Instruction: Generate impression based on findings.

Input: Male, 58 years old, with left frontal tumor and word finding deficits. Evaluate speech and language function for presurgical planning. Of the tested language paradigms, the most reliable language related cortical activation is seen with the word generation, verb generation, and sentence completion paradigms. Wernicke's area activity is particularly well visualized on the sentence completion paradigm where it maps to its expected location along the posterior aspect of the left superior temporal gyrus. Wernicke's activity is strongly left dominant.Presumed Broca's area activity, however, appears to be more evenly distributed between the right and left hemispheres. Potential Broca's area activity is best visualized on the word generation paradigm where it maps bilaterally to the inferior frontal gyri, particularly the pars opercularis and to a lesser degree the pars triangularis.The visualized putative Wernicke's area activity is well removed from the patient's large left frontal lobe tumor and the extensive edema which it creates. The visualized putative Broca's area activity sits mainly at the margins of the tumor-induced edema. The anterior medial aspect of this activity does, however, reach to within one gyrus of the inferior lateral margin of the tumor itself (see image 96, series 601, and image 46, series 602).No functional activation is identified frankly within the tumor itself or the edematous surrounding parenchyma. Please note, however, that nonvisualization of functional activity does not ensure that there is no functional capacity in these areas.Somewhat less than the typical amount of secondary language activity is seen in the middle frontal gyri. Language SMA activity is, however visualized in its expected paramedian location along the superior frontal gyri, and this too approaches the margin of tumoral edema.

Output: 1.Wernicke's area activity is strongly left dominant, visualized in its expected location along the posterior aspect of the superior left temporal gyrus, and is well removed from the patient's tumor.2.Broca's area activity is somewhat more evenly distributed between the right and left hemispheres, which may reflect compensation due to the clear extension of edema into the expected domain of Broca's area on the left. Cortical activation felt to reflect Broca's area approaches the margins of tumoral edema, primarily within the pars opercularis. The most anterior medial aspect of this activation does approach within one gyrus to the inferior lateral margin of the tumor.


Instruction: Generate impression based on findings.

Input: 37-year-old female with acute cholecystitis, elevated T bilirubin, mention of common bile duct stone on outside hospital imaging ABDOMEN:LIVER, BILIARY TRACT: Scattered subcentimeter T2 hyperintensities throughout the liver likely benign. No suspicious liver lesions. Minimal intrahepatic biliary ductal dilatation. The common bile duct measures up to 7 mm in diameter. No choledocholithiasis is evident. Cholelithiasis. Cholecystostomy tube is present. Gallbladder wall enhancement and thickening compatible with known diagnosis of acute cholecystitis.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: IVC filter is present. BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Lumbar stabilization hardware and associated susceptibility artifact is present.OTHER: Consolidation/atelectasis in bilateral lung bases.

Output: 1. Cholelithiasis and gallbladder wall enhancement and thickening compatible with known diagnosis of acute cholecystitis status post cholecystostomy tube.2. No evidence of choledocholithiasis.3. Consolidation/atelectasis possibly from aspiration in bilateral lung bases.


Instruction: Generate impression based on findings.

Input: 59 year old male with history of thyroid cancer with metastases. Status post resection, brain irradiation, chemotherapy. On clinical trial. CT of the soft tissues of the neck.Images through the skull base including cavernous sinuses are within normal limits.Images through the soft tissues of the neck demonstrate a well demarcated enhancement involving the posterior wall of nasopharynx (axial image 24 through 28). There is no evidence of an increased soft tissue mass with this finding. All of the prior studies where re-examined and demonstrated the same finding with no interval change. The exact etiology of this finding is not clear. Possibility of a tumor would be considered very low considering its stable appearance since 4 -- 28 -- 2008. An MRI may be helpful to precisely determine the etiology of this finding. This finding does not appear as a postsurgical change.An enhancing right posterior triangular lymph nodes on axial image 35 is again identified and no interval change since prior study. This node measures identical to the prior exam and is 10 mm times 11.8-mm in size.A smaller enhancing right posterior triangular lymph nodes is again also identified with no interval change. Enhancement could appearance of a central necrosis immediately medial to the right internal carotid artery is believed to represent a Trumbull was to jugular vein. This finding is also stable since prior exam (axial image 34 through 39).Extensive post therapy changes of the soft tissues of the neck with distortion of anatomy is again identified. No definitive evidence of recurrence of tumor or pathologic adenopathy. Extensive metastatic lesion two bilateral upper lung fields are noted. Please review the dictated report of CT of chest. No osseous metastatic lesion.CT of brain with infusion.Multiple small supra-and infratentorial foci of increased density (cannot be certain whether they represent small calcific post treated metastases or enhancement) are again identified and with no interval change. No evidence of new lesions is identified. No evidence of hemorrhage, edema, midline shift or hydrocephalus.

Output: 1.Stable CT examination of soft tissues of the neck and with no definitive evidence of recurrence of tumor or pathologic adenopathy. Please see above comments.2.Stable findings on CT of brain which may represent post treated metastatic lesions.


Instruction: Generate impression based on findings.

Input: 46-year-old woman called back for bilateral breast masses on screening mammogram. An ML view and two spot compression views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density(BiRads Density Category B), unchanged in pattern and distribution. There are partially circumscribed masses in the lateral right breast near 9:00 position, central right breast near the 12:00 position and lateral left breast near the 2-o'clock position which which all persist on additional views. An ultrasound will be performed for further evaluation. Additional upper inner left breast mass also again seen, previously noted to be stable. No suspicious microcalcifications or areas of architectural distortion in either breast. BILATERAL BREAST ULTRASOUND:On physical exam, there is no palpable or visible abnormality of either breast.Targeted grayscale and color Doppler ultrasound right breast was performed for the mammographic areas of concern. Corresponding to the well-circumscribed mass seen in the lateral right breast is a 9 mm cluster of cysts with punctate echogenic foci likely representing milk of calcium at the 9:00 position 5 cm from nipple. The largest cyst within this cluster measures approximately 5 x 3 mm. Corresponding to the well-circumscribed mass seen in the central right breast on mammogram is a cluster of complex cysts at the 12:00 position 2 cm from nipple, with the largest cyst within this cluster measuring 7 x 7 mm. No internal vascularity or nodularity is appreciated in either location.Targeted grayscale and color Doppler ultrasound of left breast was performed for the mammographic area of concern. Correlating to the left upper outer quadrant mass seen on mammogram is a 5 x 6 x 5 mm cyst at the 2:00 position 5 cm from nipple. No internal vascularity or nodularity. Note that these findings correlate well to an MRI that was recently submitted showing multiple bilateral cysts.

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


Instruction: Generate impression based on findings.

Input: There is no evidence of acute infarct. The ventricles and sulci are prominent, consistent with mild age-related volume loss. In addition, the ventricular prominence appears somewhat disproportionate to sulcal prominence. There is no midline shift or mass effect. There are scattered punctate foci and confluent areas of abnormal T2/FLAIR hyperintensity within the basal ganglia as well as the periventricular and subcortical white matter, consistent with moderate chronic small vessel ischemic changes. Chronic lacunar infarcts are present within the right head of the caudate. Scattered punctate foci of susceptibility are present most prominent in the bilateral basal ganglia. There is no abnormal intracranial enhancement. The midline structures and craniocervical junction are within normal limits. The major cerebral flow voids are intact. There is minimal mucosal thickening in the right frontoethmoidal recess. The remainder of the visualized portions of the paranasal sinuses and mastoids/middle ears are grossly clear.

Output: 1.No evidence of acute ischemic infarction. Moderate chronic small vessel ischemic changes.2.No evidence of mass lesion to account for patient's seizures.3.Scattered presumed chronic microhemorrhages most prominent in the basal ganglia which may be related to hypertension, with peripheral findings also possibly related to amyloid angiopathy.4.Disproportionate ventricular dilatation with respect to sulci. While this simply may be related to preferential periventricular white matter volume loss from chronic small vessel ischemic changes, correlate for symptoms of normal pressure hydrocephalus.


Instruction: Generate impression based on findings.

Input: Reason: 28yo female with history of stage IB1 cervical cancer s/p radical hysterectomy, bilateral salpingectomy, bilateral ovary tacking on 2/21/15. Assess for recurrent disease. History: soft mobile mass above vaginal cuff PELVIS:UTERUS, ADNEXA: Status post hysterectomy and oophorectomy. No evidence of recurrent tumor.BLADDER: No significant abnormality noted.LYMPH NODES: Small subcentimeter inguinal lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Status post hysterectomy without evidence of recurrent disease or lymphadenopathy.


Instruction: Generate impression based on findings.

Input: Female, 61 years old, with relapsed multiple myeloma and concern for new plasmacytoma. Cervical:Spinal alignment is anatomic. Vertebral body heights are preserved. Marrow signal characteristics are slightly heterogeneous. However, no focal STIR hyperintense or enhancing lesions are seen. The visualized spinal cord is within normal limits. The intervertebral discs are preserved. No significant compromise of the spinal canal or neural foramina is seen. Several mildly prominent and enhancing lymph nodes are seen in the left neck at level II. The left thyroid lobe is enlarged and heterogeneous.Thoracic:Exaggeration of the thoracic kyphosis is seen. Multiple thoracic spine compression deformities are noted including T6, T10, T11 and T12, showing no significant interval change. Marrow signal characteristics are heterogeneous but without focal STIR hyperintensity or pathologic enhancement. The visualized spinal cord is within normal limits. Mild disc bulging is seen at several levels but at no level is there any significant spinal canal or foraminal compromise.Lumbar:A compression deformity of the L1 vertebral body with evidence of kyphoplasty is redemonstrated showing no significant interval change. Mild retropulsion of vertebral body material causes mild effacement of the ventral thecal sac.Superior endplate cavity is seen at L3 with mild associated T1 hypointense marrow signal but no evidence of STIR hyperintensity or pathologic enhancement. However, an area of marrow replacement and pathologic enhancement is seen within the right sacral ala measuring 3 to 4 cm in diameter. This lesion abuts and may infiltrate the right S1 neural foramen.Nonspecific enhancement is seen along and within the left SI joint. No other focal enhancing lesions are detected.The visualized distal spinal cord, conus and cauda equina are within normal limits.At L1-2, there is mild effacement of the ventral thecal sac and mild foraminal narrowing due to vertebral body retropulsion. At the remaining lumbar levels only minimal disc bulging is seen. However, facet arthropathy becomes progressively worse at lower levels. No other significant spinal canal or foraminal stenosis is seen.

Output: 1.An enhancing lesion is present within the right sacral ala with probable infiltration of the right S1 neural foramen. This lesion correlates with elevated FDG uptake on PET and could therefore represent a site of active myelomatous disease.2.Nonspecific enhancement centered on the left SI joint may simply be degenerative in nature.3.Marrow signal of the spine is diffusely somewhat heterogeneous but there are no additional focal or enhancing lesions seen. This heterogeneity may reflect prior disease involvement.4.Multiple compression deformities are unchanged with no new compression deformity identified.5.Mildly prominent left upper cervical lymph nodes are nonspecific. Enlargement of the left thyroid lobe is also nonspecific but could be better assessed with dedicated imaging if clinically warranted.


Instruction: Generate impression based on findings.

Input: 14 year old female with congenital pulmonary stenosis s/p balloon valvuloplasty. Referred for research cardiovascular MRI to evaluate right ventricular volume and function. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 63%, the LV end diastolic volume index is 81 ml/m2 (normal range: 65+/-11), the LVEDV is 133 ml (normal range 109+/-23), the LV end systolic volume index is 30 ml/m2 (normal range 18+/-5), the LVESV is 49 ml (normal range 31+/-10), the LV mass index is 18 g/m2 (normal range 67+/-11), and the LV mass is 78 g (normal range 114+/-24). There are no regional wall motion abnormalities present. Left AtriumThe left atrium is normal in size.Right VentricleThe right ventricle is severely dilated with normal systolic function. The overall RV ejection fraction is 53%, the RV end diastolic volume index is 183 ml/m2 (normal range 69+/-14), the RVEDV is 299 ml (normal range 110+/-24), the RV end systolic volume index is 87 ml/m2 (normal range 22+/-8), and the RVESV is 141 ml (normal range 35+/-13). Right AtriumThe right atrium is moderately dilated. Aortic ValveThe aortic valve is trileaflet, 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 is thickened but opens widely. There is severe pulmonic regurgitation, and no stenosis.Pulmonary valve regurgitant fraction is 41%Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a pseudo-bovine brachiocephalic branching pattern. The aortic root is normal in sizePulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteriesThe main pulmonary artery is hyper-pulsatile. The increases from 33mm to 43mm during the cardiac cycle. The right pulmonary artery as a diameter of 22mm and recieves approximately 60% of cardiac output The left pulmonary artery is mildly stenotic with a diameter of 17mm with evidence of flow acceleration. It receives approximately 40% of cardiac output.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is a trace pericardial effusion. Extracardiac FindingsResidual thymus tissue is noted. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: This is a limited cardiac MRI without contrast performed for research purposes. The following observations are made.1. Severely dilated right ventricle with normal systolic function. (RVEF 53%, RVEDV indexed 183 mL/m2)2. Severe pulmonary valve insufficiency.3. Significant dilation of the main pulmonary artery with evidence of mild left pulmonary artery stenosis.4. Normal left ventricular size and systolic function (LVEF 63%).I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Tongue cancer 20 years ago and new dysarthria: evaluate for recurrence. Dental artifact obscures the anterior oral cavity. Otherwise, no measurable mass is apparent in the posterior tongue. The rest of the upper aerodigestive tract is unremarkable. There is also no significant lymphadenopathy in the neck based on size criteria or abnormal signal characteristics. The thyroid and salivary glands appear to be intact. There is extensive volume loss in the imaged portions of the brain. There are bilateral lens implants. There are secretions in the left sphenoid sinus. There is multilevel degenerative spondylosis of the cervical spine.

Output: 1. Dental artifact obscures the anterior oral cavity. Otherwise, no measurable mass is apparent in the posterior tongue. 2. No significant lymphadenopathy in the neck based on size criteria or abnormal signal characteristics.3. Extensive volume loss in the imaged portions of the brain. 4. Secretions in the left sphenoid sinus may be due to acute sinusitis.


Instruction: Generate impression based on findings.

Input: Reason: eval for etiology of pneumobilia History: nausea, vomiting, epigastric abdominal pain, history of ERCP and cholecystectomy ABDOMEN:LIVER, BILIARY TRACT: No suspicious hepatic lesions. Peripheral perfusional abnormalities are present in the right liver. The common bile duct is dilated to 1.5 cm narrowing distally with peripheral enhancement an wall thickening as well as adjacent inflammatory changes. No choledocholithiasis. No intrahepatic biliary ductal dilatation. Status post cholecystectomy.SPLEEN: No significant abnormality noted.PANCREAS: There are 2 tiny cystic lesions in the pancreatic tail measuring up to 3 mm (501/21). At the pancreatic head neck junction, there is a cystic lesion measuring 1.2 cm. Within the pancreatic head there is another adjacent cystic lesion measuring 0.9 cm. No dilatation of the main pancreatic duct. There is atrophy of the pancreatic tail.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple bilateral renal cysts, the largest measuring up to 4.2 cm in the left midpole.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Again seen is duodenal dilatation raising the suspicion of SMA syndrome.BONES, SOFT TISSUES: Rightward curvature of the spine.OTHER: Cardiomegaly.

Output: 1.Dilatation of the common bile duct with peripheral enhancement, wall thickening and adjacent inflammatory changes along the mid to distal common bile duct, likely reflecting inflammatory changes, possibly cholangitis. No choledocholithiasis.2.Multiple cystic lesions within the pancreas likely represent side branch IPMN's.3.Dilatation of the duodenum is again seen and may suggest SMA syndrome.


Instruction: Generate impression based on findings.

Input: Male, 9 years old.Scapula winging, and palpable mass under the superior medial angle of scapula The images are somewhat degraded due to increased field of view. The soft tissues about the shoulder and scapula have normal MR appearance, without solid mass lesion, discrete fluid collection, or abnormal focal enhancement. The rotator cuff muscles and tendons are grossly unremarkable. The underlying osseous structures are unremarkable, with normal cortical thickness and marrow signal.

Output: No mass lesion or other focal abnormality on MR to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: History of renal carcinoma and vertebral compression fractures. Thoracic spine: The expansile, lobulated metastatic lesion involving the left side of the T3 vertebra is overall slightly smaller, with almost complete resolution of the mass-effect on the thecal sac. In the axial plane, the mass along with its left paraspinal component measures 5.7 cm x 5.4 cm compared to 6.7 cm x 6.0 cm, previously. Obliteration of the left T2-T3 and T3-T4 neural foramina persists. The T7-L3 posterior fixation hardware, which is composed of bilateral transpedicular screws at T7, T8, T11, T12, L2 and L3 and dual posterior rods remain grossly unchanged. The metastatic, expansile lesion involving T9 and the smaller T10 vertebral body lesion are also improved with almost complete resolution of the mass-effect on the thecal sac at T9. The mild right T9 vertebral body compression fracture is unchanged or minimally increased. Vertebral body heights across the fused segment also remain preserved. The thoracic spinal cord shows normal signal and shape.Lumbar spine: There is an expandible cage in the right corpectomy defect at L1. Epidural extension of tumor at this level has virtually resolved. There is no significant change in a subcentimeter enhancing lesion in the inferior L5 vertebral body. There is no significant spinal canal stenosis at any of the lumbar spine levels. The L2 through L5 vertebral body heights are preserved. The metastatic, expansile lesions involving the right sacral ala are slightly smaller with less impingement on the epidural fat and nerve sleeves of the right first and second sacral nerves. Another lesion involving the left iliac crest is better defined and perhaps slightly larger and now contains foci of central T2-hyperintensity and peripheral T2-hypointensity. There are changes of previous left nephrectomy. The right adrenal mass is not completely imaged, while the left adrenal mass is not significantly changed in size, but shows central T2-hyperintensity, which may reflect necrosis.

Output: 1.The expansile metastatic lesions at T3 and T9 are overall smaller with almost complete resolution of the mass-effect on thecal sac. Also, the smaller T10 vertebral body lesion has regressed since January 2016. Mild right sided T9 vertebral body compression fracture is unchanged or minimally increased.2.The minimally expanded metastatic lesion at L1 vertebral body is slightly improved, with no significant impingement upon the lumbar spinal canal.3.A metastatic lesion involving the right sacral ala is also slightly smaller, with less impingement on the sacral neural foramina, while the left iliac crest metastatic lesion appears to be slightly larger, but may also feature treatment effects. 4.The left adrenal mass now demonstrates necrosis, while the right adrenal lesion is not completely imaged.


Instruction: Generate impression based on findings.

Input: 77-year-old male patient with HCC, status post resection. Evaluate for evidence of disease progression. ABDOMEN:LIVER, BILIARY TRACT: Postsurgical changes of a right hepatic segmentectomy. There are at least four lesions within the liver in segment 5/8 (image 43, series 10), segment 4 (image 30, series 10), segment 6/7 (image 44, series 10), and segment 6 (image 64, series 10) which demonstrate mildly hyperintense T2 signal, arterial enhancement, and washout; these are suspicious for hepatocellular carcinoma. The segment 6 lesion measures 1.2 x 1.1 cm (image 64, series 10). Comparison to the prior studies is limited secondary to poor arterial timing on those studies, however, many of these lesions are present on T2 weighted and diffusion weighted imaging on the 5/26/2016 study. Some of these lesions are new from the 2/9/2016 MRI. Multiple other small foci of arterial enhancement without definitive washout are indeterminate. The portal vein is patent.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: At least four hepatic lesions with imaging features suspicious for hepatocellular carcinoma. Additional hepatic subcentimeter arterially enhancing foci are indeterminate.


Instruction: Generate impression based on findings.

Input: 5-year-old with juvenile pilocytic astrocytoma status post induction chemotherapy. Evaluate for interval change. There are postoperative findings related to occipital craniotomy and C1 laminectomy for partial resection of a posterior fossa mass with subjacent susceptibility effect compatible with chronic blood products. There is a right parietal approach ventriculostomy catheter that terminates near the foramen of Monro, which is unchanged in position. The ventricles have not significantly changed in size compared to prior exam. The tumor centered in the right cerebellar hemisphere and brainstem with encasement of the basilar artery and right 7th and 8th cranial nerves has decreased in size. Indeed, the tumor overall measures 24 x 36 mm, previously 29 x 40 mm. In particular, a T2 hyperintense portion involving the medulla and upper cervical cord measures 22 x 10 mm, previously 28 x 18 mm. There has also been interval decrease of the associated enhancement. There is interval decrease in the tumor extension along the cisternal portion of the right trigeminal nerve and into Meckel cave. Apparent high signal in the left cerebellopontine angle cistern on the FLAIR sequence without correlate on other sequences likely represents CSF flow artifact. There is no evidence of acute infarct. The major cerebral flow voids are intact. The skull and scalp soft tissues are unchanged.

Output: Interval decrease in size and enhancement of the residual posterior fossa pilocytic astrocytoma is compatible with treatment response. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Male, 30 years old. Wrist pain. Concern for FCR tendinitis versus ganglion. LIGAMENTS: Evaluation of the ligaments is limited due to lack of intra-articular contrast. However, we see no findings to suggest injury of the intrinsic ligaments.TRIANGULAR FIBROCARTILAGE COMPLEX: There is a small perforation within the articular disc of the triangular fibrocartilage situated approximately 2 mm from its radial attachment.TENDONS: The visualized portions of the flexor carpi radialis tendon appear normal. The remaining flexor tendons appear normal, although a discrete palmaris longus tendon is not visualized and may be absent. The remaining tendons appear normal.BONES: Bone marrow signal intensity is normal.ADDITIONAL

Output: 1.Small masses of near-fluid signal intensity as described above likely representing ganglia, given the limitations of a nonenhanced study.2.Focal perforation of the articular disc of the triangular fibrocartilage.


Instruction: Generate impression based on findings.

Input: 31-year-old female with groin pain. Evaluate for labral tear. ACETABULAR LABRUM: There is high signal intensity which incompletely separates the anterior labrum from the underlying acetabulum from the 2 o'clock position to the 4 o'clock position. Although inferiorly this defect has the appearance of a normal variant sublabral recess, it extends more superiorly than the typical recess and therefore we suspect this represents an incomplete undersurface tear of the acetabular labrum. The posterior labrum appears intact. The remainder of the superior labrum appears intact.ARTICULAR CARTILAGE AND BONE: The articular cartilage appears intact. We see no CAM deformity. The bone marrow signal intensity is within normal limits. The ligamentum teres appears intact. The left hip is unremarkable. The pubic symphysis and sacroiliac joints are unremarkable. The imaged lower lumbar spine is unremarkable.SOFT TISSUES: The musculature of the hip is normal in appearance. ADDITIONAL

Output: Incomplete undersurface tear of the anterior labrum.


Instruction: Generate impression based on findings.

Input: Other specified disorders of muscle [M62.89], Reason for Study: ^Reason: evaluate for intracranial mass History: R sided numbness, word finding difficulty. Multifocal scattered left frontal lobe diffusion restriction lesions were seen without evidence of susceptibility artifacts indicating acute ischemic stroke.Underlying brain shows patch bihemispheric periventricular white matter FLAIR/T2 high signal intensity lesions indicating nonspecific small vessel ischemic disease, unchanged.On gadolinium enhanced scan, especially medial aspect of the left frontal lobe shows gyral pattern vascular enhancement again consistent with acute vascular territorial (left anterior cerebral artery) ischemic stroke.Lobulating contoured nonenhancing right parotid deep lobe mass is again seen, measured size was 23 mm x 9.6 mm, 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. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear. Small retention cyst on the left maxillary sinus.

Output: 1. Acute ischemic stroke without evidence of hemorrhagic conversion at the left frontal lobe as described above.2. Unchanged underlying nonspecific small vessel ischemic disease.3. Unchanged right deep parotid gland correlating contour not enhancing lesion since prior scan.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Perianal pain and history of abscess, evaluate for perianal fistula. PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is a curvilinear focus of increased signal on diffusion weighted and postcontrast subtraction images extending from the anus at the 6:00 position slightly eccentric to the right which does not have a definite correlate on T2 weighted images and is equivocal for a perianal fistula. No associated perianal drainable fluid collections are identified.BONES, SOFT TISSUES: There is an osseous lesion with thin sclerotic margins within the intertrochanteric region of the right femur (series 6, image 20) which measures 2.5 x 1.5 x 3.9 cm. The lesion demonstrates intermediate T1 signal, increased T2 signal, and does not enhance. The lesion does not appear to have significantly changed in size since 2002 CT. There are small foci of fluid signal within the origin of the left hamstring tendon origin with associated tendon thickening as well as surrounding fluid and enhancement compatible with tendinosis and partial tendon tear. There is also subtle increased fluid signal surrounding the origin of the right hamstring tendon origin compatible with mild tendinosis.OTHER: A nonenhancing subcentimeter soft tissue nodule within the superficial subcutaneous fat of the right labia is nonspecific but may represent a sebaceous cyst. There is an additional nonspecific subcentimeter enhancing nodule within the subcutaneous soft tissues of the left gluteal region.

Output: 1.Equivocal perianal fistula at 6:00 position without drainable collection.2.Left greater than right hamstring tendinopathy with partial tendon tear on the left.3.Nonspecific right femoral intertrochanteric osseous lesion. Given imaging features and stability since 2002, favor benign etiology. However, if there is clinical concern for metastatic bone disease, nuclear medicine bone scan could be considered.4.Nonspecific subcentimeter right labial and left gluteal subcutaneous soft tissue nodules, recommend correlation with physical exam, sebaceous cyst formation a differential consideration.


Instruction: Generate impression based on findings.

Input: Contrast remained within the radiocarpal joint without extension into the mid-carpal or distal radioulnar joints. Please refer to the subsequent MRI report for further information.Exposure time: 2:14 minutes

Output: Successful right wrist arthrogram as above.


Instruction: Generate impression based on findings.

Input: Male, 58 years old, with Parkinson's disease, pre-DBS evaluation. No enhancing lesions are seen. A chronic appearing lacunar infarct of the right basal ganglia is noted. Mild additional scattered areas of periventricular T2 hyperintensity are seen likely indicating microvascular ischemic disease. There may be some obscuration of the substantia nigra and red nucleus on the right as visualized on 3-D T2 weighted images, though this sequence is artifact prone and the findings may not be reliable. It does appear that there are scattered prominent perivascular spaces within the midbrain. The left temporal horn and atrium are more prominent than on the right which may reflect anatomic variation. Diffuse paranasal sinus mucosal thickening is seen particularly affecting the ethmoid air cells.

Output: Limited sequences are provided for surgical planning purposes. No acute intracranial abnormalities are suspected.


Instruction: Generate impression based on findings.

Input: 40 years Male (DOB:2/28/1975)Reason: Evaluate for any structural abnormality given new HAs of R occipital to frontal region, constant and dull History: pls see abovePROVIDER/ATTENDING NAME: RIMAS V LUKAS RIMAS V LUKAS The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate minor opacities in the right middle ethmoid air cells. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: MRI of the brain is within normal limits


Instruction: Generate impression based on findings.

Input: Unqualified visual loss, both eyes [H54.3], Reason for Study: ^Reason: Bilateral vision loss History: above There is no evidence of restricted diffusion lesion.There is no abnormal signal intensity on this scan.There is no evidence of mass.The ventricles, sulci and cisterns are slightly prominent but symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: No evidence of acute ischemic stroke.No evidence of mass or abnormal signal intensity on this scan.


Instruction: Generate impression based on findings.

Input: 50 year old male with left shoulder pain. ROTATOR CUFF: There is a full-thickness tear of the anterior fibers of the supraspinatus tendon at the level of its insertion on the greater tuberosity measuring approximately 9 mm in AP dimension. There is no significant retraction. The supraspinatus muscle appears intact. The infraspinatus muscle and tendon appear intact. The subscapularis and teres minor muscles and tendons appear intact.SUPRASPINATUS OUTLET: There is a trace amount of fluid within the subacromial subdeltoid bursa. Mild degenerative changes affect the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is anatomic. Although this examination was not protocoled for evaluation of the glenoid labrum, the labrum appears intact.BICEPS TENDON: The tendon of the long head of the biceps appears intact. ADDITIONAL

Output: Full-thickness tear of the rotator cuff without retraction as described above. The long head of the biceps tendon appears intact.


Instruction: Generate impression based on findings.

Input: Female 78 years old Reason: Evaluate for cause of knee pain History: knee pain Exam is slightly limited by motion artifact.MENISCI: Complex tearing of the medial and lateral menisci with marked loss of substance of the body of the lateral meniscus.ARTICULAR CARTILAGE AND BONE: There is complete cartilage loss of the medial patellar facet and patellar eminence with a few foci of underlying reactive marrow change. The articular cartilage of the lateral patellar facet is thinned but without full thickness defect. There is fraying and irregularity of the articular cartilage in the femoral trochlea without evidence of full-thickness cartilage defect.There is marked loss of cartilage in the medial and lateral compartments with areas of full-thickness loss in both compartments and associated marrow edema. There are tricompartmental osteophytes. LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1.Severe degeneration and complex tearing of the medial and lateral menisci.2.Marked cartilage loss and osteoarthritic changes in all 3 compartments.


Instruction: Generate impression based on findings.

Input: Female, 37 years old. Reason: r/o adenopathy, recurrence History: h/o thyroid cancer, s/p lobectomy (no RAI) RIGHT LOBE MEASUREMENTS: Status post right thyroid lobectomy.LEFT LOBE MEASUREMENTS: 1.6 x 1.0 x 5.0 cm.ISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: Status post right thyroid lobectomy, without focal lesion in the right thyroid bed.LEFT LOBE: Homogeneous echotexture, without focal lesion.ISTHMUS: Homogeneous echotexture, without focal lesion.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Benign-appearing cervical lymph nodes are identified. A left level 3 lymph node measures 0.3 x 0.2 x 1.8 cm.OTHER: No significant abnormality noted.

Output: Status post right thyroid lobectomy, without evidence of recurrent disease.


Instruction: Generate impression based on findings.

Input: The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. Mucosal thickening is present throughout the paranasal sinuses and there are superimposed air-fluid levels in the maxillary sinuses. There is no abnormal enhancement within the brain.

Output: Negative MRI of the brain including gadolinium enhancement. Specifically, there are no MRI findings to explain the patient's symptoms.


Instruction: Generate impression based on findings.

Input: 42-year-old woman with history of pancreatic lesion. ABDOMEN:LIVER, BILIARY TRACT: The liver appears normal in signal and morphology. Cholelithiasis without evidence of cholecystitis. No intra or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: The tail of the pancreas (6/17) there is a 38 x 34 mm homogenous markedly T2 hyperintense lobulated lesion without enhancement. A few thin internal septations are noted, but there is no nodular component. Along the medial aspect there is a small, tail-like extension towards the pancreatic parenchyma (900/22), but lesion otherwise does not clearly communicate with the pancreatic duct. This lesion measured 34 x 31 mm on the prior exam and has significantly increased in size since exam in 2008 (when measured up to 1.3 cm). The remainder of the pancreas appears normal and there is no pancreatic ductal dilatation.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: Simple ovarian cysts noted.

Output: Nonenhancing cystic pancreatic lesion containing thin septations located in the tail of the pancreas, gradually increasing in size over serial exams. Based on imaging appearance, this could represent a oligocystic or macrocystic variant of serous cystadenoma but a purely cystic mucinous cystic neoplasm cannot be entirely excluded (the cystic components of lesion do not demonstrate variable or increased T1 signal). Please correlate with clinical findings and, given continued increasing size (lesion now measures up to 3.8 cm), consider repeat EUS/biopsy.


Instruction: Generate impression based on findings.

Input: Clinical question: Intracranial hemorrhage. Signs and symptoms: Confusion, seizures. Nonenhanced head CT:Images through posterior fossa are unremarkable and stable since prior study. Previously noted acute hematoma in the right occipital lobe is again identified in the definitive interval change in its density or measurements. Mildly dilated supratentorial ventricular system likely result of parenchymal volume loss remain stable. Small amount of blood in the dependent portion of occipital horn of the lateral ventricle is noted. There is slight increase in the amount of blood in the left occipital horn likely result profunda precipitation of blood within the ventricle. Small amount of blood in the subarachnoid space also is noted and stable.Advanced periventricular and subcortical low attenuation of white matter is suspected for extensive small vessel ischemic stroke of indeterminate age. This findings were present on multiple prior CT and MRI exams and if no appreciable change.

Output: Stable constellation of intracranial findings of right occipital lobe hematoma and its minimal surrounding vasogenic edema, mildly dilated supratentorial ventricular system and extensive small vessel disease.


Instruction: Generate impression based on findings.

Input: 35 years Female (DOB:10/18/1980)Reason: preop planning for brain biopsy. To be done under general anesthesia right before her OR time History: preopPROVIDER/ATTENDING NAME: BAKHTIAR YAMINI EHTASHAM G KHATTAK Since prior exam some leptomeningeal enhancement has resolved.Periventricular and subcortical white matter lesions of a mild degree are nonspecific but unchanged since the prior exam. At this age they are most likely vascular related. Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related. Punctate foci of T2 signal hyperintensity also present in the middle cerebellar peduncles which were also present on the prior exam and have not changed substantially. They were less conspicuous on the 5/5/2016 exam.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. There are retained secretions in the nasopharynx and the patient appears to be status post intubation.

Output: 1.Please note that this examination was performed for the purpose of stereotactic guidance during surgery and is a limited exam. 2.There is no residual leptomeningeal enhancement convincingly appreciated on the current exam.3.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related. 4.Punctate lesions in the middle cerebellar peduncles are redemonstrated and stable since the prior exam but new since the 5/5/2016 exam. It is suspected to be sequela of the patient's prior leptomeningeal disease.


Instruction: Generate impression based on findings.

Input: 55-year-old male with hematuria. RIGHT KIDNEY: The right kidney measures 10.8 cm in length. Mildly echogenic renal parenchyma. No hydronephrosis.LEFT KIDNEY: The left kidney measures approximately 12 cm in length. Suboptimal visualization of the left upper pole. The known subcapsular seroma of the left upper pole measures approximately 6.4 cm in diameter, however there is incomplete visualization due to extensive shadowing.URINARY BLADDER: Partially distended urinary bladder without significant abnormality.OTHER: No significant abnormalities noted.

Output: Suboptimal visualization of the left kidney. A subcapsular seroma was described on the 5/5/2016 MRI exam, however there is extensive shadowing of the left upper renal pole precluding further evaluation. There could be overlying calcifications. Consider CT for further evaluation.


Instruction: Generate impression based on findings.

Input: Biliary stricture with history of duplicated CBD with hepaticojejunostomy ABDOMEN:LIVER, BILIARY TRACT: Hepatic steatosis. No focal parenchymal lesions. The hepatic vasculature is patent. Status post hepaticojejunostomy. Mild prominence of the intrahepatic biliary ducts without (ducts measure less than 2 mm) significant dilation or evidence of stenosis. 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: The appendix is normal. BONES, SOFT TISSUES: No significant abnormality noted.

Output: Hepaticojejunostomy without evidence of stenosis, no significant biliary ductal dilatation. 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: History of epidermoid cyst. Evaluate for change. Signs and symptoms: Headache. Pre and post enhanced brain MRI:Examination demonstrates a loculated extra-axial T1 hypointense, T2 hyperintense, FLAIR hyperintense restricted diffusion in the medial right anterior temporal lobe which partially herniates through the tentorium into the right perimesencephalic cistern similar to prior exam. A larger slightly more posteriorly located similar signal changes in the right posterior medial temporal and perimesencephalic cistern similar to prior exam consistent with patient's known epidermoid tumor. The largest transaxial dimensions of the more anteriorly located component of tumor is 22.5 x 25 mm compared to prior study measurement of 22 x 23.5 mm. There is subtle associated mass effect of this component of tumor on the right cerebral peduncle. The larger contiguous more posteriorly located component of epidermoid demonstrate interval increased size and measures at 21 x 28 mm in transaxial dimensions compared to prior study re-measurements of 17.5 x 23 mm. There is also subtle interval increased size and mass effect of the infratentorially herniated component of epidermoid on the superior aspect of right cerebellar. There is no edema of the adjacent brain parenchyma. Similar to prior exam there is expected restricted diffusion of epidermoid and without abnormal enhancement. The anatomical morphology and signal intensity of brain parenchyma is otherwise within normal on all MRI sequences and without change since prior study.Ventricular system remains within normal and with maintained midline. There is no detectable abnormal parenchymal or leptomeningeal enhancement.Calvarium has normal signal intensity and without abnormal enhancement.Unremarkable images through the orbits and including axial fat sat post enhanced series.

Output: 1.No acute intracranial process.2.Examination redemonstrates a loculated right medial temporal and right perimesencephalic cistern epidermoid with interval increased size of its more posteriorly located perimesencephalic and infratentorially herniated components with resultant increased mass effect on the superior aspect of right cerebellum as detailed/measured above. 3.Unremarkable pre and post enhanced brain MRI otherwise.


Instruction: Generate impression based on findings.

Input: A 53 year old male with personal history of hypertension, hyperlipidemia, 3 vessels coronary artery bypass graft and mitral valve repair (2012). Recently heart failure symptoms with an echocardiography that showedLVEF of 40%. Referred to stress cardiac MRI for further evaluation. MEDICATIONS: aspirin, atorvastatin, carvedilol, enalapril, hydralazine, isosorbide mononitrate, spironolactone. First Pass PerfusionDuring hyperemia, there is a perfusion defect involving the entire apex apex, all but the mid anterolateral, anterior, anteroseptal, and inferoseptal walls, and the basal inferior and inferolateral walls. Most of these perfusion defects are secondary to the below described transmural myocardial infarctions and not due to ischemia.Viability/ Myocardial ScarThere is are two large transmural myocardial infarctions based on late gadolinium enhancement imaging. The first involves the basal inferior and inferolateral wall. The second involve the mid ventricular anterolateral, anterior, anteroseptal, and inferoseptal walls and the apical anterior, septal, and inferior walls. These segments are not viable. The remainder of the segments are free of myocardial infarction and are likely to be viable.Left VentricleThe left ventricle is severely dilated with moderate-to-severe left ventricular systolic dysfunction. The overall LV ejection fraction is 34%, the LV end diastolic volume index is 114 ml/m2 (normal range: 65+/-11), the LVEDV is 223 ml (normal range 109+/-23), the LV end systolic volume index is 75 ml/m2 (normal range 18+/-5), the LVESV is 146 ml (normal range 31+/-10), the LV mass index is 54 g/m2, and the LV mass is 106 g. Regional wall motion abnormalities corresponding to the above myocardial infarctions are noted.There is no intracavitary thrombus.Left AtriumThe left atrium is normal in size (94ml). Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 55%, the RV end diastolic volume index is 81 ml/m2 (normal range 69+/-14), the RVEDV is 158 ml (normal range 110+/-24), the RV end systolic volume index is 36 ml/m2 (normal range 22+/-8), and the RVESV is 70 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThere is a mitral valve ring present and there is trace 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. There is a "pseudo-bovine" brachiocephalic branching pattern (normal variant).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 FindingsSternal wires were noted. Small hiatal hernia is noted. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. There are two large transmural myocardial infarctions with only a small amount of residual peri-infarct ischemia involving the apical lateral wall. The segments affected by the myocardial infarctions are not likely to be viable. The remainder of the myocardium is free of myocardial infarction and likely to be viable. 2. Severe LV dilation with moderate to severe systolic dysfunction (LVEF 34%).3. Normal RV size and systolic function (RVEF 55%).4. A mitral valve ring was noted without significant mitral regurgitation.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 34 years Female (DOB:11/30/1981)Reason: evaluate structural lesion History: seizurePROVIDER/ATTENDING NAME: JAMES X. TAO JAMES X. TAO There is right-sided soft tissue isn't separately present which appears to be open lip. There appears to be an adjacent cortical dysplasia or polymicrogyria present. The septum pellucidum appears to be absent. The pituitary appears to be within normal limits. The optic nerves appear intact to the extent of visualization.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: Right-sided schizencephaly associated with absence of the septum pellucidum and some adjacent cortical dysplasia..


Instruction: Generate impression based on findings.

Input: There is no restricted diffusion to suggest acute ischemia. Redemonstrated is extensive encephalomalacia in the right temporal lobe lobe with ex vacuo dilatation of the right lateral ventricle. As before, there are areas of high T2/FLAIR hyperintensity in the subcortical and the periventricular white matter bilaterally consistent with chronic ischemic disease. Chronic lacunar infarcts involving the bilateral corona radiata, as well as the right posterior frontal centrum semiovale are again seen. The ventricles and the sulci are prominent related to volume loss, as before. Punctate susceptibility is seen in the right temporal lobe, suggestive of chronic blood products in the area of previous infarct. There has been some improvement in right maxillary sinus opacification. There is mildly increased mucosal thickening in the left maxillary sinus. Partial left mastoid air cell opacification again seen. Bilateral lens implants.

Output: 1. No evidence of acute ischemia.2. Chronic large right temporal lobe infarct again seen. Chronic small vessel ischemic disease with multiple bilateral lacunar infarcts also again seen.


Instruction: Generate impression based on findings.

Input: Reason: Cervical cancer, MRI for radiation planning History: None currently, cervical cancer PELVIS:UTERUS, ADNEXA:Applicators are present within the vagina and uterus. T1/T2 hypointense cervical mass seen on the prior exam is no longer evident. No measurable disease is present. The ovaries appear normal.BLADDER: Foley catheter.LYMPH NODES: No pelvic lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Complete resolution of previously seen cervical mass. No measurable disease is present.


Instruction: Generate impression based on findings.

Input: Obstructing right colon cancer mass status post ileocolic resection. Indeterminate liver lesions. Pathology states invasive colonic adenocarcinoma. ABDOMEN:LIVER, BILIARY TRACT: Normal liver morphology. Several mildly T2-weighted hyperintense and diffusion restricting lesions which demonstrate rim and mild internal enhancement. The right hepatic lobe segment 7 lesion measures 1.3 x 1.1 cm (series 901/274). Segment 8 lesion measures 1.2 x 1.0 cm (series 701/259). These are most suspicious for metastatic disease. Punctate lesion in the segment IVb (series 901/333) has subtle rim-enhancement, suspicious for metastatic disease. There are several additional punctate lesions in the both the right and left hepatic lobe which demonstrates and restricted diffusion (series 806, image 248, 208, 200, and 168). They cannot be characterized on post-contrast imaging due to their small size. These are not clearly associated with cyst-like T2-weighted hyperintensity, therefore metastatic disease cannot be excluded.T2-weighted very hyperintense foci in the left hepatic lobe are noted (series 701/28) without restricted diffusion or abnormal enhancement, likely representing hepatic cysts.No intra or extrahepatic biliary ductal dilatation. Cholelithiasis within a normally distended gallbladder without evidence of gallbladder inflammation. Debris/gallstone at level of gallbladder neck/cystic duct.SPLEEN: The spleen is normal in size and morphology without a focal abnormality.PANCREAS: Moderately atrophic pancreas without pancreatic ductal dilatation or focal lesion.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Symmetric perinephric fat stranding/fluid. No hydroureteronephrosis or suspicious lesion.RETROPERITONEUM, LYMPH NODES: No enlarged retroperitoneal lymphadenopathy.BOWEL, MESENTERY: There is moderate small bowel dilatation up to 4.2 cm. The right lower quadrant is not included in the field-of-view. Fluid-filled colon is not significantly distended.BONES, SOFT TISSUES: Trace bilateral pleural effusions with adjacent compressive atelectasis.OTHER: No significant abnormality noted.

Output: 1.Right hepatic lobe lesions, the largest of which are most suspicious for metastatic disease. Suspected segment IVa subcentimeter metastatic lesion. Several additional punctate lesions in both the right and left hepatic lobe demonstrate restricted diffusion without characteristics of cysts or hemangioma, therefore additional sites of metastatic disease cannot be excluded. 2. Cholelithiasis.3. Small bowel dilatation may represent post-operative ileus; please correlate for obstruction.


Instruction: Generate impression based on findings.

Input: 64-year-old male with left knee pain. Evaluate for lateral meniscus tear. MENISCI: There is a vertically oriented intermediate signal intensity traversing the peripheral aspect of the posterior horn of the medial meniscus compatible with a vertical tear. The anterior horn of the medial meniscus appears normal. The lateral meniscus appears normal.ARTICULAR CARTILAGE AND BONE: There is generalized thinning of the articular cartilage of the medial femoral condyle with areas of full-thickness intermediate signal intensity defects traversing the articular cartilage of the medial femoral condyle with adjacent bone marrow edema. The articular cartilage of the tibia appears normal. There is mild subchondral bone marrow edema within the medial tibial plateau. There are focal areas of partial thickness fissures within the articular cartilage of the mid femoral trochlea. There is small amount of bone marrow edema within the lateral facet of the patella. The articular cartilage of the patella appears normal.LIGAMENTS: The cruciate and collateral ligaments appear normal.EXTENSOR MECHANISM: The extensor mechanism appears normal and intact throughout its course.ADDITIONAL

Output: 1. Findings compatible with a vertical tear of the posterior horn of the medial meniscus. No evidence of lateral meniscus tear as clinically questioned.2. Articular cartilage defects affect the medial femoral condyle and trochlea. 3. Small joint effusion about the knee. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Female, 22 years old, with weakness and paresthesias. Brain:Brain parenchymal morphology and signal characteristics are within normal limits. No focal lesions are seen. No edema or mass effect is detected. Diffusion-weighted images are within normal limits. There is no evidence to suggest intracranial hemorrhage or any abnormal extra-axial fluid collection. The ventricles are normal in size and morphology.Cervical spine:The spinal cord demonstrates normal signal intensity and morphology and is free of focal lesions. No epidural abnormalities are suspected. Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. Marrow signal characteristics are unremarkable. The intervertebral discs are preserved with no significant spinal canal or foraminal compromise.Thoracic spine:The spinal cord demonstrates normal signal intensity and morphology and is free of focal lesions. No epidural abnormalities are suspected. Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. Marrow signal characteristics are unremarkable. The intervertebral discs are preserved with no significant spinal canal or foraminal compromise.

Output: Unremarkable noncontrast evaluations of the brain, cervical and thoracic spine. No specific findings are seen to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: 62-year-old male with chronic viral hepatitis ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology. Focus of arterial blush in the right lobe of the liver, segment five without definite washout. No restricted diffusion. SPLEEN: The spleen is enlarged measuring 16 mm.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Minimally complex cyst in the inferior pole of the left kidney. Small subcentimeter cyst in the interpolar right kidney. No hydronephrosis bilaterally.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Cirrhotic liver morphology with focal arterial blush in the right lobe of the liver without definite washout or restricted diffusion is nonspecific. Close follow-up is recommended.


Instruction: Generate impression based on findings.

Input: Wrist mass and pain. Rule out dorsal wrist mass, cartilage lesion versus bony. A marker was placed along the wrist dorsal to the bases of the second and third metacarpals. Just lateral and deep to this marker is a 6 mm focus of low signal intensity adherent to the dorsal aspect of the base of the second metacarpal and the dorsal aspect of the trapezoid, spanning the second carpometacarpal joint. I cannot tell if this represents a prominent bridging osteophyte or thickened fibrotic capsule, but I suspect this represents the palpable mass. I see no other findings to suggest to indicate a mass. There may be mild tendinosis of the extensor carpi ulnaris as it courses adjacent to the ulnar styloid, but the tendons of the wrist are otherwise unremarkable. A small amount of increased signal intensity within the distal radioulnar joint may represent fluid and/or synovitis. There is also fluid signal intensity concentrated within the pisotriquetral recesses. Cysts and edema within the proximal and medial aspect of the lunate may reflect ulnolunate impaction. Additional rounded foci of signal abnormality within multiple carpal bones may represent cysts or chronic erosions. Mild deformity of the ulnar styloid may reflect old trauma. The scapholunate ligament appears intact. Mild increased signal intensity centrally within the lunotriquetral ligament suggests mild degeneration. There is also increased signal intensity within the articular disc of the triangular fibrocartilage suggesting degeneration. Tiny foci of fluid signal intensity volar to the scaphoid may represent small synovial cysts or tiny ganglia.

Output: Subcentimeter low signal intensity focus along the dorsal aspect of the second carpometacarpal joint may either represent a bridging osteophyte or focal thickening/fibrosis of the joint capsule. This can be further evaluated with computed tomography, if clinically warranted. Other findings as above.


Instruction: Generate impression based on findings.

Input: Diagnosis: Weakness WeaknessClinical question: strokeSigns and Symptoms: l weakness MRI of the brainA small focus of diffusion restriction is present in the right pons.Punctate foci of T2 hyperintensity with FLAIR and T1 hypointensity are present in the pons and right cerebellum. There is a moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. T2 and FLAIR hyperintense lesions are also present in the pons and thalami.A punctate focus of signal loss on SWI is identified in the right upper pons while others identified in the left cerebral peduncle, several in each thalamus, basal ganglia, cerebellar hemispheres, deep structures of the cerebellum, left centrum semiovale and to a lesser degree subcortical white matter of the right temporal lobe, right frontal lobe and bilateral parietal lobes.The CSF spaces are appropriate for the patient's stated age with no midline shift. The visualized portions of the paranasal sinuses demonstrate some mile mucosal thickening in the right maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries. There are foci of narrowing along the intracranial vertebral arteries.There is a high grade stenosis of the proximal basilar artery. There is fetal origin of the posterior cerebral arteries bilaterally with very small p1 segments.Loss of signal from the left m1 segment suggests stenosis.The anterior communicating artery is identified. The left A1 segment is small.

Output: 1.Acute lacunar infarction involving the right paramedian pons.2.There is vertebrobasilar cerebrovascular disease with high grade stenosis of the proximal basilar artery. Please note that there are bilateral PCA fetal origins.3.Left m1 segment MCA stenosis4.Multiple microhemorrhages in a pattern suggestive of hypertension.5.Periventricular and subcortical white matter lesions of a moderate degree are nonspecific. At this age they are most likely vascular related. 6.Brainstem and thalamic lesions are nonspecific. At this age they are most likely vascular related. 7.Old lacunar infarcts are suspected in the pons and right inferior cerebellumI 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 bone left-sided weakness. Signs and symptoms: left-sided weakness. Status post craniotomy. Nonenhanced CT of brain:Examination demonstrate a large right frontal -- temporal craniotomy. Residual air and blood (epidural space) under the craniotomy flap is noted. This finding measures approximately 10.4 mm in thickness. There is large area of vasogenic edema in the right frontal lobe with multiple foci of small hemorrhage. The area of vasogenic edema was noted on prior MRI examination however no hemorrhage was detected on preoperative study. There is diffuse effacement of cortical sulci in the right hemisphere. There is approximately 2 mm midline shift. No hydrocephalus.

Output: 1.Epidural blood under the craniotomy flap measuring approximately 10.4 mm.2.extensive vasogenic edema of right frontal lobe with multiple small foci of hemorrhage.3.Approximately 2 mm midline shift. No hydrocephalus.


Instruction: Generate impression based on findings.

Input: History of hepatitis C cirrhosis and hepatocellular carcinoma. Surveillance examination. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic morphology of liver with a nodular surface contour.Immediately adjacent to the segment 2/3 ablation cavity there is a 1.6 x 1.3 cm lesion with restricted diffusion, as increased T2 signal, demonstrates early arterial enhancement as well as venous washout compatible with hepatocellular carcinoma.There are multiple patchy wedge-shaped areas of transient hepatic intensity difference on the arterial phase postcontrast images, however none of these areas show early washout to suggest hepatocellular carcinoma.The portal vein, hepatic veins, and hepatic artery are patent.No ascites. Numerous gastric and esophageal varices appearing similar to prior.Cholelithiasis. No intrahepatic or extrahepatic biliary ductal dilatation.SPLEEN: The spleen is surgically absent.PANCREAS: Status post distal pancreatectomy.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Unchanged simple cyst in the lower pole of the right kidney. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: Tortuous but nondilated abdominal aorta.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.1.6 cm hepatocellular carcinoma immediately adjacent to the segment 2/3 ablation cavity.2.Prominent gastric and esophageal varices. Similar to prior.


Instruction: Generate impression based on findings.

Input: History of locally advanced multicentric left breast cancer status post chemotherapy with good response, patient presents for left breast mammogram and ultrasound to look for residual tumor. Ultrasound of the left axilla to be performed to locate the clip within the biopsied lymph node for future localization. Mammogram: Three standard views of the left breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses(BiRads Density Category C), unchanged in pattern and distribution. Hydro mark Clip identified in the left lower axillary region with irregular density around it. No definite lymph node morphology is noted surrounding the clip which could be due to post biopsy change.2 oval focal asymmetries identified in the posterior superior left breast best seen on MLO view inferior to the clip which most likely represent cysts on subsequent ultrasound and MRI performed today.Hydro mark clip identified in the left breast 6:00 position. Large area of focal asymmetry with suspicious calcifications extending from approximately 4-8 o'clock position still spans most of the central left breast approximately measuring 12 cm predominantly in the inferior breast on the MLO view.Approximately 2 cm area of focal asymmetry is identified in the left retroareolar region which corresponds to the findings on MRI.Ultrasound: Irregular mixed echogenic mass is identified in the retroareolar region measuring 2 x 0.7 x 2.2 cm. Multiple similar morphology masses discontinuous in nature are identified in the left breast from 6 to 9:00 position. Largest mass at 6:00 position approximately measures 2.8 x 1.2 x 3.2 cm, previously measured 2.4 x 1.3 x 1.6 cm, almost stable to minimally increased given difference in technique.2 Simple cysts are identified at 2:00 position 8 cm from the nipple and 10 cm from the nipple most likely corresponding to the MRI findings and the 2 focal asymmetries seen on the MLO view. In the same plane at 2:00 position 12 cm from the nipple there is an irregular hypodense area measuring 6 x 4 x 7 mm with a possible clip artifact. This corresponds most likely to the clip within the low-lying left axillary lymph node.2 lymph nodes identified in the left axillary region, the smaller of the 2 lymph nodes was previously visualized on ultrasound, measures 5 x 7 mm and does not demonstrate a definite central fatty hilum.

Output: 1. Multicentric disease in the left breast on mammogram and ultrasound.2. Possible clip with adjacent irregular density/post biopsy change after lymph node biopsy is identified on ultrasound. If localization of this clip is needed, an attempt can be made under mammographic guidance; if not then under ultrasound.3. Two left axillary lymph nodes identified, smaller of the 2 appears abnormal.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Shoulder pain and limited range of motion. Some sequences are limited by patient motion artifact.ROTATOR CUFF: The supraspinatus muscle and tendon appear intact; the suspected tendinosis and undersurface tearing seen on ultrasound is not evident on this study. There is increased signal intensity along the undersurface of the infraspinatus at its insertion, which may reflect tendinosis or undersurface fraying/insertional tearing (and perhaps representing the suspected abnormality in the posterior supraspinatus seen on US), but we see no full-thickness tear. There is focal scalloping of the underlying humeral head which may reflect old trauma or chronic remodeling, but is not necessarily of any clinical significance. The infraspinatus muscle appears intact. The subscapularis and teres minor muscles and tendons appear intact; the suspected undersurface fraying of the subscapularis tendon seen on the prior ultrasound is not evident on this study, although there are small cysts in the underlying anterior humeral head.SUPRASPINATUS OUTLET: Tiny acromioclavicular joint osteophytes suggest minimal osteoarthritis. There is mild impression upon the superior fibers of the supraspinatus by the distal end of the clavicle. There is increased signal intensity within the distal clavicle on the fluid sensitive sequences, which may represent mild edema or residual red marrow. There is a trace amount of fluid within the subacromial/subdeltoid bursa which is not necessarily of any clinical significance.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is within normal limits. The glenoid labrum appears normal, given the limitations of a non arthrogram study.BICEPS TENDON: The tendon of the long head of the biceps appears intact, within the limitations of a non arthrogram study. The tendon is not well visualized at its transition from the rotator interval to the intertubercular groove, but we see no tendon thickening to confirm tendinosis.ADDITIONAL

Output: Increased signal intensity along the undersurface fibers of the infraspinatus at its insertion could represent tendinosis, fraying, or mild focal articular surface insertional tearing, but we see no full-thickness rotator cuff tear. Other findings as described above.


Instruction: Generate impression based on findings.

Input: 61-year-old male with shoulder pain and symptoms of a rotator cuff tear. Assess for rotator cuff tear or pathology. ROTATOR CUFF: There is thickening and increased signal abnormality within the supraspinatus tendon indicating moderate tendinosis. The supraspinatus and infraspinatus muscles and tendons appear intact. The teres minor and subscapularis muscles and tendons appear intact.SUPRASPINATUS OUTLET: There is a small amount of fluid within the subacromial subdeltoid bursa which may reflect a mild bursitis. Mild degenerative changes affect the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: Mild to moderate degenerative changes affect the glenohumeral joint. The glenohumeral joint alignment is anatomic. No full-thickness articular cartilage defects are identified. There is a small amount of fluid within the glenohumeral joint without evidence of a large effusion. Although this examination was not protocoled for evaluation of the glenoid labrum, there is heterogeneity and increased signal abnormality within the anterior labrum suggestive of degenerative tearing. There is subchondral cyst formation within the humeral head, likely degenerative in etiology.BICEPS TENDON: There is circumferential fluid within the tendon sheath of the long head of the biceps may reflect fluid extension from the glenohumeral joint versus a mild tenosynovitis ADDITIONAL

Output: Rotator cuff tendinosis without evidence of a full-thickness rotator cuff tear and other findings as described above.


Instruction: Generate impression based on findings.

Input: 75-year-old woman with history of buttock and left lower extremity burning pain. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is levoscoliosis of the lumbar spine with apex at L2/L3. Additionally, there is minimal anterolisthesis of L5 on S1. There are multiple Schmorl's nodes and areas of endplate T1 and T2 hyperintensity suggesting fatty change, most predominantly at L2/L3. The intervertebral discs are desiccated with loss of height. The conus medullaris is normal in position at L1/L2.Multilevel degenerative changes are seen, as described below:L1-L2: There is a disc bulge, facet arthropathy, and ligamentum flavum thickening. There is no significant spinal canal stenosis. There is mild left and moderate right neural foraminal stenosis.L2-L3: There is a disc bulge, facet arthropathy, and ligamentum flavum thickening. There is mild spinal canal stenosis. There is mild bilateral neural foraminal stenosis.L3-L4: There is a disc bulge, facet arthropathy, and ligamentum flavum thickening, right greater than left. There is mild spinal canal stenosis and narrowing of the right lateral recess. There is mild left and moderate right neural foraminal stenosis.L4-L5: There is a disc bulge, facet arthropathy, and ligamentum flavum thickening. There is mild spinal canal stenosis. There is moderate to severe right and moderate left neural foraminal stenosis.L5-S1: There is a disc bulge, advanced facet arthropathy, and ligamentum flavum thickening. There is no significant spinal canal stenosis. There is severe left neural foraminal stenosis and mild right neural foraminal stenosis.There are bilateral renal cysts.

Output: Multilevel degenerative disc disease, facet arthropathy, and scoliosis. No high-grade spinal canal stenosis at any level. Multilevel neural foraminal narrowing, worst at L5/S1 where there is severe neural foraminal stenosis with possible impingement of the exiting left L5 nerve root. Additional details as above.


Instruction: Generate impression based on findings.

Input: Knee pain. Lateral joint space pathology versus patellar tendinitis. MENISCI: The anterior horn of the lateral meniscus appears abnormally small with heterogeneous signal representing degeneration and tearing. The tearing extends into the body of the lateral meniscus, and there appears to be a shallow defect of the undersurface of the anterior half of the meniscal body. Increased signal intensity along the undersurface of the inner fibers of the posterior horn of the lateral meniscus likely represents additional fraying/degenerative tearing.There is increased signal intensity within the undersurface of the inner third of the body and posterior horn of the medial meniscus likely representing fraying/degenerative tearing. The anterior horn of the medial meniscus appears intactARTICULAR CARTILAGE AND BONE: There is full-thickness degeneration of the articular cartilage of the lateral tibial plateau beneath and anterior to the posterior horn of the lateral meniscus. There is also full-thickness degeneration of the articular cartilage of the weightbearing portion of the medial tibial plateau between the anterior and posterior meniscal horns with a small amount of underlying degenerative subchondral signal abnormality.. There is focal full-thickness degeneration of the articular cartilage of the patella centrally with underlying subchondral cyst formation. Additional superficial fraying is noted along the articular cartilage of the medial and lateral facets. The articular cartilage of the femoral trochlea appears relatively intact, although the trochlea itself subjectively appears shallow which may reflect dysplasia. There are small tricompartmental osteophytes.LIGAMENTS: The cruciate and collateral ligaments appear intact EXTENSOR MECHANISM: There is slight thickening of the patellar tendon with intermediate signal intensity at its proximal and distal attachment suggesting mild tendinosis. The quadriceps tendon appears intact.ADDITIONAL

Output: 1.Tricompartmental cartilage degeneration as described above.2.Degeneration/tearing of the menisci, lateral greater than medial, as described above.3.Patellar tendinosis.4.Joint effusion and other findings as described above.


Instruction: Generate impression based on findings.

Input: Reason: eval for dynamic instability and spondylolisthesis; flexion and extension views History: low back pain, lumbar degeneration Degenerative disc disease most severe at L4-5 and L5-S1 levels with vacuum phenomena. Alignment is anatomic without evidence of spinal instability. Small anterior osteophyte formation.

Output: Degenerative changes of the lumbar spine as above. No evidence of spinal instability.


Instruction: Generate impression based on findings.

Input: 72 year-old female with altered mental status. There is no evidence of intracranial hemorrhage, mass or edema. A moderate amount of diffuse hypodensity within a periventricular and subcortical white matter distribution consistent with small vessel 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: Small vessel disease, age indeterminate. If there is clinical concern for acute ischemia, an MRI may be considered.


Instruction: Generate impression based on findings.

Input: There is diffuse osseous metastatic involvement that has significantly progressed compared to the prior exam. There are unchanged mild compression deformities of T4, T6, and T12. While on the prior exam there was minimal ventral epidural tumor at T6 and T8 without cord compression, there is now new epidural extension of varying degress throughout the thoracic spine at the T3 - T12 levels. The tumor is mainly ventral and lateral, circumferentially encasing the spinal cord from the T3 through T7 levels and mainly on the right and dorsal to the spinal cord at the T8 and T9 levels. There is also new mild T11-T12 right foraminal epidural extension. The spinal cord compression is most severe at the T4, T6, and T8 levels with T2 hyperintense cord signal at the T8-T9 level and questionably at the T5-T6 level. In addition, there multilevel degenerative changes with disc osteophyte complexes at C3 through C7 resulting in mild spinal canal stenosis and mild degenerative changes at the remaining spinal levels. There is reidentified partially imaged mediastinal lymphadenopathy. There are redemonstrated subcentimeter lesions within both kidneys which likely represent cysts. In addition there is an unchanged subcentimeter T2 hypointense lesion within the right kidney that likely represents a complex cyst. There is a small left pleural effusion and a nonspecific partially imaged lesion within the left upper lobe of the lung.

Output: 1.Marked progression of diffuse osseous metastatic disease with significant worsening of the epidural extension that is now throughout the thoracic spine resulting in cord compression that is most severe at the T4, T6, and T8 levels. There is resultant new cord signal abnormality at the T8-T9 level and questionably at the T5-T6 level.2.Partially imaged mediastinal lymphadenopathy, small left pleural effusion, and a left pulmonary mass that are better assessed on CT.


Instruction: Generate impression based on findings.

Input: Pain over scapholunate ligament. Evaluate for scapholunate ligament tear. LIGAMENTS: No contrast is identified within the radiocarpal joint. The lunotriquetral and scapholunate ligaments appear intact. TRIANGULAR FIBROCARTILAGE COMPLEX: The triangular fibrocartilage complex is grossly intact.TENDONS: The tendons are intact. BONES: There is increased T2 signal within the inferior and ulnar aspect of the lunate bone. Additionally, there is positive ulnar variance. These findings are compatible with ulnar abutment of the lunate. Bone marrow signal is otherwise within normal limits. ADDITIONAL

Output: 1. No evidence of scapholunate ligamentous disruption.2. Findings compatible with ulnar abutment of the lunate.


Instruction: Generate impression based on findings.

Input: 25 year old male with seizure disorder for increased frequency of seizures. generalized discharges. History of staring spells with unresponsiveness. There is no evidence of mesial temporal sclerosis of heterotopia. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No discernible seizure foci.


Instruction: Generate impression based on findings.

Input: 28-year-old female with history of leiomyoma of the uterus presents for MRI evaluation. ABDOMEN:LIVER, BILIARY TRACT: Few scattered subcentimeter T2 hyperintense lesions which do not enhance compatible with cysts. No intrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple T2 high signal and intermediate signal lesions throughout both kidneys. The larger lesions do not demonstrate obvious enhancement. The smaller lesions are small to characterize.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:UTERUS, ADNEXA: There is a large T1 and T2 heterogeneous intramural lesion measuring 11 x 8 x 12 cm (series 17, image 23; series 19, image 15) which demonstrates avid enhancement. The endometrial stripe is displaced inferiorly from mass effect.BLADDER: No significant abnormality noted.LYMPH NODES: No evidence of pelvic lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Large avidly enhancing intramural uterine lesion, likely a leiomyoma.2.Multiple kidney lesions, some of which are compatible with simple cysts. The other renal cysts demonstrate T2 intermediate signal however there is no obvious enhancement. Probable subcentimeter scattered hepatic cysts. Findings most compatible with autosomal polycystic kidney disease.


Instruction: Generate impression based on findings.

Input: 14 years Female (DOB:4/14/2002)Reason: history of NF1 and optic gliomas s/p chemotherapy History: off therapy evaluationPROVIDER/ATTENDING NAME: KELLY KRAMER RUTH RUDINSKY MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. There is redemonstration of signal abnormalities in the right cerebellum, left anterolateral medulla, dentate nuclei, right thalamus and the left thalamus without enhancement.No abnormal enhancing mass lesions are appreciated within the brain parenchyma. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mild mucosal thickening. The visualized portions of the mastoid air cells demonstrate some opacities. MRI orbits:There is a redemonstration of enlargement of the left optic nerve due to an optic nerve glioma which currently measures 7 x 8 mm coronal dimensions and 22 x 8 mm sagittal dimensions. This has not changed since the prior exam from August 2010. In general it has not changed in appearance since the past exam.There is redemonstration of a suprasellar mass extending along the chiasm and right optic nerve measuring 14 by 27 mm axial dimensions on the current exam and has similar dimensions on the August 2010 exam.The eyeballs are intact. No extraconal space mass is identified. The extraocular muscles are intact. The lacrimal glands are symmetric and within normal limits in size and configuration.

Output: 1.redemonstration of bilateral optic gliomas which are stable since the previous exam.2.Redemonstration of multiple lesions in the brain parenchyma within basal ganglia brainstem and cerebellum which are stable since prior exam and suspected represent hamartomatous lesions.3.No new lesions are identified in the brain parenchyma.4.Mucosal thickening in the paranasal sinuses and partial desiccation of the mastoid air cells. This was also present on the prior exam.


Instruction: Generate impression based on findings.

Input: History of gastric bypass presenting with abdominal pain. Evaluate for bowel obstruction. Per EPIC note patient had a Roux-en-Y gastric bypass. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Several small bowel loops are poorly distended. There are several jejunal bowel loops which are significantly dilated up to 4.9 cm (series 701/20) in the left upper quadrant with a suspected high-grade transition point in the lower mid-abdomen (series 701/13). There are additional dilated bowel loops in the epigastric region (series 501/8). No discrete mass is seen at the transition point. Of note, the duodenojejunal junction does not appear to cross the midline, this may be sequela from prior surgery or due to an internal hernia. Contrast has progressed distally to the proximal colon. The sigmoid colon is tortuous and redundant with the transverse colon collapsed in the mid-abdomen. No significant interloop loop fluid, differential bowel enhancement or bowel wall thickening. No significant free fluid or loculated fluid collection. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: See discussion above. There is a small volume free fluid in the pelvis, unchanged.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Dilated proximal mid small bowel with a high-grade transition point in the mid abdomen suspicious for a small bowel obstruction. The findings suggest that this may be due to adhesive disease or an internal hernia. No specific findings of bowel compromise. These findings were discussed with the ordering physician (Dr. Alverdy) at 1645 on 05/17/2016.


Instruction: Generate impression based on findings.

Input: 10 year old male patient with culture negative left hip osteomyelitis. PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: There are small bilateral inguinal lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: There is a region of signal abnormality with decreased T1 signal, increased T2 signal, and enhancement predominantly within the posterior left acetabulum with extension into the left iliac bone and the left ischium; these findings are compatible with osteomyelitis. Interval development of a 1.9 x 0.5 cm peripherally enhancing collection within the superior and posterior left acetabulum which is compatible with abscess formation. This collection abuts the cortex. Two additional cystic foci inferior to this new collection which were present on the prior OSH study are less distinct on this examination.Linear focus of low signal intensity within the left femoral neck is presumably related to prior biopsy.No discrete drainable fluid collection is identified in the surrounding soft tissues of the hip. There is enhancement of the left synovium and trace fluid within the left hip joint. Bone marrow signal intensity within the left femur is grossly normal.OTHER: No significant abnormality noted.

Output: Findings compatible with osteomyelitis of the left acetabulum and surrounding pelvic bones with interval intraosseous abscess formation.


Instruction: Generate impression based on findings.

Input: Female, 62 years old, with spastic quadriparesis. Reversal of the cervical lordosis is seen similar to that noted on the prior examination. Vertebral body heights are preserved. Since the prior examination, there has been progressive partial osseous fusion of at least C5 and C6 if not C7 as well. The intervening disc spaces demonstrate progressive degeneration.The spinal cord shows normal signal intensity throughout. No epidural abnormalities are suspected.C2-3: Progressive facet arthropathy and ligamentum flavum thickening. Progressive disc osteophyte formation and left uncovertebral hypertrophy. Mild generalized spinal canal stenosis. Progressive moderate left foraminal narrowing.C3-4: Progressive facet arthropathy and ligamentum flavum thickening. Progressive posterior disc-osteophyte complex formation with small superimposed central disc extrusion. Progressive moderate generalized spinal canal stenosis. Progressive moderate right foraminal narrowing.C4-5: Facet arthropathy. Posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Mild bilateral foraminal narrowing. No significant interval changes. C5-6: Facet arthropathy on the left. At least partial autofusion of the intervertebral disc with no significant posterior disc-osteophyte complex formation. No spinal canal stenosis. Mild left foraminal narrowing. C6-7: Facet arthropathy on the left and ligamentum flavum thickening slightly progressed. Posterior disc-osteophyte complex formation similar to prior. Mild spinal canal narrowing without significant interval change. Severe left and moderate right foraminal narrowing, unchanged.C7-T1: Facet arthropathy and ligamentum flavum thickening. No significant spinal canal or foraminal stenosis.

Output: 1.Progression of disc degeneration at several levels including C3-4 where there is a moderate generalized spinal canal stenosis.2.Interval partial fusion of the C5 and C6 vertebral bodies and potentially also C7 to some degree.3.Severe foraminal narrowing is evident on the left at C6-7 with mild to moderate narrowing elsewhere.


Instruction: Generate impression based on findings.

Input: Clinical question: Any change in schwannoma at C7 -- T1 or other tumors. Signs and symptoms: NF Type 2. cord compression, multiple meningioma schwannomas and worsening gait. Pre-and post-enhanced cervical MRI:Examination is severely limited to nearly nondiagnostic in particular on post enhanced series due to extensive motion artifact. Post-enhanced series was repeated however without improvement of image quality due to motion and the exam was eventually terminated by patient.There also note prior MRI of cervical spine for comparison.Within the indication examination demonstrate multiple small foci of T2 stir hyperintensity throughout the cervical cord some with resultant subtle focal bulge of the cord and consistent with neurofibromas. The subarachnoid space surrounding cord however is still preserved and no significant spinal canal compromise detected. The lesions demonstrate enhancement on post infused images.There is a large intramedullary enhancing mass centered at T1 -- T2 disk level with resultant expansion of the cord and complete effacement of subarachnoid space consistent with a previously known intra-neurofibroma. Considering suboptimal quality of images there is no convincing evidence of any significant change in the size of this lesion since prior study. There is no appreciable neural foraminal widening at any level. Foramen magnum is unremarkable. Partially visualized posterior fossa demonstrate a well demarcated mass along the inferior surface of tentorium consistent the patient's previously known meningioma. It measures approximately 26 x 22 mm on sagittal T2 weighted images compared to prior study from 2014 measurement of approximately 26 x 25 mm.A previously known large right cerebellopontine angle meningioma is also again partially visualized and appears grossly similar to prior exam measuring maximal 24 x 24-mm on sagittal T2 weighted series.Pre-and post enhanced thoracic MRI:Examination redemonstrate a bone detailed intramedullary enhancing neurofibroma at T1 -- T2 disk level with resultant expansion of the cord and complete effacement of subarachnoid space. No convincing interval change in the size of this lesion since prior study.A posterior dural -based enhancing meningioma at lower T4 level with significant mass-effect and forward displacement of the cord and central spinal stenosis is again identified and without convincing evidence of change. It measures approximately 14 mm in cranial cephalad and 9.5-mm in AP axis. The compressed cord at this level demonstrate no definitive evidence of cord signal abnormality.Multiple tiny additional neurofibromas on the surface of the cord at T7 and T10 through T12 are again identified and without significant change. No evidence of central spinal stenosis at any other level other than T4 level.Incidental note is made of minimal bilateral pleural effusion. There is a single locule well demarcated cyst along the superior aspect of the left kidney measuring approximately 30 mm contrast is diameter and demonstrate interval increased since prior study measurement of approximately 25.

Output: 1.MRI examination of cervical spine is suboptimal due to motion artifact. Multiple small intra-medullary enhancing neurofibromas are identified. No spinal stenosis or neural foraminal compromise. Limited view of posterior fossa partially demonstrate stable meningioma in the right cerebellopontine angle and along the inferior surface of tentorium on the left.2.MRI of thoracic spine demonstrate a stable intramedullary expansile cord lesion at T4 level with resultant complete effacement of subarachnoid space. Stable posterior dural based meningioma at T4 with significant mass effect, flattening and forward displacement of the cord and central spinal stenosis. Multiple additional superficially located neurofibromas of the cord without significant change since prior exam. Slight interval increased size of a single locule cyst along the superior left kidney since prior exam. Minimal bilateral pleural effusion.