Instruction: Generate impression based on findings.

Input: Patient is status post stereotactic biopsy of left breast calcifications, resulting ALH and FEA. Clip displacement approximately 2 cm inferiorly. This was discussed at the multidisciplinary conference on 09/10/2015. Recommendations are to obtain a MRI (high-risk lesion protocol) along with a 6 month left unilateral diagnostic mammogram as follow-up in order to confirm stability of these findings. The breasts are composed of heterogeneous fibroglandular tissues. On postcontrast images, mild parenchymal enhancement is seen bilaterally. A signal void likely from the displaced biopsy clip is noted in the central aspect of the right breast, middle depth. No abnormal enhancement is seen in either breast including the biopsy site. No abnormal axillary lymph nodes are identified in either axillary region.

Output: No abnormal MRI enhancement to suggest malignancy. Biopsy clip in the central right breast.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: Female, 49 years old, with neck and shoulder pain, worsening. Minimal reversal of the cervical lordosis is seen. Spinal alignment is otherwise unremarkable.Vertebral body morphology is within normal limits. No worrisome marrow signal abnormality or marrow edema is detected.The visualized spinal cord demonstrates normal signal intensity and morphology throughout.No evidence of significant disc degeneration or osteophyte formation is seen. No spinal canal or neuroforaminal stenosis is detected.

Output: Unremarkable evaluation of the cervical spine with no findings to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: Male, 18 years old, with history of pineal germinoma status post chemoradiation, end therapy 07/2014, complaining of intermittent bilateral lower leg crampy pain since February, no vision changes, no headaches. Brain:Redemonstrated is evidence of right frontal approach stereotactic pineal biopsy. Susceptibility effect is again seen in the pineal region, but there are no new lesions to suggest recurrent tumor. No evidence of focal parenchymal edema or mass effect is detected. No pathologic parenchymal or extra-axial enhancement is seen. No abnormal extra-axial collections are observed. The ventricles remain normal in size and morphology.Spine:Axial sequences of the spine are moderately degraded by motion artifact. Alignment is anatomic. Vertebral body height and morphology are within normal limits. No evidence of pathologic marrow replacement or enhancement is seen. The visualized spinal cord, conus and nerve roots of the cauda equina are within normal limits and free of pathologic enhancement. No significant spinal canal or foraminal stenosis is detected.

Output: 1.No evidence of residual or recurrent pineal region tumor.2.No evidence of metastases in the brain or spine.


Instruction: Generate impression based on findings.

Input: Status post fall. Low back pain radiating to both legs. Lytic lesions are seen throughout the lumbosacral spine, from T12 to the sacrum, correlating with the enhancing lesions seen on the prior MRI study. There is involvement of the anterior and posterior elements. There is involvement of the distal sacrum. There are small pathological fractures at the left pedicle and transverse process of T12, at the inferior endplate of L5 and superior endplate of S1, with minimal displacement of small fracture fragments. There is scoliosis in the lumbar spine, but the alignment of the lumbosacral spine is essentially maintained. There is lesion extending into the right sacroiliac joint. There are lesions involving the iliac bones bilaterally.

Output: Diffuse metastatic disease involving the thoracolumbar junction, throughout the lumbar spine, sacrum, and iliac bones bilaterally. There are small minimally displaced pathological fractures as described.


Instruction: Generate impression based on findings.

Input: Male, 66 years old, with a mass in the right parotid tail. Several small T1 hypointense nodules are seen within the superficial right parotid gland, corresponding to an area of ill-defined soft tissue thickening seen on prior CT. The largest of these nodules measures up to 6 mm and shows questionable minimal enhancement. These nodules are not specifically visualized on either T2 weighted or diffusion weighted images. Overall, the abnormality has become significantly less conspicuous when compared to the prior CT.More superiorly in the right parotid gland, there is a 3 mm superficial cystic lesion which is nonspecific. The remaining salivary glands are unremarkable. The aerodigestive mucosa as visualized is free of mass lesions. No fluid collections are detected. No pathologic adenopathy is seen. The bone marrow shows normal signal characteristics. Mucosal thickening is evident in the right maxillary sinus.

Output: Several subcentimeter T1 hypointense structures are evident within the right parotid gland correlating to an area of ill-defined thickening seen on prior CT. This tissue does not exhibit specifically aggressive features, and overall the abnormality is much less conspicuous than on the prior examination.Given the relatively benign appearance and overall interval improvement, the possibility of an inflammatory process should be considered. Although a neoplastic process cannot be entirely excluded, it is felt to be less likely.


Instruction: Generate impression based on findings.

Input: Left shoulder pain ROTATOR CUFF: No significant abnormality noted.SUPRASPINATUS OUTLET: There is mild osteoarthritis of acromioclavicular joint. GLENOHUMERAL JOINT AND GLENOID LABRUM: No significant abnormality noted. Age-appropriate degenerative changes of the labrum noted.BICEPS TENDON: The intra-articular portion of the biceps tendon is poorly seen but appears intact. ADDITIONAL

Output: No significant internal derangement of the shoulder. Age-related changes detailed above.


Instruction: Generate impression based on findings.

Input: 57-year-old female with acute left hip pain, lower back pain with radiculopathy down the left leg. ACETABULAR LABRUM: Although this examination was not protocoled for evaluation of acetabular labrum, no discrete labral tear is identified.ARTICULAR CARTILAGE AND BONE: Note is made of curvilinear signal abnormality within the right femoral head consistent with avascular necrosis. Additionally, there is diffuse increased signal abnormality within the left femoral head and neck also consistent with avascular necrosis. The possibility of subchondral fracture cannot be excluded and correlation with dedicated left hip radiographs is recommended.SOFT TISSUES: There is generalized muscle atrophy bilaterally. ADDITIONAL

Output: Findings most consistent with avascular necrosis of the hips, left greater than right. The possibility of subchondral fracture cannot be completely excluded and correlation with dedicated left hip radiographs is recommended.


Instruction: Generate impression based on findings.

Input: 43 year old with history of atypical chest pain and family history for CAD presenting for evaluation of chest pain. MEDICATIONS: none 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 78 ml/m2 (normal range: 65+/-11), the LVEDV is 159 ml (normal range 109+/-23), the LV end systolic volume index is 32 ml/m2 (normal range 18+/-5), the LVESV is 66 ml (normal range 31+/-10), the LV mass index is 37 g/m2, and the LV mass is 74 g. There are no regional wall motion abnormalities present. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 56%, the RV end diastolic volume index is 81 ml/m2 (normal range 69+/-14), the RVEDV is 166 ml (normal range 110+/-24), the RV end systolic volume index is 36 ml/m2 (normal range 22+/-8), and the RVESV is 74 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal 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. Normal RV size and systolic function (RVEF 55%).I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Pain. Possible triangular fibrocartilage complex tear versus lunotriquetral ligament tear status post distal radius fracture Some sequences are limited by patient motion artifact. There is mild deformity of the distal radius and its articular surface reflecting a healing/healed fracture. There is a resultant small gap along the articular surface of the distal radius in the coronal plane, but minimal if any articular surface depression. There is also mild deformity of the tip of the ulnar styloid with underlying cyst formation, indicating prior trauma. Small ossicles are again noted along the dorsal aspects of the scaphoid and capitate perhaps representing ununited fracture fragments as seen on recent CT scan. Mild osteophytes affects the wrist.Contrast is present within the radiocarpal and midcarpal articulations. Contrast extends between the two articulations via a defect in the membranous portion of the scapholunate ligament; the dorsal and volar components of the ligament appear intact. The lunotriquetral ligament perforation suspected on the conventional arthrogram component of the study is not clearly evident on this MRI exam. No contrast is seen traversing the triangular fibrocartilage and entering the distal radioulnar joint indicate a full-thickness tear; however, there is mild generalized deformity and heterogeneity of signal of the articular disc, with contrast filling small defects along its distal surface suggesting partial thickness tearing. The tendons of the wrist are unremarkable.

Output: 1.Mild post-traumatic deformity of the distal radius and ulnar styloid indicating healing/healed fractures.2.Mild osteoarthritis of the wrist.3.Tear of the membranous portion of the scapholunate ligament. The lunotriquetral ligament perforation suspected on the conventional arthrographic component of the study is not clearly evident on this MRI exam.4.Partial thickness tearing of the articular disk of the triangular fibrocartilage.


Instruction: Generate impression based on findings.

Input: 32-year-old male with pituitary cancer, status post chemo and radiation in 2006. Radiation to left sacrum 6/30 through 7/10/2008. December 2008 MRI showed abnormal left hemisacrum, possibly representing disease progression. Please perform CT guided sacral biopsy. Following a discussion of the procedures risks, benefits and alternatives, informed written consent was obtained from the patient's mother.The patient was placed in a prone position. A radiopaque grid was placed over the patient’s left sacrum for needle localization. Using multidetector helical CT, axial 5 mm scans were obtained through the sacrum demonstrating mild irregularity of the left superior sacroiliac joint. A trajectory was plotted into the left hemi-sacrum based on review of pelvis MRI 12/5/2008. The patient's lower back was prepped with Betadine and draped in sterile fashion. The subcutaneous and deeper soft tissues were anesthetized with 1% lidocaine. A 13-gauge Bonopty needle was advanced into the posterior aspect of the left hemisacrum. An inner drill cutting needle was utilized to advance the coaxial Bonopty needle into the posterior lateral aspect of the left hemisacrum. A bone biopsy was performed with an inner bone cutting needle, which yielded a solid bone core. The sample was placed in formalin and sent directly to pathology for diagnostic analysis. The coaxial needle was removed and adequate stasis was achieved with manual compression for 5 minutes.The patient tolerated the procedure well with no immediate complications. The patient remained neurologically intact at baseline at the end of the procedure. The patient was transferred to interventional radiology holding for routine post-procedure monitoring.

Output: Successful CT-guided core bone biopsy of the left hemisacrum.


Instruction: Generate impression based on findings.

Input: 13 year-old male with effusion, popping, pain for one year, evaluate for internal derangement MENISCI: There displacement of the posterior horn and body of the lateral meniscus into the intercondylar notch, adjacent to the lateral fibers of the ACL. There is enlargement and increased signal intensity of the anterior horn of lateral meniscus, indicating extensive mucoid degeneration, with small degenerative type tears extending to the femoral articular surface. These findings suggest the possibility of a discoid meniscus with degenerative tearing and displacement as described above, although we cannot confirm discoid morphology on the base of this study.ARTICULAR CARTILAGE AND BONE: No focal articular cartilage defects. The bone marrow signal is within normal limits.LIGAMENTS: The ACL is intact although there may be some mucoid degeneration of the ligament extending from the anterior horn of the lateral meniscus. The PCL is intact. The medial and lateral collateral ligaments are intact.EXTENSOR MECHANISM: The quadriceps and patella tendons are intact.ADDITIONAL

Output: Degeneration, tearing and displacement of the lateral meniscus as well as other findings as described above.


Instruction: Generate impression based on findings.

Input: Male, 55 years old, status post removal of an intrathecal pain pump and catheter system, evaluate for abscess. Since the prior examination, the patient has undergone a bilateral laminectomy at T11 with partial resection of the T10 spinous process. A fluid collection is present within the laminectomy bed measuring up to 41 mm in CC dimension and up to 11 mm in the AP dimension. A focus of signal void within this collection probably represents a bubble of air or perhaps some surgical material. This fluid collection does bulge into the spinal canal, displacing the dura anteriorly. The conus is also displaced anteriorly and compressed.The dura along the operative bed enhances. In addition, there remains a region of intramedullary cord enhancement, but this seems to be less pronounced than on the preoperative examination. Spinal cord edema has, however, significantly improved extending only up to the T9 vertebral body, previously to the T6 vertebral body.

Output: Findings are seen compatible with laminectomy and interval partial removal of an intraspinal abscess centered at T11. There is a fluid collection within the laminectomy bed which anteriorly displaces and compresses the conus.Intramedullary cord enhancement at the T11 level seems to have improved at least somewhat relative to the prior examination. More notable, however, is the significant interval reduction in spinal cord edema.


Instruction: Generate impression based on findings.

Input: Examination of participant in clinical trial [V70.7], Reason for Study: ^Reason: mets lung cancer, ALK+, brain mets -- s/p resection, now with a new brain lesion, pls c/w previous outside MRI brain to evaluate dx status. Pls provide bi-dimensional measurement. There is outside MR scan available which was performed on Jul 29 2015. Please be reminded that the imaging technique especially spatial resolution (field of view, matrix size and slice thickness) is different, direct comparison of the lesion size cannot be interpreted with caution.There is multilobulated irregularly enhancing right middle frontal gyrus intra axial mass which was measured about 16.8mm x 10.5mm on axial scan, 18.1mm x 10.4mm on sagittal scan, and 19.9mm x 11.6mm on coronal scan. The lesion was 17.3mm x 10.2mm on axial, 18mm x 10.3mm on sagittal scan, and 18.5mm x 10.9mm on coronal scan. Considering the difference in imaging parameters, there is no significant interval change in terms of maximum diameter in each scan direction.However, it appears to be that the enhancing portion of inferolateral aspect of the lesion could be more prominent on today's scan. Again this finding could also be related to the time of Gadolinium infusion and scanning.There are, however, small nodular enhancing lesions on right posterior parietal lobe (series 11, image 11/33), left frontal deep white matter (series 11. Image 10/33) and left postcentral gyrus (series 11, image 7/33). These lesions were not seen on prior scan. The ventricles, sulci and cisterns are symmetric and unremarkable. There is no edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Right middle frontal gyrus multiloculated irregularly enhancing lesion, no significant interval change in maximum diameter compared to outside scan with possible larger portion of enhancement especially inferolateral aspect.2. Newly seen nodular enhancing lesions on the right parietal lobe, left frontal and left parietal lobe as described above.


Instruction: Generate impression based on findings.

Input: Male, 54 years old. Inability to move left shoulder. Rule out shoulder tear. Motion artifact markedly limits the examination.ROTATOR CUFF: Given the above limitations, there is high signal within the supraspinatus tendon which indicates at least a moderate to severe tendinosis. There is questionable intrasubstance tear within the supraspinatus tendon which is difficult to confirm. At least some of the fibers of the supraspinatus tendon are seen all the way to its attachment at the greater tuberosity. The infraspinatus, teres minor, and subscapularis are grossly intact.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral alignment is within normal limits. The glenoid labrum is grossly intact.BICEPS TENDON: There is nonspecific fluid around the biceps tendon. The biceps tendon is grossly intact.ADDITIONAL

Output: Markedly limited examination due to motion. There is increased signal in the supraspinatus tendon indicating a questionable intrasubstance tear which is difficult to confirm in what is at least moderate to severe tendinosis. However, at least some of the fibers of the supraspinatus tendon are intact all the way to its attachment.


Instruction: Generate impression based on findings.

Input: History of aqueductal stenosis, status post 3rd ventriculostomy-cisternostomy. There are postoperative findings related to endoscopic third ventriculostomy-cisternostomy, where there is a prominent CSF flow jet. The ventricles are unchanged in size and configuration. There are unchanged mild scattered nonspecific T2 hyperintense foci in the cerebral white matter. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is no midline shift or herniation. The skull and scalp soft tissues are unchanged. There is bilateral maxillary sinus mucosal thickening and retention cyst formation.

Output: 1. The third ventriculostomy-cisternostomy appears to be patent.2. No significant interval change in the size and configuration of the ventricular system.


Instruction: Generate impression based on findings.

Input: 58-year-old male with large necrotic liver mass. Additional history from prior reports: History of esophageal squamous cell carcinoma status post neoadjuvant chemoradiation therapy and subtotal esophagectomy in 2003. Recently found to have 5 cm necrotic liver mass. Pathology report says "poorly differentiated adenocarcinoma. Findings are not consistent with metastasis from squamous primary. Instead, a primary intrahepatic cholangiocarcinoma or metastasis from a primary pancreaticobiliary adenocarcinoma is regarded as most likely." ABDOMEN:LIVER, BILIARY TRACT: A large well-defined segment 8 lesion measures approximately 4.1 x 4.3 cm and demonstrates delayed heterogeneous enhancement with lack of enhancement centrally suggesting central necrosis. There is no associated biliary ductal dilatation. The background liver is otherwise unremarkable with no other suspicious lesions. These findings are most suggestive of cholangiocarcinoma. No evidence of local nodal disease.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: Large 4.3 cm segment 8 hepatic lesion with findings favoring cholangiocarcinoma.No other hepatic lesions or evidence of nodal disease is identified.


Instruction: Generate impression based on findings.

Input: Diagnosis: Other malformations of cerebral vesselsClinical question: AVM; please assess for RT planningSigns and Symptoms: AVMComments: Please perform MRI with SPGR | The CSF spaces are appropriate for the patient's stated age with no midline shift. There is susceptibility effect present along the left side of the tectal plate which was also present on the prior exam and is unchanged. There is a some serpiginous contrast enhancement present along the left tectal plate corresponding to patient's known arteriovenous malformation.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.Examination is performed for the purpose of imaging guidance for treatment. There is a small lesion along the left tectal plate representing an arteriovenous malformation associated with blood products.


Instruction: Generate impression based on findings.

Input: 55-year-old female with headaches and nausea and loss of consciousness. Status post fall this a.m.. Neurologically intact. Multiple small subcortical and periventricular areas of low-attenuation are not a specific all were often these findings are secondary to small vessel disease or demyelinating disease. Considering patient's age findings are more likely to represent small vessel disease. Age of these show cannot be determined on CT.No evidence of hemorrhage, mass-effect, midline shift or hydrocephalus is detected. There is subtle prominence of the basilar tip which demonstrate punctate calcification this can be result of atherosclerotic disease and vascular tortuosity the remote possibility of an aneurysm cannot be entirely ruled out. Further evaluation with an MRI and MRA is recommended to exclude acute stroke and also evaluate for possibility of aneurysm of the basilar tip.The bony density of calvarium is unremarkable. Pneumatization of paranasal sinuses and mastoid air cells also unremarkable.

Output: 1.Nonspecific white matter patchy areas of low attenuation which are suspicious for small vessel disease of undetermined age.2.No evidence of an acute posttraumatic findings.3.Slight prominence of basilar tip as detailed.


Instruction: Generate impression based on findings.

Input: Follow up pf pineal cyst and seizures. Normal EEG study for age obtained in awake and drowsy states on 12/30/14. There is no significant interval change in the cystic pineal gland, which measures up to 10 mm. There is peripheral linear enhancement, but no nodular enhancement within the pineal gland. There is no evidence of intracranial hemorrhage or acute infarct. The brain parenchyma appears unremarkable. The pituitary gland is intact. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable. However, there is mild scattered paranasal sinus mucosal thickening.

Output: 1. Unchanged cystic pineal gland.2. No potential seizure foci are apparent.3. Findings suggestive of sinusitis.


Instruction: Generate impression based on findings.

Input: Hypertensive emergency [I16.1] / Abnormal findings on diagnostic imaging of skull and head, not elsewhere classified [R93.0], Reason for Study: ^Reason: patient with lesion on head CT that cannot be ruled out as hemorrhage, eval for hemorrhage vs meningioma There is about 8.4 mm sized well-circumscribed lesion of the left with right cerebellar hemisphere. Due to the patient motion artifact, the lesion is not conspicuous on either sagittal T1 weighted image or T2 coronal scan. There is no evidence of associated susceptibility artifacts of the lesion, thus the lesion is unlikely to contain blood products. There is no evidence of associated surrounding edema.Constellation of above findings indicate likely represent such as tentorial based meningioma instead of intra-axial lesion. If clinically indicated, contrast enhanced MRI scan weight the thin section T2 coronal scan can be considered for further imaging evaluation.There is no evidence of acute ischemic lesion.There are multifocal encephalomalacia seen on bilateral basal ganglia.There are scattered bihemispheric multiple susceptibility lesions indicate chronic hemosiderin deposition or parenchymal mineralization.The ventricles, sulci and cisterns are unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. About 0.8mm sized well circumscribed lesion overlapped with right cerebellar hemisphere likely represent extra axial lesion such as tentorial meningioma. However, small cerebellar intra axial mass lesion cannot be completely excluded. Gad enhanced MRI with thin section T2 coronal scan can be considered if clinically indicated.2. Multiple encephalomalacia with multifocal parenchymal hemosiderin deposition.3. No evidence of acute ischemic or hemorrhagic lesion.


Instruction: Generate impression based on findings.

Input: Hearing loss and right cochlear implant, which was partly removed for the MRI exam. Internal Auditory Canal: There is right retrosigmoid and mastoid air cell fluid related to recent removal of a portion of the right cochlear implant components, with electrodes that remain within the right cochlea. Otherwise, there is no evidence of gross inner ear anomalies bilaterally and the bilateral cranial nerve 7 and 8 complexes are intact. There is no evidence of mass lesions. The inner ear structures, including the cochlea, vestibule, endolymphatic duct, and semicircular canals, appear unremarkable. The left mastoid air cells and middle ears appear unremarkable.Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain, brainstem, cerebellum, 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 are grossly unremarkable. There are secretions in the right anterior ethmoid sinuses.

Output: Findings related to recent removal of a portion of the right cochlear implant components, but no evidence of cochlear nerve deficiency or gross structural brain anomalies.


Instruction: Generate impression based on findings.

Input: Bloating and abdominal pain. Evaluate for small bowel inflammation. 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: No significant abnormality noted.BOWEL, MESENTERY: There is mild bowel wall thickening of the terminal ileum (series 6, image 26), with enhancement and restricted diffusion, compatible with enteritis. The remaining bowel is unremarkable. There is no evidence of fistula, abscess or stricture.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Mild enteritis involving the terminal ileum. No abscess, fistula or stricture identified.


Instruction: Generate impression based on findings.

Input: Other congenital malformations of spine, not associated with scoliosis [Q76.49], Reason for Study: ^Reason: evaluate T10 lucency History: incidental finding on CT Due to patient's motion and inability to stay in MR scanner, this examination is limited.There is no evidence of abnormal MR signal intensity of T10 vertebral body on this limited scan. In particular, there is no evidence of bone marrow edema or evidence of compression fracture or surrounding soft tissue.There are thickening of bilateral posterior pleural spaces indicating pleural effusions.There is normal thoracic kyphosis. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. The epidural space, thecal sac, and spinal cord are preserved with no evidence of spinal canal/neural foraminal narrowing, cord compression, or myelopathy. The conus medullaris terminates at the L1 level.

Output: 1. Limited exam.2. No evidence of abnormal signal intensity on T10 vertebral body on this scan. No bone marrow edema, no compression fracture of T10 are seen. 3. No evidence of abnormal soft tissue lesion around the T10 vertebral body. Comment: if clinically indicated, bone scan for further imaging investigation or bone biopsy can be considered for further evaluations.


Instruction: Generate impression based on findings.

Input: 51-year-old female with left knee pain, evaluate for meniscal tear. MENISCI: The lateral and medial menisci are intact with no evidence of meniscal tear.ARTICULAR CARTILAGE AND BONE: There is marked loss of cartilage in the patellofemoral compartment. There is generalized thinning of the medial facet and complete loss of cartilage of the lateral facet with underlying bone marrow edema.LIGAMENTS: The anterior cruciate ligament, posterior cruciate ligament, medial collateral ligament, and lateral collateral ligament complex are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: Marked cartilage loss of the patellofemoral compartment as described above.


Instruction: Generate impression based on findings.

Input: 58 years Female (DOB:8/15/1958)Reason: preop planning for tumor resection History: headachesPROVIDER/ATTENDING NAME: BAKHTIAR YAMINI BAKHTIAR YAMINI The CSF spaces are appropriate for the patient's stated age with no midline shift. There is redemonstration of a mass centered in the right temporal lobe with peripheral enhancement and the nodular areas measuring approximately 56 x 33 mm axial dimensions which appears similar in size relative to the previous exam. There is surrounding T2 and FLAIR signal hyperintensity. There is associated mass effect with mild uncal herniation. The patient status post right temporal lobe surgery. There is several millimeters midline shift presentNormal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Examination was performed the purpose of stereotactic guidance for surgery and is limited for that purpose. There is a right temporal lobe mass present associated with mass effect with mild uncal herniation as well as mild transtentorial herniation. There is several millimeters midline shift present


Instruction: Generate impression based on findings.

Input: MRI Brain:There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mild periventricular and subcortical white matter T2/FLAIR hyperintensity, which is nonspecific but likely related to mild chronic small vessel ischemic disease. These changes are slightly progressed since prior study from 2007. 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. There is mild scattered paranasal sinus opacification.MRA Brain: The intracranial internal carotid arteries demonstrate no significant stenosis. The middle and anterior cerebral arteries are also patent. The vertebral arteries, basilar artery, and posterior cerebral arteries also are patent with no significant stenosis. No evidence of aneurysms or vascular malformations. MRA Neck: There is a separate origin of the left subclavian artery, left common carotid artery, and brachiocephalic artery from the arch. The common carotid arteries and cervical internal carotid arteries are normal in course and caliber. Both vertebral artery origins are patent. There is no evidence of stenosis or occlusion.

Output: 1.No evidence of acute infarct, edema or mass effect.2.No significant stenosis involving the intracranial arteries or arteries of the neck.3.Mild chronic small vessel ischemic changes, which have progressed since prior MRI from 2007.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Female, 61 years old, with left arm weakness and right leg decreased pin prick, left arm and left leg weakness with hypotonia/hyperreflexia in the left arm. Brain:One or two scattered foci of T2 hyperintensity are evident within the cerebral hemispheres. No parenchymal edema or mass effect is detected. No restricted diffusion is seen. No pathologic parenchymal or extra-axial enhancement is observed. No evidence of intracranial hemorrhage or abnormal extra-axial fluid collection is seen. The ventricles are normal in size and morphology. A 4 mm focus of enhancement within the left aspect of the occipital bone is nonspecific. Elsewhere, signal characteristics of the marrow are unremarkable. A mucous retention cyst is present in the right maxillary sinus.Cervical spine:A T2 heterogeneous, homogeneously enhancing extra medullary mass is present within the left aspect of the spinal canal centered at C5. This lesion occupies approximately two thirds of the spinal canal and causes significant is compression of the adjacent spinal cord. Edema tracks within the spinal cord from the C3 level down to C7.The tumor itself extends craniocaudally within the spinal canal spanning from the mid C4 to the upper C6 levels. The inferior most margin of this lesion is T2 hypointense which may reflect mineralization or blood product. The lesion extends through the left C4-5 neural foramen, and even tracks for some distance laterally into the paraspinal musculature, likely following the course of the exiting nerve roots. The left vertebral artery abuts this lesion as it passes adjacent to the foramen and may be narrowed but the flow void does seem to be preserved.A small deposit of abnormal enhancing tissue is also seen within the left aspect of the thecal sac at the C4 level. This lesion is perhaps contiguous with minimal suspected tumor within the adjacent left C3-4 neural foramen.The cervical vertebral bodies demonstrate mildly heterogeneous marrow signal characteristics with scattered small areas of nonspecific marrow enhancement. Some or all of this may reflect degenerative disk disease prominently affecting the C4, C5 and C6 disk spaces and endplates.The cervical lordosis is reversed. Vertebral body heights are preserved. Vertebral morphology, accounting for degenerative disease, is otherwise unremarkable.C2-3: No spinal canal stenosis or neuroforaminal narrowing. C3-4: Left paracentral disk osteophyte or perhaps thickened PLL causing mild mass effect on the ventral spinal cord. No significant generalized spinal canal stenosis. Cord signal is abnormal at this level due to tracking edema from below. The neural foramina are not significantly narrowed, allowing for the suspected tumor involvement of the left C3-4 foramen. C4-5: Right paracentral disk osteophyte or thickened PLL. In combination with intracanalicular tumor, there is a severe spinal canal stenosis with marked cord compression and cord edema. Mild bilateral foraminal narrowing is seen along with tumor infiltration of the left C4-5 foramen.C5-6: Central disk osteophyte or thickened PLL. In combination with intracanalicular tumor, there is a severe spinal canal stenosis with cord compression and edema. Moderate right and mild left neuroforaminal narrowing. C6-7: Central disk osteophyte or thickened PLL. No significant spinal canal or neuroforaminal stenosis.C7-T1: Unremarkable. Thoracic spine:A marrow replacing, homogeneously enhancing lesion is evident within the T1 vertebral body without evidence of epidural or extraosseous extension. Similar appearing smaller lesions are also seen within the left T4 vertebral body and pedicle, the left T7 pedicle and minimally scattered through the T5, T8, T9 and T10 vertebral bodies.At T11, significant marrow replacement and enhancement is seen within the left aspect of the vertebral body, pedicle and facet complex. The vertebral body is compressed centrally with at least 60% loss of height. Significant epidural disease extension is noted with encroachment upon the left lateral and ventral epidural space. This results in mild displacement of the spinal cord but no definite evidence of spinal cord compression or edema.A large lesion is also demonstrated within the T12 vertebral body without extraosseous spread or loss of vertebral body height. The partially visualized L1 vertebral body is also diffusely infiltrated and compressed. There is likely some epidural disease extension at this level as well, but it is only partially visualized.Except as discussed above, the thoracic spinal canal is patent. The spinal cord itself demonstrates normal morphology and signal characteristics. No pathologic intramedullary or leptomeningeal enhancement is clearly seen. No significant degenerative disk disease is identified. The left T10-11 and T11-12 neural foramina are mildly narrowed due to the epidural encroachment from T11.Tumor deposits are seen within the right supraclavicular fossa and right axilla. A tumor deposit is also evident within the left paraspinal musculature at the L1 level. This lesion protrudes into the abdominal cavity perhaps exerting slight mass effect on the adjacent left kidney.

Output: An extramedullary, intracanalicular tumor is present centered at C5 spanning from C4 to C6. This lesion causes a severe cord compression with evidence of tracking cord edema.The above lesion extends in infiltrative fashion through the left C4-5 neural foramen into the adjacent paraspinal soft tissues. A small deposit of tumor is also suspected within the left lateral aspect of the spinal canal and left neural foramen at C3-4.Numerous tumor deposits are evident within the thoracic spine. At the T11 level, this is associated with significant epidural extension which causes spinal canal narrowing and a mild rightward displacement of the spinal cord but no frank cord impingement. A compression fracture of T11 is seen, as well as at L1.Soft tissue tumor deposits are evident in the right supraclavicular fossa, the right axilla and within the deep left paraspinal musculature at L1.No evidence of intracranial metastatic disease is seen.All the above lesions most likely represent metastatic disease from either the known breast or endometrial cancers. This constellation of findings would be a very atypical presentation for the patient's multiple myeloma, and this is therefore considered less likely.


Instruction: Generate impression based on findings.

Input: Reason: Right occipital meningioma; F/U History: Visual disturbance The CSF spaces are appropriate for the patient's stated age with no midline shift. The patient is status post right occipital craniotomyThere is redemonstration of a 20 x 15 mm axial dimension and 34 x 12 mm coronal dimension extra-axial mass adjacent to the medial aspect of the right occipital lobe which is centered within the superior sagittal sinus. The adjacent flow void of the superior sagittal sinus appear significantly narrowed but not defintively obstructed. On susceptibility imaging there are punctate signals of hypointensity within this mass. There is homogeneous enhancement following gadolinium administration. There is a small focus of enhancement which appears to extend into the an adjacent sulcus at the right occipital lobe. Compared to the 9/29 /2009 exam this has not changed in sizeThere is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Findings are compatible with residual right parafalcine meningioma without no significant change in size compared to previous exams. The adjacent superior sagittal sinus is significantly narrowed but does not appear to be obstructed at this time.2.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: 54-year-old female with history of bilateral lumpectomies in 2003 for infiltrating ductal carcinoma and received radiation and chemotherapy, presents for breast MRI to evaluate newly diagnosed left breast cancer. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.A scar from prior surgery is present at upper inner aspect in the right breast and lower outer aspect in the left breast.In the left at 12 o'clock position, there is a regional non mass enhancement, measuring 20 x 17 x 24 mm (AP x LR x CC), which is a biopsy proven malignancy. A marker clip is present at the central aspect of this lesion.No abnormal enhancement is seen in right breast. No abnormal lymph nodes are identified in either axillary region.Probable liver cyst in the right lobe.

Output: 1. Biopsy proven left breast cancer.2. No MR evidence for malignancy in the right breast or either axilla.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Vomiting, unspecified [R11.10] / Headache [R51], Reason for Study: ^Reason: r/o obstruction - mass or Chiari malformation History: persistent and emesis, slightly abnormal CT No evidence of acute ischemic or hemorrhagic lesion.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: No evidence of acute ischemic or hemorrhagic lesion.


Instruction: Generate impression based on findings.

Input: Lumbar radiculopathy: radiating pain down left leg. There are annular fissures and small disc central protrusions at L4-5 and L5-S1 and mild bilateral facet hypertrophy with slight narrowing of the bilateral neural foramina at these levels, but no significant spinal canal stenosis. There is no significant spinal canal or neural foraminal stenosis at the other lumbar spine levels. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable. There are adnexal cysts that are likely functional.

Output: Annular fissures and small disc central protrusions at L4-5 and L5-S1 and mild bilateral facet hypertrophy with slight narrowing of the bilateral neural foramina at these levels, but no significant spinal canal stenosis.


Instruction: Generate impression based on findings.

Input: New neuro deficits in patient with history of right basal ganglia and thalamic hyperintense signals, status post brain biopsy, now with new unequal pupils and diplopia (partial Parinaud syndrome). There are postoperative findings related to prior right transfrontal biopsy. There is decreased T2 hyperintensity in the right basal ganglia, cerebral peduncle, and pon. However, there is a new, mildly expansile, infiltrative, T2 hyperintense lesion involving the left posterior limb of the internal capsule and midbrain with patchy enhancement, which resembles the previous lesion in this region. There is no evidence of acute intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable. There is mild scattered paranasal sinus mucosal thickening.

Output: Interval decrease in size of the lesion involving the right basal ganglia, cerebral peduncle, and pons, but new left internal capsule and midbrain lesion with patchy enhancement. The constellation of findings may represent an inflammatory process or perhaps an atypical infectious encephalitis. Although potentially nonspecific, MR spectroscopy may provide additional insights.


Instruction: Generate impression based on findings.

Input: Neck enlarged. Assess thyroid. RIGHT LOBE MEASUREMENTS: 4.8 x 2.9 x 2.7 cmLEFT LOBE MEASUREMENTS: 3.4 x 1.9 x 1.8 cmISTHMUS MEASUREMENTS: 0.6 cmRIGHT LOBE: Markedly heterogeneous with a solitary brightly echogenic and partly complex nodule measuring 1.7 x 1.6 x 1.5 cm. This is slightly irregular in shape with questionable microcalcifications. It would be amenable to FNA if desired clinicallyLEFT LOBE: Heterogeneous with no focal lesionsISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Solitary, slightly complex nodule in the right lobe. This would be amenable to FNA if desired clinically


Instruction: Generate impression based on findings.

Input: Reason: Hx of clear cell ovarian cancer s/p TAH BSO, mildly dilated appendix, low mucinous neoplasm of the appendix vs chronic appendicitis ABDOMEN:LIVER, BILIARY TRACT: Normal hepatic morphology. The liver demonstrates normal parenchymal signal intensity and enhancement. Segment 7/8 mildly T2 hyperintense lesion has peripheral nodular enhancement and progressive fill-in and is compatible with a hemangioma. There are scattered small T2 hyperintense foci in the liver compatible with cysts.The hepatic vasculature appears patent.No biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small bowel is normal caliber and course. The colon is nondistended. A tubular structure which appears to be the appendix is dilated up to 10 mm (series 14, image 27) and demonstrates mild wall thickening and increased enhancement, not significantly changed compared to the 7/8/2016 examination. No adjacent surrounding inflammatory changes are identified.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Status post hysterectomy.BLADDER: No significant abnormality noted. LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Please see aboveBONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Non-specific mildly dilated appendix with wall thickening, not significantly changed.


Instruction: Generate impression based on findings.

Input: Left sensorineural hearing loss and tinnitus. Also confused status post ECT. The bilateral cranial nerve 7 and 8 complexes are intact. There is no evidence of mass lesions. The inner ear structures, including the cochlea, vestibule, endolymphatic duct, and semicircular canals, appear unremarkable. The bilateral mastoid air cells and middle ears also appear unremarkable. There is a punctate focus of restricted diffusion in the left hippocampus. There are also punctate left hippocampal remnant cysts. There is also mild nonspecific periventricular white matter T2 hyperintensity. The brain otherwise appears unremarkable.

Output: 1. No evidence of retrocochlear lesions.2. A punctate focus of restricted diffusion in the left hippocampus may represent global transient amnesia.


Instruction: Generate impression based on findings.

Input: 35-year-old male with a history of Crohn's disease status post ileocecectomy. Presents with abdominal pain. ABDOMEN:LIVER, BILIARY TRACT: Large dependent gallstone without evidence of acute cholecystitis. No intra-or extrahepatic biliary ductal dilation. Subcentimeter hepatic cyst, unchanged.SPLEEN: Small splenule.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: Postsurgical changes consistent with the stated history of ileocecectomy. There is wall thickening and enhancement of a long segment of the neoterminal ileum, measuring approximately 4.0 cm in length, consistent with acute on chronic fibro-stenotic disease. There is prestenotic dilatation of the distal ileum proximal to this area of active disease. There is mesenteric hyperemia in the surrounding area. Again seen is a complex fistulous network in the right lower quadrant, involving multiple loops of distal ileum, appearing similar to the prior study. No fluid collection is identified to suggest abscess formation.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Acute fibro-stenotic disease involving the neo-terminal ileum with measurements provided above. Again seen is a complex fistulous network in the right lower quadrant involving multiple loops of distal ileum. No evidence of abscess formation.


Instruction: Generate impression based on findings.

Input: 71-year-old male with acute altered mental status. Evaluate for intracranial hemorrhage. There is no evidence of intracranial hemorrhage, mass or edema. No evidence of acute cortical ischemia. Multifocal regions of patchy low attenuation throughout the periventricular and subcortical deep white matter, nonspecific, however most likely secondary to small vessel ischemic disease, age indeterminate. If there is clinical concern for acute ischemia, an MRI may be considered.Focal region of encephalomalacia along the left temporoparietal region, not grossly changed compared with the previous examination of 4/23/2005.The ventricles and basal cisterns are mildly enlarged secondary to volume loss.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. No evidence of acute cortical infarction. Left temporoparietal encephalomalacia secondary to previous infarction. Diffuse white matter change most likely secondary to small vessel ischemic disease, age indeterminate. If there is clinical concern for acute ischemia, an MRI may be considered.3. No evidence of intracranial hemorrhage.


Instruction: Generate impression based on findings.

Input: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are no areas of abnormal parenchymal signal. There is no abnormal intracranial enhancement. Prominence of the cortical sulci is compatible with cerebral volume loss. The ventricles 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 unremarkable. Trace mucosal thickening is present within the paranasal sinuses. The midline structures and craniocervical junction are within normal limits. There is a subcentimeter homogeneously T2 hyperintense lesion within the left palatine tonsil only included on the T2 coronal sequence which likely represents a mucous retention cyst.

Output: No evidence of metastatic disease.


Instruction: Generate impression based on findings.

Input: Recurrent laryngeal malignancy. Status post radiation treatment and multiple laryngeal procedures at outside hospital.Additional clinical history from electronic medical records: Recurrent laryngeal cancer; status post radiotherapy in 2012. He presented in February 2016 with a right neck mass resection of which showed squamous carcinoma with extracapsular extension. This may represent metastasis/recurrence of the original laryngeal carcinoma or may represent nodal metastasis from new head and neck primary cancer. There is a tracheostomy as well as changes of previous total laryngectomy. There is a pectoralis major flap in the right side of the neck. There is nodular contrast enhancement along the superior margin of the flap extending posterior and medial to the right parotid gland into the parapharyngeal space, which is the site of the most recently resected nodal mass. However, there is no discernible mass and there was no significant FDG activity in this region on the recent PET CT scan. Additionally, the medialized retropharyngeal course of the right internal carotid artery is probably also contributing to the asymmetric contrast enhancement in the area. There is no discrete cervical lymph node enlargement. Small, left more than right level 1B lymph nodes and tiny level 1A lymph nodes are not changed from the previous CT scan and showed only mild FDG activity on the recent PET/CT scan.There is slight asymmetric right-sided mucosal thickening along the upper end of the neopharynx but no discrete mass, which correlated with FDG avidity on the recent PET. This asymmetry also extends along the right side of the base of the tongue. An eccentric atheroma, versus intramural hematoma, involves the right common carotid artery and is not significantly changed compared to the previous CT scan, resulting in moderate stenosis. The right internal jugular vein is not visualized, probably ligated.Otherwise, the thyroid and major salivary glands are unremarkable. The cervical spinal canal is developmentally narrow. There is multilevel cervical degenerative spondylosis, most pronounced at C6-C7 where disc-osteophyte complex and ligamentum flavum thickening result in mild-to-moderate spinal canal stenosis. Focal marrow abnormality subjacent to the inferior endplates of C3 and C6 most probably represent intrabody disc herniations. There is no suspicious marrow lesion. There is fatty atrophy, increased STIR signal and contrast enhancement in the right hemitongue and the right trapezius muscle. There is small volume of fluid within the posterior naso/oro/neopharynx. There is mild mucosal thickening in the paranasal sinuses. There is fluid intensity in the right mastoid air cells. The imaged intracranial structures are unremarkable.

Output: 1.Contrast-enhancement posterior and deep to the right parotid gland, at the site of the recent nodal resection, is favored to be postoperative in nature given the lack of a discrete mass as well as the lack of significant FDG activity on the recent PET. 2.Asymmetric right-sided thickening in the oropharynx/upper neopharynx without a discrete mass might be inflammatory/postoperative in nature but is better assessed clinically. 3.Otherwise, expected postoperative changes are present in the neck as described above. 4.Small level 1 lymph nodes remain unchanged. No cervical lymph node enlargement by size criteria.5.Incidental finding of right carotid artery mural hematoma relating to dissection versus asymmetric atherosclerotic plaque, resulting in more than 50% luminal narrowing but unchanged since February 2016 examination.6.Right hemitongue and trapezius muscle abnormal signal and enhancement, likely relating to denervation of 11th and 12th cranial nerves.


Instruction: Generate impression based on findings.

Input: 14-year-old male with soft tissue sarcoma of the left thigh status post resection. Evaluate for disease recurrence.EXAMINATION: MRI left femur without and with IV contrast 12/14/2016 There is near complete interval resolution of linear enhancement along the surgical bed within the rectus femoris and left vastus lateralis muscles. Again noted are foci of susceptibility artifact in the subcutis tissues as well as within the muscles. There is associated minimal enhancement with correlative subtle T2 signal hyperintensity in the rectus femoris and medial aspect of the vastus lateralis muscles adjacent to the surgical bed. There is no evidence of tumor recurrence.The underlying femur is normal.

Output: 1.Evolution of postsurgical changes in the soft tissues of the anterior thigh without evidence of tumor recurrence.2.Increased T2 signal intensity and subtle enhancement of the rectus femoris and medial aspect of the vastus lateralis adjacent to the surgical bed is nonspecific and raises question of myositis.


Instruction: Generate impression based on findings.

Input: 45-year-old male with maxillary sinus cancer. To status post chemo. Evaluate disease compared to the prior study. CT of the soft tissues of the neck.A very large destructive mass within the bilateral ethmoid sinuses with extension bilaterally into the orbits (right greater than left with significant mass-effect on the optic nerve), sphenoid sinus, nasal cavity, right maxillary sinus with extensive bony destruction is again identified. The mass at the level of skull base causes erosion and extends into bilateral subfrontal extra-axial space. No definitive evidence of any parenchymal edema is detected. In comparison with the prior exam no appreciable interval change in the size of this tumor is detected. The mass on the right involves the right pterygopalatine fossa. No abnormality of the cavernous sinus can be detected on this exam. If this area needs to be further evaluated an MRI examination is recommended.Images through the rest of the soft tissues of the neck demonstrate no pathologic adenopathy.No evidence of spinal column abnormality is detected.Limited images through the apices of the lungs are negative. Limited view of mediastinum is negative for lymphadenopathy. Please review the dictated report of CT of chest performed the same date.CT of brain with infusion.Enhancing mass in bilateral subfrontal region secondary to spread of tumor into the intracranial spaces noted. No areas of vasogenic edema of the frontal lobes is detected. No evidence of enhancement of the brain parenchyma or the leptomeninges is identified. The brain parenchyma remains essentially within normal limits.

Output: 1.No definitive evidence of any appreciable change in in the size, morphology or pattern of enhancement of a large destructive mass in bilateral ethmoid air cells, sphenoid sinus, skull base, nasal cavity and right maxillary sinus.2.Bilateral subfrontal tumor spread with no evidence of edema or leptomeningeal enhancement all frontal lobes.3.Unremarkable CT I examination of brain parenchyma and leptomeninges.


Instruction: Generate impression based on findings.

Input: Evaluate optic glioma, any evidence of hypothalamic tumor: girl with NF1 and premature adrenarche. Orbits: There is diffuse enlargement of the bilateral intraorbital and canalicular segments of the optic nerves, measuring up to 5 mm in thickness on the right and 7 mm in thickness on the left. However, there is no associated abnormal enhancement. The other intraorbital contents are unremarkable bilaterally.Brain: There is mild enlargement of the post-chiasmatic segments of the bilateral optic nerves in continuity with the more anterior involvement. However, the hypothalamus appears to be intact. There is an ovoid T2 hyperintense lesion in the right body of the corpus callosum that measures up to 10 mm. There are also unchanged patchy areas of T2 hyperintensity in the bilateral cerebellar hemispheres, as well as in the brainstem, and perhaps in the thalami. There is no evidence of associated abnormal enhancement, however. The pituitary gland is unremarkable. There is an unchanged cavum velum interpositum cyst. The ventricles are otherwise normal in size and configuration. There is no midline shift or herniation. The left internal carotid artery flow void is diffusely diminutive. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There are retained secretions in the left petrous apex air cells.

Output: 1. Bilateral optic gliomas without evidence of hypothalamic involvement.2. Multiple unchanged supratentorial and infratentorial lesions also likely represent stigmata of neurofibromatosis type 1.3. Diffuse stenosis of the left internal carotid artery is also likely associated with neurofibromatosis type 1. Dedicated vascular imaging of the head and neck may be useful for further evaluation.


Instruction: Generate impression based on findings.

Input: Clinical question to be answered coned rule out intracranial process. Signs and symptoms: Newborn with apnea. Poor quality exam secondary to extensive motion artifact. No definitive abnormalities detected. However poor quality of examination can obscure subtle findings. Repeat exam or an MRI is recommended. No evidence of hemorrhage, edema, mass-effect, midline shift or hydrocephalus. No definitive calvarial abnormality.

Output: No gross abnormality in this limited examination of brain due to extensive motion.


Instruction: Generate impression based on findings.

Input: Reason: STROKE History: STROKE There is a focus of diffusion restriction in the left lateral thalamus compatible with an acute infarct. There is mild associated increased T2 signal without susceptibility to suggest hemorrhage. There are additional scattered areas of increased T2 signal/encephalomalacia without diffusion restriction, particularly in the occipital lobes, right greater than left, bilateral medial thalami, left putamen and bilateral cerebellum, right greater than left which are likely due to chronic ischemia. There is volume loss and gyriform T2 signal associated with the occipital lesions with some increased signal on T1-weighted images, likely reflecting laminar necrosis. Small foci of susceptibility are present within the occipital lesions as well as within the left anterior thalamus, likely reflecting chronic microhemorrhage.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. Chronic deformity of the medial wall of the left maxillary sinus.

Output: 1.Acute lacunar infarct in the left thalamus.2.Multifocal infratentorial and supratentorial areas of abnormal T2 signal likely represent chronic infarcts, most prominent in the occipital lobes bilaterally.


Instruction: Generate impression based on findings.

Input: Brain: There is a 30 mm diameter smooth, incomplete peripherally-enhancing, cystic left temporoparietal lesion with surrounding confluent T2 hyperintensity. There is disproportionate paucity of mass effect for the size of the lesion. There are also multiple, greater than 10, subcentimeter periventricular and pericallosal T2 hyperintense white matter lesions. Some of these lesions demonstrate patchy enhancement. There is no evidence of acute hemorrhage or infarction. The ventricles and sulci are within normal limits. There is no midline shift or mass effect. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. Cervical Spine: The spinal cord displays normal signal. There is normal cervical lordosis. The cervical spine alignment is anatomic. The vertebral body heights are preserved. The bone marrow signal is unremarkable. There is mild degenerative spondylosis at C3-4 through C5-6, with mild spinal canal, but no significant neural foraminal narrowing. The paraspinal soft tissues are unremarkable. There is no evidence of abnormal enhancement, cord compression or mass.

Output: 1. Multiple periventricular and pericallosal white matter lesions, including enhancing lesions, likely represent a demyelinating process with acute inflammatory lesions. A large, smooth, incomplete peripherally-enhancing, cystic left temporoparietal mass with surrounding vasogenic edema may represent an associated pseudotumor cystic demyelinating plaque in the setting of other demyelinating lesions. Neoplasm is a less likely differential consideration.2. No evidence of cervical spinal cord lesions.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Pseudotumor cerebri, neck pain, shunt, evaluate for changes There is straightening of the normal cervical lordosis. The alignment of the cervical spine is normal. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis or neural foraminal narrowing at any level. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable. The imaged posterior fossa is within normal limits. The cerebellar tonsils are normal position.

Output: Essentially normal MRI cervical spine without findings to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: Artifact from the right frontal ventriculostomy catheter partially obscures adjacent structures. Within this limitation, the following observations can be made. There is no restricted diffusion to suggest acute ischemic infarction involving visualized intracranial structures. A right frontal ventriculostomy catheter is present with the tip in the body of the right lateral ventricle. There is no evidence of intracranial mass or hemorrhage. There is redemonstration of multiple punctate foci of high T2 signal within the subcortical and periventricular white matter appearing similar to 4/6/2011. Compared to the 4/12/2013 CT, the lateral ventricles are no longer collapsed but are not significantly enlarged. The basal cisterns remain patent. There is no midline shift or herniation. There is no abnormal intracranial enhancement. The major cerebral flow voids are intact. The midline structures and craniocervical junction are within normal limits.

Output: 1.Exam limited by artifact due to right ventriculostomy catheter.2.No evidence of metastases.3.Slight increase in size of lateral ventricles compared to 4/12/2013 without ventriculomegaly, with stable ventriculostomy catheter.4.Nonspecific nonenhancing cerebral white matter signal abnormality appearing similar to 4/6/2011 which can be seen with migraine, demyelinating disease, and microangiopathy.


Instruction: Generate impression based on findings.

Input: 23-year-old male with wrist pain and suspected scapholunate disruption/tear. LIGAMENTS: No intra-articular contrast traversing the scapholunate ligament or within the radiocarpal joint is identified to suggest ligamentous disruption.TRIANGULAR FIBROCARTILAGE COMPLEX: The triangular fibrocartilage appears intact. TENDONS: No significant abnormality noted. BONES: Note is made of findings compatible with negative ulnar variance. There is mild diffuse increased bone marrow signal abnormality affecting the lunate, which may represent bone marrow edema.ADDITIONAL

Output: 1. Mild bone marrow edema affecting the lunate without evidence to suggest disruption of the scapholunate ligament, as clinically questioned. 2. Negative ulnar variance.


Instruction: Generate impression based on findings.

Input: 17-year-old female with history of lateral knee pain status post injury MENISCI: The medial and lateral menisci are intact.ARTICULAR CARTILAGE AND BONE: The articular cartilage is within normal limits, with no significant thinning or clefts. Abnormal high T2 signal intensity of the lateral tibial plateau suggests bone marrow edema and possible bone contusion. However, there is no linear abnormal T1 signal intensity to suggest fracture.LIGAMENTS: The cruciate and collateral ligaments are intact. Small amount of abnormal high T2 signal intensity over the distal insertion of the lateral collateral ligament may represent edema from trauma.EXTENSOR MECHANISM: The extensor mechanism is intact, without significant joint effusion.ADDITIONAL

Output: Lateral tibial plateau bone contusion, and other findings as above.


Instruction: Generate impression based on findings.

Input: Abdominal pain, enlarged bladder seen on MRI KIDNEYS  Cortical Echogenicity: Normal   Medullary Echogenicity: Normal   Pelvicaliceal System -- SFU Grade*  Right: 0 Left: 0  Length*** Right: 6.7 cm Left: 6.3 cm   Mean for age: 7.5 cm  Range for age: 6.5 - 8.5 cmADDITIONAL OBSERVATIONS: The bladder is underdistended.

Output: Normal sonographic evaluation of the kidneys and urinary bladder.*SFU grading system: Grade 0: No hydronephrosis. Grade 1: The renal pelvis is visualized. Grade 2: A few but not all of the calices are identified in addition to the renal pelvis. Grade 3: Virtually all the calices are seen. Grade 4: Grade 3 and parenchymal thinning.Fernbach SK, Maizels M, Conway JJ. Ultrasound Grading of Hydronephrosis: Introduction to the System used by the Society for Fetal Urology. Pediatric Radiology (1993) 23: 478-480.***Rosenbaum DM, Korngold E, Teele RL. Sonographic Assessment of Renal Length in Normal Children. AJR Am J. Roentgenol (1984) 142:467-469


Instruction: Generate impression based on findings.

Input: Diagnosis: Arteriovenous malformation of cerebral vesselsClinical question: 3 t scanner please, s/p SRS for AVM 8/15/14 MRI of the brainNo diffusion weighted abnormalities are appreciated.The patient is status post left-sided craniotomy for removal of an arteriovenous malformation. Some signal changes at the surgical bed likely represent gliotic changesThere is a small tangle of flow voids present in the right perimesencephalic cistern and in the right geniculate nucleus. There is associated enhancement at the right geniculate nucleus which has decreased compared to the prior exam but is larger this focus of enhancement currently measures 13 x 6 mm axial dimensions. Than on the 11/17/2014 exam. On susceptibility there is new signal loss at the area of contrast enhancement.A punctate microhemorrhage is present in the left middle frontal gyrus. This is stable when compared to the prior examThe visualized portions of the paranasal sinuses demonstrate a small mucus retention cyst in the right maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is a small tangle of vascular structures centered in the expected location of the right geniculate nucleus associated with mild enlargement of the the thalamogeniculate branches of the right posterior cerebral artery. These are less prominent than on the previous exams.The anterior communicating artery is medium-sized. The posterior communicating arteries are small. The vertebral arteries are similar in size.

Output: 1.Status post removal of left temporal lobe arteriovenous malformation with expected post treatment change.2.Findings suggest persistence of an arteriovenous malformation centered in the right geniculate nucleus. It appears to be slightly less prominent than on prior exams. Contrast enhancement possibly related to radiation treatment has regressed. There is susceptibility effect in this region likely relating to a reaction to the radiation treatment.


Instruction: Generate impression based on findings.

Input: Female 2 years old Reason: PK deficiency, multiple blood transfusions, t2* to assess for iron overload History: multiple blood transfusions, t2* to assess for iron overload Multiple sequences in coronal and axial views of the chest and abdomen was performed only to assess iron load.There decay signal time (T2*relaxation) is on average 4.1 ms with a range of 3.3 to 5.3 ms. (Normal value is above 6.7 ms)

Output: 1.Mild liver iron load as described.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Lower extremity weakness, breast cancer. There is a T1 hypointense lesion in the right aspect of the T2 vertebra with apparent slight narrowing of the adjacent neural foramen, but no evidence of spinal cord compression. There is congenital fusion of the C3 and C4 vertebrae. There are posterior disc-osteophyte complexes at C4-5 and C5-6, which abut the anterior aspect of the spinal cord. The vertebral body heights and alignment are preserved. There are numerous liver, spleen, and bilateral lung lesions. There is also mediastinal and right lower neck lymphadenopathy.

Output: 1. A metastasis in the right aspect of the T2 vertebra with apparent slight narrowing of the adjacent neural foramen, but no evidence of spinal cord compression. Characterization is otherwise limited due to the abridged nature of the study.2. Multiple liver, spleen, bilateral lung, and lymph node metastases.3. Posterior disc-osteophyte complexes at C4-5 and C5-6 abut the anterior aspect of the spinal cord.


Instruction: Generate impression based on findings.

Input: Reason: ACL or meniscal injury? History: pain behind knee and inability to bear weight after basketball injury MENISCI: There is a 3 mm focus of fluid signal intensity within the anterior horn of the lateral meniscus, near its root, consistent with parameniscal cyst formation, indicating a small tear, likely longitudinal (image 12; series 7). The posterior horn of lateral meniscus appears intact. The medial meniscus appears intact.ARTICULAR CARTILAGE AND BONE: No full-thickness or near full-thickness articular cartilage defects are identified. No bone marrow signal abnormality is seen. There is subjective thinning of the articular cartilage along the patellofemoral articulation.LIGAMENTS: The cruciate and collateral ligaments appear intact EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Parameniscal cyst within the anterior horn of the lateral meniscus, near its root, indicating a tear.2. Elevated tibial tubercle to trochlear groove distance, which can be seen in patellofemoral instability.


Instruction: Generate impression based on findings.

Input: The patient is a 5-year-old female with history of teratoid rhabdoid tumor status post radiation. Status post VPS revision. Stable from the previous exam are craniotomy and parenchymal defects, the approximately 17 mm hyperattenuating left CP angle mass and calcification in the dentate nuclei and pons.Ventricular volumes are mildly enlarged, similar to the prior study. Right frontal shunt catheter tip terminates near midline in the right lateral ventricle. Hypoattenuation of the white matter adjacent to the ventricles could be due to transependymal edema or white matter disease secondary to treatment. A vague hyper-attenuation in the left cerebellar tonsil could be residual of the known second lesion seen on MRI. No evidence of intracranial hemorrhage. Extra-axial fluid along the posterior calvarium is unchanged.The calvaria and skull base are radiographically normal except for postsurgical changes. There is abnormal opacity in the right ethmoid and maxillary sinuses, but otherwise the visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Stable hydrocephalus and postoperative changes as described above with no evidence of intracranial hemorrhage.


Instruction: Generate impression based on findings.

Input: Left inferior ramus lesion.IMAGE ACQUISITIONS: Noncontrast CT of the pelvis was performed with standard CT protocol. There is an irregular lucency measuring approximately 1.2 cm through the left inferior pubic ramus which demonstrates sclerotic margins and slight expansile remodeling however there is no associated soft tissue mass. There is no similar findings on the contralateral side. The remainder of the visualized osseous structures are within normal limits. The visualized lower lumbar spine and sacrum also are within normal limits. Sacroiliac joints are within normal limitsThe surrounding soft tissue structures including the musculature surrounding this lucency in the left inferior pubic ramus appears within normal limits. The edema seen on outside MRI study surrounding this lesion is not appreciated on CT examination which is expected.

Output: Irregular lucency with sclerotic margins in the left inferior pubic ramus with no associated soft tissue mass is most compatible with a benign lesion. The location and imaging appearance of this finding is highly suggestive of the ischiopubic synchondrosis which represents a normal ossification process however given the patient is symptomatic, it has been described to have stress reaction or swelling of the synchondrosis. Alternatively, this could be a fracture however it is an atypical place. Much less likely and still benign in etiology, this could represent an atypical appearing eosinophilic granuloma.Given the findings are most likely secondary to a swollen ischiopubic synchondrosis, short-term follow-up CT examination in 3 to 6 months is recommended to evaluate for change or resolution of findings.


Instruction: Generate impression based on findings.

Input: 45-year-old female with hepatic adenomas. Evaluate. ABDOMEN:LIVER, BILIARY TRACT: Redemonstration of numerous well-circumscribed, enhancing masses in both lobes of the liver that do not demonstrate washout. Largest lesion is in the left lobe of the liver measuring 6.1 x 4.0 cm (series 3, image 8), unchanged.No biliary ductal dilatation. The main portal vein and its branches are patent.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Numerous stable hepatic lesions as above without washout, previously characterized as hepatic adenomas.


Instruction: Generate impression based on findings.

Input: Left wrist/hand mass Note that the examination is limited by the patient terminating the study prematurely. Also note that the patient declined administration of intravenous contrast.A marker was placed on the mass in question which is subcutaneous in nature and situated volar and radial to the second metacarpal head. The mass is isointense to skeletal muscle on T1WI while on fat-suppressed T2 images, it contains contains an area of low signal intensity centrally surrounded by a rind of high signal intensity. It measures approximately 8 mm in the greatest transverse dimension and 9 mm longitudinally and does not appear associated with any underlying tendon. A small cluster of vascular structures is noted immediately posterior to the mass suggesting the possibility of a vascular malformation with central thrombosis.Small ganglia are noted along the volar margin of the distal radius. The remaining soft tissues are unremarkable with no additional masses identified. Mild osteoarthritis affects the basilar joint and the remaining marrow signal of the hand is otherwise normal for the patient's age.

Output: Small subcutaneous mass volar and radial to the head of the second metacarpal as detailed above. Although we cannot make an exact histological diagnosis on the basis of this imaging, the possibility of a small vascular malformation is considered.


Instruction: Generate impression based on findings.

Input: Evaluate for tethered cord: achondroplasia with lumbar tuft of hair. There is gibbus thoracolumbar kyphosis with bullet-shaped and hypoplastic vertebra with progressive decrease in interpedicular distance in lumbar spine, as well as short pedicle spinal canal stenosis. The conus medullaris is situated at the T12-L1 level and appears to shift appropriately between the supine and prone positions. The vertebral bone marrow signal is unremarkable.

Output: Stigmata of achondroplasia in the imaged portions of the spine including gibbus thoracolumbar kyphosis with dysplastic vertebrae and associated short pedicle spinal canal stenosis, but no imaging findings to suggest tethered cord.


Instruction: Generate impression based on findings.

Input: 50-year-old male patient with left shoulder pain after breaking up a fight three days ago. Evaluate for cause of left shoulder pain. ROTATOR CUFF: There is increased signal intensity within the superior aspect of the subscapularis muscle along the myotendinous junction likely representing a muscle strain. Also, there is increased signal intensity within the superior tendons of the subscapularis which may represent interstitial tearing, but we see no discrete full-thickness rotator cuff injury. The muscles and tendons of the supraspinatus, infraspinatus, and teres minor are intact.SUPRASPINATUS OUTLET: There is prominence of the distal end of the clavicle. Trace fluid within the subacromial bursa is not necessarily of any current clinical significance.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral alignment is within normal limits. There is apparent detachment of the anterior/superior labrum from the underlying glenoid which may represent a normal variant foramen. We otherwise see no evidence of a labral tear given this nonarthrogram evaluation.BICEPS TENDON: The long head of the biceps tendon is intact and positioned normally within the bicipital groove. ADDITIONAL

Output: Strain injury of the subscapularis tendon with interstitial tearing, but no full-thickness rotator cuff tear.


Instruction: Generate impression based on findings.

Input: Clinical question: New onset of seizure. Signs and symptoms: As above. Pre- and post enhanced lumbar MRI:Negative diffusion weighted images.Examination redemonstrate moderately extensive periventricular and to a lesser degree subcortical, bilateral basal ganglia and minimally pontine foci of nonspecific FLAIR hyperintensity without gross interval change since prior exam. Although nonspecific the findings at this age group often are result of microvascular ischemic changes. This findings are not associated with any susceptibility signal changes and are nonhemorrhagic.There is resultant mild ex vacuo dilatation of lateral ventricle however with maintained midline.Examination fail to demonstrate findings to account for patient's seizure.Post contrast images demonstrate no detectable abnormal parenchymal or leptomeningeal enhancement. There is also normal signal intensity of the calvarium without abnormal enhancement. Unremarkable images through the orbits without enhancement.Signal void of major intracranial arterial branches are identified. The signal intensity of intracranial venous sinuses are within normal and with normal pattern of enhancement.

Output: 1.No acute intracranial process.2.Findings suggestive of chronic nonhemorrhagic small vessel ischemic strokes of moderate degree without gross interval change.3.No detectable abnormal enhancement.4.No finding to account for patient's recent seizure.


Instruction: Generate impression based on findings.

Input: Knee pain There is moderate osteoarthritis of the knee with tricompartmental joint space narrowing and osteophytosis. There is no sizable effusion. There is no malalignment.

Output: Moderate osteoarthritis of the right knee.


Instruction: Generate impression based on findings.

Input: 52 year old female with right pain, evaluate for labral tear, FAI. ACETABULAR LABRUM: There is extravasated contrast within the anterior soft tissues which is iatrogenic related to the injection. There is contour irregularity of the acetabular labrum suggestive of degenerative tearing.ARTICULAR CARTILAGE AND BONE: There is irregularity of articular cartilage of the femoral head and acetabulum with subchondral sclerosis in the femoral head and subchondral cyst formation in the acetabulum. No evidence of femoral head collapse. Bone marrow signal is otherwise normal. There are no findings suggest femoral acetabular impingement with a normal alpha angle measurement.SOFT TISSUES: As mentioned above there is extravasated contrast within the anterior soft tissues which is iatrogenic related to injection.ADDITIONAL

Output: Posterior arthritic changes of the right hip as discussed above. No evidence of femoral acetabular impingement.


Instruction: Generate impression based on findings.

Input: 38 year old with history of NICM s/p heart transplant in may 2015, hypertension, gout and pericarditis. Referred for cardiac CT to better delineate right atrial mass seen on cardiac MRI 11/17/16.CPT Code: 75574 (AP) Coronary arteries: This study was not optimized for the visualization of the coronary vasculature.LM: The left main coronary artery arises normally from the left sinus of valsalva and bifurcates into the left anterior descending and left circumflex coronary arteries. LAD: The left anterior descending coronary artery courses normally in the anterior interventricular groove. LCx: The left circumflex coronary artery courses normally in the left AV groove.RCA: The right coronary artery arises normally from the right sinus of valsalva.Left Ventricle: The left ventricular late diastolic volume is normal.Right Ventricle: Visually the right ventricular late diastolic volume is within normal limits. Epicardial pacer wires are noted on the right ventricle.Left Atrium: Visually, the left atrial volume has transplant morphology. There are five distinct pulmonary veins (3 on right, 2 on left) which drain normally into the left atrium. There is no evidence of left atrial appendage thrombus.Right atrium, vena cavae, and coronary sinus: The right atrial volume appears to be normal in size. There is a well defined/ circumscribed right atrial mass 17x15x11 mm in size with a thin stalk which is attached near the tip of the eustachian valve. Although the differential diagnosis includes a variety of cardiac masses including vegetation and myxoma, I suspect it is most likely a thrombus. It is unlikely to be a malignant tumor based on its morphology. The superior vena cava is dilated because there is azygous continuation of the inferior vena cava. The hepatic veins drain directly into the right atrium. The coronary sinus is normal in size. Valves: There is no calcification on the aortic or mitral valves.Great vessels: The visualized portions of the thoracic aorta demonstrate no evidence of dissection or aneurysm. The main pulmonary artery is normal in size.Pericardium: There is a small pericardial effusion. Epicardial pacing wires are noted.

Output: 1.There is a well defined/ circumscribed right atrial mass 17x15x11 mm in size with a thin stalk which is attached near the tip of the eustachian valve. Although the differential diagnosis includes a variety of cardiac masses including myxoma and vegetation, I suspect it is most likely a thrombus. It is unlikely to be a malignant tumor based on its morphology. The mass is new from 4/19/2016 cardiac MRI.2.The superior vena cava is dilated because there is azygous continuation of the inferior vena cava which does not drain directly into the right atrium. The hepatic veins drain directly into the right atrium. This portion of the report pertains to the heart and great vessels only. The remaining soft tissues of the thorax and upper abdomen will be interpreted by the attending chest radiologist and included as an addendum to this report.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 65-year-old male patient with cirrhosis with history of treated HCC. Status post TACE/RFA in 3/2015. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology. Area of T2 hypoenhancement compatible with RFA ablation cavity. There is a marginal nodule along the ablation cavity that measures 0.5 x 0.9 cm (series 10 image 32) that demonstrates arterial enhancement and washout on delayed images, suspicious for marginal recurrence. There is a focus less than 5 mm of arterial enhancement anteromedially to the resection cavity (series 10 image 32) that demonstrates questionable washout on delayed images.SPLEEN: Splenomegaly, measuring up to 13.5 cm in craniocaudal dimension.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: Hiatal hernia with paraesophageal and perigastric varices.BONES, SOFT TISSUES: Umbilical hernia noted.OTHER: No significant abnormality noted.

Output: 1.Cirrhotic liver morphology with findings of a small marginal recurrence along the RFA resection cavity in the right lobe as described above.2.Focus of arterial enhancement with questionable washout anteromedial to the resection cavity is too small to accurately characterize. Attention to this area on follow-up imaging is recommended.


Instruction: Generate impression based on findings.

Input: Evaluate for cauda equina syndrome, low back pain and decreased urine output Five lumbar type vertebral bodies are presumed to be present. There is moderate chronic compression fracture involving the T12 vertebral body with approximately 70% loss of height; no associated bone marrow edema or interval loss of height compared to CT 3/1/2014. There is a mild compression fracture involving the L4 vertebral body with 20% loss of height with associated bone marrow edema and new since 3/1/2014. No associated osseous retropulsion into the spinal canal. Schmorl's nodes are noted at L2 and L3 similar to prior. Alignment is maintained. Conus is in normal position and with normal signal intensity.Multilevel degenerative changes are seen with disc desiccation and vacuum phenomena throughout, better appreciated on prior CT. Bone marrow signal is heterogeneous. More focal area of edema enhancement are noted involving the right L5 pedicle which may be on a degenerative basis. There is also abnormal signal with low T1 signal, T2 hyperintensity, and enhancement involving the right L3 transverse process which may be related to recent fracture versus underlying other osseous lesion.Individual levels as below:L1-L2: There is a disc bulge without significant spinal canal or neural foraminal stenosis.L2-L3: There is loss of disc height and disc bulge with central osteophyte and protrusion component resulting in mild central canal stenosis. No significant neural foraminal stenosis. L3-L4: Minimal disc bulge eccentric to the right and loss of disc height. Mild right neural foraminal stenosis. No spinal canal or left neural foraminal stenosis.L4-L5: Minimal disc bulge and loss of disc height. There is mild to moderate right neural foraminal stenosis and minimal left neural foraminal stenosis. No spinal canal stenosis.L5-S1: Minimal disc bulge. Severe loss of disc height. No significant spinal canal stenosis. Mild bilateral neural foraminal stenosis. No findings to suggest discitis-osteomyelitis or epidural or paraspinous abscess. Subcapsular lesion along the posterior aspect of the left kidney is again seen which may be related to prior hemorrhage.

Output: 1. No high-grade spinal canal stenosis is seen at any level to suggest cauda equina syndrome.2. Multilevel degenerative changes as detailed above with mild spinal canal stenosis at the L2-L3 level.3. Mild compression fracture involving L4 with edema suggesting acuity/recent loss of height.4. Chronic compression fracture at T12.5. Edema and enhancement involving the right L3 transverse process which may be related to underlying fracture versus other osseous lesion. CT may be helpful for differentiation. There is also focal enhancement involving the right superior L5 articular facet/pedicle which is nonspecific and may be on a degenerative basis or similar to process at L3.


Instruction: Generate impression based on findings.

Input: Headache [R51], Reason for Study: ^Reason: new type of headache History: new headache No evidence of acute ischemic or hemorrhagic lesion.Multiple scattered bihemispheric high signal intensities on FLAIR/T2 images on periventricular white matter and centrum semiovale indicating nonspecific small vessel ischemic disease.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: Minimal nonspecific small vessel ischemic disease.No evidence of acute ischemic or hemorrhagic lesion.No evidence of abnormal enhancement.


Instruction: Generate impression based on findings.

Input: 65-year-old female with pelvic mass. Follow-up recurrent endometrial cancer. PELVIS:UTERUS, ADNEXA: Status post hysterectomy and oophorectomy. No recurrent mass of the vaginal cuff.Stable cystic focus in the left pelvis possibly representing a lymphocele is unchanged (axial series 4 image 27).BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy.BOWEL, MESENTERY: No bowel obstruction or ascites. Mild thickening of the rectum with mild fibrofatty proliferation, which could be related to prior radiation. No abnormal wall enhancement.BONES, SOFT TISSUES: Stable broad-based ventral hernia containing small bowel and fat.OTHER: No significant abnormality noted.

Output: 1.Status post hysterectomy and oophorectomy. No recurrent mass of the vaginal cuff. No pelvic lymphadenopathy.2.Stable cystic structure of the left pelvis most compatible with a lymphocele.3.Stable bowel and fat-containing ventral hernia.


Instruction: Generate impression based on findings.

Input: Reason: grade III oligodendroglioma, s/p RT/TMZ, 12 cycle TMZ, assess status History: grade III oligodendroglioma, s/p RT/TMZ, 12 cycle TMZ, assess status. There is redemonstration of the expansile infiltrative T2/FLAIR hyperintense lesion extending along the left pons, midbrain, and into the left thalamus. There is again no associated enhancement or diffusion restriction. There is a similar degree of lobulated extension into the mesial left temporal lobe, with localized mass effect. Compared to more recent exams, this area of abnormality is unchanged, although comparing to more remote exams suggests gradual decreased size since September 2013. However, there is now increased conspicuity of small cysts along the medial aspect of the lesion seen on 8/20-21. There is increased conspicuity of the anterior oval cyst, with emergence of a now well delineated 7 mm posterior cyst on 6/15. On perfusion imaging, there is relative hypoperfusion along the area of abnormal signal in the left brainstem and thalamus.There is redemonstration of subtle FLAIR hyperintensity along the left ventral lateral cerebellum, and questioned along the right ventral pons on T2-weighted images. The right ventral medulla also appear slightly asymmetrically prominent on 6/5 with questioned abnormal signal.Postsurgical changes including right cerebellar tissue loss appear similar to the prior exam. There has been slight interval increased number of scattered foci of susceptibility, especially along the superior frontal gyri, which may be posttreatment related. There is no pathological enhancement.The ventricles and basal cisterns prominent for age, consistent with diffuse volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact.

Output: 1. No significant recent change in size of the left brainstem/thalamic nonenhancing infiltrative mass, although overall gradually decreasing in size since baseline exam. Increased conspicuity and size of discrete cysts along the medial aspect of the lesion. Overall, is no definite associated hyperperfusion.2. Stable additional questioned areas of subtle signal and contour abnormality along the left ventral cerebellum, right ventral pons and possibly the right ventral medulla. Continued follow-up is recommended.