Instruction: Generate impression based on findings.

Input: Reason: Left knee meniscus tear History: Left knee pain and swelling MENISCI: There is a linear defect involving anterior horn of the lateral meniscus extending to the femoral articular surface, consistent with a horizontal tear. The medial meniscus is intact. ARTICULAR CARTILAGE AND BONE: Edema-type signal is seen within the medial femoral condyle and medial tibial plateau. There is a fluid-filled full-thickness defect within the patellar articular cartilage with subchondral cyst formation in the underlying patella. There is thinning of the articular cartilage of the bilateral tibial plateaus and bilateral femoral condyles but no focal full-thickness defect is seen.LIGAMENTS: There is disruption of the medial collateral ligament and surrounding edema type signal, consistent with tearing. The ligaments are otherwise intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. MCL tear with underlying bone contusions.2. Horizontal lateral meniscal tear.3. Patellar osteoarthritis.


Instruction: Generate impression based on findings.

Input: Impaired delay recall. Evaluate for vascular dementia due to increased memory difficulties. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles and sulci are prominent, consistent with mild age-related volume loss. The basal cisterns remain patent. There are scattered punctate foci and confluent areas of abnormal T2 hyperintensity within the periventricular and subcortical white matter, which are non-specific, but most consistent with stable mild chronic small vessel ischemic changes. There are scattered foci of susceptibility artifact, likely representing hemosiderin deposition from chronic microhemorrhage. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable. There are mucous retention cysts in the bilateral maxillary sinuses.

Output: 1. No evidence of intracranial hemorrhage, mass, or acute infarct.2. Stable mild chronic small vessel ischemic changes.


Instruction: Generate impression based on findings.

Input: Pain and numbness cervical spine Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained. Bone marrow signal is within normal limits. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal enhancement.Mild degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: No significant compromise to the spinal canal or neural foramina.C4-5: No significant compromise to the spinal canal or neural foramina.C5-6: Small disc osteophyte complex and bilateral uncovertebral hypertrophy. There is minimal spinal canal narrowing which is slightly worse since prior from 3/17/2009. There is also mild right neural foraminal narrowing. No significant left neural foraminal narrowing. C6-7: Disc osteophyte complex and ligamentum flavum thickening with mild spinal canal stenosis which is worse since prior from 3/17/2009. No abnormal cord signal. No significant neural foraminal stenosis.C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: Mild degenerative changes in the cervical spine at the C5-C6 and C6-C7 levels which appear slightly worse since 3/17/2009. There is mild spinal canal stenosis at the C6-C7 level as well as mild right neural foraminal narrowing at the C5-C6 level. Please see details above.


Instruction: Generate impression based on findings.

Input: 76-year-old female with acute ischemic stroke on heparin. Evaluate for worsening hemorrhagic conversion. Subacute infarcts in left and right occipital lobes are reidentified, appearing similar to prior study without evidence of hemorrhagic conversion. Patchy areas of low attenuation in the periventricular and subcortical white matter bilaterally, including the acute infarcts seen on prior MRI brain, are unchanged on comparison to most recent CT head.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses are normally pneumatized. Opacification of the mastoid air cells, which was seen on prior exam.

Output: Stable bilateral occipital subacute strokes without evidence of acute hemorrhage.


Instruction: Generate impression based on findings.

Input: 32 year-old male liver donor. Evaluate. ABDOMEN:LIVER, BILIARY TRACT: Hepatic parenchyma is normal in intensity without evidence of a mass. No intra or extrahepatic biliary ductal dilatation. The common bile duct tapers smoothly to the level of the ampulla without evidence of stone, lesion, or mass.The celiac axis, splenic artery, common hepatic artery, proximal right hepatic artery, and the proximal left hepatic artery are well opacified and patent. The main portal vein, right portal vein, and left portal vein are patent. The hepatic veins are patent.SPLEEN: No significant abnormality noted.PANCREAS: No pancreatic ductal dilatation. Pancreas demonstrates normal intrinsic T1 hyperintensity.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.No evidence of hepatic mass or biliary ductal dilatation.2.Patent hepatic vasculature as detailed.


Instruction: Generate impression based on findings.

Input: Right hip pain. Possible anterior proximal thigh mass. Mild osteoarthritis affects the right hip with subchondral cyst formation. We see no joint effusion or enhancement of the synovium to suggest synovitis. Please note that this study was not protocoled for detailed evaluation of the acetabular labrum. The musculature of the hip appears normal. We see no soft tissue mass.On the large field-of-view images, the left hip is unremarkable as are the sacroiliac joints and pubic symphysis. There is mild degenerative disc disease of L5-S1. Note is made of nabothian cysts and what we suspect are small uterine fibroids.Additional scans through thighs distally reveal no mass. Osteoarthritis affects both knees with joint effusion on the left. A lesion in the right distal femur likely represents a benign enchondroma.

Output: Mild osteoarthritis of the right hip and other findings as described above. We see no mass.


Instruction: Generate impression based on findings.

Input: This exam is mildly degraded by motion artifact. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are no areas of abnormal parenchymal signal. There is mild prominence of the ventricles and extra-axial spaces. There is no midline shift or herniation. There is asymmetric prominent T2 and FLAIR hyperintensity within the right transverse sinus, without susceptibility or diffusion restriction. The remainder of the major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unremarkable. The midline structures and craniocervical junction are within normal limits.

Output: 1.Mildly motion degraded exam without evidence of mass, acute infarct, or structural abnormality. 2.Findings compatible with benign external hydrocephalus, a finding that should resolve by 2 years of age. Follow-up imaging may be obtained as clinically indicated.3.Apparent asymmetric signal within the right transverse sinus is likely artifactual relating to differential venous flow, however, an MRV or contrast-enhanced MRI to exclude the possibility of thrombus.


Instruction: Generate impression based on findings.

Input: 66 year old male patient with prostate cancer. PELVIS:PROSTATE:Prostate Size: 3.4 x 4.5 x 3.5 cm (AP x transverse x craniocaudal)Peripheral Zone: There is a 1.9 x 0.6 cm lesion in the left base which demonstrates T2 hypointensity, ADC hypointensity, and enhancement compatible with carcinoma.Central Gland: Hypertrophy of the central gland.Seminal Vesicles: No definite invasion.Extracapsular Extension: Tumor abuts the left base and focal extracapsular extension is not excluded.BLADDER: The bladder is distended.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Tumor in the left base with possible focal extracapsular extension.


Instruction: Generate impression based on findings.

Input: Strong family history of early age of breast cancer There is heterogeneous amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: NS - Routine Screening Mammogram.


Instruction: Generate impression based on findings.

Input: 27-year-old female with NF1 with shooting pains into middle two fingers of the right hand. Evaluate for any evidence of lesion in the median nerve. Multiple lesions are present which demonstrates isointense signal to skeletal muscle T1-weighted images and hyperintense signal to skeletal muscle on T2-weighted images are present throughout the course of the median nerve which demonstrate enhancement after intravenous contrast administration, the largest of which measures 3 mm x 3 mm (series 501, image 14). The median nerve appears thickened throughout its course. Multiple lesions are present throughout the course of the ulnar nerve, the largest of which measures 6 mm x 5 mm x 13 mm (series 501, image 10) located in the distal forearm approximately 2 cm proximal to the carpal tunnel and corresponds to the reference lesion on MRI study of the forearm.The tendons and muscles of the wrist appear normal. Bone marrow signal intensity is normal.

Output: Findings compatible with neurofibromas affecting the median and ulnar nerves with measurements provided above.


Instruction: Generate impression based on findings.

Input: 73-year-old male with back pain and elevated white blood cell count.. The study limited due to patient motion despite numerous repeat sequences and the lack of intravenous contrast. There are postsurgical findings related to laminectomy from C3 to C7. There is diffuse high T2 signal in the posterior soft tissues of the neck along the surgical incision plane. A focal lesion in the subcutaneous tissues of the upper thoracic spine measuring 3.4 x 1.1 cm with high T1 and T2 signal suggestive of a subacute hematoma. There is multilevel degenerative spondylosis of the cervical spine associated with mild spinal canal narrowing and variable degrees of neural foramen stenosis. There is high T2 signal and volume loss within the spinal cord extending from C3 to C7. The remainder of the spine shows no abnormal signal within the cord. There are postsurgical findings related toL3-4 laminectomy. There is loss of height of the L3 and L4 vertebral bodies with irregular endplates and possible vaccuum disc phenomenon otherwise surrounded by high T2 signal in the L3-4 disc space. There is also a disc bulge at L3-4 that results in mild spinal canal and bilateral neural foramen stenosis. Minimal degenerative spondylosis is present at other lumbar spine levels. There is also extensive high T2 and low T1 signal within the L3, and L4 vertebrae, which may represent reactive bone edema from degenerative disc disease.

Output: 1.No definite epidural spinal abscess is identified. However, the exam is limited due to lack of intravenous contrast and motion artifact.2.Postsurgical changes related to multilevel cervical laminectomy with underlying high T2 signal within the cord, likely reflecting myelomalacia associated with multilevel cervical spinal canal stenosis related to degenerative spondylosis.3.Diffuse signal abnormality in the posterior paraspinal soft tissues at the cervical spine level is likely postoperative in nature, but is otherwise nonspecific and incompletely characterized.4.Hematoma in the posterior subcutaneous tissues of the upper thoracic region.5.Degenerative spondylosis at L3-4 with mild spinal canal and neural foramen stenosis, as well as signal abnormality within the L3, and L4 vertebrae, which may represent reactive bone edema from the degenerative disc disease, although superimposed infectious discitis-osteomyelitis cannot be entirely excluded.


Instruction: Generate impression based on findings.

Input: There is no acute infarct, suspicious intracranial enhancement, mass, or cerebral edema. There are scattered periventricular and subcortical white matter T2 hyperintensities, which are nonspecific, but likely represent mild chronic microvascular ischemic changes. There is mild diffuse parenchymal volume loss, commensurate with age.There are several scattered punctate foci of susceptibility effect including the right superior frontal gyrus, left temporal, parietal and occipital lobes which are compatible with chronic microhemorrhages. No extra-axial collections. No hydrocephalus. There is no midline shift or herniation. Major flow-voids are preserved. The skull and extracranial soft tissues are unremarkable.

Output: 1. Mild global volume loss and mild chronic microvascular ischemic changes. No intracranial mass or acute infarct.2. Several tiny foci of chronic microhemorrhages in a lobar distribution which may be related to amyloid angiopathy.


Instruction: Generate impression based on findings.

Input: 64 years, Female, persistent photophobia and headaches/migraines. 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. Few foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild age-related white matter changes. Brain parenchyma is otherwise unremarkable for age.No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved.There is possible symmetric smooth uveoscleral thickening involving the bilateral globes posteriorly without nodularity or mass. Partially empty sella is seen which can be normal variant. Bone marrow signal and extracranial soft tissues are otherwise within normal limits.

Output: 1. MRI of the brain is within normal limits for age. Specifically no intracranial mass or abnormal enhancement is appreciated.2. Questionable symmetrical, smooth uveoscleral thickening involving the bilateral globes. Finding is suspected to be artifactual but suggest correlation with ophthalmologic findings.


Instruction: Generate impression based on findings.

Input: History of breast cancer now with headacheIMAGE ACQUISITIONS: Brain CT without and with contrast. 100 cc nonionic Omnipaque 350. There is questionable punctate foci of enhancement which likely represent volume averaging from the vessels in the deep sulci. However, small metastases cannot be excluded. We recommend a brain MRI without and with contrast to further evaluate.Remainder of the cerebrum, cerebellum, and brainstem show normal morphology and attenuation. There are no other areas of abnormal enhancement. No intracranial hemorrhages or abnormal extra-axial fluid collections. Visualized paranasal sinuses and mastoid air cells are pneumatized normally.

Output: Questionable foci of abnormal enhancement. Although these are likely artifactual, we recommend brain MRI without and with contrast given patient's history of breast cancer.


Instruction: Generate impression based on findings.

Input: Female, 63 years old, with multiple sclerosis and worsening spasticity. Brain:Numerous white matter T2 hyperintense lesions are seen involving the juxtacortical and periventricular white matter as well as the brainstem and minimally the cerebellum. Many of these lesions are oval in shape and oriented radially with respect to the ventricles. These lesions show varying degrees of associated T1 hypointensity ranging from minimal to marked. No definite associated enhancement is seen with these lesions, nor is there any pathologic enhancement elsewhere within the intracranial space.No significant parenchymal edema or mass effect is seen. The corpus callosum is perhaps mildly thinned which may reflect disease related volume loss. No intracranial hemorrhage or any abnormal extra-axial fluid is detected. Ventricular size and morphology are within normal limits.C-spine:Although image quality is somewhat degraded by motion artifact, a subtle but longitudinally extensive area of T2 signal abnormality is suspected within the spinal cord beginning at C2 and continuing down to C5 or C6. No significant cord swelling is seen in this area. There may be an additional more focal area of cord signal abnormality at T3. No pathologic cord or leptomeningeal enhancement is seen.Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. No worrisome marrow signal replacement or enhancement is detected.C2-3: No spinal canal stenosis or neuroforaminal narrowing. C3-4: Mild posterior disc-osteophyte complex formation. No significant spinal canal narrowing. Mild right and moderate left foraminal narrowing. C4-5: Minimal posterior disc-osteophyte complex formation. No significant spinal canal or foraminal stenosis. C5-6: Unremarkable. C6-7: Unremarkable. C7-T1: Unremarkable.

Output: 1.Numerous white matter lesions are demonstrated in the brain compatible with demyelinating disease and typical of MS in particular. These lesions demonstrate variable corresponding T1 hypointensity suggesting varying degrees chronicity. No definite enhancing lesions are seen.2.A subtle but longitudinally extensive region of signal abnormality is suspected within the spinal cord spanning from at least C2 down to C5. Such an appearance is relatively unusual for MS, though it could represent the accumulation of numerous, nearly confluent lesions in the context of long-standing disease. The possibility of an atypical demyelinating process can also be considered.


Instruction: Generate impression based on findings.

Input: Clinical question: Rule out demyelinating pathology. Signs and symptoms: Numbness and tingling of the arms and legs, on and off for years. Pre and post enhanced brain MRI:Negative diffusion-weighted images.Examination demonstrates several tiny foci of FLAIR hyperintensity in the periventricular and subcortical white matter of cerebral hemispheres and a single similar lesion in the right external capsule which are nonspecific, nonhemorrhagic and demonstrate no abnormal enhancement. Findings are nonspecific and possibilities of mild chronic small vessel ischemic strokes or demyelinating disease should be considered. The lesion do not present typical morphology for demyelinating disease and are not identified in the corpus callosum, pons, midbrain or the cerebellar peduncles.The cerebral cortex, cortical sulci, ventricular system and CSF spaces are within normal for patient's stated age.There is no detectable abnormal parenchymal or leptomeningeal enhancement.The signal void of major intracranial arterial branches are identified.The signal intensity of intracranial venous sinuses are within normal and with normal pattern of enhancement.Unremarkable images through the orbits and including axial fat sat postcontrast enhanced series.Paranasal sinuses and bilateral mastoid air cells and middle ear cavities demonstrate normal pneumatization signal patterns.

Output: 1.No diffusion-weighted abnormalities.2.Few nonspecific punctate foci of FLAIR and T2 hyperintensity only in the subcortical and periventricular white matter as detailed above.3.Unremarkable pre and post enhanced brain MRI otherwise.


Instruction: Generate impression based on findings.

Input: Secondary malignant neoplasm of brain and spinal cord [198.3], Reason for Study: ^Reason: adenoid cystic carcinoma w/ L orbital involvement. History: Eval extent of tumor and change from prior imaging. Orbit MRIThere are T2 low to intermediate signal intensity and T1 low signal intensity with inhomogeneously enhancing mass at the left pterygopalatine fossa which ascends through the left inferior orbital fissure and the left temporal lobe. The enhancing mass encases left optic nerve and appears to be involving the anterior aspect of the left cavernous sinus.Prior scan obtained out side hospital is available but cannot be compared directly due to different technical parameters and motion artifacts, however, it appears to be grossly no significant interval change in terms of the extent of the disease.The right side globes, optic nerves, extraocular muscles and retroglobal spaces are symmetric and normal. The lacrimal glands are normal. Brain MRI There is evidence of intra axial mass with surrounding edema on the left temporal lobe with irregular margined enhancing mass which appears to be connected to the mass on the posterior aspect of orbit, anterior and lateral aspect of the left cavernous sinus. There is also enhancing lesion on the left side foramen ovale which is connected to the left middle cranial fossa.There is also acute/subacute ICH on the left frontal lobe with subtle mass effects.Underlying brain shows multiple scattered high signal intensities on FLAIR images indicating non specific small vessel disease.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no restricted diffusion/acute ischemia.The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear.Opacifications of the left ethmoid sinus, sphenoid sinus and frontal sinus were seen.

Output: 1. Extension of extracranial mass through the left inferior orbital fissure and left side foramen ovale toward posterior aspect of the left orbit, anterolateral aspect of the left cavernous sinus and left anteromesial temporal lobe. 2. Left frontal subacute/acute ICH.3. Non specific small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: Status post meningioma resection in 2012, surveillance imaging. Shoulder pain. Brain: Absence of contrast slightly limits evaluation. Again seen are postsurgical changes of right frontoparietal craniotomy for meningioma resection with encephalomalacia involving the right paracentral lobule appearing unchanged since 9/30/2014. No discrete mass to suggest tumor recurrence is appreciated. Scattered T2/FLAIR hyperintensity in the deep, subcortical, and periventricular white matter are nonspecific but likely represent chronic small vessel ischemic changes and similar to prior. No intracranial mass effect, midline shift or herniation. No hydrocephalus.Mild cerebellar tonsillar ectopia and foramen magnum crowding remains unchanged. Left phthisis bulbi is noted. Right globe prosthesis again seen. Paranasal sinuses and mastoid air cells are clear. Cervical spine: Again seen are postsurgical changes of prior anterior cervical discectomy and fusion at the C5-C6 levels. Hardware is better assessed on prior radiograph including lucency surrounding the C5 screw. There is partial fusion involving the C4-C6 vertebral bodies. Again seen is a tiny syrinx extending from the T1-T2 level in the left aspect of the cord. Again seen is straightening of the normal cervical lordosis and multilevel degenerative changes, individual levels as below:C2-3: Small central disc protrusion. No significant compromise to the spinal canal or neural foramina.C3-4: Small central disc protrusion. No significant compromise to the spinal canal or neural foramina.C4-5: Left paracentral disc osteophyte complex resulting in flattening of the ventral cord on the left. Dorsal thecal sac is patent. No cord signal abnormality. No significant neural foraminal stenosis.C5-6: Small osteophyte. Minimal spinal canal narrowing. No significant neural foraminal stenosis.C6-7: There is a disc bulge and ligamentum flavum thickening resulting in mild to moderate spinal canal stenosis. No significant neural foraminal stenosis.C7-T1: No significant compromise to the spinal canal or neural foramina.

Output: 1. Postsurgical changes of prior right posterior frontal convexity meningioma resection. No evidence of tumor recurrence within the limitations of noncontrast study.2. There are multilevel degenerative changes in the cervical spine including prominent left paracentral disc osteophyte complex at the C4-C5 level which mildly impresses on the left ventral aspect of the cord, similar to 7/10/2012. Dorsal thecal sac is patent at this level. No associated cord signal abnormality. There is also mild to moderate spinal canal stenosis at the C6-C7 level which is minimally worse since 7/10/2012. No significant neural foraminal stenosis at any level in the cervical spine. 3. Anterior cervical fusion hardware better assessed on recent radiograph.4. Tiny syrinx at the T1-T2 level just to the left of the midline remains unchanged since 7/10/2012.


Instruction: Generate impression based on findings.

Input: Right shoulder mass Note that the examination is limited secondary to motion artifact as well as lack of intravenous contrast secondary to patient's inability to complete the exam.ROTATOR CUFF: Note that this exam was not tailored for the evaluation of the rotator cuff. Within these limits, there is mild insertional tendinosis of the supra and infraspinatus tendons without evidence of discrete full-thickness tear. Degenerative cysts are also present along the greater trochanter at the insertion of rotator cuff. The subscapularis and teres minor tendons are normal. The rotator cuff musculature appears normal.SUPRASPINATUS OUTLET: There is mild osteoarthritis of the acromioclavicular joint. There is a trace amount of fluid within the subacromial subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Evaluation of the glenoid labrum is limited given motion artifact and the lack of intra-articular contrast. Within these limits, there is no gross labral detachment. Alignment of the glenohumeral joint is normal.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: Subcutaneous mass within the right shoulder demonstrates imaging characteristics consistent with a lipoma, although no contrast was administered due to the patient's inability to tolerate the exam. Additional findings of the shoulder are described above.


Instruction: Generate impression based on findings.

Input: History of right renal mass. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology, size, signal intensity and enhancement. No biliary ductal dilatation. Normally distended gallbladder with a 2 cm gallstone at the gallbladder neck without acute inflammation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: There is a large mass originating from the inferior right kidney extending inferiorly measuring 13.5 x 13.2 x 13.6 cm (series 6/43 and series 3/26). The lesion is heterogeneous in signal intensity and demonstrates postcontrast enhancement with several nonenhancing cystic/necrotic components. There is moderate pelviectasis of the superior pole of the right kidney. The mass results in mass effect on the descending colon anteriorly. There is suspected tumor thrombus extending into the intrahepatic IVC just inferior to the hepatic veins. There is no significant regional lymphadenopathy.Small left renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Non-obstructive bland thrombus is suspected of the suprarenal IVC.OTHER: No significant abnormality noted.

Output: Large right renal inferior pole solid mass with suspected tumor thrombus extending into the intrahepatic IVC just inferior to the hepatic veins.


Instruction: Generate impression based on findings.

Input: 71 years Male (DOB:10/19/1944)Reason: Hx of head and neck cancer with altered mental status R/o brain mets Vs infarct History: altered mental statusPROVIDER/ATTENDING NAME: ANUBHA C GANJOO ANUBHA C GANJOO There is a small focus of diffusion restriction present in the left para hippocampal gyrus posteriorly measuring approximately 7 mm in diameter. This is also somewhat hyperintense on T2 and FLAIR imaging.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.There is T2 and FLAIR signal hyperintensity present along the anterior aspect of the right inferior frontal gyrus associated volume loss. The patient is status post right-sided craniotomy.There is a focus of signal hypointensity on susceptibility imaging in the right insular cortex which is low signal on T2. It measures approximate 9 mm on T2 imaging.Another T2 hypointense focus is present in the left cerebellar hemisphere along the inferior semilunar lobule associated with susceptibility effect.There is a T2 hypointense lesions present in the right cerebellar hemisphere which has some susceptibility effectPunctate focus of signal loss and susceptibility weighted imaging is present in the left inferior parietal lobule and another in the left superior frontal gyrus.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 middle cerebral artery vasculature appears rather ectatic. The basilar artery also appears somewhat ectaticThe visualized portions of the paranasal sinuses demonstrate partial opacification of the left maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Hemorrhagic appearing focus is present in the right insular cortex and external capsule associated with adjacent edema. The possibility this represents hemorrhagic metastasis cannot be excluded given the patient has known primary lesion elsewhere. Another possibility is that this may represent an aneurysm or cavernous malformation. If clinically appropriate a CT angiogram of the brain may be of further benefit to evaluate this.2.There is a very small hemorrhagic lesion in the right and left cerebellar hemisphere as well as a couple smaller hemorrhagic lesions in the left frontal lobe and left parietal lobe. The possibility this represents metastatic disease cannot be excluded.3.There are small lesions present in the left parahippocampal gyrus. Although this could very well represent a subacute infarction, this is a relatively unusual location for cerebral infarction, the signal characteristics are not very convincing and there is local volume loss. As a result a different type of pathology may be present here.4.Findings suggest encephalomalacia along the right prefrontal artery territory. This could be a result of prior vascular event5.Please note that contrast-enhanced exams or more sensitive in detection of brain metastases.6.The patient status post right-sided craniotomy.


Instruction: Generate impression based on findings.

Input: 66 years Male (DOB:7/16/1949)Reason: Evaluate for underlying mass or ischemia associated with cerebellar hemorrhage History: as abovePROVIDER/ATTENDING NAME: CHRISTOPHER L KRAMER CHRISTOPHER L KRAMER There is a 51 x 27 mm axial dimension hematoma involving the superior aspects of the vermis and left cerebellar hemisphere. There is associated mass effect with compression of the fourth ventricle.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Couple punctate foci of diffusion restriction are present in the right posterior cerebral artery territory in the left hippocampus.There are small foci of microhemorrhage identified in the basal ganglia and left insular cortex as well as right frontal lobe subcortical matter.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate small opacities in the maxillary sinuses and scattered opacities in the ethmoid air cells and left frontal sinus with some mucosal thickening in the sphenoid sinuses. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.Incidental note is made of partial empty sella

Output: 1.There is redemonstration of a hematoma in the cerebellum which results in compression of the fourth ventricle.2.There are multiple microhemorrhages present in the basal ganglia and left insular cortex.3.A couple acute Microinfarcts are present in the right and left posterior cerebral artery territories. No ischemic infarction is identified in the brain tissue immediately surrounding the patient's hematoma.4.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related. 5.No contrast enhanced exam was performed. The examination is somewhat limited due to patient motion artifact and patient inability to complete the exam.


Instruction: Generate impression based on findings.

Input: Toe walking and brisk reflexes. Evaluate for pathology. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits aside from loss of lumbar lordosis which may in part positional. Bone marrow signal is benign. The conus medullaris is normal in position at the lower L1 level without evidence of cord tethering. No abnormal enhancement.Individual levels described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: No significant disc disease. No spinal canal or neural foraminal stenosis.L4-L5: No significant disc disease. No spinal canal or neural foraminal stenosis.L5-S1: No significant disc disease. No spinal canal or neural foraminal stenosis.Paraspinous soft tissues are within normal limits.

Output: Loss of lumbar lordosis which may be in part positional. Lumbar spine MRI is otherwise unremarkable.


Instruction: Generate impression based on findings.

Input: Reason: h/o Lhermitte duclos and cerebellar lesion - pls do T2/FLAIR History: preop planning for craniotomy - pls do T2/FLAIR The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a tiger stripe non-enhancing appearance of the left cerebellar hemisphere and vermis with distortion of the morphology of these structures. The cerebellar tonsils extend through the foramen magnum by approximately 10 mm.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Findings suggest a burr hole in the right frontal bone as well as prior ventriculostomy tract along the right frontal lobe.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.Findings are suspicious for Lhermitte Duclos (dysplastic gangliocytoma) involvement of the left cerebellar hemisphere and vermis. There is associated Chiari one malformation. The lateral ventricles are not enlarged at this time.2.Periventricular and subcortical white matter signal changes of a mild degree (several lesions) are present which are nonspecific. They are likely of little clinical significance.


Instruction: Generate impression based on findings.

Input: Reason: Patient with newly diagnosed Marfan Syndrome. normal aortic root by ECHO. needs full aortic evaluation prior planned pregnancy. History: ectopia lentis, pathological fibrillin mutation CHEST:Mediastinum: Heart size is normal with no pericardial effusion. No lymphadenopathy.Vasculature: No thoracic aortic dissection or aneurysm. Orthogonal (double oblique) Measurements:Sinus of Valsalva: 2.7 x 2.7 x 2.3 cmSinotubular Junction: 2.4 x 2.4 cmProximal aortic arch: 1.8 x 20 cmDistal transverse aortic arch: 1.6 x 1.6 cmMid descending thoracic aorta: 1.3 x 1.4 cmdistal descending thoracic aorta: 1.3 x 1.3 cmUPPER ABDOMEN: There caliber of the origin of the celiac artery appears slightly decreased compared to the proximal celiac artery.

Output: No thoracic aortic dissection or aneurysm.Contrast extravasation description:Supervising radiologist: Dr. Stephanie McCannContrast type: 15 cc of Multihance were administered. Signs and symptoms: Itchiness in patient's throat and eyes. Patient sneezed 3 times. No shortness of breath, neurological symptoms, or hypotension. Patient had an MRI with contrast at Northwestern Hospital without any reaction. Patient stated she "felt OK" and wanted to finish the exam. Patient's husband will drive her home.Treatment given: 50 mg p.o. BenadrylDischarge instructions given: Yes


Instruction: Generate impression based on findings.

Input: 35 year old female with biopsy proven DCIS in the left breast. The DCIS was diagnosed in February 2015. The patient presents for re-assessment of the tumor. There is extreme amount of fibroglandular tissue in both breasts.There are scattered small cysts in both breasts.Mild parenchymal enhancement is noted bilaterally.In the left breast, there is a large non-mass enhancement, extending upper-lower outer and upper-inner quadrants, measuring 69 x 63 x 69 mm (AP x LR x CC). This non-mass enhancement presents predominantly in mid-posterior breast. In addition, there are two suspicious enhancing masses in the left retroareolar region, measuring 8 x 6 x 6 mm in total. No abnormal enhancement is seen in right breast. No abnormal lymph nodes are identified in either axillary region.

Output: 1. Large non-mass enhancement corresponding to DCIS, with small anterior masses in the left breast.2. No MR evidence of malignancy in right breast. 3. No abnormal lymph nodes in either axillary region.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: 69 years, Male. Reason: r/o ileus History: constipation Midline surgical staples. IVC filter in place. Spinal rod and screw device as well as a spacer is noted.Nonobstructive bowel gas pattern. Nondilated loops of large and small bowel are seen. Air and stool is noted in the colon with an average stool burden. A moderate amount of inspissated stool is noted within the rectum. Osseous metastatic disease better seen on prior spinal MRI.

Output: Nonobstructive bowel gas pattern. Moderate amount of inspissated stool is noted within the rectum.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Female 54 years old with history of NF1 and astrocytoma (resected 20+ years ago) complicated with NPH, presenting with left sided weakness, evaluate for contrast enhancing lesion. Limited exam with post-contrast images to complement exam dated 6/19/2016. Small supratentorial subdural fluid collections noted bilaterally. There is a small enhancing extra-axial left parietal convexity mass (series 7 image 101) measuring 5 x 10 mm, which appears similar in size to prior exams dating back to 11/12/2012. The dura is diffusely thickened and enhancing, which may be related to prior craniotomy or reactive to subdural collections. No additional enhancing lesions are identified.

Output: 1. Small left parietal convexity lesion appearing unchanged from prior exams dating back to 11/12/2012 and suggestive of a meningioma. No additional enhancing lesions identified. 2. Additional findings are unchanged from pre-contrast exam dated 6/19/2016.


Instruction: Generate impression based on findings.

Input: 69 year old female with retropharyngeal abscess. Please evaluate for spread to mediastinum. Images through the skull base and including cavernous sinuses remain within normal limits. Mastoid air cells and paranasal sinuses are also well pneumatized and unremarkable. Images through the soft tissues of the neck demonstrate edematous changes of the retropharyngeal space however no definitive evidence of an abscess is detected. Extensive post therapy changes are identified. Soft tissue prominence at the base of tongue is believed to be artifactual and secondary to placement of endotracheal tube. No definitive evidence of mass is identified. There are no old films available for comparison. No evidence of any abnormal enhancing nodes is detected.Increased soft tissue density with cavity formation is noted in the prevertebral space at the level of the larynx and extends inferiorly to at least to the level of the aortic arch in the mediastinum. The quality of images are very poor and further evaluation with an MRI is recommended. At the level of larynx this cavity contains air and may indicate patient's known abscess. At C6 and C7 within intervertebral disk a small amount of air collection may represent vacuum phenomenon however this is immediately at the level of abscess and although the bony density of the spine is not suggestive of osteomyelitis this possibility cannot be entirely ruled out and further investigation with MRI is recommended. This finding is best appreciated on axial images 63 and 64. The largest transverse diameter of this abscess cavity at the level of C5 -- C6 intervertebral disk space measures 33.2-mm (axial image 64 of 88). The cranial cephalad axis of the abscess measures approximately 82 mm. A component of this lesion within the mediastinum appears more solid and contains male multiple linear areas of increased density which may be vascular. This raises the possibility of a neoplastic process. This finding causes anterior displacement of the trachea and is best appreciated on axial image 76 to 88. The finding at this level on this examination is inseparable from the esophagus.Extensive apical scarring of bilateral lungs is noted. Significant amount of pleural effusion on the left and to lesser degree on the right is noted.

Output: 1.Prevertebral abscess extending from the level of the larynx to approximately the level of aortic arch in the mediastinum.2.The intra mediastinum component of this finding is more solid with no air collection and demonstrates multiple vasculature which may indicate presence of the mass in addition to more superiorly located abscess.3.On this examination possibility of osteomyelitis specifically at C6 and C7 cannot be rule out due to apparent continuity of air within the disk space and air within the abscess.


Instruction: Generate impression based on findings.

Input: Clinical question: 73-year-old male with metastatic prostate cancer. Recent chemotherapy and thrombocytopenia with altered mental status. Signs and symptoms: Altered mental status. Non-enhanced head CT:Technique.Axial contiguous CT images of head were obtained. Sagittal and coronal 2-D reformatted images were also acquired.There is no any subacute intracranial hemorrhage, edema, mass effect, midline shift or hydrocephalus.The cortical sulci, ventricular system, CSF cisterns and gray -- white matter differentiation remains within normal.Calvarium is intact.Visualized paranasal sinuses, mastoid air cells and middle ear cavities are pneumatized and unremarkable.Images through the orbits demonstrate bilateral retro-orbital high density lesions that may represent very prominent bilateral superior ophthalmic veins or bilateral retro-orbital masses (hemangiomas). Correlate with patient's history and physical exam. This finding can be further evaluated with a dedicated MRI examination of orbits.

Output: 1.Unremarkable CT examination of brain.2.There prominent bilateral superior ophthalmic veins and or retro-orbital hemangiomas. Please correlate with history and direct physical exam and if clinically warranted recommend further follow-up with dedicated MRI examination of orbits.


Instruction: Generate impression based on findings.

Input: Pelvic/hip pain with negative x-rays. Evaluate for abnormality to account for pain. Per conversation with ordering physician, though not included on the history request, concern for mass lesion status post lumbar MRI. Study was performed with contrast for this reason. The right hip joint is anatomically situated within the right acetabulum without evidence of femoral neck or pelvic fracture. Hip joint space is relative well-preserved and there are no large marginal osteophytes. Sacral arcuate lines are intact without CT evidence for insufficiency fracture. Degenerative spurring is noted at the pubic symphysis and there is vacuum gas and spurring at the SI joints indicating mild degenerative change.There is no mass lesion within the pelvis or hip girdles. There are no enlarged lymph nodes.The adductor, hamstring and gluteal musculature are within normal limits for CT technique.Non-specific stranding is noted in the posterior subcutaneous soft tissues on the most inferior CT cut on the left, perhaps denoting mild inflammation.Moderate to severe disk and endplate degenerative changes are noted at L4 L5 and L5-S1 with broad based disk bulges. No neuroforaminal compromise is appreciated on the sagittal images, but correlation with recent MRI of the lumbar spine is advised.

Output: 1.No evidence of mass lesion or other pathology to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: Diagnosis: Other symptoms and signs involving the musculoskeletal system Other lack of coordinationClinical question: is there signs of acute stroke?Signs and Symptoms: 3days of RUE dysmetria and LE weakness MRI of the brainThere is a focus of diffusion restriction involving the anterior aspect of the right lentiform nuclei which extends into the right centrum semiovale.There is a moderate to marked degree of periventricular confluent T2 and FLAIR signal hyperintensities.There are punctate foci of T2 and FLAIR signal hyperintensity involving the brainstem, thalami and basal ganglia bilaterally.There are foci of encephalomalacia present along the occipital poles bilaterally involving the right occipital pole more than the left. There is associated ex vacuo effect on the trigones and occipital horns of the lateral ventricles.There is encephalomalacia involving the cerebellar hemispheres bilaterally with signal change in the cerebellar white matter and ex vacuo effect on the fourth ventricle. The right middle cerebellar peduncle is atrophicIncidental note is made of partial empty sella.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries and the proximal anterior, middle and posterior cerebral arteries. The vertebral arteries are identified only piecemeal. The right vertebral artery appears to be occluded and the left vertebral artery is only identified in small portions. The basilar artery appears to be occluded between the superior cerebellar arteries and the anterior inferior cerebellar artery. The posterior communicating arteries are identified. The left posterior communicating artery appears to be small in the right posterior communicating artery is not readily identified. The cerebellar arteries are not readily identified. Small portion of the left posterior inferior cerebellar artery is identified and a small portion of the right anterior inferior cerebellar artery is identified. It is suspected that these 2 vessels are likely dominant branches.The left posterior cerebral artery appears larger than the right posterior cerebral artery. The right posterior cerebral artery is not identified beyond the proximal P2 segment. The left posterior cerebral artery is not readily identified beyond the mid to distal P3 segment.The internal carotid arteries and proximal anterior and middle cerebral arteries are irregular with areas of only mild narrowing and dilation. There is approximately 40% narrowing at the proximal left middle cerebral artery M1 segment. There is also approximately 40% narrowing at the communicating segment of the left internal carotid artery. There are foci of narrowing in many of the middle cerebral artery and anterior cerebral artery branches present.The anterior communicating artery is identified and is medium sized. The MRA of the brain is degraded due to some motion artifact.

Output: 1.There is a subacute infarction involving the right lentiform nuclei and adjacent centrum semiovale.2.Findings suggest significant vertebrobasilar disease with suspected occlusion of the right vertebral artery and basilar artery and significant stenosis along the left vertebral artery. Please note that the MRA of the brain is degraded due to motion artifact which may obscure the intracranial vasculature especially in the setting of stenoses and occlusions.3.Findings suggest stenosis or occlusion along the right P2 segment and the left P3/P4 segments. Please note that the MRA of the brain is degraded due to motion artifact which may obscure the intracranial vasculature especially in the setting of stenoses and occlusions.4.There are multiple foci of atherosclerotic narrowing throughout the intracranial vasculature.5.There are multiple old lacunar infarcts involving the thalami, basal ganglia and brainstem.6.Multiple foci of encephalomalacia in the cerebellum, right middle cerebellar peduncle and occipital poles bilaterally are most likely vascular related.


Instruction: Generate impression based on findings.

Input: Sagittal imaging is diagnostic. Axial imaging is degraded secondary to motion artifact. Given this caveat:Cerebellar ectopia is noted measuring 6-7 mm below the level of the foramen magnum demonstrating a mild peglike morphology. CSF flow analysis demonstrates the presence of biphasic CSF flow posteriorly at the level of the cerebellar tonsils.Alignment is anatomic. There are no fractures or subluxations. The marrow signal is benign. The cervical and upper thoracic cord are normal in signal. Postinflammatory cysts are noted in the nasopharynx. Otherwise the visualized paraspinal contents are unremarkable.C2/3: UnremarkableC3/4:UnremarkableC4/5: UnremarkableC5/6: Mild posterior osteophyte disc complex without stenosis.C6/7: Mild posterior osteophyte disc complex without stenosis.C7/T1: Unremarkable

Output: Cerebellar ectopia is noted measuring 6-7 mm below the level of the foramen magnum demonstrating a mild peglike morphology. CSF flow analysis demonstrates the presence of biphasic CSF flow posteriorly at the level of the cerebellar tonsils.


Instruction: Generate impression based on findings.

Input: Female 12 years old with neck swelling unable to palpate edges of thyroid gland. Please assess for nodules or masses and thyroid size. RIGHT LOBE MEASUREMENTS: 1.3 x 1.2 x 4.0 cm transverse by AP by craniocaudalLEFT LOBE MEASUREMENTS: 1.3 x 1.0 x 3.6 cm transverse by AP by craniocaudalISTHMUS MEASUREMENTS: 0.2 cmRIGHT LOBE: Mildly heterogeneous but no nodules are present.LEFT LOBE: Mildly heterogeneous but no nodules are present.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: A few prominent left level 3 and 4 lymph nodes with normal morphology and fatty hila are identified. The largest level 3 lymph node on the left measures 1.6 x 0.6 x 2.0 cm.OTHER: No significant abnormality noted.

Output: No evidence of thyroid nodules.


Instruction: Generate impression based on findings.

Input: Balance issues and clumsiness Vertebral body heights in the cervical spine are normal. There is been progression of ankylosis involving the C3-C4 intervertebral disc space. There is minimal retrolisthesis of C4 on C5 and C5 on C6 and minimal anterolisthesis of C7 on T1. Alignment is similar to prior.Advanced degenerative changes are again seen throughout the cervical spine. There is abnormal T2 hyperintensity in the cervical cord at the C4, C5, and to a lesser degree C6 levels with cord parenchymal thinning consistent with myelomalacia and similar to prior. No new cord signal abnormality. Again noted is probable ossification of the posterior longitudinal ligament from C3-C4 through C6-C7. Individual levels as below:At C2-C3, there is no disk pathology or stenosis.At C3-C4, there is a posterior osteophyte disk complex, PLL thickening/calcification, and bilateral uncovertebral hypertrophy. There is volume loss resulting in preservation of the ventral and dorsal subarachnoid spaces. There is moderate bilateral foraminal narrowing. At C4-C5, there is a central disc osteophyte complex with indentation of the ventral cord. There is moderate to severe spinal canal stenosis which appears slightly worse in the interval. There is moderate left and mild-moderate right foraminal narrowing related to uncovertebral hypertrophy.At C5-C6, there is a disc osteophyte complex with significant right greater than left uncovertebral hypertrophy. There is moderate to severe spinal canal stenosis similar to prior. There is moderate to severe bilateral neural foraminal narrowing as well. Ligamentum flavum thickening is present.At C6-C7, there is a disc osteophyte complex resulting in mild central spinal canal stenosis. There is bilateral uncovertebral hypertrophy. There is severe left and moderate right foraminal narrowing. Ligamentum flavum thickening again seen.At C7-T1, there is no significant disk bulge or spinal canal or neural foraminal stenosis.Patchy T2/STIR hyperintensity is again seen within the pons likely related to chronic small vessel ischemic disease.

Output: 1. Advanced degenerative changes in the cervical spine are again seen. Again seen is T2 signal abnormality involving the C4, C5, and to a lesser degree C6 levels with thinning of the cord consistent with myelomalacia. No new cord signal abnormality.2. There is moderate to severe spinal canal stenosis at C4-C5 and C5-C6 which appears minimally worse in the interval at the C4-C5 level and not significantly changed at the C5-C6 level compared to 7/20/2013.3. There is also neural foraminal stenosis involving the C3-C4 to the C6-C7 levels as detailed above and similar to prior.4. Again seen is thickening of the posterior longitudinal ligament from C3 to C7 with low T1 and low T2 signal which may represent ossification but can be better assessed with CT.


Instruction: Generate impression based on findings.

Input: 69 year old male with history of CVA in 2004. Now presents with left-sided weakness and diffuse headaches. Images through posterior fossa are unremarkable with the exception of minimal calcification of the vertebral arteries.Images through supratentorial brain parenchyma demonstrate no evidence of hemorrhage, edema, mass effect among midline shift or hydrocephalus. No evidence of cortical stroke is detected. Ventricular system, cortical sulci and all CSF cisterns remain within normal limits.If clinical concern for stroke persist an MRI is recommended.

Output: Negative CT of brain.


Instruction: Generate impression based on findings.

Input: 68 year old man with history of pericarditis, continued chest pain, referred for evaluation of continued pericarditis. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 64%, the LV end diastolic volume index is 70 ml/m2 (normal range: 74+/-15), the LVEDV is 141 ml (normal range 142+/-34), the LV end systolic volume index is 25 ml/m2 (normal range 25+/-9), the LVESV is 52 ml (normal range 47+/-19), the LV mass index is 40 g/m2 (normal range 85+/-15), and the LV mass is 81 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is a small patch of atypical late gadolinium enhancement in the basal inferior wall suggestive of the presence of a prior underlying fibrosing, infiltrative, or inflammatory process. This was seen on prior cardiac MRI and is unchanged. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 55%, the RV end diastolic volume index is 83 ml/m2 (normal range 82+/-16), the RVEDV is 168 ml (normal range 142+/-31), the RV end systolic volume index is 38 ml/m2 (normal range 31+/-9), and the RVESV is 76 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a psuedo-bovine branching pattern. The aortic root is mildly dilated (ascending aorta 41mm).Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is no pericardial effusion. The pericardium is mildly thickened, similar to prior study. There is increased signal on T2-weighted imaging and also on late gadolinium enhancement consistent with pericarditis, although it appears less intense than on prior study. Extracardiac FindingsFocal hypointense nodular lesion is noted between the LV and pulmonary artery. This was present on previous study from 10/2015 but was not apparent on 5/2015; this lesion can be reevaluated on future follow-up imaging. Probable renal and hepatic cysts again noted bilaterally. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Mild pericardial thickening with evidence of subacute pericarditis. No clear evidence of constriction. Compared to prior, T2 signal appears less intense, indicative of less overall inflammation.2. Normal LV size with systolic function (LVEF 64%) with evidence of a small amount of atypical late gadolinium enhancement involving the basal inferolateral wall, which was also present on the prior study. It suggests the presence of underlying myocardial fibrosis, inflammation, or infiltration.3. Normal RV size and systolic function (RVEF 55%).4. Mild aortic root dilation. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Brachial neuritis or radiculitis NOSClinical question: Rule Out Cervical Spine Stenosis/Impingement.Signs and Symptoms: Rule Out Cervical Spine Stenosis/Impingement. The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There is abnormal T2 signal hyperintensity within the pons. There is a left sided C3 vertebral body lesion present measuring approximately 10 mm x 8 mm axial dimensions which is bright on T1 and T2 imaging and most likely represents a hemangioma. It suppresses on the fat suppressed images. A similar-appearing but smaller lesion is present along the odontoid.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is some loss of disc space height, endplate osteophytes and a disc bulge as well as uncovertebral osteophytes at this level and some posterior ligamentous hypertrophy. There is associated effacement of spinal fluid ventral and posterior to the spinal cord and encroachment of the exiting nerve roots within the neural foramina bilaterally at this level. There are endplate reactive changes present which are T2 hyperintense. Overall there is a mild to moderate degree of spinal stenosis present at this level and encroachment of the left-sided exiting nerve roots within the neural foramina. Overall this has not changed substantially since the prior exam from 11/15/2014.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.There are degenerative changes present in the cervical spine at C6-7 where there is a mild to moderate degree of spinal stenosis and encroachment of the left-sided exiting nerve roots. Endplate reactive change - with findings suggestive of a subacute stage- is present. Overall this has not changed substantially since the prior exam from 11/15/20142.There are signal changes within the pons. This is somewhat unusual at age 44. Overall this has not changed substantially since the prior exam from 11/15/2014. Please correlate with patient's clinical symptoms. Further imaging evaluation can be obtained using a dedicated MRI of the brain.


Instruction: Generate impression based on findings.

Input: 38 year old female with biopsy proven invasive ductal carcinoma in the left breast. There are a possible satellite near the index cancer, a questionable enlarged left axillary lymph node, and questionable asymmetries in the right breast on the outside studies. There is heterogeneous amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.LEFT BREAST:There is an enhancing mass at posterior 5:30 position measuring 22 x 19 x 20 mm (AP x LR x CC), which is proven malignancy. Marker clip is present just medial to this mass. There are additional 4 small masses, measuring up to 9 mm, located anteriorly from the index mass. Total AP measurement including most anterior mass and index mass is 4.9 cm. In addition, there is a enhancing mass measuring 11 x 10 x 11 mm at 12:00 position. Distance from this mass to the index mass is approximately 8 cm.There is a lymph node with thickened cortex at left axilla.RIGHT BREAST:No abnormal enhancement is seen in right breast. No abnormal lymph nodes are identified in right axillary region.

Output: 1. Biopsy proven cancer in the posterior left 5:30 position with anterior satellites. In addition, an enhancing mass is present at 12:00 position. MR directed ultrasound for the left breast to look for the additional lesions is recommended.2. Suspicious lymph node in the left axilla. MR directed ultrasound is recommended.3. No MRI evidence for malignancy in the right breast or right axilla.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Optic atrophy, bilateral, retinal detachments. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mild scattered nonspecific cerebral white matter T2 hyperintensity, which may represent chronic small vessel ischemic disease. There is a right cerebellar hemisphere developmental venous anomaly. There is mild diffuse cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull and scalp soft tissues are grossly unremarkable. There is moderate mucosal thickening and secretions within the left frontal, bilateral ethmoid, and right maxillary sinuses.Orbits: There appears to be mild diffuse atrophy of the bilateral optic nerves. There is no evidence of orbital mass lesions or abnormal enhancement. The globes, extraocular muscles, and orbital fat appear to be intact. The orbital wall appear to be grossly intact.

Output: 1. Apparent mild diffuse atrophy of the bilateral optic nerves, without evidence of compressive mass lesions.2. No evidence of intracranial hemorrhage, mass, or acute infarct. 3. Findings suggestive of acute sinusitis.


Instruction: Generate impression based on findings.

Input: Biopsy-proven DCIS in 2015 presents for staging. History of nipple discharge. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.Spanning the anterior to posterior depth of the left upper outer quadrant is suspicious nonmass enhancement compatible with known DCIS. This extends from near the chest wall to the level of the nipple. Overall extent measures 13.7 x 4.6 x 3.8 cm. Given the nonmass enhancement pattern, this is favored to represent DCIS rather than invasive malignancy.In the right inferior breast near 6:00, a 5 mm enhancing focus with areas of high T2 signal adjacent to it may represent a cluster of cysts with rim enhancement versus a small papilloma with adjacent dilated fluid filled duct. An enhancing skin lesion is also present on the right inferior breast, likely benign, though suggest correlation with physical exam.No abnormal axillary lymph nodes are identified in either axillary region. Normal sized symmetric lymph nodes are in each axilla.

Output: 1. Extensive nonmass enhancement in the left breast spanning over 13 cm compatible with the patient's known DCIS. This extends from near the chest wall to near the level of the nipple.2. Enhancing focus in the right inferior breast is low suspicion. However, correlation with ultrasound is recommended, and if a solid vascular mass is seen, then biopsy should be performed. If only cysts are seen, or if ultrasound is negative, then a 6 month follow up MRI would be reasonable.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Clinical question: MS; follow progression. Signs and symptoms: Paresthesia. Nonenhanced brain MRI:Examination is performed utilizing Dr. Javed's study. Multiple sclerosis protocol margin 1.1.There are no prior exams for comparison.There are several varying sized foci of flair hyperintensity in the subcortical, periventricular white matter of the cerebral hemispheres as well as corpus callosum, right basal ganglia, left thalamus, left cerebral peduncle, right lateral aspect of the pons and bilateral middle cerebellar peduncles and minimally of the right cerebellum consistent the patient's known history of multiple sclerosis.The cortical sulci as well as ventricular system and the CSF cisterns remain within normal for stated age of 28. Unremarkable calvarial, orbits, paranasal sinuses and mastoid air cells. A small left maxillary retention cyst however it is detected.

Output: 1.Findings consistent with demyelinating disease involving the supra-and infratentorial brain parenchyma as detailed.2.There are no prior exams for comparison.


Instruction: Generate impression based on findings.

Input: Following a discussion of the procedure with the patient and/or family, including its risks, benefits, alternatives and steps to prevent infection, informed written consent was obtained and documented in the patient's chart. The time-out form was completed to confirm patient identity and side/type of procedure. All operators present for the case performed standard preprocedural prep including hand washing, sterile gloves, mask and cap. The patient was prepped and draped in the usual aseptic fashion. Local anesthesia over the target area was obtained by 1% lidocaine. Midazolam and fentanyl were administered IV by the nurses during continuous hemodynamic monitoring. Targeted CT examination demonstrates an expansile lytic lesion within the left ilium along the left sacroiliac joint with associated periosteal reaction corresponding to the findings on the patient's recent PET/CT and MRI examinations. Using CT guidance, a 12-gauge OnControl core biopsy needle was advanced into the lesion at 2 12-gauge core needle biopsy specimens were obtained and placed in 10% formalin.The core biopsy specimens were hand carried to the Surgical Pathology lab.The patient tolerated the procedure well without immediate complication. Routine post procedure instructions were communicated to the patient.ESTIMATED BLOOD LOSS: Less than 5cc. An adhesive bandage was placed on the patient’s skin.

Output: CT-guided biopsy of left ilium lesion.


Instruction: Generate impression based on findings.

Input: History of left parotid surgery for resection of an oncocytoma. History of papillary thyroid cancer, colon cancer, and left submandibular gland pleomorphic adenoma, as well. There is a slightly irregularly-marginated, enhancing, nodular lesion in the deep lobe of the left parotid gland, just posteromedial to the retromandibular vein, which measures up to 9 mm. There is a nonspecific prominent right retropharyngeal lymph node that measures 5 mm in short axis. There is no evidence of other mass lesions of lymphadenopathy elsewhere in the neck. The right parotid gland and bilateral submandibular glands are unremarkable. There has been total thyroidectomy. The pharyngeal and laryngeal structures are unremarkable. The orbits and imaged portions of the intracranial structures are unremarkable. There is a small posterior disc-osteophyte complex at C5-C6, which abuts the spinal cord.

Output: A subcentimeter nodular lesion in the deep lobe of the left parotid gland may represent recurrent oncocytoma.


Instruction: Generate impression based on findings.

Input: Evaluate for early signs of avascular necrosis. Severe osteoarthritis affects the right hip with severe cartilage loss and bone-on-bone apposition anteriorly and superiorly. There is edema-type signal within the acetabular dome that we suspect is degenerative in etiology. We see no specific imaging features of avascular necrosis. Small right hip joint effusion containing intermediate signal intensity likely representing synovitis and debris. There is degeneration and tearing of the anterior labrum.On the large field-of-view images, moderate osteoarthritis affects the right hip.The musculature appears intact. There is metallic susceptibility artifact from tubal ligation clips.

Output: Severe osteoarthritis of the right hip and other findings as described above without evidence of avascular necrosis.


Instruction: Generate impression based on findings.

Input: MRI BRAIN:The ventricles and sulci are within normal limits. The basal cisterns remain patent. There is no midline shift or mass effect. There is minimal scattered periventricular and subcortical T2 hyperintensities which are nonspecific but likely related to chronic small vessel ischemic disease. There is also extensive confluent increased T2 signal in the pons with peripheral sparing and no associated diffusion restriction. There is overall no diffusion abnormality.No extra-axial fluid collection is identified. Rightward deviation of the nasal septum is unchanged. Right maxillary mucus retention cyst/polyp. Mild mucosal thickening of the right sinuses. Pituitary is prominent but measures within normal limits, likely accentuated by a relatively small suprasellar cistern. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. MRA brain:The internal carotid arteries are patent without evidence of stenosis or aneurysm. No significant stenosis or aneurysm is identified within the MCAs. The right A1 is hypoplastic. PCOM arteries identified bilaterally. The posterior circulation is patent without significant stenosis or aneurysm. There is a dominant left vertebral artery.

Output: 1.Increased T2 signal within the pons without diffusion restriction. Differential includes metabolic etiologies, demyelinating processes including central pontine myelinolysis, and chronic small vessel ischemic changes although somewhat atypical given relative lack of supratentorial abnormality. Neoplasm felt to be unlikely. Please correlate clinically. No evidence of acute infarct.2.Minimal periventricular and subcortical T2 hyperintensities are nonspecific but likely related to chronic small vessel ischemic disease.3.No evidence of aneurysm or significant stenosis.


Instruction: Generate impression based on findings.

Input: Female 54 years old; Reason: please get MRI of L stump to r/o osteo History: draining wound cultures L below the knee amputation There has been a below the knee amputation of the left lower extremity. There is mild subcutaneous edema in the distal soft tissues of the amputated left lower extremity, without definite sinus tract or fluid collection to suggest abscess formation. The underlying bone marrow signal of the postsurgical tibia and fibula are within normal limits, excluding osteomyelitis. There is moderate fatty atrophy of the left lower extremity musculature. An above the knee amputation of the right lower extremity is partially visualized.

Output: No evidence of soft tissue abscess or osteomyelitis.


Instruction: Generate impression based on findings.

Input: Male, 72 years old, with mid back pain around L2 and sciatica radiating to the left buttock. History of stem cell transplant for AML three months ago. Alignment is anatomic. Vertebral body heights are preserved. Marrow signal characteristics are diffusely hypointense on T1 and T2-weighted images, though there is no evidence of concerning edema or STIR signal abnormality.The visualized distal spinal cord and conus are within normal limits. The cauda equina is also unremarkable except as discussed below. No epidural abnormalities are suspected.Disc degeneration is seen at all levels with reduced disc height and endplate irregularity. At L4-5 and L5-S1, there is near-complete loss of disc height is seen. Additional level specific findings are as follows:T12-L1: Mild facet arthropathy. No significant spinal canal or foraminal stenosis. L1-2: Mild facet arthropathy. Minimal disc bulging. No significant spinal canal or foraminal stenosis.L2-3: Facet arthropathy and ligamentum flavum thickening. Disc bulging. Moderate generalized spinal canal stenosis with crowding of the cauda equina and near complete effacement of CSF. Mild bilateral foraminal narrowing. L3-4: Facet arthropathy and ligamentum flavum thickening. Disc bulging. Moderate generalized spinal canal stenosis with crowding of the cauda equina and near complete effacement of CSF. Mild bilateral foraminal narrowing. L4-5: Marked facet arthropathy. Ligamentum flavum thickening. Bulging disc. Moderate to severe spinal canal stenosis with crowding of the cauda equina and effacement of CSF. Moderate right and mild left foraminal narrowing. L5-S1: Marked facet arthropathy. Bulging disc. No significant spinal canal stenosis. Mild to moderate bilateral foraminal narrowing.

Output: 1.Diffuse hypointense signal in the bone marrow is seen without concerning edema or STIR signal abnormality. This likely represents marrow reconversion as a reaction to chronic anemia, transplantation or treatment.2.Multilevel disc and posterior element degeneration is seen with significant associated spinal canal stenoses at L2-3, L3-4 and L4-5. In addition there is significant foraminal narrowing on the right at L4-5.


Instruction: Generate impression based on findings.

Input: Patient used prophylactic antibiotics before and after the procedure as prescribed. The patient received antibiotic prophylaxis with oral Ciprofloxacin 500mg and Vantin 200mg. The patient took 1 tablet of Ciprofloxacin 500mg the night before and morning of the procedure. The patient also took 2 tablets of Avantin 200mg the morning of the procedure. After the procedures, the patient will take 2 tablets of Ciprofloxacin 500mg and 2 tablets of Avantin 200mg.Following the discussion of the risks, benefits, and alternatives of the procedure, informed consent was obtained. DynaCad was used to localize the suspicious lesions for prostate cancer in the apex anteriorly, apex posteriorly and right base. Using the Dynatrim guidance system an 18-gauge MR- compatible needle was inserted into the prostate and upon confirmation of the tip of the needles close to the suspected sites, MR guided biopsy using an 18 gauge Bard biopsy needle was performed and 3 cores were obtained from the left apex posteriorly lesion, 2 cores were obtained from the left apex anterior lesion and 2 cores were obtained from the right base lesion..The cores were hand delivered to the pathology lab.The patient tolerated the procedure well and was discharged without any immediate complications.ESTIMATED BLOOD LOSS: Less than 5 cc.

Output: 1. Successful core-biopsies of the 3 sites in the prostate


Instruction: Generate impression based on findings.

Input: 24 years Female (DOB:7/11/1991)Reason: Patient with HIV, ESRD, seizures w/ brain lesions seen on MRI concern for HIV encephalopathy, toxo, PML, vs. other History: SeizuresPROVIDER/ATTENDING NAME: MADHU C YARLAGADDA MADHU C YARLAGADDA The CSF spaces are appropriate for the patient's stated age with no midline shift. There are patchy but confluent periventricular white matter lesions present bilaterally but mildly asymmetrically which were also present on the prior exam and are unchanged. These are not associated with contrast enhancement. They do not involve the u-fibers. There is no evidence of a dependable enhancement or intraparenchymal enhancement.A punctate signal hypointensity on susceptibility weighted imaging is present in the body of the right caudate nucleus which was also present on the prior exam. It is also identified on coronal T2 imaging.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: There are patchy periventricular white matter lesions present bilaterally but mildly asymmetrically. These are nonspecific. It's possible that they are related to demyelination. This is not particularly characteristic of a specific infectious cause. In the setting of HIV their pattern and location in part suggest HIV encephalopathy though asymmetry is somewhat atypical for this. Alternative considerations include CMV encephalitis (however, there is relative lack of appendiceal malignant enhancement and prominent and PML (which often involves the u-fibers) as well as demyelination due to other causes.


Instruction: Generate impression based on findings.

Input: Reason: Evaluate for rotator cuff tear. History of rotator cuff repair in 2003 with recent fall with concern for partial tear History: pain, decreased ROM ROTATOR CUFF: Evaluation of the rotator cuff is limited due to metallic susceptibility artifact from suture anchors within the humeral head as well as additional foci of susceptibility artifact within the soft tissues adjacent to the rotator cuff. The anterior fibers of the supraspinatus tendon are poorly defined. The distal 1 cm of the anterior fibers of the tendon are replaced with intermediate-high signal intensity that we suspect represents tendinosis, and although we see no frank fluid signal intensity traversing the tendon, we cannot exclude the possibility of a chronic tear filled with granulation tissue. There is also irregularity of the undersurface of the supraspinatus tendon indicating undersurface fraying and furthermore, the supraspinatus tendon is thinned, posteriorly, likely reflecting chronic attritional tearing. There is mild fatty atrophy of the supraspinatus at the level of the myotendinous junction. The infraspinatus tendon appears intact, although there is mild to moderate atrophy of the infraspinatus muscle. The teres minor and subscapularis muscles and tendons appear intact.SUPRASPINATUS OUTLET: Mild to moderate osteoarthritis affects the acromioclavicular joint. There is a trace amount of fluid within the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: The superior portion of the anterior labrum is not well visualized and the middle glenohumeral ligament is noted to be prominent. This may represent a normal variant Buford complex. Mild osteoarthritis affects the glenohumeral joint. BICEPS TENDON: There is mild tendinosis of the intra-articular portion of the long head of the biceps tendon.

Output: 1. Limited evaluation of the rotator cuff due to metallic susceptibility artifact showing chronic tendinosis and attritional tearing of the supraspinatus. We suspect that increased signal intensity within the anterior fibers of the supraspinatus represents tendinosis, as we see no fluid signal intensity traversing the tendon, nor do we see a large subdeltoid bursitis; however, we cannot exclude the possibility of a chronic full-thickness tear filled with granulation tissue. If further imaging is clinically warranted, MR arthrography could be considered.2. Mild osteoarthritis and other findings as described above.


Instruction: Generate impression based on findings.

Input: Symptomatic pontine cavernous malformation, associated with venous anomaly. Symptoms abated for a number of years, then the lesion grew with new gaze symptoms in 2010. The cavernoma was exophytic at the fourth ventricular floor and was resected via a posterior fossa trans-vermian exposure.. There are postoperative findings related to suboccipital craniotomy and trans-vermian approach for resection of a posterior pontine cavernous malformation, where there is a crescentic area of susceptibility effect that measures up to 8 mm in length. There are multiple other punctate foci of susceptibility effect in the pons and midbrain. There is also a left pons developmental venous anomaly. There is diffuse cerebral white matter T2 hyperintensity, primarily in a periventricular distribution. There is also nonspecific patchy T2 hyperintensity in the medulla. The ventricles and basal cisterns are normal in size. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable. There is a nodule lesion in the left nasal bridge subcutaneous tissues that measures up to 12 mm and which likely represents an inclusion cyst. There is bilateral maxillary sinus mucosal thickening with fluid on the right side.

Output: 1. Postoperative findings related to resection of a posterior pontine cavernous malformation with an associated left pons developmental venous anomaly. Areas of susceptibility effect along the margin of the surgical bed may represent postoperative hemorrhage versus residual hemosiderin that comprised the periphery of the cavernous malformation. More precise characterization is otherwise limited without available preoperative imaging.2. Punctate areas of susceptibility effect in the pons and midbrain beyond the surgical bed may represent microhemorrhages or additional cavernous malformations.3. Findings suggestive of acute sinusitis.


Instruction: Generate impression based on findings.

Input: 81-year-old female with HCC. No contrast due to low GFR, THERASPERE protocol. ABDOMEN:LIVER, BILIARY TRACT: The ablation cavity has increased in the interval and now extends towards the hepatic dome. Diffuse increased T2 signal intensity of the left hepatic lobe due to Therasphere effect. Normal flow void of the left portal vein indicating patency. Similar trace anterior perihepatic ascites.There is patchy increased T2 signal intensity in the posterior right hepatic lobe. A 1.1 x 1.3 cm T2 hypointense focus of the posterior right hepatic lobe is slightly more prominent compared to the prior exam and partially expands the hepatic capsule (axial series 8 image 24). However, the lack of intravenous contrast limits complete evaluation.Cholecystectomy catheter remains in place, and intraluminal gallstones are again noted.SPLEEN: Splenomegaly measuring 14.8 cm in length.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right renal cysts.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.Limited exam due to the lack of intravenous contrast. Increased size of the known ablation cavity.2.Normal flow void of the left portal vein indicating patency.3.A 1.1 x 1.3 cm T2 hypointense focus of the posterior right hepatic lobe is incompletely characterized due to the lack of intravenous contrast.


Instruction: Generate impression based on findings.

Input: History of terminal ileum Crohn's disease. History of perianal disease. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The small bowel is adequately distended with oral contrast. It is normal in caliber and wall thickness. No abnormal postcontrast enhancement restricted diffusion or adjacent inflammatory changes. No free or loculated fluid collection. The terminal ileum is well seen without evidence of acute inflammation. No fixed stricture is evident.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: See above.BONES, SOFT TISSUES: Bilateral peritrochanteric fluid is noted.OTHER: No significant abnormality noted.

Output: No evidence of acute bowel inflammation. No focal stricture is identified.Please note that the study was not performed for adequate evaluation of the perineal soft tissues.Bilateral peritrochanteric fluid signal is noted and may represent trochanteric bursitis.


Instruction: Generate impression based on findings.

Input: History of sidebranch IPMN. Follow-up exam. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in signal and morphology. No focal mass lesion.No intrahepatic or extrahepatic biliary duct dilatation.SPLEEN: The spleen is normal in size.PANCREAS: There is redemonstration of a minimally complex cystic lesion within the pancreatic tail that connect to the main pancreatic duct via a small side branch compatible with a sidebranch IPMN. It measures 2.8 x 2.2 cm in maximum dimension (series 4 image 133), previously 2.5 x 2.2 cm. There are no solid, nodular, or enhancing components. The main pancreatic duct is nondilated.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple bilateral renal cysts, including a right upper lobe minimally complex cyst with thin septations, are not significant changed from prior. No hydronephrosis.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 sidebranch IPMN.


Instruction: Generate impression based on findings.

Input: Other malaise and fatigue [780.79], Reason for Study: ^Reason: eval for CVA History: L-sided numbness and weakness Brain MRI:No evidence of acute ischemic or hemorrhagic lesion on the scan.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, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear. Retention cyst on the right maxillary sinus.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal. Bilateral P-comm arteries are patent, a common artery is also patent.Brain MRV3D MRV brain using phase contrast technique with maximum intensity projections of the superficial/deep intracranial venous drainage demonstrate normal flow enhancement in the superior sagittal sinus, transverse sinuses, sigmoid sinuses, internal cerebral veins, vein of Galen and straight sinus.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. Normal brain MRI and normal brain MRV


Instruction: Generate impression based on findings.

Input: 59 year old male patient with invasive adenocarcinoma in rectal polyp, positive margin. Evaluate rectal cancer and lymph nodes. Study is limited secondary to degradation of many sequences from patient motion artifact.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: The bladder is distended.LYMPH NODES: No significant lymphadenopathy.BOWEL, MESENTERY: Within limitations of the study as described above, no definite tumor is identified. No evidence of tumor extending beyond the muscularis propria. There is no involvement of the mesorectal fat or fascia.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No definite tumor is identified. 2.No pelvic lymphadenopathy.


Instruction: Generate impression based on findings.

Input: The risks (including, but not limited to, those of bleeding, infection, allergic reaction, temporary nerve block, pain, and inability to access the joint) and benefits of the procedure were explained to the patient, and informed written consent was obtained. A pre-procedural “time-out” form was completed.The patient was placed supine on the fluoroscopy table. The right hip was localized fluoroscopically, and a spot radiograph was obtained. The course of the femoral artery was noted on the patient's skin using an ink marker. The skin was cleansed and covered with a sterile drape. The skin and subcutaneous tissues were anesthetized with 1% lidocaine using 25-gauge and 21-gauge needles.Under fluoroscopic guidance, a 20-gauge spinal needle was advanced into the joint. Attempted aspiration yielded no fluid. Next, 10 ml of a 50/50 mixture of Omnipaque 240 (to confirm the intra-articular position of the needle) and dilute Multihance (0.1 cc in a 10 cc vial of saline, for subsequent MR imaging) were injected into the joint. Contrast opacified the joint in the expected manner. A spot radiograph was obtained for documentation. The needle was withdrawn. Blood loss was negligible (<1cc), and patient tolerated the procedure well without immediate complication. An adhesive bandage was placed on the patient’s skin. Routine post procedure instructions were communicated to the patient. The patient was escorted to the MRI suite for further imaging in stable condition. Please refer to the subsequent MRI report for further information.Exposure time: 3 minutes and 25 seconds.

Output: Successful right hip arthrogram for MRI study.


Instruction: Generate impression based on findings.

Input: 46 your female with lower back pain. The bony density and vertebral alignment are normal. No central spinal stenosis is apparent on exam. The neural foramen are widely patent. L3/4, L4/5, L5/S1 show minimal disk disease, minimal hypertrophy of the posterior elements, and overall minimal degenerative changes. In the last image of the study at S2, there is expansion of the thecal sac without epidural fat. This is of CSF density and may represent an ectatic thecal sac versus a Tarlov cyst. MRI may further evaluate if indicated.

Output: 1. Minimal degenerative changes, hypertrophy of the posterior element, and disk disease in the lower lumbar spine.2. Expansion of the thecal sac at S2 that may represent an ectatic thecal sac versus a Tarlov cyst. MRI may further evaluate if indicated.


Instruction: Generate impression based on findings.

Input: Back pain, evaluate spinal stenosis. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is mild rightward translation of L2 on L3, leftward translation of L4 on L5, and overall levoscoliosis of the lumbar spine with apex at the L3-L4 level. There is severe loss of disc height involving the right aspect of the L3-L4 level.Bone marrow signal is benign with degenerative endplate changes, relatively more prominent involving the left aspect of the L4-L5 endplates. The conus medullaris is normal in position.Multilevel degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: Rightward translation of L2 on L3 and moderate disc height loss and disc bulge which is eccentric to the left. There is also mild bilateral facet arthropathy. There is no significant central spinal canal stenosis. There is however mild to moderate left neural foraminal stenosis. Right neural foramen is patent.L3-L4: Severe loss of disc height on the right with subchondral cysts, endplate irregularity, mild disc bulge, and vacuum phenomena. There is also advanced right-sided facet arthropathy with mild distention of the facet joint. There is mild central spinal canal stenosis. There is moderate to severe right-sided neural foraminal stenosis. Left neural foramen is patent.L4-L5: Mild leftward translation of L4 and L5, disc bulge with vacuum phenomena, ligamentum flavum thickening, and moderate to severe bilateral facet arthropathy. There is also a small central disc extrusion. There is partial effacement of the left lateral recess without significant central spinal canal stenosis. There is moderate to severe left and moderate right neural foraminal stenosis.L5-S1: Mild disc bulge with vacuum disc phenomena and significant loss of height involving the left aspect of the disc space. There is a prominent left lateral osteophyte. Moderate bilateral facet arthropathy. There is no significant central spinal canal stenosis. There is moderate to severe left and mild right neural foraminal stenosis.

Output: 1. Degenerative changes throughout the lumbar spine with malalignment including levoscoliosis with apex at the L3-L4 level. 2. There is mild central spinal canal stenosis at L3-L4. No high-grade spinal canal stenosis is present at any level.3. Neural foraminal stenoses are most significant at the right L3-L4 and left L2-L3, L4-L5, and L5-S1 levels. Additional details as above.


Instruction: Generate impression based on findings.

Input: Female, 74 years old, with right-sided weakness. Corresponding to the area of abnormality noted on prior CT, there is restricted diffusion involving the left operculum and insula, as well as the left frontoparietal junction, with smaller scattered foci of diffusion restriction in the left anterior frontal lobe, the temporal lobe and the occipital lobe. Mild T2 hyperintensity is seen corresponding to these areas of restricted diffusion. No significant generalized mass effect is detected. There may be minimal petechial blood product in the infarct region but no frank hemorrhagic conversion is seen.Elsewhere, scattered foci of T2 hyperintensity are seen within the cerebral hemispheres appearing similar to those noted on prior MRI. No abnormal fluid collections are detected. The ventricular system is normal in size and morphology.Abrupt occlusion of the inferior division of the left MCA is seen within the sylvian fissure. No other significant intracranial stenosis is suspected. No aneurysms are detected within the limitations of technique. The region of the ACOM artery is unremarkable. Prominent bilateral PCOM arteries are seen.In the neck, there is moderate narrowing of the right carotid bifurcation but no significant stenosis by NASCET criteria. The carotid system is otherwise unremarkable. The vertebral vessels of the neck are likewise free of significant vascular stenosis.

Output: 1.Findings compatible with acute left MCA stroke fusion infarction. No significant generalized mass effect or frank hemorrhagic conversion is seen.2.Abrupt occlusion of the inferior division of the left MCA is seen. Elsewhere, no significant intracranial vascular stenosis is detected.3.No significant vascular stenosis is seen in the neck.


Instruction: Generate impression based on findings.

Input: 50-year-old female status post excision of right popliteal fossa synovial cell sarcoma. Evaluate for recurrence. A vitamin E capsule was placed along the posterior aspect of the knee, above the joint, presumably corresponding to the patient's scar from prior surgery. Again seen are postsurgical changes consistent with the patient's history of prior removal of a large biopsy-proven synovial sarcoma. There are multiple foci of metallic susceptibility artifact along the posterior aspect of the knee which are presumably postsurgical in etiology. There is bandlike subcutaneous decreased signal abnormality traversing the popliteal fossa compatible with scarring from prior surgery. Again seen is poorly defined intermediate signal abnormality lateral to the popliteal artery compatible with scar tissue, without abnormal enhancement to suggest residual/recurrent tumor, appearing slightly decreased in its extent when compared to the prior study. No joint effusion is identified. No significant muscular fatty atrophy or edema is identified. Underlying osseous structures are unremarkable.Please note this exam was not protocoled for fine detailed evaluation of the knee. Again seen is a horizontal tear involving the medial meniscus similar to prior. Heterogeneous signal within the medial patellar facet cartilage suggests mild degeneration also appearing similar to the prior study.

Output: Postoperative changes of prior resection of a right knee synovial sarcoma without evidence of residual or recurrent tumor. Other findings as above.