Instruction: Generate impression based on findings.

Input: 75 year-old female with NSTEMI am diffuse coronary disease on OSH cath. MRI requested to assess for perfusion defects and viability. MEDICATIONS: ASA, atorvastatin, bumetanide, carvedilol, clopidogrel, nifedipine. First Pass PerfusionDuring hyperemia, no perfusion defects were present. Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 61%, the LV end diastolic volume index is 69 ml/m2 (normal range: 65+/-11), the LVEDV is 1335 ml (normal range 109+/-23), the LV end systolic volume index is 27 ml/m2 (normal range 18+/-5), the LVESV is 53 ml (normal range 31+/-10), the LV mass index is 42 g/m2, and the LV mass is 81 g. There are no regional wall motion abnormalities present. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 57%, the RV end diastolic volume index is 76 ml/m2 (normal range 69+/-14), the RVEDV is 148 ml (normal range 110+/-24), the RV end systolic volume index is 33 ml/m2 (normal range 22+/-8), and the RVESV is 64 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is mild pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsThree pulmonary veins were seen entering the left atrium. The right lower pulmonary vein was not visualized.Pulmonary ArteryThe main pulmonary artery is mildly dilated (33 mm).Venous AnatomyThe SVC and IVC drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsBilateral axillary lymphadenopathy noted. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. No perfusion defects/ "ischemia" present during hyperemia.2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and systolic function (LVEF 61%).4. Normal RV size and systolic function (RVEF 57%).I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 36-year-old female with facial osteomyelitis, fevers, enhancing liver lesions, and pancreatic thickening. Currently with abdominal pain, high inflammatory markers. Please perform MRI/MRCP given elevation of alkaline phosphatase and prior abnormal pancreas. ABDOMEN:LIVER, BILIARY TRACT: Mild central intrahepatic biliary ductal dilatation is noted. No discrete lesion is identified. Normal common bile duct.In hepatic segment 5, there is a 0.9 x 1.2 cm hypoenhancing lesion (axial series 13 image 164) that also demonstrates intralesional fat (axial series 1100 image 59). This lesion is faintly hypointense on the precontrast T1 fat-saturated series (axial series 11 image 59). No restricted diffusion.In hepatic segment 4B, there is 3.9 x 1.6 cm hypoenhancing lesion (axial series 13 image 186). This lesion is isointense on the T1 precontrast series. No restricted diffusion.SPLEEN: No significant abnormality noted.PANCREAS: No pancreatic ductal dilatation. No parenchymal abnormality.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.There are 2 hypoenhancing hepatic lesions. The smaller lesion in segment 5 is favored to represent an adenoma, and the larger lesion in segment IVb could represent an adenoma versus an FNH.2.Mild central intrahepatic biliary ductal dilatation. No discrete lesion is identified. Comparison with prior outside imaging would be helpful.3.No pancreatic abnormality is identified.


Instruction: Generate impression based on findings.

Input: SLE, 3rd lifetime seizures, provoked by URI. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma, including the hippocampi, appears unremarkable. There is a small pontine developmental venous anomaly. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is mild mucosal thickening in the left maxillary sinus.

Output: No evidence of potential seizure foci.


Instruction: Generate impression based on findings.

Input: Right facial weakness. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are numerous foci of high T2 signal in the supratentorial and infratentorial white matter. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is a nonspecific subcentimeter nodule in the right parietal scalp. The skull, orbits, and scalp soft tissues are otherwise unremarkable. There is diffuse paranasal sinus mucosal thickening and secretions, including air-fluid levels in the left maxillary sinus.

Output: 1. Numerous foci of high T2 signal in the supratentorial and infratentorial white matter are nonspecific, but may represent chronic small vessel ischemic disease, for example. Otherwise, no evidence of intracranial hemorrhage, mass, or cerebral edema.2. Evidence of acute sinusitis.


Instruction: Generate impression based on findings.

Input: Alcoholic hepatitis. ABDOMEN:LIVER, BILIARY TRACT: Noncirrhotic liver morphology. No focal hepatic lesions. No biliary ductal dilation. Normal appearance of the gallbladder.SPLEEN: No splenomegaly. The splenic vein is attenuated at the splenic hilum, similar to the prior study.PANCREAS: There is mild pancreatic atrophy, particularly at the tail. Punctate fluid intensity signal in the pancreatic tail may represent residual fluid from the prior pseudocyst seen on 3/15/13 or possibly very small side branch IPMNs. No enhancing lesion seen. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small hiatal hernia. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. No ascites.

Output: 1. No evidence of cirrhosis or focal hepatic lesion. 2. No MR evidence of acute pancreatic abnormality. Mild pancreatic atrophy, particularly at the tail. Punctate fluid intensity signal in the pancreatic tail may represent residual fluid from the prior pseudocyst seen on 3/15/13 or possibly very small side branch IPMNs. No enhancing lesion seen.


Instruction: Generate impression based on findings.

Input: Acoustic schwannoma: Radiosurgery planning. There is a heterogeneously enhancing left cerebellopontine angle cistern mass with extension into the internal auditory canal, which measures up to approximately 25 mm. The tumor also contains scattered foci of susceptibility effect likely related to chronic microhemorrhages. There is no significant mass effect upon the adjacent parenchyma. There is no evidence of acute infarct. There are mild nonspecific scattered foci of high T2 signal in the cerebral white matter. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and mastoid air cells are grossly unremarkable. There are scattered paranasal sinus secretions. There is a right occipital scalp lipoma that measures up to 6 mm in thickness.

Output: Pre-treatment planning MRI demonstrates a left vestibular schwannoma that measures up to approximately 25 mm.


Instruction: Generate impression based on findings.

Input: Male, 66 years old, with metastatic thyroid cancer to the brain, follow-up examination. Evidence is seen compatible with prior lesion resection from the left inferior parietal lobule. Mild T2 hyperintensity and hemosiderin staining at the resection site are unchanged. No pathologic enhancement is seen at this location.A 5 mm enhancing lesion with susceptibility effect in the left superior parietal lobule is unchanged. A 3 mm focus of enhancement in the left postcentral gyrus is unchanged. A vague 3 mm focus of enhancement in the right middle frontal gyrus is unchanged from prior. A nonenhancing focus of susceptibility along the right caudate head is unchanged.No areas of new pathologic enhancement or parenchymal signal abnormality are seen. No evidence of significant edema or mass effect is detected. The ventricles are stable and normal in size.

Output: 1.Stable postoperative findings in the left inferior parietal lobule with no evidence of residual or recurrent metastatic tumor.2.Small enhancing foci within the left superior parietal lobule, the left postcentral gyrus and the right middle frontal gyrus are unchanged. No new intracranial lesions are seen.


Instruction: Generate impression based on findings.

Input: 56 year old woman with history of lung cancer, new renal lesion, and progressive generalized weakness. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. The brain parenchyma is unremarkable for age. The major flow-voids are preserved.Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: 1.Incomplete study due to patient's inability to tolerate the examination.2.No gross evidence of intracranial metastasis, hemorrhage, or acute infarct.


Instruction: Generate impression based on findings.

Input: Clinical question: Reason for low back and bilateral leg pain. Signs and symptoms: Symptoms of lumbar spinal stenosis. Nonenhanced lumbar MRI:Lower most visualized thoracic spine and thoracic cord from T9 inferiorly demonstrate no pathology.T12-L1 is unremarkable with the exception of mild degenerative changes.L1-L2 demonstrate moderate disc disease, loss of disc height and moderate bilateral ligamentum flavum and mild facet hypertrophy. No spinal stenosis or neural foraminal compromise.L2-L3 demonstrate mild disc disease and loss of disc height, moderate bilateral ligamentum flavum and mild facet hypertrophic changes. No spinal stenosis or neural foraminal compromise.L3-L4 demonstrate mild disc disease with loss of disc height, mild broad-based bulging disc, moderate bilateral ligamentum flavum hypertrophy and mild facet disease. Constellation of findings result in mild central spinal stenosis and moderate right neural foraminal compromise. There is a central and right paramedian tiny annular fissure present.L4-L5 demonstrate mild to moderate disc disease and loss of disc height, broad-based bulging disc, moderate bilateral ligamentum flavum and facet hypertrophic changes. Findings result in mild central spinal stenosis, moderate left neural foraminal and lateral recess and mild to moderate right neural foraminal compromise.L5-S1 demonstrate moderate disc disease, loss of disc height, moderate ligamentum flavum and mild facet hypertrophic changes. No spinal stenosis, mild bilateral neural foraminal compromise.Unremarkable. Spinal soft tissues.

Output: 1.Degenerative changes at L3-L4 and L4-L5 levels with resultant mild central spinal stenosis.2.Mild to moderate neural foraminal and lateral recess compromise as detailed per level above.


Instruction: Generate impression based on findings.

Input: Male 47 years old Reason: Shoulder pain possible RC tear. Motion artifact as well as internal rotation of the humeral head degrades image quality within multiple sequences which limits interpretation.ROTATOR CUFF: There is intermediate signal intensity within the supraspinatus tendon consistent with moderate tendinosis. There is full thickness tearing of the supraspinatus tendon with retraction of approximately 2.0 cm and some intact posterior fibers. There is atrophy of the supraspinatus muscle at the myotendinous junction subjacent to the acromioclavicular joint. There is intermediate signal intensity within the infraspinatus tendon consistent with moderate tendinosis and small foci of interstitial tearing. The teres minor tendon and muscle are unremarkable. There is diffuse thickening and intermediate signal within the subscapularis tendon, most marked in the superior tendon fibers consistent with tendinosis.SUPRASPINATUS OUTLET: There is an os acromiale with a small hook osteophyte on the lateral margin of the ossicle. Moderate/severe osteoarthritis affects the acromioclavicular joint. There is trace fluid in the subacromial subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral joint alignment is within normal limits. The labrum is diminutive but appears grossly intact within the limitations on this non-arthrographic study.BICEPS TENDON: There is diffuse thickening and intermediate signal within the long head of the biceps tendon consistent with tendinosis.ADDITIONAL

Output: 1. Full thickness tearing of the supraspinatus tendon on a background of moderate tendinosis. 2. Infraspinatus, subscapularis and long head of the biceps tendinosis.3. Osteoarthritis of the acromioclavicular joint.4. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Clinical question: Lumbar stenosis. Signs and symptoms : Low back pain and leg pain. Nonenhanced lumbar MRI:There is normal anatomical alignment the vertebral column. There is unremarkable signal intensity of vertebral column other than changes related to degenerative disease.Unremarkable lower most visualized thoracic spine and thoracic cord.T12 -- L1 is unremarkable.L1 -- L2 is unremarkable.L2 -- L3 is unremarkable with the exception of mild degenerative changes.L3 -- L4 demonstrate mild disk disease and loss of disk height, mild bilateral ligamentum flavum hypertrophy and minimal facet disease. No spinal stenosis or neural foraminal compromise.L4 -- L5 demonstrate mild disk disease and loss of disk height, moderate bilateral ligamentum flavum and facet hypertrophy changes as well as bilateral facet diffusion. No spinal stenosis or neural foraminal compromise.L5 -- S1 demonstrate advanced disk disease and significant loss of disk height, moderate bilateral facet and ligamentum flavum hypertrophy. No evidence of central spinal stenosis. There is however moderate to severe left and mild to moderate right neural foraminal compromise.Perispinal soft tissues demonstrate no abnormalities. Incidental note is made of a small single locule superficially located left renal cyst.

Output: 1.Degenerative changes of the lumber spine primarily at L4 -- L5 and at L5 -- S1 level as detailed.2.Neuroforaminal compromise at L5 -- S1 and unremarkable at other levels as detailed per level.3.No evidence of central spinal stenosis at any level.


Instruction: Generate impression based on findings.

Input: 69 years Female (DOB:7/13/1947)Reason: stroke? History: ischemia on CT, ams, word finding difficulty, L sided neglectPROVIDER/ATTENDING NAME: AGNIESZKA ANNA ARDELT AGNIESZKA ANNA ARDELT There is diffusion restriction present involving the right parietal lobe including superior and inferior parietal lobules as well as some of the adjacent right temporal lobe at the posterior aspect of the right superior temporal gyrus and the posterior aspect of the right insular cortex. Additional diffusion restriction is present along the right paracentral lobule and posterior aspects of the right cingulate gyrus. These same areas are hyperintense on FLAIR MRI have some adjacent cerebral swelling and leptomeningeal enhancement.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.On susceptibility imaging there is a low signal focus present along the right orbital gyrus associated with surrounding T2 and FLAIR signal hyperintensity as well as some associated T1 signal hyperintensity but no significant contrast enhancement at this timeNormal 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: Subacute infarction involving the right posterior parietal and angular artery territories as well as part of the callosomarginal artery territory.Is a hemorrhagic focus present along the right orbital gyrus which appears to represent a recent hemorrhage in a typical location for trauma related contusion.


Instruction: Generate impression based on findings.

Input: 73-year-old female with right upper quadrant pain, history of Roux-en-Y ABDOMEN:LIVER, BILIARY TRACT: No focal liver lesions are present.The gallbladder is mildly distended with layering cholelithiasis. There is mild thickening/edema of the gallbladder wall. There is choledocholithiasis with dilation of the common bile duct measuring up to 11 mm. At least two stones are visualized measuring up to 5 mm. There is mild enhancement of the bile duct walls. There is no intrahepatic biliary ductal dilatation. The pancreatic duct is normal in caliber.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts with the largest measuring 3.8 x 2.8 cm and the right superior pole. Mild mucosal enhancement of the left upper pole calyx. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Small ventral abdominal rectus defect in the left paramedian region.OTHER: No significant abnormality noted.

Output: 1.Choledocholithiasis as described above. 2.Cholelithiasis with mild gallbladder distention and wall edema/thickening without pericholecystic fluid. No overt evidence of acute cholelithiasis.3.Mild mucosal enhancement of the left upper pole calyx. Findings may reflect inflammation, infection, or possibly neoplasm. Correlate for hematuria or atypical cells in urine.


Instruction: Generate impression based on findings.

Input: 49 year old man with NICM and VT, referred for evaluation of underlying scar. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 30%, the LV end diastolic volume index is 152 ml/m2 (normal range: 74+/-15), the LVEDV is 324 ml (normal range 142+/-34), the LV end systolic volume index is 106 ml/m2 (normal range 25+/-9), the LVESV is 226 ml (normal range 47+/-19), the LV mass index is 63 g/m2 (normal range 85+/-15), and the LV mass is 135 g (normal range 164+/-36). LV dysfunction is global. There is a mid-wall stripe pattern of late gadolinium enhancement involving the basal to mid septum. There is also epicardial late gadolinium enhancement of the basal inferior and inferolateral walls. These findings are atypical for prior myocardial infarction and suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. Much of the anterior and anterolateral wall is not well seen due to artifact from the ICD.Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 57%, the RV end diastolic volume index is 93 ml/m2 (normal range 82+/-16), the RVEDV is 198 ml (normal range 142+/-31), the RV end systolic volume index is 40 ml/m2 (normal range 31+/-9), and the RVESV is 85 ml (normal range 54+/-17).Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Severe LV dilation with severely reduced systolic function (LVEF 30%). 2. There is a mid-wall stripe pattern of late gadolinium enhancement involving the basal to mid septum. There is also epicardial late gadolinium enhancement of the basal inferior and inferolateral walls. These findings are atypical for prior myocardial infarction and suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. Much of the anterior and anterolateral wall is not well seen due to artifact from the ICD. This pattern of late gadolinium enhancement has been described in dilated cardiomyopathy and also old myocarditis. 3. Normal RV size and systolic function (RVEF 57%). I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 67-year-old male with a history of transient alteration of awareness and subdural hematoma on outside hospital examination. Follow up examination. There is encephalomalacia of the right superior frontal gyrus. These findings are consistent with the patient's history of right superior frontal infarct. There is no evidence of intracranial hemorrhage, mass or edema. Additionally, there are age indeterminant multiple scattered hypodensities in the periventricular and deep white matter. These findings are nonspecific and likely represent small vessel ischemic disease, however, if acute infarct remains a clinical concern further evaluation with MRI could be considered.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. No evidence of acute territorial infarct, intracranial hemorrhage, mass or edema.2. Encephalomalacia in the right superior frontal gyrus secondary to prior ischemic infarct.3. Age indeterminant multiple scattered hypodensities in the periventricular and deep white matter bilaterally. These findings are nonspecific and likely represent small vessel ischemic disease, however, if acute infarct remains a clinical concern further evaluation with MRI could be considered.


Instruction: Generate impression based on findings.

Input: Pelvic/hip pain with negative x-rays. Evaluate for abnormality to account for pain. Per conversation with ordering physician, though not included on the history request, concern for mass lesion status post lumbar MRI. Study was performed with contrast for this reason. The right hip joint is anatomically situated within the right acetabulum without evidence of femoral neck or pelvic fracture. Hip joint space is relative well-preserved and there are no large marginal osteophytes. Sacral arcuate lines are intact without CT evidence for insufficiency fracture. Degenerative spurring is noted at the pubic symphysis and there is vacuum gas and spurring at the SI joints indicating mild degenerative change.There is no mass lesion within the pelvis or hip girdles. There are no enlarged lymph nodes.The adductor, hamstring and gluteal musculature are within normal limits for CT technique.Non-specific stranding is noted in the posterior subcutaneous soft tissues on the most inferior CT cut on the left, perhaps denoting mild inflammation.Moderate to severe disk and endplate degenerative changes are noted at L4 L5 and L5-S1 with broad based disk bulges. No neuroforaminal compromise is appreciated on the sagittal images, but correlation with recent MRI of the lumbar spine is advised.

Output: 1.No evidence of mass lesion or other pathology to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: 70-year-old female with recent fall, hip pain ACETABULAR LABRUM: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: There is a an abnormal signal intensity in the right ischium compatible with a nondisplaced fracture with surrounding soft tissue edema. Additional signal abnormality in the left pubic bone near the pubic symphysis is also compatible with a nondisplaced fracture with surrounding soft tissue edema. Small amount of fluid in the right hip join with no frank effusion. SOFT TISSUES: Soft tissue edema surrounding the fracture sites as described above. ADDITIONAL

Output: Nondisplaced fractures of the right ischium and left pubic bone near the pubic symphysis as above. Findings were discussed with Dr. Velamati by phone on 5/14/2015 at 11:20 AM.


Instruction: Generate impression based on findings.

Input: MS flare versus new ischemia. There is redemonstration of multiple hyperintense T2/FLAIR foci in the periventricular region. Two large lesions are seen in the right peri-atrial white matter, which demonstrates progressive T1 hypointensity, suggestive of chronic evolution and tissue loss. A high T2 signal lesion is seen in the splenium and posterior aspect of the corpus callosal body. High T2 signal is also seen in the hypothalamus, left greater than right. Additional high T2 signal is seen in the left periventricular region of the temporal horn with tiny lesions in the right greater than left cerebellum. There are a few subcortical high signal lesions. There is high T2 right cerebellar peduncle. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable. There is interval progression of mucosal thickening of the visualized paranasal sinuses. There is a partially empty sella.

Output: 1. Multiple scattered white matter lesions without significant interval change. No enhancing lesion to suggest active demyelination.2. No evidence of acute intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: Cervical spine:There is mild straightening of the normal cervical lordosis. There is diffuse heterogeneity of the bone marrow signal. The cervical cord is normal in signal without abnormal enhancement. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable.C1/2: No significant canal stenosis.C2/3: No significant canal or neural foraminal stenosis.C3/4: No significant canal or neuroforaminal stenosis.C4/5: No significant canal stenosis. Mild bilateral uncovertebral hypertrophy without neural foraminal stenosis.C5/6: No significant canal stenosis. Mild right uncovertebral hypertrophy without neural foraminal stenosis.C6/7: Degenerative disc disease with a posterior disc osteophyte complex causing mild canal stenosis. There is marked right and moderate left uncovertebral hypertrophy causing moderate to severe right and moderate left neural foraminal stenosis.C7/T1: No significant canal or neuroforaminal stenosis.Thoracic spine:There is a smooth, physiologic thoracic kyphotic curve. There is mild anterior wedging of the T12 vertebral body without significant internal T2 signal abnormality. There is endplate irregularity of multiple lower thoracic vertebra consistent with degenerative changes. A nonenhancing focus abutting the inferior endplate of T7 with high T1 and low T2 signal is suggestive of a degenerative Schmorl's node as well as herniated disc material within the superior endplate of T12 . Marrow signal intensity is slightly heterogeneous throughout the thoracic spine. There are no masses or abnormal enhancement. The spinal cord has a smooth contour and is without focal atrophy, edema, or myelomalacia. T1/2 demonstrates no significant disc bulge or cord encroachment.T2/3 demonstrates no significant disc bulge or cord encroachment. T3/4 demonstrates no significant disc bulge or cord encroachment. T4/5 demonstrates no significant disc bulge or cord encroachment. T5/6 demonstrates no significant disc bulge or cord encroachment.T6/7 demonstrates a small central disc protrusion which causes mild flattening of the cord without internal signal abnormality.T7/8 demonstrates no significant disc bulge or cord encroachment. T8/9 demonstrates no significant disc bulge or cord encroachment. T9/10 demonstrates no significant disc bulge or cord encroachment.T10/11 demonstrates no significant disc bulge or cord encroachment. T11/12 demonstrates no significant disc bulge or cord encroachment. T12/L1 demonstrates no significant disc bulge or cord encroachment. Lumbar spine:Alignment is anatomic. There are no fractures or subluxations. There is diffuse heterogeneity of the bone marrow. Endplate irregularity of the upper lumbar vertebral bodies compatible with degenerative disc disease. The conus is normal in signal and morphology and terminates at an appropriate level. There is a small linear focus of fat within the filum terminale from L2-L3. The visualized intra-abdominal and paraspinal contents are unremarkable. There is no abnormal enhancement.L1/2: Mild posterior disc bulge and ligamentum flavum hypertrophy cause mild canal stenosis. No significant neural foraminal stenosis.L2/3: No significant canal stenosis. Mild right greater than left ligamentum flavum hypertrophy with mild right foraminal stenosis.L3/4: Mild ligamentum flavum hypertrophy without significant canal or neural foraminal stenosis. L4/5: Bilateral ligamentum flavum hypertrophy with mild right neural foraminal stenosis. No significant canal stenosis.L5/S1: No significant canal or neural foraminal stenosis.

Output: 1. Multilevel spondylosis of the cervical, thoracic ,and lumbar spine with a small disc protrusion at T6/T7 causing mild flattening of the cord without intrinsic cord signal abnormality.2. Mild chronic anterior wedging of the T12 vertebral body.3. Small linear fatty lesion within the filum terminale.4. Diffuse bone marrow heterogeneity, however, without suspicious findings on STIR imaging. This is felt to represent a benign process; the differential diagnosis most likely includes anemia of any cause and/or chronic smoking.


Instruction: Generate impression based on findings.

Input: 45 years, Male, Reason: hepatocellular carcinoma History: history of hepatitis C, multiple liver lesions seen on abdominal US. ABDOMEN:LUNG BASES: Right upper lobe airspace opacity was not seen on the prior CT and may represent progression of air space disease.LIVER, BILIARY TRACT: Small amount sludge within the gallbladder. Hepatomegaly. Mild perihepatic ascites. Mildly cirrhotic contour.Enhancing heterogeneous lesion expanding the left hepatic lobe, primarily in segments 2 and 3, but also involving segment 4 demonstrates washout, compatible with hepatocellular carcinoma. There is also a foci of fat present within the lesion. The left portal vein enters the left hepatic lobe mass and is not well seen, likely thrombosed. The left hepatic vein is also not well seen and may be occluded. The remaining portal system is normal.There are additional lesions in the right hepatic lobe which demonstrates enhancement and washout also compatible with hepatocellular carcinoma. For example, right segment 7 lesions measure 1.5 x 1.6 cm (1201/257) and 1.9 x 1.7 cm (1201/269). There are a few smaller enhancing lesions with mild washout (1202/248 and 292). SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple left-sided simple cysts. Additional T2 hyperintense lesions are too small to characterize.RETROPERITONEUM, LYMPH NODES: Mildly enlarged periportal node measures 1.1 x 1.1 cm (1001/26). Mildly enlarged left para-aortic node measures 1.4 x 1.07 m (1001/25).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Gynecomastia.

Output: 1.Findings compatible with multifocal hepatocellular carcinoma.2.Mild retroperitoneal lymphadenopathy.3.Right upper lobe air space opacities are new from prior CT.


Instruction: Generate impression based on findings.

Input: SIRS, bacteremia. Presence of effusion? Concern for septic arthritis. A marker was placed along the dorsal aspect of the wrist. There is reticulation of the subcutaneous fat of the dorsal aspect of the wrist, and to lesser degree the volar aspect of the wrist, indicating edema. I see no discrete fluid collection within the subcutaneous tissues to suggest an abscess.A small amount of fluid is present within the dorsal recesses of the radiocarpal and midcarpal joints, and there is thin synovial enhancement within these compartments and to a lesser degree within the distal radioulnar joint. Small low signal intensity defects are noted within multiple carpal bones on the T1-weighted images, some of which show mild enhancement following gadolinium administration; however, I see no frank edema within any of the carpal bones. There is mild enhancement surrounding the flexor tendons within the distal forearm and carpal tunnel suggesting additional inflammation. The extensor tendons are unremarkable. There is mild enhancement of the synovium of the first carpometacarpal joint which is nonspecific and could be degenerative in etiology.Please note that this study was not protocoled for detailed evaluation of the small intrinsic structures of the wrist, but I see no specific findings to suggest a tear of the scapholunate lunotriquetral ligaments. Intermediate signal intensity within the triangular fibrocartilage likely reflects tearing near its radial attachment and ulnar attachments.

Output: 1.Superficial soft tissue edema predominantly along the dorsal aspect of the wrist without evidence of abscess.2.Findings suggestive of a mild inflammatory arthritis of the wrist. This is nonspecific and I cannot exclude the possibility of a septic arthritis, although the lack of significant bone marrow edema would argue against a septic joint. Small enhancing defects/erosions within multiple carpal bones are noted which I suspect are chronic in etiology.3.Other findings as above.


Instruction: Generate impression based on findings.

Input: New diagnosis of adenocarcinoma of lung; staging MRI of brain. There are multiple, approximately 20, ring-enhancing supratentorial and infratentorial lesions. For example, the largest supratentorial lesion is located in the left occipital lobe and measures up to 18 mm and the largest infratentorial lesion is located in the right cerebellar hemisphere and measures up to 12 mm. There is no significant associated vasogenic edema and no evidence of acute intracranial hemorrhage. There is a background of mild scattered nonspecific foci of cerebral white matter T2 hyperintensive, but no evidence of acute infarct. The ventricles and sulci are mildly prominent diffusely due to cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and paranasal sinuses are grossly unremarkable. There is a left occipital scalp lipoma that measures 5 mm in thickness.

Output: Multiple supratentorial and infratentorial lesions are compatible with metastases, but no evidence of midline shift or acute intracranial hemorrhage.Discussed with Dr. Maitland at 11 AM on 5/13/15.


Instruction: Generate impression based on findings.

Input: 33-year-old male with pain and swelling along the lateral aspect of foot TENDONS: There is increased signal intensity within the peroneus brevis tendon as it courses distal to the fibular tip, indicating moderate tendinosis. The tendon also appears abnormally flattened posterior and distal to the fibular tip, which we suspect represents incomplete longitudinal tearing. Fluid within the peroneal tendon sheath indicates mild tenosynovitis. A small amount of fluid extends distally along the peroneus longus tendon sheath, which otherwise appears intact. A small amount of fluid within additional medial tendon sheaths we suspect is of no current clinical significance. The tendons themselves appear normal. Fluid within the tibialis anterior tendon sheath may represent mild tenosynovitis. The tendon itself appears normal.LIGAMENTS: The ATFL and PTFL are intact. The calcaneofibular ligament appears slightly thickened, perhaps due to tendinopathy involving the adjacent peroneal tendon. The visualized tibiofibular ligaments appear intact. The visualized components of the deltoid ligament appear intact.ARTICULAR SURFACES AND BONE: We see no fracture or osteochondral defect. The bone marrow signal is within normal limits.

Output: Tendinosis and partial longitudinal tearing of the peroneus brevis with associated tenosynovitis and other findings as described above.


Instruction: Generate impression based on findings.

Input: The extensive white matter T2 hyperintense lesions are stable to perhaps minimally progressed in the superior frontal gyri. There is unchanged encephalomalacia with prominent perivascular spaces within the left parietal white matter. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are stable in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is mucosal thickening of the left maxillary sinus. The orbits, skull, and scalp soft tissues are unremarkable.

Output: Stable to minimal progression of the demyelinating lesions in the brain without specific findings to suggest PML.


Instruction: Generate impression based on findings.

Input: Female 53 years old Reason: Evaluate for ligament or meniscus injury History: L knee pain/injury with gait instability MENISCI: Blunting of the medial meniscus with a complex tear of the posterior horn, consisting of a horizontal cleavage tear with an associated vertical component. The anterior horn of the lateral meniscus is obscured by metallic artifact. Anterior to the joint, at the fat pad of Hoffa there is considerable metallic artifact which may be concealing arthrofibrosis or a Cyclops lesion.ARTICULAR CARTILAGE AND BONE: There is severe thinning of the patellofemoral cartilage particularly overlying the lateral facet. There is mild thinning of the cartilage in the medial and lateral joint compartments however no full-thickness defect is identified.LIGAMENTS: Evaluation of the ACL autograft is limited by metallic artifact. Within this limitation the autograft appears to be impinging on the roof of the intercondylar notch with at least a partial ACL tear. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Complex tear of the posterior horn of the medial meniscus.2. The ACL autograft appears to be impinging on the roof of the intercondylar notch with at least a partial ACL tear. 3. Metallic artifact anterior to the joint at the fat pad of Hoffa may be concealing arthrofibrosis or Cyclops lesion.4. Severe thinning of the patellofemoral cartilage.4. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Right shoulder pain ROTATOR CUFF: No rotator cuff atrophy or tear.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: No focal defect within the superior labrum suggests a SLAP tear. Minimal surface irregularity involving the superior labrum near the biceps anchor without discrete tear.BICEPS TENDON: Biceps tendon is normal in signal and morphology. ADDITIONAL

Output: Normal MR arthrogram of the right shoulder.


Instruction: Generate impression based on findings.

Input: CLL and MDS admitted for worsening anemia and found with disease evolution to AML. Co-morbid conditions include CHF, SLE and Renal Transplantation. Course complicated by extremely poor functional status and delirium. There are subcentimeter foci of high T2 signal with mildly restricted diffusion, but no enhancement, within the left frontal lobe, in a linear trajectory. There are otherwise a few scattered nonspecific foci of high T2 signal within the cerebral white matter bilaterally. There is a left paraclinoid dural-based enhancing mass that measures up to 17 mm. There is no evidence of intracranial hemorrhage. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is moderate mucosal thickening in the right maxillary sinus.

Output: 1. Subcentimeter foci of high T2 signal with mildly restricted diffusion, but no enhancement, in a linear trajectory within the left frontal lobe, may represent recent infarcts rather than a neoplastic process.2. A left paraclinoid dural-based enhancing mass that measures up to 17 mm likely represents a meningioma.


Instruction: Generate impression based on findings.

Input: History of prostate cancer, status post radical prostatectomy in 2011 (pT3aN0) with detectable PSA. PELVIS:PROSTATE: Status post prostatectomy. There is a subtle 2-3 mm irregular nodularity at the vesicoureteral anastomosis on the right, which is best seen on the axial T2 series (series 501 image 40). No definite corresponding abnormality is identified on the postcontrast images.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Status post prostatectomy. A subtle 2 to 3 mm irregular nodularity at the right vesicoureteral anastomosis could represent a small focus of recurrence.


Instruction: Generate impression based on findings.

Input: There is minimal retrolisthesis of C3 on C4. There is mild anterolisthesis of C5 on C6. There is ankylosis involving the facet joints bilaterally at C4-C5. There is otherwise normal alignment of the vertebral bodies. Bone marrow signal is benign. Small focus of T1 and T2 hyperintensity in the dense is consistent with a small focus of fat or hemangioma. No cord signal abnormality.There are multilevel degenerative changes with multilevel disc osteophyte complexes, individual levels as below:At the level of C2-C3 there is a broad-based disc bulge. There is hypertrophy of the ligamentum flavum. There is facet arthropathy. No significant spinal canal stenosis. Minimal left neural foraminal narrowing. No significant right neural foraminal narrowing.At the level of C3-C4 there is a moderate disc bulge with mild-to-moderate spinal stenosis. There is hypertrophy of the ligamentum flavum. There is mild facet hypertrophy. Mild uncovertebral hypertrophy is seen. There is mild bilateral neural foraminal stenosis.At the level of C4-C5 there is no disc bulge and no spinal or neural foraminal compromise.At the level of C5-C6 there is minimal spinal stenosis related to small disc osteophyte complex and hypertrophy of the ligamentum flavum. There is mild to moderate narrowing of the bilateral neural foramina.At the level of C6-C7 there is no spinal stenosis. Left paracentral disc disc osteophyte complex and uncovertebral hypertrophy. There is also left facet hypertrophy with mild to moderate left neural foramina compromise.At the level of C7-T1 there is left facet hypertrophy with no evidence of spinal stenosis or neural foraminal compromise. Left-sided perineural cyst incidentally noted.

Output: Multilevel degenerative changes in the cervical spine with up to mild to moderate spinal canal stenosis at the C3-C4 level. No cord signal abnormality. There is neural foraminal stenosis at multiple levels as detailed 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: Follow-up hypoechoic lesion seen on ultrasound. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology and size. It measures 15.8 cm in the craniocaudal dimension. No focal suspicious lesion. No biliary ductal dilatation. The gallbladder is normal in appearance. There is mild signal loss on out of phase imaging compatible with steatosis.SPLEEN: The spleen is normal in size, morphology and signal intensity without a focal lesion.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left renal subcentimeter simple cyst. Mild right renal cortical scarring. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Steatosis without a focal suspicious liver lesion.


Instruction: Generate impression based on findings.

Input: Alignment of the thoracic spine is anatomic. There is a compression deformity of the T5 vertebral body with unchanged height loss and STIR hyperintensity compared to the prior exam. There are no new acute fractures. The marrow signal is heterogeneous compatible with patient's history of multiple myeloma. Focal fatty bone marrow affects the upper thoracic spine compatible with prior radiation. There is a new small dorsal epidural hematoma at the level of T5 with new associated mild spinal canal stenosis at this level. There is no cord compression or abnormal cord signal. There is no abnormal enhancement. Additionally, there is mild facet arthropathy and ligamentum flavum calcification at T10-11 with mild spinal canal stenosis, unchanged. There is mild bilateral neural foraminal narrowing at T4-5 and T5-6, right greater than left.

Output: 1. New small dorsal epidural hematoma at the level of T5 with associated new mild spinal canal stenosis. No evidence of cord compression or cord signal abnormality. 2. Unchanged T5 compression fracture with marrow edema.


Instruction: Generate impression based on findings.

Input: 58-year-old female with a history of hypophosphatemic rickets and fracture of the tibia and fibula. Is there evidence of a mesenchymal tumor. Fractures are noted about the distal tibia and fibula with surrounding stir signal abnormality within the adjacent bone marrow and soft tissues compatible with nondisplaced fractures. There is evidence of periosteal response which indicates attempt at healing and a subacute age to the fracture. There is no mass lesion in the vicinity of the fracture within the soft tissues or within the bone to indicate a neoplastic process.

Output: Findings compatible with subacute nondisplaced distal tibial and fibular fractures with evidence of healing but without evidence of an underlying neoplasm. Plain radiographs would be helpful for further delineation of the fractures if clinically warranted.


Instruction: Generate impression based on findings.

Input: 52-year-old male, evaluate lesion in cervical spine. Evaluate for tumor in cervical spine.IMAGE ACQUISITION: Contrast-enhanced CT of the cervical spine was performed after the administration of 80 mL of Omnipaque 350 at 2.5 ml/sec. Again seen is abnormal sclerosis of the left occipital condyle, left lateral mass of C1, posterior arch of C1 with associated collapse. This was previously described on the prior CT and its overall appearance of is unchanged. Associated soft tissue and marrow abnormalities are better appreciated on the recent MRI.Also seen is a subtle focus of cortical erosion along the medial aspect of the right occipital condyle which was present retrospectively on the prior CT. This lies just lateral to a fluid signal collection much better seen by prior MR technique.The vertebral arteries are patent.There is no evidence of fracture or significant degenerative disease in the cervical spine.A new air-fluid level is present in the sphenoid sinus.

Output: 1. Abnormal sclerotic change in the left occipital condyle and left C1 vertebra which has not significantly changed from the prior study. There is also subtle cortical erosion along the medial aspect of the right occipital condyle which was also present retrospectively on the prior CT. These findings in addition to the abnormalities seen on the recent MRI are suspicious for neoplastic disease versus osteoradionecrosis. Infection is considered less likely.2. New air-fluid level in the sphenoid sinus.


Instruction: Generate impression based on findings.

Input: A patient submitted outside study for review. Submitted for review are left breast MR guided biopsy images from 7/21/2016 performed at 8:00 AM GI general surgery 10 the Park . For comparison,none are available. Left breast MR guided biopsy images were interpreted on Dyna CAD. This is not a diagnostic MRI. Right breast is not in the field of view. 2 areas were biopsied in the left breast.Lesion 1 is an oval heterogeneously enhancing mass at 12:00 position posterior depth that measures 9 x 8 x 8 mm (AP X ML X CC) and lesion 2 is area of non mass enhancement in central mid depth measuring 17 x 7 x 7 mm (AP X ML X CC) . The distance between lesion 1 and lesion 2 is approximately 16 mm. And the total extent in the AP dimension measures approximately 5 cm.Targeting appears appropriate of both these areas. As per the report clips were placed.

Output: MR guided biopsy of 2 sites in the left breast. Pathology results have not been submitted.Please submit the diagnostic MRI and other imaging such as diagnostic mammogram and ultrasound and post procedure mammogram (which was obtained as per the report) for completion of the examinationBIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: 41-year-old female with history of recurrent colon cancer. Nodularity of the vaginal cuff on pelvic exam. PELVIS:UTERUS, ADNEXA: Status post hysterectomy bilateral salpingo-oophorectomy.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: There is a triangular-shaped soft tissue focus near the right/superior aspect of the vaginal cuff which demonstrates mild enhancement measuring 10 x 7 mm (image 53 of series 100), mild adjacent tethering noted. Mild stranding of fat near left aspect of vaginal cuff also seen, however no visible nodular enhancement.Small volume ascites.

Output: Small, mildly enhancing soft tissue focus near right aspect of vaginal cuff is nonspecific and may be secondary to postoperative sequale/scarring, but recurrent disease cannot be excluded. Consider PET/CT for further evaluation as clinically warranted.


Instruction: Generate impression based on findings.

Input: A patient submitted outside study for review. Submitted for review are digital mammographic images (4/10/15), ultrasound images of right breast and right axilla (4/10/2015), images from ultrasound guided biopsy of right breast and postprocedural right mammographic images (4/16/2015), images from ultrasound guided biopsy of right axilla (4/16/2015), breast MRI (4/28/2015), images from MRI guided biopsy of both breasts and postprocedural bilateral mammographic images (5/7/2015), breast MRI (8/25/2015) performed at Silver Cross Hospital. DIGITAL MAMMOGRAPHIC IMAGES (4/10/15):The breast parenchyma is composed of scattered fibroglandular elements. A triangular marker is placed at right retroareolar region, denoting the area of palpable abnormality. There is an ill-defined, irregularly-shaped mass measuring 51 x 43 mm at right retroareolar region, associated with architectural distortions, nipple retraction and skin thickening.There are diffuse benign calcifications in the left breast.No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in left breast. ULTRASOUND IMAGES OF RIGHT BREAST AND RIGHT AXILLA (4/10/2015):An irregularly shaped hypoechoic mass is present at 11:00 position in the right breast, measuring 53 mm, corresponding to the mass on the mammogram. There is a lymph node with partially thickened cortex in the right axilla.IMAGES FROM ULTRASOUND GUIDED BIOPSY OF RIGHT BREAST AND POSTPROCEDURAL RIGHT MAMMOGRAPHIC IMAGES (4/16/2015), IMAGES FROM ULTRASOUND GUIDED BIOPSY OF RIGHT AXILLA (4/16/2015):Ultrasound guided biopsy of the right breast mass and right axillary lymph node was performed with appropriate needle placement. A marker clip is placed at anterior aspect of the right breast mass. Postprocedural right mammographic images show a marker clip at superior lateral aspect of the mass.Per outside radiology report, biopsy result of the right breast mass and right axillary lymph node was malignant, infiltrating lobular carcinoma grade 3, lobular carcinoma in situ. Right axillary lymph node was metastatic carcinoma.BREAST MRI (4/28/2015):Imaging protocol is outlined in the outside radiology report.In the right breast, there is a large irregularly shaped mass measuring 65 x 48 x 80 mm (AP x LR x CC) at anterior-middle superior breast. A marker clip is present at lateral aspect in this mass lesion. There is a suspicious enhancing focus is present at posterior 12:00 position. AP distance of this abnormal findings including this enhancing focus is 84 mm. There is a suspicious enhancing mass measuring 10 x 5 x 8 mm at anterior 7:00 position.In the left breast, there is an enhancing mass measuring 6 x 5 x 7 mm at 1:00 position.A marker clip is present within a right axillary lymph node with borderline cortical thickening. Other than this lymph node, there are no abnormal lymph nodes in either axilla.IMAGES FROM MRI GUIDED BIOPSY OF BOTH BREASTS AND POSTPROCEDURAL BILATERAL MAMMOGRAPHIC IMAGES (5/7/2015):MRI guided biopsy was performed for the enhancing mass in the right breast at anterior 7:00 position, and the enhancing mass at 1:00 position in the left breast. A marker clip for each biopsy site is present at expected location on the postprocedural mammogram. Pathology results were followings;A. RIGHT BREAST TISSUE; MRI GUIDED BIOPSY:– INFILTRATING LOBULAR CARCINOMA, NUCLEAR GRADE 3– E-CADHERIN STAIN EXAMINED AND SUPPORTS.B. LEFT BREAST; MRI GUIDED BIOPSY: – SMALL BENIGN INTRADUCTAL PAPILLOMAS, SCLEROSING ADENOSIS WITH MICROCALCIFICATIONS AND COLUMNAR CELL AND FIBROCYSTIC CHANGES– ATYPICAL LOBULAR HYPERPLASIABREAST MRI (8/25/2015):Imaging protocol is outlined in the outside radiology report.The patient presumably received neoadjuvant chemotherapy.Right breast mass becomes smaller, measuring 56 x 33 x 16 mm (previously 65 x 48 x 80 mm). An enhancing mass at posterior 12:00 position is no longer visualized in the right breast.No abnormal enhancing lesions in left breast.Biopsied right axillary lymph node becomes normal appearing.

Output: Interval imaging response of the right breast cancer with metastatic right axillary lymph node.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Reason: labral tear/dislocation History: pain ROTATOR CUFF: The rotator cuff is intact.SUPRASPINATUS OUTLET: The supraspinatus outlet is within normal limits. GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint and glenoid labrum are intact. BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: Normal-appearing shoulder without evidence of labral pathology.


Instruction: Generate impression based on findings.

Input: Diagnosis: Altered mental statusClinical question: episodic memory loss The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: MRI of the brain is within normal limits


Instruction: Generate impression based on findings.

Input: 71-year-old female with history of melanoma. Metastatic melanoma liver lesion. Evaluate post-chemoembolization. ABDOMEN:LIVER, BILIARY TRACT: Innumerable bilobar T2 hyperintense lesions that demonstrate restricted diffusion and are compatible with metastatic disease. Some of these lesions are T1 hyperintense on the precontrast series compatible with the history of melanoma. Index lesion measurements listed below. The hepatic vessels are compressed but patent. These lesions are relatively stable in number compared to to the partially visualized liver on the 10/15/2016 CT chest exam.Since the right hepatic chemoembolization, some right-sided lesions demonstrate no postcontrast enhancement, and others show peripheral enhancement, and some still demonstrate solid enhancement. These findings are likely related to posttreatment effect.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left lower pole renal cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: There are T1 hyperintense lesions in the iliac bones and lower lumbar spine that demonstrate contrast enhancement on the subtraction series (series 12 images 7, 12, 15, 23, 27) (series 10012 images 6, 11, 16, 23, 27), compatible with unchanged osseous metastatic disease compared to the 11/29 2016 MRI lumbar and pelvic exams.OTHER: No significant abnormality noted.INDEX LESION MEASUREMENTS (Current exam date/time: 12/20/2016 09:00:00)SEGMENT 7 LESION: 2.1 x 1.7 cm (Image 12, Series 9).

Output: 1.Innumerable bilobar hepatic lesions compatible with metastatic disease. Some lesions are apparently T1 hyperintense and compatible with the history of melanoma.2.Since the right hepatic chemoembolization, some right-sided lesions demonstrate no postcontrast enhancement, and others show peripheral enhancement, and some still demonstrate solid enhancement. These findings are likely related to posttreatment effect.3.Unchanged osseous metastatic disease in the pelvis and lower lumbar spine.


Instruction: Generate impression based on findings.

Input: 51-year-old female with knee pain. The knee appears normal for age without findings to account for patient's pain. Soft tissue opacity posterior to the knee likely represents Baker's cyst seen on recent MRI. We otherwise see no findings to account for patient's pain.

Output: Baker's cyst without further findings to account for patient's pain. Please refer to recent MRI for further findings.


Instruction: Generate impression based on findings.

Input: There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. There are no restriction or diffusion abnormalities. Ventricular size is normal. There is no evidence of hemorrhage, mass effect, or edema.Paranasal sinuses and mastoid cells are clear.Vascular flow voids are normal.There is bilateral lens prosthesis.

Output: 1. No evidence of hemorrhage, mass effect, or edema. No evidence for acute ischemic cerebral infarction.2. Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: Glioblastoma 1mnth post RT/TMZ MRI. There are postoperative findings related to right transfrontal biopsy. There is overall interval increase in size of the multiple lesions within the bilateral cerebral hemispheres. For example, the dominant right frontal lobe mass now measures up to 54 mm, previously 51 mm, and a left occipital lobe lesion measures up to 14 mm, previously 8 mm. The edema associated with many of the lesions is slightly increased or at least persists and there is 8 mm of midline shift to the left. The ventricles are not significantly changed in size. There is no evidence of acute infarction. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are unchanged.

Output: Overall interval increase in size of the multifocal glioblastoma.


Instruction: Generate impression based on findings.

Input: 43-year-old woman with history of right upper quadrant pain, leukocytosis, and common duct dilation on ultrasound. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in signal and morphology. The common bile duct is dilated up to 8 mm in diameter. There is no significant intrahepatic biliary ductal dilatation. There is an 8 mm round filling defect in the distal common bile duct (601/79). No stone in the ampulla.Additionally, the gallbladder is full of stones of varying size including a 21 mm stone at the gallbladder neck (401/29). The gallbladder is distended with small amount of pericholecystic fluid.SPLEEN: No significant abnormality noted.PANCREAS: The pancreas is normal with nondilated pancreatic duct.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: 16 mm T1 hyperintense, T2 hypointense lesion in the upper pole of the left kidney (801/17) likely represents a hemorrhagic or proteinaceous cyst. There is a large right upper pole simple renal cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: There is a small amount of perihepatic ascites.

Output: 1.8 mm distal common bile duct stone with mild extrahepatic biliary ductal dilatation.2.Large stone in the gallbladder neck with acute cholecystitis.


Instruction: Generate impression based on findings.

Input: Brain MRI:Redemonstrated are a few stable scattered punctate foci of T2 hyperintensity without restricted diffusion, mass effect, or susceptibility abnormality. A previously demonstrated subcentimeter hyperdense focus along the inner table of the right parietal bone, unchanged since 2009, is better seen on today's MRI as a prominent vein. The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. Incidental note is made of a partially empty sella. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. Sporadic foci of mucosal thickening are present in the paranasal sinuses and the mastoid air cells are clear. Brain MRA: There is antegrade flow within the distal bilateral vertebral arteries, within the basilar artery, distal bilateral internal carotid arteries and carotid siphons and bilateral anterior, middle and posterior cerebral arteries. No arterial stenoses, occlusions or aneurysms are identified. No arteriovenous malformations are identified and there is no evidence for cerebral vasculitis. Neck MRA:There is conventional takeoff of the great vessels from the aortic arch without evidence for stenosis of the origin of the great vessels or of the bilateral vertebral arteries which are codominant. There are no stenoses of the bilateral common, internal or external carotid arteries or of the bilateral carotid bifurcations. There is no evidence for vasculitis, fibromuscular dysplasia or dissection of the carotid or vertebral arterial systems within the neck. Note is made of mild atherosclerotic irregularity throughout the subclavian, common carotid, and bilateral internal carotid arteries without hemodynamically significant stenosis.

Output: 1.Stable minimal chronic small vessel ischemic disease.2.Negative MRA of the brain.3.Mild atherosclerotic irregularity throughout the subclavian, common carotid, and bilateral internal carotid arteries without hemodynamically significant stenosis..


Instruction: Generate impression based on findings.

Input: Syncope. Suspicion of seizure. There is a punctate focus of susceptibility effect in the subcortical right superior frontal gyrus is not associated with edema. Otherwise, there is moderate T2 signal involving the frontoparietal white-matter. There are also small linear foci of encephalomalacia in the cerebellar hemispheres. There is no intracranial mass or acute infarct. There is no abnormal intracranial enhancement. There is no midline shift or herniation. There is mild diffuse cerebral volume loss and a partially empty sella. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. The eye lenses are replaced bilaterally. There is degenerative spondylosis in the upper cervical spine, with mild indentation of the spinal cord by a C4-5 disc-osteophyte complex.

Output: 1.No evidence of acute intracranial hemorrhage, mass, or acute infarct. 2.Non-specific diffuse patchy cerebral white matter may represent small vessel ischemic disease.3.Small chronic cerebellar infarcts.4.Chronic focus of microhemorrhage in the right frontal lobe.


Instruction: Generate impression based on findings.

Input: Right maxillary sinus squamous cell carcinoma. There is an enhancing mass centered in the right maxillary sinus with extension into the premalar space via a 15 mm wide dehiscence of the anterior maxillary sinus wall. The tumor also erodes into the right maxillary gingiva and protrudes into the right inferior meatus. Overall, the mass measures up to approximately 4.5 cm. There is also apparent perineural extension into the right pterygopalatine fossa via a thickened right infraorbital nerve. The orbital contents are otherwise unremarkable and the right cavernous sinus is not particularly enlarged. There is nasal packing material in the right middle meatus and obstructed secretions throughout the right osteomeatal unit. There is right level 1 and 2 lymphadenopathy and an enlarged right lateral retropharyngeal lymph node, which measures 10 x 12 mm. The imaged portions of the brain parenchyma are unremarkable.

Output: 1. A mass measuring up to approximately 4.5 cm centered in the right maxillary sinus with extension beyond the sinus is compatible with squamous cell carcinoma, including apparent perineural extension into the right pterygopalatine fossa via the infraorbital nerve. 2. Metastatic right cervical lymphadenopathy is partly imaged. Please refer to the separate PET and neck CT reports for additional details.


Instruction: Generate impression based on findings.

Input: 11-week-old female with associated anorectal malformation. Evaluate for tethered cord. Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology.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. Lumbar spine:Most inferior well-defined disc is L5-S1. Five lumbar type vertebral bodies are present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L1-2 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 L3-4 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 L5-S1 there is no significant compromise to spinal canal or neural foramina.The conus medullaris terminates at the lower L2 level and within normal limits. There is no evidence of a tethered cord. No masses involving the filum or cauda equina nerve roots. Posterior elements are intact. Prone images are motion degraded but demonstrate some anterior motion of the conus and cauda equina nerve roots.

Output: Conus medullaris terminates at the lower L2 level which is at the lower limits of normal. No evidence of tethered cord. No masses involving the filum or cauda equina nerve roots.


Instruction: Generate impression based on findings.

Input: 33 years, Female, multiple sclerosis. Numbness, weakness left leg. Follow-up for progression.. There are greater than 20 T2/FLAIR hyperintense lesions in the bilateral periventricular and subcortical white matter with morphology and distribution compatible with known demyelinating disease. There are slight difference in technique with the most recent study 12/17/2015 performed with thicker slices, while the study from 11/4/2014 is more comparable to the current study. Since 11/4/2014 there appear to be at least 2 new lesions involving the left posterior frontal white matter, series 501 images 47 and 51. The more inferior medial one was also present on most recent study 12/17/2015 while the more superior lateral one is not definitively present on 12/17/2015. No posterior fossa lesions are definitively appreciated.There is mild burden of T1 hypointense lesions. Brain parenchymal volume is preserved. No intracranial mass or mass effect. Ventricles and sulci are within normal limits. Calvarium and extracranial soft tissues are grossly unremarkable.

Output: Findings suggesting very mild gradual progression of demyelinating disease with two new left posterior frontal lobe lesions since 11/4/2014, and one new lesion since 12/17/2015.


Instruction: Generate impression based on findings.

Input: Clinical question: Is there Chiari malformation. Signs and symptoms: Dizzy, headache and syncope. Nonenhanced brain MRI:Negative diffusion weighted images.There is no evidence of Chiari malformation as is questioned clinically.There is normal anatomical development and morphology of the brain and with normal signal intensity on all MRI sequences.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination.The signal void of major intracranial arterial branches are identified. The signal intensity of intracranial venous sinuses it is within normal.Unremarkable images through the orbits, paranasal sinuses and mastoid air cells.

Output: Negative nonenhanced brain MRI.


Instruction: Generate impression based on findings.

Input: Unspecified convulsions [R56.9], Reason for Study: ^Reason: parieto-occipital hypodensity on CT head 12/28/16. Follow up study. History: abnormal CTH on 12/28/2016. Brain MRINo evidence of acute ischemic or hemorrhagic lesion on the scan.Bihemispheric patchy FLAIR/T2 high signal intensities on bilateral periventricular white matter indicate nonspecific small vessel ischemic disease.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. 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 MRV3D MRV brain post-gadolinium with maximum intensity projections of the superficial/deep intracranial venous drainage demonstrate normal flow enhancement in the superior sagittal sinus, transverse sinuses, sigmoid sinuses, internal cerebral veins, vein of Galen and straight sinus.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. Non specific small vessel ischemic disease.3. Normal brain MRV.


Instruction: Generate impression based on findings.

Input: 69-year-old male. Follow-up after ESS subtotal removal of left maxillary sinus mass (final path solitary fibrous tumor). Patient with persistent disease extending into the orbit. This is limited by motion because of sleep apnea, accentuated by oral sedative that the patient took prior to the procedure.The lobulated, solid contrast enhancing mass involving the left orbit with extension into left nasal cavity and left maxillary sinus as well as adjacent retromaxillary and premaxillary spaces (through erosion of the maxillary sinus walls) has progressed in size since the previous examination. In the axial plane, it measures maximally 4.6 cm x 4.2 cm (image #16 of series #10) compared to 3.9 cm x 2.9 cm previously (image #7 of series #401). On the coronal images, it has a maximum dimension of 5.2 cm (image #18 of series #15) compared to 4.8 cm previously (image #12 of series #1801). The associated left proptosis has slightly increased as well as the stretching of the left optic nerve which is draped over the superior aspect of the mass but is not encased or invaded. The mass causes more narrowing of the left nasal cavity. The mass abuts and mildly deforms the anterior and of the left temporalis muscle. There is no direct involvement of the pterygopalatine fossa, second division of the trigeminal nerve or cavernous sinus. There is no intracranial extension of the mass. On diffusion-weighted imaging, the mass has diffusion characteristics that are slightly more restricted compared to the brain gray matter. Osseous destruction along the floor of the left orbit and along the maxillary sinus wall is better assessed on the previous CT scan dated April 2, 2015.Associated mucosal thickening in the remaining part of the left maxillary sinus is reactive/inflammatory and has not changed. Changes of previous endoscopic sinus surgery and partial tumor resection are present. The included brain shows no abnormality.

Output: Compared to the June 2015 examination, the mass involving the left orbit, left maxillary sinus, and left nasal cavity demonstrates mild interval enlargement as detailed above. No intracranial extension.


Instruction: Generate impression based on findings.

Input: Clinical question: Rule out brain aneurysm. Signs and symptoms: Headaches CTA of intracranial circulation:Vertebrobasilar system.There is normal appearing bilateral intracranial vertebral arteries, bilateral pica branches and basilar artery. No abnormality in particular no aneurysm is detected.Carotid system there are normal bilateral internal carotid arteries, bilateral anterior and middle cerebral arteries and their branches.There are no posterior communicating arteries identified.A very large mass within the sella with expansion of the sella and extension superiorly into the basal cistern is identified. There is no evidence of contrast within this mass. Further evaluation with dedicated MRI examination of pituitary is recommended. This mass results in significant bony remodeling/thinning and posterior displacement of dorsum sella. There is also extension of mass anteriorly and inferiorly into the sphenoid sinus and posterior right ethmoid air cells. On the right side the mass supplies mass effect and displaces the right supraclinoid internal carotid artery to the right.65 cc of Omnipaque 350 is administered for above study.

Output: 1.No evidence of vascular abnormality and in particular no aneurysm of intracranial vasculature. 2.Large expansile mass within the sella with extension into the sphenoid sinus and right posterior ethmoid air cells and with associated mass-effect and lateral displacement of supraclinoid right internal carotid artery. There is no evidence of contrast within this mass on the CTA examination.


Instruction: Generate impression based on findings.

Input: Evaluate for RCC. History of Cowden Syndrome and/or SDHB mutation, attenuated FAP, history of clear cell RCC, thyroid cancer, oligo-polyposis. ABDOMEN:LIVER, BILIARY TRACT: Numerous bilateral liver lesions have not significantly changed in size or imaging characteristics.The right hepatic dome lesion measures 6.1 by x 4.5 cm (series 1501/66), essentially unchanged, with imaging features compatible with focal nodular hyperplasia.The reference segment 4 lesion, more compatible with an adenoma is also stable in size measuring 2.4 x 2.4 cm (series 1503/52).The segment 6 subcapsular hemangioma is unchanged in size.The remaining liver lesions appear to retain contrast on delayed hepatobiliary phase imaging compatible with numerous FNHs.No new lesion is identified.SPLEEN: No significant abnormality noted.PANCREAS: Pancreas divisum. No ductal dilatation or significant parenchymal abnormality. Punctate cystic foci are unchanged and may represent small IPMNs.ADRENAL GLANDS: The right adrenal lesion is homogeneous in intensity and demonstrates loss of signal on out of phase imaging compatible with a lipid rich adrenal adenoma.KIDNEYS, URETERS: No suspicious renal lesion. Distortion of fat dorsal to the left kidney is compatible with post-surgical changes given the provided history of RCC. No evidence of tumor recurrence. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Left adnexal cyst is within physiologic limits. Unremarkable uterus and right adnexa.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No significant interval change with bilobar hepatic lesions compatible with hemangioma, adenoma and numerous focal nodular hyperplasia.2.Unchanged right adrenal lipid-rich adenoma.3.No suspicious renal lesion.


Instruction: Generate impression based on findings.

Input: 37-year-old male with history of stage I seminoma (92) status post left orchiectomy and XRT. Evaluate for recurrence. As per oacis, subcutaneous lesion in the back muscles was biopsy proven granular cell tumor. CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: Precarinal lymph node measuring 1.3 x 0.6 cm, (image 36, series 4) a second reference lymph node measures 0.9 x 1.4 cm, (image 48, series 4).CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Three well-defined hypervascular lesions are seen within the liver which are not identified on prior examinations. Segment two liver lesion measures 0.9 x 0.8 cm, (image 75, series 4). Segment eight liver lesion measures 1.4 by 1.2 cm, (image 82, series 4). Segment four A liver lesion measures 1.3 x 1.1 cm, (image 86, series 4). Dedicated liver protocol was not obtained.These lesions demonstrate an appearance of hemangioma however since these lesions are not seen on previous examinations other considerations must include hypervascular metastatic lesions which would be atypical for seminomatous dissemination. Further evaluation with MRI or PET CT may be considered as clinically indicated.SPLEEN: Single ill-defined hypodense lesion remains stable compared to previous examinations.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: 1. Nonspecific mediastinal lymphadenopathy. 2. Multiple hypervascular hepatic lesions likely demonstrate an appearance of hemangioma however since these lesions are not seen on previous examinations other considerations must include hypervascular metastasis which would be atypical for seminomatous dissemination. Further evaluation with MRI or PET CT may be considered as clinically indicated.


Instruction: Generate impression based on findings.

Input: 26-year-old woman with history of abnormal uterine bleeding and symptomatic fibroids. PELVIS:UTERUS, ADNEXA: The uterus is anteverted and anteflexed. In the anterior right fundus, there is a 63 x 54 mm intramural/submucosal mass (5/21) which is T1 and T2 heterogeneous with avid homogenous postcontrast enhancement (11/58). This mass displaces the endometrium. Within the endometrial canal, there is small amount of material with signal compatible with old hemorrhage.The ovaries appear normal with follicles.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Left Bartholin's gland cyst noted. There appears to be a tampon in the vagina. Nonspecific small foci of susceptibility artifact are favored to represent old blood products.OTHER: No significant abnormality noted.

Output: 1.Large, avidly enhancing intramural/submucosal fibroid arising from the right fundus.2.Blood in the endometrial canal with vaginal tampon, correlate with menstrual cycle.


Instruction: Generate impression based on findings.

Input: A patient submitted outside study for review. Submitted for review are bilateral breast MRI dated 6/2/2016 from central to be hospital. For comparison,mammogram dated 7/30/2015, 8/4/2015, 7/24/2014 have been submitted. MRI dated 6/2/2016 was postprocessed using Dyna CAD for interpretation.Heterogeneously dense breast tissue noted in both breasts. Marked parenchymal enhancement is seen in both breast limiting the sensitivity of MRI. No evidence of suspicious masses or nonmass enhancement in either breast.Normal axillary lymph nodes identified in bilateral axillary regions.Patient is due for a bilateral diagnostic mammogram. Nodularity questioned in the upper outer quadrant of the right breast will be evaluated on bilateral diagnostic mammogram. Diffuse bilateral calcifications in both breast most of which layer on ML view will also be evaluated on bilateral diagnostic mammogram.

Output: Marked parenchymal enhancement noted in both breast on MRI. Given this limitation no suspicious area of enhancement was noted in either breast.Patient is due for a bilateral diagnostic mammogram. Nodularity questioned in the upper outer quadrant of the right breast will be evaluated on bilateral diagnostic mammogram. Diffuse bilateral calcifications in both breast most of which layer on ML view will also be evaluated on bilateral diagnostic mammogram.BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: History of orthotopic liver transplant and renal transplant in June 2013, evaluate for changes in known IPMN. ABDOMEN:LIVER, BILIARY TRACT: Postsurgical changes of liver transplant. The liver demonstrates normal signal intensity without suspicious focal lesions. There is mild narrowing at the site of biliary duct duct anastomosis appearing similar to prior. No significant intrahepatic or extrahepatic biliary ductal dilatation. The distal branches of the hepatic artery are not well-visualized, similar to prior. The proximal hepatic artery, portal venous system, and hepatic veins appear patent.SPLEEN: No significant abnormality noted.PANCREAS: There is a 8 mm T2 hyperintense focus within the pancreatic head (series 9, image 37) which is nonspecific but compatible with a sidebranch intraductal papillary mucinous neoplasm, unchanged compared to 4/22/2014 (series 4, image 16). The pancreas demonstrates normal signal intensity and enhancement. The pancreatic duct is not dilated.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Atrophic kidneys. Stable 2 cm lower pole left renal cyst. Mild left greater than right perinephric stranding appearing similar to prior. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small bilateral gynecomastia.

Output: 1.Postsurgical changes of liver transplant with unchanged mild narrowing at the biliary anastomosis, unchanged. 2.8 mm cystic lesion within the pancreatic head which is nonspecific but likely represents a sidebranch IPMN, unchanged.


Instruction: Generate impression based on findings.

Input: 60 year old female who presents with seizure with a history of a lung mass. Evaluate for intracranial hemorrhage or metastases. Given the lack of intravenous contrast, evaluation for metastatic lesions is limited. Given these limitations, the following observations are made:Brain:There is a large area of hypoattenuation in the high convexity of the left frontal lobe. There is associated subtle ex vacuo dilatation of the lateral ventricle and loss of surrounding cortex. These findings may represent a remote infarct and encephalomalacia, however, metastatic disease cannot be excluded on this noncontrast examination. There is a area of hypodensity in the right posterior subcortical periventricular white matter adjacent to the right trigone. There is no associated mass effect, ex vacuo dilation, or enlargement of the sulci. These findings likely represent vasogenic edema. It is less likely a remote infarct. Additionally, there is an area of hypodensity within the left cerebellum. This likely represents encephalomalacia from prior infarct, however, these findings may possibly represent an arachnoid cyst. There is no evidence of intracranial hemorrhage or mass.There are multiple scattered hypodensities within the periventricular and deep white matter which are age indeterminate and nonspecific but may be related to chronic small vessel ischemic disease. It should be noted that CT is insensitive in detecting acute ischemic infarct an MRI can be considered for further evaluation if clinically indicated.The basal cisterns are normal in size and configuration. There is no effacement of the cortical sulci. There is no mass effect or midline shift.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.Neck/cervical spine:No evidence of malalignment or acute fracture. A lytic lesion is noted in the T2 vertebral body. The posterior cortex of the vertebral body is eroded. There is no associated soft tissue abnormality on this limited non-infusion study. No evidence of canal stenosis. There is multi-level mild degenerative disk disease. There is multi-level disk bulge from C3/C4 to C6/C7. There is no evidence cervical spinal canal stenosis. The neuroforamina are patent bilaterally.

Output: 1. Hypoattenuation in the left frontal lobe and right posterior temporal lobe. These findings likely represent vasogenic edema secondary to metastatic disease versus encephalomalacia from a remote infarct. Given the limitations in detecting metastatic disease in a non-enhanced CT examination, further evaluation with contrast-enhanced CT or MRI is recommended. These findings and recommendation were relayed to the emergency department via the STAT consult system.2. There is a lytic lesion in the T2 vertebral body which may represent a metastatic lesion. A bone scan may help further evaluate.  3. Multiple scattered hypodensities within the periventricular and deep white matter, which are age indeterminate and nonspecific but may be related to chronic small vessel ischemic disease. There is no evidence of intracranial hemorrhage. It should be noted that CT is insensitive in detecting acute ischemic infarct and MRI can be considered for further evaluation if clinically indicated.4. Hypodensity within the left cerebellum. This likely represents encephalomalacia from a prior infarct, however, these findings may possibly represent an arachnoid cyst.


Instruction: Generate impression based on findings.

Input: Glioblastoma. Patient is receiving reradiation and on temozolomide and Avastin. Last tumor resection was on April 28, 2015 at UIC. Path at that time redemonstrated WHO grade IV, IDH wt, 1p19q codeletion absent, MGMT promoter unmethylated. He had notable clinical improvement following resection and then enrolled in a trial of reRT/TMZ/bevacizumab (8 week cycles). While the right frontoparietal surgical cavity and the contiguous abnormality along the resection margin remain unchanged, multiple relatively well-defined and homogeneously T2-hyperintense lesions have developed in the deep gray nuclei, the right midbrain, and the adjacent right superior cerebellar peduncle, as well as in the corpus callosum and left frontal parietal white-matter. These new lesions demonstrate heterogeneous contrast enhancement and small foci of susceptibility effect. The largest of these involves the body of the corpus callosum and measures up to 3.1 cm. The second largest lesions, which measures up to 2.4 cm, involves the right thalamus and is likely partly cystic or necrotic. These lesions are associated with increased cerebral blood volume ratio, up to 8 times when compared to the least abnormal-appearing left parietal white-matter. The lesions are associated with mass-effect, but no herniation. Besides the focal mass-effect on the lateral and third ventricles, the ventricular system is overall less dilated than on the previous examination. The focal contrast enhancement in the left internal auditory canal is unchanged. The orbits and the paranasal sinuses remain unchanged. Thinning and flattening at the site of the large right pterional craniotomy flap is unchanged.

Output: Since February 2016, multiple new significantly hyperperfused, mildly hemorrhagic lesions have developed in the bilateral cerebral hemispheres and brainstem, most compatible with disease progression.


Instruction: Generate impression based on findings.

Input: Female, 53 years old, with history of transverse myelitis, numbness of the legs. Approximately 10 small T2 hyperintense lesions are evident within the cerebral white matter involving predominantly the periventricular regions and corpus callosum. Several of the lesions are linear and oriented radially with respect to the ventricles. One lesion in the left periatrial region demonstrates corresponding marked T1 hypointensity. No edema or mass effect is detected. Brain parenchymal volume is preserved. No intracranial hemorrhage or any abnormal extra axial fluid collection is suspected. Ventricular size and morphology are within normal limits.

Output: Scattered T2 hyperintense lesions are seen within the cerebral white matter showing a morphology and distribution compatible with demyelinating disease. If necessary, the differential can be broadened to include sequelae of other inflammatory or infectious processes, gliosis, and vasculitis, though these possibilities are considered less likely.


Instruction: Generate impression based on findings.

Input: Female, 66 years old, with left-sided numbness, history of sarcoid, not on therapy. Alignment is anatomic. Vertebral body heights are preserved. No worrisome marrow signal abnormality or pathologic marrow enhancement is detected.The visualized spinal cord demonstrates normal signal, caliber and morphology throughout. No pathologic cord enhancement is seen.C2-3: No spinal canal stenosis or neuroforaminal narrowing. C3-4: No spinal canal stenosis or neuroforaminal narrowing. C4-5: No spinal canal stenosis or neuroforaminal narrowing. C5-6: Loss of disc height and disc osteophyte formation. No significant spinal canal stenosis. Moderate bilateral foraminal narrowing. C6-7: Loss of disc height and disc osteophyte formation. No significant spinal canal stenosis. Moderate left and mild right foraminal narrowing. C7-T1: No spinal canal stenosis or neuroforaminal narrowing.

Output: 1.No evidence of spinal cord edema or pathologic spinal cord enhancement is seen to suggest sarcoid involvement.2.Degenerative disc disease at C5-6 and C6-7 is seen. Although there is no significant spinal canal stenosis at these levels, the neural foramina are significantly narrowed bilaterally at C5-6 and on the left at C6-7.


Instruction: Generate impression based on findings.

Input: Neck pain and recent trauma. There appears to be intermediate T2 and T2 signal epidural material in the right aspect of the partly imaged upper thoracic spine. There is absence of the usual cervical lordosis, but no spondylolisthesis. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: Apparent intermediate T2 and T2 signal material in the right epidural space of the partly imaged upper thoracic spine may be volume averaging artifact, although hemorrhage cannot be entirely excluded in the setting of trauma. A dedicated thoracic spine MRI may be useful for further evaluation if clinically warranted. Otherwise, no evidence of cervical spine ligamentous injury or spinal cord lesions. Findings discussed with Dr. Hobbs at 2:20pm on 4/18/15.


Instruction: Generate impression based on findings.

Input: Male 32 years old Reason: 32 yo M with history of left upper quadrant abdominal pain since March 2015. OSH EUS was concerning for chronic pancreatitis in the head. no history of acute pancreatitis. MRI/MRCP with gad and secretin to assess for chronic pancreatitis History: diagnosed with chronic pancreatitis at OSH, want to rule out ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. There are a few scattered subcentimeter T2 hyperintense foci that do not enhance in the liver compatible with cysts. Gallbladder and biliary tree are unremarkable. No focal ductal dilatation or stricture.SPLEEN: No significant abnormality noted.PANCREAS: Pancreas is normal in morphology. Signal characteristics are normal for age. No focal changes in the pancreatic head to suggest chronic pancreatitis. Pancreatic duct is normal in caliber.Subcentimeter cystic focus within the pancreatic head that communicates with the pancreatic duct likely represents a small branch type IPMN.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.No MR findings to suggest acute or chronic pancreatitis.2.Pancreas is normal in morphology and signal.


Instruction: Generate impression based on findings.

Input: Reason: Eval GBM. pt s/p reRT/TMZ/bev. A large resection cavity contiguous with the right lateral ventricle is again seen incorporating portions of the right frontal and parietal lobes and a small portion of the the temporal lobe. The cavity is unchanged in size and morphology.Around the periphery of the resection cavity, there is a rind of thickened, T2 hyperintense tissue which has not significant changed from the prior examination. Scattered foci of susceptibility and patchy restricted diffusion within this tissue are also unchanged. The tissue surrounding the resection cavity shows mild patchy areas of intrinsic T1 hyperintensity with superimposed ill-defined enhancement, also unchanged. No new enhancing lesions are seen. A focus of enhancement within the left IAC has been stable over many prior exams. Ill-defined periventricular hypoattenuation, right side more than left, is unchanged and likely represents a posttreatment effect. Tract-like T2 hyperintensity conforming to the right corticospinal tract within the brainstem is also unchanged and may represent Wallerian degeneration. No new areas of parenchymal signal abnormality are seen. Ventricular size and morphology are stable.

Output: Compared to 1/27/2016 and 12/30/2015, there are no findings to suggest interval tumor progression.