Instruction: Generate impression based on findings.

Input: Headache [R51] / Other visual disturbances [H53.8], Reason for Study: ^Reason: 73 yo F admitted with bilateral uveitis, HA, blurry vision, possibly vasculitis on CT chest, eval for GCA and any other cause of HA/blurry vision History: bilateral eye redness Brain MRIThere is no evidence of acute ischemic or hemorrhagic lesion.On Gad enhanced scan, bihemispheric diffuse dural enhancement are seen. This diffuse pachymeningeal enhancement indicate possible dural irritation including meningitis, or some dural infiltrative lesions such as metastasis or lymphoma. Or this can also be seen after lumbar puncture. Intracranial hypotension can also show dural enhancement, however, there is no other supporting imaging evidence on this scan. Clinical correlation is recommended.There are about 6-8mm thickness extra axial fluid collections on bilateral frontal convexities. These fluid collections are non enhancing and follows CSF signal intensity. There is no evidence of mass effects against underlying brain parenchyme. There are also evidence of susceptibility lesions on dependent portion especially on the left side. Few vascular signal voids within those fluid collections are also seen. These lesions may indicate subdural hygroma. There are scattered somewhat patchy FLAIR/T2 high signal intensities on bilateral white matter. These are non specific but at this age could represent small vessel ischemic disease.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal.

Output: 1. Diffuse pachymeningeal enhancement, diagnostic possibilities include meningitis, infiltrative lesions or post lumbar puncture status.2. Bilateral frontal convexity extra axial CSF collections, may represent subdural hygroma.3.Non specific scattered T2/FLAIR high signal intensity lesions.4. No evidence of acute ischemic or hemorrhagic lesion.5. Normal brain MRA


Instruction: Generate impression based on findings.

Input: Left hemispheric syndrome. There is a subcentimeter area of restricted diffusion involving the left postcentral gyrus with associated high T2 signal. There is a punctate defect in the left thalamus. There is moderate predominantly periventricular cerebral white matter T2 hyperintensity. There are a few scattered punctate foci of susceptibility effect in the cerebral hemispheres. There is no evidence of intracranial mass. There is mild diffuse cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are grossly intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is mild mucosal thickening in the left maxillary sinus.

Output: Punctate acute infarct involving the left postcentral gyrus superimposed upon moderate probable chronic small vessel ischemic disease, a chronic lacunar infarct in the left thalamus, and chronic microhemorrhages.Discussed with Dr. Guan at 10:10 AM on 5/15/15.


Instruction: Generate impression based on findings.

Input: 42-year-old female with suspicious palpable right breast mass, presenting for biopsy. Patient is under the Alan Penn protocol, and had an MRI breast performed on the same day. Targeted ultrasound of the right breast at 6:00 position reveals a 2.9 x 1.9 cm irregular shadowing hypoechoic mass with indistinct margins and mild internal vascularity. This was the target for biopsy.On same day breast MRI study, an enhancing focus was identified in the medial right breast around 3:00 position. For this reason, targeted ultrasound evaluation of the medial right breast was performed which revealed a 5 x 2 x 5 mm circumscribed homogenous hypoechoic avascular mass, and benign in appearance. This mass correlates to an enhancing mass on MRI in the medial right breast.PROCEDURE: The procedure and its risks, including bleeding, infection, and failure to diagnose, and expected benefits of ultrasound-guided core biopsy with percutaneous placement of a marking clip and post-procedure unilateral mammogram were discussed with the patient. Questions were answered. Consent was obtained both verbally and in writing. The time-out form was completed to confirm patient identity and side/type of procedure.The right breast was cleansed with chlorhexidine over the target area. Transducer was sterilely sheathed. Local anesthesia was obtained using 2% lidocaine superficially and at depth. A 3 mm incision was made in the skin with a #11 scalpel blade. Using aseptic technique, continuous ultrasound guidance and a mediolateral approach, three 14-gauge core needle (Celero) specimens were obtained of the lesion. Targeting was judged excellent. All specimens sank to the bottom of the prefilled container of 10% formalin. Specimen quality was judged excellent.Specimens were sent to Pathology with an accompanying history sheet. Using continuous ultrasound-guidance a Hydromark clip was placed into the lesion in the usual manner. Pressure was held over the biopsy site until all bleeding subsided. The skin incision was closed with a Steri-Strip. Post-procedure digital right CC and ML views revealed the percutaneously placed clip to be in the expected location in the central aspect of the lesion. No evidence of hematoma or other complication.A pressure dressing was positioned over the biopsy site and an ice pack positioned over the pressure dressing. Post-procedure instructions were reviewed with the patient both verbally and in writing. She tolerated the procedure well with no evident complications and left the Breast Imaging Department in stable condition.The procedure was performed by Drs. Kulkarni and Tremblay. Dr. Kulkarni was present during the procedure at all times.

Output: 1. Successful ultrasound-guided core biopsy of the right breast lesion and clip placement. Pathology is pending at this time.2. Nonspecific benign-appearing subcentimeter mass within the right medial breast, 4:00, correlates to enhancing focus on same day MRI.BIRADS: 5 - Highly suggestive of malignancy.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: 66 years, Female, headache. No intracranial mass or mass effect. There are multiple foci of T2/FLAIR hyperintensity involving the bilateral periventricular and subcortical white matter. Few foci in the anterior temporal subcortical white matter as well as the external capsules also noted. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. Brain parenchyma is otherwise unremarkable for age. Major flow-voids are preserved. Mild mucosal thickening is seen involving the anterior ethmoid air cells and minimal mucosal thickening involving the bilateral maxillary sinuses. Bone marrow signal and extracranial soft tissues are grossly unremarkable.

Output: 1. No intracranial mass or mass effect is appreciated on this MRI brain without contrast. No contrast was administered due to patient's GFR of less than 30.2. Multiple foci of T2/FLAIR hyperintensity in the bilateral subcortical and periventricular white matter are nonspecific but likely related to chronic small vessel ischemic disease. Etiologies such as CADASIL may also be considered given lesions in the anterior subcortical white matter and external capsule; this is felt to be less likely given patient's relatively older age, but can be correlated with clinical findings.3. Mild paranasal sinus disease.


Instruction: Generate impression based on findings.

Input: Pathological hyper-reflexia. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are minimal scattered nonenhancing punctate foci of cerebral white matter T2 hyperintensity. There is a left cerebellar hemisphere developmental venous anomaly. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, mastoid air cells, and scalp soft tissues are grossly unremarkable. There is mild mucosal thickening in the bilateral maxillary sinuses. Cervical Spine: 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 a small disc-osteophyte complex at C5-6, but no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable. However, there is a heterogeneous nodule in the right tracheoesophageal groove that measures up to approximately 20 mm.

Output: 1. Minimal scattered punctate foci of cerebral white matter T2 hyperintensity are nonspecific. Otherwise, no characteristic findings to suggest multiple sclerosis, for example. 2. Incidental left cerebellar hemisphere developmental venous anomaly. 3. No evidence of cervical spinal cord compression or demyelinating lesions.4. A nodule in the right tracheoesophageal groove that measures up to approximately 20 mm may represent a thyroid lesion. A thyroid ultrasound may be useful for further evaluation.


Instruction: Generate impression based on findings.

Input: 53-year-old male with lymphoma and persistent altered mental status. There is no evidence of intracranial hemorrhage or acute infarct. There is diffuse, mild, confluent, thin, high T2 signal along the bilateral ventricles, with a more focal area of increased T2 signal along the posterior horn of the left lateral ventricle. There is also a focus of increased T2 signal in the left cerebral hemisphere, which measures up to 8 mm. There is a right choroid fissure cyst. There is no abnormal intracranial enhancement. There is diffuse cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. There are innumerable enhancing lesions distributed throughout the calvarium, which correspond to lytic lesions demonstrated on the prior CT. There is high T2 signal in the bilateral mastoid air cells, suggestive of effusions. The orbits and scalp soft tissues are grossly unremarkable.

Output: 1. Innumerable enhancing lesions throughout the skull are consistent with lymphoma.2. Small lesions in the left cerebellar hemisphere and left periventricular white matter are nonspecific, but may represent sequelae of treated central nervous system lymphoma, prior infection, or chronic ischemia.3. No evidence of intracranial hemorrhage or acute infarct.


Instruction: Generate impression based on findings.

Input: Male; 64 years old. Reason: elevated psa History: elevated psa PELVIS:PROSTATE:Prostate Size: 3.4 x 4.6 x 4.6 cm (AP by transverse by craniocaudal)Peripheral Zone: Focus of restricted diffusion with low T2 signal and hazy, wedge-shaped appearance at the left apex, most likely due to scarring and/or inflammation.Focus of restricted diffusion with dark T2 signal at the mid prostate gland at the right edge of the transition zone, most likely secondary to BPH nodule.Central Gland: Nonspecific asymmetric dark T2 signal is noted at the right central zone.Seminal Vesicles: Normal.Extracapsular Extension: None.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No definite prostate cancer is evident, but follow-up examination in 6 months is recommended given the above nonspecific findings.Findings discussed with the patient by Dr. Oto at the time of the examination.


Instruction: Generate impression based on findings.

Input: Ms. Wesley is a 47-year-old female with known right breast IDC with lobular features/DCIS and a metastatic right axillary lymph node. She presents today for I-SPY research MRI (#4). Note that this exam is performed for her research protocol, as the necessary images were not obtained on the scan from earlier this week. There is scattered fibroglandular tissue in both breasts. Mild background parenchymal enhancement is noted bilaterally.RIGHT BREAST: The reference biopsy-proven malignancy in the right retroareolar region measures 3.2 x 1.4 x 3.0 cm, unchanged when compared to the prior study from 5/9/2016, however, this previously measured 3.2 x 2.7 x 3.3 cm (AP x ML x SI) on 3/14/2016. The biopsy-proven malignancy demonstrates less avid enhancement compared to the study from several days ago, likely due to differences in technique (3T vs. 1.5 T). Again seen is a biopsy marker clip located centrally within this malignancy. There continues to be minimal persistent periareolar skin thickening. Multiple benign enhancing masses in the right breast are unchanged. Biopsy-proven metastatic right axillary lymph node now measures 1.5 x 0.9 cm, unchanged compared to the prior study from 5/9/2016, however, this previously measured 1.8 x 1.1 cm on 3/14/2016. Biopsy marker clip is located centrally within this lymph node. No new abnormal enhancement is identified in the right breast. LEFT BREAST:No abnormal enhancement is seen in the left breast. No abnormal axillary lymph nodes are identified in the left axillary region. Vascular port again present in the left medial chest wall.

Output: (1) Decreased enhancement of right breast cancer compared to the March study. No significant change comparing the two studies performed this week. (2) No MRI evidence of malignancy in the left breast. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Diagnosis: Malignant neoplasm of breast (female), unspecified site. Secondary malignant neoplasm of brain and spinal cord(198.3)Clinical question: metastatic breast cancer please assess brain mets There is redemonstration of multiple ring-enhancing lesions enhancing lesions throughout the brain parenchyma. One located in the left cingulate gyrus measures 20 x 18 mm sagittal dimensions. One in the anterior left cingulate gyrus lesion measures 6 mm. One in the right basal ganglia measures 10 x 9 mm axial dimensions one in the left middle frontal gyrus measures 4 mm in diameter. One in the right post central gyrus close to the subcentral lobule measures 5 mm diameter. One in the right anterior temporal lobe measures 16 x 13 mm axial dimensions. One in the vermis currently measures 4 mm On the prior exam the right anterior temporal lesion measured 20 x 19 mm axial dimensions. The right basal ganglia lesion measured 12 x 9 mm axial dimensions; the left cingulate gyrus lesion measured 27 x 19 mm axial dimensions. The right postcentral gyrus lesion measured 8 mm; the smaller anterior left cingulate gyrus lesion previously measured 8 mm. The left middle frontal gyrus lesion previously measured 7 mm. The one in the vermis previously measured 4 mm.Compared to the prior exam the degree of vasogenic edema has regressed but not resolved.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: Since the prior exam multiple lesions scattered in the brain as detailed above have decreased in size and the associated vasogenic edema has regressed but not resolved. These are compatible with metastatic disease..


Instruction: Generate impression based on findings.

Input: Female; 26 years old. Reason: Ileal Crohn's disease, history of abscess, elevated CRP repeat to evaluate distal ileal disease, length, and for abscess History: abdominal pain 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: Moderate circumferential wall thickening of the terminal ileum causing stenosis over a length of approximately 9 cm. Mild dilation of the ileal loop just proximal to the stenotic segment, but no evidence of bowel obstruction. Mild increased striated wall enhancement of this segment, most compatible with active inflammatory bowel disease. No pericolonic abscess or fistula.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Trace endometrial fluid, likely physiologic.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: As above.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Trace pelvic free fluid, likely physiologic.

Output: Findings most compatible with active terminal ileitis superimposed over chronic disease as detailed above.


Instruction: Generate impression based on findings.

Input: 70-year-old man with left knee pain. MENISCI: There is severe mucoid degeneration of the posterior horn of the medial meniscus with intrameniscal cyst formation and extensive degenerative tearing of the posterior horn. Intrasubstance degeneration extends into the body of the medial meniscus, with signal contacting the undersurface of the meniscus, likely representing additional degenerative tearing. The anterior horn of the medial meniscus appears preserved. The lateral meniscus has minimal intrasubstance degeneration, but otherwise appears normal for age.ARTICULAR CARTILAGE AND BONE: There is full-thickness degeneration and fissuring of the articular cartilage of the lateral facet of the patella with underlying subchondral cyst formation. There is relatively mild degeneration of the articular cartilage of the medial facet of the patella. Relatively mild degeneration also affects the femoral trochlea. There is full-thickness degeneration of the articular cartilage along the weightbearing portion of the medial tibial plateau and along the medial femoral condyle above the degenerated posterior horn of the medial meniscus. There are underlying subchondral cysts in this region of the medial femoral condyle. There is also full-thickness fissuring of the articular cartilage of the lateral femoral condyle above the posterior horn of the lateral meniscus. There is a rounded focus of signal abnormality in the proximal tibia near the attachment of the PCL, which may represent an intraosseous ganglion.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1. Tricompartmental osteoarthritis as described above.2. Severe mucoid degeneration of the medial meniscus with degenerative tearing as described above.3. Joint effusion and other findings as above.


Instruction: Generate impression based on findings.

Input: There is status post resection of of meningioma with postsurgical changes seen in the right superior frontal gyrus and anterior aspect of the falx. There is high signal on T2 and FLAIR images with subtle enhancement within the resection cavity, likely representing postop scar and fibrous tissues. Tear drop shaped anterior falx shows high signal intensity on T1, low signal intensity on T2 and significant signal drop on Fat Saturated T1 without evidence of enhancement indicating fatty tissue .On the posterior margin of the resection cavity, there is a small 15 x 5 mm lesion, which is broad based and attached to the falx with intense enhancement and low signal in T2, representing residual or separated remained meningioma.Punctate high signal foci are seen in T2 and FLAIR in the periventricular white matter, consistent with nonspecific small vessel ischemic changes.The ventricles and sulci are within normal limits. The basal cisterns remain patent. There is no midline shift or mass effect. There are no areas of abnormal signal. There is no diffusion abnormality. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits.

Output: Post surgical changes of resected meningioma in the right superior frontal gyrus. Small residual or separated meningioma attached on anterior falx, measuring 15 x 5 mm, is seen on the posterior aspect of the resection cavity.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 36-year-old man with left hip pain, evaluate for labral tear. ACETABULAR LABRUM: There is abnormal linear signal intensity within the anterior superior labrum, compatible with a tear, extending from the 1 o’clock to the 2 o’clock position. The posterior labrum appears normal. ARTICULAR CARTILAGE AND BONE: There is minimal prominence of the anterior femoral head-neck junction from the 3 o’clock to 4 o’clock position, suggesting a very mild cam deformity with an alpha angle of 55 degrees. We see no bone marrow edema. We see no focal articular cartilage defects. SOFT TISSUES: The muscles and tendons of the hip appear normal, as do the remaining soft tissues.  ADDITIONAL

Output: Tear of the anterior superior labrum with borderline anterior cam deformity. Other findings as above.


Instruction: Generate impression based on findings.

Input: GBM. There is redemonstration of postoperative changes from previous resection of the right anterior temporal lobe, portion of the right insula, and right inferior frontal lobe. Compared to the more recent 7/1/2016 exam, there is apparent increased conspicuity of slightly nodular appearing enhancement along the medial margin of the resection cavity, now extending minimally along the anterior body the right lateral ventricle. There is also apparent increased conspicuity of nodular ependymal enhancement along the medial margins of the anterior body of the lateral ventricles. However, previous exam was performed 1.5T on the current exam is at 3T. A more comparable comparison is made with the 5/6/2016 exam which is of the same scanner, where overall there is no significant interval change in appearance of the scattered areas of nodular enhancement. Subtle enhancement is now again seen along the lateral aspect of the right ventricular atrium. Although there remains slight deformity along the lateral aspect of the anterior body the left lateral ventricle, the degree of associated nodular enhancement has decreased compared to 5/6/2016.Extent of surrounding T2/FLAIR hyperintensity along the cavity margins extending posteriorly remains unchanged, with ex vacuo dilatation of the right lateral ventricle. Ill-defined T2/FLAIR hyperintensity along the left lateral ventricular margins is also unchanged and remains nonspecific.There is mild mucosal thickening in the right maxillary sinus with a mucosal retention cyst in the left. There is trace fluid in the right mastoid air cells.

Output: 1.Allowing for differences in technique, stable appearance of the resection cavity.2.No significant change in scattered areas of nodular ependymal enhancement along the lateral ventricular margins when compared to 5/6/2016 exam, except for decreased degree of of nodular enhancement along the lateral margin of the anterior body of the left lateral ventricle. Previous apparent diminished ependymal enhancement may have been technical in nature.


Instruction: Generate impression based on findings.

Input: Alignment is anatomic. There are no fractures or subluxations. There are degenerative changes at the inferior endplate of L5 and superior endplate of S1. The conus is normal in signal and morphology and terminates at the L2 level. The visualized intra-abdominal and paraspinal contents are unremarkable.T12/L1: There is no spinal canal or neural foraminal narrowing.L1/2: There is no spinal canal or neural foraminal narrowing.L2/3: There is no spinal canal or neural foraminal narrowing.L3/4: There is no spinal canal or neural foraminal narrowing.L4/5: There is minimal bilateral neuroforaminal narrowing. There is no spinal canal narrowing.L5/S1: There is disk dessication, posterior central disk protrusion, and adjacent Schmorl's node at L5 and S1. There is mild to moderate bilateral neural foraminal narrowing, left slightly greater than right, and partial effacement of the lateral recesses. No central spinal canal stenosis.

Output: Degenerative changes at L5-S1 with mild to moderate bilateral neural foraminal narrowing related to disc protrusion. No significant spinal canal stenosis.


Instruction: Generate impression based on findings.

Input: Stage IV lung adenocarcinoma with brain metastasis. There are postoperative findings related to resection of a left occipital mass with decrease in size of the heterogeneously enhancing mass with areas of susceptibility effect along the margins of the resection cavity. There is also decreased confluent T2 hyperintensity surrounding the resection cavity, which may represent residual vasogenic edema. The ventricles are unchanged in size and configuration. There is an unchanged peripherally enhancing lesion in the right orbitofrontal region, which measures up to 14 mm and an unchanged punctate enhancing lesion in the right postcentral gyrus. However, there is a new punctate enhancing lesion in the left middle frontal gyrus. There is no midline shift or herniation. There are multiple new punctate foci of restricted diffusion in the bilateral cerebral hemispheres and right cerebellar hemisphere with corresponding high T2 signal. Aside from the expected postoperative findings, the skull and extracranial structures are unremarkable.

Output: 1. Postoperative findings in the left occipital lobe with decrease in size of the lesion in the resection cavity and associated surrounding vasogenic edema. 2. Unchanged right orbitofrontal and right postcentral gyrus metastases.3. New punctate lesion in the left middle frontal gyrus likely represents a metastasis.4. Multiple punctate foci of restricted diffusion in the bilateral cerebral hemispheres and right cerebellar hemisphere likely represent recent infarcts. Discussed with Dr. Luke at 11:20 AM on 10/16/15.


Instruction: Generate impression based on findings.

Input: 42-year-old female with no significant past medical history presenting with headache (left-sided frontal) and nausea. Please evaluate for sinus inflammation. There is no evidence of acute findings including intracranial hemorrhage, edema or midline shift. A left frontal hypodense mass lesion appears extra-axial and is associated with adjacent bony remodeling. There is no evidence of mass effect on the adjacent cerebral cortex. It is of unclear etiology and an MRI is recommended for further evaluation. Prominence of the sulci and ventricles indicates diffuse parenchymal volume loss especially considering the patient's age.The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. Left frontal extra axial hypodense mass is of unclear etiology and an MRI is recommended for further evaluation. 2. No evidence of paranasal sinus inflammatory disease.3. Diffuse parenchymal volume loss considering the patient's age.


Instruction: Generate impression based on findings.

Input: Contrast remained within the radiocarpal joint. Please refer to the subsequent MRI report for further information.Exposure time: 2:40 minutes

Output: Successful arthrogram of the left radiocarpal joint as above.


Instruction: Generate impression based on findings.

Input: Evaluate for progression of metastatic disease. Images through the skull base and including cavernous sinuses remain free of malignancy. Paranasal sinuses and mastoid air cells are unremarkable.Images through the soft tissues of the neck demonstrate a cluster of large nonenhancing mass is in the left supraclavicular region. The transverse diameter of this cluster of tumors measures 21-mm x 40 3-mm on axial image 74. On coronal reformatted image 37 the cranial cervical and the transverse axises of the tumor measures 40-mm. There are no prior examinations for comparison. There is evidence of mass effect and medial deviation of the left common carotid artery and left internal jugular vein by the cluster of nodes. There is no evidence of bony destruction with this finding.Metastatic lesion to vertebral body of C6 with near complete collapse of vertebrae and enhancing extra osseous extension of tumor into the ventral epidural space is noted. Sagittal reformatted images demonstrate mass effect and deviation of the cord posteriorly. Metastatic lesion to the posterior body of C7 also demonstrates epidural extension of tumor into the ventral epidural space. No compression deformity of C7 is detected. These findings can be further evaluated with a dedicated MRI of the spine. No evidence of any additional osseous metastases in the area of exam is identified.Limited images of the apices of the lungs demonstrates extensive scarring (left greater than right). A non-calcific nodule measuring approximately 7 mm times 15-mm is identified in the posterior aspect of right upper lung field (axial image 94). No mediastinal lymphadenopathy is detected.

Output: 1.Cluster of metastatic nodes in the left supraclavicular region as detailed above.2.Metastatic lesion to C6 with significant compression deformity and metastatic lesion to the posterior aspect of C7 vertebrae. There is extraosseous epidural spread of tumor at this level into the cervical spinal canal.3.Metastatic nodule in the right upper lung field.4.Mass-effect and posterior deviation of the cord at C6 is noted. This area can be further evaluated with a dedicated MRI of spine.5.No prior examinations from this institution for comparison.


Instruction: Generate impression based on findings.

Input: Knee pain MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: There is partial-thickness degeneration and fissuring of the articular cartilage of the patella, particularly involving the lateral facet. There is partial-thickness to near full-thickness fissuring of the articular cartilage of the femoral trochlea also along the lateral facet. There is an additional area of focal articular degeneration involving the inferior femoral trochlea.A small cyst is noted within the medial tibial plateau, anterior to the attachment of the PCL. Residual red marrow signal is noted within the distal femur and proximal tibia.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Articular cartilage degeneration affecting the patellofemoral joint with other findings as above. There is no meniscal or ligamentous injury evident.


Instruction: Generate impression based on findings.

Input: 60-year-old male patient with history of right pontine cavernoma. The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mass redemonstrated the the right paracentric pons which has changed imaging characteristics when compared to the prior exam. There is interval decrease in central T2 signal hyperintensity with increased susceptibility effect centrally. The lesion is stable in size and currently measures 8 x 10 mm on T2-weighted imaging. It measures 8 x 10 mm on T2 weighted imaging. The lesion extends from the level of the superior cerebellar peduncle down to the pontomedullary junction.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mucosal thickening in the maxillary sinuses, right greater than left, unchanged. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: Right pontine cavernoma is stable in size with interval increasing susceptibility artifact centrally.


Instruction: Generate impression based on findings.

Input: 61-year-old male with history of left facial squamous cell cancer (likely cutaneous). Status post surgery and adjuvant RT. Please evaluate. Enhanced CT of soft tissues of neck:60 cc of Omnipaque 350 was administered for this exam.Axial 3 mm CT images of the soft tissues of the neck after administration of contrast are obtained. Coronal and sagittal 2-D reformatted images are also acquired.Diffusely irregular pattern of enhancement in the left parotid gland remains identical to prior study. Stranding of overlapping subcutaneous fat is also similar to prior study. The overall size and morphology of this abnormal parotid is identical to prior exam. These changes could represent residual tumor as well as post treatment changes. An MRI examination may be useful for further assessment of this changes.There is interval reduction in the degree of thickening and enhancement of the mucosal of the left lateral pharyngeal wall which extends to involve the left common base. These changes are likely secondary to post treatment. There is no evidence of pathologic lymphadenopathy.Enhanced head CT:This examination is essentially within normal limits and in particular no evidence of metastatic disease to brain parenchyma, that the meninges or the calvarium is detected.Calvarium, paranasal sinuses and mastoid air cells are unremarkable.

Output: 1.Stable appearance of irregularly enhancing left parotid gland in size, morphology and pattern of enhancement since prior study.2.Decrease in the degree of mucosal enhancement of the left lateral oropharyngeal wall and left basal scarring likely representing improved posttherapy changes.3.No evidence of pathologic lymph nodes.4.Negative enhanced head CT.


Instruction: Generate impression based on findings.

Input: 58-year-old woman personal history of left breast biopsy at outside hospital with pathology showing ADH presents for research MRI. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. Specifically, there is no abnormal enhancement in the upper outer quadrant of the left breast at the site of stereotactic biopsy or in the inferior posterior lateral left breast at the site of the additional cluster microcalcifications identified on outside hospital mammogram. Please note that diagnostic mammogram was performed for additional calcifications and results will be reported separately.No abnormal lymph nodes are identified in either axillary region.

Output: (1) No MRI evidence for malignancy. (2) Please note that diagnostic mammogram was performed for additional calcifications in the left breast and the results will be reported under a separate accession.BIRADS: 1 - Negative.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Male, 70 years old, with history of grade 3 meningioma. Postoperative findings are again seen compatible with left parietal craniotomy and tumor resection. A thin layer of extra-axial fluid along the craniotomy is unchanged. T2 hyperintensity and hemosiderin staining within the underlying precentral and postcentral gyri are also unchanged. No evidence of recurrent tumor is seen in the operative bed.A nodular area of dural based masslike enhancement is seen centered on the paramedian high right vertex with involvement of the superior sagittal sinus (see image 131 series 1203). This lesion has increased mildly in size when compared to the prior examination. A tumor-like lesion was, however, evident in this location on exams which predated the most recent surgery. More anteriorly, non-tumoral bilateral dural thickening along the vertex is unchanged likely related to prior subdural collections. No new enhancing lesions are seen. No new areas of parenchymal signal abnormality are detected. Hemosiderin staining is redemonstrated along the bilateral frontal lobe surfaces, right more than left. No evidence of acute intracranial hemorrhage is seen. The ventricular system is within normal limits.

Output: Postoperative findings are demonstrated compatible with tumor resection from the left high convexity. No definite progressive tumor is seen in this location.A separate nodule of probable tumor located along the right paramedian vertex with involvement of the superior sagittal sinus has increased slightly in size.No entirely new intracranial lesions are seen.


Instruction: Generate impression based on findings.

Input: Female, 39 years old, with a right cranial nerve 6 palsy, assess for brainstem lesion, please compare to MRI up loaded on PACS, please do Dr. Javed MS protocol. Multiple round and oval T2 hyperintense lesions are demonstrated within the bilateral cerebral white matter. Some of these contact the ventricular surface and are oriented radially with respect to the ventricles. Most of these lesions have not significantly change from the prior examination. One lesion in the right corona radiata has however notably decreased in size. This lesion enhanced vigorously on the prior examination and does so only minimally on today's study. Several additional lesions showed a faint blush of enhancement on the prior examination which has resolved.Since the prior examination, a new 5-mm focus of T2 hyperintensity has developed within the right aspect of the midbrain, lateral to the red nucleus and just posterior to the substantia nigra (image 13 series 501). This lesion does enhance on postcontrast imaging. Within the pons, there is a punctate (2-mm) focus of T2 hyperintensity just to the right of midline which is also probably new (image 11 of series 501). No clear evidence of enhancement is seen. There may also be a new 4-mm focus of T2 hyperintensity within the right aspect of the medulla (image 12 series 1601).No evidence of significant mass effect is detected. No acute intracranial hemorrhage or abnormal extra-axial fluid is seen. The lateral ventricles are slightly asymmetric in size but this is likely within the limits of normal variation.The cisternal portions of the visualized cranial nerves are within normal limits. The pineal gland is mildly prominent which may represent the presence of small internal cysts, a stable finding.

Output: 1. Multiple supratentorial white matter lesions are seen compatible with demyelinating disease. Most of these lesions are stable in size with the exception of one in the right corona radiata which has decreased in both size and enhancement from the prior exam.2. Several new lesions are identified within the brainstem including one at the right aspect of the midbrain, another just to the right of midline in the pons, and a third in the right aspect of the medulla. The lesion in the pons could potentially be affecting the right sixth cranial nerve as it passes from its nucleus anteriorly to its root exit point at the ventral pons.


Instruction: Generate impression based on findings.

Input: 65 years Female (DOB:8/4/1951)Reason: Evaluation of lumbar spine History: lumbar back pain, not sciaticaPROVIDER/ATTENDING NAME: SARAH CHOXI SARAH CHOXI Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is loss of disc space height this desiccation and diffuse disc bulge at this level associated with bilateral ligamentum flavum and facet hypertrophy. There is some narrowing of the neural foramina bilaterally but worse on the right when compared to the left side. Although the neural foraminal are narrowed, within the neural foramina the exiting nerve roots are surrounded by fat.At L4-5 there is loss of disc space height, disc desiccation and diffuse disc bulge associated with some partial effacement of the fat at the lateral recess bilaterally. There is some narrowing of the neural foramina bilaterally at this level. Disc material extends into the left far lateral region where there is some mild encroachment of the left-sided exiting nerve roots after it exits the neural foramen. Overall there is a mild degree of spinal stenosis at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is bilateral facet ligamentum flavum hypertrophy at this level associated with 1 to 2 mm anterior subluxation of L3 on L4. There is disc desiccation at this level.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: There are degenerative changes present in the lower lumbar spine worse at L4-5 where there is a mild degree of spinal stenosis and some mild encroachment of the exiting nerve roots within the left neural foramen.


Instruction: Generate impression based on findings.

Input: Reason: Biopsy needed of PET positive lesion at the T5 vertebra History: History of Hodgkins Lymphoma Serial CT images obtained during the biopsy procedure demonstrate the needle placement within the vertebral lesion. No complications were identified following the procedure

Output: T6 vertebral bone biopsy under CT guidance. A total of six samples were delivered to pathology for analysis.


Instruction: Generate impression based on findings.

Input: Female, 18 years old, 30 weeks and 5 days GA, with nonvisualization of the cavum septum pellucidum on fetal ultrasound, concern for absent corpus callosum. The corpus callosum is absent in its entirety with an expected colpocephalic pattern of ventricular dilatation. The caliber of the ventricles at the level of the atria is approximately 13 mm bilaterally.Asymmetry is also evident involving the frontal lobes and insula. The left frontal lobe is smaller than the right and the left insula may be smaller as well, or perhaps it simply appears this way due to a greater degree of closure of the left sylvian fissure.The brainstem and cerebellum are within normal limits. No evidence of any mass lesion is seen. No abnormal extra-axial collections or evidence of intracranial hemorrhage is seen.

Output: 1.Agenesis of the corpus callosum.2.Asymmetry of the frontal lobes and insular regions is seen with structures on the left being somewhat smaller than those on the right. The precise nature and etiology for this asymmetry is not clear on the present examination. Findings can be better assessed on postnatal imaging.


Instruction: Generate impression based on findings.

Input: Female, 62 years old, with multiple myeloma and kyphosis with back pain. Patchy inhomogeneous marrow signal intensity is seen with areas of T1 hypointense and STIR hyperintense signal most pronounced in the L3, L4 and L5 vertebral bodies as well as the sacrum.Spinal alignment is anatomic. Mild, less than 50%, loss of vertebral body height is evident at L3 and L4. Mild superior endplate concavity of the L1 vertebral body is also seen. These findings have not substantially changed from the prior examination.The visualized distal spinal cord, conus and nerve roots of the cauda equina are unremarkable. No epidural abnormalities are suspected.L1-2: Right greater than left facet arthropathy. No significant spinal canal or foraminal stenosis. No interval changes. L2-3: Mild facet arthropathy. No significant spinal canal or foraminal stenosis. No interval changes. L3-4: Moderate facet arthropathy. Minimal disc bulging. No significant spinal canal stenosis. Mild left foraminal narrowing. No interval changes. L4-5: Moderate facet arthropathy. Mild bulging disc. No significant spinal canal stenosis but the left lateral recess is slightly effaced. Moderate left and mild right foraminal narrowing. No interval changes. L5-S1: Moderate bilateral facet arthropathy. Mild disc bulging asymmetric to the left. No significant spinal canal stenosis. Mild left foraminal narrowing. No interval changes.

Output: 1.Patchy abnormal marrow signal is seen most conspicuously affecting the lower lumbar spine and sacrum, similar to the prior examination, and compatible with multiple myeloma.2.Mild loss of height of the L1, L3 and L4 vertebral bodies is unchanged.3.Mild to moderate degenerative findings without significant change and without high-grade spinal canal stenosis.


Instruction: Generate impression based on findings.

Input: Reason: further evaluate pancreatic changes noted on recent CT History: abdominal pain, anorexia ABDOMEN: Suboptimal examination due to motion artifact of several sequences. LIVER, BILIARY TRACT: The liver is enlarged measuring 23 cm in craniocaudal dimension, which may be due to a normal variant Riedel lobe. No focal hepatic lesion. No intrahepatic or extrahepatic biliary ductal dilatation. No gallstones. SPLEEN: No significant abnormality noted.PANCREAS: Fullness and mild restricted diffusion of the pancreatic head with marked fatty atrophy of the body and tail. There is diffuse decreased enhancement of the pancreatic head relative to the remainder of the pancreas, raising the question of parenchymal necrosis. No discrete abnormal fluid collection. No pancreatic mass identified. No pancreatic ductal dilatation. Peripancreatic and perigastric enlarged lymph nodes are unchanged and likely reactive.The SMV-portal vein junction is narrowed, although patent. No vascular complication. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postsurgical changes of the stomach. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Fullness of the pancreatic head with associated likely reactive lymphadenopathy compatible with history of pancreatitis. Diffuse decreased enhancement of the pancreatic head raises the question of parenchymal necrosis. Recommend short term follow-up to resolution.


Instruction: Generate impression based on findings.

Input: A patient submitted outside study for review. Submitted for review are breast MRI (12/24/15) performed at DuPage Medical Group. For comparison, digital mammographic images (11/21/15, 12/2/15), images from stereotactic biopsy of right breast with specimen radiograph and postprocedural right mammographic images (12/7/15) are available. Breast MRI was performed with a protocol outlined in the outside radiology report.Submitted images could not be processed with our dedicated workstation.There are 2 small seroma cavities from recent biopsy at 3:00 position in the right breast. Mild regional enhancement around the seroma cavities are also present, likely biopsy changes. No abnormal enhancement is seen elsewhere in the right breast or in the left breast.No abnormal lymph nodes are identified in either axillary region.

Output: MRI demonstrated postbiopsy changes at the site of proven DCIS in the right breast at 3:00 position. There were no additional abnormal enhancement in either breast. No abnormal lymph nodes in either axillary regionBIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Enhancing lesion involving the involving the inferior cerebellar vermis and inferior fourth ventricle is again seen. The cervical spine is in normal alignment, with a normal cervical lordosis. 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.Mild degenerative changes are present in the cervical spine including small disc osteophyte complexes and uncovertebral hypertrophy, worst at the C4-C5 level where there is moderate right and mild left neural foraminal stenosis. There is also mild right C5-C6 neural foraminal stenosis. Spinal canal is grossly patent aside from mild developmental narrowing.THORACIC SPINE

Output: 1. No evidence of spinal drop metastases.2. Mild developmental narrowing of the spinal canal, and mild degenerative changes as described above.


Instruction: Generate impression based on findings.

Input: Male, 53 years old, with right-sided weakness. No evidence of restricted diffusion is seen. Numerous scattered small foci of T2 hyperintensity are demonstrated in the subcortical and periventricular white matter, unchanged and nonspecific.No evidence of parenchymal edema or mass effect is seen. No acute intracranial hemorrhage or any abnormal extra-axial fluid collection is detected. A single punctate focus of susceptibility is seen within the posterior left parietal lobe compatible with a microhemorrhage, stable. The ventricles are normal in size and morphology.

Output: 1.No evidence of acute ischemia.2.Scattered foci of white matter signal abnormality are nonspecific but probably represent chronic microvascular ischemic disease.


Instruction: Generate impression based on findings.

Input: Stage IIIB (cT3N3) lung adenocarcinoma. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is unchanged minimal scattered nonspecific cerebral white matter T2 hyperintensity. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No evidence of intracranial metastases.


Instruction: Generate impression based on findings.

Input: 26-year-old female with history of prior meningioma resection, placement of spinal instrumentation, and now more recently hardware removal. Patient now presents with back pain. Thoracic: Compared to prior MRI from 7/23/2015, thoracic fusion hardware has been removed. Redemonstrated is an extra-axial mass located at a T6-7 vertebral body level along the right posterior lateral aspect of the spinal canal which measures 5 x 10 mm in the axial plane and up to 19 mm in the craniocaudal dimension. This mass is not significantly changed since 7/23/2015 but demonstrates slight gradual enlargement when compared to more remote studies dating back to 6/5/2012. Associated calcifications better demonstrated on prior CT. As before, the mass contacts the thoracic cord without evidence of frank cord compression.There is focal dural thickening along the lateral aspects of the thecal sac at the T9-T10 level, which was present previously on the left but is new on the right, and much of it likely represents granulation tissue. Redemonstrated is an additional small focus of dural thickening along the left anterolateral thecal sac at the T10-T11 level measuring 4 x 7.5 mm in the axial plane and up to 12 mm in the craniocaudal dimension, grossly similar to prior although not well imaged on prior study due to presence of hardware. Focal T2 hyperintensity within the spinal cord at T10 with associated volume loss is not significantly changed and consistent with myomalacia. There remains deformity of the left anterolateral aspect of the cord with mild flattening from approximately the T7-T8 level to the T10-T11 levels which is suspected to be related to adhesions in the thecal sac but not significantly changed since prior. Dorsal epidural thickening with mild effacement of the dorsal thecal sac at the site of prior surgeries is compatible with granulation tissue and is not associated with mass effect. No evidence of high-grade spinal canal stenosis at any level. Neural foramina are also patent. The thoracic vertebral bodies are appropriate in the overall alignment and height. Lumbar: Vertebral body heights and alignment in the lumbar spine are normal. Alignment is normal. Bone marrow signal is benign. No significant disc disease. There is no significant spinal canal or neural foraminal stenosis in the lumbar spine. Lumbar paraspinous soft tissues are unremarkable. No abnormal enhancement.

Output: 1.Interval removal of thoracic spinal fusion hardware. There is no significant change in extra-axial mass likely representing a calcified meningioma at the T6-7 level compared to 7/23/2015. There is evidence of slight enlargement when compared to remote studies dating back to 2012.2.Again seen is dural thickening along the lateral aspects of the thecal sac at the T9-T10 level which was present on the left previously, but appears new on the right, and much of it likely represents granulation tissue. Small residual meningioma remains a possibility. No significant mass effect on the cord.3.No significant change in additional nodular focus of dural thickening along the left anterolateral thecal sac at the T10-T11 level which may also represent minimal residual meningioma. No significant mass effect on the cord.4.No change in T2 signal hyperintensity in the thoracic cord at the T10 level likely representing myelomalacia. Mild deformity of the left anterolateral aspect of the cord from approximately the T7-T8 level to the T10-T11 levels is suspected to be related to adhesions in the thecal sac and also not significantly changed since prior. 5. Lumbar spine MRI is unremarkable.


Instruction: Generate impression based on findings.

Input: Acute on chronic LBP with vertebral tenderness, please r/o fracture or other acute abnormality vs prior MRI in 2014 History: h/o chronic LBP, acute worsening Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment. There is mild loss of the disc height at the L2-3 and L5-S1 levels. No abnormal cord signal.T12-1: Mild degenerative disc disease and loss of height but no neuroforaminal or spinal canal stenosis.L1-L2: Mild degenerative disc disease and loss of height but no neuroforaminal or spinal central spinal canal stenosis. There is a far lateral left annular fissure noted on series 701, image 43 which just abuts the left L1 nerve root.L2-3: Moderate disc disease in moderate facet and ligamentum flavum hypertrophic changes, including bilateral facet effusions and facet joint widening which has progressed compared to the previous exam. There is a shallow broad-based disc bulge along the lateral right and far lateral right neural foramen which causes mild neuroforaminal stenosis but this was seen previously. No central spinal canal or left neuroforaminal stenosis.L3-4: Mild degenerative disc disease and moderate bilateral facet and ligamentum flavum hypertrophic changes, including bilateral facet effusions right greater than left. There has been progression of the facet effusion and widening of the facet spaces. Similar to the previous exam, there is resultant mild central canal stenosis and the transverse dimension but not in AP dimension. No neuroforaminal stenosis.L4-5: Mild degenerative disc disease and moderate to severe left and moderate right facet degenerative changes. No central spinal canal or neuroforaminal stenosis. Again seen is evidence of a prior left-sided laminectomy.L5-S1: Moderate degenerative disc disease with mild facet degenerative changes. No central spinal canal or neuroforaminal stenosis. A tiny annular fissure is noted but unchanged.The paraspinous soft tissue structures appear within normal limits. Within the right SI joint is a small amount of increased signal which may represent a small joint effusion.

Output: Multilevel degenerative changes appearing similar to the prior exam with the exception of progression of the facet joint effusions and facet joint widening at the L2-3 and L3-4 levels which can be a cause of increased pain.


Instruction: Generate impression based on findings.

Input: Malignant neoplasm of ovary [183.0] / Secondary malignant neoplasm of brain and spinal cord(198.3) [198.3] / Other malignant neoplasm without specification of site [199.1], Reason for Study: ^Reason: Ovarian cancer with brain mets post radiation therapy. Overall metastatic lesions' maximum diameter and enhancing portions have been decreased since prior scan.Specifically, the right frontal lobe dural metastatic lesion shows significant size reduction of lenticular shaped metastatic lesion which now remained linear dural enhancement.The right frontal lobe middle frontal gyrus rim enhancing lesion shows significantly reduced enhancing portion since prior scan.Other parenchymal lesions including left frontal lobe just lateral aspect of left lateral ventricle frontal horn, right periventricular white matter lesion just outside of the right lateral ventricle occipital horn, and right cerebellar hemisphere all show decreased size since prior scan.There is no evidence of acute ischemic or hemorrhagic lesion.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: Interval decrease size of enhancing portion as well as size of dural and multiple brain parenchymal metastatic lesions as described above.No evidence of new enhancing lesion.No evidence of acute ischemic or hemorrhagic lesion.


Instruction: Generate impression based on findings.

Input: 26-year-old female with stricture and small bowel Crohn's disease now with subacute nausea and vomiting. ABDOMEN: The study is limited due to lack of IV contrast.LIVER, BILIARY TRACT: Status post cholecystectomy.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: Scattered mesenteric and porta hepatis lymph nodes.BOWEL, MESENTERY: There is a long segment of mid terminal ileum wall thickening with mild proximal small bowel dilation. There is a short segment of intervening normal appearing bowel in between the 15 long segment affected distal ileum The colon is fluid distended with air-fluid levels. There is corresponding restricted diffusion involving this segment reflecting active disease.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1.Probable active on chronic disease involving the neoterminal ileum. No evidence of abscess. There is mild proximal dilation of small bowel without high-grade obstruction.


Instruction: Generate impression based on findings.

Input: Acute onset paresthesias and back pain after twisting injury: left sided radiculopathy. There are far left lateral foraminal and perhaps extraforaminal disc protrusions superimposed upon disc bulges and mild facet hypertrophy at L4-5 and L5-S1, which compress the exiting nerve roots at these levels. There is also mild to moderate right neural foraminal stenosis at these levels. In general, the pedicles appear rather short, such that the neural foramina throughout the lumbar spine are not very capacious. Otherwise, there is no significant spinal canal stenosis. 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 spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: Far left lateral foraminal and perhaps extraforaminal disc protrusions superimposed upon disc bulges and mild facet hypertrophy at L4-5 and L5-S1, which compress the exiting nerve roots at these levels.


Instruction: Generate impression based on findings.

Input: 9-year-old male with vision loss. Evaluate for abnormalities. MRI brain:Exam is limited by motion. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no evidence of abnormal enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is scattered opacification of the ethmoid air cells and minimal mucosal thickening involving mucosa of the bilateral maxillary sinuses. Incidental note is made of rightward nasal septal deviation.MRI orbits:Exam is severely limited by motion rendering it nearly nondiagnostic. No gross space-occupying lesions are identified within the orbits. Image quality is not adequate for the detection of small or subtle lesions.

Output: 1.No acute intracranial abnormality.2.Nearly nondiagnostic examination of the orbits. No gross space-occupying lesion is identified.


Instruction: Generate impression based on findings.

Input: Malaise and fatigue. Left-sided weakness. Evaluate for stroke. There is restricted diffusion within the right posterior basal ganglia with associated T2 hyperintensity, compatible with acute infarction, as identified on recent CT. There is associated susceptibility, consistent with new hemorrhage since CT July 14, 2015. There are multiple additional punctate foci of the restricted diffusion within the right basal ganglia and the right MCA watershed territory in the deep white matter. A focus of restricted diffusion within the right inferior frontal cortex (series 501, image 248) is less intense on diffusion weighted imaging, probably subacute. There is a linear area of restricted diffusion within the right posterior parietal cortex (series 501, image 241), possibly artifactual, as no FLAIR abnormality is detected. There is no midline shift or herniation. There is loss of the normal right M2 flow void, best visualized on series 1301, image 15. There is corresponding mild intrinsic T1 hyperintensity in this location.There are additional foci of T2 hyperintensity within the periventricular and subcortical white matter, with no restricted diffusion, probably sequela of chronic microvascular ischemic disease. The ventricles and basal cisterns are normal in size and configuration. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1.Acute infarct within the right basal ganglia now with associated blood products, with multiple additional adjacent foci of restricted diffusion, consistent with punctate infarcts.2.Additional possible subacute infarct in right inferior frontal gyrus.3.There is loss of the normal right M2 flow void, compatible with slow/irregular flow, corresponding to the hyperdense MCA seen on CT.


Instruction: Generate impression based on findings.

Input: 46-year-old female with right first MTP pain and history of stepping on glass under fourth metatarsal head one month ago. Evaluate for foreign body and osteoarthritis. A marker was placed on the ball of the foot, plantar to the fourth MTP joint of the foot. Just beneath the skin surface adjacent to the marker, is a nonenhancing focus of intermediate signal intensity which is slightly hyperintense to skeletal muscle on T1-weighted images and also hyperintense to skeletal muscle on fat-saturated T2-weighted images, which measures approximately 7 mm in the longitudinal dimension and 7 x 3 mm and the transverse dimension. There is very mild, if any, enhancement of the adjacent soft tissues. The fourth metatarsal and phalanges of the fourth toe appear normal. There is a moderate hallux valgus deformity (metatarsal-phalangeal angle of approximately 30 degrees) with moderate osteoarthritis of the first MTP joint, as seen on recent radiographs. There is associated lateral subluxation of the sesamoid bones relative to their normal location beneath the first metatarsal head and moderate degenerative arthritic changes at the metatarsal-sesamoid articulations. There is low signal intensity within the subcutaneous fat along the medial aspect of the first metatarsal head with enhancement on postcontrast sequences that presumably representing scar tissue. There is a mild synovitis of the first MTP joint.

Output: 1. Small cutaneous/subcutaneus focus of intermediate signal intensity within the soft tissues along the plantar aspect of the base of the proximal phalanx. The etiology and significance of this finding is uncertain, but the signal characteristics are atypical for a foreign body. This could represent a focus prior soft tissue injury. If there is strong clinical concern for a foreign body, targeted ultrasound examination is recommended.2. Osteoarthritis and hallux valgus deformity of the first MTP joint.


Instruction: Generate impression based on findings.

Input: 57 years, Male, metastatic renal cell cancer with suspicious brain lesion. There are multiple enhancing lesions throughout the brain consistent with metastatic disease. At least 8 lesions are identified which on axial post gadolinium series 1201 are seen in the left posterior frontal lobe (image 240), left posterior cingulate gyrus (image 239), along the left mid callosal body surface (image 230), right precuneus (image 230), left occipital lobe (image 180), left occipital lobe (image 166), and bilateral occipital lobes (image 124). The largest of these are the left posterior mid callosal body lesion which measures 5 mm in diameter and the right parietal precuneus lesion which also measures approximately 5 mm in diameter. There is mild surrounding edema associated with the lesions. Some of these lesions demonstrate punctate foci of susceptibility compatible with minimal blood products.No abnormal dural or leptomeningeal enhancement. No midline shift or herniation. No hydrocephalus. No evidence of the infarct. Left cerebellar developmental venous anomaly incidentally noted. Major flow-voids are preserved. Minimal paranasal sinus mucosal thickening and small maxillary mucus retention cysts. Calvarium and extracranial soft tissues are otherwise grossly unremarkable.

Output: There are at least 8 enhancing lesions throughout the brain as detailed above consistent with metastatic disease. Lesions measure up to 5 mm in diameter and are associated with mild surrounding edema. No midline shift or herniation. Some of these lesions demonstrate minimal associated blood products.


Instruction: Generate impression based on findings.

Input: Vertebral body heights in the cervical spine are normal. Alignment is normal. Bone marrow signal is heterogeneous which is nonspecific but without focal suspicious lesions. T1, T2 hyperintense area in the C3 vertebral body may represent focal fat or hemangioma. The cervical cord is normal in signal without abnormal enhancement. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable.C2/3: Central disc protrusion is present without spinal canal or neural foraminal stenoses. C3/4: Central disc protrusion is present without spinal canal stenosis. Minimal right neural foraminal narrowing is noted.C4/5: Mild diffuse disc bulge is noted with moderate right and mild left neural foraminal narrowing. There is also mild spinal canal stenosis.C5/6: Mild diffuse disc bulge is present with bilateral mild-to-moderate neural foraminal narrowing. No spinal canal stenosis.C6/7: Mild diffuse disc bulge is present with bilateral moderate neural foraminal narrowing. No spinal canal stenosis.C7/T1: Minimal diffuse disc bulge is present without spinal canal or neural foraminal narrowing.

Output: Mild to moderate degenerative changes in the cervical spine with scattered mild to moderate neural foraminal narrowing and mild spinal canal stenosis, predominantly in the lower cervical spine.


Instruction: Generate impression based on findings.

Input: Reason: evaluate for dominant lesion for prostate biopsy History: hx of chronic prostatitis, Low grade prostate cancer under active surveillance Please note that study was terminated due to patient discomfort and claustrophobia. Full field of view images of the pelvis were not obtained.PELVIS:PROSTATE:Prostate Size: 6.0 x 4.5 x 4.6 cmPeripheral Zone: Linear area of low T2/ADC signal within the peripheral right mid peripheral zone may represent scarring. An adjacent well-defined T2 hypointense lesion measuring approximately 5 x 5 mm (701/19) within the right anterior peripheral zone is indeterminate.Central Gland: Multiple BPH nodules.Seminal Vesicles: No seminal vesicle involvement.Extracapsular Extension: No evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: Small subcentimeter pelvic and inguinal lymph nodes.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Please note that the patient could not tolerate the postcontrast images and aborted the exam before acquisition of those images.1.Right anterior mid peripheral zone lesion is indeterminate, but may represent small focus of neoplasm.2.A additional linear lesion in the right peripheral zone may represent scarring.3.Small subcentimeter pelvic lymph nodes.


Instruction: Generate impression based on findings.

Input: 66 year old female with personal history of breast cancer and strong family history of breast cancer. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. Post-surgical density in the posterior depth of the left outer breast is without suspicious enhancement.No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Diagnosis: Alzheimer's disease Dementia in conditions classified elsewhere without behavioral disturbance. Vascular dementia, uncomplicatedClinical question: cognitive declineSigns and Symptoms: memory loss 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.There is a moderate degree of periventricular and subcortical confluent hyperintense white matter lesions present identified on the FLAIR and T2 images. Additionally multiple signal hyperintensities are also present in the brainstem and deep gray nuclei and internal capsules as well as the cerebellar hemispheres.There are punctate foci of signal loss present in the brainstem, left cerebellar hemisphere , bilateral thalami left medial temporal lobe, left and right inferior temporal gyrus and frontal lobes and parietal lobes bilaterally.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 demonstrate subchoroidal fluid along the right eye.

Output: 1.There are periventricular, subcortical white matter, internal capsule, deep gray nuclei and brainstem signal changes present. These are nonspecific and could be vascular related. This could also relate to a neurodegenerative process such as nonspecific leukoencephalopathy of aging or represent a mixed pattern.2.There are multiple microhemorrhages present within the brain. This appears to be a mixed pattern without predominantly a hypertensive pattern. A superimposed less prevalent secondary pattern with subcortical and cortical microhemorrhages resulting for example from amyloid angiopathy cannot be excluded.


Instruction: Generate impression based on findings.

Input: 61-year-old female with bladder cancer, status post ileostomy. Fever and shock. Indiana pouch with ileostomy. Evaluate for GI source of infection. Pulmonary embolism CT scan examination was performed in conjunction with this study, but will be reported separately. ABDOMEN:LUNG BASES: CT scan of the thorax for pulmonary embolism was performed and will be reported separately.LIVER, BILIARY TRACT: There are multiple benign-appearing simple hepatic cysts, unchanged from the recent MRI examination. There is diffuse gallbladder wall thickening with mucosal enhancement suggesting cholecystitis.SPLEEN: There is a splenic hemangioma unchanged since the recent MRI examination.PANCREAS: No evidence of pancreatitis was found.KIDNEYS, URETERS: Mild left hydronephrosis is found, as expected in this patient who is status post Indiana pouch ilial conduit. There is a focal left mid pole cortical thinning, probably due to prior infarct. No acute changes are found and compared with the prior examination.ADRENAL GLANDS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: There is focal fat stranding in the right or quadrant, especially axial image 81/162, adjacent to the ilial conduit and a drainage tubing at axial image 97 / 162.PELVIS:UTERUS, ADNEXAE: Status post hysterectomy.BLADDER: Status post cystectomy.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: There is a left lower quadrant ileostomy at axial image 91/ 158.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: New gallbladder wall thickening suggests interval development of cholecystitis. Multiple postoperative changes. No abscess or ascites. Multiple additional findings, as described above.


Instruction: Generate impression based on findings.

Input: 80 year-old male with history of thyroid cancer status post thyroidectomy. Restaging of disease. Limited evaluation due to lack of contrast. MRI may be considered for further evaluation as clinically warranted.BRAIN: Limited intracranial images demonstrate no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized mastoid air cells are normally pneumatized. Sinus disease affects the ethmoid sinuses bilaterally.Skull base:Small nodules in the neck cannot be ruled out due to lack of contrast. MRI may be considered for further evaluation as clinically warranted.Fascial planes appear intact without evidence of architectural distortion or abnormal mass. The airways are patent.

Output: Limited evaluation due to lack of contrast without evidence of gross abnormality. MRI can be considered for further evaluation as clinically warranted.


Instruction: Generate impression based on findings.

Input: Reason: meniscus tear History: pain and catching. MENISCI: The medial and lateral menisci are intact.ARTICULAR CARTILAGE AND BONE: Diffuse thinning of the medial compartment articular cartilage. Diffuse thinning of the lateral compartment articular cartilage with at least near full-thickness defect involving the weightbearing portion of the lateral tibial plateau measuring approximately 8 mm in AP dimension with associated underlying subchondral bone marrow edema. Diffuse thinning of the patellofemoral compartment without discrete defect.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: Osteoarthritis, greatest in the lateral compartment, where there is a near full-thickness defect involving the weightbearing portion of the lateral tibial plateau.


Instruction: Generate impression based on findings.

Input: 63-year-old male, rule out rotator cuff tear ROTATOR CUFF: The patient is status post rotator cuff repair. There is full thickness near full width tearing of the distal supraspinatus with retraction of the undersurface fibers to the level of the glenoid. Some fibers of the supraspinatus remain attached to the greater tuberosity. The tear of the anterior aspect of the tendon measures approximately 1.2 cm in AP dimension and of the posterior aspect of the tendon measures 1.4 cm (images 19 and 17, series 8). There is mild to moderate supraspinatus muscle atrophy. Increased signal intensity within the supraspinatus and infraspinatus fibers within the supraspinatus outlet is compatible with tendinosis. There is mild infraspinatus muscle atrophy. The teres minor and subscapularis muscles and tendons are intact.SUPRASPINATUS OUTLET: An os acromiale is noted with mild to moderate AC joint osteoarthritis.GLENOHUMERAL JOINT AND GLENOID LABRUM: Evaluation of the labrum is limited, but there appears to be degeneration of the labrum with degenerative tearing anteriorly.BICEPS TENDON: Status post biceps tenodesis.ADDITIONAL

Output: 1. Full thickness, near full width tear of the supraspinatus tendon with retraction of the undersurface fibers to the level of the glenoid.2. Degeneration and tearing of the labrum as described above.3. Moderate distention of the subacromial subdeltoid bursa, containing debris.4. Os acromiale.


Instruction: Generate impression based on findings.

Input: Spasticity, evaluate for cervical stenosis Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. There is osseous fusion involving the C3-C4 vertebral bodies and the C5-C6 vertebral bodies. There is minimal retrolisthesis of C5 on C6. Alignment is otherwise grossly maintained. Bone marrow signal is benign.Degenerative changes are seen in the cervical spine as described below:C2-3: There is mild right neural foraminal narrowing related to uncovertebral hypertrophy and facet arthropathy. No significant compromise to the spinal canal or left neural foramen.C3-4: There is a subligamentous disc extrusion with approximately 6 mm superior migration. There is at least moderate spinal canal stenosis at this level with complete effacement of the ventral and dorsal thecal sac and subtle impression on the cord. There is questionable subtle T2 hyperintensity within the cord at this level.C4-5: Fusion at the intervertebral discs level. There is a small dorsally projecting osteophyte which results in mild spinal canal stenosis at this level. Mild left and minimal right neural foraminal narrowing.C5-6: There is a disc osteophyte complex and ligamentum flavum thickening which contribute to moderate to severe spinal canal stenosis at this level and deformity of the cord particularly in its right aspect. There is T2 hyperintensity in the cord and volume loss consistent with myomalacia. There is severe right and moderate left neural foraminal stenosis related to uncovertebral hypertrophy and to a lesser degree facet arthropathy.C6-7: Fusion at the intervertebral disc level. No significant spinal canal stenosis. There is mild left and minimal right neural foraminal stenosis. C7-T1: There is a disc osteophyte complex and bilateral uncovertebral hypertrophy. There is mild spinal canal stenosis at this level. There is mild to moderate bilateral neural foraminal stenosis.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: 1. Postsurgical changes of remote anterior cervical fusion with solid osseous fusion evident at C4-C5 and C6-C7. 2. There is moderate to severe spinal canal stenosis at the C5-C6 level which is not fused. There is cord deformity at this level particularly on the right. There is also T2 hyperintensity and volume loss consistent with myelomalacia.3. There is also at least moderate stenosis at the C3-C4 level related to disc extrusion with superior migration. There is questionable subtle T2 signal abnormality at this level.4. Multilevel neural foraminal stenosis, worst at the C5-C6 level where there is severe right-sided neural foraminal stenosis. Additional levels as above.


Instruction: Generate impression based on findings.

Input: Diagnosis: Secondary malignant neoplasm of brain and spinal cordClinical question: characterization of brain metsSigns and Symptoms: gait instability, newly diagnosed lung cancer There is an 18 x 24 mm axial dimension mass redemonstrated at the left cerebellopontine angle cistern which is associated with some adjacent dural thickening and has a broad-based towards the dura. Some susceptibility effect is associated with this lesion suggesting blood products lesion. It appears to have partial extra-axial location and may be exophytic from the adjacent cerebellumThere is a 6 x 8 mm axial dimension enhancing lesion present at the periphery of the left cerebellar hemisphere which was also present on the prior exam and is associated with susceptibility effect.There is redemonstration of a 16 x 21 mm sagittal dimension and 16 x 21 mm axial dimension ring-enhancing mass centered in the right cingulate gyrus which is associated with adjacent vasogenic edema and has also not changed substantially compared to the previous exam and is associated with susceptibility effectThere is a 3 mm enhancing focus in the right cerebellar hemisphereNormal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate partial opacification of the left frontal sinus The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin.

Output: There are multiple hemorrhagic intracranial lesions present which are stable compared to prior exam. One in the left cerebellopontine angle cistern appears to be exophytic. There are others in the left cerebellar hemisphere and right cingulate gyrus. Metastatic disease is not most likely consideration under the circumstances.


Instruction: Generate impression based on findings.

Input: Please refer to the subsequent MRI report for further information.Exposure time: 50 seconds

Output: Successful wrist arthrogram into the radiocarpal joint.


Instruction: Generate impression based on findings.

Input: Multiple sclerosis, history of sensory and worsening leg weakness. Brain: There are multiple supratentorial and infratentorial T2 hyperintense lesions. Some of the lesions demonstrate corresponding T1 hypointensity. However, there is no abnormal enhancement or associated restricted diffusion in any of these lesions. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There is an unchanged subcentimeter cystic pineal gland. The major cerebral flow voids are intact. There is hypoplasia of the right maxillary sinus with mild mucosal thickening and mucosal thickening involving the right ethmoid sinus. There is also fluid within the right sphenoid sinus. The orbits, skull, and scalp soft tissues are grossly unremarkable.Thoracic Spine: The thoracic spinal cord signal appears unremarkable. There is no evidence of mass lesions or abnormal enhancement. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. There are prominent posterior disc osteophyte complex at T6-T7 and T7-T8, which indent the spinal cord. There is also a right neural foraminal disc-osteophyte complex at T9-10. The paravertebral soft tissue structures are otherwise unremarkable.

Output: 1. No significant interval change of the demyelinating lesions in the brain.2. No evidence of demyelinating lesions in the thoracic cord.3. Prominent posterior disc osteophyte complex at T6-T7, T7-T8, and T9-T10 indent the spinal cord.4. Findings suggestive of acute sinusitis.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 65-year-old female history of progressive change in mental status, with symptom onset 1 month ago, and acute worsening overnight. History of DM, HTN, and RA (on weekly Enbrel). Elevated neuronal enolase. Patient motion limits evaluation. There are new confluent areas of increased T2 and decreased T1 signal abnormality especially within the grey and subcortical as well as deep white matter of bilateral occipital lobes and to a lesser extent other bilateral scattered cortex. Additionally, there is restricted diffusion and FLAIR hyperintensity present in the left greater than right caudate nuclei and bilateral putamen (in retrospect, the caudate abnormality may have been present on the prior MRI) with questionable restricted diffusion in bilateral occipital lobes. The left caudate appears mildly enlarged and edematous. There are progressive scattered punctate foci of subcortical white matter T2/FLAIR hyperintensity. There is no evidence of abnormal enhancement.There is asymmetric susceptibility suggested associated with the left dentate nucleus, although no other signal abnormality in this area is appreciated. The ventricles and basal cisterns are normal in size and configuration. There is no evidence of midline shift or mass-effect. The major cerebral flow voids are intact.

Output: New areas of increased T2/FLAIR signal abnormality throughout bilateral occipital lobes, progressive scattered focal subcortical and cortical T2/FLAIR hyperintensity, and FLAIR hyperintensity as well as restricted diffusion within left greater than right caudate nuclei and putamen. No associated enhancement, with questionable susceptibility in left dentate nucleus.The differential diagnosis includes PRES (posterior reversible encephalopathy syndrome) possibly secondary to hypertension and/or from medications. There have been reports of Enbrel resulting in PRES. Other differential considerations should include various encephalitides, metabolic derangements including osmotic demyelination (extrapontine) if clinically appropriate, or the Headenhain variant of CJD given occipital involvement, although subcortical findings would be atypical.


Instruction: Generate impression based on findings.

Input: Female 33 years old Reason: Labral tear? Instability ROTATOR CUFF: All the components of the rotator cuff are intact.SUPRASPINATUS OUTLET: Type I acromion. No abnormal narrowing of the supraspinatus outlet.GLENOHUMERAL JOINT AND GLENOID LABRUM: Focal gadolinium filled defect in the posterior labrum from the 3 to 4 o'clock location (series 501, image 11). No other labral defects are present. No loose bodies or visualized hyaline cartilage defect. The humeral head is normal in appearance and is well-seated at the glenoid. No evidence of osteoarthritis.BICEPS TENDON: The biceps tendon is situated within the bicipital groove and is normal in appearance. ADDITIONAL

Output: Focal posterior labral tear.


Instruction: Generate impression based on findings.

Input: Straightening of cervical spine which can be seen with positioning or muscle spasm. Otherwise, anatomic alignment with preservation of vertebral body heights, disk spaces, bony contour and morphology. Atlantal axial and atlantal dental intervals are preserved. No prevertebral soft tissue swelling and preservation of paraspinal fat pads. Circumscribed lucency at C4-5 with circumscribed margins and no cortical breakthrough most commonly focal fat or a hemangioma.

Output: No acute traumatic abnormalities to the cervical spine.


Instruction: Generate impression based on findings.

Input: Contrast promptly passed into the radioulnar joint suggest a tear of the triangular fibrocartilage complex. Please refer to the subsequent MRI report for further information.Exposure time: 0:31 minutes

Output: Successful arthrogram of the right radiocarpal joint. Findings suggestive of a tear of the triangular fibrocartilage complex as above. Please refer to the subsequent MRI report for further information.


Instruction: Generate impression based on findings.

Input: Male, 46 years old, with altered mental status and C-spine injury. Image quality is limited by patient motion artifact. No restricted diffusion is seen. No large areas of parenchymal signal abnormality, edema or mass effect are detected. The ventricles are not dilated. No large intracranial hemorrhage is suspected. Opacification and/or mucosal thickening is seen within the paranasal sinuses.

Output: Limited examination due to motion artifact, but no large intracranial abnormality is suspected.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for hemorrhage. Signs and symptoms: New aphasia Non-infused CT of brain:Postoperative changes of an old left craniotomy in the frontal and temporal region. Focal areas of encephalomalacia in the left frontal, temporal and left caudate nucleus are again identified. There is ex vacuo dilatation of left frontal horn.Expected postoperative changes of a large right-sided frontal -- temporal craniotomy which extends across the midline. There is no evidence of parenchymal hemorrhage no definitive evidence of an ischemic process. Aneurysm clips bilaterally adjacent to the sella from prior surgeries produce significant artifact and obscures the detail in the peri-surgical site. Further follow-up with an MRI is recommended considering provided clinical data. The ventricular system are within normal size and no midline shift.No definitive detectable acute intracranial finding.

Output: 1.No definitive new acute intracranial findings.2.Expected postoperative changes of a larger right frontal and temporal craniotomy.3.Old left frontal and temporal craniectomy with underlying foci of encephalomalacia in the right temporal, right frontal and right caudate nucleus.


Instruction: Generate impression based on findings.

Input: Hepatomegaly and cirrhosis. Liver lesion on ultrasound and CT. History of HCV. ABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy. Mild intra and extrahepatic biliary ductal prominence is likely related to cholecystectomy state.The liver measures 18 cm in craniocaudal dimension.The segment 4 liver lesion is homogeneously intermediate signal intensity on T2-weighted images and measures approximately 3.8 x 3.0 x 4.9 cm (series 3/18). The lesion demonstrates a thick rind of peripheral enhancement and central heterogeneous enhancement. Small adjacent punctate arterial enhancing foci are noted (series 10/31).There is an additional rim-enhancing lesion in segment 7 of the liver (series 10/28) measuring 9 mm which fills in with contrast on delayed phase imaging.SPLEEN: The spleen is normal in size without a focal lesion.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: Small fat-containing umbilical hernia. OTHER: No significant abnormality noted.

Output: The dominant segment 4 lesion measuring at least 3.8 x 3.0 cm is not compatible with a hemangioma. It does not meet imaging criteria for HCC. A cholangiocarcinoma is favored over an atypical HCC or metastases. Additional rim-enhancing lesion in segment 7 is suspicious for a satellite versus metastatic lesion.


Instruction: Generate impression based on findings.

Input: Reason: CCA screening History: PSC ABDOMEN:LIVER, BILIARY TRACT: Narrowing of the distal 1.8 cm common bile duct is similar to prior (series 3 image 70). Mild focal narrowing of the proximal hepatic duct is also unchanged. Subtle common hepatic and common bile ductal wall enhancement is unchanged. Mild intrahepatic biliary ductal dilatation, unchanged. No suspicious focal hepatic lesion.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: Nonspecific portacaval lymph nodes, unchanged. BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Stable narrowing of the proximal hepatic and distal common bile ducts with mild intrahepatic biliary ductal dilatation. No suspicious focal hepatic lesion.


Instruction: Generate impression based on findings.

Input: Reason: intracranial lesion on OSH imaging History: intracranial lesion on OSH imaging, p/w episode of syncope The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a uniformly enhancing mass present along the anterior cranial fossa centered at the midline measuring 44 x 50 mm axial dimensions and 30 x 50 mm sagittal dimensions. It contains a few flow voids. It displaces the inferior aspects of the frontal lobes posteriorly. It displaces the corpus callosum and anterior cerebral arteries superiorly and posteriorly. Within the adjacent brain parenchyma there is no significant signal change. The mass extends into the olfactory grooves. The olfactory bulbs are not separately identified. There is a large vein which courses along the right aspect of the mass anteriorly and laterally.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 superior ophthalmic veins are large .

Output: 1.Large anterior fossa extracranial masses most likely represents a meningioma.


Instruction: Generate impression based on findings.

Input: 19-year-old male with debridement of the right proximal tibia for osteomyelitis now complains of pain.VIEWS: Right tibia/fibula AP and lateral (2 views) 5/24/2016 at 1427 hours Again noted is a round lucent defect in the proximal tibial metaepiphysis compatible with debridement of osteomyelitis. Again noted are the radiodense antibiotic beads. Widespread osteonecrosis is better noted on the prior MRI examination. No regions of soft tissue gas or osseous erosions to suggest new osteomyelitis. No acute fracture.

Output: No significant change in the postsurgical appearance of the right proximal tibial osteomyelitis debridement.


Instruction: Generate impression based on findings.

Input: 58 years Female (DOB: 10/10/1957)Reason: stenosis? History: hyperreflexiaPROVIDER/ATTENDING NAME: THOMAS J. KELLY THOMAS J. KELLY 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. There is mild left-sided facet hypertrophy at this level.At C3-4 there is no significant compromise to the spinal canal . There is right-sided facet hypertrophy at this level associated with mild encroachment of the right-sided exiting nerve roots within the neural foramen..At C4-5 there is no significant compromise to the spinal canal. There is right-sided facet hypertrophy at this level associated with mild encroachment of the right-sided exiting nerve roots.At C5-6 there is loss of disc space height, diffuse disc bulge, endplate osteophytes and uncovertebral osteophytes associated with encroachment of the neural foramina bilaterally. Neural foraminal encroachment is worse on the left side where there is encroachment of the left-sided exiting nerve. There is partial effacement of spinal fluid ventral and posterior the spinal cord at this level with mild to moderate spinal stenosis.At C6-7 there is loss of disc space height and disc desiccation, endplate osteophyte formation and uncovertebral osteophytes with associated encroachment of the neural foramina bilaterally and encroachment of the exiting nerve roots bilaterally but worse on the right relative to the left side. There are some effacement of spinal fluid ventral to the spinal cord at this level.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: There are multilevel degenerative changes present in the cervical spine associated with encroachment of the right-sided exiting nerve roots at C6-7, left-sided exiting nerve roots at C5-6 due to uncovertebral osteophytes and disc material and some encroachment of right-sided exiting nerve roots at C4-5 due to facet hypertrophy. There is also mild to moderate spinal stenosis at C5-6 due to degenerative change.


Instruction: Generate impression based on findings.

Input: Gait difficulty, memory issues, evaluate for NPH or any abnormality. No intracranial mass or mass-effect. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. There is mild global parenchymal loss, which appears appropriate for patient's age. There is minimally more prominent volume loss involving the bilateral frontal lobes and mild disproportional prominence of the bilateral frontal horns, which is favored to be on an ex vacuo basis. No findings to suggest communicating hydrocephalus. No disproportional volume loss involving the hippocampi is seen. No extra-axial collections are seen. Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with minimal chronic small vessel ischemic changes. Brain parenchyma is otherwise unremarkable for age. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: 1. No evidence of intracranial mass or mass effect. 2. Minimal chronic small vessel ischemic changes.3. Mild global parenchymal volume loss which appears appropriate for age. There is mildly more prominent volume loss involving the bilateral frontal lobes. There is also mild disproportionate prominence of the bilateral frontal horns, which is favored to be on an ex vacuo basis and unchanged since CT dated 11/24/2014. No findings to suggest communicating hydrocephalus/NPH.