identified in either axillary region.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration.


Instruction: Generate impression based on findings.

Input: Diagnosis: Other specified counseling. Neoplasm of unspecified behavior of unspecified siteClinical question: Patient has MRI compatible pacemaker. Will see Device Clinic. Preop planning for brain biopsy. Signs and Symptoms: preop planning The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a 73 x 53 mm axial dimension mass involving right basal ganglia and adjacent right frontal lobe which extends to involve gray and white matter of the insular cortex and right orbital gyrus and right inferior frontal gyrus does not display any contrast enhancement.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate a mucous retention cyst in the right maxillary sinus and mucosal thickening elsewhere in the paranasal sinuses. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: There is a mass involving right frontal lobe, insular cortex and basal ganglia. Most likely this represents a primary brain tumor such as an oligodendroglioma. Please note this examination is a limited exam for the purposes of stereotactic guidance.


Instruction: Generate impression based on findings.

Input: Clinical question: Persistent nausea without clear etiology. Rule out mass/neural cause. Signs and symptoms: Nausea Nonenhanced head CT:Examination demonstrates several periventricular and subcortical nonspecific foci of low attenuation of white matter. As was noted on prior MRI examination these findings are suggestive of demyelinating disease. There is no evidence of hemorrhage, edema, mass-effect, midline shift or hydrocephalus.The cortical sulci and ventricular system remain normal for patient stated age.Calvarium is intact. Visualized paranasal sinuses, mastoid air cells and middle ear cavities are unremarkable.

Output: 1.Periventricular and subcortical white matter low-attenuation and white matter consistent with patient's known multiple sclerosis.2.No evidence of acute intracranial hemorrhage, edema, mass-effect, midline shift or hydrocephalus.


Instruction: Generate impression based on findings.

Input: 33-year-old with history bilateral breast cancers. Prior benign MRI guided biopsy of the left breast. Minimal parenchymal enhancement is noted bilaterally. There is scattered fibroglandular tissue in both breasts. No suspicious enhancement is seen in either breast. The small enhancing mass in the left breast near the 4 clock position does not appear significantly changed. Signal changes suggestive of an adjacent biopsy clip are present. Elsewhere, a few scattered enhancing foci do not appear significantly changed. Postsurgical changes in each breast are noted.No abnormal axillary lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: Multiple myeloma. New left hip pain. Examination of the images reveal normal bone marrow throughout the pelvis including the proximal femurs. No evidence is seen of any myelomatous lesions. The soft tissues are unremarkable.

Output: No evidence is seen of any bone lesions.


Instruction: Generate impression based on findings.

Input: Evaluate for vascular disease in stroke and dementia. MRI: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is an areas of encephalomalacia in the right cerebellar hemisphere that measures up to 15 mm. There is moderate scattered cerebral white matter T2 hyperintensity. There is mild diffuse cerebral volume loss. There is no midline shift or herniation. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is nonspecific fluid in the right mastoid air cells.MRA: There is mild basilar dolichoectasia. Otherwise, there is no evidence of significant steno-occlusive lesions or aneurysms.

Output: 1. Chronic right cerebellar hemisphere infarct and probable chronic small vessel ischemic disease, but no evidence of acute intracranial hemorrhage, mass, or acute infarct.2. Mild diffuse cerebral volume loss. 3. No evidence of significant steno-occlusive lesions


Instruction: Generate impression based on findings.

Input: Clinical question: Surgical planning for craniotomy. Signs and symptoms: Weakness. Pre and post enhanced Stealth brain MRI:Examination is performed utilizing surgical planning protocol and is not a complete diagnostic study.There is a large necrotic and rim enhancing mass in the right mid temporal lobe and extending superiorly into the right basal ganglia. The largest transaxial dimensions of tumor measures approximately at 41 x 33 mm. The mass applies mass effect on the right temporal horn of lateral ventricle and inseparable from the ventricle or the right choroid plexus in the trigone of right lateral ventricle. There is however no detectable ependymoma enhancement of the ventricular wall.Mass effect results in leftward deviation of midline of approximately 7 mm and without evidence of ventriculomegaly. There is no detectable additional foci parenchymal or leptomeningeal enhancement. There is also no detectable calvarial or retro-orbital enhancement.

Output: Necrotic rim enhancing tumor (41 x 33 mm) suspected of GBM in the right temporal lobe with surrounding vasogenic edema and 7 mm leftward midline shift.


Instruction: Generate impression based on findings.

Input: Breast cancer with brain metastases: surveillance. There are multiple predominantly ring-enhancing lesions in the bilateral cerebral hemispheres and right cerebellar hemisphere, which are stable to decreased in size. For example, a left anterior cingulate gyrus lesion measures up to 10 mm, previously 13 mm, while a right basal ganglia lesion measures up to 12 mm, previously also 12 mm. In addition, the degree of with associated vasogenic edema has diminished, accounting for differences in technique. The ventricles appear to be similar in size and configuration. There is no midline shift or herniation. The orbits are unremarkable. There is a newly apparent subcentimeter nodule in the apical scalp, perhaps with mild enhancement.

Output: 1. The multiple intracranial metastases and associated vasogenic edema are stable to decreased in size, accounting for differences in technique. 2. A newly apparent subcentimeter nodule in the apical scalp is nonspecific, but may represent a metastatic lesion, for example.


Instruction: Generate impression based on findings.

Input: Redemonstrated is nonenhancing T2/FLAIR hyperintense lesion with gyral thickening involving the left medial and anterior temporal lobe including the amygdala and extending to the insular cortex. Asymmetric T2/FLAIR hyperintensity is also noted involving the left posterior frontal corona radiata extending towards the posterior limb of the internal capsule and similar to prior. There is no new mass effect. There is an unchanged left thalamic developmental venous anomaly and adjacent T1 shortening and enhancement. Unchanged small focus of T2/FLAIR hyperintensity involving the left parietal subcortical white matter related to prior ischemia. Additional scattered foci of T2/FLAIR hyperintensity in the periventricular and subcortical white matter are nonspecific but compatible with small vessel ischemic and/or posttreatment changes. There is no evidence of acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No significant change in appearance of the infiltrating neoplasm involving the medial and anterior left temporal lobe as well as the insular cortex dating back to 12/19/2014.


Instruction: Generate impression based on findings.

Input: Colloid cyst resection, evaluate for recurrence. Again seen are postsurgical changes related to transcallosal resection of colloid cyst. There is no discernible intraventricular lesion, and the ventricles are unchanged in size. Again seen is extensive patchy cerebral white matter T2 hyperintensity in the periventricular and subcortical white matter, which may represent moderate chronic small vessel ischemic disease. There is mild increase in prominence of the FLAIR signal abnormality in the bilateral frontal lobes, which is favored to represent evolution of the perioperative cytotoxic edema evident on prior MRI from 4/6/2015. No midline shift or herniation. There are postoperative findings related to rhinoplasty.

Output: Slight further evolution of postoperative findings related to colloid cyst resection without evidence of recurrent colloid cyst.


Instruction: Generate impression based on findings.

Input: Compared to 7/23/2015, there is mild decrease in size of intradural enhancing mass at the L3 level. The mass previously measuring 14 x 19 x 30 mm now measures 14 x 18 x 25 mm in the AP, transverse, and craniocaudal dimensions. Mass is again noted to occupy the entire sac in the transverse plane. There is T1 shortening involving the marrow which may be related to radiation treatment. No suspicious osseous lesions in the lumbar spine are appreciated. No new intradural enhancing lesion.Again seen is a lesion involving the right sacrum with linear low T1 and T2 signal and surrounding enhancement. This finding is suboptimally visualized due to its location. Mixed lytic and sclerotic changes are seen on prior CT. Finding is most consistent with a healing fracture although an underlying osseous lesion is not entirely excluded. Vertebral body heights and alignment are maintained. Mild degenerative changes are seen as described below:T12/L1: UnremarkableL1/2: UnremarkableL2/3: Mild disc bulge without significant spinal canal or neural foraminal stenosisL3/4: Asymmetric bulge to the right, ligamentum flavum thickening, and mild bilateral facet hypertrophy. There is mild right neural foraminal stenosis as before. No significant spinal canal or left neural foraminal stenosis.L4/5: There is a small central disc protrusion with superimposed asymmetric bulge to the right. There is also ligamentum flavum thickening and mild bilateral facet hypertrophy. There is mild right neural foraminal stenosis. No significant spinal canal or left neural foraminal narrowing.L5/S1: Asymmetric bulge to the left causing mild left neural foraminal stenosis. No spinal canal or right neural foraminal narrowing.

Output: 1.Compared to 7/23/2015, there is decrease in size of intradural enhancing mass at the L3 level compatible with treatment response. No new lesions. 2.Partially visualized linear signal abnormality involving the right sacrum again seen which is favored to represent an insufficiency fracture. Underlying metastatic lesion seems less likely but not entirely excluded.


Instruction: Generate impression based on findings.

Input: Intracerebral hemorrhage. Right sided weakness not explained by intracranial hemorrhage. MRI thoracic spine:There are patchy T2 hyperintense signal changes involving the right peripheral hemicord more than the left at the T3-4 level (series 801 images 16-20). There is no mass effect or cord enlargement associate with these.There are endplate osteophytes at T4-5 and to a lesser degree at other levels.There is a T1 hyperintense lesion at T1 likely representing hemangioma.There are multilevel small perineural cysts present in the neural foramina.The thoracic vertebral bodies are appropriate in the overall alignment and height. There is no compromise of thoracic spinal canal or exiting nerve roots. 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. There is multilevel disk dessication present. At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is bilateral facet hypertrophy present at this level.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is mild bilateral facet hypertrophy present at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.There are small Tarlov cysts in the sacral spinal canal.

Output: 1.Thoracic spinal cord lesions involving the right hemicord more than the left are non-specific. These could relate to demyelination, though the possibility that they are the consequence of transverse myelitis cannot be excluded. They involve periphery of the cord (white matter).2.There are mild degenerative changes in the lumbar and thoracic spines.


Instruction: Generate impression based on findings.

Input: 66-year-old woman history of bilateral breast biopsies with pathology showing atypia presents for further evaluation of a right breast mass identified on CT 4/7/2016. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is extremely dense, which lowers the sensitivity of mammography(BiRads Density Category D), unchanged in pattern and distribution. Linear scar markers were placed over both breasts. There is postsurgical distortion in the central left breast deep to the scar markers, stable dating back to 2013. There is an encapsulated mass in the right lower outer quadrant correlating to the finding on CT. The density of this mass is similar to the density of the breast tissue. Upon review of prior mammograms and MRI dating back to 2005, this mass is unchanged over many years. Overall imaging characteristics are consistent with a fibroadenolipoma (hamartoma), benign.There is no suspicious mass or microcalcification in either breast. A few scattered benign calcifications are present.

Output: Right breast fibroadenolipoma, unchanged dating back to 2005 and correlating to the finding on recent CT. Postsurgical changes of both breasts. No mammographic evidence of malignancy. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: Evaluate pancreatic pseudocyst evolvement. History of Crohn's disease and chronic pancreatitis. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology size, signal intensity and enhancement. No intrahepatic or extrahepatic biliary ductal dilatation. Normally distended gallbladder without gallstones.SPLEEN: Trace perisplenic fluid. Otherwise the spleen is normal in morphology and size.PANCREAS: Compared to the recent 1/2/2015 MRI there is mild increase in interstitial edema-type signal of the pancreatic parenchyma and peripancreatic inflammatory fluid/fat stranding. However the peripancreatic peripherally enhancing lobular fluid collections extending superiorly towards the porta hepatis measuring approximately 3.1 x 1.7 cm (series 1201/192) and anteroinferiorly towards the lesser curvature of the stomach measuring 1.4 cm (series 1201/102) are significantly decreased in size. There is heterogeneous enhancement of the pancreatic parenchyma predominantly affecting the body but no evidence of parenchymal necrosis or hemorrhage. There is narrowing and irregular mild dilatation of the pancreatic duct which is improved from the 1/2/2015 study.Please note that the retroperitoneal heterogeneous mass about the SMA noted on the 10/26/2015 study has essentially resolved.There is narrowing of the SMV splenic vein and portal vein confluence without discrete thrombus.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Partially duplicated right collecting system.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Mild right basilar atelectasis. Susceptibly artifact from sternotomy hardware.

Output: Findings compatible with acute edematous interstitial pancreatitis superimposed on chronic pancreatitis with short interval decrease in the peripancreatic fluid collections.


Instruction: Generate impression based on findings.

Input: The risks (including, but not limited to, those of bleeding, infection, allergic reaction, temporary nerve block, pain, and inability to access the joint) and benefits of the procedure were explained to the patient, and informed written consent was obtained. A pre-procedural “time-out” form was completed.The patient was placed supine on the fluoroscopy table. The right hip was localized fluoroscopically, and a spot radiograph was obtained. The course of the femoral artery was noted on the patient's skin using an ink marker. The skin was cleansed and covered with a sterile drape. The skin and subcutaneous tissues were anesthetized with 1% lidocaine using 25-gauge and 22-gauge needles.Under fluoroscopic guidance, a 20-gauge spinal needle was advanced into the joint. Attempted aspiration yielded no fluid. Next, 8 ml of a 50/50 mixture of Omnipaque 240 (to confirm the intra-articular position of the needle) and dilute Multihance (0.1 cc in a 10 cc vial of saline, for subsequent MR imaging) were injected into the joint. Contrast opacified the joint in the expected manner. A spot radiograph was obtained for documentation. The needle was withdrawn. Blood loss was negligible (<1cc), and patient tolerated the procedure well without immediate complication. An adhesive bandage was placed on the patient’s skin. Routine post procedure instructions were communicated to the patient. The patient was escorted to the MRI suite for further imaging in stable condition. Please refer to the subsequent MRI report for further information.Exposure time: 16 seconds.

Output: Successful fluoroscopic guided injection of dilute gadolinium into the right hip for subsequent MRI arthrogram examination.


Instruction: Generate impression based on findings.

Input: 56 year old man with elevated cardiac biomarkers but no evidence of obstructive coronary artery disease. He is referred to evaluate for myocarditis. Left VentricleThe left ventricle is normal in size with low normal systolic function. The overall LV ejection fraction is 53%, the LV end diastolic volume index is 89 ml/m2 (normal range: 74+/-15), the LVEDV is 200 ml (normal range 142+/-34), the LV end systolic volume index is 42 ml/m2 (normal range 25+/-9), the LVESV is 95 ml (normal range 47+/-19), the LV mass index is 63 g/m2 (normal range 85+/-15), and the LV mass is 141 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is epicardial late gadolinium enhancement in a pattern atypical for prior myocardial infarction. It involves the mid anterolateral and inferolateral walls and the apical lateral wall. The finding most likely represents myocarditis. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 58%, the RV end diastolic volume index is 92 ml/m2 (normal range 82+/-16), the RVEDV is 207 ml (normal range 142+/-31), the RV end systolic volume index is 38 ml/m2 (normal range 31+/-9), and the RVESV is 87 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 mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is mildly dilated (32mm).Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Normal LV size with low normal systolic function (LVEF 53%). There is epicardial late gadolinium enhancement in a pattern atypical for prior myocardial infarction. It involves the mid anterolateral and inferolateral walls and the apical lateral wall. The finding most likely represents acute/ subacute myocarditis. 2. Normal RV size and systolic function (RVEF 58%). 3. Mild mitral regurgitation.4. Mild dilation of the main pulmonary artery.


Instruction: Generate impression based on findings.

Input: Female 52 years old Reason: Assess ulnar length for ulna plus in pt with known TFCC injury and lunate cysts History: ulnar wrist pain Bone mineralization is normal. There are cystic changes in the proximal pole of the lunate adjacent to the ulna.Ulnar variance is near neutral. Degenerative changes at the basilar joint.

Output: Cystic changes in the proximal pole of the lunate and ulnar variance which is near neutral.


Instruction: Generate impression based on findings.

Input: 76-year-old female with pain and swelling history of left leg abscess and lower left extremity bypass. There is diffuse fatty atrophy of the musculature about the left knee and leg. There is nonspecific subcutaneous edema, most pronounced along the medial aspect of the leg. There is increased signal abnormality within the flexor hallucis longus and gastrocnemius muscles on fluid sensitive sequences which is nonspecific. No focal fluid collection to suggest abscess formation. No bone marrow signal abnormality is identified. No findings to suggest osteomyelitis. Note is made of foci of signal void along the medial aspect of the knee which are presumably postsurgical in etiology. Linear decreased signal abnormality along the medial aspect of the knee presumably represents scarring. Although this examination was not protocoled for detailed evaluation of the knee, severe osteoarthritis affects the left knee.

Output: Osteoarthritis of the left knee as well as nonspecific subcutaneous and soft tissue edema about the leg. No focal fluid collection to suggest abscess formation, as clinically questioned.


Instruction: Generate impression based on findings.

Input: 18 year old male with a history of palpitations and tachycardia, and family history of RV dysplasia (cousin). Referred for cardiovascular MRI to evaluate for right ventricular dysplasia. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 59%, the LV end diastolic volume index is 89 ml/m2 (normal range: 74+/-15), the LVEDV is 180 ml (normal range 142+/-34), the LV end systolic volume index is 38 ml/m2 (normal range 25+/-9), the LVESV is 77 ml (normal range 47+/-19), the LV mass index is 75 g/m2 (normal range 85+/-15), and the LV mass is 152 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and systolic function without focal wall motion abnormality. The overall RV ejection fraction is 57%, the RV end diastolic volume index is 79 ml/m2 (normal range 82+/-16), the RVEDV is 191 ml (normal range 142+/-31), the RV end systolic volume index is 34 ml/m2 (normal range 31+/-9), and the RVESV is 69 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Left ventricle is normal in size and systolic function (LVEF 59%) without evidence of underlying myocardial fibrosis, inflammation, or infiltration. 2. Right ventricle is normal in size and systolic function (RVEF 57%) without cardiac MRI evidence of arrhythmogenic right ventricular dysplasia. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 26 year old woman lactating, retrobulbar headaches. Evaluate for mass, pituitary adenoma. There is no evidence of intracranial hemorrhage, mass or edema. There is a lateral temporal hypodensity visualized on a single slice (series 2 image 10). This is likely volume averaging artifact. There is no definite pituitary adenoma, however MRI is superior for detection of pituitary adenomas.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: 1. Normal brain CT. Unclear from the history if patient has galactorrhea or normal lactation. It galactorrhea is present, MRI would be appropriate to evaluate for pituitary adenoma.


Instruction: Generate impression based on findings.

Input: 58-year-old male with alcoholic cirrhosis who presents for HCC screening. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic nodular morphology with caudate lobe enlargement. Sequela of portal hypertension including portosystemic shunts. Hepatic vasculature including portal vein are patent. No arterially enhancing hepatic lesions with washout.SPLEEN: Splenomegaly.PANCREAS: Arteriovenous malformation in the body the pancreas is better appreciated on the CT examination.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Cirrhotic liver with evidence of portal hypertension.2.No suspicious hepatic arterially enhancing lesions.


Instruction: Generate impression based on findings.

Input: Evaluation of the fetal brain demonstrates that the posterior fossa is small with crowding of the posterior fossa elements including the fourth ventricle. The cerebellar tonsils appear pointed in morphology and may be low lying. The atrium of the left lateral ventricle measures 10-11 mm in diameter and is larger than the right. However, the remainder of the supratentorial ventricular system is otherwise unremarkable.The corpus callosum is present. The gyral pattern is within range for reported gestational age. There is no parenchymal signal alteration or intracranial hemorrhage.Evaluation of the patient's spine demonstrates osseous dysraphism at the lower lumbar/sacral levels with extension of CSF-containing meninges and low-lying spinal cord elements through the dorsal defect.

Output: Myelomeningocele in the lower lumbar spine/sacrum containing spinal cord elements. In addition, the posterior fossa is small with pointed and possibly low-lying cerebellar tonsils. The constellation of findings is suggestive of a Chiari II malformation.The left lateral ventricular atrium is larger than the right measuring at the upper end of normal. This could relate to normal anatomic variation, a choroid plexus cyst or other developmental cyst, or could perhaps be related to the suspected Chiari II malformation. The remainder of the supratentorial brain is within normal limits.


Instruction: Generate impression based on findings.

Input: 71-year-old male with left-sided weakness status post EVAR, TEVAR. Evaluate for cord compression There is extensive artifact from the adjacent aortic stent graft. Within these limitations, there is an area of T2/STIR signal abnormality seen on sagittal sequences in the distal cord/conus. This is supported by additional T2 hyperintensity seen on axial imaging series 11, images 14-16.The vertebral bodies are appropriate in the overall alignment and height. There is mild disc disease and disc height loss involving L4-5 level and a moderate disc disease and disc height loss involving the L5-S1 level. Additional facet hypertrophy at the L5-S1 level contributes to moderate bilateral neural foraminal stenosis at this level but there is no significant spinal canal stenosis or cord compression at any level in the spine.Additional degenerative changes are also visualized in the cervical spine with multilevel disc height loss most prominent at the C5-6 level on the provided sagittal sequences. At this level there is moderate spinal canal stenosis.The large aortic aneurysm is only partially visualized and perhaps better appreciated on the previous CTA of the chest abdomen and pelvis from 7/21/2016. There are bilateral pleural effusions with right basilar pulmonary opacity which may relate to atelectasis.

Output: 1.Exam is limited by artifact from the adjacent aortic stent graft. Within these limitations, concerning for an acute cord infarct involving the distal cord/conus provided the patient's history, although other etiologies could have a similar appearance. There is no evidence of cord compression. Diffusion-weighted images were attempted but were nondiagnostic secondary to the susceptibility artifact.2.Multilevel degenerative changes mostly involving the cervical and lumbar spine with at most moderate spinal canal stenosis at C5-6 and at most moderate bilateral neural foraminal narrowing at the L5-S1 level.Due to the screening nature of this protocol details are not as evident on imaging as dedicated protocols of the spine.


Instruction: Generate impression based on findings.

Input: Patient with stooped posture, memory decline. Concern for normal pressure hydrocephalus. No evidence of hemorrhage, edema, mass effect or midline shift is detected. Cortical sulci and ventricular system are proportionately enlarged and unchanged since prior MRI examination from 2007. Findings although may be at the upper limits of normal for age however they may represent underlying parenchymal volume loss. Calvarium is intact. Mastoid air cells and paranasal sinuses are unremarkable.

Output: No evidence of acute findings. Please see above comments.


Instruction: Generate impression based on findings.

Input: There is a small approximate 6 mm focus of enhancement in the left caudate head with associated T2 hyperintensity. There is no restricted diffusion or susceptibility abnormality.There are scattered foci of T2 hyperintensity in periventricular and subcortical white matter locations without associated mass effect, restricted diffusion, susceptibility abnormality, or enhancement. The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain.

Output: 1.There is a small approximate 6 mm focus of enhancement in the left caudate head with associated T2 hyperintensity. There is no restricted diffusion or susceptibility abnormality. This constellation of features is most suggestive of early chronic resolving ischemia. However, a small neoplastic or inflammatory process cannot entirely be excluded. Thus, repeat brain MRI with contrast is recommended in 2-3 months to evaluate for interval change.2.Mild chronic small vessel ischemic disease.3.Results were discussed with Dr. Anderson on 5/18/2015 at approximately 2:15 PM.


Instruction: Generate impression based on findings.

Input: Stem cell transplant patient with sickle cell disease. Experiencing new tunnel vision with dizziness There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is encephalomalacia involving the left middle and inferior frontal gyri and in the right caudate nucleus. There is sulcal susceptibility predominantly in the superior parietal lobe region. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There are probable retention cysts in the maxillary sinuses.

Output: 1. No evidence of intracranial hemorrhage, mass, or acute infarct. 2. Chronic infarction involving the left middle and inferior frontal gyri, as well as the right caudate nucleus.3. Stigmata of prior subarachnoid hemorrhage.


Instruction: Generate impression based on findings.

Input: Recurrent/metastatic nasopharyngeal cancer, status post treatment. There are post-treatment findings in the nasopharyngeal region. There is no gross residual right cavernous sinus region tumor. There is persistent enhancement within the right foramen rotundum and Vidian canal, as well as in the right sphenopalatine foramen region. There is no evidence of acute infarct. The brain parenchyma appears unremarkable, aside from minimal, nonspecific, scattered, punctate T2 hyperintense foci in the cerebral white matter. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. No gross residual right cavernous sinus region tumor. 2. Persistent enhancement within the right foramen rotundum and Vidian canal, as well as in the right sphenopalatine foramen region may represent residual treated tumor with perineural extension.


Instruction: Generate impression based on findings.

Input: Reason: rule out cerebellar process or lesions History: bilateral lower extremity paresthesias and balance issues. The ventricles and sulci are within normal limits. The basal cisterns remain patent. There is no midline shift or mass effect. There are no areas of abnormal signal. There is no diffusion abnormality. There is no pathological enhancement. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: MRI of the brain is within normal limits.


Instruction: Generate impression based on findings.

Input: 71 year-old female with left hip antero-medial thigh pain The exam is limited due to extensive motion artifact. There is edema within the medial acetabulum with associated linear decreased T1 signal, consistent with a nondisplaced acetabular fracture. Joint space narrowing and subchondral cysts and edema within the superolateral acetabulum appears degenerative in etiology. No abnormal enhancement in the soft tissues.

Output: Limited exam due to motion artifact demonstrating a nondisplaced medial acetabular fracture. Further evaluation with CT is recommended.Findings discussed with Dr. Chaichian (pager 3546) at the time of dictation.


Instruction: Generate impression based on findings.

Input: 60 year old with BRCA positive, strong family history of breast cancer Breast parenchyma is almost entirely fat in both breasts.Minimal parenchymal enhancement is noted bilaterally.No significant change in the 7 mm oval mass, likely an intramammary lymph node, in the central left 6:00 position. No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Recent onset of cognitive changes: memory impairment. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are prominent subcentimeter perivascular spaces in the bilateral inferior basal ganglia. 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, and scalp soft tissues are grossly unremarkable. There is mild scattered paranasal sinus mucosal thickening.

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


Instruction: Generate impression based on findings.

Input: 59-year-old male patient with ill-defined pancreatic lesion found on CT and jaundice. ABDOMEN:LIVER, BILIARY TRACT: There is hepatomegaly. There is questionable mild nodular contour of the liver suggestive of cirrhosis. The gallbladder is hydropic of uncertain etiology. The distal common bile duct is not well seen; a focal stricture is not excluded. However, no definite lesion is identified.SPLEEN: No significant abnormality noted.PANCREAS: There is a focus of increased T2 signal and corresponding signal void on subtraction sequences within the body of the pancreas (image 26, series 10) which most likely represents a sidebranch IPMN; this lesion correlation to finding made on prior CT exam. An additional small cystic focus is suggested in the pancreatic head. There is no significant pancreatic ductal dilatation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: There is mild gastrohepatic, periportal and peripancreatic lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.At least two cystic foci within the pancreas with imaging characteristic most characteristic of sidebranch IPMNs (larger of these corresponds to hypodensity seen on prior CT). 2.Hydropic gallbladder of uncertain etiology and poorly visualized distal common bile duct without definite obstructing lesion; a distal CBD focal stricture is not excluded, although CBD is normal in size. 3.Questioned mild cirrhotic morphology of the liver. Mild gastrohepatic, periportal and peripancreatic lymphadenopathy may be reactive in etiology.


Instruction: Generate impression based on findings.

Input: Reason: lesion History: history of NMO The thoracic vertebral bodies are appropriate in the overall alignment and height. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots. Since the prior exam T2 signal hyperintensity previously noted from approximately C3 down to T8 to 3 disk space level has a regressed and is not readily identified. At the edge of the film at the C7 vertebral body level there appears to be right hemicord signal hyperintensity on T2 imaging which is not completely included on this exam. At the T9 T10 disk space level there is right hemicord signal hyperintensity on T2 imaging.

Output: 1.Since the prior exam thoracic spinal cord lesion extending from me cervical spinal cord has regressed.2.There is a right hemi-cord lesion present in the C7 level which is not completely included on this exam. Perhaps an MRI of the cervical spine with help further assess this lesion. The possibility of demyelination cannot be excluded.3.There is a lesion present in the right hemicord at T9-10. The possibility of demyelination cannot be excluded.


Instruction: Generate impression based on findings.

Input: Chronic right shoulder pain, evaluate for rotator cuff tear. ROTATOR CUFF: There is moderate to severe fatty atrophy of the supraspinatus muscle. The supraspinatus tendon can be followed distally to the level of the glenoid beyond which it is ill-defined likely reflecting a chronic, full-thickness retracted tear. Similarly, there is severe fatty atrophy of the infraspinatus muscle, with most if not all of the fibers of the tendon torn and retracted to the level of the glenohumeral joint, with delamination of some fibers that appear retracted even further proximally. The resultant gap contains intermediate signal which likely represents scar tissue. The teres minor muscle and tendon appear intact. The distal subscapular tendon appears thickened and replaced with intermediate signal intensity likely reflecting a combination of severe tendinosis and full-thickness insertional tearing. There is minimal if any atrophy of the subscapularis muscle.SUPRASPINATUS OUTLET: An os acromiale is present. Mild osteoarthritis affects the acromioclavicular joint. A trace amount of fluid is present within the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Mild osteoarthritis affects the glenohumeral joint. The humeral head is high riding consistent with chronic rotator cuff tear. A small cyst in the lesser tuberosity is likely degenerative in etiology. Intermediate signal within the superior and anterior labrum likely reflects degenerative tearing.BICEPS TENDON: The tendon of the long head of the biceps is perched upon the lesser tuberosity (indicating a biceps pulley lesion) with abnormal morphology suggesting partial thickness tearing. Fluid within the biceps tendon sheath may represent biceps tenosynovitis.

Output: 1.Extensive chronic appearing tearing of the rotator cuff with retraction as described above.2.Biceps tendon abnormalities including partial thickness tearing as described above.3.Osteoarthritis and other findings as described above.


Instruction: Generate impression based on findings.

Input: Low back pain and right lower extremity paresthesias/weakness. History of SLE. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign including a small focus of T1 hyperintensity involving the right aspect of the L3 vertebral body compatible with a small hemangioma. The conus medullaris is normal in position.Multilevel degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: Minimal disc bulge with minimal right neural foraminal narrowing. Otherwise no spinal canal or neural foraminal stenosis.L4-L5: Minimal disc bulge with mild narrowing of the right neural foramen. Otherwise no significant spinal canal or neural foraminal stenosis. Mild facet arthropathy.L5-S1: Disc desiccation with mild height loss. There is disc bulge with a right foraminal component which results in moderate to severe right-sided neural foraminal stenosis and suspected impingement of the right L5 nerve root. No significant spinal canal stenosis. There is mild left neural foraminal narrowing. Mild facet arthropathy.Paraspinous soft tissues are within normal limits.

Output: Disc bulge at L5-S1 results in moderate to severe right-sided neural foraminal stenosis with suspected impingement of the right L5 nerve root.Minimal degenerative changes at additional levels as above.


Instruction: Generate impression based on findings.

Input: History of acoustic schwannoma. There no significant change in size and enhancement characteristics of the right cerebellopontine angle tumor with extension into the medial internal auditory canal that measures 11 x 15 mm, previously 11 x 16 mm. There is no mass effect upon the brainstem. There is no evidence of intracranial hemorrhage or acute infarct. The brain parenchyma appears unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There an unchanged probable retention cyst in the left nasopharynx. The skull, paranasal sinuses, and scalp soft tissues are otherwise unremarkable.

Output: No significant change in size and enhancement characteristics of the right vestibular schwannoma.


Instruction: Generate impression based on findings.

Input: 36 year old female for breast cancer screening. BRCA mutation. History of bilateral implants. Family history of breast cancer diagnosed in mother at age 51 and in maternal aunt. There is heterogeneous amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally, greater on the left.Intact retropectoral silicone implants again noted.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: NS - Routine Screening Mammogram.


Instruction: Generate impression based on findings.

Input: Spasmodic dysphonia. There is no evidence of measurable mass lesions or significant cervical lymphadenopathy based on size criteria. The thyroid and major salivary glands are unremarkable. The major cervical vessels are patent. The osseous structures are unremarkable. The airways are patent. There is a partially empty sella. The imaged portions of the lungs are grossly unremarkable.

Output: 1. No evidence of mass lesions in the neck.2. A partially empty sella may be related to pseudotumor cerebri.