Instruction: Generate impression based on findings.

Input: Bilateral hand grip weakness and tingling to right arm and hand Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is grossly maintained aside from mild retrolisthesis of C4 on C5 and anterolisthesis of C5 on C6. Bone marrow signal is benign with interval increase in edema involving the C4 and upper C5 vertebral bodies, which is most likely on a degenerative basis. The cervical spinal cord has normal signal characteristics and overall morphology.Degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal. There is moderate left and mild right neural foraminal narrowing related to facet arthropathy on the left and mild uncovertebral hypertrophy.C3-4: Previously seen disc bulge is improved without significant spinal canal at this level on the current study. There is moderate bilateral neural foraminal stenosis related to facet arthropathy and uncovertebral hypertrophy.C4-5: There is a disc bulge, ligamentum flavum thickening, and bilateral uncovertebral hypertrophy. There is mild to moderate spinal canal stenosis at this level which is progressed since 11/27/2013. There is moderate right and mild left neural foraminal stenosis. C5-6: Small disc bulge. No significant spinal canal stenosis. There is moderate bilateral neural foraminal stenosis related to uncovertebral hypertrophy and left-sided facet arthropathy.C6-7: Small disc bulge without significant spinal canal stenosis. There is bilateral uncovertebral hypertrophy resulting in moderate bilateral neural foraminal narrowing. C7-T1: No significant compromise to the spinal canal or neural foramina. There is right-sided facet arthropathy.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: 1. Multilevel degenerative changes in the cervical spine. There is mild to moderate spinal canal stenosis at the C4-C5 level which is worse compared to prior study from 11/27/2013. No higher grade spinal canal stenosis or cord signal abnormality is appreciated.2. Moderate neural foraminal stenosis at multiple levels throughout the cervical spine as detailed above.


Instruction: Generate impression based on findings.

Input: Right lower extremity weakness/sensory changes, pain, and vision changes. Orbits: There are bilateral lens implants. The globes, extraocular muscles, orbital fat, lacrimal glands, and optic nerves otherwise appear to be unremarkable bilaterally. There is no evidence of intraorbital massa lesions or abnormal enhancement. The bilateral orbital walls appear to be intact. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mild scattered cerebral white matter T2 hyperintensity. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. However, there is a prominent extra-axial cerebrospinal fluid signal intensity space that likely represents an arachnoid cyst. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is fluid within multiple paranasal sinuses.Cervical Spine: There is 3 mm of anterolisthesis of C2 on C3 and generalized loss of the usual cervical lordosis. There is multilevel degenerative spondylosis, predominantly affecting C2-3 through C5-6, which results in spinal canal stenosis with spinal cord impingement and neural foraminal stenosis. The spinal cord displays normal signal otherwise. The paraspinal soft tissues are unremarkable.

Output: 1. No evidence of optic neuritis.2. Probable chronic small vessel ischemic white matter disease, but no evidence of intracranial hemorrhage, mass, or acute infarct. 3. Multilevel degenerative cervical spondylosis with impingement upon the spinal cord. 4. Findings suggestive of acute sinusitis.


Instruction: Generate impression based on findings.

Input: A patient submitted outside study for review. Submitted for review are digital mammographic images (3/31/15, 4/6/15, 10/9/15, 11/2/15), ultrasound images of right breast (10/12/15), images from ultrasound guided biopsy and postprocedural right mammographic images (11/2/2015), breast MRI (11/10/2015), ultrasound images of right breast (11/12/2015), images from stereotactic needle biopsy of right breast and postprocedural right mammographic images (11/19/2015) performed at Presence St. Joseph Medical Center. For comparison, digital mammographic images (1/11/14) are available. DIGITAL MAMMOGRAPHIC IMAGES (3/31/15, 4/6/15, 10/9/15, 11/2/15): The breast parenchyma is composed of scattered fibroglandular elements (BiRADS Density Category B), unchanged in pattern and distribution.In the right breast at lateral aspect around 9:00 position, there are pleomorphic calcifications, including fine linear type with a developing focal asymmetry. The calcifications are extending segmentally in discontiguous fashion, measuring 60 x 40 mm (AP x LR). The focal asymmetry is present at posterior aspect of these calcifications, measuring 11 mm. There is another asymmetry seen best on CC view at medial anterior aspect of the right breast measuring 7 mm.A circumscribed oval mass with multiple coarse benign-appearing calcifications is present at 12:00 position in the right breast, likely a fibroadenoma.No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in left breast. ULTRASOUND IMAGES OF RIGHT BREAST (10/12/15):Ill-defined hypoechoic mass measuring 7 x 9 mm at 9:00 position with echogenic rim is detected, corresponding to the focal asymmetry seen on the mammogram at posterior aspect of the segmentally distributed calcifications.IMAGES FROM ULTRASOUND GUIDED BIOPSY AND POSTPROCEDURAL RIGHT MAMMOGRAPHIC IMAGES (11/2/2015):Ultrasound guided biopsy was performed for the mass at 9:00 position with an appropriate needle placement. Postprocedural mammograms demonstrate a marker clip (Hydromark) at the site of the focal asymmetry at 9:00 position in the right breast.Per outside radiology report, the result was malignant.BREAST MRI (11/10/2015):The study was performed with a protocol outlined in the outside report.There are 2 enhancing masses in the right breast, one at 9:00 position measuring 19 x 13 x 12 mm (AP x LR x CC), and the other at 3:00 position measuring 14 x 21 x 11 mm. The one at 9:00 position is proven carcinoma and the marker clip is present at the anterior aspect of this mass. Non-mass enhancement is present between the two masses, measuring 49 x 71 x 20 mm.No abnormal enhancement is seen in the left breast.No abnormal lymph nodes are present in either axilla.ULTRASOUND IMAGES OF RIGHT BREAST (11/12/2015):The study was performed as second look ultrasound to look for a correlate of MR detected mass at 3:00 position in the right breast. No sonographic correlate was detected in this study.IMAGES FROM STEREOTACTIC NEEDLE BIOPSY OF RIGHT BREAST AND POSTPROCEDURAL RIGHT MAMMOGRAPHIC IMAGES (11/19/2015):Stereotactic biopsy was performed for the asymmetry best seen on CC view at medial right breast, because the asymmetry is likely correlating to the MR detected mass at 3:00 position. Postprocedural mammograms demonstrate a marker clip at upper inner aspect of the right breast, near the site of the enhancing mass seen on the MRI. Distance between 2 clips is 135 mm on CC view.Per outside radiology report, the biopsy result was malignant; invasive ductal carcinoma.

Output: 1. Biopsy proven carcinoma in the right breast, 2 sites; one at 9:00 position and the other at 3:00 position. Mammograms demonstrate suspicious calcifications segmentally at lateral right breast and MRI demonstrates extensive non-mass enhancement between the two malignant masses in the right breast.2. No mammographic or MR evidence of malignancy in the left breast.3. No MR evidence of abnormal lymph nodes in either axilla.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: 66-year-old female with altered mental status and recent history of PRES. There is interval near resolution of several areas of bilateral posterior cerebral hemisphere cortical and subcortical, superior frontal lobe, as well as bilateral thalami T2 hyperintensity. There are scattered foci of T2 hyperintensity in the bilateral cerebral white matter, a few of which appear to be new or more conspicuous compared to the prior exam. There are no areas of restricted diffusion. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is an unchanged punctate focus of susceptibility in the left frontal lobe, which is nonspecific, but likely related to trace mineralization or chronic hemosiderin. The ventricles and sulci are unchanged. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Interval near-resolution of abnormality predominantly involving the bilateral posterior cerebral hemispheres likely related to PRES. However, a few nonspecific scattered cerebral white matter lesions appear to be new or more conspicuous, but no evidence of acute infarction. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: ORBITS: The right optic nerve is slightly smaller in caliber than the left optic nerve. The optic nerves are otherwise normal in signal intensity. Failure of fat saturation on the coronal post-gadolinium images slightly limits evaluation, but no intraorbital mass or abnormal enhancement is convincingly identified. There is no chiasmatic mass or parasellar abnormality. The extraocular muscles are unremarkable.BRAIN: There is a subcentimeter focus of increased signal on DWI images in the right frontal periventricular white matter which does not have corresponding low signal on ADC images and demonstrates low T1 hypointensity; finding likely represents a subacute to chronic infarct. There is a lobulated, extra-axial collection along the bilateral superior frontal lobes measuring up to 9 mm in maximum thickness. The collection demonstrates heterogenous increased T1 signal, intermediate to low T2 signal, and low signal on susceptibility weighted images and is favored to represent a subacute to chronic subdural hematoma. The collection causes minimal local mass effect. Nonspecific scattered punctate foci of increased T2/FLAIR signal are present within the subcortical and periventricular white matter. There is nonspecific increased T2/FLAIR signal within the bilateral globus pallidi. There is no abnormal intracranial enhancement. Prominence of the cortical sulci and ventricles is compatible with moderate global cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull and scalp soft tissues are unremarkable. There is trace mucosal thickening within the paranasal sinuses. The midline structures and craniocervical junction are within normal limits.

Output: 1.Multifocal small extra-axial collections along the bifrontal convexities likely represent subacute to chronic subdural hematomas with minimal local mass effect. Follow-up noncontrasted CT may be obtained as clinically warranted.2.Subcentimeter focus of DWI signal hyperintensity in the right periventricular white matter without low signal on ADC which is favored to represent a subacute to chronic infarct.3.Additional scattered foci of white matter signal abnormality in the periventricular and subcortical white matter are nonspecific but favor chronic small vessel ischemic changes. Demyelinating disease considered less likely.4.T2 hyperintensity involving the globus pallidus bilaterally which is nonspecific but may be related to prior toxic-metabolic event.5.Moderate global cerebral volume loss.6.Minimally asymmetrically decreased caliber of the right optic nerve without associated optic nerve signal abnormality or abnormal enhancement.Notified Dr. Nichols's answering service of unexpected finding at 5:15 PM on 9/3/2015.


Instruction: Generate impression based on findings.

Input: 48 year old with history of left mastectomy for IDC and DCIS and right prophylactic mastectomy in 2012. Bilateral reconstruction with silicone implants. Left chest pain. Status post bilateral mastectomies and post-pectoral silicone implants.Both implants appear intact.No abnormal enhancement is seen in either breast. Benign appearing lymph node is presen at at axillary tail in both breasts. No abnormal lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: 46 year old woman referred for further evaluation of RA mass. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 63%, the LV end diastolic volume index is 85 ml/m2 (normal range: 65+/-11), the LVEDV is 194 ml (normal range 109+/-23), the LV end systolic volume index is 32 ml/m2 (normal range 18+/-5), the LVESV is 72 ml (normal range 31+/-10), the LV mass index is 47 g/m2 (normal range 67+/-11), and the LV mass is 107 g (normal range 114+/-24). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 64%, the RV end diastolic volume index is 94 ml/m2 (normal range 69+/-14), the RVEDV is 215 ml (normal range 110+/-24), the RV end systolic volume index is 34 ml/m2 (normal range 22+/-8), and the RVESV is 79 ml (normal range 35+/-13). Right AtriumThe right atrium is mildly dilated. There are a small nodule appearing mass attached to the RA side of the interatrial septum, adjacent to the fossa ovalis near the IVC, It measures about 7x7mm and does not appear to be highly vascular nor have late gadolinium enhancement. There is additionally no increased signal intensity on T1 and hypointensity on T2. Overall they do not have features concerning for a malignant process. Based on the location, I would suspect that the mass represents remnant tissue from atrial septal embryogenesis; however, repeat imaging to demonstrate stability would be reassuring.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsMild lymphadenopathy in bilateral axilla (all <1cm). This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 63%. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.2. The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 64%.3. There is a small nodular mass located adjacent to the fossa ovalis near the IVC of unclear etiology. Its morphologic appearance does not appear malignant. Based on the location, it may represent remnant tissue from atrial embryogenesis; however, demonstration of stability on repeat imaging would prove to be reassuring.4. Mild biatrial dilation. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Person injured in collision between other specified motor vehicles (traffic), initial encounter [V87.7XXA], Reason for Study: ^Reason: Evaluate C1, cervical spine History: Fracture C1 Motion artifacts degraded exam quality.Straightening of cervical spine which is non specific. Bony defect on the posterior arch of the C1 is not as conspicuous as CT scan. However, there is no evidence of surrounding edema or soft tissue swelling. Thus, the C1 posterior arch bony defect seen on CT scan represents either chronic fracture with non union or congenital defect.The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The cord signal is normal. The epidural space, thecal sac, and spinal cord are preserved with no evidence of spinal canal/neural foraminal stenosis, cord compression or myelopathy. C2-C3: no neuroforaminal narrowing or spinal stenosis. C3-C4: no neuroforaminal narrowing or spinal stenosis. C4-C5: no neuroforaminal narrowing or spinal stenosis. C5-C6: no neuroforaminal narrowing or spinal stenosis. C6-C7: no neuroforaminal narrowing or spinal stenosis. C7-T1: no neuroforaminal narrowing or spinal stenosis.

Output: 1. No evidence of acute fracture of cervical spine. 2. No abnormal spinal cord signal intensity.3. No evidence of bone marrow edema or surrounding soft tissue swelling around C1 posterior arch bony defect area indicating either chronic fracture with non-union or possible congential defect.


Instruction: Generate impression based on findings.

Input: Note that examination is limited by metal artifact from anterior fusion hardware. Postsurgical changes are noted from anterior fusion of the C4-C6 vertebral bodies. A known left cerebellopontine angle mass is again noted on sagittal images and measures 15 mm in AP dimension, unchanged. A 12 mm midline nasopharyngeal cyst is unchanged and likely presents a Thornwaldt cyst. There is uniform narrowing of the cervical spinal canal, measuring approximately 8 mm in diameter, compatible with congenital narrowing. The cervical and upper thoracic cord is normal in signal without abnormal enhancement. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. C1/2: No significant spinal canal or neuroforaminal narrowing.C2/3: Mild spinal canal narrowing. No significant neuroforaminal narrowing.C3/4: Mild spinal canal narrowing. Mild left neural foraminal narrowing.C4/5: Mild spinal canal narrowing. No significant neuroforaminal narrowing.C5/6: Mild spinal canal narrowing. No significant neuroforaminal narrowing.C6/7: Mild spinal canal narrowing. No significant neuroforaminal narrowing.C7/T1: There is central and leftward disc extrusion with mild superior displacement. This causes complete effacement of the thecal sac and flattening of the spinal cord, compatible with moderate spinal stenosis. There is no signal abnormality at this level within the cord. The visualized thoracic spine up to the level of T4 does not have significant spinal canal narrowing.

Output: 1.Congenital narrowing of the cervical spinal canal with moderate spinal canal narrowing at the C7-T1 level secondary to disc extrusion. Please see above comments.2.Postsurgical changes from anterior fusion of C4-C6 without evidence of spinal cord signal abnormality.


Instruction: Generate impression based on findings.

Input: Microcephaly and lack of coordination. Additional history collected from electronic medical record: 4-year-old female born at 34 gestational weeks. Her foster mother brought her to pediatric neurology clinic with delayed speech, hypertonia-flexibility issues, developmental delays. Foster mom describes the patient as super forgetful. Had IEP which stated she functions at 30 months of age. It is believed that her birth mom was developmentally delayed and she did not receive any prenatal care. There is report of intrauterine growth retardation and question of intrauterine drug exposure. Her birth weight was 4 pounds 7 ounces. There is no developmental history of when Olivia walked or developed language. Foster mom states Olivia does have two siblings, one 8 year old and one 10 year old and they both also have some degree of microcephaly. There is a diffusely simplified gyral pattern of the cerebral hemispheres bilaterally and marked microcephaly. Otherwise, the degree of myelination is appropriate for age and the corpus callosum is fully formed. The cerebellar vermis may be mildly hypoplastic, but the cerebellar hemispheres and brainstem are intact. The pituitary gland is grossly unremarkable, with the posterior pituitary bright spot is demonstrated in normal location. There is no evidence of intracranial hemorrhage, mass, or infarction. The ventricles are not enlarged. There is no evidence of heterotopia or enlarged extra-axial cerebrospinal fluid spaces. There is no midline shift or mass effect. The cerebral flow voids appear to be intact. The orbits, paranasal sinuses, and mastoid air cells are grossly unremarkable.

Output: Microcephaly with simplified gyral pattern.


Instruction: Generate impression based on findings.

Input: 33 years, Male, memory problems, dementia. Brain parenchymal volume is within normal limits. There is no intracranial mass. There is ectopia of the cerebellar tonsils, right greater than left, with peglike configuration and measuring up to 17 mm below the foramen magnum. There is associated mild crowding at the foramen magnum. A left frontal developmental venous anomaly is incidentally noted. Brain parenchyma is otherwise unremarkable with no focal signal abnormality. Bilateral hippocampi are unremarkable. No evidence of ischemia or hemorrhage. No hydrocephalus. No extra-axial collections. No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved. There is minimal mucosal thickening in the paranasal sinuses and mucous retention cysts involving the maxillary sinuses, right larger than left. Bone marrow signal and extracranial soft tissues are unremarkable.

Output: Incidentally seen are findings compatible with Chiari 1 malformation with mild associated crowding at the foramen magnum. Brain parenchyma appears otherwise within normal limits.


Instruction: Generate impression based on findings.

Input: Breast cancer, with additional lung cancer patient. Metastasis workup. Due to significant motion artifacts, image quality has been degraded.There is focal mildly restricted diffusion area on the left middle temporal gyrus posterior aspect. The lesion shows subtle high signal intensity on FLAIR images but no susceptibility artifacts on gradient echo images, thought there were significant motion artifacts. Thus, this lesion is likely represent a subacute subcortical ischemic lesion.There is no large intracranial mass.Scattered high signal intensities on FLAIR images are non specific.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Possible subacute ischemic lesion on the left middle temporal gyrus posterior aspect.2. Non specific small vessel ischemic disease.3. No evidence of intra cranial mass or abnormal edema.Comment: if clinically indicated, brain MRI with and without contrast enhancement is recommended for metastasis work up.


Instruction: Generate impression based on findings.

Input: Diagnosis: Other musculoskeletal symptoms referable to limbs(729.89)Other musculoskeletal symptoms referable to limbs(729.89)Clinical question: Evaluate for cervical spondylosis or myelopathy in patient with spinal stenosisSigns and Symptoms: worsening upper and lower extremity weakness The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal. There is loss of disc space height and disc desiccation at this level. There are bilateral uncovertebral osteophytes present at this level associated with some posterior ligamentous hypertrophy and some endplate osteophytes. There are endplate reactive changes at this level which are bright on T1. There is encroachment of the exiting nerve roots within the neural foramina bilaterally at this level. Overall there is a very mild degree of spinal stenosis at this level.At C4-5 there is no significant compromise to the spinal canal. There is loss of disc space height and disc desiccation at this level. There are bilateral uncovertebral osteophytes present at this level associated with some endplate osteophytes. There are endplate reactive changes at this level which are bright on T1. There is mild encroachment of the exiting nerve roots within the left neural foramen at this level.At C5-6 there is no significant compromise to the spinal canal. There is loss of disc space height and disc desiccation at this level. There are bilateral uncovertebral osteophytes present at this level associated with some posterior ligamentous hypertrophy and some endplate osteophytes. There are endplate reactive changes at this level which are bright on T1. There is encroachment of the exiting nerve roots within the neural foramina bilaterally at this level. At C6-7 there is no significant compromise to the spinal canal. There is loss of disc space height and disc desiccation at this level. There are bilateral uncovertebral osteophytes present at this level associated with some posterior ligamentous hypertrophy and some endplate osteophytes. There are endplate reactive changes at this level which are bright on T1. There is mild encroachment of the exiting nerve roots within the left neural foramen. At C7-T1 there is no significant compromise to the spinal canal or neural foramina. There is some disc desiccation and posterior ligamentous hypertrophy at this level.The vertebral artery flow voids appear to be intact.

Output: 1.There are multilevel degenerative changes present in the cervical spine without any significant spinal stenosis as detailed above. There is neural foraminal encroachment of exiting nerve roots bilaterally at C5-6 and C3-4 as detailed above.


Instruction: Generate impression based on findings.

Input: 49 years Male (DOB: 12/20/1966)Reason: please compare to prior History: progressionPROVIDER NAME: JACQUELINE T BERNARD MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. There is redemonstration of multiple periventricular and subcortical white matter lesions many of which are perpendicularly oriented to the lateral ventricles. Additional lesions are present in the internal capsules bilaterally which are also unchanged.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. . No abnormal enhancing lesions are identified in the cervical spine.There is a high signal focus present within the cervical spinal cord at the C3 vertebral body level measuring 6 x 12 mm sagittal dimensions which is eccentric to the right hemicord. There is a 34 mm in length T2 hyperintense lesion within the cervical spinal cord extending from the C4 level to the C6 level which is eccentric to the left hemicord. There is a T2 hyperintense lesion within the cervical spinal cord at the C2 vertebral body level involving the right hemicord. Overall the cervical spinal cord is small. These lesions were also present on the prior exam from 5/22/2012At C2-3 there is no significant compromise to the spinal canal or neural foramina. There is disc desiccation at this level.At C3-4 there is no significant compromise to the spinal canal. There is disc desiccation present at this level. There is a left lateral recess disc protrusion present at this level which is associated with uncovertebral osteophytes and encroachment of the left-sided exiting nerve roots. This has not significantly progressed since the prior exam.At C4-5 there is no significant compromise to the spinal canal. There is disc desiccation at this level associated with diffuse disc bulge and endplate and uncovertebral osteophytes with narrowing of the neural foramina bilaterally and encroachment of the left-sided exiting nerve roots. This has not significantly progressed since the prior exam.At C5-6 there is loss of disc space height, disc desiccation, diffuse disc bulge and endplate uncovertebral osteophytes associated with ligamentum flavum hypertrophy. There is effacement of spinal fluid ventral and posterior the spinal cord and encroachment of the exiting nerve roots within the right neural foramen at this level. Overall there is mild to moderate spinal stenosis at this level. This has not significantly progressed since the prior exam.At C6-7 there is loss of disc space height, disc desiccation and diffuse disc bulge associated with endplate and uncovertebral osteophytes. There is some narrowing of the neural foramina but no significant optimized to the exiting nerve roots. There is partial effacement of spinal fluid ventral and posterior the spinal cord. Overall there is a mild degree of spinal stenosis at this level. This has not significantly progressed since the prior exam.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.There are multiple lesions within the cervical spinal cord which are compatible with demyelinating disorder. These were also present on the prior exam from 5/22/2012 and have not changed significantly.2.There are multilevel degenerative changes present in the cervical spine which appear to be worse at C5-6 where there is mild to moderate spinal stenosis and encroachment of right-sided exiting nerve roots. There is some encroachment of exiting nerve roots at other levels as well. These findings are stable compared to the prior exam.3.There are multiple white matter lesions scattered within the brain parenchyma which are stable compared to prior exam 5/22/2012 which support the patient's clinical diagnosis of multiple sclerosis.


Instruction: Generate impression based on findings.

Input: 23-year-old female with history of Lhermitte-Duclos and left posterior fossa tumor resection on 2/23/15. Patient returned on 3/11/15 due to concern for meninigitis and was sent home with linezolid and cefepime. Patient states she had a generalized tonic-clonic seizure that lasted <2 min after a dose of cefepime. Evaluate for infection and abscess. Redemonstrated are postoperative findings related to a left occipital craniotomy for resection of a left cerebellar lesion. There is a resection cavity within the left cerebellum containing fluid of mixed intensity and minimal rim enhancement, which is likely post-surgical. There is interval increase in peripheral enhancement of the previously seen fluid collection superficial to the cranioplasty mesh, measuring approximately 4.5 x 1.7 cm (series 1001, image 4), and extends to the inferior margin of the mid C2 level. There is no diffusion restriction within the collection. Again noted are multiple foci of susceptibility artifact along the resection margin, consistent with blood products. Minimal rounded susceptibility is also present in the third ventricle. There is interval resolution of the other previously described areas of susceptibility artifact. The ventricles and sulci are unchanged without hydrocephalus. The cisterns remain patent. The left transverse sinus is patent. There is no midline shift. There are no areas of pathological leptomeningeal enhancement. Minimal linear T2/FLAIR hyperintensity is seen just above the midbody of the lateral ventricles, with extension through the right frontal lobe likely relating to a previous tract via right frontal burr hole.Normal flow-voids are demonstrated in the major intracranial vascular structures. There is abnormal up to 11-mm extension of the cerebellar tonsils below the level of the foramen magnum, likely relating to an acquired Chiari malformation. There is associated significant crowding at this level, although the cerebellar tonsil contour remains rounded. The midline structures and craniocervical junction are otherwise within normal limits.

Output: 1. Postoperative findings related to resection of a left cerebellar lesion consistent with dysplastic gangliocytoma. 2. No abnormal leptomeningeal enhancement to suggest meningitis, although lumbar puncture would be more sensitive. No intracranial abscess or empyema. 3. Again seen is a left suboccipital fluid collection superficial to the cranioplasty mesh which may represent a pseudomeningocele measuring 4.5x1.7 cm. There is interval increase in peripheral enhancement compared to prior postoperative MRI which may be related to evolving granulation tissue although superinfection of the collection is not excluded. No restricted diffusion within this collection to suggest pus. Consider sampling as clinically warranted.


Instruction: Generate impression based on findings.

Input: 39-year-old female with bilateral lower extremity pain and numbness. Evaluate for stenosis. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is an apparent small foraminal disc protrusion involving the left L2-3 level, but no high grade neuroforaminal narrowing or spinal canal stenosis involving the lumbar spine. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: Apparent small foraminal disc protrusion involving the left L2-3 level, but no high grade neuroforaminal narrowing or spinal canal stenosis involving the lumbar spine.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Reason: Astrocytoma, s/p RT now on TMZ. History: astrocytoma. CERVICAL SPINE:There is mild reversal of the normal cervical lordosis. Vertebral body heights are intact. Mild multilevel disc desiccation with and mild degenerative disc disease at C5-C6 and C6-C7 is unchanged. Diffuse T1 hyperintensity throughout the vertebral bodies suggests prior radiation. Postsurgical changes along the posterior cervical spine with laminectomies at C5 and C6 are unchanged.T2 hyperintense expansile mass within the right aspect of the cord extending from the C3-C4 level to C7-T1 is overall unchanged in size measuring approximately 1.5 x 1.2 cm in transverse dimension (701/12) and 4.9 cm in length. There is some T2 hyperintensity also on the left side of the cord at these levels, unchanged. Mild effacement of the surrounding subarachnoid space, particularly at C5, is unchanged. There is subtle enhancement within the right ventral aspect of the midportion of the lesion at C5-C6, seen in both the axial and sagittal planes (1901/7, 2001/12) which was not definitely evident on the prior exams. It is more conspicuous on the axial delayed postcontrast images.THORACIC SPINE:Alignment is anatomic. Vertebral body heights and discs are intact. There are diffuse marrow changes related to prior radiation. Conus terminates at T12-L1.T2 hyperintense expansile mass centered on the left aspect of the cord extending from the T2-T3 level to the T8 level is unchanged in size and overall distribution, measuring 1.2 x 0.9 cm in transverse dimension and 11.4 cm in length. No enhancement is seen within the lesion. No significant spinal or neural foraminal narrowing throughout the thoracic spine. Central disc osteophyte complex at T7-T8 appears decreased from the prior exam. Other scattered mild spondylotic changes appear similar.

Output: Cervical and thoracic astrocytomas are unchanged in extent. There is subtle questioned enhancement within the cervical intramedullary mass at C5-6 seen in two planes, which was not definitely present on the prior exam. Close attention should be made to this region on follow-up exams, to exclude the possibility of malignant degeneration.


Instruction: Generate impression based on findings.

Input: Female, 48 years old, with pulsatile tinnitus and white matter lesion. Assess for change in white matter lesion. Again seen is an area of ill-defined T2 hyperintensity spreading from the left periatrial white matter superiorly into the left postcentral gyrus. The overall size and extent of this lesion have not significantly changed. The lesion is somewhat more distinct on the current examination, possibly due to imaging at 3 Tesla. As before, this lesion induces no mass effect and there is no associated pathologic enhancement. Single voxel spectroscopy of this lesion demonstrates a nonspecific elevation of choline relative to the contralateral normal side. The NAA level is unaffected. No unexpected metabolite resonances are seen.A punctate focus of T2 hyperintensity is seen within the right orbital gyrus, unchanged and nonspecific. No new areas of parenchymal signal abnormality are seen. No pathologic parenchymal enhancement is detected. Redemonstrated is a 5 mm lobular focus of enhancement within the left cerebellopontine angle cistern adjacent to the petrosal vein which is unchanged.No restricted diffusion is seen. No abnormal extra-axial fluid or evidence of intracranial hemorrhage is seen. The ventricular system is normal in size and morphology. Patchy, moderately severe paranasal sinus mucosal thickening is seen, similar to prior.

Output: 1.No significant interval change is seen in the overall size of a nonenhancing ill-defined T2 hyperintense lesion in the left parietal lobe. Single voxel spectroscopy of this lesion shows a nonspecific degree of choline elevation with preserved NAA. Differential diagnosis would continue to include both non-neoplastic and neoplastic etiologies including sequela of prior inflammation or demyelination, dysplastic tissue, or low-grade neoplasm.2.Stable lobular enhancing structure within the left cerebellopontine angle cistern which may represent a focally dilated vascular structure, probably venous.


Instruction: Generate impression based on findings.

Input: Clinical question: Likely soft tissue lipoma; lesion in the midline; evaluate depth/size, spinal abnormality. Signs and symptoms: Soft tissue mass. Nonenhanced thoracic spine MRI:There is normal anatomical alignment and signal intensity of vertebral column. There is no detectable significant degenerative disease at any level. There is no evidence of the spinal canal or neural foraminal compromise at any level. There is normal signal intensity and caliber of thoracic cord.There is a small well demarcated subcutaneous mid line lipoma in the subcutaneous soft tissues of the spine posteriorly at T9 and T10 measuring 40-mm in cranial cephalad access and 8mm in AP axis and 31-mm in transverse axis. The lipoma is directly over the musculature without extension into the musculature.The paraspinal soft tissues are otherwise entirely within normal.

Output: 1.Well-demarcated posterior subcutaneous midline lipoma at T9 and T10 measuring at 8 mm in AP x 40 mm in cc and 31mm in transverse axis as detailed above.2.Negative nonenhanced thoracic spine MRI otherwise.


Instruction: Generate impression based on findings.

Input: 78-year-old with history of left lumpectomy and radiation therapy. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. No dominant mass, suspicious microcalcifications or areas of architectural distortion in either breast. Stable postoperative distortion, density and volume loss in the left breast. Surgical clips are seen in the lumpectomy bed and left axilla. MRI biopsy clip again seen on the right.Benign appearing lymph nodes are projected over the right axilla.

Output: No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: 61-year-old female patient with right knee pain and effusion x2 weeks and history of dry tap. Evaluate for meniscal tear. MENISCI: There is blunting of the free edge of the body of the medial meniscus, which may represent mild chronic attritional tearing. We see no fluid-filled or unstable meniscal tear in the medial or lateral menisci.ARTICULAR CARTILAGE AND BONE: There is near full-thickness degeneration of the articular cartilage of the weightbearing portion of the medial femoral condyle and medial tibial plateau anteriorly. There is a small amount of edema type signal and subchondral cyst formation in the anterior aspect of the medial tibial plateau. There is subchondral cyst formation in the posterior aspect of the medial femoral condyle with degeneration of the overlying articular cartilage. There is also focal heterogeneous signal intensity of the articular cartilage of the weightbearing portions of the lateral femoral condyle and lateral tibial plateau, indicating focal degeneration. There is full-thickness degeneration of the articular cartilage of the medial patellar facet.LIGAMENTS: The anterior cruciate ligament, posterior cruciate ligament, medial collateral ligament, and lateral collateral ligament complex are intact.EXTENSOR MECHANISM: There is intermediate signal intensity within the proximal fibers of the patellar tendon that may reflect focal tendinosis, however, this is equivocal and is of uncertain current clinical significance. Otherwise, the extensor mechanism is intact.ADDITIONAL

Output: 1.Blunting of the free edge of the body of the medial meniscus may represent mild chronic attritional tearing, but we see no fluid-filled or unstable meniscal tear in the medial or lateral menisci.2.Tricompartmental articular cartilage degeneration, particularly in the medial and patellofemoral compartments.3.Small joint effusion and findings suggestive of minimal synovitis.4.Lobulated fluid collection in the posterior knee may represent cranial extension of a Baker's cyst or a ganglion cyst.


Instruction: Generate impression based on findings.

Input: Male, 68 years old, with acute onset of altered mental status on Monday, confused and agitated. Persistent altered mental status. A few scattered foci of T2 hyperintensity are seen within the periventricular and subcortical white matter, a nonspecific finding. No restricted diffusion is seen. No parenchymal edema or mass effect is detected. No pathologic enhancement is seen. No intracranial hemorrhage or any abnormal extra-axial fluid collection is detected. The ventricles are normal in size and morphology. Bone marrow signal characteristics are within normal limits.

Output: No acute intracranial abnormality and no specific findings to account for the patient's altered mental status.


Instruction: Generate impression based on findings.

Input: Brain MRI: The presence of braces cause significant artifact anteriorly.The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain. Sagittally acquired CSF flow demonstrates normal biphasic both anteriorly and posteriorly, maintained at the level of the foramen magnum and cerebellar tonsils.Complete spine MRI:Subtle enhancement is noted along the anterior surface of the distal conus involving the adjacent anterior nerve roots with questionable nerve root thickening.Numbering the complete spine beginning at C2 and progressing inferiorly demonstrates there is transitional anatomy with lumbarization of S1 resulting in a rudimentary S1/2 disc.There are no osseous dysplasias. There are no fractures or subluxations. The marrow signal is benign. The spinal cord and conus are normal in signal and morphology. The conus terminates at L2. There is no fatty filum. There are no findings of tethered cord. The visualized intra-abdominal and paraspinal contents are unremarkable.Slight reversal cervical curvature accentuates disc bulges within the cervical spine without morphologic abnormality of protrusion.Mild disc bulges are noted at T11/12 and T12/L1 without morphologic abnormality of protrusion.A Schmorl's node is present involving the superior endplate of L1.Abnormality within the spinal CSF spaces is felt to be secondary to CSF flow artifact and not AVM.There are no stenoses throughout the spine.Upon prone positioning, the conus and proximal cauda translate anteriorly.

Output: 1.The presence of braces cause significant artifact anteriorly. Given this caveat, negative MRI of the brain including gadolinium enhancement.2.Subtle enhancement is noted along the anterior surface of the distal conus involving the adjacent anterior nerve roots with questionable nerve root thickening. This is nonspecific and may be secondary to infectious or inflammatory etiologies. Given a negative contrast enhanced study of the remaining neuraxis, neoplastic etiologies are felt to be less likely.3.Abnormality within the spinal CSF spaces is felt to be secondary to CSF flow artifact and not AVM.4.No MRI evidence of Chiari malformation, fatty filum, or tethered cord.5.There are no stenoses throughout the spine.6.Findings were discussed with Dr. Frim on 3/23/2015 approximately 4:45 p.m.


Instruction: Generate impression based on findings.

Input: History of nasopharyngeal cancer. Evaluate extent of disease. Extensive patient motion limits evaluation, particularly of the lower neck.Redemonstration of extensive posttreatment changes in the neck. There is extensive ill-defined enhancement involving the pharyngeal walls without a discrete measurable mass lesion. The abnormal enhancement extends posteriorly into the anterior arch and lateral mass of C1, left longus colli muscle, and left occipital condyle/skull base. This includes soft tissue extension into the hypoglossal canal and jugular foramen.There is also extension of enhancing soft tissue into the left cavernous sinus and left Meckel's cave that appears progressed from prior, however evaluation of this area is limited on the prior MRI. Definitely new from prior however is loss of the left internal carotid vascular flow void. There is also increased thickening and enhancement of the cisternal trigeminal nerve segment, foramen rotundum, and and ovale indicating worsening perineural tumor spread. Abnromal enhancement is also present in the inferior orbital fissure.Asymmetrically increased T2 signal is present in the masticator space as well as in the left aspect of the tongue. This possibly is related to denervation, but evaluation is limited by motion.There is a new mildly prominent left intraparotid lymph node measuring 11 x 6 mm. No cervical lymph adenopathy in the lower neck is appreciated although images are significantly motion degraded. Mucosal thickening and partial opacification affecting the maxillary sinuses and ethmoid air cells as well as near complete opacification of the sphenoid sinuses is likely inflammatory in etiology. Near complete opacification of the left mastoid air cells and to a lesser extent the right mastoid air cells is similar to prior and likely related to posttreatment change.

Output: 1. Extensive posttreatment changes in the neck as described. There is extensive ill-defined enhancement surrounding the nasopharynx without a measurable mass lesion; similar to prior.2. Compared to prior there appears to be increased tumor extension into the left cavernous sinus as well as worsening perineural tumor spread along the trigeminal nerve. This is now associated with loss of the left cavernous ICA vascular flow void. CTA may be considered for further evaluation.3. Abnormal enhancement extends into the left skull base, occipital condyles, and C1 vertebrae. This includes involvement of the left skull base neuroforamina as described above and probably contributing to patient's cranial nerve palsies. These osseous changes appear grossly similar to prior from 9/22/2015. Finding may represent posttreatment change although residual tumor cannot be excluded.4. No definite lymphadenopathy is identified, however evaluation of the lower neck is significantly limited by motion artifact.


Instruction: Generate impression based on findings.

Input: 64-year-old male with history of gallstone pancreatitis and pseudocyst. ABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy. Mild central intrahepatic and extrahepatic biliary ductal dilation. The common bile duct measures up to 18 mm in diameter with smooth tapering near the pancreatic head with no evidence of abnormal filling defect or stone. The hepatic vasculature is patent.SPLEEN: Chronically thrombosed splenic vein.PANCREAS: Dilated pancreatic duct with multiple blown out side branches. Other cystic foci without clear communication to main duct likely also represent dilated side branches, however small IPMN without suspicious features cannot be entirely excluded. No evidence of pancreas divisum.Pancreatic exocrine function is moderately reduced.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Mild cardiomegaly.

Output: Findings compatible with chronic pancreatitis with a dilated pancreatic duct with blown out sidebranches vs. small IPMN. No evidence of active inflammation. Moderately reduced pancreatic exocrine function.


Instruction: Generate impression based on findings.

Input: There is herniation of a portion of right medial orbitofrontal gyrus measuring up to 9 mm in width into the right ethmoid air cells through a defect in the right anterior cranial fossa measuring 7 mm. There is mild scattered paranasal sinus mucosal There are multiple prominent arachnoid granulation in the bilateral greater sphenoid wings. There is ptosis of the bilateral lacrimal glands.

Output: Subcentimeter right anterior cranial fossa encephalocele.


Instruction: Generate impression based on findings.

Input: Severe neck stiffness (less than 20 degrees in any direction x1 month). History of Hepatocellular carcinoma. There is an enhancing lesion in the dens and a portion of the C2 body anteriorly. There is diffuse heterogeneous bone marrow signal from C3 through C7 with endplate irregularities and small disc-osteophyte complexes that appear to mildly indent the spinal cord. The vertebral body heights appear to be grossly preserved, however. There is no evidence of significant lymphadenopathy in the neck. The salivary glands are unremarkable. There is a T1 and T2 hyperintense nodule in the left thyroid gland that measures up to 7 mm. There are T1 hyperintense secretions in the right sphenoid sinus. There is a small amount of fluid in the left mastoid air cells. The imaged portions of the intracranial structures and orbits are unremarkable.

Output: 1. A lesion in the dens and a portion of the C2 body anteriorly likely represents metastatic disease. 2. Diffuse heterogeneous bone marrow signal from C3 through C7 is likely degenerative in nature, with endplate irregularities and small disc-osteophyte complexes that appear to mildly indent the spinal cord. 3. A small nodule in the left thyroid gland likely represents a colloid cyst.


Instruction: Generate impression based on findings.

Input: 72-year-old male with history of lymphoma left greater trochanter lesion. There is an enhancing, low T1, high T2 signal lesion within the proximal left femur involving the entire femoral neck and intertrochanteric femur with intramedullary tunneling inferiorly into the proximal femoral diaphysis, extending off the field-of-view inferiorly. There is cortical irregularity and thinning proximally with associated circumferential soft tissue mass, which also extends off the field-of-view inferiorly. The findings are highly suspicious for lymphoma, given the patient's history.

Output: Left proximal femur lesion highly suspicious for lymphoma, given the patient's history. Additional differential considerations include metastasis and osteomyelitis. The lesion extends inferiorly off the field-of-view on the current exam, and MRI of the femur can be performed for full extent of the lesion, as clinically indicated.


Instruction: Generate impression based on findings.

Input: 57-year-old man with history of alcohol use and hyperbilirubinemia, please evaluate for biliary obstruction. ABDOMEN:LIVER, BILIARY TRACT: The liver is enlarged measuring approximately 23.5 cm in length. No suspicious focal hepatic lesion identified.No gross intra or extrahepatic biliary ductal dilatation. Small amount of pericholecystic fluid nonspecific in the setting of ascites. The gallbladder is distended.SPLEEN: No significant abnormality noted.PANCREAS: The pancreas appears atrophic. There is no gross pancreatic ductal dilatation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: The right kidney appears normal. Left kidney not present.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Moderate amount of ascites, slightly decreased from prior.

Output: 1.Markedly limited evaluation due to patient's inability to tolerate the study.2.No gross biliary ductal dilatation.3.Hepatomegaly with ascites.


Instruction: Generate impression based on findings.

Input: Seizures, behavior disorder. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is diffuse paranasal sinus mucosal thickening and secretions. There is also a small amount of fluid signal in the left mastoid air cells.

Output: 1. No seizure focus identified.2. Extensive paranasal sinus inflammatory changes.3. A small amount of fluid signal in the left mastoid air cells may represent mastoiditis in the appropriate clinical setting.


Instruction: Generate impression based on findings.

Input: Systemic lupus erythematosus and neuromyelitis optica on research treatment protocol. Evaluation for progressive multifocal leukoencephalopathy is requested. There are numerous T2 hyperintense lesions in the cerebral white matter. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Multiple nonspecific cerebral white matter lesions, but no particular findings to suggest progressive multifocal leukoencephalopathy.


Instruction: Generate impression based on findings.

Input: Male, 29 years old. Evaluate glenoid labrum. History of recurrent left shoulder dislocation. ROTATOR CUFF: The tendons of the supraspinatus, infraspinatus, subscapularis and teres minor appear intact.SUPRASPINATUS OUTLET: The AC joint is normal. There is no fluid in the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is increased signal intensity within the anterior inferior labrum with ill-defined margins and medialization along the anterior inferior aspect of the glenoid. This is compatible with labral degeneration/tearing and an ALPSA-type lesion. There is also irregularity of the margin of the anterior superior labrum which represents additional degeneration/fraying. Gadolinium separates the superior labrum from the underlying glenoid. While the margins of the superior labrum are well-defined, the gadolinium-filled gap is slightly wider and extends slightly more posteriorly than a typical normal variant sublabral recess, and therefore may represent a SLAP tear. There is minimal posterior translation of the humeral head in relation to the central glenoid. The articular cartilage appears intact. There is flattening of the posterior aspect of the humeral head indicating a Hill-Sachs deformity.BICEPS TENDON: Tendon of the long head of the biceps appears intact. ADDITIONAL

Output: 1. Anterior inferior labral degeneration/tear with medialization of the labrum suggestive of an ALPSA-type lesion. 2. Degeneration of the anterior superior labrum and what we suspect is a SLAP tear.3. Hill-Sachs deformity and other findings as above.


Instruction: Generate impression based on findings.

Input: 35-year-old male with right-sided weakness, history of potential multiple sclerosis Redemonstrated are numerous T2 hyperintense lesions within the supratentorial and infratentorial brain, many of which demonstrate an ovoid shape, are perpendicular to the callosal-septal interface, and are confluent in several locations. Several lesions with low T1 signal are again noted. Unlike previously, none demonstrate enhancement, and there are no definite new discrete lesions. No evidence of acute ischemia or hemorrhage. No intracranial mass or mass effect. No hydrocephalus. No extra-axial collections. There is volume loss, particularly involving the corpus callosum. Major flow-voids are preserved. Sella and orbits are grossly within normal limits. Mucous retention cysts are again seen within the maxillary sinuses. Paranasal sinuses and mastoid cells are otherwise clear.

Output: Redemonstrated are numerous T2 hyperintense lesions within the supratentorial and infratentorial brain, many of which demonstrate an ovoid shape, are perpendicular to the callosal-septal interface, and are confluent in several locations. Several lesions with low T1 signal are again noted. Unlike previously, none demonstrate enhancement, and there are no definite new discrete lesions. The constellation of these features are suggestive of demyelination (e.g. multiple sclerosis) in the correct clinical context.


Instruction: Generate impression based on findings.

Input: 67 year old with history of left mastectomy for ILC. Dense breasts, and prior mammographically occult cancer. Patient is on Arimidex. There is heterogeneous amount of fibroglandular tissue in right breast. The patient is status post left mastectomy. Mild parenchymal enhancement is noted in the right breast.No abnormal enhancement is seen in the right breast or left chest wall. No abnormal lymph nodes are identified in either axillary region. Stable high signal lesions on T2 weighted sequence in left lobe of liver most likely representing liver cysts or hemangiomas are stable dating back to 5/29/2013 (outside hospital MRI)

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


Instruction: Generate impression based on findings.

Input: 76 years Female (DOB:7/11/1939)Reason: eval for vascular malformation History: eval for vascular abnormalityPROVIDER/ATTENDING NAME: JOSHUA D MOSS JOSHUA D MOSS MRI of the brainThe focus of questionable enhancement along the ependymal and intraventricular focus in the trigone of the left lateral ventricle contains the left lateral atrial vein extending into the vein of Galen as well as a portion of the left choroid plexus.A small amount of blood layers in the occipital horn of the left lateral ventricle.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is fenestration of the right A2 segment.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. The posterior communicating arteries are not readily identified. The vertebral arteries are similar in size. There is extracranial origin the left posterior inferior cerebellar artery.

Output: 1.The parenchymal lesion at the anterior aspect of the trigone of the left lateral ventricle appears to represent a confluence of the draining vein and choroid plexus. 2.No evidence for cerebrovascular occlusive disease.3.No evidence for intracranial aneurysm or arteriovenous malformation.4.A small amount of blood layers in the occipital horn of the left lateral ventricle. This was also identified in the recent CT exam.


Instruction: Generate impression based on findings.

Input: Diagnosis: Other specified endocrine disorders. Lack of coordinationClinical question: drive fiesta sequences recommendedSigns and Symptoms: ataxia. Extraaxial lesion Rt pinealComments: drive fiesta sequences recommended | The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a 16 x 11 mm cystic appearing lesion present in the pineal region. It follows spinal fluid on most pulse sequences on the FLAIR MRI and is slightly hyperintense relative to CSF. It does not demonstrate any diffusion restriction. It displaces the vein of Galen and the right basal vein of Rosenthal.. It mildly impresses upon the posterior aspect of the right tectal plate and thalamus. It does not enhance following gadolinium administration. It appears to have multiple compartments.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 demonstrate a 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.

Output: There is a multiloculated cystic lesion present within the pineal region. It is greater than 1 cm in size and mildly impresses on the right half of the tectal plate and thalamus. Although most of such lesions are generally benign, the possibility that this represents a cystic neoplasm cannot be excluded as a result follow up the exams are suggested.


Instruction: Generate impression based on findings.

Input: Female 68 years old Reason: medullary thyroid CA with mets to liver on clinical trial XL184/cabozantinib trial (IRB16-360), here for f/u (began 2/15/2011).Compare to previous scans History: medullary thyroid CA with mets to liver on clinical trial XL184/cabozantinib trial (IRB16-360), here for f/u (began 2/15/2011).Compare to previous scans ABDOMEN:LIVER, BILIARY TRACT: Again noted are multiple hepatic metastases lesions. Right posterior segment peripheral lesion measures 12 x 12 mm on image #11, series #5, slightly increased in size.More inferior posterior segment lesion measures 11 x 9 mm on image #14, series #5, slightly increased in size compared to previous study.Most inferior index lesion measures 12 x 12 mm on image #19, series #5, grossly unchanged compared to previous study.Anterior segment lesion measures 14 x 10 mm on image #17, series #5, slightly increased in size compared to previous study.There is diffuse low signal in MRI likely secondary to interposition.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Enhancing right L2 vertebral body lesion is unchanged. Its best seen on image #160, series #14. Enhancing left T12 pedicle lesion on image #137, series #14 is slightly increased in size compared to previous study.OTHER: No significant abnormality noted.

Output: 1.Slight interval increase in the size of the most of the hepatic metastases and left T12 pedicle lesion.


Instruction: Generate impression based on findings.

Input: 43-year-old male with left shoulder pain and weakness. Evaluate for rotator cuff tear. ROTATOR CUFF: There is thickening and increased signal abnormality within the supraspinatus tendon consistent with moderate tendinosis. No full-thickness or near full-thickness tear is evident. There is interstitial tearing of the infraspinatus tendon. The supraspinatus and infraspinatus muscles appear intact. The subscapularis and teres minor muscle and tendon appear intact.SUPRASPINATUS OUTLET: Note is made of an os acromiale.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is a small glenohumeral joint effusion. Note is made of low signal abnormality within the fluid within the glenohumeral joint (image 12; series 4). There is fragmentation of the superior posterior glenoid labrum which is suspicious for degenerative labral tearing.BICEPS TENDON: There is a large amount of fluid within the tendon sheath of the long head of the biceps tendon. There is associated low signal intensity abnormality identified within the aforementioned fluid along the long head of the biceps tendon (image 10; series 4). ADDITIONAL

Output: 1. Findings suspicious for synovitis of the glenohumeral joint with associated tenosynovitis of the long head of the biceps tendon. 2. Interstitial tearing of the rotator cuff without evidence of near full-thickness or full-thickness rotator cuff tear.3. Os acromiale. 4. Fragmentation of the superior posterior glenoid labrum which is suspicious for degenerative labral tearing.


Instruction: Generate impression based on findings.

Input: Female, 65 years old, with compression fracture noted on x-rays. Planning examination for kyphoplasty. Thoracic:A compression deformity of the T6 vertebral body is seen with up to 60% loss of height centrally. No significant retropulsion is detected. A compression deformity of the T12 vertebral body is also seen with up to 50% loss of height centrally and mild retropulsion into the left ventral epidural space. Both vertebrae are edematous and both demonstrate heterogeneous marrow enhancement. However, the retropulsed material at T12 does not enhance.An 8 x 5 mm enhancing extramedullary dural based mass is seen within the left ventral thecal sac at T10. This lesion exerts mild mass effect upon the spinal cord but does not produce a significant generalized stenosis. No significant abnormality of the adjacent vertebral body is seen. No other enhancing lesions are detected. The spinal cord demonstrates normal signal intensity throughout.A slight exaggeration of the thoracic kyphosis is seen. Multiple midthoracic vertebrae show mild anterior wedging and generalized reduction in height. The intervertebral discs are preserved. With the exception of the T10 and T12 levels, no other significant compromise of the spinal canal or neural foramina is detected.Pleural effusions are seen, left side greater than right. It also appears that the left upper lobe is atelectatic with a masslike process at the hilum.Lumbar:An expansile enhancing lesion is evident centered on the L3 spinous process and laminae. A round enhancing lesion is seen within the left sacrum, and a large masslike, centrally necrotic process is partially visualized in the left iliac bone. Edema and enhancement of the right L4-5 facet complex is favored to be inflammatory in nature. Vague edema and enhancement within the posterior L1 and L2 vertebral bodies is nonspecific.Vertebral body heights are generally preserved allowing for mild endplate concavity at most levels. Facet arthropathy is seen at lower lumbar levels along with mild disc bulging. No significant spinal canal stenosis is observed. The right L5-S1 neural foramen is mildly narrowed.The visualized distal spinal cord, conus and nerve roots of cauda equina are within normal limits. No definite pathologic intrathecal enhancement is seen.The left adrenal gland is thickened concerning for the presence of a mass.

Output: 1.Enhancing osseous lesions within the posterior elements of L3, the left sacrum and the left iliac bone are highly concerning for metastatic deposits. Given this, the compression deformities at T6 and T12 are highly suspected to be pathologic in nature.2.An extramedullary intradural mass is seen within the left ventral thecal sac at T10. Given the above findings, this is concerning for an intradural metastasis, though theoretically this could also represent an incidental meningioma.3.Atelectasis of the left upper lobe and a left hilar mass are suspected. Bilateral pleural effusions are seen. In addition, the left adrenal gland is thickened. These findings should be assessed with dedicated CT imaging.4.The above findings were discussed with Dr. Kallepalli at 4:30 PM on 11/1/16.


Instruction: Generate impression based on findings.

Input: 63-year-old male with elevated PSA and 2 negative presents for evaluation of the prostate gland. PELVIS:PROSTATE:Prostate Size: 5.3 x 4.4 cmPeripheral Zone: The peripheral zone is heterogeneous in appearance. There is a focus in the mid gland posteriorly which demonstrates T2 hypointensity, corresponding low signal on ADC, and enhancement measuring 11 x 5 mm. Additionally, there is a small focus of hypointensity in the left mid gland anteriorly and centrally which measures approximately 12 x 5 mm with the aforementioned signal characteristics.Central Gland: Central gland is heterogeneous in appearance, consistent with benign prostatic hypertrophy.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: No evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Increased T2 signal in the right hamstring tendon consistent with tendinopathy. Degenerative changes about the visualized spine.

Output: 1.Two foci in the prostate gland suspicious for neoplasm as detailed above.2.Findings consistent with right hamstring tendinopathy.


Instruction: Generate impression based on findings.

Input: No evidence of any pathologic parenchymal or extra-axial enhancement is seen. No findings to suggest focal parenchymal edema or mass effect are observed. Ill-defined fairly confluent and symmetric periventricular white matter T2 hyperintensity has become slightly more conspicuous when compared to prior examinations compatible with radiation related changes. Numerous scattered foci of susceptibility are again seen with the largest number clustered in the left parietal-occipital junction and these are unchanged. No acute intracranial hemorrhage or any abnormal extra-axial fluid collections are observed. The ventricles are stable in size and morphology.

Output: No evidence of active or progressive intracranial metastatic disease.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 31-year-old male with L1 compression fracture There is normal lumbar lordosis. Multilevel superior and inferior endplate undulation with multiple Schmorl's nodes with sclerotic margins. Unusually large lucency of the L5 vertebral body with well defined margins extending from the intravertebral disk and associated with L5 superior endplate depression most likely representing a large Schmorl's node. Minimal anterior wedging of T12 and L1 vertebral bodies is noted. Otherwise the pedicles, lamina, facets, and posterior elements are intact without evidence of fracture or subluxation. At the level of the L5-S1 there degenerative disk disease with posterior disk bulge to the right of the midline causing moderate neuroforamina narrowing.Otherwise there is no significant neuroforaminal narrowing on the lumbar spine.The thecal sac and spinal cord are preserved with no evidence of spinal canal stenosis. The paraspinal and prevertebral soft tissues are unremarkable.

Output: 1.Findings compatible with Scheuermann's disease no acute fractures identified.2.L5-S1 degenerative disk disease with moderate right neuroforaminal narrowing.


Instruction: Generate impression based on findings.

Input: Female, 57 years old, with worsening mental status, known JC numerous infection/PML. Planning for JC treatment, requesting baseline MRI. Since the prior examination, ill-defined restricted diffusion and thickening have progressed in the left periatrial white matter. Abnormal restricted diffusion also appears more conspicuous along the left occipital and temporal horns, within the splenium of the corpus callosum, and along the right occipital and temporal horns. Corresponding T2 signal abnormality is also seen.Scattered areas of subcortical T2 hyperintensity in both cerebral hemispheres are redemonstrated showing no significant interval change over multiple prior exams. A small area of encephalomalacia is also unchanged in the left frontal lobe. No abnormal fluid collections are detected. The ventricles are not dilated and, in fact, appear slightly effaced by the periventricular process as described above.

Output: Restricted diffusion and mild thickening have progressed in the left periatrial white matter, as well as within the splenium of corpus callosum and along the bilateral occipital and temporal horns. Given the clinical history, the findings would be consistent with worsening PML.


Instruction: Generate impression based on findings.

Input: There is an abnormal appearance of the flow void within the distal right vertebral artery. Additionally, there is a small aneurysm focus of enhancement measuring 4 x 4 mm (series 24, image 70) at the bifurcation of the right middle cerebral artery.The olfactory groove and bulbs are symmetric without evidence of a mass or abnormal enhancement. No evidence of abnormal enhancement or a mass along the course of olfactory nerves bilaterally.There are no intracranial mass, mass effect, or midline shift. No evidence of intracranial hemorrhage or diffusion weighted abnormalities. No extra-axial fluid collections or subdural hematomas. Mild to moderate periventricular and subcortical white matter FLAIR/T2 signal abnormality consistent with chronic small vessel ischemic disease. The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. Small left maxillary retention cyst as well as two subcentimeter postinflammatory cysts in the nasopharynx. Otherwise, paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain.

Output: 1.There is an abnormal appearance of the flow void within the distal right vertebral artery.2.Small presumed 4 x 4 mm aneurysm at the bifurcation of right middle cerebral artery.3.Further evaluation with CTA of the head and neck is recommended further characterization of items 1 and 2.4.No evidence of mass along the olfactory groove, bulbs, or the expected location of the nerves as clinically questioned.Findings relayed to Susan Curtis, RN, telephonically at approximately 10:00 am on 2/20/2015.


Instruction: Generate impression based on findings.

Input: 71-year-old female with HCC status post TACE/RFA ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology with high T2 signal reticulation compatible with fibrosis.An ablation cavity in the left lobe of the liver, segment two, is present in the region of the previously identified suspicious lesion. T1 hyperintensity within the lesion is consistent with post-procedural blood product. No abnormal enhancement is present in or around the ablation cavity. No focal liver lesions are present.The vasculature is patent.The gallbladder is within normal limits. 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: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Unchanged superior endplate compression deformity of L5 and wedge compression deformity of L1 with focal kyphosis at L1 level.OTHER: Partially imaged mixed solid and cystic lesion (series 201, image 17) is presumed to be a portion of the large fibroid uterus seen on prior CT imaging.

Output: 1.Cirrhotic liver morphology with no evidence of residual tumor in or around the ablation cavity. No new suspicious lesions are evident.


Instruction: Generate impression based on findings.

Input: A 33 year old male with personal history of diabetes mellitus, hypertension and end stage renal disease on dialysis treatment. Now hospitalized with heart failure symptoms. An echocardiography study showed preserved systolic function with left ventricular hypertrophy. Referred to cardiac MRI for further evaluation. Left VentricleThe left ventricle is severely dilated with mildly reduced systolic function. The overall LV ejection fraction is 51%, the LV end diastolic volume index is 134 ml/m2 (normal range: 74+/-15), the LVEDV is 278 ml (normal range 142+/-34), the LV end systolic volume index is 66 ml/m2 (normal range 25+/-9), the LVESV is 137 ml (normal range 47+/-19). There is global left ventricular concentric hypertrophy maximal at basal antero-septum of 16mm. LV dysfunction is global. Native T1-mapping showed normal native times at base, mid and apical segments.Left AtriumThe left atrium is mildly enlarged (122ml). Right VentricleThe right ventricle is mildly dilated with normal systolic function. The overall RV ejection fraction is 66%, the RV end diastolic volume index is 114 ml/m2 (normal range 82+/-16), the RVEDV is 238 ml (normal range 142+/-31), the RV end systolic volume index is 38 ml/m2 (normal range 31+/-9), and the RVESV is 79 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 trace tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are drain normally into the right atrium. Dilated IVC. There is a catheter in the SVC.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThere is small pleural effusion on the left lung and trivial on the right lung. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is severely dilated with mildly reduced systolic function, the LVEF is 51%. There is global left ventricular concentric hypertrophy maximal at basal antero-septum of 16mm. Native T1-mapping showed normal native times at base, mid and apical segments, which does not suggest myocardial infiltration. Delayed enhancement imaging not performed due to ESRD.2. The left atrium is mildly enlarged. 3. The right ventricle is mildly dilated with normal systolic function, the RVEF is 66%. 4. There is mild mitral regurgitation.5. There is a catheter in the SVC.6. See extracardiac findings. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Male; 50 years old. Reason: 48M with h/o chronic pancreatitis and recurrent acute pancreatitis, s/p surgical cystogastrostomy by Dr. Roggin in 2010, followed by a pseudocyst. Now with concern for percutaneous fistula along midline incision History: Concern for fistula Lack of intravenous contrast limits sensitivity for solid organ pathology.ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesions. No biliary ductal dilation.SPLEEN: No significant abnormality noted.PANCREAS: Mild pancreatic atrophy with prominence of the main pancreatic duct and a few side branches seen, as well as slightly patchy T1 signal, suggestive of chronic pancreatitis. No focal pancreatic lesions.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: In the area of previously described soft tissue induration at the anterior midline on the recent CT, there is an 8 x 12 mm subcutaneous fluid collection (series 9/20) which likely communicates with a 12 x 33 mm fluid collection just beneath the anterior peritoneal surface (series 7/23). This latter fluid collection has a linear low T2 signal tract extending to the mid transverse colon (series 7/22). Overall, the findings are most suspicious for small enterocutaneous fistula with associated fluid collections involving the transverse colon and anterior abdominal wall.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Findings suspicious for small enterocutaneous fistula extending from the transverse colon to the anterior abdominal wall, though evaluation is limited without intravenous contrast. Findings could be confirmed with retrograde fistulography.


Instruction: Generate impression based on findings.

Input: 28 years, Male, Reason: 28 yo male with VHL and history of enhancing renal masses; measure for growth and new lesions History: 28 yo male with VHL and history of enhancing renal masses; measure for growth and new lesions. ABDOMEN:LUNGS: Small bilateral pleural effusions and basilar atelectasis.LIVER, BILIARY TRACT: Loss of signal on out of phase images suggest diffuse steatosis. No focal hepatic lesions.SPLEEN: Small splenule.PANCREAS: Multiple small pancreatic cysts are increased from the prior exam. No dilatation of the main pancreatic duct.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Well-circumscribed left upper pole enhancing lesion is increased in size measuring 2.9 x 2.7 cm (1401/242), previously 1.6 x 1.2 cm, and suspicious for renal cell carcinoma.. Multiple additional subcentimeter lesions are likely enhancing but too small to characterize.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS: MalePROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Left upper pole enhancing renal lesion is increased in size and suspicious for renal cell carcinoma. Additional subcentimeter lesions are also likely enhancing and suspicious for neoplasm but are too small to definitely characterize.2.Increased pancreatic cysts.


Instruction: Generate impression based on findings.

Input: There is a punctate focus of restricted diffusion and high T2 signal in the left corona radiata. There are also scattered punctate foci and confluent areas of T2 hyperintensity within the periventricular and subcortical white matter, right cerebellar hemisphere, as well as in the pons without restricted diffusion. In addition, there also appear to be scattered prominent perivascular spaces. There is linear and branching susceptibility effect in the right parietal lobe, which likely represent developmental venous anomaly. The ventricles and sulci are within normal limits. The basal cisterns are patent. There is no midline shift or mass effect. The major cerebral flow voids are intact. The midline structures and craniocervical junction are within normal limits. There are nasopharyngeal Tornwaldt and/or mucous retention cysts.

Output: A punctate focus of acute microvascular infarct in the left corona radiata. Other areas of white matter abnormality likely represent chronic small vessel ischemic disease and lacunar infarcts.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 14-year-old male with ulnar-sided elbow pain with throwing and a baseball catheter. Evaluate for ulnar collateral ligament tear. LIGAMENTS: There is a small amount of intra-articular contrast that surrounds and passes the sublime tubercle which may represent a small partial tear of the ulnar collateral ligament. No dominant " T sign" is identified to suggest complete rupture of the ulnar collateral ligament.TENDONS: No significant abnormality noted.ARTICULAR SURFACES AND BONE: No bone marrow signal abnormality is identified. The articular cartilage is within normal limits. SURROUNDING STRUCTURES: No significant abnormality noted.ADDITIONAL

Output: Findings suspicious for a small partial tear of the ulnar collateral ligament as described above.


Instruction: Generate impression based on findings.

Input: 73-year-old male with urinary retention. Evaluate for cord compression. There is normal lordotic curvature to the cervical spine. There is diffuse T1 dark signal indicating marrow replacement most likely from a history of myelomatous disease. There is no vertebral body height loss in the cervical spine. There are multilevel degenerative changes including variable disc height loss most prominently involving the C6-7 level. There are also multilevel mild disc osteophyte complexes involving the C3-4 through C7-T1 levels. There is no discrete cord signal abnormality or evidence of cord compression in the cervical spine.There is normal kyphotic curvature of the thoracic spine. There is diffuse T1 dark signal indicating marrow replacement most likely from a history of myelomatous disease. There are compression fractures involving the T7, T8, T9 and T11 vertebral bodies but without retropulsion. The vertebral body fracture at the T11 level has approximately 50-75% height loss. The vertebral body fracture at the T7 and T9 levels level have approximately 25-50% % height loss. The vertebral body fractures at the T8 levels have approximately 10 to 25% height loss. There are mild disc bulges at the T7-8 and T9-T10 through T11-12 levels but no spinal canal compromise. There is no discrete cord signal abnormality or evidence of cord compression within the thoracic spine. In the lumbar spine there is diffuse T1 dark signal indicating marrow replacement most likely from a history of myelomatous disease. There are multilevel degenerative changes and grade 1 anterolisthesis of L4 on L5. The remainder of the lumbar spine has lordotic curvature. There is approximately 25-50% vertebral body height loss compression fracture involving the L2 vertebral vertebral body. There is no evidence of retropulsion of the fracture fragments. There is variable disc height loss involving the lumbar spine, most prominent at the L2-3, L4-5 and L5-S1 levels. Epidural thickening is evident beginning at the L1 level and continuing down to L5 which results in significant spinal canal narrowing most notable from L2 through L4.

Output: 1.Due to the screening nature of this protocol details are not as evident on imaging as dedicated protocols of the spine.2.Severe spinal canal stenosis in the lumbar region due to circumferential epidural soft tissue with some contribution from adjacent degenerative change. 3.Please see the dedicated pre and post-contrast lumbar spine MRI which has seen become available for further details.


Instruction: Generate impression based on findings.

Input: Female, 53 years old, with a posterior fossa meningioma. Findings related to prior left suboccipital craniotomy are redemonstrated with stable left cerebellar encephalomalacia. Findings are also redemonstrated status post left temporal craniotomy with encephalomalacia in the left anterior temporal lobe.An enhancing mass is redemonstrated centered on the left petro-clival ligament. As before, the lesion invades the left cavernous sinus and Meckel's cave with extension into the prepontine cistern and left middle cranial fossa. There has been interval increase in size of the lesion, specifically extending further posteriorly causing increasing deformation of the leftward pons (best seen series 1401 image 10/30 and series 1501 image 15/33). The remaining boundaries of the lesion appear unchanged.A right frontal approach ventricular shunt catheter is in stable position. The ventricular system is normal in size. Mild diffuse dural enhancement is seen which may be secondary to prior surgery or shunting. No new intracranial lesions are seen. Mild scattered white matter T2 hyperintense foci are nonspecific and unchanged. No evidence of significant intracranial hemorrhage is detected.

Output: The patient's left petroclival meningioma demonstrates interval increase in size, specifically extending further posteriorly causing increasing deformation of the leftward pons (best seen series 1401 image 10/30 and series 1501 image 15/33). The remaining boundaries of the lesion appear unchanged.


Instruction: Generate impression based on findings.

Input: Female 48 years old Reason: Dilated biliary duct, evaluate for obstruction LUNG BASES: Cardiomegaly.ABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis. Mild intrahepatic duct dilatation. The common bile duct is dilated measuring 1.2 cm in transverse dimension. This continues to the to the ampulla. No filling defect identified however the possibility of distal CBD or ampullary benign stricture cannot be excluded. Small T2 hyperintensity in the inferior right hepatic lobe is too small to characterize but may represent cyst.SPLEEN: No significant abnormality noted.PANCREAS: Irregularity of the pancreatic duct with alternating areas of dilatation and stricturing with more normal appearance of the duct in the pancreatic head. The largest area of stricturing measures approximately 1.8 cm in length. The duct measures approximately 6 mm in transverse dimension. There is loss of the normal intrinsic T1 signal throughout the pancreas which is also hypoenhancing. There is marked atrophy of the head, uncinate process and body. No mass is identified. Overall the appearance is suggestive of chronic pancreatitis with multifocal pancreatic duct stricturing.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1.Stricturing of the pancreatic duct with background pancreatic parenchymal atrophy. The findings are suggestive of chronic pancreatitis.2.Cholelithiasis with dilatation of the common bile duct to the ampulla. No filling defect identified within the common duct however the possibility of benign distal CBD stricture cannot be excluded.


Instruction: Generate impression based on findings.

Input: Reason: patient with b/l knee ulcerations and zygomycetes infection. Eval for extension of infection History: above There are ulcerations affecting the soft tissues of the knee. The largest is situated just below the patella with nonenhancing near-fluid-signal-intensity extending to the inferior pole of the patella disrupting the attachment of the patellar tendon indicating a complete or near complete tear. The patella itself is slightly high riding and there is undulation of the distal quadriceps tendon. There also may be a small erosion along the inferior margin of the patella with edema within the adjacent bone, concerning for osteomyelitis. There is a thin elongated rim-enhancing collection superficial to the medial retinacular structures measuring 3.3 x 0.7 x 3.1 cm, which could represent a small abscess. This may communicate with the aforementioned large anterior ulceration, but this is equivocal. There is extensive edema within the subcutaneous fat, some of which becomes confluent. There is a moderate-sized joint effusion with thickened and enhancing synovium. This may also communicate with the aforementioned large anterior ulceration, but this is equivocal. Nonetheless, this is concerning for septic arthritis. We see no erosions within the femur or tibia. While this study was not protocoled for detailed evaluation of the articular cartilage, we see no definite articular cartilage defects. The cruciate and collateral ligaments appear intact.

Output: 1. Large anterior soft tissue ulceration associated with disruption of the proximal patellar tendon and joint effusion as well as a thin elongated rim-enhancing fluid collection along the medial retinacular structures which may communicate with this ulceration but this is equivocal.2. Edema within the patella with possible focal erosion of the inferior pole of the patella which is concerning for osteomyelitis.These findings were discussed with Dr. Bacaloa, by phone at 1:15 PM on 2/17/2016.


Instruction: Generate impression based on findings.

Input: 21-year-old female with right knee injury 6 months ago, persistent pain, both medial and lateral. MENISCI: The medial and lateral meniscus appear normal.ARTICULAR CARTILAGE AND BONE: The articular cartilage and bone marrow signal intensity appear normal.LIGAMENTS: There is intermediate signal intensity throughout the course of the anterior cruciate ligament with the contiguous fibers not visualized very well. Additionally the posterior cruciate ligament seems somewhat buckled in appearance. Findings are compatible with an anterior cruciate ligament tear. The collateral ligaments of the knee appear normal.EXTENSOR MECHANISM: The extensor mechanism appears normal.ADDITIONAL

Output: Findings are compatible with an anterior cruciate ligament tear as described above.


Instruction: Generate impression based on findings.

Input: There is minimal anterolisthesis of L4 on L5 and mild retrolisthesis of L5 on S1. The vertebral body heights are well-maintained. There is mild loss of disc height at L3-L4 and moderate loss of disc height at L4-L5 and L5-S1. There are Schmorl's nodes at the inferior endplate of L3 and L4. There are endplate degenerative changes at L5-S1. No worrisome focal marrow signal abnormality is appreciated. The distal spinal cord and conus are within normal limits with the conus terminating at the L1 level. T12-L1: No significant disc bulge, spinal canal or foraminal stenosis.L1-L2: Mild bilateral facet degeneration. No significant disc bulge, herniation, spinal canal or foraminal stenosis. L2-L3: Mild disc bulge, mild bilateral facet degeneration and thickening of the ligamentum flavum. No significant spinal canal or foraminal stenosis.L3-L4: Slightly progressed disc bulge, moderate bilateral facet degeneration and thickening of the ligamentum flavum, contributing to minimal bilateral foraminal stenosis. No significant spinal canal stenosis. L4-L5: Disc bulge, advanced bilateral facet degeneration and thickening of the ligamentum flavum, contributing to mild left relatively worse in right foraminal stenosis. No significant spinal canal stenosis. L5-S1: Generalized disc bulge with interval decrease in size of previously seen central disc herniation. Loss of disc height is progressed since 12/15/2011. Advanced bilateral facet arthropathy. There is effacement of the lateral recesses and mild central canal stenosis. There is mild bilateral foraminal stenosis, left worse in right.

Output: 1. No high-grade neural foraminal stenosis or central canal stenosis is seen at any level. 2. Compared to 12/15/2011, there is interval decrease in size of previously seen herniated disk at L5-S1. There is mild bilateral L5-S1 neural foraminal stenosis, left relatively worse than right, as well as effacement of the lateral recesses with contact of the descending S1 nerve roots. 3. Moderate degenerative disc disease at L4-L5 and mild degenerative disc disease at L3-L4 levels also present as described above. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.