Instruction: Generate impression based on findings.

Input: Reason: r/o new demyelinating lesions History: stiffness, confusion MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. There is redemonstration of a moderate degree of periventricular and subcortical white matter lesions which are hyperintense on T2 and flair sequences. Many of these lesions are perpendicular to the lateral ventricles. There is a lesser degree of posterior fossa white matter lesions present in the brain stem. There are enhancing foci present in the periventricular white matter adjacent to the frontal horn of the right lateral ventricle and the periventricular white matter adjacent to the right ventricular trigone. There are a couple subcortical white matter enhancing foci in the left middle frontal gyrus there and additional punctate focus of contrast enhancement is present in the subcortical white matter of the right precentral gyrus medially.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 cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. There is a redemonstration of cord signal hyperintensity along the right posterior lateral aspect of the spinal cord at the C3 vertebral body level, the right posterolateral aspect of the spinal cord at the C4 vertebral body level,at the left hemicord at the C3 vertebral body level and the posterior spinal cord at the C5-6 level.Since the prior exam the patient has undergone anterior fusion from C3 through C6. Compared previous effacement of spinal fluid ventral and posterior the spinal cord at C3-4 and C4-5 has improved. There is no spinal stenosis appreciated on the current exam.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.Thoracic spine:The thoracic vertebral bodies are appropriate in the overall alignment and height. No abnormal foci of enhancement are appreciated in the thoracic spinal cord.There is T2 signal hyperintensity in the thoracic spinal cord at the right posterior and lateral aspect of the spinal cord at the T3-4 level, along the right hemicord at the the T6 and T7 vertebral levels There is artifact which partly obscures visualization of the spinal cord at the T9 level..There is no compromise of thoracic spinal canal or exiting nerve roots. No abnormal enhancing lesions are identified in the thoracic spine.There are small pleural effusions present

Output: 1.Enhancing lesions located in the left and right frontal lobe subcortical white matter as well as along the periventricular white matter adjacent to the right lateral ventricle are suspected to represent acute plaque formation. There are multiple white matter lesions scattered predominantly and supratentorial brain but also infratentorial brain are compatible with patient's diagnosis of demyelinating disorder. These are mostly similar compared to the prior exam.2.Multiple cervical spinal cord lesions are stable compared to prior exam and are compatible with patient's diagnosis of demyelinating disorder. 3.Status post cervical spine surgery with reduction of spinal stenosis4.Thoracic spinal cord lesions are present which are compatible with patient's diagnosis of demyelinating disorder. These were not clearly identified on the prior exam5.There are small pleural effusions present


Instruction: Generate impression based on findings.

Input: There is no evidence of acute intracranial hemorrhage, mass, or acute infarct. There is susceptibility effect within the right superior frontal sulcus compatible with chronic subarachnoid hemorrhage. There are mild scattered punctate foci of T2 hyperintensity within the supratentorial white matter. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact, although, there is an apparent medially directed 2-mm outpouching involving the flow void of the right cavernous internal carotid artery. The skull and scalp soft tissues are unremarkable. There is minimal fluid and mucosal thickening within the sphenoid sinuses. There are partially imaged degenerative changes of the cervical spine resulting in at least mild spinal canal stenosis at C4-C5.

Output: 1.No evidence of acute infarct. 2.Mild chronic small vessel ischemic disease.3.Chronic right frontal subarachnoid hemorrhage. 4.Probable approximately 2mm aneurysm of the medial right cavernous carotid artery into the cavernous sinus is not well evaluated on this exam. Dedicated vascular imaging may be obtained for further evaluation.5.Fluid in sphenoid sinuses. Please correlate clinically.


Instruction: Generate impression based on findings.

Input: Examination is mildly limited secondary to patient motion. The ventricles and sulci are within normal limits. The cisterns remain patent. There is no midline shift or mass effect. Multifocal small round subcortical T2 hyperintense foci are noted without associated susceptibility artifact or enhancement. Additionally, there is patchy T2 hyperintensity within the pons. There are no areas of pathological enhancement. There is no diffusion abnormality. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. There is fluid in the bilateral mastoid air cells, left greater than right. Patchy T1 and T2 signal hyperintensity in the left posterior tongue with suggestion of volume loss may represent posttreatment/postoperative changes when compared to prior MRI of the neck dated 05/18/2016.

Output: 1.No areas of abnormal pathologic enhancement to suggest metastatic disease.2.Multiple foci of subcortical T2 hyperintensity are nonspecific, some of which may represent mild chronic small vessel ischemic changes, with smaller foci along the superior frontal gyri possibly relating to enlarged perivascular spaces with marginal gliosis.3.Postoperative/posttreatment changes suggested along the left posterior oral tongue, incompletely evaluated


Instruction: Generate impression based on findings.

Input: Ms. Dazzena is a 59-year-old female with biopsy-proven right breast cancer and disease positive lymph node. She presents today for staging. There is scattered fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.Spanning the entire right superior breast is an extensive area of clumped nonmass enhancement measuring approximately 4.7 x 8.2 x 3.9 cm (AP x ML x SI). Within this region of clumped non-mass enhancement are three discrete irregular enhancing masses, which correspond to the masses identified on recent ultrasound exam in the right breast 1:00, 3:00 and 9:00 radians respectively. Susceptibility artifact from biopsy marker clip is identified in the medial aspect of this clumped nonmass enhancement (adjacent to the right 3:00 radian mass), compatible with biopsy-proven malignancy. In addition, there is diffuse skin thickening present about the entire right breast, measuring up to 8 mm in thickness.There is no abnormal MR enhancement identified in the left breast.There are multiple enlarged right axillary lymph nodes identified, the largest of which measures approximately 1.9 cm. One of these enlarged axillary lymph nodes has susceptibility artifact from a biopsy marker clip, compatible with recently biopsy proven lymph node. There are no abnormal axillary lymph nodes in the left axillary region.

Output: (1) Multicentric biopsy proven malignancy of the right breast with disease positive lymph node(2) No MR evidence of malignancy in the left breast.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: 54 year old with a history of left nipple-sparing mastectomy and sentinel node biopsy for DCIS/ADH with reconstruction in 09/2011. There is scattered fibroglandular tissue in the right breast.Mild parenchymal enhancement is noted in the right breast. The patient is status post left mastectomy and reconstruction.No abnormal enhancement is seen in either the right breast or left reconstruction. A few scattered cysts are present in the right breast. A few scattered enhancing foci are similar to the prior study. No abnormal lymph nodes are identified in either axillary region.A few tiny high T2 signal hepatic lesions are probably benign such as cysts.

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


Instruction: Generate impression based on findings.

Input: Evaluate for biliary stones, dilatation seen on prior sonography, reportedly status post OLT in 1996 ABDOMEN:LIVER, BILIARY TRACT: Mild hepatomegaly. Left greater than right biliary duct dilatation. Dilatation extends to level of what appears to be proximalmost CBD where there is a focus of signal void suspicious for choledocholithiasis, focus measures up to 10 mm in coronal plane (image 20 series 701). Please note that a focal stricture at this level (at presumed site of postsurgical anastomosis) cannot be excluded. Possible separate left-sided biliary system that appears to end blindly on image 23 series 601, correlate with patient's operative report. Possible additional minimal ductal debris/stones in left liver. There is a fairly simple appearing fluid collection in the left upper quadrant that extends to level of greater curvature of stomach, collection measures 10 x 3 cm on image 19 series 501 and was not present on prior 2012 CT study, no corresponding T1 hyperintensity seen. Hepatic cyst formation.SPLEEN: Splenule formation. Relatively decreased T2 signal in spleen when compared to liver and suggestion of mildly decreased signal in liver parenchyma on in phase imaging compared to opposed phase imaging, may be seen in setting of iron deposition disease.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small renal cyst formation.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Mild anasarca. Possible subcentimeter thoracic vertebral body hemangioma. Ventral abdominal postsurgical sequela.

Output: 1. Left greater than right intrahepatic biliary duct dilatation, extending to level of 10 mm focus of signal void suspicious for choledocholithiasis. Please note that a focal stricture at this level, at presumed site of postsurgical anastomosis, cannot be excluded.2. Left upper quadrant fluid collection extending from superior/medialmost aspect of liver inferiorly towards greater curvature of stomach, nonspecific and correlation with patient's procedural history recommended, biliary leak not excluded.3. Equivocal findings for iron deposition disease as above.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for possible aneurysms seen on MRI. Signs and symptoms: Possible aneurysm seen on MRI. CTA of intracranial circulation:Source images, MIP and 3-D reformatted images were obtained.Vertebral basilar system:Patent bilateral intracranial vertebral arteries and bilateral pica branches. Patent basilar artery and its branches and with no pathology.Carotid system:Right internal carotid artery across the skull base and through the cavernous sinus remains normal. Right supraclinoid internal carotid artery is unremarkable. Hypoplastic left A1.Right middle cerebral artery is normal in its M1 segment. There is an aneurysm at the bifurcation of right middle cerebral artery which measures 11.2-mm in transverse axis and 8.5-mm in cranial cephalad axis (coronal reformatted image 120). This aneurysm projects directly laterally and shows uniform enhancement. The aneurysm sac appears to incorporate the distal tip of right middle cerebral artery and the origins of superior and inferior divisions of the right middle cerebral artery. There is no detectable internal defect to suggest presence of clot. The distal branches of right MCA beyond this aneurysm remain normal.The left internal carotid artery across the skull base and in its cavernous component are within normal limits. The left missing or free and its branches are within normal limits. The left A1 is prominent and fills both anterior cerebral arteries through a patent anterior communicating artery. There is slight ectasia of the distal left A1 immediately proximal to its junction to the anterior communicating artery. There is no distinct aneurysm.CTA of the vasculature of the neck:Right common carotid artery, right internal carotid artery and including their origins are normal thereleft common carotid, left external carotid artery and their origins are within normal.Right vertebral artery and including its origin is unremarkable.Left vertebral artery and including its origin is normal.Nonenhanced CT of brain:Focal area of increased density along the superior aspect of the vermis a left paramedian location is again identified. There is no associated mass effect with this finding and no change in its size since prior CT and MRI exam. Findings could represent area of calcification or a cavernoma. On coronal reformatted image number 53 this lesion measures 14.2 times 10.5-mm.Well demarcated high density lesion at the expected level of right MCA bifurcation measures 9.3 x 9.7-mm and is believed to represent an aneurysm. This examination is otherwise essentially unremarkable.60 cc of Omnipaque 350 is administered problem study.

Output: 1.Aneurysm of right MCA bifurcation with no internal thrombus. Aneurysm measures 11.2 x 8.5-mm in size and has a direct lateral projection. The aneurysm sac appears to incorporate distal right M1 and the origins of M2 segments of the middle cerebral artery. There is hypoplastic right A1 with minimally ectatic distal left A1 however no distinct aneurysm. The CTA of intracranial circulation is otherwise unremarkable.2.Unremarkable CTA of the vasculature of the neck.3.Stable CT examination of brain with partially thrombosed right MCA aneurysm and focal area of calcification or cavernoma in the superior vermis in left paramedian location.


Instruction: Generate impression based on findings.

Input: 77 year old male with a history of lymphoma, cardiomyopathy, hypertension, hyperlipidemia, diabetes, and chronic kidney disease. Etiology of cardiomyopathy unclear.MEDICATIONS: Alendronate, Iron, Finasteride, Folic Acid, Glipizide, Insulin, Lisinopril, Metformin, Potassium, Sitagliptin. First Pass PerfusionDuring hyperemia, no perfusion defects were present.Viability/ Myocardial ScarThere is a small non-transmural myocardial infarction involving the apical inferior wall and a very small focal transmural myocardial infarction involving the apical anterior wall, based on late gadolinium enhancement. The remainder of the myocardial is free of myocardial infarction, fibrosis, inflammation, or infiltration. The majority of the myocardium is viable.Left VentricleThe left ventricle is mildly dilated with mildly reduced systolic function. The overall LV ejection fraction is 45%, the LV end diastolic volume index is 111 ml/m2 (normal range: 74+/-15), the LVEDV is 229 ml (normal range 142+/-34), the LV end systolic volume index is 61 ml/m2 (normal range 25+/-9), the LVESV is 126 ml (normal range 47+/-19), the LV mass index is 68 g/m2, and the LV mass is 140 g. There is hypokinesis of the apical inferior wall. Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 49%, the RV end diastolic volume index is 91 ml/m2 (normal range 82+/-16), the RVEDV is 187 ml (normal range 142+/-31), the RV end systolic volume index is 47 ml/m2 (normal range 31+/-9), and the RVESV is 96 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern. The proximal portion of the descending thoracic aorta is mildly dilated (34mm). Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. No perfusion defects/ "ischemia" present during hyperemia; however, the diagnostic sensitivity may be limited in individuals with reduced ejection fraction.2. There is a small non-transmural myocardial infarction involving the apical inferior wall and a very small focal transmural myocardial infarction involving the apical anterior wall. The remainder of the myocardial is free of myocardial infarction, fibrosis, inflammation, or infiltration. The majority of the myocardium is viable.3. Mild left ventricular dilation with mildly reduced systolic function (LVEF 45%). There is hypokinesis of the apical inferior wall.4. Normal RV size with mildly reduced systolic function (RVEF 49%).5. Proximal portion of the descending thoracic aorta is mildly dilated.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Female, 49 years old, with pituitary adenoma, off Dostinex for one year, assess for changes. The right aspect of the pituitary gland remains slightly fuller than the left, a stable finding over multiple prior studies. Contrast enhancement within the right aspect of the gland is very slightly heterogeneous, also unchanged. No discretely measurable mass is identified within the pituitary gland on the present study and no new abnormalities are detected. The pituitary stalk continues to enhance normally and sits at midline. No encroachment of the suprasellar cistern is seen. The visualized optic apparatus is unremarkable. Incidental note is made of a subcentimeter enhancing focus within the right frontal white matter which is stable dating back to 2003 and which likely represents a small vascular anomaly.

Output: Very slight heterogeneity of contrast enhancement persists in the right aspect of the pituitary gland which may reflect the previously treated lesion at this location. No new or concerning findings are seen on today's study.


Instruction: Generate impression based on findings.

Input: 66-year-old woman with history of pancreatic cancer status post multiple Whipple 8/2014, now with liver mass, pain, and fever. ABDOMEN:LIVER, BILIARY TRACT: Multiple, mildly T2 hyperintense lesions with thick peripheral enhancement are seen throughout the liver. The largest of these in the hepatic hilum and measures 83 x 79 mm (series 16, image 74). Additional, smaller lesions are seen including a segment 8 lesion (series 16, image 52) which measures 18 x 18 mm and a subcentimeter lesion in the peripheral segment 8 (series 16, image 64).The left portal vein appears to be obliterated by the adjacent tumor (series 1503, image 60).There is moderate to severe biliary duct dilatation of the right and left hepatic biliary system. The main hepatic duct is not visualized.SPLEEN: Spleen is normal.PANCREAS: The patient is status post Whipple procedure.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left renal cysts are noted, the kidneys are otherwise normal.RETROPERITONEUM, LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: Patient status post duodenectomy/Whipple. The visualized colon is normal.BONES, SOFT TISSUES: Postoperative findings are seen in the ventral abdominal soft tissues.OTHER: There are small bilateral pleural effusions.

Output: 1.Multiple hepatic lesions compatible with metastases from patient's known pancreatic cancer.2.Intrahepatic biliary dilatation secondary to metastatic lesions


Instruction: Generate impression based on findings.

Input: Pre-op planning for biopsy: left sided progressive weakness and concern for encephalopathy. There is mild swelling and T2 hyperintensity involving the majority of the right frontal lobe cortex most conspicuous involvement along the right lateral frontal lobe, perisylvian region, and insula. There is also diffuse abnormal signal and edematous appearance of the mildly enlarged right thalamus and basal ganglia. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Preoperative planning MRI for biopsy of extensive right cerebral hemisphere grey matter abnormality.


Instruction: Generate impression based on findings.

Input: Chronic low back and hip pain Due to technician error, the sacroiliac joints are only partially visualized on axial T1 and axial STIR sequences. As a result, the patient will be recalled for repeat imaging at no additional cost. What is seen of the sacroiliac joints on this exam is unremarkable.

Output: Nondiagnostic study due to technician error. The patient will be recalled for repeat imaging at no additional cost.


Instruction: Generate impression based on findings.

Input: Female, 31 years old, with history of metastatic breast cancer and extensive bony metastases complaining of weakness and paresthesias in the lower extremities for three days. Concern for cord compression. Widespread osseous metastatic disease is again seen affecting all spinal levels. Extent of disease appears grossly similar to prior examinations. Scattered mild to moderately compressed vertebral bodies without significant retropulsion are also unchanged.No definite evidence of any cord compression or extrinsic mass effect on the cord is seen. Subtle thickening of the cord and STIR hyperintensity at the T12-L1 level is noted, of uncertain significance.

Output: 1.Widespread osseous metastatic disease, grossly similar to prior in terms of extent.2.No definite evidence of extrinsic cord compression.3.An area of subtle cord thickening and STIR hyperintensity is seen at the T12-L1 level. This should be further evaluated with dedicated MR imaging with contrast.


Instruction: Generate impression based on findings.

Input: Evaluate for possibility of infection or neurosarcoid given history of sarcoid or immunocompromised state. Persistent headaches since february following head trauma. There is no evidence of intracranial hemorrhage, abscess, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No stigmata of neurosarcoidosis or intracranial infection.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 45-year-old female with mother diagnosed with breast cancer at 42 years old. Multiple prior right breast biopsies with atypical lobular hyperplasia. On tamoxifen for 2 months. Prior right breast surgery/scarring. Per EPIC, patient with history of ADH and LCIS. There is extreme amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.Few bilateral subcentimeter cysts are again identified, some of which are new from prior. Biopsy clip artifact is again identified within the right outer breast, unchanged.No suspicious enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Sarcoidosis, unspecified [D86.9], Reason for Study: ^Reason: question of neurosarcoidosis (cannot get contrast) History: fall with h/o sarcoid No evidence of acute ischemic or hemorrhagic lesion on the scan.Several scattered FLAIR/T2 high signal intensities on bilateral periventricular white matter are nonspecific, likely represent small vessel ischemic disease at this age group.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, 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.Bilateral lenses are not seen representing post operative status.

Output: 1. Nonspecific periventricular white matter lesions likely represent small vessel ischemic disease.2. No evidence of acute ischemic or hemorrhagic lesion.


Instruction: Generate impression based on findings.

Input: 51-year-old female with knee pain and instability, rule out meniscal or ligamentous injury MENISCI: The menisci are intact bilaterallyARTICULAR CARTILAGE AND BONE: There is focal full-thickness cartilage loss along the medial femoral condyle measuring approximately 7 mm (ML) x 5 mm (AP). The articular cartilage of the lateral compartment is intact. There is severe narrowing at the patellofemoral articulation with bone on bone apposition as well as underlying edema and subchondral cysts in the patella and lateral aspect of the trochlea. There is full-thickness cartilage loss involving the patellar apex and lateral facet as well as the lateral aspect of the trochlea.LIGAMENTS: The ACL and PCL are intact. The medial and lateral collateral ligament complexes are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: Focal full-thickness defect in the articular cartilage along the lateral femoral condyle as well as severe osteoarthritis and cartilage loss at the patellofemoral articulation. The menisci and ligaments appear intact.


Instruction: Generate impression based on findings.

Input: Nasopharyngeal carcinoma treated with chemotherapy and radiation. There are secretions in the posterior nasopharynx, but no evidence of measurable nasopharyngeal mass. The skull base appears to be intact. There is no significant cervical lymphadenopathy. The partially imaged intracranial structures are unremarkable. The thyroid and salivary glands appear unchanged. There is fluid signal in the bilateral mastoid air cells. The major cervical flow voids are grossly intact. There is a posterior small disc osteophyte complex at C5-6 that abuts the spinal cord.

Output: 1. No evidence of locoregional nasopharyngeal tumor recurrence of significant lymphadenopathy.2. Nonspecific effusions in the bilateral mastoid air cells.


Instruction: Generate impression based on findings.

Input: Reason: History of urothelial carcinoma, evaluate for lesion seen near/in liver - is it cancer, or something else? Please use low dose of contrast - pt has GFR in the 30s History: as above ABDOMEN:LIVER, BILIARY TRACT: Left hepatic lobe lesion, corresponding to findings on prior CT, measures 2.3 x 2.3 cm. This lesion is bright on T2-weighted images with peripheral nodular enhancement which fills in, likely a hemangioma. An additional punctate nonenhancing T2 hyperintensity is present in the right hepatic lobe, too small to characterize but likely representing a cystSPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right ureter is mildly dilated with hyperenhancing wall, likely reflecting inflammation. There is mild atrophy of the right kidneyRETROPERITONEUM, 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.Left hepatic lobe lesion has imaging features suggestive of a hemangioma.2.Inflammatory changes involving the right ureter with mild atrophy of the right kidney.


Instruction: Generate impression based on findings.

Input: The study is limited due to motion. The cord demonstrates no gross abnormality. No evidence of spinal stenosis. The vertebral body heights and disc space, and alignments are maintained. Normal marrow signal throughout the vertebral bodies.

Output: Study is limited by motion with no gross abnormality. No evidence of cord compression.


Instruction: Generate impression based on findings.

Input: Epilepsy status post laser ablation: surveillance of laser focus. There are findings related to laser ablation of the right hippocampus, with a small amount of associated peripheral susceptibility effect and encephalomalacia within the ablation zone. There is no evidence of acute intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are unchanged.

Output: Expected evolution of the laser ablation effects in the right hippocampus.


Instruction: Generate impression based on findings.

Input: 44 year old male with hx of bicuspid aortic valve, s/p valvuloplasty, s/p aortic valve replacement. Last ascending aorta measurement 49mm. Evaluate ascending aorta, para-valvar leak, LV size and function. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 53%. The LVEDV is 191 ml (normal range 142+/-34), the LV end diastolic volume index is 113 ml/m2 (normal range: 74+/-15), the LVESV is 89 ml (normal range 47+/-19) and the LV end systolic volume index is 53 ml/m2 (normal range 25+/-9). The LV mass is 113 g (normal range 164+/-36) and the LV mass index is 67 g/m2 (normal range 85+/-15). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.The native T1 myocardial relaxation time is <1000 ms suggestive of absence of underlying diffuse fibrosis or infiltration. There is no myocardial iron overload. 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 52%. The RVEDV is 214 ml (normal range 142+/-31), RV end diastolic volume index is 127 ml/m2 (normal range 82+/-16), the RVESV is 103 ml (normal range 54+/-17), and the RV end systolic volume index is 61 ml/m2 (normal range 31+/-9).Right AtriumThe right atrium is normal in size.Aortic ValveThe mechanical aortic valve is in good position with mild regurgitation (regurgitant fraction 14%). Location of regurgitation can not be determined due to valve-related artifact. Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size. The maximum dimension of the ascending aorta is 41 mm (mildly dilated). There is no coarctation noted.Sinus of Valsalva: 38x35mmST Junction: 35x34mmAscending Ao (4.5cm from Ao Annulus): 41x39mmProximal Arch: 32x36mmMid Arch: 25x25mmDesc Thoracic Ao: 22x24mmPulmonary 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 noted. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1.Normal sized LV with normal systolic function, LVEF 53% without evidence of underlying myocardial fibrosis, inflammation, or infiltration .2.Mildly dilated RV with normal systolic function, RVEF 52%.3.Mild mechanical aortic valve regurgitation.4.The ascending aorta is mildly dilated (41mm). When remeasured on prior CT scan, there is no change in aorta size. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 29 year old female with a history of extraosseous Ewing sarcoma of the right hand. Surveillance 12 months off of therapy. No focal mass lesions or pathologic enhancement is identified. No bone marrow signal abnormality is identified. The extensor and flexor tendons are intact. The imaged musculature is normal in appearance. There is minimal metallic susceptibility artifact along the dorsal aspect of the base of the second metacarpal which presumably represents postsurgical change. No joint effusion is evident.

Output: No evidence of residual or recurrent disease.


Instruction: Generate impression based on findings.

Input: History of testicular cancer. Stage I testicular seminoma status post left orchiectomy. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology, size, and signal intensity without a suspicious lesion. Right hepatic lobe T2-weighted hyperintensities are unchanged and likely represent hemangiomas. Normally distended gallbladder. No biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant change in shotty subcentimeter retroperitoneal lymph nodes. BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVISPROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Shotty subcentimeter retroperitoneal lymph nodes are not enlarged by CT size criteria and are relatively stable.Stable T2 hyperintense liver lesions are not significantly changed, likely represent benign hemangiomas.


Instruction: Generate impression based on findings.

Input: There is redemonstration of right frontoparietal craniotomy. There is significant interval increase in extent of T2/FLAIR hyperintensity in the right cerebral hemisphere related to vasogenic edema compared to 7/30/2015. There is minimal leftward midline shift of 3 mm at the level of the lateral ventricles (401/24) that was not seen in the previous study. There is effacement of the right lateral ventricle Restricted diffusion is seen in the right frontal lobe which is more pronounced and increased in size. There is irregular nodular rim enhancement surrounding the resection site which has increased since the previous study of 7/30/2015. The lesion measures 37 mm in its craniocaudal extent (1701/22) compared to 27 mm in the previous study.Susceptibility images demonstrates blood products within the lesion similar to prior. No uncal herniation. No hydrocephalus.Perfusion images were obtained and processed on a separate workstation but could not be transferred to local PACS. There are areas of elevated CBV associated with the enhancement surrounding the resection cavity raising suspicion for tumor. There is also mild associated restricted diffusion.

Output: 1. In comparison to the previous study there is significant increase in the vasogenic edema of the right frontal and parietal lobes with increased mass effect including minimal leftward midline shift and downward partial effacement of the right lateral ventricle. There is also marked increase in enhancement surrounding the resection cavity with mild restricted diffusion and elevated cerebral blood volumes. Although patient has had recent radiation and posttreatment change is in the differential, early tumor recurrence remains a strong possibility. 2. Minor contrast extravasation as described in the technique section.


Instruction: Generate impression based on findings.

Input: Cirrhosis, HCC ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic morphology. Arterially enhancing lesion in segment 8 with washout measures 1.5 x 1.3 cm (series 12, image 29), unchanged. Unchanged left hepatic lobe T2 hyperintense focus without arterial enhancement or washout (series 3, image 19). Cholelithiasis. Common hepatic artery arises from the aorta; normal variant. Recanalized umbilical vein.SPLEEN: Splenomegaly.PANCREAS: Cystic lesion of the pancreatic head measures 1.4 x 1.0 cm (series 5, image 27), unchanged.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1.Unchanged arterially enhancing lesion in segment 8 compatible with HCC. No new lesions.2.Cystic lesion in the pancreatic head may represent a cystic neoplasm such as an IPMN. Consider MRCP at next follow up for further characterization.


Instruction: Generate impression based on findings.

Input: Slurred speech, stuttering, and developmental delay, as well as staring spells and confusion. There are diffusely prominent cerebellar fissures and a widened fourth ventricle. There also appears to be a mega cisterna magna. The third and lateral ventricles are otherwise normal in size. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The extent of myelination is appropriate. 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: Apparent mild nonspecific diffusely diminished cerebellar volume, but no evidence of mass lesions or signs of hydrocephalus.


Instruction: Generate impression based on findings.

Input: Multiple patellar dislocations MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: There is marrow edema within the lateral femoral condyle and medial patellar facet consistent with prior dislocation. Additionally, there is a 1 cm ossicle medial to the patella that likely represents a chronic avulsion fracture fragment. The femoral trochlea is abnormally shallow indicating dysplasia. There is a small full-thickness cartilage defect along the lateral femoral condyle above the junction of the anterior horn and body of the lateral meniscus. The remaining articular cartilage and marrow signal is normal.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The patellar and quadriceps tendons are intact. The Insall Salvati ratio is 1.4 suggesting mild patella alta. The TT to TG distance is 2.3 cm. ADDITIONAL

Output: 1. Findings indicating prior patellar dislocation including an ossicle present along the medial aspect of the patella which is thought to represent a chronic avulsion fracture. Furthermore, there is femoral trochlear dysplasia, an elevated TT to TG distance, and mild patella alta.2. Small but full-thickness articular cartilage defect of the lateral femoral condyle with other findings described above.


Instruction: Generate impression based on findings.

Input: Secondary malignant neoplasm of brain [C79.31], Reason for Study: ^Reason: brain mets (tonsil SCC) s/p resection, post-op SRS History: assess for EOD There is no evidence of acute ischemic or hemorrhagic lesion.There is no evidence of abnormal enhancement.Focal high signal intensity on the left parietal lobe precuneus referred to prior resection of metastatic lesion on FLAIR imaging is still seen, unchanged since prior scan.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear.Mucosal thickenings on ethmoid sinus, bilateral maxillary sinuses and frontal sinus with retention cyst is on the left maxillary sinus, grossly unchanged since prior scan.

Output: Unchanged resection area focal FLAIR high signal intensity since prior scan.No evidence of new abnormal enhancement.No evidence of acute ischemic or hemorrhagic lesion.


Instruction: Generate impression based on findings.

Input: 15-year-old male with history of perianal swelling noted at outside hospital. Evaluate for perirectal abscess. PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Again noted is narrowing of the terminal ileum; however, no evidence of enhancement to suggest acute inflammation. The rectum is moderately distended and stool-filled. Small volume pelvic ascites,BONES, SOFT TISSUES: No evidence of rim-enhancing fluid collections to suggest abscess. The previously noted perirenal inflammatory changes and perianal fistulas are no longer demonstrated.OTHER: No significant abnormality noted.

Output: 1.No evidence of a perirectal abscess as clinically questioned. 2.Moderately distended stool-filled rectum.


Instruction: Generate impression based on findings.

Input: History of left acoustic neuroma status post stereotactic radiosurgery. There is an unchanged homogeneously enhancing left vestibular tumor that measures up to 12 mm. There is no extension through the porus acusticus or into the labyrinthine structures. The right internal auditory canal is intact. There is an unchanged 10 mm diameter cystic pineal gland without nodular enhancement. There are bilateral lens implants. The imaging potions of the skull, including prominent right occipital arachnoid granulations, are unchanged.

Output: No significant interval change in left vestibular schwannoma.


Instruction: Generate impression based on findings.

Input: Reason: Evaluate left knee for lateral meniscus tear (compare with 2007) History: lateral joint line pain MENISCI: There is increased signal abnormality and deformity of the posterior horn of the lateral meniscus which extends to the tibial articular surface indicating intrasubstance degeneration as well as a complex tear with a predominantly horizontal component. The medial meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is full-thickness articular cartilage degeneration along the weightbearing surface of the lateral femoral condyle above the posterior horn of the meniscus with areas devoid of articular cartilage. There is near full-thickness articular cartilage degeneration along the lateral aspect of the tibial plateau underlying the posterior horn of the lateral meniscus. There is partial-thickness articular cartilage degeneration along the weightbearing surface of the medial femoral condyle above the posterior horn and body of the meniscus. There is a near full-thickness to full-thickness articular cartilage defect along the lateral facet of the patella with associated delamination. There is full-thickness articular cartilage degeneration along the medial facet of the patella, centrally. There are tricompartmental osteophytes.LIGAMENTS: The cruciate and collateral ligaments appear intact. There are multiple foci of fluid signal intensity along the posterior aspect of the PCL which may reflect mucoid degeneration. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Degeneration and complex degenerative tearing of the posterior horn of the lateral meniscus which is progressed when compared to the prior examination. 2. Osteoarthritis of the knee including articular cartilage degeneration, full-thickness defects, and delamination, most pronounced along the lateral tibiofemoral and patellofemoral articulations. 3. Moderate size joint effusion.


Instruction: Generate impression based on findings.

Input: Clinical question: New onset of dystonia, concern for Wilson's disease versus ischemia. Signs and symptoms: Dystonia. Pre and post enhanced brain MRI:No diffusion-weighted abnormalities.Examination demonstrates normal anatomical development, morphology and with normal signal intensity on all MRI sequences.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination.There is no detectable abnormal enhancement of the brain parenchyma or the leptomeninges.The signal void of major intracranial arterial branches are identified.The signal intensity of intracranial venous sinuses are within normal and with normal pattern of enhancement.Unremarkable images through the orbits including axial fat sat post enhanced series.Unremarkable calvarium and soft tissues of the scalp without abnormal enhancement.All paranasal sinuses and bilateral mastoid air cells and middle ear cavities demonstrate normal pneumatization signal pattern.

Output: Unremarkable pre and post enhanced brain MRI.


Instruction: Generate impression based on findings.

Input: Female, 19 years old, with five episodes of loss of consciousness since June 2015, possibly secondary to seizures, sometimes associated with bilateral lower extremity shaking. The cerebral and cerebellar hemispheres and brainstem show normal signal intensity and morphology. No restricted diffusion is seen. No pathologic parenchymal or extra-axial enhancement is detected.No evidence of parenchymal edema, mass, or mass effect is seen. There is no evidence of intracranial hemorrhage or abnormal extra-axial fluid. The ventricular system is normal in caliber and morphology. On dedicated MR imaging of the brain, the major intracranial vessels are well visualized. No significant stenosis or occlusion is detected. No aneurysms are seen.Signal intensity of the bone marrow is unremarkable. No significant abnormalities of the paranasal sinuses are detected.

Output: Unremarkable MRI and MRA evaluation of the brain. No specific findings are seen which would account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: Secondary malignant neoplasm of brain [C79.31] / Secondary malignant neoplasm of other parts of nervous system [C79.49], Reason for Study: ^Reason: history brain mets nad SRS please compare History: headache Redemonstration of enhancing lesions one on the left postcentral gyrus (about 5 mm) and somewhat patch and irregular enhancing lesions on the right inferior parietal lobule. Comparing to prior scan, left post central gyrus enhancing lesion is more conspicuous than prior however measured the size appears to be similar.The right inferior parietal lobule lesion does not show any significant interval change.There is no evidence of new abnormal enhancing lesion on the scan.There is no evidence of acute ischemic or hemorrhagic lesion on the scan.The ventricles, sulci and cisterns are unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Stable 2 previously seen enhancing lesions, one at the right inferior parietal lobule and another at the left post central gyrus since prior scan.2. No evidence of new abnormal enhancing lesion.3. No evidence of acute ischemic or hemorrhagic lesion.


Instruction: Generate impression based on findings.

Input: The thoracic spine is in normal alignment, with a normal thoracic kyphosis. The vertebral body and disk heights are well maintained. No worrisome focal marrow signal abnormality is appreciated.There is redemonstration of focal bilobed appearing T2 hyperintensity within the center of the cord spanning the T1 and T2 levels, with more cranially extending abnormal signal into the lower cervical cord. This measures up to 7 x 6 mm in greatest axial dimensions at the upper T2 level on 901/20, compared to previous remeasurement of 6 x 5 mm at the same level. More ill-defined T2 hyperintensity is seen within the center of the cord extending to the mid T3 level, also similar to prior. No other thoracic cord signal abnormality is appreciated.There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the thoracic spine.Crowding of the foramen magnum due to abnormal caudal extension of cerebellar tonsillar is only partially visualized on the counting sequence. Extensive abnormal T2 hyperintense signal within the lower cervical cord appears slightly more extensive although not well assessed.LUMBAR SPINE

Output: 1. Transitional lumbosacral anatomy as detailed above. If surgery is to be contemplated, correlation with imaging of entire spine is recommended.2. Redemonstration of cervicothoracic syringohydromyelia, appearing very slightly intervally increased in size since prior dedicated brain/cervical exam. Syrinx only extends to the T2-T3 level although there is additional likely soft syrinx to the mid T3 level.3. Known Chiari I malformation not well assessed on this exam.


Instruction: Generate impression based on findings.

Input: T2 hyperintensity is present within the periventricular white matter, confluent around the bilateral frontal horns and occipital horns, associated with a few additional punctate foci of T2 hyperintensity in the adjacent white matter. This is associated with mild bilateral colpocephaly and adjacent white matter loss.There are no findings of hydrocephalus. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain.

Output: MRI evidence for periventricular leukomalacia as described in detail above.


Instruction: Generate impression based on findings.

Input: Bell's palsy [G51.0], Reason for Study: ^Reason: Eval for neoplastic vs vasculitis History: Bilateral bells palsy in setting of SCLC. Brain MRINo evidence of acute ischemic or hemorrhagic lesion on the scan.There is no abnormal enhancement.About 2mm herniation of cerebellar tonsil through the foramen magnum, this is normal but can be said as benign tonsilar ectopia.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.MRI IACThe brainstem, cerebellum, vermis and tonsils are normal. The inner ear structures, cochlea, vestibule, semicircular labyrinth are normal. The internal auditory canals are normal with delineation of the facial, cochlear and vestibular nerves. No evidence of signal abnormality, mass or abnormal enhancement is noted.

Output: Normal brain and IAC MRI


Instruction: Generate impression based on findings.

Input: History of laparoscopic cholecystectomy November 2015 now with constant right upper quadrant pain unrelated to eating. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology, size and signal intensity. No suspicious liver lesion. Moderate intrahepatic and extrahepatic biliary ductal dilatation to the level of the ampulla without an obstructing stone or focal mass. The common bile duct is tortuous just superior to the pancreatic head.The remnant cystic duct is noted.Status post cholecystectomy without a fluid collection in the cholecystectomy bed. Following hepatobiliary contrast intravenous administration the hepatic parenchyma takes up the agent but there is no significant biliary excretion on the delayed hepatobiliary phase imaging.SPLEEN: No significant abnormality noted.PANCREAS: The main pancreatic duct is mildly prominent to the level of the ampulla without a discrete mass lesion. The pancreas is otherwise normal in morphology signal intensity and enhancement.ADRENAL GLANDS: Right adrenal 2.9 x 1.6 cm nodule demonstrate loss of signal on out of phase imaging compatible with a lipid rich adrenal adenoma.KIDNEYS, URETERS: Bilateral simple appearing cysts.RETROPERITONEUM, LYMPH NODES: Tortuous and mildly ectatic abdominal aorta. Note is made of narrowing of the visceral artery origins.BOWEL, MESENTERY: No free fluid or loculated fluid collection.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.There is moderate intra and extrahepatic biliary ductal dilatation as well as mild prominence of the main pancreatic duct to the level of the ampulla raising the possibility of ampullary stenosis. No discrete mass or stone. No fluid collection to suggest a bile leak.2.No excretion of hepatobiliary agent in the biliary system raises the possibility of parenchymal/hepatocyte dysfunction.3.Tortuous mildly ectatic and atherosclerotic abdominal aorta. Narrowing of the visceral artery origins may be correlated with mesenteric Doppler ultrasound to evaluate for mesenteric angina.


Instruction: Generate impression based on findings.

Input: Recent Chiari re-decompression with dura graft. There are postoperative findings related to Chiari decompression surgery with minimal fluid overlying the dural graft. There appears to be robust CSF flow across the anterior aspect of the neo-foramen magnum. There also appears to be intact CSF flow across the posterior aspect of the neo-foramen magnum, although relatively attenuated. The cerebellar morphology appears to be grossly unchanged, accounting for differences in technique. There is surgical hardware in the anterior cervical spine, which produces extensive artifact that obscures surrounding anatomy. The vertebral column alignment appears to be unchanged and the portions of spinal cord that are not obscured by artifact appear unremarkable.

Output: Expected postoperative findings related to Chiari decompression surgery. Otherwise, assessment of the cervical spine is considerably limited due to artifacts from surgical hardware.


Instruction: Generate impression based on findings.

Input: Cystic fibrosis c/b pancreatic exocrine insufficiency, recurrent pseudomonas pneumonia, and chronic hemoptysis s/p multiple bronchial embolizations with ongoing hemoptysis, adrenal insufficiency, and protein malnutrition on PEG tube who presents with AMS and witnessed seizure. There is diffuse gyriform restricted diffusion in the bilateral cerebral hemispheres in a watershed distribution, including the right frontal and parietal lobes and left frontal lobe, with underlying white matter vasogenic edema. There is no evidence of intracranial hemorrhage or mass. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, mastoid air cells, and scalp soft tissues are grossly unremarkable. There is scattered paranasal sinus mucosal thickening and secretions.

Output: 1. Gyriform restricted diffusion in the bilateral cerebral hemispheres in a watershed distribution, right more than left, with underlying white matter vasogenic edema. These findings may represent recent watershed infarction or perhaps posterior reversible encephalopathy syndrome with associated infarction or cytotic edema related to seizure activity. 2. Pansinus disease likely related to cystic fibrosis.Discussed with Dr. Kress at 4:45 PM on 6/29/16.


Instruction: Generate impression based on findings.

Input: Follow up of an incidental right parotid mass. There is a bosselated, mixed solid and cystic lesion in the superficial right parotid gland that measures up to approximately 15 mm, which is not significantly changed since November 2014. The left parotid gland is unremarkable. The bilateral submandibular glands are mildly prominent, but without evidence of mass lesions. There is a mildly prominent right level 2A lymph node that measures 10 mm. There is enhancement within the left mandibular body dental extraction cavity, which likely represents granulation tissue. The cervical lymph node are otherwise not particularly enlarged. The imaged intracranial structures and orbits are unremarkable.

Output: Unchanged small right parotid tumor, which may represent a pleomorphic adenoma versus other probable benign salivary neoplasms.


Instruction: Generate impression based on findings.

Input: 56 years Female (DOB:9/9/1960)Reason: T6 compression fracture History: back painPROVIDER/ATTENDING NAME: MAGDALENA ANITESCU MAGDALENA ANITESCU There is a compression fracture present at T6 associated with approximately 50% loss of vertebral body height and convex posterior retropulsion into the spinal canal. There is marrow replacement throughout the T6 vertebra associated contrast enhancement. There is narrowing of the spinal canal at this level with a mild degree of spinal stenosis. There is effacement of spinal fluid ventral to the spinal cord. There is associated narrowing of the neural foramina.There is a large right-sided pleural effusion present.The thoracic vertebral bodies are appropriate in the overall alignment. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots. No abnormal enhancing lesions are identified in the thoracic spine.

Output: 1.Findings are compatible with malignant compression fracture at T6 associated with mild spinal stenosis and 50% loss of vertebral body height2.Large right-sided pleural effusion.


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. Attempted aspiration yielded no fluid. Next, 13 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: 14 seconds.

Output: Successful fluoroscopic guided right hip arthrogram.


Instruction: Generate impression based on findings.

Input: 54-year-old male with head and neck cancer, evaluate response to therapy CHEST:LUNGS AND PLEURA: Scattered areas of scarring in both lungs are unchanged. Volume loss in the left lower lobe. No suspicious nodules or masses can be identified. No evidence of pleural effusion. Bronchial wall thickening, particularly at the left lung base is unchanged. The left upper lobe mucoid impaction is stable.Mild paraseptal and centrilobular emphysema.MEDIASTINUM AND HILA: Tracheostomy tube in place. Right Port-A-Cath with its tip in the SVC. Mediastinal lymph node enlargement is stable.CHEST WALL: Right chest port. Soft tissue collection of air is identified in the region of the right subclavian vein may be secondary to recent instrumentation. Increasing areas of sclerosis involving the T1, T2, and T3 vertebrae may be near the radiation therapy. Osseous metastases cannot be definitely excluded. MRI of the cervical and thoracic spine is recommended. Large soft tissue mass in the lower portion of the left neck partially visualized on this exam. Will be evaluated on CT of the head and neckABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedPANCREAS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: G-tube in placeBONES, SOFT TISSUES: Sclerotic areas in the upper vertebrae and impending collapse of the T2 vertebrae may represent post radiation changes and/or metastatic disease.OTHER: No significant abnormality noted

Output: 1.No evidence of pulmonary metastatic disease. Stable mediastinal adenopathy.2.Low left neck mass better evaluated on CT of the head and neck.3.Sclerotic lesions in the T1, T2, T3 vertebrae with impending collapse of the T2 vertebrae may represent post radiation changes or metastatic disease. Recommend MRI and he cervical and thoracic spine for further evaluation.


Instruction: Generate impression based on findings.

Input: 22 years, Female, Reason: episodes of profuse bleeding for 2 months after spontaneous miscarriage. no retained products on ultrasound, small pumping vessel in uterine cavity. suspected pseudoaneurysm or uterine arteriovenous malformation. History: abnormal uterine bleeding requiring transfusion. PELVIS:UTERUS, ADNEXA: There is an enhancing focus within the uterine cavity along the posterior aspect of the fundus which appears to have a feeding vessel on arterial phase images (1102/442) it is associated with numerous flow voids and T2-weighted sequences. The uterine vessels on the right in this region appear engorged. There is intrinsic T1 shortening within the endometrial cavity, likely representing blood products.Right Bartholin's gland cyst measuring 1.8 cm. BLADDER: Diffuse bladder wall thickening. 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: Enhancing nidus in the posterior uterine fundus with numerous associated flow voids likely represents an AV malformation arising from the right uterine vessels. There is a small amount of associated blood within the endometrial cavity. Interventional radiology consult may be considered.Findings discussed with the service at the time of reporting.


Instruction: Generate impression based on findings.

Input: Known left breast DCIS with additional mass seen on MRI. A potential correlate for the MRI finding was noted on ultrasound and ultrasound guided biopsy is requested. Left ultrasound re-identified the target lesion for biopsy. The lesion to be targeted is a hypoechoic mass measuring 5 mm at the 12 o’clock position without increased vascularity, 4 cm from the nipple. The lesion was readily visible.PROCEDURE: The procedure and its risks, including bleeding, infection, and failure to diagnose, and expected benefits of ultrasound-guided core biopsy with percutaneous placement of a marking clip and post-procedure unilateral mammogram were discussed with the patient. Questions were answered. Consent was obtained both verbally and in writing. The time-out form was completed to confirm patient identity and side/type of procedure.The left breast was cleansed with chlorhexidine over the target area. Transducer was sterilely sheathed. Local anesthesia was obtained using 2% lidocaine superficially, with 1% lidocaine with 1:100,000 epinephrine at depth. A 3 mm incision was made in the skin with a #11 scalpel blade. Using aseptic technique, continuous ultrasound guidance and a inferolateral to superomedial approach, four 14-gauge core needle (InRad) specimens were obtained of the lesion. Targeting was judged excellent. Two specimens sank to the bottom of the prefilled container of 10% formalin. One specimen floated. Specimen quality was judged excellent.Specimens were sent to Pathology with an accompanying history sheet. Using continuous ultrasound-guidance a Hydromark clip was placed into the lesion in the usual manner. Pressure was held over the biopsy site until all bleeding subsided. The skin incision was closed with a Steri-Strip. Post-procedure digital left CC and ML views revealed the percutaneously placed clip to be in the 12:00 location. However, there is concern that this position may be too superficial to truly represent the MRI finding. No evidence of hematoma or other complication.A pressure dressing was positioned over the biopsy site and an ice pack positioned over the pressure dressing. Post-procedure instructions were reviewed with the patient both verbally and in writing. She tolerated the procedure well with no evident complications and left the Breast Imaging Department in stable condition.The procedure was performed by Dr. Schacht. Dr. Schacht was present during the procedure at all times.

Output: Successful ultrasound-guided core biopsy of the left breast lesion and clip placement. Pathology is pending at this time.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Strong family history of breast cancer and BRCA 2 mutation carrier. Breast parenchyma is almost entirely fat in both breasts.Minimal parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: 77 years Male (DOB:12/29/1938)Reason: left thalamic hemorrhage with IVH History: as abovePROVIDER/ATTENDING NAME: PETER C WARNKE PETER C WARNKE There is redemonstration of a hematoma centered in the left thalamus and associated with the third and lateral ventricular blood.The patient is status post right sided ventriculostomy tube placement. The ventriculostomy tube courses the right frontal bone, through the right frontal lobe and has tip in the right lateral ventricle.Periventricular and subcortical white matter T2 and FLAIR hyperintense lesions of a moderate degree are present.The lateral ventricles are large but stable compared to the prior exam.Atherosclerotic calcifications are present along the distal internal carotid arteries.The visualized portions of the paranasal sinuses demonstrate mild mucosal thickening. The patient status post intubation. There are retained secretions within the nasal cavity. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.There is no significant interval change compared to prior exam. There is redemonstration of a large left thalamic hemorrhage associated with extensive intraventricular blood and ventriculomegaly. This is stable compared to the prior exam.2.There is a moderate degree of periventricular white matter lesions present which at this age is most likely vascular related but nonspecific. It could also be related to a neurodegenerative process as well


Instruction: Generate impression based on findings.

Input: 50-year-old with left breast IDC and left axillary metastatic lymph node disease. MRI per highest PY to protocol There is an extreme amount of fibroglandular tissue in both breasts. On postcontrast images, moderate parenchymal enhancement is seen bilaterally.The T2 precontrast sequences again demonstrate extensive bilateral cystic disease, right greater than left.LEFT BREAST:The index enhancing irregularly marginated mass lesion in the 3:00 radian mid depth measures 2.3 x 2.2 x 2.4 cm (AP by transverse by CC), previously 2.6 x 2.3 cm. A biopsy clip artifact is present in the center of the mass.There is a satellite enhancing mass in the 6:00 radian anterior to middle depth measuring 11 x 7 x 11 mm, previously 12 mm in maximum dimension. This contains artifact from a biopsy clip.In the anterior breast 7:00 radian there is a satellite enhancing mass measuring 6 x 8 x 8 mm, previously 8 mm in maximum dimension.There is an additional enhancing mass located 14 mm posterior to the index mass in the 2:00 radian mid to posterior depth that measures 9 x 9 x 10 mm. This is more readily visualized than on the previous study.The total extent of disease measures 6.7 cm in craniocaudal dimension and 4.4 cm anterior to posterior.RIGHT BREAST:No suspicious mass lesions or areas of enhancement.AXILLAE: Again noted are two enlarged and enhancing left axillary lymph nodes. The largest of these contains postbiopsy change and metallic clip artifact. It measures 2.5 x 2.1 cm, previously 3 cm in maximum dimension. No abnormalities noted in the right axilla.

Output: 1. Biopsy-proven cancer in the left breast. 3 enhancing satellite nodules are also not significantly changed. Total extent of disease is 6.7 x 4.4 cm.2. Slight interval decrease in size of left axillary lymphadenopathy corresponding to biopsy-proven metastatic disease.3. No abnormal enhancement or mass lesions in the right breast and right axilla.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Clinical question: Metastatic lung cancer, brain metastases, status post RT, status post 4 cycles of Alectinib. Compared to prior exam. Signs and symptoms: Brain metastases. Pre and post enhanced brain MRI:Negative diffusion weighted series.There is revisualization of a focus of FLAIR hyperintensity in the pattern of vasogenic edema surrounding the right central sulcus without detectable mass effect or definitive interval change since prior study. Postcontrast images demonstrate further decreased leptomeningeal enhancement at this site to near complete resolution. There is no measurable focus of enhancement for comparison.Admission nearly a previously noted tiny focus of susceptibility and enhancement along the interhemispheric aspect of the right frontal lobe demonstrate interval improvement and only trace residual enhancement at this site.There is no detectable new foci of edema or abnormal parenchymal-meningeal enhancement since prior exam. Ventricular system and CSF spaces are within normal for age and midline is maintained.

Output: 1.Further improvement to near complete resolution of the leptomeningeal enhancement surrounding the right central sulcus since prior study. Stable associated FLAIR hyperintensity and susceptibility signal changes at this level.2.Further decrease in a tiny focus of meningeal enhancement with susceptibility signal changes in the right frontal size prior exam.3.Unremarkable exam otherwise and stable since prior study.


Instruction: Generate impression based on findings.

Input: 15-year-old female with history of Ewing's sarcoma of the left masticator space, interval examination following chemotherapy. There is marked interval decrease in size of the mass arising from the left mandibular ramus, which now measures up to 19 mm in maximal dimension, previously 48 mm. There is patchy T2 hyperintensity and enhancement in the treatment bed. The previously associated oropharyngeal narrowing and mass effect on the left internal jugular vein have resolved. There is no convincing evidence of significant regional lymphadenopathy. There is no evidence of intracranial extension. Aside from mild mass effect on the left parotid gland, the salivary glands are intact. There is scattered paranasal sinus mucosal thickening.

Output: Significant interval decrease in size of the treated left masticator space Ewing's sarcoma.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 89-year-old female with mental status changes and recent falls. There is no evidence of intracranial hemorrhage, mass or edema. Previously described left posterior parietal stroke appear stable without evidence of hemorrhage or interval acute cortical stroke. Multiple areas of patchy hypodensity in a periventricular distribution consistent with small vessel disease, age indeterminate. If there is clinical concern for new acute ischemia, MRI may be considered.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Nonhemorrhagic cortical stroke in the left posterior parietal region without interval change.


Instruction: Generate impression based on findings.

Input: Reason: lateral meniscal tear? History: continued lateral pain with reduced ROM to extension 1 month after injury MENISCI: The lateral meniscus is abnormal. The anterior horn appears unusually large and the body appears unusually small with extensive increased signal intensity within its substance. There is also vertically oriented increased signal intensity at the junction of the body and anterior horn of the lateral meniscus. An additional obliquely oriented signal abnormality is seen within the junction of the body and posterior horn of the lateral meniscus. These findings suggest a complex tear likely with a displaced flap fragment. The medial meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is mild subchondral edema within the patella along the lateral facet with mild heterogeneity of the overlying cartilage, which may reflect mild degeneration.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Complex tear of the lateral meniscus.2. Mild focal degeneration of the articular cartilage of the patella.3. Joint effusion.


Instruction: Generate impression based on findings.

Input: Osteoarthrosis and pain in the joints, right hip pain and thigh pain radiating to the foot. Evaluate for lumbar spinal stenosis. There is multilevel degenerative spondylosis. In particular, at L1-L2, there is a small disc bulge and facet arthropathy, but no spinal canal or neural foraminal stenosis. At L2-L3, there is a small disc bulge and facet arthropathy with mild spinal canal stenosis, but no significant neural foraminal stenosis. At L3-L4, there is a small disc bulge and facet arthropathy, with mild bilateral neural foraminal stenosis, but no significant spinal canal stenosis. At L4-L5, there is there is a small disc bulge and facet arthropathy, with moderate bilateral neural foraminal narrowing, but no significant spinal canal stenosis. At L5-S1, there is a small disc bulge and facet arthropathy, with mild spinal canal narrowing and moderate bilateral neural foraminal stenosis. The vertebral body heights are preserved. The spinal cord displays normal signal and morphology. There are multiple areas of focal fat in the lumbosacral bone marrow. The right psoas muscle is smaller than the left psoas muscle.

Output: Multilevel degenerative spondylosis, including moderate bilateral neural foraminal narrowing at L4-L5 and L5-S1.


Instruction: Generate impression based on findings.

Input: 38-year-old male with diarrhea and abdominal pain. Evaluate for recurrent Crohn's disease. Status post 2002 ileocecectomy with repair of enterovesicular fistula. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Extensive mesenteric fat could represent fibrofatty proliferation with peripheralization of the small bowel loops. The neoterminal ileum shows concentric wall thickening with phlegmonous changes and mild increased wall enhancement (coronal series 14 image 371) consistent with active disease. No drainable fluid collection. The proximal jejunal loops have a normal appearance, and the mid/distal jejunal and ileal loops demonstrate mild diffuse wall thickening. There is no bowel obstruction.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: As above.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.The neoterminal ileum shows concentric wall thickening with phlegmonous changes and mild increased wall enhancement consistent with active disease. No bowel obstruction or drainable fluid collection.2.Mild small bowel wall thickening seen extensively throughout the mid/distal jejunal and ileal loops suggestive of chronic disease. There is extensive fibrofatty proliferation.


Instruction: Generate impression based on findings.

Input: Right knee pain. 4 views of the right knee including weightbearing are unremarkable.

Output: Negative right knee examination.


Instruction: Generate impression based on findings.

Input: Elevated prolactin. Pituitary: There appears to be a punctate hypoenhancing focus in the right pituitary lobe. The pituitary gland is otherwise not enlarged, measuring up to 6 mm in craniocaudal dimension. The posterior pituitary bright spot and stalk are intact. The cavernous sinuses and optic apparatus are unremarkable. Brain: There is no evidence of intracranial hemorrhage or acute infarct. The brain parenchyma appears unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: An apparent punctate hypoenhancing focus in the right pituitary lobe may represent a microadenoma or physiologic variant.


Instruction: Generate impression based on findings.

Input: 51-year-old with right breast high grade DCIS presents for wire localization There is a cluster of calcifications immediately anterior to the Hydromark clip placed at recent ultrasound-guided biopsy at anterior 12:00 position in the right breast. Architectural distortions are present posterior to the same marker clip. There is a rod shaped clip, which is from prior MRI guided biopsy revealing LCIS, located medial and posterior to the Hydromark clip. The plan was made to place one wire anterior to the clustered calcifications, second wire posterior to the architectural distortions, and third wire at the rod shaped clip.The procedure, risks including bleeding, mistargeting and infection, and benefits of needle-wire localization were discussed with the patient. Questions were answered. Consent was obtained both verbally and in writing. The time out form was completed to confirm patient identity and site of procedure. The right breast was placed in an alphanumeric grid using superior to inferior approach. When the target was positioned in the aperture of the grid, the skin was cleansed with chlorhexidine. Local anesthesia was obtained using 2% Lidocaine. Using coordinates from the grid, a 5 cm x 1, and 9 cm x 2 Kopans needles were placed adjacent to the targets. On orthogonal mammography, adequate positioning of the needle was confirmed after adjusting depth so the needle tip was approximately 2cm deep to the center of the target. A spring wires were then deployed. Repeat two view orthogonal mammograms reveal the spring wires to be in adequate position. The mammogram was annotated and reviewed with Dr. Jaskowiak prior to the patient's procedure. Patient tolerated the procedure well and was sent to the holding area in stable condition. Dr. Abe performed the procedure.Orthogonal digital specimen radiographs revealed the calcifications and two clips and three spring wires to be within the specimen. Dr. Jaskowiak will shave posterior and inferior margins.

Output: Successful needle localization of the right breast malignancy.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Multinodular goiter RIGHT LOBE MEASUREMENTS: 6 x 2.7 x 2.9 cmLEFT LOBE MEASUREMENTS: 5.7 x 1.8 x 1.9 cmISTHMUS MEASUREMENTS: 4-mmRIGHT LOBE: Previous described right lower lobe solid nodule is grossly unchanged measuring 2.7 x 2.1 x 1.9 cm.LEFT LOBE: Previous described left lower lobe solid nodule is also grossly unchanged measuring 0.9 x 1 x 1.4 cm.ISTHMUS: A new solid nodule measuring 1.1 x 0.8 cm in the isthmus.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Bilateral multiple lymph nodes are again noted. Largest lymph node on the right measures 2.1 x 1 cm inferiorly and largest lymph node on the left measures 1 x 1.2 cm superiorly. The etiology of the lymph nodes is unknown.OTHER: No significant abnormality noted.

Output: Multinodular goiter with no significant change in the right and left lobe nodules and a new isthmic nodule. Bilateral multiple lymph nodes in the neck are again noted and are nonspecific.


Instruction: Generate impression based on findings.

Input: There are a few scattered subcortical T2/FLAIR hyperintense foci in the left frontal lobe and in bilateral parietal lobes. These are nonspecific, as they are not linear or perpendicular to the lateral ventricles. No definite callosal lesions are identified. There is no abnormal enhancement. Ventricles and sulci are within normal limits. There is no midline shift or mass effect. There is no extraaxial fluid collection. Midline structures are unremarkable.

Output: A few nonspecific nonenhancing T2/FLAIR hyperintense punctate foci in the subcortical white matter as described above. No definite MR evidence of demyelinating disease at this time.


Instruction: Generate impression based on findings.

Input: Reason: mesenteric mass seen on laparoscopy at OSH and ill defined on CT scan History: MassAdditional history per electronic medical record: 62Yrs male who underwent an elective laparoscopic umbilical hernia repair in February of this year. At that time they saw a mass within his left upper abdomen. It is described as just below the transverse colon and within the mesentery. It is variably described as possibly fluid filled and also possibly pulsatile. It was measured to be over 12cm. He then had a biopsy of the mass on 6/17/16 which showed fat necrosis and red/white blood cells. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is an approximately 14.3 x 7.8 cm area of fat stranding involving the macroscopic fat of the small bowel mesentery centered at the mesenteric root (series 6, image 36) with associated mild restricted diffusion, a pseudocapsule, and relatively uninvolved fat surrounding the vessels ("fat halo" sign). The process does not narrow the mesenteric vasculature, and there is no associated discrete lymphadenopathy or solid mesenteric masses.Mild colonic diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Signal abnormality involving an approximately 14 cm portion of the small bowel mesentery with imaging features most suggestive of mesenteric panniculitis given evidence of a pseudocapsule and "fat halo" sign, with sclerosing mesenteritis considered less likely due to lack of discrete soft tissue nodularity. Metastases or neoplasm are additional less likely differential considerations (also secondary to absence of nodular soft tissue signal), but are not entirely excluded.2.Findings suggestive of prostatic neoplasm involving the left peripheral zone mid gland. Correlation with PSA levels and urologic consultation are recommended.


Instruction: Generate impression based on findings.

Input: 84-year-old female with right renal mass. Evaluate right renal versus adrenal mass. Evaluate IVC involvement. ABDOMEN:LIVER, BILIARY TRACT: There are at least 3 lesions of the right hepatic lobe demonstrating increased T2 signal hyperintensity, contiguous peripheral enhancement, and restricted diffusion, appearance most concerning for metastatic disease (series 5 images 7, 15) (series 10 images 356, 342) (series 100103 images 465, 479). Portal vein displaced by large right suprarenal mass lesion, described below.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Large heterogenous mass most likely originating from the right adrenal gland (a normal right adrenal gland is not seen) based on imaging measuring 18.4 x 13.7 x 15.8 cm (axial series 5 image 33, coronal image 25). The large mass exerts mass effect on the right kidney (displaced inferiorly) and left hepatic lobe superiorly. Heterogenous enhancement is noted on the postcontrast series. There is encasement of the infrahepatic IVC, which also contains intraluminal thrombus (series 10 image 440). No significant abnormality of the left adrenal gland.KIDNEYS, URETERS: In the right lower renal pole, there is a 2.1 x 2 cm T1 hyperintense focus compatible with a proteinaceous cyst (series 10 image 15). Additional subcentimeter T2 hyperintense foci, favored to be tiny cysts. In the left mid kidney, there is a minimally complex cyst containing T2 hyperintense signal with layering T1 hyperintense debris inferiorly (series 4 image 66, series 6 image 12). In the left kidney, there are multiple subcentimeter T2 hyperintense foci, small size makes definitive characterization difficult but favor cysts.On the postcontrast subtraction series, no suspicious enhancing components identified.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.Large heterogenous enhancing mass likely originating from the right adrenal gland measuring 18.4 x 13.7 x 15.8 cm. Associated IVC encasement and invasion seen tumor thrombus seen. Malignancy specifically adrenocortical carcinoma is favored in light of suspicious hepatic lesions concerning for metastatic disease. 2.Bilateral renal cysts, some containing T1 hyperintense/proteinaceous material. There is a minimally complex cyst of the left lower renal pole containing layering T1 hyperintense debris. No suspicious enhancing components delineated.


Instruction: Generate impression based on findings.

Input: Adenoid cystic carcinoma with left maxillary lesion and liver metastasis. Neck CT:Extensive post-treatment changes are again present involving the left orbit, maxillary region and upper neck. Again noted are enhancing soft tissue lesion involving the left orbit, extending to the orbital apex, superior and inferior orbital fissure. There is extension into the region of the left pterygopalatine fossa and left cavernous sinus. There is lesion at the left nasolacrimal sac and canal. There is lesion involving anterior maxilla with very minimally increased bony erosion, measuring 26 mm (series 8035, image 52), with similar measurement on prior study. There is lesion involving the left nasopharyx and sphenopalatine foramen, with bony destruction at the floor of the sphenoid sinus and bone destruction of the left basisphenoid. There is soft tissue lesion involving the left temporalis muscle. The lesion at the left lacrimal fossa measures 19 x 7 mm (image 14, series 4) compared to prior measurement of 21 x 5 mm (image 12, series 3), not significantly changed in size. There is increased erosion of the lateral wall of the left orbit. There is soft tissue lesion overlying and lateral to the ramus of the left mandible. An enhancing lesion involving the anterior pole of the left temporal lobe is unchanged compared to MRI of 11/16/2010. Enhancement in the left foramen ovale seen on the prior MRI is not as well appreciated on this CT study and may be related to technical difference.There is patchy opacity in the right lung apex, which may represent inflammatory change. Degenerative disease of cervical spine is noted.

Output: 1. Enhancing lesions involving the left and anterior maxillary region and left orbit with extension into the left nasopharynx, left masticator space, sphenoid sinus, skull base, and left cavernous sinus as described above. There is subtle interval increase of bone erosion associated with the lesions at the left lacrimal fossa and anterior maxilla, but the soft tissue components of the lesions demonstrate no significant interval change in size.2. Enhancing lesion in anterior pole of the left temporal lobe seen on prior MRI study is not significantly changed. This could potentially represent post radiation necrosis versus tumor brain parenchymal involvement.


Instruction: Generate impression based on findings.

Input: 7-year-old male with neurofibromatosis type I, assess for change of known brainstem tumor or optic glioma. Patient is experiencing headaches. MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. There is redemonstration of an infiltrative mass at the cervicomedullary junction associated with mass effect. It is predominantly high signal on T2 and low signal on T1. Given slight differences in level of slice acquisition, this is unchanged in size or morphology. Associated patchy contrast enhancement has has decreased, especially along its left lateral aspect.There is a redemonstration of a T2 signal hyperintense lesions located in the bilateral cerebellar gray nuclei as well as the thalami and basal ganglia which were also present on the prior exam and not substantially changedNormal 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.Mucosal thickening can be found throughout the paranasal sinuses, with complete obstruction of the left maxillary sinus. The visualized portions of the mastoid air cells are clear.MRI orbits:Redemonstrated is hypothalamic enlargement, unchanged in morphology, however demonstrating a new subtle focus of enhancement just superior to the junction with the pituitary stalk (best seen on image 3, series 3901).Redemonstrated is a small 3-mm T2 hyperintense, enhancing mass with hypointense center immediately inferior to the left optic nerve in the region of the left orbital apex, unchanged in appearance. Orbits and globes are otherwise unremarkable. The optic chiasm is normal. Optic tracts appear unremarkable. Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. Redemonstrated is enlargement of the central canal in the upper thoracic spine not entirely included on this exam.No abnormal enhancing lesions are appreciated in the cervical cord.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is a left-sided nerve sheath lesion associated with patchy contrast enhancement. It is associated with enlargement of the adjacent neural foramen. These findings are unchanged.At C4-5 there is a left-sided nerve sheath lesion which is stable compared to the prior exam. It is associated with patchy contrast enhancement and slight flattening of the left lateral cord. It is associated with enlargement of the adjacent neural foramen.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.There is an infiltrative mass at the cervicomedullary junction associated with mass effect. It is predominantly high signal on T2 and low signal on T1. Given slight differences in level of slice acquisition, this is unchanged in size or morphology. Associated patchy contrast enhancement has has decreased, especially along its left lateral aspect.2.T2 signal hyperintense lesions located in the bilateral cerebellar gray nuclei as well as the thalami and basal ganglia have not substantially changed.3.Redemonstrated is hypothalamic enlargement, unchanged in morphology, however demonstrating a new subtle focus of enhancement just superior to the junction with the pituitary stalk (best seen on image 3, series 3901).4.There is a small 3-mm T2 hyperintense, enhancing mass with hypointense center immediately inferior to the left optic nerve in the region of the left orbital apex, unchanged in appearance.5.Redemonstrated is enlargement of the central canal in the upper thoracic spine not entirely included on this exam.6.At C3-4 there is a left-sided nerve sheath lesion associated with patchy contrast enhancement, unchanged.7.At C4-5 there is a left-sided nerve sheath lesion associated with patchy contrast enhancement and slight flattening of the left lateral cord, unchanged.


Instruction: Generate impression based on findings.

Input: Knee pain. MENISCI: There is abnormal signal intensity within the body and posterior horn of the medial meniscus indicating a complex tear which includes a horizontal component that extends to the femoral articular surface as well as a vertical component which appears to extend through the meniscus. There is also blunting of the free edge of the body of the medial meniscus. A focus of low signal intensity situated above the body of the medial meniscus medial to the medial femoral condyle is suspicious for a displaced flap fragment. There is slight medial extrusion of the body of the medial meniscus. The anterior horn of the medial meniscus appears intact. The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is moderate diffuse degeneration of the articular cartilage of the medial facet of the patella with fissuring and delamination extending into the articular cartilage of the lateral facet. There is a superficial defect of the articular cartilage of the femoral trochlea centrally. There is partial thickness degeneration of the articular cartilage of the medial femoral condyle above the posterior horn of the medial meniscus. The articular cartilage of the lateral compartment appears relatively intact.LIGAMENTS: The cruciate ligaments appear intact. The medial collateral ligament appears intact. A collection of lobulated fluid signal intensity between the IT band and the lateral collateral ligament proper which measures approximately 17 mm in the AP dimension and 2 cm in the craniocaudal dimension may represent a ganglion or distended bursa. The structures of the LCL complex themselves appear intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1.Complex tear of the medial meniscus with possible displaced meniscal fragment in the medial gutter.2.Cartilaginous degeneration as described above.3.Baker's cyst and other findings as described above.


Instruction: Generate impression based on findings.

Input: Adenopathy, including a focus adjacent to the rightward trachea at the level of T1, and a left pulmonary mass are better visualized on prior chest CT. There is no involvement of the spinal column or components. Alignment is normal. The marrow signal is benign. The spinal cord is normal in signal without abnormal enhancement. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The conus is normal in morphology and terminates at T12/L1. There are no findings of fatty filum. There are no osseous dysplasias. There are no stenoses. Incidental note is made of a conjoined right S1 and S2 nerve root sheath.

Output: Adenopathy, including a focus adjacent to the rightward trachea at the level of T1, and a left pulmonary mass are better visualized on prior chest CT. There is no involvement of the spinal column or components.