Instruction: Generate impression based on findings.

Input: Reason: pre-op planning History: pre-op There is an extra-axial mass measuring 87 x 65 mm axial dimensions and 71 x 51 mm coronal dimensions anterior to the corpus callosum and between the frontal lobes associated with numerous flow voids on susceptibility imaging. Some small foci of non-enhancement along the right superior aspect of the tumor most likely a result of the recent embolizationNormal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Large mass adjacent to the frontal lobes bilaterally and associated with mass effect on the frontal lobes and callosum most likely represents meningioma.


Instruction: Generate impression based on findings.

Input: Knee pain MENISCI: The medial meniscus is intact. There is thin vertically oriented linear intermediate signal intensity along the posterior horn of the lateral meniscus that is suspected to represent a prominent interface between the posterior horn and the meniscofemoral ligament of Wrisberg as opposed to true tear. The popliteomeniscal fascicles are intact.ARTICULAR CARTILAGE AND BONE: There are no fluid-filled cartilage defects and no bone marrow edema.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: No findings to account for the patient's pain.


Instruction: Generate impression based on findings.

Input: 35 year old with proven right breast cancer (IDC grade 3) presents for MRI for I-SPY #1. There is extreme amount of fibroglandular tissue in both breasts.Marked parenchymal enhancement is noted bilaterally.The right breast shows diffuse abnormal enhancement, measuring 71 x 97 x 72 mm (AP x LR x CC), consistent with biopsy proven carcinoma. Diffuse skin thickening is also present in the right breast.There are at least five abnormal lymph nodes showing cortical thickening in the right axilla.No abnormal enhancement is seen in left breast. No abnormal axillary lymph nodes are identified in left axillary region.

Output: 1. Right proven carcinoma shows diffuse enhancement, almost whole breast, with skin thickening.2. Multiple abnormal lymph nodes in the right axilla3. No abnormal enhancement in left breast. No abnormal axillary lymph nodes in left axillary regionBIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: 41-year-old female with history of recurrent headaches and left facial numbness. Evaluate for lupus cerebritis. There are mild scattered punctate foci of T2 hyperintensity in the cerebral white matter. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Mild scattered punctate foci of T2 hyperintensity in the cerebral white matter are nonspecific, but may be a manifestation of lupus vasculitis.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 50-year-old male with newly diagnosed prostate cancer. Evaluate.Per pathology:-right base- Prostatic adenocarcinoma, Gleason grade 3+3=6 -right mid- Prostatic adenocarcinoma, Gleason grade 3+4=7 -right apex- Prostatic adenocarcinoma, Gleason grade 3+4=7-right base lateral- Prostatic adenocarcinoma, Gleason grade 3+3=6 -right mid lateral- Prostatic adenocarcinoma, Gleason grade 3+4=7 -right apex lateral- Prostatic adenocarcinoma, Gleason grade 3+3=6 (ISUP grade 1 of 5).-left base lateral- Prostatic adenocarcinoma, Gleason grade 3+3=6 PELVIS:PROSTATE:Prostate Size: 3.1 x 4.5 x 2.6 cmPeripheral Zone: There are several T2 hypointense lesions within the prostate gland with corresponding low ADC signal. The largest lesion in the right mid gland measures 10 x 3 mm (series 801, image 11). The largest lesion in the anterior left mid gland measures 8 x 6 mm (series 301, image 80). These lesions do not demonstrate early enhancement with washout. Additionally lesions in the right base, right apex, and left base.Central Gland: Mildly heterogeneous in appearance.Seminal Vesicles: No seminal vesicle invasion.Extracapsular Extension: No extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: There is a nonspecific right perirectal lymph node measuring 9 x 8 mm (series 1701, image 77).BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Suspicious prostatic lesions as detailed without extracapsular extension.2.Nonspecific right perirectal lymph node.


Instruction: Generate impression based on findings.

Input: Clinical question: Cerebellar disease showing marked signs and symptoms: Staggering gait. Pre and post enhanced brain MRI:Negative diffusion weighted series.Images through posterior fossa demonstrate mild prominence of cerebellar and vermian folia which may stable be within normal range for patient's stated age of 56.Images through supratentorial space demonstrate few tiny nonspecific foci of subcortical and periventricular FLAIR hyperintensity in bilateral frontal lobes and unremarkable otherwise.Unremarkable cerebral cortex, cortical sulci, ventricular system and CSF spaces.No detectable abnormal parenchymal, leptomeningeal or calvarial enhancement.Unremarkable images through the orbits and including axial fat sat post enhanced series.Normal signal intensity of intracranial venous sinuses and with normal pattern of enhancement.Normal signal intensity of the visualized paranasal sinuses and mastoid air cells.

Output: 1.No acute intracranial process and negative diffusion weighted series.2.A few punctate nonspecific FLAIR hyperintensity in bilateral frontal subcortical and periventricular white matter.3.Slight prominence of cerebellar and vermian folia which may be at the upper limits of normal and unremarkable pre and postcontrast enhanced study otherwise.


Instruction: Generate impression based on findings.

Input: MRI BRAIN: The ventricles and sulci are within normal limits. The cisterns remain patent. There is no midline shift or mass effect. There are multiple scattered foci of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, which are nonspecific. There are no areas of pathological enhancement. There is no diffusion abnormality. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits.  MRV BRAIN: The superior sagittal sinus, inferior sagittal sinus, transverse sinuses, sigmoid sinuses, straight sinus, vein of Galen, internal cerebral veins, and several visualized cortical veins are patent. There is no evidence of venous thrombosis.

Output: 1. No evidence of acute ischemia or venous sinus thrombosis.2. Multiple scattered T2/FLAIR signal in the cerebral white matter, which are non-specific and grossly unchanged. Differential considerations include white matter changes associated with chronic migraines, small vessel ischemic changes, and atypical demyelinating process among others.


Instruction: Generate impression based on findings.

Input: 69-year-old male with knee pain. Assess for lateral meniscus tear. Some sequences are limited by patient motion artifact.MENISCI: There is mild increased signal abnormality within the lateral meniscus indicating intrasubstance degeneration, but we see no discrete tear. There is also increased signal abnormality within the medial meniscus indicating intrasubstance degeneration of the medial meniscus. This signal extends in a linear fashion to the free edge of the posterior horn and may represent a degenerative horizontal tear but this is equivocal. We see no fluid signal intensity within the meniscus to confirm an unstable tear.ARTICULAR CARTILAGE AND BONE: There is severe degeneration of the articular cartilage of the patellofemoral joint with large portions of the medial facet of the patella and femoral trochlea devoid of articular cartilage with associated underlying degenerative subchondral signal abnormality. There is also near full-thickness to full-thickness degeneration of the articular cartilage along the inferior aspect of the femoral trochlea, centrally, with underlying subchondral cyst formation. There is also moderate articular cartilage degeneration affecting the medial tibiofemoral compartment with near full-thickness to full-thickness cartilage loss along the medial femoral condyle, particularly along its medial aspect, with underlying subchondral cyst formation. Beneath the posterior horn of the lateral meniscus there is near full-thickness to full-thickness cartilage degeneration. There is tricompartmental osteophyte formation.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. No evidence of lateral meniscus tear. Equivocal medial meniscal horizontal tear.2. Tricompartmental articular cartilage degeneration.3. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Ms. Kerber is a 51 year old female with a personal history of benign right breast biopsy in 2009 for benign breast tissue. Family history breast cancer mother, two maternal aunts, maternal grandmother, and ovarian cancer in paternal cousin. Personal history of right thigh liposarcoma. She has no current breast related complaints. Three standard views of both breasts 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.Benign biopsy marker clip is stable in the right breast. Scattered benign calcifications and benign morphology masses are stable bilaterally, many of which have previously been characterized as cysts on prior ultrasound and MRI examinations. There are no new masses, suspicious microcalcifications or areas of architectural distortion identified in either breast.

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


Instruction: Generate impression based on findings.

Input: Enhancing liver lesion on CT, follow-up exam ABDOMEN:LIVER, BILIARY TRACT: 5 mm T2 hyperintense enhancing lesion in the right hepatic lobe, which corresponds anatomically to enhancing lesion seen on CT. Additional small T2 hyperintense lesions in the left hepatic lobe. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: 8 mm enhancing right adrenal nodule.KIDNEYS, URETERS: 4 cm hemorrhagic poorly enhancing mass in the right superior pole.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1.Multiple small T2 hyperintense enhancing lesions in the liver, all of which have similar imaging features suggestive of hemangiomas.2.Indeterminate enhancing right adrenal nodule, which does not meet the criteria for an adenoma and is too small to fully characterize.3.Right superior pole renal mass most consistent with renal cell carcinoma.Discussed with pager x9301 at time of dictation.


Instruction: Generate impression based on findings.

Input: Slurred speech and weakness, evaluate for stroke. The exam is partly motion degraded.MRI BRAIN: There are multiple small areas of diffusion restriction in the left occipital, frontal, parietal, and occipital lobes. There is a moderate amount of subcortical and periventricular white matter T2 hyperintensity. There are punctate foci of encephalomalacia within the bilateral basal ganglia, coronal radiata, and pons. There are also numerous scattered punctate foci of supratentorial and infratentorial susceptibility effect. There is no evidence of intracranial mass. There is mild diffuse cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. There is a right sphenoid retention cyst. The orbits, skull, and scalp soft tissues are grossly unremarkable.MRA NECK: There common origin of innominate and left common carotid arteries. There is normal contrast opacification through the bilateral common carotid arteries, carotid bifurcations, and cervical internal/external carotids. The left vertebral artery is diminutive with multifocal areas of narrowing and loss of contrast opacification along V4. The right vertebral artery is dominant with focal high-grade stenosis at its origin. No evidence of aneurysm, dissection, or vascular malformation is apparent.

Output: 1. Multiple small areas of acute to early subacute infarcts involving the left occipital, frontal, parietal, and temporal lobes.2. The left vertebral artery is diminutive with multifocal areas of narrowing, as well as chronic occlusion along V4. The right vertebral artery is dominant with focal high-grade stenosis at its origin.3. No evidence of flow-limiting stenosis involving the carotid arteries.4. Scattered bilateral basal ganglia, corona radiata, and pons lacunar infarcts, as well as non-specific subcortical and periventricular T2 hyperintensity suggestive of chronic small vessel ischemic disease.5. Multiple supratentorial and infratentorial punctate foci of susceptibility effect may represent chronic microhemorrhages, perhaps related to hypertension or amyloid angiopathy, or septic emboli, for example.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 58-year-old female presents with hand numbness and pain, evaluate for stroke. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are scattered punctate foci of abnormal T2 hyperintensity within the periventricular and subcortical white matter. There are also apparent scattered areas of cerebral sulcal FLAIR hyperintensity bilaterally. The pituitary gland appears 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. There is degenerative spondylosis in the imaged upper cervical spine.

Output: 1. No evidence of intracranial hemorrhage, mass, or acute infarct. 2. Nonspecific scattered punctate periventricular and subcortical white matter lesions may represent mild chronic small vessel ischemic changes. 3. Apparent scattered areas of sulcal FLAIR hyperintensity may represent artifact or less likely meningitis, given the lack of corresponding clinical findings.The above findings were discussed via telephone with Dr. Mastrianni at 11:15 AM on 1/06/2016.


Instruction: Generate impression based on findings.

Input: Ms. Scarlata is a 56 year old female with personal history of left breast mastectomy in 11/2010 for IDC treated with radiation and neoadjuvant chemotherapy. Patient also has a personal history of right breast mastopexy (02/2012) as well as a benign right breast biopsy (07/2010) for fibroadenoma. The patient is status post left mastectomy with reconstruction. No abnormal enhancement is present along the left reconstructed breast or within the left axillary region. Minimal background parenchymal enhancement is noted in the right breast. There is no abnormal enhancement identified. No abnormal right axillary lymph nodes are present.

Output: No interval change on MRI. No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: There is redemonstration of postoperative changes from prior left paramedian posterior fossa resection with minimal marginal FLAIR hyperintensity cerebellum resection site. There is no pathological enhancement identified. Previous linear and curvilinear enhancement along the resection site is difficult to appreciate on the current postcontrast images secondary to slice selection and lack of coronal images. There is unchanged subtle focus of T2/FLAIR hyperintensity in the left thalamus.The ventricles and sulci are stable, slightly prominent for the patient's stated age. The cisterns remain patent. There is no midline shift or mass effect. There is no diffusion abnormality. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. Asymmetric signal is again seen along the left petrous apex, likely relating to fluid within asymmetrically pneumatized air cells.

Output: Stable appearance of postoperative changes without MR evidence of recurrent tumor.


Instruction: Generate impression based on findings.

Input: History of cirrhosis. Evaluate for HCC. ABDOMEN:LIVER, BILIARY TRACT: The previously described segment 4 lesion measures approximately 9 x 7 mm (series 15/34) previously 12 x 10 mm. It demonstrates central washout on delayed phase images but no appreciable enhancement. No associated T2-weighted or restricted diffusion. It does demonstrate signal loss on out of phase images suggesting intracellular fat.No other new or suspicious hepatic lesions. The hepatic vasculature is patent. No intra or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Minimal decrease in size of the nonspecific segment 4 lesion as described above. No new suspicious hepatic lesion.


Instruction: Generate impression based on findings.

Input: Altered mental status. Past medical history of ESRD, HTN, anemia of CKD presenting as an OSH transfer for altered mental status and continued MSSA bacteremia. There are numerous punctate foci of restricted diffusion and high T2 signal within multiple cerebral and cerebellar bilaterally, mainly involving watershed zones. There is a small amount of susceptibility effect in the left occipital lobe. There is no evidence of intracranial mass. There is mild diffuse cerebral volume loss. 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. There are bilateral tympanomastoid effusions.

Output: 1. Numerous punctate foci of cerebral and cerebellar acute ischemia bilaterally, mainly involving watershed zones with possible petechial hemorrhage in the left occipital lobe. Differential considerations include hypotensive infarction or perhaps septic emboli. Assessment is otherwise limited without intravenous contrast, acknowledging the renal failure as a contraindication.2. Nonspecific bilateral tympanomastoid effusions.


Instruction: Generate impression based on findings.

Input: 43-year-old male with history of VHL status post bilateral adrenalectomy. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Scattered subcentimeter hepatic cysts. No suspicious lesions.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral benign cysts appearing similar to prior. No suspicious lesions identified.RETROPERITONEUM, LYMPH NODES: Status post bilateral adrenalectomy. Left retroperitoneal nodule measures 10 x 8mm, previously 11 x 8 mm (image 19 of series 601).T2 hyperintense enhancing lesion at the midline inferior to the aortic bifurcation measures 9 x 8 mm, previously 12 x 10 mm (image 43 of series 1601).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: At the level of L1, a presumed hemangioblastoma measures 15 x 10 mm, previously 14 x 13 mm (image 13 of series 601). Other smaller similar appearing lesions have not appreciably changed.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Overall unchanged exam. Left retroperitoneal nodule, paraganglioma inferior to the aortic bifurcation and spinal hemangioblastomas without significant interval change.


Instruction: Generate impression based on findings.

Input: Pain Persistent large cysts within the humeral head immediately proximal to the tuberosity. Appearance correlates with recent MRI and again measures approximately 1.8 cm and demonstrates a discreet thin sclerotic margin.

Output: Essentially unchanged large cyst with benign characteristics observed in the humeral head.


Instruction: Generate impression based on findings.

Input: 68-year-old female with history of melanoma, evaluate for local recurrence. Femur: We see no lesions in the soft tissues of the thighs, although there may perhaps be mild atrophy of the lateral head of the biceps femoris. There is a small lobulated focus of abnormal signal intensity and mild enhancement within the distal femur that likely represents a benign enchondroma.Tibia/fibula: Small foci of signal void in the lateral soft tissues adjacent to the fibular head presumably represent metallic susceptibility artifact from prior surgery. There is poorly-defined enhancement of the adjacent subcutaneous fat which is nonspecific and may represent scar tissue. There is additional mild edema and enhancement in the subcutaneous fat along the patellar tendon indicating mild inflammation, perhaps a mild bursitis. Moderate osteoarthritis affects the knee. Mild nonenhancing edema is present along the lateral aspect of the lower leg, which is nonspecific. The remaining soft tissues are unremarkable.

Output: Surgical changes along the lateral soft tissues presumably represent the site of prior melanoma resection with poorly defined enhancement within the subcutaneous fat which is compatible with scar tissue; although we cannot exclude the possibility of tumor recurrence, we see no discrete mass. Repeat follow-up exams may be considered as clinically warranted.


Instruction: Generate impression based on findings.

Input: Dysarthria. There is no evidence of acute infarction. There are extensive areas of cerebral and pontine white matter T2 hyperintensity. There are scattered supratentorial and infratentorial punctate foci of susceptibility effect primarily in the deep grey matter structures sand periventricular white matter. There are numerous prominent perivascular spaces in the bilateral basal ganglia, resulting in an etat crible appearance. The ventricles and basal cisterns are prominent and there is ex vacuo dilatation of the left lateral ventricle. There is no midline shift or herniation. The skull and paranasal sinuses are grossly unremarkable. There are intracranial atherosclerotic vascular calcifications. There are bilateral lens implants.

Output: 1. No evidence of acute intracranial hemorrhage or acute infarction. 2. Extensive areas of cerebral and pontine white matter signal abnormality likely represent chronic small vessel ischemia. 3. Scattered chronic microhemorrhages, which may be hypertensive in nature.4. Diffuse cerebral volume loss.


Instruction: Generate impression based on findings.

Input: 41-year-old male with right shoulder pain and weakness with a history of fall. Evaluate for cuff tear. ROTATOR CUFF: There is a full thickness tear of the supraspinatus tendon at the level of its insertion on the greater tuberosity, measuring approximately 17 mm in the AP dimension, which extends proximally along it's undersurface fibers resulting in delamination and mild retraction of the undersurface fibers to the level of the humeral head. The supraspinatus muscle appears intact. There is partial thickness tearing of the undersurface fibers of the anterior infraspinatus tendon at the level of its insertion on the greater tuberosity. The infraspinatus muscle appears intact. The subscapularis tendon and muscle appear intact. The teres minor muscle and tendon appear intact.SUPRASPINATUS OUTLET: There is no fluid within the subacromial subdeltoid bursa. Mild degenerative changes affect the acromioclavicular joint with subchondral cyst formation within the distal clavicle and small inferior osteophyte formation.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is anatomic. The glenoid labrum appears intact within the limitations of a non arthrogram study.BICEPS TENDON: The tendon of the long head of the biceps appears intact. ADDITIONAL

Output: Full-thickness tearing of the rotator cuff with mild retraction as described above.


Instruction: Generate impression based on findings.

Input: Reason: New brain mets, MRI for SRS treatment planning History: None There is redemonstration of punctate enhancing lesions at the grey-white matter junctions in the superior right postcentral gyrus x2 and the left superior frontal gyrus that measure up to 4 mm with minimal associated vasogenic edema. There is a mild degree of periventricular and subcortical confluent hyperintense white matter lesions present identified on the FLAIR and T2 images.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1. Punctate metastases in the superior right postcentral gyrus and left superior frontal gyrus. 2. Confluent periventricular white matter signal change is probably treatment related


Instruction: Generate impression based on findings.

Input: 83 year old female status post partial simple mastectomy, stage V chronic kidney disease on dialysis and diabetes, hypertension and anemia. Evaluate for possible CVA. There is no evidence of intracranial hemorrhage, mass or edema. Note is made of bilateral basal ganglia calcifications. Diffuse hyperdensity in the 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: Clinical question: Neck and arm pain. Pain across mid back. Signs and symptoms: Neck and arm pain. Pain across mid back. Non-enhanced cervical MRI:There is normal anatomical alignment the vertebral column.There is unremarkable signal intensity of vertebral column.Foramen magnum is unremarkable. C2 -- C3 is unremarkable.C3 -- C4 demonstrate mild degenerative changes without spinal stenosis or neural foraminal compromise.C4 -- C5 demonstrate mild degenerative disk disease and mild asymmetric left facet hypertrophic changes and mild bilateral ligamentum flavum hypertrophy. There is a tiny annular fissure in the midline and to the left best appreciated on sagittal T2 stir. Mild central spinal stenosis and mild left neural foraminal compromise.C5 -- C6 demonstrate prior corpectomy and anterior fusion without evidence of spinal stenosis or neural foraminal compromise.C6 -- C7 demonstrate mild degenerative disk disease, uncovertebral hypertrophy on the left a mild left facet hypertrophy changes are noted. There is mild to moderate left neural foraminal compromise and mild central spinal stenosis.C7 -- T1 demonstrate minimal disk disease, moderate right-sided asymmetric uncovertebral hypertrophic changes resulting in significant right neural foraminal compromise. No spinal stenosis and patent left neural foramina.The signal intensity of the cord remains ".Fluid signal intensity along the left aspect of C6 spinous process is believed to represent post operative change. No prior exams for comparison. The fluid collection measures approximately 6 mm in transverse axis and 23-mm in AP axis.Nonenhanced thoracic MRI:There is normal anatomical alignment of the column. The signal intensity of vertebral column is unremarkable.There is normal signal intensity and caliber of thoracic cord.There is no significant degenerative disease, no evidence of spinal stenosis or neural foraminal compromise at any level.

Output: 1.Postoperative changes of anterior corpectomy and fusion at C5 -- C6 without evidence of spinal stenosis or neural foraminal compromise.2.Degenerative changes at C4 -- C5 and including a tiny annular fissure is noted. Mild central spinal stenosis and left neural foraminal compromise.3.Degenerative changes at C6 -- C7 and asymmetrical left uncovertebral hypertrophy results in left neural foraminal compromise and mild central spinal stenosis.4.Loculated fluid collection along the left side of C6 spinous process as detailed.5.Asymmetric right sided moderate uncovertebral hypertrophy results in significant right neural foraminal compromise at C7 -- T1 level.6.Unremarkable nonenhanced thoracic spine MRI.


Instruction: Generate impression based on findings.

Input: There are 5 enhancing masses, 3 within the supratentorial brain, 2 within the infratentorial cerebellum:*Left lateral occipital lobe, heterogeneous enhancement, 23 mm AP x 19 mm transverse x 20 mm craniocaudal.*Left temporal occipital junction, homogeneous enhancement, 8 x 8 x 8 mm.*The right cerebellar hemisphere, heterogeneous enhancement, 35 mm AP x 37 mm transverse x 33 mm craniocaudal.*Left cerebellar hemisphere, heterogeneous enhancement, 35 mm transverse x 3 mm AP x 29 mm craniocaudal.*Tiny nodular enhancement right frontal lobe (image 25, series 1101)Significant vasogenic edema and mass effect is noted within the cerebellar hemispheres resulting in deformation and partial effacement of the fourth ventricle. The third and lateral ventricles are enlarged with T2 hyperintense findings suggesting transependymal CSF resorption from early hydrocephalus. Note is made of what appears to be bilateral, connatal cysts with right frontal horn coarctation. Additionally, there are few foci of T2 hyperintensity in the white matter, especially involving the right caudate head.The cerebellar tonsils are in normal position. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear.

Output: 1.There are 5 enhancing masses, 3 within the supratentorial brain, 2 within the infratentorial cerebellum, most suggestive of metastatic disease.2.Significant vasogenic edema and mass effect is noted within the cerebellar hemispheres resulting in deformation and partial effacement of the fourth ventricle.3.Findings suggestive of early hydrocephalus with lateral and third ventricle enlargement and a suggestion of CSF resorption.


Instruction: Generate impression based on findings.

Input: 62-year-old male. Transaminitis. Increased alk phos. Rising LFTs. Significant motion artifact and lack of intravenous contrast severely limits evaluation of solid organ pathology.ABDOMEN:LIVER, BILIARY TRACT: Diffusely decreased T2 signal in the liver suggestive of iron deposition. No biliary ductal dilatation. Gallbladder is collapsed and the cholecystostomy tube is not well-seen. No definite focal hepatic lesion within limits of exam.SPLEEN: Diffusely decreased T2 signal and signal loss on in phase images within the spleen suggestive of iron deposition. Focal T2 hyperintensity in the spleen correlating with an ill-defined hypodense lesion on prior CT (series 901, image 26), not well characterized due to significant motion and lack of contrast.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: T2 hyperintense foci in the mid to lower pole of right kidney, incompletely evaluated without contrast, likely a cyst. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: Infrarenal IVC filter.BOWEL, MESENTERY: Small fat-containing umbilical hernia.BONES, SOFT TISSUES: Multiple compression deformities in the thoracolumbar spine with vertebroplasty changes. Anasarca. Small cystic foci at the sacral neural foramina, likely Tarlov cysts.OTHER: Foley catheter terminates in the bladder. Bilateral pleural effusions and nonspecific basilar opacities. 5 x 10.6 cm anterior mediastinal hematoma causing mild mass effect upon the right heart border; there is mild associated diffusion restriction and superimposed infection is not excluded. Trace scattered abdominal ascites. No loculated fluid collection.

Output: 1. No biliary ductal dilatation.2. Known anterior mediastinal hematoma with mild associated diffusion restriction, superimposed infection not excluded.


Instruction: Generate impression based on findings.

Input: Female, 68 years old, with pain in the L5 distribution. Spinal alignment is anatomic. Vertebral body morphology is within normal limits. No concerning marrow replacement is seen. Mild osseous and extraosseous edema is present along the L4-5 facet complexes.The visualized spinal cord, conus and cauda equina demonstrate normal signal characteristics and morphology.L1-2: Unremarkable. L2-3: Mild facet hypertrophy. No significant spinal canal or neuroforaminal stenosis. L3-4: Moderate facet hypertrophy and ligamentum flavum thickening. Mild predominantly laterally bulging disk. Mild narrowing of the spinal canal. No significant foraminal narrowing. L4-5: Moderate facet hypertrophy and ligamentum flavum thickening with small facet effusions. Moderately bulging disk with perhaps a superimposed right paracentral protrusion. Severe spinal canal stenosis with crowding of the cauda equina and near complete exclusion of CSF. Minimal bilateral foraminal narrowing. L5-S1: Mild facet hypertrophy and ligamentum flavum thickening. Mild bulging disk with a small superimposed central protrusion. No significant spinal canal stenosis. No significant foraminal narrowing.

Output: 1. Severe spinal canal stenosis at L4-5 arising from disk degeneration and posterior element hypertrophy.2. Edematous facet arthropathy at L4-5 bilaterally.


Instruction: Generate impression based on findings.

Input: Foreign body check prior to MR No radiographic abnormality. Specifically no radiopaque foreign body observed or finding to prevent MRI scanning

Output: Normal


Instruction: Generate impression based on findings.

Input: History of relapsed astrocytoma status post craniotomy and radiation therapy: off therapy evaluation. There are post-treatment findings, including suboccipital craniotomy. There appears to be interval decrease in size of the partially enhancing infiltrative mass involving the tectum, midbrain, right cerebellar peduncle, cerebellar vermis and superior cerebellar hemispheres. The mass now measures up to approximately 30 mm, previously 35 mm. There are multiple unchanged foci of susceptibility effect in the treatment bed, bilateral occipital lobes, and medial temporal lobe. There is a right transfrontal ventricular shunt catheter that terminates in the left lateral ventricle. The ventricles are unchanged 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. There is a probable right mesiodens.

Output: Apparent interval decrease in size of the infiltrative hindbrain mass.


Instruction: Generate impression based on findings.

Input: 25 year old M with history of ileocecectomy and multiple small bowel resections. Now with electrolyte abnormalities and elevated CRP. Please evaluate for active Crohn's disease. ABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis without evidence of cholecystitis. No focal liver lesions identified.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 patient is status post ileocecectomy and small bowel resection. The ileocolonic anastomosis is identified in the right hemiabdomen and is patent (series 401, images 20-231) without wall thickening. The distal ileum is markedly dilated up to 9 cm in diameter, with a normal caliber colon distally and jejunum proximally, similar to the prior small bowel follow through on 12/12/13. Fibrofatty proliferation of the mesentery is noted in the right hemiabdomen. No definite areas of stricturing or abnormal bowel wall enhancement are seen. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No ascites.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: see Bowel/Mesentery section above.BONES, SOFT TISSUES: No significant abnormality noted.

Output: Apparently chronically dilated distal small bowel, with a patent ileocolonic anastomosis. No definite areas of stricturing or abnormal bowel wall enhancement is seen to suggest sites of active acute inflammation. If there remains clinical concern, complementary small bowel follow through examination may be helpful.


Instruction: Generate impression based on findings.

Input: Left shoulder pain. Evaluate for fracture. I see no fracture. There is slight irregularity of the inferior margin of the glenoid on the neutral AP view, although no fracture is evident on the Grashey or axillary views, and I suspect this simply represents normal variant anatomy for this patient. However, if there is strong clinical concern for fracture (e.g., in the setting of prior shoulder dislocation), CT or MRI may be considered. Alignment is normal.

Output: No definite fracture or other specific findings to account for the patient's pain. Please see above.


Instruction: Generate impression based on findings.

Input: 72 year old with bloody left nipple discharge started 2 days ago. Biopsy proven left papilloma. History of breast cancer in mother diagnosed at age 56 and sister diagnosed at age 63. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD, 9.3. The breast parenchyma is composed of scattered fibroglandular elements, unchanged in pattern and distribution. The left breast demonstrates stable dilated ductal system extending to the mid breast at the level of the biopsy clip. Stable benign calcifications are present adjacent to the clip. No new masses, suspicious microcalcifications or areas of architectural distortion are present in either breast. Note is made that bloody discharge was seen from left nipple when left breast was compressed with mammographic plate.Left breast ultrasound was performed. In the retroareolar region, there are dilated ducts, without intraductal lesion detected. At left 3:00 position, 3 cm from nipple, there is an intraductal solid lesion with a marker clip and calcifications, measuring 11 x 6 mm, consistent with a biopsy proven papilloma. Increased blood flow is detected within this lesion. Compared to the prior MRI (8/15/11), the size of the papilloma is not significantly changed.

Output: Stable biopsy proven papilloma in the left breast. No mammographic or sonographic evidence for malignancy.Breast MRI would be useful for follow-up of the papilloma and to rule out new breast lesion. If the known papilloma is confirmed as a cause of bloody discharge, a vacuum assisted large core biopsy might be an option to reduce the symptom.BIRADS: 2 - Benign finding.RECOMMENDATION: C - Clinical Correlation Needed.


Instruction: Generate impression based on findings.

Input: Reason: h/o nasopharyngeal ca and CRT, compare to previous, measurements pls History: none. There is motion degradation on the current study which limits assessment. Again seen is evidence of perineural tumor spread along the left trigeminal nerve with thickening and enhancement involving the left foramen ovale, left cavernous sinus, and left pterygopalatine fossa not significantly changed since prior. No new tumor involving the left Meckel's cave or cisternal segment of the left trigeminal nerve is appreciated within the limits of a motion degraded study.Tubular T2 hyperintensity in the right retromaxillary fat measures 14 x 5 mm and not significantly changed since 3/12/2016.Abnormal T2 hyperintensity in the left optic nerve is again seen. Diffuse opacification of the left mastoid air cells and middle ear cavity again seen. Mucosal thickening within atelectatic left maxillary sinus again seen.

Output: 1. Significantly motion degraded study. No gross interval change in the appearance of the treated perineural tumor involving the left trigeminal nerve.2. Unchanged nonspecific defect in the left greater with of the sphenoid with enhancement.3. Diffuse T2 signal abnormality involving the left optic nerve again seen.4. No appreciable change in tubular T2 hyperintense lesion in the right retromaxillary fat pad, biopsy of which was recently performed.


Instruction: Generate impression based on findings.

Input: 68-year-old male status post laparoscopic cholecystectomy found to have a mesenteric/small bowel mass ABDOMEN:LIVER, BILIARY TRACT: Scattered T2 hyperintense foci in the liver, likely benign. The hepatic vasculature is patent. Status post cholecystectomy. No biliary ductal dilation.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: Focal chronic dissection of the infrarenal abdominal aorta. Duplicated IVC.BOWEL, MESENTERY: Encapsulated, nonenhancing and predominantly fatty mesenteric mass measures 15.2 x 6.1 cm (series 12, image 74). Multiple mesenteric vessels course through this mass including the SMA and SMV. No significant nodularity or lymphadenopathy.Cystic structure contiguous with the duodenum suggestive of a duodenal diverticulum (series 9, image 19).BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: Large fat-containing mesenteric mass most consistent with mesenteric panniculitis.


Instruction: Generate impression based on findings.

Input: History of elevated PSA. PELVIS:PROSTATE:Prostate Size: 3.8 x 4.7 x 4.2 cm. Peripheral Zone: Unremarkable.Central Gland: There is an ill-defined 1.8 x 1.1 cm hypointense area in the left anterior mid transition zone best seen on image #344 series #543, suspicious for prostate cancer. This lesion abuts the capsule. No evidence of obvious extracapsular extension.Seminal Vesicles: Unremarkable.Extracapsular Extension: Not present.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Large hypointense lesion in the anterior prostate transition zone suspicious for prostate cancer.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 22-year-old female with instability of the right knee with starting and stopping. MENISCI: The medial and lateral menisci are intact.ARTICULAR CARTILAGE AND BONE: No articular cartilage defects are evident, and the bone marrow signal is normal.LIGAMENTS: The anterior and posterior cruciate ligaments are intact, as are the medial collateral ligament and lateral collateral ligament complex. EXTENSOR MECHANISM: The extensor mechanism is intact. There is mild edema in the superolateral aspect of the Hoffa's fat pad, which can be seen in patients with patellofemoral instability; however, we see no frank femoral trochlear dysplasia. The tibial tuberosity to trochlear groove distance is 1.4 cm, which is within normal limits. The Insall-Salvati ratio is 1.37, suggesting a mild patella alta deformity.ADDITIONAL

Output: 1.Mildly increased signal intensity in the superolateral aspect of Hoffa's fat pad indicating edema, which can be seen in patients with patellofemoral instability. There is a slight patella alta deformity, but we see no frank femoral trochlear dysplasia and the tibial tuberosity to trochlear groove distance is within normal limits.2.The ligaments and menisci are within normal limits.3.Nodular mass within the subcutaneous fat of the medial knee, which is nonspecific on this nonenhanced imaging study. The differential diagnosis includes an angiomatous lesion, particularly given its proximity to the saphenous vein. A peculiar lymph node is another possibility. Although I suspect that this is a benign entity, I cannot exclude the less likely possibility of a small but malignant lesion on the basis of this single imaging study. Further evaluation with contrast-enhanced MRI is recommended and referral to orthopedic oncology should be considered.


Instruction: Generate impression based on findings.

Input: Male, 54 years old, left handed, with history of progressive brain tumor, presenting with weakness and headache, functional MRI and Stealth MRI requested for surgical planning. Motor cortical activation of the hand is weakly visualized bilaterally along the precentral gyri. On the right, this area of activation falls between two areas of pathologic enhancement which straddle the central sulcus involving both the pre- and postcentral gyri.Motor cortical activation of the feet maps as expected at the medial aspect of the central sulci. Likewise, facial motor cortical activation maps as expected along the inferior lateral extent of the central sulci. Please note that on the hand motor and foot motor paradigms, there is a band of likely artifactual activation centered on the left post central sulcus.On passive visual stimulation, cortical activation is seen along the calcarine sulcus on the left, but is conspicuously absent on the right. This may reflect tumor related disruption of the right optic radiations. Given the patient's left handedness, several language paradigms were also employed. Language is left dominant with Broca's and Wernicke's areas identified in their customary locations.Stealth MRI findings:Evidence of prior right parietotemporal craniotomy is again seen. An irregularly marginated rim-enhancing lesion is present centered on the right mesial temporal lobe. This lesion shows no significant interval change from the immediate prior study. More superiorly, and discontiguous with the mesial temporal lesion, there is a large irregularly marginated enhancing lesion centered on the right parietal white matter with extension into the pre- and postcentral gyri and more posteriorly into the superior parietal lobule. This lesion has increased very slightly in size. Extensive T2 hyperintensity and associated mass effect are again seen involving the right parietal and right temporal lobes showing some slight progression as well.Please note that the size of any given region of activation on BOLD fMRI is dependent upon the specific task performed and statistical thresholding. The size of the actual functional domain may be larger or smaller than that shown on color map images.

Output: 1. Weak motor cortical activation of the left hand is visualized along the right central sulcus, situated in between two projections of presumed infiltrative tumor which straddle the central sulcus and involve both the precentral and postcentral gyri. Foot motor cortical activation is situated at the medial extent of the T2 signal abnormality. Language is left dominant.2. Stealth MRI imaging demonstrates interval stability of the enhancing lesion centered on the right mesial temporal lobe. However, the irregularly marginated enhancing lesion centered on the right parietal white matter has slightly increased in size.


Instruction: Generate impression based on findings.

Input: Cervical cancer. Evaluate for extent of disease prior to brachytherapy. PELVIS:UTERUS, ADNEXA: There is a tandem and ovoid device in place within the vagina and uterus. Marked interval decrease in size of patient's known cervical mass. In total axial dimension it now measures 7.1 x 4.2 cm (series 1103 image 473), previously 8.5 x 6.6 cm. Enhancement is now more heterogeneous with central areas of nonenhancement suggesting necrosis. The tumor is circumferential but the bulk of the disease is posterior to the cervix. There is involvement of the vagina.Uterus is normal in size. The ovaries are unremarkable and contain small follicles bilaterally.BLADDER: A Foley catheter is in the bladder which is collapsed limiting evaluation.LYMPH NODES: Borderline enlarged right external iliac lymph node measuring 10 x 6 mm has loss of the normal reniform contour suggesting nodal metastases (series 401 image 60). This is not significantly changed from prior.BOWEL, MESENTERY: Small bore rectal tube. The rectosigmoid colon abuts the cervical mass and there is no clear residual fat plane between the 2 structures (series 601 image 39, series 401 image 58). This suggests tumor invasion appears somewhat prior. No obstruction.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Marked interval decrease in size of cervical mass with measurements as described. Findings suspicious for tumor invasion into the adjacent rectosigmoid colon.2.Stable borderline enlarged right external iliac lymph node suspicious for metastasis.


Instruction: Generate impression based on findings.

Input: Male 50 years old Reason: osteo History: drainage, xray suspicious Postsurgical findings of fourth and fifth transmetatarsal amputations. A large soft tissue defect/ulcer with surrounding inflammation extends along the lateral foot overlying the metatarsals. There is no rim enhancing focus to suggest abscess. The inflammation extends to the subjacent fourth and fifth metatarsal bones which demonstrate cortical irregularity as well as abnormal T1 hypointense/STIR hyperintense signal and enhancement consistent with osteomyelitis. The third metatarsal demonstrates stir hyperintense signal throughout the body without convincing enhancement or T1 hypointense signal and this may represent edema rather than frank osteomyelitis. There is marked edema within the superficial and deep subcutaneous tissues as well as the muscles of the foot. There is abnormal STIR hyperintense signal at the tarsometatarsal joints which is likely degenerative.

Output: Osteomyelitis involving the amputated fourth and fifth metatarsals which underlies deep skin ulceration.


Instruction: Generate impression based on findings.

Input: Base of tongue cyst seen on outside MRI. Evaluate for possible vallecular cyst or thyroglossal duct cyst. There is a lobulated structure measuring approximately 18 x 10 mm (CC x TR) at the base of the tongue extending to the anterior margin of the hyoid bone with prominent T2 hyperintense and slight T1 hyperintense signal. It is slightly eccentric to the left of midline. There is no associated fat signal. There is no evidence of abnormal enhancement or significant cervical lymphadenopathy. The thyroid and major salivary glands are unremarkable. The osseous structures are unremarkable. The airways are patent. The imaged intracranial structures are unremarkable.

Output: 18 mm lobulated structure extending from the base of the tongue towards the anterior margin of the hyoid bone, favoring a thyroglossal duct cyst based on location. However, other considerations such as lymphatic malformation remain within the differential.


Instruction: Generate impression based on findings.

Input: Central hypothyroidism. The pituitary gland is not particularly enlarged overall, but appears to enhance heterogeneously, with an ill-defined relatively hypoenhancing subcentimeter area in the left lobe of the adenohypophysis, which is slightly larger than the right lobe. The posterior pituitary bright spot is intact. The pituitary infundibulum is intact, but deviated slightly to the left. The cavernous sinuses and optic apparatus are intact. There is a nonspecific left cheek skin excrescence.

Output: The pituitary gland is not particularly enlarged overall, but appears to enhance heterogeneously, with a relatively hypoenhancing subcentimeter area in the left lobe of the adenohypophysis, which may indicate an underlying microadenoma. Follow up via dynamic contrast enhanced MRI of the pituitary may be useful. Otherwise, no evidence of macroadenoma.


Instruction: Generate impression based on findings.

Input: 37 years, Male, glioblastoma multiforme diagnosed in June 2006, status post resection in 2006 and January 2013. Status post radiotherapy and chemotherapy. There is a right parieto-occipital lesion with T2 hyperintensity extending into the temporoparietal and occipital lobes, probably combination of tumor and vasogenic edema, unchanged from prior. This mass contains numerous foci of susceptibility consistent with hemorrhage, not substantially changed from prior MRI. This mass extends across the midline involving the splenium of the corpus callosum and ependymal surface of the left lateral ventricle, unchanged. There is effacement of the occipital horn of the right lateral ventricle, unchanged from prior. There is a 4 mm right to left midline shift, unchanged. A right occipital resection cavity is again identified. There is no evidence of acute infarction. There is no hydrocephalus. There is an area of nodular enhancement within the right occipital lobe measuring 1.7 x 0.7 cm, probably subacute hemorrhage, unchanged from CT July 10, 2015.Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal is within normal limits. A right posterior occipital lipoma is unchanged.

Output: 1.Unchanged large enhancing, hemorrhagic right hemispheric glioblastoma multiforme that extends into the left corpus callosum and along the left lateral ventricle. Unchanged 4 mm right to left midline shift.2.Unchanged right posterior occipital subacute intratumoral hemorrhage identified on prior CT July 10, 2015.3.Unchanged right occipital lobe resection cavity and radiation changes.


Instruction: Generate impression based on findings.

Input: Diagnosis: Backache, unspecified. Other chronic painClinical question: lower back pain with history of stress fracture at L5Signs and Symptoms: Pain Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. Incidental note is made of fatty filum terminaleAt L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is no significant compromise to spinal canal or neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: No compromise to lumbar spinal canal or neural foramina.


Instruction: Generate impression based on findings.

Input: 50 year-old female with history of surgical repair, felt pop LIGAMENTS: Evaluation of the ligaments is limited due to lack of intra-articular contrast. There is perhaps mildly increased signal intensity within the volar fibers of the scapholunate ligament which may represent degeneration, but no specific findings are seen to suggest full-thickness disruption of the scapholunate or lunotriquetral ligaments.TRIANGULAR FIBROCARTILAGE COMPLEX: Although no fluid signal intensity is seen traversing the TFCC, there is focal intermediate signal intensity within the radial fibers of the TFCC, which could represent focal degeneration or small non-fluid filled tear.TENDONS: The tendons appear normal. BONES: Small foci of signal abnormality within the scaphoid, lunate, and capitate may represent degenerative cysts. There is a small amount of fluid within the distal radioulnar joint, but no frank effusion or synovitis.

Output: 1. No evidence of tendon injury.2. Small carpal bone cysts, which are likely degenerative in etiology.3. Focal signal abnormality within the TFCC disk, which may represent focal degeneration or a small non-fluid-filled tear.


Instruction: Generate impression based on findings.

Input: Male, 13 years old, with autism and several hyperpigmented macules, presenting with new stereotypedmouth movements. Evaluate for cerebral malformation, gliosis or basal ganglia abnormality. Brain parenchymal morphology is within normal limits. No structural abnormalities are detected. There are no areas of focal signal alteration, restricted diffusion, edema or mass effect. No findings are seen to suggest acute or chronic intracranial hemorrhage. The ventricular system is within normal limits. No abnormal extra axial fluid collections are observed.

Output: Unremarkable evaluation with no specific findings to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: Male, 55 years old, history of metastatic prostate cancer with pain and numbness in the lower pelvis and perineum. All the visualized osseous structures of the lumbar spine and sacrum demonstrate diffuse patchy abnormal marrow signal along with heterogeneous enhancement compatible with widespread osseous metastatic disease.Trace retrolisthesis of L2 relative to L3 and L3 relative to L4 are seen. The T11 vertebral body demonstrates mild central compression with approximately 40% loss of vertebral body height centrally. No retropulsion is seen. The remaining vertebral bodies demonstrate aspiration of height.No evidence of any significant epidural tumor encroachment is seen within the lumbar spine. In the sacral spine, however, there are several areas of nodular and plaque-like epidural thickening which involves the sacral spinal canal and some of the sacral foramina which result in significant narrowing and potential nerve root compression.Superimposed level specific degenerative findings are as follows:L1-2: Unremarkable. L2-3: Bulging disc. Mild generalized spinal canal narrowing. Mild bilateral foraminal narrowing. L3-4: Bulging disc. Minimal generalized spinal canal narrowing. Mild bilateral foraminal narrowing. L4-5: Mild facet hypertrophy. Mild bulging disc. No significant generalized spinal canal narrowing. Mild to moderate bilateral foraminal narrowing. L5-S1: Facet hypertrophy. Mild bulging disc. No significant generalized spinal canal narrowing. Moderate left and mild right foraminal narrowing.

Output: 1. Diffuse osseous metastatic disease.2. Relatively mild central compression deformity of T11 vertebral body without retropulsion.3. No definite or significant epidural disease spread in the lumbar spine.4. Plaque-like and nodular areas of epidural tumor are highly suspected within the sacral spinal canal and some of the sacral foramina. These lesions result in narrowing of the spinal canal and possible compression of adjacent nerve roots. These findings could potentially account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: Female; 50 years old. Reason: evaluate bilateral renal masses, adrenal mass History: hx of renal cell carcinoma, sp partial nephrectomy. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Enhancing left adrenal nodule demonstrates signal loss on out of phase images and measures 1.6 cm, unchanged (series 601, image 51). KIDNEYS, URETERS: Status post partial right nephrectomy for resection of inferior pole mass. Bilateral renal cysts, including minimally complex cyst with septations in the left upper pole measuring 2.2 x 2.0 cm (series 701, image 21). 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.Left upper pole renal cyst which demonstrates some internal complexity as described above. Follow-up is recommended given the imaging findings. 2.Unchanged left adrenal nodule, which meets imaging criteria for a lipid-rich adenoma.


Instruction: Generate impression based on findings.

Input: 54-year-old female with symptoms of right medial epicondylitis. TENDONS: There is intermediate signal intensity within the common flexor tendon at its insertion, suggesting tendinosis. There is also mild edema within the adjacent subcutaneous fat indicating mild inflammation. We see no fluid signal intensity within the tendon to indicate a tear, nor do we see signal abnormality within the underlying bone. The common extensor tendon appears thickened with intermediate signal intensity at its origin also likely representing chronic tendinosis. There are small foci of signal void within the adjacent soft tissues suggestive of metallic susceptibility artifact, perhaps from prior surgery. The biceps, brachialis, and triceps tendons appear normal.LIGAMENTS: The ulnar collateral ligament appears intact. The radial collateral ligament proper appears thickened and is difficult to separate from the overlying common extensor tendon, perhaps due to scarring. ARTICULAR SURFACES AND BONE: There is mild thinning of the articular cartilage along the radiocapitellar articulation. The bone marrow signal intensity is within normal limits.SURROUNDING STRUCTURES: No significant abnormality.ADDITIONAL

Output: 1. Mild tendinosis of the common flexor tendon with mild adjacent soft tissue inflammation consistent with "medial epicondylitis".2. Findings compatible with chronic tendinosis or scarring of the common extensor tendon with adjacent foci of metallic susceptibility artifact suggesting prior surgery.


Instruction: Generate impression based on findings.

Input: 60 year-old male with history of end-stage renal disease with altered mental status. Evaluate for intracranial hemorrhage. There is no evidence of intracranial hemorrhage, mass or edema. Multiple, mild areas of patchy hypodensity in a periventricular and subcortical white matter distribution consistent with microangiopathic changes. If there is clinical concern for acute ischemia, an MRI may be considered. Dystrophic calcifications along the cerebellar tentorium.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: Age indeterminate microangiopathic changes. No evidence of intracranial bleed. If there is clinical concern for acute ischemia, an MRI may be considered.


Instruction: Generate impression based on findings.

Input: 72-year-old female with endometrial cancer status post external beam radiation PELVIS:UTERUS, ADNEXA: Brachytherapy leads are present within the vaginal canal. BLADDER: Foley catheter within a collapsed bladder.LYMPH NODES: No significant lymphadenopathy is present.BOWEL, MESENTERY: A rectal catheter is present. Sigmoid diverticulosis without evidence of diverticulitis. The appendix is well-visualized and within normal limits. Visualized small bowel caliber is within normal limits without evidence of obstruction.BONES, SOFT TISSUES: Previously referenced presacral lesion measures 1.4 x 1.4 cm, previously 1.3 x 2.2 cm. Previously referenced large left iliacus muscle lesion is partially imaged and measures 2.6 x 1.7 cm, previously 3.8 x 2.9 cm.OTHER: No significant abnormality noted.

Output: 1.Placement of brachytherapy leads within the vaginal canal.2.No significant change of presacral lesion and interval decrease in size of left iliacus muscle lesion.


Instruction: Generate impression based on findings.

Input: Check for myositis in the right thigh. High CK levels with pain Markers are observed overlying the anterior aspect of the mid thigh overlying the rectus femoris. Inflammation in the subcutaneous soft tissues with small punctate areas of signal dropout are observed, questionably representing small foci of gas and or possible punctate metal, including surgical clips or bullet fragments. Please correlate with patient history and consider possible plain film correlation. This area of involvement measures under 3 cm in all dimensions.This ill-defined area of change demonstrates minimal focal enhancement and this may represent increased vascularity (possibly a poorly defined small hemangioma, image 23 series 9) overlying and abutting the surface of the rectus bundle yet without definite distinct involvement or displacement. The remaining muscular compartments and muscle bodies are otherwise entirely intact without abnormality. Specifically compartmental fat planes are distinct and observed. No findings to support a diagnosis of myositis.The underlying osseous structures are entirely normal. Normal marrow signal is also observed throughout. No abnormal enhancement other than this focal area described above. No lymphadenopathy

Output: Minimal focal change involving the subcutaneous soft tissues involving the anterior right thigh. Minimal enhancement with questionable increased focal vascularity is nonspecific and although possibly related to minimal infection or possibly artifact from punctate metal (please correlate with patient history), mild focal and enhancement may represent an underlying benign vascular benign process.


Instruction: Generate impression based on findings.

Input: Reason: rule out SL ligament injury and possible occult ganglion cyst History: pain with range of motion over SL dorsally LIGAMENTS: No intra-articular gadolinium is identified within the radiocarpal joint. The scapholunate and lunotriquetral ligaments appear intact. There is a lobulated focus of fluid signal intensity along the volar aspect of the radioscaphocapitate ligament which likely represents ganglion formation measuring 8 x 3 x 10 mm (image 10; series 601).TRIANGULAR FIBROCARTILAGE COMPLEX: There is heterogeneity and intermediate signal intensity within the triangular fibrocartilage complex at the level of the foveal attachment which may reflect minimal degeneration. There is a lobulated focus of fluid signal intensity along the volar aspect of the triangular fibrocartilage and ulnar styloid measuring approximately 9 x 7 x 8 mm which likely represents ganglion formation (image 5; series 501). The ulnar styloid and foveal attachment of the triangular fibrocartilage appear intact. There is no significant fluid within the distal radioulnar joint.TENDONS: The flexor and extensor tendons appear intact. BONES: No bone marrow signal abnormality is identified.

Output: 1. No evidence of scapholunate or lunotriquetral ligament injury.2. Lobulated focus of fluid signal intensity along the volar aspect of the triangular fibrocartilage complex likely representing ganglion formation.3. Lobulated focus of fluid signal intensity along the volar aspect of the radioscaphocapitate ligament also likely represents ganglion formation.


Instruction: Generate impression based on findings.

Input: 53 year old female admitted with worsening dyspnea. Has known extrapulmonary sarcoid, pulmonary hypertension and RV dysfunction. MRI done to evaluate for cardiac sarcoidosis. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 72%, the LV end diastolic volume index is 58 ml/m2 (normal range: 65+/-11), the LVEDV is 99 ml (normal range 109+/-23), the LV end systolic volume index is 16 ml/m2 (normal range 18+/-5), the LVESV is 27 ml (normal range 31+/-10), the LV mass index is 47 g/m2 (normal range 67+/-11), and the LV mass is 79 g (normal range 114+/-24). There are no regional wall motion abnormalities present. . No evidence of inflammation or edema on T2 STIR sequences. There is a small area of mid-myocardial/epicardial late gadolinium enhancement suggestive of an underlying fibrosing, infiltrative, or inflammatory process, located in the mid to apical inferoseptal region. This pattern is not consistent with prior myocardial infarction, but could be consistent with a history of prior myocarditis.Left AtriumThe left atrium is mildly enlarged. Right VentricleThe right ventricle is quantitatively mildly dilated, however on visual observation appears moderately dilated. The overall RV ejection fraction is 42%, the RV end diastolic volume index is 104 ml/m2 (normal range 69+/-14), the RVEDV is 176 ml (normal range 110+/-24), the RV end systolic volume index is 60 ml/m2 (normal range 22+/-8), and the RVESV is 101 ml (normal range 35+/-13). Right AtriumThe right atrium is moderately enlarged. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a pseudo-bovine branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is dilated (37mm). Venous AnatomyThe SVC and IVC drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsPulmonary findings as noted in CT chest done 10/7/2016. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size and systolic function. The overall LV ejection fraction is 72%. There are no regional wall motion abnormalities present. There is a small area of mid-myocardial/epicardial late gadolinium enhancement suggestive of an underlying fibrosing, infiltrative, or inflammatory process, located in the mid to apical inferoseptal region. This pattern is not consistent with prior myocardial infarction, but could be consistent with a history of prior myocarditis. No evidence of inflammation or edema on T2 STIR sequences. No evidence of acute myocarditis or pericarditis.2. The right ventricle is quantitatively mildly dilated, however on visual observation appears moderately dilated. The overall RV ejection fraction is 42%.3. The left atrium is mildly enlarged. The right atrium is moderately enlarged. 4. The main pulmonary artery is dilated (37mm). 5. See extracardiac findings.


Instruction: Generate impression based on findings.

Input: Brain MRI:There are a few scattered punctate foci of T2 hyperintensity without mass effect or restricted diffusion. The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. Cervical spine MRI:There are no fractures. The marrow signal is benign. The cervical and upper thoracic cord are normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable.Discogenic reactive endplate changes are present at C3/4 (Modic type II) as well as at C6/7 (Modic type I).Disc desiccation is noted throughout the cervical spine with disc space narrowing at C3/4, C4/5, and C5/6.C2/3: Mild bilateral facet hypertrophy and slight ligamentum flavum thickening without stenosis.C3/4: Posterior osteophyte disc complex, bilateral uncinate hypertrophy, slight ligamentum flavum thickening, moderate left facet hypertrophy, and mild right facet hypertrophy. There is no central stenosis, however there is moderate bilateral neural foraminal stenosis.C4/5: Trace anterolisthesis C4 and C5, posterior osteophyte disc complex, bilateral uncinate hypertrophy, ligamentum flavum thickening, and moderate bilateral facet hypertrophy. There is no central stenosis, however there is moderate bilateral neural foraminal stenosis.C5/6: Trace anterolisthesis C5 on C6, minimal posterior osteophyte disc complex, moderate bilateral facet hypertrophy, partial bilateral facet fusion, and partial vertebral body fusion. There are no significant stenoses.C6/7: Posterior osteophyte disc complex and bilateral uncinate hypertrophy. There is no central stenosis however there is mild bilateral neural foraminal stenosis.C7/T1: UnremarkableT1/2: There is a small midline disc protrusion which causes anterior cord flattening without intrinsic cord signal abnormality. There is also trace anterolisthesis T1 on T2 and bilateral facet hypertrophy. There are no significant stenoses.T2/3: Trace anterolisthesis T2 on T3 secondary to facet hypertrophy. There are no significant stenoses.

Output: 1.Mild chronic small vessel ischemic disease.2.C3/4: Moderate bilateral neural foraminal stenosis.3.C4/5: Moderate bilateral neural foraminal stenosis.4.C6/7: Mild bilateral neural foraminal stenosis.5.T1/2: There is a small midline disc protrusion which causes anterior cord flattening without intrinsic cord signal abnormality.6.Within limits of noncontrast MRI imaging, there are no findings of metastatic disease.


Instruction: Generate impression based on findings.

Input: Congenital anomaly of cerebrovascular system [747.81] / Hereditary hemorrhagic telangiectasia [448.0], Reason for Study: ^Reason: 3T Scanner, please evaluate for cerebral AVMs History: HHT No evidence of acute ischemic or hemorrhagic lesion on the scan.There is focal CSF filled cleft on the left posterior temporal lobe which extends from cortical surface to the left lateral ventricle. The cleft was lined with gray mater without evidence of encephalomalacia indicating focal open lip schizencephaly.Septum pellucidum, optic chiasm and bilateral optic nerves appear to be normal in size, shape and MR signal intensity. There is no evidence of cortical dysplasia.There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. The mastoid air cells are clear. Fluid collections on the right maxillary sinus.3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal. The left distal vertebral artery is hypoplastic.There is no evidence of intracranial arterial aneurysm or arterial luminal stenosis. There is no evidence of aggregated or increased vascular signal void or focal enhancement on this scan.

Output: 1. Open lip schizencephaly on the left temporal lobe posterior aspect.2. No evidence of acute ischemic or hemorrhagic lesion on this scan.3. Normal brain MRA


Instruction: Generate impression based on findings.

Input: Evaluate renal masses, RCC versus angiomyolipoma ABDOMEN:LIVER, BILIARY TRACT: Hepatic segment 7/6 arterially enhancing focus, measuring 7 x 7 mm, image 40 series 10, appears to retain contrast to some degree on subsequent more delayed imaging, increased T2 signal seen, characteristics suggestive of a hemangioma. Mild biliary duct dilatation, particularly intrahepatic, left greater than right.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple bilateral renal masses, all of which appear to contain macroscopic fat, consistent with angiomyolipomas, representative measurements as follows:Largest mass visualized extending exophytically from right kidney, measuring 7.2 x 6.8 cm (image 37 series 901), associated mass effect on adjacent right kidney and liver seen.Another mass extending exophytically from the right kidney more inferiorly measures 4.2 x 3.9 cm, image 58 series 901.Additional right-sided angiomyolipoma measuring 4.7 x 3.7 cm, image 68 series 901.Small right lower pole angiomyolipoma measuring 1.4 x 1.3 cm, image 70 series 901.Largest mass on left side measures 5.3 x 4.2 cm, extending exophytically from lower pole, image 61 series 901.Additional left angiomyolipoma seen extending from upper pole, measuring 5.3 x 3.3 cm, image 29 series 901.Another left-sided angiomyolipoma seen at mid level of left kidney, measuring 3.9 x 3.4 cm, image 59 series 901.Additional enhancing renal lesions seen without internal macroscopic fat, largest ones as follows: Another 3 x 2.5 cm lesion seen in right kidney, image 28 series 10, mass effect on right adrenal gland.2 x 1.7 cm right renal lesion, image 28 series 10.Left-sided renal lesion measuring 1.9 x 1.7 cm, image 48 series 9.Given the corresponding T2 hypointense signal demonstrated by these lesions, lipid poor AMLs are favored (as opposed to clear cell renal cell carcinomas, which would demonstrate avid postcontrast enhancement, too, but with T2 hyperintense signal). Additional smaller angiomyolipomas and renal lesions are also seen that are too small to characterize. Masses are without significant change in size when compared to earlier imaging.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.BONES, SOFT TISSUES: Incompletely imaged breast prostheses.OTHER: No significant abnormality noted.

Output: 1. Bilateral lipidrich and lipidpoor angiomyolipomas.2. Stable subcentimeter arterially enhancing right hepatic lesion, imaging features suggest a hemangioma.


Instruction: Generate impression based on findings.

Input: 2-year-old male with history of neuroblastoma. Status-post two cycles of chemotherapy. Follow up exam. Views of the soft tissue neck show a large relatively homogeneous mass involving the left super mediastinum. This mass extends from the level of the thyroid gland and posterior to the carotid space down through the thoracic inlet. The inferior extent of this lesion is limited due to cut off however it extends beyond the thoracic inlet. This mass currently measures 44.3 x 29.9 mm in the transverse oblique and AP projections, and on the prior MRI exam it measured 38.1 x 23.7 mm on prior MRI exam in one accounting for differences in technique there is suggestion of mild interval increase in the size of this lesion.The remaining views and soft tissue neck show multiple lymph nodes involve the jugular chain and posterior triangle region with a prominent enhancing node involving the left jugular chain jugular digastric region approximating 14.4 mm. there is mild prominence of the tonsillar tissue within the oropharynx with no significant compromise of the pharyngeal/laryngeal airway. Normal enhancement is seen involving the carotid vasculature.

Output: 1. The large left-sided superior mediastinal mass with low cervical involvement air as described above. When accounting for differences in technique there is suggestion of mild interval increase in size from the previous MRI performed on 4/7/2010.2. Cervical lymphadenopathy most prominent in the left jugulodigastric region. See above discussion.


Instruction: Generate impression based on findings.

Input: Male, 72 years old, with right-sided facial droop and left body weakness. Evaluate for stroke. Restricted diffusion is seen beginning in the right subinsular region and continuing through the corona radiata to reach the right lateral ventricular margin. There is no evidence of significant associated edema or mass effect. No acute intracranial hemorrhage is detected. Mild hemosiderin staining is seen along the right caudate nucleus secondary to chronic ischemia. Moderately extensive patchy periventricular and brainstem T2 hyperintensity is seen compatible with chronic small vessel ischemic disease. Also noted is evidence of a chronic right basal ganglia lacunar infarct. Apart from mild ex vacuo dilatation of the right frontal horn, the ventricular system is within normal limits.

Output: 1.Acute ischemia involving the right corona radiata. No significant associated edema, mass effect or acute hemorrhage is observed.2.Moderately extensive sequelae of chronic microvascular ischemic disease and chronic right basal ganglia lacunar infarction are seen.


Instruction: Generate impression based on findings.

Input: Reason: 71M s/p chole c/b recurrent pancreatitis and pseudocyst formation s/p drainage History: pancreatic pseudocyst, nausea, fatigue ABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy. Small cysts in the periphery of segment 4A/8 and 6 are unchanged. No suspicious hepatic lesions.Common bile duct is minimally decreased in size measuring 7 mm in diameter, previously 9 mm. Circumferential thickening and enhancement of the wall of the common bile duct is similar to the prior exam.Intrahepatic biliary ductal dilatation with narrowing of the proximal common bile duct and distal right and left intrahepatic biliary ducts is overall similar to the prior exam.SPLEEN: No significant abnormality noted.PANCREAS: Interval cystoduodenostomy with placement of an AXIOS stent and resolution of the large cystic lesion in the region of the pancreatic head. Mass effect on the common bile duct from the large cyst has decreased. A cluster of smaller cysts more inferiorly measuring up to 1.7 x 1.2 cm appears similar in size to the prior exam.Dilated main pancreatic duct to 5 mm with multiple dilated side branches appear similar to the prior exam. Atrophy of the pancreatic tail is unchanged.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Mildly enlarged portacaval nodes measuring up to 1.5 cm (13011/526).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Interval cystoduodenostomy with resolution of large cyst in the pancreatic head.2.Intrahepatic biliary ductal dilatation with stricturing of the proximal common bile duct and distal intrahepatic biliary ducts is unchanged. Hyperenhancement and thickening of the biliary wall is also unchanged and may be inflammatory in etiology.3.Findings suggestive of chronic pancreatitis are unchanged.


Instruction: Generate impression based on findings.

Input: A patient submitted outside study for review. Submitted for review are bilateral diagnostic mammogram dated 9/12/2015Bilateral breast MRI dated 11/7/2015MR directed ultrasound dated 11/11/2015Bilateral breast MR guided biopsy dated 11/16/2015 with postprocedure mammogram performed at Midwest Center for Advanced Imaging. For comparison,mammogram 9/6/2014 are available. Patient has history of left breast DCIS with excision in 2008, diagnosed with Cowden syndrome 1. Bilateral diagnostic mammogram dated 9/12/2015: 2 standard views of both breasts were obtained. Tomo synthesis cannot be interpreted. The breast parenchyma is composed of scattered fibroglandular elements, unchanged in pattern and distribution. Scar marker overlies the left lower inner quadrant. Multiple scattered benign calcifications seen in both breast.No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in either breast. Benign appearing lymph nodes are projected over the left axillae.2. Bilateral breast MRI:Images were uploaded on Dyna CAD workstation for final interpretation.Linear area of non mass enhancement identified in the right breast 10:00 position approximately measuring 16 x 2 x 10 mm in the AP X ML x CC dimension.In the left breast 7:00 position there is a circumscribed oval mass is intensely enhancing that measures 8 x 5 x 7 mm (AP X ML x CC) with most likely benign morphology.Outside hospital report mentions an enhancing nodule measuring 8 x 7 x 5 mm at 12:00 position of the left breast which appears to represent parenchymal enhancementNo abnormality noted in the axillary region.3. MR directed ultrasound: No correlate was identified to the lesions identified in the outside hospital.4. Bilateral breast MRI biopsy: Right breast 10:00 and 2 sites in the left breast (7:00 and 12:00) were biopsied under MRI guidance. Targeting appears adequate. Clips were placed. A dumble-shaped clip is identified in the right upper-outer quadrant at appropriate location. A rod-shaped clip is identified in the left upper inner quadrant. A dumble-shaped clip is identified in the left lower inner quadrant.Pathology: Right breast 10:00 MR biopsy: DCIS high-grade, malignant and concordantLeft breast 7:00 MR biopsy: Benign breast tissue showing evidence of dense fibrosis suggestive of scarLeft breast 12:00 MRI guided biopsy: Benign breast tissue showing evidence of patchy fibrosis with duct ectasia and apocrine metaplasia with radiation type changes.Both left breast results are benign and concordant

Output: MRI guided biopsy right breast 10:00 linear non mass enhancement shows DCIS.2 sites left breast MRI guided biopsy results are benign and concordant.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Female, 87 years old, presenting with diplopia, with history of metastatic adenocarcinoma of the breast with possible orbital involvement, on therapy, restaging exam. Mild stranding of the orbital fat is seen bilaterally. No discrete masslike lesions are detected. The optic nerves demonstrate a relatively unremarkable morphology. The extraocular muscles are within normal limits. The globes are round and symmetric. No diffusion-weighted abnormal are detected. Please note that abnormalities within the orbits on the prior examination were most conspicuous on postcontrast sequences. Given the limitations of this noncontrast examination, no significant interval change is appreciated.

Output: Within the limitations of this noncontrast examination, no significant interval change is seen. Only mild stranding is evident within the orbital fat. There are no discrete masslike lesions.


Instruction: Generate impression based on findings.

Input: 53-year-old female with shoulder pain x2 months ROTATOR CUFF: The supraspinatus muscle and tendon intact and within normal limits. The infraspinatus muscle and tendon are intact and within normal limits. The teres minor muscle and tendon are intact and within normal limits. The subscapularis muscle and tendon are intact and within normal limits.SUPRASPINATUS OUTLET: Moderate to severe degenerative disease of the acromioclavicular joint with adjacent edema type marrow signal in the acromion and distal clavicle.GLENOHUMERAL JOINT AND GLENOID LABRUM: Linear intermediate signal within the posterior labrum from the eight to ten o'clock position compatible with a labral tear. BICEPS TENDON: Small amount of fluid within the biceps tendon sheath. The biceps tendon is within the bicipital groove with normal signal.ADDITIONAL

Output: 1.Posterior labral tear extending from the eight to ten o'clock position. Subchondral cyst in the posterior humeral head. This constellation of findings has been associated with superior posterior glenoid impingement (internal impingement). No posterior rotator cuff tear.2.Moderate to severe degenerative disease at the acromioclavicular joint with adjacent edema type marrow signal in the acromion and distal clavicle. This finding can be seen in weightlifters.


Instruction: Generate impression based on findings.

Input: Reason: eval for rotator cuff tendon tear vs labral tear History: shoulder apin for a year s/p fall and ski injury then click and pop ROTATOR CUFF: There is mildly increased T2 signal within the distal supraspinatus tendon at its attachment. No rotator cuff tear. SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is a small defect in the superior acetabular labrum oriented anterior-posterior. BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: 1.Small SLAP tear.2.Mild degenerative changes of the acromioclavicular joint. 3.Mild supraspinatus tendinopathy.


Instruction: Generate impression based on findings.

Input: Female, 41 years old, with left ptosis and diplopia, progressive right-sided weakness, and sensory symptoms over three months. New bladder incontinence. Please note that only postcontrast sequences were obtained at the request of the ordering service.Scattered small lesions are redemonstrated including within the periventricular white matter, the left genu of the corpus callosum and at the left pontomedullary junction. None of these lesions demonstrates pathologic enhancement. In fact, no abnormal enhancing lesions are identified intracranially.

Output: No pathologic enhancement is seen to correlate with multiple lesions identified on the prior MRI. Although the lack of enhancement does not provide for a more specific differential diagnosis, it does suggest that these lesions are not actively inflamed.


Instruction: Generate impression based on findings.

Input: 52-year-old female with biopsy proven invasive mammary carcinoma in the left breast presents for breast MRI. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.An enhancing mass, which is a biopsy-proven carcinoma, measuring 20 x 20 x 19 mm, is visualized at 11:00 position in the left breast. A biopsy clip is present anterior aspect of this mass. No other abnormal enhancement is seen elsewhere in the left breast.No abnormal enhancement is seen in right breast. No abnormal lymph nodes are identified in either axillary region.

Output: 1. Unifocal cancer in the left breast. Single wire localization was utilized localization can be performed, if breast conservation surgery is planned.2. No MRI evidence for malignancy in the right breast. 3. No abnormal lymph nodes in either axillary region.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Rule out mass or mass effect. History of histiocytosis X. Non-enhanced CT of brain: There is no evidence of intracranial hemorrhage, edema, mass effect, mass, midline shift or hydrocephalus. Cortical sulci, ventricular system, CSF cisterns and gray -- white matter remains within normal. If clinical concern persists follow-up with an MRI is recommended.Visualized paranasal sinuses and mastoid air cells on the left are unremarkable. There is almost no pneumatization of right mastoid air cells. The right middle ear cavity however is well pneumatized.Calvarium is intact.Limited images of orbits are unremarkable. No abnormality of soft tissues of the scalp is detected.

Output: Negative nonenhanced CT of brain and calvarium.


Instruction: Generate impression based on findings.

Input: Neck pain. Right upper extremity radiculopathy, history of ACDF. Evaluate for stenosis Craniocervical junction is within normal limits. Again seen are post surgical changes of anterior cervical discectomy and fusion from C3 to C6 with solid osseous fusion again evident at C4-C5 and perhaps minimally at C3-C4 and C5-C6, which can be better assessed with CT. There is straightening of the cervical spinal curvature. Alignment of the cervical spine is otherwise maintained. Vertebral body heights are maintained.There is diffuse edema involving the bone marrow of the C6 and C7 vertebral bodies which is new. There is mild disc height loss at the C6-C7 level which is slightly worse anteriorly in the interval. No suspicious osseous lesions.There is trace prominence of the central canal at the C2 level measuring 1 to 2 mm and present on prior studies. No new cord signal abnormality.There is developmental narrowing of the cervical spinal canal with superimposed degenerative changes as described below:At C2-C3, there is minimal right-sided uncovertebral hypertrophy and mild facet arthropathy. There is no significant spinal canal stenosis. Mild bilateral foraminal narrowing.At C3-C4, there is right greater than left uncovertebral hypertrophy and mild facet arthropathy. There is moderate-severe right neural foraminal stenosis which is minimally worse since prior. There is also mild left neural foraminal stenosis. No significant spinal canal stenosis aside from developmental narrowing.At C4-C5, there is left greater than right uncovertebral hypertrophy. There is mild to moderate left and mild right foraminal narrowing. No significant spinal canal stenosis aside from development of narrowing.At C5-C6, there is right greater than left uncovertebral hypertrophy. There is severe right and mild left foraminal narrowing. There is mild spinal canal stenosis with partial effacement of the ventral and dorsal thecal sac.At C6-C7, again seen is a disc bulge and suggestion of a small left central disc extrusion with mild cranial migration, which is minimally more prominent than on prior. There is also ligamentum flavum thickening and mild facet arthropathy. There is at least moderate spinal canal stenosis with mild flattening of the cord, similar to prior. Moderate to severe right and moderate left neural foraminal stenosis is also similar to prior.At C7-T1, there is no significant spinal canal or neural foraminal stenosis.There is partial opacification of the bilateral mastoid air cells, which is again seen.

Output: 1. Compared to 8/22/2014, there is mild interval progression of degenerative changes. There is new bone marrow edema involving the C6 and C7 vertebral bodies which is favored to be on a degenerative basis. There is mild interval worsening of height loss at this level and minimal increase in prominence of a small disc extrusion at this level. There is at least moderate spinal canal stenosis at this level with mild cord flattening, but not significantly changed since prior.2. Neural foraminal stenoses are most significant at the right C3-C4, right C5-C6, and right greater than left C6-C7 levels.3. Postsurgical changes of anterior cervical fusion from C3 to C6 are again seen with solid osseous fusion at C4-C5 and to a minimal degree at C3-C4 and C5-C6, which can be better assessed with CT.4. Trace prominence of the central canal at the C2 level is again seen and of doubtful clinical significance.


Instruction: Generate impression based on findings.

Input: 55-year-old male with weakness, evaluate for tumor or ligamentous injury There is diffuse increased T2 signal and mild enhancement within the visualized portions of the rectus femoris, vastus lateralis, gluteal muscles and the adductor muscles given the field of view amd the extent of which is only partially visualized on this exam. There are no avulsions or discrete tears visualized. The hip joint itself appears unremarkable. The bone marrow signal is within normal limits. Note is made of artifact within the scrotum, likely due to testicular calcification and prior abscess drainage as seen on prior exams.

Output: Edema and enhancement of the muscles of the thigh which is consistent with denervation and changes described on the correlating lumbar MR; however the appearance and changes are non-specific. In the appropriate clinical setting an infectious or inflammatory myositis could not be entirely excluded.


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. Mild mucosal thickening is present within the left maxillary sinus, otherwise the paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain.

Output: Negative MRI of the brain including gadolinium enhancement.