Instruction: Generate impression based on findings.

Input: Ms. McDonnell is a 50-year-old female presenting with right breast erythema and palpable mass. She had diagnostic imaging workup on 4/22/2016 which revealed a cyst corresponding to the patient's palpable area of concern. She presents today for MRI for further evaluation of these clinical symptoms. Family history of breast cancer in mother, diagnosed at age of 30. There is heterogeneous amount of fibroglandular tissue in both breasts. There is asymmetric background parenchymal enhancement (right greater than left) noted. The right breast enhancement is seen only within the breast parenchymal tissue and is greater in volume and intensity when compared to the contralateral left breast. However, no one area is more suspicious than the rest. Given clinical history, findings likely reflect mild mastitis versus normal physiological finding. Of note, there is no abnormal skin thickening seen in either breast. Numerous nonenhancing cysts of varying sizes are present bilaterally.No abnormal axillary lymph nodes are identified in either axillary region.

Output: (1) Asymmetric background parenchymal enhancement (right > left) identified, which may reflect mild mastitis versus normal physiological findings. Recommend correlation with clinical history and physical exam findings. (2) No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: C - Clinical Correlation Needed.


Instruction: Generate impression based on findings.

Input: Female, 72 years old, with aphasia and right facial droop, suspected left MCA syndrome.] For stroke. Gyriform restricted diffusion is evident within the lower left precentral gyrus and middle frontal gyrus. There may be a small focus of restricted diffusion within the left postcentral gyrus as well. Very mild patchy cortical restricted diffusion is also suspected along the left temporal and occipital junction.Sequelae of prior ischemia are seen within the left temporal and occipital lobes with associated gliosis and encephalomalacia. There is mild ex vacuo dilatation of the left ventricular atrium. Numerous scattered foci of periventricular white matter T2 hyperintensity are also seen compatible with chronic microvascular ischemic disease.No evidence of significant generalized mass effect is seen. No findings to suggest acute intracranial hemorrhage are noted. Several scattered foci of susceptibility are seen predominantly in the left cerebral hemisphere compatible with chronic microhemorrhage. Except as above, the ventricles are within normal limits.

Output: 1.Acute ischemia involving the lower left precentral gyrus and part of the left middle frontal gyrus. There may be an additional small focus of acute ischemia within the left postcentral gyrus, and mild, perhaps subacute ischemia at the left temporal occipital junction.2.Sequelae of multiple prior territorial and small vessel ischemic lesions are seen. No evidence of significant intracranial hemorrhage or any generalized cerebral mass effect is seen.


Instruction: Generate impression based on findings.

Input: There is no territorially restricted diffusion to suggest acute territorial ischemic infarction. There is an intra-axial lesion centered within the left superior parietal lobe which demonstrates a thin rim of peripheral enhancement and measures approximately 10 x 12 x 14 mm. This lesion demonstrates restricted diffusion centrally. There is a moderate amount of abnormally increased T2/FLAIR signal within the adjacent white matter in the left parietal lobe compatible with vasogenic edema. There is an additional focus of abnormal enhancement in the left precuneus parietal lobe just posterior to the splenium which measures 6 x 6 mm and also has a small amount of adjacent vasogenic edema. There is an additional abnormal enhancing lesion within the right temporal lobe within the posterior aspect of the inferior temporal gyrus which measures 6 x 9 mm with a moderate amount of surrounding vasogenic edema extending into the adjacent temporal lobe. Each of the lesions demonstrates subtle decreased signal on susceptibility weighted images compatible with small amount of microhemorrhage. There are additional punctate confluent foci of increased T2/FLAIR signal within the periventricular and subcortical white matter compatible with mild chronic small vessel ischemic changes. The ventricles are normal in size and configuration. Basal cisterns remain patent. The expected major intracranial vessel flow voids are present. The skull and extracranial soft tissues are grossly unremarkable.

Output: 1.Abnormal enhancing lesions within the supratentorial brain with associated surrounding vasogenic edema. Primary differential considerations include multiple metastases or abscesses.2.No acute territorial infarction. Mild chronic small vessel ischemic changes.


Instruction: Generate impression based on findings.

Input: Male 59 years old. Reason: S1 left sciatica pain .Right lower thoracic pain. Hx T5 plasmacytoma s/p RT. History: S1 left sciatica pain. Right lower thoracic pain. Hx T5 plasmacytoma s/p RT. BONE MARROW: There is extensive red marrow in the proximal femurs, spine, and innominate bones. There is also widespread myelomatous involvement with the largest lesion being an expansile focus in the right ilium abutting the sacroiliac joint (series 4, image 29). There is an additional prominent lesion in the inferior right sacrum. Several small myelomatous lesions are noted within the left femoral head and the lesser trochanter.SOFT TISSUES: No significant abnormality noted. JOINTS: No significant abnormality noted.ADDITIONAL

Output: Widespread myelomatous involvement in the pelvis, sacrum and bilateral femurs as described above.


Instruction: Generate impression based on findings.

Input: Female, 47 years old, status post resection of a large acoustic neuroma in April, 2015, 6 months status post SRS for residual tumor at Swedish Covenant in September, 2015. IACs:Redemonstrated are findings related to prior translabyrinthine resection of a left IAC and CP angle schwannoma. Residual enhancing tumor remains evident within the left cerebellar pontine angle cistern and skeletonized IAC. The lesion measures 26 mm TV, 14 mm AP and 17 mm CC (previously 32 x 15 x 20 mm). The tumor itself is more heterogeneously enhancing than previously. Mass effect upon the adjacent pons and middle cerebellar peduncle with mild parenchymal T2 hyperintensity has not significantly changed.Brain:No other specific intracranial lesions are seen. Brain parenchymal morphology and signal characteristics are otherwise unremarkable. No other pathologic intracranial enhancement is detected. No intracranial hemorrhage or any abnormal extra-axial fluid collection is detected. The ventricular system is normal in size and morphology.

Output: 1.Slight interval decrease in the size of the residual left IAC/CP angle schwannoma. Progressive heterogeneity of tumor enhancement may also reflect a treatment related effect.2.Otherwise unremarkable evaluation of the brain.


Instruction: Generate impression based on findings.

Input: Clinical question: Worsening encephalopathy. Signs and symptoms: Encephalopathic Extensive vasogenic edema of the left frontal and parietal lobes and to a lesser degree of right frontal lobe is noted. These findings were not identified on prior CT examination of the brain. Review of prior MRI examination of brain from 11 -- 17 -- 2009 demonstrated similar findings. There is extensive effacement of cortical sulci throughout bilateral cerebral hemispheres. There is no evidence of hydrocephalus and no midline shift is detected. There is no evidence of hemorrhage. Basal cisterns and all the other CSF cisterns remain patent. Calvarium, limited real paranasal sinuses and mastoid air cells are also unremarkable. High density within the superior sagittal sinus it could represent previously recognized thrombosed superior sagittal sinus.

Output: Bihemispheric frontal -- parietal areas of vasogenic edema without hemorrhage secondary to patient's known intracranial sinus thrombosis.


Instruction: Generate impression based on findings.

Input: Left-sided weakness in arm and leg, progressive over one year. Brain: Brain parenchyma appears within normal limits. No findings to suggest ischemia, intracranial mass, or demyelinating disease. No evidence of mass effect, midline shift, or herniation. The ventricles are within normal limits in size and configuration. Major flow-voids are preserved. Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits. Cervical Spine: Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate height. There is loss of normal cervical lordosis. Alignment is otherwise 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: No significant compromise to the spinal canal or neural foramina.C4-5: There is mild disc bulge and bilateral uncovertebral hypertrophy. No significant spinal canal stenosis. There is mild left neural foraminal stenosis. No significant right neural foraminal narrowing. C5-6: There is mild disc bulge and bilateral uncovertebral hypertrophy. There is effacement of the ventral thecal sac and minimal impression on the ventral cord. No cord signal abnormality. There is minimal left neural foraminal narrowing. No significant right neural foraminal narrowing.C6-7: There is disc osteophyte complex with effacement of the ventral thecal sac and mild impression on the left ventral cord. There is mild right neural foraminal narrowing. No significant left neural foraminal narrowing.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. Noncontrast MRI of the brain appears within normal limits. 2. No cervical cord signal abnormality. There are degenerative changes at C4-C5, C5-C6, and C6-C7 with mild spinal canal stenosis at C5-C6 and C6-C7. There is also mild left C4-C5 and minimal left C5-C6 neural foraminal narrowing which may be affecting the left C5 and C6 nerve roots. No higher grade neural foraminal stenosis is appreciated.


Instruction: Generate impression based on findings.

Input: Diagnosis: Altered mental status, unspecifiedClinical question: determine age of right MCA infarctSigns and Symptoms: AMSComments: Verifying presence of metal with family | There is encephalomalacia involving much of the right hemisphere and predominantly the right middle cerebral artery territory. This is associated with multiple punctate foci of susceptibility effect on susceptibility weighted imaging within the right middle cerebral artery territory. Some susceptibility effect is present in the region of the basal ganglia. There is a small area of diffusion restriction involving the right basal ganglia and portions of the right centrum semiovale. Within this area of diffusion restriction there is T2 hypointensity and even some FLAIR hypointensity as well as some T1 hyperintensity.A focus of encephalomalacia is present along the medial aspect of the left occipital lobe extending into the medial left temporal lobe and the left posterior cerebral artery territory.Some small T2 hyperintense lesions are present in the cerebellar hemispheres.There is a moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.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 right cerebral peduncle is small and has abnormal signal. Additionally there is some abnormal signal in the right pons and medulla. This is suggestive of Wallerian degeneration.The visualized portions of the paranasal sinuses demonstrate scattered opacities. The visualized portions of the mastoid air cells are partially opacified on the right side more than the left.. The visualized portions of the orbits are intact.Exam is somewhat compromised due to patient motion.

Output: 1.There is encephalomalacia involving a significant portion of the right hemisphere predominantly involving the right middle cerebral artery territory but also involving portions of the anterior cerebral artery territory and posterior cerebral artery territory. Most likely is related prior cerebral infarction in the right middle cerebral artery territory.2.There is encephalomalacia present in the left medial temporal and occipital lobes. Most likely this is related to prior cerebral infarction in the left posterior cerebral artery territory.3.Diffusion restriction is present in the region of the right basal ganglia and centrum semiovale which suggests some superimposed subacute infarction, however, the pattern is somewhat unusual and could represent sequela from a prior hemorrhagic event superimposed on prior infarction given it a more complex appearance.4.Periventricular and subcortical white matter changes of a moderate degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: Male 41 years old with acute pancreatitis on 8/21/16 and s/p EUS on 11/18/16 with heterogenous hyper and hypoechoic foci within enlarged pancreatic head. FNA -prelim with inflammatory process, otherwise normal. MRI/MRCP for further evaluation given persistent abdominal pain. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in size and smooth in contour. A well-defined, subcentimeter T2 hyperintense nonenhancing lesion in segment 2 of the liver is compatible with a simple cyst. No suspicious liver lesion.Normally distended gallbladder with no cholelithiasis. No intra or extrahepatic biliary ductal dilatation. There is mild narrowing of the common bile duct at the level of the pancreatic head.SPLEEN: No significant abnormality noted.PANCREAS: There is masslike enlargement of the pancreatic head with areas of abnormal low T1 signal and small foci of nonenhancement likely corresponding to areas of necrosis. An additional smaller focus with similar imaging characteristics is seen in the pancreatic tail (series 16, image 42). The body and tail of the pancreas are slightly atrophic. The pancreatic duct is not seen at the level of the pancreatic head, the duct is prominent in the body and tail measuring 3 mm in diameter.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: There are a few bilateral simple renal cysts. No suspicious renal lesion. No hydronephrosis.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: Masslike enlargement of the pancreatic head is with areas of necrosis is most suggestive of autoimmune or resolving acute interstitial pancreatitis. A lesion with similar imaging characteristics in the pancreatic tail may be part of the same process. Follow-up MRI in 6-8 weeks is suggested to ensure the process has resolved.


Instruction: Generate impression based on findings.

Input: 31-year-old man with history of known primary sclerosing cholangitis. ABDOMEN:LIVER, BILIARY TRACT: The liver appears normal in signal and morphology without focal hepatic lesion.Previously seen dominant stricture near the ampulla (8/70) appear similar to the prior examination with mild upstream ductal dilatation measuring up to 7 mm. Secondary area of apparent narrowing near the porta hepatis (8/62) corresponds to crossing right hepatic artery.Multiple areas of intrahepatic biliary ductal stricturing (8/76) with upstream dilatation appears worse than the prior examination.The gallbladder is distended and normal.SPLEEN: The spleen is small, but otherwise unremarkable.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: Previously seen colonic wall thickening appears to have resolved.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Multifocal intra and extrahepatic biliary strictures compatible with history of PSC. Of note, the intrahepatic strictures appear worse compared to 2014.2.Interval resolution of previously seen colonic wall thickening.


Instruction: Generate impression based on findings.

Input: GBM resected in 2/15 on TMZ Right frontal oval resection cavity is not significantly changed in size measuring approximately 59 x 36 mm in oblique cross-sectional dimensions (series 801, image 18). There is a thin rim of hemosiderin and minimal peripheral FLAIR signal surrounding the resection cavity. There are subcortical foci of FLAIR hyperintensity in the right anterior temporal lobe that are stable and likely related to areas of gliosis, perhaps post-operative. There is no abnormal enhancement in the brain. Dural enhancement and thickening at the craniotomy site is postoperative in etiology. No significant interval change in relative cerebral blood volume around the resection cavity or elsewhere in the brain to suggest tumor recurrence. There is no significant interval change in size of the small extra-axial fluid collection along the undersurface of the craniotomy flap. Mild effacement of the right frontal horn is unchanged. No midline shift.Perfusion imaging does not demonstrate any evidence of hyperperfusion along the resection cavity.

Output: Stable postsurgical changes without evidence of tumor recurrence.


Instruction: Generate impression based on findings.

Input: Lateral knee pain Note that the exam is significantly limited by motion artifact.MENISCI: There is maceration of the lateral meniscus with associated extrusion into the lateral gutter. The medial meniscus appears relatively intact. ARTICULAR CARTILAGE AND BONE: There is severe cartilage loss of the lateral compartment involving both the femoral condyle and tibial plateau. There is associated reactive marrow changes. Moderate thinning of the medial compartment is noted with severe loss of the patellofemoral compartment also present. Tricompartmental osteophytes are noted. Intraosseous ganglion is seen near the root of the medial meniscus and there are degenerative marrow changes of the tibiofibular articulation.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The quadriceps and patellar tendons are intact.ADDITIONAL

Output: 1. Maceration of the lateral meniscus.2. Severe cartilage of the knee most notably in the lateral compartment.3. Moderate size joint effusion.


Instruction: Generate impression based on findings.

Input: Recent brain cyst removal w/ NSG 11/11, now with post op seizure. There are postoperative findings of left frontal craniotomy for resection of previous identified third ventricular cystic lesion. There is gliosis and a small amount of enhancement along the surgical tract in the left frontal lobe with a small amount of residual enhancement involving the anterior body of the corpus callosum. There is an evolving infarct with enhancement involving the genu of the right internal capsule extending inferiorly to the level of the hypothalamus. Blood products with prominent associated susceptibility are again demonstrated within the surgical bed involving the body of the corpus callosum. There are additional blood products within the ventricles, especially along the left side casting the choroid plexus. There is a small area of diffusion restriction within the surgical bed, decreased since prior examination. No acute intracranial hemorrhage is identified. There is no midline shift appreciated.

Output: 1. Expected evolution of postoperative changes related to the lateral ventricular mass resection are again identified.2. Blood products with small area of diffusion restriction is again seen in the surgical bed involving the body of the corpus callosum.3. Evolving infarct with enhancement is again seen involving the genu of the right internal capsule, extending inferiorly to the level of the hypothalamus.


Instruction: Generate impression based on findings.

Input: Metastatic prostate cancer with brain lesion: assess for disease status. There is a peripherally enhancing ovoid lesion with susceptibility effect and intrinsic T1 hyperintensity centrally, which measures up to 15 mm. There is no evidence of acute intracranial hemorrhage 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.

Output: A peripherally enhancing ovoid lesion with susceptibility effect and intrinsic T1 hyperintensity centrally, which measures up to 15 mm is nonspecific. The lesion may represent a previously hemorrhagic process, perhaps related to an underlying vascular tumor and less likely a metastasis, given that prostate cancer rarely metastasizes to the brain parenchyma. FOllow up imaging may be useful.


Instruction: Generate impression based on findings.

Input: 62 year old with biopsy proven right breast invasive carcinoma presents for MRI evaluation. Family history of breast carcinoma in her sister. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.The proven carcinoma is demonstrated as an enhancing oval mass at posterior 1:00 position, measuring 11 x 14 x 13 mm (AP x LR x CC), in the right breast. A marker clip is identified within the mass.Multiple enhancing foci are present in both breast, but none of them are uniquely enhancing. No abnormal enhancement is seen in left breast. No abnormal lymph nodes are identified in either axillary region.

Output: 1. Unifocal biopsy proven right breast cancer.2. No abnormal enhancement in left breast.3. No abnormal lymph nodes in either axillary regionBIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: cT2N0M0 left oral tongue squamous cell carcinoma, p16 negative, status post glossectomy with free flap reconstruction. There are interval postoperative findings related to glossectomy and free flap reconstruction, without evidence of gross residual tumor. There is no evidence of significant cervical lymphadenopathy. The remaining salivary glands and thyroid appear unremarkable. There are cystic defects in the anterior mandible, which may be related to prior dental disease. There are small posterior disc-osteophyte complexes at C5-6 and C6-7. The orbits and imaged intracranial structures are grossly unremarkable.

Output: 1. Interval postoperative findings related to glossectomy and free flap reconstruction, without evidence of gross residual tumor. 2. No evidence of significant cervical lymphadenopathy.


Instruction: Generate impression based on findings.

Input: 67-year-old woman with known breast cancer metastatic on chemo. Reevaluate. CHEST:LUNGS AND PLEURA: Stable appearance of left apical traction bronchiectasis with fibrosis likely due to radiation change. New moderate to large left pleural effusion. Stable subcentimeter micronodule in the right upper lobe (image 27/95). There is a new air space opacity involving the left lingular segment anteriorly (image 45/95) that demonstrated increased activity on recent PET scan.MEDIASTINUM AND HILA: The left vocal cord is midline, compatible with known vocal cord paralysis. Thyroid hypodense lesions. Paratracheal enhancing soft tissue has decreased. Normal cardiac size. Mild pericardial wall thickening. Subcentimeter mediastinal nodes are unchanged. Slightly increased right hilar nodes.CHEST WALL: No significant axillary lymphadenopathy. Surgical clips are noted left axilla. Status post left mastectomy. A right-sided chest port is seen with its tip in the SVC/RA junction. Interval development of multiple sclerotic foci in the mid and lower thoracic spine suspicious for metastatic disease.ABDOMEN:LIVER, BILIARY TRACT: Stable hypodense lesion in the lateral segment of the left lobe (image 95/144).SPLEEN: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedPANCREAS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Scattered borderline mesenteric nodes. The largest measures approximately 11 mm (image 140/144) adjacent to the cecum.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Interval development of multiple sclerotic foci with inferior endplate depression involving the lumbar spine suspicious for metastatic disease better demonstrated on recent MRI from 7/2/08.

Output: 1. Interval development of new moderate left pleural effusion with new airspace opacity in the left lingular segment that was shown to have increased activity on PET/CT from 6/24/08.2. Interval development of multiple thoracic and lumbar osseous metastatic disease better seen on MRI from 7/2/08.


Instruction: Generate impression based on findings.

Input: cT4N1Mx left tongue squamous cell carcinoma, status post treatment. There are post-treatment findings in the left oral cavity region and anterior neck subcutaneous tissues. There is no evidence of measurable mass lesions or significant cervical lymphadenopathy based on size criteria. For example, a left level 2A lymph node measures 4 x 6 mm in axial cross-section. The thyroid and major salivary glands are unchanged. The osseous structures are unremarkable. The airways are patent. The orbits and imaged intracranial structures are unremarkable.

Output: Post-treatment findings without evidence of residual measurable mass lesions or significant cervical lymphadenopathy.


Instruction: Generate impression based on findings.

Input: 67-year-old woman with history of PSC status post partial hepatectomy. High-grade dysplasia of the left intrahepatic and extrahepatic bile ducts on surgical pathology, margins clear. ABDOMEN:LIVER, BILIARY TRACT: Patient is status post left hepatectomy with hepaticojejunostomy. No focal hepatic lesions are identified.Multifocal mild intra and extra hepatic biliary strictures (11/57 and 58) are identified. Additionally, a stricture within the central right posterior bile duct (11/52) appears slightly worsened from the prior exam and there is new pre-stenotic ductal dilatation.SPLEEN: Spleen appears normal.PANCREAS: The pancreatic duct appears normal. The pancreas is unremarkable.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant retroperitoneal lymphadenopathy.BOWEL, MESENTERY: Partially visualized small bowel and colon appear normal.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Intra and extrahepatic biliary strictures with newly worsening stricture and prestenotic dilatation of a right posterior bile duct.2.No evidence of malignancy.


Instruction: Generate impression based on findings.

Input: Male, 54 years old, with blurry vision and a subtle left posterior globe lesions seen on prior CT imaging. History of base of tongue cancer. An enhancing intraocular mass is evident on the left along the posterior inferior aspect of the globe. This lesion measures 14 x 7 mm in the axial plane and has increased in size from the prior CT where it was very subtle.The choroidal layer of the left globe is uniformly enhancing and there appears to be some mild separation of the choroid from the underlying sclera, at least laterally if not medially. The periorbital tissues on the left are diffusely inflamed with evidence of abnormal signal and strandy enhancement both intraconally and extraconally.A 6 mm enhancing lesion is partially visualized within the left anterior cerebellum.

Output: 1.An intraocular mass on the left has increased in size from the prior examination. Given the clinical history of head and neck cancer, the findings are concerning for a metastatic lesion.2.In addition, there is diffuse left choroidal inflammation with a mild degree of choroidal detachment suspected at least on the left, with or without subchoroidal bleeding. Generalized left orbital inflammation is seen both intraconally and extraconally.3.A 6 mm enhancing lesion within the left anterior cerebellum is partially visualized on this examination. Dedicated contrast enhanced brain MRI is recommended to assess for the possibility of intracranial metastases.


Instruction: Generate impression based on findings.

Input: 21 years Male (DOB:11/19/1994)Reason: Evaluate for etiology of L sided headaches, episode of L sided numbness and weakness History: L sided headaches after head trauma, episode of L sided numbness and weaknessPROVIDER/ATTENDING NAME: THOMAS J KELLY THOMAS J KELLY MRI of the brainNo diffusion weighted abnormalities are appreciated.The cerebellar tonsils extend 3-4mm below the level of the foramen magnum.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate small mucous retention cysts in the right maxillary and ethmoid air cells and to a lesser degree left maxillary sinus The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. Asymmetric mucosal thickening in the right nasal cavity is not entirely attributable in part to nasal cycling. Findings suggest that polypoid mucosal thickening may be present.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. The posterior communicating arteries are intact and very small. The vertebral arteries are similar in size.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries. Fat sat axial and coronal imaging were performed following contrast. Presence of contrast confounds the evaluation for a subtle dissection on these sequences. The 2DTOF and 3DTOF sequences reveal no evidence for vertebral or carotid dissection.

Output: 1.There is no evidence for intracranial or extracranial cerebrovascular occlusive disease.2.No evidence for cerebral hemorrhage.3.The cerebellar tonsils are low lying and borderline for Chiari 1 malformation. There is no evidence for ventriculomegaly.4.Mucosal thickening in the right nasal cavity is non-specific. The possibility of a small polypoid lesion such as a nasal polyp or other polypoid lesion cannot be excluded. If clinically appropriate, direct visualization may be helpful. The pattern of adjacent right maxillary and ethmoid mucosal thickening suggests this may be obstructive.


Instruction: Generate impression based on findings.

Input: History of fever and nausea. Evaluate for biliary obstruction. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology and size. The hepatic and portal vessels are patent.There is at least mild narrowing at the biliary-enteric anastomosis with interval increase in now moderate intrahepatic ductal dilatation.The previously seen circumferential thickening of the bile duct system and mild postcontrast enhancement and restricted diffusion has resolved.No focal suspicious lesion. Vague regions of geographic wedge-shaped peripheral hyperintensity with associated arterial enhancement likely represent perfusion anomalies.SPLEEN: Mild splenomegaly without focal lesion.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small left renal cysts. Small right proteinaceous/hemorrhagic cyst. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Postsurgical changes of anterior pelvic wall.OTHER: Trace right pleural effusion. Minimal basilar atelectasis.

Output: Mild narrowing at the biliary enteric anastomosis with interval increase in now moderate intrahepatic ductal dilatation may represent a stricture. Reflux is also consideration. Interval resolution of the bile duct system wall thickening and enhancement.


Instruction: Generate impression based on findings.

Input: Patient walks with limp with pain, check for bursitis Mild osteoarthritic changes without definite distinct additional plain film abnormalities, specifically no specific findings to suggest bursitis. Please note however that exam is relatively insensitive, follow-up imaging including MRI may be indicated

Output: Mild osteoarthritis


Instruction: Generate impression based on findings.

Input: 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. There is interval increase in mild mucosal thickening in the left maxillary sinus. There is minimal mucosal thickening in the bilateral ethmoid air cells. There is a punctate adenoid retention cyst.

Output: 1. No evidence of mass lesions, hydrocephalus, or intracranial hemorrhage.2. Mild paranasal sinus inflammation, which has slightly increased.


Instruction: Generate impression based on findings.

Input: 72-year-old male with right nasal high-grade carcinoma, evaluate for possible skull base involvement. There has been interval resection of the previously noted heterogeneously enhancing mass in the posterior right nasal cavity and ethmoid sinuses. No definite residual enhancing tumor is identified. There is a nonspecific thin peripheral rim of enhancing tissue along the expected location of the posterior ethmoid cavity. There is persistent residual bony expansion and minimal mass effect on the medial right orbit.No definite evidence of osseous involvement of the skull base is identified. STIR hyperintensity in the central skull base is compatible with edema and likely related to posttreatment changes. The V3 branch of the right trigeminal nerve is slightly irregular just proximal to the foramen ovale, with low T1 and T2 signal and minimal linear enhancement, which may be related to surrounding vessels.There is minimal mucosal thickening of the right maxillary sinus.Incidental note is made of a small pineal cyst. Prominent area of encephalomalacia and cortical thinning along the left sylvian fissure is compatible with chronic infarct.

Output: Interval resection of posterior right nasal cavity and ethmoid sinus mass, with no definite residual enhancing disease or evidence of osseous involvement. Nonspecific thickening along the expected location of the right posterior ethmoid cavity is likely postoperative in nature given absence of abnormality in this area on the preoperative exam, but attention to this area on subsequent imaging is suggested to exclude recurrent tumor.


Instruction: Generate impression based on findings.

Input: Cervical spondylosis with myelopathy. Status post decompression and fusion. Since the previous MRI examination, the patient underwent C3-C7 (partial at C3 and C7) laminectomies. There are bilateral posterior rods with lateral mass' screws at C3-C6 as well as screws at the T1 levels. Heterogeneity and T2 signal in the overlying soft tissues is an expected postoperative appearance.Compared to the previous MRI, there has been decompression of the thecal sac at the laminectomy levels. Focal, central T2 hyperintensity in the spinal cord at C6-C7 level persists but somewhat obscured by the susceptibility related artifact. There is no other cord signal abnormality. Prior anterior C6-C7 hardware is again seen.Susceptibility artifact slightly limits evaluation of the neural foramina which are better seen on recent MRI. Individual levels as below:C2-C3: No spinal canal or foraminal stenosis.C3-C4: Bilateral, left more than right, foraminal stenosis caused by uncovertebral and facet proliferative changes present. The left paracentral disc-osteophyte complex causes no significant narrowing given the decompression laminectomy.C4-C5, C5-C6: Severe bilateral foraminal stenosis by uncovertebral and facet proliferative change are described in detail on the previous report. The right paracentral C4-C5 and the central C5-C6 disc-osteophyte complexes cause no significant spinal canal narrowings given the decompression laminectomies.C6-C7: Severe left and mild right foraminal stenosis by uncovertebral and facet proliferative change. The central disc-osteophyte complex causes no significant spinal canal narrowings given the decompression laminectomies.C7-T1: There is no spinal canal or foraminal stenosis.

Output: 1.Since previous MRI of May 2015, there has been interval decompression of the cervical spinal canal and placement of posterior fusion hardware which extends from C3 to T1. Spinal canal is well decompressed.2.Small focus of abnormal signal at C6-C7 again seen and compatible with myelomalacia. 3.Bilateral foraminal stenoses at multiple levels as described above and on the previous MRI report.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Male, 16 years old, with cervical spinal tumor. Assess the rest of the spine. Extensive bulky and contiguous extramedullary tumor is partially visualized in the cervical region. Areas of tumor are found both within the spinal canal, the foramina, which are chronically widened, and beyond the foramen in the paraspinal soft tissues.Although the bulk of this disease is in the cervical region, it does extend down to the T1-2 level where there is tumor within the left aspect of the spinal canal and within the left T1-2 neural foramen.No evidence of any additional canalicular or foraminal tumor is seen in the thoracic or lumbar spine. In these areas, there is no evidence of significant spinal canal or neuroforaminal stenosis. The intervertebral disks are preserved.Spinal cord, conus and cauda equina demonstrate normal signal intensity and morphology. No pathologic cord signal or enhancement can be detected.It should be noted that the partially visualized cervical spine vertebral bodies, and the T1 vertebral body, demonstrate abnormal T1 hypointense and T2 hyperintense signal with equivocal enhancement. Elsewhere in the thoracic and lumbar spine, vertebral body signal and pattern of enhancement are unremarkable.

Output: 1. Redemonstration of bulky, contiguous extra medullary tumor involving the left aspect of the spinal canal, the left neural foramina, and the left paraspinal soft tissues with disease centered predominantly in the cervical spine. Please note that the cervical spine is only partially viewed on this study.2. Disease extends as far down as the T1-2 level where there is evidence of tumor in the left aspect of the spinal canal and left neural foramen. Below this level, no additional areas of tumor are suspected in the thoracic or lumbar spine.3. Abnormal marrow signal intensity involving the cervical and T1 vertebral bodies is of uncertain significance. Findings could represent reactive edema or bony disease involvement.


Instruction: Generate impression based on findings.

Input: clinical question: Patient with decreased mental status and with new right facial droop. Signs and symptoms: Right facial droop. Nonenhanced head CT:Extensive small vessel disease as was noted on prior MRI exam is again identified. The age of a small was ischemic strokes cannot be determined on CT.Also as was noted on prior exam an old large right frontal MCA territory cortical stroke shows no interval change. Prominence of cortical sulci and ventricular system are believed to be at least partially secondary to underlying parenchymal volume loss secondary to old ischemic strokes.No evidence of hemorrhage, mass effect or midline shift or hydrocephalus.Head CT is not sensitive for detection of any acute strokes.Calvarium is intact. There is evidence of an old left orbital blowout fracture of the floor and the lamina papyracea as was noted on prior exam.

Output: 1.Advanced to small vessel is of indeterminate age.2.Old right MCA frontal lobe cortical stroke as was noted on prior exam.3.No evidence of hemorrhage, mass-effect or midline shift.


Instruction: Generate impression based on findings.

Input: 43-year-old woman with history of lung and breast cancer, with questionably PET positive lesion in the rectum/vagina. PELVIS:UTERUS, ADNEXA: No focal masses are identified in the uterus or adnexa.BLADDER: The bladder is normal.LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No abnormality is noted in the rectum or vagina.

Output: No abnormality correlating with the finding on PET/CT.


Instruction: Generate impression based on findings.

Input: 52 year old female with breast cancer (metastatic). Please evaluate disease. On chemotherapy. No evidence of metastatic disease to the brain or the leptomeninges is identified. An expansile and suspected of hypervascular mass is identified in the left occipital bone. This mass measures approximately 43 mm in transverse axis and 25-mm in AP axis. This is highly suspected of a metastatic skull lesion. The mass minimally expands into the epidural space and is suspected of producing vasogenic edema of the left occipital lobe. There is significant extra osseous spread of tumor into the soft tissues of the scalp. For further evaluation and in particular for better evaluation of the status of brain parenchymal under this tumor an MRI is recommended.

Output: 1.No evidence of intracranial brain parenchymal or leptomeningeal metastases.2.Expansile destructive and suspected of highly vascular tumor in the left occipital bone with vasogenic edema left occipital lobe.3.Further evaluation with an MRI is recommended.


Instruction: Generate impression based on findings.

Input: 6 years, Female, nose bleeds. Hereditary hemorrhagic telangiectasia. Brain MRI: Brain parenchyma appears within normal limits. There is no parenchymal signal abnormality. 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. Post gadolinium sequences, series 1501 and 1701, demonstrate no abnormal parenchymal or meningeal enhancement.Sella and orbits are grossly within normal limits. There is diffuse opacification of the left maxillary and left sphenoid sinuses. There is mild opacification involving the paranasal sinuses on the right. There is also diffuse opacification of the left middle ear cavity and left mastoid air cells. Bone marrow signal and extracranial soft tissues are otherwise grossly unremarkable. There is mild asymmetric prominence of the left cervical lymph nodes, which is nonspecific.Brain MRA: The intracranial internal carotid arteries demonstrate no significant stenosis. The middle and anterior cerebral arteries are also patent. The vertebral arteries, basilar artery, and posterior cerebral arteries also are patent with no significant stenosis. No evidence of aneurysms or vascular malformations.

Output: 1. Brain MRI and MRA appear within normal limits. Specifically, there is no evidence of a vascular malformation.2. Diffuse opacification of the left-sided paranasal sinuses as well as the left middle ear cavity and mastoid air cells, which can be correlated with clinical findings.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for meningioma. Signs and symptoms: Meningioma. Headache. Pre and post enhanced brain MRI:No acute intracranial process and negative diffusion weighted series.Examination redemonstrates a stable small meningioma in right anterior frontal along the inner table of the skull and measuring 8 x 9 mm in transaxial dimensions. This finding is not associated with any appreciable mass effect or edema of the adjacent parenchyma.The cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination is otherwise within normal and stable since prior exam. There is no detectable abnormal parenchymal or leptomeningeal enhancement other than above detailed meningioma. Calvarium and soft tissues of the scapula unremarkable.Images through the orbits including axial fat sat post enhanced series are negative.All paranasal sinuses and bilateral mastoid air cells and middle ear cavities demonstrate normal pneumatization signal patterns.

Output: 1.No acute intracranial process.2.Stable small 8 x 9 mm right frontal convexity meningioma since prior exam.3.Unremarkable pre and post enhanced brain MRI otherwise.4.Normal pneumatization signal pattern of all paranasal sinuses and bilateral mastoid air cells and middle ear cavities.


Instruction: Generate impression based on findings.

Input: 43-year-old female with metrorrhagia. PELVIS:UTERUS, ADNEXA: 5.9 x 6.4 cm T2 hypointense, nearly-homogeneously enhancing, subserosal fibroid at the left anterior aspect of the lower uterine segment (series 13/19), not significantly changed since prior exam. Multiple additional smaller fibroids are also not significantly changed.Findings of uterine adenomyosis, not significantly changed. Mild scarring of the anterior uterus from prior cesarean section, unchanged.Left ovarian simple cyst measuring up to 3.8 cm (series 5/13). Smaller cysts/follicles are seen in both ovaries.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Stable 10 mm right perineal T2 hyperintense cystic lesion with appearance most typical of Bartholin's gland cyst (series 5/32). Stable 8 mm right superior vaginal T2 hyperintense cystic lesion with appearance most typical of urethral diverticulum versus Gartner's duct cyst (series 5/25).OTHER: No significant abnormality noted.

Output: Uterine fibroids and adenomyosis as detailed above, not significantly changed.


Instruction: Generate impression based on findings.

Input: 59-year-old female with low back pain and left hip pain Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is heterogeneous without destructive lesions. The conus medullaris is normal in position and signal intensity. There is partially visualized calcification and hypertrophy of the ligamentum flavum/facet hypertrophy at T10-T11.Multilevel degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: Facet and ligamentum flavum hypertrophy, greater on the left and mild disk bulge. Mild to moderate left and mild right neuroforaminal narrowing. Mild narrowing of the spinal canal.L3-L4: Moderate bilateral facet and ligamentum flavum hypertrophy and minimal disk bulge. Mild bilateral neuroforaminal narrowing. Mild narrowing of the spinal canal.L4-L5: Moderate bilateral facet and ligamentum flavum hypertrophy. No significant disc disease. No spinal canal or neural foraminal stenosis. L5-S1: Mild bilateral facet hypertrophy. No significant disc disease. No spinal canal or neural foraminal stenosis.Paraspinous soft tissues are within normal limits.

Output: 1. Multilevel degenerative changes in the lumbar spine without high grade spinal canal stenosis at any level. There is mild to moderate neuroforaminal narrowing at L2/3 and L3/4, as described above. 2. Advanced facet arthropathy at L3-4 and L4-5 which may be contributing to patient's low back pain.


Instruction: Generate impression based on findings.

Input: Subdural hematomas; secondary CNS lymphoma s/p WBRT: bilateral 3rd nerve palsy and balance issues. There are bilateral high T2 and intermediate to high T1 signal posterior cerebral convexity subdural hematomas, measuring up to 12 mm on the right and 10 mm on the left. Linear hypoattenuating components within the bilateral subdural collections may represent membrane formation. There is also diffuse smooth cerebral convexity dural enhancement and thickening bilaterally, which may be reactive. There is mild mass effect upon the underlying brain parenchyma, but no significant midline shift or herniation. There is no evidence of acute infarct. There is diffuse confluent periventricular white matter T2 hyperintensity. There are postoperative findings related to right transfrontal biopsy, but no evidence of intracranial tumor. There is a punctate focus of enhancement and susceptibility effect in the anterior periaqueductal region. In addition, there are unchanged areas of susceptibility effect and enhancement in the posterior right temporal and frontal periventricular regions. There are also unchanged punctate foci of susceptibility effect in the bilateral anterior frontal lobe periventricular regions. There is mild diffuse cerebral and cerebellar volume loss. Otherwise, the punctate focus of enhancement in the right insula is less conspicuous. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. Persistent subacute upon chronic bilateral posterior cerebral convexity subdural hematomas.2. Unchanged punctate focus of enhancement and susceptibility effect in the anterior periaqueductal region, unchanged areas of susceptibility effect and enhancement in the posterior right temporal and frontal periventricular regions, and unchanged punctate foci of susceptibility effect in the bilateral anterior frontal lobe periventricular regions may represent treated lymphoma. 3. A nonspecific punctate focus of enhancement in the right insula is less conspicuous. 4. Post-treatment findings with cerebral white matter abnormality and brain volume loss.


Instruction: Generate impression based on findings.

Input: C1 meningioma, postoperative evaluation There are postsurgical changes of resection of previously seen meningioma at the right C1 level. There appears to be total resection without evidence of residual tumor. There is prominent dural and epidural enhancement which is likely reactive. No evidence of intraspinal hematoma. There is minimal fluid in the posterior upper paraspinous soft tissues related to recent surgery.Again seen is evidence of prior wide laminectomies from C4 to C6 with posterior spinal fusion hardware at these levels including lateral mass screws and paraspinous rods. Susceptibility artifact slightly limits evaluation. Spinal canal is however well decompressed at these levels. Multilevel degenerative changes are again seen including multilevel disc osteophyte complexes. There remains mild spinal canal stenosis at the C2-C3 level above the laminectomy and at the C7-T1 level, and to a slightly greater degree at the T1-T2 level where there is a disc extrusion and up to moderate spinal canal stenosis similar to prior. Abnormal T2 signal at the C4-C5 level is unchanged and associated with mild volume loss consistent with myomalacia. No new cord signal abnormality. There is multilevel neural foraminal narrowing relatively worse at the T1-T2 level where there is mild to moderate left greater than right neural foraminal narrowing.

Output: 1. Interval postsurgical changes of right lateral C1 meningioma resection without evidence of residual tumor.2. Postsurgical changes related to spinal canal decompression from C4 to C6 with posterior spinal fusion. Multilevel degenerative changes as before including up to moderate spinal canal stenosis at the T1-T2 level primarily related to disc extrusion.3. Myelomalacia at the C4-C5 level, as seen before. No new cord signal normally.


Instruction: Generate impression based on findings.

Input: Intra-articular contrast traverses the expected location of the lunotriquetral ligament suspicious for lunotriquetral ligament injury/disruption. No definitive contrast is identified traversing the expected location of the scapholunate ligament to suggest a tear.Exposure time: 1 minute and 19 seconds.

Output: Successful fluoroscopic-guided left wrist arthrogram with findings suggestive of lunotriquetral ligament disruption. Please refer to the subsequent MRI examination report for further information.


Instruction: Generate impression based on findings.

Input: 55 year old female with fever and old brain mass; evaluate state of intracranial mass There is no evidence of intracranial hemorrhage or edema. No obvious mass or fluid collection is seen on this noncontrast CT. If further evaluation is warranted, MRI or CT with contrast may be obtained.Diffuse areas of hypoattenuation are noted in the periventricular and subcortical white matter, most prominent in the right frontal lobe, which most likely represents gliosis or post-treatment demyelination, versus small vessel ischemic disease of indeterminate age. Presence of vasogenic edema is difficult to be completely excluded in the absence of a prior study for comparison.There is mild asymmetric dilatation of the right lateral ventricle with the remaining ventricles and basal cisterns appearing normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: No acute intracranial abnormality or obvious mass is seen on this noncontrast CT. However, this study has limited sensitivity for small intracranial neoplasm or infection. If further evaluation is warranted, MRI or CT with contrast of the brain may be obtained.


Instruction: Generate impression based on findings.

Input: Clinical question: New tiny a lesion on MRI. Concern for arteriovenous malformation. Evaluate for arteriovenous malformation. Signs and symptoms: Neck pain/stiffness/headaches. Non-enhanced CT of brain:Examination demonstrate no evidence of intracranial hemorrhage, edema, mass effect, midline shift or hydrocephalus. Cortical sulci, ventricular system, CSF cisterns and gray -- white matter differentiation remains within normal. Previously noted mildly enhancing cranial mass is not identified on this exam. There was no evidence of arteriovenous malformation malformation on prior MRI exam or the current CT.Calvarium is intact.Mastoid air cells, middle ear cavities and limited view of the paranasal sinuses are within normal.CTA of intracranial circulation:Right internal carotid is well visualized across the skull base and through the cavernous sinus with no abnormality. Supraclinoid right internal carotid artery, right posterior communicating artery, right anterior and middle cerebral arteries and their branches are within normal limits.Left internal carotid is well visualized and unremarkable in its cavernous and supraclinoid portion. There is normal visualization of a small posterior communicating artery. The anterior and middle cerebral arteries are within normal limits. There is anatomical variation of hypoplastic left A1. There is no evidence of arteriovenous malformation.Vertebral basilar system, there is normal visualization of bilateral intracranial vertebral arteries. Normal appearing right pica is identified. There is no visualization of the left pica. Basilar artery, superior cerebellar arteries and posterior cerebral arteries are well visualized and within normal limits. There is no detectable arteriovenous malformation as clinically questioned. The findings in the pineal region noted on prior MRI is not consistent with an arteriovenous malformation and it represents a mass.65 cc of Omnipaque 350 is administered for above study.

Output: 1.Negative non-enhanced CT of brain. 2.Previously noted less than one CM mass in the pineal region is not identified on this non-infused head CT.3.No evidence of arteriovenous malformation on this CTA or prior MRI exam.4.Negative CTA of intracranial circulation.


Instruction: Generate impression based on findings.

Input: A patient submitted outside study for review. Submitted for review are screening mammogram (1/6/2015), screening whole breast ultrasound (2/10/2015), images from ultrasound guided right breast biopsy and post procedural mammogram (2/27/2015), and MRI (3/5/2015) performed at Advocate Illinois Masonic Hospital. For comparison, mammogram and ultrasound dated 7/3/2013, and mammogram dated 7/16/2012 are available. MAMMOGRAM (1/6/2015): Two standard views of both breasts were obtained. The breast parenchyma is heterogeneously dense, unchanged in pattern and distribution. Scattered benign calcifications are present. No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in either breast. Benign appearing lymph nodes are projected over both axillae.WHOLE BREAST ULTRASOUND (2/10/2015): Multiple images from bilateral screening whole breast ultrasound are submitted. At the two o'clock position of the right breast, 5 cm from the nipple, there is an irregular, hypoechoic mass measuring 1.0 x 0.8 x 0.9 cm. This mass demonstrates apical vascularity on Doppler imaging. Elsewhere in both breasts, multiple subcentimeter anechoic, simple cysts are present.IMAGES FROM ULTRASOUND GUIDED RIGHT BREAST BIOPSY AND POST PROCEDURAL MAMMOGRAM (2/27/2015): Images from ultrasound guided biopsy of the right breast mass at the 2:00 position, 5 cm from the nipple were submitted. Targeting appears appropriate. A clip was left at the biopsy site. Post procedural unilateral right CC and ML views demonstrate a coil-shaped clip within the central inner right breast.MRI (3/5/2015): Heterogeneous fibroglandular tissue is noted bilaterally, with moderate background parenchymal enhancement. A 0.7 x 0.7 cm enhancing mass is present within the inner, slightly upper right breast, approximate 2:00 position. Susceptibility artifact from biopsy clip is noted adjacent to this mass, compatible with the patient's known malignancy. The left breast is unremarkable. No abnormal lymph nodes are present within the axillae.

Output: Enhancing 0.7 cm mass with adjacent biopsy clip at the 2:00 position of the right breast, compatible with the patient's known malignancy.BIRADS:6 - Known cancer. RECOMMENDATION:T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Male, 28 years old, neurofibromatosis type I with extensive neck tumors. Cervical:Innumerable subcutaneous and paraspinal T2 hyperintense masses are again seen compatible with neurofibromas. There has been no significant interval change in the overall size or number of these lesions.Also stable are foraminal neurofibromas which are present bilaterally at every level. The largest of these occupies the right C5-6 foramen measuring 30 x 20 mm, previously 30 x 20 mm. This lesion, and several others to a lesser degree, do extend into the spinal canal with resultant canal narrowing and some deformation of the spinal cord, findings which are overall unchanged. No definite evidence of cord edema is seen.Again seen is evidence of laminectomy from C4 through C7. A focal kyphotic angulation of the spine is seen at C6-7, unchanged. Alignment is unremarkable. Marrow signal characteristics are within normal limits.Lumbar:Innumerable subcutaneous and paraspinal neurofibromas are redemonstrated, without significant interval change. Neurofibromas within or adjacent to all of the visualized neural foramina are also grossly unchanged. The nerve roots of cauda equina remain diffusely thickened likely secondary to the presence of numerous lesions. A dominant lesion situated within and effacing the right lateral recess at the L4-5 level measures 11 x 10 mm, previously 11 x 9 mm. This lesion results in moderately severe encroachment upon the thecal sac and some crowding of the cauda equina.Spinal alignment is anatomic. Vertebral body morphology and signal characteristics are within normal limits.

Output: 1.Stable neurofibromas in the cervical region. Several of these encroach upon the spinal canal with resultant canal stenosis and cord deformation, most notably at C5-6 and C6-7.2.Stable neurofibromas in the lumbar region. A dominant lesion within the right lateral recess at L4-5 continues to cause moderate sac encroachment.


Instruction: Generate impression based on findings.

Input: 46 year old female with left-sided headaches. No evidence of intracranial hemorrhage, mass effect, edema, or abnormal enhancement. Ventricles and basal cisterns are within normal limits.Paranasal sinuses, orbits, and osseous structures appear unremarkable.

Output: No abnormality to account for patient's symptoms.


Instruction: Generate impression based on findings.

Input: Lung cancer brain metstases status post resection. There are postoperative findings related to right frontal lobe lesionectomy, with a small area of high T2 signal surrounding the right precentral gyrus resection cavity, but no evidence of residual enhancing tumor. There is no evidence of acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are unremarkable. There are small retention cysts in the maxillary sinuses. There is persistent asymmetric prominence of the left parotid duct. There is a small apical scalp lipoma.

Output: Postoperative findings related to right frontal lobe lesionectomy, with a small area of gliosis or edema surrounding the resection cavity, but no evidence of residual enhancing tumor.


Instruction: Generate impression based on findings.

Input: Reason: preop planning for tumor resection History: vertigo, nausea The CSF spaces are appropriate for the patient's stated age with no midline shift. There is an extra-axial mass located at the right cerebellar medullary angle cistern and right cerebellopontine angle cistern which measures 9 x 16 mm in axial dimensions.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.There is a right sided posterior fossa mass present which is suspected most likely to represent meningioma2.examination was performed for stereotactic guidance during surgery.


Instruction: Generate impression based on findings.

Input: Preoperative evaluation. History of malignant fibrous histiocytoma. Metallic artifact limits evaluation of the right frontal and parietal lobe. The dominant left temporal lesion measures up to approximately 48 mm, previously 42 mm, and contains blood products that are mixed T1 isointense and hyperintense and T2 hyperintense and hypointense, compatible with a combination of acute and subacute hemorrhage. There is adjacent T2 hyperintensity, compatible with vasogenic edema, and mild effacement of the occipital horn of the left lateral ventricle, unchanged. There are several other hemorrhagic lesions in the right occipital lobe, right medial temporal lobe, left inferior frontal lobe, right thalamus, and left cerebellar hemisphere. Many of the lesions display T1 hyperintensity and some have increased in size since 10/6/16. There is a small amount of right occipital horn intraventricular hemorrhage. The right frontal approach ventriculostomy catheter tip terminates in the region of the left thalamus, unchanged. There has been slight interval increased effacement of the left lateral ventricle trigone. The ventricles have otherwise not significantly changed in size, with mild diffuse periventricular T2 hyperintensity. There is no midline shift or herniation. The cerebral flow voids are grossly intact. The orbits are grossly unremarkable. There are left maxillary sinus retention cysts. There are postsurgical findings related to left frontoparietal craniotomy.

Output: 1.Multiple intracranial metastases with interval increase in size of the dominant left temporal lobe metastasis with acute upon subacute hemorrhage and vasogenic edema, accounting for differences in technique. Furthermore, some of the other intracranial metastatic lesions have increased in size since 10/6/16, perhaps due to recent hemorrhage.2.Shunted ventricular system with a small amount of intraventricular hemorrhage and slight interval increased effacement of the left lateral ventricle trigone. Of note, the tip of the catheter projects into the left thalamus.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Cirrhosis. HCC status post TACE RFA. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology. No intra or extrahepatic biliary ductal dilatation. Normally distended gallbladder. The hepatic vasculature is patent.The segment 6 ablation cavity measures approximately 3.7 x 2.9 cm containing heterogeneous proteinaceous/hemorrhagic products.The right hepatic dome lesion measures approximately 2 x 1.6 cm containing heterogeneous proteinaceous/hemorrhagic products. Adjacent peripheral wedge-shaped increased T2-weighted signal intensity is likely posttreatment related, unchanged.No areas of suspicious focal enhancement.The vasculature is patent.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts. No hydroureteronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Left superior lumbar fat-containing hernia.OTHER: No significant abnormality noted.

Output: Post ablation changes of segment 6 and the right hepatic dome without evidence of marginal recurrent or residual disease.Cirrhotic liver without new suspicious lesion.


Instruction: Generate impression based on findings.

Input: Two day old female with apnea. Evaluate for bleeding or ischemia. There is no evidence of intracranial hemorrhage, mass, edema or hydrocephalus. Asymmetric attenuation is present in the right frontal lobe greater than the left which is nonspecific but if there is concern for ischemia MRI may be considered.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses are normally pneumatized.

Output: 1. Asymmetric attenuation is present in the right frontal lobe greater than the left which is nonspecific but if there is concern for ischemia MRI may be considered.2. No evidence of intracranial hemorrhage or other acute intracranial abnormality.


Instruction: Generate impression based on findings.

Input: Male, 19 years old, with chronic low back pain following sports injury two years ago. Alignment is anatomic. Vertebral body height and morphology are within normal limits. No evidence of marrow replacement or marrow edema is seen. The visualized distal spinal cord, conus and cauda equina are within normal limits. No epidural abnormalities are suspected. The intervertebral discs are preserved. No disc bulging or herniation is seen. No significant spinal canal or foraminal stenosis is detected. The paraspinal soft tissues are within normal limits.

Output: Unremarkable evaluation with no specific findings to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: Female 56 years old Reason: Eval for intra-articular pathology History: Left knee pain MENISCI: Menisci are intact.ARTICULAR CARTILAGE AND BONE: Bone marrow is normal in appearance. There is no focal articular cartilage defect.LIGAMENTS: The ligaments including the ACL, PCL, MCL, and lateral collateral complex are intact. EXTENSOR MECHANISM: Extensor mechanism is intact.ADDITIONAL

Output: Small joint effusion and minimal Baker's cyst. Otherwise unremarkable MRI of the knee.


Instruction: Generate impression based on findings.

Input: 65-year-old man with non-Hodgkin's lymphoma status post 16 cycles of chemotherapy. Thyroid uptake on PET scan. RIGHT LOBE MEASUREMENTS: 1.9 x 1.5 x 4.5 cmLEFT LOBE MEASUREMENTS: 1.4 x 1.4 x 4.0 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: 3 mm nonspecific complex nodule laterally in the right lobeLEFT LOBE: 0.7 x 0.6 cm irregular nodule medially in the left lobe adjacent to the isthmus with a few microcalcifications.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Indeterminate 7 x 6 mm nodule in the medial left thyroid. On side to side comparison, this does not exactly match the uptake identified on prior PET CT (nodule appeared lateral rather than medial on that study) however it is possible this simply represents slight misregistration given the small size of the nodule. Findings discussed with Dr. Soni Smith at the time of dictation.


Instruction: Generate impression based on findings.

Input: History of glioblastoma multiforme on therapy. Evaluate disease status. There is redemonstration of a right frontal approach biopsy with minimal gliosis along the biopsy tract through the right centrum semiovale, and the presence of a biopsy marker along the right aspect of the midbrain just below the thalamus. Patchy infiltrative T2 hyperintensity involving the midbrain and to a less degree the pons is again noted and unchanged in geographic extent and signal quality. No new enhancing lesions are detected. Minimal enhancement in the pons and midbrain, versus intrinsic T1 hyperintensity, is unchanged. There is no evidence of intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation.

Output: Sequelae of right frontal approach biopsy are again seen. Stable examination with no evidence of new or progressive disease.


Instruction: Generate impression based on findings.

Input: Female, 51 years old. Reason: thyromegaly RIGHT LOBE MEASUREMENTS: 4.8 x 1.5 x 1.6 cmLEFT LOBE MEASUREMENTS: 4.5 x 1.2 x 1.2 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: Mildly heterogeneous echotexture with numerous very small nodules. An ill-defined heterogeneous hypoechoic region of confluent nodules in the upper pole of the right thyroid lobe measures 1.9 x 0.6 x 1.1 cm, noncalcified, without significant internal vascularity.LEFT LOBE: Mildly heterogeneous echotexture with numerous very small nodules.ISTHMUS: Mildly heterogeneous echotexture with numerous very small nodules.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Nonenlarged cervical lymph nodes are identified. A left lateral lymph node measures 1.4 x 0.5 x 1 .6 cm, without a definite fatty hilum.OTHER: No significant abnormality noted.

Output: Minimally enlarged, heterogeneous thyroid with numerous very small nodules as described above.


Instruction: Generate impression based on findings.

Input: Reason: patient with questionable diagnosis of parkinsonism, assess for alternative cause of tremor and weakness History: questionable history of parkinsonism MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mucosal thickening in the maxillary sinuses right more than left and to lesser degree left anterior ethmoid air cells and left frontal sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.Examination is degraded due to patient motion.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There is multilevel disk desiccation present .At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina. There are endplate and uncovertebral osteophytes present at this level associated with loss of disk space height and endplate reactive changes.At C6-7 there is no significant compromise to the spinal canal or neural foramina. There are endplate and uncovertebral osteophytes present at this level associated with loss of disk space height and endplate reactive changes.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.Exam is degraded due to patient motion

Output: 1.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 2.There some degenerative changes present in the cervical spine without any obvious compromise to the spinal canal .3.Examination is degraded by patient motion artifact which may obscure smaller and more subtle abnormalities.


Instruction: Generate impression based on findings.

Input: Clinical question: Infection/inflammation? Signs and symptoms: Acute cerebellar signs. Pre- and post enhanced brain MRI:Diffusion weighted images are degraded due to extensive metallic artifact in particular in the posterior fossa. Beyond the region of artifact no detectable acute ischemic change is noted.Examination demonstrate normal anatomical development/morphology of brain parenchymal and with normal signal intensity on all MRI sequences.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination for age.Signal void of major intracranial arterial branches are identified.There is no detectable abnormal parenchymal, meningeal or calvarial enhancement. Note however should be made that the inferior aspect of cerebellum is obscured by metallic artifact and cannot be assessed.Unremarkable images through the orbits and including axial fat sat post enhanced series.The signal intensity of the intracranial venous sinuses are within normal.Unremarkable calvarium and soft tissues of the scalp.Unremarkable images through the paranasal sinuses and mastoid air cells.Nonenhanced total spine MRI:Examination is performed utilizing cord compression protocol.Examination demonstrate normal anatomical development of vertebral column.There is normal anatomical alignment and signal intensity of vertebral column.There is no evidence of spinal canal or neural foraminal compromise or stenosis at any level.There is normal signal intensity and caliber of the cord, conus and the cauda equina.No detectable paraspinal soft tissue abnormalities.

Output: 1.Negative nonenhanced total spine MRI utilizing cord compression protocol.2.Unremarkable pre and post enhanced brain MRI.


Instruction: Generate impression based on findings.

Input: 74 year-old female with recurrent laryngeal cancer. Status post laryngectomy. Rule out recurrence and lung metastases. CT of the soft tissues of the neck with infusion:Images through the skull base, cavernous sinuses, paranasal sinuses and petrous bones remain negative for malignancy. Small retention cyst within the left maxillary sinus is again identified with no interval change.Images through the neck demonstrate post therapy/surgical changes. No evidence of a mass or pathologic adenopathy is present. Tracheostomy is noted. Small foci of nonenhancing tissue within the right lobe of thyroid matter present assist and remains stable since prior exam. This lesion measures approximately 4 mm in transaxial dimension. No detectable left lobe of thyroid.Limited images of mediastinum are negative for adenopathy.Limited images of the apices of the lungs are negative for metastatic lesions minimal apical scarring is noted. Please review the dictated report of CT of chest.No evidence of osseous or cartilaginous erosion. Complete laryngectomy is noted.CT of brain with infusion:No evidence of metastatic lesion to the brain, leptomeninges or the calvarium is detected. Findings of possible minimal small vessel disease of indeterminate age is again identified.Significant increased vascularity at the level of the tentorium and across the left cerebellum is highly concerning for an arteriovenous malformation/dural AVF. This finding was present on multiple prior studies and without any significant interval change. Further evaluation with a CT A4 MRA -- MRI is recommended.60 cc of Omnipaque 350 was utilized for the above studies.

Output: 1.No evidence of recurrence of disease in neck.2.No evidence of metastatic disease to the brain, leptomeninges or the calvarium.3.Arteriovenous malformation or an AVF in the left cerebellum needs further follow-up with dedicated studies of MRI / MRA or CTA examination or conventional angiogram.


Instruction: Generate impression based on findings.

Input: 45-year-old male with anosmia. History of stereotactic brain biopsy in frontal lobe. CT of brain with infusion:Dural based enhancing tumor is noted in bifrontal regions (right greater than left). The mass extends along the false bilaterally for approximately 24 mm from the inner table of the skull in the frontal region. Bifrontal dural based enhancing tissue extends to mid convexity of calvarium. There is also suggestion of extension of dural based mass along the floor of bilateral anterior cranial fossa which appears to extend along the greater wings of the sphenoid in bilateral middle cranial fossa. In comparison with the prior MRI examination of brain with infusion no definitive evidence of interval change can be appreciated. There is evidence of subtle mass effect on the brain parenchyma however no vasogenic edema is detected. The density of brain parenchyma, vertical sulci and ventricular system remains within normal. No definite osseous abnormality is noted. The immediate prior CT examination of the brain was performed without the infusion and cannot be compared with the current study. Comparison with any CT of brain dated 9 -- 20 -- 2008 demonstrate significant interval reduction in the size of dural based mass and also resolution of previously noted edema brain parenchyma.CT of paranasal sinuses with infusion:The paranasal sinuses are well pneumatized and with no evidence of acute or chronic sinus disease. The ostiomeatal units of maxillary sinuses are patent bilaterally. No evidence of any osseous abnormality is detected. Images at the level of the skull base including palnum sphenoidale, cribriform plate and fovea ethmoidalis demonstrate no abnormality. 80 cc of Omnipaque 350 was utilized for the above study.

Output: 1.Bilateral frontal dural based enhancing lesion likely represents patient's known sarcoidosis. In comparison with prior MRI from 6 -- 30 -- 2009 no definitive interval change is noted however in comparison with prior CT examination from 9 -- 3 -- 2008 there is significant reduction in size as described.2.Subtle mass effect on bifrontal lobes with no evidence of edema or enhancement of brain parenchymal or pia matter.3.Well pneumatized paranasal sinuses and with patent bilateral ostiomeatal units.


Instruction: Generate impression based on findings.

Input: Unspecified visual disturbance [H53.9] / Dizziness and giddiness [R42], Reason for Study: ^Reason: 50M with recurrent episodes of visual disturbances initially with bilateral "wavy lines" but now with unilateral (left-sided) vision blurring/loss that res No evidence of acute ischemic or hemorrhagic lesion.Several nonspecific scattered punctate T-2/flair high signal intensity lesions on bilateral hemispheric white matter are seen. These lesions likely represent nonspecific small vessel ischemic disease.The ventricles, sulci and cisterns are unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1.No evidence of acute ischemic or hemorrhagic lesion.2. Nonspecific FLAIR/T2 high signal intensity lesions on white matter.


Instruction: Generate impression based on findings.

Input: Benign neoplasm of pituitary gland [D35.2], Reason for Study: ^Reason: Known pituitary macroadenoma, eval invasion, mass effect History: Known pituitary macroadenoma, no imaging in house, all from OSH 61 years Male (DOB:12/17/1955)Reason: Known pituitary macroadenoma, eval invasion, mass effect History: Known pituitary macroadenoma, no imaging in house, all from OSHPROVIDER/ATTENDING NAME: SANDEEP NATHAN There is a relatively well-circumscribed T1 low, T2 Main the low signal intensity with the some high signal intensity foci with reasonably homogeneous enhancement mass of pituitary gland [ CC:20.7mm x RL:20.6mm x AP:23.1mm]. The mass abuts optic chiasm superiorly and widening sellar turcica,On post Gad enhancement scan, the differentiation between the mass and mesial aspects of bilateral cavernous sinuses is not possible but certainly the mass does not appear to encircle cavernous sinus segment of ICAs bilaterally.The orbits and contents are unremarkable.  The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Pituitary macroadenoma which abuts optic chiasm superiorly and mesial aspects of bilateral cavernous sinus segment of ICA.2. No evidence of intra tumoral acute hemorrhage.


Instruction: Generate impression based on findings.

Input: Evidence of again seen of left temporal craniotomy with resolution of the swelling along the scalp and in the left periorbital tissue. The resection cavity appears smaller with some clearance of the blood products. Hemosiderin staining around the cavity remains. The hemosiderin appears more conspicuous than in the previous study, likely due to imaging at 3T.There is normal gray-white matter differentiation with normal ventricular size. No midline shift. Basal cisterns are patent. No evidence of infarction. No evidence of new hemorrhage. Mastoid air cells and paranasal sinuses are clear.

Output: Status post recent resection of a left temporal lobe cavernous malformation with residual blood products along the periphery of the resection cavity, not significantly changed from the previous study.


Instruction: Generate impression based on findings.

Input: 70-year-old female with advanced stage small cell lung cancer presenting with diffuse pain. Assess for progressive neoplastic disease. CHEST:LUNGS: There is moderate centrilobular emphysema with a predominantly upper lobe distribution. Abnormal soft tissue surrounds the structures of the right hilum, representing lymphadenopathy and/or the primary tumor. This appears similar to the prior CT dated 6/4/2010.Several new nodular lesions suspicious for metastases are present in the right lung. A reference lesion in the right middle lobe (series 5, image 65) measures 0.9 x 0.8 cm.MEDIASTINUM: Enhancing mediastinal lymph nodes and right hilar lymphadenopathy remains. A reference pre-carinal lymph node (series 3, image 37) now measures 1.7 x 1.7 cm compared to 0.8 x 0.8 cm on the scan dated 6/4/2010.Coronary artery calcifications.CHEST WALL: Scattered sclerotic lesions are present in the ribs and thoracic vertebral bodies. These are not appreciably changed in comparison to the prior CT and likely reflect the patient's known diffuse osseous metastases.ABDOMEN: LIVER, BILIARY TRACT: The liver metastases appear increased in size and number in comparison to the prior CT but are not as extensive as on the scan dated 5/3/2010. The reference lesion in segment 7 (series 3 image 82) now measures 1.7 x 1.6 cm. This lesion was not clearly visible on the scan dated 6/4/2010 and measured 1.8 x 1.7 cm on the scan dated 5/3/2010.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Simple-appearing left renal cysts remain.RETROPERITONEUM, LYMPH NODES: Extensive aortic atherosclerosis.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: There is heterogeneous sclerosis throughout the vertebral bodies of the cervical, thoracic, and lumbar spine as well as the bones of the pelvis -- reflecting the diffuse osseous metastases seen on the recent MRI.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: As above.OTHER: No significant abnormality noted.

Output: 1. Interval progression of pulmonary metastases and mediastinal lymphadenopathy.2. Interval progression of hepatic metastases.3. Diffuse osseous metastases.


Instruction: Generate impression based on findings.

Input: Postconcussional syndrome [F07.81] / Headache [R51], Reason for Study: ^Reason: structural abnormality, shearing injury History: severe headaches, location left side and right back No evidence of acute ischemic or hemorrhagic lesion.Mucosal thickening on frontal sinus indicating sinusitis.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. 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. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear.

Output: Frontal sinus sinusitis.Otherwise unremarkable brain MRI.


Instruction: Generate impression based on findings.

Input: Diagnosis: Encounter for examination for normal comparison and control in clinical research programClinical question: mets small cell lung cancer, progressed from 1st line therapy and chest RT. pls evaluate dx status.Signs and Symptoms: small cell lung cancer. The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.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 mucosal thickening in the maxillary sinuses.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: Benign neoplasm of cerebral meninges [D32.0], Reason for Study: ^Reason: recurrent meningioma, s/p RT (2014), s/p resection (7/2015); surveillance History: recurrent meningioma Post right fronto-parietal craniotomy status for frontoparietal meningioma resection.There are a couple of crescent shape enhancements as well as thick linear enhancements on the tumor bed. The largest one was measured as 7mm (RL) x 14mm (AP) x 9mm (CC). There is localized extra-axial fluid collection overlying the lesion with thick but smooth dural enhancement.There is linear susceptibility lesion on the right pre central gyrus indicate postsurgical changes.Comparing to prior scan which showed multifocal scattered enhancement over the right pre central gyrus, those enhancing lesions are now more conspicuous and relatively better defined. This configuration change could be related to the overlying extra axial fluid collection or could be related to reduction of postoperative edema.In addition, overlying dural and bone flap also show more enhancement on today's scan which could represent postoperative changes.Constellation of above findings could represent focal either local residual mass or localized inflammatory lesions. Underlying brain shows multifocal scattered high signal intensity lesions on FLAIR images indicating non specific small vessel ischemic disease, no change since prior scan.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no evidence of acute ischemic or hemorrhagic lesion.The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Interval configuration change of operation site enhancing lesion as well as more confined extra axial fluid collection overlying the tumor bed as described above. More conspicuous and discrete looking enhancing lesions on prior tumor bed may indicate possible residual tumor but cannot completely exclude focal residual postoperative inflammatory reaction. Follow up MR imaging is recommended.2. No evidence of acute ischemic or hemorrhagic lesion on this scan.3. No change of non specific small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: 37-year-old female with weakness in the right side. Evaluate for cord compression or lesions. The craniovertebral junction appears within normal limits. The cervical spine alignment is maintained with a developmentally slender spinal canal. The cervical vertebral bodies are maintained. There is diffuse decreased marrow signal but no focal worrisome signal abnormality. There is no abnormal enhancement or STIR signal abnormality. There is mild disc height loss most prominently involving the C3-4, C4-5 and C6-7 levels. The cervical spinal cord has normal signal characteristics and overall morphology. The vertebral artery flow voids appear to be intact. The paraspinous soft tissue structures appear within normal limits.Interspace observations:C2-3: Small disc osteophyte complex mild facet hypertrophy. No neuroforaminal or spinal canal stenosis.C3-4: Small disc osteophyte complex. No neuroforaminal narrowing. Mild spinal canal stenosis.C4-5: Disc osteophyte complex and right paracentral disc extrusion with mild inferior migration. Mild facet hypertrophy. No significant neural foraminal narrowing. Up to moderate spinal canal stenosis with mild flattening of the right ventral aspect of the spinal cord.C5-6: Disc osteophyte complex greater along the left paracentral region. Mild facet hypertrophy. No neural foraminal narrowing. Mild to moderate spinal canal stenosis with mild flattening of the ventral left aspect of the spinal cord. C6-7: Disc osteophyte complex and facet hypertrophy. No neural foraminal narrowing. No significant spinal canal stenosis. C7-T1: No significant neural foraminal or spinal canal stenosis.

Output: Multilevel degenerative changes and developmentally slender canal most predominantly involving C4-5 level where there is moderate spinal canal stenosis with mild flattening of the right ventral aspect of the spinal cord from a right paracentral disc extrusion. There is no cord signal abnormality.


Instruction: Generate impression based on findings.

Input: 54 year old male with non specific abnormal ECG. Referred for cardiac MRI to rule out HCM. Left VentricleThe left ventricle is normal in size with normal systolic function. There is focal hypertrophy along the basal anterior wall with a maximum thickness of 15mm. Although the LV apex appears hypertrophied, it is instead heavily trabeculated with normal wall thickness. The remainder of the myocardium has a wall thickness of approximately 10mm. The overall LV ejection fraction is 65%. The LVEDV is 185 ml (normal range 142+/-34), the LV end diastolic volume index is 95 ml/m2 (normal range: 74+/-15), the LVESV is 65 ml (normal range 47+/-19) and the LV end systolic volume index is 33 ml/m2 (normal range 25+/-9). The LV mass is 140 g (normal range 164+/-36) and the LV mass index is 71 g/m2 (normal range 85+/-15). There are no regional wall motion abnormalities present. There is a small amount of patchy late gadolinium enhancement within the hypertrophied basal anterior wall to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. The overall burden of fibrosis is <5% of the total myocardial mass. The native T1 and T2 myocardial relaxation times are within normal limits. There is no myocardial iron overload.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 57%. The RVEDV is 193 ml (normal range 142+/-31), RV end diastolic volume index is 99 ml/m2 (normal range 82+/-16), the RVESV is 82 ml (normal range 54+/-17), and the RV end systolic volume index is 42 ml/m2 (normal range 31+/-9).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve is trileaflet, opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1.The left ventricle is normal in size with normal systolic function. LVEF 65%. There is a focal area of hypertrophy involving the basal anterior wall. Although the LV apex appears hypertrophied, it is instead heavily trabeculated with normal wall thickness. There is a small amount of patchy late gadolinium enhancement within the hypertrophied basal anterior wall to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. Taken together, these findings support the diagnosis of hypertrophic cardiomyopathy. However, the differential diagnosis also includes some of the infiltrative cardiomyopathies. 2.The right ventricle is normal in size with normal systolic function. RVEF 57%.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Reason: Left proximal thigh leiomyosarcoma, evaluate for size prior to surgical excision History: above A marker was placed along the medial aspect of the proximal to mid thigh. Deep to the marker, there is a mass within the subcutaneous fat superficial to the gracilis muscle, measuring approximately 3.5 cm in its greatest transverse dimension and just under 4 cm in the craniocaudal dimension. It is isointense to skeletal muscle on T1-weighted images, heterogeneous on T2 weighted images with foci of high, intermediate and low signal intensity, and shows heterogeneous enhancement following contrast administration. The mass has slightly irregular margins and extends from the skin through the peripheral deep fascia. It results in mild mass effect on the gracilis, although there is a very thin fat plane which appears to separate the majority of the mass from the gracilis on the axial T1-weighted images. We see no frank invasion of the muscle itself. The musculature of the posterior and medial compartments appears slightly atrophic. We see no abnormal enhancement of the musculature of the thigh. The bone marrow signal intensity of the left femur appears normal although the distal end of the femur is not included on the field-of-view of this study.

Output: Medial thigh leiomyosarcoma as described above.