Instruction: Generate impression based on findings.

Input: 70-year-old male with history of epidural lipomatosis, status post T6-T9 laminectomies with posterior spinal fixation at T6-T10. There has been recent T6-T10 posterior fusion. The surgical hardware causes artifact that obscures the spinal canal at these levels. There is also underlying diffuse epidural lipomatosis that contributes to spinal canal narrowing, with near complete effacement of the thecal sac cerebrospinal fluid superior and inferior to the operated levels. In addition, there are multiple prominent anterior thoracic disc-osteophyte complexes. There are postoperative findings related to multilevel anterior fusion from C3 to C6. There are disc-osteophytes at C6-C7, T1-2, and T2-3, where in conjunction with epidural lipomatosis and ligamentum flavum thickening, there is mild indentation of the spinal cord, which appears to display mild T2 hyperintensity. Enhancement within the inferior right aspect of the T1 vertebral body is likely degenerative in nature. The thoracic vertebral column alignment is near anatomic and the vertebral body heights are essentially intact. There are small bilateral pleural effusions.

Output: 1. Postoperative findings related to recent midthoracic laminectomy and fusion, although surgical hardware artifact limits assessment of this region.2. Diffuse narrowing of the spinal canal superior and inferior to the operated levels due to extensive epidural lipomatosis. In addition, disc-osteophytes at C6-C7, T1-2, and T2-3, which in conjunction with the epidural lipomatosis and ligamentum flavum thickening result in mild indentation of the spinal cord with associated myelomalacia. 3. Multiple prominent anterior thoracic disc-osteophyte complexes are likely related to degenerative spondylosis. 4. Small bilateral pleural effusions.


Instruction: Generate impression based on findings.

Input: 28-year-old man with possible posterior labral tear and/or scapulothoracic bursitis. ROTATOR CUFF: There is no evidence of a rotator cuff tear.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is a complex, nondisplaced posterior labral tear.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: Complex, nondisplaced posterior labral tear.


Instruction: Generate impression based on findings.

Input: History of sinus cancer. Status post chemo/RT 3 -- 09 CT of the soft tissues of the neck with infusion:Images through the skull base demonstrate a large destructive mass with intracranial extension at the level of cribriform plate and planum study done. There is elevation of bilateral frontal lobes (right greater than left) due to spread of tumor from the sinuses into the intracranial space. On this examination no definitive evidence of edema all brain parenchyma and in particular in the frontal lobes is detected. Spread of tumor intracranially is believed to be extradural. MRI examination is recommended to confirm this finding.Destructive mass involves bilateral ethmoid air cells (right greater than left) and the bilateral extension of tumor into the orbits bilaterally (right greater than left. There is no definitive involvement of cavernous sinuses. Tumor within the sphenoid sinus is also noted. Extensive bony destruction of the sinuses is noted. The mass extends inferiorly into the nasal cavity and bilateral maxillary sinuses. There is no definitive evidence of erosion of hard palate. However the mass appears to extend inferiorly to the hard palate. In comparison with the prior examination no definitive appreciable interval change is detected.Images through the soft tissues of the neck demonstrate no definitive adenopathy. New since prior examination is a mixed soft tissue and fluid density on the right which appears to surround the right thyroid cartilage. This is best appreciated on axial images 49 through 56 on coronal images. This finding is best appreciated on on images 48 through 52 there is however no definitive erosion of thyroid cartilage. The exact etiology of this finding is not clear and follow-up with an MRI is recommended.Images through the apices of the lungs demonstrate very large bilateral necrotic cavity forming masses which are new since prior study. Please review dedicated CT of chest performed the same date.CT of brain with infusion.Likely epidural intracranial spread of tumor in bilateral subfrontal region however no parenchymal edema is detected. This examination is otherwise unremarkable.80 cc of Omnipaque 350 was utilized for this study.

Output: 1.Large destructive mass at the skull base with involvement of bilateral ethmoid, nasal cavities, bilateral maxillary sinuses and sphenoid sinus as detailed. There is evidence of extension of tumor intracranially as well. This findings remains stable since prior study.2.No evidence of lymphadenopathy in the neck.3.New since prior examination is a soft tissue and fluid density lesion surrounding the right thyroid cartilage of unknown etiology. Correlate with history and follow up with an MRI is recommended.4.CT of brain demonstrates epidural intracranial spread of tumor in bilateral subfrontal region without edema of the brain parenchyma and with no evidence of leptomeningeal or parenchymal enhancement.


Instruction: Generate impression based on findings.

Input: Right lower extremity radiculopathy with lumbar spondylolisthesis. Five lumbar type vertebral bodies are present. There is loss of lumbar lordosis and dextroscoliosis with apex at the L3-L4 level. There is 1 cm right lateral subluxation of L3 on L4. No compression fractures. Advanced degenerative changes are seen at the L3-L4 and L4-L5 levels with severe loss of intravertebral disk height and associated endplate changes. No suspicious osseous lesions are seen. The conus medullaris is normal in position at the L1-L2 level.Multilevel degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: Trace disk bulge, asymmetric to the right, with minimal right neural foraminal narrowing. There is also mild left neural foraminal stenosis related to facet arthropathy. No spinal canal stenosis.L3-L4: Advanced degenerative changes with right lateral subluxation, loss of disk height, and type II Modic endplate signal changes. There is disk bulge which in combination with prominence of the epidural fat and facet arthropathy results in mild to moderate spinal canal stenosis. There is effacement of the lateral recesses, left greater than right. There is mild right and mild to moderate left neural foramina stenosis.L4-L5: Advanced degenerative changes with loss of disk height and Modic type 1/edematous endplate marrow signal changes. There is disk bulge with effacement of the lateral recesses without significant central spinal canal stenosis. There is severe right neural foramina stenosis, and mild left neural foramina stenosis. L5-S1: Small central protrusion. No spinal canal or neural foraminal stenosis.There is facet arthropathy throughout the lumbar spine. Small left renal cysts incidentally noted.

Output: 1. Advanced degenerative changes in the lumbar spine at L3-L4 and L4-L5 as detailed above with loss of lumbar lordosis and 1 cm right lateral subluxation of L3 on L4. Multilevel facet arthropathy.2. Severe right L4-L5 neural foramina stenosis with suspected impingement of the exiting right L4 nerve root. Stenosis at additional levels as described above.3. Mild to moderate spinal canal stenosis at L3-L4 related to combination of disk bulge and epidural fat.


Instruction: Generate impression based on findings.

Input: Left hip pain ACETABULAR LABRUM: Elevation of the labrum is limited given the lack of intra-articular contrast. Within these limits, there is a focus of increased signal intensity extending into the anterior labrum best seen on series 1301 images 11 and 12 of 20.ARTICULAR CARTILAGE AND BONE: Mild osteoarthritis affects the hip. Otherwise the marrow signal is normal.SOFT TISSUES: No significant abnormality noted. ADDITIONAL

Output: Small labral tear and mild osteoarthritis of the left hip.


Instruction: Generate impression based on findings.

Input: 74-year-old female with screening detected lesions in the right breast 7:00 position presents for Allen Penn research study There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.Right breast:Heterogeneously enhancing irregular mass in the right breast 7:00 position measures 20 x 13 x 10 mm (AP x ML X CC). Located anterior to this are 3 small satellite lesions, anterior most satellite lesion measures 7 x 6 x 6 mm (AP x ML X CC). Total extent measures 33 x 17 x 11 mm. Located 14 mm medial and slightly posterior to the largest mass at approximately 6:00 position there is a 5 mm focus of enhancement which also appears suspicious making the total extent approximately 4 x 3.5 cm.Linear non mass enhancement measuring 11 x 6 x 6 mm (AP x ML X CC) is noted in the right breast 12:00 position.Left breast:Multiple small enhancing foci identified in the left breast, largest of them at 10:00 position measures 6 x 5 x 3 mm(AP x ML X CC). A focus is also noted at 5:00 position measuring 4 x 4 mm.No abnormal lymph nodes are identified in either axillary region.

Output: 1. A suspicious mass in the right breast 7:00 position with 3 small anterior satellite lesions. A small medial satellite lesion is also noted which appear suspicious. MR directed ultrasound can be attempted.2. Suspicious linear nonmass enhancement in the right breast 12:00 position for which MR directed ultrasound is recommended.3. Multiple enhancing masses/foci in the left breast, largest lesion located at 10:00 position, and a superficial focus noted at 5:00 position. MR directed ultrasound is recommended, if lesions not identified, six-month follow-up MRI is recommended to confirm stability of these small foci.4. No abnormal axillary lymph nodes are noted.BIRADS: 5 - Highly suggestive of malignancy.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Neoplasm of unspecified behavior of bone, soft tissue, and skin [D49.2] / Neoplasm of uncertain behavior of brain, unspecified [D43.2], Reason for Study: ^Reason: hx meningioma. Eval for change. Yearly follow up History: surveillance imaging Brain MRIRedemonstration of the right frontal operculum area extra axial enhancing lesion likely represent meningioma, no change in size, configuration and MR characteristics since prior scan. There is no evidence of other abnormal enhancement on the scan.There is no evidence of acute ischemic or hemorrhagic lesion either.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear. Right maxillary sinus retention cyst.Lumbar spine MRIFor the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. There are multifocal enhancing lesions especially around endplate. Enhancing lesions were seen on T11, T12, L1, L2, L3, L5 and S1 endplates were previously seen but the configuration has been changed. In particular, previously the enhancing pattern was diffuse enhancement but today's exam shows more confined with surrounding low signal intensity rim indicating sclerotic margin. There are, however, new enhancement on L4 inferior endplate which shows relatively diffuse enhancement as if shown on other level on previous scan. Thus, this new enhancement might be the same nature of other levels.There is no definitive evidence of metastatic lesion on this scan.At the level of L1-L2, there is about 4.7mm x7mm sized enhancing lesion indicating a small nerve sheath tumor, no change since prior scan. The spine alignment is anatomic. The vertebral body height is preserved. The signal of the visualized cord is normal. The conus medullaris terminates at theL1 level.Degenerative changes are specified by the intervertebral level as follows: L1-L2: Schmorl's node seen, no change since prior scan. No neuroforaminal narrowing or spinal stenosis. L2-L3: diffuse bulging of disc, mild to moderate left side neuroforaminal narrowing. No change since prior scan. L3-L4: broad based disc bulge with mild facet hypertrophy and ligamentum flavum hypertrophy resulting minimal to mild spinal canal stenosis, no change since prior scan. L4-L5: broad based disc bulge, facet hypertrophy and bilateral ligamentum flavum thickening indicating mild spinal canal stenosis. There is mild right side neuroforaminal narrowing. L5-S1: diffuse broad based disc bulge slightly eccentric toward right side results mild right side lateral recess narrowing.

Output: 1. No evidence of metastatic lesion on either brain MRI or Lumbar spine MRI2. Stable right frontal operculum area meningioma since prior scan.3. Interval change of previously seen multifocal vertebral endplates' diffuse enhancement into more confined with surrounding sclerotic rim indicating formation of Schmorl's nodes.4. New enhancement on the L4 vertebral body shows similar MR characteristics which was shown on other levels, thus indicating development of Schmorl's node.5. No change of L1-L2 level nerve sheath tumor since prior scan.6. Multi-level various degree degenerative changes as described above, no significant interval change since prior scan.


Instruction: Generate impression based on findings.

Input: Male, 14 years old, with right eye swelling and pain, headache, fevers, elevated WBCs. Several sequences are affected by image distortion likely due to orthodontic braces.An epidural fluid collection is evident along the right frontal lobe measuring 20 x 10 x 15 mm. The surrounding dura is thickened and enhancing. Although the collection mildly displaces the adjacent brain parenchyma, the parenchyma is free of pathologic signal abnormality and enhancement. Cerebral morphology and signal characteristics are otherwise unremarkable. No evidence of intracranial hemorrhage is seen. The ventricles are normal in size and morphology.Directly opposite the epidural collection within the subcutaneous tissues of the right frontal scalp, there is a small collection measuring approximately 7 x 7 x 2 mm with surrounding inflammatory stranding and enhancement. Inferior to the epidural collection, there is an additional small irregularly marginated collection within the extraconal right orbit. As a result of this, the right globe is proptotic and inferiorly displaced. Due to artifact, additional details of the orbital process are better assessed on CT.Extensive paranasal sinus opacification is demonstrated with enhancing mucosa including complete opacification of the maxillary sinuses and partial opacification of the right sphenoid sinus, ethmoid air cells and the frontal sinuses. Inflammatory changes are seen within the subcutaneous tissues of the right face and scalp.

Output: In the context of extensive paranasal sinus inflammation, an epidural abscess is present along the right frontal lobe with no evidence of associated cerebritis. Opposite this abscess, there is a small subcutaneous, probably subperiosteal abscess along the right frontal scalp. An additional abscess is also seen within the superior extraconal right orbit resulting in proptosis and inferior displacement of the right globe. Due to of the presence of metallic artifact, additional orbital details are better assessed on CT.


Instruction: Generate impression based on findings.

Input: Male, 57 years old, with altered mental status. Numerous areas of restricted diffusion are redemonstrated involving both cerebral hemispheres and to a lesser degree the cerebellum. As before, the largest lesion occupies the right parietal, occipital and temporal lobes and is associated with patchy T1 hyperintensity.As before, the dominant right parieto-occipito-temporal lesion demonstrates gyriform enhancement while the remaining smaller lesions demonstrate rim enhancement. All lesions are associated with some degree of susceptibility artifact indicating blood product.There has been no significant change in the size or number of these lesions. Associated edema and mass effect, most notably affecting the right parietal and occipital lobes, are unchanged. The right lateral ventricle remains partially effaced.No change is seen in the appearance of intraocular presumed blood product on the right.

Output: There has been no significant interval change in the size, number or morphology of multiple diffusion restricting lesions within both cerebral hemispheres and the cerebellum. As before, these lesions are enhancing and associated with at least microscopic or petechial blood product. These lesions likely reflect an embolic phenomenon, and the possibility that some or most of them represent septic embolic lesions with abscess formation should still be considered.


Instruction: Generate impression based on findings.

Input: 55 year old male with history of DVT/PE, HTN, DM, hemachromatosis (heterozygous), and family history of premature CAD who presents for evaluation of possible cardiac involvement of sarcoidosis given history of palpitations/PVCs. Left VentricleThe left ventricle is normal in size with low normal systolic function (LVEF 54%). The overall LV ejection fraction is 54%, the LV end diastolic volume index is 93 ml/m2 (normal range: 74+/-15), the LVEDV is 210 ml (normal range 142+/-34), the LV end systolic volume index is 43 ml/m2 (normal range 25+/-9), the LVESV is 98 ml (normal range 47+/-19), the LV mass index is 32 g/m2 (normal range 85+/-15), and the LV mass is 72 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is gadolinium enhancement in the mid lateral and inferolateral walls and the basal inferolateral wall in the mid to subendocardial distribution. This, along with the mediastinal lymphadenopathy, is suggestive of cardiac sarcoidosis. No intracardiac thrombus.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 58%, the RV end diastolic volume index is 88 ml/m2 (normal range 82+/-16), the RVEDV is 199 ml (normal range 142+/-31), the RV end systolic volume index is 37 ml/m2 (normal range 31+/-9), and the RVESV is 84 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is evidence of tricuspid regurgitation which is not quantified.AortaThere is a left sided aortic arch with a common origin of the innominate and left common carotid artery. The aortic root is mildly dilated (SoV 44 mm, Ascending Aorta 34 mm on coronal views/non-orthogonal plane images).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 drain normally into the right atrium.PericardiumThere is no pericardial effusion.Extracardiac FindingsThere is stable mediastinal lymphadenopathy (right paratracheal, aortopulmonary, right hilar and sub carinal).

Output: 1. The left ventricle is normal in size with low normal systolic function (LVEF 54%). There is left ventricular gadolinium enhancement which is mid myocardial and subendocardial n the mid lateral and inferolateral walls and the basal inferolateral wall. This, along with the mediastinal lymphadenopathy, is suggestive of cardiac sarcoidosis.2. The right ventricle is normal in size and systolic function (RVEF 58%)3. Mild dilatation of the sinus of Valsalva.


Instruction: Generate impression based on findings.

Input: Diagnosis: Multiple sclerosisClinical question: MS, f/u progressionSigns and Symptoms: paresthesias There is a mild degree of periventricular and subcortical white matter FLAIR and T2 signal hyperintensity is present. They have not changed since prior exam.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: Periventricular and subcortical white matter signal changes of a mild degree are present which are nonspecific. Patient with clinical history there are known to be related to demyelinating disorder. Compared to the prior exam the have not changed.


Instruction: Generate impression based on findings.

Input: Diagnosis: Other convulsions.Clinical question: r/o structural diseaseSigns and Symptoms: seizures like activity The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells demonstrate partial opacification of the right mastoid air cells. The visualized portions of the orbits are intact.

Output: 1.No evidence for intracranial mass lesion or infarction or hemorrhage to explain the patient's seizure. MRI of the brain is within normal limits2.Opacification of right mastoid air cells and middle ear is a nonspecific finding and could be inflammatory related.3.Exam did not include all the pulse sequences normally performed for MRI of the brain for seizures (based on patient's inability to complete all sequences). As a result subtle lesions such as cortical dysplasia may not be identified.


Instruction: Generate impression based on findings.

Input: 30 year-old female with lateral joint tenderness, recent trauma MENISCI: There is abnormal signal within the anterior horn of the lateral meniscus with surface regularity, unchanged from the prior exam. The posterior horn of the lateral meniscus and medial meniscus are intact.ARTICULAR CARTILAGE AND BONE: Diffuse edema is present within the posterolateral condyle of the femur without distinct fracture line. There is a full-thickness articular cartilage defect measuring approximately 1 cm along the posterolateral femoral condyle. There is mild unchanged thinning of the patellofemoral cartilage.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The quadriceps tendon and patellar tendon are intact.ADDITIONAL

Output: 1. 1 cm full thickness articular coverage defect along the posterolateral femoral condyle. 2. Edema within the posterolateral femoral condyle.3. Moderate joint effusion.4. Intact cruciate and collateral ligaments.


Instruction: Generate impression based on findings.

Input: Clinical question: Rule out cord compression/cauda equina. Signs and symptoms: Bowel incontinence and metastatic breast cancer. Nonenhanced complete spine MRI:Examination demonstrate diffuse patchy foci of marrow signal changes consistent with previously known diffuse osseous metastases disease.There is also evidence of mild compression deformity of T6, T7, T8, T11 and L1 vertebral bodies. There is mild expansion of compressed vertebrae at the one into the spinal canal with resultant complete effacement of the subarachnoid space and flattening and posterior displacement of the cord and central spinal stenosis. There is no evidence of cord signal abnormality.Compared to prior CT examination from February 3rd of 2015 there is no convincing evidence of internal progression of this finding. Very minimal bulge of compressed T6 vertebrae into the spinal canal with mild compromise of the spinal canal is also present. There is also a shallow ventral epidural soft tissue density at the level of compressed T8 vertebrae which is suggestive of small epidural spread of tumor. There is no evidence of any significant spinal canal compromise at these levels. The signal intensity of the cord also remains normal.There is significant exaggeration of thoracic kyphosis secondary to multilevel compression deformity without change since prior chest CT.There is evidence of bilateral pleural effusion which are only partially visualized and measure maximum of 16 mm in thickness on the right.MRI of thoracic spine:Axial T2 weighted images of thoracic and spine were also acquired which demonstrate the small focus of epidural spread of tumor on the left at T5 level without spinal stenosis and shallow ventral epidural spread of tumor at T8 as detailed above.MRI of lumbar spine:Additional axial T2-weighted images of the lumbar spine were also acquired for her assessment of one compression fracture. These images confirm mass effect on the cord and complete effacement of subarachnoid space and spinal stenosis. Compromise of bilateral neural foramina at this level is also detected.

Output: 1.Examination demonstrate diffuse osseous metastatic lesions involving the entire visualized lower cervical, thoracic and lumbosacral spine as detailed.2.Significant compression fracture of L1 with extension into the spinal canal results in mass-effect and posterior displacement of the cord and central spinal stenosis as detailed. The fracture demonstrates no significant change since prior studies.3.There is no detectable signal abnormality of the cord or the conus. 4.Multi-additional levels of mild compression fractures of the thoracic spine without significant compromise of canal or mass effect on the cord. There is however result in significant kyphotic deformity of the thoracic spine.5.Bilateral pleural effusions are detected.


Instruction: Generate impression based on findings.

Input: Diagnosis: LumbagoClinical question: Pt with bilateral shooting leg pain and back pain; please eval for spinal stenosis or herniated diskSigns and Symptoms: back pain, leg pain Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is right-sided facet hypertrophy present at this level resulting in some minimal displacement of the nerve root at the right lateral recess.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is mild disc desiccation at this level. There is bilateral facet hypertrophy at this level right more than left with some mild displacement of the nerve root in the right lateral recessAt L3-4 there is no significant compromise to spinal canal or neural foramina. There is mild to moderate disc desiccation at this levelAt L2-3 there is no significant compromise to spinal canal or neural foramina. There is some facet hypertrophy present on the right side at this level associated ligamentum flavum hypertrophy and some mild encroachment of the right-sided exiting nerve root within the neural foramen.At L1-2 there is no significant compromise to spinal canal or neural foramina.The left kidney was not identified. There is metal artifact present at the expected location of the left kidney suggesting prior removal of the left kidney.There is atrophy of the right paraspinous musculature in the lower lumbar spine. This finding is been present on prior exams dating back to at least 2011.

Output: There is some mild encroachment of right-sided exiting nerve roots at L3-4 and to a lesser degree L4-5 due to dominant right sided facet hypertrophy. The nerve roots at the right lateral recess are displaced by a facet hypertrophy.


Instruction: Generate impression based on findings.

Input: Check for stress fracture, tendonitis History of right leg and ankle pain Lower leg and ankle: TENDONS: No significant abnormality noted. Specifically tendons and muscle compartments are well visualized and intact.LIGAMENTS: No significant abnormality noted. Specific attention was placed in the region of the ankle without acute abnormalityARTICULAR SURFACES AND BONE: No significant abnormality noted. Marrow and cortical bone signal are unremarkable. Specifically no findings to suggest stress fracture or periosteal cortical abnormality.ADDITIONAL

Output: Normal examI personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 56-year-old woman strong family history of breast cancer and BRCA2 positive. Family history of breast cancer in sister at age 35 paternal aunt at age 45. There is heterogeneous amount of fibroglandular tissue in both breasts.Minimal parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: 58-year-old woman with unresectable right breast cancer present for MRI for treatment planning. Patient initially presented with a palpable right breast mass in 12/24/2015 which was reported at that time to be have been growing in size over the past year. Subsequent biopsy revealed invasive ductal carcinoma grade 3. There is scattered fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.Right breast: Centered in the inferior right breast near 5-6:00 position, posterior depth is a heterogeneously enhancing centrally necrotic mass with associated clip artifact, consistent with biopsy-proven malignancy. This mass measures approximately 4.3 x 4.2 x 5.2 cm (AP x TV x CC) and demonstrates rapid uptake and washout on dynamic evaluation. There is a complete loss of fat planes between the mass and the pectoralis muscle and pectoralis muscle enhancement, consistent with pectoralis muscle invasion. Completely surrounding the mass are areas of nodular and non mass enhancement, suspicious for malignancy. The entire extent of abnormal enhancement including the mass is 9.1 x 5.2 cm in AP and transverse dimension, respectively.Left breast: There is no abnormal enhancement.Axilla: A few axillary lymph nodes are seen in the bilateral axilla, none of which demonstrate abnormal morphology or size. Other: A left chest wall port is noted.

Output: (1) Locally advanced biopsy-proven right breast cancer centered in the inferior right breast with involvement of the pectoralis muscle. The entire extent of abnormal enhancement in the right breast including the biopsy-proven malignancy measures up to 9.1 cm.(2) No MRI evidence for malignancy in the left breast. BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Male, 36 years old, with anaplastic astrocytoma status post surgery, RT and TMZ, now off all therapy. The right middle frontal gyrus resection cavity is again seen appearing similar in size and shape to prior exams. The degree and extent of T2 hyperintensity surrounding the resection cavity are unchanged. No suspicious enhancement is seen within or along the margins of the cavity.Two foci of enhancement seen previously within the right superior temporal gyrus show no significant interval change from the immediate prior exam. Several additional foci of enhancement are also seen within the right insula. One rather linear lesion demonstrates slightly more conspicuous enhancement (see image 87 series 1401), and increased FLAIR hyperintensity. A second lesion more anteriorly within the insula (image 93 series 1401), is new or increased in size from prior. One or two additional small lesions, however, are smaller when compared to prior exams. Apart from this, no new areas of pathologic enhancement or parenchymal signal abnormal are seen. No significant generalized mass effect or parenchymal edema is noted. No acute intracranial hemorrhage or any new abnormal fluid collection is detected. The ventricular system is normal in size and morphology. A chronic presumed left orbital floor fracture is again seen with fat herniation into the maxillary sinus.

Output: 1.Stable appearance of the right frontal lobe resection cavity with no new or concerning features in the immediate surrounding parenchyma.2.Several nonspecific foci of enhancement are seen involving the right superior temporal gyrus as well as the right insula. Some of these are stable in size, some new or slightly more conspicuous, and others are smaller when compared to prior exams. Given this somewhat waxing and waning pattern, these may simply represent a posttreatment effect, though continued close follow-up should be considered.


Instruction: Generate impression based on findings.

Input: Local superficial swelling, mass in the mid lumbar region. History of traumatic hematoma. There is a lentiform fluid collection measuring up to approximately 6 cm in length within the midline subcutaneous tissues of the lower lumbar spine at the level of L5 to S1. There is thick, but smooth, enhancement surrounding the collection and partial septations within the collection. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology.

Output: A fluid collection within the subcutaneous tissues of the lower lumbar spine at the level of L5 to S1 that measures up to 6 cm in length likely represents a chronic hematic cyst or hematoma.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 59-year-old woman with history of alcoholic liver disease, evaluate for cirrhosis or portal vein thrombosis. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in signal and morphology. There is no nodular contour or widening of the fissures to suggest cirrhosis. No significant signal dropout on out-of-phase imaging seen to indicate hepatic steatosis. The gallbladder is normal. Preserved signal void in portal veins, SMV and splenic vein, supporting patency. There is no intra or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: There is infiltration of the fat planes surrounding the pancreas along with edema of the tail (5/25). There is mild pancreatic ductal prominence involving the distal body and tail. There is mild diffusion restriction within the distal pancreatic parenchyma. As this is a nonenhanced study, parenchymal enhancement cannot be evaluated, difficult to assess for parenchymal necrosis.Additionally, there is an 11 x 10 mm T1 and T2 hyperintense rounded structure posterior and inferior to the pancreatic tail (5/24). The splenic artery courses adjacent to this structure and may be contiguous with structure. If this in fact a vascular structure, the absence of the normal T2 flow void and increased T1 signal may reflect a thrombosed pseudoaneurysm, or possibly slow flow.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: There is a moderate amount of free abdominal fluid which tracks along the left paracolic gutter.

Output: 1. No imaging findings of hepatic cirrhosis as clinically questioned. Noncontrast study but preserved signal void in portal veins, SMV and splenic vein, likely reflecting patent vessels.2. Findings concerning for acute pancreatitis involving the distal body and tail. Correlation with patient's clinical history and laboratory values recommended.3. Rounded structure posterior and inferior to the pancreatic tail adjacent to and possibly contiguous with the splenic artery which could represent a small splenic artery aneurysm/pseudoaneurysm versus a pseudocyst. Further evaluation with contrast-enhanced CT angiography is recommended.


Instruction: Generate impression based on findings.

Input: Pelvic mass. Evaluate proximity to nerves, vessels, and ureter. PELVIS:UTERUS, ADNEXA: Surgically absent.BLADDER: No significant abnormality noted. No hydroureter.LYMPH NODES: 6.1 x 3.2 x 5.0 cm heterogeneously enhancing left obturator soft tissue lesion, suspicious for metastatic nodal mass, similar to prior. Lesion is situated between the left external and internal iliac veins, and it compresses without occluding the left external iliac vein. Lesion abuts the adjacent sigmoid colon, without invasion. The visualized left obturator nerve passes just posterior to the aforementioned lesion, no secondary signs of nerve impingement such as muscle atrophy seen.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: The visualized musculature is symmetric bilaterally.There is nonenhancing soft tissue prominence about the left vaginal cuff (series 601, image 23), likely postsurgical. The punctate focus of hypermetabolic activity in the pelvis posterior to the lesion alluded to above seen on the prior PET, corresponds to a nonenhancing nonspecific thin linear focus of low T2 signal, may reflect scarring.OTHER: Subcentimeter Tarlov cysts noted.

Output: Left obturator lesion suspicious for metastatic nodal disease or implant unchanged, associated compression of left external iliac vein seen, left obturator nerve passes just posteriorly, no evidence of neurovascular involvement otherwise.


Instruction: Generate impression based on findings.

Input: Clinical question: Mass or infarct? Signs and symptoms: Right side decreased sensation, weakness and ataxia. Pre-and post contrast brain MRI:No detectable acute intracranial process and no evidence of acute ischemic stroke.Examination demonstrates a very prominent cerebellar and vermian folia for patient's stated age of 41 consistent with significant parenchymal volume loss. There is also resultant mild expansion of the fourth ventricle. There is no convincing evidence of any signal abnormality abdominal aortogram is. There is also suggestion of subtle pontine and medullary parenchymal volume loss. Correlate with history and risk factors.The anatomical morphology and the signal intensity of the cerebral hemispheres remains within normal on all MRI sequences. The cerebral cortex, cortical sulci, ventricular system and the CSF spaces as well as the brain myelination is unremarkable. Post enhanced images demonstrate no abnormal parenchymal, leptomeningeal, calvarial or retropatellar enhancement.Signal void of major intracranial arterial branches are identified.The signal intensity of intracranial venous sinuses are beginning normal with normal pattern of enhancement.Unremarkable orbits, paranasal sinuses and mastoid air cells.

Output: 1.Parenchymal volume loss of cerebellum, vermis and suspected volume loss of pons / medulla without associated signal abnormality or enhancement.2.Unremarkable pre-and post enhanced brain MRI on.


Instruction: Generate impression based on findings.

Input: Clinical question: History of NSCLC brain metastases. Status post surgery and multiple arteries. Signs and symptoms: As above. Nonenhanced brain MRI:Examination is performed without intravenous contrast as is requested by the clinical services.Large focus of FLAIR hyperintensity surrounding a right posterior temporal-parietal surgical cavity containing CSF signal intensity and without evidence of mass effect remains identical to prior exam. Findings representing post operative changes and surrounding gliosis. There is resultant mild ex vacuo dilatation of right trigone and temporal horn of lateral ventricle similar to prior study.Patchy and confluent foci of FLAIR hyperintensity in the periventricular white matter of bilateral cerebral hemispheres and more localized in the right posterior parietal similar to prior exam and representing posttreatment changes. Slight prominence of cortical sulci similar to prior study. Mildly prominent supratentorial ventricular system with maintained midline identical to prior exam.Stable focus of encephalomalacia under a right suboccipital craniectomy demonstrate no interval change and unremarkable images through posterior fossa otherwise.Unremarkable images through the orbits, paranasal sinuses and mastoid air cells.

Output: 1.Within the limitation of this nonenhanced exam there is no convincing evidence of any acute or new finding since prior study.2.Stable postoperative changes of right posterior temporal-parietal tumor resection with residual gliosis as detailed.3.Stable findings of a right suboccipital craniectomy since prior exam.4.Stable mildly dilated supratentorial ventricular system and with maintained midline.


Instruction: Generate impression based on findings.

Input: Recurrent bowel obstruction versus severe constipation. Evaluate for stricture. ABDOMEN:LIVER, BILIARY TRACT: Right hepatic dome simple appearing cyst. No suspicious liver lesion. The liver is normal in morphology, size, signal intensity and enhancement. No suspicious liver lesion or biliary duct dilatation. Partially contracted gallbladder.SPLEEN: The spleen is normal in size and signal intensity without a focal lesion.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The small bowel is adequately distended with oral contrast. The small bowel fold pattern is maintained.There is a long segment of small bowel in the left hemiabdomen which is persistently dilated up to 4.3 cm. There is no associated bowel wall thickening, restricted diffusion, T2 weighted signal abnormality or postcontrast abnormal enhancement. No obstructing mass or flow limiting stricture is evident. No perienteric inflammatory changes, fibrofatty proliferation or reactive lymphadenopathy.The terminal ileum is well seen and is unremarkable.The colon is normal caliber without evidence of active inflammation or flow limiting stricture.No free fluid or loculated fluid collection. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Nodular signal abnormality in the right lung base without corresponding abnormality on recent chest CT.

Output: 1. Persistently moderately dilated single long segment of small bowel in the left hemiabdomen without a discrete obstructing mass or stricture evident. There is no significant upstream dilatation. This may be residua of the recent resolved bowel obstruction. No specific findings to account for the patient's recent bowel obstruction. No evidence of active inflammation, flow limiting stricture or discrete mass. Adhesive disease remains on the differential.2. Right lung base nodule, not seen on recent chest CT. Also likely infectious/inflammatory, a repeat diagnostic chest CT in 3-6 months is recommended to confirm resolution. (Findings were paged to the covering service for pager 2750 at 1703 03/31/2016).


Instruction: Generate impression based on findings.

Input: Female 62 years old with right shoulder pain. Evaluate rotator cuff. ROTATOR CUFF: There is mild tendinosis of the supraspinatus tendon and perhaps mild undersurface fraying. In addition, there is a tiny cyst at the insertion of the supraspinatus tendon on the humerus but we see no full-thickness supraspinatus tendon tear. There is mild fatty atrophy of the supraspinatus muscle belly proximally. There is longitudinal, predominantly interstitial, tearing of the distal infraspinatus tendon perhaps with surface extension but no tendon retraction. There is edema in the underlying humeral head. The infraspinatus muscle appears normal. The teres minor and subscapularis muscles and tendons appear intact although there is a small cyst in the humeral head underlying the teres minor tendon insertion.SUPRASPINATUS OUTLET: Moderate osteoarthritis affects the acromioclavicular joint. There is trace fluid in the subacromial bursa of doubtful clinical significance.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral joint alignment is normal. There is a small amount of fluid within the joint but no effusion. Linear intermediate signal in the posterior superior labrum may represent a tear. Fluid signal intensity more anteriorly could represent additional tearing or simply a normal variant sublabral recess. The inferior labrum appears normal.BICEPS TENDON: The long head of the biceps is normal in appearance. ADDITIONAL

Output: 1.Partial thickness rotator cuff tearing as described above.2.Osteoarthritis of the acromioclavicular joint.3.Edema at the origin of the deltoid muscle posteriorly may represent a strain or enthesopathic inflammation.4.Other findings as above.


Instruction: Generate impression based on findings.

Input: Cognitive deficits, hypertension, and diabetes. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is susceptibility effect and high T2 signal in the bilateral globi pallidi. There is minimal diffuse cerebral volume loss. There is minimal nonspecific periventricular T2 hyperintensity. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and paranasal sinuses are grossly unremarkable. There is a 12 mm thick right occipital scalp lipoma.

Output: 1. No evidence of acute intracranial hemorrhage, mass, or acute infarct.2. minimal nonspecific periventricular T2 hyperintensity, which may be related to chronic small vessel ischemia.3. Nonspecific mineralization of the globi pallidi.4. Minimal diffuse cerebral volume loss.


Instruction: Generate impression based on findings.

Input: Low back pain, fatigue Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is grade 1 retrolisthesis of L2 on L3. Alignment is otherwise within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position.Multilevel degenerative changes are seen, with disc desiccation throughout the lumbar spine and multilevel loss of disc height, worst at the L5-S1 level. Individual levels as described below:L1-L2: Minimal disc bulge. No spinal canal or neural foraminal stenosis.L2-L3: Mild disc bulge eccentric to the right. There is mild effacement of the right lateral recess and mild right neural foraminal stenosis. No left neural foraminal stenosis. There is no significant central canal stenosis. L3-L4: Mild disc bulge, ligamentum flavum thickening and facet arthropathy. There is mild central canal stenosis and partial effacement of the bilateral lateral recesses. There is moderate right and minimal left neural foraminal stenosis. L4-L5: Mild disc bulge, ligamentum flavum thickening and facet arthropathy. No significant spinal canal stenosis. There is no significant right and mild to moderate left neural foraminal stenosis. L5-S1: Minimal disc bulge, eccentric to the left. No spinal canal stenosis. There is up to moderate bilateral neural foraminal stenosis. Paraspinous soft tissues are within normal limits.

Output: Mild to moderate degenerative changes in the lumbar spine. There is mild spinal canal stenosis at the L3-L4 level; otherwise no high-grade spinal canal stenosis at any level. There is varying degrees of mild to moderate neural foraminal stenosis as detailed above.


Instruction: Generate impression based on findings.

Input: Female, 77 years old, with intracranial hemorrhage. Evaluate for underlying cause. A large parenchymal hemorrhage is redemonstrated in the right cerebral hemisphere measuring up to 82 x 52 x 57 mm. The hemorrhagic cavity has coalesced and has mildly increased in size relative to the prior MRI. Internal signal characteristics are compatible with subacute blood product.The parenchyma surrounding the hemorrhagic cavity is edematous. Generalized mass effect is seen including a midline shift to the left of approximately 10 mm, partial effacement of the right lateral ventricle, subfalcine herniation and generalized sulcal effacement in the right cerebral hemisphere. Mass effect is increased from the prior MRI but is relatively unchanged when compared to more recent CTs.Without the benefit of IV contrast, no definite causative lesion is detected within or adjacent to the hemorrhagic cavity. A few scattered foci of T2 hyperintensity are evident within the cerebral hemispheres, a nonspecific finding. The left lateral ventricle remains mildly dilated suggesting entrapment. No definite evidence of intraventricular blood product is seen. No new intracranial lesions are seen.

Output: A large subacute hematoma is again seen in the right cerebral hemisphere with substantial generalized mass effect. Without the benefit of IV contrast, no definite causative lesion is seen within or adjacent to the hematoma.


Instruction: Generate impression based on findings.

Input: Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with complex partial seizures, not intractable, without status epilepticus [G40.209] / Migraine with aura, not intractable, without status migrainosus [G43.109], No evidence of acute ischemic or hemorrhagic lesion.No abnormal enhancement.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: Normal brain MRI


Instruction: Generate impression based on findings.

Input: Carcinoid syndrome and seizures. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mild nonspecific periventricular white matter T2 hyperintensity. There is no abnormal intracranial enhancement. There is diffuse cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, mastoid air cells, and scalp soft tissues are grossly unremarkable. There is mucosal thickening and secretions within the right osteomeatal unit.

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


Instruction: Generate impression based on findings.

Input: Female, 44 years old, with history of recurrent triple negative breast cancer with right pectoralis muscle tumor causing paresthesias and weakness of the right arm. Evaluate for extent of tumor involvement in the plexus and nearby supraclavicular and axillary disease. A large centrally necrotic tumor aggregate is evident within the right subpectoral axilla. This lesion measures up to 128 mm CC x 111 mm AP x 90 mm TV. The mass is contiguous with the chest wall and extends laterally almost to the humeral cortex but with no evidence of osseous invasion. Superiorly it extends just above the clavicle, and inferiorly it indents the breast prosthesis. Much smaller discontiguous tumor deposits are evident within the right supraclavicular fossa.The above lesion resides predominantly at the level of the cords and terminal branches of the right brachial plexus. The neural structures are displaced posteriorly by the mass but they do remain visible throughout which would argue against encasement.Multiple lung nodules and perihilar adenopathy are also seen.

Output: A bulky necrotic right axillary mass is identified situated predominately at the level of the cords and terminal branches of the brachial plexus. The neural structures are displaced and potentially compressed by the lesion, but they do not appear to be encased.


Instruction: Generate impression based on findings.

Input: Bariatric surgery history and AMS, high grade fevers, sepsis, and reported seizures. CSF with high WBCs, normal protein, and high glucose. Brain MRI: 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. There is mild fluid signal within the mastoid air cells. There is also fluid within the upper aerodigestive track associated with intubation.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. No evidence of intracranial abscess or acute infarct.2. No evidence of significant steno-occlusive lesions in the head and neck.


Instruction: Generate impression based on findings.

Input: Glioblastoma: behavioral changes and confusion. There are postoperative findings related to left anterior temporal lobectomy. There is persistent confluent T2 hyperintensity and swelling in the remaining portions of the left temporal lobe, with an enhancing component that measures up to approximately 15 mm. Overall, this appears similar in extent as on the prior scan. There is no evidence of acute intracranial hemorrhage or acute infarct. There is also unchanged patchy T2 hyperintensity within the left periatrial white matter and minimal punctate T2 hyperintensity in the right posterior centrum semiovale. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are unchanged. There are retention cysts in the bilateral nasopharyngeal recesses. There is fluid within the bilateral mastoid air cells.

Output: Postoperative findings with what may represent persistent tumor in the left temporal lobe.


Instruction: Generate impression based on findings.

Input: Clinical question: Status post biopsy. Signs and symptoms: Status post biopsy. Pre and post enhanced brain Stealth MRI:Examination demonstrates a thin rim enhancing lesion in the anterior and mid temporal lobe lateral to the trigone of left lateral ventricle. It measures approximately 25 mm in AP axis and 8mm in transverse. No significant change since prior exam.Extensive surrounding FLAIR and T2 hyperintensity without enhancement is again also noted suspected of nonenhancing component of tumor. There are thin serpiginous low T2 signal intensity consistent with previously seen cortical calcification on prior CT is again noted without change. Beyond this region vasogenic edema anterior and posterior to the mass similar to prior exam is again noted. Findings resulting regional mass effect as well as trace the radiation of midline to the right without significant change since prior exam. A small linear and loculated internal focus of T2 hyperintensity suggestive of track of prior biopsy approach.Stable normal size of ventricular system.No detectable new foci of signal abnormality or abnormal parenchymal/leptomeningeal enhancement.There is however new thin uniform dural thickening and enhancement in the left temporal and frontal region likely as result of recent surgical intervention.

Output: 1.Revisualization of partially enhancing mass in the left anterior and mid temporal lobe without significant change since prebiopsy study. Stable regional mass effect and trace deviation of midline to the right.2.Expected post biopsy changes and including mild uniform dural thickening and enhancement in the left frontal and temporal region.


Instruction: Generate impression based on findings.

Input: Inflammatory joint disease, Crohn's BONE MARROW: No significant abnormality noted.SOFT TISSUES: No significant abnormality noted. JOINTS: No significant abnormality noted. Specifically, the sacroiliac joints are normal.ADDITIONAL

Output: Normal unenhanced MRI of the sacroiliac joints.


Instruction: Generate impression based on findings.

Input: 66-year-old man with history of prostate cancer status post laparoscopic prostatectomy 8/3/2015. Final pathology revealed Gleason 9 adenocarcinoma, postoperative PSA of 1.04, current PSA of 1.28 nanograms per milliliter. PELVIS:PROSTATE:The patient is status post prostatectomy. No abnormal soft tissue seen in the surgical bed.BLADDER: There is asymmetry and nodular thickening on the right side of the vesicourethral anastomosis. This area measures approximately 7 x 4 mm (series 601, image 8) There is significant artifact with signal loss in this region on the gradient echo images secondary to the surgical clips.LYMPH NODES: No significant lymphadenopathy noted.BONES, SOFT TISSUES: No osseous lesion noted.OTHER: No significant abnormality noted.

Output: Thickening on the right side of the vesicourethral anastomosis which may represent local recurrence.


Instruction: Generate impression based on findings.

Input: There are multiple foci of restricted diffusion in the left cerebral hemisphere predominantly involving the deep white matter of the left frontal lobe with additional foci in the left frontal, parietal, and left temporal lobes. Few foci of restricted diffusion within the left frontoparietal cortex are also seen. There is also restricted diffusion involving the left caudate head and anterior putamen. Compared to recent outside MRI, there are new foci of restricted diffusion involving the left frontal centrum semiovale as well as the left temporal subcortical white matterThere is FLAIR hyperintensity corresponding to the recent infarcts. No evidence of hemorrhagic conversion. There is also minimal additional nonspecific scattered T2/FLAIR hyperintensity involving the right parietal lobe. There is no significant intracranial mass effect, midline shift, or herniation. No hydrocephalus. There is mild scattered paranasal sinus opacification on the particularly the left maxillary sinus and right posterior ethmoid sinuses. Calvarium and extracranial soft tissues are grossly unremarkable.MRA HEAD

Output: 1. Multiple acute to early subacute infarcts in the left cerebral hemisphere. There are multiple new infarcts since prior MRI from 12/2/2016 including the left frontoparietal centrum semiovale and the subcortical left temporal white matter.2. High-grade stenosis/short segment occlusion involving the left ICA terminus and proximal left M1 segment similar to prior CTA. There is a small plaque involving the left ICA origin without hemodynamically significant stenosis.3. There is near occlusion of the right vertebral artery with minimal flow in the cervical segment better seen on recent CTA. There is also small amount of flow involving the right intracranial distal vertebral artery which may be retrograde. 4. Additional mild to moderate multifocal stenoses include the bilateral cavernous and supraclinoid internal carotid arteries and focal high-grade stenosis involving the right proximal A1 segment.


Instruction: Generate impression based on findings.

Input: 9-year-old male with headaches. Rule out multiple sclerosis. MRI BRAIN:Focus of T2/FLAIR hyperintense signal abnormality in the left centrum semiovale with mild asymmetric enlargement of the adjacent frontal horn of the left lateral ventricle probably representing ex vacuo dilatation, suggesting encephalomalacia in this area. These findings are not significantly changed from the previous exam.There is no evidence of acute intracranial hemorrhage, mass or edema. The ventricles and sulci are within normal limits. There is no midline shift or mass effect. The midline structures and craniocervical junction are within normal limits. The ventricles and basal cisterns are normal in size and configuration. No extra-axial fluid collection is identified.Minimal bilateral maxillary sinus mucosal thickening. The visualized mastoid air cells are clear. The orbits are unremarkable.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. The posterior communicating arteries are not readily identified. The vertebral arteries are similar in size.

Output: 1.Stable small focus of encephalomalacia in the left centrum semiovale.2.No evidence for cerebrovascular occlusive disease or intracranial aneurysm.


Instruction: Generate impression based on findings.

Input: Weakness [R53.1], Reason for Study: ^Reason: rule out new ischemia History: L sided weakness and hypoesthesia Brain MRIThere is no evidence of acute ischemic infarct.Multifocal susceptibility lesions on bilateral hemisphere are seen. These lesions may reflect chronic microhemorrhages or mineralizations.Multiple small lacunar infarcts are seen on bilateral thalami as well as is a ganglia.Wedge-shaped tissue defect on the left cerebellar hemisphere indicate chronic ischemic infarct.There are patchy and somewhat confluent T2/FLAIR high signal intensity lesions on periventricular white matter indicate nonspecific small vessel ischemic disease. The ventricles, sulci and cisterns are unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. 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 some luminal irregularities of the bilateral MCA branches. However, overall, bilateral ICAs, MCAs and ACAs and vertebrobasilar system appear to be normal.

Output: 1. No evidence of acute ischemic lesion.2. Multifocal susceptibility lesions on bilateral hemisphere without associated surrounding edema indicate chronic hemorrhages or mineralizations.3. Multiple infarcts with tissue loss involving bilateral thalami, basal ganglia, corpus callosum and left cerebellar hemisphere.4. Nonspecific small vessel ischemic disease.5. Normal brain MRA


Instruction: Generate impression based on findings.

Input: Clinical question: History of bilateral MCA aneurysm coiling 2005. Presents with headache and encephalopathy. Signs and symptoms: As above. Nonenhanced brain MRI:Negative diffusion weighted series.Examination demonstrates a well demarcated round extra axial lesion in convexity paramedian left posterior frontal measuring approximately 11 times 12-mm. It demonstrates isointense signal on T2 and T1-weighted images and abuts the inner table calvarium. Finding is highly suggestive of a small meningioma which demonstrate no change since prior head CT study from 3 -- 8 -- 15.Examination demonstrates findings suggestive of mild chronic small vessel scan is strokes evident by tiny foci of subcortical and periventricular flair/T2 hyperintensity of bilateral cerebral hemispheres. Minimal similar finding in the right basal ganglial is also noted. The signal intensity of brain parenchyma is otherwise within normal on all MRI sequences. Well-demarcated round foci of susceptibility representing previously coiled supraclinoid internal carotid artery aneurysms are identified.Prominence of cortical sulci for patient's stated age of 66 and remains similar to prior head CT examination. The signal void of major intracranial arterial branches are identified.Unremarkable images through the orbits, paranasal sinuses and mastoid air cells.

Output: 1.No acute intracranial process.2.Findings of mild age indeterminate small vessel ischemic strokes.3.High convexity left posterior frontal paramedian extra-axial meningioma (12 x 11-mm) without change since prior study.4.Susceptibility signal changes representing coiled bilateral supraclinoid internal carotid artery aneurysms.5.


Instruction: Generate impression based on findings.

Input: Female; 61 years old. Reason: 61 y/o recurrent acute pancreatitis, dilated PD and CBD with concern of ampullary stricture, but new episode of pancreatitis after double sphincterotomy. ABDOMEN:MRCP SECRETIN STUDY:Normal physiologic response to secretin with pancreatic secretions seen readily filling the duodenum and proximal jejunum. Unchanged anatomic appearance of the biliary tree as detailed on yesterday's MRI exam. Again seen is a dilated main pancreatic duct and common bile duct with possible short segment stricture at the level of the ampulla Vater. A normal caliber ventral accessory pancreatic duct is seen draining into a superiorly located minor papilla.

Output: 1. Normal physiologic response to secretin.2. Possible short segment stricture at the level of the ampulla Vater.


Instruction: Generate impression based on findings.

Input: 91-year-old male with a history of urinary incontinence, gait disorder, and cognitive decline. The third and lateral ventricles are enlarged somewhat out of portion compared to the sulci and there is a prominent jet of cerebrospinal fluid into the third ventricle. There is no midline shift or herniation. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mild to moderate periventricular and subcortical cerebral white matter T2 hyperintensity. The pituitary gland appears unremarkable. The major cerebral flow voids are intact. There is fluid within the right mastoid air cells. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There are bilateral lens implants.

Output: 1. Findings suggestive of normal pressure hydrocephalus.2. No evidence of intracranial hemorrhage, mass, or acute infarct. 3. Fluid within the right mastoid air cells may represent mastoiditis. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Epithelioid hemangioendothelioma Foot: Multiple small foci of signal void are noted within the medial soft tissues of the midfoot representing metallic susceptibility artifact from prior surgical intervention. The previously seen enhancing mass within the abductor hallucis muscle inferior to the medial cuneiform has been resected. In its place is a collection of high signal intensity on both T1 and T2 sequences measuring just under 1 cm in the transverse dimension and just under 2 cm in the longitudinal dimension. This collection likely represents a small hematoma. There is mild edema and enhancement of the adjacent muscles and soft tissues likely representing postoperative inflammation and/or early scarring. There is otherwise no well-defined enhancing mass to suggest recurrent or residual tumor. There are no additional soft tissue or bony masses affecting the foot. Note is made of a bipartite medial sesamoid (normal variant) and mild osteoarthritis of the first MTP joint.Tibia/Fibula: There are no masses or abnormal foci of enhancement within the bones or soft tissues of the tibia or fibula. Although the exam was not tailored for the evaluation of the knee, there appears to be a shallow femoral trochlea with lateralization of the tibial tuberosity with relation to the trochlea. This can be further evaluated with MRI of the knee, if clinically warranted. There is mild edema type signal within the distal soleus along the myotendinous junction of the Achilles which may represent a mild strain but this is equivocal and of doubtful clinical significance.

Output: Surgical changes of epithelioid hemangioendothelioma resection from the medial midfoot with a small residual hematoma. There is no evidence of residual or recurrent mass within the foot or and no evidence of mass or signal abnormality within the leg. Other findings are described above.


Instruction: Generate impression based on findings.

Input: Reason: Tear v tendonitis History: Pain > 90 ROTATOR CUFF: There is complete/near-complete tearing of the supraspinatus tendon from its insertion on the greater tuberosity with approximately 1.5 cm of retraction. There also appears to be delamination of the undersurface fibers of the supraspinatus with further retraction to the level of the glenohumeral joint. This tear extends posteriorly to involve the anterior fibers of the infraspinatus and there is interstitial tearing of the tendon more posteriorly. Mild enthesopathic changes are identified along the posterolateral aspect of the humeral head at the infraspinatus insertion. There is thickening and intermediate signal intensity of the infraspinatus indicating tendinosis. There is increased signal intensity within the distal fibers of the subscapularis tendon suggesting tendinosis and high-grade partial thickness insertional tearing of the superior fibers. The supraspinatus, infraspinatus, teres minor, and subscapularis muscles are normal in appearance.SUPRASPINATUS OUTLET: Moderate osteoarthritis affects the acromioclavicular joint. There is a small amount of fluid within the subacromial subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is anatomic. There is a small amount of fluid within the joint without evidence of a large effusion. There is intermediate signal intensity within the superior labrum likely representing degeneration and degenerative tearing. Mild osteoarthritis affects the glenohumeral joint.BICEPS TENDON: The tendon of the long head of the biceps appears intact.

Output: Rotator cuff tears and osteoarthritis with other findings as described above.


Instruction: Generate impression based on findings.

Input: History of left breast cancer status post mastectomy. Bilateral implants. Left implant capsular contracture. There is heterogeneous amount of fibroglandular tissue in the right breast. The patient is status post left mastectomy. Bilateral retropectoral silicone implants appear intact, in similar morphology to the prior study.Mild parenchymal enhancement is noted in the right breast.No abnormal enhancement is seen in the right breast or left chest wall. Normal morphology intramammary lymph node adjacent to the lateral aspect of the right implant is stable. No abnormal axillary lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: There are nonspecific foci of T2/FLAIR hyperintensity in the periventricular and subcortical white matter which are favored to represent chronic small vessel ischemic disease. A focus of peripherally increased T2-weighted signal in the left anterior parietal white matter is favored to represent a chronic lacunar infarct. Foci of increased T2 weighted signal in the globi pallidi may be related to prior toxic metabolic or ischemic injury. No evidence of intracranial hemorrhage or acute infarction. There are no extra-axial fluid collections or subdural hematomas. No evidence of intracranial mass, mass effect, or midline shift. There is no abnormal enhancement within the brain. The ventricles and sulci are normal in size. The cerebellar tonsils are normal in position. Flow-voids are present within the major vessels indicating patency. The visualized paranasal sinuses and mastoid air cells are clear. Calvarium and extracranial soft tissues are grossly unremarkable.

Output: 1. No evidence of intracranial metastases.2. Additional chronic findings, including mild chronic small vessel ischemic disease, lacunar infarct in the left anterior parietal white matter and areas of T2 hyperintensity in the globi pallidi, which may be related to remote toxic metabolic or ischemic injury.


Instruction: Generate impression based on findings.

Input: 39 year old with known head and neck cancer, axillary adenopathy, and recent malignant biopsy of the right breast. Mild parenchymal enhancement is noted bilaterally. Scattered fibroglandular tissue is seen.The biopsy proven cancer in the right 10:00 position measures 2.1 x 1.7 x 1.8 cm and contains artifact from the Hydromark biopsy clip. An intramammary lymph node posterior to the mass is of normal size on MRI and had typically normal morphology on ultrasound. There is no significant enhancement near the site of the satellite lesion biopsy. No suspicious enhancement is seen in the left breast. A benign enhancing focus is present in the left outer breast, and has typically benign persistent enhancement when accounting for patient motion.No abnormal axillary lymph nodes are identified in either axillary region. Biopsy clip artifact noted in a left axillary node, obscuring the morphology of that node.

Output: Biopsy proven right breast cancer measures up to 2.1 cm. No new findings requiring additional work up are noted.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: ORBITS: Previously reported slightly prominent T2 hyperintensity surrounding the right optic nerve head and subtle contour abnormality of the inferior aspect of the right globe is noted, however the technical differences between the Lurie and comparison older Comer scans is significant given different MRI vendors and sequences, thus this may be artifactual. There is no associated abnormal enhancement. The optic nerves are otherwise symmetric and normal in size and signal intensity. There is no evidence of intraorbital mass or abnormal enhancement. There is no chiasmatic mass or parasellar abnormality. The extraocular muscles are unremarkable.BRAIN: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is an unchanged punctate focus of T2 hyperintensity within the left frontoparietal deep white matter. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unremarkable.

Output: Previously reported slightly prominent T2 hyperintensity surrounding the right optic nerve head and subtle contour abnormality of the inferior aspect of the right globe is noted, however the technical differences between the Lurie and comparison older Comer scans is significant given different MRI vendors and sequences, thus this may be artifactual. It would be helpful if future imaging could be performed on a single platform to more easily allow for comparison of these subtle findings.


Instruction: Generate impression based on findings.

Input: 70-year-old man with history of Gleason 6 prostate cancer in the right mid gland found on single core in August 2015. Subsequent MRI and biopsy identified Gleason 7 cancer in the right mid gland and right apex. PELVIS:PROSTATE:Prostate Size: 40 x 30 mmPeripheral Zone: Within the lateral right mid gland (1001/14), there is a 7 x 5 mm area of T2 hypointense signal and slight diffusion restriction which abuts the capsule.Central Gland: Enlargement with impression on the bladder base.Seminal Vesicles: Normal in appearance.Extracapsular Extension: NoneBLADDER: No significant abnormality noted.LYMPH NODES: No significant lymphadenopathy noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Focus of signal abnormality in the right lateral mid gland suspicious for adenocarcinoma.


Instruction: Generate impression based on findings.

Input: 71-year-old female with bilateral lumbar plexopathy. Assess for nerve root and lumbar plexus infiltration. There is a levoscoliosis of the lower lumbar spine with apex of curvature at L4. The lumbar spine is in normal sagittal alignment, with a slightly exaggerated lumbar lordosis. There is moderate to severe disc height loss at L4-L5 with a vacuum disc, and mild disc space narrowing at L5-S1. There is disc desiccation from L3-L4 through L5-S1. The vertebral body heights are otherwise well-maintained. Prominent degenerative endplate marrow changes are noted at L4-L5. No worrisome focal marrow signal abnormality is appreciated. There is no pathological enhancement. The distal spinal cord and conus are within normal limits with the conus terminating at the lower L1 level.At L1-L2, there is a small left paracentral to foraminal disc protrusion without spinal canal or neural foraminal stenosis..At L2-L3, there is a minimal disc bulge with significant left far lateral prominence. There is mild left foraminal narrowing. Spinal canal and right neural foramen are patent.At L3-L4, there is a trace disc bulge with left foraminal prominence and central to right paracentral annular fissure.At L4-L5, there is a mild diffuse posterior osteophyte disc complex with minimal narrowing of the lateral recesses and central spinal canal. There is mild to moderate right and minimal left foraminal narrowing.At L5-S1, there is a mild disc bulge without significant spinal canal or neural foraminal stenosis.Linear enhancement within the lumbar spinal canal, axial post gad series 901 image 38, is similar to prior and may represent normal vascular enhancement. No definite enhancement involving the cauda equina nerve roots. There is however abnormal enhancement involving the left L4 nerve root and to a mild degree the left L5 nerve root extraforaminally. These findings are slightly less pronounced than on prior study from 8/30/2016.

Output: 1. Unchanged relatively mild scattered spondylotic disease most prominent at L4-L5 with up to mild central spinal canal stenosis and mild-moderate right foraminal narrowing at this level.2. Abnormal enhancement involving the extraforaminal left L4 and to a lesser degree left L5 nerve roots extra foraminally appear slightly less prominent than on 8/30/2016. Note current study is limited to the lumbar spine. Findings may represent an inflammatory process. Please see comment regarding cauda equina nerve roots above.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Recurrent perianal abscess. PELVIS:UTERUS, ADNEXA: Anteflexed uterus measuring 10.0 x 5.5 cm in the sagittal plane. Small bilateral intramural fibroids are noted. The endometrial cavity/endometrium is normal in thickness. Small cervical nabothian cysts.The parametrial soft tissues are unremarkable. The right and left ovary are normal in morphology and size with small physiologic follicles.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: On the sagittal T2-weighted images there is a very short fluid-filled tract (series 6/26) which likely extends from the 7:00 position of the anal canal. This does not clearly extend to the skin surface or extend through the external sphincter. There is mild soft tissue enhancement and edema near the 7:00 position of the anal canal without a fluid collection to suggest an abscess.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Punctate fluid-filled sinus tract with mild surrounding soft tissue inflammation near the 7:00 position of the anal canal without evidence of extension through the external sphincter, associated abscess or extension to the skin surface.


Instruction: Generate impression based on findings.

Input: 35 years Male (DOB:7/5/1980)Reason: Eval GBM. History: GBM on TMZ.PROVIDER/ATTENDING NAME: RIMAS V. LUKAS RIMAS V. LUKAS The patient has undergone right-sided craniotomy for removal of a right frontal lobe mass. The fluid collection present at the surgical site measuring 55 x 38 mm axial dimensions. It follows spinal fluid on all pulse sequences. The line of the fluid collection has some susceptibility effect. In general this appearance is stableNormal 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: Sagittal right frontal lobe surgery for tumor removal. There is no evidence for local recurrence.


Instruction: Generate impression based on findings.

Input: Diagnosis: SarcoidosisClinical question: osteomyelitisSigns and Symptoms: pain, fever, bacteremia. MRI thoracic spine:The thoracic vertebral bodies are appropriate in the overall alignment and height. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots. There is mild loss of vertebral body height present at T7 associated with T2 signal hyperintensity within the vertebral body. Overall there is approximately 25% loss of vertebral body height. There is associated contrast enhancement adjacent to the superior endplate of a T7. Additionally there is some marrow replacement along the proximal aspect of the right T7 rib and right transverse process associated with adjacent soft tissue infiltration with soft tissue thickening and enhancement following contrast administration along the right paraspinous tissues surrounding the right T7 rib and transverse process and adjacent to the T7 vertebral body into a lesser degree T6 vertebral body and T6-7 disc space. The endplates at the T6-7 disc space are preserved. A recent CT of the chest indicates there is a proximal fracture along the right T7 rib and of the right T7 transverse process present.There is mild loss of vertebral body height at T8, T9, T10 and T11 with hyperintense signal on T1-weighted imaging but not so much on T2 STIR imaging.The patient is status post vertebroplasty at T12. The appearance of the T12 vertebral body is not changed since the 4/13/2015 examLumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment. The conus medullaris on sagittal imaging is grossly intact.The patient is status post vertebroplasty at T12, L1, and L3. Compared to the prior exam of 4/13/2015 there is no significant change in the vertebral body height at these levels. There is redemonstration of a compression fractures at L4 and L5. Signal changes along the superior endplate of L5 include hyperintense T2 STIR signal along the Schmorl's node associated with contrast enhancement. There is redemonstration of bone cement within the epidural venous plexus at the T12, L1 and L3.Along the anterior-inferior aspect of the L2 vertebral body there is low signal on T1 and high signal on T2 STIR associated with contrast enhancement. This measures 17 x 14 mm sagittal dimensions and was previously not present in April. The adjacent endplates are preserved.At L5-S1 there is no significant compromise to spinal canal. There is loss of disc space height and a disc bulge at this level with partial effacement of the fat surrounding the left-sided exiting nerve root within the neural foramen.At L4-5 there is mild loss of disc space height, diffuse disc bulge and bilateral facet hypertrophy and some ligamentum flavum hypertrophy the fat at the lateral recess is not effaced bilaterally. Overall there is mild spinal stenosis at this level.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.Findings the are compatible with acute compression fracture of T7 associated with CT identified adjacent fractures of the proximal aspect of the right T7 rib and right T7 transverse process as well as adjacent inflammatory changes. The possibility of infection cannot be excluded but most likely this is related to reaction to the adjacent fractures. The possibility this is related sarcoid involvement cannot be excluded.2.There is an enhancing lesion present within the L2 vertebral body. This may represent an inflammatory process but is nonspecific. It was not present on the previous exam. One possibility is that this represents sarcoid involvement. The possibility of infection cannot be excluded, though has a somewhat unusual appearance.3.The patient is status post multilevel vertebroplasty.4.There is redemonstration of degenerative changes in the lower lumbar spine with mild spinal stenosis at L4-5 and some encroachment of the left exiting nerve roots at L5-S1. This is stable compared to the prior exam.5.There are multilevel compression fractures in the lumbar spine which appear relatively stable when compared to the prior exam. There is a new Schmorl's node present at L5.6.There are multilevel mild compression fractures in the lower thoracic spine from T7 to T12.


Instruction: Generate impression based on findings.

Input: Small cell lung cancer, initial staging: cough. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is scattered patchy cerebral and pontine 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 major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is a right lens implant.

Output: Findings suggestive of chronic small vessel ischemic white matter disease, but no evidence of intracranial metastases.


Instruction: Generate impression based on findings.

Input: There are innumerable punctate foci of enhancement throughout the supratentorial as well as infratentorial brain, some of which have associated T2 hyperintensity. None of which demonstrate mass effect or associated susceptibility abnormality. There are other foci of T2 hyperintensity are present throughout the white matter, primarily subcortical in location, none of which restrict nor have associated susceptibility abnormality. Redemonstrated is mild diffuse volume loss without a specific lobar predominant atrophy pattern. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. Opacification is noted of aright posterior ethmoid air cell. The mastoid air cells are clear. There is no abnormal enhancement within the brain.

Output: 1.There are innumerable punctate foci of enhancement throughout the supratentorial as well as infratentorial brain, some of which have associated T2 hyperintensity. None of which demonstrate mass effect or associated susceptibility abnormality. These findings are most consistent with metastatic disease.2.Mild chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: 23-year-old female with history of ependymoma in remission presenting with a waxing and weaning of mental status. Redemonstrated are stable changes from previous right suboccipital craniotomy. The fourth ventricle remains dilated similar to the prior examination. No evidence of worrisome signal abnormality or pathologic enhancement is detected the posterior fossa or elsewhere in the brain. Diffusion weighted images are normal. Cerebral morphology and signal characteristics are unremarkable. The supratentorial ventricular system is stable and normal in size. No abnormal fluid collections are detected. Expected vascular flow voids are demonstrated. The paranasal sinuses and mastoid air cells are clear.

Output: 1.No evidence of recurrent tumor in the brain.2.No MRI evidence of acute intracranial pathology to explain the patient's symptoms.


Instruction: Generate impression based on findings.

Input: Male, 73 years old, with burning sensation in the buttocks, evaluate for possible syrinx in the lower thoracic area. Prominence of the central canal of the spinal cord is seen affecting much of the thoracic spinal cord albeit discontiguously. The canal becomes most prominent at the T10 level where it measures 2 x 1 mm in the axial plane. The spinal cord is otherwise unremarkable. No epidural abnormalities are suspected.There is a scoliotic curvature of the thoracic spine. Sagittal alignment, however, is within normal limits. Vertebral body heights are preserved. A few scattered Schmorl's nodes are seen. No pathologic marrow replacement or marrow edema is detected. Very mild disc degenerative findings are seen. No significant spinal canal or foraminal stenosis is evident.

Output: The central canal of the spinal cord is discontinuously prominent through much of the thoracic region, potentially representing syringohydromyelia. No other specific abnormalities are detected which would account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: History of sinus surgery with concern for CSF leak sphenoid: previous CT showed dehiscence sphenoid roof and floor. There is low T1 and T2 signal material in the right sphenoid sinus with surrounding mild diffuse mucosal enhancement. There are dehiscences of the right sphenoid sinus walls, which are better depicted on the prior CT. However, there is no evidence of intracranial extension of the sinus contents. There is also mild diffuse mucosal thickening in the right maxillary sinus, which contains secretions. There is trace mucosal thickening in the left frontal and bilateral ethmoid sinuses. The orbits and intracranial structures are unremarkable.

Output: The right sphenoid sinus abnormality may represent chronic sinusitis, perhaps with a superimposed chronic allergic fungal component. Dehiscences of the right sphenoid sinus walls are better depicted on the prior CT, but there is no evidence of intracranial extension of the sinus contents.


Instruction: Generate impression based on findings.

Input: Lateral knee arthritis MENISCI: The medial meniscus is unremarkable. There is some lateral extrusion of the lateral meniscus but no discrete tears.ARTICULAR CARTILAGE AND BONE: There is some generalized thinning of the articular cartilage of the lateral plateau. No focal abnormalities..LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Bone marrow edema and subchondral cysts in the lateral plateau with generalized thinning of the articular cartilage


Instruction: Generate impression based on findings.

Input: Male, 46 years old, with abnormal brain vasculature noted on prior MRI. Evaluate for any aneurysms. History of multiple sclerosis. The caliber of the visualized right ICA is uniformly small. As best as can be determined on MRI, it appears that the bony carotid canal is proportionately and uniformly small as well. The right MCA originates from the basilar artery, an anatomic variation. The right A1 segment is not visualized and the right ACA is supplied through the ACOM artery. No aneurysm or vascular malformation is seen. No other areas of significant vascular stenosis or occlusion are detected.

Output: Findings are seen most compatible with congenital hypoplasia of the right ICA and basilar origin of the right MCA. No aneurysm or vascular malformation is seen.


Instruction: Generate impression based on findings.

Input: Diagnosis: Seroma versus abscess in a patient with prior history of multiple cranial infections at the craniotomy site. MRI shows a fluid collection at the anterior aspect of the craniotomy site. Please aspirate and culture.Clinical question: s/p craniotomy on 6/4 now with MRI evidence of fluid collection; evaluate fluid collection Serial CT images obtained during the aspiration procedure demonstrate the needle placement within the fluid collection. Following needle removal images obtained demonstrate no complications . Air was present in the remaining cavity which was aspirated subsequently. The patient is status post left craniectomy with bone graft placement and myocutaneous free flap placement. There is encephalomalacia along the left frontal lobe and left parietal lobe.

Output: Left craniotomy site collection aspiration under CT guidance. Two mL clear straw colored fluid was aspirated from the fluid collection.


Instruction: Generate impression based on findings.

Input: 54-year-old male with history of rectal cancer status post chemoradiation. Evaluate for evidence of disease. PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant interval change in the very low T2-weighted signal intensity affecting the anterior aspect of the distal rectum favoring posttreatment-related scarring. The signal abnormality again is noted to abut the posterior to the prostate. No measurable intermediate T2 signal weighted intensity, restricted diffusion, or abnormal enhancement to suggest residual disease.BONES, SOFT TISSUES: No mesorectal lymphadenopathy. Bilateral fat-containing internal hernias.OTHER: No significant abnormality noted.

Output: Stable posttreatment related residual scarring/fibrosis at the anterior rectum without measurable disease. No suspicious pelvic lymphadenopathy.


Instruction: Generate impression based on findings.

Input: 38-year-old male with small perianal abscess. PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant lymphadenopathy; scattered subcentimeter lymph nodes noted.BOWEL, MESENTERY: A left 3 o'clock position perianal fistula extending to the left and bifurcating extending both superiorly and inferiorly. Inferiorly, the fistula extends to the left gluteal crease. Superiorly, the tract extends to the left pelvic sling muscle, possibly puborectalis muscle, with thickening and high T2 edema type signal. The tract dilates up to 8 mm in width. The tracts together measure 9 cm when measuring from the inferior gluteal fold to pelvic sling musculature. Slightly more superiorly (series 501, image 27) is another sinus tract at the 2 o'clock position extending to the left pelvic muscle measuring 2 cm in length and 7 mm in width (image 28). Status post J-pouch creation with stool noted in the J-pouch. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Minimally complex fistulous and sinus perianal tracts as described above. Small collections measuring less than 1 cm in width.


Instruction: Generate impression based on findings.

Input: 67-year-old man with history of asymmetric right sensorineural hearing loss, tinnitus, and dizziness. The bilateral cranial nerve 7 and 8 complexes are intact. The inner ear structures are normal bilaterally. There is no mass or abnormal enhancement within the temporal bones cerebellopontine angle cisterns bilaterally. There are scattered foci of T2 hyperintensity in the imaged portions of the cerebral white matter. There is a subcentimeter hippocampal sulcus remnant cyst.

Output: No evidence of inner ear retrocochlear lesions. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: There has been near complete resolution of right frontal/parietal extra-axial collection with minimal residual collection still present measuring up to 3 mm on series 701 image 14 without significant mass effect. There is no acute infarct, mass effect or midline shift. There is mild periventricular and subcortical white matter T2 signal abnormality which is nonspecific, likely representing chronic microvascular ischemic changes. There is mild diffuse volume loss which is slightly asymmetrically prominent in the left frontal and parietal lobe. There is no hydrocephalus. There is mild bilateral maxillary, scattered ethmoid and trace right mastoid mucosal thickening. There is a right frontal/parietal burr hole.

Output: 1.Mild chronic microvessel ischemic changes with no acute infarct.2.Near complete resolution with 3-mm thick residual right frontal/parietal extra-axial collection.3.Mild diffuse volume loss which is slightly asymmetrically prominent in the left frontal and parietal lobes.


Instruction: Generate impression based on findings.

Input: Male, 53 years old, with seizures. Numerous scattered small foci of T2 hyperintensity are identified within the subcortical and periventricular white matter as well as the basal ganglia, thalami and brainstem. Many of these lesions are hypointense on FLAIR and T1-weighted images which suggests tissue loss.No evidence of parenchymal edema or mass effect is seen. No restricted diffusion is detected. No large intracranial hemorrhages or abnormal extra axial fluid collections are detected. The ventricles and sulci are mildly prominent compatible with generalized parenchymal volume loss, but are otherwise unremarkable.

Output: 1. Numerous scattered small white matter lesions are identified in the cerebral hemispheres bilaterally. These most likely represent chronic microvascular ischemic lesions, though a complete differential would include the sequelae of demyelinating or vasculitic diseases as well as sequelae of prior inflammation.2. No evidence of acute intracranial abnormality is seen. No mass, edema or other additional specific finding is seen to account for the patient's seizures.