Instruction: Generate impression based on findings.

Input: History of uterine cancer and new onset seizure. An EEG did not show any epileptiform abnormalities. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is a small linear area of high T2 signal within the left frontal lobe corona radiata. There are also nonspecific scattered foci of T2 hyperintensity in elsewhere in the cerebral white matter. There are mildly prominent perivascular spaces in the bilateral basal ganglia. 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. There is a subcentimeter left nasolabial cyst.

Output: Chronic left corona radiata lacunar infarct, but no evidence of intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: Stage IV non-small cell lung cancer now with headaches for two weeks. There is no evidence of intracranial hemorrhage or acute infarct. However, there is a new 5 mm focus of high T2 signal in the superior right cerebellar hemisphere, which demonstrates no appreciable enhancement. There are additional unchanged scattered punctate foci of increased T2 signal in the periventricular white matter, which are nonspecific, but suggest chronic small vessel ischemic disease. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: A new punctate focus of T2 signal in the right cerebellum is nonspecific, but could represent an unusual metastasis, among other differential considerations.


Instruction: Generate impression based on findings.

Input: Back pain, left-sided sciatica For the purposes of numbering there are 5 nonrib-bearing lumbar type vertebral bodies. The last well-formed disc is at L5-S1.There is mild loss of lumbar lordosis. Alignment is otherwise anatomic. The vertebral bodies are preserved in height. There is minimal degenerative marrow signal subjacent to the endplates at L5-S1. The L5-S1 in addition to L1-L2 discs show desiccation. Otherwise, the disks are preserved. The tip of the conus medullaris lies normally at the L1-L2 level. The conus medullaris shows normal signal. There are mild osteoarthritic changes involving the visualized sacroiliac joints.Individual levels as below:T11-T12 and T12-L1: No disc herniation and no spinal canal or foraminal stenosis.L1-L2: Right paracentral disc protrusion but no significant spinal canal or foraminal stenosis.L2-L3, L3-L4, and L4-L5: No disc herniation and no spinal canal or foraminal stenosis.L5-S1: Disc bulge and minimal left more than right endplate osteophyte formation and facet arthropathy. No significant spinal canal stenosis. There is mild right and mild to moderate left neural foraminal stenosis.

Output: Mild degenerative changes in the lumbar spine, relatively worst at the L5-S1 level. There is mild to moderate neural foraminal stenosis at the left L5-S1 level which may be effecting the left L5 nerve root.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 70 year old male with history of prostate cancer, atrial fibrillation, hypertension who presents for cardiac MRI for evaluation of pulmonary vein anatomy prior to possible RF ablation Left VentricleThe left ventricle is normal in size with moderately reduced systolic function. The overall LV ejection fraction is 34%, the LV end diastolic volume index is 94 ml/m2 (normal range: 74+/-15), the LVEDV is 216 ml (normal range 142+/-34), the LV end systolic volume index is 62 ml/m2 (normal range 25+/-9), the LVESV is 143 ml (normal range 47+/-19), the LV mass index is 75 g/m2 (normal range 85+/-15), and the LV mass is 170 g (normal range 164+/-36). There is global diffuse hypokinesis. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size with moderately reduced systolic function. The overall RV ejection fraction is 36%, the RV end diastolic volume index is 82 ml/m2 (normal range 82+/-16), the RVEDV is 186 ml (normal range 142+/-31), the RV end systolic volume index is 52 ml/m2 (normal range 31+/-9), and the RVESV is 120 ml (normal range 54+/-17).Right AtriumThe right atrium is moderately dilated.Aortic ValveThe aortic valve opens widely and there is at least mild aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is at least mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size. The ascending aorta is mildly dilated, measuring 38x39 mm.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium. The ostia of the pulmonary veins were measured and found to be: RUPV = 28 x 22 mmLUPV = 25 x21 mmLLPV = 22 x15 mmRLPV = 20 x 18 mm.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. The left ventricle is normal in size with moderately reduced systolic function[LVEF 34%]. No late gadolinium enhancement noted.2. The right ventricle is normal in size with moderately reduced systolic function [RVEF 36%]3. Pulmonary vein anatomy and measurements as above4. Mild ascending aorta dilation5. Moderate right atrial dilationI personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Reason: R shoulder pain, eval for rotator cuff tear History: see above. ROTATOR CUFF: Near full-thickness tear of the anterior fibers of the supraspinatus tendon measuring 4 mm in AP dimension in a background of moderate tendinopathy. Mild infraspinatus tendinopathy. The subscapularis and teres minor are intact. No significant fatty muscle atrophy.SUPRASPINATUS OUTLET: Moderate to severe AC joint osteoarthritis with joint fluid, osteophyte formation, including inferiorly, and subchondral bone marrow edema. Small amount of edema within the subacromial subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral joint alignment is anatomic. The labrum is grossly intact on this non-arthrographic study.BICEPS TENDON: The biceps tendon is intact. ADDITIONAL

Output: 1.Small near full-thickness tear of the supraspinatus tendon.2.Moderate to severe AC joint osteoarthritis.


Instruction: Generate impression based on findings.

Input: Low back pain. Five lumbar vertebrae are identified with a lumbosacral transitional morphology of L5. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. There is mild disc desiccation at L3-4. There is mild, diffusely decreased T1 signal within the bone marrow which remains hyperintense to skeletal muscle and which may be related to red marrow. Additional scattered foci of increased T1 and T2 signal within the vertebral bodies are compatible with benign hemangiomas and/or focal fat deposition. There is an area of cortical irregularity and/or defect involving the anterior inferior lateral aspect of the left T12 vertebral body with associated edema signal within the vertebral body. In addition, there is asymmetric enlargement and edema involving the left psoas muscle from T12 to approximately L4 without associated discrete collections.Mild facet arthropathy affects the lower lumbar spine. No significant disc pathology is noted within the lumbar spine. No significant central canal or foraminal stenosis. The visualized spinal cord, conus and nerve roots of the cauda equina are within normal limits.

Output: 1.Left anterolateral cortical irregularity and associated bone marrow edema involving the T12 vertebral body which is nonspecific but may reflect traumatic injury. There is associated edema involving the left psoas muscle. CT of the thoracolumbar lumbar spine is recommended for additional evaluation.2.Minimal degenerative changes of the lumbar spine without significant central canal or foraminal stenosis.


Instruction: Generate impression based on findings.

Input: Thoracic spine:There is a smooth, physiologic thoracic kyphotic curve. The vertebral body heights and disc spaces are maintained. Marrow signal intensity is benign throughout. The spinal cord has a smooth contour and is without focal atrophy, edema, or myelomalacia. There are no masses. There is no abnormal enhancement. Mild dependent atelectasis is most likely secondary to the patient's sedation status during image acquisition, although this has been described on previous chest x-ray. There is a small right pleural effusion. There are no stenoses.Lumbar spine:There is partial lumbarization of S1 including a rudimentary disc at S1/2.Alignment is anatomic. There are no fractures or subluxations. The marrow signal is benign. The conus is normal in signal and morphology and terminates at the L2 level. The visualized intra-abdominal and paraspinal contents are unremarkable. There is no abnormal enhancement. There is no fatty filum. There are no stenoses.

Output: 1.Mild dependent atelectasis is most likely secondary to the patient's sedation status during image acquisition, although this has been described on previous chest x-ray. 2.There is a small right pleural effusion.3.Otherwise negative noncontrast MRI of the thoracic and lumbar spine. Specifically, there are no MRI findings to explain the patient's difficulty with gait.


Instruction: Generate impression based on findings.

Input: Leg pain with numbness, rule-out lumbar radiculopathy Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position.Individual levels as below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: No significant disc disease. No spinal canal or neural foraminal stenosis.L4-L5: No significant disc disease. No spinal canal or neural foraminal stenosis.L5-S1: No significant disc disease. No spinal canal or neural foraminal stenosis.Paraspinous soft tissues are within normal limits.

Output: No significant disk disease. No compromise to the lumbar spinal canal or neural foramina.


Instruction: Generate impression based on findings.

Input: History of brain abscess related to mastoiditis, status post resection: headaches and pain behind the right eye. There are unchanged postoperative findings related to prior right tympanomastoidectomy and temporal craniotomy. There is unchanged high T2 signal within the mastoidectomy bowl. There is a small area of encephalomalacia in the inferior right temporal lobe, but no evidence of abscess or mass lesions. There is no evidence of acute hemorrhage or infarction. 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 orbital contents are grossly unremarkable. There is mild mucosal thickening in the bilateral maxillary and sphenoid sinuses. The scalp soft tissue appears unchanged, with a focal subcentimeter fat-signal structure in the right temporal fossa.

Output: 1. Postoperative findings related to right mastoidectomy and temporal craniotomy without evidence of intracranial abscess or mass lesions.2. A focal subcentimeter fat-signal structure in the right temporal fossa is of uncertain significance, perhaps postoperative in nature.


Instruction: Generate impression based on findings.

Input: Ms. Doyle is a 51 year old female with a personal history of left breast lumpectomy in 2012 for IDC/DCIS treated with radiation. She has a family history of breast cancer in her mother, diagnosed at the age of 56. There is scattered fibroglandular tissue in both breasts. Minimal parenchymal enhancement is noted bilaterally.Stable postsurgical changes are identified in the left upper outer breast and left axillary region, consistent with patient's prior surgical history. Minimal fluid is reidentified in a single right retroareolar duct, without associated abnormal enhancement.There is no abnormal enhancement seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: 70-year-old male with history of prostate cancer. PELVIS:PROSTATE:Prostate Size: 6 x 5 cmPeripheral Zone: Right peripheral zone mid gland T2 hypointense lesion with restricted diffusion measures 7 x 5 mm.Right apical T2 hypointense lesion with strict effusion measures 9 x 3 mm.Central Gland: BPH.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: NoneBLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Suspicious right midgland and apical peripheral lesions with no evidence of extracapsular extension.


Instruction: Generate impression based on findings.

Input: Follow-up for rectal cancer. Rectal polyp 1/28/2014 with invasive moderately differentiated adenocarcinoma arising from a tubular adenoma invading into the submucosa. Patient underwent transanal excision of the residual polyp and polypectomy scar 2/26/2014 without evidence of residual invasive adenocarcinoma. PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Stable punctate sub-5 mm nonspecific mesorectal lymph nodes are again noted. No enlarged pelvic lymphadenopathy.BOWEL, MESENTERY: Stable appearance of the rectum without evidence of local tumor recurrence. Sigmoid diverticula without acute diverticulitis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Stable examination including nonspecific sub-5 mm mesorectal fat lymph nodes.


Instruction: Generate impression based on findings.

Input: Tongue vascular malformation: evaluate extent as well as type. MRI: There is a T2 hyperintense, enhancing lesion in the anterior oral tongue, which measures up to 25 mm. There is also an infiltrative T2 hyperintense, enhancing lesion in the right submandibular space that measures up to 45 mm, as well as a subcentimeter nodular component within the submandibular gland itself. There appear to be septations, flow voids, and perhaps phleboliths within the lesions. An area of high T2 signal in the left supraclavicular fossa may represent an additional lesion or a cluster or lymph nodes, although assessment is limited due to artifacts in this region on some sequences. Otherwise, there is no evidence of significant cervical lymphadenopathy. The thyroid is unremarkable. The osseous structures are unremarkable. The airways are intact. The imaged intracranial structures are unremarkable. MRA: The major venous and arteries structures are intact, without evidence of enlarged feeding arteries or draining veins associated with the tongue and submandibular space lesions. There is no significant steno-occlusive disease in the cervical arteries.

Output: Lesions in the oral tongue and right submandibular space likely represents a low flow vascular malformation, such as a venous malformations. An area of high T2 signal in the left supraclavicular fossa may represent an additional vascular malformation or a cluster or lymph nodes, although assessment is limited due to artifacts in this region on some sequences.


Instruction: Generate impression based on findings.

Input: Chronic low back pain now with new radiation down right leg. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position.Minimal loss of T2 signal indicating minimal disc desiccation is noted throughout the lumbar spine without loss of disc height. Individual levels, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: No significant disc disease. No spinal canal or neural foraminal stenosis.L4-L5: No significant disc disease. No spinal canal or neural foraminal stenosis.L5-S1: No significant disc disease. No spinal canal or neural foraminal stenosis.Paraspinous soft tissues are within normal limits.

Output: Examination is essentially unremarkable with no significant disc disease or spinal canal or neural foraminal stenosis at any level.


Instruction: Generate impression based on findings.

Input: MRI Brain:There is no evidence of acute infarct, hemorrhage, mass, or mass effect. There are patchy foci of susceptibility involving the bilateral basal ganglia which may represent mineralization/calcification. Small focus of mineralization involving the left midbrain also noted. There is also focus of susceptibility involving the right frontal centrum semiovale with faint T2 hyperintensity, which is nonspecific and may be related to mineralization or a capillary telangiectasia. There is no abnormal parenchymal or meningeal enhancement. No extra-axial collections. Ventricles are normal in size. There is a 3 mm focus of nonenhancement within the pituitary gland which may represent a tiny pars intermedia or Rathke's cleft cyst. Orbits and sella are otherwise grossly unremarkable. There is minimal scattered paranasal sinus opacification including small maxillary sinus mucus retention cysts. Bone marrow signal and extracranial soft tissues are grossly unremarkable.MRA Brain: The intracranial internal carotid arteries demonstrate no significant stenosis. The middle and anterior cerebral arteries are also patent. The vertebral arteries, basilar artery, and posterior cerebral arteries also are patent with no significant stenosis. Left posterior cerebral artery is fetal in origin which is a normal variant. Left vertebral artery is dominant. No evidence of aneurysms or vascular malformations.

Output: 1. There is no intracranial mass, mass effect, parenchymal edema, or abnormal enhancement.2. Scattered foci of susceptibility of what likely represents mineralization in the basal ganglia. The nodular pattern and extent however appears somewhat unusual for physiologic mineralization in this age group. CT may be helpful for further assessment of extent of mineralization or calcification. This finding is nonspecific but can be seen with metabolic conditions such as disorders of calcium metabolism, for example. The right frontal lobe focus of susceptibility may represent capillary telangiectasia which is a normal variant.3.. Unremarkable brain MRA without evidence of aneurysm.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Low grade astrocytoma of the medulla oblongata status post biopsy and chemotherapy. Brain: There is no significant interval change in size of the infiltrative, non-enhancing T2 hyperintense mass within the medulla, which now measures up to 24 mm, . There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears unremarkable. The ventricles are stable in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unchanged. Cervical spine: There is no signal abnormality in the spinal cord. There is no evidence of tumor within the cervical spine. There is unchanged straightening of the vertebral column in the sagittal plane. The vertebral body heights are preserved. The vertebral bone marrow signa is unremarkable. There is no spinal canal narrowing. The paraspinal soft tissues are unremarkable.

Output: No significant change in size of the low grade astrocytoma involving the the medulla oblongata.


Instruction: Generate impression based on findings.

Input: Claudication. There is degenerative spondylosis at L4-5 and L5-S1 with disc space narrowing and dessication. In particular, there is a central disc protrusion with annular fissuring at L4-5 that results in mild spinal canal narrowing, but no significant neural foraminal stenosis. Likewise, there is a central disc protrusion with annular fissuring at L4-5 that results in mild spinal canal narrowing, but no significant neural foraminal stenosis. There appears to be mild impingement of the adjacent nerve roots at these levels. There is no significant spinal canal or neural foraminal stenosis at the other levels of the lumbar spine. The vertebral column alignment is within normal limits. The vertebral body heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable. There is persistent dilatation of the proximal right renal collecting system.

Output: 1. Degenerative spondylosis at L4-5 and L5-S1. In particular, there is a central disc protrusion with annular fissuring at L4-5 and L4-5 that results in mild spinal canal narrowing, with apparent mild impingement of the adjacent nerve roots.2. Persistent dilatation of the proximal right renal collecting system. A renal ultrasound may be useful for further evaluation.


Instruction: Generate impression based on findings.

Input: Please evaluate for myeloma lesions. The vertebral column alignment is within normal limits. The vertebral body are preserved. The vertebral bone marrow signal is unremarkable, aside from scattered areas of focal fat and endplate signal alterations related to mild degenerative spondylosis lower lumbar spine. In particular, there are bilateral facet joint effusions, bilateral neural foraminal narrowing, and evidence of Baastrup disease at L4-S1. There are also small posterior disc-osteophyte complexes at multiple levels of the cervical spine. However, there is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. There are subcentimeter perineural cysts in the sacral spinal canal. The paravertebral soft tissues are unremarkable.

Output: No evidence of multiple myeloma involving the spinal column.


Instruction: Generate impression based on findings.

Input: Headache and presyncope. There is a right transoccipital ventricular catheter that terminates in the left lateral ventricle. Artifact associated with the shunt catheter hardware obscures a portion of the right cerebral and cerebellar hemispheres. Otherwise, the ventricular system does not appear to be particularly dilated. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are mildly prominent perivesicular spaces in the frontal lobes. The brain parenchyma and pituitary gland otherwise appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable.

Output: 1. The shunted ventricular system does not appear to be particularly enlarged. 2. No evidence of acute intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: Male, 64 years old, history of meningioma. Surveillance scan. An enhancing extra-axial nodule, which projects superiorly from the junction of the right tentorium and transverse sinus, continues to measure 9 x 9 x 8 mm and shows no significant interval change since the prior exam. The transverse sinus remains patent based on preservation of the T2 flow void and contrast opacification.No new enhancing or nonenhancing intracranial lesions are demonstrated. A few scattered small foci of white matter T2 hyperintensity are again seen, similar to prior. No evidence of parenchymal edema or significant mass effect is seen. No intracranial hemorrhage or any abnormal extra-axial collections are seen. Mild prominence of the CSF space in the posterior fossa, and along the cerebral vertices, is stable and may reflect some degree of volume loss. The ventricular system is stable and normal in size.

Output: Stable right occipital region extra-axial mass presumed to represent a meningioma.


Instruction: Generate impression based on findings.

Input: New onset seizure. Examination demonstrates diffuse edema in the right frontal lobe and genu of corpus callosum. The appears slightly effacement of the frontal horn of the right lateral ventricle. These findings have been unchanged since prior MRI. There is no intracranial hemorrhage, midline shift or abnormal extra-axial fluid collection. The ventricles are normal in size and symmetric.The visualized paranasal sinuses and mastoid air cells are normally pneumatized. In view of the orbits is unremarkable. The calvarium is intact.

Output: Right frontal cerebral edema with involvement of the genu of corpus callosum likely represent underlying tumor (primary versus metastasis).


Instruction: Generate impression based on findings.

Input: 75 year old woman with LV dysfunction of unclear etiology, referred for further assessment with cardiac MRI. Left VentricleThe left ventricle is severely dilated with moderately decreased systolic function . The overall LV ejection fraction is 36%, the LV end diastolic volume index is 126 ml/m2 (normal range: 65+/-11), the LVEDV is 173 ml (normal range 109+/-23), the LV end systolic volume index is 81 ml/m2 (normal range 18+/-5), the LVESV is 111 ml (normal range 31+/-10), the LV mass index is 58 g/m2 (normal range 67+/-11), and the LV mass is 80 g (normal range 114+/-24). LV dysfunction is global with regional variation. There is a dyssynergic septum consistent with patient's underlying left bundle branch block. Single tiny patch of late gadolinium enhancement in the basal inferior wall of unclear significance. Otherwise no LGE to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 65%, the RV end diastolic volume index is 56 ml/m2 (normal range 69+/-14), the RVEDV is 77 ml (normal range 110+/-24), the RV end systolic volume index is 20 ml/m2 (normal range 22+/-8), and the RVESV is 27 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild-moderate mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size (28mm). Venous AnatomyThe SVC has a previously placed stent present. There is a right sided catheter with tip terminating in the SVC-RA junction. The IVC is normal in size and drains normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is severely dilated with moderately decreased systolic function . The overall LV ejection fraction is 36%. LV dysfunction is global with regional variation. There is a single tiny patch of late gadolinium enhancement in the basal inferior wall of unclear significance. Otherwise no LGE to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.2. The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 65%.3. The left atrium is moderately dilated. 4. There is mild-moderate mitral regurgitation.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Breast cancer and brain metastases treated with surgery and CyberKnife treatments. There are postoperative findings related to right frontal lesionectomy. There is confluent high T2 signal and susceptibility effect surrounding the resection cavity, but no evidence of associated abnormal enhancement. However, there is an irregularly enhancing lesion in the left cerebellar hemisphere that measures up to 20 mm with extensive surrounding vasogenic edema. There is also an irregularly enhancing lesion in the left cerebellar hemisphere that measures up to 10 mm with mild surrounding vasogenic edema and a punctate focus of enhancement in the superior right cerebellar hemisphere. In addition, there is an enhancing lesion in the right occipital lobe that measures up to 5 mm. There are a few punctate foci of nonspecific cerebral white matter T2 hyperintensity without associated enhancement. There is no evidence of acute intracranial hemorrhage or acute infarct. The ventricles are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact.

Output: 1. Postoperative findings related to right frontal lesionectomy, without evidence of recurrent tumor in this area. 2. Multiple enhancing intracranial lesions are compatible with metastases, the largest of which is located in the left cerebellar hemisphere with extensive vasogenic edema, but no herniation.


Instruction: Generate impression based on findings.

Input: 84 year old male presents with sepsis. There is clinical concern for sacral osteomyelitis. Evaluate for radiographic signs of osteomyelitis. There are numerous radio opaque foreign bodies throughout the pelvis, representing surgical skin staples and surgical clips. The coccyx is well corticated without radiographic evidence of osteomyelitis. If clinical concern is high, then further evaluation can be obtained with an MRI. We see no fractures.

Output: 1. No radiographic evidence of osteomyelitis. If clinical concern is high, then further evaluation with an MRI can be considered.


Instruction: Generate impression based on findings.

Input: 34-year-old female with history of left bloody nipple discharge and bilateral suspicious areas of enhancement on MRI examination, presents for MR guided ultrasound. A targeted left ultrasound was performed for the MRI area of concern. There is no solid or cystic mass identified.A targeted right ultrasound was performed for the MRI area of concern. There is no solid or cystic mass identified.

Output: No sonographic correlates for the areas of enhancement within both breasts on recent MRI examination. MRI guided biopsy of two areas of enhancement in the left breast, and a single area of enhancement in the right breast, is recommended for definitive histologic diagnosis. Results and recommendations were discussed with the patient.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration.


Instruction: Generate impression based on findings.

Input: 82 years Female (DOB: 7/31/1933)Reason: bilateral arm pain History: bilateral arm painPROVIDER/ATTENDING NAME: BEN-ZION ROITBERG BEN-ZION ROITBERG The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology.At C2-3 there is no significant compromise to the spinal canal or neural foramina. There is disc desiccation at this level.At C3-4 there is no significant compromise to the spinal canal. There are small uncovertebral osteophytes present associated loss of disc space height and disc desiccation. There is narrowing of the neural foramina bilaterally at this level. There is encroachment of the exiting nerve roots within the neural foramen at this level.At C4-5 there is loss of disc space height, disc desiccation and diffuse disc bulge associated with endplate and uncovertebral osteophytes and effacement of spinal fluid ventral and posterior the spinal cord. There is some hypertrophy of the ligamentum flavum at this level. There is narrowing of the neural foramina bilaterally with encroachment of exiting nerve roots due to uncovertebral osteophytes and disc material. Overall there is a mild to moderate degree of spinal stenosis at this.At C5-6 there is loss of disc space height, disc desiccation and bilateral uncovertebral and endplate osteophytes associated with encroachment of the exiting nerve roots within the neural foramina bilaterally. There is some hypertrophy of the ligamentum flavum at this level. There is effacement of spinal fluid ventral and posterior the spinal cord and overall a mild to moderate degree of spinal stenosis at this level.At C6-7 there is no significant compromise to the spinal canal . There is loss of disc space height, disc desiccation and a diffuse disc bulge associated with endplate uncovertebral osteophytes at this level. There is encroachment of the exiting nerve roots within the neural foramina bilaterally at this level.At C7-T1 there is no significant compromise to the spinal canal or neural foramina. There is a disc bulge at this level as well as disc desiccation.The vertebral artery flow voids appear to be intact.Additional left parotid gland there is a cystic appearing lesion which is incompletely imaged on this exam.

Output: 1.There are multilevel degenerative changes present in the cervical spine with mild to moderate spinal stenosis at C4-5 and C5-6 and encroachment of exiting nerve roots in the neural foramina at C3-4, C4-5, C5-6 and C6-7.2.The inferior tip of the cystic appearing lesion is included in the left parotid space right behind the mandible which is not adequately assessed on this exam is uncertain what this represents. If clinically indicated additional imaging of the parotid gland may be of benefit.


Instruction: Generate impression based on findings.

Input: Reason: hemorrhage vs mets History: headache, aphasia There is a redemonstration of a hemorrhagic lesion involving the left inferior parietal lobule which is associated with heterogeneous enhancement in the region measuring approximately 37 by 34 mm axial dimensions and is associated with some adjacent leptomeningeal reaction.There is redemonstration of small foci of gyriform enhancement along the left postcentral gyrus and left middle frontal gyrus which have progressed when compared to the prior exam.There is a 5-mm left occipital lobe cortical based lesion which is also unchanged compared to the prior exam.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Small T2 and flair punctate hyperintense lesions are present in the left thalamus and right basal ganglia.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Findings are suspected to represent hemorrhagic conversion of ischemic infarction in the left parietal lobe and small foci of early chronic phase ischemic infarction involving involving left frontal, left parietal and left occipital lobes rather than metastatic disease . A follow-up exam in one or two months would help confirm this.2.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 3.Small lesions in the left thalamus and right basal ganglia are suspected to represent prior lacunar infarcts


Instruction: Generate impression based on findings.

Input: Malignant neoplasm of unspecified part of right bronchus or lung [C34.91], Reason for Study: ^Reason: stage IV lung ca History: above There is no evidence of acute ischemic or hemorrhagic lesion on the scan.No evidence of abnormal enhancement.Underlying brain shows multifocal scattered high signal intensity lesions on FLAIR/T2 images indicating nonspecific small vessel ischemic disease.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: No evidence of acute ischemic or hemorrhagic lesion.No evidence of abnormal enhancement.


Instruction: Generate impression based on findings.

Input: Diagnosis: Dizziness and giddinessClinical question: r/o occlusion or stenosisSigns and Symptoms: vertigo 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 enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The left maxillary sinus is small. There is depression of the left orbital floor The visualized portions of the mastoid air cells are clear. MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. The posterior communicating arteries are intact. The left vertebral artery is larger than the right vertebral artery.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries.

Output: 1.No evidence for intracranial or extracranial cerebrovascular occlusive disease.2.No evidence for acute ischemic cerebral infarction and no evidence for intracranial mass lesion.3.Findings suggest old left orbital floor blowout fracture vs prolapse of the floor due to maxillary sinus atelectasis (silent sinus syndrome).


Instruction: Generate impression based on findings.

Input: Concern for progression of sarcoid intracranially: worsening headache. There are unchanged multifocal osseous lesions, including within the right parietal calvarium, occipital bone, central skull base, bilateral sphenoid greater wings, and right mandible condyle and neck. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are a few scattered punctate foci of nonspecific T2 hyperintensity in the cerebral white matter bilaterally. There is no abnormal leptomeningeal or intraparenchymal enhancement. The pituitary gland appears to be unchanged. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable.

Output: 1. Unchanged stigmata of multifocal osseous sarcoidosis in the head and upper cervical spine.2. A few scattered punctate foci of T2 hyperintensity in the cerebral white matter bilaterally are nonspecific. Otherwise, no evidence of neurosarcoidosis involving the brain parenchyma.


Instruction: Generate impression based on findings.

Input: Patient with history of Crohn's disease. Stricture seen on double balloon enteroscopy 120 cm proximal to the ileocecal valve, evaluate for other small bowel strictures. ABDOMEN:LIVER, BILIARY TRACT: The liver parenchyma demonstrates normal signal intensity. There are 2 subcentimeter T2 hyperintense lesions within the anterior segment of the right hepatic lobe which demonstrate equivocal peripheral nodular enhancement and are favored to represent benign simple cysts over benign hemangiomas. No suspicious focal hepatic lesions are identified. The gallbladder is unremarkable in appearance. There is no intra or extrahepatic biliary ductal 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: The bowel is normal in caliber without evidence of obstruction. There is no bowel wall thickening or abnormal enhancement. There are no abnormal intra-abdominal fluid collections. The previously seen circumferential bowel thickening involving a segment of the distal ileum as seen on 9/14/2015 outside CT is no longer present.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No current evidence of inflammatory bowel disease.


Instruction: Generate impression based on findings.

Input: MRI BRAIN: There is a punctate acute infarct in the left superior parietal lobule (series 1106 image 216). There are small to moderate sized acute infarcts in the left centrum semiovale and corona radiata, as well as linear diffusion restriction in the left temporal/occipital white matter tract adjacent to the left occipital horn. There is also a linear focus of diffusion restriction in the left cerebellum. There are otherwise stable moderate to severe nonspecific T2 white matter hyperintense signal likely representing severe chronic microvessel ischemic changes. There is an old infarct again seen in the right parietal lobe with encephalomalacia. There are small bilateral chronic cerebellar hemispheric, and brainstem infarcts. There is an unchanged small dural based lesion, presumably representing meningioma, along the right frontal dura measuring 14 x 7 mm on series 1301 image 20. There is no significant mass effect or vasogenic edema associated with this lesion. There are scattered small to punctate foci of susceptibility effect again seen in the right thalamus, the pons, and left cerebellar hemisphere probably representing chronic microhemorrhages. The left supraclinoid internal carotid artery flow void is seen, however the more proximal left internal carotid flow void is obscured which is slightly worsened from the prior exam. There is extensive diffuse volume loss. There is a cavum septum pellucidum et vergae, normal variant. There is a right maxillary sinus mucus retention cyst again seen.MRA BRAIN: There is moderate motion degradation limiting evaluation, especially of the smaller/distal arteries. There is significant tortuosity of the upper cervical right internal carotid artery. There is further decreased flow related enhancement in the infraclinoid left internal carotid artery with some reconstitution of the proximal left MCA and left ACA through collateral circulation. However, there is flow related enhancement present in the distal left MCA branches.There is an unchanged 3-mm aneurysm at the junction of the left posterior communicating artery and posterior cerebral artery. There is an unchanged 6 x 5 mm aneurysmal dilatation at the right internal carotid artery terminus. There are multifocal luminal irregularities in the ophthalmic and supraclinoid segments of the right internal carotid artery likely representing areas of mild atherosclerosis. There is unchanged luminal irregularity and narrowing of the right distal M1 segment representing moderate stenosis, although evaluation is somewhat limited due to motion.The diminutive left vertebral artery is barely visualized compared to the right with persistent near absent flow-related enhancement. The right vertebral artery predominantly forms the basilar artery. There are diffuse luminal irregularity of the diminutive basilar artery with multifocal areas of at least moderate luminal stenosis in the distal aspect, without significant change from prior exam. There is also redemonstration of moderate to moderate-severe scattered narrowing and irregularity at the right V4 segment, most conspicuous just inside the dural margin. Evaluation of the posterior cerebral arteries is limited due to motion artifact, however there is again paucity of the distal PCA branches bilaterally, with narrowing of the right P1-P2 junction, left proximal P2, and scattered along the right P2 segment.MRA NECK: There is moderate motion artifact and lack of IV contrast significantly limiting evaluation. The right vertebral artery origin is not well visualized with evaluation limited by artifact. The remaining great vessel origins appear grossly intact allowing for the motion artifact. The right internal carotid artery origin appears mildly irregular with prominent flattening of the carotid bulb with likely mild narrowing. However, the left internal carotid artery shows at most minimal flow related enhancement just at the origin, compatible with occlusion.

Output: 1.Acute scattered small to moderate foci of infarction in the left centrum semiovale, corona radiata, left cerebellum, as well as left occipital/temporal white matter without evidence of hemorrhage. This is likely related to an embolic phenomenon. Underlying severe chronic small vessel ischemic changes.2.Stable small right frontal dural based mass presumably representing meningioma without associated mass effect or vasogenic edema.3.Limited MRA of the neck. Long segment occlusion of the left internal carotid artery essentially from its origin.4.Limited MRA of the brain due to motion artifact. Further decreased flow related enhancement in the distal left internal chronic artery, with reconstitution of flow in the left MCA and ACA.5.Grossly stable 6-mm right internal carotid artery terminus aneurysm, and 3 mm left PCA/PCOM junction aneurysm.6.Redemonstration of extensive atherosclerotic disease involving intracranial vasculatureI personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 65-year-old male with HCV cirrhosis and history of HCC status post resection in 2014 who persents for hepatocellular carcinoma surveillance. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic hepatic morphology. No evidence of disease recurrence in segment 2. No suspicious arterially enhancing and washing out lesions to suggest hepatocellular carcinoma. There is a nonspecific arterially enhancing subcentimeter lesion (series 1001, image 342) without evidence of washout.SPLEEN: Mild splenomegaly.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: Susceptibility artifact from median sternotomy hardware. Scoliosis.OTHER: No significant abnormality noted.

Output: 1.Cirrhotic liver morphology without new suspicious lesion.2.Nonspecific subcentimeter arterially enhancing lesion without definite washout. Attention on subsequent imaging is recommended.


Instruction: Generate impression based on findings.

Input: Treated nasopharyngeal carcinoma with headaches. There is encephalomalacia and susceptibility effect in the left cerebellar hemisphere. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles are unchanged in size. There are post-treatment findings in the left nasopharyngeal region with soft tissue deficiency involving the pharyngeal mucosal and left parapharyngeal spaces, where there is diffuse enhancement of the residual soft tissues, but no discernible tumor. There is persistent diffuse T2 hyperintensity and enhancement in the central skull base. There are postoperative findings related to left mastoidectomy with fluid in the remaining mastoid air cells. There also a small amount of fluid signal within the right mastoid air cells. There is moderate mucosal thickening involving most of the paranasal sinuses, with possible secretions in the right maxillary sinus. There are bilateral subcentimeter lacrimal gland cysts. The orbits are grossly unremarkable.

Output: 1. Chronic infarct in the left cerebellar hemisphere, but no evidence of acute infarction or intracranial tumor.2. Post-treatment findings in the left nasopharyngeal region with no definite evidence of gross tumor.3. Findings related to prior central skull base osteomyelitis and osteoradionecrosis.4. Postoperative findings related to left mastoidectomy with nonspecific fluid in the remaining mastoid air cells.5. Findings suggestive of acute sinusitis.6. Bilateral subcentimeter lacrimal gland cysts.


Instruction: Generate impression based on findings.

Input: 76-year-old male with prostate cancer. Rule out metastatic disease. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Multiple, small nonenlarged retroperitoneal lymph nodes. A reference left para-aortic lymph node measures 10 x 7 mm image number 58, series number 3.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Focal enhancing nodule in the right base of the prostate is suspicious for patient's known prostate cancer. Bilateral seminal vesicles are enlarged. The local staging is clinically critical, MRI of the prostate may be helpful for further evaluation.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Small retroperitoneal lymph nodes. No evidence of definite metastatic disease in the abdomen or pelvis.


Instruction: Generate impression based on findings.

Input: 59-year-old female presents with altered mental status an lethargy. There is no evidence of acute intracranial hemorrhage or midline shift. There is redemonstration of areas of encephalomalacia involving the right insular cortex, right temporal and right frontal lobes in the distribution of the right middle cerebral artery. There is also encephalomalacia in the left posterior cerebral artery involving the left occipital lobe.The ventricles and basal cisterns are unchanged in appearance compared to prior exam, including small right frontal horn.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1.No acute intracranial hemorrhage or midline shift.2.Stable multiple areas of encephalomalacia.3.CT is insensitive for the early detection of non-hemorrhagic CVA. MRI should be considered if clinical suspicion for CVA persists.


Instruction: Generate impression based on findings.

Input: 50-year-old man with medial ankle pain and swelling. TENDONS: There is a small amount of fluid within the sheath of the posterior tibialis tendon, flexor digitorum tendon, and flexor hallucis tendon. We see no findings to suggest a tendon tear. There is a small amount of fluid adjacent to the distal fibers of the posterior tibialis tendon just proximal to its insertion on the navicular bone, which may represent a very mild peritendinitis, but this is equivocal. The Achilles tendon appears normal, however, there is distention of the retrocalcaneal bursa indicating a bursitis. There are small quantities of fluid within the peroneal tendon sheaths, not necessarily of any clinical significance. There is increased signal intensity along the posterior margin of the peroneus brevis tendon as it courses beneath the fibular tip, which may represent a small partial-thickness longitudinal tear, but the clinical significance of this finding is uncertain. The peroneus longus tendon appears intact. The extensor tendons appear intact.LIGAMENTS: The lateral collateral ligament complex appears intact. The distal tibiofibular syndesmotic complex appears intact. The visualized components of the deltoid ligament are intact.ARTICULAR SURFACES AND BONE: There is a tibiotalar joint effusion, but the ankle joint otherwise appears normal without evidence of an osteochondral defect. There is also a small amount of fluid extending into the anterior and posterior recesses of the subtalar joint. Mild osteoarthritis affects the ankle and midfoot. We see no fracture.ADDITIONAL

Output: 1. Small amount of fluid within the posterior tibialis tendon sheath and possible mild peritendinitis of the distal fibers of the posterior tibialis tendon. We see no evidence of tendon tear/rupture.2. Hematoma within the subcutaneous fat medial to the posterior tibialis tendon.3. Retrocalcaneal bursitis and tibiotalar joint effusion along with diffuse subcutaneous edema.4. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Upper extremity weakness, left hand weakness. Cervical stenosis, evaluate for preoperative planning for decompression. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained, aside from straightening, which may be in part positional. Bone marrow signal is benign.There is flattening of the cord with significant bilateral parenchymal volume loss and T2 hyperintensity bilaterally at the C5-C6 level consistent with myelomalacia. There is prominent low T2 signal dorsal to the C5 and C6 vertebral bodies compatible with ossification of the posterior longitudinal ligament, better assessed on CT.The upper and mid cervical spinal canal appears developmentally narrow with superimposed degenerative changes as described below: C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: No significant compromise to the spinal canal or neural foramina.C4-5: Small dorsal annular fissure and protrusion. There is mild spinal canal stenosis. Neural foramina are patent.C5-6: Prominent disc osteophyte complex slightly eccentric to the left which is associated with flattening of the cord, volume loss, and bilateral T2 cord signal abnormality. There is moderate to severe spinal canal stenosis. There is moderate left and mild right neural foraminal stenosis.C6-7: Right paracentral disc osteophyte complex which effaces the right ventral aspect of the thecal sac. No significant spinal canal stenosis overall at this level. Neural foramina are patent.C7-T1: Small left paracentral disc osteophyte complex without significant spinal canal stenosis. There is minimal left neural foraminal narrowing. Right neural foramen is patent.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear grossly within normal limits. Partially imaged left mastoid air cell opacification.

Output: Moderate to severe spinal canal stenosis at the C5-C6 level related to disc osteophyte complex and ossification of the posterior longitudinal ligament. There is flattening and volume loss of the cord at this level, as well as prominent bilateral cord signal abnormality; findings are most consistent with myelomalacia from chronic compression. There is also moderate left and mild right neural foraminal stenosis at this level. Mild degenerative changes at additional levels as above.


Instruction: Generate impression based on findings.

Input: Left mastectomy for breast cancer, patient has implants There is heterogeneous amount of fibroglandular tissue in the right breast. Status post left mastectomy and retropectoral silicone implant. The implant appears intact.Mild parenchymal enhancement is noted in the right breast.No abnormal enhancement is seen in the right breast and left chest wall. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: 52 year old female with a personal history of right breast lumpectomy for invasive ductal carcinoma with DCIS in 2009 followed by chemotherapy and radiation therapy. She also has a personal history of Hodgkin's lymphoma, right breast reconstruction and left breast lift in 2012. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.Post-operative changes in the right lumpectomy bed are stable.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Diagnosis: Dizziness and giddinessClinical question: evaluate for CVASigns and Symptoms: evaluate for CVA MRI of the brainThe CSF spaces are appropriate for the patient's stated age of 70 with no midline shift. The right lateral ventricle is larger than the left.No foci of diffusion restriction are identified in the brain parenchyma. A couple small foci of susceptibility effect in the left middle frontal gyrus correspond to calcifications identified on a recent head CT. These were not present on the prior exam from 2012. These ae associated with surrounding signal hypointensity on T2/FLAIR and a minor degree of subtle encephalomalacia (volume loss).A punctate focus of susceptibility effect is present in the left hippocampus and left middle temporal gyrus in addition to the left middle frontal gyrus foci corresponding to calcifications.There is a moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. These appear stable since 2012 but more prominent (possibly due to differences in MR technique).A small focus of encephalomalacia has developed in the right middle temporal gyrus.There is redemonstration of a couple irregularly shaped T2 hyperintense foci in the brainstem and another couple in the basal ganglia as well as T2 and FLAIR hyperintense lesions in the internal capsules.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. A mucous retention cyst is present in the left maxillary sinus. The visualized portions of the orbits are intact. The eye lenses are thin. There is thinning of the posteromedial sclera with AP elongation of the eyes bilaterally and symmetrically.A 4mm well circumscribed T2/FLAIR hyperintense lesion in the right parotid gland is stable.A 4mm well circumscribed T2 hyperintense lesion in the right paramedian pharyngeal mucosal space thought to represent Thornwaldt cyst is stable.Incidental note is made of partial empty sella.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is small. The posterior communicating arteries are intact and very small. The right vertebral artery is very small.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. The great vessels from the aortic arch and the origins of the vertebral arteries are not adequately evaluated. There is a CTA of the chest from 4/2013 which does not identify any significant stenosis of the great vessels not the origin of the left vertebral artery. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries. The right vertebral artery is small.

Output: 1.No evidence for acute ischemic cerebral infarction.2.Periventricular and subcortical white matter changes of a moderate degree are nonspecific. At this age they are most likely vascular related. They have not changed since the prior exam.3.Calcific density lesions along the left middle frontal gyrus were not present on the prior exam of 2012. These are non-specific. They could represent dystrophic calcifications associated with prior microhemorrhages. Other causes may include dystrophic calcifications from inflammatory lesions or calcific emboli.4.A new (since 2012) small (1cm) focus of encephalomalacia is present in the right middle temporal gyrus along its posterior aspect.5.There is no change in the lesions of the brainstem, internal capsules and basal ganglia suspected to represent old lacunar infarcts.6.No evidence for intracranial aneurysm.7.No evidence for intracranial or extracranial cervicocerebral vascular occlusive disease.8.The great vessels from the aortic arch and the origins of the vertebral arteries are not adequately evaluated. 9.A 4mm benign appearing lesion in the right parotid gland is stable.10.Staphylomas of the eyes are not substantially changed.


Instruction: Generate impression based on findings.

Input: Male 12 years old Reason: evaluate pineal cyst for growth History: HA Again seen is a cystic anterior pineal lesion with mild heterogeneity involving the posterior aspect of the pineal gland. The cystic lesion measures 8 x 5 x 6 mm (AP by CC by transverse), previously also 8 x 5 x 6. Remainder of the brain demonstrates no other intracranial mass or mass effect. No evidence of ischemia or hemorrhage. No extra-axial collections. No hydrocephalus. Calvarium and extracranial soft tissues are unremarkable.

Output: Unchanged size of slightly complex appearing pineal cyst dating back to 2/13/2014. Brain parenchyma is otherwise unremarkable.


Instruction: Generate impression based on findings.

Input: Female, 53 years old. Right knee pain MENISCI: There is almost complete loss of the posterior horn of the medial meniscus with a small focal round. The anterior horn and the lateral meniscus are intact.ARTICULAR CARTILAGE AND BONE: There is diffuse cartilage thinning of the patellofemoral articulation with underlying marrow reactive changes in the lateral patellar facet. There is diffuse thinning of the medial and lateral tibiofemoral articular cartilage, with complete loss of the weightbearing cartilage of the medial femoral condyle and medial tibial plateau with underlying marrow edema in both sides of the joint in this location. Tricompartmental osteophytes are noted.LIGAMENTS: Fibers of a normal ACL and visualize, compatible with a tear which is likely chronic. The PCL is unremarkable. The collateral ligaments are unremarkable. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1.Osteoarthritis with cartilage loss predominantly affecting the medial patellofemoral articulation.2.Near absence of the posterior horn of the medial meniscus as above.3.Chronic tear of the ACL.4.Moderate joint effusion and Baker's cyst with multiple loose bodies as above.


Instruction: Generate impression based on findings.

Input: Diagnosis: WeaknessClinical question: r/o strokeSigns and Symptoms: slurred speech, left sided weakness MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. This is not a typical at this age and likely of little clinical significanceNormal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries. There is fetal origin of the posterior cerebral arteries bilaterally with the a hypoplastic left P1 segment and a medium sized right P1 segment. Intracranially the right vertebral artery is diminutive and predominantly supplies the right posterior inferior cerebellar artery.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. The left vertebral artery is larger than the right vertebral artery. The left vertebral artery is tortuous at its origin. There is mild narrowing at the origin of the left vertebral artery. The right vertebral artery has a long segment stenosis at its origin.

Output: 1.There is no evidence for acute ischemic cerebral infarction appreciated.2. There is mild narrowing at the origin of the left vertebral artery. Intracranially the right vertebral artery is diminutive and predominantly supplies the right posterior inferior cerebellar artery.3.No evidence for intracranial cerebrovascular occlusion.


Instruction: Generate impression based on findings.

Input: 39-year-old female with new diagnosis of invasive ductal carcinoma. Evaluate for satellite lesion, identified on recent mammogram. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.Right Breast: Within the right breast at 10-11 o'clock, mid to posterior depth, there is a 4.8 x 2.8 x 3.2 cm (AP x ML x CC) irregular heterogenously enhancing mass with type III washout, containing clip artifact from prior biopsy. Multiple adjacent satellite lesions and non mass enhancement is identified anterior, posterior and inferior to it. The most anterior satellite lesion is located retroareolar, measures 6 x 10 x 7 mm (AP x ML x CC) and is mammography occult. This retroareolar satellite is located 4.3 cm anterior to the index lesion. The largest posterior satellite lesion is located at 9:00, posterior depth, 1.9 cm posterior inferior to the index mass, has a mammographic correlate and measures 8 x 7 x 7 mm (AP x ML x CC). The index mass with adjacent satellite lesions and non mass enhancement span 13.0 x 3.8 x 5.3 cm (AP x ML x CC) in total extent.Left Breast: No abnormal enhancement is identified in the left breast. Axillae: No abnormal lymph nodes are identified in either axillary region.

Output: 1.Right breast multifocal cancer spanning 13 cm. Right 10:00 index mass, pathology confirmed breast cancer. Multiple satellite lesions, with the largest posterior or anterior satellites that can be further evaluated with MRI directed ultrasound, amenable for ultrasound guided biopsy. 2.No suspicious enhancement within the left breast or axillary regions.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Study is degraded by most likely dental braces.There are no diffusion abnormalities in the visualized portion of the study. There are no T2/FLAIR abnormalities. There are no diffusion or susceptibility abnormalities. There is no abnormal enhancement. There is normal ventricular size with no midline shift. There is normal gray-white matter differentiation. There is no evidence of herniation. Basal cisterns are patent.Vascular flow voids are normal.

Output: No evidence for acute intracranial hemorrhage, acute ischemic stroke, mass effect, or edema. No abnormal enhancement. No T2/FLAIR foci of abnormality.


Instruction: Generate impression based on findings.

Input: Primary hyperparathyroidism. Adenoma localization RIGHT LOBE MEASUREMENTS: 6.0 x 2.6 x 1.7 cmLEFT LOBE MEASUREMENTS: 5.3 x 2.4 x 1.2 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: Tiny complex nodule measures 0.5 x 0.4 x 0.4 cm.LEFT LOBE: Tiny complex nodule measures 0.6 x 0.7 x 0.4 cmISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: 2 nodules are identified inferior and posterior to both lobes of the thyroid (1 on each side). The right nodule measures 0.4 x 0.5 x 0.4 cm and the left nodule measures 1.0 x 0.6 x 0.5 cmLYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Possible bilateral parathyroid adenomas as described above. Correlate with nuclear medicine study.


Instruction: Generate impression based on findings.

Input: Per EPIC, past medical history significant for "brain tumor", hepatitis C, epilepsy, alcohol abuse, and hypertension who presents with headaches. There are post-surgical changes related to a remote right temporal craniotomy. There is a surgical cavity with surrounding mild confluent T2 hyperintensity in the right inferior temporo-occipital region. There is ex vacuo dilatation of the right occipital horn. There is mild dural enhancement along the right tentorium, which is likely treatment-related. There is otherwise no evidence of abnormal intraparenchymal enhancement. There is no definite evidence of elevated relative cerebral blood volume. There is no evidence of acute intracranial hemorrhage or acute cerebral infarction. There is diffuse prominence of the cerebellar sulci. There are a few scattered foci of nonspecific susceptibility effect in the right cerebellar hemisphere. There is no midline shift or herniation.

Output: 1. Post-surgical changes in the right temporo-occipital region with mild surrounding signal abnormality that may be treatment-related, but no appreciable mass effect to suggest tumor. However, the evaluation is limited without the availability of prior imaging and without specific information regarding the particular tumor type.2. Diffuse cerebellar atrophy, which may be related to seizure medication or alcohol abuse.


Instruction: Generate impression based on findings.

Input: Evaluate for occipital seizure focus. There is a punctate focus of diffusion hyperintensity in the left middle frontal gyrus with corresponding T2/FLAIR hyperintensity suspected to represent a tiny subacute infarct.Again seen are postoperative changes of left-sided craniotomy for resection of cavernous reformation at the left temporal-occipital junction. There has been evolution of the previously seen postsurgical changes with decrease in vasogenic edema with minimal FLAIR hyperintensity surrounding the resection cavity compatible with gliosis. There is also susceptibility in this region compatible with hemosiderin staining. There is also a nonspecific linear T2 hyperintensity involving the more anterior left temporal and parietal subcortical white matter. There is a tiny focus of susceptibility in the left frontal lobe involving the left anterior aspect of the cingulate gyrus compatible with chronic microhemorrhage and unchanged since 11/11/2015.Remainder of the brain parenchyma appears within normal limits. Bilateral hippocampi are symmetric and without evidence of mesial temporal sclerosis. No other lesions to suggest seizure focus are appreciated. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There is minimal scattered paranasal sinus mucosal thickening and small right maxillary sinus mucus retention cyst.

Output: 1. Interval evolution of postsurgical changes related to resection of prior cavernous malformation at the left posterior temporal/occipital lobe junction. There is hemosiderin staining and mild gliosis in this region. 2. Punctate focus of diffusion hyperintensity in the left middle frontal gyrus with associated FLAIR hyperintensity is suspected to represent a focus of subacute ischemia.3. Punctate focus of susceptibility effect in the left frontal lobe involving the left anterior cingulate gyrus is nonspecific, but compatible with chronic microhemorrhage and unchanged.


Instruction: Generate impression based on findings.

Input: Clinical question: Low back pain with reduced patellar reflex on the left and left calf pain. Signs and symptoms: As above. Nonenhanced lumbar MRI:The alignment of vertebral column is anatomical.The signal intensity of the vertebral column is unremarkable.The lower most visualized thoracic spine and thoracic cord is unremarkable.T12 measured bone is unremarkable.L1-L2 is unremarkable.L2-L3 demonstrate mild disc disease and loss of disc signal and height, mild facet disease and ligamentum flavum hypertrophy. No spinal stenosis or neural foraminal compromise.L3-L4 demonstrate mild disc disease, mild ligamentum flavum hypertrophy and mild facet disease. Mild bilateral facet effusion. No spinal stenosis or neural foraminal compromise.L4-L5 demonstrate mild degenerative disc disease and moderate left and mild right facet hypertrophic changes and including facet effusion however without spinal stenosis or neural foraminal compromise.L5-S1 demonstrate also mild facet and ligamentum flavum degenerative changes and minimal disc disease without spinal stenosis or neural foraminal compromise.Visualized SI joints are unremarkable.There is no perispinal soft tissue abnormalities.

Output: 1.No acute findings.2.Mild degenerative changes of lower lumbar spine including mild facet effusion at L3-L4 and L4-L5 levels bilaterally however without spinal stenosis, neural foraminal or lateral recess compromise at any level.3.Unremarkable perispinal soft tissues.


Instruction: Generate impression based on findings.

Input: Male 78 years old Reason: rectal cancer History: rectal cancer Overall image quality: ExcellentPELVIS:PROSTATE/SEMINAL VESICLES: Heterogeneous prostate gland which is enlarged and measures up to 4 x 5.5 cm (series 3/38).BLADDER: No significant abnormality noted. LYMPH NODES: Lymph nodes in the perirectal space, within the mesorectal fat: Six which are suspicious due to restricted diffusion and enhancement, with the largest at the level of the rectosigmoid junction on the left measuring up to 1.4 x 0.9 cm (series 8/12).Lymph nodes outside the mesorectal fascia: None which are suspicious. Subcentimeter in short axis left pelvic sidewall and bilateral inguinal lymph nodes are not enlarged by size criteria and do not demonstrate restricted diffusion or enhancement.BOWEL, MESENTERY: Rectal Tumor:Size: 4.4 x 3 x 5.1 cm (AP x transverse x craniocaudal) (series 7/152 and series 4/18).Tumor appearance on T2-weighted images: Predominantly solid lesion with intermediate signal intensity.Tumor location: Lower-third(For lower rectal tumors):Distance of the lower edge of the tumor to the anal verge (lower edge of the anal canal): 2.4-cm.Distance of the lower edge of the tumor to the pelvic floor (relationship of the tumor to the anal sphincter complex): 1-cm.Circumference of the rectum involved: 75 to 100% (series 3/33).Relationship and proximity of the tumor to adjacent structures (prostate, seminal vesicles): No abutment or invasion.MRI T-stage: T3a - Tumor invades < 0.5cm into perirectal fat or extramural (series 3/38).Tumor Distance to Mesorectal Fascia: Approximately 1.5-cm (series 3/35).BONES, SOFT TISSUES: Small fat-containing left inguinal hernia.OTHER: No significant abnormality noted.

Output: Rectal cancer with mesorectal fat invasion and metastatic perirectal lymphadenopathy seen.


Instruction: Generate impression based on findings.

Input: BRAIN: There is no evidence of intracranial hemorrhage, mass, or acute infarct. Scattered areas of periventricular and subcortical white matter FLAIR signal abnormality are consistent with age indeterminate small vessel ischemic disease. There is an old lacunar infarct in the right cerebellar hemisphere. Global parenchymal volume loss appears commensurate for the patient's age. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unremarkable.MRA HEAD: The exam is significantly degraded by motion artifact. There is an apparent protrusion of the left cavernous ICA and slight prominence of the vasculature at the right MCA bifurcation. The intracranial internal carotid arteries are normal in course and caliber. The middle and anterior cerebral arteries are unremarkable. The left vertebral artery is dominant. The basilar artery and posterior cerebral arteries are normal in course and caliber. The posterior communicating arteries are not definitely visualized. There is no evidence of flow-limiting stenosis.

Output: 1. Chronic small vessel ischemic disease. No evidence of acute infarct.2. Apparent protrusion of the left cavernous ICA and slight prominence of the vasculature at the right MCA bifurcation may be artifactual or related to atherosclerotic irregularity, although aneurysmal dilatation cannot be excluded. If further imaging is clinically indicated, CTA may provide more reliable information.


Instruction: Generate impression based on findings.

Input: Male, 65 years old, history of meningioma. Surveillance scan. Again seen is an enhancing extra-axial nodule, which projects superiorly from the junction of the right tentorium and transverse sinus, and measures 9 x 9 x 8 mm, which is unchanged since the prior exam. The transverse sinus remains patent based on preservation of the T2 flow void and contrast opacification.No new lesions or masses are appreciated. A few scattered small foci of white matter T2 hyperintensity are again seen, similar to prior. No evidence of parenchymal edema or significant mass effect is seen. No new infarct or hemorrhage.Mild prominence of the CSF space in the posterior fossa, and along the cerebral vertices, is stable and may reflect volume loss. The ventricular system is stable and normal in size.

Output: No appreciable change in right occipital region extra-axial mass presumed to represent a meningioma.


Instruction: Generate impression based on findings.

Input: Back pain, recurrent, Lumbago [724.2] For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. Normal lumbar lordosis appear to be slightly decreased. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. The conus medullaris terminates at the L1 level. The paraspinal soft tissues are unremarkable.Degenerative changes are specified by the intervertebral level as follows: L1-L2: no neuroforaminal narrowing or spinal stenosis. L2-L3: no neuroforaminal narrowing or spinal stenosis. L3-L4: Diffuse bulging of disc, no neuroforaminal narrowing or spinal stenosis. L4-L5: Diffuse bulging of disc, no neuroforaminal narrowing or spinal stenosis. L5-S1: There is evidence of right side hemi-laminectomy. Decreased disc height with low signal intensity of intervertebral disc on both T1 and T2-weighted images indicating disc desiccation and degeneration. There is osteophyte from the right side facet joint toward neural foramen narrowing the right side neural foraminal recess. In addition, there appears to be soft tissue lesion connected to the intervertebral disc showing central to right focal bulging of disc which abuts thecal sac. Since this scan was not performed with contrast enhancement, differentiation between disc herniation from postoperative scar cannot be performed.

Output: 1. Post hemilaminectomy status of the right L5.2. Central to right broad based disc herniation which abuts thecal sac, differential diagnosis of this lesion could be postoperative scar formation, if clinically indicated, Gad enhanced MRI can be considered. 3. Right side facet joint osteophyte narrows right side lateral recess stenosis at the level of L5S1.4. Disc degeneration with Modic 2 endplate changes of L5S1.


Instruction: Generate impression based on findings.

Input: Ms.Laura Valle, 39 years old, submitted outside study for review. Images performed at Northwestern Memorial Hospital submitted for review: Mammogram 12/10/2015 and 12/21/2015Breast ultrasound 12/21/2015Stereotactic guided biopsy imaging 12/30/2015Postprocedure mammogram 12/30/2015MRI breast 1/13/2015Images submitted for comparison:None SCREENING MAMMOGRAM 12/10/2015 AND DIAGNOSTIC MAMMOGRAM 12/21/2015: Multiple MLO, CC views, spot compression views of both breasts and magnification views of the left breast. The breast parenchyma is heterogeneously dense, which may obscure small masses. Numerous pleomorphic calcifications are noted in the left inner breast which extends close to the skin and the nipple base, measuring up to 9.5 cm in maximum AP dimension. No dominant mass or areas of architectural distortion are noted in either breast. Questionable focal asymmetries in both breasts efface with spot compression.BILATERAL BREAST ULTRASOUND 12/21/2015 : Static ultrasound images are submitted for interpretation.Bilateral whole breast ultrasound was performed. No sonographic abnormality was seen in the area of mammogram detected calcifications. There is a 4 x 2 x 5 mm mm benign-appearing cyst noted in the right breast, 7:00 location, 5 cm from the nipple. There is another 7 x 2 x 6 mm benign appearing cyst in the left breast, 1:00 position, 2 cm from the nipple. No additional suspicious finding is identified.STEREOTACTIC BIOPSY OF THE LEFT BREAST 12/30/2015: Previously identified anteriorly and posteriorly located calcifications in the left breast central inner region are the targets for the biopsy. Targeting appears appropriate. Calcifications are noted on the specimen radiograph.LEFT UNILATERAL POST PROCEDURE MAMMOGRAM (12/30/2015): A dumbbell clip is placed in the left breast anteriorly. Another X shaped clip is placed in the left breast posteriorly. The 2 clips are separated by 2.4 cm. Residual calcifications are noted in the left inner central breast.MRI BREAST 1/13/2016:Multiplanar and multisequence of breast MRI with and without IV contrast were performed as per outside facility protocol. The breasts are composed of heterogeneous fibroglandular tissue. There is extremely marked background parenchymal enhancement in both breasts, which limits the sensitivity and specificity of this examination. Additionally, image could not be reviewed on DynaCad, but are reviewed on PACS. Susceptibility artifact from 2 biopsy clips are noted in the medial aspect of the left breast. There is faint but extensive nonmass enhancement surrounding the 2 biopsy clips, in segmental distribution, spanning left central inner breast and extending into the left upper breast. The total extent of the non mass enhancement measures approximately 7.4 x 3.6 x 4.6 cm (AP x ML X SI). This is difficult to differentiate from background enhancement level. The anterior and medial aspect of the enhancement is very close to the skin. The anterior most extent of this enhancement is approximately 1.3 cm from the nipple base.There is no focal suspicious enhancement is noted in the right breast.Bilateral axillary lymph nodes are unremarkable.PER OUTSIDE PATHOLOGY:A. left breast calcifications, central inner posterior; stereotactic guided core needle biopsy:- DCIS, grade 3B. left breast calcifications, central inner anterior; stereotactic guided core needle biopsy:- DCIS, grade 3

Output: Biopsy proven extensive multicentric DCIS predominantly in the inner and upper left breast likely correlates with the 7.4 cm nonmass enhancement on the MRI and 9.5 cm suspicious calcifications on the mammogram. Given her extensive background enhancement on MRI, the calcifications should be the target of any necessary localization procedure, such as marking of calcifications near the skin prior to surgery. BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 59 year-old female with right toe pain, evaluate for osteomyelitis Soft tissue Ulceration along the distal phalanx of the great toe with interval improvement in underlying marrow signal abnormality, now with mild residual edema. There is a new punched out lesion along the first metatarsal head with sclerotic margins and associated enhancement, which is likely chronic and may represent chronic infection or gout, correlate clinically. Mild degenerative changes affect the midfoot.

Output: 1. Soft tissue ulceration about the distal first phalanx with minimal underlying marrow edema, improved from the prior exam, now without specific evidence of osteomyelitis.2. New punched out sclerotic lesion involving the first metatarsal head which appears chronic and may be secondary to infection or gout, correlate clinically.


Instruction: Generate impression based on findings.

Input: Macrocephaly, the possibility of hydrocephalus, and a history of papilledema in the setting of chromosome 4 duplication: new headaches. There is persistent mild prominence of the ventricular system and cerebral convexity subarachnoid spaces. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mild crowding of tissue at the foramen magnum, but the cerebellar tonsils are not low-lying. The brain parenchymal signal appears unremarkable, with an appropriate degree of myelination. There is no midline shift. The major cerebral flow voids are intact. The orbits, paranasal sinuses, and scalp soft tissues are grossly unremarkable. However, the calvarium is elongated in the anteroposterior dimension, while the central skull base appears to be hypoplastic. The optic apparatus slopes inferiorly anterior to the optic chiasm.

Output: 1. Persistent mild prominence of the ventricular system and cerebral convexity subarachnoid spaces, but no evidence of intracranial hemorrhage, mass, or acute infarct.2. Mild crowding of tissue at the foramen magnum, but the cerebellar tonsils are not low-lying. 3. The calvarium is elongated in the anteroposterior dimension, while the central skull base appears to be hypoplastic.


Instruction: Generate impression based on findings.

Input: Ms.Luella Baab, 45 years old, submitted outside study for review. Images performed at Advocate Lutheran General Hospital submitted for review: Mammogram 4/25/2016Ultrasound of 4/25/2016Ultrasound of 5/18/2016MRI 6/1/2016Images submitted for comparison:Ultrasound and mammogram 6/27/2013 MAMMOGRAM: 2 standard views of both breasts and 2 additional views of the left breast were obtained. The breast parenchyma is heterogeneously dense, unchanged in pattern and distribution. A palpable marker overlies the skin of the right upper outer left breast. There is a underlying 2.5 x 3.4 cm dense mass in the left upper outer breast, posterior depth.No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in the right breast. ULTRASOUND OF THE LEFT BREAST : Static ultrasound images are submitted for interpretation.In the left breast, 2:00 position, 11 cm from the nipple, there is a hypoechoic, irregular mass with associated internal and peripheral flow which corresponds to the palpable concern. No suspicious left axillary lymph nodes are identified.ULTRASOUND-GUIDED BIOPSY OF THE LEFT BREAST: Previously identified mass in the left breast 2:00 position is the target for the biopsy. Targeting appears appropriate.POST PROCEDURE MAMMOGRAM : A lock shaped clip is placed in the superior aspect of the mass in the right upper outer left breast. A focal asymmetry in the lateral and anterior aspect of the left breast on the exaggerated CC view is likely due to the summation artifact. MRI breast:Multisequence MRI breast imaging with and without 9 cc intravenous gadavist contrast was performed as per outside MRI breast protocol. The breasts are composed of heterogeneous fibroglandular tissue. There is moderate background parenchymal enhancement bilaterally. Kinetic analysis of these images was not possible. RIGHT BREAST:There is no suspicious enhancement in the right breast.LEFT BREAST:In the posterior upper outer left breast, 2:00 position, 8 cm from the nipple, there is a heterogeneously enhancing mass measuring 3.5 x 3.2 x 3.4 cm (LR x AP X SI). The lateral margin of this mass is the approximately 3 mm from the skin. There is no abnormal enhancement involving the chest wall. The subtle susceptibility artifact from the biopsy clip is the noted in the superior aspect of this mass.No additional suspicious enhancement is identified in the left breast.AXILLAE:No suspicious lymph node is identified.Incidental note is made of a 1.2 cm area of high T2 signal intensity adjacent to the anterior aspect of the right middle lobe in the lung.PER OUTSIDE PATHOLOGY:A. left breast at 2:00 lesion, ultrasound guided core needle biopsy:- Metaplastic carcinoma with an invasive focal glandular component, grade 3 and regions of the chondroid-like matrix production.- This result is concordant with the imaging findings.

Output: LEFT BREAST:3.5 cm biopsy-proven unifocal malignancy in the left posterior breast, 2:00 position. Clip is at the expected position.RIGHT BREAST:No imaging evidence of malignancy.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: 34 year old with history of pulmonary sarcoidosis and morbid obesity presenting for cardiac evaluation. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 58%, the LV end diastolic volume index is 51 ml/m2 (normal range: 65+/-11), the LVEDV is 120 ml (normal range 109+/-23), the LV end systolic volume index is 22 ml/m2 (normal range 18+/-5), the LVESV is 21 ml (normal range 31+/-10). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is normal in size.Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 53%, the RV end diastolic volume index is 58 ml/m2 (normal range 69+/-14), the RVEDV is 136 ml (normal range 110+/-24), the RV end systolic volume index is 27 ml/m2 (normal range 22+/-8), and the RVESV is 64 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThere are diffuse interstitial markings seen on bilateral lung fields. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Normal left ventricular size and systolic function (LVEF 58%). 2. Normal right ventricular size and systolic function (RVEF 53%). 3. No evidence fibrosis or inflammation seen within the myocardium. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 10-year-old male patient with with history of perianal abscess/fistula. PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: There are mildly enlarged lymph nodes bilaterally within the pelvis as well as the bilateral inguinal regions.BOWEL, MESENTERY: From the 7:00 location of the anus there is increased T2 signal intensity extending from the anus to the right gluteal fold, compatible with a perianal fissure. There is an additional fissure extending from the 12:00 location to the left perineal region near the base of the scrotum. These perianal fissures appear similar compared to prior examination.There is persistent transmural thickening and enhancement of the rectum, similar to prior.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Perianal fissures at the 7:00 and 12:00 locations, not significantly changed from prior.2.Thickening and enhancement of the rectum appears similar to prior.


Instruction: Generate impression based on findings.

Input: Male, 61 years old, with epidural abscess on antibiotic therapy. Assess for changes. Evaluation of progressive abscess is compromised by lack of IV contrast. Within this limitation, the following observations are made.Since the prior examination, it appears that thickening of the ventral epidural soft tissues has progressed along the L5 and S1 vertebral bodies. This tissue now measures up to 12 mm in thickness, previously 8 mm. There is a greater degree of encroachment upon the spinal canal and thecal sac, particularly at the level of the L5-S1 disc space.Edema within the L5 and S1 vertebral bodies as manifest on STIR images seems to be mildly more conspicuous than on the prior examination. Similarly, inflammatory STIR hyperintensity within the anterior paraspinal soft tissues along L5 and S1 has increased.The remainder of the examination shows no significant interval change including mild to moderate degenerative findings. The visualized spinal cord and conus are unremarkable.

Output: Without the benefit of IV contrast, it does appear that an infectious/inflammatory process within the ventral epidural space at L5 and S1 has expanded. The epidural soft tissues have progressively thickened and there is a greater degree of spinal canal encroachment. Edema within the L5 and S1 vertebral bodies, and in the anterior paraspinal soft tissues, has also slightly progressed.


Instruction: Generate impression based on findings.

Input: Oligodendroglioma, WHO grade II, pre-treatment planning. There are postoperative findings related to left transfrontal biopsy of an infiltrative T2 hyperintense left insular mass, which measures up to approximately 3 cm. The ventricles and other cerebrospinal fluid spaces are unchanged in size and configuration, including a cystic septum pellucidum and vergae. There is no midline shift or herniation. The major cerebral flow voids are intact. There are skin fiducial markers in position.

Output: Pre-treatment planning MRI for a left insular oligodendroglioma, with skin fiducial markers present.


Instruction: Generate impression based on findings.

Input: 34 yo F with SLE with chronic depression; evaluate for any underlying white matter changes/lupus cerebritis 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.There is a subcortical white matter lesion in the left centrum semiovale which is bright on T2 and FLAIR MRI. In isolation this is nonspecific.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 a mucous retention cyst in the left maxillary sinus.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: There is no evidence for cerebral infarction or any convincing evidence for effects of encephalitis on this exam.