Instruction: Generate impression based on findings.

Input: 59 year old with strong family history of breast cancer including a sister at age of 21 and another sister at age 54. History of benign biopsy of the left medial breast on 1/7/05 and right anterior 12 o'clock lesion on 7/30/10. There is heterogeneous amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally. A few high T2 signal cysts are present. No suspicious enhancement is seen in either breast. Bilateral enhancing foci are again noted. None of the enhancing lesions is significantly changed compared to prior studies. Left post surgical distortion and right breast biopsy clip from prior benign biopsies are noted. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: 47-year-old female history of ESRD on HD, now status post kidney transplant 2005 presenting with left-sided abdominal pain and hematuria. Noncontrast renal stone protocol requested. ABDOMEN: Exam is not sensitive for detecting lesions in the solid organs of the upper to lack of oral or IV contrast dedicated nature the protocol.LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: The native right kidney is atrophic. The native left kidney has high density material in the collecting system consistent with blood. There is a 4.5-cm diameter lesion off the posterior aspect of the left kidney with the average density of 12 Hounsfield units likely representing a cyst. On the posterior aspect of the cyst is a small exophytic 1.1-cm lesion seen on axial series 4 image 52 and coronal image 47 where in average density of 28 Hounsfield units. There is also rim-like thick calcification along the posterior wall of the dominant lesion bordering on the smaller lesion. No other definite lesions are seen in the kidney. Given hematuria and a small exophytic lesion consider contrast enhanced CT or MRI to rule out renal malignancy.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postsurgical changes consistent with gastric surgery. Dilated to the nature of the surgery.BONES, SOFT TISSUES: Focal large area of calcification or ossification in the subcutaneous fat of the right back series 4 image 55 possibly post traumatic.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXAE: Left adnexal mass with fat fluid level and multifocal calcifications on the soft tissue plug and in the rim in the pattern consistent with ovarian teratoma dermoid.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Postsurgical changes clips anterior abdominal pelvic wallSurgical pins both hips.

Output: Left adnexal mass consistent with dermoid / teratoma. Blood in collecting system of native left kidney with large lower pole cyst and small exophytic mass. This could be evaluated better with IV contrast enhanced scan. Postsurgical changes stomach and hips.


Instruction: Generate impression based on findings.

Input: Reason: Identification of left posterior leg mass History: Pain, nodule in left posterior thigh Some sequences are slightly limited by patient motion artifact. There are 2 markers along the posterior aspect of the mid thigh presumably denoting the patient's palpable nodule. There is possibly a small fatty lobule within the subcutaneous fat between the 2 markers, perhaps representing a lipoma, but we see no definite mass lesion. We see no signal abnormality in the muscles or the imaged osseous structures. No abnormal enhancing structure is identified. There is a left inguinal lymph node, not necessarily of any clinical significance.

Output: Possible subcutaneous lipoma of the posterior mid thigh. No suspicious mass or nodule.


Instruction: Generate impression based on findings.

Input: Brain mass mortise arthritic. 59-year-old female. The brainstem appears enlarged. Comparing to the recent MRI there is redemonstration of a been expansile mass within the brainstem involving the pons and the right cerebellar peduncle as well as the medulla.The CSF spaces are appropriate for the patient's stated age with no midline shift. The fourth ventricle is mildly distortedNo intracranial hemorrhage is identified. The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.There is no evidence for acute intracranial hemorrhage.2.The brainstem appears enlarged. There is a been expansile mass within the brainstem involving the pons and the right cerebellar peduncle as well as the medulla better imaged on the recent MRI from 2/5 /10. There is no obvious change.


Instruction: Generate impression based on findings.

Input: Transient right face and hand numbness. There is a punctate focus of high T2 signal in the left pons with what may represent restricted diffusion versus artifact. There is otherwise pontine scattered cerebral white matter T2 hyperintensity bilaterally without restricted diffusion. There also appears to be a punctate focus of encephalomalacia in the left thalamus. There are bilateral choroid plexus xanthogranulomas. There is mild diffuse cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull and scalp soft tissues are grossly unremarkable. There are unchanged postoperative findings in the right orbit. There is mild scattered paranasal sinus mucosal thickening.

Output: 1. A punctate focus of high T2 signal in the left pons with what may represent restricted diffusion from an acute infarction versus chronic small vessel ischemic disease with artifact. Otherwise, pontine scattered cerebral white matter T2 hyperintensity bilaterally without restricted diffusion likely represent chronic small vessel ischemic disease, as well as a chronic lacunar infarct in the left thalamus. 2. Unchanged postoperative findings in the right orbit.


Instruction: Generate impression based on findings.

Input: Male, 68 years old, preoperative planning examination for colloid cyst removal. An 8 mm, nonenhancing, slightly T2 hypointense nodule is evident within the superior third ventricle centered at the foramina of Monro. No evidence of ventricular dilatation is seen, although the ventricles and sulci are proportionately prominent compatible with underlying volume loss. No enhancing lesions are seen. No evidence of parenchymal edema or mass effect is seen. Patchy mucosal thickening is evident in the paranasal sinuses.

Output: Limited examination for surgical navigation redemonstrates a nodule in the third ventricle at the level of the foramina of Monro compatible with a colloid cyst.


Instruction: Generate impression based on findings.

Input: Locking, catching pain. Question of meniscus tear. MENISCI: There is increased signal in the inner one third of the posterior horn of the medial meniscus extending from the tibial to femoral surfaces which likely represents a tear, unchanged. The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is thinning of the patellar cartilage. The medial and lateral compartments are intact. Again seen is deformity of the lateral aspect of the patella with an adjacent fracture fragment which is likely post-traumatic. There is subchondral cyst formation within the lateral patella and the adjacent fracture fragment. LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: There is redemonstration of diffuse thickening and heterogeneous signal in the quadriceps tendon which likely represents a combination of tendinosis and posttraumatic/postoperative scarring. Again seen are foci of metallic susceptibility artifact within the distal fibers of the quadriceps tendon. There are three linear foci of intermediate signal intensity extending vertically through the medial, central, and lateral aspects of the patella which presumably represent suture tunnels for tendon reattachment. The medial fibers of the tendon can be followed into the medial tunnel, however, no tendon is seen entering the central or lateral tunnels, similar to the prior study. ADDITIONAL

Output: 1. Tearing of the inner 1/3 of the posterior horn of the medial meniscus. 2. Post-traumatic/post-surgical changes of the quadriceps tendon and post-traumatic changes of the lateral patella. 3. Thinning of the patellar cartilage.


Instruction: Generate impression based on findings.

Input: 83-year-old woman with headache. Question intracranial hemorrhage. There is no evidence of intracranial hemorrhage, mass or edema. Right frontal encephalomalacia remains. Extensive periventricular and subcortical white matter hypoattenuation is present. This most likely represents age-indeterminate small vessel ischemic disease. Large vessel calcifications are noted. If acute stroke is suspected, MRI is recommended. The ventricles and basal cisterns are unchanged in size and configuration from the CT scan dated 10/20/2009.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized. Calcifications of the lateral limbus of the right eye are unchanged.

Output: 1. No CT findings of acute intracranial process. If there is clinical concern for acute stroke, MRI is recommended.2. Findings of small vessel ischemic disease, prior right frontal infarct, and large vessel calcifications.


Instruction: Generate impression based on findings.

Input: Multiple sclerosis. Follow up progression MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of subcortical and to a lesser degree periventricular punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. They are unchanged since the previous exam from February 2014.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 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. There is a T2 hyperintense lesion present along the anterior aspect of the left to side of the cervical spinal cord associated with some focal volume loss. This is unchanged since the previous exam from February 2014.No abnormal enhancing lesions are identified in the cervical spine. The patient status post anterior fusion at C6-7 with anterior plate and screws as well as bone plug.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.Myelomalacia involving the left hemicord at C7. This is unchanged since the previous exam from February 2014.2.Periventricular and subcortical white matter signal changes of a mild degree are present which are nonspecific. They could be vascular related, related to demyelination, trauma, vasculitis, sarcoid. They are nonspecific. They are unchanged since the previous exam from February 2014.


Instruction: Generate impression based on findings.

Input: Female, 37 years old. Reason: SLE pt with palpable bilateral goiter. History: no symptoms - feeling hot a lot of the time. RIGHT LOBE MEASUREMENTS: 3.4 x 1.8 x 6.5 cmLEFT LOBE MEASUREMENTS: 2.4 x 2 .0 by 4.8 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: Heterogeneous echotexture. Multiple predominantly cystic. A dominant cystic lesion in the right thyroid lobe measures 3.7 x 1.9 x 4.7 cm, with small mural nodular solid component, with mildly increased vascularity of the solid component. An additional right thyroid lobe complex cystic nodule measures 1.0 x 0.7 x 1 .0 cm, with peripheral vascularity. An additional mixed cystic and solid nodule in the right thyroid lobe measures 2.3 x 2.2 x 1.2 cm, with increased vascularity of the solid component.LEFT LOBE: Heterogeneous echotexture, with multiple subcentimeter predominantly cystic. A larger nodule with cystic and solid components measures 2.2 x 2.1 x 1.7 cm, with increased vascularity of the solid component, and may be part of a larger nodule with a hypoechoic rim.ISTHMUS: Mildly heterogeneous echotexture.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Multiple bilateral predominantly cystic lesions as detailed above, which most likely represent colloid nodules. A mixed cystic and solid nodule in the left thyroid lobe may be part of a larger nodule with a hypoechoic rim.


Instruction: Generate impression based on findings.

Input: 34-year-old male patient with left knee pain. MENISCI: The lateral meniscus is intact.There is faint increased signal intensity within the peripheral one third of the posterior horn of the medial meniscus that appears to extend to the tibial articular surface on a single sagittal image. While it is conceivable this could represent a small tear of the vascularized peripheral meniscus, it may be healed and we see no findings to confirm an unstable tear of the meniscus.ARTICULAR CARTILAGE AND BONE: Bone marrow signal intensity is within normal limits. There is perhaps a small focal cartilage defect beneath the posterior horn of the lateral meniscus, but the articular cartilage otherwise appears normal.LIGAMENTS: The anterior and posterior cruciate ligaments are intact. There is thickening of the superficial band of the medial collateral ligament with surrounding edema indicating a sprain with partial-thickness tearing of the proximal fibers of the ligament. The lateral collateral ligament complex is intact.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: Sprain of the medial collateral ligament with partial thickness tearing of the proximal fibers and other findings as described above.


Instruction: Generate impression based on findings.

Input: 77 year old female with right-sided weakness; evaluate for CVA There is no evidence of acute intracranial hemorrhage, significant mass effect/midline shift or edema. Areas of encephalomalacia are again seen in the right parietal lobe and left temporal pole appearing similar to the prior study. Basal ganglia hypodensities, likely representing lacunar infarcts, with associated ex vacuo dilatation of the lateral ventricles. Extensive confluent hypodensities are seen in the periventricular and subcortical white matter which are nonspecific, but likely represent small vessel ischemic disease of indeterminate age showing mild interval progression from the previous exam. An area of hypoattenuation appears to involve the left frontal white and possibly gray matter which is new from the previous exam and may represent a focus of previous infarction. If high clinical suspicion for acute nonhemorrhagic stroke, MRI may be performed for further evaluation.Prominence of the ventricles, sulci and basal cisterns likely representing age-related volume loss. Extensive atherosclerotic calcifications are seen in the distal internal carotid arteries and vertebro-basilar system.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. No acute intracranial hemorrhage. CT is insensitive for the early diagnosis of acute nonhemorrhagic CVA. 2. New left frontal focus of hypoattenuation appears to involve the gray and white matter and may represent a previous infarct. MRI may be performed if high clinical suspicion for acute nonhemorrhagic CVA.


Instruction: Generate impression based on findings.

Input: Late onset headaches consistent with migraine. Nevertheless, a mass or vascular lesion should be excluded. MRI: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. The right maxillary sinus appears atelectatic and contains inflammatory changes. MRA: There is no evidence of significant steno-occlusive lesions or aneurysms.

Output: 1. No evidence of acute intracranial hemorrhage or mass.2. No evidence of significant steno-occlusive lesions or aneurysms.3. The right maxillary sinus appears atelectatic and contains inflammatory changes.


Instruction: Generate impression based on findings.

Input: 61-year-old female with lower extremity wounds, assess for osteomyelitis. There is diffuse edema of the subcutaneous soft tissues without evidence of discrete fluid collection or sinus tract. Marrow signal of the forefoot and midfoot appears within normal limits, without evidence of osteomyelitis. There is no pathologic enhancement on postcontrast images.

Output: Diffuse soft tissue swelling without evidence of osteomyelitis.


Instruction: Generate impression based on findings.

Input: 59-year-old female with diffuse large B cell of the sinus status post 4 cycles of chemotherapy. There is redemonstration of soft tissue density within the maxillary sinus immediately posterior to the anterior wall of the left maxillary sinus. This soft tissue prominence again extends posteriorly and posterior laterally to the left maxillary sinus and along the enlarged infraorbital nerve groove. The osseous involvement of the anterior aspect of the maxillary sinus, including a mixed sclerotic and lucent area, appears unchanged. There is increased mucosal thickening and opacification of both maxillary sinuses. This appearance may be due to chronic sinus disease, although lymphomatous involvement cannot be excluded. MRI may be more helpful in delineating tumor from inflammatory disease. Opacification of the left frontal and bilateral ethmoid sinuses, as well as mucosal thickening of the right sphenoid sinus is also noted. The retro-orbital fat remains within normal limits. Extraocular musculature and globe remain within normal limits. No definitive abnormality of cavernous sinus or Meckel's cave on this exam is detected. Limited view of nasopharynx demonstrates no abnormality.

Output: Persistent abnormal soft tissue within the left maxillary sinus with associated osseous changes as detailed. Increased pan-sinus opacification. MRI may be more helpful in delineating tumor involvement from inflammatory disease.


Instruction: Generate impression based on findings.

Input: 65-year-old female with pain, evaluate for meniscal tear MENISCI: There is globular signal abnormality within the body and posterior horn of the medial meniscus extending to the tibial articular surface, suggesting degeneration with possible undersurface tearing. A subcentimeter focus of signal abnormality adjacent to the superior margin of the posterior horn of the medial meniscus, extending towards the meniscal root may represent a small bucket handle tear. The anterior and posterior horns of the lateral meniscus are intact. ARTICULAR CARTILAGE AND BONE: There is mild thinning of articular cartilage of the medial and lateral tibiofemoral compartments without full thickness defect. There heterogeneity of the cartilage along the undersurface of the patella. There a 1 cm focal cartilaginous defect along the trochlea with underlying reactive marrow signal abnormality.LIGAMENTS: The cruciate and collateral ligaments are intact.EXTENSOR MECHANISM: The quadriceps and patella tendons are intact.ADDITIONAL

Output: 1. Mucoid degeneration of the body and posterior horn of the medial meniscus with possible small bucket-handle tear with flipped fragment extending towards the meniscal root.2. Osteoarthritic changes as detailed above.


Instruction: Generate impression based on findings.

Input: History of recurrent acute pancreatitis with pancreas divisum. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology, size, signal intensity and enhancement. No focal suspicious lesion. The vessels are patent. No biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: The pancreas appears edematous with peripancreatic inflammatory fluid consistent with acute pancreatitis. There is mild heterogeneity of enhancement of the uncinate process, developing necrosis is a consideration. The remainder of the pancreas enhances homogeneously.There is mild caliber attenuation of the splenic vein just proximal to the portal vein confluence but it is patent. The portal vein and SMV are unremarkable. No arterial complication. No discrete fluid collection.Pancreas divisum. The pancreatic duct is not dilated and poorly visualized. The excretory function of the pancreas was not adequately assessed on the secretin portion. 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 of acute pancreatitis. Mild heterogeneity of enhancement of the uncinate process, developing necrosis is a consideration. Otherwise, the remainder the pancreas enhances homogeneously. Mild caliber attenuation of the splenic vein which is otherwise patent. No other vascular complication or discrete fluid collection.2. Evidence of pancreas divisum.


Instruction: Generate impression based on findings.

Input: Brain: Several, at least 5, small foci of white matter T2 hyperintensities are noted scattered throughout the brain parenchyma some of which are in the periventricular region and some in the subcortical white matter. There is no associated mass effect. No evidence of restricted diffusion. None of these punctate lesions demonstrate enhancement.The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. C-Spine: Alignment is normal. The marrow signal is benign. The cervical and upper thoracic cord is normal in signal without abnormal enhancement. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable.

Output: 1.At least 5 very small foci of white matter signal abnormality are seen in the cerebral hemispheres. The morphology of these lesions is nonspecific but this is an atypical finding for a patient of this age and could represent demyelinating disease among other etiologies.2.Normal MRI of the cervical spine.


Instruction: Generate impression based on findings.

Input: 60-year-old female presents for breast cancer screening, In MRI study IRB 13073B. Personal history of breast cancer, BRCA 1 mutation. There is scattered fibroglandular tissuein both breasts.Moderate parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. Stable postsurgical distortion is present in the left lower outer quadrant. Scattered foci in the right breast are stable, similar to the prior studies. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Assess for spinal stenosis. Pain and hyperreflexia. Nonenhanced lumbar MRI:T12 -- L1 demonstrate mild degenerative changes without spinal stenosis or neural foraminal compromise. Large left-sided adrenal cyst is noted.L1 -- L2 demonstrate mild degenerative changes without central spinal stenosis or neural foraminal compromise.L2 -- L3 demonstrate mild degenerative changes without central spinal stenosis. Mild bilateral neural foraminal compromise is present.L3 -- L4 demonstrate mild disk disease and moderate (left greater than right) facet and ligamentum flavum hypertrophy. Findings results in moderate left and mild right neural foraminal compromise and no central spinal stenosis.L4 -- L5 demonstrate moderate disk disease, mild loss of disk height and extensive (left greater than right) facet and ligamentum flavum hypertrophic changes. There is resultant significant central spinal stenosis with significant bilateral (right greater than left) foraminal compromise.There is a small left-sided synovial cyst projecting laterally from the left facet complex immediately at the level of the left neural foramina which contribute to compromise of the left neural foramina. This finding is best appreciated on axial T2 series 1401 on image 15 and sagittal T2/T2 stir image 5.L5 -- S1 demonstrate mild chronic compression deformity of the superior endplate of L5 (new since prior exam), mild disk disease and moderate left and mild right facet and ligamentum flavum hypertrophy. No spinal stenosis however left neural foramina compromise of moderate degree is noted.Compared to prior exam there is interval progression of degenerative changes and including progression of central spinal stenosis at L4 -- L5 as detailed.

Output: 1.Examination of the L4 -- L5 demonstrate extensive degenerative changes mostly of the posterior elements with resultant significant central spinal stenosis and neural foraminal compromise as detailed. There is interval progression of disease since prior study.2.Degenerative changes at other levels however none with significant central spinal stenosis. Multilevel neural foraminal compromise as detailed per level.


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 interval increase in size of an enhancing dural based lesion deep to the craniotomy, with extension into the superior sagittal sinus that measures 14 x 12 mm, previously 11 x 8 mm. There is also interval increase in size of the enhancing dural-based lesion along the right lateral parietal convexity adjacent to the craniotomy flap margin that now measures 12 x 8 mm, previously 10 x 7 mm. 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. The skull and extracranial soft tissues are unchanged.

Output: 1. Interval increase 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 consisting of radiation necrosis.3. Persistent partial thrombosis of the posterior superior sagittal sinus.


Instruction: Generate impression based on findings.

Input: 25 years Female (DOB:8/19/1990)Reason: Eval for demyelinating disease History: headaches; paresthesiasPROVIDER/ATTENDING NAME: ADIL JAVED ADIL JAVED MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.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. At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.There are no intracranial mass lesions to explain patient's headaches. 2.No abnormal white matter lesions are appreciated to suggest demyelinating disorder involving the brain or cervical spinal cord.


Instruction: Generate impression based on findings.

Input: The ventricles and sulci are within normal limits. The basal cisterns remain patent. There is no midline shift or mass effect. There is mild increased T2 signal in the periventricular and a few foci in the subcortical white matter which are nonspecific. There is no diffusion abnormality. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. The mesial temporal lobes are symmetric.

Output: Unremarkable brain MRI.


Instruction: Generate impression based on findings.

Input: 51 year old woman with history of HCV and segment 7 HCC status post resection 10/2015. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in signal. Postsurgical changes from segment 7 wedge resection noted. No abnormal enhancement surrounding the surgical cavity (10/304) and no additional suspicious hepatic foci.The patient is status post cholecystectomy. There is stable extrahepatic biliary ductal dilatation, expected in the postcholecystectomy setting.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Postsurgical changes without evidence of recurrent or metastatic disease.


Instruction: Generate impression based on findings.

Input: Female, 31 years old, with demyelinating disease and paresthesias. Assess white matter abnormalities. Redemonstrated are several (at least 5) very small foci of T2 hyperintensity scattered throughout the periventricular and subcortical white matter. Accounting for differences in technique, including 3T versus 1.5 T imaging, there has been no significant interval change in the size or number of these lesions. As on the prior examination, none of these lesions demonstrates pathologic enhancement. No evidence of any new intracranial lesion is seen. There are no findings to suggest parenchymal edema or mass effect. No intracranial hemorrhage or any abnormal extra-axial fluid collection is seen. The ventricles are normal in size and morphology.

Output: No significant interval change in the size or number of several scattered very small white matter lesions.


Instruction: Generate impression based on findings.

Input: 42-year-old female with SLE, antiphospholipid syndrome vs DIC, subdural lesion and dural sinus thrombosis on MRI, now with worsening neuro status after anticoagulation. Small right subdural collection is stable in size compared to prior MRI. Again, this could represent chronic subdural hemorrhage or infection. There is no evidence of new intracranial hemorrhage, mass or edema. Continued evolution of right occipital lobe infarct, currently measuring 2.5 x 2.1 cm (series 6, image 16/32). No additional foci of cortical low attenuation is identified.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. Partial opacification of the visualized sinuses are again noted. Nasopharyngeal soft tissue thickening is noted. These findings are likely accounted for on the basis of the patient's intubation status. The mastoid air cells are partially opacified.There is new left facial soft tissue thickening (series 6 image 10/32). Questionable right subretinal thickening (series 6 image 10/32).Microcalcifications within the parotid glands bilaterally associated with punctate hypodensities.

Output: 1. Stable small right subdural collection. Please refer to MRI of the brain from 1-3-12 for further comments.2. Continued evolution of right occipital lobe infarct.3. Questionable right subretinal thickening that be due to partial retinal detachment or small subretinal hematoma. Recommend ophthalmoscopy for further assessment if clinically indicated.4. Parotid gland microcalcifications and hypodensities.Please correlate with clinical history for chronic inflammatory process involving the parotid glands bilaterally such as sialadenitis, Sjogren's syndrome, Sarcoid or other.5. New left facial soft tissue swelling. Correlate with clinical examination.6. Opacification of paranasal sinuses and nasopharynx is suspected to be at least in part related to intubation status.Findings discussed with Dr. Chwalisz at 10:30 AM 1/9/2012.


Instruction: Generate impression based on findings.

Input: 64-year-old female with history of breast cancer and osseous metastasis. There is redemonstration of extensive osseous metastatic disease. There is extension of tumor into the ventral epidural space involving the right neural foramen at T9-10 and to a lesser extent T10-11. The spinal canal is mildly narrowed, but there is no spinal cord compression or signal abnormality. A partially imaged metastatic lesion is not significantly changed. There is no discrete evidence of leptomeningeal disease. The vertebral body heights are maintained. There is small central disc protrusion at T5-6 without significant spinal canal stenosis. Diffuse lung metastasis are redemonstrated.

Output: No significant interval change in the extensive metastatic disease to the axial skeleton and lungs, with mild epidural extension of tumor at T9-10 and T10-11, but no evidence of spinal cord compression.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Left frontal hemorrhage. The images are markedly degraded by patient motion.MRI: There is predominantly T1 and T2 high signal extensive hemorrhage in the anterior left frontal lobe with peripheral susceptibility effect and surrounding vasogenic edema. The hematomas collectively measures up to approximately 6 x 4 cm in axial cross-section. There is effacement of the anterior portions of the lateral ventricles and 8 mm of midline shift to the left. There is no evidence of acute infarct. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.MRA: There is no gross intracranial arterial anomaly, within the limits of motion artifact. MRV: There appears to be hypoplasia of the left transverse sinus. The other major cerebral venous sinuses are grossly intact, within the limits of motion artifact.

Output: Subacute left frontal lobe intraparenchymal hemorrhage with surrounding vasogenic edema. No gross cerebral artery or venous abnormalities are apparent, although the images are markedly degraded by patient motion. Consequently, CTA and CTV may be considered for further evaluation.


Instruction: Generate impression based on findings.

Input: 14-year-old male patient with right knee pain and swelling. Question of right knee injury. MENISCI: The medial and lateral menisci are intact.ARTICULAR CARTILAGE AND BONE: The articular cartilage of all three compartments is intact.There is a region of decreased T1 and high T2 signal within the medial aspect of the medial femoral condyle without a discrete fluid-filled fracture line. This likely represents a bone contusion.LIGAMENTS: The cruciate and collateral ligaments are intact. The popliteus muscle and tendon are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: Medial femoral condyle bone contusion with large joint effusion.


Instruction: Generate impression based on findings.

Input: 72-year-old male with complex left renal lesion seen on outside hospital MRI examination. Needs dedicated renal imaging to evaluate for RCC. ABDOMEN:LUNG BASES: No significant abnormality noted. There is coronary artery calcification.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality noted. There is a splenule at the splenic hilum.PANCREAS: No significant abnormality notedADRENAL GLANDS: There is mild eccentric thickening of the left adrenal that measures 1 cm in greatest dimension.KIDNEYS, URETERS: The right kidney is normal. No hydronephrosis. There are two left renal cysts, including a mid pole region cortical cyst and a more inferior exophytic cyst. The cortical cyst measures approximately 1.5 x 1.8 cm and demonstrates no significant contrast enhancement on immediate and delayed sequences. The exophytic cyst measures 2.7 x 3.3 cm with attenuation value of 2 Hounsfield units prior to contrast, and 4 - 6 Hounsfield units after contrast and approximately 2 Hounsfield units on delay. The renal cortical cyst is uniloculated and compatible with a benign simple cyst. The wall of the larger exophytic cyst appears eccentrically thickened at axial image 56/172 of the axial postcontrast series 9. This Bosniak II category cyst should be followed in 4 to 6 months. Alternatively, comparison can be made with the patient's outside MRI examination, if available.RETROPERITONEUM, LYMPH NODES: There is an enlarged aortocaval periportal lymph node at axial image 43/172 which measures 2 x 2.7 cm. Several additional enlarged lymph nodes are seen in the celiac region.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: There is diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: There are degenerative changes in the lumbosacral spine and pelvis.OTHER: No significant abnormality noted

Output: Two left renal cysts, but no significant enhancement with contrast administration. The larger exophytic left mid pole cyst has a eccentrically thickened wall and should be followed. Comparison with outside MRI examination may be helpful, if available. No solid renal mass was found. Enlarged periportal & celiac lymph nodes. See above.


Instruction: Generate impression based on findings.

Input: Reason: r/o fracture History: pain tenderness s/p trauma Rib series:A marker was placed along the lateral aspect of the left rib cage. There is a mildly displaced fracture through the anterior aspect of the left sixth rib.Left hip:There is patchy lucency and sclerosis in the femoral head indicating avascular necrosis. There is also narrowing of the hip joint indicating moderate to severe osteoarthritis. We see no acute fracture. If there is strong clinical concern for fracture, MRI may be considered.

Output: 1. Minimally displaced fracture of the anterior aspect of the left sixth rib.2. Avascular necrosis of the left femoral head with osteoarthritis of the left hip, but no acute fracture is evident. If further imaging is clinically warranted, MRI could be considered.These findings were relayed to Dr. Pursell by phone at 1:45 PM on 4/5/2016.


Instruction: Generate impression based on findings.

Input: Patient with poorly controlled hypertension presenting with occipital headache x 1 week. There is no evidence of intracranial hemorrhage, mass, edema or midline shift. Patchy areas of subcortical and periventricular white matter hypodensity likely represent small vessel ischemic disease, age indeterminate by CT. If there is concern for an acute stroke, an MRI may be considered for further evaluation.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Small vessel ischemic disease, age indeterminate. If there is concern for an acute stroke, an MRI may be considered for further evaluation.


Instruction: Generate impression based on findings.

Input: Reason: osteo? History: foot pain, h/o osteo, dm, stepped on glass Right foot: Increased erosion and deformity of the head of the first metatarsal and the base of the proximal phalanx of the great toe compatible with progression of osteomyelitis. There is adjacent soft tissue swelling and hallux valgus deformity. Second toe is amputated. Mild deformity of the second metatarsal head appears similar to prior study, and we see no progression of osteomyelitis at this location.Left foot: Laceration at the ball of the foot, but we see no underlying radiopaque foreign body. There is mild soft tissue swelling without evidence of osteomyelitis.

Output: Increased erosion and deformity of the right first metatarsal head and base of the proximal phalanx compared to prior study, indicating progression of osteomyelitis.


Instruction: Generate impression based on findings.

Input: Male, 32 years old, with headaches and right frontal lobe lesion. Nonenhancing T2 hyperintensity and gyral thickening is again seen involving the posterior aspect of the right frontal operculum. There is evidence of prior biopsy with a burr hole and small biopsy tract just superior to the lesion. No additional abnormality is identified. No pathologic intracranial enhancement is observed. The ventricles are normal in size and morphology.

Output: Demonstration of a region of nonenhancing T2 hyperintense gyral thickening involving the posterior aspect of the right frontal operculum.


Instruction: Generate impression based on findings.

Input: 67 year old with FNA proven left breast cancer for research Alan Penn study. There is heterogeneous amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.In the left breast, there is an irregularly shaped enhancing mass, measuring 25 x 15 x 18 mm (AP x LR x CC), at 10 o'clock position, consistent with FNA proven malignancy.There is a small round enhancing mass, measuring 6 x 6 x 5 mm, at 2 o'clock position in the left breast.An enlarged lymph node with thickened cortex is present in the left medial axilla, measuring 18 x 15 mm. Other left axillary lymph nodes are normal appearing.Multiple enhancing foci are seen bilaterally, likely parenchymal enhancement.No abnormal enhancement is seen in right breast. No abnormal lymph nodes are identified in right axillary region.

Output: 1. FNA proven left breast malignancy at 10 o'clock position2. Small round mass in the left breast at 2 o'clock position. MR directed ultrasound study and biopsy was performed later today.3. Abnormal left axillary lymph node4. No MR evidence of malignancy in the right breast or right axillaBIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: 3+3 disease in the left mid medial peripheral zone 3 mm 15%. PELVIS:PROSTATE:Prostate Size: 2.8 x 4.6 x 3.2 cm.Peripheral Zone: 1.0 x 0.7 cm focus of restricted diffusion (series 603/344) and associated low T2-weighted signal intensity (series 901/18) in the medial right mid gland peripheral zone without associated early arterial enhancement.Approximately 6 mm focus of restricted diffusion (603/324) and associated T2-weighted hyperintensity (series 901/17) in the left medial mid gland.Central Gland: In the anterior left apex there is a poorly defined region of restricted diffusion measuring 1.3 x 0.8 cm (series 603/264) associated with poorly defined intermediately low T2-weighted signal abnormality (series 901/14) with suspected arterial enhancement.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: The right mid gland lesion abuts the prostatic margin without frank extension.BLADDER: Small right lateral bladder wall diverticulum.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Two peripheral zone subcentimeter foci are suspicious for prostatic adenocarcinoma.2. 1.3 cm lesion in the left apex of the mid gland may represent a dominant site of disease and is amenable to MRI/ultrasound fusion biopsy.


Instruction: Generate impression based on findings.

Input: 57-year-old male with right shoulder pain after multiple surgeries ROTATOR CUFF: Mild intermediate signal within the distal tendon of the supraspinatus suggestive of tendinosis. No discrete fluid-filled tear is evident. The infraspinatus, teres minor, and subscapularis muscles and tendons are within normal limits. No fatty atrophy is evident.SUPRASPINATUS OUTLET: Status post acromioclavicular excision arthroplasty with fluid within the joint and spurring along the inferior aspect.GLENOHUMERAL JOINT AND GLENOID LABRUM: Degeneration, blunting, and tearing of the glenoid labrum along the anterior inferior to the posterior superior aspect from the eleven o'clock position to the five o'clock position.BICEPS TENDON: Status post biceps tenodesis into the distal humeral diaphysis.ADDITIONAL

Output: 1.Supraspinatus tendinosis as described above. No discrete fluid-filled tear is evident.2.Degenerative tearing of the glenoid labrum as detailed above. 3.Status post long head of the biceps tenodesis and acromioclavicular joint excision arthroplasty.


Instruction: Generate impression based on findings.

Input: MRI brain: There is no diffusion abnormality. There are a few scattered T2 and FLAIR hyperintensities in the periventricular and subcortical white matter which are nonspecific. The ventricles and sulci are within normal limits. The basal cisterns remain patent. There is no midline shift or mass effect. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits.MRI spine: There is mild reversal of curvature of the spine, otherwise the cervical spine is in normal alignment. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. Central cord T2 signal abnormal at the C2 level is seen. No associated cord swelling is and in fact there is mild thinning of the cord at this level. No other area of significant abnormality is seen in the remaining cervical cord.The spinal canal is congenitally slender. Additional level specific findings are as follows.C2-C3: There is mild uncovertebral hypertrophy and facet arthropathy. There is no significant neural foraminal or spinal canal stenosis.C3-C4: There is uncovertebral hypertrophy and mild facet arthropathy resulting in moderate left neural foraminal narrowing. Minimal spinal canal stenosis is seen.C4-C5: There is uncovertebral hypertrophy and right paracentral disc osteophyte complex with effacement of ventral thecal sac. There is resultant moderate left neural foramina narrowing. No significant spinal canal stenosis.C5-C6: There is mild central disc osteophyte complex and mild left neuroforaminal narrowing. There is no spinal canal stenosis.C6-C7. There is osteophytic disc complex and mild uncovertebral hypertrophy resulting in mild bilateral neuroforaminal narrowing. There is no spinal canal stenosis.C7-T1: There is minimal disc osteophyte complex without significant spinal canal or neuroforaminal narrowing.Paraspinal soft tissue structures are grossly unremarkable.

Output: 1. Small foci of T2 hyperintensity are seen scattered in the cerebral white matter, which are nonspecific.2. Central spinal cord T2 signal abnormality at C2 with associated cord thinning suggesting a chronic lesion. The differential is broad and includes previous inflammation/infection as well as demyelination or post infectious/autoimmune conditions.3. Mild degenerative changes in the cervical spine without high-grade neural foraminal or spinal canal stenosis.


Instruction: Generate impression based on findings.

Input: The thoracic spine is in normal alignment, with a normal thoracic kyphosis. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal.There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the thoracic spine. LUMBAR

Output: 1. Stable lipomyelomeningocele within the spinal canal at L3-L5 levels.2. Unchanged cystic lesion along the right lateral spinal canal at L3-L4.3. Stable ventral motion of the thoracolumbar spinal cord at T11-L2, below which distal cord and conus is tethered.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 19 year-old male status post left S1 tumor resection. Osteoblastoma. Lumbar spine:Since the previous examination there are new postoperative changes including bilateral pedicular fusion of the L5 vertebrae and trans-sacral alar fusion at the S1 level. There is no evidence of hardware complication including loosening or fracture of the osseous structures or hardware components. There is 1-2 mm of extracortical extension of the screw tip of the left S1 hardware component.Alignment of the lumbar spine is within normal limits. Attenuation and morphology of the vertebral bodies and intervertebral disk spaces is within normal limits. The pre-and paravertebral soft tissues are within normal limits. Limited intra-abdominal imaging is within normal limits.L1-2: within normal limits without central or neuroforaminal narrowing.L2-3: within normal limits without central or neuroforaminal narrowing.L3-4: within normal limits without central or neuroforaminal narrowing.L4-5: within normal limits without central or neuroforaminal narrowing. Left-sided L5 and S1 laminectomies. L5-S1: within normal limits without central or neuroforaminal narrowing. Mottled and expansile appearance of the left S1 facet with left-sided neuroforaminal narrowing from bony encroachment. Expansile and lytic/sclerotic appearance of the left S1 facet extends to the dorsal aspect of the body of S1 and minimally into the left transverse process, most likely representing postsurgical change. Soft tissues within the surgical site and within the intracanalicular space cannot be evaluated on this examination secondary to lack of contrast. If there is further need for soft tissue evaluation an MRI with contrast may be considered.

Output: 1. Postoperative changes including bilateral pedicular fusion at L5-S1 without gross hardware complication.2. Postoperative change including left-sided L5 and S1 laminectomies with mottled and expansile appearance of the left S1 facet joint, body of S1 and left transverse process as described above.


Instruction: Generate impression based on findings.

Input: History of tongue cancer. Right hepatic lobe lesion. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology, signal intensity and size. Status post cholecystectomy with expected mild prominence of the common bile duct which tapers smoothly to the ampulla without obstructing stone or lesion. No intrahepatic biliary ductal dilatation.SPLEEN: The spleen is normal in morphology, size and signal intensity without a focal lesion. Small splenules are noted anteriorly.PANCREAS: The pancreas is normal in morphology without a focal lesion or pancreatic ductal dilatation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted. Mild symmetric perinephric fluid is likely chronic.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: No suspicious liver lesion is identified. Please note that the outside hospital PET/CT was unavailable for comparison.


Instruction: Generate impression based on findings.

Input: Pelvic soft tissues are, status post partial resection on August 22, 2014, status post radiation therapy January 9, 2015 PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Stable focus of postcontrast enhancement in left piriformis muscle, measuring 1.1 x 0.8 cm, image 30 series 9/sagittal image 38 series 101. Stable T2 hypointense signal corresponding to left piriformis muscle, may be posttreatment-related.

Output: 1. Stable exam. Unchanged focus of enhancement in left piriformis muscle. While this may be a focus of residual or recurrent disease, further evaluation with CTA recommended to exclude vascular structure such as pseudoaneurysm or AV fistula recommended.


Instruction: Generate impression based on findings.

Input: 94 years, Male, memory deterioration. No restricted diffusion to suggest acute ischemia. No intracranial mass or mass-effect. The ventricles are prominent likely reflective of moderate degree of global parenchymal volume loss and commensurate with patient's advanced age. There is patchy T2/FLAIR hyperintensity in the bilateral subcortical and periventricular white matter, which is nonspecific, but compatible with moderate degree of chronic small vessel ischemic disease. There are a few scattered foci of susceptibility compatible with chronic microhemorrhages and in a nonspecific distribution. Brain parenchyma is otherwise unremarkable for age. Postgadolinium images are slightly motion degraded. There is however no appreciable abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are grossly clear. Calvarium and extracranial soft tissues are grossly unremarkable. Bilateral lens implants.

Output: 1. No evidence of acute infarct. No intracranial mass or mass effect. 2. Moderate degree of chronic small vessel ischemic disease. Few scattered nonspecific foci of chronic microhemorrhage.3. Moderate degree of global parenchymal volume loss commensurate with patient's advanced age.


Instruction: Generate impression based on findings.

Input: Orbits: No abnormal signal is seen within the optic nerves. No intraorbital mass or abnormal enhancement is appreciated. Extraocular muscles and globes are grossly unremarkable. Brain: Chronic infarct is evident involving the right basal ganglia, anterior limb of the internal capsule, and the right frontal corona radiata. There are scattered nonspecific T2/FLAIR hyperintensities in the periventricular and subcortical white matter, which are nonspecific but likely represent chronic small vessel ischemic disease. There are however multiple T2/FLAIR hyperintense lesions adjacent to the bilateral temporal horns as well as in the right temporal subcortical white matter which are unusual for small vessel ischemic disease. Ventricular size is normal with no midline shift. The basal cisterns are patent with no herniation. There is no restricted diffusion. There are linear susceptibility signal in the basal ganglia bilaterally, most likely representing blood products from previous hemorrhage. There is no acute hemorrhage. No evidence of mass effect. The postcontrast images degraded by motion however, there is no appreciable abnormal enhancement.Small ovoid lesions involving the bilateral parotid glands which probably represent small lymph nodes. There is fluid in the bilateral mastoid air cells. Calvarium and extracranial soft tissues are otherwise unremarkable.

Output: 1. No abnormal signal is seen involving the optic nerves. Bilateral orbits appear within normal limits.2. MRI of the brain demonstrates evidence of chronic small vessel ischemic disease including a chronic infarct involving the right frontal corona radiata, basal ganglia, and anterior limb of the internal capsule.3. There are multiple T2/FLAIR hyperintense lesions adjacent to the bilateral temporal horns as well as in the right temporal subcortical white matter which are unusual for small vessel ischemic disease. As such, other etiologies such as demyelinating disease and inflammatory processes should be considered. No abnormal enhancement to suggest an active demyelination/active inflammation.


Instruction: Generate impression based on findings.

Input: Shoulder pain. Evaluate rotator cuff. ROTATOR CUFF: No evidence is seen of any rotator cuff tears. Note is made of a large focus of calcium hydroxyapatite in the infraspinatus consistent with calcific tendinopathy.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: No significant abnormality noted.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: Calcific tendinopathy in the infraspinatus. No evidence of rotator cuff tear.


Instruction: Generate impression based on findings.

Input: 72 years Female (DOB:10/18/1943)Reason: post-concussion headaches, to evaluate possible structural changes History: as abovePROVIDER/ATTENDING NAME: RAYMOND ROOS RAYMOND ROOS The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.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 eyeball lenses are thin.

Output: 1.No evidence of intracranial mass lesion.2.No evidence for intracranial hemorrhage.3.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: Global developmental delay, truncal hypotonia, and lower hyper-reflexia. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. Mild patchy areas of T2 hyperintensity in the posterior periventricular white matter regions may represent terminal zones of myelination. The brain parenchyma and pituitary gland otherwise appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Spine: The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The conus medullaris lies at the L1-2 level. There appears to be fine linear T1 hyperintensity along the filum terminale at the L4-5 level. The paravertebral soft tissues are unremarkable.

Output: 1. No evidence of intracranial malformations.2. Apparent fine linear T1 hyperintensity along the filum terminale at the L4-5 level may represent a fibrofatty filum. The spine otherwise appears unremarkable.


Instruction: Generate impression based on findings.

Input: 73 year-old female with recurrent ovarian cancer. Status post TAH/BSO/tumor debulking and radiation therapy. Evaluate for extent of recurrent disease. Abdominal pain in the right lower quadrant for two weeks. 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: Note is made of right retrocrural lymphadenopathy, which extends above the level of the diaphragm into the chest, measuring 2.5 x 1.9 cm (36; series 601). There are numerous prominent retroperitoneal lymph nodes which demonstrate restricted diffusion.BOWEL, MESENTERY: Diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS: Metallic susceptibility artifact from a right total hip arthroplasty device limits evaluation of the pelvis.UTERUS, ADNEXA: Status post hysterectomy and bilateral oophorectomy.BLADDER: No significant abnormality noted.LYMPH NODES: Reference left common iliac lymph node measures 1.2 x 0.9 cm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative changes affect the left hip.OTHER: There is a small amount of free fluid within the pelvis. Again seen is a fluid signal intensity collection in the soft tissues along the midline of the anterior abdominal wall, measuring 3.0 x 0.7 cm, previously 5.9 x 1.5 cm.

Output: Postsurgical changes with persistent retrocrural lymphadenopathy. There is no significant interval change in the previously described reference pelvic and retroperitoneal lymph nodes.


Instruction: Generate impression based on findings.

Input: Hip dislocation after hip scopic labral repair. Question of recurrent labral tear or capsular tear. ACETABULAR LABRUM: There is increased signal intensity within the anterior superior labrum with entrance of gadolinium into the labrum compatible with a tear. ARTICULAR CARTILAGE AND BONE: There is mild bone edema within the posterior femoral head. No fracture is evident. SOFT TISSUES: No significant abnormality noted. ADDITIONAL

Output: 1. Anterior superior labral tear.2. Small amount of gadolinium anterior to the joint capsule may be related to post-surgical changes or capsular disruption.


Instruction: Generate impression based on findings.

Input: 50 year old male physician with a history of paroxysmal atrial fibrillation with recent increasing frequency of paroxysms including present admission with rapid ventricular rate. He is referred for stress cardiac MRI for further evaluation. MEDICATIONS: Apixaban, Metoprolol First Pass PerfusionDuring hyperemia, no perfusion defects were present.Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable.Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 58%, the LV end diastolic volume index is 108 ml/m2 (normal range: 74+/-15), the LVEDV is 216 ml (normal range 142+/-34), the LV end systolic volume index is 45 ml/m2 (normal range 25+/-9), the LVESV is 90 ml (normal range 47+/-19), the LV mass index is 46 g/m2, and the LV mass is 92 g. There are no regional wall motion abnormalities present. Pre-contrast native myocardial T1 relaxation times are normal (980 ms).Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is upper normal size with normal systolic function. The overall RV ejection fraction is 54%, the RV end diastolic volume index is 126 ml/m2 (normal range 82+/-16), the RVEDV is 253 ml (normal range 142+/-31), the RV end systolic volume index is 57 ml/m2 (normal range 31+/-9), and the RVESV is 115 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is trace mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. No perfusion defects/ "ischemia" present during hyperemia.2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and systolic function (LVEF 58%).4. Upper normal RV size and normal systolic function (RVEF 54%).5. Biatrial enlargement.


Instruction: Generate impression based on findings.

Input: Female, 14 years old, with brain AVM, fMRI for pre-surgical speech and motor assessment. Sensorimotor cortical activation of the hand and face/tongue maps as expected along the pre- and post-central gyri. Both of these areas are well removed from the site of the patient's known left posterior temporal vascular malformation. Mapping of lower extremity/foot sensorimotor cortical activation was attempted, but due to the patient's reduced lower extremity mobility, data was unreliable and therefore not shown.Of the tested language paradigms, the most reliable language related cortical activation is seen with the verb generation and sentence completion paradigms. Language is left dominant. Activity corresponding to the putative Broca's area is seen in the left inferior frontal gyrus (primarily pars opercularis). A band of activity is seen corresponding to the expected location of Wernicke's area along the superior temporal sulcus. This activity runs obliquely from anterior to posterior in close proximity to the inferior margin of the vascular malformation. A second region of activation is seen within the left angular gyrus which runs in close proximity to the posterior superior margin of the lesion. This activity is contiguous with the more typical Wernicke's activity via a band which runs along the medial margin of the lesion.

Output: 1.Sensorimotor cortical activation for the hand and face/tongue maps as expected along the pre- and post-central gyri. Data for foot/lower extremity function is unreliable due to the patient's limited lower extremity mobility.2.Language is left dominant. Broca's area is identified in its customary location of the left inferior frontal gyrus and is well removed from the patient's temporal lobe lesion.3.Typical Wernicke's area activity is identified along the posterior superior left temporal sulcus. This activity runs obliquely along, and in close proximity to, the inferior margin of the lesion.4.Language-related activity is also seen in the left angular gyrus running in close proximity to the posterior superior margin of the lesion. This activity is contiguous with the more typical Wernicke's activity via a band which runs along the medial margin of the lesion. The angular gyrus is a know site of secondary language processing and, in this regard, is not unexpected. However, the possibility that this activity may contain some Wernicke's function displaced by the lesion should also be considered.


Instruction: Generate impression based on findings.

Input: Female, 41 years old, with severe headaches and right eye ptosis. No restricted diffusion is seen. No evidence of parenchymal edema or mass effect is detected. There are no findings to suggest acute intracranial hemorrhage or any abnormal extra-axial fluid collection. A partially empty sella is noted. The lateral ventricles are small in caliber.Motion artifact limits evaluation of the orbits. Given this caveat, no abnormalities of the optic nerves or chiasm are suspected. The extraocular muscles are symmetric in size and show normal signal intensity. The globes are round and symmetric. No orbital mass lesions are demonstrated.

Output: 1.Partially empty sella and small caliber of the lateral ventricles are findings which can be seen in conditions of elevated intracranial pressure such as IIH. 2.No acute intracranial abnormalities are detected. No specific orbital lesions are seen.


Instruction: Generate impression based on findings.

Input: Sacral dimples, abnormal ultrasound lumbar spine, evaluate for Chiari malformation, tethered cord protocol and syrinx, spina bifida.Two small red blanching vascular lesions above gluteal cleft. Brain: The cerebellar tonsils are not low-lying and there is intact cerebrospinal fluid flow across the foramen magnum. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Spine: The skin or subcutaneous lesions are not discernible. There is no evidence of a sinus tract. The conus medullaris lies at the L1 vertebral body level and the spinal cord displays normal signal and morphology. There is no evidence of a fibrofatty filum terminale. There is mild convex left thoracic scoliosis. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The paravertebral soft tissues are unremarkable. The urinary bladder appears distended.

Output: 1. No evidence of acute Chiari malformation.2. The skin or subcutaneous lesions superior to the gluteal cleft are not discernible, likely due to the inherent resolution limitations of the modality. 3. The conus medullaris lies at the L1 vertebral body level, without evidence of a fibrofatty filum terminale. 4. Mild convex left thoracic scoliosis.


Instruction: Generate impression based on findings.

Input: 79 years Female (DOB:4/8/1936)Reason: low back pain with compression fracture- healed or not? History: low back painPROVIDER/ATTENDING NAME: MICHAEL J LEE MICHAEL J LEE Five lumbar type vertebral bodies are presumed to be present . The conus medullaris on sagittal imaging is grossly intact. There is 30% loss of height of the L5 vertebral body which is new since the prior exam. There is some associated T1 and T2 signal hyperintensity but predominantly T1 hyperintensity. There is redemonstration of a mild L1 compression fracture.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is moderate bilateral facet hypertrophy present associated with a diffuse disc bulge. There is effacement of spinal fluid surrounding the nerve roots within the thecal sac. There is ligamentum flavum hypertrophy present. There is moderate spinal stenosis present. This has progressed since the prior examAt L3-4 there is disc desiccation and a disc bulge associated with posterior ligamentous hypertrophy at this level. There is effacement of fluid surrounding the nerve roots within the thecal sac at this level. There is ligamentum flavum hypertrophy present. There is moderate spinal stenosis present. This is stable since the prior examAt L2-3 there is disc desiccation and a disc bulge associated with posterior ligamentous hypertrophy at this level. There is effacement of fluid surrounding the nerve roots within the thecal sac at this level. There is ligamentum flavum hypertrophy present. There is moderate spinal stenosis present. This is stable since the prior examAt L1-2 there is disc desiccation, diffuse disc bulge and some ligamentum flavum hypertrophy associated with a mild degree of spinal stenosis.There is redemonstration of multiple cysts along the kidneys the largest one is in the left kidney inferior pole measuring 10 mm in diameter.

Output: 1.Since prior examination patient developed a compression fracture at L5 which has a benign appearance. It appears to be in a late subacute stage2.Since the prior exam spinal stenosis at L4-5 appears to have progressed.3.There is moderate spinal stenosis at L2-3 and L3-4 degenerative changes which is stable since the prior exam.4.There is redemonstration of a mild L1 compression fracture.


Instruction: Generate impression based on findings.

Input: 20-year-old female with groin pain x6 weeks, evaluate for stress fracture ACETABULAR LABRUM: The acetabular labrum is intact on this nonarthrographic study.ARTICULAR CARTILAGE AND BONE: Increased T2 signal within the right inferior pubic ramus with callus formation compatible with a subacute stress fracture. SOFT TISSUES: No significant abnormality noted. ADDITIONAL

Output: 1.Inflammatory changes noted within the inferior pubic ramus and obturator externus muscle with callus formation compatible with subacute stress fracture.2.Multiple follicles in bilateral ovaries are suggestive of polycystic ovarian syndrome in the correct clinical context.


Instruction: Generate impression based on findings.

Input: Redemonstrated are post-surgical changes related to posterior spinal fusion with bipedicle screws at L3 and L4 as well as intervertebral disc spacer. There straightening of the usual lumbar lordosis. The vertebral body heights are preserved. The vertebral bone marrow signal is mildly heterogeneous. The spinal cord displays normal signal and morphology. However, there is mild enhancement of the cauda equina nerve roots. The tip of the conus medullaris terminates at the level of L1. There is lumbosacral epidural lipomatosis. There is a 2.5 cm cyst in the lower pole of the right kidney with fluid-fluid level, likely representing a hemorrhagic cyst. There is also a 1.4 cm right renal cystic lesion. There is diffuse paraspinal muscle atrophy.T12-L1: No significant disc bulge, spinal canal or foraminal stenosis. L1-L2: Mild bilateral facet arthropathy. No significant disc bulge, spinal canal or foraminal stenosis.L2-L3: Disc bulge and bilateral facet arthropathy, contributing to mild left greater than right foraminal stenosis. No significant spinal canal stenosis.  L3-L4: Status post laminectomies at L3 and L4. Evaluation is somewhat limited by susceptibility artifact, but no significant spinal canal or foraminal stenosis. L4-L5: Mild disc bulge and bilateral facet arthropathy, contributing to mild bilateral foraminal stenosis. No significant spinal canal stenosis. L5-S1: Mild disc bulge and bilateral facet arthropathy. No significant spinal canal or foraminal stenosis.

Output: 1. Post-surgical changes related to posterior spinal fusion and intervertebral disc spacer at L3-L4. 2. Lumbosacral epidural lipomatosis and degenerative lumbar spondylosis with mild foraminal stenosis at L2-L3 and L4-L5, without significant spinal canal stenosis. Evaluation at L3-L4 is somewhat limited by susceptibility artifact.3. Apparent mild enhancement of the cauda equina nerve roots without associated thickening, which may be infectious or inflammatory in etiology. 4. Bilateral renal cystic lesions. Renal ultrasonography may be useful for further characterization. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Hodgkin's lymphoma, preoperative evaluation. MRI brain: Please note, sequences of the brain are limited for presurgical planning and includes 3-D T2 and post gadolinium 3-D T1 sequences. Again seen is persistent diffusely enhancing tumor centered in the right lateral skull base region with soft tissue extension into the right upper deep neck spaces, right cerebellomedullary cistern, right jugular foramen, hypoglossal canal, right Meckel's cave extending to the posterior right cavernous sinus as seen on prior MRI. There is persistent diffuse enhancement of the bone marrow involving the right lateral and central skull base as seen on the prior exam. There is persistent right tympanomastoid opacification.There is redemonstration of bilateral optic disc protrusion and prominence of the optic sheaths compatible with intracranial hypertension.The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation.MRV brain: There is tumor involving the right jugular foramen with occlusion of the upper right internal jugular vein. Tumor appears to extend intracranially at the level of the right sigmoid sinus and resulting in partial occlusion of the right sigmoid sinus. More proximally, there is diminished flow/partial thrombosis involving the right transverse sinus. The right jugular vein more distally is patent as seen on recent CT neck study from 3/31/2016.There is heterogeneous signal involving the posterior aspect of the superior sagittal sinus suspected to represent partial thrombosis with preserved flow more anteriorly and posteriorly in the superior sagittal sinus. Nondominant/hypoplastic left transverse and sigmoid sinuses are are patent as is the left internal jugular vein.The straight sinus, vein of Galen, internal cerebral veins, and several visualized cortical veins are patent.

Output: 1. Limited sequences of MRI brain for presurgical planning redemonstrates right lateral skull base tumor with enhancing soft tissue extension into the upper deep neck spaces and intracranial extension along the right jugular foramen, hypoglossal canal, right Meckel's cave, and posterior inferior aspect of the right cavernous sinus compatible with known lymphoma.2. Occlusion of the upper right internal jugular vein at the level of the tumor which involves the jugular foramen. The right internal jugular vein more inferiorly is patent as demonstrated on CT neck from 3/31/2016. There is partial thrombosis and slow flow involving the right sigmoid sinus and right transverse sinus. There is also irregularity involving the posterior aspect of superior sagittal sinus suspicious for partial thrombosis. The superior sagittal sinus more anteriorly and posteriorly however remain patent. The nondominant/hypoplastic left transverse sinus, sigmoid sinus, and jugular vein remain patent.3. Persistent right tympanomastoid effusion.4. Papilledema and prominence of the optic nerve sheath are compatible with elevated intracranial pressure.


Instruction: Generate impression based on findings.

Input: 43-year-old male, evaluate for AC joint arthritis. ROTATOR CUFF: There may be minimal tendinosis of the posterior fibers of the supraspinatus tendon, but the supraspinatus tendon and muscle otherwise are within normal limits. There is mild increased signal intensity and thickening of the anterior fibers of the infraspinatus tendon indicating mild tendinosis, with cyst formation in the underlying humeral head. The remaining infraspinatus tendon and muscle are within normal limits. The teres minor and subscapularis tendons and muscles appear normal.SUPRASPINATUS OUTLET: Small foci of metallic artifact within the soft tissues about the acromioclavicular joint likely reflect prior surgery. The AC joint is slightly widened and contains a small amount of fluid, which may be due to prior surgery. There are small cysts in the anterior distal clavicle as well as mild edema within the distal clavicle that we suspect is degenerative in etiology. Alignment is within normal limits. The signal intensity of the acromion process appears normal. There is no frank fluid in the subacromial-subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral alignment is within normal limits. Given the limitations of a non-arthrogram examination the glenoid labrum appears intact.BICEPS TENDON: Given the limitations of a non-arthrogram examination the biceps tendon appears normal.

Output: 1. Presumed postoperative changes of the AC joint as described above. In addition, there is edema and cyst formation in the distal clavicle which may be degenerative in etiology.2. Mild rotator cuff tendinosis.


Instruction: Generate impression based on findings.

Input: The last well formed disk space is referred to as L5-S1. There straightening of the lumbar lordosis. Vertebral body heights are preserved. There is disk desiccation at multiple levels in the lumbar spine with loss of disk height at L2-3 through L5-S1, most severe in the lower lumbar levels. There are type 2 degenerative changes at the L5-S1 endplates, and the L4-L5 endplates. There is mild edema in the L3-4 endplates and right pedicle of L4 likely secondary to advanced degenerative disease. There are scattered foci of high T1 signal within the vertebral bodies representing focal fatty deposition versus hemangiomas. The conus terminates at L1-2 and shows normal caliber and signal.T11-12: No disk herniation, central spinal canal or neural foraminal stenosis.T12-L1: No disk herniation, central spinal canal or neural foraminal stenosis.L1-2: Left foraminal/extra foraminal disk protrusion and mild disk bulge causing moderate left neural foraminal stenosis. No central spinal canal or right neural foraminal stenosis.L2-3: Diffuse disk bulge, mild bilateral facet arthropathy and ligamentum flavum thickening causing minimal bilateral neural foraminal stenosis and minimal central spinal canal stenosis.L3-4: Diffuse disk bulge, bilateral facet arthropathy and ligamentum flavum thickening causing mild central spinal canal stenosis, moderate right and minimal left neural foraminal stenosis. There is encroachment of the bilateral subarticular zones at this level.L4-5: Diffuse disk bulge asymmetric to the right, moderate bilateral facet arthropathy and ligamentum flavum thickening causing mild left greater than right neural foraminal stenosis and mild central spinal canal stenosis. Disk material encroaches upon both subarticular zones (right greater than left), with mild posterior displacement of the traversing L5 nerve roots suspected, right greater than left.L5-S1: Disk bulge and osteophytic ridging, bilateral facet arthropathy causing no significant spinal canal stenosis and mild right and moderate left neural foraminal stenosis.

Output: 1.Advanced degenerative disk and facet changes at multiple levels in the lumbar spine causing multilevel variable spinal canal and neural foraminal stenoses as detailed above.2.Particularly, there is disk material encroaching upon the subarticular zones at L4-5 (right greater than left) which may be contacting the traversing L5 nerve roots, more on the right. Additional levels of foraminal narrowing as above.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 71 year old with personal and family history of breast cancer. Personal history of left breast lumpectomy in 1992 for cancer followed by radiation and hormonal therapy. She also had a benign right breast surgery approximately 27 years ago. There is heterogeneous amount of fibroglandular tissue in both breasts.Minimal parenchymal enhancement is noted bilaterally.Mild enhancement of the left nipple is stable since 7/27/11No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: Right ptosis and diplopia. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are mild scattered nonspecific cerebral white matter T2 hyperintense foci. 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 skull and scalp soft tissues are grossly unremarkable. There is mild right maxillary sinus mucosal thickening.Orbits: There is no evidence of orbital mass lesions. The bilateral globes, optic nerves, extraocular muscles, lacrimal glands, and orbital fat are unremarkable.

Output: 1. No evidence of intracranial hemorrhage, mass, or acute infarct. 2. No evidence of orbital mass lesions.


Instruction: Generate impression based on findings.

Input: Reason: Follow up: assess status of extensive chest, neck, bilateral upper extremity lymphatic/venous malformation (possible CLOVES syndrome variant). History: Chest wall involvement with persistent retractions, growth retardation. LUNGS AND PLEURA: Bibasilar subsegmental atelectasis is present. A few subcentimeter nonspecific pulmonary nodules are again present, the largest which is in the right lower lobe (series 6, image 34) measuring up to 6 mm.MEDIASTINUM AND HILA: The cystic, multiloculated right axillary mass extends into the upper mediastinum involving the bilateral apical spaces, as well as the posterior mediastinum adjacent to the descending thoracic aorta. The anterior mediastinum appears uninvolved. The visualized airway is patent.CHEST WALL: There is a T2 hyperintense, T1 hypointense cystic, extensive mass measuring approximately 5.6 x 7.2 x 14.7 cm, previously 9.4 x 5.2 x 14.0 cm containing multiple septations/loculations with its epicenter in the right axilla extending down the right arm, and involving the right chest wall, and right cervical region, consistent with lymphangioma. Layering material within the cystic spaces could represent proteinaceous debris or blood product. The septations demonstrate enhancement on post contrast images. There is a redemonstration of a mild deformity of one of the right midthoracic ribs (series 601, image 32). There is a smaller, multi-septated cystic left axillary mass measuring approximately 7.2 x 2.9 x 7.5 cm previously 4.7 x 2.1 by 5.1 cm with similar characteristics consistent with lymphangioma.UPPER ABDOMEN: No significant abnormality.

Output: 1. Multiple lymphangiomas are again present. The largest is centered in the right axilla with extension into the into the right arm, neck, and mediastinum and has slightly decreased in size compared to the prior examination2. Pulmonary basilar atelectasis are nonspecific subcentimeter pulmonary nodules.


Instruction: Generate impression based on findings.

Input: Diagnosis: Lumbago with sciatica, left sideClinical question: eval for lumbar spine pathologySigns and Symptoms: LBP and LLE pain 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. A small high signal focus is present within the L1 vertebral body measuring approximately 6 mm in diameter which is bright on T1 and T2 and suppresses on inversion recovery sequence. Most likely represents a vertebral body hemangioma.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is redemonstration of a broad-based left lateral recess and left lateral disk protrusion which effaces the fat at the left lateral recess and extends into the left neural foramen where it partially effaces the fat along the inferior aspect of the neural foramen. The exiting nerve root is surrounded by fat. There is also some ligamentum flavum hypertrophy present at this level. There is a small right lateral disk protrusion at this level which is also stable since the prior exam. It mildly narrows the right neural foramen. There is loss of disk space height and desiccation present at this level. Overall there is no substantial change since the prior exam at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is loss of disk space height and desiccation present at this level. There is a right lateral disk protrusion present at this level which partially effaces fat along the lower aspect of the neural foramen and partially effaces fat at the right lateral recess. The exiting nerve root is surrounded by fat.At L2-3 there is no significant compromise to spinal canal or neural foramina. There is loss of disk space height and desiccation present at this level. At L1-2 there is no significant compromise to spinal canal or neural foramina.There is redemonstration of a small cystic lesion along the right kidney probably representing cortical cyst it has not changed since the prior exam.

Output: There are degenerative changes present in the lumbar spine worse at L4-5 where there is a broad-based left lateral recess disk protrusion which encroaches on the right the left lateral recess (probably left L5 nerve root). This is stable since the prior exam. There is also some milder encroachment of the nerve root at the right lateral recess at L3-4 due to disk protrusion which is also unchanged.


Instruction: Generate impression based on findings.

Input: 80 years Male (DOB:3/16/1936)Reason: Metastatic lung cancer, evaluate brain mets History: memory impairmentPROVIDER/ATTENDING NAME: JYOTI D PATEL JYOTI D PATEL The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Compared to the prior exam from 5/27/2015 there are more subcortical white matter lesions on the current exam especially in the right frontal lobe and right parietal lobe subcortical white matterThere is a subdural effusion the posterior fossa which is likely related to atrophy and has not changed substantially compared to prior exam.At T2 hyperintense and FLAIR hypointense lesion is present in the left paramedian pons which is unchanged since the prior exam.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.There is a 14 x 21 mm axial dimension enhancing focus present adjacent to and medial to the left lateral pterygoid musculature which is suspected to represent venous plexusNormal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate some small mucous retention cysts.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The right eyeball lenses is thin.

Output: 1.Periventricular and subcortical white matter lesions of a mild to moderate degree are nonspecific. At this age they are most likely vascular related. Since the prior exam there are more than of accumulated in the right hemisphere.2.Old lacunar infarct involving the left paramedian pons.3.There is no evidence for brain metastases on the basis of this exam.4.A lesion in the left pterygoid musculature is suspected to be related to pterygoid venous plexus


Instruction: Generate impression based on findings.

Input: Male, 59 years old, with history of Klippel-Feil syndrome, presenting with neck pain. Due to the ambiguous appearance of several cervical vertebral body levels, vertebral body numbering is by necessity somewhat arbitrary. Please see the accompanying CT report for further explanation of the numbering rationale.Partial atlantooccipital assimilation is seen with fusion of the left lateral mass and left arch of C1 to the occipital bone. Non fusion of the two halves of the anterior arch of C1 is seen, and the right C1 arch is fused to C2. The C2-C5 vertebral bodies are malformed and there is evidence of osseous fusion across the vertebral bodies and the posterior elements.Extensive disc degeneration is seen at C5-6. Wasp waist morphology is evident between C6 and T1 with fusion across the vertebral bodies and posterior elements at these levels. Fusion across the vertebral bodies and posterior elements is also seen at T2-3 .The visualized spinal cord demonstrates normal signal characteristics and normal morphology throughout. The spinal canal is narrowed at the C4 and C5 levels but this does not appear to result in significant cord deformation. Additional level specific findings are as follows:C2-3: Right neuroforaminal narrowing. No discrete left neural foramen is seen at this level though the left C1-2 neural foramen is capacious. C3-4: Moderate to severe left and mild right foraminal narrowing. Mild generalized spinal canal narrowing. C4-5: Moderate right and mild left foraminal narrowing. Mild generalized spinal canal narrowing. C5-6: Right facet hypertrophy. Posterior disc-osteophyte complex formation. Moderate generalized spinal canal stenosis. Severe right and mild left foraminal narrowing.C6-7: No significant spinal canal stenosis. No significant foraminal narrowing.C7-T1: No significant spinal canal or foraminal stenosis. T1-2: No significant spinal canal or foraminal stenosis.

Output: 1.Multiple vertebral body anomalies and osseous fusion compatible with the stated history of Klippel-Feil syndrome.2.Spinal canal narrowing is evident at the C3-C5 levels but without significant cord impingement and no evidence of cord signal abnormality.3.Scattered variable foraminal narrowing as above.


Instruction: Generate impression based on findings.

Input: Brain: No diffusion weighted abnormalities. Stable focus of encephalomalacia in the high convexity right posterior frontoparietal region at the site of prior craniotomy without evidence of interval change. Extensive periventricular and subcortical T2 hyperintensity of the bilateral cerebral hemispheres, which appears without symmetric and change from prior study. Extensive similar foci of flair hyperintensity are also noted in bilateral paramedian pons without change. Marrow signal changes of clivus and increased tissue fullness within the dorsal aspect of the sphenoid sinus which with mild enhancement, stable from 06/2013 study. No evidence of mass, mass effect, or hydrocephalus. No extra-axial fluid collections. Flow voids are present within the major vessels indicating patency. Unchanged patchy opacification of bilateral ethmoid air cells, left greater than right.Cervical spine: There is loss of the cervical lordosis. There is multilevel degenerative endplate degenerative marrow signal changes. There is mild multilevel spinal canal stenosis associated with disc-osteophyte complexes. There is no abnormal spinal cord signal or enhancement. There is no evidence of mass lesions. The paraspinal soft tissues are unremarkable. C1/2: No evidence of foraminal narrowing or spinal canal stenosis.C2/3: Mild disk disease. No evidence of foraminal narrowing or spinal canal stenosis.C3/4: Moderate disk disease. Severe left and mild right neural foraminal narrowing. Mild central canal stenosis. C4/5: Advanced disk disease with loss of disk height. Minimal retrolisthesis of L4 over L5 vertebral body. There is shallow ventral epidural defects, likely spur, with progression of Modic endplate changes. Mild ligamentum and facet hypertrophy. Significant bilateral neural foraminal narrowing, right greater than left. There is progression of moderate central canal stenosis. C5/6: Advanced disk disease with loss of disk height. Significant right and mild left neuroforamina stenosis. Mild central canal stenosis. C6/7: Mild disk disease. No evidence of foraminal narrowing or spinal stenosis. C7/T1: Mild disk disease. No evidence of foraminal narrowing or spinal stenosis.

Output: 1.Periventricular and subcortical white matter T2 hyperintensity, stable from prior study.2.Stable marrow signal change, increased tissue density, and mild enhancement of the clivus. This finding is stable from 06/2013 study, but recommend CT without contrast with thin section through the skull base for further evaluation.3.Multilevel degenerative disk disease of the cervical spine with progression of disease at C4/5 level with moderate central canal stenosis.


Instruction: Generate impression based on findings.

Input: Clinical question to be answered: Evaluate for intracranial process. Signs and symptoms: 51-year-old female with severe headaches x 4 days, family history of brain aneurysm. MRI CT of brain without and with infusion of contrast.No evidence of hemorrhage, edema, mass-effect, midline shift or hydrocephalus. Cortical sulci, ventricular system and all CSF cisterns remain within normal. Calvarium, paranasal sinuses and mastoid air cells are unremarkable.Post infusion images demonstrate no abnormal enhancement the brain parenchyma or leptomeninges. This examination cannot exclude possibility of aneurysm. If an aneurysm is highly suspected a CTA of intracranial circulation is the appropriate test for detection of aneurysm.65 cc of Omnipaque was utilized for this study.

Output: Normal CT of brain without and with infusion of contrast.


Instruction: Generate impression based on findings.

Input: Female, 8 years old. Pain. Myositis vs deep abscess. ARTICULAR CARTILAGE AND BONE: Bone marrow signal intensity is normal. Alignment is anatomic. No significant joint effusion. No abnormal enhancement.SOFT TISSUES: No solid mass lesion or discrete fluid collection. ADDITIONAL

Output: Normal examination.