Instruction: Generate impression based on findings.

Input: 45 years Female (DOB:6/11/1971)Reason: Evaluate for etiology of persistent headache, history of polycythemia History: as abovePROVIDER/ATTENDING NAME: THOMAS J KELLY THOMAS J KELLY MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRV brain:The dural venous sinuses are patent. Straight sinus, internal cerebral veins and basal veins are identified and appear patent. The right basal vein of Rosenthal appears larger than the left counterpart.

Output: 1.No abnormal intracranial mass lesion is appreciated.2.There is no evidence for dural venous sinus thrombosis.


Instruction: Generate impression based on findings.

Input: 13-year-old female with low back pain over a year, previous abnormal spine MRI The vertebral column alignment is within normal limits. The vertebral body heights are preserved. There is mild disc bulge and superimposed tiny central disc protrusion at L5-S1, unchanged in appearance, without significant associated stenosis or resulting mass effect. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal or neural foraminal stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: Stable mild disc bulge and superimposed tiny central disc protrusion at L5-S1, unchanged in appearance, without significant associated stenosis or resulting mass effect.


Instruction: Generate impression based on findings.

Input: The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain. 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 are no vascular anomalies.

Output: Negative MRI of the brain and internal auditory canals including gadolinium enhancement. Specifically, the seventh/eighth nerve complexes are intact within bilaterally.


Instruction: Generate impression based on findings.

Input: Other facial nerve disorders [351.8], Reason for Study: ^Reason: LT hemifacial spasm History: as above There is fluid collections on the left mastoid air cells indicate possible left mastoiditis.On post Gad enhanced images, the left transverse sinus and sigmoid sinus were not well seen. This could represent normal variation of hypoplastic left transverse and sigmoid sinus. This possibility is supported by the finding of relatively smaller left jugular bulb comparing to that of right side.In addition, especially on the axial scan (series 1201, image 29, 32 and 33/90), there are multifocal non-enhancing areas which are surrounded by enhancement. These lesions could represent intra-dural sinus fibrous septae more likely. Other possibility is dural sinus thrombosis without complete occlusion. There is no evidence of brain parenchymal edema or hemorrhages suggesting venous congestive encephalopathy. Considering the patient's presenting symptoms and lack of other MRI findings suggesting venous congestive encephalopathy, the chance of being dural sinus thrombosis would be very low. The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. Mucosal thickenings on bilateral maxillary sinuses and sphenoid sinus with a small retention cyst on the left maxillary sinus.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. Hypoplastic left transverse and sigmoid sinus with intra-luminal filling defects indicating intra dural fibrous septae, the chance of dural sinus thrombosis is low.3. Left mastoid air cell fluid collections. Mucosal thickenings on paranasal sinuses as described above.


Instruction: Generate impression based on findings.

Input: Reason: 67 F s/p h/o maxillary sinus tumor now s/p resection/reconstruction; please evaluate for tumor recurrence at base of skull History: h/o maxillary sinus tumor. On the closed-mouth views, the mandibular condyles are well-situated within the glenoid fossae bilaterally. The menisci appear situated appropriately between the condyles and the articular eminences bilaterally. No erosions. No soft tissue mass.On open-mouth series, the menisci remain appropriately situated between the condyle and articular eminence, which shows appropriate anterior translation of the condyles.

Output: Normal examination. Please see separately dedicated MRI brain, facial bones, and orbits.


Instruction: Generate impression based on findings.

Input: Pain in right knee, check for meniscal tear and MCL injury MENISCI: No significant abnormality noted. Specifically menisci are intact, no findings to suggest acute tear and both menisci are properly inserted posteriorly.ARTICULAR CARTILAGE AND BONE: Moderate edema is observed throughout the lateral compartment, both within the distal femur and proximal tibia. Cartilage is intact throughout.LIGAMENTS: Abnormal signal within the ACL with small amount of fluid suggesting intrasubstance tear, however fibers are intact throughout. Additionally the MCL demonstrates marked abnormal inflammation and strain involving the proximal insertion with mild adjacent inflammatory changes and minimal fluid. Suspected subacute abnormality, please correlate patient injury.PCL, LCL and retinaculum are otherwise intactEXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Acute tendinosis and mild intrasubstance tear of the ACL and proximal MCL. The constellation along with bone edema and contusion correlate with a clipping injury.


Instruction: Generate impression based on findings.

Input: 75-year-old female with nausea and emesis with a previously noted biliary mass. Evaluate the mass. ABDOMEN:LUNG BASES: Stable right subpleural atelectasis with adjacent pleural thickening/small effusion, probably round atelectasis. Small left pleural effusion.LIVER, BILIARY TRACT: At the junction of segment 4A and segment IVb, again seen is intrahepatic periductal mild T2 hyperintensity (series 6, image 19) and diffusion restriction which is not measurable; however, this finding is unchanged from the previous examination. Intrahepatic biliary ductal dilatation has improved compared to the previous exam.No evidence of extrahepatic biliary ductal dilatation; the common bile duct tapers to the level of the ampulla without evidence of a stone, significant stricture, or lesion.SPLEEN: Splenomegaly persists.PANCREAS: Subcentimeter pancreatic head T2 hyperintense nonenhancing focus has slightly increased in size compared to the 2014 examination. This is favored to be side branch type IPMN. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Subcentimeter scattered renal cysts. Mild perinephric fluid bilaterally.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small hiatal hernia.BONES, SOFT TISSUES: Anasarca.OTHER: No significant abnormality noted.

Output: 1.Intrahepatic periductal mild T2 hyperintensity and diffusion restriction is not measurable; however, unchanged compared to the prior examination. Differential considerations include inflammatory sequelae related to patient's sarcoidosis.2.Persistent right basilar segmental consolidation/atelectasis.3.Anasarca.


Instruction: Generate impression based on findings.

Input: Postop 3-month tumor follow-up of cervical tumor. Compared to prior MRI from 9/9/2014, there is been interval evolution of postoperative changes of C3 to C5 laminectomy and resection of neurofibromas at the bilateral C4-C5 and C5-C6 levels. Again seen is posterior spinal fusion hardware at the C3 to C5 levels with susceptibility artifact slightly limiting evaluation Again seen is deformity involving the cervical cord from the C3 to the C5-C6 levels with areas of cystic change particularly at the C3 and C5-C6 levels. Previously seen expansile T2 hyperintensity at the C3 and C4 levels has markedly decreased with decrease in edema and development of volume loss at this level consistent with myelomalacia. There is some irregularity in the contour of the cord at this level which may also be related to adhesions. Extensive paraspinal neurofibromas are evident throughout the cervical spine, entering and expanding the neural foramina with individual levels as below:C2/3: Neurofibromas are confined to the extradural space, presumably postoperative. The postoperative canal at this level is patulous.C3/4: Neurofibromas are confined to the extradural space, presumably postoperative. The postoperative canal at this level is patulous. Cystic encephalomalacia and adhesions noted.C4/5: Previously seen neurofibromas involving the lateral epidural space and compressing the cord have been resected. Spinal canal is patent. Cord is deformed.C5/6: Previously seen neurofibromas involving the lateral epidural space and compressing the cord have been resected. Spinal canal is patent. Cord is deformed.C6/7: Bilateral dumbbell neurofibromas extend into the lateral epidural space posteriorly and mildly compress the cord, left relatively greater than right are unchanged since 8/28/2014.C7/T1: Bilateral dumbbell neurofibromas extend into the lateral epidural space mildly compress the cord, left significantly greater than right. No significant change is 8/28/2014.Multiple muscular and cutaneous neurofibromas are also again noted.

Output: 1.Compared to immediate postoperative study from 9/9/2014 and earlier study from 8/28/2014, there is evolution of recent postsurgical changes related to resection of neurofibromas at the C4-C5 and C5-C6 levels which were previously seen extending into the lateral epidural space and compressing the cord.2. There is decrease in previously seen edema at the C3 and C4 levels and progression of myelomalacia extending to the C5-C6 level inferiorly. Irregularity involving the cord contour likely related to combination of myelomalacia and adhesions in the thecal sac.3. Neurofibromas involving the C6-C7 and C7-T1 levels with mild epidural extension and mild mass effect on the cord are not significantly changed since 8/28/2014.


Instruction: Generate impression based on findings.

Input: Male, 79 years old, with right lower extremity weakness, history of prostate cancer and renal cell carcinoma. Evaluate for metastatic disease. Since the prior examination, the compression deformity of L3 has progressed with at least 60% loss of vertebral body height. The marrow space is more diffusely STIR hyperintense and enhancing.A chronic compression deformity of the L1 vertebral body is unchanged. The remaining vertebral bodies demonstrate preservation of height.Mildly diminished T1 and T2 signal intensity is seen in T11, T12, L2 and L4, of uncertain significance but unchanged from prior examination. These vertebral bodies demonstrate no abnormal STIR signal or pathologic enhancement. A subcentimeter focus of T2 hyperintensity and enhancement within the left anterior L2 vertebral body is unchanged and nonspecific.There is mild retropulsion of the L1 vertebral body due to compression. Otherwise, sagittal alignment of the spine is grossly anatomic.T12-L1: Mild retropulsion of the L1 vertebral body but no significant generalized spinal canal stenosis. Mild bilateral foraminal narrowing. No interval changes.L1-2: Ligamentum flavum thickening, and mild bilateral facet joint arthropathy. Minimal disc bulging. There is moderate right and mild left neural foraminal narrowing. There is no narrowing of the spinal canal. No interval changes. L2-3: Minimal disc bulge. Ligamentum flavum thickening, and moderate bilateral facet joint arthropathy. There is a left far lateral annular disc fissure. There is bilateral mild neural foraminal narrowing. There is mild narrowing of the spinal canal with effacement of the CSF space anteriorly. No interval changes.L3-4: Ligamentum flavum thickening. Moderate to severe bilateral facet joint arthropathy. Trace bulging disc. Moderate generalized spinal canal narrowing with crowding of the cauda equina. There is moderate right and mild left neural foraminal narrowing. No interval changes.L4-5: Ligamentum flavum thickening. Moderate to severe bilateral facet joint arthropathy . Mild disc bulging with only mild spinal canal narrowing. Moderate left and mild right foraminal narrowing. No interval changes. L5-S1: Facet arthropathy. Bulging disc. No significant spinal canal stenosis. Mild bilateral foraminal narrowing. No interval changes.

Output: 1.Progressive compression of the L3 vertebral body is seen. The marrow space is now more uniformly edematous and enhancing. The possibility of an underlying metastatic lesion cannot be excluded though the signal characteristics of the marrow could entirely reflect fracture-related edema and inflammation.2.No other definite metastatic lesions are seen in the lumbar spine. A chronic compression deformity of the L1 vertebral body is unchanged.3.Multilevel disc degeneration is also unchanged.


Instruction: Generate impression based on findings.

Input: Female, 32 years old. Reason: assess for labral tear History: hip pain ACETABULAR LABRUM: There is irregularity at the anterior superior labrum with internal signal abnormality that most likely represents a tear.ARTICULAR CARTILAGE AND BONE: The visualized bones have normal marrow signal. The imaged articular cartilage appears normal.SOFT TISSUES: The musculature and other soft tissues appear unremarkable. ADDITIONAL

Output: Anterior superior labral tear as described above.


Instruction: Generate impression based on findings.

Input: Female 53 years old Reason: History of pelvic fracture, no intervention, status post fall, please re-evaluate. History: As above ACETABULAR LABRUM: No significant abnormality.ARTICULAR CARTILAGE AND BONE: There is increased signal at the right pubic symphysis and the right inferior ischium consistent with nondisplaced fractures as seen on the comparison radiograph. There is bone marrow edema in the left superior ramus without definite evidence of fracture. These have not not significantly changed compared to prior exam. SOFT TISSUES: There is a fluid collection in the soft tissue adjacent to the right inferior ischium which may represent a hematoma. There is abnormal signal in the bilateral hamstring insertion possibly representing a partial ligament tear. Again seen is edema in the right adductor muscles down to their insertion on the pubic tubercle.ADDITIONAL

Output: Nondisplaced right pubic symphysis and left inferior ischium fractures.


Instruction: Generate impression based on findings.

Input: Pain. Check for ACL rupture and MCL tear. Possible lateral collateral ligament or meniscal tear as well as following patient falling down multiple stairs 5 days ago. Positive Lachman, varu and valgus stress tests. MENISCI: The lateral meniscus appears intact, however a discrete questionably complex star like tear is observed in the posterior medial meniscal horn extending to the inferior articular surface (image 19 series 601). Further characterization is difficult, specifically due to motion on the coronal projections.ARTICULAR CARTILAGE AND BONE: Diffuse marrow signal largely involving the medial tibial plateau representing a suspected contusion. Diffuse cartilaginous structures are intact without focal defectsLIGAMENTS: The LCL demonstrates intact fibers with questionable partial tearing of the short component given incomplete visualization. No surrounding soft tissue inflammation is also observed. The MCL is torn near its origin proximally with abnormal central fluid suggesting a longitudinal like tear. Similar surrounding soft tissue inflammation and surrounding minimal fluid.The PCL appears intact along with the patellar tendon however the ACL is not completely visualized and without contact discrete fibers. Suspected partial tearing with minimal retraction. Associated questionable small cyst at its insertion adjacent to the tibia.EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: ACL, MCL tearing with questionable more moderate changes in the LCL. Additional tear of the posterior medial meniscal horn; see detail provided


Instruction: Generate impression based on findings.

Input: Bell's palsy [351.0], Reason for Study: ^Reason: eval underlying structural lesions; neurosarcoidosis History: recurrent bell's palsy Bilateral facial nerves especially geniculate ganglions, tympanic segment and mastoid segment show enhancement on Gad infusion. Although the right side enhancement appears to be a bit more prominent than that of the left, the degree of enhancement should be interpreted as not significantly different.There is no evidence of acute ischemic or hemorrhagic lesion on this scan.There is no evidence of abnormal intra axial enhancement.There is no mass.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, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: Bilateral enhancement of facial nerves as described above, no definitive asymmetric or focal enhancement was seen.No evidence of acute ischemic or hemorrhagic lesion on this scan.No evidence of mass.


Instruction: Generate impression based on findings.

Input: 14-year-old male with right wrist pain, possible scaphoid fracture Periosteal new bone formation along the volar and ulnar aspect of the distal radial metaphysis presumably represents attempted healing of an underlying occult fracture. Please note that this periosteal reaction is nonspecific and if there is no history of trauma, MRI is recommended for further evaluation. The scaphoid appears normal.

Output: Periosteal new bone formation along the radial metaphysis, which is nonspecific and may represent attempted healing of underlying occult fracture. If there is no history of trauma, MRI is recommended for further evaluation.


Instruction: Generate impression based on findings.

Input: Reason: ?rotator cuff tear, supraspinatus - unable to raise arm, recent h/o injury lifting heavy weight History: left shoulder weakness Several sequences are limited by patient motion artifact.ROTATOR CUFF: There are massive tears of the rotator cuff, with complete tears of the supraspinatus and infraspinatus tendons with retraction to the level of the glenohumeral joint. There is mild to moderate atrophy of the supraspinatus and infraspinatus muscles. There is a full-thickness near-complete tear of the subscapularis tendon with only the most inferior fibers extending to the lesser tuberosity; the majority of the subscapularis tendon fibers are retracted to the level of the glenoid. Moderate to severe fatty atrophy of the subscapularis muscle. Teres minor tendon and muscle are intact. SUPRASPINATUS OUTLET: Moderate osteoarthritis of the acromioclavicular joint. There is a small amount of fluid in the subacromial/subdeltoid bursa containing intermediate signal intensity, likely reflecting bursitis. This fluid extends into and through the acromioclavicular joint resulting in a small fluid collection dorsal to the joint. Humeral head is high riding with the acromiohumeral interval measuring 1 to 2 mm.GLENOHUMERAL JOINT AND GLENOID LABRUM: Small to moderate glenohumeral joint effusion containing small foci of intermediate signal intensity, likely debris. Mild osteoarthritis of the glenohumeral joint. Bone marrow signal is normal.There is increased signal in the anterior and superior labrum, which may reflect degeneration/degenerative tearing.BICEPS TENDON: There is full-thickness rupture of the biceps tendon within the rotator interval. The tendon is not visualized within the bicipital groove.

Output: Massive rotator cuff tear and other findings as above.


Instruction: Generate impression based on findings.

Input: Clinical question: No back pain with radicular symptoms. Signs and symptoms: As above. Pre and post enhanced lumbar MRI:T12-L1 demonstrate mild degenerative changes and unremarkable otherwise.L1-L2 demonstrate a small left paramedian disc protrusion with minor indentation of thecal sac. No spinal stenosis, or neural foraminal or lateral recess compromise.L2-L3 demonstrate mild to moderate disc disease and loss of disc height, mild bilateral ligamentum flavum hypertrophy, mild facet disease however with evidence of bilateral facet effusion. There is also minimal grade 1 retrolisthesis at this level. No spinal stenosis or neural foraminal compromise.L3-L4 demonstrate mild disc disease and loss of disc height and mild bilateral ligamentum flavum hypertrophy. Mild bilateral facet effusion and mild degenerative changes. There is a linear increased T2/T2 STIR signal intensity on the left and far laterally representing a small annular fissure. There is no evidence of a spinal stenosis, lateral recess or neural foraminal compromise.L4-L5 demonstrate advanced degenerative disc disease and loss of disc height, mild right lateral facet and ligamentum flavum hypertrophy without spinal stenosis or neural foraminal compromise.There is sacralization of S1 and without intravenous of a spinal stenosis or neural foraminal compromise.Post enhanced images demonstrate no detectable enhancement of the cord, cauda equina or the leptomeninges. There is expected subtle enhancement of the above detailed annular fissure and unremarkable post infused images of lumbosacral spine.When compared with prior examination from 2013 there is no significant interval change in the extent of the findings detailed above.

Output: 1.Degenerative changes of the lumbar spine however without evidence of spinal stenosis, neural foraminal or lateral recess compromise.2.Tiny right lateral disc protrusion at L1-L2 on the left and an annular fissure on the left at L3-L4 as detailed.3.No abnormal enhancement of the vertebral column, lowermost visualized thoracic cord, conus or the cauda equina.


Instruction: Generate impression based on findings.

Input: Ms. Johnson is a 46 year old female presenting for a short-term 6 month follow-up of a left nipple mass, suspected to be a papilloma. She denies skin changes or bloody nipple discharge. Upon physical exam, no discrete mass is appreciated in the left nipple.A targeted left ultrasound was performed at the nipple. There is reidentification of a circumscribed isoechoic mass in the left nipple, now measuring 7 x 3 x 4 mm (previously 6 x 3 x 4 mm), grossly unchanged in size allowing for technical differences. This corresponds to the enhancing area seen in the left nipple on breast MRI 8/6/2014 and likely represents a papilloma.

Output: High probability benign mass in the left nipple, likely representing a papilloma. The patient is due for her annual bilateral diagnostic mammogram in July 2016. This area can be evaluated mammographically at that time. Additional imaging, including ultrasound examination, can be performed as clinically warranted. All results and recommendations were discussed with the patient.BIRADS: 3 - Probably benign finding.RECOMMENDATION: 3B - Followup at Short Interval (1-11 Months).


Instruction: Generate impression based on findings.

Input: Prostate cancer. On active surveillance. Gleason 3+4. RLA disease. PELVIS:PROSTATE:Prostate Size: 3.1 x 5.3 x 4.6 cmPeripheral Zone: Within the right mid gland there is a 3 mm T2 weighted hypointense focus with restricted diffusion (series 901/11 and series 704/164), suspicious for prostate cancer.Within the right apex there is 3 mm T2 weighted hypointense focus with restricted diffusion (series 901/7 and series 704/84), suspicious for prostate cancer.Central Gland: Near the prostate apex in the region of the transition zone there is a 2.3 x 1.7 focus which T2-weighted hypointensity and demonstrates restricted diffusion (series 704/104 and series 901/8). Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Low volume disease with 3 mm right mid gland peripheral zone and 3 mm right apex peripheral zone foci, suspicious for carcinoma.2. 2.2 x 1.7 cm focus of T2-weighted hyperintensity and restricted diffusion in the anterior apex which may represent the transition zone and less likely cancer.


Instruction: Generate impression based on findings.

Input: Reason: shooting pain in right groin History: shooting pain in right groin 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. Incidental note is made of a fatty filum terminale.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is no significant compromise to spinal canal or neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.No compromise to lumbar spinal canal or neural foramina.2.There is fatty filum terminale present which represents an incidental finding


Instruction: Generate impression based on findings.

Input: Repeat MRI without charge per report on mri on 7/22, DRIVE sequence requested with higher matrix size: sensorineural hearing loss Internal Auditory Canals: The bilateral cochlear nerves are intact. The vestibular and facial nerves also appear to be intact. There is no evidence of mass lesions. The inner ear structures, including the cochlea, vestibule, endolymphatic duct, and semicircular canals, appear unremarkable. The bilateral mastoid air cells and middle ears also appear unremarkable.Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. The bilateral cochlear nerves are intact.2. The intracranial structures appear unremarkable.


Instruction: Generate impression based on findings.

Input: History of pancreatic mass. Increasing abdominal distention. ABDOMEN:LIVER, BILIARY TRACT: Several scattered cysts. The common bile duct measures 6 mm and tapers smoothly at the ampulla. This is within normal limits given the patient's age and post cholecystectomy state. No suspicious liver lesion.SPLEEN: No significant abnormality noted.PANCREAS: Several punctate pancreatic cystic foci appear to communicate with a normal caliber main pancreatic duct compatible with sidebranch IPMNs without suspicious imaging characteristics (series 11/5). No suspicious solid pancreatic lesion.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: Scoliosis.OTHER: No significant abnormality noted.

Output: 1.Small pancreatic IPMNs without suspicious imaging characteristics.2.No suspicious liver lesion.


Instruction: Generate impression based on findings.

Input: Elevated PSA. PELVIS:PROSTATE:Prostate Size: 4.7 x 5.9 x 7.1 cm.Peripheral Zone: The peripheral zone is diffusely thinned and demonstrates mildly heterogeneous T2 signal intensity without a dominant lesion.Central Gland: Markedly enlarged with changes of BPH.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: NoneBLADDER: No significant abnormality noted.LYMPH NODES: Few nonspecific subcentimeter pelvic lymph nodes are noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No dominant lesion. Enlarged prostate with changes of BPH.


Instruction: Generate impression based on findings.

Input: NF type 1 with visual changes with eye exam. Brain: There are T2 hyperintense lesions in the medial cerebellar hemispheres and periventricular white matter adjacent to the frontal horns bilaterally. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The intracranial portions of the optic nerves and optic chiasm are unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Orbits: There appears to be high T2 signal in the orbital and canalicular portions of the optic nerves bilaterally, left more than right, without appreciable expansion of the optic nerves. The bilateral globes and ocular adnexa are unremarkable. There is no evidence of abnormal intraorbital enhancement.

Output: 1. Lesions in the medial cerebellar hemispheres and periventricular white matter adjacent to the frontal horns bilaterally likely represent stigmata of neurofibromatosis type 2. Apparent signal abnormality in the orbital and canalicular portions of the optic nerves bilaterally, left more than right, without appreciable expansion of the optic nerves may nevertheless represent optic gliomas versus artifact.


Instruction: Generate impression based on findings.

Input: Prominent susceptibility is again identified along the left greater than right posterior scalp, with limited evaluation of surrounding structures, likely relating to postoperative changes. In addition, there are a few foci of susceptibility in the posterior fossa, with a prominent area along the left brachium pontis, presumably relating to previous vestibular schwannoma resections. There are also scattered areas of T2/FLAIR hyperintensity along the right cerebellar hemisphere and right greater than left brachium pontis with volume loss on the left, also presumably postoperative. There is mild diffuse dural thickening and enhancement appears similar.Additional punctate susceptibility is present along the posterior right frontal lobe. A prominent heterogeneous area of susceptibility persists in the right frontal lobe corresponding to a known meningioma which is presumably partially calcified. This dural based enhancing extra-axial mass is unchanged in size measuring 3.0 cm transverse x 3.1 cm CC x 2.9 cm AP. An adjacent smaller left paramedian enhancing extra-axial oval mass off the anterior aspect of the falx again measures 1.7 x 1.2 cm in greatest axial dimensions. Multiple other scattered plaque-like extra-axial dural based masses along the cerebral convexity and falx, some of which are located along the margins of the superior sagittal sinus appear stable. Grossly, the superior sagittal sinus remains patent, although there are areas of mass effect or centrally located parasagittal masses. A few smaller presumed meningiomas are seen along the inferior and lateral frontal lobes as well as the anterior right temporal lobe, which are also unchanged.There is a lobulated homogeneous enhancing mass at the right cerebellopontine angle, presumably a vestibular schwannoma, measuring 2.4 x 3.1 cm in greatest axial dimensions, unchanged. There is also abnormal extra-axial enhancement along the left cerebellopontine angle extending into the region of the left internal auditory canal which could be better assessed with a dedicated IAC MRI.A right Meckel's cave/cavernous sinus mass with central heterogeneity measures 1.9 x 2.2 cm, unchanged. Enhancing tissue is also seen in left Meckel's cave, grossly similar, likely an additional trigeminal schwannoma. Asymmetric T1 and T2 hyperintense fat signal is identified right masticator space and right sphenoid region which may relate to prior radiation treatment.There is a stable oval enhancing mass along the right retropharyngeal space, partially visualized but grossly similar, measuring up to 1.7 x 2.7 cm. As before, smaller enhancing masses are seen in the left lateral parapharyngeal space as well as within the deep left parotid gland. A smaller enhancing nodule is seen ventral to the left midbrain with adjacent nerve thickening extending into the left cavernous sinus, which appears to represent the cisternal left oculomotor nerve, unchanged in appearance.The ventricles and sulci are within normal limits. The basal cisterns remain patent. There is no midline shift. There are no areas of pathological parenchymal enhancement. There is no diffusion abnormality. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. As before, there is fluid opacification in the left mastoid region.SPINE

Output: 1.Stable multiple intracranial masses, representing multiple meningiomas and cranial nerve schwannomas as detailed above.2.No significant interval change in foramen magnum level partially exophytic mass at the level of the cervicomedullary junction, which may relate to an ependymoma, less likely a meningioma or nerve sheath tumor at this level.3.Extensive intramedullary neoplastic disease throughout the entire cord as well as intradural extra medullary lesions. No significant interval change with essentially complete effacement of CSF space along the expanded cervical cord and upper thoracic levels.4.Postoperative changes along the upper lumbar spine with no definite masslike recurrence of enhancement at the level of previous conus ependymoma, although significant intrathecal burden of masses remaining at other levels, stable in appearance.5.Other partially visualized masses such as in the right suprarenal location, right retropharyngeal space, posterior to the right thyroid gland, and along the lower neck paraspinal musculature are grossly stable.


Instruction: Generate impression based on findings.

Input: 71-year-old female status post right TKA with history of CVA. As increased irritability and decreased responsiveness. Rule out subdural hematoma or infarction. The examination demonstrates some periventricular hypodensity consistent with small vessel ischemic disease. In the left temporal region there is an area of hypodensity which may or present area of acute ischemia. The appearance is somewhat atypical however with a central area of relative hyperdensity. I cannot exclude the possibility of prior hemorrhage or even underlying mass lesion.. No significant mass-effect is seen. I would recommend obtaining an MRI of the brain with contrast to further evaluate this region.Bone windows reveal no osseous abnormality.

Output: Small vessel disease an area of atypical density along the left temporal lobe. Possibilities include an area of subacute ischemia versus evolving hematoma (possibly evolution of hemorrhagic transformation of an infarct) or less likely mass lesion. MRI of the brain with contrast is recommended to fully evaluate.


Instruction: Generate impression based on findings.

Input: posterolateral ankle pain and swelling. Assess peroneal tendons, posterior subtalar joint and achilles tendon TENDONS: The Achilles is normal. The remaining tendons of the ankle are also normal in appearance. No evidence of tenosynovitis.LIGAMENTS: The anterior talofibular ligament and lateral collateral complex is intact. No abnormality of the ligaments.ARTICULAR SURFACES AND BONE: Edema is present within the posterior calcaneus with a T1 and T2 hypointense stress fracture line through the body of the calcaneus extending from the superior surface, inferiorly to the mid body. The stress fracture is nondisplaced and in anatomic alignment. In the inferior lateral portion of the talus there is bone marrow edema without evidence of fracture. No additional areas of bone marrow edema or fracture.ADDITIONAL

Output: Nondisplaced linear stress fracture through the posterior calcaneus.


Instruction: Generate impression based on findings.

Input: 84-year-old female with shoulder pain and possible tear. ROTATOR CUFF: There is complete rupture of the supraspinatus and infraspinatus tendons with associated 16 mm of retraction. There is atrophy of the supraspinatus and infraspinatus muscles. There is partial-thickness undersurface tearing of the subscapularis tendon. There is thickening and increased signal abnormality within the subscapularis tendon consistent with moderate to severe tendinosis. The subscapularis muscle appears intact. The tears minor muscle and tendon appear intact.SUPRASPINATUS OUTLET: Note is made of narrowing of the subacromial interval consistent with chronic rotator cuff tearing. There is fluid within the subacromial subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Marked degenerative changes affect the glenohumeral joint with extensive subchondral cyst formation. There is a moderate amount of fluid within the glenohumeral joint.BICEPS TENDON: Circumferential fluid is identified within the tendon sheath of the long head of the biceps which may represent extension of fluid from the glenohumeral joint. ADDITIONAL

Output: Degenerative changes with chronic appearing high grade rotator cuff tear and atrophy, as described above.


Instruction: Generate impression based on findings.

Input: 53-year-old female with left hand weakness. The exam is degraded by patient motion artifact.There are small T2 hyperintensities in the pons, which are nonspecific but likely reflect age-indeterminate small vessel ischemic disease. The cranial-cervical junction is normal. There is reversal of the normal cervical lordosis. Mild loss of the C6 vertebral body height is again seen with associated endplate irregularities. The vertebral body heights are otherwise preserved. There is disc desiccation at all levels of the cervical spine and moderate loss of the intervertebral disc space at C5-6 and C6-7. There is stepwise degenerative retrolisthesis of C5 on C6 and C6 and C7. The bone marrow demonstrates a normal MR appearance other than mild endplate degenerative marrow changes at C5-C6 and C6-C7. The signal of the visualized cord is normal. The paraspinal soft tissues are unremarkable.There is no evidence of cord compression or mass. Degenerative changes are specified by the intervertebral level as follows: C2-C3: No neuroforaminal narrowing or spinal stenosis. C3-C4: Mild disc bulge but no neuroforaminal narrowing or spinal canal stenosis. C4-C5: There is left paracentral disc protrusion, which deforms the left ventral spinal cord and ventral left C5 nerve root. There is mild to moderate spinal canal stenosis and mild-to-moderate right neuroforaminal stenosis. Bilateral uncovertebral hypertrophy is also present.C5-C6: There is shallow central/left paracentral posterior disc osteophyte formation that results in mild spinal canal stenosis with slight flattening of the left ventral cord and moderate left neural foraminal narrowing. Left greater than right uncovertebral hypertrophy and right facet hypertrophy are also noted.C6-C7: There is mild posterior disc osteophyte formation with mild spinal canal stenosis, mild right neuroforaminal narrowing and mild to moderate left neuroforaminal narrowing. Bilateral uncovertebral hypertrophy is also noted.C7-T1: No neuroforaminal narrowing or spinal stenosis.

Output: Multilevel cervical spine spondylosis, most pronounced C4-5 where there is impingement of the left ventral spinal cord and upon the ventral left C5 nerve root by a left paracentral disc protrusion. These findings do not appear significantly changed from the prior exam.


Instruction: Generate impression based on findings.

Input: BRAIN: There are postoperative findings related to suboccipital craniectomy and C1 laminectomy as well as duraplasty and tonsillopexy. There is minimal T2 hyperintensity within the residual cerebellar tonsils as well as within the bilateral biventral lobules. There are also punctate foci of susceptibility effect within the right biventral lobule, as well as in the posterior medulla, which are compatible with blood products. There is mild tenting of the inferior left cerebellar hemisphere towards the overlying dura. The neo-foramen magnum is patent with intact biphasic CSF flow anteriorly and posteriorly up to the area of the mildly deformed posterior cerebellar hemisphere. There appears to be minimal fluid posteroinferior to the duraplasty site. There is no evidence of 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.CERVICAL SPINE: The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology without evidence of syringohydromyelia.

Output: 1. Postoperative findings related to recent Chiari decompression with a small focus of hemorrhage in the right biventral lobule, as well as in the posterior medulla. 2. Mild deformity of the posterior cerebellum with possible adhesion formation with the overlying dura. Otherwise, the neo-foramen magnum is patent with normal CSF flow dynamics and no residual tonsillar herniation.3. No evidence of syringohydromyelia. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Infrapatellar pain. Tiny osteophytes suggest minimal osteoarthritis, essentially within normal limits considering the patient's age. There is perhaps a slight varus deformity of the knee but otherwise alignment is within normal limits. I see no joint effusion. The patellar tendon silhouette appears normal.

Output: Minimal osteoarthritis, essentially within normal limits considering the patient's age.


Instruction: Generate impression based on findings.

Input: Outside CT reportedly showed 1.3 cm lesion at the head of the pancreas. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology, size, signal intensity and enhancement without a focal suspicious lesion. Punctate cyst. No intrahepatic or extrahepatic biliary ductal dilatation. Normally distended gallbladder.SPLEEN: No significant abnormality noted.PANCREAS: In the pancreatic uncinate process there is a cystic lesion measuring 1.4 x 1.3 cm (series 9/34). The lesion appears to communicate with the main pancreatic duct (series 5/57), favoring a side branch IPMN. Additional punctate subcentimeter cystic foci in the pancreatic body and tail (series 8/20). The main pancreatic duct is normal in caliber.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: 1.4 cm uncinate process cystic lesion likely represents a side branch type IPMN without suspicious imaging features.


Instruction: Generate impression based on findings.

Input: 61-year-old female with neck, back and shoulder pain. Evaluate four lytic bone lesion. MRI C-Spine:An avidly enhancing soft tissue mass is redemonstrated involving the left C7 transverse process, pedicle and lamina. The lesion certainly encroaches upon the left C6-7 and C7-T1 neural foramina. However the lesion is most likely osseous in origin, and is best as can be determined, seems to be separate from the exiting nerve nerve roots. There is no significant intraspinal epidural encroachment. Much smaller but similar-appearing enhancing lesions are also evident within the spinous processes of C5 and T1. The cervical spinal cord has normal signal characteristics and overall morphology. The vertebral artery flow voids appear to be intact. There is a normal variant enlarged foramen transversarium secondary to mildly hypertrophied/tortuous vertebral artery involving the left C3 level. The paraspinous soft tissue structures appear within normal limits.The craniovertebral junction appears within normal limits. The cervical spine alignment is maintained and the cervical vertebral bodies are appropriate in height. There is multilevel disc height loss most prominently involving the lower cervical spine at C5-6. There are small disc osteophyte complexes at multiple levels in the cervical spine extending from C3-4 through C6-7. Facet hypertrophy and ligamentum flavum thickening involving the C5-6 and C6-7 levels along with the disc osteophyte complexes at these level causes mild spinal canal stenosis. There is moderate bilateral neural foraminal narrowing involving C5-6 level. The left C6-7 and C7-T1 neural foramina are narrowed due to a combination of tumor and degenerative change.MRI Cord Compression Protocol:No acute cord compression is seen. In addition to the above-mentioned findings, there also appears to be a small focal STIR hyperintense lesion within the inferior articulating facet of T12 on the right.

Output: A solidly enhancing, expansile mass is present centered on the left C7 transverse process, pedicle and lamina. Although the adjacent neural foramina are compromised by this lesion, there is no significant intraspinal epidural involvement. Additional small lesions are also seen within the spinous processes of C5 and T1, and the right inferior articulating facet of T12. No acute cord compression is detected at any level.Given the relatively aggressive appearance on CT, and the multiplicity of lesions, the possibility of a malignant process must be considered. Metastatic disease, myeloma and lymphoma would be in the differential diagnosis. The possibility of a benign lesion is not entirely excluded, though this is considered less likely.Findings were relayed to Dr. Castro, of Neurosurgery service, by Dr. Veronesi, Neuroradiology Fellow, on 10/30/2016 at 11 am.


Instruction: Generate impression based on findings.

Input: 71Yrs male with a hx of CAD s/p CABG 5/2016, HFpEF, HTN, HLD, CKD, PAD and recent diagnosis of amyloid presenting from cardiology clinic with concern for cardiac amyloidosis. Left VentricleThe left ventricle is normal in size with severe concentric hypertrophy and normal systolic function. The overall LV ejection fraction is 55%. The LVEDV is 157 ml (normal range 142+/-34), the LV end diastolic volume index is 79 ml/m2 (normal range: 74+/-15), the LVESV is 71 ml (normal range 47+/-19) and the LV end systolic volume index is 36 ml/m2 (normal range 25+/-9). The LV mass is 165 g (normal range 164+/-36) and the LV mass index is 84 g/m2 (normal range 85+/-15). There are no regional wall motion abnormalities present. The native T1 myocardial relaxation time is normal (1013-1053 ms). However, on TI imaging, the blood pool and myocardium null at the same time. This, along with subtle diffuse subendocardial late gadolinium enhancement, is highly consistent with a diagnosis of cardiac amyloid deposition.There is no myocardial iron overload. There is no LV thrombus. Left AtriumThe left atrium is moderately dilated. There is no left atrial appendage thrombus.Right VentricleThe right ventricle is normal ion size with mild to moderate hypertrophy and normal systolic function. The overall RV ejection fraction is 53%. The RVEDV is 138 ml (normal range 142+/-31), RV end diastolic volume index is 70 ml/m2 (normal range 82+/-16), the RVESV is 65 ml (normal range 54+/-17), and the RV end systolic volume index is 33 ml/m2 (normal range 31+/-9).Right AtriumThe right atrium is moderately dilated.Aortic ValveThe aortic valve is trileaflet, opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is moderate eccentric mitral regurgitation directed to worse the lateral left atrial wall. There is systolic anterior motion of the mitral valve causing flow turbulence in the left ventricular outflow tract.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsLarge right pleural effusion. Small left pleural effusion. Elevation of the left hemidiaphragm suggesting left phrenic nerve or hemidiaphragmatic dysfunction, as before. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1.TI imaging with nulling of the blood pool and myocardium together is highly diagnostic of cardiac amyloidosis. 2.Subtle diffuse subendocardial late gadolinium enhancement, highly consistent with a diagnosis of cardiac amyloidosis.3.Normal left ventricular size and systolic function (LVEF 55%) with severe concentric hypertrophy.4.Systolic anterior motion of the mitral valve with flow acceleration in the left ventricular outflow tract. 5.Moderate mitral regurgitation with an eccentric jet directed to the lateral left atrial wall. 6.Moderate left and right atrial dilation.7.Normal right ventricular size and systolic function (RVEF 53%) with mild to moderate hypertrophy.8.Large right and small left pleural effusion.9.Elevation of the left hemidiaphragm suggesting left phrenic nerve or hemidiaphragmatic dysfunction, as before.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 49-year-old male with history of testicular cancer. Evaluate for metastatic disease. ABDOMEN:LIVER, BILIARY TRACT: Scattered subcentimeter lesions within the liver, some of which are T2 hyperintense and diffusion restricting. Some of these lesions demonstrate peripheral nodular discontinuous enhancement. The other lesions are benign cysts.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.Subcentimeter liver hemangiomas and cysts. 2.No evidence of recurrence or metastatic disease.


Instruction: Generate impression based on findings.

Input: History of demyelinating disease (ADEM versus NMO). Follow-up exam. Brain:No abnormal signal is seen on the T2, FLAIR or diffusion weighted images. No abnormal enhancement is noted on the postcontrast images. There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration. The expected intracranial vascular flow voids are present.The paranasal sinuses are clear. The visualized mastoid air cells are clear. The orbits are unremarkable.Cervical spine:The vertebral body and intervertebral disc heights are maintained. Alignment is anatomic. Small disc osteophyte complex at C5-6. No significant spinal canal or neural foraminal stenosis.The cord is normal in morphology. There is residual trace foci of increased T2 signal in the anterior right cord at the mid C3 level. Focus of increased T2 signal in the right anterior cord at C6 and C7 is also not significantly changed. No abnormal enhancement is noted on the postcontrast images.

Output: 1. Essentially normal MRI brain. No evidence of demyelinating lesion.2. Scattered foci of increased T2 signal within the anterior cervical spinal cord which may reflect a demyelinating process are not significantly changed from prior.


Instruction: Generate impression based on findings.

Input: 77 year old with history of coronary artery disease who underwent two vessel total endoscopic coronary artery bypass and failed intervention of the right coronary chronic total occlusion presenting for cardiac evaluation. MEDICATIONS: atorvastatin, clopidogrel First Pass PerfusionDuring hyperemia, there is a large burden of ischemia. There is a transmural perfusion defect involving the basal infero-septum, inferior, and inferolateral walls. There is a non-transmural perfusion defect involving the basal anteroseptum, anterior, and anterolateral walls. At the mid ventricular level, there is a non-transmural perfusion defect involving the inferoseptal and inferior walls. At the apical level, there is a mild circumferential perfusion defect. Viability/ Myocardial ScarThere is a small transmural myocardial infarction limited to the basal inferior wall. This segment is unlikely to be viable; however, the remainder of the myocardium is viable. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 63 %, the LV end diastolic volume index is 61 ml/m2 (normal range: 74+/-15), the LVEDV is 115 ml (normal range 142+/-34), the LV end systolic volume index is 23 ml/m2 (normal range 25+/-9), the LVESV is 43 ml (normal range 47+/-19), the LV mass index is 47 g/m2, and the LV mass is 88 g. There is mild hypokinesis of the basal inferior wall. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 63%, the RV end diastolic volume index is 63 ml/m2 (normal range 82+/-16), the RVEDV is 117 ml (normal range 142+/-31), the RV end systolic volume index is 23 ml/m2 (normal range 31+/-9), and the RVESV is 44 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly enlarged.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild to moderate mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is trace pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern. There is atherosclerosis seen in the descending thoracic aorta. Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. There is a large burden of ischemia in a multivessel coronary distribution.2. The most severe defect is in the usual territory of the right coronary. Although a small portion of this territory has a transmural myocardial infarction which is not viable, most of the RCA territory is free of myocardial infarction and highly likely to be viable. 3. There is also mild ischemia in the other coronary artery territories. There is no myocardial infarction in these areas and they are highly likely to be viable. 4. Normal LV size and systolic function (LVEF 63%).5. Normal RV size and systolic function (RVEF 63%).6. Mild to moderate mitral regurgitation.


Instruction: Generate impression based on findings.

Input: Clinical question: 74 year old male with glioblastoma multiforme. On anticoagulation for acute DVT. Now with acute decline in mental status. Signs and symptoms: Obtunded. Nonenhanced CT of brain:Very poor study due to extensive motion artifact. New since prior examination is a large area of vasogenic edema in the left anterior, mid and posterior temporal lobe with significant effacement of adjacent cortical sulci. There is no significant mass effect on the lateral ventricle and no midline shift is detected. Findings are concerning for increased/recurrence of tumor and should be further evaluated with a dedicated MRI examination.Ventricular system remain within normal size and stable since prior study. No additional findings.

Output: 1.Significant new area of vasogenic edema in the left temporal lobe concerning for increase in the size of patient's known left temporal lobe glioblastoma. 2.No evidence of midline shift or hydrocephalus or any additional findings.3.Follow-up with an enhanced MRI is recommended.


Instruction: Generate impression based on findings.

Input: Reason: evaluate for small bowel inflammation History: abdominal distention, family history of IBD ABDOMEN:LIVER, BILIARY TRACT: Questionable small gallstone, please correlate with ultrasound. No focal liver lesion or biliary dilatation.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.PELVIS:UTERUS, ADNEXA: Possible arcuate morphology of the uterus. Numerous small peripheral cysts in the bilateral ovaries, raising the possibility of PCOS. Please correlate with patient's history and obtain pelvic ultrasound if indicated. 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 MR evidence of inflammatory bowel disease.2.Questionable small gallstone, please correlate with ultrasound.3.Incidental findings of possible PCOS (polycystic ovarian syndrome) and arcuate morphology of the uterus. Please correlate with patient's history and obtain pelvic ultrasound if indicated.


Instruction: Generate impression based on findings.

Input: Cervical lesion surveillance; slight arm weakness. There is slight interval decrease in size of the T2 hyperintense, mildly expansile intramedullary lesion within the cervical spinal cord that extends from the level of C2 to C4. Indeed, the lesion measures up to 7 mm in width, previously 9 mm, although the craniocaudal extent is not significantly changed. Furthermore, the associated abnormal enhancement has resolved. The cervical spine alignment and appearance of the bone marrow are unchanged. The vertebral body heights are preserved. There is congenital narrowing of the cervical spine and superimposed multilevel degenerative spondylosis of the cervical spine. The previously demonstrated thyroid lesions are masked by the saturation bands on this exam.

Output: 1. Slight interval decrease in size of the indeterminate cervical spinal cord lesion with resolution of the abnormal enhancement. The differential diagnosis includes demyelinating and inflammatory conditions, or perhaps a neoplastic process with superimposed treatment effects.2. Unchanged congenital cervical spinal canal narrowing with superimposed multilevel cervical spondylosis.


Instruction: Generate impression based on findings.

Input: 25 years Female (DOB:9/1/1991)Reason: 3 t scanner ccm protocol qsm/permeabililty evaluate for cavernoma History: screen for cavernomaPROVIDER/ATTENDING NAME: ISSAM A. AWAD ISSAM A. AWAD There are multiple lesions with susceptibility effect scattered throughout the brain. The largest one is in the superior aspect of the vermis eccentric to the right side and measures 9 x 7 mm in axial dimensions on T1 imaging and 10 mm x 9 mm in sagittal imaging. A right occipital lobe measures 5 mm axial dimensions on T2 imaging and has a thick halo of susceptibility effect surrounding it. One in the left frontal lobe periventricular white matter measures 4 mm in diameter. Additional lesions are scattered elsewhere. One is located in the left cerebellar hemisphere, one is located in the right frontal lobe another one is located along the left superior frontal gyrus and another one along the right parietal lobe.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: There are multiple hemorrhagic lesions scattered throughout the brain compatible with cavernous hemangiomas. One in the right occipital lobe has a thick halo of hemosiderin suggesting may have hemorrhaged previously. The largest one appears to be located in the superior aspect of the vermis.


Instruction: Generate impression based on findings.

Input: cT4N1Mx left tongue squamous cell carcinoma, status post chemoradiation treatment (finished TFHX ON 11/12/2015). There are post-treatment findings in the left oral cavity region and anterior neck subcutaneous tissues. There is no evidence of measurable mass lesions or significant cervical lymphadenopathy based on size criteria. The thyroid and major salivary glands are unchanged. The osseous structures are unremarkable. The airways are patent. The orbits and imaged intracranial structures are unremarkable.

Output: Post-treatment findings without definite evidence of residual measurable mass lesions or significant cervical lymphadenopathy.


Instruction: Generate impression based on findings.

Input: Prostate cancer with bone metastasis. Evaluate for disease progression.. The patient could not tolerate doing the thoracolumbar examination and only the thoracic spine was scanned. There is anterior and posterior fusion of C3-C4. T1-hypointense signal at C5-C6 vertebral bodies and pedicles is incompletely assessed. In addition, the lesion with a central compression fracture involving the L1 vertebral body is not fully characterized, but there is apparently increased retropulsion. There is a rightward convex curvature that is mild and broad-based. The T1 and T2 hyperintense lesions involving the C7, T5, T7, T8, and T10 vertebral bodies are unchanged, most compatible with hemangiomas. Focal T1-hypointense, T2 hyperintense, contrast-enhancing marrow abnormality just subjacent to the focally deficient inferior endplate of T8 vertebral body is most likely a Schmorl node. A smaller similar one is present at T9 also along the inferior endplate. There is subtle increase in T2 signal and decrease in T1 signal along the anterior aspect of T11 and T12 vertebral bodies with associated mild contrast enhancement. This was present previously and may be degenerative in nature. The vertebral body heights are preserved. The minimal T2-T3 disc-osteophyte complex indenting the thecal sac but no causing significant spinal canal or foraminal narrowing has not changed. Otherwise, the disc space heights are preserved. There are prominent midthoracic anterior spinal osteophytes, which are predominately right-sided and may reflect diffuse idiopathic skeletal hyperostosis. The spinal cord displays normal signal and morphology. There is interval increase in size of a left retroperitoneal nodule, which may represent a lymph node metastases, although this is incompletely characterized.

Output: 1.The patient was unable to complete the examination and only the thoracic spine was imaged.2.Minimal, focal contrast enhancement along the inferior aspect of T8 and T9 vertebral bodies is probably related to Schmorl nodes. Multilevel hemangiomas are unchanged. There is no suspicious thoracic spine lesion, otherwise.3.The pathologic compression fracture involving the L1 vertebral body is not diagnostically imaged, but there is increased retropulsion.4.Interval increase in size of a left retroperitoneal nodule, which may represent a lymph node metastases, although this is incompletely characterized.


Instruction: Generate impression based on findings.

Input: Reason: left knee pain after MVA, swelling, difficulty bearing weight History: r/o ligamentous injury from trauma MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: The articular cartilage appears normal. A small low intensity focus in the fibular head represents a bone island.LIGAMENTS: The cruciate collateral ligaments are intact. EXTENSOR MECHANISM: The quadriceps and patellar tendons are intact.ADDITIONAL

Output: Anteromedial soft tissue contusion without evidence of ligamentous injury.


Instruction: Generate impression based on findings.

Input: Reason: Elevated lipase and ALP, abd pain. R/o PSC. History: Elevated lipase and ALP, abd pain. Hx of Crohn's. R/o PSC. ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesions. Noncirrhotic morphology.There is mild narrowing of the at the junction of the distal intrahepatic ducts and proximal common hepatic duct. The remainder of the common bile duct is normal in caliber. No intrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: Pancreas parenchyma appears normal. Main pancreatic duct is nondilated. No focal lesions within the pancreas.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: The lower pole T2 hyperintensity, likely a cyst.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: Mild biliary narrowing at the Klatskin point which is nonspecific. The common bile duct and intrahepatic ducts are otherwise unremarkable. No focal hepatic lesions.


Instruction: Generate impression based on findings.

Input: Possible sidebranch IPMN, evaluate for interval change ABDOMEN:LIVER, BILIARY TRACT: No intrahepatic or extrahepatic biliary duct dilatation. Right hepatic subcentimeter T2 hyperintense focus most likely a cyst, image 23 series 501.SPLEEN: Scattered vague T2 hypointensities again seen, nonspecific and unchanged.PANCREAS: Nondilated pancreatic duct, measures upper limits of normal. Stable 3 mm cystic focus in pancreatic body, most likely a sidebranch type intraductal papillary mucinous neoplasm, image 71 series 701.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Stable prominent peripancreatic lymph nodes, reference lymph node again measures 0.9 cm in maximum short axis, image 18 series 501.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Spinal degenerative disease and scoliosis. Lower thoracic right perineural cyst formation.OTHER: No significant abnormality noted.

Output: Stable exam as described.


Instruction: Generate impression based on findings.

Input: 15-year-old male status post blunt head trauma with loss of consciousness. Evaluate for intracranial hemorrhage. Preseptal and periorbital soft tissue swelling on the left. Minimal fat stranding of the retro-orbital fat on the left appear stable. If further evaluation is clinically warranted, an MRI is suggested. The globe appears normal in morphology and density in the anterior and posterior chambers. Extraocular muscles appear intact. There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration.There is soft tissue swelling overlying the left orbit. There is minimal opacification of bilateral maxillary sinuses. The calvaria and skull base are radiographically normal. The remaining visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Preseptal and periorbital soft tissue edema on the left with minimal fat stranding a left retro-orbital fat unchanged from prior exam. If further evaluation is clinically warranted, an MRI may be obtained.


Instruction: Generate impression based on findings.

Input: Reason: dystonic reaction vs seizure History: as above There is no evidence of intracranial hemorrhage, mass or diffusion restriction.There are scattered punctate periventricular and subcortical T2 hyperintensities without diffusion restriction. Similarly there are punctate T2 and FLAIR hyperintense lesions in the left thalamus and pons.A cavum septum pellucidum and vergae are noted. The ventricles and sulci are prominent suggesting mild age-related volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull and scalp soft tissues are grossly unremarkable. The paranasal sinuses are unremarkable.

Output: 1.No findings to explain patient's seizures.2.Periventricular and subcortical white matter changes of a moderate degree as well as several punctate lesions in the brainstem and left thalamus are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: Male, 61 years old, with loss of dexterity and concern for myelopathy. Evaluate for cord signal abnormality. Sagittal alignment is anatomic. Vertebral body heights are preserved. Degenerative endplate irregularity and signal alteration are noted at C5-6. Otherwise, morphology and signal characteristics of the vertebral bodies are within normal limits. No concerning marrow replacement or marrow edema is detected.The visualized spinal cord demonstrates normal signal intensity and morphology. No cord edema or focal cord lesions are seen. No epidural abnormalities are suspected.C2-3: Mild facet hypertrophy. No significant spinal canal or foraminal stenosis. C3-4: Mild facet hypertrophy. No significant spinal canal or foraminal stenosis. C4-5: Mild facet hypertrophy. No significant spinal canal or foraminal stenosis.C5-6: Mild facet hypertrophy. Loss of disc height and disc osteophyte formation. Mild generalized spinal canal narrowing without frank cord impingement. Mild bilateral foraminal narrowing. C6-7: Mild facet hypertrophy. No significant spinal canal or foraminal stenosis. C7-T1: Mild facet hypertrophy. Minimal disc osteophyte formation. No significant spinal canal or foraminal stenosis.

Output: 1.No evidence of spinal cord myelopathy.2.Disc degeneration at C5-6 contributing to mild spinal canal stenosis and mild foraminal narrowing.3.The remaining cervical levels are free of significant spinal canal or foraminal compromise.


Instruction: Generate impression based on findings.

Input: 50-year-old female with recurrent acute pancreatitis and pancreas divisum. Evaluate for lesions or pancreatic ductal dilation. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No focal pancreatic lesions. Normal caliber of the main pancreatic duct. Normal physiologic response to secretin. On presecretin images, the main pancreatic duct is thin and difficult to visualize. On postsecretin images, the overlying duodenum obscures the ampullary region. However, there is suggestion of pancreas divisum anatomy, particularly given the provided clinical history.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: No focal pancreatic lesions or pancreatic ductal dilation, as clinically questioned. Probable pancreas divisum anatomy, particularly given the provided clinical history.


Instruction: Generate impression based on findings.

Input: 52 years Male (DOB:5/18/1963)Reason: schwannoma removed. 6 month follow up History: 6 month follow upReferring Attending: EDWIN RAMOS 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. The patient status post right-sided hemilaminectomy at the L3 vertebral body level for removal of an intrathecal mass. There is some central and to lesser degree peripheral clumping of nerve roots present at the L3-4 disc space level at the prior location of the patient's intrathecal mass. There is a fluid collection present at the hemilaminectomy site currently measuring 20 x 27 mm axial dimensions and previously measuring approximately 16 x 11 mm axial dimensions. It currently measures 27 x 47 mm sagittal dimensions. It has a thin enhancing wall. Previously noted fluid in the subcutaneous tissues superficial to the paravertebral muscles at the incision site has resolved.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is disc desiccation, loss of disc space height and a disc bulge at this level.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is disc desiccation, loss of disc space height and a disc bulge at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.A previously noted 27 x 28 mm axial dimension mass at the inferior pole of the left kidney which also be identified on the recent abdomen CT from 10/29/2015 is not included on the current exam.

Output: 1.Since the prior exam, a fluid collection at the right hemilaminectomy site at L3 has enlarged. It is not clear based on this exam whether this communicates with the thecal sac.2.Some clumping of nerve roots at the level of the mass is concerning for potential arachnoiditis. Please correlate with clinical symptoms.


Instruction: Generate impression based on findings.

Input: 26-year-old female with shoulder pain in sports for years with instability and subluxation, evaluate for labral tear ROTATOR CUFF: The supraspinatus, infraspinatus, subscapularis and teres minor muscles and tendons are intact.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: A defect in the anterior superior labrum at the 2:30 position likely represents a sublabral foramen. Otherwise, the labrum is intact without a discrete tear.BICEPS TENDON: The biceps tendon is intact. ADDITIONAL

Output: Normal shoulder MR without evidence of glenoid labral tear.


Instruction: Generate impression based on findings.

Input: Reason: assess for medial meniscus tear History: medial knee pain. MENISCI: Increased signal intensity within the inner one third of the posterior horn of the medial meniscus is compatible with a partial thickness radial tear. There is also blunting of the body of the medial meniscus suggestive of an additional partial thickness radial tear. Low signal intensity extending inferiorly from the periphery of the body of the medial meniscus along the lip of the medial tibial plateau may represent a displaced meniscal flap fragment or thickening of the coronary ligament. The anterior horn of the medial meniscus is intact.Mild intrasubstance signal intensity within the lateral meniscus suggests mild degeneration, but we see no discrete tear.ARTICULAR CARTILAGE AND BONE: There is edema within the medial femoral condyle concentrated along the medial aspect of the subarticular bone. Within this edema, just above the body of the medial meniscus, is a small curvilinear focus of subchondral low signal intensity, which could conceivably represent a small stress fracture, but this location is atypical. Mild increased signal intensity within the articular cartilage of the medial femoral condyle more laterally suggests mild degeneration. There is also relatively mild edema within the medial tibial plateau.The lateral compartment articular cartilage is intact.There is mild to moderate diffuse thinning and degeneration of the articular cartilage of the patella. There is mild heterogeneity within the articular cartilage of the lateral facet of the trochlea inferiorly, indicating mild degeneration as well.LIGAMENTS: The anterior cruciate ligament and posterior cruciate ligament are intact. There is mild edema along the medial collateral ligament which could reflect a sprain in the correct clinical setting, but the superficial fibers of the medial collateral ligament otherwise appear intact. The lateral collateral ligament complex is intact.EXTENSOR MECHANISM: The quadriceps and patellar tendons are intact. There is mild edema along the medial retinaculum structures, nonspecific.ADDITIONAL

Output: 1.Radial tears of the medial meniscus as described above with possible displaced meniscal tissue in the medial gutter.2.Edema within the medial femoral condyle associated with a curvilinear subchondral focus of low signal intensity that could represent a stress fracture albeit in a peculiar location. Alternatively, it could represent a precursor to a degenerative cyst or small focus of AVN.3.Articular cartilage degeneration as described above.4.Baker's cyst and nonspecific soft tissue edema as described above.


Instruction: Generate impression based on findings.

Input: Female 12 years old Reason: R radial sided wrist pain and thumb clicking, evaluate for lesion or stenosing tenosynovitis LIGAMENTS: No significant abnormality noted.TRIANGULAR FIBROCARTILAGE COMPLEX: No significant abnormality noted.TENDONS: No significant abnormality noted. BONES: No significant abnormality noted.ADDITIONAL

Output: Normal examination.


Instruction: Generate impression based on findings.

Input: The image quality is degraded by motion artifact. There is a right supraclavicular mass measuring approximately 3.7 x 5.0 x 4.9 cm (AP x TR x CC) with central necrosis and infiltration of a portion of the brachial plexus. It is difficult to make a direct comparison due to differences in technique, but the lesion measured approximately 3.1 x 4.3 cm (AP x TR) on the CT neck of 10/21/2014 and 5.2 x 5.8 cm (AP x TR) on the MRI brachial plexus of 7/7/2014. There is interval increase in diffuse high T2 signal and enhancement involving the right trapezius, pectoralis major and minor, supraspinatus, infraspinatus, and subscapularis muscles and overlying subcutaneous tissues. There is a 1.4 x 0.8 cm right level 2A lymph node, which is unchanged from CT neck dated 10/21/2014. There are partially imaged right upper lobe post-radiation change and/or atelectasis as well as a small right pleural effusion. The cervical and upper thoracic spine appear grossly unremarkable. There is a right glenohumeral joint effusion.

Output: 1. A necrotic right supraclavicular mass with infiltration of the brachial plexus, measures up to 5 cm, which is slightly increased in size compared to CT neck of 10/21/2014, but smaller compared to MR brachial plexus of 7/7/2014. 2. Diffuse signal abnormality elsewhere in the right shoulder region likely represent denervation changes and treatment effects, although smaller foci of tumor deposition cannot be entirely excluded.3. The right pulmonary consolidation and pleural effusion are partially imaged. Please refer to the separate chest CT report for additional details.


Instruction: Generate impression based on findings.

Input: Hemangioma of skin and subcutaneous tissue [D18.01], Reason for Study: ^Reason: Evaluate for PHACE syndrome and possibly airway hemangioma in infant with segmental hemangioma of R face History: Hemangioma involving R lower lip, cheek, pre-auricular region and tragus Brain MRIThere is no evidence of acute ischemic or hemorrhagic lesion.There is no evidence of abnormal enhancement.Myelination degree is normal for the patient age. In particular, there is no evidence of posterior fossa brain abnormality.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, or abnormal contrast enhancement. 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.Neck MRA3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The vertebral artery origins are normal. There is normal flow enhancement through the bilateral common carotid, carotid bifurcations, internal/external carotid, and vertebral arteries. Neck MRIThere are multifocal well-circumscribed multi compartmental lesion involving right parotid and right submandibular space as well as bilateral posterior triangles. The longest diameter of the lesion measured at the deep lobe of the right parotid gland which extends toward posterior aspect of the right medial pterygoid muscle is about 35mm and craniocaudal direction measurement is about 32mm.The lesions show T2 high signal intensity, T1 low or iso to adjacent muscle signal intensity with relatively homogeneous enhancement. Especially on T2 weighted images, some of compartments show fluid fluid level indicating internal blood products. Constellation of above findings indicate benign lesions such as such as muti-focal hemangiomas. Lymphangiomas and venous vascular malformations are differential diagnosis but less likely based on MR signal characteristics. Airway does not appear to be compromised and widely patent.

Output: 1. No evidence of intracranial abnormality, especially posterior fossa appears to be normal.2. Normal brain and neck MRA3. Multifocal hemangiomas involving right parotid space, right submandibular space as well as bilateral posterior triangles. Lymphangiomas and venous vascular malformations are differential diagnosis but less likely based on MR characteristics.4. No MR evidence of airway compromise due to the lesion.


Instruction: Generate impression based on findings.

Input: This exam is mildly degraded by motion artifact. There is unchanged dilatation of the central spinal canal extending from the T6-T10 levels, largest at the T8 level where it measures 3 x 4 mm in the axial plane. The spinal cord otherwise displays normal signal and morphology with the conus terminating at L2. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The paravertebral soft tissues are unremarkable.

Output: Stable midthoracic syringohydromyelia.


Instruction: Generate impression based on findings.

Input: Metastatic melanoma. Neck CT:Again seen is soft tissue mass in the right nasopharynx which measures 24 mm in largest dimension on coronal images (series 80564, image 54) compared to prior measurement of 19 mm on prior study (series 80324, image 46). On axial plane, it measures 19 x 17 mm (series 6, image 34) compared to prior measurement of 17 x 13 mm (series 4, image 18). There is no lymphadenopathy of pathological size.As seen before there is a left sided 6 -mm nodule in the left dorsal subcutaneous fat at level of C3 showing no significant interval change in size or appearance.There are enhancing lesions in the right cerebral hemisphere. These lesions were also present on prior MRI brain of 2/23/2011.There are degenerative changes in the cervical spine. No definite bone metastasis is identified in the cervical spine.

Output: 1. Slight increased size of right nasopharynx soft tissue lesion.2. Brain lesions partially visualized. Please refer to dedicated brain study.


Instruction: Generate impression based on findings.

Input: A patient submitted outside study for review. Submitted for review are bilateral diagnostic mammogram and diagnotic bilateral ultrasound dated 1/30/2015, ultrasound guided left breast biopsy and mammogram dated 2/6/2015, bilateral mammogram dated 4/10/2015, and breast MRI dated 2/20/2015 performed at Franciscan Alliance. BILATERAL DIAGNOSTIC MAMMOGRAM (1/30/2015): Note that only left breast images were uploaded. Tomosynthesis was performed on the LLM view only. Dilated ducts and focal asymmetries are noted in the left breast extending from the nipple over a distance of 8.4 cm. There is a dilated duct in the retroareolar region with an associated 13 mm mass. In the left breast at the 12 o'clock position at mid-depth there is a lobulated oval mass measuring up to 2 cm. Area of asymmetry extends posterior to this oval mass. Scattered benign calcifications are noted. BILATERAL BREAST ULTRASOUND (1/30/2015): Targeted right breast ultrasound demonstrated normal fibroglandular tissue in the upper outer quadrant. Targeted left breast ultrasound demonstrated dilated ducts in the retroareolar region with internal echoes that could represent debris or an intraductal mass and a small amount of calcium. There is a hypoechoic mass at the 12 o'clock position that measures 10 x 7 x 13 mm. There are no abnormal lymph nodes in left axilla.LEFT BREAST ULTRASOUND GUIDED BIOPSY AND POST-BIOPSY MAMMOGRAM (2/6/2015): Masses in the 12 o'clock and retroareolar area were targeted for biopsy. Post-biopsy mammogram demonstrates percutaneously placed clips in the appropriate positions within the aforementioned masses, which are decreased in size compared to prior mammogram. The maximum distance between the two clips is 4.5 cm.SURGICAL PATHOLOGY: Left breast 12 o'clock position is atypical sclerosing papillary lesion. Left breast retroareolar region with DCIS grade 2, cribriform and micropapillary types as well as atypical sclerosing papillary lesion. Results are concordant.BREAST MRI (2/20/2015): Biopsy clip artifact seen in the retroareolar area and a posterior clip the 12:00 position at mid depth. There is clumped non-mass enhancement in the 2 o'clock position in a linear distribution extending upto the nipple. There is non-mass enhancement extending 2 cm posterior to the posterior biopsy clip. The extent of the enhancement measures 8.9 x 3.1 x 2.7 cm (AP x ML x CC). No abnormal lymph nodes in either axilla. No abnormal enhancement in the right breast.LEFT BREAST DIAGNOSTIC MAMMOGRAM (4/10/2015): Three standard views of the left breast and tomosynthesis were submitted. Again seen is a left retroareolar focal asymmetry containing a biopsy clip corresponding to known cancer. Additional clip in the 12 o'clock at mid depth is again noted. Dilated ductal process and focal asymmetry extends from the nipple to 2 cm posterior to the posterior clip, correlating with extensive enhancement seen on MRI.

Output: 1.Extensive non-mass enhancement in the left breast consistent with DCIS measures 8.9 cm in maximal dimension. If sampling of the posterior aspect of the non-mass enhancement is needed, an MR directed ultrasound and possible biopsy can be attempted.2.Right mammogram images from 1/30/2015 should be submitted for completion.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Left temporal parietal slow on EEG and autism. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears unremarkable. In particular, the hippocampi appear to be unremarkable and there is no evidence of grey matter heterotopia. There is no abnormal intracranial enhancement. There is prominence of the retrocerebellar and right lateral cerebellar convexity cerebrospinal fluid spaces. The ventricles and basal cisterns are normal in size and configuration, which is likely developmental in nature. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No evidence of potential seizure foci.


Instruction: Generate impression based on findings.

Input: Pain. Rule out patellar dislocation/chondromalacia, ACL injury, meniscal pathology. MENISCI: The menisci appear normal.ARTICULAR CARTILAGE: I see no focal articular cartilage defects.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: There is focal increased signal intensity within the lateral fibers of the proximal patellar tendon at its attachment to the patella, likely representing a combination of focal tendinosis and partial-thickness undersurface tearing. There is a small amount of edema within the underlying inferior pole of the patella. Distally, there is ossification within the patellar tendon just proximal to its insertion on the anterior tibial tubercle that may reflect prior injury/Osgood-Schlatter disease; however, I see no edema at this location currently. The quadriceps tendon appears normal. The tibial tubercle to trochlear groove distance and the Insall-Salvati ratio are within normal limits.ADDITIONAL

Output: Focal tendinosis and undersurface tearing of the proximal patellar tendon.


Instruction: Generate impression based on findings.

Input: Male 21 years old with von Hippel Lindau disease and previously seen of pancreatic cysts. Evaluate for growth of cysts and new pancreatic, renal and adrenal lesions. ABDOMEN:LIVER, BILIARY TRACT: No focal liver lesion, biliary ductal dilation, or ascites.SPLEEN: No significant abnormality noted.PANCREAS: There are scattered subcentimeter pancreatic cysts which, when accounting for differences in technique, were present on the previous exam. The index cyst in the uncinate process measures 4 mm (series 3, image 22), previously 3 mm, unchanged when accounting for differences in technique.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: There is a 1.2 cm partially exophytic right upper pole renal lesion that is T2 hyperintense and heterogeneously enhancing suspicious for renal cell carcinoma, particularly clear cell subtype (902, image 43). Corresponding restricted diffusion also seen.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is a large amount of ingested material within the stomach, may be related to timing of exam but nonspecific.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.New 1.2 cm right upper pole renal lesion is suspicious for renal cell carcinoma, particularly clear cell subtype (based on imaging appearance as well as increased incidence of subtype among patients with VHL disease) .2.Stable subcentimeter pancreatic cysts.3.Please note that this exam was not performed as a dedicated pancreas protocol. If the patient returns the additional sequences may be obtained at no cost and an addendum will be added to the report.Findings discussed with Dr. Jane Churpek by phone at 13:40 on 11/22/2016.


Instruction: Generate impression based on findings.

Input: Female, 61 years old, with history of lumbar osteoarthritis and new right proximal leg weakness. Maintaining the previously utilized numbering scheme, the L1 vertebral body bears rudimentary ribs.A mild scoliotic curvature of the lumbar spine is seen. In the sagittal plane, the lumbar lordosis is mildly straightened but alignment is otherwise unremarkable.Vertebral body height and morphology are normal allowing for endplate degenerative irregularity and signal change at most levels. No evidence of concerning marrow replacement or marrow edema is seen.The visualized spinal canal, conus and cauda equina are unremarkable.Multilevel disc degeneration with loss of height and T2 signal is again seen similar to prior. Additional level specific findings are as follows:L1-2: Mild facet hypertrophy and ligamentum flavum thickening. Mild bulging disc. No significant generalized spinal canal stenosis. No significant neuroforaminal narrowing. No significant interval changes.L2-3: Moderate facet hypertrophy and ligamentum flavum thickening. Mild bulging disc asymmetric to the right. No significant generalized spinal canal stenosis. No significant spinal canal stenosis. Moderate right foraminal narrowing. No significant interval changes.L3-4: Moderate facet hypertrophy and ligamentum flavum thickening, right greater than left. Moderate bulging disc asymmetric to the right. Moderate generalized spinal canal stenosis. Moderate right and mild left foraminal narrowing. No significant interval changes.L4-5: Severe facet hypertrophy and ligamentum flavum thickening. Moderate bulging disc. Moderate generalized spinal canal stenosis. Severe left and moderate right foraminal narrowing. No significant interval changes.L5-S1: Moderate facet hypertrophy. Mild bulging disc. No significant generalized spinal canal stenosis. Moderate bilateral foraminal narrowing. No significant interval changes.A left renal cystic lesion is again seen.

Output: No significant interval change in multilevel degenerative disease as detailed above.


Instruction: Generate impression based on findings.

Input: 69-year-old male with a history of elevated PSA and previous negative prostate biopsy. Please evaluate. Biopsy to follow. PELVIS:PROSTATE: There is a focus of equivocal decreased T2 signal abnormality with apparent restricted diffusion and enhancement in the left posterior apex of the peripheral zone of the prostate gland (image 29; series 601). No additional foci of convincing T2 signal abnormality are identified. Prostate Size: 5.2 x 3.7 cm.Seminal Vesicles: No evidence of seminal vesicle involvement.Extracapsular Extension: No evidence of extracapsular extension or capsular bulge.BLADDER: No significant abnormality noted.LYMPH NODES: No evidence of lymphadenopathy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Equivocal focus of T2 signal abnormality in the left posterior apex of the peripheral zone of the prostate gland suspicious for prostate adenocarcinoma.


Instruction: Generate impression based on findings.

Input: 59 years Female (DOB:1/10/1957)Reason: Metastatic breast cancer History: restagingPROVIDER/ATTENDING NAME: MURTUZA M RAMPURWALA MURTUZA M RAMPURWALA The CSF spaces are appropriate for the patient's stated age with no midline shift. The patient is status post left parietal craniotomy for removal of a left frontal lobe mass involving precentral gyrus as well as portions of the adjacent superior frontal gyrus left middle frontal gyrus. There is now a hemorrhagic cavity at the site of the prior neoplasm. This cavity has decreased in size when compared to the November/7/16 exam. This cavity currently measures 18 x 20 mm and previously measured 35 x 30 mm. There is less vasogenic pattern of edema associated with it on the current exam when compared to the prior exam. There is contrast enhancement along the margins of the tumor resection site.A hemorrhagic lesion is present in the left occipital lobe. The T1 hyperintense component measures approximately 13 mm diameter. The measurements on T2 imaging are approximately 10 mm x 19 mm axial dimensions. It was not present on the 11/1/2016 exam or the 11/4/2016 exam but was present on the 11/7/2016 exam where it represented a larger hemorrhage measuring 29 x 17 mm axial dimensions on T2 imaging at that time.There is redemonstration of a developmental venous anomaly in the right occipital lobe which is associated with some vague enhancement along the cortex. This appearance is stable compared to the prior exam.There is a developmental venous anomaly present in the right cerebellar hemisphere which is also stable compared to prior exam.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate some mild mucosal thickening in the left maxillary sinus.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Since the previous exam the cystic cavity at the tumor resection site the left frontal lobe has decreased in size. Some enhancement along the margins of the tumor resection site could represent postoperative change. Follow-up examination would help confirm this.2.A hemorrhage in the left occipital lobe has decreased in size compared the prior exam.3.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related. 4.There is a developmental venous anomaly present in the right occipital lobe associated with some vague enhancement. The possibility this represents capillary telangiectasia associated with a developmental venous anomaly is raised. It is stable compared to prior exams.5.There is a developmental venous anomaly in the right cerebellar hemisphere.