Instruction: Generate impression based on findings.

Input: Mass on scalp: painful, enlarging mass. There are 2 mm thick left superior parietal scalp and 7 mm thick bilateral posterior parietal scalp fat signal lesions. The larger lesion contains a band of low signal, which may a represent fibrous tissue septation. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and mastoid air cells are grossly unremarkable.

Output: Small left parietal scalp lipoma and larger bilateral posterior parietal scalp lesions are compatible with lipomas, although the larger lesion has a more complex appearance.


Instruction: Generate impression based on findings.

Input: H/o lung cancer. Evaluate for brain metastasis. The previously described left occipital cortical nodule (image# 18-19 of series# 3151) is considered occipital gyrus. The current infused exam shows a 4-mm nodule left adjacent to the posterior sagittal sinus in the left occipital lobe, which corresponds to the lesion identified on the initial MRI dated 12/4/08. The surrounding edema/encephalomalacia is seen. No additional lesion is identified. The small vessel ischemic disease and right parietal encephalomalacia are again identified. No intracranial hemorrhage, mass effect, midline shift or abnormal extraaxial fluid collection is identified. The ventricles are normal in volume. The calvarium is intact.

Output: Essentially stable head CT with a left occipital metastatic lesion. Small vessel ischemic disease of indeterminate age.


Instruction: Generate impression based on findings.

Input: Migraines different in nature. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma, brainstem, cerebellum, 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, paranasal sinuses, and scalp soft tissues are grossly unremarkable. However, there are multiple mildly prominent lymph nodes in the imaged portions of the head and neck.

Output: 1. No evidence of acute intracranial hemorrhage, mass, or ventriculomegaly.2. Multiple nonspecific mildly prominent lymph nodes in the imaged portions of the head and neck, ranging from normal variant, to a reactive process, to potentially a manifestation of a lymphoproliferative process, for example. Perhaps dedicated imaging of the neck would be useful.


Instruction: Generate impression based on findings.

Input: Cervicalgia. Rule out cuff tear. Evaluation of the shoulder is limited on some sequences due to patient motion artifact.ROTATOR CUFF: There is thickening of the supraspinatus and infraspinatus tendons indicating tendinosis. Best seen on coronal oblique image 13 of series 4 is high signal intensity within the distal fibers of the supraspinatus tendon 1 cm proximal to its insertion on the greater tuberosity, indicating a tear. The tear disrupts the bursal surface fibers of the tendon and extends through the majority of the tendon thickness; however, I cannot ascertain with certainty if this is a full-thickness tear or a high-grade bursal surface tear. The tear appears to be less than 1 cm in diameter, and results in approximately 5 mm of retraction of the bursal surface fibers. The supraspinatus muscle is within normal limits. There is mild fatty atrophy along the myotendinous junction of the infraspinatus muscle. The teres minor tendon and muscle appear intact. The subscapularis tendon can be followed to its insertion on the lesser tuberosity. Focal intermediate signal intensity along its undersurface fibers may reflect fraying. The subscapularis muscle is within normal limits. SUPRASPINATUS OUTLET: Moderate osteoarthritis affects the acromioclavicular joint and there is mild spurring of the anterior aspect of the acromion. There is a small amount of fluid within the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral joint alignment is within normal limits. There is a small amount of fluid within the glenohumeral joint. Evaluation of the glenoid labrum and articular cartilage of the glenohumeral joint is limited by patient motion artifact. I see no fluid-filled labral tears, although intermediate signal intensity within the superior labrum likely reflects degenerative tearing.BICEPS TENDON: Mild increased signal intensity centrally within the intra-articular portion of the tendon of long head of the biceps may reflect mild degeneration, but I see no tear of the tendon. There is a small amount of fluid surrounding the tendon as it courses down the intertubercular groove which could represent a mild tenosynovitis or simply extension of fluid from the glenohumeral joint. ADDITIONAL

Output: 1.Limited study due to patient motion artifact.2.Rotator cuff tendinosis as described above with a focal full-thickness or high-grade bursal surface tear of the supraspinatus.3.Degenerative arthritic changes as described above.4.Fluid anterior to the subscapularis muscle may reflect subcoracoid bursitis.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Reason: Evaluate right knee for lateral meniscus tear, possibly chronic discoid History: right knee pain, locking MENISCI: There is abrupt attenuation of the posterior half of the body and much of the posterior horn of the lateral meniscus with only a thin rind of peripheral meniscal tissue remaining, presumably representing extensive tearing of the lateral meniscus in the absence of prior partial meniscectomy. The anterior horn of the lateral meniscus is intact.There is mild intrasubstance degeneration of the medial meniscus, but no discrete tear is identified.ARTICULAR CARTILAGE AND BONE: There is full-thickness degeneration of the articular cartilage in the lateral tibiofemoral compartment particularly along the lateral tibial plateau, posteriorly. There is also full-thickness degeneration of the articular cartilage of the lateral femoral condyle posteriorly. There is focal degenerative signal abnormality in the underlying subchondral bone.The articular cartilage within the medial tibiofemoral and patellofemoral compartments is intact.LIGAMENTS: The anterior cruciate ligament is not visualized, presumably representing a chronic tear. The posterior cruciate ligament is intact. The medial collateral ligament and lateral collateral ligament complex are intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1.Marked attenuation of the posterior horn and body of the lateral meniscus presumably representing extensive tearing in the absence of prior meniscectomy.2.Articular cartilage loss of the lateral tibiofemoral compartment as described above.3.Chronic tear of the anterior cruciate ligament.


Instruction: Generate impression based on findings.

Input: 53 years Male (DOB:12/24/1962)Reason: Treatment planning for post-op SRS to brain met resection cavity History: Treatment planning for post-op SRS to brain met resection cavityPROVIDER/ATTENDING NAME: STEVEN J CHMURA STEVEN J CHMURA Since previous examination patient is undergone right-sided craniotomy for removal of a right frontal lobe mass. The remaining some T2 signal abnormality within the right precentral gyrus associated with blood products and some surrounding contrast enhancement. This measures approximately 9 mm in diameter.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.Incidental note is made of a subgaleal lipoma adjacent to the frontal bone a couple centimeters anterior to the coronal suture at the midline.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: Status post right frontal lobe precentral gyrus surgery for removal of a mass. There are findings compatible with post operative effect.


Instruction: Generate impression based on findings.

Input: Reason: eval for rotator cuff tear History: shoulder pain on and off afor 10 years + impingement ROTATOR CUFF: No significant abnormality noted.SUPRASPINATUS OUTLET: No significant abnormality noted. Specifically, there is no evidence of impingement.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is a thin linear focus of low signal in the glenohumeral joint on the T2-weighted images, which is favored to represent chondrocalcinosis. The glenohumeral joint and glenoid labrum are otherwise within normal limits.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: Chondrocalcinosis within the glenohumeral joint. Otherwise, normal appearing shoulder without evidence of impingement as clinically questioned.


Instruction: Generate impression based on findings.

Input: Osteomyelitis, unspecified [M86.9], Reason for Study: ^Reason: evaluation of back pain and weakness in the setting of osteo History: pain and weakness of LE For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1.  There is new enhancing lesions on the right side of L45 transverse process which extends toward right side paraspinal muscle. The lesion extends around the level of the right side posterior SI joint level. Comparing to prior scan especially CT guided biopsy, the lesions is matching with the needle path. Thus, this new lesion is likely an extension of discitis infection through the biopsy needle path. A simple bit exaggerated inflammatory reaction through the needle track is another possibility but less likely.Enhancing lesions on both L45 and L5S1 as well as L4 and L5 vertebral bodies with bone marrow edema indicating discitis and osteomyelitis are again seen, unchanged since prior scan.Mild to moderate spinal canal stenosis with bilateral mild to moderate neuroforaminal stenosis at the level of L34, and L45, unchanged since prior scan.Spinal cord signal intensity is normal.Lumbar spine alignment is normal.The vertebral body height is preserved. The conus medullaris terminates at the T12-L1 level.

Output: 1. Interval development of right paraspinal muscle enhancing lesion at the level of L45 which likely represent infection extension through prior post CT guided disc biopsy needle track. 2. Otherwise unchanged MR findings of L45 and L5S1 discitis and osteomyelitis.3. Unchanged multilevel spinal stenosis and neuroforaminal stenosis.


Instruction: Generate impression based on findings.

Input: Resection of CCM on 4/23/15. There are postoperative findings related to right frontal craniotomy. There is a cavity in the right gyrus rectus region with linear susceptibility effect along the margins and mild confluent T2 hyperintensity in the surrounding white matter. There is diffuse mild thickening and hyperenhancement of the overlying dura. There is an unchanged punctate cavernous malformation in the pontomedullary junction. There are multiple nonspecific scattered foci of cerebral white matter T2 hyperintensity. There is no evidence of acute infarct or acute intracranial hemorrhage. The ventricles are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable.

Output: 1. Postoperative findings related to right frontal lobe cavernous malformation resection with mild susceptibility effect along the margins of the resection cavity, which is likely attributable to residual blood products from the surgery.2. Unchanged punctate cavernous malformation in the pontomedullary junction.3.


Instruction: Generate impression based on findings.

Input: Status post liver transplant now with Klebsiella bacteremia. Evaluate for source of infection. ABDOMEN:LIVER, BILIARY TRACT: Status post liver transplant with cholecystectomy. The common bile duct measures 8 mm and appears widely patent at the hepaticojejunostomy. No significant intrahepatic biliary ductal dilatation. There is no abnormal bile duct wall enhancement. The liver is normal in morphology without a discrete lesion. The veins are patent. The hepatic arteries patent.There is a small amount of nonloculated fluid within the gallbladder fossa which is nonspecific and was present on the prior study.SPLEEN: The spleen is normal in size measuring 12 cm in craniocaudal dimension without discrete lesion.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No hydronephrosis or suspicious lesion.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant free or loculated fluid.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Status post liver transplant without evidence of complication.


Instruction: Generate impression based on findings.

Input: Male, 54 years old, status post stem cell transplant with progressive a standing muscle weakness, now the level of the diaphragm. Spinal alignment is anatomic. Vertebral body height and morphology are normal. No concerning areas of marrow replacement or marrow edema are seen. The pattern of marrow enhancement is within normal limits.The visualized spinal cord shows normal signal intensity and caliber. On postcontrast images, there is the suggestion of enhancement along some of the cervical nerve roots. The cord itself shows no evidence of pathologic enhancement.C2-3: Facet hypertrophy. Minimal posterior disk osteophyte formation. No significant spinal canal or neuroforaminal stenosis. C3-4: Facet hypertrophy. Minimal posterior disk osteophyte formation. No significant spinal canal or neuroforaminal stenosis.C4-5: Facet hypertrophy. No significant disk degeneration, spinal canal stenosis or neuroforaminal narrowing. C5-6: Facet hypertrophy. Mild posterior disk osteophyte formation. No significant spinal canal or neuroforaminal stenosis.C6-7: Posterior disk osteophyte formation with asymmetric osteophytic ridging and or disk protrusion in the left foraminal and subarticular zones. Minimal displacement of the adjacent spinal cord is seen without cord signal abnormality. The left neural foramen is moderately narrowed. C7-T1: Facet hypertrophy. No significant disk degeneration, spinal canal or neuroforaminal stenosis.

Output: 1. Mild scattered enhancement of some of the cervical intradural nerve roots is suspected, though it is possible that this appearance may be due in part to imaging artifact. If further imaging evaluation is warranted, a dedicated pre- and post contrast study of the lumbar spine might be considered as subtle nerve root enhancement is usually more reliably diagnosed among the nerve roots of the cauda equina. If real, the differential for this finding would include post infectious and autoimmune phenomenon, non infectious inflammatory/granulomatous diseases, among numerous other etiologies.2. Relatively mild degenerative disk disease most severely affecting the C6-7 level where asymmetric left-sided osteophytic ridging and/or a disk protrusion results in mild cord deformation. No areas of high-grade spinal canal stenosis are seen.


Instruction: Generate impression based on findings.

Input: Diagnosis: Other amnesiaClinical question: atrophy, lesionsSigns and Symptoms: memory and attention problems The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate partial opacification of the ethmoid air cells and some mucosal thickening in the maxillary sinuses with milder mucosal thickening in the frontal sinuses.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.There is minor thickening in the left side of the nasopharynx which is suspected to be related to a benign cyst measuring 3 mm in size.

Output: 1.MRI of the brain is within normal limits. No findings are identified which support the patient's memory loss and attention problems.2.Mucosal thickening in the paranasal sinuses is most likely inflammatory in nature.


Instruction: Generate impression based on findings.

Input: Clinical question: Cervical spine degenerative disease? Signs and symptoms: 55-year-old male with left-sided numbness and tingling of left arm and leg, unresponsive to medication. Nonenhanced cervical spine MRI:There is normal anatomical alignment of the cervical and upper most visualized thoracic spine.The signal intensity which column is unremarkable.There is normal signal intensity and caliber of the cervical and upper most visualized thoracic cord.There is no evidence of spinal canal compromise or stenosis at any level.There is mild degenerative changes of cervical spine.Foramen magnum is unremarkable.C2 -- C3 is unremarkable.C3 -- C4 demonstrate a shallow central disk protrusion (axial T2 series 701 image 22). Findings results in partial effacement of ventral subarachnoid space and very subtle flattening deformity of the cord without spinal stenosis or neural foraminal compromise.C4 -- C5 demonstrate mild degenerative changes with resultant mild left neural foraminal compromise.C5 -- C6 demonstrate minimal degenerative changes with questionable mild right neural foraminal compromise.C6 -- C7 demonstrate mild degenerative changes and unremarkable otherwise.C7-T1 through T4 -- T5 is unremarkable.

Output: 1.Shallow central disk protrusion at C3 -- C4 without spinal stenosis or neural foraminal compromise. 2.Mild degenerative changes of cervical spine with resultant mild left neural foraminal compromise at C4 -- C5, questionable mild right neural foraminal compromise at C5 -- C6 as detailed.3.Unremarkable exam otherwise.


Instruction: Generate impression based on findings.

Input: Back pain with history of myeloma . Rule out compression versus lesion. Severe degenerative disc disease affects L4-L5 and L5-S1 with moderate degenerative disc disease at L3-L4, appearing similar to the prior study. Vertebral body heights are preserved. Severe facet joint osteoarthritis affects the lower lumbar spine. Small lucency in the anterior superior corner of L3 likely represents part of a myelomatous deposit better seen on prior MRI studies, but we see no frank compression fracture. Hypertrophy of spinous processes with associated degenerative changes are seen. The lytic lesion in the left ilium is partially visualized in this study as is a right total hip arthroplasty.

Output: Degenerative disc disease and facet joint osteoarthritis of the lumbar spine with other findings as described above. Myelomatous lesions are better seen on prior studies, but we see no evidence of progression.


Instruction: Generate impression based on findings.

Input: 36-year-old male with right shoulder pain for the past 2 weeks after fall on an outstretched arm. ROTATOR CUFF: There is thickening and intermediate signal intensity of the supraspinatus and infraspinatus tendons indicating mild to moderate tendinosis. There is a focus of fluid signal intensity within the anterior fibers of the distal supraspinatus tendon at its insertion, representing a tear that measures just under 1 cm in the AP dimension. This may represent a concealed tear as this does not definitively disrupt either surface of the tendon. It is associated with a cyst within the underlying greater tuberosity. There are additional smaller foci of increased signal intensity more proximally and posteriorly within the cuff which may represent small interstitial tears. The supraspinatus and infraspinatus muscles are otherwise within normal limits. There is mild increased signal intensity within the subscapularis tendon suggestive of mild tendinosis. The teres minor muscle and tendon appear intact.SUPRASPINATUS OUTLET: There is edema within the distal end of the clavicle. There is a questionable cortical step-off along the anterior tip of the distal clavicle as seen on image 16 of series 8 which could represent a nondisplaced fracture, but this is equivocal. There are also small cysts within the distal end of the clavicle which can be seen as part of a stress reaction (osteolysis), particularly in patients that engage in weightlifting. There is also edema along the distal end of the clavicle which appears to undercut the acromioclavicular joint ligament. While it is possible that this could be due to a low-grade acromioclavicular joint separation, we see no edema within the acromion process or the coracoacromial ligament to suggest a higher-grade injury. There is a trace amount of fluid within the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is within normal limits. Given the limitations of a non-arthrogram study, the glenoid labrum appears normal.BICEPS TENDON: The long of the biceps tendon appears intact.

Output: 1. Edema within the distal clavicle and surrounding soft tissue as described above. These findings could reflect a nondisplaced fracture of the anterior tip of the distal clavicle, a low-grade acromioclavicular joint separation, posttraumatic osteolysis of the clavicle, or a combination of the above. Radiographs of the acromioclavicular joint may provide further information.2. Tendinosis and interstitial tearing of the supraspinatus and infraspinatus tendons as described above. Given the findings in the distal clavicle, these rotator cuff findings are not necessarily of current clinical significance.


Instruction: Generate impression based on findings.

Input: Neoplasm of unspecified nature of endocrine glands and other parts of nervous system [239.7], Reason for Study: ^Reason: Change in pineal germinoma s/p 4 cycles of chemotherapy? History: 16 year old with pineal germinoma. Interval reduction of the size of solidly enhancing pineal as well as minimally enhancing more mixed cystic and solid bilateral mesial thalamic lesions comparing to prior scan.In particular, the size of solid enhancing pineal lesion is now measured about 9.4mm x 11.4mm (was 17.4mm x 16.1mm on corresponding image) on the sagittal post enhanced scan, and the mixed cystic and solid lesion is measured about19.5mm x 22.2mm on coronal T2 weighted image (was 23.9mm x 26.2mm on corresponding images).Bone marrow signal appears to be normal.No evidence of meningeal enhancement.Ommaya catheter is seen inserted through the right frontal burr hole and the tip is located in the right side of foramen of Monroe, no change since prior scan.No evidence of acute ischemic or hemorrhagic lesion on this scan.The ventricles, sulci and cisterns are symmetric and unremarkable, no change since prior scan.The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Interval reduction in size of both pineal solid enhancing lesion and mixed cystic solid lesion on bilateral thalami since prior scan.2. No change in ventricle size and ventriculostomy tube location since prior scan. 3. No evidence of new enhancing lesion. No evidence of acute ischemic or hemorrhagic lesion on this scan.


Instruction: Generate impression based on findings.

Input: Elevated PSA for 2 years with 2 negative prostate biopsies. PELVIS:PROSTATE:Prostate Size: 7.3 x 5.9 x 9.3 cmPeripheral Zone: The peripheral zone is diffusely thinned.There is a small focus of T1 weighted hyperintensity in the right paramedial mid gland through apex compatible with hemorrhage.Subcentimeter left apex wedge-shaped T2 weighted hypointensity has no corresponding restricted diffusion or enhancement.No discrete suspicious lesion.Central Gland: Marked enlargement of the central gland due to prostatic hyperplasia. No discrete suspicious lesion.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: No discrete suspicious lesion (dominant lesion). Marked prostatic hyperplasia.


Instruction: Generate impression based on findings.

Input: Type I neurofibromatosis. Evaluate change in brainstem tumor or optic glioma MRI Brain: There is no restricted diffusion to suggest acute infarction. There are unchanged ill-defined foci of T2 hyperintensity involving bilateral globus pallidi and thalami. There is no mass effect. A hypothalamic mass abuts the posterior aspect of the optic chiasm measuring 14 x 11 mm (series 601, image 13), unchanged in size, and without significant enhancement. There is no evidence of intracranial hemorrhage. The pituitary gland appears unremarkable. The ventricles and basal cisterns are normal 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 grossly unremarkable. There are retained secretions within the right mastoid air cells. There is also a lower medullary lesion, described in the MRI Cervical spine section.MRI Cervical Spine: There is a T2 hyperintense infiltrative lesion within the lower medulla, with interval reduction in size of the T2 hyperintense component now measuring 6 x 5 mm (series 601, image 4), previously 10 x 8 mm. This medullary lesion no longer demonstrates contrast enhancement (seen on MRI 4/20/2015). The medulla is expanded measuring 17mm, unchanged from prior. There are enhancing, T2 hyperintense lesions involving the left C4 and C5 nerve roots, which expand their respective neural foramina. The left C4-5 lesion also has an enhancing intradural component measuring 6 mm, that causes mass effect on the left lateral aspect of the spinal cord, probably unchanged. There is a small syrinx involving the central canal of the spinal cord in the upper thoracic region (series 1601, image 9), present on prior and probably unchanged given limitations in technique.There is straightening of the cervical spine, which may be due to patient positioning. Alignment is otherwise normal. Vertebral bodies are preserved in height. There is no suspicious bone marrow signal. MRI Orbits: There is a 3-mm well-circumscribed (series 3401, image 7), minimally enhancing lesion abutting the inferior aspect of the left optic nerve, probably unchanged in size, but with reduced enhancement when compared to the MRI of 4/28/2015. Orbits and globes are otherwise unremarkable. The optic chiasm is normal. Optic tracts appear unremarkable.

Output: 1. No new lesions are identified.2. Infiltrative, expansive medullary mass extending to the cervicomedullary junction, with grossly unchanged brainstem expansion, but decreased extent of T2 hyperintensity and resolution of previously seen enhancement. 3. Probably unchanged T2 hyperintense lesions involving left C3-4 and C4-5 neural foramina, with mass effect on the left lateral spinal cord at C4-5.4. Unchanged lesions involving the hypothalamus, inferior aspect of the left optic nerve, basal ganglia and thalamus.5. Probably unchanged prominence of the central canal of the spinal cord involving the upper thoracic central spinal cord.


Instruction: Generate impression based on findings.

Input: 42-year-old female who is pregnant with right lower quadrant pain concerning for ovarian vein thrombosis. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Gravid uterus. Prominent and patent ovarian veins as expected. BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Gravid uterus. Intrauterine pregnancy is not well evaluated on this non-dedicated exam. 2.Prominent and patent ovarian veins.


Instruction: Generate impression based on findings.

Input: Recent laser ablation of the corpus callosum. There has been interval laser ablution of the corpus callosum via right transparietal and transfrontal approaches. There is expected peripheral restricted diffusion associated with the ablation zones, but no evidence of acute territorial infarction. There is no evidence of gross intracranial hemorrhage. There is no midline shift.

Output: Expected findings related to interval laser ablation of the corpus callosum.


Instruction: Generate impression based on findings.

Input: 64 year old woman with history of severe pulmonary hypertension and systemic hypertension referred for non-contrast MRI to assist with RV assessment. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 59%, the LV end diastolic volume index is 53 ml/m2 (normal range: 65+/-11), the LVEDV is 96 ml (normal range 109+/-23), the LV end systolic volume index is 22 ml/m2 (normal range 18+/-5), the LVESV is 40 ml (normal range 31+/-10). There is systolic flattening of the interventricular septum which suggests RV pressure overload.Left AtriumThe left atrium is severely dilated.Right VentricleThe right ventricle is severely dilated with mildly reduced systolic function. The overall RV ejection fraction is 48%, the RV end diastolic volume index is 205 ml/m2 (normal range 69+/-14), the RVEDV is 372 ml (normal range 110+/-24), the RV end systolic volume index is 106 ml/m2 (normal range 22+/-8), and the RVESV is 192 ml (normal range 35+/-13). Right AtriumThe right atrium is severely dilated. The coronary sinus is dilated.Aortic ValveThe aortic valve opens widely and there is trivial aortic regurgitation (regurgitant fraction of 4%).Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is trivial pulmonic regurgitation regurgitant fraction of 2%).Tricuspid ValveThe tricuspid valve opens widely. There is severe tricuspid regurgitation. AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is severely dilated (39mm).Venous AnatomyThe SVC and IVC drain normally into the right atrium.ShuntsThere is apparent left to right flow across the interatrial septum which suggests the presence of an interatrial septal defect. Qp:Qs is 2.4, supportive of significant L to R shunt. (Pulmonic flow 8.4L/min; Systemic flow 3.7L/min).PericardiumThere is a trivial pericardial effusion.Extracardiac FindingsDilated hepatic veins. 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. Normal size LV with normal systolic function (EF 59%). Interventricular septal flattening in systole which suggests RV pressure overload.2. Severe RV dilation with mildly reduced systolic function (EF 48%).3. Evidence of interatrial septal defect with Qp:Qs of 2.4 indicating significant L to R shunting. 4. Severe biatrial dilation. 5. Severe tricuspid regurgitation.6. Mild mitral regurgitation.7. Severely dilated main pulmonary artery.


Instruction: Generate impression based on findings.

Input: 57-year-old male with bilateral lower extremity weakness. Evaluate for spinal cord compression. The vertebral bodies are appropriate in the overall alignment and height. The spinal cord has normal signal characteristics and overall morphology. Mild degenerative changes are visualized within the lower cervical and lower lumbar spine but there is no central spinal canal stenosis or cord compromise. There is edema in the soft tissues around the facet complexes in the lower lumbar spine greater on the right which is similar to the prior exam and may be related to facet arthropathy.

Output: This is a limited exam specific for the exclusion of cord compression only and does not exclude more subtle lesions such as intrinsic cord abnormalities. Mild degenerative changes in cervical spine and changes related to facet arthropathy involving the lower lumbar spine. However there is no central spinal canal stenosis or cord compression.Due to the screening nature of this protocol details are not as evident on imaging as dedicated protocols of the spine.


Instruction: Generate impression based on findings.

Input: Female, 52 years old. Palpable nodule around left 2nd PIP There is an area of abnormal signal within the volar and ulnar subcutaneous soft tissues of the second finger adjacent to the PIP joint. This area measures approximately 5 x 3 x 8 m (series 1401, image 38; series 1501, image 30) with increased signal on T2-weighted images, decreased signal on T1-weighted images, and heterogeneous enhancement. No other focal abnormalities are noted in the soft tissues of the finger. The underlying osseous structures, tendons, and ligaments appear normal.

Output: An enhancing soft tissue mass within the subcutaneous tissues of the second finger near the PIP joint is nonspecific, but may reflect enhancing synovitis. However, a small soft tissue tumor cannot be excluded. Correlation with plain radiographs may be useful for further evaluation as clinically warranted.


Instruction: Generate impression based on findings.

Input: 66 years Male (DOB:3/6/1949)Reason: known HNP L4-5 pain resolved over 6 months with PT but he is left with EHL weakness and hamstring weakness. History: compare to previous MRI for disc material still present. Is surgery still an option to resolve weakness??PROVIDER/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. Overall the patient's lumbar spinal canal is relatively small on a congenital basis. The pedicles are thickened short .At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is a disc bulge present at this level associated with mild narrowing of the right neural foramen.At L4-5 there is a central disc protrusion present with disc material extending behind the adjacent endplates which compresses the thecal sac and effaces the fat at the lateral recess is bilaterally. Some disc material extends into the inferior aspects of the neural foramina. The exiting nerve roots within the neural foramina are surrounded by fat. Overall there is a moderate to severe degree of spinal stenosis present. Compared to prior exam this has not changed substantially.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is a diffuse disc bulge present at this level. Overall there is mild degree are spell stenosis at this level. Some disc material extends into the inferior aspects of the neural foramina. The exiting nerve roots within the neural foramina are surrounded by fat. At L2-3 there is no significant compromise to spinal canal or neural foramina. There is a diffuse disc bulge present at this level. Some disc material extends into the inferior aspects of the neural foramina. The exiting nerve roots within the neural foramina are surrounded by fat. At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.There are multilevel degenerative changes present lumbar spine worse at L4-5 where there is spinal stenosis resulting from disc extrusion. This appears stable compared to prior exam from July.


Instruction: Generate impression based on findings.

Input: 38-year-old female with maternal aunt 3 cousins with breast cancer at unknown age. History of benign right breast biopsy. The exam is moderately degraded by motion.Heterogenously dense breast parenchyma is noted. On postcontrast images, moderate parenchymal enhancement is seen bilaterally. There are multiple small benign morphology enhancing foci seen in both breasts that are mostly stable. In the right breast the biopsy-proven fibroadenoma at 2:00 measures 1.5 x 1 x 1.2 cm and previously measured 1.5 x 1 cm, not significantly changed. An additional small fibroadenoma at 10:00 in the right breast is also again noted without significant interval change. There are multiple bilateral cysts greater on the right as well as retained fluid within the ducts.No abnormal enhancement or suspicious mass is seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. Continued screening MRI and mammograms are recommended. Findings relayed to Dr. Cifu (pager 6608). BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram.


Instruction: Generate impression based on findings.

Input: 41-year-old with strong family history of breast cancer. Moderate to marked symmetric parenchymal enhancement is noted bilaterally, limiting this exam. Heterogeneously dense fibroglandular tissue is present. Numerous high T2 signal cysts are again seen. No suspicious enhancement is seen in either breast. No uniquely suspicious focus is seen, allowing for the high background enhancement. No abnormal axillary lymph nodes are identified in either axillary region.Presumed hepatic cyst again noted.

Output: No MRI evidence for malignancy. For future screening MRI, please schedule the exams during the second week of the patient's menstrual cycle to minimize the effects of background enhancement. BIRADS: 1 - Negative.RECOMMENDATION: NS - Routine Screening Mammogram.


Instruction: Generate impression based on findings.

Input: Other speech disturbances [R47.89], Reason for Study: ^Reason: any ischemic lesions? History: transient speech arrest No evidence of acute ischemic or hemorrhagic lesion on this scan.There are enlarged CSF spaces especially in front of bilateral cerebellar hemispheres without showing any evidence of cerebellar dysplasia, atrophy or other structural change. Thus, most likely explanation may include extra axial CSF collections such as arachnoid cyst. Multifocal lacunar infarctionUnderlying brain show multifocal patchy scattered high signal intensity lesions on bilateral periventricular white matter and centrum semiovale indicating non specific small vessel ischemic disease.The ventricles, sulci are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Extra axial CSF collections especially in front of bilateral cerebellar hemispheres suggest possible arachnoid cysts.2. Non specific small vessel ischemic disease.3. No acute ischemic or hemorrhagic lesion.


Instruction: Generate impression based on findings.

Input: 72-year-old male with elevated PSA, history of prostate cancer PELVIS:PROSTATE:Prostate Size: 6.0 x 3.9 x 6.0 cm.Peripheral Zone: Previously seen restricted focus measuring 4 x 5 mm in the right peripheral gland apex is again noted, unchanged. Central Gland: Marked degree of benign prostatic hypertrophy.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: No extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Clonic diverticulosis without evidence of diverticulitis.

Output: 1.Right apical lesion as described above demonstrates characteristics consistent with prostate cancer.


Instruction: Generate impression based on findings.

Input: 30 years Female (DOB:1/27/1986)Reason: Pain History: lumbago s/p MVAPROVIDER/ATTENDING NAME: RODERICK H. BIRNIE RODERICK H. BIRNIE 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. Thre are small Tarlov cysts in the sacral spinal canal.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is no significant compromise to spinal canal or neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: No compromise to lumbar spinal canal or neural foramina.


Instruction: Generate impression based on findings.

Input: Male, 30 years old, with pseudomeningocele, follow-up for changes. Alignment is anatomic. Vertebral body height and morphology are within normal limits. No evidence of marrow replacement or marrow edema is seen. The distal spinal cord, conus and nerve is the cord and cauda equina are within normal limits. No epidural abnormalities are suspected. No paraspinal collections are seen. The intervertebral discs are preserved. No significant compromise of the spinal canal or neural foramina is seen. Mild facet arthropathy is evident at L5-S1.

Output: No significant abnormalities are detected in the lumbar spine.


Instruction: Generate impression based on findings.

Input: 16 year old girl with history of left knee osteochondral defect and intra-articular loose body, presenting with continued left knee pain. MENISCI: There is marked attenuation of the anterior horn and body of the lateral meniscus. As the previous study showed a discoid lateral meniscus, the meniscal attenuation seen on the current study likely in part reflects interval surgery. However, there is also obliquely oriented signal extending through the junction of the body and posterior horn, compatible with a tear, and we suspect that the attenuation of the remainder of the body of the lateral meniscus as well as the anterior horn also in part reflects chronic attritional tearing. Blunting of the free edge of the posterior horn of the lateral meniscus may also represent prior surgery. There is a cyst along the posterior horn of the medial meniscus that appears to arise from its peripheral fibers. Horizontally oriented linear signal within the posterior body of the medial meniscus extending to the femoral articular surface seen on a single MRI slice may represent a horizontal tear. ARTICULAR CARTILAGE AND BONE: Cortically-based intramedullary low signal intensity within the distal femoral metaphysis posteriorly likely represents a healed nonossifying fibroma. As seen on prior radiographs, there is an osteochondral defect of the weightbearing portion of the lateral femoral condyle with heterogeneity of the overlying cartilage. The osteochondral defect measures approximately 1.4cm in greatest dimension. There is an ovoid loose body situated anterior to the lateral meniscus, which measures just over 1cm in greatest dimension. The articular cartilage of the medial tibiofemoral compartment appears normal, as does that of the patellofemoral compartment. LIGAMENTS: Anterior and posterior cruciate ligaments are intact. Medial collateral ligament and lateral collateral ligament complex are intact. EXTENSOR MECHANISM: Quadriceps tendon and patellar tendon are intact.ADDITIONAL

Output: 1.Osteochondral defect of the lateral femoral condyle with intra-articular loose body.2.Lateral meniscal abnormalities described above likely representing a combination of tearing and prior surgery for discoid meniscus.3.Parameniscal cyst that appears to arise from the posterior horn of the medial meniscus, possibly associated with a horizontal tear.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for infection. Signs and symptoms: Meningitis, post infection, stopped antibiotic one week ago now with headaches and low grade temperature. Pre-and post-enhanced brain MRI:Diffusion-weighted images are extensively obscured by metallic artifact ( large aneurysm clips) which partially also a few incisional left craniectomy. Within this limitation there is no evidence of restricted diffusion. The extra-axial fluid collection at the surgical site also is negative for any restricted diffusion.Flair and T2 weighted images demonstrate mild dilatation of lateral ventricles (right greater than left. There is a focus of encephalomalacia in the right posterior temporal and occipital lobe with ex vacuo dilatation of trigone and occipital horn of right lateral ventricle similar to multiple prior CT exams. There is a large left anterior frontal and temporal craniectomy. There is a CSF signal intensity epidural collection at the site measuring maximum of 21 mm in transverse axis and 43 mm in AP. The adjacent parenchyma demonstrates no evidence of any inflammatory/edematous changes. This finding applies subtle mass effect on the left anterior frontal lobe. Post-enhanced images demonstrate expected pain uniform enhancement of dura and a thin uniform enhancement of lateral soft tissue boundary of fluid collection. Overlapping soft tissues demonstrate no edematous changes and adjacent native calvarial bone demonstrate no evidence edematous changes. There is no evidence of interval change in the size of this collection since prior head CT exam from 24 hours earlier. Based on findings on this exam there is no convincing evidence of an infectious process present however the extra-axial collection is superficially located and accessible for aspiration biopsy if clinically deemed necessary.Additionally there is a small left anterior frontal subdural collection which extends from the anterior edge of craniectomy medially and reaching the falx. This finding demonstrates a tiny linear enhancement along its dorsal edge. It measures approximately 32 mm in transverse axis and axial view and 6.7-mm in thickness. The finding results in very subtle flattening of the adjacent brain parenchyma.

Output: 1.No diffusion-weighted abnormality although this sequence is severely compromised due to metallic artifact from aneurysm clips on the left.2.CSF signal intensity extra axial epidural collection in the left anterior frontal -- temporal lobe with very thin rim of enhancement is highly suggestive of post operative change and findings are not highly suggestive of an infectious process however this collection can be directly aspirated for analysis if clinically deemed necessary. Please see detailed report above.3.Tiny extra-axial left anterior frontal subdural collection as detailed.4.Stable size of ventricular system and large area of encephalomalacia in the right posterior temporal -- occipital region at the site of previously treated AVM. 5.No areas of abnormal enhancement of brain parenchymal for the pia meninges.


Instruction: Generate impression based on findings.

Input: Left knee pain MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: There is a 1.4 cm full-thickness articular cartilage defect of the lateral femoral trochlea anteriorly with additional areas of near full-thickness loss and associated underlying subchondral marrow edema. The articular cartilage of the patella demonstrates areas of heterogeneity but no full-thickness loss. The articular cartilage of the weightbearing portions of the lateral compartment appears spared as does the articular cartilage of the medial compartment. LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Full-thickness articular cartilage defect of the lateral femoral trochlea with additional areas of near full-thickness loss and associated marrow edema.2. Possible mild strain of the semimembranosus.3. Intact medial and lateral menisci.


Instruction: Generate impression based on findings.

Input: 6-year-old with history of astrocytoma status post craniotomy and chemotherapy. Interval follow-up exam. Postsurgical changes involving the right posterior fossa. Redemonstration of a predominantly extra-axial soft tissue mass at the right cerebellar pontine angle without significant enhancement. Accounting for differences in slice selection through the mass, this is not significantly changed measuring 3.4 x 1.7 cm (series 801 image 19), previously 3.2 x 2.2 cm. The mass crosses midline and encases the vertebral artery. Inferiorly it tracks along the posterolateral aspect of the spinal cord and beyond the field-of-view of this exam. These more inferior components are partially cystic. Anterosuperiorly there is stable extension into the right Meckel's cave and right internal auditory canal.Unchanged right parietal ventriculostomy catheter which approaches midline. The ventricles and sulci are stable and not enlarged. The cisterns remain patent. Normal intravascular flow voids are preserved. New severe opacification of the maxillary and sphenoid sinuses as well as new partial opacification of the right mastoid air cells.

Output: 1. Stable appearance of predominantly extra-axial right posterior fossa juvenile pilocytic astrocytoma with extension inferiorly through the foramen magnum and anterolaterally through the skull base foramina.2. Stable appearance of the supratentorial brain without additional suspicious lesion.3. New marked opacification of the paranasal sinuses and right mastoid air cells; correlate for symptoms of sinusitis.


Instruction: Generate impression based on findings.

Input: Signs and symptoms: History of meningioma. Syncopal episode today, balance problem for one week. Clinical question: Change of meningioma. Non-infused CT of brain:Small partially calcific meningioma along the right petroclinoid ligament is identified. Non-infused study is significantly less sensitive for detection of true measurements of meningioma. On this non-infused study meningioma measures approximately 13.7 mm in AP access and 10.6-mm in transverse axis (axial image 8). Considering the significant difference between the two studies of CT of brain today an MRI from 8 -- 28 -- 2009 no significant interval change can be appreciated. This mass is in contact with the right aspect of the pons with minimal flattening. This was noted on prior study as well. There is no evidence of edema of brain parenchyma adjacent to the meningioma. This non-infused CT examination of brain also demonstrates findings consistent with small vessel disease of indeterminate age. No intracranial hemorrhage is detected.

Output: 1.Small vessel disease of indeterminate age.2.Stable right petroclinoid meningioma and B. no appreciable change since prior MRI study. Please see above comments.3.No acute intracranial findings.


Instruction: Generate impression based on findings.

Input: 40 years, Female, Reason: 40 History: 40 with chrons and abnl LFT r/o PSC. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: There is geographic regions of its hyperenhancement and T2 hyperintensity likely represent fibrosis. There is diffuse hepatic steatosis. Lesion the right hepatic lobe measuring 1.6 x 1.0 cm (13/36) peripheral nodular centripetal enhancement, likely hemangioma.There may be minimal stricturing in the proximal common bile duct, however there is no significant intrahepatic biliary ductal dilatation. The right hepatic bile duct is poorly filled with contrast.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Hepatic steatosis and fibrosis.2.Minimal narrowing of the proximal common bile left. The right hepatic ducts is not well-visualized. While the appearance is not classic for primary sclerosing cholangitis, could represent early findingsI personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Disorder of brain, unspecified [G93.9], Reason for Study: ^Reason: preoperative eval, mri under anesthesia History: preoperative eval, mri under anesthesia Multiple fiducial markers attached on the scalp for the preparation of image guided surgical planning.Redemonstration of right parietal craniotomy with right high parietal resection cavity with diffuse infiltrative intra axial mass and focal enhancing lesions especially mesial anterior aspect of the resection cavity, unchanged since prior scan.Surrounding edema which effacing right lateral ventricle is again seen, unchanged.There are new enhancing lesions on the right side midbrain.Mass effects with midline shift toward left side is again seen, unchanged.

Output: Preoperative MR scan with contrast enhancement shows new development of nodular enhancement on the right side midbrain.Diffuse infiltrative intraaxial lesion with focal enhancement as well as prior resection status of the right parietal lobe are seen, unchanged since prior scan.


Instruction: Generate impression based on findings.

Input: 13-year-old male with perianal Crohn's; evaluate for perianal fistula or abscess PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Bowel wall thickening and enhancement of the rectosigmoid colon with high T2 signal in the surrounding fat tissues consistent with inflammatory changes and edema. BONES, SOFT TISSUES: Previously described ischiorectal fossa abscess has resolved with minimal scarring in the area. No enhancement or diffusion restriction is present in the ishiorectal fossa. Low T1 signal and intermediate T2 signal in the area of the previously noted abscess likely represent scarring. No residual fluid collection. No new abscess noted.OTHER: Minimal free fluid is present.

Output: 1.Bowel wall thickening, edema, and adjacent inflammatory changes of the rectosigmoid colon.2.Interval resolution of ischiorectal fossa abscess. No new abscess is identified.


Instruction: Generate impression based on findings.

Input: Evaluate for ACL and/or medial meniscus tear. Lachman 2b, medial joint line tenderness, possible right. Injury 7/12/2015. MENISCI: There is multidirectional tearing of the posterior horn of the medial meniscus, with longitudinal component extending to the anterior horn and flipped bucket-handle fragment seen within the intercondylar notch. The lateral meniscus demonstrates normal morphology and signal characteristics without evidence of discrete tear.ARTICULAR CARTILAGE AND BONE: The articular cartilage in the medial, lateral, and patellofemoral compartments appears intact. There is patchy increased marrow signal in the distal femoral diaphysis and proximal tibial metaphysis, which may reflect red marrow changes. In addition, however, there are more focal areas of bone marrow edema in the anterior lateral femoral condyle and anterior tibial plateau, suggestive of contusions.LIGAMENTS: There is increased signal and thickening of the ACL with some fibers remaining intact, suggesting partial tear. There is increased fluid signal surrounding the medial collateral ligament, which may represent MCL sprain in the setting of acute trauma, or otherwise may simply reflect medial compartment pathology.EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Complex tearing of the posterior horn of the medial meniscus, including flipped bucket-handle fragment, partial ACL tear, and other findings as above.


Instruction: Generate impression based on findings.

Input: Low back pain radiating to the left lower extremity. There is mild degenerative spondylosis of the lower lumbar spine, with mild bilateral L4-5 and left L5-S1 neural foraminal stenosis, but no significant spinal canal stenosis. The vertebral column alignment is within normal limits. The vertebral body heights are preserved. The vertebral bone marrow signal is unremarkable. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable. There are bilateral physiologic ovarian cysts.

Output: Mild degenerative spondylosis of the lower lumbar spine, with mild bilateral L4-5 and left L5-S1 neural foraminal stenosis, but no significant spinal canal stenosis.


Instruction: Generate impression based on findings.

Input: Shoulder pain. Concern for rotator cuff tear. ROTATOR CUFF: There is a partial thickness articular surface tear of the distal supraspinatus tendon without retraction. There is no muscle atrophy. The infraspinatus, teres minor, and subscapularis muscles/tendons are intact. SUPRASPINATUS OUTLET: There is non-visualization of the coracohumeral ligament and obliteration of the subcoracoid fat consistent with adhesive capsulitis. The acromioclavicular joint is normal in appearance. There is a small amount of fluid in the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral joint alignment is within normal limits. Subchondral cysts are noted within the humeral head. The labrum is grossly intact. BICEPS TENDON: The biceps tendon is intact. ADDITIONAL

Output: 1. Findings consistent with adhesive capsulitis.2. Partial thickness tear of the supraspinatus tendon.


Instruction: Generate impression based on findings.

Input: The risks (including, but not limited to, those of bleeding, infection, allergic reaction, temporary nerve block, pain, and inability to access the joint) and benefits of the procedure were explained to the patient, and informed written consent was obtained. A pre-procedural “time-out” form was completed.The patient was placed supine on the fluoroscopy table. The right wrist was localized fluoroscopically, and a spot radiograph was obtained. The course of the femoral artery was noted on the patient's skin using an ink marker. The skin was cleansed and covered with a sterile drape. The skin and subcutaneous tissues were anesthetized with 1% lidocaine using 25-gauge.Under fluoroscopic guidance, a 21-gauge spinal needle was advanced into the joint. Next, 5 ml of a 50/50 mixture of Omnipaque 240 (to confirm the intra-articular position of the needle) and dilute Multihance (0.1 cc in a 10 cc vial of saline, for subsequent MR imaging) were injected into the joint. Contrast opacified the joint in the expected manner. A spot radiograph was obtained for documentation. The needle was withdrawn. Blood loss was negligible (<1cc), and patient tolerated the procedure well without immediate complication. An adhesive bandage was placed on the patient’s skin. Routine post procedure instructions were communicated to the patient. The patient was escorted to the MRI suite for further imaging in stable condition. Please refer to the subsequent MRI report for further information.Exposure time: 56 seconds

Output: Successful right wrist arthrogram in preparation for MRI.


Instruction: Generate impression based on findings.

Input: Cervicalgia [M54.2], Reason for Study: ^Reason: eval degenerative disease History: distal numbness and tingling despite carpal tunnel release There is normal cervical lordosis. The cranial-cervical junction is normal. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The cord signal is normal. Degenerative changes are specified by the intervertebral level as follows: C2-C3: no neuroforaminal narrowing or spinal stenosis. C3-C4: no neuroforaminal narrowing or spinal stenosis. C4-C5: no neuroforaminal narrowing or spinal stenosis. C5-C6: there is minimal bulging of disc toward right side lateral recess without definitive evidence of nerve root compression. no spinal stenosis is seen. C6-C7: no neuroforaminal narrowing or spinal stenosis. C7-T1: no neuroforaminal narrowing or spinal stenosis.

Output: 1. Minimal focal bulging of disc at the level of C56 toward left side lateral recess as described above.2. Otherwise unremarkable C spine MRI.


Instruction: Generate impression based on findings.

Input: 30-month-old female with history of neonatal infections for evaluation of femur and proximal tibiaEXAMINATION: MRI pelvis, right femur, left femur without IV contrast 12/22/2016 Left femur: A left coxa vara deformity is noted with dysplastic, nonossified femoral head. The left femoral head is mildly laterally and superiorly displaced with moderate uncovering. The left acetabulum appears shallow with asymmetric expansion of fibrofatty pulvinar when compared to the right. No hip joint effusion is present. There is mild irregularity and slanted appearance of the proximal tibial physis along the medial aspect suggestive of growth arrest at the medial aspect. No knee joint effusion is present. No abnormal signal is noted within the musculature and soft tissues.Right femur: The right femoral head is well directed towards the acetabulum. No evidence of dislocation. The right femur is bowed and externally rotated appearing similar to that seen on the prior radiographs. There is mild irregularity and uneven appearance at the distal femoral physis along the lateral aspect suggestive of growth arrest at the lateral aspect. The right distal femoral epiphyseal ossification center is smaller relative to the contralateral side. No hip or knee joint effusion is present. No abnormal signal is noted within the musculature and soft tissues.The visualized portions of the pelvis are within normal limits.

Output: 1.Bowing and external rotation of the right femur with irregular appearance of the distal femoral physis suggestive of a growth arrest at the lateral aspect.2.Mildly dysplastic left acetabulum and nonossified and dysplastic left femoral head with coxa vara deformity.3.Irregular appearance of the proximal left tibial physis suggestive of growth arrest at the medial aspect.


Instruction: Generate impression based on findings.

Input: Tuberous sclerosis [Q85.1], Reason for Study: ^Reason: evaluate cortical tubers, SEN, SEGA History: tuberous sclerosis Multifocal bihemispheric cortical tubers involving bilateral frontal and parietal lobes (left greater than right) appear to be stable without evidence of enhancement, thus unchanged since prior scan.There are two susceptibility lesions on the left lateral ventricle and both show evidence of enhancement; one on the ependymal surface of the left lateral ventricle frontal horn, caudate head area and another on the ependymal surface of the left side foramen of Monroe area. Both were seen on prior scans and the both nodules showed enhancement (the former greater than the latter) on prior scans. Thus, unchanged MR characteristics and size since prior scan. The right frontal lobe DVA is again seen, unchanged since prior scan.No evidence of acute ischemic or hemorrhagic lesion.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. Evidence of bilateral frontal and right temporal craniotomy, unchanged since prior scan.The paranasal sinuses and mastoid air cells are clear.

Output: Unchanged multifocal cortical tubers as described above.Stable size and MR characteristics including enhancement pattern of two subependymal nodules on the ependymal surface of the left lateral ventricle frontal horn.


Instruction: Generate impression based on findings.

Input: Reason: syrinx History: abd pain Thoracic spine:Alignment is anatomic. Vertebral body heights and discs are intact. No abnormal marrow signal. No abnormal signal within the cord. No abnormal enhancement. No significant spinal or neural foraminal narrowing.Lumbar spine:Please note that there are 4 lumbar vertebrae identified, counting from C2 down.Alignment is anatomic. No abnormal marrow signal. Disc desiccation is noted at L2-L3, L3-L4 and L4 S1. No abnormal signal in the distal cord or conus which ends at T12-L1. Mild mid endplate depression along inferior aspect of L4.T12-L1: No significant disc disease. No spinal canal or neural foraminal stenosis.L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: No significant disc disease. No spinal canal or neural foraminal stenosis.L4-S1: Mild diffuse disc bulge with a small right paracentral protrusion and small annular fissure. No spinal canal or neural foraminal stenosis.Paraspinous soft tissues are within normal limits.

Output: Minimal disc degeneration at L4-S1 without evidence of syrinx or significant spinal or neuroforaminal narrowing.


Instruction: Generate impression based on findings.

Input: 2-year-old with history of brain abscess and hemorrhage. Follow-up exam. There is decrease in size of the right temporo-occipital region hemorrhagic lesion, which now measures approximately 8 x 4 mm, previously 12 x 8 mm. There is a stable to slightly decreased focus of enhancement in the left inferior parietal lobule. There are unchanged scattered punctate foci of susceptibility within the cerebellum. The ventricles are unchanged in size and there is no midline shift. There is no evidence of acute infarction. The skull and extracranial structures are unchanged.

Output: 1. Expected interval evolution of the right temporo-occipital region intraparenchymal hemorrhagic lesion.2. Stable to slight decrease in size of a punctate focus of enhancement in the left inferior parietal lobule.3. Unchanged punctate microhemorrhages or calcifications in the cerebellum.


Instruction: Generate impression based on findings.

Input: Diagnosis: Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with complex partial seizures, not intractable, without status epilepticus Temporal sclerosisClinical question: h/o epilepsy s/p hippocampal laser ablationSigns and Symptoms: surveillance The patient is status post bilateral parietal bone and right temporal bone burr hole placement. There are T2 and FLAIR hyperintense tracts extending from the burr holes into the brain parenchyma.There is redemonstration of an irregularly shaped ring-enhancing lesions located in the right hippocampal head together which is smaller on the current exam compared to the prior exam and associated with enlargement of the temporal horn of the right lateral ventricle.. This was also present on prior exam from 7/17/2015. On FLAIR MRI imaging it is low signal centrally and high signal peripherally. It is smaller on the current exam compared to the prior. On FLAIR imaging axial dimensions are currently 13 x 8 mm and previously were 19 x 14 mm. There is no evidence for diffusion restriction associated with it.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: There is a ring-enhancing lesion present in the right hippocampus. Since the prior exam it has decreased in dimensions. Most likely this represents posttreatment effect.


Instruction: Generate impression based on findings.

Input: Evaluate for structural abnormality: New onset seizure, abnormal EEG, headache. Dental brace artifact degraded some of the sequences. Within this limitation, there is no definite evidence of heterotopia, intracranial hemorrhage, mass, or acute infarct. The brain parenchyma, including the bilateral hippocampi, appears unremarkable. The brainstem and cerebellum are also 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, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No definite evidence of potential seizure foci, although some of the images are undermined by dental brace artifact.


Instruction: Generate impression based on findings.

Input: Male, 22 years old, with left insular brain lesion and headache, preoperative fusion protocol. Redemonstrated is the patient's T2 hyperintense, nonenhancing left insular lesion. Cavum septum et vergae is redemonstrated. Expected vascular flow-voids are demonstrated. Sporadic mucosal thickening is noted within maxillary and left ethmoid air cells without superimposed fluid levels. Bilateral mastoid air cells are clear.

Output: Redemonstrated is the patient's T2 hyperintense, nonenhancing left insular lesion.


Instruction: Generate impression based on findings.

Input: Clinical question: NSCLC restaging. Signs and symptoms: As above. Pre-and post-enhanced brain MRI:No diffusion weighted abnormalities.Examination demonstrates interval further decreased size of metastatic lesions since prior study. On the current exam there is only a single detectable metastatic lesion in the subcortical white matter of right frontal lobe measuring approximately 2.6 mm in size (axial post enhanced series 12 image 175) which previously measured at 4-mm. A 1 mm punctate focus of enhancement in the left cerebellum consistent with residual metastatic lesion which previously measured at 3.3-mm.there is no convincing evidence of any additional detectable metastatic lesions. Multiple small foci of flair hyperintensity in periventricular and subcortical white matter of bilateral cerebral hemispheres demonstrate no change. The findings could represent posttreatment/radiation changes.Unremarkable calvarium and orbits without evidence of abnormal enhancement.All paranasal sinuses demonstrate normal pneumatization signal pattern.

Output: 1.Negative diffusion weighted images.2.Further improvement of metastatic disease since prior exam as detailed. Some of the smaller lesions are no longer identified. Visualized remaining metastatic lesions are smaller than prior exam. Please see above comments as/measurements.3.Stable nonspecific periventricular and subcortical flair hyperintensity which could represent post treatment/radiation change.


Instruction: Generate impression based on findings.

Input: 59 year-old BRCA1 positive with family history of breast and ovarian cancer. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally. A few small high T2 signal cysts are seen. Mild motion artifact is noted on subtraction images. No suspicious 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, evaluate for progression of periventricular signal abnormality. Again seen is aconfluent hyperintense T2/flair signal in the bilateral centrum semiovale, corona radiata and basal ganglia, including a focus of CSF-like signal in the right centrum semiovale, which have been unchanged in extent since prior exam. There is however a T2 hyperintense focus/cystic encephalomalacia involving the left frontal corona radiata, axial T2 image 19 of series 7 which appears new since prior. There is also a prominent focus of susceptibility effect along the upper aspect of the left caudate head which is not seen on the prior study. There is a tiny focus of susceptibility within this region on the prior study. Punctate focus of susceptibility in the left posterior frontal corona radiata is not definitively seen on prior and may be new although differences in susceptibility-weighting technique limit direct comparison. No evidence of acute infarct, acute hemorrhage, intracranial mass or mass effect. No hydrocephalus. No extra-axial collections. Extracranial soft tissues structures are unremarkable. Mucous retention cysts again seen in the left greater than right maxillary sinuses.

Output: Extensive white matter signal abnormality is largely stable compared to 2/26/2010; however, there is small focus of cystic encephalomalacia involving the left frontal corona radiata and an adjacent chronic hemorrhage which appear new, suggesting mild progression of disease. Differential is broad but favor advanced chronic small vessel ischemic disease. Given a patient's age, entities such as Binswanger and CADASIL could be considered, for example; although characteristic anterior temporal lesions associated with CADASIL are not seen. Other white matter diseases such as chronic demyelinating disease are also in the differential although felt to be less likely.


Instruction: Generate impression based on findings.

Input: Male 57 years old Reason: please evaluate for local spread of disease History: biopsy proven rectal cancer. EPIC Pathology OSH Report: 6/2/15 colonoscopy. 8 mm sessile polyp in cecum. 8 mm sessile polyp in hepatic flexure. 1.4 cm sessile polyp with central ulcerations in rectum at 3 cm from anal verge. Diverticuli in left colon, Internal hemorrhoids. 6/2/15 cecal polyp fragments of tubular adenoma. Hepatic flexure polyp tubular adenoma. Rectal polyp moderately differentiated adenocarcinoma arising in an adenomatous polyp. Overall image quality: ExcellentPELVIS:PROSTATE/SEMINAL VESICLES: Abnormal signal in the anterior mid-gland of the prostate is suboptimally evaluated on this large field MRI.BLADDER: No significant abnormality noted. LYMPH NODES: No suspicious mesorectal lymph nodes.Lymph nodes in the perirectal space, within the mesorectal fascia: N/ALymph nodes outside the mesorectal fascia: N/ABOWEL, MESENTERY: Rectal Tumor: No abnormal focal wall thickening or post-contrast enhancement is evident. No residual abnormality is evident.Size: N/ATumor appearance on T2-weighted images: N/ATumor location: N/A(For lower rectal tumors): N/ADistance of the lower edge of the tumor to the anal verge (lower edge of the anal canal): N/ADistance of the lower edge of the tumor to the pelvic floor (relationship of the tumor to the anal sphincter complex): N/ACircumference of the rectum involved: N/ARelationship and proximity of the tumor to adjacent structures (prostate, seminal vesicles): N/AMRI T-stage: N/ATumor Distance to Mesorectal Fascia: N/A BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No abnormal focal wall thickening or post-contrast enhancement is evident. No residual abnormality is evident in the region of the reported cancerous polyp resection. No pelvic lymphadenopathy.2.Signal abnormality in the anterior mid-gland of the prostate is suboptimally evaluated on this large field MRI. Correlation with PSA is recommended.


Instruction: Generate impression based on findings.

Input: Knee pain, history of microfracture surgery MENISCI: There is increased signal within the anterior horn of the lateral meniscus suggesting intrasubstance degeneration although no discrete tear is identified. The medial meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is thinning of the articular cartilage of the medial compartment although no discrete full-thickness defect is identified. Moderate diffuse thinning of the patellar cartilage is noted with areas of partial-thickness defects seen laterally. There is near full-thickness loss of the articular cartilage of the femoral trochlea. A small focus of marrow changes noted within the lateral tibial plateau may relate to the area of prior intervention.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: Mildly increased signal is noted within the patellar tendon which may reflect mild tendinosis.ADDITIONAL

Output: Moderate articular cartilage loss of the patellofemoral compartment with milder changes noted in the medial and lateral compartments. Remaining internal structures of the knee are otherwise intact.


Instruction: Generate impression based on findings.

Input: 47 years Male (DOB:2/15/1969)Reason: stroke evaluation History: L sided numbness/tinglingPROVIDER/ATTENDING NAME: DIANE B CHANEY CHRISTOPHER M GOMEZ MRI of the brainNo diffusion weighted abnormalities are appreciated.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.The CSF spaces are appropriate for the patient's stated age with no midline shift. No 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.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. The posterior communicating arteries are intact. MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries. Left common carotid artery originates from the innominate artery.

Output: 1.There is no evidence for acute ischemic cerebral infarction appreciated.2.There is no evidence for extracranial cerebrovascular occlusive disease.3.There is no evidence for intracranial cerebrovascular occlusive disease.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: Prostate cancer. PSA 7.0. Outside biopsy right base adenocarcinoma (Gleason 6). PELVIS:PROSTATE:Prostate Size: The prostate measures 4.4 x 3.9 cm.Peripheral Zone: There is an enhancing T2 hypointense subcentimeter lesion within the right mid peripheral zone that restricts diffusion, measuring 0.7 x 0.5 cm (series 1801, image 95), suspicious for carcinoma.Central Gland: The transition zone is nodular in appearance, compatible with benign prostatic hyperplasia.Seminal Vesicles: The seminal vesicles are normal in appearance.Extracapsular Extension: NoneBLADDER: No significant abnormality noted.LYMPH NODES: Mildly enlarged nonspecific bilateral external iliac lymph nodes. Representative right external iliac lymph and measures 1.6 x 1.0 cm (series 2101, image 87). BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Subcentimeter lesion within the right mid gland peripheral zone, suspicious for malignancy. No evidence of seminal vesicle invasion or extracapsular extension.


Instruction: Generate impression based on findings.

Input: 21 weeks pregnant with anhydramnios on prenatal screening. Evaluate for renal agenesis. PELVIS:UTERUS, ADNEXA: An intrauterine gestation is identified. Limited imaging was performed to evaluate the kidneys. No kidneys or ureters are identified. Bladder is not well identified. There is a paucity of amniotic fluid, compatible with oligohydramnios. Brain development appears normal for fetal age, without gross abnormality.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Limited examination to evaluate for renal agenesis.Renal agenesis. Bladder not visualized as above. Oligohydramnios. Findings discussed with Dr. Ismail at 12:13pm on 1/27/2016


Instruction: Generate impression based on findings.

Input: 22 years Female (DOB:3/2/1994)Reason: chiari malformation s/p decompression, post op follow up MRI , new symptoms after surgery, please do with csf flow study History: new neck pain after surgeryPROVIDER/ATTENDING NAME: DAVID M. FRIM DAVID M. FRIM MRI brain:The patient is status post suboccipital craniectomy and removal of the posterior arch of C1 for Chiari decompression.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.The left vertebral artery ends in the left posterior inferior cerebellar artery which has a coarse echoes down to the C1-2 level.A normal biphasic flow is present at the level of foramen magnum.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.Status post posterior fossa surgery and C1 surgery for Chiari decompression. There is no evidence for obstruction at the level of the foramen magnum. There is no syrinx or ventriculomegaly appreciated.2.Low-lying left posterior inferior cerebellar artery.


Instruction: Generate impression based on findings.

Input: 55-year-old female with known IDC in the left breast on chemotherapy presents for I-SPY 2 research MRI #3. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.RIGHT BREAST:The index mass currently measures 11 x 10 x 10 mm (previously 15 x 16 x 14 mm).Anterior satellite mass is not visualized. A small enhancing focus (5mm) located medially and superiorly to the index mass remains. Small enhancing masses medial to the index mass are no longer visualized along the pectoralis muscle. Areas of chest wall enhancement are not seen. The non-mass enhancement due to biopsy becomes less enhancing.LEFT BREAST:No abnormal enhancement is seen in the left breast. AXILLAE:No abnormal axillary lymph nodes are identified in either axillary region.OTHERS:Scattered high T2 liver lesions are not significantly changed.

Output: 1. Interval decrease of index cancer in the right breast.2. Additional enhancing lesions in the right breast and chest wall are no longer visualized, except for the enhancing focus located medially and superiorly to the index mass.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Left hip pain Osseous structures: The signal intensity of the bone marrow throughout the pelvis is normal. Mild osteoarthritis affects the hips bilaterally.Muscles: There is mild muscle atrophy which is commensurate for the patient's age. A more focal area of edema is noted within the fibers of the left gluteus maximus which is nonspecific in nature.Soft tissues: There is mild subcutaneous edema particularly posteriorly and to the right of midline. This is nonspecific in nature. There is also mild intermuscular edema bilaterally which is also nonspecific. A trace amount of free fluid is noted within the pelvis.Following contrast administration, there is no abnormal enhancement or evidence of enhancing mass.

Output: Mild osteoarthritis of the hips with mild nonspecific soft tissue edema. Otherwise there are no specific findings to account for the patient's radiculopathy.


Instruction: Generate impression based on findings.

Input: Ms. Pistorio is a 31-year-old female with a personal history of left triple negative breast cancer, with left axillary metastatic lymph nodes, status post neoadjuvant chemotherapy. She presents today for MRI evaluation to assess for treatment response. I-Spy trial MRI #4. There is extreme amount of fibroglandular tissuein both breasts. Moderate background parenchymal enhancement is noted bilaterally, which limits the sensitivity of this examination.LEFT BREAST: The known index malignancy in the left axillary tail no longer enhances on this examination. However, there are several enhancing foci/masses seen extending inferiorly, the largest one of which measures approximately 0.9 x 0.7 x 1.0 cm, previously measuring 0.9 x 0.5 x 0.9 cm. Susceptibility artifact from a hydromark biopsy clip is again noted lateral to this lesion. The total span of abnormal enhancement (of the residual enhancing foci/masses) measures approximately 4.9 cm in the AP oblique dimension, previously measuring 5.1 cm. However, the total span of enhancement including the biopsy marker clip from index malignancy and residual enhancing foci/masses measures approximately 6.9 cm. This corresponds to the mammographically-identified distance between the index malignancy biopsy marker clip and satellite lesion biopsy marker clip of 7.2 cm.In the left axilla, the biopsy proven lymph node now measures 0.9 cm, compared to 0.9 cm. RIGHT BREAST: Several benign enhancing foci/masses are again seen in the right breast, and stable when compared to prior MRI examinations. There is no new abnormal enhancement within the right breast. No abnormal right axillary lymph nodes are identified.

Output: (1) Interval decrease in enhancement of left axillary tail index malignancy. Total span of abnormal enhancement (of residual enhancing foci/masses), measures approximately 4.9 cm. Total span of abnormal enhancement (including biopsy marker clip from index malignancy + residual enhancing foci/masses), measures approximately 6.9 cm. Any breast conservation therapy would have to include both biopsy marker clips (index + satellite) which are currently separated by approximately 7 cm (on both MRI and mammogram). (2) Stable size and appearance of metastatic left axillary lymph node.(3) No MRI evidence of malignancy of the right breast. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Right hemispheric glioblastoma. Had open biopsy showing residual tumor and significant amounts of necrosis. Initially underwent a resection (11/18/11) and received RT/TMZ (12/11 to 01/12). There are postoperative findings related to right frontoparietal craniotomy. There is a heterogeneously enhancing mass with areas of restricted diffusion involving the right frontal lobe, insula, basal ganglia, and temporal and parietal lobes, with extension across the corpus callosum, which measures up to 10.5 cm, previously 9.5 cm. There more pronounced enhancement in the tumor and increased regional mass effect with effacement of the right lateral ventricle. The confluent T2 hyperintensity surrounding the enhancing tumor has minimally increased in extent. There is approximately 10 mm of midline shift to the left and mild right uncal and subfalcine herniation. There is no evidence of acute territorial infarction. The extracranial structures are unchanged.

Output: Continued increase in size of the tumor involving much of the right cerebral hemisphere.


Instruction: Generate impression based on findings.

Input: 59 year-old female with left knee pain, concern for meniscal tear MENISCI: There is extrusion of the anterior horn of the medial meniscus with an underlying flap of meniscal tissue representing a displaced flap tear. The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is complete loss of the articular cartilage along the weight-bearing portion of the medial femoral condyle and medial tibial plateau with underlying reactive marrow changes. There is otherwise intact articular cartilage apart from minimal articular cartilage degeneration along the medial patella facet.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The quadriceps and patella tendons are intact.ADDITIONAL

Output: 1. Tear of the anterior horn of the medial meniscus with displaced flap underlying the extruded anterior horn.2. Complete loss of articular cartilage along the weight bearing portions of the medial tibiofemoral joint compartment3. Moderate joint effusion.


Instruction: Generate impression based on findings.

Input: 56-year-old male with history of L4-5 spondylolisthesis with right lower extremity radiculopathy. There is approximately 5 mm of anterolisthesis of L4 on L5 and 6 mm of retrolisthesis of L5 on S1. There are chronic bilateral pars defects at L4. The vertebral body heights are intact. The conus medullaris is mildly low lying, terminating at the level of L2-3. The paraspinous soft tissues are grossly unremarkable. There are multilevel degenerative changes:L1-L2: No significant disc disease. No spinal canal or neuroforaminal stenosis.L2-L3: Mild disc bulge. No spinal canal or neuroforaminal stenosis.L3-L4: Mild disc bulge. No spinal canal or neuroforaminal stenosis.L4-L5: Disc uncovering and bulging with an extruded component extending cranially within the midline ventral epidural space. There is moderate to severe neuroforaminal canal stenosis at this level. No significant spinal canal stenosis. There is also facet arthropathy and a medial subcentimeter right synovial cyst that appears to impinge upon the adjacent nerve roots.L5-S1: There is a disc bulge resulting in moderate bilateral neuroforaminal stenosis. No significant spinal canal stenosis. Moderate facet arthropathy and bilateral facet joint effusions.

Output: 1. Bilateral L4 spondylolysis with grade 1 anterolisthesis of L4 on L5 and moderate to severe bilateral neuroforaminal stenosis. Advanced facet arthropathy is present at this level as well, with an associated subcentimeter right synovial cyst.2. An L5-S1 disc bulge results in moderate bilateral neuroforaminal narrowing. Advanced facet arthropathy is present at this level as well.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Diagnosis: Tuberous sclerosis. Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with complex partial seizures, intractable, without status epilepticus Benign neoplasm of brain, unspecifiedClinical question: Evaluate SEGA and cortical tubers for change, compare with previous, pt on Afinitor therapySigns and Symptoms: Tuberous sclerosis, seizure The patient is status post right frontal craniotomy.There is redemonstration of a focus of encephalomalacia in the right middle frontal gyrus and right orbital gyrus with some involvement of the pars orbitalis of the right inferior frontal gyrus. There are some contrast enhancement present along the posterior aspect of this signal abnormality which is stable compared to the prior exam.There is redemonstration of multiple cortical tubers scattered in both hemispheres of the brain. One of these in the right temporal lobe displays a small amount of contrast enhancement which is stable compared to prior exam.There is redemonstration of multiple subependymal nodules best seen on susceptibility imaging. There is a focus of hypointensity on susceptibility weighted imaging in the right temporal lobe subcortical white matter associated with a cortical tuber which on FLAIR MRI measures approximately 6 mm. It was also present on the prior exam from 2013 and is unchanged.A T1 hyperintense lesion is present in the left caudate nucleus which was also present on the previous exam and has not changed. It measures 7 mm in sizeNormal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mucosal thickening in the paranasal sinuses diffusely. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Patient has multiple stigmata of tuberous sclerosis which include multiple subependymoma nodules as well as multiple cortical tubers. These are are stable since the prior exam from 2013.2.There is no evidence for subependymal giant cell astrocytoma appreciated.3.Status post right frontal lobe surgery with associated postoperative change.


Instruction: Generate impression based on findings.

Input: There is no acute cord compression.

Output: No acute cord compression. Dedicated segment-specific MRI is recommended if symptomology localizes.


Instruction: Generate impression based on findings.

Input: 65-year-old female patient with history of nausea, vomiting, and abnormal LFTs. Evaluate for pancreatic biliary etiology and liver morphology. ABDOMEN:LIVER, BILIARY TRACT: There is mild intrahepatic and extrahepatic biliary ductal dilatation to the level of the ampulla. However, there is no stone or soft tissue lesion seen. Multiple nonenhancing probable hepatic cysts are too small to characterize.The gallbladder is distended and filled with sludge and gallstones.SPLEEN: No significant abnormality noted.PANCREAS: The pancreatic duct is diffusely dilated up to 4 mm.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Prominent left retroperitoneal lymph node measures 1.5 x 0.9 cm (series 3 image 8).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Intra and extrahepatic biliary dilatation to the level of the ampulla without evidence of stone or obstructive soft tissue lesion. There may be a benign ampullary stricture. 2.Diffuse mild pancreatic duct dilatation.


Instruction: Generate impression based on findings.

Input: Female, 60 years old, history of new primary tonsil cancer (prior history of cT1 N2a squamous cell carcinoma of the left tonsil in 1994, with second primary cT4a Nx at the left base of tongue) status post induction chemotherapy. Assess response. Findings are redemonstrated presumed to represent prior treatment including volume loss in the left submandibular space and scarring which extends from the left oropharynx to the skin surface.An ulcerated mass is redemonstrated centered on the left tongue base extending medially to cross the midline, and laterally to track along the glossotonsillar sulcus and left lateral oral tongue. The left tonsillar pillar is also thickened and likely involved with disease. Anteriorly the lesion extends for some distance into the floor of mouth structures with infiltration of at least the left genioglossus muscle. Inferiorly, the lesion extends to the level of the vallecula.The lesion continues to show ill-defined enhancement, but is less T2 hyperintense and is overall smaller. The maximum dimension of this lesion is obtained in the coronal plane where it measures up to 38 mm (image 18 series 4), previously 45 mm.As on the prior examination, signal abnormality does extend to involve the left masticator space and the adjacent mandibular marrow space without significant interval change. The left aspect of the hypopharynx remains mildly T2 hyperintense, similar to prior, but without discrete mass lesion.No pathologically enlarged nodes are detected by size criteria. As before, though, several small left-sided level II and III lymph nodes show hyperintense T2 signal compared to other cervical nodes.Scarring is evident in the lung apices. No definite concerning marrow replacement is seen in the osseous structures.

Output: 1.Interval decrease in the size of a mass involving the left oral tongue, tongue base, and tonsillar pillar.2.No definite pathologic adenopathy by size criteria, and no change in the appearance of T2 hyperintense left cervical lymph nodes.3.Redemonstration of nonspecific findings including abnormal signal involving the left masticator space, left mandibular marrow space, and left hypopharynx.


Instruction: Generate impression based on findings.

Input: Incidental finding of head of pancreas cyst. Likely IPMN. ABDOMEN:LIVER, BILIARY TRACT: Hepatomegaly, measuring 23 cm in the coronal plane. No focal hepatic lesion is identified. The gallbladder is normal in appearance.SPLEEN: No significant abnormality noted.PANCREAS: A nonenhancing, cystic lesion within the pancreatic tail measures 0.8 x 0.6 cm (series 5, image 18), probably unchanged since July 2, 2014. The pancreatic duct is normal in caliber. No new lesion is identified.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Trace perihepatic ascites. Bowel loops are normal in appearance.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Unchanged cystic lesion within the pancreatic tail, probable IPMN.2.Hepatomegaly.