Instruction: Generate impression based on findings.

Input: 76-year-old female with acute ischemic stroke on heparin. Evaluate for worsening hemorrhagic conversion. Subacute infarcts in left and right occipital lobes are reidentified, appearing similar to prior study without evidence of hemorrhagic conversion. Patchy areas of low attenuation in the periventricular and subcortical white matter bilaterally, including the acute infarcts seen on prior MRI brain, are unchanged on comparison to most recent CT head.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses are normally pneumatized. Opacification of the mastoid air cells, which was seen on prior exam.

Output: Stable bilateral occipital subacute strokes without evidence of acute hemorrhage.


Instruction: Generate impression based on findings.

Input: Female, 59 years old, syrinx, history of tethering and spina bifida Extensive postoperative findings are again seen in the lumbar spine related to lipomyelomeningocele repair and cord detethering. Mild syringohydromyelia of the distal spinal cord spanning from approximately T12 to L2 is unchanged in caliber and extent. At its widest point it measures approximately 5 x 3 mm. Cord parenchymal volume loss is also noted.The distal spinal cord remains closely apposed to the posterior aspect of the spinal canal. No change in distal cord position is seen on prone imaging although there is ventral motion of the lower thoracic cord.The distal lumbar spinal canal is ectatic with septations in the thecal sac as seen before. Partial nonsegmentation of the posterior aspects of the L4 and L5 vertebral bodies is again seen. Dysplastic posterior elements again seen.There is prominence of the thoracic kyphosis and lumbar lordosis which can be better assessed with standing radiographs. Vertebral body heights are preserved. No marrow replacement or marrow edema is detected. Again seen are mild multilevel degenerative changes. There is a new disc extrusion at the T10-T11 level with partial effacement of the ventral thecal sac, but no significant stenosis overall at this level. Small left paracentral disc extrusion at T12-L1 and small protrusion at T11-T12 not significantly changed.Again seen is marked fatty atrophy of the lower lumbar paraspinal musculature. Small left renal cysts again seen.

Output: 1. Postoperative changes related to lipomyelomeningocele repair and cord untethering. There is no significant change in small syrinx involving the distal spinal cord. No significant change in position of the distal cord which does not demonstrate ventral motion on the prone sequence and may represent re-tethering in the appropriate clinical setting. Distal thoracic cord does demonstrate ventral motion on the prone sequences.2. Mild multilevel degenerative changes are again seen with a new T10-T11 disc extrusion without significant mass effect


Instruction: Generate impression based on findings.

Input: Female, 42 years old, with breast cancer and worsening nausea, evaluate for brain metastases. A 6 mm enhancing nodule is evident along the superior surface of the left cerebellum with minimal associated parenchymal edema. No definite additional lesions are seen. No significant generalized mass effect is detected. A few scattered small foci of white matter T2 hyperintensity are nonspecific. No evidence of intracranial hemorrhage or any abnormal extra-axial fluid collection is seen. The ventricles are within normal limits. Bone marrow signal characteristics are unremarkable.

Output: A single 6 mm lesion is evident along the superior surface of the left cerebellum compatible with metastatic disease.


Instruction: Generate impression based on findings.

Input: New onset left retro-orbital headaches. Brain MRI: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are scattered foci of T2 hyperintensity in the cerebral white matter. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull and scalp soft tissues are grossly unremarkable. There is a small left maxillary sinus retention cyst.Brain MRA: The bilateral opthalmic arteries are not very well-delineated, likely due to technical factors. Otherwise, there is no evidence of significant steno-occlusive lesions or cerebral aneurysms.Orbits MRI: There are bilateral lens implants. Otherwise, the bilateral globes, optic nerves, lacrimal glands, extraocular muscles, and orbital fat are unremarkable. There is no evidence of intraorbital mass lesions.

Output: 1. Scattered foci of T2 hyperintensity in the cerebral white matter are nonspecific, but may represent chronic small vessel ischemic disease. Otherwise, no evidence of acute intracranial hemorrhage, mass, or acute infarct.2. The bilateral opthalmic arteries are not very well-delineated, likely due to technical factors. Otherwise, no evidence of significant steno-occlusive lesions or cerebral aneurysms.3. No evidence of intraorbital tumors.


Instruction: Generate impression based on findings.

Input: 25-year-old female status post multilevel thoracic laminectomy and resection of 2 large dorsolateral meningiomas, along with pedicle screw fixation fusion in 2012. The patient is now experiencing back pain. Redemonstrated are changes from previous thoracic spine surgery with pedicle screw placement of a right-sided T8, T9, T11 and T12 an interconnecting rod as well as laminectomies at T8 through T10.Redemonstrated is an extra-axial mass located at a T6-7 vertebral body level along the right posterior lateral aspect of the spinal canal which measures5 x 8 mm axial dimensions and 14 mm in length (previously 5 x 8 mm axial dimensions and 12 mm in length) minimally changed in craniocaudal direction. As before, there is no associated cord abutment or compression.Redemonstrated is a small focus of dural thickening is located along the left lateral thecal sac at the T9/10 level measuring 5 x 3 mm in axial plane, difficult to measure in the sagittal plane given its small size. This finding is unchanged.Redemonstrated is a third tiny focus of dural thickening is located along the left anterolateral thecal sac at the T10 level measuring 4 x 2.5 mm in axial plane, difficult to measure in the sagittal plane given its tiny size. This finding is unchanged.A previously demonstrated subtle cord morphology change at the T10/11 approximate level (best seen sagittal T2 series 1101 image 8 and axial T2 series 801 image 11) is unchanged. This appears as a subtle flattening of the anterior cord although there is no discernible lesion or focus of enhancement to account for this, specifically there are no MR evident membranes to suggest formation of an arachnoid cyst or other postprocedural septation. This is of uncertain etiology or significance.Focal T2 hyperintensity within the spinal cord at T10 with associated loss of spinal cord volume is again noted and not significant changedThe thoracic vertebral bodies are appropriate in the overall alignment and height. There is no compromise of thoracic spinal canal or exiting nerve roots.

Output: 1.No change in the size of the extra-axial mass presumably representing meningioma at the T6-7 level.2.No change of a small focus of dural thickening is located along the left lateral thecal sac at the T9/10 level.3.No change of a third tiny focus of dural thickening is located along the left anterolateral thecal sac measuring 4 x 2.5 mm in axial plane4.No change of T2 signal hyperintensity within the spinal cord associated with cord atrophy and at the prior locations of the patient's tumor presumably representing myelomalacia.


Instruction: Generate impression based on findings.

Input: Diagnosis: Chronic migraine without aura, with intractable migraine, so stated, without mention of status migrainosusClinical question: intractable headacheSigns and Symptoms: intractable headache The CSF spaces are appropriate for the patient's stated age with no midline shift. No foci of diffusion restriction are appreciated.There is a subtle 3 mm T2 hyperintense focus within the center of the pons which is associated with some mild contrast enhancement which measures approximately 5 mm x 4 mm in axial dimensions. It is slightly eccentric towards the left side. It is low signal on susceptibility weighted imaging.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.Incidental note is made of congenital fusion of C2 and C3.

Output: 1.There is a small pontine lesion present which is nonspecific. One possibility is that this represents capillary telangiectasia.2.There is no evidence for intracranial mass lesion.


Instruction: Generate impression based on findings.

Input: History of relapsing polychondritis, limbic encephalitis, and left posterior scleritis. Evaluate for structural lesions Brain: There is mild increased T2/FLAIR signal in the hippocampi and bilateral medial and anterior temporal lobes which is less prominent than on the initial exam from 5/10/2014. There is no associated hemorrhage and the volume of the temporal lobe structures is unchanged.There is no intracranial mass or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There are patchy areas of mucosal thickening within the ethmoid air cells. The skull and scalp soft tissues are grossly unremarkable.Orbits: The exam is limited by motion artifact.There is mild thickening of the posterior scleral wall with increased T2 signal and mild enhancement in the mid to lateral retrobulbar fat on the left. The optic nerves are normal in size and signal intensity and are symmetric bilaterally. The extraocular muscles appear normal. No retrobulbar mass, chiasmatic mass, or parasellar abnormality is seen.

Output: 1.Mild residual T2/FLAIR signal in the bilateral temporal lobes is slightly less prominent then on the initial exam from 5/10/2014.2.Mild thickening and enhancement of the posterior left sclera and retrobulbar fat is nonspecific but compatible with the history of recent posterior scleritis.


Instruction: Generate impression based on findings.

Input: History of bladder cancer with metastasis to L2 and trauma presents with pain. The vertebral bodies are appropriate in the overall alignment and height. The spinal cord has grossly normal signal characteristics and overall morphology. There is no frank cord compression or high-grade spinal canal stenosis. There is reversal of cervical lordosis with moderate degenerative changes in the cervical spine including multilevel disc desiccation and loss of disc height at several levels. No evidence of high-grade spinal canal stenosis in the cervical or thoracic region.There is kyphotic angulation centered at L2 with retrolisthesis of L2 over L3. There is degenerative changes with endplate irregularity and marrow signal changes involving the L2 and L3 vertebral bodies. There is severe loss of L2-L3 disc space. In addition there is T1 hypointense lesion along the posterior superior aspect of L2 vertebral body with soft tissue extending to the ventral epidural space., There is mild to moderate spinal canal stenosis at this level.Again seen partially visualized bladder tumor and bladder diverticula, better seen on prior CT dated 3/16/2016.

Output: 1. This is a limited exam specific for the exclusion of cord compression only and does not exclude more subtle lesions such as intrinsic cord abnormalities. No frank cord compression is identified. Due to the screening nature of this protocol details are not as evident on imaging as dedicated protocols of the spine.2. Likely metastatic lesion involving the posterior superior L2 vertebral body with suggestion of mild epidural extension. There is mild to moderate spinal canal stenosis suspected at this level. Suggest dedicated lumbar spine MRI with gadolinium for further evaluation.3. Partially imaged known bladder carcinoma and bladder diverticula, better seen on prior cross-sectional imaging.4. Degenerative changes in the cervical and lumbar spine without high-grade spinal canal stenosis.


Instruction: Generate impression based on findings.

Input: 31-year-old male with pain. Evaluate PD tendon ring finger for adhesion versus re-rupture. The patient returned for additional sequences in an attempt to better depict the flexor apparatus of the ring finger.There is intermediate signal intensity of the flexor digitorum profundus at the level of the head/neck of the middle phalanx, which may reflect degeneration or the sequela of prior tear and surgery, but we see no frank gap within the tendon to indicate re-rupture. There is low signal intensity material adjacent to the flexor digitorum profundus tendon distally, likely representing scar tissue. The radial slip of the flexor digitorum superficialis tendon can be traced to its insertion on the middle phalanx. The ulnar slip appears to be disrupted, but we suspect this is surgical in etiology based on the patient's operative report. There is slightly increased distance between the flexor apparatus and the proximal phalanx. The A2 pulley is stretched and of high signal intensity, but appears grossly intact.

Output: Low to intermediate signal within the flexor digitorum profundus tendon presumably representing scarring. We see no specific findings to suggest re-rupture. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Ms. Spearson is a 50 year old female with a family history of breast cancer in her mother, diagnosed at the age of 49. Personal history of left breast excisional biopsy in 2009 for benign papilloma. Breast cancer screening MRI performed on study irb 13073b There is heterogeneous amount of fibroglandular tissue in both breasts. Moderate parenchymal enhancement is noted bilaterally, with stable nodular symmetric pattern. There are multiple foci of enhancement, unchanged. No new suspicious enhancing foci or lesions are identified. No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary or internal mammary region.

Output: No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Routine Screening Mammogram.


Instruction: Generate impression based on findings.

Input: Evaluate for leptomeningeal diseaseSigns and Symptoms: met breast cancer There is a hyperintense sulcal signal identified on FLAIR MR images located along the high convexities of the left frontal lobe at the posterior aspect of the superior frontal sulcus, the left central sulcus and the sulci of the left parietal lobe as well as some of the right central sulcus and right medial parietal lobe. Postcontrast imaging indicates that there is a mild degree of leptomeningeal enhancement associated with this. There is also some associated gyral signal hyperintensity on FLAIR and T2 MR images along the left parietal lobe.There is redemonstration of ventriculomegaly associated with mild periventricular signal hyperintensity on T2 and FLAIR MR height.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.There is leptomeningeal disease present. Although this is a nonspecific finding, in the context of breast cancer this is concerning for carcinomatosis.2.There is ventriculomegaly present. There is associated periventricular signal hyperintensity. The possibility of hydrocephalus cannot be excluded Please correlate with patient's clinical symptoms3.Periventricular and subcortical white matter signal changes of a mild degree are present which are nonspecific. They could be vascular related, related to demyelination, trauma, vasculitis, sarcoid. They are nonspecific.


Instruction: Generate impression based on findings.

Input: Reason: 26yo male with Crohn's ileitis. Assess disease activity History: constipation ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: Small non-specific T2 hyperintense splenic structure unchanged and likely benign.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: There is an approximately 7 cm long segment of abnormal asymmetric bowel wall thickening involving the terminal ileum (series 4, image 20) with saccular dilation on the antimesenteric border, increased mucosal enhancement, and mild upstream bowel dilation appearing similar to the prior examination and compatible with chronic inflammatory changes of Crohn's disease. No associated high-grade bowel obstruction. No definite additional areas of involved bowel. No associated ascites or evidence of fistulous connection.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Chronic inflammatory changes involving the terminal ileum appearing similar to prior without definite evidence of additional bowel involvement or complication.


Instruction: Generate impression based on findings.

Input: Breast cancer and C3-C4 autofusion (Klippel-Feil?): right upper extremity pain and tingling sensation, with decreased strength throughout. There are multiple Multiple unchanged congenital anomalies of the cervical spine, including incomplete fusion of the posterior elements of C1, a C4 butterfly-type vertebra fused with the C3 vertebral body, and dysplasia of the C5 posterior elements. There is no significant spondylolisthesis. There is also multilevel degenerative spondylosis. At C2/3, ligamentum flavum thickening and facet arthropathy result in mild to moderate left foraminal narrowing with mild bilateral neural foraminal narrowing, but no significant spinal canal stenosis. At C3/4, there is mild to moderate narrowing of the bilateral neural foramina, but no significant spinal canal stenosis. At C4/5, there is bilateral mild to moderate foraminal narrowing. At C5/6, a disc-osteophyte complex results in severe narrowing of the right neural foramen and moderate narrowing of the left neural foramen, as well as mild right paracentral narrowing of the spinal canal. At C6/7, a disc-osteophyte complex, ligamentum flavum thickening, and facet arthropathy result in moderate narrowing of the spinal canal, as well as severe bilateral neural foraminal narrowing. Aside from degenerative signal alterations, the vertebral bone marrow signal appears unremarkable. The spinal cord appears unremarkable. There is no evidence of mass lesions in the cervical spine. The paraspinal soft tissues are unremarkable.

Output: 1. Multiple congenital segmentation anomalies in the cervical spine and degenerative spondylosis that is most pronounced at the C5/6 and C6/7 levels.2. No evidence of metastases in the cervical spine.


Instruction: Generate impression based on findings.

Input: 56-year-old male. + HCC on last imaging, but size < 2 cm. Evaluate size of HCC. ABDOMEN:LIVER, BILIARY TRACT: Mildly arterial enhancing lesion with washout in segment 8 is 11 x 10 mm (series 11, image 30), unchanged. No new suspicious lesions. Subcentimeter left hepatic cyst.Cirrhotic liver morphology.Patent hepatic vasculature. No biliary ductal dilatation. Cholelithiasis. Subcentimeter sessile enhancing polypoid lesion in the gallbladder fundus (series 12, image 72), unchanged from 2013 CT. Paraumbilical and esophageal varices, unchanged.SPLEEN: Mild splenomegaly.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Segment 8 lesion consistent with HCC, unchanged.


Instruction: Generate impression based on findings.

Input: Lymphangioma status post treatment. Sepsis concern for meningitis. Neck: There are multiple cystic lesions in the right face, the parapharyngeal, carotid, masticator, parotid, buccal, submandibular, and submental spaces, as well as the floor of mouth and pterygopalatine fossa. There has been interval resection of the previously demonstrated nasopharyngeal components that protruded into the nasopharynx and oropharynx. Otherwise, some of the components have increased in size, such as the dominant component in the right cheek, which measures up to 43 mm, previously 35 mm. A fluid level in another component has resolved. Otherwise, some of the lesions contains septations and display peripheral enhancement. There is mild narrowing of the pharyngeal airway and mass effect upon the right submandibular and parotid glands. There is a cleft palate. The orbits appear to be grossly unremarkable, aside from mild prominence of the anterior cerebral subarachnoid spaces bilaterally.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.

Output: 1. Interval resection of the components of lymphatic malformation protruding into the nasopharynx and oropharynx, but increase in size of some of the components of in the right side of the face.2. Cleft palate.3. No evidence of intracranial abscess.


Instruction: Generate impression based on findings.

Input: 40 year old female who underwent breast MRI earlier today for evaluating multiple masses in the left breast, one mass in the right breast and a suspicious left axillary lymph node, which had been detected at recent diagnostic mammogram and ultrasound (2/16/16). MRI demonstrated a highly suspicious mass with a possible satellite in the left breast, an enlarged intramammary lymph node in the left breast, a highly suspicious left axillary lymph node, and a small enhancing mass in the right breast. Following MRI findings correlated with the findings of recent mammogram and ultrasound performed on 2/16/16;A highly suspicious mass in the left breast, an enlarged intramammary lymph node in the left breast, a highly suspicious left axillary lymph node, and a small mass in the right breast. Because MR demonstrated a new finding, a possible satellite focus at lower outer quadrant in the left breast, MR-directed ultrasound was performed. A 4 mm mass was detected at 8:00 position, 3 cm from the nipple in the left breast, and it corresponded with the enhancing focus on MRI.Subsequently, ultrasound guided biopsy of following lesions were performed. 1. Right breast, 4 x 5 x 6 mm, 3:00 position, 2 cm from the nipple 2. Left breast, 11 x 10 x 13 mm, 7:00 position, 2 cm from the nipple (a highly suspicious mass)3. Left breast, 4 x 3 x 4 mm, 8:00 position, 3 cm from the nipple (a possible satellite focus)4. Left axilla, 21 x 17 x 21 mm necrotic lymph node.All the lesions demonstrate increased vascularity and readily visible.PROCEDURE: The procedure and its risks, including bleeding, infection, and failure to diagnose, and expected benefits of ultrasound-guided core biopsy with percutaneous placement of a marking clip to each biopsy site and post-procedural mammogram were discussed with the patient. Questions were answered. Consent was obtained both verbally and in writing. The time-out form was completed to confirm patient identity and side/type of procedure.First, the right breast lesion was biopsied.The right breast was cleansed with chlorhexidine over the target area. Transducer was sterilely sheathed. Local anesthesia was obtained using 2% lidocaine superficially, with 1% lidocaine with 1:100,000 epinephrine at depth. A 3 mm incision was made in the skin with a #11 scalpel blade. Using aseptic technique, continuous ultrasound guidance and a inferior to superior approach, three 14-gauge core needle (Inrad) specimens were obtained of the lesion. Targeting was judged very good. All specimens floated in the prefilled container of 10% formalin. Specimen quality was judged good. Using continuous ultrasound-guidance a Bard ribbon clip was placed into the lesion in the usual manner. Second, the mass in the left breast at 7:00 position (highly suspicious mass) was biopsied.The left breast was cleansed with chlorhexidine over the target area. Transducer was sterilely sheathed. Local anesthesia was obtained using 2% lidocaine superficially, with 1% lidocaine with 1:100,000 epinephrine at depth. A 3 mm incision was made in the skin with a #11 scalpel blade. Using aseptic technique, continuous ultrasound guidance and a lateromedial approach, three 12-gauge core needle (Celero) specimens were obtained of the lesion at the 7:00 position. Targeting was judged very good. All specimens floated in the prefilled container of 10% formalin but contained solid white tissue. Specimen quality was judged very good. Using continuous ultrasound-guidance a Hydromark clip was placed into the lesion in the usual manner. Third, the mass in the left breast at 8:00 position (possible satellite) was biopsied.Using the same sterile technique and local anesthesia, the 8:00 position lesion was biopsied by inferolateral to superomedial approach, and three 14-gauge core needle (Inrad) specimens were obtained of the lesion. All specimens floated. One specimen were fragmented. Specimen quality was judged good. Using continuous ultrasound-guidance a Bard wing clip was placed into the lesion in the usual manner. Finally, the largest suspicious left axillary lymph node was biopsied.Using same aseptic technique and local anesthesia, continuous ultrasound guidance and a inferolateral to superomedial approach, two 14-gauge core needle (Inrad) specimens were obtained of the lesion. Targeting was judged very good. All specimens sank to the bottom of the prefilled container of 10% formalin. Specimen quality was judged very good. Using continuous ultrasound-guidance a Hydromark clip was placed into the lesion in the usual mannerSpecimens were sent to Pathology with an accompanying history sheet. Pressure was held over the biopsy site until all bleeding subsided. The skin incision was closed with a Steri-Strip. Post-procedure digital right and left CC and ML views and the left axillary view revealed the percutaneously placed clips to be in the expected location, within the targets. No evidence of hematoma or other complication.A pressure dressing was positioned over the biopsy site and an ice pack positioned over the pressure dressing. Post-procedure instructions were reviewed with the patient both verbally and in writing. She tolerated the procedure well with no evident complications and left the Breast Imaging Department in stable condition.The procedure was performed by Dr. Wang and Al-Saraf. Dr. Abe was present during the procedure at all times.

Output: Successful ultrasound-guided core biopsy of following lesions and clip placement;1. Right breast mass at 3:00 position: a Bard ribbon clip2. Left breast mass at 7:00 position (a highly suspicious mass): a Hydromark clip3. Left breast mass at 8:00 position (a possible satellite focus): a Bard wing clip4. Left suspicious axillary lymph node: a Hydromark clipPathology is pending at this time.BIRADS: 5 - Highly suggestive of malignancy.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Evaluate rotator cuff. Sprain of left rotator cuff capsule and pectoralis tear. Pain in left shoulder. ROTATOR CUFF: The supraspinatus, infraspinatus, subscapularis and teres minor appear intact, with normal signal and morphology. There is no evidence of full-thickness tear, retraction or muscular atrophy. There is no contrast identified in the subdeltoid or subacromial bursa.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: No significant abnormality noted.BICEPS TENDON: The proximal portion of the long head of the biceps has been resected and the patient is status post tenodesis into the humeral diaphysis.ADDITIONAL

Output: No evidence of rotator cuff tear.


Instruction: Generate impression based on findings.

Input: 39 year old with strong family history of breast cancer, grandmother, mother and great aunt. There is heterogeneous amount of fibroglandular tissue in both breasts.Marked parenchymal enhancement is noted bilaterally.There are circumscribed masses in the right breast at 3 o'clock position (11 x 7 x 7 mm; AP x LR x CC), and 12 o'clock position (9 x 10 x 9 mm), and a circumscribed mass in the left breast at 8 o'clock position (15 x 12 x 10 mm). All are consistent with fibroadenoma.No suspicious enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. Multiple fibroadenomata.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Routine Screening Mammogram.


Instruction: Generate impression based on findings.

Input: Bilateral tinnitus, followed by concussion in September. The bilateral cranial nerve 7 and 8 complexes are intact. There is no evidence of mass lesions. The inner ear structures, including the cochlea, vestibule, endolymphatic duct, and semicircular canals, appear unremarkable. The bilateral mastoid air cells and middle ears also appear unremarkable. There is a partially imaged left superficial parotid mass that measures up to approximately 20 mm.

Output: 1. No evidence of retrocochlear or inner ear lesions.2. A partially imaged left superficial parotid mass that measures up to approximately 20 mm may represent lymphadenopathy or a salivary neoplasm, for example. Dedicated parotid imaging may be useful for further evaluation.


Instruction: Generate impression based on findings.

Input: Male, 55 years old, with intracranial abscesses. For numbering purposes, there appear to be 13 rib-bearing vertebral bodies. No evidence of acute cord compression is seen. There is mild to moderate chronic degenerative narrowing of the spinal canal in the cervical region. A small focus of linear cord T2 signal abnormality at the C4-5 level may reflect myelomalacia. Elsewhere, no significant compromise of the spinal canal is seen. Reversal of the cervical lordosis is noted. Elsewhere, spinal alignment is anatomic. Vertebral body heights are preserved. Mild endplate edema and facet arthropathy are seen in the lower lumbar region. A 1 cm focus of enhancement within the L1 vertebral body is nonspecific but may represent a hemangioma.

Output: 1.No evidence of acute cord compression.2.Chronic degenerative narrowing of the spinal canal in the cervical region can be better assessed with dedicated imaging when clinically appropriate.


Instruction: Generate impression based on findings.

Input: Right parotid mass follow up. There is a fairly well defined, but heterogeneous mass in the superficial right parotid gland that measures up to 35 mm. There is suggestion of what may represent a hilum within the mass. The mass appears to have increased in size since 2013, accounting for differences in technique. The other salivary glands are unremarkable. There is no significant upper cervical lymphadenopathy based on size criteria otherwise. There is a small left vallecular retention cyst versus secretions. There is diffuse paranasal sinus mucosal thickening. There is a left inferior orbital wall blow out fracture, as well as a defect in the right lamina papyracea. There is probable plaque at the bilateral carotid bifurcations. There appears to be patchy high T2 signal in the pons and cerebral white matter, which likely represent chronic small vessel ischemia. There is multilevel degenerative cervical spondylosis.

Output: The right parotid mass has increased in size since 2013.


Instruction: Generate impression based on findings.

Input: History of von Hippel-Lindau and kidney cysts. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: There are 2 lesions in the right kidney. A dorsal cortex inferior pole lesion measures 1.5 x 1.5 cm (series 5/41) and demonstrates mild T2-weighted heterogeneous hyperintensity and solid postcontrast enhancement (series 100/86).A partially exophytic lesion in the interpolar region demonstrates solid enhancement and measures 9 x 7 mm (series 100/82).Both of these lesions demonstrate loss of signal intensity on out of phase imaging compatible with intra-Voxel fat.A left inferior pole T2 hyperintense lesion measures 2.0 x 2.0 cm (series 5/47) with mild internal complexity/septations which appear to enhance on subtraction imaging (series 100/92).RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: T2 hyperintense focus in the lower thoracic spinal cord is incompletely characterized.

Output: 1.Two solidly enhancing right renal lesions measuring 1.5 and 0.9 cm. Intra-Voxel fat is noted. Differential considerations include lipid poor angiomyolipoma or clear cell type renal cell carcinoma with intracellular fat.2.2.0 cm left renal inferior pole cystic lesion does not meet criteria for a simple cyst and has suspected thin enhancing septations. 6-12 month follow-up is recommended.3.T2 hyperintense focus in the lower thoracic spinal cord is incompletely characterized. This was imaged on the outside hospital MRI of the spine.4.Nonspecific trace free fluid in the pelvis.


Instruction: Generate impression based on findings.

Input: MRI Brain:There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are two nonspecific T2/flair hyperintensities in the right periatrial white matter which are nonspecific. There is no abnormal brain parenchymal contrast enhancement. There is a punctate area of susceptibility abnormality along the right lateral cerebellum which is nonspecific and possibly related to chronic microhemorrhage or mineralization. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.MRA Brain: The intracranial internal carotid arteries demonstrate no significant stenosis. The middle and anterior cerebral arteries are also patent. There is a small left A1 segment and small right P-comm artery which are normal variants. The left P-comm artery is large. The vertebral arteries, basilar artery, and posterior cerebral arteries also are patent with no significant stenosis. No evidence of aneurysms or vascular malformations.MRV Brain:There is a dominant right transverse and sigmoid sinus. The superior sagittal sinus, inferior sagittal sinus, transverse sinuses, sigmoid sinuses, straight sinus, vein of Galen, and internal cerebral veins are patent. There is no evidence of venous thrombosis.

Output: No evidence of acute infarct, hemorrhage or venous sinus thrombosis.


Instruction: Generate impression based on findings.

Input: Right shoulder instability Examination is slightly limited by motion artifact. ROTATOR CUFF: No significant abnormality noted.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is a somewhat rounded appearance to the posterior labrum with blunting of the posterior inferior glenoid suggesting mild dysplasia. There is mild undercutting of the anterior labrum with contrast best seen on series 2 image 16/27. The anterior labrum also demonstrates a slightly heterogeneous signal intensity. There is no evidence of a discrete Hill-Sachs deformity.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: 1. Slight contrast undercutting the anterior labrum which itself demonstrates a slightly heterogeneous appearance. This may relate to prior scarring or prior tearing. There is no evidence of labral detachment.2. Findings suggestive of mild posterior glenoid dysplasia.


Instruction: Generate impression based on findings.

Input: Status post lumbar spine surgery. There are new postsurgical changes since the prior MRI study, with hardware related to posterior spinal fusion from L2 to S1 levels. Postsurgical changes of anterior L2 -- L3 to L4 -- L5 interbody fusion are also present. There is a surgical drainage catheter in the posterior surgical bed. The orthopedic hardware generous streak artifacts, causing obscuration of image details in the surrounding area. This is small fracture at the right inferolateral aspect of the L4 vertebra, extending from the right L4 pedicle screw placement. Again noted is widening of anterior L1 -- L2 intervertebral disk space, with sclerotic endplate changes and air within the intervertebral disk space. This is similar in appearance to the prior MRI study. This may be related to severe degenerative disk disease; diskitis is less likely given the lack of interval change compared to the prior MR study, but this cannot be excluded.

Output: 1. New postsurgical changes as described above. There is a fracture at the right inferolateral aspect of L4 vertebra, extending from the right L4 screw placement.2. Residual degenerative disease as described above. There remains sclerotic endplate changes with bone erosion at endplates of L1 -- L2 level, likely representing severe degenerative disk disease. Diskitis is less likely but is not completely excluded.


Instruction: Generate impression based on findings.

Input: Bilateral severe to profound sensorineural hearing loss. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is an appropriate degree of myelination, with terminal zones of myelination that are most pronounced in the bilateral parietal periventricular regions. Indeed, the brain parenchyma, brainstem, cerebellum, and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Internal Auditory Canals: The bilateral cranial nerve 7 and 8 complexes are intact. There is no evidence of mass lesions. The inner ear structures, including the cochlea, vestibule, endolymphatic duct, and semicircular canals, appear unremarkable. The bilateral mastoid air cells and middle ears also appear unremarkable.

Output: 1. No evidence of intracranial hemorrhage, mass, or acute infarct. 2. No discernible inner ear anomalies of cochlear nerve deficiency.


Instruction: Generate impression based on findings.

Input: Pituitary adenoma status post surgery. There are postoperative findings related to left frontal craniotomy for debulking of a sellar and suprasellar mass, which appears to have slightly increased in size in the bilateral cavernous sinuses, with encasement of the bilateral internal carotid arteries. There is persistent mass effect upon the adjacent brain and brainstem and inferior extension into the sphenoid sinuses. There are areas of susceptibility effect within the tumor and along the surgical approach related to prior hemorrhage. There is also confluent high T2 signal in the brain parenchyma surrounding the surgical approach. There is associated ex vacuo dilatation of the left lateral ventricle and mild dilatation of the right lateral ventricle. There is no evidence of acute infarct. There is no residual subgaleal collection.

Output: Postoperative findings related to left frontal craniotomy for debulking of a sellar and suprasellar pituitary adenoma, which appears to have slightly increased in size in the bilateral cavernous sinuses.


Instruction: Generate impression based on findings.

Input: Benign intracranial hypertension [G93.2] / Fusion of spine, thoracic region [M43.24] / Low back pain [M54.5], Reason for Study: ^Reason: 24 weeks pregnant, patient having severe back pain, LP shunt, NO CONTRAST, Lumbar/thor congential disc fusion Thoracic SpineThere are fusion of vertebral bodies from T8 to T10 vertebral bodies especially anterior and midline which lessened normal thoracic kyphotic angulation. However, 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. There is no evidence of spinal canal or neuroforaminal stenosis. There is no evidence of syrinx. Intervertebral discs except the fused area appear to be normal.L-Spine:For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. There are multiple ovoid shaped fluid containing lesions on the left side of L3 spinous process arranged in a linear direction and the largest one is measured about 6mm x 9.9mm. There are other small fluid containing lesions on L34 posterior epidural space which replacing normal fat signal intensity (series 18, #25, series 19, #25). Another similar lesion was seen on L23 intervertebral disc level. However, certainly, those lesions do not demonstrate any mass effects against surrounding structures. These lesions likely represent procedure related soft tissue fluid collections such as small seroma, the chance of small CSF collections especially epidural lesions would be less likely.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 epidural space, thecal sac, and spinal cord are preserved with no evidence of spinal canal/neural foraminal narrowing. The conus medullaris terminates at the L1 level. The intervertebral discs demonstrate normal T2 intensity and height with no evidence of disc herniation. The paraspinal soft tissues are unremarkable.

Output: Multifocal benign looking fluid containing extra spinal and epidural lesions as described above. Follow up scan can be considered if clinically indicated.


Instruction: Generate impression based on findings.

Input: Headache with a history of ALL. Question metastases or mass. There is suggestion of a small subdural hematoma at the vertex. There is no evidence of mass effect, edema or midline shift. Lack of intravenous contrast limits the evaluation for metastases. If there is clinical concern for metastases, an MRI with contrast is recommended for better evaluation.The ventricles and sulci appear prominent for the patient's age, consistent with volume loss. This is more prominent than on the prior study.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Suggestion of a small subdural hematoma at the vertex. If there is clinical concern for metastases, an MRI with contrast is recommended for evaluation.


Instruction: Generate impression based on findings.

Input: Multiple sclerosis. Follow-up progression. There are unchanged scattered foci of T2 hyperintensity, involving periventricular and subcortical white matter, the largest along the occipital horn of the left lateral ventricle. T2 hyperintense lesions are also identified within the medulla and right brachium pontis. No new lesions are identified. The pituitary gland appears unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Unchanged supra and infratentorial demyelinating lesions, compatible with history of multiple sclerosis. No new lesions are identified.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Female 68 years old with a stable pancreatic head/neck neuroendocrine tumor. Please evaluate for any changes. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in size and smooth in contour. There are a few scattered T2 hyperintense foci throughout the liver compatible with simple cysts. The segment 7 measures 3.0 x 3.3 cm (series 7/17), unchanged when measured similarly. There is no enhancing hepatic lesion. The hepatic vasculature appears patent.The gallbladder is normally distended without cholelithiasis. The common duct measures up to 9 mm in diameter. No intrahepatic biliary ductal dilatation.SPLEEN: The splenic lesion measures 2.0 x 1.8 cm (series 7/17), previously 2.3 x 2.8 cm, but unchanged in imaging characteristics.PANCREAS: The pancreatic duct is dilated to throughout the tail and body up to 7 mm with abrupt tapering at the level of the pancreatic neck and is again mildly prominent in the ampulla. This is unchanged since the previous exam. At the level of ductal narrowing is a 5 mm hyperenhancing intraductal lesion (series 10013/248), unchanged. Moderate to severe atrophy of the pancreatic body and tail is also stable.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Note is made of a small duodenal diverticulum.BONES, SOFT TISSUES: Degenerative changes affect the spine.OTHER: No significant abnormality noted.

Output: 1.Stable 5 mm lesion in the pancreatic head/neck with resulting pancreatic ductal dilatation is compatible with the patient's known intraductal narrowing.2.Interval decrease in size of the splenic lesion.


Instruction: Generate impression based on findings.

Input: Follow up exam for patient with Sturge Weber syndrome. There is redemonstration of mild focal right frontal lobe volume loss and diffusely prominent leptomeningeal enhancement, but deficiency of overlying cortical veins. There are associated enlarged medullary and deep veins in the right frontal lobe and a dilated striate vein. There are a few scattered foci of nonspecific T2 hyperintensity in the white matter of the bilateral cerebral hemispheres. The ventricles are unchanged in size and configuration. There is a partially empty sella. There is no evidence of acute cerebral infarction of hemorrhage. There is no midline shift. The skull and orbits appear unremarkable.

Output: Unchanged stigmata of Sturge Weber syndrome, predominantly involving the right frontal lobe.


Instruction: Generate impression based on findings.

Input: Vertigo sustained for >1min after Dix Hallpike maneuver; specifically want to evaluate for acoustic schwannoma: nystagmus, tinnitus. The bilateral cranial nerve 7 and 8 complexes are intact. There is no evidence of mass lesions. The inner ear structures, including the cochlea, vestibule, endolymphatic duct, and semicircular canals, appear unremarkable. The bilateral mastoid air cells and middle ears also appear unremarkable.

Output: No evidence of vestibular schwannoma.


Instruction: Generate impression based on findings.

Input: 71 year old female with known coronary artery disease, shortness of breath, and evidence of micronodules on her lungs. She is referred to rule out ischemia and infiltrative processes. MEDICATIONS: amlodipine, rosuvastatin, aspirin First Pass PerfusionDuring hyperemia, a mild perfusion defect was noted in the basal anterior wall; mid anteroseptum, anterior, and anterolateral walls; and in the apical septum, anterior, lateral, and inferior walls.Viability/ Myocardial ScarThere was evidence of a moderate amount of late gadolinium enhancement in the pattern of a stripe along the anterolateral wall which spares the endocardium. The pattern is atypical for prior myocardial infarction and suggests the presence of underlying myocardial fibrosis, inflammation, or infiltration. The remainder of the myocardium is free of myocardial infarction and likely to be viable. Left VentricleThe left ventricle is normal in size with normal systolic function with mild concentric left ventricular hypertrophy. The overall LV ejection fraction is 71%, the LV end diastolic volume index is 53 ml/m2 (normal range: 65+/-11), the LVEDV is 94 ml (normal range 109+/-23), the LV end systolic volume index is 16 ml/m2 (normal range 18+/-5), the LVESV is 28 ml (normal range 31+/-10), the LV mass index is 52 g/m2, and the LV mass is 92 g. There are no regional wall motion abnormalities present. Left AtriumThe left atrium is mild to moderately dilated. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 70%, the RV end diastolic volume index is 51 ml/m2 (normal range 69+/-14), the RVEDV is 90 ml (normal range 110+/-24), the RV end systolic volume index is 15 ml/m2 (normal range 22+/-8), and the RVESV is 27 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation. There is a subaortic membrane with evidence of flow acceleration in the LVOT, correlation with echocardiogram suggested to determine peak gradient.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease. Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. A mild perfusion defect/ "ischemia" is noted in much of the left anterior descending artery territory as described above. 2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and systolic function (LVEF 71%) with mild, concentric left ventricular hypertrophy. There was evidence of a moderate amount of late gadolinium enhancement in the pattern of a long thin stripe along the anterolateral wall which spares the endocardium. The pattern is atypical for prior myocardial infarction and suggests the presence of underlying myocardial fibrosis, inflammation, or infiltration. 4. Normal RV size and systolic function (RVEF 70%).5. Mild to moderate left atrial dilation.6. A subaortic valve membrane is noted and associated with flow acceleration in the LVOT. Correlation with echocardiography suggested.Findings discussed with referring physician.


Instruction: Generate impression based on findings.

Input: Loss of balance. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is diffuse patchy cerebral and pontine white matter T2 hyperintensity. 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 paranasal sinuses are grossly unremarkable. There are subcentimeter T1 hyperintense foci in the right parietal calvarium, which may represent hemangiomas. There are bilateral lens implants. There is also staphylomatous deformity of the right globe.

Output: 1. No evidence of intracranial hemorrhage, mass, or acute infarct. 2. Nonspecific diffuse patchy cerebral and pontine white matter T2 hyperintensity may represent chronic small vessel white matter ischemic disease.


Instruction: Generate impression based on findings.

Input: History of hepatitis C. Multiple liver lesions previously characterized as multifocal hepatocellular carcinoma on imaging. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic nodular liver morphology.Since the prior study there has been significant increase in size of the previously measured liver mass and multiple new and enlarging liver masses infiltrating the right hepatic lobe. The reference lateral segment confluent mass measures approximately 17.9 x 8.9 cm compared to 14.3 x 6.4 cm previously.The portal vein is poorly demonstrated. Gallstones within a normally distended gallbladder.SPLEEN: The spleen measures 11.2 cm in length without a focal lesion.PANCREAS: Pancreas divisum. No pancreatic ductal dilatation or focal lesion. No stigmata of chronic pancreatitis.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left renal simple appearing cyst. Punctate hyperintensities bilaterally are too small to characterize, likely cysts. No hydroureteronephrosis or suspicious lesion.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Large volume abdominal pelvic ascites.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Mild basilar atelectasis.

Output: Interval increase in the large lateral segment reference mass and increase in size and number of numerous additional liver masses compatible with progression of multifocal hepatocellular carcinoma.The portal vein is poorly demonstrated. If there is clinical concern for occlusion an ultrasound may be considered.Cholelithiasis without cholecystitis.


Instruction: Generate impression based on findings.

Input: Female 63 years old with HCV cirrhosis and HCC s/p TACE/RFA 7/2016, follow up imaging for recurrence. ABDOMEN:LIVER, BILIARY TRACT: Nodular liver contour with a cirrhotic morphology including caudate and left hepatic lobe hypertrophy and fissural prominence, unchanged.The ablation cavity in hepatic segment 5 measures 3.6 x 1.7 cm (series 904, image 211), previously 3.7 x 1.7 cm and has intrinsic T1 hyperintensity consistent with blood products. There is a nodular focus of enhancement along the superolateral aspect of the ablation cavity with no definite washout. This lesion should be followed on subsequent exams. The focus of arterial enhancement in segment 6 has increased in size now measuring 2.0 x 0.9 cm (series 903, image 206), previously 1.3 x 0.9 cm with diffusion restriction but no washout on delayed images. This does not meet criteria for HCC but is suspicious for neoplasm, perhaps atypical HCC or a small cholangiocarcinoma.There is a new subcentimeter enhancing lesion in segment IVb with no diffusion restriction or washout (series 3, image 218). This lesion is indeterminate and can be followed on subsequent exams.No intra or extrahepatic biliary ductal dilatation. Status post cholecystectomy with prominent common duct measuring up to 11 mm, unchanged.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: Prominent periportal lymph nodes are nonspecific in the setting of cirrhosis.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Cirrhotic liver morphology.2.Segment 5 ablation cavity is unchanged in size however there is a new focus of nodular enhancement along the superolateral aspect of the should be followed on subsequent exams.3.Arterially enhancing segment 6 lesion with restricted diffusion has increase in size. While this does not meet criteria for hepatocellular carcinoma, it is suspicious for a neoplastic process such as atypical hepatocellular carcinoma or a small cholangiocarcinoma.4.There is a new enhancing lesion in segment IVb which is indeterminate and can be followed on subsequent exams.


Instruction: Generate impression based on findings.

Input: 97-year-old male with altered mental status. There is no evidence of intracranial hemorrhage, mass or edema. Mild small vessel disease of indeterminate age. No evidence of acute CVA. If clinically indicated, further evaluation by MRI may be considered.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.Band-like hypodensity surrounding the right globe is reidentified and likely represents previous banding.

Output: No acute abnormalities. If clinically indicated, further evaluation by MRI may be considered.


Instruction: Generate impression based on findings.

Input: History of Gleason 6 prostate cancer in the right mid gland and apex. Considering active surveillance. Evaluate extent of disease. PELVIS:PROSTATE:Prostate Size: 5.3 x 4.4 x 2.8 cmPeripheral Zone: There is heterogeneous low T2 signal throughout the peripheral zone. In the right lateral mid gland and approaching the apex there is low T2 signal become slightly more confluent measuring 10 x 0.11 mm (series 801 image 19). This is associated with mild restricted diffusion and mild early arterial enhancement. There is a similar focus in the left mid gland/apex which also measures 11 x 10 mm and has mild restricted diffusion and early arterial enhancement. Central Gland: Mild to moderate nodular hypertrophic changes of benign prostatic hypertrophy.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: None detected.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Findings suspicious for but not definitive of malignancy involving the bilateral mid to apical peripheral zones as described. Linear margins are noted which may be seen in setting of underlying scarring or prostatitis also making detection of an underlying lesion suboptimal. No evidence of extracapsular extension or metastatic disease.


Instruction: Generate impression based on findings.

Input: Left knee pain MENISCI: There is complex but predominantly horizontally oriented tearing of the medial meniscus which extends to rule out the body but also affects the anterior and posterior horns. There is mild extrusion of the meniscus into the medial gutter. The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is diffuse full-thickness cartilage loss of the medial compartment both of the femoral condyle and tibial plateau. There is underlying degenerative marrow signal. There is diffuse thinning of the lateral compartment although to a lesser degree. There is heterogeneity of the articular cartilage of the patellofemoral compartment with areas of full-thickness loss involving the lateral patellar facet.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Predominantly horizontal tearing of the medial meniscus extending through the anterior horn, body, and posterior horn.2. Severe cartilage loss of the medial compartment with milder changes noted in the patellofemoral and lateral compartments.3. Large Baker's cyst.


Instruction: Generate impression based on findings.

Input: Reason: Left knee pain MENISCI: The medial and lateral meniscus are in tact.ARTICULAR CARTILAGE AND BONE: No significant abnormality noted.LIGAMENTS: The ACL, PCL, MCL, and LCL are intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Small joint effusion. Otherwise normal MRI of the left knee.


Instruction: Generate impression based on findings.

Input: Acute onset paresthesias and back pain after twisting injury: left sided radiculopathy. There are far left lateral foraminal disc protrusions superimposed upon disc bulges and mild facet hypertrophy at L4-5 and L5-S1, which compress the exiting nerve roots at these levels. There is also mild to moderate right neural foraminal stenosis at these levels. In general, the pedicles appear rather short, such that the neural foramina throughout the lumbar spine are not very capacious. Otherwise there is no significant spinal canal stenosis. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: Far left lateral foraminal disc protrusions superimposed upon disc bulges and mild facet hypertrophy at L4-5 and L5-S1, which compress the exiting nerve roots at these levels.


Instruction: Generate impression based on findings.

Input: History of Peutz-Jeghers syndrome with small bowel polyps in the past. No GI symptoms. ABDOMEN:LIVER, BILIARY TRACT: Fatty infiltration of the liver. No suspicious liver lesion. No ductal dilatation or vascular abnormality.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small renal cysts on the left.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.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Fatty infiltration of the liver without a focal lesion. No enhancing polyps or active small bowel malformation.


Instruction: Generate impression based on findings.

Input: Male, 81 years old, with weakness. Alignment is grossly anatomic. Vertebral body heights are preserved. Marrow signal characteristics are somewhat heterogeneous which is likely degenerative in nature. No areas of pathologic marrow replacement or edema are seen.The spinal canal is narrowed at all levels in the cervical spine beginning at C3-4. The spinal cord is impinged to varying degrees at these levels with associated cord thinning and mild somewhat diffuse cord signal abnormality.Incidental note is made of an enlarged and heterogeneous thyroid gland, particularly on the left. The right vertebral artery flow void is not well visualized which can indicate occlusion or slow flow.C2-3: Facet arthropathy, right worse than left. Posterior disc-osteophyte complex formation. No significant spinal canal stenosis. No significant foraminal narrowing.C3-4: Facet arthropathy and ligamentum flavum thickening. Posterior disc-osteophyte complex formation. Severe generalized spinal canal stenosis with marked cord flattening. Moderate bilateral foraminal narrowing. C4-5: Facet arthropathy and ligamentum flavum thickening. Posterior disc-osteophyte complex formation. Severe generalized spinal canal stenosis with marked cord flattening. Severe bilateral foraminal narrowing. C5-6: Facet arthropathy. Posterior disc-osteophyte complex formation. Moderate generalized spinal canal stenosis with slight indentation of the cord. Severe bilateral foraminal narrowing. C6-7: Facet arthropathy. Posterior disc-osteophyte complex formation. Moderate generalized spinal canal stenosis with slight indentation of the cord. Severe bilateral foraminal narrowing. C7-T1: Facet arthropathy. Posterior disc-osteophyte complex formation. Moderate generalized spinal canal stenosis with slight indentation of the cord and evidence of myelomalacia. Severe bilateral foraminal narrowing.

Output: Multilevel cervical spondylosis is seen resulting in significant compromise of the spinal canal at most levels with impingement of the spinal cord. The spinal cord is thinned and demonstrates abnormal T2 signal compatible with myelomalacia. Multilevel severe foraminal compromise is also noted.Incidental note is made of an enlarged and heterogeneous thyroid gland which can be further assessed with nonemergent dedicated thyroid sonography if clinically warranted.


Instruction: Generate impression based on findings.

Input: 30-year-old female presents with right shoulder pain, evaluate for a labral tear. ROTATOR CUFF: No significant abnormality noted.SUPRASPINATUS OUTLET: The acromioclavicular joint appears normal. There is no fluid in the subcoracoid/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral joint alignment is normal. There is mild deformity of the posterior superior labrum with high signal partially undercutting the labrum suggestive of a small SLAP tear. A small focus of linear signal intensity between the anterior superior labrum and the adjacent articular cartilage may represent a sublabral sulcus, a normal anatomic variant. Increased signal intensity within the anterior labrum above the equator is comparable to that seen on the prior study and may represent a normal variant rather than a tear. The inferior labrum appears normal.BICEPS TENDON: The tendon of the long head of the biceps appears normal. ADDITIONAL

Output: Findings suggestive of a small SLAP tear of the posterior superior labrum and other findings as described above.


Instruction: Generate impression based on findings.

Input: 4 month old male with history of cerebrovascular accident; please evaluate for interval change. Low attenuation and loss of gray-white differentiation within the left temporal lobe extending to the occipital lobe, bilateral frontal lobes and right temporal lobe extending to the parietal lobe compatible with CVA. When compared to the MRI performed on 12/5/2008, the extent of these infarcts is increased.There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Increasing extent of bilateral, large infarcts as described above.


Instruction: Generate impression based on findings.

Input: One year follow-up scan status post craniotomy for left temporal CCM resection. There are post left temporal craniotomy changes including susceptibility artifact related to hardware. There has been interval decrease in the amount of high T2 signal surrounding resection cavity within the left temporal lobe. There remains a small rim of high T1 signal and susceptibility effect consistent with the presence of hemosiderin. Otherwise, there is no residual mass, fluid collection, hemorrhage, hydrocephalus, or acute ischemia. The midline is intact. The left mastoid fluid has resolved.There is a small mucus retention cyst within the right maxillary sinus. The orbits are unremarkable.

Output: Expected interval evolution of postoperative findings related to the resection of the left temporal cavernous malformation with minimal residual hemosiderin in the surgical bed.


Instruction: Generate impression based on findings.

Input: The intracranial internal carotid arteries are normal in course and caliber. The middle and anterior cerebral arteries are unremarkable. There appear to be two fenestrations involving the proximal right PICA. The left vertebral artery, basilar artery, and posterior cerebral arteries are normal in course and caliber. There is no evidence of flow-limiting stenosis, aneurysm or AVM.

Output: 1.No evidence of aneurysm or arteriovenous malformation within the field of view.2.There appear to be two adjacent fenestrations of the proximal right PICA.


Instruction: Generate impression based on findings.

Input: Reason: concern for physical exam changes since last MRI. Disc herniation History: + straight leg and faber test in the setting of L back pain For the purposes of this exam, there are 5 nonrib-bearing lumbar-type vertebral bodies with the most inferior well-defined disc space labeled L5-S1 as before. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign with small T1 hyperintense lesion at the S1 level compatible with focal fat or hemangioma. The conus medullaris is normal in position.Mild degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: No significant disc disease. No spinal canal or neural foraminal stenosis.L4-L5: No significant disc disease. No spinal canal or neural foraminal stenosis.L5-S1: Bilateral L5 pars defects are again seen. There is disc desiccation as well as disc bulge with a more focal left-sided protrusion which slightly effaces the left lateral recess and mildly narrows the left-sided neural foramen similar to prior. There is an associated left-sided dorsal annular fissure which is more apparent than prior. No significant spinal canal stenosis or right neural foraminal stenosis. Bilateral facet effusions are again seen. Paraspinous soft tissues are within normal limits.

Output: Overall no significant change since MRI from 8/9/2014. Bilateral L5 pars defects again seen. There is a left-sided disc protrusion at the L5-S1 level which is associated with mild narrowing of the left lateral recess as well as mild left neural foraminal narrowing, similar to prior. Spinal canal is patent. L5-S1 facet joint effusions again seen. Dynamic radiographs may be considered to assess for instability at this level.


Instruction: Generate impression based on findings.

Input: Reason: knee pain and locking, assess meniscus History: knee pain and locking MENISCI: The majority of the anterior horn of the lateral meniscus is replaced with intermediate signal intensity indicating extensive degeneration and degenerative tearing. The tearing extends into the body of the meniscus as well. There is mild blunting of the inner edge of the posterior horn of the lateral meniscus which may reflect chronic fraying. There is abnormal signal intensity within the posterior horn of the medial meniscus extending to the tibial articular surface indicating a horizontal tear.ARTICULAR CARTILAGE AND BONE: There is severe degeneration of the articular cartilage of the lateral compartment with full-thickness cartilage loss along the lateral femoral condyle and lateral tibial plateau. There is mild bone marrow signal abnormality in the lateral femoral condyle and lateral tibial plateau which is likely degenerative in etiology. There is near full-thickness to full-thickness cartilage loss along the posterior aspect of the medial femoral condyle. There is also focal degeneration of the articular cartilage of the femoral trochlea centrally. There are tricompartmental osteophytes.LIGAMENTS: The majority of the ACL is not well visualized, likely representing a tear. The PCL appears slightly thickened likely representing mild degeneration. The LCL and MCL appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Severe osteoarthritis of the knee including full-thickness articular cartilage degeneration most pronounced along the lateral tibiofemoral compartment.2. Degeneration and tearing of the medial and lateral meniscus.3. The ACL is not well visualized, likely representing a chronic tear.4. Moderate-sized joint effusion and Baker's cyst.5. Inflammation between the iliotibial band and lateral femoral condyle.


Instruction: Generate impression based on findings.

Input: 45-year-old female with right hip pain. History of streptococcal pharyngitis. Evaluate for osteoarthritis vs labral tear vs impingement. ACETABULAR LABRUM: Rounded intermediate signal within the anterior superior labrum which may represent mucoid degeneration (coronal series 8, image 14). No definite labral tear.ARTICULAR CARTILAGE AND BONE: The articular cartilage appears intact. The bone marrow signal appears normal.SOFT TISSUES: The soft tissues are unremarkable. ADDITIONAL

Output: Intermediate signal within the anterior superior labrum which may represent mucoid degeneration, however, there is no definite labral tear.


Instruction: Generate impression based on findings.

Input: 67 year old female patient with history of neuroendocrine tumor. ABDOMEN:LIVER, BILIARY TRACT: No suspicious arterially enhancing lesion is identified to suggest metastatic disease. There is a simple cyst within segment VIII of the liver. An additional lesion within the right hepatic dome which is moderately T2 hyperintense appears to demonstrate peripheral nodular enhancement compatible with a hemangioma. An additional subcentimeter lesion within the inferior right hepatic lobe is too small to characterize, but unchanged in size. SPLEEN: No significant abnormality noted.PANCREAS: No pancreatic mass is identified. The main pancreatic duct is not dilated.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Subcentimeter T2 hyperintense left renal lesions likely represent cysts. 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: No evidence of recurrence or metastatic disease in the abdomen.


Instruction: Generate impression based on findings.

Input: Female, 91 years old, with a lesion in the corpus callosum, follow-up exam. Motion artifact degrades image quality on multiple sequences. T2 hyperintensity without mass effect is redemonstrated involving the inferior portion of the splenium, and to lesser degree the undersurface of the posterior body of the corpus callosum and the posterior fornices. No associated pathologic enhancement is seen. In comparison with multiple prior examinations, there has been no significant interval change in these findings. No evidence for restricted diffusion is seen. Numerous additional small foci of T2 hyperintensity are seen within the cerebral white matter including the periventricular tissues. These findings are also unchanged. No mass-effect or parenchymal edema is detected. No evidence of intracranial hemorrhage or any pathologic extra-axial fluid is seen. No enhancing lesions are detected. The ventricles remain within normal limits in size and shape for patient age.

Output: Examination slightly limited due to patient motion. No significant interval change is seen in the appearance of signal abnormality involving the inferior aspect of the splenium, the undersurface of the posterior body of the corpus callosum and the posterior fornices. The differential remains wide and includes the chronic sequelae of a vascular, metabolic or toxic process (including medication-related toxicity), as well as demyelinating, postinfectious or postinflammatory etiologies.


Instruction: Generate impression based on findings.

Input: Reason: Increased seizure frequency and recent history of septic shock and profound hypotension. Evaluate for structural and/or ischemic changes. History: Trisomy 21, seizure disorder, OSA and central apnea S/P Severe septic shock. The ventricles, cortical sulci, and extra-axial spaces are prominent compatible with diffuse parenchymal volume loss which can be seen with Down syndrome and which appears similar in distribution to the 10/16/2009 examination. There are diffusely scattered punctate foci of susceptibility effect in a nonspecific distribution compatible with chronic microhemorrhages. No additional parenchymal signal abnormalities are identified. There is no restricted diffusion to suggest acute infarct. No focal signal rebound is involving the hippocampi. No cortical dysplasias, gray matter heterotopias, or other structural abnormalities are identified to suggest a seizure focus.There is partial opacification of the left mastoid air cells The paranasal sinuses are underpneumatized.

Output: 1.Diffuse parenchymal volume loss appearing similar in distribution to the 2009 and which can be seen with Down's syndrome.2.No focal cortical abnormalities.3.Nonspecific, multiple scattered foci of chronic microhemorrhage throughout the brain. 4.Partial opacification of the left mastoid air cells.


Instruction: Generate impression based on findings.

Input: ACL rupture, check lateral collateral ligament. MENISCI: Horizontal linear signal is observed in the posterior horn of the medial meniscus without definite clear extension to the inferior articular surface. The remaining menisci are otherwise intact and well positioned, specifically the posterior aspects are well anchored bilaterally.ARTICULAR CARTILAGE AND BONE: Marrow signal within osseous structures are intact and well aligned. Specifically no evidence of contusion or acute abnormality. Cartilage is well visualized throughoutLIGAMENTS: Minimal signal is observed along the medial retinaculum and medial collateral ligament with adjacent soft tissue changes suggesting mild to moderate sprain. Fibers appear intact in both these ligaments. Additionally the ACL, PCL and remaining ligaments are also otherwise intact. Specifically ACL is well visualized.EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: MCL and medial retinaculum appear moderately sprained, along with an intrasubstance linear signal within the medial posterior meniscal horn, as described.


Instruction: Generate impression based on findings.

Input: Neck pain with left upper extremity weakness Examination is limited to sequences per cord compression protocol. The vertebral bodies are appropriate in the overall alignment and height. The spinal cord has grossly normal signal characteristics and overall morphology. There is no compromise of the spinal cord. No evidence of intraspinal hematoma.

Output: Examination is obtained per limited MRI screening cord compression protocol. There is no evidence of cord compression. There is also no gross evidence of intraspinal hematoma, disc herniation, or ligamentous injury.


Instruction: Generate impression based on findings.

Input: Exaggerated cervical lordosis, similar to prior CT. Endplate degenerative changes, most severe at C3-C4. There is also degenerative changes at the C1-C2 articulation with thickening along the posterior aspect of the dens corresponding to calcifications seen on prior CT. Multilevel disc desiccation and disc space loss throughout the cervical spine. Vertebral body heights are intact. No abnormal signal within the cord.C2-C3: Mild posterior disc osteophyte complex without significant central or foraminal stenosisC3-C4: Moderate posterior disc osteophyte complex producing moderate central stenosis. Moderate right and mild left neural foraminal stenosis.C4-C5: Mild posterior disc osteophyte complex. Mild central canal stenosis and mild bilateral foraminal stenosisC5-C6: Mild posterior disc osteophyte complex without central canal stenosis. Moderate left and mild right neural foraminal stenosis.C6-C7: Mild posterior disc osteophyte complex. No central canal stenosis. Mild left neural foraminal stenosisC7-T1: No significant central or neural foraminal stenosis.

Output: Cervical spondylosis, most severe at C3-C4, where there is moderate spinal stenosis. No evidence of acute cord compression.


Instruction: Generate impression based on findings.

Input: Mesenchymal chondrosarcoma of the left maxillary sinus; completed radiation therapy in March 2013 and chemotherapy in May 2013. There are post-treatment findings in the left maxillary sinus and nasal cavity region. There is no evidence of measurable mass lesions to suggest tumor recurrence. There is scattered mucosal thickening in the ethmoid sinuses and small retention cysts in the right maxillary sinus. The facial soft tissues are unremarkable. There is no significant cervical lymphadenopathy. The partially imaged intracranial structures and orbits are grossly unremarkable.

Output: Post-treatment findings in the left sinonasal region without evidence of measurable locoregional tumor recurrence.


Instruction: Generate impression based on findings.

Input: Sacral lesion, leukemia There is diffuse signal abnormality and enhancement involving the bones of the pelvis likely representing diffuse leukemic infiltration. There is a curvilinear enhancement pattern of the iliac bones and sacrum also suggesting the presence of bone infarctions which are more evident on the current exam than the prior. There is dural enhancement of the visualized spinal canal but we see no discrete mass lesion. There is extensive subcutaneous edema and mild intra- and intramuscular edema in the pelvis and proximal thighs appearing similar to the prior exam. The muscles of the pelvis and upper thigh demonstrate mild generalized atrophy as well. There is also edema and enhancement of the paraspinal musculature posteriorly which is nonspecific but again no discrete mass is appreciated. We see no hip joint effusion or synovitis.Please refer to the corresponding lumbosacral MRI for further details regarding the spine.

Output: Marrow signal abnormalities as described above likely reflecting a combination of leukemic infiltrate and bone infarctions. Although there is mild dural enhancement, there is no discrete spinal or sacral mass.


Instruction: Generate impression based on findings.

Input: 36-year-old male with history of Crohn's disease status post ileal resection and right hemicolectomy in the past and a recent stricturoplasty. Presents with diarrhea, multiple bowel movements, and excessive gas. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: There is mild diffuse dilation of the main pancreatic duct, as well as apparent mild atrophy of the pancreas, which is nonspecific but suggestive of chronic pancreatitis.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Again seen are postoperative changes of prior small bowel resections and partial right hemicolectomy. The anastomosis appears patent, without evidence of wall thickening, abnormal enhancement, or signal abnormality to suggest active inflammation. There is dilation of the distal small bowel up to 3.0 cm in diameter. The distal small bowel appears decompressed. There is an apparent transition point in the left lower quadrant. These findings may represent the sequela of adhesive disease. No focal fluid collections are identified to suggest abscess formation. No fistula is identified.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Dilated loops of small bowel in the left hemiabdomen with an apparent transition point in the left lower quadrant, suggestive of a partial small bowel obstruction, which may be related to adhesive disease.2.No evidence of active inflammatory bowel disease. No focal fluid collection to suggest abscess formation. No fistula formation is evident.


Instruction: Generate impression based on findings.

Input: Brain: Again seen are postoperative findings related to Chiari decompression. Minimal T2 hyperintensity and volume loss in the inferior right cerebellar hemisphere compatible with gliosis. Neo-foramen magnum is widely patent. CSF flow is preserved across the anterior and posterior aspects of the neo-foramen magnum, although the anterior flow column remains minimally focally constricted due to the retroflexed dens. The third and lateral ventricles are mildly prominent but unchanged. Cerebral aqueduct is patent, most evident on 3-D T2 as well as CSF flow sequences. There is no midline shift or mass effect. There is no evidence of acute infarct or hemorrhage. Spine: There is trace prominence of the central canal from C3 to C5 levels as before. Again seen is a syrinx extending from the lower C6 level into the thoracic cord. Syrinx measures approximately 2 x 2 mm at the T1 level, previously 3 x 3 mm on cervical spine study from 7/27/2016. At the T3-T4 level, the syrinx measures 2 x 3 mm, previously 3 x 4 mm on thoracic study from 2/11/2016.Caudally in the thoracic spine, the syrinx tapers inferiorly to the T11-12 level which is unchanged. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal or neural foraminal stenosis at any level. Conus terminates normally at the upper L2 level.

Output: 1.Postoperative findings related to Chiari I decompression with preserved ventral and dorsal CSF flow at the foramen magnum.2.Mild decrease in size of cervicothoracic syrinx compared to 7/27/2016 and 2/11/2016.3.Unchanged mildly dilated lateral and third ventricles with patent cerebral aqueduct.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Optic neuritis and history of type 2 diabetes, TIA one seizure episode associated with her TIA, hypertension, and smoking. Orbits: There is diffuse atrophy of the left optic nerve, without associated signal abnormality. The right optic nerve appears unremarkable. There is no evidence of mass lesions in the bilateral orbits. The globes, lacrimal glands, and extraocular muscles are unremarkable. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mild scattered cerebral white matter T2 hyperintensity. There are subcentimeter foci of encephalomalacia in the right caudothalamic groove and left caudate. There is no abnormal intracranial enhancement. The ventricles and sulci are mildly prominent diffusely due to cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull and scalp soft tissues are grossly unremarkable. There is mild scattered paranasal sinus mucosal thickening. There are also several subcentimeter nasopharyngeal mucosal retention cysts.

Output: 1. Left optic nerve atrophy, without evidence of acute optic neuritis.2. No evidence of intracranial hemorrhage, mass, or acute infarct. 3. Subcentimeter foci of encephalomalacia in the right caudothalamic groove and left caudate likely represent chronic lacunar infarcts, superimposed upon a background of mild chronic cerebral white matter small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: Fevers and leukocytosis There has been amputation of the great toe through the proximal phalanx and of the second toe through the head of the proximal phalanx.There is ulceration of the soft tissues along the medial plantar aspect of the great toe with a fluid signal intensity tract extending to the base of the remaining proximal phalanx. There is enhancement of the soft tissue around the sinus tract indicating inflammation although no discrete focal collection is identified. On T1-weighted images, there is focal intermediate signal intensity within the base of the proximal phalanx at the site of the sinus tract with enhancement of the marrow following contrast administration. There is diffuse edema of the bone on the T2 fat sat sequences. The constellation of these findings strongly suggests osteomyelitis. The remaining marrow of the first metatarsal, sesamoid bones, and phalanges is otherwise normal. There is mild osteoarthritis of the midfoot.There is atrophy of the musculature with mild edema along the dorsal soft tissues.

Output: Soft tissue ulceration with associated osteomyelitis of the proximal phalanx of the great toe.


Instruction: Generate impression based on findings.

Input: 61-year-old male with history of left facial squamous cell cancer (likely cutaneous). Status post surgery and adjuvant RT. Please evaluate. Enhanced CT of soft tissues of neck:60 cc of Omnipaque 350 was administered for this exam.Axial 3 mm CT images of the soft tissues of the neck after administration of contrast are obtained. Coronal and sagittal 2-D reformatted images are also acquired.Diffusely irregular pattern of enhancement in the left parotid gland remains identical to prior study. Stranding of overlapping subcutaneous fat is also similar to prior study. The overall size and morphology of this abnormal parotid is identical to prior exam. These changes could represent residual tumor as well as post treatment changes. An MRI examination may be useful for further assessment of this changes.There is interval reduction in the degree of thickening and enhancement of the mucosal of the left lateral pharyngeal wall which extends to involve the left common base. These changes are likely secondary to post treatment. There is no evidence of pathologic lymphadenopathy.Enhanced head CT:This examination is essentially within normal limits and in particular no evidence of metastatic disease to brain parenchyma, that the meninges or the calvarium is detected.Calvarium, paranasal sinuses and mastoid air cells are unremarkable.

Output: 1.Stable appearance of irregularly enhancing left parotid gland in size, morphology and pattern of enhancement since prior study.2.Decrease in the degree of mucosal enhancement of the left lateral oropharyngeal wall and left basal scarring likely representing improved posttherapy changes.3.No evidence of pathologic lymph nodes.4.Negative enhanced head CT.


Instruction: Generate impression based on findings.

Input: 23-year-old female with medial shin pain, evaluate for stress fracture or an old wall is in a year with a as is usually A skin marker was placed along the medial aspect of the mid to distal left tibial diaphysis. There is edema at this level within the bilateral mid to distal tibial diaphyses, more pronounced on the right, consistent with stress reaction. There is also a small amount of edema within the periosteal soft tissues. No discrete fracture is identified. The fibula appears normal bilaterally.

Output: Bilateral tibial stress reaction without fracture.


Instruction: Generate impression based on findings.

Input: Memory changes. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is a small right maxillary sinus retention cyst.

Output: No evidence of acute intracranial hemorrhage, mass, or acute infarct.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 42 years Male (DOB:9/24/1973)Reason: s/p SRS for AVM, radiation changes History: Please evaluate radiation changesPROVIDER/ATTENDING NAME: ISSAM A. AWAD ISSAM A. AWAD MRI of the brainA couple punctate foci of diffusion restriction are present in the right hemispheric subcortical and periventricular white matter.The CSF spaces are appropriate for the patient's stated age with no midline shift. There is redemonstration of a heterogeneous lesion located in the left postcentral gyrus laterally which was also present on the prior exam. It is associated with small serpiginous signal voids laterally and the cystic component medially. There is surrounding T2 and FLAIR signal hyperintensities in the adjacent subcortical white matter in the region measuring approximately 42 x 34 mm axial dimensions. There are small foci of contrast enhancement on the T1 postcontrast images scattered within this area of T2 and FLAIR signal hyperintensity.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:There is a 9 mm arteriovenous malformation located along the left postcentral gyrus. Although much smaller than the 2012 exam it has not resolved.Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. There is fetal origin of the left posterior cerebral artery associated with a hypoplastic left P1 segment. The right posterior communicating artery is not readily visualized The vertebral arteries are similar in size.

Output: 1.There is a 9mm residual AVM present along the left postcentral gyrus also identified on the 2013 exam. Since the prior exam patient has developed some contrast enhancement and some signal change surrounding the arteriovenous malformation which is suggestive of postradiation reaction.2.A couple foci of diffusion restriction the right hemisphere likely represent acute microinfarcts.


Instruction: Generate impression based on findings.

Input: 29 years, Female, status post craniotomy for right frontal mass. There are expected postsurgical changes of recent right frontal craniotomy for resection of right frontal lobe tumor. Expected postsurgical changes include blood products and foci of air within the resection cavity and along the right frontal convexity. Tumor margins were not well-defined. There is T2/FLAIR hyperintensity surrounding the resection cavity extending to the right lateral ventricle as well as corpus callosal body, with the medial aspect of the signal abnormality similar to the preoperative study. There is mild leftward subfalcine herniation and midline shift measuring approximately 3 mm at the foramen of Monro similar to prior. No uncal herniation There is minimal restricted diffusion compatible with cytotoxic edema and blood products along the medial aspect of the resection cavity margin. No large infarct or hemorrhage elsewhere in the brain is evident. No additional lesions elsewhere in the brain. No hydrocephalus. Ventricles remain nondilated with mild effacement of the right lateral ventricles similar to prior. Major flow-voids are preserved.

Output: Expected postsurgical changes of right frontal lobe tumor resection. There appears to be resection of at least a majority of the tumor. Nonenhancing T2/FLAIR hyperintensity surrounding the resection cavity may represent a combination of residual infiltrative tumor and vasogenic edema.


Instruction: Generate impression based on findings.

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

Output: No evidence of acute intracranial hemorrhage, mass, or acute infarct. Scattered punctate foci of T2 hyperintensity in the cerebral white matter bilaterally are nonspecific and may represent chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: Ms. Woodard is a 29-year-old female with newly diagnosed triple negative breast cancer in the left breast. There is heterogeneous amount of fibroglandular tissue in both breasts. Scattered foci of enhancement are seen bilaterally, compatible with moderate parenchymal enhancement. No one focus appears more suspicious than the rest.In the left upper outer breast, 11:00 location, there is an irregular enhancing mass measuring 1.5 x 1.2 x 2.0 cm. Susceptibility artifact from biopsy marker clip is seen at the peripheral aspect of this lesion, compatible with biopsy-proven malignancy. Although this mass is quite posteriorly located, there is a discrete fat plane identified between the mass and the pectoralis muscle. The pectoralis muscle itself is of normal contour and enhancement. No abnormal enhancement is seen in the rest of the left breast. No abnormal enhancement is seen in the right breast. No abnormal lymph nodes are identified in either axillary region.

Output: Unifocal malignancy of the left breast. Normal axillary lymph nodes. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Reason: history of ibd, evaluate small bowel History: nausea, vomiting, abdominal pain, diarrhea ABDOMEN:LIVER, BILIARY TRACT: Common bile duct dilatation measuring up to 8 mm, unchanged. No focal narrowing identified. No focal hepatic lesion.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No bowel wall thickening. No abnormal enhancement. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No abnormal fluid collection. PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No bowel wall thickening. No abnormal enhancement. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No abnormal fluid collection.

Output: 1.No evidence of active inflammatory bowel disease.2.Stable mild extrahepatic biliary ductal dilatation. No new or suspicious focal hepatic lesions.