Instruction: Generate impression based on findings.

Input: Right-sided hemiparalysis. There is a patchy high signal intensity on FLAIR and T2-weighted images on the left side of the pons indicating chronic ischemic lesion. However, there is no evidence of acute ischemic or hemorrhagic lesion on the scan.Minimal scattered hyperintensities on the bilateral periventricular white matter indicate minimal nonspecific small vessel disease. Most of low attenuations on CT scan are more likely representing perivascular space.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: No evidence of acute ischemic or hemorrhagic lesion.Chronic ischemic lesion on the left side of pons as described above.Minimal nonspecific small vessel disease.


Instruction: Generate impression based on findings.

Input: 16-year-old male with a abnormality in the frontal area on CT unimpressive on MR. History of amnestic episode questionable history of trauma and seizure. The appearance of the current CT scan versus the prior is slightly different. There are foci of hypodensity present along knee left the superior frontal gyrus and right precentral gyrus subcortical white matter. Relating to the recent MRI it appears that this potentially represents sulcation and volume averaging. AThere is some asymmetry in the size of the sigmoid sinuses right larger than left and attendant asymmetry in the size of the junction of transverse and sigmoid sinuses.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.No evidence for acute intracranial hemorrhage.2.Small hypodense foci superimposed on the left superior frontal gyrus and the right precentral gyrus. These were also identified on the previous exam. The possibility of these represent subcortical abnormality cannot be excluded. It's conceivable that these are related to sulcation and volume averaging. These findings were discussed with the clinical service. The MRI performed recently does not confirm this.


Instruction: Generate impression based on findings.

Input: 39-year-old male with shoulder pain. Evaluate cuff, biceps. ROTATOR CUFF: There is intermediate signal intensity within the distal fibers of the supraspinatus tendon anteriorly indicating tendinosis. A tiny (2 mm) focus of fluid signal intensity within the distal fibers of the tendon at its insertion is suggestive of an interstitial tear but we see no disruption of either surface of the tendon. The supraspinatus muscle appears normal. The infraspinatus muscle and tendon appear normal. The teres minor muscle and tendon appear normal. There is increased signal intensity and thickening of the subscapularis tendon indicating tendinosis and possibly undersurface fraying but we see no fluid-filled tear. The subscapularis muscle appears normal.SUPRASPINATUS OUTLET: Os acromiale. There is edema within the os acromiale with minimal, if any, osteoarthritic changes at the acromioclavicular joint. There is a small amount of fluid in the subacromial subdeltoid bursa which may represent a mild bursitis. GLENOHUMERAL JOINT AND GLENOID LABRUM: Joint alignment is normal. There is a small amount of fluid in the joint but no effusion. Given the limitations of a non-arthrogram study we see no labral tear. The articular cartilage appears normal. There are small cysts along the posterolateral aspect of the humeral head which is not necessarily of any current clinical significance.BICEPS TENDON: There is increased signal intensity within the long head of the biceps tendon at its transition from the intertubercular groove to the rotator interval indicating mild tendinosis.

Output: 1. Os acromiale with edema within the os which may reflect instability.2. Mild subacromial subdeltoid bursitis.3. Mild supraspinatus tendinosis and tiny insertional interstitial tear.4. Subscapularis tendinosis and undersurface fraying.5. Tendinosis of the long head of the biceps tendon.


Instruction: Generate impression based on findings.

Input: 34 years Female (DOB:6/23/1981)Reason: Eval for demyelinating disease History: paresthesiasPROVIDER/ATTENDING NAME: ADIL JAVED ADIL JAVED MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. There are several subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. Metallic artifact partially sutures the left orbit which is less not readily visualized on this exam.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.No abnormal lesions are identified in the cervical spinal cord.2.There are several subcortical white matter lesions present which are nonspecific. They could be vascular related, related to demyelination, trauma, vasculitis, sarcoid. They are nonspecific. In general they are not typical in imaging appearance of demyelinating lesions related to multiple sclerosis


Instruction: Generate impression based on findings.

Input: Redemonstrated is a mixed signal T1 and T2 intensity lesion within the medial rolandic brain involving both sensory and motor cortices, measuring 17 mm AP by 13 mm transverse dimensions (as measured on axial T2 technique), unchanged in size or morphology. This is associated with susceptibility hypointense abnormality, however without perilesional edema. Postcontrast images demonstrate an associated developmental venous anomaly which drains posteriorly, superiorly, and medially. There are no other foci of susceptibility abnormality.The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no other masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for acute intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear.

Output: Stable cerebral cavernous malformation involving left medial rolandic brain involving both sensory and motor cortices with an associated developmental venous anomaly.


Instruction: Generate impression based on findings.

Input: The ventricles and sulci are prominent, consistent with mild age-related volume loss. However, there is enlargement of the lateral and third ventricles, out of proportion to the degree of sulcal prominence; this is grossly stable when compared to remote MRI from 2006. The basal cisterns remain patent. There is no midline shift or mass effect. There are scattered punctate foci of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, which are nonspecific, slightly progressed from prior MRI. There is no pathological enhancement. There is no diffusion abnormality. No extra-axial fluid collection is identified.There is a multilobulated structure of CSF-signal extending medially and inferiorly from the medial right middle cranial fossa, immediately posterior to Meckel's cave, which was not seen on the previous study, measuring up to 1 cm (series 901, image 17). This structure appears contiguous with the adjacent subarachnoid space. No significant CT abnormality is seen in this location previously.Normal flow-voids are demonstrated in the major intracranial vascular structures. There is a partially empty sella. There is horizontal angulation of the clivus, resulting in flattening of the skull base, likely developmental.

Output: 1.No intracranial metastatic lesions are identified.2.Subcentimeter, multilobulated, CSF-signal intensity structure inferomedially adjacent to the right middle cranial fossa, not seen on prior MRI and without significant prior CT correlate. Given apparent contiguity with the adjacent subarachnoid space, this may represent an encephalocele. Consider MRI brain with thin cuts or CT through the skull base if further evaluation is warranted.3.Stable chronic disproportionate enlargement of the lateral and third ventricles, of uncertain clinical significance.


Instruction: Generate impression based on findings.

Input: Clinical question: Traumatic brain injury. Signs and symptoms: Increased tone. None CT of brain:Examination demonstrates significant ventriculomegaly of the lateral and third ventricle. There is a ventricular catheter entering from right posterior frontal, traversing the right parietal lobe and enters into the right lateral ventricle. The tip of the catheter traverses the midline and is at the level of the left foramina of Monro. There are no old films available for comparison of the ventricular size. There is a shallow CSF dense CT extra axial collection surrounding the bilateral cerebral hemispheres and is consistent with chronic subdurals. On the right side the thickest portion of the subdural measures 7.5-mm (axial image 17) and on the left subdural measures approximately 6.5 mm on axial image 15 in the frontal region). There is no areas of acute blood product within the subdural space.There is no evidence of parenchymal hemorrhage.No attenuation of brain parenchyma in the left temporal lobe extends from left anterior temporal posteriorly to involve the entire length of the left temporal lobe. This is believed to represent an area of old encephalomalacia. Possibility of an ischemic stroke cannot be however entire without. Please review outside studies or follow-up with an MRI exam. The cortical sulci are still preserved and are prominent and overall appearance of brain is suggestive of diffuse right lung volume loss.

Output: 1.No detectable acute posttraumatic findings.2.Low density extra-axial subdural collection encircles the entire brain parenchyma bilaterally as detailed.3.Significant ventriculomegaly and supratentorial space with a shunt in place. There are no old studies for comparison.4.Large area of low-attenuation involves the left temporal lobe which may represent encephalomalacia however less likely possibility of an ischemic stroke of more recent onset cannot be entirely ruled out.5.There is no evidence of skull fracture.6.Extensive exaggerated pneumatization of visualized paranasal sinuses.


Instruction: Generate impression based on findings.

Input: 43-year-old male with left-sided weakness and numbness; evaluate for stroke There is no evidence of acute intracranial hemorrhage, significant mass effect/midline shift, hydrocephalus or edema. Gray-white matter differentiation is preserved.The ventricles and basal cisterns are normal in size and configuration. There is mild ectopia of the cerebellar tonsils. Recommend MRI with CSF flow study for further evaluation.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses, middle ear cavities and mastoid air cells are normally pneumatized.

Output: 1. No acute intracranial hemorrhage, cortical infarct, mass-effect or edema. 2. Mild ectopia of the cerebellar tonsils. Recommend MRI with CSF flow study for further evaluation.


Instruction: Generate impression based on findings.

Input: 57 year old with left breast carcinoma and metastatic left axillary lymph nodes, status post chemotherapy. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.The known carcinoma at posterior 2 o'clock position in the left breast seen on the prior study is no longer visualized. Marker clip is identified at left posterior 2 o'clock position.A proven fibroadenoma is unchanged at posterior 12 o'clock position in the left breast, with a marker clip at anterior aspect.There are again multiple enlarged lymph nodes (at least 9 abnormally enlarged lymph nodes) in the left axilla, although all of them appear reduced in size. Five of the 9 nodes are in the level one region, and three of them are in the level two region. The largest lymph node measures 17 mm in maximum diameter (previously 28 mm).Metallic artifacts from a port-A-cath is seen in the medial upper right breast.No abnormal enhancement is seen in right breast. No abnormal lymph nodes are identified in right axillary region.

Output: 1. Complete imaging response of the right breast cancer.2. Interval reduction in size of the multiple abnormal left axillary lymph nodes3. No abnormal enhancement in right breast. 4. No abnormal lymph nodes in right axillary region. BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Right knee pain for 1 day no known trauma Minimal osteoarthritic changes with chondrocalcinosis. Given patient's age, this latter finding may be age-related. Small effusion. MRI may be indicated to exclude an internal derangement, however no acute osseous abnormalities currently observed

Output: Mild degenerative changes without definite superimposed acute abnormality other than a small effusion. See detail provided


Instruction: Generate impression based on findings.

Input: CT best demonstrates a lucency involving the posterior arch of C1, rightward, just posterior to lateral masses, not involving adjacent transverse foramen. The edges are not rounded, however do demonstrate increased sclerosis. There is no evident bony bridging of trabeculation across the defect. There are no secondary C1 ring fractures. STIR MRI imaging demonstrates no adjacent muscle, subcutaneous, or ligamentous signal abnormalities to suggest the presence of injury or edema. Only a small focus of fluid is evident within the fracture cleft.Alignment is anatomic. There are no subluxations. The visualized intracranial and paraspinal contents are unremarkable.There is no significant disc pathology and there are no significant stenoses.

Output: CT best demonstrates a lucency involving the posterior arch of C1, rightward, just posterior to lateral masses, not involving adjacent transverse foramen. The edges are not rounded, however do demonstrate increased sclerosis. There is no evident bony bridging of trabeculation across the defect. There are no secondary C1 ring fractures. STIR MRI imaging demonstrates no adjacent muscle, subcutaneous, or ligamentous signal abnormalities to suggest the presence of injury or edema. Only a small focus of fluid is evident within the fracture cleft. The constellation of the CT and MRI features provide evidence for a fracture, which is more likely subacute in age given these aforementioned imaging characteristics.


Instruction: Generate impression based on findings.

Input: Clinical question: Evidence of new CVA. Signs and symptoms: Patient with history of ischemic CVA x 5, presents with some similar symptoms, initial CT of head is negative. Pre and post enhanced brain MRI:No evidence of acute intracranial process and in particular no detectable acute ischemic stroke is seen.There is a large area of encephalomalacia of the left cerebral hemisphere invaginating the left frontal, parietal and occipital lobes. There is resultant significant extra-axial dilatation of left lateral ventricle. Findings consistent with a large chronic ischemic stroke with minimal chronic hemorrhagic changes. There is resultant Wallerian degeneration.Patchy foci of periventricular flair hyperintensity in the right frontal suggestive of chronic small vessel ischemic strokes are noted. There is absence of signal void of the cavernous and supraclinoid left internal carotid artery consistent with complete occlusion. If further assessment is clinically been necessary CTA or MRA is recommended.Unremarkable calvarium and soft tissues of the scalp.Unremarkable paranasal sinuses and orbits.Extensive opacification of right mastoid air cells without convincing evidence of opacification of right middle ear cavity is noted.

Output: 1.No acute ischemic process.2.Extensive left hemispheric encephalomalacia consistent with a chronic minimally hemorrhagic stroke.3.Minimal chronic small vessel ischemic stroke.4.Absence of signal void of left cavernous and supraclinoid internal carotid consistent with occlusion.5.Extensive opacification of right mastoid air cells without opacification of right middle ear cavity similar to prior head CT.


Instruction: Generate impression based on findings.

Input: Female, 68 years old, history of GBM, now on temozolomide plus TTF. A lesion is redemonstrated involving the left inferior and middle frontal gyri with findings seen indicating prior biopsy or resection. Somewhat nodular foci of enhancement superficially along the operative site are unchanged. Deep to the resection site, a centrally nonenhancing lesion with ill-defined granular rim enhancement and some peripheral diffusion restriction is also unchanged. T2 hyperintensity which surrounds these lesions and spreads into the adjacent frontal and parietal lobes has not significantly changed.No new enhancing lesions are demonstrated. Multiple scattered small foci of white matter T2 hyperintensity are seen in the periventricular and subcortical regions without significant change. No abnormal extra-axial fluid collections are detected. The ventricles are stable and normal in size.

Output: Stable enhancing lesions within the left inferior and middle frontal gyri with stable surrounding T2 signal abnormality.


Instruction: Generate impression based on findings.

Input: Alignment is anatomic. There are no fractures or subluxations. The marrow signal is benign. The cervical and upper thoracic cord is somewhat heterogeneous, which limits evaluation. There is no evidence of acute cord compression. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable.C2/3: No significant spinal canal or neuroforaminal narrowing.C3/4: There is a posterior disc osteophyte with resultant moderate narrowing of the spinal canal. There is bilateral uncovertebral hypertrophy with mild to moderate right neuroforaminal narrowing.C4/5: There is a posterior disc osteophyte with resultant moderate narrowing of the spinal canal. There is bilateral uncovertebral hypertrophy. There is moderate to severe right neuroforaminal narrowing and moderate left neuroforaminal narrowing.C5/6: There is a posterior disc osteophyte with resultant moderate narrowing of the spinal canal. There is bilateral uncovertebral hypertrophy. There is moderate to severe right neuroforaminal narrowing and moderate left neuroforaminal narrowing.C6/7: There is a trace posterior disc osteophyte complex. There is moderate bilateral neuroforaminal narrowing.C7/T1: There is a diffuse posterior disc osteophyte. There is mild to moderate right-sided neural foraminal narrowing.

Output: 1.Multilevel degenerative changes with posterior disc osteophyte complexes and scattered neuroforaminal narrowing including moderate-severe narrowing on the right at C4-C5. 2.No acute cord pathology.


Instruction: Generate impression based on findings.

Input: 41-year-old female presents with numbness tingling to the right lower extremity, decreased sensation, and urinary retention; evaluate for cauda equina syndrome. The vertebral bodies are appropriate in the overall alignment and height. The spinal cord has grossly normal signal characteristics and overall morphology. There is no compromise of the spinal cord.There is straightening of the cervical and lumbar lordosis. There is a disc osteophyte complex at C5-C6 with indentation of the ventral thecal sac, but no high grade stenosis.Multilevel thoracic disc bulges and ligamentum flavum thickening which contribute to mild to moderate spinal canal stenosis at several levels, but appear grossly similar to the prior exams. Minimal retrolisthesis at the lumbosacral junction. No gross change in additional multilevel spondylosis of the lumbar spine without high grade spinal canal stenosis. Evaluation of the spinal canal is better assessed on prior dedicated spine studies from 11/2015.

Output: 1. 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. No cord or cauda equina compression is identified. 2. Due to the screening nature of this protocol details are not as evident on imaging as dedicated protocols of the spine. Multilevel spondylosis in the cervical, thoracic, and lumbar spine has not significantly changed since the prior examination and is discussed in detail above.The above findings were discussed with Tifuh Ambah, APN by Arun Nagaraju, MD at 5:15 PM on 10/5/2016.


Instruction: Generate impression based on findings.

Input: 53-year-old female with epigastric pain, nausea and vomiting. Evaluate for acute on chronic pancreatitis, pancreatic pseudocyst, and biliary obstruction. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology. No suspicious parenchymal lesions.Intra and extraperitoneal biliary ductal dilatation remain. The common bile duct measures 1.2 cm in diameter. The duct tapers abruptly at the level of the pancreatic head, and a long segment stricture of the distal CBD measuring 2.3 cm (coronal series 3 image 22) is present.SPLEEN: Splenomegaly measuring 17 cm in length. There is interval thrombosis of the splenic vein with development of collateral vessels.PANCREAS: The pancreatic duct remains dilated measuring up to 5 mm in diameter extending to the level of the pancreatic head. Enlargement of the pancreatic head is again seen, and there is increased surrounding inflammatory change that partially extends to the descending duodenum. Findings are compatible with recurrent acute pancreatitis.Within the pancreatic head, a central fluid signal focus (axial series 6 image 33) has recurred within increase in size measuring 2 x 1 cm (prior 1.3 x 1.4 cm). This fluid collection has an anterior-superior exophytic component measuring 1.4 x 0.9 cm (axial series 6 image 31).A separate intraparenchymal fluid collection of the pancreatic head inferiorly has also recurred with increase in size measuring 1.4 x 0.9 cm (axial series 6 image 36) (prior 0.9 x 0.8 cm).There is a new 2.6 x 3 cm exophytic fluid signal intensity focus of the pancreatic tail (axial series 6 image 29).There is interval thrombosis of the splenic vein with development of collateral vessels. The main portal vein is narrowed at its confluence with the superior mesenteric vein. The celiac, superior mesenteric artery, and superior mesenteric vein are patent. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No hydronephrosis. Two small simple cysts of the right mid/lower renal pole.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.Findings compatible with recurrent acute pancreatitis of the pancreatic head. New and increasing fluid collections within and adjacent to the pancreas need correlation with timing of symptomatology. Less than 4 weeks duration would classify these as acute peripancreatic fluid collections, however greater than 4 weeks duration would classify these as pancreatic pseudocysts.2.Persistent long segment stricture of the distal CBD with upstream intrahepatic ductal dilatation. Dilatation of the pancreatic duct of the body and tail remain, and underlying stricture of the downstream pancreatic duct cannot be excluded.3.Interval development of splenic vein thrombosis now with collateral flow. Stable splenomegaly.


Instruction: Generate impression based on findings.

Input: Right lower extremity radicular pain, evaluate for herniated disc Please note for the purposes of numbering, there are 4 lumbar type vertebral bodies with hypoplastic ribs associated with T12 and a transitional segment below L4 labeled S1.Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position at the L1-L2 level.Mild degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: Minimal disc bulge and facet arthropathy. No significant spinal canal stenosis. No significant neural foraminal stenosis.L3-L4: Disc desiccation and minimal bulge. There is moderate bilateral facet arthropathy. No significant spinal canal stenosis. There is mild to moderate bilateral, right greater than left, neural foraminal stenosis.L4-S1: There is right foraminal disc protrusion and advanced facet arthropathy, right worse in left. There is severe right neural foraminal stenosis and mild to moderate left neural foraminal stenosis.S1-2: Hypoplastic disc. No spinal canal or neural foraminal stenosis.Degenerative changes are noted at the bilateral sacroiliac joints. Paraspinous soft tissues are within normal limits.

Output: 1. Please note variant numbering with hypoplastic ribs associated with T12, 4 lumbar type vertebral bodies, and a transitional segment below L4 labeled S1 for the purposes of this study. As numbered, there is severe right-sided neural foraminal stenosis at the L4-S1 level related to foraminal disc protrusion and advanced facet arthropathy with suspected impingement of the exiting nerve root.2. No significant spinal canal stenosis at any level. Additional levels of neural foraminal narrowing as detailed above.


Instruction: Generate impression based on findings.

Input: History of left neck carcinoma. Question of pulmonary embolism. Complains of acute onset shortness of breath. Likely PE but also evaluate for possible mass effect on trachea.IMAGE ACQUISITIONS: CT neck soft tissues with contrast. On the uppermost image of the neck CT, the previously noted right parietal metastasis is again seen and measures 19 x 19 mm, minimally larger than the comparison brain MRI.There has been interval growth of the left neck mass . At the level of the vocal cords the airway appears narrowed although this is more likely due to a left vocal cord paralysis than direct mass effect. More inferiorly the trachea does appear slightly narrowed by mass effect. The mass measures 67 x 80 mm transaxially and 90 mm in the craniocaudad dimension. Note that the inferior margin of this mass extends into the superior mediastinum. Multiple new enhancing lymph nodes are seen in the left posterior neck, the two largest of these measure 11 mm in diameter. The right jugular vein is thrombosed. Within the isthmus of the thyroid there is a central low attenuation region which may represent a new thyroid metastasis.

Output: 1. Asymmetric narrowing at the level of the vocal cords more likely due to left vocal cord nerve paralysis. Inferior to this level there is slight narrowing of the trachea due to mass effect.2. Progression of disease in the neck with enlargement of the mass as well small small new pathologic lymph nodes, and likely new thyroid metastasis.3. Right parietal brain metastasis is incompletely visualized but appears slightly larger than the comparison MRI brain exam.4. Right internal jugular vein thrombosis.


Instruction: Generate impression based on findings.

Input: 5 month old female patient with spasmus nutans. Question of glioma or brain lesion. BRAIN: The images are degraded by patient motion. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There appears to be a normal degree of myelination. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.ORBITS: The bilateral globes and ocular adnexa are unremarkable. There is no evidence of abnormal intraorbital enhancement or mass lesions.

Output: 1. No evidence of intracranial hemorrhage, mass, or acute infarct. 2. Unremarkable examination of the bilateral orbits.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: low back pain, history of multiple myeloma History: low back pain Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. Since the prior examination has undergone laminectomies at L4 and L5 as well as posterior fusion using pedicle screws and interconnecting rods at L4-5 and L5-S1.At L5-S1 there is disk desiccation and loss of disk space height. There is a narrowing of the right neural foramen at this level with some encroachment of right-sided exiting nerve roots .At L4-5 there is disk desiccation, mild disk bulge and loss of disk space height. There is a narrowing of the right neural foramen at this level with some encroachment of right-sided exiting nerve roots .At L3-4 there is loss of disk space height, disk desiccation, Schmorl's node and diffuse disk bulge associated with bilateral facet and ligamentum flavum hypertrophy and effacement of the spinal fluid surrounding the nerve roots within the thecal sac. Overall there is a moderate to severe degree of spinal stenosis at this level. This has significantly progressed since the prior exam.At L2-3 there is loss of disk space height, disk desiccation and diffuse disk bulge associated with ligamentum flavum hypertrophy and mild narrowing of the neural foramina . Overall there is a mild degree of progression of the narrowing of the spinal canal at this level when compared to the previous exam. Currently there is a mild degree of spinal stenosis at this level.At L1-2 there is loss of disk space height, and disk desiccation and diffuse disk bulge associated with a Schmorl's node and some mild narrowing of the neural foramina. Overall there is no significant change since the prior examA cystic lesion is present along the right kidney which is not entirely imaged on this exam but was present on the prior exam as well

Output: 1.Since the prior exam the patient has undergone laminectomy and fusion in the lower lumbar spine.2.Since the prior exam the patient has developed a moderate to severe degree of spinal stenosis at L3-4.


Instruction: Generate impression based on findings.

Input: 57 years, Male, Reason: ?s/p OLT, w/ perihepatic abscesses, now w/ drain, draining fluid w/ high amylase, eval for pancreatic duct leak History: abd pain, OLT. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Postoperative findings of orthotopic liver transplant There is an intrahepatic pigtail drainage catheter with its tip in the region of the hepatic hilum. A loculated collection extending from the hilum to the posterior aspect of the right hepatic lobe has resolved.Hyper enhancement in the left hepatic lobe on arterial phase images likely represents arterioportal shuntingSPLEEN: Wedge-shaped edema and hypoenhancement within the spleen appears similar to the prior CT and likely represents infarction. Splenomegaly.PANCREAS: T1 hyperintense lesion along the tail of the pancreas measures 1.8 x 1.5 cm (1001/51), previously 2.7 x 1.6 cm and most likely represents hemorrhage. There is mild diffusion restriction within the pancreatic tail which is nonspecific.The pancreatic duct in the tail is mildly dilated, with focal dilatation at the proximal body proximal to an abrupt termination. The pancreatic duct in this region traverses superiorly to the region of the prior fluid collection. The main pancreatic duct is anterior to the distal common bile duct, suggestive of pancreatic divisum at the pancreatic head.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Mild narrowing of the suprahepatic IVC at the anastomosis is unchanged.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Mild scattered abdominal ascites.

Output: 1.The distal pancreatic duct is mildly dilated and abruptly terminates, traversing superiorly to the region of prior perihepatic fluid collection. A focal pancreatic ductal injury is possible causing the fluid high in amylase. 2.Resolution of perihepatic fluid collection.3.Fluid collection adjacent to the pancreatic tail is decrease in size and is consistent with a hematoma.4.Stable splenic infarct.5.Arterioportal shunting within the left hepatic lobe.


Instruction: Generate impression based on findings.

Input: Acute thalamic infarct. Evaluate for signs of neoplasm. There are new punctate foci of restricted diffusion in the right and left occipital lobes. The previously seen punctate focus of diffusion restriction along the left superior thalamus is less prominent.There are multiple punctate foci and extensive confluent areas of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter which are nonspecific but consistent with advanced chronic small vessel ischemic changes. There are chronic lacunar infarcts in the basal ganglia and thalamus. There are numerous punctate foci of susceptibility artifact in the supratentorial and infratentorial compartments, consistent with hemosiderin deposition from chronic microhemorrhage. These are particularly prominent in the cerebellum and basal ganglia, favored to be related chronic hypertension. Examination is slightly motion degraded. No pathological enhancement is seen. Global parenchymal volume loss again noted. No hydrocephalus. There is no midline shift or herniation. Minimal paranasal sinus mucosal thickening. The skull and extracranial soft tissues are unremarkable. Incidental note is made of a partially empty sella.

Output: 1. Two new punctate foci of restricted diffusion compared to 1/23/2015 compatible with acute infarcts in the bilateral occipital lobes. Recent infarct in the left superior thalamus also again seen and slightly less prominent compatible with evolution.2. Advanced chronic small vessel ischemic disease including multiple lacunar infarcts.3. Innumerable chronic microhemorrhages, particularly in the basal ganglia and cerebellum in a pattern suggestive of chronic hypertension. Additional foci in a lobar distribution may be due to chronic amyloid angiopathy.4. No findings to suggest neoplasm.


Instruction: Generate impression based on findings.

Input: MRI brain: There are significant susceptibility artifacts arising from the ventriculostomy reservoir. There are bihemispheric subdural fluid collections in the frontoparietal convexities which demonstrates fluid signal intensity containing internal susceptibility artifacts consistent with chronic subdural hematoma. The extension of the subdural collection with bilateral temporo-occipital area and subtentorial T1 and T2 hyperintense lesions indicate subacute subdural hematoma do not show any interval change since prior scan. Gyriform high signal intensities on T1 weighted images on bilateral frontal lobes indicate laminar necrosis related to prior ischemic insults.There is a left frontal approach ventriculostomy catheter with tip terminating in the region of right thalamus, unchanged from previous exam. There is effacement of the right lateral ventricle which is unchanged from previous exam. There is no midline shift or herniation.Incidentally noted is partially empty sella, a normal variant. Please note that this study was not tailored for pituitary evaluation.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. There is opacification of bilateral maxillary sinuses, left frontal sinuses including mild opacification of the ethmoid sinuses. There are partial opacifications of bilateral mastoid air cells.MRI cervical spine:There is loss of normal cervical lordosis. There is degenerative changes involving multiple cervical vertebrae, including loss of intervertebral disc height at C6-C7. No focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal. C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: There are diffuse disc bulge and mild central osteophyte disc complex resulting in mild effacement of the anterior thecal sac. There is mild spinal canal stenosis. There is no significant neuroforaminal narrowing.C4-5: There is mild disc bulge. There is mild to moderate spinal canal stenosis. There is minimal bilateral neuroforaminal narrowing.C5-6: There is diffuse disc bulge. There is minimal spinal canal stenosis. No significant compromise to the neural foramina.C6-7:No significant compromise to the spinal canal or neural foramina.C7-T1: No significant compromise to the spinal canal or neural foramina.

Output: 1. Bihemispheric multi-stage subdural hematoma including bilateral temporo-occipital subacute SDH as described above.2. Left frontal approach ventriculostomy catheter, is unchanged from previous.3. Effacement of the right lateral ventricle, unchanged from previous.4. Partially empty sella, a normal variant. Please note that this study is not tailored for pituitary evaluation. Dedicated pituitary MRI can be considered if clinically indicated.5. Opacification of the paranasal sinuses and mastoid air cells.6. Degenerative changes in the cervical spine with mild to moderate spinal canal stenosis at C4-C5. There are mild spinal canal stenosis at C3-C4, and C5-C6 levels. Mild neural foraminal narrowing is noted at C4-C5.


Instruction: Generate impression based on findings.

Input: Strong family history of breast cancer in her mother, grandmother and two great grandmothers. The patient also has had a recent ultrasound for a left breast lesion that will be biopsied later today. There is heterogeneous amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. Multiple bilateral focal and patchy areas of parenchymal enhancement are present, similar to prior studies. These are in fact more similar to older comparison studies such as the MRI from 1/14/13. No suspicious enhancement is seen near the planned site of biopsy in the left inferior breast. No abnormal axillary lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: There is an ovoid lesion within the central spinal cord centered at the T1 level that measures up to 21 mm. The mass appears to be peripherally T1 hyperintense and T2 hyperintense centrally with a thin peripheral rim of T2 hypointensity. There is no appreciable enhancement. There are minimal patchy foci of T1 and T2 hyperintensity both above and below the lesion extending from the C7 - T2 levels. There is no significant edema outside this region. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. The paravertebral soft tissues are unremarkable. There is a congenitally narrow cervical spinal canal. Superimposed upon this are mild degenerative changes, including small disc-osteophyte complexes and uncovertebral joint arthropathy. These findings result in mild spinal canal stenosis at C4-C5, C5-C6, and C6-C7, as well as moderate to severe bilateral neural foramen narrowing at C5-C6. Within the thoracic spine there are scattered mild degenerative changes including multiple small central disc protrusions, most prominent at T5-T6, where it indents the ventral thecal sac and results in mild spinal stenosis.

Output: 1. Findings most compatible with a late subacute spinal cord hematoma or hematomyelia with minimal edema centered at the T1 level, whereby spontaneous hemorrhage, post-traumatic hemorrhage, hemorrhagic infarction, or an underlying cavernous malformation are potential etiologies, for example. An underlying neoplasm is perhaps less likely, given absence of associated enhancement. Nevertheless, follow up imaging would be useful for further characterization.2. Multilevel mild degenerative spondylosis, most prominent at T5-T6, where a disc-osteophyte complex effaces the ventral thecal sac and results in mild spinal stenosis.Findings called to Dr. Ali Ahmer by Dr. Michael Rozenfeld at 4:45pm on 1/14/15.


Instruction: Generate impression based on findings.

Input: Diagnosis: Primary central nervous system lymphoma, unspecified site, extranodal and solid organ sitesClinical question: Primary CNS NHLSigns and Symptoms: Evaluate for continued remission The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild to moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. There are multiple small foci of signal hyperintensity on T2 and FLAIR MR imaging in the basal ganglia (more on the right basal ganglia versus the left). These are stable and compared to the prior exam from JuneThere is a punctate focus of signal hypointensity on susceptibility imaging along the medial aspect of the left cerebellar hemisphere. A focus of signal hypointensity on susceptibility imaging is present in the left cerebellar hemisphere in a small focus of encephalomalacia. On the MRI from 5/15/2014 there is an enhancing lesion in this location.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.No abnormal enhancing lesions are appreciated within the brain parenchyma to suggest CNS lymphoma.2.There are periventricular white matter lesions and subcortical white matter lesions as well as lesions in the basal ganglia and cerebellum which are stable and compared to the prior exam from June. These are nonspecific. Some of these may be vascular related and others may be posttreatment related.


Instruction: Generate impression based on findings.

Input: Reason: r/o cavernous sinus thrombosis, mass History: proptosis bilaterally, HA, vision changes MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. 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 AP dimension of the right eye is increased relative to left and the right eyeball lens is absent.Cavernous sinuses are symmetric and without any abnormal lesions appreciated pairedMRV brain:The dural venous sinuses are patent. Straight sinus, internal cerebral veins and basal veins are identified and appear patent.

Output: 1.No evidence for cerebrovascular occlusive disease.2.No evidence for intracranial aneurysm.3.There is no evidence for cavernous sinus thrombosis.4.Enlarged right eye with findings suggestive of coloboma.


Instruction: Generate impression based on findings.

Input: Male 60 years old with prostate cancer undergoing active surveillance. Staging exam. PELVIS:PROSTATE:Prostate Size: 5.3 x 4.2 cmPeripheral Zone: Several foci of low T2 signal intensity in the peripheral zone of the prostate gland are compatible with the known history of prostate cancer. The index lesion located anteriorly and there is evidence of extracapsular extension anteriorly, particularly on the left. The index lesion measures 3.4 x 1.5 cm (series 801, image 20), increased in size since 2011. An anterior apical focus has also increased in size now measuring 1.5 x 0.8 cm (series 801, image 12) and is invading the urethra. Additional small lesions have also increased in size.Central Gland: Large anterior transitional zone cancer with extracapsular extension.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: Anterior extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: Multiple small bilateral iliac and obturator nodes are unchanged and non-specific. Given the location they are not particularly suspicious for metastasis. The reference node in the left iliac chain measures 1.8 x 0.7 cm (series 1601, image 108), previously 1.8 x 0.6 cm.BONES, SOFT TISSUES: Bone marrow signal intensity is within normal limits.OTHER: No significant abnormality noted.

Output: 1.The index large anterior transitional zone cancer with extracapsular extension has increased in size. 2.A smaller lesion in the anterior apex invades the urethra. 3.Other small bilateral peripheral zone foci are also suspicious for prostate cancer and have also increased in size.


Instruction: Generate impression based on findings.

Input: There are post-treatment findings in the nasopharyngeal region. There has been interval decrease in the enhancing lesion in the superior right parasagittal posterior nasopharynx, with mild asymmetric prominence on that side, but no discretely measurable tumor. There is no evidence of skull base invasion or intracranial extension. The pre-vertebral, parapharyngeal, and masticator spaces are intact. There is no significant lymphadenopathy in the neck. The parotid and submandibular glands are unremarkable. There is degenerative spondylosis in the cervical spine, which is most pronounced at C4/5.

Output: No measurable residual nasopharyngeal carcinoma and no evidence of significant cervical lymphadenopathy.


Instruction: Generate impression based on findings.

Input: History of retroperitoneal liposarcoma. Evaluate for response to treatment. PELVIS:UTERUS, ADNEXA: The uterus is displaced towards the left by the large right hemipelvis mass. Otherwise it is unremarkable. The adnexa are not clearly identified.BLADDER: The bladder is mostly collapsed and displaced by the large right hemipelvis mass.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Demonstrated again is the heterogeneously enhancing mass in the right hemipelvis measuring 11.8 x 8.1 cm in maximal cross section (series 13/16), compared to 11.5 x 7.8 cm previously. In the craniocaudal dimension the lesion measures 12.9 cm (series 12/18). It contains heterogeneously intrinsic signal, including that of fat intensity compatible with states history of liposarcoma.The mass displaces the bladder, uterus and mesorectal fascia towards the left.The fat planes between the mass, the right piriformis muscle, uterus and bladder are indistinct, appearing similar to the prior study.The mass partially encases the right common and external iliac artery and vein, similar to the prior study. The lesion encases the right internal iliac artery and vein and their branches which are generally opacified, unchanged.The component of the lesion extending through the sacrosciatic notch to the level of the ischial tuberosity is not significantly changed in size. It encases the sciatic nerve as well as the more proximal sacral nerve roots. The tumor tracks along the sacral plexus to level of the right L5 and S1 neural foramen. The lesion abuts the right sacral ala and medial right iliac bone without definite osseous invasion, similar to prior.Small amount of presacral fluid is unchanged.OTHER: No significant abnormality noted.

Output: 1. No significant interval change in the right pelvic mass with extensive mass effect and soft tissue involvement as described.2. Stable involvement of the sciatic nerve to the level of the ischial tuberosity and tracking along the sacral plexus to the L5 and S1 right neural foramen.


Instruction: Generate impression based on findings.

Input: Reason: 59F, episode off necrotizing pancreatitis march 2015 (images on PACS) with 9cm pseudocyst and SMV and PVT. Chole 30 years ago, rule out stones and lesion and evaluate PFC. Perform with gadolinium, thanks History: pain ABDOMEN:LIVER, BILIARY TRACT: Postsurgical changes of a cholecystectomy. Mild intrahepatic biliary ductal dilatation. Questionable focal narrowing of the right main biliary duct (series 6 image 71). The main portal vein is attenuated at the level of the pancreatic fluid collection due to mass effect, although patent. The left portal vein is not visualized in its entirety, although the proximal portion is patent. The SMV is patent.SPLEEN: No significant abnormality noted.PANCREAS: Within the pancreatic head and body, there is a 8.4 x 5.9 x 10 cm complex fluid collection (series 10 image 17, series 9 image 11) compatible with a pseudocyst. Additional peripancreatic cystic lesion measures 2.9 x 4.4 x 6.9 cm (series 10 image 14 and series 9 image 18) compatible with a peripancreatic pseudocyst.The remainder of the pancreas demonstrates loss of intrinsic T1 hyperintense signal with normal enhancement suggestive of parenchymal dysfunction. Edema within the peripancreatic fat likely reflects resolving pancreatitis. Punctate T2 hyperintense focus in the pancreatic head that communicates with the pancreatic duct compatible with a side branch IPMN. 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.Large 10 cm pancreatic pseudocyst. Additional 4 cm peripancreatic pseudocyst.2.Peripancreatic edema likely representing resolving pancreatitis. 3.Main portal vein and superior mesenteric veins are patent.4.No suspicious lesions.


Instruction: Generate impression based on findings.

Input: Male 58 years old with bladder and prostate cancer. Evaluate liver lesions seen on CT. ABDOMEN:LIVER, BILIARY TRACT: The liver measures 15 cm in length and has a smooth contour. There are several T2 hyperintense, circumscribed, nonenhancing lesion in both lobes of the liver compatible with simple cysts. For example, a segment 4a lesion measures 1.3 x 1.2 cm (series 6, image 10). There is no enhancing liver lesion. Hepatic vasculature is patent.The gallbladder is normally distended and there is no cholelithiasis. No intra or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: The pancreas enhances homogeneously. The pancreatic duct is not dilated.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Mild to moderate bilateral hydronephrosis is markedly improved compared to the prior CT.RETROPERITONEUM, LYMPH NODES: There is a nonspecific 13 x 6 mm left retroperitoneal, periaortic T2 hyperintense focus which may be lymphatic in origin (series 3, image 34).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Multiple T2 hyperintense hepatic lesions with no enhancement are favored to represent cysts. There is no enhancing liver lesion.2.Interval improvement in bilateral hydronephrosis.


Instruction: Generate impression based on findings.

Input: Female 13 years old History: h/o L knee twisting injury 2/28 with immediate knee pain and swelling; significant effusion and +lachman exam in clinic 3/8, c/f ACL tear MENISCI: The menisci are intact without tear or other significant abnormality.ARTICULAR CARTILAGE AND BONE: There are bone contusions of the lateral femoral condyle and medial patellar facet. There is fragmentation of the articular cartilage of the medial patellar facet (Series 501 image 13 and 14). The trochlear groove is mildly flat. No acute fracture is identified.LIGAMENTS: The ACL, PCL, MCL, and LCL complex are intact and normal in appearance. Partial tearing of the medial patellofemoral ligament with few strands appearing intact.EXTENSOR MECHANISM: No significant abnormality of the extensor mechanism.ADDITIONAL

Output: 1.Findings consistent with transient patellar dislocation with associated partial tearing of the medial patellofemoral ligament, medial patellar cartilage fragmentation and moderate joint effusion.2.Small Baker's cyst.


Instruction: Generate impression based on findings.

Input: Female 31 years old Reason: peroneus brevis tear. please image from above the ankle down to insertion on the base of 5th metatarsal History: pain TENDONS: No significant abnormality noted.LIGAMENTS: No significant abnormality noted.ARTICULAR SURFACES AND BONE: No significant abnormality noted. ADDITIONAL

Output: No evidence of peroneus brevis tear. No specific findings to account for patient's symptoms.


Instruction: Generate impression based on findings.

Input: seizure, evaluate for seizure focus Exam is limited by motion artifact. No abnormal diffusion restriction. There is encephalomalacia right occipital lobe with ex vacuo dilatation of the right lateral ventricle, likely from prior infarct. There is periventricular white matter and right cerebellar FLAIR signal hyperintensity, which is nonspecific but may represent small vessel ischemic disease.

Output: Only a part of the exam was performed as patient could not tolerate the entire exam. Exam is limited by motion artifact. No evidence of acute ischemia.


Instruction: Generate impression based on findings.

Input: Loose body on radiograph. History of patellar dislocation medial sided knee pain. MENISCI: Adjacent to the anterior horn of the lateral meniscus there is a parameniscal cyst. The menisci are otherwise unremarkable.ARTICULAR CARTILAGE AND BONE: There is focal thinning of the patellar cartilage at the lateral facet, with a subchondral cyst identified in the lateral patella. There is mild bone marrow edema at the lateral femoral condyle.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Loose body within the anteromedial aspect of the joint, with moderate effusion.2. Thinning of the cartilage of the lateral patella with a patellar subchondral cyst and adjacent anterior parameniscal cyst.


Instruction: Generate impression based on findings.

Input: 48-year-old female with sacral mass precluding evaluation of the cervix PELVIS:UTERUS, ADNEXA: Displaced anteriorly by presacral mass described below. The endometrial canal is distended with small amount of fluid. There is an enhancing, partially cystic lesion in the lower uterine segment extending from the anterior wall measuring approximately 3.1 x 1.4 x 1.6 cm. Multiple T2 hyperintense cysts are noted in the cervix compatible with Nabothian cysts. No abnormal enhancement or mass of the cervix is noted. Junctional zone thickness and appearance is within normal limits. Small focus of T2 hyperintensity may represent focus of subendometrial tissue. Bilateral ovaries are normal in appearance.BLADDER: No significant abnormality noted.LYMPH NODES: Scattered bilateral subcentimeter external iliac and inguinal lymph nodes.BOWEL, MESENTERY: Visualized small bowel caliber is within normal limits without evidence of obstruction. The appendix is well visualized and within normal limits.BONES, SOFT TISSUES: Large, enhancing, well demarcated, pedunculated mass located in the rectouterine pouch measuring 8.4 x 8.5 x 11.4 cm extending from the right S2 neural foramina is compatible with pathologically proven neurilemmoma. This lesion is similar to slightly larger when compared to the prior examination. There is mass effect on the rectum without evidence of obstruction or invasion. There is mass effect on the uterus without evidence of invasion.OTHER: No significant abnormality noted.

Output: 1.No significant change in an enhancing, partially cystic lesion extending from the anterior wall of the lower uterine segment favored to represent a polyp. 2.Nabothian cysts are noted without evidence of suspicious masslesion of the cervix. 3.Stable to slight interval increase in size of pathologically proven sacral neurilemmoma as described above.


Instruction: Generate impression based on findings.

Input: Clinical question: Rule out CVA. Signs and symptoms: Altered mental status, on possible. Non-infused CT of brain:Images through posterior fossa are unremarkable.Images through the supratentorial space demonstrates advanced small vessel disease of indeterminate age.No definite evidence of cortical stroke is detected. No evidence of hemorrhage, mass-effect, midline shift or hydrocephalus. No definitive interval change since prior exam. Follow-up with an MRI examination is recommended.

Output: 1.Advanced small vessel disease of indeterminate age.2.No definitive cortical stroke and no hemorrhage.3.Follow-up with an MRI is recommended.


Instruction: Generate impression based on findings.

Input: Clinical question: Rule out intracranial lesion, evaluate for bitemporal visual field cut and pale optic disc and blurry vision. Signs and symptoms: As above. Pre- and post enhanced brain MRI:Unremarkable diffusion-weighted images.Examination demonstrate a small focus of FLAIR hyperintensity in the right centrum semiovale measuring 7 x 8 mm in transaxial dimensions. Finding is without detectable susceptibility signal changes or enhancement.Small well demarcated focus of FLAIR and T2 hyperintensity is noted in the right cerebral peduncle measuring 5 x 5 mm in transaxial dimensions. This finding also demonstrate no associated susceptibility signal changes or enhancement and no detectable mass effect.There is a very poorly defined small focus of FLAIR/T2 hyperintensity in the subcortical white matter of left posterior frontal lobe (axial FLAIR and T2 image 11) with subtle enhancement and measuring at approximately 8 mm in transaxial dimensions. The finding demonstrates faint enhanced (coronal post enhanced series 11 image 17 and axial post enhanced series 19 image 12).Post enhanced images demonstrate a small linear vascular enhancement in the right basal ganglia along the course of the right lenticulostriate branches. The enhancement is nonspecific and could represent an intravascular enhancement due to distal occlusion and lacunar infarct. Lack of any visible vasculature and susceptibility MR images precludes possibility of a developmental venous anomaly however this possibility cannot be entirely excluded. Additionally examination demonstrate a well demarcated uniformly enhancing focus immediately anterior to the temporal horn of left lateral ventricle measuring at 6 x 7 mm in transaxial dimensions. This finding demonstrate no signal abnormality on any other MRI sequence and cannot be detected with certainty. This is a nonspecific finding however possibilities of an occult arteriovenous malformation, demyelinating plaque or remote possibility of a metastatic disease cannot be entirely excluded.Unremarkable images through the orbits and including axial fat sat post enhanced series.Calvarium is intact and without abnormal enhancement.All paranasal sinuses and bilateral mastoid air cells and middle ear cavities are well pneumatized however a small retention cyst in the left maxillary sinus is noted.Pre- and post enhanced pituitary MRI:There is normal anatomical morphology, signal intensity, size and pattern of enhancement of pituitary gland, pituitary stalk and bilateral cavernous sinuses without evidence of mass. Unremarkable images through the basal cistern and hypothalamic region without abnormal mass or enhancement. Unremarkable images through the paranasal sinuses and skull base.

Output: 1.Pre- and post enhanced pituitary MRI is unremarkable.2.Pre and post enhanced brain MRI demonstrate 2 small foci of FLAIR hyperintensity in the right centrum semiovale and right cerebral peduncle without enhancement. Small focus of FLAIR hyperintensity in subcortical white matter of right posterior frontal lobe with faint enhancement measuring 5 mm in transaxial dimensions. Focus of well demarcated enhancement measuring 6 x 7 mm anterior to the tip of the left temporal horn which cannot be identified on any other MRI sequence as detailed. Faint focus of enhancement in the left frontal subcortical white matter with subtle FLAIR/T2 hyperintensity as detailed. Constellation of findings are confusing as some are detectable on FLAIR and T2 weighted series with enhancement and some demonstrate enhancement without any detectable FLAIR/T2 signal changes. Considering patient's age and symptomatology demyelinating disease should be considered. Correlate with history and risk factors is recommended since possibility of small vessel ischemic strokes although unusual for age cannot be entirely excluded. Please review detailed report above.3.A linear vascular enhancement in the right basal ganglia along the course of the right lenticulostriate branches is noted. Possibilities of a nonspecific finding, an intravascular enhancement secondary to distal vascular occlusion/lacunar infarct or a developmental venous anomaly should be considered.


Instruction: Generate impression based on findings.

Input: Mass measuring is a 49-year-old female with a strong family history of breast cancer in her mother (diagnosed twice at the ages of 39 and 54) and maternal aunt (diagnosed at the age of 50). Personal history of benign right breast biopsy in 2007 for stromal fibrosis/fat necrosis. There is heterogeneous amount of fibroglandular tissue in both breasts. Mild background parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary or internal mammary region.

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


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for pathology of lumbar pain. Signs and symptoms: Lumbar pain with radiculopathy. Nonenhanced lumbar MRI:There is normal anatomical alignment of vertebral colon.The signal intensity of vertebral column demonstrate mild changes secondary to degenerative disease and unremarkable otherwise.T12-L1 is unremarkable.L1-L2 is unremarkable.L2-L3 is unremarkable.L3-L4 demonstrate mild ligamentum flavum hypertrophy and mild facet disease and unremarkable otherwise.L4-L5 demonstrate mild to moderate bilateral ligamentum flavum hypertrophy and mild facet disease and including minimal left facet effusion. No spinal stenosis or neural foraminal compromise.L5-S1 demonstrate moderate disc disease and loss of disc height, mild to moderate bilateral ligamentum flavum hypertrophy and mild facet disease. There is a midline and right lateral broad-based disc protrusion with resultant significant right lateral recess compromise and evidence of mass effect on the right S1 nerve root. No spinal stenosis however moderate right neural foraminal compromise secondary to degenerative changes is present.The paraspinal soft tissues are unremarkable.The signal intensity and caliber of the lower most visualized thoracic cord, conus and cauda equina is unremarkable.

Output: 1.Central and right lateral broad-based disc protrusion with resultant mass effect and right lateral recess compromise at L5-S1 as detailed. Right neural foraminal compromise at L5-S1 secondary to degenerative disease is also present.2.Unremarkable exam at all other levels and without spinal stenosis at any level.


Instruction: Generate impression based on findings.

Input: BRAIN MRI: The posterior fossa has a small capacities and the cerebellar tonsils display pointed morphologies and extend up to 15 mm inferior to the foramen magnum with crowding of the foramen magnum, which is unchanged. There is effacement of the basal cisterns. There is no evidence of cerebral edema, intracranial mass lesions, acute infarction, or intracranial hemorrhage. There is mild prominence of the clival epidural venous plexus, which may be due to engorgement from altered hemodynamics at the craniocervical junction. There is also minimal diffuse prominence of dural enhancement. The ventricles are unchanged in size and configuration, without evidence of ventriculomegaly or ventricular collapse. There is mild mucosal thickening of the right ethmoid air cells, scattered opacification of the left ethmoid air cells, and minimal mucosal thickening of the right frontal sinus. There is mild mucosal thickening of the right maxillary sinus with air-fluid level and a mucus retention cyst in the left maxillary sinus. There is fluid within the upper aerodigestive track as well. The mastoid air cells are clear. The orbits and extracranial soft tissues are unremarkable. CERVICAL SPINE: There is mild expansion and high T2 signal intensity diffusely within the central spinal cord extending from the C2/C3 level to the upper thoracic level, beyond the field of view. At the C2/C3 level, there is also a distinct punctate focus of T2 signal intensity in the anterior right aspect of the spinal cord with CSF signal characteristics, suggestive of cavitation. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. There are small bilateral pleural effusions.BRAIN MRV: There is evidence of dural venous sinus thromboses.BRAIN MRA: There is no evidence of significant steno-occlusive lesions or aneurysms.NECK MRA: There is no evidence of significant steno-occlusive lesions.

Output: 1.Markedly low-lying cerebellar tonsils with crowding of the foramen magnum and effacement of the basal cisterns, as well as a small posterior fossa may represent an underlying Chiari 1 malformation with superimposed effects of intracranial hypotension manifesting as hindbrain herniation. However, no cerebral edema or intracranial mass is identified. 2.Long segment edema in the imaged portion of the central spinal cord may represent a spinal cord infarct in the setting of coagulopathy and hypoxia or presyrinx state related to the hindbrain configuration. Follow up via a complete spine MRI with diffusion-weighted imaging may be useful for further evaluation.3.No cerebrovascular arterial steno-occlusive disease or evidence of dural venous thrombosis.Findings discussed with Dr. Mikhal, neuro ICU resident on call by Dr. McCann at 4:45 PM on 5/13/2015.


Instruction: Generate impression based on findings.

Input: Right arm pain and weakness. Concern for rotator cuff injury. ROTATOR CUFF: There is diffuse edema throughout the rotator cuff and surrounding musculature. There is severe tendinosis of the supraspinatus with partial thickness tearing. No full thickness tear is evident.  SUPRASPINATUS OUTLET: There is fluid in the subacromial and subdeltoid bursa compatible with bursitis.GLENOHUMERAL JOINT AND GLENOID LABRUM: The humeral head is mildly displaced posteriorly, compatible with posterior capsule laxity. There is degenerative tearing of the anterior and posterior labrum. A small glenohumeral joint effusion is noted.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: 1. Severe tendinosis of the supraspinatus with partial tearing. No full-thickness tear is evident.2. Diffuse edema throughout the rotator cuff and surrounding musculature, suggestive of recent injury.3. Mild posterior displacement of the humeral head compatible with posterior capsule laxity, with degenerative tearing of the labrum.


Instruction: Generate impression based on findings.

Input: 53 years Male (DOB:8/17/1962)Reason: evaluate stage of disease History: anaplastic large cell lymphoma with brain metastasisPROVIDER/ATTENDING NAME: GREG TOMCZYK SONALI M SMITH There is a nonenhancing heterogeneous lesion present in the right cingulate gyrus and adjacent to right paracentral lobule associated with the foci of susceptibility effect and local volume loss. It is associated with some foci of T1 signal hyperintensity. Axial dimensions of the FLAIR signal abnormality are approximately 54 x 28 mm axial dimensions. On coronal T2 imaging measures approximately 34 x 27 mm coronal dimensions. This is stable since 4/11/2016.Another nonenhancing heterogeneous lesion is present in the right basal ganglia which measures 20 x 16 mm axial dimensions. This was larger on the prior exam. It is associated with some foci of T1 signal hyperintensityThere is a nonenhancing 3 mm T2 hyperintense lesion associated with susceptibility effect located in the left caudate nucleus which remains stable compared to the prior exam. It is associated with T1 signal hyperintensity.A small focus of susceptibility effect is present along the left occipital lobe lingual gyrus adjacent to the calcarine sulcus anteriorly. It is stable compared to the prior exam.A punctate focus of T2 and FLAIR hyperintensity is present in the right thalamus stable. It is associated with susceptibility effect.FLAIR signal hyperintensity at the temporal lobe is suspected to represent artifact as it is not seen on the T2 imaging studies.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.Some of the images are degraded due to patient motion as well as by motion. Many of the imaging sequences were repeated.

Output: 1.Since the previous examination a lesion located in the right basal ganglia has regressed in overall size.2.Small lesions in the left caudate nucleus, right thalamus and the left occipital lobe as well as a larger lesion centered in the right cingulate gyrus are stable .3.Although no cranial nerve lesion is identified contrast-enhanced MRI exams or more sensitive in identifying cranial nerve lesions when compared to noncontrast exams.


Instruction: Generate impression based on findings.

Input: Male, 61 years old, with newly diagnosed GBM status post biopsy. Postoperative MRI for radiotherapy treatment planning. Post biopsy changes are seen at the site of the right posterior frontal paramedian enhancing lesion. On comparison with the prior examination the lesion shows continued interval increase in size now measuring up to 27 x 18 mm, previously 20 x 15 mm. An increased quantity of central nonenhancing tissue may reflect further internal necrosis and/or blood product. Several of the paramedian sulci just posterior to the lesion demonstrate enhancement which is concerning for leptomeningeal spread of tumor.No other concerning enhancing lesions are seen. Minimal enhancement along the right frontal biopsy tract likely represents granulation tissue. A developmental venous anomaly is evident in the right cerebellum. The right sided dura is mildly but diffusely thickened and there is a thin layer of low T1-signal subdural fluid on the right with susceptibility effect likely representing old subdural blood product.

Output: Interval increase in the size of an enhancing right posterior superior frontal mass status post biopsy.


Instruction: Generate impression based on findings.

Input: Left neck mass. There is a skin marked overlying the left cheek. There is a fat signal intensity mass within the anterior superficial left parotid gland that measures up to 3 cm. The other salivary glands and upper aerodigestive tract are unremarkable. There is no evidence of significant lymphadenopathy in the images portions of the neck. There is a retropharyngeal right carotid artery flow void. The orbits are grossly unremarkable. There appears to be a nodule within the isthmus of the thyroid gland. There is diffuse cerebral volume loss and chronic left cerebellar and right caudate infarcts superimposed upon a background of diffuse cerebral white matter chronic ischemic disease.

Output: 1. Left parotid lipoma measuring up to 3 cm.2. Apparent nodule within the isthmus of the thyroid gland, which is otherwise incompletely characterized. A thyroid ultrasound may be useful for further evaluation.3. Diffuse cerebral volume loss and chronic left cerebellar and right caudate infarcts.


Instruction: Generate impression based on findings.

Input: Biopsy proven left breast cancer. There is scattered fibroglandular tissue in both breasts. Bilateral retropectoral silicone implants are intact. Mild parenchymal enhancement is noted bilaterally.The index mass near the left 12:00 has internal artifact from the biopsy clip and measures 2.2 x 1.2 x 1.9 cm. Immediately lateral/posterior and inferior to the index mass are additional suspicious masses that appear contiguous with the index lesion in some planes. A 1:00 mass measures 0.9 x 1.0 x 1.0 cm and is probably a correlate for the mammographic asymmetry posterior to the biopsied cancer. Additional at 2:00 an additional mass measures 0.7 x 0.7 x 0.7 cm. The overall extent of these adjacent masses is 3.0 x 1.3 x 2.5 cm. A typically benign enhancing focus is seen in the left 6:00 position.No suspicious enhancement is seen in the right breast. There are two sub-centimeter enhancing foci adjacent to the implant inferiorly. These are typically benign in morphology and enhancement pattern. No abnormal lymph nodes are identified in either axillary region.

Output: 1. Left breast malignancy consisting of a 2.2 cm index lesion with adjacent satellite masses extending from the 12:00-2:00 positions. Overall extent is up to 3.0 x 1.3 x 2.5 cm.2. No suspicious axillary lymph node.3. Highly likely benign foci in the right breast. Recommend 6 month MRI follow up to ensure stability. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: This is a limited exam specific for the exclusion of acute cord compression. Given this caveat, there is no acute cord compression. Redemonstrated are foci of T2 hyperintense foci within the cervical cord. Extensive metastatic disease involving the osseous elements are noted.

Output: 1.No acute cord compression.2.Redemonstrated are foci of T2 hyperintense foci within the cervical cord.3.Extensive metastatic disease involving the osseous elements are noted.


Instruction: Generate impression based on findings.

Input: 79-year-old female with pain and cortical irregularity on radiograph. Evaluate left femoral neck. ACETABULAR LABRUM: There is linear increased signal abnormality traversing the anterior labrum consistent with degenerative tearing. There is also heterogeneity and increased signal abnormality within the anterior acetabular labrum suggesting degeneration within the limitations of this non arthrogram study.ARTICULAR CARTILAGE AND BONE: No bone marrow signal abnormalities identified. There is no linear signal abnormality to suggest an acute fracture. There is no linear signal abnormality to correspond to the findings on recent radiographic examination.SOFT TISSUES: The imaged musculature of the left hip is within normal limits. ADDITIONAL

Output: No evidence of acute fracture as clinically questioned. Osteoarthritis of the left hip and other findings as described above.


Instruction: Generate impression based on findings.

Input: Reason: NEEDS SECRETIN STIMULATION - evaluate for features of chronic pancreatitis History: OSH diagnosis of chronic pancreatitis ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: The main pancreatic duct is nondilated. There are no dilated side branches. There is an appropriate response to secretin administration. No peripancreatic edema or abnormal signal on T1-weighted images. No evidence of pancreatic divisum.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: No MR findings of chronic pancreatitis.


Instruction: Generate impression based on findings.

Input: 55 years, Male, status post meningioma resection. There are postsurgical changes of occipital craniotomy for resection of extra-axial tumor which was abutting the dorsal aspect of the cerebellum. There appears to be near total tumor resection. There is residual extra-axial enhancement abutting/invading the torcular herophili and medial aspect of the right transverse sinus which is suspected to represent minimal residual tumor. This area of enhancement measures approximately 10 x 6 mm. Dural venous sinuses remain otherwise patent. There is restricted diffusion involving the right posterior medial cerebellar hemisphere compatible with cytotoxic edema. Small scattered foci of air as well as small fluid collection with blood products at the resection site and beneath the craniotomy are noted. No large hemorrhage or significant mass effect is appreciated. No midline shift or herniation.Remainder of the brain again demonstrates minimal scattered foci of T2/FLAIR hyperintensity in the bilateral periventricular and subcortical white matter, which are nonspecific but compatible with mild chronic small vessel ischemic changes. More focal area of T2 hyperintensity involving the left inferior lateral aspect of the putamen is suspected to represent a chronic lacunar infarct and was seen previously. Ventricles are normal in size without evidence of hydrocephalus. Moderate degree of paranasal sinus opacification is again noted.

Output: Near total resection of previously seen posterior fossa extra-axial mass, presumably representing meningioma. Minimal residual tumor is suspected along the wall of the torcular herophili and medial aspect of the right transverse sinus. Venous sinuses remain patent.


Instruction: Generate impression based on findings.

Input: Ms. Ottenweller is a 61-year-old female with history of recurrent right breast IDC status post mastectomy and sentinel lymph node biopsy in December 2014. Patient also has personal history of benign MRI-guided biopsy of the left breast in 02/2009 for periductal chronic inflammation. No family history of breast cancer. No current breast complaints. Three standard views of the left breast were performed digitally and reviewed with the aid of R2 CAD, 9.3. The breast parenchyma is composed of scattered fibroglandular elements (BiRADS Density Category B), unchanged in pattern and distribution. Surgical clips are reidentified along the inferomedial aspect of the left breast, along with postsurgical architectural distortion from prior breast reduction surgery. Biopsy marker clip is reidentified in the left breast from prior benign MRI-guided biopsy. No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in the left breast.

Output: Stable postsurgical changes of the left breast. No mammographic evidence of malignancy. As long as the patient's physical examination remains unremarkable, left unilateral diagnostic mammogram is recommended annually. Results and recommendations were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: 59-year-old female with pain. Evaluate for rotator cuff tear ROTATOR CUFF: There is a wavy appearance of the subscapularis tendon with surrounding edema and intermediate signal intensity of the tendinous fibers distally near their insertion site compatible with at least a partial thickness tear. The tendon of the supraspinatus muscle demonstrates a similar appearance and signal intensity near its insertion site. The tendons of the infraspinatus and teres minor muscles appear normal. There is generalized fatty infiltration and atrophy of the rotator cuff muscles.SUPRASPINATUS OUTLET: Degenerative changes affect the acromioclavicular joint with small amount of fluid within the joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: Moderate degenerative changes affect the glenohumeral joint with subchondral cysts within the humeral head.. There is a small effusion within the glenohumeral joint and subscapular recess. There is also fluid present within the tendon sheath of the long head of biceps tendon. The glenoid labrum appears grossly normal. BICEPS TENDON: The long head of the biceps tendon is difficult to see proximally and may be dislocated. Distally the tendon is visualized and appears intact.ADDITIONAL

Output: 1. At least partial thickness tear of the subscapularis and supraspinatus tendons with generalized fatty atrophy and infiltration of the rotator cuff musculature.2. Findings are suspicious for displacement of the long head of the biceps tendon proximally.3. Degenerative changes affect the acromioclavicular and glenohumeral joint with a small joint effusion present extending to the subscapular recess.


Instruction: Generate impression based on findings.

Input: Cervical Spine: Again seen are postsurgical changes of anterior cervical discectomy and fusion from C3 to C6. There appears to be solid osseous fusion across the vertebral bodies. Vertebral body heights are maintained. Alignment is maintained. Prominence of the dorsal epidural fat from the C6-C7 level extending inferiorly into the thoracic spine is again noted, not appreciably changed since outside study from 4/9/2015.Multilevel degenerative changes are again seen, individual levels as below:C2-3: Mild narrowing of the spinal canal with partial effacement of the ventral and dorsal thecal sac related to right paracentral disc osteophyte complex and ligamentum flavum thickening. There is mild to moderate right and no significant left neural foraminal stenosis.C3-4: No significant compromise to the spinal canal. There is moderate right and mild left neural foraminal stenosis related to uncovertebral hypertrophy and facet arthropathy. C4-5: No significant compromise to the spinal canal. Mild to moderate right and mild left neural foraminal narrowing.C5-6: No significant compromise to the spinal canal. Mild bilateral neural foraminal narrowing. T2 hyperintensity is noted in the dorsal cord posteriorly at this level. There is abnormal T2 hyperintensity involving the right hemicord at the upper C6 level.C6-7: There is moderate spinal canal stenosis related to disc osteophyte complex and ligamentum flavum thickening. There is mild to moderate bilateral neural foraminal stenosis, right relatively worse than left. Findings are not appreciably changed since outside prior study.C7-T1: No significant compromise to the neural foramina. Mild spinal canal stenosis related to epidural lipomatosis. No significant disc disease.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear grossly unremarkable. Partially imaged is opacification of the left mastoid air cells.Thoracic Spine: Postsurgical changes of thoracic laminectomy and fusion from T6 to T10 are again seen. Spinal canal is well decompressed at these levels. Epidural lipomatosis is again seen extending from the lower cervical spine to the T5-T6 level.At the T1-T2 level, there is moderate spinal canal stenosis with mild flattening of the cord. No cord signal abnormality at this level is appreciated. There is also moderate neural foraminal stenosis, right worse than left related to facet arthropathy.At the T2-T3 level, there is moderate spinal canal stenosis related to epidural lipomatosis with mild cord flattening. No cord signal abnormality. There is mild right neural foraminal narrowing. No significant left neural foraminal narrowing.From T3-T4 to the T12-L1 levels, there is no significant spinal canal stenosis. Neural foramina also appear patent. Susceptibility artifact slightly limits evaluation however no new cord signal abnormality in the mid or lower thoracic cord is appreciated. Prominent ventral bridging osteophytes suggestive of DISH again noted.

Output: 1. Postsurgical changes of ACDF from C3 to C6 again seen. Degenerative changes in the cervical spine with moderate spinal canal stenosis at C6-C7 related to disc osteophyte complex and epidural lipomatosis is not significantly changed since 4/9/2015.2. Cord signal abnormality involving the cervical cord at the C5-C6 level, predominantly on the right is also not significantly changed and consistent with myelomalacia.3. There is moderate spinal canal stenosis with mild cord flattening at the T1-T2 and T2-T3 levels and to a mild degree at C7-T1. These findings are predominantly related to epidural lipomatosis. No associated cord signal abnormality is definitively appreciated. There is also neural foraminal stenosis right worse than left at T1-T2.4. Postsurgical changes of epidural fat resection, laminectomy, and fusion from T6 through T10 again seen. Spinal canal remains well decompressed at these levels.


Instruction: Generate impression based on findings.

Input: 41 year old male with a hypergammaglobulinemia. SKULL: No discrete lytic lesions seen.CERVICAL SPINE: There is disc space narrowing at C3-C4, C4-5.THORACIC SPINE: Loss of height of several mid thoracic vertebral bodies which could be pathological and would be better evaluated with MRI. LUMBAR SPINE: Loss of height at the body of L3 which may be pathological.RIBS: Questionable lytic lesions noted in the right 7th ribs, denoted by arrows in the frontal radiograph of the ribs.PELVIS: No discrete lytic lesions seen.UPPER EXTREMITY: No discrete lytic lesions seen.LOWER EXTREMITY: No discrete lytic lesions seen.

Output: 1. Questionable lytic lesions in the ribs.2. Compression fractures of the mid thoracic spine and L3 which could be pathological fractures.


Instruction: Generate impression based on findings.

Input: 51-year-old female with hepatitis B. New liver lesion on ultrasound. ABDOMEN:LIVER, BILIARY TRACT: No suspicious hepatic lesions demonstrating enhancement and/or washout. Specifically, no lesions are identified to correlate with findings seen on the 12/19/2016 ultrasound abdomen exam. No anatomic evidence for cirrhosis. Patent vasculature. No intra or extrahepatic biliary ductal dilatation. Gallbladder contains T1 hyperintense bile.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: Multiple T2 hyperintense foci of the lumbar spine with increased signal intensity on the fat sensitive sequences (series 701 images 5, 20) are compatible with benign osseous hemangiomas.OTHER: No significant abnormality noted.

Output: 1.No suspicious hepatic lesions. Specifically, no lesions are identified to correlate with findings seen on the 12/19/2016 ultrasound abdomen exam.


Instruction: Generate impression based on findings.

Input: A patient submitted outside study for review. Submitted for review are right unilateral breast MRI (10/4/2016) performed at outside institution. For comparison, breast MRI (9/26/2016) are available. An attempt of MR guided biopsy of an enhancing lesion in the right breast at the retroareolar region was performed. The target lesion was not reproduced, and thus the procedure was canceled. The suspected lesion on the prior MRI appeared to be a nipple.

Output: MR guided biopsy was canceled because the target was not reproduced in the right breast. The suspected lesion on the prior MRI appeared to be a nipple.BIRADS: 1 - Negative.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: 43-year-old female with history of Crohn's, evaluate disease status 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: There is mild thickening in the rectosigmoid without enhancement, possibly reflecting prior inflammation. The transverse colon, descending colon and rectosigmoid are also relatively ahaustral with suggestion of fibrofatty proliferation, also likely the sequela of prior inflammation. No hyper enhancement or diffusion restriction. No abscesses or fistulas. The terminal ileum is normal-appearing.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: 3.4 mm cyst in the left adnexa.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: See above.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No evidence of active Crohn's disease.2.Findings suggestive of chronic inflammation involving the rectosigmoid, descending colon and transverse colon.


Instruction: Generate impression based on findings.

Input: Secondary malignant neoplasm of brain [C79.31], Reason for Study: ^Reason: 57F with metastatic NSCLC with brain mets s/p WBRT and SRS (thought to be curative) here with diffuse weakness of LE and difficulty walking x1 week Redemonstration of tumor resection areas especially on the right temporoparietal and right cerebellar hemisphere with the surrounding FLAIR/T2 high signal intensity, unchanged since prior scan.Confluent FLAIR/T2 high signal intensities on bilateral periventricular white matter and centrum semiovale indicating nonspecific small vessel ischemic disease, unchanged.The ventricles, sulci and cisterns are unremarkable except ex vacuo changes of the right lateral ventricle, unchanged since prior scan. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The paranasal sinuses and mastoid air cells are clear.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. Unchanged postoperative changes of the right parieto-temporal and right cerebellar hemisphere since prior scan.3. Unchanged non specific small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: Male, 17 years old. Reason: Evaluate for right labral tear. History: Right hip pain ACETABULAR LABRUM: The anterior superior labrum is blunted and irregular likely representing a tear. There is a small fluid collection which may represent a paralabral cyst.ARTICULAR CARTILAGE AND BONE: No significant abnormality noted.SOFT TISSUES: No significant abnormality noted. ADDITIONAL

Output: Tear of the anterior superior labrum with possible paralabral cyst.


Instruction: Generate impression based on findings.

Input: Metastatic pancreatic cancer. Biliary ductal dilatation. ABDOMEN:LIVER, BILIARY TRACT: Several segments have significant intrahepatic ductal dilatation. Segment 5/8 biliary ductal dilatation terminates at a 0.9 x 0.9 cm hypoenhancing mass, compatible with metastatic disease. There is an associated transient hepatic intensity difference in this segment of the liver.There is severe intrahepatic ductal dilatation in the lateral segment of the left hepatic lobe likely related to a small metastasis which cannot be seen. There is no significant dilatation of the common hepatic duct which is poorly seen at the level of hilum. The common bile duct at the level of the pancreatic head is not significantly dilated.Right hepatic lobe hypoenhancing liver metastasis is again seen, measuring 1.5 x 1.2 cm. Mild perihepatic ascites.SPLEEN: The spleen measures 12 cm in length without focal lesion.PANCREAS: Poorly defined hypoenhancing lesion involving the pancreatic body and extending dorsally is difficult to accurately measure and is better characterized on the recent CT. The pancreatic tail is atrophic and decreased in signal intensity. Again the mass encases multiple vessels, better seen on recent CT. Obliteration of the superior mesenteric and splenic vein confluence with numerous collateral vessels is again noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small volume pelvic ascites. Note is made of distended mid small bowel loops without proximal dilatation. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Limited by motion. 1.Several hepatic segments with significant intrahepatic biliary ductal dilatation likely related to small metastatic lesions. A lesion in segment 5/8 is well demonstrated. An underlying lesion related to the lateral segment biliary dilatation is not discernable but is suspected given the abrupt bile duct caliber change. Known larger hepatic metastases are not significantly changed. 2.The locally infiltrating pancreatic mass with associated local vascular involvement is better characterized on recent CT.3.Distended mid small bowel loops may reflect an ileus, but are incompletely evaluated. Follow-up imaging may be obtained as clinically warranted.


Instruction: Generate impression based on findings.

Input: Other disturbances of skin sensation [R20.8] / Flat foot (pes planus) (acquired), left foot [M21.42], Reason for Study: ^Reason: cervical myelopathy, brisk reflexes History: as above C spine:Disc dessication and diffuse bulging of disc which abuts thecal sac at the level of C56. The C67 level also shows mild disc degeneration. However, there is no evidence of significant neural foraminal stenosis or spinal canal stenosis on Cervical spine.Spinal cord signal intensity is normal.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. Thoracic spine MRIThere is normal thoracic kyphosis. 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. The epidural space, thecal sac, and spinal cord are preserved with no evidence of spinal canal/neural foraminal stenosis, cord compression or myelopathy. The conus medullaris terminates at the level of T12-L1. The intervertebral discs demonstrate normal T2 intensity and height with no evidence of disc herniation. The paraspinal soft tissues and musculature are unremarkable.

Output: 1. Disc degeneration with diffuse bulging of disc at the level of C56. And disc degeneration at the level of C67. 2. No evidence of spinal canal and neuroforaminal stenosis on both C and T spine.3. Spinal cord signal intensity is normal.


Instruction: Generate impression based on findings.

Input: The thoracic spine is in normal alignment, with a normal thoracic kyphosis. The vertebral body and disk heights are well maintained. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal. There is no pathological enhancement.There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the thoracic spine.LUMBAR SPINE

Output: Compared to MRI lumbar spine dated 8/31/2014, there has been some increase in size of the previously debulked large pelvic schwannoma including increased intraspinal extension involving the sacral spinal canal as detailed above.