Instruction: Generate impression based on findings.

Input: A 18 year old female with palpitations and syncope. The workup until now was negative including ecg, echocardiography, stress test, holter, head CT and MRI. Referred now to cardiac MRI for further evaluation Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 53%, the LV end diastolic volume index is 64 ml/m2 (normal range: 65+/-11), the LVEDV is 90 ml (normal range 109+/-23), the LV end systolic volume index is 30 ml/m2 (normal range 18+/-5), the LVESV is 42 ml (normal range 31+/-10). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 50%, the RV end diastolic volume index is 70 ml/m2 (normal range 69+/-14), the RVEDV is 99 ml (normal range 110+/-24), the RV end systolic volume index is 35 ml/m2 (normal range 22+/-8), and the RVESV is 49 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size and systolic function, the LVEF is 53%. There are no regional wall motion abnormalities present. 2. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.3. The right ventricle is normal in size and systolic function, the RVEF is 50%.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Slurred speech [R47.81], Reason for Study: ^Reason: stroke History: slurred speech Multifocal scattered restricted diffusion lesions on the left frontal lobe especially involving precentral gyrus as well as periventricular white matter without evidence of hemorrhagic conversion indicating acute ischemic infarct.There are scattered small focal susceptibility lesions bilateral cerebellar hemispheres, left more than right indicating possible chronic petechial hemorrhages.Patchy bilateral high signal intensities on FLAIR/T2 images at periventricular white matter and centrum semiovale indicate non specific small vessel disease. In addition, there are multifocal chronic lacunar infarction involving right external capsule, left internal capsule anterior limb, and pons.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. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1, Acute ischemic infarctions without evidence hemorrhagic conversion on the right frontal lobe pre central gyrus and periventricular white matter as described above.2. Underlying brain shows non specific small vessel disease with multifocal lacunar infarcts.3. Petechial chronic hemorrhagic lesions on the bilateral cerebellar hemispheres.


Instruction: Generate impression based on findings.

Input: 65-year-old woman with left breast calcifications presents for second look ultrasound for lesion found on recent MRI. A targeted gray scale and color Doppler left ultrasound was performed for the area of concern seen on MRI. In the left breast 3:00 position 4 cm from the nipple there is a small area of focally dilated ducts. Within a dilated duct is a 8 x 3 x 4 mm hypoechoic mass without internal vascularity, correlating to the abnormality on MRI and indeterminate. An ultrasound guided biopsy is recommended for further evaluation.

Output: 8 x 3 x 4 mm left breast mass is indeterminate. Ultrasound guided biopsy is recommended for further evaluation. Findings are recommendations were discussed with the patient at the time of the exam.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration.


Instruction: Generate impression based on findings.

Input: The thoracic spine is in normal alignment. The vertebral body and disk heights are well maintained. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal. Apparent STIR hyperintensity in the lower thoracic cord is likely artifactual as it is not appreciated on the sagittal or axial T2 sequences.There is mild degenerative changes including disc height loss at disc bulge at the T11-T12 level without significant spinal canal or neural foraminal stenosis. There is no significant disk bulge, herniation, spinal canal or foraminal stenosis elsewhere within the thoracic spine. No abnormal enhancement.LUMBAR SPINE

Output: No cord signal abnormality or abnormal enhancement. No spinal canal or neural foraminal stenosis in the thoracic or lumbar spine.


Instruction: Generate impression based on findings.

Input: History of metastatic melanoma with brain metastasis treated with CTX: visual changes and headaches. There is a cystic tumor with a heterogeneously enhancing mural nodule in the left occipital lobe and surrounding vasogenic edema that measure up to 45 mm. There is a cystic tumor with a heterogeneously enhancing mural nodule and layering susceptibility effect from hemorrhage in the left cingulate gyrus and surrounding vasogenic edema that measures up to 17 mm. There is a heterogeneously enhancing tumor in the left postcentral gyrus with surrounding vasogenic edema that measures up to 10 mm with surrounding vasogenic edema. There is a cystic tumor with heterogeneous mural nodule with surrounding vasogenic edema that spans the right occipital and parietal lobes and measures up to 42 mm. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. There is no evidence of acute infarction. There is a left maxillary retention cyst. There are post-operative findings related to left posterior parietal craniotomy. The orbits are grossly unremarkable.

Output: Multiple brain metastases, including a tumor in the left occipital lobe that measures up to 45 mm, a tumor with layering hemorrhage in the left cingulate gyrus that measures up to 17 mm, a tumor in the left postcentral gyrus that measures up to 10 mm, and a tumor that spans the right occipital and parietal lobes and measures up to 42 mm. While the lesions are associated with vasogenic edema, there is no midline shift.


Instruction: Generate impression based on findings.

Input: 17 month old male with ventriculomegaly and porencephalic cyst experiencing continued increasing head circumference. Evaluate for aqueductal stenosis. Sagittal T1 and T2 images demonstrate narrowing of the mid point of the cerebral aqueduct due to dysmorphism of the adjacent quadrigeminal plate. Minimal biphasic CSF flow is identified at the level of the aqueduct and fourth ventricle, although normal biphasic flow is noted anteriorly and at the level of the cerebellar tonsils.Redemonstrated is a right transfrontal Rickham catheter that terminates in a large right frontal lobe porencephalic cyst. The porencephalic cyst, lateral ventricles, and third ventricle have continued to increased in size, although this seems commensurate with calvarial growth. There remain a few scattered foci of residual susceptibility effect within and along the margins of the ventricular system and perhaps within the right prepontine cistern, unchanged. Also redemonstrated is diffuse cerebral white matter volume loss. There is no evidence of acute intracranial hemorrhage or acute infarct. There is approximately 5 mm midline shift to the left. The major cerebral flow voids appear to be intact. The cranial vault appears macrocephalic. Mastoid air cells and middle ear cavities are clear.

Output: Sagittal T1 and T2 images demonstrate narrowing of the mid point of the cerebral aqueduct due to dysmorphism of the adjacent quadrigeminal plate. Minimal biphasic CSF flow is identified at the level of the aqueduct and fourth ventricle, although normal biphasic flow is noted anteriorly and at the level of the cerebellar tonsils.


Instruction: Generate impression based on findings.

Input: 23 year-old female with right lower quadrant pain. Rule-out appendicitis. CHEST:LUNG BASES: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: A 4+ zero at 2.4-cm cystic hypoattenuating lesion with thin internal septations and nodular components is seen arising from the body of the pancreas. An MRI is recommended for further evaluation. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The visualized gas filled appendix is normal in appearance. Mild cecal and terminal ileum thickening is seen with an enlarged regional lymph node. In a patient of this age, infectious versus inflammatory etiologies would be the most likely considerations. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No other significant abnormality noted.PELVIS:UTERUS, ADNEXAE: Bilateral ovarian cysts are seen with a small amount of free pelvic fluid, likely physiological given the patient's age.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy noted.BOWEL, MESENTERY: The visualized gas filled appendix is normal in appearance. Mild cecal and terminal ileum thickening is seen with an enlarged regional lymph node. In a patient of this age, infectious versus inflammatory etiologies would be the most likely considerations. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No other significant abnormality noted.

Output: 1. Focal thickening of the cecum and terminal ileum as described above. The etiology of disease is most likely infectious versus inflammatory. Ischemic disease is considered less likely.2. Cystic lesion in the pancreas as described above. MRI is recommended for further evaluation.These findings were relayed to the Dr. Eric Beck at 9 a.m. on 10/29/2010


Instruction: Generate impression based on findings.

Input: Pituitary tumor surgical planning; headache. There is a pituitary mass with suprasellar extension that measures up to 33 mm. There is associated mass-effect on the optic apparatus and mild extension into the bilateral cavernous sinuses. The mass also protrudes into the sphenoid sinuses and nearly abuts the A1 segment of the right anterior cerebral artery. The rest of the intracranial structures are grossly unremarkable.

Output: Preoperative planning MRI for a pituitary mass with suprasellar extension that measures up to 33 mm.


Instruction: Generate impression based on findings.

Input: Left cerebellar hemisphere lesion, spine survey due to symptoms, 6 month follow up: precocious puberty. Brain: There is a persistent patchy T2 hyperintense lesion in the left cerebellar hemisphere, now measuring up to approximately 10 x 12 mm, previously 9 x 12 mm. There is no associated enhancement. There is a right cerebellar hemisphere developmental venous anomaly. There is no evidence of intracranial hemorrhage or acute infarct. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is scattered paranasal sinus mucosal thickening, particularly in the right frontal sinus.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 no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: 1. Persistent left cerebellar hemisphere lesion, which may represent a neoplasm.2. No evidence of Chiari malformation or spine lesions.3. Paranasal sinus inflammatory changes, particularly in the right frontal sinus.


Instruction: Generate impression based on findings.

Input: 69 year old male with history of lung cancer with metastases to the brain and thoracic spine. Patient had multiple new strokes recently. Rule out acute bleed or stroke. Curvilinear high density within the right subinsular cortex surrounded by low attenuation white matter corresponds to region of ischemia on MRI dated 11/5/2008 and likely represents dystrophic calcification within an area of chronic ischemia.There is no evidence of intracranial hemorrhage or edema. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: No acute abnormality. Chronic ischemia within the right subinsular cortex with encephalomalacia and dystrophic calcification.


Instruction: Generate impression based on findings.

Input: Male, 62 years old, Reason: S/p SRS for brain mets. Surveillance exam. There is no evidence of progression of metastatic disease. A small hemosiderin stained resection cavity is again seen involving the left precuneus. No pathologic enhancement or new signal abnormality is detected in this vicinity. A 2 focus of enhancement within the left putamen with associated susceptibility effect is stable to minimally smaller since 9/6/2016 and particularly smaller when compared to earlier studies. No new enhancing lesions are seen. Scattered foci of nonspecific FLAIR hyperintensity within the cerebral hemispheres show no significant interval change. No evidence of acute ischemia. Diffuse prominence of the perivascular spaces is again seen. No abnormal extra axial collections are detected. The ventricles are stable in size and morphology.There is moderate degree of opacification involving the bilateral anterior ethmoid air cells and to a lesser degree the remainder of the paranasal sinuses, grossly similar to prior.

Output: 1. Postoperative findings in the left parietal lobe without evidence of local tumor recurrence.2. Minimal residual punctate focus of enhancement within the anterior left putamen corresponding to a treated metastasis. 3. No new or enlarging lesions to suggest progression of metastatic disease.


Instruction: Generate impression based on findings.

Input: Clinical question: History of lung cancer. Please evaluate for metastases. Signs and symptoms: Lung cancer. Enhanced CT of brain:There is no definite evidence of metastatic disease to the brain, leptomeninges or the calvarium. This examination is essentially within normal limits for patient's stated age of 73. CAT scan can miss very small metastatic lesions. Please correlate with history and follow-up with an enhanced MRI is recommended.Calvarium, visualized orbits, paranasal sinuses and mastoid air cells are unremarkable.90 cc of Omnipaque 3 350 is administered for above study.

Output: No evidence of metastatic disease and essentially unremarkable enhanced CT of brain for patient's stated age of 73.


Instruction: Generate impression based on findings.

Input: 45-year-old female with history of right breast invasive ductal carcinoma status post lumpectomy in 2008 with radiation and chemotherapy. Patient presents today for screening MRI. No current breast related complaints. There is heterogeneous amount of fibroglandular tissue in both breasts. Minimal parenchymal enhancement is noted bilaterally.Stable postsurgical changes from prior right lumpectomy. Mildly prominent, but normal edge parenchymal enhancement is present in the lateral right breast.No suspicious enhancement is seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. Stable post surgery changes in the right breast.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Routine Screening Mammogram.


Instruction: Generate impression based on findings.

Input: 52-year-old African-American male with left-sided weakness. Possible CVA. There is no evidence of intracranial hemorrhage, mass or edema. Diffuse hypodensity in the periventricular and subcortical white matter distribution consistent with small vessel ischemic disease, age indeterminate. If there is clinical concern for acute ischemia, MRI may be considered.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Small vessel disease, age indeterminate. If there is clinical concern for ischemia, MRI may be considered.


Instruction: Generate impression based on findings.

Input: Female 47 years old Reason: MS, f/u progression History: weakness. MRI brain: There is been interval increased number and/or size of scattered as well as confluent areas of T2/FLAIR signal abnormality within the periventricular and subcortical white matter. For example, there has been conspicuous development of a new lesion in the left frontal subcortical white matter on 401/47 as well as one within the right frontal deep white matter on 401/50. There is also a large lesion which is now present in the right aspect of the pons. A right periatrial lesion has increased in extent of central FLAIR hyperintensity compared to prior exam. Many of the lesions oriented perpendicular to the long axis of the lateral ventricles. The majority of the lesions demonstrate corresponding T1 hypointensity. Incidental note is made of a chronic appearing lesion just anterior to the left trigeminal root insertion. There is also a stable lesion in the right cerebellum inferiorly.The ventricles and basal cisterns are prominent for age, consistent with moderate global volume loss greater than expected. There is no midline shift or herniation. There is mild right maxillary and bilateral ethmoid air cell mucosal thickening.MRI C-Spine:There is redemonstration of persistent patchy areas of abnormal T2/STIR hyperintensity throughout cervical cord with associated volume loss, most conspicuously involving the C2, C4-5 and C6-7 levels. There is signal additional abnormality at T1-T2, as previously seen. There are no definite new lesions.The cervical spine is in normal alignment, with reversal of the normal cervical lordosis. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the cervical spine.

Output: 1. Significant progression of intracranial demyelinating disease with multiple new lesions as well as increased size as well as confluence of abnormal signal of previously seen lesions. Both supratentorial and infratentorial disease is identified, including a large new right pontine lesion. Overall, moderate T1 and moderate-severe T2 burden of disease.2. Similar distribution of patchy abnormal signal throughout the visualized cervical and upper thoracic cord with associated areas of volume loss consistent with chronic demyelinating disease.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 50-year-old female with glioblastoma on radiation therapy, evaluate for change in tumor size while on treatment area patient is experiencing headaches. There has been interval decrease in size of the patient's enhancing right posterior frontal lobe mass, measuring 34 mm transverse x 30 mm AP (previously 35 mm transverse x 38 mm AP. Additionally, there is significantly less vasogenic edema and its related mass effect, with right to left midline shift now measuring 4 mm (previously 7 mm). Beyond the vasogenic edema, there has been an increase in the degree of T2 abnormality involving the anteromedial frontal lobe, now crossing the splenium, and extending into the adjacent left frontal lobe. As before, there is persistent T2 abnormality with gyral thickening involving the anterior right temporal lobe and insula. There are small, patchy foci of new enhancement associated with both the T2 abnormality crossing the corpus callosum as well as within the right peri-insular frontal gyri. Perfusion analysis demonstrates elevated corrected rCBV within the enhancing rim of the primary lesion, especially along its undersurface. There is a suggestion of subtly increased rCBV involving the involved right hemispheric white matter (including the rightward corpus callosum) as compared to the contralateral side.There is no evidence of acute intracranial hemorrhage or acute infarct. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. Redemonstrated is a right maxillary sinus retention cyst. Remaining paranasal sinuses and mastoid air cells are clear. Expected vascular flow-voids are demonstrated.

Output: 1.Decreased size of a right posterior frontal lobe high-grade astrocytic neoplasm with concurrent decrease of associated vasogenic edema as well as mass effect.2.There has been an increase in the degree of T2 abnormality involving the anteromedial frontal lobe, now crossing the splenium, and extending into the adjacent left frontal lobe. 3.As before, there is persistent T2 abnormality with gyral thickening involving the anterior right temporal lobe and insula.4.There are small, patchy foci of new enhancement associated with both the T2 abnormality crossing the corpus callosum as well as within the right peri-insular frontal gyri. 5.Perfusion analysis demonstrates elevated corrected rCBV within the enhancing rim of the primary lesion, especially along its undersurface, evidence for viable tumor. There is also a suggestion of subtly increased rCBV involving the involved right hemispheric white matter (including the rightward corpus callosum) as compared to the contralateral side.


Instruction: Generate impression based on findings.

Input: Male, 19 years old, with history of Chiari status post decompression. Assess decompression and for syrinx. Evidence of Chiari decompressive surgery is again seen with suboccipital craniectomy and resection of the posterior arch of C1. A catheter remains visible spanning from the fourth ventricle through the foramen of Magendie.Morphology and positioning of the cervical tonsils is similar to the prior exam. As on the prior examination, CSF flow is seen anteriorly along the brainstem through the foramen magnum with attenuation at the level of the dens. Little if any flow is seen posteriorly through the foramen magnum or around the cerebellar tonsils.A syrinx cavity is redemonstrated beginning at the C6-7 disc level and continuing to the mid T1 level, unchanged from prior. The maximum caliber of the syrinx measures approximately 3 x 2 mm which is not significantly changed from the prior exam.Evaluation of the thoracic cord is limited by motion artifact. This makes accurate assessment of the thoracic syrinx unreliable. However, it does appear that the discontiguous syrinx extending from the upper thoracic region to T7 may be somewhat improved.Multiple Schmorl's nodes with mild anterior wedging from C6 through T10 are again seen, similar to the prior examination and suggestive of Scheuermann's disease.Spinal alignment is anatomic. Vertebral body morphology and signal characteristics are within normal limits. No significant spinal canal or neuroforaminal stenosis is identified.

Output: 1.Redemonstration of findings compatible with Chiari malformation and decompressive surgery without significant interval change.2.Stable syrinx in the lower cervical region.3.Poor visualization of the thoracic syrinx due to motion artifact. However, it does appear that at least some portions of the syrinx may be improved from prior.


Instruction: Generate impression based on findings.

Input: Male, 60 years old, with low right-sided back pain, getting worse over the past one year. Minimal anterolisthesis of L3 relative to L4 is seen without change. Spinal alignment is otherwise anatomic. Mild chronic wedging of the anterior aspect of the T11 vertebral body is again seen. Vertebral body heights are otherwise within normal limits. No evidence of marrow replacement is observed. Mild edema is evident centered on the L4-5 facet complexes, similar to prior. The visualized distal spinal cord and conus are within normal limits. No epidural abnormalities are suspected. Disorganization of the cauda equina nerve roots is seen likely secondary to spinal canal stenosis at the L3-4 level.T11-12: Facet arthropathy and disc bulging. No significant spinal canal or foraminal stenosis.T12-L1: Mild disc bulging. A superimposed left paracentral disc extrusion is new. Mild generalized spinal canal narrowing with effacement of the left ventral thecal sac, new from prior. No significant foraminal narrowing.L1-2: Unremarkable. L2-3: Mild facet arthropathy. Ligamentum flavum thickening. Mild disc bulging with a superimposed left foraminal and far lateral protrusion, unchanged. No significant generalized spinal canal stenosis. Mild left foraminal narrowing, unchanged. L3-4: Facet arthropathy. Ligamentum flavum thickening. Disc bulge. Severe generalized spinal canal stenosis with effacement of CSF and crowding/impingement of the nerve roots of the cauda equina, unchanged. Mild lateral foraminal narrowing, unchanged. L4-5: Facet arthropathy. Ligamentum flavum thickening. Bulging disc with a superimposed left foraminal and far lateral protrusion which has increased in size. Moderate generalized spinal canal stenosis, particularly affecting the left lateral recess. Moderate left foraminal narrowing, unchanged. L5-S1: Facet arthropathy. No significant spinal canal or foraminal stenosis.

Output: 1.Severe spinal canal stenosis at L3-4, caused by a combination of posterior element hypertrophy and disc bulging, has not significantly changed.2.A left paracentral disc extrusion at T12-L1 is new, though it causes only mild effacement of the thecal sac. A left foraminal/far lateral protrusion at L4-5 has also increased in size though the resulting left foraminal stenosis is unchanged.


Instruction: Generate impression based on findings.

Input: 36-year-old male. History of IBD and perianal abscess. Diarrhea and weight loss. Assess for small bowel disease. ABDOMEN:LIVER, BILIARY TRACT: Scattered hepatic cysts. No biliary ductal dilatation. No suspicious hepatic mass. Gallbladder sludge.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral small renal cysts. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Long segment (approximately 35 cm) of featureless distal sigmoid colon and rectum with associated circumferential wall thickening, cord like enhancement, and mild pericolonic fat stranding suggestive of acute on chronic inflammatory bowel disease. Mild fibrofatty proliferation.Small bowel is unremarkable in appearance.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Findings consistent with acute on chronic inflammatory bowel disease involving a long segment of distal sigmoid colon and rectum. 2. Two fistula tracts arising from the distal rectum terminating in two small perirectal abscesses.


Instruction: Generate impression based on findings.

Input: Brain parenchyma appears within normal limits. The ventricles and sulci are within normal limits. The cisterns remain patent. There is no midline shift or mass effect. There are no areas of abnormal signal or enhancement. 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. There is diffusely low marrow signal of the osseous structures, likely related to patient's history of sickle cell disease. There is mild nonspecific prominence of the bilateral palatine tonsils.

Output: MRI of the brain is within normal limits. Specifically, there is no evidence of infarct.


Instruction: Generate impression based on findings.

Input: History of spinal cord injury following a fall in 2012 resulting in cervical cord impingement requiring C3-C6 laminectomies and C3-C5 instrumented fusion. New upper extremity numbness post assault 2 weeks ago. There is mildly increased STIR signal within bone marrow of the C5, C6 and C7 vertebral bodies with subtle hypointensity on T1 and may reflect edema. There is also edema in and around the left T1 transverse process and adjacent ribs. The vertebral bone marrow signal is otherwise less fatty than expected, which may reflect red marrow reconversion. There appears to be trace left-sided epidural high T2 and low T1 signal at the C6 level anteriorly. There are postoperative findings related to previous C3-C6 laminectomies and C3-C5 instrumented fusion. There is reversal of the usual cervical lordosis. The vertebral column alignment is within normal limits otherwise. The vertebral body heights are preserved. The thecal sac is expanded at the laminectomy levels. However, C6-C7 and C7-T1 disc-osteophyte complexes cause slight spinal canal stenosis. There is no significant spinal canal narrowing otherwise. The focal T2 hyperintensity within the spinal cord centrally at the upper C4 level in unchanged. The remainder of the spinal cord displays normal signal and morphology.

Output: 1.No evidence of spinal cord compression. 2.Focal central T2 hyperintensity in the cervical spinal cord has not changed since 2012 and may represent myelomalacia. 3.Mildly altered signal in the marrow of the corresponding vertebral bodies, which likely represents edema, and trace left-sided epidural high T2 and low T1 signal at the C6 level anteriorly, which may represent an epidural hematoma. 4.Edema in and around the left T1 transverse process and adjacent ribs is likely related to the fracture that is better depicted on CT.5.Findings related to previous cervical spine laminectomies and instrument fusion, as described above, with residual C6-C7 and C7-T1 disc-osteophyte complexes cause slight spinal canal stenosis.


Instruction: Generate impression based on findings.

Input: 2 day old female with left lower extremity hemangioma, evaluate for extent of involvement Multiple conglomerate foci of T2 signal abnormality extend from the retroperitoneum inferior to the left kidney to the pelvis with encasement of the rectum and extension into the peritoneum. There is encasement of the left buttock with less extensive involvement of the right buttock as well as encasement of the proximal left thigh along its lateral, posterior, and medial aspects. Foci of signal abnormality extend along the femur to the level of the knee with involvement of the popliteal fossa and distally along the posterior and medial leg the level of the ankle. There is delayed enhancement of these lesions without early arterial enhancement or large flow-voids.The bladder is moderately distended with fluid. High T1 signal within the bowel likely represents meconium.

Output: Findings compatible with multiple hemangiomas involving the abdomen, pelvis, and left lower extremity as described above.


Instruction: Generate impression based on findings.

Input: There is no evidence of intracranial hemorrhage or mass. There are punctate foci of restricted diffusion in the left superior frontal sulcus and precentral gyrus. There is otherwise a small area of encephalomalacia in the left precentral gyrus. Additional scattered punctate foci and confluent areas of T2 hyperintensity within the periventricular and subcortical white matter without associated restricted diffusion. The ventricles and basal cisterns are unchanged 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. There are bilateral maxillary osteointegrated dental implants and sinus lift surgery.

Output: 1. Punctate foci of restricted diffusion in the left superior frontal sulcus and precentral gyrus may reflect acute to early subacute ischemia superimposed upon an otherwise small chronic infarct involving the left precentral gyrus and a background of diffuse mild chronic small vessel ischemic disease.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 31 year old female with nausea/vomiting, headache, fatigue, history of VP shunt placed 2/02/12 currently on intrathecal chemotherapy for history of breast cancer with leptomeningeal/thoracic metastases. Shunt unable to be opened status post chemotherapy on 2/22/12. There is redemonstration of a right frontal approach VP shunt terminating in the region of the left foramen of Monro, unchanged in position when compared to the previous study. Interval enlargement of the lateral ventricles bilaterally and the third ventricle. The frontal horn of the left lateral ventricle measures 16 mm (15; series 4), previously 13 mm. The third ventricle measures 10 mm, previously 9 mm. There is no evidence of transependymal CSF flow. The sulci are normal in size and configuration. There is no midline shift or basal cistern effacement.There is no evidence of acute intracranial hemorrhage, extra-axial fluid collection, mass or edema. There is preservation of the gray-white matter interface. There is no evidence of acute territorial ischemia. The leptomeningeal metastatic disease seen on the prior MRI is not resolved on this noncontrast CT.The calvaria and skull base are radiographically normal. Previously seen swelling over the right scalp has subsided. The visualized mastoid air cells and paranasal sinuses are clear apart from some debris within the sphenoid sinuses, unchanged.

Output: Stable positioning of right sided VP shunt with mild interval enlargement of the lateral ventricles and third ventricle. No transependymal CSF resorption, acute intracranial hemorrhage, or mass effect.


Instruction: Generate impression based on findings.

Input: 64-year-old male with history of TB infection now with superficial infection, rule out fracture or osteomyelitis. Known mycobacterium chelonae infection. History of diffuse large B-cell lymphoma status post MUD stem cell transplant. There is cortical disruption and periosteal reaction along the ulnar aspect of the distal ulna with small lucencies and a permeative appearance extending to the mid diaphysis, suspicious for osteomyelitis and in a similar distribution as the prior MRI. Swelling is seen in the soft tissues along the dorsal and ulnar aspect of the distal forearm. No definite radiographic evidence of osteomyelitis in the carpals or metacarpals to correspond to findings on MRI. No acute fractures are evident.

Output: Osteomyelitis of the distal ulna. No fracture is evident.


Instruction: Generate impression based on findings.

Input: Female, 67 years old, with myelitis. Cervical:Redemonstrated is non-expansile, non-enhancing T2 hyperintensity affecting the upper cervical cord. This finding is most prominent from C2 through C4. Below C4, this abnormality seems to have become less conspicuous when compared to the prior examination. No pathologic intrathecal enhancement is detected.Spinal alignment is anatomic. Vertebral body heights are preserved. There is partial fusion of the C5 and C6 vertebral bodies. Marrow signal characteristics and pattern of enhancement are normal.C2-3: Unremarkable. C3-4: Small posterior disk osteophyte which mildly contacts the ventral cord. No significant generalized spinal canal stenosis. No significant neuroforaminal narrowing.C4-5: Broad posterior disk osteophyte formation resulting in a moderate generalized spinal canal stenosis and ventral cord flattening. Severe right and moderate left foraminal narrowing. No interval changes.C5-6: Obliteration of the disk space. No significant spinal canal stenosis. Mild left foraminal narrowing. No interval changes.C6-7: Minimal posterior disk osteophyte formation. No significant spinal canal stenosis. Moderate left foraminal narrowing. No interval changes.C7-T1: Unremarkable. Thoracic:The spinal cord shows grossly unremarkable morphology and signal characteristics. Although image quality is not adequate to exclude very mild or subtle abnormalities, no large regions of signal abnormality are suspected, and the appearance of the cord is unchanged relative to the prior exam. No pathologic enhancement is seen.There is a very slight scoliotic curvature of the thoracic spine. Vertebral body heights are preserved. No marrow replacement or evidence of marrow edema is seen.Mild degenerative disk disease is seen at T7-8, T8-9 and T9-10 with loss of disk height and disk bulging with a protrusion at T9-10. No significant spinal canal or neuroforaminal stenosis is seen.Lumbar:The visualized spinal cord, conus and cauda equina show normal morphology and signal characteristics. No convincing pathologic intrathecal enhancement is seen.There is a mild scoliotic curvature of the lumbar spine. Vertabral body heights are preserved.The L2-3 disk space shows abnormal increased T2 signal with mild T2 signal extending to the adjacent endplates. Patchy ill-defined enhancement is also seen along the endplates.No other disk space demonstrates pathologic T2 signal. There is elevated T1 signal within the L4-5 disk space reflect proteinaceous degeneration or mineralization. Elsewhere, no definite pathologic marrow enhancement is seen.No discrete or enhancing paraspinal fluid collections are seen. There is some fluid tracking fluid along the fascia of the upper lumbar region. There may also be some edema within or along the anterior paraspinal soft tissues. In particular, the right psoas muscle seems to be slightly edematous and T2 hyperintense relative to the left. Free pelvic fluid is also partially visualized.T11-12: Small right paracentral disk protrusion. No spinal canal and foraminal stenosis.T12-L1: Small left paracentral annular fissure. No spinal canal or neuroforaminal stenosis.L1-2: Facet hypertrophy. Mild bulging disk. No significant generalized spinal canal stenosis. No significant neuroforaminal narrowing. L2-3: Mild facet hypertrophy and ligamentum flavum thickening. Moderate bulging disk. Mild generalized spinal canal stenosis. Moderate right and mild left foraminal narrowing. L3-4: Moderate facet hypertrophy and ligamentum flavum thickening. Minimal bulging disk. No spinal canal stenosis. Moderate right foraminal narrowing. L4-5: Marked facet hypertrophy. Mild bulging disk. Effacement of the left ventral thecal sac but no significant generalized canal stenosis. Moderate left foraminal narrowing.L5-S1: Marked left and moderate right facet hypertrophy. Minimal bulging disk with bilateral paracentral annular fissures. No significant spinal canal or neuroforaminal stenosis.

Output: 1. Non-expansile, non-enhancing T2 signal abnormality affecting the cervical spinal cord is again seen, and this appears to have improved somewhat relative to the prior examination. No definite additional areas of cord signal abnormality are seen. The differential diagnosis continues to include an infectious or postinfectious process, or a noninfectious inflammatory/autoimmune phenomenon.2. T2 hyperintensity is seen within the L2-3 disk space with mild signal abnormality in the adjacent endplates and mild associated patchy enhancement. Although this finding and could represent an inflammatory component of degenerative disk disease, the possibility that this represents diskitis osteomyelitis must also be considered. The presence of paraspinal edema, for example involving the right psoas muscle, would also support the possibility of an infectious process.


Instruction: Generate impression based on findings.

Input: BRAIN: There multiple supratentorial white matter lesions including within the periventricular and juxtacortical white matter. Some of these are new or increased in size while others have resolved or decreased in size. A single right cerebellar lesion is present and has decreased in size. Many the larger lesions again demonstrate T1 hypointensity. Many of the larger lesions also demonstrate new mild enhancement most prominent along the leading-edge. The overall lesion burden has increased. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unremarkable. CERVICAL SPINE: There is a small new focus of T2 hyperintensity within spinal cord at C1-C2 level. There are unchanged foci of T2 hyperintensity at the C4-C5 level on the left and C5-C6 level on the right as well as multiple other questionable small foci of T2 hyperintensity. There is no associated enhancement of these lesions. The overall lesion burden has improved. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The paravertebral soft tissues are unremarkable.

Output: Multiple supratentorial, infratentorial, and cervical spinal cord lesions as detailed above are compatible with history of multiple sclerosis. The overall supratentorial lesion burden has increased with multiple new and newly enhancing lesions. The infratentorial and cervical spinal cord lesion burden has improved.


Instruction: Generate impression based on findings.

Input: Patient with metastatic lung cancer with mets to the right femur, status post chemo and radiation therapy. Please evaluate for change.IMAGE ACQUISITIONS: Contiguous noncontrast axial images of the right hip were obtained using routine protocol with coronal and sagittal reformats There is increased density in the medullary cavity of the mid femoral diaphysis measuring approximately 4 to 5 cm in craniocaudal dimension with endosteal scalloping of the posterior cortex consistent with a metastatic lesion. Please note that the current CT likely underestimates the exact craniocaudal extent of the disease as prior MRI study of 10/6/08 demonstrates the craniocaudad extent of metastases to be approximately 15 to 17 cm. A very thin line of contiguous peripheral cortex remains measuring approximately 1 mm, not significantly changed since prior study. There is stable surrounding ring of periosteal reaction.Aggressive demineralization is noted in the distal femur and around the knee joint.Mild osteoarthritis affects the right hip.

Output: Readministration of metastatic focus to the mid femoral diaphysis with large erosion of the posterior lateral endosteal cortex and very thin residual remnant of cortical bone posteriorly, essentially stable since MRI study of 10/6/08. The patient remains at increased risk for pathologic fracture.


Instruction: Generate impression based on findings.

Input: Reason: Pt is s/p w whipple for IPMN. She needs a 1 year f/u MRCP. History: none ABDOMEN:LIVER, BILIARY TRACT: Peripheral enhancement in the right hepatic lobe on arterial phase which is not seen on subsequent phases is likely perfusional. No suspicious enhancing lesions. Mild pneumobilia, indicating patency of the anastomosis.Mild intrahepatic biliary ductal dilatation with apparent narrowing at the biliary enteric anastomosis (5/86).SPLEEN: No significant abnormality noted.PANCREAS: Postsurgical changes of Whipple procedure. The pancreaticojejunal anastomosis is intact. There is minimal prominence of the mid pancreatic duct. No evidence of pancreatic fistula. The distal pancreas is atrophic. No enhancing tissue within the surgical bed to indicate recurrence.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: Scoliosis.OTHER: Adnexal cysts with a cyst measuring up to 2.4 cm on the left side.

Output: 1.No evidence of recurrent or metastatic disease.2.Mild intrahepatic biliary ductal dilatation with narrowing at the biliary enteric anastomosis, suggesting a mild anastomotic stricture.3.Adnexal cysts measuring up to 2.4 cm on left side (individual cysts versus septated multicystic dominant lesion) abnormal in a postmenopausal female. Recommend ultrasound follow-up for these findings.


Instruction: Generate impression based on findings.

Input: Pituitary lesion; preoperative planning for resection. There is a pituitary lesion with suprasellar extension and mass effect upon the optic chiasm. There is also a subcentimeter extra-axial lesion along the left aspect of the superior sagittal sinus. Fiducial markers are present on the skin.

Output: 1. Preoperative planning MRI demonstrates a pituitary lesion with suprasellar extension, which likely represents a pituitary macroadenoma. Please refer to the prior MRI report for additional details.2. A subcentimeter extra-axial lesion along the left aspect of the superior sagittal sinus may represent a meningioma. Please refer to the prior MRI report for additional details.


Instruction: Generate impression based on findings.

Input: There are multiple scattered foci of T2/FLAIR hyperintensity in the bilateral periventricular and subcortical white matter with a nonspecific distribution. There is also abnormal signal within the bilateral pons. No lesions with enhancement are appreciated. There is a small left parietal developmental venous anomaly which is incidentally noted.No intracranial mass or mass effect. Brain parenchymal volume is preserved. No hydrocephalus. No extra-axial collections. There is diffuse opacification involving the right maxillary sinus which is small, which may reflect atelectasis from chronic sinusitis.CERVICAL SPINE

Output: 1. Multiple nonspecific scattered foci of T2/FLAIR hyperintensity in the brain which may be related to small vessel ischemic disease and/or prior inflammation or perhaps demyelination. Overall distribution of the lesions however is not typical for demyelinating disease. No enhancing lesions in the brain.2. Abnormal enhancement involving the dorsal medial aspect of the cord from the C4 level down to at least the mid thoracic level which overall appears similar to prior study from 3/26/2016. Differentials remains broad include an ongoing inflammatory process such as sarcoid, long segment demyelination such as with NMO, or perhaps toxic metabolic injury effecting the dorsal columns such as subacute combined degeneration or vacuolar myelopathy. Despite the persistent enhancement, which is in usual, there is no discrete mass evident and neoplasm seems less likely.3. Note patient could not tolerate the entire study and post gadolinium images of the lumbar spine or axial post gadolinium images of the lower thoracic spine were not obtained.


Instruction: Generate impression based on findings.

Input: Reason: adhesive capsulitis History: L shoulder pain and stiffness ROTATOR CUFF: There is minimal increased signal intensity within the distal supraspinatus suggesting very mild tendinosis with perhaps minimal undersurface fraying, but we see no discrete tear of the supraspinatus and the muscle appears normal. The infraspinatus muscle and tendon appear intact. The teres minor muscle and tendon appear intact. The subscapularis muscle and tendon appear intact.SUPRASPINATUS OUTLET: The acromioclavicular joint is within normal limits. No fluid is identified within the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is within normal limits. Subjectively, the articular cartilage of the glenohumeral joint appears thinned suggesting degeneration. We see no fluid-filled labral tear. There is no glenohumeral joint effusion.BICEPS TENDON: There is increased signal intensity within the tendon of the long head of the biceps, particularly within the rotator interval, just proximal to its extra-articular transition, suggesting mild tendinosis. ADDITIONAL

Output: 1. Mild stranding of the fat beneath the coracohumeral ligament, but otherwise no findings to suggest adhesive capsulitis.2. The glenohumeral joint cartilage appears thinned suggesting mild degeneration.3. Mild rotator cuff tendinosis and biceps tendinosis.4. Foci of metallic susceptibility artifact within the anterior soft tissues and glenohumeral joint presumably reflect prior surgery.


Instruction: Generate impression based on findings.

Input: Diagnosis: Unspecified abnormalities of gait and mobilityClinical question: altered gaitSigns and Symptoms: altered gait MRI thoracic spine:The thoracic vertebral bodies are appropriate in the overall alignment and height. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots. Lumbar spine: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. The patient is status post left-sided hemilaminectomy at the L4-5 level.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is loss of disc space height, disc desiccation and a broad-based left lateral disc protrusion at this level. The fat at the lateral recess on the left side is mildly effaced.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.There are some degenerative changes present lumbar spine worse at L4-5 without significant compromise to spinal canal or exiting nerve roots. There is mild displacement of the nerve roots at the left lateral recess at L4-5 due to a small left lateral recess disc protrusion.2.No spinal cord lesions or compromise to the spinal cord is appreciated in the thoracic spine.


Instruction: Generate impression based on findings.

Input: MRI Brain:There is a small focus of restricted diffusion corresponding to the posterior limb of the right internal capsule/right lateral thalamus. This also demonstrates FLAIR signal abnormality and is compatible with an acute infarct. More anteriorly within the right thalamus is a punctate focus of susceptibility abnormality likely indicating a punctate old microhemorrhage. Again seen is moderate periventricular and subcortical white matter T2/FLAIR hyperintensity which is nonspecific but likely related to small vessel ischemic disease. 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.MRA Brain: The intracranial internal carotid arteries demonstrate no significant stenosis. The middle and anterior cerebral arteries are also patent. The vertebral arteries, basilar artery, and posterior cerebral arteries also are patent with no significant stenosis. No evidence of aneurysms or vascular malformations.MRA Neck: There is a separate origin of the left subclavian artery, left common carotid artery, and brachiocephalic artery from the arch. The common carotid arteries and cervical internal carotid arteries are normal in course and caliber. Both vertebral artery origins are patent. There is no evidence of stenosis or occlusion.MRI C-spine: The craniovertebral junction appears within normal limits. The cervical spine alignment is maintained and the cervical vertebral bodies and are appropriate in height. The bone marrow signal is within normal limits. The cervical spinal cord has normal signal characteristics and overall morphology. The vertebral artery flow voids appear to be intact. A cystic structure is noted within the right thyroid region. The paraspinous soft tissue structures otherwise appear within normal limits. Level specific observations:C2-3: Left foraminal disc protrusion and bilateral facet hypertrophy. Moderate left neural foraminal narrowing. No spinal canal stenosis.C3-4: Bilateral facet and uncovertebral hypertrophy. Mild bilateral neuroforaminal narrowing. No significant spinal canal stenosis.C4-5: Bilateral facet and uncovertebral hypertrophy. Moderate right neural foraminal narrowing. No spinal canal stenosis.C5-6: Bilateral facet hypertrophy. Mild bilateral neural foraminal narrowing. No spinal canal stenosis.C6-7 and C7-T1: No significant compromise to the spinal canal or neural foramina.

Output: 1.Small acute infarct involving the posterior limb of the right internal capsule/lateral thalamus. No evidence of acute intracranial hemorrhage mass effect, midline shift or herniation.2.No significant flow-limiting stenosis of the major intracranial arteries or arteries of the neck.3.Underlying moderate chronic small vessel ischemic disease.4.Mild degenerative changes involving the cervical spine without appreciable cord signal abnormality or spinal canal stenosis.Findings were discussed with the neurology resident on call Dr. Quaynor (pager 1769) at the time of the preliminary entry at 1600 on 9/14/2016.


Instruction: Generate impression based on findings.

Input: There is redemonstration of abnormal signal and enhancement involving the L1 vertebral body, with inferior endplate deformity and mild vertebral body height loss. There is continued ill-defined abnormal enhancement and signal within the anterior superior endplate of L2, although this is felt to relate to degenerative marrow changes and does not appear to represent a focal metastatic lesion, given previous lack of abnormality on bone scan at this level. There is also persistent metastatic disease within the visualized sacrum, with progression since the previous MRI. There are areas of extensive abnormal signal and enhancement involving the left hemisacrum, now involving S2 and more caudal levels, corresponding to large areas of lytic change on CT. There is also a persistent large left iliac metastasis appears increased in confluence since the previous MRI. Bilateral iliac involvement also extends to the acetabula, as previously noted, again progressed since previous bone scan.There is again diffuse enhancement and abnormal signal of the lower paraspinal musculature which may relate to denervation changes, with enhancement and abnormal signal within the subcutaneous fat which may represent dependent reactive changes.The lumbar spine is in stable alignment with trace grade 1 anterolisthesis of L5 on S1, with a normal lumbar lordosis. The vertebral body and disk heights are stable, with multilevel disc narrowing and desiccation. The distal spinal cord and conus are within normal limits with the conus terminating at the L1-L2 level.There is redemonstration of spondylotic changes at L1-L2 and L3-L4, with at most mild central spinal canal stenosis at L1-L2. There is redemonstration of a small enhancing T2 hypointense lesion along the cauda equina nerve roots centered at the L2-L3 level.

Output: 1. Stable appearance of osseous metastatic disease compared to more recent CT, with progression since prior MRI especially involving the left mid to lower sacrum without interval extension into sacral foramina. Stable L1 vertebral body metastatic lesion with mild compression deformity.2. Stable appearance of leptomeningeal nodule along the right cauda equina nerve roots at the L2-L3 level with minimal nodular enhancement.3. No significant interval progression of spondylotic changes.


Instruction: Generate impression based on findings.

Input: Asymptomatic female presents for routine screening mammography. Family history of breast cancer, BRCA 2 mutation carrier. Prior benign MRI guided biopsy of the right breast. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. There is a clip in the right breast at the 12 o'clock position from prior benign MRI guided biopsy. Multiple, scattered benign punctate calcifications seen in the right upper outer quadrant, mostly unchanged. No suspicious masses, microcalcifications or areas of architectural distortion are present.

Output: No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 2 - Benign finding.RECOMMENDATION: NSC - Screening Mammogram.


Instruction: Generate impression based on findings.

Input: 85 year old with history of coronary artery disease and ventricular tachycardia presenting for evaluation of scar related VT. Left VentricleThe left ventricle is moderately dilated with moderately reduced. The overall LV ejection fraction is 32%, the LV end diastolic volume index is 122 ml/m2 (normal range: 74+/-15), the LVEDV is 222 ml (normal range 142+/-34), the LV end systolic volume index is 83 ml/m2 (normal range 25+/-9), the LVESV is 151 ml (normal range 47+/-19). There is significant thinning and an associated wall motion abnormality in the mid and basal inferior and inferolateral walls. There is a large area of transmural late gadolinium enhancement in a pattern consistent with myocardial infarction in the mid to basal inferior and inferolateral wall. This area is unlikely to be viable. The remaining myocardium is likely to be viable. Left AtriumThe left atrium is mildly enlarged. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 52%, the RV end diastolic volume index is 65 ml/m2 (normal range 82+/-16), the RVEDV is 118 ml (normal range 142+/-31), the RV end systolic volume index is 31 ml/m2 (normal range 31+/-9), and the RVESV is 57 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is mild pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThere are diffuse bilateral infiltrates in lung field and bilateral small pleural effusions. Atherosclerosis in descending thoracic aorta. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is moderately dilated with moderately reduced systolic function. The overall LV ejection fraction is 32%. There is significant thinning and an associated wall motion abnormality in the mid and basal inferior and inferolateral walls. There is a large area of transmural late gadolinium enhancement in a pattern consistent with myocardial infarction in the mid to basal inferior and inferolateral wall. This area is unlikely to be viable. The remaining myocardium is likely to be viable. 2. The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 52%3. Extracardiac findings as above.


Instruction: Generate impression based on findings.

Input: Stroke: right upper extremity ataxia. There is restricted diffusion and high T2 signal involving the left parietal and occipital lobes over an area of up to 5 cm with a small amount of petechial hemorrhages, but no large hemorrhagic transformation or midline shift. There also appear to be additional punctate foci of restricted diffusion and in the left subinsular region and inferior left frontal gyrus. The cerebellum is unremarkable. The ventricles and basal cisterns are normal in size and configuration. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is a small left maxillary sinus retention cyst. There is a small amount of fluid within the right mastoid air cells.

Output: Recent infarction involving the left parietal and occipital lobes over an area of up to 5 cm with a small amount of petechial hemorrhage, but no large hemorrhagic transformation or midline shift. There also appear to be punctate recent infarcts in the left subinsular region and inferior left frontal gyrus.


Instruction: Generate impression based on findings.

Input: Secondary malignant neoplasm of brain [C79.31] / Secondary malignant neoplasm of other parts of nervous system [C79.49], Reason for Study: ^Reason: metastatic NSCLC s/p resection of R sided metastasis and adjuvant WBRT; please evaluate for response/progress Previously seen right frontal operculum cystic lesion appears to be smaller in size (10.4mm x 16.1mm, previously 18mm x 12.2mm). In addition, the daughter nodules some are on the enhancing rim also appear to be smaller in size comparing to prior study. The extent of surrounding edema also appears to be lessen than prior scan.A small nodular enhancing lesion on the right middle frontal sulcus (series 11, image 117) is again shown, unchanged in its size and configuration since prior scan. No other abnormal enhancing lesion is seen.Scattered patchy FLAIR high signal intensity lesions on bilateral periventricular white matter are again seen, unchanged since prior scan.No evidence of acute ischemic lesion on this scan.Evidence of right fronto temporal craniotomy is seen, unchanged. 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. Fluid collections on the right mastoid air cells, unchanged.

Output: 1. Interval decrease in size of right frontal operculum mass as well as daughter nodules since prior scan as described above.2. No evidence of new abnormal enhancement.3. No acute ischemic lesion.4. Unchanged non specific small vessel ischemic lesions and right middle frontal sulcus enhancing lesion since prior scan.


Instruction: Generate impression based on findings.

Input: A patient submitted outside study for review. Submitted for review are breast MRI (5/1/15). Dynamic contrast enhanced breast MRI was performed with a protocol outlined in the outside radiology report. The images could not be processed with our CAD system; therefore, interpretation is limited.There are 2 large enhancing masses in the left breast, one at posterior upper-outer quadrant measuring 47 x 32 mm (AP x LR), and the other at the central left breast measuring 51 x 44 mm. Those 2 masses are proven malignancy, as per outside radiology report. There are additional 2 smaller masses in the left breast, one at middle 3:00 position measuring 8 mm, and the other at anterior lower inner quadrant measuring 10 mm. There are at least 2 abnormal axillary tail lymph nodes located superiorly to the mass at posterior upper outer quadrant, and 2 abnormal lymph nodes in the left axilla. The largest lymph node measures 16 mm located at left axillary tail.No abnormal enhancing lesions in the right breast. No abnormal lymph nodes in the right axilla.

Output: 1. Two biopsy-proven cancers with 2 additional small masses in the left breast. Abnormal lymph nodes in the left axilla and left axillary tail.2. No abnormal enhancing lesions in the right breast, no abnormal lymph nodes in the right axilla.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Reason: eval lumbar spine, known spondylosis History: back pain Using the last set of ribs as guidance, there are 4 lumbar type vertebral bodies with a sacralized L5. There is grade 1 retrolisthesis of L4 over L5. Loss of disc height is seen at the L4/5 level. Otherwise vertebral body heights and disc heights are maintained. There is degenerative endplate signal abnormalities at L4/5, otherwise bone marrow signal is unremarkable. Normal-appearing conus terminates at L1/2 level. Right renal cyst is noted. Otherwise visualized intra-abdominal and paraspinal structures appear unremarkable.T12/L1: No significant spinal canal stenosis or foraminal narrowing.L1/2: No significant spinal canal stenosis or foraminal narrowing.L2/3: Desiccated disc with mild lateral disc bulge. Mild facet arthropathy with ligamentum flavum thickening. No significant spinal canal stenosis. Mild bilateral foraminal narrowing.L3/4: Lateral disc bulge, facet arthropathy, and ligamentum flavum thickening resulting in mild spinal canal stenosis and mild bilateral foraminal narrowing.L4/5: Degenerative endplate changes of the bone marrow. Loss of disc height with desiccation of the disc. Uncovering of the disc posteriorly due to retrolisthesis with bulging disc symmetric to the right foraminal region. Moderate facet arthropathy with ligamentum flavum thickening. Mild to moderate spinal canal stenosis particularly affecting the lateral recesses. Severe right and moderate left foraminal narrowing.L5/S1: No significant spinal canal stenosis or foraminal narrowing.

Output: Grade 1 retrolisthesis of L4 over L5. Degenerative changes of the lumbar spine most severe at the L4-5 level.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for spondylolysis. Signs and symptoms: Low-back pain, sports month. Nonenhanced lumbar MRI:Examination demonstrates unilateral left-sided pars defect at L5 level with associated adjacent marrow signal hyperintensity on T2 and T2 STIR consistent with bone edema. The finding is best appreciated on sagittal T2 and T2 STIR on images 1 through 6 and axial images 11 and 12 on series 801 and 701.The signal intensity and the anatomical alignment of the vertebral column remains however beginning normal. There is mild decrease in disc height at L5-S1 level without significant signal abnormality/T2 hypointensity. No evidence of a spinal stenosis or neural foraminal compromise at any level.

Output: 1.Unilateral left-sided pars defect with associated adjacent bony edema as detailed.2.Mild degenerative disc disease and loss of disc height at L5/S1 level.3.Unremarkable nonenhanced lumbar MRI otherwise and without evidence of malalignment, spinal stenosis or neural foraminal compromise at any level.


Instruction: Generate impression based on findings.

Input: 27-year-old female with history of Crohn's disease. Assess for recurrent ileal Crohn's. 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: Significant improvement in inflammatory changes of the terminal ileum since prior study. Narrowing of the terminal ileum is seen, suggestive of quiescent disease. No evidence of active inflammatory bowel disease on the current exam.Interval resolution of right lower quadrant phlegmon and abscess adjacent to the terminal ileum. No evidence of abscess or fistula on the current exam.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: Interval resolution of right bladder dome wall thickening. No significant abnormality noted on the current exam.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: As above.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Findings suggestive of quiescent disease of the terminal ileum. No evidence of active inflammatory bowel disease.2.Interval resolution of phlegmon/abscess in the right lower quadrant. No evidence of abscess or fistula on the current exam.


Instruction: Generate impression based on findings.

Input: 18-year-old female soccer player status post noncontact knee injury with positive Lockman's. Assess for ACL or meniscal injury. MENISCI: There is linear branching increased signal abnormality within the posterior horn of the medial meniscus which extends to the femoral articular surface consistent with a complex tear with a horizontal component. There is linear increased signal abnormality within the posterior horn of the lateral meniscus which extends to the femoral articular surface consistent with a horizontal tear.ARTICULAR CARTILAGE AND BONE: There is increased signal abnormality within the lateral femoral condyle and the posterior aspect of the lateral tibial plateau consistent with bone contusions. There is depression of the cortex of the lateral femoral condyle overlying this edema which may represent an impaction fracture of the lateral femoral condyle/ lateral "notch" sign. Focus of low signal intensity within the proximal tibial metadiaphysis likely represents a bone island. There is subchondral cyst formation within the lateral facet of the patella. Evaluation of the articular cartilage of the patellofemoral joint is suboptimal secondary to patient motion artifact.LIGAMENTS: There is complete disruption of the proximal and midsubstance fibers of the anterior cruciate ligament. The PCL appears intact. There is increased signal abnormality within the meniscofemoral coronary ligament which may represent a sprain. The superficial band of the MCL appears intact. There is increased signal abnormality within the lateral collateral ligament proper suggesting a sprain.EXTENSOR MECHANISM: The extensor mechanism appears intact. The proximal fibers of the medial retinaculum at the level of their insertion on the femur are indistinct and associated with increased signal abnormality on fluid sensitive sequences indicating partial thickness tearing. There is a slight lateral tilt of the patella.ADDITIONAL

Output: 1. Complete rupture of the ACL. 2. Medial and lateral meniscus tears. Bone contusions. Moderate size joint effusion.3. Elevated tibial tubercle to trochlear groove distance and partial thickness tearing of the medial retinacular structures as described above, which can be seen in patient's with patellofemoral instability. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Multiple spinal lesions of uncertain origin. Neoplasia cannot be excluded. Patient has associated pain. Serial CT images obtained during the biopsy procedure demonstrate the needle placement within the vertebral lesion. Post procedural CT demonstrates no complications.

Output: T10 vertebral bone biopsy under CT guidance. A total of five core biopsy samples were delivered to surgical pathology for analysis. The cytopathologist did not report any neoplastic cause at the time of the procedure.


Instruction: Generate impression based on findings.

Input: Reason: r/o CVA History: confusion, syncope like episode with LE weakness 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 mild/minimal degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. This is not unusual at this age and was previously present.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 a minor right sphenoid sinus opacity. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin.Images are degraded by patient motion.

Output: 1.There is no evidence for acute cerebral infarction appreciated.2.Several periventricular and subcortical white matter changes of a mild degree are nonspecific and likely age related with little clinical significance.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for spinal stenosis, history of T12 compression fracture signs and symptoms: Neurogenic claudication Nonenhanced lumbar MRI:T10-T11 is unremarkable.T11-T12 demonstrate mild compression deformity of the superior endplate of T12 which is new since prior lumbar MRI exam from 2012. This finding is associated with subtle T2/T2 stir hyperintensity of the adjacent bone marrow suggestive of edema and suggesting of acute process. There is no evidence of expansion of mildly compressed vertebra into the spinal canal. Hypertrophic changes of the ligamentum flavum posteriorly as well as degenerative changes of the disc at this level results in mild central spinal stenosis with significant left and moderate right neural foraminal compromise. There are no axial images acquired through this level and findings are assess based on sagittal images only.T12-L1 demonstrate moderate disc disease and loss of disc height, moderate bilateral ligamentum flavum hypertrophy and mild facet disease. There is no central spinal stenosis however moderate left and mild right neural foraminal compromise is detected.L1-L2 demonstrate mild disc disease and loss of disc height, moderate bilateral ligamentum flavum hypertrophy and mild facet disease without central spinal stenosis. There is no significant neural foraminal compromise. Degenerative changes at this level demonstrate interval progression since prior exam.L2-L3 demonstrate mild disc disease and loss of disc height, moderate to significant bilateral ligamentum flavum hypertrophy and mild bilateral facet disease without significant hypertrophic changes. Constellation of findings results in moderate central spinal stenosis, moderate left and mild right neural foraminal compromise. Degenerative changes at this level and including central spinal stenosis demonstrate mild interval progression.L3-L4 demonstrate mild disc desiccation, severe bilateral ligamentum flavum hypertrophy and mild (L>R) facet degenerative disease without significant hypertrophy. Constellation of findings results in moderate central spinal stenosis, moderate to severe right and mild to moderate left neural foraminal compromise. Degenerative changes at this level demonstrate subtle interval progression.L4-L5 demonstrate mild disc disease without significant loss of disc height, significant bilateral ligamentum flavum hypertrophy and mild left and moderate right facet degenerative changes and hypertrophy. Constellation of changes results in significant central spinal stenosis with interval progression since prior exam from 2012. Mild to moderate bilateral neural foraminal compromise demonstrate no significant change.L5-S1 demonstrates moderate disc disease, loss of disc height, significant bilateral ligamentum flavum and facet hypertrophic changes and evidence of mild grade 1 anterolisthesis. There is interval progression of degenerative changes at this level however without convincing evidence of central spinal stenosis. Moderate bilateral foraminal compromise with mild interval progression.

Output: 1.New since prior lumbar MRI there is mild compression deformity of superior endplate of T12 without retropulsion into the spinal canal. Degenerative changes at T11-T12 however results in mild central spinal stenosis as detailed above.2.Interval mild progression of degenerative changes of lumbar spine and including multilevel central spinal stenosis at L2-L3, L3-L4 and more significantly at the L4-L5 levels as detailed.3.Multilevel neural foraminal compromise as detailed per level above.


Instruction: Generate impression based on findings.

Input: Episodic symptoms of sudden behavioral change for the past 2 years with acute worsening following febrile illness. Brain parenchyma appears within normal limits. No parenchymal signal abnormality, intracranial mass, or mass effect is appreciated. Hippocampi appear grossly normal. No abnormal parenchymal or meningeal enhancement. No evidence of infarct or hemorrhage. No extra-axial collections. Ventricles are normal in size. The major cerebral flow voids are intact. There is susceptibility artifact centered in the right side of the oral cavity, probably related to dental hardware. There is moderate left maxillary mucosal thickening. Remainder of the calvarium and extracranial soft tissues are unremarkable.

Output: 1. MRI of the brain appears within normal limits. 2.Specifically, no appreciable abnormality involving the temporal lobes including the hippocampi. If there remains clinical suspicion for possibility of a small epileptogenic focus, high resolution imaging per seizure protocol, perhaps with sedation, may be considered.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Left alveolar palate composite resection for invasive squamous cell carcinoma. There are postoperative findings related to left palatectomy and partial maxillectomy with an oroantral fistula. There is no evidence of measurable locoregional mass lesions or significant cervical lymphadenopathy based on size criteria. There are bubbly secretions in the left maxillary sinus. There is a right thyroid nodule that measures up to 12 mm. The major salivary glands are unremarkable. There is multilevel degenerative spondylosis with indentation of the spinal cord at C3-4 and C4-5. The imaged intracranial structures are unremarkable, aside from a prominent perivascular space in the right basal ganglia region. The orbits are unremarkable. There is minimal fluid within the left mastoid air cells.

Output: 1. Postoperative findings with an oroantral fistula, but no evidence of measurable locoregional mass lesions or significant cervical lymphadenopathy, although assessment is limited by the lack of intravenous contrast.2. Nonspecific right thyroid nodule that measures up to 12 mm.


Instruction: Generate impression based on findings.

Input: Reason: femur pain/ stress fracture? History: pain There are 2 skin markers. One marker is placed over the anterior aspect of the mid femoral diaphysis. Note is made of focal increased bone marrow signal abnormality within the mid diaphysis of the left femur on fluid sensitive sequences with corresponding decreased signal abnormality and T1-weighted images (image 12; series 801), adjacent to the aforementioned skin marker. There is no cortical disruption. These findings are consistent with stress reaction in the correct clinical context. There is an additional skin marker along the lateral aspect of the left hip. Additionally, there is increased signal abnormality about the pubic symphysis, predominantly within the left pubic bone (image 4; series 801). There is minimal if any fluid within the pubic symphysis. These findings could be further evaluated with a dedicated pubalgia protocol if clinically warranted. Additional foci of heterogeneous bone marrow signal abnormality likely represent residual islands of red marrow. The alignment is anatomic. There is a small amount of fluid within the left hip without evidence of a large effusion. The imaged musculature of the left thigh is unremarkable.

Output: 1. Findings indicating stress reaction along the medial aspect of the mid diaphysis of the left femur as described above. There is no discrete fracture line at this time.2. Findings indicating osteitis pubis, affecting the pubic bones, left greater than the right. If there is concern for a "sports hernia", these findings could be further evaluated with a dedicated pubalgia protocol MRI, if clinically warranted.


Instruction: Generate impression based on findings.

Input: Ms. Cool is a 52-year-old female with a personal history of left breast lumpectomy for DCIS in 2014 treated with radiation. Family history of breast cancer in sister (diagnosed at the age of 37) and maternal niece (diagnosed at the age of 39). Of note, patient recently presented with hardness/mass in the left lower inner breast, which was felt to be due to treatment-related changes at the time. There is scattered fibroglandular tissue in both breasts. Minimal parenchymal enhancement is noted bilaterally.Stable postsurgical changes are identified in the left lower outer breast, at site of prior lumpectomy. No abnormal enhancement is seen in either breast. Specifically, there is no abnormal enhancement seen in the left lower inner breast, at site of prior hardness/mass. Stable intramammary lymph node of the right breast. No abnormal axillary lymph nodes are identified in either axillary region.

Output: Stable postsurgical changes of the left breast. No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: Disorientation, unspecified [R41.0] / Other speech disturbances [R47.89], Reason for Study: ^Reason: MS changes, slowed speech History: slowed speech There is no evidence of acute ischemic or hemorrhagic lesion. There is a focal nodular enhancing lesion on the left parietotemporal subcortical white matter (series #1001, image #21). However, this lesion was not seen on sagittal postcontrast image nor postcontrast 3-D SPGR image. Therefore, this nodular enhancing lesion is likely to be artifacts. In addition, images slices above that lesion area also show artifacts.There is no other evidence of abnormal enhancement on the scan.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: No evidence of acute ischemic or hemorrhagic lesion.No evidence of abnormal enhancement.


Instruction: Generate impression based on findings.

Input: 69 years Female (DOB: 3/2/1947)Reason: rule out demyelinating lesion History: LUE and LLE weakness and paresthesiasPROVIDER NAME: MAHESH PADMANABAN MAHESH PADMANABAN MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing lesions are appreciated within the brain parenchyma.There are periventricular white matter lesions present without specific lesions in the corpus callosum. These are bright signal on FLAIR MRI.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. Incidental note is made of partial empty sella.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal enhancing lesions are identified in the cervical spine.At C2-3 there is no significant compromise to the spinal canal or neural foramina. There is a disc bulge at this level.At C3-4 there is no significant compromise to the spinal canal or neural foramina. There is a disc bulge at this level.At C4-5 there is no significant compromise to the spinal canal or neural foramina. There is a disc bulge at this level.At C5-6 there is no significant compromise to the spinal canal or neural foramina. There is a disc bulge at this level.At C6-7 there is no significant compromise to the spinal canal or neural foramina. There is a disc bulge 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: 1.No demyelinating lesions are appreciated in the cervical spinal cord.2.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related. 3.There are degenerative changes present cervical spine without significant compromise to spinal canal or exiting nerve roots.


Instruction: Generate impression based on findings.

Input: Diagnosis: Radiculopathy, cervical regionClinical question: evaluate for left sided radiculopathySigns and Symptoms: left upper extremity pain The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There is multilevel disc desiccation present.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal. There is right-sided facet hypertrophy present at this level. There are some uncovertebral osteophyte formation at this level associated with some encroachment of the right-sided exiting nerve roots.At C4-5 there is no significant compromise to the spinal canal or neural foramina. There is mild bilateral facet hypertrophy at this level.At C5-6 there is no significant compromise to the spinal canal. There is a disc bulge at this level associated with endplate and uncovertebral osteophytes. There is mild ligamentum flavum hypertrophy at this level. There is mild to moderate encroachment of the left-sided exiting nerve roots at this level. There is mild encroachment of the right-sided exiting nerve roots.At C6-7 there is no significant compromise to the spinal canal. There is a disc bulge at this level associated with endplate and uncovertebral osteophytes. There is mild ligamentum flavum hypertrophy at this level. There is mild to moderate encroachment of the left-sided exiting nerve roots at this level. There is mild encroachment of the right-sided exiting nerve roots.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 some mild to moderate encroachment of left-sided exiting nerve roots at C6 and C6-7.


Instruction: Generate impression based on findings.

Input: Female 46 years old Reason: pancreatic cancer, pancreatitis, pancreatic cyst History: concern for above from GI fellow; h/o chronic pancreatitis p/w n/v/epigastric pain. fam hx of pancreatic ca ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: Pancreatic duct is dilated measuring up to 4 mm. The duct tapers gradually at the level of the ampulla. Benign stricture at the level of ampulla cannot be excluded. Compared to the prior MRI the amount of pancreatic ductal dilatation has minimally progressed. No focal lesions are seen suspicious for pancreatic cancer.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Prominence and slightly dilated pancreatic duct up to the level of the ampulla. This has slightly progressed compared to previous study. A benign stricture at the level of the ampulla cannot be excluded.


Instruction: Generate impression based on findings.

Input: History of elevated LFTs and abdominal pain. History of liver transplant. ABDOMEN:LIVER, BILIARY TRACT: Postsurgical changes from an orthotopic left liver lobe transplant. There is moderate intrahepatic biliary ductal dilatation with a 1.1 x 0.9 cm filling defect proximal to the hepaticojejunostomy compatible with obstructive hepatolithiasis. There is probable narrowing at the hepaticojejunostomy accounting for stasis and stone formation. There is trace perihepatic ascites. No abnormal T2-weighted signal intensity or restricted diffusion to suggest cholangitis, although evaluation is limited by lack of intravenous contrast. No focal suspicious liver lesion.SPLEEN: Mild splenomegaly measuring 15 cm in craniocaudal dimension with minimal perisplenic fluid.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: There is a small central right diaphragmatic defect with herniation of retroperitoneal fat.OTHER: No significant abnormality noted.

Output: Hepatolithiasis with downstream moderate intrahepatic biliary ductal dilatation with suspected narrowing at the hepaticojejunostomy accounting for stasis and stone formation. No specific findings of cholangitis although evaluation is limited by lack of intravenous contrast.Trace ascites. Mild splenomegaly. Small right diaphragmatic defect with herniating retroperitoneal fat.


Instruction: Generate impression based on findings.

Input: 35-year-old female patient with right-sided ear and facial pain. Evaluate for TMJ pathology. The anterior band of the right temporomandibular joint disc is abnormally thickened with increased signal intensity likely representing degeneration and tearing. The disc as a whole appears slightly anteriorly displaced relative to the left side. There is anterior translation of the mandibular condyle on the open mouth views that appears normal on the left and slightly decreased on the right. On the open-mouth view, the anterior band again appears enlarged with abnormal signal intensity representing degeneration and tearing with the posterior band appearing abnormally small. We see no erosive changes of the bones or large effusion.

Output: Degeneration and tearing of the articular disc of the right temporomandibular joint with other findings as described above.


Instruction: Generate impression based on findings.

Input: seizure The CSF spaces are appropriate for the patient's stated age with no midline shift. A small 10x15 cystic lesion anterior to the left temporal lobe associated with mild bone remodeling is present. It follows CSF on all pulse sequences.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate small mucous retention cysts in the maxillary sinuses. The visualized portions of the mastoid air cells demonstrate scattered opacities. The visualized portions of the orbits are intact.

Output: 1.Periventricular and subcortical white matter signal changes of a mild degree are present which are nonspecific. They could be vascular related, related to demyelination, trauma, vasculitis, sarcoid. They are nonspecific. 2.Small left middle cranial fossa arachnoid cyst.


Instruction: Generate impression based on findings.

Input: Lateral knee pain MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: No significant abnormality noted.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Moderate joint effusion. Otherwise no evidence of internal derangement of the knee.


Instruction: Generate impression based on findings.

Input: A patient submitted outside study for review. Submitted for review are digital mammographic images (10/6/15) performed at Franciscan Alliance. For comparison, digital mammographic images (9/24/12, 3/10/14), ultrasound images of both breasts (3/10/14), breast MRI (3/8/14) are available. DIGITAL MAMMOGRAPHIC IMAGES (10/6/15):The breast parenchyma is composed of scattered fibroglandular elements, unchanged in pattern and distribution. A few small focal asymmetries at lower inner quadrant in the right breast are unchanged. There are scattered benign calcifications in both breasts. No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in either breast. Followings are studies more than one year old:ULTRASOUND IMAGES OF BOTH BREASTS (3/10/14):Partially dilated ducts are seen in the left 11:00 position. Normal appearing lymph nodes are seen in the right axilla. No solid or cystic masses, or suspicious findings are seen in either breast.BREAST MRI (3/8/14):There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.Relatively strong parenchymal enhancement is seen at lateral aspect in the right breast.There are no suspicious findings in either breast.

Output: No mammographic evidence for malignancy in either breast. Outside radiology report (10/6/15) states that there are abnormal findings in the left breast on ultrasound study, which has not been submitted for interpretation. Recommend submission of outside ultrasound study of the left breast.BIRADS: 1 - Negative.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Clinical question: Rule-out CVA. Signs and symptoms: Not bilateral carotid stenosis, intermittent left photophobia, reports are left hand weakness PTA. Nonenhanced brain MRI:Diffusion-weighted images demonstrate no evidence of an acute ischemic stroke.Flair and T2 weighted images diffuse tiny foci of hyperintensity in the subcortical and to a lesser degree third ventricle right matter of cerebral hemispheres which in proper clinical setting could represent chronic small vessel ischemic strokes. There are no detectable similar lesion and the rest of the brain parenchyma. Bilateral basal ganglia, thalami, pons and cerebellum demonstrate normal signal intensity and morphology.The signal voids of major intracranial arterial branches are identified.Images through the orbits demonstrate a dislocated right lens lying in the dorsal aspect of the globe as well as noted on prior studies.Unremarkable calvarium and soft tissues of the scalp. Unremarkable paranasal sinuses and mastoid air cells.

Output: 1.No acute ischemic stroke.2.Findings suggestive of mild chronic small vessel ischemic strokes only in the subcortical and periventricular white matter of cerebral hemispheres.3.Dislocated right lens.4.Unremarkable nonenhanced brain MRI otherwise.


Instruction: Generate impression based on findings.

Input: 66-year-old male with history of prostate cancer status post prostatectomy. Evaluate for recurrence. PELVIS:PROSTATE:Patient is status post prostatectomy.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 evidence of recurrent disease.


Instruction: Generate impression based on findings.

Input: Persistent headaches. Non-enhanced CT of brain:There is no evidence of intracranial hemorrhage, edema, mass effect or midline shift or hydrocephalus. There is a small foci of low-attenuation in the right basal ganglia close to CSF density on axial image 13 which may represent small old lacunar in part. This examination is otherwise unremarkable. Please correlate with history and risk factors and follow-up with an MRI.The cortical sulci, ventricular system, CSF cisterns and gray -- white matter remains otherwise within normal limits. Calvarium is intact. Visualized paranasal sinuses and mastoid air cells are unremarkable.

Output: 1.A single small focus of low-attenuation in the right basal ganglia measuring 7 times 4-mm in size with close to CSF density is suspected for an old lacunar infarct. Exam is otherwise unremarkable. Correlate with history and risk factors and follow.2.Normal calvarium, visualized paranasal sinuses and mastoid air cells.


Instruction: Generate impression based on findings.

Input: Altered mental status and possible malignancy. Some of the images are degraded by patient motion. There is a T2 hyperintense lesion in the splenium of the corpus callosum that measures up to 20 mm and multiple scattered punctate foci of high T2 signal in the bilateral cerebral hemisphere white matter. Many of the lesions demonstrate mild restricted diffusion. There is no definite evidence of gross intracranial hemorrhage. The ventricles and basal cisterns are unchanged 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: 1. Multiple scattered white matter lesions, including within the splenium of the corpus callosum and in the bilateral cerebral hemispheres may represent late subacute infarcts perhaps superimposed upon chronic small vessel ischemia, or possibly form of infectious process, versus less likely metastatic disease given the atypical distribution. However, the assessment is limited by the lack of intravenous contrast. 2. No evidence of gross acute intracranial hemorrhage, although the images are somewhat degraded by patient motion.