Instruction: Generate impression based on findings.

Input: Multiple cystic lesions to thighs bilaterally and varicosities to lower legs. Left tibia/fibula: Bone marrow signal is within normal limits. There are numerous serpiginous vascular structures within the soft tissues communicating with veins compatible with varicose veins. No abnormal enhancing mass lesion is identified. The musculature appears normal.Right tibia/fibula: Bone marrow signal is within normal limits. There are numerous serpiginous vascular structures within the soft tissues communicating with veins compatible with varicose veins. No abnormal enhancing mass lesion is identified. The musculature appears normal.

Output: Bilateral varicose veins.


Instruction: Generate impression based on findings.

Input: 58 years Female (DOB:11/17/1957)Reason: Increased vertigo and episodes of loss of consciousness and h/o posterior circulation aneurysm. Eval for structural lesion/aneurysm change History: vertigo, loss of consciousnessPROVIDER/ATTENDING NAME: SANDRA LYNN ROSE SANDRA LYNN ROSE MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:The left posterior communicating artery has a sizable infundibulum measuring approximately 3 mm in diameter. There is a 3.5 mm aneurysm originating from the infundibulum and projecting posteriorly, laterally and inferiorly when compared to prior exam of 11/18/2014 it appears slightly enlarged.Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial cerebrovascular occlusion.The anterior communicating artery is identified. The posterior communicating arteries are not readily identified. The vertebral arteries are similar in size.

Output: 1.There is redemonstration of a left posterior communicating artery aneurysm associated with an infundibulum of the left PCOMA which appears to be perhaps a millimeter larger on the current versus the prior exam. 2.No evidence for cerebrovascular occlusive disease.3.No evidence for acute ischemic cerebral infarction.


Instruction: Generate impression based on findings.

Input: Laser ablation of the corpus callosum. There has been interval laser ablution of the corpus callosum via right transparietal and right transfrontal approaches. There is expected peripheral enhancement of the ablation zones. There is no evidence of gross intracranial hemorrhage. There is no midline shift.

Output: Expected findings related to interval laser ablation of the corpus callosum.


Instruction: Generate impression based on findings.

Input: 67 years, Female, evaluate changes to meningioma. Again seen is an enhancing lesion along the surface of the left inferior frontal lobe, which is likely extra-axial in location and demonstrates a broad base compatible with meningioma. The lesion measures up to 8 x 8 x 6 mm in the AP, transverse, and craniocaudal dimensions, which is unchanged. No associated edema or mass effect. There is confluent as well as scattered foci of T2/FLAIR hyperintensity involving the bilateral periventricular and subcortical white matter which are nonspecific but compatible with moderate chronic small vessel ischemic disease. No evidence of acute infarct or hemorrhage. There is prominence of the perivascular spaces in the basal ganglia. T2/FLAIR hyperintensity involving the pons is also nonspecific but compatible with small vessel ischemic disease. No hydrocephalus. No extra-axial collections. There is a nonenhancing 5 x 6 mm T1 hyperintense and T2 hypointense lesion involving the posterior aspect of the pituitary gland which may represent a Rathke's cleft cyst. No suprasellar extension or evidence of mass effect.There is opacification involving the lateral recess of the left sphenoid sinus similar to prior. There is also mild mucosal thickening involving the inferior aspect of the bilateral maxillary sinuses also similar to prior. Calvarium and remainder of the extracranial soft tissues are unremarkable.

Output: 1. Unchanged subcentimeter enhancing lesion along the surface of the left inferior frontal lobe likely representing a meningioma. No associated edema. No other enhancing lesions within the brain or evidence of intracranial mass effect.2. Unchanged subcentimeter nonenhancing lesion involving the posterior aspect of the sella, which can be better assessed with a dedicated pituitary MRI study but may represent a Rathke's cleft cyst. No associated mass effect.3. Multiple foci of T2/FLAIR hyperintensity in the periventricular and subcortical white matter as well as in the pons are nonspecific but compatible with moderate chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: Again seen are numerous supratentorial, predominantly periventricular, T2/FLAIR hyperintense lesions with morphology and distribution consistent with known demyelinating disease. Several infratentorial lesions including the middle cerebellar peduncles and right cerebellar hemisphere are also again seen. Cervicomedullary junction lesion is also unchanged. No new lesions are appreciated. No abnormal enhancement. There is moderate to severe burden of T1 hypointense lesions similar to prior. There is also mild parenchymal volume loss including thinning of the corpus callosum. No evidence of infarct or hemorrhage. No intracranial mass or mass effect. No hydrocephalus or extra-axial collections. Calvarium and extracranial soft tissues in the head are otherwise grossly unremarkable.Partially imaged in the neck is what likely represents focal enlargement of an enhancing vascular structure immediately adjacent to or involving the right jugular vein (best seen on coronal series 1303, image 95). This lesion measures up to 2.2 cm in diameter and has been present on multiple prior studies.

Output: 1. Compared to 1/24/2015, there is no evidence of progression of demyelinating disease in the brain.2. Focal enlargement of a vascular structure in the right neck. Unclear if this may represent the jugular vein itself or possibly aneurysm of an arterial structure just next to the jugular vein. Would consider dedicated CTA neck further evaluation. This lesion however has been present on multiple prior studies.


Instruction: Generate impression based on findings.

Input: Reason: 3T Scanner, SRS for AVM March 2013 History: Please evaluate for changes post SRS MRI of the brainAn arteriovenous malformation located adjacent to and posterior medial to the trigone of the left lateral ventricle is less conspicuous on the T2 images relative to the prior exam, however, it is still visible on the SWI and GRE images indicating that it has decreased in size compared to the prior exams. Feeding arteries and draining veins have also decreased in caliber. Post contrast images demonstrate some of the adjacent draining veins. The right basal vein is larger than the left basal vein. This is non-specific, however, and may relate to normal asymmetry, decrease in caliber of the left basal vein with redirection of venous drainage - especially since the straight sinus was reportedly narrowed proximally - or persistent venous drainage for the AVM. The patient has developed some T2 and flair bright signal changes in the adjacent brain parenchyma which has regressed since the prior exam and is associated with encephalomalacia. There is associated contrast enhancement along a small portion of this signal changeIncidental note is made of a left-sided periclival persistent trigeminal arteryThe visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is 3 mm axial dimension arteriovenous malformation located adjacent to and posterior medial to the trigone of the left lateral ventricle. On the 10/6/14 exam it measured 7mm. Its drainage into the vein of Galen is note readily depicted, however, its drainage into the superior sagittal sinus remains visible. The left posterior cerebral artery distal branches near the AVM appear larger than the right posterior cerebral artery distal branches, suggesting supply from the left posterior cerebral artery.Incidental note is made of a left-sided periclival persistent trigeminal artery

Output: 1.Continued regression of arteriovenous malformation located adjacent to the trigone of the left lateral ventricle.2.Tissue reaction surrounding the AVM along the adjacent brain parenchyma - likely related to postradiation effect - continues to regress.3.Persistent trigeminal artery.


Instruction: Generate impression based on findings.

Input: Secondary malignant neoplasm of brain [C79.31], Reason for Study: ^Reason: RCC to brain; history of RT to brain; now with new brain met; MRI for RT planning History: RT planning Motion artifact degraded image quality.Previously demonstrated enhancing nodule with the surrounding edema located at the right inferior parietal lobule close to the distal portion of intraparietal sulcus, is unchanged since prior scan (measured about 8mm on 3D SPGR sequence). There are also susceptibility artifacts on the right inferior parietal lobule which again unchanged since prior scan.There is no other abnormal enhancing lesion seen on the scan.There is evidence of right parietotemporal craniotomy.The ventricles, sulci and cisterns are unremarkable. The gray-white matter differentiation is normal. The mastoid air cells are clear. Left maxillary sinus retention cyst is seen, unchanged since prior scan.

Output: 1. Preoperative localization scan was performed.2. Unchanged the size of the right inferior parietal lobule nodular enhancing lesion and the extent of the surrounding edema since prior scan.3. Unchanged hemorrhagic lesion at the right parietal lobe since prior scan.


Instruction: Generate impression based on findings.

Input: Pain, anal canal stricturing, Crohn's protocol to assess for fistula/abscess PELVIS:UTERUS, ADNEXA: Physiologic ovarian follicles. BLADDER: Collapsed bladder, making assessment for wall thickening suboptimal. LYMPH NODES: Bilateral mildly prominent inguinal lymph nodes, measuring up to 1.2 cm. BOWEL, MESENTERY: Perianal fistulae formation seen at 4 o'clock and 6 o'clock positions terminating in intergluteal inflammatory focus posteroinferiorly, measuring 2.7 x 1 cm, with associated peripheral enhancement, no drainable internal fluid. Ahaustral appearance of colon. Small pelvic free fluid, may be physiologic or reactive. Incompletely imaged thickwalled right lower quadrant bowel, appears to be primarily ascending colon, ahaustral in appearance.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1. Perianal fistulae visualized at 4 o'clock and 6 o'clock positions, fistulae join beyond the origin of the 6 o'clock position tract, terminating in intergluteal inflammatory focus posteroinferiorly, measuring 2.7 x 1 cm.2. Incompletely imaged thickened right-sided bowel as described, likely reflecting sequela of patient's known inflammatory bowel disease.


Instruction: Generate impression based on findings.

Input: History of HCV cirrhosis, HCC screening. ABDOMEN:LIVER, BILIARY TRACT: There is minimal enlargement of the caudate and left hepatic lobes as well as minimal nodular contour of the liver, suggestive of early cirrhosis.The liver demonstrates normal background parenchymal signal intensity and enhancement. The is redemonstration of T2 hyperintense lesions within hepatic segments 2 and 6, not significantly changed with reference measurements as below. The lesions demonstrate progressive filling in on more delayed images and most likely represent benign hemangiomas. There are couple peripheral areas of arterial enhancement within hepatic segment 7 without washout on more delayed images compatible with transient hepatic intensity differences. No suspicious focal hepatic lesions are identified.Status post cholecystectomy, metallic clips from which causes susceptibility artifact which somewhat obscures surrounding structures. There is mild intra and extra hepatic biliary ductal dilatation. The common bile duct measures up to 10 mm in diameter, slightly increased from prior. No bile duct stones or high-grade stenoses are identified.SPLEEN: No significant abnormality noted.PANCREAS: The pancreas demonstrates normal background parenchymal signal intensity and enhancement. There are several subcentimeter T2 hyperintense lesions within the pancreas which appear grossly similar to prior when accounting for differences in technique. The largest is in the uncinate process with reference measurements below.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.INDEX LESION MEASUREMENTS (Current exam date/time: 9/19/2016 13:00:00)HEPATIC SEGMENT 6 LESION: 1.1 x 0.6 cm (Image 14, Series 401); 1.1 x 0.7 cm on prior (8/19/2014) (Image 7, Series 5).HEPATIC SEGMENT 2 LESION: 1.1 x 0.9 cm (Image 33, Series 401); 1.1 x 0.9 cm on prior (8/19/2014) (Image 20, Series 5).PANCREAS UNCINATE PROCESS CYSTIC LESION: 0.4 cm (Image 10, Series 401); 0.4 cm on prior (8/19/2014) (Image 6, Series 5).

Output: 1.Mild cirrhotic liver morphology.2.Unchanged segment 2 and 6 hepatic lesion compatible with hemangiomas. No suspicious focal hepatic lesions are identified.3.Several subcentimeter cystic structures within the pancreas which most likely represent side branch IPMNs and can be followed on subsequent examinations.4.Status post cholecystectomy with associated mild dilation of the common bile duct.


Instruction: Generate impression based on findings.

Input: Persistently altered mental status. MRI: There is a 3 cm wide area of gyriform restricted diffusion and high T2 signal in the right precentral gyrus. There are also several punctate foci of restricted diffusion and high T2 signal in the subcortical white matter of the right occipital lobe and left frontal lobes. There is no evidence of intracranial hemorrhage or mass. There is diffuse cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is bilateral tympanomastoid fluid.MRA: There is no evidence of significant steno-occlusive lesions or saccular aneurysms. There is a fetal right posterior cerebral artery.

Output: 1. Moderate-sized recent infarction involving the right precentral gyrus and punctate recent infarcts in the right occipital lobe and left frontal lobes, which may be embolic in nature.2. No evidence of significant steno-occlusive lesions of the proximal intracranial arteries. Vascular imaging of the neck may be useful for further evaluation.3. Diffuse cerebral volume loss.4. Nonspecific bilateral tympanomastoid effusions.


Instruction: Generate impression based on findings.

Input: New daily persistent headache [339.42], Reason for Study: ^Reason: brain lesion or dural enhancement? History: daily headaches No evidence of acute ischemic or hemorrhagic lesion.There is no abnormal enhancement.There are scattered multiple high signal intensities on FLAIR imaging on bilateral hemisphere subcortical white matter (series 801, image 18, 19 and 22) , which most likely to be nonspecific.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: Nonspecific white matter high signal intensity lesions as described above.Otherwise no evidence of acute ischemic or hemorrhagic lesion, no abnormal enhancement.


Instruction: Generate impression based on findings.

Input: Diagnosis: Acute lymphoblastic leukemia not having achieved remission Unspecified mycosisClinical question: disseminated fungal infection in brainSigns and Symptoms: fungal stain positive, pulm nodules The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate a mucous retention cyst in the right maxillary sinus.. The visualized portions of the mastoid air cells demonstrate minor opacities. The visualized portions of the orbits are intact.There is diffuse marrow replacement present in the visualized calvarium, skull base and C1 and C2 vertebrae.

Output: 1.Diffuse marrow replacement is compatible with patient's clinical diagnosis of a lymphoblastic leukemia.2.No intracranial mass lesions are appreciated to suggest a fungal infection to the brain at this time. There is also no evidence for brain metastases appreciated.


Instruction: Generate impression based on findings.

Input: 58-year-old male with history of hepatic encephalopathy and portosystemic shunting. ABDOMEN:LUNG BASES: Small right pleural effusion.LIVER, BILIARY TRACT: Status post OLT. Patent portal vein. No significant intra or extra hepatic biliary ductal dilatation.SPLEEN: Portosystemic shunting with abundant dilated collaterals near the splenic hilum.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral renal cysts unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: There are tortuous collateral vessels in the right retroperitoneum arising from the SMV which have increased in size when compared to the prior MRI from 2014 now measuring up to 25 mm, previously 19mm. Segment of abnormal straightening near the confluence with the IVC likely represents area of stent placement and intervention. Moderate volume ascites.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Small bowel is dilated with some bowel wall thickening.BONES, SOFT TISSUES: No significant abnormality notedOTHER: There are tortuous collateral vessels in the right retroperitoneum arising from the SMV which have increased in size when compared to the prior MRI from 2014 now measuring up to 25 mm, previously 19mm. Segment of abnormal straightening near the confluence with the IVC likely represents area of stent placement and intervention. Moderate volume ascites.

Output: Enlargement of prominent spontaneous right retroperitoneal portosystemic shunt. Moderate ascites. Patent portal vein. Small right pleural effusion.


Instruction: Generate impression based on findings.

Input: 68 years, Male, memory difficulty. Evaluate for hippocampal atrophy. Remote history of epilepsy. There is mild global parenchymal volume loss which appears appropriate for patient's age. There is mild volume loss involving the bilateral hippocampi which does not appear to be disproportional to the remainder of the brain. No abnormal FLAIR signal involving the hippocampi or evidence of mesial temporal sclerosis. Several scattered foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with minimal chronic small vessel ischemic changes. Brain parenchyma is otherwise unremarkable for age. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: Brain parenchyma appears within normal limits for age. There are minimal chronic small vessel ischemic changes. There is also fairly mild global parenchymal volume loss including the hippocampi, but appears age-appropriate.


Instruction: Generate impression based on findings.

Input: Reason: ACUTE STROKE PROTOCOL perfusion post-stroke History: stroke, cerebral infarction identified on CT. Patient status post right sided aneurysm embolization. Please evaluate for thrombus currently at the distal right internal carotid artery and perfusion asymmetry between the two hemispheres which may place the patient at risk for additional cerebral infarctions. MRI of the brainThere are foci of diffusion restriction in the right MCA territory and right PCA territory. One in the right inferior frontal gyrus measures 25mm, one in the right occipital lobe measures 30x20 mm, one in the right inferior parietal lobule measures 25x36mm. Smaller (<10mm) ones are present in the right caudate nucleus and right insular cortex.Perfusion images demonstrate mild delay in mean transit time with increased cerebral blood volume in the right versus the left hemisphere. There is no significant difference in the cerebral blood flow between the two hemispheres with the exception of the infarcted areas.There is a 6mm thick hyperdense subdural collection adjacent to the right hemisphere associated with effacement of adjacent sulci, mild midline shift and adjacent leptomeningeal enhancement.There is a 15mm intraparenchymal hematoma at the medial right temporal lobe associated with mild uncal herniation.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:No significant narrowing is identified at the distal right ICA to suggest thrombus within the right ICA.Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries. There is a 4x2.5 mm ACOMA aneurysm present directed superiorly. The A1 segments are similar in diameter. The aneurysm originates from the left A1/A2 junction.The anterior communicating artery is small to medium sized. There is fetal origin of the PCA bilaterally with medium sized left p1 segment and hypoplastic right p1 segment.There is extracranial origin of the right PICA. The RVA is smaller than the LVA intracranially distal to the right PICA origin.

Output: 1.Multiple gray matter based foci of acute infarction in the right hemisphere.2.No evidence for thrombus at the distal right ICA.3.Although there is mild delay in perfusion to the non-infarcted portions of the right hemisphere, there is no significant difference in cerebral blood flow.4.Right subdural hematoma is stable.5.Right temporal lobe hematoma is stable.


Instruction: Generate impression based on findings.

Input: Evaluate for cystic duct stump leak. Patient has a drain in the cholecystectomy bed. ABDOMEN:LIVER, BILIARY TRACT: The patient is status post cholecystectomy. The cystic duct remnant is identified. Within the cholecystectomy bed there is a pigtail percutaneous drainage catheter within a collapsed gallbladder fossa which measures 4.2 x 1.3 cm with no significant fluid, improved from the prior.There is no evidence of hepatobiliary agent spillage into the cholecystectomy bed or abdomen. No biliary ductal dilatation with contrast being excreted into the duodenum. No focal suspicious lesion. The main portal vein is patent.SPLEEN: Chronic splenic vein thrombosis with perisplenic collateral vessels.PANCREAS: Pancreatic fluid collection measures 1.9 x 1.1 cm along the superior anterior aspect of the pancreatic body (series 5/25), decreased from 2.6 x 1.0 cm previously. Aside from the pancreatic head there is decreased intrinsic T1 weighted signal intensity of the pancreatic parenchyma likely related to prior pancreatitis. Mild peripancreatic fat stranding is noted. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Discoid right mid lung atelectasis.

Output: 1.Percutaneous drainage catheter in the cholecystectomy fossa with no measurable fluid collection. No evidence of cystic duct stump leak. No biliary ductal dilatation.2.Interval decrease in size of the pancreatic pseudocyst, currently measuring 1.9 x 1.1 cm. Minimal peripancreatic inflammatory changes.


Instruction: Generate impression based on findings.

Input: Pituitary lesion. The T2 hyperintense and slightly hypoenhancing lesion in the left adenohypophysis appears to have increased in size, measuring up to 7 mm. The posterior pituitary, cavernous sinuses, optic apparatus, and infundibulum are intact. There are partially imaged mild scattered punctate foci of nonspecific T2 hyperintensity within the cerebral white matter. There is no abnormal intracranial enhancement.

Output: The left pituitary lesion, which may represent a microadenoma, appears to have slightly increased in size.


Instruction: Generate impression based on findings.

Input: Recurrent T2N2B squamous cell carcinoma of the base of the tongue, previously treated with concurrent cisplatin/RT and now receiving chemotherapy. There are post-treatment findings in the neck, including partial left glossectomy and pharyngectomy with flap reconstruction via mandibulotomy. There are persistent patchy areas of edema and enhancement in the remaining portions of the oral tongue and surrounding soft tissues, which may be related to treatment effects or denervation, but no evidence of measurable tumor in the oral cavity. There is no evidence of significant cervical lymphadenopathy based on size criteria. The remaining salivary glands appear to be unchanged. There are multilevel posterior cervical disc-osteophyte complexes that narrow the spinal canal. The imaged intracranial structures and orbits are unremarkable.

Output: 1. Extensive treatment effects in the upper aerodigestive tract region without evidence of gross tumor recurrence in the oral cavity region.2. No significant lymphadenopathy in the neck.


Instruction: Generate impression based on findings.

Input: Multiple sclerosis, evaluate for progression Brain: Examination is compared to prior MRI from 1/24/2011 which was obtained per treatment planning protocol and includes axial FLAIR sequences. Again seen are confluent and patchy foci of T2/FLAIR hyperintensity throughout the bilateral periventricular and subcortical white matter. Multiple infratentorial lesions including the midbrain, pons, and medulla as well as the middle cerebellar peduncles and the bilateral cerebellar hemispheres are also again seen. Morphology and distribution of these lesions is again consistent with known demyelinating disease. Due to technique differences, comparison with small lesions is limited. There is however suggestion of mild interval increase in T2/FLAIR hyperintensity in the left parietal periventricular white matter, series 401 axial FLAIR image 18, as well as a lesion in the right cerebellar hemisphere, axial FLAIR image 9, which were not present previously. There are no new large lesions.There is moderate degree of global parenchymal volume loss including diffuse thinning of the corpus callosum. There is moderate burden of T1 hypointense lesions. No intracranial mass or mass effect. No evidence of infarct or hemorrhage. Calvarium and extracranial soft tissues are grossly unremarkable.Cervical spine: Cervical spine sequences are motion degraded. There are multiple T2/STIR hyperintense lesions throughout the cervical cord including at the C1 level bilaterally, confluent signal abnormality from the mid C2 to the C3-C4 level, as well as a lesion extending from C4-C5 to C5-C6.Vertebral body heights and alignment in the cervical spine are maintained. Fairly mild multilevel degenerative changes are present including small disc osteophyte complexes at the C3-C4, C4-C5, and C5-C6 levels. There is no significant spinal canal or neural foraminal stenosis at any level.

Output: 1. Again seen are numerous supra- and infratentorial lesions consistent with known demyelinating disease. Comparison of small lesions is limited due to differences in techniques. There is however question of slight progression since 1/24/2011, with small foci of T2/FLAIR hyperintensity in the left parietal periventricular white matter and right cerebellar hemisphere not definitively seen previously. No new large lesions. 2. Moderate degree of global parenchymal volume loss and a moderate burden of T1 hypointense lesions.3. Multiple demyelinating lesions in the cervical cord. No prior cervical spine MRI is available for comparison.


Instruction: Generate impression based on findings.

Input: History of lymphoma treated with chest radiation (> 20 Gy). Surveillance mammogram and MRI at 8 years post radiation requested. Symmetric scattered fibroglandular tissue is present bilaterally. Minimal parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: NS - Routine Screening Mammogram.


Instruction: Generate impression based on findings.

Input: Abnormal PSA PELVIS:PROSTATE:Prostate Size: 3.1 x 4.4 x 3.1 cm (AP x TR x CC).Peripheral Zone: Foci of T2 signal abnormality involving the right mid gland peripheral zone without a dominant lesion.Central Gland: Benign prostatic hyperplasia.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Left internal iliac lymph node measures 0.8 x 0.7 cm (series 1001, image 126).BONES, SOFT TISSUES: No significant abnormality noted.

Output: T2 foci of signal abnormality involving the right mid gland peripheral zone are nonspecific and may represent chronic prostatitis or cancer. No dominant lesion.


Instruction: Generate impression based on findings.

Input: A 32 year old male with atrial tachycardia, s/p ablation (5/13/2014), who continues to feel palpitations. 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 57%, the LV end diastolic volume index is 68 ml/m2 (normal range: 74+/-15), the LVEDV is 170 ml (normal range 142+/-34), the LV end systolic volume index is 29 ml/m2 (normal range 25+/-9), the LVESV is 74 ml (normal range 47+/-19), the LV mass index is 38 g/m2 (normal range 85+/-15), and the LV mass is 96 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 53%, the RV end diastolic volume index is 73 ml/m2 (normal range 82+/-16), the RVEDV is 182 ml (normal range 142+/-31), the RV end systolic volume index is 34 ml/m2 (normal range 31+/-9), and the RVESV is 86 ml (normal range 54+/-17).Ne evidence of ARVD.Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no pericardial effusion.

Output: 1. The left ventricle is normal in size with normal systolic function, the LVEF is 57%. There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.2. The right ventricle is normal in size with normal systolic function, the RVEF is 53%. No MRI evidence of ARVD.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Metastatic melanoma to brain. Planning for SRS. There is interval increase in size of multiple intracranial metastases with associated vasogenic edema, including including a dominant 18 mm diameter lesion in the right occipital lobe. There is confluent T2 hyperintensity surrounding the lesions. Some of the lesions contain susceptibility effect, suggestive of prior hemorrhage. There is slight effacement of the posterior right lateral ventricle, but no midline shift or herniation. There is mild scattered subcortical and confluent periventricular white matter T2 hyperintensity without associated enhancement. The major cerebral flow voids are intact. The orbital contents are grossly unremarkable. However, there is a subcentimeter exophytic cystic lesion in the skin along the left lateral eyelid region, which may represent a hidrocystoma. There is a small apical scalp lipoma. There is a right maxillary sinus retention cyst.

Output: Pre-treatment planning MRI demonstrates overall increase in size of multiple supratentorial and infratentorial metastases and associated vasogenic edema, including a dominant 18 mm diameter lesion in the right occipital lobe, but no midline shift or herniation.


Instruction: Generate impression based on findings.

Input: Redness, swelling and pain. Evaluate for cellulitis, necrotizing fasciitis and abscess. There is thickening of the skin along the posterolateral aspect of the right hip and upper thigh. There is reticulation of underlying subcutaneous fat, with enhancement on postcontrast imaging. These findings are compatible with cellulitis. We see no fluid collection. The underlying musculature appears normal. We see no finding to suggest osteomyelitis. We see no specific evidence of necrotizing fasciitis.Evaluation of the pelvis is limited on this femur study; note is made of bladder diverticula.

Output: Cellulitis, without evidence of abscess or specific imaging findings of necrotizing fascitis.


Instruction: Generate impression based on findings.

Input: Male 58 years old with a posterior ilium lesion, check for interval change. BONE MARROW: Again seen is a focus of abnormal signal intensity within the posterior left ilium lateral to the sacroiliac joint. It measures approximately 15 x 10 mm in transverse dimension and 16 mm in craniocaudal dimension similar to the prior study upon remeasurement of the lesion on that study. Signal intensity characteristics are similar to the prior study as well, although the lesion is slightly less conspicuous on the T2 weighted images of the current study than on the prior study. The lesion disrupts the cortex of the lateral ilium but we see no evidence of progression into the soft tissues. We see no additional lesions. The remaining bone marrow signal intensity is normal. The musculature is normal in appearance. There is mild facet joint osteoarthritis lower lumbar spine.

Output: Small left iliac bone lesion as described above. Lack of interval change in size suggests a benign etiology perhaps a small benign cartilage lesion.


Instruction: Generate impression based on findings.

Input: Male, 34 years old, with known although astrocytoma and seizures. A large left frontal lobe resection cavity is redemonstrated showing no significant change in size or morphology. Scattered foci of susceptibility are again seen surrounding the cavity compatible with chronic hemosiderin.Since the prior examinations, however, T2 signal abnormality and nodular enhancing tissue along the lateral margin of the cavity have progressed. The dominant nodular lesion shows correlating elevated rCBV. Progressive T2 signal abnormality and ill-defined enhancement is also seen posterior to the resection cavity, again with correlating elevated rCBV.Scattered additional areas of infiltrative T2 signal, tissue thickening and variable enhancement have also progressed including within the splenium of the corpus callosum and at the level of the hypothalamus. These areas are not well assessed on rCBV maps.Most notably, however, is extensive progressive T2 signal abnormality and irregular enhancement inferior to the resection cavity with extension into the basal ganglia and insula. Interestingly, little if any mass effect is detected. Furthermore, these tissues demonstrate markedly reduced rCBV, and single voxel spectroscopic assessment shows prominent lipid peaks but no other reliably detectable metabolites.The right lateral ventricle is shunted and decompressed. Mild ex vacuo dilatation of the left lateral ventricle is seen. The remaining ventricles are unremarkable. Mild T2 hyperintensity is seen surrounding the right frontal horn which is unchanged and nonspecific.

Output: Evidence of a prior left frontal lobe tumor resection is demonstrated. Since the prior examinations, several changes are noted. For example, nodular enhancing tissue along the lateral margin of the cavity, and ill-defined enhancement with T2 signal abnormality along the posterior margin of the cavity, have progressed. Both areas demonstrate correlating elevated rCBV which would favor progressive tumor over treatment effect.Additional scattered areas of progressive signal abnormality and/or enhancement are seen involving the splenium of the corpus callosum and particularly the hypothalamus which is clearly thickened. For technical reasons, these areas are not well assessed on rCBV mapping. However, the distribution and morphology of the changes would also favor progressive tumor over treatment effect.Inferior to the resection cavity, however, extensive progressive T2 signal abnormality and enhancement is seen with a notable lack of significant mass effect. Furthermore, this tissue demonstrates reduced rCBV and a spectroscopic pattern consistent with predominant necrosis. As such, it is possible that these findings may reflect treatment related change/radiation necrosis.


Instruction: Generate impression based on findings.

Input: Numbness and tingling on the left side of the face. Evaluate for cranial nerve inflammation and cerebrovascular accident. Motion artifact somewhat limits evaluation. There is a large enhancing cystic mass in the left cerebellopontine angle, which extends into the internal auditory canal and has significantly increased in size compared to 12/27/2007. This lesion measures approximately 40 x 32 x 33 mm (AP x TR x CC) and exerts mass effect on the left aspect of the brainstem, especially the pons, left cerebellar hemisphere and peduncles as well as contributing to deformity of the fourth ventricle. The lateral and third ventricles are mildly prominent in size. The cisternal segment of the left trigeminal nerve is not identified due to mass effect on the left pons. There is no evidence of intracranial hemorrhage or acute infarct. The skull and extracranial soft tissues are unremarkable. There is a mucus retention cyst in the left maxillary sinus.

Output: 1. Left cerebellopontine angle cystic mass measuring up to 40 mm, markedly progressed since 12/27/2007, and most compatible with a cystic vestibular schwannoma. There is mass effect on the left aspect of the brainstem, cerebellum, peduncles with deformity of the fourth ventricle and mild prominence of the lateral and third ventricles.2. Mass effect on the cisternal segment of the left trigeminal nerve which may explain reported history of left facial sensory symptoms.


Instruction: Generate impression based on findings.

Input: Status post L1 -- L3 spinal fusion and tumor resection. There is mild thickening at the posterior aspect of the trachea at the T3 level. At T10 - T11 right neural foramen, there is prominent soft tissue density of uncertain etiology. This may represent prominent nerve root sleeve or perineural cyst and can be better assessed with MRI study.Postsurgical changes of tumor resection at L2 vertebral level, and spinal fusion from L1 to L3 are again noted. Hardware is intact without evidence of acute fracture. Fusion cage at L2 level is again seen positioned posteriorly laterally, and is causing effacement of the left neural foramina at L2 -- L3, with possible nerve impingement. Multi-level degenerative disease of the lumbar spine is again noted with spinal canal and neuroforaminal narrowing as described previously. No significant interval change is noted.

Output: 1. Postsurgical changes and degenerative disease of the lumbar spine as described above. No evidence of interval change.2. Mild thickening at the posterior aspect of the trachea at the T3 level of uncertain significance. This can represent secretion. Please correlate or follow-up as clinically indicated.3. At T10 - T11 right neural foramen, there is prominent soft tissue density of uncertain etiology. This may represent prominent nerve root sleeve or perineural cyst and can be better assessed with MRI study.


Instruction: Generate impression based on findings.

Input: 85-year-old female with HCV, cirrhosis, assess for HCC. ABDOMEN:LIVER, BILIARY TRACT: Liver contour: The liver contour is nodular. Cirrhotic liver morphology.Cholelithiasis again noted. No intrahepatic or extrahepatic biliary ductal dilatation. Portal vein: patent Hepatic veins: patentHepatic artery: patentLesions: Reference arterial enhancing lesion with no definite washout measures 0.9 x 1.0 cm or restricted diffusion, previously 0.8 x 1 cm lesion (image 68, series 100) in the hepatic dome adjacent to the middle hepatic vein.There is a second arterially enhancing lesion measuring 0.9 x 0.9 cm, appearing similar to the prior study (68; series 100), no definite washout or restricted diffusion.  SPLEEN: Mild splenomegaly and varices again noted. PANCREAS: Redemonstration of cystic lesions in the pancreatic body that likely represent sidebranch IPMNs (intraductal papillary mucinous neoplasms). The reference lesion in the body of the pancreas measures 0.9 x 0.8 cm, previously measuring 1.0 x 0.8 cm (19; series 9). The second reference lesion in the body of the pancreas measures 0.6 x 0.6 cm, previously 0.5 x 0.5 cm. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral cysts, unchanged. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1.Persistent subcentimeter arterially enhancing lesions in the dome of the liver without definite evidence of washout or restricted diffusion. Attention on follow-up examination recommended. Cirrhotic liver morphology.2.No significant interval change in the reference cystic lesions in the pancreatic body, which most likely represent sidebranch IPMNs.


Instruction: Generate impression based on findings.

Input: 77 year old male with stenosis. Evaluate for cause of myelopathy. There is mild reversal of the cervical lordosis secondary to the fusion. Postsurgical changes are visualized of a C3-C5 anterior cervical discectomy and fusion. There is grade 1 anterolisthesis of C4 on C5. There is high T2 signal within the cord posterior to the C4 level which is likely chronic. The craniovertebral junction appears within normal limits. The bone marrow signal is within normal limits.Degenerative changes are seen in the cervical spine as described below:C2-3: There is a disc bulge and prominent ligamentum flavum hypertrophy causes moderate to severe central spinal canal stenosis. There is also mild to moderate bilateral neural foraminal stenosis.C3-4: There is uncovertebral and facet hypertrophy which causes moderate to severe bilateral neuroforaminal stenosis. There is mild central spinal canal stenosis.C4-5: There is uncovertebral and facet hypertrophy which causes severe bilateral neuroforaminal stenosis. There is mild central spinal canal stenosis.C5-6: There is a tiny disc bulge and uncovertebral and facet hypertrophy which causes mild to moderate central canal and neuroforaminal stenosis.C6-7: There is a mild disc bulge and uncovertebral and facet hypertrophy which causes severe the left and moderate right bilateral stenosis. There is mild central canal stenosis.C7-T1: There is a disc bulge with a right paracentral disc protrusion which abuts the thecal sac and causes moderate right neuroforaminal stenosis.On sagittal imaging, there is a mild disc bulge at T1-T2 and T2-T3 but no significant spinal canal stenosis.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: 1.Postsurgical changes from an anterior cervical discectomy and fusion from C3 to C5 with grade 1 anterolisthesis of C4 on C5.2.Multilevel cervical spine degenerative changes. There is at most moderate to severe central canal stenosis at the C2-C3 level and severe neuroforaminal stenosis involving the C4-5, C5-6 and C6-7 levels.3.T2/STIR signal hyperintensity posterior to the C4 vertebral body favors chronic myelomalacia.


Instruction: Generate impression based on findings.

Input: Ms. Sullivan is a 50 year old female with family history of breast cancer in sister (diagnosed at the age of 41), paternal aunt, and two paternal cousins. Family history of ovarian cancer in mother, diagnosed at the age of 70. Patient is BRCA1 positive. There is scattered fibroglandular tissue in both breasts. Minimal parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary or internal mammary region.

Output: No MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: NS - Routine Screening Mammogram.


Instruction: Generate impression based on findings.

Input: Reason: evaluate labrum and cuff History: pain ROTATOR CUFF: There is thickening and intermediate signal intensity within the supraspinatus indicating mild to moderate tendinosis. The supraspinatus tendon appears intact. There is intermediate signal intensity within the infraspinatus at the level of its insertion on the greater tuberosity which likely represents focal tendinosis versus a tiny interstitial insertional tear. The subscapularis and teres minor muscles and tendons appear intact.SUPRASPINATUS OUTLET: The acromioclavicular joint is normal in appearance. No significant amount of fluid is identified within the subacromial subdeltoid bursa. No intra-articular contrast is identified within the subacromial subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is anatomic. There is linear increased signal abnormality traversing the posterior superior labrum extending from the 11 o'clock to the 9 o'clock position indicating a tear. There is associated paralabral cyst formation along the posterior aspect of the glenoid. There is intra-articular contrast extending into the superior labrum at the 12 o'clock position which likely represents a normal variant sublabral recess.BICEPS TENDON: The tendon to long head of the biceps appears intact. ADDITIONAL

Output: 1. Tear of the posterior superior glenoid labrum with associated paralabral cyst formation as described above.2. Rotator cuff tendinosis without evidence of a full-thickness rotator cuff tear or retraction.


Instruction: Generate impression based on findings.

Input: Female 20 years old Reason: evaluate for injury History: pain after 15 mi run, instability with knee "buckling" twice MENISCI: No meniscal tears.ARTICULAR CARTILAGE AND BONE: Bone marrow signal intensity is normal. There is a linear focus of low signal intensity extending through the articular cartilage of the femoral trochlea; this could represent a non-fluid-filled full-thickness cartilage fissure. The remainder of the cartilage appears normal.LIGAMENTS: The cruciate and collateral ligaments are intact. There is mild edema between the iliotibial band and lateral femoral condyle suggesting "iliotibial band friction syndrome". EXTENSOR MECHANISM: Appears normal.ADDITIONAL

Output: 1.Findings suggestive of iliotibial band friction syndrome.2.Findings suggestive of a non-fluid filled fissure of the cartilage of the femoral trochlea.


Instruction: Generate impression based on findings.

Input: Lower extremity weakness and decreased sensation, urinary retention, back pain: eval for cord compression and epidural abscess. There is congenital fusion of the C5 and C6 vertebrae. There is cervical kyphosis rather than lordosis, but no spondylolisthesis. Otherwise the rest of the vertebral column alignment is normal and the vertebral body heights are otherwise intact. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable. The uterus is retroflexed and there is a small amount of fluid in the cul de sac. The urinary bladder is distended.

Output: 1. No evidence of spinal cord compression or intraspinal mass lesions.2. Congenital fusion of C5 and C6 vertebrae.


Instruction: Generate impression based on findings.

Input: Multiple myeloma not having achieved remission [C90.00], Reason for Study: ^Reason: relapsed myeloma with new neck pain, xrays unrevealing, severe kyphosis History: neck pain Cervical spine MRIDue to motion artifact, image quality is degraded.There is exaggerated kyphotic angulation of cervical spine.At the level of C5, vertebral body signal intensity on T1 is a low and high signal on T2 and STIR images indicating acute compression fracture with about 10% height loss. Comparing to prior scan, this C5 compression fracture is new. Soft tissue lesions seen on prior scan posterior to the C5 body is not seen on today's scan.There is no evidence of retropulsion or abnormal spinal cord signal intensity. Next line however, at the level of C4-5, C5-6, there are moderate degree spinal canal stenosis due to ligamentum flavum thickening.Thoracic spine MRI.Again multiple compression fractures seen from T4 to T12.Previously identified discrete lesion at T4 vertebral body is not as conspicuous as it was before.Intravertebral body low signal intensity lesions at the level of T7, 8, 9 and 10 vertebral bodies indicating post cement augmentation procedure, unchanged.T6 vertebral body shows more than 70% of compression fracture with bone marrow edema, comparing to prior scan, no change of the degree of compression fracture as well as MR signal characteristics.Loss of normal fatty marrow signal intensity of thoracic vertebral bodies including about 20% of compression fracture of L1 vertebral body are again demonstrated, grossly unchanged since prior scan.Multifocal rib lesions are again seen, unchanged.Bilateral multifocal lung nodules and pleura based lesions are seen, unchanged since prior scan. There is no evidence of spinal stenosis.Spinal cord signal intensity is normal.

Output: 1. New abnormal bone marrow signal with about 10% of height loss at the level of C5 indicating acute compression fracture without evidence of retropulsion.2. Interval resolution of epidural soft tissue at the level of C5.3. Unchanged multi-level various degree compression fractures, post cement augmentations and cervical spinal stenosis since prior scan.4. No abnormal spinal cord signal intensity.


Instruction: Generate impression based on findings.

Input: Multiple myeloma not having achieved remission [C90.00], Reason for Study: ^Reason: 64 y/o with multiple myeloma; please evaluate L5 lesion seen on previous MRI History: right hip/low back pain For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. Previously seen L5 body right inferior posterior aspect lesion is again seen. The lesion shows eccentric protrusion toward right L5S1 lateral recess and abuts thecal sac with slightly inhomogeneous enhancement.Though the imaging parameters are different, overall size and MR imaging characteristics of above lesions such as signal intensity do not show any significant interval change since prior scan.The MR signal intensity of whole lumbosacral spine and bilateral iliac bones show replacement of normal fatty marrow signal intensity, unchanged since prior scan.On Gad enhanced scan, multifocal inhomogeneous enhancing lesions are seen all lumbosacral vertebral bodies and bilateral iliac bones, these lesions may indicate focal aggregation of tumor lesions. There is normal lumbar lordosis. The spine alignment is anatomic. The vertebral body height is preserved. The signal of the visualized cord is normal. The conus medullaris terminates at the L1-L2 level. Degenerative changes are specified by the intervertebral level as follows: T12-L1: no neuroforaminal narrowing or spinal stenosis. L1-L2: no neuroforaminal narrowing or spinal stenosis. L2-L3: no neuroforaminal narrowing or spinal stenosis. L3-L4: minimal left paramedian focal disc bulging, unchanged since prior scan. Minimal spinal canal narrowing due to bilateral ligamentum flavum thickening. L4-L5: Broad based central to left disc protrusion, unchanged. The protruded disc results minimal left side lateral recess narrowing, again, unchanged. L5-S1: Right posterior inferior L5 vertebral body lesion which abuts thecal sac especially on the right side and mildly narrows right lateral recess, unchanged since prior scan.

Output: 1. Unchanged size and MR characteristics of the L5 vertebral body right posterior inferior lesion since prior scan.2. Diffuse replacement of normal fatty marrow with multifocal enhancing lesions, consistent with multiple myeloma involvement.3. No evidence of compression fracture.4. Unchanged degenerative disc lesions of lumbar spine since prior scan.


Instruction: Generate impression based on findings.

Input: Postoperative headache, history of Chiari decompression on 4/28/2015 Again seen are postsurgical changes of Chiari decompression including suboccipital craniectomy and removal of posterior arch of C1. There is also evidence of tonsillar debulking with T2 hyperintensity and enhancement involving the cerebellar tonsils, which shows evolution. Residual tonsils are again seen extending to the C2 level, lower on the left than the right. Again seen is retroversion of the dens which indents the cervicomedullary junction ventrally. There remains diminished CSF spaces ventrally and dorsally at the foramen magnum although significantly improved dorsally at the C1 and C2 levels compared to the preoperative study particularly in the midline. CSF flow sequence demonstrates some, although diminished, biphasic flow at the foramen magnum anteriorly and posteriorly.This small fluid collection in the posterior soft tissues measuring 1.5 x 2.7 cm in the axial plane and up to 2.5 cm in the craniocaudal dimension and consistent with a small pseudomeningocele similar to prior.There is no evidence for ventriculomegaly. No evidence of acute infarct, intracranial hemorrhage, or new intracranial mass or mass effect. Major flow voids are preserved. Mild mucosal thickening is seen in the paranasal sinuses. Minimal mastoid air cell fluid.

Output: 1. Evolution of postsurgical changes related to recent Chiari I decompression including tonsillar debulking. There remains diminished CSF spaces ventrally as well as dorsally at the foramen magnum, although significantly improved dorsally at the C1 and C2 levels compared to the preoperative study--particularly in the midline. CSF flow sequence demonstrates some, although diminished, biphasic flow at the foramen magnum anteriorly and posteriorly.2. Unchanged ventricular size without hydrocephalus.3. Small fluid collection, likely representing a pseudomeningocele, in the dorsal upper cervical paraspinous soft tissues.


Instruction: Generate impression based on findings.

Input: Female, 53 years old, with history of brain mass/skull lesion. Evaluate for change. A heterogeneously enhancing, expansile mass is redemonstrated centered on the calvarium, just to the left of midline at the cranial vertex. The lesion measures 48 mm AP, 58 mm TV, and 32 mm CC showing no significant change from the prior examination.The lesion displaces both the inner and outer tables of the skull. It indents the underlying left parietal lobe, along with the cortical veins and the superior sagittal sinus which nevertheless appear patent. No evidence of parenchymal invasion or parenchymal edema is seen. No other enhancing calvarial lesions are detected . Minimal scattered small foci of T2 hyperintensity are seen within the cerebral white matter, a stable and nonspecific finding. No evidence of significant parenchymal edema or restricted diffusion is seen. No abnormal extra-axial fluid collections are detected. The ventricles are normal in size and morphology.

Output: 1.No significant change in the size or appearance of a large, expansile mass centered on the calvarium at the cranial vertex.2.As before, the lesion indents the underlying brain parenchyma, but there is no evidence of brain invasion or parenchymal edema.3.No other concerning osseous lesions are seen. Evaluation of the brain parenchyma is unremarkable.


Instruction: Generate impression based on findings.

Input: Persistent left sided throat discomfort after tonsillectomy for reactive follicular hyperplasia with occasional non-necrotizinggranulomas. There are interval postoperative findings related to left tonsillectomy, without evidence of measurable residual hyperplastic tonsillar tissue. The upper airway is patent and the parapharyngeal spaces are intact. There is no evidence of tumors or significant lymphadenopathy. The thyroid and salivary glands are unremarkable. There is mild scattered paranasal sinus mucosal thickening. There are postoperative findings related to anterior surgical fusion of C5 and C6. There is a small posterior disc osteophyte complex at C4-5. The imaged intracranial structures and orbits are unremarkable.

Output: 1. Interval postoperative findings related to left tonsillectomy, without evidence of measurable residual hyperplastic tonsillar tissue. 2. Postoperative findings related to anterior surgical fusion of C5 and C6.


Instruction: Generate impression based on findings.

Input: Sepsis and bilateral lower extremity wound infections. Evaluate for osteomyelitis. Right:There is irregularity of the skin surface with shallow soft tissue defects affecting the mid and lower right leg consistent with ulceration. There is mild enhancement of the skin of the lower leg as well as reticulation of the subcutaneous fat indicating edema and inflammation. The edema becomes confluent within the posterior and lateral subcutaneous fat of the leg, but we see no rim-enhancing fluid collections to suggest abscess. There is mild edema between the medial head of the gastrocnemius and the underlying soleus as well as within the peroneal musculature, but we see no well-defined inter- or intramuscular fluid collections. Bone marrow signal intensity of the tibia and fibula is normal without evidence of osteomyelitis. Note is made of chronic periosteal reaction along the distal fibula.Left:There is mild enhancement of the skin as well as edema in the subcutaneous fat of the mid and lower left leg indicating inflammation. Although the edema becomes confluent particularly along the posterior aspect of the leg musculature we see no rim-enhancing fluid collections to indicate an abscess. We see no inter- or intramuscular fluid collection. There is a small intramedullary focus of abnormal signal intensity (low on T1-weighted images, high on T2 weighted images) again seen within the fibular head, showing minimal if any enhancement following contrast administration, which is nonspecific but could possibly reflect sequelae of prior infection; it is identical to the prior study. We otherwise see no signal abnormality within the tibia or fibula to indicate osteomyelitis.

Output: Soft tissue inflammation consistent with cellulitis without evidence of acute osteomyelitis.


Instruction: Generate impression based on findings.

Input: Diagnosis: LumbagoClinical question: disc degenerationSigns and Symptoms: pain began after epidural for childbirth 4 y prior Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is a central disk protrusion which is slightly eccentric towards the left at this level which minimally affects the nerve roots at the lateral recesses. There is a clear fat plane between the nerve root sleeves and the ligamentum flavum. There is disk dessication present at this level.At L4-5 there is no significant compromise to spinal canal or neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.There is a central disk protrusion at L5-S1 which is slightly eccentric towards the left.2.No compromise to lumbar spinal canal or neural foramina.


Instruction: Generate impression based on findings.

Input: Ms. Uppal submitted outside study for review. Submitted for review are:-Right breast ultrasound: 7/22/2016-Right breast ultrasound-guided biopsy: 7/29/2016-Bilateral breast MRI: 8/23/2016-Post stereotactic biopsy left breast mammogram: 8/26/2016The right breast ultrasound and right ultrasound-guided biopsy were performed at Advocate Good Samaritan Hospital. The bilateral breast MRI and post-stereotactic biopsy left breast mammogram examinations were performed at Northwestern Memorial HealthCare. RIGHT BREAST ULTRASOUND: Static ultrasound images are submitted for interpretation.At 10:00, 3 cm from the nipple, there is a 1.1 x 0.6 x 1.3 cm hypoechoic lesion with posterior acoustic enhancement, suggestive of a cyst.RIGHT BREAST ULTRASOUND-GUIDED BIOPSY: Static ultrasound images are submitted for interpretation.Previously described hypoechoic lesion in the left breast at 10:00 was targeted for biopsy. Targeting appears appropriate with clip placement.BILATERAL BREAST MRI: Multiple enhanced MR sequences are submitted per outside institution protocol.There is extreme fibroglandular tissue in both breasts. There is mild background parenchymal enhancement.LEFT BREAST:There are two vitamin E capsules overlying the outer posterior left breast. There is clumped nonmass enhancement in the central outer left breast that demonstrates mixed enhancement kinetics, spanning approximately 1.6 x 1.5 x 1 cm (TV x AP x CC). No additional areas of suspicious enhancement in the left breast. No left axillary or internal mammary lymphadenopathy.RIGHT BREAST:There are vitamin E capsules overlying the lower inner and upper outer quadrants of the right breast.In the central inner right breast, along the 3:00 radian, there is a 1.4 x 1.3 x 3.2 cm mass with T1 and T2 hyperintense signal and peripheral enhancement, suggestive of hematoma. Per outside pathology report, this area corresponds to the site of prior stereotactic biopsy. There is a focus of susceptibility artifact along the superior aspect of this mass (series 2, image 49), which may correspond to a biopsy marker clip.In the upper outer right breast, there is a focus of susceptibility artifact (series 2, image 53), which may correspond to a biopsy marker clip. Per outside report, this location corresponds to the site of prior ultrasound-guided biopsy.In the outer far posterior right breast, there is a focus of susceptibility artifact (series 2, image 43).In the low right axilla, there is a 5 mm reniform enhancing mass, suggestive of benign intramammary lymph node.POST STEREOTACTIC BIOPSY MAMMOGRAMS, LEFT BREAST: A CC, XCCL, and LM views of the left breast are submitted.There is heterogeneous fibroglandular tissue, which may obscure small masses. There is an hourglass-shaped biopsy clip in the upper outer quadrant of the left breast. There are residual calcifications in the upper outer left breast adjacent to this clip, spanning approximately 3.6 cm on the XCCL view. There are additional calcifications in the lower inner left breast.PER OUTSIDE PATHOLOGY:-Right breast, stereotactic core biopsies, 3:00: DCIS, grade 2, with necrosis and associated calcifications, involving two cores. The carcinoma extends to the edge of the core biopsy fragment.-Right breast, ultrasound guided core biopsies, 10:00: Histiocytic and chronic inflammatory cell reaction consistent with a ruptured duct/cyst. Moderate ductal hyperplasia, columnar cell change, and stromal fibrosis. Negative for malignancy.-Left breast, stereotactic core needle biopsy, upper outer quadrant: DCIS, solid type, nuclear grade 3

Output: Biopsy-proven DCIS of both breasts. Surgical management is recommended for known malignancy. Submission of all mammograms would be of benefit to see if left lower breast calcifications are stable, document morphology of calcifications on magnification views and to document clip locations in the right breast. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: 66-year-old female with papillary serous endometrial cancer status post TAH/BSO now with pelvic mass, assess disease extent. PELVIS:UTERUS, ADNEXA: There are postsurgical changes of hysterectomy and oophorectomy. At the vaginal cuff, there is a soft tissue mass measuring 7.0 x 3.6 cm in the transverse dimension (801/27) and 2.0 cm in the craniocaudal dimension. This mass is ill-defined with multiple satellite nodules and extension into the peritoneum with small peritoneal implants, reflecting carcinomatosis. Some of these implants are removed from the soft tissue mass (601/64). There is extension throughout the parametrial fat with implants close to but not immediately associated with the sidewall (601/45). Tumor is present along the peritoneal reflection of the bladder. The mass also abuts the anterior aspect of the rectum (601/47). There is enhancing tissue along the anterior surgical scar which also likely represents tumor.BLADDER: See above.LYMPH NODES: There is inguinal lymphadenopathy with enlarged left inguinal node measuring 2.3 x 1.7 cm (601/31). There are multiple enlarged pelvic lymph nodes with an enlarged right common iliac node measuring 2.1 x 1.4 cm (601/57).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: There is a large amount of abdominal ascites.

Output: 1.Infiltrative soft tissue mass at the vaginal cuff with extension into the parametrial soft tissues and peritoneum as well as abutment of the bladder and rectum. Consider upper abdominal imaging by CT.2.Multiple peritoneal implants with a large amount of abdominal ascites.3.Pelvic and inguinal lymphadenopathy.


Instruction: Generate impression based on findings.

Input: History of lung carcinoma with metastases to brain and bones status post whole brain radiation therapy completed on 3/28 and is on Tarceva. Please compare to prior study. There is no intracranial mass or mass effect. No convincing abnormal focus of parenchymal or meningeal enhancement is seen to suggest residual or recurrent metastatic disease. There is no evidence of acute intracranial hemorrhage or acute infarct. There are minimal scattered foci of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, which are nonspecific, but compatible with age-related white matter changes. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There is mild mucosal thickening of the left maxillary sinus. There is complete opacification of the right mastoid air cells and partial opacification of the left mastoid air cells. The skull and extracranial soft tissues are unremarkable. There are bilateral lens implants.

Output: 1. Prior imaging is not available for comparison. However current study demonstrates no convincing evidence of residual metastatic lesion.2. Opacification of the bilateral mastoid air cells, right greater than left, which is nonspecific.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Reason: Uterine fibroids/imaging prior to UFE History: menorrhagia and dysmenorrhea PELVIS:UTERUS, ADNEXA: Uterus is mildly enlarged containing multiple small fibroids. There is a mildly enhancing submucosal fibroid along the right aspect of the fundus with central necrosis measuring 4.6 x 3.7 cm (1005/340). A mildly enhancing anterior fundal intramural fibroid measures 3.9 x 4.0 cm (100 5/372).The cervix is dilated containing nonenhancing tissue measuring 2.0 x 1.3 cm (501/22) in transverse dimension and 2.3 cm and craniocaudal dimension (701/18). Small adjacent nabothian cysts are present.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Multiple mildly enhancing fibroids as above.2.Dilated cervix with nonenhancing tissue suggested within, likely debris/hemorrhagic products.3.Minor contrast extravasation as above.


Instruction: Generate impression based on findings.

Input: 81-year-old presenting with stroke symptoms. Evaluate for ischemia. No restricted diffusion to indicate an acute infarct. Redemonstration of extensive near confluent increased T2 signal in the subcortical and periventricular white matter. This appears slightly progressed compared to prior most notably in the left anterior temporal and left parietal subcortical white matter. Chronic infarct involving the left inferior frontal lobe again seen. Numerous foci of susceptibility artifact within the subcortical white matter throughout the supratentorial and to a lesser extent infratentorial brain parenchyma compatible with cerebral amyloid angiopathy.There is no evidence of acute intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration for the patient's age. The expected intracranial vascular flow voids are present.The paranasal sinuses are grossly clear. Mild opacification of the left mastoid air cells.

Output: 1. No evidence of acute infarct.2. Extensive white matter signal abnormality which is mildly progressed since 2/17/2014, specifically the involvement of the left anterior temporal and left parietal subcortical white matter. Finding is nonspecific but favored to represent chronic ischemic injury. No associated diffusion abnormality.3. Numerous foci of susceptibility throughout the brain which are predominantly in a peripheral lobar distribution and likely representing amyloid angiopathy.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Left eye blurry vision and proptosis concern for Graves disease. Orbits: There appears to be mild left proptosis and there is mild contour deformity of the left globe. Otherwise, the left extraocular muscles, orbital fat, and optic nerve are unremarkable. The right globe, extraocular muscles, orbital fat, and optic nerve are also unremarkable. There is no evidence of orbital mass lesions.  Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mild scattered cerebral white matter T2 hyperintensity, which may represent chronic small vessel ischemic disease. 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 skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. Mild left proptosis and mild contour deformity of the left globe, suggestive of staphyloma, but no findings to suggest dysthyroid orbitopathy.2. No evidence of intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: 22-month-old male with history of Langerhans cell histiocytosis involving the left temporal bone and T7 vertebra: end of therapy evaluation. Brain: There has no discernible evidence of residual lesion in the left temporal bone region. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears unremarkable. The ventricles and basal cisterns are stable in size and configuration. There is no midline shift or herniation. The paranasal sinuses are unremarkable. Spine: There is compression deformity and mild focal kyphosis at T7, although the vertebral body height has increased, now measuring a minimum of 4 mm in thickness centrally, previously approximately 2 mm. Furthermore, there is no significant spinal canal stenosis and no associated enhancement or edema. The other thoracic vertebrae are intact. The spinal cord and cauda equina nerve root signal is within normal limits. The paraspinal soft tissues are unremarkable.

Output: 1. No discernible evidence of residual or recurrent Langerhans cell histocytosis in the left temporal bone region.2. Mild interval increase in height of the T7 vertebral body associated with the treated Langerhans cell histocytosis.


Instruction: Generate impression based on findings.

Input: Global developmental delay with left hemiparesis, left ptosis, recurrent neck abscess, and tuft of hair on the sacral area. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain, brainstem, cerebellum, and pituitary gland appear unremarkable. There is perhaps minimal prominence of the subarachnoid cerebrospinal fluid spaces overlying the bilateral frontal convexities. Otherwise, the ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is nonspecific bilateral otomastoid fluid.Neck: There is a 5 mm diameter cystic focus in the right tracheoesophageal groove at the level of the thyroid gland. Otherwise, there is no evidence of abscess, mass lesions, or significant cervical lymphadenopathy. The major salivary glands are unremarkable. The major cervical flow voids are intact. Spine: There appears to be lumbarization of S1. 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 no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The conus medullaris terminates at the T12-L1 level. The paravertebral soft tissues are unremarkable.

Output: 1. No evidence of acute intracranial hemorrhage, mass, or acute infarct.2. Nonspecific 5 mm diameter cystic focus in the right tracheoesophageal groove at the level of the thyroid gland, for which the differential diagnosis includes a branchial apparatus anomaly or thyroid cyst, for example, but no evidence of residual retropharyngeal abscess. Ultrasound may be useful for further evaluation.3. Apparent lumbarization of S1 with conus medullaris at the T12-L1 level, but no evidence of fibrofatty filum or syringohydromyelia.


Instruction: Generate impression based on findings.

Input: 48-year-old woman with known suspicious mass in the left breast presents second look ultrasound of MR detected mass in the right breast. On review of MRI, there is an enhancing mass in the right breast posterior depth central to the nipple near the 6:00 position, for which second look ultrasound was recommended. The mass measures up to 1.6 cm on MRI.A targeted right ultrasound was performed for the area of concern. In the right breast 6:00 position 1 cm from the nipple, there is a oval lobulated hypoechoic mass measuring 1.8 x 0.8 x 1.3 cm with mild increased vascularity. This mass is indeterminate and correlates with the finding on MRI. Ultrasound-guided percutaneous biopsy is recommended.

Output: Indeterminate right breast 6:00 position mass measuring up to 1.8 cm, correlating with finding on MRI. This mass was biopsied with ultrasound guidance today and findings are reported under a separate accession.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Ms. Mauldin is a 50 year old female presenting with segmentally distributed calcifications, enlarged left intramammary lymph node and enlarged left axillary lymph nodes. She presents for MRI for further evaluation. There is heterogeneous amount of fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.LEFT BREAST:Spanning the entire left lateral breast, there is extensive, segmentally distributed, non-mass enhancement seen measuring approximately 13.9 x 4.9 x 7.7 cm (AP x ML x SI). The enhancement extends from the left nipple base to the pectoralis muscle posteriorly. Although this enhancement abuts against the pectoralis muscle, the muscle itself is of normal contour and enhancement pattern.Within this nonmass enhancement, there are three discrete irregular enhancing masses identified, the largest of which measures approximately 2.6 x 1.8 x 2.5 cm. These are suspicious for invasive components.In addition, there is an enlarged intramammary lymph node identified, measuring up to 1.3 cm.RIGHT BREAST:There is no abnormal enhancement seen in the right breast.AXILLAE:Unfortunately, there is a shimming artifact seen in bilateral axillary regions, limiting evaluation of this area. However, based on recent ultrasound workup, several borderline enlarged left axillary lymph nodes were seen.

Output: (1) 14 cm of extensive nonmass enhancement in the left lateral breast, extending from the pectoralis muscle to the nipple base. This corresponds in distribution and span to the mammographically detected calcifications. A two site ultrasound guided biopsy with clip placement will be performed later today.(2) Enlarged left intramammary lymph node and sonographically detected enlarged left axillary lymph nodes. An ultrasound-guided biopsy with clip placement will be performed of the intramammary lymph node and one left axillary lymph node later today.(3) No MR evidence of malignancy in the right breast.BIRADS: 5 - Highly suggestive of malignancy.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration.


Instruction: Generate impression based on findings.

Input: Chiari malformation: headaches. The pointed cerebellar tonsils extend up to 6 mm inferior to the crowded foramen magnum. Indeed, there is impeded flow of cerebrospinal fluid across the foramen magnum and compression of the cervicomedullary junction. There is a long-segment cervicothoracic syrinx that measures up to 6 mm in width. In addition, there is a cavitary space adjacent to the syrinx in the right lower cervical cord that measures 2 mm in width. There is evidence of mass lesions. 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 are minimal posterior disc-osteophyte complexes in the cervical spine, but there is no significant spinal canal stenosis. The paravertebral soft tissues are unremarkable.

Output: Findings related to Chiari I malformation and a long segment cervicothoracic syrinx that measures up to 6 mm in width. A cavitary space adjacent to the syrinx in the right lower cervical cord that measures 2 mm in width may represent a compartment of the syrinx or associated myelomalacia.


Instruction: Generate impression based on findings.

Input: Medulloblastoma status post craniotomy and chemoradiation: surveillance scan. BRAIN: There are postsurgical findings related to right cerebellar medulloblastoma resection. The resection cavity and surrounding cerebellar encephalomalacia. There is no abnormal enhancement in the region of the resection bed. There is no evidence of acute intracranial hemorrhage or acute infarct. The ventricles and sulci are unchanged in size and configuration. There is no midline shift or herniation. There are bilateral maxillary sinus retention cysts.SPINE: There is no abnormal intraspinal enhancement to suggest drop metastasis. The cord is normal in caliber and signal. The conus terminates at the L1 level. The vertebral body height and sagittal alignment is preserved. The intervertebral discs are intact. There is no central canal or neural foraminal narrowing. The paraspinal tissues are unremarkable.

Output: No evidence of recurrent tumor or drop metastasis.


Instruction: Generate impression based on findings.

Input: 81-year-old man status post Whipple 9/2016 for ampullary adenocarcinoma, now with recurrent pancreatitis and abdominal pain. ABDOMEN:LIVER, BILIARY TRACT: Round foci of diffusion restriction, mild T2 hyperintensity, and peripheral enhancement are seen in segments 4A and 6. The segment 4 lesion (1101/235) measures 10 x 9 mm and the segment 6 lesion (1101/270) measures 12 x 8 mm. The liver is otherwise normal in signal and morphology.There is no significant intra or extrahepatic biliary ductal dilatation. The portal vein is patent.SPLEEN: No significant abnormality noted.PANCREAS: Patient status post resection of the pancreatic head. There is vague, geographic diffusion restriction at the pancreatic anastomosis (506/184) without a corresponding abnormality on T1 or T2 weighted images to suggest a lesion. The pancreatic duct is mildly prominent.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral simple renal cysts noted. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: Scattered subcentimeter retroperitoneal and peripancreatic lymph nodes are noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Segment 4A and 6 hepatic lesions highly suspicious for metastases.2.Nonspecific diffusion restriction near the pancreatic anastomosis without discrete lesion identified on T1 or T2-weighted images, possibly related to inflammation.


Instruction: Generate impression based on findings.

Input: Clinical question:CVA. Signs and symptoms : CVA Nonenhanced head CT :There is no evidence of intracranial hemorrhage, edema, mass-effect, midline shift or hydrocephalus.Cortical sulci, ventricular system, CSF cisterns and gray -- white matter differentiation remains within normal.If concern for acute ischemic stroke persist recommend an MRI.

Output: Negative head CT.


Instruction: Generate impression based on findings.

Input: Pineal cyst. There is a cystic pineal gland that measures up to 11 mm. There is no evidence of intracranial hemorrhage or acute infarct. The brain parenchyma appears 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. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: The cystic pineal gland measures up to 11 mm.


Instruction: Generate impression based on findings.

Input: Glioblastoma status post biopsy, assess tumor. There are interval left transparietal biopsy findings in the heterogeneously enhancing mass, with diffuse susceptibility effect and areas of restricted diffuse, centered in the left parietal lobe with extension across the splenium of the corpus callosum. There is a new intermediate T1 and low T2 signal hematoma within the mass that measures up to 19 mm. Overall, the lesion measures up to 60 mm on the axial sections, previously 55 mm, and there appears to be expansion of the necrotic components. There is mass effect and effacement of the left occipital horn has slightly increased. However, the surrounding confluent T2 hyperintensity is not significantly changed in the left hemisphere and has actually diminished in the right posterior cingulate region. There are few scattered punctate white matter hyperintensities, which are nonspecific, but may represent chronic small vessel ischemic disease. There is a punctate focus of T2 hyperintensity in the right cerebellum is unchanged and may represent a chronic infarct. There is no midline shift or herniation. The orbits and paranasal sinuses are grossly unremarkable.

Output: Interval left transparietal biopsy findings in the glioblastoma that appears to have increased in size slightly due to expansion of the necrotic components and development of intratumoral hemorrhage. However, the surrounding confluent T2 hyperintensity, which may represent at least in part vasogenic edema is not significantly changed in the left hemisphere and has actually diminished in the right posterior cingulate region.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Male, 21 years old, with headaches and history of cervical GBM, evaluate for intracranial lesions. Postoperative changes are partially visualized on sagittal images related to laminectomy of the upper cervical levels and biopsy of the patient's known spinal cord tumor. On comparison with the preoperative examination, there appears to be more conspicuous enhancement within the lesion. Also of note, there is a fluid collection within the laminectomy bed which measures up to 46 mm in sagittal length and 11 mm in thickness.Intracranially, dural thickening and mild prominence of the extra-axial spaces is seen along the frontal lobes. Mild generalized sulcal vascular prominence is also noted. No evidence of parenchymal edema or mass effect is seen. No diffusion restricting lesions are demonstrated. No evidence of any pathologic intra-axial enhancement is seen. The ventricles and basal cisterns remain normal in size and morphology.

Output: Postoperative findings are seen reflecting prior cervical laminectomy and spinal cord lesion biopsy. The degree of enhancement within the cord lesion appears to have increased, though it is incompletely assessed on this examination. There are no findings to suggest any intracranial tumor involvement at this time.A fluid collection is present within the cervical laminectomy bed which follows CSF signal characteristics and which is suspicious for a pseudomeningocele. Intracranial findings including dural thickening, slight widening of the extra-axial spaces, and sulcal vascular prominence may reflect changes in intracranial pressure related to this potential CSF leak.


Instruction: Generate impression based on findings.

Input: Yearly follow up surveillance imaging, history of transphenoidal pituitary tumor.. Again seen are postoperative findings related to transsphenoidal pituitary surgery. There is no evidence of residual mass lesions within the sella. There is unchanged mild ptosis of the optic apparatus. The infundibulum is intact and mildly thickened, which is unchanged. The cavernous sinuses and internal carotid arteries are intact. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears unremarkable. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unchanged.

Output: Postsurgical changes of prior transphenoidal tumor resection. No evidence of residual or recurrent tumor.


Instruction: Generate impression based on findings.

Input: Clinical question to be answered:? Tumor. Signs and symptoms: Headaches. Prominence of cerebellar sulci and fourth ventricle is consistent with underlying cerebellar parenchymal volume loss. This finding was noted on prior MRI examination of brain. No hemorrhage is detected. Images two supratentorial space demonstrate normal density and morphology of brain parenchymal. Cortical sulci, ventricular system and all CSF cisterns remain within normal. No evidence of hemorrhage, edema, mass-effect, midline shift or hydrocephalus.Calvarium is intact. Mastoid air cells are well pneumatized and unremarkable. Very limited view of ethmoid and sphenoid sinuses demonstrate no abnormality.

Output: 1.No evidence of tumor or acute findings.2.Cerebellar volume loss.


Instruction: Generate impression based on findings.

Input: 15-year-old female with history of ankle pain. TENDONS: No significant abnormality noted.LIGAMENTS: The deltoid, anterior talofibular and spring ligaments are intact.ARTICULAR SURFACES AND BONE: There is abnormal cortical thickening of the proximal 2nd metatarsal with the suggestion of increased bone marrow signal intensity. There is increased edema throughout the imaged 3rd metatarsal diaphysis. No obvious fracture lines are seen. There is a mild amount of edema along the posterior aspect of the talus, improved from prior.Incidental note is made of an os trigonum, a normal variant, with mildly increased bone marrow signal abnormality. No surrounding fluid is present.ADDITIONAL

Output: 1. Probable stress reaction of the 2nd and 3rd metatarsals.2. Mild edema-type signal abnormality within the posterior aspect of the talus and os trigonum. These findings are improved from prior and this may represent a degree of posterior impingement syndrome.


Instruction: Generate impression based on findings.

Input: 71-year-old female with non-small cell lung cancer. Status post several cycles of treatment. New T5 lesion. Back pain and urinary incontinence. Restaging. LUNGS AND PLEURA: Slight interval decrease in right-sided pleural effusion. New atelectasis in the anterior right lung. Multiple pleural based nodules are grossly similar in size. New suspicious pulmonary nodules in right upper lobe measure 7 mm in diameter at images 43 and 44 of series 3. Probable new segmental right upper lobe atelectasis at image 44 of series 3 with ill-defined mass at major fissure. MEDIASTINUM AND HILA: Stable right paramediastinal nodular thickening at the level of the carina measures 34 x 9 mm, (image 32, series 3). Paraesophageal lymph node is stable measuring 25 x 16 mm, (image 64, series 3). Aortic calcifications. Stable subcentimeter left thyroid gland hypodense lesion.CHEST WALL: Lytic lesion in left T5 vertebral body and pedicle at axial image 26 of series 3.ABDOMEN:LIVER, BILIARY TRACT: Subcentimeter hepatic hypodensities are too small to characterize.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Mild lumbar spine degenerative disease.PELVIS:UTERUS, ADNEXA: Status post hysterectomy. Diffuse round calcifications in the left adnexa at axial image 162 of series 3.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Degenerative changes in the lumbosacral spine and pelvis.OTHER: Multiple enhancing focal lesions seen throughout the spine and sacrum on the recent MRI exam, concerning for metastatic involvement, are not detected on this CT exam.

Output: 1. Pleural-based nodules and right pleural effusion.2. Increased atelectasis anteriorly in the right lung.3. New 7-mm right upper lobe nodules. Lytic lesion in left T5 pedicle.


Instruction: Generate impression based on findings.

Input: Male 67 years old Reason: Right Knee Pain, HTN, Hyperlipidemia, Anemia, Hypothyroidism, Obesity. History: Right Knee Pain, HTN, Hyperlipidemia, Anemia, Hypothyroidism, Obesity. MENISCI: There is complete degenerative tearing of the medial meniscus with extrusion of the meniscal fragments into the medial joint space.There is severe tearing of the anterior horn and body of lateral meniscus.ARTICULAR CARTILAGE AND BONE: Full-thickness cartilage loss involving the medial, lateral and extensor compartments. There is bone-on-bone apposition with subchondral cystic change and osteophyte formation.No acute fracture.LIGAMENTS: Anterior and posterior cruciate ligaments are intact. There is a small ganglion cyst within the ACL. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Severe tricompartmental osteoarthritis with full-thickness cartilage loss and degenerative meniscal tears.


Instruction: Generate impression based on findings.

Input: 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. There are minimal punctate nonspecific foci of T2 signal hyperintensity in the deep white matter. The cerebral flow-voids appear to be intact. There is a mucus retention cyst in the right maxillary sinus. The orbits, skull, and scalp soft tissues are grossly unremarkable.

Output: No evidence of intracranial metastatic disease.


Instruction: Generate impression based on findings.

Input: 73 years Male (DOB:5/21/1943)Reason: hx left side meningioma/Schwannoma. Preop planning for surgery History: left side hearing loss, ataxiaPROVIDER/ATTENDING NAME: BAKHTIAR YAMINI BAKHTIAR YAMINI There is a 27 x 34 mm enhancing mass located at the left cerebellopontine angle cistern associated with extension to the left internal auditory canal. This associated with compression of the adjacent brainstem and some T2 signal hyperintensity within the left cerebral peduncle, left midbrain, pons and left the middle cerebellar peduncle. Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.There is mild ventriculomegaly present which has progressed since the prior exam. On the current exam biventricular diameter is approximately 42 mm whereas on the prior it was 35 mm.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 a left cerebellopontine angle cistern mass present which is associated compression of the adjacent brainstem and cerebellum where there is also edema. This compatible with schwannoma.2.There is ventriculomegaly which has mildly progressed compared to the prior exam..3.This examination was performed the purpose of stereotactic guidance during surgery.


Instruction: Generate impression based on findings.

Input: Brain MRINo evidence of acute ischemic or hemorrhagic lesion.No evidence of abnormal enhancement.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. 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. No evidence of intracranial arterial luminal stenosis. No aneurysm.

Output: 1. Normal brain MRI2. Normal brain MRA


Instruction: Generate impression based on findings.

Input: Patient has a strong family history of breast cancer in her mother and sister and personal history of benign MR guided left breast biopsy in March 2013. No current breast related complaints. There is scattered fibroglandular tissue in both breasts. Moderate parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region. Biopsy clip in the left breast from her prior MRI biopsy is again noted. An 8 mm focal high T2 signal area in the right hepatic lobe is stable from the prior study and likely represents a benign cyst or hemangioma.

Output: No MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: NS - Routine Screening Mammogram.