Instruction: Generate impression based on findings.

Input: Reason: intracranial stenosis? History: imbalance MRI of the brainThere is a 5 mm thick by 22-mm wide extra-axial lesion which is bright on flair and T1 weighted imaging.Small focus of encephalomalacia present along the right orbital gyrus which is associated with some susceptibility effect and superficial siderosis .There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is small in. The posterior communicating arteries are identified. The left posterior communicating artery is fairly large whereas the right posterior communicating artery is a very small. The vertebral arteries are similar in size.

Output: 1.A small extra-axial lesion is present adjacent to the left frontal lobe. There is no associated mass effect. Differential considerations include a small subacute hematoma.2.Small focus of encephalomalacia and he right orbital gyrus is present. This specific location and is often associated with posttraumatic injury.3.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: Female, 71 years old, with remote history of TIA, hypertension, diabetes, presenting with altered mental status and fever to 40.5, now improved status post antibiotics. No restricted diffusion is seen. Minimal scattered small foci of T2 hyperintensity are seen in the cerebral white matter, a nonspecific finding. No parenchymal edema or mass effect is detected. No pathologic parenchymal or extra-axial enhancement is observed. A developmental venous anomaly is noted in the right cerebellum. No abnormal extra-axial fluid collection is detected. There are no findings to suggest acute intracranial hemorrhage. The ventricular system is within normal limits.

Output: No acute intracranial abnormality or other specific findings to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: Brain tumor preoperative planning. There is a hemorrhagic lesion that measures up to approximately 4 cm in the left frontal lobe with associated surrounding vasogenic edema. There is also associated effacement of the anterior aspects of the lateral ventricles, 8 mm of midline shift to the right, and mild subfalcine herniation. Skin-based fiducial markers are present.

Output: Limited preoperative MRI demonstrates a left frontal lobe hemorrhagic tumor with surrounding vasogenic edema. Please refer to the prior exams for additional details regarding the lesion.


Instruction: Generate impression based on findings.

Input: Female 42 years old Reason: relationship of rectal cancer to posterior vagina History: new diagnosis of rectal cancer Overall image quality: GoodPELVIS:UTERUS, ADNEXA: Invasion of the posterior cervix as below. BLADDER: No significant abnormality noted. LYMPH NODES: Lymph nodes in the perirectal space, within the mesorectal fascia: NoneLymph nodes outside the mesorectal fascia: NoneBOWEL, MESENTERY: Rectal Tumor:Size: 1.9 x 3.4 x 12.5 cm (image 37/series 3 and image 21/series 4)Tumor appearance on T2-weighted images: Circumferential tumor with large soft tissue component along the left aspect of the rectum.Tumor location: Extending from the anal verge 12.5 cm proximally, involving the rectum and proximal sigmoid colon(For lower rectal tumors):Distance of the lower edge of the tumor to the anal verge (lower edge of the anal canal): 1.4 cmDistance of the lower edge of the tumor to the pelvic floor (relationship of the tumor to the anal sphincter complex): Extends from the anal sphincter proximally.Circumference of the rectum involved: Complete circumferential distally but proximally occupies 180 degrees along the left aspectRelationship and proximity of the tumor to adjacent structures (uterus, cervix, vagina): There is invasion of the adjacent mesorectal fat and fascia as well as invasion into the posterior wall of the upper vagina and cervix (4/22 and 3/38).MRI T-stage: T4 - Tumor invades adjacent organs, as described aboveTumor Distance to Mesorectal Fascia: 0 cm (image 3/series 40).BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small amount of free fluid, likely physiologic.

Output: 1.Circumferential rectal mass with invasion of adjacent vagina and cervix, compatible with patient's known rectal adenocarcinoma.2.No lymphadenopathy.3.


Instruction: Generate impression based on findings.

Input: Male, 3 years old. Reason: MRCP to evaluate biliary system for strictures. History: s/p liver transplant with elevated LFTs, bile duct dilatation on USEXAMINATION: MRI abdomen with and without contrast ABDOMEN:LIVER, BILIARY TRACT: Dilation of the proximal and distal aspects of the left hepatic duct, measuring 6-7mm.Dilation of the proximal aspect of the right hepatic duct, measuring approximately 5mm. The distal portion of the right hepatic duct is not dilated.The common hepatic duct is dilated, measuring 6mm.The common bile duct is only partially visualized, with the visualized portion mildly dilated, measuring 5-6mm. The distal portion of the common bile duct at its insertion is not visualized.No filling defect in the visualized portions of the biliary tree.Hepatomegaly, with the liver measuring approximately 16cm.The gallbladder is partially collapsed.SPLEEN: Normal size and morphology. Small splenules.PANCREAS: Normal size and morphology. The pancreatic duct is not visualized.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Normal size and morphology. No focal mass or hydronephrosis.BOWEL, MESENTERY:No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Intrahepatic and extrahepatic biliary ductal dilatation as detailed above. Note that the entire length of the common bile duct is not completely visualized.


Instruction: Generate impression based on findings.

Input: Male, 4 years old. Reason: eval for mass, trauma History: AMS There is mild to moderate enlargement of the lateral ventricles with a wavy configuration consistent with periventricular infarction. Findings correlate with prior MRI examination. There is evidence of cavum vergae which is stable from the previous exam. There is no evidence of intracranial hemorrhage, mass or edema. The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Findings compatible with periventricular leukomalacia, no acute intracranial abnormality.


Instruction: Generate impression based on findings.

Input: Female 61 years old with lateral elbow pain. Evaluate for ligamentous injury. Evaluation is limited as study was not able to be completed due to the patient's claustrophobia. No sagittal sequences were performed.LIGAMENTS AND TENDONS: There is focal increased signal intensity within the deep fibers of the common extensor tendon at its origin indicating tendinosis and perhaps a small partial-thickness tear. There is also mild edema within the soft tissues superficial to the tendon at its origin. Focal increased signal intensity within the proximal fibers of the underlying radial collateral ligament could conceivably reflect additional degeneration and/or focal tearing but this is equivocal and the majority of the ligament appears intact. The medial supporting structures of the elbow appear intact. There is a small focus of increased signal intensity within the distal biceps tendon which may reflect tendinosis with a tiny amount of fluid in the bicipitoradial bursa. The brachialis tendon and triceps tendon appear normal.ARTICULAR SURFACES AND BONE: Bone marrow signal intensity appears normal. There is a small amount of fluid within the joint but no frank effusion. We see no osteochondral defect. SURROUNDING STRUCTURES: The muscles of the elbow appear normal and we see no soft tissue masses.

Output: Common extensor tendinosis ("lateral epicondylitis") and other findings as described above.


Instruction: Generate impression based on findings.

Input: 27-year-old female with NF1 who has pain that radiates into right hand, mainly middle two fingers. Also largish cutaneous neurofibroma at ulnar border. Multiple lesions are present located in the superficial cutaneous tissues which demonstrate low T1, bright T2/STIR and heterogeneous enhancement after contrast administration most compatible with neurofibromas. The largest is located within the dorsal soft tissues of the distal forearm measuring 14 mm (anteroposterior) x 24 mm (mediolateral) by x 25 mm (craniocaudal). Additional lesions are located more deeply within the volar soft tissues of the distal forearm along the coarse of the ulnar and median nerves; the largest in the ulnar nerve distally near the carpal tunnel measures 8 mm (anteroposterior) x 5 mm (mediolateral) x 14 mm (craniocaudal). The largest in the median nerve measures 7 mm (mediolateral) x 6 mm (anteroposterior) overlying the distal humeral diaphysis. Additional subcentimeter lesions appear to occupy the posterior interosseous nerve overlying the mid to distal humeral diaphysis (series 1101, image 48).The tendons and muscles of the forearm appear normal. Bone marrow signal intensity is normal.

Output: Multiple neurofibromas along the forearm, the largest of which occupy the superficial cutaneous tissues, with additional smaller lesions affecting the ulnar, median and posterior interosseous nerve as described above.


Instruction: Generate impression based on findings.

Input: 8-year-old girl with a history of sickle cell disease and left MCA stroke. Evaluate for stenosis and moyamoya. MRI brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. Again seen is volume loss and T2 hyperintensity indicating encephalomalacia in the left MCA territory including the left temporal and to a lesser degree left parietal lobe. Additional foci of T2 hyperintensity in the left frontal lobe white matter are unchanged. The right inferior frontal gyrus developmental venous anomaly is redemonstrated. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.MRA brain: Evaluation is somewhat limited due to motion artifact. There is narrowing in the bilateral supraclinoid internal carotid arteries and diminished flow focally in the proximal right M1 segment. There is also diminished flow at the left MCA bifurcation which appears more severe when compared to prior however there is artifact at this location. There is reconstitution of flow in the more distal MCA branches bilaterally. The bilateral A1 segments are narrowed but reconstituted distally. These findings are overall similar to the prior study as is the appearance of prominent lenticulostriate collaterals vessels allowing for differences in technique and artifacts. The vertebral arteries, basilar artery, and posterior cerebral arteries are normal in course and caliber. No aneurysm is identified.

Output: 1.Stable findings of encephalomalacia related to prior left MCA infarct. No new or acute infarct.2.Allowing for differences in technique there is no significant interval change in stenosis in the supraclinoid ICAs, bilateral M1 and A1 segments. The mildly prominent lenticulostriate collaterals also appears similar. These findings are again compatible with moyamoya pattern.


Instruction: Generate impression based on findings.

Input: 82 years Female (DOB:11/28/1933)Reason: assess for aneurysm History: thalamic bleedPROVIDER/ATTENDING NAME: AGNIESZKA A ARDELT RAYMOND A ROOS MRI of the brainNo diffusion weighted abnormalities are appreciated.. Patchy T2 and FLAIR hyperintense foci are present in the thalami and basal ganglia as well as the brainstem.On susceptibility imaging there are multiple small foci of signal loss present in the thalami to a lesser degree basal ganglia and internal capsules and in the upper brainstem as well as some of the subcortical white matter in the frontal, parietal and temporal lobes and also scattered in the cerebellar hemispheres.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mucous retention cyst in the left maxillary sinus.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. There is extracranial origin of the left posterior inferior cerebellar artery. There is triplication of the anterior cerebral artery. Anterior communicating artery appears to be incompletely. The posterior communicating arteries are not readily appreciated. The left vertebral artery slightly smaller than the right vertebral artery.

Output: 1.No evidence for cerebrovascular occlusive disease.2.There is no evidence for acute ischemic cerebral infarction.3.There are multiple microhemorrhages scattered throughout the brain parenchyma a somewhat favor thalami and internal capsules and upper brainstem but are present throughout the cerebellum and to lesser subcortical white matter. This pattern is suggestive of hypertensive microhemorrhages however superimposed process may be present.4.Patchy lesions in the brainstem and thalami basal ganglia are likely vascular related at this age.5.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: Left hip pain The examination is limited by motion artifact particularly of the postcontrast sequences.The marrow signal of the pelvis and specifically the left hip is normal. There is no fracture or malalignment. A small focus of heterotopic ossification or spurring is seen along the greater trochanter of the left hip which may be the result of prior trauma or chronic enthesopathic change. Mild degenerative changes are noted in the pubic symphysis and mild osteoarthritis affects the hips.Following contrast administration, there is no abnormal enhancement within the limits of the motion degraded sequences.

Output: Motion degraded exam without focal abnormality.


Instruction: Generate impression based on findings.

Input: Reason: rule out osteomyelitis History: non healing wound There is a large cutaneous defect in the posterior soft tissues of the right upper thigh/buttocks with deep soft tissue ulceration extending between the gluteus maximus and medius muscles and extensive intramuscular granulation tissue. Abnormal T1 hypointense signal and enhancement is seen throughout the bone marrow of the right femur, extending from the femoral neck and greater trochanter and inferiorly 4 cm below the intertrochanteric line. There is no involvement of the right femoral head, acetabulum, or the left hip.There is extensive T2 hyperintense signal and enhancement throughout the musculature of the right leg, with involvement of the gluteus maximize, minimus, and medius muscles as well as the posterior and anterior compartments of the leg and extending beyond the field of view.Additionally, there is a more shallow, broad-based ulceration over the sacrum and coccyx with subtle enhancement of the sacrococcygeal soft tissues and the lower coccygeal segments, concerning for an additional site of osteomyelitis.There is no definite evidence of discrete focal fluid collection or abscess, however there are pockets of air and granulation tissue with peripheral enhancement in the anterior compartment of the thigh, similar to that seen on CT of the pelvis dated 7/28/2016.The neobladder appears distended with an irregular contour, please consider dedicated imaging if clinically indicated.

Output: Findings consistent with osteomyelitis of the right femoral diaphysis and femoral neck with probable involvement of the coccyx.


Instruction: Generate impression based on findings.

Input: Reason: Patient with history of chronic knee pain, swelling noted on exam, with pain on valgus stress, concern for MCL tear vs sprain MENISCI: There is predominantly horizontal tear of the lateral meniscus extending from the anterior root to the body. The lateral meniscus is extruded. Medial meniscus is normal in signal characteristics and morphology.ARTICULAR CARTILAGE AND BONE: Bone marrow signal is within normal limits. Osseous alignment is anatomic. There is thinning of the patellar cartilage, particularly at the lateral facet. There is also thinning of the cartilage at lateral femoral condyle and lateral tibial plateau overlying the meniscal tear.LIGAMENTS: Cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: Quadriceps tendon and patellar tendon are intact.ADDITIONAL

Output: Horizontal tear of the lateral meniscus from the anterior root to the body. There is cartilage thinning of the lateral femoral condyle overlying this region. There is also thinning of the patellar cartilage particularly at the lateral facet. Other findings as above.


Instruction: Generate impression based on findings.

Input: 54-year-old female with history of ventral hernia and hematuria ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Left adrenal nodule, enlarged from previous study now measuring 9 by 9 mm on image number 43, series number 7. MRI of the adrenal gland it helpful for further evaluation.KIDNEYS, URETERS: No focal lesions in both kidneys. No evidence of stones. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Postsurgical changes in the lower anterior abdominal wall. There is a midline tissue defect through a short segment of midline incision. No evidence of herniating bowel segments. Small amount of fat indenting the fascia however no obvious evidence of herniation. OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Heterogeneous uterus with possible multiple fibroids.BLADDER: Wall thickening of the bladder. This may represent cystitis.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Postsurgical changes involving the bowel.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Midline tissue defect along incision. Post surgical changes in the anterior abdominal wall. No evidence of obvious herniation.Mild wall thickening of the bladder suggestive of cystitis.MRI of the adrenal may be helpful for further evaluation of small left adrenal nodule, which is increased in size compared to previous study. Clinical correlation is recommended.


Instruction: Generate impression based on findings.

Input: Female, 61 years old, with a sellar mass seen on prior MRI. Image quality is degraded by motion artifact. A lobular mass is present within the sella and extending into the suprasellar cistern measuring 16 mm CC, 13 mm TV, and 17 mm AP. The lesion is T2 heterogeneous and relatively T1 isointense to brain. The native pituitary gland cannot be recognized as separate from this lesion though artifact and technical factors may contribute.The lesion fills the space between the distal internal carotid arteries, contacting and perhaps partial enwrapping than but without evidence of vascular compromise. The lesion extends superiorly to contact the ACA vessels. The optic nerves appear to be splayed around the lesion. Anteriorly, the lesion appears to extend over the anterior sellar wall and along the planum sphenoidale for a short distance.Right frontal encephalomalacia seen compatible with a chronic infarct. Additional scattered small white matter lesions are seen likely indicating microvascular ischemic disease. Restricted diffusion is again seen in the left middle frontal gyrus.

Output: A mass is present involving the sella and suprasellar cistern. The native pituitary gland cannot be identified as separate from this lesion. Given lack of fine detail deformation due to motion artifact, and without the benefit of IV contrast, macroadenoma or meningioma would be the statistically most likely considerations.


Instruction: Generate impression based on findings.

Input: Prostatic adenocarcinoma.2014 Biopsy: Prostate, left base medial; needle biopsy: - Prostatic adenocarcinoma, Gleason score 6 (3+3), 1.5 mm focus. - Tumor volume is 5% of the submitted tissue.Prostate, left mid lateral; needle biopsy: - Prostatic adenocarcinoma, Gleason score 6 (3+3), 1.0 mm focus. - Tumor volume is 5% of the submitted tissue.2013 Biopsy: 3+3 disease in the right apex medially and left apex laterally. PELVIS:PROSTATE:Prostate Size: 2.9 x 4.7 x 4.6 cm.Peripheral Zone: Approximately 7 mm T2-weighted hypointense lesion in the left base may represent a site of carcinoma, alternatively this may represent an asymmetric central zone.Approximately 5 mm T2 hypointense focus in the right mid gland may represent a site of carcinoma.Additional scattered punctate T2 hypointense foci in the peripheral zone without a dominant lesion.Central Gland: No significant abnormality.Seminal Vesicles: No evidence of seminal vesicle in relation.Extracapsular Extension: No evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 7 mm left base and 5 mm right mid gland foci may represent sites of carcinoma and are amenable to MRI/ultrasound fusion biopsy.


Instruction: Generate impression based on findings.

Input: 42 years Male (DOB:5/11/1974)Reason: stroke History: left arm numbness and tinglingPROVIDER/ATTENDING NAME: MICHAEL ANDREW WARD MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mild mucosal thickening. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries. There is fetal origin of the posterior cerebral arteries bilaterally. The P1 segments are small to medium sized. The anterior communicating artery is medium-sized.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. The posterior communicating arteries are not readily identified. The vertebral arteries are similar in size.

Output: 1.No evidence for cerebrovascular occlusive disease.2.No evidence for intracranial aneurysm.3.No evidence for acute cerebral infarction.


Instruction: Generate impression based on findings.

Input: Reason: ? Full thickness tear of rotator cuff? History: pain ROTATOR CUFF: On the fluid sensitive sequences, there is mild increased signal intensity within the supraspinatus, infraspinatus, and teres minor muscles with sparing of the subscapularis muscle. Similarly, there is mild increased signal intensity within the anterior fibers of the deltoid and the trapezius with sparing of the posterior fibers of the deltoid as well as sparing of the teres major muscle. There is more focal increased signal intensity on fluid sensitive sequences within the distal fibers of the teres minor along the myotendinous junction which corresponds to fat signal intensity on T1-weighted images perhaps representing focal atrophy; while it is possible this teres minor signal abnormality could be due to a prior tear, this would be an unusual location for an isolated rotator cuff tear as we see no tear of the supraspinatus, infraspinatus, or subscapularis. We see no cyst or mass lesion within the spinoglenoid or suprascapular notch.SUPRASPINATUS OUTLET: There is mild increased signal intensity within the subdeltoid bursa along the lateral aspect of the humeral head containing tiny foci of low to intermediate signal intensity as well. This may represent mild inflammation of the bursa possibly with small calcium deposits which could be better evaluated with dedicated shoulder radiographs.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is a trace amount of fluid within the glenohumeral joint but no large effusion. Given the limitations of a non arthrogram study, we see no fluid-filled labral tear.BICEPS TENDON: Given the limitations of a non arthrogram study, the long head of the biceps tendon appears intact. ADDITIONAL

Output: 1. Mild edema type signal involving several of the muscles of the shoulder as described above which is nonspecific, but could represent early denervation atrophy or Parsonage-Turner syndrome.2. Focal increased signal intensity along the myotendinous junction of the distal teres minor is suggestive of focal atrophy perhaps due to an old tear, although an isolated tear at this location would be unusual.3. Abnormal signal intensity within the subdeltoid bursa along the lateral aspect of the humeral head suggesting mild inflammation. Radiographs may be considered to evaluate for calcific bursitis.


Instruction: Generate impression based on findings.

Input: Female 58 years old Reason: lateral elbow synovitis History: pain Diluted gadolinium is noted within the elbow joint. Additionally, there is extensive gadolinium infiltrating the surrounding musculature and subcutaneous fat both anteriorly and posteriorly, likely iatrogenic, but limiting detailed evaluation. There is heterogeneity of the anterior fibers of the common extensor tendon representing a combination of tendinosis, partial thickness tearing, and prior intervention, improved from the prior examination. There are postsurgical changes involving the lateral compartment of the elbow with foci of susceptibility artifact from surgical material. Heterogenous signal and lower signal changes within the joint and olecranon fossa represents presumed scarring. No discrete loose joint bodies are identified within the pooled contrast and arthrogram. No frank signs of synovitis, yet more subtle changes prevent exclusion given the limitations described.Gadolinium is identified within the fibers of the lateral collateral ligament complex again suggests that there may be a defect. There is a small amount of marrow edema within the capitellum and proximal radius. Osteoarthritic changes affecting the radiocapitellar articulation are again noted with a stable subchondral cyst in the radial head. The ulnar collateral ligament and common flexor tendon appear intact. The ulnotrochlear articulation appears normal. As well again there may be some tendinosis of the common flexor tendon, though fibers remain intact. The biceps and biceps brachialis tendon appear normal. Evaluation of soft tissues changes in the surrounding anatomy is also limited especially for edema given gadolinium infiltration. The remaining visualized osseous structures and musculature is normal.

Output: 1. Limited evaluation due to extensive gadolinium infiltration. Postsurgical changes involving the lateral compartment. Gadolinium is identified within the fibers of the lateral collateral ligament complex suggesting that there may be a defect with accompanying mild marrow edema at this location. Heterogeneity of the common extensor tendon appears stable to slightly improved compared to the prior exam likely reflecting combination of tendinosis, partial thickness tearing, and prior intervention.2. Stable radiocapitellar osteoarthritis.


Instruction: Generate impression based on findings.

Input: 15-year-old male. Trauma. CT of brain without infusion.This examination is negative for any post traumatic intracranial findings. No evidence of hemorrhage, edema, mass effect, midline shift or hydrocephalus is detected. The cortical sulci, ventricular system and all CSF cisterns are unremarkable.The bony density of calvarium, pneumatization of mastoid air cells and limited view of paranasal sinuses are unremarkable. Minimal soft tissue swelling in the left preseptal periorbital region is noted.CT of maxillofacial.Large retention cyst within the right maxillary sinus is noted. No evidence of any fracture of the maxillofacial region is present.Swelling of the left preseptal periorbital and minimally retro-orbital is noted.Minimal stranding of retro-orbital fat on the left is detected. This may represent minimal hemorrhage or edema. If clinical concern persist an MRI of orbit may add additional information. The morphology and density of the globe in both anterior and posterior chambers remains within normal limits. The extraocular musculature are intact and the optic nerve from this examination appears to be within normal limits.

Output: 1.Normal CT of brain.2.No meniscal fracture of maxillofacial region.3.Left-sided preseptal periorbital soft tissue swelling.4.Minimal stranding of retro-orbital fat on the left as detailed.


Instruction: Generate impression based on findings.

Input: 45-year-old male. Shoulder pain months with overhead activities and clicking. Evaluate for labral tear, loose body. ROTATOR CUFF: Mild tendinosis of the supraspinatus without evidence of a full thickness tear. No gross abnormality of the infraspinatus and subscapularis tendons. Diffuse marked fatty atrophy of the teres minor, unchanged.SUPRASPINATUS OUTLET: Again seen is a large os acromiale. Mild osteoarthritis of the AC joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: Gadolinium extends into a linear tear within the substance of the superior labrum from the 2 o'clock to 10 o'clock position consistent with a SLAP tear. There are small adjacent associated paralabral cysts. There is blunting/fraying of the anterior and posterior inferior labrum consistent with degenerative tearing. Degenerative cysts within the humeral head near the cuff insertion.A large subchondral cyst-like focus in the inferior glenoid, unchanged, may represent an intraosseous ganglion versus a degenerative cyst. Chronic deformity of the anterior inferior glenoid, may be from remote trauma. Mild osteoarthritis of the glenohumeral joint.BICEPS TENDON: Long head of the biceps tendon is intact and is normally situated in the bicipital groove.ADDITIONAL

Output: Findings consistent with a SLAP tear.


Instruction: Generate impression based on findings.

Input: Male, 2 years old, with difficulty walking upstairs, sitting down, hypotonic lower extremities, decreased overhead motion of the upper extremities. Brain:The cerebral and cerebellar hemispheres and brainstem show normal signal intensity and morphology. No restricted diffusion is seen. No pathologic parenchymal or extra-axial enhancement is detected.The pattern of white matter myelination is appropriate for age and essentially mature. The pituitary region is within normal limits. The brainstem, cerebellar vermis and cerebellar hemispheres are unremarkable. The corpus callosum is fully formed and normal.No evidence of parenchymal edema, mass, or mass effect is seen. There is no evidence of intracranial hemorrhage or abnormal extra-axial fluid. The ventricular system is normal in caliber and morphology. Spine:A full complement of normally formed vertebral bodies is present. Marrow signal intensity and pattern of enhancement are within normal limits. Spinal alignment is anatomic.The spinal cord demonstrates normal morphology and, allowing for mild motion degradation, shows no evidence of any pathologic signal abnormality. No abnormal cord or leptomeningeal enhancement is seen. The conus tip terminates at the L1-2 level which is within normal limits. The nerve roots of the cauda equina dispersed evenly through the thecal sac. No intraspinal fatty material is observed.The paraspinal musculature is diffusely hyperintense on T2-weighted images and shows diffuse pathologic enhancement.

Output: 1.Unremarkable evaluation of the brain.2.Unremarkable evaluation of the spinal cord and osseous spine.3.Diffuse paraspinal muscular signal abnormality and enhancement is seen compatible with a systemic myositis.


Instruction: Generate impression based on findings.

Input: Limited MRI demonstrates diffuse ventriculomegaly, similar to prior examination. For example, the third ventricle measures 1.2 cm transverse, previously 1.1 cm. There has been overall increase in cortical mantle thickness, now measuring 9 mm in the left occipital region, previously 3 mm. However, there continues to be relative diffuse thinning of the cortex. The myelination landmarks are not well assessed by this technique. No obstructive lesion is identified. No new midline shift or mass effect is appreciated. The intraventricular debris seen on prior examination is no longer visualized.

Output: Diffuse ventriculomegaly, not significantly changed since prior examination.


Instruction: Generate impression based on findings.

Input: Clinical question: History of cervical schwannoma, evaluate for recurrence. Signs and symptoms: Yearly follow-up. Pre and post enhanced cervical MRI: Examination redemonstrates a well-demarcated mass within the left neural foraminal C2-C3 level demonstrating mixed T2 hyperintense signal intensity and with enhancement. Finding results in mild expansion of the left neural foramina similar to prior exam. The finding measures approximately 8.2 x 14 mm which is not significantly different when compared with prior study which measured at 9 x 15 mm.Similar to prior exam there is extensive degenerative changes of cervical spine without appreciable significant interval progression. Mild central spinal stenosis secondary to degenerative disease at C3-C4 is noted. Moderate central spinal stenosis at C4-C5 and C5-C6 are again noted without significant change. Also similar to prior exam there are multilevel neural foraminal compromise (some significantly) without significant change since prior study.The signal intensity and caliber of the cervical and upper most visualized thoracic cord to T4 level is within normal and without detectable abnormal enhancement.

Output: 1.Stable size of a left C2-C3 neural foraminal schwannoma since prior exam.2.Stable extensive degenerative changes of cervical spine with multilevel mild-to-moderate central spinal stenosis C3-C4 through C5-C6 levels.3.Stable multilevel neural foraminal compromise (some significantly) since prior study.


Instruction: Generate impression based on findings.

Input: Evaluate posterior disc osteophyte complex at C3-C4, which appears to indent the spinal cord. There is moderate to severe multilevel degenerative disc disease with relative sparing of C5-C6. There is mild multilevel facet joint osteoarthritis. There are grade 1 retrolistheses of C2 and C3. There is narrowing of the C3-C4 and C4-C5 neural foramina on the right.

Output: Degenerative disc disease of the cervical spine and other findings as described above.


Instruction: Generate impression based on findings.

Input: Reason: history of pelvic rhabdomyosarcoma; treated with chemotherapy and radiation; palpable nodules to lower back that are painful and increasing in size; MRI on 10/01/16 noted distended bladder. PELVIS:UTERUS, ADNEXA: Status post hysterectomy and partial pelvic exenteration. No adnexal mass is seen.BLADDER: The bladder is mildly distended, but appears normal. LYMPH NODES: No pelvic lymphadenopathy is identified.BOWEL, MESENTERY: The visualized bowel is normal in caliber without evidence of obstruction. No abnormal bowel wall thickening is seen.BONES, SOFT TISSUES: There is mild disc desiccation and disc bulge at L4-5, without nerve root compression, as previously described on recent MRI lumbar spine. No abnormal focal marrow signal abnormality or pathologic enhancement.OTHER: A small amount of free fluid is present in the pelvis which is likely physiologic. No subcutaneous nodule is identified.

Output: 1.Stable postsurgical changes related to hysterectomy and partial pelvic exenteration. No evidence of recurrent disease.2.Mild disc desiccation and bulge at L4-5, as previously described on recent MRI lumbar spine.


Instruction: Generate impression based on findings.

Input: Redemonstrated is straightening of the normal cervical lordosis. The vertebral body heights are well-maintained. There is multilevel disk narrowing as demonstrated previously. No worrisome focal marrow signal abnormality is appreciated. There is developmental narrowing of the mid cervical spine canal.At C2-C3,there is no significant disk pathology or stenosis, unchanged.At C3-C4, there is a mild diffuse posterior osteophyte disk complex as well as right greater than left uncovertebral hypertrophy and right-sided facet arthropathy. The previous disk protrusion component has slightly increased as well as ligamentum flavum thickening. These progressive findings now result in severe central stenosis (previously moderate-severe), with new intrinsic T2 cord hyperintensity. Moderate left and moderate-severe right foraminal stenosis is stable.At C4-C5, there is a persistent mild posterior osteophyte disk complex with left greater than right uncovertebral hypertrophy. There is moderate central spinal canal stenosis as well as moderate-severe left and moderate right foraminal narrowing. There is also trace ligamentum flavum thickening. These findings are unchanged.At C5-C6, there is a posterior osteophyte disk complex with mild bilateral uncovertebral hypertrophy, and moderate bilateral foraminal narrowing. These findings are unchanged.At C6-C7, there is a mild posterior osteophyte disk complex and superimposed right paramedian disk protrusion with annular fissure. This flattens the right ventral cord without intrinsic cord signal abnormality. There are no significant stenoses. These findings are unchanged..At C7-T1,there is no significant disk pathology or stenosis, unchanged.Facet arthropathy results in foraminal encroachment on the right at T1/2, T2/3, and T3/4, unchanged.

Output: 1.At C3-C4, there is a mild diffuse posterior osteophyte disk complex as well as right greater than left uncovertebral hypertrophy and right-sided facet arthropathy. The previous disk protrusion component has slightly increased as well as ligamentum flavum thickening. These progressive findings now result in severe central stenosis (previously moderate-severe), with new intrinsic T2 cord hyperintensity. Moderate left and moderate-severe right foraminal stenosis is stable.2.At C4-C5, there is moderate central spinal canal stenosis as well as moderate-severe left and moderate right foraminal narrowing, unchanged.3.At C5-C6, there is moderate bilateral foraminal narrowing, unchanged.4.At C6-C7, there is a mild posterior osteophyte disk complex and superimposed right paramedian disk protrusion with annular fissure. This flattens the right ventral cord without intrinsic cord signal abnormality, unchanged.5.Facet arthropathy results in foraminal encroachment on the right at T1/2, T2/3, and T3/4, unchanged.


Instruction: Generate impression based on findings.

Input: Compared to MRI from 6/16/2015 there has been worsening of the diffusely heterogeneous bone marrow signal abnormality. There are new discrete lesions involving the upper aspect of the T1 vertebral body, right T7 transverse process, right lamina and spinous process of T9, left lamina and spinous process of T11, and bilateral lamina and spinous process of T12. There are also lesions involving the T12 and L1 vertebral bodies. Additional small lesions are seen such as the right transverse process at T2 and multiple bilateral ribs which are suboptimally imaged due to motion degradation on the axial sequences of the upper thoracic spine. There is tumor involving the dorsal epidural space at the T12-L1 level with mild narrowing of the spinal canal at this level. There is also minimal dorsal epidural tumor related to the T9 lesion without spinal canal stenosis. There is also minimal right anterior epidural tumor associated with the L1 lesion. There is suggestion of minimal epidural tumor at the ventral T4 level, with motion degraded axial images limiting precise evaluation.There is diffuse low T1 and low T2 signal involving the T4 vertebral body indicative of sclerosis with approximately 60% loss of height, new since prior. No associated osseous retropulsion or spinal canal stenosis. Aside from the T4 level, vertebral body heights in the thoracic spine are maintained. Alignment is maintained. Neural foramina in the thoracic spine are preserved. Aside from the mild stenosis at the T12-L1 level, spinal canal in the thoracic spine is also preserved. No cord signal abnormality.

Output: 1. Evidence of interval development of osseous metastatic disease throughout thoracic spine and partially imaged chest wall as detailed above. 2. There is dorsal epidural tumor at the T9 and T12-L1 levels as well as anterolateral epidural tumor at the L1 level. There may be minimal epidural tumor at the T4 level which is not well assessed. There is mild associated narrowing of the spinal canal at the T12-L1 level.3. There is a sclerotic appearing lesion involving the T4 vertebral body with moderate compression fracture. No associated osseous retropulsion or spinal canal stenosis.


Instruction: Generate impression based on findings.

Input: Severe neck pain, evaluate for disc herniation. Additional history, patient had recent trauma following which she developed neck pain. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. There is mild anterolisthesis of C2 on C3 and C3 on C4 as well as mild reversal of cervical lordosis. Bone marrow signal is benign. Motion artifact somewhat limits assessment. There is however no gross cord signal abnormality.Degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or right neural foramen. There is mild left neural foraminal narrowing related to facet arthropathy.C3-4: There is moderate right and mild to moderate left neural foraminal stenosis related to prominent bilateral facet arthropathy. No significant spinal canal stenosis.C4-5: Disc osteophyte complex with uncovertebral hypertrophy and facet arthropathy, particularly on the left. There is is mild to moderate spinal canal stenosis. There is moderate bilateral neural foraminal stenosis, worse on the left, with also edema surrounding the left facet joint. There is also mild edema involving the bone marrow of the facets on the left.C5-6: Small disc defect complex and ligamentum flavum thickening contribute to mild to moderate spinal canal stenosis. There is moderate left-sided neural foraminal stenosis and mild to moderate on the right related to uncovertebral hypertrophy and facet arthropathy.C6-7: Small disc osteophyte complex and bilateral uncovertebral hypertrophy. There is partial effacement of the left ventral aspect of the thecal sac but otherwise no significant spinal canal stenosis. There is moderate left-sided neural foraminal stenosis and to a milder degree on the right.C7-T1: No significant compromise to the spinal canal or neural foramina. Left-sided perineural cysts incidentally noted. There is facet arthropathy, particularly on the left.Facet arthropathy on the left at the T1-T2 level is also noted and contributes to mild to moderate left T1-T2 neural foraminal stenosis.The vertebral artery flow voids appear to be intact. There is edema involving the left paraspinous muscular at the left C4-C5 level and extending more inferiorly into the lower cervical spine. Mild edema involving the right lower cervical paraspinous musculature is also noted.

Output: 1. Multilevel degenerative changes in the cervical spine with mild to moderate spinal canal stenosis at C4-C5 and C5-C6 levels. There is also multilevel neural foraminal stenoses, which are detailed above.2. There is edema involving the left paraspinous musculature, relatively greatest at the left C4-C5 level with extension more inferiorly. There is also suggestion of mild soft tissue edema in the right lower cervical paraspinous muscle structure. These findings are nonspecific and may be related to recent trauma or inflammation related to facet arthropathy, with infection not entirely excluded. Post gadolinium sequences with axial and postgadolinium T1 fat-sat images is suggested if there is suspicion for infection.Dr. Ali discussed findings with the treating nurse practitioner at the time of this report.


Instruction: Generate impression based on findings.

Input: Pain and numbness right arm and right thigh. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal or neural foraminal stenosis in the cervical spine. The spinal cord displays normal signal and morphology. There is no evidence of abnormal enhancement in the cervical spine. There is a mildly low-lying right cerebellar tonsil. The paravertebral soft tissues are unremarkable.

Output: 1. No evidence of spinal canal or neural foraminal narrowing. 2. No evidence of cervical spinal cord lesions.3. Mildly low-lying right cerebellar tonsil.


Instruction: Generate impression based on findings.

Input: For numbering purposes, 5 lumbar type vertebral bodies are identified. Alignment is anatomic. The marrow signal is generally somewhat heterogenous, particularly centered on the L4-5 endplates, suggestive of degenerative changes and similar to prior exam.The conus is normal in signal and morphology and terminates at T12-L1 level. The visualized intra-abdominal and paraspinal contents are unremarkable. T12/L1: No significant spinal canal or neural foraminal stenosis.L1/2: No significant spinal canal or neural foraminal stenosis.L2/3: No significant spinal canal or neural foraminal stenosis.L3/4: There is mild facet joint arthropathy resulting in a mildly narrowed left neural foramen. Otherwise no significant spinal canal or right foraminal stenosis.L4/5: There is loss of intervertebral disc space with diffuse disc bulge, facet joint arthropathy, and ligamentum flavum thickening resulting in moderate spinal canal stenosis and mild bilateral neural foraminal narrowing. Overall, there appears to be minimal improvement in the disc bulge, with less effacement of the lateral recesses. The posterior elements are unchanged.L5/S1:Mild facet joint arthropathy with no significant spinal canal or neural foraminal stenosis.SI Joints: No significant abnormalities noted.

Output: Multilevel degenerative disease of the lumbar spine, most prominent at L4-L5 level with diffuse disc bulge and moderate spinal canal stenosis. Overall, there appears to be improvement in disc bulge at the L4-5 level with decrease in effacement of the thecal sac and left lateral recesses. Otherwise the exam is not significantly changed as compared to prior study from 11/14/2011.


Instruction: Generate impression based on findings.

Input: Male 55 years old Reason: Evaluate soft tissue mass left ankle History: Palpable STM medial left ankle at level of medial malleolus and posterior, firm to palpate, non-mobile, horizontal, +pain with +Tinels Markers are placed along the posteromedial aspect of the ankle, presumably representing site of palpable mass. Mild reticulation of the underlying subcutaneous fat is present which may represent edema or scarring, but we see no distinct soft tissue mass. There is a large enthesophyte emanating from the calcaneus posteriorly at the insertion of the Achilles. There is slight thickening of the distal Achilles, which otherwise appears normal.Minimal osteoarthritis affects the midfoot. Small ossicles distal to the medial malleolus, which may represent chronic ligamentous injury. Cysts are present in the medial malleolus as well.Mild enhancement of the tendon sheath of the distal posterior tibialis tendon suggests mild tenosynovitis.

Output: 1.We see no discrete soft tissue mass. There is mild reticulation of the subcutaneous fat of the medial ankle which may reflect edema or scarring.2.Findings suggestive of mild tenosynovitis of the posterior tibialis tendon.3.Large enthesophyte at the insertion of the Achilles.4.Findings suggestive of prior injury to the deltoid ligament and mild osteoarthritic changes as above.


Instruction: Generate impression based on findings.

Input: 45-year-old female with new diagnosis of early stage colon cancer and abnormal CT. Patient with known liver hemangiomas. Evaluate for metastatic liver disease. ABDOMEN:LIVER, BILIARY TRACT: Multiple T2 hyperintense diffusion restricting lesions within the liver which demonstrate peripheral nodular discontinuous enhancement. The largest of these within the left hepatic lobe measures 4.4 x 2.5 cm (series 4, image 8). Findings consistent with hemangiomas.There is an additional segment 7 punctate linear enhancing focus which persists on all phases, likely benign.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Multiple hepatic hemangiomas.


Instruction: Generate impression based on findings.

Input: Left tinnitus, constant, for the past 8 months. Left asymmetric sensorineural hearing loss. The bilateral cranial nerve 7 and 8 complexes are intact. There is no evidence of mass lesions. The 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. Small hippocampal sulcus remnant cysts are more pronounced on the right. There is bilateral parotid sialosis and temporomandibular osteoarthrosis. There is an incidental right occipital developmental venous anomaly.

Output: No evidence of retrocochlear or inner ear lesions.


Instruction: Generate impression based on findings.

Input: 64-year-old male patient with elevated PSA. Biopsy from 2/4/2010 demonstrated focus suspicious for carcinoma within the left medial base. PELVIS:PROSTATE:Prostate Size: 6.3 x 4.1 x 5.5 cm.Peripheral Zone: There is a region of signal abnormality within the right peripheral zone extending from the right base to the right mid gland which demonstrates T2 hypointensity with mild to moderate corresponding ADC hypointensity. For example, a region of signal abnormality within the right mid gland measures 1.4 x 0.6 cm (image 65, series 401). Additionally there is a focus of signal abnormality within the anterior left mid gland/apex with T2 hypointensity and mild ADC hypointensity measuring 0.3 x 0.7 cm (image 57, series 401). These regions are suspicious for tumor.Central Gland: Central gland is hyperplastic with BPH nodules.Seminal Vesicles: No definite involvement.Extracapsular Extension: No definite extraprostatic extension.BLADDER: No significant abnormality noted.LYMPH NODES: There is a prominent left internal iliac lymph node which is non-specific.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Regions of signal abnormality within the bilateral peripheral zones as above suspicious for tumor without evidence of extraprostatic extension.


Instruction: Generate impression based on findings.

Input: Chiari malformation, status post decompression with new headaches. Again seen are postsurgical changes of suboccipital craniectomy and resection of the posterior arch of C1 for Chiari decompression. The posterior CSF space at the level of the foramen magnum remains well expanded and similar to the prior exam. The cerebellar tonsils descend to the level of the basion and the demonstrating normal rounded configuration. Normal CSF flow is seen both anterior and posterior to the brainstem at the level of the foramen magnum. There is diminished flow dorsal to the more superior aspect of the cerebellum with suggestion of adhesion but unchanged. The remainder of the brain demonstrates normal morphology. Few foci of T2/FLAIR hyperintensity are seen in the subcortical and periventricular white matter, which are nonspecific, but compatible with mild age-related white matter changes. No new focal abnormalities are detected. The ventricular system is patent and normal in size.There is moderate aspiration of the sphenoid sinus which is increased since 12/11/2014.CERVICAL SPINE MRI

Output: 1.Again seen are postsurgical changes of Chiari decompression with preserved CSF spaces and biphasic flow at the neo-foramen magnum. There is diminished flow dorsal to the superior cerebellum at the margin of the suboccipital craniectomy with suspected adhesion. Finding is unchanged. There is increased opacification of the sphenoid sinus. Otherwise the remainder of the brain parenchyma is within normal limits for age.2. Stable minimal degenerative disk disease in the cervical spine. No cord signal abnormality or syrinx. No spinal canal or neural foraminal stenosis.


Instruction: Generate impression based on findings.

Input: Lower extremity weakness There is mildly increased T2/STIR signal scattered throughout the musculature of the thigh bilaterally particularly involving the adductor compartments, right greater than left. Most notable examples include the vastus medialis on the left in the adductor magnus on the right. There is no abnormal fluid collection identified.The underlying bone marrow signal is normal. There is no osseous abnormality.

Output: Mild diffuse edema of the musculature of the thigh, right greater than left, consistent with mild myositis.


Instruction: Generate impression based on findings.

Input: Male, 44 years old, with lower extremity weakness, tingling and numbness. History of degenerative disc disease. Spinal alignment is within normal limits. Vertebral body heights are maintained. Bone marrow signal intensity is within normal limits. The visualized spinal cord, conus and cauda equina demonstrate normal signal intensity and morphology. No epidural abnormalities are suspected.L1-2: Unremarkable. L2-3: Unremarkable. L3-4: A small left foraminal annular fissure and disc protrusion shows no significant interval change from prior. The left neural foramen remains mildly narrowed. No significant spinal canal stenosis is seen. No interval changes. L4-5: Very slight bulging disc with a minimal right foraminal protrusion. No significant spinal canal or foraminal narrowing. No interval changes. L5-S1: Mild facet arthropathy. Small central disc protrusion, unchanged, without significant spinal canal or foraminal stenosis.

Output: 1.Mild degenerative findings are unchanged.2.No areas of significant spinal canal or foraminal stenosis are seen.3.No new lesions are detected.


Instruction: Generate impression based on findings.

Input: History of worsening migraines with aura and vision changes, evaluate for underlying abnormality. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

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


Instruction: Generate impression based on findings.

Input: 60 year-old female. Recurrent endometrial cancer in pelvis with bladder involvement, planning for pelvic exenteration. PELVIS:UTERUS, ADNEXA: Post-surgical findings of hysterectomy with a 5 x 4.3 cm soft tissue mass in the operative bed, consistent with stated history of recurrent endometrial cancer. Approximately 4.5 cm above the anorectal junction, the tumor invades into the anterior wall of around a 7 cm long segment of rectum and distal sigmoid colon (series 701, image 27). Tumor invades into the left posterolateral pelvic sidewall (series 1101, image 243) and into the left superior and posterior vaginal cuff (series 701, image 21). There is also invasion of tumor in the left posterior bladder dome, which is eccentrically thickened (series 1101, image 260)Mass invades and obstructs the distal left ureter with proximal ureteral dilatation (series 501, image 23).BLADDER: See above. LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: See above.BONES, SOFT TISSUES: Small Tarlov cysts in the sacral foramina.OTHER: No significant abnormality noted.

Output: Large pelvic mass consistent with recurrent endometrial cancer with invasion into the distal sigmoid colon/rectum, left posterior bladder dome, left posterolateral pelvic sidewall, left ureter, and superior vaginal cuff.


Instruction: Generate impression based on findings.

Input: 50 years, Female, metastatic lung cancer. ALK+, failed Crizotinib. Baseline study for Alectinib trial. No intracranial mass or abnormal parenchymal or meningeal enhancement to suggest metastatic disease. Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with chronic small vessel ischemic changes. Brain parenchyma is otherwise unremarkable for age. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. The ventricles are within normal limits in size and configuration. No midline shift or herniation. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Lipoma is incidentally noted involving the left frontal scalp. Bone marrow signal and extracranial soft tissues are otherwise unremarkable.

Output: 1. No evidence of intracranial metastatic disease.2. Scattered foci of T2/FLAIR hyperintensity in the supratentorial white matter are nonspecific but compatible with mild chronic small vessel ischemic and/or posttreatment-related changes.


Instruction: Generate impression based on findings.

Input: 7-year-old male with cerebral cavernous malformation, six-month follow-up. There has been continued slight interval increase in size of a posterior right cerebellar hemisphere cavernous malformation, specifically of the more posteriorly located multi locular component which measures 14 x 14 mm in transverse dimension (previously 11 x 12 mm). Additionally, a few of the cystic interstices account for the enlargement, with a heme/fluid level is now evident within the largest. There remains no perilesional edema or significant associated mass effect.There is no appreciable interval change in the numerous other supratentorial and infratentorial cavernous malformations. There is no evidence of acute intracranial hemorrhage or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. 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. Mastoid air cells are clear.

Output: 1.There has been continued slight interval increase in size of a posterior right cerebellar hemisphere cavernous malformation, specifically of the more posteriorly located multi locular component. Additionally, a few of the cystic interstices account for the enlargement, with a heme/fluid level is now evident within the largest. There remains no perilesional edema or significant associated mass effect.2.There is no appreciable interval change in the numerous other supratentorial and infratentorial cavernous malformations.


Instruction: Generate impression based on findings.

Input: Female 60 years old Reason: hx of biliary dilation on previous MRI/MRCP. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology. There is no abnormal focal parenchymal enhancing lesion within the liver. There is persistent moderate to severe intrahepatic and extrahepatic biliary ductal dilatation extending to the level of the ampulla. The common bile duct measures 12 mm, previously 13 mm in maximum diameter. The bile ducts are smooth in contour. No definite obstructing mass lesion is noted within the head of the pancreas. The gallbladder is mildly distended. No gallstones or wall thickening is evident.SPLEEN: Small accessory splenule.PANCREAS: Pancreatic parenchyma is atrophic with fatty replacement. The main pancreatic duct is markedly dilated throughout measuring up to 7 mm, previously 8 mm in diameter. The dilatation extends to the level of the ampulla. No definite obstructing mass lesion is evident.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left inferior pole simple cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Left basilar atelectasis.

Output: Persistent biliary and pancreatic ductal dilation to the level of the ampulla without evidence of focal mass lesion. Differential considerations include the benign stricture or nonvisualized obstructing mass. These findings seem somewhat atypical for biliary dilation secondary to narcotic use, as the pancreatic duct is also dilated, however, clinical correlation is indicated.


Instruction: Generate impression based on findings.

Input: 70-year-old woman with lower back pain. There is multilevel degenerative spondylosis. At L1-L2, there is mild facet joint arthropathy and a minimal disc bulge, but no spinal canal or neural foraminal stenosis. At L2-L3, there is mild facet joint arthropathy. There is moderate disc bulge with a superimposed left paracentral disc protrusion with impingement upon the descending nerve roots. At L3-L4, there is facet joint arthropathy with effusions and disc bulging associated with significant narrowing of the spinal canal and mild narrowing of the bilateral neural foramina. At L4-L5, there is facet joint arthropathy with effusions and several small posterior synovial cysts, as well as a mild disc bulge with mild narrowing of the spinal canal and bilateral neural foramina. At L5-S1, there is facet joint arthropathy and mild disc bulge without significant narrowing of the spinal canal. There are small perineural cysts in the bilateral neural foramina at T12-L1. The vertebral column alignment is within normal limits. The vertebral body heights are preserved. The vertebral bone marrow signal is unremarkable. The imaged portions of the spinal cord displays normal signal and morphology. The paraspinous soft tissues are unremarkable.

Output: Degenerative spondylosis of the lumbar spine, which is most pronounced at the L2-L3 and L3-L4 levels.


Instruction: Generate impression based on findings.

Input: 54-year-old woman with history of sarcoidosis and coronary artery disease. Left VentricleNormal-appearing left ventricle. Qualitatively normal LV function. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is normal in appearance. Small patent foramen ovale, as before.Right VentricleNormal-appearing right ventricle. Qualitatively normal RV function.Right AtriumThe right atrium is normal in appearance.Aortic ValveMild aortic regurgitation. Question of mild aortic stenosis.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 no obvious pericardial disease.Extracardiac FindingsAxillary lymphadenopathy again noted. Scarlike/fibrotic changes in the lungs again noted. Pulmonary nodules are better assessed on recent chest CT. Probable right renal cyst noted. Heterogeneous enhancement of the thyroid gland. 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: No convincing evidence of cardiac sarcoidosis. No delayed hyperenhancement within the LV myocardium.Axillary lymphadenopathy, as before.Pulmonary changes consistent with given history of sarcoidosis.


Instruction: Generate impression based on findings.

Input: Reason: stroke History: acute aphasia MRI brain:There are numerous supratentorial and infratentorial bilateral foci of diffusion restriction with large regions of restricted diffusion in the right frontal and left occipital lobes. Right frontal and right parietal foci areas of diffusion restriction correspond to findings on recent CT. Hyperdensity within the right frontal lesion demonstrates susceptibility, likely reflecting petechial hemorrhage. A few of these lesions have increased FLAIR signal, although many do not. Numerous punctate foci of susceptibility are present bilaterally, many of which are not associated with areas of diffusion restriction. No frank hematoma is evident. 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 and scalp soft tissues are grossly unremarkable. There is mild mucosal thickening in the bilateral maxillary sinuses. Opacification of the mastoid air cells bilaterally is likely related to intubation.MRA brain:The intracranial internal carotid arteries are normal in course and caliber. There is a hypoplastic A1 segment. The middle and anterior cerebral arteries are otherwise unremarkable. The vertebral arteries, basilar artery, and posterior cerebral arteries are normal in course and caliber. There is no evidence of flow-limiting stenosis or aneurysm.MRA neck:There is a separate origin of the left subclavian artery, left common carotid artery, and brachiocephalic artery from the arch. The common carotid arteries and cervical internal carotid arteries are normal in course and caliber. Both vertebral artery origins are patent. There is no evidence of flow-limiting stenosis or occlusion.

Output: 1.Numerous bilateral foci of diffusion restriction in the anterior and posterior distributions compatible with acute infarcts and favoring embolic etiology.2.Multiple foci of susceptibility effect within the infarcts are compatible with petechial hemorrhages. No frank hematoma formation is evident. Numerous additional bilateral foci of punctate susceptibility not associated with areas of diffusion restriction likely represent chronic microhemorrhages, which may be related to thrombotic microangiopathy or anticoagulation among other causes. No significant mass effect, midline shift, or herniation.3.No significant stenosis in the intracranial vasculature. No significant stenosis in the neck vasculature.


Instruction: Generate impression based on findings.

Input: Knee pain MENISCI: There is mild fraying of the inner free edge of both the medial and lateral menisci. There is no evidence of a meniscal tear.ARTICULAR CARTILAGE AND BONE: There is mild thinning of the articular cartilage of the lateral compartment otherwise the articular cartilage of the medial, patellofemoral, and lateral compartments are intact. Low signal intensity foci are noted within the joint space just posterior to the ACL (best seen on series 5 image 20/36).LIGAMENTS: There is mild signal intensity within the anterior fibers of the MCL which may relate to remote injury however the MCL is intact. The remaining cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Low signal intensity foci within the joint space posterior to the ACL correspond to findings on recent radiographs and reflect fixed calcifications. Otherwise there is no acute internal derangement of the knee.


Instruction: Generate impression based on findings.

Input: Ascending aortic aneurysm follow-up. CHEST:LUNGS AND PLEURA: Evaluation of the pulmonary parenchyma is limited. Small pulmonary nodules and micronodules better visualized on 12/18/2014 CT.MEDIASTINUM AND HILA: The ascending thoracic aorta measures 4.4 x 4.4 cm at the level of the main pulmonary artery, unchanged from the 9/22/2015 exam when analogous measurement technique used. The main pulmonary artery measures 2.8 in diameter, unchanged. The remainder of the thoracic aorta is unremarkable.CHEST WALL: There is an enhancing nodule within the left breast (series 1501, image 9) which measures 1.5 x 1.4 cm.UPPER ABDOMEN: Redemonstration of asymmetric wall thickening at the level of the gastroesophageal junction not significantly changed compared to multiple prior examinations.Partially imaged small area of increased balance signal within segment 4A of the liver which is favored to reflect partially imaged branch of the portal vein based on comparison with prior studies.Status post cholecystectomy.

Output: 1.Aneurysmal dilatation of the ascending aorta without significant interval change compared to prior exam dated 9/22/2015.2.Enhancing nodule within the left breast suspicious for neoplasm. Diagnostic mammography is recommended for further evaluation. Findings discussed with A.P.N Carlson at time of dictation.


Instruction: Generate impression based on findings.

Input: Diagnosis: Headache Personal history of other diseases of the nervous system and sense organsClinical question: h/o clival chordoma s/p resection x 2, apparent recurrence on HCTSigns and Symptoms: h/o clival chordoma s/p resection x 2, apparent recurrence on HCT, c/o headache dizziness, slurred speech Since prior exam of 2004 the mass associated with the left half of the clivus extending into the left cerebellopontine angle cistern has enlarged. The mass extends down to the left cerebellar medullary angle cistern. The exophytic intracranial component now measures approximately 40 x 25 mm axial dimensions and 35 x 25 mm sagittal dimensions. The mass displaces the left cranial nerves VII and VIII as well as the left trigeminal nerve. It compresses the brainstem and displaces it and distorts it. It invaginates into the pons. The mass is heterogeneous in appearance on T1 and T2 imaging and known to contain calcifications. There are small cystic components associated with it.The component within the sphenoid bone is associated with expansion into the right middle cranial fossa which was also present on the prior exam and is also identified on CT. The internal carotid arteries are displaced laterally - especially the right internal carotid artery. The pituitary gland is displaced superiorly.There is metal artifact present adjacent to the left parietal bone. This distorts the imaging appearance of the left hemisphere. Ventriculostomy tube courses through the left frontal lobe into the left lateral ventricle with tip in the region of the foramen of Monro.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 right internal carotid arteries significantly displaced towards the right this includes the petrous portion of the right carotid canal in the cavernous portion of the right internal carotid artery. The basilar artery and posterior cerebral arteries as well as the superior cerebellar arteries drape around the posterior fossa tumor.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.Since the prior exam from 2004, the exophytic component of a clival mass has significantly increased in size and invaginates into the brainstem and displaces adjacent structures. This mass is known to represent a chordoma.2.The patient is status post ventriculostomy tube placement. The lateral ventricles are not dilated on the current exam


Instruction: Generate impression based on findings.

Input: 71 year old BRCA 2 mutation carrier. Personal history of stage III ovarian cancer diagnosed at the age of 41. History of breast carcinoma in paternal grandmother, uncle and cousins. There is heterogeneous amount of fibroglandular tissue in both breasts.Minimal parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Hyperparathyroidism. Evaluate for parathyroid adenoma RIGHT LOBE MEASUREMENTS: 4.7 x 1.9 x 2.0 cmLEFT LOBE MEASUREMENTS: 3.1 x 1.3 x 1.6 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: Complex nodule at the upper pole measuring 1.3 x 1.0 x 1.2 cmLEFT LOBE: Heterogeneous with no discrete nodulesISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: 1.1 x 0.7 cm hypoechoic nodule posterior and inferior to the left lobe of the thyroid may represent a parathyroid adenoma; correlate with nuclear medicine study.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Possible parathyroid adenoma posterior and inferior to the left lobe of thyroid.


Instruction: Generate impression based on findings.

Input: Evaluate for extensor tendon tear. Elbow pain for months, right greater than left. LIGAMENTS: The lateral collateral, ulnar collateral and lateral ulnar collateral ligaments appear intact.TENDONS: The common flexor, common extensor, biceps, triceps and brachialis tendons appear intact. ARTICULAR SURFACES AND BONE: No significant abnormality noted. SURROUNDING STRUCTURES: No significant abnormality noted.ADDITIONAL

Output: Normal MRI of the left elbow.


Instruction: Generate impression based on findings.

Input: 70-year-old female with smoldering myeloma. Evaluate for bonelesions. BONE MARROW: There is a lobulated focus of increased signal abnormality on fluid sensitivesequences within the intertrochanteric region of the left femur with the imagingcharacteristics most consistent with an enchondroma. No additional bone marrow signalabnormality is identified.SOFT TISSUES: There is nonspecific subcutaneous edema along the posterior aspect of thelumbar spine. The imaged musculature of the pelvis is normal in appearance.JOINTS: There is a small amount of fluid within the hips without evidence of a largeeffusion.ADDITIONAL

Output: Findings most consistent with a benign enchondroma within the left femurwithout evidence of a definite myelomatous deposit affecting the pelvis.


Instruction: Generate impression based on findings.

Input: 68-year-old female with history of lumbar cyst and compression fractures presenting with worsening back pain, incontinence. There are mild to moderate multilevel degenerative changes throughout the cervical spine with disc osteophyte complexes. No high-grade stenosis. There are multiple compression fractures throughout the spine at T5, T6, T7, T8, T10, T12 and all lumbar levels.. There is increased STIR signal intensity within L1 and L2 and to a lesser degree at T10 and T12.There is partial effacement of the ventral thecal sac at T12 related to osseous retropulsion. There is mild neural foraminal narrowing at L1-L2. The spinal cord has grossly normal signal characteristics and overall morphology. There is no compromise of the spinal cord.

Output: 1. 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. No cord compression is identified.2. Multiple thoracic and lumbar compression fractures, most severe at T12 where there is mild osseous retropulsion without high-grade spinal canal stenosis. Edema within L1 and L2 and to a lesser degree T10 and T12 vertebral bodies may represent more acute compression fractures. Due to the screening nature of this protocol details are not as evident on imaging as dedicated protocols of the spine.


Instruction: Generate impression based on findings.

Input: 79 years, Male, metastatic melanoma. Evaluate for brain metastases. Multiple sequences are motion degraded. There is however no intracranial mass or abnormal enhancement to suggest metastatic disease. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. Ventricles and sulci are prominent related to global parenchymal volume loss but appropriate for age. No hydrocephalus. Similar to prior, there are foci of T2/FLAIR hyperintensity in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild chronic small vessel ischemic changes. Brain parenchyma is otherwise unremarkable for age. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. There is partial opacification involving the bilateral ethmoid air cells as well as mild opacification involving the maxillary sinuses. Calvarium and extracranial soft tissues are grossly unremarkable.There is abnormal marrow signal involving the C4 vertebral body which is partially imaged and suspicious for osseous metastasis. This finding was also present on prior PET from 7/15/2016.

Output: 1. No evidence of intracranial metastatic disease although suboptimally evaluated due to motion degradation.2. Osseous metastasis involving the C4 vertebral body is partially imaged and was also present on prior PET from 7/15/2016.


Instruction: Generate impression based on findings.

Input: There is now thick irregular enhancement in the site of the previous resection cavity and along the surgical tract in the left occipital lobe. No diffusion restriction in the area of the enhancement. There has been extensive interval increase in the associated T2/FLAIR hyperintensity surrounding the resection cavity, with predominantly white matter involvement although some cortex is also involved. There is associated mass effect, specifically on the left lateral ventricular atrium which is displaced anteriorly and partially effaced, as well as sulcal effacement. No midline shift. No additional enhancing lesions are noted.

Output: Interval significant increased irregular enhancement in the left occipital lobe resection cavity and surgical tract as above. Extensive associated T2/FLAIR hyperintensity with localized mass effect. Differential considerations include radiation necrosis, and perhaps slightly less likely tumor recurrence. Clinical correlation with history of radiation port/field is recommended. Additionally, supplemental MR perfusion imaging, with or without spectroscopy, is recommended for a more complete evaluation.


Instruction: Generate impression based on findings.

Input: MRI brain:Numerous scattered foci of restricted diffusion are present in both cerebral hemispheres and left middle cerebellar peduncle, most of which are associated with increased FLAIR signal. There are at least 2 small foci of foci of abnormal enhancement noted in the region of the anterior limb of the left internal capsule and head of the right caudate nucleus, where foci of diffusion restriction were noted on the prior MRI and therefore felt to represent subacute infarcts. The subacute infarct in the anterior limb of the left internal capsule also corresponds to a area of subtle intrinsic T1 hyperintensity and susceptibility artifact likely representing minimal hemorrhage or mineralization.Hypointense T1 and hyperintense T2/FLAIR signal in the pons, periventricular and subcortical white matter is nonspecific, but most likely related to chronic small vessel ischemic change. The ventricles and sulci are prominent, in keeping with generalized cerebral volume loss. The cisterns remain patent. There is no midline shift or mass effect. No extra-axial fluid collection is identified.The midline structures and craniocervical junction are otherwise within normal limits. Fluid signal with air-fluid levels are present in the bilateral sphenoid sinus and left maxillary sinus. MRA brain:The intracranial internal carotid arteries are normal in course and caliber. The middle and anterior cerebral arteries are unremarkable. The vertebral arteries, basilar artery, and right posterior cerebral arteries are normal in course and caliber. There is moderate to severe focal narrowing of the mid left P2 segment. There is no evidence of flow-limiting stenosis or aneurysm.

Output: 1. Increased number of punctate foci of abnormal signal and/or diffusion restriction in the cerebral hemispheres and left middle cerebellar peduncle likely related to embolic infarcts of multiple ages (overall acute to subacute), given patient history. No evidence of significant hemorrhagic conversion or mass effect.2. Abnormal signal in the periventricular and subcortical white matter is nonspecific, but likely related to moderate chronic small vessel ischemic changes.3. No evidence of occlusion or aneurysm in the major intracerebral arteries. Moderate to severe focal narrowing at the mid left P2 segment.


Instruction: Generate impression based on findings.

Input: 28-year-old male with UC on Humira with cat bite. Right forearm cellulitis, pain with extension and flexion of the wrist. Rule out abscess or tenosynovitis. Markers were placed along the radial aspect of the wrist and distal forearm. There is thickening of the skin along the radial aspect of the wrist and forearm with reticulation of the underlying subcutaneous fat and enhancement compatible with the stated history of cellulitis. There is also mild enhancement of the peripheral deep fascia of the forearm musculature along its volar and distal aspect. This enhancement also surrounds the flexor carpi radialis tendon and its muscle, distally, and there is mild edema and enhancement of the distal fibers of the flexor carpi radialis muscle. There is enlargement of and increased signal intensity within the tendon. We see no frank fluid surrounding the tendon. Inflammation also extends medially along the superficial aspect of the flexor forearm musculature with minimal thin enhancement between the superficial and deep musculature of the distal forearm. There is mild edema within the pronator quadratus muscle at its radial attachment. We see no fluid collection to indicate abscess formation. The remaining tendons are unremarkable. The bone marrow signal intensity is within normal limits.

Output: Cellulitis of the right forearm with mild fascial inflammation as described above as well as enhancement surrounding the flexor carpi radialis tendon indicating a tenosynovitis. The tendon itself appears enlarged with increased signal intensity which may reflect chronic tendinosis or acute inflammation.


Instruction: Generate impression based on findings.

Input: History of left lumpectomy for invasive ductal carcinoma with lymphovascular invasion and associated DCIS 3/2014. Patient received chemotherapy and radiation therapy and is currently on letrozole. History of benign right breast biopsy. History of breast cancer in sister. Heterogeneous fibroglandular tissue is present bilaterally. Mild parenchymal enhancement is noted bilaterally.Left breast: There has been interval surgical excision of the mass at the 5 o'clock position of the left breast. A 4.2 x 2.8 x 3.3 cm (AP x LR x CC) fluid filled seroma cavity is present in the lumpectomy bed with thin enhancing wall. Overlying nonenhancing skin thickening is present. Susceptibility artifact from surgical clips are present in the lumpectomy bed. No abnormal enhancement is present in the left breast and no abnormal left axillary lymph nodes are present.Right breast: Previously described enhancing mass at the 12 o'clock position of the right breast is not seen on the current study. Susceptibility artifact at the 7 o'clock position from benign right breast biopsy is present without surrounding enhancement. No abnormal enhancing masses, non-mass enhancement or uniquely enhancing foci are present in the right breast. No abnormal axillary lymph nodes are identified in the right axillary region.

Output: Postsurgical changes of the left breast. Previously described enhancing mass in the 12 o'clock position of the right breast is not seen on the current study. No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: Male, 23 months old, status post unrestrained motor vehicle collision, assess for diffuse axonal injury. Assess for spinal cord injury. Brain:Numerous scattered foci of restricted diffusion are seen, predominantly at the gray-white interface, within both cerebral hemispheres. Prominent diffusion restriction is demonstrated at the splenium of the corpus callosum. Restricted diffusion is also seen along the anteromedial thalami. Scattered punctate susceptibility effect are present in association with some of these lesions.No large intraparenchymal hematoma is seen. However, scattered trace FLAIR hyperintensity in the cerebral sulci probably reflects subarachnoid blood product as suspected on prior CT. A fluid level within the left occipital horn, and to a lesser extent in the right occipital horn, may also represent blood product. Trace subdural FLAIR hyperintensity is seen along the right occipital and temporal lobes compatible with minimal blood product.No evidence of significant parenchymal edema or generalized mass effect is seen. The expected flow voids are appropriately visualized. Ventricular size and morphology are within normal limits. Opacification of the paranasal sinuses and mastoid air cells is seen bilaterally.Cervical spine:The articulation of the right lateral masses of C1 and C2 is slightly widened and edematous. Mild edema is also seen within the posterior lateral paraspinal soft tissues at C1-2. The posterior atlantoaxial ligament is visualized and appears to be intact. The craniocervical junction and the remaining cervical ligamentous structures appear to be intact. No evidence of spinal malalignment is seen. The intervertebral discs are intact and the vertebral bodies show no evidence of marrow edema. The visualized spinal cord shows no obvious focal signal abnormality given the limitation of moderate motion artifact. No compromise of the spinal canal or neural foramina is seen.Airspace opacity and perhaps some pleural fluid are partially visualized on the right. The anterior tongue appears to be edematous.

Output: 1.Multiple intracranial findings are seen compatible with diffuse axonal injury. In addition, scattered trace subarachnoid and subdural blood product is redemonstrated. Mild intraventricular blood product is seen without evidence of ventricular dilatation.2.No definite evidence of spinal cord injury is seen within the limitations of motion artifact. However, there are findings to indicate ligamentous injury involving the articulation of the right lateral masses of C1 and C2. Soft tissue injury is also seen within the posterior lateral paraspinal soft tissues at C1-2. No vertebral body or disc injuries are evident.


Instruction: Generate impression based on findings.

Input: 70 year old male with a history of coronary artery disease, mitral stenosis, aortic insufficiency, status post CABG, status post placement of mechanical mitral and aortic valves. Referred for evaluation of scar tissue progression for planning prior to possible insertion of device. Left VentricleThe interventricular septum has a sigmoid appearance. The overall LV ejection fraction is 55%, the LV end diastolic volume index is 93 ml/m2 (normal range: 74+/-15), the LVEDV is 189 ml (normal range 142+/-34), the LV end systolic volume index is 42 ml/m2 (normal range 25+/-9), the LVESV is 85 ml (normal range 47+/-19). There is late gadolinium enhancement in the an epicardial band in the basal inferior and inferoseptal walls. The pattern of late gadolinium enhancement is atypical for prior myocardial infarction and amyloidosis, and suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process. The amount of late gadolinium enhancement is mildly improved when compared to prior cardiac MRI images done 8/26/2014. There is delayed enhancement at the RV point, in a pattern typical for PA HTN. There is no evidence of myocardial iron overload. The differential diagnosis of these findings include, infiltrative disorders such as cardiac sarcoidosis, and prior myocarditis. Left AtriumThe left atrium is severely enlarged. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 50%, the RV end diastolic volume index is 116 ml/m2 (normal range 82+/-16), the RVEDV is 237 ml (normal range 142+/-31), the RV end systolic volume index is 59 ml/m2 (normal range 31+/-9), and the RVESV is 119 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveA prosthetic mechanical aortic valve is noted. Mitral ValveA prosthetic mechanical mitral valve is noted. Pulmonic ValveThe pulmonic valve opens widely. There is mild pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThere are a small number of subcarinal lymph nodes noted. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Normal left ventricular size and systolic function (LVEF 55%). 2. There is presence of patient motion in the LGE images, contributing to difficultly with interpretation. There is late gadolinium enhancement in the basal inferior and inferoseptal walls. The pattern of late gadolinium enhancement is atypical for prior myocardial infarction and amyloidosis, and suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process. The amount of late gadolinium enhancement is mildly improved when compared to prior cardiac MRI images done 8/26/2014. 3. There is delayed enhancement at the RV insertion point, in a pattern typical for PA HTN.4. Normal RV size and systolic function (RVEF 50%).5. Mechanical aortic and mitral valves noted.6. See extra-cardiac findings.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: MRI brain:The ventricles and sulci are within normal limits. The cisterns remain patent. There is no midline shift or mass effect. There is minimal nonspecific periventricular and subcortical white matter FLAIR signal, which likely represents minimal small vessel ischemic disease. There are no areas of pathological enhancement. There is no diffusion abnormality. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. MRA brain:The intracranial internal carotid arteries are normal in course and caliber. The middle and anterior cerebral arteries are unremarkable. The vertebral arteries, basilar artery, and posterior cerebral arteries are normal in course and caliber. There is no evidence of flow-limiting stenosis, AVM or aneurysm.

Output: MRI and MRA are within normal limits. No vascular lesions associated with HHT are appreciated.


Instruction: Generate impression based on findings.

Input: 57 year old with history of left mastectomy for breast cancer. Bilateral implants. Status post left mastectomy.There is heterogeneous amount of fibroglandular tissue in the right breast.Minimal parenchymal enhancement is noted in the right breast.Bilateral retropectoral silicone implants appear intact.No abnormal enhancement is seen in right breast or left mastectomy bed. A normal intramammary lymph node is identified at posterior upper outer right breast. No abnormal lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: 66 year old female with left sided headaches for one month. History of colon cancer, MET to the brain status post resection 2006. Stable extensive areas of encephalomalacia within bilateral cerebral hemispheres, left greater than right. There is also stable left craniotomy. There is no evidence of acute intracranial hemorrhage, mass, or abnormal enhancement. The ventricles and basal cisterns are normal in size and configuration. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: No acute intracranial hemorrhage, mass, or abnormal enhancement.


Instruction: Generate impression based on findings.

Input: There is minimal straightening of the cervical lordosis which may be related to positioning. The vertebral body heights are maintained. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal. The craniocervical junction is not compromised.C2-C3: No significant abnormalities are appreciated at this level. Specifically there is no evidence for neural foraminal or spinal canal stenosis.C3-C4: No significant abnormalities are appreciated at this level. Specifically there is no evidence for neural foraminal or spinal canal stenosis.C4-C5: There is posterior osteophytic disc complex and bilateral uncinate hypertrophy causing mild left and mild right neural foraminal narrowing. There is no evidence for spinal canal stenosis.C5-C6: No significant abnormalities are appreciated at this level. Specifically there is no evidence for neural foraminal or spinal canal stenosis.C6-C7: There is a right paracentral disc protrusion causing moderate right proximal neuroforaminal stenosis with effacement of the ventral thecal sac. No significant left neural foraminal stenosis is noted at this level.C7-T1: No significant abnormalities are appreciated at this level. Specifically there is no evidence for neural foraminal or spinal canal stenosis.

Output: 1.C4-C5: Mild left and mild right neural foraminal narrowing.2.C6-C7: There is a right paracentral disc protrusion causing moderate right proximal neuroforaminal stenosis with effacement of the ventral thecal sac.