Instruction: Generate impression based on findings.

Input: 69-year-old male with pain in thigh when walking. Assess for lumbar stenosis/radiculopathy There is grade 1 anterolisthesis of L4 on L5. Alignment of the lumbar spine is otherwise maintained. Small Schmorl's nodes are noted at the endplates at multiple levels. There are mild anterior wedging of T11 and T12 which may be physiologic. Vertebral body heights are otherwise maintained. There is no suspicious marrow signal. Conus is in normal position and demonstrates normal signal. There are multilevel degenerative changes, individual levels as below:At T11-T12, there is no significant narrowing of the spinal canal or neural foraminal narrowing. At T12-L1, there is no significant narrowing of the spinal canal or neural foraminal narrowing.At L1-L2, there is mild disc bulge, ligamentum flavum thickening, and mild facet arthropathy resulting in mild spinal canal stenosis. No significant neural foraminal stenosis. At L2-L3, there is no significant narrowing of the spinal canal or neural foraminal narrowing.At L3-L4, there is a mild spinal canal stenosis related to mild disc bulge, facet arthropathy, and prominence of the epidural fat. There is no significant right neural foraminal narrowing. There is mild left neural foraminal narrowing.At L4-L5, there is grade 1 anterolisthesis with disc uncovering and mild bulge, advanced bilateral facet arthropathy, and ligamentum flavum thickening resulting in moderate spinal canal stenosis. There is mild bilateral neural foraminal stenosis.At L5-S1, there is a minimal disc bulge with no significant narrowing of the spinal canal or neural foraminal narrowing.There are bilateral T2 hyperintense lesions involving the kidneys likely representing cysts.

Output: Moderate degenerative changes in the lumbar spine, worst at the L4-L5 level where there is advanced facet arthropathy, grade 1 anterolisthesis, and disc bulge with resulting moderate spinal canal stenosis. Relatively mild neural foraminal narrowing at L4-L5 bilaterally and on the left at L3-L4.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Intracranial mass. There is an irregularly rim-enhancing mass centered in the right temporal stem that measures up to approximately 3 cm, with multiple adjacent smaller peripherally-enhancing nodules and extensive surrounding edema involving right thalamus, right middle cerebral peduncle, right basal ganglia, and right frontal lobe. There is a small amount of susceptibility effect in the dominant mass, but no evidence of acute intracranial hemorrhage or acute infarct. There are areas of T2 hyperintensity in the right parietal lobe white matter without corresponding enhancement. There is effacement of the temporal horn of the right lateral ventricle and mild midline shift to the left, but no herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There are retention cysts in the left maxillary sinuses.

Output: A dominant mass centered in the right temporal stem that measures up to approximately 3 cm, with multiple satellite lesions likely represents a high grade glial neoplasm. Nonenhancing white matter lesions in the right parietal lobe are nonspecific.


Instruction: Generate impression based on findings.

Input: History of left mastectomy for IDC and DCIS with TRAM reconstruction in 2003. Patient received chemotherapy. Patient has had two percutaneous biopsies in the superior and posterior aspect of the reconstructed left breast, both of which were shown to represent extensive fat necrosis with dystrophic calcifications. There is scattered fibroglandular tissue in the right breast.Mild parenchymal enhancement is noted in the right breast.The patient is status post left mastectomy with autologous reconstruction. No abnormal enhancement is seen in either the right breast or left reconstruction. A few non-suspicious foci in the right breast are stable. Clip artifact and minimal enhancement is seen at the site of proven left reconstruction fat necrosis. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: History of prostate cancer. 3+3 left mid. PELVIS:PROSTATE:Prostate Size: 2.6 x 4.8 x 4.2 cmPeripheral Zone: In the left mid gland there is a 3 mm focus of restricted diffusion (series 403/304) and subtle T2-weighted hyperintensity (series 801/15 which may represent the site of the patient's known prostatic adenocarcinoma. No additional sites of disease.Central Gland: No significant abnormality noted.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: No evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: Nonspecific prominent right external iliac lymph node measuring 1.1 cm in short axis (series 1601/114), likely reactive.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.3 mm focus of restricted diffusion in the left mid gland peripheral zone may represent the site of the patient's known prostatic adenocarcinoma without evidence of extraprostatic extension or seminal vesicle invasion.2.Nonspecific 1.1 cm right external iliac lymph node is likely reactive.


Instruction: Generate impression based on findings.

Input: Cervical spine:There is slight reversal of normal upper cervical curvature. There are no fractures or subluxations. The marrow signal is benign. The cervical cord is normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable. There are no congenital dysplasias or stenoses.Thoracic spine:Redemonstrated is dextrorotoscoliosis centered at approximately T7. The vertebral body heights and disc spaces are maintained. Marrow signal intensity is benign throughout. The spinal cord has a smooth contour and is without focal atrophy, edema, or myelomalacia. There are no congenital dysplasias or stenoses.Lumbar spine:Alignment is anatomic. There are no fractures or subluxations. The marrow signal is benign. The conus is normal in signal and morphology and terminates at an appropriate level. The visualized intra-abdominal and paraspinal contents are unremarkable. There are no osseous dysplasias or stenoses.At the approximate L3/4 level, chemical shift artifact is noted on the axial T2 images which correlates with linear T1 hyperintensity on the sagittal T1 images, consistent with fat within the filum terminale.

Output: 1.There are no congenital dysplasias or stenoses.2.Redemonstrated is dextrorotoscoliosis centered at approximately T7.3.The cord is normal in signal throughout without intramedullary lesion.4.There is a fatty filum terminale.


Instruction: Generate impression based on findings.

Input: A 53 year old male with history of heart, kidney and pancreas transplant in 2006. Referred to cardiac MRI to evaluate rejection. Left VentricleThe left ventricle is normal in size with hyperdynamic systolic function. The overall LV ejection fraction is 73%, the LV end diastolic volume index is 73 ml/m2 (normal range: 74+/-15), the LVEDV is 149 ml (normal range 142+/-34), the LV end systolic volume index is 19 ml/m2 (normal range 25+/-9), the LVESV is 39 ml (normal range 47+/-19), the LV mass index is 60 g/m2 (normal range 85+/-15), and the LV mass is 124 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.The GRE (global relative enhancement) value is normal (1.90).The T2 STIR ER (edema ratio) value is normal (1.70).The EVF (extracellular volume fraction is above normal (36.6%).No intracardiac thrombus.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 61%, the RV end diastolic volume index is 82 ml/m2 (normal range 82+/-16), the RVEDV is 169 ml (normal range 142+/-31), the RV end systolic volume index is 31 ml/m2 (normal range 31+/-9), and the RVESV is 64 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild 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 no pericardial effusion.Extracardiac FindingsSternal wires were noted. Bilateral pleural effusions, mild on the right and trace on the left. Rounded atelectasis at the posterior basal segment right lower lobe. Postsurgical findings compatible with cardiac transplant.

Output: 1. The left ventricle is normal in size with hyperdynamic systolic function, the LVEF is 73%. 2. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.3. The GRE (global relative enhancement) value is normal (1.90). The T2 STIR ER (edema ratio) value is normal (1.70). The EVF (extracellular volume fraction is above normal (36.6%). These findings are basal numbers for future follow up.4. No findings that support heart transplant rejection.5. The left atrium is mildly dilated. 6. The right ventricle is normal in size with normal systolic function, the RVEF is 61%.7. Mild tricuspid regurgitation.


Instruction: Generate impression based on findings.

Input: Reason: History of arachnoid cyst and fenestration. Evaluate CSF flow thru fenestration. new increasing headaches. History: new worsening headachesAdditional history from EMR: Chronic hydrocephalus due to temporal tip arachnoid cyst herniating against the brainstem causing aqueduct stenosis. Status post endoscopic third ventriculocisternostomy and endoscopic fenestration of temporal tip arachnoid cyst on the right side, 7/2/2007. Images are slightly limited by patient motion. There is a stable right frontal approach ventriculostomy catheter, with its tip along the lateral aspect of the mid right lateral ventricle. Susceptibility from the shunt limits evaluation of surrounding structures. While the fourth ventricle remains normal in size, lateral and third ventriculomegaly is essentially stable. No residual or recurrent arachnoid cyst is identified along the medial right middle cranial fossa, although there remains slight asymmetric prominence of subarachnoid space along the floor of the right middle cranial fossa. Septum pellucidum remains absent.CSF flow does not include the area of the previously seen arachnoid cyst. However, with regards to the third ventriculostomy site, a T2 hypointense flow-void is not visualized on the 3-D T2 weighted images. However, 3-D T2 weighted images do suggest attenuation of the floor of the third ventricle as suggested on 1201/32 although this is to the right of midline. There is questioned very faint biphasic CSF flow suggested slightly more posteriorly to the suspected area of surgery (1302/63-65). Regardless, the appearance is similar to prior exams.Biphasic flow is identified ventral to the brainstem and cervical spinal canal, and to a lesser degree along the dorsal upper cervical spinal canal. Only faint biphasic flow is seen along the cerebellar tonsils. The cerebellar tonsils have a pointed configuration, especially on the left where they extend 6 mm below the level of the foramen magnum. The foramen magnum does not appear crowded. Dysmorphic cerebral parenchyma appears similar, with areas of thinning noted, especially involving the periventricular white matter along the left occipital pole. Previously noted susceptibility in the left occipital horn has resolved, although there is persistent susceptibility along the right medial thalamus, decreased in extent. The basal cisterns remain patent. There is no diffusion abnormality. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. There is diffuse thinning of the corpus callosum, relating to chronic hydrocephalus. The remainder of the midline structures and craniocervical junction are within normal limits. There is a right lateral sphenoid mucosal retention cyst.

Output: 1. Stable appearance of lateral and third ventriculomegaly consistent with chronic obstructive hydrocephalus. No definite evidence of recurrent right middle cranial fossa arachnoid cyst although there remains slight asymmetric prominence of the subarachnoid space inferior to the right temporal lobe. Please note that CSF flow is not obtained through the area of cyst fenestration.2. CSF flow not well visualized through the expected location of third ventriculostomy, although there may be faint biphasic flow identified just posteriorly, similar to prior exams.3. CSF flow visualized along the ventral brainstem and upper cervical cord as well as at the level of the foramen magnum dorsally, although the dorsal flow appears slightly less well visualized compared to prior exam. Redemonstration of pointed cerebellar tonsils although ample CSF space is seen at the foramen magnum level. Please correlate clinically.


Instruction: Generate impression based on findings.

Input: Evaluate for cholangiocarcinoma. Recurrent PSC status post liver transplant. ABDOMEN:LIVER, BILIARY TRACT: Postsurgical changes from liver transplant. The vessels are patent.There is mild intrahepatic biliary ductal irregular narrowing and dilatation compatible with recurrent primary coursing cholangitis. Mild extrahepatic bile ductal dilatation is unchanged. The hepaticojejunostomy anastomosis appearance is unchanged.In the periphery of segment 8 there is stable mild focal intrahepatic ductal dilatation which is now associated with a geographic perfusional abnormality without an obstructive lesion evident.No focal stricture or discrete mass.SPLEEN: Mild splenomegaly measuring 14.5 cm.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: Bilateral breast prosthesis.

Output: No dominant stricture or focal mass. Stable focal mild intrahepatic ductal dilatation in the periphery of segment 8 is now associated with a perfusional abnormality without an obstructing lesion evident.


Instruction: Generate impression based on findings.

Input: Clinical question: Hemorrhage, recent hemorrhage reports from outside hospital. Signs and symptoms: Follow-up hemorrhage A small focal area of increased density in the cingulate gyrus of right posterior parietal is suspicious for small area of hemorrhage or possible calcification (cavernoma). This finding measures approximately 6 mm times 6-mm and is visualized on axial image number 15. Subtle area of low attenuation in the subcortical white matter of the left frontal lobe is also noted. The area of low-attenuation may represent an area of ischemic change. There is a subtle linear increased density within this area of low-attenuation which may represent either minimal hemorrhage or volume averaging of the adjacent cortex. In high convexity right frontal lobe large area of encephalomalacia is noted which is believed to represent an area of old ischemic stroke. To exclude other possibilities an MRI examination is recommended.Cortical sulci, ventricular system and all CSF cisterns are within normal limits for patient's stated age.Slight prominence of the folia of the cerebellum and the vermis may represent minimal underlying parenchymal volume loss. Calvarium, paranasal sinuses and mastoid vessels are unremarkable.

Output: 1.Small area of increased density suspected for minimal hemorrhage and less likely calcification in this gyrus of the right parietal lobe as detailed above.2.Additional areas of suspected ischemic change of indeterminate age.3.Further evaluation for confirmation of the above findings and to exclude other possibilities an MRI is recommended.


Instruction: Generate impression based on findings.

Input: The study is degraded by motion artifacts. There are T2/FLAIR hyperintensities in the subcortical and the periventricular white matter, suggestive of chronic vascular ischemic changes. There are prominence of the ventricles and the sulci suggestive of age related volume loss. There is no midline shift. There is no evidence of acute hemorrhage. There are no diffusion or susceptibility abnormalities. There is no abnormal enhancement.Vascular flow voids are normal.There is fluid in the left nasal cavity.

Output: 1. No evidence for acute intracranial hemorrhage, mass effect, or edema. 2. Subcortical and periventricular white matter chronic ischemic small vessel changes.


Instruction: Generate impression based on findings.

Input: 54 year old male. Knee pain. Evaluate for meniscus. MENISCI: Globular signal abnormality in the body of the medial meniscus that extends into the posterior horn consistent with intrasubstance degeneration. The posterior horn of the medial meniscus near the intercondylar notch cannot be traced to its root and a complete radial tear is of concern (series 501, image 16; series 801, image 21). Lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: Diffuse moderate thinning of the medial tibiofemoral compartment articular cartilage and mild thinning of the lateral compartment cartilage with no focal abnormality. Scattered signal abnormality diffusely in the patellar articular cartilage without thinning or focal defect.LIGAMENTS: ACL, PCL, MCL, and lateral collateral ligament complex are intact.EXTENSOR MECHANISM: Extensor mechanism is intact.ADDITIONAL

Output: 1. Findings concerning for a complete radial tear of the posterior horn of the medial meniscus near its root. Intrasubstance degeneration of the body and posterior horn of the medial meniscus.2. Diffuse cartilage thinning of the tibiofemoral compartment, medial greater than lateral, with no focal abnormality.


Instruction: Generate impression based on findings.

Input: Female, 73 years old, with proximal muscle weakness, right side more than left. No evidence of restricted diffusion is seen. Scattered periventricular foci of T2 hyperintensity are demonstrated. No edema or mass effect is detected. No pathologic intracranial enhancement is seen. There are no findings to suggest acute intracranial hemorrhage or any abnormal extra-axial fluid collections. The ventricles are normal in size and morphology.

Output: 1.No evidence of acute ischemia or any other definite acute intracranial abnormality.2.Findings most compatible with chronic microvascular ischemia.


Instruction: Generate impression based on findings.

Input: 77-year-old man undergoing surveillance for a previously resected meningioma. There are postoperative changes of right frontotemporal craniotomy for meningioma resection. There is susceptibility artifact in the right basal ganglia, inferior right frontal lobe and along the craniotomy site detected above blood products. Peripheral enhancement persists surrounding the residual blood products in the right caudate head. T2 hyperintensity from gliosis extends along the right frontal lobe unchanged from prior exam.Residual enhancing tumor in the anterior medial right middle cranial fossa measures 3.6 x 3.2 x 2.6 cm (series 902, image 108 and at series 3, image 69), unchanged. It extends into the right cavernous sinus as well as medially crossing the midline as on the previous exam. The mass encases the right cavernous and supraclinoid internal carotid arteries and is located directly anterior to and abutting the M1 and M2 segments of the right middle cerebral artery, with patent flow voids. No new areas of intracranial enhancement are identified.Scattered foci of T2 hyperintensity in the subcortical and periventricular white matter are compatible with mild chronic small vessel ischemic disease. There is a punctate foci of susceptibility artifact in the subcortical white matter in the left frontal lobe, stable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. Mild thickening in scattered paranasal sinuses is unchanged. There is a sebaceous cyst along the left frontal scalp.

Output: Stable postoperative changes related to subtotal right middle cranial fossa meningioma resection. The residual tumor is unchanged in size. No new enhancing lesions are identified.


Instruction: Generate impression based on findings.

Input: A patient submitted outside study for review. Submitted for review are screening mammogram dated 4/2/2014, and left diagnostic mammogram dated 10/15/2014, performed at High Tech Medical Park in Palos Heights, IL as well as screening MRI dated 12/2/2014 and images from MRI guided left breast biopsy dated 12/19/2014 performed at Silver Cross Hospital. For comparison, bilateral screening mammogram dated 2/28/2013 and left diagnostic mammogram dated 3/23/2013 are available. MAMMOGRAMS (4/2/2014 and 10/15/2014): Two standard views of both breasts, and spot magnification views of the left breast were obtained on 4/2/2014. Additional left MLO, CC and magnification was performed in October. The breast parenchyma is extremely dense, limiting mammographic sensitivity, unchanged in pattern and distribution.Scattered benign calcifications are present bilaterally. A loosely grouped cluster of calcifications is present within the upper central, slightly inner left breast. Some of these calcifications demonstrate a layered appearance on magnification views, suggesting milk of calcium. The calcifications in the left upper central breast are stable in the short term. No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in either breast. BILATERAL SCREENING MRI (12/2/2014): MRI was performed without and with gadolinium as per outside hospital protocol. There is extremely dense fibroglandular tissue bilaterally, with moderate background parenchymal enhancement, which may decrease the sensitivity of the examination. Multiple cysts are present bilaterally. At the approximate 12:00 position of the left breast, there is a circumscribed, enhancing mass measuring 0.7 x 0.7 x 0.9 cm which demonstrates hyperintense signal on T2 imaging. Dark internal septations are noted. The mass may represent a fibroadenoma. No additional enhancing masses are present in either breast. IMAGES FROM MRI GUIDED LEFT BREAST BIOPSY (12/19/2014): Images from an attempted left breast MRI-guided biopsy were submitted. There is redemonstration of a circumscribed, enhancing mass at the approximate 12:00 position of the left breast. Per report, biopsy was not performed at the time of imaging due to difficulties in accessing the target site.

Output: Enhancing, circumscribed mass at the 12:00 position of the left breast. While this may represent a fibroadenoma, follow up MRI, and possible MRI-guided left ultrasound, should be performed. Additionally, the patient is due for bilateral annual mammogram at this time. It is suggested that the MRI be performed before mammography/ultrasound so that any work-up needed due to the MRI can be performed at the time of the diagnostic mammogram. BIRADS: 3 - Probably benign finding.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Diagnosis: Other symptoms and signs involving the musculoskeletal systemClinical question: please eval for CVASigns and Symptoms: left sided weakness The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Small patchy foci of signal hyperintensity on T2 and FLAIR MR imaging are present in the right cerebellar hemisphere. Punctate foci of T2 and FLAIR signal hyperintensity are present in the cerebellar hemispheres bilaterally. There is no associated mass effect or diffusion restriction associated with these. There is a focus of susceptibility effect present along the inferior aspect of the left cerebellar hemisphere along the cortex of the left inferior semilunar lobule.A T2 and FLAIR signal hyperintense lesion is present in the medial aspect of the left thalamusSeveral punctate foci of signal loss on susceptibility imaging are present in the right medial temporal lobe subcortical white matter, the right frontal lobe, the left thalamus and the right basal gangliaNo abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Lesions present in the cerebellum are present more on the right cerebellar hemisphere than the left which are suspected most likely to be vascular in etiology.2.Findings are compatible with an old hemorrhagic focus in the left cerebellar hemisphere inferiorly3.Findings are compatible with old lacunar infarction in the left thalamus4..Microhemorrhages present in the left thalamus, right basal ganglia and some of the subcortical white matter are nonspecific5.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 6.There is no evidence for acute ischemic cerebral infarction present.7.Examination is mildly compromised due to patient motion which may obscure more subtle abnormalities.


Instruction: Generate impression based on findings.

Input: MRI: An area of T2 hyperintense, disorganized appearing tissue is redemonstrated within the cerebellar vermis measuring 22 x 25 mm. This lesion contains several foci of internal susceptibility corresponding to calcification on prior head CT, along with small foci of noncontiguous nodular enhancement. On some slices, there is the suggestion of a striated or "tigroid" appearance within the lesion best appreciated on thin slice T2 axial images. Mild bulging of the posterior wall of the fourth ventricle is seen without significant mass effect or hydrocephalus. The ventricles and sulci are unchanged.There are findings consistent with patient's known Chiari I malformation with inferior cerebellar tonsillar herniation and flattening. There is no acute infarct or midline shift. There are no separate areas of suspicious intracranial enhancement.MRS: Single voxel short and long TE spectroscopy of the cerebellar vermian lesion shows uniformly decreased myoinositol, choline, creatine and NAA peaks. Interrogation of normal-appearing cerebellar tissue demonstrates a normal spectroscopic pattern.

Output: Midline cerebellar vermian lesion with internal foci of calcification and scattered small foci of enhancement. There has been no significant interval change since prior imaging. Spectroscopic assessment of this lesion shows uniform reduction of all major detectable metabolites. This pattern is non specific but argues against an aggressive, highly proliferative process. The differential diagnosis would include non neoplastic or equivocally neoplastic processes such as dysplastic cerebellar gangliocytoma (Lhermitte-Duclos disease) or simply a developmental dysplasia of the cerebellum. Uniform reduction of MRS peaks has been reported in Lhermitte-Duclos. Low grade tumors such as ganglioglioma or pilocytic astrocytoma among others may also be considered, but the MRS features are not typical.


Instruction: Generate impression based on findings.

Input: Moderate degenerative changes in the cervical spine are partially imaged on the sagittal counting sequence and appear grossly similar to prior study from 7/1/2016. There is at least moderate degree of spinal canal stenosis at the C2-C3 and C3-C4 levels.THORACIC SPINE: Again seen is evidence of discitis-osteomyelitis at the T10-T11 level with edema and enhancement involving the T10-T11 disc space with extension into the epidural space. There has been slight interval increase in erosive changes involving the inferior T10 endplate and stable to minimal worsening of anterior vertebral body height loss at the T11 level.Remainder of the thoracic intervertebral disc levels demonstrate no significant edema or enhancement to suggest new level of discitis-osteomyelitis. Multilevel degenerative changes are again seen including a small right paracentral disc protrusion at the T1-T2 level with mild spinal canal stenosis including mild deformity of the right ventral aspect of the cord, not appreciably changed in the interval. Minimal left paracentral disc protrusion is also evident at the left T6-T7 level also not significantly changed.Circumferential epidural enhancement at the T10-T11 level is again seen and in combination with disc bulge, ligamentum flavum thickening, and facet arthropathy contributes to severe spinal canal stenosis and cord deformity similar to prior. The extent of epidural enhancement is stable to minimally decreased in the interval. There is T2 hyperintense cord signal abnormality at the T10-T11 level which is again evident and similar to prior. There is also moderate to severe neural foraminal stenosis at the T10-T11 level similar to prior.Previously seen multiloculated paraspinous abscess centered at the T10-T11 level demonstrates mild decrease in size and demonstrates more homogeneous enhancement which may represent residual phlegmon and/or granulation tissue. No new fluid collection. LUMBAR SPINE: For the purposes of numbering, the most inferior well-defined disc space is labeled L5-S1. The lumbar spine is in normal alignment aside from minimal L4 on L5 anterolisthesis.. The vertebral body heights are maintained. No worrisome focal marrow signal abnormality is appreciated. The conus terminates at the lower limits of normal at the L2-L3 level.There is no edema or abnormal enhancement involving the disc spaces to suggest discitis-osteomyelitis. No epidural abscess in the lumbar spine. No paraspinous collections in the lumbar spine.Multilevel degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: Mild disc bulge with right foraminal protrusion component. There is mild right and minimal left neural foraminal stenosis. No significant spinal canal stenosis.L3-L4: Disc bulge with right foraminal protrusion component. Small dorsal annular fissure. There is no significant spinal canal stenosis. There is mild to moderate right and mild left neural foraminal stenosis. L4-L5: There is minimal anterolisthesis. Small dorsal annular fissure. There is a disc bulge with partial effacement of the lateral recesses. There is also facet arthropathy and ligamentum flavum thickening contributing to mild central spinal canal stenosis. There is moderate bilateral, right worse than left, neural foraminal stenosis. L5-S1: No significant disc disease. No spinal canal or neural foraminal stenosis.

Output: 1. Again seen is evidence of discitis-osteomyelitis at the T10-T11 level with evidence of extension into the epidural space as well as the paraspinous soft tissues. Overall findings are slightly improved since 7/1/2016. In particular, the paraspinous fluid collection demonstrates mild decrease in size is now more homogeneously enhancing suggesting residual phlegmon and/or granulation tissue. Interval increased lytic changes at the inferior T10 endplate and stable to minimal worsening of anterior vertebral height loss of T11 may represent evolving sequela of infection rather than progression of infection. However, there remains severe spinal canal stenosis at this level with cord deformity and cord edema similar to prior.2. No evidence of discitis-osteomyelitis or epidural abscess in the lumbar spine or elsewhere in the thoracic spine.3. Mild multilevel degenerative changes in the lumbar spine, worst at the L4-L5 level where there is mild spinal canal stenosis and moderate, right greater than left, neural foraminal stenosis. In the thoracic spine, degenerative changes include a small right paracentral T1-T2 disc protrusion with mild spinal canal stenosis. Moderate degenerative changes in the cervical spine are partially imaged.


Instruction: Generate impression based on findings.

Input: Male 4 years old Reason: assess aortic valve stenosis Left VentricleThe left ventricle is normal in size. The overall LV ejection fraction is 69.4%, the LV end diastolic volume index is 79.62 ml/m2 (normal range: 74+/-15), the LVEDV is 55.74 ml (normal range 142+/-34), the LV end systolic volume index is 24.32 ml/m2 (normal range 25+/-9), the LVESV is 17.03 ml (normal range 47+/-19), the LV mass index is 41.2 g/m2 (normal range 85+/-15), and the LV mass is 28.84 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size. The overall RV ejection fraction is 50.1%, the RV end diastolic volume index is 62.3 ml/m2 (normal range 82+/-16), the RVEDV is 43.63 ml (normal range 142+/-31), the RV end systolic volume index is 31.11 ml/m2 (normal range 31+/-9), and the RVESV is 21.78 ml (normal range 54+/-17). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve is trileaflet. Possible partial fusion (multiple valvuloplasties) There there is systolic and diastolic dephasing of the aortic valve suggesting aortic stenosis and aortic regurgitation. The maximal surface area of the aortic valve in systole is 1.14 cm2. The index valve area is: 1.62 cm2.AORTIC VALVE QUANTITATION: Stroke volume in ml: 37Forward flow volume in ml: 43.9Backward flow volume in ml: 6.9Regurgitant factor in %: 15.6Peak velocity in ml/sec.: 200 Mitral ValveThe mitral valve opens widely. There is no significant mitral regurgitation. Dedicated through plane imaging of the mitral valve was not performed.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation visualized. Dedicated through plane imaging of the pulmonic valve was not performed.PULMONARY VALVE QUANTITATION:Stroke volume in ml: 32.1Forward flow volume in ml: 32.5Backward flow volume in ml: 0.4Regurgitant factor in %: 1.2Peak velocity in ml/sec.: 160Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation visualized. Dedicated through plane imaging of the tricuspid valve was not performed.AortaThe ascending aorta is mildly dilated with minimal . Sinotubular junction narrowing is noted as well. There is a left sided aortic arch.The coronary sinus diameter is 17.4 mm and the sinotubular junction measures 11.2 mm. A sending aorta diameter is 13.8 mm. The aortic arch is 14 mm in diameter. Descending aorta diameter is 10.8 mm.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 or effusion.Extracardiac Findings

Output: 1.


Instruction: Generate impression based on findings.

Input: Stage III B cervical poorly/moderately differentiated adenocarcinoma. PELVIS:UTERUS, ADNEXA: The uterus measures 5.1 x 2.9 cm in the sagittal plane, within normal limits for a postmenopausal patient.The endometrium measures 3 mm in thickness, within normal limits.The endometrium/inner myometrial junction is well-defined. The fundus there is a well-defined 1.1 cm T1 iso and T2 hypoechoic lesion compatible with a intramural/submucosal fibroid.The cervical stroma demonstrates normal intermediate T2-weighted signal intensity without a discrete lesion. Postcontrast and restricted diffusion images demonstrate no discrete measurable lesion. The parametrial soft tissues are unremarkable.The adnexa are unremarkable. BLADDER: No significant abnormality noted.LYMPH NODES: Interval decrease in size of pelvic lymph nodes. The left internal iliac lymph node measures 0.9 x 0.6 cm (series 601/46), compared to 1.3 x 0.8 cm previously (series 3/3).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Interval marked decrease in the cervical mass lesion seen on the prior outside MRI dated 10/8/2015 without a measurable residual lesion. The parametrial soft tissues are unremarkable. The pelvic lymph nodes, including a previously mildly enlarged FDG avid left internal iliac lymph node has decreased in size.


Instruction: Generate impression based on findings.

Input: Female, 36 years old, new onset headaches since 12/28. Improving after LP on 12/30 at outside hospital. Unknown opening pressure. The cerebellar tonsils are ectopic descending 2 to 3 mm below the level of the foramen magnum. The tonsils maintain a round morphology. There is mild CSF effacement at the level of the foramen magnum. A single non specific focus of T2 hyperintensity is seen within the white matter of the left inferior frontal lobe. The cerebral and cerebellar hemispheres and brainstem are otherwise unremarkable. Diffusion-weighted images show no evidence of restricted diffusion.No intracranial hemorrhage, mass, edema or midline shift is noted. No abnormal extra-axial fluid is present. Mild asymmetry in the size of the lateral ventricles is within normal limits. Ventricular caliber and morphology are unremarkable. On postcontrast images, no pathologic parenchymal or extra-axial enhancement is detected.

Output: 1. Cerebellar tonsillar ectopia is of uncertain significance relative to the patient's presenting complaint.2. No other specific findings are seen which would account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: Female, 33 years old. Status post ACL reconstruction with right knee pain. Rule out chondral injury. Exam slightly limited due to artifact from the femoral and tibial tunnels.MENISCI: There is nodular thickening at the anterior root of the lateral meniscus measuring up to 1 cm which is adjacent to the tibial tunnel and extends into Hoffa's fat pad. This nodularity has decreased signal on both T1 and T2 imaging and likely represents fibrosis. The posterior horn of the lateral meniscus is intact. Mild residual signal abnormality is present in the posterior horn of the medial meniscus which likely represents postoperative changes. The anterior horn of the medial meniscus is intact.ARTICULAR CARTILAGE AND BONE: The cartilage appears intact without full-thickness cartilaginous defect.LIGAMENTS: The patient is status post ACL repair. The ACL graft appears intact. The posterior cruciate ligament is intact. The collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1. Nodular fibrosis at the anterior root of the lateral meniscus adjacent to the tibial tunnel and extending into Hoffa's fat pad. 2. Mild signal abnormality in the posterior horn of the medial meniscus which is likely postoperative in etiology.


Instruction: Generate impression based on findings.

Input: Abdominal pain status post endoscopic ultrasound. Elevated LFTs and jaundice. ABDOMEN:LIVER, BILIARY TRACT: Mild intra and moderate extrahepatic biliary ductal dilatation with the common duct measuring 1.2 cm. The duct tapers abruptly at the level of pancreatic head. The liver is normal in morphology, signal intensity and enhancement. The vessels are patent. No focal suspicious liver lesion.SPLEEN: Moderate splenomegaly with the spleen measuring 15.4 cm in craniocaudal dimension.PANCREAS: The pancreatic duct is mildly prominent measuring up to 5 mm. It abruptly terminates at the level of the pancreatic head. There is heterogeneous edematous enlargement of the pancreatic head which demonstrates heterogeneous T2-weighted signal intensity and subtle differential enhancement relative to the remainder of the pancreatic parenchyma. There are adjacent inflammatory changes, compatible with focal acute pancreatitis.Within the pancreatic head at the level of the abrupt pancreatic and bile duct narrowing there is a 1.3 x 1.4 cm mildly T2 hyperintense and restricting lesion (series 501/17), suspicious for a neoplasm. There is minimal enhancement of the lesion.There is a very small intrapancreatic fluid collection more inferiorly (series 501/13).There is no soft tissue encasement of the celiac axis or superior mesenteric artery. The portal vein, splenic vein and superior mesenteric vein appear patent. Periportal lymph node measuring 8 mm in short axis.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Subcentimeter right renal superior pole cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Small volume ascites. Bilateral mild discoid atelectasis. Small pleural effusions. Mild body wall edema.OTHER: No significant abnormality noted.

Output: 1. Findings compatible with mild focal pancreatitis of the pancreatic head with a very small intrapancreatic fluid collection.2. 1.4 cm pancreatic head lesion with associated pancreatic and biliary ductal dilatation suspicious for a neoplasm, including a cystic islet cell tumor or pancreatic adenocarcinoma.3. Splenomegaly of uncertain etiology. 4. Small pleural effusions and small volume ascites.


Instruction: Generate impression based on findings.

Input: Clinical question: Trauma secondary to MVA. Findings and symptoms: Headache. Nonenhanced brain MRI:No diffusion weighted abnormalities.There is normal anatomical morphology of brain. There is normal signal intensity of brain parenchyma on all MRI sequences. Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination.The signal void of major intracranial arterial branches are identified. The signal intensity of the intracranial venous sinuses is within normal.Calvarium and soft tissues of the scalp are unremarkable.Orbits, paranasal sinuses and mastoid air cells are unremarkable.Nonenhanced cervical MRI:There is normal anatomical alignment of the vertebral column however with mild straightening of cervical lordosis.There is no detectable posttraumatic soft tissue or bony abnormality of vertebral column.There is mild uniform smaller than expected caliber of the spinal canal and which is highly suspected of a congenital anatomical variation of short pedicle.Foramen magnum is unremarkable.C2 -- C3 is unremarkable. C3 -- C4 demonstrate mild disk desiccation and loss of disk height, mild bilateral ( R >L) uncovertebral hypertrophy and subtle volume disk. There is mild right neural foraminal compromise. Minimal degenerative changes at this level with congenitally smaller size of the spinal canal results in mild central spinal stenosis.C4 -- C5 demonstrate mild disk disease and loss of disk height, bilateral uncovertebral hypertrophic changes and mild bulging disk is noted. Findings results in mild bilateral neural foraminal compromise and central spinal stenosis.C5 -- C6 demonstrate mild disk disease and loss of disk height, bilateral ( R > L ) uncovertebral hypertrophy is also present. Constellation of findings is seen significant right and mild to moderate left neural foraminal compromise and moderate central spinal stenosis.C6 -- C7 demonstrate minimal disk disease, mild uncovertebral hypertrophy on the left. No spinal stenosis and mild left neural foraminal compromise is noted.C7 -- T1 is unremarkable.Uppermost visualized thoracic spine and thoracic cord through T4 is unremarkable.

Output: 1.Unremarkable nonenhanced brain MRI.2.Nonenhanced cervical MRI demonstrate congenital anatomical variation of short pedicles/small canal. Mild degenerative changes at C3 -- C4, C4 -- C5 and C5 -- C6 levels with congenitally small canal results in mild to moderate central spinal stenosis and with neural foraminal compromise as detailed per level above. There is normal signal intensity and caliber of the cervical cord. There is no detectable posttraumatic changes of vertebral column for the perispinal soft tissues.


Instruction: Generate impression based on findings.

Input: Prior left optic neuritis. There appears to be mild high T2 signal in the left intraorbital optic nerve. There is a punctate focus of high T2 signal in the right superior frontal gyrus white matter. The rest of the cerebral white matter appears unremarkable. There is no evidence of intracranial mass. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. Apparent mild high T2 signal in the left intraorbital optic nerve may represent sequela of prior optic neuritis, although it is incompletely characterized in this study.2. A punctate focus of high T2 signal in the right superior frontal gyrus white matter is nonspecific.


Instruction: Generate impression based on findings.

Input: Intermittent bilateral vision loss. Orbit MRI: The globes and ocular adnexa are intact bilaterally. There is no evidence of orbital mass lesions or abnormal enhancement. Brain MRI: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is a small amount of fluid within the right mastoid air cells. There are subcentimeter retention cysts in the maxillary sinuses. Brain MRA: There is no evidence of significant steno-occlusive lesions or cerebral aneurysms. There is a right fetal posterior cerebral artery, which is an anatomic variant.Neck MRA: There is no evidence of significant steno-occlusive lesions.

Output: 1. Unremarkable orbits.2. No evidence of acute intracranial hemorrhage, mass, or acute infarction.3. No evidence of significant cerebrovascular steno-occlusive lesions, although the sensitivity for small vessel vasculitis on MRA is relatively low.


Instruction: Generate impression based on findings.

Input: 58 yo with history of neck surgery, now with chronic neck pain and bilateral radicular symptoms. Evaluate for disk disease and/or nerve impingement. Patient's body habitus limits image quality. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate height. Alignment is maintained. Bone marrow signal is within normal limits. The cervical spinal cord has normal signal characteristics and overall morphology.Mild degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: No significant compromise to the spinal canal or neural foramina.C4-5: Small disk osteophyte complex and uncovertebral hypertrophy is seen. There is minimal spinal canal stenosis. There is mild left and minimal right neural foramina narrowing. There is facet arthropathy on the left.C5-6: There is loss of intravertebral disk space. There is minimal disk osteophyte complex and uncovertebral hypertrophy. There is no significant spinal canal stenosis. There is mild right and minimal left neural foraminal stenosis.C6-7: There is loss of intravertebral disk space. No significant compromise to the spinal canal or left neural foramina. There is minimal right neural foraminal narrowing. C7-T1: No significant compromise to the spinal canal or left neural foramina. There is mild right neural foraminal narrowing. The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits. On the sagittal sequences, there is evidence of facet arthropathy at the left T2-T3 level with focus of T2 hyperintensity posteriorly which may represent a small synovial cyst but is not imaged on the axial sequence. No associated spinal canal or neural foramina narrowing.

Output: Mild degenerative changes in the cervical spine relatively worse at C4-5. There is mild multilevel neural foraminal narrowing as detailed above. No high-grade spinal canal or neural foramina stenosis at any level.


Instruction: Generate impression based on findings.

Input: Generalized tonic clonic seizures in a previously healthy 37 year old male. 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 gross seizure foci.


Instruction: Generate impression based on findings.

Input: 31-year-old female with 5 month history left lateral midfoot pain > plantar pain, please help evaluate etiology. The cortex and marrow signal in the visualized bones appears normal without evidence of fracture. Intrinsic muscles of the foot also demonstrate normal signal without of edema. The visualized tendons appear intact. Hallux sesamoid complex is normal. Plantar plate is unremarkable. There is subcutaneous edema along the lateral aspect of the foot in the area of the symptom site marker. Mild edema is also seen surrounding the lower leg.

Output: Subcutaneous edema along the lateral aspect of the foot without underlying bony abnormality.


Instruction: Generate impression based on findings.

Input: 41 year old with history of right breast ILC status post modified radical mastectomy and chemoradiation in 2009. Status post right mastectomy.There is heterogeneous amount of fibroglandular tissue in the left breast.Marked parenchymal enhancement is noted in the left breast.A small benign mass is unchanged in the left central breast.No abnormal enhancement is seen in left breast or in the right mastectomy bed. No abnormal lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: History of partial seizures and pseudotumor cerebri with VP shunt in place. There is a right transfrontal ventricular shunt catheter that traverses the frontal horn of the right lateral ventricle and terminates in the right gyrus rectus posteriorly. There is also mild T2 hyperintensity in the white matter surrounding the catheter in the right frontal lobe. There is a partially empty sella. The hippocampi are unremarkable. There is no evidence of intracranial hemorrhage or mass. The ventricles and sulci are normal in size and configuration. There is no midline shift or herniation. The orbits are grossly unremarkable.

Output: 1. A right transfrontal ventricular shunt catheter that terminates in the right gyrus rectus posteriorly, with nonspecific signal abnormality in the right frontal lobe white matter surrounding the catheter. 2. A partially empty sella can be a manifestation of pseudotumor cerebri.


Instruction: Generate impression based on findings.

Input: Malignant neoplasm of unspecified part of right bronchus or lung [C34.91], Reason for Study: ^Reason: Evaluate for progression of metastatic disease; compare to previous scan if able. History: Malignant neoplasm of right lung Previously seen right frontal lobe middle frontal gyrus enhancing lesion is not July 7 today's scan.There is no evidence of acute ischemic or hemorrhagic lesion.Patchy FLAIR/T2 high signal intensity lesions on bilateral periventricular white matter and centrum semiovale indicate nonspecific small vessel ischemic disease, unchanged since prior scan.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Non-visualization of previously seen right frontal lobe middle frontal gyrus enhancing nodule.2. No new abnormal enhancement is seen.3. No acute ischemic or hemorrhagic lesion.


Instruction: Generate impression based on findings.

Input: Reason: h/o recurrent endometrial cancer, surveillance ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology, size, signal intensity and enhancement without a focal suspicious lesion. No intra or extrahepatic biliary ductal dilatation. Distended gallbladder again seen.SPLEEN: The spleen is normal in size and enhancement without focal lesion.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Postsurgical changes from anterior pelvic exenteration with cystectomy and hysterectomy. BLADDER: Postsurgical changes from anterior pelvic exenteration with cystectomy and hysterectomy. Right lower quadrant ileal conduit.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Spiculated T1 low tissue in the pelvis is stable and likely postsurgical. There is questionable mild enhancement, which may be related to fibrosis/scarring. Right sacral insufficiency fracture, not significantly changed. OTHER: Trace fluid in the pelvis is stable, likely postsurgical.

Output: Postsurgical changes from anterior pelvic exenteration without evidence of recurrent or metastatic disease.Stable appearance of right sacral insufficiency fracture.


Instruction: Generate impression based on findings.

Input: dementia, visuospatial poor but attention fairly preserved. No evidence of acute ischemic or hemorrhagic lesion on this scan.Minimal patchy high signal intensities on bilateral periventricular white matter indicate non specific small vessel ischemic disease.Prominent sulci may indicate mild brain atrophy.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, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear.The left maxillary sinus shows fluid collection.

Output: No evidence of acute ischemic or hemorrhagic lesion on this scan.Minimal brain atrophy.Otherwise unremarkable brain MRI.


Instruction: Generate impression based on findings.

Input: The spinal cord and cauda equina nerve roots display normal signal and morphology. There is minimal retrolisthesis of L5 on S1 with loss of disc height and posterior disc osteophyte complex. There is degenerative spondylosis in the lower lumbar spine, with up to mild bilateral neural foraminal stenosis at L4-L5 and L5-S1. However, there is no significant spinal canal stenosis. The vertebral body heights are preserved. The vertebral bone marrow is mildly heterogeneous diffusely, but without focal lesions. There are no mass lesions in the spine. There is a partially-imaged cyst in the superior right kidney that measures at least 5 cm in diameter. The paravertebral soft tissues are otherwise unremarkable.

Output: 1. Mild degenerative spondylosis in the lower lumbar spine without spinal canal stenosis.2. A partially-imaged cyst in the right kidney measures at least 5 cm in diameter. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Male, 39 years old, with cervical radiculopathy, evaluate for stenosis. Alignment is anatomic. Vertebral body heights are preserved. No pathologic marrow replacement or significant marrow edema is detected.The visualized spinal cord demonstrates normal signal intensity throughout. No epidural abnormalities are suspected.C2-3: Mild facet arthropathy. Small central annular fissure. No significant spinal canal or foraminal stenosis. C3-4: Posterior disc-osteophyte complex formation, asymmetric to the right. Slight effacement of the right ventral thecal sac but no significant generalized spinal canal stenosis. Mild right foraminal narrowing. C4-5: Left facet arthropathy. No significant spinal canal stenosis. Mild left foraminal narrowing. C5-6: Facet arthropathy. Posterior disc-osteophyte complex formation asymmetric to the left. Effacement of the left ventral thecal sac and slight flattening of the left ventral cord. Mild right and moderate left foraminal narrowing.C6-7: Facet arthropathy. Broad posterior disc-osteophyte complex formation. Moderate generalized spinal canal stenosis with near complete effacement and slight flattening of the ventral cord. Severe bilateral foraminal narrowing. C7-T1: No significant spinal canal or foraminal stenosis.

Output: 1.Multilevel disc degeneration and posterior element hypertrophy.2.The spinal canal is most severely affected at the C6-7 level where a broad disc-osteophyte complex causes moderate generalized spinal canal stenosis.3.The neural foramina are severely narrowed bilaterally at C6-7, with moderate left foraminal narrowing at C5-6.


Instruction: Generate impression based on findings.

Input: T2N2b p16 positive left tonsil squamous cell carcinoma. There is an enhancing mass within the left tonsillar fossa that measures up to 37 mm. There is no extension of tumor into the parapharyngeal space, masticator space, tongue base, or soft palate. There is left level 2B lymphadenopathy with corresponding hypermetabolism on PET, including a lymph node that measures 25 x 30 mm in axial section and another that measures 12 x 20 mm in axial section. There is no significant lymphoadenopathy in the right neck by size criteria. The imaged portions of the thyroid and major salivary glands are unremarkable. The nasopharynx appears to be intact. There is mild multilevel degenerative cervical spondylosis and subcentimeter neural foraminal perineural cysts. There is mild mucosal thickening in the left maxillary sinus. The imaged intracranial structures are unremarkable.

Output: 1. An enhancing mass within the left tonsillar fossa that measures up to 37 mm is compatible with squamous cell carcinoma. 2. Left level 2B lymphadenopathy with corresponding hypermetabolism on PET is compatible with metastatic disease.


Instruction: Generate impression based on findings.

Input: Ms. Wasik submitted outside study for review. Submitted for review are unilateral mammogram (1/14/2016 and 1/19/2016), ultrasound (1/14/2016 and 1/19/2016), MR (1/18/2016) performed at Little Company of Mary Hospital and Health Care Centers, Evergreen Park, Illinois. For comparison, prior mammograms dating back to 2013 are available. MAMMOGRAM 1/14/2016: Three standard and spot compression views of the right breast were obtained. The breast parenchyma is heterogeneously dense, which limits the sensitivity of the mammogram . There is increased mammographic density involving the superior portion of the right breast. In the superior central breast, there is an asymmetry with associated architectural distortion, spanning approximately 7 cm. Additionally, loosely scattered heterogeneous calcifications are seen throughout the right breast. Scattered benign calcifications are present on the left. ULTRASOUND 1/14/2016: Static images of the right breast and axilla were submitted. At the 12:00 position 7 cm from nipple, at the site of palpable abnormality there is a mixed echogenicity mass measures up to 2.8 cm with internal vascularity. Static images of the right axilla demonstrate a normal morphology lymph node measuring up to 2.2 cm.MRI 1/18/2016:Axial T1, fat suppressed T2 and fat-suppressed pre and postcontrast sequences were submitted and analyzed with Dyna CAD. There is moderate heterogeneous fibroglandular tissue and mild background parenchymal enhancement in both breasts.In the right breast, there is clumped non mass enhancement in a segmental distribution predominantly involving the upper inner quadrant. This correlates to the area of architectural distortion and calcifications seen on the mammogram. This area demonstrates rapid uptake with persistent enhancement on dynamic evaluation. The entire extent of abnormality measures 7.9 x 3.0 x 2.6 cm (AP x TV x CC). No suspicious enhancement elsewhere in the right breast.In the left breast, there enhancing foci are seen consistent with background enhancement. No suspicious mass or non mass enhancement. There are a few axillary lymph nodes seen bilaterally, none suspicious in appearance.ULTRASOUND/CORE BIOPSY AND POST BIOPSY MAMMOGRAM 1/19/2016:Static images submitted show ultrasound-guided core biopsy of an irregular mixed echogenicity mass in the 12-1:00 position of the right breast 4-7 cm from the nipple, measuring up to 3.9 cm. Internal vascularity is present. Targeting appears appropriate. A clip was placed as is seen on the post biopsy ultrasound and CC mammogram view. The clip may overly calcifications on the ML view. Per the report, preliminary pathology report demonstrated infiltrative ductal carcinoma.Static images of a normal morphology left breast 2:00-3:00 lymph node measuring up to 1.3 cm is shown on this day, correlating with MRI.

Output: Extensive mammographic abnormality of the superior right breast correlating with a large area of clumped nonmass enhancement on MRI in the superior right breast measuring up to 7.9 cm. Per outside hospital radiology report, pathology revealed infiltrating ductal carcinoma, which is concordant with imaging.No evidence of malignancy in the left breast.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: 48-year-old male patient with abnormal findings in the hip. Bone marrow signals within normal limits. No significant abnormal signal is identified within the visualized musculature of the left hip.There is a small left hip joint effusion. The left hip articular cartilage appears grossly intact. No gross labral abnormality on this limited examination in the absence of arthrogram augmented MRI.Mild osteoarthritis affects the right hip. The visualized intrapelvic structures are unremarkable.

Output: Mild osteoarthritis of the left hip with a small left hip joint effusion.


Instruction: Generate impression based on findings.

Input: Reason: fell on left knee History: has difficulty walking and swelling above the patella MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: There is blistering and fraying of the articular cartilage of the medial patellar facet with edema-type signal in the underlying bone. Otherwise, the articular cartilage is unremarkable.LIGAMENTS: There is minimal edema along the superficial band of the MCL as well as the posterior oblique ligament which may represent sprain in the appropriate clinical context, but the medial collateral ligament is otherwise intact. The lateral collateral ligament is intact. EXTENSOR MECHANISM: The quadriceps and patellar tendons appear intact. There are enthesopathic changes affecting the anterior patella as seen on recent radiographs. There is edema in the soft tissues anterior to the patella as well as the patellar tendon, indicating inflammation, perhaps a bursitis. Furthermore, the fibers of the quadriceps continuation anterior to the patella appear focally disrupted, suggesting a partial tear.ADDITIONAL

Output: 1.Edema anterior to the patella and the patellar tendon suggests inflammation, perhaps a mild bursitis. Furthermore, the fibers of the quadriceps continuation anterior to the patella appear focally disrupted, suggesting a partial-thickness tear.2.Degeneration of the articular cartilage along the medial patellar facet with edema in the underlying bone.3.Moderate to large joint effusion and other findings as above.


Instruction: Generate impression based on findings.

Input: Male, 52 years old, with history of lung cancer metastasis to the brain, status post surgery technique radiosurgery. A minimally enhancing lesion within the left inferior frontal lobe shows no significant interval change in size. On T2-weighted images, it measures 8 x 5 mm (image 16 series 801), previously 8 x 5 mm.A mildly rim-enhancing lesion within the left cerebellar hemisphere measures up to 6 mm in diameter (image 32 series 1101). This is similar to the prior examination and smaller than was seen on older examinations.Small enhancing lesions seen within the right superior parietal lobule (image 121 series 1101), along the left intraparietal sulcus (image 110 series 1101), and along the right occipital cortex (image 84 series 1101) show no significant interval change.None of the above lesions is associated with any significant parenchymal edema or mass effect. No new intracranial lesions are identified. No abnormal extra-axial fluid collections are evident. The ventricular system remains normal in size and morphology.

Output: Multiple intracranial lesions are redemonstrated showing either stability or interval reduction in size. No new intracranial lesions are identified.


Instruction: Generate impression based on findings.

Input: 74-year-old female with fluid collection versus obstruction ABDOMEN:LUNG BASES: New right-sided pleural effusion and right lower lobe airspace opacities which may represent atelectasis versus early pneumonia.LIVER, BILIARY TRACT: Mild splenomegaly. Cholelithiasis is unchanged.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Left adrenal adenoma, unchanged.KIDNEYS, URETERS: Moderate right hydronephrosis with hydroureter slightly worsened compared to previous study.Subcentimeter cyst off the left lower pole kidney.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Mild dilatation of the proximal small bowel loops measuring up to 4.2-cm. distal small bowel loops in the pelvis are decompressed. These findings are suggestive of mild and likely partial small bowel obstruction. No evidence of abscess.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Not visualized.BLADDER: Not visualized.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Right lower quadrant ostomy with ileal conduit.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Ill-defined fluid collection in the right side of the pelvis and one the small bowel loops likely measures 3.9 x 3 cm. This is difficult to differentiate from the nonopacified small bowel loops. Small amount of free fluid is also likely present in the pelvis. Further evaluation of this collection with MRI of the pelvis may be helpful, if clinically indicated.

Output: Partial small bowel obstruction.Ill-defined possible small bowel obstruction which is difficult to differentiate from surrounding unopacified bowel loops on the right side of the pelvis. Further evaluation of this collection with pelvic MR may be helpful, if clinically indicated.Slight interval worsening of the right-sided moderate hydronephrosis and hydroureter.New right-sided pleural effusion and dependent air space opacities which represent atelectasis versus early pneumonia.Dr. Famakinwa was notified and acknowledged at the time of dictation.


Instruction: Generate impression based on findings.

Input: Clinical question: Rule out intracranial mass. Signs and symptoms: Proximal muscle weakness. Nonenhanced head CT:There are few very subtle nonspecific foci of low attenuation in the subcortical white matter of the cerebral hemispheres. Considering patient's age possibility of a small was ischemic disease and demyelinating disease should be considered. Recommend further follow-up with a dedicated brain MRI.There is no evidence of hemorrhage, edema, mass effect or midline shift or hydrocephalus. Calvarium, paranasal sinuses and mastoid air cells are unremarkable.

Output: Very few subtle nonspecific foci of subcortical low attenuation of bilateral cerebral hemispheres. Please follow-up with an MRI exam.


Instruction: Generate impression based on findings.

Input: Ischemic infarct: right sided weakness. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is diffuse ventricular enlargement, predominantly in the occipital regions associated with brain parenchymal volume loss, which is not significantly changed. There is mild predominantly periventricular white matter T2 hyperintensity. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. No evidence of acute intracranial hemorrhage, mass, or acute infarction.2. Unchanged ventriculomegaly associated with extensive cerebral volume loss.


Instruction: Generate impression based on findings.

Input: Clinical question: Neurology request to evaluate for cord compression; known sacral lytic lesion. 66-year-old male with metastatic prostate cancer. Signs and symptoms: Numbness lower extremities up to the rectum and penis; back pain. Pre-and post-enhanced lumbar MRI:Examination demonstrate extensive marrow signal changes of vertebral bodies and the posterior elements of the lumbar spine and visualized sacrum and iliac wings consistent with extensive osseous metastatic lesions from patient's known prostate cancer. There is no meniscal fracture or malalignment of vertebral column. Enhancing metastatic lesions at S2 and S3 demonstrate significant expansion into the ventral epidural space and with resultant complete obliteration of the subarachnoid space. Very minimal presacral expansion of tumor is noted. There is no evidence of spinal stenosis secondary to number at any other levels. There is no meniscal fracture of vertebral column.Pre-and post-enhanced thoracic MRI:Examination demonstrate marrow signal replacement and enhancement consistent with metastatic disease involving the entire osseous structures of thoracic spine. There is normal anatomical alignment the vertebral column however with mild exaggeration of thoracic kyphosis. There is no significant epidural spread of tumor into the spinal canal at any level. There is mild central spinal stenosis in the upper thoracic spine which is believed to be secondary to degenerative changes however possibility of overlapping thin epidural spread of tumor cannot be entirely excluded. This mild spinal stenosis extends from approximately T2 to T6 level. The signal intensity and caliber of thoracic cord remains within normal and without or abnormal enhancement.

Output: 1.Pre-and post-enhanced MRI of lumbar spine demonstrate extensive osseous metastatic lesions involving the entire visualized lumbosacral spine and lower most visualized thoracic spine. There is no fracture or malalignment. There is significant intracanicular spread of tumor from S2 and to a lesser degree S3 metastatic lesions with resultant significant central spinal stenosis. No spinal stenosis at any other level.2.Pre-and post-enhanced MRI of thoracic spine demonstrate osseous metastatic disease involving the entire osseous structures of thoracic spine. There is mild central spinal stenosis extending from T2 through T6 which is primarily due to degenerative changes however minimal epidural spread of tumor as a contributing factor cannot be excluded. There is normal signal intensity and caliber of thoracic cord without abnormal enhancement.


Instruction: Generate impression based on findings.

Input: 66-year-old male evaluate disease is status. Metastatic renal cancer. Limited lateral examination due to lack of contrast.Images through the skull base are within normal limits.Images through the soft tissues of the neck demonstrate no definitive evidence of pathologic adenopathy. No definitive evidence of any masses is detected. Limited images of the apices of the long demonstrate no definitive pathology however in please review dedicated CT of chest performed the same date. Bony density of the area of exam is unremarkable for metastatic disease. Significant degenerative disk disease with areas of significant central spinal stenosis is again identified and can be further evaluated with dedicated MRI. Extensive opacification of bilateral maxillary sinuses are consistent with chronic inflammatory sinus disease.

Output: 1.No evidence of any masses or pathologic adenopathy in the neck.2.Very advanced degenerative disk disease with compromise of the canal and neuroforamina.3.Extensive chronic inflammatory sinus disease of maxillary sinuses.


Instruction: Generate impression based on findings.

Input: Signs of optic nerve compromise: decreased vision OD. Brain: There is a low T1 and high T2 signal right sellar tumor with suprasellar extension and susceptibility effect as well as possible peritumor cyst formation that measures up to 23 mm and exerts marked mass effect upon the optic apparatus and inferior right frontal lobe. There is also mass effect upon the right cavernous sinus. The tumor also abuts and perhaps encases a portion of the adjacent right internal carotid artery. There is no evidence of acute infarct. The ventricles are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Orbits: There is engorgement of the right superior ophthalmic vein due to mass effect upon the right cavernous sinus. The right intraorbital optic nerve appears to be mildly atrophic. The left intraorbital optic nerve appears to be grossly intact. The globes, extraocular muscles, lacrimal glands, and orbital fat are intact bilaterally.

Output: A right sellar tumor with suprasellar extension measuring up to 23 mm exerts mass effect upon the optic apparatus and likely represents a pituitary macroadenoma with prior intratumoral hemorrhage. The right intraorbital optic nerve appears to be mildly atrophic perhaps due to chronic pressure-induced effects by the tumor. Assessment is otherwise limited due to the lack of intravenous contrast, acknowledging pregnancy status.Discussed with Dr. Zeyer at 2 PM on 7/1/16.


Instruction: Generate impression based on findings.

Input: Metastatic head and neck caner with suspicious lesion on head CT. There are at least six bilateral cerebral hemisphere nodular and ring-enhancing lesions with minimal to mild vasogenic edema. For example, the largest measures up to 9 mm in the left middle frontal gyrus. There is also a punctate enhancing lesion in the left cerebellar hemisphere. There is no evidence of acute intracranial hemorrhage or cerebral infarction. The ventricles are normal in size and configuration. There is no midline shift or herniation. The orbits, paranasal sinuses, and mastoid air cells are unremarkable.

Output: 1. Several subcentimeter supratentorial and infratentorial subcentimeter lesions are compatible with metastases.2. Multiple skull lesions are also compatible with metastases.


Instruction: Generate impression based on findings.

Input: MRI CARD W/VASODILATOR STRESS WWO CNTRST, 7/27/2016 1:21 PM 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 structure and function. The overall LV ejection fraction is 54%, the LV end diastolic volume index is 97 ml/m2 (normal range: 74+/-15), the LVEDV is 200 ml (normal range 142+/-34), the LV end systolic volume index is 44 ml/m2 (normal range 25+/-9), the LVESV is 91 ml (normal range 47+/-19), the LV mass index is 69 g/m2, and the LV mass is 141 g. There are no regional wall motion abnormalities present. . Left AtriumThe left atrium is normal size. Right VentricleThe right ventricle is normal in size and function. The overall RV ejection fraction is 53%, the RV end diastolic volume index is 101 ml/m2 (normal range 82+/-16), the RVEDV is 209 ml (normal range 142+/-31), the RV end systolic volume index is 47 ml/m2 (normal range 31+/-9), and the RVESV is 98 ml (normal range 54+/-17).Right AtriumThe right atrium is normal.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 brachiocephalic 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 drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.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. No perfusion defects/ "ischemia" present during hyperemia.2. No prior myocardial infarction. The entire myocardium is viable.3. Near-normal LV size and systolic function (LVEF 54%).4. Normal RV size and systolic function (RVEF 53%).I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 38 year old female patient who is status post Right MRM in 7/2014 for node + right breast cancer; received chemo with and XRT - finished in 3/2015. Patient will undergo left prophylactic mastectomy with immediate bilateral DIEP reconstruction on 9/1/2015-MRI to assess additional lesions and axilla. Postsurgical changes of right modified radical mastectomy without any suspicious findings.There is scattered fibroglandular tissue in the left breast. Mild parenchymal enhancement is noted in the left breast.Clip artifact noted in the left breast 3:00 position at the site of prior benign biopsy. No abnormal enhancement is seen in the left breast or right chest wall. No abnormal lymph nodes are identified in the axillary region.

Output: No MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Reason: sp seizures, r/o intracranial pathologies History: seizures The CSF spaces are appropriate for the patient's stated age with no midline shift. On the flair and T2 MR imaging there is signal hyperintensity present along the cortex at the level of the pre-cuneus and cuneus bilaterally as well as to a lesser degree in the frontal lobes bilaterally at the junction of superior and middle frontal gyri and along the right posterior temporal lobe. There is no associated diffusion restriction.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Lesions in the cuneus, precuneus and frontal lobes bilaterally are suggestive of posterior reversible encephalopathy syndrome.


Instruction: Generate impression based on findings.

Input: 42 year old history of left lumpectomy in September 2013 for DCIS. Patient received radiation and is on tamoxifen. No current breast complaints. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.There is a 4 mm focus of enhancement seen in the right breast 11:00 location with plateau kinetics, indeterminant and could be a lymph node. On review of mammogram 7/23/2015, this mass is not discretely seen. Recommend MRI in 6 months to confirm stability.No abnormal enhancement the left breast and either axilla.

Output: 4 mm focus of enhancement seen in the right breast 11:00 location, benign appearing. Recommend MRI in 6 months to confirm stability. No MRI evidence for malignancy in left breast. BIRADS: 3 - Probably benign finding.RECOMMENDATION: 3B - Followup at Short Interval (6 Months).


Instruction: Generate impression based on findings.

Input: Reason: Is there a rotator cuff tear or tendinopathy? History: shoulder pain in a volleyball coach ROTATOR CUFF: The supraspinatus and infraspinatus muscles and tendons appear intact. The subscapularis and teres minor muscles and tendons appear intact.SUPRASPINATUS OUTLET: There is no significant fluid within the subacromial/subdeltoid bursa. The acromioclavicular joint appears normal.GLENOHUMERAL JOINT AND GLENOID LABRUM: Increased signal intensity traverses the anterior superior labrum from the 2 to 3 o'clock position. While we cannot entirely exclude a labral tear, this may simply represent a normal variant sublabral foramen. The remainder of the labrum appears normal given the limitations of a non arthrogram study.BICEPS TENDON: The tendon of the long head of the biceps appears intact. ADDITIONAL

Output: Normal-appearing rotator cuff without evidence of a rotator cuff tear or tendinopathy. Increased signal intensity traversing the anterior superior labrum. While we cannot exclude a labral tear, this likely represents a normal variant sublabral foramen. Otherwise we see no specific findings to account for the patient's pain.


Instruction: Generate impression based on findings.

Input: Right thigh and groin pain. Metastatic salivary ductal carcinoma. There are innumerable T2 hyperintense, contrast enhancing lesions within the femur extending to the level of the mid to distal diaphysis, compatible with metastases. Lesions extend into the cortex at the femoral neck, which is concerning for pending fracture. There is mid diaphyseal enhancing periosteal reaction with soft tissue component.Limited evaluation of the left femur on comparison imaging demonstrates similarly extensive osseous lesions demonstrating T2 hyperintensity and enhancement, confluent within the femoral neck, and also concerning for pending fracture. No fracture is identified. Pelvic metastases are also identified.

Output: Innumerable bilateral femoral metastases, with extensive involvement of the femoral neck concerning for pending fracture. No fracture identified at this time.These findings were discussed with Dr. Charney at 9:55 AM on 11/20/2015.


Instruction: Generate impression based on findings.

Input: Reason: left sided weakness History: left sided weakness A small focus of diffusion restriction is present in the right basal ganglia.There is a T2 and flair signal hyperintensity present in the left centrum semiovale. This is associated with some punctate loss of signal in the susceptibility images. This is not associated with diffusion restriction. There are couple of subcortical white matter lesions present. This is not associated with diffusion restriction. It is likely of little clinical significance in isolationThe CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate some mild mucosal thickening in the scattered opacities. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Acute phase lacunar infarct in the right basal ganglia2.The findings are suspicious for an old lacunar infarct in the left centrum semiovale.


Instruction: Generate impression based on findings.

Input: 74-year-old male with left knee pain for several years, increasing discomfort over last 5 weeks, evaluate for chondral injury versus meniscal tear MENISCI: Complex tearing of the posterior horn of the medial meniscus. This tear consists of a radial component with blunting of the majority of the posterior horn in addition to cleavage of the free edge of the posterior horn near its root. Medially within the posterior horn and body, there is linear branching signal abnormality that extends to the tibial articular surface. There is also slight medial extrusion of the body of the medial meniscus. Anterior horn is intact. These findings are similar to those seen on the MR dated 12/29/2005.There is seen increased signal intensity within the body and posterior horn of the lateral meniscus compatible with intrasubstance degeneration. Additionally, there is linear signal intensity extending to the tibial articular surface consistent with a horizontal tear appearing similar to the prior exam.ARTICULAR CARTILAGE AND BONE: Moderate osteoarthritis with tricompartmental osteophytes. The articular cartilage of the medial tibiofemoral compartment is thinned with heterogeneous signal along the medial femoral condyle indicating degeneration. There are near full-thickness to full-thickness defects along the articular cartilage of the lateral femoral condyle and lateral tibial plateau adjacent to the posterior horn of the lateral meniscus. Additionally, there is heterogeneity of the articular cartilage anteriorly indicating degeneration. Foci of full-thickness defects involving the articular cartilage of the patella with underlying subchondral cyst formation as well as the articular cartilage of the trochlea. Overall, the osteoarthritis has progressed since the prior studyLIGAMENTS: The cruciate and collateral ligaments are intact.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1.Meniscal tears as described above appear grossly similar to the prior study.2.Moderate tricompartmental osteoarthritis has progressed since the prior study.3.Other findings as above.


Instruction: Generate impression based on findings.

Input: Female 15 years old Reason: eval for tfcc tear; cyst History: wrist pain druj and swelling in area of tfcc. TRIANGULAR FIBROCARTILAGE COMPLEX: There is dorsal subluxation of the distal ulna relative to the sigmoid notch of the radius. There is positive ulnar variance. The volar and dorsal radioulnar ligaments are grossly intact at their radial attachments. The intervening articular disk of the triangular fibrocartilage complex has laminar increased signal intensity that we suspect reflects intrasubstance degeneration. We see no gadolinium entering the substance of the triangular fibrocartilage complex to indicate a tear. LIGAMENTS: Contrast is noted within the radiocarpal joint as expected. Although no contrast was seen in the midcarpal joint on conventional arthrogram, contrast is identified in the mid carpal joint on this study. We suspect that this reflects a small tear of the lunotriquetral ligament, perhaps most evident on image 8, series 601. The scapholunate ligament appears intact.TENDONS: The tendons and remaining soft tissue structures appear normal. BONES: There is mild edema type signal in the ulnar styloid which may relate to the aforementioned degeneration of the triangular fibrocartilage complex. There is also a small defect along the margin of the triquetrum with small cysts in the underlying marrow. The signal intensity of the bone marrow is otherwise within normal limits.

Output: Positive ulnar variance and dorsal subluxation of the distal ulna with degeneration of the triangular fibrocartilage complex articular disk and probable tear of the lunotriquetral ligament. Signal intensity within the ulnar styloid and triquetrum may reflect ulnar abutment.


Instruction: Generate impression based on findings.

Input: Metastatic breast cancer with compression fracture. Increasing low back pain. The extensive metastatic involvement through the lumbar and included lower thoracic spine is now more T1/T2 hypointense and less contrast-enhancing which may reflect treatment response. The associated compression fractures at L4 and L5 as well as T12 have increased. There is severe height loss at T12 and L5, at 70% and 75% percent/ respectively. There is thickening of the soft tissue posterior to the compressed L5 vertebral body suggesting a small epidural component which now indents the thecal sac and the left lateral/subarticular recess. There is also slightly increased compression of the thecal sac at T12 level related to retropulsion, although without spinal cord compression.T11-T12: The increased T12 compression fracture is associated with moderate left and mild right foraminal narrowing. There is mild mass effect on the thecal sac related to retropulsion at T12 level but no spinal cord compression.T12-L1: There is mild-to-moderate left and mild right neural foraminal narrowing but no spinal canal narrowing.L1-L2 and L2-L3: There is no significant spinal canal or neural foraminal narrowing.L3-L4 and L4-5: There is minimal bilateral neural foraminal narrowing. No significant spinal canal narrowing.L5-S1: There is slightly increased narrowing of the left lateral recess and proximal neural foramen. Otherwise no significant spinal canal or neural foraminal stenosis. Linear T2 hyperintensity involving the posterior aspect of the disc, mainly to the left of midline, may represent an annular fissure.The metastatic involvement of the iliac bones is slightly more discretely T1-hypointense compared to the previous examination.Extensive liver metastatic involvement is only partly imaged.Again seen is epidural enhancement dorsal to the L5 vertebral body which may represent small amount of epidural tumor, although some of this enhancement likely represents epidural venous plexus. No significant associated stenosis.

Output: 1.Diffuse osseous metastatic disease with slight differences in associated signal abnormalities compared to 2/9/2015 including decrease in enhancement, findings overall representing treatment response. Please note however given the extensive osseous metastatic disease, follow-up bone scan may be helpful to assess for changes in the overall burden of osseous metastatic disease. 2.Pathologic compression fractures at T12, L4 and L5 are worse in the interval. There is also increased osseous retropulsion particularly at T12, where there is mild spinal canal stenosis without frank cord compression.3.Minimal ventral epidural tumor is suspected at the L5 level which is slightly more prominent than before but without significant spinal canal stenosis.


Instruction: Generate impression based on findings.

Input: 64 years Female (DOB:12/30/1951)Reason: brain mass History: haPROVIDER/ATTENDING NAME: PETER C. WARNKE PETER C. WARNKE The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a 9 x 11 mm axial dimension mass adjacent and abutting the trigone of the right lateral ventricle which enhances heterogeneously. On the prior exam it measured similar dimensions. It is associated with surrounding T2 signal hyperintensity. There is a resection cavity present in the right middle frontal gyrus which was also previously present.There is a small ring-enhancing focus in the left temporal lobe measuring 6 mm in diameter associated with some surrounding T2 signal hyperintensity. This is also stableThere is redemonstration of an enhancing punctate focus adjacent to the frontal horn of the left lateral ventricle.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin.

Output: Multiple intracranial lesions are stable compared to prior exam. Please note that this exam was performed the purpose of stereotactic guidance during surgery.


Instruction: Generate impression based on findings.

Input: Left saline implant is deviated versus ruptured, patient has swelling and pain Intravenous contrast was not administered. This is for implant evaluation.A double lumen retropectoral implant identified in the left breast. The central saline component and outside silicone component is noted. No evidence of extra or intracapsular extension. Multiple foci of saline component identified along the lateral aspect of the saline component of the implant which could be seen due to a leak in the saline component of the double lumen implant.There is scattered fibroglandular tissue in both breasts. 5 mm focus in the left breast 6:00 position most likely corresponds to a benign intramammary lymph node. Another benign intramammary lymph node with similar morphology identified in the left lower axillary region.Noted is a collapsed shrunken right retropectoral double lumen implant. Multiple enlarged left axillary and left subpectoral lymph nodes (at least 4) are identified. Referenced left deep axillary lymph node measures 19 x 18 mm.No evidence of right axillary lymphadenopathy.

Output: 1. Collapse trunk and right retropectoral double lumen implant.2. No evidence of intra or extracapsular extension noted off the left retropectoral double lumen implant. Few small foci of saline component identified along the lateral aspect of the saline component of the implant which could be seen due to a leak in the saline component of the double lumen implant.3. Enlarged left axillary and retropectoral lymph nodes. Further evaluation with left axillary ultrasound is recommended. Patient is 30 years old, if left axillary lymph nodes appear suspicious on ultrasound, bilateral diagnostic mammogram can be performed.BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: E - Additional Mammo/Ultrasound Workup Required.


Instruction: Generate impression based on findings.

Input: 47 years, Female, with a history of MS, evaluate for progression. A few punctate and curvilinear T2/FLAIR hyperintense lesions are demonstrated in the bilateral periventricular and subcortical white matter. There has been no significant interval change in size or morphology of these lesions, and no new lesion is detected.No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. Paranasal sinuses are slightly thickened. The remainder of the maxillofacial sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: No significant interval change in size or number of a few scattered T2 hyperintense lesions compatible with the history of demyelinating disease.


Instruction: Generate impression based on findings.

Input: Diagnosis: Secondary malignant neoplasm of brain Malignant neoplasm of unspecified kidney, except renal pelvisClinical question: history of metastatic renal cell carcinoma with single brain met s/p radiosurgerySigns and Symptoms: brain metastasis 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.There is a mild to moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Periventricular and subcortical white matter changes of a mild to moderate degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: The ventricles and sulci are normal in size. There are no masses, mass effect or midline shift. No parenchymal signal abnormalities. There is no evidence for intracranial hemorrhage or infarct. There are no extraaxial fluid collections or subdural hematomas. Incidental note is made of partially empty sella without associated distended optic nerve sheaths or papilledema by MRI. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear.

Output: 1.MRI of the brain is essentially within normal limits.2.Incidental note is made of partially empty sella, which can be a normal variant or associated with intracranial hypertension in the appropriate clinical setting.