Instruction: Generate impression based on findings.

Input: Diagnosis: Brachial neuritis or radiculitis NOSClinical question: cervical radiculopathySigns and Symptoms: pain, numbness tingling in R arm The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There is multilevel disc desiccation present.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina. There are small uncovertebral osteophytes present at this level.At C4-5 there is no significant compromise to the spinal canal or neural foramina. There is loss of disc space height, diffuse disc bulge and endplate and uncovertebral osteophytes associated with narrowing of the neural foramina bilaterally. Overall there is no significant change compared to the previous examAt C5-6 there is no significant compromise to the spinal canal . There are bilateral uncovertebral osteophytes present at this level associated with disc material and encroachment of the exiting nerve roots within the neural foramina bilaterally. Overall this remains stable compared to the previous exam.At C6-7 there is no significant compromise to the spinal canal . Since the prior exam patient has developed the right lateral recess disc protrusion at this level associated with encroachment of the right-sided exiting nerve roots within the neural foramina. Additionally the patient has developed a smaller left lateral recess disc protrusion at this level which mildly encroaches on the left-sided exiting nerve roots.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.Since the previous exam the patient has developed new disc protrusions at C6-7 right worse than left where there is encroachment of now of the right-sided exiting nerve roots .2.There is redemonstration and no change in degenerative changes present at C3-4, C4-5 and C5-6 with bilateral encroachment of exiting nerve roots at C5-6 as well as narrowing of the neural foramina at C4-5 and C3-4


Instruction: Generate impression based on findings.

Input: Thoracic spine:There is a smooth, physiologic thoracic kyphotic curve. The vertebral body heights and disc spaces are maintained. Marrow signal intensity is benign throughout. The spinal cord has a smooth contour and is without focal atrophy, edema, or myelomalacia. There are no masses.T1/2 demonstrates no significant disc bulge or cord encroachment.T2/3 demonstrates no significant disc bulge or cord encroachment. T3/4 demonstrates no significant disc bulge or cord encroachment. T4/5 demonstrates no significant disc bulge or cord encroachment. T5/6 demonstrates no significant disc bulge or cord encroachment.T6/7 demonstrates no significant disc bulge or cord encroachment. T7/8 demonstrates no significant disc bulge or cord encroachment. T8/9 demonstrates no significant disc bulge or cord encroachment. T9/10 demonstrates no significant disc bulge or cord encroachment.T10/11 demonstrates no significant disc bulge or cord encroachment. T11/12 demonstrates no significant disc bulge or cord encroachment. T12/L1 demonstrates no significant disc bulge or cord encroachment. Lumbar spine:Alignment is anatomic. There are no fractures or subluxations. The marrow signal is benign. The conus is normal in signal and morphology and terminates at an appropriate level. The visualized intra-abdominal and paraspinal contents are unremarkable.L1/2: UnremarkableL2/3: UnremarkableL3/4: UnremarkableL4/5: UnremarkableL5/S1:There is a small central disc protrusion confined anterior epidural fat without nerve root sheath or thecal sac abutment, and no resulting stenosis.

Output: 1.Negative noncontrast thoracic spine MRI.2.L5/S1:There is a small central disc protrusion confined anterior epidural fat without nerve root sheath or thecal sac abutment, and no resulting stenosis.


Instruction: Generate impression based on findings.

Input: 45-year-old female with right knee pain. Evaluate for meniscus tear. MENISCI: The medial meniscus appears intact. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: Heterogeneous bone marrow signal abnormality most consistent with residual islands of red marrow. There is subjective thinning of the articular cartilage of the medial tibiofemoral compartment. There is relative sparing of the lateral tibiofemoral compartment. There is a focal partial thickness articular cartilage cleft along the lateral facet of the patella. There is underlying subchondral signal abnormality.LIGAMENTS: The ACL and PCL appear intact. There is thickening and increased signal intensity on fluid sensitive sequences within the proximal fibers of the superficial band of the MCL which may reflect a sprain. The MCL appears intact. The LCL appears intact.EXTENSOR MECHANISM: The extensor mechanism appears intact. There is a small amount of fluid within the deep infrapatellar bursa, which is likely of no current clinical significance.ADDITIONAL

Output: 1. Findings suggestive of patellofemoral instability with a partial-thickness articular cartilage cleft along the lateral facet of the patella.2. Findings suggestive of an MCL sprain.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate spinal anatomy for possible fusion. Signs and symptoms: Pain and weakness. Non-enhanced CT of lumbar spine:Examination redemonstrates destructive changes of the L1 vertebral body with collapse of more than 50% of one. There is fragmentation of the body of L1 vertebrae with expansion into the spinal canal posteriorly. These findings are similar to what was noted on prior MRI of lumbar spine. There is compromise of the AP diameter of thecal sac secondary to retropulsion of fragments into the canal. There is widening of the articulating facets space between T12 -- L1 and L1 -- L2 levels.There is evidence of minimal lytic changes of the inferior endplate of T12 vertebrae as well. This is result of patient's known diskitis/osteomyelitis. The T12 vertebral body and its pedicles are otherwise unremarkable.Very advanced degenerative disk disease throughout the rest of the lumbar spine with significant loss of disk height and sclerotic changes of the adjacent endplates as well as vacuum phenomenon. The alignment of vertebral column is otherwise unremarkable. There is no evidence of any abnormality of the pedicles of the lumbar spine except for partial involvement of pedicles of L1 with technique changes. Very extensive hypertrophic changes of articulating facets bilaterally are noted throughout the lumbar spine. Multilevel mild neural foramina compromise secondary to degenerative changes are suspected.Nonenhanced CT of thoracic spine:A small leak change along the inferior endplate of T12 is consistent with patient's known osteomyelitis/diskitis noted on multiple prior MRI exams. The density of vertebral column in the thoracic spine is otherwise unremarkable. There is no evidence of sclerotic or lytic changes of the rest of thoracic spine. Could the exception of hypertrophic changes no additional abnormality of the facets or the pedicles are detected.The alignment the vertebral column is within normal limits.Mild-to-moderate degenerative disk disease and hypertrophic changes of posterior elements throughout the thoracic spine is noted.

Output: 1.Lytic/destructive changes of L1 vertebrae with retropulsion of fracture body of L1 into the spinal canal and resultant central spinal stenosis. There is also lytic changes involving the anterior aspect of L1 pedicles bilaterally which is also result the patient's osteomyelitis.2.Extensive degenerative changes of lumbar spine of both disks and posterior elements and with multilevel neural frontal compromise as detailed. There is no evidence of any bony defect in the rest of lumber spine other than L1 level.3.Degenerative changes of disk and posterior elements in thoracic spine. Minimal lytic changes of the inferior endplate of T12 related to patient's known osteomyelitis. Unremarkable CT of thoracic spine otherwise.


Instruction: Generate impression based on findings.

Input: 31-year-old female with history of left triple negative breast cancer with metastatic left axillary lymph nodes status post neoadjuvant chemotherapy presenting for assessment of treatment response. Patient had bilateral breast MRI on 10/10/2016 which revealed significant reduction in size of index tumor and satellites in the left breast. Family history is positive for breast cancer in aunts on both the maternal and paternal sides. Three standard views of the left breast were performed digitally and reviewed with the aid of R2 CAD, 9.3. The breast parenchyma is extremely dense (BiRADS Density Category D), which lowers the sensitivity of mammography, unchanged in pattern and distribution. Redemonstrated wing clip at the level of the axillary tail, where index malignancy was biopsied. A Hydromark biopsy clip marker is again seen in the outer central posterior breast, at site of biopsy-proven malignant satellite lesion. The index malignancy and biopsied satellite are not well visualized on the mammogram. Clips are approximately 7.2cm apart on the ML view.Ribbon and hydromark biopsy clip markers are reidentified at site of biopsy-proven metastatic left axillary lymph node, which appears slightly decreased in size currently measuring 1.7 cm in maximum dimension, previously 2.6 cm.No suspicious microcalcifications or areas of architectural distortion are noted in the left breast. LEFT BREAST AND AXILLARY ULTRASOUND:Targeted ultrasound of the left breast 3:00 position presents clip artifact with surrounding elongated anechoic mass likely reflecting gel capsule associated with the biopsy clip. No definite residual solid mass.Targeted ultrasound of the left axillary tail reveals a 0.8 x 0.6 cm elongated hypoechoic mass (previously measuring 1.9 x 1.0 x 3.9 cm on 8/8/2016) with peripheral vascularity and eccentric biopsy clip marker artifact, at site of index malignancy.Targeted ultrasound of the left axilla reveals a 1.1 x 0.5 x 1.0 cm lymph node (previously measuring 1.6 x 0.9 cm on breast MRI dated 10/10/2016) with artifact from 2 echogenic biopsy clip markers.

Output: Interim decrease in size of index left axilla tail mass and metastatic left axillary lymph node, and sonographic resolution of malignant satellite lesion (located approximately 7.2 cm from the index malignancy). Patient is scheduled for bilateral breast MRI today and that will be separately reported.  BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Status post recent 5/23/2015 liver transplant with elevated LFTs. ABDOMEN:LIVER, BILIARY TRACT: Postsurgical changes from liver transplant. The hepaticojejunostomy is unremarkable without intrahepatic biliary ductal dilatation. No focal lesion. Along the dorsal surface of the liver extending from the porta hepatis and dorsal to the left hepatic lobe is a loculated homogeneous fluid collection measuring 14.8 x 3.1 cm.SPLEEN: Minimal peri-splenic fluid. Borderline splenomegaly. PANCREAS: The pancreas is atrophic and significantly decreased in signal intensity suggestive of iron deposition. 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: Bilateral gynecomastia.OTHER: Small right greater than left pleural effusion with adjacent compressive atelectasis.

Output: This study is limited for evaluation of solid organ and vascular pathology without intravenous contrast. No intrahepatic biliary ductal dilatation. Fluid collection extending from the porta hepatis along the dorsal surface of the left hepatic lobe, persistent and mildly increased since the CT dated 6/16/2015. If there is clinical concern for a biloma a HIDA scan may be obtained.


Instruction: Generate impression based on findings.

Input: Lateral and forefoot pain Tendons and ligaments: The visualized extensor tendons are intact. The visualized flexor tendons are intact. The peroneal tendons are intact. The Lisfranc ligament is intact. There is no subluxation or dislocation in the tarsometatarsal articulations.Joints: There is no joint effusion. There are no osteochondral lesions identified. Note is made of a type 2 accessory navicular. Alignment: There is normal alignment of the metatarsals. There is no hallux valgus deformity.Muscles: The plantar musculature is unremarkable.Bone Marrow: There is marrow edema involving the base of the fourth metatarsal which is best appreciated on series 11 image 18/43. There is no discrete fracture line evident however. Mild amount of soft tissue edema surrounds the lateral foot.

Output: Marrow edema of the base of the fourth metatarsal without definite fracture line, likely representing a stress reaction.


Instruction: Generate impression based on findings.

Input: Knee pain. Meniscal tear? MENISCI: There is blunting of the free edge of the posterior horn of the medial meniscus indicating tearing of the inner-most fibers. There is also increased signal within the posterior horn and body of the medial meniscus indicating intrasubstance degeneration with poorly defined signal extending to the blunted free edge and undersurface of the meniscus, suggesting additional degenerative tearing/fraying. The anterior horn of the medial meniscus appears intact.There is increased signal intensity within the body and posterior horn of the lateral meniscus indicating intrasubstance degeneration with extension to the tibial articular surface suggesting degenerative undersurface tearing/fraying. The anterior horn of the lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is near full-thickness to full-thickness degeneration of the articular cartilage of the medial tibial plateau just lateral to the free edge of the body of the meniscus, with degenerative edema-type signal in the underlying subchondral bone. There is diffuse thinning of the articular cartilage of the weightbearing portion of the medial femoral condyle. There appears to be full-thickness degeneration of the articular cartilage of the lateral tibial plateau posteriorly, beneath the posterior horn of the lateral meniscus. Subjectively, the articular cartilage of the patella appears thinned, with more focal superficial degeneration of the articular cartilage of the medial facet. There is also a partial thickness cleft of the articular cartilage of the femoral trochlea, best seen on the sagittal sequences.LIGAMENTS: The cruciate and collateral ligaments appear intact. A small amount of edema along the superficial band of the medial collateral ligament may simply be secondary to underlying medial compartment pathology. There is increased signal intensity within the meniscofemoral ligament of Wrisberg which may reflect degeneration. EXTENSOR MECHANISM: The extensor mechanism is intact. There is edema within the subcutaneous fat anterior to the patellar tendon that is nonspecific.ADDITIONAL

Output: 1.Meniscal degeneration and degenerative fraying/tearing as described above.2.Tricompartment cartilage degeneration as described above.3.Other findings as described above.


Instruction: Generate impression based on findings.

Input: History of symptomatic uterine fibroids. Presents for evaluation prior to uterine artery embolization. PELVIS:UTERUS, ADNEXA: The uterus measures 7.0 x 5.0 cm in the sagittal plane.The endometrium is normal in thickness.The inner myometrium/junctional zone is mildly thickened measuring up to 10 mm in thickness without cystic or hemorrhagic changes.Several well-defined T2 hypointense myometrial masses are noted compatible with fibroids.The largest is a right intramural uterine body fibroid measuring 2.3 x 1.8 cm.The cervical stroma and parametrium is unremarkable. Several nabothian cysts are noted. The left ovary is not well seen. The right ovary measures approximately 3.8 x 1.8 cm.BLADDER: Nondistended urinary bladder without a focal abnormality.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: Several uterine fibroids measuring up to 2.3 cm. This was a nonenhanced study as the patient has a history of numerous allergies and presented without pre-medication. The service will be notified by the technologist regarding premedication and recalled for post-contrast imaging. Suspected adenomyosis.


Instruction: Generate impression based on findings.

Input: 61-year-old male with a history of Gleason 6 prostate cancer in the right base of the prostate. Please evaluate. PELVIS:PROSTATE: There is a focus of decreased T2 signal abnormality with associated restricted diffusion and enhancement on post-contrast sequences in the right posterior base of the peripheral zone of the prostate gland, suspicious for prostate carcinoma. No additional convincing foci of T2 signal abnormality are identified.Prostate Size: 5.3 x 3.1 cm.Seminal Vesicles: There is no extension to involve the seminal vesicles.Extracapsular Extension: There is no extracapsular extension or capsular bulge.BLADDER: There is a 4.5-mm stone in the region of the right ureterovesical junction with associated mild hydroureter of the visualized portions of the right ureterLYMPH NODES: No evidence of lymphadenopathy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Enhancing focus of T2 signal abnormality in the right posterior base of the peripheral zone of the prostate gland, suspicious for prostate carcinoma.2.4.5 mm ureteral stone at the level of the right UVJ, with incompletely visualized mild right hydroureter.


Instruction: Generate impression based on findings.

Input: 38-year-old female with history of lumbar radiculopathy, now with left-sided shoulder pain and weakness Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. There is loss of normal cervical lordosis with mild kyphotic angulation centered at the C5-C6 level. Minimal anterolisthesis of C4 on C5. Bone marrow signal is benign with STIR hyperintensity involving the C5-C7 vertebral bodies likely on a degenerative basis..The cervical spinal cord has normal signal characteristics.Degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: No significant compromise to the spinal canal. Minimal right neural foraminal narrowing. No left neural foraminal narrowing. C4-5: No significant compromise to the spinal canal or neural foramina.C5-6: There is a disc osteophyte complex and prominent left uncovertebral spur with moderate to severe narrowing of the left neural foramen. There is mild narrowing of the spinal canal at this level. Mild right neural foraminal narrowing. C6-7: There is disc osteophyte complex and bilateral uncovertebral hypertrophy with moderate right and moderate to severe left neural foraminal narrowing. Minimal narrowing of the spinal canal. C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: Degenerative changes in the cervical spine, particularly at the C5-C6 and C6-C7 levels as detailed above. There is prominent left-sided uncovertebral hypertrophy at these levels with associated moderate to severe left neural foraminal stenosis. There may be impingement of the left C6 and C7 nerve roots.


Instruction: Generate impression based on findings.

Input: Bilateral hip pain, possibly referred. There is mild degenerative spondylosis at multiple levels of the thoracic and lumbar spine, including endplate edema, intravertebral disc herniations, and slight disc bulges. However, there is no significant spinal canal or neural foraminal stenosis. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. There is no evidence of mass lesions in the imaged portions of the spine. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable. There is a left adnexal cyst that measures up to 29 mm.

Output: 1. Mild degenerative spondylosis at multiple levels of the thoracic and lumbar spine, but no significant spinal canal or neural foraminal stenosis. 2. A left adnexal cyst that measures up to 29 mm likely represents a functional ovarian cyst. However, further evaluation via a pelvic ultrasound may be useful.


Instruction: Generate impression based on findings.

Input: Diagnosis: Unspecified convulsions Human immunodeficiency virus (HIV) diseaseDiagnosis Edits: |Clinical question: Pt w/ h/o HIV presenting w/ seizures. Assess for mass lesion or any other possible causesSigns and Symptoms: SeizuresComments: Patient states that he previously had pins placed in his foot. He believes that they have been removed. He states that he has had an MRI since that surgery w/o incident | Given the patient's stated age of 42 there is a mild degree of generalized brain atrophy present. There are some subtle FLAIR and T2 signal hyperintensity along the periventricular white matter. There are also several subcortical punctate foci of FLAIR and T2 signal hyperintensity present.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.There is mild degree of generalized brain atrophy present which is a little more than what is expected at this age. Given the patient's HIV status and may be related to HIV encephalitis.2.There is some mild FLAIR and T2 signal hyperintensity along the periventricular white matter. Which is nonspecific


Instruction: Generate impression based on findings.

Input: New onset seizure with left temporoparietal localization. Given gross patient motion throughout the examination and inability to cooperate, the examination protocol was changed and the seizure localization specific sequences were not performed. There is no mass-effect or brain herniation. Accounting for patient motion, there is no gross intracranial hemorrhage or gross acute infarct. Mild-to-moderate periventricular frontoparietal confluent T2-hyperintensity probably reflect microvascular ischemia. There is also dilatation of the ventricular system and the other CSF-containing spaces, reflective of underlying moderate brain volume loss. The major intracranial vascular flow voids are preserved.The orbits are notable for bilateral lens replacement. The lobulated right facial mass is markedly T2-hyperintense and T1-hypointense in its posterior larger component but is more solid in its anterior component. It probably arises from the right first gland but is incompletely imaged. There is no associated skull lesion.

Output: 1.Limited, incomplete examination, because of patient's gross motion and inability to cooperate.2.There are cerebral white-matter changes of chronic microvascular ischemia and global brain volume loss. There is no gross signs of acute ischemia/infarct or intracranial hemorrhage.3.Large right facial mass probably arises from the right parietal gland and shows findings suggestive of being partly cystic and partly solid. However, the mass is not completely assessed.


Instruction: Generate impression based on findings.

Input: 25-year-old female with history of endometrial cancer. PELVIS:UTERUS, ADNEXA: Arcuate uterine configuration.Complex multilobulated cystic lesion centered within the cervix containing internal T1 hyperintensity. The endometrial canal is smooth and normal appearing with a maximal width of 9 mm. No evidence of myometrial invasion. Normal junctional zone.The ovaries are slightly enlarged with innumerable small peripherally-based follicles.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. No evidence of myometrial invasion.2. Findings suggestive of polycystic ovarian syndrome in the appropriate clinical scenario.3. Complex multiloculated cystic lesion centered within the cervix likely represents a complex Nabothian cyst.


Instruction: Generate impression based on findings.

Input: Reason: 63 yo male with hx of PJS (Peutz Jeghers Syndrome) please evaluate for any abnormalities History: PJS. History of distal pancreatectomy for intraductal papillary mucinous carcinoma ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS:Postsurgical changes of distal pancreatectomy. A nonenhancing T1 hyperintense lesion in the pancreatic tail is unchanged in size measuring 1.4 x 1.1 cm (4/29), possibly an old hematoma. Small fluid collection along the anterior aspect of the pancreatic body is no longer evident.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small subcentimeter bilateral renal cyst. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small umbilical hernia containing a loop of bowel without evidence of obstruction. Diverticulosis without evidence of diverticulitis.Evaluation of the small bowel is limited due to poor distention. There are a few soft tissue nodules within the small bowel which may represent polyps. For example, there are soft tissue nodules in the right lower quadrant ileal loops measuring 1.0 x 1.3 cm (15/60) and 15 x 11 cm (15/38). There is also a possible lesion within jejunal loops in the left mid upper abdomen measuring 1.2 x 1.1 cm (15/48).BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Resolution of cystic lesion along the anterior pancreatic body.2.No evidence of intra-abdominal neoplasm.3.A few enhancing nodules within ileal and jejunal small bowel loops may represent polyps.


Instruction: Generate impression based on findings.

Input: Ms. Moran is a 42-year-old female with a personal history of left breast simple skin sparing mastectomy for multifocal IDC/DCIS with immediate reconstruction in 2012. Patient is on Arimidex. Personal history of benign left chest wall biopsy in 2013. Family history of breast cancer in mother, diagnosed at the age of 44. She has no current breast related complaints. RIGHT BREAST:There is scattered fibroglandular tissue in the right breast. Minimal parenchymal enhancement is noted.Scattered foci of enhancement, particularly in the right lower inner breast, are stable dating back to 2012. There is no new abnormal enhancement seen in the right breast. No abnormal axillary lymph nodes are identified in the right axillary region.LEFT RECONSTRUCTED BREAST:Stable postsurgical changes from a left breast mastectomy with reconstruction and left axillary dissection are identified. Previously identified areas of enhancing fat necrosis have decreased when compared to prior examination. There is no new abnormal enhancement seen in the left reconstructed breast. No abnormal axillary lymph nodes are identified in the left axillary region.Multiple enhancing T2 hyperintense lesions in the sternum are stable.

Output: Stable postsurgical changes in the left reconstructed breast. No MR evidence for malignancy.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: Paresthesia of skin [R20.2] / Anesthesia of skin [R20.0], Reason for Study: ^Reason: eval for stenosis, herniation History: b/l foot numbness Cervical Spine MRILoss of normal cervical lordosis with straightening of cervical spine.There is no evidence of abnormal spinal cord signal intensity.Vertebral body height is preserved and MR signal intensity is normal.Degenerative changes are as follow;C23: Within normal limits.C34: Broad-based central to left disc protrusion which minimally narrows right lateral recess. Otherwise unremarkable.C45: Minimal bulging of disc otherwise unremarkable.C56: Broad based disc protrusion which abuts thecal sac with evidence of annular fissure. In addition, associated focal protrusion of disc narrows right lateral recess. C67: Within normal limitsC7T1: Within normal limitsLumbar spine MRIFor the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. The lumbar lordosis appears to be lessen than normal, unchanged since prior scan. The spine alignment is anatomic. The vertebral body height is preserved. The signal of the visualized cord is normal. The conus medullaris terminates at the L1 level. Degenerative changes are specified by the intervertebral level as follows: T12-L1: no neuroforaminal narrowing or spinal stenosis. L1-L2: Broad based disc bulging which indents thecal sac results mild to moderate spinal canal stenosis. Disc dessication is seen. Unchanged since prior scan. L2-L3: Diffuse bulging of disc with disc dessication which abuts thecal sac results minimal spinal canal stenosis, unchanged since prior scan. L3-L4: Interval development od broad based disc bulging which abuts thecal sac results mild to moderate spinal canal stenosis.no neuroforaminal narrowing or spinal stenosis. L4-L5: Disc dessication, otherwise unremarkable. L5-S1: no neuroforaminal narrowing or spinal stenosis.

Output: 1. Multilevel various degree disc degenerations as described above. 2. Disc herniation at the level C56 and interval disc bulging of L34 are noted. 3. Unchanged disc bulging with mild to moderate spinal canal stenosis at the level of L12 and L23 since prior scan.4. Normal spinal cord signal intensity.


Instruction: Generate impression based on findings.

Input: Back pain. A sigmoid shaped lumbar curvature is convex to the right in the upper lumbar region, centered at L2-L3, and convex to the left in the lower lumbar region, centered at L4. This is associated with right lateral translation of L3 relative to L4 as well as mild left-sided L3 and right-sided L4 vertebral body height loss. Sagittal alignment is notable for straightening and minimal posterior subluxation of L3 relative to L4, L4 relative to L5 and L5 relative to S1. Conus is in normal position at the mid L1 level. There is no definite abnormal T2 signal in the conus.There is disc desiccation at the lumbar and included lower thoracic levels associated with severe height loss and degenerative endplate changes and subjacent degenerative marrow changes. This is associated with multilevel degenerative spinal canal stenosis as described below which is superimposed on congenitally, diffusely small lumbar spinal canal. Prominence of the epidural fat also contributes to the stenosis. There is no suspicious marrow signal abnormality.Mild osteoarthritic changes are present at the sacroiliac joints. There is fatty infiltration/atrophy involving the paraspinal muscles.Extensive degenerative changes as described below:T11-T12: There is a right paracentral/foraminal disc protrusion and moderate facet arthropathy. The disc moderately to severely narrows the right side of the spinal canal deforming the conus medullaris but no definite increased cord T2 signal. There is severe right and mild-to-moderate left neural foraminal stenosis.T12-L1: Central/right paracentral disc protrusion resulting in mild right-sided spinal canal stenosis. Moderate facet arthropathy contributes to moderate-to-severe right and mild-to-moderate left foraminal stenosis.L1-L2: Disc bulge is eccentric to the left along with left more than right facet arthropathy result in severe central and left paracentral spinal canal stenosis in addition to moderate-to-severe left and mild right foraminal stenoses.L2-L3: Disc bulge is eccentric to the left and there is moderate-to-severe right worse than left facet arthropathy and moderate ligamenta flava thickening. Combined, these result in severe central spinal canal stenosis and moderate-to-severe left and moderate right foraminal stenoses.L3-L4: Disc bulge is eccentric to the left. There is also moderate facet arthropathy and ligamenta flava thickening. These combined result in severe central and left worse than right paracentral spinal canal stenosis. There is also severe right and moderate left foraminal stenoses.L4-L5: Disc bulge is eccentric to the right. There is right more than left moderate facet arthropathy and moderate ligamenta flava thickening. These result in mild spinal canal stenosis. There is stenosis of the right subarticular recess. There is moderate-to-severe right and mild-to-moderate left neuroforaminal stenoses.L5-S1: The subluxation along with left more than right moderate facet arthropathy results in stenosis of the subarticular recesses. No significant central canal stenosis. There is severe left and moderate right foraminal stenoses.

Output: 1.Advanced multilevel degenerative changes superimposed on a congenitally narrow spinal canal and prominence of the epidural fat result in severe spinal canal stenoses from L1-L2 through L3-L4 as described above. There is variable multilevel neural foraminal stenoses, most severe on the right at T11-T12, L3-L4 and L4-L5 and on the left at L1-L2, L2-L3 and L5-S1.2.In addition, T11-T12 disc protrusion mildly deforms the conus medullaris but no definite increased cord T2 signal.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 64-year-old female with metastatic renal cell carcinoma and possible metastases ABDOMEN:LUNG BASES: Small left-sided pleural effusion and dependent atelectasis. Calcified mediastinal lymph nodes.LIVER, BILIARY TRACT: Bilateral extensive liver metastases. An index lesion in the left lobe measures 3.3 x 2.7 cm, image number 51, series number 3.Cholelithiasis.SPLEEN: No significant abnormality notedPANCREAS: The tail of the pancreas is diffuse the hypodense. A solid neoplasm in the distal body and tail cannot be excluded. Further evaluation with MRI of the pancreas is recommended. Splenic vein is not well seen. There are venous collaterals around the stomach.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral atrophic kidneys.Small hypodense lesions in the left kidney which are too small to accurate characterize.Right kidney is very heterogeneous with multiple scars. Multiple cysts in the upper pole. Lower pole of the right kidney has lobulated contours with ill-defined heterogeneous density. These findings may represent postsurgical changes, however, a solid lesion cannot excluded with this single phase study.RETROPERITONEUM, LYMPH NODES: Borderline enlarged retroperitoneal lymph nodes. Index portacaval node measures 15 by 11 mm on image number 55, series number 3.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Not well visualized.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Extensive hepatic metastatic disease.Diffusing hypodense tail of the pancreas. A solid neoplasm cannot be excluded. Further evaluation with MRI of the pancreas is recommended.Cholelithiasis.Bilateral atrophic kidneys. Lower pole of the right kidney is heterogeneous with lobulations. Possibility of a solid lesion in the lower pole of the right kidney cannot be excluded. Follow-up imaging is recommended.


Instruction: Generate impression based on findings.

Input: Knee locking MENISCI: There is no evidence of a discrete meniscal tear.ARTICULAR CARTILAGE AND BONE: There is full-thickness articular cartilage loss of the medial compartment, particularly the femoral condyle. There is associated underlying degenerative marrow signal within the femoral condyle near the junction of the posterior horn and body.There is heterogeneity of the articular cartilage of the lateral compartment without fluid-filled partial or full-thickness defect.There is heterogeneity and fibrillation of the articular cartilage of the patellofemoral compartment particularly of the medial patellar facet and femoral trochlea centrally although there is no discrete full-thickness cleft.Tricompartmental osteophytes are evident, particularly along the medial tibial plateau. There is no evidence of discrete loose body.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Marked cartilage loss of the medial femoral compartment. The menisci are intact and there is no evidence of a discrete loose body.


Instruction: Generate impression based on findings.

Input: Female, 57 years old, status post resection and reconstruction for left retromolar trigone cancer, evaluate for disease extension, specifically in the skull base. Neck:Extensive postoperative findings are redemonstrated including resection of the left hemimandible, left floor of mouth, portions of the left oral tongue, left pharynx, left masticator space and the overlying lateral cutaneous and subcutaneous tissues. A soft tissue graft has been interposed within the surgical defect.A superficial fluid-filled cavity along the left posterolateral aspect of the graft is again seen most likely representing seroma. A somewhat more complex appearing, tracking fluid collection is also redemonstrated deep to the left sternocleidomastoid muscle which likely also represents a postoperative seroma. Without the benefit of contrast enhanced images, the possibility of lymph nodes within this space cannot be adequately assessed.Ill-defined signal abnormality seen throughout the left masticator space. Thickening of the V3 segment of the cranial nerve V is also suspected within the masticator space extending to the level of the foramen ovale. The inferior aspect of Meckel's cave is mildly thickened as well, but no obvious abnormalities are detected in the cavernous sinus.Brain:Elsewhere intracranially, patchy white matter T2 hyperintense lesions are seen which are nonspecific but produce no significant edema or mass effect. Parenchymal morphology and signal characteristics are otherwise unremarkable. No evidence of restricted diffusion is seen. There are no findings to suggest acute intracranial hemorrhage or any abnormal extra-axial fluid collections. The ventricles are normal in size and morphology.

Output: 1.Extensive postoperative findings are seen in the left face and neck status post resection of a large tumor centered on the left mandible. A soft tissue graft has been interposed in the surgical defect.2.A superficial fluid collection is seen along the left posterolateral aspect of the graft which likely represents a seroma. A more complex appearing fluid collection tracking along the undersurface of the left sternocleidomastoid muscle may also represent a seroma. The possibility that there may be lymph nodes interspersed in this space cannot be excluded in the absence of contrast.3.The extracranial V3 segment appears to be thickened in the left masticator space extending up to the level of the foramen ovale. The inferior aspect of Meckel's cave may also be involved. Findings are concerning for perineural tumor involvement.4.Elsewhere intracranially, no evidence of metastatic disease is seen.


Instruction: Generate impression based on findings.

Input: Reason: Evaluate for abnormality; history of synovial sarcoma of the thigh. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are a few small foci of increased T2 signal within the periventricular and subcortical white matter without enhancement, susceptibility or diffusion restriction. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are mildly enlarged and may reflect some volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits and skull are grossly unremarkable. There is a focal prominence of fat in the subcutaneous tissues overlying the right parietal calvarium which may represent a small lipoma. Mild mucosal thickening of the bilateral sphenoid and maxillary sinuses. There is fluid within the mastoid air cells bilaterally.

Output: 1.No evidence of intracranial metastases.2.A few subcortical and periventricular T2 hyperintense foci without diffusion restriction or enhancement are nonspecific. Differential includes migraine headaches, small vessel ischemic disease, demyelinating diseases and other infectious/inflammatory etiologies.3.Fluid in the mastoid air cells bilaterally.4.Mild volume loss, more than would be expected considering patient's age.


Instruction: Generate impression based on findings.

Input: Arachnoid cyst, Chiari malformation, and neck and back pain. Brain: There is inferior extension of the cerebellar tonsils, left greater than right, by approximately 15 mm with a peg-like configuration with crowding of tissue at the foramen magnum that results in impeded CSF flow across the posterior foramen magnum and a relatively small posterior fossa. There is a 7 mm wide extra-axial CSF space medial to the left temporal lobe. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are normal in size and configuration, including a subcentimeter right lateral ventricular xanthogranuloma. There is no midline shift. The major cerebral flow voids are intact. There is mild posterior plagiocephaly. The orbits, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Spine: There is thoracic syringohydromyelia centered at the T7 vertebral body level that measures up to 7 mm in width. There is mild retroflexion of the dens with minimally attenuated adjacent CSF flow. The conus medullaris is positioned at the L1 vertebral body level. The vertebral column alignment is otherwise within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The paravertebral soft tissues are unremarkable.

Output: 1. Findings compatible with Chiari malformation with inferior extension of the cerebellar tonsils, left greater than right, by approximately 15 mm and a thoracic syrinx that measures up to 7 mm in width.2. Mildly retroflexed dens.3. Small medial temporal region arachnoid cyst.


Instruction: Generate impression based on findings.

Input: Transient alteration of awareness [R40.4], Reason for Study: ^Reason: new abnormalities History: weakness, ams No evidence of acute ischemic or hemorrhagic lesion on this scan.There is, however, extra axial masses one at the left middle cranial fossa which extends toward left side cavernous sinus and pituitary fossa (about 31.8mm x 36mm) and another at the right middle cranial fossa anterolateral to the right temporal pole (about 23mm x 30mm on coronal scan).Comparing to prior scan, the configuration, approximate size, and the degree of mass effects toward adjacent brain do not show any interval change since prior scan.Significant encephalomalacia on both right and left fronto temporal lobes do not show any interval change since prior scan.Ex vacuo changes of both the left and right lateral ventricles are seen, unchanged. Left fronto temporal craniotomy site are seen, unchanged.Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear.Mucosal thickening of the sphenoid sinus are seen.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. Bilateral middle cranial fossa extra-axial mass, in particular, left side mass is extending toward the left cavernous sinus as well as pituitary fossa, likely representing meningioma are demonstrated, unchanged since prior scan.3. Unchanged bilateral frontal temporal encephalomalacia, ex vacuo changes of bilateral lateral ventricles, and mass effect of extra-axial masses


Instruction: Generate impression based on findings.

Input: There are postoperative findings within the right occipital scalp soft tissues related to prior lesion resection and skin grafting with nonspecific ill-defined non-masslike enhancement in the surgical bed. There are also unchanged postoperative findings within the right parietal scalp soft tissues with susceptibility artifact that limits local evaluation. There is unchanged nonenhancing thickening of the optic chiasm which measures up to 11 mm in AP dimension although is not well evaluated on this non-dedicated exam. 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. 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.

Output: 1.Postoperative findings within the right occipital scalp soft tissues related to prior lesion resection and skin grafting without definite evidence of tumor recurrence. 2.Unchanged post-operative findings within the right parietal scalp soft tissues. 3.Unchanged optic chiasm non-enhancing lesion.


Instruction: Generate impression based on findings.

Input: History of sarcoidosis. Right-sided facial droop and right upper extremity weakness. Evaluate for CNS involvement by sarcoidosis or stroke. . The study is limited by patient motion, most pronounced on the postcontrast images. There appears to be possible faint enhancement within the right internal auditory canal. There is apparent linear post-contrast high T1 signal along the right post-chiasmatic optic nerve. A small focus of contrast enhancement within the left side of the pons does correlate with susceptibility effect is compatible with a capillary telangiectasia, which is an incidental finding. There are few scattered, punctate T2 hyperintense foci in the frontoparietal white matter without associated diffusion restriction or abnormal contrast enhancement, most likely representing mild chronic microvascular ischemia. There is no evidence of intracranial hemorrhage, mass, 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, skull, and scalp soft tissues are grossly unremarkable. There is minimal maxillary mucosal thickening without fluid. The other paranasal sinuses are clear.

Output: The study is limited by motion, especially the post-contrast images, with possible mild enhancement in the right internal auditory canal, which may represent neurosarcoidosis involvement of the facial nerve versus artifact or prominent vessels. Follow up via dedicated internal auditory canal MRI may be useful. Apparent linear post-contrast high T1 signal along the right post-chiasmatic optic nerve may be artifactual versus another potential manifestation of neurosarcoidosis. Otherwise, not evidence of acute infarction or mass 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: Small cell lung cancer restaging. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is unchanged predominantly periventricular white matter T2 hyperintensity. There is no abnormal intracranial enhancement. The ventricles and sulci are diffuse prominent due to cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is a right lens implant and scleral buckle.

Output: 1. No evidence of intracranial metastases.2. Unchanged diffuse white matter abnormalities are nonspecific, but may represent chronic small vessel disease and/or treatment effects.


Instruction: Generate impression based on findings.

Input: Male, 6 years old, with history of intracranial abscess, evaluate for change after one more month of antibiotics. Redemonstrated are findings related to prior right temporal craniotomy/craniectomy and mastoidectomy. The mastoidectomy bed continues to remain fluid opacified.The T2 hypointense, predominantly rim-enhancing nodule within the right inferior temporal lobe along the mastoid roof is unchanged in size measuring approximately 14 x 12 mm. The degree of T2 hyperintense signal surrounding this lesion, presumed to reflect edema, is also unchanged from the prior examination though it is improved when compared to older studies.No additional intracranial lesions are seen. Brain parenchymal morphology and signal characteristics are otherwise unremarkable. No evidence of significant generalized mass effect is seen. The ventricles are stable and normal in size.

Output: 1. No significant interval change in the size of the enhancing process along the inferior right temporal lobe.2. No significant interval change in the pattern or extent of mild edema surrounding this process.


Instruction: Generate impression based on findings.

Input: 44 years Female (DOB:6/6/1971)Reason: metastatic breast cancer, known disease T7 and T8 History: worse pain and increased uptake on PET scanPROVIDER/ATTENDING NAME: GINI FLEMING GINI FLEMING There is redemonstration of a marrow replacing lesions within the T6 and T7 vertebral segments. These are associated with some heterogeneous enhancement.At T6 there is a marrow replacing lesion along the right posterior aspect of the T6 vertebral body which extends into the right pedicle and also involves the right transverse process and right lamina. Compared to the previous exam this become a little more extensive.At the T7 there is a marrow replacing lesion involving the right pedicle, right lamina part of the right transverse process and the posterior lateral aspect of the vertebral body adjacent to the pedicle. Compared to the prior exam this appears to be more extensive and involves more of the pedicle and it now some of the vertebral body on the current exam relative to the prior.A focus of questionable marrow replacement along the head of the right T10 rib is redemonstrated which is not associated with contrast enhancement and not associated with sclerosis on the MRI and not associated with increased uptake on the bone scan.The thoracic vertebral bodies are appropriate in the overall alignment and height. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots.

Output: 1.Since the previous exam the patient's T6 and T7 marrow replacing lesions compatible with bone metastases appear to have mildly increased in size.


Instruction: Generate impression based on findings.

Input: 62 year-old female with Chiari I, vertigo, worsening disequilibrium. Motion degrades a few sequences. Given this caveat:Redemonstrated is crowding at the level of the foramen magnum. As before, the tonsils lie 4 mm below the foramen magnum, within the upper limits of normal range. There is some minimal, persistent pointed morphology of the left cerebellar tonsil. The right cerebellar tonsil is normally rounded in morphology. CSF flow analysis demonstrates biphasic flow posteriorly at the level of the foramen magnum and cerebellar tonsillar tips.There is a subtle 2-3 mm focus of abnormality within the posterior inferior pituitary which is slightly hyperintense on T1, minimally hyperintense on T2, demonstrating relative hypoenhancement. This appears more prominent than the comparison, where it was extremely subtle. However, technique differences on the current study due to the added IAC sequences make it more conspicuous.There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma signal appears unremarkable. There are no areas of abnormal contrast enhancement. The ventricles and basal cisterns are otherwise normal in size and configuration. The skull and extracranial soft tissues are unremarkable. Suprasellar cistern is diminutive in size.Images of the internal auditory canals demonstrate the seventh and eighth nerves to be normal in size and symmetric bilaterally without masses or enhancing lesions along the course of these nerves or in the cerebellopontine angle cisterns bilaterally. The inner ear structures are normal in appearance and symmetric bilaterally without congenital inner ear anomalies identified on either side. There is stable mild mucosal thickening in the right maxillary sinus. There is fluid opacification of right mastoid air cells which is nonspecific and unchanged.

Output: 1.Redemonstrated is crowding at the level of the foramen magnum. As before, the tonsils lie 4 mm below the foramen magnum, within the upper limits of normal range. There is some minimal, persistent pointed morphology of the left cerebellar tonsil. The right cerebellar tonsil is normally rounded in morphology. CSF flow analysis demonstrates biphasic flow posteriorly at the level of the foramen magnum and cerebellar tonsillar tips.2.There is a subtle 2-3 mm focus of abnormality within the posterior inferior pituitary which is slightly hyperintense on T1, minimally hyperintense on T2, demonstrating relative hypoenhancement. This appears more prominent than the comparison, where it was extremely subtle. However, technique differences on the current study due to the added IAC sequences make it more conspicuous. The differential diagnosis would include a microadenoma or complicated cystic lesion. Recommend dedicated pituitary MRI imaging with contrast for complete characterization.3.There is fluid opacification of right mastoid air cells which is nonspecific and unchanged.4.Negative MRI of the internal auditory canals.


Instruction: Generate impression based on findings.

Input: 37-year-old female with pain. Evaluate for chronic tibialis posterior tendinitis/possible tear. TENDONS: There is thickening and increased signal abnormality within the tibialis posterior tendon at the level of the distal tip of the medial malleolus indicating moderate tendinosis. There is increased fluid signal abnormality and deformity within the distal tendon consistent with a longitudinal split tear. There is circumferential fluid within the tendon sheath of the flexor hallucis longus which may represent fluid extension from the joint space versus a tenosynovitis. The peroneal tendons appear intact. The extensor tendons appear intact. The Achilles tendon is normal in appearance. LIGAMENTS: The lateral collateral ligament complex appears intact. The distal tibiofibular syndesmotic complex appears intact. The image components of the deltoid ligament appear intact. The cervical ligament and the interosseous talocalcaneal ligament are poorly visualized secondary to subtalar joint fluid.ARTICULAR SURFACES AND BONE: There is increased signal abnormality within the medial malleolus which may be related to the aforementioned posterior tibialis tendinosis. No other bone marrow signal abnormality is identified. ADDITIONAL

Output: 1. Tibialis posterior tendinosis and longitudinal split tear as described above. There is associated reactive osteitis within the medial malleolus.2. Subtalar joint effusion with circumferential fluid within the tendon sheaths of flexor tendons which may represent fluid extension from the joint versus a tenosynovitis.


Instruction: Generate impression based on findings.

Input: Diagnosis: Backache, unspecifiedClinical question: R/O abscess vs discitis, Extreme tenderness to palpation and at rest MRI thoracic spine:The thoracic vertebral bodies are appropriate in the overall alignment and height. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots. No abnormal enhancing lesions are appreciated in the thoracic spine.Lumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.No abnormal enhancing lesions are appreciated in the lumbar spine. There are small perineural cysts present in the sacral spinal canal. One is adjacent to the right S1 nerve root at the L5-S1 disc space level while others are present at the S2 segment level.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is a mild disc bulge present at this level which is associated with some disc desiccation. There is some T2 signal hyperintensity along the posterior aspect of the annulus of the disc.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is a mild disc bulge present at this level which is associated with some disc desiccation. There is some T2 signal hyperintensity along the posterior aspect of the annulus of the disc.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is a mild disc bulge present at this level which is associated with some disc desiccation. There is some T2 signal hyperintensity along the posterior aspect of the annulus of the disc.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.Incidental note is made of a 7 x 9 mm axial dimensions cyst the left kidney.

Output: 1.There are some mild degenerative changes present in the lower lumbar spine without significant compromise to spinal canal or neural foramina.2.No intrinsic thoracic spinal cord lesion is appreciated. There is no compromise of thoracic spinal cord or neural foramina.3.No evidence for discitis or osteomyelitis.


Instruction: Generate impression based on findings.

Input: 35-year-old male with right knee pain, flexion contracture. Evaluate for chondral injury. Status post right knee patellar tendon repair. MENISCI: There is minimal globular increased signal abnormality within the anterior horn of the lateral meniscus consistent with mucoid degeneration. The medial and lateral meniscus appear intact.ARTICULAR CARTILAGE AND BONE: There is a full-thickness articular cartilage defect along the medial facet of the patella with associated articular cartilage delamination. There is a near full-thickness articular cartilage fissure along the far lateral aspect of the lateral facet of the patella with associated delamination of the articular cartilage. There is partial-thickness articular cartilage degeneration along the posterior aspect of the lateral femoral condyleLIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: There is thickening and deformity of the patellar tendon which presumably represents postsurgical changes and tendinopathy. The patellar tendon appears intact. There is an osseous tunnel in the proximal tibial tubercle consistent with the patient's history of patellar tendon repair.ADDITIONAL

Output: 1. Full-thickness articular cartilage defects of the patella as described above.2. Thickening and deformity of the patellar tendon which presumably represents a combination of postsurgical change and tendinopathy.


Instruction: Generate impression based on findings.

Input: The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology with the conus terminating at L1-L2. The craniocervical junction is normal. There is no evidence of filar thickening or fibrofatty infiltration and there is normal anterior translation of the conus and cauda equina upon prone positioning. The bladder is mildly distended.

Output: Unremarkable MRI without evidence of tethered cord.


Instruction: Generate impression based on findings.

Input: Malignant neoplasm of kidney, except pelvis [189.0], Reason for Study: ^Reason: cord compression 2/2 bony mets from RCC History: weakness, pain Previously seen T12 vertebral body enhancing metastatic lesion with compression fracture shows interval progression of compression fracture degree. In addition, the degree of retropulsion appears to be worsen, thus, spinal cord compression has been aggravated since prior scan.The increased signal intensity of spinal cord on STIR images show compressive myelopathy.There are multiple vertebral body lesions indicating metastatic lesions including T3,T4,T7,T8,T9, T11 and L4 but without compression fracture.Spinal alignment is anatomic apart from a mild kyphotic angulation centered at T12. The intervertebral discs are largely preserved with only mild loss of disc height and disc bulging seen at L5-S1. Otherwise, no interval change of minimal degenerative changes of lumbar vertebral discs and Tarlov cyst on the S2 and S3 level since prior exam.

Output: 1. Interval aggravation of T12 compression fracture with worsen retropulsion and spinal cord compressive myelopathy.2. Multifocal vertebral body lesions indicating multiple vertebral metastasis.


Instruction: Generate impression based on findings.

Input: History of liver lesions. History of cirrhosis. ABDOMEN: Susceptibility artifact in the left upper quadrant slightly limits evaluation of the lateral hepatic segment.LIVER, BILIARY TRACT: Cirrhotic fibrotic liver morphology. Several punctate siderotic nodules are noted on the in phase imaging.Demonstrated again is the arterially enhancing lesion in the inferior aspect of the right hepatic lobe measuring 1.6 x 1.5 cm (series 1501/107), compared to 1.4 x 1.3 cm previously. There is no definite washout of the lesion. The lesion is associated with mild T2-weighted hyperintensity and restricted diffusion. The lesion bulges the capsule.The segment 8 focus with mild intrinsic T1 weighted hyperintensity with questionable arterial enhancement with suspected washout, measuring approximately 8 mm (series 1 501/2 37), unchanged.There are several additional punctate foci of arterial enhancement some of which are better seen than on the prior study, but are grossly unchanged, dating back to 8/18/2015.The hepatic vasculature is unremarkable.No intra or extrahepatic biliary ductal dilatation. Normally distended gallbladder.Trace perihepatic ascites. Recannulated periumbilical vein.SPLEEN: The spleen measures 13.1 cm in length. In the superior dorsal aspect of the spleen there is a small wedge-shaped signal abnormality likely reflecting a small chronic infarct.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Several bilateral T2-weighted hyperintense foci some of which are too small to characterize, likely simple cysts. Mild right renal cortical scarring/thinning.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Mild bilateral gynecomastia. Compression deformity of a midthoracic vertebral body is incompletely evaluated and only seen on the coronal images. Cardiomegaly.OTHER: No significant abnormality noted.

Output: 1.Cirrhotic fibrotic liver with a 1.6 cm segment 5 arterially enhancing lesion without definite washout demonstrating T2-weighted hyperintensity and restricted diffusion. In 2015 the lesion measured approximately 1.2 cm. The lesion is suspicious for HCC but does not meet AASLD imaging criteria for HCC.2.Stable additional arterial enhancing subcentimeter foci, including a segment 8 lesion; attention to these on follow-up imaging is recommended.3.Borderline splenomegaly, trace perihepatic ascites and recanalized umbilical vein.4.New mid thoracic vertebral body compression deformity.


Instruction: Generate impression based on findings.

Input: 45-year-old woman status post repair of type B aortic dissection now with increased ICP and headache. The quality of the study is suboptimal. Since the previous study, diffuse effacement of the cortical sulci has developed. There is interval decrease in size ventricular system and partial effacement of the basal cisterns. These findings are consistent with diffuse cerebral edema. There is hypoattenuation in the right MCA territory suggestive of cortical edema. Recommend MRI to assess for acute stroke.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized. Incidental note is made of an accessory suture in the frontal bone.A nasogastric tube is present in the right naris.

Output: 1. Interval development of diffuse cerebral edema.2. Cortical hypoattenuation in right MCA territory. Recommend MRI to evaluate for acute stroke.


Instruction: Generate impression based on findings.

Input: Female, 66 years old, with left gluteal pain. Assess for sacroiliac joint disease or other etiologies of left hip pain. 5 mm of anterolisthesis of L5 relative to S1 is demonstrated. Elsewhere, sagittal alignment of the spine is anatomic.Vertebral body height and morphology are within normal limits. Marrow signal is mildly heterogeneous but free of pathologic marrow replacement and edema.The visualized distal spinal cord is unremarkable. The conus tip terminates at the level of the inferior L2 endplate which is the lower level of normal. The nerve roots of the cauda equina are unremarkable. No epidural abnormalities are suspected.T11-12: Facet arthropathy. Bulging disc. Mild spinal canal narrowing without cord impingement. Moderate left and mild right foraminal narrowing.T12-L1: Unremarkable.L1-2: Mild facet arthropathy. Ligamentum flavum thickening. No spinal canal or foraminal stenosis. L2-3: Moderate facet arthropathy. Ligamentum flavum thickening. No spinal canal or foraminal stenosis. L3-4: Marked facet arthropathy. Ligamentum flavum thickening. Slight encroachment upon the posterolateral thecal sac but no significant generalized spinal canal stenosis. No significant foraminal narrowing. L4-5: Marked facet arthropathy. Ligamentum flavum thickening. Mild bulging disc. Mild generalized spinal canal narrowing. Mild bilateral foraminal narrowing. L5-S1: Facet arthropathy. Ligament thickening. Disc bulging and disc uncovering with annular fissuring. Moderate generalized spinal canal stenosis with effacement of the lateral recesses. Moderate bilateral foraminal narrowing. The sacroiliac joints are only partially visualized on this examination but show some evidence of sclerosis.

Output: 1.Spondylolisthesis at L5-S1 with associated posterior element hypertrophy results in a moderate spinal canal stenosis and moderate foraminal narrowing. 2.At the remaining lumbar levels, posterior element hypertrophy is seen with relative sparing of the intervertebral discs.3.There may be sclerosis of the sacroiliac joints, but this region is only partially visualized on the present study.


Instruction: Generate impression based on findings.

Input: Shoulder pain ROTATOR CUFF: There is mild increased signal of the anterior fibers of the supraspinatus tendon with mild bursal fraying. No discrete rotator cuff tear is identified.SUPRASPINATUS OUTLET: Moderate hypertrophic changes of the acromioclavicular joint are noted. There is thickening of the coracoclavicular and coracohumeral ligaments as well as of the IGHL.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is degenerative tearing of the labrum with more focal tearing of the superior labrum.BICEPS TENDON: Increased signal and enlargement of the biceps tendon is noted reflecting tendinopathy. There is no discrete biceps tear. ADDITIONAL

Output: 1. Mild tendinosis with possible interstitial tearing of the supraspinatus tendon but otherwise there is no discrete rotator cuff tear.2. Thickening of the coracoclavicular and coracohumeral ligaments which can be seen in cases of adhesive capsulitis.3. Mild biceps tendinopathy and degenerative labral tearing.


Instruction: Generate impression based on findings.

Input: Evaluate for hemorrhage no onset seizures teslas brain biopsy. 75-year-old male Since the prior exam patient has undergone a right sided to craniotomy for biopsy purpose paired some minor blood products in the air is present at the surgical site.There is a prior MRI of the brain from 10/19/09 which demonstrates enhancing mass at the biopsy site. The degree of hypodensity involving the right parietal, temporal and frontal lobes appears similar to the MRI examination from 10/19/09.There is redemonstration of mid to cisterna magna and arachnoid cyst in the left middle cranial fossa. 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.The patient is status post recent craniotomy for Biaxin. Some minor blood products and postsurgical changes are present appeared the degree of hypodensity does not appear different on the current exam when compared to the MRI exam is2.Redemonstration and no change in arachnoid cysts.


Instruction: Generate impression based on findings.

Input: 50-year-old male patient with three year history of lateral elbow pain. Question of lateral epicondylitis. LIGAMENTS: The ulnar collateral ligament is intact.TENDONS: There is increased signal within and partial-thickness tearing of the insertion of the common extensor tendon origin from the lateral epicondyle.ARTICULAR SURFACES AND BONE: Bone marrow signal is within normal limits. The articular surfaces are intact.SURROUNDING STRUCTURES: No significant abnormality noted.ADDITIONAL

Output: Partial thickness tearing of the common extensor tendon origin from the lateral epicondyle.


Instruction: Generate impression based on findings.

Input: 68-year-old woman with history of Crohn's disease and anemia, evaluate for small bowel inflammation. ABDOMEN:LIVER, BILIARY TRACT: The liver is mildly enlarged. There is an 8 mm nodule adjacent to the gallbladder fundus (series 7, image 60). The liver and gallbladder appear otherwise normal.SPLEEN: The spleen appears normal.PANCREAS: There is a 10 x 6 mm cystic lesion in the tail of the pancreas (series 3, image 21) without nodular component or enhancement. The pancreatic duct is normal in size.ADRENAL GLANDS: The adrenal glands are normal.KIDNEYS, URETERS: There are multiple bilateral renal cysts, one of which in the posterior mid right renal pole (series 5, image 6) is mildly complex. The kidneys are otherwise normal.RETROPERITONEUM, LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: The patient is status post total colectomy with end ileostomy in the right mid abdomen. The loops of small bowel appear normal. There is apparent mild enhancement of short segment of small bowel most distal in the subcutaneous soft tissues, however there is no thickening or diffusion restriction.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Patient status post colectomy and end ileostomy without evidence of active inflammation.2.Less than 2 cm, cystic lesion in the pancreatic tail, likely a sidebranch IPMN. A 1-year MR follow-up exam to ensure stability is recommended.3.Nodule adjacent to the gallbladder fundus which is likely a lymph node, but ultrasound can be considered to confirm if clinically warranted.


Instruction: Generate impression based on findings.

Input: 87-year-old male with stage IV chronic kidney disease. Evaluate for renal mass. Motion artifact limits evaluation.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: There are multiple bilateral T1 hyperintense and T2 intermediate signal foci within the kidneys most likely proteinaceous cysts. Additionally, there are multiple T2 hyperintense and T1 hypointense subcentimeter foci within bilateral kidneys compatible with cysts. There is a T1 and T2 heterogeneous lesion in the right upper pole measuring 2.1 x 1.8 cm, previously measuring 5.2 x 4.0 cm on the CT9/11/2015.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Significant interval decrease in size of the right upper pole exophytic mass when compared to prior sonographic and CT imaging. Although lack of contrast limits evaluation, given significant interval decrease in size, an involuting hemorrhagic cyst is favored.2.Multiple bilateral proteinaceous and simple cysts.


Instruction: Generate impression based on findings.

Input: 58-year-old female with cervical cancer, vaginal bleeding PELVIS:UTERUS, ADNEXA: 1.1 x 1.2 cm T2 hyperintense cystic lesion in the region of the previously noted hypermetabolic lesion on PET may be adnexal. Anteverted fibroid uterus. There is an enhancing cervical mass with indistinct fibrous stroma. BLADDER: Bladder is underdistended.LYMPH NODES: No significant lymphadenopathy. Right pelvic hypermetabolic focus seen on prior PET is not well seen on the current study.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Enhancing cervical mass with indistinct fibrous stroma suspicious for parametrial invasion. 2.Right pelvic lymphadenopathy is not well seen on the current study. Cystic right adnexal lesion may be physiologic.


Instruction: Generate impression based on findings.

Input: 68 years, Male, h/o OLT in 1996, DMII, HTN, here with unexplained hyponatremia. No intracranial mass or mass-effect. Scattered foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild chronic small vessel ischemic changes. The ventricles are within normal limits in size and configuration. No evidence of cerebral edema. No restricted diffusion to suggest acute ischemia. There are foci of susceptibility along the surface of the right lateral ventricle in the periatrial region, in the right parietal corona radiata, and left cerebellar hemisphere compatible with chronic microhemorrhages. No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved.There is a partially empty sella which can be normal variant. Dedicated sequences of the pituitary gland were not obtained; however, it appears grossly unremarkable including presence of the T1 hyperintensity of the neurohypophysis. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: 1. No specific findings to explain patient's hyponatremia/SIADH. No evidence of intracranial neoplasm. 2. Mild chronic small vessel ischemic changes.3. Scattered foci of chronic microhemorrhage in a nonspecific distribution.4. Partially empty sella, which can be a normal variant.


Instruction: Generate impression based on findings.

Input: 43-year-old male with primary sclerosing cholangitis who presents for evaluation of dominant stricture or dilatation. Evaluate for hepatic lesions as well. ABDOMEN:LIVER, BILIARY TRACT: No significant interval change in the minimal irregularity of the intrahepatic biliary ducts, most prominent at the confluence of the common hepatic duct. Sites of mild focal intrahepatic biliary ductal dilatation is stable and may reflect adjacent focal areas of stricturing. No suspicious hepatic mass. Patent hepatic vasculature. Minimal gallbladder sludge. 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: 1. Stable exam with sites of mild ductal irregularity and intrahepatic biliary duct dilatation, see discussion above.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Diagnosis: Radiculopathy, lumbar regionClinical question: evaluate for degenerative change, lumbar stenosisSigns and Symptoms: Right LE Radiculopathy Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is redemonstration of mild to moderate bilateral facet hypertrophy at this level, mild loss of disc space height and mild disc desiccation. There is redemonstration of a small synovial cyst posterior to the right side facet joint at this level which was also present on the prior exam.At L4-5 there is no significant compromise to the neural foramina. There is redemonstration of bilateral facet and ligamentum flavum hypertrophy at this level associated with some narrowing of the spinal canal. There is partial effacement of the fat at the lateral recess bilaterally at this level. Overall there is a mild degree of spinal stenosis present. Overall the findings are stable compared to the prior exam.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is mild facet and ligamentum flavum hypertrophy present at this level.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina. There are endplate reactive changes present at this level associated with some loss of disc space height. There is a diffuse disc bulge present at this level. Compared to the prior exam the endplate reactive changes have not changed substantially. The appear to be in the subacute stage with high signal on T2 imaging and low signal on T1 imaging.

Output: 1.There is redemonstration of multilevel degenerative changes in the lumbar spine with subacute endplate reactive changes at L1-2 and mild stenosis at L4-5 which are stable and compared to the prior exam from January 2014.


Instruction: Generate impression based on findings.

Input: Reason: hcc History: hcc. Status post radial embolization 12/1/2015. ABDOMEN:LIVER, BILIARY TRACT: Enhancing lesion in the right hepatic lobe measures 7.7 x 6.2 cm, grossly similar in overall size to the prior CT but significantly decreased from the prior MRI. However, the enhancing portion of the lesion has increased from the prior CT measuring 6.1 x 6.1 cm (11/68), previously 4.3 x 4.8 cm.An adjacent satellite lesion in the hepatic dome is also increased in size since the prior CT measuring 1.7 cm, previously 1.3 cm. A peripheral satellite nodule is slightly increased in size as well.Additional punctate enhancing subcentimeter lesions on the arterial phase without washout may be perfusional.Portal vein is patent.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal hypodensities, likely cysts.RETROPERITONEUM, LYMPH NODES: Mildly ectatic infrarenal abdominal aorta is unchanged.BOWEL, MESENTERY: Diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.INDEX LESION MEASUREMENTS (Current exam date/time: 5/24/2016 11:58:00)RIGHT LOBE MASS: 6.2 x 7.7 cm (Image 73, Series 11); 7.7 x 6.4 cm on prior (4/13/2016) (Image 24, Series 9).ADJACENT SATELLITE NODULE: 1.3 x 1.1 cm (Image 76, Series 11); 1.2 cm on prior (4/13/2016) (Image 40, Series 11).ENHANCING PORTION OF HEPATIC MASS: 6.1 x 6.1 cm (Image 68, Series 11); 4.8 x 4.3 cm on prior (4/13/2016) (Image 28, Series 9).

Output: 1.Right hepatic lobe mass is decreased in size from pretreatment MRI, however there is been an increase size in the enhancing portion of the lesion compared to the more recent posttreatment CT of 4/13/2016.2.Satellite lesions have increased in size from both the prior MRI and recent CT.


Instruction: Generate impression based on findings.

Input: 74-year-old female with architectural distortion in the right breast identified on screening mammogram, subsequent ultrasound identified 2 suspicious areas in the right breast. Subsequent MRI identified additional lesions in the right breast, 12 o'clock position, 6:00 position, and left breast 9-10 o'clock position and 5:00 position. Right ultrasound re-identified the target lesion for biopsy. Lesion to be targeted for biopsy in the right breast at the 7:00 position 4 cm from the nipple (labeled #1) is hypoechoic and ill-defined and measures 1.9 x 1.0 cm. 2 masses identified at the at the 7:00 position 2 cm from the nipple in the right breast, with the largest lesion measuring 6 x 4 mm (labeled #2 and 3) which will be targeted to biopsy. No correlate was identified with MR finding in the right breast 6:00 position. Oval hypoechoic lesion in the right breast at the 12:00 position 4 cm from the nipple measures 4 x 3 mm, thought to correspond to the MRI finding, was chosen for biopsy.Targeted left breast second look ultrasound in the 9:00 position in the area of the enhancing mass identified at MR was not identified on ultrasound. Enhancing focus in the left breast at the 4-5 o'clock position identified on MRI had no ultrasound correlate.PROCEDURE: The procedure and its risks, including bleeding, infection, and failure to diagnose, and expected benefits of ultrasound-guided core biopsy with percutaneous placement of a marking clip and post-procedure unilateral mammogram were discussed with the patient. Questions were answered. Consent was obtained both verbally and in writing. The time-out form was completed to confirm patient identity and side/type of procedure.The right breast lesion 7:00 position #1 biopsy was cleansed with chlorhexidine over the target area. Transducer was sterilely sheathed. Local anesthesia was obtained using 2% lidocaine superficially and at depth. A 3 mm incision was made in the skin with a #11 scalpel blade. Using aseptic technique, continuous ultrasound guidance and a mediolateral approach, three 14-gauge core needle (Inrad) specimens were obtained of the lesion. Targeting was judged excellent. No specimens sank to the bottom of the prefilled container of 10% formalin. All specimens partially sank. Specimen quality was judged very good.Specimens were sent to Pathology with an accompanying history sheet. Using continuous ultrasound-guidance a Hydromark clip was placed into the lesion in the usual manner. Pressure was held over the biopsy site until all bleeding subsided. The skin incision was closed with a Steri-Strip. The right breast lesion 7:00 position #2 biopsy was cleansed with chlorhexidine over the target area. Transducer was sterilely sheathed. Local anesthesia was obtained using 2% lidocaine superficially and at depth. A 3 mm incision was made in the skin with a #11 scalpel blade. Using aseptic technique, continuous ultrasound guidance and a mediolateral approach, three 14-gauge core needle (Inrad) specimens were obtained of the lesion. Targeting was judged excellent. No specimens sank to the bottom of the prefilled container of 10% formalin. All specimens partially sank. Specimen quality was judged very good.Specimens were sent to Pathology with an accompanying history sheet. Using continuous ultrasound-guidance a Hydromark clip was placed into the lesion in the usual manner. Pressure was held over the biopsy site until all bleeding subsided. The skin incision was closed with a Steri-Strip. The right breast 12:00 position biopsy was cleansed with chlorhexidine over the target area. Transducer was sterilely sheathed. Local anesthesia was obtained using 2% lidocaine superficially and at depth. A 3 mm incision was made in the skin with a #11 scalpel blade. Using aseptic technique, continuous ultrasound guidance and a mediolateral approach, three 14-gauge core needle (Inrad) specimens were obtained of the lesion. Targeting was judged excellent. No specimens sank to the bottom of the prefilled container of 10% formalin. All specimens partially sank. Specimen quality was judged very good.Specimens were sent to Pathology with an accompanying history sheet. Using continuous ultrasound-guidance a Bard ribbon clip was placed into the lesion in the usual manner. Pressure was held over the biopsy site until all bleeding subsided. The skin incision was closed with a Steri-Strip. Post-procedure digital right CC and ML views revealed the percutaneously placed clips to be in the expected location in the central anterior aspect of the lesion. No evidence of hematoma or other complication. Distance between the 2 Hydro mark clips is 2.2 cm.A pressure dressing was positioned over the biopsy sites and an ice pack positioned over the pressure dressing. Post-procedure instructions were reviewed with the patient both verbally and in writing. She tolerated the procedure well with no evident complications and left the Breast Imaging Department in stable condition.The procedure was performed by Dr. Kulkarni and Dr. Jahangir. Dr. Kulkarni was present during the procedure at all times.

Output: Successful ultrasound-guided core biopsy of the right breast lesions ( 7:00 (#1 and satellite) and 12:00 position) and clip placement. This is most likely a malignancy. Pathology is pending at this time.No sonographic correlate identified to the lesions seen on MRI in the left breast.No sonographic correlate identified to the lesion seen on MRI in the right breast 6:00 position.BIRADS: 5 - Highly suggestive of malignancy.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: There is a mild dextrothoracic and levolumbar S-shaped scoliosis. There is minimal retrolisthesis of L1 on L2, L2 on L3 and L3 on L4. There is mild anterior wedging of the T12 vertebra. There is loss of disc height at T11-T12. There are scattered punctate T1 hyperintense foci throughout the lumbar spine, which are nonspecific, but likely represent focal fatty replacement or fat containing hemangiomas. The distal spinal cord and conus are within normal limits with the conus terminating at the L1 level.T12-L1: Bilateral facet arthropathy. No significant disc bulge, spinal canal or foraminal stenosis. L1-L2: Mild retrolisthesis of L1 on L2 with pseudo disc bulge and bilateral facet arthropathy, contributing to mild spinal canal stenosis and mild bilateral foraminal stenosis. L2-L3: Mild retrolisthesis of L2 on L3 with pseudo disc bulge and bilateral facet arthropathy, contributing to moderate spinal canal stenosis and severe right and mild left foraminal stenosis.L3-L4: Mild retrolisthesis of L3 on L4 with pseudo disc bulge and bilateral facet arthropathy, contributing to moderate spinal canal stenosis and severe right and moderate left foraminal stenosis.L4-L5: Disc bulge and bilateral facet arthropathy, contributing to moderate bilateral foraminal stenosis. No significant spinal canal stenosis.L5-S1: Disc bulge and bilateral facet arthropathy, contributing to moderate bilateral foraminal stenosis. No significant spinal canal stenosis.

Output: S-shaped scoliosis with degenerative lumbar spondylosis, most prominent at the L2-L3 and L3-L4 levels, with moderate spinal canal stenosis and severe right and mild to moderate left foraminal stenoses.


Instruction: Generate impression based on findings.

Input: Male, 58 years old, with known brain metastases. Preparing for radiotherapy. Numerous, at least 15, solidly enhancing parenchymal metastases are demonstrated. Lesions are seen within both cerebral hemispheres and within the left cerebellum. The largest lesion, in the left frontal lobe, measures 34 x 28 mm and induces significant regional edema. There is associated sulcal effacement, deformation of the left lateral ventricle and a slight midline shift to the right. The other intracranial lesions range in size from punctate up to about 2 cm and cause variable but milder degrees edema.Encephalomalacia of the right inferior frontal lobe is seen. The overlying calvarium demonstrates changes suggestive of prior surgery. No findings to suggest acute intracranial hemorrhage or any abnormal extra-axial fluid collections are seen. Apart from contour deformity related to regional edema, the ventricular system is unremarkable with no evidence of hydrocephalus.

Output: Numerous parenchymal metastases are identified ranging in size from punctate up to several centimeters. The largest lesion is found in the left frontal lobe.


Instruction: Generate impression based on findings.

Input: Metastatic NSCLC and pancytopenia. No focal neurological deficits. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are a few scattered punctate foci of high T2 signal in the cerebral white matter, without associated enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. However, there is partly imaged bilateral cervical lymphadenopathy.

Output: 1. A few scattered punctate foci of high T2 signal in the cerebral white matter are nonspecific, but could represent chronic small vessel ischemic disease. Otherwise, no evidence of intracranial metastases. 2. Partly imaged bilateral cervical lymphadenopathy. Dedicated neck imaging may be useful for further evaluation.


Instruction: Generate impression based on findings.

Input: 73-year-old male patient with right knee pain. MENISCI: There is abnormal increased intrasubstance signal intensity in the posterior horn of the medial meniscus that is compatible with minimal intrasubstance degeneration without tearing.There is increased intrasubstance signal intensity in the body and posterior horn of the lateral meniscus with globular increased signal intensity in the posterior horn of the lateral meniscus at its root that extends to the tibial articular surface, compatible with a degenerative tear. Additionally, there is mucoid degeneration within the anterior horn attachment of the lateral meniscus with an adjacent small subchondral cyst in the tibial plateau that is likely degenerative in etiology.ARTICULAR CARTILAGE AND BONE: There is perhaps minimal subjective thinning of the articular cartilage, which is essentially within normal limits for age. We see no fluid-filled defects. Small osteophytes are noted. There is a small focus of abnormal signal intensity in the posterior aspect of the medial femoral condyle, which may represent a developmental defect, although the overlying articular cartilage appears intact.LIGAMENTS: The anterior cruciate ligament, posterior cruciate ligament, medial collateral ligament, lateral collateral ligament complex, and patellar retinacula are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1.Mild intrasubstance degeneration of the menisci with possible degenerative undersurface tearing of the root of the posterior horn of the lateral meniscus, the clinical significance of which is uncertain.2.Minimal osteoarthritis, which is commensurate for age, without fluid filled cartilage defect. 3.Other findings as above.


Instruction: Generate impression based on findings.

Input: Right suboccipital mass with questionable change in size. There is a right suboccipital subcutaneous mass with fat signal characteristics that measures up to nearly 3 cm. There is no abnormal enhancing component. There is no significant cervical lymphadenopathy. The parotid submandibular glands appear unremarkable. There is mild mucosal thickening of the left ethmoid air cells and a small retention cyst in the atelectatic left maxilla sinus. The imaged portions of the brain and orbits are unremarkable. There is mild multilevel spondylosis of the cervical spine.

Output: A right suboccipital subcutaneous soft tissue lipoma measures up to 3 cm.


Instruction: Generate impression based on findings.

Input: Clinical question: History spinal stenosis from spinal cyst. Signs and symptoms: No like pain and stiffness, hard to bend over. Nonenhanced lumbar MRI:T11 -- T12 is unremarkable.T12 -- L1 is unremarkable.L1 -- L2 demonstrate mild disk disease and loss of disk height and mild bilateral (left greater than right) facet and ligamentum flavum hypertrophy. There is a left far lateral small disk protrusion (sagittal T2/T2 stir image 6 and axial T2 series 701 image 32 and 33). Finding resulting subtle mass effect on the thecal sac on the left and extends into the left neural foramina with resultant mild compromise of the inferior aspect of neural foraminal. No spinal stenosis.L2 -- L3 moderate disk disease and loss of disk height with interval progression since prior study. Moderate bilateral facet and ligamentum flavum hypertrophy changes are also present. There is redemonstration of a right-sided synovial cyst with mass effect and forward and leftward displacement of thecal sac and moderate central spinal stenosis. The cyst appears to partially herniate through the ligamentum flavum. It however demonstrate slight interval decreased size since prior to study. There is mild right neural foraminal compromise secondary to degenerative changes with slight interval progression since prior exam from 2010.L3 -- L4 demonstrate moderate disk disease and loss of disk height and mild bilateral (left greater than right) facet and ligamentum flavum hypertrophy. No spinal stenosis or neural foraminal compromise. No significant change since prior exam.L4 -- L5 demonstrate advanced disk disease and significant loss of disk height, moderate left and mild right facet and ligamentum flavum hypertrophy. No spinal stenosis or neural foraminal compromise.L5 -- S1 demonstrate moderate advanced disk disease and loss of disk height and mild bilateral facet and ligamentum flavum hypertrophy. No significant change since prior exam. No spinal stenosis or neural foraminal compromise.

Output: 1.Extensive degenerative changes of lumber spine with mild interval progression since prior study from 2010.2.Extensive degenerative changes at L2 -- L3 with subtle interval progression. Interval decreased size of a right-sided synovial cyst however with persistent central spinal stenosis and significant right lateral recess compromise as detailed.3.At L1 -- L2 there is a left-sided lateral and far lateral shallow disk protrusion with subtle mass effect on the thecal sac and mild compromise of the lower aspect of the left neural foramina as detailed above.


Instruction: Generate impression based on findings.

Input: Headache [R51], Reason for Study: ^Reason: r/o structural abnormality History: headache. Neonatal candida infection. Brain MRINo evidence of acute ischemic or hemorrhagic lesion. The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal.Brain MRV3D MRV brain non-gadolinium enhanced scan with maximum intensity projections of the superficial/deep intracranial venous drainage demonstrate normal flow enhancement in the superior sagittal sinus, transverse sinuses, sigmoid sinuses, internal cerebral veins, vein of Galen and straight sinus.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion. No identifiable structure abnormality on the scan.2. Normal brain MRA.3. Normal brain MRV.


Instruction: Generate impression based on findings.

Input: Diagnosis: Nontraumatic subarachnoid hemorrhage, unspecifiedClinical question: SAH s/p EVD placement and removal, 3T Scanner pleaseSigns and Symptoms: 2 month follow up s/p SAH and EVD placement and removal MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a focus of susceptibility effect present along the central portion of the midbrain and narrowing which measures approximately 14 x 4 mm axial dimensions on FLAIR imaging. It was in an acute stage on the 8/14/2015 MRI of the head. There is no new extension of this hematoma.A ventriculostomy tract courses through the right frontal lobe into the right lateral ventricle .There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. These are stable compared to the 8/14/2015 exam.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.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 no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. The posterior communicating arteries are not readily identified. The vertebral arteries are similar in size.Incidental note is made of dorsal origin of the left ophthalmic artery from the cavernous segment of the left internal carotid artery.The right v4 segment distal to the origin of the right PICA is hypoplastic.

Output: 1.No evidence for cerebrovascular occlusive disease.2.No evidence for intracranial aneurysm.3.There is a hemorrhagic focus present in the midbrain which was in an acute stage in August.4.Periventricular and subcortical white matter signal changes of a mild degree are present which are nonspecific. They could be vascular related, related to demyelination, trauma, vasculitis, or sarcoid. They are nonspecific.