Instruction: Generate impression based on findings.

Input: 62 year old woman with history of metastatic squamous cell cancer. Presents with neutropenic fever and hemoptysis. Also thrombocytopenic. Evaluate for bleed, metastasis. There is no evidence of intracranial hemorrhage, mass or edema. If high suspicion exists for metastasis, contrast enhanced MRI would be more sensitive.The ventricles are unchanged in size from prior studies. The basilar cisterns are preserved.The calvaria and skull base are radiographically normal. Minimal air-fluid levels are present in the maxillary sinuses bilaterally. Mastoid air cells are partially opacified bilaterally.

Output: No CT evidence of hemorrhage or metastasis.


Instruction: Generate impression based on findings.

Input: 3 years, Male, history of nasal polyps, tics concerning for possible seizure activity. Brain parenchyma appears within normal limits without evidence of intracranial mass or mass effect. No findings to suggest seizure focus are appreciated. No evidence of cortical dysplasia or gray matter heterotopia. Bilateral hippocampi appear unremarkable. No evidence of prior ischemia or hemorrhage. The ventricles are within normal limits in size and configuration. No extra-axial collections. Major flow-voids are preserved. There is diffuse opacification of the bilateral middle ear cavities and mastoid air cells.Examination of the paranasal sinuses demonstrates moderate opacification of the ethmoid air cells and partially pneumatized maxillary sinuses. Bilateral frontal sinuses and sphenoid sinuses have not yet pneumatized. No discrete polypoid lesion is evident. No discrete polypoid lesion is evident.

Output: 1. Brain MRI appears within normal limits without findings to suggest a seizure focus2. Moderate opacification of the partially pneumatized maxillary sinuses and the bilateral anterior and posterior ethmoid air cells, which is nonspecific. No discrete polypoid lesion is evident but can be correlated with direct endoscopic exam.3. Opacification of the bilateral mastoid air cells and middle ear cavities.


Instruction: Generate impression based on findings.

Input: Tuberous sclerosis complex: intractable epilepsy and autism. There is no significant interval change in size of the lobulated enhancing mass with areas of susceptibility effect in the left lateral ventricle, which measures up to 32 mm, previously 32 mm. There is persistent mild vasogenic edema in the surrounding brain parenchyma. There is also an enhancing mass within the right lateral ventricle, which measures up to 8 mm, previously 8 mm. There is slightly decrease prominence of the lateral ventricles, which are mildly dilated, and slightly increased diffuse periventricular white matter T2 hyperintensity. There is no significant interval change in numerous foci of subcortical T2 hyperintensity, some of which demonstrate enhancement. There is no evidence of intracranial hemorrhage or acute infarct. There is a right cerebellar hemisphere developmental venous anomaly. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable. There is left tympanomastoid fluid has resolved.

Output: 1. No significant interval change in size of bilateral lateral ventricular subependymal giant astrocytomas, left larger than right.2. Other stigmata of tuberous sclerosis are also not significantly changed.3. Interval resolution of the left tympanomastoid fluid.


Instruction: Generate impression based on findings.

Input: 16 year old female with sickle cell disease. Headache. There is no evidence of intracranial hemorrhage, mass or edema. Slight prominence of the sulci in the right frontoparietal region and small areas of hypoattenuation in the right centrum semiovale are consistent with known prior strokes in this region as visualized on the MRI dated 4/1/2009. As with all CT findings of prior stroke, superimposed acute stroke cannot be entirely excluded.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: Sulcal prominence and white matter hypoattenuation in the right frontoparietal region consistent with known prior stroke as detailed above.


Instruction: Generate impression based on findings.

Input: Right chronic parotidis. There is an ovoid low T1 and T2 structure within parotid duct along the anterior aspect of the right parotid gland that measures 4 mm in width and 10 mm in length, which is compatible with a calculus. There is an additional low T1 and T2 structure within parotid duct compatible with a calculus overlying the anterior masseter muscle, measuring 3 mm in length and 2 mm in width. There is dilatation of the parotid duct up to 6 mm over a length of 25 mm between the two calculi. However, the duct is relatively narrow focally just anterior to the larger calculus. There is also mild diffuse intraparotid ductal dilatation, as well as considerable thickening and enhancement of the walls of the right parotid duct. There is also extensive enhancement of the right parotid gland and overlying subcutaneous tissues, but no evidence of abscess or discrete tumor. There are mild prominent right parotid lymph nodes, which are likely reactive. The left parotid gland appears to be unremarkable. There is fluid and mild mucosal thickening within the right maxillary sinus. There is a partially-characterized left supraclinoid internal carotid artery aneurysm that measures up to approximately 15 mm.

Output: 1. Acute upon chronic right parotitis and overlying cellulitis associated with parotid sialodocholithiasis and ductal dilatation.2. Findings compatible with acute rhinosinusitis.3. Partially-characterized left supraclinoid internal carotid artery aneurysm that measures up to approximately 15 mm.


Instruction: Generate impression based on findings.

Input: Left leg posterior pain. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. There is dependent edema in the posterior lumbar subcutaneous tissues. The paravertebral soft tissues are unremarkable. There is a partially-imaged and incompletely characterized left adnexal structure that measures at least 35 mm.

Output: 1. No evidence of significant spinal canal or neural foramen stenosis in the lumbar spine.2. Partially-imaged and incompletely characterized left adnexal possibly cystic structure that measures at least 35 mm. A pelvic ultrasound may be useful for further evaluation.


Instruction: Generate impression based on findings.

Input: Female, 19 years old, with multiple sclerosis, eval for progression. Multiple scattered foci of T2 hyperintensity are again seen in the periventricular and juxtacortical white matter of the cerebral hemispheres as well as the corpus callosum. The brainstem and cerebellum are minimally affected, if at all. Since the prior exam, there has been no significant change in the size or number of these lesions. Some demonstrate moderate T1 hypointensity and this too is unchanged. Brain volume is within normal limits. The ventricles are stable and normal in size.

Output: Multiple white matter lesions are redemonstrated compatible with multiple sclerosis. There has been no significant interval change in lesion burden.


Instruction: Generate impression based on findings.

Input: Metastatic breast cancer, pain and weakness Cervical Spine: Bone marrow signal is within normal limits. No suspicion osseous lesions are seen. Postcontrast sequences are motion degraded, but no pathologic enhancement is definitively appreciated. No evidence of epidural tumor. No pathologic compression fractures. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained. The cervical spinal cord has normal signal characteristics and overall morphology.Mild degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: No significant compromise to the spinal canal or neural foramina.C4-5: There is disc osteophyte complex and right-sided uncovertebral hypertrophy with minimal narrowing of the spinal canal. There is moderate right and mild to moderate left neural foraminal stenosis.C5-6: There is disc osteophyte complex and bilateral uncovertebral hypertrophy with minimal narrowing of the spinal canal. There is mild to moderate bilateral neural foraminal stenosis.C6-7: No significant compromise to the spinal canal or neural foramina.C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.Brachial plexus: There is significant motion degradation on multiple brachial plexus sequences. No suspicious enhancement or clumping is demonstrated to suggest neoplastic involvement of the brachial plexi. No extrinsic compressive masses are evident. There is abnormal T2 hyperintensity involving the right C5 nerve root, best seen on coronal series 13 image 22 as well as coronal series 22 image 18. There is apparent T2 hyperintensity involving the right C7 nerve which is favored to be artifactual.

Output: 1. Degenerative changes in the cervical spine at C4-C5 and C5-C6 with mild to moderate narrowing of the neural foramina right worse in left as detailed above. There may be associated impingement of the right C5 and right C6 nerve roots. Brachial plexus study is significantly motion degraded however there is abnormal T2 signal involving the right C5 nerve root which is favored to be related to the proximal neural foraminal stenosis.2. No evidence of metastatic disease in this cervical spine. Brachial plexus study is motion degraded however no findings to suggest metastatic involvement of the brachial plexus.


Instruction: Generate impression based on findings.

Input: Severe loss in right shoulder range of motion.. Pain, check for tear Motion degrades sensitivityROTATOR CUFF: Extensive changes throughout the entire rotator cuff are observed with marked thickening of the supraspinatus with suspected intrasubstance tear underlying the acromion as well as fraying of the undersurface. Diffuse thickening and associated additional signal suggests marked tendinosis. Additional thickening and abnormal signal within the subscapularis is observed with otherwise grossly intact fibers. The infraspinatus additionally demonstrates abnormal signal and marked thickening within the distal most centimeter with partial tearing at the attachment given that fibers cannot be traced to the humeral head.SUPRASPINATUS OUTLET: Similar mild-to-moderate osteoarthritic changes mildly more pronounced involving the AC jointGLENOHUMERAL JOINT AND GLENOID LABRUM: No gross labral abnormality in this limited nonaugmented examBICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: Marked rotator cuff involving predominantly the supraspinatus and infraspinatus tendons as described.


Instruction: Generate impression based on findings.

Input: Pituitary adenoma with galactorrhea and elevated prolactin. There has been slight interval increase in size of an enhancing T2 hyperintense lesion within the left pituitary lobe, which now measures up to 12 mm, previously 10 mm. There is no mass effect upon the optic apparatus or cavernous sinuses. The pituitary stalk is intact.

Output: Slight interval increase in size of the pituitary adenoma.


Instruction: Generate impression based on findings.

Input: 33-year-old female patient with weakness in the bilateral lower extremities, extreme gastroparesis, and numbness in extremities. Evaluate for multiple sclerosis. BRAIN: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is mild prominence of the optic nerve sheaths. There is a left maxillary sinus mucous retention cyst. SPINE: There is no cord signal abnormality or enhancement within the cervical, thoracic, or lumbar spine. Alignment is anatomic throughout the spine. Vertebral body height and disc spaces are preserved. There is no significant spinal canal stenosis or neural foraminal stenosis.There is a partially imaged nasogastric tube with fluid within the posterior nasopharynx. There is non-specific sclerosis (low T1 and T2 signal) about the sacroiliac joints without evidence of edema, which could reflect osteitis condensans ilii. There is a subcentimeter low T2 signal intensity lesion within the uterine fundus; this is non-specific and can be further evaluated with dedicated pelvic imaging if clinically warranted.

Output: 1. No obvious lesion within the brain or spine to account for the patient's symptoms.2. Mild prominence of the optic nerve sheaths is non-specific and can be a normal finding, but has also been reported in the setting of increased intracranial pressure due to various etiologies including pseudotumor cerebri.


Instruction: Generate impression based on findings.

Input: HCC screening and gallbladder. PBC, RUQ tenderness on palpation. Evaluate gallbladder. ABDOMEN:LIVER, BILIARY TRACT: No suspicious hepatic mass. Patent hepatic vasculature. Unremarkable appearance of the gallbladder. No cholelithiasis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No ascites or varices.

Output: No suspicious hepatic mass. Unremarkable appearance of the gallbladder.


Instruction: Generate impression based on findings.

Input: 81 years, Female, assess recently seen left internal capsule lesion.. There is a small focus of restricted diffusion involving the left anterior limb of the internal capsule near the genu. There is also a focus of more mildly restricted diffusion with isointense ADC signal involving the right posterior frontal semiovale suspected to represent a subacute infarct. There are additional scattered foci of T2/FLAIR hyperintensity in the bilateral periventricular and subcortical white matter as well as the pons which are nonspecific but compatible with chronic small vessel ischemic disease. There is a encephalomalacia in the left occipital lobe consistent with chronic infarct. Additional smaller cortical infarcts are also noted involving the left frontal and right parietal lobes.There is a small, 8 x 5 mm extra-axial enhancing lesion, sagittal postgadolinium series 1101 image 90, along the anterior aspect of the planum sphenoidale, likely representing a meningioma. No intracranial hemorrhage. No intracranial mass-effect. The ventricles are within normal limits in size and configuration for age. There is mild scattered paranasal sinus mucosal thickening with small fluid levels, relatively greater in the left maxillary sinus.Degenerative changes in the partially imaged cervical spine are better assessed on recent CT.

Output: 1. Small acute infarct involving the anterior limb of the left internal capsule near the genu. A punctate focus of likely subacute ischemia is also seen in the right posterior frontal centrum semiovale. 2. Additional chronic cortical infarcts are also seen in the left occipital lobe, left frontal lobe and right parietal lobe. There is also a background of mild to moderate chronic small vessel ischemic disease.3. Subcentimeter enhancing lesion along the anterior planum sphenoidale likely represents a meningioma.


Instruction: Generate impression based on findings.

Input: Unspecified cerebral artery occlusion with cerebral infarctionClinical question: strokeSigns and Symptoms: slurred speech The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.There is a small focus of encephalomalacia present along the isthmus of the right cingulate gyrus.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.No evidence for acute ischemic cerebral infarction.2.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 3.Continued evolution of a small infarction involving the isthmus of the right cingulate gyrus


Instruction: Generate impression based on findings.

Input: 80-year-old male subcentimeter hypodensity in the tail of the pancreas seen on prior CT. ABDOMEN:LIVER, BILIARY TRACT: No suspicious hepatic lesions. Status post cholecystectomy. No biliary ductal dilation.SPLEEN: No significant abnormality noted.PANCREAS: There are three small T2 hyperintense cystic foci throughout the pancreas, some of which demonstrate connection to the pancreatic duct, most compatible with multiple side branch type IPMNs. For future reference, a lesion in the tail the pancreas measures 10 mm (series 7/17), and a lesion at the head measures 10 mm (series 7/22). The smallest lesion is seen in the uncinate process. No suspicious features. Normal caliber of the main pancreatic duct.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts and other too small to characterize T2 hyperintense lesions, likely additional cysts. Stable mild left hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Ileal conduit is partially visualized.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Findings most compatible with multiple small pancreatic side branch IPMNs. Continued follow-up is suggested.


Instruction: Generate impression based on findings.

Input: Left knee pain, prior ACL repair MENISCI: The posterior horn of the medial meniscus is abnormally small which may reflect interval tearing or postmeniscectomy changes. There is abnormal signal within the posterior horn of the medial meniscus near its free edge which extends to both articular surfaces and is suspicious for an oblique tear. Additionally, there is blunting of the free edge of the body which may also reflect interval tearing or meniscectomy changes. A subcentimeter ovoid focus of low signal intensity is noted along the periphery of the meniscus at the junction of the body and posterior horn which is suspicious for a displaced meniscal fragment.There is attenuation of the anterior horn of the lateral meniscus but no discrete meniscal tear is identified.ARTICULAR CARTILAGE AND BONE: There is mild depression of the articular surface of the lateral femoral condyle at the level of the posterior horn of the meniscus which is thought to relate to an impaction fracture sustained at the time of initial ACL injury. There is degenerative thinning of the overlying lateral femoral cartilage but no fluid-filled articular cartilage defects are identified in medial, lateral, or patellofemoral compartments.LIGAMENTS: There are surgical changes relating to ACL repair. The ACL graft appears slightly thickened but is otherwise intact. A small focus of low signal intensity is noted within the joint space anterior to the graft which may reflect a small area of arthrofibrosis (cyclops lesion). The remaining ligamentous structures of the knee are intact.EXTENSOR MECHANISM: A small amount of edema is noted within the superolateral corner of Hoffa's fat pad. The Insall-Salvati ratio is 1.2 (borderline). There is slight prominence of the lateral femoral condyle anteriorly which may reflect a component of mild dysplasia. The tibial tuberosity to trochlear distance is 14 mm which is within normal limits. There is slight lateral translation of the patella in relation to the trochlea.ADDITIONAL

Output: 1. Slight thickening of the ACL graft which is otherwise intact. An area of low signal intensity is noted anterior to the graft which may represent a small focus of arthrofibrosis (cyclops lesion).2. Abnormal morphology of the medial meniscus which could in part be related to prior meniscectomy changes; however tearing of the meniscus with a displaced fragment is suspected as described above.3. Additional findings as described above.


Instruction: Generate impression based on findings.

Input: Mild prominence of the ventricles and sulci are appropriate for age. 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 are clear. Fluid signal material is noted in bilateral mastoid air cells. There is no abnormal enhancement within the brain. There is a 10 mm transverse x 5 mm AP x 4 mm craniocaudal enhancing mass within the distal left internal auditory canal, completely intracanalicular in location, without extension beyond the porous acusticus. Images of right internal auditory canal demonstrates the seventh and eighth nerves to be normal in size and symmetric bilaterally without masses or enhancing lesions. The inner ear structures are normal in appearance and symmetric bilaterally without congenital inner ear anomalies identified on either side. There are no vascular anomalies.

Output: 1.There is a 10 mm transverse x 5 mm AP x 4 mm craniocaudal enhancing mass within the distal left internal auditory canal, completely intracanalicular in location, without extension beyond the porous acusticus.2.Fluid signal material is noted in bilateral mastoid air cells.


Instruction: Generate impression based on findings.

Input: There is grade 1 anterolisthesis of L4 on L5. The vertebral column alignment is otherwise within normal limits. The vertebral body heights are preserved. There is multilevel disc desiccation and mild loss of intervertebral disc height throughout the lumbar spine. The bone marrow appears unremarkable. The distal spinal cord and conus medullaris display normal signal. However, there is redundancy of the cauda equina nerve roots above the level of stenosis at L1. The paravertebral soft tissues are unremarkable. At T10-11, there is a relatively large right paracentral/foraminal disc protrusion, bilateral ligamentum flavum hypertrophy/facet arthropathy, with effacement of the right ventral aspect of the thecal sac and mild mass effect on the distal spinal cord with mild overall spinal canal stenosis, and severe right neural foraminal stenosis. At T11-T12 and T12-L1, there is mild bilateral facet mild bilateral facet arthropathy and ligamentum flavum hypertrophy, but no significant spinal canal or neural foraminal narrowing. At L1-L2, there is a disc bulge with left paracentral disc extrusion, bilateral facet arthropathy and ligamentum flavum hypertrophy, with severe spinal canal stenosis, and mild to moderate bilateral neural foraminal stenosis. At L2-L3, there is a disc bulge, bilateral facet arthropathy and ligamentum flavum hypertrophy, with severe spinal canal stenosis and mild to moderate bilateral neural foraminal narrowing. At L3-L4, there is a disc bulge, bilateral facet arthropathy and ligamentum flavum hypertrophy, with severe spinal canal stenosis and mild left and severe right neural foraminal narrowing. At L4-L5, there is a disc bulge with a right foraminal and lateral disc protrusion, bilateral facet arthropathy and ligamentum flavum hypertrophy, with severe spinal canal stenosis, severe right neural foraminal narrowing, and mild to moderate left neural foraminal narrowing. At L5-S1, there is a disc bulge eccentric to the left, facet arthropathy/ligamentum flavum hypertrophy, but no significant spinal canal stenosis. There is moderate left and mild right neural foraminal stenosis at this level, however.

Output: Multilevel degenerative spondylosis in the lumbar spine, including severe spinal canal narrowing at L1 though L5, as well as moderate to severe right neural foraminal narrowing at L3-4 and L4-5.


Instruction: Generate impression based on findings.

Input: 55-year-old female patient with pain with movement, subjective weakness. Evaluate for tendinopathy or right rotator cuff tear. ROTATOR CUFF: The subscapularis tendon is intact with increased signal intensity near its insertion compatible with tendinopathy. The supraspinatus tendon is intact with increased signal intensity near its insertion compatible with tendinopathy. The infraspinatus tendon is intact with increased signal intensity near its insertion compatible with tendinopathy. There is a focus of calcium in the tendon near its insertion consistent with calcific tendinopathy. The teres minor tendon is intact.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is tearing of the anterior horn of the labrum and loss of the superior aspect of the posterior horn.BICEPS TENDON: The biceps tendon is intact. ADDITIONAL

Output: 1. Calcific tendinopathy of the infraspinatus without rotator cuff tear.2. Tendinopathy of the subscapularis and supraspinatus tendons.3. Tearing of the labrum.


Instruction: Generate impression based on findings.

Input: Male, 2 years old, with history of hypoxia in the setting of respiratory distress, extubated on 4/12 with lip smacking and eye twitching. Assess for evidence of hypoxic injury or other abnormality. The cerebral and cerebellar hemispheres and brainstem show normal signal intensity and morphology. No restricted diffusion is seen. No evidence of parenchymal edema, mass, or mass effect is seen. There is no evidence of intracranial hemorrhage or abnormal extra-axial fluid. The ventricular system is normal in caliber and morphology.

Output: Unremarkable examination.


Instruction: Generate impression based on findings.

Input: 39 year old female with a personal history of left breast IDC and DCIS status post lumpectomy in 2007 followed by radiation, chemotherapy, and hormonal therapy. No current breast complaints. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.Expected volume loss and lower inner quadrant post surgical architectural distortion are present in the left breast. Previously seen skin enhancement in the right breast is no longer present.No abnormal enhancement is seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Compared to prior MRI, interval postsurgical changes of right temporal craniotomy are seen. Previously seen enhancing solid component of the tumor appears to have been completely resected. There remains a cyst medial to the resection cavity without peripheral enhancement and appear smaller than prior. There is been interval decrease in mass effect on the right temporal horn.Expected postsurgical changes include resection cavity with blood products, small extra-axial collection, dural enhancement, and pneumocephalus. No large hemorrhage, significant edema, new mass effect or infarct is appreciated. No midline shift or herniation. No hydrocephalus. Small right cerebellar development of venous anomaly is incidentally noted.

Output: Interval postsurgical changes of right temporal tumor resection. The enhancing solid component of the tumor appears to have been completely resected. There remains a cystic component of the lesion without peripheral enhancement more medially which is smaller than prior.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Female, 46 years old, with right temporal epilepsy. Presurgical planning exam. Sensorimotor cortical activity maps as expected along the pre- and post-central gyri. All tested language paradigms produced reliable language related activity with the exception of the object naming paradigm. Language is left dominant. Broca's area maps to its expected location in the left inferior frontal lobe (pars opercularis and triangularis). Wernicke's area maps to its expected location along the posterior aspect of the left superior temporal gyrus. Mild right sided Broca's area contributions are also seen with certain language tasks which is a common finding.

Output: Successful functional MRI for surgical planning purposes. Sensorimotor cortical activity maps as expected along the pre- and post-central gyri. Language is left dominant with Broca's and Wernicke's areas mapping to their expected locations.


Instruction: Generate impression based on findings.

Input: 61-year-old female patient with Crohn's disease of ileum and perianal area with perianal pain. Evaluate for perianal abscess or fistula. PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is a small tract of signal abnormality arising off the 1'clock position of the distal rectum/anus (image 25, series 1101) which continues posteriorly and tapers in diameter near the cutaneous surface; it is unclear if it terminates as a sinus tract or communicates with the cutaneous surface as a fistula. There is no associated abscess collection. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No intrapelvic abscess is identified.

Output: Small sinus tract/fistula arising from the distal rectum/anus. No abscess is identified.


Instruction: Generate impression based on findings.

Input: Clinical question: History of lung cancer with metastases to brain. Evaluate for edema or new metastases. Signs and symptoms: Left hand locking up and left leg heaviness. Pre-and post enhanced brain MRI:Examination demonstrate multiple new small bilateral hemispheric and cerebellar metastatic lesions since prior exam. Radiologist supratentorially no metastatic lesion measures approximately at 6-mm in transaxial dimensions and located superficially in the left posterior temporal -- parietal junction. All additional new metastatic lesions are significantly smaller in size.There is evidence of interval decreased size of few previously known metastatic lesions since prior exam. A left posterior temporal metastatic lesion measures at 5.4-mm compared to prior study measurement of approximately 8.5 mm.There is no evidence of hemorrhage or any significant surrounding vasogenic edema or mass effect. The ventricular system remain within normal size and with maintained midline.Calvarium demonstrate no metastatic lesions.Images through the orbits and including axial fat sat post enhanced series are unremarkable.

Output: 1.Multiple new supratentorial and infratentorial small metastatic lesions since prior exam as detailed/measured above.2.Several decreased size of multiple previously known metastatic lesions as detailed.3.No significant peritumoral edema, mass effect or midline shift.


Instruction: Generate impression based on findings.

Input: Orbital cellulitisClinical question: assess after ENT decompressionSigns and Symptoms: s/p abscess drainageEpidural abscess There is redemonstration of ring-enhancing fluid collection along the left superior lateral aspect of the orbits which extends from the extraconal space to the preseptal space and superficial to the left cerebral orbital rim. It measures 15 x 25 mm axial dimensions. In general it appears larger on the current MRI exam relative to the prior CT exam. There is associated infiltration along the left extraconal space. The distance between the interzygomatic line and the left eye lens is approximately 21 mm.There is vacuum and meningeal enhancement present adjacent to the left frontal lobe. There is enhancement present across the left superior orbital roof. There is some leptomeningeal enhancement adjacent to the left frontal lobe.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate partial opacification of the left-sided paranasal sinuses more than the right sided paranasal sinuses. The visualized portions of the mastoid air cells demonstrate partial opacification of the mastoid air cells.

Output: 1.There is a left orbital abscess present centered in the left superior lateral aspect of the left orbit preseptal space at the expected location of the lacrimal gland which extends across the left extraconal space including the superior aspect of the extraconal space as well as the subcutaneous tissues surrounding the left orbit. 2.There is associated with the pachymeningeal and leptomeningeal enhancement adjacent to the left frontal lobe suggesting possible intracranial extension with meningitis.3.Findings are suspicious for proptosis on the left side.4.There are inflammatory changes present within the left ethmoid air cells and the left maxillary sinus which were also present on the prior exam and likely related to sinusitis


Instruction: Generate impression based on findings.

Input: A 59 years old male with HCV and past liver transplant, chronic kidney disease. Referred to MRI to evaluate suspected hypertrophic cardiomyopathy on echocardiography. Left VentricleThe left ventricle has hyperdynamic systolic function with normal size. A basal septum is 14mm thick and the posterior wall is 11mm thick. Although there is regional variation in the hypertrophy, strict criteria for hypertrophic cardiomyopathy are not met. Additionally, the regional function, as assessed by myocardial tagging, reveals preserved intramyocardial function. The overall LV ejection fraction is 72%, the LV end diastolic volume index is 54 ml/m2 (normal range: 74+/-15), the LVEDV is 123 ml (normal range 142+/-34), the LV end systolic volume index is 15 ml/m2 (normal range 25+/-9), the LVESV is 34 ml (normal range 47+/-19), the LV mass index is 52 g/m2 (normal range 85+/-15), and the LV mass is 118 g (normal range 164+/-36). There are no regional wall motion abnormalities present.There is small amount of late gadolinium enhancement in the mid-myocardium only in the mid segment of the inferolateral wall. This finding is atypical for myocardial infarction and suggest the presence of a mild underlying fibrosing, infiltrative, or inflammatory process, such as old myocarditis. No evidence of iron overload. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle has hyperdynamic systolic function with normal size. The overall RV ejection fraction is 71%, the RV end diastolic volume index is 52 ml/m2 (normal range 82+/-16), the RVEDV is 119 ml (normal range 142+/-31), the RV end systolic volume index is 15 ml/m2 (normal range 31+/-9), and the RVESV is 34 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation. There is a mild systolic anterior motion of the mitral leaflets and chordal structures causing mild flow acceleration in the left ventricular outflow tract.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac Finding.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 has hyperdynamic systolic function with normal size, LVEF 72%. There are no regional wall motion abnormalities present. There is mild left ventricular hypertrophy with some degree of region variation; however, strict criteria for hypertrophic cardiomyopathy are not met.2. There is small amount of late gadolinium enhancement in the mid-myocardium only in the mid segment of the inferolateral wall. This finding is atypical for myocardial infarction and suggest the presence of a mild underlying fibrosing, infiltrative, or inflammatory process such as old myocarditis.3. The right ventricle has hyperdynamic systolic function with normal size, RVEF 71%. 4. There is mild systolic anterior motion of the mitral leaflets/ chordal apparatus associated with mild flow acceleration in the LVOT.


Instruction: Generate impression based on findings.

Input: 58 year-old male with primary aldosteronism, severe hypertension and hypokalemia. Evaluate for adrenal nodule. ABDOMEN:LIVER, BILIARY TRACT: Subcentimeter foci of fluid signal intensity in the liver are too small to characterize, but likely represent simple cysts.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted. No focal mass lesions or suspicious nodules are identified. KIDNEYS, URETERS: Foci of fluid signal intensity are identified within the kidneys bilaterally, consistent with simple cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Multiple foci of signal abnormality identified within multiple vertebral bodies of the lumbar spine most consistent with hemangiomas. OTHER: No significant abnormality noted.

Output: No evidence of adrenal nodule or mass, as clinically questioned.


Instruction: Generate impression based on findings.

Input: Female 58 years old Reason: Pancreatic Cancer? or other cause of ductal dilatation History: abdominal pain ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: There is a 1.6 x 2.3 cm hypo enhancing mass within the pancreatic neck/proximal body (series 1602, image 44). There is is marked pancreatic duct dilatation and atrophy of the distal pancreatic body and tail with associated loss of normal T1 hyperintense signal distal to the mass. At its superior aspect the mass narrows the portal vein at the confluence. There is infiltration of the fat surrounding the mass and extending superiorly towards the region of the hepatic artery and hepatic artery involvement is not excluded. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Subcentimeter T2 hyperintensities in the kidneys are likely cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 2.3-cm hypoenhancing mass within the pancreatic neck/proximal body. This is suspicious for malignancy, favor adenocarcinoma.


Instruction: Generate impression based on findings.

Input: Left knee pain MENISCI: There is complex increased signal within the medial meniscus, particularly within the posterior horn, suggesting the presence of at least an oblique tear. Additionally, there is extrusion of the body of the medial meniscus into the medial gutter.The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is full-thickness cartilage loss of the medial compartment involving both the femoral condyle and the tibial plateau. There is underlying degenerative marrow signal. These findings have progressed from the prior exam. The lateral compartment also demonstrates moderate thinning. Additionally, there is full-thickness articular cartilage loss superimposed upon mild to moderate thinning diffusely. LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted. Subcutaneous edema fluid seen overlying the patella soft tissues.ADDITIONAL

Output: Progression of articular cartilage loss of the knee most notably within the medial compartment where there is extensive full-thickness loss with associated degenerative marrow signal and extrusion of the medial meniscus which appears torn.


Instruction: Generate impression based on findings.

Input: Patient used prophylactic antibiotics before and after the procedure as prescribed. The patient received antibiotic prophylaxis with oral Ciprofloxacin 500mg and Keflex 500 mg. The patient took 1 tablet of Ciprofloxacin 500mg the night before and morning of the procedure. The patient also took 2 tablets of Keflex 500 mg the morning of the procedure. After the procedures, the patient will take 2 tablets of Ciprofloxacin 500mg and 2 tablets of Keflex 500 mg.Following the discussion of the risks, benefits, and alternatives of the procedure, informed consent was obtained.  DynaCad was used to localize the right anterior apex of the prostate at the site of the T2 hypointense lesion. Using the Dynatrim guidance system an 18-gauge MR- compatible needle was inserted into the right side of the prostate. Upon confirmation of the tip of the needles close to the suspected lesion, MR guided biopsy using an 18 gauge biopsy needle was performed and 3 cores were obtained.Subsequently, DynaCad was used to localize the left anterior apex of the prostate at the site of the T2 hypointense lesions. Using the Dynatrim guidance system an 18-gauge MR- compatible needle was inserted into the left side of the prostate. Upon confirmation of the tip of the needles close to the suspected lesion, MR guided biopsy using an 18 gauge biopsy needle was performed and 3 cores were obtained. The cores were hand delivered to the pathology lab.The patient tolerated the procedure well and was discharged without any immediate complications.ESTIMATED BLOOD LOSS: Less than 5 cc.

Output: Successful core-biopsies of the 1.3 cm right anterior apex and 7 mm left anterior apex prostate gland lesions.


Instruction: Generate impression based on findings.

Input: 67-year-old woman with right breast ILC and DCIS presents for staging bilateral breast MRI. There is heterogeneous amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally. This limits the sensitivity of MRI in detecting subtle lesions.RIGHT BREAST: In the right breast upper outer quadrant, there is a heterogeneously enhancing mass with clip artifact along the anterior aspect consistent with the biopsy proven cancer. The mass has a tubular bilobed morphology and measures 3.0 x 1.0 x 1.5 cm. Also in the right breast at the upper quadrant near the 12:00 position, superior and medial to the index cancer is an area of non mass enhancement, indeterminate. This area measures approximately 1.7 x 0.8 x 0.8 cm and when correlated to the most recent mammogram, heterogeneous/amorphous calcifications are extending close to this area. Stereotactic biopsy targeting the amorphous calcifications can be performed. Alternatively, MR guided biopsy of the non mass enhancement could be considered if there is difficulty targeting the calcifications. Additional rounded subcentimeter foci of enhancement seen scattered throughout the right breast while nonspecific are likely related to background parenchymal enhancement.No abnormal lymph nodes are identified in the right axilla.LEFT BREAST: Clip artifact is seen near the 12:00 position at the site of benign stereotactic biopsy. Scattered rounded subcentimeter foci of enhancement are seen throughout the left breast, nonspecific and likely related to background parenchymal enhancement. No discrete enhancing mass or suspicious focus of enhancement is identified. No abnormal lymph nodes are identified in the left axilla.

Output: (1) Heterogeneously enhancing mass with associated clip artifact in the right upper outer quadrant measuring up to 3.0 cm, consistent with biopsy-proven cancer.(2) Non-mass enhancement in the right breast 12 o'clock location, superior and medial to the index cancer measuring up to 1.7 cm, indeterminate. When correlated to the most recent mammogram, heterogeneous/amorphous calcifications are identified near this area. Stereotactic biopsy targeting the calcifications can be performed.(3) No abnormal enhancement in the left breast or either axilla.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Assess hepatic vessel patency. Status post orthotopic liver transplant in 1990. Recurrent cirrhosis. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology with regions of confluent fibrosis with no suspicious focal lesion. Two small hepatic cysts.Dilated patent portal vein. TIPS catheter in expected position was better opacified on the prior study with poor opacification near its middle hepatic vein landing site on today's examination.Diffuse iron deposition.SPLEEN: Splenomegaly measuring 17 cm in length without a focal lesion. Perisplenic collateral vessels.PANCREAS: 9 mm pancreatic head cystic lesion appears to communicate with the normal caliber main pancreatic duct, compatible with a side branch IPMN without suspicious imaging features, unchanged.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.The TIPS catheter is poorly opacified at the level of the middle hepatic vein landing site, especially when compared to the prior. Consider ultrasound evaluation if there is concern for TIPS thrombosis/stenosis. No ascites.2.Cirrhosis and stigmata of portal hypertension (splenomegaly and perisplenic collateral vessel formation). No suspicious liver lesion.3.Stable pancreatic head subcentimeter sidebranch IPMN without suspicious imaging features.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate subdural hematoma. Signs and symptoms: Headache. Pre and post enhanced brain MRI:Diffusion weighted images are partially obscured due to metallic artifacts in the posterior fossa on the left as well as right anterior cerebral hemisphere. Beyond the artifacts no evidence of acute ischemic process is noted.Examination demonstrates significant interval decreased size of right hemispheric convexity subdural since prior study. A small residual right anterior frontal subdural measures maximum of 7 mm in thickness with subtle mass effect on the adjacent parenchyma. A large left hemispheric convexity subdural is again noted. There is slight interval increased size of subdural since prior study. In the left anterior subdural measures approximately 22 mm in thickness compared to prior study measurement of 17. In the left posterior frontal the subdural measures approximately a 22 mm compared to prior study measurement of 18. There is also subtle interval increased susceptibility signal within the subdural since prior study suggestive of new hemorrhage or be secondary to interval surgical intervention. There is a new right frontal burr hole since prior study.There is interval increased size of supratentorial ventricular system and with evidence of new midline shift of approximately 7 mm at the level of septum pellucidum.Metallic artifact from multiple surgical clips in the right sylvian fissure and a catheter in the posterior fossa on the left is noted. There are few small foci of subcortical and periventricular FLAIR hyperintensity which are more conspicuous on current exam likely secondary to decreased right sided subdural. Similar to prior exam on post enhanced images there is thickening and enhancement of dura along the entire extent of bilateral subdurals. There is also similar to prior exam there is a ringlike focus of enhancement at approximately the level of the tip of left posterior fossa catheter measuring at 6 x 10 mm on axial post enhanced series 12 image 8.

Output: 1.Significant interval decreased size of right hemispheric convexity subdural with 7 mm thick right anterior frontal residual.2.Slight interval increased size of left hemispheric convexity subdural as detailed/measured above.3.Interval mild enlargement of supratentorial ventricular system and new rightward deviation of midline of 7 mm.4.New left sided burr hole and subtle signal changes within the left subdural suggestive of new hemorrhage.5.Similar to prior exam dural thickening and enhancement along bilateral subdurals are again identified.6.Small focus of enhancement at the level of tip of posterior fossa catheter on the left is again noted.


Instruction: Generate impression based on findings.

Input: Severe back pain radiating into leg, question positive SLR on right. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is moderate degree of dextroscoliosis with apex at the L1-L2 level, which has progressed since 3/2/2012 and can be correlated with radiographs. There is also mild retrolisthesis of L1 on L2 and L2 on L3 as well as mild anterolisthesis of L3 on L4 and L5 on S1. There is fusion across the L1-L2 disc space. There is also severe disc height loss at the L4-L5 and L5-S1 levels as well as the left aspect L2-L3 disc space. Degenerative multilevel endplate marrow signal changes are seen particularly at the L2-L3 and L5-S1 levels. Vacuum phenomenon and subchondral cyst formation better seen on CT abdomen from 10/2/2015.. No suspicious osseous lesions. The conus medullaris is normal in position.Individual levels as below: L1-L2: Mild retrolisthesis and disc bulge. No spinal canal stenosis. There is moderate to severe left greater than right neural foraminal stenosis. L2-L3: Mild retrolisthesis and disc bulge. Advanced facet arthropathy, particularly on the left. There is effacement of the left lateral recess. No significant central canal stenosis. Right neural foramen is patent. There is mild to moderate left neural foraminal stenosis. L3-L4: Mild anterolisthesis and asymmetric left sided disc bulge which effaces the left lateral recess and also contributes to moderate left-sided neural foraminal stenosis. There is also moderate central canal stenosis. Minimal right neural foraminal narrowing.L4-L5: There is a right foraminal disc protrusion and facet arthropathy resulting in moderate right neural foraminal stenosis. There is mild left neural foraminal stenosis. No significant central canal stenosis.L5-S1: Mild anterolisthesis and minimal disc bulge. There is no significant central canal stenosis. There is partial effacement of the lateral recesses. There is moderate to severe bilateral neural foraminal stenosis.Fatty atrophic changes are noted in the lower lumbar paraspinous musculature. Spinal soft tissues are otherwise unremarkable.

Output: Advanced degenerative changes throughout the lumbar spine including dextroscoliosis which demonstrates progression when compared to remote lumbar spine MRI study from 3/2/2012. There is up to moderate central canal stenosis at L3-L4 level. There is also significant multilevel neural foraminal stenoses as detailed above.


Instruction: Generate impression based on findings.

Input: 60 year-old female with right hip pain. There is severe osteoarthritic degeneration of the right hip joint including bone-on-bone narrowing, severe subchondral sclerosis and subchondral cysts, as well as osteophyte formation. There is osteophyte formation at the greater trochanter as well.

Output: Severe osteoarthritic degeneration of the right hip.


Instruction: Generate impression based on findings.

Input: 60-year-old man with history of pain and weakness, evaluate for rotator cuff tear. ROTATOR CUFF: There are postoperative findings of rotator cuff repair with surgical anchors within the humeral head. Compared to the prior study, there is a new full-thickness, full width tear of the insertional supraspinatus tendon (series 4, image 10) with approximately 13 mm retraction of the proximal tendon. Additionally, there is mild muscle atrophy of the supraspinatus belly. Increased T2 signal within the distal fibers of the infraspinatus tendon indicate severe tendinosis. There is mild atrophy of the infraspinatus and subscapularis muscles. A small amount of fluid is noted in the subacromial/subdeltoid bursa.SUPRASPINATUS OUTLET: There is a type I acromion with mild degenerative change at the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenoid labrum is intact and the glenohumeral joint alignment is anatomic.BICEPS TENDON: There are postoperative findings of biceps tenodesis with partially imaged surgical screw in the mid humerus. ADDITIONAL

Output: 1.New full thickness, full width retracted tear of the supraspinatus tendon.2.Infraspinatus tendinopathy without discrete tear.3.Postoperative findings of biceps tenodesis.


Instruction: Generate impression based on findings.

Input: Seizure, evaluate for infection MRI brain:T2 hyperintense T1 hypointense lesion at the gray-white junction of the left superior frontal gyrus has not significantly changed in size now measuring 1.4 x 1.2 cm (image 29, series 7). There is again no internal enhancement within this lesion, with an adjacent vessel again noted. There is no surrounding signal abnormality to suggest edema.No diffusion restriction is seen to suggest acute ischemia. No abnormal areas of enhancement are seen. The CSF spaces are appropriate for the patient's stated age with no midline shift. Normal vascular flow voids are present in the major intracranial vasculature.Moderate to severe mucosal thickening is seen throughout the paranasal sinuses. The mastoid air cells and middle ears are partially opacified. These findings are new from the prior study. The visualized portions of the orbits are intact.Nasogastric tube is seen in place with fluid filling the nasopharynx.MRV brain:The intracranial dural sinuses are patent without evidence of thrombosis.

Output: 1.No change in left superior frontal gyrus lesion.2.Moderate to severe mucosal thickening of the paranasal sinuses with partial opacification of the mastoid air cells and middle ears.3.No evidence of dural sinus thrombosis.


Instruction: Generate impression based on findings.

Input: Low back pain [M54.5], Reason for Study: ^Reason: evaluate for neuroforaminal stenosis History: lumbago, sciatica, hx osteoporosis For the purposes of numbering, the lower most fully formed vertebral disc space is considered the L5-S1 intervertebral disc space. There is a lumbarized S1.There is straightening of the lumbar lordosis. Mild to moderate endplate irregularity with edema is demonstrated at L5-S1. Otherwise, the vertebral body heights are maintained. There is mild loss of intervertebral disc space at T12-L1 and moderate loss of intervertebral disc space at L5-S1. The conus terminates at distal L1. The visualized spinal cord and cauda equina demonstrate normal signal intensity and morphology. No focal worrisome marrow signal or abnormal postcontrast enhancement is identified.T11-12: No significant disc herniation, neuroforaminal stenosis, or spinal stenosis is noted at this level.T12-L1: There is a small right paracentral abutting the right anterior spinal cord. No significant neuroforaminal stenosis is noted.L1-2: No significant disc herniation, neuroforaminal stenosis, or spinal stenosis is noted at this level.L2-3: No significant disc herniation, neuroforaminal stenosis, or spinal stenosis is noted at this level.L3-4: No significant disc herniation, neuroforaminal stenosis, or spinal stenosis is noted at this level.L4-5: There is a disc bulge resulting in mild neuroforaminal narrowing bilaterally. There is also epidural lipomatosis deforming the left posterior lateral thecal sac (series 900, image 30). There are moderate bilateral facet degenerative changes with bilateral facet effusions.L5-S1: There is a diffuse disc bulge resulting in moderate bilateral neuroforaminal stenosis and mass effect on the traversing bilateral S1 nerve roots. There is also anterior and posterior epidural lipomatosis resulting in central spinal stenosis. There are moderate bilateral facet degenerative changes.

Output: 1. Anterior and posterior epidural lipomatosis from L4 to S1 levels contributes to central spinal stenosis. 2. There is a diffuse disc bulge at L5-S1 resulting in moderate bilateral neuroforaminal stenosis with compression of the bilateral traversing S1 nerve roots.3. At L4-5 there is a diffuse disc bulge resulting in mild bilateral neuroforaminal stenosis.4. There are moderate facet degenerative changes at L4-5 and L5-S1.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for disk protrusion, mass. Signs and symptoms: Right thoracic back pain. Unenhanced thoracic MRI:There is normal anatomical development and alignment of the vertebral column. The signal intensity of vertebral column is within normal on all MRI sequences. There is no evidence of spinal canal or neural foraminal compromise or stenosis at any level. There is no detectable degenerative changes, mass or mass effect and no evidence of disc protrusion as is questioned clinically.There is redemonstration of a previously known horseshoe kidney and otherwise unremarkable perispinal soft tissues. There is normal signal intensity and caliber of the cord. There is normal termination of the cord at lower L1 level.

Output: Unremarkable nonenhanced MRI of the thoracic spine.


Instruction: Generate impression based on findings.

Input: 74-year-old female with fluid collection versus obstruction ABDOMEN:LUNG BASES: New right-sided pleural effusion and right lower lobe airspace opacities which may represent atelectasis versus early pneumonia.LIVER, BILIARY TRACT: Mild splenomegaly. Cholelithiasis is unchanged.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Left adrenal adenoma, unchanged.KIDNEYS, URETERS: Moderate right hydronephrosis with hydroureter slightly worsened compared to previous study.Subcentimeter cyst off the left lower pole kidney.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Mild dilatation of the proximal small bowel loops measuring up to 4.2-cm. distal small bowel loops in the pelvis are decompressed. These findings are suggestive of mild and likely partial small bowel obstruction. No evidence of abscess.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Not visualized.BLADDER: Not visualized.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Right lower quadrant ostomy with ileal conduit.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Ill-defined fluid collection in the right side of the pelvis and one the small bowel loops likely measures 3.9 x 3 cm. This is difficult to differentiate from the nonopacified small bowel loops. Small amount of free fluid is also likely present in the pelvis. Further evaluation of this collection with MRI of the pelvis may be helpful, if clinically indicated.

Output: Partial small bowel obstruction.Ill-defined possible small bowel obstruction which is difficult to differentiate from surrounding unopacified bowel loops on the right side of the pelvis. Further evaluation of this collection with pelvic MR may be helpful, if clinically indicated.Slight interval worsening of the right-sided moderate hydronephrosis and hydroureter.New right-sided pleural effusion and dependent air space opacities which represent atelectasis versus early pneumonia.Dr. Famakinwa was notified and acknowledged at the time of dictation.


Instruction: Generate impression based on findings.

Input: 70 years Female (DOB:8/29/1945)Reason: Patient with left back and hip pain with sciatica. Please identify lumbar spine pathology. History: Patient with left back and hip pain with sciatica.PROVIDER/ATTENDING NAME: ELBERT S. HUANG ELBERT S. HUANG Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is bilateral facet hypertrophy of moderate degree associated with ligamentum flavum hypertrophy. The fat at the lateral recess is not effaced on either side. The right-sided exiting nerve root within the neural foramen appears thickened at this level there is a cystic structure at the lateral most aspects of the neural foramen associated with the facet joint which encroaches on the right-sided exiting nerve root within the neural foramen.At L4-5 there is loss of disc space height, disc desiccation, diffuse disc bulge and bilateral facet and ligamentum flavum hypertrophy associated with mild anterior subluxation of L4 on L5 and narrowing of the spinal canal with crowding of the nerve roots within the thecal sac and effacement of the fat at the lateral recess. Overall there is a moderate to severe degree of spinal stenosis at this level. The neural foramina are narrowed bilaterally at this level but worse on the left lung compared to the right side and there is encroachment of the exiting nerve roots bilaterally within the neural foramina but worse on the left than the right side.At L3-4 there is loss of disc space height, disc desiccation and a diffuse disc bulge associated with ligamentum flavum and facet hypertrophy. Although the neural foraminal are narrowed, within the neural foramina the exiting nerve roots are surrounded by fat. There is mild encroachment of the nerve roots of the left lateral recess at this level.At L2-3 there is no significant compromise to spinal canal or neural foramina. There is a disc bulge present at this level associated disc desiccation and mild loss of disc space height.At L1-2 there is no significant compromise to spinal canal or neural foramina.There are multiple small cysts present within the kidneys. In the larger one along the left kidney which is not well demonstrated on this exam but measures approximately 4 to 5 cm in size.At T10-11 there is obliteration of the disc space height. There appears to be a disc protrusion at that level but does not appear to compromise to spinal cord.

Output: 1.There are multilevel degenerative changes present in the lower lumbar spine with moderate to severe degree of spinal stenosis at L4-5 related to disc disease and facet disease as well as subluxation. 2.There is encroachment of exiting nerve roots within the right neural foramen at L5-S1 due to right-sided facet disease and a cystic lesion adjacent to the right facet joint.3.There is encroachment of exiting nerve roots within the right neural foramen at bilaterally at L4-5 related to degenerative changes4.There are degenerative changes also present in the thoracic spine which are not well documented on this exam.


Instruction: Generate impression based on findings.

Input: 37 year old woman with history of NICM, referred for evaluation of infiltrative disease and constrictive physiology. Left VentricleThe left ventricle is normal in size with severely reduced systolic function. The overall LV ejection fraction is 22%, the LV end diastolic volume index is 73 ml/m2 (normal range: 65+/-11), the LVEDV is 85 ml (normal range 109+/-23), the LV end systolic volume index is 57 ml/m2 (normal range 18+/-5), the LVESV is 66 ml (normal range 31+/-10), the LV mass index is 31 g/m2 (normal range 67+/-11), and the LV mass is 36 g (normal range 114+/-24). LV dysfunction is global. The myocardial native T1 time is 1047, which is within normal range. There is no evidence of iron overload on T2 star imaging. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with moderately reduced systolic function. The overall RV ejection fraction is 35%, the RV end diastolic volume index is 58 ml/m2 (normal range 69+/-14), the RVEDV is 68 ml (normal range 110+/-24), the RV end systolic volume index is 38 ml/m2 (normal range 22+/-8), and the RVESV is 44 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 trace pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no significant pericardial thickening. No evidence of myocardial to pericardial tethering on myocardial tagging imaging. No respiratory-related changes in interventricular septal position. There is no MRI findings consistent with constrictive physiology.Extracardiac FindingsRight adnexal cyst noted, please refer to dedicated abdominal imaging studies for further description. 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. No imaging evidence of infiltrative disease or constrictive physiology; however, no late gadolinium enhancement image was performed due to patient's contra-indication to gadolinium.2. The left ventricle is normal in size with severely reduced systolic function. The overall LV ejection fraction is 22% without evidence of myocardial fibrosis, based on the presence of normal native myocardial T1 times.3. The right ventricle is normal in size with moderately reduced systolic function. The overall RV ejection fraction is 35%. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 77 years Female (DOB:12/26/1938)Reason: 77 y/o lady w/ hx of TIA who p/w dizziness History: 77 y/o lady w/ hx of TIA who p/w dizzinessPROVIDER/ATTENDING NAME: JONAH N RUBIN JONAH N RUBIN The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.Some foci of marrow replacement are present at C3 and in the spinous process of C4.

Output: 1.There is no evidence for acute ischemic cerebral infarction.2.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related. 3.Some foci of marrow replacement are identified in the visualized upper cervical spine. These are of unknown significance. Please correlate with patient's clinical history. These are nonspecific findings.


Instruction: Generate impression based on findings.

Input: 66-year-old female with chronic open wound, evaluate for osteomyelitis of the right tibia There is a focal defect in the skin along the anterior aspect of the distal tibial diaphysis which likely represents the patient's chronic ulcer. This lesion extends deep into the adjacent tibia where there is increased T2 signal, enhancement and destruction of the anterior cortex, consistent with osteomyelitis. Diffuse edema is seen within the anterior subcutaneous tissues at the level of the ulcer with enhancement, which is nonspecific but may suggest cellulitis. Nonenhancing edema is seen in the posterior and lateral subcutaneous tissues more superiorly. However, no focal fluid collection is evident to suggest abscess formation. A small joint effusion is seen within the visualized knee. The fibula appears intact

Output: Anterior ulcer along the distal leg extending into the adjacent tibia, compatible with osteomyelitis.


Instruction: Generate impression based on findings.

Input: Clinical question to be answered: Response. Clinical question to be answered: Rule-out intracranial process. Extensive decreased density of white matter of both cerebral hemispheres are redemonstrated. There is no evidence of effacement of cortical sulci or mass effect on the lateral ventricles. No evidence of hemorrhage, hydrocephalus or midline shift. In comparison with the prior CT examination from 11 -- 25 -- 2008 and MRI examination from 5 -- 15 -- 2009 no evidence of interval change is detected.

Output: No evidence of new finding since prior study.


Instruction: Generate impression based on findings.

Input: Hypogonadotropic hypogonadism. The pituitary gland demonstrates homogenous enhancement, without evidence of focal lesions. The pituitary stalk is intact and positioned in the midline. The pituitary gland is not enlarged nor atrophic. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is unchanged scattered mild nonspecific cerebral white matter T2 hyperintensity. There is no abnormal intracranial enhancement. The ventricles are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No evidence of pituitary mass.


Instruction: Generate impression based on findings.

Input: There is minimal grade 1 retrolisthesis of C3 on C4 and of C5 on C6, which appears degenerative in etiology. The cervical spine is otherwise in normal alignment, with a slight exaggeration of the normal cervical lordosis. The vertebral body heights are well-maintained. There is multilevel disc narrowing, moderate at the majority of the levels, with mineralization of the C6-C7 disc space. No worrisome focal marrow signal abnormality is appreciated. Mild endplate degenerative marrow changes are noted at C6-C7.As noted on the prior MRI of the brain, there is abnormal signal centrally within the entire visualized cervical cord. There is trace prominence of the central spinal canal just distal to the obex, with a small area of discontinuity before redemonstration of abnormal T2 hyperintensity throughout the center of the cervical cord, extending from mid C2 level into the thoracic cord. Within the cervical cord, this measures up to 7 x 5 mm at the lower C7 level.At C2-C3, there is uncovering the disc with a central disc protrusion which indents the ventral thecal sac and minimally flattens the right paramedian ventral cord. There is mild bilateral facet arthropathy without stenosis.At C3-C4, there is uncovering of the disc with a mild diffuse posterior osteophyte disk complex. There is mild central spinal canal stenosis. There is mild bilateral uncovertebral hypertrophy and ligamentum flavum thickening. There is mild to moderate right foraminal narrowing and moderate left foraminal narrowing.At C4-C5, there is a mild diffuse posterior osteophyte disk complex with mild central spinal canal stenosis and mild to moderate left foraminal narrowingAt C5-C6, there is uncovering of the disc with superimposed mild diffuse posterior osteophyte disk complex. There is right sided uncovertebral hypertrophy resulting in moderate right foraminal narrowing and mild-moderate central spinal canal stenosis.At C6-C7, there is a mild to moderate diffuse posterior osteophyte disk complex along with mild ligamentum flavum thickening and uncovertebral hypertrophy. There is overall moderate-severe right and moderate left foraminal narrowing and mild central spinal canal stenosis.At C7-T1, there is no significant disk pathology or stenosis.The appearance of the craniocervical junction is unchanged compared to the prior exam, with slight caudal extension of the a still rounded right cerebellar tonsil to 6 mm below the level of the foramen magnum with persistent moderate crowding at this level.THORACIC SPINE

Output: 1.Confirmation of cervical thoracic cord syringohydromyelia as previously suspected, extending from the mid C2 level down to the mid T8 level.2.Redemonstration of crowding at the level of the foramen magnum with mild abnormal caudal extension of the right cerebellar tonsil which could represent a very mild Chiari I malformation although the tonsil remains rounded in morphology.3.Mild-moderate cervical spondylotic changes, most conspicuous at C6-C7 where there is moderate-severe right foraminal narrowing.4.Partially visualized incidental findings, including possible right hepatic cyst, adrenal thickening with possible nodules bilaterally, and mediastinal cystic-appearing structure. Dedicated CT of the chest and abdomen recommended for further evaluation.5.Heterogeneous appearance of the thyroid gland diffusely with multiple foci of T2 hyperintensity. Correlation with thyroid function tests is recommended and thyroid ultrasound may be obtained as clinically indicated.


Instruction: Generate impression based on findings.

Input: 44 year old with history of DLBCL and history of acute pericarditis presenting for evaluation of chest pain and evaluation for chronic pericarditis and/or constrictive physiology. MEDICATIONS: colchicine, prednisone First Pass PerfusionDuring hyperemia, no perfusion defects were present.Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable.Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 58%, the LV end diastolic volume index is 60 ml/m2 (normal range: 65+/-11), the LVEDV is 98 ml (normal range 109+/-23), the LV end systolic volume index is 25 ml/m2 (normal range 18+/-5), the LVESV is 40 ml (normal range 31+/-10), the LV mass index is 45 g/m2, and the LV mass is 74 g. There are no regional wall motion abnormalities present. The native T1 times are mildly to moderately elevated at approximately 1150 ms, possibly due to interstitial fibrosis. Left AtriumThe left atrium is grossly normal in size. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 55%, the RV end diastolic volume index is 66 ml/m2 (normal range 69+/-14), the RVEDV is 108 ml (normal range 110+/-24), the RV end systolic volume index is 29 ml/m2 (normal range 22+/-8), and the RVESV is 48 ml (normal range 35+/-13). Right AtriumThe right atrium is grossly 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.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 mild circumferential pericardial thickening with evidence of increased signal on T2-weighted imaging, early gadolinium enhancement, and late gadolinium enhancement. All of these findings are consistent with the diagnosis of inflammatory pericarditis. There is no obvious change in septal motion during respiration; nor is there evidence of pericardial to myocardial tethering noted on myocardial tagging images suggesting the absence of constriction. Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. No perfusion defects/ "ischemia" present during hyperemia.2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and systolic function (LVEF 58%).4. Normal RV size and systolic function (RVEF 55%).5. There is mild circumferential pericardial thickening with evidence of increased signal on T2-weighted imaging, early gadolinium enhancement, and late gadolinium enhancement. All of these findings are consistent with the diagnosis of inflammatory pericarditis. There is no obvious evidence of pericardial constriction. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: There are a few nonspecific foci of T2 hyperintensity in the cerebral white matter, which are unchanged from previous exam, the largest of which measures up to 7 mm in the left frontal lobe. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable. There is mild mucosal thickening and retention cyst formation in the maxillary sinuses.

Output: Unchanged appearance of a few scattered nonspecific T2 hyperintensity in the cerebral white matter, which are nonspecific. No evidence of acute intracranial hemorrhage, mass, or infarction. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 75 years Male (DOB: 1/19/1941)Reason: r/o metastatic disease History: hyperreflexic BLE, c/f upper motor neuron processPROVIDER NAME: THOMAS F. GAJEWSKI THOMAS F. GAJEWSKI MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. There is asymmetry of the lateral ventricles of the right being larger than the left. There is a 15 mm arachnoid cyst in the right middle cranial fossa.Some opacification at the right jugular bulb on T2 and FLAIR imaging is a nonspecific finding which could simply be related to slow flow.There is a T2 signal hyperintense lesion in T1 and FLAIR hypointense lesion located in the left basal ganglia which likely represents an expanded perivascular spaceNo 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. The right high lens is thin.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. There is multilevel disc desiccation present.There is an 11 x 15 mm sagittal dimension enhancing lesion along the posterior aspect of the T2 vertebral body associated with adjacent signal change.At C2-3 there is no significant compromise to the spinal canal or neural foramina. There is mild facet hypertrophy at this level.At C3-4 there is mild to moderate facet hypertrophy present bilaterally at this level but more on the left versus the right side. There are bilateral uncovertebral osteophytes present at this level associated with the effacement of fat surrounding the exiting nerve roots bilaterally. The nerve root encroachment appears to be worse on the left compared to the right side. There is partial effacement of spinal fluid ventral to the spinal cord at this level. Overall there is a mild degree of spinal stenosis presentAt C4-5 there is mild facet hypertrophy present bilaterally at this level but more on the left versus the right side. There are bilateral uncovertebral osteophytes present at this level associated with the effacement of fat surrounding the exiting nerve roots bilaterally. The nerve root encroachment appears to be worse on the left compared to the right side. There is partial effacement of spinal fluid ventral to the spinal cord at this level. Overall there is a mild degree of spinal stenosis presentAt C5-6 there is a disc bulge present at this level associated with some mild effacement of spinal fluid ventral and posterior the spinal cord and mild narrowing of the neural foramina but no significant compromise to spinal canal or exiting nerve roots.At C6-7 there is a disc bulge present at this level associated with some mild effacement of spinal fluid ventral and posterior the spinal cord and mild narrowing of the neural foramina but no significant compromise to spinal canal or exiting nerve roots.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. The right vertebral artery flow-void is not readily identified.Thoracic spine:The overall marrow signal of the lower thoracic spine from T6 through T12 on T1-weighted imaging is high suggesting prior radiation treatment. There are marrow replacing and contrast enhancement lesions present at T2, T7, T10 and T11.The lesion at T2 along the posterior aspect of the vertebral body measures 11 x 15 mm sagittal dimensions. The one at T7 measures 16 x 15 mm sagittal dimensions with a second lesion adjacent to and involving the right pedicle of T7 measuring 30 x 22 mm sagittal dimensions and a third lesion in the right pedicle measuring 12 x 17 mm sagittal dimensions. The lesion at T10 measures 5 mm and is adjacent to the superior endplate. The lesion at T11 is associated with approximately 60% loss of vertebral body height and mild retropulsion. There is some narrowing of the T11-T12 neural foramina present, however, the exiting nerve roots are still surrounded by fat.There is no compromise of thoracic spinal canal or exiting nerve roots. There are small pleural effusions present.Lumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. No contrast enhancing lesions present at L3 and L4 as well as S1 the one at L3 is not the right posterior lateral aspect of the vertebral body and measures approximately 12 mm and is associated with the right anterolateral lesion measuring 13 mm. 1's at L4 are present measuring 16 mm and another measuring 13 mm. There are punctate lesions present in L5 and the lesion at S1 measuring 13 mm.Another lesion is present in the left iliac bone which enhances with contrast and measures approximately 30 x 14 mm. One in the right iliac bone measures 30 x 14 mm axial dimensions.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is a disc bulge present at this level. There is some disc desiccation at this level. There is mild facet hypertrophy at this level.At L4-5 there is there is some disc desiccation and a disc bulge present at this level associated with some ligamentum flavum hypertrophy bilaterally. There is effacement of the fat at the left lateral recess at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.The left kidney is not readily identified.

Output: 1.There are multiple lesions present in the thoracic and lumbar spines as well as the visualized sacrum and iliac bones compatible with metastatic disease as detailed above.2.There is a malignant compression fracture present at T11 with mild retropulsion but no significant compromise to the spinal canal at this time.3.There is no evidence for brain metastases on the basis of this exam.4.The right vertebral artery flow-void is not readily identified throughout its course suggesting possible occlusion along the cervical segment.5.There are some degenerative changes present in the cervical spine with neural foramen encroachment as detailed above.6.There are some mild degenerative changes present in the lumbar spine without significant compromise to spinal canal or exiting nerve roots.7.There are small pleural effusions present.


Instruction: Generate impression based on findings.

Input: 56-year-old male with elevated PSA who presents for evaluation of the prostate gland. Patient with biopsy in August 20, 2011 which showed benign prostatic tissue. PELVIS:PROSTATE:Prostate Size: 5.0 x 3.0 x 3.9 cmPeripheral Zone: There are multiple lesions in the peripheral zone which demonstrate T2 hypointensity with corresponding low ADC signal; these lesions are stable compared to the previous examination. For example, the left lateral peripheral zone lesion from approximately 1 to 3:00 position is unchanged and measures 1.3 x 0.5 cm (series 801, image 13).Central Gland: There is a lesion in the right transitional zone which demonstrates T2 hypointensity with corresponding low ADC signal and early enhancement with washout; this lesion is slightly increased in size compared to the previous examination and measures 1.5 x 1.5 cm (series 801, image 10).Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: No extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Right transitional zone lesion is slightly increased in size compared to the previous examination with signal characteristics as above. This may represent stromal benign prostatic hypertrophy but prostatic adenocarcinoma cannot be excluded.2.Multiple stable peripheral zone lesions with abnormal signal suspicious for prostate carcinoma.


Instruction: Generate impression based on findings.

Input: Clinical question: Rule out CVA. Signs and symptoms: Right upper and lower extremity weakness. Nonenhanced head CT:Large vessel intracranial calcification of bilateral vertebral and cavernous carotids are noted. Images through posterior fossa are unremarkable.On axial images 11 and 12 there is a focus of low attenuation in the pons on the left extending across the midline. This is believed to represent artifact. Please correlate with neurological examination findings and if concern persists recommend and MRI.Images through the supratentorial space demonstrate no detectable hemorrhage, edema, mass effect, midline shift or hydrocephalus. There is a slight prominence of cortical sulci and ventricular system which may represent mild underlying parenchymal volume loss.

Output: 1.No definitive acute intracranial findings.2.Foci of low-attenuation in the pons on the left which also extend across the midline to the right and is believed to represent an artifact. Please correlate with neurological findings and if there is concern for stroke in this region recommend follow-up with CT or an MRI.


Instruction: Generate impression based on findings.

Input: 71-year-old male with Gleason 6/7 prostate cancer. Patient was administered prophylactic intravenous gentamycin prior to the procedure. Following the discussion of the risks (bleeding, infection, pain, soft tissue injury, incontinence, impotence), benefits, and alternatives of the procedure. Informed consent was obtained from the patient. The procedure was performed under moderate conscious sedation with nurse monitoring.The MRI focus in the left mid peripheral zone suspicious for patient's known cancer was localized with T2 weighted MR images. Following sterile preparation, Visualase laser ablation template was placed on to the perineum of the patient and localized on MR images and registered to the MR images where the prostate lesion could be visualized.Following local anesthesia with lidocaine, 14-gauge MR- compatible needles were inserted into the left side of the prostate. Upon confirmation of the tip of the needle in the region of the known lesion, 6 laser ablations (3 sites, 2 depths per site) with 30-W, 90 % power were performed within the left mid peripheral zone of the prostate. The patient tolerated the procedure well without any immediate complications.Pre-and postcontrast axial MR images were obtained before and after administration of 16 ml of MultiHance, upon completion of the procedure. The non-enhancing ablation defect was noted, centered in the left posterior lateral quadrant of the mid gland at the site of prior lesion, but also extending to the left apex and base. Edema was seen within the left aspect of the prostate and periprostatic tissues, corresponding to lidocaine. COMPLICATIONS: NoneBLOOD LOSS: 5 ml

Output: MR guided laser ablation of the left mid gland peripheral zone of the prostate at the site of the previously described suspicious focus.PLAN: The patient was subsequently transferred to the recovery room for nurse monitoring. The patient will be discharged after voiding or with a Foley catheter. The patient will follow-up with urology.


Instruction: Generate impression based on findings.

Input: 48 years Female (DOB:3/6/1967)Reason: please do Dr Javed MS protocol, compare to prior History: MS progression, onTysabri, had speech arrest 9/15, concern for stroke vs PMLPROVIDER/ATTENDING NAME: JACQUELINE T BERNARD JACQUELINE T BERNARD The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a subcortical white matter lesion present in the left parietal lobe. It is hypointense on T1-weighted imaging. There are periventricular white matter FLAIR hyperintense lesions adjacent to the occipital horns of the lateral ventricles bilaterally. These were also present on the prior exam and are not hypointense on T1.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.There is a new subcortical white matter lesion in the left parietal lobe. This is nonspecific especially in isolation. Differential considerations include MS plaque as well as other demyelinating lesions such as early PML.2.No abnormal enhancing lesions are appreciated to suggest acute or subacute plaque.


Instruction: Generate impression based on findings.

Input: Reason: DLBCL w/ CSF involvement. Receiving IT rituximab. History: CSF lymphoma. Images are somewhat limited by patient motion. There is stable ill-defined patchy T2/FLAIR hyperintensity along the medial right basal ganglia. There is no significant residual enhancement in this area. Previously seen FLAIR hyperintensity along the cerebellar tonsils in September 2015 is again no longer appreciated. The previously noted enhancement along the left optic nerve is not well assessed on this exam secondary to motion artifact.There is a stable right frontal approach Ommaya catheter with its tip in stable position along the right foramen of Monro. Ventricular caliber is unchanged.There is trace mucosal thickening in the right maxillary sinus and in scattered ethmoid air cells bilaterally. Flow-voids within the major intracranial vascular structures are present.SPINE

Output: 1. Persistent ill-defined abnormal signal although no significant residual abnormal enhancement along the right basal ganglia region likely representing evolution of lymphomatous involvement.2. Previously seen left optic nerve enhancement cannot be well assessed on this exam secondary to motion.3. No evidence of leptomeningeal disease within the spine.


Instruction: Generate impression based on findings.

Input: A patient submitted outside study for review. Submitted for review are mammographic wire localization (6/8/2016); specimen radiograph (6/8/2016) and breast MRI (8/8/ 2016) performed at Advocate South Suburban Hospital . For comparison, breast mammogram 10/27/2015; ultrasound 10/27/2015 and MRI 10/20/2015 are available. Stereotactic wire localization (6/8/16): Mammogram demonstrates a left retroareolar, central area of architectural distortion/mass measuring approximately 5 cm with clip located centrally. Compared to mammogram 10/27/15 this lesion appears slightly less dense, but mostly unchanged in size. This mass was initially identified on breast ultrasound 9/22/2015. An irregular suspicious hypoechoic mass was noted in the left breast 3:00 position that measured 3.3 x 2.7 x 4.3 cm. An MRI performed 10/20/2015, confirmed an oval heterogenously enhancing mass within the left central breast, retroareolar location measuring approximately 4.0 x 4.0 x 4.2 cm (AP X ML X CC). Ultrasound-guided biopsy of this mass was performed on 10/27/2015, with post biopsy mammogram demonstrating clip in appropriate position within the central mass. Pathology result is not available.Mammogram 6/8/2016, also demonstrates a second clip within the left upper breast, at site of prior lymph node biopsy. This lymph node was first identified on breast MRI 10/20/2015, within the left upper breast measuring 1 cm. This lymph node was confirmed on second look ultrasound performed 10/27/2016, which demonstrated an abnormal intramammary lymph node with thickened cortex within the left breast, 10:00 location, 7cm from the nipple. Subsequent ultrasound-guided biopsy was performed on 10/27/2015, with postbiopsy mammogram demonstrating the biopsy clip in appropriate position. Pathology result is not available.Mammographic guidance needle localization images 6/8/2016 demonstrate the left breast placed in an alphanumeric grid using lateral to medial approach. 2 wires were placed, with one wire targeting the clip within the central left breast mass and the second wire targeting the left intramammary lymph node biopsy clip, in appropriate position.Specimen radiograph 6/8/2016: Specimen radiograph of the mass demonstrates a clip within the breast mass with wire within it. The mass extends to the specimen margin at 3B, 4C, 4D and 6B. Second specimen radiograph shows the clip within the lymph node and the lymph node and wire to be within the specimen. Final pathology has not been submitted. Breast MRI 8/8/2016 post processed on DYNACAD: There is heterogeneous amount of fibroglandular tissue in both breasts. Moderate parenchymal enhancement is noted bilaterally.Within the left central breast at site of prior lumpectomy, a seroma cavity measures 2.5 x 1.4 x 1.1 cm (AP X ML X CC). There is an enhancing spiculated mass, located at 12:00, abutting the superolateral seroma cavity margin, measuring 1.0 x 1.0 x 0.8 cm (AP X ML X CC). Two additional enhancing foci are identified anterior to this mass, and measures 5 mm. The total extent of disease measures 2.8 cm.There is postsurgical changes within the left lateral breast, at site of intramammary lymph node excision and enhancement within the skin along the left lateral breast, probably postsurgical change.No abnormal enhancement is identified within the right breast. No abnormal lymph nodes are identified in either axillary or internal mammary region.

Output: Status post left breast lumpectomy at 2 sites, with post lumpectomy MRI showing residual disease abutting the seroma cavity. No abnormality in the right breast. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.