Instruction: Generate impression based on findings.

Input: A patient submitted outside study for review. Submitted for review are ultrasound images of right breast (3/14/16, 4/27/16, 5/2/16), breast MRI (5/2/16), digital mammographic images (5/3/16) performed at University of Tennessee Medical Center. ULTRASOUND IMAGES (3/14/16, 4/27/16, 5/2/16):An irregularly shaped complicated cyst is visualized at 12:00 position, measuring 9 x 5 mm in the right breast on 3/14/2016. Aspiration of this complicated cyst was performed on 4/27/2016, and complete resolution of the cyst is obtained after the aspiration.Per outside radiology report, the fluid was bloody and sent to cytology, and rare atypical cells were found within the fluid.On the images obtained on 5/2/2016, mild reaccumulation of the cyst is seen at 12:00 position in the right breast. There are no suspicious findings in those images.BREAST MRI (5/2/16):Breast MRI was performed with a protocol outlined in the outside radiology report.There is heterogeneous amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.Bilateral retropectoral saline implants appear intact.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.DIGITAL MAMMOGRAPHIC IMAGES (5/3/16):The breast parenchyma is heterogeneously dense (BiRADS Density Category C). Bilateral retropectoral saline implants appear intact. There are scattered benign-appearing calcifications in both breasts. No suspicious mass, suspicious microcalcifications or suspicious areas of architectural distortion are noted in either breast.

Output: No mammographic, sonographic or MR evidence for malignancy in either breast. Status post cyst aspiration of right breast at 12:00 position, with cytology result of rare atypical cells. If excision of an area of aspiration is needed, needle localization can be performed with ultrasound guidance.BIRADS: 2 - Benign finding.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Newly diagnosed presumed locally advance urothelial cancer with hypercalcemia. More lethargic today, worsening aphasia. There are areas of restricted diffusion and high T2 signal involving the right precentral and postcentral gyri measuring up to 30 mm. There are also punctate foci of restricted diffusion and high T2 signal involving the right lateral occipital lobe and bilateral anterior frontal lobes, including periventricular and subcortical white matter, as well as cerebral cortex. There is a small focus of encephalomalacia in the left basal ganglia. There is a diffuse background of cerebral white matter T2 hyperintensity bilaterally. There is a punctate focus of susceptibility effect in the left pons, which may represent a chronic microhemorrhage. There is no evidence of intracranial hemorrhage or mass. There is diffuse cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable, aside from a small left frontal scalp lipoma and a small residual left parietal scalp hematoma.

Output: 1. Multiple subacute-appearing infarcts in the bilateral cerebral hemispheres, most notably involving the right precentral and postcentral gyri.2. Chronic left basal ganglia lacunar infarct and diffuse probable chronic small vessel ischemic disease.3. No evidence of intracranial metastases, although the assessment is limited without contrast.


Instruction: Generate impression based on findings.

Input: Thoracic: The thoracic spine is in normal alignment. The vertebral body heights are maintained. Bone marrow signal is benign. The spinal cord is of normal caliber and signal. Mild degenerative changes include disc height loss at the T7-T8 level with associated edematous marrow signal changes. Small Schmorl's node at the superior T6 endplate with mild edema also seen. There are minimal multilevel bulges in the lower thoracic spine. There is also mild to moderate generalized facet arthropathy in the mid and lower thoracic spine as well as ligamentum flavum thickening. There is no significant spinal canal stenosis or significant neural foraminal stenosis at any level in the thoracic spine..Lumbar: For the purposes of numbering, there are 5 lumbar type vertebral bodies. Vertebral body heights in the lumbar spine are normal. Again seen is loss of normal lumbar lordosis which is similar to prior. Minimal retrolisthesis of L3 on L4 is also similar to prior. Vertebral body heights are maintained. Conus is in normal position.There are multilevel degenerative changes including disc desiccation and small Schmorl's nodes throughout the lumbar spine which are similar to prior. Additional details as below:L1-L2: Mild disc bulge eccentric to the right with ligamentum flavum thickening and mild facet arthropathy. There is partial effacement of the right lateral recess similar to prior, but otherwise no significant central canal stenosis. Neural foramina are patent.L2-L3: Minimal disc bulge and mild ligamentum flavum thickening and facet arthropathy. There is no significant spinal canal or neural foraminal stenosis.L3-L4: There is mild disc bulge, ligamentum flavum thickening and facet arthropathy. Distention of the facet joints is again seen. There is mild effacement of the right lateral recess, but no significant central canal stenosis. There is moderate right and mild left neural foraminal stenosis similar to prior.L4-L5: Mild disc bulge and mild facet arthropathy. No significant spinal canal stenosis. Mild narrowing of the bilateral neural foramina. There is subtle clumping of the left-sided cauda equina nerve roots which is unchanged and may represent mild arachnoiditis.L5-S1: No significant disc disease. Mild left neural foraminal stenosis related to left-sided facet arthropathy similar to prior. No spinal canal or right neural foraminal stenosis.

Output: 1. Mild multilevel degenerative changes in the thoracic spine without significant spinal canal or neural foraminal stenosis. 2. Mild to moderate degenerative changes in the lumbar spine which are not significantly changed since 8/23/2014. There is no high-grade spinal canal stenosis at any level. There is up to moderate right L3-L4 neural foraminal stenosis. Additional details as above.


Instruction: Generate impression based on findings.

Input: 79-year-old female with a history of metastatic thyroid cancer, please compare to previous CHEST:LUNGS AND PLEURA: Multiple pulmonary nodules demonstrate diffuse increase in the size.Reference left costophrenic nodule (image 240, series 6) measures 8 mm x 6 mm, previously, measuring 6 mm x 4 mm..Focal opacity with branching appearance in the superior segment of the left lower lobe (image 61, series 7) may represent inspissated mucus within a dilated bronchus.MEDIASTINUM AND HILA: Partially visualized heterogeneous thyroid mass is again noted.Prominent prevascular, precarinal, and subcarinal lymph nodes are stable.Moderate coronary artery calcifications with a stent identified in the LAD.CHEST WALL: Sclerotic focus within the manubrium is stable compared to prior exam dated 11/20/10ABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy.SPLEEN: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: The hypodense lesion in the inferior pole. The right kidney is unchanged and may represent a complex cyst however neoplasia cannot be excluded. Dedicated renal CT and/or MRI is recommended.PANCREAS: 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 noted

Output: Multiple pulmonary nodules demonstrating diffuse increase in size compatible with progression of disease. No new sites of disease can be identified.


Instruction: Generate impression based on findings.

Input: Sturge Weber syndrome with intractable epilepsy status post radiofrequency ablation for right frontal disconnection. There are postoperative findings related to recent radiofrequency ablation for right frontal disconnection, with foci of high T2 signal adjacent ot the right frontal horn and overlying scalp swelling. There is no evidence of acute intracranial hemorrhage, mass, or acute infarct. There is otherwise diffuse right frontal, right temporo-parieto-occipital, left parietal, left occipital and left temporal atrophy and subcortical calcifications, diffuse supratentorial and infratentorial leptomeningeal enhancement, as well as anomalous venous drainage. 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 are grossly unremarkable.

Output: 1. Expected recent postoperative findings related to radiofrequency ablation for right frontal disconnection.2. Extensive stigmata of Sturge Weber syndrome are unchanged.


Instruction: Generate impression based on findings.

Input: History of bladder cancer status post cystectomy. Evaluate for metastatic disease. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology, size, signal intensity and enhancement without a suspicious lesion. No biliary ductal dilatation or vascular abnormality. No intra or extrahepatic biliary ductal dilatation. Normally distended gallbladder.SPLEEN: Spleen is normal in morphology, size, signal intensity and enhancement.PANCREAS: The pancreas is normal in morphology and enhancement without a focal lesion or pancreatic ductal dilatation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Status post left nephrectomy. No evidence of tumor recurrence in the nephrectomy bed. No locoregional lymphadenopathy.Nonspecific striated early arterial enhancement of the right kidney with wedge-shaped regions of hypoattenuation which fill in on more delayed imaging without an underlying suspicious lesion. Small stable and new subcentimeter cysts.RETROPERITONEUM, LYMPH NODES: No enlarged retroperitoneal lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: Status post cystoprostatectomy.BLADDER: Status post cystoprostatectomy with neobladder formation.LYMPH NODES: Solidly enhancing left pelvic nodule measures approximately 1.6 x 1.0 cm (series 11/63), unchanged from the prior.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Stable nonspecific 6 mm enhancing focus in the right sacral ala is unchanged (series 11/36). OTHER: No significant abnormality noted.

Output: 1.Stable solidly enhancing left pelvic 1.6 cm lesion.2.Striated early enhancement of the right kidney without a discrete suspicious lesion.3.No new sites of disease.


Instruction: Generate impression based on findings.

Input: Female 62 years old known hepatic abscess, status post 3 courses of antibiotics. Also potential IPMN. Please eval for resolution of abscess and confirmation of IPMN. ABDOMEN:LIVER, BILIARY TRACT: There is mild wedge shaped signal abnormality including restricted diffusion, T2 hyperintensity and heterogeneous enhancement but no washout in segment 7 in the region of the previously seen hepatic abscess. There are linear regions of nonenhancement corresponding to hypoattenuating regions seen on the prior CT. The region of signal abnormality is not discretely measurable but has improved since the CT from 9/24/2016. A focus of restricted diffusion in region segment 6 (series 12, image 81) is associated with susceptibility artifact but no enhancement in the location of the hepatic/perihepatic abscess seen on CT from 8/19/2016. Scattered punctate foci of T2 hyperintensity are too small to accurately characterize but appear to represent simple cyst giving the degree of T2 hyperintensity. No cholelithiasis, biliary ductal dilatation or ascites.SPLEEN: No significant abnormality noted.PANCREAS: There is a 9 x 7 mm T2 hyperintense lesion in the body of the pancreas with no clear communication with the main pancreatic duct and no enhancement. A second lesion with similar imaging characteristics measures 4 x 3 mm. There is no pancreatic ductal dilatation. The pancreas enhances homogeneously.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Colonic diverticulosis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Mild signal abnormality and heterogeneous enhancement within hepatic segment 7 has improved since the prior CT and is compatible with the history of hepatic abscess.2.The smaller hepatic/perihepatic abscess in region of segment 6 has resolved3.Two cystic lesions within the pancreatic body are favored to represent side branch IPMNs.


Instruction: Generate impression based on findings.

Input: 72 years, Female, lung cancer with brain metastases. Evaluate response to chemotherapy. Status post whole brain radiation in June 2015. Within the right posterior parietal white matter there is an enhancing T1 isointense lesion measuring up to 1.0 cm (series 11, image 10), previously 1.8 x 0.6 cm. A right cerebellar enhancing lesion measures 0.7 x 0.5 cm (series 11, image 24), previously 1.1 x 0.8 cm. Additional foci of enhancement particularly within the left parietal lobe appear more conspicuous (series 11, image 10), while others are no longer visualized. There is a single new enhancing lesion within the left middle frontal gyrus measuring up to 4 mm (series 11, image 11). No restricted diffusion to suggest acute ischemia. There is no intracranial hemorrhage. The ventricles are within normal limits in size and configuration. Additional subcortical and periventricular T2 hyperintense foci do not enhance and are nonspecific, but most likely due to chronic microvascular ischemic disease, unchanged from prior.There is no abnormal parenchymal or meningeal enhancement. Major flow-voids are preservedSella 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: Decreased size of largest brain metastases, with stability of additional smaller lesions. However, a single new enhancing focus within the left middle frontal gyrus is seen. Findings compatible with mixed treatment response.


Instruction: Generate impression based on findings.

Input: This exam is markedly degraded by motion artifact. There is no evidence of large mass or acute infarct. There are scattered patchy foci of non-specific T2 hyperintensity within the supratentorial white matter. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact.

Output: No evidence of acute infarct or large mass on this motion degraded non-contrast exam. Scattered foci of T2 hyperintensity within the supratentorial white matter are non-specific and may represent chronic small vessel ischemic disease. If there is concern for metastases, contrast enhanced, sedated, MRI is recommended.


Instruction: Generate impression based on findings.

Input: 56 year old female with a history of COPD, Diabetes, sarcoidosis, and myocardial infarction approximately 20 years ago. Referred for vasodilator stress MRI due to recent development of chest pain, shortness of breath, and T-wave changes on ECG.MEDICATIONS: Metformin, Simvastatin, Valsartan, Fluticasone-Salmeterol, Aspirin. 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 and systolic function. The overall LV ejection fraction is 60%, the LV end diastolic volume index is 66 ml/m2 (normal range: 65+/-11), the LVEDV is 133 ml (normal range 109+/-23), the LV end systolic volume index is 57 ml/m2 (normal range 18+/-5), the LVESV is 54 ml (normal range 31+/-10), the LV mass index is 52 g/m2, and the LV mass is 104 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 and systolic function. The overall RV ejection fraction is 56%, the RV end diastolic volume index is 60 ml/m2 (normal range 69+/-14), the RVEDV is 122 ml (normal range 110+/-24), the RV end systolic volume index is 27 ml/m2 (normal range 22+/-8), and the RVESV is 54 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 no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal arch branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no pericardial thickening.Extracardiac FindingsAn upper pole cyst is seen in the left kidney, which was described in an abdominal ultrasound on 6/3/2014. It is incompletely imaged on this exam.

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 60%).4. Normal RV size and systolic function (RVEF 56%).I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: There is no suspicious intracranial enhancement, acute infarct, mass effect, midline shift or herniation. There is no suspicious enhancement or thickening of the bilateral cranial nerves 7/8 complexes. There is redemonstration a few scattered punctate nonenhancing and nonspecific foci of T2 signal abnormality, for example in the periventricular white matter adjacent to the atria of the lateral ventricles, right superior frontal gyrus, and left cerebellar hemisphere. There is stable prominence of the pituitary gland dating back to 12/13/2010.

Output: No acute intracranial process. Stable nonspecific punctate T2 signal abnormalities seen previously.


Instruction: Generate impression based on findings.

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

Output: No evidence of intracranial hemorrhage, mass, or ventriculomegaly.


Instruction: Generate impression based on findings.

Input: Grade II glioma status post treatment. There are postoperative findings related to right frontal craniotomy. There is unchanged confluent T2 hyperintensity in along the margins of the right frontal lobe resection cavity. There is no evidence of intracranial hemorrhage, mass, or acute infarct. In particular, there is no elevated perfusion or enhancement within the treatment bed. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are unchanged.

Output: Stable post-treatment findings in the right frontal lobe region, without evidence of tumor progression.


Instruction: Generate impression based on findings.

Input: Evaluate right wrist fractureIMAGE ACQUISITIONS: CT of the right wrist was performed without contrast using the ultra high resolution protocol. There is a transverse fracture of the ulnar styloid. The bones appear in near anatomic alignment. There is a comminuted fracture of the radial aspect of the trapezium with it least two separate fragments adjacent to the main trapezium bone. There is mild displacement of the fracture fragments. There is a 2-mm ossific fragments in the just posterior and on the radial side of the lunate which which is likely a fragment from the trapezial fracture. Another 2-mm ossific fragment located just superior to the trapezium in between the trapezium and first metacarpal also is likely a fracture fragement given its proximity to the fracture trapezium comment this could be an acute fracture fragment.There is a 4-mm well corticated ossific density anterior to the lunate which does not appear to be an acute fracture fragment.There is slight widening of the scapholunate interval however this does appear stable. The patient had a previous MRI which shows a tear the scapholunate ligament which appear chronic.Small to moderate sized joint effusion is present.The remainder of the carpal bones, distal radius, and proximal metacarpal bones which are visualized on this study appear intact. No other fractures are identified.Cast material is seen surrounding the wrist.

Output: Fractures of the ulnar styloid and trapezium as described above.


Instruction: Generate impression based on findings.

Input: There is straightening of the normal lumbar lordosis. The vertebral body heights are well-maintained. There is loss of disc space at L5-S1, slightly progressed from the prior study. No worrisome focal marrow signal abnormality is appreciated. The distal spinal cord and conus are within normal limits with the conus terminating at the L1 level.T12-L1: No significant disc bulge, herniation, spinal canal or foraminal stenosis. L1-L2: No significant disc bulge, herniation, spinal canal or foraminal stenosis. L2-L3: No significant disc bulge, herniation, spinal canal or foraminal stenosis. L3-L4: No significant disc bulge, herniation, spinal canal or foraminal stenosis. L4-L5: Mild disc bulge. No significant herniation, spinal canal or foraminal stenosis. L5-S1: Slight interval progression of large central/left paracentral disc extrusion with increased left posterior extension and indenting the left thecal sac, resulting in an eccentric mild spinal canal stenosis with impingement of the descending left greater than right S1 and S2 nerve roots. The 11 mm extent of caudal migration is approximately the same. No significant foraminal stenosis.

Output: Slight interval progression of large central/left paracentral disc extrusion at L5-S1, contributing to eccentric mild spinal canal stenosis with impingement of the left greater than right descending S1 and S2 nerve roots. No significant foraminal stenosis.


Instruction: Generate impression based on findings.

Input: 70-year-old male with history of prostate cancer.Additional history obtained from EPIC: Recently noted to have an elevated PSA of 5.8 ng/ml. This prompted a TRUS guided biopsy of the prostate revealing adenocarcinoma Gleason 3+3=6 involving three cores from the right side of the prostate, 2 with 10% involvement of the total core length and 1 core with 20% involvement. There was also one core from the left with Gleason 3+3=6 with 25% involvement. PELVIS:PROSTATE:Prostate Size: 5.6 x 3.0 x 5.0 cm.Peripheral Zone: Lesion in the left mid peripheral zone measuring 0.6 x 0.6 cm (704/284) which is dark T2/ADC and demonstrates early enhancement is suspicious for prostate cancer. Smaller lesion within the right apical peripheral zone is dark on T2/ADC with questionable early enhancement may represent an additional foci of prostate cancer.Central Gland: Multiple BPH nodules. Seminal Vesicles: No significant abnormality.Extracapsular Extension: None.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Left mid peripheral zone lesion is suspicious for prostate cancer. No evidence of extracapsular extension.2.Questionable lesion in the right apical peripheral zone may represent an additional foci of cancer.3.No pelvic lymphadenopathy.


Instruction: Generate impression based on findings.

Input: Reason: ? cuff tear History: pain. Metallic artifact compatible with prior surgery limits evaluation.ROTATOR CUFF: Full-thickness tear of the anterior insertional fibers of the supraspinatus tendon with retraction almost to the level of the glenohumeral joint. Severe insertional tearing of the infraspinatus tendon. Full-thickness tear of the subscapularis tendon with retraction. The teres minor is intact. Associated severe fatty muscle atrophy of the supraspinatus, infraspinatus and subscapularis.SUPRASPINATUS OUTLET: Moderate osteoarthritis affects the AC joint. Small amount of fluid within the subacromial subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenoid labrum is difficult to evaluate due to metallic artifact. Mild osteoarthritis affects the glenohumeral joint. The humeral head is high riding relative to the glenoid.BICEPS TENDON: The biceps tendon is intact. ADDITIONAL

Output: Full-thickness rotator cuff tears as described above.


Instruction: Generate impression based on findings.

Input: Knee pain, prior ACL reconstruction MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: There is thinning of the articular cartilage of the medial with some cortical irregularity which may relate to prior impaction injury. The lateral and patellofemoral compartments are normal. The bone marrow signal is normal.LIGAMENTS: There are changes of prior ACL reconstruction. The ACL graft is intact. The remaining cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. ACL reconstruction with intact ACL graft.2. Thinning of the articular cartilage with some cortical irregularity likely relating to prior impaction injury.3. Scarring within Hoffa's fat pad relating to prior arthroscopy.


Instruction: Generate impression based on findings.

Input: Male, 25 years old, with bilateral lower extremity paresthesias. Alignment is anatomic. Vertebral body morphology is within normal limits with mild transitional anatomy of the L5 vertebral body. No evidence of pathologic marrow replacement, edema or enhancement is seen.The visualized distal spinal cord, conus and nerve roots of the cauda equina are unremarkable. No pathologic spinal cord or leptomeningeal enhancement is seen. No epidural abnormalities are suspected.L1-2: Unremarkable. L2-3: Unremarkable. L3-4: Facet arthropathy. Loss of disc T2 signal and minimal loss of disc height. Mild disc bulging with a small superimposed central disc protrusion. No significant spinal canal stenosis. Mild right foraminal narrowing. L4-5: Facet arthropathy. Loss of disc T2 signal and minimal loss of disc height. Disc bulging with central annular fissuring. No significant spinal canal stenosis. No significant foraminal narrowing. L5-S1: Facet arthropathy. No significant spinal canal stenosis. No significant foraminal narrowing.

Output: Mild disc degeneration at L3-4 and L4-5 with no significant spinal canal stenosis and only mild foraminal narrowing as above.


Instruction: Generate impression based on findings.

Input: Right hand numbness and weakness. Evaluate for CVA, disc herniation. Brain: Brain parenchyma appears essentially within normal limits for age. There are minimal scattered punctate foci of T2/FLAIR hyperintensity, which are nonspecific and may represent minimal chronic small vessel ischemic changes. No evidence of acute infarct. No evidence of hemorrhage. No intracranial mass or mass effect. No midline shift or herniation. Ventricles and sulci appear within normal limits. Calvarium and extracranial soft tissues are grossly unremarkable.Cervical spine: Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained. Bone marrow signal is benign. The cervical spinal cord has normal signal characteristics and overall morphology.Mild degenerative changes are seen in the cervical spine with mild multilevel disc desiccation. Individual levels as below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: No significant compromise to the spinal canal or neural foramina.C4-5: No significant compromise to the spinal canal or neural foramina.C5-6: There is a central disc protrusion which effaces the ventral thecal sac and results in mild narrowing of the spinal canal. No significant stenosis involving the neural foramina. C6-7: Minimal left neural foraminal narrowing. Otherwise no compromise to the spinal canal or neural foramina.C7-T1: No significant compromise to the spinal canal or neural foramina. There is mild bilateral facet arthropathy.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: 1. Brain MRI appears within normal limits for age. No evidence of acute infarct.2. Mild degenerative changes in the cervical spine including a central disc protrusion at the C5-C6 level. There is at most mild spinal canal stenosis at this level. There is minimal left C6-C7 neural foraminal narrowing. Spinal canal and neural foramina are otherwise patent.


Instruction: Generate impression based on findings.

Input: Status post kidney transplant c/b MI. PEA arrest, perforated diverticulitis, colon resection, r/o CVA No abnormal diffusion restriction. No acute intracranial hemorrhage is identified. No evidence of intracranial mass, mass-effect, or midline shift. No extra-axial fluid collections. Nonspecific scattered subcortical and periventricular white matter FLAIR hyperintensity. The ventricles and sulci are prominent related to generalized volume loss. Gray-white matter differentiation is preserved. The imaged paranasal sinuses and mastoid air cells are clear. The imaged orbits are intact. The osseous structures are unremarkable.

Output: No evidence of acute ischemia.


Instruction: Generate impression based on findings.

Input: A 29 year old male with end stage renal disease on dialysis, now diagnosed with hear failure with biventricular dysfunction and echocardiographic suspicion of non-compaction cardiomyopathy. Referred to cardiac for further evaluation. Left VentricleThe left ventricle is severely dilated with moderate to severe systolic dysfunction. The overall LV ejection fraction is 33%, the LV end diastolic volume index is 158 ml/m2 (normal range: 74+/-15), the LVEDV is 275 ml (normal range 142+/-34), the LV end systolic volume index is 106 ml/m2 (normal range 25+/-9), the LVESV is 185 ml (normal range 47+/-19), the LV mass index is 98 g/m2 (normal range 85+/-15), and the LV mass is 170 g (normal range 164+/-36). There is global dysfunction with regional variation. There is mild hypertrophy (up to 12mm). The trabeculation pattern does not meet criteria for noncompaction.Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is mildly dilated with mild to moderate systolic dysfunction. The overall RV ejection fraction is 40%, the RV end diastolic volume index is 125 ml/m2 (normal range 82+/-16), the RVEDV is 218 ml (normal range 142+/-31), the RV end systolic volume index is 75 ml/m2 (normal range 31+/-9), and the RVESV is 131 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is trace pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is trace tricuspid regurgitation.AortaThere is a left sided aortic arch with a common origin of innominate and left common carotid artery. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is a small pericardial effusion.

Output: 1. The left ventricle is severely dilated with moderate to severe systolic dysfunction, the LVEF is 33%. There is global dysfunction with regional variation. There is mild hypertrophy (up to 12mm). Prominent trabeculae without meeting criteria for non-compaction cardiomyopathy.2. The right ventricle is mildly dilated with mild to moderate systolic dysfunction, the RVEF is 40%. 3. The left atrium is moderately dilated. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Straightening of the cervical spine which may be secondary to muscle spasm or positioning. Alignment is anatomic. There are no fractures or subluxations. The marrow signal is benign. The cervical and upper thoracic cord are normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable.C1/2: No significant central canal stenosis or neuroforaminal compromise, unchanged.C2/3: No significant central canal stenosis or neuroforaminal compromise, unchanged.C3/4: No significant central canal stenosis or neuroforaminal compromise, unchanged.C4/5:Shallow disk protrusion without significant central canal stenosis or neuroforaminal compromise, unchanged.C5/6:Shallow left paracentral disk protrusion without significant central canal stenosis or neuroforaminal compromise, unchanged. C6/7: Shallow left paracentral disk protrusion without significant central canal stenosis or neuroforaminal compromise, unchanged.C7/T1: No significant central canal stenosis or neuroforaminal compromise, unchanged.

Output: 1.C4/5:Shallow disk protrusion without significant central canal stenosis or neuroforaminal compromise, unchanged.2.C5/6:Shallow left paracentral disk protrusion without significant central canal stenosis or neuroforaminal compromise, unchanged. 3.C6/7: Shallow left paracentral disk protrusion without significant central canal stenosis or neuroforaminal compromise, unchanged.


Instruction: Generate impression based on findings.

Input: 9 years Female (DOB:3/24/2006)Reason: patient with chronic headaches, holocephalic with visual changes with the HA History: holocephalic headaches at times waking patient up in the middle of the nightPROVIDER/ATTENDING NAME: CHALONGCHAI PHITSANUWONG CHALONGCHAI PHITSANUWONG The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate a small mucous retention cyst in the left maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: No abnormal intracranial mass lesion is appreciated to explain the patient's headaches associated with visual changes.


Instruction: Generate impression based on findings.

Input: Altered mental status. Post heart transplant. Rule out PRES. The multiple chronic cortical infarcts involving the bilateral cerebral hemispheres, with a relatively large region involving the right temporal lobes and the right frontal lobe remain unchanged. The additional T2/FLAIR hyperintensity within the periventricular and subcortical white matter consistent with small vessel ischemic disease is also unchanged, accounting for technique differences. Changes of laminar necrosis and foci of susceptibility effect representing hemosiderin staining or calcification also remain unchanged. The small chronic lacunar infarcts involving the left thalamus, right periatrial white matter, and bilateral cerebellar hemispheres, right greater than left, are unchanged. There is no acute infarct or new intracranial hemorrhage. There is no significant abnormal contrast enhancement. The ventricles and other CSF-containing spaces are unchanged in size, reflecting underlying mild-to-moderate brain volume loss. There is no evidence of intracranial mass effect, midline shift, or herniation. Normal flow-voids are demonstrated in the major intracranial vascular structures. There is a small, intermuscular left occipital lipoma, measuring up to 2.4 cm in diameter.

Output: 1.Unchanged multiple cortical and lacunar infarcts involving the bilateral cerebral hemispheres and cerebellum as detailed above with no new infarcts or imaging findings of posterior reversible encephalopathy.2.Unchanged laminar necrosis and foci of hemosiderin staining or calcification. No new hemorrhage.3.Incidental small left occipital scalp lipoma.


Instruction: Generate impression based on findings.

Input: Male, 17 months old, with focal seizure, abnormal EEG, nonaccidental injury. Also with difficulty passing ET tube. Brain:The suspected nondisplaced left parietal bone fracture is visualized on this examination as a thin T2 hyperintense defect in the bone coursing from the sagittal suture down almost to the squamosal suture. The defect contains mild enhancement suggesting granulation and the adjacent dura is mildly thickened on several slices, likely reactive. Mild thickening and edema of the right supraorbital scalp and the right temporal scalp is suspected.No significant extra-axial collections are detected intracranially. No evidence of parenchymal edema or mass effect is seen. On diffusion-weighted images, several scattered punctate foci of high signal are demonstrated within the right temporal operculum, the right inferior frontal lobe, the right paramedian frontal lobe, and along the inferior left postcentral gyrus in the vicinity of the fracture. Most of these foci demonstrate probable correlation on the ADC map. None is associated with any significant susceptibility artifact.The pituitary region is unremarkable. The brainstem, cerebellar vermis and cerebellar hemispheres are normally formed. The corpus callosum is intact and fully formed. The pattern of white matter myelination is appropriate for the stated age.Orbits:The globes are round, symmetric and intact. The lenses are normally positioned. The extraocular muscles show normal caliber and pattern of enhancement. The optic nerves are of normal caliber and do not enhance. The intraconal fat is clean and free of inflammation.Soft tissue neck:An ET tube is in place. Although this does obscure visualization of the airway mucosa to some degree, no discrete or significant lesions are suspected. The fat planes are preserved. The salivary glands and thyroid are unremarkable. No significant adenopathy is detected. No significant bone marrow signal abnormalities are seen. Opacification of the posterior right lung apex is partially visualized.

Output: 1.Findings compatible with a nondisplaced left parietal bone fracture and associated reactive changes. No definite additional skull fractures are detected on the basis of MRI. Scalp swelling is seen in the right supraorbital and right temporal regions.2.No significant extra-axial or parenchymal hemorrhage is suspected. No significant parenchymal edema or mass effect is seen. Several scattered punctate foci of diffusion signal abnormality suggest sites of shear or contusive injury given their locations.3.No evidence of any acute injury to the orbital structures is seen.4.No specific abnormalities are detected in the soft tissues of the neck.5.Right apical lung opacification, partial visualized, is nonspecific but may reflect atelectasis.


Instruction: Generate impression based on findings.

Input: Brain: There is infiltrative mass centered in the right infratemporal fossa that measures up to approximately 4 cm, which extends along the right trigeminal nerve trunk into the cavernous sinus, Meckel's cave, right foramen rotundum, and the cisternal segment of the trigeminal nerve towards the brainstem. There also extension of tumor with cystic components along the floor of the right middle cranial fossa with mass effect upon the right temporal lobe, where there is mild vasogenic edema. However, there is no evidence of abnormal intra-axial enhancement. There are multiple foci of white matter T2 hyperintensity in the frontal lobes consistent with age indeterminate small vessel ischemic disease. There is no evidence of acute infarction or intracranial hemorrhage. The ventricles and sulci are normal. The facial nerve is unremarkable in appearance. The orbits are grossly unremarkable. The paranasal sinuses are grossly aerated. There is opacification of the right mastoid air cells.Neck: There are post-treatment findings in the right neck. The infratemporal fossa tumor extends laterally with extension in the right inferior alveolar canal. There is also diffuse enhancement and swelling of the masticator muscles. In addition, there is linear enhancement in the right parotid gland. The other remaining salivary glands are unremarkable. There is no significant lymphadenopathy in the neck. There are multilevel degenerative changes in the cervical spine.

Output: 1. Post-treatment findings in the right neck with a recurrent tumor centered in the right infratemporal fossa with infiltration of the right pterygoid muscle and perineural spread along the trigeminal nerve, with involvement of the right inferior alveolar canal, cavernous sinus, Meckel's cave, right foramen rotundum, and the cisternal segment of the trigeminal nerve towards the brainstem. In addition tumor extends along the floor of the right middle cranial fossa with mass effect upon the right temporal lobe, where there is mild vasogenic edema. 2. Linear enhancement in the right parotid gland may represent perineural tumor spread along the right facial nerve versus radiation neuritis. 3. Superimposed acute denervation changes in the right masticator muscles beyond the areas involved by tumor associated with compromise of the right trigeminal nerve.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: No evidence of acute infarction. There is small focus of volume loss involving the left inferior cerebellar hemisphere with suggestion of susceptibility effect which may be related to chronic blood products or mineralization related to prior infarct. There are few punctate nonspecific T2/FLAIR foci in the corona radiata and in the centrum semiovale as well as the right posterior pons suggestive of mild chronic microvascular ischemic changes.Ventricular size is normal. There is no midline shift. There is no evidence of mass effect or edema. Vascular flow voids are normal. There is minimal fluid in the bilateral mastoid air cells, right greater than left. There is partial opacification of the right posterior ethmoid air cells. Paranasal sinuses are otherwise clear.

Output: 1. No evidence of acute infarction. No evidence of mass effect or edema.2. Small chronic left inferior cerebellar infarct.


Instruction: Generate impression based on findings.

Input: 52-year-old with atrial fibrillation and RVR.Hyperthyroidism. Evaluate for nodules and vascularity. RIGHT LOBE MEASUREMENTS: 6.1 x 2.8 x 2.8 cmLEFT LOBE MEASUREMENTS: 6.3 x 2.4 x 2.2 cmISTHMUS MEASUREMENTS: 0.4 cmRIGHT LOBE: 1.1 x 1.0 x 0.9 cm slightly irregular and complex nodule at the equator of the right lobe of thyroid. This be amenable to FNA if desired clinically.LEFT LOBE: No significant abnormality noted.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Solitary 1 cm slightly irregular right lobe thyroid nodule which would be amenable to FNA if desired clinically.


Instruction: Generate impression based on findings.

Input: 67-year-old male with cirrhosis, PVT. Assess liver for HCC. Assess for portal vein thrombosis. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic morphology with sequela of portal hypertension including splenomegaly, gastroesophageal varices, splenorenal shunt, and ascites. No suspicious arterially enhancing lesions or definite washout. Stable appearance of the previously described linear filling defect within the portal vein at the hepatic hilum branching into the right and left portal veins (series 10 image 263), favor to to represent a web. The intrahepatic main portal vein is diminutive but patent, however the extrahepatic main portal vein has an irregular appearance at the confluence and could arise from a collateral vessel. The SMV and splenic veins are also patent.SPLEEN: Splenomegaly measuring 15.7 cm in length.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No adrenal nodule is identified. There is a splenorenal shunt in close proximity to the normal left adrenal gland.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Stable small gastrohepatic and portacaval lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Right pleural effusion.

Output: 1.Hepatic cirrhosis and sequelae of portal hypertension. No suspicious hepatic lesion.2.Stable appearance of the previously described linear filling defect within the main portal vein at the hepatic hilum, likely representing a web. The portal vein is otherwise patent.3.Stable right pleural effusion and mild ascites.4.No evidence for an adrenal nodule. A splenorenal shunt is in close proximity to the normal left adrenal gland.


Instruction: Generate impression based on findings.

Input: There is slight reversal of upper cervical curvature. There are no fractures or subluxations. The marrow signal is benign. The cervical and upper thoracic cord are normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable.C2/3: Right facet hypertrophy causes mild right neural foraminal stenosis.C3/4: Posterior osteophyte disc complex and bilateral uncinate hypertrophy cause mild bilateral neural foraminal stenosis.C4/5: Posterior osteophyte disc complex, bilateral uncinate hypertrophy, and ligamentum flavum thickening. There is mild central and mild bilateral neural foraminal stenosis.C5/6: Osteophyte disc complex, ligamentum flavum thickening, and uncinate hypertrophy. There is mild bilateral neural foraminal stenosis.C6/7: Osteophyte disc complex, bilateral uncinate hypertrophy, and ligamentum flavum thickening. There is mild bilateral neural foraminal stenosis.C7/T1: Unremarkable

Output: 1.C2/3: Mild right neural foraminal stenosis.2.C3/4: Mild bilateral neural foraminal stenosis.3.C4/5: Mild central and mild bilateral neural foraminal stenosis.4.C5/6: Mild bilateral neural foraminal stenosis.5.C6/7: Mild bilateral neural foraminal stenosis.


Instruction: Generate impression based on findings.

Input: New left breast mass. The patient is undergoing MRI per Alan Penn research study. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.In the left inner breast near 7:00 at mid to posterior depth, a suspicious peripherally enhancing mass measures 8 x 7 x 7 mm. No other suspicious left breast finding. A minimally enhancing mass in the retroareolar region is compatible with the biopsy proven benign lesion from 2012. No abnormal enhancement is seen in the right breast. No abnormal lymph nodes are identified in either axillary region.

Output: Unifocal suspicious left breast mass measures up to 8 mm. This mass was biopsied immediately following this MRI. BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Reason: pt with met melanoma on chemo please assess response to therapy and compare to previous imaging History: met melanoma. There are multiple new and enhancing lesions throughout the brain, likely representing progression of metastases, including lesions in the bilateral frontal lobes, right posterior parietal lobe, head of the left caudate and bilateral cerebellum. Some of these lesions have increased intrinsic T1 signal and susceptibility which may represent melanin or blood products. Other lesions have only increased susceptibility, likely hemorrhage. A left occipital lobe lesion seen previously is unchanged in size measuring 5 mm. Additional lesions seen previously are slightly enlarged and, as above, multiple new punctate lesions are present throughout the supratentorial parenchyma. There is a minimal amount of edema surrounding some of these lesions. Hemosiderin deposition along the left frontal lobe sulcus is stable. There are also new enhancing lesions involving the right inferior rectus, right superior oblique and left superior rectus which likely represent metastases.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. Pineal cyst is unchanged. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Progression of intracranial metastatic disease with multiple new metastatic lesions within the brain parenchyma and involving the extraocular muscles bilaterally.


Instruction: Generate impression based on findings.

Input: Herniated disk, lower back pain, left-sided CVA, tenderness, radiating pain, numbness, tingling to left leg. Please note for the purposes of numbering, there are 5 lumbar type vertebral bodies with T12 bearing hypoplastic ribs as seen on prior CT. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position.Minimal degenerative changes are seen, as described below:L1-L2: Minimal disk bulge. No spinal canal or neural foraminal stenosis.L2-L3: Minimal disk bulge. No spinal canal or neural foraminal stenosis.L3-L4: Minimal disk bulge. No spinal canal or neural foraminal stenosis.L4-L5: Minimal disk bulge eccentric to the right with partial effacement of the lateral recesses. No central spinal canal or neural foraminal stenosis.L5-S1: Minimal disk bulge. No spinal canal or neural foraminal stenosis.Paraspinous soft tissues are within normal limits. Please see separate report for findings in the abdomen.

Output: 1. Minimal disk bulges in the lumbar spine. There is no significant spinal canal or neural foraminal stenosis at any level.2. Please see separate MR report for findings in the abdomen.


Instruction: Generate impression based on findings.

Input: 80 year-old female with left PCA the and left PICA infarctions and possible occluded left vertebral artery. Evaluate for structural changes. There is no evidence of intracranial hemorrhage, mass, extra-axial fluid collection or midline shift. An area of hyperdensity is noted within the left medial temporal lobe. Additionally areas of hypodensity are noted within the left thalamus, the left superior medial cerebellum and the left occipital lobe. There is no volume loss or effacement of the sulci. These findings are consistent with the patient's history of stroke. Additionally, there are multiple areas of hypodensity within the periventricular and deep white matter which are compatible with the MRI findings of chronic small vessel disease.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses are normally pneumatized. There is minimal opacification of the mastoid air cells. Vascular calcifications of the internal carotid and vertebral arteries bilaterally.

Output: Findings consistent with known stroke involving the left medial temporal lobe, left thalamus, left superior medial cerebellum, and the left occipital lobe. There is no mass effect, midline shift, or evidence of hemorrhagic conversion. These findings appear stable since the previous MRI examination on 10/24/2011.


Instruction: Generate impression based on findings.

Input: History of diabetes, hypertension, blindness, presenting to the ED for evaluation of confusion/disorientation with slurred speech.. There is no evidence of intracranial hemorrhage, mass, or acute infarct. However, there is mild scattered cerebral white matter T2 hyperintensity without corresponding restricted diffusion. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull and scalp soft tissues are grossly unremarkable. There is mild scattered paranasal sinus mucosal thickening. There is bilateral intraocular silicone oil and a left superotemporal glaucoma drainage device.

Output: 1. Mild probable chronic small vessel white matter ischemic disease, but no evidence of acute intracranial hemorrhage, mass, or acute infarct.2. Bilateral intraocular silicone oil.


Instruction: Generate impression based on findings.

Input: 80-year-old female with fecal incontinence, back pain, and back tenderness. There is partial fusion of the osseous structures of C2-C4, with what may represent associated segmentation anomalies. There are disc osteophyte complexes at C4-C5 and C5-C6 that cause moderate cervical spinal canal stenosis with an apparent punctate focus of increased T2 signal in the adjacent spinal cord. There is also bilateral moderate neural foraminal stenoses at C4-5 to C5-C6. There is loss of the normal cervical lordosis, but the rest of the vertebral column alignment is intact. There is mild anterior wedge deformity of the T6 vertebra that appears chronic in nature. The thoracic and lumbar spinal cord has normal signal characteristics and morphology. The conus terminates at the L2 level. The vertebral bone marrow signal is grossly unremarkable, aside from scattered areas of focal fat and endplate degenerative changes in the cervical spine. The paraspinous soft tissue structures appear unremarkable. However, there is a 5 mm wide lipoma associated with the left strap muscle overlying the thyroid cartilage.

Output: 1. Partial fusion of the osseous structures of C2-C4.2. Disc-osteophyte complexes at C4-C5 and C5-C6 result in moderate cervical spinal canal stenosis, perhaps with mild signal abnormality in the adjacent spinal cord. The degenerative changes may be associated with what may represent segmentation anomalies with fusion of C2 through C4. 3. Bilateral moderate neural foraminal stenoses at C4-5 to C5-C6. 4. Mild anterior wedge deformity at T6 is likely chronic.


Instruction: Generate impression based on findings.

Input: There is mild retrolisthesis of C5 on C6, measuring approximately 4 mm. There is mild loss of disc height and endplate degenerative changes at C5-C6. The vertebral body heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal. There is no pathological enhancement. Incidentally noted are emphysematous changes of the partially imaged lung apices with scarring or spiculated lesion at the left apex. The right thyroid lobe is mildly enlarged.C2-C3: No significant disc bulge, spinal canal or foraminal stenosis.C3-C4: Small left uncinate spur, contributing to mild left foraminal narrowing. No significant disc bulge, spinal canal or right foraminal stenosis.C4-C5: Left paracentral shallow disc protrusion and minimal uncinate spur, contributing to minimal left foraminal stenosis. No significant spinal canal stenosis or right foraminal stenosis.C5-C6: Mild retrolisthesis of C5 on C6 with mild bilateral uncinate spurs, contributing to mild bilateral foraminal stenosis. No significant spinal canal stenosis.C6-C7: No significant disc bulge, spinal canal or foraminal stenosis. C7-T1: No significant disc bulge, spinal canal or foraminal stenosis.

Output: 1. Mild degenerative cervical spondylosis, most prominent at C5-C6, with mild bilateral foraminal stenosis. No significant spinal canal stenosis. 2. Partially imaged biapical emphysematous changes with incompletely evaluated scarring versus spiculated lesion at the left lung apex. In light of clinical history, CT chest is recommended to exclude neoplasm.Findings discussed with Dr. Schipper by Dr. Judy Wu on 3/25/2015 at the time of dictation.


Instruction: Generate impression based on findings.

Input: Weakness [R53.1], Reason for Study: ^Reason: stroke History: stroke There is no evidence of acute ischemic lesion on the scan.There is a focal nodular susceptibility lesion on the left frontal lobe frontal operculum (image #115/230, series #801) without evidence of surrounding edema which may indicate chronic petechial hemorrhage.There is no evidence of acute hemorrhagic lesion on the scan.There is no evidence of abnormal enhancement either.Underlying brain shows scattered FLAIR/T2 high signal intensity lesions on bilateral periventricular white matter indicating 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, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear. Mucosal thickenings on bilateral maxillary sinus and sphenoid sinus are seen.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion on the scan.2. No abnormal enhancement.3. Nonspecific small vessel ischemic disease.


Instruction: Generate impression based on findings.

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

Output: No evidence of intracranial metastases.


Instruction: Generate impression based on findings.

Input: Clinical question: Known brain tumor with postop epidural fluid collection. Evaluate fluid collection. Signs and symptoms: None Non-enhanced CT of brain:Postoperative changes of right temporal -- frontal craniotomy for large partial resection of right frontal and anterior temporal lobe and. CSF density intradural collection at the surgical site.Epidural collection under the craniotomy flap measures 18-mm in thickness and extend along the entire length of the craniotomy flap (approximately 89 mm). The epidural collection has a thick high density rim along its medial aspect which is believed to represent thickened scarred and possibly calcified dura. When compared with prior MRI examination there is interval decrease in the thickness of epidural collection from 22.9-mm on prior exam to 18-mm on current exam. There is a subtle mass effect on the right frontal horn likely due to large extra-axial intradural CSF collection at the site of partial lobectomy. No midline shift is detected. There is no evidence of any edema of the adjacent brain parenchymal to this CSF collection.

Output: 1.Interval decrease in the size of epidural collection under the craniotomy flap in the right frontal region from prior MRI measurements of 22.9-mm to 18-mm on current exam.2.Postoperative changes of a large right anterior frontal and temporal lobectomy related CSF collection at the surgical site.3.No evidence of any new edema of the adjacent brain parenchymal to the lobectomy site.4.No evidence of hydrocephalus or midline shift.


Instruction: Generate impression based on findings.

Input: Reason: possible achilles rupture History: right achilles pain - rule out tendon tear TENDONS: There is complete rupture of the Achilles tendon approximately 5 cm proximal to its insertion on the calcaneus. There is a gap of approximately 3 to 4 cm between the distal fibers of the Achilles tendon and the retracted proximal fibers, which contains heterogeneous signal intensity that likely represents a combination of fluid, blood products, and perhaps granulation tissue. The Achilles tendon itself appears slightly thickened which likely represents underlying tendinosis. The remaining ankle tendons appear intact.LIGAMENTS: The lateral collateral ligament complex appears intact. The distal tibiofibular syndesmotic complex and imaged components of the deltoid ligament are grossly intact.ARTICULAR SURFACES AND BONE: Mild osteoarthritis affects the ankle and midfoot articulations. We see no osteochondral defects.ADDITIONAL

Output: Achilles tendon rupture and other findings as described above.


Instruction: Generate impression based on findings.

Input: 85 year-old female with facial asymmetry and left hand weakness. There is redemonstration of a left temporal craniotomy with underlying extensive encephalomalacia in the left frontotemporal and ex vacuo dilatation of the left lateral ventricle, unchanged when compared to the previous study. There is no new parenchymal lesion or CT evidence of acute territorial ischemia. MRI would be more sensitive for small or acute infarctions.There is no acute intracranial hemorrhage or extraaxial collection. The ventricles and sulci are stable with ex vacuo dilation of the left lateral ventricle as noted earlier. No midline shift or basal cistern effacement.The visualized mastoid air cells and paranasal sinuses are within normal limits. Orbits unremarkable. Redemonstration of debris within the extra auditory canals bilaterally.

Output: 1. No evidence of acute intracranial hemorrhage or CT evidence of acute territorial ischemia. MRI is offered as a more sensitive test should there be a high degree of suspicion for acute infarction.2. Stable left temporal lobe encephalomalacia underlying prior craniotomy site consistent with prior left MCA infarct.


Instruction: Generate impression based on findings.

Input: 20-year-old female with pain, known fracture. Evaluate for ligamentous injury. ARTICULAR CARTILAGE AND BONE: Again seen is a comminuted depressed fracture of the lateral tibial plateau better assessed on recent CT scan with edema in the adjacent bone marrow. Evaluation of the overlying articular cartilage is limited but the articular cartilage along the lateral tibial plateau anteriorly is poorly defined likely due to disruption. We see no defects within the medial compartment and patellofemoral articular cartilage.MENISCI: The lateral meniscus appears slightly posteriorly displaced along the posterior fragment of the aforementioned tibial plateau fracture, but otherwise appears intact without a discrete meniscal tear. The medial meniscus appears intact.LIGAMENTS: The anterior cruciate ligament appears intact. The posterior cruciate ligament appears intact. The medial collateral ligament appears intact. The major components of the lateral collateral ligament complex appear intact.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: Depressed lateral tibial plateau fracture with a lipohemarthrosis. The menisci and major ligaments appear intact.


Instruction: Generate impression based on findings.

Input: History of breast cancer and transaminitis with liver lesion seen on ultrasound. Additional history per Epic: left breast reduction/mastopexy for symmetry 8/2/16. ABDOMEN:LUNG BASES: Partially visualized postsurgical changes to the right breast more fully characterized on recent dedicated breast imaging. There is a T2 hyperintense structure within the posterior left breast which measures 2.1 x 3.9 cm and demonstrates a rim of intrinsic T1 hyperintensity as well as possible mild surrounding enhancement. These findings are compatible with postsurgical changes related to breast reduction/mastopexy.LIVER, BILIARY TRACT: The liver parenchyma demonstrates normal signal intensity and enhancement without focal lesions. Specifically, no lesion is identified corresponding with the hyperechoic focus seen on recent ultrasound. The gallbladder appears within normal limits. No biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: On the large field-of-view coronal T2 images, there are two T2 hyperintense cystic structures in the left adnexa the largest of which measures up to 3 cm and demonstrates complex features.

Output: 1.Normal appearance of the liver without focal lesions.2.Complex cystic structures in the left adnexa measuring up to 3 cm. Though these may be related to a benign etiology, pelvic ultrasound is recommended for further characterization to exclude the possibility of neoplasm.3.Small fluid collection within the left breast likely related to recent mastopexy/reduction.


Instruction: Generate impression based on findings.

Input: 36 year old woman with newly diagnosed non ischemic cardiomyopathy referred for cardiac MRI to evaluate for possible etiologies. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 24%, the LV end diastolic volume index is 162 ml/m2 (normal range: 65+/-11), the LVEDV is 363 ml (normal range 109+/-23), the LV end systolic volume index is 123 ml/m2 (normal range 18+/-5), the LVESV is 274 ml (normal range 31+/-10), the LV mass index is 72 g/m2 (normal range 67+/-11), and the LV mass is 161 g (normal range 114+/-24). There are no regional wall motion abnormalities present. There is a mid-wall stripe pattern of late gadolinium enhancement in the interventricular septum and a patchy pattern of late gadolinium enhancement involving the basal inferior and inferolateral walls. These patterns are not typical for prior myocardial infarction and suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. The pattern is commonly described in dilated cardiomyopathy due to old myocarditis but is also seen in other forms of non-ischemic cardiomyopathy. No evidence of cardiac amyloidosis or myocardial iron overload. Left AtriumThe left atrium is severely dilated.Right VentricleThe right ventricle is mildly dilated with severely reduced systolic function. The overall RV ejection fraction is 25%, the RV end diastolic volume index is 99 ml/m2 (normal range 69+/-14), the RVEDV is 222 ml (normal range 110+/-24), the RV end systolic volume index is 75 ml/m2 (normal range 22+/-8), and the RVESV is 167 ml (normal range 35+/-13). Right AtriumThe right atrium is mildly dilated. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild to moderate mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is a small pericardial effusion.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Severe LV dilation with severely reduced systolic function (LVEF 24%) with evidence of a mid-wall stripe pattern of late gadolinium enhancement in the interventricular septum and a patchy pattern of late gadolinium enhancement involving the basal inferior and inferolateral walls. These patterns are not typical for prior myocardial infarction and suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. The pattern is commonly described in dilated cardiomyopathy due to old myocarditis but is also seen in other forms of non-ischemic cardiomyopathy. 2. Normal RV size with severely reduced systolic function (RVEF 25%).3. Severe LA dilation.4. Mild to moderate mitral regurgitation.5. Small pericardial effusion.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: History of IBD and pilonidal cyst. Evaluate for fistula. PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: The perianal soft tissues demonstrates no evidence of a sinus tract or fistula formation. No free or loculated fluid collection to suggest an abscess.No findings to suggest a pilonidal cyst.OTHER: Small left hydrocele.

Output: No peri-anal fistula or abscess.


Instruction: Generate impression based on findings.

Input: Paresthesia. Evaluate for demyelinating lesions. The study is limited by patient motion.CERVICAL SPINE:There is straightening which likely reflect patient positioning. There is mild-to-moderate right and T2 signal loss involving the C4-C5 through C5-C6 intervertebral discs. This is associated with minimal degenerative signal subjacent to the inferior endplate of C4. The vertebral bodies are preserved in height. Mild degenerative spinal canal narrowing is most pronounced at C4-C5, as described lobe. The spinal cord shows normal signal characteristics and shape.C2-C3: There is no spinal canal or foraminal stenosis.C3-C4: Mild left more than right foraminal stenosis is caused by uncovertebral arthropathy. There is no central spinal canal stenosis.C4-C5: Disc-osteophyte complex is eccentric to the left causing mild left foraminal stenoses but no significant spinal canal stenosis. Left more than right facet arthropathy is mild.C5-C6: There is mild right foraminal stenosis by uncovertebral arthropathy. There is no significant spinal canal or left foraminal stenosis.C6-C7: Left more than right uncovertebral and facet arthropathy results in mild left foraminal stenosis. There is no signal spinal canal stenosis.C7-T1: There is no spinal canal or foraminal stenosis.THORACIC SPINE:Alignment is anatomic. There is about 40% anterior vertebral body height loss at T8. This is not associated with significant retropulsion, paraspinal soft tissue or gross cortical breach. The marrow signal is unremarkable accounting for minimal digit change adjacent to a central intrabody herniation along the superior endplate. Similarly, there are intrabody herniations along the superior endplates of T9, T10 and T11 vertebral bodies associated with minimal subjacent reactive signal and minimal central vertebral body height loss. Otherwise, there is no suspicious marrow signal abnormality. There is mild T2 signal loss in the mid thoracic discs but no significant disc herniation. The spinal canal is preserved. There is no foraminal stenosis is also.Multiple variably sized T2-hyperintense lesions in the spleen are nonspecific and incompletely characterized. A small T2-hyperintense lesion is also present in the medial aspect of the right liver lobe that is also incompletely assessed.

Output: 1.There is no definite cervical or thoracic spinal cord abnormality but the study is limited by motion which can obscure small lesions.2.Mild multilevel degenerative cervical spondylosis results in mild left C3-C4 and C4-C5 as well as mild right C5-C6 foraminal stenoses but no significant spinal canal stenosis.3.T8 anterior vertebral body height loss without other suspicious features as well as intrabody herniations/Schmorl's nodes involving T8-T11 vertebral bodies are suggestive of bone softening.4.Splenic lesions and possibly a liver lesion are incompletely assessed on this examination.


Instruction: Generate impression based on findings.

Input: Reason: labral tear; MR arthrogram History: pain ROTATOR CUFF: No significant abnormality noted.SUPRASPINATUS OUTLET: There is a type IV acromion process, which may result in narrowing of the supraspinatus outlet.GLENOHUMERAL JOINT AND GLENOID LABRUM: A singular cyst is noted in the posterior superior portion of the humeral head. There is no Hill-Sachs or Bankart lesion identified. There is no labral tear identified. The glenohumeral joint is otherwise unremarkable.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: No evidence of labral tear or specific findings to explain the patient's pain.


Instruction: Generate impression based on findings.

Input: History of right hemipelvis retroperitoneal mass. Evaluate for change. The reference predominantly fatty mass within the adductor musculature of the right hip extending through the obturator foramen to involve the obturator internus muscle, measuring approximately 12.3 x 6.2 cm, previously 12.3 x 6.2 cm in the transverse dimension upon remeasurement, not significantly changed. Additionally, the portion of the mass which extends through the obturator foramen demonstrates increased signal abnormality on T2-weighted images, appearing similar to the prior study which may represent small regions of necrosis but we see no dominant soft tissue nodule. The mass also appears to extend slightly into the acetabular fossa. We see no invasion of the bone. There are septations within the mass, some of which appear to show mild enhancement. There is also a small focus of increased signal abnormality internally within the mass on T2-weighted images which demonstrate minimal, if any, enhancement on postcontrast sequences, appearing similar to the prior study. The obturator nerve and artery are not well seen below the level of the pubic ramus. The mass results in slight lateral displacement of the right femoral artery and vein. There is also slight posterior displacement of the right sciatic nerve. The bone marrow signal intensity is within normal limits. Degenerative disc disease affects the visualized lower lumbar spine. There is low signal intensity within the uterus which likely represents fibroids, as seen on the prior study. There is also a mass with fat signal intensity within the left adnexal region which may represent a dermoid, appearing similar to the prior study.

Output: Predominately fatty mass as described above, appearing similar to the prior study. Given the presence of enhancing septations and nonadipose elements, this raises the possibility of an atypical lipoma, although the relative stability suggests that this may simply represent a benign lipoma.


Instruction: Generate impression based on findings.

Input: Female 9 years old; Reason: History of JIA, please evaluate for TMJ arthritis vs mechanical problem History: pain and popping, morning stiffness, discomfort with eating On the closed-mouth views, the mandibular condyles are well-situated within the glenoid fossae bilaterally. The menisci appear situated appropriately between the condyles and the articular eminences bilaterally. No erosion or synovitis is seen on post-contrast images. On open-mouth series, the mandibular condyles remain within the glenoid fossae, the significance of which is uncertain and may reflect the patient's inability to fully open her mouth as the remainder of the joints appear normal.

Output: Normal appearance of the temporomandibular joints. Lack of anterior translation of the mandibular condyles on open-mouth series is of uncertain clinical significance and may reflect the patient's inability to fully open her mouth as the remainder of the joints appear normal.


Instruction: Generate impression based on findings.

Input: Reason: 49F with chronic abdominal pain without significant systemic symptoms abnormal ultrasound c/f gallbladder malignancy and ?hemangioma, ?cancer, ?cause of pain ABDOMEN:LIVER, BILIARY TRACT: Large gallstone measuring 2.4 x 1.9 cm. Multiple enhancing soft tissue polyps in the gallbladder, radiology and significance unknown, but malignancy cannot be excluded (series 4 image 26). Largest nodularity measures 1.5 x 1.1 cm (series 14 image 135). Common bile but measures 8mm.Segment 4 hepatic dome lesion enhances heterogeneously without washout measuring 3.3 x 2.8 cm (series 10 image 7). This lesion restricts on diffusion but there is no intralesional fat. Differential diagnoses include FNH or adenoma, but malignancy cannot be excluded.Segment 8 subcentimeter T2 hyperintense lesion is compatible with hemangioma.SPLEEN: Splenule noted inferior to the spleen.PANCREAS: Pancreatic parenchyma is slightly atrophic.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.Multiple soft tissue polyps in the gallbladder, etiology and significance unknown, malignancy cannot be excluded.2.Heterogeneously enhancing segment 4 lesion without washout. Differential diagnoses include FNH or adenoma, but malignancy cannot be excluded.3.Cholelithiasis, including 2.4 cm gallstone.


Instruction: Generate impression based on findings.

Input: 39-year-old male with metastatic esophageal adenocarcinoma with increasing liver values, evaluate for biliary ductal dilatation/obstruction ABDOMEN:LIVER, BILIARY TRACT: Innumerable enhancing lesions compatible with metastatic disease in both lobes of the liver, right greater than left.Status post cholecystectomy. No intra or extrahepatic biliary ductal dilation.The right portal vein is attenuated up to the confluence. The left portal vein is widely patent. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Anterior mid abdominal mesentery lymph node measuring 2.8 x 2.8 cm (series 9, image 43).A 3.5 x 3.4 cm heterogeneously enhancing paraesophageal lymph node is noted (series 13, image 28).BOWEL, MESENTERY: Moderate hiatal hernia. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: New moderate right and trace left pleural effusions adjacent atelectasis.. Redemonstrated is a 6 mm nodule in the right lung base.

Output: 1.Innumerable enhancing liver lesions compatible with metastatic disease and associated metastatic lymphadenopathy. No intrahepatic or extrahepatic biliary ductal dilatation.2.New moderate right and trace left pleural effusions with adjacent atelectasis.


Instruction: Generate impression based on findings.

Input: 55-year-old female, follow-up L4 extraspinal lesionIMAGE ACQUISITIONS: Lumbar spine CT without contrast Soft tissue mass at the L4/L5 level is not well-visualized on this exam. If clinical concern remains, an MRI could be obtained for further evaluation.The alignment of the lumbar spine is anatomic. The vertebral body heights and disk spaces are preserved. There is minimal disc bulging with no mass effect upon the cord at L2/L3 and L3/L4. There is diffuse disc bulging at L4/L5 with narrowing of the neural foramina, left greater than right. At L5/S1 diffuse disc bulge is seen with no mass effect upon the cord.

Output: 1. previously seen left-sided soft tissue mass is not well-visualized on this study and can be further evaluated with MRI2. degenerative disc disease of the lumbar spine as described.


Instruction: Generate impression based on findings.

Input: 54 years old patient with a newly diagnosed larynx cancer. CT scan of the head and neck requested to evaluate the extent of the cancer and to rule out brain metastases. Neck CT:At the supraglottic level of the larynx, we note a complete obliteration of the epiglottic fat by an enhanced mass, which extends from the vocal cords inferiorly to the superior tip of the epiglottis superiorly. There is involvement of the aryepiglottic folds, resulting in effacement of the piriform sinuses. There is effacement of the bilateral valleculae, and likely involvement of the most inferior aspect of the tongue base. The lesion measures 45-mm as largest cranio-caudal diameter and 21 x 34 mm axially . The lesion is homogeneously enhanced with a central focal low attenuation probably related to focal necrosis.Inferiorly, at the glottic level, we note thickening of the vocal cords, probably related to infiltration of the mass, but without any evidence of subluxation or complete invasion of the arytenoid or cricoid cartilage.The thyroid cartilage appears heterogeneous with mild scalloping on the surface abutting the mass; although this may represent variant of cartilage ossification, focal infiltration of the cartilage near the anterior commissure is suspected. A gadolinium injected MRI of the neck can be considered for better definition of cartilage invasion.Presence of 3 to 4 small lymph nodes measuring less than 1 cm in short axis diameter are considered nonpathological based on CT criteria (level II and III). There is a slightly bigger 12-mm diameter lymph node located on the left side at the level 3 and level 4 junction.Presence of a 8mm diamter lymphatic node in the superior mediastinum is nonspecific.No obvious noduel is seen in the lung apices. Please correlate with chest CT scan.Study of the bone structure shows degenerative disease of the spine related to the age of the patient.Head CT: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.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.No enhancing intracranial abnormalities are seen.

Output: 1. Presence of a large laryngeal supraglottic mass occupying and obliterating completely the preepiglottic space, infiltrating inferiorly to the vocal cords and extended superiorly to the level of the hyoid cartilage as described above.2. Probable invasion of the anterior aspect of the thyroid cartilage. Better evaluation of the cartilage invasion can be obtained by an enhanced MRI of the neck.3. Presence of a slightly enlarged lymph node at left level 3 and 4 junction. Multiple other small lymph nodes are still within normal limits based on CT criteria.4. Negative brain CT scan.Electronically Signed: 7/7/2010 9:48 AM Raghid Kikano, MD


Instruction: Generate impression based on findings.

Input: Primary sclerosing cholangitis. Presents for cholangiocarcinoma screening. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology. Right-sided percutaneous drain is noted. The biliary tree demonstrates irregularity with intermittent minimal dilatation narrowing and irregularity compatible with stated history of primary sclerosing cholangitis. No dominant stricture is evident.There is moderate biliary wall thickening and irregularity with mild increased intraluminal signal intensity (series 4/18) without associated abnormal enhancement which may represent debris, overall appearing similar to the prior.Right hepatic lobe cavernous hemangioma are noted with the largest measuring 1.1 cm. No suspicious liver lesion.The vessels are patent.The patient is status post cholecystectomy.SPLEEN: No significant abnormality noted.PANCREAS: Punctate T2-weighted hyperintense lesions in the pancreatic tail measure less than 1 cm in size, likely represent side branch IPMNs, grossly unchanged. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable bilateral simple appearing cysts.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.Stable appearance of the biliary tree, compatible with history of PSC without a dominant lesion or discrete lesion. 2.There is moderate biliary wall thickening and irregularity with mild increased intraluminal signal intensity (series 4/18) without associated abnormal enhancement which may represent debris, overall appearing similar to the prior.


Instruction: Generate impression based on findings.

Input: 27 year old male with history of Crohn's disease and perianal abscess. Please evaluate for perianal abscess, fistula, sinus tract to evaluate for discomfort in left buttock, perianal pain. PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: The reference pelvic perirectal lymph node demonstrates interval decrease in size, measuring 6 mm, previously 9 mm in short axis diameter (series 3; image 19).BOWEL, MESENTERY: Again seen is a T2 hyperintense tract extending from the five o'clock position of the anus with extension towards the gluteal skin along the left gluteal crease (series 4 image 51), which measures approximately 2 mm in diameter, previously 4 mm. This tract is associated with restricted diffusion. Findings are compatible with the known history of perianal fistula, appearing less pronounced when compared to the prior study.The reference saccular fluid collection located within the rectal wall above the anal sphincter measures 1.0 x 0.7, previously 1.6 x 0.9 cm and is compatible with a small intramural fluid collection (series 4; image 38).BONES, SOFT TISSUES: No significant abnormality noted.OTHER: There is no focal fluid collection or abscess.

Output: 1.The reference perianal fistula extending from the 5 o'clock position of the anus is persistent but appears less pronounced when compared to the prior study.2.Stable to slight interval decrease in size of the reference small intramural rectal fluid collection located above the anal sphincter.


Instruction: Generate impression based on findings.

Input: 36 year old with strong family history of breast cancer in her sister at age 26. A palpable area of concern has been noted in the right upper breast. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.There is a large enhancing area in the right upper inner breast. This is located somewhat medial to the area of concern noted by the patient at prior diagnostic imaging. This measures 5.5 x 3.5 x 2.5 cm and approaches to within 5 mm of the pectoralis posteriorly. Scattered cysts are also noted through the right breast. No abnormal enhancement is seen in the left breast. No abnormal lymph nodes are identified in either axillary region.High T2 signal round lesion in the liver is likely benign such as a cyst.

Output: Enhancing area in the right upper inner breast measures up to 5.5 cm and is suspicious for malignancy, possibly ILC. Presuming no palpably guided sampling will be done, repeat ultrasound and probably ultrasound guided biopsy targeting the upper inner breast, more medial than the previous palpable area of concern, is recommended. Donna Christian was informed of the results and recommendations. BIRADS: 5 - Highly suggestive of malignancy.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Reason: L knee meniscus tear History: Left knee pain MENISCI: The lateral meniscus is abnormally thickened, compatible with a discoid meniscus. Additionally, there is mild fraying of the inner margin of the body of the lateral meniscus. The medial meniscus is intact.ARTICULAR CARTILAGE AND BONE: No significant abnormality noted.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Discoid lateral meniscus with mild fraying of the inner margin.


Instruction: Generate impression based on findings.

Input: Newly diagnosed base of tongue cancer status post excisional biopsy and left neck lymph node. There is an enhancing mass in the left tongue base, which measures up to 22 mm. The tumor abuts the left styloglossus muscle, but does not invade the pterygoid musculature. The tumor does not extend across the midline. There is an enlarged left level 2A lymph node, which measures 12 x 26 mm in axial cross-section. There appears to be associated infiltration of the left sternocleidomastoid muscle. Other cervical lymph nodes are not particularly enlarged. The thyroid and salivary glands are unremarkable. There is a disc-osteophyte complex at C5-6, which mildly indents the spinal cord. There is a subcutaneous cystic lesion in the posterior left neck, which measures up to 15 mm, with surrounding inflammatory changes. There is fluid within the right maxillary sinus. The orbits and imaged intracranial structures are unremarkable.

Output: 1. A left tongue base mass that measures up to 22 mm is compatible with squamous cell carcinoma, although superimposed biopsy effects can confound the extent of disease.2. An enlarged left level 2A lymph node likely represents metastatic disease, perhaps with extracapsular extension. 3. Findings suggestive of acute right maxillary sinusitis.4. Inflamed inclusion or sebaceous cyst in the left posterior neck.


Instruction: Generate impression based on findings.

Input: Female, 64 years old, with hearing loss and a lesion in the left auditory canal. Enhancement of the left facial nerve is seen beginning at the pre-meatal segment and continuing into the geniculate region with involvement of the labyrinthine, tympanic and mastoid segments of the nerve. In addition, the vestibule and semicircular canals on the left also appear to be enhancing to some degree (see key images).The geniculate region as well as the tympanic and mastoid segments of the facial nerve on the right also appear to enhance but to a milder degree than on the left. The vestibule and semicircular canals are questionably enhancing on the right as well.No masslike lesions are seen. No abnormalities of the prepontine or CP angle cisterns are demonstrated. Limited views of the remainder of the brain show scattered nonspecific T2 hyperintense lesions.

Output: Enhancement of the facial nerves is seen as they traverse the temporal bones, left side more than right. There is also likely some degree of labyrinthine enhancement as well, again left greater than right. Given the bilateral nature of these findings, an underlying systemic process is favored, for example an infectious or postinfectious phenomenon, or perhaps an autoimmune or granulomatous process.


Instruction: Generate impression based on findings.

Input: 60-year-old female with foot pain for years, right greater than left. Evaluate for plantar calcaneal heel spur and DJD. Left foot:There is a moderate-sized plantar calcaneal heel spur. There is an os trigonum. Moderate osteoarthritis affects the first MTP joint. Mineralization along the distal diaphysis of the third metatarsal may represent old trauma or a prior stress fracture, appearing similar to the prior study.Right foot:There is a small plantar calcaneal heel spur. Osteoarthritis affects the talonavicular joint as seen on the prior MRI. There is a small lucency along the articular surface of the navicular bone that may represent prior trauma or an old stress fracture. There is an os trigonum. Moderate osteoarthritis affects the first MTP joint.

Output: Plantar calcaneal spurs, degenerative changes, and other findings as described above.


Instruction: Generate impression based on findings.

Input: Artifact from the shunt device limits evaluation in the left parietal and occipital lobes and posterior fossa. Shunt tubing enters through a left parietal burr hole and has its tip in the posterior horn of the left lateral ventricle. A small amount of increased T2 signal intensity is present anterior to the shunt tubing otherwise there is no abnormal parenchymal signal. A second catheter is seen along the left temporal lobe coursing through the sylvian fissure.There is prominent extra-axial fluid along the left frontal lobe with posterior displacement of the frontal lobe and mass effect on the left lateral ventricle which is asymmetrically smaller compared to the right. There is also prominence of CSF along the anterior left temporal lobe. The prepontine cistern is prominent. There may be a small ependymal cyst at the level of the atrium of the right lateral ventricle curving along the right lateral thalamus and into the temporal lobe.The superior vermis is small and slightly dysmorphic in appearance. The junction of the vein of Galen and straight sinus appears abnormally superiorly positioned which probably contributes to the appearance of a tall and thin superior vermian cistern. The contour of the roof of the fourth ventricle is also atypical in that the superior medullary vellum is relatively convex superiorly.No acute abnormal bodies are seen. No parenchymal edema is detected.

Output: 1.Asymmetric but nondilated ventricles.2.Areas of prominent extra-axial CSF and mass effect on the left cerebral hemisphere may be related to cysts.3.Mildly dysmorphic brain parenchyma is likely chronic.


Instruction: Generate impression based on findings.

Input: History of recent stroke. Altered mental status. The study is mildly limited by patient motion.There is no acute infarct or acute intracranial hemorrhage. Confluent and patchy T2-hyperintensity in the cerebral white-matter is nonspecific but most likely represent chronic microvascular ischemia. Small foci of more CSF-like signal in the cerebral white-matter, the lateral aspect of the right thalamus and in the left cerebellar hemisphere most likely represent chronic lacunar infarcts. There is no mass-effect, midline shift or brain herniation. The ventricles and the other CSF-containing spaces are mildly expanded, reflecting mild underlying parenchymal volume loss. Major intracranial vascular flow voids are preserved.The orbits are unremarkable. There is trace mucosal thickening in the paranasal sinuses. There is no skeletal destructive lesion. There is a 3.5 cm left suboccipital intermuscular lipoma.

Output: 1.No acute infarct or intracranial hemorrhage.2.Moderate cerebral changes of chronic microvascular ischemia and a few chronic lacunar infarcts. If there remains concern for acute ischemic event, MRI brain can be obtained.


Instruction: Generate impression based on findings.

Input: 52 year old man with history of CAD s/p CABG and PCI, with recent cardiac catheterization demonstrating a chronic total occlusion of the 1st obtuse marginal branch. He is referred for cardiac MRI to evaluate myocardial viability. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 55%, the LV end diastolic volume index is 93 ml/m2 (normal range: 74+/-15), the LVEDV is 210 ml (normal range 142+/-34), the LV end systolic volume index is 41 ml/m2 (normal range 25+/-9), the LVESV is 93 ml (normal range 47+/-19). There is increased wall thickness (12-13mm) consistent with left ventricular hypertrophy. There is hypokinesis of the basal to mid inferior and basal inferoseptal wall. There is subendocardial late gadolinium enhancement in the mid inferior and inferoseptal wall to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process, suggestive of intermediate viability. The remainder of the myocardium is viable. There is no evidence of myocardial iron overload. ECV is calculated at 27%, which is within normal limits. Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 50%, the RV end diastolic volume index is 107 ml/m2 (normal range 82+/-16), the RVEDV is 241 ml (normal range 142+/-31), the RV end systolic volume index is 54 ml/m2 (normal range 31+/-9), and the RVESV is 121 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is trivial tricuspid regurgitation.AortaThere is a left sided aortic archs with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsSternotomy wires are present. There is artifact in the AV groove which may be related to his coronary stents. 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. Normal LV size and function (EF 55%). There is hypokinesis of the basal to mid inferior and basal inferoseptal wall. 2. Mild left ventricular hypertrophy. 3. There is subendocardial late gadolinium enhancement in the mid inferior and inferoseptal wall to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process, suggestive of intermediate viability. The remainder of the myocardium is viable.4. Normal size RV with normal systolic function (EF 50%). I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.