Instruction: Generate impression based on findings.

Input: Brain: There is no intracranial mass or abnormal parenchymal or meningeal enhancement. Brain parenchyma appears within normal limits. Ventricles and sulci are normal. No extra-axial collections. No findings to suggest ischemia or hemorrhage. Incidentally noted is cerebellar tonsillar ectopia with the right cerebellar tonsil measuring up to 7 mm below the foramen magnum.Unchanged small left maxillary mucus retention cyst. Paranasal sinuses and mastoid air cells are otherwise clear. Major flow-voids are preserved.Soft tissues Head/Neck: As seen on recent CT, there are postoperative findings related to right hemimandibulectomy and superficial parotidectomy. There is diffuse atrophy of the right masticator muscles. Enhancement along the right temporalis muscle extending to the overlying scalp is consistent with posttreatment change. There is small area of enhancement measuring approximately 11 x 8 mm involving the deep aspect of the resection bed anterior lateral to the level of the hypoglossal canal which may be related to post treatment change versus minimal residual tumor (series 4 image 15, series 11 image 17). Otherwise no discrete mass to definitively suggest recurrent tumor is appreciated. There are small adjacent lymph nodes as well as elsewhere in the neck which are nonspecific. No pathologically enlarged or necrotic lymph nodes are seen. No discrete masses or evidence of pathologic enhancement elsewhere in the neck. The airway remains patent. Visualized spinal canal appears within normal limits without abnormal masses within the spinal canal or neural foramina appreciated. Paraspinous soft tissues are unremarkable.

Output: 1. MRI of the brain demonstrates no intracranial mass or abnormal enhancement to suggest neoplasm. Incidentally seen is ectopia of the cerebellar tonsils with the right cerebellar tonsil measuring up to 7 mm below the foramen magnum. Brain parenchyma is otherwise unremarkable.2. Posttreatment changes in the right masticator space/mandibular region related to prior tumor resection as seen on recent CT studies. There is small focus of nodular enhancement deep to the resection cavity which may represent postsurgical change versus minimal residual tumor. No prior postoperative MRI is available for direct comparison and attention on follow-up is suggested.3. No significant cervical lymphadenopathy or other neck masses.


Instruction: Generate impression based on findings.

Input: Status post C3-C7 laminoplasty on October 2, 2015. Persistent MRSA bacteremia. New onset right deltoid weakness. Patient was imaged in a neck collar and unable to lie straight in the scanner. There are changes related to previous C3-C7 laminoplasty with bone graft struts at C4 and C6. The osseous findings are better assessed on the most recent CT scan from December 6, 2015. There is fluid within the paraspinal soft tissues along the posterior midline incision with associated extensive surrounding inflammatory change. Axially, the fluid is the largest C4-C5 level where it measures 2.2 cm x 1.8 cm. Craniocaudally, it measures 4.8 cm. Numerous foci of susceptibility artifact within the fluid may relate to the presence of microscopic metallic fragments or less likely gas. Given the timing of the laminoplasty, the inflammatory change is more extensive than expected. This above inflammatory change is associated with abnormal increased T2 signal along the C3-C4 and C4-C5 facets bilaterally. This is new compared to the preoperative MRI. This correlates with erosion involving the left C3-C4 facet which had progressed between the CT scans from October 3, 2015 and December 6, 2015. While this facet abnormality might be partly reactive from the adjacent soft tissue inflammation in the setting of pre-existing degenerative facet disease, the possibility of osteomyelitis should also be considered.There is abnormally increased T2 signal within the C3-C4 disc which is new since the previous preoperative MRI. Associated irregularity focally involving the endplates along the right posterior-lateral aspect of the disc was present on the previous MRI and probably reflect degenerative change. This increased disc T2 signal extends into the epidural space and reflect fluid within the pre-existing central and right posterior-lateral extruded disc. However, compared to the preoperative MRI, this epidural soft tissue thickening has minimally increased if at all from prior. This results in no significant mass effect on the spinal cord given the recent laminoplasty. There is no significant epidural collection at any other level. There is no definite cord signal abnormality. There is edema and fluid in the prevertebral space extending from C5-C6 level cranially to the level of the skull base with abnormal signal involving the left longus coli muscle. This is increased compared to the most recent CT scan from December 2015. The thickness of the prevertebral soft tissues at C3 is 16 mm now, compared to 7 mm on the CT scan from December 2015.The multilevel spinal canal narrowing on the preoperative MRI has improved at C3-C4 and resolved at the other levels, especially C6-C7. Foraminal stenoses are not significantly change since the preoperative MRI.Imaging through the upper thorax, there is dependent signal abnormality which may reflect small pleural effusions and atelectasis. As minimal fluid in the mastoid air cells.C2-C3: There is no spinal canal or foraminal stenosis.C3-C4: Improved, now mild, canal stenosis following laminoplasty. There is a right paracentral disc extrusion which is unchanged to very minimally increased compared to the previous MRI examination. There is unchanged mild left neuroforaminal stenosis.C4-C5: There is no spinal canal stenosis. There is mild bilateral foraminal stenoses.C5-C6: There is a disc-osteophyte complex but no spinal canal stenosis. There is moderate left and mild right foraminal stenosis.C6-C7: Disc-osteophyte complex asymmetric to the right. These changes, however, result in no significant spinal canal stenosis given the recent decompression through laminoplasty. There is moderate left and mild right foraminal stenosis, which are unchanged.C7-T1: There is no spinal canal or foraminal stenosis.

Output: 1.The study was performed without intravenous contrast and is of suboptimal quality.2.The spinal canal has been decompressed following laminoplasty. There is no spinal cord signal abnormality. There is no definite epidural abscess but the study was performed without intravenous contrast.3.Fluid in the paraspinal soft tissues along the posterior midline incision along with extensive surrounding soft tissue inflammatory change is more than expected at this point postoperatively.4.Progressive prevertebral edema, especially on the left, and retropharyngeal effusion are also present. These findings could be infectious in nature.5.Increased T2 signal in the C3-C4 disc with minimal if any increase in the associated ventral epidural thickening, which is at least partly related to disc extrusion and is nonspecific in this postoperative setting. It may relate to degenerative disease or early/treated discitis.6.Abnormal T2 signal at the C3-C4 and C4-C5 facets with associated progressive erosions at the left C3-C4 facet may be related to a combination of degenerative disease and reactive change caused by the adjacent soft tissue inflammation. However, osteomyelitis should also be considered.7.Findings in the included upper chest (pleural effusions and atelectasis) are better assessed on the recent CT scan from December 11, 2015. 8.Also, please refer to the previous CT scan from December 6, 2015 for an assessment of fine osseous detail.


Instruction: Generate impression based on findings.

Input: 50 years Female (DOB:1/14/1966)Reason: lt sided weakness with neck pain r/o epidural hematoma History: lt sided weakness with neck pain r/o epidural hematomaPROVIDER/ATTENDING NAME: FERNANDO D. GOLDENBERG FERNANDO D. GOLDENBERG The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal enhancing lesions are identified in the cervical spine. There is reversal of the normal cervical curvature which is a nonspecific finding which could be related to muscle spasm or patient positioning.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 a broad-based left paramedian disc protrusion which mildly encroaches on the left hemicord and left-sided exiting nerve roots.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 are identified. The left vertebral artery is very small.

Output: 1.There is a left paramedian disc protrusion present at C5-6 which mildly encroaches on the left-sided exiting nerve roots and left hemicord.2.The left vertebral artery is very small. As has been noted on the recent CTA the possibility of a high-grade stenosis at its origin cannot be excluded.


Instruction: Generate impression based on findings.

Input: Reason: prostate cancer s/p prostatectomy with PSA 0.27 now History: none PELVIS:PROSTATE:Prostate Size: Status post prostatectomy.Peripheral Zone: Status post prostatectomyCentral Gland: Status post prostatectomy. There is a small amount of residual tissue within the surgical bed along the posterior aspect of the bladder measuring 1.1 x 0.4 cm which demonstrates diffusion restriction and enhances, suspicious for tumor recurrence. Enhancing tissue identified on prior CT likely represents fibrosis.Seminal Vesicles: No significant abnormality.Extracapsular Extension: Not applicable.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small bilateral fat-containing inguinal hernias.

Output: 1.Enhancing tissue in surgical bed is suspicious for tumor recurrence.2. No pelvic lymphadenopathy.


Instruction: Generate impression based on findings.

Input: 20-year-old male with talonavicular erosive arthritis TENDONS: No significant abnormality noted.LIGAMENTS: The lateral collateral ligament complex is intact. ARTICULAR SURFACES AND BONE: Again seen is talonavicular arthritis and erosions along the talar head and neck as well as the superior aspect of the navicular. There is increased abnormal T2 signal compatible with bone marrow edema throughout the navicular relative to the prior exam. A small amount of fluid is noted within the superior and lateral aspect of the talonavicular joint.Arthritic changes are also seen along the medial facet of the subtalar joint with subchondral sclerosis, cysts, and reactive bone marrow edema. Interval decrease in bone marrow edema within the medial talus.ADDITIONAL

Output: Interval worsening of the talonavicular joint arthritis as described above. No significant change in subtalar joint arthritis. Findings compatible with erosive arthritis and synovitis or consider reactive arthritis.


Instruction: Generate impression based on findings.

Input: The last well-formed disk space is referred to as L5-S1. There is straightening of the lumbar spine. There are type II degenerative endplate changes at L3-4 and L4-5 with severe loss of disk height and dessication. The conus terminates at L1-2.T12-L1: No disk herniation or spinal stenosis.L1-2: Minimal disk bulge without spinal stenosis.L2-3: Minimal disk bulge without spinal stenosis.L3-4: Disk bulge, mild facet arthropathy with no spinal canal stenosis; disk material abuts the bilateral L4 nerve roots in subarticular zones without subarticular stenosis. Moderate right greater than left neural foraminal stenosis.L4-5: Disk bulge, mild facet arthropathy with no spinal canal stenosis; disk material abuts the bilateral L5 nerve roots in subarticular zones without subarticular stenosis. Moderate bilateral neural foraminal stenosis.L5-S1: Disk bulge with tiny central protrusion with no spinal stenosis.

Output: Multilevel lumbar spondylosis, worst at L3-4 and L4-5 where there are moderate neural foraminal stenoses. No spinal canal stenosis at any level.


Instruction: Generate impression based on findings.

Input: History of lung carcinoma with left facial droop and seizure. Evaluate for stroke versus metastases. There is redemonstration of a 5 x 5 mm left lateral temporal extra-axial enhancing lesion causing minimal focal mass effect on the adjacent left inferior temporal gyrus cortex. There is associated T2/flair hyperintensity. There is no acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The imaged paranasal sinuses are clear. The skull and extracranial soft tissues are unremarkable.

Output: No significant interval change in a 5 mm left lateral temporal extra-axial enhancing lesion presumably represents a tiny meningioma. Minimal adjacent mass effect on the adjacent cortex. Otherwise, no abnormal parenchymal or meningeal enhancement is seen to suggest metastatic disease. No evidence of acute infarct. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Elevated PSA. No pathology results available. PELVIS:PROSTATE:Prostate Size: 3.2 x 5.2 x 4.8 cmPeripheral Zone: Diffuse linear decreased T2-weighted signal intensity of the peripheral zone without a discrete nodule.Central Gland: Changes of benign prostatic hyperplasia.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: No evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Diffuse linear mildly decreased T2-weighted signal intensity of the peripheral zone favoring prior inflammation/scarring.2. No discrete focus suspicious for prostatic adenocarcinoma.


Instruction: Generate impression based on findings.

Input: 40 year-old female with headache. There is no evidence of intracranial hemorrhage, mass or edema. Minimal nonspecific white matter hypoattenuation is noted and reported on previous MRI of the patient.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The right ethmoid air cells are partially opacified. Otherwise, the visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: No acute intracranial abnormality.


Instruction: Generate impression based on findings.

Input: Chiari malformation, decompression, scar tissue to bovine patch, new symptoms, with numbness and tingling right hand, neck pain, and headache. Brain: There are postoperative findings related to Chiari decompression. There is mild tenting of the posteroinferior cerebellum with fine linear hyperintensities that extend to the overlying dura. The CSF flow across the posterior neo-foramen magnum appears to be perhaps slightly blunted. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears unremarkable. The ventricles are unchanged in size and configuration. There is no midline shift. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unchanged.Cervical Spine: The vertebral column alignment is unchanged. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unchanged.

Output: 1. Postoperative findings related to Chiari decompression with mild tenting of the posteroinferior cerebellum with fine linear hyperintensities that extend to the overlying dura, which may represent adhesions. 2. No evidence of syringohydromyelia in the cervical spine.


Instruction: Generate impression based on findings.

Input: Female, 44 years old. Reason: evaluating goiter noted on exam RIGHT LOBE MEASUREMENTS: 5.6 x 1.8 x 1.8 cmLEFT LOBE MEASUREMENTS: 5.1 x 1.6 x 1.7 cmISTHMUS MEASUREMENTS: 0.2 cmRIGHT LOBE: Minimally heterogeneous echotexture, without focal lesion.LEFT LOBE: Minimally heterogeneous echotexture. A nodule in the mid left lobe measures 0.3 x 0.3 x 0 .4 cm, spongiform, with minimal internal vascularity. An additional nodule in the mid left lobe measures 0.5 x 0.5 x 0.6 cm, homogeneous and hypoechoic, noncalcified, with minimal internal vascularity.ISTHMUS: Minimally heterogeneous echotexture, without focal lesion.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Benign-appearing cervical lymph nodes are identified. A left level 2 lymph node measures 0.9 x 0.7 x 1.0 cm.OTHER: No significant abnormality noted.

Output: Non-enlarged thyroid with two subcentimeter nodules in the left lobe. No regional adenopathy.


Instruction: Generate impression based on findings.

Input: 29 year-old male with left-sided weakness, evaluate for CVA.. There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Normal brain CT.


Instruction: Generate impression based on findings.

Input: New metastatic breast cancer in the brain: altered mental status. There is an irregular, heterogeneously enhancing mass along the left superior frontal convexity, which measures up to approximately 6 cm in length and 2 cm in thickness. There is associated diffuse thickening and hyperenhancement of the adjacent dura. There is extensive vasogenic edema in the underlying let frontal lobe. There is no evidence of acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no mild midline shift, but no herniation. The major cerebral flow voids are intact. There are multiple irregular lytic and sclerotic foci in the calvarium and right mandibular condyle, and perhaps in the partially imaged upper cervical spine. There is mild maxillary sinus mucosal thickening. The orbits are grossly unremarkable.

Output: 1. An irregular, heterogeneously enhancing mass along the left superior frontal convexity, which measures up to approximately 6 cm in length and 2 cm in thickness likely represents a dural-based metastasis. 2. Multiple bone metastases.


Instruction: Generate impression based on findings.

Input: 52 M with Hx of left renal mass, split renal function The posterior abdominal radionuclide angiogram demonstrates normal right renal function and no functional renal activity in the left. There is minimal uptake in the left retroperitoneal region corresponding to tumor as seen on MRI.

Output: Normal right renal function and absent left renal function.


Instruction: Generate impression based on findings.

Input: 66 years Male (DOB:3/9/1950)Reason: GBM. Pt om TMZ+TTF. History: GBM.PROVIDER/ATTENDING NAME: RIMAS V. LUKAS RIMAS V. LUKAS There is 78 by 42 mm mm sagittal dimension heterogenously enhancing mass centered in the deep white matter of the right frontal lobe and the adjacent subcortical white matter of the right parietal lobe . This previously measured similar sagittal dimensions. Cerebral blood volume map indicates that the enhancing component of the lesion within the right centrum semiovale is relatively high whereas other more peripheral components tends to be relatively lower.There is however a little more contrast enhancement within the right basal ganglia. Cerebral blood volume within this component appears to be very low. Contrast enhancement within the basal ganglia component of the lesion currently measures 18 x 17 mm and previously measured 13 x 16 mm. There is adjacentT2/FLAIR signal hyperintensity compatible with vasogenic edema in an area measuring 142 x 60 mm axial dimensions. This previously measured similar axial dimensions. There are satellite foci of enhancement in the adjacent brain. There is susceptibility effect within the mass. There is T2 signal hyperintensity present in the right midbrain and pons on the current exam which was also present on the prior exam. There are multiple microhemorrhages scattered throughout the lesion which were also present on the previous exam.There is associated mass effect with approximately 9 mm shift of the midline towards the left on the current exam which was approximately 9 mm on the prior exam. There is associated uncal herniation which was also previously present. There is also associated dilation of the left lateral ventricle associated with subfalcine herniation and there is a mild degree of transtentorial herniation also present.The patient is status post recent right sided craniotomy. There is an underlying extra-axial collection measuring up to 5mm thickness.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 distal right vertebral artery appears to be hypoplasticThe visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Since the prior exam the patient's right hemispheric mass consistent with glioblastoma has developed enlargement of the an enhancing component within the right basal ganglia. This component has low cerebral blood volume and is thus suspected to potentially represent radiation necrosis based on perfusion imaging. There is a component with high cerebral blood volume within the central portion of the lesion which based on the perfusion imaging would be more likely related to active neoplasm which has not enlarged since prior exam. 2.There is associated uncal, transtentorial and subfalcine herniation present.


Instruction: Generate impression based on findings.

Input: Numbness in the legs, assess for demyelinating disease or other inflammatory disease such as Sjogren's. Brain:Brain parenchyma is within normal limits for age. No findings to suggest demyelinating disease. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. Major flow-voids are preservedSella and orbits are grossly within normal limits. Evidence of left intraocular lens replacement. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits. Lacrimal glands and partially visualized parotid glands appear unremarkable.Cervical:The spinal cord is of normal caliber and signal. Mild to moderate degenerative changes are seen including disk desiccation at C5-C6 and C6-C7 with disk osteophyte complexes and mild ligamentum flavum thickening resulting in mild spinal canal stenosis at C5-C6 and C6-C7. There is minimal, right greater than left, neural foramina narrowing at these levels related to uncovertebral hypertrophy. Neural foramina are otherwise patent. There is mild loss of cervical lordosis. Alignment of the cervical spine is otherwise maintained. Vertebral body heights are normal. Small scattered foci of marrow T1 hyperintensity compatible with focal fat or small hemangiomas. No worrisome focal marrow signal abnormality is appreciated. Thoracic:The spinal cord is of normal caliber and signal. The thoracic spine is in normal alignment with a normal thoracic kyphosis. Minimal degenerative changes are seen including mild T11-T12 disc bulge without significant spinal canal or neural foraminal stenosis. The vertebral body and disk heights are otherwise well maintained. T1 hyperintense vertebral body lesion at T8 consistent with hemangioma. No worrisome focal marrow signal abnormality is appreciated. There is no significant spinal canal or foraminal stenosis within the thoracic spine. Conus is in normal position.

Output: 1. Unremarkable MRI of the brain.2. Spinal cord is of normal caliber and signal. 3. Degenerative changes in the cervical spine with mild spinal canal stenosis at C5-6 and C6-7. Minimal disc bulge at T11-T2 without spinal canal or neural foraminal stenosis.


Instruction: Generate impression based on findings.

Input: Clinical question: R/O appendiceal pathology, evaluate for complications from Crohn, fistulae, etc. Signs and symptoms: Liquid stools, abdominal pain. Pre-and post-enhanced lumbar MRI:The field of exam extends from T10 -- T11 disk space inferiorly through S3 level.There is normal anatomical development of vertebral column.There is normal anatomical alignment of the right common. There is no appreciative degenerative disk disease or hypertrophic changes of posterior elements. There is no evidence of spinal canal compromise or stenosis at any level.There is no evidence of neural foraminal compromise at any level.There is normal morphology and signal intensity of the perispinal soft tissues and the musculature.Visualized SI joints are unremarkable.There is normal signal intensity and caliber of the lower thoracic cord, conus and the cauda equina.Post enhanced images demonstrate no detectable abnormal enhancement of the vertebral column, cord or the cauda equina.

Output: Unremarkable pre-and post enhanced MRI of the lumbar spine.


Instruction: Generate impression based on findings.

Input: Clinical question: Rule out bleed. Signs and symptoms: Fall. Unenhanced head CT:There is no evidence of intracranial hemorrhage, edema, mass-effect, midline shift or hydrocephalus.The cortical sulci, ventricular system, CSF cisterns and gray -- white matter that initiation is well preserved.There is higher density of left supraclinoid internal carotid artery compared to the right lower compared to any of the other visualized intracranial large vessels. Recommend follow-up with an MRI to entirely exclude possibility of thrombus. The calvarium is intact. There is no detectable abnormality of the soft tissues of the scalp. Limited real paranasal sinuses and mastoid air cells are unremarkable.Above findings were discussed with the physician in the emergency room at the time of interpretation on the phone number 45968.

Output: Negative head CT.


Instruction: Generate impression based on findings.

Input: 31 years Female (DOB:1/10/1985)Reason: low back pain leg pain History: low back pain left leg painPROVIDER/ATTENDING NAME: BEN-ZION ROITBERG BEN-ZION ROITBERG Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. There is multilevel disc desiccation present. The patient is status post left-sided hemilaminectomy at L4-5.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is a broad-based central disc protrusion present at this level which minimally abuts the nerve roots at the lateral recesses sees but does not compress them.At L4-5 the patient status post left-sided hemilaminectomy. There is effacement of the fat surrounding the nerve roots at the left lateral recess at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina. There is a Schmorl's node present at this level.

Output: 1.There is a lesion of the left lateral recess at L4-5 involving the nerve roots of the left lateral recess (most likely the left L5 nerve root) which could either represent scar formation or disc protrusion. A contrast-enhanced exam could help differentiate.2.The patient status post left-sided hemilaminectomy at L4-5.


Instruction: Generate impression based on findings.

Input: Male, 16 years old, with sickle cell disease. Assess for stenosis/moyamoya. No evidence of restricted diffusion is seen. No significant parenchymal signal abnormality, edema or mass effect is appreciated. The pattern of enhancement is within normal limits.No evidence of intracranial hemorrhage or any abnormal extra-axial fluid collection is seen. The ventricles are normal in size and morphology.The ICAs are widely patent bilaterally with no evidence of stenosis, occlusion or moya-moya. In fact, no significant vascular stenosis or occlusion is evident in any vascular distribution. Normal variant fenestration of the left A1 segment is seen. There may also be fenestration of the ACOM artery. The right PCOM artery is small. The left PCOM artery is moderately sized. An infundibulum is seen at the origin of the left PCOM artery.

Output: 1.No evidence of any significant brain parenchymal abnormality.2.No evidence of ICA stenosis or moya-moya.


Instruction: Generate impression based on findings.

Input: Female 66 years old Reason: stenosis of IVC on recent transjugular liver biopsy, please eval for vascular abnormalities History: HCV, elevated portal pressures. ABDOMEN:LIVER, BILIARY TRACT: Liver has mildly widened fissures and hypertrophy of the caudate suggesting chronic liver disease. There is narrowing of the IVC near the diaphragm due to caudate and surrounding central hepatic hypertrophy. No definite mass lesion identified in the liver. Study suboptimal due to the lack of intravenous contrast.SPLEEN: No significant abnormality noted.PANCREAS: There is mild pancreatic ductal dilatation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Focal scarring at the upper pole of the right kidney. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Narrowing of the intrahepatic IVC near the diaphragm due to caudate and hepatic parenchyma hypertrophy surrounding the IVC. Contrast extravasation description:Supervising radiologist: MULLIGANMinor or major extravasation: MinorContrast type:16 cc of MultiHance were administered. and salineAmount extravasated: 35 ccLocation of extravasation: Left antecubital fossaSigns and symptoms: Swelling, painTreatment given: Cold compressDischarge instructions given: Yes


Instruction: Generate impression based on findings.

Input: BRACHIAL PLEXUS: There is an approximately 5.3 x 1.8 cm left supraclavicular ill-defined mass that extends into and expands the left C6-C7 neural foramen and tracks along the roots and trunks of the left brachial plexus. There is a well-defined remodelling of the adjacent left C7 vertebral body and left posterior elements. There is no resultant spinal canal stenosis. CERVICAL SPINE:The vertebral column alignment is within normal limits. The vertebral body heights are preserved. The vertebral bone marrow signal is slightly heterogenous, a non-specific appearance. The imaged spinal cord displays normal signal and morphology. There is multilevel disc desiccation and a congenitally narrow cervical spinal canal.C2-C3: There is bilateral facet arthropathy as well as a right paracentral disc osteophyte complex without significant spinal canal or neural foramen stenosis.C3-C4: There is bilateral facet arthropathy, left greater than right, as well as mild bilateral uncovertebral joint arthropathy and a small central disc osteophyte complex. There is moderate left neural foramen narrowing and mild spinal canal stenosis.C4-C5: There is moderate left facet arthropathy and bilateral uncovertebral arthropathy as well as a mild disc osteophyte complex. These findings result in mild bilateral neural foramen narrowing and mild spinal canal stenosis.C5-C6: There is loss of disc height, endplate degenerative change, mild bilateral facet arthropathy, and bilateral uncovertebral arthropathy, left greater than right, as well as a posterior disc osteophyte complex. These findings result in moderate left and mild right neural foramen stenosis and mild spinal canal stenosis.C6-C7: There is mild disc height loss and mild posterior disc osteophyte complex. There is also a left paraspinal mass that is further described in the brachial plexus portion of the report. There is no significant spinal canal or right neural foramen stenosis.C7-T1: There is no disc bulge or herniation, and no significant spinal canal or neural foramen stenosis.

Output: 1.Left supraclavicular mass extending along the roots and trunks of the left brachial plexus, as well as into the left C6-C7 neural foramen with adjacent bony remodeling but without associated spinal canal stenosis. The differential diagnosis includes neural tumor such as schwannoma or neurofibroma.2.Mild cervical spine degenerative changes superimposed on a congenitally narrow spinal canal resulting in multilevel mild spinal canal stenosis and multilevel neural foramen narrowing as detailed above.


Instruction: Generate impression based on findings.

Input: Images are limited by patient motion. The cervical spine is in normal alignment, with straightening of the normal cervical lordosis. There is mild disc narrowing at C5-C6. The vertebral body and disk heights are otherwise well-maintained. There are scattered areas of abnormal marrow signal and mild enhancement within the cervical vertebrae along the posterior superior C7 vertebral body. Spinal cord is of normal caliber and signal. At C2-C3, there is a shallow central disc protrusion and mild left facet arthropathy.At C3-C4, there is a stable mild posterior osteophyte disk complex with tiny central annular fissures. There is mild bilateral uncovertebral hypertrophy resulting in mild bilateral foraminal narrowing. There is overall mild to moderate central spinal canal stenosis as there is also minimal ligamentum flavum thickening. Flattening the ventral cord is noted.At C4-C5, there is a stable tiny central disc protrusion indenting the ventral thecal sac with no significant stenosis.At C5-C6, there is a stable mild diffuse posterior osteophyte disk complex with slight left sided prominence. There is left greater than right uncovertebral hypertrophy, facet arthropathy, as well as ligamentum flavum thickening. There is moderate central spinal canal stenosis as well as moderate left and mild to moderate right foraminal narrowing.At C6-C7, there is progression of previous pathology, with persistent posterior osteophyte disk complex with superimposed central/right paracentral disc protrusion indenting the ventral cord. There is There is mild bilateral uncovertebral hypertrophy as well as facet arthropathy and ligamentum flavum thickening. There is mild to moderate central spinal canal stenosis and mild bilateral foraminal narrowing.At C7-T1, there is no significant disk pathology or stenosis. Small nerve root sleeve cysts are incidentally noted at this level.The previously seen rounded T2 hyperintense lesion within the left thyroid gland now measures 3 x 3 mm, having decreased in size from previous 7 x 6 mm. There is prominent patchy STIR hyperintensity throughout the pons which is nonspecific but may relate to small vessel ischemic changes.THORACIC SPINE

Output: 1.Diffuse osseous metastatic disease throughout the spine, with moderate pathologic compression deformity of T6 and mild-moderate compression deformity of T11, with only minimal retropulsion of fracture fragments although there is associated up to moderate right T6-T7 foraminal narrowing. Diffuse involvement of L3 vertebral body with only mild concavity of the endplates.2.No significant epidural disease at any level this time, and no evidence of pathological intrathecal enhancement.3.Pleural based enhancing mass along the right lower lobe with adjacent destructive metastatic lesion involving the right T6 posterior rib. Additional metastatic lesions in the manubrium and right clavicular head.4.Focal abnormality along the left lateral aspect of the aortic arch is suspected to represent focal aortic saccular type aneurysm which may be ulcerative, as this does not appear to have an appearance of adjacent periaortic node. CTA of the chest would be helpful for further evaluation. Other areas of scattered mural thickening are noted consistent with atherosclerotic disease.5.Right adrenal mass concerning for metastatic disease. Severely atrophic right kidney.6.Transitional lumbosacral anatomy as detailed above. If surgery is to be contemplated, correlation with imaging of entire spine is recommended.7.Scattered spondylotic changes throughout the spine, with high-grade foraminal narrowing along the lower lumbar spine. Please see above for details.


Instruction: Generate impression based on findings.

Input: Transient alteration of awareness [780.02], Reason for Study: ^Reason: r/o CNS lesion History: TIA No evidence of acute ischemic or hemorrhagic lesion on the scan.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: Normal brain MRI.


Instruction: Generate impression based on findings.

Input: 68-year-old male with abdominal pain, vomiting ABDOMEN:LUNG BASES: Calcified granuloma in the right lung baseLIVER, BILIARY TRACT: Subcentimeter hypodensity at the dome of the liver may represent a hemangioma, suggested on prior MRI.SPLEEN: The spleen is mildly enlargedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Multiple mildly enlarged mesenteric and retroperitoneal lymph nodes are identified, stable. A left paraaortic lymph node (series 2; image 66) is unchanged, measuring 1.4 cm.Scattered calcified lymph nodes are identified.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: The prostate gland is enlarged.BLADDER: 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: No acute abnormality. Stable scattered adenopathy.


Instruction: Generate impression based on findings.

Input: 59-year-old female with history of ampullary carcinoma status post Whipple. Now with abdominal pain and nausea. ABDOMEN:LIVER, BILIARY TRACT: No hepatic masses identified. Status post Whipple procedure. The hepaticojejunostomy is patent, though the common hepatic bile duct is irregular. The intrahepatic biliary ducts demonstrate multifocal stenoses. The gallbladder is surgically absent.SPLEEN: No significant abnormality noted.PANCREAS: Status post Whipple procedure. There is a short stricture of the distal pancreatic duct at the pancreaticojejunostomy, with mild diffuse dilation of the pancreatic duct proximally. No focal pancreatic without focal mass identified. Response to secretin is identified. No peripancreatic fluid collections are present.ADRENAL GLANDS: Right adrenal adenoma. Left adrenal gland thickening.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1.Short stricture of the postsurgical distal pancreatic duct near the pancreaticojejunostomy, with mild diffuse dilation of the pancreatic duct proximally.2.Multifocal stenoses of the hepatic biliary system, which may represent autoimmune cholangiopathy or primary sclerosing cholangitis.3.No hepatic or pancreatic mass identified.4.Pancreatic response to secretin identified.


Instruction: Generate impression based on findings.

Input: 51-year-old female with history of benign right breast biopsy. She has a strong family history, including breast cancer diagnosed in her mother. She presents for routine MRI screening; no current breast related complaints. There is a heterogeneous amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally. Multiple cysts are again seen throughout both breasts.No abnormal enhancement is seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: 61-year-old female with metastatic breast cancer and known brain metastases with new onset atrial fibrillation. Now with mental status change. Evaluate for acute CVA or hemorrhage. Multiple low attenuation areas correspond to vasogenic edema secondary to known metastatic foci are seen involving both cerebral hemispheres. Some of these lesions correspond to those on MRI from 3 months prior, however all cannot be appreciated on this exam. No definite new lesions identified. There is no evidence of intracranial hemorrhage. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Multiple low attenuation areas correspond to vasogenic edema from known brain metastases are seen. MRI is suggested for further evaluation if clinical concern remains for acute CVA.


Instruction: Generate impression based on findings.

Input: History of pituitary apoplexy in 2006, now with growing pituitary lesion. There is an enhancing mass within the sella, somewhat eccentric to the right, with extension into the sphenoid sinuses. Overall, the mass measures up to 20 mm, previously 18 mm. The infundibulum is deviated to the left. There is perhaps slight mass effect upon the right prechiasmatic optic nerve and protrusion into the right cavernous sinus. The internal carotid artery flow voids are intact.

Output: Interval increase in size of the invasive pituitary tumor.


Instruction: Generate impression based on findings.

Input: 48-year-old male with DLBCL of the primary bone site (left hip). Restaging examination. Please reassess for response in the primary site BONE MARROW: Note is made of increased signal abnormality within the left acetabulum extending inferiorly along the left inferior ramus, consistent with the patient's history of primary lymphoma of bone. There is associated enhancement on postcontrast sequences. There is cortical destruction with a small amount of soft tissue extension involving the obturator internus muscle on the left. When compared to prior imaging from 8/24/2015, these findings appear decreased in size and extent. There is also nonspecific increased signal abnormality on fluid sensitive sequences within the superolateral left femoral head/neck which does not definitively enhance, but also appears decreased in size when compared to the prior study. Attention to this finding on follow-up examination is recommended.SOFT TISSUES: Again seen is enhancing soft tissue extension involving the left obturator internus muscle which appears decreased in size when compared to the prior examination.JOINTS: The femoroacetabular joint alignment is anatomic.ADDITIONAL

Output: Enhancing lesion within the left acetabulum extending to the inferior pubic ramus with soft tissue extension as described above, consistent with the patient's known history of primary lymphoma of bone. These findings appear decreased in size and extent when compared to the prior examination from 8/24/2015. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Right shoulder pain, positive impingement symptoms check for rotator cuff tear ROTATOR CUFF: Moderate thickening with minimal undersurface tearing and increased signal within the supraspinatus underlying the acromion and extending towards the attachment. Involvement is both anterior and posterior aspects of the tendon with identification of fibers extending throughout and no specific focal changes of retraction. More mild tendinopathy is observed in the infraspinatus towards the attachment without evidence of undersurface or intrasubstance focal abnormalities. Subscapularis and teres minor are normalSUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: Moderate osteoarthritic changes including narrowing, subchondral cysts and osteophytes most pronounced involving the glenohumeral articulation and humeral head. Mild globular signal observed in the anterior labrum without discrete focal additional changes within this limited nonaugmented exam.BICEPS TENDON: Bicep tendon is observed extending in the groove with poor visualization involving the horizontal component representing concern for mild tendinopathy.ADDITIONAL

Output: Mild to moderate tendinopathy of the supraspinatus with more minimal changes of the infraspinatus as described. Questionable small loose bodies and associated similar changes of the biceps tendon. See detail providedI personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Patient fell downs tears, right hip pain. Check for fracture. Patient is on Lovenox Patient motion and bowel peristalsis limits sensitivity.BONE MARROW: Very faint central intramedullary signal observed in the intertrochanteric and femoral neck regions suggesting minimal edema or contusion. Specifically no linear component or extension to the cortical margin. The remainder of the pelvis and opposite hip are otherwise unremarkable.SOFT TISSUES: No significant abnormality noted and muscle compartments are symmetric and unremarkable. Specifically no findings to suggest a large hemorrhage or free fluid within the pelvis. Uterus and ovaries are otherwise unremarkable for age.JOINTS: No significant abnormality noted.ADDITIONAL

Output: Findings correlating with a minimal contusion within the proximal femur yet no MR findings to suggest fracture or hematoma. No additional acute abnormalities


Instruction: Generate impression based on findings.

Input: 52-year-old male with lateral joint line pain, rule out lateral meniscal tear MENISCI: There is a radial tear of the lateral meniscal body. The lateral meniscal body is mildly extruded laterally. The medial meniscus is intactARTICULAR CARTILAGE AND BONE: There is a 1.6 cm of full-thickness cartilage loss along the lateral tibial plateau with underlying edema in the subchondral bone. Additional edema is present within the lateral tibial plateau more anteriorly with a small subchondral cyst at the ACL insertion. There are areas of partial-thickness cartilage loss along the lateral femoral condyle. Articular cartilage of the medial compartment is intact. There is near full-thickness cartilage loss along the lateral patellar facet with underlying increased T2 signal within the patella, likely reactive. Mild thinning is seen along the medial patellar facet. The trochlear cartilage is intact. Small tricompartmental osteophytes are present. There is an ossicle at the patellar tendon insertion which may be related to old trauma. There is edema along the anterior aspect of the lateral femoral condyle which is likely reactive.LIGAMENTS: The medial and lateral collateral ligament complexes are intact. The ACL and PCL are intact.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1.Radial tear of the lateral meniscus with associated osteoarthritic changes in the lateral compartment including areas of full-thickness cartilage loss.2.Osteoarthritic changes in the patellofemoral compartment with near full-thickness articular cartilage loss along the lateral facet.


Instruction: Generate impression based on findings.

Input: Patient presenting with bilateral shaking spells possibly reflecting seizure. Patient reported history of a midline tumor in the anterior brain. Questionable cystic lesion in the sella on recent CT. Evaluate mass. Motion artifact mildly limits evaluation.Similar to recent CT, there is a cystic appearance of the sella. The pituitary is small and displaced inferiorly within the sella. The hypothalamic stalk traverses the cystic space. Separate from the pituitary and stalk, there is a soft tissue nodule which sits along the anterior superior aspect of the cyst. No significant mass effect on the adjacent brain parenchyma, hypothalamus, and optic chiasm. No abnormal parenchymal signal is seen on the T2, FLAIR or diffusion weighted images. There is no evidence of intracranial hemorrhage or edema. The ventricles and basal cisterns are normal in size and configuration. The expected intracranial vascular flow voids are present. Partial opacification of the ethmoid air cells and right mastoid sinus mucous retention cyst, mild left maxillary sinus mucosal thickening. The visualized mastoid air cells are clear. The orbits are unremarkable.

Output: Cystic lesion with associated soft tissue nodule within the sella with apparent mass effect which inferiorly displaces and flattens the pituitary gland. No definite/significant calcification is noted on recent CT. Within the limits of a noncontrast exam, these findings may reflect either a Rathke's cleft cyst or possibly a craniopharyngioma.


Instruction: Generate impression based on findings.

Input: Ulnar sided wrist pain. Evaluate triangular fibrocartilage complex LIGAMENTS: The scapholunate and the lunate triquetral ligaments are intactTRIANGULAR FIBROCARTILAGE COMPLEX: No significant abnormality noted.TENDONS: No significant abnormality noted. ADDITIONAL

Output: Degenerative changes at the distal radioulnar joint.


Instruction: Generate impression based on findings.

Input: Male, 55 years old, with brain disorder, unspecified, evaluate for mycotic aneurysm. Normal flow related signal is seen within the vessels of the intracranial circulation. No significant stenosis or occlusion is observed. No evidence of any aneurysmal dilatation or other vascular malformation is seen. The patient's bilateral parietal lesions are vaguely discerned as areas of abnormal parenchymal signal.

Output: No evidence of mycotic aneurysm or other significant vascular abnormalities.


Instruction: Generate impression based on findings.

Input: Nasopharyngeal cancer, status post treatment. There are post-treatment findings the posterior nasopharynx, but no evidence of measurable nasopharyngeal mass. The skull base appears to be intact. There is no significant cervical lymphadenopathy. The salivary glands and thyroid appear unchanged. There is a posterior small disc osteophyte complex at C5-6. There is a small amount of fluid in the right mastoid air cells. The orbits are unremarkable. The numerous subcentimeter non-enhancing lesions with associated susceptibility effect in the brain are better depicted on the recent brain MRI. There is a 3 mm diameter posteromedially directed right aneurysm arising from the anterior genu of the internal carotid artery.

Output: 1. Post-treatment findings in the nasopharyngeal region without evidence of measurable locoregional tumor.2. The numerous subcentimeter non-enhancing lesions with associated susceptibility effect in the brain are better depicted on the recent brain MRI. 3. A 3 mm diameter posteromedially directed right aneurysm arising from the anterior genu of the internal carotid artery is better depicted on the recent brain MRA.


Instruction: Generate impression based on findings.

Input: 32-year-old male patient with painless left posterior thigh mass. Patient has history of lipoma on back. A marker is placed over the posterior left thigh in the region of the patient's palpable abnormality.No discrete mass is identified underlying the skin marker within the posterior left thigh. Signal within the bone marrow and musculature is within normal limits. The visualized ligamentous and tendinous structures are intact.

Output: No discrete mass is identified underlying the patient's palpable abnormality within the posterior thigh.


Instruction: Generate impression based on findings.

Input: Altered mental status, unspecified [R41.82], Reason for Study: ^Reason: AMS (decreased alertness/responsiveness, non-verbal) w/ hx of SDH s/p crani and evacuation w/ new hypernatremia and UTI. CT head w/o acute change. History: Please see above Post left fronto parietal cranioplasty status follow up.There is no evidence of acute ischemic or hemorrhagic lesion.There is high signal intensity of the left frontal and parietal lobes underneath of the cranioplasty site which may indicate parenchymal edema. There is thin layer of extra axial fluid collections with evidence hemosiderin indicating blood products. There is 22.5mm x 36mm sized left parietal subgaleal fluid collection overlying the cranioplasty site.Underlying brain shows bilateral patchy high signal intensity lesions on periventricular white matter indicating non specific small vessel ischemic disease. Multifocal lacunar infarctions including right external capsule and left thalamiThe ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Post left fronto-parietal cranioplasty status with thin extra axial fluid collections without evidence of mass effects against underlying brain parenchyma.2. The left fronto-parietal lobe high signal intensity on T2/FALIR images were again seen which may indicate reactive changes after extra axial fluid evacuation.3. No evidence of acute ischemic or hemorrhagic lesion.4. Subgaleal fluid collections on the cranioplasty site.5. Non specific small vessel ischemic disease and multifocal lacunar infarctions.


Instruction: Generate impression based on findings.

Input: Acute mental status change. Brain MRI:There are 2 high signal intensity lesions on diffusion-weighted imaging, one on the right precentral gyrus just around paracentral lobule and another one right posterior temporal lobe. The precentral gyrus lesion is more likely T2 shine through but the right posterior temporal lesion is likely represent acute or subacute ischemic infarct.There is no evidence of associated hemorrhagic transformation.Multifocal scattered high signal intensity lesions on FLAIR imaging on white matter and periventricular white matter including brain stem indicating either nonspecific small vessel disease or chronic ischemic lacunar infarcts.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.MRA head:3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate slightly irregular but without evidence of significant luminal stenosis on narrowing on bilateral ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal.There is no intracranial aneurysm.

Output: 1. Focal small acute ischemic infarction on the right posterior temporal lobe as described above (series 402, image 116/32).2. Extensive white matter changes indicating nonspecific small vessel disease and multifocal chronic lacunar infarctions involving brainstem and periventricular white matter.3. No evidence of major intracranial arterial occlusion or intracranial arterial aneurysm.


Instruction: Generate impression based on findings.

Input: Female, 62 years old, with narcolepsy. No restricted diffusion is seen. A few punctate foci of T2 hyperintensity are seen scattered through the cerebral hemispheres and pons. No edema or mass effect is seen. There are no findings to suggest intracranial hemorrhage or any abnormal extra-axial fluid. Ventricular size and morphology are within normal limits. MRA images reveal no significant intracranial stenosis or occlusion. Fetal origin of the left PCA is noted.

Output: No evidence is seen of acute ischemia or any other acute abnormality. A few scattered foci of signal abnormality are non-specific. No significant vascular abnormalities are detected.


Instruction: Generate impression based on findings.

Input: Diagnosis: Nontraumatic intracerebral hemorrhage in hemisphere, corticalClinical question: assess hematoma status for the MISTIE trial There is redemonstration of a large hematoma measuring 90 cm x 42 cm axial dimensions involving the right basal ganglia and adjacent right centrum semiovale. There is surrounding contrast enhancement and T2 and FLAIR signal change. There is associated mass effect present with shift of the third ventricle 11 mm to the left of midline. There is redemonstration of uncal herniation and mild transtentorial herniation with some displacement of the brainstem towards the left. The left lateral ventricle is mildly enlarged. There is a fluid fluid level present in the left lateral ventricle and the right lateral ventricle compatible with intraventricular blood.There is diffusion restriction evident along the cerebral peduncles bilaterally right more than left. Punctate foci of diffusion restriction are present in the left periventricular white matter.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate partial opacification The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin.

Output: 1.Since the prior exam patient has developed new foci of diffusion restriction compatible with infarction along the cerebral peduncles. The patient does have transtentorial herniation associated with compression of the brainstem. 2.There is redemonstration of a large hematoma centered in the right basal ganglia and right centrum semiovale associated with mass effect including uncal and transtentorial herniation as well as intraventricular blood. These findings were also present on the previous exam and continue to evolve.3.Small punctate foci of infarction are present in the periventricular white matter.4.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.


Instruction: Generate impression based on findings.

Input: Reason: 73yo female with newly diagnosed endometrial cancer. History: Mass posterior to uterus on CT, but not palpated on pelvic exam The exam is limited due to the lack of intravaginal gel instillation.PELVIS:UTERUS, ADNEXA: Retroverted uterus. Asymmetric thickening of the left aspect of the endometrium with associated restricted diffusion and enhancement is likely related to the patient's known diagnosis of endometrial cancer. The tumor extends inferiorly to the level of the cervix (series 401 images 33-34). Focal indistinctness of the myometrial/endometrial junction is suggestive of myometrial invasion (series 401 image 37), and extrauterine extension cannot be excluded (series 1001 image 18). Ovaries are not well visualized, presumably atrophic.BLADDER: The urinary bladder is collapsed.LYMPH NODES: No pelvic lymphadenopathy.BOWEL, MESENTERY: Trace free fluid in the dependent pelvis.BONES, SOFT TISSUES: Artifacts related to surgical hardware of the lower lumbar spine.OTHER: No significant abnormality identified.

Output: 1.Marked left-sided endometrial thickening and enhancement likely reflecting the patient's known diagnosis of endometrial cancer. There is evidence for myometrial invasion, and extrauterine extension cannot be excluded.2.No definite separate mass posterior to the uterus is identified. Please obtain prior to imaging and report for comparison if available.


Instruction: Generate impression based on findings.

Input: Male; 65 years old. Reason: Evaluate for rotator cuff tear, dislocation History: Pain on abduction. ROTATOR CUFF: Intermediate signal and mild thickening involving the supraspinatus tendon at its insertion site. Findings are compatible with tendinopathy but no frank tear is evident. Remaining rotator cuff muscles are within normal limits.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: No significant abnormality noted.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: 1.Supraspinatus tendinopathy without evidence of frank tear. 2.Findings compatible with calcific bursitis.


Instruction: Generate impression based on findings.

Input: Patient used prophylactic antibiotics before and after the procedure as prescribed. The patient received antibiotic prophylaxis with oral Ciprofloxacin 500mg and Vantin 200mg. The patient took 1 tablet of Ciprofloxacin 500mg the night before and morning of the procedure. The patient also took 2 tablets of Avantin 200mg the morning of the procedure. After the procedures, the patient will take 2 tablets of Ciprofloxacin 500mg and 2 tablets of Avantin 200mg.Following the discussion of the risks, benefits, and alternatives of the procedure, informed consent was obtained. DynaTrim device was used to localize the lesion in the left seminal vesicle. Using the Dynatrim guidance system an 18-gauge MR- compatible needle was inserted into the this lesion. Upon confirmation of the tip of the needles close to the suspected lesion, MR guided biopsy using an 18 gauge Bard biopsy needle was performed and three cores were obtained.The cores were hand delivered to the pathology lab.The patient tolerated the procedure well and was discharged without any immediate complications.ESTIMATED BLOOD LOSS: Less than 5 cc.

Output: 1. Successful core-biopsies of the left seminal vesicle lesion.


Instruction: Generate impression based on findings.

Input: Severe calf pain. No osseous or marrow abnormality is observed. Specifically no findings to suggest stress fracture. Alignment preserved. Surrounding musculature, compartments and soft tissues are also unremarkable. No vascular abnormalities identified

Output: Normal


Instruction: Generate impression based on findings.

Input: Female, 61 years old, with low back pain radiating from the feet. Alignment is anatomic. Vertebral body height and morphology are within normal limits. Degenerative endplate edema is seen at L5-S1 and minimally at L4-5. Elsewhere, no evidence of marrow edema or replacement is seen.The visualized distal spinal cord, conus and cauda equina are unremarkable. No epidural abnormalities are suspected.L1-2: Mild facet hypertrophy. No significant spinal canal or neuroforaminal stenosis. L2-3: Mild facet hypertrophy. Minimal bulging disc. Minimal foraminal narrowing.L3-4: Moderate facet hypertrophy and ligamentum flavum thickening. Mild bulging disc. No significant generalized spinal canal stenosis. Moderate left foraminal narrowing. L4-5: Moderate facet hypertrophy, right worse than left, and ligamentum flavum thickening. Mild disc bulging with a superimposed right foraminal protrusion. No significant spinal canal stenosis. Moderate bilateral foraminal narrowing. L5-S1: Moderate facet hypertrophy and ligamentum flavum thickening. Bulging disc. No significant spinal canal stenosis. Severe bilateral foraminal narrowing.

Output: Multilevel disc and posterior element degeneration is seen. No areas of high-grade spinal canal stenosis are demonstrated. However, the neural foramina at L5-S1 are severely narrowed bilaterally.


Instruction: Generate impression based on findings.

Input: 84 year old with fall. Diffuse decreased periventricular white matter attenuation, representing age -- indeterminate small vessel disease. The ventricles are midline and normal in size, and there is no intracranial hemorrhage or abnormal extra-axial fluid.A calcified mass is again seen projecting from the left side of the falx anteriorly (image 19/30 bone windows), representing the patient's known meningioma. No CT is available for comparison, however when compared to the MRI dated 2004, this is likely stable.The calvarium is normal and the mastoid air cells and visualized paranasal sinuses are normally pneumatized. Diffuse calcifications of the vertebrobasilar system and circle of Willis are present.

Output: Diffuse periventricular small vessel white matter ischemic disease, age-indeterminate, and a stable left frontal meningioma. No intracranial hemorrhage.


Instruction: Generate impression based on findings.

Input: 65-year-old female with left shoulder pain, loss of range of motion, weakness ROTATOR CUFF: Normal muscle bulk. No fatty infiltration. No discrete tear is evident. Minimal enthesopathic changes at the insertion of the supraspinatus tendon.SUPRASPINATUS OUTLET: Mildly at the acromioclavicular joint with mild osteophytes.GLENOHUMERAL JOINT AND GLENOID LABRUM: Minimal osteoarthritis affects the glenohumeral joint. No labral tear is evident.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: 1.No evidence of rotator cuff tear. 2.Minimal osteoarthritis as described above. 3.Mild subacromial and subdeltoid bursitis.


Instruction: Generate impression based on findings.

Input: 39-year-old female with right-sided weakness and facial droop. Evaluate for acute infarct. MRI Brain:There is no evidence of intracranial hemorrhage, mass, or acute infarct. Redemonstrated are several foci of T2/FLAIR hyperintensity within the supratentorial periventricular and subcortical white matter. These include few foci along the bilateral corpus callosal bodies as well as a juxtacortical lesion along the right parietal lobe. There is no significant change in the interval. No new lesions are appreciated.The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.MRI C-Spine:Again demonstrated is abnormal T2/STIR hyperintense cord signal involving the right posterolateral aspect of the spinal cord at the C3-4 level as well as a second smaller lesion again involving the right lateral aspect of the cord at the C5 level. The C3-C4 lesion appears slightly larger with increased cranial extension. There also appears to be enhancement involving the superior aspect of this lesion.There are otherwise no new lesions or abnormal enhancement elsewhere in the cervical cord.The cervical spine alignment is maintained and the cervical vertebral bodies are appropriate in height. There are mild degenerative changes are relatively more prominently involving the C5-6 level where there is a small disc osteophyte but there is no significant spinal canal or neural foraminal stenosis at any level. The bone marrow signal is within normal limits. The vertebral artery flow voids appear to be intact. The paraspinous soft tissue structures appear within normal limits.

Output: 1. No significant change in several scattered supratentorial T2/FLAIR hyperintense lesions including two small foci along the corpus callosum and a right parietal juxtacortical lesion which are suggestive of demyelinating disease. No new lesions in the brain or abnormal enhancement to suggest active demyelination in the brain.2. There is increase in cranial extent of T2 signal abnormality associated with a previously seen C3-C4 lesion. There is also associated enhancement, findings which are suspicious for active demyelination adjacent to a chronic demyelinating plaque. Smaller right C5 lesion also again seen. Dr. Ali discussed findings with Dr. Burns at 1005 hours on 12/12/2016.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 54-year-old male with history of colon/rectal cancer Large area of vasogenic edema and high convexity left frontal lobe contains an internal area of soft tissue density with central lucency. This finding is believed to represent a necrotic metastatic lesion which measures 28-mm x 26-mm in transaxial dimension (image 18). The edema causes subtle focal mass effect and no evidence of midline shift. No evidence of an additional lesion is detected. Further evaluation with dedicated MRI of brain with infusion is recommended.The bony density of calvarium demonstrates no evidence of metastatic lesions.

Output: Large necrotic mass with surrounding vasogenic edema in left high convexity frontal lobe consistent with a metastases lesion.


Instruction: Generate impression based on findings.

Input: 35-year-old female with wrist pain. Evaluate wrist mass. LIGAMENTS: The scapholunate and lunotriquetral ligaments appear intact within the limitations of a non arthrogram study.TRIANGULAR FIBROCARTILAGE COMPLEX: The triangular fibrocartilage complex appears intact. TENDONS: There is slight palmar subluxation of the extensor carpi ulnaris which may be chronic in etiology. There is a small amount of fluid about the extensor digitorum and extensor carpi radialis tendons which may reflect a very mild tenosynovitis. There is nonspecific subcutaneous edema within the soft tissues about the posterior aspect of the wrist as seen on fluid sensitive sequences. The flexor tendons appear intact. BONES: No bone marrow signal abnormality is identified.ADDITIONAL

Output: Nonspecific subcentimeter foci of heterogenous signal abnormality about the posterior aspect of the wrist as described above, which may reflect a synovitis, although this is incompletely characterized on this noncontrast examination. Further evaluation with a dedicated contrast enhanced MRI examination could be considered if further imaging is clinically warrented. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Reason: hx of bladder cancer, evaluate for metastatic disease.Additional history per electronic medical record:Ronnie Thomas is a 68Yrs old male with a history of bladder cancer status post cystectomy, orthotopic neobladder in 7/2006. Final pathology revealed high grade noninvasive papillary urothelial carcinoma and Gleason 3+3=6 adenocarcinoma of the prostate (pT2cN0Mx). He was most recently seen by Dr. Steinberg, who performed his cystectomy, and was found to be NED. He has also been admitted in the interim for SBO, managed conservatively.  He presented to clinic to discuss new gross hematuria, for which he was recently seen in the ED. His most recent CT scan was 9/20/2015 which revealed no evidence of recurrent or metastatic disease. ABDOMEN:LUNG BASES: Partially visualized thoracic aortic dissection. Sternotomy changes.LIVER, BILIARY TRACT: The liver demonstrates normal signal intensity and enhancement. There is a 2 mm nonenhancing focus within hepatic segment 6 which is too small to characterize. No additional focal hepatic lesions are identified.Cholelithiasis without pericholecystic inflammatory changes. No biliary ductal dilatation.SPLEEN: Normal variant splenule.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: There is a 2 mm nonenhancing focus within the midpole of the right kidney which is too small to characterize but may reflect a cyst. No suspicious enhancing renal lesions are identified. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: Partially visualized aortic dissection extending to near the level of the right renal artery origin appearing grossly similar to prior CTA.BOWEL, MESENTERY: Interval resolution of previously seen dilated small bowel.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Postsurgical changes related to cystoprostatectomy and neobladder formation.2.No specific evidence of residual or metastatic neoplastic disease. 2 mm nonenhancing hepatic segment 6 lesion too small to characterize but may reflect a cyst and can be followed on subsequent examinations.3.Partially imaged aortic dissection appearing grossly similar to prior.4.Interval resolution of previously seen small bowel obstruction. Persistent small bowel containing left inguinal hernia.5.Cholelithiasis.


Instruction: Generate impression based on findings.

Input: 74 years, Female, Reason: eval liver lesions, eval for biliary obstruction History: elevated lfts, cholestatic picture. Evaluation of MRCP sequences is limited due to respiratory artifact.ABDOMEN:LUNG BASES: Bilateral pleural effusions. Left-sided chest tube. Cardiomegaly.LIVER, BILIARY TRACT: There is an enhancing lesion throughout the majority of the right hepatic lobe with patchy high signal on T2 and demonstrates progressive enhancement. For reference, the lesion measures 8.7 x 13.6 cm. There is no significant signal loss on out of phase images to indicate fat. The posterior right portal vein is encased but appears patent. The IVC is also significantly narrowed but appears patent both proximally and distally.Left hepatic lobe subcentimeter simple cysts. Diffuse gallbladder wall thickening is likely related to fluid overload. No cholelithiasis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Minimally complex cystic lesion in the left upper pole with several septations but no suspicious enhancing or nodular components. Left lower pole subcentimeter hemorrhagic/proteinacious cyst. Additional subcentimeter T2 hyperintense lesions likely represents cysts but are too small to characterize. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Mild abdominal ascites.

Output: 1.Large progressively enhancing hepatic lesion occupying the majority of the right hepatic lobe likely represents neoplasm. Cholangiocarcinoma is favored, however the differential diagnosis would also include metastases.2.Minimally complex left upper pole cyst without suspicious enhancing components.3.Mild abdominal ascites and large effusions.


Instruction: Generate impression based on findings.

Input: Female 57 years old Reason: pain in right knee after jumping off a bus History: pain, swelling at right knee MENISCI: The lateral meniscus appears partially extruded. There is fraying of the inner edges of both menisci, lateral greater than medial.ARTICULAR CARTILAGE AND BONE: There is loss of the articular cartilage of the medial patellar facet. Focal degenerative changes in the medial aspect of the lateral tibial plateau with underlying cyst and bone marrow edema appearing most likely due to chronic degenerative changes although this could be worsened due to recent trauma. There is overlying cartilage thinning/defect.LIGAMENTS: Cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: Extensor mechanism is intact.ADDITIONAL

Output: Degenerative arthritic changes as described above, which could be exacerbated due to recent trauma. Fraying of the inner edges of the menisci.


Instruction: Generate impression based on findings.

Input: 64 year old man with history of ischemic cardiomyopathy s/p CABG, referred for viability assessment. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 14%, the LV end diastolic volume index is 217 ml/m2 (normal range: 74+/-15), the LVEDV is 410 ml (normal range 142+/-34), the LV end systolic volume index is 188 ml/m2 (normal range 25+/-9), the LVESV is 355 ml (normal range 47+/-19). There is apical dyskinesis. There is akinesis of the mid-distal lateral wall, mid to apical anterior/anteroseptal walls, mid to apical septum and inferoseptum with associated thinning of the myocardium. There is late gadolinium enhancement in a transmural pattern, suggesting non-viability in nearly all of the hypokinetic segments described, other than a very small basal segment of the lateral wall and mid septum.Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 44%, the RV end diastolic volume index is 80 ml/m2 (normal range 82+/-16), the RVEDV is 151 ml (normal range 142+/-31), the RV end systolic volume index is 45 ml/m2 (normal range 31+/-9), and the RVESV is 85 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve is trileaflet and opens widely. There is mild aortic regurgitation.Mitral ValveThe mitral valve is apically displaced due to bileaflet tethering. There is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is dilated.Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is no pericardial effusion.Extracardiac FindingsThere are moderate bilateral pleural effusions. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 14%.2. There is an extensive wall motion abnormality with predominately no viability on LGE imaging.3. The right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 44%.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Anaplastic astrocytoma status post chemotherapy and radiation treatment. Headache and weakness. Right parietal temporal craniotomy changes are again seen. There has been interval progression of right parietotemporal lobe enhancing infiltrative tumor with new extension into the right frontal lobe surrounding the anterior horn of the right lateral ventricle with extension superiorly along the midline vertex. There is increased infiltrative tumor extending along the genu, body, and splenium of corpus callosum. New foci of enhancement are demonstrated in the left centrum semiovale. There is overall increased mass effect and effacement of the right lateral ventricle. T2 signal extending inferiorly along the right cerebral peduncle also appears increased since prior examination. A focus of susceptibility along the right precentral gyrus likely represents a biopsy marker. Hemosiderin deposition the surgical bed is similar to prior examination.

Output: Interval unfavorable changes with significant progression of tumor involvement within the right frontal lobe, corpus callosum, with extension into the left cerebral hemisphere.


Instruction: Generate impression based on findings.

Input: Diagnosis: Abnormal involuntary movements(781.0)Clinical question: any cerebellar abnormality?Signs and Symptoms: fine intention tremor The CSF spaces are appropriate for the patient's stated age with no midline shift. Incidental note is made of mega cisterna magna eccentric towards the left side.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: MRI of the brain is within normal limits. No evidence for cerebellar mass.


Instruction: Generate impression based on findings.

Input: Reason: mass under the inferior border of both scapular History: mass under the inferior border of both scapulae. There are crescentic masses deep to both scapular tips between the serratus anterior and the underlying rib cage. The masses are predominantly isointense to muscle but contain small foci of high signal intensity on T1 weighted images compatible with fatty elements, are slightly hyperintense to skeletal muscle on fluid sensitive sequences, and show enhancement following gadolinium administration. The location, morphology, and signal characteristics are compatible with elastofibromas. The right mass measures approximately 7 x 2 cm in the transverse dimension and approximately 8 cm in the craniocaudal dimension. The left mass measures approximately 6.5 cm x 1.5 cm in the transverse dimension and 8 cm in the craniocaudal dimension. There is a lesion within segment 8 of the liver which demonstrates increased signal intensity on T1 and STIR sequences and shows mild peripheral enhancement on postcontrast sequences. This is nonspecific and incompletely characterized/imaged on this examination. After consult with the abdominal imaging section, a triple phase MRI of the liver is recommended for further evaluation. Moderate degenerative disc disease is identified throughout the visualized cervical and thoracic spine. There are fluid collections along the anterior aspect of the subscapularis muscles, bilaterally, that we suspect represent bilateral subcoracoid bursitis. There also appears to be osteoarthritis of the acromioclavicular joints as well as a full-thickness rotator cuff tear on the right.

Output: 1. Bilateral elastofibromas as described above. 2. Incompletely characterized segment 8 liver lesion for which further evaluation with a dedicated triple phase MRI examination of the liver is recommended.3. Other findings as described above.


Instruction: Generate impression based on findings.

Input: 62-year-old female with abdominal pain, fever, chronic cystitis, self-catheterization. Status post appendectomy. Creatinine is 1.7. This examination is limited by the absence of intravenous contrast. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: There is cholelithiasis without evidence of cholecystitis.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: There is extensive fat stranding surrounding the right kidney. In the right midpole region there is a faintly seen cystic mass which measures approximately 4 cm in diameter. CT or MRI examination with contrast would be required to further delineate this potential lesion. There is mild right hydronephrosis and hydroureter. No renal calculus are present. There are several small calcifications in the course of the distal ureter and in the pelvis, but these cannot be convincingly demonstrated to be within the ureter. There is a left midpole faint hypodensity measuring approximately 1.8 cm in diameter which may be a simple cyst. The left kidney is otherwise within normal limits. The findings in the right kidney are most likely due to pyelonephritis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS: UTERUS, ADNEXAE: No significant abnormality notedBLADDER: There is a small amount of air within the bladder compatible with history of self-catheterization.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Degenerative changes in the lumbosacral spine and pelvis.OTHER: No significant abnormality noted

Output: Fat stranding, mild hydronephrosis and hydroureter of the right kidney compatible with pyelonephritis. No definite evidence of renal stones. Bilateral renal cortical hypodensities are faintly seen, but cannot be further characterized without IV contrast. Cholelithiasis without evidence of cholecystitis.


Instruction: Generate impression based on findings.

Input: 58 year old with highly suspicious mass in the right breast at posterior upper outer quadrant with segmental pleomorphic calcifications extending anteriorly. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.RIGHT BREAST:There was an irregularly shaped, heterogeneously enhancing mass at posterior 10:00 position, measuring 28 x 23 x 24 mm (AP x LR x CC). There is a thin fat plane between this mass and pectoralis muscle on T2 weighted images, and there is no pectoral enhancement, suggesting no invasion into the muscle. Segmental non mass enhancement extends from the mass toward the nipple at upper outer quadrant, measuring 51 x 13 x 17 mm. Overall measurement including mass and non mass enhancement is 73 x 23 x 28 mm.LEFT BREAST:No abnormal enhancement is seen in left breast. AXILLAE:No abnormal lymph nodes are identified in either axillary region.

Output: 1. Highly suspicious mass with non mass enhancement in the right upper outer quadrant, posterior to anterior aspect. Although the mass is located immediately anterior to the pectoralis muscle, there is no definite evidence for invasion into the muscle.2. No MR evidence for malignancy in the left breast.3. No abnormal lymph nodes in either axilla.BIRADS: 5 - Highly suggestive of malignancy.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: 4-month-old male with persistent vomiting and macrocephaly. Increased head circumference in past one month. Please evaluate for hydrocephalus. There are bilateral extra-axial fluid collections in the frontal regions. There are no clearly visible bridging cerebral veins to indicate a subarachnoid location. Based on the current study, chronic subdural hematoma cannot be excluded. Recommend MRI for further evaluation of these fluid collections as clinically indicated.The ventricles and basal cisterns are slightly prominent but not clearly abnormal.The calvaria appears enlarged. The skull base is radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. Bilateral extra-axial fluid collections. Chronic subdurals versus subdural hygroma. Recommend MRI to better evaluate as clinically indicated.


Instruction: Generate impression based on findings.

Input: Seizure overnight. Many of the images are degraded by patient motion. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is a right maxillary sinus retention cyst.

Output: No potential seizure foci are identified, although many of the images are degraded by patient motion.


Instruction: Generate impression based on findings.

Input: 63-year-old female with rectal GIST on therapy. Assess size. PELVIS:UTERUS, ADNEXA: Status post hysterectomy.BLADDER: No significant abnormality noted.LYMPH NODES: No enlarged perirectal lymph nodes.BOWEL, MESENTERY: The known T2 hyperintense rectal lesion along the right lower rectal wall is stable in size measuring 2.1 x 2.3 cm (series 3 image 32) (prior 2.2 x 2.4 cm) and again involves the anorectal junction. Further evaluation is limited due to the lack of intravenous contrast. Sigmoid diverticulosis is noted. No evidence for acute diverticulitis. Small loculated ascites posterior to the bladder is unchanged (series 3 image 45).BONES, SOFT TISSUES: Stable suspected left S3 perineural cyst (series 3 image 64).OTHER: No significant abnormality noted.

Output: 1.The known T2 hyperintense rectal lesion along the right lower rectal wall is stable in size measuring 2.1 x 2.3 cm (series 3 image 32). Further evaluation is limited due to the lack of intravenous contrast.


Instruction: Generate impression based on findings.

Input: Reason: lower back pain, right hip pain, left hip pain, right knee pain History: mechanical fall Lumbar spine: There are 5 lumbar vertebral bodies. There is grade 1 anterolisthesis of L4 on L5. There is anterior wedging of L1, which appears new compared to MRI dated 8/9/2011. Multilevel degenerative disc disease affects the lumbar spine, with most prominent loss of disc space height and vacuum-disc phenomenon at L1-L2. Moderate to severe facet osteoarthritis and hypertrophy of the posterior elements affects the lumbar spine.Right hip: Moderate osteoarthritis affects the right hip with heterotopic bone formation around the greater trochanter. We see no fracture. Left hip: Moderate osteoarthritis affects the left hip with heterotopic bone formation around the greater trochanter. We see no fracture.Right knee: There is a small joint effusion. Severe osteophytosis affects the right knee, with lateral, medial, and patellofemoral joint space narrowing and tricompartmental osteophytosis. We see no fracture.

Output: 1. New compression fracture of L1 compared to MRI dated 8/9/2011, of indeterminate age.2. Multilevel moderate to severe facet arthritis and degenerative disc disease of the lumbar spine.3. Grade 1 anterolisthesis of L4 on L5.4. Small joint effusion of the right knee. Osteoarthritis of the right knee and hips without fracture as detailed above.


Instruction: Generate impression based on findings.

Input: History of breast cancer in her mother diagnosed at age 50. Enrolled in high-risk research breast cancer screening study. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.Multiple enhancing foci are unchanged in both breasts.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Headaches for the past 2 weeks. Rule out structural abnormality. BRAIN MRI:There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is trace mucosal thickening in the maxillary and ethmoid sinuses, which is nonspecific.CRANIAL MRA:No significant stenosis in the intracranial anterior or posterior circulations. The cavernous segment of the left internal carotid artery is tortuous. No evidence of aneurysm.

Output: Brain MRI and MRA are within normal limits. Specifically, no evidence of intracranial mass or aneurysm.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Chronic maxillary sinusitis [J32.0] / Human immunodeficiency virus (HIV) disease [B20], Reason for Study: ^Reason: h/o HIV/AIDs now with seizures of uncertain etiology History: as above. Brain MRINo evidence of acute ischemic or hemorrhagic lesion.Scattered T2/FLAIR high signal intensities on bilateral periventricular white matter indicate nonspecific small vessel ischemic disease.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, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The pmastoid air cells are clear.There is a Developmental Venous Anomaly on the right pre central gyrus.Mucosal thickening with opacification of the right maxillary sinus, right side frontal sinus, sphenoid sinus as well as ethmoid sinus are seen.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. Bilateral Pcom arteries are patent as well as Acom artery. No aneurysm. No arterial luminal stenosis.Brain MRV3D MRV brain post-gadolinium with maximum intensity projections of the superficial/deep intracranial venous drainage demonstrate normal flow enhancement in the superior sagittal sinus, transverse sinuses, sigmoid sinuses, internal cerebral veins, vein of Galen and straight sinus.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion. No abnormal enhancement.2. Right frontal lobe pre central gyrus DVA.3. Normal brain MRA and MRV.


Instruction: Generate impression based on findings.

Input: 55-year-old female, follow-up L4 extraspinal lesionIMAGE ACQUISITIONS: Lumbar spine CT without contrast Soft tissue mass at the L4/L5 level is not well-visualized on this exam. If clinical concern remains, an MRI could be obtained for further evaluation.The alignment of the lumbar spine is anatomic. The vertebral body heights and disk spaces are preserved. There is minimal disc bulging with no mass effect upon the cord at L2/L3 and L3/L4. There is diffuse disc bulging at L4/L5 with narrowing of the neural foramina, left greater than right. At L5/S1 diffuse disc bulge is seen with no mass effect upon the cord.

Output: 1. previously seen left-sided soft tissue mass is not well-visualized on this study and can be further evaluated with MRI2. degenerative disc disease of the lumbar spine as described.


Instruction: Generate impression based on findings.

Input: Hyperreflexia and weakness. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. There is mild kyphotic angulation at the C6-C7 level on a degenerative basis. Alignment is otherwise maintained. The cervical spinal cord has normal signal characteristics and overall morphology.Degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: Small disc osteophyte complex and ligamentum flavum thickening. No significant compromise to the spinal canal or right neural foramen. Moderate left-sided neural foraminal stenosis related to uncovertebral hypertrophy and facet arthropathy.C4-5: Right ventral disc osteophyte complex and ligamentum flavum thickening. No significant compromise to the spinal canal or right neural foramen. Minimal left neural foraminal narrowing.C5-6: Small disc osteophyte complex and uncovertebral hypertrophy on the left. No significant spinal canal or right neural foraminal stenosis. Mild left neural foraminal narrowing. C6-7: Significant loss of disc height with associated fatty endplate marrow signal changes. No significant compromise to the spinal canal. Mild bilateral neural foraminal narrowing related to uncovertebral hypertrophy. C7-T1: No significant compromise to the spinal canal or right neural foramen. Minimal left neural foraminal narrowing related left-sided facet arthropathy.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: Mild multilevel degenerative changes in the cervical spine. There is no significant spinal canal stenosis or cord signal abnormality. Please see details above.


Instruction: Generate impression based on findings.

Input: There is mild straightening of the lumbar spine the vertebral bodies are normally aligned. The vertebral body heights are maintained. Focal fat or hemangioma is demonstrated in the T10 vertebral body, similar to prior examination. The distal spinal cord and conus are within normal limits with the conus terminating at the L1-L2 level.T9-T10: There is mild diffuse disc bulge causing mild bilateral neuroforaminal narrowing at this level. No significant facet disease is appreciated at this level.T10-T11: There is a diffuse disc bulge at this level causing moderate left and mild right neural foraminal narrowing as well as mild central spinal stenosis. No significant facet disease is appreciated at this level.T11-T12: No significant spinal neural foraminal stenosis is noted at this level. Mild to moderate posterior facet and ligamentum flavum hypertrophic degenerative changes are demonstrated at this level.T12-L1: There is a mild diffuse disc bulge causing mild central spinal and mild bilateral neural foraminal stenosis. Mild posterior facet degenerative changes are demonstrated at this level.L1-L2: There is a diffuse disc bulge causing moderate right and mild left neural foraminal stenosis with mild effacement of the ventral thecal sac. There are mild degenerative changes of the posterior facets at this level.L2-L3: There is a diffuse disc bulge causing mild bilateral neural foraminal narrowing without central spinal stenosis at this level. Mild posterior facet degenerative changes are present.L3-L4: There is a left paracentral disc herniation causing moderate left neural foraminal stenosis at this level. There is no central spinal stenosis.L4-L5: There is a diffuse disc bulge causing moderate bilateral neural foraminal stenosis without central spinal stenosis at this level. There are moderate degenerative changes of the posterior facets at this level.L5-S1: There is mild bilateral neuroforaminal narrowing at this level secondary to diffuse disc bulge without central spinal stenosis. There are moderate degenerative changes of the posterior facets at this level.Multiple bilateral renal cysts are visualized.

Output: 1. No evidence for cord compression as clinically questioned.2. Multilevel degenerative changes of the lumbar spine progressed since 4/11/2013.