Instruction: Generate impression based on findings.

Input: Postoperative changes are again noted from previous left frontal temporal craniotomy/cranioplasty. There is no intracranial mass or mass effect or pathologic enhancement within the brain to suggest metastatic disease. The ventricles and sulci are within normal limits. No evidence of ischemia or hemorrhage. No hydrocephalus or extra-axial collections. There is an incidental left cerebellar developmental venous anomaly as well as a mega cisterna magna. Paranasal sinuses and mastoid air cells are clear.Again seen is irregularity involving the left lateral orbital wall and sclerosis with mild expansion involving the left greater sphenoid wing as demonstrated on recent CT and MRI. No suspicious enhancement or discrete intraorbital mass is seen to suggest residual or recurrent tumor. Again noted is prominence of the left V2 nerve and mild enlargement of the left foramen rotundum, similar to prior, in the region of the previously seen mass. The optic nerves are normal in size and signal intensity, and are symmetric bilaterally. No retrobulbar mass, chiasmatic mass, or parasellar abnormality is seen. Extraocular muscles are unremarkable.

Output: 1. Posttreatment changes involving the left lateral orbit/sphenoid wing without evidence of recurrent tumor.2. No evidence of intracranial metastatic disease.


Instruction: Generate impression based on findings.

Input: Medial joint pain Note that the exam is slightly limited on several sequences secondary to motion artifact.MENISCI: There is globular increased T2 signal within the posterior horn of the medial meniscus which extends into the body, representing myxomatous degeneration of the meniscus; however no discrete tear is identified. The lateral meniscus is unremarkable. ARTICULAR CARTILAGE AND BONE: A small focus of signal abnormality is noted within the subchondral bone of the medial femoral condyle anteriorly, with heterogeneity of the overlying cartilage indicating focal degeneration. The remaining articular cartilage and marrow signal is otherwise normal for the patient's age. LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Mild cartilaginous degeneration of the knee with other findings described above.


Instruction: Generate impression based on findings.

Input: Foci of enhancement measuring less than 5 mm in the right insula, as well as other punctate foci in the anteromedial and lateral right superior frontal gyrus, and the left pons are unchanged. These are associated with susceptibility effect indicative of hemorrhagic metastases. There are no new foci of susceptibility effect or new suspicious intra-axial enhancement. There is no acute infarct, mass effect or midline shift. There are mild periventricular and subcortical white matter T2 hyperintensities which are nonspecific and likely represent chronic microvascular ischemic changes.There are several scattered calvarial enhancing lesions again seen as well as one involving the right mandibular condyle. There is diffuse worsening of T1 hypointensity involving the visualized upper cervical spine as well as the bilateral occipital condyles. There is increased enhancement involving the clivus.

Output: 1. No significant change in subcentimeter enhancing metastatic lesions within the brain parenchyma. No significant edema or mass-effect with any of the lesions. 2. Scattered small enhancing lesions in the calvarium are not significantly changed. There is more diffuse worsening of bone marrow signal abnormality involving the upper cervical spine as well as the occipital condyles which can be seen with marrow reconversion (such as with treatment with hematopoietic growth factors), although progression of osseous metastasis remains a less likely possibility.


Instruction: Generate impression based on findings.

Input: 68-year-old male with urothelial cancer. Concern for metastatic disease. ABDOMEN:LIVER, BILIARY TRACT: No hepatic lesions.SPLEEN: No significant abnormality noted.PANCREAS: Atrophic pancreatic parenchyma.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right-sided renal cysts most prominently in the lower pole, and no complex features are identified.New mild right-sided hydronephrosis with prominent wall thickening and corresponding T2 hyperintense signal intensity of the proximal ureter (axial series 4 image 44).RETROPERITONEUM, LYMPH NODES: Incidental note is made of a duplicated IVC (series 8 image 45). No retroperitoneal lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: Enlarged prostate compressing the base of the urinary bladder.BLADDER: Persistent asymmetric thickening and enhancement of the left lateral bladder wall. Mildly trabeculated urinary bladder, and increased T1 hyperintense signal could represent blood products (series 1401 image 63).LYMPH NODES: No suspicious pelvic lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Stable small sclerotic focus of the right sacrum (axial series 16 image 27) compared to the 4/20/2016 CT abdomen and pelvis exam.OTHER: No significant abnormality noted.

Output: 1. Persistent asymmetric left lateral wall thickening and enhancement of the urinary bladder. No suspicious pelvic or retroperitoneal lymphadenopathy seen.2. New mild right-sided hydronephrosis, appears to extend to level of proximal ureter where there is wall thickening and edema, uncertain whether related to inflammatory or infectious etiology given length of involvement (as opposed to neoplastic site); correlation with patient's clinical history and urinalysis recommended.


Instruction: Generate impression based on findings.

Input: 49-year-old male with right medial knee pain for 6 months with no improvement after physical therapy. Evaluate for meniscal tear versus chondral injury. MENISCI: Branching, linear signal abnormality is seen within the posterior horn of the medial meniscus extending from the root into the posterior aspect of the meniscal body, with a dominant horizontal component extending to the femoral articular surface and an additional vertically-oriented component seen more peripherally extending to the tibial articular surface. These findings are compatible with complex tear. Tiny para-meniscal cysts are seen at the periphery of the posterior horn. Anterior horn of the medial meniscus is preserved. Lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: Subjectively there is mild diffuse thinning of the femoral articular cartilage within the medial compartment without focal defect. The lateral compartment articular cartilage and patellofemoral articular cartilage are within normal limits.Bone marrow signal intensity is within normal limits.LIGAMENTS: Cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: Extensor mechanism is intact. ADDITIONAL

Output: Complex tear of the posterior horn of the medial meniscus as detailed above.


Instruction: Generate impression based on findings.

Input: History of papillary thyroid cancer and metastatic EBV associated nasopharyngeal carcinoma to the lung status post radiotherapy, which was completed in 3/2014 and surgery and radiotherapy for the lung metastasis completed in 10/2014. There is no appreciable residual nasopharyngeal mass. The skull base and cavernous sinuses appear to be intact. However, there is fat signal intensity in the regional bone marrow, which is likely attributable to radiation therapy. There are new bubbly T1 and T2 hyperintense secretions in the left sphenoid sinus. There is no significant lymphadenopathy in the imaged portions of the neck. There is a subcentimeter cystic lesion associated with the right temporomandibular joint. The lesion in the left midbrain has involuted. The lesion now measures up to 3 mm, previously 5 mm. There is no associated enhancement or associated surrounding edema. However, a lesion in the anterior right frontal lobe with an associated developmental venous anomaly has increased in size and contains a hematocrit level with T1 hyperintensity. There is an unchanged enhancing extra-axial mass overlying the left middle frontal gyrus that measures up to 7 mm in width with associated calvarial hyperostosis. The orbits are unremarkable.

Output: 1. No evidence of recurrent nasopharyngeal tumor.2. A cavernous malformation in the anterior right frontal lobe has increased in size due to interval subacute hemorrhage.3. Further decrease in size of the left midbrain cavernous malformation that previously hemorrhaged. 4. The extra-axial lesion overlying the left middle frontal gyrus is unchanged and likely represents a meningioma.5. Right temporomandibular joint synovial cyst.6. New secretions in the left sphenoid sinus may represent sinusitis.


Instruction: Generate impression based on findings.

Input: A 38 year old male with bicuspid aortic valve referred to cardiac MRI for further evaluation. Left VentricleThe left ventricle is in the upper limit of normal size with normal systolic function. The overall LV ejection fraction is 61%, the LV end diastolic volume index is 104 ml/m2 (normal range: 74+/-15), the LVEDV is 231 ml (normal range 142+/-34), the LV end systolic volume index is 52 ml/m2 (normal range 25+/-9), the LVESV is 116 ml (normal range 47+/-19), the LV mass index is 41 g/m2 (normal range 85+/-15), and the LV mass is 90 g (normal range 164+/-36). There are no regional wall motion abnormalities present. No evidence of myocardial late gadolinium enhancement to suggest underlying myocardial fibrosis, inflammation, or infiltration. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is mildly dilated with normal systolic function. The overall RV ejection fraction is 62%, the RV end diastolic volume index is 118 ml/m2 (normal range 82+/-16), the RVEDV is 248 ml (normal range 142+/-31), the RV end systolic volume index is 42 ml/m2 (normal range 31+/-9), and the RVESV is 93 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValvePatient is s/p aortic valve and aortic replacement. There is normal leaflet excursion. There is moderate aortic regurgitation. The regurgitant volume is 32ml and the regurgitant fraction is 28%.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve leaflets are thickened but open widely. There is moderate pulmonic regurgitation. His regurgitant volume is 41ml and his regurgitant fraction is 34%.Tricuspid ValveThe tricuspid valve opens widely. There is trace tricuspid regurgitation.AortaThere is a left sided aortic arch with a pseudo-bovine brachiocephalic branching pattern. An aortic root replacement is noted. There is no residual thoracic aortic aneurysm, dissection, or coarctation noted. The aortic measurements are as below:Sinus of Valsalva: 38x41mmSinotubular Junction: 31x33mmAscending Aorta: 32x33mmAortic Arch: 26x27mmDescending Aorta: 26x27mmPulmonary 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 FindingsSternal wires are noted. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is in the upper limit of normal size with normal systolic function, the LVEF is 61%. 2. The right ventricle is mildly dilated with normal systolic function, the RVEF is 62%. 3. An aortic valve and aortic root replacement are noted. There is mild thickening of the aortic valve with evidence of moderate aortic regurgitation.4. The pulmonic valve leaflets are thickened with moderate pulmonic valve regurgitation. 5. No evidence of thoracic aortic aneurysm, dissection, or coarctation. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Reason: eval for rotator cuff pathology History: R shoulder pain Images are of slightly suboptimal quality, secondary to noise.ROTATOR CUFF: Mild intermediate signal within the undersurface fibers of the supraspinatus and infraspinatus tendons suggests mild tendinosis, and perhaps mild undersurface fraying. We see no discrete rotator cuff tear, however. The supraspinatus and infraspinatus muscles are within normal limits. The teres minor and subscapularis muscles and tendons are within normal limits.SUPRASPINATUS OUTLET: There is edema within the distal clavicle; while this may be degenerative in etiology, there is a band of low signal intensity traversing the distal end of the clavicle, which raises the possibility of a small stress fracture. We see no abnormal edema within the acromion. There is no fluid in the subacromial/subdeltoid bursa. The acromion morphology is type II.GLENOHUMERAL JOINT AND GLENOID LABRUM: Given the limitations of a non-arthrogram study, the labrum is unremarkable. The glenohumeral joint is within normal limits. There is no joint effusion.BICEPS TENDON: The biceps tendon is within normal limits. ADDITIONAL

Output: 1.Very mild rotator cuff tendinosis. No discrete rotator cuff tear is identified.2.Edema within the distal clavicle, while nonspecific, may represent a stress fracture in the correct clinical context.


Instruction: Generate impression based on findings.

Input: Clinical question: Multiple sclerosis. Signs and symptoms: Numbness and tremor. Pre-and post enhanced brain MRI:Examination demonstrate slight prominence of cortical show slight primarily in the parietal lobes in a symmetrical bilateral fashion. This finding was noted on prior exam and demonstrate no significant change. The anatomical morphology of the brain is otherwise within normal. Signal intensity of brain parenchyma is also normal and without any detectable abnormal parenchymal or leptomeningeal enhancement.Pre-and post enhanced cervical MRI:Examination demonstrate normal signal intensity and caliber of cervical and uppermost visualized thoracic cord. There is no detectable abnormal enhancement of the cord or leptomeninges.There is normal signal intensity and alignment of the vertebral column. There is no detectable abnormal enhancement the vertebral column. There is no spinal stenosis or neural foraminal compromise at any level.

Output: 1.Pre-and post enhanced brain MRI demonstrates prominence of cortical sulci for patient's stated age of 38 in a symmetrical bilateral parietal lobes as detailed and without significant change since 2012 study. No signal abnormality of abnormal enhancement of the brain parenchyma. Unremarkable brain MRI otherwise.2.Unremarkable pre-and post enhanced cervical MRI.


Instruction: Generate impression based on findings.

Input: 43 year old female with a history of uterine fibroids. Status post bilateral uterine artery embolization. PELVIS:UTERUS, ADNEXA: Again seen is a myomatous uterus. The largest reference intramural posterior mid-body leiomyoma measures 6.3 x 5.6 x 5.1 cm (TR by AP by CC), previously 6.3 x 5.5 x 4.9 cm (series 601 image 37). There is persistent heterogeneous enhancement, which appears slightly decreased when compared to the prior study.Again seen are multiple additional fibroids measuring up to 2.0 cm which demonstrate persistent enhancement. The reference subserosal, pedunculated, fibroid arising off the anterior fundus measures 1.6 cm, previously 1.4 cm (22; series 901).There is thickening of the endometrium measuring up to 2.9 cm in diameter, with associated multiple subcentimeter foci of fluid signal intensity, which is nonspecific but suggestive of adenomyosis. Note is made of multiple small nabothian cysts. The reference collection in the right vaginal introitus measures 2.8 cm, previously 2.7 cm, compatible with a Gardner's duct cyst. There is a nonenhancing 2.9 cm collection in the expected location of the right adnexa which may represent a physiologic cyst, new from prior examination.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: 1.Persistent enhancement of multiple reference uterine fibroids which appear similar in size when compared to the prior study.2.Thickening of the endometrium with foci of subcentimeter cysts suggestive of adenomyosis without evidence of focal adenomyoma.3.Nonenhancing 2.9 cm right adnexal fluid collection may represent a physiologic cyst.


Instruction: Generate impression based on findings.

Input: 65-year-old woman with history of liver/pancreatic lesions and abdominal pain. ABDOMEN:LIVER, BILIARY TRACT: Two lesions are identified in segments 5 and 6 of the liver, both of which are T2 hyperintense, more so in the center, restrict on diffusion weighted images, and enhance peripherally. The remaining liver parenchyma is normal in signal and morphology. There is no intrahepatic biliary duct dilatation.The gallbladder is normal. There is mild common bile duct prominence measuring up to 4 mm.SPLEEN: The spleen is normal.PANCREAS: There is a multilobulated lesion with increased T2 signal in the pancreatic body measuring approximately 30 x 11 mm (series 501, image 17). Additionally, there is mild prominence of the pancreatic duct measuring up to 4 mm to the level of the ampulla.ADRENAL GLANDS: The adrenal glands are normal.KIDNEYS, URETERS: The kidneys are normal.RETROPERITONEUM, LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: The visualized small bowel is unremarkable. There is colonic diverticulosis without diverticulitis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Two solid hepatic lesions in segments 5 and 6 highly suspicious for malignancy, probably metastases although a primary site is not identified. Tissue diagnosis can be considered for further evaluation if clinically warranted.2.Sidebranch type IPMN of the pancreas.3.Mild prominence of the common bile duct and pancreatic duct to the level of the ampulla, likely with benign stricture.


Instruction: Generate impression based on findings.

Input: 36-year-old female patient with history of cholecystectomy with retained stones. Right upper quadrant/epigastric abdominal pain. ABDOMEN:LIVER, BILIARY TRACT: The patient is status post cholecystectomy. There are no foci of signal void within the common bile duct to suggest choledocholithiasis. There is no intra or extra hepatic biliary ductal dilatation. No abnormal fluid collection is identified. A hepatic cyst is noted within the caudate lobe.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: There is left renal cortical scarring. No evidence of hydronephrosis.RETROPERITONEUM, LYMPH NODES: Small gastrohepatic lymph nodes are likely reactive.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Postsurgical sequela of a prior cholecystectomy in the anterior abdominal wall.OTHER: No significant abnormality noted.

Output: Post-surgical changes of a cholecystectomy without evidence of abnormal fluid collection, biliary stones, biliary dilatation, or other acute finding to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: Fluid collection in lumbosacral region after trauma. There are partially-imaged fluid collections in the posterior lower back deep subcutaneous tissues that measure up to 9 mm in thickness at the level of L3 to L5 and 4 mm in thickness at the level of T12 to L1, where there are also several low signal partial septations. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. There is a partially imaged distended urinary bladder.

Output: Partially imaged nonspecific fluid collections in the posterior lower back subcutaneous tissues that measure up to 9 mm in thickness at the level of L3 to L5 and 4 mm in thickness at the level of T12 to L1. Differential considerations include hematomas versus a closed degloving injury (Morel Lavallee lesion).


Instruction: Generate impression based on findings.

Input: An extra-axial homogenously enhancing mass lesion located in the left cerebellum along the tentorium has minimally increased in size, currently measuring 1.8cm (AP) x 1.8 cm (ML) x 2.0cm (CC), previously 1.6 x 1.7 x 2.0 cm with MRI 7/30/2015, respectively. There is no significant adjacent parenchymal edema. This lesion is adjacent to the left transverse sinus which is focally narrowed but patent proximally and distally, similar to the prior exam. There is an additional extra-axial enhancing lesion in the left frontal high convexity which is calcified on prior CTs measuring 7 mm in thickness and is also unchanged in size. No new enhancing lesions are present. There is no evidence of intracranial hemorrhage.There is a new T2/FLAIR hyperintense focus at the right temporoparietal occipital junction, which is nonspecific and may relate to ischemia or other injury. Otherwise scattered punctate foci of T2 and FLAIR hyperintensity within the white matter are nonspecific and may reflect minimal small vessel ischemic changes similar to prior. Ventricles are normal in size. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1.Minimal gradual increase in size of a left posterior fossa meningioma compared to prior studies from 7/30/2015 and 8/7/2014.2.Stable appearance of a subcentimeter enhancing extra-axial lesion along the left high convexity, consistent with an additional meningioma.3.Again seen are minimal scattered foci of T2/FLAIR hyperintensity which are nonspecific but compatible with mild chronic small vessel ischemic changes. There is however a new focus at the right temporo-occipital junction, which is nonspecific and may relate to interval ischemia, inflammation, or other injury. No evidence of 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: History of visualization. Evaluate for adrenal pathology. Please note that the field of view of this study is intended to be limited to the adrenal glands.ABDOMEN:LIVER, BILIARY TRACT: The liver is not completely evaluated. There is no gross abnormality.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: The inferior extent of the left adrenal gland is not included in the field-of-view on the axial images. The patient is returning for a repeat study at no additional charge to the patient.KIDNEYS, URETERS: Subcentimeter T2-weighted hyperintensities, likely benign simple 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: The inferior extent of the left adrenal gland is not included in the field-of-view on the axial images. The patient is returning for a repeat study at no additional charge to the patient, please refer to this subsequent examination report for characterization of the adrenal glands.


Instruction: Generate impression based on findings.

Input: 45-year-old female presents with right knee weakness. MENISCI: Large horizontal tear with degeneration involving the entire lateral meniscus. There is also an intermargin tear of the posterior horn of the medial meniscus.ARTICULAR CARTILAGE AND BONE: There is full thickness cartilage loss, particularly along the posterior aspect of the lateral femoral condyle and also of the lateral tibial plateau. There is deep fissuring of the patellofemoral cartilage. Marrow edema in the lateral compartment is noted.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: Extensive tears involving the lateral meniscus and to a lesser extent the medial meniscus with full-thickness cartilage loss most severe in the lateral compartment.


Instruction: Generate impression based on findings.

Input: There are no areas of restricted diffusion to suggest acute ischemic infarction. There are several foci of abnormal signal compatible with subacute hemorrhage within the supratentorial brain parenchyma involving the left frontal, right parietal, bilateral temporal, and left occipital lobes appearing grossly similar to the recent CT. The largest focus of hemorrhage is in the left posterior temporal lobe and measures approximately 9 x 14 mm. These areas of hemorrhage are surrounded by varying amounts of increased T2/FLAIR signal compatible with vasogenic edema. Additional punctate foci of decreased signal on susceptibility-weighted images within the bilateral cerebral hemispheres is nonspecific but may reflect additional foci of chronic microhemorrhage. Increased FLAIR signal is present within the cortical sulci most prominent in the bilateral frontal and occipital lobes compatible with subarachnoid hemorrhage. 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 midline structures and craniocervical junction are within normal limits. Partial opacification of the paranasal sinuses and mastoid air cells is likely related to endotracheal intubation.There is no abnormal intracranial enhancement.

Output: 1.Multiple foci of subacute intraparenchymal hemorrhage within the bilateral cerebral hemispheres without associated significant mass effect. Additional punctate foci of susceptibility artifact in the bilateral cerebral hemispheres may reflect chronic microhemorrhages. Areas of hemorrhage may be related to bleeding diathesis and recent cardiac arrest. Given distribution, amyloid angiopathy is an additional differential consideration.2.Subarachnoid hemorrhage within the cortical sulci; continued follow-up is recommended as clinically warranted.3.No evidence of acute ischemic infarction.4.No abnormal enhancing lesions are detected.Findings discussed with Dr. PATEL, PARITA at 11:15 a.m. on 8/24/2015.


Instruction: Generate impression based on findings.

Input: A patient submitted outside study for review. Submitted for review are digital mammographic images (5/24/16), images from ultrasound guided biopsy of right breast with specimen radiograph and postprocedural right mammographic images (5/27/2016), breast MRI (6/3/16), ultrasound images (6/9/16) performed at outside institution. DIGITAL MAMMOGRAPHIC IMAGES (5/24/16):The breast parenchyma is extremely dense (BiRADS Density Category D), which limits the sensitivity of the mammogram . A BB marker is placed at upper outer quadrant of right breast, denoting the area of palpable lump.There is a cluster of pleomorphic calcifications at the site of palpable lump in the right breast at upper outer quadrant. The cluster measures approximately 18 mm in AP dimension.No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in left breast. IMAGES FROM ULTRASOUND GUIDED BIOPSY OF RIGHT BREAST WITH SPECIMEN RADIOGRAPH AND POSTPROCEDURAL RIGHT MAMMOGRAPHIC IMAGES (5/27/2016):An irregularly-shaped, ill-defined hypoechoic mass is detected at 11:00 position in the right breast, measuring 21 x 11 mm. This lesion likely corresponds to the area of pleomorphic calcifications on the mammogram., In addition, there is an ill-defined hypoechoic mass measuring 12 x 7 mm at 10:00 position. This mass is annotated as "area of pain/area of palp." There are a few benign-appearing lymph nodes in the right axilla.Ultrasound guided biopsy for the mass at 11:00 position and 10:00 position in the right breast were performed with an appropriate needle placement. Specimen radiograph demonstrates a single calcification within one of the cores.Postprocedural mammographic images demonstrate a coil clip at 11:00 position, near the cluster of calcifications, and a ribbon clip at 10:00 position in the right breast. Distance between these 2 clips is 23 mm on CC view, and 17 mm on ML view.Per outside radiology report, the pathology results for both sites were malignant.BREAST MRI (6/3/16):MR images were submitted with non-DICOM format, and this could not be processed at our workstation. We tried to upload the images from the original DVD, but again images could not be uploaded to our workstation.Pre and post contrast MR images uploaded to PACS are not interpretable, because only axial images are available and no subtraction images are available. On T2 weighted images and non-contrast T1 weighted images, there are two metallic artifacts, at posterior upper outer quadrant, corresponding to the biopsy clips. There are a few small cysts in the right breast.ULTRASOUND IMAGES (6/9/16):This study was performed for MR directed ultrasound after abnormal findings on the MRI performed 6/3/2016. Per outside radiology report, there was a small focal area of masslike enhancement in the retroareolar region in the right breast. On the provided ultrasound images, there is a simple cyst at retroareolar region, and a complicated cyst next to it. There are no suspicious findings in the ultrasound images.

Output: Biopsy proven malignancy in the right breast at upper outer quadrant. MRI provided from outside institution is not interpretable. MR directed ultrasound for the right retroareolar region demonstrated a simple cyst with a complicated cyst.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: The risks (including, but not limited to, those of bleeding, infection, allergic reaction, temporary nerve block, pain, and inability to access the joint) and benefits of the procedure were explained to the patient, and informed written consent was obtained. A pre-procedural “time-out” form was completed.The patient was placed supine on the fluoroscopy table. The right hip was localized fluoroscopically, and a spot radiograph was obtained. The course of the femoral artery was noted on the patient's skin using an ink marker. The skin was cleansed and covered with a sterile drape. The skin and subcutaneous tissues were anesthetized with 1% lidocaine using 25-gauge and 22-gauge needles.Under fluoroscopic guidance, a 20-gauge spinal needle was advanced into the joint. Next, 10 ml of a 50/50 mixture of Omnipaque 240 (to confirm the intra-articular position of the needle) and dilute Multihance (0.1 cc in a 10 cc vial of saline, for subsequent MR imaging) were injected into the joint. Contrast opacified the joint in the expected manner. A spot radiograph was obtained for documentation. The needle was withdrawn. Blood loss was negligible (<1cc), and patient tolerated the procedure well without immediate complication. An adhesive bandage was placed on the patient’s skin. Routine post procedure instructions were communicated to the patient. The patient was escorted to the MRI suite for further imaging in stable condition. Please refer to the subsequent MRI report for further information.Exposure time: 42 seconds.

Output: Successful right hip arthrogram injection.


Instruction: Generate impression based on findings.

Input: Female, 71 years old, with right foot pain. Assess for stenosis. Spinal alignment is within normal limits with the exception of a very mild curvature in the coronal plane. Vertebral body heights are maintained allowing for degenerative endplate irregularity. Mild degenerative endplate edema is seen at L1-2 and L5-S1. Predominantly fatty degenerative endplate signal change is seen from L2 through L4. Otherwise, bone marrow signal intensity is within normal limits. The visualized spinal cord and conus demonstrate normal signal intensity and morphology. Details pertaining to the cauda equina will be discussed below.All the intervertebral discs demonstrate loss of T2 signal. There is significant loss of disc height at L2-3 and L3-4 with less notable loss of height at other levels. Additional level specific findings are as follows:T11-12: As seen on sagittal images, mild bulging disc and superimposed right foraminal protrusion resulting in moderate right foraminal narrowing.T12-L1: Unremarkable.L1-2: Facet hypertrophy with small effusions. Ligamentum flavum thickening. Bulging disc with a superimposed right foraminal and far lateral protrusion. Mild generalized spinal canal stenosis. Moderate right foraminal narrowing. L2-3: Facet hypertrophy. Ligamentum flavum thickening. Bulging disc. Moderate generalized spinal canal stenosis with slight crowding of the cauda equina. Moderate left and mild right foraminal narrowing. L3-4: Facet hypertrophy. Ligamentum flavum thickening. Bulging disc. Moderate generalized spinal canal stenosis with slight crowding of the cauda equina. Moderate left and mild right foraminal narrowing. L4-5: Facet hypertrophy with minimal effusions. Ligamentum flavum thickening. Posteriorly projecting facet synovial cyst on the left. Severe generalized spinal canal stenosis with crowding and possible impingement of the cauda equina. Moderate left and mild right foraminal narrowing. L5-S1: Marked facet hypertrophy with effusions. Ligamentum flavum thickening. Disc bulging. Severe generalized spinal canal stenosis with slight crowding of the cauda equina. Moderate bilateral foraminal narrowing.

Output: Moderate to severe degenerative disease is seen at multiple levels in the lumbar spine. Fairly significant spinal canal stenosis is seen from L2-3 through L5-S1 with nerve root crowding and impingement as discussed above. Scattered mild-to-moderate foraminal narrowing is also demonstrated.


Instruction: Generate impression based on findings.

Input: Female 49 years old Reason: right knee pain History: as above MENISCI: Mild intrasubstance degeneration involving the posterior horn of lateral meniscus and posterior horn of medial meniscus that does not extend to an articular surface. The menisci are otherwise unremarkable.ARTICULAR CARTILAGE AND BONE: There is diffuse chondral thinning in the medial and lateral compartments with small foci of deeper chondral defects. There is foci of cartilage fibrillation and degeneration involving the extensor compartment.Marrow signal is normal. No acute fracture or malalignment.LIGAMENTS: Anterior and posterior cruciate ligaments are intact. EXTENSOR MECHANISM: The quadriceps and patellar tendons are intact.ADDITIONAL

Output: Intact menisci and cruciate ligaments.Mild tricompartmental cartilage degeneration.


Instruction: Generate impression based on findings.

Input: Meningioma and breakthrough seizure. There is an avidly enhancing right superior parietal convexity extra-axial mass that measures up to 22 mm. There is associated mass effect upon the underlying brain parenchyma, but no evidence of regional vasogenic edema. There are postoperative findings related to left suboccipital craniotomy with encephalomalacia in the left cerebellar hemisphere, but no evidence of a mass in the posterior fossa. There is diffuse dural thickening related to calcifications. There is encephalomalacia in the right lateral temporal lobe. There are scattered punctate foci of susceptibility effect in the bilateral posterior cerebral hemispheres. There is no evidence of acute intracranial hemorrhage or acute infarct. There is a left transparietal ventricular catheter in unchanged position. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is an enhancing mass in the right frontal scalp that measures up to 16 mm. There are bilateral posterior maxillary and mandibular cystic lesions.

Output: 1. Right parietal convexity meningioma with associated mass effect upon the underlying brain parenchyma, but no evidence of regional vasogenic edema2. Postoperative findings related to left suboccipital craniotomy related to medulloblastoma resection with encephalomalacia in the left cerebellar hemisphere, but no evidence of a mass in the posterior fossa. 3. Diffuse dural calcification may be a manifestation of Gorlin syndrome.4. Bilateral posterior maxillary and mandibular cystic lesions may represent keratocystic odontogenic tumors, which may also be a manifestation of Gorlin syndrome.5. A right frontal scalp lesion may represent a basal cell nevus or carcinoma.6. Scattered punctate foci of susceptibility effect in the bilateral posterior cerebral hemispheres may represent cavernous malformations.


Instruction: Generate impression based on findings.

Input: Female, 68 years old, with word finding difficulties. Brain lesion. Evaluate for growth, change. A large region of parenchymal thickening and T2 hyperintensity is seen centered on the left temporal lobe with involvement of both cortex and white matter. The lesion fills a majority of the left temporal lobe but does not extend completely to the anterior temporal tip. Posteriorly and superiorly, the lesion extends in infiltrative fashion into the left occipital lobe, the left splenium of the corpus callosum, and then superiorly into the left parietal white matter. In maximal dimension, the lesion measures up to 88 mm.The region of the lesion demonstrates mild diffusion restriction suggesting hypercellularity. The lesion enhances in a very vague and cloudlike matter with a few superimposed small nodules of enhancement. Increased vascularity within the lesion can be appreciated visually on the postcontrast images and is corroborated by rCBV mapping which shows significant elevated blood volume. Single and multi voxel spectroscopy performed on the lesion shows significant elevation of choline, reduction of NAA and presence of above normal levels of lipid. Myoinositol, an astrocytic marker, is also elevated within the lesion.The lesion induces moderate regional mass effect in the form of sulcal effacement and effacement of the left ventricular atrium and temporal horn. No brain herniation is suspected. Elsewhere in the brain, scattered small foci of T2 hyperintensity are seen in the periventricular regions, a nonspecific finding which may reflect chronic microvascular ischemic disease. No evidence of intracranial hemorrhage or any abnormal extra axial fluid collection is seen. The ventricular system, except as above, is unremarkable.

Output: A large infiltrative masslike lesion is seen centered on the left temporal lobe with extension into the occipital and parietal lobes as well as the splenium of the corpus callosum. Data from blood volume mapping and spectroscopy favor a glioma, perhaps of relatively higher grade.


Instruction: Generate impression based on findings.

Input: Left-sided sciatica with severe lumbar degenerative disease seen on x-ray. Five lumbar type vertebral bodies are presumed to be present. There are compression fractures involving the T12, L1, L2, L3, and L4 vertebral bodies. L5 vertebral body also demonstrates subtle deformity of the superior endplate without significant loss of height. Height loss is relatively worse involving the T12, L1, and L3 levels which appear to have been treated with cement augmentation/vertebroplasty. No edema within these vertebral bodies to suggest recent loss of height. There is some dextrocurvature involving the lower lumbar spine as well as minimal retrolisthesis of L5 on S1. Focal marrow signal abnormality is evident at the level of the vertebroplasties particularly at T12, possibly related to myeloma, but nonspecific, and can be correlated with history of the etiology of these compression fractures. No infiltrative or destructive lesions are evident within the remainder of the lumbar spine. Osteopenia is also evident on prior radiographs. Multilevel degenerative changes are seen, as described below:T12-L1: Mild disc bulge. No significant spinal canal stenosis. Mild right neural foraminal narrowing. No significant left neural foraminal narrowing.L1-L2: Mild disc bulge. No significant spinal canal or neural foraminal stenosis.L2-L3: Mild disc bulge as well as mild facet arthropathy. No significant spinal canal stenosis. Mild right neural foraminal narrowing. No significant left neural foraminal narrowing.L3-L4: Mild disc bulge, facet arthropathy, ligamentum flavum thickening. No significant spinal canal stenosis. Mild left and minimal right neural foraminal narrowing.L4-L5: Minimal disc bulge and moderate bilateral facet arthropathy. No significant spinal canal stenosis. Minimal narrowing of the neural foramina.L5-S1: Disc height loss with vacuum phenomena. Moderate bilateral facet arthropathy. No significant spinal canal stenosis. Mild left neural foraminal stenosis. Right neural foramen is patent.Paraspinous soft tissues are within normal limits.

Output: 1. Multiple compression fractures in the lumbar spine, relatively worse at the T12, L1, and L5 levels which have been treated with cement augmentation. No evidence of edema at any level to suggest recent loss of height.2. There is no spinal canal stenosis at any level. There is fairly mild neural foraminal narrowing at multiple levels, relatively worse at the left L3-L4 and left L5-S1 levels.3. Multilevel facet arthropathy, relatively worse at the L4-L5 and L5-S1 levels.


Instruction: Generate impression based on findings.

Input: There is no conclusive acute cord compression.There is abnormally low T1 and high T2 signal throughout multiple vertebrae and the sacrum compatible with metastatic disease. These findings are most extensive in the lower thoracic and upper lumbar spine vertebral bodies. The entire T12 and L1 vertebral bodies are involved and there is mild loss of height at L1 with dorsal convexity of the posterior cortex, which deforms the thecal sac resulting in moderate spinal canal narrowing. As seen on the prior MRI of the lumbar spine, the conus terminates at the L1-2 level. There is a decrease in caliber of the distal cord and conus with minimal high T2 signal which likely represents myelomalacia although given the adjacent bulging vertebral body cortex, some areas of recent mass effect cannot be excluded. CSF is seen surrounding the cord at this level.There is mild anterior wedge deformity of T5, deformity of both endplates of the T9 vertebral body as well as moderate deformities of the L2, 3 and 5 vertebral bodies with associated edema involving the adjacent discs and marrow.There is developmental narrowing of the entire cervical and mid to distal lumbar spine which, combined with degenerative disc disease, leads to spinal canal narrowing that is moderate to severe in the mid cervical spine and mild to moderate in the mid to lower lumbar spine. There is no abnormal cord signal at these levels.

Output: 1.No conclusive acute cord compression. Dedicated segment-specific MRI is recommended if symptomology localizes and/or if subsequent therapies are required for areas which have not had previous dedicated imaging.2.Diffuse vertebral and left sacral metastases with pathologic compression fractures at T5, T9, L1, L2 , L3 and L5. Convexity of the posterior aspect of the L1 vertebral body deforms thecal sac and results in moderate narrowing of the spinal canal. Decreased caliber and mild increased signal of the distal cord and conus at this level is most likely due to myelomalacia although superimposed recent mass effect on the cord cannot be entirely excluded.3.Developmental narrowing of the cervical and mid to distal lumbar spine with superimposed multilevel degenerative changes results in progressive spinal canal narrowing which is moderate to severe in the cervical spine and mild to moderate in the mid to lower lumbar spine.


Instruction: Generate impression based on findings.

Input: 54-year-old male with cutaneous T-cell lymphoma. Presents with right eye swelling and purulent drainage. Please evaluate for orbital cellulitis, sinusitis or abscess. Images of the retroseptal space of both orbits remain within normal limits. There is no evidence of any edematous changes of retro-orbital fat. The morphology and density of the globe remains within normal limits bilaterally in both their anterior and posterior chambers. The lens are in normal location.The extraocular musculature and optic nerves remain normal bilaterally.Extensive periorbital preseptal soft tissue thickening anterior to the right orbit is identified. No definitive evidence of any cavity formation or a sinus tract can be identified. The paranasal sinuses are well pneumatized and demonstrate no evidence of acute or chronic sinus disease.Limited images through the brain parenchyma demonstrates large area of low density in the left frontal lobe with no definitive evidence of enhancement. There are no prior CT examination or MRI examination of the brain on this patient's radiology file. This above finding may represent an area of old stroke and encephalomalacia however this should be further evaluated with dedicated CT of brain or an MRI for better evaluation.

Output: 1.Extensive right-sided preseptal periorbital cellulitis. No evidence of abscess formation or a sinus tract2.No evidence of any retroseptal abnormality.3.No evidence of acute or chronic sinusitis..


Instruction: Generate impression based on findings.

Input: Diagnosis: Neoplasm of unspecified nature of brain Malignant neoplasm of brain, unspecified siteClinical question: Eval for growth of high-risk low grade glioma on TMZ.Signs and Symptoms: astrocytoma.Comments: High-risk low grade astrocytoma. S/p RT/TMZ and now on TMZ. | The CSF spaces are appropriate for the patient's stated age with no midline shift. The patient is status post left frontal burr hole placement a track of susceptibility effect can be course from the burr hole to the left thalamic lesion suggesting this could be related to prior stereotactic biopsy.There is a left posterior thalamic lesion present with T1 hyperintensity and a focus of susceptibility effect which is stable in appearance when compared to the previous exam.There is a nonenhancing focus present in the left centrum semiovale T2 and FLAIR signal hyperintensity which is stable compared to the prior exam.A small lesion in the left temporal lobe subcortical white matter associated with contrast enhancement and susceptibility artifact measuring 6 mm in size is unchanged since the prior exam.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: Compared to the prior exam is no significant interval change in the patients left thalamic, left centrum semiovale lesions in the left periventricular white matter lesions.


Instruction: Generate impression based on findings.

Input: History of hepatitis C cirrhosis and HCC status post TACE RFA. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology.RFA defect in the inferior segment VI measuring approximately 2.5 x 2.2 cm (series 10/265). There is new central nodular rim-enhancement (series 10/image 57) measuring up to 1.9 cm which washes out on delayed imaging suspicious for tumor recurrence.No significant change in the RFA defect in segment VIII measuring 4 x 2.1 cm demonstrating intrinsic heterogeneous T1 weighted signal (series 9, image 30)a compatible with proteinaceous or blood products. Surrounding postcontrast peripheral wedge-shaped progressive enhancement likely represents post-treatment fibrosis.No new arterial enhancing lesions.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts and too small to characterize hyperintensities.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: There is new nodular rim enhancement within the segment VI RFA ablation cavity measuring up to 1.9 cm which demonstrates washout and is suspicious for tumor recurrence.


Instruction: Generate impression based on findings.

Input: Patient is status post left craniotomy for tumor resection with small extra-axial collection beneath the craniotomy flap appearing unchanged. There is increased T2/FLAIR signal surrounding the resection cavity with linear enhancement along the medial border appearing unchanged from the previous study. No new FLAIR signal abnormality, new mass effect, or suspicious enhancement. Susceptibility effect related to chronic blood products again seen. No hydrocephalus, mass effect, midline shift or herniation. Paranasal sinuses and the osseous structures are within the normal limits.

Output: Unchanged posttreatment changes in the left frontoparietal lobes without evidence of tumor recurrence.


Instruction: Generate impression based on findings.

Input: Clinical question: Stroke. Signs and symptoms: Left-sided weakness. Nonenhanced CT of brain:There is diffuse low-attenuation of the left cerebellum along its inferior portion. I cannot be certain whether this represent a stroke or is artifact please correlate with history and physical exam and if there is worsening of neurological condition follow-up with an MRI is recommended. There is no evidence of hemorrhage. Right-sided pontine stroke shows no definite change. Fourth ventricle remains within normal size and in midline. No evidence of any significant mass effect in the posterior fossa. Images through supratentorial space are unremarkable.

Output: 1.No evidence of hemorrhage since prior study.2.Larger area of low attenuation in the inferior left cerebellum could represent an artifact however possibility of an additional stroke cannot be ruled out. Correlate with history and neurological exam and if there is deterioration follow-up with an MRI is recommended.


Instruction: Generate impression based on findings.

Input: Clinical question: Is there evidence of bleed. Signs and symptoms: Altered mental status. Non-infused head CT:Examination demonstrates small foci of low attenuation involving the cortex of left frontal lobe in the distribution of left middle cerebral artery and is consistent with acute/early subacute cortical stroke. Follow-up with an MRI is recommended. There is no evidence of hemorrhage associated with this finding. This finding is best appreciated on axial images 15 through 17.Few small periventricular foci of low attenuation are primarily on the left side and are concerning for a small was ischemic stroke of indeterminate age. Considering that all findings are on the left side possibility of high-grade stenosis of the larger proximal vessel of the MCA or left internal carotid artery should be considered and follow all but his CTA is recommended.There is no detectable abnormality of right hemisphere. The ventricular system and midline is within normal.Calvarium is intact. Visualized mastoid air cells, orbits and paranasal sinuses are unremarkable.

Output: 1.Acute left middle cerebral artery stroke in the frontal lobe with no hemorrhagic component.2.Findings of a small vessel disease primarily in the left hemisphere.3.There is no evidence of hemorrhage, is significant mass effect, midline shift or hydrocephalus.4.Follow-up with an MR/MRA and or CTA is recommended.


Instruction: Generate impression based on findings.

Input: Male, 2 years old, with sensorineural hearing loss status post meningitis. Bilateral pathologic enhancement of the cochlea, vestibules, and to a lesser degree the semicircular canals is seen. The inner ear structures otherwise demonstrate normal morphology and T2 signal characteristics.No mass lesion or pathologic enhancement is evident in the IACs or CP angles. The eighth cranial nerves are present bilaterally. Questionable enhancement of the bilateral canalicular and the left cisternal segments of the facial nerve are seen. No abnormalities of the visualized brainstem are appreciated. Limited views of the brain again show prominence of the sulci and ventricles.

Output: 1.Bilateral pathologic enhancement of the cochlea and vestibular apparatus is seen. Findings are compatible with post meningitic labyrinthitis.2.The eighth cranial nerves are present bilaterally. There is questionable pathologic enhancement of portions of the bilateral facial nerve which may also be related to prior infection.


Instruction: Generate impression based on findings.

Input: Female, 41 years old.Weakness, radicular pain. Five lumbar type vertebral bodies are presumed to be present. The lumbar spine is in normal alignment, with a normal lumbar lordosis. The vertebral body and disk heights are well-maintained. The conus medullaris terminates at the L1-2 level. At T12-L1 through L4-5, there is no significant compromise to spinal canal or neural foramina. There is mild chronic marrow reactive change at the inferior endplate of L5. At L5-S1, there is a broad-based left latera recess disk extrusion which effaces the fat of the left lateral recess and posteriorly displaces the descending left S1 nerve root. The extrusion crosses midline, mildly effacing the fat of the right lateral recess as well. There is mild bilateral neural foraminal narrowing at this level, but the exiting L5 nerve roots are surrounded by fat.

Output: Disc extrusion at L5-S1 leading to encroaching the nerve roots at the left lateral recess and to a lesser degree the right lateral recess and posterior displacement of the descending left sided S1 nerve roots.


Instruction: Generate impression based on findings.

Input: 80 year-old female with hypertension, two weeks of forget fullness and falls. Evaluate for recent stroke. There is no evidence of any definitive interval change since prior examination. No evidence of any active stroke is detected. There is no evidence of hemorrhage, edema, mass-effect, midline shift or hydrocephalus. Further lobulation but an MRI is recommended.

Output: Stable CT of brain since prior study.


Instruction: Generate impression based on findings.

Input: Type 1 diabetes mellitus without complications [E10.9], Reason for Study: ^Reason: 27 y/o wm with T1Dm x 21 years, recent acute onset numness and tingling in hands and feet with 7 lb weight loss - eval for MS History: numbness pani and tingling in hands 27 years Male (DOB:1/19/1989)Reason: 27 y/o wm with T1Dm x 21 years, recent acute onset numness and tingling in hands and feet with 7 lb weight loss - eval for MS History: numbness pani and tingling in hands and feet, decreased appeite and weight lossPROVIDER/ATTENDING NAME: LOUIS H. PHILIPSON LOUIS H. PHILIPSON The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: MRI of the brain is within normal limits


Instruction: Generate impression based on findings.

Input: 45-year-old with history of right breast cancer on neoadjuvant chemotherapy. Please assess response. The patient also palpates a superficial mass in the left outer breast for which ultrasound is requested. A targeted bilateral ultrasound was performed for the known cancer and also the patient's area of concern. In the right breast 9 o'clock position at the site of the Hydromark biopsy clip, there is a residual hypoechoic area measuring 0.6 x 0.5 x 0.5 cm. This has no significant Doppler vascularity. Previously this measured 0.8 x 0.7 x 0.8 cm on 1/6/2015, 1.1 x 1.0 x 0.7 cm on 12/1/2014, and 2.5 x 1.2 x 1.6 cm before therapy. In the left breast at the site of patient concern, a 5-mm simple cyst was seen. This correlates with the MRI which showed cysts scattered in the left breast.

Output: 1. Minimal remaining soft tissue density adjacent to the Hydromark biopsy clip could represent a small focus of residual tumor versus fibrosis/scarring.2. Left breast simple cyst.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Clinical question: Patient with metastatic lung cancer with prior brain metastases status post radiation. Signs and symptoms: As above. Pre and post enhanced brain MRI:No evidence of restricted diffusion.Examination redemonstrate a small enhancing metastatic focus in the left anterior temporal lobe measuring approximately 4.5 mm compared to prior study measurement of 6 mm. There is no convincing evidence of any additional enhancing metastases lesions in the left anterior temporal lobe as was reported on prior study.There are no additional foci of parenchymal or leptomeningeal enhancement to suggest additional metastatic lesions. There are however multiple small foci of susceptibility signal changes without enhancement in bilateral cerebral and bilateral cerebellum without change since prior exam which could represent regions of chronic hemorrhage, abnormal, treated metastatic lesions or post treatment related findings.Ventricular system, CSF spaces and cortical sulci remain within normal and without change since prior exam.Calvarium is again demonstrate multiple foci of signal changes and enhancement without convincing evidence of interval change. The enhancement of the left frontal calvarial metastatic lesion is less conspicuous on current study which may be as a result of interval treatment. There is no detectable epidural spread of tumor from calvarial metastatic lesions.Approximately 5 mm left retro-orbital enhancing presumably metastatic lesion demonstrates no significant change.

Output: 1.No acute intracranial process.2.4.5 mm left anterior temporal metastatic lesion compared to prior study measurement of 6 mm. No convincing evidence of additional parenchymal or leptomeningeal enhancing metastatic lesions.3.Stable approximately 5 mm left retro-orbital enhancing metastatic focus.4.Multiple calvarial metastatic lesions without change in the size however the left frontal calvarial metastases demonstrate less conspicuous pattern of enhancement.


Instruction: Generate impression based on findings.

Input: Cystic renal mass. ABDOMEN:LIVER, BILIARY TRACT: Nodular liver morphology, without focal lesion. No biliary ductal dilation.SPLEEN: No significant abnormality noted.PANCREAS: Mild diffuse pancreatic duct dilation, similar to prior exam, without focal parenchymal lesion.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: The coarsely calcified cystic lesion in the mid-to-lower left kidney measures 2.0 x 1.7 cm (series 8, image 19), previously 1.9 x 1.8 cm. The lesion contains a small focus of apparent internal enhancement (series 13, images 31-34), enhancement is questioned based on subjective evaluation as, per the MRI technologist, satisfactory subtraction imaging sequences were not able to be acquired secondary to patient motion. Additional bilateral simple and hemorrhagic renal cysts are noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted. No lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: Calcified cystic lesion in the left kidney with a small focus of apparent enhancement, suspicious for a cystic renal cell carcinoma.


Instruction: Generate impression based on findings.

Input: Female 20 years old Reason: muscle inflammation - evaluate gluteal muscle and hamstring insertion History: lower extremity muscle pain and tightness PELVIS:No fracture is identified. There is mildly increased, asymmetric T2 and STIR signal in the left ischial tuberosity at the origin of the hamstring muscles. This abnormal signal is also seen along the tendon sheath. The hamstring tendons are intact and there is no edema within the imaged portions of the biceps femoris, semitendinosis, or semimembranosus muscles. The origin of the gluteal muscles appear normal without surrounding edema.

Output: Mild left hamstring strain without evidence of tendon tear.


Instruction: Generate impression based on findings.

Input: Transient right weakness, numbness, visual change, and headache. There is no evidence of masses in the spine. The vertebral column alignment is within normal limits, aside from mild straightening of the cervical spine. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal or neural foraminal stenosis. The spinal cord and cauda equina nerve roots are unremarkable. The paravertebral soft tissues are unremarkable. There is nonspecific prominence of the adenoids.

Output: No evidence of masses in the spine.


Instruction: Generate impression based on findings.

Input: Forgetfulness PTC refractory to I131. Increasing pulmonary mets and expansile lesion of C7. The vertebral column alignment is within normal limits. There is an expansile enhancing lesion within the anterior C7 vertebral body, without retropulsion or significant loss of vertebral body height. There is multilevel cervical and lumbar degenerative spondylosis with generally mild spinal canal stenosis, but up to moderate left L5-S1 neural foraminal stenosis. The spinal cord displays normal signal and morphology. The vertebral column alignment is anatomic, aside from slight retrolisthesis of L5 on S1. The paravertebral soft tissues are unremarkable. However, there are multiple pulmonary nodules.

Output: 1. Metastatic lesion within the anterior C7 vertebral body without retropulsion. 2. Multiple pulmonary metastases. Please refer to the separate chest CT report for additional details.3. Multilevel cervical and lumbar degenerative spondylosis with generally mild spinal canal stenosis, but up to moderate left L5-S1 neural foraminal stenosis.


Instruction: Generate impression based on findings.

Input: Clinical question: Adenocarcinoma, initial staging. Signs and symptoms: Adenocarcinoma. Pre-and post-enhanced brain MRI:Negative diffusion weighted series.The anatomical morphology as well as the signal intensity of brain parenchyma remains within normal on all MRI sequences.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination.There is no detectable abnormal enhancement the brain parenchyma or the meninges to suggest metastatic disease.The signal void of major intracranial arterial branches are identified.The signal intensity of the intracranial venous sinuses and pattern of enhancement is within normal limits.Calvarium demonstrate normal signal intensity and without detectable abnormal enhancement.Unremarkable images through the orbits and including axial fat sat post enhanced series.All paranasal sinuses and bilateral mastoid air cells and middle ear cavities demonstrate normal pneumatization signal patterns.

Output: Negative pre-and post enhanced brain MRI.


Instruction: Generate impression based on findings.

Input: Female, 38 years old, back pain with radiation to the right lateral thigh. The alignment is notable for mild straightening which may reflect patient positioning. The vertebrae are of normal morphology and normal marrow signal. The vertebral bodies are preserved in height. Intervertebral discs are notable for mild loss of T2 signal at L4-L5. The heights are preserved. The spinal cord is of normal morphology and signal characteristics. The tip of the conus medullaris is at the upper L2 vertebral level.L1-L2, L2-L3 and L3-L4: There is no significant degenerative change. There is no spinal canal or neural foraminal narrowing.L4-L5: There is a disc bulge, which causes flattening of the anterior aspect of thecal sac (mild spinal canal narrowing). There is also a superimposed right foraminal protrusion component resulting in moderate-to-severe right neural foraminal narrowing. There is mild left neural foraminal narrowing. There is facet arthropathy.L5-S1: There is right worse than left facet arthropathy but there is no spinal or neural foraminal narrowing.

Output: 1.A right foraminal L4-L5 disc protrusion causes moderate-to-severe right foraminal narrowing, affecting the right L4 nerve root. Other milder degenerative findings are present at L4-L5 as described above.2.There is no significant spinal canal or foraminal stenosis at the other levels.


Instruction: Generate impression based on findings.

Input: Reason: r/o osteomyelitis History: pain after needle stick There is mild edema and reticulation of the subcutaneous fat along the posteromedial aspect of the heel presumably at the site of the previously seen broken needle that has been extracted. There are small linear foci of low signal intensity within the subcutaneous tissues in this location which may represent suture material. We see no fluid collection within the soft tissues, nor do we see any abnormal signal intensity within the bones to indicate osteomyelitis. The visualized tendons appear intact. The ligamentous structures appear normal for age. Mild osteoarthritis affects the tibiotalar joint, but otherwise the ankle appears normal for age. We see no abnormal enhancement.

Output: Mild inflammatory changes in the soft tissues of the heel without evidence of osteomyelitis. Other findings as described above.


Instruction: Generate impression based on findings.

Input: A patient submitted outside study for review. Submitted for review are MRI guided biopsy images and right breast mammogram dated 5/13/2015 and performed at Rush University Medical Center. For comparison, MRI breast 4/21/2015 are available. MRI breast 4/21/2015: There is extreme amount of fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally. There is a 8 x 5 x 5 mm irregular mass in the right breast at the 11 to 12 o'clock position, for which MRI guided biopsy was subsequently done. Multiple cysts are seen in both breasts, right greater than left, on the T2W sequences.MRI breast guided biopsy and right breast post-procedure mammogram 5/13/2015: The obturator of the biopsy needle is along the posterior aspect and slightly deep to the 8 mm irregular mass at the time of biopsy in the right breast. Post-procedure ML and exaggerated CC lateral view of the right breast showed the biopsy clip to be in the appropriate location in the upper outer to central breast. Multiple scattered calcifications are present.Outside hospital pathology results from this biopsy showed Grade I DCIS, which is felt to be concordant with imaging.

Output: 8 mm irregular enhancing mass in the right breast 11 to 12 o'clock position biopsied to be Grade 1 DCIS with an appropriately positioned biopsy clip.Kindly submit bilateral diagnostic mammogram if performed. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Assess for vascular malformations compressing IAC nerve bundles: vertigo and noise in the left ear. Internal Auditory Canals MRI: 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 are secretions within the right maxillary sinus.Brain MRA: There is no evidence of significant steno-occlusive lesions, aneurysms, or vascular malformations. There is an accessory left superior cerebellar artery, which is a normal variant.

Output: No evidence of lesions compromising the internal auditory canal contents.


Instruction: Generate impression based on findings.

Input: 74 year old female status post vertebroplasty of L1. Low back pain. Evaluate cement placement. Since the prior MRI exam, there has been interval placement of methacrylate into the L1 vertebral body, which redemonstrates a compression fracture. There is stable mild retropulsion of the superior fracture fragment. No extravasation of methacrylate is seen. No evidence of complication of recent vertebroplasty procedure.Diffuse degenerative disk disease affects the lumbar spine. Degenerative change with vacuum phenomenon is seen at T11/12. Please refer to recent MRI for more specific description of neuroforaminal and central spinal stenosis.

Output: Findings of recent L1 vertebroplasty without evidence of complication.


Instruction: Generate impression based on findings.

Input: Reason: is there a dislocation/fx? History: deformity-pain Soft tissue swelling and patella alta, which can be seen with patellar tendon rupture. Both the patellar and quadriceps tendons are indistinct, and would be better evaluated with MRI as clinically warranted.Ossific density near medial femoral condyle likely a Pellegrini-Stieda lesion, which is seen following medial collateral ligament injury.

Output: Soft tissue swelling and patella alta, which can be seen with patellar tendon rupture. Both the patellar and quadriceps tendons are indistinct, and would be better evaluated with MRI as clinically warranted.


Instruction: Generate impression based on findings.

Input: Known left breast cancer evaluate response to chemotherapy Technical error during performing the scan. Repeat scan post contrast images will be performed. The referring physician and the patient were notified by the MRI technologist, Felicia.

Output: Technical error during performing the scan. Repeat scan to be performed.


Instruction: Generate impression based on findings.

Input: 44-year-old female with known CCMs and DVAs, prior history of bleeds in 1997, 2008, and 2012. Gamma Knife resection in 2002 of cavernoma. 2008 resection. Second CCM in the left parietal region found in 2012. There is a 7 x 7 mm (series 1301/72) T2 hypointense, central T1 hyperintense and peripherally T1 hypointense lesion in the posterior left middle temporal gyrus, which demonstrates mild-moderate contrast enhancement, consistent with a cavernous venous malformation. There is associated blooming on susceptibility weighted imaging. Adjacent prominent vessel, which extends to the margin of the left lateral ventricle, is consistent with an associated developmental venous anomaly.Focal deformity of the left inferior occipital bone with underlying hemosiderin staining and associated volume loss of the left cerebellar hemisphere, is compatible with prior surgery. There is a resection cavity in the left cerebellum, with associated atrophy of the inferior and middle cerebellar peduncles. There is a prominent associated vessel running posterior and lateral to the resection cavity, which may represent an associated developmental venous abnormality of the resected cavernoma.There is no restricted diffusion seen to suggest acute infarction. There is mild ex vacuo dilatation of the fourth ventricle; but otherwise, the ventricles and basal cisterns are normal. There is no midline shift or herniation. Few scattered punctate T2 hyperintense foci in the subcortical white matter are nonspecific. Intrinsic T1 hyperintensity in the dentate nuclei are seen bilaterally, likely relating to mineralization.

Output: 1. Findings compatible with cerebral cavernous venous malformation and developmental venous anomaly in the left posterior temporal lobe.2. Postsurgical changes consistent with reported history of prior cerebral cavernous venous malformation resection in the left cerebellar hemisphere, with possible associated developmental venous anomaly.


Instruction: Generate impression based on findings.

Input: Again seen are remote postsurgical changes of suboccipital craniectomy and encephalomalacia involving the bilateral medial cerebellar hemispheres. Previously seen acute infarct involving the left cerebellum on 9/1/2015 MRI has evolved with increased gliosis involving the left cerebellar vermis and hemisphere. There is new restricted diffusion involving the right cerebellar vermis suspicious for acute infarct with susceptibility artifact related to postsurgical changes limiting evaluation of this region. No associated mass effect or evidence of hemorrhage within the limitations of artifact.Elsewhere in the brain, there is no evidence of intracranial mass or mass effect. There is global parenchymal volume loss similar to prior. There is encephalomalacia involving the right superior frontal gyrus as seen before. There is also evidence of prior right anterior parietal burr hole placement. Additional scattered foci of T2/FLAIR hyperintensity in the periventricular and subcortical white matter are nonspecific but compatible with mild chronic small vessel ischemic disease. There is ex vacuo dilatation of the frontal horns, right greater than left. No hydrocephalus. There is moderate opacification of the right maxillary sinus similar to prior. Bilateral lens implants are noted. MRA HEAD

Output: 1. Acute infarct involving the right cerebellar vermis. Evolution of previously seen left cerebellar infarct and extensive encephalomalacia involving the bilateral medial aspect of the bilateral cerebellar hemispheres. Postsurgical changes in the posterior fossa again seen.2. Encephalomalacia involving the right frontal lobe again seen. Mild chronic small vessel ischemic disease.3. No high-grade stenosis or occlusion involving the major intracranial vasculature within the limitations of motion degraded study. Note MRA neck with gadolinium was not performed as patient could not tolerate further imaging.Dr. Ali discussed findings with Dr. Raychaudhuri at 1410 hours on 3/29/2016.


Instruction: Generate impression based on findings.

Input: Reason: progressive vision loss for the past few years History: progressive vision loss for the past few years MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Similar punctate lesions are present in the ponsNo abnormal enhancing mass lesions are appreciated within the brain parenchyma. 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.MRI orbits:The eyeballs are intact. No intraconal or extraconal space mass is identified. The extraocular muscles are intact. The lacrimal glands are symmetric and within normal limits in size and configuration. There is no optic nerve enhancement appreciated. The suprasellar cistern is intact .Some of the images are degraded by patient motion

Output: 1.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 2.Punctate lesions are present in the pons which are most likely vascular related at this age.3.No abnormal lesions are appreciated within the orbits.4.Some of the images are degraded by patient motion which could obscure more subtle abnormalities.


Instruction: Generate impression based on findings.

Input: Female, 85 years old, with hyperreflexia and falls. Evaluate for cervical stenosis, myelopathy. Alignment is anatomic. Vertebral body height and morphology are within normal limits. No evidence of pathologic marrow replacement or edema is seen. The visualized spinal cord is free of focal signal abnormality. No epidural lesions are suspected.C2-3: Posterior disc-osteophyte complex formation. No spinal canal or foraminal stenosis. C3-4: Posterior disc-osteophyte complex formation. No spinal canal or foraminal stenosis. C4-5: Posterior disc-osteophyte complex formation. Ligamentum flavum thickening. Mild spinal canal stenosis. Moderate right and mild left foraminal narrowing. C5-6: Posterior disc-osteophyte complex formation. No spinal canal stenosis. Severe left and moderate right foraminal narrowing. C6-7: Posterior disc-osteophyte complex formation. The spinal canal stenosis. Mild left foraminal narrowing. C7-T1: Posterior disc-osteophyte complex formation. No spinal canal stenosis. Mild left foraminal narrowing due largely to facet arthropathy.

Output: Degenerative disease of the disks and posterior elements is seen throughout the cervical spine. While there are no areas of severe spinal canal stenosis or obvious spinal cord impingement, significant neuroforaminal narrowing is evident on the right at C4-5 and bilaterally at C5-6.


Instruction: Generate impression based on findings.

Input: Reason: Pt complaining of pain in right knee 2 weeks History: pain in right knee, no swelling MENISCI: The medial and lateral menisci are normal in appearance.ARTICULAR CARTILAGE AND BONE: There is a full thickness cartilaginous defect measuring 9 x 8 mm in the lateral femoral condyle with underlying bone marrow edema. There is partial thickness cartilage tearing along the medial femoral condyle. The articular cartilage of the tibial plateau is intact. A small T2-bright focus along the physeal scar of the distal femur is mostly likely a small enchondroma. LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The quadriceps and patellar tendon appear intact.ADDITIONAL

Output: Full thickness cartilage defect in the lateral femoral condyle with underlying bone marrow edema.


Instruction: Generate impression based on findings.

Input: Facial weakness No evidence of acute ischemic or hemorrhagic lesion.Scattered high signal intensity lesions on bilateral periventricular white matter and centrum semiovale on FLAIR imaging indicate nonspecific small vessel ischemic disease.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: No evidence of acute ischemic or hemorrhagic lesion.Nonspecific small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: Elevated PSA, evaluate for Prostate cancer. PELVIS:PROSTATE:Prostate Size: 5.2 x 6.2 x 5.3 cmPeripheral Zone: Peripheral zone is fairly homogeneous without definite focal lesion.Central Gland: Hypertrophied central gland with likely hypertrophic nodules. One of the nodules in the right mid gland is fairly round circumscribed that is dark on T2-weighted sequence (image 22, series 601) measuring 1.3 x 1.1 cm with restricted diffusion (image 244, series 704) ; however favor a BPH nodule over malignancy.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: No definite evidence of extracapsular extensionBLADDER: No significant abnormality noted.LYMPH NODES: Small nonspecific external iliac lymph nodes are noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No suspicious lesion in the peripheral zone.2.Central gland hypertrophy with a dominant nodule in the right mid gland, favor BPH nodule over malignancy.


Instruction: Generate impression based on findings.

Input: Male, 78 years old, with acoustic neuroma and hearing loss, status post radiosurgery and 4/17/2015. A tumor is redemonstrated involving the left internal auditory canal and extending into the left cerebellopontine angle cistern. The lesion is stable or at most 1 mm larger in some dimensions. However, the lesion shows less intense internal enhancement and contains areas of T2 hypointensity and susceptibility suggesting hemosiderin staining.No additional intracranial enhancing lesions are seen. No restricted diffusion is detected. Patchy periventricular and subcortical white matter T2 hyperintensity is redemonstrated appearing similar to the prior examination. No abnormal extra-axial collections are observed. There is no evidence of acute intracranial hemorrhage. The ventricles and sulci are slightly prominent compatible with underlying parenchymal volume loss.Bone marrow signal characteristics are within normal limits. Chronic mucosal thickening or a mucous retention cyst is again seen within the right sphenoid sinus. Minimal mucosal thickening is seen within the maxillary sinuses.

Output: A tumor is redemonstrated involving the left IAC and CP angle cistern compatible with a vestibular schwannoma. Since the prior examination, this lesion is stable or at most 1 mm larger. It does, however, show less intense internal enhancement and appears to have developed internal hemosiderin staining. These findings could very well reflect the effects of radiosurgery. Continued follow-up is advised.


Instruction: Generate impression based on findings.

Input: Diagnosis: Migraine, unspecified, without mention of intractable migraine without mention of status migrainosus. Other convulsionsClinical question: Headache and history of seizures, evaluate for structural abnormalitySigns and Symptoms: New onset headaches, history of seizures The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Incidental note is made of a developmental venous anomaly in the left orbital gyrus.The hippocampi are symmetric bilaterally without signal abnormality or abnormal enhancementNormal 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: No abnormal mass lesions are appreciated intracranially to account for the patient's seizures. There is a developmental venous anomaly in the left frontal lobe which is an incidental finding


Instruction: Generate impression based on findings.

Input: 73-year-old female with HCV cirrhosis, hepatic lesion. Evaluate for HCC. Reevaluate nonspecific subcentimeter hepatic lesion noted on last CT. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic morphology with evidence of portal hypertension including mild splenomegaly, esophageal varices, splenorenal shunt, and recanalization of the umbilical vein. The portal veins are patent. No intra or extrahepatic ductal dilatation. The previously described arterially enhancing subcentimeter focus in hepatic segment 7 demonstrates mild apparent restricted diffusion (series 4 images 11, 45), no significant corresponding T2 signal abnormality, arterial enhancement (series 10008 image 31), and no washout. In retrospect, similar arterial enhancement in this region was present on the 6/8/2015 MRI abdomen exam (prior MRI series 10 image 30).SPLEEN: Mild splenomegaly measuring 12 cm in length. Subcentimeter T2 hyperintense foci compatible with cysts.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 ascites.BONES, SOFT TISSUES: T2 hyperintense fat-containing lesion of the T12 vertebral body is unchanged and likely represents a benign osseous hemangioma.OTHER: No significant abnormality noted.

Output: 1.Cirrhotic morphology with evidence of portal hypertension.2.The previously described subcentimeter arterially enhancing focus in hepatic segment 7 is again seen, shows mild apparent restricted diffusion, no washout, and no corresponding T2 signal abnormality. In retrospect, similar arterial enhancement in this region was present on the 6/8/2015 MRI abdomen exam. An early stage small HCC cannot be excluded, and continued surveillance imaging is recommended.


Instruction: Generate impression based on findings.

Input: Diagnosis: Migraine without aura, not intractable, without status migrainosusClinical question: assess for thrombusSigns and Symptoms: headache with right visual field loss, h/x of hemiplegic migraines MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.There appears be an arachnoid granulation in the junction of the left transverse sinus with the sigmoid sinus. This appearance has not changed since the MRI from 2/19/2016.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.MRV brain:The dural venous sinuses are patent. Straight sinus, internal cerebral veins and basal veins are identified and appear patent. The left jugular bulb and left sigmoid sinus are small. The left transverse sinus does not opacify. CT exam demonstrates congenitally small left jugular bulb and sigmoid sinus groove.

Output: 1.Hypoplastic left transverse sinus associated with congenitally small left sigmoid sinus and jugular bulb. There is no convincing evidence for dural sinus thrombosis.2.No abnormal lesions are identified within the brain parenchyma to explain the patient's right visual field loss


Instruction: Generate impression based on findings.

Input: Reason: meniscus tear History: pain and locked knee MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: A small bone contusion is present in the medial aspect of the lateral tibial plateau. There is irregularity and generalized thinning of the articular cartilage along the lateral facet of the patella, without definitive full thickness defect. The remainder of the articular cartilage of the right knee is unremarkable.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1.Small bone contusion in the medial aspect of the lateral tibial plateau.2.Irregularity and generalized thinning of the articular cartilage of the lateral patellar facet, without full-thickness defect.3.The menisci are unremarkable.


Instruction: Generate impression based on findings.

Input: 56 year old woman with history of VF arrest in the setting of an LAD dissection, referred for serial cardiac MRI to evaluate LV function and scar burden. Left VentricleThe left ventricle is mildly dilated with normal systolic function. The overall LV ejection fraction is 57%, the LV end diastolic volume index is 94 ml/m2 (normal range: 65+/-11), the LVEDV is 166 ml (normal range 109+/-23), the LV end systolic volume index is 42 ml/m2 (normal range 18+/-5), the LVESV is 71 ml (normal range 31+/-10), the LV mass index is 27 g/m2 (normal range 67+/-11), and the LV mass is 46 g (normal range 114+/-24). There is akinesis of the apical septum and anteroapical walls and thinning of the walls. There is persistent late gadolinium enhancement seen in the anteroapical/apical septum which is transmural and consistent with previous myocardial infarction. In addition, there is a new small focus of low signal in the same region suggestive of small calcification.Left AtriumThe left atrium is normal in size.Right VentricleThe right ventricle is upper normal in size with normal systolic function. The overall RV ejection fraction is 62%, the RV end diastolic volume index is 98ml/m2 (normal range 69+/-14), the RVEDV is 167l (normal range 110+/-24), the RV end systolic volume index is 38ml/m2 (normal range 22+/-8), and the RVESV is 64ml (normal range 35+/-13). Right AtriumThe right atrium is mildly dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is trivial mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC 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. Evidence of previous myocardial infarction in the apical septum and apical anterior walls with wall thinning, akinesis and transmural late gadolinium enhancement. This looks essentially unchanged when compared to the previous study. 2. The LV is mildly dilated with normal systolic function (EF 57%).3. The RV is upper normal in size with normal systolic function (EF 62%). When compared to the previous study of 2015, the LV function is unchanged and late gadolinium enhancement region is stable.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Ureter 91 for meniscal tear MENISCI: The lateral meniscus is normalThere is marked degeneration and fragmentation of the posterior horn of the medial meniscus. The anterior medial meniscus is extruded..ARTICULAR CARTILAGE AND BONE: There is marked loss of cartilage involving the medial condyle and medial tibial plateau.There are two focal full-thickness defects in the patella hyaline cartilage. LIGAMENTS: The posterior cruciate ligament is intact. The anterior cruciate ligament is completely torn.EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Marked abnormalities involving the medial joint along with tearing of the anterior cruciate ligament


Instruction: Generate impression based on findings.

Input: Cirrhosis due to hepatolithiasis. Evaluate for new biliary strictures and for HCC. ABDOMEN:LIVER, BILIARY TRACT: No suspicious hepatic mass.Mild central intrahepatic biliary ductal dilatation/irregularity, greater on the left, with narrowing of the left and right ducts near the common hepatic duct, similar to prior. Mild wall thickening of the common bile duct near the porta hepatis, unchanged.No hepatolithiasis or choledocholithiasis. Mild enlargement of the caudate lobe of the liver consistent with known cirrhosis, unchanged. Patent hepatic vasculature.SPLEEN: Unchanged mild splenomegaly. Small splenic cyst.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small bilateral renal cysts, unchanged. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. No suspicious hepatic mass. 2. Unchanged mild central intrahepatic biliary ductal dilatation/irregularity with narrowing of the left and right ducts near their confluence, likely due to areas of mild stricturing. No hepatolithiasis or choledocholithiasis.


Instruction: Generate impression based on findings.

Input: 64-year-old female with proximal muscle weakness. Evaluate for inflammatory myopathy. Moderate to severe degenerative changes affect both hips, right greater than left. There is associated increased bone marrow signal abnormality within the femoral heads and acetabuli, likely reflecting degenerative signal abnormality. There is osteophyte formation, subchondral cysts, and joint space narrowing. There is no increased signal abnormality within the imaged musculature of the left thigh to suggest myositis, as clinically questioned. There is no abnormal enhancement on postcontrast sequences. There is nonspecific subcutaneous edema along the lateral aspect of the vastus lateralis muscle.

Output: Degenerative osteoarthritic changes of both hips without evidence of inflammatory myopathy as clinically questioned.


Instruction: Generate impression based on findings.

Input: Evaluate for metastatic cutaneous squamous cell carcinoma. Face: There are postoperative findings in the left frontal scalp with an irregular, enhancing skin lesion that measures up to approximately 8 mm in thickness. The lesion extends towards the periosteum, but there is no invasion of the underlying calvarium. Other known face and scalp lesions are not discernible on the imaging. There is a left maxillary sinus retention cyst. The orbital contents are unremarkable.Neck: There is no evidence of measurable mass lesions or significant lymphadenopathy in the neck. The thyroid and major salivary glands are unremarkable. The major cervical flow voids are grossly intact. The osseous structures are unremarkable. The imaged intracranial structures are unremarkable.

Output: 1. Postoperative findings in the left frontal scalp with an irregular, enhancing skin lesion that corresponds to the known cutaneous squamous cell carcinoma. The lesion extends towards the periosteum, but there is no invasion of the underlying calvarium. Other known face and scalp lesions are not discernible on the imaging.2. No evidence of cervical lymphadenopathy.


Instruction: Generate impression based on findings.

Input: 64-year-old female with back pain. There are five lumbar type vertebral bodies. There is straightening of the normal lumbar lordosis. Vertebral body heights are maintained. Degenerative marrow changes are present in the L4, L5, and S1 vertebral bodies. Otherwise, bone marrow signal intensity is within normal limits. There is endplate irregularity at L4-5 and, to a lesser extent, at L5-S1 with loss of disc height at these levels. The conus medullaris terminates at L2-3.The mid to distal lumbar spine developmentally narrowed due to short pedicles and slight proliferation of the dorsal epidural fat. There is redundancy and thickening of the cauda equina nerve roots.On sagittal images at T9-10 and T10-11, there are diffuse disc bulges resulting in moderate spinal canal narrowing at both levels, with and moderate neural foraminal narrowing at T9-10. At T10-11, there is moderate to severe bilateral neural foraminal narrowing.T11-12: Mild disc bulge results in flattening of the ventral thecal sac. No significant compromise the neural foramina.T12-L1: There is no significant compromise to spinal canal or neural foramina.L1-L2: There is ligamentum flavum thickening but no significant compromise to spinal canal or neural foramina. Trace fluid in the right facet joint is likely degenerative in etiology.L2-L3: There is ligamentum flavum thickening a mild disc bulge with superimposed right distal foraminal/far lateral shallow disc protrusion resulting in mild right greater than left neural foraminal narrowing and mild central spinal canal narrowing.L3-L4: There is ligamentum flavum thickening and mild disc bulge resulting in moderate left and mild right neural foraminal narrowing and moderate central spinal canal narrowing.L4-L5: There is moderate diffuse disc bulge, severe ligamentum flavum thickening and moderate facet joint arthropathy resulting in severe central spinal canal narrowing, severe right neural foraminal and moderate left neural foraminal narrowing.L5-S1: There is mild diffuse disc bulge resulting in moderate central spinal stenosis, mild to moderate right neural foraminal and moderate to severe left neural foraminal narrowing. There is fluid in the facet joints bilaterally.

Output: 1.Multilevel degenerative changes worse at L4-5 where there is severe central spinal canal narrowing, severe right neural foraminal and moderate left neural foraminal narrowing.2.Underlying mid to distal lumbar spine developmental narrowing.