Instruction: Generate impression based on findings.

Input: Known left breast IDC post neoadjuvant chemotherapy presents for triple wire needle localization On review of the prior studies, significant reduction in size of the known mass in the left upper-outer quadrant is noted. A clip is identified along the posterior aspect of the mass. A vague band like focal asymmetry is located anterior and posterior to the clip. Recent MRI dated 9/22/2015 demonstrated area of non mass enhancement anterior and posterior to the clip spanning approximately 5.9 x 3.7 x 2.5 cm. Plan is to perform a triple wire needle localization targeting the posteriormost extent of focal asymmetry, the clip in the midportion and the anteriormost extent of the focal asymmetry. The procedure, risks including bleeding, mistargeting and infection, and benefits of triple needle-wire localization were discussed with the patient. Questions were answered. Consent was obtained both verbally and in writing. The time out form was completed to confirm patient identity and site of procedure. The left breast was placed in an alphanumeric grid using lateral to medial approach. When the target was positioned in the aperture of the grid, the skin was cleansed with chlorhexidine. Local anesthesia was obtained using 2% Lidocaine. Using coordinates from the grid, a 9 cm Kopans needle was placed posterior most extent of the focal asymmetry, 7 cm Kopans needle was placed at the clip in the midportion, and a 9 cm Kopans needle was placed at the anterior most extent of the focal asymmetry. On orthogonal mammography, adequate positioning of the needles was confirmed after adjusting depth so the needle tip was approximately 2cm deep to the center of the targets. The spring wires were deployed. Repeat two view orthogonal mammograms reveal the spring wires to be in excellent position. The mammogram was annotated and reviewed with Dr. Jaskowiak prior to the patient's procedure. Patient tolerated the procedure well and was sent to the holding area in stable condition. Dr. Kulkarni performed the procedure and was present during the procedure at all times.Orthogonal digital specimen radiographs revealed the 3 wires, one clip, focal asymmetry to be within the specimen.

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


Instruction: Generate impression based on findings.

Input: 69 year-old female with a history of metastatic renal cancer, assess for recurrence. ABDOMEN:LIVER, BILIARY TRACT: Multiple T2 hyperintense hepatic lesions unchanged on multiple prior studies dating back to 11/29/2012, may represent cavernous hemangiomas. No intrahepatic or extrahepatic duct dilation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Status post left adrenalectomy. The right adrenal gland is normal.KIDNEYS, URETERS: Status post left nephrectomy. No residual soft tissue signal is seen in the nephrectomy bed.Status post multiple partial right nephrectomies. Septated thick walled cystic lesion in the inferior pole of the right kidney measures 1.4 x 1.1 cm (image 12; series 41) and appears similar to the prior study. This lesion is thought to represent postsurgical changes given relative stability.Additional simple cysts are seen within the right kidney.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: No significant interval change in the reference complex cystic inferior pole right kidney lesion, which likely represents postsurgical changes given stability.


Instruction: Generate impression based on findings.

Input: 38 year-old female with history of breast cancer. ABDOMEN:LIVER, BILIARY TRACT: There is a T2 hyperintense lesion within segment 2 measuring 17 x 14 mm without contrast enhancement. There are several other subcentimeter cystic lesions with similar imaging characteristics noted throughout the liver parenchyma. No enhancing lesions are identified. No intrahepatic 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: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Multiple bilobar hepatic lesions with imaging characteristics of benign cysts. No suspicious hepatic lesions.


Instruction: Generate impression based on findings.

Input: 64-year-old female with diarrhea, nausea, vomiting and abdominal pain. History of see differential colitis with abnormal guaiac two days ago. Evaluate for colitis. Previous history of multiple myeloma. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Hepatic hypodensities in the right lobe at axial image 31/162 and 38/162 were present in 2005 and most likely represent benign cysts. However, the lesion at image 31/162 has a larger size and may be better characterized for staging, if needed, with dedicated CT or MRI. This lesion now measures 12 mm in diameter. SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Multiple bilateral renal cortical hypodensities are present compatible with simple cysts. These are stable since 2005. Punctate calcifications in the renal pelves are most likely vascular. No hydronephrosis or hydroureter.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Focal right eighth anterior rib expansion at axial image 38/162 is stable since 2005 and most likely represents changes of multiple myeloma.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXAE: Status post hysterectomy.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: There is a 4-cm segment of thickened narrowed sigmoid colon at axial image 107/162 with sharp zones of transition has appearance consistent with colon cancer. The remainder of the colon wall thickness and lumen diameter are normal.BONES, SOFT TISSUES: Degenerative changes in the lumbosacral spine and pelvis. Multiple stable lesions in the pelvis and hip compatible with history of multiple myeloma. These are stable since 2/5.OTHER: No significant abnormality noted

Output: 4 cm lesion in sigmoid with appearance suggesting colon cancer. Right hepatic lobe hypodensity was present in 2005, but appears larger. Bony changes compatible with stable multiple myeloma.


Instruction: Generate impression based on findings.

Input: Reason: anterolateral ankle pain after ankle sprain 2+ months ago. Is there and OCD, what is status of ATFL and CFL History: pain at night TENDONS: The Achilles tendon is intact. The peroneal tendons are intact. The extensor tendons are intact. There is a small amount of fluid surrounding the posterior tibialis, flexor digitorum longus and flexor hallucis longus tendons suggesting mild tenosynovitis.LIGAMENTS: The anterior talofibular ligament is not identified and likely torn. The posterior talofibular ligament, tibiofibular ligaments and calcaneofibular ligaments are intact.ARTICULAR SURFACES AND BONE: There is a os trigonum is noted. There is a small defect in the posterior lateral talus measuring 4 mm which likely represents a small osteochondral defect. ADDITIONAL

Output: 1.Small osteochondral defect along the posterior lateral talus.2.Grade 3 sprain of the anterior talofibular ligament.3.Thickening of the plantar fascia suggesting plantar fasciitis.4.Tenosynovitis of the flexor tendons.


Instruction: Generate impression based on findings.

Input: Diagnosis: Disturbance of skin sensationClinical question: please r/o stenosis or occlusive vessels and look for signs of strokeSigns and Symptoms: left facial weakness and slurred speech MRI of the brainScattered foci of diffusion restriction are present in the right post central gyrus and the right inferior parietal lobule. A couple punctate foci of diffusion restriction are present in the medial right parietal lobe and the centrum semiovale.A T2 and FLAIR signal hyperintense area is present in the right centrum semiovale associated with mild ex-vacuo effect on the adjacent lateral ventricle.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.There is signal loss in the right hemispheric cortical venous vasculature presentThe CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.A small focus of encephalomalacia is present in the right cerebellar hemisphere.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal left vertebral artery, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is a high grade stenosis at the distal right ICA involving the ophthalmic segment and the communicating segment.There is occlusion of the right vertebral artery present. There is a stenosis at the intracranial left vertebral artery at the PICA origin.There is fetal origin of the left PCA with a small left p1 segment. The right PCOMA is small.The ACOMA is medium size. There is triplication of the ACA. The right A1 segment is very small.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. The posterior communicating arteries are intact. The vertebral arteries are similar in size.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries. The LVA has aortic arch origin. The RVA is very small and occluded distally.

Output: 1.High grade distal right ICA long segment stenosis with small right PCOMA and hypoplastic right A1 segment.2.Occlusion of the right vertebral artery with small left p1 segment and high grade stenosis at the intracranial LVA at the PICA origin.3.Acute foci of infarction in the right MCA territory.4.Chronic right sided watershed distribution infarctions and ischemic changes to the right MCA territory.5.Findings suggest hypoxia to the right MCA territory.6.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 7.Small right cerebellar chronic stage infarction.


Instruction: Generate impression based on findings.

Input: 19-year-old male with sickle cell disease and persistent bilateral knee pain. Evaluate for avascular necrosis. RIGHT KNEE: MENISCI: The medial and lateral meniscus are intact and demonstrate normal signal intensity.ARTICULAR CARTILAGE AND BONE: No significant abnormality noted. Specifically the distal femur and proximal tibia/below demonstrate normal bone marrow signal intensity.LIGAMENTS: The cruciate and collateral ligaments are intact and demonstrate normal signal intensity appear.EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Normal MRI examination of the right and left knees. Specifically no evidence of avascular necrosis as clinically questioned..


Instruction: Generate impression based on findings.

Input: Dysphagia, unspecified [R13.10], Reason for Study: ^Reason: compare to mri in pax History: opsoclonus Redemonstration of bilateral symmetric FLAIR/T2 high signal intensity lesions on anterior aspect of medulla without evidence of restricted diffusion or susceptibility artifact, unchanged since prior scan.There is no evidence of acute ischemic or hemorrhagic lesion on the scan.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Bilateral symmetric anterior medullary high signal intensity lesions, unchanged in their extent and MR characteristics since prior scan.2. No evidence of acute ischemic or hemorrhagic lesion on the scan.


Instruction: Generate impression based on findings.

Input: weakness, malaise and fatigue No evidence of acute ischemic or hemorrhagic lesion.Multifocal high signal intensities on periventricular and brain stem white matter indicate non specific age indeterminate small vessel ischemic disease.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal proximal ICAs and vertebrobasilar system. However, distal intracranial arteries such as MCA M2 segments and PCA P2 and P3 segments appear to be a bit irregular but without evidence of significant luminal stenosis. These findings indicate possible intracranial atherosclerosis.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. Multifocal age indeterminate non specific small vessel ischemic disease.3. Evidence of mild intracranial atherosclerosis without large vessel occlusion or significant luminal stenosis.


Instruction: Generate impression based on findings.

Input: Metastatic esophageal cancer and left lower extremity weakness.. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mild diffuse cerebral volume loss. There is trace nonspecific periventricular white matter T2 hyperintensity. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, and scalp soft tissues are grossly unremarkable. There are mild secretions in the anterior left ethmoid sinus. There is a subcentimeter retention cyst in the right lateral nasopharyngeal recess. There are bilateral lens implants.Cervical Spine: There is fusion of the C3 through C6 vertebral body with loss of the usual kyphosis and bony projection into the spinal canal C3-4 and C5-6 with mild indentation of the spinal cord at C3-4. There are also disc-osteophyte complexes and prominent facet joint hypertrophy at C2-3, right greater than left, and at C7-T1. There is mild left C2-3, severe left C3-4, moderate left C4 though C6, severe right C2 though C6, and bilateral moderate C7-T1 neural foraminal stenosis. There are foci of high T2 signal in the grey matter bilaterally and associated mild volume loss in the spinal cord at the C5 level. However, there is no evidence of mass lesions in the cervical spine and the vertebral bone marrow appears unremarkable.

Output: 1. No evidence of intracranial metastases or acute infarction.2. Fusion of the C3 through C6 vertebral body, multilevel neural foraminal stenosis, moderate spinal canal stenosis at C3-4, and myelomalacia at C5, but no evidence of cervical spine metastases.


Instruction: Generate impression based on findings.

Input: 75-year-old man with history of pancreatic cyst. ABDOMEN:LIVER, BILIARY TRACT: The liver appears normal. There is no intrahepatic biliary duct dilatation. The gallbladder is normal.SPLEEN: Spleen appears normal.PANCREAS: A 12 x 12 T2 hyperintense lesion in the ventral body of the pancreas (series 701, image 23) is seen, does not enhance, and does not communicate with the pancreatic duct. Of note, this lesion is minimally increased in size from the CT in 1/2011. Additional, very small T2 hyperintense lesions are seen in the pancreatic neck and communicated with the pancreatic duct.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Simple cyst in the pancreatic body which does not communicate with the pancreatic duct but has minimally increased in size over 4 year interval.2.Small sidebranch IMPNs in the pancreatic neck.


Instruction: Generate impression based on findings.

Input: Chiari malformation, status post decompression, occipital neuralgia, hemangioblastoma, benign tumor of the pituitary: yearly followup. There are stable postoperative findings related to Chiari decompression and fourth ventricular stenting. The cerebellum displays an unchanged morphology and signal characteristics. There is cerebrospinal fluid flow across the foramen magnum and through the fourth ventricular stent. There is an unchanged 5 mm diameter T1 hyperintense nodule along the superior aspect of the pituitary gland. There are unchanged minimal nonspecific scattered punctate foci of T2 hyperintensity in the cerebral white matter. There is no evidence of intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits and paranasal sinuses are grossly unremarkable. There is no evidence of pseudomeningocele.

Output: 1. Stable postoperative findings related to Chiari decompression and fourth ventricular stenting with flow of cerebrospinal fluid across the foramen magnum and into the fourth ventricular stent.2. An unchanged 5 mm diameter T1 hyperintense nodule along the superior aspect of the pituitary gland likely represents a Rathke cleft cyst.


Instruction: Generate impression based on findings.

Input: Pancreatic cancer with elevated CA 19 9 status post chemoradiation therapy to periaortic lymph node. ABDOMEN:LIVER, BILIARY TRACT: Steatosis. The liver is normal in morphology and enhancement without a focal lesion biliary ductal dilatation or vascular abnormality. Postsurgical changes from Whipple procedure with hepaticojejunostomy without evidence of complication.SPLEEN: Normal splenic size without a focal lesion.PANCREAS: Postsurgical changes from Whipple procedure. No evidence of recurrent or residual disease in the surgical bed.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Dorsal to the infrarenal IVC is a 1.8 x 1.4 cm enhancing soft tissue nodule(series 17/251). Left periaortic 8 mm enhancing focus at the same level is also noted. These are new from the prior.Celiac axis lymph node measures 1.4 x 0.9 cm (series 17/207) compared to 1.4 x 1.0 cm previously.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Bone marrow signal intensity changes related to radiation. OTHER: No significant abnormality noted.

Output: Enhancing soft tissue nodules dorsal to the inferior IVC and in the left periaortic region are suspicious for new sites of tumor. This site appears to be just inferior to the radiation bed.The celiac axis lymph node is essentially unchanged.


Instruction: Generate impression based on findings.

Input: Female 28 years old with Crohn's ileitis seen on MRE 12/2015. Now on therapy for a year, evaluate for improvement. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in size, smooth in contour and without focal lesion. No intra or extrahepatic biliary ductal dilatation. The hepatic vasculature is patent.SPLEEN: No significant abnormality noted.PANCREAS: Pancreatic duct is nondilated. The parenchyma enhances homogeneously.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Best seen on coronal images is persistent, but improved, short segment mild mucosal enhancement of the terminal ilium (series 13, image 54) extending over a distance of 1.4 cm, unchanged in length when compared to the coronal images on prior exam. Also noted is unchanged associated luminal narrowing but no significant upstream dilatation to suggest flow-limiting obstruction at this level. No additional areas of abnormal enhancement or stricturing are seen. There is no abscess or fistulous tract within the abdomen or pelvis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Right adnexal rim-enhancing lesion is favored to represent a corpus luteum.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: As seen on the previous exam in the 9:00 position is an intersphincteric fistulous tract extending posteriorly to the right gluteal cleft with no evidence of associated abscess.BONES, SOFT TISSUES: Lumbar levoscoliosis.OTHER: No significant abnormality noted.

Output: 1.Persistent but improved mild short segment terminal ileal inflammatory changes with mild associated luminal narrowing, no upstream bowel dilatation seen to suggest flow-limiting stricture.2.Unchanged intersphincteric fistulous tract extending to the right gluteal cleft.


Instruction: Generate impression based on findings.

Input: Male, 69 years old. Bilateral knee pain, instability. ARTICULAR CARTILAGE AND BONE: There are large osteophytes at the medial, lateral, and patellofemoral compartments. There is marked medial joint space narrowing with complete loss of the articular cartilage. There is also significant lateral joint space narrowing with some residual thinned articular cartilage. The patellar cartilage is diffusely absent. There is bone marrow edema within the medial and lateral tibial plateaus.MENISCI: There is complete loss of the posterior horn of the medial meniscus and the anterior horn of the lateral meniscus, with irregular small blunted residual posterior horn of the lateral meniscus and anterior horn of the medial meniscus.LIGAMENTS: The ACL is not visualized, compatible with chronic tear. The PCL and collateral ligaments are unremarkable.EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1.Severe osteoarthritis with associated cartilage loss, bone marrow reactive changes, and significant meniscal degeneration as described above.2.Chronically torn ACL.


Instruction: Generate impression based on findings.

Input: Male, 43 years old, with numbness and tingling down the left arm. Suspected cervical radiculopathy at C5-6. Anterior instrumented spinal fusion has been performed from C5 through C7. Spinal alignment is mildly straightened. No worrisome marrow signal abnormality is detected. The visualized spinal cord demonstrates normal signal intensity and morphology. No detectable cord edema is noted.C2-3: Unremarkable. C3-4: Mild facet hypertrophy. No significant spinal canal or neuroforaminal stenosis. No interval changes. C4-5: Mild facet hypertrophy. Mild left neuroforaminal narrowing. No significant interval changes. C5-6: Postoperative findings. Left facet hypertrophy. Significant improvement in the previously seen disc osteophyte complex with superimposed left central/paracentral protrusion. There is no longer any significant spinal canal stenosis or frank cord impingement. Left neuroforaminal narrowing seen on the prior examination is also nearly completely resolved. C6-7: Facet hypertrophy. Improvement in prior disc osteophyte complex. No significant spinal canal stenosis. Moderate left foraminal narrowing without significant change. C7-T1: Facet hypertrophy. Otherwise unremarkable.

Output: 1.Postoperative findings compatible with anterior instrumented fusion from C5 through C7. 2.Disc osteophyte formation with associated canal stenosis and cord impingement at C5-6 is significantly improved. There is no longer any evidence of cord impingement and prior left foraminal narrowing at this level is also improved.3.Interval improvement in disc osteophyte formation at C6-7 as well with persistent moderate left foraminal narrowing.4.No significant abnormalities are detected at the remaining levels.


Instruction: Generate impression based on findings.

Input: Malignant neoplasm of brain, as described. Evaluate for growth of GBM, s/p reRT/Avastin/TMZ. Pt had initial marked radiographic response on Tx.. Again seen are postoperative findings related to right frontoparietal craniotomy with heterogeneously enhancing mass with areas of restricted diffusion involving the right frontal lobe, insula, basal ganglia, and temporal and parietal lobes, with extension across the corpus callosum. The heterogeneous enhancement surrounding the treated cavity overall remains unchanged compared to previous exam, for example irregular enhancing component in the anterior aspect of the tumor measures 20 mm, previously 20 mm. There is significant interval improvement in the extent of enhancement compared to 7/10/2015, compatible with Avastin effect. There is extensive T2/FLAIR hyperintensity surrounding the surrounding the resection cavity in the temporal and frontoparietal region, extending to involve the splenium and along the right corticospinal tract which is unchanged. No new mass or new mass effect. There is no midline shift or herniation. The orbits and paranasal sinuses are grossly unremarkable. The skull and scalp soft tissues are unchanged.

Output: No evidence of interval tumor progression, with no significant change in extent of FLAIR hyperintensity and enhancement surrounding the resection cavity compared to 9/9/2015. There is however significant decrease in the area of FLAIR hyperintensity and enhancement when compared to prior study from 7/10/2015 consistent with Avastin response.


Instruction: Generate impression based on findings.

Input: Right knee pain. Possible medial meniscus tear. MENISCI: The medial and lateral menisci are intact.ARTICULAR CARTILAGE AND BONE: The articular cartilage of all three compartments is intact. Bone marrow signal is within normal limits. LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1. Intact menisci and ligaments.2. Questionable loose body vs medial PLICA adjacent to the medial patellar facet.


Instruction: Generate impression based on findings.

Input: Reason: Recent gross hematuria with hx kidney transplant and low GFR. request MR Urogram History: As above ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral atrophic native kidneys with small cysts. Additional subcentimeter lesions within the native kidneys are too small to characterize.Right iliac fossa transplant. There is a cyst within the transplant kidney measuring up to 2.8 cm with small septations, similar to the prior CT. No hydronephrosis. Delayed images show normal opacification of the transplant pelvis and ureter. No associated fluid collections.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Right iliac fossa transplant with a minimally complex cyst which is unchanged in size. Otherwise, no hydronephrosis or other findings to account for patient's hematuria.


Instruction: Generate impression based on findings.

Input: Ms. Bednarek is a 56-year-old female status post palpably-guided partial mastectomy for grade 2 ILC in the left breast with multiple positive margins (per EMR, positive margins were present at the medial, posterior, inferior, and lateral margins). There is heterogeneous amount of fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.In the left upper outer breast, a T2 hyperintense fluid collection is identified measuring 6.0 x 4.8 cm (AP x SI), compatible with the provided history of a recent lumpectomy. The seroma cavity is associated with irregular peripheral enhancement with at least six discrete areas of nodular thickening. These areas of nodular thickening are present in the following locations: anteromedial superior margin, anterolateral superior margin, inferior central margin and posterior central margin.The thickest area of nodular enhancement is present in the anteromedial superior margin, measuring up to 1.0 cm. These areas of nodular enhancement are highly suspicious for residual disease (particularly given the history of positive margins), however, fat necrosis cannot entirely be excluded. Several foci of enhancement are seen in the right breast, none of which appear more suspicious than the rest. No abnormal axillary lymph nodes are identified in either axillary region.

Output: Postsurgical changes in the left upper outer breast with multiple discrete areas of focal nodular thickening around the seroma cavity, highly suspicious for residual disease. Recommend correlation with final pathology report along with surgical consultation for further management. BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: 82-year-old male with left frontal intracranial hemorrhage and intraventricular extension. Acute left frontal parenchymal hemorrhage is new with adjacent edema and mass effect. No definite underlying mass is seen, but if suspicion is high, further imaging evaluation with MRI may be obtained. Hemorrhage extends intraventricularly layering dependently within the posterior horns of the lateral ventricles. Scattered foci of periventricular and subcortical low attenuation likely represent small vessel ischemic disease of indeterminate age. Dystrophic cortical calcification is evident within the right posterior parietal lobe with adjacent low attenuation suggesting a prior ischemic event. This finding is unchanged. The ventricles are prominent and slightly asymmetric. Complete opacification of the frontal and ethmoid sinuses is unchanged. The visualized mastoid air cells appear well pneumatized. Calvarial bones are grossly unremarkable.

Output: No interval change.


Instruction: Generate impression based on findings.

Input: Metastatic NSCLC: left lower extremity weakness. There is a new peripherally enhancing mass in the right superior frontal gyrus that measures up to 30 mm and is surrounded by vasogenic edema. There is a small amount of susceptibility effect within the tumor, which may represent blood products. There is no evidence of acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is a new enhancing lesion in the midline occipital bone that measures up to 20 mm. The orbits, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is a small amount of fluid in the left mastoid air cells. However, there is an unchanged cystic lesion in the skin adjacent to the right eye, which may represent a hydrocystoma. There is also a nonspecific punctate nodule in the left preauricular skin.

Output: New metastases in the right superior frontal gyrus and occipital bone.


Instruction: Generate impression based on findings.

Input: Redemonstration of multifocal variable sized periventricular and deep white matter FLAIR high signal intensity lesions consistent with multiple sclerosis. There are couple new lesions seen including right posterior superior basal ganglia (series 701, image 45) and right upper pons (series 701, image 30) which appears to be extension of right cerebral peduncle lesion. However, current scans were obtained with a different technical parameters than prior (previously the scan was obtained with 5 mm thickness and 6 mm gap, but current scan is 2 mm thickness and 2 mm gap), thus these findings could be related to technical factors. On Gad enhanced scans, there is no evidence of abnormal enhancement. Focal tissue loss at the C1-2 junction area spinal cord with subtle increased signal intensity is again seen, unchanged.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The paranasal sinuses and mastoid air cells are clear.

Output: 1. A couple of new lesions seen including the left basal ganglia posterior superior aspect and right upper pons lesion. However, these lesions could be related to technical factors as described above.2. No evidence of abnormal enhancement.


Instruction: Generate impression based on findings.

Input: Male 19 years old Reason: eval for hip flexor tendon tear vs fai History: hip pain for weeks with crew and kicking BONE MARROW: No significant abnormality noted.SOFT TISSUES: No significant abnormality noted. JOINTS: No significant abnormality noted.ADDITIONAL

Output: Normal examination.


Instruction: Generate impression based on findings.

Input: Again seen is an infiltrating mass involving the hypothalamus extending into the optic chiasm, left greater than right. Mass measures approximately 17 x 20 x 13 mm and unchanged allowing for differences in measurement technique. Posteriorly mass abuts the mamillary bodies. Pituitary gland and infundibulum which are more inferior appear grossly unremarkable. Again noted is focal enlargement of the left prechiasmatic optic nerve likely reflecting tumor involvement, coronal STIR series 1201 images, and is adjacent to/contiguous with the larger mass more posterior superiorly. No findings to suggest interval enlargement or new enhancement.Images of the remainder of the brain again demonstrate patchy foci of T2 hyperintensity within the basal ganglia, thalami, cerebral peduncles, brainstem, cerebellum as well as within the left amygdala/medial temporal lobe where there is also mild expansion without enhancement. Again seen is a tiny linear focus of enhancement within the right precentral gyrus with susceptibility most likely representing an incidental small developmental venous anomaly or capillary telangiectasia. There is no evidence of acute infarct or hemorrhage. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1.Compared to 5/22/2015, there is no significant change in size of glioma involving the hypothalamus/optic chiasm and extending mildly to involve the left prechiasmatic optic nerve.2.Additional stigmata of NF 1 including numerous supratentorial and infratentorial foci of T2/FLAIR signal abnormality" are unchanged.3.The left medial temporal lobe/amygdala focus of signal abnormality with mild expansion also remains unchanged. Suggest attention on follow-up for possibility of an additional focus of glial neoplasm.


Instruction: Generate impression based on findings.

Input: Female 37 years old Reason: Brachytherapy planning History: Brachytherapy planning PELVIS:UTERUS, ADNEXA: Significant decrease in the size of the patient's known cervical mass which now measures 6.6 x 5.4 cm image #44, series #4 a 1. Again noted uterine and bilateral parametrial invasion.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Significant interval increase in the size of the patient's known cervical mass.


Instruction: Generate impression based on findings.

Input: 52 years Female (DOB:5/14/1963)Reason: History of metastatic renal cancer and MS. s/p SRS. Assess for progression (on bevacizumab) History: MS symptoms stablePROVIDER/ATTENDING NAME: WALTER M. STADLER WALTER M. STADLER There is a patchy focus of susceptibility effect present in the right parietal lobe associated with T2 and FLAIR signal hyperintensity. There is some punctate foci of contrast enhancement associated with this. Compared to the October exam there is less enhancement on the current exam versus the prior exam. There also appears to be more volume loss on the current versus the prior exam.There is a smaller focus of signal loss on susceptibility imaging associated with contrast enhancement and T2 and FLAIR signal hyperintensity located in the superior aspect of the left cerebellar hemisphere which was larger on the prior exam than on the current exam. This contrast enhancing focus currently measures approximately 4 mm and previously measured approximately 14 x 16 mm.The right cerebral peduncle is smaller than the left cerebral peduncle. There is T2 signal hyperintensity along the posterior limb of the right internal capsule tracking down into the right cerebral peduncle. This is stable compared to the prior exam. It likely represents Wallerian degeneration.There is a moderate degree of periventricular and subcortical confluent hyperintense white matter lesions present identified on the FLAIR and T2 images.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Since the prior exam lesions in the right parietal lobe and left cerebellar hemisphere have regressed2.There is a moderate degree of periventricular white matter lesions present which are long-standing.3.Findings suggest long standing wallerian degeneration.


Instruction: Generate impression based on findings.

Input: Lumbar radiculopathy. Evaluate for lumbar stenosis. There are 5 rib-less, lumbar-type vertebrae. The last well-formed disc is at L5-S1. Alignment is notable for straightening which may reflect patient position. The vertebral bodies are preserved in height. Focal signal abnormalities involving the T11 and T10 vertebral bodies, which contain fat are most compatible with hemangiomas. The marrow otherwise shows no suspicious lesion. There is mild loss of disc T2-signal and height at L3-L4 through L5-S1, associated with small posterior bulges as detailed below. The tip of the conus medullaris is at the upper L2 level. The conus medullaris and the included lower spinal cord show normal signal and morphology. The right kidney is laterally rotated. Subcentimeter T1-hypointense, T2-hyperintense lesions in the kidneys and liver may represent cysts but are not completely assessed on this examination. T12-L1, L1-L2 and L2-L3: There is no significant disc herniation. There is no spinal canal or foraminal stenosis. There is mild facet arthropathy.L3-L4: Minimal disc bulge is present along with mild ligamenta flava thickening and mild facet arthropathy. There is no significant spinal canal or foraminal stenosis.L4-L5: Mild disc bulge only flattens the ventral thecal sac. There is mild ligamenta flava thickening and mild-to-moderate facet arthropathy. There is mild-to-moderate left neural foraminal stenosis. There is no spinal canal or right foraminal stenosis.L5-S1: Minimal disc bulge is associated with moderate to severe, left worse than right facet arthropathy. There is also mild ligamenta flava thickening. There is no significant spinal canal stenosis. There is mild bilateral foraminal stenosis.

Output: 1.Mild lower lumbar degenerative spondylosis results in no significant spinal canal stenosis and only mild left L4-L5 and bilateral L5-S1 neural foraminal stenoses.2.Facet arthropathy is significant in the lower lumbar spine and might be contributing to back pain, especially the left L5-S1 facet.3.Subcentimetric liver and kidney lesions are not completely assessed but may represent cysts.


Instruction: Generate impression based on findings.

Input: Pain. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable, including a few scattered foci of focal fat. There are small posterior disc-osteophyte complexes at T7-8 and T8-9, without no significant spinal canal stenosis. Otherwise, there is no evidence of mass lesions or abnormal enhancement. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: Small posterior disc-osteophyte complexes at T7-8 and T8-9, without no significant spinal canal stenosis.


Instruction: Generate impression based on findings.

Input: Diagnosis: Cerebral infarction, unspecified Chronic kidney disease, stage 4 (severe)Clinical question: StrokeSigns and Symptoms: R hemiparesis, R hemisensory loss, neglect vs hemianopsiaComments: The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.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. There is medial deviation of the left lamina papyracea.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.There is no evidence for acute ischemic cerebral infarction.2.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: 66-year-old male with metastatic thyroid cancer to the liver. Compared to previous with measurements. ABDOMEN:LIVER, BILIARY TRACT: Normal morphology of the liver.In hepatic segment 8, the T2 hyperintense lesion measuring 1.1 x 1 cm (axial series 7 image 11) again demonstrates discontiguous nodular enhancement compatible with a benign hemangioma (prior 1.1 x 1.1 cm).In the hepatic dome/superior-lateral caudate lobe, the faintly T2 hyperintense, strongly T1 hyperintense lesion measuring 2.6 x 1.7 cm (axial series 9 image 20) (prior 2.1 x 1.8 cm) shows no definite intralesional enhancement on the postcontrast subtraction series (axial series 100 image 18). Mild restricted diffusion is noted on DWI series and remains suspicious for metastatic disease. In hepatic segment 6, the faintly T2 hyperintense T1 hypointense lesion is increased in size currently measuring 2.1 x 1.5 cm (axial series 9 image 43). The prior measurement was approximately 1.5 x 1 cm. The lesion demonstrates enhancement and washout.The gallbladder is partially distended with T1 hyperintense fluid, which could represent biliary sludge versus vicarious excretion of intravenous contrast from the same day CT head and chest exams with intravenous contrast.The T2 hyperintense foci scattered throughout the liver are again noted and too small to characterize, favor cysts.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: Trace upper abdominal ascites.BONES, SOFT TISSUES: Similar-appearing hyperintense focus of the T10 vertebral body again suggestive of a benign osseous hemangioma.The previously described curvilinear T2 hypointense signal of the bilateral femoral heads and the previously described T2 hyperintense lesion of the posterior left iliac wing are not well visualized.OTHER: Suspected nodules in the lung bases.

Output: 1.Enhancing lesion with washout in hepatic segment 6 has increased in size and again consistent with metastatic disease.2.The T1 hyperintense lesion in hepatic segment 1/caudate is stable in size, and no intralesional enhancement is appreciated on the postcontrast subtraction sequence. The intralesional restricted diffusion is again worrisome for a metastatic focus.3.Stable appearance of the segment 8 suspected hepatic hemangioma.4.Suspected nodules in the lung bases. Please refer to same day CT chest exam for further details.


Instruction: Generate impression based on findings.

Input: Ms. Hibbs is a 61 year old female with a personal history of left breast lumpectomy for breast cancer in 1997 followed by chemoradiation therapy. BRCA1 positive. Family history of breast cancer in sister and niece. There is scattered fibroglandular tissue in both breasts. Minimal parenchymal enhancement is noted bilaterally.Stable postsurgical changes are identified in the left lower breast, at site of prior lumpectomy. There is no abnormal enhancement seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.

Output: Stable postsurgical changes of the left breast. No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: 20 years Female (DOB:3/10/1996)Reason: Eval for demyelinating disease History: paresthesias, handsPROVIDER/ATTENDING NAME: ADIL JAVED SERVICES ANCILLARY The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal enhancing lesions are identified in the cervical spine.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: No abnormal lesions are appreciated within the cervical spinal cord. There is no significant compromise to the cervical spinal canal or exiting nerve roots.


Instruction: Generate impression based on findings.

Input: Urinary retention, lower back pain, new since Saturday No evidence of high-grade spinal canal stenosis in the cervical, thoracic, or lumbar spine. No evidence of cord compression. The vertebral bodies are appropriate in the overall alignment and height. No obvious cord signal abnormality.Mild degenerative changes are seen in the cervical spine without evidence of cord compression. Degenerative changes are noted at the L4-L5 and L5-S1 levels including disc height loss and mild to moderate bilateral neural foraminal stenosis, relatively worse at L5-S1. There is facet arthropathy at L4-L5 and L5-S1. There is mild to moderate spinal canal stenosis at the L4-L5 level. These findings can be better assessed with a dedicated lumbar spine MRI study.

Output: 1. This is a limited exam specific for the exclusion of cord compression only and does not exclude more subtle lesions such as intrinsic cord abnormalities. No cord compression or high-grade spinal canal stenosis in the cervical, thoracic, or lumbar spine is identified. Due to the screening nature of this protocol, details are not as evident on imaging as dedicated protocols of the spine.2. Mild to moderate degenerative changes in the lower lumbar spine as described above.


Instruction: Generate impression based on findings.

Input: 60-year-old female on heparin and eptifibatide drips with an INR of 2.1, presenting with headache. No evidence of intracranial hemorrhage, edema, mass, midline shift or hydrocephalus. Nonspecific small right frontal hypodensity. Left frontal hypodensity is likely post-traumatic change but very nonspecific. If further evaluation is clinically warranted, MRI is recommended for further characterization.The ventricles and basal cisterns are unremarkable in size and configuration.The calvaria and skull base are radiographically unremarkable. Visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. No evidence for acute intracranial hemorrhage.2. Left frontal hypodensity along the orbital gyrus is is nonspecific. Although location raises the question of trauma, additional considerations include edema due to other causes such as neoplasm or infarction. If further evaluation is clinically warranted, MRI is recommended for further characterization.


Instruction: Generate impression based on findings.

Input: GBM. There is redemonstration of postoperative changes from previous resection of the right anterior temporal lobe, a portion of the right insula, and right inferior frontal lobe. Overall, there is no significant interval change in appearance of the scattered areas of nodular enhancement along the lateral ventricular margins.Extent of surrounding T2/FLAIR hyperintensity along the cavity margins extending posteriorly remains unchanged, with ex vacuo dilatation of the right lateral ventricle. Ill-defined T2/FLAIR hyperintensity along the left lateral ventricular margins is also stable. There is no diffusion abnormality to suggest recent ischemia. No extra-axial fluid collection is identified. There is no midline shift or mass effect.There is mild mucosal thickening in the right maxillary sinus with a mucosal retention cyst in the left. Mild fluid is noted in right mastoids.

Output: 1.Continued stable appearance of the resection cavity.2.No significant change in scattered areas of nodular ependymal enhancement along the lateral ventricular margins.


Instruction: Generate impression based on findings.

Input: Mild motion artifact and lack of IV contrast limits evaluation of more subtle abnormalities/metastases. However, there is low T1 and heterogeneous T2 signal abnormality in the C7 vertebral body extending into the left pedicle, facet and spinous process, which on the prior PET/CT was hypermetabolic, consistent with osseous metastasis. There is also similar low T1 and high T2 signal abnormality in the left facet of C6 which may be due to degenerative disease and/or a subtle metastasis. The cord caliber and signal are within normal limits.C2-3: Small central disk osteophyte complex with no spinal stenosis.C3-4: Disk osteophyte complex and uncovertebral hypertrophy with mild facet arthropathy causing ventral CSF attenuation with no significant spinal canal stenosis and moderate right neural foraminal stenosis.C4-5: Disk osteophyte complex and bilateral uncovertebral hypertrophy causing moderate spinal canal stenosis and no significant neural foraminal stenosis.C5-6: Disk osteophyte complex eccentric to the left causing focal indentation of the ventral cord surface on the left. There is mild spinal canal stenosis and no significant neural foraminal stenosis.C6-7: Disk osteophyte complex causing no significant spinal no stenosis. There is mild left uncovertebral causing mild left neural foraminal stenosis.C7-T1: Vertebral body metastasis extending into the left pedicle with expansion of the left pedicle (with possible epidural tumor) causing severe left neural foraminal stenosis.T1-2: No disk herniation or spinal stenosis.

Output: 1.Vertebral body metastasis at C7 extending into the left pedicle, facet and spinous process. There is expansion of the left pedicle (with possible epidural tumor) causing severe left foraminal stenosis at C7-T1.2.Multilevel cervical spondylosis with moderate spinal canal stenosis at C4-5.3.No definite cord signal abnormality, however the exam is mildly degraded by motion artifact.4.Lack of IV contrast limits evaluation for more subtle abnormalities including metastases.


Instruction: Generate impression based on findings.

Input: Post-concussion syndrome, mild TBI. There are three tiny foci of susceptibility effect in the bilateral frontal lobes, best seen on series 801 images 134 on the right, image 95 on the right, and image 106 on the left compatible with chronic microhemorrhages. No surrounding edema. No lesions within the corpus callosum or brainstem are demonstrated. No findings to suggest traumatic encephalomalacia. No intracranial mass or mass effect. No evidence of acute ischemia or acute hemorrhage. Brain parenchyma is otherwise unremarkable. No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: 1. Three punctate foci of susceptibility effect consistent with chronic microhemorrhages in the bilateral frontal lobes. These lesions, while nonspecific, are compatible with given history of prior traumatic brain injury.2. Brain parenchyma is otherwise unremarkable. No intracranial mass or mass effect. No evidence of traumatic encephalomalacia.


Instruction: Generate impression based on findings.

Input: 53 year old with history of hypertension, diabetes, OSA, CKD and CHF presenting for evaluation of left ventricular size and function and to evaluate degree of aortic regurgitation. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 19%, the LV end diastolic volume index is 180 ml/m2 (normal range: 65+/-11), the LVEDV is 395 ml (normal range 109+/-23), the LV end systolic volume index is 145 ml/m2 (normal range 18+/-5), the LVESV is 318 ml (normal range 31+/-10), the LV mass index is 94 g/m2 (normal range 67+/-11), and the LV mass is 206 g (normal range 114+/-24). The left ventricular dysfunction is global with regional variation. There is subendocardial (involving nearly 50% of the wall thickness) late gadolinium enhancement of the mid to basal inferior and inferolateral walls. The pattern is consistent with prior myocardial infarction. There is additionally a mid-wall stripe pattern of late gadolinium enhancement involving the basal to mid interventricular septum. This pattern suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. No LV thrombus seen. Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is normal in size with moderately reduced systolic function. The overall RV ejection fraction is 32%, the RV end diastolic volume index is 78 ml/m2 (normal range 69+/-14), the RVEDV is 171 ml (normal range 110+/-24), the RV end systolic volume index is 53 ml/m2 (normal range 22+/-8), and the RVESV is 116 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve is trileaflet, opens widely and there is moderate aortic regurgitation with calculated regurgitant fraction of 34%. 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 trivial tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root, arch and descending thoracic aorta are normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 19%.2. There is subendocardial (involving nearly 50% of the wall thickness) late gadolinium enhancement of the mid to basal inferior and inferolateral walls. The pattern is consistent with prior myocardial infarction. There is additionally a mid-wall stripe pattern of late gadolinium enhancement involving the basal to mid interventricular septum. This pattern suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.3. The right ventricle is normal in size with moderately reduced systolic function. The overall RV ejection fraction is 32%.4. The aortic valve is trileaflet, opens widely and there is moderate aortic regurgitation with calculated regurgitant fraction of 34%.


Instruction: Generate impression based on findings.

Input: 71-year-old female with transient alteration of awareness and sodium of 117. Evaluate for cerebral edema. There is no evidence of intracranial hemorrhage, mass or edema. Diffuse areas of periventricular white matter hypodensity consistent with small vessel ischemic disease, age indeterminate. If there is clinical concern for acute ischemia, an MRI may be considered.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Diffuse areas of periventricular white matter hypodensity consistent with small vessel ischemic disease, age indeterminate. If there is clinical concern for acute ischemia, an MRI may be considered.


Instruction: Generate impression based on findings.

Input: Male, 83 years old, with non-small cell lung cancer, memory problems, abnormality noted on prior limited noncontrast MRI. Redemonstrated is a well-circumscribed, 16 x 16 x 12 mm mass which is centered on the anterior wall of the third ventricle. The lesion occupies the anterior aspect of the third ventricle and appears to splay the walls of the third ventricle laterally. The lesion is T2 hyperintense, T1 hypointense, non-diffusion restricting and solidly enhancing. Although the lesion is in close contact with the hypothalamic and thalamic tissues, there is no evidence of significant edema or invasion into these tissues.Within the limitations of motion degradation on the postcontrast sequences, no definite additional enhancing lesions are seen. Scattered small foci of FLAIR hyperintensity are seen within the periventricular white matter. No evidence of significant parenchymal edema is seen. No findings to suggest acute intracranial hemorrhage or any abnormal extra axial fluid collection are noted. Ventricular size and morphology are within normal limits.

Output: A well-circumscribed, solidly enhancing mass is present occupying the anterior aspect of the third ventricle. The lesion appears relatively nonaggressive in that there is no evidence of invasion or edema within the adjacent thalamic and hypothalamic tissues.The morphology and location of this lesion are relatively characteristic of a chordoid glioma. A rare manifestation of some other indolent or low-grade glioma would also remain within the differential. Although metastatic disease cannot be excluded, this would be a very atypical presentation.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Clinical question: Subarachnoid hemorrhage. Signs and symptoms: Same. Non-infused head CT:As was noted on multiple prior head CTs a large hematoma in the interhemispheric fissure with associated mass effect on lateral ventricles is again identified. The largest transverse axes measurement of hematoma is 29.9-mm which is similar to prior study.The lateral ventricles are shunted and remains stable in their normal size. No change in the position of the right-sided ventricular catheter with the tip in the right frontal horn of lateral ventricle.Examination demonstrates a well demarcated foci of low attenuation of cortex and subcortical white matter of right frontal and parietal lobes along its interhemispheric aspect consistent with ischemic strokes. These findings are best appreciated on axial image 30. The new area of ischemic stroke in the right frontal lobe measures approximately 11.4 x 19.2-mm and the right posterior parietal cortical stroke measures 13.4 x 25.8 mm. the stroke in the right parietal lobe extends inferiorly to involve the singlet gyrus.There is generalized paucity of cortical sulci in bilateral cerebral hemisphere and with suspected interval worsening suggestive of cerebral edema and possible additional nondetectable on this exam cortical strokes. MRI can further delineate the extent of cortical strokes.Residual blood in the subarachnoid space is again identified. There is no suggestion of any additional subarachnoid hemorrhage since prior study.

Output: 1.No evidence of new hemorrhage since prior study.2.Foci of ischemic cortical stroke in the right frontal and parietal lobes with no evidence of hemorrhage.3.Suspected further effacement of cortical sulci in bilateral cerebral hemispheres as detailed.4.The stable size of hematoma in the interhemispheric fissure since prior study.5.Stable size and right-sided ventricular catheter since prior exam.


Instruction: Generate impression based on findings.

Input: 52-year-old female. Subcutaneous nodule. Evaluate for soft tissue mass and extension of mass. The leg was imaged from the tibial articulation in the knee to the ankle joint. Three markers were placed around the patient's palpable abnormality in the posterior lateral mid leg. This corresponded to a T1 hypointense and STIR hyperintense subcutaneous nodule that measures 1.4 x 2.6 cm in maximal transaxial dimensions and 1.9 cm in the CC dimension (series 6, image 22; series 6, image 22). Its enhancement cannot be assessed on post-contrast sequences due to extensive artifact at the edge of the coil. A second subcutaneous nodule with similar signal intensity and that diffusely enhances is seen in the medial anterior upper leg. It has maximal transaxial dimensions of 1 x 2.2 cm and a CC dimension of 1.8 cm (series 13, image 32; series 15, image 12). Neither of these nodules extend to the underlying musculature. Diffuse mild atrophy of the musculature of the leg. Varicose veins are noted mostly in the medial aspect of the leg. Mild subcutaneous edema greatest in the anterior and lower lateral aspect of the leg. Bone marrow signal intensity is normal. Incompletely imaging of the knee shows a small joint effusion with synovial thickening and enhancement, suggestive of synovitis. A small Baker's cyst is noted.

Output: Two subcutaneous nodules in the leg with nonspecific signal characteristics; both benign and malignant etiologies are included in the differential.


Instruction: Generate impression based on findings.

Input: 52 year old female with pain, evaluate rotator cuff ROTATOR CUFF: There is increased signal intensity within the distal supraspinatus tendon at its insertion on the greater tuberosity, consistent with a mild insertional tendinosis. We see no discrete tear. Minimal edema within the myotendinous junction of the supraspinatus centrally may represent a mild strain, but the muscle otherwise appears normal. A small cyst is present within the humeral head with possible mild undersurface fraying of the overlying infraspinatus tendon. The infraspinatus tendon and muscle otherwise appear normal. The teres minor muscle and tendon are within normal limits. The subscapularis tendon and muscle are intact. SUPRASPINATUS OUTLET: There is minimal if any acromioclavicular joint osteoarthritis. Trace fluid is noted within the subacromial-subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral joint alignment is within normal limits. Mild irregularity of the margin of the superior labrum likely represents mild fraying. The anterior labrum is poorly defined at 2 o'clock, which is of uncertain clinical significance and may represent a normal variant. The inferior labrum appears normal. Trace fluid is in the joint without significant effusion.BICEPS TENDON: There is mild increased intrasubstance signal within the tendon of the long head of the biceps at its transition from the rotator interval to the intertubercular groove suggesting mild tendinosis. The tendon is otherwise normal. Fluid within the biceps tendon sheath more likely represents extension of fluid from the joint rather than tenosynovitis.

Output: Mild rotator cuff tendinosis and possible mild supraspinatus muscle strain, but no discrete rotator cuff tear. Other findings as described above.


Instruction: Generate impression based on findings.

Input: A patient submitted outside study for review. Submitted for review are digital mammographic images (4/15/15), ultrasound images of left breast (4/15/15), breast MRI (4/20/15) performed at Central DuPage Hospital. For comparison, digital mammographic images (10/1/13) are available. DIGITAL MAMMOGRAPHIC IMAGES (4/15/15):The breast parenchyma is composed of scattered fibroglandular elements, unchanged in pattern and distribution. A lobulated mass with ill-defined margins, measuring 3 cm, is present at posterior lower outer quadrant in the left breast.Dense calcification is present immediately inferior to the mass.No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in right breast. ULTRASOUND IMAGES OF LEFT BREAST (4/15/15):A lobulated mass is seen at the 5 o'clock position, measuring 29 x 21 x 26 mm, in the left breast, corresponding to the mammographic findings. A few normal-appearing lymph nodes are detected in the left axilla.BREAST MRI (4/20/15):An enhancing mass is present at middle 5:30 position in the left breast, measuring 34 x 32 x 35 mm (AP x LR x CC). This mass is located close to the skin. No suspicious findings are seen in the right breast.An enlarged lymph node (maximum diameter: 2.7-cm) is seen at left axilla.Per outside radiology report, the pathology of the left breast mass is malignant.

Output: Unifocal malignant mass in the left breast with an enlarged left axillary lymph node. Repeat ultrasound of left axilla is recommended.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Male 54 years old Reason: staging exam History: prostate cancer PELVIS:PROSTATE:Prostate Size: The prostate measures 5.0 x 3.4 x 4.5 cm.Peripheral Zone: The peripheral zone is amorphously heterogeneous. Dominant focus of T2 signal abnormality in the paracentral left peripheral zone in the midgland and base. This is dark on the ADC map. This measures 1.5 x 0.7 cm. Additional smaller foci are identified for example in the right peripheral zone at the base (series 801, image 17).Central Gland: Enlarged and heterogeneous.Seminal Vesicles: No seminal vesical invasion.Extracapsular Extension: While the above described dominant lesion abuts the prostatic capsule there is no definite extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: Nonspecific subcentimeter left external iliac lymph node.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Dominant focus of signal abnormality in the left paracentral peripheral zone of the mid gland and base. This is suspicious for a focus of prostatic adenocarcinoma. There is no extracapsular extension or seminal vesicle invasion.


Instruction: Generate impression based on findings.

Input: 77-year-old female with mass in the uncinate process of the pancreas. ABDOMEN:LIVER, BILIARY TRACT: The left and right extrahepatic bile ducts join into a single common bile duct inferior to the insertion of the cystic duct, normal variant.SPLEEN: No significant abnormality noted.PANCREAS: There is a T2 hyperintense focus in the uncinate process measuring 1.4 x 1.1 cm (series 801, image 12). There is no communication with the pancreatic duct. This lesion does not demonstrate contrast enhancement.There are additional subcentimeter T2 hyperintense focus is in the pancreatic body and tail (series 801, image 19).ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right subcentimeter renal cysts.RETROPERITONEUM, LYMPH NODES: Nonspecific mildly prominent retroperitoneal lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Soft tissue signal foci in the right axilla, likely represents lymph nodes (series 801, image 33).

Output: 1.Uncinate process cystic lesion. Differential considerations include a sidebranch IPMN; a serous cystoadenoma is considered less likely.2.Additional subcentimeter pancreatic body and tail cystic lesions likely represent sidebranch IPMNs.3.Rounded and ovoid foci of soft tissue signal in the right axilla, likely lymph nodes. Correlation with recent mammography recommended.


Instruction: Generate impression based on findings.

Input: Clinical question: Low-back pain neck pain. Signs and symptoms: As above. Nonenhanced lumbar MRI:T11-T12 demonstrate mild degenerative disc disease and a small shallow central disc protrusion without spinal stenosis or neural foraminal compromise. There are no axial images through the level.T12-L1 is unremarkable.L1-L2 is unremarkable.L2-L3 demonstrate mild hypertrophic changes of facets and ligamentum flavum and unremarkable otherwiseL3-L4 demonstrate mild disc desiccation, mild to moderate bilateral facet and ligamentum flavum hypertrophy without spinal stenosis or neural foraminal compromise.L4-L5 demonstrates mild disc desiccation, mild to moderate bilateral facet and ligamentum flavum hypertrophy constellation of changes and including slight prominence of dorsal epidural fat pad results in mild central spinal stenosis without neural foraminal compromise.L5-S1 demonstrate advanced disc disease, significant loss of disc height, moderate to severe left and moderate right facet hypertrophic changes and mild right ligamentum flavum hypertrophy. There is evidence of a prior left sided laminectomy with resultant expansion of thecal sac. No spinal stenosis and no convincing evidence of neural foraminal compromise.Incidental note is made of a well demarcated single locule cyst of the posterior aspect of right kidney measuring 21 x 20 mm in transaxial dimensions and 2 additional foci of T2 hyperintensity within the right kidney measuring at 5.5 and 3.7 which could represent cyst. Unremarkable paraspinal soft tissues otherwise.The lower most visualized thoracic cord, conus and cauda equina remain unremarkable

Output: 1.Advanced degenerative disc disease at L5-S1 without spinal stenosis or neural foraminal compromise. Evidence of prior left-sided laminectomy at this site.2.Mild degenerative changes at other levels.3.Mild central spinal stenosis only at L4-L5 level.4.No evidence of neural foraminal compromise at any level.


Instruction: Generate impression based on findings.

Input: There appears to be lumbarization of S1 based on the location of the last rib and the the lumbar ligament. For the purposes of this exam, the last fully formed disc space will be termed of S1-S2. There is an apex rightward lumbar spinal curvature. The vertebral body heights are preserved. With the exception of endplate degenerative change and presumed hemangiomas, the vertebral bone marrow signal is unremarkable. The imaged spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.L1-L2: Unremarkable.L2-L3: There is mild disc desiccation without significant bulge, herniation, spinal canal, or neural foramen stenosis.L3-L4: There is mild disc desiccation and mild disc bulge as well as mild facet arthropathy and ligamentum flavum thickening without significant spinal canal or neural foramen stenosis.L4-L5: There is disc desiccation and mild disc bulge as well as endplate degenerative change, facet arthropathy, and ligamentum flavum thickening. These findings result in moderate spinal canal stenosis as well as moderate bilateral neural foramen stenosis.L5-S1: There are postoperative findings related to prior bilateral laminotomies, left facetectomy, and microdiscectomy. There is disc desiccation, loss of disc height, endplate degenerative change, and tissue posterior and contiguous with the disc that may represent disc material or granulation tissue. There is also similar signal intensity tissue along the left posterior lateral aspect of the spinal canal. There is bilateral moderate-severe neural foraminal stenosis and mild-moderate spinal canal stenosis.S1-S2: There is disc desiccation, endplate degenerative change, and mild disc bulge with a superimposed mild central disc herniation. These findings result in moderate left neural foramen stenosis.

Output: 1.Probable transitional anatomy with lumbarization of S1 as detailed above. If surgery is to be contemplated, correlation with imaging of the entire spine is recommended.2.Postoperative findings at L5-S1 with nonspecific tissue anteriorly contiguous of the disc and along the left ventrolateral epidural space, with mild spinal canal stenosis and bilateral moderate neural foramen stenosis. This tissue could be further characterized with postcontrast sequences.3.Additional lumbar spine degenerative changes as detailed above resulting in at most moderate spinal canal stenosis and moderate foraminal stenosis.


Instruction: Generate impression based on findings.

Input: 62 year old man with coronary artery disease s/p CABG in 1998 with known occluded SVG to RCA and OM. He is referred to assess for ischemia and viability.MEDICATIONS: aspirin, clopidogrel, lisinopril, metoprolol First Pass PerfusionDuring hyperemia, there was a perfusion defect involving the basal inferior, inferolateral, and anterolateral wall.Viability/ Myocardial ScarThere are 2 large myocardial infarctions (i.e. late gadolinium enhancement). The first is transmural and involves the basal to mid inferior walls (RCA territory). These segments are very unlikely to be viable. The second is non-transmural and involves the basal to mid inferolateral and anterolateral walls (LCx territory) and has an intermediate probability of viability. The remainder of the myocardium (LAD territory) is free of myocardial infarction and is viable.Left VentricleThe left ventricle is severely dilated with moderately reduced systolic function. There is akinesis of the basal to mid inferior, inferolateral, and anterolateral walls. The overall LV ejection fraction is 34%, the LV end diastolic volume index is 142 ml/m2 (normal range: 74+/-15), the LVEDV is 289 ml (normal range 142+/-34), the LV end systolic volume index is 94 ml/m2 (normal range 25+/-9), the LVESV is 191 ml (normal range 47+/-19), the LV mass index is 62 g/m2, and the LV mass is 126 g. Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 52%, the RV end diastolic volume index is 81 ml/m2 (normal range 82+/-16), the RVEDV is 165 ml (normal range 142+/-31), the RV end systolic volume index is 39 ml/m2 (normal range 31+/-9), and the RVESV is 78 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is 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 FindingsThere are numerous masses in the liver, consistent with the patient's diagnosis of metastatic renal cell cancer. 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. There is a large severe perfusion defect involving the basal inferior, inferolateral and anterolateral walls during hyperemia.2. There are 2 large myocardial infarctions (i.e. late gadolinium enhancement). The first is transmural and involves the basal to mid inferior walls (RCA territory). These segments are very unlikely to be viable. The second is non-transmural and involves the basal to mid inferolateral and anterolateral walls (LCx territory) and has an intermediate probability of viability. The remainder of the myocardium (LAD territory) is free of myocardial infarction and is viable.3. Severe LV dilation with moderately reduced systolic function (LVEF 34%) with akinesis of the basal to mid inferior, inferolateral, and anterolateral walls. 4. Normal RV size and systolic function (RVEF 52%).5. See extra-cardiac findings.


Instruction: Generate impression based on findings.

Input: Female, 63 years old, with GBM, status post clinical investigation. Postoperative findings are again seen at the left parieto-occipital junction. The heterogeneously rim-enhancing lesion at this location has increased in size with a maximal axial dimension of approximately 50 mm, previously 38 mm. As before, the lesion extends to the ependyma of the left ventricular atrium which is progressively effaced. A small portion of the enhancing component correlates to elevated rCBV, but the majority shows relatively reduced rCBV. T2 hyperintense signal abnormality and edema within the adjacent parenchyma has progressed further into the anterior temporal lobe, temporal stem and capsular white matter, the splenium of the corpus callosum, and the superior parietal lobule. No entirely new enhancing lesions are seen. No definite contralateral involvement is detected.

Output: There has been interval increase in size of the enhancing lesion in the left parieto-occipital junction along with progressive T2 hyperintensity and edema. These findings are concerning for progressive disease. However, given that the lesion demonstrates overall low rCBV, the possibility of a treatment related effect can be entertained. Correlation with timing and nature of treatment may be helpful.


Instruction: Generate impression based on findings.

Input: 63 years Female (DOB: 10/20/1952)Reason: eval for R Radiculopathy History: C6 numbness and shoulder painPROVIDER/ATTENDING NAME: LEWIS L SHI LEWIS L SHI The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There is multilevel disc desiccation present.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina. There is a mild disc bulge and mild loss of disc space height at this level.At C5-6 there is no significant compromise to the spinal canal. There are endplate and bilateral uncovertebral osteophytes present this level associated with disc material. There is associated moderate encroachment of the left-sided exiting nerve roots within the neural foramen.At C6-7 there is no significant compromise to the spinal canal. There are endplate and bilateral uncovertebral osteophytes present this level associated with disc material. There is associated mild to moderate encroachment of the left-sided exiting nerve roots within the neural foramen.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: There are degenerative changes present in the cervical spine which are worse at C5-6 and C6-7 where there is a left-sided encroachment of the exiting nerve roots at C5-6 more than C6-7.


Instruction: Generate impression based on findings.

Input: Reason: 36-year-old Male with persistent pain at bone marrow biopsy site History: pain There is minimal signal heterogeneity within the superomedial aspect of the right iliac bone which presumably represents the site of prior bone marrow biopsy, but we see no specific findings to account for the patient's pain. We see no abnormal enhancement. Mild osteoarthritis affects both hips. The remaining bone marrow signal intensity is within normal limits. No joint effusion is evident.

Output: Minimal osteoarthritis of both hips, but no specific findings to account for the patient's pain at the prior bone marrow biopsy site.


Instruction: Generate impression based on findings.

Input: Female, 40 years old, with metastatic breast cancer to the brain, status post resection of a brain lesion, evaluate for resection and for question of new altered mental status prior to surgery. Postoperative findings are seen compatible with a left frontal craniotomy for tumor resection. The previously demonstrated dominant left frontal lobe lesion has been excised. A surgical cavity is evident in its place which is filled with a mixture of air, fluid and blood product. The tumor appears to have been nearly completely resected. A 12 mm region of enhancement along the inferior aspect of the cavity, adjacent to the left frontal horn, most likely represents a small amount of residual tumor. Scattered subcentimeter foci of enhancement elsewhere along the margins of the resection cavity are nonspecific. Edema in the surrounding parenchyma related to this lesion appears to be slightly improved from the preoperative examination.The second largest lesion within the right parietal lobe continues to measure up to 26 mm in length showing no significant interval change. Moderate edema associated with this lesion is also grossly unchanged. Approximately 15 additional scattered parenchymal enhancing lesions are also redemonstrated ranging in size from punctate up to 1 cm. These involve both cerebral hemispheres, the brainstem and cerebellum. There has been no significant interval change in the size or number of these lesions.Local mass effect persists in the left frontal and right parietal lobes. The smaller lesions cause no significant parenchymal mass effect. No evidence of brain herniation is seen. No diffusion restriction is seen apart from the expected cytotoxic edema along the resection cavity margins. The ventricles are stable in size and morphology.

Output: 1.Findings are seen compatible with near complete resection of the large left frontal lobe tumor. A small amount of residual tumor is seen along the inferior margin of the resection cavity. Scattered small foci of enhancing tissue elsewhere along the cavity margin are nonspecific.2.The second largest metastatic lesion, in the right parietal lobe, shows no significant interval change in size and continues to induce a similar degree of edema and mass effect.3.Numerous additional small parenchymal metastases are redemonstrated without significant interval change.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for intracranial hemorrhage, worsening metastases. Signs and symptoms: Seizures, history of cancer with brain metastases. Non-enhanced CT of brain:There is no detectable acute intracranial findings. No evidence of hemorrhage, edema, mass-effect, midline shift or hydrocephalus is detected. The cortical sulci, ventricular system and all CSF cisterns as well as the gray white matter differentiation remains within normal. Further follow-up with an MRI is recommended. This examination is suboptimal due to motion artifact.

Output: No areas of acute intracranial findings and essentially unremarkable CT of brain and calvarium.


Instruction: Generate impression based on findings.

Input: Male, 60 years old, new diagnosis of head and neck cancer, abnormal lesion in the left thalamus on CT. Assess for metastases. T1 hyperintensity and mild susceptibility artifact is seen within the pulvinar of the left thalamus with at most a slight expansion of the affected tissue. There is no convincing enhancement above and beyond the intrinsic T1 hyperintensity. However, a venous structure originates within this tissue and passes through it to drain to the vein of Galen. Minimal T2 hyperintensity is seen in this location without evidence of edema.No restricted diffusion is seen in the brain. No other areas of significant parenchymal signal abnormality are detected. At most, there may be a few scattered punctate foci of white matter T2 hyperintensity which are nonspecific. No mass or pathologic enhancement is detected. No abnormal extra axial collections are seen. The ventricles are normal in size and morphology.

Output: Corresponding to the lesion seen on recent prior CT, intrinsic T1 hyperintensity and mild susceptibility artifact are seen within the pulvinar of the left thalamus. The lesion as a whole does not enhance. However, there is a developmental venous anomaly which originates within and passes through the lesion.The findings are most suggestive of an incidental cavernous malformation with associated developmental venous anomaly. Alternately, the abnormal signal could reflect a complication of the developmental venous anomaly without an associated cavernoma. Other processes are known to produce T1 hyperintensity in the pulvinar, including metabolic and endocrinologic conditions, but these are usually bilateral and symmetric.In any event, this lesion is not consistent with a metastatic deposit, and there is no evidence of any additional intracranial metastatic disease.


Instruction: Generate impression based on findings.

Input: 25-year-old female with right hip pain. ACETABULAR LABRUM: There is linear increased signal abnormality traversing the anterior superior acetabular labrum consistent with a labral tear.ARTICULAR CARTILAGE AND BONE: No bone marrow signal abnormalities are identified. No articular cartilage defects are identified.SOFT TISSUES: No significant abnormality noted. ADDITIONAL

Output: Anterior superior acetabular labral tear as described above.


Instruction: Generate impression based on findings.

Input: Meningioma status post resection. There are postoperative findings in the posterior fossa. There appears to be a small amount of tumor along the medial right transverse sinus, measuring up to approximately 10 mm. There are mild scattered foci of cerebral white matter T2, but no 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 orbits are grossly unremarkable. There is scattered paranasal sinus inflammation.

Output: Postoperative findings with what appears to be a small amount of tumor along the medial right transverse sinus.


Instruction: Generate impression based on findings.

Input: Muscle weakness (generalized) [M62.81], Reason for Study: ^Reason: r/o cerebellar stroke History: RLE weakness, poor balance MRI BRAIN: There is a small area of diffusion restriction in the posterior left frontal lobe periventricular white matter and extending slightly into the posterior aspect of the putamen consistent with acute ischemia. No additional areas of diffusion restriction are identified. There are several foci of T2/FLAIR hyperintensity in the periventricular and subcortical white matter, predominantly on the left. Cortical sulci are in proportion to cerebral ventricles. The gray-white matter differentiation is preserved. There is no midline shift or mass effect. No intracranial hemorrhage is identified.MRA BRAIN: The examination is slightly motion degraded. There is irregularity of the right greater than left internal carotid arteries consistent with mild to moderate right and mild left stenosis secondary to atherosclerotic disease as seen on recent prior CT. The bilateral anterior and middle cerebral arteries appear unremarkable. The bilateral vertebral arteries and basilar arteries are grossly unremarkable. There is mild narrowing of the P2 segment of the left posterior cerebral artery. The right P-comm is smaller than the left.

Output: 1. Small area of acute ischemia involving the left posterior frontal periventricular white matter.2. Several foci of T2/FLAIR hyperintensity are demonstrated in the periventricular white matter, predominantly on the left. These may represent chronic microvascular ischemic change versus less likely inflammatory or demyelinating etiologies.3. Limited MRA of the brain demonstrates intracranial atherosclerotic disease without evidence for high-grade stenosis or occlusion.


Instruction: Generate impression based on findings.

Input: Female, 43 years old, with low back pain. Spinal alignment is anatomic with the exception of a very slight retrolisthesis of L5 relative to S1. Vertebral body morphology and signal characteristics are within normal limits.The visualized spinal cord, conus and cauda equina are unremarkable.Facet hypertrophy develops progressively at lower lumbar levels becoming marked at L4-5 and L5-S1. Disc degeneration with disc bulging and a very small central protrusion are evident at L5-S1. These findings cause no significant spinal canal stenosis, though there is severe right and moderate left foraminal narrowing at this level.The remaining lumbar discs are within normal limits. No significant spinal canal stenosis is seen. Mild narrowing of the right L4-5 neural foramen is evident secondary to posterior element hypertrophy.

Output: 1.Facet hypertrophy at lower lumbar levels, most severely affecting L4-5 and L5-S1.2.Disc degeneration at L5-S1 with mild disc bulging and a very small central disc protrusion. No spinal canal stenosis is evident at this level, though the right neural foramen is severely narrowed and the left is moderately narrowed.3.No significant findings are evident elsewhere in the lumbar spine.


Instruction: Generate impression based on findings.

Input: Female, 43 years old, with daily neck pain radiating to the left shoulder, not improved with conservative treatment. The normal cervical lordosis is straightened. Sagittal alignment is otherwise unremarkable. Vertebral body height and morphology are within normal limits. No concerning marrow replacement or evidence of marrow edema is seen.The visualized spinal cord demonstrates normal signal characteristics and morphology except as discussed by specific level below. No epidural abnormalities are suspected.The spinal canal is congenitally slender through the cervical region. Additional level specific findings are as follows:C2-3: No spinal canal stenosis or neuroforaminal narrowing. C3-4: Minimal posterior disc-osteophyte complex formation. No significant spinal canal stenosis. No significant foraminal narrowing. C4-5: Minimal posterior disc-osteophyte complex formation with a right paracentral protrusion which may very slightly indent the ventral spinal cord. No significant generalized spinal canal stenosis. No significant foraminal narrowing. C5-6: Mild posterior disc-osteophyte complex formation no significant spinal canal stenosis. Mild left foraminal narrowing. C6-7: Minimal posterior disc-osteophyte complex formation. No significant spinal canal stenosis or neuroforaminal narrowing. C7-T1: No spinal canal stenosis or neuroforaminal narrowing.

Output: 1.Relatively mild degenerative findings are seen in the cervical spine with no areas of high-grade spinal canal or neuroforaminal stenosis.2.At the C4-5 level, there is a right paracentral disc protrusion which may minimally impinge upon the right ventral aspect of the spinal cord. However, the spinal canal at this level is otherwise well preserved.3.No spinal cord edema or other cord parenchymal abnormalities are detected. No epidural pathology is suspected.


Instruction: Generate impression based on findings.

Input: 63-year-old woman with history of side branch type IPMN. ABDOMEN:LIVER, BILIARY TRACT: Right lobe simple cyst unchanged. The liver is otherwise normal in signal and morphology. No intra or extrahepatic biliary ductal dilatation. The gallbladder is normal.SPLEEN: Simple splenic cyst is unchanged.PANCREAS: The pancreas is fatty atrophied and contains multiple cystic lesions, some of which communicate with the pancreatic duct. The largest of these in the mid body (7/26) measures 16 x 11 mm and is stable since October 2013. Multiple additional subcentimeter cystic lesions throughout the entire pancreatic body also appear stable from 2013. No enhancing lesions identified. The pancreatic duct is normal in size and smooth in contour.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Simple left renal cyst unchanged. The kidneys are otherwise normal in signal and morphology.RETROPERITONEUM, LYMPH NODES: No significant retroperitoneal lymphadenopathy.BOWEL, MESENTERY: There are a few colonic diverticula, otherwise the partially visualized small bowel and colon appear normal.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Stable cystic pancreatic lesions compatible with multiple sidebranch IPMNs.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate underlying structural lesions. Signs and symptoms: Headaches. Pre and post enhanced brain MRI:No diffusion-weighted abnormalities.Examination demonstrates normal anatomical development, morphology and signal intensity of brain parenchyma on all MRI sequences.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination.There is normal anatomical variation of partially empty sella.No detectable abnormal enhancement of brain parenchyma or the leptomeninges.The signal void of major intracranial arterial branches are identified.The signal intensity of the intracranial venous sinuses are within normal and with normal pattern of enhancement.Unremarkable calvarium and orbits and without detectable abnormal enhancement.Paranasal sinuses demonstrate a moderate size retention cyst in the right maxillary sinus and unremarkable paranasal sinuses otherwise.Pre- and post enhanced cervical MRI:Examination demonstrates normal signal intensity and anatomical alignment of the vertebral column.There is normal signal intensity and caliber of cervical and upper most visualized thoracic cord.There is no detectable abnormal enhancement of the vertebral column, cord or the leptomeninges.There is mild degenerative disc disease at C6-C7 and with subtle bulging disc as well as a tiny annular fissure with expected enhancement. No spinal stenosis or neural foraminal compromise at any level.

Output: 1.Pre and post enhanced MRI of brain is unremarkable. Moderate size right maxillary sinus dictation cyst and unremarkable paranasal sinuses.2.Pre- and post enhanced MRI of cervical spine demonstrate normal signal intensity and caliber of the cord without abnormal enhancement. Mild degenerative disease and a central annular fissure at C6/C7 with expected enhancement. No spinal stenosis or neural foraminal compromise at any level.


Instruction: Generate impression based on findings.

Input: Patient with history of multiple sclerosis, presenting with paresthesias, evaluate for progression. Again noted is mild degree of periventricular and subcortical punctate hyperintense FLAIR lesions, which appear stable as compared to prior exam. 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. The cerebellar tonsils are slightly low-lying, similar to prior exam. There has been interval resolution of left maxillary sinus mucosal thickening.

Output: Stable periventricular and subcortical white matter T2/FLAIR lesions, consistent with patient's known history of demyelinating disease.


Instruction: Generate impression based on findings.

Input: Male, 65 years old, history of 4.4 ascending aortic aneurysm The quality of this examination is nondiagnostic. The patient will be called back for repeat examination at no additional cost.

Output: Nondiagnostic exam.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.