Instruction: Generate impression based on findings.

Input: Wrist pain following injury LIGAMENTS: No significant abnormality noted.TRIANGULAR FIBROCARTILAGE COMPLEX: No significant abnormality noted.TENDONS: No significant abnormality noted. BONES: There is a nondisplaced intra-articular fracture of the distal radius. Increased signal is also evident in the scaphoid which may reflect a contusion versus nondisplaced vertical fracture.ADDITIONAL

Output: 1. Nondisplaced intra-articular fracture of the distal radius with possible nondisplaced vertical fracture versus contusion of the scaphoid. The scapholunate and lunotriquetral ligaments as well as the TFCC appear intact.2. Enlarged median nerve. Correlate with any symptomatology of carpal tunnel syndrome.


Instruction: Generate impression based on findings.

Input: Female, 18 years old, with neurofibromatosis type I and moyamoya syndrome, known brainstem tumor and frontal white matter encephalomalacia. Presenting with left pupil dilation and exotropia, dysarthria. Evaluate for new infarct or tumor. A heterogeneously enhancing tumor is redemonstrated within the right aspect of the midbrain measuring 22 x 19 x 19 mm, not significantly changed from the prior examination. No new enhancing or masslike lesions are observed.Encephalomalacia is again seen within the deep left frontal white matter, and involving the right temporo-occipital cortical and subcortical tissues, without significant interval change. No new parenchymal lesions are observed. No evidence of acute intracranial hemorrhage or any abnormal extra-axial fluid collection is seen. The ventricles are normal in size and morphology. Absence of the left sigmoid and transverse sinus flow void is noted, but this finding was present on multiple prior examinations and may simply be artifactual.A right basal ganglia developmental venous anomaly is suspected. The terminal ICA and MCA flow voids are not well seen compatible with the history of moyamoya disease. Postoperative findings compatible with bilateral pial synangiosis are redemonstrated.Findings related to cleft palate are partially visualized.

Output: 1.No change in the size of the midbrain tumor.2.No change in left frontal and right temporo-occipital encephalomalacia.3.No acute ischemia or other acute intracranial abnormality.


Instruction: Generate impression based on findings.

Input: Right shoulder pain ROTATOR CUFF: There is a complete tear of the infraspinatus tendon with at least 3 cm of proximal retraction. The tear extends anteriorly to involve much of the supraspinatus tendon although there may be some anterior fibers which extend to the greater tuberosity. There is moderate fatty atrophy of the infraspinatus muscle with relatively mild fatty atrophy of the supraspinatus muscle. Additionally, there is increased signal within the subscapularis tendon which likely represents a combination of tendinosis and laminar tearing and there is moderate fatty atrophy of the superior fibers of the associated muscle. The teres minor tendon and muscle are normal. SUPRASPINATUS OUTLET: There is mild osteoarthritis of the acromioclavicular joint. A small amount of fluid is noted within the subacromial subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is mild osteoarthritis of the glenohumeral joint and humeral head is slightly high riding. There is a glenohumeral joint effusion with extension of fluid to the subscapular recess. Additional fluid anterior to the subscapularis likely represents a subcoracoid bursitis. There is poorly defined intermediate signal within the axillary recess reflecting mild synovitis. There is blunting and increased signal of the superior labrum representing degeneration and degenerative tearing.BICEPS TENDON: The intra-articular portion of the biceps tendon is poorly visualized likely secondary to tearing. The extra-articular portion appears attenuated and irregular also likely representing additional tearing. ADDITIONAL

Output: Full-thickness rotator cuff tear with additional findings described above.


Instruction: Generate impression based on findings.

Input: History of breast cancer in her mother diagnosed at age 50. Enrolled in high-risk research breast cancer screening study. There is heterogeneous amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally, with a prominent normal edge parenchymal enhancement pattern. For future exams, scheduling during the 2nd week of her menstrual cycle may help minimize the degree of background enhancement. No abnormal enhancement is seen in either breast. Numerous foci in each breast are similar to prior studies. 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: Ataxia and weakness. Rule out spinal tumor or involvement by multiple sclerosis. THORACIC SPINE:There is moderate-to-severe spinal canal stenosis in the lower cervical spine. Also, the thyroid gland is diffusely enlarged. Please refer to the report of the cervical spine MRI from the day prior for more details.Thoracic spinal alignment is anatomic. The vertebral bodies are preserved in height. Marrow signal is notable for fat-containing lesions in T7, T9 and T12 vertebral bodies and most probably represent intraosseous lipomas or hemangiomas. There is no suspicious marrow abnormality, otherwise. Right anterolateral bridging osteophytes are present at T7-T12, most pronounced at T9-T10. The intervertebral discs show variable loss of T2 signal and mild height loss but there is no significant disc pathology. The thoracic spinal canal is preserved. There is also no significant neuroforaminal stenosis. The thoracic spinal cord shows normal morphology and signal. There is no abnormal thoracic spinal cord, leptomeningeal or nerve root contrast enhancement. Paraspinal tissues are notable for a 4 mm T2-hyperintense, T1-hypointense, non-contrast enhancing lesion in the upper pole of the left kidney which is incompletely assessed though likely represents a cyst. There is also a dilatation of the included extrahepatic bile duct, up to 10 mm for the pancreatic segment of the common bile duct. The gallbladder is also partially visualized and not enlarged.LUMBAR SPINE:There are 5 lumbar type, ribless vertebrae. The last well-formed disc is at L5-S1. Lumbar spinal alignment is anatomic. The vertebral bodies are preserved in height. Fat-containing lesion in the first sacral segment is probably either intraosseous lipoma or a hemangioma. There is no suspicious marrow abnormality, otherwise. The intervertebral discs are preserved in height but show partial loss of the T2 signal, compatible with desiccation. The spinal canal is fairly preserved. The conus medullaris tip is at the lower L1 level. The conus shows normal morphology and signal characteristics. There is increased contrast enhancement and STIR signal in the interspinous ligament at L3-L4 and to a lesser extent L4-L5, which is associated with minimal dorsal indentations of the thecal sac. This compatible with Baastrup disease.T12-L1, L1-L2, L2-L3: There is no significant disc herniation. There is no spinal canal or foraminal stenosis. There is mild thickening of ligamenta flava.L3-4: Minimal disc bulge is present along with moderate ligamentum flavum thickening. There is no significant spinal canal or foraminal stenosis.L4-L5: Minimal disc bulge and moderate ligamentum flavum thickening present without significant spinal canal or foraminal stenoses.L5-S1: There is no significant spinal canal or foraminal stenosis. There is moderate right and mild left facet arthropathy associated with increased contrast enhancement.There are typical changes are present at the sacroiliac joints with subchondral sclerosis and articular surface irregularity as well as marginal osteophytes/syndesmophytes. There is T1 hypointensity with more linear configuration in the right sacral ala with surrounding ill-defined abnormal signal, which may reflect a nondisplaced insufficiency fracture. Similar change is present also in the adjacent right iliac bone.

Output: 1.Bilateral sacroiliac joint osteoarthritic changes are present. Additional T1 hypointensity including in a more linear configuration in the right sacral ala and possible in adjacent right iliac bone which could reflect a nondisplaced insufficiency fracture. Please correlate clinically. MR of the sacrum could be obtained for further evaluation.2.There is no spinal cord abnormality to suggest demyelinating disease. No MR evidence of spinal tumor as clinically questioned.3.Reactive inflammatory change in the interspinous spaces of L3-L4 and L4-L5, which could indicate Baastrup disease. Inflammatory degenerative changes are also present at the L5-S1 facets, right more than left. These findings can contribute to back pain.4.Moderate-to-severe lower cervical spinal canal stenosis with mass-effect on the spinal cord. Please refer to the report on the cervical spine MRI from the day prior for more details.5.Incidental dilated extrahepatic bile ducts but no gallbladder dilatation. Please correlate with cholestatic laboratory parameters and potentially dedicated hepatobiliary imaging.


Instruction: Generate impression based on findings.

Input: Reason: Hx Multiple Myeloma; new onset back pain. Evaluate for myeloma lesions. History: Hx Multiple Myeloma; new onset back pain. Evaluate for myeloma lesions. Note is made of diffuse heterogeneous bone marrow signal abnormality within the imaged bones of the pelvis lower lumbar spine, and proximal femora. These findings likely represent residual islands of red marrow. No discrete myelomatous deposits are identified. The imaged musculature of the pelvis is unremarkable. Although this examination was not protocoled for detailed evaluation of the pelvic viscera, no acute abnormality is identified. There is a small amount of peritrochanteric inflammation, left greater than right which may be of no clinical significance. There is a 6 x 8 x 16 mm enhancing focus of increased signal abnormality and fluid sensitive sequences within the subcutaneous tissue abutting the lateral aspect of the right gluteal musculature. Tiny focus of enhancing signal abnormality in the right superior iliac bone adjacent to the sacroiliac joint may represent a site of prior bone marrow biopsy. There is a small amount of fluid within the hips bilaterally which is not necessarily of any clinical significance.

Output: 1. Diffuse heterogeneous bone marrow signal abnormality may represent islands of red marrow. No discrete myelomatous deposits are identified.2. Nonspecific 16 mm enhancing nodule within the subcutaneous tissue along the lateral aspect of the right gluteal musculature. A soft tissue myelomatous deposit is considered unlikely.


Instruction: Generate impression based on findings.

Input: History of uterus fibroids. Evaluation for embolization. PELVIS:UTERUS, ADNEXA: The uterus is markedly enlarged due to multiple fibroids including intramural and subserosal fibroids. It measures 11.4 x 11.2 cm in the sagittal plane.The dominant subserosal fibroid in the left uterine body/fundus measures 8.7 x 7.9 cm, compared to 9.2 x 8.5 cm previously. The right fundal subserosal exophytic fibroid measures 5.5 x 4.8 cm. These demonstrate avid postcontrast enhancement.Demonstrated again is a T1 hyperintense T2 hypointense right adnexal lesion measuring 2.8 x 2.4 cm (series 4/19), compared to 2.8 x 2.2 cm previously, compatible with an endometrioma. Similar lesion in the left adnexa measures approximately 1.8 x 1.0 cm.Normal endometrial thickness. Several punctate T2 cystic foci in the inner myometrium/junctional zone compatible with adenomyosis.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: There is a T2 hyperintense enhancing lesion in the S1 vertebral body measuring 2.6 x 2.6 cm (series 4/34) suspicious for a metastatic lesion given the history of carcinoid.OTHER: No significant abnormality noted.

Output: 1.2.6 cm enhancing S1 vertebral body lesion suspicious for metastatic disease especially given the history of carcinoid. Further staging imaging is recommended to evaluate for other sites of metastatic disease.2.Enlarged myomatous uterus containing avidly enhancing fibroids. 3.Adenomyosis.


Instruction: Generate impression based on findings.

Input: 42-year-old male. Rule out RCC metastases. ABDOMEN:LIVER, BILIARY TRACT: Subcentimeter T2 hyperintense foci favored to be cystic (series 1/1/2001 images 36, 30).SPLEEN: Status post splenectomy.PANCREAS: Status post distal pancreatectomy, and no recurrent nodular enhancement is identified. The previously described fluid collection in the left-sided surgical bed has decreased in size and now measures 2.0 x 2.6 cm (series 1001 image 21) (prior 3.1 x 3.2 cm). The fluid collection demonstrates thin peripheral enhancement on the delayed phase (series 1506 image 205), which may represent fibrosis. Small subcentimeter adjacent lymph nodes are noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Status post right nephrectomy. RETROPERITONEUM, LYMPH NODES: No new lymphadenopathy. Incidental note is made of a retroaortic left renal vein.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Subcentimeter T2 hyperintense focus of the left costochondral junction (series 1001 image 18) correlates with a hypodense focus on the prior CT exam and is of uncertain clinical significance.Tiny foci of susceptibility artifact and linear delayed enhancement of the left ventral abdominal wall (series 1506 image 40) is likely postsurgical in origin and corresponds to the region of subcutaneous emphysema from the prior CT exam.T1 hyperintense linear focus across the anterior abdominal wall (series 1506 image 5) could represent prior ventral hernia repair with mesh, and clinical correlation is needed.OTHER: No significant abnormality noted.

Output: Status post right nephrectomy, distal pancreatectomy, and splenectomy. Decreased size of the previously seen fluid collection in region of surgical bed. No evidence of recurrent nodular enhancement in the residual pancreatic parenchyma. No specific evidence of metastatic disease.


Instruction: Generate impression based on findings.

Input: 68 year old woman with history of lung cancer s/p resection, pulmonary arterial hypertension, and aortic regurgitation referred for cardiac MRI to serially evaluate cardiac function and valvular disease. Left VentricleThe left ventricle is qualitative normal in size and systolic function. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is normal in size.Right VentricleThe right ventricle is qualitatively moderate to severely dilated with preserved systolic function. Right AtriumThe right atrium is severely dilated. Aortic ValveThe aortic valve is trileaflet and opens widely. There is mild aortic regurgitation. Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation. There is mild thickening of the leaflet tips.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is severe tricuspid regurgitation which appears more prominent than on the previous MRI.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern, though the overall course of the aorta is deviated towards the left hemithorax.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is mildly dilated. The main PA size is 28 x 29 mm, the right PA size is 23x19 mm, and the left PA size is 21x22 mm. The left PA ends in a blind pouch.Venous AnatomyThe SVC and IVC drain normally into the right atrium. PericardiumThere is no pericardial effusion.Extracardiac FindingsAs noted on previous studies, due to prior lung resection the cardiac structures are significantly deviated into the left hemithorax. There is associated mediastial/tracheal deviation to the left. There is a 19 x 16mm ovoid mass in the liver which has been visualized on previous abdominal imaging and is stable in size compared to the previous MRI. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Normal LV size and systolic function without evidence of underlying myocardial fibrosis, inflammation, or infiltration. 2. Moderate to severe RV dilation with preserved systolic function.3. Severe right atrial dilation.4. Severe tricuspid regurgitation. 5. See extra-cardiac findings.6. Quantitative software not currently available. Addendum to be added to reports once quantification can be performed.7. When compared to study from 7/17/2015, the tricuspid regurgitation is a little worse. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 67 year-old female with right hip pain, end-stage renal disease on hemodialysis. ACETABULAR LABRUM: Degenerative changes involving the acetabular labrum.ARTICULAR CARTILAGE AND BONE: Mild degenerative changes of the articular cartilage in the right hip. The lesser trochanter is intact, without evidence of fracture.SOFT TISSUES: There is a rupture of the distal right iliopsoas tendon, which is retracted to the level of the acetabulum. The underlying lesser trochanter is intact. There is significant edema in the surrounding musculature and along the iliopsoas tendon. No significant muscle atrophy is noted.ADDITIONAL

Output: 1.Tear of the right iliopsoas tendon, with retraction to the level of the acetabulum. 2.Significant associated edema of the surrounding musculature and iliopsoas tendon. 3.The right lesser trochanter is intact, without evidence of fracture.


Instruction: Generate impression based on findings.

Input: History of elevated PSA with a negative prostate biopsy. PELVIS:PROSTATE:Prostate Size: 5.7 x 6.4 x 7.7 cmPeripheral Zone: There is asymmetric atrophy and scarring of the left peripheral zone with contiguous small wedge-shaped linear scar-like foci. No suspicious T2-weighted lesion, restricted diffusion or arterial enhancement. Central Gland: Marked central gland enlargement with numerous well-defined nodules compatible with BPH.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: No evidence of extraprostatic extension.BLADDER: No significant abnormality noted.LYMPH NODES: Nonspecific 7 mm right obturator lymph node. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No discrete suspicious lesion with asymmetric left peripheral zone atrophy and scarring seen. Marked BPH.


Instruction: Generate impression based on findings.

Input: 32 day old female with Mucolipidosis type II. (CGA: 40 4/7 weeks) There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is a small focus of high T2 and low T1 signal in the right putamen. There also appears to be mild deficiency of myelination in the bilateral perirolandic regions. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable. The skull appears to be brachycephalic.

Output: 1. Nonspecific small focus of high T2 and low T1 signal in the right putamen, which may represent a prior infarct, for example. Otherwise, no evidence of acute infarction or intracranial mass lesions. 2. Apparent mild deficiency of myelination in the bilateral perirolandic regions.


Instruction: Generate impression based on findings.

Input: 22 year old male patient with history of testicular cancer. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Reference left para-aortic lymph node is unchanged. No new sites of lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No new sites of disease or significant interval change.


Instruction: Generate impression based on findings.

Input: 64-year-old male with pain and crepitus. ROTATOR CUFF: There is a tear of the insertion of the rotator cuff involving the supraspinatus as well as anterior fibers of the infraspinatus with minimal (5 mm) of retraction. There is full-thickness involvement of the anterior infraspinatus/posterior supraspinatus, and there appears to be additional bursal surface tearing of the anterior fibers of the supraspinatus. Overall, we estimate the tear is approximately 1.5 cm in AP dimension. Mild tendinosis affects the retracted supraspinatus tendon. There is mild fatty atrophy along the myotendinous junction of the supraspinatus and infraspinatus tendons. The teres minor muscle and tendon appear intact. There is a tiny undersurface insertional tear of the subscapularis as well as additional undersurface fraying, but we see no full-thickness tear and the muscle appears normal.SUPRASPINATUS OUTLET: Mild to moderate osteoarthritis affects the acromioclavicular joint with small synovial cysts along the undersurface of the joint. There is a trace amount of fluid within the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: No joint effusion is evident. Mild osteoarthritis affects the glenohumeral joint. There is increased signal intensity within the anterior labrum likely reflecting degenerative tearing. There are small cysts within the anterior aspect of the humeral head.BICEPS TENDON: The tendon of long head of the biceps appears intact.ADDITIONAL

Output: 1. Full-thickness insertional tear of the supraspinatus/infraspinatus as described above with minimal retraction as well as undersurface fraying of the subscapularis with a tiny insertional undersurface tear.2. Mild to moderate osteoarthritis affects the acromioclavicular and glenohumeral joints as well as other findings as described above.


Instruction: Generate impression based on findings.

Input: Preterm newborn; born at gestational age 31 weeks via emergent C-section for cord prolapse. Sepsis and neonatal depression. For the calculated gestational age, myelination is age-appropriate. There is no acute infarct or intracranial hemorrhage. There is no sign of malformation of cortical development. There is no mass-effect, midline shift or brain herniation. The major intracranial vascular flow voids are grossly preserved. The ventricles and CSF-containing spaces are normal in size. The skull, orbits and scalp are grossly unremarkable.

Output: Unremarkable evaluation. No acute infarct or intracranial hemorrhage. Myelination is appropriate for calculated gestational age.


Instruction: Generate impression based on findings.

Input: History of breast cancer now with shoulder pain, evaluate for metastasis. ROTATOR CUFF: There is mild thickening of as well as intermediate signal within the supraspinatus tendon compatible with mild tendinosis. No discrete tears are identified. The remaining tendons and muscles of the rotator cuff are within normal limits.SUPRASPINATUS OUTLET: Mild-moderate osteoarthritis affects the acromioclavicular joint. No significant fluid is present within the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Bone marrow signal within the visualized osseous structures is within normal limits without evidence of metastatic disease. A small subchondral cyst is present within the humeral head. The articular cartilage of the glenohumeral joint is grossly intact. The labrum is grossly intact.BICEPS TENDON: The tendon of the long head of the biceps is intact. ADDITIONAL

Output: 1.No evidence of metastatic disease.2.Mild supraspinatus tendinosis.3.Additional findings as described above.


Instruction: Generate impression based on findings.

Input: Locking and pain. Question of meniscal tear. MENISCI: The medial and lateral menisci are intact.ARTICULAR CARTILAGE AND BONE: The articular cartilage of all three compartments is intact. Bone marrow signals within normal limits.LIGAMENTS: The collateral and cruciate ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact. ADDITIONAL

Output: Intact menisci and ligaments.


Instruction: Generate impression based on findings.

Input: The patient is a 68-year-old male with history of lung cancer status post resection and brain mets status post resection presenting with two days of confusion. In the area of the known posterior parietal lobe metastatic lesion seen on the comparison MRI, there is a 2.8 x 1.6 cm area of high attenuation consistent with hemorrhagic conversion of this lesion. Edema appears increased from the time of the comparison study. Effacement of the sulci is increased from the MRI secondary to the increase in edema, metastasis and subdural fluid. The second left parietal metastatic lesion is not well visualized on this examination.There are bilateral subdural hematomas, larger on the right. A high density component to the right sided subdural hematoma is consistent with an acute component to this subdural hemorrhage.The patient has undergone two craniotomies. Encephalomalacia and bony defects are seen in the right frontal and left parietal regions.The calvaria and skull base are radiographically normal except for the postsurgical changes. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. Progression of metastatic disease with hemorrhagic conversion of the left posterior parietal lesion.2. Subdural hematomas with acute component seen on the right.3. Increased edema and effacement of the sulci, but no herniation.


Instruction: Generate impression based on findings.

Input: 42 years Male (DOB:1/30/1974)Reason: brain lesion History: brain tumor, haPROVIDER/ATTENDING NAME: RAYMOND ROOS RAYMOND ROOS There is redemonstration of a ring-enhancing mass centered along the left gyrus rectus associated with vasogenic pattern of edema in the left inferior frontal lobe white matter and to a lesser degree right inferior medial frontal lobe white matter.There are small foci of volume loss associated with T2 signal hyperintensity present in the left cerebellar hemisphere and left occipital lobe.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 demonstrate minor opacities. The visualized portions of the orbits are intact.

Output: 1.There is a left frontal lobe ring-enhancing mass present which is suspicious for a pyogenic abscess centered in the left gyrus rectus displacing the left medial frontal lobe across the midline.2.Foci of encephalomalacia are redemonstrated in the left cerebellar hemisphere and left occipital lobe.3.Examination was obtained for stereotactic surgical guidance


Instruction: Generate impression based on findings.

Input: Ms. Weinstein is a 52 year old female with a family history of breast cancer in her sister (diagnosed at the age of 52) and maternal grandmother. Minimal parenchymal enhancement is noted bilaterally. There is a 4 mm focus identified in the left lower inner breast with persistent-type kinetics and internal fat signal intensity; the features of which all favor a benign intra-mammary lymph node. No suspicious abnormal enhancement is seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.Incidental note is made of a subcentimeter T2 hyperintense lesion in the right hepatic lobe, compatible with a simple hepatic cyst.

Output: No MRI evidence for malignancy. No mammogram is available in our system for comparison purposes. MRI is optimally interpreted with a comparison mammogram. If the patient's prior mammograms are submitted, then an addendum to this report will be made.BIRADS: 1 - Negative.RECOMMENDATION: NS - Routine Screening Mammogram.


Instruction: Generate impression based on findings.

Input: Grade 2 meningioma treated with surgery and radiation therapy. There are post-treatment findings related to right parietal craniotomy and radiation therapy. There is no significant interval change in size of an enhancing dural based lesion deep to the craniotomy that measures up to 10 mm in thickness, with extension to the superior sagittal sinus. There is also no significant interval change in size of the enhancing dural-based lesion along the right lateral parietal convexity with infiltration of the craniotomy flap margin that measures 10 mm in thickness. There is non-opacification of portions of the posterior superior sagittal sinus. There is persistent high T2 signal and scattered areas of gyriform enhancement in the posterior parietal lobes near the midline. There is no evidence of acute cerebral infarction. The ventricles are stable in size and configuration. There is no midline shift or herniation. There is a partially-empty sella. The skull and extracranial soft tissues are unchanged.

Output: 1. No significant interval change in size of the residual tumor in the right parasagittal surgical bed and the recurrent tumor in the lateral right parietal convexity. 2. Persistent treatment effects in the bilateral posterior cerebral hemispheres, likely related to radiation necrosis.


Instruction: Generate impression based on findings.

Input: Change in mental status. Rule out bleed Extensive a small vessel disease of undetermined age is detected.Bilateral chronic appearing subdurals are identified in the frontal and parietal region.No evidence of hemorrhage, mass effect, midline shift or hydrocephalus is detected. Further evaluation with an MRI is recommended for evaluation of subdurals and possible new acute small vessel strokes. Calvarium is unremarkable.

Output: 1.Extensive small vessel disease of undetermined age. Further follow-up with MRI is recommended.2.Bilateral chronic subdural CSF collections.3.No evidence of mass effect, hemorrhage, midline shift or hydrocephalus.4.5.


Instruction: Generate impression based on findings.

Input: 42 years Female (DOB:12/8/1973)Reason: Chiari decompression, Lp shunt, with new symptoms, evaluate for changes History: new headaches, neck pain, dizziness.PROVIDER/ATTENDING NAME: DAVID M. FRIM DAVID M. FRIM MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. Incidental note is made of partial empty sella.The cerebellar tonsils extend approximately 3 mm below the level of foramen magnum. CSF flow at the level of the foramen magnum is within normal limits.There several periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. This is stable compared to prior examNo abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There is multilevel disc desiccation present.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina. There are small uncovertebral osteophytes at this level mildly narrowing the neural foramina.At C5-6 there is loss of disc space height, disc desiccation and a disc bulge associated with small uncovertebral osteophytes and mild narrowing of the neural foramina bilaterally. There is encroachment of the right-sided exiting nerve roots and to a lesser degree left-sided exiting nerve roots due to uncovertebral osteophytes. There is partial effacement of spinal fluid ventral and posterior the spinal cord. Overall there is mild spinal stenosis at this level. This is stable compared to the prior exam.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.There are mild degenerative changes present in the cervical spine without significant compromise to the spinal canal. There is mild encroachment of exiting nerve roots at C5-6 due to uncovertebral osteophytes which appear worse on the right compared to the left side. This is stable compared to the prior exam.2.The cerebellar tonsils are low lying which is borderline for Chiari I malformation. There is no evidence for ventriculomegaly or syrinx and no CSF flow obstruction at the level of the foramen magnum. This is stable compared to the prior exam.3.Several periventricular and subcortical white matter are present which are nonspecific and not unusual in this number at this age. They are therefore of little clinical significance. This is stable compared to the prior exam.


Instruction: Generate impression based on findings.

Input: 46 years, Female, Reason: h/o Acinic cell carcinoma of the parotid and chemoradiation Again seen are postoperative findings related to right parotidectomy. Interval postsurgical changes of partial mastoidectomy are seen with mild increase in surrounding enhancement which may reflect granulation tissue. No significant change in the remainder of the ill-defined heterogeneously enhancing mass that involves the right basiocciput, petrous ridge, mastoid portions of the right temporal bone, and condylar and lateral squamous portions of the occipital bone. The central areas of non-enhancement within the mass likely represent necrosis and are not significantly changed. The mass still abuts the right ICA and encases the right internal jugular vein. There is also unchanged abnormal enhancement within the lateral mass of the C1 vertebra. Diffuse heterogeneity of the bone marrow signal in the remainder of the calvarium is similar to prior and nonspecific.There is no evidence of intracranial hemorrhage or acute infarct. There is no appreciable mass effect upon the cerebellum or brainstem. There are a few unchanged nonspecific foci of T2 hyperintensity in the cerebral white matter. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The orbits are unremarkable. The remaining salivary glands are unremarkable.

Output: Compared to 4/29/2015 interval postsurgical changes of partial mastoidectomy for debridement related to osteoradionecrosis is seen. There is mild increased surrounding enhancement likely reflecting postsurgical change/granulation tissue. Otherwise there is no significant change in appearance of the heterogeneously enhancing necrotic mass centered at the right lateral skull base and craniocervical junction consistent with treated tumor.


Instruction: Generate impression based on findings.

Input: MRI brain:Punctate focus of diffusion restriction along the posterior limb of the left internal capsule. No other areas of diffusion restriction are identified. There are chronic lacunar infarcts noted in the pons and left thalamus. Pontine infarct also is associated susceptibility artifact suggesting chronic microhemorrhage. Volume loss in the cerebellum is noted. The basal cisterns remain patent. There is no midline shift or mass effect. No extra-axial fluid collection is identified.The midline structures and craniocervical junction are within normal limits. MRA brain:MRA is slightly limited by artifact. Mild irregularity involving the right cavernous and supraclinoid ICA segments as well as minimal irregularity of the right M1 segment, without high grade stenosis. The nondominant distal left vertebral artery is diminutive, especially beyond the PICA origin. There also appears to be a focal high-grade stenosis at the left vertebrobasilar junction. While these findings are probably related atherosclerosis, the possibility of remote dissection cannot be excluded. No findings to suggest intimal flap. No evidence of aneurysm.MRA neck:There is a separate origin of the left subclavian artery, left common carotid artery, and brachiocephalic artery from the arch. The common carotid arteries and cervical internal carotid arteries are normal in course and caliber, without evidence of stenosis or occlusion.Both vertebral artery origins are patent. The right vertebral artery is dominant. There is no evidence of stenosis or occlusion in the extracranial portions of the major neck vasculature.

Output: 1.Punctate focus of acute infarct along the posterior limb of the left internal capsule. Chronic left thalamic and pontine lacunar infarcts.2.Diminutive nondominant distal left vertebral artery, particularly beyond the PICA origin, with more focal high-grade stenosis at the left vertebrobasilar junction. Findings may related to atherosclerotic disease although possibility of prior dissection is not entirely excluded. 3.Other low-grade stenoses/irregularities in the right ICA and MCA, as described above.4.No significant steno-occlusive lesion in the arterial vasculature in the neck.


Instruction: Generate impression based on findings.

Input: 28-year-old female with headaches for the past three weeks, worse in the morning. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is approximately 3-4 mm inferior protrusion of the cerebellar tonsils through the foramen magnum. There is apparent mild crowding of the foramen magnum and a mildly pointed morphology of the inferior aspect of the cerebellar tonsils bilaterally. 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 evidence of acute intracranial hemorrhage, mass, or acute infarct.2. Bilateral cerebellar tonsillar ectopia. The relevance of this finding is uncertain so correlation with symptoms is suggested.


Instruction: Generate impression based on findings.

Input: History of metastatic renal cell cancer, now with new onset double vision. The enhancing lesion in the left parietal lobe is unchanged, measuring up to 6 mm, previously also 6 mm. Likewise, the associated minimal confluent surrounding T2 hyperintensity has not significantly changed. The enhancing right inferior temporal gyrus lesion is unchanged in size, measuring up to 4 mm, previously also 4 mm. There is unchanged nonspecific mild, predominantly periventricular, cerebral white matter T2 hyperintensity. There is no evidence of intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is minimal fluid in the mastoid air cells and retention cyst formation in the maxillary sinuses.

Output: 1. No significant interval change in size of the left parietal and right temporal lobe metastases.2. No evidence of new intracranial metastases or acute infarction.3. The orbits appear to be grossly unremarkable. However, dedicated orbital imaging may be useful for evaluating the symptomatology.


Instruction: Generate impression based on findings.

Input: Osteosarcoma, left scapular mass The examination is limited secondary to metallic susceptibility artifact by the presence of the left humerus endoprosthesis as well as by motion artifact. A large multifocal mass surrounds the scapula with replacement of the majority of the supra and infraspinatus muscles and a portion of the superior subscapularis muscle. Exact delineation of the mass is somewhat difficult given the multifocal nature however its entirety measures approximately 11 x 11 x 7.3 cm in the greatest craniocaudal, transverse, and AP dimensions. The mass demonstrates a multicystic appearance, appearing predominantly isointense to muscle on T1 sequences and hyperintense to muscle on T2 sequences. Areas of increased T1 signal within the supraspinatus and infraspinatus portions likely reflect areas of hemorrhage. Small scattered fluid fluid levels are identified within the mass and following contrast administration, there is a heterogeneous, septal-like enhancement pattern. Abnormal marrow signal is seen throughout the scapular spine. There is a mild amount increased signal and enhancement within the subcutaneous tissues likely reflecting edema and inflammation. There is partial visualization of scarring in the left upper lobe

Output: Large multifocal mass surrounding the scapula consistent with recurrent malignancy.


Instruction: Generate impression based on findings.

Input: 64 years Female (DOB:4/28/1952)Reason: 64 year old with primary CNS lymphoma who is s/p consolidation chemotherapy with cytarabine on 11/27. History: primary CNS lymphomaPROVIDER/ATTENDING NAME: KENNETH S COHEN EVERETT E VOKES The patient status post left parietal craniotomy for removal of a neoplasm. There are some encephalomalacia and susceptibility effect present in the underlying left parietal lobe which extends to the left postcentral gyrus and the superior parietal lobule. This appearance is stable compared to the previous exam.There is redemonstration of a right paramedian mass adjacent to the right cuneus and superior sagittal sinus which extends into the superior sagittal sinus. It measures 13 x 9 mm axial dimensions and has not changed significantly compared to the prior 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 demonstrate partial opacification of the right sphenoid sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Status post left parietal craniotomy for removal of a neoplasm. There is no evidence for local recurrence.2.Right paramedian extra-axial mass extending into the superior sagittal sinus is stable compared to the prior exam. Venography may help further assess superior sagittal sinus involvement. Differential considerations include angioma as well as lymphoma.


Instruction: Generate impression based on findings.

Input: 79-year-old female with syncope and fall. Rule out bleed. There is no evidence of intracranial hemorrhage, mass or edema. Extensive periventricular and subcortical white matter areas of hypoattenuation appear unchanged and are consistent with chronic small vessel ischemic disease. Prominent sulci are consistent with parenchymal volume loss, appropriate for age.The ventricles and basal cisterns are normal in size and configuration.Mild irregularity of right orbital roof appears unchanged, and is possibly result of prior trauma. Otherwise, calvaria and skull base are radiographically normal. Right mastoid air cells are opacified, unchanged. Otherwise, the visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1.No acute intracranial abnormality or interval change.2.Stable chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: 10 year old female with a history of Tetralogy of Fallot, s/p valve sparing repair. Referred for cardiovascular MRI to evaluate right ventricular size and function as part of a research study. Left VentricleThe left ventricle is moderately enlarged with mildly reduced systolic function. There is diastolic flattening of the interventricular septum. The overall LV ejection fraction is 54%, the LV end diastolic volume index is 105 ml/m2, the LVEDV is 132 ml (Z-score +3.5), the LV end systolic volume index is 48 ml/m2, the LVESV is 61 ml, the LV mass index is 43 g/m2, and the LV mass is 54 g. There are no regional wall motion abnormalities present. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is moderately enlarged with normal systolic function. The overall RV ejection fraction is 57%, the RV end diastolic volume index is 116 ml/m2, the RVEDV is 147 ml (Z-score +3.2), the RV end systolic volume index is 50 ml/m2, and the RVESV is 63 ml. Right AtriumThe right atrium is dilated. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is moderate pulmonary valve regurgitation. Regurgitant fraction is 30%.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 ArteriesThe main pulmonary artery is normal in size. There is discrete ostial stenosis of the left pulmonary artery. LPA receives 40% of pulmonary flow, and RPA receives 60% of pulmonary flow. MPA measures 26 x21 mm. Ostium of the LPA measures 11 x 9 mm. Distal LPA measures 14 x 13 mm. Venous AnatomyThe SVC and IVC drain normally into the right atrium. The coronary sinus appears dilated. Possible small left-sided SVC.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. Moderate left ventricular enlargement with mildly reduced systolic function. (LVEF 54%)2. Moderate right ventricular enlargement with normal systolic function. (RVEF 57%, RVEDV 116 mL/m2)3. Moderate pulmonary valve insufficiency.4. Mild left pulmonary artery ostial stenosis.5. Possible small left-sided SVC.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Reason: cord compression History: weakness of extremities.Additional history collected from electronic medical record: Mr. Warshall is a 66 y/o male with a PMH of COPD, HTN, and metastatic melanoma (BRAF mutant; mets to brain, lymph nodes, mediastinum, and lungs). There are multilevel degenerative changes affecting the cervical spine, with mild to moderate spinal canal stenosis spanning from C4 to C6 with mild cord deformity. There is mild anterolisthesis of C4 on C5. There is moderate retrolisthesis of C6 on C7. There is a compression fracture of the L1 vertebral body, affecting the superior endplate. Otherwise, vertebral bodies are appropriate in the overall alignment and height. Bone marrow signal intensity is diffusely heterogeneous, which is nonspecific and not well evaluated on this examination. Bone marrow signal abnormality is relatively more prominent within the C5 and L2 vertebral bodies. No obvious cord signal abnormality or evidence of acute cord compression. Previously described left upper lobe and lingular opacities are incompletely evaluated on this examination.

Output: This is a limited exam specific for the exclusion of cord compression only and does not exclude more subtle lesions such as intrinsic cord abnormalities. No acute cord compression is identified.Up to moderate spinal canal stenosis in the cervical spine is suspected spanning the C4-C6 levels, with mild cord deformity, which can be better assessed with dedicated cervical spine MRI.Marrow signal abnormality is most conspicuous at the C5 and L2 levels. Consider dedicated spine imaging with contrast to better assess for osseous metastatic disease. Due to the screening nature of this protocol details are not as evident on imaging as dedicated protocols of the spine.


Instruction: Generate impression based on findings.

Input: New left hand weakness. Rule out stroke. MRI: There is a small area of cortical and subcortical diffusion restriction and T2 hyperintensity involving the postcentral gyrus, with minimal gyriform susceptibility effect. An additional punctate focus of susceptibility effect is present in the left thalamus without associated edema, which may represent focus of prior microhemorrhage. There are multiple foci of T2 hyperintensity involving the cerebral white-matter and punctate foci of encephalomalacia in the deep gray nuclei in addition to periventricular white-matter confluent T2 hyperintensity. There is mild diffuse cerebral volume loss. There is no midline shift or herniation. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is mild mucosal thickening in the paranasal sinuses.MRA: There is no evidence of significant steno-occlusive lesions. There appears to be mild narrowing of the anterior genu of the left cavernous internal carotid arteries and the mid left V4 segment. There is no evidence of saccular aneurysms.

Output: 1.Small acute right middle cerebral artery infarct, involving the precentral gyrus, with minimal susceptibility effect, which may represent prominent collateral blood flow or microhemorrhage, for example.2.Moderate chronic microvascular ischemia and multiple lacunar infarcts.3.No significant steno-occlusive lesions involving the large cerebral arteries.


Instruction: Generate impression based on findings.

Input: There is motion degradation limiting evaluation. However, there is no evidence of cord compression. However, as this exam was tailored only to evaluate for acute cord compression, subtle abnormalities may be inapparent. For the purposes of this dictation, the last well formed disk space is referred to as L5-S1.There is a 28 x 33 mm expansile heterogeneously T2 hyperintense and T1 hypointense mass in the spinous process and lamina of the L1 vertebral body with 5 mm thick posterior epidural tumor extending superiorly up to the low T12 level. There is ventral displacement of the conus and the cauda equina nerve roots without significant edema within the conus. There is additional T2 hyperintense signal abnormality in the L4 spinous process as well. There are scattered foci of T2 hyperintensity in the sacrum, and T8 vertebral body suggesting osseous metastases. There is no evidence of cord signal abnormality or expansion of the cord. There is no significant spinal canal stenosis elsewhere. There is diffuse heterogeneous low T1 osseous marrow signal consistent with osseous metastatic disease.There are degenerative changes in the cervical spine and lumbar spine with disk osteophyte complexes, ligamenta flava thickening causing mild spinal canal stenosis at C3-4 and C5-6.

Output: 1.No evidence of acute cord compression.2.Please refer to dedicated accompanying lumbar spine MRI for further details regarding osseous metastatic disease to the lumbar spine.3.Findings were electronically communicated with the clinical service by the radiology on call resident at the time of initial interpretation.


Instruction: Generate impression based on findings.

Input: 24 year old female with RUQ pain and elevated lipase. Assess for pancreatitis and liver inflammation. ABDOMEN:LUNG BASES: Mild bibasilar atelectasis. LIVER, BILIARY TRACT: Mild hepatomegaly. No intrahepatic biliary ductal dilatation. No focal lesions within the liver. Gallbladder is markedly distended with multiple gallstones. No gallbladder wall thickening. No stent identified within the common bile duct. The patient underwent ERCP with balloon angioplasty of a CHD biliary duct stenosis and removal of CBD stent on 12/21/2011. SPLEEN: Moderate splenomegaly. Solid, heterogeneous mixed signal intensity mass arising in the spleen, measures 6.6 x 5.4 cm appears stable since the most recent MRI exam.PANCREAS: Pancreatic duct is not dilated. No definite findings of acute pancreatitis. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Hepatosplenomegaly. CBD stent is not seen. No definite evidence of pancreatitis. Stable solitary splenic lesion. Cholelithiasis without evidence of cholecystitis.


Instruction: Generate impression based on findings.

Input: Lumbago. Spinal stenosis, lumbar region, without neurogenic claudication Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is some mild disc desiccation at this level and a minor disc bulge. There is a Schmorl's node at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is some mild disc desiccation at this level and a minor disc bulge. There is a Schmorl's node at this level.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina. There is a Schmorl's node at this level.

Output: No compromise to lumbar spinal canal or neural foramina. There are mild degenerative changes present in the lower lumbar spine.


Instruction: Generate impression based on findings.

Input: 74 years Male (DOB:3/20/1942)Reason: basal ganglia stroke? History: L hand myotoniaPROVIDER/ATTENDING NAME: ANTHONY T REDER ANTHONY T REDER The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical as well as brainstem punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeballs are elongated in the AP dimension with some thinning of the posterior sclera.

Output: 1.Periventricular and subcortical white matter lesions as well as a couple punctate lesions in the brainstem of a mild degree are nonspecific. At this age they are most likely vascular related. 2.Staphylomas of the eyes.3.There is no evidence for acute cerebral ischemia. No intracranial lesions are appreciated which can explain the patient's myotonia.


Instruction: Generate impression based on findings.

Input: 17 year old man with dilated cardiomyopathy, referred for CMR for further evaluation of underlying etiology. Left VentricleThe left ventricle is severely dilated with moderately reduced systolic function. The overall LV ejection fraction is 32%, the LV end diastolic volume index is 136 ml/m2 (normal range: 74+/-15), the LVEDV is 223 ml (normal range 142+/-34), the LV end systolic volume index is 93 ml/m2 (normal range 25+/-9), the LVESV is 153 ml (normal range 47+/-19), the LV mass index is 61 g/m2 (normal range 85+/-15), and the LV mass is 101 g (normal range 164+/-36). LV dysfunction is global with regional variation. There is transmural late gadolinium enhancement involving the entire anterolateral wall, the basal to mid inferior wall, and the mid anterior wall. The pattern is atypical for prior myocardial infarction suggesting the presence of an underlying fibrosing, infiltrative, or inflammatory process. The lateral wall also has increased T2-signal suggesting the presence of myocardial inflammation. The global relative enhancement ratio is normal. Taken together, these findings support the diagnosis of myocarditis. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 52%, the RV end diastolic volume index is 80 ml/m2 (normal range 82+/-16), the RVEDV is 131 ml (normal range 142+/-31), the RV end systolic volume index is 38 ml/m2 (normal range 31+/-9), and the RVESV is 62 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is 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 severely dilated with moderately reduced systolic function. The overall LV ejection fraction is 32%. 2. There is evidence of a large amount of late gadolinium enhancement as described above associated with increased myocardial T2-signal. Taken together, these findings support the diagnosis of acute myocarditis. 3. The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 52%.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 56 years Male (DOB:3/23/1960)Reason: Stroke protocol - DWI and MRA ONLY, no perfusion History: L MCA syndrome. Right hemiparesis, right hemisensory loss, aphasia, NIH SSS = 22PROVIDER/ATTENDING NAME: DAVID A HARTER DAVID A HARTER MRI of the brainThere is diffusion restriction involving the left basal ganglia, anterior half of the left insular cortex, an small portions of subcortical white matter in the left inferior and middle frontal gyri, as well as subcentimeter foci in the left temporal and parietal lobes. This diffusion restriction is not associated with significant FLAIR signal hyperintensity. There is intravascular signal hyperintensity in the left operculum and Sylvian fissure. There is SWI left hemispheric transmedullary vein and cortical signal hyperintensityThe CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild to moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.A couple punctate foci of FLAIR signal hyperintensity are present in the right internal capsule.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, right middle and posterior cerebral arteries. The left MCA is occluded at its origin.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. The posterior communicating arteries are not readily identified. The vertebral arteries are similar in size.

Output: 1.Left MCA occlusion.2.Hyperacute infarction involving left basal ganglia, part of the left insular cortex and small foci in the left frontal lobe and to an even lesser degree left parietal and temporal lobes. The clear majority of the left MCA territory is currently spared.3.Hypoxia involving the left MCA territory.4.Periventricular and subcortical white matter lesions of a mild to moderate degree are nonspecific. At this age they are most likely vascular related. 5.Chronic stage lacunar infarcts in the right internal capsule.


Instruction: Generate impression based on findings.

Input: Female, 44 years old, with low back pain for one month. Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. No evidence of edema or marrow replacement is seen. The visualized distal spinal cord, conus and nerve roots of the cauda equina are unremarkable. No epidural abnormalities are suspected.At L1-2 and L2-3, no significant abnormalities are detected.At L3-4, mild facet arthropathy is seen without significant spinal canal or foraminal stenosis.At L3-4, mild arthropathy is seen without significant spinal canal or foraminal stenosis.At L4-5, advanced facet degeneration is seen along with ligamentum flavum thickening. Disc is bulging with a small superimposed right paracentral/foraminal protrusion. The right lateral recess is effaced and there is a moderate generalized spinal canal stenosis with moderate right and mild left foraminal narrowing.At L5-S1, advanced facet arthropathy is seen, left greater than right. No significant spinal canal stenosis is demonstrated, but the neural foramina are mildly narrowed.

Output: 1.Disc and posterior element degeneration at L4-5 result in a moderate generalized spinal canal stenosis and moderate narrowing of the right neural foramen. 2.Relatively mild degenerative changes are seen at additional levels without significant compromise of the spinal canal or neural foramina.


Instruction: Generate impression based on findings.

Input: BRAIN: There is no acute infarct, mass, or cerebral edema. There are scattered periventricular and subcortical white matter T2 signal abnormalities which are nonspecific but similar to prior exams. The ventricles and basal cisterns are normal in size and configuration. There is no significant volume loss greater than expected for patient age, in particular no significant volume loss of the brainstem or in the cerebellar hemispheres. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable. There is persistent hyperintensity with corresponding T1 hypointensity and no definitive enhancement along the petrous apex.CERVICAL: Images are limited by patient motion. There is straightening of the cervical spine. The osseous marrow signal is within normal limits, although evaluation is limited secondary to incomplete fat saturation along the cervical spine. The vertebral body heights are preserved. The cord signal and caliber are within normal limits. There is no pathologic enhancement in the cervical spine, although evaluation is limited on sagittal images secondary to incomplete fat saturation along the cervical spine.C2-3: No disk herniation or spinal stenosis.C3-4: No disk herniation or spinal stenosis.C4-5: Small disk osteophyte complex with no spinal stenosis.C5-6: Small disk osteophyte complex and uncovertebral hypertrophy with no significant spinal stenosis. C6-7: Disk osteophyte complex and mild bilateral uncovertebral hypertrophy with no significant spinal stenosis. There is at most mild left foraminal narrowing.C7-T1: No disk herniation or spinal stenosis.Images of the the upper thoracic spine shows no significant disk herniation or spinal stenosis on the sagittal images. Findings are unchanged from the outside MRI.

Output: 1.Stable exam with no significant cerebellar or brainstem volume loss.2.Nonspecific white matter signal abnormalities favored to represent mild chronic microvascular ischemic changes with no acute intracranial abnormality.3.Stable exam of the cervical spine with no spinal stenosis or other significant abnormality in the cervical spine.4.Nonenhancing FLAIR hyperintense area within the left petrous apex which may represent a small amount of trapped fluid within asymmetrically pneumatized portion of the bone.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: History of cervicothoracic laminectomy for tumor resection. Evaluate for infection. There are postsurgical changes of laminectomy from C7 to T2 and resection of previously seen intramedullary hemorrhagic lesion. Prior postoperative MRI was of the thoracic spine and in comparison with the limited view of the cervical spine on the sagittal sequence, there is interval development of a fluid collection in the paraspinous soft tissues at the C4-C5 to mid T1 level and a second component from which extends inferiorly to the T3 level which is in continuity. Total fluid collection measures approximately 5.8 x 5.7 x 8.1 cm in the AP, transverse, and craniocaudal dimensions. There are fluid-fluid levels. Fluid collection demonstrates predominantly low T1 signal with some areas of T1 hyperintensity and T2 hyperintensity indicative of at least some component of blood products.Fluid collection mostly involves the subcutaneous soft tissues with a smaller component extending into the paraspinous soft tissues and tracking along the surgical incision site into the extrathecal space from C6 to the upper T2 level. There is anterior displacement of the cervical cord. Examination is slightly motion degraded. There is T2 hyperintensity within the cord associated with the resection cavity. No new cord edema is appreciated. Vertebral body heights and alignment are maintained. No evidence of diskitis osteomyelitis. There is mild thin enhancement surrounding the fluid collection with relatively greater enhancement involving the paraspinous soft tissues.

Output: 1. Comparison with prior postoperative thoracic spine study is slightly limited. There is however interval development of a large fluid collection measuring 5.8 x 5.7 x 8.1 cm with fluid levels primarily involving the subcutaneous soft tissues with extension into the paraspinous soft tissues and a small component within the spinal canal. Signal intensity is indicative of at least some blood products. Fluid collection extends from the C4-C5 to the T3-T4 levels. There is a fluid-fluid level which may be related to hematocrit effect and raises possibility of active bleeding. There is some enhancement surrounding the paraspinous soft tissues which may be postsurgical. Overall signal features are not consistent with simple pseudomeningocele although some of the fluid may be CSF admixed with blood products. Mild enhancement in the surgical bed may be postsurgical; superimposed infection cannot entirely be excluded and aspiration can be considered as clinically warranted.2. Mild mass-effect on the upper thoracic cord which is anteriorly displaced. There is some T2 hyperintensity within the cord which was seen on prior and may be related to the resection cavity. No definitive evidence of new cord edema.Dr. Ali discussed findings with Dr. Lesniak at 945 hrs on 2/25/2015.


Instruction: Generate impression based on findings.

Input: History of ulcerative colitis status post total proctocolectomy and ileal pouch anal anastomosis presenting with loose stools and ulcers in the pouch. History of PSC. ABDOMEN: Susceptibility artifact from the IVC stent severely limits multiple image sequences.LIVER, BILIARY TRACT: Limited evaluation of the liver due to susceptibility artifact.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Note is made of mild right-sided pelvocaliectasis and mild dilatation of the proximal ureter, increased from the prior study. The mid ureter is collapsed and mildly thickened, uncertain in etiology and may be post surgical. T2 hyperintense renal foci, likely cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postsurgical changes from total proctocolectomy with ileal pouch anal anastomosis.There is mildly T2 hyperintense wall thickening and hyperenhancement of the ileal pouch with surrounding fibrofatty proliferation and small lymph nodes compatible with active inflammation. Proximal to the ileal pouch there are several short segment discontinuous thickened and narrowed bowel loops including a 7.5 cm narrowed bowel loop in the mid abdomen (series 5/26) without associated upstream dilatation. Additional short segment skip lesion (series 3/21).No free fluid or loculated fluid collection. No evidence of bowel obstruction.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Severely limited evaluation of the upper abdomen due to susceptibility artifact from the IVC stent.2.Findings suggesting moderate pouchitis and multiple skip lesions involving the distal ileum. No evidence of flow-limiting stricture or drainable fluid collection.3.New mild right-sided pelvocaliectasis with mid right ureter thickening and narrowing of uncertain etiology. This may be post surgical.


Instruction: Generate impression based on findings.

Input: Tinnitus, bilateral [H93.13], Reason for Study: ^Reason: acustic schwannoma History: tinnitus No evidence of acute ischemic or hemorrhagic lesion.No evidence of abnormal enhancement.The brainstem, cerebellum, vermis and tonsils are normal. The inner ear structures, cochlea, vestibule, semicircular labyrinth are normal. The internal auditory canals are normal with delineation of the facial, cochlear and vestibular nerves. No evidence of signal abnormality, mass or abnormal enhancement is noted. The ventricles, cerebral sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. 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.Normal internal auditory canal on this MRI scan.If indicated, temporal bone CT scan can be considered for further imaging evaluation.


Instruction: Generate impression based on findings.

Input: Female, 10 years old, status post motor vehicle collision with subdural hemorrhage. Evaluate for diffuse axonal injury. A 7 mm diffusion restricting and T2 hyperintense focus is evident within the corpus callosum at the junction of the posterior body and splenium (see image 13 series 701, and image 186 series 401).No other convincing areas of parenchymal signal abnormality are detected. Minimal FLAIR hyperintensity is seen in two or three of the right temporal sulci, though this could be artifactual or related to vascular flow.A very thin layer of T1 hyperintense fluid is evident along the right occipital lobe and right tentorium compatible with the known subdural hemorrhage. No additional significant extra-axial collections are seen. The ventricular system is normal in size and morphology.Metallic artifact is present overlying the right frontal bone. Elsewhere, marrow signal characteristics are unremarkable. Opacification of the right maxillary sinus and right ethmoid air cells is evident. Also seen is significant bilateral mastoid air cell opacification.

Output: 1.A focus of diffusion restriction and T2 hyperintensity is evident at the junction of the posterior body and splenium of the corpus callosum. This could represent a site of axonal shear injury, and indeed, this is a fairly typical location for such an injury.2.No definite additional parenchymal lesions are detected. A thin layer of subdural blood is seen along the right occipital lobe and tentorium.3.Significant paranasal sinus and mastoid opacification is redemonstrated.


Instruction: Generate impression based on findings.

Input: Right hip pain. ACETABULAR LABRUM: There is abnormal signal intensity within the anterior labrum from approximately the 1:00 to 4:00 position, indicating a tear. The remainder of the labrum appears normal.ARTICULAR CARTILAGE AND BONE: There is edema within the femoral neck and intertrochanteric region concentrated medially with a small cortically based focus of low signal intensity along the medial aspect of the femoral neck, indicating a stress fracture. No cam deformity is seen. The bone marrow signal intensity is otherwise normal.SOFT TISSUES: There is edema type signal of the distal iliopsoas, likely iatrogenic secondary to the contrast injection. The musculature appears otherwise normal.

Output: 1. Right femoral neck stress fracture.2. Right acetabular anterior labral tear.Findings were relayed to Dr. Birnie's nurse Ashley Fraction by Dr. J. Dickherber on 9/20/2016 at 14:40.


Instruction: Generate impression based on findings.

Input: Male 77 years old with history of stroke p/w AMS Focal area of T2/FLAIR hyperintensity within the left parietal lobe white matter corresponding to low-density on CT, suggestive of remote infarct. Chronic confluent and patchy areas of periventricular, subcortical, and brainstem T2/FLAIR white matter hyperintensities, which is suggestive of chronic small vessel ischemic changes. There is no evidence of intracranial mass. There is no restricted diffusion to suggest acute infarct or increased susceptibility to suggest hemorrhage. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues demonstrate no gross abnormality.

Output: 1. No evidence of acute intracranial hemorrhage, mass, or acute infarct.2. Small remote infarct located within the left parietal lobe as well as chronic small vessel ischemic changes.


Instruction: Generate impression based on findings.

Input: 68 year old female with a personal history of left breast lumpectomy in 2002 and left breast benign biopsy in 1967. She is status post chemotherapy and radiation. She reports a family history of breast cancer in her sister and maternal aunt, and she is BRCA2 positive. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. Post operative volume loss and scarring of the left breast is stable. Left 3:00 intramammary lymph node also unchanged. No abnormal lymph nodes are identified in either axillary region.Trace pleural fluid. High T2 hepatic lesions which may represent cysts are again noted.

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


Instruction: Generate impression based on findings.

Input: 49 years, Female, Reason: Extent of tumor in pelvis History: uterine sarcoma. UTERUS, ADNEXA: There is a large lesion centered in the region of the cervix compatible with patient's known sarcoma measuring 7.4 x 8.0 x 15.7 cm (701/25, 601/31). There is a vaginal invasion extending to the nearly the introitus. There is full thickness stromal invasion and bilateral parametrial invasion. There is invasion of the bladder anteriorly. There is also extension of the tumor along the broad ligaments bilaterally and into the ovaries which are enlarged and invaded with tumor measuring 7.2 x 6.1 cm on the right (41/57) and 7.2 x 6.0 cm on the left (41/58). The left ovary contains a cyst with old hemorrhage. There is abutment of the rectum posteriorly without definite invasion. The left posterior lateral pelvic side wall is invaded, with tumor extending immediately inferior to the left piriformis. A small amount of fluid is present within the fundus of the uterus. Bulky bilateral pelvic lymphadenopathy is present. The left external and internal iliac arteries are encased with lymph nodes. The right external and internal iliac veins are splayed by adjacent lymph nodes with invasion of the right iliacus muscle.BLADDER: Foley catheter with posterior bladder wall invasion. Bilateral ureteral stents are present.LYMPH NODES: Enlarged right external iliac node measuring 3.2 x 2.7 cm (601/27). Enlarged left internal iliac node measuring 3.6 x 1.9 cm (701/31). Retroperitoneal lymphadenopathy is partially visualized.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small amount of ascites.

Output: 1.Large cervical tumor with extensive invasion of adjacent structures including the pelvic sidewall, ovaries, lower vagina and bladder.2.Pelvic and retroperitoneal lymphadenopathy.3.Small amount of ascites.


Instruction: Generate impression based on findings.

Input: Clinical question: Patient with multiple cerebral infarcts and cerebellar hypoattenuation. Signs and symptoms: AMS. Nonenhanced brain MRI:Acute bilateral cerebellar strokes are again demonstrated with increased internal hemorrhage since prior exam. The size of strokes on FLAIR and T2-weighted images demonstrate no significant change. The fourth ventricle demonstrates subtle decreased size secondary to mass effect and in midline similar to prior exam. Numerous tiny scattered foci of restricted diffusion in the periventricular, subcortical, bilateral basal ganglia (L>R) demonstrate no significant change since prior exam. These findings are not associated with any susceptibility signal changes to suggest hemorrhage. Mildly prominent supratentorial ventricular system remain stable since prior exam and with maintained midline.The signal void of major intracranial arterial branches are identified. The signal intensity of intracranial venous sinuses are within normal.Unremarkable calvarium and orbits.

Output: 1.Large bilateral cerebellar acute strokes demonstrate no change in size or subtle mass effect however there is interval increased internal petechial hemorrhage since prior exam.2.Stable scattered multifocal periventricular, subcortical and bilateral basal ganglia acute ischemic stroke demonstrate no significant change and no evidence of hemorrhagic conversion.3.Stable mildly dilated supratentorial ventricular system and with maintained midline.


Instruction: Generate impression based on findings.

Input: Metastatic renal carcinoma. Evaluate level for tumor thrombus. ABDOMEN:LIVER, BILIARY TRACT: No focal liver lesion is identified. There is mass effect on the liver by right renal mass.SPLEEN: Metastatic disease involving left posterior thoracic ribs extends to level of left hemidiaphragm/possibly touches posterior aspect of the splenic capsule.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: The right adrenal gland is probably engulfed by the right renal mass. The left adrenal gland is unremarkable.KIDNEYS, URETERS: The right kidney measures 12.6 x 9.4 cm and is replaced by tumor. Tumor obliterates the right renal vein, enlarges the IVC and extends to the level of the inferior cavoatrial junction (series 23, image 34). The left kidney is unremarkable.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is a T2 hyperintense 1.1 cm peritoneal nodule in the left anterior abdomen, consistent with peritoneal implant (series 13, image 8).BONES, SOFT TISSUES: Large osseous metastases involving lower left thoracic ribs measuring 12.1 x 5.3 cm in largest dimension, with extension into the spinal canal, best seen on series 20, image 95. Please refer to bone scan performed January 21, 2016 for additional information.OTHER: Trace left pleural effusion. There is indentation of the left diaphragm.

Output: 1.Renal cell carcinoma largely replaces the right kidney with IVC invasion extending to the inferior cavoatrial junction.2.Peritoneal and osseous metastases. Extension into the spinal canal, may be better evaluated with dedicated thoracic spine MRI.


Instruction: Generate impression based on findings.

Input: The heterogeneously enhancing, well circumscribed ovoid mass extending from the T4-5 to the T5-6 level measures 4.7 x 3.1 x 3.4 cm, not significantly changed when measured similarly. There is no evidence of extension into the spinal canal. The lumbar spine is in normal alignment, with a normal lumbar lordosis. There are central endplate depressions from T11 to L1 and mild anterior wedging of the L1 vertebral body are stable. The vertebral body and disc heights are otherwise well-maintained. The T10 hemangioma is unchanged, as are two well-defined areas of low T1 and T2 signal in the T7 vertebral body with subtle enhancement. The spinal cord signal is normal throughout. There is no significant disc bulge, herniation, spinal canal, or foraminal stenosis within the thoracic spine. There is a small right renal probable cyst only apparent on the localizer images.

Output: 1. Stable size and appearance of the right thoracic paraspinous mass most compatible with a peripheral nerve sheath tumor.2. Unchanged hemangioma in the T10 vertebra and enhancing lesions in the T7 and T9 vertebral bodies, which may represent atypical hemangiomas.


Instruction: Generate impression based on findings.

Input: Head of pancreas mass. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology, signal intensity, size and enhancement.Several small rim-enhancing lesions are compatible with metastatic disease the largest being a segment 2/3 lesion measuring 1.7 x 1.3 cm (series 1203/43) lesion. Additional lesion in segment 5. Several posterior segment lesions are too small to definitively characterize but demonstrate mild T2-weighted hyperintensity and restricted diffusion. The vessels are patent.Severe extra and moderate intrahepatic biliary ductal dilatation with common duct measuring 1.8 cm. The duct abruptly transitions at the level of the pancreatic head mass.SPLEEN: The spleen is normal in size morphology and signal intensity.PANCREAS: Heterogeneous pancreatic head mass measuring approximately 3.8 x 3.2 cm (series 5/14). There is mild pancreatic parenchymal atrophy distally and main pancreatic ductal dilatation up to 4 mm which is displaced dorsally.The GDA is encased by tumor and is not clearly opacified distally. Otherwise the celiac trunk and its branch vessels are patent. The superior mesenteric artery is spared.The lesion abuts approximately 90 degrees of the superior mesenteric vein, however the portal vein confluence and splenic vein appears spared.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Small peripancreatic and aortocaval lymph nodes, the largest measuring 1.0 x 0.7 cm (series 1201/82).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Head of the pancreas mass with bilobar hepatic metastases and vascular involvement as described above.Severe extrahepatic and moderate intrahepatic biliary ductal dilatation.


Instruction: Generate impression based on findings.

Input: Cord compression, metastasis, right lower extremity weakness There is mild depression involving the superior endplate of the L1 vertebral body without associated bone marrow edema compatible with chronic mild compression fracture. The vertebral bodies are otherwise appropriate in the overall height. There is S-shaped scoliosis with lumbar levoscoliosis with apex at the L1-L2 level. The spinal cord has normal signal characteristics and overall morphology. There is no compromise of the spinal canal. T4 and T7 vertebral body lesions with T1 hyperintensity are compatible with hemangiomas.Degenerative changes are seen in the cervical and lumbar spine. Up to moderate neural foraminal stenosis is suspected at multiple levels in the lumbar spine which can be evaluated with dedicated lumbar spine study. Facet effusion is seen at the right L3-L4 level which may be on a degenerative basis. Tarlov cysts noted at the level of the sacrum.

Output: 1. This is a limited exam specific for the exclusion of cord compression only and does not exclude more subtle lesions such as intrinsic cord abnormalities or leptomeningeal disease. No cord compression or evidence of high-grade stenosis in the cervical, thoracic, lumbar spine is identified.2. Mild chronic compression fracture of the L1 vertebral body.3. Degenerative changes in the lumbar spine with up to moderate neural foraminal stenosis in the lumbar spine, consider dedicated lumbar spine MRI for further evaluation if clinically indicated.


Instruction: Generate impression based on findings.

Input: Muscle weakness (generalized) [M62.81], Reason for Study: ^Reason: left6 weakness etiology History: left arm weakness There is a focal restricted diffusion on the right precentral gyrus.On gradient echo image, there is focal susceptibility lesion anterior portion of the restricted diffusion. However, this is more likely represent a partial volume effect of adjacent cortical vein, the chance of hemorrhagic transformation is low.Underlying brain shows multifocal scattered FLAIR/T2 high signal intensity lesions on bilateral periventricular white matter indicating non specific small vessel ischemic disease.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Acute ischemic infarction, right precentral gyrus most likely without hemorrhagic transformation.2. Non specific small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: 40 years Female (DOB:1/24/1976)Reason: 3 t scanner s/p tumor resection History: surveillancePROVIDER/ATTENDING NAME: PETER C. WARNKE PETER C. WARNKE There is a small hemorrhagic focus present in the left paracentral lobule which currently measures 4 x 5 mm axial dimensions and previously measured 8 x 7 mm axial dimensions. There is less surrounding T2 signal hyperintensity present. Patient is status post left parietal craniotomy just behind the coronal suture. The needle tract courses from the craniotomy site to the left paracentral lobule lesion.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: A left paracentral lobule hemorrhagic lesion is smaller on the current exam compared to the prior exam. The patient status post recent biopsy of this lesion. It is known to represent a low grade glioneuronal lesion based on biopsy.


Instruction: Generate impression based on findings.

Input: 65-year-old female with nonweightbearing for 5 weeks. Evaluate for fracture. ACETABULAR LABRUM: The labrum appears intact within the limits of a non arthrographic examination.ARTICULAR CARTILAGE AND BONE: Marrow signal appears within normal limits without evidence of fracture.SOFT TISSUES: The musculature of the left hip and pelvis appears within normal limits.ADDITIONAL

Output: No evidence of fracture or other finding to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: Chiari malformation. Follow-up of cervical spine T2 hyperintensity (syrinx). Brain:Changes of Chiari I malformation have not changed since the previous examination. The cerebellar tonsils are pointed and descend up to 23 mm below the level of foramen magnum (upper C2 level). This is associated with severe crowding of the CSF space/cisterns at the level of foramen magnum. This is associated with severely diminished pulsatile CSF flow across the foramen magnum, which is worse posteriorly. There is no contrast enhancing brain lesion.The remainder of the brain shows normal signal and morphology. The mastoid air cells are clear. There is minimal maxillary and sphenoid mucosal thickening. The orbits are unremarkable.Cervical Spine:The poorly defined, T2-hyperintense, T1-hypointense signal involving the posterior central cervical spinal cord at lower C2 level has not changed since the previous examination. This is not associated with discrete cavitation. This probably represents a presyrinx rather than a developed syrinx.The cervical spine is also notable for retroflexed dens which contributes to the compression at the level of foramen magnum. The remainder of the cervical examination is normal. Alignment is anatomic accounting for straightening which may reflect patient position. Vertebral bodies are preserved in height. Intervertebral discs are preserved in height and T2 signal. The spinal canal is not narrowed nor the neural foramina.

Output: 1.No significant change in findings of Chiari I malformation including descent of peglike cerebellar tonsils to the level of C2. Retroflexed dens also contributes to the stenosis at the level of foramen magnum.2.Ill-defined defined mild T1-hypointense and T2 hyperintense signal without discrete cavitation in the cervical spinal cord at C2 level is compatible with presyrinx and has not changed since May 2015.


Instruction: Generate impression based on findings.

Input: Female 61 years old with right flank pain, ulcerative colitis and a dilated pancreatic duct on outside hospital ultrasound. ABDOMEN:LIVER, BILIARY TRACT: No focal liver lesion, biliary ductal dilation, or ascites. The vasculature is patent.SPLEEN: No significant abnormality noted.PANCREAS: No focal pancreatic lesion is identified. Note is made of pancreas divisum. The pancreatic duct is mildly prominent. There was a normal response to secretin.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: There is a 4.7 x 3.6 cm T2 hyperintense, circumscribed, nonenhancing left renal lesion with a single thin septation consistent with a cyst. Smaller left renal and 2 smaller right renal lesions are also consistent with simple cysts. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: Note is made of a prominent cisterna chyli.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Pancreas divisum with mild prominence of the pancreatic duct.


Instruction: Generate impression based on findings.

Input: 53 year old female. History of PVD and DM2, right calcaneal osteomyelitis. ? progression of disease. Right ankle: Again seen is a small ulcer in the soft tissues of the heel with underlying soft tissue signal abnormality that is T1 intermediate and heterogeneously T2 hyperintense consistent with fluid and scar tissue. Mild decrease in the amount of fluid signal extending along the medial and lateral aspects of the calcaneus. Focal erosion of the inferior posterior calcaneal body with slight interval decrease in confluent edema, consistent with osteomyelitis.Interval resolution of previously seen signal abnormality in the fibular tip as well as adjacent small collection. Chronic infarction of the distal tibia, unchanged. Right foot: There is a deep plantar ulcer in the forefoot going down to the 2nd metatarsal head. The 2nd MTP joint is dislocated with the 2nd metatarsal head directed inferiorly into the plantar soft tissues. There is confluent signal abnormality (T1 hypointense and T2 hyperintense) in the 2nd metatarsal epiphysis and proximal diaphysis consistent with osteomyelitis. Postsurgical findings of distal fifth metatarsal amputation. Diffuse subcutaneous edema.

Output: 1. Right calcaneus osteomyelitis is slightly decreased in extent. Previously seen osteomyelitis of the fibular tip has resolved.2. Deep plantar soft tissue ulcer going down to the 2nd metatarsal head, which has signal abnormality consistent with osteomyelitis. Dislocation of the 2nd MTP joint.


Instruction: Generate impression based on findings.

Input: History of pancreatitis and annular pancreas, please evaluate for abnormalities or obstruction. ABDOMEN:LIVER, BILIARY TRACT: The liver demonstrates normal parenchymal signal intensity without focal lesions. The gallbladder is mildly prominent in size without cholelithiasis or evidence of cholecystitis.There is mild intrahepatic biliary ductal dilatation within the central intrahepatic bile ducts measuring up to 5 mm. The common hepatic and proximal common bile duct are mildly dilated measuring up to 6 mm up until the pancreatic head where the common bile duct smoothly narrows to diameter of approximately 2 mm for length of approximately 2.7 cm until the ampulla. There is mild circumferential enhancement surrounding the narrowed portion of common bile duct on delayed images which may be related to chronic inflammatory change.SPLEEN: No significant abnormality noted.PANCREAS: Pancreatic parenchyma appears to partially encase the second portion of the duodenum suggestive of at least partial annular pancreas. The pancreatic parenchyma demonstrates normal signal intensity. The pancreatic duct measures up to 3 mm in diameter. The pancreatic duct is not well-visualized in the pancreatic head but appears to join the common bile duct approximately 3 cm from the ampulla. There is mild circumferential enhancement surrounding the visualized portions of the proximal pancreatic duct on delayed images which may be related to chronic inflammatory change from repeated bouts of pancreatitis. 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.Findings suggestive of at least partial annular pancreas.2.Suspected approximately 3 cm common channel of pancreatic duct and common bile duct which may be partially related to the annular pancreas morphology.3.Approximately 2.7 cm segment narrowing of the distal common bile duct with upstream mild biliary ductal dilatation which may also be related to annular pancreas. 4.Mild circumferential delayed enhancement surrounding the narrowed distal common bile duct as well as pancreatic duct in the pancreatic head and proximal body suggestive of chronic inflammatory change, likely from known bouts of pancreatitis.5.Pancreatic duct is compliant following administration of secretin.


Instruction: Generate impression based on findings.

Input: Diagnosis: Unspecified convulsionsDiagnosis Edits: Clinical question: Seizure 2 protocol, please perform in 3 TeslaSigns and Symptoms: seizure workup; episodes of GTCs and absence seizures. EEG revealing for L temporal focality The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mucosal thickening along the right maxillary sinus and ethmoid air cells. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.Incidental note is made of partial empty sella.

Output: 1.There are not intracranial lesions present to explain the patient's seizures.2.Partial empty sella is an incidental findings and is probably of little clinical significance.


Instruction: Generate impression based on findings.

Input: Generalized abdominal pain. Needing additional workup per Dr. Renz. ABDOMEN:LUNG BASES: Dependent opacities in the lung bases, likely atelectasis. LIVER, BILIARY TRACT: 3.1 x 3.6 cm complex cystic lesion in the right hepatic lobe with thin septations. No associated enhancing solid nodularity.Mild fatty infiltration of the liver. No biliary ductal dilatation. No choledocholithiasis or cholelithiasis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right lower pole heterogeneously enhancing mass measures 5.3 x 4.7 (series 1302, image 182), highly suspicious for a renal cell carcinoma.No renal vein or IVC invasion is evident.RETROPERITONEUM, LYMPH NODES: Scattered small retroperitoneal lymph nodes. No lymphadenopathy. BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Right lower pole enhancing mass highly suspicious for a renal cell carcinoma. No evidence of local metastatic disease.2.Mildly complex septated right hepatic lobe lesion, likely a complex cyst, with biliary cystadenoma much less likely given male gender. Special attention on follow-up scans.