Instruction: Generate impression based on findings.

Input: Hypoglycemia and growth hormone deficiency. There is a small focus of T1 hyperintensity on the fat-suppressed images in the midline along the stalk of the pituitary with a relatively small posterior pituitary bright spot within the sella, compatible with partially ectopic posterior pituitary gland. There is no abnormal enlargement of the pituitary gland or focal lesion identified within the gland itself. There is apparent dilatation of the lateral and third ventricles. The fourth ventricle appears to be within normal limits. No obstructing lesion is identified. The corpus callosum appears formed, but abnormally thin. Furthermore, there is diffuse paucity of white matter bulk in the cerebral hemispheres. There is no midline shift or herniation. The major cerebral flow voids are intact. There is mild mucosal thickening in the paranasal sinuses. The skull base appears to be somewhat dysplastic.

Output: 1. Findings compatible with partially ectopic posterior pituitary gland.2. Diffuse white matter deficiency with ventriculomegaly, which may be related to growth hormone deficiency. Further evaluation with a dedicated brain MRI may be useful.3. The skull base appears to be somewhat dysplastic, which may also be related to growth hormone deficiency.


Instruction: Generate impression based on findings.

Input: 47 years old who is status post bilateral nipple sparing mastectomy (May 2015) for right breast DCIS. In the specimen of the left breast, DCIS was found incidentally with a very close margin to the nipple. Bilateral nipple discharge. Status post bilateral mastectomy with retropectoral silicone implants.Implants appear intact, with no evidence of rupture or herniation.Significant signal loss at anterior right breast is seen on T1 weighted images, possibly due to hardware malfunction.

Output: Incomplete study. Signal loss at anterior right breast, possibly due to hardware malfunction. Technical repeat study will be performed.BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Left sided paraesthesias. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are a few scattered foci of high T2 signal in the cerebral and pontine white matter. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No evidence of acute intracranial hemorrhage, mass, or acute infarct. A few scattered foci of high T2 signal in the cerebral and pontine white matter are nonspecific, but may represent chronic small vessel ischemic disease versus vasculitis or demyelination, for example.


Instruction: Generate impression based on findings.

Input: Prostate cancer, evaluate for disease, biopsy to follow PELVIS:PROSTATE:Prostate Size: 5 cm in transverse dimension x 3.4 cm in AP dimension x 4.8 cm in craniocaudal dimension. Prostate: Bilateral lesions suspicious for prostate adenocarcinoma visualized:Largest focus seen in left mid gland with 1.9 x 1.3 cm peripheral zone T2 hypointense/low ADC signal lesion visualized, abnormal signal extends to towards apex as well.Another focus demonstrating similar imaging characteristics seen in right mid gland peripheral zone measuring 0.6 x 0.6 cm. More superiorly towards base in the right peripheral zone is another T2 hypointense lesion measuring 0.8 x 0.6 cm with more intermediate dark ADC signal, also suspicious. Extracapsular extension suggested.Additional low ADC/T2 hypointense signal suspicious lesion seen in transition zone in lower mid gland towards apex, measures approximately 1.1 x 1 cm, image 13 series 901.Small amount of postbiopsy hemorrhage.Seminal Vesicles: No significant abnormality noted. BLADDER: No significant abnormality noted.LYMPH NODES: No pathologically enlarged lymph nodes.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Findings suspicious for multifocal prostatic adenocarcinoma as above.


Instruction: Generate impression based on findings.

Input: 24 years, Male, Reason: 24 year old male with history of recurrent acute pancreatitis with progression to chronic calcific pancreatitis, prior MRI/MRCPs have been without secretin. Ordering MRCP with secretin to assess for PD stones History: abdominal pain, pancreatic head calcifications seen on CTs/MRIs. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Loss of signal on out of phase images suggests hepatic steatosis. Status post cholecystectomy.SPLEEN: Small splenule.PANCREAS:The distal main pancreatic duct is dilated to 5 mm without dilatation upon secretin administration. Side branches within the pancreatic tail are also dilated. This is proximal to an area of stricturing within the mid duct. There is a blunted response upon secretin administration filling only the proximal duodenum. There is a filling defect within the distal pancreatic duct measuring 6 mm which likely represents a stone with upstream dilatation. Restricted diffusion is seen within the pancreatic head without peripancreatic edema.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.Findings of chronic pancreatitis including pancreatic ductal dilatation and stricturing as well as a 6-mm stone within the distal pancreatic duct.2.Hepatic steatosis.


Instruction: Generate impression based on findings.

Input: 58 y.o with a h/o of testicular CA w/orchiectomy and chemo, autoimmune hemolytic anemia and CVID on IVIG with fatigue and diarrhea. Please eval for small bowel involvement. ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesion. Signal characteristics on T2 and in and out of phase sequences suggest possible iron deposition in the liver. Gallbladder is unremarkable.SPLEEN: Status post splenectomy.PANCREAS: Pancreas is unremarkable.ADRENAL GLANDS: No adrenal nodularity or thickening.KIDNEYS, URETERS: Multiple bilateral simple cysts. Kidneys enhance symmetrically. No suspicious renal mass is identified.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Bowel is normal in caliber without evidence of obstruction or ileus. There is no suspicious bowel wall thickening. No abnormal mural enhancement is identified.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No evidence of significant bowel pathology to suggest metastatic involvement.


Instruction: Generate impression based on findings.

Input: Diagnosis: HeadacheClinical question: cause of headaches , leptomeningeal disease vs stokeSigns and Symptoms: headaches The CSF spaces are appropriate for the patient's stated age with no midline shift. No foci of diffusion restriction are appreciated.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. There is generalized brain atrophy present.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.There is heterogeneous marrow signal present within the visualized upper cervical spine

Output: 1.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 2.There is no evidence for acute ischemic cerebral infarction.3.There is no evidence for leptomeningeal disease.4.There is heterogeneous marrow signal in the visualized upper cervical spine. This is a nonspecific finding . Please correlate with patient's clinical history for chronic disease or myeloproliferative disorder or lymphoproliferative disorder.


Instruction: Generate impression based on findings.

Input: 58-year-old male with trochlear pain refractory to injection. ARTICULAR CARTILAGE AND BONE: No bone marrow signal abnormality is identified. No articular cartilage defects are seen.SOFT TISSUES: There is increased signal abnormality within the proximal muscle belly of the right gluteus minimus muscle, indicating a strain. The gluteus minimus tendon appears intact. The gluteus medius and maximus muscles and tendons appear intact. There is minimal peritrochanteric signal abnormality on fluid sensitive sequences without evidence of a focal fluid collection to suggest a bursitis. ADDITIONAL

Output: 1. Mild increased signal abnormality within the proximal muscle belly of the right gluteus minimus muscle is nonspecific but may represent a mild muscle strain. The gluteal muscles and tendons appear intact.2. Decreased T2 signal abnormality within the peripheral zone of the prostate gland is incompletely characterized on this examination, however, correlation with PSA and physical examination is recommended to exclude the possibility of prostate carcinoma. Further evaluation with a dedicated contrast enhanced prostate MRI examination could be considered if clinically warranted.


Instruction: Generate impression based on findings.

Input: Diagnosis: Dementia, unspecified, without behavioral disturbanceClinical question: Is there focal abnormality or signs c/w a type of dementia?Signs and Symptoms: memory loss, asymmetric reflexes The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.On FLAIR MRI images there is sulcal signal hyperintensity and intraventricular signal hyperintensity on many of the images. This is suspected to represent some artifact. There is no abnormal enhancing lesion appreciated intracranially.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.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 2.Examination is mildly compromised due to some artifact on the FLAIR MRI images


Instruction: Generate impression based on findings.

Input: 31 year old female with history of Chiari 1 malformation, pseudotumor, and hypertension, presenting with acute dysarthria and confusion. Evaluate for intracranial hemorrhage versus enlarging ventricular size. There is no evidence of intracranial hemorrhage or edema. A round homogeneously hypoattenuating mass is seen in the region of the pineal gland, which may represent a cyst. 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: 1. No acute intracranial abnormalities.2. Hypoattenuating mass in the region of pineal gland, which may represent a cyst. Consider MRI to further evaluate if clinically indicated.


Instruction: Generate impression based on findings.

Input: 51 years Male (DOB:9/14/1965)Reason: compare to image in epic. Unknown lesion 3 month follow up History: lesion in cervical spinePROVIDER/ATTENDING NAME: BEN-ZION ROITBERG BEN-ZION ROITBERG The cervical vertebral bodies are appropriate in overall alignment and height. The C1 vertebral body appears to be fused to the skull base. The posterior arch of C1 is not readily identifiedPatient status post laminectomies from C3 through C6. There is redemonstration of an enhancing lesion present within the spinal cord at the C4 vertebral body level measuring 6 x 4 x 6 mm in size which measured 6 x 6 x 9 mm. There is redemonstration of associated T2 signal hyperintensity within the spinal cord extending from the C2-3 down to the C4 vertebral level. This T2 signal hyperintensity has regressed since the prior exam.There is redemonstration of low-lying cerebellar tonsils which extend approximately 20 mm below the level of the foramen magnum. It have a pointed appearance and have not changed substantially since prior exam.At C2-3 there is no significant compromise to the spinal canal. There is a disc bulge present at level associated with some uncovertebral osteophytes and narrowing of the neural foraminal encroachment of left-sided exiting nerve roots..At C3-4 there is no significant compromise to the spinal canal. There is a disc bulge present this level associated with uncovertebral osteophytes and narrowing of the neural foramina bilaterally and encroachment of the exiting nerve roots.At C4-5 there is no significant compromise to the spinal canal or neural foramina. There is a disc bulge at this level. There are some right-sided uncovertebral osteophytes at this level.At C5-6 there is no significant compromise to the spinal canal. There is a disc bulge at this level associated with uncovertebral osteophytes bilaterally worse on the right side. There is encroachment of the right exiting nerve roots within the neural foramen.At C6-7 there is no significant compromise to the spinal canal. There are endplate and uncovertebral osteophytes present this level associated with encroachment of the exiting nerve roots within the neural foramina bilaterally.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.An enhancing lesion within the cervical spinal cord is slightly smaller on the current exam compared to the prior exam. Since the prior exam there has been some regression of associated cord edema.2.Chiari I malformation.3.Multilevel degenerative changes present in the cervical spine with encroachment of exiting nerve roots within the neural foramina bilaterally at C6-7, on the right-sided C6, bilaterally at C3-4 and on the left side at C2-3.4.Congenital malformation of the C1 vertebra with fusion to the occiput and absence of the posterior arch.


Instruction: Generate impression based on findings.

Input: Weakness. Correlating with the homogeneously hyperattenuating mass on CT, there is a mildly T1-hypointense, T2-hyperintense, relative to gray matter, mass in the periventricular/deep left frontal white-matter involving the left centrum semiovale as well as the body of the corpus callosum, which measures transaxially 2.6 cm x 2.2 cm and craniocaudally 1.9 cm. It shows solid but mildly heterogeneous pattern of contrast enhancement and has diffusion characteristics that are similar to gray matter. It causes mild mass-effect on the adjacent structures, including the roof of the left lateral ventricle. Accounting for the fairly symmetric bifrontal periventricular hypoattenuation, which may reflect microvascular ischemia, there is no definite perilesional hypoattenuation/edema.Another lesion with similar signal characteristics but only minimal, vascular pattern of vascular contrast enhancement is present in the region of the posterior limb of the right internal capsule which has superior extension along the corona radiata. This is not associated with perilesional edema. A third lesion with similar signal characteristics but without perceivable contrast enhancement is present in the splenium of the corpus callosum. This is associated with minimal associated perilesional edema.There is no midline shift or brain herniation. Similar to the above-described confluent periventricular bifrontal white-matter T2-hyperintensity, there is confluent biparietal white-matter T2-hyperintensity. There are also multiple punctate T2-hyperintense lesions in the cerebral white-matter. These findings likely reflect incidental chronic microvascular ischemia. The ventricles and the other CSF-containing spaces are mildly expanded, reflecting global mild brain volume loss. There is also a cavum septum vergae/cyst with mild mass-effect on the internal cerebral veins, which is incidental.There is mucosal thickening in the maxillary and ethmoid sinuses. There is also a left maxillary retention cyst. The orbits are notable for bilateral lens replacement. There is no destructive skull lesion.

Output: 1.Multifocal periventricular and deep cerebral white-matter lesions show signal characteristics that are suggestive of dense cellularity or high nucleus-to-cytoplasmic ratio. One shows solid contrast enhancement while the other shows minimal vascular to no contrast enhancement. The mass-effect is relatively mild to the size of the lesions and there is no or minimal associated peripheral lesional edema as described above. The imaging characteristics are most suggestive of CNS involvement by lymphoma. The homogeneity of the lesions and the lack of perilesional edema or significant mass-effect would make primary brain tumor, metastasis and inflammatory/infectious etiologies much less likely.2.Otherwise, there are relatively mild changes of chronic microvascular ischemia and global brain volume loss. Incidental cavum septum vergae/cyst with mild mass-effect on the internal cerebral veins.


Instruction: Generate impression based on findings.

Input: Clinical question: CVA. Signs and symptoms: Left weakness. CT of brain without infusion: Findings consistent with small vessel disease of indeterminate age are again identified. The strokes are again bilateral subcortical, periventricular and basal ganglia. No definitive evidence of cortical stroke is detected. There is no evidence of hemorrhage. This findings remains similar to what was noted on prior examination of the same date. Cortical sulci, ventricular system and all CSF cisterns remain within normal. Hard or follow-up with an MRI examination is recommended.CTA of intracranial circulation:Right internal carotid:There is heavy calcification of cavernous carotid however on sagittal MIP images no stenosis is detected. The supraclinoid right internal carotid artery is unremarkable. A normal and patent right posterior communicating artery is identified. The right anterior and middle cerebral arteries are visualized and patent. Very minimal irregularity of the vessel walls on 3-D reformatted images may indicate atherosclerotic disease. There is however no evidence of any area of significant stenosis.There is filling of both anterior cerebral arteries from the right side which is secondary to hypoplastic left A1. Right ophthalmic artery on 2-D reformatted images is identified.Left internal carotid:Heavy vascular calcification of the left cavernous carotid on sagittal MIP images are noted. No hemodynamically significant stenosis is detected. Supraclinoid internal carotid artery demonstrate minimal vascular calcification and is otherwise unremarkable. Eight patent prominent left posterior communicating artery is identified. Ophthalmic artery on coronal MIP images is identified.There is hypoplastic left A1 and with no visualization of the A1 segment.The left middle cerebral artery and all of its branches are well visualized and with no evidence of definitive pathology. Very minimal irregularity on 3-D images of these branches may represent atherosclerotic disease however possibility of reformatted artifact cannot be entirely.Vertebral -- basilar system:A very small right vertebral artery note the process well please and within the subarachnoid space at the level of foramen magnum. On 2-D reformatted images a small right pica is identified. Distal portion of small right vertebral artery appears to continue and communicates with the basilar artery.A dominant left vertebral artery is noted to traverse the foramina magnum and give rise to a patent left pica branch. Basilar artery is uniformly narrow along its entire course and is smaller than is expected. I believe this is secondary to prominent patent bilateral posterior communicating arteries that supply the posterior cerebral arteries. Very minimal irregularity of the lumen of basilar artery on 3-D reformatted images may represent minimal atherosclerotic disease. No significant foci of stenosis however is identified.Superior cerebellar arteries are visualized and unremarkable.Hypoplastic bilateral P1 segments of posterior cerebral arteries are noted.MRA of neck:Right carotid.Right brachial cephalic artery and including its origin remains normal. The origin of right common carotid artery and its entire course remains patent. Heavy vascular calcification at the level of carotid bifurcation with extension into proximal internal carotid artery is present. There is however no hemodynamically significant stenosis. The cervical portion of right internal carotid artery is unremarkable.The external carotid arteries unremarkable.Left carotid.Small calcification at the origin of the left common carotid artery is noted. No stenosis at this location is identified. Shallow plaques within the mid cervical portion of the left common carotid artery some with minimal calcification are present. There is minimal compromise of the lumen however no hemodynamically significant stenosis. Minimally calcified plaques at the origin of the left internal carotid artery are noted. No hemodynamically significant stenosis of the left internal carotid artery at any level is detected. External carotid artery is unremarkable.Vertebral -- basilar system:Left vertebral.Dominant left vertebral artery is patent throughout its course. The overall caliber of this dominant vessel is however smaller than usual which is believed to be secondary to patent large bilateral posterior communicating arteries. A small calcific plaque at the origin of left vertebral artery is noted. No focal area of the stenosis of the left vertebral.Right vertebral.The intracranial component of very small size right vertebral artery is identified on 2-D reformatted images and can be traced retrogradely to the level of foramina magnum. This artery cannot be identified from the level from the magnum inferiorly to approximately C2 level. This is small vertebral artery is reidentified at C2 level and can be traced retrogradely to C3 -- C4 intervertebral disk level. There is no visualization of vertebral artery from this level inferiorly to the level of the origin of right vertebral artery. The right subclavian is tortuous and demonstrates minimal after sclerotic disease with calcification however no significant stenosis is detected.

Output: 1.Minimal small vessel disease and a known definitive at pressure or interval change since prior study of the same date.2.No evidence of any hemodynamically significant stenosis of the intracranial vasculature. Minimal atherosclerotic disease is suspected.3.Heavy vascular calcification of bilateral cavernous carotids with no detectable significant stenosis.4.Uniformly smaller than expected basilar artery lumen which is believed to be secondary to a large patent bilateral posterior communicating arteries. No significant focal area of stenosis.5.No significant stenosis of carotid arteries in the neck. Please see above comments.6.Vascular calcification of carotid bifurcations.7.Complete occlusion of the right vertebral artery at its origin up up to approximately C3 -- C4 level. Fragmented visualization of small right vertebral artery superiorly to the level of foramina magnum. Patent right vertebral artery intracranially and with visualization of right pica.8.Patent small dominant left vertebral artery as detailed.9.Visualized origins of major vessels arising from the arch appear unremarkable.


Instruction: Generate impression based on findings.

Input: Right calf pain Ankle: TENDONS: No significant abnormality noted.LIGAMENTS: No significant abnormality noted.ARTICULAR SURFACES AND BONE: No significant abnormality noted. ADDITIONAL

Output: Soleus muscle tear with associated hematoma.


Instruction: Generate impression based on findings.

Input: Diagnosis: Multiple sclerosisClinical question: MS, f/u progressionSigns and Symptoms: paresthesiasComments: 3T CCD, MS protocol. There is redemonstration of multiple subcortical and periventricular white matter lesions which were also present on the prior exam and does not appear to have changed in number or extent.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: Multiple periventricular subcortical white matter lesions are stable compared to the prior exam. These support the clinical diagnosis of multiple sclerosis.


Instruction: Generate impression based on findings.

Input: Knee effusion. NoneMENISCI: The lateral meniscus is intact. The posterior horn of the medial meniscus appears normal. There is slight medial extrusion of the body of the medial meniscus. There is low signal intensity adjacent to the peripheral margin of the anterior horn of the medial meniscus. It is conceivable this could represent displaced meniscal tissue but it may simply represent peculiar scarring; I am uncertain of its clinical significance.ARTICULAR CARTILAGE AND BONE: There is near full-thickness to full-thickness degeneration of the articular cartilage of the medial facet of the patella with relatively mild degeneration of the articular cartilage of the lateral facet. Small foci of degenerative subchondral signal abnormality are noted within the median eminence of the patella. There is diffuse near-full-thickness to full-thickness degeneration of the articular cartilage of the weightbearing portion of the medial tibiofemoral compartment. There is a subchondral cyst along the posterior aspect of the medial femoral condyle with delamination of the overlying articular cartilage. The articular cartilage of the lateral tibiofemoral compartment appears relatively preserved. There are small tricompartmental osteophytes.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1.Osteoarthritis predominantly affecting the patellofemoral and medial compartments.2.Joint effusion and loose body as described above.3.Low signal intensity adjacent to the anterior horn of the medial meniscus is of uncertain significance. It may simply represent a peculiar collection of scar tissue, although I cannot entirely exclude the possibility of displaced meniscal tissue.


Instruction: Generate impression based on findings.

Input: 55-year-old female patient with cirrhosis. Screening HCC. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology. Small volume of perihepatic ascites. TIPS in place. There is a 0.9 x 0.9 cm (series 801 image 31) T1 hyperintense lesion in the hepatic dome that does not demonstrate enhancement on arterial or subtraction images. This lesion corresponds with the previously described enhancing lesion that do not meet criteria for HCC, unchanged in size.SPLEEN: Borderline splenomegaly, measuring up to 12 cm in craniocaudal dimension. Stable 1.8 cm distal splenic artery aneurysm (series 401 image 17).PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: There is a tubular cystic lesion anterior to T11/T12 and to the right of the aorta that does not enhance and measures up to 1.5 cm in maximal diameter, suggestive of a cisterna chyli. This is new compared to prior.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Cirrhotic liver morphology.2.Subcentimeter lesion in the dome of the right hepatic lobe does not demonstrate enhancement and does not meet criteria for hepatocellular carcinoma.3.Stable splenic artery aneurysm.4.Probable new cisterna chyli.


Instruction: Generate impression based on findings.

Input: Lower sacroiliitis. BONE MARROW: Normal marrow signal throughout without significant abnormality noted.SOFT TISSUES: No significant abnormality noted. JOINTS: Mild degenerative changes of the synovial sacroiliac joint. There is no underlying acute osseous abnormality.ADDITIONAL

Output: No evidence of sacroiliitis.


Instruction: Generate impression based on findings.

Input: 69-year-old male with hypertension, diabetes, and esophageal carcinoma, transhiatal esophagectomy Pulmonary Artery: Technically good study. No pulmonary embolism noted to the subsegmental level.MEDIASTINUM AND HILA: There has been interval subxiphoid pericardial drain placement. The drain traverses the distal transverse colon and enters the pericardial sac from a trans-diaphragmatic location (image 32/99). There is a moderately sized pericardial effusion of water density at this time. The right atrium is dilated, a mid LAD stent is present.Again noted are findings compatible with a gastric pull-up containing fluid, air and debris. There is no enteric contrast leak into the mediastinum. Calcified right hilar and mediastinal lymph nodes consistent with prior granulomatous infection.LUNGS AND PLEURA: There is a loculated left pleural effusion with peripheral pleural enhancement and associated internal adhesions suggestive of inflammation. Small associated loculated component within the major fissure on the left. Associated left lower lobe atelectasis. Trace right pleural effusion.Stable biapical pleural scarring with calcification. A reference right-sided, pleural-based nodule has decreased in size measuring 5 x 5 millimeters (22/111). A pulmonary micronodule in the left apical posterior segment is stable.CHEST WALL: No suspicious osseous lesions.UPPER ABDOMEN: An ill-defined area of hypodensity within segment two of the liver (91/111) is present. This is not a dedicated evaluation of the hepatic parenchyma. A metastasis cannot be excluded. Therefore, either a triphasic CT or dedicated hepatic MRI recommended. Multiple bilateral renal cysts.

Output: 1. Interval placement of subxiphoid pericardial drain that traverses the distal transverse colon and anterior diaphragm. Findings have been verbally relayed, images have been reviewed with the clinical service at the time of dictation. Moderate pericardial effusion, water density at this time.2. Low-density lesion of segment two hepatic parenchyma raising question of metastasis. Further investigation with either triphasic CT or dedicated hepatic MRI is advised.3. Near complete resolution right pleural effusion. Loculated left pleural effusion with peripheral enhancement and possible internal adhesions.


Instruction: Generate impression based on findings.

Input: Diffuse osseous metastases is seen throughout the cervical, thoracic and lumbar spine, with metastases seen at nearly all levels of the thoracic and lumbar spine. Vertebral bodies are nearly completely replaced by tumor at the C4, T6, T7, T10, T11 and L5 levels. Tumor involvement causes moderate spinal canal stenosis at the C3-C4, T6-T7 and the T10-T11 levels. There is thickening of the anterior epidural space at the C4 and T7 levels, suspicious for epidural extension of tumor. Increased size of soft tissue metastasis posterior to the sacrum is also noted.Grade 1 retrolisthesis of L5 on S1. Alignment is otherwise within normal limits. Vertebral body heights are within normal limits. Severe disc degeneration with loss of disc height is seen at the L4-5 and L5-S1 levels.

Output: This is a limited exam specific for the exclusion of cord compression only and does not exclude more subtle lesions such as intrinsic cord abnormalities. Diffuse osseous metastases is present throughout the cervical, thoracic and lumbar spine. There is suspicion for thickening of the anterior epidural space at the C4 and T7 levels, suspicious for epidural extension of tumor. Consider MRI of the cervical and thoracic spines with contrast for further evaluation.Findings were discussed with PA Anderson at 11:45 AM on 12/21/2016.


Instruction: Generate impression based on findings.

Input: For the purposes of numbering, there are 5 lumbar type vertebral bodies. Vertebral body heights are maintained. Alignment is maintained. Note is made of a subtle linear defect within the right L1 transverse process which is not well evaluated on MRI but may represent a remote fracture. There is general disc desiccation at most lumbar levels which is worse at the L5-S1 level. The cord signal is normal and the cord terminates normally at the L1-L2 level.Multilevel degenerative changes are seen, as describe below:At L1-2 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is mild facet degenerative changes and mild ligamentum flavum hypertrophy. No significant compromise to spinal canal or neural foramina.At L3-4 there is mild facet degenerative changes and mild ligamentum flavum hypertrophy with minimal right neuroforaminal stenosis. There is no significant compromise to spinal canal or left neural foramen.At L4-5 there is a mild disc protrusion and mild to moderate degenerative changes and ligamentum flavum hypertrophy which causes minimal bilateral neural foraminal stenosis. There is no significant compromise to spinal canal.At L5-S1 there is a mild disc protrusion as well as advanced facet degenerative changes and ligamentum flavum hypertrophy which cause moderate to severe right and mild to moderate left neuroforaminal stenosis. There is no significant compromise to spinal canal. A small synovial cyst is noted posterior to the left L5-S1 facet joint.The paraspinous soft tissues are within normal limits.

Output: Degenerative changes involving the lumbar spine, worse at the L5-S1 level where there are advanced facet degenerative changes and ligamentum flavum hypertrophy, which result in moderate to severe right neuroforaminal stenosis and possible impingement of the exiting right L5 nerve root. Individual levels as above. No significant spinal canal stenosis at any level.


Instruction: Generate impression based on findings.

Input: 6-year-old female with tuberous sclerosis. Evaluate for renal angiomyolipomas.EXAMINATION: MRI kidneys without and with intravenous contrast 12/16/2016 8;44 The kidneys contain innumerable subcentimeter cysts. In the left upper pole peripheral renal cortex there is a low signal intensity lesion on the fat saturated sequences without enhancement measuring 6 mm (series 501, image 22; series 1001, image 49) ; this likely corresponds to the hyperechoic lesion seen on previous renal ultrasound. No hydronephrosis. The liver is normal with no focal hepatic lesion. No intra or extrahepatic biliary ductal dilatation. Normal well-distended gallbladder.The spleen is normal.The pancreas is normal with no focal lesion. No pancreatic ductal dilatation.Adrenal glands are normal.The bowel loops are not dilated.Subsegmental atelectasis at the lung bases.Bone marrow signal intensity is normal.The soft tissues are normal.

Output: Bilateral innumerable subcentimeter simple renal cysts. Focal 6 mm low signal intensity lesion on the fat saturated sequences in the peripheral left renal cortex at the upper pole likely represents a small angiomyolipoma corresponding to the hyperechoic lesion seen on previous sonogram.


Instruction: Generate impression based on findings.

Input: 79-year-old male with recent code, hypotension, on pressors. Rule out stroke Exam limited by motion artifact.Again seen is a low-attenuation lesion in the left frontal deep white matter that extends to the basal ganglia. This is seen on previous studies dating back to an MRI from 2/05 and is consistent with chronic ischemic changes.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The mastoid air cells are normally pneumatized.

Output: Chronic ischemic changes unchanged. No CT finding suggesting acute ischemia. Recommend MRI exam once the patient is clinically stable to rule-out acute ischemia as clinically indicated.


Instruction: Generate impression based on findings.

Input: 29-year-old female with persistent knee pain. History of right knee tibial tubercle osteotomy. Metallic susceptibility artifact from orthopedic fixation of the proximal tibia results in suboptimal image quality.MENISCI: The medial and lateral meniscus appear intact.ARTICULAR CARTILAGE AND BONE: Note is made of postoperative changes consistent with the stated history of tibial tubercle osteotomy. There is partial-thickness articular cartilage degeneration along the lateral facet of the patella. There is a focal full-thickness articular cartilage cleft along the lateral facet of the patella. There is partial-thickness articular cartilage degeneration along the medial facet of the patella. The femoral trochlea is shallow, superiorly, suggesting femoral trochlear dysplasia. Heterogeneous bone marrow signal abnormality may represent residual islands of red marrow. There is subjective thinning of the articular cartilage of the lateral tibiofemoral compartment.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: Postoperative changes of prior tibial tubercle osteotomy. Partial-thickness articular cartilage degeneration affecting the patellofemoral joint, including a full-thickness articular cartilage cleft, as well as findings consistent with femoral trochlear dysplasia as described above.


Instruction: Generate impression based on findings.

Input: Malignant neoplasm of unspecified site of unspecified female breast [C50.919] / Secondary malignant neoplasm of brain [C79.31], Reason for Study: ^Reason: history of brain mets please COMPARE History: NONE Previously seen linear and nodular enhancing lesions on the margin of resection cavity has been significantly decreased but remained focal enhancing area at the anterior lateral aspect of resection cavity. There is no other abnormal enhancing lesion seen on the scan.There is no surrounding edema.Susceptibility artifacts seen on the margin of resection cavity indicate operation related blood product deposition.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Nonvisualization of the most of previously seen resection cavity margin enhancements indicate previous lesions are operation related reactive changes.2. Remained enhancing lesion at the anterior lateral aspect of the resection cavity may represent reactive changes but needs follow up.3. No evidence of acute ischemic or hemorrhagic lesion. No new abnormal enhancement.


Instruction: Generate impression based on findings.

Input: Right hip pain for 4 months. ACETABULAR LABRUM: There is intermediate signal abnormality of the anterosuperior labrum, without discrete fluid-filled cleft. Findings are compatible with intrasubstance degeneration and early tearing.ARTICULAR CARTILAGE AND BONE: There is abnormal offset of the femoral head-neck junction consistent with cam-type deformity, with estimated alpha angle of 57 degrees. Articular cartilage appears intact. Cam-type type deformity of the left femoral head-neck junction is also suggested on limited wide field-of-view sequences.SOFT TISSUES: Muscles about the right hip joint are unremarkable without evidence of inflammation or edema. ADDITIONAL

Output: Cam-type deformity of the right femoral head-neck junction with associated anterosuperior labral degeneration and early tearing.


Instruction: Generate impression based on findings.

Input: There are postsurgical changes of recent syringopleural catheter placement and prior posterior thoracic fusion, with hardware extending from the T4 level inferiorly outside the field of view. Superior screws extending into the T3-T4 disc space better assessed on recent CT.Evaluation of the cervical spine demonstrates syrinx throughout the visualized cervical cord, particularly in its left aspect, and extending into the thoracic cord. Syrinx extends superiorly to the cervicomedullary junction. Comparison is limited however the partially imaged thoracic cord demonstrates marked decrease in size of the syrinx, with residual ill-defined T2 signal abnormality in the thoracic cord. In comparing the sagittal T1 sequence of the cervical cord on the current study and the sagittal T1 counting sequence on the prior study, extent of cervical syrinx is also decreased, measuring approximately 3.8 mm at the C3-C4 level in the AP dimension, previously 6.0 mm. There is a new extra thecal fluid collection in the right posterior thoracic spine which displaces the thoracic cord anteriorly. Vertebral body heights and alignment in the cervical spine are maintained. No significant cervical spinal canal or neural foraminal stenosis is evident.

Output: 1. Please note thoracic MRI was not performed as patient could not tolerate further imaging. See comment in the technique section.2. Comparison with MRI thoracic spine study from 12/24/2015 is limited, but there is marked decrease in size of the visualized portions of the cervical and thoracic syrinx. There has been interval development of an extrathecal fluid collection in the right posterior thoracic spinal canal which is partially imaged, but appears to have mass effect with displacement of the thoracic cord ventrally. Suggest patient returning for dedicated thoracic spine study for further evaluation.


Instruction: Generate impression based on findings.

Input: 72 year old male with a past medical history significant for COPD, CAD, HFpEF, severe LVH (with concern for infiltrative process), intracavitary gradient, HTN, DM2, and CKD presenting with worsening dyspnea. Left VentricleThe left ventricle is normal in size with hyperdynamic systolic function with severe concentric left ventricular hypertrophy (15-16mm). The overall LV ejection fraction is 69%, the LV end diastolic volume index is 100 ml/m2 (normal range: 74+/-15), the LVEDV is 205 ml (normal range 142+/-34), the LV end systolic volume index is 27 ml/m2 (normal range 25+/-9), the LVESV is 63 ml (normal range 47+/-19), the LV mass index is 100 g/m2 (normal range 85+/-15), and the LV mass is 231 g (normal range 164+/-36). There are no regional wall motion abnormalities present. Native T1 times are 1110 ms, which is mildly elevated. Given the amount of hypertrophy, one would expect moderate to severe elevations in the native myocardial T1 relaxation time in the case of cardiac amyloidosis. I suspect the mild elevation in native myocardial T1 relaxation times is most likely due to mild, diffuse interstitial fibrosis rather than infiltrative heart disease.Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 58%, the RV end diastolic volume index is 101 ml/m2 (normal range 82+/-16), the RVEDV is 232 ml (normal range 142+/-31), the RV end systolic volume index is 42 ml/m2 (normal range 31+/-9), and the RVESV is 96 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in sizeAortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is a moderate to large pericardial effusion which is mostly overlying the posterior left ventricle. There is no cine evidence of chamber collapse. Extracardiac FindingsThere is ascites seen. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with hyperdynamic systolic function with severe concentric left ventricular hypertrophy (15-16mm). The overall LV ejection fraction is 69%. The native myocardial T1 relaxation time is mildly elevated. Given the fact that the severe LVH is only associated with a mild elevation in native myocardial T1 relaxation time, I suspect the elevated T1 is most likely due to mild, diffuse interstitial fibrosis rather than infiltrative heart disease.2. The right ventricle is normal in size and systolic function (RVEF 58%). 3. Moderate to large pericardial effusion without evidence of obvious hemodynamic compromise. The pericardial effusion is significantly larger than appreciated on his echocardiogram because most of it is posteriorly located.


Instruction: Generate impression based on findings.

Input: 66-year-old woman with history of family history of pancreatic cancer and cystic lesion in the head of pancreas. ABDOMEN:LIVER, BILIARY TRACT: There is a 13 x 10 mm T2 hyperintense, gradually enhancing lesion in segment 7 (series 3, image 10), likely a hemangioma. The gallbladder is normal. There is no intra or extrahepatic biliary duct dilatation.SPLEEN: The spleen is normal.PANCREAS: There is a 6 mm T2 hyperintense lesion which communicates with the pancreatic duct in the pancreatic body (series 5, image 51) and a 5 mm T2 hyperintense lesion in the pancreatic neck (series 5, image 36). There is no abnormal enhancement. The pancreatic parenchyma is otherwise normal.ADRENAL GLANDS: The adrenal glands are normal.KIDNEYS, URETERS: There is a subcentimeter left upper pole renal cyst and a cyst in the anterior right kidney. The kidneys are otherwise normal and enhance symmetrically.RETROPERITONEUM, LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: The partially visualized small bowel and colon is normal.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Subcentimeter ectatic side branch ducts or small IPMNs in the pancreatic neck and tail.


Instruction: Generate impression based on findings.

Input: History of Merkel cell carcinoma. Mass in the right lateral chest wall. History of flap reconstruction (forehead). LUNGS AND PLEURA: No significant abnormality noted. MRI suboptimal to evaluate for lung lesions.MEDIASTINUM AND HILA: Tortuous thoracic aorta. Normal cardiac size without pericardial effusion.CHEST WALL: Mild dextroscoliosis and kyphosis. Degenerative disc disease of the lower cervical spine.Along the lower right lateral chest wall is a lenticular-shaped lesion demonstrating intrinsic T1-weighted hyperintensity (series 19/55) and T2-weighted hyperintensity (series 18/27). The central hyperintensity measures approximately 3.6 x 0.8 x 5.6 cm (series 18/27). There is moderate surrounding soft tissue enhancement. Overall the lesion appears slightly decreased from the prior study. Assessment for osseous involvement is more reliable on the recent prior CT. There is an adjacent prominent lymph node, likely reactive and unchanged. More superiorly, there is edema that extends near the axilla.UPPER ABDOMEN: Limited sequences through the upper abdomen show no discrete abnormality.

Output: The complex lesion involving the right lateral chest wall demonstrates interval mild decrease in size with imaging characteristics favoring a resolving hematoma or treated infection. Although treated metastatic disease is a possibility, this is considered unlikely. Correlation with surgical and clinical history is recommended. If there is continued concern for metastatic disease follow-up CT of the chest can more reliably monitor the lesion. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: acute mental status change, prior stroke history. Motion artifacts degraded exam quality.No evidence of acute ischemic or hemorrhagic lesion on this scan.High signal intensities on FLAIR images are seen on right frontal lobe, right temporal lobe, right basal ganglia,and right thalamus with volume loss indicating prior infarctions. The right cerebellar hemisphere also shows focal tissue loss indicating chronic infarction.Underlying brain shows patchy high signal intensity lesions on periventricular white matter on FLAIR images indicating non specific small vessel disease. No change since prior exam.The ventricles, sulci and cisterns are unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: No evidence of acute ischemic or hemorrhagic lesion on this scan.Multifocal chronic infarction with encephalomalacia involving right frontal lobe, right temporal lobe, right insular, right basal ganglia, right thalamus and right cerebellar hemisphere as described above.Non specific small vessel disease, no change since prior exam.


Instruction: Generate impression based on findings.

Input: 69-year-old female with known left IDC, receiving hormonal therapy. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.A known cancer is again seen at posterior 11:00 position in the left breast, measuring 25 x 22 x 30 mm (AP x ML x SI; previously 32 x 29 x 37 mm). Pectoral muscle tenting is again associated with this mass; however, there is no enhancement in the pectoralis muscle in this current study. No abnormal enhancement is seen in right breast. No abnormal lymph nodes are identified in either axillary region.

Output: 1. Interval mild decrease in the size of the known cancer in the left breast, associated with pectoral muscle tenting.2. No MRI evidence of malignancy in the right breast.3. No abnormal lymph nodes in either axilla.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Examination is motion degraded. Again seen is enhancing mass in the sella extending superiorly and filling the suprasellar cistern measuring up to 30 mm in the craniocaudal dimension and 20 mm in the AP dimension, sagittal series 11 image 14, which is not significantly changed. Transverse dimension of approximately 24 mm, measured at the level of the optic nerves, is also not significantly changed. Encasement of the optic chiasm is again seen. The mass also appears to involve the bilateral A1 segments which are not well identified. There is increased T2/FLAIR hyperintensity along the optic tracts as well as in the left inferior frontal lobe as before which may reflect edema and/or gliosis.Extra-axial mass consistent with meningioma along the right greater sphenoid wing is also again seen and measures approximately 15 mm in the short axis, similar to prior. In the craniocaudal dimension, this lesion measures up to 34 mm, previously 31 mm, sagittal series 11 image 22.Additional meningioma in the posterior fossa along the inferior aspect of the tentorium narrows the right transverse sinus as before. This lesion measures 16 x 24 mm, which is not significantly changed. There is susceptibility effect within this lesion likely reflecting calcification.Left frontal craniotomy changes are again seen. Stable small area of encephalomalacia in the left frontal lobe is again seen. There is no diffusion abnormality to suspect acute stroke. The ventricles and sulci are normal. No intra-axial masses are identified. Normal flow-voids are demonstrated from major intracranial arteries.

Output: 1.Compared to 8/14/2013, there is no significant change in meningioma involving the sella and suprasellar cistern.2.Stable to minimal interval increase size of right sphenoid wing meningioma.3. No significant change in meningioma in the posterior fossa along the tentorium.


Instruction: Generate impression based on findings.

Input: 35-year-old female with myalgia. Assess for pilonidal cyst, abscess. Please note that the lateral soft tissues of the pelvis are not included in the field-of-view of this study. We see no findings to suggest a pilonidal cyst or abscess formation. There is a small lobulated collection of fluid signal intensity situated between the posterior aspect of the vastus lateralis and vastus intermedius just below the level of the lesser trochanter that does not show enhancement following contrast administration, measuring approximately 16 mm in the longitudinal dimension and 7 mm and the transverse dimension. We otherwise see no soft tissue masses. The bone marrow signal intensity is within normal limits. Moderate degenerative disc disease affects the level of L5/S1 with a broad-based posterior disc protrusion and degenerative endplate abnormalities at the level of L5. There is a small amount of free fluid within the pelvis. Note is made of subcentimeter foci of fluid signal abnormality within the uterus which are incompletely characterized but can be seen in adenomyosis.

Output: 1. No evidence of abscess or pilonidal cyst.2. Small multilobulated structure of fluid signal intensity between the posterior aspect of the vastus lateralis and intermedius on the right without enhancement which may represent a small ganglion and is not necessarily of any current clinical significance.3. Degenerative disc disease and broad-based posterior disc protrusion at the level of L5/S1.4. Subcentimeter foci of fluid signal abnormality within the uterus which are incompletely characterized but can be seen in adenomyosis. These findings could be further evaluated with a dedicated transvaginal ultrasound examination if clinically warranted.


Instruction: Generate impression based on findings.

Input: History of anoxic brain injury, now with increased seizure frequency. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The hippocampi are intact and there is no evidence of heterotopia. The brain parenchymal signal 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. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No potential seizure foci are identified.


Instruction: Generate impression based on findings.

Input: Altered mental status, unspecified [R41.82], Reason for Study: ^Reason: assess for seizure focus History: seizure There is relatively well-circumscribed T1 and T2 low signal intensity pituitary fossa mass measured 22.1 mm (RL) X 15.3mm (CC) x 23.9mm (AP) with homogeneous enhancement and slightly eccentric toward left side. Possible diagnosis is pituitary adenoma.There is no evidence of acute ischemic or hemorrhagic lesion.The right PCA territory especially right parahippocampal gyrus and part of right side fusiform gyrus show encephalomalacia indicating chronic ischemic infarction with evidence of ex vacuo changes of the right lateral ventricle temporal horn.The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Pituitary adenoma as described above.2. Chronic encephalomalacia on the right PCA territory as described above.3. No evidence of acute ischemic or hemorrhagic lesion.


Instruction: Generate impression based on findings.

Input: s/p left craniotomy with grid placement attempt post surgical follow up, epilepsy patient. No evidence of acute ischemic or hemorrhagic lesion on this scan.Evidence of left fronto-temporo-parietal craniotomy with think subdural fluid collections underneath of the craniotomy site.There is no evidence of intra parenchymal hemorrhage or ischemic lesions on this scan.Again, there is redemonstration of polymicrogyria involving the superior aspect of the left sylvian fissure over the left parietal and temporal lobe, as well as some of the left frontal lobe. The left hemisphere shows volume decrease. These findings do not show any significant interval change since prior exam.The right hemisphere appears to be within normal limits.There are multiple tubular signal voids on the surface of the left hemisphere, again no significant interval change since prior exam.The ventricles, sulci and cisterns are unremarkable. The mucosal thickening on bilateral paranasal sinuses and mastoid air cells show fluid collections.3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal.There are linear intra luminal low signal intensities on bilateral distal ICAs around paraclinoid segments which likely represent flow related artifacts.

Output: 1. Post left fronto-parieto-temporal craniotomy status with postoperative fluid collections underneath of craniotomy. Postoperative no unusual finding.2. No evidence of acute ischemic or hemorrhagic lesion on this scan.3. Enlarged cortical veins, however, there is no evidence of intracranial arterial aneurysm, arterial luminal stenosis


Instruction: Generate impression based on findings.

Input: Shoulder pain Note that the exam is limited by motion artifact.ROTATOR CUFF: There is a small full-thickness tear of the distal posterior fibers of the supraspinatus tendon. This may extend into the anterior fibers of the infraspinatus tendon although this is unclear given the limitations due to motion. There is increased thickness and signal of the supraspinatus tendon reflecting tendinosis.SUPRASPINATUS OUTLET: There is moderate acromioclavicular arthrosis with a trace amount of fluid in the subacromial subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is degenerative signal of the superior labrum but the labrum otherwise appears intact. There is severe cartilage loss of the humeral head reflecting moderate to severe osteoarthritis of the glenohumeral joint.BICEPS TENDON: The intra-articular portion of the biceps tendon appears intact.ADDITIONAL

Output: Significantly limited exam secondary to motion artifact. Within normal limits, there is a small full-thickness tear of the distal supraspinatus tendon which may extend to involve the anterior infraspinatus tendon although this is unclear.


Instruction: Generate impression based on findings.

Input: Transient gait abnormality. Evaluate for metastasis or stroke. There is no acute infarct or intracranial hemorrhage. There is no mass-effect, midline shift or brain herniation. There is mild-to-moderate confluent T2-hyperintensity involving the periventricular frontoparietal white-matter. Scattered punctate T2-hyperintense lesions are present in both cerebral hemispheres as well. These, though nonspecific, are likely related to microvascular ischemia. The ventricles are enlarged and so are the other CSF-containing spaces and basal cisterns. The volume loss is more pronounced in the parietal lobes. There is focal expansion of a left parietal sulcus with suggestion of peripheral displacement of the traversing vessels. While this may still relate to underlying volume loss, as small arachnoid cyst can also give a similar appearance. There is no abnormal brain or leptomeningeal contrast enhancement.There has been left eye lens replacement. The orbits are otherwise grossly unremarkable. There is no skull destructive lesion.

Output: 1. There is no brain or leptomeningeal abnormal contrast enhancement to indicate metastasis.2. Mild-to-moderate cerebral white-matter T2-hyperintense lesions are nonspecific but likely reflect chronic microvascular ischemia. 3. There is also mild brain volume loss, most pronounced in the parietal lobes. Focal expansion of a left parietal sulcus with suggestion of displacement of the traversing vessels may still relate to underlying volume loss but a small arachnoid cyst can result in a similar appearance.


Instruction: Generate impression based on findings.

Input: Postconcussional syndrome [F07.81], Reason for Study: ^Reason: Previous non con MRI showed :marginating rt caudate nucleus was noted a 7X12X6mm area of increased signal intensity in all series of unknown significance done at OSH. To evaluate for any increase in size There is about 12mm x 7mm sized ovoid shape high signal intensity lesion at the deep white matter around the right caudate nucleus head. The lesion follows the signal intensity of gray matter on all sequences without evidence of any enhancement. There is no evidence of local mass effect.The lesion is non specific and imaging findings are not exactly matching any particular diagnosis. Diagnostic possibility include focal heterotopia, white matter disease such as demyelination. The possibility of low grade tumor cannot be completely excluded. Thus, follow up imaging about 6 months can be considered if clinically indicated. There is no evidence of acute ischemic or hemorrhagic lesion.There is no evidence of abnormal enhancement.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: Right frontal deep white matter non enhancing lesion without mass effect as described above. Differential diagnosis include focal heterotopia, or demyelinating disease. Low grade tumor cannot be completely excluded. Follow up imaging can be considered if clinically indicated.


Instruction: Generate impression based on findings.

Input: Ms. Cordova is a 65-year-old woman with biopsy-proven right breast invasive ductal carcinoma. She presents today for MR imaging for further evaluation. There is scattered fibroglandular tissuein both breasts. Mild parenchymal enhancement is noted bilaterally.RIGHT BREAST: In the right upper outer breast, anterior depth, there is a spiculated enhancing mass identified measuring approximately 1.8 x 1.7 x 2.2 cm (AP x ML x SI). Susceptibility artifact from biopsy marker clip is seen centrally within this lesion, compatible with biopsy-proven malignancy. Seen infero-posteriorly are two additional enhancing lesions, suspected to be adjacent satellite lesions. Total span of abnormal enhancement (index lesion + two adjacent satellite lesions) measures approximately 2.7 x 1.8 x 2.3 cm. In the right lower inner breast (approximately 3 cm infero-postero-medial to the index malignancy), is a linear area of clumped non-mass enhancement measuring approximately 1.6 cm in total dimension.LEFT BREAST: Few scattered enhancing foci are seen in the left breast, none of which are more suspicious than the rest. There is no abnormal enhancement in the left breast. No abnormal axillary lymph nodes are identified in either axillary region.

Output: (1) Biopsy proven malignancy of the right breast with two adjacent satellite lesions. Total span of abnormal enhancement measures approximately 2.7 cm in the AP dimension. (2) 1.6 cm linear area of clumped non-mass enhancement in the right lower inner breast. An MR-guided biopsy with clip placement is recommended for further evaluation. (3) No MRI evidence of malignancy in the left breast. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Desmoid. Evaluate for progression. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: The infiltrative right retroperitoneal T2 hypointense lesion anterior to the right psoas muscle is only partially imaged in the field of view. BOWEL, MESENTERY: No significant abnormality noted, though the previously-described tethered bowel loops are not imaged in the field of view of the current exam. BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: Right retroperitoneal mass consistent with fibromatosis. This mass is incompletely evaluated as it is only partially imaged in the field-of-view of this examination. The patient will return for repeat sequences at no additional charge, at which time an addendum to this report will be made.


Instruction: Generate impression based on findings.

Input: Malignant melanoma of skin, unspecified [C43.9], Reason for Study: ^Reason: stage IV melanoma to brain on treatment History: assess for treatment response No evidence of acute ischemic or hemorrhagic lesion on this scan.There is no evidence of abnormal enhancement.The left pontine, non enhancing focal encephalomalacia with gliosis is again seen, unchanged.The right side corpus callosum genu portion again shows gliotic changes with focal encephalomalacia without evidence of enhancement, unchanged since prior scan.The ventricles, sulci and cisterns are unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear. There is a retention cyst on the right maxillary sinus.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion. No evidence of abnormal enhancement.2. Previously seen nonenhancing left pontine and right corpus callosum genu encephalomalacia with gliosis are again seen, unchanged since prior scan.


Instruction: Generate impression based on findings.

Input: Ms. Woodard is a 30 year old female with triple negative left breast cancer. She just finished neoadjuvant chemotherapy and presents today for MR imaging to evaluate treatment response. There is extreme amount of fibroglandular tissue in both breasts. Minimal parenchymal enhancement is noted bilaterally.There continues to be an interval decrease in size of biopsy-proven malignancy in the left upper breast, now measuring 0.7 x 0.7 x 0.8 cm (previously measuring 1.4 x 1.1 x 1.5 cm). There is no new abnormal enhancement identified in either breast. No abnormal axillary lymph nodes are identified in either axillary region. A vascular port overlies the right chest wall.

Output: Interval decrease in size of biopsy-proven malignancy in the left breast.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Clinical question : Status post craniotomy for removal of a seizure focus. Now with seizures. Signs and symptoms: Possible. Nonenhanced head CT:Examination the most postoperative changes of a large right frontal /temporal craniotomy. Epidural fluid -- air collection under the craniotomy flap is present. This finding is within the expected postop changes. There is evidence of partial right anterior temporal lobectomy with residual air and minimal postoperative hemorrhage. There is a area of low-attenuation in the inferior aspect of right frontal lobe and to a lesser degree of the left frontal lobe consistent with areas of encephalomalacia as was noted on prior MRI examination from 3 -- 24 -- 11.Superior to the surgical site focal area of edema is noted in the right frontal lobe. Residual small amount of subarachnoid blood within the cortical sulci of bilateral cerebral hemispheres are noted. A thin CSF density right parafalcine subdural measures approximately 2 mm in thickness. Prominent bilateral basal ganglial calcification and left frontal periventricular calcification is noted.

Output: 1.Expected postoperative changes of a large right frontal and temporal craniotomy.2.Small area of edema lungs immediately superior to the surgical site which may be postop change.3.Residual subarachnoid blood from surgery both in supero-and infratentorial spaces.4.Extensive bilateral basal ganglial calcification.5.Extensive inferior bifrontal encephalomalacia unchanged since prior studies.


Instruction: Generate impression based on findings.

Input: Weakness, surgical planning. There are numerous ring-enhancing lesions of various sizes in the bilateral cerebral hemispheres, as well as in the left cerebellum. Additional foci of enhancement in the posterior fossa along the posterior wall of the fourth ventricle and interpeduncular cistern. A lesion involving the anterior left body of the corpus callosum demonstrate significant mass effect upon the anterior horn of the left lateral ventricle, similar to prior examination. There are postsurgical findings related to right frontal craniotomy for right frontal lobe lesion biopsy with diffuse peripheral enhancement along the surgical cavity margins, at least some of which likely represent residual components of a lesion. There are also enhancing calvarial lesions involving the left parietal bone and at the junction of the left greater wing of the sphenoid and squamous temporal bone.

Output: 1. Numerous ring-enhancing lesions scattered throughout the brain parenchyma as well as enhancing lesions involving the calvarium and left skull base may represent metastatic disease and appear similar to prior examination, but have generally enlarged since 10/13/16.2. Leptomeningeal disease in the posterior fossa.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Unspecified convulsions [R56.9] / Cerebral infarction, unspecified [I63.9], Reason for Study: ^Reason: Acute onset R sided facial weakness, RUE weakness, pure motor deficit History: pls see above There is restricted diffusion on the left basal ganglia posterior aspect extends toward periventricular white matter indicating acute ischemic stroke. Since we do not have the gradient-echo images, it is not possible to evaluate hemorrhagic conversion with this image set.On FLAIR images, there are patchy bilateral periventricular white matter high signal intensities indicating underlying nonspecific small vessel ischemic disease.There are also evidence of chronic ischemic infarction with encephlomalacia on the left parietal lobe especially inferior parietal lobule and some superior parietal lobule.The ventricles, sulci and cisterns are symmetric and unremarkable.

Output: Incomplete MR exam.Acute ischemic infarction on the left basal ganglia as described above.Chronic ischemic infarction on the left parietal lobe.


Instruction: Generate impression based on findings.

Input: Left vestibular schwannoma: dizziness and tinnitus. There is an unchanged lesion that measures up to 5 mm in the fundus of the left internal auditory canal. The right cranial nerve 7 and 8 complexes are intact. The bilateral inner ear structures, including the cochlea, vestibule, endolymphatic duct, and semicircular canals, appear unremarkable. The bilateral mastoid air cells and middle ears also appear unremarkable.

Output: Unchanged lesion that measures up to 5 mm in the fundus of the left internal auditory canal, which likely represents a vestibular schwannoma.


Instruction: Generate impression based on findings.

Input: 66-year-old female with BRCA 2 gene mutation and a strong family history of breast and ovarian cancer including her mother and two maternal cousins. Personal history of left breast benign MRI guided biopsy in 2011. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD, 9.3. The breast parenchyma is composed of scattered fibroglandular elements (BiRADS Density Category B), unchanged in pattern and distribution. The left breast 5 o'clock position 1 cm mass is unchanged. MRI biopsy clip in the left breast is unchanged in position. No suspicious mass, suspicious microcalcifications or suspicious areas of architectural distortion are noted in either breast.

Output: No mammographic evidence of malignancy. As long as the patient's physical examination remains unremarkable, bilateral diagnostic mammogram is recommended annually. Results and recommendations were discussed with the patient. BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: Reason: history of optic gliomas s/p chemotherapy, surveillance exam History: history of optic gliomas s/p chemotherapy, surveillance exam There is interval worsening of the left enhancing lesions along the optic pathway. For reference, enhancing component just posterior to the left optic chiasm measures 1.2-cm (series 1401 image 15), previously 0.5-cm. More posteriorly located left enhancing lesion also appears more convex and rounded. There is interval improvement of the right enhancing lesions along the optic pathway. For reference, enhancing lesion adjacent to the basal ganglia and measures 0.7 x 0.7 cm (series 1401 image 14), previously 0.9 x 0.9 cm.There is new right hypothalamic punctate lesion with new mild mass effect on the inferior third ventricle.Intraorbital component of the optic nerve gliomas, right larger than left, appear to stable with persistent mild enhancement of the orbital segment of the right optic nerve and marked dilatation of the right optic nerve sheath. There is persistent faint intrinsic T1 hyperintensity of the bilateral basal ganglia and dentate nuclei, which may be metabolic in etiology. There is no evidence of acute infarct. The ventricles are mildly prominent, which is unchanged. There is no midline shift. Moderate amount of fluid is noted in the left mastoid air cells, new from prior study. Mucosal thickening of right maxillary and left ethmoid sinuses.

Output: 1.Interval worsening of the left enhancing lesions along the optic pathway.2.Interval improvement of the right enhancing lesions along the optic pathway. 3.New right hypothalamic punctate lesion with mild mass effect on the third ventricle, likely representing additional tumor.4.Stable appearing intraorbital component of the optic nerve gliomas.5.Moderate amount of fluid in the left mastoid air cells. Please correlate clinically.


Instruction: Generate impression based on findings.

Input: There is an enhancing lesion posteriorly along the right posterior clinoid process and clivus that extends posteriorly into the right prepontine cistern. This lesion measures approximately 10 x 5 mm (series 1001, image 10). There is no adjacent osseous erosion or destruction. No additional masses, mass effect, or midline shift. No acute intracranial hemorrhage or diffusion abnormalities to suggest acute ischemia. Mild interval progression of scattered T2/FLAIR hyperintense foci in the subcortical white matter, likely chronic small vessel ischemic disease. The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. The pituitary gland is normal in size. Flow voids are present within the major vessels indicating patency. Complete opacification of the left maxillary sinus, which is unchanged; otherwise, the paranasal sinuses and mastoid air cells are clear.

Output: 1.Stable small enhancing extra axial mass posteriorly along the superior clivus on the right which could represent a meningioma.2.Chronic mild small vessel ischemic disease.3.Left maxillary chronic sinusitis.


Instruction: Generate impression based on findings.

Input: 86 years, Male, altered mental status, assess flow through the third ventriculostomy. No restricted diffusion to suggest acute ischemia. No intracranial mass or mass-effect. There is no significant change in size of the ventricular system compared to MRI dated 4/29/2016. Global parenchymal volume loss is again evident. Prominence of the extra-axial spaces again seen with decrease in a small amount of blood products associated with the subdural effusion seen previously. Unchanged focus of pineal region calcification which narrows the cerebral aqueduct and mildly deforms the tectal plate. There is a prior right transfrontal ventriculostomy tract which is again seen. The third ventriculostomy is favored to be patent as evidenced with preservation of flow void at this level. The gated CSF flow sequence is however nondiagnostic despite multiple attempts related to patient's atrial fibrillation.Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild chronic small vessel ischemic changes. Small chronic cortical infarcts such as the left middle frontal gyrus and right peri-Rolandic region again seen. Scattered foci of susceptibility compatible with chronic microhemorrhages are again seen.

Output: 1. No evidence of acute infarct.2. No significant change in size of the ventricular system which remains prominent compared to MRI dated 4/29/2016. Parenchymal volume loss as well as calcification in the pineal region narrowing the cerebral aqueduct are again seen. 3. CSF flow sequence is nondiagnostic as described above limiting assessment for third ventriculostomy patency but is likely patent as evidenced by flow-void on the sagittal T1 sequence across the floor of the third ventricle. 3-D T2 sequence may also be helpful for further visualization.


Instruction: Generate impression based on findings.

Input: Plexiform tumor of left side of neck with facial involvement and left sided weakness History: large plexiform tumor of left side of face and neck and facial weakness. There is an infiltrative mass centered in the right pterygopalatine fossa with extension into the foramen ovale, foramen rotundum, Vidian canal, right cavernous sinus, posterior right nasal cavity, buccal space, and protrudes slightly into the right orbit via the inferior orbital fissure. Overall, the tumor measures up to approximately 7 cm. There is right tympanomastoid fluid. There is a partially-imaged transpatial mass centered in the posterior triangle of the left lower neck, which measures at least up to 10 mm. Furthermore, tumor extends into the left C5 though at least the T2 neural foramina, but there does not appear to be spinal cord compression. There are postoperative findings related to laminotomies from C5 to T1. There is kyphotic deformity at the cervical thoracic junction, but no spondylolisthesis. There is a punctate T2 hyperintense lesion in the left upper lip. There is diffuse moderate paranasal sinus mucosal thickening. There is no significant cervical lymphadenopathy. There is mild prominence of the Waldeyer ring structures, which is a common finding for the age of the patient.

Output: 1. A plexiform neurofibroma centered in the right pterygopalatine fossa with extension into the foramen ovale, foramen rotundum, Vidian canal, right cavernous sinus, posterior right nasal cavity, and buccal space. Overall, the tumor measures up to approximately 7 cm. Right tympanomastoid fluid may represent retained effusions due to mass effect upon the Eustachian tube. 2. A partially-imaged transpatial plexiform neurofibroma centered in the posterior triangle of the left lower neck measures at least up to 10 mm. Furthermore, tumor extends into the left C5 though at least the T2 neural foramina, but there does not appear to be spinal cord compression. Please refer to the separate chest MRI report for additional details.3. Kyphotic deformity at the cervical thoracic junction, but no spondylolisthesis. 4. A punctate T2 hyperintense lesion in the left upper lip may represent a neurofibroma.


Instruction: Generate impression based on findings.

Input: 51 year-old female. Fibromatosis. Evaluate for recurrence. ABDOMEN:LIVER, BILIARY TRACT: Enhancing lesion in segment 6 of the liver measures 1.6 x 2.4 cm, previously 1.6 x 1.6 cm (series 11, image 60), characterized before to be compatible with an FNH and less likely an adenoma. A second enhancing lesion in the right hepatic lobe measures 1.1 x 1.1 cm, unchanged (series 11, image 67).No biliary ductal dilatation. Scattered small hepatic cysts.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Colonic diverticulosis.BONES, SOFT TISSUES: Midline small incisional hernia containing a small bowel loop without evidence of obstruction.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Colonic diverticulosis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Right sided Bartholin cyst.

Output: No evidence of recurrent disease. Mild increased size of the segment 6 hepatic lesion.


Instruction: Generate impression based on findings.

Input: 31 year old male with history of sickle cell anemia who presents for cardiac MRI for evaluation of shortness of breath and abnormal ECHO at OSH Left VentricleThe left ventricle is severely dilated with normal systolic function. The overall LV ejection fraction is 56%, the LV end diastolic volume index is 172 ml/m2 (normal range: 74+/-15), the LVEDV is 335 ml (normal range 142+/-34), the LV end systolic volume index is 75 ml/m2 (normal range 25+/-9), the LVESV is 147 ml (normal range 47+/-19), the LV mass index is 101 g/m2 (normal range 85+/-15), and the LV mass is 198 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.There is no evidence of iron overload in the myocardium.Left AtriumThe left atrium is moderately dilated in size. Right VentricleThe right ventricle is severely dilated and normal in systolic function. The overall RV ejection fraction is 53%, the RV end diastolic volume index is 172 ml/m2 (normal range 82+/-16), the RVEDV is 335 ml (normal range 142+/-31), the RV end systolic volume index is 75 ml/m2 (normal range 31+/-9), and the RVESV is 147 ml (normal range 54+/-17).Right AtriumThe right atrium is moderately dilated in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is a moderate to large amount of pericardial effusion without evidence of hemodynamic compromise.Extracardiac FindingsThere is evidence of iron overload in the liver (T2-star = 6ms). There are small bilateral nodules present in the lung fields in addition to bilateral atelectasis. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is severely dilated with normal systolic function (LVEF 56%)2. The right ventricle is severely dilated and normal in systolic function (RVEF 53%)3. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.4. There is no evidence of iron overload in the myocardium. However, there is iron overload present in the liver.6. Moderate biatrial dilation7. Moderate to large pericardial effusion8. In comparison to the cardiac MRI dated 12/15/2009, there is no longer evidence of LGE on this scan. The size of the pericardial effusion is slightly decreased in size.


Instruction: Generate impression based on findings.

Input: Status post excision of a borderline Phyllodes tumor. Three standard views of the right breast and multiple spot compression views were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is extremely dense, which lowers the sensitivity of mammography(BiRads Density Category D), unchanged in pattern and distribution. No suspicious microcalcifications or areas of architectural distortion in the right breast. Small obscured masses near the scar marker are probably cysts as can be seen on prior MRI. These are more apparent on the full field views than on spot views.ULTRASOUND

Output: Numerous cysts, but no solid lesion is apparent. Given the complexity of her mammogram due to density and difficulty following on ultrasound due to numerous cysts, MRI may be the best future surveillance examination, if she qualifies based on her diagnosis, density and history. Other potential follow-up imaging such as automated whole breast ultrasound was discussed, and could be performed if desired by Dr. Jaskowiak.BIRADS: 2 - Benign finding.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Preop planning for tumor biopsy. This is a limited MRI of brain for preoperative planning. There is redemonstration of abnormal T2 signal within the right greater than left basal ganglia and right anterior thalamus. There is also abnormal T2 signal within the right cerebral peduncle, which extends caudally to the level of upper pons. There is no abnormal intracranial enhancement. Compared to 5/27/2015, there appears to be decrease in T2 hyperintensity within the right basal ganglia as well as resolution of enhancement. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift. The skull and extracranial soft tissues are unremarkable. There is a small mucous retention cyst in the left maxillary sinus.

Output: Limited study MRI of the brain for preoperative planning. Compared to MRI brain dated 5/27/2015, interval decrease in T2 signal within the right basal ganglia as well as resolution of right basal ganglia enhancement is noted.


Instruction: Generate impression based on findings.

Input: Male, 52 years old, with septic shock secondary to MRSA bacteremia, assess for infection. Brain:Brain parenchymal morphology is unremarkable. No evidence of edema, mass effect or significant parenchymal signal alteration is demonstrated. Diffusion-weighted images are within normal limits.No evidence of acute intracranial hemorrhage or any abnormal extra-axial fluid collection is seen. The ventricular system is normal in size and morphology. Loss of the left sigmoid sinus and internal jugular flow void is seen compatible with thrombosis.The mastoid air cells are opacified and there is mucosal thickening in the sphenoid sinuses. Pooling fluid is seen in the nasal cavity and pharynx likely related to intubation.Neck:The left IJ vein is thrombosed down to the level of C6. Extensive edema of the paraspinal musculature is seen most severely centered at the C1 and C2 levels. This edema wraps around the left aspect of the vertebral bodies to involve the left longus coli.At the C2 level, and to a lesser degree at C1 and C3, the ventral epidural space is thickened with very T2 hyperintense, diffusion restricting material. This results in a moderate narrowing of the spinal canal at C2 and minimal deformation of the spinal cord contour. No evidence of spinal cord edema is seen. The adjacent vertebral bodies show no evidence of significant marrow edema. However, the left lateral C1-2 articulation is edematous and may contain some fluid.Fluid and edema involving pharynx are again seen. Scattered prominent lymph nodes are evident more so in the left neck than the right. The visualized major salivary glands are unremarkable. The thyroid is not well assessed due to artifact in the region. Opacification is noted in the left lung apex.

Output: The left IJ vein is thrombosed down to the C6 level. In addition, significant edema is seen within the paraspinal muscles of the upper neck, centered at C2, also wrapping anteriorly to involve the left longus coli muscle. In association with this, there is thickened, T2 hyperintense and diffusion restricted material within the ventral epidural space at C2, and to a lesser degree at C1 and C3. This results in a moderate narrowing of the spinal canal and slight deformation of the cord but no evidence of cord edema. Taken as a whole, these findings are highly concerning for paraspinal cellulitis with associated epidural abscess or phlegmon, perhaps secondary to infected thrombophlebitis of the left internal jugular vein. Findings were discussed with Dr. Ernst at 9:30 AM on 1/12/2016.Intracranially, left IJ thrombosis continues into the left sigmoid sinus. However, no significant parenchymal signal abnormality or intracranial fluid collections are observed. The mastoid air cells are opacified which, given the clinical context, could be reactive to intubation or reflective of an infectious process.


Instruction: Generate impression based on findings.

Input: Cognitive impairment and memory decline. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is global parenchymal volume loss. There is no midline shift or herniation. There are symmetric bilateral T2 hyperintensities involving predominantly the inferior basal ganglia without edema or mass effect. There are 1-2 small foci of nonspecific T2 hyperintensity in the right parietal lobe. There are no other areas of significant abnormality.The major cerebral flow voids are intact. There is mild mucosal thickening involving the maxillary and ethmoid sinuses. There is nonspecific left parietal bone lesion, likely benign.

Output: No definite findings to account for patient's symptoms. Bilateral chronic appearing signal abnormality in the lower basal ganglia is seen which may be incidental. Given the clinical presentation, the differential would include sequelae of prior toxic exposure, metabolic derangement or infection.


Instruction: Generate impression based on findings.

Input: BRCA 1 carrier. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.No suspicious enhancement is seen in either breast. The few areas of scattered parenchymal enhancement are normal in appearance. No abnormal lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. Annual mammography should also be performed for this high risk patient. BIRADS: 1 - Negative.RECOMMENDATION: NS - Routine Screening Mammogram.


Instruction: Generate impression based on findings.

Input: Male, 56 years old, status post resection of the spinal lesion in 1985, with back pain and evidence of a spinal lesion on prior MRI. Three-month follow-up exam. Thoracic:Evidence of prior surgery seen including laminectomy from T8 through T10.Interval evolution of the abnormal extradural soft tissue process is seen within the laminectomy defect. This tissue has become somewhat less protuberant towards the spinal canal, now measuring up to 5 mm in thickness, previously up to 8 mm. The signal intensity of this tissue has also evolved. It now appears hyperintense on both T1 and T2 weighted images whereas previously it was T1 hyperintense and T2 hypointense. The rim of this tissue may be enhancing, but the internal components are intrinsically T1 bright and not definitely enhancing.As before, the spinal cord is deformed and tethered to the dura through this region without significant interval change.Elsewhere in the thoracic spine, the spinal cord demonstrates normal signal intensity and morphology. Spinal alignment is anatomic and vertebral body height and morphology are within normal limits. No significant disc bulge or disc herniation is seen. No significant compromise spinal canal or neural foramina is noted.Lumbar:Alignment is anatomic. Vertebral body height and morphology are within normal limits. No concerning marrow replacement or edema is seen. No pathologic enhancement is detected. The distal spinal cord, conus and nerve roots of the cauda equina are unremarkable. Mild degenerative disc disease is seen at L3-4 and L5-S1 with mild disc bulging. The right L3-4 neural foramen is mildly narrowed. Otherwise, no significant spinal canal or foraminal stenosis is seen. Facet arthropathy is also evident at lower lumbar levels. No interval changes are detected.

Output: 1.Abnormal soft tissue is redemonstrated within the extradural space of the laminectomy bed from T8 through T10. Given the signal characteristics and interval changes in imaging characteristics of this process, evolving hematoma with perhaps some granulation tissue is favored as the etiology. No clear evidence of an enhancing tumor is seen.2.The spinal cord through this region remains deformed and tethered to the dura, similar to the prior examination. Elsewhere, the spinal cord is unremarkable.3.No other significant findings are seen in the thoracic or lumbar spine.


Instruction: Generate impression based on findings.

Input: 32-year-old female with right shoulder pain after fall. Evaluate rotator cuff and labrum. ROTATOR CUFF: No evidence of rotator cuff tear. No muscle atrophy or edema.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: Linear track of contrast in the superior labrum from the level of the biceps anchor extending posteriorly compatible with a SLAP tear. This may be due to extension of the tear of the anterior labrum superiorly (described below).Tearing and avulsion of the anterior labrum with periosteal stripping from the anterior scapular neck extending from the anterior superior labrum to inferior labrum. There is mild granulation tissue and some synovitis in the area.The posterior labrum is diminutive and possibly torn. There is fissuring of the cartilage posteriorly and may represent a tear at the chondrolabral junction.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: 1. Mild bone marrow edema in the posterior aspect of the humeral head without distinct fracture line and some associated changes in the anterior glenoid suggests possible prior dislocation. There is no discrete Hill-Sachs deformity.2. Tearing and avulsion of the anterior labrum with periosteal stripping from the anterior scapular neck extending from the anterior superior labrum to inferior labrum - (Perthes Lesion).3. Possible tear of the posterior labrum (with fraying) which is diminutive with a cartilage fissure at the chondrolabral junction. 4. No rotator cuff tear.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Multifocal bihemispheric and supra and infratentorial high signal intensity lesions on FLAIR images involving periventricular, subcortical, corpus callosum, midbrain, pons, medulla and bilateral cerebellar hemispheres which are consistent with the diagnosis of multiple sclerosis are seen, unchanged in terms of their extent, configuration and number since prior scan. There is prominence of the ventricles and the sulci suggestive of volume loss, again unchanged. There is no restricted diffusion. There are few foci in the periventricular white matter of high signal in the diffusion and in the ADC sequence, representing T2 shine through. There are no susceptibility abnormalities.

Output: No significant changes of multifocal white matter lesions on FLAIR images since the previous study.


Instruction: Generate impression based on findings.

Input: Poorly controlled diabetic with left foot soft tissue infection and gas on prior film. Please rule out osteomyelitis. There is irregular low T1 signal within the distal portion of the proximal phalanx of the great toe without associated STIR signal. These findings are most compatible with chronic fracture. No significant enhancement. No specific findings of osteomyelitis. Diffuse soft tissue swelling about the great toe. No other significant osseous deformity. Susceptibility artifact presumably from subcutaneous emphysema noted on prior radiographs about the base of the great toe.

Output: Findings compatible with chronic fracture of the distal aspect of the proximal phalanx of the great toe without specific findings of osteomyelitis.