Instruction: Generate impression based on findings.

Input: Female 2 years old Reason: Cardiomyopathy and pulmonary hypertension. Left VentricleThe left ventricle is normal. The overall LV ejection fraction is 64.9%, the LV end diastolic volume index is N/A ml/m2 (normal range: 65+/-11), the LVEDV is 30.29 ml (normal range 109+/-23), the LV end systolic volume index is N/A ml/m2 (normal range 18+/-5), the LVESV is 10.62 ml (normal range 31+/-10), the LV mass index is N/A g/m2, and the LV mass is N/A g. There are no regional wall motion abnormalities present. No evidence of late gadolinium enhancement.PERFUSION \T\ MYOCARDIAL VIABILITY:There are no perfusion defects and the LV myocardium does not enhance abnormally.Left AtriumThe left atrium is normal in size, large ASD noted. Right VentricleThe right ventricle is enlarged. The overall RV ejection fraction is 62.5%, the RV end diastolic volume index is N/A ml/m2 (normal range 69+/-14), the RVEDV is 57.07 ml (normal range 110+/-24), the RV end systolic volume index is N/A ml/m2 (normal range 22+/-8), and the RVESV is 21.4 ml (normal range 35+/-13). Right AtriumThe right atrium is enlarged and a large ASD is noted. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation visualized. Dedicated through plane imaging was not performed.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation visualized. Dedicated through plane imaging was not performed.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation visualized. Dedicated through plane imaging was not performed.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation visualized. Dedicated through plane imaging was not performed.AortaThe ascending thoracic aorta is normal in size. There is a left sided aortic arch.AORTA FLOW QUANTITATION:Stroke volume in ml: 16.6Forward flow volume in ml: 17.1Backward flow volume in ml: 0.5Regurgitant factor in %: 2.9Pulmonary ArteryThe main, left and right pulmonary arteries are enlarged in size. PULMONARY ARTERIES FLOW QUANTITATION:Main pulmonary arteries flow quantitation values are as follows:Stroke volume in ml: 46Forward flow volume in ml: 46.2Backward flow volume in ml: 0.1Regurgitant factor in %: 0.3Right pulmonary artery flow quantitation values are as follows:Stroke volume in ml: 21.1Forward flow volume in ml: 21.1Backward flow volume in ml: 0Regurgitant factor in %: 0Left pulmonary artery flow quantitation values are as follows:Stroke volume in ml: 9.1Forward flow volume in ml: 9.5Backward flow volume in ml: 0.4Regurgitant factor in %: 4Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no pericardial thickening or effusion.Extracardiac FindingsTHORAX AND UPPER ABDOMEN:The aortic arch is left-sided and normal caliber; the brachiocephalic vessels branchnormally from the aortic arch. Chest wall is intact and pleural margins are sharp. No pleural effusions orpneumothorax.  Partial view of the liver, kidneys, adrenal glands, and spleen are normal..

Output: 1. Large ASD2. Right atrium and ventricle enlargement3 Increase flow to pulmonary circulation 2.77:14 No evidence of late gadolinium enhancement


Instruction: Generate impression based on findings.

Input: 75 years, Male, right-sided weakness, evaluate for stroke. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. There is mild supra and infratentorial parenchymal volume loss, commensurate with patient's age. Unchanged prominence of the extra-axial CSF spaces along the superior cerebellar surfaces which may be related to underlying parenchymal volume loss or represent small chronic subdural effusions without significant mass effect. Brain parenchyma is otherwise unremarkable for age. Major flow-voids are preserved.Patchy opacification of the mastoid air cells is again seen, right worse than left. Diffuse opacification of the right frontal sinus is again seen. There is also diffuse opacification of the bilateral anterior and posterior ethmoid air cells, which is slightly worse since prior. There is mild bilateral maxillary sinus mucosal thickening. There is also mucosal thickening in the left sphenoid sinus which is also similar to prior. Evidence of left hard palate resection.

Output: 1. No evidence of acute infarct, hemorrhage, or intracranial mass effect.2. Slight worsening of paranasal sinus opacification compared to 2/25/2016.


Instruction: Generate impression based on findings.

Input: 64 years Female (DOB:8/5/1951)Reason: pre-op planning History: pre-op planningPROVIDER/ATTENDING NAME: PETER C WARNKE PETER C WARNKE There is an extra-axial contrast enhancing mass present which abuts the falx and is medial to the right frontal lobe. It has a broad-based the dura and measures 46 x 39 mm axial dimensions. It is heterogeneous on signal intensity on all pulse sequences. It has a low signal center. There is susceptibility effect within much of the lesion. Within the white matter in the adjacent right frontal lobe there is T2 and FLAIR signal hyperintensity suggestive of vasogenic edema. There is mass effect present with distortion of the right lateral ventricle and corpus callosum. There is also shift of the falx to the left of midline x 10 mm. An 8 mm component of the mass protrudes across midline along the anterior and superior aspect of the mass.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: There is a large right parafalcine extra-axial mass present adjacent to the right frontal lobe associated with compression of adjacent brain parenchymal structures as well as some vasogenic edema. Most likely this represents a meningioma.


Instruction: Generate impression based on findings.

Input: Clinical question: Cerebral edema. Signs and symptoms: Asterixis, head CT of cerebral edema. Nonenhanced brain MRI:Negative diffusion weighted series.Very subtle FLAIR hyperintensity of bilateral hemispheric white matter likely representing patient's known mild cerebral edema. The cortical sulci, ventricular system and all the CSF spaces remain widely patent and with maintained. The cerebral cortex demonstrate normal signal intensity and without convincing evidence of edema. There is no evidence of hemorrhage.The signal void of major intracranial arterial branches are identified. The signal intensity of the intracranial venous sinuses are within normal.Unremarkable calvarium, soft tissues of the scalp, orbits and paranasal sinuses. Mild opacification of bilateral mastoid air cells and with normal signal intensity of the middle ear cavities.

Output: 1.Negative diffusion-weighted series.2.Suspected mild bilateral hemispheric white matter FLAIR hyperintensity which could represent subtle underlying edema.3.Unremarkable exam otherwise as detailed above.


Instruction: Generate impression based on findings.

Input: Metastatic papular thyroid cancer with single met to L3 vertebral body. Status post RT. Please assess for progression of disease. Unenhanced CT of thoracic spine:Axial immediate CT images of the entire thoracic spine were obtained. Sagittal and coronal 2-D reformatted images were acquired as well.The bony density in the alignment of the vertebral column is within normal limits. There is no evidence of a sclerotic or lytic changes of vertebral column. No minimal degenerative changes of the thoracic spine are noted. There is no evidence of any perispinal soft tissue abnormality. This examination remains stable since prior study.Unenhanced CT of the lumbar spine:Examination again demonstrates a stable findings of the L3 vertebrae. Subtle sclerotic changes of the L3 vertebrae are similar to prior exam. The exact etiology of this finding is not clear. Possibility of a hemangioma or a metastatic disease should be considered. CT exam is not the appropriate test for definitive diagnosis of metastatic bony lesions. MRI examination is recommended. There is however as mentioned above no change in the size, distribution and pattern of this not a specific L3 vertebrae. This lesion however can be further evaluated with biopsy if patient is unable to obtain an MRI examination.

Output: 1.Unremarkable CT of breath.2.Stable nonspecific sclerotic changes of L3 vertebrae since prior exam.


Instruction: Generate impression based on findings.

Input: 25-year-old male with Chiari I malformation status post Chiari decompression with hydrosalpinx and pseudotumor treated with lumbar peritoneal shunt. MRI brain:No restricted diffusion to suggest acute ischemia or susceptibility lesions to suggest hematoma. Again seen are posterior fossa postsurgical changes. A stent is seen extending from the cerebral aqueduct inferiorly to posterior spinal canal at the level of C2. Both are unchanged in position. Crowding of the foramen magnum by low lying cerebellar tonsils is redemonstrated, however with slightly less beaking of the cerebellar tonsils. No other structural abnormalities. No brain parenchymal signal abnormalities are identified. The ventricles are decompressed. No mass-effect or midline shift.CSF flow studies demonstrates preserved flow, anterior greater than posterior, through neo-foramen magnum. Spine MRI:Alignment, vertebral body heights, and bone marrow signal appear normal. The previously described syrinx appears shorter now extending from C3 to approximately C7 (decompressed from C7 to T5), it also appears smaller in diameter to prior exam. For example, at the level of C5 measures 4 mm versus previously 8 mm. No new syrinx is identified. Conus ends at L1, which is normal. Mild degenerative disease is again seen in several cervical and thoracic intravertebral disks, appearing similar prior study. Mild disk protrusions are seen at T3-T4, minimally at T4-T5, T9-T10, and T11-12. No central canal stenosis or neural foraminal narrowing.

Output: 1.Decreased size of previously described hydrosalpinx.2.Interval decrease in the beaking of the bilateral cerebellar tonsils. Preserved CSF flow through the neo-foramen magnum.3.No hydrocephalus.


Instruction: Generate impression based on findings.

Input: hypothyroidism. Evaluate for thyroid gland abnormality.EXAMINATION: Sonogram thyroid RIGHT LOBE MEASUREMENTS: 1 x 2 x 0.8 cmLEFT LOBE MEASUREMENTS: 0.8 x 2 x 0.8 cmISTHMUS MEASUREMENTS: 2 mmRIGHT LOBE: Normal in echogenicity and vascularity with no focal lesion.LEFT LOBE: Normal in echogenicity and vascularity with no focal lesion.ISTHMUS: Normal in echogenicity and vascularity with no focal lesion.PARATHYROID GLANDS: Not visualized. LYMPH NODES: Normal size and appearance of cervical lymph nodes.OTHER: No significant abnormality noted.

Output: Normal examination.


Instruction: Generate impression based on findings.

Input: Reason: comparison to RUQ US History: hx of HHT. ABDOMEN:LUNG BASES: Small bilateral pleural effusions.LIVER, BILIARY TRACT: The liver is mildly enlarged measuring 20.8 cm in craniocaudal dimension. On out of phase sequence, there is diffuse significant decreased signal compatible with hepatic steatosis. Nodular contour with caudate lobe enlargement and widening of the fissure suggestive of cirrhotic morphology. There is diffusely heterogeneous enhancement of the liver with multiple perfusional abnormalities and early enhancement of the hepatic veins during the arterial phase compatible with shunting. There are innumerable predominantly subcentimeter lesion in both lobes that demonstrate T1 hypointense, T2 iso to slightly hyperintense signal with early and persistent enhancement that are difficult to further characterize due to their size. Although, the largest, which measure 2.1 cm in the left lobe of the liver (series 803 image 328) and 2.0 cm in the right lobe of the liver adjacent to the gallbladder fossa (series 803 image 193), demonstrate homogeneous arterial and persistent enhancement and presumably represent telangiectasias given patient's history. Also adjacent to the gallbladder fossa, there is a T1 hypointense, T2 mildly hyperintense lesion with early peripheral enhancement that progressively fills in and demonstrates restricted diffusion, measuring 2.5 x 1.9 cm (series 803 image 238).Hepatic vasculature is patent with early enhancement of the hepatic veins. No intrahepatic or extrahepatic biliary ductal dilatation. Mild gallbladder wall thickening, likely related to ascites. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left small subcentimeter parapelvic cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Large amount of abdominal ascites.

Output: 1.Cirrhotic morphology. 2.5 cm lesion within the right lobe of the liver that demonstrates peripheral arterial enhancement with progressive delayed filling in, suspicious for cholangiocarcinoma. 2.Findings compatible with arteriovenous shunting and innumerable predominately subcentimeter arterial enhancing lesions with persistent enhancement, likely representing telangiectasias given the patient's history. 3.Large amount of ascites and small bilateral pleural effusions. 4.No biliary ductal dilatation.


Instruction: Generate impression based on findings.

Input: Reason: r/o acute ischemia History: word finding difficulties Exam is limited by motion artifact. There is effacement of the right central sulcus with nonsuppression of the CSF on FLAIR sequence. There is no evidence of underlying subarachnoid blood on susceptibility-weighted sequence or on earlier CT. There is also FLAIR hyperintensity involving the right frontal cortex. There appears to small left frontal convexity subdural effusion with T2 and FLAIR hyperintensity without mass effect. Nonspecific scattered periventricular and subcortical white matter FLAIR hyperintensity, which may represent chronic small vessel ischemic disease.  No abnormal diffusion restriction. No acute intracranial hemorrhage is identified. No evidence of intracranial mass, mass effect, or midline shift. The ventricles, sulci, and cisterns are age appropriate in size without evidence of hydrocephalus. Gray-white matter differentiation is preserved. The imaged paranasal sinuses and mastoid air cells are clear. The imaged orbits are intact. The osseous structures are unremarkable.

Output: 1. No evidence of acute infarct or intracranial mass effect.2. Nonspecific asymmetric effacement of the right central sulcus with nonsuppression of CSF on FLAIR sequence. Findings raise suspicion for an underlying leptomeningeal process such as infection. FLAIR hyperintensity involving the right frontal cortex, which is also nonspecific but can be seen with cerebritis. There is also a small left frontal subdural effusion which may be unrelated and without associated mass effect. If post gadolinium sequences cannot be obtained, consider lumbar puncture for further evaluation if clinically indicated.Findings discussed with Dr. Eisha Wali at the time of dictation.


Instruction: Generate impression based on findings.

Input: History of rectal carcinoid tumor status post resection. Status post lower anterior resection. End to side coloanal anastomosis. 9/25/2014 pathology showed multifocal rectal wall differentiated neuroendocrine tumor. Family history of colon cancer. ABDOMEN:LIVER, BILIARY TRACT: Stable simple right hepatic lobe segment VIII cyst and segment 6/7 indeterminate focus. No focal suspicious lesion, biliary ductal dilatation or vascular abnormality. Normally distended gallbladder.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Right adnexal physiologic cyst. Small uterine fibroids. Nabothian cysts noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postsurgical changes from a lower anterior resection with side to end anastomosis appearing mildly thickened, but unchanged dating back to 4/13/2015. The appearance is unchanged from the prior study. No measurable residual or recurrent disease.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Stable examination without evidence of residual or recurrent disease. Mild thickening/prominence at the side-to-end coloanal anastomosis without a focal lesion is unchanged dating back to 4/13/2015, correlate with colonoscopy findings.2.Stable indeterminate subcentimeter segment 6/7 lesion.


Instruction: Generate impression based on findings.

Input: 65 years, Female, stage III B lung cancer. Evaluate for brain metastasis. Mild headaches.. No evidence of metastatic disease. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. Few scattered foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild chronic small vessel ischemic changes. Brain parenchyma is otherwise unremarkable for age. No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. There is nonspecific heterogeneity of the bone marrow particularly at the central skull base with a small focus of enhancement involving the upper aspect of the clivus. No frank destructive osseous lesions are appreciated.

Output: 1. No evidence of intracranial metastatic disease.2. Nonspecific heterogeneity of the bone marrow particularly at the central skull base with a small focus of enhancement involving the upper aspect of the clivus. These findings are nonspecific. No frank destructive osseous lesions are appreciated. Would suggest correlation with recent bone scan or PET to better assess for osseous metastatic disease.


Instruction: Generate impression based on findings.

Input: 18 year-old female with foot and ankle pain TENDONS: The extensor and flexor tendons are intact. The Achilles tendon appears within normal limits.LIGAMENTS: The medial and lateral collateral ligaments are intact. The ATFL is intact.ARTICULAR SURFACES AND BONE: There is edema surrounding the posterior subtalar joint, more extensive within the talus than in the calcaneus. There is widening of the talonavicular articulation, without significant adjacent bone marrow edema. No fibrous or osseous coalition is evident. Subchondral reactive bone marrow signal is noted along the tibiotalar joint. No fracture is visualized.ADDITIONAL

Output: Bone marrow edema on both aspects of the posterior subtalar joint, raising the question of abnormal mechanics. No evidence of fibrous or osseous coalition.


Instruction: Generate impression based on findings.

Input: 30 years Female (DOB:12/21/1985)Reason: Headaches, mother with Chiari malformation History: Headaches, normal neurological examPROVIDER/ATTENDING NAME: NAOUM P ISSA NAOUM P ISSA The CSF spaces are appropriate for the patient's stated age with no midline shift. The cerebellar tonsils extend down to the level of the foramen magnum.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 demonstrate some scattered opacities. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.There is a 6 mm T1 hyperintense focus in the right parietal bone probably representing a hemangioma.Incidental note is made of susceptibility effect along the right tentorial leaf and the anterior aspect of the falx cerebri which most likely represent dural calcifications.

Output: 1.There are no prior studies available for comparison. The cerebellar tonsils do not extend below the level of the foramen magnum.2.No evidence for intracranial mass lesion.


Instruction: Generate impression based on findings.

Input: 54-year old male with swelling and tenderness; assess for infection of the soft tissues and bones Mild straightening of the normal cervical lordosis is seen which may be due to patient positioning versus muscle spasm. Vertebral body heights are maintained without evidence of fracture. The prevertebral soft tissues are unremarkable. Multiple cervical lymph nodes are seen, none pathologically enlarged.Status post bilateral laminectomy and removal of the spinous processes of C3 and C4 with fluid accumulation seen dorsal to the laminectomy site without significant mass effect on the cord/thecal sac. The spinal subarachnoid space is well visualized without definite evidence of abscess. Fluid collection is also seen along the incision site with fluid seen accumulating in the subcutaneous tissues. The paraspinal muscles appear normal in density. These findings are consistent with the expected post operative findings of a bilateral laminectomy; however correlation with the patient's clinical history and symptoms is recommended. If high clinical concern for infection, contrast enhanced MRI is recommended.Multilevel degenerative changes are again seen appearing similar to the prior study. No significant compromise of the spinal canal.Degenerative changes as described below:C2-3: Prominent disk bulge is seen impressing on the spinal cord with bilateral neural foramina narrowing and facet joint hypertrophy.C3-4: Disk/osteophyte complex is seen impressing on the spinal cord which is unchanged in size and degree of cord compression. Bilateral neural foramina narrowing and facet joint hypertrophy.C4-5: Disk/osteophyte complex is seen abutting the spinal cord. Bilateral neural foraminal narrowing and facet joint hypertrophy. Extensive artifact limits evaluation of the spinal canal inferior to C5.

Output: 1. Status post bilateral laminectomy at C3 and C4 with fluid accumulation dorsal to the laminectomy site which is consistent with expected postoperative changes. Recommend correlation with patient's symptoms and clinical history. If clinical concern for infection, recommend contrast enhanced MRI for further evaluation.2. Extensive multilevel degenerative disk disease, as described above, appearing similar to the prior study.


Instruction: Generate impression based on findings.

Input: There is no evidence of intracranial hemorrhage or acute infarct. There is non-enhancing peri-aquaductal T2 hyperintensity without mass effect. Tectal T1 hyperintensity seen only on the sagittal sequence is compatible with artifact. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is a slightly enlarged cisterna magna. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unremarkable.

Output: Periaqueductal nonenhancing T2 hyperintensity is nonspecific and of uncertain clinical significance though a follow-up MRI in 6 months is recommended to ensure stability. The examination is otherwise unremarkable.


Instruction: Generate impression based on findings.

Input: Reason: occipital neuralsgia History: headahe, neck pain The CSF spaces are appropriate for the patient's stated age with no midline shift. Exam is degraded by patient motion.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.No evidence for intracranial mass or infarction. To the extent of visualization this MRI of the brain is within normal limits. 2.Exam is degraded by patient motion. This may obscure more subtle abnormalities.


Instruction: Generate impression based on findings.

Input: Female 55 years old with a history of multiple anterior shoulder dislocations. Now with shoulder pain with provocative exams indicating biceps tendinitis or labral tear. Assess for labral tear, bankhart lesion and biceps tendonitis/tearing; less concern for rotator cuff tear. Patient could not tolerate positioning for ABER view.ROTATOR CUFF: There is mild tendinopathy of the supraspinatus without evidence of tear. The infraspinatus, subscapularis and teres minor tendons are intact. Muscle bulk is maintained.SUPRASPINATUS OUTLET: No significant abnormality.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is thinning of the glenoid and humeral head cartilage with associated cystic and reactive marrow changes. There is thinning of the articular cartilage of the humeral head. The glenoid labrum is intact.BICEPS TENDON: The biceps tendon is normal in appearance and appropriately located within the biceps groove. ADDITIONAL

Output: 1.Chronic Hill-Sachs deformity consistent with prior anterior shoulder dislocation.2.Moderate osteoarthritis of the glenohumeral joint.


Instruction: Generate impression based on findings.

Input: 75 year-old female history of myelofibrosis. Evaluate spleen size. ABDOMEN:LIVER, BILIARY TRACT: Hepatomegaly measuring up to 20 cm in length. The liver is also diffusely hypointense suggestive of hemachromatosis. No intrahepatic biliary ductal dilatation.SPLEEN: Massive splenomegaly. The spleen measures 13.9 x 7.8 cm in maximal axial dimensions over a craniocaudal distance of 18.2 cm. Spleen is also diffusely hypointense on T2. Scattered hypointense, nonenhancing splenic lesions are indeterminant, but stable from prior.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Massive hepatosplenomegaly with measurements provided. Findings in the liver and spleen suggestive of hemochromatosis.


Instruction: Generate impression based on findings.

Input: Chronic neck pain with intermittent numbness in the upper extremities. Follow-up cervical spondylosis. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. There is kyphosis of the cervical spine with apex at C5-C6 similar to prior. There is also minimal C4 on C5 anterolisthesis as before. Bone marrow signal is benign. There is multilevel disc height loss, severe at the C6-C7 level but similar to prior.The cervical spinal cord has normal signal characteristics.There is developmental narrowing of the cervical spinal canal with superimposed degenerative changes which are suboptimally evaluated. Individual levels as below: C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: Uncovertebral hypertrophy and facet arthropathy on the left contribute to mild to moderate left neural foraminal stenosis, stable to minimally worse in the interval with motion degradation limiting assessment. No significant spinal canal or right neural foraminal stenosis.C4-5: There is facet arthropathy on the right with suggestion of partial ankylosis. No significant spinal canal or neural foraminal stenosis. C5-C6: Small disc osteophyte complex including left-sided uncovertebral hypertrophy. There is no significant spinal canal stenosis. There is mild left neural foraminal stenosis. No significant right neural foraminal narrowing. C6-C7: There is a disc osteophyte complex with suggestion of component of disc extrusion, but similar to prior. There is partial effacement of the ventral thecal sac. Otherwise no significant spinal canal stenosis. Neural foramina are also patent. C7-T1: Minimal disc osteophyte complex without spinal canal or neural foraminal stenosis.Paraspinous soft tissue structures appear grossly unremarkable.

Output: 1. Mild to moderate multilevel degenerative changes throughout the cervical spine without high-grade spinal canal or high-grade neural foraminal stenosis at any level.2. Motion degradation on the current study somewhat limits assessment however there is no gross change since prior MRI from 6/7/2012.3. Additional details as above.


Instruction: Generate impression based on findings.

Input: There are minimal patchy areas of T2/FLAIR hyperintensities in the subcortical and in the periventricular white matter, which are nonspecific, but most likely consistent with chronic small vessel ischemic changes. There are no diffusion or susceptibility abnormalities. The ventricular size is normal. No evidence for acute intracranial hemorrhage, mass effect, or edema. There is no midline shift. Basal cisterns are patent.There is global parenchymal loss with prominence of the ventricular system, which is mildly advanced for age.

Output: 1. No intracranial mass or mass effect. Minimal chronic small vessel ischemic changes.2. There is global parenchymal loss which is mildly advanced for age. The prominence of ventricular system is at least predominantly related to volume loss. There may be however a component of communicating hydrocephalus/NPH which can be considered in the appropriate clinical setting.


Instruction: Generate impression based on findings.

Input: History of Crohn's disease. Persistent right lower quadrant pain since small bowel resection. Patient feels mass in right lower quadrant. ABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy. No intra or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable cysts of the left mid/lower renal pole.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Status post ileocecectomy. At the distal most ileum at the anastomosis and other adjacent ileal loops, there is mild wall thickening, enhancement, and a luminal narrowing that appears to persistent on all sequences. No flow limiting stricture is identified. Mild tethering is also suspected in the right lower quadrant as seen in the coronal plane (series 14 image 59). Persistent fibrofatty infiltration and mild mesenteric lymphadenopathy are again noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Status post ileocecectomy. Evidence of chronic disease at the level of the anastomosis and mild acute on chronic inflammation suggested involving adjacent ileal loops. No flow limiting stricture.


Instruction: Generate impression based on findings.

Input: 47-year-old female with history of right lumpectomy for mammographically occult IDC in December 2012 followed by chemoradiation. There is heterogeneous amount of fibroglandular tissue in both breasts.Minimal parenchymal enhancement is noted bilaterally.Post surgical changes in the right breast are identified. 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: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: The patient submitted outside studies for review. Bilateral breast MRI dated 5/28/2015 from High Tech Medical Park South was submitted. MRI 6/8/2015: MRI images were reviewed on PACS and DynaCAD. According to the MRI report, biopsy of this mass was performed and confirmed the diagnosis of breast cancer. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.There is a 2.3 x 1.7 x 2.1 cm (AP X ML X CC) enhancing mass in the left breast at 5:00 with abnormal clumped linear enhancement and small adjacent enhancing foci extending anteriorly, medially, laterally and slightly posteriorly. Multiple blood vessels extend through this region as well. The total extent of disease in the AP dimension measures 5.3 cm. Susceptibility artifact within the mass is noted, suggestive of a biopsy clip.Normal axillary lymph nodes noted. No abnormal enhancement in the right breast.

Output: 1. Biopsy-proven cancer in the left breast at 5:00 with anterior extension as described above, the total extent of disease measuring 5.3 cm. Surgical consultation is recommended. If sampling of the anterior extent of disease is clinically warranted, MR directed ultrasound is recommended for further evaluation and biopsy.2.Recommend submission of outside biopsy images including postprocedural mammogram to document appropriate clip placement.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Right leg tingling Conventional anatomy with 5 lumbar type vertebral bodies are presumed, with the most inferior well-defined disc space labeled L5-S1. Vertebral body heights are within normal limits. There is grade 1 anterolisthesis of L4 and L5 as well as minimal retrolisthesis of L5 on S1. Bone marrow signal is benign. The conus medullaris is normal in position.Multilevel degenerative changes are seen, as described below:L1-L2: Minimal disc bulge, ligamentum flavum thickening, and facet arthropathy. No spinal canal or neural foraminal stenosis.L2-L3: Minimal disc bulge, ligamentum flavum thickening, and facet arthropathy. No spinal canal or neural foraminal stenosis.L3-L4: Disc bulge eccentric to the left. There is moderate bilateral facet arthropathy. There is partial effacement of the left lateral recess as well as mild central canal narrowing. Neural foramina are patent.L4-L5: Grade 1 anterolisthesis and mild disc bulge with advanced bilateral facet arthropathy and ligamentum flavum thickening. There is moderate spinal canal stenosis including partial effacement of the bilateral lateral recesses. There is mild narrowing of the neural foramina, right worse than left. L5-S1: Minimal retrolisthesis and disc bulge. There is no significant spinal canal stenosis. Bilateral facet arthropathy. There is mild narrowing of the neural foramina, left relatively greater than right.Paraspinous soft tissues are within normal limits.

Output: 1. Multilevel degenerative changes in the lumbar spine, worst at the L4-L5 level, where there is moderate moderate spinal canal stenosis and evidence of degenerative grade 1 anterolisthesis. There is mild neural foraminal stenosis at this level, right relatively greater than left.2. Multilevel facet arthropathy, worst at L4-L5 and L3-L4 and to a lesser degree at additional levels.


Instruction: Generate impression based on findings.

Input: Status post tumor resection. There has been interval left temporal lobe tumor resection with blood products and air in the surgical cavity. There is a subcentimeter enhancing nodule anterior to the resection cavity. There is also surrounding confluent T2 hyperintensity in the white matter. There is also scattered patchy cerebral white matter T2 hyperintensity elsewhere. There is a small area of restricted diffusion along the posteromedial aspect of the resection cavity and a punctate focus of apparent restricted diffusion in the left caudate. There is a punctate defect in the right basal ganglia without restricted diffusion, which may represent a chronic infarct. There is a probable small posterior corpus callosum developmental venous anomaly. The ventricles are unchanged in size and configuration. There is no midline shift or herniation. There is an unchanged hypoplastic right cerebellar hemisphere. The major cerebral flow voids are grossly intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are unchanged.

Output: 1. Recent postoperative findings with apparent subcentimeter residual enhancing tumor along the anterior aspect of the left temporal resection cavity and surrounding confluent T2 hyperintensity.2. A punctate focus of apparent restricted diffusion in the left caudate may represent a recent infarct.


Instruction: Generate impression based on findings.

Input: Brain: Motion artifact somewhat limits evaluation. There are approximately fiveT2/FLAIR hyperintense lesions involving the periventricular and subcortical white matter compatible with known demyelinating disease. These lesions include a juxtacortical lesion involving the left superior frontal gyrus and periventricular lesions adjacent to the left frontal horn and atria of the bilateral lateral ventricles. There is T1 hypointensity associated with the right parietal lesion. No intracranial mass or mass effect. There is minimal global parenchymal volume loss for age. Thoracic Spine: There are multiple T2 hyperintense lesions throughout the thoracic cord consistent with known demyelinating disease. These lesions are best seen on the sagittal T2 and STIR sequences and include T1-T2, T3-T4, T4-T5, T6, T8, T9, and T10 levels. The right dorsal T1-T2 lesion is associated with mild volume loss similar to prior. At least majority if not all of the remainder of the lesions are present on prior study but more apparent on the current study likely due to differences in technique, and perhaps evolution of the lesions. The thoracic spine is in normal alignment. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the thoracic spine.

Output: 1. Approximately 5 T2/FLAIR hyperintense lesions in the supratentorial white matter consistent with known demyelinating disease. No prior brain MRI is available for comparison. Addendum can be issued if prior imaging is made available.2. Multiple T2 hyperintense lesions throughout the thoracic cord consistent with demyelinating disease. Prior thoracic spine MRI study was limited due to artifact however in retrospect, the lesions identified on the current study appear to be present (although more subtle) on the prior study. As such there is no convincing evidence of progression of demyelinating disease in the thoracic cord.


Instruction: Generate impression based on findings.

Input: There is no evidence of acute infarct. There are no areas of abnormal parenchymal signal. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is a small retention cyst within the left maxillary sinus. There is a left globe prosthesis. The skull is unremarkable.

Output: 1.Limited exam secondary to patient termination of the study prior to completion.2.No evidence of acute infarct or parenchymal signal abnormality.


Instruction: Generate impression based on findings.

Input: 4 day old 36 week gestation with history of respiratory distress and neurologic deficits after cooling protocol. Evaluate for evidence of hypoxic ischemic encephalopathy. There is no restricted diffusion involving the brain parenchyma or signal abnormality in the cortex or basal ganglia to suggest ischemic injury. Myelination appears appropriate for patient's age of 36 weeks. No focal parenchymal signal abnormalities in the brain are appreciated. No evidence of hemorrhage, intracranial mass, or mass effect. Midline structures including the corpus callosum and posterior fossa appear within normal limits. The ventricles and basal cisterns are normal in size and configuration. The expected intracranial vascular flow voids are present. There is a small parieto-occipital caput succedaneum.

Output: No findings to suggest hypoxic-ischemic injury are definitively appreciated. If there remains high suspicion for ischemic injury, follow-up study may be helpful.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Recto-urethral fistula status post repair. Please evaluate for resolution. PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER/URETHRA: Suprapubic catheter in place. Foley catheter in place. Note that presence of the Foley catheter, local soft tissue edema, and lack of IV contrast results in suboptimal evaluation for rectourethral fistula (series 5, image 27). No definite tract is seen on diffusion-weighted images to suggest a large fistula.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted. No tract is visualized from the urethra to the rectum.BONES, SOFT TISSUES: Fat-containing right inguinal hernia.OTHER: Bilateral scrotal hydroceles noted.

Output: Limited evaluation due to Foley catheter, local soft tissue edema, and lack of IV contrast, without large rectourethral fistula identified.


Instruction: Generate impression based on findings.

Input: History of hepatocellular carcinoma status post TACE/RFA. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology with extensive fibrosis.Stable segment 3 ablation cavity measuring approximately 2.5 x 1.9 cm (series 11/44), containing proteinaceous/hemorrhagic debris without evidence of marginal recurrent or residual disease.Stable hepatic cysts in the right hepatic lobe.Cholelithiasis within a contracted gallbladder. Trace perihepatic fluid. Recanalized periumbilical vein.SPLEEN: Splenomegaly measuring 22 cm in craniocaudal dimension. Trace perisplenic fluid.PANCREAS: There are numerous cystic pancreatic foci which appear to communicate with the main pancreatic duct, appearing similar to the prior study. Index proximal pancreatic tail cystic lesion measures 1.2 x 0.9 cm (series 5/32), compared to 1.4 x 1.0 cm previously. No suspicious post contrast features. The main pancreatic duct is mildly prominent in the distal body and tail, appearing similar to the prior study. No peripancreatic inflammatory changes. No solid pancreatic lesion.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Punctate hyperintensities in both kidneys are too small to characterize, unchanged and likely benign cysts.RETROPERITONEUM, LYMPH NODES: No enlarged retroperitoneal lymphadenopathy.BOWEL, MESENTERY: Gastroesophageal and retroperitoneal varices.BONES, SOFT TISSUES: Mild bilateral gynecomastia. Small volume right pleural effusion with adjacent mild consolidation/atelectasis, better characterized on prior chest CT. OTHER: No significant abnormality noted.

Output: 1.Stable examination including postablation changes of segment 3 without evidence of residual or recurrent disease. No new suspicious liver lesion.2.Cirrhotic liver with extensive fibrosis and stigmata of portal hypertension.3.Numerous cystic pancreatic lesions likely represent branch type IPMNs without suspicious imaging features, unchanged.


Instruction: Generate impression based on findings.

Input: Female 39 years old Reason: plantar fascia and posterior tibial tendon History: pain in arch. TENDONS: There is nonspecific fluid surrounding the tendon of the flexor hallucis longus and the tibialis posterior tendon. The tendons appear normal.LIGAMENTS: No significant abnormality noted.ARTICULAR SURFACES AND BONE: No significant abnormality noted. ADDITIONAL

Output: 1. Fluid surrounding the flexor hallucis longus tendon and posterior tibialis tendon which is nonspecific but may be seen with synovitis.2. No evidence of plantar fasciitis.


Instruction: Generate impression based on findings.

Input: 43 year-old female with a history of fatty liver. Rule out liver lesions. ABDOMEN:LIVER, BILIARY TRACT: Note is made of multiple foci of signal loss in the right lobe of the liver on out of phase sequences, consistent with focal fatty infiltration. Additionally, note is made of focal fatty sparing along the gallbladder fossa. No evidence of intra-or extrahepatic biliary ductal dilation. No enhancing mass lesions are identified. Mild hepatomegaly.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple subcentimeter foci of fluid signal intensity are identified in the kidneys bilaterally, which are too small to characterize, but likely represent simple cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is mild wall thickening affecting a loop of jejunum in the left hemiabdomen. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Fatty infiltration of the liver without evidence of a focal mass lesion, as clinically questioned.2. Nonspecific wall thickening of a loop of jejunum in the left hemi-abdomen. Differential considerations include infectious and inflammatory etiologies. These findings can also be seen with chronic NSAID use related strictures. Neoplasm cannot be completely excluded and clinical correlation is indicated.


Instruction: Generate impression based on findings.

Input: Breast mass, confusion and headache, metastasis workup There is a 18 mm x 29 mm x 30 mm sized enhancing mass on the right frontal skull.There is minimal frontal dural enhancements adjacent to the inner table side of the mass, this finding indicate possible either dural involvement of the mass or at least inflammatory changes.The diagnostic possibility should exclude metastatic lesion.There is no other intra axial or extra axial lesion identified.There is no evidence of acute ischemic or hemorrhagic lesion.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: Right frontal skull bony lesion with contrast enhancement indicating possible metastatic lesion.Adjacent dural enhancement suggest possible dural involvement or inflammatory changes.No other intra axial or extra axial lesion has been found.No evidence of acute ischemic or hemorrhagic lesion on this scan.


Instruction: Generate impression based on findings.

Input: Memory loss. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is diffuse cerebral white matter T2 hyperintensity bilaterally. There is slight diffuse cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There are bilateral lens implants.

Output: No evidence of acute intracranial hemorrhage, mass, or acute infarct. Diffuse cerebral white matter T2 hyperintensity is nonspecific, but may represent chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: Per outside hospital report, patient underwent MRI of the neck to follow a benign tongue mass. Report noted a left axillary node with the largest measuring 15 mm, nonspecific in appearance. Most recent bilateral screening mammogram from 10/20/2014 at Advocate Christ Center was benign. MAMMOGRAM: Two standard and implant displaced views of the left breast were performed digitally and reviewed with the aid of R2 CAD 9.3. Retropectoral silicone implants are present bilaterally. The breast parenchyma is composed of scattered fibroglandular density. No dominant mass, suspicious microcalcifications or areas of architectural distortion in the left breast. Benign appearing lymph nodes are projected over the left axilla.LEFT ULTRASOUND:Targeted grayscale and color Doppler ultrasound of the left axilla was performed for the clinical area of concern. There is a 1.9 x 0.6 x 2.3 cm normal morphology lymph node with fatty hilum and uniform cortical thickness, could correspond to findings on MRI neck 04/06/2015. The remainder of the left axilla is unremarkable.

Output: Benign left axillary lymph node as described. No mammographic or sonographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram.


Instruction: Generate impression based on findings.

Input: A patient submitted outside study for review. Submitted for review are breast MRI (11/23/16) performed at outside institution. For comparison, following outside studies are available; Bilateral screening mammogram: 10/7/2016,Left unilateral diagnostic mammogram: 11/1/2016, Ultrasound of left breast: 11/1/2016, Ultrasound-guided biopsy of left breast: 11/3/2016, Left unilateral postprocedure mammogram: 11/3/2016. There is a biopsy proven malignancy in the left breast. BREAST MRI (11/23/16):The study 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.There is a round artifact from a marker clip at 4:00 position in the left breast. A small enhancing focus (5 x 4 mm) immediately posterior to this clip is a biopsy proven malignancy. No other abnormal enhancing lesions elsewhere in the left breast or in the right breast, except for the scattered parenchymal enhancement. No abnormal lymph nodes are identified in either axillary region.

Output: A small unifocal malignancy in the left breast at 4:00 position, next to a marker clip artifact.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Bilateral papilledema on ophthalmic exam. There appears to be mild protrusion of the bilateral optic nerve discs, although the exam is not optimized for assessment of the orbits. There is no gross orbital mass. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears unremarkable. There is no abnormal intracranial enhancement. There is cavum septum pellucidum and vergae. There is no midline shift or herniation. The major cerebral flow voids are intact. There are postoperative findings related to left mastoidectomy, without gross lesions in this region. There are bilateral small maxillary sinus retention cysts.

Output: Apparent mild protrusion of the bilateral optic nerve discs related to papilledema, although the exam is not optimized for assessment of the orbits. No evidence of intracranial hemorrhage, mass, or acute ventriculomegaly, aside from cavum septum pellucidum and vergae.


Instruction: Generate impression based on findings.

Input: There are postsurgical findings from multiple osteotomies of the bilateral frontal bones. 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. 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.

Output: 1.No findings to account for patient's headaches.2.Postsurgical findings from multiple osteotomies of the bilateral frontal bones.


Instruction: Generate impression based on findings.

Input: Intractable seizure, aphasia evaluation. Through the right occipital bone, the laser catheter was inserted into the right hippocampus head. There is relatively thick peripheral enhancement (about 23mm x 16mm) on the tract of laser probe indicated local inflammation. The size and pattern of enhancement appear to be slightly lessen since prior exam.Limited view of the ventricles, sulci and cisterns are symmetric and unremarkable. The paranasal sinuses and mastoid air cells are clear.

Output: Post the lesion if lesion of right hippocampal lesion.Slightly lessen right laser catheter track enhancement since prior exam.


Instruction: Generate impression based on findings.

Input: MRI Brain:This is a motion degraded exam. Redemonstrated is an evolving subacute infarct within the left basal ganglia, left caudate, left thalamus, and left temporal lobe with overlying susceptibility abnormality compatible with mild hemorrhagic transformation, which appears similar to the previous exam. There is associated T2/FLAIR signal abnormality in this region and there is unchanged mass effect on the adjacent frontal horn of the left lateral ventricle. There is also an acute infarct involving the left periatrial white matter which was also present on recent prior exams. There are chronic right cerebellar infarcts. There is additional superimposed mild periventricular and subcortical white matter T2/FLAIR hyperintensity which is nonspecific but likely related to small vessel ischemic disease. There is diffuse volume loss. The ventricles and basal cisterns are otherwise unchanged. 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.MRA Brain: Exam is severely limited by motion artifact. Within these limitations, there is no visible high-grade stenosis involving the intracranial ICAs, MCA's or ACAs bilaterally. The right vertebral artery is diminutive which may be related to stenosis and or hypoplasia. The left PCA is asymmetrically diminutive compared to the right. The left vertebral, basilar, and right posterior cerebral arteries are patent with no significant stenosis.

Output: 1.Continued evolution of a subacute infarct involving the left basal ganglia, left caudate nucleus, left thalamus, and left temporal lobe with mild hemorrhagic transformation and with unchanged mass effect on the frontal horn of left lateral ventricle.2.Evolving acute/subacute infarct in the left periatrial white matter which was also present previously.3.Mild chronic small vessel ischemic disease.4.Within the limitations of motion degradation on the MRA brain, there is a diminutive right V4 which may be related to stenosis and/or hypoplasia and the left PCA is also asymmetrically diminutive compared to the right. Remainder of the major intracranial vasculature is grossly patent.


Instruction: Generate impression based on findings.

Input: Patient with neck stiffness, hyperreflexia, spasticity of the bilateral lower extremities Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained. Bone marrow signal is within normal limits. The cervical spinal cord has normal signal characteristics and overall morphology.Degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: Small disc osteophyte complex without compromise to the spinal canal. Mild right neural foraminal narrowing related to facet arthropathy. Left neural foramen is patent.C4-5: Uncovertebral hypertrophy and facet arthropathy contribute to mild left and minimal right neural foraminal narrowing. C5-6: There is mild to moderate degree of spinal canal stenosis related to disc osteophyte complex and ligamentum flavum thickening. No cord signal abnormality. There is mild to moderate bilateral neural foraminal stenosis related to uncovertebral hypertrophy and facet arthropathy.C6-7: There is mild degree of spinal canal stenosis related to disc osteophyte complex and ligamentum flavum thickening. No cord signal abnormality. Mild to moderate left and mild right neural foraminal stenosis related to uncovertebral hypertrophy and facet arthropathy.C7-T1: No significant compromise to the spinal canal or neural foramina.There is a heterogeneous nodule along the posterior aspect of the left thyroid lobe measuring 2.8 x 1.8 cm which is not well assessed but present on prior CT from 6/23/2006.

Output: 1. Multilevel degenerative changes in the cervical spine. There is mild to moderate spinal canal stenosis at the C5-C6 level and mild spinal canal stenosis at the C6-C7 level. No evidence of higher grade stenosis or cord signal abnormality. Varying degrees of mild to moderate neural foraminal narrowing as described above.2. 2.8 x 1.8 cm heterogeneous nodule at the level of the left thyroid lobe which may represent large thyroid nodule or perhaps enlarged parathyroid tissue and was present on prior CT neck from 6/23/2006. Ultrasound can be considered for further evaluation if clinically indicated.


Instruction: Generate impression based on findings.

Input: Seizures and pituitary lesion. Per EPIC: supratherapeutic dilantin, hyperammonia from VPA; Possible toxic-metabolic component: pending workup; Paraneoplastic panel negative; LP negative for infection. Pituitary: There is an intrinsically T1 hyperintense lesion in the pituitary gland that measures up to 9 mm. The infundibulum is intact. There is no mass effect upon the optic apparatus or cavernous sinuses.Brain: There is diffuse T2 hyperintensity of the hippocampi. The rest of the brain parenchyma appears unremarkable. There is no evidence of intracranial heterotopia, hemorrhage, or acute infarct. 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, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is a small probable retention cyst in the adenoids. There is a small hemangioma in the left parietal calvarium.

Output: 1. An intrinsically T1 hyperintense lesion in the pituitary gland that measures up to 9 mm likely represents a Rathke cleft cyst. 2. Diffuse T2 hyperintensity of the hippocampi likely represents vasogenic edema, which can be a result of a toxic-metabolic process, such as hyperammonemia, for example.


Instruction: Generate impression based on findings.

Input: History of Crohn's disease, on Humira. Presented with 2-week history of left-sided numbness, mild weakness. Evaluate for demyelinating syndrome. Brain:Brain parenchyma appears within normal limits, specifically without signal abnormalities to suggest demyelinating disease. There is no mass-effect or midline shift. There is no contrast enhancing brain lesion. The ventricles and the other CSF-containing spaces are normal in size. The major intracranial vessels are patent. There is also no abnormality on diffusion- or susceptibility-weighted imaging.Orbits are normal. Mastoid air cells and paranasal sinuses are clear. There is no destructive skull lesion. The pituitary gland is prominent which is appropriate for patient's age.Cervical Spine:The cervical spinal cord also shows normal morphology and signal characteristics. There is no abnormal spinal cord or leptomeningeal contrast enhancement.Cervical spinal alignment is notable for straightening which may reflect patient position. The vertebrae are of normal morphology with preserved body height. The marrow signal shows no suspicious lesions. The cervical spinal canal is preserved with no compression of the thecal sac. The neural foramina are also patent without significant degenerative disease at any level.Included cervical soft tissues are notable for incidental Thornwald cysts in the nasopharynx. There are also small lymph nodes in the upper neck that are probably reactive. The left thyroid lobe is smaller than the right. Thoracic Spine:Thoracic spinal cord also shows normal morphology and signal characteristics. The postcontrast images are mildly degraded by motion but there is no gross abnormal contrast enhancement. The spinal canal is preserved as well as the neural foramina without stenoses. The thoracic vertebrae as well as L1 show normal alignment, morphology and marrow signal characteristics. Included paraspinal soft tissues show no gross abnormality neither.

Output: 1.Brain parenchyma appears within normal limits without evidence of demyelinating disease.2.No abnormal signal in the cervical or thoracic cord.


Instruction: Generate impression based on findings.

Input: [11-year-old male patient with bone lesion in distal left tibia.] [There is a well-defined eccentrically positioned lesion within the lateral aspect of the left distal tibial metaphysis. The lesion appears multiloculated with predominantly low T1 signal though with areas of high T1 signal suggesting blood products. The lesion is heterogeneously hyperintense on T2-weighted images with multiple fluid-fluid levels. Edema type signal is also noted within the bone surrounding the lesion and extending up the diaphysis. There is nodular and septal enhancement of the lesion following contrast administration. The superior and lateral metaphyseal cortex surrounding the lesion is indistinct, appearing similar to the prior radiograph. Furthermore there is circumferential abnormal T2 signal surrounding the metaphysis with enhancement of these soft tissues on postcontrast imaging. The lesion extends up to, but not across the distal tibial physis. Bone marrow signal within the distal left tibial epiphysis and left fibula are within normal limits. The remaining visualized soft tissue structures are unremarkable.

Output: [Enhancing lesion within the distal tibial metaphysis with fluid-fluid levels, cortical erosion, and surrounding soft tissue enhancement; these findings are concerning for a primary bone sarcoma, particularly a telangiectatic osteosarcoma. A benign, but aggressive aneurysmal bone cyst is considered less likely given surrounding soft tissue findings.


Instruction: Generate impression based on findings.

Input: BRAIN: The most superior aspect of the brain is not included on this exam. This exam is also degraded by motion artifact. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are scattered patchy foci of T2 hyperintensity throughout the supratentorial white matter most compatible with chronic small vessel ischemic disease. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull and scalp soft tissues are unremarkable. There is minimal paranasal sinus mucosal thickening and a small right sphenoid sinus retention cyst.SPINE: There is a large heterogeneously enhancing partially imaged retroperitoneal mass that may rise from the left kidney. There is a partially imaged pleural or rib based mass involving the right sixth rib that measures at least 28 x 38 mm. There is also a pleural-based mass within the left posterior chest wall invading into the left sixth rib that measures 18 x 15 mm.There is a large heterogeneously enhancing mass involving the posterior elements of L3 and L4 that measures 98 x 62 mm. It involves the spinous processes as well as the left lateral masses and pushes the dura anteriorly resulting in severe cauda equina stenosis at the L3 and L4 levels. The mass also results in severe left neural foramen stenosis at L3-L4 and L4-L5. There is an additional heterogeneously enhancing mass involving the L1 posterior elements that measures approximately 27 x 29 mm. It abuts the dura without spinal canal or neural foramen stenosis.There are moderate degenerative changes within the cervical spine as evidenced by multilevel disc desiccation, mild loss of disc height, facet and uncovertebral joint arthropathy and a grade 1 retrolisthesis of C4 on C5. These findings result in mild spinal canal stenosis at C4-C5, and multilevel neural foramen stenosis that is moderate on the left at C3-C4, and severe bilaterally at C4-C5. There are also moderate degenerative changes within the thoracic spine as evidenced by multilevel disc desiccation, loss of disc height, end plate degenerative changes, and mild anterior wedging of T7 with an exaggerated kyphosis. There are small central disc protrusions at T6-T7 and T7-T8 without significant spinal canal stenosis. The left thyroid lobe is enlarged and heterogeneous. There is no evidence of spinal cord or conus compression. The spinal cord displays normal signal and morphology.

Output: Large partially imaged retroperitoneal mass that may arise from the left kidney. There are presumed metastases invading the posterior chest wall and sixth ribs bilaterally. There are also presumed metastases involving the posterior elements of L1 as well as at L3-L4 where there is severe spinal canal stenosis and severe left neural foramen stenosis at L3-L4 and L4-L5. There is no evidence of spinal cord or conus compression. A CT chest / abdomen / pelvis is recommended for further characterization and staging purposes.


Instruction: Generate impression based on findings.

Input: 32 years Female (DOB:1/1/1984)Reason: Chiari with new vision changes and headaches/dizziness, sp decompression, please do with csf flow History: headache, dizziness and vision changesPROVIDER/ATTENDING NAME: DAVID M FRIM DAVID M FRIM MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. There appears to be some bidirectional flow at the level of foramen magnum.The patient status post suboccipital craniotomy and C1 posterior arch surgery for Chiari decompressionNo abnormal enhancing mass lesions are appreciated within the brain parenchyma. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate a small mucous retention cyst. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI orbits:The eyeballs are intact. No intraconal or extraconal space mass is identified. The extraocular muscles are intact. The lacrimal glands are symmetric and within normal limits in size and configuration. The suprasellar cistern is intact .

Output: 1.There is no evidence for an intraorbital mass.2.Some bidirectional flow present at the level of the foramen magnum which may suggest that there is some mild impedance to CSF flow at the level of the foramen magnum. There is no evidence for ventriculomegaly on this exam.3.Status post Chiari I decompression.


Instruction: Generate impression based on findings.

Input: Pain and altered sensation. Five lumbar type vertebral bodies are present. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign. There is disc desiccation at L3-4 and L4-5. 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: There is a left disc protrusion, with moderate left neuroforaminal stenosis. There is no spinal canal or right neural foraminal stenosis.L4-L5: There is an annular tear at L4-5 associated with a small central disc protrusion resulting in mild central canal as well as lateral recess narrowing. There is no neuroforaminal stenosis.L5-S1: No significant disc disease. No spinal canal or neural foraminal stenosis.Paraspinous soft tissues are within normal limits.

Output: Multilevel degenerative disc disease most significant at L3-4 and L4-5. There is moderate left neural foraminal stenosis at L3-4 and mild central canal/lateral recess stenosis at L4-5.


Instruction: Generate impression based on findings.

Input: 42-year-old female patient with BRCA 2 mutation. Pancreatic screening. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No pancreatic lesion is identified. 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: Partially imaged bilateral breast prostheses. A focal lesion within the L1 vertebral body with high T2 signal, high T1 signal, and mild enhancement appears stable from the prior examination.OTHER: No significant abnormality noted.

Output: 1.No specific evidence of a pancreatic malignancy.2.Stable L1 vertebral body lesion which likely represents a hemangioma.


Instruction: Generate impression based on findings.

Input: 32 year old female patient with non-small cell lung cancer. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.There is abnormal low T1 bone marrow signal and loss of height of the C4 vertebral body. There is no abnormality in the epidural space at this level on sagittal imaging. Enhancement within the vertebral body cannot be adequately assessed due to non-fat saturated imaging.

Output: 1. No evidence of intracranial metastases.2. Loss of height and signal abnormality within the C4 vertebral body. Without an adequate history of prior trauma or prior imaging demonstrating chronicity, the potential for a metastatic lesion should be considered; this can be further evaluated with MRI of the cervical spine with contrast or a bone scan.


Instruction: Generate impression based on findings.

Input: 72-year-old woman with history of portal vein thrombosis and cystic pancreatic lesions on ultrasound. ABDOMEN:LIVER, BILIARY TRACT: The liver is cirrhotic in morphology with nodular contour and relative atrophy of the right lobe compared to the hypertrophic left lobe. No suspicious focal enhancing hepatic lesions identified.The main, right, and proximal left portal veins are patent. The lateral left portal vein is small but patent (1204/223). The medial left portal vein is patent and feeds a large paraumbilical collateral vein.The gallbladder appears normal. There is no intra or extrahepatic biliary ductal dilatation.SPLEEN: There is splenomegaly. The spleen is otherwise normal.PANCREAS: Multiple cystic lesions are noted in the pancreas without enhancement and without clear communication to the pancreatic duct (MRCP images are significantly degraded due to motion). The main pancreatic duct is nondilated. The remainder of the pancreatic parenchyma appears normal.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Paraumbilical and retroperitoneal/perisplenic collaterals seen. The left renal vein and left gonadal vein are dilated, definitive renal vein to splenic vein communication not able to be visualized.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Circumferential gastric wall thickening is nonspecific in the setting of ascites.BONES, SOFT TISSUES: There is soft tissue anasarca.OTHER: Ascites noted. There is cardiomegaly.

Output: 1.Cirrhotic morphology of liver without suspicious focal hepatic lesion.2.Patent portal veins. Evidence of portal hypertension with splenomegaly and paraumbilical and retroperitoneal/perisplenic collaterals. 3.Multiple cystic pancreatic lesions, likely side branch IPMNs.


Instruction: Generate impression based on findings.

Input: Female, 75 years old, with Parkinson's disease. A limited selection of sequences is provided for surgical planning purposes. Mild prominence of the sulci is compatible with underlying volume loss. No edema or mass effect is seen. No evidence of intracranial hemorrhage or any abnormal extra-axial fluid collections is detected. The pattern of intracranial enhancement is within normal limits.

Output: Limited imaging for surgical planning purposes demonstrates no significant intracranial abnormality.


Instruction: Generate impression based on findings.

Input: 46 years Male (DOB:6/13/1969)Reason: MS, f/u progression History: paresthesiasPROVIDER/ATTENDING NAME: ADIL JAVED ADIL JAVED There is redemonstration of multiple periventricular and subcortical white matter lesions which are high signal on T2 and FLAIR and low signal on T1-weighted imaging. Lesions in the periventricular white matter are perpendicularly oriented to the lateral ventricles. No abnormal enhancing lesions are appreciated within the brain parenchyma. These have not changed substantially since the prior exam. There is an additional lesion present in the right posterior pons which was also present on the prior exam.Findings suggest cerebellar atrophy which was also present on the prior examNo abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The right internal carotid artery flow-void is very small along the ophthalmic segment on the current and on the prior exams. The right internal carotid arteries identified along the petrous segment and is diminutive. The right ophthalmic artery cannot be resolved on this exam. The right middle cerebral artery appears to originate from the basilar artery. Normal vascular flow voids are present in the distal left carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate some mucosal thickening. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Since the prior exam there is no significant interval change. There is redemonstration of periventricular and subcortical as well as brainstem lesions which are compatible with demyelination.2.The right internal carotid artery is very small along the opthalmic segment. This could represent an acquired defect from prior carotid injury or developmental variant such as a hypoplastic opthalmic segment ICA with associated persistent fetal PCA redistribution of flow to the right middle cerebral artery via the vertebrobasilar system (Basilar origin of MCA). A CT angiogram of the brain may be of benefit to further evaluate this. A CT of the head with help confirm whether this is developmental (based on appearance of the petrous carotid canal) or acquired.


Instruction: Generate impression based on findings.

Input: Increased weakness of right leg, patient has multiple sclerosis. Rule out disc herniation in cervical spine. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained. Bone marrow signal is within normal limits. There are multiple T2 hyperintense lesions throughout the cervical cord consistent with known demyelinating disease. Relatively larger of these lesions are seen including the dorsal upper C2 level, dorsal and left ventral C3 level with focal volume loss, right lateral C4-C5 level, and right lateral C5 to C6 levels where there is also focal volume loss. Thoracic lesion at the right T1-T2 level is also noted and was present on prior thoracic MRI. No lesions with enhancement are definitively appreciated. Apparent high signal on the sagittal post gadolinium sequence at the C7 level is not corroborated on the axials and is most likely artifactual.Mild degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: No significant compromise to the spinal canal or left neural foramen. Mild to moderate right neural foraminal stenosis related to uncovertebral hypertrophy and facet arthropathy.C4-5: No significant compromise to the spinal canal or neural foramina.C5-6: Mild disc bulge and bilateral uncovertebral hypertrophy with mild bilateral neural foraminal narrowing. No significant spinal canal stenosis.C6-7: Small disc osteophyte complex and bilateral uncovertebral hypertrophy. There is no significant spinal canal or neural foraminal stenosis.C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: 1. Multiple T2 hyperintense lesions throughout the cervical cord consistent with chronic demyelinating disease. No lesions with enhancement are definitively appreciated to suggest active demyelination. Comparison can be made to prior study if made available.2. Mild degenerative changes in the cervical spine without significant spinal canal stenosis at any level. There is mild neural foraminal narrowing as detailed above. No high-grade neural foraminal stenosis at any level.


Instruction: Generate impression based on findings.

Input: Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears 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 unremarkable.Lumbar Spine: There is diffuse thickening of most of the cauda equina nerve roots, generally to a mild degree. Otherwise, the imaged spinal cord displays normal signal and morphology. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. At L3-4, there is mild facet hypertrophy and ligamentum flavum thickening, without no significant spinal canal stenosis, but mild bilateral neural foramen narrowing. At L4-5, there is a based disc bulge with mild bilateral neural foramen narrowing, but no significant spinal canal. At L5-S1, there is disc desiccation and small central disc protrusion with no significant neural foramen or spinal canal stenosis. There paraspinal soft tissues are unremarkable.

Output: 1. No evidence of acute cerebral infarction, intracranial mass, or intracranial hemorrhage.2. Diffuse thickening of the cauda equina nerve roots. Differential include an inflammatory or neoplastic process, or perhaps a hereditary motor sensory neuropathy. Further evaluation via MRI with contrast and DRIVE/FIESTA sequence may be useful. 3. Mild degenerative spondylosis of the lumbar spine with small central disc protrusion at the L5-S1 level, but no significant spinal canal stenosis.


Instruction: Generate impression based on findings.

Input: Reason: eval cause of pain History: right back, SI, and leg pain BONE MARROW: Normal bone marrow signal is seen throughout the pelvis.SOFT TISSUES: There is diffuse muscle atrophy, otherwise, no significant abnormality. JOINTS: Sacroiliac joints are normal in appearance, without evidence of sacroiliitis.ADDITIONAL

Output: No evidence of sacroiliitis. Diffuse muscle atrophy. Normal bone marrow signal.


Instruction: Generate impression based on findings.

Input: 62 year-old female with lower abdominal, hip, and back pain.IMAGE ACQUISITIONS: Lumbar spine CT without contrast Vertebral column alignment and density are normal. There is posterior disk bulge, bilateral facet joint hypertrophy, and ligamentum flavum thickening at L5-S1 causing mild spinal stenosis and bilateral neuroforaminal narrowing. No other significant lumbar degenerative disease is noted. MRI of the lumbar spine would provide a more detailed evaluation.

Output: Degenerative disk disease at L5-S1 causing mild spinal stenosis


Instruction: Generate impression based on findings.

Input: Ms. Bergiel is a 34 year old female with a personal history of known right breast cancer presenting for assessment of tumor response. Family history includes mother, maternal grandmother, and maternal great grandmother diagnosed breast cancer. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. 3 additional spot compression views and one exaggerated CC view of the right breast were obtained. Targeted grayscale and color ultrasound was subsequently performed.MAMMOGRAM:The breast parenchyma is heterogeneously dense, which may obscure small masses (BiRads Density Category C), unchanged in pattern and distribution. Benign-appearing calcification in the retroareolar space is unchanged.4 biopsy clips are visualized in the lower, inner right breast. One placed at the time of MRI biopsy in the anterior depth, 2 clustered hydromark biopsy clips within one of the masses that were biopsied at University of Chicago, and a wing clip placed within the adjacent mass placed at outside hospital. The 2 hydromark clips from the University of Chicago performed biopsy appear superomedial in comparison to the wing clip. There are calcifications present between the clips.ULTRASOUND:2 biopsy clips are visualized within the University of Chicago performed biopsy in the superomedial lesion. Just inferolateral to this lesion is a possible biopsy clip with adjacent hypoechoic lesion measuring 0.8 x 0.3 x 0.5 cm, previously 1.0 x 0.8 x 1.0. Punctate calcifications are visualized between these clip locations. The wing clip is difficult to identify.

Output: Near complete response of masses within the right inner, medial breast. Results and recommendations were discussed with the patient.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: 48-year-old BRCA2 positive woman with family history of breast cancer presents for second look ultrasound and biopsy of suspicious mass detected in the left breast on screening MRI. LEFT BREAST ULTRASOUND: Targeted grayscale and color Doppler left breast ultrasound identified the target lesion for biopsy. The lesion to be targeted is a hypoechoic mass measuring 5 x 6 x 8 mm (CC x AP x TV) at the 4 o’clock position without increased vascularity, 2 cm from the nipple. The lesion was readily visible and corresponds with the lesion seen on screening MRI 7/30/2015.PROCEDURE: The procedure and its risks, including bleeding, infection, and failure to diagnose, and expected benefits of ultrasound-guided core biopsy with percutaneous placement of a marking clip and post-procedure unilateral mammogram were discussed with the patient. Questions were answered. Consent was obtained both verbally and in writing. The time-out form was completed to confirm patient identity and side/type of procedure.The left breast was cleansed with chlorhexidine over the target area. Transducer was sterilely sheathed. Local anesthesia was obtained using 2% lidocaine superficially, with 1% lidocaine with 1:100,000 epinephrine at depth. A 3 mm incision was made in the skin with a #11 scalpel blade. Using aseptic technique, continuous ultrasound guidance and a lateromedial approach, four 12-gauge core needle (Celero) specimens were obtained of the lesion. Targeting was judged very good. Three specimens sank to the bottom of the prefilled container of 10% formalin. One specimen partially sank. Specimen quality was judged very good.Specimens were sent to Pathology with an accompanying history sheet. Using continuous ultrasound-guidance a Hydromark clip was placed into the lesion in the usual manner. Pressure was held over the biopsy site until all bleeding subsided. The skin incision was closed with a Steri-Strip. Post-procedure digital left CC and ML views revealed the percutaneously placed clip to be in the expected location in the peripheral lateral aspect of the lesion (3 mm laterally by ultrasound). No evidence of hematoma or other complication.A pressure dressing was positioned over the biopsy site and an ice pack positioned over the pressure dressing. Post-procedure instructions were reviewed with the patient both verbally and in writing. She tolerated the procedure well with no evident complications and left the Breast Imaging Department in stable condition.The procedure was performed by Dr. Kulkarni and Dr. Udoji. Dr. Kulkarni was present during the procedure at all times.

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


Instruction: Generate impression based on findings.

Input: 21-year-old male with lateral knee pain and catching MENISCI: The lateral meniscus is intact. There is mild signal heterogeneity within the peripheral fibers of the medial meniscus at the junction of the body and posterior horn extending to the femoral articular surface. This may represent a tear in the vascularized periphery of the meniscus but may be chronic and not necessarily of any current clinical significance.ARTICULAR CARTILAGE AND BONE: There is mild edema type signal within the posterior medial tibial plateau. The overlying articular cartilage is intact. The remainder of the tibiofemoral and patellofemoral articular cartilage is also intact.LIGAMENTS: The cruciate and collateral ligaments are intact.EXTENSOR MECHANISM: The quadriceps and patella tendons are intact.ADDITIONAL

Output: 1. No evidence of lateral meniscus tear. Mild heterogeneous signal intensity within the peripheral fibers of the medial meniscus could represent a tear in the red zone and may be chronic in etiology and not necessarily of any current clinical significance.2. Mild edema within the posterior medial tibial plateau, which is nonspecific but may represent a contusion.3. Baker's cyst.4. Mild nonspecific edema between the lateral gastrocnemius and popliteal tendons without disruption of the muscles or tendons.


Instruction: Generate impression based on findings.

Input: Male, 2 years old, with seizures. The atria of the lateral ventricles are mildly prominent with a slight waviness to their contour. The adjacent parietal lobe white matter appears to be mildly reduced in volume.Elsewhere brain parenchymal morphology and signal characteristics are within normal limits. No restricted diffusion is seen. No edema or mass effect is detected.The pattern of white matter myelination is appropriate for age. The pituitary region is unremarkable. The brainstem, cerebellar vermis and cerebellar hemispheres are within normal limits.Except as above, the ventricular system is normal in size and morphology. No evidence of intracranial hemorrhage or abnormal extra-axial fluid is seen.Mucosal thickening is evident within the paranasal sinuses.

Output: 1.Findings suggestive of mild periventricular leukomalacia affecting the periatrial parietal regions.2.No other significant abnormalities are seen to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: 68-year-old man with history of paroxysmal atrial fibrillation. Left VentricleMorphologically and function are normal ventricular function. Mild patchy delayed hyperenhancement within the mid wall of the left ventricle in the basal and mid-cavity LV.Left AtriumThe left atrium is mildly to moderately dilated.. Right VentricleMorphologically normal ventricular function. Mild RV dilation.Right AtriumThe right atrium is mildly to moderately dilated..Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveMild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveMild 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. There is early branching of the right superior pulmonary vein. No evidence of pulmonary vein stenosis.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: Mild patchy delayed hyperenhancement within the mid wall of the left ventricle in the basal and mid-cavity LV, which may represent myocarditis, fibrosis, or an infiltrative process. Consider cardiac MRI follow-up in 6 months or as per clinical protocol for reevaluation.Normal pulmonary vein anatomy with early branching of the right superior pulmonary vein. No evidence of pulmonary vein stenosis.Mild cardiomegaly predominantly involving the atria and right ventricle.


Instruction: Generate impression based on findings.

Input: Neck and back pain with bilateral lower extremity numbness. Cervical: There are postsurgical changes of anterior cervical fusion from C5 to T1 with anterior plate, screws, and interbody graft. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate height. Alignment is grossly maintained. Bone marrow signal is within normal limits. The cervical spinal cord has normal signal characteristics and overall morphology.Degenerative changes are seen in the cervical spine as described below:C2-3: Small central disk protrusion, uncovertebral hypertrophy, and facet arthropathy. There is mild to moderate right and minimal left neural foramina stenosis. No significant compromise to the spinal canal.C3-4: Minimal disk bulge. There is mild to moderate right and moderate to severe left neural foramina stenosis related to prominent osteophyte related to facet arthropathy and uncovertebral hypertrophy. No significant spinal canal stenosis.C4-5: Minimal disk bulge. There is moderate to severe right and moderate left neural foramina stenosis related to uncovertebral hypertrophy and bilateral facet arthropathy. No significant spinal canal stenosis.C5-6: There is mild right neural foramina stenosis. No significant spinal canal or left neural foramina narrowing.C6-7: Mild bilateral neural foraminal narrowing. No significant spinal canal narrowing.C7-T1: No significant spinal canal or neural foramina narrowing.Paraspinous soft tissue structures appear within normal limits.Thoracic:Vertebral body heights and alignment are normal. Bone marrow signal is within normal limits. Mild degenerative changes are seen.At T1-T2, there is moderate left neural foraminal stenosis related to ligamentum flavum thickening and facet arthropathy. No significant spinal canal or right neural foraminal narrowing.There is mild bilateral neural foramina stenosis at T9-T10, worse on the right. There is a mild disk bulge at T10-T11 without significant spinal canal stenosis. There is also moderate right and mild left neural foramina stenosis at T10-T11.Apparent subtle T2 hyperintensity on the axial sequence in the lower thoracic cord and conus is most likely artifactual and not seen on the sagittal T2 or stir sequence. No convincing cord signal abnormality is seen. Paraspinous soft tissues unremarkable.

Output: 1. Status post anterior fusion C5-T1with solid osseous fusion as seen on radiographs.2. Up to moderate to severe neural foraminal narrowing at C2-C3, C3-C4, and C4-C5 as detailed above.3. No significant cervical spinal canal stenosis or cord signal abnormality. 4. Neural foramina narrowing on the left at T1-T2 and at T9-T10 and T10-T11 as detailed above.5. No cord signal abnormality or significant spinal canal stenosis in the thoracic spine.


Instruction: Generate impression based on findings.

Input: Reason: metastatic uveal melanoma to liver s/p ablation History: assess for treatment response ABDOMEN:LIVER, BILIARY TRACT: Segment 6 lesion with discontinuous peripheral nodular enhancement is stable measuring 1.9 x 1.5 cm (3/21), likely a hemangioma. Additional subcentimeter cysts are stable.There has been interval thermoablation of a caudate lobe lesion. No residual enhancement is evident.The portal venous system is patent.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Thermoablation of caudate lobe lesion without residual enhancement.2.Segment 6 hemangioma is stable.


Instruction: Generate impression based on findings.

Input: Reason: Patella Chondromalacia History: Pain, Swelling MENISCI: There is blunting and deformity within the posterior horn of the medial meniscus indicating complex tearing that extends to involve the body of the meniscus. There is also a large radial component which extends near the root of the posterior horn of the meniscus. There is a focus of low signal intensity within the intercondylar notch which may represent a flipped meniscal fragment. The anterior horn appears intact. There is globular increased signal abnormality within the anterior horn of the lateral meniscus indicating intrasubstance degeneration. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is a focal near full-thickness to full-thickness articular cartilage defect along the lateral femoral condyle, anteriorly, with underlying subchondral signal abnormality. There is full-thickness articular cartilage degeneration along the lateral facet of the patella and median eminence of the patella with underlying subchondral signal abnormality with large areas completely devoid of cartilage. There are tricompartmental osteophytes.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact. There is minimal intermediate signal intensity within the proximal fibers of the patellar tendon indicating a mild tendinosis.ADDITIONAL

Output: 1. Complex tearing and degeneration of the medial meniscus.2. Osteoarthritis of the knee including full-thickness articular cartilage degeneration most pronounced along the patellofemoral and lateral tibiofemoral compartments. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Medial knee pain. Injury 3/18/2015 MENISCI: Very minimal fraying of the inner edge adjacent to the body of the right medial meniscus cannot entirely be excluded, however the remainder of the meniscus is well visualized and normal. Lateral meniscus is unremarkable and both menisci are properly anchored posteriorly.ARTICULAR CARTILAGE AND BONE: Discrete bone contusion is observed underlying the posterior medial tibial plateau and tibial spines. No discrete linear component or evidence to suggest a fracture is observed. Marrow signal otherwise unremarkable. Cartilage is well visualized and normalLIGAMENTS: No abnormality noted. EXTENSOR MECHANISM: No abnormality noted.ADDITIONAL

Output: Proximal tibial apophyseal and metaphyseal contusion.


Instruction: Generate impression based on findings.

Input: There are multiple foci of abnormal enhancement within both the supratentorial and infratentorial brain. The larger lesions are associated with vasogenic edema and susceptibility abnormality suggesting internal hemorrhage. The largest of these measures up to 21 mm in maximal dimension and is located in the posterior left frontal lobe.The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are is no midline shift. The pituitary gland is normal in size. There is no evidence for acute cerebral, brainstem or cerebellar infarction. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear.

Output: Multiple brain metastases, the largest of which is 21 millimeters in maximal dimension located in the posterior left frontal lobe.


Instruction: Generate impression based on findings.

Input: seizures, No evidence of acute ischemic or hemorrhagic lesion on this scan.There are patchy high signal intensity lesions on bilateral periventricular white matters indicate non specific small vessel ischemic lesion. Underlying brain shows minimal to mild brain atrophy which could be a bit more prominent than age.The ventricles appear to be a bit prominent but no evidence of occlusive lesion.There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. The mastoid air cells are clear.Sphenoid sinus as well as bilateral maxillary sinuses show mucosal thickening and fluid level indicating sinusitis.3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal distal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal. The right Pcom artery is patent and Acom artery is patent but the left Pcom artery is not seen.3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The left vertebral artery origin appears to be narrowed about 50%. The right vertebral artery is hypoplastic. Bilateral common carotid, carotid bifurcations, internal/external carotid show tortuous course but do not show any significant luminal narrowing. There is no evidence of intracranial arterial luminal narrowing or arterial aneurysm.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. No evidence of intracranial and extracranial craniocervical arterial luminal narrowing.3. No evidence of intracranial aneurysm.4. Non specific white matter changes with mild brain atrophy as described above.