Instruction: Generate impression based on findings.

Input: Reason: Assess for medial meniscus tear; possible chondromalacia; PLEASE MEASURE TT-TG History: Medial joint line tenderness; h/o MPFL recon, chondroplasty and microfracture of PF compartment MENISCI: The medial and lateral meniscus appear intact.ARTICULAR CARTILAGE AND BONE: There is near full-thickness articular cartilage signal abnormality along the lateral facet of the femoral trochlea with underlying subchondral signal abnormality which may represent a combination of degeneration and postsurgical change from prior microfracture. No full-thickness defects are identified. There is linear decreased T2 signal abnormality along the medial facet of the femoral trochlea likely representing a full-thickness articular cartilage fissure with underlying degenerative subchondral signal abnormality. There is partial-thickness articular cartilage degeneration and thinning along the lateral facet of the patella.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact. The Insall Salvati ratio is within normal limits. There is increased intermediate signal intensity within the patellar tendon indicating a mild tendinosis. There is thickening of the medial retinaculum which may represent postsurgical change, however, the retinaculum appears intact.ADDITIONAL

Output: Postsurgical changes of prior MPFL reconstruction. Articular cartilage degeneration and postsurgical change of prior microfracture as well as articular cartilage fissuring affecting the patellofemoral articulation. Elevated tibial tubercle to trochlear groove distance with reference measurement provided above.


Instruction: Generate impression based on findings.

Input: Female, 52 years old, with paresthesias, history of MS, follow-up progression. Numerous T2 hyperintense white matter lesions are redemonstrated within the corpus callosum, periventricular white matter, left thalamus, brainstem and posterior fossa. The number and distribution of these lesions have not significantly changed. At most, punctate very subtle foci of signal abnormality within the right superior frontal gyrus and the left cerebral hemisphere are not clearly identified on the prior examination, but this could be due to differences in technique and generally improved image quality on the present study.These lesions exert no mass effect and there is no evidence of parenchymal edema. No restricted diffusion is seen. There is no evidence to suggest intracranial hemorrhage or any abnormal extra-axial fluid collections. The ventricular system stable and normal in size.

Output: Numerous white matter lesions are demonstrated compatible with the history of multiple sclerosis. The size and number of these lesions have not convincingly changed from the prior exam.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for hemorrhage and edema. Signs and symptoms: Evaluate for edema. Nonenhanced brain MRI:Examination demonstrates an acute hematoma in the left thalamus measuring 18 x 20 mm in transaxial dimensions and without significant change since prior head CT exam.Diffuse surrounding vasogenic edema and resultant mass effect on the adjacent ventricle and trace to radiation of midline to the right demonstrate no significant change.Similar to prior exam there is evidence of extension of hemorrhage extensively into the right lateral ventricle without change.Stable mildly dilated lateral ventricles and prominence of bilateral cerebral cortical sulci without change since prior study.Extensive subcortical, periventricular, basal ganglia, thalamic and pontine foci of FLAIR hyperintensity highly suspected of advanced chronic small vessel ischemic strokes is noted. There is minimal susceptibility signal changes in the pons representing chronic hemorrhagic changes.

Output: 1.Stable acute left thalamic hematoma, surrounding vasogenic edema, associated mass effect and extension of hemorrhage into the ventricular system since prior study.2.Extensive patchy confluent foci of FLAIR hyperintensity in the periventricular, subcortical, bilateral basal ganglia, left thalamus and extensively of the pons are suggestive of advanced chronic small vessel ischemic strokes. Minimal susceptibility signal changes in the pons suggest chronic hemorrhagic changes.


Instruction: Generate impression based on findings.

Input: Ms. Pascoe is a 62 year old female presenting for high risk MRI screening. Strong family history of breast cancer in mother diagnosed at age 60 and ovarian cancer at 86, breast cancer in maternal grandmother, and breast cancer in paternal aunt diagnosed at age 60. Personal history of skin cancer diagnosed at age of 52. There is scattered fibroglandular tissue in both breasts. Moderate to marked background parenchymal enhancement is noted bilaterally, which limits the sensitivity of this examination.Multiple subcentimeter nonenhancing cysts are seen bilaterally. There is no new abnormal enhancement seen in either breast.No abnormal axillary lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Reason: eval for superior labral tear History: worker comp injury. Prior mri in pacs. Has continued pain. 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 a small amount of fluid within the subacromial subdeltoid bursa which could reflect a mild bursitis. The acromioclavicular joint appears normal.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is intermediate signal intensity directed superomedially along the base of the anterior superior labrum likely representing a normal variant sublabral recess. We see no gadolinium entering the substance of the labrum to indicate a tear.BICEPS TENDON: The tendon of the long head of the biceps appears intact. ADDITIONAL

Output: 1. There is a small amount of fluid within the subacromial bursa which may reflect a mild bursitis.2. Small focus of edema within the greater tuberosity is nonspecific.


Instruction: Generate impression based on findings.

Input: 15 years, Female, Reason: evaluate position of electrodes. Examination is limited to sequences for operative planning and intraoperative navigation. Nodular subependymoma heterotopia and findings suspicious for left mesial temporal sclerosis are again seen. Placement of three depth electrodes via left parieto-occipital burr holes is seen which terminate in the left medial temporal lobe just anterior to the left hippocampal head as well as within the subependymal gray matter heterotopia along the posterior body on the left lateral ventricle and left periatrial regions. There is also a subdural grid placed along the left anterior temporal convexity via a left temporal burr hole with small adjacent extra-axial collection. No large hemorrhage or intracranial mass effect is evident. No hydrocephalus.

Output: Examination for operative planning and intraoperative navigation demonstrating multiple left hemicranial depth electrodes in the left medial temporal lobe and within the left nodular subependymal heterotopia as well as subdural grid along the left temporal convexity.


Instruction: Generate impression based on findings.

Input: Ms. Jellinek is a 64-year-old patient with BRCA mutation and a strong family history presents for high risk MRI screening. Family history includes ovarian cancer in her mother diagnosed at age of 49, breast cancer in her sister diagnosed at age of 40 and daughter diagnosed at age of 24. There is scattered fibroglandular tissue in both breasts. Minimal parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: NS - Routine Screening Mammogram.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Spina bifida without mention of hydrocephalus, lumbar region Other specified congenital anomaly of spinal cord Backache, unspecifiedClinical question: history of Lipomyelomeningocele, tethered cord release , pt with new back pain, eval for retethereing,Signs and Symptoms: abnormal neurological exam(gait, pain) eval for changes MRI thoracic spine:The thoracic vertebral bodies are appropriate in the overall alignment and height. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots. Lumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. There is redemonstration of a lipomyelomeningocele with tethering of the cord. The lipoma extends from L3 to L5. The cord joins the lipoma at L3. From supine to prone there is forward movement of the spinal cord above the level of the lipoma. Since the prior exam there appears to be more fat accumulation within the intrathecal portion of the lipoma. The AP dimension of the lipoma is 22mm on the current and 17 mm on the prior exam. A cystic lesion along the right posterior aspect of the spinal canal at the L3 and L4 vertebral levels has rearranged relative to this fat accumulation. There is accumulation of significantly more subcutaneous fat since the prior exam. Interestingly at L4-5 a previously present Schmorl's node is smaller on the current exam and the disk space height has increased by a couple millimeters. The lumbar lordosis on the other hand is exaggerated relative to the prior exam. There is spina bifida present.The patient is status post lumbar spine surgery. At L5-S1 there is no significant compromise to spinal canal or neural foramina. The distorted configuration of the thecal sac is unchanged and the intrathecal nerve roots are displaced peripherally in similar positions as on the prior exam. At L4-5 there is no significant compromise to spinal canal or neural foramina. At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.Since the prior exam from 2010, there has been fatty accumulation within the spinal canal at the L3 and L4 levels but otherwise no change in the lipomyelomeningocele. Movement of the cord from supine to prone is unchanged.


Instruction: Generate impression based on findings.

Input: There is a small collection of T2 hyperintense foci within right periventricular white matter.Just superolateral to the left frontal horn is a 4 mm, ovoid, well-circumscribed focus of CSF intensity without mass effect, which nulls completely on FLAIR technique. This appearance is consistent with a connatal cyst which is of no clinical significance.The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The mastoid air cells are clear.Coronal images of the temporal lobes demonstrate the temporal horns, hippocampal formations and parahippocampal gyri to be normal in size and symmetric bilaterally without signal abnormalities or masses identified within the medial temporal lobes on either side. There is no evidence of mesial temporal sclerosis and there are no foci of heterotopic gray matter.

Output: 1.There is a small collection of T2 hyperintense foci within right periventricular white matter. This is nonspecific in appearance, however for a patient of 9 years this may reflect mild residua of periventricular leukomalacia. Alternatively, it may represent small vessel disease or the sequelae of some other prior gliotic event. Other etiologies are felt to be less likely.2.Just superolateral to the left frontal horn is a 4 mm, ovoid, well-circumscribed focus of CSF intensity without mass effect, which nulls completely on FLAIR technique. This appearance is consistent with a connatal cyst which is of no clinical significance.


Instruction: Generate impression based on findings.

Input: 33 years, Male, paresthesias, new facial symptoms. Brain: Brain parenchyma appears within normal limits without evidence of demyelinating lesions in the brain. Specifically, no pontine lesions are appreciated along the trigeminal nerve root entry zones. 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. Dedicated orbital sequences were not obtained but orbits appear grossly unremarkable. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits. Cervical Spine: No abnormal signal in the cervical cord to suggest demyelinating disease. The cervical vertebral bodies are appropriate in height. Alignment is maintained. No fractures are identified in the cervical spine. No suspicious bony lesions are identified in the cervical spine. There is no significant spinal canal or neural foraminal stenosis at any level in the cervical spine. Paraspinous soft tissues are unremarkable.

Output: No evidence of demyelinating disease involving the brain or cervical cord.


Instruction: Generate impression based on findings.

Input: Male, 27 years old. Twisted knee while playing soccer, has history of partial ACL tear in the past that was not operated upon. MENISCI: The menisci appear intact.ARTICULAR CARTILAGE AND BONE: There is edema within the medial and lateral tibial plateaus posteriorly indicating bone contusions. There is also subchondral edema within the lateral femoral condyle above the anterior horn of the lateral meniscus with slight depression of the articular surface indicating a mild impaction fracture. A low signal intensity focus within the articular cartilage of the lateral articular facet of the patella may reflect focal degeneration or tearing. The femoral trochlea appears shallow, suggesting femoral trochlear dysplasia. We see no fluid-filled articular cartilage defects.LIGAMENTS: The anterior cruciate ligament is thickened and poorly defined indicating a full-thickness rupture, we suspect through its proximal to mid fibers. The PCL is intact. The medial collateral ligament and lateral collateral ligament complex are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: Anterior cruciate ligament rupture and other findings as above.


Instruction: Generate impression based on findings.

Input: 58 year old woman with history of ILD pulmonary fibrosis on oxygen who presents for cardiac MRI for further evaluation of right heart size and function Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 58%, the LV end diastolic volume index is 49 ml/m2 (normal range: 65+/-11), the LVEDV is 105 ml (normal range 109+/-23), the LV end systolic volume index is 21 ml/m2 (normal range 18+/-5), the LVESV is 45 ml (normal range 31+/-10), the LV mass index is 35 g/m2 (normal range 67+/-11), and the LV mass is 75 g (normal range 114+/-24). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement (LGE) to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. There is an area of increased signal on the LGE images in the basal inferolateral wall, which most likely represents an imaging artifact. Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 46%, the RV end diastolic volume index is 62 ml/m2 (normal range 69+/-14), the RVEDV is 133 ml (normal range 110+/-24), the RV end systolic volume index is 33 ml/m2 (normal range 22+/-8), and the RVESV is 72 ml (normal range 35+/-13). No evidence of RV insertion point late gadolinium enhancement. AtriaMild left atrial dilation. The right atrium is mildly increased. The interatrial septum is aneurysmal. No evidence of atrial septal defect. 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 mildly dilated. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsSevere right hemi-diaphragmatic elevation. Consolidation/ atelectasis of bilateral lower lungs. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size and systolic function[LVEF 58%]2. The right ventricle is normal in size with mildly reduced systolic function [RVEF 46%]. RV/LV volume ratio is 1.3. No evidence of RV insertion point late gadolinium enhancement. 3. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.4. Mild biatrial dilation with an aneurysmal interatrial septum. 5. Mild dilation of the main pulmonary artery dilation. 6. Extra-cardiac findings as aboveI personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 82-year-old male with history of colon cancer, status post resection. Presents with abdominal distention and emesis This examination is limited by the absence of intravenous contrast. ABDOMEN: Within the limits of a non-IV contrast enhanced examination of following observations are made. LUNG BASES: No significant abnormality noted LIVER, BILIARY TRACT: No significant abnormality noted SPLEEN: No significant abnormality noted PANCREAS: No significant abnormality noted ADRENAL GLANDS: Low-attenuation right adrenal gland lesion with characteristics typical of benign adenoma seen unchanged dating back to MRI exam of 3/3/2004. KIDNEYS, URETERS: Small kidneys bilaterally with bilateral urinary tract calculi seen. The total burden of calcifications appears relatively unchanged although the location of these calcifications has changed from 2007. No hydronephrosis. Simple cyst seen bilaterally unchanged. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted. BOWEL, MESENTERY: Marked dilatation of colon with redundant colon isvirtually unchanged since CT 1/3/207 and similar to computed radiographs dating back to 2004. Colon is seen with distention and fluid and air through the entire length through to the rectum although collapse of the sigmoid is seen at one location but without surrounding mass. While CT cannot exclude a colonic neoplasm, there is no mass effect around this collapsed colon and this presumably is physiologic. Small bowel is dilated distally while proximally it is of normal caliber. There is no transition point throughout the entire colon to suggest an element of obstruction and this pattern and the chronicity suggests colonic pseudoobstruction. BONES, SOFT TISSUES: No significant abnormality noted OTHER: No significant abnormality noted PELVIS: PROSTATE, SEMINAL VESICLES: No significant abnormality noted BLADDER: No significant abnormality noted LYMPH NODES: No significant abnormality noted BOWEL, MESENTERY: See above discussion in the abdomen. BONES, SOFT TISSUES: No significant abnormality noted OTHER: No significant abnormality noted

Output: 1. Marked diffuse dilatation of the colon to maximum diameter 12 cm, without evidence of mass lesion or transition point -- chronic dating back to 2004. Findings are most consistent with colonic pseudoobstruction.2 Right adrenal adenoma is unchanged 3. Bilateral renal calculi with no evidence of urinary obstruction.


Instruction: Generate impression based on findings.

Input: Diagnosis: Muscle weakness (generalized). Muscle weakness (generalized)Clinical question: evaluate for cervical stenosis or radiculopathySigns and Symptoms: Rt-sided weakness The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There is reversal of the normal cervical curvature presentAt C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina. There are small left-sided uncovertebral osteophytes associated with disc material present at this level which mildly encroach the left-sided exiting nerve roots.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina. There is a small right paramedian disc extrusion present at this level with disc material extending behind the adjacent endplates. There is partial effacement of CSF ventral but not posterior to the spinal cord.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.There are mild degenerative changes present in the cervical spine with a disc protrusion at C6-7 and some small uncovertebral osteophytes at C4-5 but no significant compromise to the spinal canal or exiting nerve roots.2.Reversal of the normal cervical curvature is a nonspecific finding which could relate to patient positioning in the magnet or could be related to muscle spasm.


Instruction: Generate impression based on findings.

Input: The images will be interpreted as per research protocol.

Output: Research PEM to be evaluated per protocol.TECHNIQUE: Axial CT images are obtained through the abdomen and pelvis after administration of oral contrast and 120 ml intravenous Omnipaque 350 . Coronal reformats were also generated and reviewed.


Instruction: Generate impression based on findings.

Input: Female, 27 years old, with Ehlers-Danlos syndrome status post cervical fusion presenting with neck pain and uncontrollable belching/hiccuping. Evidence of posterior instrumented fusion is seen from the occiput down to T2. The spinous processes have been resected through the operative region. There is a T2 hyperintense and T1 intermediate intensity fluid collection within the posterior soft tissues of the neck spanning from C1 down to C7 measuring up to 9 cm in craniocaudal length and 3.5 x 1.7 cm in maximal transaxial dimensions.Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. No evidence of marrow edema or pathologic marrow replacement is seen. The visualized spinal cord demonstrates normal signal intensity and morphology. The intervertebral discs are preserved. No significant compromise of the spinal canal or neural foramina is seen.

Output: 1.Evidence of instrumented fusion is seen from the occiput down to T2. There is a fluid collection within the posterior soft tissues of the operative bed which, in the recent postsurgical period, is expected and may represent a seroma based on signal characteristics.2.Spinal alignment is anatomic and vertebral body morphology is unremarkable. The spinal cord shows normal morphology and signal characteristics.


Instruction: Generate impression based on findings.

Input: Multiple sclerosis with weakness. Follow up progression. There are scattered punctate and confluent areas of abnormal T2/FLAIR hyperintensity within the supratentorial periventricular and subcortical white matter in a pattern compatible with known demyelinating disease. There are multiple new foci of T2/FLAIR signal abnormality such as the left superior frontal gyrus subcortical white matter, bilateral frontal and parietal corona radiata, and left anterior temporal subcortical white matter. Multiple lesions with T1 hypointensity again seen. There is mild volume loss involving the corpus callosum, similar to prior. There is no evidence of intracranial mass or mass effect. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable.

Output: Interval progression of known demyelinating disease compared to 4/25/2013 with multiple new lesions as described above.


Instruction: Generate impression based on findings.

Input: 43-year-old female with exacerbation of medial knee pain. Evaluate meniscus. MENISCI: There is a horizontally oriented tear (possibly a "flap tear") of the posterior horn of the medial meniscus predominantly involving the undersurface of the inner half of the meniscus, which is new when compared to the prior examination. There is additional intrasubstance signal within the posterior horn of the medial meniscus indicating degeneration, which is also new from prior examination. There is also mucoid degeneration and slight medial extrusion of the body of the medial meniscus, which has progressed when compared to the prior study. The anterior horn of the medial meniscus appears intact. There is attenuation of the posterior horn of the lateral meniscus that may reflect interval partial meniscectomy, although such history was not provided. There is also intrasubstance signal within the posterior horn and body of the lateral meniscus indicating degeneration. The anterior horn of the lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is near full-thickness to full-thickness degeneration of the articular cartilage of the weightbearing portion of the medial femoral condyle, just above and anterior to the posterior horn of the medial meniscus. There is also a small focus of edema type signal within the underlying subchondral bone which is new when compared to the prior study. There is a small cyst noted within the posterior aspect of the medial tibial plateau with adjacent edema and probable thinning of the overlying articular cartilage, new from prior examination. There is full-thickness degeneration of the articular cartilage of the posterior lateral femoral condyle with edema type signal within the underlying marrow, appearing similar to the prior study. There is superficial degeneration of the articular cartilage of the weightbearing portion of the lateral femoral condyle and lateral tibial plateau between the meniscal horns, appearing similar to the prior study. There is severe degeneration of the articular cartilage along the lateral facet of the patella with areas devoid of articular cartilage and associated subchondral cysts, appearing similar to the prior study. There is superficial degeneration of the articular cartilage of the medial facet of the patella, appearing similar to the prior study. There is full-thickness degeneration of the articular cartilage of the lateral facet of the femoral trochlea, appearing similar to the prior study. There are tricompartmental osteophytes.LIGAMENTS: There is a defect of the proximal fibers of the MCL with minimal, if any, associated edema which was not present on the prior study and may reflect interval trauma or may be iatrogenic from interval arthroscopy. The ACL and PCL appear intact. The LCL appears intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. New medial meniscus tear as described above.2. Attenuation of the posterior horn of the lateral meniscus may reflect interval partial meniscectomy, although this information was not included in the stated clinical information.3. Tricompartmental cartilage degeneration and other findings as described above.


Instruction: Generate impression based on findings.

Input: Left tonsil squamous cell carcinoma status post treatment. There are treatment effects in the left oropharyngeal region. However, there is no residual measurable tumor in the left tonsillar fossa. There is no residual significant cervical lymphadenopathy. The parotid, submandibular, sublingual, and thyroid glands are unremarkable. The cervical arterial flow voids are grossly intact. There is mild degenerative spondylosis of the cervical spine. There is mild paranasal sinus mucosal thickening, most notably in the maxillary sinuses. There is a right subacromial bursa effusion. The orbits and imaged intracanal structures are unremarkable. Thre is mild mucosal thickening in the right maxillary sinus. There are nodular lesions in the imaged portions of the lungs.

Output: 1. Post-treatment findings without evidence of residual or recurrent tumor in the oropharynx and no significant residual cervical lymphadenopathy.2. Nodular lesions in the imaged portions of the lungs may be related to sarcoidosis. Please refer to the separate chest CT report for additional details.


Instruction: Generate impression based on findings.

Input: Reason: contusions, concussions, intracranial changes History: headache, personality change There is T2 hyperintensity and surrounding inflammatory changes of the right frontal scalp, which may represent fluid or blood products. There is a 11 mm x 5 mm peripherally enhancing collection (series 1201 image 124) s, which may represent sequela of prior hematoma but superimposed infection cannot be excluded. The underlying bone is intact without intracranial extension.No abnormal diffusion restriction. No intracranial hemorrhage. Mild nonspecific foci of bilateral frontal subcortical white matter T2 hyperintensities, which may be related to prior inflammation, ischemia, trauma, or migraines for example. No extra-axial fluid collections. The ventricles, sulci, and cisterns are normal in size without evidence of hydrocephalus. Gray-white matter differentiation is preserved. The imaged paranasal sinuses and mastoid air cells are clear. The imaged orbits are intact. The osseous structures are unremarkable.

Output: 1.Soft tissue edema and inflammatory changes of the right frontal scalp at the location of the scalp hematoma seen on prior study. There is a small peripherally enhancing scalp fluid collection, which may represent sequela of prior hematoma but superimposed infection/abscess cannot be excluded. The underlying bone is intact without intracranial extension.2.No evidence of intracranial hemorrhage, edema, or mass effect. No abnormal parenchymal or meningeal enhancement.3.Mild nonspecific foci of T2 hyperintensity in the bilateral frontal subcortical white matter, etiology of which may be prior inflammation, ischemia, trauma, or migraines, for example.


Instruction: Generate impression based on findings.

Input: Diagnosis: Neoplasm of uncertain behavior of brain, unspecified Neoplasm of uncertain behavior of spinal cord.Clinical question: hx craniotomy for lesion : hemangioblastoma. 3 month f/u eval change/recurrenceSigns and Symptoms: none- surveillance The patient status post right suboccipital craniotomy. Since the prior exam a hemorrhagic lesion located in the right cerebellar hemisphere has regressed. It currently measures approximately 10 x 6 mm axial dimensions and previously measured 17 x 16 mm axial dimension. There is no associated contrast enhancement. Since the prior exam edema and mass effect in the right cerebellar hemisphere has regressed significantly.There is redemonstration of a new enlarged perivascular space in the right midbrainNormal 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: The patient status post surgery for right cerebellar mass. This was known to represent a hemangioblastoma. Since the prior exam there has been regression of a right mass and its associated findings. Right cerebellar edema and hemorrhage has regressed. A nodular lesion in the right cerebellar hemisphere has also regressed.


Instruction: Generate impression based on findings.

Input: Disorientation, unspecified [R41.0] / Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits [Z86.73], Reason for Study: ^Reason: AMS, h/o ?recent CVA History: AMS Redemonstration of prior craniotomy with metastatic colon cancer resection on the left frontal lobe superior frontal gyrus and adjacent encephalomalacia, no change since prior scan.Localized encephalomalacia of the left occipital lobe, no change since prior scan.Underlying brain shows extensive patchy high signal intensity lesions on bihemispheric periventricular white matter, likely related to prior treatment, no change since prior scan.Multifocal various sized bihemispheric susceptibility lesions on gradient echo images indicating possible prior radiation therapy related are again seen, no change since prior scan.There is no evidence of abnormal enhancement.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion. No abnormal enhancement.2. No change of multifocal encephalomalacia, non specific white matter lesions and susceptibility lesions since prior scan.


Instruction: Generate impression based on findings.

Input: Reason: left temporal hypodense lesion History: seizure The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a hemorrhagic lesion present in the left temporal lobe located in the fusiform gyrus and extending underneath the temporal horn of the left lateral ventricle. The lesion itself abuts the temporal horn of the right lateral ventricle. The temporal horn of left lateral ventricle is narrowed and displaced superiorly. The hemorrhagic focus is low signal on susceptibility imaging and has blooming effect. There is heterogenous signal hyperintensity on FLAIR and T2 imaging surrounding the 5mm focus of hemorrhage. The T2/FLAIR signal change measures 52 x 40 mm axial dimensions and involves left fusiform gyrus and left parahippocampal gyrus. There is associated heterogenous and ring like contrast enhancement measuring 23x33mm axial dimensions. There is no convincing evidence for diffusion restriction. There are some small serpiginous low signal foci on susceptibility imaging within this lesion. No ependymal enhancement is identified on the current exam.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.Examination is degraded by motion artifact.

Output: 1.Findings are suggestive of neoplasm in the left temporal lobe. The serpiginous signal voids are suggestive of microvascularity which in the case of a primary brain tumor would support a higher grade lesion.


Instruction: Generate impression based on findings.

Input: History of HCV and alcohol cirrhosis. 2.9 cm right liver lesion. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic nodular liver morphology. Small volume perihepatic ascites. No intra or extrahepatic biliary ductal dilatation. The vessels are patent. Cholelithiasis without cholecystitis. Segment 6/7 lesion measuring 3.2 x 2.8 cm demonstrating intrinsic T1 weighted hyperintensity (series 801/57) with regions of T2-weighted hypointensity posteriorly and T2-weighted hyperintensity anteriorly and mild restricted diffusion. There is arterial-enhancement on subtraction images (series 902/272). The intrinsic T1 weighted hyperintensity limits evaluation for washout on delayed images although it is suspected given the subtraction images.Recanalized periumbilical vein. The vessels are patent.SPLEEN: The spleen measures 10.7 cm in craniocaudal dimension. Minimal perisplenic fluid.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: Partially imaged incisional hernia containing fluid better seen on prior CT.OTHER: Body wall collateral vessels.

Output: The segment 6/7 3.2 cm lesion demonstrates intrinsic T1 weighted hyperintensity and arterial enhancement. Intrinsic T1 weighted hyperintensity limits evaluation for washout on delayed images although it is suspected given the subtraction images. The findings are suspicious for hepatocellular carcinoma.Cirrhosis with trace ascites.


Instruction: Generate impression based on findings.

Input: Clinical question: Lung cancer, right arm weakness. Signs and symptoms: Right arm weakness. Pre and post enhanced brain MRI:No acute intracranial process and negative diffusion weighted series.There is a new ring-enhancing lesion with subtle surrounding edema consistent with a metastatic lesion in the right cerebellum measuring approximately at 5.5 mm.An additional tiny focus of enhancement in the right anterior temporal lobe measures approximately at 5 mm is also noted. This finding demonstrate no associated edema or mass effect.Additional cortical based ring-enhancing lesion in the right precentral virus measuring approximately at 9 mm without surrounding vasogenic edema or appreciable mass effect.There is no detectable leptomeningeal enhancement.Unremarkable cerebral cortex, cortical sulci, ventricular system and CSF spaces are otherwise. Minimal periventricular and multiple tiny foci of FLAIR hyperintensity in the subcortical white matter of bilateral cerebral hemispheres are suggestive of mild chronic small vessel ischemic strokes without significant change since prior exam.Calvarium and soft tissues of the scalp are unremarkable.Unremarkable images through the orbits and including axial fat sat post enhanced series.Unremarkable all visualized paranasal sinuses and bilateral mastoid air cells and middle ear cavities.

Output: 1.Multiple new small supratentorial and infratentorial metastatic lesions as detailed/measured above.2.No evidence of intracranial hemorrhage or significant vasogenic edema/mass effect.3.Unremarkable calvarium, orbits, paranasal sinuses and mastoid air cells.


Instruction: Generate impression based on findings.

Input: For the purposes of reference, the last rib bearing vertebral body is at T12 and 5 lumbar vertebral bodies visualized. Images are slightly slightly limited by suboptimal signal to noise.The conus medullaris ends at the level of the mid L1. Distal cord is unremarkable.There is a stable mild-moderate chronic compression fracture of L4. There is a chronic compression fracture of T12 with moderate decrease in height of its right aspect and the mild decreased in height of its left aspect.There is stable mild retrolisthesis of L3 on L4.Mild increased STIR marrow signal is seen associated with T11, T12, L3, and L4 vertebral bodies, slightly more extensive at L3 and L4, but otherwise unchanged since the previous study.At T11-T12 there is high T2 signal within the disc space, most likely representing chronic fluid with no visualization of disc signal. There is bilateral moderate foraminal stenosis, with effacement of the foraminal fat perhaps due to chronic inflammatory changes.At T12-L1, there is no evidence of spinal stenosis or neural foraminal compromise.At L1-L2, there is no evidence of spinal stenosis. There is mild right facet hypertrophy with mild right neural foraminal stenosis.At L2-L3, there is broad-based mild to moderate disc bulge. There is moderate spinal stenosis and effacement of the anterior CSF space. There is mild bilateral facet hypertrophy with moderate to severe stenosis of the right neural foramen and mild to moderate narrowing of the left neural foramen.At L3-L4, there is mild disc bulge. The disc is mildly uncovered. There is a moderate spinal stenosis with partial effacement of the anterior CSF space. Facet hypertrophy is seen bilaterally, more on the left. Bilateral moderate to severe stenosis of the neural foramina is seen. The foraminal fat is not identified, most likely due to chronic infection. Increased T2 signal is seen in the disc space which is unchanged since the previous study. Encroachment of the lateral recesses is seen.At L4-L5, there is mild disc bulge with mild spinal stenosis. There is bilateral facet hypertrophy, left more than the right. There is severe neural foraminal narrowing on the left and moderate foraminal narrowing on the right.At L5-S1, mild facet hypertrophy is seen bilaterally.There is a slight asymmetric increase in T1/T2 signal in the right psoas and iliacus muscles which in part may be artifactual, although could also relate to asymmetric fatty replacement and/or sequelae of chronic infection.Subcentimeter cysts are noted in the kidneys bilaterally. Small bone island is seen in the left iliac wing with low T1 and T2 signal.

Output: 1. Redemonstration of now chronic discitis/osteomyelitis at L3-L4 and T11-T12, not significantly changed since the previous study. 2. Moderate central spinal stenosis persisting at L2-L3 and L3-L4, unchanged.3. Bilateral neural foraminal compromise in lumbar spine as described above, most severe at the level of L3-L4.


Instruction: Generate impression based on findings.

Input: Atypical left parietal meningioma status post resection, surveillance MRI. There are postoperative findings related to left parietal convexity meningioma resection with T1 hyperintense material with susceptibility effect in the surgical cavity, which are compatible with subacute blood products. There appears to be mild diffuse linear enhancement along the margins of the cavity. However, there is nodular enhancement in the adjacent portion of the superior sagittal sinus that measures up to 23 mm. There is a mixed intermediate and high T1 signal and mixed low and high T2 signal epidural collection at the surgical site that measures up to 22 mm in width. There is mild effacement of the left lateral ventricle, but no significant midline shift. There is no evidence of acute infarct.

Output: 1. Recent postoperative findings related to left parietal convexity meningioma resection with an acute to early subacute epidural hematoma at the surgical site that measures up to 22 mm in width, but no significant midline shift. 2. Findings suggestive of residual tumor involving the superior sagittal sinus.


Instruction: Generate impression based on findings.

Input: Female, 35 years old, with history of breast cancer and metastases to the brain, status post radiotherapy. Since the prior examinations, further interval reduction has occurred in the size of enhancing lesions along the periphery of the cerebellar hemispheres. A lesion along the left inferior paramedian cerebellum now shows only minimal residual enhancement measuring approximately 4 mm whereas it measured 15 mm on 9/11/2015 and 19 mm on 7/9/2015. An enhancing lesion along the right anterior cerebellum is no longer clearly visualized. A lesion along the right lateral cerebellum shows relatively stable size on postcontrast images.The extent of T2 hyperintensity associated with these lesions is similar to that seen on the immediate prior examination and improved relative to 7/5/2015. No new enhancing or nonenhancing lesions are detected. The cerebral hemispheres are within normal limits. A small T1 isointense and T2 hypointense cyst at the foramina of Monro is unchanged. The ventricles are normal in size and morphology.

Output: 1.Continued interval improvement is seen in most of the cerebellar metastatic lesions. Several are significantly smaller or no longer clearly identified. One lesion, along the right lateral cerebellum, is unchanged in size.2.No new intracranial lesions are seen. A presumed incidental colloid cyst at the foramina of Monro is unchanged.


Instruction: Generate impression based on findings.

Input: Outside imaging showing right lung mass with invasion of the thoracic spine compromising spinal cord. There is a large right apical lung mass which infiltrates the T1-T4 vertebral bodies including the posterior elements. There is at least moderate degree of height loss associated with compression fractures of T2 and T3 vertebral bodies with osseous retropulsion. There is evidence of epidural tumor encroaching into the spinal canal and causing mild deformity of the thoracic cord. There is also extensive involvement of the right neural foramina at the level of the tumor as well as invasion of the right chest wall. Evidence of left-sided pneumonectomy.Degenerative changes in the cervical spine with moderate stenosis at the C3-C4 level also noted related to disc osteophyte complex and ligamentum flavum thickening. There is straightening of the normal lower thoracic and lumbar curvature. Multilevel degenerative changes are also seen in the lumbar spine with suspected mild to moderate degree of spinal canal stenosis; however no high-grade stenosis involving the lower thoracic or lumbar spine is appreciated.

Output: This is a limited exam specific for the exclusion of cord compression only. There is a large right apical lung mass which infiltrates into the upper thoracic spine, is associated with pathologic compression fractures of the T2 and T3 vertebral bodies, and demonstrates epidural extension with mild deformity of the thoracic cord. Please refer to separate dedicated thoracic spine MRI with contrast report for additional details.Moderate degenerative changes are noted in the cervical and lumbar spine without high-grade spinal canal stenosis.


Instruction: Generate impression based on findings.

Input: 31-year-old female with right lower quadrant pain. Evaluate for TOA and appendicitis. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: The spleen is enlarged.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Punctate nonobstructing right renal calculi are evident.RETROPERITONEUM, LYMPH NODES: Numerous small mesenteric lymph nodes are evident as well as a few prominent retroperitoneal nodes.BOWEL, MESENTERY: Trace peritoneal fluid. The appendix is normal. The omentum and peritoneum are infiltrated and the small bowel, particularly in the left lower quadrant, appears matted. Along with the presence of numerous mesenteric and retroperitoneal lymph nodes as described above, these findings most likely represent a diffuse inflammatory process such as gastroenteritis or mesenteric adenitis. Neoplastic disease is considered less likely.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Bilateral adnexal cystic lesions are inadequately evaluated on CT. If further imaging evaluation is clinically warranted, gynecologic ultrasound or MRI may be considered.BLADDER: No significant abnormality notedLYMPH NODES: Multiple prominent iliac, obturator, and inguinal lymph nodes are seen. See discussion above.BOWEL, MESENTERY: See above.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Omental and mesenteric infiltration along with matted bowel and numerous mesenteric, retroperitoneal and pelvic lymph nodes suggests a diffuse inflammatory process such as gastroenteritis or mesenteric adenitis. Neoplastic disease is considered less likely. Cystic adnexal lesions may be further evaluated on ultrasound or MRI if clinically indicated.


Instruction: Generate impression based on findings.

Input: 47-year-old woman with IDC grade 3 with lobular features and DCIS grade 3, and metastatic right axillary lymph node, presents for I-SPY research MRI (#1). There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.RIGHT BREAST:There is a heterogeneous lobulated mass, measuring 49 x 48 x 62 mm (AP x LR x CC), at anterior 12:00 position, consistent with a biopsy proven carcinoma. There is associated nipple retraction and periareolar skin thickening. There are multiple benign masses (three in the lateral breast and one in the medial breast, posterior depth).There is an abnormally enlarged right axillary lymph node, measuring 33 x 23 mm, which is a proven metastatic node. A marker clip is present within the lymph node. There are a few lymph nodes with mild cortical thickening in the right axilla. LEFT BREAST:No abnormal enhancement is seen in left breast. A few lymph nodes with mild cortical thickening are present in the left axilla.

Output: 1. Proven carcinoma in the right breast with a metastatic lymph node in the right axilla.2. No MR evidence for malignancy in the left breastBIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Developmental delay, porencephaly, 4 month history of progressive hearing loss, gait decline, change in speech, and multifocal pains, intracranial bleeding, new-onset seizure like episodes and 50pound weight loss. Brain: There are bifrontal porencephalic cysts and deficiency of much of the septum pellucidum. There is layering intermediate T1 and low T2 signal hemorrhage in the occipital horns of the bilateral lateral ventricles. There is extensive supratentorial and infratentorial superificial siderosis. There are bilateral cerebral convexity subdural fluid collections, measuring 16 mm on the left and 6 mm on the right, with compression of the underlying brain. The ventricular system is unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is staphylomatous deformity of the right globe. There is a left maxillary retention cyst and mild right maxillary sinus mucosal thickening.Lumbar Spine: There is diffuse T2 hypointensity along the surface of the imaged spinal cord. There is also a small amount of high T1 and low T2 signal material within the inferior spinal canal. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The paravertebral soft tissues are unremarkable.

Output: 1. Bifrontal porencephalic cysts.2. Layering subacute hemorrhage in the occipital horns of the bilateral lateral ventricles and subacute hemorrhage in the inferior spinal canal. 3. Bilateral cerebral convexity subdural effusions, left larger than right.4. Extensive superficial siderosis involving the intracranial contents and imaged potions of the spinal cord.


Instruction: Generate impression based on findings.

Input: Female 63 years old with right shoulder pain and difficulty raising arm. Evaluate for rotator cuff tear. The exam is somewhat limited due to patient motion.ROTATOR CUFF: A full-thickness tear of the supraspinatus tendon extends posteriorly where there is a partial thickness bursal surface tear of the infraspinatus tendon. The subscapularis and teres minor tendons are intact. Infraspinatus and supraspinatus muscles are atrophic. Fluid is present within the subacromial/subdeltoid bursa.SUPRASPINATUS OUTLET: There is fluid within the acromioclavicular joint and osteophyte formation indicating mild acromioclavicular joint osteoarthritis.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenoid labrum is grossly normal within the limits of a nonarthrogram exam. The glenohumeral joint is grossly normal.BICEPS TENDON: The long head of the biceps tendon is normally located within its groove and normal in appearance. ADDITIONAL

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


Instruction: Generate impression based on findings.

Input: 55-year-old male with history of chronic pancreatitis and abdominal pain. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology, signal intensity and enhancement without biliary ductal dilatation focal suspicious lesion or vascular abnormality. The posterior right hepatic bile duct inserts directly onto the common hepatic duct distal inferior to the junction of the anterior right hepatic bile duct and left hepatic bile duct, a normal variant.SPLEEN: No significant abnormality noted.PANCREAS: Pancreas divisum. Mildly decreased intrinsic T1 weighted signal intensity of the pancreas may reflect parenchymal dysfunction possibly from chronic pancreatitis. The pancreatic parenchyma enhances homogeneously. No peripancreatic inflammatory changes or fluid collections. No arterial or venous complication.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Pancreas divisum. Mildly decreased intrinsic T1 weighted signal intensity in the pancreas may reflect parenchymal dysfunction possibly from chronic pancreatitis. No evidence of acute inflammation or complication.2.The secretin portion of the examination was not performed.


Instruction: Generate impression based on findings.

Input: Female 39 years old Reason: ? LT ligament tear History: pain LIGAMENTS: No significant abnormality noted. The intrinsic ligaments including the lunotriquetral ligament are intact without abnormal signal.TRIANGULAR FIBROCARTILAGE COMPLEX: Triangular fibrocartilage complex is intact without abnormal signal.TENDONS: No significant abnormality of the tendons. No abnormal thickening, tears, or abnormal fluid surrounding the tendons.BONES: Bone marrow signal is normal. No fracture.ADDITIONAL

Output: Normal MRI of the hand with intra-articular contrast. The intrinsic ligaments of the hand are intact, including the lunotriquetral ligament, as clinically questioned.


Instruction: Generate impression based on findings.

Input: Reason: history of pituitary enlargement and stalk thickening on outside imaging, hyperprolactinemia History: hyperprolactinemia. Please note that dynamic contrast-enhanced sequences were not obtained.The pituitary is slightly prominent measuring 9 mm with a convex superior margin as well as prominence of the inferior infundibulum. No identifiable microadenoma or macroadenoma. Small linear foci of low signal in the posterior pituitary favored to represent a tiny pars intermedius cyst/remnant.There is otherwise no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1.No convincing evidence of a pituitary microadenoma or macroadenoma. Please note dynamic postcontrast sequences were not obtained with slightly limits sensitivity for pituitary microadenomas. If clinically indicated, patient may return for this additional sequence at no additional charge. 2.Mild diffuse prominence of the pituitary and lower aspect of the infundibulum is nonspecific but within normal limits for patient's age.


Instruction: Generate impression based on findings.

Input: Reason: Please do with CSF flow study, Chiari malformation, evaluate for changes History: neck pain, headache Please note that the susceptibility artifact from braces severely limits evaluation of anterior structures on gradient echo images.MRI brain:There are postsurgical changes of suboccipital decompression and resection of the posterior arch of C1 with interval improvement of CSF spaces at the foramen magnum ventrally and dorsally. The tonsils extend to the upper margin of C1. CSF flow demonstrates brisk biphasic flow anteriorly. Mildly diminished flow posteriorly is noted which may be technical. Dorsal cerebellar surface is noted to abut the posterior dural margin which may suggest scarring.There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears unremarkable. 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. Evaluation of the orbits and paranasal sinuses is limited due to artifact.MRI cervical spine:Postsurgical changes of suboccipital decompression as above. Vertebral body heights and discs are intact. Alignment is anatomic. Marrow signal is normal. No significant spinal or neural foraminal stenosis. No abnormal signal within the cord. No evidence of syrinx.

Output: 1.No recent comparison studies available. Compared to 2011, there has been interval suboccipital decompression of Chiari I malformation with improvement in CSF spaces and flow ventrally and dorsally at the neo foramen magnum. Dorsal cerebellum abuts the dural surface which may indicate some scarring.2.No evidence of syrinx in the cervical cord.


Instruction: Generate impression based on findings.

Input: Ms. Diaz is a 36 year old female with a strong family history of breast cancer (mother and three maternal aunts). She has a personal history of benign MRI-guided biopsy of the right breast in 2010 for columnar cell changes/papilloma. There is scattered fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. Susceptibility artifact from prior benign MRI guided biopsy marker clip in the right breast is unchanged.No abnormal lymph nodes are identified in either axillary or internal mammary region.

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


Instruction: Generate impression based on findings.

Input: Reason: Recent gross hematuria with hx kidney transplant and low GFR. request MR Urogram History: As above ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral atrophic native kidneys with small cysts. Additional subcentimeter lesions within the native kidneys are too small to characterize.Right iliac fossa transplant. There is a cyst within the transplant kidney measuring up to 2.8 cm with small septations, similar to the prior CT. No hydronephrosis. Delayed images show normal opacification of the transplant pelvis and ureter. No associated fluid collections.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:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Right iliac fossa transplant with a minimally complex cyst which is unchanged in size. Otherwise, no hydronephrosis or other findings to account for patient's hematuria.


Instruction: Generate impression based on findings.

Input: Female, 5 years old, with seizure, grade 4 intraventricular hemorrhage as an infant, periventricular leukomalacia. Evaluate for progression of PVL. The lateral ventricles are prominent, left side more than right, and both demonstrate a somewhat wavy external contour. A porencephalic cyst is redemonstrated along the body of the left lateral ventricle. This correlates to the location of the patient's prior hemorrhage and has not significantly changed when compared to a prior head ultrasound. Diffusion-weighted images are within normal limits. No edema or mass effect is observed. No acute intracranial hemorrhage is detected.The cerebral white matter is thinned bilaterally, but otherwise, the degree of myelination is appropriate for age. The pituitary region is unremarkable. The brainstem and cerebellum are fully formed and intact. The corpus callosum is fully formed and intact although somewhat thinned. The mesial temporal lobe structures are symmetric and free of focal signal abnormality. The left thalamus and left cerebral peduncle are atrophic relative to the right which probably reflects loss of white matter fiber tracts.

Output: Findings are seen compatible with periventricular leukomalacia and porencephalic cyst formation along the left lateral ventricle related to prior grade 4 IVH. Given that comparison has been made to prior ultrasound examinations, no significant interval change in these chronic findings is suspected. No acute abnormalities are detected.


Instruction: Generate impression based on findings.

Input: Hyperprolactinemia. There is a possible hypoenhancing focus in the left lobe of the pituitary gland that measures up to 3 mm. Otherwise, the pituitary gland is not enlarged and there is no mass effect upon the optic apparatus or cavernous sinuses. The infundibulum are posterior pituitary bright spot are intact.

Output: Candidate pituitary microadenoma in the left lobe of the pituitary gland that measures up to 3 mm.


Instruction: Generate impression based on findings.

Input: 65 years, Male, intermittent left-sided weakness, history of well-controlled HIV, concussions from prior sports. Brain: Again seen are multiple foci of T2/FLAIR hyperintensity in the bilateral periventricular and subcortical white matter, notably punctate foci in the left frontal corona radiata, adjacent to the bilateral temporal horns, and a relatively larger focus surrounding the atrium of the right lateral ventricle which measures approximately 10 x 20 mm in the coronal plane. Compared to 6/26/2009 there is no appreciable change. No intracranial mass or mass effect. No abnormal enhancement. No evidence of acute ischemia or hemorrhage. Major flow-voids are preserved. Brain parenchymal volume is preserved. Paranasal sinuses and mastoid air cells are clear. Calvarium and extracranial soft tissues are unremarkable. Cervical spine: Craniocervical junction is within normal limits. Vertebral body heights are normal. Alignment of the cervical spine is maintained. Bone marrow signal is benign. T1 hyperintense lesion involving the right aspect of the C6 vertebral body is consistent with a small hemangioma. The cervical cord is normal in signal characteristics and contour. There is no significant spinal canal stenosis at any level. No abnormal enhancement is appreciated. There are mild multilevel degenerative changes including disc desiccation throughout. Individual levels as below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: There is no significant spinal canal stenosis. There is uncovertebral hypertrophy bilaterally resulting in mild left worse in right neural foraminal stenosis, and slightly worse then on prior from 2011C4-5: No significant compromise to the spinal canal or neural foramina.C5-6: No significant compromise to the spinal canal or neural foramina.C6-7: No significant spinal canal or right neural foraminal narrowing. There is mild left-sided neural foraminal stenosis related to uncovertebral hypertrophy minimally worse than prior.C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: 1. Compared to MRI brain dated 6/26/2009, there is no significant change in multiple foci of T2/FLAIR signal abnormality involving the periventricular and subcortical white matter including a relatively larger area in the right periatrial white matter. Findings most likely represent sequela of prior demyelination, infection, or other remote injury. 2. No abnormal signal in the cervical cord or abnormal enhancement. Mild degenerative changes are seen in the cervical spine which are stable to minimally worse since prior study from 2011. There is up to mild left greater than right C3-C4 neural foraminal stenosis and mild left C6-C7 neural foraminal stenosis. No high-grade neural foraminal or spinal canal stenosis at any level.


Instruction: Generate impression based on findings.

Input: 29-year-old girl with history of peritoneal mesothelioma status post resection and HIPEC, new liver lesion seen on study from 8/10/2015. ABDOMEN:LIVER, BILIARY TRACT: There is a subcapsular 19 x 10 mm focus of T2 hyperintensity in segment 6 of the liver (series 6, image 17). This area demonstrates no diffusion restriction or enhancement.SPLEEN: The spleen is normal.PANCREAS: The pancreas is normal.ADRENAL GLANDS: The adrenal glands are normal.KIDNEYS, URETERS: The kidneys are normal and enhance symmetrically.RETROPERITONEUM, LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: The partially visualized small bowel and colon are normal.BONES, SOFT TISSUES: Post surgical changes are seen in the ventral abdomen.OTHER: No significant abnormality noted.

Output: Simple cyst in segment 6 of the liver corresponding to lesion seen on CT from 8/2015.


Instruction: Generate impression based on findings.

Input: 10 years Female (DOB:9/3/2005)Reason: epilepsy History: seizuresPROVIDER/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 some volume loss present in the left subcentral lobule and adjacent insular cortex associated with a T2 hyperintense lesion suspected to represent a cyst.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.There is a combination of the cystic lesion and encephalomalacia at the expected location of the left subcentral lobule and adjacent left insular cortex at the sylvian fissure.2.The T2 imaging of the brain was degraded due to patient motion despite repetition. The technologist will be contacting the referring service to review. An alphanumeric page was sent to Dr. Warnke.


Instruction: Generate impression based on findings.

Input: 63 year old male with history of hypertension, dyslipidemia, and coronary artery disease with myocardial infarction presenting for evaluation of infarct and ejection fraction. Left VentricleThe left ventricle is moderately dilated with mild-moderately reduced systolic function. The overall LV ejection fraction is 43%, the LV end diastolic volume index is 127 ml/m2 (normal range: 74+/-15), the LVEDV is 227 ml (normal range 142+/-34), the LV end systolic volume index is 73 ml/m2 (normal range 25+/-9), the LVESV is 130 ml (normal range 47+/-19). There is hypokinesis in the mid and distal inferolateral and inferior walls and basal infero-septum. There is subendocardial late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process in a pattern typical for myocardial infarction located in the basal-mid inferolateral and inferior and basal infero-septal walls. The infarct is transmural in the basal inferior and mid inferolateral walls and otherwise is < 50% transmurality. Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 50%, the RV end diastolic volume index is 98 ml/m2 (normal range 82+/-16), the RVEDV is 177 ml (normal range 142+/-31), the RV end systolic volume index is 49 ml/m2 (normal range 31+/-9), and the RVESV is 89 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 trace mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC 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. The left ventricle is moderately dilated with mild-moderately reduced systolic function. The overall LV ejection fraction is 43%. There is hypokinesis in the mid and distal inferolateral and inferior walls and basal infero-septum. There is subendocardial late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process in a pattern typical for myocardial infarction located in the basal-mid inferolateral and inferior and basal infero-septal walls. The infarct is transmural in the basal inferior and mid inferolateral walls and otherwise is < 50% transmurality. 2. The right ventricle is normal in size with normal systolic function (RVEF 50%).


Instruction: Generate impression based on findings.

Input: 67 year old woman with history of CABG, Type A dissection s/p repair, permanent pacemaker placement for significant pauses, now s/p VT ablation. Referred for cardiac MRI to evaluate RV size/function and presence of scar. The patient has a permanent pacemaker, but is not pacemaker dependent. EP was present to reprogram the device pre and post study. Left VentricleThe left ventricle is moderately dilated with mildly reduced systolic function. The overall LV ejection fraction is 50%, the LV end diastolic volume index is 111 ml/m2 (normal range: 65+/-11), the LVEDV is 213 ml (normal range 109+/-23), the LV end systolic volume index is 56 ml/m2 (normal range 18+/-5), the LVESV is 107 ml (normal range 31+/-10), the LV mass index is 44 g/m2 (normal range 67+/-11), and the LV mass is 84 g (normal range 114+/-24). Basal to mid inferior hypokinesis and thinning. There is late gadolinium enhancement extending from the basal to mid inferior walls, suggesting the presence of an underlying fibrosing, infiltrative, or inflammatory process. The pattern is patchy, however there a portions which appear to involve the sub-endocardium. The significance of this pattern is unclear, but could be explained by prior coronary disease.Left AtriumThe left atrium is severely dilated.Right VentricleThe right ventricle is severely dilated with severely reduced systolic function. The overall RV ejection fraction is 33%, the RV end diastolic volume index is 193 ml/m2 (normal range 69+/-14), the RVEDV is 369 ml (normal range 110+/-24), the RV end systolic volume index is 130 ml/m2 (normal range 22+/-8), and the RVESV is 248 ml (normal range 35+/-13). Of note, there is significant artifact present due to the patient's RV pacemaker lead. Right AtriumThe right atrium is severely dilated. Mitral ValveThe mitral valve opens widely with mild-moderate mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is severe tricuspid regurgitation.Aorta/Aortic ValveThere is a left sided aortic arch with a normal brachiocephalic branching pattern. There is a graft extending from the ascending aorta to the mid arch consistent with patient prior surgery for type A dissection. The native aortic valve was re-suspended. There is trace AI. The aortic root at the sinus of valsalva measures 41mm. The ascending aorta measures 45mm (graft). There is atherosclerosis of the descending thoracic aorta.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is mildly dilated, measuring 34mm.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. There is a pacemaker lead noted in the SVC and RA.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsSternal wires are present. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is moderately dilated with mildly reduced systolic function. The overall LV ejection fraction is 50%. There is basal to mid inferior hypokinesis and thinning. There is late gadolinium enhancement extending from the basal to mid inferior walls, suggesting the presence of an underlying fibrosing, infiltrative, or inflammatory process. The pattern is patchy, however there a portions which appear to involve the sub-endocardium. The significance of this pattern is unclear, but could be explained by prior coronary disease.2. The right ventricle is severely dilated with severely reduced systolic function. The overall RV ejection fraction is 33%. No RV LGE was seen.3. Pacemaker lead is noted coursing to the RV apex.4. There is severe tricuspid regurgitation.5. Severe biatrial enlargement.


Instruction: Generate impression based on findings.

Input: 74-year-old female with urethral cancer, preop planning. PELVIS:UTERUS, ADNEXA: The uterus is either atrophic or has been surgically removed.BLADDER: There is a Foley catheter in place and the urinary bladder is nondistended. There is trabeculation of the bladder wall which may reflect chronic outlet obstruction.LYMPH NODES: There is an enlarged right inguinal lymph node, most likely representing a metastatic deposit.BOWEL, MESENTERY: There is severe diverticulosis of the sigmoid colon and distal descending colon.BONES, SOFT TISSUES: There are degenerative changes of the lower lumbar spine resulting in spinal canal stenosis.OTHER: There is an ovoid mass within the urethra extending from the vesicourethral junction into the distal urethra, near the introitus. The mass demonstrates intermediate T2 signal and enhancement, compatible with reported history of urethral cancer. The Foley catheter traverses the mass. Ill-defined crescentic enhancement is noted posterior to the urethra extending towards the vagina (series 1009/142), suspicious for extraurethral extension. Associated punctate susceptibility artifact may reflect hemorrhage from prior biopsy. Diffusion-weighted imaging is limited by motion. Reference measurements below.INDEX LESION MEASUREMENTS (Current exam date/time: 10/7/2016 08:00:00)URETHRAL MASS: 2.8 x 2.6 cm (Image 140, Series 9).RIGHT INGUINAL LYMPH NODE: 2.1 x 1.9 cm (Image 145, Series 9).

Output: 1.Findings compatible with a urethral mass with possible posterior extraurethral extension.2.Enlarged right inguinal lymph node consistent with metastatic disease.


Instruction: Generate impression based on findings.

Input: 23 year-old female with right lower quadrant pain. Rule-out appendicitis. CHEST:LUNG BASES: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: A 4+ zero at 2.4-cm cystic hypoattenuating lesion with thin internal septations and nodular components is seen arising from the body of the pancreas. An MRI is recommended for further evaluation. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The visualized gas filled appendix is normal in appearance. Mild cecal and terminal ileum thickening is seen with an enlarged regional lymph node. In a patient of this age, infectious versus inflammatory etiologies would be the most likely considerations. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No other significant abnormality noted.PELVIS:UTERUS, ADNEXAE: Bilateral ovarian cysts are seen with a small amount of free pelvic fluid, likely physiological given the patient's age.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy noted.BOWEL, MESENTERY: The visualized gas filled appendix is normal in appearance. Mild cecal and terminal ileum thickening is seen with an enlarged regional lymph node. In a patient of this age, infectious versus inflammatory etiologies would be the most likely considerations. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No other significant abnormality noted.

Output: 1. Focal thickening of the cecum and terminal ileum as described above. The etiology of disease is most likely infectious versus inflammatory. Ischemic disease is considered less likely.2. Cystic lesion in the pancreas as described above. MRI is recommended for further evaluation.These findings were relayed to the Dr. Eric Beck at 9 a.m. on 10/29/2010


Instruction: Generate impression based on findings.

Input: 59-year-old male with neck pain for years, reported history of C5-C7 patient nerves, now with recurrence of pain, evaluate for neural foraminal disease. Neck and arm pain. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Minimal retrolisthesis is noted at C4 on C5. Alignment is otherwise maintained. Bone marrow signal is within normal limits. The cervical spinal cord has normal signal characteristics and overall morphology.Degenerative changes are seen in the cervical spine as described below:C2-3: Minimal disc bulge. No significant compromise to the spinal canal or neural foramina.C3-4: Minimal disc bulge. No significant compromise to the spinal canal. Minimal bilateral neural foraminal narrowing related to uncovertebral hypertrophy.C4-5: Minimal disc osteophyte complex and uncovertebral hypertrophy. There is no significant spinal canal stenosis. There is moderate bilateral neural foraminal narrowing. C5-6: Disc osteophyte complex eccentric to the left. There is effacement of the ventral thecal sac and mild indentation on the ventral cord. Dorsal thecal sac is patent. There is moderate left neural foraminal stenosis. No significant right neural foraminal narrowing.C6-7: Minimal disc osteophyte complex and uncovertebral hypertrophy. There is moderate right neural foraminal stenosis. No significant spinal canal or left neural foraminal narrowing.C7-T1: Minimal disc osteophyte complex with uncovertebral hypertrophy. There is advanced facet arthropathy on the right. There is mild to moderate bilateral neural foraminal narrowing.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: Multilevel degenerative changes in the cervical spine. There is mild spinal canal narrowing at C5-C6. No high-grade spinal canal stenosis or cord signal abnormality at any level. There is multilevel foraminal narrowing including bilateral C4-C5, left C5-C6, right C6-C7, and bilateral C7-T1 levels.


Instruction: Generate impression based on findings.

Input: Small pineal mass yearly follow up evaluate for changes. There are postoperative findings in the posterior fossa. There is no significant interval change in the pineal lesion with areas of susceptibility effect, but no appreciable enhancement. There is a right transfrontal ventricular catheter that terminates ni the region of the right foramen of Monro. The ventricles are unchanged in size and configuration. There is no midline shift or herniation. There is a prior left transfrontal ventricular catheter track with surrounding T2 hyperintensity, which likely represents gliosis. There is no evidence of acute infarction, although the images are degraded by shunt artifact in the right hemisphere region. There is no midline shift. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are unchanged.

Output: No significant interval change in the treated pineal tumor and shunted ventricular system.


Instruction: Generate impression based on findings.

Input: 31-year-old male with right handed weakness and numbness. Evaluate for disease. There is straightening of the cervical spine, but no spondylolisthesis. The cervical vertebral bodies are appropriate in height. There is mild disc height loss involving the C5-6 level where there is a trace diffuse disc bulge. The bone marrow signal is within normal limits. The cervical spinal cord has normal signal characteristics and overall morphology. There is mild facet and uncovertebral hypertrophy involving the C3-4 through C5-6 levels and trace disc-osteophyte formation at C4-5, with at most mild right neural foraminal narrowing involving the right C4-5 level. There is no significant spinal canal stenosis at any level of the cervical spine. The vertebral artery flow voids appear to be intact. The paraspinous soft tissue structures appear within normal limits.

Output: Mild degenerative spondylosis involving the C3-4 through C5-6 levels, with at the most mild right neural foraminal narrowing involving the right C4-5 level, but no significant spinal canal stenosis at any level in the cervical spine.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: A patient submitted outside study for review. Submitted for review are left digital mammographic images (3/9/15), ultrasound images of left breast (3/9/15), right digital mammographic images (3/11/15), ultrasound images of right breast (3/11/15), images from ultrasound-guided biopsy of left breast and postprocedural left digital mammographic images (3/11/15), breast MRI (3/20/15) performed at Advocate Lutheran General Hospital. For comparison, digital mammographic images (10/24/15, 11/5/14), ultrasound images of right breast (11/5/14) are available. LEFT DIGITAL MAMMOGRAPHIC IMAGES (3/9/15):The breast parenchyma is heterogeneously dense. A spiculated mass is present in the retroareolar region, measuring 2 cm. A nipple retraction is associated. No suspicious calcifications are seen in the left breast.ULTRASOUND IMAGES OF LEFT BREAST (3/9/15):An irregularly shaped hypoechoic mass is present at retroareolar region measuring 12 x 10 x 15 mm. The mass is attached to the nipple. A few normal appearing lymph nodes are seen in the left axilla.RIGHT DIGITAL MAMMOGRAPHIC IMAGES (3/11/15):The breast parenchyma is heterogeneously dense. Three circumscribed round masses are present at upper outer quadrant, likely cysts. They are confirmed benign cysts on the Utrasound study (3/11/15) and MRI (3/20/15). The asymmetry, measuring 2 cm, at posterior superior aspect on ML and MLO view. This lesion needs additional work-up.ULTRASOUND IMAGES OF RIGHT BREAST (3/11/15):Two simple cysts at 9:00 position-10:00 position are present in the right breast, corresponding to the mammographic findings.IMAGES FROM ULTRASOUND-GUIDED BIOPSY OF LEFT BREAST AND POSTPROCEDURAL LEFT DIGITAL MAMMOGRAPHIC IMAGES (3/11/15):Ultrasound guided needle biopsy was performed for the left retroareolar mass, with appropriate needle placement. Postprocedural left on graphic images show a marker clip within the left retroareolar mass.Per outside report, the result was malignant.BREAST MRI (3/20/15):Breast MRI was performed with a protocol outlined in the outside radiology report.Known carcinoma is visualized at left retroareolar region as a spiculated mass measuring 26 x 18 x 31 mm (AP x LR x CC). The mass abuts the nipple, which is enhancing with this mass, suspicious for invasion.A linear non-mass enhancement, measuring 21 x 6 x 11 mm, is seen in the right breast at far posterior upper outer quadrant. This enhancing lesion likely corresponds to the asymmetry on the mammogram.Three simple cysts are seen in the right breast.No abnormal axillary lymph nodes are identified in either axillary region.

Output: 1. Biopsy proven left breast malignancy, suspicious for invading to the nipple.2. Linear enhancing lesion in the right far posterior upper outer quadrant. This lesion could correspond to the asymmetry on mammogram. Additional work-up for the asymmetry at posterior upper outer quadrant in the work-up is recommended.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Abnormal reflex [R29.2], Reason for Study: ^Reason: assess for hemispheric lesion History: diffuse hyperreflexia and chronic pain There is no evidence of acute ischemic or hemorrhagic lesion on the scan.There is developmental venous anomaly on the right anterior aspect of insula. Otherwise is no abnormal enhancement on the 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: Normal brain MRI.A developmental venous anomaly at the right anterior aspect of insular.


Instruction: Generate impression based on findings.

Input: Clinical question: History of CVA. Signs and symptoms: AMS. Nonenhanced brain MRI:Examination demonstrates an acute ischemic stroke in the distribution of left MCA in the operculum on the left frontal lobe. The finding measures at least 29 x 39 transaxial dimensions and 29-mm craniocephalad axis. There is evidence of mild hemorrhagic changes within the stroke. There is very subtle regional mass effect and effacement of adjacent cortical sulci without deviation of midline.Examination in addition demonstrate extensive periventricular and subcortical patchy foci of flair hyperintensity consistent with moderate chronic nonhemorrhagic small vessel ischemic stroke. Similar signal changes are also present in bilateral basal ganglia, thalami and pons.There are tiny foci of flair hyperintensity in bilateral cerebellar hemispheres inferiorly representing small bilateral chronic cerebellar pica territory ischemic strokes. There is no evidence of chronic cortical stroke of the cerebral hemispheres.Slight prominence of cortical sulci and ventricular system is within expected range for the stated age of 80.The signal void of major intracranial arterial branches are identified.

Output: 1.Acute minimally hemorrhagic ischemic stroke in the operculum of left frontal lobe measuring at least 29 x 39 x 29-mm size. Subtle regional mass effect and no deviation of midline.2.Extensive chronic nonhemorrhagic small muscle ischemic strokes.3.Multiple tiny bilateral pica territory chronic cerebellar strokes.


Instruction: Generate impression based on findings.

Input: 65-year-old female with HCC, please evaluate for metastases LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No hilar or mediastinal lymphadenopathy.The prominent pericardial recess in the right paratracheal region.Probable tracheal diverticulum unchanged from the prior exam.CHEST WALL: Degenerative changes in the thoracic spineUPPER ABDOMEN: Hypodense lesions with internal calcification within the right lobe of liver compatible with treatedtumor (recent MRI dated 6/29/11).

Output: No evidence of metastatic disease within the chest.


Instruction: Generate impression based on findings.

Input: Male, 8 years old. Posterior right knee pain, not relieved by ibuprofen. Limping. MENISCI: The medial and lateral menisci are normal.ARTICULAR CARTILAGE AND BONE: Bone marrow signal is normal. No focal cartilage defect.LIGAMENTS: The cruciate and collateral ligaments are normal. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Normal examination.


Instruction: Generate impression based on findings.

Input: Bitemporal hemianopia. There is no evidence of pituitary or other sellar region lesions. The infundibulum is intact and positioned in the midline. The optic apparatus and cavernous sinuses are intact. The There is a small left maxillary sinus retention cyst.

Output: No evidence of sella region mass lesions.


Instruction: Generate impression based on findings.

Input: Female, 50 years old, with weakness and numbness as well as neck pain. Straightening of the cervical lordosis is likely positional. Sagittal alignment is unremarkable. Vertebral body height and morphology are within normal limits. No pathologic marrow replacement, edema or enhancement is seen.The spinal canal is congenitally slender. Superimposed upon this are spondylotic changes particularly at C3-4, C4-5 and C5-6. Particularly at C3-4, the spinal cord is impinged with faint T2 signal abnormality. Elsewhere, cord signal intensity is within normal limits.C2-3: No spinal canal stenosis or neuroforaminal narrowing. No interval changes.C3-4: Large posterior disc osteophyte asymmetric to the right paracentral region. Significant spinal canal compromise with impingement of the cord. No significant foraminal narrowing. Findings have progressed.C4-5: Small central disc osteophyte complex which slightly indents the ventral cord. No significant generalized canal stenosis. Mild left foraminal narrowing. Findings have progressed.C5-6: Posterior disc-osteophyte complex formation asymmetric to the left paracentral zone where it slightly indents the ventral cord. No significant generalized canal stenosis although the lateral recess is narrowed on the left. Mild bilateral foraminal narrowing. Findings have progressed.C6-7: No spinal canal stenosis or neuroforaminal narrowing. No interval changes.C7-T1: No spinal canal stenosis or neuroforaminal narrowing. No interval changes.

Output: Multilevel cervical spondylosis is seen. C3-4 is the most severely affected level where there is a central and right paracentral disc osteophyte which impinges on the cord with evidence of mild cord edema or myelomalacia. Smaller disc osteophytes are evident at C4-5 and C5-6.


Instruction: Generate impression based on findings.

Input: 62-year-old man with intermittent right leg numbness and weakness in the right L4 or 5 distribution when sitting in a cramped position. There are five lumbar type vertebral bodies present. There is minimal anterolisthesis of L5 on S1 and loss of disc height at this level; otherwise, the vertebral body and disk heights are well-maintained. The conus medullaris terminates at L1. At L4-5, there is bilateral facet joint hypertrophy and ligamentum flavum thickening resulting in mild bilateral neural foraminal narrowing, but no significant compromise to spinal canal. At L5-S1, there is degenerative disc disease with fatty endplate bone marrow signal alterations and mild facet arthropathy resulting in moderate right and severe left neural foraminal narrowing, but no significant compromise to the spinal canal. While the entire kidneys are not included in the field of view, the imaged portions appear extensively replaced with cysts. There is atrophy of the paraspinous muscles.

Output: 1.Degenerative disc disease at L5-S1 and mild to moderate bilateral neural foraminal narrowing at L5-5 and moderate right and severe neural foraminal narrowing at L5-S1, but no significant spinal canal stenosis.2.The imaged portions of the kidneys appear replaced with cysts, which may represent polycystic kidney disease or other form or renal disease. Dedicated renal imaging is recommended for further evaluation if outside studies are unavailable for comparison.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 2-year-old male with history of neuroblastoma. Status-post two cycles of chemotherapy. Follow up exam. Views of the soft tissue neck show a large relatively homogeneous mass involving the left super mediastinum. This mass extends from the level of the thyroid gland and posterior to the carotid space down through the thoracic inlet. The inferior extent of this lesion is limited due to cut off however it extends beyond the thoracic inlet. This mass currently measures 44.3 x 29.9 mm in the transverse oblique and AP projections, and on the prior MRI exam it measured 38.1 x 23.7 mm on prior MRI exam in one accounting for differences in technique there is suggestion of mild interval increase in the size of this lesion.The remaining views and soft tissue neck show multiple lymph nodes involve the jugular chain and posterior triangle region with a prominent enhancing node involving the left jugular chain jugular digastric region approximating 14.4 mm. there is mild prominence of the tonsillar tissue within the oropharynx with no significant compromise of the pharyngeal/laryngeal airway. Normal enhancement is seen involving the carotid vasculature.

Output: 1. The large left-sided superior mediastinal mass with low cervical involvement air as described above. When accounting for differences in technique there is suggestion of mild interval increase in size from the previous MRI performed on 4/7/2010.2. Cervical lymphadenopathy most prominent in the left jugulodigastric region. See above discussion.


Instruction: Generate impression based on findings.

Input: Male, 59 years old, with right MCA stroke, evaluate for penumbra. On perfusion imaging, markedly reduced relative cerebral blood volume and blood flow are seen corresponding to the area of restricted diffusion involving the right middle frontal gyrus, operculum and insula. The region of elevated time-to-peak and mean transit time is, however, significantly larger than the infarct core, encompassing a majority of the right MCA territory.FLAIR signal abnormality within the infarct core is not significantly changed in geographic extent. Scattered additional foci of white matter T2 hyperintensity are also unchanged. As before, there may be mild effacement of the right lateral ventricle, but no significant generalized mass effect is seen.On postcontrast images, there is prominence of sulcal vascularity throughout the right cerebral hemisphere possibly representing compensatory vasodilatation and/or collateralization. No pathologic enhancement is detected. A nodular enhancing structure within the left lateral ventricle is unchanged from 2010 likely representing a venous varix or venous aneurysm of doubtful clinical significance.

Output: rCBV and rCBF mapping demonstrate findings compatible with completed infarction involving the right middle frontal gyrus, operculum and insula, corresponding very well with the area of restricted diffusion on prior MRI. MTT and TTP mapping, however, demonstrate a penumbra of compromised perfusion which is significantly larger than the infarct core, encompassing a majority of the right MCA territory.


Instruction: Generate impression based on findings.

Input: 82 years, Female, metastatic non-small lung cancer status post SRS to the left frontal lesion. Evaluate for interval growth vs necrosis and also the left parietal focus. Unchanged size of left frontal lobe enhancing lesion measuring 15 x 15 x 14 mm, although with increased thickness of the rind of peripheral enhancement and decreased extent of central enhancement. There is now also associated restricted diffusion. There is adjacent T2 hyperintense vasogenic edema, which is decreased in extent especially cranially with overall decreased gyral/parenchymal enhancement. There are no new enhancing lesions. There is no midline shift or herniation. There is a small focus of likely chronic hemosiderin within the superior right frontal lobe. The ventricles are within normal limits in size and configuration. Several foci of nonspecific T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, similar to prior. Left occipital white matter T2/FLAIR hyperintense focus has resolved. A left cortical parietal focus of enhancement adjacent to the intraparietal sulcus is no longer appreciated. Major flow-voids are preservedThere is fluid within the left mastoid air cells.

Output: Given unchanged overall size of the enhancing left frontal lobe lesion and significantly decreased extent of surrounding white matter FLAIR hyperintensity and parenchymal expansion, although with slight increased thickness of the lesion's enhancing rim and new diffusion restriction, finding is favored to relate evolving post-treatment changes.Previously seen left parietal cortical punctate focus of enhancement has resolved.


Instruction: Generate impression based on findings.

Input: Reason: right knee injury, giving way symptoms, exam findings of ACL rupture MENISCI: Marked disruption of the posterior horn of the medial meniscus. Lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: Partial thickness tear of the medial femoral condyle hyaline cartilage with adjacent bone marrow edema.LIGAMENTS: ACL is not well visualized, indicating tear. PCL is intact. EXTENSOR MECHANISM: Quadriceps and patellar tendons are intact.ADDITIONAL

Output: ACL tear, disruption of the posterior horn of the medial meniscus, and partial thickness tear of the medial femoral condyle hyaline cartilage as above.