Instruction: Generate impression based on findings.

Input: Reason: eval for cord compression History: eval for cord compression Exam is limited by metal artifact from spinal fixation devices. There is evidence of anterior instrumented fusion at C3 and C4. Now seen is evidence of recent posterior decompression and fixation from C2 through C5. Thecal sac is expanded in the operative region with normal-appearing cord. However, at C2/3 level, above the decompression, there is kinking of the cord associated with left-sided, predominantly central cord T2 hyperintensity along with increased cord caliber. Multilevel disc desiccation is noted. Reversal of cervical lordosis is seen. Marrow signal is benign.T12/L1: No significant spinal canal stenosis or foraminal narrowing.C1/2: No significant spinal canal stenosis or foraminal narrowing.C2/3: Disc osteophyte formation with a small central disc protrusion. Kinking of the spinal cord with left-sided predominantly central cord signal abnormality with increased cord caliber. Moderate spinal canal stenosis. No significant foraminal narrowing.C3/4: Status post spinal canal decompression without obvious impingement of the cord. Mild to moderate bilateral foraminal narrowing.C4/5: Status post spinal canal decompression without obvious impingement of the cord. Posterior disc osteophyte complex noted. No significant foraminal narrowing.C5/6: Moderate to severe spinal canal stenosis. No cord signal abnormality. Moderate left and mild right foraminal narrowing.C6/7: Posterior disc osteophyte formation and ligamentum flavum thickening. Mild spinal canal narrowing. Moderate left and mild right foraminal narrowing.C7/T1: No significant spinal canal stenosis. Mild left foraminal narrowing from ligamentum flavum thickening.

Output: 1.Exam is limited by metal artifact from spinal fixation devices.2.Postsurgical changes of anterior spinal fixation at C3 and C4, and posterior decompression and fixation at C3, C4, and C5.3.Left sided, predominantly central spinal cord signal abnormality at the C2-3 level in association with spinal canal stenosis and mild kinking of the cord. The etiology for this finding is uncertain but it could represent compressive myelopathy.4.Multilevel degenerative changes of the cervical spine as above.


Instruction: Generate impression based on findings.

Input: 32 year old female with gliosarcoma. Recently on chemo/RT. Now with acute 10/10 headaches. Nausea, vomiting. Evaluate for edema or bleed. Large area of vasogenic edema /encephalomalacia in the right posterior frontal, parietal extending inferiorly into the occipital lobe, basal ganglia/thalami and frontal lobe is noted. In comparison to prior MRI there is evidence of increase in the degree of edema since prior exam. There is evidence of midline shift of approximately 6 mm which has increased since prior examination. The no evidence of hemorrhage is identified. Also new since prior examination is further interval dietitian of the right temporal horn this is believed to be secondary to entrapment of right temporal horn secondary to the mass. No evidence of hemorrhage is detected.

Output: 1.Increase in the amount of vasogenic edema in the right cerebral hemisphere surrounding the patient's known tumor.2.Enlarged right temporal horn due to entrapment.3.No evidence of hemorrhage.


Instruction: Generate impression based on findings.

Input: There are again stable postoperative findings from prior right frontal craniotomy for right frontal lobe ganglioglioma resection. There are a few foci of postoperative susceptibility. There is minimal persistent T2/FLAIR hyperintensity along the resection margins extending towards the right lateral ventricle margin, without associated nodular enhancement.There is no evidence of diffusion weighted abnormality. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are patent.

Output: Continued stable postoperative changes from prior right frontal craniotomy for right frontal lobe ganglioglioma resection, without evidence of tumor recurrence.


Instruction: Generate impression based on findings.

Input: Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits [Z86.73], Reason for Study: ^Reason: r/o CVA - stroke protocol History: AMS Brain MRIThere is no evidence of acute ischemic infarct.Encephalomalacia are seen on the left frontal and right parietal lobes indicating chronic ischemic infarctions. Multifocal susceptibility lesions including bilateral frontal and right parietal lobe are again seen, unchanged since prior scan.There is no evidence of acute hemorrhagic lesion on the scan. Patchy FLAIR/T2 high signal intensity lesions on periventricular white matter and centrum semiovale are again seen, indicating nonspecific small vessel ischemic disease, unchanged since prior scan.There is no evidence of abnormal enhancement.The ventricles, sulci and cisterns are 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. The paranasal sinuses and mastoid air cells are clear.Brain MRAMotion artifact degraded exam quality.3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate there is about 3 to 4 mm sized right paraophthalmic aneurysm, comparing to prior scan, there is no significant interval change. However, due to motion artifact and limitation of MR angiogram, precise evaluation of aneurysm interval change is not possible.There is no other aneurysm seen.There is no evidence of significant (50% or more) intracranial arterial luminal stenosis. Vertebrobasilar system appears to be normal.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. Multifocal chronic ischemic lesions and hemosiderin depositions, unchanged.3. Mild to moderate non specific small vessel ischemic disease, unchanged.4. Right paraophthalmic aneurysm, about 3-4mm in size, unchanged in terms of size and configuration since prior scan.5. No other aneurysm was seen. No evidence of significant intracranial arterial luminal stenosis.


Instruction: Generate impression based on findings.

Input: A 51 year old male with history of hypertension, hyperlipidemia, atrial fibrillation. Patient with possible ventricular arrhythmia noted during stress test. Referred to stress cardiac MRI for further evaluation of ischemia and infiltrative disease.MEDICATIONS: Aspirin, Atorvastatin, Atenolol, Flecainide First Pass PerfusionDuring hyperemia, no perfusion defects were present. A mild dark ring artifact is noted.Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable.Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 66%, the LV end diastolic volume index is 83 ml/m2 (normal range: 74+/-15), the LVEDV is 168 ml (normal range 142+/-34), the LV end systolic volume index is 28 ml/m2 (normal range 25+/-9), the LVESV is 57 ml (normal range 47+/-19), the LV mass index is 50 g/m2, and the LV mass is 101 g. There are no regional wall motion abnormalities present. Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 55%, the RV end diastolic volume index is 95 ml/m2 (normal range 82+/-16), the RVEDV is 193 ml (normal range 142+/-31), the RV end systolic volume index is 42 ml/m2 (normal range 31+/-9), and the RVESV is 86 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is a trace pericardial effusion.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. No perfusion defects/ "ischemia" present during hyperemia.2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and systolic function (LVEF 66%) without evidence of underlying myocardial fibrosis, inflammation, or infiltration.4. Normal RV size and systolic function (RVEF 55%).5. There is mild mitral regurgitation.6. Mild biatrial dilation.


Instruction: Generate impression based on findings.

Input: Family history of pancreatic cancer in mother and father. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology, signal intensity and size. No focal suspicious lesion, biliary ductal dilatation or vascular abnormality. Normally distended gallbladder without gallstones.SPLEEN: No significant abnormality noted.PANCREAS: Mildly heterogeneous enhancement of the uncinate process without a focal lesion, unchanged. No main pancreatic ductal dilatation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Stable examination without evidence of pancreatic cancer.


Instruction: Generate impression based on findings.

Input: Hip pain. Question of sacroiliitis. BONE MARROW: Bone marrow signal is within normal limits.SOFT TISSUES: There is increased, somewhat speckled T2 signal within the proximal aspect of the left vastus lateralis muscle. This region is isointense to muscle on T1 sequences. JOINTS: The sacroiliac joints are normal. Bilateral hip joints appear normal. There is increased T2 signal around the greater trochanter of the left femur which may represent some degree of a bursitis.ADDITIONAL

Output: Findings most likely represent an intramuscular hemangioma of the left vastus lateralis muscle. Another possibility is localized inflammation to the muscle. Plain film radiographs are recommended for further evaluation.


Instruction: Generate impression based on findings.

Input: 48-year-old female with history of right breast cancer status post mastectomy in 2009 with autologous breast reconstruction. Patient received radiation, chemotherapy, and hormonal therapy. History of left breast reconstruction as well. Family history breast cancer diagnosed in sister at age 36. Personal history of Cowden syndrome. There is heterogeneous amount of fibroglandular tissue in the left breast.Mild parenchymal enhancement is noted bilaterally.There are stable postsurgical changes of a right mastectomy and breast reconstruction.There are stable enhancing foci in the left breast. No new or suspicious enhancement is seen in the left 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: Clinical question: Seizure protocol. Signs and symptoms: 21 year old male with epilepsy since age 13. EEG left frontal temporal spikes in the past. Nonenhanced brain MRI:Unremarkable diffusion weighted series.Examination demonstrates normal anatomical development of brain parenchyma.There are few tiny foci of FLAIR hyperintensity in the subcortical white matter of the bilateral cerebral hemispheres which are nonspecific.The anatomical morphology as well as the signal intensity of brain parenchyma is otherwise within normal on all MRI sequences. In particular there is no detectable abnormal anatomical morphology or signal intensity of the left frontotemporal region.Unremarkable CT pole cortex, cortical sulci, ventricular system and CSF spaces.Signal void of major intracranial arterial branches are identified.Unremarkable calvarium, soft tissues of the scalp, orbits, mastoid air cells, middle ear cavities and all visualized paranasal sinuses.

Output: 1.Negative diffusion-weighted images.2.Few punctate-sized subcortical foci of nonspecific FLAIR hyperintensity.3.Unremarkable nonenhanced brain MRI otherwise and in particular no detectable signal abnormality of the left frontal temporal region.


Instruction: Generate impression based on findings.

Input: Reason: 64 yo woman with pain, swelling ulnar aspect of right hand/wrist. Dystrophic calcifications seen in soft tissue of right hand History: pain, swelling ulnar aspect of right hand/wrist There is degenerative subchondral cyst formation within the lunate and capitate bones. Note is made of a short fourth metacarpal. There is peripherally enhancing fluid within the ulnocarpal joint indicating a synovitis. There are multiple foci of decreased signal abnormality within the abductor digiti minimi muscle corresponding to the findings on recent radiographs which may reflect dystrophic calcification. There is enhancing signal abnormality within the abductor digiti minimi muscle at the level of the myotendinous junction indicating nonspecific inflammatory change. Although this examination was not optimized for evaluation of the triangular fibrocartilage complex, there is increased signal abnormality within the articular cartilage disc just proximal to its attachment on the ulnar styloid indicating degeneration or perhaps degenerative tearing. There is increased signal abnormality within the extensor carpi ulnaris tendon which may reflect a mild tendinosis. The flexor and chest with tendons appear intact. No additional bone marrow signal abnormality is identified.

Output: 1. Findings indicating a synovitis of the ulnocarpal articulation.2. Nonspecific inflammatory change within the abductor digiti minimi muscle at the level of the myotendinous junction.3. Punctate foci of decreased signal abnormality within the abductor digit minimi may represent dystrophic calcification.4. Short fourth metacarpal.


Instruction: Generate impression based on findings.

Input: History of syncope and possible seizure, evaluate for meningioma growth. There is a dural based extra-axial mass in the anterior left middle cranial fossa along the greater wing of the sphenoid, which measures 32 x 19 x 30 mm, previously 31 x 17 x 28 mm. The lesion demonstrates avid homogeneous enhancement. There is resultant mass effect and posterior displacement of the left temporal tip without parenchymal signal abnormality to suggest vasogenic edema. There are scattered punctate foci of high T2 signal within the periventricular and subcortical white matter, basal ganglia, and pons, which are nonspecific but compatible with chronic small vessel ischemic changes. There is no evidence of intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is mild mucosal thickening within the visualized paranasal sinuses. The orbits and scalp soft tissues are grossly unremarkable.

Output: The left anterior middle cranial fossa extra-axial mass, which is compatible with meningioma, has slightly increased in size.


Instruction: Generate impression based on findings.

Input: Neuroblastoma; assess for progression of disease. Neck Soft Tissues: There is no evidence of measurable mass lesions or significant cervical lymphadenopathy based on size criteria. The thyroid and major salivary glands are unremarkable. The major cervical flow voids are intact. The imaged intracranial structures are unremarkable. Cervical and Thoracic Spine: There is no evidence of abnormal enhancement or mass lesions in the spine. There vertebral column alignment is within normal limits. There is no spondylolisthesis. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: No evidence of recurrent neuroblastoma in the neck or cervical and thoracic spine.


Instruction: Generate impression based on findings.

Input: History of von Hippel-Lindau disease. Evaluate for renal, pancreatic or adrenal lesion mass. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology size and signal intensity without a focal suspicious lesion biliary ductal dilatation or vascular abnormality.SPLEEN: Normal splenic size without a focal lesion.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: T2 hyperintense lesion involving the lower thoracic spinal cord is better evaluated on the dedicated MRI of the spine, associated small focal enhancing nodularity suggested.

Output: 1.No suspicious lesion of the abdominopelvic visceral organs.2.Please see the separately dictated report of the dedicated MRI of the spine regarding a cystic thoracic spinal cord lesion, suspicious for hemangioblastoma given the clinical history of von Hippel-Lindau syndrome.


Instruction: Generate impression based on findings.

Input: Female, 41 years old, with lumbar radiculopathy. Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. No edema or marrow replacement is seen. A small focus of STIR hyperintensity within the L1 vertebral body is nonspecific. A focus of fatty signal abnormality within the L4 vertebral body may represent focal fat or hemangioma. The visualized distal spinal cord, conus and nerve roots of the cauda equina are within normal limits. No epidural abnormalities are suspected. The intervertebral discs are preserved with no evidence of bulging or herniation. No significant compromise of the spinal canal or neural foramina is seen. Moderate facet arthropathy is seen at L4-5 and L5-S1.

Output: 1.No significant spinal canal or neuroforaminal stenosis is detected.2.No specific findings are seen which would account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: History of primary sclerosing cholangitis and ulcerative colitis. Evaluate for dominant stricture. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology and signal intensity.Demonstrated again is multifocal narrowing and mild prominence/ectasia of the biliary tree not significantly changed from the prior study. There is a long segment 2.5 cm stricture of the left hepatic duct (series 10/1), similar to the prior study without associated abnormal enhancement. Similar stricturing affects the more central right and left hepatic ducts. No abnormal postcontrast enhancement or suspicious liver lesion.Note is made of an enhancing plaque-like lesion in the gallbladder fundus which is slightly increased from the prior study (series 13/53) measuring 1.9 cm.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Small fat-containing umbilical hernia.OTHER: No significant abnormality noted.

Output: 1.Mild progression of irregular narrowing and dilatation of the right and left intrahepatic biliary ducts without a new dominant stricture or discrete mass.2.Increasing size of a plaque-like mucosal lesion of the gallbladder fundus. The lesion does not have the typical features of adenomyomatosis.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for etiology of altered mental status (metastases, CVA). Signs and symptoms cord altered mental status No evidence of hemorrhage, edema, mass-effect, midline shift or hydrocephalus. Extensive patchy periventricular and subcortical areas of low attenuation are nonspecific however likelihood of advanced small vessel disease should be considered. No evidence of cortical abnormality. Cortical sulci and ventricular system as well as the CSF cisterns are within normal range for patient's stated age.This examination cannot exclude metastatic lesion to the brain or leptomeninges without the benefit of contrast infusion. Further follow-up with an MRI is recommended. There is however no definitive evidence of metastatic disease on this non-infused study. Calvarial, paranasal sinuses and mastoid air cells are unremarkable.

Output: 1.Findings highly suspected off small vessel disease of indeterminate age.2.Limited value examination for dictation of metastatic disease due to lack of contrast. Follow-up with an MRI is recommended.3.Calvarium, paranasal sinuses and mastoid air cells are unremarkable.


Instruction: Generate impression based on findings.

Input: Clinical question: History of pituitary tumor, evaluate for change or growth. Signs and symptoms: Headache. Pre- and postenhanced pituitary MRI:Examination demonstrates a well-demarcated round mass occupying the entire sella and with resultant mild expansion of the sella. It measures approximately 15 mm in craniocaudad and 16 mm in transverse axis and 19 mm on AP measured on post enhanced images. The mass is nearly identical to prior brain MRI exam from 10-15-2014 (no prior dedicated pituitary MRI). The lesion minimally bulges into the basal cistern however it is not in contact with the suprasellar visual complex. There is also no evidence of extension of the lesion into the cavernous sinuses. The lesion demonstrates mildly heterogeneous diffuse enhancement and highly suspected of a pituitary macroadenoma. There is mild deviation of the pituitary stalk to the right as result of this mass.Pre and post enhanced brain MRI:Negative diffusion-weighted images.Other than above detailed intrasellar pituitary lesion the overall anatomic cord morphology and signal intensity of brain parenchyma remains within normal on all MRI sequences.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination.Unremarkable calvarium, soft tissues of the scalp, orbits, paranasal sinuses and mastoid air cells.Postenhanced images demonstrate no detectable abnormal parenchymal or leptomeningeal enhancement. Above mentioned pituitary mass however demonstrate diffuse mildly heterogeneous enhancement.

Output: 1.Pre- and postenhanced pituitary MRI demonstrate uniformly enlarged pituitary gland with mild deviation of pituitary stock to the right and highly suggestive of a pituitary macroadenoma without interval change since prior brain MRI exam from 2014. No evidence of mass effect on the suprasellar visual complex or extension into the cavernous sinuses.2.Pre and post enhanced brain MRI is unremarkable other than above mentioned adenoma.3.Unremarkable calvarium, orbits, paranasal sinuses and mastoid air cells.


Instruction: Generate impression based on findings.

Input: 54 year-old female with CAD s/p PCI to LAD in 3/2015, RCA CTO s/p PCI in 12/2015 and 4/2016, LV dysfunction, hypertension, OSA with chest pain.MEDICATIONS: Aspirin, Atorvastatin, Bumex, Carvediolol, Clopidogrel, Gabapentin, Hydroxychloroquine, Isosorbide mononitrate, Prednisone, Ranolazine, Spironolactone, Valsartan First Pass PerfusionDuring hyperemia, possible mild perfusion defect noted at the mid inferior segment. No significant perfusion defects noted. Stress perfusion study improved when compared with previous performed 3/2016.Viability/ Myocardial ScarDiffuse subendocardial LGE extending from the base to mid inferior wall. This was noted in the previous study from 3/2016. The entire myocardium is viable.Left VentricleThe left ventricle is normal in size in function. The overall LV ejection fraction is 56%, the LV end diastolic volume index is 82 ml/m2 (normal range: 65+/-11), the LVEDV is 170 ml (normal range 109+/-23), the LV end systolic volume index is 36 ml/m2 (normal range 18+/-5), the LVESV is 75 ml (normal range 31+/-10), the LV mass index is 35 g/m2, and the LV mass is 72 g. Basal to mid inferior wall hypokinesis (mild). Pre-contrast T1 mapping = 973 msLeft AtriumThe left atrium is normal sized. Right VentricleThe right ventricle is normal in size in function. The overall RV ejection fraction is 54%, the RV end diastolic volume index is 69 ml/m2 (normal range 69+/-14), the RVEDV is 144 ml (normal range 110+/-24), the RV end systolic volume index is 32 ml/m2 (normal range 22+/-8), and the RVESV is 77 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in sized. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC 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. During hyperemia, possible mildmid inferior wall perfusion defect. This defect is much improved from previous stress MRI dated 3/3016.2. Diffuse area of LGE extending from the base to mid inferior wall. This was noted on the previous study and is still present. The entire myocardium is viable.3. Normal LV size and systolic function (LVEF 56%). Basal inferior wall hypokinesis (mild)4. Normal RV size and systolic function (RVEF 54%).I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Female; 20 years old. Reason: renal lesion found on recent ultrasound. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Circumscribed slightly T2 hyperintense lesion in the left lower pole measures 1.5 x 1.4 cm (series 801, image 15). This lesion does not demonstrate any appreciable enhancement on post-contrast sequences, and measured approximately 1.1-1.3 cm in maximal dimension on studies dating back to 2011. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Slightly T2 hyperintense, non-enhancing left lower pole renal lesion, stable to slightly increased in size since 2011. Imaging findings are most suggestive of a cyst.


Instruction: Generate impression based on findings.

Input: History of cirrhosis. ABDOMEN: is LIVER, BILIARY TRACT: The demonstrated cirrhotic morphology with atrophy of the right lobe, widening of intrahepatic fissures and surface nodularity.Anterior to the right hepatic vein segment VIII is an arterially enhancing focus measuring up to 2.0 x 1.4 cm (series 36/75). The lesion demonstrates washout on the delayed/equilibrium phase (series 39/72) and mild T2-weighted hyperintensity (series 22/29). The lesion demonstrates mild loss of signal on out-of-phase imaging compatible with focal fat. These findings meet the accepted imaging criteria for imaging diagnosis of HCC.No additional suspicious arterial enhancing liver lesion.Portal and hepatic veins are patent without evidence of intraluminal thrombosis.The gallbladder is full of gallstones with non-specific mild wall thickening and mild pericholecystic fluid. No intra or extrahepatic biliary ductal dilatation.Recannulated umbilical vein and other portosystemic collaterals indicative of portal hypertension.. SPLEEN: Moderate splenomegaly measuring 18.7 cm in craniocaudal dimension. Perisplenic collaterals. PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: 5.7 cm exophytic cyst of the inferior pole of the left kidney. Right renal cysts. No hydronephrosis. Small splenorenal shunt. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted. Small amount of ascites seen about the inferior right liver.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Cirrhosis with splenomegaly indicating portal hypertension, with small amount of ascites. 2. Approximately 2.0 cm arterial enhancing lesion in segment VIII with washout and T2 hyperintensity meeting imaging criteria for HCC.3. Cholelithiasis with gallbladder wall thickening -- in the absence of symptomatology suggesting acute gallbladder disease, gallbladder wall thickening is common in patients with cirrhosis and not indicative of acute disease.


Instruction: Generate impression based on findings.

Input: Known migraines. Now awakening from sleep with headache. Evaluated for structural etiology. 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 visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.Incidental note is made of foot cystic lesion in the pharyngeal mucosal space eccentric towards the right side which is adjacent to the orifice of the eustachian tube.

Output: 1.MRI of the brain is within normal limits.2.A cystic lesion in the pharyngeal mucosal space in the nasopharynx is present which could represent a mucous retention cyst. This is an incidental finding.


Instruction: Generate impression based on findings.

Input: There is a 6 mm diameter T1 hyperintense lesion with fluid signal intensity on T2-weighted images with central low signal intracystic nodule in the left pituitary. There is an additional punctate T1 hyperintense focus in the pituitary gland anterior to the usual location of the posterior pituitary bright spot. There is compression of the adjacent pituitary gland. The pituitary stalk lies in the midline. The suprasellar cistern, optic chiasm, cavernous sinuses, and intracranial portions of the optic nerves appear unremarkable.

Output: A 6 mm lesion in the left pituitary has features highly suggestive Rathke's cleft cyst. An additional punctate T1 hyperintense focus in the pituitary gland anterior to the usual location of the posterior pituitary bright spot may represent another Rathke's cleft cyst.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: History of hepatitis C cirrhosis. ABDOMEN:LIVER, BILIARY TRACT: The liver demonstrates a mildly undulating contour and mild fissural prominence suggestive of cirrhosis. No stigmata of portal hypertension. Normally distended gallbladder. No biliary ductal dilatation. The vessels are patent.No suspicious liver lesion.SPLEEN: The spleen is normal in size morphology and signal intensity without a focal lesion.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Mildly cirrhotic liver morphology without a suspicious liver lesion.


Instruction: Generate impression based on findings.

Input: Reason: pain History: pain ACETABULAR LABRUM: There is no evidence of labral tear. ARTICULAR CARTILAGE AND BONE: Bone marrow signal intensity is within normal limits throughout. Articular cartilage is normal in appearance.SOFT TISSUES: The imaged soft tissues are unremarkable. ADDITIONAL

Output: No acute abnormalities of the left hip are identified on this MRI.


Instruction: Generate impression based on findings.

Input: 47 year old female with suspicious left breast calcifications presents for Alan Penn research MRI. There is extreme amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.There are multiple cysts in both breasts.There is a focal non-mass enhancement at 4:00 position in the left breast, measuring 17 x 12 x 12 mm (AP x LR x CC). This non-mass enhancement corresponds to the area of suspicious calcifications seen on the mammogram.A regional non-mass enhancement is seen at 2:00 position in the left breast, measuring 16 x 20 x 25 mm. This lesion is mammographically occult.No abnormal enhancement is seen in right breast. No abnormal lymph nodes are identified in either axillary region.

Output: 1. Suspicious non-mass enhancement in the left breast at 2:00 position and 4:00 position. The lesion at 4:00 position corresponds to the suspicious calcifications, and the lesion at 2:00 position is mammographically occult. Both lesions were detected on ultrasound study performed later today, and a needle biopsy was performed for both lesions.2. No MRI evidence for malignancy in the right. 3. No abnormal lymph nodes in either axillary region. BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Left leg pain, low back pain 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. There is mild generalized facet arthropathy in the lumbar spine.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: There is a central and left paracentral disc protrusion which effaces the left lateral recess and may be impinging on the left S1 nerve root. There is also contact of the right S1 nerve root. There is mild central canal narrowing at this level. No significant neural foraminal narrowing.Paraspinous soft tissues are within normal limits.

Output: 1. Disc protrusion at the L5-S1 level with effacement of the left lateral recess and suspected impingement of the left S1 nerve root.2. Remainder of the lumbar levels are unremarkable. Neural foramina are patent.


Instruction: Generate impression based on findings.

Input: Reason: eval for MPFL rupture History: instability MENISCI: Menisci are intact bilaterally.ARTICULAR CARTILAGE AND BONE: There is increased T2 signal within the central and anterior aspects of the lateral tibial plateau and lateral femoral condyle which likely represent bone contusions. There is linear T1 signal along the lateral aspect of the lateral femoral condyle which likely represents an acute subchondral fracture. There is an 8 mm full-thickness defect in the associated articular cartilage of the lateral femoral condyle. The remaining articular cartilage is intact.LIGAMENTS: PCL is intact. Fraying of the ACL may indicate partial tearing. The meniscal femoral ligaments are intact.EXTENSOR MECHANISM: Extensor mechanism is intact.ADDITIONAL

Output: Partial thickness tearing of the ACL with bone contusions and subchondral fracture along the lateral femoral condyle.


Instruction: Generate impression based on findings.

Input: Female, 31 years old, with multiple sclerosis, follow-up exam. Extensive patchy, nearly confluent T2 hyperintense lesions are evident within the periventricular white matter with scattered additional lesions in the subcortical regions, brainstem and cerebellum. Many of these lesions demonstrate profound T1 hypointensity indicating chronicity and tissue loss. Since the prior examination, no evidence of any obviously new or progressing lesion is seen. One lesion previously noted in the right middle frontal subcortical white matter has evolved to a more chronic appearance.No evidence of significant parenchymal edema or mass effect is detected. The corpus callosum is severely thinned and there is mild generalized parenchymal volume loss compatible with long-standing disease. No abnormal fluid collections are detected. The ventricular system is stable in size and morphology.

Output: Findings compatible with severe long-standing demyelinating disease. No evidence of any new or progressing lesion is seen.


Instruction: Generate impression based on findings.

Input: Smoldering multiple myeloma. Evaluate for osseous lesion in left femur. There is no intramedullary lesion to suggest multiple myeloma. Mild heterogeneity of the marrow at the femoral diaphysis is within normal limits. A subcentimeter focus of intermediate signal intensity within the intertrochanteric region enhances slightly, but is too small to characterize and is unchanged from prior. The musculature of the femur is within normal limits. Subtle enhancement along the greater trochanter suggests mild inflammation, likely of no clinical significance.

Output: No definite interval change in the previously identified suspected trochanter myelomatous lesion.


Instruction: Generate impression based on findings.

Input: 42-year-old male with history of testicular cancer who presents for surveillance imaging for nodal recurrence. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Subcentimeter left renal cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No evidence of retroperitoneal lymphadenopathy or other sites of disease.


Instruction: Generate impression based on findings.

Input: Hemangioma of intracranial structures [D18.02], Reason for Study: ^Reason: 3T scanner, qsm/permeability History: Known CCM disease w prior bleeding, intermittent vision changes "upside down", vertigo There are multifocal various sized susceptibility lesions on bilateral cerebral hemispheres, bilateral cerebellar hemispheres and brainstem.There is no MR evidence of surrounding edema of those lesions. There is no evidence of abnormal contrast enhancement. The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Multifocal bihemispheric, supra and infratentorial scattered various sized susceptibility artifacts indicating multiple cavernous malformations.2. There is no evidence of surrounding edema, no mass effects.3. There is no evidence of abnormal enhancement.


Instruction: Generate impression based on findings.

Input: Male, 56 years old. Reason: better evaluation of post-surgical site, rule out osteomyelitis History: as above The examination is somewhat motion degraded. There are postsurgical changes related to amputation of the great toe through the level of the metatarsal diaphysis. There is moderate edema in the surrounding soft tissues. There is increased STIR signal within the distal aspect of the remaining first metatarsal with decreased signal on T1-weighted images which is suspicious for osteomyelitis. Additional abnormal signal is noted within the second metatarsal head extending into the diaphysis, suspicious for an additional focal area of osteomyelitis. The remainder of the bones of the foot show normal marrow signal. There is no discrete fluid collection identified within the soft tissues.

Output: Postsurgical changes related to amputation through the first metatarsal. Abnormal marrow signal involving the remaining portion of the first metatarsal as well as the distal aspect of the second metatarsal, highly suspicious for osteomyelitis in these two areas.


Instruction: Generate impression based on findings.

Input: Pain. Rule out soft tissue pathology. Evaluation of the shoulder is slightly limited due to relatively poor signal on the fat-suppressed T2-weighted images.ROTATOR CUFF: There is a complete tear of the supraspinatus tendon from the greater tuberosity with retraction of the tendon to the level of the glenohumeral joint. Increased signal intensity within the distal end of the retracted tendon suggests tendinosis. There is mild fatty atrophy of the supraspinatus muscle. There is a near-complete to complete tear of the infraspinatus tendon, possibly with a few tendinous strands extending to the greater tuberosity posteriorly. The majority of the tendon is retracted to the level of the glenohumeral joint. Increased signal intensity within the retracted tendon reflects tendinosis and interstitial tearing. There is moderate fatty atrophy of the infraspinatus muscle. The teres minor muscle and tendon appear intact. There is thickening of the subscapularis tendon near its insertion on the lesser tuberosity that likely reflects a combination of tendinosis and redundancy due to internal rotation of the humeral head. Additional foci of increased signal intensity within the distal subscapularis tendon likely reflect interstitial and undersurface tearing. The subscapularis muscle is within normal limits for age.SUPRASPINATUS OUTLET: Mild osteoarthritis affects the acromioclavicular joint. There is a small amount of fluid within the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: The humeral head is high riding, but otherwise alignment is within normal limits. There is mild to moderate degeneration of the articular cartilage of the glenohumeral joint. Intermediate signal intensity within the superior labrum likely reflects degeneration, but I see no fluid-filled labral tear.BICEPS TENDON: The tendon of the long head of the biceps is poorly defined within the rotator interval which may simply be a technical phenomenon. The tendon is visualized within the intertubercular groove with a small amount of fluid in the biceps tendon sheath. Bone marrow signal intensity is within normal limits.

Output: Rotator cuff tear and other findings as described above.


Instruction: Generate impression based on findings.

Input: 29-year-old male patient with history of PSC, autoimmune hepatitis cirrhosis. Evaluate for HCC and clinical carcinoma. ABDOMEN:LIVER, BILIARY TRACT: Subtle nodular contour and mildly widened left hepatic fissure compatible with known cirrhosis.Again seen is mild irregularity and beading of the intrahepatic biliary ducts. Focal stricture that measures 9 mm in length and the left hepatic lobe appear similar compared to prior examination. Irregularity and mild stenosis of the common bile duct is unchanged. No focal hepatic mass.Patent hepatic vasculature.SPLEEN: Stable 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: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Stable left hepatic lobe biliary duct stricture. 2.No specific evidence of cholangiocarcinoma or HCC.


Instruction: Generate impression based on findings.

Input: Reason: evaluate for disease activity History: dizziness and worsening visual acuity; h/o multiple sclerosis MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. One of the lesions is in the right calloso-cingulate junction. Another lesion is present along splenium of the corpus callosum on the left side and is new compared to the prior exam. Previously enhancing lesion in the corpus callosum posteriorly within the body no longer enhances.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI orbits:The eyeballs are intact. No intraconal or extraconal space mass is identified. The extraocular muscles are intact. The lacrimal glands are symmetric and within normal limits in size and configuration. There is no optic nerve enhancement appreciated. The suprasellar cistern is intact .

Output: 1.Periventricular and subcortical white matter signal changes of a mild degree are present which are nonspecific. They could be vascular related, related to demyelination, trauma, vasculitis, sarcoid. They are nonspecific. There is a new lesion present along the splenium of the corpus callosum which was not clearly present on the prior exams.ptic neu2.There's evidence for optic nerve enhancement to suggest optic neuritis.


Instruction: Generate impression based on findings.

Input: 37-year-old female with secondary hyperparathyroidism. Evaluate for parathyroid autograft. Evaluation is limited secondary to patient motion artifact.A dialysis graft is noted within the antecubital fossa. Adjacent to the graft within the volar soft tissues is a lobular area that demonstrates isointense signal to skeletal muscle on T1-weighted images and intermediate heterogeneous signal to skeletal muscle on T2-weighted images measuring approximately 1.5 cm (series 8, image 33) most likely represents small hematoma related to recent episode of dialysis. There is mild induration within the subcutaneous soft tissues presumably related to dialysis. Bone marrow signal intensity is normal. The muscles, tendons and ligamentous structures of the forearm appear normal and intact throughout their course.

Output: 1. Likely small hematoma adjacent to the dialysis graft presumably related to recent episode of dialysis. Mild induration within the subcutis tissues also presumably related to dialysis.2. The forearm musculature appears normal with the parathyroid autograft not definitively visualized.


Instruction: Generate impression based on findings.

Input: Speech disturbance, altered consciousness. There is restricted diffusion on the left side of pons indicating acute ischemic stroke.On the right side pons, there are a couple of focal tissue loss indicating prior ischemic stroke.There is no evidence of acute hemorrhage lesion on the scan.Patch bilateral high signal intensities on FLAIR imaging on periventricular white matter indicate nonspecific small vessel ischemic disease.There are multiple scattered bihemispheric round low signal intensities on gradient echo scans indicate either brain calcifications or chronic hemorrhagic foci.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: Acute ischemic infarct, left side of pons without evidence of hemorrhagic transformation.Nonspecific small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: 59 year old female with a history of biopsy proven amyloidosis referred for cardiovascular MRI to evaluate for cardiac involvement. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 67%, the LV end diastolic volume index is 84 ml/m2 (normal range: 65+/-11), the LVEDV is 135 ml (normal range 109+/-23), the LV end systolic volume index is 28 ml/m2 (normal range 18+/-5), the LVESV is 44 ml (normal range 31+/-10), the LV mass index is 73 g/m2 (normal range 67+/-11), and the LV mass is 117 g (normal range 114+/-24). There are no regional wall motion abnormalities present. Late gadolinium kinetics are abnormal on the TI scout images (50 msec between cavity and myocardial nulling). There are several areas of abnormal Gd uptake in a patchy pattern involving the basal inferior and posterior wall and IVS. Left AtriumThe left atrium is dilated.Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 67%, the RV end diastolic volume index is 75 ml/m2 (normal range 69+/-14), the RVEDV is 120 ml (normal range 110+/-24), the RV end systolic volume index is 25 ml/m2 (normal range 22+/-8), and the RVESV is 39 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 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. Abnormal Gd kinetic and patches of late Gd enhancement c/w cardiac amyloid.2. Compared to 1-2014 Gd enhancement appears similar.


Instruction: Generate impression based on findings.

Input: Reason: s/p fall from 3rd story building, with multiple facial and cranial fractures, sdh, cervical C2 fracture. Please evaluate for healing and changes to C2 fx. History: 2 month follow up for cervical fracture. The cervical vertebral bodies are appropriate in height. No appreciable fracture within the limits of MRI. Craniovertebral junction alignment as well as alignment of the remainder of the cervical spine is maintained. Ligamentous structures are intact. Bone marrow signal is within normal limits. The cervical spinal cord has normal signal characteristics and overall morphology. No spinal canal or neural foraminal stenosis is seen at any level.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: Cervical vertebrae appear within normal limits for age. Alignment is also maintained. No evidence of ligamentous injury in the cervical spine.


Instruction: Generate impression based on findings.

Input: HIV on HART, polysubstance abuse, reported h/o brain tumor, multiple falls, slurred speech, dysmetria although confounded by admitting to opiate intoxication. There are multiple scattered foci of predominantly subcortical white matter T2 hyperintensity without restricted diffusion. There is also patchy T2 hyperintensity and swelling within the central pons and within the medial cerebellar hemisphere white matter, right greater than left. The cerebellar tonsils are mildly low-lying. There is a punctate focus of susceptibility effect in the periventricular white matter adjacent to the frontal horn of the left lateral ventricle, with what appears to be adjacent linear susceptibility effect. There is no evidence of acute intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift. The major cerebral flow voids are intact. The orbits are grossly unremarkable. The calvarial bone marrow is diffusely heterogenous. The adenoids are prominent. There is mild diffuse paranasal sinus mucosal thickening.

Output: 1. Multiple supratentorial and infratentorial white matter lesions may represent progressive multifocal leukoencephalopathy or other opportunistic infection, the primary effects of HIV, neoplasm, such as CNS lymphoma, and/or the effects of opiate intoxication, with what may represent mild tonsillar herniation versus baseline low-lying tonsils. However, assessment is limited due to the lack of intravenous contrast. Otherwise, no evidence of acute intracranial hemorrhage or acute infarct.2. A punctate focus of susceptibility effect in the periventricular white matter adjacent to the frontal horn of the left lateral ventricle may represent a cavernous malformation associated with a developmental venous anomaly. 3. Nonspecific prominence of the adenoids may be related to HIV, for example.4. The appearance of the calvarial bone marrow may also be attributable to HIV.


Instruction: Generate impression based on findings.

Input: Right hip pain Despite attempts to minimize the artifact, the examination is limited by susceptibility artifact due to the presence of a right total hip arthroplasty.There is no abnormal signal intensity within the surrounding pelvic musculature. There is more pronounced fatty atrophy of the right hip musculature when compared to the left. Examples of this include the obturator externus (series 4 image 19) and the gluteus medius (series 4 image 15). There is slightly increased signal intensity of the attachment of the gluteus medius tendon although the tendon itself appears intact.A small fluid collection is seen along the greater trochanter of the right hip which extends into the soft tissues beyond the gluteus maximus muscle. A similar but smaller collection is seen along the greater trochanter of the left hip.The marrow signal intensity of the bony pelvis is normal.

Output: 1. Limited examination secondary to susceptibility artifact from right hip arthroplasty.2. Small amount of fluid along the right greater trochanter may reflect a small bursal collection or may be postsurgical in nature given that it appears to extend beyond the gluteus maximus muscle.3. Mild fatty atrophy of the right hip musculature compared to the left although there is no abnormal signal intensity to suggest edema or inflammation.


Instruction: Generate impression based on findings.

Input: There is a subcentimeter focus of mild restricted diffusion overlying the posterior limb of the left internal capsule which has a "ring" appearance demonstrating a lack of restricted diffusion centrally. This correlates with a minimal hypointense ring on ADC with central hyperintensity. T2 imaging demonstrates this to be hyperintense, T1 is hypointense, and there is no contrast enhancement. There is also no associated susceptibility abnormality or mass effect.There are multiple foci of T2 hyperintensity throughout the periventricular and subcortical white matter without associated mass effect, restricted diffusion, susceptibility abnormality, or enhancement.The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain.

Output: 1.Resolving, late subacute lacunar infarct overlying the posterior limb of the left internal capsule. There is no acute ischemia.2.Chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: 60 year-old male with right maxillary squamous cell carcinoma, status post induction chemotherapy, for the study. Brain CT:The attenuation and morphology of the brain parenchyma is within normal limits for patient's stated age. No evidence of hemorrhage, edema, mass-effect, midline shift, no abnormal enhancement in the brain parenchyma is detected. Ill-defined linear enhancement identified along the right side medial aspect of the middle cranial fossa contiguous with right foramen ovale and along the cavernous sinus seen on the prior MRI is not as well appreciated on this CT study. Cortical sulci, ventricular system and all basal cisterns are normal in size and configuration. Partial opacification of right mastoid air cells is redemonstrated. Neck CT:There is mottled radiolucent destruction involving right side hard palate, medial and lateral pterygoid plate, greater wing of sphenoid and the posterior wall of right maxillary sinus. The right vidian canal is not visualized. The right maxillary sinus soft tissue mass appears to have been largely resected. There is residual soft tissue thickening along the wall of the right maxillary sinus and status post uncinectomy and partial turbinectomy change. Soft tissue enhancement/irregularity in right pterygopalatine fossa and masticator space are persistent. The parapharyngeal space is preserved. Views of soft tissue neck is negative for discrete mass. No pathologic lymphadenopathy is appreciated based on the size criteria for lymphadenopathy. Scattered small lymph nodes are seen in bilateral level II to IV . A retention cyst is again noted in left maxillary sinus.The airways are patent. The epiglottis, vallecula, piriform sinuses, and vocal cords are normal. The parotid and thyroid glands are unremarkable. The carotid arteries and jugular veins are patent. The visualized portion of the lungs are clear. Please refer to the dedicated chest CT for more comments. The cervical vertebral bodies in general are intact with no evidence for canal stenosis.

Output: 1. Interval post surgery and treatment change in the right maxillary sinus region. There is residual soft tissue thickening along the the maxillary wall. Soft tissue enhancement/irregularity in right pterygopalatine fossa, masticator space are persistent. These findings can represent residual tumor.2. There is no pathologic lymphadenopathy based on radiological criteria.3. Ill-defined linear enhancement in medial aspect of the middle cranial fossa along the lateral cavernous sinus, contiguous with right foramen ovale erosion. These findings were better seen on prior MRI and could represent intracranial spread. They are less well appreciated on this CT, and it is uncertain whether this is secondary to interval improvement or differences in techniques.4. Right mastoid, left maxillary sinus inflammatory change.


Instruction: Generate impression based on findings.

Input: NAION (non-arteritic anterior ischemic optic neuropathy), right eye. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are minimal scattered nonspecific cerebral white matter foci. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Orbits: There appears to be mild atrophy of the right optic nerve along with perhaps mildly high T2 signal in the anterior portion of the optic nerve. The left optic nerve appears unremarkable. There is no abnormal intraorbital enhancement or mass lesions. The bilateral globes and ocular adnexa are unremarkable.

Output: 1. Possible mild atrophy of the right optic nerve, which may represent a sequela of non-arteritic anterior ischemic optic neuropathy.2. No evidence of intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: There is transitional anatomy with lumbarization of S1. As numbered previously, the last fully formed disc is at S1-S2.There are stable postoperative findings in the lumbar region related to resection of a previous left paraspinal mass including resection of the left paraspinal musculature. There is persistent laxity of the left posterior abdominal wall with partial herniation of the left kidney. There is no mass-like enhancement within the surgical bed or within the spinal canal. The cauda equina remains along the right aspect of the spinal canal, likely secondary to the scoliosis, which includes convex leftward lumbar curvature and a rightward thoracic curvature, better assessed on standing radiographs. Again seen is hypertrophy of the left lumbar posterior elements which is likely compensatory. The vertebral body heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. No abnormal signal in the spinal cord. Conus terminates normally. Again seen is multilevel left-sided lumbar neural foraminal stenosis related to the hypertrophy of the posterior elements.

Output: 1. Stable postoperative findings in the left lumbar region without evidence of tumor recurrence. Would suggest obtaining both axial and sagittal post contrast sequences with fat saturation in the lumbar spine on next follow-up study.2. Again seen is scoliosis which is better assessed on prior serial thoracolumbar standing radiographs. There is significant left-sided neural foraminal stenosis throughout the lumbar spine related to hypertrophy of the posterior elements.


Instruction: Generate impression based on findings.

Input: Male, 57 years old, with benign neoplasm of the pituitary gland. The 2 mm hypoenhancing lesion seen on the prior examination within the anterior aspect of the pituitary gland is no longer clearly visualized. The pituitary is otherwise unchanged in appearance. No new mass lesions are suspected. No suprasellar abnormality is observed. The visualized optic apparatus is unremarkable.

Output: A small lesion seen previously in the anterior pituitary gland is no longer distinctly visualized. No new pituitary lesions are identified.


Instruction: Generate impression based on findings.

Input: Malignant neoplasm of liver, primary, unspecified as to type [C22.8], Reason for Study: ^Reason: s/p vertebrectomy and fusion, h/o HCC History: s/p vertebrectomy and fusion, h/o HCC Interval T5 corpectomy with the cement augmentation as well as external fixation using screws and rods status.Previously seen significant spinal canal stenosis with cord compression by the T5 spinal mass has been significantly relieved. For example, demonstration of the CSF spaces around the spinal cord at the level of T5 indicating complete relief of cord compression.Spinal cord at the level of T5 shows subtle T2 high signal intensity which indicate possible post spinal cord compression myelomalacia or remained cord edema.On axial scans, the T5 level shows subtle soft tissue enhancements which suggest residual soft tissue mass or postoperative changes. Follow up MR imaging with or without contrast enhancement is indicated.The vertebral body height is preserved. The signal of the visualized cord except at the level of T5 is normal. The conus medullaris terminates at the T12-L1 level. The intervertebral discs demonstrate normal T2 intensity and height with no evidence of disc herniation. There is no evidence of cord compression.

Output: 1. Post surgical decompression of T5 level cord compression through T5 colpectomy with cement argumentation status.2. Subtle T2 high signal intensity at the T5 level spinal cord indicate either residual cord edema or post compression related myelomalacia.3. Subtle enhancing soft tissue lesions at the level of T5 vertebra and perivertebral soft tissue indicate either residual tumor or post operative changes. Follow up imaging is indicated.4. No other metastatic lesion is seen. No other compression fracture of vertebral body is seen.


Instruction: Generate impression based on findings.

Input: 64-year-old female with epigastric pain radiating to the back ABDOMEN:LIVER, BILIARY TRACT: Fatty liver infiltration. Cholelithiasis with small amount of pericholecystic fluid at the gallbladder fundus. Enhancement of the gallbladder mucosa and thickening of the gallbladder wall measuring up to 5 mm. Nonspecific soft tissue infiltration at the porta hepatis with enlarged porta hepatis lymph node.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Atrophic left kidney with T2 hyperintensities compatible with cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Findings suspicious for acute on chronic cholecystitis with cholelithiasis as described above.2.Nonspecific soft tissue infiltration at the porta hepatis with enlarged porta hepatis lymph node.


Instruction: Generate impression based on findings.

Input: Asymmetric tremor of the upper extremities. Brain parenchyma appears within normal limits. Specifically bilateral basal ganglia and brainstem appear without focal lesions. No abnormal mineralization in the basal ganglia, brainstem, cerebellum, or elsewhere in the brain. No intracranial mass or mass effect. No evidence of intracranial hemorrhage or infarct. No suspicious intracranial enhancement. Faint, partially linear contrast enhancement and susceptibility in the left posterior mid brain is compatible with small capillary telangiectasia or developmental venous anomaly and not an uncommon incidental finding. The ventricles and basal cisterns are normal in size and configuration. The major cerebral flow voids are intact. There is a small mucous retention cyst in the inferior aspect of the left maxillary sinus along with trace mucosal thickening. Minimal mucosal thickening is also present in the ethmoid and right maxillary sinuses. Calvarium and extracranial soft tissues are otherwise unremarkable.

Output: MRI of the brain appears within normal limits.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 21 years, Female, neurofibromatosis type I, cerebellar astrocytoma, hydrocephalus with VP shunt. Presenting with intermittent dull headaches. Susceptibility artifact related to right transparietal VP shunt catheter slightly limits evaluation. Ventricular system is well decompressed, similar to CT from 2/16/2012. Ventriculostomy catheter appears in unchanged position. There is no significant change in appearance of the masslike FLAIR hyperintensity corresponding to the known astrocytoma involving the left cerebellar hemisphere and extending into the vermis left greater than right. Unchanged mass effect including deformity of the fourth ventricle. Unchanged areas of susceptibility effect related to calcification and chronic blood products. Evidence of prior suboccipital craniectomy for partial tumor resection and volume loss primarily involving the right cerebral hemisphere similar to prior. No suspicious enhancement. Again seen is linear T2 hyperintensity involving the right frontal lobe related to prior right frontal ventriculostomy tract.No evidence of acute infarct, hemorrhage, new mass or new mass effect. Minimal mucosal thickening involving the paranasal sinuses. Mastoid air cells are clear. Diffuse fatty atrophy of the right muscles of mastication is again seen.

Output: No significant change in infiltrating cerebellar mass compared to 11/30/2011 consistent with known residual cerebellar astrocytoma. Unchanged associated mass effect and deformity of the fourth ventricle. Ventricular system remains decompressed.


Instruction: Generate impression based on findings.

Input: Female, 61 years old, with history of lung cancer and brain metastases status post radiosurgery. A focus of enhancement in the right postcentral gyrus now measures 6 mm diameter, previously 4 mm, with mildly increased FLAIR hyperintensity in the surrounding parenchyma. This lesion was initially detected on the 07/07/16 examination. However, there had been an enhancing lesion at this location first identified on the 10/07/14 examination and which subsequently resolved.No additional pathologic enhancement is identified. A small developmental venous anomaly seen in the left superior cerebellum. Nearly confluent white matter T2 hyperintensity in the periventricular regions is unchanged and likely related to therapy. No evidence of significant generalized mass effect is seen. Ventricular size and morphology remain within normal limits.

Output: A small focus of enhancement in the right precentral gyrus continues to increase in size, now measuring up to 6 mm. As this is the site of a previously treated lesion, the possibility of recurrent disease would need to be considered. However, a treatment related effect can be considered as well, particularly if this area received a substantial radiation dose.


Instruction: Generate impression based on findings.

Input: 68 years Female (DOB:4/25/1948)Reason: 68 yo F acute on chronic lower back pain radiating to her stomach, known lumbar spondylosis; assess for acute lower back pathology History: see aboveReferring Attending: Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. No abnormal enhancing lesions are appreciated in the lumbar spine.At L5-S1 there is loss of disc space height, disc desiccation and diffuse disc bulge associated with endplate reactive change. The endplate reactive changes bright on T1. There is no significant compromise to the spinal canal or exiting nerve roots at this level. At L4-5 there is loss of disc space height, disc desiccation and diffuse disc bulge associated with endplate reactive change. The endplate reactive changes bright on T1. There is no significant compromise to the spinal canal or exiting nerve roots at this level. There is some mild ligamentum flavum thickening this level.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is a minor disc bulge present at this level. There is some mild ligamentum flavum thickening this level.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina. There is a minor disc bulge present at this level.

Output: There are some degenerative changes present predominantly in the form of disc disease especially in the lower lumbar spine without significant compromise to spinal canal or neural foramina.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for disc herniation, spinal stenosis to account for right hip pain. Signs and symptoms: Right hip pain, inability to walk Pre and post enhanced lumbar MRI:Realignment of vertebral column is anatomical.Signal intensity of vertebral column is unremarkable other than changes related to degenerative disease.T12-L1 is unremarkable.L1-L2 is unremarkable. Incidental note is made of a large fluid signal intensity lesion along the superior right kidney consistent with a renal cyst without evidence of hemorrhage which measures approximately 50 x 40 mm in transaxial dimensions. A smaller second cyst on the right measures at 24 x 22 mm. Both cysts were present on prior exam from 2012 and the smaller cyst appears slightly decreased in size since prior exam.L2-L3 demonstrate mild disc and facet/ligamentum flavum hypertrophy without spinal stenosis or neural foraminal compromise.L3-L4 demonstrate advanced disc disease and loss of disc height, shadow broad-based disc-osteophyte, moderate to severe bilateral ligamentum flavum hypertrophy and mild facet disease.. Mild central spinal stenosis and moderate bilateral neural foraminal compromise is detected. Interval progression of degenerative changes since prior exam.L4-L5 demonstrate moderate disc disease and loss of disc height, significant left facet and mild right facet hypertrophic changes and significant bilateral ligamentum flavum hypertrophy. Constellation of changes results in mild central spinal stenosis and moderate bilateral neural foraminal compromise. There is progression of degenerative changes since prior exam.L5-S1 demonstrate advanced disc disease and loss of disc height, significant bilateral ligamentum flavum hypertrophy and moderate facet degenerative changes. There is a broad based disc/osteophyte on the left which in combination with facet hypertrophy results in significant left lateral recess and moderate left neural foraminal compromise. Post enhanced images demonstrate expected subtle enhancement of hypertrophic changes of the ligamentum flavum and superior endplate of L5 and unremarkable otherwise.

Output: 1.There is interval progression of degenerative changes of lumbar spine primarily in the lower lumbar levels as detailed.2.Mild Central spinal stenosis at L3-L4 and L4-L5 levels are noted.3.Broad-based disc-osteophyte on the left at L5-S1 level results in significant left lateral recess and moderate left neural foraminal compromise without central spinal stenosis.4.Post enhanced images demonstrate expected mild enhancement, hypertrophic changes and unremarkable otherwise.


Instruction: Generate impression based on findings.

Input: Small cell lung cancer. Screening for IRB 15-1384. There is an inferior left cerebellar hemisphere enhancing lesion that measures up to 9 mm, an enhancing right superior cerebellar hemisphere lesion that measures up to 5 mm, and a left occipital lobe enhancing lesion that measures up to 3 mm. There is a mild degree of surrounding high T2 signal associated with these lesions. There is no evidence of intracranial hemorrhage or acute infarct. There is mild diffuse bilateral predominantly periventricular white matter T2 hyperintensity. There is diffuse susceptibility effect within the bilateral basal ganglia, which likely represents mineralization. There is no abnormal intracranial enhancement. There is mild diffuse cerebral volume loss. There is no midline shift or herniation. There is a 7 mm diameter leftward outpouching along the anterior communicating artery. There are multiple enhancing lesions within the skull and imaged portions of the cervical spine. The scalp soft tissues are grossly unremarkable. There are right maxillary sinus retention cysts. There are bilateral lens implants.

Output: 1. Subcentimeter supratentorial and infratentorial metastases with mild vasogenic edema, but no acute hemorrhage.2. Multiple osseous metastases.3. An anterior communicating artery aneurysm measures 7 mm in diameter.


Instruction: Generate impression based on findings.

Input: Reason: eval cuff History: shoulder pain ROTATOR CUFF: Complete tear of the supraspinatus tendon with retraction to the glenohumeral joint. Relatively mild fatty atrophy of the supraspinatus muscle. This tear extends posteriorly to involve majority of the infraspinatus tendon which is similarly retracted, with a small portion of the posterior infraspinatus tendon that appears to extend to its insertion at greater tuberosity. Mild to moderate fatty atrophy of the infraspinatus muscle. Teres minor tendon and muscle are intact. Thickening and increased signal intensity of the inferior fibers of the subscapularis indicating tendinosis. Near full thickness to full thickness disruption of the superior subscapularis fibers at their insertion. Superficial fibers may extend across the bicipital groove. Fatty infiltration along the myotendinous junction of the subscapularis. SUPRASPINATUS OUTLET: Moderate osteoarthritis of the AC joint, with small ossicles along the anterior acromion that may represent multipartite os acromiale. Small amount of fluid in the subacromial bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Humeral head is high riding, but otherwise glenohumeral joint alignment is within normal limits. Thinning of the glenohumeral joint cartilage indicating mild osteoarthritis. Small amount of fluid in the glenohumeral joint is present. Increased signal intensity in the superior labrum likely representing degeneration.BICEPS TENDON: Thickening and increased signal of the tendon of the long head of the biceps with the rotator interval indicating severe tendinosis and degenerative tearing. Small amount of fluid in the biceps tendon sheath.

Output: Rotator cuff tears and other findings as described above.


Instruction: Generate impression based on findings.

Input: 33-year-old male with left knee pain. Minimal degenerative changes affect the patellofemoral compartment as described on recent MRI.

Output: Minimal osteoarthritis affects the knee.


Instruction: Generate impression based on findings.

Input: Left shoulder pain ROTATOR CUFF: There is mildly increased signal intensity within the supraspinatus tendon reflecting mild tendinosis with perhaps mild bursal surface fraying of the posterior fibers. However, there is no discrete fluid-filled gap to indicate full-thickness tear. A degenerative cyst is noted in the greater tuberosity at the insertion of the supraspinatus tendon. The tendinosis and fraying extends posteriorly to involve the anterior fibers of the infraspinatus tendon but there is no discrete fluid-filled rotator cuff tear. There is mild fatty atrophy of the supraspinatus and infraspinatus musculature. A dumbbell-shaped lipoma is situated between the supraspinatus and infraspinatus muscles at the level of the glenohumeral joint and measures 3 x 2 x 3.5 cm. The teres minor and subscapularis tendons and muscles are intact.SUPRASPINATUS OUTLET: There is mild osteoarthritis of the acromioclavicular joint. A trace amount of fluid is noted in the subacromial subdeltoid bursa which is of doubtful clinical significance.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is mild osteoarthritis of the glenohumeral joint with cartilage thinning and subchondral cysts evident within the glenoid. The glenohumeral alignment is normal. There is no joint effusion. There is slight blunting of the superior labrum which may be degenerative in nature but there is no fluid-filled tear identified.BICEPS TENDON: No significant abnormality noted.

Output: 1. Mild osteoarthritis of the glenohumeral and acromioclavicular joints.2. Mild tendinosis and possible bursal fraying of the rotator cuff without discrete full-thickness tear.3. Other findings as detailed above.


Instruction: Generate impression based on findings.

Input: Evaluate ventriculoperitoneal shunt. Nonenhanced head CT:Examination demonstrates a right-sided ventricular catheter entering from the right paramedian high convexity frontal lobe, traversing the right frontal lobe, entering the dilated right frontal horn, traversing the midline and the tip in the left dilated frontal horn. The position of the shunt has not change since prior head CT.Dilated supratentorial ventricular system is again noted. Compared to prior MRI and head CT no definitive appreciable interval change.Periventricular low-attenuation white matter a similar to increased signal intensity noted on prior MRI.No evidence of intracranial hemorrhage, edema or midline shift.

Output: 1.Dilated supratentorial ventricular system with no appreciable interval change since prior exam.2.No change in position of right-sided ventricular catheter.3.No evidence of any new acute intracranial findings.


Instruction: Generate impression based on findings.

Input: Rule out cord compression. Lower back pain, lower extremity weakness. Multiple small foci of osseous metastatic disease are better appreciated on dedicated complete spine study with contrast. A previously described 10 x 9 mm (AP x craniocaudal) lesion involving the right posterior superior aspect of the T11 vertebral body demonstrates slight enlargement now measuring 15 x 12 mm. Small spinous process lesions involving T5 and T12 are again seen. There is a metastatic lesion involving the sacrum at the right S2 level with epidural extension which is partially imaged and was present previously. No new large infiltrating lesions or obvious epidural tumor is appreciated in the cervical, thoracic, or lumbar spine. No evidence of pathologic compression fractures. No obvious cord signal abnormality within the limits of the study. Alignment is also not significantly changed.Multilevel degenerative changes with mild to moderate spinal canal stenosis in the cervical spine at the C5-C6 and C6-C7 levels again seen. Multilevel degenerative changes in the lumbar spine including moderate spinal canal stenosis at the L4-L5 level is also again seen. These findings are better assessed on prior complete spine study.

Output: 1. Limited sequences of the spine were obtained per acute cord compression protocol. No findings to suggest acute cord compression in the cervical, thoracic, or lumbar spine. Sacral lesion with epidural extension is partially imaged.2. Multiple small metastatic lesions in the spine are also again seen and better assessed on prior dedicated complete spine MRI from 3/4/2016. There is evidence of slight interval enlargement of a relatively small T11 vertebral body lesion. 3. Degenerative changes including mild to moderate stenosis in the cervical spine and moderate spinal canal stenosis at the L4-L5 level are also again seen. 4. Note due to the screening nature of this protocol details are not as evident on imaging as dedicated protocols of the spine.


Instruction: Generate impression based on findings.

Input: 53 year-old female with strong family history of breast cancer There is scattered fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.There are multiple cysts, some of which show thin rim enhancement, in both breasts.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: NS - Routine Screening Mammogram.


Instruction: Generate impression based on findings.

Input: Clinical question: Cervical stenosis? Signs and symptoms: Bilateral (R>L) shoulder pain, work injury. No unenhanced cervical MRI:Examination demonstrates no detectable post traumatic changes of the cervical spine and including soft tissues.The signal intensity of vertebral column demonstrates some changes secondary to degenerative disease.The alignment of cervical spine is anatomical.Foramen magnum is unremarkable.C2-C3 is unremarkable.C3-C4 demonstrate mild to moderate degenerative disc disease and loss of disc height, bilateral (L>R) uncovertebral hypertrophy and without appreciable facet or ligamentum flavum hypertrophy. Findings results in mild right and moderate left neural foraminal compromise without spinal stenosis.C4-C5 demonstrate mild to moderate disc disease and loss of disc height, bilateral uncovertebral hypertrophic changes without appreciable facet or ligamentum flavum degenerative/hypertrophic findings. Constellation of above findings results in mild central spinal stenosis, moderate right neural foraminal compromise.C5-C6 demonstrate mild to moderate disc disease and loss of disc height, bilateral uncovertebral hypertrophic spurs and no significant facet or ligamentum flavum hypertrophy. There is resultant mild central spinal stenosis, moderate right and severe left neural foraminal compromise.C6-C7 demonstrate mild disc disease and loss of disc height bilateral uncovertebral hypertrophic spurs and no significant degenerative changes of posterior elements (facets/ligamentum flavum). There is resultant moderate to severe bilateral (L>R) neural foraminal compromise.C7-T1 demonstrate mild degenerative changes without spinal canal and mild left neural foraminal compromise.The signal intensity and caliber of the cervical and upper most visualized thoracic cord is within normal.

Output: 1.Degenerative changes of the cervical spine primarily involving the disks with bilateral uncovertebral hypertrophic spurs without significant degenerative or hypertrophic changes of posterior elements.2.Above degenerative changes are detected at C3-C4 through C6-C7 levels with resultant bilateral (L>R) neural foraminal compromise of varying degrees at these levels.3.Mild central spinal stenosis also present at C3-C4 through C5-C6 levels however more conspicuous at C4-C5 level.4.There is normal signal intensity and caliber of the cervical and uppermost visualized thoracic cord.5.There is no evidence of posttraumatic findings.


Instruction: Generate impression based on findings.

Input: 53-year-old man with history of prostate cancer. PELVIS:PROSTATE:Prostate Size: The prostate measures 45 x 34 mm.Peripheral Zone: UnremarkableCentral Gland: Within the left anterior mid/apical prostate (series 501, image 62; series 604, image 224) there is an area of T2 hypointensity and diffusion restriction which measures 13 x 12 mm. This area enhances early and washes out on the dynamic contrast sequences. The remainder of the transition zone is unremarkable. This focus has not significantly changed compare to previous MRI. Seminal Vesicles: The seminal vesicles appear normal.Extracapsular Extension: There is no evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant lymphadenopathy noted.BONES, SOFT TISSUES: There is a fat-containing right inguinal hernia.OTHER: No significant abnormality noted.

Output: Area of abnormal signal in the left anterior mid/apical prostate suspicious for adenocarcinoma.


Instruction: Generate impression based on findings.

Input: 65-year-old female with history of CVA in 5/07 is presents with altered male mental status and decreased LOC x 3 days. There is no evidence of intracranial hemorrhage, mass or edema. Well-defined hypodensity within the left temporal and biparietal regions consistent with chronic ischemia, unchanged from the previous examination. Multiple areas of diffuse hypodensity in a periventricular and subcortical white matter distribution consistent with small vessel ischemic disease, age. indeterminate. If there is clinical concern for acute ischemia, an MRI may be considered.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Stable chronic ischemic changes. If there is clinical concern for acute ischemia, an MRI may be considered.


Instruction: Generate impression based on findings.

Input: 48 year-old female anterior thigh numbness 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.Mild degenerative changes are seen, 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: There is disk desiccation and mild height loss. No spinal canal or neural foraminal stenosis.L4-L5: There is mild disk bulge and mild facet arthropathy with resultant mild narrowing of the bilateral neural foramina, relatively worse on the right. Small dorsal annular fissure. No spinal canal stenosis. L5-S1: No significant disc disease. No spinal canal or neural foraminal stenosis. Mild bilateral facet arthropathy.Paraspinous soft tissues are within normal limits.

Output: Mild degenerative changes in the lumbar spine with mild neural foraminal narrowing bilaterally at L4-L5 related to mild disk bulge and facet arthropathy. Otherwise no significant spinal canal or neural foramina stenosis is seen in the lumbar spine.


Instruction: Generate impression based on findings.

Input: Reason: eval enlarging mass over greater troch History: s/p excision of DFSP, reconstruction with V-Y advancement perforator flap 11/17/14 with enlarging mass over left hip There are surgical changes related to excision of the patient's dermatofibrosarcoma protuberans and soft tissue flap reconstruction. We see no enhancing mass overlying the greater trochanter to indicate tumor recurrence. Slightly amorphous and linear signal abnormality in the overlying subcutaneous fat may represent surgical scarring. The signal intensity of the musculature is within normal limits. Bone marrow signal intensity is normal. There are a few inguinal lymph nodes, several of which have increased in size slightly when compared with the CT scan from 2/9/2016 but the clinical significance of this is uncertain. There is mild degenerative disc disease at L4-5.

Output: Surgical changes of dermatofibrosarcoma protuberans excision and soft tissue flap reconstruction involving the lateral aspect of the upper left thigh. We see no imaging features of tumor recurrence. Several inguinal lymph nodes appear to have increased slightly when compared with the recent CT scan but the clinical significance of this is uncertain.


Instruction: Generate impression based on findings.

Input: PTLD and headache. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is unchanged mild scattered nonspecific cerebral white matter T2 hyperintensity. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There are bilateral lens implants.

Output: No evidence of intracranial post-transplant lymphoproliferative disorder or lymphoma.


Instruction: Generate impression based on findings.

Input: Gangliocytoma / ganglioglioma, WHO grade I, 3 month follow up. There are post-biopsy findings in the left temporal lobe with linear susceptibility effect that extends to the mildly expansile, infiltrative, T2 hyperintense tumor centered in the medial left temporal lobe, with slight extension into the posterior limb of the left internal capsule. The mass displays diffuse intrinsic T1 hyperintensity, but there is also minimal superimposed patchy enhancement in portions of the mass. The tumor measures up to approximately 40 mm in size, which is not significantly changed. There is no evidence of acute intracranial hemorrhage or acute infarct. 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 unchanged.

Output: No evidence of progression of the tumor centered in the medial left temporal lobe.


Instruction: Generate impression based on findings.

Input: History of grade 1 left breast IDC, status post lumpectomy and radiation therapy. BRCA carrier. There is heterogeneous amount of fibroglandular tissue in both breasts.Minimal parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. Post operative distortion and volume loss are noted in the left upper outer breast.No abnormal lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. Given her personal and genetic history, annual mammography and MRI follow up are both recommended. BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: 51 years Male (DOB:8/22/1964)Reason: eval for cord compression, History: hx of compression, recent cervical surgery, past hx of lumbar spinal hematomaPROVIDER/ATTENDING NAME: DAVID HOWES DAVID HOWES The patient is status post cervical spine surgery with multilevel laminectomies at C4, C5 and C6. There is signal hyperintensity on T2 imaging within the cervical spinal cord at the C4 level. This was present on the 1/28/2016 exam. There are signal changes within the soft tissues behind the thecal sac at the surgical site.There are degenerative changes present in the lower lumbar spine without spinal stenosis.The vertebral bodies are appropriate in the overall alignment and height. The spinal cord has normal signal characteristics and overall morphology. There is no compromise of the spinal cord.

Output: 1.This is a limited exam specific for the exclusion of cord compression only and does not exclude more subtle lesions such as intrinsic cord abnormalities. No cord compression is identified.2.Due to the screening nature of this protocol details are not as evident on imaging as dedicated protocols of the spine.3.There is cord signal change present at the C4 vertebral body level. This is not adequately evaluated on this exam. It was present on the preoperative exam from 1/28/2016.4.There are degenerative changes present in the lower lumbar spine. Please refer to MRI from 1/28/2016 for further comments


Instruction: Generate impression based on findings.

Input: 24 year old male. Hypogonadism. Evaluate for anatomical location of the left and right testes as well as prostate. PELVIS:PROSTATE/SEMINAL VESICLES: Prostate gland is in its anatomical location and is unremarkable. The right seminal vesicle is unremarkable. The left seminal vesicle is not visualized, presumably absent.BLADDER: No significant abnormality noted.LYMPH NODES: Scattered prominent inguinal lymph nodes, unchanged.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: The testes are not identified within the inguinal canals or lower pelvis.

Output: 1.Anatomic location of the prostate gland.2.Testes are not identified within the lower pelvis or scrotum. Attempt was made to image the abdomen for localization of the testicles; however, patient could not continue with imaging due to claustrophobia. Patient will be recalled for images of the abdomen at no additional charge.


Instruction: Generate impression based on findings.

Input: Unresectable pancreatic cancer status post chemotherapy with increasing alkaline phosphatase, transaminases and bilirubin, evaluate for biliary obstruction ABDOMEN: The vasculature is not evaluated due to lack of intravenous contrast.LIVER, BILIARY TRACT: Marked increase in both intra and extrahepatic biliary ductal dilation with the common bile duct measuring 1.8 cm in maximal diameter (series 10, image 21), previously approximately 1.2 cm on the comparison CT. SPLEEN: No significant abnormality noted.PANCREAS: Ill-defined pancreatic head mass measures 2.7 x 2.0 cm (series 9, image 16). Marked dilation of the pancreatic duct measuring up to 1.3 cm in diameter (series 9, image 14). Atrophy of the distal pancreas.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Clonic diverticulosis.BONES, SOFT TISSUES: No significant abnormality noted.

Output: Increasing intra and extrahepatic biliary ductal dilation secondary to obstructive pancreatic head mass.


Instruction: Generate impression based on findings.

Input: 48-year-old female with left heel pain and swelling for 2 weeks. Assess for possible stress fracture. The flexor and and extensor tendons appear intact. The peroneal tendons appear intact.There is slight thickening of the anterior talofibular ligament, which may represent an old sprain. The calcaneofibular ligament appears intact. The posterior talofibular ligament appears intact. There is thickening of the anterior tibiofibular ligament likely indicating prior injury. The posterior tibiofibular ligament appears intact. The visualized components of the deltoid ligament appear intact.There is thickening and mild increased signal intensity of the plantar fascia at its attachment to the calcaneus suggesting plantar fasciitis. There is edema type signal abnormality within the surrounding soft tissues. There is a small plantar calcaneal spur with mild edema within the spur and adjacent marrow, likely reactive in etiology, but we see no fracture line. There is a trace amount of fluid within the ankle joint but no frank effusion is evident. There is an oblique band of abnormal signal intensity partially traversing the distal fibula indicating the residua of a chronic fracture. There is bony bridging both medially and laterally along the fracture. There is a small focus of edema type signal abnormality within the body of the talus along the posterior facet which may be degenerative in etiology, but this does not have the appearance of a stress fracture. There are small cysts within the anterior aspect of the tibial plafond suggesting minimal osteoarthritis.

Output: 1. Plantar fasciitis.2. Chronic fibular fracture and mild osteoarthritic changes as described above, without findings to suggest a stress fracture.