Instruction: Generate impression based on findings.

Input: The risks (including, but not limited to, those of bleeding, infection, allergic reaction, temporary nerve block, pain, and inability to access the joint) and benefits of the procedure were explained to the patient, and informed written consent was obtained. A pre-procedural “time-out” form was completed.The patient was placed supine on the fluoroscopy table. The left hip was localized fluoroscopically, and a spot radiograph was obtained. The course of the femoral artery was noted on the patient's skin using an ink marker. The skin was cleansed and covered with a sterile drape. The skin and subcutaneous tissues were anesthetized with 1% lidocaine using 25-gauge and 22-gauge needles.Under fluoroscopic guidance, a 20-gauge spinal needle was advanced into the joint. Attempted aspiration yielded no fluid. Next, 10 ml of a 50/50 mixture of Omnipaque 240 (to confirm the intra-articular position of the needle) and dilute Multihance (0.1 cc in a 10 cc vial of saline, for subsequent MR imaging) were injected into the joint. Contrast opacified the joint in the expected manner. A spot radiograph was obtained for documentation. The needle was withdrawn. Blood loss was negligible (<1cc), and the patient tolerated the procedure well without immediate complication. An adhesive bandage was placed on the patient’s skin. Routine post procedure instructions were communicated to the patient. The patient was escorted to the MRI suite for further imaging in stable condition. Please refer to the subsequent MRI report for further information.Exposure time: 56 seconds

Output: Successful arthrogram of the left hip.


Instruction: Generate impression based on findings.

Input: Clinical question: Rule out hydrocephalus. Signs and symptoms: concern for developmental delay. Nonenhanced head CT:There is no evidence of intracranial hemorrhage, edema, mass effect or midline shift or hydrocephalus.The cortical sulci, ventricular system and midline is within normal. There is prominence of subarachnoid space with CSF density which is within normal range for patient stated age. There is no evidence of any developmental abnormality or brain parenchyma on this non-infused head CT. If clinical concern persists follow-up with an MRI is highly recommended.Calvarium is intact.Limited view of the orbits are unremarkable.

Output: No definitive evidence of intracranial pathology for patient stated age. If there is concern for developmental delay follow-up with an MRI is recommended.


Instruction: Generate impression based on findings.

Input: Reason: evaluate for residual cyst History: hx of epidermoid cyst resection. Postoperative changes of epidermoid resection including a left suboccipital craniotomy. Asymmetric prominence of the left ventral medulla without diffusion restriction or enhancement appears similar to the prior exam. Evaluation of this region is limited on 3-D T1 sequences due to artifact.The brain parenchyma appears otherwise 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. There has been interval resolution of mucosal thickening in ethmoid and maxillary sinuses. Prominent adenoids are decreased in size compared to the prior exam.

Output: 1.Postoperative changes of epidermoid resection without definite evidence of recurrence.2.Asymmetric prominence of the left ventral medulla is stable and likely postoperative.


Instruction: Generate impression based on findings.

Input: question: Bleed? mass? Signs and symptoms: Acute onset of left-sided weakness. Non-infused CT of brain:Examination demonstrates well demarcated area of low attenuation of the cortex of right parietal lobe with effacement of adjacent cortical sulci highly suspected of an acute/subacute cortical stroke. There is no evidence of a hemorrhagic component. There is no evidence of mass effect on the lateral ventricle or midline shift. There is no definitive evidence of any abnormal density of the intracranial vasculature of arterial circulation or the venous sinuses. Further follow-up with dedicated MRI examination is recommended. This examination is otherwise unremarkable.Calvarium is intact.No abnormalities of the scalp is detected.Limited images of the orbits are unremarkable.Mastoid air cells and middle ear cavities are pneumatized. Limited view of paranasal sinuses demonstrate chronic sinus disease of bilateral maxillary sinuses (right greater than left).Above findings were text message to Dr. Lisa McQueen on pager number 4933 utilizing the paging tool option on a PACS system.

Output: Acute nonhemorrhagic right MCA stroke in the parietal lobe with effacement of adjacent cortical sulci. No hemorrhage, mass effect on the right lateral ventricle or midline shift.


Instruction: Generate impression based on findings.

Input: Back pain, frequent muscle cramps. For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. There is normal lumbar lordosis. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. The epidural space, thecal sac, and spinal cord are preserved with no evidence of spinal canal/neural foraminal narrowing. The conus medullaris terminates at the T12-L1 level. The paraspinal soft tissues are unremarkable.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: no neuroforaminal narrowing or spinal stenosis. There is about 3 mm sized well-circumscribed cystic lesion on posterior aspect of left facet joint. This may represent exophytic left facet synovial cyst or benign intramuscular cyst.L4-L5: no neuroforaminal narrowing or spinal stenosis. Mild disc desiccation with diffuse disc bulging. In particular, there is a broad-based disc bulging toward left side lateral recess, however, no blood compression is not evident.L5-S1: no neuroforaminal narrowing or spinal stenosis.

Output: Disc desiccation with a diffuse disc bulging associated with focal bulging towards left lateral recess without evidence of nerve root compression at the level of L4-5 as described above.Otherwise unremarkable.


Instruction: Generate impression based on findings.

Input: The coronal T2 images are somewhat degraded by motion artifact. Dedicated images through the sella demonstrate a normal height of the pituitary gland. The infundibulum is slightly tilted. There is lower enhancement seen along the left half of the pituitary gland when compared to the right (series 801, image 11). The suprasellar cistern, optic chiasm, cavernous sinuses and intracranial portions of the optic nerves appear unremarkable.

Output: Lower enhancement along the inferior aspect of the left half of the pituitary gland raises suspicion for micro-adenoma.


Instruction: Generate impression based on findings.

Input: Provided history of recurrent rectal cancer. Concern for vaginal extension. PELVIS:UTERUS, ADNEXA: 3.7 x 3.3 cm submucosal/intramural left uterine body well-defined mass with punctate cystic foci and postcontrast enhancement likely represents a fibroid and less likely focal adenomyoma. The visualized endometrium is unremarkable otherwise.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Approximately 3 to 4 cm above the anal verge there is a 1.8 x 1.7 cm round soft tissue mass abutting the right anterolateral aspect of the rectum without a distinguishable fat plane and irregularity of the rectal wall at this level. Additionally the mass abuts the posterior right vaginal cuff wall, without a distinguishable fat plane. The mass demonstrates postcontrast enhancement most significantly around the periphery. The surrounding mucosa demonstrates normal enhancement.The lesion abuts the adjacent right levator ani musculature.There is a 3 mm perirectal lymph node (series 401/41) at the 7 o'clock position. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.8 cm enhancing soft tissue mass in between the right anterolateral aspect of the rectum and posterior right vaginal cuff wall. Its imaging appearance is unusual for the given history of rectal cancer, and sampling should be considered as this may represent a vaginal neoplasm extending into and invading the rectum.


Instruction: Generate impression based on findings.

Input: Dizziness and ataxia There is no evidence of intracranial hemorrhage, mass or edema.There is a questionable area of hypodensity in the subcortical white matter of the left frontal lobe. A while this may be artifactual, MRI of the brain is recommended to evaluate for possible white matter abnormality. The ventricles and basal cisterns are normal in size and configuration.The calvarium and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Questionable area of hypodensity in the left corona radiata region of the left frontal lobe. While this may be artifactual, MRI is recommended to fully evaluate.


Instruction: Generate impression based on findings.

Input: History of prostatectomy with positive margins. Detectable PSA postop. PELVIS:PROSTATE: Status post prostatectomy. No measurable residual disease in the prostatectomy bed.BLADDER: The vesicourethral anastomosis is unremarkable.LYMPH NODES: There are several prominent femoral lymph nodes which are nonspecific. No pelvic adenopathy is suspected.BONES, SOFT TISSUES: Right acetabular dome enhancing lesion (series 1702/92) is incompletely characterized.2.4 x 2.0 low T1 high T2 left external iliac collection without abnormal postcontrast enhancement likely represents a postoperative lymphocele.OTHER: No significant abnormality noted.

Output: 1.No specific evidence of residual tumor within the pelvis.2.Incompletely characterized right acetabular dome enhancing lesion; no correlate lesion is noted on the outside hospital CT dated 01/23/2015 or prior bone scan. A repeat nuclear medicine bone scan should be considered for further evaluation to exclude bony metastatic disease.


Instruction: Generate impression based on findings.

Input: Female; 47 years old. Reason: 46yo female with ulcerative colitis, originally diagnosed as Crohn's. Please evaluate for small bowel inflammatory bowel disease History: abdominal pain, distention ABDOMEN:LIVER, BILIARY TRACT: Stable right hepatic lobe hemangiomas.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Interval resolution of pancolitis seen on prior CT. No specific evidence of inflammatory bowel disease affecting the terminal ileum or small bowel. No evidence of fistula or pericolonic abscess.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Interval resolution of pancolitis seen on prior CT.2. No specific evidence of inflammatory bowel disease affecting the terminal ileum or small bowel.


Instruction: Generate impression based on findings.

Input: 56-year-old female with suspected right thumb ulnar collateral ligament injury. Presents with pain and decreased range of motion. LIGAMENTS: There is disruption of the distal fibers of the ulnar collateral ligament just proximal to its insertion on the proximal phalanx. The proximal fibers of the UCL are retracted and appear to be situated superficial to the adductor pollicis aponeurosis, compatible with a Stener lesion.TENDONS: The adductor pollicis aponeurosis/tendon appear intact. The flexor and extensor tendons appear intact.BONES: No bone marrow signal abnormalities identified.ADDITIONAL

Output: 1. Disruption of the ulnar collateral ligament with findings suggestive of a Stener lesion as described above.2. 1 mm focus of low signal abnormality may represent a loose body/articular cartilage fragment within the MCP joint of the thumb.


Instruction: Generate impression based on findings.

Input: 14-year-old with history of Guillain Barre and left temporal lobe masslike lesion: 3 month follow-up exam. There is persistent diffuse T2 hyperintensity in the head and body of the left hippocampus associated with minimal swelling and poorly defined internal architecture. There is no associated restricted diffusion or contrast enhancement. There is no abnormal signal or enhancement elsewhere in the brain. There is no evidence of intracranial hemorrhage or acute infarction. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major intracranial vascular flow voids are intact. There is near-complete opacification of the sphenoid sinuses, as well as partial opacification of the ethmoid air cells. The imaged mastoid air cells are clear. The orbits are unremarkable.

Output: 1. No significant interval change in the left hippocampus lesion, accounting for difference in technique. Differential considerations include a low-grade glioma or autoimmune encephalitis and less likely a sequela of infectious encephalitis.2. Findings suggestive of sinusitis.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Headache, left hemiparetic gait. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No evidence of intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: Left ankle pain There is a 2.5 cm bone fragment situated along the posterior medial aspect of the talus which may represent an ununited fracture fragment. The fragment lies just lateral to the flexor digitorum longus tendon and anterior to the flexor hallucis longus tendon. An additional ossicle measuring approximately 2 cm is seen posterior to the talus which may represent an additional ununited fracture fragment or a large os trigonum. Subcentimeter ossicles distal to the tibiofibular joint, anterior to the tibiotalar joint, and along the talonavicular joint may also be the result of prior trauma. Mild to moderate osteoarthritis affects the tibiotalar joint with anterior osteophytes and subchondral cysts present in the talar dome. There is moderate osteoarthritis of the posterior facet of the subtalar joint with osteophyte formation, near bone-on-bone apposition, and subchondral cyst formation. Moderate osteoarthritis affects the talonavicular joint with osteophyte formation and subchondral cysts present. A subchondral cyst is also noted in the lateral cuneiform which is likely degenerative in nature.The ankle tendons are normal. The anterior talofibular ligament appears to extend to the aforementioned ossicle distal to the fibula which likely represents an old avulsion injury. The calcaneofibular ligament is intact. The posterior talofibular ligament extends to the previously described os trigonum/ununited fracture fragment but is otherwise intact. The distal tibiofibular syndesmotic complex is intact. There is loss of the normal fatty striations of the deep tibiotalar fibers of the deltoid likely the result of prior injury. There is increased signal intensity on T2-weighted sequences along the anterior margin of the ankle gutters which could represent a mild synovitis. There is intermediate signal intensity within the sinus tarsus which likely represents scarring.

Output: Multiple ossicles about the ankle further detailed above which likely represent remote fracture fragments. There is posttraumatic osteoarthritis of the ankle with other findings as described above.


Instruction: Generate impression based on findings.

Input: 67-year-old male with left renal mass ABDOMEN:LIVER, BILIARY TRACT: Scattered subcentimeter T2 hyperintense cysts are unchanged.SPLEEN: No significant abnormality noted.PANCREAS: Scattered punctate cystic foci in the body of the pancreas is unchanged and could represent a side branch type IPMN. The main pancreatic duct is normal in caliber.ADRENAL GLANDS: Small left myelolipoma. KIDNEYS, URETERS: Left superior pole renal cyst appears similar to the prior exam. No hydronephrosis or perinephric inflammation. Status post right nephrectomy. No evidence of local or regional recurrence.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Status post right nephrectomy without evidence of recurrent disease.


Instruction: Generate impression based on findings.

Input: Right shoulder pain, bicipital tendinitis ROTATOR CUFF: There is moderate tendinosis of the supraspinatus tendon. There is a high-grade undersurface tear of the supraspinatus tendon measuring approximately 7-8 mm in diameter proximal to the tendon insertion. The tear appears to extend through the majority of the thickness of the tendon. There may be a focal perforation of the bursal surface fibers but this is equivocal and overall the bursal surface fibers appear intact. There is additional fraying of the articular surface fibers of the supraspinatus. Moderate tendinosis also affects the infraspinatus tendon with additional interstitial tearing extending along the myotendinous junction. There is increased signal intensity within the distal subscapularis tendon indicating moderate insertional tendinosis. The rotator cuff musculature is intact.SUPRASPINATUS OUTLET: Moderate osteoarthritis affects the acromioclavicular joint. There is a trace amount of fluid within the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Intermediate signal intensity replaces the superior labrum representing degeneration and degenerative tearing. The inferior labrum appears relatively intact. There is mild osteoarthritis of the glenohumeral joint and a small joint effusion with fluid concentrating in the subscapular recess.BICEPS TENDON: Evaluation of the long head of the biceps tendon is limited given the lack of intra-articular contrast and the internally rotated position of the patient. Within these limits, the tendon is not well seen within the rotator interval and portions of the biceps tendon are not seen within the bicipital groove suggesting rupture.

Output: 1. Rotator cuff tendinosis with high-grade partial-thickness tearing of the supraspinatus tendon; additional rotator cuff tearing as described above.2. Poor visualization of the long head of the biceps tendon suggesting complete tear.3. Osteoarthritis of the shoulder with other findings described above.


Instruction: Generate impression based on findings.

Input: 5 years Male (DOB:12/14/2010)Reason: recurrent fevers and back pain, concern for spinal abscess History: recurrent fevers and back painPROVIDER/ATTENDING NAME: HILARY R JERICHO TIFFANY J PATTON 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.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.No compromise to lumbar spinal canal or neural foramina.2.There is no evidence for discitis or osteomyelitis.


Instruction: Generate impression based on findings.

Input: 33 year old with proven left breast cancer presents for I-SPY 2 study #1. There is extreme amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.The left breast shows diffuse abnormal enhancement, measuring 65 x 97 x 126 mm (AP x LR x CC), consistent with biopsy proven carcinoma. Diffuse edema is present. A Hydromark clip is identified at anterior 12 o'clock position in the left breast.There one abnormal lymph node showing cortical thickening, measuring 26 mm in maximum diameter, in the left axilla. This lymph node shows a high T2 signal marker, consistent with proven metastatic lymph node. Multiple small cysts are present in the right breast.No abnormal enhancement is seen in right breast. No abnormal axillary lymph nodes are identified in right axillary region.

Output: 1. Diffuse enhancement in the left breast, consistent with proven cancer, with a metastatic left axillary lymph node2. No MR evidence of malignancy in the right breast.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Redemonstrated are right frontal postoperative changes with underlying encephalomalacia and gliosis along the right frontal lobe.The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are is no midline shift. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. There is a relatively homogeneously enhancing mass arising from the sella measuring up to 30 mm craniocaudal by 24 mm transverse by 22 m AP dimension. It significantly bows the optic apparatus superiorly, and there is associated T2 hyperintensity within the right optic tract. It enters into the cavernous sinuses bilaterally, however without demonstrable narrowing of the internal cavernous carotids.

Output: 1.Redemonstrated are right frontal postoperative changes with underlying encephalomalacia and gliosis along the right frontal lobe.2.There is a relatively homogeneously enhancing mass arising from the sella measuring up to 30 mm craniocaudal by 24 mm transverse by 22 m AP dimension, most suggestive of a microadenoma. It significantly bows the optic apparatus superiorly, and there is associated T2 hyperintensity within the right optic tract. It enters into the cavernous sinuses bilaterally, however without demonstrable narrowing of the internal cavernous carotids.


Instruction: Generate impression based on findings.

Input: Rotator cuff injury in past. Patient presents with pain and weakness. ROTATOR CUFF: There is a near-complete to complete tear of the supraspinatus tendon with retraction of the majority of the tendon to the level of the glenohumeral joint although a few anterior fibers may extend to the greater tuberosity.There is a complete tear of the infraspinatus tendon with similar retraction to the level of the glenohumeral joint.There is severe fatty atrophy of the supraspinatus and infraspinatus muscles.The teres minor tendon appears intact. There is moderate fatty atrophy of the teres minor muscle.There is thickening and increased signal intensity of the subscapularis tendon indicating moderate tendinosis. There is mild fatty atrophy of the subscapularis muscle.SUPRASPINATUS OUTLET: Moderate osteoarthritis affects the acromioclavicular joint. There is a small amount of fluid in the subacromial subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is mild to moderate osteoarthritis of the glenohumeral joint which has progressed slightly when compared to the prior study. The humeral head is high riding due to the chronic rotator cuff tear.There is a tear of the superior labrum extending down the posterior labrum that has perhaps progressed slightly when compared to the prior study.Increased signal intensity within the superior aspect of the anterior labrum likely also represents additional degenerative tearing.Multiple cysts are again noted within the greater tuberosity.There is a small glenohumeral joint effusion containing foci of intermediate signal intensity likely reflecting synovitis and cartilaginous debris. BICEPS TENDON: The tendon of the long head of the biceps is visualized within the inferior aspect of the bicipital groove, however it is not well visualized within the superior aspect of the groove or within the rotator interval, suspicious for a proximal tear. This appears similar to that seen on the prior study.

Output: 1. Tears of the supraspinatus and infraspinatus tendons as described above with further tendinous retraction as well as atrophy of the muscles. Other rotator cuff findings as described above2. Acromioclavicular joint osteoarthritis.3. Slight progression of glenohumeral joint osteoarthritis with labral tearing.4. Findings suggestive of proximal rupture of the tendon of the long head of the biceps.


Instruction: Generate impression based on findings.

Input: Images are slightly limited by patient motion. The ventricles and sulci are within normal limits. The cisterns remain patent. There is no midline shift or mass effect. There is redemonstration a single punctate focus of T2/FLAIR hyperintensity within the right frontal centrum semiovale on 801/55, although not as well visualized as on the prior exam. There is stable linear enhancement in the left lateral frontal lobe white matter which appears to relate to an developmental venous anomaly. There are no new areas of abnormal signal or pathological enhancement. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. MRI THORACIC SPINE

Output: 1. Stable nonenhancing nonspecific punctate focus of FLAIR hyperintensity the right frontal lobe white matter.2. Small area of abnormal signal suggested along the dorsal cord at the upper T7 level without enhancement. This could be compatible with a demyelinating lesion if clinically appropriate.


Instruction: Generate impression based on findings.

Input: Reason: s/p Cervical lami for tumor/ Schwannoma. f/u 2 months postop for change. Surveillance. There are postsurgical changes of laminectomy at the left C4-C5 level. There has been near total resection of the intradural extramedullary tumor at the C4-C5 level which is contiguous with the left C4-C5 foraminal tumor and likely representing a schwannoma. There is minimal residual enhancement measuring approximately 5 x 4 mm on the left ventral surface of the cord. The spinal canal however is well decompressed and previously seen compressed cervical cord is now well expanded. There is T2 hyperintensity involving the cervical cord at the C4-C5 level particularly in its central aspect with evidence of mild volume loss, at least much of the signal abnormality which is reflective of myelomalacia from prior chronic compression.The foraminal and extraforaminal portion of the tumor at the left C4-C5 level is similar to prior and again noted to displace and partially compress the left vertebral artery. This tumor measures up to 14 mm in the short axis, similar to prior.Posterior small dural based lesions at the C1-C2 level measuring approximately 7 x 10 mm and at the inferior C2 level measuring approximately 3 x 6 mm again seen and likely representing small meningiomas. These lesions contact the posterior lateral aspect of the cervical cord with minimal local mass effect. 2 mm intradural extramedullary lesion in the left dorsal aspect of the spinal canal at the C5 level is also again seen. Small right C5-C6 neural foraminal lesion is also again seen without intraspinal extension.Vertebral body heights are maintained. Diffuse low T1 marrow signal is again evident and nonspecific. Mild anterolisthesis at C4 and C5 and kyphotic angulation centered at the C5 level is grossly similar to prior. Partially imaged brain again demonstrates volume loss involving the right lateral aspect of the cerebellum and a T2 hyperintense lesion in the left parotid gland, better assessed previously.

Output: 1. Expected interval postsurgical changes of resection of intradural extramedullary mass at the C4-C5 level with near total resection of the intraspinal component of the tumor. There is resolution of the previously seen compression of the cord. There is T2 cord signal abnormality at this level, at least most of which represents myelomalacia related to prior compression from the tumor.2. Additional stigmata of NF 2 including residual foraminal/extraforaminal tumor at the left C4-C5 level and a small right C5-C6 foraminal lesion are consistent with schwannomas and similar to prior. Additional small probable meningiomas at the C1 and C2 level involving the posterior aspects of the spinal canal are also similar to prior with minimal local mass effect on the dorsolateral aspect of the cord.


Instruction: Generate impression based on findings.

Input: 47 years, Male, chronic headaches, pressure behind eyes, numbness on face. Well controlled HIV. No intracranial mass or mass-effect. No abnormal parenchymal or meningeal enhancement. No restricted diffusion to suggest acute ischemia. There is a punctate focus of susceptibility effect in the left parietal cortex abutting the sulcus favored to represent chronic microhemorrhage and nonspecific; there is no corresponding enhancement to suggest a tiny peripheral/mycotic aneurysm. 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: 1. No intracranial mass or mass effect. No abnormal parenchymal or meningeal enhancement.2. Solitary punctate focus of susceptibility effect in the left parietal lobe which appears to be along the cortical surface and favored to represent a chronic microhemorrhage or focus of mineralization. Given absence of associated enhancement, much less likely this represent a tiny peripheral aneurysm in the adjacent subarachnoid space. If further evaluation however is desired, CTA head without and with contrast may be helpful. MRI brain is otherwise unremarkable.


Instruction: Generate impression based on findings.

Input: 73 years Female (DOB:2/13/1943)Reason: Evaluate for steno-occlusive disease or etiology of stroke History: aphasia, R sided neglectPROVIDER/ATTENDING NAME: WILLARD W SHARP Brain MRIMultifocal scattered restricted diffusion lesions are seen on the left middle frontal gyrus, precentral gyrus, post central gyrus and inferior parietal lobule indicating acute ischemic infarctions. There is no evidence of hemorrhagic conversion.Multiple FLAIR/T2 high signal intensity lesions seen mainly on periventricular white matter and centrum semiovale likely represent non specific small vessel ischemic disease.There are also susceptibility lesions without associated with surrounding edema on the left temporal lobe, left posterior insular, right thalamus, bilateral cerebellar hemispheres suggest possible chronic petechial hemorrhages or parenchymal mineralizations. The ventricles, sulci and cisterns are unremarkable. There is no mass, mass effect. The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.Brain MRAMotion artifacts significantly reduces image quality.3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal. No evidence of intracranial arterial luminal narrowing or irregularity. No arterial aneurysm is seen.Neck MRA3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate tortuosities of extracranial bilateral ICAs without evidence of significant luminal stenosis. The left proximal ICA just above the bifurcation shows less than 50% of luminal stenosis.Aortic arch and major arch vessels appear to be patent without evidence of luminal stenosis.The vertebral artery origins are normal.

Output: 1. Scattered acute ischemic infarctions on the left frontal and parietal lobes in particular, middle frontal gyrus, pre and post central gyrus and inferior parietal lobule without evidence of hemorrhagic conversion.2. No evidence of acute hemorrhagic lesions.3. Non specific small vessel ischemic disease. Multifocal chronic petechial hemorrhages or mineralizations.4. Significant motion artifacts degraded image quality for brain MRA. However, no definitive evidence of intracranial major arterial luminal narrowing is seen. No evidence of intracranial aneurysm.5. Tortuous course of extracranial arterial system indicating atherosclerosis without evidence of significant (more than 50%) of luminal stenosis.If clinical indicated, more precise craniofacial arterial system can be considered with head and neck CTA.


Instruction: Generate impression based on findings.

Input: There is a large right pleural effusion, increased from the prior examination with associated compressive atelectasis, increased from the prior examination. No abnormal signal foci are evident within the right hemithorax to suggest splenosis. Trace left pleural effusion. The heart is normal in size.There is diffuse marked decreased signal on in-phase T1 imaging suggests chronic liver disease related to iron deposition. In addition, there is moderate heterogenous decreased on oppose-phase T1 imaging compatible with superimposed fatty infiltration. There is cholelithiasis without evidence of cholecystitis. The spleen is not identified status post splenectomy. There is a vena cava filter in place.There is no hydronephrosis.No significant lymphadenopathy is noted. The abdominal aorta is normal in course and caliber.

Output: 1.No abnormal signal foci within the right thoracic cavity to suggest splenosis.2.Increased right pleural effusion and associated compressive atelectasis which appear to correlate with abnormal foci radiotracer accumulation on recent heat damaged RBC scan.3.Diffuse abnormal hepatic signal correlating with chronic liver disease related to iron deposition and superimposed component of fatty infiltration.


Instruction: Generate impression based on findings.

Input: Reason: history of metastatic breast cancer with brain mets s/p whole brain RT History: surveillance MRI. No significant residual abnormal parenchymal or leptomeningeal enhancement. Multiple treated intracranial metastases are again seen including small lesions in the right frontal, right paramedian parietal, left temporooccipital and cerebellum. A right paramedian parietal lesion is unchanged measuring 1.1 x 0.8 cm (10/13) with minimal if any residual enhancement. Intrinsic T1 shortening associated with the right cerebellar lesion, left temporooccipital and right paramedian parietal lesions has decreased. Susceptibility associated with these lesions indicative of chronic blood products is unchanged. No new enhancing lesions are present.Slightly prominent ventricles and sulci is unchanged from the prior exam. Scattered punctate periventricular and subcortical T2 hyperintensities are nonspecific and may be related to gluteal cyst from prior metastases and/or chronic small vessel ischemic disease.. No areas of diffusion restriction. No midline shift or herniation. The major cerebral flow voids are intact. There is mild opacification of the left anterior ethmoid and sphenoid sinuses. The orbits are intact.Increased T1 signal within the clivus and skull base osseous structures is unchanged and consistent with radiation therapy. Enhancement of the left parietal calvarium is unchanged and likely represents a metastases. Enhancement of the left occipital condyle is unchanged.

Output: 1.Evidence of multiple treated metastases without significant residual enhancement. No new lesions identified.2.Stable appearance of calvarial metastases.


Instruction: Generate impression based on findings.

Input: Pain, evaluate stenosis Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is grade 1 anterolisthesis at L4 on L5 which appears slightly worse since 2/25/2013 on the supine MRI images, further evaluation with flexion-extension radiographs can be considered as clinically indicated. Alignment is otherwise within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position. Unchanged subcentimeter lesion at the S2 level.Multilevel degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: Disc desiccation and some loss of height. Mild disc bulge, facet arthropathy, and ligamentum flavum thickening. No significant spinal canal stenosis. There is mild left neural foraminal stenosis. No significant right neural foraminal stenosis.L4-L5: There is disc uncovering and disc bulge and advanced bilateral facet arthropathy. There is mild spinal canal stenosis. There is moderate bilateral neural foraminal stenosis, worse on the left than the right. L5-S1: Diffuse disc bulge with small central protrusion. Advanced facet arthropathy with mild distention. There is partial effacement of the lateral recesses without significant central canal stenosis. There is mild right and mild-to-moderate left neural foraminal stenosis.Paraspinous soft tissues are within normal limits.

Output: 1. Multilevel degenerative changes as detailed above with grade 1 degenerative spondylolisthesis at L4 on L5. There is mild spinal canal stenosis and moderate bilateral neural foraminal stenosis at L4-5. There is partial effacement of the lateral recesses and mild to moderate foraminal narrowing at L5-S1 as described above. There is overall mild progression since 2/25/2013.2. Subcentimeter well-circumscribed lesion at the S2 vertebral body remains unchanged and most likely benign given stability since 2012.3. Advanced facet arthropathy at L4-L5 and L5-S1 which may be contributing to patient's low back pain.


Instruction: Generate impression based on findings.

Input: Stage IV CRC. Evaluate for syncope. Enhanced CT of brain: Examination demonstrates no evidence of hemorrhage, edema, mass-effect, midline shift or hydrocephalus. There is no evidence of any abnormal enhancement of brain parenchymal or the leptomeninges. The cortical sulci, ventricular system and all CSF cisterns remain within normal for patient's stated age. The gray -- white matter differentiation is well-preserved.Slight prominence of the left cavernous sinus is noted. This finding could be secondary to tortuosity of internal carotid artery within the cavernous sinus considering the patient's age. If patient has symptoms related to be peroneal nerves within the cavernous sinus follow-up exam with a dedicated MRI is recommended. Possibility of a mass or atherosclerotic aneurysm is also another differential diagnosis.

Output: 1.Unremarkable CT examination of brain with enhancement.2.Left cavernous sinus demonstrates expansion on its posterior aspect. This finding could be secondary to tortuosity and atherosclerotic ectasia of internal carotid artery considering patient's age. To exclude possibility of underlying mass or an aneurysm a dedicated MRI is recommended.


Instruction: Generate impression based on findings.

Input: There is straightening of the normal cervical lordosis, thoracic kyphosis, and lumbar lordosis. The cervical, thoracic and lumbar spine is otherwise normal in alignment. The vertebral body and disk heights are well-maintained. There is no abnormal marrow signal. The spinal cord is of normal caliber and signal. There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the cervical, thoracic, or lumbar spine. The distal spinal cord and conus are within normal limits with the conus terminating at the L1 level. The paraspinous soft tissues are unremarkable.

Output: Mild loss of normal spinal curvature. No cord signal abnormality. No significant spinal canal or neural foraminal stenosis at any level. Conus is in normal position.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate CVA's, ischemia. Signs and symptoms : Status post CVA. Nonenhanced brain MRI:The examination demonstrates many small foci of hyperintensity on diffusion weighted images in the anterior right paramedian medulla, right middle cerebellar peduncle, left mid and posterior temporal white matter, right cerebral peduncle, midline splenium of corpus callosum, splenium of corpus callosum and several larger lesions in bilateral subcortical and periventricular white matter of the cerebral hemispheres. Only the tiny right anterior medullary lesion demonstrate true restricted diffusion and consistent with an acute lacunar infarct. None of the other foci of diffusion hyperintensity demonstrate restricted diffusion and are not consistent with acute strokes. These lesions however are all well visualized on flair and T2-weighted images as well demarcated foci of hyperintensity and majority demonstrate tiny internal signal void suggestive of vasculature. Findings are highly suspected of demyelinating disease. Follow-up with enhanced imaging is recommended for better assessment and to exclude other pathologies.Examination additionally demonstrated multiple ill-defined foci of flair hyperintensity in bilateral middle cerebral peduncles, diffusely in the pons and a focus of hemorrhagic encephalomalacia in the right cerebellum. Many of these lesions are highly suggestive of chronic ischemic changes however possibility of overlapping chronic demyelinating disease cannot be entirely excluded.Slight prominence of cortical sulci and supratentorial ventricular system for patient's stated age is noted. No evidence of midline shift.The sequelae of bilateral internal carotid arteries , bilateral anterior and middle cerebral arteries are identified. Small caliber bilateral vertebrals and basilar artery is noted. There is abnormal signal intensity of the left intracranial vertebral artery (increased T2 signal within the lumen) which could be artifactual or as a result of vascular lumen compromise. Follow-up with vascular imaging is recommended considering punctate focus of restricted diffusion in the medulla.Unremarkable barium and orbits. Left maxillary sinusitis and unremarkable other paranasal sinuses

Output: 1.Diffusion-weighted images demonstrate a single tiny focus of restricted diffusion in the right anterior paramedian medulla (acute stroke).2.None of the many additional supratentorial and infratentorial foci of diffusion hyperintensity (including two lesion in the corpus callosum) demonstrate no restricted diffusion and are not consistent with acute stroke. These findings are concerning for demyelinating disease and follow up with enhanced imaging is recommended for further assessment and exclusion of other pathology.3.Additionally patchy foci of flair hyperintensity is noted in the periventricular and sub-cortical white matter, pons, bilateral middle cerebellar peduncles, corpus callosum and right cerebellum as detailed above. Please see above comments


Instruction: Generate impression based on findings.

Input: Reason: 55 yo female with hx of resected retroperitoneal liposarcoma; please evaluate for any changes and or abnormalities History: retroperitoneal liposarcoma ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable left renal cortical defect.RETROPERITONEUM, LYMPH NODES: Focal asymmetric fat/fibrous tissue (questionable delayed enhancement) anterior to the left kidney (103:63). Retroperitoneal fat anterior to the left kidney is similar to prior study with minimal mass effect. No enhancing nodularity. Stable surgical clips. No new adenopathy. Stable nodule along the pancreatic tail (9:58) may be a small splenule.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Trace pelvic free fluid is noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Stable examination. No lymphadenopathy.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate cause of left facial heaviness. Signs and symptoms: History of the left Bell's palsy, now with worsening left facial heaviness. Pre and post enhanced brain MRI:Negative diffusion weighted images.Examination demonstrate normal anatomical morphology of brain parenchyma.There are a few punctate foci of flair hyperintensity in the subcortical white matter of the bilateral cerebral hemispheres only. Although nonspecific this appearance could represent minimal chronic non-hemorrhagic small vessel ischemic strokes. The signal intensity of brain parenchyma is otherwise within normal on all MRI sequences. Unremarkable cerebral cortex, cortical parenchyma ventricular system spaces and brain myelination. Negative post enhanced images or any abnormal parenchymal or leptomeningeal enhancement.Unremarkable calvarium and orbits without evidence of abnormal enhancement. Unremarkable images through the paranasal sinuses and mastoid air cells.Dedicated thin pre-and post enhanced images through posterior fossa for cranial nerve evaluation demonstrate no evidence of abnormality. Bilateral facial nerves demonstrate normal signal intensity and with symmetrical mild expected enhancement.

Output: 1.No acute intracranial process.2.Minimal chronic nonhemorrhagic small vessel ischemic strokes and unremarkable exam otherwise.


Instruction: Generate impression based on findings.

Input: Neck pain radiating to right shoulder. Evaluate for stenosis, disc herniation or other abnormality Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. There is loss of cervical lordosis. Alignment is otherwise maintained. Bone marrow signal is benign. There is mild apparent thickening along the posterior longitudinal ligament from C4 to C6; possible calcifications can be better appreciated with CT. There is small linear focus of T2 hyperintensity involving the right lateral aspect of the cervical cord at the C5-C6 level likely representing myomalacia. Remainder of the cervical cord is normal in signal.Degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: There is a right paracentral disc protrusion which effaces the right lateral aspect of the ventral thecal sac. Spinal canal and neural foramina are otherwise patent.C4-5: There is a central disc protrusion which partially flattens the ventral cervical cord. There is overall moderate to severe spinal canal stenosis at this level. Neural foramina are patent. C5-6: There is a disc osteophyte complex including bilateral uncovertebral hypertrophy. There is partial flattening of the cervical cord and moderate to severe spinal canal stenosis. There is abnormal T2 hyperintensity involving the lateral aspect of the cervical cord on the right. There is also moderate left and mild to moderate right neural foraminal stenosis.C6-7: There is a disc osteophyte complex including uncovertebral hypertrophy. There is partial flattening of the cervical cord with moderate to severe spinal canal stenosis. There is mild right and minimal left neural foraminal stenosis. C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: 1. Moderate to severe spinal canal stenosis at the C4-C5, C5-C6, and C6-C7 levels. There is abnormal T2 hyperintensity involving the lateral aspect of the cervical cord on the right at the C5-C6 level likely representing myelomalacia.2. Neural foraminal stenoses are relatively worse at the left C5-C6 and right C6-C7 levels. There is also a right paracentral disc protrusion at C3-C4 which appears to contact the right-sided C4 nerve rootlets proximal to the neural foramen.


Instruction: Generate impression based on findings.

Input: Lack of contrast limits evaluation for small lesions including small foci of epidural tumor. Again seen is osseous metastatic disease throughout the thoracic spine. Relatively larger lesions are present at the T7 and T8 levels which were present previously. No new large lesions are evident although there is suggestion of increased tumor infiltration involving the T10 and T11 vertebral bodies with worsening diffuse T1 hypointensity. Thoracic vertebral body heights are maintained. Alignment is maintained. Previously seen epidural tumor at the T7-T8 level on MRI 3/10/2015 study has regressed and no longer appreciable. Thoracic spinal canal demonstrates no significant stenosis at any level.Axial T2 images of the lower thoracic spine were not obtained. Based on the sagittal sequences there is a large right paraspinous mass extending from the right T9-T10 to the T12 levels with extension into the lower thoracic neural foramina. No obvious extension into the spinal canal or mass effect on the cord based on the sagittal sequences.LUMBAR SPINE

Output: Please note patient could not tolerate the full study and limited sequences of the thoracic and lumbar were obtained. There is no evidence of a new pathologic compression fracture, significant spinal canal stenosis at any level, or epidural tumor. If complete MRI study cannot be obtained, follow-up bone scan or PET may be helpful to assess the burden of active osseous metastatic disease.There is a right lower thoracic paraspinous mass which appears to extend into the neural foramina. No significant intraspinal extension is appreciated based on the sagittal sequences. Dorsal epidural tumor at the T7-T8 level seen on prior study from 3/10/2015 has regressed and no longer appreciated.


Instruction: Generate impression based on findings.

Input: 43-year-old male with right knee pain status post partial medial meniscectomy and patellar chondroplasty 5 years ago. Evaluate for medial meniscus tear versus chondromalacia. MENISCI: There is a defect in the undersurface fibers of the free edge of the posterior horn of the medial meniscus. There is branching intermediate signal intensity within the body of the medial meniscus which appears to extend to this defect as well as to both the tibial and femoral articular surfaces. Additional bandlike intermediate signal intensity within the posterior horn of the medial meniscus extends to this defect on multiple sequential images. This constellation of findings is more suggestive of a tear rather than postoperative changes. The anterior horn of the medial meniscus appears intact. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is thinning of the articular cartilage along the medial femoral condyle above the body of the medial meniscus. There is minimal edema type signal abnormality within the posterior aspect of the tibial plateau which is presumably degenerative in etiology. There is mild heterogeneity of the signal of the articular cartilage along the medial facet of the patella which may represent a combination of articular cartilage degeneration or postsurgical changes. There also appears to be a small fissure partially traversing the articular cartilage of the medial facet of the patella. We see no large fluid-filled defect. The trochlear cartilage appears intact.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: Findings compatible with a medial meniscus tear and articular cartilage degeneration as described above.


Instruction: Generate impression based on findings.

Input: Neoplasm of unspecified behavior of unspecified site [D49.9], Reason for Study: ^Reason: preop planning for tumor resection. History: brain tumor Multiple fiducial markers are attached on scalp.There is about 50mm x 46.7mm x 48.4mm sized mixed cystic and solid posterior fossa mass located at 4th ventricle inferior aspect. There is no evidence of adjacent brain edema but shows mass effects toward 4th ventricle and cerebellar vermis. The 4th ventricle is obliterated and there are evidence of ventriculomegaly.The enhancement is slightly inhomogeneous on solid portion. There is no evidence of peripheral enhancement of cystic portion.Constellation of these findings indicate series of differential diagnosis of ependymoma, hemangioblastoma, medulloblastoma, glioblastoma, metastasis, and choroid plexus papilloma. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: About 50mm x 48mm x 49mm sized posterior fossa, mainly 4th ventricular mixed solid and cystic enhancing mass as described above.Differential diagnosis include ependymoma, hemangioblastoma, medulloblastoma, glioblastoma, metastasis, and choroid plexus papilloma.


Instruction: Generate impression based on findings.

Input: Despite of IV contrast administration with no gross evidence of contrast extravasation, there is significantly suboptimal contrast enhancement of the brain. Essentially the post contrast images are nondiagnostic due to suboptimal contrast administration/enhancement. This limits evaluation for smaller and newer metastases.There are multiple intra-axial hemorrhagic metastases once again showing high intensity T1 signal, and varying degrees of susceptibility effect.A lesion in the left frontal lobe has significantly increased in size due to interval hemorrhage within the lesion measuring 26 x 23 mm compared with 9 mm previously, with moderate new vasogenic edema.Additionally, there are two lesions in the occipital lobes bilaterally which have bled in the interval, with intraventricular extension in the left occipital horn. These occipital lesions can explain patient's new onset cortical blindness. They measure 40 x 22 mm in the left head 26 x 17 mm on the right. Most of the other masses have decreased in size. Representative measurements are as follows, once again limited due to suboptimal enhancement:1.Stable dural based falcine mass by the vertex measuring 19 x 13 mm without significant associated vasogenic edema2.Stable subcentimeter right parafalcine dural based lesion again seen without significant vasogenic edema3.Stable left superior frontal gyrus lesion best imaged on T2 sequence measuring 8 mm with no significant vasogenic edema4.Smaller left precentral gyrus mass measuring up to 9 mm today compared to 12 mm previously with decreased minimal vasogenic edema5.Smaller left posterior frontal lobe mass measuring 10 mm today compared to 12 mm previously on series 401 image 24 with decreased vasogenic edema6.Smaller left inferior parietal lobule mass measuring 12 mm compared to 23 x 16 mm previously and decreased vasogenic edema7.Smaller left parietal/occipital lobe mass measuring 6 x 18 mm compared to 10 x 20 mm previously (series 401 image 19)8.Smaller right occipital lobe mass on series 40 on image 15 measuring 12 x 6 mm compared to 12 x 14 mm previouslyThere is mild mass effect upon the left occipital horn. There is no hydrocephalus. There is now minimal rightward midline shift due to mass effect on the left lateral ventricle frontal horn from the left frontal lobe hematoma/hemorrhagic lesion. There are scattered foci of high diffusion signal, most of which are also high on the ADC , limiting sensitivity, however there is no definite acute infarction. There is moderate right maxillary sinus mucosal thickening.

Output: 1.Multiple hemorrhagic intracranial masses consistent with metastatic disease. At least two masses, in the left frontal lobe and left occipital lobe, have bled in the interval with significant vasogenic edema. There is a right occipital lobe hematoma as well without an underlying lesion seen on the prior MRI which may be due to a new metastasis which underwent interval bleeding, or less likely due to spontaneous parenchymal bleed.2.Essentially all other intracranial metastases have decreased in size and surrounding vasogenic edema status post interval therapy.3.Post contrast images are nondiagnostic due to suboptimal contrast administration/enhancement. This limits evaluation for smaller and newer metastases.


Instruction: Generate impression based on findings.

Input: Meningioma surveillance imaging. There is an unchanged small heterogeneously enhancing dural-based lesion overlying the right peri-rolandic region, without significant mass effect upon the brain. There is no evidence of intracranial hemorrhage or acute infarct. There are unchanged minimal scattered foci of T2 hyperintensity in the cerebral white matter. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull and scalp soft tissues are grossly unremarkable. There is right aphakia. There is mild scattered paranasal sinus mucosal thickening.

Output: 1. No significant interval change in an extra-axial dural based enhancing lesion overlying the right peri-rolandic region, which may represent a meningioma. 2. Minimal probable chronic small vessel ischemic disease, without evidence of acute infarction.


Instruction: Generate impression based on findings.

Input: Cerebral infarction due to unspecified occlusion or stenosis of left middle cerebral artery [I63.512], Reason for Study: ^Reason: evaluate for stroke extension History: as above Brain MRIThere is no evidence of acute ischemic stroke on the scan.Previously seen left MCA territorial ischemic stroke demonstrate usual evolution weight multifocal susceptibility lesions indicating hemorrhagic conversion. There is no evidence of mass effect.There is interval development of subdural hematoma along the right temporo-parieto-occipital lobe.The ventricles, sulci and cisterns are unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate severe (based on MRA, it appears to be close to more than 90%) luminal stenosis at the proximal left MCA M1 segment, unchanged.Other intracranial vascular structures appear to be normal.

Output: 1. No acute ischemic lesion.2. Normal evolution of left MCA territorial ischemic stroke with multifocal hemorrhagic conversion lesions.3. Interval development of the right temporo-parieto-occipital subdural hematoma.4. Unchanged high grade left MCA proximal M1 segment stenosis.


Instruction: Generate impression based on findings.

Input: Left shoulder pain ROTATOR CUFF: No significant abnormality noted.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: No significant abnormality noted.BICEPS TENDON: There is irregularity of the biceps tendon within the intertubercular groove which may be the result of multiple longitudinal split tears. The origin of the biceps tendon appears intact. ADDITIONAL

Output: Irregularity of the biceps tendon within the intertubercular groove which may be the result of multiple longitudinal split tears. Remaining evaluation of the shoulder is otherwise unremarkable.


Instruction: Generate impression based on findings.

Input: Female; 57 years old. Reason: Brachytherapy planning History: Brachytherapy planning PELVIS:UTERUS, ADNEXA: Cervical mass, compatible with the known cervical cancer, demonstrating intermediate T2 signal, restricted diffusion, and increased enhancement. The mass measures up to approximately 2.8 x 4.6 x 4.3 cm (AP by transverse by craniocaudal, sagittal series 601/35 and axial series 401/18). There is mild anterior and bilateral parametrial invasion, right greater than left (series 41/19 and series 1109/325), mild invasion of the tumor into the lower uterine segment and the myometrium, mild invasion into the anterior vaginal cuff (series 601/33), mild invasion into the posterior superior bladder wall (series 601/33), and abutment of but no definite invasion into the rectum.BLADDER: As above.LYMPH NODES: Subcentimeter pelvic sidewall lymph nodes are not enlarged by size criteria. Prominent bilateral inguinal lymph nodes, which were not FDG avid on prior study.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Moderate amount of pelvic ascites.

Output: Cervical cancer with invasion into surrounding structures as detailed above.


Instruction: Generate impression based on findings.

Input: 67 year old with status post benign biopsy in the right breast at 7:00 position, presents for follow up MRI. There is heterogeneous amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.There are multiple enhancing foci in both breasts, right greater than left.The linear non-mass enhancement in the right breast at the central aspect seen in the prior MRI is no longer visible.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: 54-year-old female with left knee pain, locking/clicking, and anterior laxity. Evaluate for ACL or meniscal tear. MENISCI: The lateral meniscus appears intact. The medial meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is moderate degeneration of the articular cartilage of the medial facet of the patella with both blistering and thinning of the cartilage. There is also a cleft through the articular cartilage along the median eminence. There are foci of low signal intensity within the articular cartilage of the femoral trochlea, centrally and within the medial facet, likely representing focal degeneration. The articular cartilage of the tibiofemoral compartments appears intact.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: There are enthesophytes at the quadriceps insertion on the patella, otherwise, the extensor mechanism appears intact.ADDITIONAL

Output: 1. No evidence of ACL or meniscal tear.2. Mild to moderate degeneration of the articular cartilage of the patellofemoral joint.3. Mild nonspecific edema along the anterior and lateral aspect of the knee.


Instruction: Generate impression based on findings.

Input: Please note lack of contrast limits evaluation, especially for leptomeningeal metastatic disease. On the sagittal counter series, note is made of extensive, expansile T2 signal involving the brainstem, better characterized on MRI brain dated 1/30/2016.Thoracic spine:No discrete mass within the thoracic spinal canal is appreciated. Apparent region of low T1 signal in the dorsal epidural region of the thoracic spine is favored to represent artifact related to motion degradation. The alignment of the thoracic spine is anatomic. The vertebral body heights and intervertebral disc spaces are preserved. There is no abnormal bone marrow signal. There is no evidence of spinal canal stenosis or significant neural foraminal narrowing. The cord is normal in signal and caliber. There are multiple T2 hyperintense lesions involving several neural foramina, intercostal nerves, and posterior subcutaneous soft tissues most consistent with neurofibromas. No intraspinal extension. Lumbar spine:The alignment of the lumbar spine is anatomic. The vertebral body heights and intervertebral disc spaces are preserved. There is no abnormal bone marrow signal. There is no evidence of spinal canal stenosis or significant neural foraminal narrowing. The cord is normal in signal and caliber. There are multiple T2 hyperintense lesions involving the bilateral neural foramina and posterior subcutaneous tissues which are most consistent with neurofibromas. No intraspinal extension. Neurofibromas involving the lumbosacral plexus are also noted.

Output: 1. Please note patient could not tolerate the study including the post contrast sequences. Evaluation for leptomeningeal metastatic disease is severely limited by lack of intravenous contrast.2. No abnormal cord signal or intraspinal mass within the limits on noncontrast study.3. Numerous T2 hyperintense lesions involving several neural foramina in the thoracolumbar spine, intercostal spaces, and the posterior subcutaneous tissues compatible with multiple neurofibromas.


Instruction: Generate impression based on findings.

Input: Acute expressive aphasia. There is scattered cerebral white mater T2 hyperintensity. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are prominent extra-axial CSF spaces, particularly in the left parietal convexity with mild flattening of the underlying parenchyma. The ventricles are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The paranasal sinuses are grossly unremarkable. There are bilateral lens implants. There is a right frontal calvarium osteoma.

Output: 1. Mild to moderate chronic small vessel ischemic disease, but no evidence of acute infaraction.2. Prominent extra-axial CSF spaces, particularly in the left parietal convexity may represent hygroma, but no evidence of acute intracranial hemorrhage.


Instruction: Generate impression based on findings.

Input: 46 years Female (DOB:10/3/1969)Reason: cervical SCC to brain s/p whole brain radiation History: assess for EODPROVIDER/ATTENDING NAME: STEVEN J CHMURA STEVEN J CHMURA The patient is status post right-sided craniotomy for removal of a previously noted right middle frontal gyrus lesion known to represent squamous cell carcinoma metastasis. There is redemonstration of adjacent dural thickening and the CSF cavity at the surgical site which remains stable since the prior exam. Adjacent signal change in the white matter appears stable compared to the prior exam. The enhancement pattern of the current exam is similar to the prior exam.No new enhancing lesions are appreciated 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.

Output: 1.The patient is status post right-sided craniotomy for a right middle frontal gyrus lesion. The appearance of the surgical site is stable compared to the prior exam. Given the initial appearance of a leptomeningeal and pachymeningeal involvement on the 7/23/2015 exam, the possibility of there is residual tumor cannot be excluded. In general, the lesion is significantly reduced when compared to the July exam.


Instruction: Generate impression based on findings.

Input: History of anemia recently admitted for dysarthria and found to have left MCA sub-acute ischemic infarct. Brain MRI: There is predominantly gyriform T2 hyperintensity and swelling with associated restricted diffusion involving large areas of the inferior division of the left middle cerebral artery territory, predominantly involving the lateral left temporal lobe, as well as a small area of involvement in the lateral left occipital lobe. There is no evidence of intracranial hemorrhage or mass. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Brain MRA: There appears to be paucity of flow related enhancement to a branch of the inferior division of the left middle cerebral artery. However, there is no evidence of significant steno-occlusive lesions at the circle of Willis. There may be a mildly prominent infundibulum of the left posterior communicating artery, but there is no evidence of saccular aneurysms.Neck MRA: There is no evidence of significant steno-occlusive lesions. In particular, there is no evidence of dissection. There is a two vessel aortic arch, which is an anatomic variant. The neck soft tissues appear to be grossly unremarkable.Neck MRV: There is no evidence of cerebral venous filling deficits.

Output: 1. Subacute infarction involving large areas of the inferior division of the left middle cerebral artery territory without evidence of hemorrhagic transformation or midline shift.2. Apparent paucity of flow related enhancement to a branch of the inferior division of the left middle cerebral artery. Otherwise, no evidence of significant steno-occlusive lesions at the circle of Willis. 3. No evidence of dissection in the cervical arteries.4. No evidence of cerebral venous thrombosis.


Instruction: Generate impression based on findings.

Input: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are no areas of abnormal parenchymal signal. There is mildly increased T2 hyperintensity throughout the right hippocampus, as well as questioned mild volume loss within the right hippocampal head. There is moderate volume loss within the cerebellum as well as mild prominence of the prepontine CSF space. The ventricles and basal cisterns are otherwise 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 unremarkable.

Output: 1.Mild abnormal signal throughout the right hippocampus and questioned mild volume loss within the right hippocampal head may represent mild mesial temporal sclerosis.2.Cerebellar volume loss is nonspecific but may be congenital or secondary to seizure medications. Comparison with prior exams is suggested.


Instruction: Generate impression based on findings.

Input: 35-year-old female with right knee pain, rule out lateral meniscal tear MENISCI: There is mild lateral extrusion of the body of the lateral meniscus, but we see no discrete meniscal tear. Mild attenuation of the body of the medial meniscus. There is also a small focus of intermediate signal intensity at the junction of the posterior horn and body of the medial meniscus which may represent a small undersurface tear. We suspect that this was present on the prior MRI of 4/3/2003 and may represent a healed tear.ARTICULAR CARTILAGE AND BONE: There is full-thickness loss of cartilage along the lateral facet of the patella with degenerative signal abnormality in the underlying subchondral bone. Moderate cartilage loss is present along the medial facet. There is perhaps mild thinning of the femoral cartilage of the trochlea. The articular cartilage of the medial and lateral compartments appears slightly thinned and there are also small tricompartmental osteophytes. Of note, review of prior studies indicate a history of JRA. A moderate sized joint effusion is present with lobulated foci of intermediate signal suggesting synovitis, but we see no well-defined erosions. The trochlear groove is shallow with slight lateral displacement of the patella. These findings suggest a femoral trochlear dysplasia. The Insall-Salvati ratio is 1.25 which is borderline abnormal and likely exaggerated due to extension of the knee.LIGAMENTS: The ACL and PCL are intact. The medial and lateral collateral ligament complex is intact.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1.Osteoarthritis as described above, most severely affecting the patellofemoral joint with full-thickness cartilage loss along the lateral facet. This may be associated with mild femoral trochlear dysplasia and may be in part secondary to chronic inflammatory arthritis.2.Mild extrusion of the body of the lateral meniscus with no discrete lateral meniscal tear and a possible healed tear of the medial meniscus as described above


Instruction: Generate impression based on findings.

Input: Back pain, left-sided sciatica, metastatic breast cancer Five lumbar type vertebral bodies are present. Vertebral body heights are within normal limits. There is grade 1 anterolisthesis of L3 on L4. Alignment is otherwise maintained. The conus medullaris is normal in position. Bone marrow signal is heterogeneous with multiple small T1 hypointense lesions consistent with known metastatic disease, as demonstrated on prior bone scan and CT studies. Relatively more prominent lesion is seen involving the left L2 pedicle and transverse process. No lesions with enhancement are demonstrated. There is no evidence of epidural tumor. No large osseous lesions or pathologic compression fractures are demonstrated. Multilevel degenerative changes are seen including severe loss of disc height at the L4-L5 levels with associated endplate edema at L4 and L5. Individual levels as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: Mild disc bulge, ligament flavum thickening, and facet arthropathy resulting in mild spinal canal stenosis. No significant neural foraminal stenosis.L3-L4: There is grade 1 anterolisthesis, disc bulge, ligamentum flavum thickening, and advanced facet arthropathy with severe spinal canal stenosis at this level. There is mild to moderate left and minimal right neural foraminal narrowing. Fragmentation involving the left facets noted. There are inflammatory changes surrounding the left facet joint with edema and enhancement.L4-L5: Significant loss of disc height, vacuum phenomenon, and disc and endplate edema which are likely on a degenerative basis. There is mild disc bulge, facet arthropathy, and ligamentum flavum thickening. There is resulting moderate spinal canal stenosis. There is also mild right and moderate left neural foraminal stenosis. L5-S1: Minimal disc bulge. No significant spinal canal or neural foraminal stenosis. There is bilateral facet arthropathy.Paraspinous soft tissues are within normal limits.

Output: 1. Multiple small osseous lesions without enhancement corresponding to sclerotic foci demonstrated on recent CT and better assessed on prior bone scan studies. There are no large lesions, pathologic fractures, or evidence of epidural tumor.2. Advanced degenerative changes with severe spinal canal stenosis at the L3-L4 level and to a lesser degree at the L4-L5 level. Neural foraminal narrowing as above including moderate left L4-L5 neural foraminal stenosis which may be impinging on the exiting left L4 nerve root. Mild to moderate left L3-L4 neural foraminal narrowing is also seen.3. Degenerative facet arthropathy at multiple levels with inflammatory changes noted surrounding the left L3-L4 facet joint.


Instruction: Generate impression based on findings.

Input: 71-year-old female with history of COPD, hundred pack year smoker infiltrate on CXR. Assess for infiltrate versus oncologic process. Limited examination due to lack of contrast. MRI may be considered for further evaluation.BRAIN: Limited intracranial images demonstrate no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.NECK:Limited value of the exam due to lack of contrast. With this limitation, imaging through the skull base and the cavernous sinus is unremarkable. Examination demonstrates no evidence of mass or pathologic lymphadenopathy in the neck. The airway and vasculature are patent. The osseous structures are intact. Effacement of the pyriform sinus is stable when compared to previous examinations dating back as far as one year ago 05/20/07.Limited view of the chest shows bilateral apical scarring.

Output: Stable examination without evidence of an oncologic process as clinically questioned.


Instruction: Generate impression based on findings.

Input: Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD. Tomosynthesis images are also obtained. The breast parenchyma is heterogeneously dense (BiRADS Density Category C), unchanged in pattern and distribution. There is a clip in the right breast at the 12 o'clock position from prior benign MRI guided biopsy. Multiple, scattered benign punctate calcifications seen in the right upper outer quadrant, unchanged. No suspicious masses, microcalcifications or areas of architectural distortion are present.

Output: No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually.   BIRADS: 2 - Benign finding.RECOMMENDATION: NSC - Screening Mammogram.


Instruction: Generate impression based on findings.

Input: Male, 34 years old, with GBM, s/p 2 cycles of Avastin, compare to 4/7/16 scan. Postoperative findings are again seen compatible with prior left frontal lobe tumor resection. The resection cavity is not significantly changed in size and the fluid in the cavity continues to progress slowly toward CSF signal on FLAIR images.Since the prior examination, soft tissue thickening inferior to the resection bed has progressed. Two previously small cystic cavities within this tissue, presumably related to prior instrumentation, have expanded. Irregular enhancement associated within this thickened tissue has also progressed. In particular, there is progressive extension of enhancement into the genu of the corpus callosum.No new areas of focal parenchymal signal abnormality or pathologic enhancement are detected elsewhere. Periventricular T2 hyperintensity, particularly around the frontal horns, has not significantly changed and is likely treatment related. The ventricles are stable in size and morphology.

Output: Soft tissue thickening inferior to the left frontal resection cavity has progressed along with associated enhancement. There is, in addition, further extension of enhancing tissue into the genu of the corpus callosum. These findings are concerning for progressive tumor with inflammation or treatment related effect considered less likely.


Instruction: Generate impression based on findings.

Input: Female, 13 years old, with syrinx of the cervical and thoracic spinal cord, 3 month follow-up to evaluate for change as previous MRI had demonstrated significant changes. Redemonstrated is evidence of prior suboccipital craniectomy and resection of the posterior arch of C1. The foramen magnum remains somewhat crowded with a relatively pointed configuration of the cerebellar tonsils, unchanged in appearance.Since the prior examination, the patient's cervicothoracic syrinx has decreased in caliber, now measuring 11 x 8 mm at the C6/7 level (previously 14 x 10 mm.) And 8 x 7 mm at the T6 level (previously 11 x 10 mm). As before, the syrinx cavity extends from C1 level to the T11 level, although both the cranial and caudal extent demonstrate a narrower tapering compared to prior. As before the syrinx contains multiple septations.Slight reversal of the cervical lordosis is seen. Spinal alignment is otherwise unremarkable. Vertebral body heights are preserved. No areas of marrow replacement or edema are seen. The thyroid gland is diffusely bulky and heterogeneous with a superimposed 15 mm T2 hyperintense lesion in the left thyroid lobe, unchanged in appearance.

Output: 1.Stable findings related to prior Chiari decompression. The foramen magnum remains somewhat crowded but appears similar to the prior study.2.Interval decrease in dimension of the cervicothoracic syrinx is demonstrated.3.The thyroid gland is incidentally remains prominent and diffusely heterogeneous with a focal lesion in the left lobe.


Instruction: Generate impression based on findings.

Input: Evaluate for HCC recurrence status post RFA ABDOMEN:LUNG BASES: Left pleural effusion with compressive atelectasis.LIVER, BILIARY TRACT: Cirrhosis with recanalized umbilical vein. Large amount of ascites. Left hepatic lobe ablation zone measures 3.9 x 3.9 cm. No definite arterially enhancing lesion. The portal vein is patent.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1. Post ablation changes without definite arterially enhancing lesion.


Instruction: Generate impression based on findings.

Input: Clinical question: Status post blunt head trauma.? Intracranial hemorrhage. Signs and symptoms: Fell from bed with blunt head trauma and 4 episodes of nausea and vomiting 7 hours later. Non-enhanced CT brain: There is no evidence of intracranial hemorrhage, edema, mass effect, midline shift or hydrocephalus. Cortical sulci, CSF cisterns and ventricular system are essentially unremarkable. Sagittal reformatted images demonstrate minimal ectopia of the cerebellar tonsils. Follow-up with an MRI is recommended.Limited images of orbits are negative. Calvarium is intact. No definitive abnormality of the scalp is detected. Mastoid air cells and middle ear cavities are pneumatized and unremarkable.

Output: 1.No evidence of acute intracranial process.2.Minimally ectopic cerebellar tonsils. Followed with an MRI is recommended.3.Calvarium is intact.


Instruction: Generate impression based on findings.

Input: 73-year-old male with prostate cancer. PELVIS:PROSTATE:Prostate Size: The prostate measures 4.1 cm in transverse, 1.7 cm in AP, and 3.3 cm in craniocaudal diameter.Peripheral Zone: Multiple small foci of T2 and ADC hypointense signal intensity suspicious for malignancy with the largest focus in the right mid gland measuring 6.6 x 4.1 mm (series 703 image 264, series 801 image 70).Central Gland: No significant abnormality noted.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: None.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Multiple small foci of T2 and ADC hypointense signal intensity suspicious for malignancy with the largest focus in the right mid gland measuring 6.6 x 4.1 mm.


Instruction: Generate impression based on findings.

Input: History of osteomyelofibrosis. Evaluate splenic size. ABDOMEN:LIVER, BILIARY TRACT: Hepatomegaly measuring 19.3 cm in craniocaudal dimension. It is markedly decreased in T2-weighted signal intensity compatible with iron deposition. No intra or extrahepatic biliary ductal dilatation. No focal suspicious lesion is apparent.SPLEEN: Significant splenomegaly measuring 17.8 cm in craniocaudal dimension and up to 13.9 x 6.8 cm in the axial plane. The spleen is diffusely hypointense on T2-weighted imaging. Stable punctate T2 hyperintense foci are noted in the spleen. Multiple presumed siderotic nodules.PANCREAS: Unchanged punctate cystic focus in the pancreatic head may represent a sidebranch IPMN without suspicious imaging features. No pancreatic ductal dilatation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Very low marrow signal intensityBONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Hepatosplenomegaly as described above. Significant iron deposition of the liver and spleen.2.Marrow signal abnormality compatible with history of myelofibrosis.


Instruction: Generate impression based on findings.

Input: 18-year-old man with history of metastatic lung cancer. ABDOMEN:LIVER, BILIARY TRACT: The liver appears normal without focal abnormality or abnormal enhancement. The gallbladder is normal.SPLEEN: The spleen appears normal.PANCREAS: The pancreas is normal.ADRENAL GLANDS: The adrenal glands are normal.KIDNEYS, URETERS: The kidneys and ureters appear normal.RETROPERITONEUM, LYMPH NODES: No retroperitoneal lymphadenopathy identified.BOWEL, MESENTERY: The small bowel and partially visualized colon are normal.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No evidence of metastatic disease in the abdomen. Please see separate report for findings from concurrent MR chest.


Instruction: Generate impression based on findings.

Input: 42-year-old female with left leg numbness, weakness and left lower back pain as well as urinary incontinence. Evaluate for cauda equina or cord compression. The vertebral bodies are appropriate in the overall alignment and height. The spinal cord has normal signal characteristics and overall morphology. There is no compromise of the spinal cord. There are degenerative spondylosis with the most prominent disc osteophyte complex within the cervical spine at the C4-5 level indents the ventral spinal cord, where there may be abnormal high T2 signal versus artifact. There are also disc bulges and facet hypertrophy at the L4-5 and L5-S1 levels bilaterally with mild to moderate neural foraminal narrowing bilaterally, but no significant spinal canal stenosis or cauda equina compression.

Output: This is a limited exam specific for the exclusion of cord compression only and does not exclude more subtle lesions such as intrinsic cord abnormalities. Degenerative spondylosis at the C4-5 level indents the ventral spinal cord, where there may be abnormal high T2 signal versus artifact. In addition, disc bulges and facet hypertrophy at the L4-5 and L5-S1 levels bilaterally result in mild to moderate neural foraminal narrowing bilaterally, but no significant spinal canal stenosis or cauda equina compression.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Complex partial seizure: acute memory impairment. Brain MRI: There is a punctate focus of restricted diffusion in the right hippocampus. There is no evidence of intracranial hemorrhage or mass. There are minimal nonspecific scattered foci of cerebral white matter T2 hyperintensity. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is a left maxillary sinus retention cyst.Brain MRA: There is no evidence of significant steno-occlusive lesions or aneurysms.Neck MRA: There is no evidence of significant steno-occlusive lesions.

Output: 1. A punctate focus of restricted diffusion in the right hippocampus likely represents an acute ischemic lesion related to "transient global amnesia".2. No evidence of significant steno-occlusive lesions involving the major head and neck arteries.


Instruction: Generate impression based on findings.

Input: There is a 5 x 5 x 5 enhancing lesion in the right precentral gyrus with corresponding mild edema demonstrated on prior study. No other parenchymal lesions or abnormal leptomeningeal enhancement.Again seen is a 2 cm enhancing lesion involving the left frontoparietal calvarium at the level of the coronal suture consistent with metastasis. There is minimal adjacent dural enhancement favored to reactive, with early dural invasion not entirely excluded.Additional findings including chronic small vessel ischemic changes, chronic left caudate head infarct, and parenchymal volume loss better demonstrated on prior study with multiple precontrast sequences. No evidence of intracranial mass effect, midline shift, or herniation. Chronic right medial orbital wall fracture with medial herniation of fat again seen.

Output: 1. 5 mm enhancing lesion in the right posterior frontal lobe consistent with metastatic disease. No other lesions or significant intracranial mass effect is appreciated.2. Enhancing left frontoparietal calvarial lesion also highly suspicious for metastasis. There is minimal adjacent dural enhancement which is favored to be reactive, with early dural invasion not entirely excluded.3. Additional findings including chronic small vessel ischemic disease and chronic left caudate head infarct better demonstrated on recent MRI from 10/19/2015.


Instruction: Generate impression based on findings.

Input: Male, 13 years old, with loss of consciousness, altered mental status, abnormal EEG with focality over the left frontal lobe. The cerebral and cerebellar hemispheres and brainstem show normal signal intensity and morphology. No restricted diffusion is seen. The pattern of intracranial enhancement is normal.No evidence of parenchymal edema, mass, or mass effect is seen. There is no evidence of intracranial hemorrhage or abnormal extra-axial fluid. The ventricular system is normal in caliber and morphology. Signal intensity of the bone marrow is unremarkable.

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


Instruction: Generate impression based on findings.

Input: Multiple sclerosisSigns and Symptoms: ms exacerbationClinical question: r/o acute ms lesionsFactor 5 leiden mutation, heterozygousMultiple sclerosisPrimary biliary cirrhosisMigrainesBlindArthritis The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild to moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. No lesions involve the corpus callosum nor the callosocingulate junction. The visualized lesions are not perpendicular to the lateral ventricles.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The right eye lens is thin.

Output: Periventricular and subcortical white matter signal changes of a mild to moderate degree are present which are nonspecific. They could be vascular related, related to demyelination, trauma, vasculitis, sarcoid. They are nonspecific.


Instruction: Generate impression based on findings.

Input: A 67 year old female with hypertension, hyperlipidemia and mitral valve prolapse. A recent echocardiography showed significant mitral and aortic regurgitation and suspected hypertrophic cardiomyopathy. Referred to cardiac MRI for further evaluation Left VentricleThe left ventricle is mildly dilated with normal systolic function. The overall LV ejection fraction is 64%, the LV end diastolic volume index is 96 ml/m2 (normal range: 65+/-11), the LVEDV is 159 ml (normal range 109+/-23), the LV end systolic volume index is 34 ml/m2 (normal range 18+/-5), the LVESV is 56 ml (normal range 31+/-10), the LV mass index is 38 g/m2 (normal range 67+/-11), and the LV mass is 62 g (normal range 114+/-24). There is mild focal hypertrophy of the basal anterior wall (12mm). The posterior wall thickness is 8mm. There is a significant left ventricular outflow tract gradient secondary to systolic anterior motion of the mitral leaflet and the above mentioned focal region of hypertrophy.There are no regional wall motion abnormalities present and intra-myocardial deformation within the hypertrophied segment is relatively normal. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. No myocardial iron overload was noted.No intracavitary thrombus was seen.Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 56%, the RV end diastolic volume index is 75 ml/m2 (normal range 69+/-14), the RVEDV is 123 ml (normal range 110+/-24), the RV end systolic volume index is 33 ml/m2 (normal range 22+/-8), and the RVESV is 54 ml (normal range 35+/-13). Right AtriumThe right atrium is mildly dilated. Aortic ValveThe aortic valve opens widely and there is mild aortic regurgitation (regurgitant fraction 13%).Mitral ValveThe mitral valve opens widely and there is at least moderate to severe mitral regurgitation likely secondary to significant systolic anterior motion of mitral leaflets. Pulmonic ValveThe pulmonic valve opens widely. There is mild pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is trace tricuspid regurgitation.AortaThere is a left sided aortic arch with a pseudo-bovine brachiocephalic branching pattern. The ascending thoracic aorta is mildly dilated (40mm). The thoracic aorta is mild to moderately tortuous.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 a trivial pericardial effusion.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is mildly dilated with normal systolic function, the LVEF is 64%. 2. There is mild focal hypertrophy of the basal anterior wall which is associated with significant systolic anterior motion of the mitral leaflets resulting in a substantial left ventricular outflow tract gradient and at least moderate to severe mitral regurgitation. Based on myocardial tagging, the intra-myocardial deformation within the hypertrophied segment is relatively normal. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process within the hypertrophied segment or elsewhere in the left ventricle. Although definitive diagnostic criteria for hypertrophic cardiomyopathy are not met on this MRI study and the morphology of the hypertrophy is consistent with a sigmoid septum associated with aging, a variant of hypertrophic cardiomyopathy remains on the differential diagnosis given the severity of the systolic anterior motion of the mitral leaflets and the presence of a basal anterior wall to posterior wall ratio of 1.5. 3. The right ventricle is normal in size with normal systolic function, the RVEF is 56%. 4. The left atrium is moderately dilated. 5. The ascending aorta is mildly dilated and there is mild aortic regurgitation. 6. There is at least moderate to severe mitral regurgitation secondary to systolic anterior motion of the mitral leaflets.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 47-year-old male with history of prostate cancer. PELVIS:PROSTATE:Prostate Size: The prostate measures 4.6 x 2.9 x 5.5 cm.Peripheral Zone: Ill-defined T2 hypointense region extending from the left apex to the base with associated decreased ADC signal measuring 1.9 x 1.3 cm in maximal axial dimensions. Small area of increased T1 signal around the left base compatible hemorrhage.Central Gland: Mild BPH.Seminal Vesicles: UnremarkableExtracapsular Extension: The lesion abuts the capsule near the apex, however no frank invasion is evident.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Ill-defined lesion extending from the left apex to base compatible with prostate adenocarcinoma with bulging of the left apex which is suspicious for capsular invasion.


Instruction: Generate impression based on findings.

Input: Clinical question to be answered: Rule out bleed or hematoma. Signs and symptoms: Mental status change. Examination demonstrates a gyriform area of increased density in the high convex to the left parietal cortex (axial image 20). This finding is associated with an adjacent area of encephalomalacia . The finding is believed to represent calcific changes of an area of old stroke which was noted on prior MRI exam. Less likely possibility of a new small hemorrhagic cortical stroke cannot be entirely ruled out. Prominence of cortical sulci and folia of the cerebellum as well as prominence of the ventricular system is concerning for underlying parenchymal volume loss.

Output: See above comments.


Instruction: Generate impression based on findings.

Input: Right breast IDC; New lytic lesion in the T12 vertebral body seen on CT scan for which bone biopsy recommended Serial CT images obtained during the biopsy procedure demonstrate the needle placement within the lytic T12 vertebral lesion. Post biopsy images demonstrate no complications.

Output: T12 vertebral bone biopsy under CT guidance. A total of two core samples were delivered to pathology for analysis. Touch preps were positive for neoplasm consistent with suspected breast cancer metastasis.