Instruction: Generate impression based on findings.

Input: 75 years Female (DOB:7/7/1941)Reason: evaluate for ischemic changes History: altered mental status, fall at home, CVA hxPROVIDER/ATTENDING NAME: ROBERT M. SARGIS MRI of the brainThere are multiple foci of diffusion restriction present. One in the right centrum semiovale and basal ganglia measures 18 x 11 mm axial dimensions. There are number of smaller foci of diffusion restriction scattered in the left basal ganglia, subcortical white matter of the frontal lobes bilaterally and subcortical white matter of the right parietal lobe.On susceptibility imaging there is a focus of signal loss present within the right lower midbrain and upper pons.A focus of encephalomalacia is present along the left inferior parietal lobule which extends to the adjacent left temporal lobe. This demonstrated diffusion restriction on 12/23/2012.There is a mild to moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Additional punctate foci of hyperintensity on T2 and FLAIR imaging are present in the brainstem. These findings have progressed since the 12/23/2012 examNo 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.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. The more distal vasculature and a smaller vasculature is not well evaluated due to signal abnormalities.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. There is fetal origin of the right posterior cerebral artery with a small medium sized right P1 segment. The left P1 segment is slightly larger than the left posterior communicating artery. The vertebral arteries are similar in size. There is extracranial origin the left posterior inferior cerebellar artery .

Output: 1.There are multiple small foci of diffusion restriction scattered in both frontal and parietal lobes as well as basal ganglia and centrum semiovale. The largest one is in the right centrum semiovale and basal ganglia. These are compatible with subacute foci of infarction2.A focus of encephalomalacia in the left parietal lobe is present which most likely represents a prior focus of cerebral infarction. This appears to have been in the acute phase December 2012.3.Findings are compatible with a chronic stage small hemorrhage in the right lower midbrain and upper pons.4.Periventricular and subcortical white matter lesions of a mild to moderate degree and punctate lesions in the brainstem are nonspecific. At this age they are most likely vascular related. This has progressed since the 12/23/2012 exam.5.There is no evidence for intracranial cerebrovascular occlusive disease. More distally cerebrovascular occlusive disease may be less obvious on this exam due to lower signal compared to 3 Tesla MR angiography.


Instruction: Generate impression based on findings.

Input: Multiple sclerosis, lower extremity weakness. Again seen are greater than 20 T2/FLAIR hyperintense lesions in the supratentorial white matter as well as infratentorially including the left middle cerebellar peduncle and cerebellar hemispheres. Compared to 9/18/2012, there is evidence of interval progression with at least 3 new lesions which are identified including the right frontal lobe, right inferior parietal lobule, as well as the left post central gyrus. No lesions with enhancement are definitively appreciated to suggest active demyelination. There is questionable peripheral enhancement on coronal post gad sequence series 12 image 10 but not present on the axial post gadolinium spin echo or 3D post gadolinium SPGR sequences and favored to be artifactual. Few lesions with T1 hypointensity are also seen. There is mild volume loss including the corpus callosum. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. No hydrocephalus. No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: 1. Greater than 20 supratentorial and infratentorial white matter lesions consistent with known demyelinating disease. There is evidence of progression compared to 9/18/2012 with at least 3 new lesions identified. No lesions without enhancement are definitively identified to indicate active demyelination. Please see comment above.2. Mild parenchymal volume loss including the corpus callosum.


Instruction: Generate impression based on findings.

Input: 64-year-old female with chronic kidney disease and CHF on warfarin for TVR replacement and recent hematoma on MRI of the hip. MRI pelvis recommended for follow-up. The previously seen soft tissue mass in the right iliacus muscle has decreased markedly in size, now measuring approximately 2.5 x 1.5 cm in the transverse dimension and 3.5 cm in the craniocaudal dimension. It is hyperintense to skeletal muscle on both T1 and T2-weighted sequences centrally, with a low signal intensity rim suggestive of an evolving hematoma. We see no additional soft tissue masses. The bone marrow signal intensity is within normal limits. There is a small rounded mass of fluid signal intensity along the right third sacral neural foramen likely representing a Tarlov cyst, appearing similar to the prior study. Mild osteoarthritis affects both hip joints. Mild facet joint osteoarthritis affects the lower lumbar spine resulting in mild narrowing of the spinal canal.

Output: 1. Evolving hematoma within the right iliacus muscle which is much smaller in size on the current study than on the prior study.2. Mild osteoarthritis of the hips and lower lumbar spine.


Instruction: Generate impression based on findings.

Input: 42 years Female (DOB:1/21/1974)Reason: R/O cervical cord lesion. R Horner's. Papillary thyroid carcinoma History: R Horner's, R arm numbnessPROVIDER/ATTENDING NAME: HELENE G. RUBEIZ HELENE G. RUBEIZ The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal enhancing lesions are identified in the cervical spine.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.There is a 45 x 42 mm heterogeneous cystic mass present centered in the left thyroid

Output: 1.No abnormal lesions are appreciated within the cervical spinal canal to account for the patient's Horner syndrome.2.There is a left thyroid lobe mass present which has been previously documented on a recent ultrasound exam. The patient is known to have papillary thyroid carcinoma.


Instruction: Generate impression based on findings.

Input: Active calciphylaxis with right-sided weakness, right-sided vision changes and right-sided hearing loss evolving over last 6 hours. History of end stage renal disease. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mild scattered cerebral white matter T2 hyperintensity. There is also a small area of encephalomalacia in the right cerebellar hemisphere. There is an enlarged partially-empty sella. 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, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is diffuse low T1 and T2 signal throughout the imaged bone marrow.

Output: 1. No evidence of intracranial hemorrhage, mass, or acute infarct. 2. Mild scattered cerebral white matter T2 hyperintensity is nonspecific, but may represent chronic small vessel ischemic disease versus early posterior reversible encephalopathy syndrome.3. Chronic right cerebellar hemisphere lacunar infarct. 4. An enlarged partially-empty sella is nonspecific, but can be a manifestation of pseudotumor cerebri. 5. Diffuse low T1 and T2 signal throughout the imaged bone marrow may be related to renal osteodystrophy.


Instruction: Generate impression based on findings.

Input: Reason: Medial meniscus tear History: knee pain, swelling MENISCI: There is minimal fraying of the bilateral menisci, without specific signal abnormality identified within either menisci to suggest tearing.ARTICULAR CARTILAGE AND BONE: There is no evidence of fracture or bone marrow edema.LIGAMENTS: There is slight thickening of the superior aspect of the MCL without internal acute signal changes, which likely reflects partially scarring from prior trauma. There is more immediate surrounding edema outlining the MCL without evidence of fiber disruption, consistent with a more acute mild sprain. The ACL, PCL, and LCL complex are intact and unremarkable. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Mild MCL sprain without evidence of tearing.


Instruction: Generate impression based on findings.

Input: Pain in left foot [M79.672], Reason for Study: ^Reason: nerve root compression History: left foot pain For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. There is normal lumbar lordosis. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. The conus medullaris terminates at the T12-L1 level. The paraspinal soft tissues are unremarkable.Degenerative changes are specified by the intervertebral level as follows: T12-L1: no neuroforaminal narrowing or spinal stenosis. L1-L2: minimal bulging of disc, no neuroforaminal narrowing or spinal stenosis. L2-L3: diffuse bulging of disc with minimal spinal canal narrowing, no neuroforaminal narrowing. L3-L4: diffuse bulging of disc which results minimal spinal canal narrowing associated with minimal bilateral ligamentum flavum thickening. There is also focal associated bulging of disc toward left side neural foramen which abuts nerve roots (series 6, image 13/25). Bilateral facet joints show joint effusion indicating arthritic changes.L4-L5: diffuse bulging of disc with eccentric bulge toward left side neural foramen results minimal to mild left neuroforaminal narrowing. Right facet joint shows subchondral sclerosis with hypertrophy and the left facet joint shows joint effusion indicating arthritic changes. L5-S1: There is focal disc protrusion central to right side which abuts thecal sac and narrows right side lateral recess. No spinal stenosis.

Output: 1. Multifocal various degree degenerative changes of lumbar spine.2. Minimal to mild neuroforaminal narrowing at the level of L34 and L45 left side.3. Focal disc protrusion central to right with right lateral recess narrowing at the level of L5S1.


Instruction: Generate impression based on findings.

Input: Reason: evaluate for etiology of L diplopia and EOM abnormalities in patient w/ history of ALL in remission. Relapsed disease vs. Infection History: L diplopia and EOM abnormalities There is mild prominence of the cortical sulci in proportion to the cerebral ventricles consistent with mild diffuse global volume loss. Extensive confluent T2/FLAIR hyperintensity is demonstrated in the periventricular and subcortical white matter as well as the infratentorial white matter, significantly increased since prior exam. There is no midline shift or mass effect appreciated. There is no diffusion restriction to suggest acute ischemia. No intracranial hemorrhage is identified. No abnormal parenchymal postcontrast enhancement is identified. Minimal mucosal thickening of the ethmoid air cells is seen. There is a nonspecific 7 mm area of nodular enhancement involving the anterior frontal scalp.There is a flattening deformity of the posterior globes, right greater than left, new since July 20, 2013. The bilateral optic nerves appeared tortuous with fluid distention of the optic nerve sheaths. Small area of enhancement is demonstrated involving the optic discs bilaterally, more conspicuous on the right. There is no definite associated diffusion restriction. There is no empty sella.Although the cranial nerves are suboptimally evaluated by this technique, there appears to be symmetric facial nerve enhancement along the distal canalicular segments within the fundus of the IACs, as well as asymmetric discontinuous enhancement involving the tympanic to mastoid segments, greater on the right side with perhaps mild nerve thickening distally on the right. There is also enhancement of the cisternal sixth cranial nerves. Additionally, there appears to be a small area of enhancement in the expected location of the left cranial nerve III origin, along the medial left cerebral peduncle. A persistent left trigeminal artery is incidentally noted.

Output: 1. Elevation of the optic nerve heads with associated punctate enhancement and tortuosity of the optic nerves with fluid distension of the sheaths, suggestive of papilledema and likely increased intracranial pressure. No definite empty sella, which can be seen with pseudotumor cerebri. Recommend correlation with ophthalmologic examination and lumbar puncture/opening pressure.2. There appears to be abnormal enhancement involving the bilateral sixth and seventh as well as possibly the origin of the left third cranial nerve. Further evaluation with cranial nerve protocol MRI of the brain/skull base, with and without contrast is recommended. No other leptomeningeal enhancement seen.3. Confluent T2/FLAIR hyperintensity involving the supratentorial and infratentorial white matter may be related to progressed leukoencephalopathy from prior reported prior treatment, including methotrexate.4. There is a nonspecific 7 mm nodular area of enhancement involving the anterior frontal scalp. Please correlate with physical exam.Findings were reported to Dr. Kelsey Reno on 10/1/2016 at 4:11 PM


Instruction: Generate impression based on findings.

Input: History of kidney transplant with radicular pain down his leg status post physical therapy for several weeks but with persistent pain, evaluate. There is a grade 1 retrolisthesis of L5 on S1. Otherwise, the alignment is anatomic. At L1-L2, there is no significant spinal canal or neural foraminal stenosis. At L2-L3, there is thickening of the ligamentum flavum with facet joint hypertrophy resulting in mild right neural foraminal stenosis. At L3-L4, there is left greater than right thickening of the ligamentum flavum and hypertrophy facet joints, resulting in moderate to severe left neural foraminal narrowing and mild right neural foraminal narrowing. At L4-L5, there is protrusion of the disc into the right neural foramina along with ligamentum flavum thickening and facet joint hypertrophy, resulting in moderate to severe right neural foraminal stenosis. At L5-S1, there is a disc bulge with no significant spinal canal stenosis. However, facet joint hypertrophy and ligamentum flavum thickening result in moderate to severe right and mild left neural foraminal stenosis. There is a subcentimeter hemangioma in the S1 vertebral body. The vertebral body heights are preserved. The imaged portions of the spinal cord are unremarkable. The native kidneys are atrophic and there is a partially imaged, but large complex lesion in the right renal fossa. There is a transplanted kidney in the right iliac fossa.

Output: 1. Multilevel degenerative lumbar spondylosis, with particularly pronounced right L4-5 and L5-S1 neural foraminal narrowing and left L3-4 neural foraminal narrowing.2. Renal transplantation and bilateral renal atrophy with a partially imaged, but large complex lesions in the right renal fossa, which may represent a neoplasm. Dedicated renal imaging may be useful for further evaluation.Discussed with Dr. Jay Koyner at 11:50 AM.


Instruction: Generate impression based on findings.

Input: 50 years, Female, left lip droop, dysarthria right lower extremely weakness. Examination is motion degraded. No restricted diffusion to suggest acute ischemia. No intracranial mass or mass-effect. There is T2/FLAIR hyperintensity with volume loss in the right frontal lobe extending into the right basal ganglia, insula, and right superior temporal gyrus consistent with encephalomalacia in the right middle cerebral artery territory. There is ex vacuo dilatation of the right lateral ventricle; no hydrocephalus. There is T2 hyperintensity extending along the right cerebral peduncle with volume loss consistent with Wallerian degeneration. There is susceptibility effect compatible with chronic hemorrhage in the right basal ganglia. There is additional mild patchy T2/FLAIR hyperintensity in the periventricular and subcortical white matter as well as the pons compatible with mild chronic small vessel ischemic changes. Major flow-voids are preserved aside from the right middle cerebral artery, which was better evaluated on recent CT angiogram.Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are grossly clear. Calvarium and extra cranial soft tissues are unremarkable.

Output: 1. Chronic right middle cerebral artery territory infarct. No evidence of acute infarct.2. Evidence of chronic hemorrhage in the right basal ganglia.


Instruction: Generate impression based on findings.

Input: 51-year-old female status post ACL reconstruction x 2 with positive Lachman's and knee pain.IMAGE ACQUISITIONS: Computed tomography of the right knee, nonenhanced, with transverse, coronal, and sagittal reformatted images As stated on the requisition, the patient is status post reconstruction of the anterior cruciate ligament as evidenced by surgical tunnels in the proximal tibia and distal femur. Although not visible on this study, the graft appears intact on the recent MRI examination. As seen on prior radiographs, there is a horizontally oriented fixation screw within the posterior aspect of the lateral femoral condyle at the superior margin of the femoral tunnel. Its pin exits the posterior femoral cortex and extends superomedially such that its tip lies immediately anterior to the popliteal artery. A small tapering focus of low to intermediate attenuation is seen immediately inferior to the pin, which may either represent a ganglion or focus of scarring; I do not believe that it is vascular in etiology.The tibial tunnel penetrates the anteromedial cortex of the proximal tibia. Additional lucent tracts are seen in the distal femur and proximal tibia compatible with more remote ACL reconstruction.Tiny patellar osteophytes indicate mild osteoarthritis. The remaining visualized bone and soft tissue structures are within normal limits.

Output: Postoperative changes as described above.


Instruction: Generate impression based on findings.

Input: 89-year-old male with history of right ureteral carcinoma status post nephroureterectomy in September 2015. ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic enhancing lesion. No intra or extra hepatic biliary ductal dilatation. There is small amount of perihepatic fluid.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Status post right nephroureterectomy. Left perinephric mild T2 hyperintensity consistent with edema. There is a subcentimeter T1 hyperintense focus in the left kidney, consistent with a hemorrhagic cyst. No hydroureteronephrosis on the left.RETROPERITONEUM, LYMPH NODES: There is a T1 hypointense and T2 hyperintense collection in the aortocaval region without evidence of restricted diffusion or enhancement; this collection measures 2.8 x 3.4 cm. Findings suggestive of a postoperative lymphocele/seroma.The infrarenal aorta measures 4.5 cm (series 12, image 62), unchanged compared to the CT May 2015 examination.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS: Susceptibility artifact from right hip prosthesis limits evaluation.PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: There is a T1 hypointense and T2 hyperintense collection in the pelvis measuring approximately 4.3 x 4.1 cm without evidence of restricted diffusion or enhancement. Findings is consistent with postoperative lymphocele/seroma.OTHER: No significant abnormality noted.

Output: 1.Postoperative changes of right nephroureterectomy.2.Retroperitoneal and pelvic fluid collections as above most consistent with postoperative lymphocele/seroma.3.Small amount of perihepatic ascites.4.Unchanged 4.5 cm infrarenal aortic abdominal aneurysm.


Instruction: Generate impression based on findings.

Input: T4bN0 small cell sinonasal neoplasm status post surgery and radiation. FACE: There are post-treatment findings in the nasopharyngeal and sinonasal regions with a defect in the exosurface of the clivus, which demonstrates diffuse enhancement, as well as prominent mucosal thickening in the bilateral maxillary sinuses and to a lesser extent in the anterior ethmoid cavity. There is diffuse hyperenhancement of the nasopharyngeal mucosal space, but no evidence of discrete mass lesions or significant cervical lymphadenopathy based on size criteria. There is a wide left mandibular molar extraction cavity containing probable granulation tissue. BRAIN: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull are grossly unremarkable.

Output: 1. Post-treatment findings in the nasopharyngeal and sinonasal regions without evidence of measurable mass lesions in the treatment bed. Indeed, diffuse hyperenhancement of the nasopharyngeal mucosal space likely represents mucositis with underlying scar or granulation tissue rather than viable tumor. 2. No evidence of intracranial metastases.


Instruction: Generate impression based on findings.

Input: 54 year old male with a history of hypothyroidism, non-ischemic dilated cardiomyopathy with new left bundle branch block now referred for repeat cardiac MRI. Left VentricleThe left ventricle is moderately dilated with mildly reduced systolic function. The overall LV ejection fraction is 45%, the LV end diastolic volume index is 127 ml/m2 (normal range: 74+/-15), the LVEDV is 268 ml (normal range 142+/-34), the LV end systolic volume index is 70 ml/m2 (normal range 25+/-9), the LVESV is 148 ml (normal range 47+/-19), the LV mass index is 62 g/m2, and the LV mass is 131 g. As seen on the previous study there is a persistent small area of late gadolinium enhancement in the basal inferior and inferolateral walls, atypical for prior myocardial infarction and suggests the presence of an underlying myocardial infiltrative, inflammatory, or fibrotic process. There is no myocardial iron overload. There is abnormal septal motion consistent with known conduction abnormality.Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is moderately dilated with normal systolic function. The overall RV ejection fraction is 50%, the RV end diastolic volume index is 134 ml/m2 (normal range 82+/-16), the RVEDV is 285 ml (normal range 142+/-31), the RV end systolic volume index is 67 ml/m2 (normal range 31+/-9), and the RVESV is 143 ml (normal range 54+/-17).Right AtriumThe right atrium is moderate-severely dilated. Aortic ValveThe aortic valve opens widely and there is trivial aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is a trivial pericardial effusionExtracardiac FindingsMultiple hepatic cysts or hemangiomas are noted. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Moderately dilated LV with mildly reduced systolic function (EF 45%). The ventricle is more dilated with slightly worse systolic function when compared to the previous study. 2. Moderately dilated RV with mildly reduced systolic function (EF 50%), essentially stable from previous.3. Unchanged area of late gadolinium enhancement in the basal inferolateral wall which is suggestive of inflammatory, infiltrative or fibrotic process. The pattern is atypical for prior myocardial infarction.4. Biatrial dilation. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: History of brain metastasis from lung cancer in the right frontal lobe, status post radiation. There is no significant interval change in size of the lesion in the right centrum semiovale with susceptibility effect and mild peripheral enhancement, which measures up to 9 mm. Likewise, there is no change in the surrounding confluent high T2 signal. There is no evidence of acute intracranial hemorrhage or infarct. The ventricles are unchanged in size and configuration. There is no midline shift or herniation. The skull and scalp soft tissues are unremarkable. There are unchanged prominent disc-osteophyte complexes in the imaged cervical spine with associated mild to moderate spinal canal stenosis.

Output: No significant interval change of the treated metastasis in the right centrum semiovale.


Instruction: Generate impression based on findings.

Input: 64-year-old man with history of HCV cirrhosis and abdominal pain. ABDOMEN:LIVER, BILIARY TRACT: The liver is slightly nodular in contour and there is caudate lobe hypertrophy. Geographic region of the right hepatic lobe has reticular T2 hyperintensity with some delayed enhancement suggested, overall consistent with underlying fibrosis. No focal hepatic lesion is identified.The gallbladder is decompressed. There is no intra or extrahepatic biliary duct dilatation.SPLEEN: Spleen appears normal.PANCREAS: 6 mm area of high T2 signal (series 7, image 19) in the pancreatic head is unchanged. The remainder of the pancreas is normal in signal and morphology.ADRENAL GLANDS: The adrenal glands are normal.KIDNEYS, URETERS: The kidneys are normal.RETROPERITONEUM, LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: The visualized small bowel and colon are normal.BONES, SOFT TISSUES: Midline abdominal surgical staples are noted.OTHER: No significant abnormality noted.

Output: 1.Findings of hepatic cirrhosis and fibrosis without suspicious lesion.2.Stable sidebranch IPMN.


Instruction: Generate impression based on findings.

Input: 64 year old female with new onset of left proptosis. Thyroid eye disease versus mass. The extraocular musculature remain within normal size and configuration. The retro-orbital fat remains within normal limits. There is a slight prominence of the right optic nerve at the site of its insertion to the right globe. No definitive evidence of enhancement in this region is detected. Review of prior MRI examination of brain without infusion from 2007 demonstrated similar finding with no interval change. The osseous structures of the orbits are unremarkable. There is prominence of bilateral superior ophthalmic veins. MRI examination of this patient from 8 -- 30 -- 2007 was reviewed which also demonstrated prominence of superior ophthalmic veins however no abnormality at the level of cavernous sinus was noted on that exam.The paranasal sinuses are well pneumatized are unremarkable with the exception of a small retention cyst in the dependent portion of right maxillary sinus. No abnormality at the level of the skull base is detected.

Output: 1.No evidence of Graves' ophthalmopathy or mass in the orbit as clinically is questioned.2.Prominence of bilateral superior ophthalmic veins which has remained stable since prior MRI examination of brain without and fusion from 8 -- 30 -- 2007.3.Prominence of right optic nerve immediately posterior to the globe no enhancement as detailed.4.Dedicated MRI examination of orbits and region of the sella with infusion is recommended for further evaluation of the above findings.


Instruction: Generate impression based on findings.

Input: Evaluate mass of right brachial plexus and shoulder: discomfort and small mass on right side just below the clavicle and far lateral. There are innumerable tumors involving multiple bilateral cervical and upper thoracic nerve roots, as well more peripheral nerves, including what may correspond to the lesion of clinical concern located inferior to the right clavicle, which measures up to 27 mm. Of note, a mass along the right C6 nerve root is heterogeneous and has increased in size, measuring 28 mm in width, previously 19 mm. While some of the tumors enlarge the neural foramina, there is no evidence of spinal cord compression. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable.

Output: Innumerable peripheral nerve sheath tumors involving multiple bilateral cervical and upper thoracic nerve roots, as well more peripheral nerves, including what may correspond to the lesion of clinical concern located inferior to the right clavicle, which measures up to 27 mm. Of note, a mass along the right C6 nerve root is heterogeneous and has increased in size, which may indicate malignant transformation.


Instruction: Generate impression based on findings.

Input: 44 year old female with perianal Crohn's disease with recurrent fistula. PELVIS:UTERUS, ADNEXA: Note is made of numerous uterine masses with decreased T2 signal abnormality and homogenous enhancement consistent with pedunculated, intramural, and subserosal fibroids. There is focal thickening of the endometrium along the posterior wall of the fundus of the uterus, measuring up to 26 mm in diameter, with associated foci of increased T2 signal abnormality, consistent with adenomyosis.There is nonspecific fluid within the endocervical canal. BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Note is made of a linear focus of enhancing increased T2 signal abnormality extending from the 12 o'clock position of the rectum to the posterior wall of the vagina, suspicious for rectovaginal fistula formation. There is an additional focus of enhancing T2 signal abnormality extending from the 7 o'clock position of the rectum to the soft tissue of the right medial thigh consistent with a trans-sphincteric fistula. There is a 8 x 5 mm fluid collection in the surrounding area (26; series 6). Additionally, there is extension of this linear increased T2 signal abnormality to involve the skin surface of the right labia suspicious for enterocutaneous fistula formation. There is an additional 9 x 5 mm fluid collection in in the right labia. There is extensive increased T2 signal abnormality and subcutaneous edema/inflammation in the soft tissues of the right labia and the medial right perineum.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: There is a small amount of free fluid within the pelvis which is nonspecific but may be physiologic.

Output: 1.Multiple perianal fistulae including extension to involve the soft tissues of the right perineum, right labia, as well as a probable rectovaginal fistula involving the posterior vaginal wall.2.Numerous uterine fibroids.3.Findings consistent with adenomyosis, most pronounced along the posterior wall of the fundus of the uterus.


Instruction: Generate impression based on findings.

Input: A patient submitted outside study for review. Submitted for review are:1.Bilateral screening mammogram 6/8/20152.Bilateral diagnostic mammogram 6/19/20153.Right breast ultrasound 6/19/20154.Ultrasound guided right-sided biopsy 6/30/20155.Post procedure right-sided mammogram 6/30/20156.Ultrasound-guided right-sided wire localization 8/6/20157.Post procedure right mammogram 8/6/20158.Mammogram of surgical specimen 8/6/20159.MRI bilateral breasts 8/27/2015performed at Adventist Bolingbrook Hospital. For comparison,5/9/2014 screening mammograms are available. 1.Bilateral screening mammogram 6/8/2015: Linear scar marker overlying the right breast. Circumscribed 5 mm oval asymmetry in the right medial breast is slightly increased in size. Asymmetry in the anterior right breast is new. Patient recalled for diagnostic mammogram due to anterior asymmetry.2.Bilateral diagnostic mammogram 6/19/2015: Asymmetry in the right anterior breast again seen. Circumscribed mass in the right medial breast. Targeted ultrasound was performed of right anterior lesion.3.Right breast ultrasound 6/19/2015: 3 lesions identified at the 3:00 position. A 5 cm from the nipple, there is a 5 mm hypoechoic mass with adjacent vessels suspected to be an intramammary lymph node. At 4 cm from the nipple, there is a 3 mm hypoechoic mass. A 2 cm from the nipple, there is a 9 x 4 x 5 mm lobulated hypoechoic mass with associated vascularity.4.Ultrasound guided right-sided biopsy 6/30/2015: Ultrasound-guided core biopsy of hypoechoic mass 2 cm from the nipple was performed. Subsequent path showed this lesion to be a sclerosing intraductal papilloma associated with marked apocrine atypia. Biopsy of lesions at 4 and 5 cm from the nipple seen on prior ultrasound was recommended.5.Post procedure right-sided mammogram 6/30/2015: Biopsy clip identified in right anterior breast at site of focal asymmetry corresponding to the anterior asymmetry.6.Ultrasound-guided right-sided wire localization 8/6/2015: Ultrasound-guided wire localization was performed prior to excisional biopsy. 2 wires were placed at the 3:00 position, entering lesions 2 cm, 4 cm and 5 cm from the nipple.7.Post procedure right mammogram 8/6/2015: Post procedure mammogram showed 2 wires. The anterior wire was adjacent to the surgical clip. The posterior wire was adjacent to the enlarging circumscribed mass in the right medial breast.8.Mammogram of surgical specimen 8/6/2015: Two mammograms were obtained following excisional biopsies post wire localization. The first specimen of the anterior lesion showed increased density with an associated biopsy clip. Pathology revealed this lesion could represent DCIS grade 2 with focal necrosis. A second specimen of the more medial posterior lesion showed increased density. Pathology revealed this specimen to represent DCIS grade 2 with focal invasive ductal carcinoma grade 2. Margins of the first specimen were negative for invasive cancer or DCIS. Margins of the second specimen were negative for invasive cancer but positive for DCIS.9.MRI bilateral breasts 8/27/2015: Evaluation of the axilla is limited with normal-appearing lymph nodes identified. There is a seroma cavity in the right breast extending from the 2:00 to 4:00 position measuring 3.9 x 2.5 x 2.8 cm. There is minimal parenchymal enhancement bilaterally with a few small foci of enhancement in the left breast. No enhancement suspicious for residual or recurrent tumor.

Output: Screening detected focal asymmetry in the right medial breast was initially evaluated with ultrasound and biopsied revealing a sclerosing intraductal papilloma with atypia. During ultrasound, two additional lesions were seen within the right medial breast. Upon biopsy results, excisional biopsy of all 3 lesions were performed with pathology revealing DCIS and IDC grade 2. Postsurgical staging MRI showed no residual or recurrent tumor.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: multiple myeloma patient with new onset headache No evidence of acute ischemic or hemorrhagic lesion.Multifocal bihemispheric scattered high signal intensities on FLAIR images indicate non specific small vessel disease.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: No evidence of acute ischemic or hemorrhagic lesion.No evidence of abnormal enhancement indicating possible metastatis on this scan.


Instruction: Generate impression based on findings.

Input: 32-year-old female with bilateral knee pain without known cause. MENISCI: The medial and lateral meniscus appear intact.ARTICULAR CARTILAGE AND BONE: No bone marrow signal abnormality is identified. No full-thickness or near full-thickness articular cartilage defects are identified. There is subjective thinning of the articular cartilage of the patellofemoral compartment.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: Nonspecific subcutaneous edema along the anterior aspect of the knee. Otherwise no findings to account for the patient's pain.


Instruction: Generate impression based on findings.

Input: Wrist pain LIGAMENTS: No significant abnormality noted.TRIANGULAR FIBROCARTILAGE COMPLEX: No significant abnormality noted.TENDONS: No significant abnormality noted. BONES: No significant abnormality noted.ADDITIONAL

Output: Normal MR arthrogram of the left wrist.


Instruction: Generate impression based on findings.

Input: 16-year-old male with pilonidal disease; non-healing, non-surgical wound; status post wound vac. Evaluate for possible osteomyelitis/foreign body/track PELVIS:PROSTATE/SEMINAL VESICLES: The prostate and seminal vesicles are normal.BLADDER: Bladder is normal.LYMPH NODES: No lymphadenopathy is noted.BOWEL, MESENTERY: As described below, there is extension of inflammatory changes within the posterior soft tissues anteriorly to the anus suspicious for a fistulous tract. No significant anal wall thickening is noted and the remainder of the imaged bowel is normal.BONES, SOFT TISSUES: Subcutaneous edema and stranding noted within the midline posterior subcutaneous soft tissues overlying the sacrococcygeal region extending to the skin surface consistent with pilonidal sinus disease. Within this inflammatory process in the deep subcutaneous soft tissues is a more discrete cystic collection measuring 2.9 cm x 1.5 cm x 3.4 cm (series 4, image 58 and series 8, image 25) demonstrating heterogeneous enhancement. This process involves the gluteal cleft with extension of the inflammatory changes anteriorly to the anus (series 4, image 40) suspicious for a fistulous tract without significant anal wall thickening. These changes also extend adjacent to the sacrum, however bone marrow signal is normal. OTHER: No significant abnormality noted.

Output: Findings compatible with pilonidal sinus disease within the posterior soft tissues overlying the sacrococcygeal region complicated by phlegmonous changes without discrete abscess formation. There is suspicion for a fistulous communication to the anus. No abnormal bone marrow signal is noted to suggest osteomyelitis.


Instruction: Generate impression based on findings.

Input: history of parotid lymphoma 20 years ago. Status post surgery/RT. Evaluate for recurrence. Also with METs to left hip, left arm and right leg. CT of the soft tissues of the neck.Images through the skull base and including cavernous sinuses, paranasal sinuses remain within normal limits. Opacification of mastoid air cells on the left may represent otitis and or secondary to prior prior treatment and compromise of the eustachian tube. There is a focal defect within the left jugular bulb with no enhancement which may represent a clot. The left internal jugular vein is not visualized and presumed occluded. Left carotid is patent. Within the soft tissues of the neck on the left side a large cluster of irregular calcification is noted immediately adjacent to the vertebral column which extends from the level of C1 inferiorly to approximately C3 -- C4 intervertebral disk level. This is not associated with any definitive soft tissue mass or enhancement. I am not certain of the etiology of this finding. However the above finding may represent calcification within a treated tumor, dystrophic calcification or embolic material. This finding is not within the parotid region and the left parotid gland is believed to have been surgically removed. No definitive evidence of a mass or pathologic adenopathy in the neck is detected. A left paramedian submental node measures 9 mm times 14-mm in transaxial dimension (axial image 47). Limited images of the apices of the lungs demonstrates no metastatic lesion please review the dictated report of CT of chest performed the same date. No definitive mediastinal abnormality. Bony density of the area of exam is negative for metastatic lesions.An MRI examination of soft tissues of the neck is recommended for better evaluation of areas of calcification and in particular to exclude the possibility of an associated soft tissue mass. Extensive degenerative changes of cervical spine with multilevel neural foramina compromise is noted.If there are outside studies available comparison will be made and if necessary an addendum will be added.CT of brain with infusion.No evidence of metastatic disease to the brain, leptomeninges or the calvarium is detected. Examination however demonstrates minimal small vessel disease.

Output: 1.Minimal small vessel disease and otherwise negative CT of brain with infusion.2.Excessive cluster of calcification within the soft tissues of the neck on the left adjacent to the vertebral column with no associated soft tissue mass or bony destruction or abnormal enhancement. The findings may represent posttreatment changes. Further follow-up with an MRI is recommended3.No evidence of residual parotid gland on either side.4.No evidence of a soft tissue mass or pathologic adenopathy.5.Extensive opacification of left mastoid air cells.1.


Instruction: Generate impression based on findings.

Input: An 83 year old female with hypertension, paroxysmal atrial fibrillation, fatigue. A recent dobutamine echocardiography stress showed regional wall motion abnormality of the antero-septum. Referred to Stress cardiac MRI for further evaluationMEDICATIONS: Aspirin, Atenolol, Citalopram, Hydrochlorothiazide, Fluticasonem Raloxifene First Pass PerfusionDuring hyperemia, there is a transmural perfusion defect involving the basal inferior, inferolateral, and anterolateral walls. The overall ischemia score is 6 out of a total 32 and 14% of the ventricle is ischemic.Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable. Left VentricleThe left ventricle is normal in size and systolic function. There is nearly circumferential hypertrophy of the basal left ventricle of unclear significance with a maximum wall thickness of 13mm; the remainder of the ventricle has normal wall thickness (~6mm). The overall LV ejection fraction is 65%, the LV end diastolic volume index is 71 ml/m2 (normal range: 65+/-11), the LVEDV is 119 ml (normal range 109+/-23), the LV end systolic volume index is 25 ml/m2 (normal range 18+/-5), the LVESV is 42 ml (normal range 31+/-10), the LV mass index is 35 g/m2, and the LV mass is 58 g. There are no regional wall motion abnormalities present. Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is moderately dilated with mildly reduced systolic function. The overall RV ejection fraction is 48%, the RV end diastolic volume index is 109 ml/m2 (normal range 69+/-14), the RVEDV is 184 ml (normal range 110+/-24), the RV end systolic volume index is 57 ml/m2 (normal range 22+/-8), and the RVESV is 88 ml (normal range 35+/-13). Right AtriumThe right atrium is moderately dilated. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation. There is mild mitral valve prolapse.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is moderate to severe tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsSmall right lower lung infiltrate of unclear significance, correlation with chest x-ray or chest CT suggested. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. There is a moderate amount of "ischemia" involving the basal inferior, inferolateral, and anterolateral walls. 2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and systolic function (LVEF 65%). There is nearly circumferential hypertrophy limited to the basal left ventricle which is of unclear significance. There is no underlying myocardial fibrosis, inflammation, or infiltration. 4. Moderate RV dilation with mildly reduced systolic function (RVEF 48%).5. There is mild mitral valve prolapse.6. Significant biatrial dilation.7. Moderate to severe tricuspid regurgitation.8. 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: New onset right sided tremor and weakness, concern for stroke. There are small areas of T2 hyperintensity in the right thalamus and right cerebellar hemisphere. There is a background of mild scattered cerebral white matter T2 hyperintensity. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: CHronic lacunar infarcts in the right thalamus and right cerebellar hemisphere superimposed upon a background of chronic probable small vessel ischemic disease, but no evidence of acute acute infarct.


Instruction: Generate impression based on findings.

Input: 74 years Female (DOB:4/16/1942)Reason: 3 t scanner HHT pt please evaluate for AVMs History: screening for HHTPROVIDER/ATTENDING NAME: ISSAM A. AWAD ISSAM A. AWAD Examination is somewhat degraded due to motion artifact.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.There is a small focus of low signal on T2 and FLAIR measuring 2 mm diameter located in the left temporal lobe adjacent to the temporal horn of the left lateral ventricle associated with blooming effect on the stability weighted imaging. There is an adjacent punctate focus of signal loss and susceptibility weighted imaging.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses 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.

Output: 1.There is a hemorrhagic lesion present in the left temporal lobe. The underlying cause is uncertain.2.Exam is degraded due to artifact related to patient motion. This will obscure more subtle abnormalities which are frequently seen with HHT.3.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: 71-year-old female patient with HCV cirrhosis. HCC screening. ABDOMEN:LIVER, BILIARY TRACT: The liver is nodular in contour. No suspicious arterially enhancing hepatic lesion is identified. SPLEEN: There is an accessory splenule.PANCREAS: Decreased T1 signal and atrophy of the pancreas is suggestive of prior pancreatitis. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: There are subcentimeter bilateral renal cysts. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: The patient is status post right mastectomy.OTHER: No significant abnormality noted.

Output: Cirrhotic morphology of the liver without suspicious lesion to suggest HCC.


Instruction: Generate impression based on findings.

Input: Female, 89 years old, expressive aphasia, had subdural hemorrhage evacuated in OR. Very limited examination due to patient intolerance. Only diffusion and sagittal T1 images were obtained, and these are severely motion degraded. Again seen is a region of restricted diffusion along the left posterior limb of the internal capsule.

Output: Very limited study which again shows ischemia along the posterior limb of the left internal capsule.


Instruction: Generate impression based on findings.

Input: Intracerebral hemorrhage identified in March 2015. Evaluate stability. Breast cancer. Mild residual enhancement within the hemosiderin-stained hemorrhage bed within the left parietal lobe has diminished from prior, consistent with expected evolution of prior hemorrhage. There is confluent T2 hyperintensity within the left frontal and parietal white matter, consistent with evolving prior ischemic injury. There is left frontal encephalomalacia and gyriform intrinsic T1 hyperintensity along the middle frontal gyrus, consistent with evolution of ischemia. There is no evidence of new intracranial hemorrhage, mass, or acute infarction. There are scattered periventricular and subcortical T2 hyperintensities, which are nonspecific, but most likely secondary to chronic microvascular ischemic disease. There is unchanged T2 hyperintensity within the left basal ganglia and thalamus, probably chronic lacunar infarctions. 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: 1.Evolving left parietal intraparenchymal hematoma with diminished mild residual enhancement in the affected parenchyma. No findings are seen to suggest an underlying lesion or mass.2.Evolving left frontal lobe encephalomalacia and areas of left frontoparietal T2 hyperintensity also consistent with evolution of prior ischemic injury.3.No definite evidence of metastatic disease or new pathologic enhancement.


Instruction: Generate impression based on findings.

Input: Right shoulder pain. ROTATOR CUFF: The muscles and tendons of the rotator cuff are intact.SUPRASPINATUS OUTLET: No fluid is present in the subacromial-subdeltoid bursa. No significant degenerative changes of the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is a wedge-shaped osseous defect within the posterolateral aspect of the humeral head compatible with a Hill-Sachs deformity from prior anterior shoulder dislocation. Mild associated bone marrow edema is present. No additional fractures are identified. The glenohumeral joint cartilage is grossly intact. Branching, linear foci of abnormally increased signal within the posterior labrum (series 9, image 22) is compatible with a multidirectional posterior labral tear. The anterior and superior labrum appear grossly intact.BICEPS TENDON: The long head of the biceps tendon appears intact. ADDITIONAL

Output: 1.Hill-Sachs deformity of the humeral head from prior anterior shoulder dislocation.2.Multidirectional complex tear of the posterior labrum.


Instruction: Generate impression based on findings.

Input: Synovial sarcoma on Pazopanib therapy; assess for progression of disease Brain: There is no intracranial mass or mass effect. No abnormal parenchymal or meningeal enhancement. There are unchanged foci of susceptibility compatible with chronic microhemorrhage or mineralization in the bilateral frontal, left temporal, as well as the right inferior parietal lobule. No evidence of recent infarct or hemorrhage. Ventricles and sulci are within normal limits. There is no midline shift or herniation. The major cerebral flow voids are intact. There is mild scattered paranasal sinus mucosal thickening which again seen, with slight interval increase in anterior ethmoid opacification. There is moderate opacification of the left mastoid air cells and to a lesser degree on the right and slightly increased in the interval on the left.Cervical and Thoracic Spine: Again seen are postoperative findings related to C2-T2 laminoplasty and tumor debulking. Again seen is a residual tumor involving the left-sided neural foramina throughout the cervical and upper thoracic spine. Minimal intraspinal component involving the left lateral epidural space is also again seen and without associated mass effect. Compared to 6/30/2016 there is no significant change in size or appearance of the tumor, again with the enhancement pattern primarily peripheral as opposed to the more solid enhancement appreciated on the earlier study from 3/1/2016. The overall bulkiness of the residual soft tissue is not significantly changed. At the left C3-C4 level, tumor measures approximately 18 x 14 mm, axial T2 image 24 series 1501, which is not changed since prior allowing for slight differences in imaging plane. Again noted is partial encasement of the left vertebral arterySimilar to prior, again seen is patchy heterogeneous marrow replacement throughout the cervical spine and upper thoracic spine, but the vertebral body heights are preserved. There is a kyphotic curvature at the cervico-thoracic junction, but no spondylolisthesis. The spinal canal is significantly narrowed from C5-C7, which is in part attributable to kyphotic curvature, a tight laminoplasty and small posterior disc-osteophyte complexes. No new osseous abnormality, new epidural tumor, or new or enlarging paraspinous soft tissue to suggest disease progression. There is associated mild spinal cord flattening in this region, without definite spinal cord signal abnormality. Please refer to separate report for findings in the chest including small pneumothorax and pulmonary nodules.

Output: 1. No evidence of intracranial metastases. Multiple scattered punctate foci of susceptibility compatible with chronic microhemorrhages and similar to recent prior studies. These are nonspecific and may be related to posttreatment changes but would suggest continued attention on follow-up.2. Compared to 6/30/2016, no significant change in size of the treated residual tumor involving the left-sided neural foramina and paraspinous tissues in the cervical and upper thoracic spine. Noted is however diminished central enhancement of the tumor compared to 3/1/2016 which is favored to represent treatment response. 3. No significant change in patchy marrow signal abnormality involving the cervical and thoracic spine compatible with treated metastases. No new enhancing lesions, pathologic compression fractures, or epidural tumor. 4. There is moderate to severe spinal canal stenosis from C5 to C7 particularly on the left with flattening of the cervical cord. Findings are related to combination of disc osteophyte complex and laminoplasty.5. Please refer to separate chest CT report for findings including small pneumothorax and pulmonary nodules.


Instruction: Generate impression based on findings.

Input: New liver lesion and abnormal LFTs. ABDOMEN:LIVER, BILIARY TRACT: The liver is increased in size from the prior study, now measuring 20 cm in craniocaudal dimension. There are innumerable T1 hyperintense small lesions in both lobes of the liver with associated T2 hypointensity, and mild restricted diffusion. Similar lesions affect the spleen. No biliary ductal dilatation or vascular abnormality.Normally distended gallbladder with a nonspecific gallbladder wall thickening. No cholelithiasis.SPLEEN: Numerous T1 hyperintense small lesions in the spleen.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Interval enlargement of a right cardiophrenic lymph node, now measuring 1.3 x 1.7 cm. Enlarging periportal lymphadenopathy. BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Numerous well-defined T1 weighted intrinsic hyperintense lesions affecting the liver and spleen. Given the history of melanoma these are highly suspicious for diffuse metastatic lesions.Suspected lymph node metastases with short interval increase in size of cardiophrenic and periportal lymphadenopathy.


Instruction: Generate impression based on findings.

Input: Female 53 years old Reason: evaluate for rotator cuff injury History: R shoulder pain status post fall on right side. ROTATOR CUFF: Thickening and increased signal intensity in the supraspinatus tendon indicating moderate tendinosis. Intermediate signal intensity along the undersurface fibers may represent associated undersurface fraying. There are also more discrete subcentimeter linear foci of fluid signal intensity within the distal fibers of the tendon at its insertion, likely representing small interstitial and undersurface tears. There is a small cyst in the underlying greater tuberosity. There is also a cyst along the musculotendinous junction of the supraspinatus more proximally measuring approximately 2.0 cm in long axis. The supraspinatus muscle appears normal. The tendinosis and undersurface fraying extends posteriorly to involve the infraspinatus tendon but the infraspinatus muscle appears normal. The teres minor muscle and tendon appear normal. The subscapularis muscle and tendon appear normal.SUPRASPINATUS OUTLET: Mild osteoarthritis affects the acromioclavicular joint. The shoulder ligaments are intact.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral joint alignment is normal. There is mild osteoarthritis of the glenohumeral joint. There is blunting and signal abnormality in the superior labrum likely reflecting degenerative tearing which extends into the anterior labrum. There is no joint effusion.BICEPS TENDON: The tendon of the long head of the biceps is intact. ADDITIONAL

Output: 1. Rotator cuff tendinosis and partial thickness tears as described above.2. Degenerative arthritic changes of the glenohumeral and acromioclavicular joints.3. Note is made of several prominent axillary lymph nodes.4. Multiple tiny foci of signal within the proximal humeral metadiaphysis are nonspecific and while they may simply represent small residual islands of red marrow we cannot exclude an underlying proliferative disorder.


Instruction: Generate impression based on findings.

Input: 30 years Male (DOB:8/13/1986)Reason: Low back pain, concerning for DJD. History: Low back painPROVIDER/ATTENDING NAME: MINDY ALYCE SCHWARTZ MINDY ALYCE SCHWARTZ Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is disc desiccation and a left lateral broad-based disc protrusion. This disc protrusion encroaches on the left-sided exiting nerve root within the neural foramen.At L4-5 there is no significant compromise to spinal canal or neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: There is a left lateral disc protrusion present at L5-S1 which encroaches on the left-sided exiting nerve root within the left L5-S1 neural foramen (most likely involving left L5 nerve root).


Instruction: Generate impression based on findings.

Input: Reason: TFCC tear after distal radius fx History: pain and popping BONES: There is abnormal signal intensity within the distal radius indicating a comminuted, intra-articular fracture with fragments in near anatomic alignment. The fracture through the tip of the ulnar styloid is better visualized on prior radiographs, but what we suspect is the fracture fragment appears displaced distally by 2 to 3 mm. There is a small ossicle dorsal to the capitate adjacent to the dorsal margin of the lunate, which may reflect old trauma. Mild osteoarthritis affects the scaphotrapezoid articulation.TRIANGULAR FIBROCARTILAGE COMPLEX: Although we see no fluid signal intensity traversing the articular disc of the triangular fibrocartilage complex, there is heterogeneous signal intensity of the medial half of the articular disc and poor definition of the lamina. Furthermore, the medial fibers appear displaced distally along with the ulnar styloid fracture fragment. We suspect that this represents degeneration and edema combined with at least partial-thickness tearing medially, although it is possible that the disc is completely torn at this site with the gap filled with granulation tissue. LIGAMENTS: Linear increased signal intensity separates the membranous portion of the scapholunate ligament from the scaphoid, indicating a tear. We suspect that the dorsal and volar components of the ligament are intact. The lunotriquetral ligament appears intact. TENDONS: Mild increased signal intensity within the extensor carpi ulnaris tendon suggests mild tendinosis. The remaining tendons appear intact.ADDITIONAL

Output: 1. Fracture of the distal radius and tip of the ulnar styloid.2. Although we see no fluid completely traversing the triangular fibrocartilage complex, heterogeneous signal within the medial half of the articular disc and poor definition of the lamina suggests degeneration and edema combined with at least partial-thickness tearing medially, although it is possible that the disc is completely torn at this site with the resultant gap filled with granulation tissue. 3. Other findings as above.


Instruction: Generate impression based on findings.

Input: Clinical question: History of venous malformation years ago, needs reevaluation. Signs and symptoms: Normal exam. Pre-and post-enhanced brain MRI:No diffusion weighted abnormalities.Images through posterior fossa demonstrates a large left cerebellar hemispheric developmental venous anomaly which extensively involve the left cerebellar hemisphere on susceptibility MRI sequence. There is no associated mass effect or parenchymal signal abnormality and in particular no evidence of an associated cavernoma is present. There is expected uniform enhancement of the developmental venous anomaly. On T1-weighted images there are punctate and thin linear T1 hyperintensity along the superior surface of the this in the midline which also demonstrates subsequently signal changes. On post enhanced images there is continued T. of the enhancement of left cerebellar developmental venous anomaly with this finding along the superior surface of the vermis in the midline. The finding could represent calcification and off questionable clinical significance. There are no prior exams for comparison.Images through supratentorial space normal anatomical morphology and with normal signal intensity of brain parenchyma on all MRI sequences. The cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination remains within normal.The signal void of major intracranial arterial branches are identified.The signal intensity of intracranial venous sinuses are normal and with normal pattern of enhancement.Unremarkable images through the orbits and including axial fat sat post enhanced series.Normal pneumatization signal pattern of bilateral mastoid air cells, middle ear cavities and the paranasal sinuses.

Output: 1.Negative diffusion weighted images.2.Left cerebellar hemispheric developmental venous anomaly as detailed. There are no prior exams for comparison.3.Unremarkable pre-and post enhanced brain MRI otherwise.


Instruction: Generate impression based on findings.

Input: Meningioma surveillance. There is no significant change in the enhancing right olfactory groove mass, which measures up to approximately 28 mm. There is mass effect upon the overlying inferior right frontal lobe, but no evidence of vasogenic edema. There are a few unchanged nonspecific scattered foci of T2 hyperintensity in the cerebral white matter, as well as small linear area of encephalomalacia in the right thalamus. There is no evidence of intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There are bilateral lens implants.

Output: 1. No significant change in the right olfactory groove meningioma.2. Chronic lacunar infarct in the right thalamus.


Instruction: Generate impression based on findings.

Input: 63-year-old male with persistent jaundice, hyper conjugated bilirubinemia status post sphincterotomy and stenting ABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis. Common bile duct stent is present. There are small foci of signal void within the common bile duct, which may reflect foci of gas while others may represent a small stone, particularly in the distal CBD. There is mild intrahepatic biliary duct dilatation. Mild enhancement of the extrahepatic biliary system may be related to recent procedure versus cholangitis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right T2 hyperintense renal cyst. No hydronephrosis or perinephric inflammation bilaterally.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Small foci of signal void within the common bile duct may reflect foci of gas while others may represent a small stone, particularly in the distal CBD. There is mild intrahepatic biliary duct dilatation. 2.Mild enhancement of the extrahepatic biliary system may be related to recent procedure (stent placement and sphincterotomy) versus cholangitis.


Instruction: Generate impression based on findings.

Input: 66-year-old male with history of IPMN. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: There are multiple T2 hyperintense nonenhancing foci within the pancreas compatible with sidebranch IPMNs. The largest within the pancreatic head measures 1.3 x 0.8 cm (series 5, image 34), unchanged. Pancreatic duct is normal in caliber.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small hiatal hernia. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Multiple side branch IPMNs with the largest in the head of the pancreas.


Instruction: Generate impression based on findings.

Input: Female, 43 years old, with ataxia. Evaluate for acoustic neuroma or malignancy, evaluate for stroke. The cerebral and cerebellar hemispheres and brainstem show normal signal intensity and morphology. No restricted diffusion is seen. No evidence of parenchymal edema, mass, or mass effect is seen. There is no evidence of intracranial hemorrhage or abnormal extra-axial fluid. The ventricular system is normal in caliber and morphology. No pathologic parenchymal or extra-axial enhancement is observed. A developmental venous anomaly seen in the left temporal lobe.Cranial nerves VII and VIII demonstrate normal morphology. No pathologic CP angle or IAC enhancement is observed. No masslike lesions are detected. The fluid-filled structures of the temporal bones demonstrate normal morphology.

Output: Unremarkable evaluation of the brain and IACs with no specific findings to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: Elevated fecal calprotectin with history of regional enteritis. Evaluate for acute small bowel formation. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology, signal intensity and size without intra or extrahepatic biliary ductal dilatation. No focal lesion. Status post cholecystectomy.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: The bowel is adequately distended with oral contrast. There appears to be fecal material in the terminal ileum suggesting stasis. The bowel fold pattern is unremarkable. The bowel is normal in caliber without evidence of obstruction, a fixed stricture or associated poststenotic dilatation.There is mild enhancement, bowel wall thickening and restricted diffusion of approximately 5 cm of the terminal ileum. Very mild adjacent mesenteric inflammatory changes are noted. No specific findings of sinus tract or fistula formation. No fibrofatty proliferation.No significant free or loculated fluid collection.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The bowel is adequately distended with oral contrast. There appears to be fecal material in the terminal ileum suggesting stasis. The bowel fold pattern is unremarkable. The bowel is normal in caliber without evidence of obstruction, a fixed stricture or associated poststenotic dilatation.There is mild enhancement, bowel wall thickening and restricted diffusion of approximately 5 cm of the terminal ileum. Very mild adjacent mesenteric inflammatory changes are noted. No specific findings of sinus tract or fistula formation. No fibrofatty proliferation.No significant free or loculated fluid collection.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Mild active inflammation of approximately 5 cm of the terminal ileum without a fixed stricture/obstruction, fluid collection or specific findings of significant sinus/fistula formation. There is fecal material in the terminal ileum suggesting stasis.


Instruction: Generate impression based on findings.

Input: Again seen are postsurgical changes of resection of previous seen enhancing extra-axial mass at the right cerebellopontine angle via retrosigmoid approach. There is no abnormal enhancement to suggest residual or recurrent tumor. There is decrease in soft tissue enhancement at the craniectomy site without discrete fluid collections.The bilateral internal auditory canals are symmetrical and normal in size and signal intensity. The inner ears are normal, with normal T2 signal and no pathological enhancement. No abnormal mass or abnormal enhancement is seen within the cerebellopontine angle cisterns bilaterally or within the internal auditory canals. Limited evaluation of the remainder of the brain parenchyma demonstrates no evidence of intracranial mass effect, herniation, or hydrocephalus.

Output: Postsurgical changes of resection of right cerebellopontine angle meningioma without evidence of residual or recurrent tumor. There is decrease in soft tissue enhancement at the right lateral occipital craniectomy site compatible with granulation tissue.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate etiology of low back pain. Signs and symptoms: Low back pain. Nonenhanced lumbar MRI:Lower most visualized thoracic spine demonstrate asymmetric right ligamentum flavum hypertrophy at T10 level without resultant spinal stenosis or neural foraminal compromise. Normal signal intensity and caliber of the visualized thoracic cord.T12-L1 is unremarkable.L1-L2 demonstrate mild disc disease and mild to moderate bilateral ligamentum flavum hypertrophy and mild facet disease without spinal stenosis or neural foraminal compromise.L2-L3 demonstrate moderate disc disease and loss of disc height tiny left paramedian disc protrusion with subtle indentation of thecal sac, mild to moderate bilateral ligamentum flavum hypertrophy and mild facet disease. No spinal stenosis or neural foraminal compromise.L3-L4 demonstrate moderate disc disease and loss of disc height, mild grade 1 anterolisthesis, moderate to severe bilateral ligamentum flavum hypertrophy and mild facet disease. There is a right lateral and far lateral broad-based disc protrusion with resultant right lateral recess compromise. Degenerative changes also results in moderate right neural foraminal compromise.L4-L5 demonstrate advanced disc disease and loss of disc height, moderate to severe bilateral ligamentum flavum hypertrophy, moderate left and mild right facet hypertrophic changes and including mild left facet widening and effusion and a tiny suspected left sided synovial cyst projecting into the left neural foramina (sagittal T2/T2 STIR images 3 and 4 and axial T2 series 601 image 9). There is a central disc protrusion present. Constellation of changes results in mild central spinal stenosis, significant left and moderate to significant right neural foraminal compromise.L5-S1 demonstrate mild disc disease and loss of disc height, moderate bilateral ligamentum flavum hypertrophy and mild facet disease/hypertrophy (left greater than right). Constellation of findings results in significant left and moderate right neural foraminal compromise without central spinal stenosis.Incidental note is made of fatty deposit within the filum terminale along its inferior segment at L5 level. There is however normal termination of the cord at lower L1 level.

Output: 1.Degenerative changes at L3-L4 and including a right lateral and far lateral disc protrusion results in mild grade 1 anterolisthesis, moderate right neural foraminal and right lateral recess compromise and no central spinal stenosis.2.Advanced degenerative changes at L4-L5 results in mild central spinal stenosis and significant left and moderate right neural foraminal compromise. Please see above detailed report.3.Degenerative changes at L5-S1 level with resultant significant left and moderate right neural foraminal compromise without central spinal stenosis.4.Fatty density of the lower filum terminale at the L5 level however with normal termination of the cord at lower L1 level.5.Please see detailed report per level above.


Instruction: Generate impression based on findings.

Input: Neck pain sports for months. There is slight reversal of the cervical lordosis in the sagittal plane, but no spondylolisthesis. 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. The spinal cord displays normal signal and morphology. The cervical flow voids are grossly intact. The paravertebral soft tissues are unremarkable.

Output: No significant spinal canal or neural foraminal stenosis.


Instruction: Generate impression based on findings.

Input: status migranosus There is no evidence of acute ischemic or hemorrhagic lesion on this scan.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal. Acom artery and bilateral Pcom arteries are patent.The distal right vertebral artery appears to be hypoplastic. No intracranial aneurysm. No intracranial arterial luminal significant stenosis.3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The vertebral artery origins are normal. There is normal flow enhancement through the bilateral common carotid, carotid bifurcations, internal/external carotid, and vertebral arteries. 3D MRV brain post-gadolinium with maximum intensity projections of the superficial/deep intracranial venous drainage demonstrate normal flow enhancement in the superior sagittal sinus, internal cerebral veins, vein of Galen and straight sinus.The left transverse sinus appears to be hypoplastic and the left sigmoid sinus is also smaller than that of the right side. On T2 coronal scan, the left transverse sinus shows high signal intensity and those show some enhancement on Gad, thus indicating age indeterminate thrombus or very slow flow. Considering there is no MR evidence of venous congestive encephalopathy, this lesion is likely represent subclinical and no clinical significance.There are some filling defects within the right transverse and sigmoid sinuses, however, the forward flow appears to be well maintained. Thus those can represent prominent arachnoid granulation or flow related artifacts.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion on this scan.2. Normal intracranial and extracranial arterial system.3. Hypoplastic left transverse and sigmoid sinuses, otherwise unremarkable brain MRV.


Instruction: Generate impression based on findings.

Input: 55-year-old female with recently diagnosed right breast cancer (IDC with DCIS), staging evaluation. There is heterogeneous amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.RIGHT BREAST:There is a 10 x 8 x 11 mm (AP X ML X CC) area of non mass enhancement at the 3:00 position, middle depth, consistent with biopsy-proven breast cancer. There are postprocedural findings related to recent biopsy, including associated clip artifact and biopsy tract. The mass resides approximately 4 mm from the skin. There is an additional focus of enhancement located 14 mm posterolateral to the mass. The total extent of the non mass enhancement, and additional enhancing focus is approximately 2.6 cm.LEFT BREAST:No abnormal enhancement is seen in the left breast. AXILLAE:No abnormal axillary lymph nodes are identified in either axillary region.

Output: Biopsy tract and 11 mm non-mass enhancement consistent with biopsy-proven breast cancer at the 3:00 position of the right breast. Additional enhancing focus approximately 14 mm posterolateral to the index cancer is noted. If breast conservation therapy is planned, generous excision posterior and lateral to the mass is suggested; otherwise, MR guided biopsy can be considered for definitive diagnosis.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Ms. Pool is a 35 -year-old female with a family history of breast cancer in her mother (diagnosed at the age of 42) and paternal grandmother (diagnosed in her late 50s). There is scattered fibroglandular tissue in both breasts. Minimal background parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Pituitary cyst surveillance. There is no significant interval change in the nonenhancing low T1 and high T2 signal lesion centered in the left posterior pituitary that measures up to approximately 5 mm. The infundibulum and posterior pituitary bright spot is intact. There is no mass effect upon the optic apparatus. The cavernous sinuses area intact.

Output: No significant interval change in the cystic lesion centered in the left posterior pituitary that measures up to approximately 5 mm.


Instruction: Generate impression based on findings.

Input: Female, 52 years old, with breast cancer. Heterogeneous T2 hyperintensity with patchy enhancement is again seen within the left aspect of the L5 vertebral body extending into the left pedicle. The overall appearance and extent of this lesion appear similar to the prior examination. Also unchanged is superior endplate collapse along the left aspect of the L5 vertebral body. No significant retropulsion into the spinal canal is seen.No concerning marrow lesions are seen elsewhere to suggest progressive metastatic spread. Diffuse fatty replacement in the marrow of L4, L5 and the sacrum likely represents radiation effect. The remaining visualized vertebral bodies show a mildly heterogeneous but benign pattern of signal intensity.No evidence of any epidural disease extension is seen. The distal spinal cord, conus and nerve roots of cauda equina are within normal limits. No pathologic intrathecal enhancement is detected.Spinal alignment is anatomic. No evidence of any significant degenerative disk disease, spinal canal stenosis or neuroforaminal narrowing.

Output: Redemonstration of a presumed metastatic lesion within the L5 vertebral body with no significant interval change from the prior examination.No evidence to suggest new or progressive metastatic disease is seen.


Instruction: Generate impression based on findings.

Input: Right knee pain. Evaluate for meniscal injury. There is susceptibility artifact from an intramedullary rod and anchoring within the femur extending to the metaphysis and limiting evaluation in this area.MENISCI: There is blunting of the free edge of the medial meniscus which otherwise appears intact. Globular high T2 signal within the anterior horn of the lateral meniscus which does not extend to the articular surface and is compatible with intrasubstance degeneration. There is branching linear signal within the posterior horn and body of the lateral meniscus which likely represents a combination of prior tear, postsurgical change and degeneration. There is no evidence of acute, new tear however, there is increasing extrusion of the lateral meniscus.ARTICULAR CARTILAGE AND BONE: The articular cartilage in the medial compartment is thinned and there is full-thickness loss along the anterior aspect of the femoral condyle spanning an AP image of 9 mm (series 1, image 9).Full thickness cartilage degeneration is seen along the posterior aspect of the lateral femoral condyle and has progressed since the previous exam. There is a fissure along the weightbearing of the lateral femoral condyle surface with delamination extending over an AP dimension of 7 mm and underlying reactive marrow change.Cartilage degeneration has progressed in the patellofemoral compartment where there is mild fraying of the patellar cartilage but full thickness degeneration along the femoral trochlea.No acute fracture. There are post surgical changes from prior anterior cruciate ligament reconstruction.LIGAMENTS: Status post anterior cruciate ligament reconstruction. There is linear high T2 signal within the ACL graft fibers near its tibial attachment which raises question of a small split tear however the graft otherwise appears intact. The posterior cruciate and medial collateral ligaments are intact. The fibular collateral ligament appears mildly redundant without evidence of discrete tear or acute abnormality.EXTENSOR MECHANISM: The extensor mechanism is intact. There is a small amount of nonspecific prepatellar edema.ADDITIONAL

Output: 1.Branching linear signal within the posterior horn and body of the lateral meniscus likely represents a combination of prior tear, postsurgical change and degeneration. There is increased extrusion of the lateral meniscus but no evidence of new, acute tear.2.Progression of cartilage degeneration with full-thickness loss over the lateral femoral condyle and femoral trochlea.3.Intact ACL graft.4.Small joint effusion with synovitis.


Instruction: Generate impression based on findings.

Input: Crohn's disease. Evaluate for abscess. PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Left internal iliac lymph node measures 0.9 x 0.6 cm. Small bilateral inguinal lymph nodes.BOWEL, MESENTERY: A right lower quadrant ileostomy is again identified. Patient is status post total colectomy. Prominent mesenteric fat is again identified.BONES, SOFT TISSUES: The previously identified left piriformis abscess has resolved. There is increased T2 hyperintensity along the left sacroiliac joint and ilioischial recess, probably sacroiliitis. No drainable collection is identified. There is a focal area of enhancement within the left obturator externus measuring 1.4 x 1.2 cm (series 1201, image 83), decreased from prior. There is underlying left ischial bone marrow changes.OTHER: No significant abnormality noted.

Output: 1.Interval resolution of left piriformis abscess. 2.Increased T2 hyperintensity along the sacroiliac joint, probably sacroiliitis.3.Decreased left obturator externus collection.


Instruction: Generate impression based on findings.

Input: 53-year-old female with pain and numbness, evaluate for ganglion LIGAMENTS: Within the limits of a non-arthrographic examination the intrinsic ligaments appear unremarkable.TRIANGULAR FIBROCARTILAGE COMPLEX: No significant abnormality noted.TENDONS: The extensor and flexor tendons are within normal limits BONES: Bone marrow signal is within normal limits. Small cysts are noted within scattered carpal bones.ADDITIONAL

Output: 1. Ganglion cyst extending from the radioscaphoid articulation as described above.2. Small lipoma adjacent to the flexor carpi ulnaris tendon.


Instruction: Generate impression based on findings.

Input: Headache(784.0) [784.0] / Other conditions of brain(348.89) [348.89] / Malignant neoplasm of colon, unspecified site [153.9], Reason for Study: ^Reason: assess posterior fossa resection History: Brain tumor, HA There is evidence of suboccipital midline craniectomy.Previously shown the acromion intra-axial mass has been resected. There is no evidence of residual mass except minimal enhancement of the margin of resection cavity which likely represent post surgical excision reactive enhancement instead of residual mass.There are local minimal scattered postoperative blood products with minimal edema indicating post operative status. Comparing to previous of MRI, surrounding edema on bilateral cerebellar hemisphere and left middle cerebral peduncle appears to be decreased on the scan.There is also irregular shaped low signal intensity on T1 and T2 weighted image with susceptibility artifacts on the resection cavity which likely represent postoperative local block products but could also be associated air.Ventricular system remains normal size without evidence of ventriculomegaly.There is no evidence of acute ischemic or hemorrhagic lesion except surgical bed minimal blood products.The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Post midline suboccipital craniectomy status with near total or total removal of superior paramedian intra-axial mass. Minimal local blood products are likely related to surgery.2. Irregular shaped low signal intensity lesion on anterior superior aspect of resection cavity indicating local blood products and or associated introduced air.3. No evidence of acute ischemic or hemorrhagic lesion except resection area blood products.4. Minimal enhancement of margin of the resection cavity likely represent reactive enhancement.


Instruction: Generate impression based on findings.

Input: Two weeks of left frontal head ache, one week of right upper extremity weakness and one day of aphasia and mild cognitive problem. Left frontal hypodensity, hydrocephalus, and temporal atrophy. Multifocal areas of restricted diffusion are noted in the left frontal lobe, left medial basal ganglia, left precentral gyrus, and left posterior parietal region indicating acute ischemic infarcts. The largest region of infarct is along the left frontal lobe cortex. There is some degree of sulcal effacement along the left frontal lobe. However, there is no midline shift or herniation. There is additional patchy periventricular and subcortical white matter signal abnormality indicating superimposed small vessel ischemic disease. There is no evidence of intracranial hemorrhage or abnormal intracranial enhancement. The ventricles are non-enlarged. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1.Multifocal areas of restricted diffusion compatible with acute infarct greatest in the left frontal lobe but also smaller infarcts in the basal ganglia and left parietal regions.2.No evidence of intracranial hemorrhage, midline shift or herniation. 3.Superimposed chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: Ms. Kurowski is a 53 year old female with a strong family history of breast cancer including in her mother, sister, maternal aunt and maternal grandmother. She presents today for MR evaluation for high risk screening. There is heterogeneous amount of fibroglandular tissue in both breasts. Mild background parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. Multiple simple and complicated cysts are seen bilaterally, the largest one of which is located in the left lower outer breast, measuring up to 1.5 cm. No abnormal lymph nodes are identified in either axillary or internal mammary region.

Output: Bilateral simple and complicated cysts of varying sizes. No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Routine Screening Mammogram.


Instruction: Generate impression based on findings.

Input: Female, 67 years old, with visual and auditory hallucinations. History of recurrent granulosa cell tumor of the ovary. Image quality is degraded by motion artifact. In addition, the examination was obtained without contrast at patient request. Within these limitations, no evidence of any significant parenchymal edema or mass effect is observed. No restricted diffusion is seen. There are numerous scattered foci of white matter T2 hyperintensity in both cerebral hemispheres, particularly in the periatrial regions, and in the left cerebellum. These findings have progressed mildly when compared to a prior examination from 2007. No acute intracranial hemorrhage or any abnormal extra axial fluid collection is seen. The ventricles are normal in size and morphology.

Output: Within the limitations of a motion degraded and noncontrast examination, no definite evidence of any acute intracranial process is seen. Moderately extensive scattered white matter lesions are redemonstrated with mild progression noted when compared to the prior examination 2007. These are favored to represent the sequelae of chronic microvascular ischemic disease, though other chronic etiologies could be in play. If clinical concern for encephalitis persists, repeat imaging in one to two weeks may be considered with contrast to improve imaging sensitivity.


Instruction: Generate impression based on findings.

Input: 57-year-old male with ulcer dorsal to the calcaneus. Evaluate for osteomyelitis. TENDONS: Mild thickening of the peroneus brevis tendon is compatible with tendinosis. Convex bulging appearance of the distal Achilles tendon is also compatible with tendinosis. The remaining flexor and extensor tendons are within normal limits.LIGAMENTS: No significant abnormality noted.ARTICULAR SURFACES AND BONE: There is a deep ulcer in the soft tissues dorsal to the calcaneus, with erosion of the underlying calcaneal cortex measuring approximately 1.5 cm in length. Just deep to the eroded cortex there is decreased T1 and increased T2/STIR signal within the posteromedial aspect of the calcaneus, compatible with osteomyelitis. No drainable abscess is identified.ADDITIONAL

Output: 1.Deep ulcer within the posterior soft tissues of the foot with osteomyelitis of the underlying posteromedial calcaneus. No drainable abscess identified.2.Peroneus brevis and Achilles tendinosis.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate intracranial process. Signs and symptoms: Weakness Non-enhanced CT brain:The examination demonstrates an extra-axial high density mass in the basal cistern measuring approximately 13.8 mm x 14.5-mm on sagittal reformatted image 26. On axial image 7 this mass measured 8 mm in the AP axis and 12.5 mm in transverse axis. The mass is in contact with dorsum sella and minimal apparent extension into the sella. The appearance of the lesion is suggestive of a meningioma considering its location and density on CT. Other differential diagnosis of pituitary macroadenoma, craniopharyngioma and very less likely aneurysm should be considered. This finding requires further dedicated MRI examination of pituitary region for better evaluation. This finding is not associated with any associated adjacent brain parenchyma abnormality.There is no evidence of intracranial hemorrhage, edema, mass effect or midline shift.There are small foci of low attenuation in the subcortical white matter of bilateral cerebral hemispheres which are nonspecific however it could represent minimal small vessel disease. The cortical sulci and ventricular system are more pronounced than is expected for patient's stated age of 69. Similar observation of the folia of the cerebellum is also made.Calvarium is intact. Mastoid air cells, middle ear cavities and visualized paranasal sinuses are unremarkable.

Output: 1.No evidence of acute intracranial finding.2.Minimal small vessel disease of indeterminate age.3.Well demarcated high-density mass in the basal cistern with minimal extension into the sella as described. Differential diagnosis of meningioma, craniopharyngioma, pituitary macroadenoma should be considered. Follow-up with a dedicated MRI of pituitary region is recommended.


Instruction: Generate impression based on findings.

Input: Reason: 65 year old female with enlarged left axillary lymph nodes on prior MRI of left shoulder and on ultrasound. Evaluate for LAD in the left axilla. PLEASE COMPARE TO PRIOR MRI. History: Left shoulder pain.. ROTATOR CUFF: Again seen is moderate tendinosis of the supraspinatus tendon. Previously seen partial thickness articular surface tear at the foot plate measuring approximately 8 mm in AP dimension has increased and is now full thickness. No retraction.The infraspinatus and teres minor tendons are intact. Mild tendinosis affects the subscapularis tendon, not significantly changed.No muscle atrophy or edema.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: Again seen is linear branching T2 signal involving the superior labrum at and posterior to the biceps anchor suggestive of a degenerative type labral tear. BICEPS TENDON: The biceps tendon is intact. Again seen is T1/T2 hypointense foci at the level of the biceps anchor likely representing small calcifications.ADDITIONAL

Output: 1.Stable left subpectoral and axillary lymph nodes. 2.Interval increase in supraspinatus tearing, now full thickness, with associated small amount of fluid in the subacromial-subdeltoid bursa. No retraction.