Instruction: Generate impression based on findings.

Input: A 74 year old female with personal history of systemic hypertension, deep vein thrombosis, GERD, pancreatitis, gallstones and systemic sarcoidosis (skin and lung). Recently had a syncope, the ECG showed sinus rhythm RBBB, the echocardiography showed normal left and right ventricular function. Referred to cardiac MRI for further evaluation. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 55%, the LV end diastolic volume index is 80 ml/m2 (normal range: 65+/-11), the LVEDV is 133 ml (normal range 109+/-23), the LV end systolic volume index is 36 ml/m2 (normal range 18+/-5), the LVESV is 60 ml (normal range 31+/-10), the LV mass index is 40 g/m2 (normal range 67+/-11), and the LV mass is 67 g (normal range 114+/-24). There are no regional wall motion abnormalities present. There is a focal high signal at the mid-myocardium at the insertion point of the right ventricle. This finding has been described in the setting of pulmonary arterial hypertension. In the context of this patient with sarcoidosis, we cannot exclude a focus of granuloma.No accelerated flow was seen in the LVOT. There is no thrombus. Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 52%, the RV end diastolic volume index is 82 ml/m2 (normal range 69+/-14), the RVEDV is 135 ml (normal range 110+/-24), the RV end systolic volume index is 39 ml/m2 (normal range 22+/-8), and the RVESV is 65 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 trace 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 mildly dilated. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no pericardial effusion.Extracardiac FindingsThere is rounded atelectasis of the right lower lobe. Mild splenomegaly. There is a low signal focus in the area of the gallbladder; this finding was better characterized on previous CT studies.

Output: 1. The left ventricle is normal in size and systolic function, the LVEF is 55%. There are no regional wall motion abnormalities present. 2. There is a focal high signal at the mid-myocardium at the insertion point of the right ventricle into the interventricular septum. This finding has been described in the setting of pulmonary arterial hypertension. In the context of this patient with sarcoidosis, we cannot exclude a focus of granuloma. 3. The right ventricle is normal in size and systolic function, the RVEF is 52%. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 42 year old with CHEK 2 mutation positive and strong family history of breast cancer There is heterogeneous amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.Simple cysts in left breast.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: 35 years, Female, Reason: 35 yo female with hx of desmoid tumor; please evaluate for recurrence and/or abnormalities History: desmoid tumor. ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Visualized liver without significant change.Lobulated lesion in the left hepatic lobe with high T2 signal and progressive peripheral nodular enhancement is unchanged in size measuring 2.3 x 2.0 cm (8/14) and likely represents a hemangioma.Three adjacent lesions in the right hepatic lobe (8/7, 8/9, 8/10 also have signal characteristics suggestive of a hemangiomas. A few punctate cysts are unchanged as well.SPLEEN: Small splenules.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: Postsurgical changes in the right rectus muscle. No evidence of local recurrence.OTHER: No significant abnormality noted.

Output: 1.No evidence of local desmoid recurrence.2.Hemangiomas within the liver are unchanged.


Instruction: Generate impression based on findings.

Input: Clinical question: History of cervical discectomy complains of neck pain. Findings and symptoms: Snoring snoring, neck pain, history of discectomy. Nonenhanced cervical MRI:Examination demonstrates expected chronic post operative changes of anterior approach spinal fusion at C5, C6 and C7 levels. There is an anterior metallic plate at these levels and with placement of fixating screws into the vertebral bodies of C5, C6 and C7. There is suggestion of fusion of the disc spaces at these levels and repeat maintained anatomical alignment similar to prior exam.The signal intensity of vertebral column is unremarkable other than findings related to prior surgery and degenerative changes.Foramen magnum is unremarkable.C2-C3 is unremarkable.C3-C4 demonstrate mild degenerative disc disease and small bilateral (L>R) uncovertebral hypertrophic spurs. No spinal stenosis however mild to moderate (R>L) bilateral neural foraminal compromise are detected. Degenerative changes at this level demonstrate no significant change since prior exam.C4-C5 demonstrates moderate disc disease and loss of disc height and mild facet hypertrophic changes with resultant moderate left neural foraminal compromise and unremarkable otherwise. Findings at this level remain fairly similar to prior study from February 2015.C5-C6 demonstrate postoperative changes, shallow right paramedian hypertrophic spur however without central spinal stenosis. Significant right and moderate left neural foraminal compromise similar to prior exam.C6-C7 demonstrate postoperative changes of prior fusion without spinal stenosis. There is redemonstration of bilateral uncovertebral hypertrophic changes with resultant moderate to severe bilateral neural foraminal compromise. Findings remain grossly similar to prior exam.C7-T1 demonstrate postop changes without central spinal stenosis. Trace anterolisthesis similar to prior exam. Severe left (sagittal T2 series 3 image 16 and 17) and mild to right neural foraminal compromise (sagittal T2 series 3 images and 7).The signal intensity and morphology of the cervical and upper most visualized thoracic cord remains feeding normal.On sagittal T2-weighted images there is suggestion of a small central disc protrusion at T2-T3 level with resultant effacement of subarachnoid space and contact with the cord. No axial images were acquired. There is no spinal stenosis or neural foraminal compromise at this level.

Output: 1.No evidence of an acute or convincing evidence of a new finding since prior MRI exam from February 2015.2.Stable postoperative changes of an anterior spinal fusion at C5-C7 as detailed.3.No evidence of central spinal stenosis at any level.4.Multiple levels of neural foraminal compromise of varying degree secondary to degenerative disease as detailed per level above.


Instruction: Generate impression based on findings.

Input: Male, 61 years old, history of stage IV lung adenocarcinoma, in need of brain MRI to complete staging. Fairly extensive patchy periventricular T2 hyperintensity seen. Notable T2 hyperintensity is also evident within the pons.Diffusion weighted images are normal. No evidence of parenchymal edema or mass effect is detected. On postcontrast images, a punctate, submillimeter focus of enhancement is seen within the right parietal white matter (image 254 series 12). Otherwise, no pathologic parenchymal or extra-axial enhancement is detected.Numerous scattered foci of susceptibility are seen, prominently clustered within the basal ganglia and thalami, but with a few scattered elsewhere including the left cerebellum. No evidence acute intracranial hemorrhage is seen. No pathologic extra-axial fluid collections are detected. The size and shape of the ventricles are within normal limits.Mucosal thickening and layering of secretions are evident in the right maxillary sinus and at the level of the right ethmoid air cells.

Output: 1.Extensive periventricular white matter signal abnormality, with scattered corresponding foci of susceptibility, likely reflect sequelae of chronic microvascular ischemic disease.2.No definite evidence of intracranial metastatic disease is seen. A punctate submillimeter focus of enhancement within the right parietal white matter is nonspecific, but given the appearance of the background parenchyma, it may reflect a resolving or subacute microvascular event. A follow up examination should be considered to verify resolution.


Instruction: Generate impression based on findings.

Input: There is extensive encephalomalacia within the bilateral anterior frontal lobes and to a lesser degree the bilateral anterior temporal lobes. There is a background of scattered patchy high T2 signal within the subcortical and periventricular white matter. There are scattered areas of susceptibility effect scattered along the bilateral cerebral convexities and a punctate focus of susceptibility effect in the left occipital horn of the left lateral ventricle. There is ex vacuo dilatation of the left greater than right frontal horns of the lateral ventricles as well as prominence of the cortical sulci and prominence of the ventricles compatible with moderate diffuse cerebral volume loss. There is no evidence of mass effect or midline shift. There are no areas of abnormal intracranial enhancement. There is trace mucosal thickening within the paranasal sinuses. There are bilateral lens implants. The skull and scalp soft tissues are unremarkable.

Output: 1.Bilateral anterior frontal and temporal lobe encephalomalacia is compatible with remote traumatic brain injury.2.Scattered areas of hemosiderosis and a punctate focus of susceptibility effect in the left occipital horn of the left lateral ventricle indicate chronic hemorrhage.3.Scattered cerebral white matter T2 hyperintensity is nonspecific, but may represent chronic small vessel ischemic disease, but no evidence of acute infarction.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 61 years, Female, right face weakness, central. Rule out stroke, metastasis.. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. Minimal scattered foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild chronic small vessel ischemic changes. Brain parenchyma is otherwise unremarkable for age. No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved. There appears to be symmetric enhancement of the bilateral facial nerves without nodules or masses.Partially empty sella incidentally noted, which may be normal variant. Small left maxillary sinus mucus retention cyst. Paranasal sinuses and mastoid cells are otherwise clear. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: MRI of the brain is essentially unremarkable for patient's age. There are minimal chronic small vessel ischemic changes. No evidence of acute infarct or metastatic disease, as questioned.


Instruction: Generate impression based on findings.

Input: Right knee pain. Check for meniscal tear MENISCI: The left meniscus is intact and unremarkable. The medial meniscus however demonstrates diffuse globular signal in the body with a complex stellate appearance posteriorly, however a more horizontal component extends and intersects the superior articular surface.ARTICULAR CARTILAGE AND BONE: Mild bone contusion is observed in the medial tibial plateau and medial femoral condyle. Mild diffuse thinning with more moderate thinning observed in the medial compartment and irregular surface and small punctate defects along the femoral condylar surface of the medial compartment (image 25 and image 26 series 2). Similar signal abnormality and irregularity with punctate defects observed in the patellar surface involving both the lateral and medial facets.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Extensive complex medial meniscal tear with more moderate to pronounced cartilaginous changes in the medial and patellofemoral compartments


Instruction: Generate impression based on findings.

Input: Moderately extensive periventricular and subcortical white matter FLAIR lesions compatible with demyelinating disease. Prominence of the ventricles and sulci likely due to volume loss. There are no enhancing lesions or other findings to suggest acute demyelination. The cisterns remain patent. There is no midline shift or mass effect. There is no diffusion abnormality. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits.

Output: Evidence of demyelinating disease with no enhancing lesions to suggest active demyelination.


Instruction: Generate impression based on findings.

Input: There are no masses, mass effect or midline shift. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. The pituitary gland is normal in size. Flow voids are present within the major vessels indicating patency. The paranasal sinuses are clear. Endotracheal tube is present. Moderate opacification of the mastoid air cells bilaterally which may be related to intubation.

Output: 1.No intracranial abnormality as clinically questioned. No specific findings to suggest PRES. 2.Moderate mastoid air cell opacification bilaterally may be related to intubation.


Instruction: Generate impression based on findings.

Input: Medically intractable epilepsy and headaches, presurgical evaluation. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is asymmetric T2 hyperintensity involving the right hippocampus with blurring of the internal architecture, but no appreciable swelling or volume loss. 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 are secretions within the left petrous apex. There are bilateral maxillary sinus retention cysts, left larger than right.

Output: Right hippocampal abnormality likely represents early medial temporal sclerosis.


Instruction: Generate impression based on findings.

Input: 64-year-old female with history of cirrhosis who presents for HCC screening and monitoring of IPMN. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology. In the medial left hepatic lobe, there is arterial enhancement without definite washout peripheral to T1 and T2 hypointense, nonenhancing tubular focus. The portal and hepatic veins are patent.T2 hyperintense foci in segment 5 and 7 without contrast enhancement, most compatible with cysts.Cholelithiasis with mild gallbladder wall thickening, which may be secondary to chronic liver disease.SPLEEN: No significant abnormality noted.PANCREAS: Normal T1 intrinsic hyperintensity of the pancreatic parenchyma. Pancreatic duct is normal in caliber. Uncinate process branch type IPMN is not significantly changed, currently measuring 9 x 8 mm.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is evidence of mesenteric edema/small volume ascites.BONES, SOFT TISSUES: Thoracic dextroscoliosis and lumbar levoscoliosis.OTHER: No significant abnormality noted.

Output: 1.In the medial left hepatic lobe, there is arterial enhancement without definite washout peripheral to a T1 and T2 hypointense, nonenhancing tubular focus. Findings may represent a thrombosed vessel with associated perfusion defect versus a central occult lesion with focal biliary dilatation. Short-term follow-up in approximately 3 months is recommended.2. Cholelithiasis and gallbladder wall thickening, which is likely secondary to chronic liver disease. 3. Stable pancreatic IPMN.


Instruction: Generate impression based on findings.

Input: Ms. Calomese is a 74 year old female presenting with newly diagnosed left breast DCIS. She presents for MRI staging evaluation. There is scattered fibroglandular tissue in both breasts. Moderate to marked background parenchymal enhancement is noted bilaterally, which limits the sensitivity of this examination.In the left inferior breast, far posterior depth, there is an area of linear nonmass enhancement identified measuring approximately 3.0 cm in AP dimension. Susceptibility artifact from biopsy marker clip is now seen at the antero-inferior aspect of this nonmass enhancement, compatible with biopsy-proven malignancy. The distribution and span of this nonmass enhancement approximates the mammographically detected calcifications, measuring slightly larger which is likely related to associated post-biopsy changes. There is no abnormal enhancement seen in the right breast. No abnormal axillary lymph nodes are identified in either axillary region.

Output: (1) Unifocal malignancy of the left breast. A mammographically-guided bracketed wire localization can be performed for preoperative surgical guidance. (2) No MRI evidence of malignancy in the right breast.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Clinical question: Rule out lacunar infarct, posterior circulation stroke. Signs and symptoms: Dysarthria, bilateral upper extremity weakness. Nonenhanced brain MRI:Examination is limited due to extensive motion artifact.No detectable acute intracranial process and in particular no evidence of acute ischemic or lacunar infarct as is questioned clinically.A single suboptimal axial T2 series is also acquired. The sequence demonstrates a few small foci of T2 hyperintensity within the pons without detectable change in size or morphology. Although nonspecific the appearance is suspicious for chronic lacunar infarcts.Small focus of left frontal subcortical T2 hyperintensity without associated mass effect is also suspected of chronic small vessel ischemic stroke.The cortical sulci and ventricular system are slightly prominent for stated age of 50.

Output: 1.Limited suboptimal exam due to extensive motion artifact.2.No acute intracranial findings.3.Minimal chronic small vessel ischemic stroke is suspected as detailed above.


Instruction: Generate impression based on findings.

Input: Metastatic renal cell carcinoma to bilateral femurs, status post ORIF of left femur. Evaluate for progression. Right femur: Lytic lesions noted in the distal diaphysis of femur also seen on prior MRI. Endosteal scalloping concerning for impending fracture.Left femur: Trochanteric femoral rod extending into distal diaphysis with additional screw in femoral head. Lesion in distal diaphysis that has been curettaged, packed with cement, and fixed with sideplate with multiple screws.

Output: Lytic lesions in distal diaphysis of right femur with cortical thinning concerning for pending fracture. Trochanteric femoral rod in left femur with lesion in distal diaphysis that has been curettaged, packed with cement, and fixed with sideplate with multiple screws.


Instruction: Generate impression based on findings.

Input: 82 years Female (DOB:12/25/1933)Reason: eval brain tumor and other causes of syncope History: syncopePROVIDER/ATTENDING NAME: KRISTINA K GALLOW EDWIN RAMOS There is a 42 x 39 mm axial dimension mass located in the trigone of the right lateral ventricle which has heterogeneous enhancement with any it is near signal void on T2 and FLAIR imaging and low signal on T1 imaging but heterogeneous. It is associated with enlargement of the adjacent lateral ventricle especially the occipital horn and some periventricular signal hyperintensity and subcortical signal hyperintensity in the adjacent right parietal lobe.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mucosal thickening in the right maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.There is a mass present within the trigone of the right lateral ventricle which appears to arise from the choroid plexus. It is associated with the adjacent periventricular edema. Based on its signal characteristics and intraventricular meningioma is suspected. Other differential considerations could potentially include choroid plexus papilloma, choroid plexus carcinoma, metastases, glial tumor and lymphoma. A CT scan may help assess for the presence of calcifications if clinically appropriate.2.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: There is a T2 hyperintense focus involving the right pedicle and immediately adjacent osseous structures of C6. This demonstrates minimal T1 hyperintensity, persistent T2 hyperintensity with STIR technique, and enhancement. This is not associated with medullary expansion or MRI evident cortical erosion. There is no adjacent soft tissue component. There is a similar-appearing focus within the left posterolateral vertebral body of C7.Alignment is normal. The marrow signal is benign. The cervical and upper thoracic cord is normal in signal without abnormal enhancement. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable. There is no significant degenerative disease, and there are no stenoses.

Output: 1.There is a T2 hyperintense focus involving the right pedicle and immediately adjacent osseous structures of C6. This demonstrates minimal T1 hyperintensity, persistent T2 hyperintensity with STIR technique, and enhancement. This is not associated with medullary expansion or MRI evident cortical erosion. There is no adjacent soft tissue component. There is a similar-appearing focus within the left posterolateral vertebral body of C7. The constellation of these MRI features is most suggestive of the atypical appearance of a benign hemangioma. This could be confirmed with CT.2.Otherwise negative contrast enhanced cervical spine MRI.


Instruction: Generate impression based on findings.

Input: Male, 66 years old, with dizziness. Evaluate for stroke. No restricted diffusion is seen. Scattered small foci of FLAIR hyperintensity are seen within the cerebral hemispheres, a nonspecific finding. No intracranial hemorrhage or any abnormal extra-axial fluid collection is seen. The ventricles are normal in size and morphology. A normal variant cavum septum pellucidum is noted. Mucosal thickening is seen in the left maxillary sinus.

Output: 1.No evidence of acute ischemia is seen.2.Findings are noted which may reflect mild chronic microvascular ischemic disease.


Instruction: Generate impression based on findings.

Input: The ventricles and sulci are normal in size. There are no masses, mass effect, midline shift, or abnormal enhancement to suggest metastatic disease. Partially empty sella is noted. There is no evidence for intracranial hemorrhage or acute infarction. There are no extraaxial fluid collections or subdural hematomas. Minimal scattered foci of T2/FLAIR hyperintensity in the periventricular deep white matter is nonspecific. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. Left lens implant is noted.

Output: MRI of the brain is within normal limits for age. No evidence of intracranial metastatic disease.


Instruction: Generate impression based on findings.

Input: Reason: knee pain, s/p patellar dislocation History: knee pain MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: No full-thickness cartilaginous defect is identified. There may be partial thickness tearing of the articular cartilage along the inferior-most aspect of the lateral facet of the patella, although this is equivocal and may simply represent volume averaging with adjacent fluid in the joint.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1.Mild edema of the superolateral aspect of Hoffa's fat pad, which can be associated with patellofemoral instability, but we see no specific imaging findings of prior patellar dislocation.2.Equivocal partial thickness tearing of the articular cartilage along the inferior aspect of the lateral facet of the patella. Otherwise, normal exam.


Instruction: Generate impression based on findings.

Input: Reserved for concepts with insufficient information to code with codable children [IMO0002], Reason for Study: ^Reason: evaluate for Right sided lumbar spine radiculopathy, History: Right LE pain and N/T into L4-S1 area For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. There is normal lumbar lordosis. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. The epidural space, thecal sac, and spinal cord are preserved with no evidence of spinal canal/neural foraminal narrowing. The conus medullaris terminates at the L1-L2 level. The intervertebral discs demonstrate normal T2 intensity and height with no evidence of disc herniation. The paraspinal soft tissues are unremarkable.Degenerative changes are specified by the intervertebral level as follows: T12-L1: no neuroforaminal narrowing or spinal stenosis. L1-L2: no neuroforaminal narrowing or spinal stenosis. L2-L3: no neuroforaminal narrowing or spinal stenosis. L3-L4: no neuroforaminal narrowing or spinal stenosis. L4-L5: no neuroforaminal narrowing or spinal stenosis. L5-S1: there is minimal bulging of disc central to slightly left without evidence of thecal sac or nerve root compression. No neuroforaminal narrowing or spinal stenosis.

Output: Central to slightly left lateral minimal bulging of L5S1 disc.Otherwise unremarkable.


Instruction: Generate impression based on findings.

Input: Altered mental status: recently diagnosed lung adenocarcinoma with brain mets s/p radiation and steroids. MRI: There are new areas of restricted diffusion and high T2 signal in the left insula, perirolandic region, parietal lobe, and medial occipital lobe superimposed upon pre-existing areas of restricted diffusion in the left basal ganglia and lateral occipital lobe. There are multiple areas of peripheral and gyriform enhancement in the left cerebral hemisphere with an overall background of decreased perfusion. The largest peripherally enhancing lesion of the left cerebral hemisphere is located in the paracentral lobe, measuring up to 15 mm. Some of the lesions demonstrate susceptibility effect and intrinsic T1 hyperintensity, particularly in the left basal ganglia and occipital lobe. There are also ring-enhancing lesions in the left cerebral hemisphere, which measure up to 5 mm. There are scattered nonspecific foci of T2 hyperintensity without restricted diffuse in the cerebral white matter. There is an enhancing pituitary mass with suprasellar extension and mass effect upon the optic apparatus that measures up to 3 cm. 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.MRA: There is an abrupt cut-off of flow-related enhancement in a left M2 branch proximally. There is also an abrupt cut-off of flow-related enhancement in a left P2 segment. The rest of the major cerebral arteries appear to be intact otherwise.

Output: 1. Acute upon subacute infarcts in the left middle and posterior cerebral artery territories associated with areas of microhemorrhage and enhancement. However, a portion of the enhancing lesions in the bilateral cerebral hemispheres likely represent underlying metastases.2. Abrupt cut-off of left M2 and P2 branches may be due to thromboembolic disease. Vascular imaging of the neck may be useful.3. A pituitary mass likely represents a macroadenoma.Discussed with Dr. GAJEWSKI at 3:15 PM on 7/10/15.


Instruction: Generate impression based on findings.

Input: 82-year-old male with ischemic cardiac disease, hypertension, diabetes mellitus, history of colon cancer status post urosepsis and extubation with persistent tachycardia today. Evaluate for PE. Findings are limited by patient motion artifact.PULMONARY ARTERIES: No evidence of pulmonary embolus as clinically questioned.LUNGS AND PLEURA: Bilateral pleural effusions with adjacent compressive atelectasis. Multiple granulomas and scattered micronodules.MEDIASTINUM AND HILA: Thinning of the left ventricular apex is concerning for left ventricular aneurysmal dilatation and may be further evaluated with echocardiogram or cardiac MRI as clinically indicated. Mild pericardial effusion.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: NG tube with distal portion in the stomach.

Output: 1. No evidence of pulmonary embolus as clinically questioned.2. Persistent bilateral pleural effusions with adjacent compressive atelectasis.3. Left ventricular aneurysmal dilatation may be further evaluated with echocardiogram or cardiac MRI as clinically indicated.


Instruction: Generate impression based on findings.

Input: Thoracic spine:Compared to the MRI performed 10 hours prior, there is new T2 hyperintensity in the left lateral aspect of the cord at the T5 level compatible with edema. In comparison with same day CT, the previously noted epidural abnormality corresponds at least predominantly to a bone fragment with minimal associated blood products. There is mild associated deformity of the left dorsal thecal sac at the T5 level, which is similar to prior.Stable height loss and STIR hyperintensity involving the T5 vertebral body. The remaining vertebral body heights are grossly preserved. Heterogeneous marrow signal is compatible with a history of multiple myeloma. Mild multilevel degenerative changes including mild spinal canal stenosis at T10-11 related to degenerative changes is unchanged. Additionally, there is mild facet arthropathy and ligamentum flavum calcification at T10-11. There is mild bilateral neural foraminal narrowing at T4-5 and T5-6, right greater than left. Paraspinal soft tissue edema is present which may be postprocedural.Lumbar spine:There is no evidence of epidural collection to suggest epidural hematoma.Alignment of the lumbar spine is within normal limits. The vertebral body heights are grossly preserved. The marrow signal abnormality has improved overall with less discrete osseous lesions compared to 4/22/2015. For example, the right iliac lesion has slightly decreased in size. There is no evidence of epidural tumor within the limits of noncontrast technique. Degenerative spondylosis affects the lumbar spine worst at L3-4, L4-5, and L4-5, at which levels there is disc desiccation. The distal cord and conus medullaris are normal in signal and caliber. The conus terminates at the L1-2 level. There is mild fatty atrophy of the paraspinal musculature. The visualized intra-abdominal contents are within normal limits.T12-L1: Minimal disc bulge without spinal canal stenosis or neural foraminal narrowing.L1-2: Minimal disc bulge without spinal canal stenosis or neural foraminal narrowing.L2-3: Minimal disc bulge, facet arthropathy, and ligamentum flavum thickening with mild spinal canal stenosis but no significant neural foraminal narrowing.L3-4: Mild disc bulge, facet arthropathy, and ligamentum flavum thickening with mild spinal canal stenosis. Mild to moderate bilateral neural foraminal narrowing. L4-5: Mild disc bulge, facet arthropathy, and ligamentum flavum thickening with mild spinal canal stenosis. Moderate bilateral neural foraminal narrowing. 11 x 9 mm T2 hyperintense focus compatible with a synovial cyst within the right neural foramen extends into the lateral recess, which appears slightly larger compared to the prior exam, and possibly impinges upon the exiting right L4 nerve root.L5-S1: Mild disc bulge and facet arthropathy without spinal canal stenosis. Minimal bilateral neural foraminal narrowing.

Output: 1. Compared to the MRI performed 10 hours prior, there is new T2 hyperintensity in the left lateral aspect of the cord at the T5 level compatible with edema. In comparison with same day CT, the previously noted epidural abnormality corresponds at least predominantly to a bone fragment in the left dorsal epidural space with minimal associated blood products. There is mild associated deformity of the left dorsal thecal sac which is similar to prior.2. No evidence of epidural collection in the lumbar spine.


Instruction: Generate impression based on findings.

Input: 15 year old female with a history of repaired Tetralogy of Fallot and a history of pulmonic regurgitation and mild pulmonic stenosis by echocardiography referred from cardiac MRI. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 66%, the LV end diastolic volume index is 76 ml/m2 (normal range: 65+/-11), the LVEDV is 122 ml (normal range 109+/-23), the LV end systolic volume index is 26 ml/m2 (normal range 18+/-5), the LVESV is 42 ml (normal range 31+/-10), the LV mass index is 37 g/m2 (normal range 67+/-11), and the LV mass is 60 g (normal range 114+/-24). There is evidence of a small ventricular septal defect adjacent to the VSD patch site. There are no regional wall motion abnormalities present. There is no left ventricular 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 mildly dilated with normal systolic function. The overall RV ejection fraction is 55%, the RV end diastolic volume index is 103 ml/m2 (normal range 69+/-14), the RVEDV is 166 ml (normal range 110+/-24), the RV end systolic volume index is 46 ml/m2 (normal range 22+/-8), and the RVESV is 74 ml (normal range 35+/-13). There is late gadolinium enhancement of the RVOT outflow patch repair. Right AtriumThe right atrium is mildly dilated. Aortic ValveThe aortic valve is trileaflet, 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 at least moderate pulmonic regurgitation (regurgitant volume 26ml, regurgitant fraction 33%). Tricuspid ValveThe tricuspid valve opens widely. There is at least moderate tricuspid regurgitation.AortaThe aortic root mildly over-rides the interventricular septum. There is a right-sided aortic arch with a mirror image brachiocephalic branching pattern. The aortic root is normal in size (sinus of Valsalva 31x31x33mm). There is normal origin of the coronary arteries. Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. The LPA takes a sharp angle at its take off and is mildly stenosed. The measurements are:MPA= 19x20mmRPA= 15x16mmLPA= 11x12mmVenous AnatomyThe SVC and IVC are normal in size and 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. Tetralogy of Fallot morphology s/p repair2. Normal left ventricular size and systolic function (LVEF 66%).3. Mild right ventricular dilation with normal systolic function (RVEF 55%) with evidence of RVOT patch repair.4. Small, residual, membranous ventricular septal defect.5. Mild right atrial dilation.6. At least moderate tricuspid valve regurgitation. 7. At least moderate pulmonic valve regurgitation.8. Mild stenosis of ostial left pulmonary artery. 9. Right-sided aortic arch with mirror image brachiocephalic branching. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Male, 66 years old, with history of grade 2 astrocytoma status post RT + TMZ. Off of all treatment since a few years. Patchy, non-masslike T2/FLAIR hyperintensity is again seen within the pons and medulla showing no significant interval change in morphology or geographic extent. No associated enhancement is seen.A focus of susceptibility within the right posterior medulla, and a very small additional focus along the left posterior medulla, are unchanged, possibly representing foci of microhemorrhage or small cavernous malformations.Subcortical T2 hyperintensity within the right cuneus and in the right inferior frontal gyrus is unchanged. Likewise, scattered small foci of periventricular and subcortical white matter T2 hyperintensity are unchanged and nonspecific. No evidence of mass effect is seen. The ventricular system is stable in size and morphology. Prominence of the CSF space along the right cerebellar hemisphere is unchanged.

Output: Compared to multiple recent examinations since 2/12/2015, there is no evidence of tumor recurrence or progression. Of note, signal abnormality in the brainstem is markedly improved since remote MRI from 8/2/2011.


Instruction: Generate impression based on findings.

Input: A patient submitted outside study for review. Submitted for review are digital mammographic images (10/25/16, 11/9/2016), ultrasound images of left breast (11/9/2016), images from ultrasound guided biopsy of left breast with postprocedural left mammographic images (11/16/2016), breast MRI (12/7/2016) performed at outside institution. DIGITAL MAMMOGRAPHIC IMAGES (10/25/16, 11/9/2016):The breast parenchyma is composed of scattered fibroglandular elements (BiRADS Density Category B). There is a small focal asymmetry in the central aspect of the left breast.No other abnormal findings are present elsewhere in the left breast.No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in right breast. ULTRASOUND IMAGES OF LEFT BREAST (11/9/2016):There is a lobulated, hypoechoic mass measuring 5 x 2 mm at 3:00 position, 8 cm from the nipple in the left breast. Note is made that a later biopsy of this lesion proved that this lesion did not correspond to the focal asymmetry in the left breast seen on the mammogram. At least 2 normal-appearing lymph nodes are present in the left axilla.ULTRASOUND IMAGES OF LEFT BREAST (11/9/2016), IMAGES FROM ULTRASOUND GUIDED BIOPSY OF LEFT BREAST WITH POSTPROCEDURAL LEFT MAMMOGRAPHIC IMAGES (11/16/2016):Ultrasound guided biopsy of the lesion at 3:00 position of the left breast was performed with an appropriate needle placement. Postprocedural mammograms demonstrate a marker clip at 3:00 position in the left breast. The focal asymmetry at central aspect in the left breast appears unchanged. This marker clip is located approximately 38 mm lateral and anterior from the focal asymmetry in the left breast.Per outside radiology report, biopsy result was malignant; infiltrating ductal carcinoma, grade 3 with DCIS intermediate to high-grade.BREAST MRI (12/7/2016):Breast MRI was performed with a protocol outlined in the outside radiology report.Breast parenchyma is almost entirely fat in both breasts.Minimal parenchymal enhancement is noted bilaterally.A metallic artifact is present at 3:00 position in the left breast, from the marker clip placed at the recent ultrasound guided biopsy.There is a linear non-mass enhancement extending posteriorly from the marker clip, measuring 17 mm.Small enhancing masses seen in the central aspect in the left breast, measuring 6 x 5 x 5 mm (AP x LR x CC), corresponding to the focal asymmetry.No abnormal enhancement is seen in right breast. No abnormal lymph nodes are identified in either axillary region.

Output: 1. Biopsy-proven invasive and in situ carcinoma in the left breast at 3:00 position. Breast MRI showed linear non-mass enhancement posteriorly from the marker clip for 17-mm. If lumpectomy is planned, posterior generous excision should be considered.2. A focal asymmetry in the left central breast, showing an enhancement on MRI. The lesion has not been biopsied. Stereotactic biopsy can be performed. Ultrasound study may be performed before a stereo biopsy to look for a target.3. No MRI or mammographic evidence of malignancy in right breast. 4. No abnormal lymph nodes in either axillary region.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Male, 8 years old, with neurologic deterioration. Assess for cerebellar degeneration or cerebral atrophy. Diagnosis of hereditary ataxia, unspecified. Patchy areas of white matter T2 hyperintensity seen on prior examinations have essentially resolved. Perivascular spaces are noted within the periatrial regions but this is within normal limits. The pattern of white matter myelination is mature. No areas of parenchymal edema or mass effect are seen. No intracranial hemorrhage or abnormal extra-axial fluid is seen. Ventricles are normal in size and morphology. The cerebral sulci are questionably and subjectively more prominent than on prior examinations. The cerebellar fissures more clearly seem to show progressive widening when compared to the prior exams.Patchy mucosal thickening and/or secretions are noted within the paranasal sinuses.

Output: 1.Mild interval progression in loss of cerebellar volume is seen.2.Questionable progressive prominence of the cerebral sulci could also indicate some very mild loss of cerebral volume, though this finding is equivocal.3.No acute intracranial abnormality.


Instruction: Generate impression based on findings.

Input: Motion limits fine detail of some sequences. There is a small linear focus of nonspecific T2 hyperintensity in the right precentral gyrus (series 801, image 17), which does not enhance. There is questionable ill-defined enhancement in the distal fundus of the left internal auditory canal, as well as asymmetric enhancement questioned in the expected location of the left geniculate ganglion. There are no masses, mass effect or midline shift. There is no evidence of hemorrhage or infarction. Incidental note is made of a partially empty sella. The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. The major vessels are patent. The paranasal sinuses are clear. The mastoid air cells demonstrate minimal opacity. The orbital globes are small with heterogeneous appearing fluid suggestive of blood products, not significantly changed compared to prior exam. The calvarial marrow is unchanged in appearance with diffuse T1 hypointense marrow replacement.

Output: 1. Questionable ill-defined enhancement in the distal fundus of the left internal auditory canal and in the expected location of the left geniculate ganglion. Patient will be recalled for dedicated internal auditory canal sequences.2. Nonspecific T2 hyperintensity in the right precentral gyrus which does not enhance.3. Diffuse marrow replacement is a nonspecific finding which can be seen with chronic disease, anemia, lymphoproliferative or myeloproliferative disorders.4. Phthisis bulbi with chronic intraocular hemorrhage.


Instruction: Generate impression based on findings.

Input: 79 years, Female, chronic dysarthria, memory loss. Stroke? No restricted diffusion to suggest acute ischemia. No evidence of acute intracranial hemorrhage. No intracranial mass or mass-effect. There is global parenchymal volume loss which is appropriate for age. Multiple foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild-to-moderate chronic small vessel ischemic disease. There is susceptibility effect along the left lateral ventricle wall which may be related to chronic blood products versus mineralization. No hydrocephalus. No extra-axial collections. Calvarium and extracranial soft tissues are grossly unremarkable.

Output: 1. No evidence of acute infarct.2. Mild to moderate chronic small vessel ischemic disease. No findings to suggest a chronic large vascular distribution infarct.3. Global parenchymal loss, which appears appropriate for patient's advanced age.


Instruction: Generate impression based on findings.

Input: 8-year-old male with neurofibromatosis type I. Assess for change of known brainstem tumor or optic glioma. BRAIN:The ill-defined foci of T2-hyperintensity involving the globus pallidi and thalami are unchanged. Similar lesions involving the middle cerebellar peduncles, cerebellar deep gray nuclei/white-matter and pons are not significantly changed. These lesions are not associated with mass-effect, consistent with FASI of neurofibromatosis.The hypothalamic mass which abuts the posterior aspect of the optic chiasm and the anterior aspect of the mamillary bodies is not significantly changed since the previous examination, accounting for different slice selection. In the axial plane, it measures 15 mm x 10 mm. The optic nerves themselves are not affected apart from the abutment described.The T2-hyperintense, T1-hypointense lesion involving the lower medulla and upper cervical spine is improved since the previous examination as well as the associated expansion. The mass is difficult to measure given its infiltrative nature. On axial T2 weighted imaging, the abnormality measures 10 mm x 8 mm (series number 1801, image #27) compared to 18 mm x 9 mm (series #701, image #22) given near complete resolution of the T2-hyperintense component along the left posterolateral aspect of the signal abnormality. Contrast enhancement characteristics of the lesion cannot be assessed given the noncontrast enhanced nature of the examination as requested.The remainder of the brain shows no abnormality. The ventricles and CSF-containing spaces are normal in size. There is no midline shift. The major intracranial vascular flow voids are preserved. Minimal ethmoid and maxillary mucosal thickening is nonspecific. Enlargement of the adenoids is a common finding at this age group.ORBITS:The minimal, focal contrast enhancement within the hypothalamic mass just superior to the attachment of the pituitary infundibulum is improved compared to the previous examination but this is nonspecific. The 3-mm well-circumscribed, T2 hyperintense lesion just inferior to the left optic nerve in the region of the left orbital apex is unchanged to minimally smaller. It shows less pronounced contrast enhancement currently. Orbits and globes are otherwise unremarkable. The optic chiasm is normal. Optic tracts appear unremarkable. CERVICAL SPINE:Focal expansion and increased T2 signal involving the left C4 and C5 nerve roots extending to just outside the also mildly expanded neural foramina is unchanged since the previous examination. Left C5 nerve root involvement as associated with a small intradural component which mildly deforms the left side of the spinal cord, as before.Alignment of the cervical spine is normal for straightening which may reflect patient positioning. The vertebral bodies are preserved in height. There is no suspicious marrow signal abnormality. Disc T2 signal and heights are preserved. There is also preservation of the spinal canal. Other than involvement of the upper part of the cervical spinal cord by the cervicomedullary infiltrative, mildly expansile mass, the cervical spinal cord shows no significant abnormality.Minimal expansion of the upper thoracic spinal central canal is not entirely included but was present previously and appears grossly similar.

Output: 1.The infiltrative mass at the cervicomedullary junction is slightly smaller, with reduced left posterolateral component. The interval decreased size is more conspicuous when compared to more remote prior exams.2.The hypothalamic mass is unchanged in size since the previous examination.3.FASI in the brain's deep gray nuclei and white-matter are unchanged.4.Expansion of the left C4 and C5 nerve roots is unchanged nor the associated mild mass-effect on the left lateral aspect of the spinal cord by the left C5 nerve root. 5.Mild expansion of the upper thoracic spinal central canal is only partially included but was present previously, grossly similar.6.Tiny, T2-hyperintense left orbital intraconal lesion is of uncertain etiology, although with decreased enhancement on current exam.


Instruction: Generate impression based on findings.

Input: 9-year-old female with previous absent seizures. Off AEDs x 2 years now with convulsive seizures not responding to meds. No intracranial mass or mass effect. No appreciable evidence of cortical dysplasia, gray matter heterotopia, or other findings to suggest possible seizure focus. Bilateral hippocampi are symmetric in size and signal characteristics without evidence of mesial temporal sclerosis. No evidence of infarct or hemorrhage. No hydrocephalus or extra-axial collections. Major flow-voids are preserved indicating vascular patency. No abnormal parenchymal or meningeal enhancement is appreciated.There is moderate mucosal thickening involving the bilateral maxillary sinuses, left greater than right, as well as patchy opacification of the ethmoid air cells.

Output: 1. No findings to suggest seizure focus. 2. Moderate mucosal thickening involving the maxillary sinuses and to a lesser degree the bilateral ethmoid air cells.


Instruction: Generate impression based on findings.

Input: Male, 37 years old, with pituitary tumor. On this limited evaluation for surgical planning purposes, a large heterogeneously T2 hyperintense lesion is evident involving the sella and suprasellar cistern. The lesion appears to invade both the sphenoid bone and the cavernous sinuses. The lesion projects superiorly indenting the brain up to the level of the foramen of Monro. The lesion is centrally nonenhancing with a thin rim of faint enhancement and a small nodule of enhancement at its superior most margin. It is difficult to determine whether the optic nerves pass through or around the lesion, though the optic chiasm is not clearly visualized and may be engulfed. The ICAs pass along the margins of this tumor. The left ICA flow void is intact. The right ICA flow void is not well seen through the region of the cavernous sinuses, though the terminal ICA and MCA branches do show typical flow voids. No other enhancing lesions are seen. No significant parenchymal edema is detected.

Output: A large mass is evident involving the sella and suprasellar cistern with encroachment into the sphenoid bone, cavernous sinuses, and the undersurface of the brain. The lesion demonstrates thin peripheral enhancement with a small nodule of enhancement at its superior most margin.


Instruction: Generate impression based on findings.

Input: Female, 49 years old, with radiculopathy in the lumbar region. Evaluate for herniated disc. Alignment is anatomic. Vertebral body height and morphology are within normal limits. No evidence of marrow replacement or marrow edema is seen. The visualized distal spinal cord, conus and nerve roots of the cauda equina are within normal limits. No epidural lesions are seen.L1-2: No significant spinal canal stenosis or neuroforaminal narrowing. L2-3: No significant spinal canal stenosis or neuroforaminal narrowing. L3-4: Facet arthropathy. No spinal canal or foraminal stenosis. L4-5: Facet arthropathy. No spinal canal or foraminal stenosis. L5-S1: Facet arthropathy. No spinal canal stenosis or foraminal narrowing. There is a perineural root sleeve cyst in the right lateral recess, likely an incidental finding.

Output: Facet arthropathy is evident at lower lumbar levels. Otherwise, no significant degenerative findings are seen. Specifically, there is no evidence of any disc herniation or significant compromise of the spinal canal or neural foramina.


Instruction: Generate impression based on findings.

Input: Female 73 years old Reason: r/o CVA History: hx of CVA , A.fib - a/w syncope. Multiple sequences are degraded by motion. There is however no evidence of acute infarct. There is periventricular white matter T2/FLAIR hyperintensity which is nonspecific but likely related to mild chronic small vessel ischemic disease. Extensive encephalomalacia related to chronic infarcts is present in the bilateral inferior cerebellar hemispheres. There is susceptibility associated with the infarct in the left cerebellar hemisphere reflecting hemosiderin deposition. There are additional smaller foci of encephalomalacia in the left occipital, left parietal, and left posterior frontal lobes. Unchanged mild global cerebral volume loss. There is no midline shift or herniation. No hydrocephalus. The skull is grossly unremarkable. Opacification of the right sphenoid sinus which was seen on the previous exam and mild mucosal thickening of anterior ethmoid air cells. There is borderline proptosis. There is unchanged soft tissue thickening in the suboccipital region, likely related to scarring.

Output: 1.No evidence of acute intracranial hemorrhage, mass, or acute infarct.2.Evidence of multiple chronic supra- and infratentorial infarcts as described above.3.Mild chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: Tinnitus left ear and headaches. Internal Auditory Canals: The bilateral cranial nerve 7 and 8 complexes are intact. There is no evidence of mass lesions. The inner ear structures, including the cochlea, vestibule, endolymphatic duct, and semicircular canals, appear unremarkable. The bilateral mastoid air cells and middle ears also appear unremarkable.Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are several unchanged non-enhancing scattered T2 hyperintense cerebral white matter lesions. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. No evidence of retrocochlear or inner ear lesions. A head CTA and temporal bone CT may be useful for further evaluation.2. Unchanged cerebral white matter lesions, which may represent multiple sclerosis.


Instruction: Generate impression based on findings.

Input: Clinical question: Stiff leg. Signs and symptoms: Lower extremity stiffness. Nonenhanced cervical MRI:Foramen magnum is unremarkable.C2-- C3 demonstrate mild degenerative changes and unremarkable otherwise.C3 -- C4 demonstrate mild degenerative changes and unremarkable otherwise.C4 -- C5 demonstrate mild degenerative changes with result in mild to moderate right neural foraminal compromise and unremarkable otherwise.C5 -- C6 demonstrate moderate degenerative disk and mild facet/ligamentum flavum hypertrophy without significant change since prior exam. There is no central spinal stenosis however moderate bilateral neural foraminal (right greater than left) compromise is present. No change since prior exam.C6 -- C7 demonstrate slight interval decreased size of a left lateral disk protrusion since prior exam. There is no central spinal stenosis. Mild left neural foraminal compromise is again noted without change.C7 -- T1 demonstrate asymmetric right-sided hypertrophic changes with resultant mild to moderate right neuroforaminal compromise.There is normal signal intensity and caliber all cervical and uppermost visualized thoracic cord similar to prior exam.

Output: 1.Stable mild to moderate degenerative changes of cervical spine.2.No evidence of central spinal stenosis at any level.3.Interval decreased size of a left lateral disk protrusion at C6 -- C7 since prior exam.4.Multiple levels of mild to moderate neural foraminal compromise without significant change since prior exam as detailed per level above.


Instruction: Generate impression based on findings.

Input: 22-year-old female with right upper quadrant ache, elevated LFTs, and dx of PSC. Assess for any stricturing/suspicious lesions. ABDOMEN:LIVER, BILIARY TRACT: Irregularity of the intra and extrahepatic biliary ducts are compatible with history of primary sclerosing cholangitis. These findings are stable in appearance. The common bile duct measures up to 1.1 mm in diameter. No new dominant stricture or suspicious hepatic lesion.SPLEEN: No significant abnormality noted.PANCREAS: No pancreatic ductal dilatation or pancreatic mass.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.Stable biliary ductal irregularity and dilatation compatible with history of PSC. No dominant new stricture or suspicious hepatic lesion.2.No pancreatic ductal dilatation or pancreatic mass.


Instruction: Generate impression based on findings.

Input: Alignment of the lumbar spine is anatomic. For numbering purposes, there are 5 lumbar-type vertebral bodies. The vertebral body heights are preserved. The bone marrow signal is within normal limits. Mild degenerative spondylosis affects the lumbar spine, most notably at L4-5 and L5-S1 where there is disc desiccation. The conus is normal in signal and morphology, terminating at the L1-L2 level. There is no abnormal leptomeningeal or epidural enhancement to suggest metastatic disease. An enlarged right retroperitoneal lymph node is present. T12/L1: No spinal canal stenosis or neural foraminal narrowing.L1/2: No spinal canal stenosis or neural foraminal narrowing.L2/3: No spinal canal stenosis or neural foraminal narrowing.L3/4: Mild disc bulge without spinal canal stenosis or neural foraminal narrowing.L4/5: Mild disc bulge without spinal canal stenosis. Minimal right neural foraminal narrowing and no significant left neural foraminal narrowing. Enhancement surrounding the facet joints is likely degenerative in etiology. A small posteriorly directly synovial cyst is present on the left.L5/S1:Mild disc bulge without spinal canal stenosis. Mild to moderate right neural foraminal narrowing and no significant right neural foraminal narrowing.Mild facet arthropathy is present throughout the lumbar spine.

Output: 1. No evidence of metastatic disease to the lumbar spine.2. Mild degenerative changes as detailed above without spinal canal stenosis at any level in the lumbar spine.


Instruction: Generate impression based on findings.

Input: evaluate osteochondritis dessicans lesion MENISCI: There is minimal fraying of the inner edge of the lateral meniscus without additional abnormality.ARTICULAR CARTILAGE AND BONE: The patient is status post osteochondral repair with bilateral screws in the medial femoral condyle of the right knee. There is surrounding edema and mild irregularity of the adjacent articular cartilage. Without prior for comparison, we cannot comment on interval change but it appears to be healingLIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Status post osteochondral repair with signs of healing.


Instruction: Generate impression based on findings.

Input: New diagnosis of lung cancer. Initial staging. There is no contrast enhancing or space-occupying brain lesion. There is no midline shift. There is no intracranial hemorrhage. The ventricles and sulci are mildly enlarged, compatible with volume loss. The dural venous sinuses and major intracranial arteries appear to be patent. There is no destructive skull lesion. The mastoid air cells are unremarkable. There is mild mucosal thickening in the paranasal sinuses. The lenses are replaced, bilaterally.

Output: No evidence of intracranial metastasis.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Clinical question: 65 year-old female with left tonsillar squamous cell carcinoma. Now presenting with seizure episode. Rule out hemorrhagic CVA, etc. Signs and symptoms: Seizures Non-infused CT of brain:A new area of low-attenuation involving the cortex and subcortical white matter of the left frontal lobe (axial images 19 and 20) is noted. There is subtle mass effect with this finding. There is no evidence of hemorrhage associated with this finding. This finding is believed to represent a small acute cortical stroke. Considering patient's history possibility of a metastatic lesion should also be considered. Further study with an infused head CT or an MRI is recommended.No evidence of hemorrhage, mass effect, midline shift or hydrocephalus. Calvarium is intact. Very extensive degenerative changes of cervical spine at C1 -- C2 level is noted.

Output: 1.New foci of low-attenuation in the left frontal lobe as detailed. Finding is concerning for ischemic stroke and considering patient's history possibility of a metastatic lesion cannot be entirely ruled out. Follow-up study would be effusion is recommended.2.No evidence of hemorrhage a standard but is questioned or any additional findings.


Instruction: Generate impression based on findings.

Input: Cellulitis. Rule out "osteo" versus necrotizing cellulitis. The subcutaneous fat of the ankle is replaced with intermediate density compatible with edema that propagates through the subcutaneous fat along the dorsum of the foot. There is associated skin thickening, as well as blistering along the lateral aspect of the ankle and dorsal aspect of the forefoot. The musculature of the forefoot also appears edematous. Furthermore, there are multiple foci of gas density within the soft tissues surrounding the head of the second metatarsal and extending dorsal to the head of the first metatarsophalangeal joint and the proximal phalanx of the second toe, in close association with the extensor tendons of the 1st and 2nd rays. There is also a poorly defined collection of low density within the plantar musculature of the foot deep to the flexor tendons of the second ray beneath the second metatarsal diaphysis which could represent a developing abscess or septic tenosynovitis; small foci of gas are seen within this collection. I see no site of skin ulceration on this study to suggest a source for this gas, and therefore, I cannot exclude the possibility of a necrotizing infection. I see no specific imaging features of osteomyelitis. Osteoarthritis affects the first metatarsophalangeal joint and midfoot articulations.

Output: Soft tissue infection of the foot as described above.


Instruction: Generate impression based on findings.

Input: Cervical spine:There is slight reversal normal upper cervical curvature. There are no fractures or subluxations. The marrow signal is benign. The cervical cord is normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. Redemonstrated is opacification of the rightSinus with mucosal thickening in the remaining visualized. As the sinuses. Otherwise the visualized paraspinal contents are unremarkable.C2/3: UnremarkableC3/4: There is a small midline disc protrusion which indents the anterior midline cord, without intrinsic cord signal abnormality. There is also bilateral uncinate hypertrophy resulting in mild bilateral neural foraminal stenosis.C4/5: There is a left paracentral disc extrusion extending above and below the disc level causing anterior left hemicord flattening, without intrinsic cord signal abnormality. There is also left uncinate hypertrophy. There is focal leftward moderate central stenosis and mild left neural foraminal stenosis.C5/6: There is a tiny central disc protrusion without significant associated mass effect and no resulting stenosis.C6/7: UnremarkableC7/T1: UnremarkableThoracic spine:Sequences acquired towards the end of the thoracic exam are significantly motion degraded. Given this caveat:There is a smooth, physiologic thoracic kyphotic curve. The vertebral body heights and disc spaces are maintained. Marrow signal intensity is benign throughout. The thoracic spinal cord is grossly unremarkable.T1/2 demonstrates no significant disc bulge or cord encroachment.T2/3 demonstrates no significant disc bulge or cord encroachment. T3/4 demonstrates no significant disc bulge or cord encroachment. T4/5 demonstrates no significant disc bulge or cord encroachment. T5/6 demonstrates no significant disc bulge or cord encroachment.T6/7 demonstrates no significant disc bulge or cord encroachment. T7/8 demonstrates no significant disc bulge or cord encroachment. T8/9 demonstrates no significant disc bulge or cord encroachment. T9/10 demonstrates no significant disc bulge or cord encroachment.T10/11 demonstrates no significant disc bulge or cord encroachment. T11/12 demonstrates no significant disc bulge or cord encroachment. T12/L1 demonstrates no significant disc bulge or cord encroachment.

Output: 1.Originally a complete MRI of the spine with and without contrast was ordered. Unfortunately, due to the patient's back pain, she was unable to tolerate the exam. Multiple sequences were repeated due to motion. Per nursing, no meds were available and the service was paged. The patient requested to complete the rest of exam as an outpatient. Sequences acquired towards the end of the thoracic exam are significantly motion degraded.2.No MRI evidence of cervical cord myelopathy. The thoracic cord is grossly unremarkable.3.C3/4: There is a small midline disc protrusion which indents the anterior midline cord, without intrinsic cord signal abnormality. There is also bilateral uncinate hypertrophy resulting in mild bilateral neural foraminal stenosis.4.C4/5: There is a left paracentral disc extrusion extending above and below the disc level causing anterior left hemicord flattening, without intrinsic cord signal abnormality. There is focal leftward moderate central stenosis and mild left neural foraminal stenosis.


Instruction: Generate impression based on findings.

Input: 27-year-old female with head injury No evidence of hemorrhage, edema, mass-effect, midline shift or hydrocephalus. Cortical sulci, ventricular system and all CSF cisterns remain within normal limits.Images at the level of common magnum demonstrates crowding of brain parenchyma at the level of the foramina magnum with effacement of subarachnoid space. This is consistent with low position of cerebellar tonsils (Chiari malformation) which requires further evaluation with a dedicated MRI exam.Calvarium, mastoid air cells and very limited view of paranasal sinuses are unremarkable.

Output: 1.No evidence of acute post traumatic findings.2.Findings consistent with Chiari malformation which requires further evaluation with an MRI.


Instruction: Generate impression based on findings.

Input: 71-year-old male with history of lung cancer, status post chemo, new left scapular mass, evaluate disease status CHEST:LUNGS AND PLEURA: Multiple pulmonary nodules are again identified. Reference left lower lobe nodule (image 66, series 4) measures 13 mm x 10 mm.Reference right middle lobe nodule (image number 52, series 4) measures 9 mm x 9 mm, previously, measuring 9 mm x 8 mm.Groundglass nodule (image 49, series 4) unchanged from the previous exam.Right subpleural upper lobe nodule (image 46, series 4) 9slightly increased in size, now measuring 12 mm, previously, measuring 10 mm.Volume loss on the left, compatible with a previous left lobectomy. Centrilobular and paraseptal emphysema. MEDIASTINUM AND HILA: Stable reference precarinal lymph node (image 43 series 3) measures 14 mm x 13 mm.Reference right hilar lymph node (image 45, series 3) is stable, measuring 10 mm x 13 mm.Makes size is normal. No evidence of pericardial effusion. There are coronary artery calcifications.Central venous catheter with its tip in the SVC.CHEST WALL: New partial collapse of the T7 vertebrae. No evidence of pathologic.ABDOMEN:LIVER, BILIARY TRACT: Stable multiple small hypodensities most likely representing cysts.SPLEEN: No significant abnormality notedADRENAL GLANDS: Stable small left adrenal nodule.KIDNEYS, URETERS: Bilateral renal cysts that are stablePANCREAS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Left scapular lesion noted on recent MRI exam is not identified on this exam.OTHER: Atherosclerotic disease of the aorta.

Output: 1.Multiple pulmonary nodules without significant interval change.2.Partial collapse of the T7 vertebrae. No definite evidence of metastatic involvement.


Instruction: Generate impression based on findings.

Input: Images are motion degraded. Given this caveat:There is slight reversal of normal upper cervical curvature.. There are no fractures or subluxations. The marrow signal is benign. The cervical and upper thoracic cord are normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable. There is no abnormal enhancement.C2/3: UnremarkableC3/4: Mild posterior osteophyte disc complex and bilateral uncinate hypertrophy without significant resulting stenosis.C4/5: Posterior osteophyte disc complex and left uncinate hypertrophy results in moderate left neural foraminal stenosis.C5/6: Posterior osteophyte disc complex asymmetric to the right causes right anterior hemicord flattening without intrinsic cord signal abnormality. There is also bilateral uncinate hypertrophy (right greater than left). Overall there is mild central and severe bilateral neural foraminal stenosis.C6/7: Posterior osteophyte disc complex and bilateral uncinate hypertrophy. There is moderate to severe bilateral neural foraminal stenosis.C7/T1: Unremarkable

Output: 1.C4/5: Moderate left neural foraminal stenosis.2.C5/6: Mild central and severe bilateral neural foraminal stenosis.3.C6/7: Moderate to severe bilateral neural foraminal stenosis.


Instruction: Generate impression based on findings.

Input: Left insular oligodendroglioma, WHO grade II. Status post resection on April 28, 2016. There are changes related to the recent trans sulcal microsurgical resection of the left insular/subinsular mass. Fluid/air in addition to overlying scalp soft tissue thickening and underlying dural thickening in relation to the left temporal craniotomy result in minimal, if any, mass effect on the underlying brain. There is also left frontal pneumocephalus.There is a small T1-hyperintense, T2-hypointense focus with blooming on SWI, which is compatible with focal blood products and measures up to 7 mm, involving the resection bed along the left insular cortex and adjacent frontal pars opercularis. This is associated with diffusion restriction along the resection margin. There is new extra-axial contrast enhancement in the overlying sylvian fissure, probably reactive meninges. Otherwise, the infiltrative subinsular T1-hypointense, T2-hyperintense, noncontrast enhancing lesion is unchanged in size or configuration. Also, the thin linear tract of the previous biopsy through the lesion remains unchanged.Given the superficial location of the lesion and adjacent immediate postoperative changes, it is difficult to assess perfusion characteristics but there is no gross hyperperfusion in the tumor/resection bed.The ventricles and other cerebrospinal fluid spaces are unchanged in size and configuration, including a cystic septum pellucidum and vergae. There is no midline shift or herniation. The major cerebral flow voids are intact. There is mild maxillary mucosal thickening.

Output: 1.Interval resection of at least the superficial portion of the infiltrative left subinsular oligodendroglioma with similar contour of the remainder of the mass.2.Minimal hemorrhage in the resection bed with associated reactive meningeal thickening and other expected postoperative findings are described above.


Instruction: Generate impression based on findings.

Input: There is atlantooccipital assimilation primarily involving the bilateral lateral masses and the occipital condyles. There is crowding of the CSF spaces at the foramen magnum with mildly elongated appearance of the cerebellar tonsils. Measuring from the inferior aspect of the occipital bone, cerebellar tonsillar ectopia measures up to 4 mm, although measuring from the level of the posterior C1 arch which is fused to the occipital bone, cerebellar tonsils do not herniate inferior to it. CSF flow sequence demonstrates focally diminished biphasic flow at the foramen magnum ventrally and dorsally. Atlantodental interval is not well assessed with MRI with appears borderline widened measuring 2 to 3 mm. There is a syrinx in the cervical cord extending from C2 mid dens to the lower C4 level. Syrinx measures up to up to 3 x 4 mm at the mid C3 and upper C4 levels, measured in the AP and transverse dimensions. Vertebral body heights are maintained. There is loss of cervical lordosis. Multilevel degenerative changes are seen including small disc osteophyte complexes at the C3-C4, C5-C6, and C6-C7 levels. There is up to mild spinal canal stenosis and mild to moderate bilateral neural foraminal stenosis at the C5-C6 level. Mild to moderate left and mild right neural foraminal stenosis is present at the C6-C7 level. Spinal canal and neural foramina in the cervical spine are otherwise patent.THORACIC SPINE

Output: 1. Atlantooccipital assimilation with mildly elongated cerebellar tonsils extending to the C1 level. There is crowding of the CSF spaces at the foramen magnum with diminished CSF flow.2. Syrinx in the cervical cord extending from the C2 mid dens to the lower C4 level. There is also trace prominence of the central canal in the thoracic cord. Aforementioned findings are compatible with Chiari I.3. No evidence of tethered cord.4. Mild multilevel degenerative changes as detailed above including mild spinal canal stenosis and mild to moderate bilateral neural foraminal stenosis at the C5-C6 level.5. Borderline widening of the atlantodental interval which can be further assessed with dynamic radiographs as clinically indicated.


Instruction: Generate impression based on findings.

Input: 64-year-old female with history of forgetfulness. There are no areas of restricted diffusion to suggest an acute infarction. There are mild scattered foci of increased T2/flair signal abnormality within the periventricular white matter, which is nonspecific. The mesial temporal lobes are unremarkable and appear symmetric. The basal cisterns are intact. There is no midline shift or mass effect. There is no evidence of intracranial hemorrhage. The orbits, paranasal sinuses, and mastoid air cells are clear. Normal vascular flow voids are present within the cerebral vasculature.

Output: Nonspecific scattered foci of increased T2/signal abnormality within the periventricular white matter likely compatible with mild chronic ischemic small vessel disease. Otherwise, no specific findings to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: A patient submitted outside study for review. Submitted for review are images from MRI guided biopsy of the right breast (10/27/2016) performed at outside institution. For comparison, outside breast MRI (10/24/2016) are available. MRI guided biopsy was performed for focal non-mass enhancement in the right breast at posterior 10:00 position. Targeting appears appropriate. Post biopsy MR images show a hematoma at the site of the target. Per outside radiology report, a marker clip was placed at the biopsy site and post biopsy mammograms are obtained; however, those images are not submitted.Pathology result of this biopsy was fibrous breast parenchyma with mild pseudoangiomatous stromal hyperplasia. Pathology result was concordant with imaging findings.

Output: Status post benign MRI guided biopsy of the focal non-mass enhancement in the right breast at posterior 10:00 position. Pathology result was concordant with the imaging findings.BIRADS: 2 - Benign finding.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Right shoulder pain Note that the examination is limited by motion artifact.ROTATOR CUFF: There is fluid signal intensity within the undersurface of the supraspinatus tendon near its attachment upon the greater tuberosity however there is no discrete full-thickness extension appreciated. There is interstitial tear is superimposed upon tendinosis of the supraspinatus tendon. There is perhaps mild atrophy along the myotendinous junction of the infraspinatus tendon but otherwise the infraspinatus tendon and muscle are intact. The teres minor and subscapularis tendons and muscles are intact.SUPRASPINATUS OUTLET: There is severe osteoarthritis of the acromioclavicular joint with slight mass effect upon the underlying supraspinatus tendon as a result of spurring. Small amount of fluid is present within the subacromial subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Alignment of the glenohumeral joint is normal. Evaluation of the labrum is limited given the lack of intra-articular contrast however within these limits, there is no evidence of gross labral detachment.BICEPS TENDON: Within the limits of the motion degraded exam, the biceps tendon appears intact.ADDITIONAL

Output: 1. Tearing of the supraspinatus tendon just proximal to its insertion on the greater tuberosity. Although there is no discrete full-thickness defect appreciated, the presence of fluid in the subacromial subdeltoid bursa suggests the presence of a full-thickness component.2. Severe osteoarthritis of the acromioclavicular joint.


Instruction: Generate impression based on findings.

Input: Male, 65 years old, with history of metastatic lumbar spine tumor burden with radiculopathy. Thoracic:Numerous foci of T1/T2 hypointensity are seen throughout the thoracic spine. Many of these lesions are surrounded by a rim of STIR hyperintensity. Vertebral body heights are generally well preserved with only slight anterior wedging at some levels most notably T6. Comparison with prior CT examinations is limited, though the number and size of lesions has progressed over the prior two years.At no level does there appear to be gross epidural extension. The spinal canal is not significantly narrowed at any level. The left T2-3 neural foramen is mildly compromised due to some extraosseous tumor extension. Elsewhere, the foramina are patent. The spinal cord shows normal signal intensity and morphology throughout.Multiple hepatic masses are partially visualized.Lumbar:Numerous T1/T2 hypointense lesions are seen involving every vertebral level. As above, most lesions demonstrate rim STIR hyperintensity. Significant tumor extension into the ventral and left lateral epidural space is seen at L5 which causes spinal canal stenosis and crowding of the cauda equina nerve roots. Minimal ventral epidural tumor extension is seen at L4. As above, comparison with prior CT examinations demonstrates interval increase in lesion size and number over the prior two years. It does appear that epidural tumor at L5 has progressed when compared to examinations from earlier this year.The visualized distal spinal cord and conus are unremarkable.. The nerve roots of the cauda equina are within normal limits except as discussed above.A renal cystic lesion is seen on the left.From L1-2 through L3-4, the intervertebral discs are relatively well preserved with no significant spinal canal or foraminal compromise.At L4-5, facet arthropathy, disc bulging, and epidural tumor contribute to a significant spinal canal narrowing, particularly below the disc level. The neural foramina are mildly narrowed.At L5-S1, facet arthropathy and disc bulging contribute to mild spinal canal narrowing. The left neural foramen is significantly narrowed due to tumor involvement and degenerative change. The right neural foramen is moderately narrowed due to degenerative change.

Output: 1.Numerous sclerotic metastases are evident throughout the thoracic and lumbar spine. Lesions have increased in size and number when comparison is made to multiple prior CT examinations dating back to 2014.2.No significant epidural tumor is seen in the thoracic region. However, epidural tumor is present at the L5 level, progressed from earlier this year, which causes a significant narrowing of the spinal canal and crowding of the cauda equina. Minimal epidural extension is also seen at L4. These findings were discussed with Dr. Reed at 4:20 PM on 11/11/16.


Instruction: Generate impression based on findings.

Input: 32-year-old male with left heel infection. Evaluate for abscess versus bone infection. TENDONS: The flexor and extensor tendons appear intact. The peroneal tendons appear intact. The Achilles tendon appears intact.LIGAMENTS: Limited evaluation secondary to patient motion artifact. The anterior talofibular ligament is not well visualized which may reflect a chronic tear/injury. The distal tibiofibular syndesmotic complex appears intact. The visualized portions of the deltoid ligament appear intact.ARTICULAR SURFACES AND BONE: No bone marrow signal abnormality is identified. No findings to suggest osteomyelitis.ADDITIONAL

Output: Nonspecific subcutaneous edema most pronounced along the medial aspect of the ankle with a 3.4 cm superficial fluid collection which does not enhance on postcontrast sequences and may represent a seroma or hematoma. No evidence to suggest osteomyelitis.


Instruction: Generate impression based on findings.

Input: History of breast cancer in mother diagnosed at the age of 49 and maternal cousin diagnosed at the age of 43. History of benign left breast biopsy. Interval placement of bilateral silicone implants which appear intact, retropectoral in right and retroglandular in left. There is extreme amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.A few enhancing foci are unchanged in both breasts.A metallic artifact from prior benign biopsy is again seen in the left lower outer quadrant.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Radicular pain in the L4 distribution on the right side. Evaluate for lumbar spinal stenosis or herniated disc. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is mild straightening of the lumbar spine and minimal retrolisthesis of L2 on L3 and L5 on S1. Bone marrow signal is benign with scattered foci of T1 hyperintensity likely representing foci of fat and small hemangiomas. There is loss of disc height at multiple levels, relatively worse at the L5-S1 level with adjacent endplate fatty marrow signal changes on a degenerative basis. The conus medullaris is normal in position.Small disc bulges in the lower thoracic spine are partially imaged. Multilevel degenerative changes are seen in the lumbar spine, as described below:L1-L2: Mild disc bulge and prominence of the dorsal epidural fat without significant spinal canal or neural foraminal stenosis.L2-L3: Disc bulge with prominence of the epidural fat, ligamentum flavum thickening, and bilateral facet arthropathy result in mild spinal canal stenosis. There is also mild left and minimal right bilateral neural foraminal narrowing.L3-L4: Minimal disc bulge eccentric to the right with ligamentum flavum thickening and minimal facet arthrosis. No significant spinal canal stenosis. There is mild right neural foraminal narrowing. No significant left neural foraminal narrowing.L4-L5: There is soft tissue dorsal to the L4 vertebral body most likely representing extruded disc material, likely originating at L4-5 with superior migration to the upper/mid L4 level. There is complete effacement of the right lateral recess from the upper L4 to the L4-L5 level. There is also moderate central canal stenosis with mass effect on the cauda equina nerve roots in the right aspect of the thecal sac. There is also moderate right neural foraminal stenosis related to eccentric disc herniation on the right. Minimal left neural foraminal narrowing. Bilateral facet arthropathy. L5-S1: Disc bulge, ligamentum flavum thickening, and bilateral facet arthropathy. There is partial effacement of the bilateral lateral recesses. No significant central canal stenosis. There is moderate bilateral neural foraminal stenosis.Bilateral renal cysts are noted. Paraspinous soft tissues are unremarkable.

Output: Multilevel degenerative changes in the lumbar spine as detailed above including a large disc extrusion at the right L4-L5 level with superior migration to the upper/mid L4 level. There is likely associated impingement of the right L4 nerve root in the lateral recess and neural foramen. There may also be impingement of the right L5 nerve root and additional lower cauda equina nerve roots related to moderate central canal stenosis at the L4/L4-L5 level related to the disc extrusion.


Instruction: Generate impression based on findings.

Input: Weight loss and dysphagia status post gastric bypass in 2014, rule out obstruction versus malrotation ABDOMEN: LUNG BASES: No significant abnormality noted.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: Postsurgical changes status post gastric bypass without evidence of obstruction or malrotation.BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: Postsurgical changes status post gastric bypass without evidence of obstruction or malrotation.


Instruction: Generate impression based on findings.

Input: Female 62 years old Reason: r/o obstruction History: conjugated hyperbilirubinemia ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. There are 2 cystic-appearing lesions involving the left hepatic lobe. The more lateral lesion has layering hemorrhage or debris within it and measures 3.9 x 3.1 cm. No definite solid hepatic lesions.There are few scattered other smaller lesions are too small to characterize.Hepatic and portal veins are patent. Gallbladder is distended with sludge and some debris. There is no intrahepatic or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small focal nonenhancing areas in the kidneys bilaterally which are wedge-shaped. Differential considerations include focal pyelonephritis vs. infarctions. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Scattered mesenteric ascites.BONES, SOFT TISSUES: Body wall anasarca.OTHER: Probable uterine fibroids.There is bibasal atelectasis and pleural effusions, right greater than left.INDEX LESION MEASUREMENTS (Current exam date/time: 2/12/2016 21:00:00)LEFT HEPATIC LOBE LESION: 3.9 x 3.1 cm (Image 85, Series 13).

Output: 1.No evidence of biliary ductal dilatation.2.Mild gallbladder distention with sludge.3.Lesion in the left hepatic lobe with layering debris or hemorrhage. Differential considerations include complex cyst, biliary cystadenoma, biliary hamartoma.4.Focal areas of nonenhancement in the kidneys differential considerations include focal pyelonephritis or infarctions. No hydronephrosis.


Instruction: Generate impression based on findings.

Input: Ms. Slay is a 77 year old female with recently diagnosed IDC/DCIS of the left breast. She presents today for MRI evaluation for staging purposes. Of note, there is motion artifact seen in this exam which limits the proper evaluation of the subtraction images. Therefore, all saved images are from the non-subtracted dynamic sequence.There is scattered fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.LEFT BREAST: In the left superior breast, there is a focal area of heterogeneous nonmass enhancement identified measuring approximately 3.9 x 2.6 x 2.9 cm (AP x ML x SI). Susceptibility artifact from biopsy marker clip is seen at the superior aspect of this, compatible with biopsy-proven malignancy. This area of enhancement corresponds in distribution and span to the mammographically detected calcifications, which span approximately 4 cm. In the left inferior breast, there is a linear distribution of clumped nonmass enhancement identified measuring approximately 7.5 cm in AP dimension. This abnormal enhancement extends up and into the left nipple. Upon comparison with recent diagnostic workup, there does appear to be a mammographic correlate with linearly distributed calcifications. In addition, there is a rim-enhancing mass identified in the left lateral breast which measures approximately 0.8 x 1.0 cm. This corresponds to the mammographically and sonographically identified intramammary lymph node and has a suspicious enhancement pattern.RIGHT BREAST: There is no abnormal enhancement seen in the right breast. AXILLA: Biopsy marker clip is identified in one of the left axillary lymph nodes, with benign pathology. No abnormal lymph nodes are identified in either axillary or internal mammary region.

Output: (1) Biopsy-proven malignancy in the left superior breast, measuring up to 4 cm in total span. MR detected enhancement corresponds in distribution and span span to the mammographically detected calcifications.(2) 7.5 cm span of clumped nonmass enhancement in the left inferior breast, which likely corresponds to the mammographically detected linearly distributed calcifications. A stereotactic biopsy targeting one of these calcifications can be performed if clinically warranted.(3) Suspicious rim-enhancement of the intramammary lymph node of the left lateral breast with sonographic correlate. An ultrasound-guided biopsy of this intramammary lymph node is recommended for further evaluation.(4) No MRI evidence for malignancy in the right breast.BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Right Bell's Palsy. The bilateral cranial nerve 7 and 8 complexes are intact. There is no evidence of mass lesions. The inner ear structures, including the cochlea, vestibule, endolymphatic duct, and semicircular canals, appear unremarkable. The bilateral mastoid air cells and middle ears also appear unremarkable. There is a small left ethmoid sinus retention cyst.

Output: No evidence of right facial nerve inflammation, tumor, or acute brainstem or cerebral infarction.


Instruction: Generate impression based on findings.

Input: 40 years Female (DOB:3/4/1976)Reason: r/o posterior circulation cva, thin cuts through auditory canal History: ataxia, dizzinessPROVIDER/ATTENDING NAME: EMILY S MURRAY 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.No abnormal lesions identified at the internal auditory canal or theThere is diffuse calvarial thickening 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 are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.There is no evidence for cerebral infarction or intracranial mass.2.Diffuse calvarial thickening is a nonspecific finding.3.There is no evidence for internal auditory canal mass.


Instruction: Generate impression based on findings.

Input: 72 year old with severe tricuspid regurgitation presenting for evaluation of right heart enlargement. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 62%, the LV end diastolic volume index is 57 ml/m2 (normal range: 65+/-11), the LVEDV is 97 ml (normal range 109+/-23), the LV end systolic volume index is 22 ml/m2 (normal range 18+/-5), the LVESV is 36 ml (normal range 31+/-10), the LV mass index is 20 g/m2 (normal range 67+/-11), and the LV mass is 33 g (normal range 114+/-24). 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 49%, the RV end diastolic volume index is 78 ml/m2 (normal range 69+/-14), the RVEDV is 132 ml (normal range 110+/-24), the RV end systolic volume index is 40 ml/m2 (normal range 22+/-8), and the RVESV is 67 ml (normal range 35+/-13). Right AtriumThe right atrium is severely dilated. 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 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 are normal in size and 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. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 35 years, Female, increase in headache intensity and frequency. History of Chiari decompression in 2013. Again seen are postsurgical changes of Chiari decompression including suboccipital craniectomy and resection of the C1 posterior arch. CSF spaces at the foramen magnum are grossly preserved ventrally and dorsally with biphasic flow.Remainder of the brain parenchyma is essentially unremarkable. Ventricles remain normal in size. Incidentally noted is a tiny punctate focus of susceptibility and enhancement involving the right anterior pons which is consistent with a tiny capillary telangiectasia. No evidence of ischemia or hemorrhage. No intracranial mass or mass effect. No abnormal enhancement. Minimal scattered mucosal thickening is present within the paranasal sinuses.

Output: 1. Postoperative changes of Chiari I decompression are again seen. Biphasic CSF flow at the foramen magnum is preserved.2. Remainder of the brain appears within normal limits.


Instruction: Generate impression based on findings.

Input: seizure. There is no acute ischemic or hemorrhagic lesion.There is,however, localized encephalomalacia on the right temporal lobe middle temporal gyrus posterior aspect which extends posteriorly following left side parallel sulcus reaching to posterior inferior aspect of the left angular gyrus.Encephalomalacia of cortex and subcortical white matter were also seen on the right lateral orbital gyrus and some of right inferior frontal gyrus (pars orbitalis). The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: No evidence of acute ischemic or hemorrhagic lesion.Multifocal encephalomalacia on the right frontal lobe and temporal lobe as described above.