Instruction: Generate impression based on findings.

Input: 52-year-old female with biopsy proven locally advanced triple negative right breast carcinoma presents for staging examination. Patient has received one round of chemotherapy. There is heterogeneous amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.Three enhancing masses are present within the central lateral right breast. The largest mass measures 3.8 x 4.1 x 3.4 cm and demonstrates heterogeneous enhancement. Susceptibility artifact from a biopsy clip is present within this mass. Immediately adjacent to the superior postero-lateral margin of the index lesion is a second heterogeneously enhancing mass measuring 2.2 x 2.6 x 3.0 cm. A third, homogeneously enhancing mass is present along the anteromedial margin of the index lesion measuring 1.0 x 0.9 x 1.0 cm. The most anterior mass resides approximately 1 cm posterior to the nipple. Total area of enhancement in the right breast measures 3.8 x 6.9 x 4.5 cm and extends to the lateral cutaneous surface, mid depth, and to the lateral margin of the nipple. Multiple (at least 4) prominent lymph nodes are present within the right axilla. The largest measures 2.6 cm with effacement of the fatty hilum, and contains susceptibility artifact from a biopsy clip. A 1.9-cm retropectoral lymph node is also present on the right. No abnormal enhancement is seen in the left breast. Multiple normal appearing lymph nodes are present in the left axilla.

Output: 1.Three masses within the central lateral right breast as above which abut the cutaneous surface laterally, and extend to the lateral margin of the nipple. Total area of enhancement in the right breast measures 6.9 cm in AP dimension. Biopsy clip is noted within the largest mass.2. At least 4 enlarged right axillary lymph nodes, the largest identified measures 2.6 cm and contains a biopsy clip.3. Enlarged right retropectoral lymph node.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: History of right mastectomy in May 2014 for breast cancer, status post neoadjuvant therapy. There is heterogeneous amount of fibroglandular tissue in the left breast. The patient is status post right mastectomy. Mild parenchymal enhancement is noted in the left breast.No abnormal enhancement is seen in either the left breast or right chest wall. No abnormal lymph nodes are identified in either axillary region. Post surgical changes are noted in the right axilla.

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


Instruction: Generate impression based on findings.

Input: 62-year-old female with history of pancreatic body cyst. ABDOMEN:LIVER, BILIARY TRACT: No suspicious hepatic lesions. Mild dilation of the common bile duct measuring up to 11 mm with smooth distal tapering and no evidence of distal obstructing stone or mass. This is likely a normal finding in this patient status post cholecystectomy.SPLEEN: No significant abnormality noted.PANCREAS: There is a multiloculated cystic lesion in the pancreatic body with connection to the pancreatic duct and measuring up to 14 x 10 mm (series 7/25), most compatible with side branch IPMN. No significant enhancement or mural nodularity. Main pancreatic duct is normal in caliber. Normal physiologic response to secretin.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small cyst in the left kidney superior pole. Other subcentimeter T2 hyperintense lesions in both kidneys are too small to characterize but likely due to additional cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Mild S-shaped scoliosis of the thoracolumbar spine.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Cystic lesion in the pancreatic body as detailed above, most compatible with sidebranch IPMN. Continued follow-up is suggested.


Instruction: Generate impression based on findings.

Input: Male; 46 years old. Reason: staging exam History: prostate cancer PELVIS:PROSTATE:Prostate Size: 2.3 x 4.3 x 3.6 cm.Peripheral Zone: Focus of low T2 signal with restricted diffusion in the right mid to basilar peripheral zone measuring up to 10 x 7 mm (series 803/144), compatible with prostate cancer. Focus of the T2 signal with restricted diffusion in the anterior mid prostate gland is suspicious for additional focus of prostate cancer (series 803/144).Central Gland: Heterogeneous. Prostatic utricle cyst noted.Seminal Vesicles: No invasion.Extracapsular Extension: Mild extracapsular extension of the right mid to basilar lesion describe above.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Findings of multifocal prostate cancer with mild extracapsular extension as detailed above.


Instruction: Generate impression based on findings.

Input: Reason: Eval cervical fusion and hardware History: none- surveillance There is an anterior plate with screws entering C5 and C6. Thin lucency about the C6 screws could represent early loosening because this is equivocal. There is an intervertebral spacer device at C5-6 with what appears to be early bony bridging between the vertebral bodies. There is 1-2 mm of anterolisthesis of C3 elicited with flexion but we see no frank instability.

Output: Orthopedic fixation of the cervical spine as described above.


Instruction: Generate impression based on findings.

Input: Brain MRI:The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement.Brain MRA:There is antegrade flow within the distal bilateral vertebral arteries, within the basilar artery, distal bilateral internal carotid arteries and carotid siphons and bilateral anterior, middle and posterior cerebral arteries. No arterial stenoses, occlusions or aneurysms are identified. No arteriovenous malformations are identified and there is no evidence for cerebral vasculitis. Incidental note is made of a small unnamed artery arising from the basilar tip (best demonstrated on axial source images, series 501).

Output: 1.Negative MRI of the brain including gadolinium enhancement.2.Negative MRA of the brain.3.Specifically, there are no MRI/MRA findings to explain the patient's symptoms.


Instruction: Generate impression based on findings.

Input: 34-year-old female with muscle weakness and EMG consistent with inflammatory myositis, evaluate for inflammation/necrosis and possible biopsy site Right femur: On the fat-suppressed T2-weighted images, there is increased signal intensity of the muscle belly of the rectus femoris, anterior fibers of the mid vastus lateralis as well as the sartorius to a lesser degree. There is also mild signal intensity of the hamstring muscles as well as the adductor magnus and gracilis. There is also mild signal intensity of the adductor longus and brevis muscles. The vastus medialis and vastus intermedius appear normal. Following contrast administration, there is enhancement of the rectus femoris muscle and anterior fibers of the vastus lateralis muscle. There is perhaps mild fatty atrophy of the hamstring and adductor muscles in addition to the sartorius although this is equivocal. We see no additional soft tissue abnormalities. No abnormal bone marrow signal.Left femur: On the fat-suppressed T2-weighted images, there is increased signal intensity of the muscle belly of the rectus femoris, anterior fibers of the vastus lateralis, vastus medialis and sartorius. There is mild increased signal intensity of the hamstring muscles, adductor magnus and gracilis. There is relative sparing of the vastus intermedius. Following contrast administration, there is mild enhancement of the rectus femoris. There is perhaps mild fatty atrophy of the hamstring muscles and adductor magnus muscle in addition to the gracilis and sartorius. We see no additional soft tissue abnormalities. No abnormal bone marrow signal.Other: Small foci of low signal within the uterus may represent fibroids. Incompletely imaged is an approximately 5 cm collection of fluid signal intensity with thin enhancing margin along the anterior and superior aspect of the uterus. This could represent an adnexal cyst. Follow-up is recommended with ultrasound.

Output: 1.Findings compatible with myositis as described above with enhancement most prominently involving the rectus femoris muscles bilaterally.2.Incompletely imaged cystic appearing collection in the pelvis for which follow-up with ultrasound is recommended.Findings discussed with Dr. Bhatia at 1021 on 5/13/15.


Instruction: Generate impression based on findings.

Input: Reason: 71 yo M with metastatic thyroid cancer to brain s/p resection and SRS History: bitemporal visual field defect Again seen are postoperative findings related to right occipital craniotomy. Given differences in technique and motion degradation, there is no significant change in mild dural thickening along the posterior falx and right convexity as well as parenchymal enhancement within the right paramedian occipital lobe resection cavity. There is no significant change in confluent T2 hyperintensity along the margins of this resection cavity compatible with gliosis. No new abnormal intracranial enhancement is identified. There is an unchanged background of nonspecific cerebral white matter T2 hyperintensity, which may represent chronic small vessel ischemic disease and/or posttreatment-related changes. Unchanged foci of susceptibility compatible with chronic blood products involving the right occipital and right posterior temporal lobes. No obvious mass involving the orbits, optic chiasm, sella. There is no evidence of acute intracranial hemorrhage or acute cerebral 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. There are bilateral lens implants. Unchanged T1 hyperintense focus in the left frontal calvarium without destructive osseous lesions apparent.

Output: Motion degradation limits sensitivity for small lesions. Compared to 8/10/2015, there is no significant change in posttreatment changes in the right occipital region without evidence of new intracranial metastases.


Instruction: Generate impression based on findings.

Input: Clinical question: The thoracic/back pain with radicular component. Is there ventral cord tethering? Signs and symptoms: Back pain. Pre and post enhanced thoracic MRI:Examination demonstrates normal signal intensity and anatomical alignment of the vertebral column without abnormal enhancement.There is normal signal intensity and morphology of the thoracic cord without abnormal enhancement. There is no evidence of anterior cord tethering as is questioned clinically.There is no evidence of any appreciable degenerative changes of thoracic spine and no evidence of spinal canal or neural foraminal compromise at any level.Mildly prominent of posterior subarachnoid space in upper thoracic region is an anatomical variation and of no clinical significance.The perispinal soft tissues are unremarkable.

Output: Negative pre and post enhanced thoracic MRI.


Instruction: Generate impression based on findings.

Input: Left radiculopathy, status post fusion Five lumbar type vertebral bodies are presumed to be present. There are postsurgical changes of partial corpectomy at L1 with cage placed as well as posterior spinal instrumentation including paraspinous rods and pedicle screws, which extend from T11 to L3. Bony bridging and hardware integrity is better assess on prior radiographs. The conus medullaris is normal in position at the mid to lower L2 level. There is mild clumping of the cauda equina nerve roots at L1-L2 suggesting arachnoiditis.Susceptibility artifact from hardware limits evaluation. There appears to be focal marrow signal abnormality involving the residual L1 vertebral body. Otherwise no large lesions are appreciated. There is loss of normal lumbar lordosis with mild focal lordotic angulation at the L1 level. There is grade 1 anterolisthesis of L3 on L4.Individual levels as below:L1-L2: No spinal canal or neural foraminal stenosis. L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: There is grade 1 anterolisthesis. There is a left foraminal disc extrusion with mild cranial migration. There is moderate to severe left neural foraminal stenosis with suspected impingement of the exiting left L3 nerve root. Spinal canal and right neural foramen are patent. There is advanced bilateral facet arthropathy.L4-L5: Mild disc bulge, which is eccentric to the right. No spinal canal stenosis. There is mild right neural foraminal stenosis. Left neural foramen is patent. Moderate bilateral facet arthropathy.L5-S1: No significant disc disease. No spinal canal or neural foraminal stenosis. Mild bilateral facet arthropathy.Paraspinous soft tissues are within normal limits.

Output: 1. Postsurgical changes of L1 partial corpectomy with placement of cage and posterior spinal fusion from T11 to L3.2. At L3-L4, there is a disc extrusion involving the left neural foramen, with associated suspected impingement of the exiting left L3 nerve root. There is also advanced facet arthropathy at this level and grade 1 anterolisthesis. Additional multilevel degenerative changes as detailed above. 3. There is focal marrow signal abnormality involving the residual L1 vertebral body which may represent treated tumor. Osseous defect involving the partially imaged right iliac bone may be related to prior myelomatous lesion or postoperative. There are otherwise no suspicious osseous lesions evident.


Instruction: Generate impression based on findings.

Input: 27-year-old male with chronic weakness. Assess for muscle disease. The imaged musculature of the right thigh is within normal limits. There is no increased signal abnormality or fatty atrophy of the imaged musculature of the right thigh. Heterogeneous bone marrow signal abnormality appears most consistent with residual islands of red marrow. There is a small amount of fluid within the right hip, which is within normal limits.

Output: No findings to account for the patient's weakness.


Instruction: Generate impression based on findings.

Input: Alzheimer versus multiple sclerosis versus depression: memory problems dating for 3 years, MOCA of 8. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is slight interval increase in the extent of the scattered cerebral and pontine white matter T2 hyperintensive lesions. There has also been interval increased prominence of the ventricles, particularly the lateral and third ventricles, as well as the sulci. There is a prominent jet of cerebrospinal fluid flow in the third ventricle. There has been interval resolution of the enlarged right parietal sulcus. 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 is mild staphylomatous deformity of the globes.

Output: 1. Slight interval increase in the extent of the scattered supratentorial and infratentorial white matter T2 hyperintensive lesions, which may represent chronic small vessel ischemic disease, perhaps superimposed on demyelinating lesions.2. Interval increased prominence of the ventricles, particularly the lateral and third ventricles, as well as the sulci, which may be due to cerebral volume loss, although a superimposed component of normal pressure hydrocephalus is a consideration. 3. No evidence of acute intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: Altered mental status, unspecified [R41.82] / Cerebral infarction, unspecified [I63.9], Reason for Study: ^Reason: rule out stroke History: altered mental status, right face droop Motion artifacts degraded exam quality.There is no evidence of acute ischemic or hemorrhagic lesion.Patchy scattered high signal intensity lesions on T2/FLAIR suggest non specific small vessel ischemic disease. Underlying brain shows minimal to mild brain atrophy which is age appropriate.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.

Output: Non specific small vessel ischemic disease and minimal to mild brain atrophy which are age appropriate.No evidence of acute ischemic or hemorrhagic lesion.


Instruction: Generate impression based on findings.

Input: 64 year old female with CAD s/p CABG in 1999, PAD s/p aortobifemoral bypass, with recent admission for angina. MEDICATIONS: Amlodipine, ASA, Atorvastatin, Plavix, HCTZ, Lisinopril, Metoprolol XL, Spironolactone Viability/ Myocardial ScarBased on late gadolinium enhancement imaging, there was a non-transmural myocardial infarction involving the basal inferior and inferolateral walls, the mid inferior and inferolateral walls, and the apical inferior wall. Based on late gadolinium enhancement imaging, these segments would be classified as having an intermediate probability of viability; however, following the administration of intermediate dose dobutamine, there was no improvement in contractility in these infarcted segments which would reclassify these segments as being unlikely to be viable. The remainder of the myocardium is free of myocardial infarction and likely to be viable. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 29%, the LV end diastolic volume index is 128 ml/m2 (normal range: 65+/-11), the LVEDV is 220 ml (normal range 109+/-23), the LV end systolic volume index is 91 ml/m2 (normal range 18+/-5), the LVESV is 157 ml (normal range 31+/-10), the LV mass index is 65 g/m2, and the LV mass is 112 g. There is hypokinesis of the basal and mid inferolateral and inferior walls. The basal anteroseptum is also hypokinetic. Left AtriumThe left atrium is moderate to severely dilated. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 56%, the RV end diastolic volume index is 59 ml/m2 (normal range 69+/-14), the RVEDV is 106 ml (normal range 110+/-24), the RV end systolic volume index is 26 ml/m2 (normal range 22+/-8), and the RVESV is 46 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild 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.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 FindingsSternal wires are noted. 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. Based on late gadolinium enhancement imaging, there was a non-transmural myocardial infarction involving the basal inferior and inferolateral walls, the mid inferior and inferolateral walls, and the apical inferior wall. Based on late gadolinium enhancement imaging, these segments (i.e. usual territory of the left circumflex artery) would be classified as having an intermediate probability of viability; however, following the administration of intermediate dose dobutamine, there was no improvement in contractility in these infarcted segments which would reclassify these segments as being unlikely to be viable. The remainder of the myocardium (LAD and RCA territory) is free of myocardial infarction and likely to be viable. 2. Severely dilated and severely reduced LV systolic function (LVEF 29%). There is a regional wall motion abnormality as described above. 3. Normal RV size and systolic function (RVEF 56%).I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Ulcer, evaluate for osteomyelitis Tibia/fibula: No abnormal bone marrow signal or enhancement suggestive of osteomyelitis. There is linear focal bone infarct in the left distal tibia. Fatty atrophy of the calf musculature particularly soleus and gastrocnemius with edema within the musculature. Achilles tendon is thickened consistent with tendinopathy. Extensor tendons are grossly normal. Diffuse subcutaneous fat stranding and skin thickening.Ankle: No abnormal bone marrow signal or enhancement suggestive of osteomyelitis. Accessory soleus muscle. There is metallic artifact in the medial ankle from surgical staples seen on prior radiographs, which limits evaluation of ulceration. Skin thickening of the ankle.

Output: No evidence of osteomyelitis. Fatty atrophy of the calf muscles. Circumferential skin thickening and diffuse inflammation of the soft tissues.


Instruction: Generate impression based on findings.

Input: Clinical question: Baseline scan prior to new treatment start following disease progression. Signs and symptoms: History of stage IV metastatic melanoma. Enhanced CT of soft tissues of neck:60 cc of Omnipaque 350 is administered for this exam.Limited view of intracranial space demonstrate a large area of vasogenic edema in the right mid and posterior temporal lobe. There is a partially visualized enhancing mass in the right posterior temporal lobe measuring 13 x 14.2-mm in size.This finding was reported on prior MRI examination of brain from 6 -- 28 -- 11.Images through the skull base including cavernous sinuses are unremarkable.A right-sided nasopharyngeal mass is again identified. In comparison to prior study from 5 -- 16 -- 11 there is interval decrease in the size of the tumor. This mass extends along the posterior wall of the nasopharynx across the midline to the left paramedian left side of nasopharynx. The largest AP axis of this tumor is 18.6 and the largest transverse axis is 32.6-mm. These measurements are smaller since prior study. On the prior exam note was also made of extension of this tumor into the right posterior choana of the right nasal cavity which is no longer present on current study.A small subcutaneous metastatic nodule or on the left at C4 level demonstrate interval increase in its size to 18.6 x 20.6-mm in size while it measured only 9 x 6-mm on prior study.A small necrotic node in the left submandibular region remains identical to prior study and measures approximately 6.5 mm.No additional foci of metastatic lesions are identified.There is no definitive evidence of any osseous metastatic lesions. Please review dedicated studies for detection of osseous metastases.

Output: 1.Interval decrease in the size of right-sided nasopharyngeal mass since prior study. The largest dimensions of this mass are 18.6 x 32.6 millimeter.2.Interval increase in the size of a left posterior upper neck subcutaneous metastases lesion from 9 x 6-mm to 18.6 x 20.6-mm on current exam. 3.No evidence of neoplastic lesions.4.Large area of vasogenic edema in the right mid to posterior temporal lobe surrounding an enhancing tumor measuring 13 x 14.2-mm in size.


Instruction: Generate impression based on findings.

Input: 52 year old female with suspicious focal asymmetry in the left breast presents for Alan Penn research MRI. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.There are two small cysts in the right breast, one which is located at 9:00 position shows ring enhancement.No abnormal enhancement is seen in either breast. Special attention is paid to the area of focal asymmetry in the left breast at upper outer quadrant, but no abnormal enhancement is seen. No abnormal lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Right hip pain Exam is slightly limited by motion artifact.ACETABULAR LABRUM: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: No significant abnormality noted.SOFT TISSUES: No significant abnormality noted. ADDITIONAL

Output: Normal MR arthrogram of the right hip.


Instruction: Generate impression based on findings.

Input: Chiari decompression with new and worsening headaches and neck pain. Brain: There has been interval Chiari decompression surgery. There is tenting of the posteroinferior cerebellum to the overlying dura associated with intervening hypointense bands. There is also blunted CSF flow across the posterior aspect of the neo-foramen magnum. Otherwise, there is intact CSF flow across the anterior neo-foramen magnum and the cerebellum extends to the level of tip of the dens inferiorly. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles are normal in size and configuration. There is no midline shift. The major cerebral flow voids are intact. The orbits and paranasal sinuses are grossly unremarkable.Cervical Spine: The spinal cord displays normal signal and morphology, without evidence of syrinx. The vertebral column alignment is unchanged. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis.

Output: 1. Interval Chiari decompression surgery with evidence of arachnoid adhesion formation along the posteroinferior cerebellum.2. No evidence of syringohydromyelia in the cervical spinal cord.


Instruction: Generate impression based on findings.

Input: 67-year-old male with history of 8-foot fall complaining of headache, loss of consciousness. Rule out hemorrhage or cervical fracture. In the right high parietal convexity, seen in image 27/36, is a high density focus within the cortex. Inferior to this, on image 21/36 there is an additional focus of high density which could lie on the surface of the cortex or be within the subarachnoid space. These findings are likely cortical hemorrhage given the history. Continued follow up is recommended, and MRI may be helpful. No associated extra-axial hemorrhage. Otherwise, there is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.CERVICAL SPINE

Output: 1. Focal cortical high density is likely hemorrhage given the history (though calcification could potentially have this appearance). Additional small focus of high density inferior to this could be with in the subarachnoid space or in the surface of the cortex. Continued follow-up is recommended, and MRI should be considered.2. Unremarkable examination of the cervical spine.


Instruction: Generate impression based on findings.

Input: Female, 85 years old, with history of neck pain and cervical stenosis, now with headaches. Spinal alignment is grossly anatomic. Vertebral body heights are preserved. Body marrow signal characteristics suggest fairly diffuse sclerosis of uncertain etiology. No marrow edema is detected.Evidence of prior laminectomy from C3 through C7 is seen with decompression of the spinal canal through that region. Several foci of volume loss and T2 hyperintensity are demonstrated within the spinal cord between C4 and C6, compatible with myelomalacia. Elsewhere, the spinal cord morphology and signal characteristics are within normal limits. No epidural abnormalities are suspected.C2-3: Facet hypertrophy and ligamentum flavum thickening. Posterior disc-osteophyte complex formation. Mild spinal canal stenosis. No significant foraminal narrowing. C3-4: Facet hypertrophy. Posterior disc-osteophyte complex formation. Spinal canal decompression. Mild bilateral foraminal narrowing. C4-5: Facet hypertrophy. Posterior disc-osteophyte complex formation. Spinal canal decompression. Moderate right and mild left foraminal narrowing. C5-6: Facet hypertrophy. Posterior disc-osteophyte complex formation. Spinal canal decompression. Moderate left and mild right foraminal narrowing. C6-7: Facet hypertrophy. Posterior disc-osteophyte complex formation. Spinal canal decompression. Mild left foraminal narrowing. C7-T1: Facet hypertrophy. No significant spinal canal or foraminal stenosis.

Output: 1.Sequelae of posterior spinal canal decompression are seen with expansion of the spinal canal from C3 through C7.2.Scattered areas of myelomalacia are seen within the spinal cord from C4 through C6, likely related to prior compressive injury. No areas of suspected acute spinal cord edema are noted.3.Disc degeneration is evident at all levels. There is a mild spinal canal stenosis at C2-3. Elsewhere, the spinal canal is decompressed, but there is variable mild to moderate foraminal narrowing.4.The vertebral bodies appear diffusely sclerotic which is of uncertain significance.


Instruction: Generate impression based on findings.

Input: 48 year-old female with difficulty speaking and right-sided weakness; evaluate for ICH There is a focus of low attenuation in the left internal capsule/basal ganglia which may indicate early ischemia. Please obtain an MRI for further evaluation as this is a subtle finding. There is no evidence of acute intracranial hemorrhage, mass or edema.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Low-attenuation focus in the left internal capsule/basal ganglia which may indicate early ischemia. Recommend MRI for further evaluation. No evidence of acute intracranial hemorrhage.


Instruction: Generate impression based on findings.

Input: Patient presenting with pain after hyperflexion and valgus injury, evaluate medial meniscus and MCL. MENISCI: We see no definite meniscal tear. Intermediate signal in the periphery of the posterior horn of the medial meniscus medial to its root is felt to represent normal anatomy for this patient. Lateral meniscus appears normal.ARTICULAR CARTILAGE AND BONE: Bone marrow is normal. We see no articular cartilage defects. LIGAMENTS: There is mild edema along the medial collateral ligament that may represent a mild sprain, but the ligament itself is normal.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: Mild sprain of the medial collateral ligament in the otherwise normal-appearing knee.


Instruction: Generate impression based on findings.

Input: Left ankle pain Note that the exam is limited by motion artifact. TENDONS: No significant abnormality noted.LIGAMENTS: No significant abnormality noted.ARTICULAR SURFACES AND BONE: There is serpentine signal abnormality within the distal tibia extending to the articular surface, indicating osteonecrosis. This appears to be chronic in nature as there is no associated marrow edema. Additional chronic-appearing osteonecrosis is seen affecting the body of the talus posteriorly. Small foci of signal abnormality within the navicular and cuboid likely represent degenerative cysts. There is a small tibiotalar joint effusion with a small amount of fluid within the subtalar and talonavicular joints, all of which is not necessarily of any current clinical significance. ADDITIONAL

Output: 1. Diffuse nonspecific subcutaneous edema of the ankle.2. Small tibiotalar and subtalar joint effusions which are of questionable clinical significance.3. Chronic osteonecrosis of the posterior talus and distal tibia.4. Mild osteoarthritis of the midfoot.5. Normal appearance of the ankle tendons.


Instruction: Generate impression based on findings.

Input: CNS lymphoma follow up. There is no significant interval change in size of the lesions in the bilateral basal ganglia, right thalamus, left frontal periventricular white matter, and left cerebellar hemisphere. There is mild intrinsic high T1 associated with many of the lesions without appreciable enhancement. There is no significant interval change in the size and morphology of the ventricular system with unchanged coaptation of the right frontal horn. There is no midline shift or herniation. There is no evidence of intracranial hemorrhage or acute infarct. There is a faint left frontal lobe developmental venous anomaly. There has been interval resolution of the mucosal thickening and secretions in the bilateral maxillary and ethmoid sinuses. The skull and extracranial soft tissues are otherwise unchanged.

Output: No significant interval change in the treated multifocal central nervous system lymphoma.


Instruction: Generate impression based on findings.

Input: 47 year old woman with recent diagnosis of diffuse large B-celllymphoma, family history of coronary disease, found to have reduced LV function onpre-chemotherapy echocardiography. She is being followed with serial MRIs while on chemotherapy. Left VentricleThe left ventricle is with normal in size with moderately reduced systolic function. The overall LV ejection fraction is 41%, the LV end diastolic volume index is 70 ml/m2 (normal range: 65+/-11), the LVEDV is 145 ml (normal range 109+/-23), the LV end systolic volume index is 41 ml/m2 (normal range 18+/-5), the LVESV is 86 ml (normal range 31+/-10). The left ventricular dysfunction is global. Native T1 times are normal (1020 ms). Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 45%, the RV end diastolic volume index is 52 ml/m2 (normal range 69+/-14), the RVEDV is 109 ml (normal range 110+/-24), the RV end systolic volume index is 29 ml/m2 (normal range 22+/-8), and the RVESV is 60 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC drain normally into the right atrium. There is a catheter in the SVC. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsPort present on right chest. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is with normal in size with moderately reduced systolic function. The overall LV ejection fraction is 41%. The left ventricular dysfunction is global.2. The right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 45%. Compared to the previous study in 2/2016, the left ventricular systolic function is quantitatively and qualitatively worse on current study.


Instruction: Generate impression based on findings.

Input: BRAIN: There are unchanged numerous T2 hyperintense lesions mainly centered within the corpus callosum and periventricular white matter as well as a few additional unchanged lesions within the cerebellar white matter and middle cerebellar peduncles. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unremarkable. CERVICAL SPINE: There are unchanged T2 hyperintense lesions located at the cervicomedullary junction, as well as at the C4 and at C6-T1 where there is unchanged mild myelomalacia. There is ill-defined enhancement at the C7 level that was not definitely present on the prior exam. There is a minimal unchanged disc osteophyte complex at C5-C6. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The paravertebral soft tissues are unremarkable.

Output: 1.There is no significant change in the supratentorial and infratentorial multiple sclerosis lesion burden.2.There is minimal enhancement of a lesion centered at the C7 level that was not definitely present on the prior exam. There is otherwise no significant change in the cervical spinal cord lesions or the myelomalacia centered at C7.


Instruction: Generate impression based on findings.

Input: Clinical question: 3-year-old female with autism, microcephaly, feeding disorder. Signs and symptoms: As above. Nonenhanced brain MRI:Examination demonstrates normal anatomic improvement of brain parenchyma and with normal appearing myelination pattern. There is no evidence of congenital malformation.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination.The signal void of major intracranial arterial branches are identified.The signal intensity of intracranial venous sinuses are within normal.Unremarkable images through the orbits, paranasal sinuses and mastoid air cells.

Output: Unremarkable nonenhanced brain MRI.


Instruction: Generate impression based on findings.

Input: Male, 73 years old, with left leg weakness and rigidity of flexor muscles, hyperreflexic patella and Achilles, history of spinal stenosis. Alignment is anatomic. Vertebral body heights are preserved. No concerning areas of marrow replacement or marrow edema are detected. Foci of T1 and T2 hyperintensity within the L4 vertebral body likely represent benign hemangiomas.The spinal canal is congenitally slender to which prominent epidural fat contributes. The distal spinal cord, conus and nerve roots of the cauda equina are unremarkable except as discussed below.L1-2: Mild disc bulging. No significant generalized canal stenosis. Mild bilateral foraminal narrowing. L2-3: Facet arthropathy. Ligamentum flavum thickening. Minimal disc bulging. Mild generalized spinal canal narrowing. Moderate bilateral foraminal narrowing. L3-4: Facet of therapy. Ligamentum flavum thickening. Disc bulging with a right paracentral protrusion is seen contributing to a moderate generalized spinal canal narrowing with crowding of the cauda equina. Moderate right and mild left foraminal narrowing. L4-5: Facet arthropathy. Ligamentum flavum thickening. Bulging disc. No significant spinal canal narrowing. Moderate bilateral foraminal narrowing. L5-S1: Facet arthropathy. Severe loss of disc height with mild disc bulging and osteophyte formation. No spinal canal stenosis. Mild bilateral foraminal narrowing.

Output: Disc degeneration is evident at every level along with posterior element hypertrophy of the lower lumbar levels. These findings, along with a congenitally slender spinal canal, resulting in multilevel spinal canal stenosis. L3-4 is the most severely affected level where there is a moderate stenosis with crowding of the cauda equina.


Instruction: Generate impression based on findings.

Input: Cerebral infarction due to embolism of left middle cerebral artery [I63.412], Reason for Study: ^Reason: evaluate penumbra, perform MRI brain with research protocol History: acute stroke from distal M1 occlusion, and right hemiparesis as result. There are multifocal restricted diffusion lesions involving left frontal lobe especially middle frontal gyrus and deep white matter of parietal and temporal lobes. There are also restricted diffusion lesions on the left external capsule and periventricular white matter. Constellation of above findings indicate both embolic and hemodynamic patterned acute ischemic infarction.On contrast enhanced scan, there are ill defined enhancement especially on the right superior frontal sulcus and adjacent to the left middle frontal gyrus which indicate contrast leakage due to blood brain barrier disruption or could represent parenchymal enhancement of acute/subacute ischemic tissue. There is no definitive evidence of hemorrhagic conversion.Underlying brain shows multifocal scattered FLAIR/T2 high signal intensities on bilateral periventricular white matter indicating non specific small vessel disease. The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.Brain perfusion imagingThe left MCA territory shows Increased MTT and Tmax comparing to that of right side.The left MCA rCBV shows significant increase and equivocal rCBF.Constellation of above findings indicate the left MCA territory is compensatory hypoperfusion status. In particular, the left frontal lobe especially middle frontal gyrus and deep white matter areas do not show increased rCBV with decreased rCBF, thus indicating ischemic tissue.

Output: 1. Acute ischemic infarctions on the left MCA territory.2. MR perfusion map shows the left MCA territory is overall compensatory hyperperfusion status with ischemic tissues on the left middle frontal gyrus and deep white matter.3. MR findings as well as perfusion map indicate the acute ischemic lesions are most likely combined embolic and hemodynamic in nature.


Instruction: Generate impression based on findings.

Input: The ventricles and sulci are prominent, consistent mild global volume loss slightly greater than expected for the patient's stated age. The cisterns remain patent. There is no midline shift or mass effect. There is a single focus of nonspecific T2/FLAIR hyperintensity within the left frontal subcortical white matter. There are no areas of pathological enhancement. There is no diffusion abnormality. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. There is mild mucosal thickening within the sphenoid sinuses and ethmoid air cells bilaterally.LUMBAR SPINE

Output: 1. Single nonenhancing nonspecific focus of T2/FLAIR hyperintensity in the left frontal subcortical white matter.2. Global volume loss greater than expected for the patient's stated age.3. Postoperative changes at L4-L5 from previous left-sided laminectomy. Mild lower lumbar spondylotic changes without significant stenosis at any level.


Instruction: Generate impression based on findings.

Input: Reason: Crohn's with history of severe perianal disease, now with deep perianal fissure, possible fistula History: Pericoccygeal pain, rule out fistula abscess PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Reactive prominent inguinal lymph nodes.BOWEL, MESENTERY: Bowel wall thickening and enhancement of the rectosigmoid colon with high T2 signal in the surrounding fat tissues consistent with inflammatory changes and edema appearing similar to prior. Enhancing creeping mesenteric fat is seen in the lower abdomen.BONES, SOFT TISSUES: There is a new enhancing sinus tract beginning at the midline posterior wall of the rectum and extending along the right medial soft tissues of the thigh into the perineum and base of the scrotum. There is a peripherally enhancing abscess in the soft tissues just inferior to the perineum and posterior to the base of the scrotum measuring 1.3 x 2.1 cm. Extensive inflammatory changes and edema are seen in the perirectal fat. A smaller 1.1 cm enhancing sinus tract arises from the posterior wall of the rectum at the 7 o'clock position without fistulization.OTHER: No significant abnormality noted.

Output: 1.1.3 x 2.1 cm perineal abscess with anoperineal fistulization.2.Additional sinus tract arising from the 7 o'clock position of the rectum without fistulization.


Instruction: Generate impression based on findings.

Input: 48 year old male patient with shoulder pain consistent with rotator cuff injury. Evaluate for tear. ROTATOR CUFF: There is marked isolated atrophy of the teres minor muscle. There is increased signal within the infraspinatus tendon compatible with tendinopathy but no discrete fluid filled tear. There is intrasubstance tearing of the posterior fibers of the supraspinatus tendon. There is increased signal within the distal fibers of the supraspinatus tendon compatible with tendinopathy. There is insertional tearing of the superior fibers of the subscapularis muscle. SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenoid articular cartilage is intact. BICEPS TENDON: The biceps tendon is intact. ADDITIONAL

Output: 1. Tendinopathy of the supraspinatus tendon with intrasubstance tearing.2. Tendinopathy of the infraspinatus tendon and insertional tearing of the subscapularis tendon.3. Isolated marked teres minor muscle atrophy.


Instruction: Generate impression based on findings.

Input: 66 year old female with history of ovarian cancer and T4 vertebral lesion. Compare to previous studies for interval change. Multilevel degenerative changes present throughout the visualized thoracic spine, lower cervical and upper lumbar segments. The attenuation of the vertebral bodies is within normal limits with exception of T4 which redemonstrates a focal area of sclerosis correlating with the metastatic lesion seen on the previous MRI examination (3/22/2011). No evidence of fracture. No evidence of new lesions.Within the limits of CT scanning, the thecal sac and spinal cord are preserved with no significant spinal canal stenosis, with the exception of T11-T12 which demonstrates a small disk protrusion abutting the spinal cord. The neural foramen are patent. The paraspinal soft tissues are unremarkable.Incidental note is made of several surgical clips that are present within the left anterior pararenal space. A large liver lesion is incompletely imaged and appears grossly similar in size to the previous MR examination representing a hemangioma as previously noted on dedicated abdominal MR examination of 4/30/2010. Atherosclerotic calcifications the visualized thoracic and abdominal aorta. Several small lymph nodes are present within the superior mediastinum the largest of which measures 9 mm at the level of the AP window, (series 4, image 41), not pathologically enlarged by CT criteria.Visualized parts of the lungs are grossly clear bilaterally.

Output: 1. Stable T4 vertebral metastasis without evidence of change in size or vertebral body fracture. No additional metastatic lesions are identified.2. Stable appearance of previously noted liver hemangioma.


Instruction: Generate impression based on findings.

Input: Female, 65 years old, status post L3 paraspinal tumor resection. Postoperative findings are seen compatible with resection of a tumor from the left paraspinal region at L3. The resection includes laminectomy at L3, partial laminectomy at L2 and L4, resection of the left L3 transverse process, resection of the L3 facet and part of the L2 and L4 facets, resection of the L3 pedicle and a portion of the L3 vertebral body. Most or all of the previously seen intensely enhancing tumor has been removed. A fingerlike area of mild enhancement projecting along the left edge of the vertebral body (image 19 series 12) was present on the preoperative exam, but it is unclear if this tissue was part of the tumor. Mild enhancement elsewhere in the operative bed is nonspecific.No new enhancing lesions are seen. Marrow signal characteristics remain heterogeneous similar to prior. A mild dextroscoliosis is unchanged. Trace retrolisthesis of L3 relative to L4 is demonstrated. Surgical instruments are in place fusing L2-L4.L1-2: Minimal degenerative disease. No significant spinal canal or foraminal stenosis. L2-3: Mild degenerative disease. No significant spinal canal stenosis. The left neural foramen is obscured by operative changes. L3-4: Facet arthropathy and ligamentum flavum thickening. Disc bulging. Mild spinal canal stenosis. The left neural foramen is obscured by postoperative changes. The right neural foramen remains moderately narrowed. L4-5: Facet arthropathy. Ligamentum flavum thickening. Minimal disc bulging. No spinal canal stenosis. Severe right and moderate left foraminal narrowing. L5-S1: Facet arthropathy. Ligamentum flavum thickening. Minimal disc bulge. No spinal canal stenosis. Mild foraminal narrowing.

Output: Postoperative findings are seen compatible with resection of a tumor from the paraspinal region at L3. It appears that most or all of the previously demonstrated intensely enhancing tumor has been resected. There is mild nonspecific enhancement in the operative region, including a fingerlike area of enhancement which projects along the left edge of the vertebral body. Attention to these areas will be required on subsequent exams.


Instruction: Generate impression based on findings.

Input: 57-year-old female with sacral decubitus ulcer and osteomyelitis on MRI, There is osteolysis and destruction of the bilateral ischium and sacrum corresponding to osteomyelitis from large sacral decubitus ulcer on MRI. There is additional destruction of the left femoral neck with an intertrochanteric fracture. Extensive heterotopic bone surrounds the left femoral neck suggesting a somewhat chronic component. The proximal femoral diaphysis is mildly proximally and laterally displaced relative to the femoral head, which articulates with the acetabulum. The proximal femoral diaphysis demonstrates cortical thickening and irregularity, likely due to chronic osteomyelitis.There is an additional fracture of the pubic bone. Mild osteoarthritic changes affect the right hip. The left lower extremity is demineralized with mild osteoarthritic changes of the left knee.

Output: Extensive destruction and osteolysis due to osteomyelitis involving the bilateral ischium, sacrum and left femoral neck with superimposed left femoral neck intertrochanteric fracture and left pubis fracture.


Instruction: Generate impression based on findings.

Input: 74-year-old female with known IPMN in the tail and body of the pancreas. ABDOMEN:LIVER, BILIARY TRACT: T2 hyperintense cyst in the left lobe of the liver.SPLEEN: No significant abnormality noted.PANCREAS: Decreased intrinsic T1 signal of the pancreas with parenchymal atrophy of the body and tail. The main pancreatic duct is dilated measuring up to 8 mm at the body of the pancreas, not significantly changed since the prior exam. Redemonstrated are dilated and cystic appearing side branches throughout the body and tail of the pancreas. There is no abnormal enhancement.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Minimally complex cyst in the inferior pole of left kidney. No hydronephrosis or perinephric inflammation.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No significant change in dilated main pancreatic duct with dilated and cystic appearing side branches throughout the body and tail of the pancreas. Findings are suggestive of combined type IPMN or chronic pancreatitis. Continued surveillance is recommended.


Instruction: Generate impression based on findings.

Input: Pituitary adenoma. There has been slight interval decrease in size of the intrinsically T1 hyperintense lesion in the right pituitary gland. The normal pituitary tissue and infundibulum remain deviated to the left. There is no mass effect upon the optic apparatus or cavernous sinuses. The internal carotid artery flow voids are intact.

Output: Continued slight interval decrease in size of the lesion in the right pituitary gland.


Instruction: Generate impression based on findings.

Input: 73Yrs gentleman on active surveillance for prostate cancer. He underwent TRUS guided prostate biopsy in 4/2014 for a PSA of 4.8 ng/ml which showed Gleason 6 in 2 cores - right lateral mid and lateral apex (maximal length of 3 mm). His PSA gradually increased- 5.6 in 5/2015, 5.8 in 12/15 and 6.9 in 8/16. He did not undergo a second biopsy. PELVIS:PROSTATE:Prostate Size: 5.1 x 5.2 x 5.0 cm.Peripheral Zone: There is an area of decreased T2 and ADC signal within the right lateral midgland and apex measuring 10 x 12 mm with suspected extracapsular extension. There are additional scattered small foci of decreased T2 and ADC signal within the left peripheral zone.Central Gland: No significant abnormality identified.Seminal Vesicles: No significant abnormality identified.Extracapsular Extension: See above.BLADDER: No significant abnormality noted.LYMPH NODES: No abnormally enlarged lymph nodes are identified within the pelvis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: A penile prosthesis is noted.

Output: Dominant lesion within the right lateral midgland/apex suspicious for neoplasm with suspected extraprostatic extension. Additional possible smaller lesions within the left peripheral zone.


Instruction: Generate impression based on findings.

Input: MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal enhancing lesions are identified in the cervical spine.At C2-3 there is no significant compromise to the spinal canal or neural foramina. There is a mild disc bulge, disc desiccation posterior ligamentous hypertrophy at this level.At C3-4 there is no significant compromise to the spinal canal. There is disc desiccation at this level associated with a mild disc bulge. There are bilateral uncovertebral osteophytes present but larger on the right versus the left side associated with encroachment of the neural foramina right worse than left. There is partial effacement of spinal fluid ventral and posterior the spinal cord at this level.At C4-5 there is disc desiccation and broad-based central disc extrusion associated with bilateral uncovertebral osteophytes and encroachment of the right sided exiting nerve roots. There is posterior ligamentous hypertrophy at this level. There is effacement of the spinal fluid ventral and posterior to the spinal cord at this level as well as mild flattening of the spinal cord. Overall there is a moderate degree of spinal stenosis at this level.At C5-6 there is a left paramedian disc extrusion present associated with effacement of spinal fluid ventral to the left hemicord. There are small uncovertebral osteophytes at this level associated with encroachment of the left-sided exiting nerve roots more than the right-sided exiting nerve roots. At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is loss of disc space height and some endplate reactive changes as well as right-sided uncovertebral osteophytes with some mild encroachment of right-sided exiting nerve roots.The vertebral artery flow voids appear to be intact.

Output: 1.There is a moderate degree of spinal stenosis present at C4-5 related to degenerative changes as described above. There is milder narrowing of the spinal canal at C3-4 and C5-6.2.There is multilevel neural foramen encroachment of exiting nerve roots due to degenerative changes as described above. This is worse on the right side at C3-4 but also present on the right side at C4-5 as well as the left-sided C5-6 and C6-7. There there is some narrowing of neural foramina at other levels as well.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: 28 year-old female with symptoms of chronic rhinosinusitis. Medtronic nonenhanced CT of sinuses:Frontal sinuses.No evidence of disease.Ethmoid sinuses.Very minimal mucosal thickening in bilateral anterior ethmoid air cells.Sphenoid sinus.Mucosal thickening in the dependent portion of the left chamber sphenoid sinus. Patent ostia of sphenoid sinuses.Maxillary sinuses. Mild mucosal thickening and retention cysts in the dependent portion of bilateral maxillary sinuses. Mucosal thickening at the level of bilateral ostiomeatal units with resultant occlusion of bilateral ostiomeatal units.Nasal cavity.Unremarkable.There is a primarily fatty density tissue posterior to the left pterygoid bone in the infratemporal fossa. There is suggestion of remodeling of the left pterygoid bone likely result of chronic long-standing mass effect. This fatty density measures approximately 17.6 X 22.6-mm in transaxial dimensions measured on axial image 11 of series 4. The finding is believed to represent a lipoma. This mass also causes some thinning of the floor of the left middle cranial fossa at the level of foramina ovale. There is no involvement of the left carotid canal. The musculature immediately adjacent to this fatty tissue demonstrate no abnormality. The fascial planes are well preserved and unremarkable. Recommend follow-up with an enhanced MRI of brain and skull base to entirely exclude the possibility of a mass other than simple lipoma.

Output: 1.Chronic bilateral maxillary sinus disease with occluded bilateral ostiomeatal units. Minimal sinus disease in bilateral ethmoids and left chamber of sphenoid sinus.2.There is a primarily fatty density mass in the left infratemporal fossa immediately posterior to the left pterygoid bone with resultant bony remodeling however with no destruction of bony changes. This is believed to represent a lipoma however to entirely exclude other possibilities recommend follow-up with a pre-and post enhanced MRI of brain and skull base.


Instruction: Generate impression based on findings.

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

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


Instruction: Generate impression based on findings.

Input: The exam is degraded by motion and other artifacts, which considerably limit the evaluation of the thoracic spine. There are diffuse osseous metastases throughout the thoracic spine. There is epidural extension of tumor at the T6 level, which appears to result in spinal cord compression, but no gross signal abnormality in the spinal cord. Due to the limited nature of the exam, more subtle epidural extension of tumor elsewhere in the thoracic spine cannot be excluded. The vertebral body heights are intact and the alignment is anatomic. There is multilevel spondylosis in associated with degenerative changes in the cervical spine with spinal canal stenosis, which is incompletely characterized.

Output: The exam is degraded by motion and artifact, but there is widespread metastatic disease involving the imaged axial skeleton with apparent epidural extension of tumor at the T6 level with compression of the spinal cord. More subtle epidural tumor extension may be present at other levels of the thoracic spine, but the exam is limited for detailed assessment of this possibility. Spinal canal stenosis associated with multilevel degenerative cervical spondylosis is incompletely characterized on this exam. Please refer to the recent prior spine MRI report for additional details.The services (Dr. Boyle, pager 1006) was notified of the limited quality of the exam and spread of tumor into the epidural space.


Instruction: Generate impression based on findings.

Input: Osteochondral dysplasia, wrist pain and swelling The bones are demineralized.Small lucencies are noted in the bases of the third and fifth metacarpals suggesting mild carpometacarpal osteoarthritis but are not necessarily of any acute clinical significance. There is no evidence of a fracture. The tendons appear normal within the limits of CT. Scattered arterial calcifications are noted.There is mild diffuse soft tissue edema but no focal fluid collection is identified. There is relatively decreased density of the hyperthenar musculature which may reflect edema and/or atrophy.

Output: Mild nonspecific soft tissue swelling and mild carpometacarpal joint osteoarthritis. These findings were discussed with the ordering physician Dr. O. Lee via telephone (219-933-6757) at the time of interpretation.


Instruction: Generate impression based on findings.

Input: There is a punctate focus of T2 hyperintensity in the white matter adjacent to the left frontal horn without restricted diffusion. This is a nonspecific finding, but may be related to early chronic small vessel ischemic disease. There is no evidence of acute infarct. There is a developmental venous anomaly in the right middle frontal gyrus. There is no evidence of associated hemorrhage or edema. There is no midline shift or herniation. The ventricles are normal in size and configuration. There is a polypoid lesion within the right maxillary sinus, which likely represents a mucous retention cyst or polyp.

Output: 1. No evidence of intracranial hemorrhage, mass, or acute infarct. 2. Developmental venous anomaly in the right frontal lobe without associated hemorrhage.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: The risks (including, but not limited to, those of bleeding, infection, allergic reaction, pain and inability to access the joint) and benefits of the procedure were explained to the patient, and informed written consent was obtained. A pre-procedural “time-out” form was completed.The patient was placed supine on the fluoroscopy table. The right elbow was localized fluoroscopically, and a spot radiograph was obtained. The skin was cleansed and covered with a sterile drape. The skin and subcutaneous tissues were anesthetized with 1% lidocaine using 25-gauge and 22-gauge needles.Under fluoroscopic guidance, a 22 gauge needle was advanced into the radiocapitellar joint. Attempted aspiration yielded no fluid. Next, 8 cc of a 50/50 mixture of Omnipaque 240 (to confirm the intra-articular position of the needle) and dilute Multihance (0.1 cc in a 10 cc vial of saline, for subsequent MR imaging) were injected into the joint. Contrast opacified the joint in the expected manner. A spot radiograph was obtained for documentation. The needle was withdrawn. Blood loss was negligible (<1cc), and the patient tolerated the procedure well without immediate complication. An adhesive bandage was placed on the patient’s skin. Routine post procedure instructions were communicated to the patient. The patient was escorted to the MRI suite for further imaging in stable condition. Please refer to the subsequent MRI report for further information.Exposure time: 2 minutes and 47 seconds.

Output: Successful fluoroscopically guided injection of dilute gadolinium into the right elbow joint for MRI arthrogram.


Instruction: Generate impression based on findings.

Input: 60 year old female with multiorgan involvement with AL amyloidosis, referred for surveillance cardiac MRI. Left VentricleThe left ventricle is normal in size with hyperdynamic systolic function. The overall LV ejection fraction is 72%, the LV end diastolic volume index is 74 ml/m2 (normal range: 65+/-11), the LVEDV is 118 ml (normal range 109+/-23), the LV end systolic volume index is 20 ml/m2 (normal range 18+/-5), the LVESV is 33 ml (normal range 31+/-10), the LV mass index is elevated at 97 g/m2 (normal range 67+/-11), with an LV mass of 155 g (normal range 114+/-24). There is concentric left ventricular hypertrophy: the maximal thickness is at the basal anterior wall of 15-16 mm, marginally greater than noted on the previous MRI. There are no regional wall motion abnormalities. There is relatively diffuse subendocardial late gadolinium enhancement involving the majority of the left ventricle, which appears grossly unchanged. The native T1 myocardial relaxation times remain elevated (1180-1220ms in the basal septum.)Left AtriumThe left atrium is moderately dilated. The interatrial septum is thickened.Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 69%, the RV end diastolic volume index is 71 ml/m2 (normal range 69+/-14), the RVEDV is 114 ml (normal range 110+/-24), the RV end systolic volume index is 22 ml/m2 (normal range 22+/-8), and the RVESV is 36 ml (normal range 35+/-13). There appears to be late gadolinium enhancement involving the RV free wall which was not evident on the previous study.Right AtriumThe right atrium is mildly dilated. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation. The leaflet tips are thickened.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant 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. There is a catheter in the SVC.PericardiumThere is a small pericardial effusion.Extracardiac FindingsMild to moderate thoracolumbar disc degeneration. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with hyperdynamic systolic function, the LVEF is 72%. There is concentric left ventricular hypertrophy: the maximal thickness is at the basal anterior wall of 15-16 mm, marginally greater than noted on the previous MRI. There is relatively diffuse subendocardial late gadolinium enhancement involving the majority of the left ventricle, which appears grossly unchanged. The native T1 myocardial relaxation times remain elevated (1180-1220ms in the basal septum.). 3. The right ventricle is normal in size with normal systolic function, the RVEF is 69%. There appears to be late gadolinium enhancement involving the RV free wall when compared to the previous study. 4. There is biatrial dilatation. 5. There is a catheter in the SVC.6. There is a small pericardial effusion.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: History of pancreatic and peribiliary cysts. Stomach and back pain. ABDOMEN:LUNG BASES: Dilated pulmonary artery redemonstrated, suggestive of pulmonary arterial hypertension.LIVER, BILIARY TRACT: Numerous peribiliary cysts are redemonstrated. They appear slightly increased in number, particularly centrally, and there has been growth of a now 3.0 cm central cyst. This cyst compresses the central ducts, and there is increased intrahepatic biliary ductal dilatation. However extrahepatic biliary ductal dilatation is new or increased, with the common duct measuring up to 9 mm.SPLEEN: No significant abnormality noted.PANCREAS: Multiple cystic lesions of the pancreas are redemonstrated, some of which have increased in size. The reference, largest lesion in the distal body measures 1.8 cm (series 1001, image 20), previously 1.4 cm.ADRENAL GLANDS: Bilateral adrenal thickening unchanged.KIDNEYS, URETERS: Bilateral renal cysts, slightly larger from the prior exam.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Increased size of multiple pancreatic cystic lesions, likely representing branch-type IPMNs.2.Increased intra and extrahepatic biliary ductal dilatation. Intrahepatic dilatation may at least in part relate to increased size of a central peribiliary cyst. However, there is also a new or increased dilation of the common duct up to 9 mm, which may reflect benign biliary stricture


Instruction: Generate impression based on findings.

Input: A patient submitted outside study for review. Submitted for review are standard mammogram (5/9/2014), and breast MRI (4/1/2014) performed at Advanced Medical Imaging in Bozeman, Montana. For comparison, standard mammogram (3/19/2014) is available. Patient is a known BRCA1 gene mutation carrier. MAMMOGRAM (5/9/14): Three standard views of both breasts were obtained with tomosynthesis. The breast parenchyma is heterogeneously dense, unchanged in pattern and distribution. No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in either breast. Benign appearing lymph nodes are projected over both axillae.Bilateral Breast MRI (4/1/14): Bilateral breast MRI was submitted, however the imaging set is incomplete. Request has been made for resubmission of the MRI, which will then be dictated separately.

Output: 1.No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended annually. Given the patient's known genetic mutation and breast density, annual screening MRI should also be considered.2. Incompletely submitted MRI images. Request has been made for resubmission of the MRI, which will then be interpreted separately.BIRADS: 1 - Negative.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Reason: eval for urethral diverticulum History: dysuria, dribbling PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER:There is a cystic lesion surrounding the proximal urethra in a horseshoe configuration measuring 2.0 x 2.4 cm in transverse dimension and 2.4 cm in craniocaudal dimension, likely representing a urethral diverticulum (801/21, 1301/8). A small amount of dependent layering debris is present within the diverticula. No abnormal enhancement is seen within the diverticula. No stones are present.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: Small fat-containing umbilical hernia.OTHER: No significant abnormality noted.

Output: Cystic lesion lesion surrounding the proximal urethra is consistent with a urethral diverticulum and measures up to 2.4 cm.


Instruction: Generate impression based on findings.

Input: 57 year old female with fever. Evaluate for bleed. Bifrontal white matter hypoattenuation appears stable since prior exam and is most consistent with vasogenic edema secondary to known intraparenchymal metastases. Ill-defined round hypodensities just superior to the lateral ventricles correlate with known intraparenchymal metastases seen on recent MRI. Internal focus of hyperattenuation in left lesion is unchanged and could represent focus of calcification.There is no evidence of intracranial hemorrhage or edema. The ventricles and basal cisterns are normal in size and configuration.Large expansile mass originating from right frontal bone and involving right orbit walls obliterates the superior right nasal cavity and ethmoid air cells, consistent with presumed fibrous dysplasia. Intraorbital soft tissues and optic canal are unremarkable. Multiple lytic skull lesions consistent with patient's known metastatic breast cancer are not significantly changed. Complete opacification of the left maxillary sinus is unchanged.

Output: 1.No acute intracranial abnormality or hemorrhage. However, noncontrast CT is not sensitive in detecting infectious process or metastases.2.Focus of hyperattenuation in the left parasagittal intraparenchymal lesion is unchanged and likely represents focus of calcification versus hemorrhage of the metastases.3.Bifrontal white matter hypoattenuation consistent with vasogenic edema secondary to known brain metastases or postradiation change is unchanged.4.No significant change in right frontal skull mass most consistent with fibrous dysplasia.5.Stable multiple lytic skull lesions consistent with known metastases.


Instruction: Generate impression based on findings.

Input: Bilateral upper extremity numbness and tingling. There is lower cervical degenerative spondylosis. At C7-T1, there is bilateral uncovertebral joint hypertrophy with mild bilateral neural foraminal stenosis, but no significant spinal canal stenosis. At C6-7, there is an eccentric left disc-osteophyte complex that results in moderate to severe left neural foraminal narrowing and mild spinal canal stenosis, but no significant right neural foraminal. At C5-6, there is slight posterior disc-osteophyte complex formation and uncovertebral joint hypertrophy bilaterally that results in mild bilateral neural foraminal stenosis, but no significant spinal canal stenosis. At C1 through C6, there is no significant spinal canal or neural stenosis. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: Lower cervical degenerative spondylosis. At C7-T1, bilateral uncovertebral joint hypertrophy results in mild bilateral neural foraminal stenosis, but no significant spinal canal stenosis. At C6-7, an eccentric left disc-osteophyte complex results in moderate to severe left neural foraminal narrowing and mild spinal canal stenosis, but no significant right neural foraminal. At C5-6, slight posterior disc-osteophyte complex formation and uncovertebral joint hypertrophy bilaterally results in mild bilateral neural foraminal stenosis, but no significant spinal canal stenosis.


Instruction: Generate impression based on findings.

Input: There are T1 and T2/STIR hyperintense lesions with enhancement involving the T9, T10, and T11 vertebral bodies corresponding to the lytic lesions on recent CT. These lesions are most consistent with hemangiomas. There are additional scattered T1 hyperintense foci such as at the left T5 vertebral body with similar MRI signal features and also consistent with hemangiomas. There is no suspicious osseous lesions in the thoracic spine. The thoracic spine is in normal alignment. The vertebral body and disk heights are well-maintained. The spinal cord is of normal caliber and signal. There are mild degenerative changes including small disc bulges and protrusions, relatively more prominent at the T7-T8 and T9-T10 levels. There is no significant spinal canal or neural foraminal stenosis at any level.

Output: No suspicious osseous lesions in the thoracic spine. Lytic lesions seen on CT involving the thoracic vertebrae are most consistent with hemangiomas.


Instruction: Generate impression based on findings.

Input: There is a dominant mass centered in the right retromolar trigone with involvement/direct invasion of the right base of tongue. The mass is diffusion restricting, avidly enhancing, and T2 hyperintense, located at the level of the angle of the mandible. It measures approximately 29 x 22 mm (series 1101, image 23) in greatest axial dimensions, previously measuring 23 x 20 mm (CT neck series 3, image 37). This mass abuts and effaces the glossotonsillar sulcus, which is better delineated on CT. The anterior aspect of the mass extends caudally and laterally towards the inferior right parotid gland, with more heterogeneous enhancement, with intervening fat plane remaining. The mass abuts the angle of the mandible (series 1101, image 24) without definite evidence of erosion or enhancing extension into the mandibular canal/foramen. There appears to be involvement of the right pterygoid muscles anteromedially with partial effacement of the right parapharyngeal fat plane. The distal right cervical ICA is partially encased by the base of the tongue/retromolar trigone mass with sparing of the lateral margin. There is an additional enhancing 8 x 6 mm nodule along the left lateral aspect of the base of tongue in the left retromolar trigone, just anterior to the left pterygoid muscles and abutting the left angle of the mandible. This is best seen on 1101/25.There are multiple enlarged or pathologic appearing cervical lymph nodes with reference measurements provided below, and many of which demonstrate hypermetabolism on recent PET/CT:Several right level Ib nodes are rounded in morphology with the larger measuring 9 mm (series 1101, image 18).Right retropharyngeal lymph node is somewhat necrotic and demonstrates partial restricted diffusion. This node measures 10 mm (series 101, image 27) and may correlate with previous questioned right torus tubarius abnormality on PET CT. This node abuts the upper cervical right carotid artery.An additional right level IIb lymph node measures 12 mm in the long axis (series 1101, image 21) and is not enlarged by size anterior, although demonstrates restricted diffusion as well as hypermetabolic activity on an outside PET examination, although described in the EMR as a right posterior cervical triangle node.There is slight prominence of T2 hyperintense signal along the left fossa of Rosenmueller laterally, although without distinct mass. The questioned thickening of the left nasopharyngeal soft tissues appears to correlate with several partially necrotic appearing left retropharyngeal lymph nodes, which measure up to 13 mm (series 101, image 31) and demonstrate hypermetabolism on recent PET/CT. There is abutment of the distal upper cervical left internal carotid artery with slight lateral displacement, with partial encasement by asymmetric enhancing T2 hyperintense tissue caudal to the distinct lymph nodes.Left level 2a necrotic mass which may be a node versus nodal conglomerate measures 20 x 17 mm (series 1101, image 20), previously measuring 21 x 17 mm (CT neck series 3, image 45). This nodal conglomerate has mass effect on the left sternocleidomastoid muscle and adjacent vasculature.Right submandibular glandular tissue is not well visualized. There are no thyroid masses. The right sternocleidomastoid muscle is atrophied.

Output: 1.Right base of the tongue/retromolar trigone mass as detailed, likely representing new primary malignancy. Extension to the right mandibular angle without definite cortical involvement. Direct extension into right parapharyngeal space and invasion of right pterygoid muscles.2.Encasement and abutment of the right distal cervical ICA by the right base of the tongue/retromolar trigone mass and abutment by the right retropharyngeal lymph node.3.Small enhancing mass along the left retromolar trigone, perhaps a lymph node. Correlation with direct inspection is recommended to exclude additional primary malignancy, although no overwhelming hypermetabolism is noted on prior PET/CT and there is no significant diffusion restriction.4.Bilateral cervical lymphadenopathy including retropharyngeal in location, with the reference measurements provided. Dominant left level IIa necrotic nodes.


Instruction: Generate impression based on findings.

Input: Progressive lower extremity weakness. Multiple intracranial metastases. Evaluate for cord compression. There is no evidence of cord compression. Vertebral body heights in the cervical, thoracic, and lumbar spine are normal. No large infiltrating or destructive osseous lesion is evident. There is a 9 mm nonspecific osseous lesion involving the L4 vertebral body. There is reversal of cervical lordosis with mild degenerative changes including small disc osteophyte complexes from C3-C4 to C6-C7. There is fairly mild associated spinal canal narrowing. No significant spinal canal or neural foraminal stenosis in the thoracic or lumbar spine is appreciable. No obvious cord signal abnormality.

Output: 1. No evidence of compression of the spinal cord or cauda equina.2. This is a limited exam specific for the exclusion of cord compression only and does not exclude more subtle lesions such as intrinsic cord abnormalities. Due to the screening nature of this protocol details are not as evident on imaging as dedicated protocols of the spine.3. Nonspecific 9 mm osseous lesion involving the L4 vertebral body.


Instruction: Generate impression based on findings.

Input: Clear cell ependymoma (grade 3) s/p craniotomy x 2 and radiation therapy. There are postoperative findings related to left frontal craniotomy for tumor resection. There is a lobulated enhancing tumor in the medial aspect of the resection cavity that measures up to approximately 12 mm, which is not significantly changed. Likewise, there is no significant change in the extent of patchy areas of T2 hyperintensity in the white matter surrounding the resection cavity. However, there is slight interval increase in size of the cystic space anterior to the tumor. There is no evidence of acute infarction. The ventricles are stable in size and configuration. There is no midline shift. The major cerebral flow voids are grossly intact. The skull and extracranial soft tissues are unchanged.

Output: Stable treated tumor measuring in the left frontal lobe resection cavity, but continued slight interval increase in size of a cystic space anterior to the tumor, which may represent an peritumoral cyst or prominent perivascular space.


Instruction: Generate impression based on findings.

Input: Reason: Evalute suspected mid thoracic meningioma seen on non contrast MRI History: Mid thoracic pain The thoracic vertebral bodies are appropriate in the overall alignment and height. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots. No abnormal enhancing lesions are identified in the thoracic spine.

Output: There is no evidence for a thoracic meningioma.


Instruction: Generate impression based on findings.

Input: There is a heterogeneously enhancing mass in the pituitary gland with infiltration into the clivus and extension into the right cavernous sinus, where there appears to be partial encasement of the internal carotid artery. The mass also extends into the sphenoid sinuses where there has interval decrease in size of an intrinsically high T1 and both high and low T2 hyperintense component with the sphenoid sinus, now measuring up to 18 mm in anteroposterior dimension, previously 24 mm. The infundibulum is slightly displaced to the left. There is no mass effect upon the optic apparatus.

Output: Invasive pituitary macroadenoma with unchanged right cavernous sinus extension, but decrease in size and evolution of the signal characteristics in the sphenoid sinus component that likely contains subacute hemorrhage.


Instruction: Generate impression based on findings.

Input: Male 70 years old Reason: 70 yo male with multiple myeloma with worsening back pain History: worsening back pain BONE MARROW: Nonspecific scattered T1 hypointense foci in the osseous structures of the pelvis. Prior needle tract noted in the left ilium.SOFT TISSUES: Presacral soft tissue mass has decreased in size with a residual component of the presacral mass on the right of the rectum measuring 4.8 x 2.7 cm (image 20/series 1401) previously, 9.7 x 7.0 cm. The mass partially encircles the rectum.The reference left subcutaneous abdominal wall mass measures 6.0 x 3.7 cm (image 35/series 1501) previously, 4.6 x 3.3 cm.There are several lesions adjacent to the right psoas muscle with an infiltrative mass that extends into the right iliac fossa. The right psoas muscle is edematous. The mass partially encases the exiting nerve roots on the right.There are additional lesions in the bilateral gluteal muscles. The right pre-sacral lesion partially impresses upon the exiting right sciatic nerve.JOINTS: Mild degenerative changes affect the hips bilaterally. Moderate to severe degenerative changes affects the lower lumbar spine at L5-S1.ADDITIONAL

Output: 1.Decrease in the size of the presacral mass.2.Increase in the size of the left body wall mass.3.New areas of signal abnormality involving the gluteal, and right psoas muscle with new small enhancing lesions.


Instruction: Generate impression based on findings.

Input: 67-year-old male with left shoulder weakness. Please note that this examination was not protocoled for evaluation of the pectoralis major muscle and its tendon. If further evaluation is clinically warranted, a dedicated chest MRI utilizing the pectoralis protocol is recommended.ROTATOR CUFF: There is mild increased signal intensity within the supraspinatus tendon suggestive of tendinosis and perhaps mild undersurface tearing. There is no discrete fluid-filled tear. There is mild fatty atrophy along the myotendinous junction of the supraspinatus muscle. The muscle otherwise is within normal limits. The infraspinatus muscle and tendon appear intact. There is mild fatty atrophy of the infraspinatus muscle along its myotendinous junction. There is perhaps minimal tendinosis of the subscapularis tendon which otherwise appears normal for the patient's age. There is however mild fatty atrophy of the superior third of the subscapularis muscle. The tear is minor muscle and tendon appear intact.SUPRASPINATUS OUTLET: There is mild to moderate osteoarthritis affecting the acromioclavicular joint with small subchondral cysts and edema type signal abnormality within the distal clavicle and acromion.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is a small amount of fluid within the glenohumeral joint without evidence of effusion. There is intermediate signal intensity within the superior labrum suggestive of degeneration.BICEPS TENDON: There is a small amount of circumferential fluid within the tendon sheath of the tendon of the long head of the biceps which may represent a mild tenosynovitis or simply fluid extending from the glenohumeral joint.ADDITIONAL

Output: Mild degenerative arthritic changes of the shoulder and other findings, as described above.


Instruction: Generate impression based on findings.

Input: 80 years, Female. Reason: OG tube position History: s/p advancement of OG tube The lower pelvis and left lateral flank are excluded from the field-of-view. Interval advancement of orogastric tube with tip projecting over the distal gastric body. Partially imaged right hip prosthesis. Multilevel degenerative disc disease with mild height loss of the L4 vertebral body, seen on the MRI of the lumbar spine from 11/20/2016. Please refer to same-day chest radiograph for thoracic findings.

Output: Orogastric tube projects over the distal gastric body.


Instruction: Generate impression based on findings.

Input: Diagnosis: Compression of brainClinical question: s/p Chiari decompression, 1 year follow up; PLEASE DO CSF FLOW STUDYSigns and Symptoms: 1 year follow up post Chiari decompressionComments: w CSF flow study | Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There is redemonstration of a syrinx which has its superior tip at the level of the C2 vertebral body and extends into the thoracic spinal cord to the level of T10 vertebral body. In the cervical spine the syrinx measures 4.5 x 14 mm axial dimensions on the current exam at the C4-5 vertebral body level. This is stable compared to the prior exam from 10/27/2014. The patient is status post posterior fossa decompression and laminectomies at C1, C2, C3 and C4. CSF flow study demonstrates good flow at the level of the foramen magnum. A previously noted fluid collection at the surgical site superficial to the duraplasty site is not visualized on the current exam.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.MRI thoracic spine:The thoracic vertebral bodies are appropriate in the overall alignment and height. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots. There is a syrinx present which continues from the cervical cord and ends at the T10 vertebral body level.

Output: 1.There is no significant change in size of the patient's syrinx.2.CSF flow appears appropriate at the level of foramen magnum.3.Status post posterior fossa decompression and multilevel upper cervical spine laminectomies. A previously noted fluid collection superficial to the duraplasty site is no longer identified.


Instruction: Generate impression based on findings.

Input: Ms. Brown is a 66 year old female with newly diagnosed right breast cancer in two locations. She has a family history of breast cancer. Preoperative MRI is requested at this time. There is heterogeneous amount of fibroglandular tissue in both breasts.There are scattered foci of enhancement seen in both breasts, compatible with mild background parenchymal enhancement. However, no one focus is more suspicious than the rest. In the right upper outer breast, there are two areas of mass-like enhancement identified, that correspond to the two biopsy-proven malignancies. - The first area of mass-like enhancement is in the 11:00 location, measuring approximately 1.6 x 0.9 x 1.5 cm. A biopsy marker clip is seen at the peripheral aspect of this enhancement. - The second area of mass-like enhancement is in the 10:00 location, measuring approximately 1.4 x 1.3 x 1.7 cm. This measures slightly larger on the MRI, likely due to related post-biopsy changes. Of note, a 1.2 cm hematoma with increased T1 signal is identified just abutting the inferior aspect of this area of enhancement. A biopsy marker clip is also seen at the peripheral aspect of this area of enhancement. - Total span of enhancement measures 4.0 x 2.9 x 3.1 cm (AP x ML x CC). The two biopsy clips are separated by approximately 2.0 cm.There is no additional site of abnormal enhancement seen in the right breast. There is no abnormal enhancement seen in the left breast. No abnormal axillary lymph nodes are identified in either axillary region.

Output: Biopsy proven multifocal breast cancer in the right breast. No additional MR evidence of malignancy identified. Given the total span of enhancement seen on the MR in the right breast, a bracketed wire localization will be performed pre-operatively under mammographic guidance. These results/recommendations were conveyed to Dr. Jaskowiak via phone on 8/12/2015.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Male, 65 years old, with IgG kappa oligosecretory multiple myeloma and new back pain. Diffuse osseous marrow replacement is seen affecting every vertebral body level compatible with myelomatous involvement. The marrow signal characteristics of a majority of the involved levels demonstrate T1 hypointensity and mild fairly uniform STIR hyperintensity.At T1, there is a severe compression deformity with slight retropulsion and effacement of the ventral thecal sac. No high-grade canal stenosis or cord compression is seen.Moderate compression deformities and or loss of vertebral body height is seen throughout the lumbar spine beginning at T4 and continuing down to T11. No significant retropulsion is seen in the thoracic region. None of these compression deformities is associated with particular STIR hyperintensity.A mild anterior compression of the L1 vertebral body is seen without retropulsion. Within the L2 vertebral body, a conspicuously STIR hyperintense lesion is evident anteriorly which may represent a relatively more active or edematous lesion.Within the sacrum, expansile tumor is demonstrated involving the posterior elements of S2 and the anterior aspects of the more distal sacral levels, partially visualized. Elsewhere, no expansile lesions or extraosseous spread is suspected. Within the limitations of a noncontrast examination, no epidural involvement is suspected.Spinal alignment of the cervical region is grossly intact. Exaggeration of the thoracic kyphosis is demonstrated. Spinal alignment in the lumbar region is grossly intact.Multilevel facet arthropathy and disc osteophyte formation is seen in the cervical spine. This affects C5-6 most severely with mild effacement of the ventral thecal sac. Scattered moderate to severe foraminal narrowing is also demonstrated. Mild degenerative findings are seen at most levels in the thoracic spine. There is a prominent right paracentral disc protrusion at T10-11. No high-grade spinal canal or foraminal stenosis is suspected.Facet arthropathy develops at lower lumbar levels. Mild disc bulging is seen at L1-2, L2-3 and L3-4. No significant spinal canal or foraminal stenosis is seen.

Output: 1.Diffuse myelomatous involvement is seen involving the entire spine including vertebral bodies and posterior elements. At most levels, no evidence of extraosseous tumor is seen. However, expansile tumor is demonstrated in the sacrum.2.Multiple compression deformities are redemonstrated including a severe compression of T1 and moderate compressions of most of the mid to distal thoracic vertebrae. These levels show no particular edema suggesting that they are relatively chronic in time course.3.Within the limitations of a noncontrast examination, no evidence of any epidural tumor involvement or cord compression is seen.4.Multilevel degenerative findings are demonstrated as discussed above but without any high-grade spinal canal stenosis.