Instruction: Generate impression based on findings.

Input: Hip pain, worsening despite nonweightbearing. Evaluate for stress fracture. Previously seen edema in the proximal femoral diaphysis below the lesser trochanter has resolved.Again seen is a linear focus of intermediate signal intensity traversing the anterior labrum at the two o'clock position compatible with a tear, appearing similar to the prior study. The tear lies just deep to the iliopsoas tendon raising the possibility of iliopsoas impingement. The articular cartilage of the hip appears normal. We see no CAM deformity.Again seen is increased signal intensity of the right hamstrings at the origin which may represent tendinosis but is of uncertain current clinical significance. The remaining bone and soft tissues appear normal.

Output: 1. Resolution of proximal femoral stress reaction.2. Anterior labral tear, appearing similar to the prior study.


Instruction: Generate impression based on findings.

Input: 69-year-old female with a personal history of a NEW biopsy-proven invasive ductal carcinoma in the right breast. She has a remote history of right lumpectomy in 2000 for breast cancer followed by radiation and hormonal therapy. There is heterogeneous amount of fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally. RIGHT BREAST:There is a spiculated mass with washout dynamic kinetics in the inferior right breast, 7:00 location, far posterior depth, measuring 1.8 x 2.7 x 2.7 cm (LR X AP X SI). Artifact from the biopsy clip is identified in this mass. This is compatible with the biopsy-proven malignancy. No enhancement in the pectoralis muscle to suggest disease involvement. Linear enhancement extending from this mass to the skin along the biopsy needle track is most consistent with the post procedure inflammatory change.There is nonspecific, asymmetric enhancement in the right nipple.LEFT BREAST:No abnormal enhancement is seen in the left breast. AXILLAE:No abnormal axillary lymph nodes are identified in either axillary region.

Output: 1. Unifocal biopsy-proven malignancy at posterior 7:00 position in the right breast.2. No MRI evidence for malignancy in the left breast. 3. No abnormal axillary lymph nodes in either axillary regionBIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: 43-year-old female with myalgia and intermittent weakness, evaluate for myopathy affecting the quadriceps. BONES: Multisequence MRI images of the right femur demonstrate mild heterogeneity of the bone marrow compatible with normal red marrow reconversion. No fractures are identified. Large field-of-view images also demonstrate grossly normal bone marrow signal within the left femur.SOFT TISSUES: ]The visualized musculature is within normal limits without abnormal signal to suggest myositis. The visualized neurovascular structures are also intact.High T2 signal tubular structures (series 9, image 1) seen on a single image in the expected location of the uterine cervix are incompletely visualized and evaluated.

Output: 1.[No evidence of myositis.2.Fluid intensity tubular structures within the expected location of the uterine cervix are incompletely imaged. If there is concern for gynecologic pathology, could be further evaluated with ultrasound.


Instruction: Generate impression based on findings.

Input: Other headache syndromes(339.89) [339.89] / Common variable immunodeficiency [279.06] / Unspecified cerebral artery occlusion with cerebral infarction [434.91], Reason for Study: ^Reason: IVIG, HA History: HA There is focal tissue loss on the left mesial thalami without evidence of hemosiderin deposition indicating possible chronic ischemic infarction with encephalomalacia.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear. Bilateral maxillary sinus show opacifications.3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal.3D MRV brain post-gadolinium with maximum intensity projections of the superficial/deep intracranial venous drainage demonstrate hypoplastic left transverse and transverse-sigmoid sinus junction. The right transverse sinus, right sigmoid sinus, superior sagittal sinus and torcular appears to be normal. Unilateral hypoplastic sinus especially transverse sinus could be regarded as a normal variation, however, this could also be a finding of idiopathic intracranial hypertension.

Output: 1. Encephalomalacia on the left mesial thalamus indicating chronic ischemic infarction. Otherwise no evidence of acute ischemic or hemorrhagic lesion on this scan.2. Normal brain MRA3. Hypoplastic left transverse and transverse-sigmoid sinus junction. This could represent a normal variation.


Instruction: Generate impression based on findings.

Input: Clinical question: Please perform Dr.Javed's MS protocol. Signs and symptoms: Multiple sclerosis with acute lumbar radiculopathy, evaluate for myelitis or disc etiology. Pre and postcontrast enhanced lumbar MRI:There is normal anatomical alignment of vertebral column. There is however mild straightening of lumbar lordosis without significant change since prior exam.There is normal signal intensity over lowermost visualized thoracic cord and the cauda equina without abnormal enhancement.T11-T12 is unremarkable.T12-L1 is unremarkable.L1-L2 is unremarkable.L2-L3 demonstrate minimal disc desiccation and mild hypertrophy of ligamentum flavum without spinal stenosis or neural foraminal compromise.L3-L4 demonstrate a broad based shallow left lateral and far lateral disc protrusion at this level without significant change since prior exam from 2010. There is no spinal stenosis or neural foraminal compromise at this level. L4-L5 demonstrate mild degenerative changes without spinal stenosis or neural foraminal compromise.L5-S1 is unremarkable.Postenhanced images demonstrate no abnormal enhancement of the vertebral column, the discs or the epidural spaces.

Output: 1.Normal signal intensity and caliber of the lower most visualized thoracic cord, conus and cauda equina without abnormal enhancement.2.Mild degenerative changes of lumbar spine without spinal stenosis or neural foraminal compromise at any level. Findings remain similar to prior exam. There is a shallow broad-based disc protrusion laterally and far laterally at L3-L4 without significant change since prior exam. Please see above comments.


Instruction: Generate impression based on findings.

Input: Female 17 years old Reason: eval for rotator cuff or labral tear History: shoulder pain with pain and weakness s/p dislocation ROTATOR CUFF: The rotator cuff is intact.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: Non-arthrographic imaging limits evaluation of the glenoid labrum, given this limitation, no labral tear is evident.BICEPS TENDON: The biceps tendon is normally positioned within the bicipital groove. ADDITIONAL

Output: 1.Trace fluid within subacromial bursa suggestive of bursitis.2.Focal high signal within the anterior aspect of the femoral heads, without associated cortical defect, is likely post traumatic.3.Evaluation of the glenoid labrum is limited given lack of intra-articular contrast, given this limitation, no labral tear is evident.


Instruction: Generate impression based on findings.

Input: Continued right forearm and hand numbness and weakness following right shoulder arthroscopy on 5/14/15 using a single shot interscalene block. There is mild diffuse high T2 signal and swelling centered fat of the right posterior triangle, but also extending into the right axilla and portions of the anterior neck along the fascial planes. The right brachial plexus appears to be grossly intact. There are partially-imaged right shoulder postoperative findings and effusions. The cervical spine appears to be unremarkable.

Output: Mild diffuse high T2 signal and swelling centered fat of the right posterior triangle may be procedure related and may consist of edema and/or hemorrhage. The right brachial plexus otherwise appears to be grossly intact. Please refer to the separate shoulder MRI report for additional details.


Instruction: Generate impression based on findings.

Input: Malignant melanoma of skin, unspecified [C43.9], Reason for Study: ^Reason: pt with melanoma please assess disease status History: melanoma Previously seen the left middle frontal gyrus susceptibility lesion is again seen and the measured size on T1 post enhancement images appears to be stable (7.1mm x9.4mm). Comparing to prior scan, curvilinear enhancing part of the lesion especially anteromesial aspect appears to be lessen than prior scan.There is no other lesion seen on this scan.Left frontal craniotomy with underlying dural enhancement appear to be stable since prior scan.Minimal craniotomy site extra axial fluid collection is still seen, no change since prior scan.There is no new acute ischemic or hemorrhagic lesion.The ventricles, sulci and cisterns are symmetric and 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. Post left frontal craniotomy status.2. Stable size of the left middle frontal gyrus susceptibility lesion with lessen anteromesial enhancement since prior scan.3. Otherwise postoperative no remarkable finding.


Instruction: Generate impression based on findings.

Input: The examination is limited by motion artifact. There is a large area of encephalomalacia and susceptibility artifact present in the right temporal lobe, which is new since August 2014. There is also encephalomalacia and susceptibility effect in the right parietal lobe. There is a diffuse background of high T2 signal involving in the bilateral cerebral white matter. In addition, there are punctate foci of what appears to be restricted diffusion adjacent to the right gyrus rectus right occipital lobe, and left middle frontal gyrus. There are scattered areas of gyriform susceptibility effect along the bilateral upper cerebral hemispheres and multiple peripheral intraparenchymal foci of susceptibility effect. There is no midline shift or mass effect. There is diffuse prominence of the cortical sulci in proportion to the cerebral ventricles consistent with diffuse cerebral atrophy. There is a left lens implant and what may represent choroidal or retinal detachment. There is mild mucosal thickening in the paranasal sinuses.

Output: 1. Chronic right temporal and parietal hemorraghic infarcts and a background of probable chronic small vessel ischemic disease, as well as what may represent recent punctate infarcts and/or artifacts adjacent to the right gyrus rectus, right occipital lobe, and left middle frontal gyrus.2. Multiple peripherally located foci of microhemorrhages are suggestive of amyloid angiopathy.3. Diffuse superficial siderosis in the superior bilateral cerebral hemispheres related to chronic subarachnoid hemorrhage.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Right upper extremity radicular pain. Evaluate for cervical nerve impingement. Craniovertebral junction appears within normal limits. There is slight straightening of the cervical spine which may be positional or related to spasm/pain. Bone marrow signal is within normal limits. The cervical spinal cord has normal signal characteristics and overall morphology.Degenerative changes are seen in the cervical spine as described below:C2-3: Minimal disc disease and degenerative changes. No central spinal canal stenosis. Mild left neuroforaminal stenosis.C3-4: Minimal disc disease. There is left-sided uncovertebral with mild left and moderate right neuroforaminal stenosis. Mild central canal stenosis is also noted.C4-5: Moderate disc disease and moderate loss of disc height with significant left neural foraminal stenosis. No right neuroforaminal stenosis or central spinal canal stenosis. There is a tortuous right vertebral artery which invades the right neural foramen but there is no neural foraminal stenosis.C5-6: Moderate disc disease and loss of disc height is noted. There is right greater than left uncovertebral hypertrophy with significant right and mild left neuroforaminal narrowing. No central spinal canal stenosis.C6-7: Mild degenerative disc disease with moderate left and mild right facet hypertrophy. Right greater than left broad-based disc protrusion with extrusion of disc material superiorly which causes severe right neuroforaminal stenosis. There is also resultant moderate central canal stenosis with flattening and displacement of the spinal cord but no detectable cord signal abnormality. C7-T1: Mild degenerative disc disease is noted without neuroforaminal or central spinal canal stenosis. Paraspinous soft tissue structures appear within normal limits.

Output: Multilevel degenerative changes at greatest the right C6-7 level where there is a broad-based disc protrusion and superior extrusion of disc material which causes severe right neural foraminal stenosis and moderate central spinal canal stenosis. No detectable cord signal abnormalities.


Instruction: Generate impression based on findings.

Input: 33 years Female (DOB:11/7/1982)Reason: r/o lesion in occipital region History: recurrent transient visual symptoms, h/o migrainePROVIDER/ATTENDING NAME: HELENE G. RUBEIZ HELENE G. RUBEIZ The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus. The right transverse sinus is larger than left transverse sinus. There is signal hyperintensity on T2-weighted imaging within the junction of left transverse and sigmoid sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.There is signal hyperintensity present within the junction of the left transverse and sigmoid sinuses. In isolation this is somewhat nonspecific. This could represent a large arachnoid granulation or early thrombus formation. There are no other associated findings. The possibility of a focal occlusion of this short segment with patency of the left transverse and sigmoid sinus elsewhere is raised. If clinically indicated venography side chest CTV or MRV of the brain may be helpful for further analysis.2.No intracranial mass lesions are appreciated to explain patient's headaches. 3.An email was sent to Dr Rubeiz.


Instruction: Generate impression based on findings.

Input: There are no masses, mass effect or midline shift. The ventricles and sulci are 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. There are minimal scattered small foci of T2/FLAIR signal hyperintensity in the deep white matter, suggestive of minimal small vessel ischemic disease. Flow voids are present within the major vessels indicating patency. There is a trace amount of fluid in the right maxillary sinus. Otherwise, the paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain. Bone marrow signal is within normal limits.

Output: 1. No evidence of intracranial metastatic disease. 2. Mild chronic small vessel ischemic changes.


Instruction: Generate impression based on findings.

Input: Malignant neoplasm of brain, unspecified [C71.9] / Encounter for examination for normal comparison and control in clinical research program [Z00.6], Reason for Study: ^Reason: GBM sp/Clinical Investigation History: GBM Right temporal lobe post tumor resection status with the resection cavity is again seen. Measured the size of the resection cavity of the right temporal lobe appears to be unchanged. However, surrounding enhancing tissues show subtle increase since prior scan. In particular, the anterior and mesial aspect of the tumor mass appears to increased since prior scan. And the enhancing lesion on the right side corpus callosum splenium lesion is more conspicuous than prior scan. Effacement of the right lateral ventricle appears to be aggravated since prior scan again indicating increased mass effects.Constellation of above findings indicate possible tumor growth especially anterior and mesial aspect of the resection cavity as well as right side corpus callosum splenium since prior scan.The cranial-cervical junction are normal. The paranasal sinuses are clear.Fluid collections are seen on the right mastoid air cells unchanged since prior scan.

Output: Interval tumor growth especially anterior and mesial aspect of the tumor resection cavity as well as right side of corpus callosum splenium is suspected with increased mass effects toward right lateral ventricle.


Instruction: Generate impression based on findings.

Input: Breast cancer with right eye proptosis and CN III deficits. There is diffuse ill-defined preseptal and postseptal soft tissue thickening and enhancement and stranding of the orbital fat, with mild right proptosis. There is enlargement of the right superior rectus muscle and hyperenhancement of the right superior oblique and medial and inferior rectus muscles. There is a defect in the right lamina papyracea with herniation of orbital fat and a portion of the medial rectus muscle. The right optic nerve appears to be intact. The left orbit is unremarkable. The bone marrow of the clivus appears to be diffusely heterogeneous. There are bilateral mastoid effusions. The imaged intracranial structures are unremarkable.

Output: 1. An infiltrative process involving the right preseptal and postseptal orbit may represent a breast cancer metastasis, although an infectious or post-traumatic process are differential considerations based on imaging.2. Right lamina papyracea fracture with herniation of orbital fat and medial rectus muscle herniation.3. Heterogeneity of the clivus may represent metastatic disease. A bone scan may be useful for further evaluation.4. Nonspecific bilateral mastoid effusions.


Instruction: Generate impression based on findings.

Input: Syncopal event versus seizure at home. Evaluate for structural abnormality. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is parenchymal volume loss including the bilateral hippocampi. The ventricles and basal cisterns are normal in size and configuration for age. There is no midline shift or herniation. There are scattered punctate foci and confluent areas of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter and pons, consistent with moderate chronic small vessel ischemic changes. There are scattered foci of susceptibility artifact particularly at the right thalamus, likely representing chronic hemosiderin deposition. The skull and extracranial soft tissues are unremarkable. There is soft tissue thickening around the odontoid process which can be seen with entities such as CPPD. There are bilateral lens implants.

Output: 1.No intracranial mass or mass effect. No evidence of acute infarct.2.Scattered foci of T2 hyperintense signal in the periventricular subcortical white matter, which are nonspecific, but likely represent moderate chronic small vessel ischemic changes.3.Multiple foci of chronic microhemorrhage particularly involving the right thalamus which can be seen with chronic hypertension.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 57 year old female with a history of non-ischemic cardiomyopathy, hypertension, and hyperlipidemia referred for cardiac MRI. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 31%, the LV end diastolic volume index is 137 ml/m2 (normal range: 65+/-11), the LVEDV is 297 ml (normal range 109+/-23), the LV end systolic volume index is 65 ml/m2 (normal range 18+/-5), the LVESV is 205 ml (normal range 31+/-10), the LV mass index is 76 g/m2 (normal range 67+/-11), and the LV mass is 165 g (normal range 114+/-24). There is global hypokinesis with regional variation. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. The pre-contrast native myocardial T1 relaxation time is normal (1066 ms). Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 47%, the RV end diastolic volume index is 78 ml/m2 (normal range 69+/-14), the RVEDV is 169 ml (normal range 110+/-24), the RV end systolic volume index is 41 ml/m2 (normal range 22+/-8), and the RVESV is 90 ml (normal range 35+/-13). Right AtriumThe right atrium is moderately dilated. Aortic ValveThe aortic valve opens widely and there is mild aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac 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. The left ventricle is severely dilated with severely reduced systolic function (LVEF 31%). There is global hypokinesis with regional variation. 2. The right ventricle is normal in size with mildly reduced systolic function (RVEF 42%). 3. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. 4. Moderately biatrial enlargement. 5. Mild aortic/mitral regurgitation.


Instruction: Generate impression based on findings.

Input: Motion artifact limits evaluation. Per technologist note, patient uncooperative and unable to hold position.Restricted diffusion in the right putaminal extending to the caudate with local mass effect upon the frontal horn of the right lateral ventricle without significant midline shift. Within limitation of motion artifact, no acute intracranial hemorrhage or extra-axial fluid collections. No underlying mass is identified. The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. The pituitary gland is normal in size. 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, with limitation of motion artifact.

Output: Findings compatible with acute ischemia in the right lenticulostriate arterial distribution as noted on the prior CT exam without evidence of acute hemorrhage.


Instruction: Generate impression based on findings.

Input: Reason: Eval for SL or TFCC injury History: same LIGAMENTS: The scapholunate ligament is indistinct, and there is contrast extravasation into the radiocarpal joint, suggesting scapholunate ligamentous disruption. The lunotriquetral ligament is not distinctly seen, suggesting that it is also injured. TRIANGULAR FIBROCARTILAGE COMPLEX: There is no extravasation of contrast into the distal radioulnar joint, indicating an intact triangular fibrocartilage complex.TENDONS: The flexor and extensor tendons appear intact. BONES: Small cysts are noted within the scaphoid, presumably degenerative in etiology. Bone marrow signal intensity is otherwise within normal limits.ADDITIONAL

Output: Scapholunate ligament and likely lunotriquetral ligament tears.


Instruction: Generate impression based on findings.

Input: Evaluate for recurrence of primary CNS lymphoma. There is redemonstration of extensive post-treatment changes of the left frontal lobe with regions of encephalomalacia and mild expansion of left frontal horn similar to prior exam. Mild signal changes of right anterior frontal lobe is also noted which as well remains stable. On the post enhanced images there is no detectable abnormal enhancement to suggest residual or recurrence of tumor. Slight prominence of cortical sulci similar to prior exam is again noted. Ventricular system remain slightly prominent. No midline shift.Multiple small patchy foci of flair hyperintensity in the periventricular and subcortical white matter of the bilateral cerebral hemispheres are redemonstrated and are nonspecific, but most likely representing chronic small vessel ischemic disease. Possibility of some overlapping posttreatment changes cannot be entirely excluded. Calvarium demonstrates post op changes but otherwise intact.

Output: Post-treatment changes in the bilateral frontal lobes, left greater than right. No evidence of tumor recurrence.


Instruction: Generate impression based on findings.

Input: Reason: Pt is an 80 y/o male with met rcc, on holiday from drug due to toxicity, evaluate for progression History: met rcc. ABDOMEN:LUNG BASES: Small right and trace left pleural effusions.LIVER, BILIARY TRACT: Cholelithiasis.Reference segment 6 lesion measures 0.9 x 0.6 cm (series 10 image 50), previously 1 x 0.6 cm.Reference segment 2 lesion measures 1.9 x 1.5 cm (series 10 image 24), previously 17 x 15 cm.Reference segment 6 lesion measures 3.4 x 2.3 cm (series 10 image 45), previously 2.8 x 2.4 cm when remeasured (series 14 image 50). Segment 5 hemangioma and adjacent cysts are unchanged.SPLEEN: No significant abnormality noted.PANCREAS: Nonenhancing cystic lesion within the pancreatic head is unchanged measuring 1.4 x 0.8 cm (series 7 image 19).ADRENAL GLANDS: Post surgical changes of the right adrenalectomy. Left adrenal gland stable.KIDNEYS, URETERS: Post surgical changes of a right nephrectomy. Complex cystic lesion in the left upper pole containing calcification, unchanged. Additional renal cysts are also unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Postsurgical changes of the right anterior abdominal wall.OTHER: No significant abnormality noted.

Output: 1.Slight interval increase in size of a segment 6 lesion. Additional lesions are stable. 2.Stable nonspecific pancreatic cyst.


Instruction: Generate impression based on findings.

Input: 66 years, Male, Reason: Study for upcoming prostate biopsy History: Elevated PSA. PELVIS:PROSTATE:Prostate Size: 5.7 x 3.9 x 3.4 cmPeripheral Zone: Lesion in the right base with low T2/ADC signal and invasion of the right seminal vesicle is suspicious for prostatic adenocarcinoma and measures 1.6 x 1.2 cm (804/364).Lesion in the left base with low T2/ADC signal and invasion of the left seminal vesicle is suspicious for prostatic adenocarcinoma and measures 1.5 x 1.9 cm (804/364).Central Gland: Multiple well-defined heterogeneous nodules likely represent benign prostatic hypertrophy.Seminal Vesicles: Bilateral invasion of the seminal vesicles.Extracapsular Extension: Bilateral extracapsular extension suggested posteriorly.BLADDER: No significant abnormality noted.LYMPH NODES: No lymphadenopathy.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1.Lesions described above in the bilateral bases are suspicious for prostatic adenocarcinoma.2.No lymphadenopathy.


Instruction: Generate impression based on findings.

Input: Diagnosis: Cerebral infarction due to unspecified occlusion or stenosis of left anterior cerebral arteryClinical question: please check vessel patencySigns and Symptoms: right sided weakness MRI of the brainA focus of diffusion restriction measuring approximately 7 mm in size is present along the posterior limb of the left internal capsule extending to involve the basal ganglia. This is associated with some T2 and FLAIR signal hyperintensity.There are subcentimeter foci of T2 and FLAIR signal hyperintensity present in the thalami, basal ganglia and cerebellar hemispheres bilaterally without associated diffusion restriction. There are patchy foci of T2 and FLAIR signal hyperintensity in the pons.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The right vertebral artery flow-void is absent, though the right vertebral artery is identified and is small.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. There is fetal origin of the posterior cerebral arteries bilaterally. The P1 segments are medium-sized. The right vertebral artery is not readily identified.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is mild narrowing at the proximal left vertebral artery. This is approximately 30% narrowing.The right vertebral artery is diminutive and stenotic proximally. It is not identified above the C1 level.

Output: 1.Subacute lacunar infarction involving the posterior limb of the left internal capsule.2.Multiple lesions in the basal ganglia, cerebellum and thalami which are compatible with prior lacunar infarcts3.Patchy lesions in the brainstem as well as periventricular and subcortical white matter lesions are present which are most likely vascular related.4.Findings suggest occlusion of the right vertebral artery distally.


Instruction: Generate impression based on findings.

Input: Reason: assess infarct size History: Patient s/p mechanical thrombectomy on 2/22/2016 There is restricted diffusion in the left MCA territory particularly in the cortex of left frontal and parietal lobes, basal ganglia, and insula. There is surrounding edema and hemorrhage with mass effect on the anterior horn of the left lateral ventricle. There is trace rightward midline shift at the level of the foramen of Monro. There is also focus of restricted diffusion in the left cerebellar hemisphere. There are additional foci of FLAIR hyperintensities in the right cerebellum and left cerebral peduncle without restricted diffusion suggestive of chronic ischemia. There is volume loss involving the left occipital lobe with mild FLAIR hyperintensity suggestive of chronic infarct with ex vacuo dilatation of the occipital horn of the left lateral ventricle. There are suspected acute subarachnoid blood products in the left sylvian fissure as seen on recent CT.Major flow voids are maintained. There is nonspecific opacification of the ethmoid air cells, left maxillary sinus, and bilateral sphenoid sinuses with air-fluid level. Mastoid air cells are clear. Imaged orbits are intact.

Output: 1.There is restricted diffusion consistent with acute infarct predominantly in the left MCA territory as described above. There is hemorrhagic transformation involving the left basal ganglia component of the infarct with surrounding edema and mass effect on the lateral ventricle with trace midline shift.2.There is tiny left cerebellar acute infarction.3.Suspected subarachnoid blood products in the left sylvian fissure which were also seen on recent CT.4.Chronic left occipital infarct.


Instruction: Generate impression based on findings.

Input: 77 years Female (DOB:10/21/1938)Reason: evaluate for increased gait unsteadiness and falls History: pls see abovePROVIDER/ATTENDING NAME: RIMAS V LUKAS RIMAS V LUKAS The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. T2 and FLAIR hyperintense patchy lesions are present in the brainstem. There is a patchy T2 and FLAIR hyperintense lesion in the left centrum semiovale.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin.

Output: Periventricular and subcortical white matter lesions as well as patchy lesions in the brainstem of a mild degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: 63-year-old female BRCA2 mutation carrier, with family history of breast cancer, presents for high-risk screening. There is heterogeneous amount of fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary or internal mammary region.

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


Instruction: Generate impression based on findings.

Input: Female 65 years old with endometrioid adenocarcinoma, please check for recurrence. PELVIS:UTERUS, ADNEXA: Status post hysterectomy and oophorectomy. No evidence of recurrent mass or abnormal enhancement along the vaginal cuff.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy.BOWEL, MESENTERY: The mild thickening of the rectum is unchanged and may be related to prior radiation. No abnormal bowel wall enhancement or dilatation.BONES, SOFT TISSUES: A broad-based ventral hernia contains small bowel and fat, not significantly changed.OTHER: A cystic focus along the left pelvic wall measures 4.4 x 2.5 cm (series 6, image 24) and is compatible with a lymphocele. It has decreased in size since the previous exam where it measured 5.4 x 3.9 cm.

Output: 1.No evidence of recurrent mass along the vaginal cuff. 2.No evidence of metastatic disease in the pelvis.3.Decrease in size of left pelvic wall lymphocele.4.Stable fat and bowel containing ventral hernia.


Instruction: Generate impression based on findings.

Input: Clinical question: Patient with bilateral upper extremity weakness and recent fall. Rule out hemorrhage/other acute processes. Signs and symptoms: Bilateral upper extremity weakness. Nonenhanced head CT:No detectable acute intracranial process. CT however is insensitive for the attention of acute nonhemorrhagic ischemic strokes.Cerebral cortex, cortical sulci and the ventricular system are within normal for patient stated age.The gray -- white matter differentiation is preserved.Calvarium and soft tissues of the scalp are unremarkable.Visualized paranasal sinuses, mastoid air cells and middle ear cavities are pneumatized and unremarkable. Very small retention cyst in the left maxillary sinus however is present.Nonenhanced cervical CT:There is no detectable bony fracture of the cervical spine.There is very significant degenerative changes of cervical spine with resultant near complete fusion of C3 and C4 , significant loss of intervertebral disk at C4 -- C5 and advanced degenerative changes at C5 -- C6 and C6 -- C7 levels. There is reversal of cervical lordosis centered at C3 there C4. There is highly suspected central spinal stenosis at C3, C4 and C5 levels.There are also bilateral multi-level neural foraminal compromise at C3 there C4, C4 -- C5 and to a lesser degree at C5 -- C6 and C6 -- C7 levels.No detectable paraspinal soft tissue abnormalities.Heavy vascular calcification of the right carotid bifurcation is noted.Enlargement of thyroid lobes with inhomogeneous pattern is concerning for goiter. There is no deviation or compromise of the trachea.

Output: 1.Negative nonenhanced head CT.2.No evidence of acute posttraumatic findings of cervical spine. Very advanced degenerative changes of cervical spine with resultant reversal of cervical lordosis and multilevel neural foraminal compromise and suspected central spinal stenosis.


Instruction: Generate impression based on findings.

Input: Female, 16 years old, with migraine headaches and trigeminal neuralgia. Please note that a cranial nerve protocol was followed for this exam, and as such, several of the standard MRI sequences are not included.No restricted diffusion is seen. No evidence of parenchymal edema, mass effect or focal parenchymal signal abnormality is detected. On postcontrast images, no pathologic parenchymal or extra-axial enhancement is seen. There is no evidence of any abnormal extra-axial fluid collection. The ventricles are normal in size and morphology.On dedicated imaging of the cranial nerves, no specific abnormality is detected. In particular, the fifth cranial nerves are symmetric and unremarkable. No pathologic skull base or cranial nerve enhancement is seen.

Output: 1.Unremarkable assessment of the cranial nerves with no specific findings to account for patients congenital neurologic symptoms.2.The brain as visualized is also unremarkable with no significant abnormal findings.


Instruction: Generate impression based on findings.

Input: Hematemesis, melena, inability to tolerate p.o. intake, gastric outlet obstruction per EGD, abnormality seen on CT concerning for pancreatic mass ABDOMEN:LIVER, BILIARY TRACT: Mild intrahepatic biliary duct prominence with tapering seen distally, transition point located near proximal common bile duct, image 24 series 801, with mild soft tissue surrounding stranding seen, site is near moderate to severe narrowing of pylorus. Duct upstream measures 9 mm, while duct below this level measures 3 mm, length of abnormality/site of transition measures approximately 1.5 cm. Unfortunately, area is not well assessed due to motion artifact at this level but findings are suggestive of focal segmental biliary duct stricture, may be of benign or malignant etiology. Hepatic steatosis. T1 hyperintense material seen in gallbladder, may reflect vicarious excretion of contrast from earlier CT study. SPLEEN: No significant abnormality noted.PANCREAS: Intrinsic T1 signal of pancreas relatively preserved. Lobulated contour of pancreatic head, particularly laterally, may be a normal variant, no discrete pancreatic mass visible. Nondilated pancreatic duct. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Tiny renal cyst formation.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Moderate to marked circumferential luminal narrowing at level of pylorus, image 317 series 1202. Moderately distended fluid and debris containing stomach.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Subcentimeter left axillary lymph nodes. Rounded 1 x 0.9 cm T2 hyperintense focus in deep inferior aspect of left breast, image 40 series 701. 1.7 cm right adnexal T2 hyperintense focus, may be a dominant ovarian follicle. Possible lobulated appearance of the uterus, suggestive of underlying leiomyomatous disease.

Output: 1. Mild intrahepatic biliary duct prominence with tapering seen distally, transition point located near proximal common bile duct with mild soft tissue surrounding stranding seen, site is near moderate to severe narrowing of pylorus. Duct upstream measures 9 mm, while duct below this level measures 3 mm, length of abnormality/site of transition measures approximately 1.5 cm. Unfortunately, area is not well assessed due to motion artifact at this level but findings are suggestive of focal segmental biliary duct stricture, may be of benign (e.g., inflammatory/secondary to nearby pyloric disease) or malignant etiology, correlation with patient's clinical history and ERCP recommended. 2. Moderate to marked pyloric narrowing with moderate gastric distention, compatible with patient's reported history of acquired hypertrophic pyloric stenosis.3. Subcentimeter left axillary lymph nodes. Rounded 1 x 0.9 cm T2 hyperintense focus in deep inferior aspect of left breast, may be an additional intramammary lymph node or reflect fibrocystic disease of the breast but indeterminate and mammographic correlation recommended.


Instruction: Generate impression based on findings.

Input: The vertebral body heights are preserved. There is 2-mm retrolisthesis of C3 on C4. Osseous marrow signal is heterogeneous and somewhat low on T1, which is nonspecific; but without destructive osseous lesions. There is no cord signal abnormality. There is disk desiccation at multiple levels in the cervical spine with loss of disk heights.C2-3: Small disk osteophyte complex with no spinal canal or neural foraminal stenosis. Disk desiccation and mild loss of disk height.C3-4: Small disk osteophyte complex with no spinal canal or neural foraminal stenosis. Disk desiccation and mild loss of disk. C4-5: Small disk osteophyte complex, right facet arthropathy with no spinal canal or neural foraminal stenosis. Disk desiccation and minimal loss of disk.C5-6: Disk desiccation with moderate loss of disk height and small disk osteophyte complex with no spinal canal or neural foraminal stenosis.C6-7: Disk desiccation with moderate loss of disk height and small disk osteophyte complex with no spinal canal or neural foraminal stenosis.C7-T1: Right facet arthrosis with no disk herniation, spinal canal or neural foraminal stenosis.T1-2: No disk herniation, spinal canal or neural foraminal stenosis.T2-3: No disk herniation, spinal canal or neural foraminal stenosis.T3-4 level shows no disk herniation, spinal canal or neural foraminal stenosis on sagittal images.

Output: Mild multilevel degenerative changes including facet arthropathy as detailed above. No significant spinal canal or neural foraminal stenosis at any level in the cervical spine.


Instruction: Generate impression based on findings.

Input: Burning pain in the medial arm and forearm, evaluate medial cutaneous nerve arm and forearm. Bone marrow signal of the visualized osseous structures is within normal limits including areas of red marrow. No fractures are identified. Glenohumeral joint alignment is within normal limits.The visualized musculature appears within normal limits without edema or atrophy.The visualized nerves are within normal limits without associated soft tissue masses to explain patient's symptoms. A few superficial varicosities are noted.No areas of abnormal enhancement are seen on postcontrast images.

Output: Unremarkable examination without specific findings to account for patient's symptoms.


Instruction: Generate impression based on findings.

Input: 76-year-old female with left neck pain and left arm radiculopathy Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. There is reversal of normal cervical lordosis with mild kyphotic angulation at the C5-C6 level. No abnormal cord signal is appreciated.Moderate degenerative changes are seen throughout the cervical spine as detailed below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: There is disc osteophyte complex and ligamentum flavum thickening with mild spinal canal stenosis. There is minimal right neural foraminal narrowing. No significant left neural foraminal narrowing.C4-5: There is disc osteophyte complex, uncovertebral hypertrophy, and ligamentum flavum thickening. There is mild to moderate spinal canal stenosis. There is mild right worse in left neural foraminal stenosis.C5-6: There is small disc osteophyte complex and kyphotic angulation at this level. There is mild to moderate spinal canal stenosis. Mild bilateral neural foraminal narrowing.C6-7: There is disc osteophyte complex and ligamentum flavum thickening with moderate spinal canal stenosis. There is moderate left and mild to moderate right neural foraminal stenosis.C7-T1: There is disc osteophyte complex, uncovertebral hypertrophy, and ligamentum flavum thickening. There is moderate spinal canal stenosis. There is moderate to severe left neural foraminal stenosis and moderate right neural foraminal stenosis.There is prominent facet arthropathy at the left C4-C5 level. The vertebral artery flow voids appear to be intact. Small bilateral thyroid nodules noted.

Output: 1. Degenerative changes throughout the cervical spine with up to moderate degree of spinal canal stenosis at multiple levels from C3-C4 to the C7-T1 levels. 2. There is multilevel neural foraminal stenosis, as detailed above, relatively worse at the left C6-C7 and C7-T1 levels which may be impinging on the left C7 and C8 nerve roots. No cord signal abnormality.3. Prominent facet arthropathy at the left C4-C5 level which may be contributing to patient's neck pain.


Instruction: Generate impression based on findings.

Input: 59 year old male with a history of heart failure with preserved ejection fraction, hypertension, coronary artery disease, atrial arrhythmias, and COPD who was recently discharged after decompensated heart failure. He is referred for cardiac MRI for further evaluation. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 64%, the LV end diastolic volume index is 58 ml/m2 (normal range: 74+/-15), the LVEDV is 146 ml (normal range 142+/-34), the LV end systolic volume index is 21 ml/m2 (normal range 25+/-9), the LVESV is 53 ml (normal range 47+/-19), the LV mass index is 55 g/m2 (normal range 85+/-15), and the LV mass is 138 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is asymmetric severe left ventricular hypertrophy (basal to mid anteroseptal wall 17mm and posterior wall 7 mm). There is no LVOT gradient or flow acceleration noted. There is a significant amount of late gadolinium enhancement which involves much of the basal to mid left ventricular endocardial surface. The pattern of late gadolinium enhancement is atypical for prior myocardial infarction and suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process. The pre-contrast native T1 myocardial relaxation time is mildly elevated (1120 ms). The morphological features of the left ventricle are suggestive of hypertrophic cardiomyopathy; however, the late gadolinium enhancement pattern is fairly suggestive of the diagnosis of cardiac amyloidosis. Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 54%, the RV end diastolic volume index is 56 ml/m2 (normal range 82+/-16), the RVEDV is 140 ml (normal range 142+/-31), the RV end systolic volume index is 26 ml/m2 (normal range 31+/-9), and the RVESV is 65 ml (normal range 54+/-17).Right AtriumThe right atrium is moderately dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation. No systolic anterior motion of the mitral leaflets. Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac 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. The left ventricle is normal in size and systolic function (LVEF 64%). There is asymmetric severe left ventricular hypertrophy which is worst in the basal anteroseptum. There is also a significant amount of late gadolinium enhancement which nearly circumferentially involves much of the basal to mid left ventricular endocardial surface. The pattern of late gadolinium enhancement is atypical for prior myocardial infarction and suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process. The morphological features of the left ventricle are suggestive of hypertrophic cardiomyopathy; however, the late gadolinium enhancement pattern is fairly suggestive of the diagnosis of cardiac amyloidosis. 2. The right ventricle is normal in size and systolic function (RVEF 54%).3. Moderate biatrial enlargement.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Slurred speech [R47.81], Reason for Study: ^Reason: Evaluate for acute intracranial abnormality History: Presented with AMS, c/f stroke/TIA A couple of FLAIR/T2 high signal intensity lesions on bilateral periventricular white matter indicating non specific chronic ischemic disease, 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, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: No evidence of no acute ischemic or hemorrhagic lesion.Unchanged minimal non specific small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: Locally advanced T4N3 NPC recurrence with right eye ptosis and diffuse right face numbness, and vision changes. There is an enhancing mass that measures up to 4 cm within the right cavernous sinus and Meckel's cave with extension into the adjacent right middle cranial fossa and petrous apex, with marked mass effect upon the right anterior temporal lobe, where there is extensive vasogenic edema and uncal medialization. There appears to be mild enhancement of the cisternal segment of the right trigeminal nerve, but the brainstem is intact. In addition, the tumor partly encases the right cavernous internal carotid artery, which appears to be mildly narrow. Tumor also extends through foramen ovale along a 10 mm length of the V3 segment trigeminal nerve, as well as into the right pterygopalatine fossa via foramen rotundum and Vidian canal. The tumor also extends to the geniculate ganglion region, where there appears to be mild thickening of the facial nerve in this region. Furthermore, the tumor abuts and mildly displaces and partly surrounds the right prechiasmatic optic nerve. Aside from post-treatment effects, there is no discernible tumor in the right lateral nasopharyngeal recess. There is no evidence of acute cerebral infarction. The ventricular system is not enlarged.

Output: Recurrent tumor measures up to 4 cm within the right cavernous sinus, Meckel's cave, and right middle cranial fossa, with marked mass effect upon the right anterior temporal lobe, with associated extensive vasogenic edema. The tumor partly encases the right cavernous internal carotid artery, which appears to be mildly narrow. Tumor also extends through foramen ovale along a 10 mm length of the V3 segment trigeminal nerve, as well as into the right pterygopalatine fossa via foramen rotundum and Vidian canal, indicating perineural tumor spread. In addition, the tumor also extends to the geniculate ganglion region, where there appears to be mild thickening of the facial nerve in this region, which may represent further perineural involvement versus reactive changes. Furthermore, the tumor abuts and mildly displaces and partly surrounds the right prechiasmatic optic nerve. Follow up via an orbital MRI may be useful for more detailed evaluation of this region. Aside from post-treatment effects, measurable tumor is identified within the right lateral nasopharyngeal recess.


Instruction: Generate impression based on findings.

Input: Pain MENISCI: There is obliquely oriented signal abnormality extending through the posterior horn of the lateral meniscus consistent with a complete tear. A flap component is suspected. Slab like configuration of the body of the lateral meniscus suggests the possibility of a torn discoid meniscus, but this is equivocal. The anterior horn of the lateral meniscus and medial meniscus are intact.ARTICULAR CARTILAGE AND BONE: There is increased signal centrally within the articular cartilage of the patella indicating degeneration without focal fluid-filled surface defect. Bone marrow signal is within normal limits. No fracture or contusion.LIGAMENTS: ACL, PCL, MCL and LCL are intact.EXTENSOR MECHANISM: Quadriceps and patellar tendon are intact.ADDITIONAL

Output: 1. Tear of the posterior horn of the lateral meniscus likely with a displaceable flap component.2. Patellar cartilage degeneration without defect.


Instruction: Generate impression based on findings.

Input: 65 years Male (DOB:5/6/1951)Reason: History of metastatic RCC with new weakness and not able to ambulate. Please r/o cord compression as cause History: back pain, LE weakness, numbness/tinglingPROVIDER/ATTENDING NAME: ANITA KALLEPALLI MRI limited complete spine for cord compression:There are multiple foci of marrow replacement throughout the patient's spine. There is a compression fracture and present at L1 associated with obliteration of the right neural foramen of L1-2. There is mild narrowing of the spinal canal at that level.. There is narrowing of the spinal canal at the T9 and T10 levels due to an epidural based lesion.There are degenerative changes present in the cervical spine.The patient status post abdominal aortic aneurysm repair.MRI thoracic spine:There is an epidural-based lesion present at the T9 and T10 levels which encircles the spinal cord and obliterates spinal fluid surrounding the spinal cord. There is extension of this epidural based lesion through the neural foramina right T9-10 and T10-11 neural foramina to a lesser degree left T10-T11 neural foramen. There is marrow replacement within the T10 vertebral body.There is a T1 hyperintense well-circumscribed lesion present within the subcutaneous tissues behind the thoracic spine measuring 38 x 11 mm sagittal dimensions it is to the left of midline behind the left perivertebral musculature extends from the T6 level to the T8 level. This represents a subcutaneous lipoma.There is a right-sided pleural effusion present.

Output: 1.There is an epidural lesion present which circumferentially encases the spinal cord at the T9 andT10 levels which extends through the right T9-10 and T10-11 neural foramina and a left and T10-11 neural foramen.2.There is an L1 compression fracture present associated with some encroachment of the exiting nerve roots within the L1-2 neural foramina worse on the right side when compared to the left.3.There are multiple foci of marrow replacement throughout the visualized spine compatible with metastatic disease.4.There is a right pleural effusion present.5.At the time of dictation an alphanumeric page was sent to pager 9100 Dr Desai Parin and the findings were discussed.


Instruction: Generate impression based on findings.

Input: Nonenhanced CT of brain:There is no evidence of interval new hemorrhage, edema, mass effect, midline shift or hydrocephalus. Very minimal residual blood in the subarachnoid space and the cortical sulci in the right frontal region is noted (axial image 18). This appears slightly smaller since prior examination from 7 -- 20 -- 2010. No evidence of residual subdural. No evidence of residual subdural. Small vessel disease of indeterminate age is again identified.A calcific lesion/mass measuring approximately 17 mm times 10 mm in size abuts the posterior aspect of the greater wing of right sphenoid bone. This shows no interval change since prior study. Finding may represent a small meningioma. An MRI examination is recommended for further evaluation of this lesion.

Output: 1.No evidence of residual subdural.2.Further decrease in the amount of minimal subarachnoid blood in the right frontal region.3.Small vessel disease of indeterminate age.4.Dural based calcific lesion posterior to the greater being the sphenoid. Likely meningioma. Follow-up with an MRI is recommended for exclusion of other possibilities.5.No evidence of new hemorrhage since prior exam.


Instruction: Generate impression based on findings.

Input: Question of osteomyelitis. Focus on right calcaneus. TENDONS: No significant abnormality noted.LIGAMENTS: No significant abnormality noted.ARTICULAR SURFACES AND BONE: There is interval increased patchy, ill-defined low T1 and high T2 signal within the calcaneus and the anterior talus. These regions demonstrate slight enhancement on post-contrast imaging. Additionally, there is new patchy abnormal T1 and T2 signal within the cuboid and the distal tibial epiphysis. Again noted is a focus of abnormal signal within the inferior margin of the calcaneus corresponding to a lucency seen on prior CT; this is less apparent on this examination. ADDITIONAL

Output: Increased non-specific bone marrow edema with new signal abnormality within the distal tibial epiphysis and cuboid which was not appreciated on the prior examination.


Instruction: Generate impression based on findings.

Input: Known left breast cancer. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.In the anterior depth of the left breast 12:00 position, there is a high T2 signal collection with minimal if any enhancement. This measures 2.8 x 1.9 x 2.5 cm. The appearance is compatible with a low grade mucinous carcinoma, as has been suggested on biopsy. No abnormal enhancement is seen in elsewhere in either breast. A few scattered enhancing foci in each breast are not uniquely enhancing or suspicious. No abnormal axillary lymph nodes are identified in either axillary region.A high T2 signal hepatic lesion on the most inferior T2 images is most likely a cyst or hemangioma.

Output: Left breast high T2 lesion measuring nearly 3 cm is compatible with a low grade mucinous carcinoma. No additional suspicious finding elsewhere in either breast or axilla. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Right facial droop and right lower extremity weakness. There is unchanged curvilinear encephalomalacia in the left basal ganglia and corona radiata. There is no evidence of intracranial hemorrhage, mass, or acute cerebral 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, and paranasal sinuses are grossly unremarkable. There is a nodule in the left temporal scalp subcutaneous tissues that displays restricted diffusion and measures up to 15 mm, which likely represents an inclusion cyst. There is a small probable retention cyst in the left sphenoid sinus.

Output: Chronic left basal ganglia and corona radiata infarct, but no evidence of acute cerebral infarction.


Instruction: Generate impression based on findings.

Input: Altered mental status, tremors, falls, abnormal upper extremity reflex response Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. There is some loss of cervical lordosis. Alignment is otherwise grossly maintained. There is abnormal signal involving multiple vertebral bodies, most notably C4, C5, T1, and T2 levels, which is likely on a degenerative basis. There is significant disc height loss from the C3-C7 levels as well as at the T1-T2 level. There is abnormal T2 signal involving the cervical cord which extends from the upper C5 to upper C7 levels with suggestion of volume loss and likely related to myelomalacia. Additional details as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: Small disc osteophyte complex and ligamentum flavum thickening result in mild spinal canal stenosis. There is mild right and mild to moderate left neural foraminal stenosis related to uncovertebral hypertrophy. C4-5: Disc osteophyte complex and ligamentum flavum thickening result in moderate spinal canal stenosis. There is mild right and mild to moderate left neural foraminal stenosis.C5-6: There is disc osteophyte complex and ligamentum flavum thickening contributing to moderate to severe spinal canal stenosis. There is moderate to severe right and moderate left neural foraminal stenosis related to uncovertebral hypertrophy. Cord signal abnormality with volume loss as mentioned above.C6-7: Disc osteophyte complex and ligamentum flavum thickening contribute to moderate spinal canal stenosis. There is moderate bilateral neural foraminal stenosis related to uncovertebral hypertrophy. Cord signal abnormality as above.C7-T1: No significant compromise to the spinal canal. There is mild to moderate right and mild left neural foraminal stenosis. Bilateral facet arthropathy.T1-T2: There is disc bulge with effacement of the ventral thecal sac. No significant spinal canal stenosis. Mild bilateral neural foraminal narrowing.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: Advanced degenerative changes in the cervical spine with moderate to severe spinal canal stenosis at the C5-C6 level and moderate spinal canal stenosis at C4-C5 and C6-C7 levels. There is T2 signal abnormality in the cord from the C5 to C7 levels with volume loss, most compatible with myelomalacia. Multilevel neural foraminal stenosis as detailed above.


Instruction: Generate impression based on findings.

Input: Burn with inhalational injury. Significant carbon monoxide levels. The brain demonstrates normal structure and signal. Specifically, there is no signal abnormality involving the globi pallidi. There is no abnormal diffusion restriction or susceptibility effect to suggest ischemia or hemorrhage. The major intracranial flow voids are present. There is no intracranial mass effect, midline shift, or herniation. There is mild prominence of the sulci compared to CT from 7/10/2015. Bone marrow signal is within normal limits.There is complete filling of the left maxillary sinus (with mucosal thickening and secretions). In the proper clinical setting, this may represent sinusitis. There is minimal nonspecific mucosal thickening in the sphenoid and right maxillary sinus. There is also minimal fluid in the mastoid air cells.

Output: 1. No parenchymal signal abnormalities to suggest toxic or ischemic brain injury.2. Direct comparison is limited however there appears to be increased prominence of the cortical sulci compared to outside CT from 7/10/2015. Finding is nonspecific but may be related to dehydration versus mild degree of cerebral edema on the prior study which has since resolved.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Pineal cyst on MRI in 2014 - follow up exam and headaches. There is a cystic pineal gland that overall measures up to approximately 10 mm, without associated nodular enhancement. There is no evidence of intracranial hemorrhage or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There are subcentimeter retention cysts in the maxillary sinuses.

Output: A cystic pineal gland that measures up to approximately 10 mm likely represents benign cystic degeneration.


Instruction: Generate impression based on findings.

Input: 49-year-old woman with multiple vascular and risk factors with acute mental status changes and slurring of speech. There is no evidence of intracranial hemorrhage, mass, edema or midline shift. The ventricles and basal cisterns are normal in size and configuration. Subtle asymmetry to the sulci is likely related to patient positioning. However subtle abnormalities cannot be ruled out and an MRI may be considered if an acute infarct is suspected.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: No acute abnormality noted. However, subtle findings cannot be ruled out and an MRI may be considered if acute infarct is suspected as clinically indicated.


Instruction: Generate impression based on findings.

Input: New and increased seizure frequency in HgSS with history of prior stroke. MRI: There is extensive encephalomalacia in the left frontal and parietal lobes. However, there is no evidence of acute infarct. The ventricles and basal cisterns are unchanged in size and configuration, with ex vacuo dilatation of the left lateral ventricle. There is no midline shift or herniation. The orbits, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is diffuse low T1 and T2 signal in the bone marrow.MRA: There is severe steno-occlusive disease of the left supraclinoid internal carotid artery. The proximal left anterior and middle cerebral arteries appear to be diffusely narrowed as well. There is a paucity of cortical vessels overlying the areas of left cerebral hemisphere encephalomalacia. There also appears to be narrowing of the supraclinoid right internal carotid artery and minimal collateral vessel formation in the region. The vertebral, basilar, and posterior cerebral arteries are intact. There is no evidence of cerebral aneurysms.

Output: 1. Chronic left middle cerebral artery territory infarction related to sickle cell disease, without evidence of acute infarction.2. Severe steno-occlusive disease of the left supraclinoid internal carotid artery. The proximal left anterior and middle cerebral arteries, and right supraclinoid internal carotid artery also appear to be narrowed.3. The bone marrow signal alterations are likely related to sickle cell disease.


Instruction: Generate impression based on findings.

Input: 29 years, Male, headache, evaluate Chiari decompression and syrinx. Additional history per chart, hx of SAH as child, chiari decompression, cervical syrinx, SVT, LPS & VPS presents with 3 week history of worsening headache, worsening nausea, blurred vision & gait instability. Brain: Again seen are postoperative findings related to right PICA aneurysm clipping as well as suboccipital craniotomy for Chiari decompression. There is artifact related to the aneurysm clip, which obscures the surrounding anatomy. There is encephalomalacia and susceptibility effect in the right caudate head likely related to prior hemorrhage. The ventricles are not significantly changed in size and configuration compared to 8/12/2015 MRI, with a left transparietal ventricular shunt catheter unchanged in position. Prior additional ventriculostomy tracts are also evident. There is no evidence of acute infarction. The cerebellum assumes an unchanged position and configuration. Unchanged signal abnormality involving the right cerebellar tonsil consistent with post treatment change. Susceptibility artifact related to aneurysm clip limits assessment for CSF spaces and flow dorsally at the foramen magnum; there is however preserved ventral CSF space at the foramen magnum with preserved biphasic flow.Cervical and Thoracic Spine:There is no significant change in size of the cervicothoracic syrinx. For example the syrinx at the C1-C2 level measures 2 x 5 mm in the AP and transverse dimensions, not significantly changed. In the lower cervical cord the syrinx occupies the right aspect of the cervical cord as before. There may be minimal decrease in component of the syrinx. For example at the mid C6 level, syrinx measures approximately 2.5 mm in the AP dimension, previously 2.7 mm. No significant change in the caudal extent of the syrinx which is at the lower T10 level. Unchanged reversal of cervical lordosis. Moderate degree of thoracic scoliosis with apex at approximately the T8 level is again noted and better assessed with standing radiographs. There is no significant spinal canal stenosis at any level. Bone marrow signal is benign.

Output: 1. Compared to prior brain MRI from 8/12/2015 there is no significant change in findings of Chiari decompression and left parietal ventriculostomy. Unchanged caliber of the ventricular system. Also evidence of prior right PICA aneurysm clipping.2. Compared to prior spine MRI from 8/12/2015 there is overall no significant change in the caliber or craniocaudal extent of the syrinx, although there are levels where the syrinx measures minimally smaller than prior.


Instruction: Generate impression based on findings.

Input: 67-year-old male with history of prostate cancer. Evaluate high-risk features and staging.Per pathology report: Prostate, left base medial; needle biopsy: Prostatic adenocarcinoma, Gleason grade 3+3=6.Prostate, left base lateral; needle biopsy: Prostatic adenocarcinoma, Gleason grade 3+4=7.Prostate, left mid lateral; needle biopsy: Prostatic adenocarcinoma, Gleason grade 3+3=6. PELVIS:PROSTATE:Prostate Size: 4.6 x 2.5 cmPeripheral Zone: There is T1 hyperintensity consistent with postbiopsy hemorrhage. There is a small focus of T2 hypointensity with corresponding low ADC signal and enhancement in the left mid peripheral zone measuring 0.7 x 0.6 cm.Central Gland: Heterogeneous signal corresponding to benign prostatic hypertrophy.Seminal Vesicles: No evidence of involvement of the seminal vesicles.Extracapsular Extension: No evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Small focus in the left mid peripheral zone consistent with known prostatic adenocarcinoma without evidence of seminal vesicle involvement or extracapsular extension.


Instruction: Generate impression based on findings.

Input: 52 y/o AAF s/p MVA several weeks ago. Lower extremity paresthesias and rectal anesthesia Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign with T1 hyperintense lesion involving the T12 vertebral body compatible with focal fat or hemangioma. The conus medullaris is normal in position.Minimal degenerative changes are seen with mild multilevel disc desiccation. Individual levels as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: Minimal disc bulge. No spinal canal or neural foraminal stenosis. Mild bilateral facet arthropathy.L4-L5: Mild disc bulge. There is minimal bilateral neural foraminal narrowing. No spinal canal stenosis. Mild facet arthropathy.L5-S1: No significant disc disease. No spinal canal or neural foraminal stenosis. Bilateral facet arthropathy.Paraspinous soft tissues are within normal limits. Small renal cysts incidentally noted.

Output: 1. Mild degenerative changes in the lumbar spine without significant spinal canal or neural foraminal stenosis at any level to explain the patient's symptoms.2. No evidence of traumatic compression fracture or spinal hematoma.


Instruction: Generate impression based on findings.

Input: Clinical question : Rule out intracranial lesion causing seizures. Signs and symptoms: Seizures Nonenhanced head CT:There is no evidence of acute intracranial hemorrhage, edema, mass effect, midline shift or hydrocephalus.The cortical sulci, ventricular system, CSF cisterns and gray -- white differentiation is within normal.Previously reported periventricular foci of low-attenuation on MRI examination of brain are not identified on this examination.Calvarium demonstrate postoperative changes of bilateral temporal small craniotomies.Extensive paranasal sinuses and mastoid air cells are unremarkable.

Output: Negative nonenhanced head CT.


Instruction: Generate impression based on findings.

Input: Muscle weakness. Evaluate for cauda equina syndrome Redemonstrated is a severe compression fracture involving the L3 vertebral body with near complete height loss involving the anterior mid aspect of the vertebral body similar to prior, without residual marrow edema. As before, there is evidence of cement augmentation of the L3 vertebral body. Remainder of the vertebral body heights are normal. Alignment is grossly maintained in the lumbar spine. There are diminished posterior osseous elements from L3-L4 to the sacrum reflecting combination of prior laminectomies and dysplasia, stable in appearance.Abnormal T2 signal likely reflecting myelomalacia in the spinal cord at the L2-L3 level again seen, which is unchanged. The spinal cord remains low-lying with the distal neural tissue/conus extending to the L5 level. Septations/adhesions are again again noted in the thecal sac from the L5 to S1 levels similar to prior. Lipoma within the thecal sac at the right lateral S1 level is again seen as well as along the distal aspect of the filum in the midline at the S2 level. These findings are stable in appearance.Degenerative changes are specified by the intervertebral level as follows and unchanged since 9/26/2016 and 3/31/2016. T12-L1: No spinal canal or neural foraminal stenosis, unchanged.L1-L2: There is bilateral facet hypertrophy and ligamentum flavum thickening. There is minimal disc bulge. There is unchanged mild spinal canal stenosis and bilateral mild to moderate neural foraminal stenosis. L2-L3: There is bilateral facet hypertrophy and ligamentum flavum thickening. There is diffuse disc bulge with central protrusion component resulting in moderate to severe spinal canal stenosis and moderate bilateral foraminal stenosis. These findings are unchanged.L3-L4: There is bilateral facet hypertrophy and ligamentum flavum thickening. There is also mild disc bulge with unchanged mild to moderate spinal canal stenosis and mild to moderate bilateral foraminal stenosis. These findings are unchanged.L4-L5: There is bilateral facet hypertrophy. There is central disc protrusion. No significant spinal canal stenosis. There is unchanged mild bilateral foraminal narrowing, relatively worse on the left. These findings are unchanged.L5-S1: There is bilateral facet hypertrophy without neuroforaminal narrowing or spinal stenosis, unchanged.Fatty atrophy involving the paraspinous musculature again seen, which is predominantly on the right. Left renal cysts again seen.

Output: 1.No significant change in moderate to severe spinal canal stenosis at the L2-L3 level. Unchanged T2 hyperintensity within the cord and volume loss at the this level consistent with myelomalacia.2.Severe chronic compression fracture of the L3 vertebral body with evidence of cement augmentation is unchanged in appearance. 3.Unchanged appearance of the low-lying conus which extends to the L5 level with adhesions within the distal thecal sac as well as residual lipoma involving the right lateral aspect of the thecal sac at the S1 level and to a minimal degree along the distal filum terminale at the S2 level. Re-tethering can be considered in the appropriate clinical setting. 4.Degenerative changes at additional levels as detailed above which are unchanged.


Instruction: Generate impression based on findings.

Input: Neck and shoulder pain, worsening ROTATOR CUFF: There is increased signal intensity within the bursal surface fibers of the distal infraspinatus tendon anteriorly compatible with a partial-thickness tear. The tear involves approximately 50% of the thickness of the tendon. The articular surface fibers of the tendon appear intact. There is mild atrophy along the myotendinous junction of the infraspinatus, but otherwise the infraspinatus muscle is within normal limits. Increased signal intensity along the bursal surface fibers of the supraspinatus tendon suggest superficial fraying, but but the articular surface fibers are intact and I see no full-thickness tear. The supraspinatus muscle appears normal. The teres minor tendon and muscle appear normal. The subscapularis tendon and muscle appear normal.SUPRASPINATUS OUTLET: There is mild spurring of the anterior aspect of the acromion process at the attachment of the coracoacromial ligament; the ligament itself appears intact. I see no frank fluid within the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Intermediate signal intensity within the superior labrum suggests degeneration, but I see no fluid-filled tear.BICEPS TENDON: The tendon of the long head of the biceps appears normal.

Output: 1.Bursal surface rotator cuff tearing as described above.2.Glenohumeral joint osteoarthritis and other findings as above.


Instruction: Generate impression based on findings.

Input: Reason: Left lumbar radicular pain. History of lumbar laminectomy History: left leg pain with low back pain and reduced patellar reflex Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. No abnormal enhancing lesions are appreciated in the lumbar spine.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is loss of disk space height, disk desiccation, endplate reactive changes and a diffuse disk bulge at this level is also mild facet hypertrophy.At L4-5 there is no significant compromise to spinal canal or neural foramina. The patient is status-post left-sided hemilaminotomy at this level. There is disk desiccation and a minor disk bulge at this level as well as any mild degree of facet and ligamentum flavum hypertrophy . At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina. There is a disk bulge at this level as well some endplate reactive change.At L1-2 there is no significant compromise to spinal canal or neural foramina. There is a disk bulge at this level and some endplate reactive change.

Output: 1.There are degenerative changes present in the lumbar spine without significant compromise of spinal canal or exiting nerve roots.2.The patient is status post lumbar spine surgery.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for an appendectomy bed may explain episodic drop attack. Signs and symptoms: Drop attacks with lower extremity weakness while climbing stairs. Pre- and post enhanced cervical MRI:There is normal anatomical development, morphology, signal intensity and alignment of vertebral column.There is normal signal intensity and caliber of the cervical cord.There is no appreciable degenerative disease, no evidence of central spinal stenosis or neural foraminal compromise at any level.Postcontrast images demonstrate no abnormal enhancement of the vertebral column, cervical cord or the leptomeninges.Pre and post enhanced thoracic MRI:There is normal anatomical development, morphology and alignment as well as signal intensity of vertebral column.There is no appreciable degenerative changes, no evidence of a spinal canal or neural foraminal compromise at any level.There is normal signal intensity and caliber of thoracic cord and without detectable abnormal enhancement. There is no detectable. Spinal soft tissue abnormalities.Pre and post enhancement lumbar MRI:There is normal anatomical development, morphology, signal intensity and alignment of vertebral column.There is no degenerative disease of lumbar spine of any significance. There is no evidence of a spinal canal or neural foraminal compromise at any level.There is normal signal intensity, morphology and normal termination of the cord at lower L1 level.There is normal signal intensity and morphology of cauda equina.There is no detectable abnormal enhancement of the vertebral column, lower most visualized thoracic cord or the cauda equina.

Output: 1.Unremarkable pre and post enhanced cervical MRI.2.Unremarkable pre and post enhanced thoracic MRI.3.Unremarkable pre and post enhanced lumbar MRI.


Instruction: Generate impression based on findings.

Input: 11-year-old female with history of Crohn's disease. Evaluate for perianal fistula. PELVIS:UTERUS, ADNEXA: Not well visualized.BLADDER: The bladder is distended and normal in appearance.LYMPH NODES: Small biinguinal lymph nodes are seen.BOWEL, MESENTERY: Several loops of small bowel in the pelvis demonstrate bowel wall thickening. There is equivocal bowel wall thickening of the descending colon, which could be attributed to under distention due to lack of oral contrast. Small amount of free fluid in the abdomen and pelvis.BONES, SOFT TISSUES: No perianal fistula is evident.

Output: Several loops of distal small bowel demonstrate bowel wall thickening, consistent with given history of Crohn's disease. No perianal fistula is evident. This may be further evaluated with MR enterography, which includes oral contrast.


Instruction: Generate impression based on findings.

Input: History of cirrhosis, HCC screening. Please also include right complex renal cyst. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology. No suspicious focal hepatic lesions are identified. The hepatic vasculature appears patent. The gallbladder is surgically absent. No significant biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: The right kidney appears atrophic, unchanged. The superior right renal pole cystic lesion with T1 hyperintense signal has slightly increased in size but lacks definite enhancement on post contrast subtraction images and remains compatible with a hemorrhagic cyst. Additional T1 hyperintense lesion at the left inferior pole also lacks definite enhancement. Multiple additional subcentimeter renal lesions are not significantly changed. 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.Cirrhotic liver morphology with no evidence of HCC or other focal hepatic lesions. 2.Right renal complex lesion compatible with a hemorrhagic cyst without definite associated enhancement to suggest neoplasm.


Instruction: Generate impression based on findings.

Input: MRI brain: There are multiple scattered foci of T2 FLAIR hyperintensity in the bilateral cerebral periventricular and subcortical white matter and in the pons, without significant interval change compared to prior exam. There is no associated postcontrast enhancement in any of these lesions. Most of these lesions are either undetectable or only mildly hypointense on T1 weighted images. No new lesions are seen.The ventricles and sulci are unchanged. The cisterns remain patent. There is no midline shift or mass effect. 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. MRI cervical spine: The cervical spine is in normal alignment, with a normal cervical lordosis. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal. As before, the central canal of the spinal cord is mildly prominent in some areas, but this can be within the limits of normal variation. There is no pathological enhancement. There are scattered perineural cyst throughout the spine.C2-C3: No significant disc herniation, spinal canal stenosis or foraminal narrowing.C3-C4: No significant interval change. No significant spinal canal or foraminal stenosis.C4-C5: Disc osteophyte complex similar to prior. No interval change. There is moderate left neural foraminal narrowing. No significant spinal canal stenosis.C5-C6: Disc osteophyte complex, no significant interval change. Mild left neural foraminal narrowing. No significant spinal canal stenosis.C6-C7: Disc osteophytic complex and ligamentum flavum thickening resulting in moderate spinal canal stenosis, unchanged. Severe bilateral neuroforaminal narrowing remains unchanged.C7-T1: No significant disc bulge, herniation, spinal canal stenosis or neuroforamina narrowing.

Output: 1. Stable bilateral cerebral and pontine demyelinating lesions. No significant interval change in size or morphology compared to prior MRI from 6/25/2015. No enhancing lesions or new lesions are seen. 2. No evidence of demyelinating lesions in the spinal cord involving the cervical region.3. Stable degenerative changes in the cervical spine including moderate spinal canal stenosis and severe bilateral neural foramina narrowing at C6-C7.


Instruction: Generate impression based on findings.

Input: Diagnosis: Malignant neoplasm of prostate. Malignant neoplasm of prostateClinical question: eval for progression of lytic metastasisSigns and Symptoms: prostate cancer with L1 metastasis Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment. The conus medullaris on sagittal imaging is grossly intact. Please note that there is a transitional vertebra present with partial lumbarization of the S1 segment.There is a marrow replacing lesion present at L1 associated with the compression fracture and convex posterior bowing of the posterior wall of the L1 vertebra into the spinal canal. Compared to the 6/5/2015 exam there is no significant change. There is approximately 20% loss of vertebral body height at L1.At S1-S2 there is a formed disc present as well as left-sided facet hypertrophyAt L5-S1 there is a diffuse disc bulge present associated with bilateral facet hypertrophy. The facet hypertrophy is worse on the left compared to the right side. There is partial effacement of the fat at the left lateral recess at this level with some encroachment of the nerve roots at the left lateral recess. There is some mild encroachment of the nerve roots within the left neural foramen at this level with some partial effacement of fat surrounding the left-sided exiting nerve root. There is loss of disc space height and disc desiccation at this level.At L4-5 there is loss of disc space height present as well as disc desiccation and a mild disc bulge associated with bilateral facet and ligamentum flavum hypertrophy. There is some effacement of the fat at the lateral recess bilaterally but slightly more on the right side when compared to the left. There is narrowing of the neural foramina bilaterally.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is some disc desiccation present at this levelAt L2-3 there is no significant compromise to spinal canal or neural foramina. There is disc desiccation present at this levelAt L1-2 there is no significant compromise to spinal canal or neural foramina.The left kidney is not readily identified. There is a retroperitoneal nodule which is not imaged on this exam.

Output: 1.Please note the enumeration vertebral bodies. S1 is a transitional vertebra.2.There is redemonstration of a malignant compression fracture at L1 which is stable compared to the prior exam.3.Status post left nephrectomy.4.There are multilevel degenerative changes present in the lumbar spine which are worse at L5-S1 where there is encroachment of the nerve roots of the left neural foramen and the left lateral recess.5.A retroperitoneal nodule suspected represent a benign adrenal gland nodule is not well imaged on this exam. There is a CT of the abdomen from 10/9/2015 which showed assesses this further. Please refer to that report for further comments.


Instruction: Generate impression based on findings.

Input: 67-year-old female with left posteromedial fascial signal changes. Evaluate for resolution. There is increased signal abnormality along the facia along the posteromedial aspect of the left thigh with associated enhancement on postcontrast sequences which appears significantly decreased in size and extent when compared to the prior examination from 4/21/15. These findings may represent a resolving edema/Morel Lavallee lesion in the correct clinical setting. There is thickening and intermediate signal intensity within the hamstring tendons at their insertion indicating moderate tendinosis. The remainder of the imaged musculature is normal in appearance. There is a 13 mm focus of heterogeneous signal abnormality with internal foci of fluid signal intensity and fluid fluid level on axial images within the vastus medialis muscle belly, appearing similar to the prior study, which may represent a partially thrombosed pseudoaneurysm from a branch of the superficial femoral artery, in the setting of trauma, versus a vascular malformation (series 11 images 52 and 51). This lesion was not definitely seen on prior CT angiogram of the extremities from 8/28/2007. Note is made of an apparent vascular graft from a femoral artery to femoral artery bypass graft which is incompletely imaged.

Output: 1. Significant interval decrease in size of the signal abnormality along the posteromedial aspect of the left thigh which may represent resolving edema/ resolving Morel Lavallee lesion in the correct clinical setting.2. 13 mm lesion within the vastus medialis muscle which may represent a pseudoaneurysm or vascular malformation. While this lesion appears similar to the prior examination from 4/21/15, this was not definitely seen on the prior CTA examination of the extremities dated 8/28/2007.


Instruction: Generate impression based on findings.

Input: 27 years, Female, Reason: structural lesion? History: seizure. Additional history per chart, patient has cerebral palsy and seizure disorder. There is diminished volume of supratentorial white matter in the bilateral parietal lobes with ex vacuo dilatation of the posterior aspects of the lateral ventricle and periventricular T2/FLAIR hyperintensity compatible with gliosis. There is associated thinning of the posterior aspect of the corpus callosum. Remainder of the brain parenchyma demonstrates no focal cortical dysplasia, gray matter heterotopia, or other lesions to suggest seizure focus. Bilateral hippocampi are symmetric in size, signal characteristics, and with preserved internal architecture. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. No hydrocephalus. Paranasal sinuses and mastoid air cells are clear. Orbits and sella are grossly unremarkable. Calvarium and remainder of the extracranial soft tissues are also unremarkable.

Output: 1. Periventricular leukomalacia with significantly diminished bilateral parietal white matter volume likely reflecting remote, probable perinatal injury.2. No other focal structural lesions to suggest seizure focus.


Instruction: Generate impression based on findings.

Input: 73 years Male (DOB:1/9/1943)Reason: Reccurent Transient AMS, concern for structural abn History: As abovePROVIDER/ATTENDING NAME: DRAGANA S RADOVANOVIC DRAGANA S RADOVANOVIC The CSF spaces are appropriate for the patient's stated age with no midline shift. The examination is degraded due to patient motion.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mucosal thickening. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin.

Output: The examination is degraded by patient motion which may obscure more subtle abnormalities. To extent of visualization no abnormal mass lesions are appreciated intracranially. There is no evidence for acute ischemic cerebral infarction on the current exam.


Instruction: Generate impression based on findings.

Input: Artifact from patient's dental braces somewhat limits this exam, especially the susceptibility weighted and diffusion weighted sequences. Incomplete suppression of CSF on the FLAIR sequence is likely secondary to this artifact. There is thinning of the perirolandic cortex bilaterally with loss of normal T2 hyperintensity. There is no associated parenchymal volume loss or abnormal white matter signal and the central sulci are normal in appearance. There is no evidence of mass or acute infarct. There are no areas of abnormal parenchymal signal. The hippocampi are symmetric and normal in appearance. The ventricles and basal cisterns are normal in size and configuration. The midline structures and craniocervical junction are within normal limits. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unremarkable.

Output: Grey matter/cortex thinning and loss of normal cortical T2 hyperintensity within the peri-Rolandic cortex bilaterally is nonspecific and of uncertain clinical significance although may be related to a early post-natal hypoxic ischemic event. There is no evidence of swelling or abnormal white matter signal to suggest an acute process. The MRI is otherwise unremarkable within the limitations as discussed above.


Instruction: Generate impression based on findings.

Input: Left renal mass ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: Subcentimeter cyst. Otherwise, no abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple non-enhancing bilateral renal cysts. RETROPERITONEUM, LYMPH NODES: There is an approximately 8.7 x 7.3 x 8.5 cm mass inferior and medial to the left kidney, displacing the left kidney superiorly. The mass is predominantly composed of fat. There is internal vasculature and enhancement, with an artery extending from the left renal artery into this mass. The left-sided hydronephrosis and probable calyceal diverticula are similar to the prior CT. The renal calculi seen on the prior CT are not evident on the current MR, likely secondary to technique.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Areas of linear enhancement in the lower anterior abdominal wall likely reflect prior surgery. No significant abnormality noted.

Output: Large fat-containing enhancing mass inferomedial to the left kidney, most likely representing a pedunculated angiomyolipoma. A retroperitoneal liposarcoma is less likely.