Instruction: Generate impression based on findings.

Input: A patient submitted outside study for review. Submitted for review are two view post procedure left mammogram (08/25/16); procedure ultrasound of the left breast (08/25/16); MRI breast (08/17/16); 2 view post procedure right mammogram (08/04/16); procedural ultrasound of the right breast (08/04/16) were performed at Advocate Good Samaritan Hospital. For comparison, standard mammogram images (11/25/13) are available. Left breast procedural ultrasound (08/25/16): An indeterminate oval, circumscribed lesion in the left breast at the 10:00 position, approximately 7 cm from the nipple measures 7 x 7 x 3 mm, which was targeted for biopsy; the targeting appears appropriate. Additional subcentimeter cysts were seen in the 12:00 position, 2 cm from the nipple as well as the 2:00 position, 6 cm from the nipple.Postprocedural left mammogram (08/25/16): Two standard views of the left breast were obtained. The breast parenchyma is heterogeneously dense, unchanged in pattern and distribution from the prior study dated 11/25/13. A clip is seen within the left upper inner breast, at the 10:00 position, at the site of previous biopsy.Breast MRI (08/17/16): Bilateral breast MRI was performed per outside protocol. There is a heterogeneous amount of fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally. Right breast: Clip artifact is seen in the right breast at the 12:00 position, well-situated within an irregular, enhancing mass, which measures 2.5 x 4.0 x 2.9 cm (AP X ML X CC). Extensive nonmass enhancement extends in all directions, but predominantly posterior and medial to this mass, in total extent measuring 6.9 x 5.4 x 5.4 cm (AP X ML X CC). Nonmass enhancement extends anteriorly within one centimeter of the nipple. Mass and nonmass enhancement correlates to patient's known right breast malignancy. No abnormal axillary lymph nodes are identified in the axillary region.Left breast: There are multiple small enhancing foci in the left breast. The most prominent area is within the left upper inner breast, at approximately the 10:00 position, with dark internal septations, measuring approximately 5 x 7 x 6 mm(AP X ML X CC) and could represent a benign fibroadenoma. No abnormal axillary lymph nodes are identified in the axillary region. Right breast procedural ultrasound (08/04/16): There is an irregular, poorly defined hypoechoic mass in the right breast at the 12:00 position, approximately 1 cm from the nipple, which was targeted for biopsy. Targeting appears appropriate.Postprocedural right mammogram (08/04/16): Two standard views of the right breast were obtained. The breast parenchyma is heterogeneously dense, unchanged in pattern and distribution from the prior study dated 11/25/13. A clip is seen within the right superior breast at mid depth, within the spiculated mass at the 12:00 position, at the site of previous biopsy. There is postbiopsy change with surrounding architectural distortion correlating to the site of patient's known malignancy.

Output: 1.Recommend submission of recent bilateral diagnostic mammograms.2.Awaiting pathology of the left breast biopsy. If malignant, appropriate action should be taken. If benign, however, a six-month follow-up with MRI is recommended.3.Recommend continued surgical management of the known right breast malignancy.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Female 73 years old. Reason: pain. History: pain Three views of the left shoulder are provided. There is a high riding humeral head compatible with the full-thickness rotator cuff tear seen on the recent MRI. Mild to moderate osteoarthritis affects the glenohumeral and acromioclavicular joints.The bones appear slightly demineralized suggesting osteopenia.Degenerative arthritic changes affect the visualized spine.

Output: Osteoarthritis and rotator cuff tear.


Instruction: Generate impression based on findings.

Input: Check for ACL tear MENISCI: Mild fraying of the inner age of both menisci without associated additional abnormality. Specifically the meniscal bodies are well-visualized and intact, as well as properly anchored posteriorly.ARTICULAR CARTILAGE AND BONE: Mild cartilaginous thinning more pronounced in the lateral compartment without focal abnormality. Bone marrow and osseous structures are otherwise unremarkable other than minimal degenerative changes.LIGAMENTS: The ACL demonstrates moderate increased signal with intact fibers throughout. A moderate tendinosis and sprain is suspected without definite tearing. The PCL, collateral ligaments, retinaculum and extensor complex are all otherwise intact .EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Moderate ACL signal abnormality with intact fibers representing moderate tendinosis and sprain. Mild degenerative changes otherwise observed, see details above.


Instruction: Generate impression based on findings.

Input: History of alcoholic cirrhosis. Liver lesion follow-up. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology. Splenomegaly and ascites compatible with portal hypertension.The study is suboptimal to detect small hepatic lesions due to respiratory motion. The previously seen right hepatic dome lesion is not well seen on today's study. It may be seen on the delayed images (series 1504, image 78) and is not significantly changed in size and is too small to characterize. There appears to be complete thrombosis of the portal vein as well as thrombus extending into the SMV. Cavernous transformation of the portal vein is also suspected given the large number of collateral vessels in the porta hepatis.Suboptimal evaluation of the hepatic artery and hepatic veins.Normally distended gallbladder.SPLEEN: Mild splenomegaly measuring 13 cm in craniocaudal dimension. Perisplenic ascites.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: There is new left-sided hydroureteronephrosis with a very low-signal intensity suspected 8 mm calculus in the proximal ureter (series 2 image 25).Stable right renal superior pole simple cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: At least partial thrombosis of the SMV with mesenteric root collateral vessels. Large volume ascites, not significantly changed.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Suboptimal study as described with stable too small to characterize right hepatic dome subcentimeter lesion.2.Cirrhosis with portal hypertension and large volume ascites, unchanged. Portal vein thrombosis with cavernous transformation (also present on 6/24/15 outside hospital study).3.New left-sided hydroureteronephrosis with an 8 mm proximal ureteral obstructing stone.These findings were discussed with Dr. Te at 1420 on 7/27/2015.


Instruction: Generate impression based on findings.

Input: 31-year-old female with pelvic pain, suprapubic pain, discharge, and fever. Evaluate for urethral diverticulum versus Gardner duct cyst versus abscess. PELVIS:UTERUS, ADNEXA: 3.0 x 2.6 x 2.7 cm U-shaped fluid collection posterior to the urethra. This collection conforms around the shape of the urethra and is located at the level of the pubic symphysis. A definite tract from the urethra to this collection is not visualized. This collection appears separate from the vagina. An internal fluid-fluid level is noted, suggestive of proteinaceous debris, possibly from stasis of fluid. There is peripheral soft tissue enhancement around this collection suggestive of infection or inflammation.The uterus is anteriorly located with foci of increased T2 signal in the anterior myometrium, likely reflecting prior C-section. The ovaries are normal in appearance. BLADDER: No significant abnormality noted.LYMPH NODES: Bilateral pelvic lymphadenopathy. The largest visualized lymph node, in the lower abdominal retroperitoneum, measures 2.4 cm in short axis (series 901, image 15), similar to the prior CT.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1.U-shaped fluid collection posterior to the urethra. Though a definite tract to the urethra is not visualized, this most likely represents a urethral diverticulum by appearance. Peripheral enhancement around this collection likely reflects concomitant infection or inflammation.2.Pelvic and lower abdominal lymphadenopathy again seen, similar to the prior abdominal CT. This is unlikely to be related to the urethral diverticulum and is nonspecific but may represents an inflammatory process such as sarcoidosis or neoplastic condition such as lymphoma.


Instruction: Generate impression based on findings.

Input: Diagnosis: Unspecified sinusitis (chronic)Clinical question: intra-operative planning; assess for frontal sinus mucoceleSigns and Symptoms: extensive pansinusitis seen on recent CT scan with bone remodeling There is an expansile mass centered in the right frontal sinus measuring 15 x 29 mm in axial dimensions with predominantly low signal on T2 and intermediate signal on T1. There is enhancement of the mucosal lining of the paranasal sinuses. The mass bulges into the superior aspect of the right orbit and displaces the superior rectus muscle inferiorly. The mass expands into the anterior cranial fossa on the right side and displaces the adjacent right frontal lobe. There is some thickening of the adjacent dura.There is opacification of the paranasal sinusesThe CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the mastoid air cells are clear.

Output: 1.Findings are compatible with a mucocele involving the right frontal sinus and expanding into the right anterior cranial fossa and right orbit. There is some associated dural reaction adjacent to this mucocele.2.Opacification of the paranasal sinuses and superior aspect of the nasal cavity is suggestive of polyposis. The possibility of associated infection cannot be excluded


Instruction: Generate impression based on findings.

Input: A 58 year old male with paroxysmal atrial fibrillation, hypertension, diabetes mellitus and asthma. Referred to cardiac MRI for further evaluation. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 55%, the LV end diastolic volume index is 83 ml/m2 (normal range: 74+/-15), the LVEDV is 168 ml (normal range 142+/-34), the LV end systolic volume index is 37 ml/m2 (normal range 25+/-9), the LVESV is 75 ml (normal range 47+/-19), the LV mass index is 62 g/m2 (normal range 85+/-15), and the LV mass is 126 g (normal range 164+/-36). There is transmural late gadolinium enhancement at the basal lateral and infero-lateral walls. This findings could be consistent with prior myocardial infarction or alternatively suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. These segments are hypokinetic. The LV septum in dyssynergic.Left AtriumThe left atrium is mildly dilated (103ml). Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 55%, the RV end diastolic volume index is 74 ml/m2 (normal range 82+/-16), the RVEDV is 149 ml (normal range 142+/-31), the RV end systolic volume index is 33 ml/m2 (normal range 31+/-9), and the RVESV is 67 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation. Ascending aorta at the level of the main pulmonary artery measures 42x43 mmMitral ValveThe mitral valve opens widely and there is at least mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is mildly dilated (41mm).Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Right upper PV = 22 x 20 mmRight lower PV = 14 x 20 mmLeft upper PV = 20 x 21 mmLeft lower PV = 18 x 14 mmPulmonary ArteryThe main pulmonary artery is normal in size (29 mm).Venous AnatomyThe SVC and IVC normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size and systolic function, the LVEF is 55%. 2. There is transmural late gadolinium enhancement at the basal lateral and infero-lateral walls. This findings could be consistent with prior myocardial infarction or alternatively suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. These segments are hypokinetic. 3. The right ventricle is normal in size and systolic function, the RVEF is 55%. 4. There is mild dilatation of the ascending aorta. See measurements above. 5. See pulmonary vein measurements above.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Demyelinating disease: fatigue, vertigo. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. 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. There are mild secretions in the left ethmoid sinuses and a small retention cyst in the left maxillary sinus. The orbits, skull, mastoid air cells, and scalp soft tissues are grossly unremarkable. There is nonspecific prominence of the adenoids.

Output: 1. No evidence of intracranial demyelinating lesions or mass. 2. Nonspecific prominence of the adenoids, which may be attributable to lymphoid hyperplasia. Nevertheless, endoscopic examination may be useful.


Instruction: Generate impression based on findings.

Input: Metastatic yolk sac tumor status post chemotherapy and radiation. Follow-up exam. Continued interval treatment response. The high posterior right frontal lesion maintains subtle T2 abnormality, but no enhancement. The posterior left temporal lesion is no longer visualized. Continued interval decrease in size of right posterior medulla lesion which now measures 4 x 3 mm, previously 7 x 6 mm. Previously noted right inferior cerebellar lesion is not visualized. No new abnormal enhancing lesions.Stable persistent foci of susceptibility artifact related to prior lesions. There is no evidence of intracranial hemorrhage. The ventricles and basal cisterns are normal in size and configuration. The expected intracranial vascular flow voids are present.The paranasal sinuses are clear. Complete opacification of the right mastoid air cells. The orbits are unremarkable.

Output: 1. Continued interval treatment response with decrease in size of the right medulla lesion. Additional previously noted lesions are no longer identified. No new lesions.2. Complete opacification of the right mastoid air cells which has progressed compared to prior and may reflect eustachian tube dysfunction.


Instruction: Generate impression based on findings.

Input: Clinical question: 17-year-old male with Chiari malformation. Status post shunt placement. Now with mental status change, concerned for stroke. Signs and symptoms: Altered mental status. Non-enhanced CT of brain:A catheter traversing the midline at the level of the foramina magnum and enters the foot ventricle which is nearly completely collapsed. The catheter extends superiorly to the level of quadrigeminal plate. This is believed to be within the aqueduct. No change since prior exam.Images through supratentorial space demonstrate normal size of lateral ventricles and with no change since prior examination. There is no evidence of intracranial hemorrhage, edema, mass effect, midline shift or hydrocephalus. Cortical sulci, ventricular system and all CSF cisterns remain within normal.Two punctate area of subcortical low attenuation symmetrically and bilateral posterior frontal lobes are again identified and are believed to represent prominent perivascular spaces as were noted on prior MRI exam.

Output: No evidence of acute new findings and stable exam since prior study.


Instruction: Generate impression based on findings.

Input: Female, 10 years old, with Chiari malformation and spinal cord syrinx, evaluate for changes, three-month follow-up. Evidence of suboccipital craniectomy and resection of the posterior arch of C1 is demonstrated for Chiari decompression. Superficial to the duraplasty, there is a fluid collection which follows the signal of CSF measuring up to 14 mm in thickness, 33 mm in length and 20 mm in width, compatible with a pseudomeningocele.Relative to the preoperative examination, the CSF space at the level of the foramen magnum has been significantly expanded. Robust biphasic CSF flow is seen through the anterior aspect of the foramen magnum. Mild but distinct biphasic CSF flow is seen through the posterior foramen magnum, around the tonsils and through the foramen of Magendie. The previously seen spinal cord syrinx has significantly decreased in size, now measuring no more than 1 mm diameter, previously 3 mm. This minimal residual prominence of the central canal of the cord begins at approximately C5 and continues down to T8.Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. No marrow replacement or marrow edema is detected. No significant compromise of the spinal canal or neural foramina is seen.

Output: 1.Findings are seen compatible with interval Chiari decompression including suboccipital craniectomy and resection of the posterior arch of C1. Just superficial to the duraplasty, there is a fluid collection measuring up to 14 mm in thickness compatible with a pseudomeningocele.2.Relative to the preoperative examination, the CSF space at the foramen magnum has been significantly expanded. Robust biphasic CSF flow is seen through the anterior aspect of the foramen, with mild but distinct biphasic flow posteriorly, along the tonsils and through the foramen of Magendie.3.A significant decrease in the size of the spinal cord syrinx is also demonstrated.


Instruction: Generate impression based on findings.

Input: Clinical question: Preoperative planning for tumor resection. Signs and symptoms: Headaches. Pre- and post enhanced Stealth brain MRI:Examination is performed utilizing Stealth protocol and is not a true diagnostic exam. There are also no prior exams for comparison.Examination demonstrates a partially solid partially cystic enhancing mass in the left inferior frontal lobe with fairly extensive surrounding vasogenic edema. Findings results in effacement of adjacent cortical sulci and deviation of midline to the right of approximately 5 mm at the level of septum pellucidum. The tumor measures at 33 x 32 x 30 in three dimensions. Posteriorly the M1 and A1 segment of the middle and anterior cerebral arteries are abutting the tumor however without evidence of encasement. There is no detectable additional foci of signal abnormality or abnormal parenchymal, leptomeningeal enhancement.Calvarium is unremarkable.Images through the orbits are unremarkable.All the paranasal sinuses and bilateral mastoid air cells and middle ear cavities demonstrate normal pneumatization signal pattern.

Output: 1.Partially cystic and solid enhancing mass (33 x 32 x 30 mm) in the left paramedian inferior frontal with surrounding vasogenic edema and resultant 5 mm deviation of midline to the right.2.Unremarkable pre and post enhanced Stealth brain MRI exam otherwise.


Instruction: Generate impression based on findings.

Input: Female, 77 years old, with left-sided weakness. Evaluate for stroke. A 6-mm focus of restricted diffusion is seen just inferior to the hand motor area of the right precentral gyrus. A 4-mm focus of restricted diffusion is also evident within the left cerebellum. There may be a punctate focus of restricted diffusion within the far posterior right cerebellum but this is equivocal.On perfusion imaging, MTT and TTP maps demonstrate abnormal elevated values corresponding to the right MCA distribution. rCBV and rCBF maps, however, show no large deficits, and if anything, the relative blood volume and blood flow within the right MCA distribution seems to be slightly increased compared to the left.Numerous scattered foci of T2 hyperintensity are seen including within the periventricular and subcortical white matter of the cerebral hemispheres and brainstem. No evidence of significant parenchymal edema or mass effect is detected. No pathologic parenchymal or extra-axial enhancement is evident.There are no findings to suggest acute intracranial hemorrhage or any abnormal extra-axial fluid collection. A focus of susceptibility along the left lateral ventricular atrium is likely related to chronic microhemorrhage. The ventricular system is normal in size and morphology.

Output: 1.Small foci of restricted diffusion are seen involving the tissues just inferior to the hand motor area of the right precentral gyrus as well as the left cerebellar hemisphere, and questionably in the right cerebral hemisphere.2.Perfusion imaging demonstrates abnormally elevated MTT and TTP in the distribution of the right MCA indicating either delayed bolus delivery and/or prolonged bolus flow-through. These findings could reflect an upstream stenosis with collateralization. However, the rCBV and rCBF maps show no significant deficits, and if anything, flow and volume are very slightly elevated in the right MCA distribution which would suggest largely intact cerebrovascular compensatory mechanisms.3.The background brain demonstrates evidence of chronic prior microvascular ischemic disease. No other acute intracranial abnormalities are seen.


Instruction: Generate impression based on findings.

Input: There are numerous periventricular, juxtacortical, and infratentorial T2 hyperintense white matter lesions as well as potentially an additional lesion at the cervicomedullary junction. Some of these lesions demonstrate T1 hypointensity. There is no evidence of acute infarct. There is a 1 cm centrally heterogeneous and peripherally T2 hypointense lesion within the left hippocampal tail that demonstrates extensive susceptibility effect and is most compatible with a cavernous malformation. There is no significant surrounding edema. There is global volume loss. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is a 1 cm pineal cyst. The skull, paranasal sinuses, and scalp soft tissues are unremarkable. There is a 13 mm T1 and T2 hyperintense well-defined rounded lesion within the C2 vertebral body on the right that likely represents a hemangioma.

Output: 1.Numerous periventricular, juxtacortical, and infratentorial white matter lesions as well as potentially an additional lesion at the cervicomedullary junction compatible with multiple sclerosis.2.1 cm cavernous malformation within the left hippocampal tail without surrounding edema.3.Moderate global volume loss.


Instruction: Generate impression based on findings.

Input: Reason: patient w/ leg wound, elevated inflammatory markers eval for osteomyelitis History: LE wounds bilat There is thickening and enhancement of the skin as well as subcutaneous edema compatible with cellulitis. There is mild fatty atrophy of the musculature of the leg. Additionally, there is mild increased signal abnormality within the muscles of the leg on fluid sensitive sequences that may represent edema, but we see no focal fluid collection to suggest abscess formation, nor do we see frank enhancement of the muscle. The bone marrow signal intensity is within normal limits without findings to suggest osteomyelitis. There is osteoarthritis of the knee and a small knee joint effusion.

Output: Cellulitis and other findings as described above without evidence of osteomyelitis.


Instruction: Generate impression based on findings.

Input: 42-year-old female with pain with movement. Evaluate for tendinopathy. LIGAMENTS: The ulnar collateral ligament and radial collateral ligament appear intact.TENDONS: Increased signal intensity at the origin of the common extensor tendon is compatible with tendinosis ("lateral epicondylitis"). There is minimal edema within the soft tissues adjacent to the common flexor tendon at its origin but the tendon itself appears normal. The biceps and brachialis tendons appear normal. The triceps tendon appears normal.ARTICULAR SURFACES AND BONE: Bone marrow signal intensity is normal. We see no osteochondral defects. There is a small amount of fluid within the joint but no frank effusion. SURROUNDING STRUCTURES: The muscles of the elbow appear normal. There is increased signal intensity on fat-suppressed T2-weighted images of the ulnar nerve within and just proximal to the cubital tunnel which could represent mild neuritis although this is equivocal.

Output: 1.Mild tendinosis of the common extensor tendon (mild "lateral epicondylitis").2.Mild increased signal intensity of the ulnar nerve may reflect mild neuritis but this is of questionable clinical significance.


Instruction: Generate impression based on findings.

Input: Clinical question: 56-year-old male with altered mental status, history of CVA, now with mental status change and focal left-sided weakness. Please evaluate for subacute stroke/other intracranial process. Signs and symptoms: Left-sided weakness, slurred speech. Non-infused CT of brain:Examination redemonstrates an old right basal ganglia lacunar infarct.No evidence of new detectable ischemic stroke, hemorrhage, edema, mass effect or midline shift.Cortical sulci, ventricular system and all CSF cisterns remain similar to prior study and within normal limits. Considering provided clinical data an MRI examination would be most helpful for detection of early acute stroke.Calvarium is intact.Limited real paranasal sinuses demonstrate minimal right maxillary chronic sinusitis.Mastoid air cells and middle ear cavities are pneumatized.

Output: 1.No definite acute detectable new ischemic stroke or hemorrhage.2.Stable previously described findings of right sided lacunar infarct.3.Overall stable exam.


Instruction: Generate impression based on findings.

Input: 56 years Female (DOB:10/25/1959)Reason: Evaluate for metastatic disease - 56 yo F with BRCA1 mutation, R Breast cancer with nodal mets now w/ 2 weeks nausea, vomiting, diffuse weakness w concern for cord compression and hypodensity in R posterior parietal lesion on CT head after fall 1 wk ago History: nausea, emesis, abnormal CT head with hypodense lesion in R posterior parietal regionPROVIDER/ATTENDING NAME: CHRISTOPHER K DAUGHERTY CHRISTOPHER K DAUGHERTY There are multiple enhancing lesions scattered throughout the brain parenchyma. There is an irregularly shaped ring-enhancing mass centered in the right inferior parietal lobule measuring 38 x 21 mm axial dimensions which is associated with some adjacent leptomeningeal and dural thickening. There are some associated punctate foci of signal loss and susceptibility imaging within this lesion which may represent microhemorrhage. There is another ring-enhancing irregularly shaped mass centered along the left para hippocampal gyrus measuring 16 x 21 mm axial dimensions. There is an enhancing nodule present in the right cerebellar hemisphere measuring 4 mm. There is leptomeningeal enhancement within the posterior fossa and along the supratentorial brain posteriorly.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.There is leptomeningeal disease predominantly involving posterior fossa and the posterior aspect of the supratentorial brain present which in the setting of breast cancer is suggestive of leptomeningeal carcinomatosis.2.There are multiple brain parenchymal lesions present in the right parietal lobe and left temporal lobe as well as the cerebellum which are compatible with brain metastases.


Instruction: Generate impression based on findings.

Input: Autonomic dysfunction with neuromuscular weakness potentially related to multisystem atrophy with Parkinsonian features (MSA-p). There is prominent susceptibility effect in the posterolateral portions of the bilateral putamina, left greater than right. There also appears to be a T2 hyperintense putaminal rim sign, at least on the left side. 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, and scalp soft tissues are grossly unremarkable. There is pansinus mucosal thickening. There is also nonspecific fluid in the bilateral mastoid air cells.

Output: 1.Findings suggestive of multisystem atrophy with Parkinsonian features.2.Pansinus mucosal thickening is suggestive of sinusitis.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Evaluate hepatic cysts. History of colon cancer. ABDOMEN:LIVER, BILIARY TRACT: Numerous bilobar cysts are not significantly changed in size or number. No suspicious liver lesion. No biliary ductal dilatation or vascular abnormality.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: Atherosclerotic disease of the abdominal aorta without aneurysmal dilatation.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Bilobar hepatic cysts without suspicious abnormality.


Instruction: Generate impression based on findings.

Input: 46 years, Female, evaluate for stroke or abscess. Additional history per chart: "history of Chiari malformation S/P decompression, pseudotumor cerebri, VPS and LPS (s/p removal), CNS infection, L4-S1 fusion surgery, PFO s/p repair and a-flutter with ablation (2012) who presented to ED after an episode of LOC and seizure-like activity". Again seen are postsurgical changes related to Chiari decompression including suboccipital craniectomy and C1 laminectomy. As seen on recent CT, there is recent placement of a left transparietal catheter which courses in the left parietal lobe, extending across the cingulate gyrus and terminating slightly to the right of the midline. Intraventricular course is not demonstrated as noted on recent CT. There is hyperintense FLAIR signal compatible with vasogenic edema involving the left parietal lobe surrounding the catheter which appears new since prior. Also noted is small fluid immediately surrounding the intracranial portion of the catheter with minimal enhancement. There is also a right frontal lobe linear tract related to prior ventriculostomy with T2 hyperintensity in this region compatible with gliosis. Susceptibility artifact related to the external portion of the left transparietal shunt catheter limits evaluation of the adjacent parenchyma. No new restricted diffusion or susceptibility is appreciated. Minimal chronic blood products are seen along the prior right transfrontal ventriculostomy tract. No abnormal parenchymal or meningeal enhancement is appreciated. Small developmental venous anomaly in the right cerebellum incidentally noted. Major arterial and venous structures appear patent.Previously seen left superior orbital extraconal collection has essentially resolved, with minimal T2 hyperintensity within this region which may represent postsurgical change.

Output: 1. No evidence of intracranial abscess or empyema. No definite evidence of infarct or acute hemorrhage, within the limitations of susceptibility artifact in the left parietotemporal region.2. Left transparietal shunt catheter courses superior to the lateral ventricles as noted on recent CT. There is interval increase in vasogenic edema in the left transparietal lobe which appears new since CT dated 1/27/2016. There is also fluid immediately adjacent to the intracranial portion of the catheter with minimal enhancement. The etiology of these findings is uncertain but possibilities include infection as well as venous injury.


Instruction: Generate impression based on findings.

Input: Clinical question: Spinal compression? Signs and symptoms: Multiple low back pain surgeries, L4 sensory loss. Cord compression nonenhanced complete spine MRI: Examination demonstrates normal anatomical alignment of vertebral column.Degenerative changes of cervical and lumbar spine with a small ventral epidural defects are noted. There is no evidence of a spinal canal compromise or stenosis at any level. Please refer to dedicated report of MRI of lumbar spine performed on 5-1-2015.The signal intensity and caliber of cord is unremarkable.No convincing evidence of perispinal soft tissue abnormalities.

Output: No evidence of cord compression. Please see above comments.


Instruction: Generate impression based on findings.

Input: Reason: 51M with high volume Gleason 7 prostate cancer, assess for pelvic metastasis History: as above PELVIS:PROSTATE:Prostate Size: 4.1 x 2.9 by 4.6 cm.Peripheral Zone: The majority of the peripheral zone in the mid prostate and prostatic apex is replaced by T2 hyperintense diffusion restricting lesion compatible with given history of high volume prostate cancer. This extends into the base of the prostate as well.Central Gland: The tumor extends into the central gland. Seminal Vesicles: Tumor extends into the inferior aspects of both seminal vesicles.Extracapsular Extension: There is extracapsular extension of the tumor in multiple areas predominantly in the mid prostate and prostatic apex.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1.High volume prostate cancer with extracapsular extension and seminal vesicle invasion.2.No abnormal pelvic lymph nodes.


Instruction: Generate impression based on findings.

Input: Reason: 3T Scanner, CCM disease with recent hemorrhage, 2-3 month follow up, please compare to prior scan History: Surveillance There is redomonstration of a focus of susceptibility effect now present in the left precuneus which has changed signal characteristics and size since the prior exam. There is no T2/FLAIR signal hyperintensity associate with the lesion on the current exam. On the prior exam it measured 11 x 11 mm coronal dimensions and on the current it measures 10x8mm coronal dimensions.There is a small hemorrhagic lesion present in the right cuneus which is stable compared to the prior exam.There is redemonstration of a small left-sided thalamic lesion which has a central signal hyperintensity on T2 and the surrounding susceptibility effect. When compared to the prior exam and appear stable.There is redemonstration of punctate focus of susceptibility at the left pons which is also stable and compared to the prior examThere is redemonstration of a punctate foci of susceptibility in the right middle frontal gyrus, left inferior parietal lobule, right medial temporal lobe, right frontal subcortical white matter and right lateral temporal lobe all of which were also identified on the prior exam on susceptibility imaging but not routine imaging.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.There is redemonstration and no change in a hemorrhagic lesion in the right cuneus. The possibility that this represents cerebral cavernous malformations cannot be excluded.2.A hemorrhagic lesion, in the left precuneus has decreased in size and evolved since the prior exam. The possibility that this represents cerebral cavernous malformations cannot be excluded.3.There is redemonstration of a left thalamic hemorrhagic lesion which is stable and compared to prior exam . This compatible with the patient's diagnosis of cerebral cavernous malformation.4.There is redemonstration of multiple punctate lesions in the pons as well as the supratentorial brain as described above. Please correlate with the patient's clinical history for possible familial cerebral cavernous malformations.


Instruction: Generate impression based on findings.

Input: Shoulder pain and weakness Examination is limited by motion artifact.ROTATOR CUFF: There is a small full-thickness tear of the distal fibers of the supraspinatus tendon which measures approximately 7 mm in the greatest AP dimension. There is additional increased signal intensity of the more proximal fibers of the tendon at the level of the glenoid which suggests some interstitial tearing. There is mild tendinopathy of the more proximal fibers but no significant retraction. The infraspinatus and teres minor tendons are intact. There is mild increased signal intensity of the insertional fibers of the subscapularis suggesting tendinosis.There is minimal fatty atrophy along the myotendinous junctions of the supra and infraspinatus muscles but otherwise the rotator cuff musculature is relatively preserved. There is a lobulated mass just superior to the supraspinatus muscle and adjacent to the acromioclavicular articulation which demonstrates fat signal intensity on all sequences and likely represents a lipoma.SUPRASPINATUS OUTLET: Moderate to severe osteoarthritis affects the acromioclavicular joint. There is no significant subacromial subdeltoid fluid.GLENOHUMERAL JOINT AND GLENOID LABRUM: Mild osteoarthritis affects the glenohumeral joint but alignment is normal. There is degenerative tearing of the anterior and inferior labrum. There is no significant joint fluid.BICEPS TENDON: There is a trace amount of fluid within the biceps tendon sheath of the biceps tendon grossly itself intact.ADDITIONAL

Output: 1. Small full-thickness tear of the distal supraspinatus tendon with additional rotator cuff tendinopathy described above.2. Moderate to severe osteoarthritis of the acromioclavicular joint.


Instruction: Generate impression based on findings.

Input: Female, 49 years old, with headache, double vision and right face numbness, status post third ventriculocisternostomy. The lateral and third ventricles remain dilated without significant interval change from the prior examination. Bilateral frontal approach ventricular shunt catheters are in stable position.A small defect within the floor of the third ventricle is again seen, best appreciated on thin section sagittal images. There does appear to be a faint jet of flow related signal spanning the third ventricle and basal cistern, though it is less conspicuous than that seen on the prior examination.A thin tract of enhancement is evident along the left frontal ventriculoscopy trajectory including at the ventricular margin where there is trace hemosiderin staining and FLAIR hyperintensity. A few additional scattered foci of FLAIR hyperintensity are unchanged. No significant parenchymal edema is seen. No other enhancing lesions are detected. No findings to suggest acute intracranial hemorrhage are seen.

Output: 1.Redemonstration of findings related to bilateral frontal approach ventriculostomy catheter placement.2.Findings are also seen compatible with recent third ventriculocisternostomy. The cisternostomy defect appears to be patent and there is evidence of flow across the floor of the third ventricle, though it appears less robust than on the prior examination.3.Expected postoperative granulation is seen along the left frontal ventriculostomy tract.4.No additional specific findings are seen to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: Stroke: left face, arm, and hand sensory change. There is an area of restricted diffusion and high T2 signal in the right lateral thalamus that measures 3 x 12 mm in the axial plane. There is a background of punctate and confluent mild cerebral white matter T2 hyperintensity. There are also small areas of high T2 signal in the left basal ganglia. There is no evidence of intracranial hemorrhage or mass lesions. 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.

Output: Small acute infarct in the right lateral thalamus without evidence of acute intracranial hemorrhage superimposed upon a background of chronic small vessel ischemic white matter disease and lacunar infarcts versus prominent perivascular spaces in the left basal ganglia.


Instruction: Generate impression based on findings.

Input: Reason: R shoulder pain History: pain. ROTATOR CUFF: Moderate supraspinatus tendinosis. The infraspinatus, subscapularis and teres minor are intact. No significant muscle atrophy.SUPRASPINATUS OUTLET: There is widening of the AC joint. No fluid within the subacromial subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Multiple subcortical cysts along the humeral head. Glenoid labrum is grossly intact within the limitations of a non-arthrographic study.BICEPS TENDON: The biceps tendon is intact. ADDITIONAL

Output: 1.Rotator cuff tendinosis without discrete tear. 2.Widening of the AC joint.3.Glenohumeral joint osteoarthritis.


Instruction: Generate impression based on findings.

Input: MRI brain:The study is motion degraded. The morphology of the brain parenchyma is within normal limits. There are a few scattered foci of white matter T2 hyperintensity, which is nonspecific but compatible with mild chronic small vessel ischemic changes. There is no restricted diffusion abnormality or abnormal signal on susceptibility weighted imaging. The ventricles and sulci are within normal limits. There is no midline shift or mass effect. No extra-axial fluid collection is identified. The orbits appear normal without evidence of mass. The midline structures and craniocervical junction are within normal limits. MRA brain:Image quality is suboptimal. The anterior and posterior intracranial circulation is patent. There is no evidence of aneurysm, vascular malformation, or flow limiting stenosis. There is fetal origin of the left PCA.

Output: 1.Mild chronic small vessel ischemic changes, but otherwise normal MRI brain for patient age. If there is high suspicion for orbital pathology, consider dedicated MR imaging of the orbits. 2.Normal MRA brain without evidence of PCA aneurysm.


Instruction: Generate impression based on findings.

Input: 49-year-old female with history of left mastectomy for breast carcinoma in 2007. Patient received chemotherapy. History of bilateral breast implants. There is heterogeneous amount of fibroglandular tissue in the right breast. Postsurgical changes from left mastectomy are present. Bilateral implants are noted.Mild parenchymal enhancement is noted in the left breast.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Breast cancer. There is a subcentimeter area of high T2 signal without associated enhancement, susceptibility effect, or restricted diffusion in the left insular subcortical white matter. There are a few other punctate foci of T2 hyperintensity in the cerebral white matter. 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: A subcentimeter nonenhancing lesion in the left insula and other smaller cerebral white matter lesions are nonspecific, but may represent chronic small vessel ischemic disease, without convincing evidence of intracranial metastases otherwise.


Instruction: Generate impression based on findings.

Input: Male 64 years old with elevated PSA, negative biopsy. Uronav biopsy targets. Evaluation is limited, particularly on DWI, due to artifact from bilateral hip arthroplasties.PELVIS:PROSTATE:Prostate Size: 5.1 x 3.2 x 3.3 cmPeripheral Zone: Within the limitations of this exam no suspicious lesion is identified.Central Gland: Benign prostatic hypertrophy.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: None.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Limited exam with no target lesions identified.


Instruction: Generate impression based on findings.

Input: Female, 65 years old, with sarcoidosis. Evaluate for evidence of neurosarcoid. No evidence of restricted diffusion is seen. No parenchymal edema or mass effect is detected. Minimal scattered small foci of T2 hyperintensity within the cerebral hemispheres are unchanged. Cerebral leptomeningeal enhancement seen on the prior examination has resolved. Enhancement of the left optic chiasm, prechiasmatic optic nerves and optic tract, as well as of the hypothalamus and pituitary infundibulum, has diminished. No new enhancing lesions are seen.No evidence of acute or chronic intracranial hemorrhage is seen. No abnormal extra axial fluid collections are detected. The ventricular system is normal in size and morphology. Large mucus retention cysts remain within the maxillary sinuses.

Output: Since the prior examination, cerebral leptomeningeal enhancement has resolved, and enhancement along the left optic apparatus, hypothalamus and pituitary infundibulum has diminished. Findings suggest at least a radiologic improvement in the appearance of neurosarcoid. No new lesions are seen.


Instruction: Generate impression based on findings.

Input: CERVICAL: There is straightening of the cervical spine. The vertebral body heights are intact. There is dessication of the C2-3 through C5-6 disks with minimal height loss. The osseous marrow signal is benign.The cord signal appears somewhat increased on T1 and T2 at C4 level and below without a focal lesion; this is consistent with artifact given corresponding high T1 and T2 signal intensity in the subcutaneous tissues as well in this region.There is a congenitally narrow spinal canal with no significant disk/endplate degenerative change or significant superimposed spinal stenosis at any level.THORACIC: There is normal alignment of the thoracic spine. The vertebral body and disk heights are intact. There are few scattered T1 hyperintense lesions representing benign hemangiomas. There is a congenitally narrow spinal canal. However, there is no significant superimposed disk herniation or spinal stenosis at any level in the thoracic spine. The cord caliber and signal are unremarkable.

Output: No evidence of cord compression or significant spinal stenosis in the cervical and thoracic spine.


Instruction: Generate impression based on findings.

Input: 39-year-old female with history of right pre-auricular area mass. Please evaluate. Examination demonstrates no definitive evidence of any masses or pathologic adenopathy of the the soft tissues of the neck. The parotid glands appear prominent bilaterally however may be minimally larger on the right side. The density and morphology of the parotid glands however remain within normal limits. No definite evidence of any masses is detected. This area is somewhat obscured by artifact from the mandible. If clinical concern for tumor exist an MRI examination is highly recommended.The bony density of the area of the exam remains essentially unremarkable for any pathology.

Output: 1.No definitive evidence of any masses or pathologic adenopathy in the neck.2.If clinical concern persist an MRI examination is highly recommended.3.4.


Instruction: Generate impression based on findings.

Input: Female, 62 years old, with right-sided paralysis. Please note that only diffusion, FLAIR and a portion of the MRA sequences could be obtained due to patient discomfort. A 5 mm focus of diffusion restriction is seen within the left precentral gyrus in the region of the hand motor area. No other diffusion restricting lesions are evident. FLAIR images are motion degraded but demonstrate hyperintense foci in the periventricular region. The ventricles are normal in size and morphology. The MRA images demonstrate possible mild narrowing to the cavernous ICAs as well as additional scattered mild areas of narrowing, for example in the basilar artery and possibly the PCAs. Please note that the vertebral arteries are not included within the imaging field.

Output: 1.Small acute infarct in the left precentral gyrus centered on the hand motor area.2.Findings compatible with chronic microvascular ischemia.3.Scattered areas of mild vascular narrowing are seen intracranially but there is no high-grade stenosis or frank occlusion detected.


Instruction: Generate impression based on findings.

Input: The risks (including, but not limited to, those of bleeding, infection, allergic reaction, temporary nerve block, pain, and inability to access the joint) and benefits of the procedure were explained to the patient, and informed written consent was obtained. A pre-procedural “time-out” form was completed.The patient was placed supine on the fluoroscopy table. The right hip was localized fluoroscopically, and a spot radiograph was obtained. The course of the femoral artery was noted on the patient's skin using an ink marker. The skin was cleansed and covered with a sterile drape. The skin and subcutaneous tissues were anesthetized with 1% lidocaine using 25-gauge and 22-gauge needles.Under fluoroscopic guidance, a 20-gauge spinal needle was advanced into the joint. Attempted aspiration yielded no fluid. Next, 15 ml of a 50/50 mixture of Omnipaque 240 (to confirm the intra-articular position of the needle) and dilute Multihance (0.1 cc in a 10 cc vial of saline, for subsequent MR imaging) were injected into the joint. Contrast opacified the joint in the expected manner. A spot radiograph was obtained for documentation. The needle was withdrawn. Blood loss was negligible (<1cc), and patient tolerated the procedure well without immediate complication. An adhesive bandage was placed on the patient’s skin. Routine post procedure instructions were communicated to the patient. The patient was escorted to the MRI suite for further imaging in stable condition. Please refer to the subsequent MRI report for further information.Exposure time: 22 seconds

Output: Successful right hip arthrogram prior to MRI.


Instruction: Generate impression based on findings.

Input: 12-year-old female with history of medulloblastoma status post craniotomy, chemotherapy and radiation therapy. MRI Brain: This study is again limited by artifact related to dental hardware and the post-contrast images are also limited by motion. Within these limitations, there are unchanged findings related to prior surgery and treatment within the posterior fossa. The tumor resection bed, and associated encephalomalacia of the cerebellar hemispheres, are stable in appearance. A small area of enhancement measuring 6 x 4 mm along the right margin of the fourth ventricle is grossly unchanged. There is no new suspicious enhancement.Elsewhere in the brain, encephalomalacia affecting the right occipital lobe is unchanged and there are no new foci of pathologic enhancement. The numerous foci of susceptibility artifact within the brain parenchyma and along the ventricular margins are not significantly changed. Ventricles are unchanged.MRI Complete Spine: Spinal cord morphology and signal characteristics are within normal limits. There is no pathologic intrathecal contrast enhancement but the cervical spine is partially obscured by artifact on the postcontrast images.Fatty marrow replacement at some levels of the spine is compatible with prior radiation therapy. There is no suspicious marrow signal abnormality, otherwise.Spinal alignment is anatomic, coming for cervical and lumbar straightening which can be related to patient position. Vertebral body heights and morphology are within normal limits. There is no spinal canal or neuroforaminal stenosis.

Output: 1.The exam is limited by artifact related to dental hardware and the post-contrast brain sequences are also limited by motion.2.Within these limitations, the posttreatment findings in the posterior fossa remain unchanged without sign of local recurrence. Minimal contrast enhancement along the right lateral fourth ventricular wall is unchanged since May 2014.3.Spinal imaging is notable for radiation treatment findings in the marrow but no sign of metastasis is seen.


Instruction: Generate impression based on findings.

Input: Female, 71 years old. Metastatic melanoma There are multiple foci of signal abnormality within the right sacral wing, both iliac wings, both ischia, and the left femoral head, compatible with metastatic disease. For reference, a lesion in the right sacrum measures 2.8 x 1.9 cm (series 601, image 35). The lesion in the left femoral head measures 1.6 x 1.2 cm (series 601, image 19). There are also additional lesions in the lower lumbar spine that are further described on the accompanying dedicated lumbar spine MRI report. There is relatively mild enhancement of these lesions following IV contrast administration. Please refer to the lumbar spine report for details regarding degenerative changes of the lumbar spine.There is mild generalized subcutaneous edema that appears to enhance mildly following contrast administration. This is nonspecific but compatible with mild inflammation. There is a fatty subcutaneous mass superficial to the lateral margin of the left gluteus maximus, likely representing a benign lipoma. Please note that the lateral extremes of the pelvis are not included within the field-of-view of this study.

Output: Multiple metastatic osseous lesions throughout the pelvis with reference measurements as above.


Instruction: Generate impression based on findings.

Input: Male, 74 years old, with history of squamous cell lung cancer and known brain metastasis, admitted with altered mental status and hypoglycemia in the setting of vomiting, now extubated but persistently confused and altered. Subtle restricted diffusion is seen involving the splenium of the corpus callosum with no evidence of associated mass effect, blood product or enhancement and minimal if any corresponding T2 signal abnormality.Scattered patchy areas of T2 hyperintensity are redemonstrated in both cerebral hemispheres, largely periventricular and particularly prominent in the periatrial regions. The appearance and number of these lesions have not significantly changed allowing for technical differences between the scans.A focus of enhancement within the inferior right cerebellar hemisphere is redemonstrated with minimal associated T2 hyperintensity. This lesion measures approximately 6 x 5 mm on the current study compared to 8 x 7 mm on the prior exam. No new pathologic parenchymal or extra-axial enhancement is clearly seen.An enhancing mass centered in the sella is not as well seen on the present study due to motion artifact but probably not changed significantly in the interval.No evidence of significant mass effect is demonstrated. No intracranial hemorrhage or abnormal extra-axial fluid collection is suspected. Ventricular system is within normal limits for size and morphology.

Output: 1. Mild restricted diffusion involving the splenium of the corpus callosum is seen. This finding carries a broad differential diagnosis including sequelae of metabolic or electrolyte derangements including hypoglycemia, ischemic injury, sequelae of seizure, a medication related phenomenon, and some viral infectious agents. Given the history, it is quite possible that this finding reflects injury related to hypoglycemia.2. Scattered additional areas of white matter signal abnormality, particularly prominent in the periatrial regions, are again seen. There has been no significant interval change in the size or number of these lesions. These may be related to chronic ischemic injury, though other etiologies including demyelination and treatment related effects may be contributing.3. An enhancing lesion in the right cerebellar hemisphere compatible with metastasis remains visible but has decreased in size relative to the prior examination. No new intracranial metastases are suspected.4. A sellar mass is redemonstrated showing no significant interval change.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for gray/white matter changes. Signs and symptoms: Vegetative state. Non-enhanced CT of brain:There is no evidence of intracranial hemorrhage, edema, mass effect, midline shift or hydrocephalus. The gray -- white matter differentiation is preserved. The cortical sulci, ventricular system and all CSF cisterns remain within normal. No detectable parenchymal volume loss. In comparison to the prior examination there is no evidence of interval change.Calvarium is intact.Limited views of the orbits, mastoid air cells and middle ear cavities are unremarkable.The visualization of fluid and soft tissue density within the sphenoid sinus with interval worsening since prior exam. This may be secondary to instrumentation an NG tube placement.Considering provided clinical date of follow-up with an MRI examination is recommended.

Output: 1.Essentially unremarkable CT of brain and unchanged since prior examination from 4 -- 26 -- 2010.2.Further follow-up with an MRI is recommended.


Instruction: Generate impression based on findings.

Input: There has been interval placement of a catheter via left frontal approach with tip in the suprasellar cystic portion of the known cystic and rim-enhancing lesion involving the sella and suprasellar cistern. Susceptibility artifact related to the catheter obscures much of the left frontal lobe and portions of the right frontal lobe. The main cystic component has significantly decreased in size now measuring approximately 12 x 19 mm in the axial plane (series 10, image 15) by approximately 22 mm in the craniocaudal dimension (series 11, image 81), previously approximately 28 x 35 x 42 mm. The superior portions of the lesion encroaches upon the third ventricle, and there is a component of the lesion which extends to the region of and probably narrows the left foramen of Monroe. Compared to the 6/29/2016 examination, there is significantly decreased mass effect related to the lesion. The left lateral ventricle remains mildly dilated, but is decreased in size both compared to the 6/29/2016 MRI as well as the 7/5/2016 CT. Previously seen midline shift has nearly resolved. A small amount of intraparenchymal hemorrhage noted on the prior CT is no longer visualized, likely post-procedural. There is a small amount of new increased T2/FLAIR signal surrounding the new catheter, likely gliosis. The previously seen increased T2/FLAIR signal within the periventricular white matter, compatible with subependymal CSF flow, has nearly resolved. The optic chiasm is not well delineated and may be adherent to the mass.There is no territorially restricted diffusion within the brain parenchyma to suggest acute ischemic infarction. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures.

Output: 1.Interval catheter placement with decrease in size of craniopharyngioma as well as decreased associated mass effect.2.Mild persistent dilation of the left lateral ventricle, improving from prior, likely related to narrowing of the left foramen of Monroe.


Instruction: Generate impression based on findings.

Input: 10-year-old male with diffuse ankle pain and instability. Evaluate for fracture or ligament tear. TENDONS: The flexor and extensor tendons appear intact. The peroneal tendons appear intact. The Achilles tendon appears intact.LIGAMENTS: The lateral collateral ligament complex appears intact. The distal tibiofibular syndesmotic complex appears intact. The imaged components of the deltoid ligament appear intact.ARTICULAR SURFACES AND BONE: The bone marrow signal intensity is normal. No osteochondral defect is identifiedADDITIONAL

Output: Normal appearing ankle without findings to account for the patient's pain.


Instruction: Generate impression based on findings.

Input: History of right breast biopsy in October 2011 demonstrating fibroadenomatous change with a 0.2 mm focus of atypia. No new breast complaints. History of breast cancer in mother. 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, unchanged in pattern and distribution. An S shaped clip with surrounding calcifications at the 12 o'clock position of the right breast is unchanged. Additional scattered benign calcifications are present bilaterally. Multiple benign bilateral circumscribed masses are present compatible with cysts as seen on MRI studies.No new masses, suspicious microcalcifications or areas of architectural distortion are present in either breast. Benign lymph nodes are projected over the left axilla.

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


Instruction: Generate impression based on findings.

Input: 54-year-old female with seizure There is no evidence of intracranial hemorrhage, mass or edema. Bilateral periventricular white matter changes increased compared to prior exam. The ventricles and basal cisterns are normal in size and configuration. The calvaria skull base are normal. The visualized paranasal air cells are normally pneumatized.

Output: 1.No acute intracranial hemorrhage, mass or edema.2.Bilateral periventricular hypodensities consistent with small vessel disease of indeterminant age, although definite progression since prior exam.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for brain metastases. Signs and symptoms: None. Pre-and post-enhanced brain MRI:Diffusion weighted abnormalities.Examination demonstrates moderate periventricular and minimally subcortical foci of flair hyperintensity likely representing chronic microvascular ischemic changes without evidence of hemorrhagic change.The anatomical morphology and the signal intensity of brain is otherwise within normal in all MRI sequences.There is no portable abnormal enhancement brain parenchyma, the meninges or the calvarium to suggest metastatic disease. Next unremarkable images through the orbits and including axial fat sat post enhanced series.Bilateral mastoid air cells comminuted cavities and alternatives of sinuses demonstrate normal pneumatization signal patterns.

Output: 1.No evidence of metastatic disease.2.Negative diffusion weighted images and mild chronic findings of small vessel ischemic strokes only in the periventricular and minimally in the subcortical white matter of cerebral hemispheres.


Instruction: Generate impression based on findings.

Input: Reason: P53 History: P53. History of breast and endometrial cancer Bilateral breast implants. Linear signal in the left implant. Prominent inguinal, axillary and supraclavicular lymph nodes are nonspecific. Left chest wall port catheter. Cholelithiasis without evidence cholecystitis. Common bile duct measures 7 mm without an obstructing lesion evident. There is a T2 hyperintense lesion in the right hepatic lobe measuring 5.0 x 4.3 cm. This is increased in size since the prior exam where lesion measured 3.7 x 3.4 cm and had characteristics of a hemangioma. Right renal cyst. Please note that evaluation of spine not optimal on this nondedicated study.

Output: 1.No evidence of metastatic disease.2.Right hepatic lobe lesion has increased in size, previously characterized as a hemangioma.3.Curvilinear signal within the left breast implant may be seen in the setting of intracapsular rupture, correlate with physical exam.


Instruction: Generate impression based on findings.

Input: 19-year-old female with wrist pain. LIGAMENTS: Intra-articular contrast is identified in the radiocarpal joint indicating ligamentous disruption. Intra-articular contrast is identified traversing the scapholunate ligament consistent with a tear. The lunotriquetral ligament appears intact.TRIANGULAR FIBROCARTILAGE COMPLEX: The triangular fibrocartilage complex appears intact.TENDONS: The flexor and extensor tendons appear intact. BONES: There is a small amount of increased signal abnormality was in the ulnar styloid which is nonspecific but may represent a direct bone contusion. No additional bone marrow signal abnormality is identified.ADDITIONAL

Output: Findings consistent with disruption of the scapholunate ligament as described above. Nonspecific bone marrow signal abnormality within the ulnar styloid may represent a direct bone contusion.


Instruction: Generate impression based on findings.

Input: 50-year-old female with left hip and groin painPOST-PROCEDURAL DIAGNOSIS: Left hip pain.PHYSICIANS AND ASSISTANTS: Drs. Sanchez and Dixon. The attending physician, Dr. Dixon, was present for the critical portions of the procedure. The risks (including, but not limited to, those of bleeding, infection, allergic reaction, temporary nerve block, pain, and inability to access the joint) and benefits of the procedure were explained to the patient, and informed written consent was obtained. A pre-procedural “time-out” form was completed.The patient was placed supine on the fluoroscopy table. The left hip was localized fluoroscopically, and a spot radiograph was obtained. The course of the femoral artery was noted on the patient's skin using an ink marker. The skin was cleansed and covered with a sterile drape. The skin and subcutaneous tissues were anesthetized with 1% lidocaine using 25-gauge and 22-gauge needles.Under fluoroscopic guidance, a 20-gauge spinal needle was advanced into the joint. Attempted aspiration yielded no fluid. Next, 10 ml of a 50/50 mixture of Omnipaque 240 (to confirm the intra-articular position of the needle) and dilute Multihance (0.1 cc in a 10 cc vial of saline, for subsequent MR imaging) were injected into the joint. Contrast opacified the joint in the expected manner. A spot radiograph was obtained for documentation. Subsequently, a mixture of 1 cc of Kenalog and 2 cc's of 1% lidocaine were injected into the joint. The needle was withdrawn. Blood loss was negligible (<1cc), and patient tolerated the procedure well without immediate complication. An adhesive bandage was placed on the patient’s skin. Routine post procedure instructions were communicated to the patient. The patient was escorted to the MRI suite for further imaging in stable condition. Please refer to the subsequent MRI report for further information.Exposure time: 13 seconds.

Output: Successful fluoroscopic guided corticosteroid injection as well as injection of dilute gadolinium into the left hip for subsequent MRI arthrogram examination.


Instruction: Generate impression based on findings.

Input: Reason: Pt is an 80 y/o female with urothelial cancer, evaluate for mets History: please assess for disease progression ABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis without evidence of cholecystitis or. No intrahepatic or extrahepatic biliary ductal dilatation. Mild hepatomegaly.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Stable left adrenal nodule, consistent with an adenoma.KIDNEYS, URETERS: Bilateral renal cysts, some of which have increased since the prior exam.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Urinary inversion in the right lower quadrant.BONES, SOFT TISSUES: Ventral hernia containing a small bowel loop without evidence of obstruction.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Status post hysterectomy.BLADDER: Status post cystectomy.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Crescentic low T2 focus in the right femoral head is suggestive of AVNOTHER: No significant abnormality noted.

Output: 1.No evidence of recurrent or metastatic disease.


Instruction: Generate impression based on findings.

Input: Reason: left hand thumb deformity, assess for tendon involvement/tumor/old trauma History: as above LIGAMENTS: No significant abnormality noted.TRIANGULAR FIBROCARTILAGE COMPLEX: No significant abnormality noted.TENDONS: No significant abnormality noted. BONES: No significant abnormality noted.ADDITIONAL

Output: Findings consistent with AVM of the thumb.


Instruction: Generate impression based on findings.

Input: Female 47 years old Reason: ? Angiolipoma of right vulva History: Asymptomatic enlarging soft tissue mass PELVIS:UTERUS, ADNEXA: The uterus is retroverted. Small submucosal T2 hyperintensities are consistent with leiomyomas. The ovaries are unremarkable.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Disc desiccation and mild bulging at the L5-S1 level with a small annular fissure.OTHER: There is mild asymmetric thickening of the right perineal soft tissue which extends into the right vulva. This follows fat signal intensity on all sequences. There is no capsule and there are no nodular enhancing foci. The lesion measures approximately 5.2 x 5.2 cm (series 1203, image 98). Trace free fluid in the pelvis.

Output: 1.Findings consistent with an unencapsulated lipoma in the right perineum extending to the right vulva.


Instruction: Generate impression based on findings.

Input: Without distance runner, check for stress fracture No radiographic abnormality observed, specifically no findings to suggest a stress fracture, however internal visualization utilizing MRI may be indicated if further characterization is needed clinically. Or possibly evaluation of the fibula due to the relayed history.

Output: Normal


Instruction: Generate impression based on findings.

Input: 19 years, Female, Reason: Patient with eye pain, headaches, photophobia: please assess for mass, evidence of elevated pressure, or other focal abnormality Brain parenchyma is within normal limits. No intracranial mass or mass-effect. No diffusion abnormality. No intracranial hemorrhage. The ventricles are within normal limits in size and configuration. No abnormal parenchymal or meningeal enhancement. Major arterial and venous flow-voids are preserved.Examination of the pituitary is unremarkable without evidence of mass or mass effect. There is normal homogeneous enhancement of the pituitary gland without evidence of micro- or macroadenoma. Bilateral orbits also appear unremarkable with no evidence of mass or mass effect. No abnormal signal involving the optic nerves or chiasm. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: MRI of the brain, orbits, and pituitary are unremarkable. Specifically no evidence of intracranial, intraorbital, or sellar masses.


Instruction: Generate impression based on findings.

Input: Congenital malformation of circulatory system, unspecified [Q28.9], Reason for Study: ^Reason: evaluate for vascular malformation History: headache; history of vascular malformation Brain MRI:There is no evidence of acute ischemic or hemorrhagic lesion on the scan. There is no abnormal enhancing lesion intracranially.There is a however 10.5 mm x 17.9 mm sized well circumscribed ovoid enhancing lesion on the left anterior aspect of temporalis muscle. The lesion showed high signal intensity on T2 weighted image and iso signal intensity on T1 weighted image. The lesion shows internal susceptibility artifacts on gradient echo images. The MR findings of this lesion suggest possible venous vascular malformation or hemangioma.The cerebellar tonsils are low lying through the foramen magnum about 6mm. No evidence of syrinx. The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear. There is mucosal thickening on the right maxillary sinus.Neck MRI:There are multiple variable sized lesions showing high signal intensity on T2, lower or iso signal intensity comparing to adjacent muscle on T1 with evidence of Gad enhancement. The lesions are located on bilateral anterior aspects of tongue (series 1501, image 24 and 27) and anterior aspect of the right SCM muscle at the level of vocal cord (series 1501, image 32). Based on MR signal characteristics, these lesions are likely represent venous vascular malformation. Otherwise oro.nasopharynx, hypopharynx, larynx and subglottic airways are unremarkable. The epiglottis, vallecula, piriform sinuses, and vocal cords are normal. The parotid, submandibular, and thyroid glands are unremarkable. The carotid arteries and jugular veins are patent.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion of brain.2. No evidence of intracranial vascular lesion on this scan.3. Low lying cerebellar tonsils about 6mm through the foramen magnum. 4. Multifocal lesions with high signal intensity on T2, low or iso signal intensity on T1 with evidence of Gad enhancement on left anterior aspect of temporalis muscle, bilateral anterior aspect of tongue and anterior aspect of the right SCM muscle at the level of vocal cord indicating possible venous vascular malformation.


Instruction: Generate impression based on findings.

Input: History of abdominal pain, elevated lipase, AST and ALT. ABDOMEN:LIVER, BILIARY TRACT: Numerous bilobar hepatic cysts. No suspicious liver lesion, biliary ductal dilatation or vascular abnormality. Small amount of perihepatic ascites. The common bile duct is dilated up to 10 mm with intrahepatic biliary ductal dilatation. There are two focal round filling defects in the common bile duct (series 901/90 and 86), suspicious for choledocholithiasis.The gallbladder is distended with wall thickening and/or pericholecystic fluid. No cholelithiasis.SPLEEN: Small amount of perisplenic ascites.PANCREAS: Several cystic pancreatic lesions, the largest of which is a uniloculated 1.4 cm lesion in the pancreatic tail which communicates with the main pancreatic duct, compatible with the sidebranch IPMN without suspicious imaging features. Additional 1.1 cm pancreatic body suspected sidebranch IPMN. Punctate cystic lesions in the uncinate process, also likely side branch type IPMNs.There is mild diffuse decrease in intrinsic pancreatic parenchymal signal intensity. The pancreas enhances homogeneously. There is a moderate amount of peripancreatic nonloculated fluid. No evidence of an arterial or venous complication.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: The kidneys are enlarged and the parenchyma is replaced with innumerable high intensity and intermediate intensity cysts consistent with polycystic kidney disease with simple and minimally complex/hemorrhagic cysts. No suspicious enhancing lesion. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.There are two focal round filling defects in the common bile duct (series 901/90 and 86), suspicious for choledocholithiasis. Distended common bile duct up to 10 mm and intrahepatic ductal dilatation, progressed from prior. ERCP is recommended. 2.Mild pancreatitis without necrosis, acute peripancreatic fluid collection or vascular complication.3.Distended gallbladder with gallbladder wall thickening/pericholecystic fluid, progressed from the prior study and suggesting cholecystitis. 4.Polycystic kidney and liver disease. 1.4 cm IPMN in the pancreatic tail and additional suspected IPMNs and/or parenchymal cysts.Findings discussed with hospitalist service (pager 5866 Kristine) at 0930 on 08/06/2015.


Instruction: Generate impression based on findings.

Input: Right hip pain, metastatic breast cancer Again seen is a lobulated subcentimeter focus of intermediate signal intensity on T1-weighted images which is hyperintense on T2-weighted images within the intertrochanteric region of the left femur. There is enhancement following gadolinium administration. This measures 6 mm in the transverse dimension and approximately 7 mm in the craniocaudal dimension and these dimensions are identical to those seen on the prior examination. The reference L5 vertebral body lesion also appears unchanged and there are no additional or new marrow abnormalities identified.The hip joints and sacroiliac joints appear normal with no abnormal enhancement to suggest synovitis. The imaged musculature and tendons of the pelvis are unremarkable.

Output: Signal abnormalities within the left proximal femur and L5 vertebral body are unchanged from the prior exam. There are no new marrow signal abnormalities or other specific findings to account for the patient's hip pain.


Instruction: Generate impression based on findings.

Input: 28-year-old male with medulloblastoma and altered mental status. Please evaluate for new mass effect/edema. Midline suboccipital craniectomy is noted. There is ex vacuo dilatation of the fourth ventricle that is similar in appearance to prior MRI. Encephalomalacia of the cerebellum as well as enlarged supratentorial ventricular size also remain unchanged.There is no evidence of intracranial hemorrhage; no new masses.Shunt tubing enters right lateral ventricle through right frontal skull. The calvaria and skull base are otherwise radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Postoperative changes relatively stable without evidence of new mass. No significant change in ventricular size on comparison to prior MR.


Instruction: Generate impression based on findings.

Input: 26-year-old female with medial pain, buckling on occasion. Evaluate for medial anterior meniscal tear. MENISCI: The menisci appear intact without evidence of tear.ARTICULAR CARTILAGE AND BONE: No significant abnormality noted.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Normal appearing knee with no findings to account for the patient's pain.


Instruction: Generate impression based on findings.

Input: Reason: Meniscus Tear vs Chondromalacia History: Medial Pain MENISCI: Note is made of a focus of intermediate signal intensity within the posterior horn of the medial meniscus, just medial to its root, extending to the tibial articular surface, suggesting a small undersurface tear that appears more prominent than on the prior study. There is a small cyst within the underlying subchondral bone. There is intrasubstance degeneration within the posterior horn and body of the medial meniscus. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: The articular cartilage is normal for age with no fluid-filled defects.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: Small focal undersurface tear of the posterior horn of the medial meniscus, near its root, with subchondral cyst formation in the underlying tibial plateau. The knee otherwise appears normal.


Instruction: Generate impression based on findings.

Input: 28-year-old female with a history of ACL reconstruction. Evaluate lateral meniscus. Presents with right knee pain. MENISCI: There is increased signal abnormality within the posterior horn of the lateral meniscus which may represent prior tearing or postsurgical change from prior partial meniscectomy, appearing similar to the prior study. There are no fluid filled defects to confirm a retear. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is partial-thickness articular cartilage degeneration along the weightbearing surface of the lateral femoral condyle above the posterior horn of the meniscus. There is superficial fraying of the articular cartilage of the weightbearing surface of the medial femoral condyle. The patellofemoral articular cartilage appears intact. There are tricompartmental osteophytes.LIGAMENTS: Note is made of postsurgical changes of prior ACL graft reconstruction. The ACL graft appears intact. There is low signal intensity along the anterior aspect of the mid substance fibers of the ACL graft which may represent anterior arthrofibrosis versus synovitis. Lobulated fluid signal intensity along the posterior aspect of the proximal fibers of the graft which may represent mucoid degeneration versus ganglion formation. The PCL appears intact. The LCL and MCL appear intact.EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Postoperative changes of ACL graft reconstruction. The ACL graft appears intact. Low signal intensity abnormality along the anterior aspect of the graft may represent anterior arthrofibrosis versus a synovitis. Lobulated fluid signal intensity along the posterior aspect of the graft may represent mucoid degeneration versus ganglion formation. 2. Mild osteoarthritic changes of the knee. 3. Nonspecific subcutaneous edema along the anterior aspect of the knee.


Instruction: Generate impression based on findings.

Input: 66 year old woman with history of mixed connective tissue disease, hypertension and atypical chest pain with previous mild LV dysfunction here for ischemic evaluation.MEDICATIONS: aspirin, diltiazem, omega 3 fatty acid, ezetimibe First Pass PerfusionDuring hyperemia, no perfusion defects were present. Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable.Left VentricleThe left ventricle is upper normal in size with normal systolic function. The overall LV ejection fraction is 64%, the LV end diastolic volume index is 89 ml/m2 (normal range: 65+/-11), the LVEDV is 186 ml (normal range 109+/-23), the LV end systolic volume index is 32 ml/m2 (normal range 18+/-5), the LVESV is 68 ml (normal range 31+/-10), the LV mass index is 40 g/m2, and the LV mass is 154 g. There are no regional wall motion abnormalities present. Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 50%, the RV end diastolic volume index is 74 ml/m2 (normal range 69+/-14), the RVEDV is 154 ml (normal range 110+/-24), the RV end systolic volume index is 37 ml/m2 (normal range 22+/-8), and the RVESV is 77 ml (normal range 35+/-13). Right AtriumThe right atrium is mildly dilated. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsProbable left renal cyst. 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. No perfusion defects/ "ischemia" present during hyperemia.2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and systolic function (LVEF 64%).4. Normal RV size and systolic function (RVEF 50%).I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 55 year-old female. Knee pain, instability, falls. MENISCI: Complete radial tear of the medial meniscal body with 4 mm of medial extrusion . Globular signal abnormality within this meniscus consistent with underlying degeneration. Lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: Full thickness cartilage loss of the medial femoral condyle. Near full thickness to full thickness articular cartilage loss of the medial tibia. Diffuse cartilage thinning of the lateral tibiofemoral compartment with no focal defect. Patellofemoral compartment cartilage is markedly thinned with fraying in the medial lateral facet. Small degenerative cyst in the lateral facet. Tricompartmental osteophytes. Patchy edema signal in the distal femur and proximal tibia, most likely degenerative in etiology.LIGAMENTS: ACL and PCL are intact.EXTENSOR MECHANISM: Intact.ADDITIONAL

Output: 1. Complete radial tear of a degenerated medial meniscus with associated extrusion.2. Moderate osteoarthritis most severe in the medial tibiofemoral compartment with areas of full thickness cartilage loss.3. Moderate knee joint effusion.


Instruction: Generate impression based on findings.

Input: History mantle cell lymphoma. Brain: There is now diffuse enlargement and enhancement of bilateral trigeminal nerves and new enhancement along the bilateral cranial nerve 7 and 8 complexes, particularly in the internal auditory canals, right greater than left, as well as the bilateral oculomotor nerves and bilateral cranial nerve 10 and 11 complexes. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is a right transfrontal Ommaya catheter. There is extensive confluent cerebral white matter T2 hyperintensity. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is a small left maxillary sinus retention cyst.Cervical Spine: There is persistent diffuse enlargement of multiple bilateral cervical and upper thoracic extraforaminal enhancing nerve roots. Otherwise, there is no evidence of tumor or abnormal enhancement within the cervical spinal canal. The spinal cord displays normal signal and morphology. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is unchanged mild multilevel degenerative spondylosis, but no significant spinal canal stenosis. The paravertebral soft tissues are unremarkable.

Output: 1. Interval increased and new enhancement and enlargement involving multiple cranial nerves, which is suggestive of lymphoma progression.2. Persistent diffuse enlargement of multiple bilateral cervical and upper thoracic extraforaminal enhancing nerve roots likely related to lymphoma.


Instruction: Generate impression based on findings.

Input: Female, 27 years old, with MS, noncompliant, right arm and bilateral leg weakness. Bilateral dysmetria. Brain:Numerous scattered T2 hyperintense lesions are again seen within the periventricular and subcortical white matter, the deep gray nuclei, brainstem, and to a lesser degree the posterior fossa. The number, size and distribution of these lesions have not changed from prior. None of these lesions shows any convincing evidence of enhancement.There is no evidence of parenchymal edema or mass effect. No abnormal extra axial fluid collections are detected. Ventricular size and morphology are within normal limits.C-spine:The cervical spinal cord is slender with superimposed areas of additional volume loss, similar to prior. Patchy T2 hyperintensity is evident throughout the visualized cord in a similar pattern and distribution to that seen previously. No definite evidence of any new lesions is seen. No definite pathologic cord enhancement seen.A mild scoliotic curvature of the cervical spine is again seen. Alignment is otherwise unremarkable. Vertebral body height and morphology are normal. No concerning marrow replacement, edema or pathologic marrow enhancement is seen.The intervertebral disks are preserved with no evidence of significant spinal canal or neuroforaminal stenosis.

Output: Stable sequela of demyelinating disease in the brain and cervical spine.


Instruction: Generate impression based on findings.

Input: Lower extremity weakness and back pain Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. There is reversal of cervical lordosis with mild anterolisthesis of C3 on C4 and to a lesser degree C4 on C5. Anterolisthesis of C3 on C4 measures up to 4 mm and is worse since prior CT when it measured approximately 1 to 2 mm. There is abnormal signal involving the cervical cord bilaterally at the C4 level. Advanced degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: There is severe spinal canal stenosis related to anterolisthesis, disc osteophyte complex, and ligamentum flavum thickening. There is flattening of the cord. Abnormal T2 signal seen in the cervical cord bilaterally at the C4 level. There is moderate to severe left and moderate right neural foraminal stenosis related to uncovertebral hypertrophy and facet arthropathy.C4-5: There is a disc osteophyte complex and ligamentum flavum thickening resulting in moderate to severe spinal canal stenosis and flattening of the cord. There is mild right and moderate left neural foraminal stenosis related to uncovertebral hypertrophy and facet arthropathy.C5-6: There is a disc osteophyte complex and bilateral uncovertebral hypertrophy. There is moderate spinal canal stenosis and mild cord informed. There is moderate left and mild right neural foraminal stenosis.C6-7: There is disc osteophyte complex and ligamentum flavum thickening with moderate spinal canal stenosis. There is mild to moderate left and mild right neural foraminal stenosis.C7-T1: No significant compromise to the spinal canal or neural foramina.The right vertebral artery flow-void is diminutive with proximal occlusion better demonstrated on prior CT. Small chronic infarcts in the right cerebellar hemisphere noted. Paraspinous soft tissue structures appear within normal limits.

Output: 1. Advanced multilevel degenerative changes in the cervical spine worst at the C3-C4 level where there is severe spinal canal stenosis with cord deformity. There is abnormal T2 signal at this level which at least predominantly likely represents myelomalacia although some of this may represent edema. Comparison with prior CT from 3/11/2013 demonstrates evidence of interval worsening of degenerative disease including worsened anterolisthesis at this level. There is also significant but to a slightly lesser degree of spinal canal stenosis at the C4-C5, C5-C6, and C6-C7 levels. Please see additional details above including multilevel neural foraminal stenosis.2. Diminutive right vertebral artery flow-void with proximal occlusion better demonstrated on prior CTA. Chronic right cerebellar infarct better seen on prior brain MRI.


Instruction: Generate impression based on findings.

Input: syncope and subacute right retro-orbital pain There is about 4.5mm x 6.4mm x 7.6mm sized well circumscribed, non enhancing fluid (likely CSF) containing lesion on the posterior aspect of the right choroidal fissure without showing evidence of mass effect or CSF flow disruption indicating benign choroidal fissure cyst. Differential diagnosis include arachnoid cyst, neuroglial cyst or enlarged perivascular space.Otherwise there is no evidence of acute ischemic or hemorrhagic lesion.There is no evidence of abnormal enhancement.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: About 4.5mm x 6.4mm x 7.6mm sized well circumscribed fluid containing lesion on the right choroidal fissure, differential diagnosis include benign choroidal fissure cyst such as arachnoid cyst or neuroglial cyst.Otherwise unremarkable.


Instruction: Generate impression based on findings.

Input: Female, 58 years old, with focal headache, left parasagittal, ventral to the crown, assess for stroke, less likely mass or vascular lesion. The cerebral and cerebellar hemispheres and brainstem show normal signal intensity and morphology. No restricted diffusion is seen.No evidence of parenchymal edema, mass, or mass effect is seen. There is no evidence of intracranial hemorrhage or abnormal extra-axial fluid. The ventricular system is normal in caliber and morphology. MRA imaging shows no evidence of any significant intracranial vascular stenosis or occlusion. No aneurysms are detected within the limitations of technique.Signal intensity of the bone marrow is unremarkable. No significant abnormalities of the paranasal sinuses are detected.

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


Instruction: Generate impression based on findings.

Input: Reason: 43 yo male with hx of right nephrectomy and cholecystectomy for renal cell carcinoma; pt has a stable hemangiomata within the liver; please evaluate for changes and or recurrence. ABDOMEN:LIVER, BILIARY TRACT: There is a diffuse decrease in hepatic parenchymal signal intensity on out of phase images consistent with fatty infiltration. There is a lobulated, well-circumscribed lesion within the right hepatic lobe (series 8, image 23) measuring 10.4 x 10.7 cm, previously 9.8 x 10.0 cm. The lesion demonstrates mild T1 hypointensity peripherally with more pronounced T1 hypointensity centrally as well as mild T2 hyperintensity peripherally and more pronounced T2 hyperintensity centrally. The lesion demonstrates discontinuous, peripheral, nodular enhancement on arterial phase images with some centripetal fill-in on delayed images compatible with a benign giant hemangioma. A well-circumscribed lesion within segment 2 of the liver (series 8, image 11) measures 2.5 x 2.9 cm, previously 2.1 x 2.4 cm. The lesion is homogeneously T2 hyperintense and T1 hypointense. The lesion demonstrates discontinuous peripheral nodular enhancement with progressive filling in on more delayed images and is compatible with a benign hemangioma. An additional lesion, also in segment 2 (series 8, image 9) measures 1.6 x 2.2 cm, previously 1.4 x 2.3 cm. The lesion is mildly T2 hyperintense and T1 hypointense, demonstrates peripheral nodular enhancement with fill-in on 1 hour delayed images, and is compatible with a benign hemangioma.Gallbladder is surgically absent.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Status post right nephrectomy. No evidence of residual or recurrent disease in the surgical bed.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.Benign hepatic hemangiomas stable to minimally increased in size. No new hepatic lesions.2.No evidence of recurrent or residual malignancy.3.Hepatic steatosis.


Instruction: Generate impression based on findings.

Input: Other symptoms and signs involving the musculoskeletal system [R29.898], Reason for Study: ^Reason: 4 days RLE weakness concerning for CVA History: RLE weakness Brain MRIRestricted diffusion lesion seen on the left thalamus indicates acute ischemic infarction.There is no evidence of hemorrhagic conversion.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage. The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.Brain MRA3D 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.There is no evidence of intracranial artery aneurysm, no intracranial arterial luminal irregularity or stenosis.

Output: 1. Acute ischemic infarction without hemorrhagic conversion, left thalamus.2. Normal brain MRA