Instruction: Generate impression based on findings.

Input: Right tonsillar squamous cell carcinoma metastatic to the left parietal lobe now status post stereotactic radiosurgery. Evaluate for interval change. Post surgical changes from left parieto-occipital craniotomy and resection of left posterior parietal tumor. Compared to prior, there is significant interval reduction in vasogenic edema adjacent to the resection cavity. There is expected evolution of the resection cavity now with a small residual heterogeneous signal compatible with residual blood products. There is expected mild thickening and enhancement of the adjacent dura and craniotomy site. No residual enhancing mass is identified.No new abnormal enhancing foci. There is no evidence of acute intracranial hemorrhage. The ventricles and basal cisterns are normal in size and configuration. The expected intracranial vascular flow voids are present.Mucosal thickening and mucous retention cysts in the maxillary sinuses. There is complete opacification of the right frontal sinus as well as scattered opacification of the anterior ethmoid air cells. Minimal opacification of the left mastoid air cells. The orbits are unremarkable.

Output: 1. No residual or recurrent enhancing tumor is appreciated at the surgical site. No new lesions.2. Evolution of posttreatment changes with near resolution of the previous seen left parietal perilesional vasogenic edema.


Instruction: Generate impression based on findings.

Input: 52-year-old male with stage IV melanoma, restaging examination. There is no evidence of intracranial hemorrhage, mass or acute infarction. No abnormal enhancement is evident. Scattered punctate T2 hyperintensities within the subcortical white matter are nonspecific, but not significantly changed from the prior examination. The ventricles and basal cisterns are unremarkable. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unremarkable.

Output: No evidence of intracranial metastases, and no significant interval change.


Instruction: Generate impression based on findings.

Input: Elevated PSA. Per epic: Pt underwent prior prostate biopsy yielding atypical small acinar proliferation. Rising PSA: 4.5 (2010) to 11.1 (2014). PELVIS:PROSTATE:Prostate Size: The prostate measures 5.7 x 4.6 cm.Peripheral Zone: No suspicious lesion identified. Linear subcentimeter T2 hypointense/low ADC signal seen laterally in peripheral zone on right side near junction with transition zone nonspecific but benignity favored. Central Gland: Nodularity consistent with benign prostatic hyperplasia. Ovoid focal T2 hypointense nodule seen in midline may be related to BPH (versus postprocedural sequela, utricle cyst felt to be less likely). Seminal Vesicles: The seminal vesicles are normal in appearance.Extracapsular Extension: NoBLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No suspicious lesion is identified.


Instruction: Generate impression based on findings.

Input: Kidney cancer. Many of the images are degraded by patient motion artifact. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is extensive diffuse patchy cerebral white matter T2 hyperintensity bilaterally. There is also mild high T2 signal within the pons. There is diffuse cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is a right maxillary sinus retention cyst and mucosal thickening in the left maxillary sinus. There is degenerative spondylosis in the imaged portions of the upper cervical spine.

Output: No definite intracranial metastases, although assessment is limited by the lack of contrast and patient motion. Extensive white matter abnormalities may represent chronic small vessel ischemia and/or perhaps treatment effects.


Instruction: Generate impression based on findings.

Input: Congenital oculomotor apraxia. The inferior cerebellar vermis appears to be slightly small and there is a mega cisterna magna. In addition, there appear to be punctate fluid signal intensity foci within the medial left cerebellar hemisphere, which may represent prominent perivascular spaces associated with a mildly anomalous foliation pattern. There is mild diffuse periventricular white matter T2 hyperintensity in the right peritrigonal region. The brain parenchyma otherwise appears unremarkable, with an expected degree of myelination. The corpus callosum is intact. There is asymmetry of the trigones of the lateral ventricles, in which the left is larger than the right. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is no evidence of hydrocephalus. There is no midline shift or herniation. The cisternal segments of the The pituitary appears unremarkable. The major cerebral flow voids are intact. There is fluid within the left mastoid air cells and and middle ear. The skull, paranasal sinuses, orbits, and scalp soft tissues otherwise appear unremarkable.

Output: 1. Suggestion of mild cerebellar development anomaly and asymmetry of the trigones of the lateral ventricles with signal abnormality in the right peritrigonal white matter may be related to congenital oculomotor apraxia.2. Nonspecific fluid in the left mastoid and middle ear may represent otomastoiditis.


Instruction: Generate impression based on findings.

Input: 53-year-old female with schwannomatosis complaining of very severe arm pains, right more than left extending from shoulder down.Evaluate for evidence of a schwannoma in the brachial plexus. No abnormal T2 signal, enhancement, or mass involving the right brachial plexus is appreciated. No extrinsic mass to suggest compression is appreciated. Coronal STIR sequence including the bilateral brachial plexus demonstrates no lesion on either side.Please refer to separate report for findings in the shoulder.

Output: 1. No evidence of schwannoma or any other signal abnormality involving the right brachial plexus. Limited evaluation of the left brachial plexus is also unremarkable.2. Please refer to separate report for findings in the shoulder.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Female, 50 years old, with lung cancer in two brain metastases treated with CyberKnife. Surveillance imaging. A rim-enhancing nodule within the left superior frontal gyrus has not clearly changed in size and continues to measure 18 x 13 mm. However, the associated parenchymal edema has improved to a mild degree.A punctate focus of enhancement within the anterior right temporal lobe has perhaps slightly decreased in size, now measuring 3 mm, previously 4 mm, with barely detectable edema. However, a new 4 mm enhancing nodule with mild local edema is seen along the lateral cortex of the right temporal lobe.No additional enhancing lesions are seen. No evidence of any significant generalized mass effect is detected. No intracranial hemorrhage or abnormal extra-axial fluid is seen. The ventricles are within normal limits.

Output: 1.The treated left superior frontal lesion is stable in size but with some interval improvement in associated edema.2.The treated right anterior temporal lesion is perhaps a millimeter smaller.3.A new 4 mm enhancing nodule is evident, however, along the lateral cortex of the right temporal lobe.


Instruction: Generate impression based on findings.

Input: Brain MRI:Postoperative findings related to suboccipital midline craniectomy and cranioplasty redemonstrated. There remains no evidence of residual tumor enhancement. The previously described nodular focus at the anteromedial aspect of the right cerebellar hemisphere with mild FLAIR hyperintensity is again seen. While more prominent than on the first two postoperative exams, it remains non-enhancing and is unchanged in intensity and size from the post recent comparison exam, again measuring 11 x 7 mm (series 801, image 20).The ventricles are stable in size and configuration. No diffusion signal abnormality to suggest acute infarction. No evidence of mass effect or midline shift. The major cerebral flow voids are intact. Complete spine MRI:The cervical, lumbar, and thoracic vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. The spinal cord ends at the L2 level. The conus medullaris on sagittal imaging is grossly intact. The paravertebral soft tissues are unremarkable. There is no abnormal enhancement.

Output: 1.Post-operative findings related to posterior fossa tumor resection.2.Nodular non-enhancing, mild FLAIR hyperintense focus at the anteromedial aspect of the right cerebellar hemisphere is not significantly changed from the previous exam. This may represent treatment-related effects versus residual tumor. Continued close attention on follow-up imaging is advised.3.No evidence of spinal metastases.


Instruction: Generate impression based on findings.

Input: There is an ossific fragment that represents the upper portion of the dens, which is displaced anterosuperiorly in relation to the remainder portion of the dens. There is approximately 55 degrees of angulation between the dens and the displaced ossific fragment. The distance between the displaced ossific fragment and the mildly hypertrophy anterior arch of C1 is 1 mm. The degree of displacement of the odontoid fragments is approximate 8 mm. There is anterior subluxation of the lateral mass of C1 in respect to C2, better visualized on CT.There is impingement of the hypoplastic dens remnant on the left ventral cord with moderate central spinal canal stenosis. There is a subtle diffuse increased T2 signal in the cord at this level. There is no significant volume loss. Fluid signal is seen between the displaced ossified fragment and the remainder of the dens.Remainder of the cervical spine is unremarkable.

Output: 1. Findings consistent with dystopic os odontoideum. The os odontoideum is anterosuperiorly displaced and angulated with the remainder of the hypoplastic remnant dens. 2. Impingement of the dens remnant on the left ventral cord with moderate spinal stenosis. High T2 signal on the cord may represent a degree of chronic myelomalacia although there is no significant cord volume loss and the possibility of superimposed cord edema cannot be excluded. Please correlate clinically.4. Trace fluid between the displaced os odontoideum and the remainder of the dens, possibly indicating atlantoaxial instability. Flexion/extension radiographs recommended.


Instruction: Generate impression based on findings.

Input: The examination is limited by motion artifact and the 3-D postcontrast T1 images are degraded by technical factors. Postsurgical findings consistent with right frontal parietal craniotomy with resection of two right parietal lobe lesions are again demonstrated. Peripheral hemosiderin deposition and blood-fluid level is demonstrated in the resection cavities. Postoperative dural thickening and enhancement is demonstrated subjacent to the craniotomy. The more superolateral resection cavity demonstrates subtle increased signal on T1 post-contrast images, surrounding the resection cavity with more nodular signal along the surgical tract. This may relate to postcontrast enhancement or intrinsic signal, however intrinsic T1 signal was not present in these locations on prior postoperative imaging. Additionally, the more medial resection cavity demonstrates subtle nodular signal along the inferomedial resection margin which may also represent contrast enhancement versus intrinsic T1 signal.There is a small posterior left frontal lobe lesion measuring 5 x 8 mm (series 503, image 144). Additionally, there is a 7 x 7 mm left parietal lobe lesion (series 503, image 125). This lesion demonstrates increased surrounding vasogenic edema. A 3 mm enhancing lesion is visualized in the right cerebellum (series 401, image 36).The ventricles and sulci are within normal limits. The cisterns remain patent. There is no midline shift or mass effect. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures.

Output: 1. Postsurgical findings related to resection of two large right parietal lobe metastatic lesions are demonstrated. The resection cavities demonstrate subtle nodular signal which may relate to postoperative change versus residual tumor. Limited evaluation due to lack of T1 precontrast imaging.2. There is interval slight increase in size of subcentimeter left parietal and posterior left frontal lobe lesions with increased edema surrounding the left parietal lobe lesion.3. A 3 mm metastatic lesion is also now visualized in the right cerebellum.


Instruction: Generate impression based on findings.

Input: 53 years, Female, memory loss. Paresthesias. Javed MS protocol requested. Brain: Limited sequences per demounting protocol. Again seen are multiple foci of T2 hyperintensity scattered throughout the periventricular and subcortical white matter, some of which are nonspecific in appearance while others which are linear and pericallosal in distribution and compatible with reported history of demyelinating disease. No new lesion compared to 10/20/2015 is seen to suggest progression of demyelinating disease. There is no abnormal enhancement. No significant burden of T1 hypointense lesions. Brain parenchymal volume is also maintained. No suspicious intracranial mass or mass effect. Unchanged pineal cyst. Ventricles remain normal in size. Cervical spine: Vertebral body heights in the cervical spine are normal. There are postsurgical changes of anterior cervical fusion from C5 through C7, which are new since prior MRI from 5/7/2014. There is no abnormal signal in the cervical cord suggest demyelinating disease. There is punctate nonspecific T2 hyperintensity in the central cord at the mid C6 level which may relate to prior stenosis (ax T2, series 1801 image 11). There is mild to moderate spinal canal stenosis at the C6-C7 level related to a dorsally projecting osteophyte. Mild spinal canal stenosis is also present at C5-C6. Overall caliber of the spinal canal at these levels is improved since the prior MRI. No abnormal enhancement is appreciated.There is moderate to severe right C3-C4 neural foraminal stenosis related to uncovertebral hypertrophy and advanced right-sided facet arthropathy as before. There is also mild to moderate left and mild right C5-C6 neural foraminal stenosis as well as mild to moderate left and mild right C6-C7 neural foraminal stenosis. No findings to suggest progressive degenerative disease since 5/7/2014.

Output: 1. No new lesions in the brain.2. No abnormal signal in the cervical cord to suggest demyelinating disease. 3. Degenerative changes are again seen in the cervical spine with improvement in degree of spinal canal stenosis at C5-C6 and C6-C7, with interval anterior cervical fusion since prior MRI from 5/7/2014. Additional details as described above including a nonspecific punctate focus of T2 hyperintensity in the central cervical cord at the C6 level which may be related to prior stenosis.


Instruction: Generate impression based on findings.

Input: Procedure: MRI LUMBAR SPINE WWODiagnosis: Malignant neoplasm of spinal cordClinical question: eval s/p lumbar tumor removalSigns and Symptoms: same Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. Since the prior exam the patient is undergone right-sided hemilaminectomy at the L3 vertebral body level for removal of an intrathecal mass.. There is some central and to lesser degree peripheral clumping of nerve roots present at the L3-4 disc space level at the prior location of the patient's intrathecal mass. This associated with some contrast enhancement. There is a small fluid collection present at the hemilaminectomy site measuring approximately 16 x 11 mm axial dimensions. There is associated fluid in the subcutaneous tissues superficial to the paravertebral muscles at the incision site.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is no significant compromise to spinal canal or neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.There is a 27 x 28 mm axial dimension mass at the inferior pole of the left kidney which also be identified on the recent abdomen CT from 10/29/2015.

Output: 1.Since the prior exam from 3 weeks ago , the patient is undergone surgery for removal of an intrathecal mass. Some clumping of nerve roots at the level of the mass is concerning for potential arachnoiditis.2.There is a fluid collection present at the surgical site could simply represent postsurgical fluid.3.There is a mass at the inferior pole of the left kidney which can also be identified on the recent CT of the abdomen. Please refer to the CT of the abdomen for further comments. The possibility this represents a neoplasm cannot be excluded.


Instruction: Generate impression based on findings.

Input: Low back pain for months with left sided pain and weakness. There is slight disc dessication at L4-5 and a small disc protrusion eccentric to the left with impingent upon the adjacent left lateral recess nerve roots and mild neural foraminal stenosis. The other lumbar spine levels are unremarkable and there is no significant spinal canal stenosis. The vertebral body heights are preserved. The vertebral column alignment is within normal limits. The vertebral bone marrow signal is unremarkable. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: Degenerative spondylosis at L4-5 with a small disc protrusion eccentric to the left that impinges upon the adjacent left lateral recess nerve roots and causes mild neural foraminal stenosis.


Instruction: Generate impression based on findings.

Input: 47-year-old male with Sjogren's and left orbital mass. Please evaluate interval change. Also has history of sinus disease, frontal sinus retention cyst. Stable postsurgical changes are seen in the left frontal sinus. Stable soft tissue density in the left frontal sinus which again most likely represents a mucous retention cyst versus a polyp. There is increased mucoperiosteal thickening in the ethmoid air cells. Significant mucoperiosteal thickening and retention cyst or polyp formation within the left maxillary sinus. The right exercise also contains a retention cyst or polyp. Ostiomeatal units appear occluded bilaterally. Stable mild nasal septal deviation towards the right. Bilateral orbits are within normal limits. Specifically, no evidence of orbital masses. The left lacrimal gland appears minimally enlarged compared to the right. MRI of the orbits could be obtained if concern for orbital pathology remains.

Output: Increased ethmoid sinus disease with occluded ostiomeatal units bilaterally. No evidence of orbital mass.


Instruction: Generate impression based on findings.

Input: Metastatic breast cancer. Baseline exam prior to enrolling in a clinical trial. Evaluate for brain metastasis.. There is a peripherally enhancing T1 hypoattenuating and T2 hyperattenuating mass in the right frontal lobe measuring up to 42 mm with surrounding vasogenic edema and mass effect upon the frontal horn of the right lateral ventricle. There is susceptibility effect within the dominant mass, likely related to hemorrhage. In addition, there is an enhancing lesion in the left frontal lobe up to 5 mm, an enhancing lesion in the right anterior parietal lobe that measures up to 7 mm, and a right cerebellar enhancing lesion that measures up to 4 mm. There leftward midline shift measuring up to 3 mm anteriorly with slight subfalcine herniation. There is also effacement of the frontal horn of the right lateral ventricle. Within the posterior aspect of the pons, there appears to be a punctate focus of diffusion restriction. The major cerebral flow voids are intact. There appears to be a punctate focus of enhancement in the right posterior globe. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There are bilateral nasolabial fold cosmetic fillers.

Output: 1. A total of four supratentorial and infratentorial lesions likely represent metastases, the largest of which measures up to 42 mm in the right frontal lobe with vasogenic edema, possible intratumoral hemorrhage, and 3 mm of midline shift. 2. A punctate focus of enhancement in the right posterior globe may also represent a metastasis. 3. Possible punctate recent infarct in the right pons.


Instruction: Generate impression based on findings.

Input: 30 year-old male with a history of osteochondral defect in the lateral femoral condyle presents with knee pain. MENISCI: Poorly defined increased signal intensity within the inner fibers of the posterior horn and body of the lateral meniscus likely represents intrasubstance degeneration and free edge fraying. These findings appear slightly more prominent compared to the prior study; this may represent progression of fraying or simply differences in technique (3T versus 1.5 T scanner).Again seen is poorly defined signal intensity within the anterior horn of the lateral meniscus suggesting additional intrasubstance degeneration. No fluid signal intensity is identified in the lateral meniscus. The medial meniscus is intact.ARTICULAR CARTILAGE AND BONE: Again seen is a linear focus of metallic susceptibility artifact in the lateral femoral condyle, compatible with an orthopedic screw that presumably affixes the patient's known osteochondral defect based on prior reports. Focal depression of the overlying subchondral bone plate appears similar to the prior study. Small cysts in the subchondral bone of the lateral femoral condyle, just above the free edge of the anterior horn of the lateral meniscus, also appear similar to the prior study. Thinning/heterogeneity of the overlying articular cartilage is not significantly changed, likely representing chronic degeneration. No large fluid-filled gaps are seen. Increased signal intensity within the articular cartilage of the lateral tibial plateau, just anterior to the free edge of the posterior horn of the lateral meniscus, appears more prominent; this finding suggests progression of full thickness cartilage degeneration. Abnormal increased signal intensity within the lateral tibial spine appears similar to previous MRI. Articular cartilage of the medial tibiofemoral compartment is intact. The patellar cartilage is also intact, but new increased signal intensity within the articular cartilage of the femoral trochlea suggests focal degeneration at this site. Tricompartmental osteophytes are again noted.LIGAMENTS: The cruciate and collateral ligaments are intact.EXTENSOR MECHANISM: The extensor mechanism is intact. Minimal thickening of the patellar tendon and scarring within Hoffa's fat pad are consistent with prior surgery.ADDITIONAL

Output: 1.Postoperative changes s/p lateral femoral condyle osteochondral defect fixation as described above, appearing similar to the prior MRI. However, there appears to have been progression of focal degeneration of the articular cartilage overlying the adjacent lateral tibial plateau.2.Degeneration and free edge fraying of the lateral meniscus, which may have slightly progressed since the prior MRI. However, no fluid-filled lateral meniscal tear is identified.3.New focal degeneration of the articular cartilage overlying the femoral trochlea and other findings as described above.


Instruction: Generate impression based on findings.

Input: Thoracic MRI:The thoracic spine is in normal alignment. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal. Minimal disc bulges are noted at the T7-8, T9-T10 and T10-11 levels. There is some STIR signal abnormality most noted at the inferior endplate of T9 and superior endplate of T10 indicating endplate degeneration. There is also some STIR signal abnormality along the anterior inferior endplate of T8 and superior anterior endplate of T9. There is ligamentum flavum thickening at the T9-10 and T11-T12 but no neuroforaminal or central canal stenosis.Lumbar MRI:The vertebral column alignment is within normal limits. The vertebral body heights are preserved but the L5-S1 disc space is decreased and there are endplate degenerative changes at the L5-S1 level. There is also multilevel disc desiccation involving the lower lumbar spine. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable. T12-L1: There is no significant compromise to spinal canal or neural foramina.L1-L2: There is no significant compromise to spinal canal or neural foramina.L2-L3: There is a mild disc bulge and mild facet arthropathy which causes mild bilateral neural foraminal stenosis. No central canal stenosis.L3-L4: There is a mild left greater than right disc bulge and mild facet arthropathy which causes moderate left neural foraminal and mild central canal stenosis. No right neuroforaminal stenosis.L4-5: There is a mild disc bulge and mild facet arthropathy which causes mild bilateral neuroforaminal stenosis along with left lateral recess effacement. There is mild to moderate central canal stenosis.L5-S1: There is a mild disc bulge and significant facet arthropathy which causes moderate transverse dimension stenosis of the spinal canal. There is also moderate to severe right and moderate left neural foraminal stenosis

Output: 1.Within the thoracic spine there are mild degenerative changes, including at the T9-T10 level. At this level there is mild endplate degeneration but no central spinal canal stenosis or evidence of a compression fracture. 2.Within the lumbar spine there are multilevel degenerative changes especially involving the lower lumbar spine. This is most prominent at the L5-S1 level where there is moderate spinal canal stenosis and moderate to severe neural foraminal stenosis.


Instruction: Generate impression based on findings.

Input: Female; 38 years old. Reason: RECTAL CARCINOID EVALUATE FOR DISEASE PROGRESSION History: RECTAL CARCINOID ABDOMEN:LIVER, BILIARY TRACT: Stable segment 8 cyst. No suspicious liver lesions. No biliary ductal dilation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Stable scattered subcentimeter retroperitoneal lymph nodes, which are not enlarged by size criteria.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Fibroid uterus. 2.1-cm physiologic cyst in the right ovary.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No abnormal mass or area of enhancement involving the rectum to suggest residual or recurrent disease.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No evidence of residual or recurrent disease.


Instruction: Generate impression based on findings.

Input: 87-year-old female status post fall loss of consciousness. Evaluate for bleed There is no evidence of intracranial hemorrhage, mass or edema. Diffuse periventricular white matter hypodensities are consistent with small vessel disease, age indeterminate. If there is clinical concern for acute ischemia and MRI may be consideredThe ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. Diffuse periventricular white matter hypodensities are consistent with small vessel disease, age indeterminate. If there is clinical concern for acute ischemia and MRI may be considered.2. No evidence of intracranial hemorrhage.


Instruction: Generate impression based on findings.

Input: 33 year old male with buttock abscess and tenderness to palpation. Evaluate for perirectal abscess. ABDOMEN:This examination is limited by absence of IV contrast. LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: There is extensive diffuse soft tissue thickening subcutaneously in the right medial buttock that extends to the anus. The enteric contrast has not reached the distal colon and rectum. Without IV and enteric contrast, it is difficult to define an abscess or fistula. No definite abscess was found. No intrapelvic extension. If this condition persists or further evaluation is required, a non-contrast MRI scan may be most helpful.There is diffuse vascular calcifications in the pelvis.

Output: Right buttock subcutaneous inflammatory changes, but no definite abscess. Sensitivity is limited without enteric or IV contrast. Consider MRI if further evaluation is required.


Instruction: Generate impression based on findings.

Input: 22-year-old female with left hip pain, limited motion, evaluate for stress fracture versus avascular necrosis versus loose body. ACETABULAR LABRUM: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: Linear T1 hypointensity along the medial cortex of the left femoral neck is compatible with an incomplete basicervical femoral neck fracture. The lateral cortex of the left femoral neck remains intact. There is high T2 signal surrounding the fracture line compatible with edema. The remainder of the bony pelvis and right hip appear within normal limits.SOFT TISSUES: The musculature of the left hip and pelvis appear within normal limits.ADDITIONAL

Output: Incomplete basicervical femoral neck fracture as described above.These findings were discussed with Barbara Engel by phone on 6/16/15 at 0920.


Instruction: Generate impression based on findings.

Input: 67 years Male (DOB:12/21/1948)Reason: assess limited MRI of head History: AMSPROVIDER/ATTENDING NAME: SHANNON K MARTIN HEMAL M. NAYAK MRI of the brainThere is redemonstration of diffusion restriction involving the right centrum semiovale and right periventricular white matter at the trigone and right occipital lobe. There is no evidence for hemorrhagic conversion. The extent has not changed since the prior exam, however, the signal intensity on DWI has decreased.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 are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. There is fetal origin of the PCA bilaterally associated with a hypoplastic p1 segment on the right and a small to medium sized p1 segment on the left. The right SCA is predominantly supplied via the anterior circulation. The RVA is hypoplastic intracranially

Output: 1.There is redemonstration and continued evolution of foci of subacute infarction involving the right centrum semiovale and right periventricular white matter at the trigone and right occipital lobe. These have not changed in extent compared to the prior exam. There is no evidence for hemorrhagic conversion at this time.2.There is bilateral fetal origin. The right SCA is predominantly supplied via the anterior circulation. The RVA is hypoplastic


Instruction: Generate impression based on findings.

Input: 43-year-old female with AUB, found to have complex atypical hyperplasia with grade 1 endometrioid endometrial cancer PELVIS:UTERUS, ADNEXA: Heterogeneous T2 hyperintense endometrial thickening and cystic changes extending to involve the outer half of the myometrium. There are foci of T1 hypointensity with associated hypoenhancement (series 1502, image 121). The junctional zone is thickened. A submucosal fibroid is noted. Nabothian cysts. The right ovary is normal. The left ovary is not visualized.BLADDER: No significant abnormality noted.LYMPH NODES: No lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: Marked cystic changes and thickening of the endometrium extending to involve the outer half of the myometrium with areas of hypoenhancement consistent with patient's history of endometrial cancer. The disease is confined to the uterus without extension to the cervix.


Instruction: Generate impression based on findings.

Input: Headache. There are scattered T2 hyperintense foci throughout the frontoparietal white matter. The largest of the lesions in the left parietal white matter is associated with facilitated diffusion without restriction. The lesions are noncontrast enhancing and are nonspecific in distribution and morphology. There is no space occupying brain lesion. There is no intracranial hemorrhage. The ventricles are mildly dilated. The other CSF-containing spaces are normal in size. Major intracranial vessels are patent.The orbits are normal. Mastoid air cells are clear. There is minimal mucosal thickening in the ethmoid and sphenoid sinuses without fluid. The other paranasal sinuses are clear. There is no skull destructive lesion.

Output: 1.Scattered frontoparietal white matter lesions are nonspecific in appearance and distribution. Such lesions are usually related to chronic microvascular ischemia.2.There is very minimal mucosal thickening in the ethmoid and sphenoid sinuses without fluid.


Instruction: Generate impression based on findings.

Input: There is no evidence of acute infarct. There is encephalomalacia predominantly involving the right parietal and temporal lobes, compatible with chronic infarcts. Foci of susceptibility in this area likely reflect chronic blood products, as well as T1 hyperintense laminar necrosis. There is additional area of volume loss and linear susceptibility involving the left external capsule, compatible with blood products associated with a chronic lacunar infarct. There are also chronic cerebellar infarcts, right greater than left, as well as small chronic infarct of the pons. There is volume loss of the right cerebral peduncle with abnormal signal extending to this level along the posterior limb of the right internal capsule, likely relating to ovarian degeneration.Additional mild scattered foci of periventricular and subcortical white matter FLAIR signal hyperintensity are nonspecific and compatible with chronic microvascular ischemic changes. There is minimal ex vacuo dilatation of the right lateral ventricle. Otherwise, the ventricles and basal cisterns are normal in size and configuration. The midline structures and craniocervical junction are otherwise within normal limits. There is no midline shift or herniation. No abnormal extra-axial fluid collection is identified.MRA HEAD

Output: 1.MRI brain showing multiple supratentorial and infratentorial chronic infarcts, without evidence of acute infarct are other acute abnormality.2.MR angiography of the brain showing irregularity and narrowing of the right MCA from the M1-M2 junction distally. No flow related enhancement of the right V4 segment.3.MR angiography of the neck showing likely chronic occlusion of the right vertebral artery with reconstitution of the distal V2 to mid-distal V3 segments by segmental collaterals. Dominant left vertebral artery with likely developmentally diminutive basilar artery.


Instruction: Generate impression based on findings.

Input: Progressive numbness, weakness in left upper extremity. Low back pain with or without sciatica. Evaluate for possible nerve root compression or other CNS pathology. Cervical: Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained. Bone marrow signal is benign.The cervical spinal cord has normal signal characteristics and overall morphology.Degenerative changes are seen in the cervical spine with disc height loss at multiple levels, relatively worse at the C4-C5, C5-6, and C6-C7. Individual levels 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: Right paracentral and foraminal disc osteophyte complex with effacement of the right ventral thecal sac. No significant spinal canal stenosis overall. There is mild to moderate right-sided neural foraminal stenosis. Left neural foramen is patent.C5-6: Disc osteophyte complex with uncovertebral hypertrophy result in moderate to severe bilateral neural foraminal stenosis, left slightly worse than right. Mild spinal canal stenosis. C6-7: Small disc osteophyte complex and bilateral uncovertebral hypertrophy. There is mild spinal canal stenosis. There is also mild to moderate right and mild left neural foraminal stenosis related to uncovertebral hypertrophy.C7-T1: No significant compromise to the spinal canal. Minimal bilateral neural foraminal narrowing related to uncovertebral hypertrophy.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.Lumbar: Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is trace anterolisthesis of L2 on L3 and trace retrolisthesis of L3 on L4. There is also mild anterolisthesis of L5 on S1. There is disc desiccation throughout the lumbar spine with suggestion of vacuum phenomena at the L4-L5 and L5-S1 levels. Bone marrow signal is benign. The conus medullaris is normal in position.Multilevel degenerative changes are seen, as described below:T12-L1: No significant disc disease. No spinal canal or neural foraminal stenosis.L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: Minimal disc bulge, ligamentum flavum thickening, and mild bilateral facet arthropathy. There is no significant spinal canal stenosis. Minimal bilateral neural foraminal narrowing.L3-L4: Mild disc bulge, and bilateral facet arthropathy. There is no significant spinal canal stenosis. There is mild bilateral neural foraminal stenosis.L4-L5: Mild disc bulge, ligamentum flavum thickening, and moderate bilateral facet arthropathy. There is also prominence of the dorsal and ventral epidural fat resulting in moderate spinal canal stenosis. There is clumped appearance of the nerve roots which is favored to be related to extrinsic compression. There is moderate to severe right neural foraminal stenosis and moderate left neural foraminal stenosis. There are mild edematous changes involving the endplates which are likely on a degenerative basis.L5-S1: There is advanced bilateral facet arthropathy and grade 1 anterolisthesis. There is no significant spinal canal stenosis. There is moderate right and mild to moderate left neural foraminal stenosis.There is mild fatty atrophy involving the lower lumbar paraspinous musculature.

Output: 1. Multilevel degenerative changes in the cervical spine. There is mild spinal canal narrowing at C5-C6 and C6-C7. No high-grade spinal canal stenosis or cord signal abnormality. There is multilevel neural foraminal stenosis, relatively worst at the left C5-C6 level where there may be impingement of the left C6 nerve root. Additional levels as above.2. Multilevel degenerative changes in the lumbar spine. There is up to moderate spinal canal stenosis at the L4-L5 level. There is also significant neural foraminal stenosis bilaterally at L4-L5 and L5-S1, right worse than left, as described above where there may be impingement of the exiting nerve roots.3. Advanced bilateral facet arthropathy at L5-S1 and to a lesser degree at L4-L5, which may be contributing to patient's low back pain.


Instruction: Generate impression based on findings.

Input: 15 year old female with history of pain after volleyball injury. Evaluate for ligamentous or meniscal injury. MENISCI: There is peripheral-based branching linear signal abnormality within the posterior horn and body of the medial meniscus extending to both the tibial and femoral articular surfaces compatible with complex tear. The superior extension is new. The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is a mild amount of bone marrow edema about the posterior lateral aspect of the lateral tibial plateau. The articular cartilage is intact with no focal defects.LIGAMENTS: There have been postoperative changes of a prior ACL reconstruction. The mid-fibers of ACL graft are indistinct with a wavy appearance compatible with ACL graft rupture. Lax ACL fibers are seen near the tibial and femoral surfaces. The PCL, MCL, and LCL couplets are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1. Postoperative changes of prior ACL reconstruction with complete rupture of the ACL graft.2. Complex tear of the body and posterior horn of the medial meniscus as above.3. Small joint effusion.


Instruction: Generate impression based on findings.

Input: Progressive right knee pain MENISCI: The lateral and medial menisci are intact.ARTICULAR CARTILAGE AND BONE: There is moderate loss of the articular cartilage of the patellofemoral articulation particularly along the lateral patellar facet. There is no discrete full-thickness defect however. The articular cartilage of the medial and lateral compartments is maintained.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: There is a small focus of increased signal within the quadriceps tendon upon its insertion at the patella which may reflect a minimal amount of tendinosis.ADDITIONAL

Output: 1. Moderate articular cartilage loss of the patellofemoral articulation. The articular cartilage of the medial and lateral compartments is preserved.2. Mild amount of increased signal noted within the superolateral portion of Hoffa's fat pad which may a component of mild patellofemoral impingement.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for etiology of right radicular symptoms. Signs and symptoms: Right radicular pain episodes. Nonenhanced lumbar MRI:There is normal anatomical alignment of vertebral column.There is mild signal changes of vertebral column secondary to minimal degenerative disease and unremarkable otherwise.T10-T11 through L3-L4 levels are unremarkable.L4-L5 demonstrate mild disc disease and loss of disc height and mild degenerative changes of posterior elements however without spinal stenosis or neural foraminal compromise.L5-S1 demonstrate mild to moderate disc disease and loss of disc height and decreased T2 signal intensity and mild bilateral facet and ligamentum flavum degenerative changes. There is a tiny shallow right median disc protrusion at this level which is best appreciated on axial T2 series 701 image 10 and sagittal T2 STIR series 601 images 7 and 8. The finding results in very subtle indentation of the thecal sac however without spinal canal, neural foraminal or lateral recess compromise.Limited view of the SI joints are unremarkable.Perispinal soft tissues are unremarkable.

Output: 1.Mild degenerative changes at L5-S1 and a tiny shallow right paramedian disc protrusion without spinal canal, neural foraminal or lateral recess compromise.2.Minimal degenerative disc disease at L4-L5 and unremarkable nonenhanced lumbar MRI otherwise.


Instruction: Generate impression based on findings.

Input: 10-year-old boy with history of ankle pain and Trevor's disease. TENDONS: The peroneus longus and brevis tendons are normal. The anterior and posterior tibial compartment tendons are normal. The Achilles tendon is normal.LIGAMENTS: The anterior talofibular ligament is intact. The spring ligament is intact.ARTICULAR SURFACES AND BONE: A 24 x 19 x 9 mm lesion is seen immediately posterior to the medial process of the talus with signal characteristics of bone and cartilage (series 5, image 16; series 4, image 18). No direct communication with the talus is identified. Additionally, multiple smaller osseous lesions are seen posterior to the talar dome measuring up to 8 mm (series 12, images 32, 59, and 60). These lesions were not visualized on the prior, outside study from 3/12/2013.Irregularity of the medial facet of the talus and sustentaculum tali is noted.ADDITIONAL

Output: 1.Large osteochondroma posterior to the medial process of the talus without osseous communication seen.2.Additional, smaller osseous lesions posterior to the talus.3.Irregularity of the middle subtalar joint, may be degenerative.


Instruction: Generate impression based on findings.

Input: 39-year-old female with posterior shoulder pain. ROTATOR CUFF: There is high signal entering the undersurface fibers of the supraspinatus tendon (series 4/10) suggestive of a partial thickness tear. There is no evidence of tendon retraction. The remainder of the rotator cuff appears intact.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is linear branching high signal within the superior glenoid labrum at the 12:00 position, which extends to the biceps tendon anchor, consistent with a labral tear.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: 1.Tear of the superior glenoid labrum at the 12:00 position extending to the anchor of the biceps tendon.2.Possible partial thickness tear of the supraspinatal tendon.


Instruction: Generate impression based on findings.

Input: 62-year-old female with Crohn's disease. Assess stoma area of right lower quadrant ileostomy. Recently discharged from hospital with vomiting. Compared to recent CT abdomen and pelvis. Minimal distention of the small bowel loops limits the exam.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable scarring or mild atrophy of the right kidney. No hydronephrosis. Small cyst of the left lower renal pole.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Status post proctocolectomy and right lower quadrant ileostomy. Stomach is distended with fluid as noted on the prior CT exam. No bowel obstruction. No bowel wall thickening or abnormal wall enhancement to suggest active disease. The previously described parastomal inflammatory change has resolved in the interval.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Status post hysterectomy.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: As above.BONES, SOFT TISSUES: Mild thoracolumbar dextroscoliosis.OTHER: No significant abnormality noted.

Output: 1. Interval improvement of the previously described parastomal inflammatory change.2. Minimal distention of the small bowel loops limits the evaluation for active Crohn's disease.3. Distended stomach could be related to outlet obstruction versus gastroparesis. No discrete mass is identified.


Instruction: Generate impression based on findings.

Input: 49 year old female with pre menopausal cancer, status post left modified radical mastectomy There is scattered fibroglandular tissue in the right breast. The patient is status post left mastectomy and reconstruction. Mild parenchymal enhancement is noted in the right breast.No abnormal enhancement is seen in right breast or left reconstructed breast. No abnormal axillary lymph nodes are identified in either axillary region.Stable high T2 signal right hepatic lobe lesion compatible with a cyst or hemangioma.

Output: No MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: Reason: With CSF flows study, please assess chiari and check for syrinx History: Chiari, HAs, blurry vision, dizziness The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology.The cerebellar tonsils extend through the foramen magnum by approximately 10 mm and are pointed. There is no evidence for a syrinx. CSF flow at the level of the foramen magnum is intact.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.Chiari one malformation without evidence for syrinx


Instruction: Generate impression based on findings.

Input: Reason: acl tear suspected History: laxity on exam, swelling MENISCI: There is a complex tear of the posterior horn and body of the medial meniscus with avulsion of the posterior root attachment and a flipped fragment in the posterior intercondylar notch. The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is mild diffuse grade 2 chondral loss in the medial and lateral tibiofemoral compartments. There is grade 1/2 chondromalacia in the patellofemoral compartment. There are no focal chondral defects. Bone marrow signal is within normal limits. There are mild tricompartmental osteophytes.LIGAMENTS: There is disruption of the proximal aspect of the anterior cruciate ligament, compatible with complete tear. The posterior cruciate ligament is intact. The medial collateral ligament and lateral collateral ligament complex are intact. EXTENSOR MECHANISM: Extensor mechanism is intact.ADDITIONAL

Output: 1.Complete rupture of the anterior cruciate ligament.2.Complex tear of the posterior horn and body of the medial meniscus with avulsion of the posterior root attachment.3.Small to moderate joint effusion and synovitis.


Instruction: Generate impression based on findings.

Input: 40-year-old female with history of SLAP tear status post ROTATOR CUFF: The rotator cuff is intact without evidence of tear. Muscle bulk is within normal limits. No significant atrophy or fatty infiltration.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is a grade 2 SLAP lesion that is less conspicuous when compared to the prior outside hospital MR. Mild degenerative changes affect the glenohumeral joint.BICEPS TENDON: The proximal biceps tendon has been resected and reattached into the proximal humeral diaphysis.ADDITIONAL

Output: 1.Grade 2 SLAP lesion as described above.2.Status post biceps tenodesis.3.No evidence of rotator cuff tear.


Instruction: Generate impression based on findings.

Input: 42-year-old woman with strong family history of breast cancer presents for high-risk screening. There is heterogeneous amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement and multiple cysts are seen in both breasts.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.A T2 bright nonenhancing lesion in the right hepatic dome, presumably a cyst, is unchanged.

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


Instruction: Generate impression based on findings.

Input: Bilateral shoulder pain ROTATOR CUFF: No evidence of rotator cuff tears. There is some tendinopathy in the supraspinatus.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: No significant abnormality noted.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: Tendinopathy of the supraspinatus. No evidence of tears


Instruction: Generate impression based on findings.

Input: 80-year-old male with bleeding via esophageal varices, portal and hepatic thromboses on abdominal ultrasound. Evaluate for portal and hepatic thrombosis. Evaluation for possible TIPS. Respiratory motion artifacts limit the exam.ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic morphology. Persistent dilated gallbladder and nonspecific wall thickening, which is likely related to the cirrhosis and ascites. No intra or extrahepatic biliary ductal dilatation.There is occlusion and and expansion of both of the right hepatic vein (axial series 16 image 526) and posterior branch of the right portal vein (axial series 16 image 399). The main portal vein is patent, however there is partial thrombus within the proximal right portal vein (axial series 16 image 401). The anterior branch of the right portal vein is patent. As seen on the recent ultrasound exam, occlusion of the the middle hepatic vein is again noted (axial series 16 image 524). The left hepatic vein is not clearly delineated.A large enhancing tumor of hepatic segment 6/7 (axial series 16 image 68) measures 6.2 x 5.6 cm. The tumor demonstrates some restricted diffusion (axial series 8 image 124). There is a perfusional abnormality extending to the periphery due to the vascular thrombus. The delayed postcontrast series demonstrates questionable intratumoral washout (axial series 16 image 512).SPLEEN: The spleen is at the upper limits of normal in size measuring 11.4 cm in length.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Simple left renal cyst. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Moderate volume ascites.BONES, SOFT TISSUES: Anasarca of the abdominal wall, left greater than right.OTHER: Bilateral pleural effusions with overlying atelectasis. Infrarenal abdominal aortic aneurysm measuring 3.9 x 3.8 cm (axial series 16 image 20).

Output: 1.Occlusion of the right hepatic vein, middle hepatic vein, and posterior branch of the right portal vein.2.Enhancing tumor of hepatic segment 6/7 with questionable intratumoral washout in the liver with cirrhotic morphology. Occlusion and extension of the right hepatic vein and posterior branch right portal vein are concerning for tumoral invasion. Findings are suspicious of atypical hepatocellular carcinoma. Clinical correlation is needed.3.Infrarenal abdominal aortic aneurysm measuring 3.9 x 3.8 cm.


Instruction: Generate impression based on findings.

Input: Elevated PRL with SOD and EPP. The imaged are partly degraded by dental brace artifact. There is redemonstration of an ectopic neurohypophysis along the tuber cinereum. There is also unchanged deficiency of the adenohypophysis. The optic apparatus appears to be diminutive. There is no evidence of tumors in the region of the sella. There is unchanged T1 hyperintensity along the right cavernous sinus. The cavernous sinuses are otherwise intact. The imaged portions of the brain and ventricles are unremarkable.

Output: Stigmata of septooptic dysplasia with an ectopic posterior pituitary and hypoplastic adenohypophysis.


Instruction: Generate impression based on findings.

Input: There is a 16 mm AP x 6 mm transverse x 6 mm craniocaudal cystic appearing focus involving the mesial right temporal lobe, lying just superior to the hippocampal formation. There is adjacent persistent FLAIR T2 hyperintensity.The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There is no mass effect or midline shift. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. Myelination is mature. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The mastoid air cells and middle ear cavities are clear. High-resolution images of the sella demonstrate the pituitary gland to be normal in size measuring for age. There is no discrete mass to confirm the presence of a pituitary microadenoma. There is no macroadenoma. The pituitary infundibulum inserts on the midline of the gland. There are no sellar, suprasellar or parasellar masses and the cavernous sinuses are symmetric bilaterally.

Output: 1.There is a 16 mm x 6 mm x 6 mm cystic appearing lesion involving the mesial right temporal lobe, lying just superior to the hippocampal formation, with adjacent persistent FLAIR T2 hyperintensity. The brain MRI portion of the exam was ordered without contrast, however the postcontrast pituitary study concurrently ordered demonstrates no enhancement of this anteriorly (although it is only partially imaged). The differential diagnosis most likely includes a postinflammatory cyst or perhaps low-grade cystic neoplasm. Given the persistent FLAIR hyperintensity, simple choroidal fissure cyst is not favored. Recommendations are made to obtain a follow-up exam in 3 months with contrast.2.Negative MRI of the sella including gadolinium enhancement.3.Findings were discussed with Dr. Patel (covering for Dr. Koren) on 9/28/2015 at 10:15 AM.


Instruction: Generate impression based on findings.

Input: 56 year old female with a history of hypertension and episodes of dizziness. There is no evidence of acute intracranial hemorrhage, extra-axial fluid collection, mass or edema. There is no mass effect or midline shift. There is preservation of the gray-white matter interface. There is no evidence of acute territorial ischemia. Incidental note is made of a dysmorphic pituitary fossa without evidence of focal mass lesion in the expected region of the pituitary gland. If the patient has symptoms consistent with a pituitary abnormality further evaluation with a dedicated MRI examination could be considered for further characterization. The ventricles and basal cisterns are normal in size and configuration. There is no effacement of the basal cisterns. The calvaria and skull base are radiographically normal. The visualized mastoid air cells and paranasal sinuses are clear.

Output: 1. Dysmorphic pituitary fossa without evidence of focal mass lesion. If the patient has symptoms suggestive of pituitary pathology, further evaluation with a dedicated MRI examination could be considered for further characterization. 2. No acute intracranial abnormality. No evidence of acute intracranial hemorrhage or mass.


Instruction: Generate impression based on findings.

Input: Status post resection of schwannoma and meningioma, NF, follow-up. Again seen are postsurgical changes of C3-C6 laminectomies related to resection of a relatively large right sided schwannoma at C4-C5 with intraspinal extension. The intraspinal component has been resected with residual tumor within the neural foramen and lateral aspect of the spinal canal at the C4-C5 level not significantly changed.Again seen is extensive cord signal abnormality involving the left aspect of the cord at the C6-C7 level which demonstrates evolution since the recent two postoperative studies. There is also extensive signal abnormality involving the dorsal columns of the cervical cord which extends from the C4-C5 to the mid C6 level which was present on recent studies but slightly more well-defined on the current study, perhaps related to technique.Small enhancing intramedullary lesions are again seen within the cord at the C1-C2 and mid C2 levels which are not appreciably changed.Enhancing mass is present at the right C1-C2 level with intraspinal extension and effacement of the right lateral thecal sac which is similar to prior.C2-C3: No spinal canal stenosis. Enhancing left nerve root with mild expansion of the neural foramen. There is an adjacent extramedullary lesion involving the left anterolateral aspect of the spinal canal without significant mass effect on the cord as before and appears contiguous with the aforementioned left foraminal lesion.C3-C4: No enhancing lesions. No spinal or neuroforaminal stenosis. C4-C5: Partial tumor resection with residual tumor involving the right lateral aspect of the spinal canal and right neural foramen. There is minimal if any residual mass effect on the cord. C5-C6: Large, predominantly extraforaminal lesion on the right unchanged. Small enhancing extra foraminal lesion on the left is unchanged. No spinal canal stenosis.C6-C7: Small,predominantly extraforaminal enhancing lesions bilaterally are unchanged unchanged. No spinal canal stenosis.C7-T1: Small predominantly extraforaminal enhancing lesions without expansion of the foramina, likely unchanged. No spinal canal stenosis.There is mild retrolisthesis of C3 on C4 and anterolisthesis of C4 on C5 as seen before. Focal kyphosis at the C5-C6 level is also again seen. Vertebral body heights are maintained. Bone marrow signal is benign. Limited images of the brain again demonstrates an enhancing lesion likely representing schwannomas at the right jugular foramen. Small extra-axial lesion along the left anterolateral surfaces of the medulla is also again noted which may represent a meningioma.

Output: 1. Interval evolution of signal abnormality seen on recent studies at the left C6-C7 level compatible with cord injury. Additional signal abnormality involving the dorsal columns of the cervical cord from the C4-C5 to the mid C6 level was also present on recent studies but is slightly more well-defined on the current study.2. Stigmata of neurofibromatosis with multiple additional schwannomas, meningioma, as well as intramedullary lesions which may represent ependymomas, not appreciably changed since 3/30/2016. Please see additional details above.


Instruction: Generate impression based on findings.

Input: 38-year-old female with multifocal left breast cancer and metastatic left axillary lymph node currently on neoadjuvant chemotherapy. A personal history of left retroareolar benign biopsy. Three standard views of both breasts were performed digitally, with additional CC and ML right spot compression views, and reviewed with the aid of R2 CAD, 9.3. The breast parenchyma is composed of scattered fibroglandular elements (BiRADS Density Category B), unchanged in pattern and distribution. Redemonstrated lock shaped clip in the left central posterior breast at the site of biopsy-proven index malignancy. Focal asymmetry previously seen at this site on mammogram of 7/7/2016 is no longer visualized.Redemonstrated hydromark clip also in the left central breast, slightly anterior to the index lesion, with no residual associated mass.A left retroareolar ribbon clip is redemonstrated, at site of previous benign biopsy.There is no mammographic correlate to the new right lower breast is unchanged right mass identified on same day MRI study.No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in either breasts.BILATERAL BREAST ULTRASOUND:Targeted ultrasound of the left lower outer breast, 5:30 3 cm from the nipple redemonstrates a Hydromark clip at site of biopsy-proven malignant satellite lesion. There is no residual mass (previously, 0.7 cm mass).Targeted ultrasound of the left lower outer breast, 5:00 3 cm from the nipple redemonstrates a biopsy clip marker at site of index malignancy. Small residual hypoechoic mass measuring 0.7 x 0.4 x 1.0 cm, previously 1.7 x 1.1 x 1.7 cm. Targeted ultrasound of the left axilla redemonstrates biopsied lymph node measuring 2.1 x 0.7 x 2.1 cm, with decreased cortical thickening (0.5 cm, previously 0.7 cm). Please note, on previous ultrasound study of 11/7/2016, 2 lymph nodes were identified. On today's ultrasound evaluation, only the biopsied lymph node is identified. Please this regard images labeled "1" and "2".Targeted ultrasound of the right breast, 6:00 2 cm from the nipple, reveals a 0.7 x 0.2 x 0.5 cm heterogeneous ill-defined mass with peripheral vascularity. This finding correlates to the new enhancing mass on MRI.

Output: 1. New indeterminate right right lower breast mass. Although imaging characteristics could be due to benign etiology, recommend ultrasound-guided biopsy and clip placement is recommended to exclude malignancy. Alternatively, since the patient is scheduled for bilateral mastectomy later this month, single needle localization could be performed.2. Interim decrease in size of left index malignancy, and resolution of adjacent malignant satellite lesion.3. Slight decrease in size of biopsied abnormal left axillary lymph node. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Male, 72 years old, with lung cancer. A new 5 mm enhancing nodule is evident within the superior right cerebellum producing minimal if any edema in the surrounding tissues. No other definite enhancing lesions are seen. No evidence of significant generalized mass effect effect is observed. Numerous scattered foci of white matter T2 hyperintensity are redemonstrated without significant interval change. No evidence of intracranial hemorrhage or any abnormal extra axial fluid collection is seen. Ventricular size and morphology are within normal limits.

Output: 1.A 5 mm enhancing lesion is seen within the superior right cerebellum concerning for metastasis.2.No additional enhancing lesions are detected.3.Findings are seen compatible with moderately advanced chronic microvascular ischemia.


Instruction: Generate impression based on findings.

Input: 47-year-old male with renal cell cancer, status post left partial nephrectomy. Evaluate disease status. Rule out metastasis. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Subcentimeter left lateral hepatic segment anterior hypodensity in is too small to characterize. This was not definitely seen on the CT scan examination from 11/2010, but the prior examination includes only a single delayed post-contrast phase. The significance is uncertain. Dedicated hepatic CT or MRI examination maybe helpful for further evaluation, if clinical indicated.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Status-post left upper pole partial nephrectomy with postoperative changes. No local recurrence. No hydronephrosis or perinephric collections. The left exophytic midpole cyst is stable.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Subcentimeter hepatic hypodensity can be further characterized with dedicated CT or MRI examination, if clinically indicated.Status post left superior pole partial nephrectomy, with postoperative changes. No local evidence of recurrence or metastasis.


Instruction: Generate impression based on findings.

Input: Reason: 62 yo CM presenting with a 1 year history of 1cm subcutaneous nodule of the R buttock, cyst v lipoma v other A marker was placed along the lower aspect of the right buttock near the midline. Deep to this marker is a subcutaneous collection of near-fluid signal intensity on T2-weighted images, that is slightly hyperintense to skeletal muscle on T1-weighted images. There is rim-enhancement following intravenous contrast administration. This subcutaneous collection, deep to the marker, measures approximately 4 x 3 x 1.5 cm. However, there is a "tail" of abnormal signal intensity and enhancement that extends anterior and superior from this collection, through the subcutaneous fat, to the inferior margin of the anal canal, over a length of approximately 7 cm. Although this "tail" does not appear to communicate with the anus itself, these findings are most suggestive of a perianal fistula, with formation of an associated abscess in the posterior inferior right buttock.A nonenhancing collection of fluid signal intensity along the anterior/superior aspect of the right testicle, measuring approximately 2 cm, may represent a cyst, perhaps arising from the epididymis. There is note made of small bilateral hydroceles. Please note the study was not protocoled for detailed evaluation of the pelvic viscera. However, we see no additional abnormalities within the pelvis. The musculature appears normal.Degenerative disk disease affects the lower lumbar spine. Mild osteoarthritis affects both hip joints. A small focus of signal abnormality in the anterior aspect of the right femoral head/neck junction likely represents a benign synovial herniation pit.

Output: 1.Findings compatible with a right perianal fistula, with formation of a subcutaneous abscess in the anteromedial aspect of the right buttock, beneath the marker denoting the site of patient's palpable abnormality.2.Other findings, as described above.


Instruction: Generate impression based on findings.

Input: Reason: Carpal abutment rule out TFCC tear History: ulnar sided pain LIGAMENTS: No contrast traverses the scapholunate or lunotriquetral ligaments to suggest a tear. No intra-articular gadolinium is identified within the mid carpal joint.TRIANGULAR FIBROCARTILAGE COMPLEX: There is disruption of the ulnar styloid attachment of the triangular fibrocartilage complex. There is a subcentimeter focus of fluid signal intensity which fills with gadolinium which presumably represents ganglion formation. There is heterogeneity of the foveal attachment indicating mild degeneration. No intra-articular gadolinium is identified within the distal radioulnar joint.TENDONS: The flexor and extensor tendons appear intact. BONES: There is a small amount of increased signal abnormality within the dorsal aspect of the lunate which is nonspecific, but could be related to ulnar abutment syndrome. Otherwise no bone marrow signal abnormality is identified.ADDITIONAL

Output: Disruption of the ulnar styloid attachment of the triangular fibrocartilage complex as described above. Tiny subchondral cyst within the lunate is nonspecific, but could be related to ulnar abutment syndrome.


Instruction: Generate impression based on findings.

Input: The risks (including, but not limited to, those of bleeding, infection, allergic reaction, temporary nerve block, pain, and inability to access the joint) and benefits of the procedure were explained to the patient, and informed written consent was obtained. A pre-procedural “time-out” form was completed.he patient was placed supine on the fluoroscopy table. The left hip was localized fluoroscopically, and a spot radiograph was obtained. The course of the femoral artery was noted on the patient's skin using an ink marker. The skin was cleansed and covered with a sterile drape. The skin and subcutaneous tissues were anesthetized with 1% lidocaine using 25-gauge and 22-gauge needles.Under fluoroscopic guidance, a 20-gauge spinal needle was advanced into the joint. Attempted aspiration yielded no fluid. Next, 11 ml of a 50/50 mixture of Omnipaque 240 (to confirm the intra-articular position of the needle) and dilute Multihance (0.1 cc in a 10 cc vial of saline, for subsequent MR imaging) were injected into the joint. Contrast opacified the joint in the expected manner. A spot radiograph was obtained for documentation. The needle was withdrawn. Blood loss was negligible (<1cc), and patient tolerated the procedure well without immediate complication. An adhesive bandage was placed on the patient’s skin. Routine post procedure instructions were communicated to the patient. The patient was escorted to the MRI suite for further imaging in stable condition. Please refer to the subsequent MRI report for further information.Exposure time: 23 seconds

Output: Successful gadolinium injection of the left hip.


Instruction: Generate impression based on findings.

Input: Reason: polycytic astrocytoma , brain tumor, resection, yearly follow up for growth or changes History: yearly follow up brain tumor Redemonstrated is a left parietal lobe resection cavity, which has not substantially changed. Minimal T2/FLAIR hyperintensity surrounding the resection cavity similar to the prior exam. No suspicious enhancement is seen within or around the resection cavity.No acute intracranial hemorrhage is identified. No abnormal diffusion restriction. No new mass or midline shift. No extra-axial fluid collections. Stable ex vacuo dilatation of the atrium and occipital horn of the left lateral ventricle. Gray-white matter differentiation is preserved. Scattered ethmoid air cell and maxillary mild mucosal thickening is noted. The imaged orbits are intact. Postsurgical changes of left parietal craniotomy.

Output: Stable postsurgical change without evidence of residual or recurrent tumor.


Instruction: Generate impression based on findings.

Input: 76-year-old female with a history of breast cancer, presenting with dizziness, lightheadedness and near-syncope for one week. No evidence of acute intracranial hemorrhage or infarction. No evidence of edema or mass. Scattered hypoattenuating regions in the cerebral white matter roughly correlate with hyperintensities seen on prior MRI form 2003.The ventricles and basal cisterns are unremarkable in size and configuration.The calvaria and skull base are radiographically unremarkable. Scattered lucent lesions in the calvarium are nonspecific, but do not appear aggressive. Visualized paranasal sinuses and mastoid air cells are normally pneumatized. Bilateral internal carotic artery calcifications are noted.

Output: No acute intracranial abnormality.


Instruction: Generate impression based on findings.

Input: This exam is mildly degraded by motion artifact. There are multiple scattered small foci of T2 hyperintensity within the periventricular white matter and centrum semiovale as well as linear lesions within the corpus callosum, perpendicular to the long axis of the lateral ventricles. There is also a single juxtacortical lesion towards the convexity. Some of these lesions demonstrate T1 hypointensity. No infratentorial lesions are identified. There is mild global volume loss. There is no evidence of acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is paranasal sinus mucosal thickening.

Output: Multiple white matter lesions involving the periventricular and juxtacortical white matter, centrum semiovale, and corpus callosum. No infratentorial lesions are identified. There is also mild global volume loss. While these findings are nonspecific, they do meet the dissemination in space component of the MRI McDonald criteria for MS.


Instruction: Generate impression based on findings.

Input: 50 years Male (DOB:7/9/1966)Reason: disc herniation History: LLE painPROVIDER/ATTENDING NAME: JAMES MOON MOK JAMES MOON MOK Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal. There is loss of disc space height and disc desiccation at this level. There is a broad-based right lateral recess disc extrusion at this level with disc material extending behind the adjacent endplates which encroaches on the nerve roots at the right lateral recess at this level. Disc material mildly displaces the nerve root the left lateral recess at this level. There is subtle effacement of the fat planes superficial to the right lamina of S1 and along the subcutaneous tissues behind the right perivertebral musculature which extends to the right lamina of L5.. There is associated T2 signal hyperintensity within the right posterior medial perivertebral musculature at this level. At L4-5 there is no significant compromise to spinal canal or neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.There is a right lateral recess disc extrusion present which encroaches on the nerve roots at the right lateral recess at L5-S1 (probably S1 nerve roots). The possibility of associated scar formation cannot be excluded. A contrast enhanced exam may help further assess this if clinically appropriate.2.Findings suggest status post right L5 laminotomy procedure.


Instruction: Generate impression based on findings.

Input: Grade 2 left medial temporal lobe astrocytoma status post radiation. Seizures. Compared to 8/30/2014, there is slight increase in masslike T2/FLAIR hyperintensity and cortical thickening involving the anterior and medial left temporal lobe, the left insular cortex and the posterior left thalamus. Much of this increase appears to involve the subcortical white matter of the left temporal lobe and left parietal periatrial white matter, favored to be related to posttreatment change. There is mild restricted diffusion involving the posterior aspect of the left parahippocampal gyrus which may be related to hypercellularity. There are subcentimeter foci of enhancement involving the left subinsular white matter and left medial temporal lobe which appear new. No hydrocephalus or extra-axial fluid collections. No midline shift or herniation. There is evidence of left transfrontal biopsy. Multiple foci of susceptibility are again noted compatible with chronic microhemorrhage consistent with hemosiderin deposition. Chronic blood products are also noted along the tract of the left transfrontal biopsy which extends to the left medial temporal lobe. Lipomatous lesion is again seen involving the posterior aspect of the left parotid gland. The skull and extracranial soft tissues are otherwise unremarkable.

Output: Compared to 8/30/2014, there is slight increase in T2/FLAIR hyperintensity involving the anterior and medial left temporal lobe, left insular cortex and left thalamus. Much of the mild increase appears to involve the subcortical white matter. There are also new foci of enhancement involving the left subinsular white matter and left medial temporal lobe. Given history of recent radiation, these findings are favored to reflect post treatment changes and can be further assessed on follow-up studies.


Instruction: Generate impression based on findings.

Input: Developmental disorder of speech and language, unspecified [F80.9], Reason for Study: ^Reason: evaluate for atrophy, concern for primary progressive aphasia History: effortful speech, paraphasic errors, paucity of speech There is no evidence of acute ischemic or hemorrhagic lesion.There are localized encephalomalacia at both middle and inferior temporal gyri of the left temporal lobe.Multifocal scattered FLAIR/T2 high signal intensities on bilateral periventricular white matter and the centrum semiovale indicating nonspecific small vessel ischemic disease.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, 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 mastoid air cells are clear.Retention cysts are seen on the right maxillary sinus.There is well circumscribed scalp mass lesion [22.9mm(CC)x20.8mm(RL)x8.3mm(AP)] indicating lipoma.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. Encephalomalacia on the left middle and inferior temporal gyri.3. Minimal non specific small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: History of nausea, right lower quadrant abdominal pain. Patient is pregnant. History of appendicitis. ABDOMEN:LIVER, BILIARY TRACT: Normal liver morphology. Trace perihepatic fluid. Minimal fluid in Morison's pouch.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Mild right-sided hydronephrosis is within physiologic limits of pregnancy.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The patient is status post appendectomy. Minimal fluid in the right lower quadrant is nonspecific.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small bilateral pleural effusions.PELVIS:UTERUS, ADNEXA: Please note that the study was not ordered or performed for fetal assessment. The placenta is located along the left anterolateral superior uterine cavity without evidence of placenta previa.There is an approximately 2.1 cm right ovarian cyst. The ovary is mildly enlarged. The vasculature cannot be evaluated.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Please note that this study was not ordered or performed for a dedicated fetal assessment.2.The appendix is not visualized as the patient is status post appendectomy.3.Small amount of fluid in the right lower quadrant with mildly enlarged ovary containing a 2.1 cm cyst. The vasculature cannot be assessed on this study. Further evaluation with pelvic ultrasound is recommended to exclude torsion.4.Physiologic right-sided hydronephrosis. Minimal free fluid in the abdomen otherwise. Small pleural effusions.Findings discussed with referring physician by Dr. Massey at 9:30pm on 8/22/2014.


Instruction: Generate impression based on findings.

Input: T4N2, WHO type III, nonkeratinizing EBV+ nasopharyngeal cancer, status post treatment. Orbits: The globes, ocular adnexa, optic nerves, and orbital fat are unremarkable, without evidence of intraorbital mass lesions. There are post-treatment findings in the nasopharyngeal region, where there is persistent enhancement of the central skull base, but no measurable residual tumor in the soft tissues. Neck: There is no evidence of significant cervical lymphadenopathy. The thyroid and major salivary glands are unremarkable. There is a right internal jugular venous catheter. The major cervical flow voids are grossly intact. There are secretions and mucosal thickening in the bilateral maxillary and ethmoid sinuses. There is bilateral tympanomastoid opacification. There is fluid within the bilateral mastoid air cells.

Output: 1. Post-treatment findings in the nasopharyngeal region without evidence of measurable tumor in this area. 2. Persistent enhancement of the central skull base is likely related to treatment-effects at the site of previous tumor infiltration.3. No evidence of significant cervical lymphadenopathy.4. Persistent bilateral otomastoid effusions, which may be attributable to Eustachian tube dysfunction and/or mastoiditis.5. Persistent evidence of acute sinusitis.6. The orbital contents are intact.


Instruction: Generate impression based on findings.

Input: Malaise and fatigue. New stroke. Left-sided weakness MRI of the brainDiffusion restriction is present along the right precentral gyrus extending into the right middle frontal gyrus with a punctate foci of diffusion restriction along the subcortical white matter of the right superior frontal gyrus extending to the right cingulate gyrus. Additional punctate foci of diffusion restriction are present in the right inferior parietal lobule. These foci of diffusion restriction are associated with flair and T2 signal hyperintensities.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin.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.The right middle cerebral artery superior division is the dominant division.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. The posterior communicating arteries are intact. The left posterior communicating artery is tiny whereas the right is small The vertebral arteries are similar in size.There is extracranial origin of the right posterior inferior cerebellar artery.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.

Output: 1.Findings are compatible with subacute foci of infarction involving portions of the superior division of the right middle cerebral artery and to a lesser degree right anterior cerebral artery as detailed above. There is no evidence for hemorrhagic conversion appreciated2.No evidence for intracranial or extracranial cerebrovascular occlusive disease.3.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: 11-year-old male, history of congenital hypothyroidismEXAMINATION: Sonogram thyroid 5/19/2016 LEFT LOBE MEASUREMENTS: 1.2 x 2.5 x 0.9 cmISTHMUS MEASUREMENTS: 1.0 x 0.2 cmRIGHT LOBE: The right thyroid is absent.LEFT LOBE: Normal, homogeneous echotexture and echogenicity. No nodules or masses.ISTHMUS: Normal, homogeneous echotexture and echogenicity. No nodules or masses.PARATHYROID GLANDS: None identified.LYMPH NODES: Multiple benign appearing non-enlarged cervical lymph nodes.OTHER: No significant abnormality noted.

Output: Congenital absence of the right thyroid lobe.


Instruction: Generate impression based on findings.

Input: Localized swelling, mass and lump, head [R22.0], Reason for Study: ^Reason: LEFT HEMIPARESIS ETIOLOGY History: LEFT HEMIPARESIS Brain MRINo evidence of acute ischemic or hemorrhagic lesion on the scan.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. The mastoid air cells are clear. Mucosal thickening and retention cyst is on bilateral maxillary sinuses. There is a prosthetic eyeball on the left side.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal.Neck MRA3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The vertebral artery origins are normal. There is normal flow enhancement through the bilateral common carotid, carotid bifurcations, internal/external carotid, and vertebral arteries.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. Normal brain MRI and normal neck MRA


Instruction: Generate impression based on findings.

Input: Male; 50 years old. Reason: prostate cancer History: prostate cancer PELVIS:PROSTATE:Prostate Size: 2.9 x 5.5 x 4.6 cm.Peripheral Zone: Scattered, mild areas of T1 hyperintensity in the peripheral zone bilaterally, likely related to hemorrhage from recent biopsies.In the left posterolateral mid to apical peripheral zone, there is a focus of low T2 signal and low signal on ADC map measuring up to 5 x 4 mm (series 701/17), compatible with prostate cancer.Central Gland: Heterogeneous.Seminal Vesicles: None.Extracapsular Extension: None.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Small focus of prostate cancer in the left peripheral zone as detailed above.


Instruction: Generate impression based on findings.

Input: Right upper extremity radiculopathy. There is reversal of the usual cervical spondylosis, but not spondylolisthesis. There is prominent disc-osteophyte complexes at C4-5, which substantially indents the right parasagittal spinal cord at this level. However, there is no associated neural foraminal stenosis. There is also a posterior disc-osteophyte complex C5-6, which mildly indents the spinal cord. However, there is no associated neural foraminal stenosis. There is no significant spinal canal or neural foraminal stenosis at the cervical spine levels other than C4-5 and C5-6. The spinal cord displays normal signal. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The paravertebral soft tissues are unremarkable.

Output: Prominent disc-osteophyte complexes at C4-5 and C5-6, which indent the spinal cord, eccentrically to the right, particularly at C4-5, but no evidence of spinal cord edema or myelomalacia.


Instruction: Generate impression based on findings.

Input: 27-year-old male with previous small bowel surgeries including multiple stricturoplasties currently with diarrhea. Evaluate for Crohn's disease. ABDOMEN:LIVER, BILIARY TRACT: No suspicious focal hepatic lesions. No intra or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No pancreatic ductal dilatation or evidence of a pancreatic lesion.ADRENAL GLANDS: Adrenal glands are normal in size and morphology bilaterally.KIDNEYS, URETERS: Kidneys enhance symmetrically without evidence of hydronephrosis.RETROPERITONEUM, LYMPH NODES: Scattered mesenteric subcentimeter lymph nodes are nonspecific.BOWEL, MESENTERY: No evidence of bowel wall thickening, diffusion restriction, or enhancement to suggest active Crohn's disease. No evidence of strictures or ulcerations.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: As above.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No MRI evidence of active Crohn's disease.2.No evidence of strictures.


Instruction: Generate impression based on findings.

Input: Benign neoplasm of cerebral meninges [225.2], Reason for Study: ^Reason: Probable meningioma. History: meningioma. There is focal restricted diffusion on the right cerebellar hemisphere indicating focal acute ischemic infarction. There is no evidence of hemorrhagic transformation. There is no other acute ischemic infarction.Re-demonstration of left anterior temporal well enhancing extra axial mass measured (33mm x 44mm x 36mm). The size and MR characteristics appear to be stable since prior scan.The left parotid gland tubular non-enhancing structure is again seen and does not show any significant interval change in terms of its size, configuration and MR characteristics since prior exam.Minimal non specific small vessel ischemic disease, no change since prior exam.The ventricles, sulci and cisterns are symmetric and unremarkable. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Acute ischemic stroke on the right cerebellar hemisphere without evidence of hemorrhagic transformation. This finding was informed to Dr. Lukas.2. No change of left temporal pole extra axial mass, left parotid gland lesion and non specific small vessel ischemic disease since prior exam.


Instruction: Generate impression based on findings.

Input: The last well-formed disk space is referred to as L5-S1, similar to last exam. There is stable mild grade 1 retrolisthesis of L2 on L3, minimal retrolisthesis of L3 on L4, and minimal anterolisthesis of L4 on L5. There is disk desiccation at all levels in the lumbar spine with up to moderate loss of disk height and L1-2, similar to prior exam. There is focal superior endplate chronic Schmorl's nodes at L2, L4 and L5 stable from prior exams. There is mild loss of vertebral body heights at L2 and L5 which is also unchanged and without evidence of bone marrow edema. The osseous marrow signal is heterogeneous but benign, with areas of fatty deposition. The conus terminates at L1-2.L1-2: Stable diffuse disk bulge with central protrusion, bilateral facet arthropathy, and new left foraminal annular fissure. No significant spinal canal or neural foraminal stenosis.L2-3: Stable moderate diffuse disk bulge, bilateral facet arthropathy and ligamentum flavum thickening causing mild encroachment upon the bilateral L3 nerve roots in the subarticular zones. No significant central canal or neural foraminal stenosis.L3-4: Diffuse disk bulge, facet arthropathy, and ligamentum flavum thickening causing mild to moderate spinal canal stenosis and moderate right and mild left neural foraminal stenosis similar to prior exam.L4-5: Diffuse disk bulge with right foraminal/far lateral protrusion, facet arthropathy and ligament flava thickening with mild right neural foraminal and mild spinal canal stenosis and no signfiicant left neural foraminal stenosis.L5-S1: Diffuse disk bulge, bilateral facet arthropathy, and ligamenta flava thickening causing mild bilateral neural foraminal stenosis and no significant spinal canal stenosis.

Output: 1. No significant interval change in multilevel lumbar spondylosis as described above. No high grade spinal canal stenosis at any level. There is up to moderate right L3-4 neural foraminal stenosis.2. No findings to suggest metastatic disease.


Instruction: Generate impression based on findings.

Input: 74-year-old female with recently diagnosed right breast cancer submitted outside breast MRI for review. Outside ultrasound dated 12/8/2015 demonstrated a 5 mm mass in the right breast 3:00 position, which was proven to be IDC and DCIS. On postcontrast images, moderate parenchymal enhancement is seen bilaterally which may reduce the sensitivity of this examination in evaluation of subtle mass or nonmass enhancement.In the right breast, approximately 3:00 position, 6.1 cm from the nipple base, there is susceptibility artifact from the biopsy marking clip. There is peripheral enhancement surrounding this biopsy clip measuring 1.1 x 1 x 1.5 cm ( LR x AP X SI ), compatible with the known history of biopsy-proven invasive ductal carcinoma and ductal carcinoma in situ.In the right breast, anterolateral to the index mass, 3:00 position, 5.2 cm from the nipple base, there is a 5 mm enhancing mass, which is probably benign finding with morphology similar to the additional 2 foci of enhancement in the anterior right breast and central left breast.There is no suspicious enhancement in the left breast.No abnormal axillary lymph nodes are identified in either axillary region.

Output: 1. Unifocal 1.5 cm cancer in the right breast 3:00 position.2. A probably benign 5 mm enhancing focus anterolateral to the index lesion (referred to as retroareolar mass at outside hospital) in the right breast 3:00 position with morphology similar to the additional enhancing foci in the anterior right breast and central left breast. Six-month follow-up of this 5 mm enhancing mass is recommended.BIRADS: 6 - Known cancer.RECOMMENDATION: 3B - Followup at Short Interval (1-11 Months).


Instruction: Generate impression based on findings.

Input: Clinical question: Intracranial hemorrhage? Signs and symptoms: Headaches. Non-enhanced MRI of brain:Extensive postoperative changes of large bifrontal craniotomy. Significant widening of the epidural space containing serosanguineous fluid and air. This is a postoperative findings. Epidural collection causes mass effect and posterior displacement of frontal lobes. Residual air within the subarachnoid space from patient's surgery. No evidence of parenchymal hemorrhage. Interval reduction in the low density cyst in the basal cistern. On the current exam the cyst measures approximately 19 mm in AP and 27-mm in transverse diameter. This is a smaller than prior examination which measured 25 mm x 36-mm. no evidence of hemorrhage within the cyst.

Output: 1.Reduction in the size of cyst within the basal cistern consistent with patient's past history of craniopharyngioma.2.Extensive postoperative changes all bifrontal craniotomy as detailed above.3.No evidence of acute hemorrhage within the brain parenchymal or cyst within the basal cistern.