Instruction: Generate impression based on findings.

Input: 45-year-old female with persistent leukocytosis and abdominal pain This study is limited due to lack of IV contrast.ABDOMEN:LUNG BASES: Bilateral small pleural effusions. Cardiomegaly. Dependent atelectasis in the left lung base. Trace pericardial effusion.LIVER, BILIARY TRACT: Nonspecific 1 cm hypodense lesion in the right lobe of the liver on image number 36 on series number 3. SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral mild calyectasis. This is likely secondary to distended bladderRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: There is a large lobulated mass arising from the pelvis and extending superiorly to the level of the kidneys. The mass is heterogeneous and measures 27 by 15 cm. This represent a large leiomyomatous uterus, however, possibility of an ovarian carcinoma cannot be entirely excluded with this noncontrast CT. Further evaluation with MRI is recommended.BLADDER: Bladder is displaced to the left and superiorly by the mass. Bladder is also distended. The mass likely causes bladder outlet obstruction.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Bilateral IVC filter is in the common iliac veins.

Output: Large pelvic mass extending superiorly to the level of the kidneys. This likely represents leiomyomatous uterus versus ovarian carcinoma. Further evaluation with pelvic MRI is recommended.Bladder obstruction and bilateral mild calyectasis.Cardiomegaly and bilateral small pleural effusions.


Instruction: Generate impression based on findings.

Input: 34 years Female (DOB: 10/17/1981)Reason: ? subacute stroke vs intracranial process History: new onset L sided weaknessPROVIDER NAME: MICHAEL A WARD MICHAEL A WARD MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate an air-fluid level in the left maxillary sinus. There is partial desiccation of the left frontal sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal enhancing lesions are identified in the cervical spine.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.No intracranial mass lesion or other explanation for the patient's generalized weakness is appreciated.2.There is no compromise of the cervical spinal canal and no abnormal enhancing lesion within the cervical spine.3.There is an air-fluid level in the left maxillary sinus. The possibility of an acute sinusitis cannot be excluded. Please correlate with patient's clinical evaluation.


Instruction: Generate impression based on findings.

Input: History of multiple sclerosis; presenting with paresthesias. Again seen are numerous T2 hyperintense supratentorial and infratentorial lesions. There are areas which appear confluent, with perpendicular orientation with respect to the lateral ventricles. There is a new T2 hyperintense lesion in the left corona radiata, which partially enhances. The previously seen area of enhancement in the left subinsular cortex has resolved. The remainder of the lesions are stable, including brainstem involvement, and possibly along the left brachium pontis. There is no evidence of intracranial hemorrhage or acute infarction. The pituitary gland is unremarkable. The ventricles and basal cisterns are unchanged. There is no midline shift or herniation. The major cerebral flow voids are intact. Cosmetic fillers again noted in the bilateral nasolabial folds.

Output: Multiple supratentorial and infratentorial demyelinating lesions consistent with history of multiple sclerosis, including a new T2 hyperintense lesion which partially enhances in the left corona radiata, compatible with an acute/active lesion. Previous enhancement associated with a left subinsular region lesion has resolved. There is mild to moderate T1 burden and moderate to severe T2 burden of disease.


Instruction: Generate impression based on findings.

Input: Right ankle pain TENDONS: A trace amount of fluid is seen about the posterior tibialis tendon with some flattening and irregularity along its inferior tibial course.LIGAMENTS: No significant abnormality noted.ARTICULAR SURFACES AND BONE: There is moderate to severe osteoarthritic changes of the foot particularly of the talonavicular articulation with possible healed erosions. ADDITIONAL

Output: 1. Moderate to severe osteoarthritic changes of the midfoot which may be secondary to rheumatoid given the patient's history and age.2. Irregularity of the posterior tibialis tendon which may reflect some interstitial degeneration/tearing.3. Mild fatty atrophy of the plantar musculature.


Instruction: Generate impression based on findings.

Input: 66 year-old male history of RCC with bone metastases. Study is obtained to evaluate for osseous metastatic disease and is thus limited for evaluation of solid organs.Large exophytic left inferior pole cystic renal mass with significant soft tissue components measuring 7.7 x 6.7 cm. Subcentimeter right inferior pole renal mass which demonstrates low T1/T2 signal, but is too small to accurately characterize. Small right inferior pole renal cyst. There is diffusely abnormal bone marrow signal intensity and diffusion restriction within the axial skeleton and bilateral proximal femurs and humeri compatible with metastatic disease.

Output: Large left renal mass compatible with RCC with increasing diffuse bone metastases within the axial skeleton as well as smaller metastatic deposits within the proximal femurs and humeri.


Instruction: Generate impression based on findings.

Input: 61 year old with unknown past medical history presenting with worsening dyspnea on exertion and pleuritic chest pain. MEDICATIONS: None prior to arrivalInpatient medications: captopril, lasix IV First Pass PerfusionDuring hyperemia, there is a large perfusion defect of moderate severity involving the basal inferior and inferolateral, mid inferior and inferolateral, apical inferior and lateral walls, corresponding to the usual territory of a large circumflex artery.Viability/ Myocardial ScarThere was a myocardial infarction present. It is non-transmural in the basal to mid inferior and inferolateral walls. It is transmural in the apical inferior and lateral wall. This corresponds to the territory of a large circumflex artery. Most of this large territory has an intermediate probability of viability. The remainder of the myocardium is free of myocardial infarction and highly likely to be viable. Left VentricleThe left ventricle is moderately dilated with moderate to severely reduced systolic function. The overall LV ejection fraction is 30%, the LV end diastolic volume index is 133 ml/m2 (normal range: 74+/-15), the LVEDV is 220 ml (normal range 142+/-34), the LV end systolic volume index is 93 ml/m2 (normal range 25+/-9), the LVESV is 155 ml (normal range 47+/-19), the LV mass index is 105 g/m2, and the LV mass is 175 g. The left ventricular dysfunction appears to be global; however, there is additional hypokinesis of the inferolateral wall.Left AtriumThe left atrium is moderately enlarged. Right VentricleThe right ventricle is normal in size with mildly reduced function. The overall RV ejection fraction is 43%, the RV end diastolic volume index is 106 ml/m2 (normal range 82+/-16), the RVEDV is 177 ml (normal range 142+/-31), the RV end systolic volume index is 61 ml/m2 (normal range 31+/-9), and the RVESV is 101 ml (normal range 54+/-17).Right AtriumThe right atrium is moderately dilated. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is moderate tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThere is a moderate left pleural effusion and a small right pleural effusion. There is an infiltrate in the right middle lung and either an infiltrate or atelectasis in the left lower lung. 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. There is a wall motion abnormality and ischemia in the usual territory of a large circumflex artery. Most of the territory has an intermediate probability of viability. The remainder of the myocardium is highly likely to be viable but is without obvious evidence of ischemia. 2. There is a large, predominantly non-transmural myocardial infarction in the left circumflex artery territory. 3. Moderate LV dilation, mild LVH, and moderate to severe systolic dysfunction (LVEF 30%). 4. Normal RV size with mildly reduced systolic function (RVEF 43%).5. Moderate biatrial dilation.6. See extra-cardiac findings.


Instruction: Generate impression based on findings.

Input: Clinical question: Sudden onset of right hand weakness following tordol/reglan/benadryl in HgSS/Moyamoya. Signs and symptoms: Right hand weakness, minimal right leg weakness. Pre-and post-enhanced brain MRI:No evidence of acute ischemic findings on diffusion weighted series.There is diffuse left hemispheric white matter flair and T2 hyperintensity signal which demonstrate no convincing evidence of any significant interval change since prior exam. Asymmetrical left-sided prominence of cerebral cortical sulci also remains identical to prior study. The left lateral ventricle is also mildly prominent likely representing ex vacuo dilatation which is also stable since prior exam. Findings are suspicious of chronic ischemic changes in the deep left hemispheric white matter.Very minimal similar findings in the right centrum semiovale also remains nearly identical to prior exam.The overall anatomical morphology and the signal intensity of brain parenchyma otherwise remains within normal on all MRI sequences. Post enhanced images demonstrate no detectable abnormal parenchymal or leptomeningeal enhancement. Calvarium demonstrate postoperative changes. There is revisualization of very small caliber of left internal carotid artery across the skull base and in its supraclinoid segment similar to prior exam. Postop changes of calvarium likely for arterial anastomotic surgery. Correlate with past surgical history.

Output: 1.No evidence of an acute or new finding since prior exam.2.Stable extensive left hemispheric subcortical and periventricular chronic ischemic changes and minimal similar findings in the right hemisphere since prior exam.3.Revisualization of a very small caliber left internal carotid artery across the skull base and its supraclinoid segment.4.Post operative changes of the left calvarium likely are vascular anastomosis surgery.5.No detectable abnormal enhancement.


Instruction: Generate impression based on findings.

Input: Pain involving the right upper arm A marker is placed in the right axilla. Osseous alignment of the glenohumeral joint is within normal limits. There are bilateral high riding humeri suggestive of chronic rotator cuff tear. Degenerative cyst formation noted in the humeral head. Otherwise no definite bone marrow signal abnormality of the shoulder suggestive of a metastasis on this limited noncontrast study. Given the large field of view on the evaluation of labrum, articular cartilage, tendons are limited on this study. There is moderate degenerative change of the AC joint.Limited view of the thoracic spine with degenerative change and endplate signal abnormality. Limited view of the lower cervical spine with degenerative change and mild to moderate spinal canal narrowing.There is questionable nodularity in the mid-aspect of the right lung, which may be artifactual. Additionally, there is a moderate hiatal hernia and esophageal ectasia.

Output: 1.No definite evidence of soft tissue or bone lesion on this limited noncontrast study. If there is high clinical suspicion contrast-enhanced MRI with defined field of view can be performed. 2.Questionable nodularity in the mid-aspect of the right lung may be artifactual and is not well evaluated on this examination. A CT chest can be considered for further evaluation.


Instruction: Generate impression based on findings.

Input: Anaplastic oligodendroglioma, WHO grade III, status post treatment. There are postoperative findings related to left craniotomy with a resection cavity in the left frontal and temporal lobes and a persistent overlying extra-axial fluid collection. There is intrinsic T1 hyperintensity and susceptibility effect along the posterior margins of the surgical cavity, with development of superimposed patchy enhancement superficially along the posteromedial margin of the resection cavity. There also appears to be slightly increased confluent T2 hyperintensity in the surrounding brain parenchyma. There is also interval development of high T2 signal and enhancement in the anterior cingulate region and along the straight gyri with adjacent gyriform mildly restricted diffusion and T2 hyperintensity. There is also diffuse enhancement along the surfaces of multiple cranial nerves and brainstem, cerebellum, including along the surfaces of the fourth ventricle. There is an unchanged subcentimeter area of T2 hyperintensity superficially along the lateral aspect of the right occipital lobe. The ventricular system and a subcentimeter arachnoid cyst in the right posterior cingulate region appear unchanged. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable.

Output: Post-treatment findings in the left the left frontal and temporal lobes without what may represent incipient local tumor progression and apparent cerebrospinal fluid dissemination to the anterior frontal lobe regions bilaterally, as well within the posterior fossa and along multiple cranial nerves. The leptomeningeal disease in the frontal regions may be associated with a vasculitic ischemic effect.


Instruction: Generate impression based on findings.

Input: Neurofibromatosis, type I. Any paraspinal plexiform neurofibromas? Intense pressure on his shoulders and low back pain. Cervical spine: Lack of contrast limits evaluation for small lesions. There is abnormal STIR hyperintensity at the C1-C2 level involving the bilateral C2 nerve roots measuring approximately 12 x 12 mm on the right and 11 x 10 mm on the left, measured in the axial plane. There is minimal epidural component involving the lateral aspects of the spinal canal. There is no spinal canal stenosis at this level or at any level in the cervical spine. No cervical cord signal abnormality or intramedullary expansile lesions.Mild prominence of multiple cervical nerve roots more inferiorly is also noted without large lesions, neural foraminal widening, or epidural extension in the the remainder of the cervical spine. There are mild degenerative changes including minimal disc bulges with dorsal annular fissures at the C4-C5 and C3-C4 levels. Vertebral body heights and alignment are maintained. Bone marrow signal is benign. There is a tubular lesion in the right neck lateral to the right internal jugular vein suspected to represent a neurofibroma. This lesion measures approximately 9 x 30 mm in the transverse and AP dimensions, series 11 image 17) and is centered at the C3-C4 level. Innumerable subcutaneous nodules are also consistent with neurofibromas.Lumbar spine: No discrete mass in the lumbar spinal canal, neural foramina, or paravertebral soft tissues is appreciated. There is a more superficial 8 x 12 mm nodule in the right lower back deep subcutaneous fat at the L4-L5 level, presumably a neurofibroma. There are also numerous more superficial subcutaneous lesions.The lumbar spine is in normal alignment, with a normal lumbar lordosis. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. The distal spinal cord and conus are within normal limits. There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the lumbar spine.

Output: 1. Likely small neurofibromas involving the C2 nerve roots in the neural foramina bilaterally with minimal epidural extension into the lateral aspect of the spinal canal at the mid C2 level. No spinal canal stenosis.2. No discrete lesions in the lumbar spinal canal or neural foramina. 3. Numerous subcutaneous lesions, as well as a relatively larger 9 x 30 mm lesion in the right neck lateral to the right internal jugular vein at the C3-C4 level as well as an 8 x 12 mm lesion in the deep subcutaneous fat at the L4-L5 level, likely representing neurofibromas.


Instruction: Generate impression based on findings.

Input: Diagnosis: Benign neoplasm of cranial nerves Benign neoplasm of cranial nervesClinical question: 54y/o with an acoustic neuromaSigns and Symptoms: hearing loss in right ear The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a right cerebellopontine angle cistern mass present extending into the right internal auditory canal which measures 17 x 9 mm in axial dimensions. 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.Right cerebellopontine angle cistern mass is suspected to represent acoustic schwannoma.2.Exam is limited for the purposes of treatment planning.


Instruction: Generate impression based on findings.

Input: Right heel pain TENDONS: No significant abnormality noted.LIGAMENTS: No significant abnormality noted.ARTICULAR SURFACES AND BONE: There is mild marrow edema of the posteroinferior calcaneus at the attachment of the plantar fascia. Additional mild edema is seen within the heel pad superficial to the plantar fascia. The plantar fascia itself is not abnormally thickened and we see no discrete fracture line. The bone marrow signal of the remaining ankle and hindfoot is normal. A type II accessory navicular is present, a normal variant.ADDITIONAL

Output: Mild edema within the calcaneus and soft tissues adjacent to the attachment of the plantar fascia. We see no discrete fracture line. While this could possibly represent a stress reaction with adjacent soft tissue edema, the findings are more in keeping with plantar fasciitis.


Instruction: Generate impression based on findings.

Input: 39 year-old female with BRCA 2 positive, family history of breast cancer There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.Mild motion artifact is present.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: Reason: 58 yo female with pancreas mass; please evaluate for changes and or abnormalities History: pancreas mass. ABDOMEN:LIVER, BILIARY TRACT: Hepatic steatosis.SPLEEN: Punctate cyst, unchanged.PANCREAS: Previously seen lobulated cystic lesion within thin septations in the pancreatic body has decreased in size, measuring 2.2 x 1.8 x 2.1 cm (series 3 image 20, series 8 image 33), previously 3.6 x 3.5 x 5.0 cm. The cystic component has decreased compared to prior with internal hypointense focus without enhancement likely representing debris. No pancreatic duct ductal dilatation. No new lesions. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left renal cyst, unchanged.RETROPERITONEUM, LYMPH NODES: No lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Interval decrease in size of cystic lesion in the pancreatic body, predominantly in its cystic component, possibly related to aspiration.


Instruction: Generate impression based on findings.

Input: Female, 82 years old, with left facial twitching and left face numbness, history of left CP angle meningioma. A solidly enhancing extra-axial mass is redemonstrated centered at the left CP angle measuring 28 x 22 mm in the axial plane, unchanged from prior examinations. This lesion impinges on the adjacent brainstem and middle cerebellar peduncle, deviating the brainstem to the right and partially effacing the fourth ventricle. The degree of mass effect is not significantly changed from prior. Mild T2 hyperintensity within the impinged parenchyma is unchanged.No new intracranial lesions are suspected. Scattered small foci of T2 hyperintensity through the cerebral hemispheres are nonspecific and unchanged. A probable small chronic lacunar infarct in the right caudate head is unchanged. The lateral ventricles remain mildly prominent but are similar in caliber and morphology to prior exams. No intracranial hemorrhage or any abnormal extra-axial fluid collection is seen.

Output: Stable left CP angle tumor with stable associated mass effect on the brainstem and cerebellum.


Instruction: Generate impression based on findings.

Input: Female 52 years old Reason: meniscal tear History: knee pain. MENISCI: There is mild intrasubstance signal within the medial meniscus suggesting mild mucoid degeneration. There is also attenuation of the body of the medial meniscus that may reflect chronic attritional fraying, but we see no discrete meniscal tear. The lateral meniscus is unremarkable.ARTICULAR CARTILAGE AND BONE: There is moderate osteoarthritis of the patellofemoral joint with full-thickness cartilage loss along the medial facet of the patella. There are also subchondral cysts in the patella and additional cartilage defects in the femoral trochlea. There is a full thickness, or near full thickness, defect of the articular cartilage of the medial femoral condyle just above the free edge of the posterior horn of the medial meniscus that measures just under 1 cm in diameter. Articular cartilage of the lateral compartment appears intact.LIGAMENTS: Cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: Extensor mechanism is intact.ADDITIONAL

Output: 1.Findings suggestive of chronic attritional fraying of the medial meniscus, but no discrete meniscal tear.2.Osteoarthritis as described above.3.Joint effusion with cartilaginous loose body as described above.


Instruction: Generate impression based on findings.

Input: Ms. Broomfield is a 66 year old female with known right breast cancer and metastatic right axillary lymph node. She has been on neoadjuvant chemotherapy and presents for MR re-imaging. There is scattered fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.RIGHT BREAST:In the right superior breast, there has been an interval decrease in size of biopsy-proven malignancy, now appearing as three subcentimeter enhancing masses/foci. The total span of enhancement measures approximately 2.1 x 1.1 x 1.5 cm (AP x ML x SI). Susceptibility artifact from biopsy marker clip is seen at the posterior aspect of this enhancement. There is no additional abnormal enhancement seen in the right breast.LEFT BREAST:There is no abnormal enhancement seen in the left breast.AXILLAE:Biopsy-proven metastatic right axillary lymph node with associated biopsy marker clip now measures 0.6 cm, previously measuring 1.1 cm. Multiple additional prominent right axillary lymph nodes are present. No abnormal axillary lymph nodes are identified in the left axillary region.

Output: (1) Interval decrease in size of biopsy proven right breast malignancy and metastatic right axillary lymph node. If breast conservation therapy is desired, the biopsy clip should be targeted for preoperative surgical guidance (with knowledge that residual MR enhancement is seen extending anterior to the clip). (2) No MRI evidence for malignancy in the left breast.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Right amygdala-hippocampectomy via laser ablation x 2. There has been interval evolution of the laser ablation effects involving the right hippocampus and posterior amygdala, with development of encephalomalacia and a small amount of residual enhancement at these sites. There is no evidence of acute infarction. The ventricles are normal in size and configuration. There is no midline shift or herniation.

Output: Interval evolution of the laser ablation effects involving the right hippocampus and posterior amygdala, with development of encephalomalacia at these sites.


Instruction: Generate impression based on findings.

Input: Male, 65 years old, with a right leg pain, shooting down the leg, back pain, reported weakness, history of prostate cancer. Diffuse patchy marrow replacement is seen compatible with widespread osseous metastatic disease, progressed from the prior MRI. No compression deformity is noted. The most conspicuous tumor deposit involves L5 and the sacrum, which show near complete marrow space involvement. At L4-5, spondylolisthesis, bulging disc and facet hypertrophy contribute to produce a moderate to severe spinal canal stenosis and bilateral foraminal narrowing. There was stenosis at this level on the prior examination, but it has progressed in the interval. Given the extensive tumor involvement of the sacrum, the possibility of foraminal encroachment and nerve root impingement by tumor is raised. Elsewhere, no significant spinal canal or foraminal stenosis is seen.

Output: 1.No evidence of acute cord compression is seen.2.Widespread osseous metastatic disease is seen.3.A large tumor deposit involving L5 sacrum seen which may contribute to L5-S1 and sacral foraminal encroachment and possible nerve root impingement. If clinically warranted, these findings can be better assessed with nonemergent dedicated lumbosacral imaging.4.Degenerative disease at L4-5 results in a moderate to severe spinal canal stenosis and foraminal narrowing, progressed from the prior examination.


Instruction: Generate impression based on findings.

Input: back pain with cancer history There is mild straightening of the lumbar lordosis which may be positional. The vertebral bodies appear normally aligned. The vertebral body heights are preserved. There is mild loss of intervertebral disc space at L5-S1. There are postoperative findings related to L5-S1 discectomy with T2 hyperintensity and enhancement within the operative bed with associated endplate degenerative changes. Several small vertebral body hemangiomas are again seen. The conus terminates at L1 and demonstrates normal morphology as well as signal intensity. The cauda equina appear unremarkable.There is a small left neural foraminal disc herniation at L5-S1, slightly increased since prior examination, resulting in mild to moderate left neural foraminal stenosis. There is mild facet arthropathy symmetric disc bulge to the right at the L4-L5 level with a small annular fissure and mild neural foramen narrowing, abutting the adjacent nerve root, however unchanged in appearance. There is a mild disc bulge and mild facet arthropathy at the L3-L4 level without stenosis, unchanged. Several scattered Schmorl's nodes are again seen.

Output: 1.No evidence for metastatic disease within the lumbar spine.2.Degenerative changes of the lumbar spine as described above with slightly progressed left L5-S1 disc herniation resulting in mild to moderate left neuroforaminal stenosis, stable at other levels.


Instruction: Generate impression based on findings.

Input: 47 year old male with decreased LVEF on recent nuclear stress test and subsequent normal coronary angiogram, MRI done to evaluate etiology Left VentricleThe left ventricle is normal in size with mildly decreased function. The overall LV ejection fraction is 42%. The LVEDV is 230 ml (normal range 142+/-34), the LV end diastolic volume index is 107 ml/m2 (normal range: 74+/-15), the LVESV is 132 ml (normal range 47+/-19) and the LV end systolic volume index is 61 ml/m2 (normal range 25+/-9). The LV mass is 134 g (normal range 164+/-36) and the LV mass index is 62 g/m2 (normal range 85+/-15). There are no regional wall motion abnormalities present. . There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is normal. Right VentricleThe right ventricle is normal in size with mildly decreased function. The overall RV ejection fraction is 34%. The RVEDV is 148 ml (normal range 142+/-31), RV end diastolic volume index is 69 ml/m2 (normal range 82+/-16), the RVESV is 98 ml (normal range 54+/-17), and the RV end systolic volume index is 46 ml/m2 (normal range 31+/-9).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve is trileaflet, opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsPersistent elevation of the right hemidiaphragm. Probable bilateral renal cysts. 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. Mildly decreased left ventricular systolic function with LVEF of 43%2. Mildly decreased right ventricular systolic function with EF of 34%3. No late gadolinium enhancement is noted in the myocardium. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Sudden loss of consciousness with amnesia. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are a few scattered nonspecific punctate foci of T2 hyperintensity in the bilateral frontal lobe white matter. There is a left cerebellar hemisphere developmental venous anomaly. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There are bilateral lens implants and scleral buckles.

Output: 1. No evidence of intracranial hemorrhage, mass, or acute infarct. 2. Incidental left cerebellar hemisphere developmental venous anomaly.


Instruction: Generate impression based on findings.

Input: Reason: 3 t scanner s/p crani for tumor resection History: surveillanceAdditional history EMR: non-small cell lung cancer status post surgery for a cerebellar lesion, SRS and WBRT. She was recently found to have a small right frontal lesion which is biopsied July 2016 with pathology consistent with gliosis. There is extensive susceptibility along the right frontal and left occipital/suboccipital regions. This relates to a previous right pterional craniotomy and multiple surgical/aneurysm clips along the right sphenoid wing, multiple bilateral burr holes and placement of a posterior fossa drainage catheter. Additional postoperative changes are seen from a right parietal craniotomy for a resection of a right precentral gyrus lesion. A small somewhat ill-defined focus of enhancement along the precentral gyrus appears similar to the preoperative examination with associated T2/FLAIR hyperintensity within the white matter.There remains diffuse pachymeningeal enhancement and dural thickening. Loculated subdural collections along the frontal lobes appears similar, measuring just under a centimeter in greatest thickness.The previously demonstrated shunted lesion within the medial left cerebellum shows no significant interval change. There is associated FLAIR hyperintensity with a central area of irregular enhancement which measures up to 13 mm in greatest axial dimension. A nonenhancing area of T2 signal abnormality within the left middle frontal gyrus appear similar. Other scattered nonspecific foci of T2/FLAIR hyperintensity are seen within the cerebral white matter, remaining nonspecific but stable. The ventricles are stable in size, with evidence of global volume loss. Incidental partially empty sella is again noted.

Output: 1.Stable postoperative changes following previous right precentral gyrus lesion biopsy. Minimal irregular enhancement along this site with associated FLAIR hyperintensity appears similar to the preoperative study.2.An irregular enhancing lesion within the left medial cerebellum and a nonenhancing FLAIR hyperintense lesion within the left middle frontal gyrus appears similar. No new intracranial lesions are seen.3.Persistent bilateral somewhat loculated frontal subdural collections are unchanged. Stable diffuse pachymeningeal enhancement and thickening.


Instruction: Generate impression based on findings.

Input: This exam is degraded by motion artifact. There is no evidence of intracranial hemorrhage, mass, or acute infarct. A single punctate foci of hyperintensity within the left frontal deep white matter is only seen on the axial FSE post contrast sequence is compatible with artifact. There is no abnormal intracranial enhancement. There are a few scattered punctate foci of T2 hyperintensity within the supratentorial white matter and brainstem that are nonspecific but most compatible chronic small vessel ischemic disease. There are a few scattered punctate foci of susceptibility effect throughout the supratentorial white matter, most compatible with chronic micro-hemorrhages. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unremarkable. There are bilateral lens implants.

Output: 1.No evidence of acute infarct, mass, or abnormal enhancement. 2.Minimal chronic small vessel disease and a few chronic micro-hemorrhages in a non-specific distribution.


Instruction: Generate impression based on findings.

Input: Female 73 years old Reason: Recurrent ovarian cancer with rising tumor marker. Assess for progressive disease. History: Increasing CA-125. Artifact from right hip prosthesis somewhat obscures evaluation of the pelvis.PELVIS:UTERUS, ADNEXA: Status post hysterectomy and bilateral oophorectomy.BLADDER: No significant abnormality noted.LYMPH NODES: The soft tissue lesion in the region of the left common iliac vessels likely corresponds to reference left common iliac node and is unchanged measuring 1.2 x 1.0 cm (series 301, image 52).BOWEL, MESENTERY: Colonic diverticular disease. Mild thickening at the anorectal junction may represent proctitis.BONES, SOFT TISSUES: Degenerative changes of the left hip. Right total hip prosthesis.OTHER: No significant abnormality noted.

Output: 1. No evidence of recurrence within the pelvis.2. Mild thickening at the anorectal junction may represent proctitis.Please note patient was found to have enlarged upper abdominal nodes on prior exam which is not included in today's study.


Instruction: Generate impression based on findings.

Input: Reason: R hip FAI / labral tear. Had 2 prior hip scopes History: R hip pain ACETABULAR LABRUM: We see no gadolinium entering the substance of the acetabular labrum. There is linear and globular intermediate signal intensity partially traversing the labrum from the 2:00 to 3:00 position anteriorly that is compatible with a tear that is perhaps scarred. More superiorly at the 1:00 position anteriorly the labrum is blunted with increased signal intensity, which may reflect a combination of postsurgical changes and degeneration. Posterior labrum is intact.ARTICULAR CARTILAGE AND BONE: There is scalloping at the femoral head/neck junction suggestive of osteoplasty. The underlying bone marrow signal is normal. We see no frank CAM deformity. There is perhaps mild degeneration of the cartilage near the fovea, which is equivocal. Tubular signal abnormalities in the acetabulum presumably represent sites of suture anchors.SOFT TISSUES: There is a large defect in the anterior capsule of the hip,. The ligament of teres is not well visualized, which may represent congenital absence or tear. There is edema in the anterior soft tissue related to injection. Otherwise, the musculature of the hip appear normal. ADDITIONAL

Output: 1. Surgical changes of the right hip as described above.2. Although no gadolinium is seen entering the substance of the labrum, there is intermediate signal intensity in the labrum which may represent a tear. However, we cannot determine if this is a chronic tear of no current clinical significance or the current source of her symptoms.3. Ligamentum teres is not well visualized, which may represent congenital absence or tear.


Instruction: Generate impression based on findings.

Input: Reason: sarcoid with worsening pain, want to assess for progression History: sarcoid with worsening pain, want to assess for progression Again seen are multiple lesions within the innominate bones, sacrum, and proximal femora compatible with the stated history of osseous sarcoid. Many of these lesions now show high signal intensity on T1-weighted images indicating fatty replacement and healing. For example, the reference right intertrochanteric lesion measures approximately 2 cm in its greatest dimension which previously demonstrated homogeneous signal abnormality now appears predominantly fatty on the T1-weighted images. Other lesions appear slightly larger on the current study than on the prior examination. For example, a lesion within the proximal left femur measures approximately 1.5 cm in its greatest transverse dimension, previously measuring 1 cm. New lesions are also identified, for example, in the left anterior column of the left acetabulum. Many of these lesions show enhancement following gadolinium administration. There is osteonecrosis of both femoral heads with progression of flattening of the anterior surface of the left femoral head. Osteoarthritic changes of the hips have also progressed slightly on the left as well. There is slight enlargement of the bilateral inguinal lymph nodes which still retain their normal fatty hilum. Degenerative disc disease affects the imaged lumbar spine. Please refer to the dedicated lumbar spine MRI report for additional details. Note is made of left hip synovitis appearing similar to the prior study.

Output: Osseous sarcoid as described above with a mixed pattern of response, with some lesions showing fatty replacement and others showing slight enlargement. A few new lesions are also identified.


Instruction: Generate impression based on findings.

Input: Back pain and left foot numbness. There is grade 1 degenerative anterolisthesis of L3 on L4, but the remaining vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. The imaged distal spinal cord displays normal signal and morphology. The conus medullaris tip is located at the level of L1. At T11-12, there is a small posterior disc bulge on sagittal view causing mild canal stenosis, but no significant neural foraminal stenosis. At T12-L1, there is no significant central or neural foraminal stenosis. At L1-L2, there is mild facet joint hypertrophy, but no significant central or neural foraminal stenosis. At L2-L3, there is bilateral paracentral disc bulges and facet joint hypertrophy result in mild central stenosis, but no significant neural foraminal stenosis. At L3-L4, a disc bulge and facet joint hypertrophy result in severe spinal canal stenosis, mild right and moderate left neural foraminal stenosis. There is also a posterior 8 mm diameter heterogeneous left synovial cyst. At L4-L5, a disc bulge and facet joint hypertrophy result in moderate spinal and right neural foraminal stenosis and mild to moderate left neural foraminal stenosis. At L5-S1, there is bilateral facet joint hypertrophy, but no significant spinal canal or neural foraminal stenosis.

Output: Multilevel degenerative spondylosis, which is most pronounced at L3-4, with severe spinal canal stenosis and moderate left neural foraminal stenosis, and at L4-5, with moderate spinal canal stenosis and mild to moderate left neural foraminal stenosis. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 42-year-old male with headaches. Question of sigmoid sinus thrombosis. CTV of intracranial venous sinuses:65 cc of Omnipaque 350 is administered for this exam.3-D reformatted images were acquired utilizing in the dependent workstation.Axial source images, axial, coronal and sagittal 0.9 mm MIP images as well as 3-D reformatted images were obtained and utilized for interpretation of the exam.Examination demonstrates an intraluminal defect seen the left transverse sinus highly suspected of a thrombosed as was suspected on prior MRI examination. There is no definitive extension of this defect into the sigmoid sinus. The lumen of the sinus however remains patent. There is also no detectable abnormality of the left jugular bulb and visualized proximal left internal jugular vein.The confluence of sinuses, right transverse and sigmoid sinus as well as right jugular bulb and proximal dominant right internal jugular remains within normal limits. The superior sagittal sinus, inferior sagittal sinus, straight sinus, vein of Galen, bilateral internal cerebral veins and bilateral thalamostriate veins remain patent and unremarkable.Nonenhanced head CT:Examination demonstrates no evidence of intracranial edema, hemorrhage, mass-effect, midline shift or hydrocephalus.The cortical sulci, ventricular system, CSF cisterns and greater white matter differentiation remains within normal.

Output: 1.Intraluminal defect in the left nondominant transverse sinus likely result of thrombus as described. The left transverse sinus lumen is compromised however remains patent and there is no definitive evidence of thrombus within the left sigmoid sinus or the jugular bulb.2.Patent all other intracranial venous sinuses as well as visualized deep venous structures.


Instruction: Generate impression based on findings.

Input: The myelination is normal for age on T1-weighted images. On T2-weighted image, the expected hypointensity associated with myelination in the posterior limb of the internal capsule is not as well visualized as expected for corrected age. This may relate to the patient's history of prematurity.Midline structures are grossly unremarkable as motion artifact is present. The ventricle size is normal. There is no abnormal signal. There is no midline shift or mass effect. There is no evidence of diffusion or susceptibility abnormalities.

Output: Mild delayed T2 pattern of myelination for corrected patient age, which may relate to patient's history of prematurity. Otherwise, unremarkable noncontrast MRI brain.


Instruction: Generate impression based on findings.

Input: 62 year old woman with history of left breast IDC, ER/PR positive, s/p mastectomy (2006) and reconstruction. There is scattered fibroglandular tissue in the right breast.Mild parenchymal enhancement is noted bilaterally.Post-operative findings of left mastectomy and reconstruction with an intact retropectoral silicone implant. An enhancing focus in the right breast at 3 o'clock position at posterior depth is stable from prior exams. No additional abnormal foci of enhancement are seen.No abnormal lymph nodes are identified in either axillary region.

Output: MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: 14-year-old male with presumed Crohn's disease, vomiting, history of fistula PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: Moderately distended with fluid.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: A thin enhancing T2 bright tract extends from the anus (3 o'clock) to the left gluteal fold, unchanged from the prior exam. An additional thin enhancing T2 bright tract extends from the anus (7 o'clock) to the medial right gluteal fold with a small associated phlegmon but no fluid collection. Moderate perianal enhancement and wall thickening. No loculated fluid collection or abscess.BONES, SOFT TISSUES: The SI joints are normal.OTHER: Moderate lower abdominal and pelvic ascites likely relates to the patient's active inflammatory bowel disease better evaluated on recent CT.

Output: 1.Perianal inflammatory changes with persistent left and new right perianal fistulas as described above. Small phlegmon along the right medial gluteal cleft without evidence of abscess.2.Moderate pelvic ascites.


Instruction: Generate impression based on findings.

Input: 60-year-old male with hepatitis C cirrhosis and encephalopathy, status post fall. Rule out bleed. There is no evidence of intracranial hemorrhage, mass or edema. Multiple areas of patchy hypoattenuation in a periventricular and subcortical pattern consistent with small vessel disease, age indeterminate. If there is clinical concern for acute ischemia, an MRI may be considered. Bilateral dystrophic calcifications noted within the basal ganglia. Proportional prominence of the sulci and ventricles.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

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


Instruction: Generate impression based on findings.

Input: History of renal cell carcinoma liver metastases. ABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis without evidence of acute cholecystitis.The reference segment 6 lesion measures approximately 8 x 7 mm (series 11/47), compared to 9 x 6 mm previously.The reference segment 2 lesion measures 2.3 x 1.5 cm (series 11/69), compared to 1.9 x 1.5 cm previously.Reference peripheral segment 6 lesion measures 3.5 x 2.1 cm (series 3/11), compared to 3.4 x 2.3 cm previously. The additional peripherally enhancing lesions in the liver are not significantly changed in size.Segment 5 hemangioma and adjacent cysts are unchanged.SPLEEN: No significant abnormality noted.PANCREAS: Stable nonenhancing cystic lesion in the pancreatic head measuring approximately 1.4 x 0.8 cm (series 11/224).ADRENAL GLANDS: Status post right adrenalectomy. The left adrenal gland is stable in appearance with mild nodular thickening.KIDNEYS, URETERS: Postsurgical changes from right nephrectomy. Complex cystic lesion in the left upper pole with calcification is unchanged. Additional renal cysts are noted and are unchanged without suspicious features.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Scoliosis.OTHER: No significant abnormality noted.

Output: 1.No significant interval change in the metastatic liver lesions. 2.Stable nonspecific pancreatic cystic lesion without suspicious imaging characteristics, likely a branch-type IPMN.


Instruction: Generate impression based on findings.

Input: 49-year-old male with pain and swelling. Evaluate for meniscus tear. MENISCI: There is globular increased signal abnormality within the posterior horn of the medial meniscus which may represent a combination of postsurgical change from prior partial meniscectomy and prior tearing. There is deformity of the posterior horn of the meniscus with associated linear signal abnormality that extends to the tibial articular surface and fills with intra-articular gadolinium consistent with a re-tear. The anterior horn appears intact.The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is a focal near full-thickness articular cartilage defect along the posterior aspect of the weightbearing surface of the medial femoral condyle, above the posterior horn of the meniscus. There is relative sparing of the lateral tibiofemoral compartment cartilage. There is full-thickness articular cartilage degeneration along the lateral facet of the patella with a large area completely devoid of cartilage. There is underlying degenerative subchondral signal abnormality.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact. There is an ossicle within the distal patellar tendon.ADDITIONAL

Output: 1. Findings consistent with a re-tear of the medial meniscus as described above.2. Full-thickness articular cartilage degeneration, most pronounced along the patellofemoral joint as described above.


Instruction: Generate impression based on findings.

Input: 47-year-old female with history of ulcerative colitis presents with periumbilical pain. ABDOMEN:LUNG BASES: The lung bases are clear and the heart size is normal.LIVER, BILIARY TRACT: No significant abnormality noted. Multiple stable hepatic lesions have been previously evaluated and are most compatible with adenomas and segments 6 and 7. No new hepatic lesions were found.SPLEEN: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedPANCREAS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: There are numerous borderline enlarged mesenteric lymph nodes.BOWEL, MESENTERY: The stomach is moderately distended and the patient was unable to tolerate the full dose of oral contrast. This may be due to delayed gastric emptying. The stomach had normal appearance on the previous CT and MRI examinations.There is diffuse small bowel wall thickening. No evidence of obstruction was found. There is diffuse thickening of the colon wall involving the descending and sigmoid colon. The colon is only minimally distended, so accurate evaluation of wall thickening is difficult.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted PELVIS:UTERUS, ADNEXAE: The uterus is markedly enlarged and it contains multiple heterogeneously enhancing masses. The myomatous uterus measures approximately 7.1 x 10.2 cm at axial image 120/166.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: There is sigmoid and rectal diffuse wall thickening which may be due to ulcerative colitis flare.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Diffuse small bowel wall thickening and diffuse descending, sigmoid and and rectal wall thickening. Findings are compatible with inflammatory bowel disease. The bowel wall thickening is new since the recent MRI examination. Multiple additional findings, as described above.


Instruction: Generate impression based on findings.

Input: 29 year-old female. Shoulder pain, questionable infraspinatus atrophy? Evaluate labrum, rotator cuff, suprascapular nerve impingement. ROTATOR CUFF: The rotator cuff tendons and muscles are normal.SUPRASPINATUS OUTLET: The acromioclavicular joint is normal. GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is anatomic. The glenoid labrum is normal. No loose bodies are evident.BICEPS TENDON: The long head of the biceps tendon is normal.ADDITIONAL

Output: Normal appearing shoulder with no specific findings to account for the patient's pain.


Instruction: Generate impression based on findings.

Input: 39 year old woman with history of SVT, sinus tachycardia and atrial fibrillation referred for cardiac MRI to evaluate for structural heart disease. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 54%, the LV end diastolic volume index is 63 ml/m2 (normal range: 65+/-11), the LVEDV is 124 ml (normal range 109+/-23), the LV end systolic volume index is 29 ml/m2 (normal range 18+/-5), the LVESV is 57 ml (normal range 31+/-10), the LV mass index is 30 g/m2 (normal range 67+/-11), and the LV mass is 59 g (normal range 114+/-24). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is normal in size. The interatrial septum is intact. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 54%, the RV end diastolic volume index is 68 ml/m2 (normal range 69+/-14), the RVEDV is 133 ml (normal range 110+/-24), the RV end systolic volume index is 31 ml/m2 (normal range 22+/-8), and the RVESV is 62 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve is trifleaflet. The 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. The tricuspid valve annulus is not apically displaced (distance 5.4mm/m2 from mitral valve annular plane). There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no pericardial effusion.Extracardiac Findings 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. Normal size left ventricle with normal systolic function (EF 54%). 2. Normal size right ventricle with normal systolic function (EF 54%). 3. No evidence for hemodynamically significant ASD or anomalous pulmonary venous return on this study. Cannot rule out a small patent foramen ovale. 4. No late gadolinium enhancement to suggest the presence of underlying fibrosis, inflammation or infiltration. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Clinical question: Reevaluate L4-L5 disc herniation; increased symptoms. Signs and symptoms: As above. Nonenhanced lumbar MRI:There is normal anatomical alignment of vertebral column.There is unremarkable signal intensity of vertebral column other than changes related to mild degenerative disease.Examination at T12-L1 through L3-L4 levels are unremarkable and without interval change since prior exam.L4-L5 demonstrate mild disc desiccation and decreased disc height and mild bilateral ligamentum flavum hypertrophy and mild facet disease. There is interval significant decreased size of a previously noted large herniated disc at this level. On current exam there is a T2 and T2 STIR linear hyperintensity along the undersurface of the disc in the midline and in bilateral paramedian (axial T2 series 601 image 8 and sagittal T2, T2 STIR image 9). Finding is consistent with an annular fissure. There is a tiny left lateral disc protrusion resulting in mild left lateral recess compromise.Mild broad-based bulging disc at this level without resultant central spinal stenosis. Mild compromise of lateral recess on the right however is noted.L5-S1 is unremarkable.

Output: 1.Interval complete resolution of large herniated disc at L4-L5 since prior exam.2.At L4-L5 there is a midline annular fissure which is new since prior exam. A tiny left lateral disc protrusion at this level with resultant left lateral recess compromise. Mild right lateral recess compromise secondary to degenerative changes and no evidence of central spinal stenosis.3.Unremarkable exam at other levels and without evidence of spinal stenosis or neural foraminal compromise.


Instruction: Generate impression based on findings.

Input: 80 year old male with a history of prostate cancer presents with shoulder pain. ROTATOR CUFF: There is a full-thickness tear of the supraspinatus tendon at the level of its insertion on the greater tuberosity measuring approximately 13 mm in the AP dimension. The supraspinatus tendon is thickened with associated increased signal abnormality consistent with moderate tendinosis. There is approximately 11 mm of retraction of the supraspinatus tendon. There is mild undersurface fraying of the anterior fibers of the infraspinatus tendon. No full-thickness or near full-thickness tearing of the infraspinatus tendon or muscle is identified. The teres minor muscle and tendon appear intact. There is thickening with increased signal abnormality within the subscapularis tendon consistent with moderate tendinosis. The muscle belly of the subscapularis muscle is within normal limits.SUPRASPINATUS OUTLET: There is a small amount of fluid within the subacromial subdeltoid space.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is a small amount of fluid within the glenohumeral joint. Although this examination was not protocoled for examination of the glenoid labrum, there is mild increased signal intensity within the superior glenoid labrum consistent with labral fraying/SLAP type I tear. There are mild degenerative arthritic changes affecting the glenohumeral and acromioclavicular joints.BICEPS TENDON: A small amount of fluid is identified along the long head of the biceps tendon which may reflect tenosynovitis versus fluid extension from the glenohumeral joint. ADDITIONAL

Output: Full-thickness tear of the supraspinatus tendon and other findings, as described above. No enhancing mass lesions or evidence of metastatic disease, as clinically questioned.


Instruction: Generate impression based on findings.

Input: Status post cavernoma resection. There are postoperative findings related to right parietal craniotomy with linear enhancement within the resection cavity and a residual adjacent developmental venous anomaly. There is also unchanged confluent T2 hyperintensity in the surrounding white matter and areas of susceptibility effect. There is no evidence of acute intracranial hemorrhage persistent acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unchanged.

Output: Postoperative findings related to right parietal lobe cavernous malformation resection with a residual adjacent developmental venous anomaly and what may represent postoperative blood products and/or small residual portions of the cavernous malformation hemosiderin staining along the margins of the surgical bed.


Instruction: Generate impression based on findings.

Input: 57-year-old female patient with continued pain status post meniscectomy. Sharpening of the tibial spines and tiny tricompartmental osteophyte formation is compatible with mild osteoarthritis. There is no significant joint effusion.

Output: Osteoarthritis as described above.


Instruction: Generate impression based on findings.

Input: Pre-stem cell transplant work up. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear essentially unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable. There is arrested pneumatization variant in the left sphenoid body.

Output: No evidence of acute intracranial hemorrhage, mass, or acute infarction.


Instruction: Generate impression based on findings.

Input: 50 year-old male with chronic headache, cranial nerve dysfunction, known brain metastases, and intracranial hemorrhage presents with deteriorating mental status. There is interval increase in the size of the left thalamic hematoma to 2.7 x 2.2 x 3.2 cm (AP x TR x CC image 14; series 4) from 2.4 x 2.1 x 2.3 cm. This enlargement extends the hematoma further into the midbrain. There is probably also some increase in the amount of vasogenic edema in the surrounding area even allowing for technique differences: Edema and hematoma measure together 4.1 cm in diameter (15; series 4) compared to 3.5 cm on February 20. There is associated distortion and rightward displacement of the third ventricle which is stable. However, there has been slight interval enlargement of the lateral ventricles bilaterally. The temporal horn of the left lateral ventricle measures 9 mm, previously 6 mm. There is interval narrowing of the basal cisterns without evidence of frank brain herniation. There is no evidence of extra-axial fluid collection. Multiple mass lesions within the cerebral hemispheres are noted, some of them hyperdense consistent with petechial hemorrhage or mineralization. Findings are consistent with known metastatic lesions and appear grossly stable. The area of dominant left frontal lobe and right cerebellar hypoattenuation also appear grossly similar to the recent brain MRI. No new parenchymal lesions or hematomas are noted. However, MRI would be more sensitive if status of metastatic disease is of particular concern.The visualized mastoid air cells and paranasal sinuses are clear. The visualized orbits are unremarkable.

Output: 1. Interval enlargement of left thalamic hematoma with further extension into the midbrain. Additionally, there is probably an interval increase in the amount of vasogenic edema in the surrounding area. Although there is stable distortion of the third ventricle (rightward shift of 4mm), the lateral ventricles have enlarged slightly and there is slightly greater basal cistern narrowing compared to the prior study. Still no frank brain herniation. 2. Redemonstration of multiple metastatic intraparenchymal brain lesions better visualized on recent MRI examination. No evidence of new parenchymal lesions or sites of hemorrhage. Findings discussed with Dr. Bergl via direct phone call at the time of dictation 5:05 pm 2/22/12.


Instruction: Generate impression based on findings.

Input: Any evidence of spinal tumors, particularly in LS spine; any evidence of disc disease or tumor in cervical spine? Pain in lower lumbar sacral spine with radiation to right leg; neck pain especially with extension that radiates to right arm. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There are small posterior disc-osteophyte complexes in the lower cervical spine, with apparent mild to moderate right and mild left neural foraminal stenosis at C6-7, but no significant spinal canal stenosis at this or the other cervical spine levels. The thoracic and lumbar spinal canals are patent. The spinal cord and cauda equina nerve roots displays normal signal and morphology. There are multiple bilateral subcentimeter thoracic spine extraforaminal perineural cysts, but otherwise no evidence of spinal tumors or abnormal enhancement. The cerebellar tonsils and conus medullaris are not low-lying. The paravertebral soft tissues are unremarkable.

Output: 1. Multiple bilateral subcentimeter thoracic spine extraforaminal perineural cysts, but otherwise no evidence of spinal tumors or abnormal enhancement. 2. Small posterior disc-osteophyte complexes in the lower cervical spine, with apparent mild to moderate right and mild left neural foraminal stenosis at C6-7.


Instruction: Generate impression based on findings.

Input: Clinical question to be answered:Evaluate face and brain. Signs and symptoms: Term infant with facial dermal cyst versus meningocele. Technique:1 mm axial images of the entire craniofacial region without infusion of contrast material were obtained. 3-D reformatted images of the bony structures and soft tissues were obtained. Sagittal and coronal 2-D reformatted images were also obtained for evaluation. Examination demonstrates a small defect in the midline at the level of cribriform plate anteriorly. CSF density appears to extend across this defect and extends inferiorly posterior to the nasal bridge and eventually terminates into a low density collection in the midline in the subcutaneous tissues of the nose. The collection measures approximately 14 mm in cranial/cephalad axis and 7-mm in AP axis.This finding is consistent with a meningocele. This finding is best appreciated on the 2-D reformatted images in all 3 axial, sagittal and coronal planes. Further evaluation with an MRI examination may assess for detection of possible presence of neural tissue within the meningocele or along its tract. Cisternography is also a helpful study for disk evaluation.Both on sagittal and coronal 2-D reformatted images there is a suspected small amount of tissue within the tract and a meningocele.This examination is otherwise unremarkable.All appropriate 3-D reformatted measurements are submitted in patient's radiology 5.

Output: Midline anterior bony defect at the level of cribriform plate with an associated meningocele as described above.


Instruction: Generate impression based on findings.

Input: There is a 3.0 x 2.1 x 3.0 cm mass within the right parotid tail, which appears to be well-defied. The mass has heterogeneous high T2 signal, with diffuse and mildly heterogeneous enhancement. There is no significant cervical lymphadenopathy. The other major salivary glands and imaged portions of the thyroid gland are unremarkable. There is scattered wall thickening and enhancement of the ethmoid and sphenoid sinuses. The orbits and imaged intracranial structures are unremarkable. There is multilevel degenerative cervical spondylolysis.

Output: A right parotid tail mass measuring up to 3 cm likely presents a benign salivary neoplasm, as suggested by the FNA results, without evidence of metastatic cervical lymphadenopathy or gross perineural tumor spread. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: There is transitional anatomy with either 11 thoracic and 5 lumbar vertebrae or 12 thoracic and 4 lumbar vertebrae. For the purposes of this exam, the last fully formed disc space will be termed L4-S1. There are postoperative findings related to suboccipital craniotomy for Chiari decompression. There is expected biphasic CSF flow anteriorly and posteriorly across the neo-foramen magnum. There is minimal retroflexion of the dens. The cerebellar tonsils lie at the level of C1. At the C1-C2 level, there is focal syringohydromyelia which measures 6 x 5 x 12 mm in the transverse by cc dimensions, previously 7 x 7 x 12 mm. There is an approximately 58 x 41 mm fluid collection within the left abdomen and pelvis, as well as smaller amount of fluid within the right abdomen that is likely related to the patient's lumboperitoneal shunt. The vertebral column alignment is unchanged, with straightening of the cervicothoracic alignment. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The conus terminates at T12-L1, using the chosen nomenclature for this exam.

Output: 1.Transitional vertebral anatomy, as detailed above. Close attention and correlation during any future spine surgery is recommended. 2.Postoperative findings related to Chiari decompression surgery with patent neo-foramen magnum. 3.A focal syringohydromyelia at the C1-C2 level has minimally decreased in size. 4.Persistent intraperitoneal fluid collections may represent a pseudocyst related to the lumboperitoneal shunt. An ultrasound of this region may be useful for further evaluation.


Instruction: Generate impression based on findings.

Input: lower extremity weakness Brain MRIThere is no evidence of acute ischemic or hemorrhagic lesion on this scan.There are scattered patchy high signal intensity lesion on periventricular white matter as well as infratentorially especially on the right side middle cerebellar peduncle and left side lower medullar on FLAIR images. On Gadolinium enhanced images, there are tubular shaped enhancement on the right trigone area and left periventricular white matter posterior aspect. These enhancements do not show any evidence of associated signal voids or nodular enhancing mass.Considering patient's age, these lesions could represent white matter lesions such as demyelinating disease or age indeterminate but likely chronic ischemic lesions. The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.Thoracic MRIThere is high signal intensity of spinal cord from T6 and T7 level on T2 weighted image and STIR images. However, there is no evidence of enhancement on post-Gad images.The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal. The conus medullaris terminates at the T12-L1 level. Intervertebral discs appear to be normal except some dessication on T10-11 level.

Output: 1. Patchy and scattered periventricualr white matter high signal intensity lesions on FLAIR images with a couple of areas of enhancements as well as high signal intensity lesion of spinal cord at the level of T6-7 indicate possibility of demyelinating disease such as multiple sclerosis.2. Non specific small vessel ischemic disease could be associated but less likely.3. Traumatic nature of the spinal cord lesion is also possible but less likely.4. Vascular nature of spinal cord lesion is unlikely


Instruction: Generate impression based on findings.

Input: Male, 45 years old, with metastatic renal cell carcinoma and increasing neck pain. Known thoracic spine metastases. Bone scan with questionable focus in the right cervical spine. The right lateral mass of C1 is infiltrated and expanded by pathologic enhancing soft tissue. This process extends to involve the adjacent paraspinal soft tissues such that the right longus coli muscle is displaced anteriorly. There may be minimal epidural extension of this process as it infiltrates around the dens, but no significant mass effect is exerted upon the thecal sac. No definite pathologic intradural enhancement is observed.C2 is not definitely involved by the above-mentioned process, nor is the occipital condyle. Likewise no definite additional disease is seen in the cervical spine. Pathologic marrow signal and enhancement is visualized at the T4 level.Spinal alignment is anatomic. Vertebral body heights are preserved. Except as above, marrow signal characteristics are unconcerning. Mildly elevated T1 and T2 signal within the C4 vertebral body may represent a benign hemangioma or focal fat.The visualized spinal cord shows normal signal intensity and morphology throughout. No pathologic cord or leptomeningeal enhancement is observed.The intervertebral disc spaces are preserved. No significant disc herniations or osteophytic spurring are seen. No significant spinal canal or foraminal stenosis is suspected though there may be mild scattered foraminal narrowing secondary to facet hypertrophy.Multiple small nodules are evident in the lung apices.

Output: Metastatic involvement of the right lateral mass of C1 is seen on this examination. The lesion is expansile and extends into the adjacent paraspinal soft tissues. There may be some mild epidural disease extension, but no significant mass effect is exerted upon the thecal sac or the spinal cord.No definite additional metastatic disease is seen in the cervical spine. Thoracic spine metastatic disease is partially visualized on this examination.No evidence of significant spinal canal or neuroforaminal stenosis is observed.


Instruction: Generate impression based on findings.

Input: 41 year old female patient with recurrent PSC after LDLT, screen for cholangiocarcinoma. Fevers, chills, tenderness to palpation in the right upper quadrant, and epigastrium; also concern for cholangitis. ABDOMEN:LIVER, BILIARY TRACT: There are post-surgical changes of a liver transplant with hepaticojejunostomy. There is a continued mottled appearance of the liver with nodular areas of T1 hyperintensity which demonstrate variable degrees of enhancement without washout on more delaying images. There is no associated restricted diffusion or delayed enhancement. No definite suspicious hepatic mass is identified. The caudate lobe has hypertrophied and compresses the adjacent IVC. There is scattered intrahepatic biliary ductal dilatation, appearing similar to the prior study.The posterior branch of the right portal vein no longer opacifies with contrast and is likely occluded. Furthermore, the peripheral right hepatic vein is filling with contrast, however, centrally there is attenuation of signal which may represent a partial or complete occlusion. The anterior branch of the right portal vein and main portal vein appear patent. The hepatic artery/anastomosis appears patent.There is mild intrahepatic biliary ductal dilatation. No dominant obstructing lesion.SPLEEN: The spleen is enlarged measuring up to 19 cm in length. The splenic vein is prominent in size and patent. PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No evidence of hydronephrosis. There is a 8 mm lesion within the right upper pole with T2 hyperintensity and the appearance of enhancing septa. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is marked wall thickening of the ascending and proximal transverse colon with surrounding edema within the abdomen.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small to moderate right pleural effusion. The azygous vein has increased in size compared to the prior study.

Output: 1. Mottled appearance of the liver with caudate lobe hypertrophy and central attenuation of signal of the hepatic venous vasculature is concerning for partial or complete central right hepatic venous obstruction. Furthermore, increase in size of the azygous vein also suggests some degree of central venous stenosis.2. Interval occlusion of the posterior branch of the right portal vein. 3. Right colonic wall thickening and surrounding inflammatory changes compatible with a colitis, possibly from an infectious or inflammatory etiology.4. 8 mm right upper pole complex cyst can be followed on subsequent imaging. 5. Scattered intrahepatic mild biliary ductal dilatation without focal dominant obstructing lesion.Findings communicated to K. Davey via telephone at 1159 hrs on 8/5/2016.


Instruction: Generate impression based on findings.

Input: Female, 65 years old, with left-sided weakness, gait difficulty, and neuropathy. Status post heart transplant on immunosuppression. No restricted diffusion is seen. Scattered small foci of T2 hyperintensity are seen within the subcortical and periventricular white matter which likely reflect chronic microvascular ischemic disease. Multiple small chronic cortical infarcts are seen within the cerebellum.No evidence of parenchymal edema or mass effect is seen. No abnormal extra-axial fluid collections are detected. No pathologic parenchymal or extra-axial enhancement is observed. The ventricles are normal in size and morphology.Intracranial MRA imaging reveals no evidence of any significant vascular stenosis or vascular occlusion. No aneurysms are detected within the limitations of technique.Postcontrast MRA imaging of the neck is compromised by poor contrast bolus timing. However, a noncontrast time-of-flight MRA sequence was obtained through the neck and this is of adequate quality. No significant vascular stenosis is detected within the carotid or vertebral vessels of the neck.

Output: 1.No acute ischemia or other acute intracranial abnormality.2.Evidence of scattered chronic small vessel and cerebellar cortical ischemic lesions.3.No findings to suggest any intracranial infectious or neoplastic process.4.No significant vascular abnormalities in the head or neck.


Instruction: Generate impression based on findings.

Input: Female, 40 years old, status post left temporal craniotomy for resection of a cerebrovascular malformation on 07/14/16. Evidence of left temporal craniotomy is seen. A small amount of fluid in the extradural space along the craniotomy is within expected limits. There is a hemosiderin stained resection cavity involving the left anterior temporal lobe extending medially to incorporate the site of previously demonstrated susceptibility inducing lesion. The surrounding brain parenchyma demonstrates encephalomalacia. Mild ill-defined enhancement along the operative tract likely represents postoperative granulation. Given that the regional anatomy is distorted, it is difficult to determine if the associated developmental venous anomaly is still present.Elsewhere no significant parenchymal signal abnormality is detected. No edema or mass effect is observed. There are no other areas of pathologic intracranial enhancement. The ventricles remain normal in size and morphology.

Output: Expected findings are seen status post resection of the previously demonstrated left temporal cerebrovascular malformation.


Instruction: Generate impression based on findings.

Input: Reason: r/o meniscal tear History: chronic knee pain. MENISCI: There is globular increased signal abnormality within the posterior horn of the medial meniscus indicating intrasubstance degeneration. Some of this signal extends to the tibial articular surface indicating a degenerative horizontal tear. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is near full-thickness to full-thickness articular cartilage degeneration along the lateral femoral condyle, anteriorly. There is full-thickness articular cartilage degeneration along the lateral facet of the femoral trochlea with underlying subchondral signal abnormality. There is partial-thickness articular cartilage degeneration along the lateral facet of the patella. There is a 1.2 cm focus of decreased signal abnormality along the anterior aspect of the lateral femoral condyle likely representing a loose body within the joint. Heterogeneous bone marrow signal abnormality is nonspecific but may reflect residual islands of red marrow.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Intrasubstance degeneration and degenerative tearing of the medial meniscus.2. Osteoarthritis of the knee including near full-thickness to full-thickness articular cartilage degeneration most pronounced along the lateral tibiofemoral and patellofemoral compartments.3. Moderate size joint effusion extending posteromedially into a Baker's cyst.


Instruction: Generate impression based on findings.

Input: 54 years, Male, prior CVA with symptoms and might be new. Unsteadiness on feet There is restricted diffusion consistent with acute infarct involving the left paramedian aspect of the pons. No additional acute infarcts are appreciated. There are scattered punctate foci and confluent areas of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, consistent with moderate chronic small vessel ischemic disease. Again seen are multiple chronic lacunar infarcts in the frontal periventricular white matter, with minimal ex vacuo dilatation of the anterior body of the left lateral ventricle. Also again seen are multiple chronic lacunar infarcts involving the bilateral cerebellar hemispheres as well as the right aspect of the midbrain along the cerebral peduncle. Also again seen are foci of susceptibility compatible with chronic microhemorrhages involving the bilateral cerebellar hemispheres as well as the right posterior inferior temporal gyrus.The ventricles and sulci are prominent, consistent with mild-moderate parenchymal volume loss and slightly advanced for age. No evidence of intracranial mass or mass effect. No midline shift or herniation. Major flow-voids are grossly preserved. There is minimal scattered paranasal sinus mucosal thickening. There is nonspecific T1 marrow signal hypointensity without discrete destructive lesions. Extracranial soft tissues are otherwise unremarkable.

Output: 1. Acute infarct involving the left aspect of the pons.2. Moderate chronic small vessel ischemic disease. Multiple supra- and infratentorial lacunar infarcts again seen. Multiple foci of chronic microhemorrhages are also again seen.


Instruction: Generate impression based on findings.

Input: Ms.Erica Izraeli, 42 years old, submitted outside study for review. She initially presented for follow-up of a probable benign right breast mass at 9:00 position on May 4, 2016 with diagnostic workup demonstrating 2 groups of indeterminate calcifications in the upper outer right breast. 2 site stereotactic biopsy on 5/9/2016 revealed IDC grade 1 in the posterior group and ALH in the anterior group. Ultrasound-guided biopsy of the right breast 9:00 mass revealed fibroadenoma. Patient has a strong family history of breast cancer in her to and ovarian cancer in her grandmother. Images performed at Northwestern Memorial Health Care submitted for review: Mammogram 5/4/2016Ultrasound of 5/4/2016Stereotactic guided biopsy two sites 5/9/2016Postprocedure right breast mammogram 5/9/2016MRI breast 5/20/2016Ultrasound guided biopsy of right breast 5/24 2016Images submitted for comparison:Mammogram 4/30/2015 and 4/23/2014 MAMMOGRAM 5/4/2016: Three standard views of both breasts and 2 additional spot compression views of the right breast were obtained. The breast parenchyma is heterogeneously dense, unchanged in pattern and distribution. In the right breast upper outer quadrant, there are 2 clusters of amorphous calcifications and punctate calcifications with associated architectural distortion measuring 2.8 x 4.3 cm. Stable intramammary lymph node in the left breast. No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in the left breast. ULTRASOUND 5/4/2016 : Static ultrasound images are submitted for interpretation.Right breast targeted ultrasound demonstrated a circumscribed, iso to slightly hypoechoic mass measuring 0.6 x 0.5 x 0.2 cm the right breast 9:00 position, 3 cm from the nipple. No other solid or cystic masses are identified in the upper outer right breast.STEREOTACTIC GUIDED BIOPSY OF RIGHT BREAST 5/9/2016: The anterior and posterior aspect of the clustered calcifications in the right breast upper outer quadrant were the targets for the biopsy. Targeting appears appropriate. Calcifications are noted on one of the specimen radiograph. POST PROCEDURE MAMMOGRAM 5/9/2016: A dumbbell shape clip is placed in the posterior aspect of the right upper outer breast. One x shaped clip is in the anterior aspect of the right upper outer breast. Biopsy clips are at the expected locations. Small amount of residual calcifications are also present.MRI breast 5/20/2016:Multisequence MRI breast imaging with and without intravenous contrast was performed as per outside MRI breast protocol. The breasts are composed of heterogeneous fibroglandular tissue. There is marked background parenchymal enhancement bilaterally. Kinetic analysis of these images was not possible. RIGHT BREAST: There is artifact from the biopsy clip in the posterior right upper outer breast, 11:00 position. An irregular enhancing mass mass surrounding the biopsy clip measures 2.2 x 1.7 x 2.2 cm (AP x LR X SI). This corresponds to the biopsy-proven malignancy in the posterior right upper outer breast. There is no suspicious enhancement in the pectoralis minor muscle.Another susceptibility artifact is identified anterior and inferior to the above enhancing mass. There is rim enhancement associated with the biopsy track. This likely represents the biopsy site in the middle right upper outer breast.There is a 0.5 cm enhancing mass in the right breast 9:00 position approximately 3 cm from the nipple. This corresponds to the stable mass demonstrated on the prior ultrasound.LEFT BREAST:No suspicious enhancement is identified in the left breast. An intramammary lymph node is noted in the upper outer left breast.Axillae:Multiple nonspecific lymph nodes are identified bilaterally.ULTRASOUND-GUIDED BIOPSY OF right breast 9:00 mass 5/24/2016: Previously identified stable mass in the right breast 9:00 position is the target for the biopsy. Targeting appears appropriate.PER OUTSIDE PATHOLOGY:A. Posterior aspect of the right upper outer calcifications; stereotactic guided core needle biopsy:- Invasive ductal carcinoma, grade 1, with tubular features. LCIS with no associated microcalcifications and ADHB. Anterior aspect of the right upper outer calcifications; stereotactically guided core needle biopsy:-Atypical lobular hyperplasiaC. Right breast 9:00 masses; ultrasound-guided core needle biopsy:-Fibroadenoma- These results are concordant with the imaging findings.

Output: 1. 2.2 cm unifocal malignancy in the posterior right upper outer breast.2. ALH in the middle right upper outer breast.3. No malignancy in the left breast.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Intra-articular contrast does not traverse the expected location of the scapholunate ligament or the lunotriquetral ligament. Please refer to the subsequent MRI report for further information.Exposure time: 1 minute and 58 seconds.

Output: Fluoroscopic guided injection of dilute gadolinium into the mid carpal joint of the left wrist for subsequent MR arthrogram examination without evidence of ligamentous disruption on fluoroscopic evaluation. Please refer to the MRI report examination for further details.


Instruction: Generate impression based on findings.

Input: Left-sided pain in anal area. Ulcerative colitis status post IPAA takedown ostomy on 11/20/2015. Difficulty passing stool. Evaluation is limited due to motion artifact.PELVIS:UTERUS, ADNEXA: No significant abnormality noted. BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is small volume of free pelvic fluid, probably physiologic. The patient is status post proctocolectomy and ileal pouch-anal anastomosis. There is no evidence of abscess, fistula or perianal pouch fluid collection. The pouch is normal in caliber.BONES, SOFT TISSUES: Multiple T2 hyperintense cystic lesions within the sacrum, probable Tarlov cysts. Postsurgical changes of the body wall are identified from prior ostomy.OTHER: No significant abnormality noted.

Output: Status post proctocolectomy and ileal pouch anal-anastomosis. No evidence of complication.


Instruction: Generate impression based on findings.

Input: 50 year-old female. Recurrent low-grade endometrial stromal sarcoma of the uterus status post resection of vaginal cuff recurrence on 2/5/2015, to assess disease response and for radiation therapy planning. EPIC history: patient had history of angiogram 2/2015 complicated by RLE DVT. PELVIS:UTERUS, ADNEXA: Postsurgical findings of hysterectomy. There has been interval resection of the two masses seen in the vaginal cuff without evidence of local recurrence.BLADDER: No significant abnormality noted.LYMPH NODES: Borderline enlarged right pelvic lymph nodes, including a 1 x 0.6 cm node, not significantly changed (series 1001, image 40).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Interval decrease in soft tissue stranding in the right groin since prior CT. In this region, there is a 2.3 x 1.5 cm T1 hyperintense lesion with surrounding soft tissue thickening and enhancement, which extrinsically compresses and severely attenuates a patent right common femoral vein (series 1401, image 661). This is favored to be a hematoma with adjacent inflammatory change.OTHER: No significant abnormality noted.

Output: 1.Interval resection of two vaginal cuff lesions without evidence of local recurrence.2.Decreased right groin soft tissue stranding. Residual T1 hyperintense lesion in this region with adjacent soft tissue thickening and enhancement, favored to be a hematoma with surrounding inflammatory change. Of note, the right common femoral vein is markedly attenuated by this hematoma.3.Borderline enlarged right pelvic lymph nodes, unchanged.


Instruction: Generate impression based on findings.

Input: 77 year old man with history of metastatic rectal cancer s/p surgery and chemotherapy, as well as LV dysfunction who was referred for cardiac MRI for quantification of cardiac volumes and function. Left VentricleThe left ventricle is severely dilated with moderately reduced systolic function. The overall LV ejection fraction is 34%, the LV end diastolic volume index is 146 ml/m2 (normal range: 74+/-15), the LVEDV is 297 ml (normal range 142+/-34), the LV end systolic volume index is 96 ml/m2 (normal range 25+/-9), the LVESV is 196 ml (normal range 47+/-19), the LV mass index is 80 g/m2 (normal range 85+/-15), and the LV mass is 163 g (normal range 164+/-36). There is thinning of the basal and mid inferior and inferolateral walls with associated akinesis. There is late gadolinium uptake in these segments which is transmural, and suggestive of previous infarction. These segments are not likely to be viable. The remainder of the myocardium is free of late gadolinium enhancement and is viable. No evidence of myocardial iron overload.Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 57%, the RV end diastolic volume index is 103 ml/m2 (normal range 82+/-16), the RVEDV is 210 ml (normal range 142+/-31), the RV end systolic volume index is 45 ml/m2 (normal range 31+/-9), and the RVESV is 91 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is trace aortic regurgitation. Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is mildly dilated (ascending aorta 40mm).Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is mildly dilated (30mm).Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThere is an SVC catheter. 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. Severely dilated left ventricle with moderate-severely reduced systolic function (LVEF 34%). There is akinesis of the basal and mid inferolateral and inferior walls. These walls have a transmural myocardial infarction and are not likely to be viable. The remainder of the left ventricle is free of myocardial infarction and is viable. 2. Normal sized RV with normal systolic function (RVEF 57%). 3. Mild left atrial dilation. 4. Mild dilation of ascending aorta and main pulmonary artery.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 68-year-old BRCA2 positive female with a history of left breast lumpectomy for DCIS in 2005, followed by radiation therapy and a personal history ovarian carcinoma. History of breast cancer in mother (diagnosed at age 82) and maternal cousin (diagnosed at age 50). There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.No suspicious enhancement is seen in either breast. Stable post-surgical volume loss, distortion and density in the left breast. Signal void from the large left retroareolar dystrophic calcification is again noted. No significant change in the small enhancing focus in the left breast at 4:00. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Diagnosis: Compression of brainClinical question: Chiari malformation , no surgery, yearly follow up , please do with CSF flow study. The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology.The cerebellar tonsils are low lying and pointed. It extend approximately 11 mm below the level of the foramen magnum.CSF flow is mildly diminished at the level of the foramen magnum.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal. There is a left lateral recess disk protrusion at this level associated with small uncovertebral osteophytes and encroachment of the left sided exiting nerve roots. This is stable compared to the prior exam.At C4-5 there is no significant compromise to the spinal canal. There are minor degenerative changes at the lateral recesses.At C5-6 there is no significant compromise to the spinal canal or the neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.Some scattered opacities are present in the mastoid air cells.

Output: 1.Findings are compatible with Chiari I malformation. CSF flow is mildly diminished at the level of the foramen magnum.2.There is no evidence for a syrinx.3.There are some degenerative changes present in the cervical spine with some encroachment of exiting nerve roots within the left neural foramen at C3-4. This is stable.


Instruction: Generate impression based on findings.

Input: Shoulder instability The exam is slightly limited by motion artifact.ROTATOR CUFF: No significant abnormality noted.SUPRASPINATUS OUTLET: No significant abnormality is noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral alignment is normal. There is undercutting of contrast below the anterior and anterosuperior labrum consistent with tear.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: Tearing of the anterior and anterior superior labrum.