Instruction: Generate impression based on findings.

Input: Urinary retention, paresthesias, and fatigue. The spinal cord displays normal signal. There is central posterior disc-osteophyte complex at C5-6, which abuts the spinal cord. There is focal thickening of the ligamentum flavum at multiple levels of the lower thoracic spine, which mildly narrow the spinal canal, but do not impinge upon the spinal cord. The vertebral column alignment is within normal limits. There is no evidence of enhancing mass lesions in the cervical or thoracic spine. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. The paravertebral soft tissues are unremarkable. There is a nodule in the right thyroid lobe, which measures up to 18 mm. There is a retention cyst in the left maxillary sinus. The imaged intracranial structures are unremarkable.

Output: 1. No evidence of demyelinating lesions in the cervical and thoracic spinal cord.2. A central posterior disc-osteophyte complex at C5-6 abuts the spinal cord. 3. Focal thickening of the ligamentum flavum at multiple levels of the lower thoracic spine, which mildly narrow the spinal canal, but do not impinge upon the spinal cord. 4. Nonspecific nodule in the right thyroid lobe, which measures up to 18 mm. A thyroid ultrasound may be useful for further evaluation.


Instruction: Generate impression based on findings.

Input: Reason: Elevated PSA, evalaute for Prostate cancer History: see aboveBiopsy 6/17/2014: Right mid small focus of atypical glands, target lesion negative.Biopsy 3/4/2013: Left posterior apex Gleason 6, 1.5 mm.PSA: 2.01 PELVIS:PROSTATE:Prostate Size: 5.0 x 2.5 x 3.6 cmPeripheral Zone: There is a small focus (804/244) of linear low ADC signal and enhancement in the left posterior apex seen previously which is suspected to represent a vessel. In the surrounding left apex peripheral zone, there is a 1.5 x 1.2 cm (1401/1210) region of early enhancement without associated abnormal T2/ADC signal.Central Gland: BPH nodules and urethral thickening.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: No evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Focus of early enhancement in the left apex peripheral zone without associated abnormal ADC/T2 signal is indeterminate.


Instruction: Generate impression based on findings.

Input: 75 years, Male, mild episodic dizziness, memory loss and lightheadedness. Evaluate for degenerative condition. No intracranial mass or mass effect. There is no restricted diffusion to suggest acute ischemia. There is no intracranial hemorrhage. The ventricles are within normal limits in size and configuration. Few foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with minimal chronic small vessel ischemic changes. Brain parenchyma is otherwise unremarkable for age. No disproportional volume loss involving the hippocampi. No abnormal parenchymal or meningeal enhancement. Major flow-voids are preservedThere are minimal retained secretions within the left sphenoid sinus. Within the right frontal bone there is an enhancing slightly tubular 0.8 x 0.7 cm lesion without mass effect on the intra-orbital structures. Bone marrow signal and extracranial soft tissues are otherwise within normal limits.

Output: 1.No intracranial mass or mass effect. No abnormal parenchymal or meningeal enhancement. There is mild global parenchymal volume loss, which appears appropriate for age. Minimal chronic small vessel ischemic changes.2.Incidentally seen is a subcentimeter slightly tubular, enhancing right frontal/supraorbital osseous lesion which may represent a benign entity suggest varix or small nerve sheath tumor for example but nonspecific. Finding is of doubtful clinical significance.


Instruction: Generate impression based on findings.

Input: There are grossly unchanged mild cervical spine degenerative changes with disc osteophyte complexes at C3 through C7 without significant spinal canal stenosis. There are minimal degenerative changes throughout the thoracic and lumbar spine without spinal canal stenosis. New thin linear T2 hyperintensity throughout the central spinal cord is likely artifactual. The spinal cord otherwise displays normal signal and morphology with the conus terminating at T12. The vertebral column alignment is within normal limits. The vertebral body heights are preserved. The vertebral bone marrow signal is unremarkable. The paravertebral soft tissues are unremarkable.

Output: 1.No acute spinal cord compression.2.Mild cervical spine degenerative changes and minimal thoracic and lumbar spine degenerative changes.


Instruction: Generate impression based on findings.

Input: Chronic meningoencephalitis, neoplasm, vasculitis. Persistent bilateral lower extremity weakness and encephalopathy of unclear etiology. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are extensive areas of abnormal T2 hyperintensity within the periventricular and subcortical white matter, a few of which are increased in size or new, notably in the left temporal lobe and posterior limbs of the bilateral internal capsules. There are similar signal changes in bilateral basal ganglia and bilateral paramedian pons to a lesser degree. There is no abnormal parenchymal or leptomeningeal enhancement. There is an apparent prior right transfrontal surgical track with linear susceptibility effect. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. There is a nonspecific peripherally enhancing 6 mm nodule in the right temporal subcutaneous tissues, which is unchanged from 11/17/2014. There are multiple prominent occipital arachnoid granulations. There is a right posterior frontal burr hole. There is a mucous retention cyst in the right maxillary sinus.

Output: 1. No evidence of acute intracranial hemorrhage, mass, brain abscess, or acute cerebral infarct.2. Extensive areas of abnormal signal in the cerebral white matter are non-specific, but may represent chronic small vessel ischemic disease. 3. A nonspecific subcentimeter nodule in the right temporal subcutaneous tissues is unchanged.


Instruction: Generate impression based on findings.

Input: 58-year-old male with left shoulder pain and weakness. Assess for rotator cuff injury or other pathology. Suboptimal examination secondary to patient motion artifact.ROTATOR CUFF: There is a full-thickness tear of the posterior fibers of the supraspinatus tendon measuring approximately 11 mm in the AP dimension with minimal retraction and delamination of the undersurface fibers. There is thickening and increased intermediate signal abnormality affecting the supraspinatus consistent with mild tendinosis. The supraspinatus muscle appears intact. The infraspinatus muscle and tendon appear intact. The teres minor and subscapularis muscles and tendons appear intact.SUPRASPINATUS OUTLET: There is a small amount of fluid within the subacromial subdeltoid bursa. Mild degenerative changes affect the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is a small amount of fluid within the glenohumeral joint without evidence of a large effusion. Suboptimal evaluation of the glenoid labrum secondary to extensive motion artifact on this non arthrogram study.BICEPS TENDON: There is a small amount of fluid within the tendon sheath of the long head of the biceps which may reflect fluid extension from the glenohumeral joint. ADDITIONAL

Output: Full-thickness tear of the rotator cuff and other findings as described above.


Instruction: Generate impression based on findings.

Input: Juvenile pilocytic astrocytoma status post resection and induction chemotherapy. There are post-treatment findings in the posterior fossa. The tumor arising from the right cerebellar hemisphere and brainstem with encasement of the basilar artery and right 7th and 8th cranial nerves appears to have slightly decreased in size, measuring 21 x 34 mm, previously 24 x 36 mm. There is no evidence of acute infarct. There is a right transparietal ventriculostomy catheter in unchanged in position. However, the lateral ventricles appear to be slightly smaller in size, now virtually collapsed. The other portions of the ventricular system appear to be unchanged. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues appear unchanged.

Output: Apparent slight interval decrease in size of the treated posterior fossa juvenile pilocystic astrocytoma.


Instruction: Generate impression based on findings.

Input: MRI Brain:There are multiple scattered areas of restricted diffusion in the right posterior frontal, right parietal, and right occipital lobes, with associated FLAIR signal abnormality compatible with acute infarcts. Foci of infarcts include the right lateral aspect of the right precentral gyrus. There are multiple additional patchy foci of FLAIR hyperintensity in the bilateral periventricular and subcortical white matter which are nonspecific but compatible with mild to moderate chronic small vessel ischemic disease. There is susceptibility effect in the left posterior frontal corona radiata likely representing a prior infarct with chronic blood products. There are additional few scattered punctate foci of susceptibility consistent with chronic microhemorrhages, suboptimally imaged due to motion degradation.There is no significant mass effect, midline shift, or herniation. The ventricles and basal cisterns are normal in size and configuration. There is suggestion of a prior right frontal burr hole craniotomy. There is moderate opacification of the anterior and posterior ethmoid air cells bilaterally.MRA Brain: There is a 1 cm segment of severe stenosis involving the right M1 segment. Evaluation of the remainder of the intracranial arteries is limited secondary to motion degradation. Within these limitations, there is moderate atherosclerotic narrowing affecting the bilateral cavernous portions of the ICAs. The remainder of the ICAs, MCAs or ACAs demonstrate no high-grade stenosis. The right V4 segment is not visible and may be occluded. There is mild to moderate multifocal irregularity involving the left distal vertebral, basilar, and left greater than right posterior cerebral arteries with motion degradation limiting detailed assessment. This study is not adequate to evaluate for small aneurysms. No aneurysm is appreciable within this limitation.

Output: 1.Multiple small acute infarcts in the right posterior frontal, right parietal, and right occipital lobes.2.Severe 1 cm segment high-grade stenosis involving the right M1 segment. There is also at least moderate degree of stenosis involving the bilateral cavernous internal carotid arteries. There is also suspected occlusion of the right distal vertebral artery.3.The remainder of the posterior intracranial circulation also demonstrates scattered multifocal irregularity likely related to atherosclerotic disease with motion degradation limiting optimal assessment. Repeat study at 3T with sedation or CTA can be considered as clinically warranted.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Knee pain following injury MENISCI: There is blunting of the inner free edge of the medial meniscus which may represent small tearing of the inner free edge. The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is extensive full-thickness cartilage loss of the medial compartment with severe degenerative cystic changes in the underlying femoral condyle. Extensive marrow edema also affects the medial femoral condyle particularly posteriorly. No discrete fracture line is appreciated.There is mild diffuse thinning of the articular cartilage of the lateral compartment. The underlying marrow signal is normal.There is full-thickness cartilage loss in the medial patellar facet with underlying subchondral cystic change. This is superimposed upon moderate diffuse cartilage thinning.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1. Severe osteoarthritis and cartilage loss of the medial compartment with extensive subchondral cystic change and marrow edema which may a combination of reactive marrow changes and bony contusion. A discrete fracture line is not visualized.2. Additional moderate to severe cartilage loss in the patellar compartment with milder changes of cartilage loss in the lateral compartment.3. Blunting of the inner free edge of the medial meniscus suggesting free edge tearing/brain.


Instruction: Generate impression based on findings.

Input: Other symptoms and signs involving cognitive functions and awareness [R41.89], Reason for Study: ^Reason: mild cognitive impairment - assess for volume loss or CVD History: mild memory problems There is about 10.3mm sized well circumscribed high T1, low T1 lesion on the right parapharyngeal space adjacent to the deep lobe of the right parotid gland. There is no other space occupying lesion seen on this scan. No evidence of lymph node enlargement. Diagnostic possibility of this lesion include minor salivary gland mass or could be an extension of the deep lobe of the right parotid gland benign looking mass lesion such as pleomorphic adenoma. There is no evidence of acute ischemic or hemorrhagic lesion.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no intracranial mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. 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: 1. Extracranial well circumscribed lesion on the right parapharyngeal space. Benign salivary gland mass such as pleomorphic adenoma can be a possibility from either minor salivary gland or extension of the deep lobe of the right parotid gland origin. Either Neck CT scan or Neck MRI with and without contrast enhancement can be considered for further imaging evaluation if clinically indicated.2. No evidence of acute ischemic or hemorrhagic lesion on this scan.


Instruction: Generate impression based on findings.

Input: Medial knee pain MENISCI: There is horizontally oriented increased signal within the anterior horn of the medial meniscus although this does not appear to extend to either articular surface. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: Mild degenerative cystic changes are noted in the tibial plateau below the region of the anterior horn of the medial meniscus. The articular cartilage of the patellofemoral, lateral, and medial compartments is preserved.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Degenerative change of the medial meniscus without discrete tearing. The knee otherwise appears intact.


Instruction: Generate impression based on findings.

Input: 29-year-old male. Rule out small bowel Crohn's disease. History of perianal disease. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No hydronephrosis. Subcentimeter cyst of the left upper renal pole.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No wall thickening or abnormal wall enhancement. No evidence for stricture, fistula, or intra-abdominal drainable fluid collection.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No wall thickening or abnormal wall enhancement. No evidence for stricture, fistula, or intra-abdominal drainable fluid collection.BONES, SOFT TISSUES: Midline posterior soft tissue defect at the level of the lower sacrum at the level of the prior subcutaneous abscess (axial series 14 image 62).OTHER: No significant abnormality noted.

Output: 1.No evidence for active intra-abdominal Crohn's disease.2.Interval drainage of the posterior midline subcutaneous abscess at the level of the lower sacrum, now with a soft tissue defect.


Instruction: Generate impression based on findings.

Input: 46-year-old female with menorrhagia. Evaluate for uterine fibroids/preimaging prior to UFE. PELVIS:UTERUS, ADNEXA: The uterus measures 18.1 cm in length, 9.1 cm in AP, and 11.9 cm in transverse diameter. The enlarged uterus contains multiple T2 hypointense lesions compatible with fibroids. The largest fibroid is located in the uterine fundus, distorts the endometrial cavity, measures 5.7 x 5.1 cm (series 5 image 19), and is likely submucosal in location. Uterine fibroid enhancement is noted.Incidentally noted are multiple Nabothian cysts and a prominent posterior Bartholin cyst (sagittal series 7 image 22).BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Enlarged uterus containing multiple fibroids with reference measurements listed above.


Instruction: Generate impression based on findings.

Input: Reason: Cognitive decline following cardiac surgery History: memory impairment and visuospatial difficulty. There is mild prominence of the ventricles as well as sulcal prominence predominantly involving the perirolandic areas and parietal lobes with relative sparing of the occipital and temporal lobes. The basal cisterns remain patent. There is no midline shift or mass effect. There are several punctate foci of increased T2/FLAIR signal within the subcortical and periventricular white matter which are nonspecific but compatible with minimal chronic small vessel ischemic changes. There is no diffusion abnormality. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is trace mucosal thickening within the paranasal sinuses. The mastoid air cells are clear.

Output: 1.No evidence of acute intracranial hemorrhage, mass, or acute infarct.2.Mild brain atrophy localized to the perirolandic regions and parietal lobes with sparing of the remainder of the brain parenchyma which is nonspecific, however, corticobasal degeneration has been reported to present in a similar fashion.3.Minimal chronic small vessel ischemic changes.


Instruction: Generate impression based on findings.

Input: The risks (including, but not limited to, those of bleeding, infection, allergic reaction, temporary nerve block, pain, and inability to access the joint) and benefits of the procedure were explained to the patient, and informed written consent was obtained. A pre-procedural “time-out” form was completed.The patient was placed supine on the fluoroscopy table. The left hip was localized fluoroscopically, and a spot radiograph was obtained. The course of the femoral artery was noted on the patient's skin using an ink marker. The skin was cleansed and covered with a sterile drape. The skin and subcutaneous tissues were anesthetized with 1% lidocaine using 25-gauge and 22-gauge needles.Under fluoroscopic guidance, a 20-gauge spinal needle was advanced into the joint. Attempted aspiration yielded no fluid. Next, 15 cc of a 50/50 mixture of Omnipaque 240 (to confirm the intra-articular position of the needle) and dilute Multihance (0.1 cc in a 10 cc vial of saline, for subsequent MR imaging) were injected into the joint. Contrast opacified the joint in the expected manner. A spot radiograph was obtained for documentation. The needle was withdrawn. Blood loss was negligible (<1cc), and patient tolerated the procedure well without immediate complication. An adhesive bandage was placed on the patient’s skin. Routine post procedure instructions were communicated to the patient. The patient was escorted to the MRI suite for further imaging in stable condition. Please refer to the subsequent MRI report for further information.Exposure time: 18 seconds

Output: Successful left hip injection.


Instruction: Generate impression based on findings.

Input: Diagnosis: Altered mental status, unspecifiedClinical question: r/o blood vessel irregularitySigns and Symptoms: nausea; lightheadedness 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.A couple subcortical punctate T2 and FLAIR signal hyperintensities in the subcortical white matter of the left frontal lobe and left parietal lobe are probably of little clinical relevance given their small number and common occurrence in the general population.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: MRI of the brain is within normal limits. There is no evidence for intracranial mass lesion or acute ischemic cerebral infarction.


Instruction: Generate impression based on findings.

Input: Prominent extrahepatic biliary ducts and pancreatic duct seen on recent CT, evaluate for biliary obstruction. ABDOMEN:LIVER, BILIARY TRACT: The liver demonstrates normal parenchymal signal. A few cysts are present within the posterior right hepatic lobe measuring less than 5 mm. An additional 6 mm cyst is present within segment 1. No suspicious focal hepatic lesions are identified. The gallbladder is within normal limits without cholelithiasis. There is no intrahepatic biliary ductal dilatation. The common bile duct is mildly prominent in caliber measuring up to 5 mm. There is short segment of mild, smooth narrowing of the distal most common bile duct just proximal to the ampulla (series 801, image 82). There are no visualized discrete masses or signal abnormalities associated with the narrowing.SPLEEN: No significant abnormality noted.PANCREAS: The pancreas demonstrates normal parenchymal signal intensity. The pancreatic duct is mildly prominent most pronounced in the pancreatic head where measures 5 mm. No obstructing lesions or stones are identified.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small mesenteric lymph nodes as well as haziness and nodularity of the peritoneum within the left lower quadrant are again identified appearing similar to recent CT.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Minimal prominence of the pancreatic duct measuring up to 5 mm without obstructing stones or lesion identified.2.Mild prominence of the common bile duct which may be due to short segment distal common bile duct stricture/stenosis.3.Ampullary stenosis or lesion is not seen but is not entirely excluded and could be further evaluated with ERCP if clinically warranted.4.Peritoneal haziness and nodularity as seen on 12/3/2015 CT and which could be seen with peritoneal carcinomatosis, recommend correlation with tumor markers.


Instruction: Generate impression based on findings.

Input: 9-year-old female patient with possible meniscal pathology/discoid meniscus. MENISCI: The lateral meniscus and the medial meniscus are intact and are normal in morphology.ARTICULAR CARTILAGE AND BONE: There are no fluid-filled focal cartilage defects. The sclerotic focus in the patella seen on prior radiograph correlates to a focus of low T1 and T2 signal intensity, compatible with a bone island.LIGAMENTS: The anterior cruciate ligament, posterior cruciate ligament, medial collateral ligament, lateral collateral ligament complex, and patellar retinacula are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: No meniscal pathology or other findings to account for patient's pain.


Instruction: Generate impression based on findings.

Input: Abnormal gait with flexed posture at the hip and right leg pain. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is maintained. There are small Schmorl's nodes involving the endplates from the T11-L4 levels. There is severe disc height loss at the L3-L4 level with associated fatty endplate marrow signal changes. There is also disc height loss with suggestion of vacuum phenomena at the L5-S1 level. Bone marrow signal is benign. The conus medullaris is normal in position.Multilevel degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis. There is bilateral facet arthropathy.L3-L4: There is a mild disc bulge, moderate bilateral facet arthropathy and ligamentum flavum thickening which contribute to mild to moderate central spinal canal stenosis. There is also mild to moderate right and mild left neural foraminal stenosis.L4-L5: Severe disc height loss and bilateral facet arthropathy. Partial effacement of the lateral recesses and minimal narrowing of the central spinal canal. There is moderate bilateral neural foraminal stenosis.L5-S1: Disc desiccation with suggestion of vacuum phenomena. Advanced bilateral facet arthropathy. There is no significant spinal canal stenosis. There is moderate left and mild right neural foraminal stenosis.Paraspinous soft tissues are within normal limits. There are cysts in the kidneys bilaterally.

Output: Multilevel degenerative changes in the lumbar spine. There is up to mild to moderate spinal canal stenosis at the L4-L5 level. No high-grade spinal canal stenosis. Multilevel neural foraminal stenoses, worst at the bilateral L4-L5 levels. Additional details as above.


Instruction: Generate impression based on findings.

Input: Reason: 85 yo F h/o with prior head CT from UIC which revealed a "shadow" in her brain that she decided to call "tumor," presenting with new onset R arm and leg paresthesias MRI of the brain: Left middle frontal gyrus hypoattenuation seen on prior CT is without diffusion restriction and increased T2/FLAIR signal compatible with chronic ischemic injury. Left occipital lobe and splenium of the corpus callosum with T2/FLAIR hyperintensity also compatible with chronic ischemic injury. There are additional scattered subcortical and periventricular white matter T2/FLAIR hyperintensities compatible with chronic small vessel ischemic disease.No acute intracranial hemorrhage. No mass, mass effect, or midline shift. Scattered foci of susceptibility artifact compatible with mineral deposition or microhemorrhages. No abnormal enhancement.MRA of the brain: Normal contrast opacification is present throughout the anterior and posterior circulation. Bilateral fetal PCAs with prominent right posterior communicating artery are noted. No significant narrowing, aneurysm, or dissection of the vasculatures. Superficial and deep intracranial venous drainage is unremarkable.MRA of the neck: Conventional anatomy of the aortic arch. Probable critical stenosis at the origin of the left vertebral artery. Tortuosity and incomplete band like signal intensity at the proximal right subclavian artery which cause about 50% of luminal stenosis. This could represent atherosclerotic luminal stenosis but could also simply reflect tortuosity of the artery. Common carotid arteries are patent. There is irregularity of the left distal common carotid artery and carotid bulb without significant stenosis.

Output: 1.Chronic ischemic changes involving left frontal lobe, left occipital lobe and left side corpus callosum splenium.2. Underlying non specific small vessel ischemic disease.3. Probable critical stenosis of the left vertebral artery origin. CT angiogram may be pursued for further imaging evaluation if clinically indicated.4. Tortuosity and possible approximately 50% stenosis of the right proximal subclavian artery as described above.


Instruction: Generate impression based on findings.

Input: Reason: evaluate labrum History: chronic instability ROTATOR CUFF: No significant abnormality noted.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: No significant abnormality noted.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: Normal MRI of the left shoulder.


Instruction: Generate impression based on findings.

Input: Persistent GBS bacteremia. Some of the sequences are degraded by patient motion. There is no evidence of intracranial abscess, hemorrhage, mass, or acute infarct. There is a subcentimeter subependymal cyst in the right caudothalamic groove. The brain parenchyma otherwise appears unremarkable and the degree of myelination appears to be appropriate for age. There is no gross evidence of abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size. There is no midline shift or herniation. The major cerebral flow voids are grossly intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. No evidence of intracranial abscess.2. Subcentimeter subependymal cyst in the right caudothalamic groove.


Instruction: Generate impression based on findings.

Input: Ms. Weiner is a 45-year-old woman with a personal history of right breast IDC/DCIS status post lumpectomy in November 20, 2012. Patient received adjuvant radiation and chemotherapy. No current breast related complaints. There is extreme amount of fibroglandular tissue in both breasts with minimal background parenchymal enhancement.Stable postsurgical changes are present within the right lower outer breast. In addition, there is a stable benign morphology mass in the left lower outer breast. No abnormal enhancement is identified in either breast. No abnormal axillary lymph nodes are identified. Postsurgical changes are noted within the right axilla.

Output: No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Routine Diagnostic Mammogram.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Female 41 years old Reason: hip pain, avn History: pain ACETABULAR LABRUM: Acetabular labrum is grossly intact on this nonarthrographic examination.ARTICULAR CARTILAGE AND BONE: There is serpiginous low T1 signal in the right femoral head compatible with avascular necrosis. There is also similar appearing signal in the left femoral head seen on large field of view. There is minimal corresponding T2 hyperintense signal.SOFT TISSUES: Fatty atrophy of the gluteus muscles bilaterally. ADDITIONAL

Output: Findings compatible with bilateral femoral head avascular necrosis.


Instruction: Generate impression based on findings.

Input: 63-year-old female with history of osteoporosis present with midline lumbar spine tenderness to palpation, evaluate for repeat fracture Evaluation is limited due to severe osteoporosis and inability to optimally position the patient. There are compression fractures of all lumbar vertebrae that appear comparable to those seen on outside MRI on May 22, 2014 given differences in technique between the two exams. Compression fractures of several lower thoracic vertebrae also appear similar to prior MRI. Degenerative changes of the disc and facet joints are better seen on prior MRI. Components of total hip arthroplasty are incompletely imaged on this lumbar spine study but appear similar to prior radiograph.

Output: Limited study due to severe osteoporosis and inability to optimally position the patient. Multilevel compression fractures and degenerative arthritic changes appear similar to prior studies.


Instruction: Generate impression based on findings.

Input: Reason: Patient with UC and cirrhosis, evaluate for PSC and HCC. Liver protocol MRI History: Evaluate for PSC and HCC ABDOMEN:LIVER, BILIARY TRACT: The intrahepatic biliary ducts are again mildly irregular, not significantly changed from the prior study. No dominant stricture is identified. Segment 6/7 T2 hyperintense liver lesion again compatible with a hemangioma and also unchanged from the prior study. No suspicious liver lesion identified.Cholelithiasis is present without complication.SPLEEN: Accessory spleens are noted inferior to the spleen.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: Small hiatal hernia is noted.BONES, SOFT TISSUES: T2 hyperintense nonenhancing lesion in the anterior pericardial fat may represent a pericardial cyst and is unchanged.

Output: Mildly irregular intrahepatic biliary ducts may be due to primary sclerosing cholangitis given the patient's history, however no dominant stricture or suspicious liver lesion is identified.


Instruction: Generate impression based on findings.

Input: Clinical question: Chiari malformation 1 found on Brain MRI now checking spine to look for other anomaliesSigns and Symptoms: check for anomalies Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. The cerebellar tonsils extend approximately 8 mm below the level of the foramen magnum.No abnormal enhancing lesions are identified in the cervical spine.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.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. No abnormal enhancing lesions are identified in the thoracic spine.Lumbar spine: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.No abnormal enhancing lesions are identified in the lumbar spine.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is no significant compromise to spinal canal or neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.No abnormal lesions are identified in the cervical spinal cord, the thoracic spinal cord or the lumbar spinal cord. There is no evidence for a syrinx.2.There is Chiari I malformation present.


Instruction: Generate impression based on findings.

Input: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is minimal nonspecific periventricular white matter T2 hyperintensity. The brain parenchyma otherwise appears unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. However, there is what appears to be a partially-imaged medial course of a prominent left vertebral artery or vein at the level of C2, where the vessel appears to indent the vertebral body. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. Minimal nonspecific periventricular white matter signal abnormality, which may represent chronic ischemic effects, but no evidence of acute cerebral infarction.2. Partially-imaged medial course of a prominent left vertebral artery or vein at the level of C2, which may be an anatomic variant, although dedicated vascular imaging of this region may be helpful for further clarification.


Instruction: Generate impression based on findings.

Input: Female, 66 years old. Reason: thyroid nodules RIGHT LOBE MEASUREMENTS: 5.0 x 2.9 x 2.7 cmLEFT LOBE MEASUREMENTS: 4.8 x 3.2 x 2.6 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: Heterogeneous echotexture. A solid, heterogeneous nodule in the mid to lower right lobe measures 3.5 x 2.3 x 2 .5 cm, unchanged, noncalcified, non-vascular.LEFT LOBE: Heterogeneous echotexture. A predominantly solid, heterogeneous, hypoechoic nodule in the mid to lower left lobe measures 3.4 x 2.1 x 2 .7 cm, unchanged, noncalcified, nonvascular.ISTHMUS: Heterogeneous echotexture.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Bilateral thyroid nodules, unchanged.


Instruction: Generate impression based on findings.

Input: 43-year-old woman with history of multiple sclerosis and paresthesias, evaluate for progression. Very few scattered punctate T-2/FLAIR hyperintense white matter lesions are seen in the subcortical white matter (401/29, 49, 59). These appear stable from the prior examination in 2012. No new suspicious foci of FLAIR signal abnormality are identified.There is no intracranial mass, hemorrhage, or edema. Flow-voids of the major intracranial vasculature are patent.Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: Stable examination with a few, scattered punctate white matter lesions. No evidence of progressive demyelination.


Instruction: Generate impression based on findings.

Input: GBM status post RT. Evaluate for change. Redemonstrated is a large periventricular mass with asymmetric lobular and thick rim enhancement centered at the posterior horn of the left lateral ventricle. This lesion also infiltrates the splenium of the corpus callosum, partially crossing to the contralateral side. This mass measures 5.2 x 7.2 cm (series 14, image 12) compared to 3.5 x 5.1 cm previously and has increased significantly compared to the previous exam. rCBV mapping demonstrates increased blood volume involving the thicker enhancing portions of the mass which lends further evidence of tumor progression. There is also new abnormal enhancement tracking along the ependymal region of the temporal horn of the left lateral ventricle as well as the body of the left lateral ventricle. The temporal horn of the left lateral ventricle is entrapped but unchanged compared to the previous exam. An additional focus of abnormal signal is visualized within the right middle frontal gyrus which is unchanged from prior. This may represent a additional site of discontiguous disease. There is surrounding extensive vasogenic edema which causes significant mass effect on the occipital horn of the left lateral ventricle and results in 6 mm of rightward midline shift. There is also extensive vasogenic edema in the adjacent parenchyma both ipsilaterally and to some extent contralaterally, which has increased compared to the previous exam and contributes to the midline shift. The major cerebral flow voids are intact. The orbits, skull and scalp soft tissues are grossly unremarkable. There is mild mucosal thickening of the right maxillary sinus.

Output: Enhancing and infiltrating periventricular mass centered at the occipital horn of the left lateral ventricle with spread along the splenium of the corpus callosum to the contralateral side showing significant increase in size compared to previous exam. There is extensive surrounding parenchymal vasogenic edema which has also increased in the interim. There is also new ependymal enhancement along the left temporal horn and body of the left lateral ventricle. These findings are highly concerning for progression of disease


Instruction: Generate impression based on findings.

Input: Congenital malformation of peripheral vascular system, unspecified [Q27.9], Reason for Study: ^Reason: 3 t scanner vascular malformation History: headache weakness This exam was performed with stealth protocol thus multiple fiducial markers are attached on scalp.Again redemonstration of left subiculum area cavernous malformation with developmental venous anomaly.Comparing to prior scan, there is no significant interval change of MR characteristics as well as the maximum diameter of the lesion.Otherwise there is no evidence of abnormal enhancement.The ventricles, sulci and cisterns are unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. MR imaging with the stress protocol.2. Unchanged left mesial hippocampal cavernous malformation associated with developmental venous anomaly.


Instruction: Generate impression based on findings.

Input: Reason: 66 y/o hx of leukemia, concern for cord compression History: back pain CORD COMPRESSION PROTOCOL:Extensive osseous metastatic disease involving the spine, ribs and sternum appearing similar to the prior CT. There is severe kyphosis of the thoracic spine with thoracic spine findings detailed below.Exaggerated lordosis of the cervical spine with multilevel degenerative disc disease, most severe at C3-C4 and C5-C6. Posterior disc osteophyte complex at C3-C4 and C5-C6 producing effacement of the ventral thecal sac. Diffuse osseous metastatic disease of the lumbar spine with mild anterior wedging of L1. No significant central canal stenosis.THORACIC SPINE MRI:Diffuse osseous metastatic disease with severe kyphosis centered at C5-C6. There is loss of vertebral body height at T6, T9 and L1. No abnormal signal within the cord. No epidural extension is noted throughout the thoracic spine.C7-T1: No significant central or neural foraminal stenosisT1-T2: No significant central or neural foraminal stenosisT2-T3: No significant central or neural foraminal stenosisT3-T4: No significant central or neural foraminal stenosisT4-T5: Osseous expansion from tumor extending inferiorly with effacement of the ventral thecal sac but no significant central stenosis. Expansion along the bilateral neural foramina producing mild foraminal stenosisT5-T6: Osseous expansion from tumor posteriorly into the left neural foramina and along the left lateral recess inferiorly producing moderate central canal stenosis. Severe left neural foraminal stenosis. Mild right neural foraminal stenosis.T6-T7: Osseous expansion from tumor along the left lateral recess and left neural foramina with mild central canal stenosis. Severe left neural foraminal stenosis. No right neural foraminal stenosis.T7-T8: Osseous expansion from tumor around the the left neural foraminal. Moderate left neuroforaminal stenosis. No right neural foraminal stenosis. No significant central canal stenosis.T8-T9: Osseous expansion from tumor in the left lamina and paraspinal soft tissues and along the left neural foramina producing mild to moderate central canal stenosis. Mild bilateral neural foraminal stenosis.T9-T10: No significant central canal stenosis. Moderate right neural foraminal stenosis mild left neural foraminal stenosis.T10-T11: No significant central or neural foraminal stenosisT11-T12: No significant central or neural foraminal stenosisT12-L1: No significant central or neural foraminal stenosisBilateral renal cysts. Small right pleural effusion with right apical pleural thickening and nodular opacities better characterized on recent CT chest.

Output: 1.No abnormal T2 signal to suggest acute cord compression2.Widespread osseous metastatic disease with multiple chronic compression fractures involving T6, T9 and L1. There is osseous expansion of tumor along the left lateral recess of T6 producing moderate central canal stenosis. There are additional levels of less severe central canal stenosis as well as multilevel neural foraminal stenosis in the mid thoracic spine.3.Small right pleural effusion with right apical pleural thickening and nodular opacities better characterized on recent CT chest.


Instruction: Generate impression based on findings.

Input: 56 years Female (DOB:9/19/1960)Reason: please rule out acute on chronic brain infarct, rule out metastatic brain disease History: see neckPROVIDER/ATTENDING NAME: ADIL JAVED ADIL JAVED MRI of the brainNo diffusion weighted abnormalities are appreciated.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.The CSF spaces are appropriate for the patient's stated age with no midline shift. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain: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 and is medium size. The posterior communicating arteries are small. Left vertebral artery is larger than the right vertebral arteryMRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries. The left common carotid artery originates from the innominate artery.A couple hypointense foci are present in the thyroid gland bilaterally which is nonspecific.

Output: 1.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related. 2.There is no evidence for acute ischemic cerebral infarction.3.There is no evidence for intracranial cerebrovascular occlusive disease4.There is no evidence for extracranial cerebrovascular occlusive disease


Instruction: Generate impression based on findings.

Input: History of small cell lung carcinoma with metastasis to the brain. There has been interval increase in size and number of numerous supratentorial and infratentorial metastatic lesions and associated vasogenic edema. For example, previously demonstrated lesion in the anterior left temporal lobe now measures 14 mm, previously 6 mm and a lesion in the superior vermis measures 13 mm, previously 4 mm. In addition, there are several new lesions in the cerebral and cerebellar hemispheres. For example, a new lesion in the left inferior temporal lobule measures 11 mm and a lesion in the right mid cerebellum measures 9 mm. Several of these lesions demonstrates leptomeningeal involvement. There is diffuse subcortical and periventricular white matter T2 hyperintensity. There is no evidence of acute intracranial hemorrhage. The ventricles and basal cisterns are unchanged configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. Interval increase in size and number of supratentorial and infratentorial metastatic lesions with associated vasogenic edema.2. Diffuse cerebral white matter T2 hyperintensity is nonspecific, but may in part be related to treatment effects and/or small vessel chronic ischemic disease.


Instruction: Generate impression based on findings.

Input: Global developmental delay. History of prematurity. The head is elongated anteroposteriorly. Gray-white matter differentiation is preserved and sulcation is normal. Increased T2 signal in the deep parietal white matter is probably the residual terminal zones of myelination. An incidental finding of cavum septa pellucidum et vergae is present. There is also an incidental CSF signal intensity small left choroid fissure cyst adjacent to the left temporal horn, with mild localized mass effect. The corpus callosum is of normal morphology. The cerebellum and brainstem are also normal. There is no abnormal brain diffusion or susceptibility effect.Other than mild anteroposterior elongation, the calvarium is unremarkable. Right posterior scalp foci of susceptibility effect likely relate to previous reported soft tissue lesion resection in this area, provided a history of hemangioma.

Output: There is no definite brain parenchymal abnormality.


Instruction: Generate impression based on findings.

Input: Female 66 years old Reason: Eval for sacral nerve injury or pelvic mass History: Pelvic pain and numbness PELVIS:UTERUS, ADNEXA: The uterus is surgically absent and a T2 hyperintense/cystic lesion in the right adnexa likely represents the right ovary. The left ovary is atrophic.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Scoliosis and degenerative changes in the lower lumbar spine are better evaluated on prior MRI lumbar spine 12/23/2014.OTHER: No significant abnormality noted.

Output: 1.No findings to account for patient's pelvic pain and numbness, specifically no evidence of pelvic mass.


Instruction: Generate impression based on findings.

Input: 78-year-old female with left buttock pain. Abnormal sacroiliac joint and left hip MRI. Evaluate left sacroiliac joint. There is increased signal abnormality within an enlarged left piriformis and left iliacus muscle as well as within the left paraspinal musculature. There is increased signal abnormality about and within the left sacroiliac joint which demonstrates enhancement on post contrast sequences consistent with sacroiliitis. No definite erosions are identified. There is heterogenous bone marrow signal abnormality which is nonspecific but likely represents residual islands of red marrow. Although this examination was not protocoled for detailed evaluation of the lumbar spine, there is an apparent disc bulge at the level of L4/L5 with associated central spinal canal stenosis. This could be further evaluated with a dedicated lumbar spine MRI if clinically warrented.

Output: 1. Findings suggestive of left sided sacroiliitis as described above. Nonspecific increased signal abnormality within the left iliacus muscle and left paraspinal musculature may also be related to the aforementioned sacroiliitis.2. Increased signal abnormality within an enlarged left piriformis muscle with inflammatory changes in the surrounding area, particularly about the left sciatic nerve, which is nonspecific and may be related to the aforementioned sacroiliitis, however, this can be seen in patient's with piriformis syndrome.3. Apparent diffuse disc bulge at the level of L4/L5 with associated central spinal canal stenosis. This is incompletely visualized and could be further evaluated with a dedicated lumbar spine MRI if clinically indicated.


Instruction: Generate impression based on findings.

Input: Diagnosis: Malignant neoplasm of unspecified part of unspecified bronchus or lung.Clinical question: New onset sacral boney pain; Hx metastatic NSCLC r/o metastasis to sacrumSigns and Symptoms: New onset sacral boney pain; Hx metastatic NSCLC 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 intactThere is small lesion measuring 10mm in size which is bright on T2 imaging and enhances following contrast administration.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is disk dessication and a broad based left lateral recess disk protrusion at this level which encroaches on the nerve roots at the left lateral recess. There is effacement of the fat at the left lateral recess.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is mild disk dessication and a disk bulge at this level. There is mild ligamentum flavum hypertrophy at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is mild disk dessication at this level.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.A small lesion in the T12 vertebral body could represent a metastatic focus. An atypical hemangioma could be an alternative explanation.2.There are degenerative changes in the lumbar spine mainly in the form of disk degeneration with encroachment of the nerve roots at the left lateral recess at L5-S1. (Most likely affecting the left S1 nerve roots).3.Please note that the lower sacrum (below S3) was not included on this exam. The patient will be asked to return for imaging to include the rest of the sacrum at no expense.


Instruction: Generate impression based on findings.

Input: Female, 46 years old, with intracranial hemorrhage. A hematoma is redemonstrated centered on the cerebellar vermis with signal characteristics (T1 isointense and T2 hypointense) compatible with an acute time course. Accounting for differences in technique, the size of the hematoma has not significantly changed from the prior CT examination. The parenchyma surrounding the hematoma demonstrates mild edema and there is mass effect partially effacing the fourth ventricle. A small focus of possible restricted diffusion with matching T2 FLAIR signal abnormality is seen within the left aspect of the anterior corpus callosum. Elsewhere, fairly extensive patchy and focal periventricular T2 hyperintensity is seen. There are a few scattered lesions in the brain stem and cerebellum as well. No other significant parenchymal edema is detected. A small amount of blood product is evident layering within the occipital horns. However, the ventricular system is not dilated.Allowing for motion artifact on the MRA images, no vascular lesion is seen within the vicinity of the vermian hematoma. No significant vascular stenosis or occlusion is demonstrated elsewhere. No aneurysms are suspected. The cervical vessels are likewise free of significant vascular stenosis or occlusion.

Output: 1.An acute hematoma is redemonstrated centered on the cerebellar vermis. Mild associated mass effect is seen along with mild intraventricular blood product.2.No obvious vascular or nonvascular lesion is seen adjacent to the hematoma. A lesion within the hematoma may not become visible until the blood product has at least partially resolved.3.Fairly extensive scattered periventricular T2 hyperintense lesions are seen, along with a possible diffusion restricting lesion within the left anterior corpus callosum. These findings could reflect microvascular ischemic disease particularly if there are known risk factors. In this age group, however, demyelinating disease should also be considered as well as a vasculitic process.4.No significant vascular stenosis is identified in the head or neck.


Instruction: Generate impression based on findings.

Input: 50 years Female (DOB:8/30/1965)Reason: new onset tremor, left arm resting tremor as well as action tremor bilaterally History: new onset tremor, left arm resting tremor as well as action tremor bilaterallyPROVIDER/ATTENDING NAME: JACQUELINE T BERNARD JACQUELINE T BERNARD The CSF spaces are appropriate for the patient's stated age with no midline shift. Exam is mildly degraded due to patient motion.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: No abnormal mass lesions are appreciated within the brain parenchyma to explain the patient's symptoms. Exam is mildly degraded due to patient motion which may obscure more subtle abnormalities.


Instruction: Generate impression based on findings.

Input: Retromolar trigone squamous cell cancer treated with CRT and thoracic spinal lesions. There is a right anterolateral paraspinal enhancing mass at the lower T6 to lower T8 vertebral body levels. The lesion measures approximately 60 mm in craniocaudal dimension and 10 mm in thickness, previously 55 mm in craniocaudal dimension and 8 mm in thickness. There is diffuse high T1 bone marrow signal within the imaged lower cervical and upper thoracic spine related to radiation therapy. From T4 through T12, there is a background of heterogenous bone marrow signal with unchanged scattered superimposed intrinsically T1 hyperintense lesions, some of which also display high T2 signal. There is no spinal canal or neural foraminal stenosis. The cystic lesion within subcutaneous tissues at the level of the T6 is unchanged and likely represents an inclusion cyst.

Output: Slight increase in size of the right anterolateral paraspinal enhancing mass extending along the lower T6 to lower T8 vertebral body levels. Otherwise, the appearance of the thoracic vertebral bone marrow appears unchanged, including what likely represent scattered hemangiomas and/or focal fat deposits.


Instruction: Generate impression based on findings.

Input: A patient submitted outside study for review. Submitted for review are ultrasound images of left breast (10/26/2016), images from ultrasound guided biopsy of the left breast (11/3/2016), breast MRI (11/9/2016) performed at outside institution. Those studies are compared to the mammogram and ultrasound performed at University of Chicago on 11/10/2016. ULTRASOUND IMAGES OF LEFT BREAST (10/26/2016):An irregularly shaped hypoechoic mass measuring 13 x 11 mm is present at 5:00 position in the left breast. This is the same lesion located at 5:30 position in the left breast at the ultrasound study performed on 11/10/2016 at University of Chicago.IMAGES FROM ULTRASOUND GUIDED BIOPSY OF THE LEFT BREAST (11/3/2016):A needle biopsy of the left breast mass was performed with an appropriate needle placement. A marker clip is placed within the mass. The pathology result was malignant.BREAST MRI (11/9/2016):The study was performed with a protocol outlined in the outside radiology report.There is heterogeneous amount of fibroglandular tissue in both breasts.Marked parenchymal enhancement is noted bilaterally.A known cancer with a marker clip is demonstrated at posterior 5:00 position measuring 18 x 15 x 17 mm (AP x LR x CC). There is possible satellite lesion measuring 6 mm, located anterior to the main lesion. Total measurement including the main mass with possible satellite is 26 mm in AP dimension. This possible satellite is not the same one as seen at the ultrasound study on 11/10/2016 at University of Chicago. The satellite lesion seen on that ultrasound study is seen as a small focus attached to the lateral portion of the main mass on MRI.No other abnormal findings are seen elsewhere in the left breast or in the right breast.No abnormal lymph nodes are identified in either axillary region.

Output: Known left breast cancer with possible anterior satellite. MR-directed ultrasound for the possible satellite lesion is recommended. If no lesion is found on ultrasound study, MR guided biopsy should be considered.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: E - Additional Mammo/Ultrasound Workup Required.


Instruction: Generate impression based on findings.

Input: 62-year-old male with prostate cancer. PELVIS:PROSTATE:Prostate Size: 5.2 x 5.2 x 3.4 cm.Peripheral Zone: There is a 6 x 5 mm T2 hypointense focus in the right apex peripheral zone with corresponding restricted diffusion (series 801, image 11). There is indeterminate 11 x 5 mm region of T2 hypointensity with corresponding restricted diffusion (series 801, image 15) in the right mid gland peripheral zone. Additional small foci of T2 hypointensity with corresponding restricted diffusion in the left peripheral zone.Central Gland: Severe degree benign prostatic hypertrophy.Seminal Vesicles: Unremarkable.Extracapsular Extension: There is no evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: Probable subchondral cyst at the right pubic symphysis.OTHER: No significant abnormality noted.

Output: 1.Suspicious focus in the right apex peripheral zone as described above.2.Indeterminate focus in the right mid gland peripheral zone as described above.3.Additional small T2 hyperintense foci with corresponding restricted diffusion in the left peripheral zone are indeterminate.


Instruction: Generate impression based on findings.

Input: Evaluate for recurrence of meningioma. Patient had two seizures today. There is no evidence of intracranial hemorrhage. A hyperdense region is identified along the superior falx. Adjacent to an area of encephalomalacia in the left frontal lobe is a density along the inner table of the left skull that likely represents cerebral cortex. However, an MRI is needed for further evaluation of these areas.White matter hypodensity in the right frontal lobe is more prominent than on the prior study. Correlate with any history of radiation therapy.The ventricles and basal cisterns are normal in size and configuration.Postsurgical findings of a craniotomy are noted. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Hyperdense region is identified along the superior falx. Further evaluation with MRI is recommended. White matter hypodensity in the right frontal lobe is more prominent than on the prior study.


Instruction: Generate impression based on findings.

Input: Chiari status post decompression several years ago with new neck pain. Do with CSF flow study. There are postoperative changes of suboccipital decompression including resection of the posterior C1 arch and widening of the foramen magnum. CSF spaces at the foramen magnum are increased since prior study. There is improvement in biphasic CSF flow at the foramen magnum, which is greater ventrally then dorsally. There is mild retroflexion of the dens contributing to partial CSF space effacement ventrally, where there is good biphasic flow. The cervical vertebral bodies are appropriate in height. Alignment is maintained. Bone marrow signal is within normal limits. The cervical spinal cord has normal signal characteristics and overall morphology. No evidence of syrinx.There is no significant disc disease, spinal canal, or neural foraminal stenosis at any level. Vertebral artery flow voids are maintained.

Output: Postoperative changes related to Chiari I decompression. Biphasic CSF flow at the neo-foramen magnum is preserved. No evidence of syrinx.


Instruction: Generate impression based on findings.

Input: Brain: There is no restricted diffusion to suggest recent infarct. No intracranial mass or mass effect. Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild chronic small vessel ischemic changes and not appreciably changed since 4/8/2015. There is mild supra and infratentorial parenchymal volume loss. The ventricles and basal cisterns are normal in size and configuration for age. There is no midline shift or herniation. The skull and extracranial soft tissues are grossly unremarkable.Cervical spine: As seen on prior CT, there are postsurgical changes of cervical laminoplasty extending from C3 to C7 with laminectomies, spinous processes resection, and bone grafts at the C4 and C6 levels, with osseous incorporation of the grafts better seen on prior CT. Spinal canal at the operated levels remains decompressed and markedly improved since prior MRI from 6/11/2014. Cervical vertebral bodies are appropriate in height. Unchanged cervical alignment without kyphosis on these supine images. No suspicious bony lesions are identified in the cervical spine. Advanced degenerative changes with multilevel disc height loss, most severely affecting the C4-C5, C5-C6, and C6-C7 disc spaces, again seen. No cord signal abnormality is definitively appreciated.Additional details as below:C2-3: No significant compromise to the spinal canal. There is mild left greater than right neural foraminal narrowing related to facet arthropathy as seen on CTC3-4: There is mild narrowing of the spinal canal with effacement of the dorsal thecal sac related to ligamentum flavum thickening and small disc osteophyte complex anteriorly. There is moderate to severe right neural foraminal stenosis related to uncovertebral hypertrophy and facet arthropathy. Left neural foramen is patent. C4-5: There is disc osteophyte complex. Spinal canal remains decompressed. There is mild to moderate left and mild right neural foraminal narrowing related to uncovertebral hypertrophy and facet arthropathy.C5-6: No spinal canal stenosis. There is uncovertebral hypertrophy and facet arthropathy. There is mild to moderate right and mild left neural foraminal narrowing. C6-7: Prominent left paracentral disc osteophyte complex and uncovertebral hypertrophy. Spinal canal is decompressed aside from partial effacement of the left ventral thecal sac. There is moderate left and mild right neural foraminal narrowing. C7-T1: No significant compromise to the spinal canal. Mild to moderate bilateral neural foraminal narrowing.Paraspinous soft tissues are unremarkable aside from postsurgical changes. Multinodular goiter is again noted.

Output: 1. Mild chronic small vessel ischemic changes similar to prior from 4/8/2015. No acute infarct, intracranial mass, or mass effect.2. Postsurgical changes of cervical laminoplasty. Spinal canal is decompressed. There is relatively mild spinal canal narrowing at the C3-C4 and C6-C7 levels. No cord signal abnormality.3. Multilevel neural foraminal stenosis throughout the cervical spine as seen on recent CT from 5/19/2015 and detailed above.


Instruction: Generate impression based on findings.

Input: Cerebral infarction due to embolism of unspecified cerebral artery [I63.40], Reason for Study: ^Reason: Evaluate for mycotic aneurysm and assess for stroke burden History: L face/arm/leg weakness with neglect Brain MRIThere is large area of restricted diffusion involving the right temporoparietal lobe as well as posterior aspect of insular cortex indicating acute ischemic infarct.Multifocal bihemispheric supra and infratentorial scattered restricted diffusion lesions are again seen, suggesting embolic in nature of multifocal ischemic infarcts.On gradient echo images, bihemispheric scattered susceptibility lesions are seen and some of them are within the area of restricted diffusion, thus may indicate focal areas of hemorrhagic conversion. Other susceptibility lesions are not associated with diffusion restriction lesions and there is no evidence of surrounding edema thus suggest chronic parenchymal petechial hemorrhages or parenchymal calcifications.There is focal encephalomalacia on the left pre central gyrus which indicate chronic ischemic infarction. Several FLAIR/T2 high signal intensity lesions on bilateral centrum semiovale, periventricular white matter and bilateral cerebellar hemispheres indicate non specific small vessel ischemic disease. The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal. No significant intracranial arterial luminal stenosis. No intracranial arterial aneurysm. Bilateral Pcom arteries are small but patent. Acom artery is patent.

Output: 1. Multifocal bihemispheric acute ischemic infarctions including large right temporo-parietal lobe acute ischemic infarctions.2. There are a couple of susceptibility lesions within the right parietal lobe ischemic infarction lesion which may indicate focal hemorrhagic conversion.3. Multiple scattered susceptibility lesions may indicate chronic hemorrhagic lesions or parenchymal calcifications.4. Minimal to mild non specific small vessel ischemic disease.5. Normal brain MRA


Instruction: Generate impression based on findings.

Input: 64-year-old female with NF type 2, memory loss, seizures, and vestibular schwannomas. Evaluate for new meningiomas or other tumors. Again seen is evidence of a large prior left fronto-parietal craniotomy. There is also evidence of a previous right mastoidectomy with resection and distortion of the right middle and inner ears structures. Since the prior MRI from 1/11/2014, there has been mild interval increase in size of multiple meningiomas along the dura along the right cerebral hemisphere, falx and tentorium. There is mild increase in parenchymal edema in the right frontal subcortical white matter associated with the increase in size of right anterior frontal meningiomas. Dense calcifications associated with the meningiomas are better seen on prior CT.There has also been significant interval increase in the multiple extra-axial skull base masses especially along the right Meckel's cave, right cerebellopontine angle and anteriorly along the brain stem. For example the right medial temporal/Meckel's cave lesion has increased in size currently measuring 2.0 x 3.0 cm (series 1802, image 93), compared to 1.3 x 2.6 cm previously. This mass is causing mass effect and lateral displacement of the mesial temporal structures. The larger more lateral right CPA tumor measures 2.4 x 2.6 cm (series 1802, image 76), compared to approximately 1.5 x 2.1 cm previously although direct comparison is limited secondary to prior motion degradation. This is causing worsened mass effect on the adjacent cerebellum and brainstem. The smaller more medial CPA tumor is grossly unchanged in size measuring 1.1 x 1.3 cm (1802, image 78). The extra-axial mass anterior to the brainstem has increased considerably compared to the previous exam and now exerts significant mass effect on the adjacent pons and medulla. This lesion measures 2.4 x 2.5 cm (series 1802, image 70), 1.6 x 1.7 cm previously in the axial plane. Also increased is the craniocaudal extent of the tumor which measures 2.6 cm compared to 1.8 cm previously. Additional multiple smaller tumors are seen within the bilateral CPA, right greater than left Meckel's cave, right greater than left cavernous sinus. There is masslike thickening and enhancement involving the left IAC compatible with a vestibular schwannoma which has increased in size and has also extended more medially. Large right greater than left foraminal-based masses are visible at the C1-2 level which have increased in size compared to the prior exam. There is effacement of the lateral aspects of the thecal sac, right greater than left, and mild contour deformity of the upper cervical cord. Soft tissue enhancing lesions in the suboccipital soft tissues are also slightly larger.There is no evidence of intracranial hemorrhage or acute infarct. No hydrocephalus. Aside from the right frontal lobe T2/FLAIR hyperintensity which is increased in the interval, FLAIR hyperintensity in the left frontal lobe likely reflecting gliosis is unchanged. There is also encephalomalacia in the left posterior frontal lobe which is again seen. Mild leftward midline shift is not significantly changed.. The major cerebral flow voids are intact.

Output: Innumerable extra-axial enhancing masses consistent with meningiomas and schwannomas involving the supra and infratentorial brain, greatest along the frontal lobes, right medial temporal lobe, right cerebellopontine angle, anterior to the pontomedullary junction, within the left IAC and along the bilateral C1-2 foramina, most of which have increased in size compared to the prior exam from 2014. In particular, the meningioma anterior to the brainstem has increased significantly and is now causing extensive mass effect on the ventral lower pons and upper medulla. There is also increase in parenchymal T2/FLAIR hyperintensity compatible with edema associated with the right anterior frontal meningiomas. Please see additional details 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: History of prostate cancer. Evaluate for metastases. CT of brain with infusion:Examination demonstrates no evidence of metastatic disease to the brain. Finding consistent with minimal small vessel disease of indeterminate age are noted. Extensive postoperative changes of left frontal craniotomy is again identified with interval improvement since prior exam. Area of low attenuation in the left frontal lobe inferiorly in the pattern of vasogenic edema is again identified and is believed to represent an area of encephalomalacia on the current exam. This area has decreased in extent since prior study. There is no evidence of mass effect as was noted on the prior exam and no midline shift is noted. Extensive postoperative changes along the floor of the left anterior cranial fossa including bony grafts and extensive sclerotic changes of the floor of the left anterior cranial fossa remains stable. Postoperative changes along the left lamina papyracea with surrounding soft tissue thickening with associated mass effect on the left medial rectus muscle appears similar to prior study. This area should be further evaluated with dedicated CT or MRI of orbit/ maxillofacial region with infusion.There is better pneumatization of the left maxillary sinus and left ethmoid air cells and left maxillary sinus since prior examination.This examination was performed without any added contrast for this study however patient received contrast for CT of abdomen and this exam was performed immediately after CT of abdomen.

Output: 1.No evidence of metastatic disease to the brain or leptomeninges.2.Extensive postoperative changes at the level of the floor of the left anterior cranial fossa, left orbit and left ethmoid air cells with no definitive appendectomy she will interval change. This area can be reevaluated with dedicated the studies.


Instruction: Generate impression based on findings.

Input: Reason: Pt w/ mesothelioma s/p multiple debulkings, HIPEC x2, last in September 2015 now w/ chronic SBO - please eval for transition point and eval for recurrent disease History: chronic SBO ABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy. Prominent common bile duct measuring 1.1 cm without an obstructing lesion evident. Mild intrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: There is mild edema and diffusion restriction involving the pancreatic tail and head which may reflect a mild pancreatitis. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Mild bilateral hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is dilatation of small bowel to 3.8 cm with collapsed terminal ileum and a transition point in the lower pelvis (19/17), likely representing a partial small bowel obstruction. Stool within the colon has slightly increased since the prior exam. There is a rim of low T2 signal surrounding multiple bowel loops in the pelvis, likely reflecting thickening and fibrosis of the peritoneal reflections. No cystic lesions are identified.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Dilated small bowel loops with collapsed terminal ileum likely represents a partial small bowel obstruction; air seen distally in colon.2.There is thickening and likely fibrosis of the peritoneal reflections in the pelvis which is suggestive of sclerosing encapsulated peritonitis, may in combination be contributing to aforementioned partial SBO.3.Bowel thickening involving the rectosigmoid suggests a mild nonspecific proctitis.4.No cystic lesions identified to suggest multicystic peritoneal mesothelioma.


Instruction: Generate impression based on findings.

Input: Female, 40 years old, history of breast cancer. Assess for metastases to the spine. Admitted with transient altered mental status and seizures. MRI concerning for leptomeningeal enhancement. Cervical:Patchy low T1/T2 signal is evident within the C5 and C7 vertebral bodies. No corresponding marrow edema or pathologic enhancement is detected.Fatty signal intensity anteriorly within the C6 vertebral body is also seen. Elsewhere, no definite concerning marrow replacement is detected. Vertebral body height and morphology are preserved. No epidural disease extension is seen. Alignment is anatomic.The visualized spinal cord shows normal signal intensity and morphology. No evidence of pathologic intramedullary or leptomeningeal enhancement is seen.C2-3: Unremarkable. C3-4: Minimal posterior disc-osteophyte complex formation. No significant spinal canal or foraminal stenosis. C4-5: Minimal posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Mild left foraminal narrowing. C5-6: Minimal posterior disc-osteophyte complex formation. No significant spinal canal or foraminal stenosis. C6-7: Unremarkable. C7-T1: Unremarkable. Thoracic:Patchy T1/T2 hypointense marrow replacement is again seen at numerous levels, most conspicuously involving T4, T8-T10, and T12. The T12 vertebral body is completely infiltrated and there is mild anterior wedging with minimal retropulsion. Speckled fatty signal is also seen scattered throughout some of these lesions and in the T11 vertebral body. Mild patchy enhancement is also seen in association with these lesions. No evidence of any significant epidural disease extension is seen.The visualized spinal cord demonstrates normal signal intensity and morphology. Postcontrast images are degraded by motion, but no definite evidence of any intramedullary or leptomeningeal enhancement is seen.A mild scoliotic curvature of the thoracic spine is demonstrated. In addition, there is a mild focal kyphotic angulation of the spine centered at T11 and T12. Otherwise, the vertebral bodies are well aligned in the sagittal plane.Scattered small disc protrusions are evident at T7-8 and T10-11. No significant spinal canal or neuroforaminal stenosis is seen.Lumbar:Patchy heterogeneous marrow replacement is seen, largely fatty at L1 and L2, but with areas of low T1/T2 signal at L3-L5. These lesions show only minimal evidence of edema and little or no pathologic enhancement. The sacrum, however, is infiltrated with patchy heterogeneous signal which does demonstrate significant associated enhancement.Vertebral body height and morphology are within normal limits. No compression fractures are seen. No significant epidural disease extension is detected. Alignment is anatomic.On postcontrast images, the nerve roots of the cauda equina appear to be diffusely enhancing. No large or nodular tumor deposits are suspected.Minimal degenerative disc disease is seen at L4-5 with loss of T2 signal and very mild disc bulging. Moderate facet hypertrophy develops at lower levels. No significant spinal canal or neuroforaminal stenosis is seen.

Output: 1. Findings are seen concerning for leptomeningeal disease involving the cauda equina. No discrete leptomeningeal involvement is suspected at more superior levels, though some images are motion degraded which reduces the sensitivity.2. Fairly diffuse and widespread osseous metastatic disease is seen. Most of these lesions demonstrate a largely T1/T2 hypointense appearance which correlates to sclerotic lesions seen on recent CT. Some of these lesions show intermixed fatty replacement and some mild associated enhancement. The pattern is suggestive of both treated and perhaps minimally active metastatic disease. The most active lesions are suspected to be in the sacrum by virtue of their robust enhancement.3. No evidence of any significant epidural disease extension is seen. No high-grade spinal canal or neuroforaminal stenosis is detected.


Instruction: Generate impression based on findings.

Input: 60-year-old female with history of HCV cirrhosis status post orthotopic liver transplant in April 20, 2011. Evaluate for hepatic lesions and assess hepatic vessel patency. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic morphology. No evidence of suspicious hepatic lesion. The liver measures approximately 19 cm.The celiac axis and its branches including splenic and common hepatic artery are patent. The right hepatic artery is opacified and patent. The left hepatic artery is opacified; however, the connection to the common hepatic artery is not well visualized.The hepatic veins are patent. Main portal vein, right and left portal veins are patent.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Cirrhotic hepatic morphology without suspicious lesions.2.Main, right, and left portal veins are patent.3.Hepatic veins are patent.4.Common hepatic artery and right hepatic artery are patent. The left hepatic artery is well opacified; however, the connection to the common hepatic artery is not well visualized, which may be related to technique or postsurgical in etiology.


Instruction: Generate impression based on findings.

Input: History of paralaryngeal circumferential mass with pathology consistent with metastatic thyroid carcinoma status post RAI with no response. There are postoperative findings related to total thyroidectomy and neck dissection. There is interval increase in size of the right tracheoesophageal groove nodule that appears indistinct from the adjacent trachea and esophagus, which now measures 15 x 25 mm, previously 5 x 12 mm. There is an infiltrative enhancing mass posterior to the lower larynx, in which the dominant portion on the left side measures approximately 15 x 20 mm, previously 14 x 18 mm. Likewise, an infiltrative tumor in the posterior visceral space that appears to indent and perhaps invade the upper trachea and esophagus has increased in size, now measuring 18 x 30 mm, previously 15 x 20 mm. There also a prominent left level 4 lymph node that measures 10 mm in short axis, previously 7 mm. The salivary glands are unremarkable. There is mild multilevel degenerative spondylosis and subcentimeter bilateral neural foramen perineural cysts at T1-2. The imaged intracranial structures are unremarkable. There are bilateral lens implants.

Output: Postoperative findings related to total thyroidectomy and neck dissection with overall increase in size of the multiple foci of recurrent tumor in the lower neck.


Instruction: Generate impression based on findings.

Input: Right knee and ankle pain after being struck by a car 3 views of the right ankle show no acute fracture. There is mild deformity of the distal tibia as well as an ossicle dorsal to the talonavicular joint which may represent sequelae of old trauma. There is mild osteoarthritis of the tibiotalar and talonavicular joints.4 nonweightbearing views of the right knee show no acute fracture. Mild osteoarthritis affects the knee. The distal quadriceps tendon appears slightly thickened with a small focus of intrasubstance ossification as well as prominent enthesophyte along the superior aspect of the patella. These findings suggest chronic tendinosis. If there is high clinical concern for an acute quadriceps injury MRI can be considered.

Output: Ankle: Osteoarthritis of the ankle and findings suggestive of old trauma without acute fracture.Knee: Mild osteoarthritis and quadriceps tendinopathy without evidence of acute fracture. If there is clinical concern for acute quadriceps injury MRI can be considered.


Instruction: Generate impression based on findings.

Input: Benign neoplasm of pituitary gland and craniopharyngeal duct ( The CSF spaces are appropriate for the patient's stated age with no midline shift. There is redemonstration of a millimeter-sized lesion along the left pituitary gland lobe superiorly which does not enhance.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.There is redemonstration of a small nonenhancing focus along the superior aspect of the left pituitary gland lobe. One possibility is that this represents a microadenoma. It is better characterized on the prior exam.2.Please note that this exam is made for the purpose of stereotactic guidance.


Instruction: Generate impression based on findings.

Input: 36 year old with known right breast cancer and metastatic right axillary lymph node presents for research MRI of I-SPY protocol (pre-chemotherapy). There is heterogeneous amount of fibroglandular tissue in both breasts.Marked parenchymal enhancement is noted bilaterally.A known cancer is demonstrated as an irregularly shaped enhancing mass at posterior 11 o'clock position, measuring 24 x 26 x 23 mm (AP x LR x CC). An artifact from marker clip is present at anterior-inferior border of the mass.No other abnormal enhancing lesions are present in the right breast.An enlarges lymph node is present in the right axilla, with maximum diameter of 17 mm, consistent with a metastatic lymph node. An artifact from marker clip is seen 6 mm lateral from the lymph node. No abnormal enhancement is seen in left breast. No abnormal axillary lymph nodes are identified in left axillary region.

Output: 1. Unifocal cancer in the right breast with known metastatic right axillary lymph node.2. No MR evidence for malignancy in the left breastBIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Female 65 years old Reason: chronic abdominal pain, r/o biliary etiology ABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy. Dilated common bile duct measuring 1.5 cm in maximum transaxial dimension (series 9, image 36). At least two filling defects identified within the distal common duct. The largest measures 1.0 x 0.9 cm (series 9, image 29).SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: T2 hyperintensities within the kidney consistent with simple cysts.RETROPERITONEUM, LYMPH NODES: Plaque within the abdominal aorta is poorly evaluated on this study.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1.Status post cholecystectomy. Choledocholithiasis with dilatation of the upstream common duct.


Instruction: Generate impression based on findings.

Input: Reason: postcontrast MRI due to abnormal noncontrast MRI per radiology recommendation History: as above Examination is limited to post contrast sequences, with precontrast imaging performed recently on 5/21/2016. There is a punctate nodule measuring 2 x 5 mm near the midline along the cauda equina nerve roots at the L1-L2 level which is again seen. Due to its small size, the lesion is not well appreciated on the axial sequences. No suspicious enhancement is appreciated elsewhere in the spine. Degenerative findings including right paracentral disc protrusion contributing to at least moderate spinal canal stenosis at L4-L5 again seen. Enhancement is evident associated with the dorsal annular fissure and disc protrusion at the L4-L5 level. Disc protrusion at the L5-S1 is also again seen. Neural foramina are patent.Please see prior report for additional details.

Output: 2 x 5 mm intradural extramedullary lesion at the L1-L2 level is again seen and statistically likely represents an incidental schwannoma. When follow-up is considered, perhaps in 6 months, would suggest obtaining thin slices through this region.Please refer to separate report dated 5/21/2016 for additional findings including spinal canal stenosis at the L4-L5 level.


Instruction: Generate impression based on findings.

Input: Clinical question: Thoracic spine lesion; follow-up progression. Signs and symptoms: Paresthesias. Nonenhanced thoracic MRI:Examination redemonstrate a stable expansile lesion of thoracic cord with hypointense T1 and hyperintense T2 signal intensity. The lesion extends from approximately T3-T4 disc level inferiorly to immediately below the T6-T7 disc level which is identical to prior exam. Similar to prior exam from the superior extent of this expanded lesion tiny focus of T2 hyperintensity extends further superiorly to approximately mid T2 level. The signal intensity of cord surrounding this lesion remains within normal. The appearance is suggestive of a syrinx. There are subtle ventral indentation of the cord at multiple levels including at the level of expanded lesion secondary to degenerative disc disease which has also remained identical to prior study. Previously mentioned internal foci of T2 hyperintensity within this finding are no longer identified and believed to have been secondary to pulsation artifact and not a true finding.Mild-to-moderate degenerative disc disease and with loss of intervertebral disc heights and multilevel shallow ventral hypertrophic changes/bulging discs remain identical to prior exam. The ventral epidural degenerative changes resulting in multilevel mild indentation of the ventral aspect of the cord including at the level of expanded lesion which are also fairly similar in appearance to prior exam.

Output: 1.Well-demarcated expansile lesion of thoracic cord remains stable since prior exam. The finding is highly suggestive of a syrinx. Possibilities of a mass is considered very unlikely however further follow-up is recommended. The signal intensity of the cord is otherwise unremarkable. Please see above comments.2.Degenerative changes of thoracic spine and with resultant multilevel ventral epidural defects (bulging disc and spurs) results in subtle indentation of the ventral aspect of the cord which has also remained stable since prior exam.


Instruction: Generate impression based on findings.

Input: Dystonia in low back and left leg. L4-5 decompression via left-sided approach. The images are degraded by patient motion. There are interval postoperative findings related to L4-5 decompression via left-sided approach. There is apparent severe narrowing of the spinal canal at L4-5 due to what may be a combination of ligamentum flavum thickening, residual disc material, scar or granulation tissue, and perhaps even surgical fluid. There is also considerable effacement of the bilateral L4-5 neural foramina. There is mild retrolisthesis of L3 on L4, as well a degenerative spondylosis with mild narrowing of the spinal canal and left neural foramen. There is also degenerative spondylosis at the L5-S1 level, with moderate narrowing of the spinal canal and bilateral neural foramina. There is superimposed effacement of the left lateral recess at this level associated with a hemilaminectomy defect due to what may represent scar formation. There is degenerative bone marrow signal alteration in the L3 though S1 vertebrae with associated endplate irregularities. There is significant compromise to spinal canal or neural foramina at T12 through L3. The imaged portions of the spinal cord are unremarkable.

Output: 1. Interval postoperative findings related to L4-5 decompression via left-sided approach, with apparent severe narrowing of the spinal canal at L4-5 due to what may be a combination of ligamentum flavum thickening, residual disc material, scar or granulation tissue, and perhaps even surgical fluid. However, precise assessment is limit by patient motion artifacts.2. Mild retrolisthesis of L3 on L4, as well a degenerative spondylosis with mild narrowing of the spinal canal and left neural foramen. 3. Degenerative spondylosis at the L5-S1 level, with moderate narrowing of the spinal canal and bilateral neural foramina, as well as superimposed effacement of the left lateral recess at this level associated with a hemilaminectomy defect due to what may represent scar formation.


Instruction: Generate impression based on findings.

Input: History of cholecystitis status post drain placement, now with altered mental status ABDOMEN:LIVER, BILIARY TRACT: Abnormal diffuse T2 hypointense signal throughout the liver, likely reflecting iron deposition. Partially imaged cholecystostomy drain. Thick-walled gallbladder containing foci of signal void consistent with cholelithiasis, small pericholecystic edema. No intrahepatic or extra hepatic biliary duct dilatation visualized.SPLEEN: Abnormal diffuse T2 hypointense signal throughout spleen, likely reflecting iron deposition.PANCREAS: Focally prominent pancreatic duct at level of head measuring up to 4 mm, however tapering suggested distally. No pancreas divisum.ADRENAL GLANDS: Stable mild adrenal thickening.KIDNEYS, URETERS: Kidneys decreased in longitudinal dimension and renal parenchyma essentially replaced by innumerable small homogeneously T2 hyperintense simple cysts as well as additional rounded lesions demonstrating low T2 signal, may reflect cyst containing proteinaceous material or hemorrhage but these are incompletely assessed on this truncated study.RETROPERITONEUM, LYMPH NODES: Aortoiliac ectasia.BOWEL, MESENTERY: No gross abnormality noted.BONES, SOFT TISSUES: Decreased T2 bone marrow signal, likely reflecting sequela of iron deposition/renal osteodystrophy, L4 compression deformity unchanged from earlier CT imaging. Scoliosis seen.OTHER: Cardiomegaly.

Output: 1. Incomplete exam secondary to patient's combative behavior and inability to follow commands. Study is also suboptimal secondary to extensive motion and respiratory artifact. Reassessment with CT imaging may be of use and should be pursued as clinically indicated. 2. Thick-walled gallbladder containing foci of signal void consistent with cholelithiasis, small pericholecystic edema, appearance consistent with patient's reported history of cholecystitis. 3. Sequela of medical renal disease including atrophic kidneys with parenchyma essentially replaced by innumerable cysts, simple as well as complex (latter incompletely assessed on this truncated study), and renal osteodystrophy, unchanged L4 compression deformity. Evidence of iron deposition as above.


Instruction: Generate impression based on findings.

Input: Gait imbalance. 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, and paranasal sinuses are grossly unremarkable. There is linear soft tissue with mild enhancement in the skin of the left temporal scalp.

Output: 1. No evidence of acute intracranial hemorrhage, mass, or acute infarct.2. Probable scar tissue in the left temporal scalp.


Instruction: Generate impression based on findings.

Input: Female, 37 years old, with pain in the right leg. Given the limitation of motion artifact, the following observations are made.Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. No pathologic marrow replacement, edema or enhancement is seen.The visualized distal spinal cord, conus and nerve roots of the cauda equina are within normal limits. No pathologic intradural or epidural enhancement is seen. There is prominence of the epidural fat in the sacral region, likely of no clinical significance.Mild disc degeneration is seen at L4-5 with slight lateral bulging. No significant spinal canal or foraminal stenosis is observed. Mild to moderate facet arthropathy is evident at L4-5 and L5-S1.

Output: 1.Mild disc degeneration is seen at L4-5 with mild to moderate facet arthropathy at L4-5 and L5-S1.2.No significant spinal canal or foraminal stenosis is seen. No other specific findings are evident to account for the patient's symptoms.