Instruction: Generate impression based on findings.

Input: History of 5mm aneurysm: surveillance. MRI: There is no evidence of intracranial hemorrhage or acute infarct. There is an unchanged left anterior temporal convexity arachnoid cyst. There is a stable punctate nonspecific focus of susceptibility in the left basal ganglia. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.MRA: There is an unchanged fusiform aneurysm arising from the M1 segment of the right middle cerebral artery that measures up to 5 mm in diameter. There is no evidence of significant steno-occlusive lesions.

Output: 1. No evidence of acute intracranial hemorrhage or acute infarct.2. Unchanged fusiform aneurysm arising from the M1 segment of the right middle cerebral artery that measures up to 5 mm in diameter.


Instruction: Generate impression based on findings.

Input: 18 years Female (DOB:9/8/1997)Reason: primary amenorrhea History: primary amenorrheaPROVIDER/ATTENDING NAME: IZHAR U QAMAR IZHAR U QAMAR MRI brain:There is redemonstration of a 90 x 85 x 65 mm cystic mass centered in the posterior aspect of the calvarium associated with adjacent scalloping. This follows spinal fluid on all pulse sequences. It extends anteriorly from the trigone and occipital horn of the left lateral ventricle. It appears stable relative to the previous exam. It appears to replace the left occipital lobe and left parietal lobe as well as the posterior aspect of the left temporal lobe. The posterior aspect of the corpus callosum is abbreviated. The left thalamus is smaller than the right thalamus.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 a small mucous retention cyst in the right maxillary sinus.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI pituitary:The pituitary gland is appropriate in overall height and morphology. The infundibulum of the pituitary gland is midline. No suprasellar or intrasellar mass is identified. The cavernous sinuses are intact bilaterally.

Output: 1.There is a very large CSF filled cyst present in the posterior aspect of the left calvarium. The left occipital lobe left parietal lobe in the posterior aspect of the left temporal lobe are replaced by this arachnoid cyst. There is associated distortion of the left thalamus. The trigone, occipital horn and temporal horn of the left lateral ventricle are also encompassed by this cyst. This cyst is stable compared to the prior exam. Most likely represents an arachnoid cyst which could've originated from the left lateral ventricle..2.The pituitary gland is appropriate in overall height and size and has not changed since the prior exam.No pituitary mass is appreciated


Instruction: Generate impression based on findings.

Input: Reason: evaluate meniscus History: mjl pain MENISCI: Blunting of the posterior horn of the medial meniscus, indicative of tear.ARTICULAR CARTILAGE AND BONE: Mild thinning of the lateral facet of the patellar cartilage without focal defect.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1.Tear of the posterior horn of the medial meniscus.2.Mild thinning of the lateral facet of the patellar cartilage without focal defect.


Instruction: Generate impression based on findings.

Input: Clinical question to be answered: Possible bleed. Signs and symptoms: Blunt head trauma. Images through posterior fossa and the straight a subtle area of low attenuation along the interhemispheric aspect of left cerebellum. This is concerning for an acute cerebellar stroke. No clinical data regarding neurological deficit is however given. Please correlate and follow-up with an MRI is recommended.This examination is otherwise unremarkable and in particular no evidence of any acute post traumatic finding is detected. Calvarium remains intact. Mastoid air cells and paranasal sinuses are unremarkable.The findings were relayed to the ER resident at pager number 2659.

Output: 1.No evidence of acute posttraumatic finding.2.Left cerebellar nonhemorrhagic acute stroke.


Instruction: Generate impression based on findings.

Input: Reason: neck pain History: neck pain The cranial-cervical junction is normal. There is straightening of the cervical spine. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. There is disc desiccation at all levels of the cervical spine. The paraspinal soft tissues are unremarkable. There is fluid within the right mastoid air cells.There is developmental narrowing of the cervical spinal canal with superimposed degenerative changes as follows: C2-C3: There is disc bulge and facet hypertrophy with mild spinal canal stenosis. No significant neuroforaminal narrowing. C3-C4: There is disc bulge, which is slightly eccentric to the right, and facet hypertrophy with moderate narrowing of the right neuroforamen but no significant compromise to the left neuroforamen or spinal canal.C4-C5: There is disc bulge and facet hypertrophy with mild narrowing of the right neuroforamen but no significant compromise to the left neuroforamen or spinal canal.C5-C6: There is relatively large disc protrusion and facet hypertrophy with moderate narrowing of the spinal canal, with left greater than right effacement of the thecal sac and indentation of the left ventral cord. There is also mild to moderate narrowing of both neuroforamina. C6-C7: There is disc bulge and facet hypertrophy resulting in moderate narrowing of the neuroforamina. There is no significant compromise spinal canal.C7-T1: No neuroforaminal narrowing or spinal stenosis.

Output: Multilevel spondylotic changes affect cervical spine, most pronounced at C4-5, where there is moderate spinal canal stenosis related to a prominent disc protrusion, and at C6-7, where there is moderate narrowing of the bilateral neuroforamina.


Instruction: Generate impression based on findings.

Input: 52 years Male (DOB:4/26/1963)Reason: intracranial abscess History: AMSPROVIDER/ATTENDING NAME: DAVID O MELTZER DAVID O MELTZER MRI of the brainNo diffusion weighted abnormalities are appreciated. The examination is degraded due to patient motion artifact which may obscure subtle abnormalities.There appears to be a small extra-axial collection adjacent to the left sigmoid sinus and left tentorial leaf measuring 7 x 19 mm axial dimensions. It is high signal on FLAIR MRI, low signal on T1 and low signal on diffusion-weighted imaging. It was present on prior exams.The CSF spaces are appropriate for the patient's stated age with no midline shift. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The left sigmoid sinus flow void is absent. This was also the case on the prior exam. Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are partially opacified (left more than right). The visualized portions of the orbits are intact.

Output: 1.There is no evidence for acute ischemic cerebral infarction.2.Findings suggest occlusion of the left sigmoid sinus and jugular vein. This is been present on prior exams.3.There is a small fluid collection present adjacent to the left sigmoid sinus and left tentorial leaf. It is not clearly delineated on this exam. It is not clear what this represents. It has not changed since prior exams.4.The exam is markedly degraded due to patient motion. This may obscure more subtle abnormalities.5.The patient was not able to cooperate for MR angiogram. Perhaps if clinically appropriate a CT angiogram may be of value.6.There is opacification of mastoid air cells and middle ears which has gradually decreased since earlier exams.


Instruction: Generate impression based on findings.

Input: Male, 11 years old, with history of GBM status post chemotherapy. Sequelae of a right frontal approach biopsy of the brainstem are redemonstrated. Volume loss and ill-defined T2 hyperintensity of the right posterior midbrain are unchanged. No pathologic enhancement is detected in this region or elsewhere. Several punctate foci of intrinsic T1 hyperintensity are redemonstrated in the pons without significant interval change. A small focus of ill-defined enhancement which was noted on the prior examination within the pons is no longer clearly appreciated.No evidence of new parenchymal edema or mass effect is seen. No abnormal extra-axial fluid collections are detected. No acute intracranial hemorrhage is noted. The ventricular system is normal in size and morphology.

Output: Signal abnormality involving the right posterior midbrain, at the site of prior tumor, is unchanged with no evidence of new signal abnormality or pathologic enhancement to suggest progressive disease.Several punctate nonspecific foci of intrinsic T1 hyperintensity are also unchanged within the pons. A suspected small focus of enhancement within the pons as noted on the prior examination is no longer clearly identified.


Instruction: Generate impression based on findings.

Input: Female, 75 years old, with known pituitary mass, assess for progression, annual screening. A heterogeneous enhancing mass centered on the sella is redemonstrated which measures up to 18 mm in the craniocaudal dimension and which shows no significant interval change in size or morphology. The lesion extends into the suprasellar cistern with mass effect upon the optic chiasm, similar to prior. The lesion fills the sella from side to side and may extend minimally into the right cavernous sinus, but without significant mass effect upon the ICA. The pituitary infundibulum deviates towards the left similar to that seen on the prior examination.

Output: No interval change in the size or morphology of the pituitary mass.


Instruction: Generate impression based on findings.

Input: Female 64 years old Reason: worsening lumbar radiculitis History: low back pain, radiculitis, numbness legs There is a rightward curve of lumbar spine. There is grade 1 anterolisthesis of L4 on L5, more prominent compared to prior exam. Vertebral body heights are preserved. There are endplate degenerative signal changes at L4-5. No suspicious osseous lesions. There is advanced facet arthropathy at L4-5, with progressive disc disease and significant disc loss of height at L4-5. The conus medullaris terminates appears unremarkable and at L1-2. There is again narrowing of the distal lumbar spinal canal predominantly due to shortened pedicles.T12-L1: Mild diffuse disc bulge without stenosis, similar to prior exam.L1-L2: Mild disc bulge, with small left paracentral protrusion, and with mild right and mild to moderate left femoral narrowing, similar to prior exam. No spinal canal stenosis.L2-L3: No significant foraminal or spinal canal narrowing.L3-L4: Diffuse disc bulge, similar to from prior exam. Mild developmental narrowing of the lumbar canal with mild spinal canal stenosis, similar to prior exam. There is effacement of the left lateral recess. Mild right and moderate left foraminal narrowing, similar to prior exam.L4-5: Progressive disc height loss. There is diffuse disc bulge, eccentric to the left side with new right extrusion with effacement of the right lateral recess. There is moderate to severe spinal canal stenosis, increased from prior exam. There is moderate right and moderate to severe left foraminal narrowing.L5-S1: Disc height loss similar to prior. Disc bulge with bilateral facet arthropathy with mild spinal canal stenosis. There is partial effacement of lateral recesses and moderate to severe bilateral foraminal narrowing.

Output: 1.Compared to 2/9/2015, there has been progression of multilevel degenerative changes, particularly at L4-5 with moderate to severe spinal canal stenosis and new right paracentral disc extrusion with superior migration. Moderate to severe neural foraminal narrowing at L4-5 and moderate to severe neural foraminal narrowing at L5-S1 also seen as detailed above.2.Grade 1 anterolisthesis of L4-5, more prominent compared to prior exam. There is also advanced facet arthropathy at L4-5 with increased fluid distention compared to prior exam. Consider dynamic radiographs to assess for stability.


Instruction: Generate impression based on findings.

Input: 56-year-old female with skiing injury, twisted knee, evaluate, MCL, patella, ACL MENISCI: Again seen is a horizontal cleavage tear of the posterior horn and body of the medial meniscus extending to the tibial articular surface, appearing similar to the prior exam. Globular and linear signal abnormality within the body and posterior horn of the lateral meniscus also appears similar to the prior exam and is compatible with intrasubstance degeneration.ARTICULAR CARTILAGE AND BONE: Increased signal intensity within the articular cartilage of the lateral facet of the patella likely represents full-thickness degeneration with cyst formation in the underlying subchondral bone. This was present on the prior exam. There is focal, new full-thickness degeneration of the articular cartilage along the median eminence along with multiple additional new partial thickness clefts. The tibiofemoral articular cartilage appears relatively intact.There is edema within the anterolateral aspect of the medial patella and within the lateral aspect of the lateral femoral condyle likely representing contusions from recent transient patellar dislocation. The cortex along the anteromedial patella appears discontinuous, which may represent a small avulsion fracture.There is flattening of the femoral trochlea superiorly, indicating dysplasia. Slight lateral tracking of the patella relative to the center of the trochlea is noted. The Insall-Salvati ratio measures 1.4, indicating mild patella alta. The tibial tubercle to trochlea groove distance measures 16 mm, which is borderline elevated, not accounting for tilt of the knee within the scanner.LIGAMENTS: The cruciate and collateral ligaments are intact.EXTENSOR MECHANISM: The quadriceps and patellar tendons are intact. There is thickening and edema within the medial patellar retinaculum at its patellar attachment, likely representing a tear. The posterior fibers of the medial patellar retinaculum are also not well visualized which could indicate a chronic tear, but this is equivocal.ADDITIONAL

Output: 1. Findings compatible with recent transient patella dislocation including what we suspect is a small avulsion fracture of the medial patella and injury to the medial patellar retinaculum as described above.2. Femoral trochlear dysplasia, slight patella alta, and slightly increased tibial tubercle to trochlea groove distance.3. Hemarthrosis.4. Progression of articular cartilage degeneration of the patella.5. Horizontal cleavage tear of the medial meniscus appearing similar to the prior exam.


Instruction: Generate impression based on findings.

Input: Female, 73 years old, with non-small cell lung cancer now with altered mental status and right-sided hemiparesis. Most of the obtained sequences are too motion degraded to be diagnostically useful. The diffusion-weighted sequences are, however, adequate for interpretation and show no evidence of restricted diffusion. Fairly extensive patchy white matter T2 hyperintensity is also noted.

Output: Examination was terminated early due to patient agitation. Most of the obtained images are too motion degraded for interpretation. However, the diffusion weighted sequence is adequate and no evidence of restricted diffusion is seen to suggest acute ischemia.


Instruction: Generate impression based on findings.

Input: There is a 3.1 cm transverse x 3.5 cm AP x 3.1 cm craniocaudal ring-enhancing lesion involving the left temporal lobe. There is associated vasogenic edema as well as small hemorrhagic components within the posterior aspect of a necrotic appearing center.A second, small, ring-enhancing lesion measuring 5 x 8 mm is present within the posterior left occipital lobe.There are scattered punctate foci of T2 hyperintensity in periventricular, although primarily subcortical, white matter locations without mass effect or restricted diffusion.The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. Minimal mucosal thickening within the left frontal and a couple left ethmoid sinuses. The remaining paranasal sinuses and mastoid air cells are clear.

Output: 1.There are 2 ring-enhancing lesions, one large within the left temporal lobe, one tiny within the left occipital lobe. Given a history of lung cancer, this is most consistent with metastasis.2.Mild chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: There are 2 intra-axial enhancing lesions within the right frontal lobe. The lesions are heterogenous on T1 and T2-weighted images and demonstrate susceptibility artifact compatible with associated blood products. Both lesions are surrounded by signal abnormality compatible with vasogenic edema. The larger lesion is centered within the deep white matter of the right frontal lobe, and the enhancing component of which measures 23 x 36 x 10 mm. This lesion also has associated prominent flow voids indicating vascularity. The smaller lesion is centered within the right superior frontal gyrus, the enhancing component which measures 9 x 9 x 10 mm. There is associated mass effect including sulcal effacement in the right frontal lobe, approximately 5 mm of leftward midline shift, and partial effacement of the right lateral ventricle. The basal cisterns are maintained. There are additional punctate foci of abnormal enhancement within the bilateral cerebellar hemispheres which are suspicious for additional metastatic lesions. The puncture lesion in the right cerebellar hemisphere demonstrates associated susceptibility artifact. There is no territorially restricted diffusion to suggest acute ischemic infarction. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unremarkable. The midline structures and craniocervical junction are within normal limits.

Output: Hemorrhagic metastases within the right frontal lobe with associated right hemispheric mass effect and midline shift. Additional cerebellar lesions also suspicious for metastases.


Instruction: Generate impression based on findings.

Input: 36 years Male (DOB:9/18/1980)Reason: 3t scanner, ccm protocol, qsm permeability, History: surveillancePROVIDER/ATTENDING NAME: ISSAM A. AWAD ISSAM A. AWAD There is some mass associated with peripheral signal hypointensity and susceptibility artifact which has a more popcorn-like appearance on T1 and T2 imaging located in the left periventricular white matter and extending to the left lateral ventricle. On T1 imaging it measures 23 x 16 mm in axial dimensions.On susceptibility imaging there is a ringlike focus located in the right temporal lobe inferiorly which is very subtle on the FLAIR and T2 imaging. It is not readily visible on noncontrast T1 imaging.Incidental note is made of cavum septum pellucidum and cavum vergae.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 vertebral artery appears to be hypoplasticThe 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.Findings compatible with the cerebral cavernous malformation located in the left periventricular white matter which extends into the left lateral ventricle.2.There is a small lesion in the right temporal lobe along the fusiform gyrus best visible on the susceptibility weighted imaging which is suspicious for a cerebral cavernous malformation. It is punctate on in size on the FLAIR and T2 images and likely a millimeter or less in size.


Instruction: Generate impression based on findings.

Input: History of jejunal thickening seen on CT scan. Evaluate for evidence of celiac versus Crohn's disease. Biopsy proven Celiac disease. ABDOMEN:LIVER, BILIARY TRACT: Contracted gallbladder. The liver is normal in morphology, size, signal intensity and enhancement without a focal lesion biliary ductal dilatation or vascular abnormality.SPLEEN: The spleen is normal in morphology and size without a focal lesion.PANCREAS: The pancreas is normal in morphology. Normal pancreatic duct caliber. No focal lesion.ADRENAL GLANDS: There is a subcentimeter right adrenal medial limb nonenhancing cyst, benign. Otherwise the adrenal glands are unremarkable.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The stomach is significantly distended with oral contrast throughout the examination suggesting delayed gastric emptying. The small bowel is suboptimally distended with oral contrast. Given this limitation the following observations are made. The small bowel fold pattern is abnormal with decreased number of jejunal folds compatible with the stated history of celiac disease. There is no wall thickening, postcontrast enhancement, restricted diffusion or other specific findings of active small bowel inflammation. No fixed stricture or prestenotic/upstream dilatation to suggest a focal stricture. No fibrofatty proliferation. No sinus or fistula tract formation. No free or loculated fluid collection.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: See discussion above.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Decreased number of jejunal folds compatible with stated history of celiac disease.2.No evidence of active small bowel inflammation.3.Significantly distended stomach throughout the course of the examination suggestive of delayed gastric emptying.


Instruction: Generate impression based on findings.

Input: Clinical question: Low back pain. Signs and symptoms: Low back pain. Nonenhanced cervical MRI:Foramen magnum is unremarkable.C2-C3 is unremarkable.C3-C4 demonstrate advanced disc disease and loss of disc height, mild hypertrophic changes of posterior elements and result in mild central spinal stenosis and mild bilateral neural foraminal compromise.C4-C5 demonstrate advanced disc disease and loss of disc height, evidence of prior bilateral laminectomy and without evidence of central spinal stenosis. Mild bilateral neural foraminal compromise is noted.C5-C6 demonstrate moderate disc disease and loss of disc height, evidence of prior posterior bilateral laminectomy with expansion of thecal sac and no residual central spinal stenosis. Mild bilateral neural foraminal compromise.C6-C7 demonstrate moderate disc disease and loss of disc height, mild hypertrophic changes of posterior elements with resultant mild to moderate central spinal stenosis and no definitive neural foraminal compromise.C7-T1 demonstrate moderate disc disease and loss of disc height, shallow broad-based bulging disc, flattening and posterior displacement of the cord and moderate central spinal stenosis and moderate left neural foraminal compromise.Upper most visualized thoracic spine to T4 level demonstrate uniformly smaller than expected caliber of the spinal canal likely representing a congenital anatomical variation.The signal intensity of cervical and upper most visualized thoracic cord remains within normal.Nonenhanced lumbar MRI:T12-L1 is unremarkable.L1-L2 is unremarkable.L2-L3 is unremarkable.L3-L4 demonstrate mild disc desiccation, mild bilateral ligamentum flavum hypertrophy and bilateral facet effusion. No spinal stenosis or neural foraminal compromise.L4-L5 demonstrate mild disc desiccation and loss of disc height, there is a central broad-based disc protrusion with subtle mass effect on the thecal sac however without convincing evidence of central spinal stenosis.Mild to moderate left neural foraminal compromise and mild left lateral recess compromise is present.L5-S1 is unremarkable.The lower most visualized thoracic cord, conus and the cauda equina is unremarkable.

Output: 1.Examination of the cervical spine is a status post multilevel laminectomy and posterior fusions including placement of transpedicular screws. No central spinal stenosis at the level of surgery. Mild Central spinal stenosis at C2-C3 level secondary to degenerative disease. Mild to moderate central spinal stenosis at C6/C7 and slightly more prominent at C7-T1 levels as detailed. There are multilevel mild neural foraminal compromise as detailed per level above. The signal intensity and caliber of cervical cord remains within normal.2.Examination of lumbar spine demonstrate a broad-based central disc protrusion at L4-L5 without definitive spinal stenosis however mild to moderate left neural foraminal and mild left lateral recess compromise is present. Mild degenerative changes at other levels without central spinal stenosis or neural foraminal compromise. Bilateral facet effusions at L3-L4 and L4-L5 levels are noted.


Instruction: Generate impression based on findings.

Input: Headaches and history of thyroid cancer. Evaluation for small intracranial metastatic lesions is limited by lack of intravenous contrast. There is no evidence of intracranial hemorrhage or acute infarct. There is a nodular 9 mm area of T2/FLAIR signal hyperintensity within the left superior frontal gyrus. An additional punctate foci within the left frontal subcortical white matter is noted. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There is diffuse low T1 signal of the calvarium, which is nonspecific, but can be seen in the setting of chronic anemia. The extracranial soft tissues are unremarkable.

Output: 1. Evaluation for small intracranial metastases is limited by lack of intravenous contrast. A 9 mm area of T2/FLAIR signal hyperintensity within the left superior frontal gyrus has a nodular appearance and suspicious for metastatic disease. Additional punctate focus in the left frontal subcortical white matter is more nonspecific and may be related to prior inflammation or infection for example. If there are no contraindications, contrast enhanced MR is recommended for further evaluation.2. No evidence of intracranial hemorrhage or acute infarct.


Instruction: Generate impression based on findings.

Input: Evaluate for biliary tract obstruction. Shortness of breath and septic shock. Cholecystectomy September 2015. ABDOMEN:The study is limited due to motion artifact.LIVER, BILIARY TRACT: Patient is status post cholecystectomy. The liver is normal in contour and size. No hepatic mass identified. There is no intra or extrahepatic biliary ductal dilatation.SPLEEN: There is lower than expected T2 signal intensity of the spleen, which may reflect early iron deposition. Please note that evaluation of in phase and out of phase imaging difficult due to motion artifact.PANCREAS: The pancreatic duct is normal in caliber. No pancreatic lesion identified.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: There is a subcentimeter right lower pole simple cyst. No suspicious renal lesion is identified. There is no hydronephrosis.RETROPERITONEUM, LYMPH NODES: No adenopathy is identified.BOWEL, MESENTERY: There is small volume ascites, similar to prior CT. The bowel is normal in caliber, without evidence of obstruction.BONES, SOFT TISSUES: Mild anasarca, similar to prior CT. No suspicious osseous lesion identified.OTHER: Basilar bronchiectasis and trace bilateral pleural effusions seen.

Output: 1.Status postcholecystectomy, no biliary ductal dilatation. 2.Small volume ascites and mild anasarca.


Instruction: Generate impression based on findings.

Input: Female, 41 years old. Flank+groin pain. Rectal cancer. Evaluate for osseous metastases. There are diffuse marrow changes predominantly affecting the sacrum, compatible with prior radiation therapy. No focal abnormal signal or enhancement within the bony pelvis and proximal femurs to suggest osseous metastases. No fracture is identified. There is mild diffuse muscle atrophy. The remainder of the pelvic soft tissues are unremarkable.Residual rectal wall thickening is compatible with tumor as seen on prior studies. Small pelvic lymph nodes are identified. The other imaged intra-abdominal/pelvic structures are grossly unremarkable.

Output: No evidence of osseous metastases.


Instruction: Generate impression based on findings.

Input: Right hip pain radiating to the groin with increasing swelling and warmth overlying the right hip in patient with history of avascular necrosis and sickle cell disease, evaluate for osteomyelitis or abscess. Large field-of-view images of the pelvis and bilateral proximal femurs demonstrate diffuse, somewhat heterogenous decreased T1 signal within the bone marrow compatible with diffuse red marrow. No abnormal foci of increased T2 bone marrow signal are identified to suggest bone marrow edema. No fractures are identified. There is no specific evidence of avascular necrosis within the femoral heads such as bone marrow edema, hemorrhage, or subchondral sclerosis. The femoral heads are grossly round without definite subchondral flattening or fracture. No hip joint effusions are identified bilaterally. Increased T2 signal within the anterior soft tissues of the upper right thigh may reflect artifact or mild soft tissue edema. No discrete fluid collections are identified. Postcontrast images are somewhat degraded by motion but do not demonstrate any grossly abnormal enhancement.

Output: 1.Diffuse red bone marrow compatible with history of sickle cell disease.2.No specific evidence of femoral head avascular necrosis or osteomyelitis.3.No hip joint effusions.4.Possible subcutaneous edema within the anterior soft tissues of the right thigh, correlate clinically for cellulitis. No abscess.


Instruction: Generate impression based on findings.

Input: Female, 36 years old, with low back pain and clicking. Transitional morphology of the L5 vertebral body is noted. Vertebral body height and morphology are within normal limits. No pathologic marrow replacement or marrow edema is observed. Sagittal alignment of the spine is anatomic.The visualized distal spinal cord is unremarkable. The conus tip terminates at the level of the lower L2 endplate which is just within normal limits. Fatty infiltration of the filum terminale is evident beginning at the L2-3 level and continuing down into the sacrum. The fatty filum measures up to 6 mm in diameter. No epidural abnormalities are suspected.The intervertebral discs are preserved. No significant bulge or herniation is seen. Facet arthropathy is evident at L3-4, L4-5 and L5-S1.

Output: 1.Fatty infiltration of the filum terminale is noted. This can be an incidental asymptomatic finding in adults, but correlation with clinical features of tethered cord is suggested.2.Facet arthropathy is evident in the lower lumbar spine. The intervertebral discs are preserved. No significant compromise of the spinal canal or neural foramina is seen.


Instruction: Generate impression based on findings.

Input: Patient used prophylactic antibiotics before and after the procedure as prescribed. The patient received antibiotic prophylaxis with oral Ciprofloxacin 500mg and Keflex 500 mg. The patient took 1 tablet of Ciprofloxacin 500mg the night before and morning of the procedure. The patient also took 2 tablets of Keflex 500 mg the morning of the procedure. After the procedures, the patient will take 2 tablets of Ciprofloxacin 500mg and 2 tablets of Keflex 500 mg.Following the discussion of the risks (pain, bleeding (urine, stool and semen), and infection), benefits, and alternatives of the procedure, informed consent was obtained.  DynaCad was used to localize the mid-gland of the prostate at the site of the T2 hypointense lesion. Using the DynaTRIM guidance system an 18-gauge MR- compatible needle was inserted into the paramedial mid-gland of the peripheral zoneof the prostate. Upon confirmation of the tip of the needle close to the suspected lesion, MR guided biopsy using an 18 gauge biopsy needle was performed and 3 cores were obtained.The cores were hand delivered to the pathology lab.The patient tolerated the procedure well and was discharged to nurse holding for observation without any immediate complications.ESTIMATED BLOOD LOSS: Less than 5 cc.

Output: Successful core-biopsies of the paramedial peripheral zone lesion in the mid-gland of the prostate. PLAN: Follow-up with pathology. Patient discharged after short observation period. The patient was instructed to contact his urologist/referring physician in case of persistent and/or severe hematuria, hematochezia or hematospermia, urinary retention, or signs/symptoms of infection.


Instruction: Generate impression based on findings.

Input: 59-year-old male to evaluate for stroke. Additionally obtained clinical history indicates left-sided numbness. There is no evidence of intracranial hemorrhage, mass or edema. There is no definite evidence of cortical stroke. The ventricles are midline, with normal volume and morphology. There is minimal crowding of the foramen magnum, raising the possibility of tonsillar ectopia/herniation. This may be further evaluated by MRI if clinically indicated.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. No evidence of acute intracranial hemorrhage or cortical stroke.2. Possible mild crowding of the foramen magnum, raising the possibility of tonsillar ectopia/herniation. This may be further evaluated by MRI if clinically indicated.Findings were discussed with Dr. M. Sih at the time of dictation.


Instruction: Generate impression based on findings.

Input: Clinical question: Left lumbar radiculopathy. Signs and symptoms: Left thigh/buttock pain. Nonenhanced lumbar MRI:Signal intensity of the vertebral column is within normal in all MRI sequences.The lower most visualized thoracic spine and thoracic cord from T10 inferiorly is unremarkable.T12-L1, L1-L2, L2-L3 and L3-L4 demonstrate mild degenerative changes without spinal stenosis or neural foraminal compromise.L4-L5 demonstrate mild disc disease and loss of disc height, moderate (right greater than left) facet and ligamentum flavum hypertrophy and trace anterolisthesis at this level. There is a shallow right lateral and far lateral disc protrusion at this level which in combination with degenerative changes results in severe right lateral recess and right neural foraminal compromise. Degenerative changes result in mild central spinal stenosis. L5-S1 demonstrate mild disc disease, severe bilateral facet hypertrophy and without significant ligamentum flavum hypertrophy. There is no spinal stenosis or neural foraminal compromise.There is spinal soft tissues and partially visualized SI joints are unremarkable.

Output: 1.At L4-L5 there is degenerative changes as well as a right lateral and far lateral disc protrusion with resultant significant right neural foraminal and lateral recess compromise. Degenerative changes at this level also results in trace anterolisthesis and mild spinal stenosis.2.Mild degenerative changes at other levels however without central spinal or neural foraminal compromise.


Instruction: Generate impression based on findings.

Input: Catatonia, limbic encephalitis. Examination is significantly motion degraded. Within this limitation, there is no restricted diffusion to suggest acute ischemia. No acute intracranial hemorrhage. No intracranial mass or mass-effect. No hydrocephalus. There is generalized global parenchymal volume loss.Multiple foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild chronic small vessel ischemic disease. T2 hyperintensity is noted within the bilateral subinsular white matter which is favored to be related to combination of chronic ischemic change and prominent perivascular spaces. There are few punctate foci of susceptibility effect in the bilateral temporal and occipital lobes compatible with chronic microhemorrhages.No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: 1. Moderately motion degraded exam demonstrates no evidence of infarct, mass, or mass effect. No clear evidence of encephalitis but consider lumbar puncture for further evaluation as clinically indicated. 2. Multiple areas of T2/FLAIR hyperintensity described above are nonspecific but compatible with mild chronic small vessel ischemic disease. There is generalized global parenchymal volume loss which is mildly prominent for age.3. Few punctate foci of susceptibility effect in the bilateral temporal and occipital lobes compatible with chronic microhemorrhages. Given the peripheral lobar distribution, these may be related to chronic amyloid angiopathy.


Instruction: Generate impression based on findings.

Input: Left lower extremity radiculopathy with L3-L4 retrolisthesis, evaluate for nerve compression Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is exaggeration of the lumbar lordosis. There is grade 1 anterolisthesis of L3 on L4 as well as mild retrolisthesis of L2 on L3. Bone marrow signal is benign. The conus medullaris is normal in position.Multilevel degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: Moderate loss of disk height with vacuum phenomena. Minimal retrolisthesis and mild disk bulge, eccentric to the left. There is ligamentum flavum thickening and mild facet arthropathy. There is mild spinal canal and mild bilateral neural foramina stenosis.L3-L4: Mild anterolisthesis with disk uncovering, advanced bilateral facet arthropathy, and ligamentum flavum thickening. There is moderate to severe spinal canal stenosis as well as mild to moderate bilateral neural foraminal stenosis.L4-L5: Significant disk height loss and vacuum phenomena. There is minimal disk bulge, ligamentum flavum thickening, as well as facet arthropathy. There is no significant spinal canal stenosis. Minimal bilateral foraminal narrowing.L5-S1: There is loss of disk height with associated endplate marrow signal changes. There is minimal disk bulge and left foraminal osteophyte as well as facet arthropathy. There is mild to moderate right and moderate left neural foraminal stenosis. Paraspinous soft tissues are within normal limits. Incidentally seen is a small perineural cyst at the S2 level.

Output: 1. Multilevel degenerative changes in the lumbar spine as detailed above. There is grade 1 L3 on L4 anterolisthesis and minimal L2 on L3 retrolisthesis.2. Moderate to severe spinal canal stenosis at L3-L4.3. There is moderate left L5-S1 neural foraminal stenosis which may be impinging on the left L5 nerve root. There is also mild to moderate left L3-L4 neural foraminal narrowing.4. Facet arthropathy throughout the lumbar spine, worst at L3-L4.


Instruction: Generate impression based on findings.

Input: Pain, question lateral meniscal tear. MENISCI: There is horizontal increased signal intensity within the body and posterior horn of the lateral meniscus indicating intrasubstance degeneration. The signal extends to the tibial articular surface indicating an undersurface horizontal tear. The anterior horn of the lateral meniscus is intact. There is fraying of the free/inner edge of the posterior horn of the medial meniscus without discrete tear. ARTICULAR CARTILAGE AND BONE: There is diffuse degeneration of the articular cartilage of the patella with full-thickness cartilage loss along the median eminence. There is perhaps mild fraying of the articular cartilage of the lateral compartment. Bone marrow signal is within normal limits. No fracture or contusion.LIGAMENTS: ACL, PCL, LCL and MCL are intact. EXTENSOR MECHANISM: Quadriceps and patellar tendons are intact.ADDITIONAL

Output: 1. Intrasubstance degeneration and horizontal tear of the posterior horn and body of the lateral meniscus.2. Cartilage degeneration most severely affecting the patella.


Instruction: Generate impression based on findings.

Input: 18 years old patient. Assess for postop bleed craniotomy in 11/19. The patient is status post left frontal craniotomy appeared and there is an extra-axial hemorrhagic fluid collection of present underneath the craniotomy flap with a fluid fluid level associated some air bubbles. It is adjacent to the high convexities and measures approximately 9 mm in thickness comparedA 1 cm hyperdense focus is present adjacent to the right chest appear frontal gyrus which has an extra-axial location. It was present on the MRI of 11/17/09.There is vasogenic edema present where the patient's known mass was paired this is edema pattern is stable since 11/19/09 MRI. There is some mass effect associated.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.Status post left frontal craniotomy for tumor surgery.2.There is a left-sided subdural hemorrhagic fluid collection present with some mild mass effect apparent3.A 7mm extra-axial hyperdense focus is present adjacent to the right superior frontal gyrus. This could represent a small meningioma.


Instruction: Generate impression based on findings.

Input: 46 years, Female, history of colon cancer with brain metastases presented with altered mental status and one episode of seizure. Planned for whole brain radiation therapy tomorrow. Please note lack of contrast limits evaluation for metastatic disease. There is evidence of multiple lesions in the brain parenchyma which demonstrate enhancement on recent postcontrast CT from 11/27/2015. For example in the right inferior parietal lobule, there is a multilobulated lesion which measures approximately 18 x 19 mm as well as a an approximately 8 mm lesion in the left posterior temporal lobe. There is extensive surrounding vasogenic edema. Additional vasogenic edema is present in the bilateral frontal lobes and left parieto-occipital region which is not evident on recent CT, although differences in technique limiting precise comparison. Small left cerebellar lesion is also again noted. No restricted diffusion to suggest acute ischemia. The ventricles are within normal limits in size and configuration. Major flow-voids are preserved. Evidence of prior left-sided craniotomy is noted with subacute to chronic blood products in the left parietal lobe resection cavity deep to the craniotomy. There is no midline shift or herniation. Susceptibility sensitive sequence was not performed limiting evaluation for hemorrhage. Calvarium and extracranial soft tissues are grossly unremarkable aside from postsurgical changes.

Output: 1. Please note this examination is limited due to lack of contrast and motion degradation on multiple sequences. There are multiple lesions in the brain with surrounding edema which were demonstrated on recent postcontrast CT head dated 11/27/2015 and compatible with intracranial metastatic disease. FLAIR, SWAN, and postcontrast sequences were not acquired on the current study and patient should return for these sequences if possible.2. There is edema in the bilateral frontal lobes and left parieto-occipital lobes which was not appreciated on recent head CT. While it is possible this is related to differences in technique and small underlying metastatic lesions, possibility of a superimposed process such as posterior reversible encephalopathy (PRES) should also be considered. 3. No midline shift or herniation.4. Evidence of left parietal craniotomy with subacute blood products in the left parietal lobe deep to the craniotomy.


Instruction: Generate impression based on findings.

Input: Acute mental status changes with right facial droop. There is no evidence of intracranial hemorrhage or midline shift. It is unclear if a hypodensity in the right occipital/cerebellar region is intra-axial or extra axial. An MRI is recommended for further evaluation of this lesion.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. There is opacification of a few ethmoid air cells. The remaining visualized paranasal sinuses and mastoid air cells are normally pneumatized.These findings were discussed with Dr Harshal Sheth at the time of interpretation.

Output: 1. Hypodensity in the right occipital/cerebellar region may be intra-axial or extra axial. An MRI is recommended for further evaluation. 2. No definite acute findings.3. Minimal inflammatory sinus disease.


Instruction: Generate impression based on findings.

Input: Low back pain with left sciatica for 4 months. There is an enhancing lesion in the lateral portion of the left L5-S1 neural foramen, which measures up to approximately 10 mm and impinges upon the exiting nerve root. There is also loss of fluid signal and height of the L5-S1 disc, with slight disc bulging. At L4-L5, there is a slight left foraminal disc protrusion, but no significant stenosis. There is also a minimal right facet effusion with tiny posterior punctate synovial cyst. At L3-L4, there are slight bilateral disc protrusions, but no significant spinal canal stenosis. At T12 though L3, there is no significant spinal canal or neural foraminal stenosis. The vertebral column alignment is within normal limits. The vertebral body heights are preserved. The vertebral bone marrow signal is unremarkable. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable. There is a splenule.

Output: Lower lumbar degenerative spondylosis and a lesion in the lateral portion of the left L5-S1 neural foramen that impinges upon the exiting nerve root, which may represent requested disc material with inflammatory changes.


Instruction: Generate impression based on findings.

Input: Achilles tendon swelling TENDONS: There is mild focal enlargement of the Achilles tendon approximately 5 to 6 cm above the insertion with associated minimal internal increased signal distally. The combination of findings is compatible with tendinopathy without evidence of a discrete tear. This corresponds with the location of the marker on the patient indicating the area of interest. The fibers of the more proximal tendon and remaining tendons all appear intact.LIGAMENTS: No significant abnormality noted.ARTICULAR SURFACES AND BONE: No significant abnormality noted. ADDITIONAL

Output: Tendinopathy of the Achilles tendon as described without evidence of discrete tear.


Instruction: Generate impression based on findings.

Input: 11 years Male (DOB:10/30/2004)Reason: 11 year old with history of GBM 8 months off therapy - please evaluate for change in tumor History: GBMPROVIDER/ATTENDING NAME: RUTH RETONDO-RUDINSKY RUTH RETONDO-RUDINSKY There is redemonstration of a lesion along the right posterior lateral aspect of the midbrain which is high signal on T2 and FLAIR MRI. This appears stable compared to prior exam.There is redemonstration of multiple punctate foci of signal loss on susceptibility weighted imaging the thalami and brainstem. These have not changed. One in the pons and another in the right thalamus are associated with punctate contrast enhancement. These too may be associated with dilated vascular structures. There is stable.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 couple mucous retention cysts.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.There is redemonstration of a lesion within the right posterior midbrain. This remains stable compared to the prior exam. The patient is known to have had a neoplasm in this location.2.Punctate lesions in the brainstem and thalami are present which are stable compared to the prior exam. These may represent a combination of microhemorrhage and vascular structures. It's possible therapy treatment related. They were not present previous to treatment.


Instruction: Generate impression based on findings.

Input: Recurrent bladder cancer and acute on chronic BLE and RUE weakness, new fecal incontinence. There is an enhancing lesion in the lesion in the T9 vertebral body without extravertebral extension. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable. However, there are multiple T2 hyperintense nodules in the partially-imaged thyroid.

Output: 1. A lesion in the T9 vertebral body may represent a metastasis, but no evidence of spinal cord compression in the thoracic spine or pathological compression fracture. 2. Multiple nonspecific nodules in the partially-imaged thyroid. A thyroid ultrasound may be useful for further evaluation.


Instruction: Generate impression based on findings.

Input: Severe headaches and new left-sided weakness and paresthesia. History of moyamoya disease and synangioplasty. BRAIN MRI:Multifocal chronic infarcts involving the frontal lobes and the right temporal and occipital lobes are not significantly changed since the previous examination including the associated FLAIR hyperintensity related to gliosis. The previously seen punctate and confluent cerebral white-matter T2 FLAIR hyperintensities that may reflect chronic microvascular ischemia is also not significant changed. Small cerebral white-matter and left thalamic chronic lacunar infarcts are unchanged. The cerebellum and brainstem remain preserved. There is no acute infarct or intracranial hemorrhage. There is prominent mineralization involving the basal ganglia which was present previously. There is no mass effect, midline shift or brain herniation. No hydrocephalus or extra-axial collections. Following contrast injection, there is prominent enhancement involving small lenticulostriate arteries related to moyamoya pattern.Multiple small defects involving the parietal bones are related to previous revascularization (synangiosis) procedures. There is nonspecific trace mucosal thickening in the maxillary and ethmoid sinuses. There is no gross orbital abnormality.CRANIAL MRA:The included upper cervical internal carotid arteries as well as the petrous and cavernous internal carotid arteries are very small and stable to minimally worse in the interval, with subtle differences which may related to technique. The internal carotid flow-related signal disappears towards the distal part of the ophthalmic segments bilaterally. There is also no detectable flow in the M1 and M2 segments. There is also no flow in the proximal anterior cerebral arteries. Flow in the distal anterior cerebral arteries remains attenuated on the right. In addition, there is a 3 mm saccular aneurysm arising from the terminal part of the right internal carotid artery. The aneurysm appears new since the previous examination.Patent vessels traverse the above described parietal skull defects representing the anastomoses between the superficial temporal arteries and the intracranial circulation. However, there is no detectable flow-related signal in the right sylvian branches of the middle cerebral artery and there is only faint signal in the left sylvian branches. This has not changed since the previous examination. The vertebral basilar system is notable for unchanged significant attenuation of the proximal P1 segments with small tortuous collateral vessels.

Output: 1.Previously seen multifocal chronic infarcts remain unchanged since the February 2010 examination. No evidence of acute infarct or new infarcts since the prior study.2.While the known moyamoya stenoses and occlusions are not significantly changed since the 2010 examination, there is a new 3 mm aneurysm arising from the right carotid terminus. Other findings compatible with moyamoya involvement are described above.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Left optic neuritis. There are multiple, greater than 10, foci of high T2 signal in the supratentorial and infratentorial white matter. Many of the lesions display T1 hypointensity, but do not enhance. There may also be high T2 signal lesions in the bilateral intraorbital optic nerves versus volume averaging, but the sequences are not optimized for evaluation of this anatomy. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Findings compatible with supratentorial and infratentorial demyelinating lesions, but no evidence of active inflammation. There may be demyelinating lesions in the bilateral intraorbital optic nerves versus volume averaging, but the sequences are not optimized for evaluation of this anatomy.


Instruction: Generate impression based on findings.

Input: Patient with biopsy-proven bilateral breast cancer. Presents for staging. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.In the right breast at the 10:00 position at posterior depth there is a heterogeneously enhancing oval mass measuring 24 x 14 x 15 mm (AP X ML X CC) with adjacent clip artifact, compatible with biopsy-proven cancer. 17 mm anteromedial from this mass there is a second lesion of 19 x 15 x 22 mm (AP X ML X CC)nonmass enhancement at the 2:00 position of the right breast, also compatible with malignancy. In total, these 2 lesions span 5.8 cm of the right breast.In the left breast at the 9:00 position there is a spiculated mass measuring 14 x 12 x 18 mm (AP X ML X CC). There is linear extension of this mass anteriorly, posteriorly, and inferiorly spanning a total of 47 x 16 x 30 mm (AP X ML X CC). No abnormal enhancement is seen in the left breast upper outer quadrant in the region of the suspicious calcifications identified on the prior mammogram.Bilateral subcentimeter nonenhancing cysts are noted, right breast greater than left.A single borderline lymph node with thickened cortex is seen in the right axilla, which may be reactive post breast biopsy.

Output: 1. Multicentric right breast cancer and extensive NME extending from the biopsy proven left breast cancer spanning 47 mm.2. No suspicious enhancement seen in the left breast upper outer quadrant to correspond to the suspicious calcifications identified on the prior mammogram. If left breast conservation is being considered, tissue sampling of the upper outer quadrant calcifications may be performed.3. Prominent right axillary lymph node most likely reactive. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: 63-year-old female with buccal mucosa cancer, compare to previous CHEST:LUNGS AND PLEURA: Stable mild central lobular emphysema and apical scarring. Stable left upper lobe micro-nodule. Mild scarring is identified posteriorly at both bases as well as in the superior segment left lower lobe. No new pulmonary nodules or masses can be identified. Demonstration of a small left pleural effusion/thickening and minimal pleural thickening on the right. MEDIASTINUM AND HILA: New central Port-A-Cath with its tip at the SVC/RA junction. No hilar or mediastinal lymphadenopathy. Coronary calcification is again noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Numerous stable small hypoattenuating lesions, consistent with cystsSPLEEN: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedPANCREAS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Interval placement of a G-tubeBONES, SOFT TISSUES: There is new partial collapse of the L4 vertebrae with increased density in the L4 vertebrae. No definite pathologic fracture identified. However MRI of the lumbar spine would be more sensitive.Previously noted small sclerotic lesion in the left iliac crest now demonstrates a radiolucent central portion and well defined peripheral rim that is sclerotic and has a benign appearance.OTHER: No significant abnormality noted

Output: 1. Interval mild pleural thickening/effusion on the left with mild pleural thickening on the right.2. No evidence of metastatic disease.3. Interval placement of a right central Port-A-Cath and NG tube


Instruction: Generate impression based on findings.

Input: 28-year-old female with known right breast cancer on chemotherapy presents for breast MRI for evaluation. There is extreme amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.A port is seen in the left medial chest wall.Known 4 masses in the right upper central breast have all become smaller. From the superiormost to the inferior most, these masses measure 14 x 6 x 12 mm (AP x LR x CC: previously 21 x 13 x 17 mm), 8 x 6 x10 mm (previously 14 x 16 x 15 mm), 5 x 6 x 6 mm (previously 10 x 9 x 11 mm), and 7 x 5 x 4 mm (previously 9 x 9 x 10 mm). Total span of these masses on sagittal plane is 37 mm (previously 52 mm). Clip artifacts are again seen within the two most superior masses and medial to the most inferior mass.No abnormal enhancement is seen in left breast. No abnormal lymph nodes are identified in either axillary region.

Output: Interval decrease in size of known tumors in the right breast.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for abnormality that can explain syncope. Signs and symptoms: Syncope Non-enhanced CT of brain:The examination demonstrates a mass in basal cistern. There is also suggestion of expansion of the sella on reformatted images.This mass measures approximately 19 mm times 16 -mm on axial image 7. There appears to be a second mass at the level of left cavernous sinus with no distinct communication with the mass within the basal cistern. This second mass measures approximately 12 times 17-mm in size measured on axial image 5. Although the lesion within the basal cistern may represent a pituitary macroadenoma sagittal reformatted images demonstrate residual CSF density within the sella which makes possibility of a macroadenoma less likely. And follow-up with an MRI examination is recommended. The second mass in the left cavernous sinus could represent an aneurysm or a meningioma. This also should be further evaluated with a dedicated enhanced MRI brain and an MRA.There is no evidence of intracranial hemorrhage, edema, mass effect, midline shift or hydrocephalus. The cortical sulci, ventricular system and CSF cisterns are otherwise unremarkable. The gray -- white matter differentiation is within normal.Above findings were relayed via paging tool to Dr. Kuznetsov on pager number 2782 after attempts to contact directly failed due to lack of response at the time of interpretation.

Output: 1.Mass within the basal cistern which may represent a pituitary macroadenoma. Follow up with dedicated MRI is recommended.2.Mass centered at the level of left cavernous sinus is concerning for an aneurysm, meningioma or a pituitary adenoma. It is possible that the above two masses are components of a single larger mass which should be further investigated with dedicated enhanced MRI and MRA.3.This examination is otherwise is unremarkable.


Instruction: Generate impression based on findings.

Input: Female, 74 years old, with neck pain. Alignment is anatomic. Vertebral body height and morphology are within normal limits. No pathologic marrow replacement or abnormal marrow enhancement is seen.The right IAC/CP angle schwannoma is partially visualized on sagittal images. The brainstem and visualized spinal cord are otherwise unremarkable. No focal signal abnormality or pathologic intradural enhancement is seen. No epidural abnormalities are suspected.C2-3: No spinal canal stenosis or neuroforaminal narrowing. C3-4: Mild right paracentral posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Mild right foraminal narrowing. C4-5: No spinal canal stenosis or neuroforaminal narrowing. C5-6: Posterior disc-osteophyte complex formation asymmetric to the left. Effacement of the ventral thecal sac and mild flattening of the ventral cord. The left neural foramen is moderately narrowed.C6-7: Minimal posterior disc-osteophyte complex formation. No significant spinal canal or foraminal stenosis. C7-T1: No spinal canal stenosis or neuroforaminal narrowing. Hyperintense signal is seen within the left T3 pedicle and transverse process. This is only visualized on sagittal cuts.

Output: 1.Disc osteophyte disease is seen at C5-6 resulting in slight flattening of the ventral cord and a significant stenosis of the left neural foramen at this level.2.The remaining cervical levels are free of significant degenerative disease, spinal canal or foraminal stenosis.3.Signal abnormality is incidentally noted within the left T3 pedicle and transverse process. This may represent an incidental hemangioma though correlation for tenderness in this location is suggested.


Instruction: Generate impression based on findings.

Input: 9-year-old female with purulent congestion for two weeks. Mucoperiosteal thickening is seen in the maxillary sinuses, ethmoid sinuses, and sphenoid sinuses. The right ostiomeatal unit is occluded. A defect in the medial wall of the left maxillary sinus likely represents the sequela of previous antrostomy, and less likely may represent a focal erosion.The ventricles and basal cisterns are symmetrically increased in volume. These findings likely represent volume loss, however, increased intraventricular pressure cannot be excluded. Please correlate clinically. MRI examination may be considered if clinically indicated.The calvaria and skull base are radiographically normal.

Output: Sinus disease as described above.1.Symmetrically enlarged ventricles and basal cisterns. These findings likely represent volume loss, however, increased intraventricular pressure cannot be excluded.


Instruction: Generate impression based on findings.

Input: 38 years Female (DOB:4/8/1977)38 year old female with new onset electrical sensation in head occurring multiple times a dayPROVIDER/ATTENDING NAME: SERVICES ANCILLARY SERVICES ANCILLARY The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: MRI of the brain is within normal limits


Instruction: Generate impression based on findings.

Input: 35-year-old female patient with history of polycystic liver and kidney disease, recent acute abdominal pain with fever. ABDOMEN:LIVER, BILIARY TRACT: There are multiple cystic lesions of varying sizes scattered throughout the liver compatible with provided history of polycystic liver and kidney disease. No suspicious hepatic lesion is identified. There is no intra- or extrahepatic biliary ductal dilatation. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral kidneys are enlarged and replaced by innumerable cystic lesions of varying size and intensity compatible with provided history of polycystic kidney disease. Some of these lesions demonstrate intermediate T2 signal with fluid fluid levels and intrinsic T1 hyperintensity compatible with blood products/complicated cysts. For example, the largest lesion within the left lower pole demonstrating intrinsic T1 hyperintensity measures 7.6 x 8.7 cm. There is no definite suspicious enhancement within either kidney on postcontrast and subtraction imaging. No evidence hydronephrosis.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: Enlarged, polycystic kidneys and multiple hepatic cysts compatible with patient's history of polycystic liver and kidney disease. No definite suspicious renal or hepatic lesion is identified.


Instruction: Generate impression based on findings.

Input: Male, 68 years old, with history of non-small cell lung cancer with brain metastases status post whole brain radiotherapy, now with vocal cord paralysis and dysphagia. Left piriform sinus mass status post ENT scope and biopsy. Multiple enhancing lesions are redemonstrated scattered through the cerebral hemispheres and cerebellum. These include punctate foci of solid enhancement measuring 2 to 3 mm in size located at the gray-white junction, as well as somewhat larger solidly enhancing nodules in the bilateral cerebellum, and ring-enhancing lesions measuring between 1 and 2 cm including one in the right superior frontal gyrus and several in the inferior left cerebellum. Some of these lesions demonstrate associated susceptibility effect. However, none produce any significant edema in the surrounding parenchyma.No evidence of generalized mass effect is seen. Additional scattered small foci of T2 hyperintensity are noted without correlating pathologic enhancement. No findings are seen to suggest acute intracranial hemorrhage. Ventricular size and morphology are within normal limits. No abnormal extra-axial collections are detected.

Output: Multiple enhancing lesions are redemonstrated scattered through the cerebral hemispheres and the cerebellum. These range from punctate solidly enhancing foci to somewhat larger rim-enhancing, hemosiderin stained lesions. Given the patient's history, it is possible that several of the above-mentioned lesions represent prior treated metastases, though it seems likely that some of the lesions probably reflect active metastatic deposits. Comparison with prior examinations may be helpful if these can be made available.


Instruction: Generate impression based on findings.

Input: Giant adrenal mass. Preoperative evaluation. ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in signal and morphology. There is a 1.9 cm simple cyst in the left lobe. No intrahepatic or extrahepatic biliary ductal dilatation. No suspicious enhancing lesion.SPLEEN: The spleen is displaced anteromedially into the midline. No focal suspicious lesion.PANCREAS: The pancreas is displaced medially. No focal lesion. No pancreatic duct dilatation.ADRENAL GLANDS: The left adrenal gland is compressed and displaced by the large retroperitoneal mass. There appears to be a fat plane between the adrenal gland and the mass. No adrenal mass is evident. The right adrenal gland is unremarkable.KIDNEYS, URETERS: The left kidney is displaced by the retroperitoneal mass. Multiple bilateral simple renal cysts. One cyst in the inferior pole of the left kidney has a rim of decreased signal and intermediate intrinsic T1 signal compatible with a hemorrhagic cyst.RETROPERITONEUM, LYMPH NODES: Within the left perirenal space posterior to the kidney there is a large mass which measures 24.1 x 13.0 x 19.3 cm. This mass is predominantly mildly increased T2 signal with with heterogeneous low signal internal components. There is prominent postcontrast enhancement of the peripheral components of the mass with areas of central hypoenhancement likely reflecting necrosis.Immediately adjacent to the main mass there are 2 additional nodules (series 2/2/2001 image 163 and image 147). It is unclear if these represent extensions of the main mass or small satellite lesions.The mass appears based within the retroperitoneal soft tissues and is not contiguous with or invading the adjacent organs.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Large retroperitoneal mass based in the left perirenal space is most compatible with a liposarcoma. There are 2 adjacent nodules which may reflect extension of the main mass or local metastases. No evidence of distant metastatic disease. There is extensive mass effect on the adjacent solid organs, but no evidence of direct invasion.


Instruction: Generate impression based on findings.

Input: Intracranial hemorrhage. There is predominantly intermediate T1 and high T2 signal left parieto-occipital intraparenchymal hematoma that measures up to approximately 3 cm. Mild surrounding restricted diffusion may be related to susceptibility from blood products and/or mild acute ischemia. There is extensive bilateral cerebral white matter T2 hyperintensity predominately in a periventricular distribution, without restricted diffusion. There is also a punctate focus of high T2 signal in the medial right thalamus. There is patchy susceptibility effect in the left medial temporal lobe. There are also punctate foci of susceptibility effect in the right thalamus, left superior frontal gyrus, and bilateral cerebellar hemispheres. A punctate focus of susceptibility effect in the left occipital lobe anterior to the hematoma may represent an additional microhemorrhage or thrombus within a left posterior cerebral branch artery. There is a right cerebellar hemisphere developmental venous anomaly. There is diffuse cerebral volume loss. There is no midline shift or herniation. The orbits are grossly unremarkable. There is a probable keloid in the right occipital scalp. There are also numerous skin tags in the face. There is a left maxillary sinus retention cyst.

Output: 1. An acute left parieto-occipital intraparenchymal hematoma that measures up to approximately 3 cm may be associated with mild surrounding acute ischemia, but no midline shift. 2. Probable chronic right thalamus lacunar infarct and a background of extensive cerebral white matter signal abnormality may represent chronic small vessel ischemic disease.3. Patchy susceptibility effect in the left medial temporal lobe may represent the sequela of a remote hemorrhage, perhaps related to infarction. 4. Punctate foci of susceptibility effect in the right thalamus, left superior frontal gyrus, and bilateral cerebellar hemispheres likely represent chronic microhemorrhages.5. A punctate focus of susceptibility effect in the left occipital lobe anterior to the hematoma may represent an additional microhemorrhage or thrombus within a posterior cerebral branch artery. 6. Right cerebellar hemisphere developmental venous anomaly.Discussed with Dr. Kramer at 10:35 AM on 1/31/16.


Instruction: Generate impression based on findings.

Input: Female 63 years old evaluate for labral tear vs other source for hip pain and limitation in lateral roatation/abduction. ACETABULAR LABRUM: No significant abnormality noted within limitations of a nonarthrogram exam.ARTICULAR CARTILAGE AND BONE: No acute fracture. Bone marrow signal intensity is within normal limits. Articular cartilage is intact.SOFT TISSUES: There is increased T2 signal within the erector spinae musculature on the right (series 301, images 35 and 44).ADDITIONAL

Output: 1.No evidence of labral tear. If there is high clinical suspicion for a labral tear a MR arthrogram would be appropriate.2.Strain of the erector spinae musculature on the right.


Instruction: Generate impression based on findings.

Input: Brain MRI:There is diffuse supratentorial cortical restricted diffusion with matching ADC hypointensity, somewhat sparing the bilateral perirolandic regions. Smaller, more punctate, yet similar appearing foci can be found involving the basal ganglia and thalami. Posterior fossa structures are spared. The cortically based abnormality is associated with T2 hyperintensity and gyral thickening. Within the bifrontal and bilateral parieto-occipital regions of cortical restricted diffusion, abnormality within the subcortical white matter demonstrates decreased diffusion intensity correlating with increased ADC signal as well as T2 hyperintensity.The ventricles are small which may reflect normal anatomic variation, however this could also reflect compression from global swelling. The cerebellar tonsils are in normal position. There are no masses. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage. There are no extraaxial fluid collections or subdural hematomas. Fluid within the nasopharynx mastoid air cells and middle ear cavities are most likely secondary to the patient's intubated status.Neck MRA:Antegrade flow is noted within the vertebral artery and carotid artery systems without occlusion or hemodynamically significant stenosis. Limited evaluation of the circle of Willis also demonstrates maintained flow without occlusion or hemodynamically significant stenosis.Neck MRI:Nasopharynx, oropharynx, and hypopharynx are unremarkable without mass lesion. Parotid and submandibular glands are normal in appearance without mass lesion. There are no thyroid masses. There is no clinically significant lymphadenopathy. The airway is patent. The right lung apex appears nonaerated, and correlation with x-ray or CT is recommended.

Output: 1.There is diffuse supratentorial cortical restricted diffusion with matching ADC hypointensity, somewhat sparing the bilateral perirolandic regions. Smaller, more punctate, yet similar appearing foci can be found involving the basal ganglia and thalami. These findings are consistent with cytotoxic edema of acute or subacute ischemia. Within the bifrontal and bilateral parieto-occipital regions of cortical restricted diffusion, abnormality within the subcortical white matter demonstrates decreased diffusion intensity correlating with increased ADC signal as well as T2 hyperintensity which represent underlying vasogenic edema. This pattern of cytotoxic edema associated with vasogenic edema has been reported as a biphasic edema pattern which can be found in the evolution of acute ischemia. However, an underlying process such as cerebritis remains a consideration with this edema pattern.2.Negative MRA of the neck.3.Negative MRI of the neck.


Instruction: Generate impression based on findings.

Input: Medical question: Rule out intracranial hemorrhage. Signs and symptoms: Altered mental status, respiratory failure, anemia. Nonenhanced CT of brain:A there is revisualization of bilateral symmetrical ventriculomegaly of lateral ventricles as well as the third ventricle. This remains identical to prior examination from 6 -- 7 -- 2010.Very minimal periventricular low-attenuation is again identified. These may represent minimal small vessel disease of indeterminate age. The cortical sulci remain within normal size and disproportionately smaller than the ventricular system. All of the findings remain stable since prior exam. Prominence of ventricular system may be at the upper limits of normal for patient's stated stated age of 78. Possibility of hydrocephalus however cannot be entirely excluded. There are no additional older studies for comparison.Also stable since prior exam is expansion of the left cavernous sinus in size possible minimal associated bony remodeling this finding is best the patient or axial images 7 and 8. There is no evidence of calcification within the cavernous sinus to suggest this finding is secondary to atherosclerotic tortuosity and ectasia of the internal carotid. I recommend follow-up with an MRI to exclude possibility of a mass in this location and in particular a meningioma.

Output: 1.No evidence of any new acute finding since prior exam.2.Stable uniform bilateral enlargement of lateral ventricles and minimally of the third ventricle. Finding may represent central atrophy or hydrocephalus. Follow-up with an MRI is recommended.3.Prominent soft tissue density of left cavernous sinus with expansion remains stable since prior study. Recommend follow-up with an infused MRI for assessment of tumor.


Instruction: Generate impression based on findings.

Input: Reason: left TMJ pain, + trismus, pain with chewing and left sided headaches History: eval for left TMJ dislocation. Left temporomandibular joint:There is normal anterior translation of the mandibular condyle on open-mouth images; however, the articular disc of the left TMJ is dislocated anteriorly on both the open and closed mouth images. The condyle itself appears normal without frank arthritic changes.Right temporomandibular joint:There is also normal anterior translation of the mandibular condyle on open mouth images with appropriate positioning of the articular disc.

Output: Abnormal anterior displacement of the left temporomandibular joint articular disc without reduction.


Instruction: Generate impression based on findings.

Input: 39-year-old female with history of left breast cancer status post left mastectomy and bilateral implants. There is extreme amount of fibroglandular tissue in the right breast. Status post left mastectomy. Marked parenchymal enhancement is noted in the right breast.Bilateral retropectoral silicone implants are intact.No abnormal enhancement is seen in right breast or left chest wall. No abnormal axillary lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on findings.

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

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


Instruction: Generate impression based on findings.

Input: 61-year-old male with new diagnosis of prostate cancer; Gleason 4+4 = 8 right mid prostate; Gleason 4+5 = 9 left base PELVIS:PROSTATE:Prostate Size: 3.1 x 3.2 x 3.8 cmPeripheral Zone: There is an elongated T2 hypointense lesion with restricted diffusion in the left peripheral zone extending from the apex to the base, largest dimensions in the mid gland measuring 16 x 9 mm. T2 hypointensity extends across midline into the right mid gland peripheral zone. This lesion demonstrates early enhancement and rapid washout. T2 hypointense lesion in the right mid gland peripheral zone with associated restricted diffusion measuring 6 x 3 mm. Additional smaller lesions are noted. Central Gland: Moderate degree of benign prostatic hypertrophy. There is extension of the left peripheral zone tumor into the mid transition zone exerting mass effect on the urethra with corresponding deformity noted. Seminal Vesicles: Extension of the left peripheral zone lesion to the medial aspect of the seminal vesicles (series 503, image 70). Extracapsular Extension: There is extracapsular extension by the left peripheral zone lesion.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Large hypointense lesion in the left peripheral zone with portions extending from apex to base and crossing midline to the right at level of mid gland peripheral zone consistent with known diagnosis of prostate carcinoma. Additional suspicious lesions are also noted.


Instruction: Generate impression based on findings.

Input: There is a common origin of the left common carotid artery and the brachiocephalic trunk. The vertebral arteries arise normally from the subclavian arteries. There is multifocal irregularity involving the right vertebral artery, which is nondominant, particularly in its lower cervical segment and the V4 segment. There is a focus of high-grade focal stenosis approximately 3 cm from the origin of the right vertebral artery. At least moderate multifocal stenosis affects the right V4 segment. Left vertebral artery, which is dominant, demonstrates no significant stenosis. The basilar artery demonstrates mild irregularity without significant stenosis. The bilateral common and internal carotid arteries also demonstrate no significant stenosis. No findings to suggest arterial dissection.

Output: Multifocal stenoses affecting the right vertebral artery in the neck and intracranially. The left vertebral artery, which is dominant, and the bilateral carotid arteries remain patent.


Instruction: Generate impression based on findings.

Input: Ms Neher submitted outside study for review. Submitted for review are:- Bilateral screening mammogram dated 10/21/2016- Left breast ultrasound dated 10/25/2016- Stereotatic biopsy dated 10/25/2016- Bilateral MRI without and with contrast dated 10/31/2016- MRI biopsy dated 11/8/2016- Postprocedure mammogram dated 11/8/2016These imaging studies were performed at Northwest community health care. For comparison,bilateral screening mammograms dating back to 9/7/2013 are available. BILATERAL SCREENING MAMMOGRAM DATED 10/21/2016:Bilateral CC and MLO views were acquired, though only the CAD overlay image is available. Further evaluation was performed for developing calcifications in the left breast and probable cysts on the right based on these mammograms. LEFT BREAST ULTRASOUND DATED 10/25/2016:Targeted ultrasound of the left upper breast at 12:00 3 cm from the nipple reveals clustered microcysts spanning 0.6 x 0.4 x 1.0 cm.Targeted ultrasound of the left upper outer breast at 1:00 3 cm from the nipple, reveals a 0.6 x 0.4 x 0.5 cm oval parallel circumscribed anechoic mass with posterior acoustic enhancement compatible with simple cyst.At the 1:30 position 2 cm from the nipple and oval parallel circumscribed 0.9 x 0.4 x 0.7 cm homogenous isoechoic mass is identified, benign in appearance and stable since ultrasound of 2015. Immediately adjacent to it is another 1.8 x 1.3 x 1.3 cm oval mass with lobulated margin and slightly heterogeneous internal echotexture. This latter finding also appears stable in volume and appearance as compared with ultrasound study of 2015.Targeted ultrasound of the left breast at the 2:00 position 2.5 cm from the nipple reveals an oval parallel nearly anechoic mass with posterior acoustic enhancement measuring 1.0 x 0.6 x 1.0 cm, likely a complicated cyst. At 2:30 4cm from the nipple, there is an oval parallel circumscribed hypoechoic mass measuring 1.0 x 0.4 x 0.7 cm, benign in appearance. Immediately adjacent to it is a circumscribed parallel anechoic 2.4 x 0.7 x 1.4 cm mass compatible with simple cyst. These findings appears stable as compared with ultrasound study of 2015.Targeted ultrasound of the left breast at the 4:00 position 4 cm from the nipple reveals another oval parallel circumscribed anechoic mass measuring 0.8 x 0.5 x 1.2 cm, with posterior acoustic enhancement compatible with simple cyst.STEREOTACTIC BIOPSY RIGHT BREAST DATED AND POSTPROCEDURE MAMMOGRAM 10/25/2016:Images from a stereotactic right breast biopsy were provided demonstrating adequate targeting. Calcifications were present on 2 out of 4 samples.A Hydromark biopsy clip marker was deployed.Postprocedure mammogram reveals a Hydromark clip in the expected location in the right outer breast, mid depth. Extensive residual microcalcifications and a small hematoma are noted.BILATERAL BREAST MRI DATED 10/31/2016:Bilateral breast MRI without and with IV contrast was performed according to outside protocol. Images were reviewed using Dyna CAD software.There is heterogeneous fibroglandular tissue, associated with moderate/marked background parenchymal enhancement slightly limiting the sensitivity and specificity of this study.Scattered cysts are identified in both breasts. Multiple similar benign appearing masses are present in both breasts, largest measuring 1.4 x 1.2 cm in the left outer mid breast. This mass was identified on prior ultrasound studies and has been stable sonographically. RIGHT BREAST: Within the right outer breast, there is a segmental area of clumped nonmass enhancement measuring 6.7 x 3.8 x 5.2 cm (AP x transverse x IS), with extension into the subareolar region (approximately 1.4 cm from the nipple), at the central aspect of which, focal susceptibility artifact from a biopsy clip marker is present from prior stereotactic biopsy. Intrinsic high T1 signal from blood products is present along the biopsy clip tract. This area of nonmass enhancement correlates to the mammographically detected right outer segmentally distributed microcalcifications.LEFT BREAST:There is no suspicious mass, or non mass enhancement in the left breast. See above discussion of multiple benign masses. No axillary or internal mammary lymphadenopathy.RIGHT MRI BIOPSY AND POSTPROCEDURE MAMMOGRAM DATED 11/8/2016:Images from a right breast MRI guided biopsy are provided.The inferior aspect of the right breast nonmass enhancement was targeted.Postprocedure mammogram reveals a new biopsy clip marker within the right inferior central anterior breast. Distance between the two clips is 4.1 cm on the ML view.PATHOLOGY:Pathology slides were reviewed at the University of Chicago.Results for the biopsies are as follows:Right breast upper outer with calcs (stereotactic biopsy dated 10/25/2016): Lobular carcinoma in situ.Right breast lower outer (MRI biopsy dated 11/8/2016): focal atypical ductal hyperplasia.

Output: 1. Extensive right outer breast calcifications extending into the periareolar region, correlating with extensive NME on prior MRI guided biopsy, corresponding to biopsy proven ADH. 2. Multiple bilateral benign-appearing masses, largest measuring 1.4 cm in the left breast. No MRI evidence of left breast malignancy.3. No axillary or internal mammary lymphadenopathy.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: 52 year old man with myositis, diabetes, hypertension, hyperlipidemia, and coronary artery disease previously treated with a stent presenting with recurrent angina. He is referred to rule out ischemia.MEDICATIONS: aspirin, clopidogrel, ezetimibe, lisinopril, First Pass PerfusionDuring hyperemia, a mild perfusion defect involving the apical anterior, lateral, inferior, and septal walls was noted. The overall ischemia score is 4 out of a possible 32 and 12% of the myocardium was ischemic.Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viableLeft VentricleThe left ventricle is moderately dilated with mildly reduced systolic function. There is mild circumferential LVH (IVSd=12mm). The overall LV ejection fraction is 43%, the LV end diastolic volume index is 123 ml/m2 (normal range: 74+/-15), the LVEDV is 257 ml (normal range 142+/-34), the LV end systolic volume index is 70 ml/m2 (normal range 25+/-9), the LVESV is 147 ml (normal range 47+/-19), the LV mass index is 99 g/m2, and the LV mass is 207 g. There is abnormal septal motion consistent with the patient's known left bundle branch block. 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 95 ml/m2 (normal range 82+/-16), the RVEDV is 198 ml (normal range 142+/-31), the RV end systolic volume index is 44 ml/m2 (normal range 31+/-9), and the RVESV is 97 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is mildly dilated.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is a small pericardial effusion.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. There is mild ischemia in the usual distribution of the mid to distal left anterior descending artery. 2. No prior myocardial infarction. The entire myocardium is viable.3. Moderate LV dilation and mild LVH with mildly reduced systolic function (LVEF 43%) without evidence of underlying myocardial fibrosis.4. Normal RV size and systolic function (RVEF 54%).5. Moderate left atrial dilation. 6. Mild mitral and tricuspid regurgitation. 7. Mild main pulmonary artery dilation. 8. Small pericardial effusion.


Instruction: Generate impression based on findings.

Input: 45 year old with history of benign right breast MRI guided biopsy in January 2015 presents for 6-month-followup MRI. Status post left mastectomy in May 2015. Status post left mastectomy and retropectoral silicone implant in both breasts.There is heterogeneous amount of fibroglandular tissue in the right breast.Mild parenchymal enhancement is noted in the right breast.A metallic artifact by a marker clip from recent benign biopsy is identified at middle upper inner aspect of right breast. Stable intramammary lymph node is present at posterior upper inner aspect in the right breast.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: Right elbow locking. Prior MRI dated 1/30/2011 demonstrated an old osteochondral defect/degenerative cyst. Prior MRI also demonstrated prominence of synovial fat versus intra-articular loose bodies. There is no significant elbow effusion.The noncontrast CT appearance of the common flexor and extensor tendons is normal. The noncontrast CT appearance of the biceps, brachialis, and triceps is normal.No fluid collections within the soft tissues.Small subchondral lucencies in the anterior aspect of the capitellum are again seen, and given differences in technique appear unchanged from the prior MRI. These may represent degenerative cysts, or old osteochondral defects. The overlying bone plate is intact, suggesting stability. A small defect more posteriorly in the capitellum may represent a normal variant "pseudodefect."No new osseous defects. No fractures.The trochlea, olecranon, and radial head appear normal.Adherent to the posterior wall of the olecranon fossa are a cluster of small 3-mm foci with central fat density, and a rim of calcification. These correspond to the finding on the prior MRI and in keeping with small intra-articular loose bodies. No additional intra-articular loose bodies are seen.

Output: 1. Cluster of small 3-mm foci with central fat density and rim calcification adherent to the posterior wall of the olecranon fossa. These correspond to the finding on prior MRI and are in keeping with small intra-articular loose bodies.2. Small unchanged subchondral cysts in the anterior aspect of the capitellum representing degenerative cysts or old osteochondral defects. The overlying bone plate is intact, suggesting stability.


Instruction: Generate impression based on findings.

Input: Numbness and tingling to left ear and left face. BRAIN: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are non-specific periventricular, subcortical, and pontine T2 hyperintensities. The internal auditory canals are grossly normal in appearance. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull and scalp soft tissues are grossly unremarkable. There is a right maxillary sinus retention cyst. CERVICAL SPINE: There are post-surgical findings related to anterior cervical fusion of C4-6. There is multilevel neural foraminal and central stenosis secondary to facet arthropathy, uncovertebral hypertrophy, and disk-osteophyte complexes. At C3-4, there is moderate left and mild right neural foraminal stenosis. At C4-5, there is mild central stenosis, as well as moderate bilateral neural foraminal stenosis. At C5-6, there is mild disc bulging causing mild effacement of the ventral thecal sac, as well as moderate bilateral neural foraminal stenosis. At C6-7, there is moderate left and mild right neural foraminal stenosis. At T1-2, there is mild disc bulging abutting the ventral thecal sac, as well as mild bilateral neural foraminal stenosis. There is straightening of the cervical spine. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: 1. Post-surgical findings from anterior cervical fusion of C4 through C6 with multilevel cervical spondylosis with variable degrees of spinal canal and neural foraminal stenoses.2. No evidence of acute intracranial hemorrhage, mass, or acute infarct.3. Cerebral white matter T2 hyperintensities are non-specific, but suggestive of chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: Cisternogram for assessment of ventricles. Hydrocephalus, VP shunt infection status post removal and EVD placement on 9 -- 11. Comparison with the prior examination of the same date which was performed at 16:59:44 hours there is evidence of increase in the size of the supratentorial ventricular system. The fourth ventricle remains stable and normal. No additional findings.

Output: Increase in the size of supratentorial ventricular system since prior study of the same date.


Instruction: Generate impression based on findings.

Input: Female, 59 years old, with history of atypical meningioma the right parietal area status post subtotal resection and radiotherapy. Findings related to right vertex craniotomy for right parietal region tumor resection are seen. An extradural fluid collection beneath the craniotomy persists measuring up to 12 mm thickness appearing similar to the prior examination allowing for resorption of previously seen surgical material.A small resection cavity within the right parietal lobe has become smaller and is filled with nonspecific ill-defined soft tissue, likely granulation. Thin enhancement along the margins of the resection cavity continues to diminish. Thickening and enhancement along the superior sagittal sinus as it traverses the operative region is again seen compatible with residual tumor. This tissue appears to be slightly less thick than on the prior examination measuring up to 18 mm thickness in the axial plane (previously 20 mm), and 11 mm thickness in the sagittal plane (previously 13 mm).No new or worrisome intracranial lesions are seen. No significant parenchymal edema is observed. The ventricular system is normal in size and morphology.

Output: 1.Findings compatible with near complete resection of a large right parietal region meningioma. The surgical cavity has decreased in size. 2.Presumed residual tumor along the superior sagittal sinus appears to have decreased in thickness which may represent a response to treatment. No new or progressing intracranial lesions are seen.