Instruction: Generate impression based on findings.

Input: 53-year-old male patient with ongoing diarrhea and history of bladder cancer status post orthotopic neobladder construction with possible fistula between small bowel and bladder. ABDOMEN:LIVER, BILIARY TRACT: Subcentimeter T2 hyperintense focus in the right hepatic lobe likely represents a cyst. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Post-surgical changes of a cystoprostatectomy with neobladder formation. There is a right extrarenal pelvis and mild interval increase in right calyceal dilatation. Furthermore, there is focal signal void within the distal right ureter measuring 5 mm, which could represent a stone (image 20, series 8). The left renal collecting system appears unchanged. 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.Mild interval increase in right calyceal dilatation with probable distal right ureteral calculus.2.No specific MR evidence of a bladder to small bowel fistula. Findings text-paged to pager 6386 prior to dictation.


Instruction: Generate impression based on findings.

Input: Seizures. There is a porencephalic cyst that measures up to 9 cm associated with considerable tissue deficiency of the right cerebral hemisphere, such portions of the frontal lobe measure less than 1 mm in thickness, but with relative sparing of the temporal lobe, although there is extension of the porencephalic cyst into the temporal horn, where there are two more discrete compartments that measure 1.0 cm and 1.5 cm in diameter. There is absence of at least a portion of the septum pellucidum. The posterior fossa structures and left cerebral hemisphere are relatively intact, with mild deformity in response to the right cerebral hemisphere abnormality. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Extensive right cerebral hemisphere volume loss associated with porencephalic cyst formation.


Instruction: Generate impression based on findings.

Input: MRI brain: There is about 10 mm inferior descent of the right cerebellar tonsil below the foramen magnum consistent with a Chiari I malformation.The ventricles and sulci are within normal limits. The cisterns remain patent. There is no midline shift or mass effect. There are no areas of abnormal signal or pathological enhancement. There is no diffusion abnormality. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. MRI cervical spine:There is a cervical syrinx which begins at the level of the C1 vertebra extending down up to mid C3 level. The syrinx occupies nearly the entire diameter of the cervical cord, measuring about 10 x 8mm in maximum axial dimensions when measured at the lower C2 vertebral body level. In the CC dimension, the syrinx extends up to 13 mm. There is no abnormal enhancement in the cervical spinal cord. There is normal biphasic CSF flow through the anterior foramen magnum, and diminished flow posteriorly.The cervical spine is in normal alignment, with a normal cervical lordosis. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal. There is no pathological enhancement.The intervertebral discs are preserved. No significant spinal canal or foraminal stenosis is seen. The paraspinal soft tissue structures are unremarkable.

Output: 1. Findings compatible with Chiari I malformation. Otherwise, MRI of the brain is unremarkable.2. Syringohydromyelia involving the upper cervical cord extending from C1 to mid C3 vertebral body as described.


Instruction: Generate impression based on findings.

Input: There tubular filling defect within the right transverse sinus which shows high signal intensity on T2, low signal intensity on T1, but best seen on postcontrast T1 coronal scan. The length was measured about 22mm and is connected to globular inferoposterior outpouching lesion from the dural sinus which may indicate involvement within arachnoid granulation. The signal characteristics of the lesion is likely represent chronic intra luminal thrombus. There is no evidence of redirection of venous flow or MR evidence of venous congestive encephalopathy.  Several punctate scattered high signal intensity foci on FLAIR on bilateral periventricular white matter indicate non specific small vessel disease. There is no evidence of acute ischemic or hemorrhagic lesion on this scan.Cerebellar sulci appear to be slightly more prominent comparing to those of cerebrum, but not that significant. The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.About 12.9mm sized left frontal epidermal inclusion cyst.

Output: 1. Chronic right transverse sinus intraluminal thrombus which extends toward adjacent arachnoid granulation without showing evidence of redirection of normal craniofugal flow nor evidence of venous congestive encephalopathy. 2. No evidence of acute ischemic or hemorrhagic lesion.3. Minimal non specific small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: 97-year-old male with neck pain, new onset.? Mass exam. Also with weight loss. Evaluate for mass,? Malignancy Enhanced CT of soft tissues of neck:Images through the skull base, cavernous sinuses, orbits, paranasal sinuses and petrous bones are unremarkable.There is no evidence of a mass or pathologic adenopathy in the neck. Multiple small nonenhancing, non-necrotic and nonpathologic by CT size criteria lymph nodes are noted on the right side of neck and to a lesser degree on the left. The largest of these nodes measures 12 mm x 9.8-mm in the right neck at the level of right thyroid lobe (axial image 71). The vasculature of the neck is intact. No evidence of erosive bony or cartilaginous lesions. He limited images of the apices of the lungs are unremarkable.Extensive degenerative changes of the cervical spine with slight reversal of cervical lordosis is noted. Degenerative changes are more pronounced at C5 -- C6 level. There is multi-level neural foramina compromise at C2 -- C3 on the right, C3 -- C4 bilaterally, C4 -- C5 bilaterally, C5 -- C6 bilaterally (most severe) and C6 and C7 levels. There is also highly suspected central spinal stenosis at multiple levels which can be further evaluated with a dedicated MRI of the cervical spine. CT examination is insensitive to detect central spinal stenosis due to soft tissue hypertrophic changes (disk material or hypertrophic soft tissue changes of the ligaments).80 CC of Omnipaque 350 was utilized for the above study.

Output: 1.No evidence of a mass in the soft tissues of the neck.2.Multiple small nonenhancing, non-necrotic and nonpathologic by CT size criteria lymph nodes as detailed above.3.Extensive degenerative changes of cervical spine with multilevel bilateral neural foramina compromise and highly suspected central spinal stenosis. Further evaluation with an MRI is recommended considering patient's provided clinical data of neck pain.


Instruction: Generate impression based on findings.

Input: 30-year-old female with peritoneal mesothelioma status post CRS HIPEC ABDOMEN:LIVER, BILIARY TRACT: Previously referenced subcapsular T2 hyperintense cystic lesion is unchanged measuring 1.7 x 0.7 cm without associated restricted diffusion or enhancement. No new focal liver lesion is evident. No intrahepatic or extrahepatic biliary ductal dilatation. Focal bulge in the right hepatic dome is unchanged.SPLEEN: No significant abnormality noted.PANCREAS: Soft tissue focus at the pancreatic tail with signal intensity matching splenic tissue on all sequences is compatible with a benign intrahepatic accessory spleen, unchanged.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Numerous mildly prominent periportal and caval lymph nodes are noted, unchanged. Additional scattered subcentimeter mesenteric lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: The uterus is absent or atrophic.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No significant change in the segment 6 benign appearing hepatic cyst. No new lesion is identified.2.The uterus is absent or atrophic. Correlate clinically.


Instruction: Generate impression based on findings.

Input: 73 year-old female status post left lumpectomy and radiation therapy in 2006. Left breast reconstruction. No current breast related complaints. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD, 8.3. The breast parenchyma is composed of scattered fibroglandular elements, unchanged in pattern and distribution. A linear opaque marker overlies a scar on the left breast at the 6 o'clock position. Stable postsurgical architectural distortion of the left breast present. Benign dystrophic calcifications in the left breast again noted. ATEC clip within the central left breast from 2006 MRI guided biopsy unchanged. No dominant mass, suspicious microcalcifications or new areas of architectural distortion in either breast. Surgical clips project over left axillary region

Output: No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are no areas of abnormal parenchymal signal. 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 unremarkable. The midline structures and craniocervical junction are within normal limits.

Output: Unremarkable brain MRI.


Instruction: Generate impression based on findings.

Input: Right wrist pain. Evaluate for carpal ligament injury. There is widening of the scapholunate interval with contrast extension consistent with scapholunate ligament disruption. The triangular fibrocartilage complex is intact, without contrast extension into the distal radioulnar joint. No fracture or bone marrow edema is noted. A small subcentimeter cyst is noted in the triquetrum.

Output: Findings compatible with scapholunate disassociation and ligamentous tear.


Instruction: Generate impression based on findings.

Input: Elevated PSA. 3/12/2014 negative biopsy. PELVIS:PROSTATE:Prostate Size: 2.4 x 4.7 x 5.0 cmPeripheral Zone: The peripheral zone is homogeneously T2 weighted hyperintense without a discrete focal lesion.Central Gland: Minimal changes of BPH.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: No evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: Nonspecific enhancing focus anterior to the right femoral neck measuring 1.3 cm. It cannot be further characterized due to small field-of-view images.OTHER: No significant abnormality noted.

Output: No focal suspicious lesion is identified.Non-specific enhancing 1.3 cm focus anterior to the right femoral neck may represent a focal synovitis; correlate with symptoms and consider dedicated imaging as clinically warranted.


Instruction: Generate impression based on findings.

Input: A 19 year old female with an atrial septal defect which was percutaneously closed on 2009 who was referred to cardiac MRI for evaluation of a residual defect after symptoms of shortness of breath and chest pain. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 55%, the LV end diastolic volume index is 71 ml/m2 (normal range: 65+/-11), the LVEDV is 119 ml (normal range 109+/-23), the LV end systolic volume index is 32 ml/m2 (normal range 18+/-5), the LVESV is 54 ml (normal range 31+/-10), the LV mass index is 25 g/m2 (normal range 67+/-11), and the LV mass is 43 g (normal range 114+/-24). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.No intracardiac thrombus.Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 53%, the RV end diastolic volume index is 70 ml/m2 (normal range 69+/-14), the RVEDV is 117 ml (normal range 110+/-24), the RV end systolic volume index is 33 ml/m2 (normal range 22+/-8), and the RVESV is 55 ml (normal range 35+/-13). AtriumsThe left atrium is normal in size. The LA volume is 51 ml.The right atrium is normal in size. The Qp:Qs ratio is normal (0.93). By recent transthoracic echocardiogram (TTE) with agitated saline, bubbles were noted to cross the interatrial septum, left to right. There is minimal high signal on both sides of the interatrial septum, close to the metallic closure device, upon dedicated first pass imaging with saturation. While this may be artifactual, in the presence of previous documented bubbles crossing the septum on TTE, trace flow around or adjacent to the device may be considered. Identification of such small potential flow may be limited by spacial resolution of MRI. Of note, no moderate or large partial anomalous right superior pulmonary vein was identified ( which can be present in the setting of superior sinus venosus atrial septal defect).Aortic ValveThe aortic valve is trileaflet, 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 pulmonic regurgitation, estimated to be trace. Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no pericardial effusion.

Output: 1. The left ventricle is normal in size with normal systolic function, the LVEF is 55%. There are no regional wall motion abnormalities present. 2. The right ventricle is normal in size with normal systolic function, the RVEF is 53%. 3. The left atrium is normal in size (LA volume is 51 ml). An ASD closure device (Helix device) occupies the inter-atrial septum at expected location for valve of fossa ovalis. The Qp:Qs ratio is 0.93; no significant shunt is present. Further details are reviewed, above.4. The right atrium is normal in size.  I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: There is a 25 x 19 x 28 mm peripherally enhancing lesion centered in the left anterior basal ganglia involving the caudate head, anterior limb of the internal capsule, and anterior putamen. There is mild local mass effect and mild vasogenic edema in the surrounding white matter. No additional abnormal foci of enhancement are identified. There is no significant midline shift. There is normal enhancement of the major intracranial vascular structures.

Output: Examination limited to sequences for operative planning demonstrates a peripherally enhancing mass centered in the left anterior basal ganglia with mild surrounding edema.


Instruction: Generate impression based on findings.

Input: anoxic brain injury, posterior circulation stroke, unresponsive There is no evidence of acute ischemic or hemorrhagic lesion on this scan.FLAIR images show patchy bilateral high signal intensity lesion on periventricular white matter indicating non specific small vessel disease. Gradient echo images show various sized susceptibility lesions on bilateral hemispheres white matter. Differential diagnosis include amyloid angiopathy, small chronic hemorrhagic lesions, parenchymal calcifications or cavernomas less likely. The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. 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.3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal bilateral ICAs, MCAs and ACAs. Bilateral PCAs are fetal origin. Vertebrobasilar system appears to be normal. No aneurysm. No intracranial arterial luminal stenosis.3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. Bilateral vertebral artery origins are not shown but source image analysis revealed no significant luminal stenosis.

Output: 1. No evidence of acute ischemic stroke. No evidence of acute hemorrhagic lesion.2. Non specific small vessel ischemic disease.3. Multiple lesions on bilateral hemispheres demonstrating susceptibility artifacts, possibilities include amyloid angiopathy, multiple chronic hemorrhagic lesions, multiple calcifications or cavernomas less likely.4. No intracranial aneurysm. No intracranial arterial stenosis. Normal extracranial cervicocarotid arterial system.


Instruction: Generate impression based on findings.

Input: Provided history of prostate cancer. No pathology results available. PELVIS:PROSTATE:Prostate Size: 3.5 x 5.8 x 5.1 cmPeripheral Zone: There is diffuse T1 weighted hyperintensity in the peripheral zone compatible with hemorrhage/proteinaceous material likely related to prior biopsy. This severely limits evaluation of the peripheral zone.Central Gland: Changes of benign prostatic hyperplasia. In the left apex adjacent to the urethra there is a 1.1 x 0.8 cm focus of intermediate T2-weighted signal intensity (series 601/16) associated with restricted diffusion (series 803/304) and suspected early arterial enhancement (series 1501/1211).Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: No evidence of extracapsular extension.BLADDER: Partially distended urinary bladder with trabecular thickening may be seen in the setting of chronic bladder outlet obstruction.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No definite suspicious arterially enhancing bone lesion. The bone marrow has a mottled appearance.OTHER: No significant abnormality noted.

Output: 1.Left apex periurethral central gland 1.1 cm lesion may represent a site of prostatic adenocarcinoma.2.The study is significantly limited by intrinsic T1 weighted hyperintensity in the peripheral zone related to recent biopsy.3.Changes of BPH.4.Mottled bone marrow signal intensity without a definite arterial enhancing bone lesion.


Instruction: Generate impression based on findings.

Input: 76 years Female (DOB:10/7/1939)Reason: eval for nerve compression History: low back pain and bilateral leg numbness/paresthesiasPROVIDER/ATTENDING NAME: RODERICK H. BIRNIE RODERICK H. BIRNIE Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall height. The conus medullaris on sagittal imaging is grossly intact. There is a sigmoid curvature to the lumbar spine.At L5-S1 there is loss of disc space height this desiccation and mild anterior subluxation of L5 on S1 associated with moderate bilateral facet ligamentum flavum hypertrophy. There is mild anterior subluxation of L5 on S1. There is mild to moderate encroachment of exiting nerve roots due to disc bulging and facet hypertrophy at this level bilaterally. There is a diffuse disc bulge with extrusion at this level. Some disc material extends behind the inferior endplate of L5. There is some epidural lipomatosis posteriorly at this level. The spinal canal appears narrowed at this level appears to be spinal stenosis at this level.At L4-5 there is loss of disc space height and endplate reactive changes at this level associated with bilateral facet and ligamentum flavum hypertrophy as well as endplate osteophytes and a diffuse disc bulge. Disc material extrudes behind the inferior aspect of L4 and also into the neural foramina bilaterally at this level and encroaches on the exiting nerve roots. There is anterior subluxation of L4 on L5 present. There are endplate reactive changes at this level which are bright on T2 STIR.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: There are degenerative changes mainly in the lower lumbar spine associated with spinal stenosis at L5-S1 and encroachment of exiting nerve roots at L4-5 and L5-S1 bilaterally. There is associated mild anterior listhesis of L4 on L5 and L5 on S1. There is a element of epidural lipomatosis at L5-S1 which contributes to the spinal stenosis at this level.


Instruction: Generate impression based on findings.

Input: There are unchanged postoperative findings related to left parietal craniotomy for resection of a left frontal lobe mass with associated susceptibility effect in and adjacent to the resection cavity compatible with chronic blood products. There is a persistent extra-axial fluid collection subjacent to the craniotomy flap. There is unchanged confluent T2 hyperintensity without associated mass effect within the left frontal white matter, in the region of the treatment bed. However, there is no enhancement in the region of the resection cavity. There is no evidence of 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 and paranasal sinuses are unremarkable.

Output: Unchanged postoperative findings without evidence of tumor progression.


Instruction: Generate impression based on findings.

Input: Ms. Pharris submitted outside studies for review.Submitted for review are:-Bilateral mammogram dated 9/22/2016 performed at Northwestern Memorial Healthcare-Images from ultrasound-guided biopsy of the left breast including postprocedure mammogram dated 9/23/2016 performed at Northwestern Memorial Healthcare-Bilateral breast MRI dated 9/29/2016 performed at Northwestern Memorial HealthcareFor comparison,screening mammogram dated 4/3/2014 and bilateral breast ultrasound dated 4/17/2014 are available. BILATERAL MAMMOGRAM:Bilateral CC and MLO views; LM, 1 spot compression, and 2 spot magnification views of the left breast were submitted for review.The breast parenchyma is extremely dense, which limits the sensitivity of mammography. There is a BB marker overlying the upper outer quadrant of the left breast, indicating the site of a palpable abnormality. There are no specific mammographic findings in the area of the BB marker. There are linear and linear branching calcifications in the lower slightly outer left breast at mid-posterior depth, spanning approximately 2.9 cm in greatest AP dimension. Outside paperwork notes that the patient identified a different site of concern than indicated by the BB during a subsequent ultrasound (those images are not available--reported size on ultrasound was up to 2.9 cm). No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in the right breast. Benign appearing lymph nodes are projected over both axillae.ULTRASOUND GUIDED BIOPSY, LEFT BREAST:Static images from ultrasound-guided biopsy of the left breast were submitted with postprocedure CC and LM views of the left breast.A hypoechoic mass in the left breast, 4:00 position, 2 cm from the nipple was targeted for biopsy. Targeting appears appropriate. Postprocedure mammograms demonstrate a Twirl clip in the lower slightly outer left breast at posterior depth. There are residual calcifications around the clip.BILATERAL BREAST MRI:Multiple enhanced MR sequences are submitted per outside institution's protocol.There is extreme fibroglandular tissue. There is moderate background parenchymal enhancement.There is a vitamin E capsule overlying the lower outer left breast, denoting the site of biopsy. In the lower slightly outer left breast at posterior depth, there is a 2.3 x 3.3 x 3.1 cm irregular necrotic mass with thick rim enhancement, corresponding to biopsied malignancy. Biopsy clip is seen within the mass. This mass demonstrates areas of rapid initial enhancement and delayed phase washout. The mass directly abuts the pectoralis muscle with mild retraction of the muscle. No definite enhancement is seen within the pectoralis muscle. No other areas of abnormal enhancement in the left breast. Enhancement lateral to the mass probably relates to the recent biopsy. Increased T2 signal on STIR images suggests edema in the breast. No suspicious left axillary or internal mammary lymph nodes.In the central outer right breast, there is a 1.2 x 0.7 x 0.5 cm focal area of clumped nonmass enhancement that demonstrates medium initial enhancement and persistent delayed phase enhancement. This focal area of nonmass enhancement is adjacent to a cyst. No suspicious right axillary or internal mammary lymph nodes.OUTSIDE PATHOLOGY (per report):Left breast, 2.9 cm mass at 4:00 and 2 cm from the nipple, ultrasound core needle biopsy: Invasive ductal carcinoma, grade 3 of 3, with apocrine features and focal necrosis.

Output: 1. A 2.3 x 3.3 x 3.1 cm centrally necrotic mass in the lower outer left breast, corresponding to biopsy-proven malignancy. The mass abuts the pectoralis muscle with no definite evidence of invasion. Continued surgical management is recommended.2. Suspicious 1.2 x 0.7 x 0.5 cm focal area of clumped nonmass enhancement in the central outer right breast adjacent to a cyst. MR guided ultrasound is recommended. If a suspicious hypoechoic vascular area can be identified on ultrasound, then US guided biopsy could be performed. If this area is not seen on ultrasound, MR guided biopsy is recommended.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Reason: possible right lateral meniscal tear vs other internal derangement History: instability MENISCI: There is undulation of the free edge of the body of the medial meniscus likely representing meniscal flounce. There is no fluid-filled or unstable tear. There is minimal globular intrasubstance degeneration within the posterior horn of the medial meniscus. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: No full-thickness or near full-thickness articular cartilage defects are identified. There is heterogeneous bone marrow which likely represents residual islands of red marrow. There is a focus of low signal intensity within the proximal fibula likely representing a benign bone island.LIGAMENTS: The cruciate and collateral ligaments appear intact. There are lobulated foci of fluid signal intensity along the posterior aspect of the PCL which may reflect mucoid degeneration or ganglion formation.EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Mild intrasubstance degeneration of the medial meniscus without evidence of a meniscal tear.2. Tiny Baker's cyst.


Instruction: Generate impression based on findings.

Input: Ankle swelling TENDONS: No significant abnormality noted.LIGAMENTS: No significant abnormality noted.ARTICULAR SURFACES AND BONE: Moderate osteoarthritic changes affect the midfoot. ADDITIONAL

Output: No evidence of tendinous or ligamentous injury. Diffuse soft tissue swelling and fatty atrophy of the ankle musculature.


Instruction: Generate impression based on findings.

Input: Diagnosis: Backache, unspecified Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There is mild disk dessication present in the mid cervical spine.No abnormal enhancing lesions are appreciated in the cervical spine.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.MRI thoracic spine:The thoracic vertebral bodies are appropriate in the overall alignment and height. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots. No abnormal enhancing lesions are appreciated in the thoracic spine.There is a mild dextrocurvature to the thoracic spine present.

Output: 1.There is no significant compromise to the cervical or thoracic spine.2.There is a mild dextrocurvature to the thoracic spine.3.There is minor disk degeneration present in the cervical spine.


Instruction: Generate impression based on findings.

Input: Acinic cell carcinoma of the right parotid gland, metastatic to the skull base, status post treatment. There are postoperative findings related to right parotidectomy and mastoidectomy, which are partially imaged. There is no significant interval change in the extent of the ill-defined heterogeneously enhancing mass that involves the right basiocciput, petrous ridge, and condylar and squamous portions of the occipital bone. The central areas of non-enhancement within the mass likely represent necrosis and are not significantly changed. The mass still abuts the right internal carotid artery and encases the right internal jugular vein. There is also unchanged abnormal enhancement within the lateral mass of the C1 vertebra. There is fluid and enhancement within the right mastoid air cells. There is no evidence of intracranial hemorrhage or acute infarct. There is no mass effect upon the cerebellum or brainstem. There are a few nonspecific foci of T2 hyperintensity in the cerebral white matter. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The orbits are unremarkable. The remaining salivary glands are unremarkable.

Output: No significant interval change in the treated acinic cell carcinoma metastasis involving the right lateral skull base and craniocervical junction, perhaps superimposed upon osteonecrosis.


Instruction: Generate impression based on findings.

Input: Female, 15 years old, with low back pain for months, worse with extension. Alignment is anatomic. Vertebral body height and morphology are within normal limits. No evidence of marrow replacement or marrow edema is seen. Within the limitations of MRI, no evidence of a pars defect is seen.The visualized distal spinal cord, conus and nerve roots of the cauda equina are within normal limits. No epidural abnormalities are detected.The intervertebral discs are preserved. No bulging or herniation is seen. No significant compromise of the spinal canal or neural foramina is detected. Mild facet hypertrophy is seen at L5-S1.

Output: Mild facet hypertrophy is seen at L5-S1. Otherwise, the examination is unremarkable with no additional findings to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: Diagnosis: Slurred speechClinical question: vascular stenosisSigns and Symptoms: slurred speech, r side weakness MRI of the brainNo diffusion weighted abnormalities are appreciated.There is a 9 mm hypointense lesion on T2-weighted imaging with surrounding T2 and FLAIR signal hyperintensity and susceptibility effect which is centered in the left cerebellar hemisphere.There are multiple punctate foci of signal loss on susceptibility weighted imaging present in addition to the above described lesion. The lesion present in the hippocampi. There are multiple punctate foci of signal loss on susceptibility imaging located in the thalami bilaterally peduncle and in the basal ganglia bilaterally. There is a slitlike focus of susceptibility effect involving right basal ganglia. There are punctate foci of signal loss and susceptibility weighted imaging in the subcortical white matter as well involving the temporal lobes and left cingulate gyrus.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mucosal thickening in the left maxillary sinus associated with a smaller left maxillary sinus compared to the right maxillary sinus. Involution of the maxillary sinus could be related related to silent sinus syndrome. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits demonstrate medial deviation of the left lamina papyracea. This suggests an old medial orbital blowoutMRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is not readily. The left A1 segment is larger than the right A1 segment. There is fetal origin of the posterior cerebral arteries bilaterally. The right vertebral artery is small and effectively ends in the right posterior inferior cerebellar artery. There is extracranial origin of the left posterior inferior cerebellar artery. The vertebral arteries are similar in size.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries. The left common carotid artery originates from the innominate artery.

Output: 1.There is a hemorrhagic lesion present in the left cerebellar hemisphere. Underlying etiology is unclear. If clinically appropriate follow-up exam which may include postcontrast imaging may be of benefit to further evaluate this.2.There are multiple microhemorrhages present as detailed above. The pattern is suggestive - but not confirmatory - of microhemorrhages related to hypertension. 3.Findings suggest an old hemorrhage involving the right basal ganglia which is now in the chronic stage.4.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related. 5.Old left medial blowout fracture and findings suggestive of left silent sinus syndrome.


Instruction: Generate impression based on findings.

Input: 51-year-old male patient with history of kidney cancer with multiple renal lesions on prior imaging. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: There are multiple lesions within both kidneys that do not meet criteria for simple cysts demonstrating low T1 signal, low T2 signal, and restriction diffusion which are most compatible with multifocal renal cell carcinoma. Some lesions are subcentimeter in size and too small to characterize. Each kidney is as described below.Right Kidney: There are at least 14 lesions within the right kidney which are suspicious for renal cell carcinoma, many of which appear larger in size compared to the prior study. There has been increase in size of a dominant right posterior interpolar region kidney lesion, which demonstrates regions of T2 hyperintensity, and now measures approximately 2.7 cm in diameter, previously 1.8 cm. Left Kidney:There are at least 12 lesions within the left kidney which are suspicious for renal cell carcinoma, many of which appear larger in size compared to the prior study. The dominant lesion in the left posterior interpolar region has increased in size measuring 1.5 cm, previously 1.1 cm (image 128, series 16). RETROPERITONEUM, LYMPH NODES: There is aneurysmal dilatation of the distal abdominal aorta near the bifurcation measuring 4.3 cm in the transverse dimension. There is circumferential mural thrombus within the aortic aneurysm. BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Interval growth of multiple bilateral renal lesions which are most compatible with multifocal renal cell carcinoma.


Instruction: Generate impression based on findings.

Input: Reason: L knee meniscus tear History: L knee pain MENISCI: There is a branching linear signal abnormality within the posterior horn of the medial meniscus extending to both the tibial and femoral articular surfaces indicating a complex tear with both horizontal and vertical components predominantly involving the inner half of the posterior horn. Signal abnormality extending into the body of the medial meniscus suggests intrasubstance degeneration. The anterior horn appears normal. The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is mild degeneration of the articular cartilage of the patellofemoral joint with underlying small subchondral cyst formation. A small full-thickness low intensity focus is also seen in the articular cartilage of the trochlea with underlying cyst formation. There is mild degeneration of the articular cartilage of the medial tibiofemoral compartment with mild edema type signal in the medial tibial plateau, which is presumably degenerative.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Medial meniscal tear as described above.2. Mild osteoarthritis as described above.


Instruction: Generate impression based on findings.

Input: DNET- 6 month follow up for change. There are postoperative findings in the right temporal lobe. There is no significant interval change in the non-enhancing T2 hyperintense mass that measures 3.1 x 3.4 cm posterior to the resection cavity, predominantly situated in the superior temporal and Heschl gyri with extension into the temporal stem. There is no evidence of acute intracranial hemorrhage or acute infarct. The ventricles are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable. There is fluid signal within the bilateral mastoid air cells. There is also scattered paranasal sinus mucosal thickening.

Output: 1. No significant interval change in the residual tumor in the right temporal lobe.2. Findings suggestive of sinusitis and mastoiditis.


Instruction: Generate impression based on findings.

Input: Headache [R51] / Chronic migraine without aura, not intractable, without status migrainosus [G43.709], Reason for Study: ^Reason: please r/o structural abnormality History: headaches No evidence of acute ischemic or hemorrhagic lesion.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: Normal brain MRI


Instruction: Generate impression based on findings.

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

Output: The study is limited by motion, especially the post-contrast images, with possible mild enhancement in the right internal auditory canal, which may represent neurosarcoidosis involvement of the facial nerve versus artifact or prominent vessels. Follow up via dedicated internal auditory canal MRI may be useful. Apparent linear post-contrast high T1 signal along the right post-chiasmatic optic nerve may be artifactual versus another potential manifestation of neurosarcoidosis. Otherwise, not evidence of acute infarction or intracranial mass lesions.


Instruction: Generate impression based on findings.

Input: Prior Whipple for IPMN. Cystic lesion in pancreatic genu. Evaluate for stricture versus cyst. ABDOMEN:LIVER, BILIARY TRACT: Right hepatic lobe simple appearing cysts. No suspicious lesion. No intrahepatic biliary ductal dilatation. The vessels are patent.The common hepatic duct measures 6 mm, similar to prior.Trace perihepatic fluid adjacent to the anterior liver margin, not significantly changed.The hepatic vasculature is patent.SPLEEN: The spleen is normal in size measuring 11.9 cm in length without a focal lesion.PANCREAS: Postsurgical changes from Whipple procedure. There is loss of intrinsic T1 weighted signal intensity of the pancreas. The pancreas enhances homogeneously without a discrete lesion.No evidence of acute pancreatitis.The residual pancreatic body and tail is moderately atrophic with irregular main pancreatic ductal dilatation up to 7 mm to the level of the pancreaticojejunostomy anastomosis. There is side branch ectasia. The appearance is similar to that seen previously. No suspicious postcontrast enhancement.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral simple appearing cystsRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postsurgical changes from Roux-en-Y. Status post colectomy. BONES, SOFT TISSUES: Mid/lower thoracic vertebral body stable hemangiomata.OTHER: No significant abnormality noted.

Output: Relatively stable post Whipple surgical changes. Significant pancreatic ductal dilatation without a discrete mass lesion, appearing similar to prior. This may be related to an anastomotic stricture and less likely a main duct IPMN.


Instruction: Generate impression based on findings.

Input: Diagnosis: Dizziness and giddiness Unspecified abnormalities of gait and mobility Unspecified sensorineural hearing lossClinical question: Evaluate vesselsSigns and Symptoms: dizziness, imbalance, Right Asymmetrical SNHL MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. The posterior communicating arteries are not readily identified. There is triplication of the anterior cerebral artery. The right vertebral artery is hypoplastic intracranially.MRV brain:The dural venous sinuses are patent. Straight sinus, internal cerebral veins and basal veins are identified and appear patent. There is narrowing of the left transverse sinus at the junction with the sigmoid sinus. A 2-D time-of-flight MR venogram demonstrates significantly decreased signal from the left transverse sinus and sigmoid sinus relative to the right transverse sinus and sigmoid sinus. This could be a result of lower outflow. There are prior MRI of the brain imaging studies dating back to 5/5/2010 which indicate that asymmetry in the appearance of the transverse and sigmoid sinus has to some degree been present on prior exams.

Output: 1.No evidence for intracranial cerebrovascular occlusive disease.2.No evidence for intracranial aneurysm.3.There is narrowing at the junction of the left transverse and sigmoid sinuses which appears to impede venous outflow. It is possible that this is a result of an arachnoid granulation and may be long-standing to some degree.


Instruction: Generate impression based on findings.

Input: Clinical question: Assess for llH, rule out mass/tumor. Signs and symptoms: Headache that is worse with sneezing, bowel movement/stranding and razing arms above head. Pre-and post-enhanced brain MRI:Diffusion-weighted images are severely distorted due to metallic artifact likely from patient's braces. No gross areas of acute ischemic change.Examination demonstrates normal signal intensity and morphology of the cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination.The signal void of major intracranial arterial branches are identified.There is no evidence of abnormal parenchymal, leptomeningeal, calvarial or orbital enhancement.The signal intensity of intracranial venous sinuses is again normal and normal pattern of enhancement.Paranasal sinuses cannot be assessed due to significant metallic hardware artifact.

Output: Negative pre-and post enhanced brain MRI.


Instruction: Generate impression based on findings.

Input: 57-year-old female with right knee pain and possible meniscal injury. MENISCI: Fragmentation and increased T2 signal within the posterior horn of the medial meniscus is compatible with a complex tear that demonstrates both horizontal and vertical components. Increased T2 signal is also noted along the inferior aspect of the anterior horn of the lateral meniscus, suspicious for a vertical undersurface tear.ARTICULAR CARTILAGE AND BONE: Within the patellofemoral compartment, there is complete loss of articular cartilage along the medial facet as well as generalized thinning of articular cartilage along the lateral facet. Mild thinning of articular cartilage along the medial femoral condyle is also noted.Bone marrow edema is identified in the medial femoral condyle and medial tibial plateau, consistent with recent injury.LIGAMENTS: The cruciate and collateral ligaments are intact.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1.Complex tear of the posterior horn of the medial meniscus with adjacent bone marrow edema.2.Findings suspicious for vertical undersurface tear of the anterior horn of the lateral meniscus.3.Complete loss of articular cartilage along the medial facet of the patella.


Instruction: Generate impression based on findings.

Input: 53-year-old female status post sacral muscle flap reconstruction now presents with sacral pain. Evaluate for sacral osteomyelitis or abscess. Postsurgical changes and scar tissue are noted in the posterior pelvic soft tissues and anterior pelvic wall. Interspersed metallic fragments likely represent surgical clips. While these areas of scarring demonstrate peripheral enhancement on post-contrast images, there is no evidence of edema or abnormal enhancement within the bone marrow. Bone marrow signal is within normal limits on T1-weighted images. No focal fluid collection to suggest abscess formation.

Output: Postsurgical changes and scarring as described above without evidence of sacral osteomyelitis or abscess.


Instruction: Generate impression based on findings.

Input: Forgetting where he leaves personal items. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are a few scattered areas of high T2 signal in the cerebral white matter, particularly in the bilateral parietal periventricular regions. The hippocampi appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is prominence of the adenoids. There appears to be right optic nerve atrophy diffusely.

Output: 1. No evidence of acute intracranial hemorrhage, mass, or acute infarct. A few scattered areas of high T2 signal in the cerebral white matter, particularly in the bilateral parietal periventricular regions are nonspecific, but may represent chronic small vessel ischemia and/or prominent perivascular space.2. Nonspecific prominence of the adenoids, which may represent lymphoid hyperplasia, although other etiologies are possible. Endoscopy may be useful for further evaluation. 3. Apparent right optic nerve atrophy.


Instruction: Generate impression based on findings.

Input: History of Crohn's ileitis. Evaluate extent of disease. ABDOMEN:LIVER, BILIARY TRACT: Few punctate liver cysts. Liver is otherwise normal in morphology, size, and signal intensity. The patient is status post cholecystectomy. No biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The small bowel is relatively well distended with oral contrast. The terminal ileum is well seen. There is minimal enhancement and wall thickening of approximately 10 cm of the terminal ileum. Otherwise the ileum is normal within caliber, wall thickness and enhancement. No adjacent acute inflammatory changes. The remainder of the small bowel is normal in caliber, wall thickness and enhancement. Segments of the jejunum are suboptimally distended but otherwise unremarkable. The colon is also normal in appearance.No free or loculated fluid.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Status post hysterectomy.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Minimal enhancement and wall thickening of 10 cm of the terminal ileum suggestive of a mild active ileitis.


Instruction: Generate impression based on findings.

Input: 35-year-old male with left knee pain. Evaluate patellar tendon instability. MENISCI: The medial and lateral menisci are morphologically normal.ARTICULAR CARTILAGE AND BONE: Note is made of a patella alta with an Insall-Savlati ratio of 1.9. The patellar tendon is intact and morphologically normal. The articular cartilage of the patella at the mid to inferior pole is markedly irregular with areas of full-thickness defects/intermediate signal intensity in the cartilage extending to the subchondral bone surface (for example series 601, image 13). There is hypoplasia of the trochlear groove which is abnormally flattened. Tibial tubercle to trochlear groove distance measures 9 mm, within normal limits.The articular cartilage of the femoral condyles and proximal tibia are morphologically normal. Bone marrow signal intensity is normal. There is no significant fluid within the knee joint.LIGAMENTS: The cruciate and collateral ligaments are morphologically normal.EXTENSOR MECHANISM: The extensor mechanism is intact and morphologically normal.ADDITIONAL

Output: 1. Patella alta as well as hypoplasia and abnormal flattening of the femoral trochlear groove.2. Patellar articular cartilage degeneration with areas of full-thickness defects extending to the subchondral bone surface.


Instruction: Generate impression based on findings.

Input: Orbital fibrous dysplasia and headaches. There is expansion of the posterior left orbital roof up to 9 mm in thickness with low signal intensity and apparent narrowing of the orbital apex. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The paranasal sinuses and scalp soft tissues are unremarkable. There is fluid signal within the bilateral mastoid air cells.

Output: 1. Finding compatible with fibrous dysplasia involving the left orbital roof with low signal and apparent narrowing of the orbital apex. Dedicated orbital imaging may be useful for evaluating the condition of the optic nerve.2. Fluid signal within the bilateral mastoid air cells may represent mastoiditis.


Instruction: Generate impression based on findings.

Input: Cervical spondylosis without myelopathy Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal. There is a disc bulge present at this level associated with bilateral uncovertebral osteophytes and narrowing of the neural foramina bilaterally. Overall there is no significant compromise of the spinal cord. These findings were present on the prior exam and have not changed substantially.At C4-5 there is no significant compromise to the spinal canal. There are small uncovertebral osteophytes present at this level associated with disc material bilateral narrowing of the neural foramina and encroachment of the left exiting nerve roots. These findings were present on the prior exam and have not changed substantially.At C5-6 there is loss of disc space height, disc bulge, endplate and uncovertebral osteophytes as well as encroachment of the neural foramina bilaterally with encroachment of exiting nerve roots and effacement of spinal fluid ventricle and posterior to spinal cord. Overall there is moderate spinal stenosis at this level. These findings were present on the prior exam and have not changed substantially.At C6-7 there is loss of disc space height, and disc bulge and bilateral uncovertebral osteophytes as well as small endplate osteophytes and narrowing of the neural foramina bilaterally and encroachment of the exiting nerve roots bilaterally. There is a mild to moderate degree of spinal stenosis present at this level. This was present on the prior exam and has not changedAt C7-T1 there is no significant compromise to the spinal canal. There is a right lateral recess disc protrusion present at this level associated with encroachment of the right-sided exiting nerve roots. This was also present on the prior exam and has not substantially progressed.The vertebral artery flow voids appear to be intact.MRI thoracic spine:The thoracic vertebral bodies are appropriate in the overall alignment and height. The patient is status post laminectomy at T11-T12. There is redemonstration of multilevel degenerative changes in the thoracic spine with a Schmorl's nodes at multiple levels. At T5-6 there is a right paramedian disc protrusion redemonstrated and unchanged.At the T11-T12 level there is a disc bulge present. Additionally there is some signal change redemonstrated within the spinal cord posteriorly and eccentric towards the right side this level associated with focal volume loss. There is no compromise of thoracic spinal canal or exiting nerve roots.

Output: 1.There is redemonstration of multilevel degenerative changes present in the cervical spine with moderate spinal stenosis at C5-6 and mild to moderate spinal stenosis at C6-7 which have not substantially progressed since the previous exam from March 2013. There is multilevel encroachment of exiting nerve roots within the neural foramina present as detailed above which for the most part has not changed since the prior exam.2.The patient is status post laminectomy at T11-T12. There is some myelomalacia present at the spinal cord at this level. This is stable when compared to the previous exam.


Instruction: Generate impression based on findings.

Input: Clinical question : History of lung cancer, base of toque cancer, status post CRT. Evaluate for disease, compared with prior. Signs and symptoms: As above. Enhanced CT of soft tissues of neck: 80 cc of Omnipaque 350 is administered for this exam.Images through the skull base and including cavernous sinuses are unremarkable with the exception of extensive vascular calcification of cavernous carotid.Images through the neck demonstrate very extensive post therapy/surgical changes of the neck and including a large anterior flap. There is however no detectable tumor or any pathologic adenopathy neck.Limited images through the apices of the lungs demonstrate complete opacification of right upper lung field similar to what was noted on prior exam. Pleural effusion bilaterally is also noted (left greater than right). This is a new finding since prior exam. Please review dedicated report of CT of the chest performed the same date which he upper lung fields with better advantage.Enhanced head CT:Examination demonstrates extensive findings suspect for a mass to small vessel disease of indeterminate age. There is a small focal area of low cortical enhancement in the right frontal lobe (axial image 15 and coronal reformatted image 48). This finding was present on prior exam however it appears more prominent on the current study. Recommend further follow with an MRI exam to exclude the possibility of metastatic disease. The finding could represent a small enhancing cortical stroke as well. This examination is otherwise unremarkable and there are no additional foci of abnormal enhancement brain parenchyma or leptomeninges.

Output: 1.No evidence of recurrence of disease in neck and the stable exam since prior study.2.CT examination of brain demonstrates small focus of cortical enhancement in the right frontal lobe (axial image 15 & coronal reformatted image 48). This finding was present on prior study however appears slightly more pronounced on the current study and recommend further follow-up with an MRI to exclude metastatic disease.


Instruction: Generate impression based on findings.

Input: Malignant neoplasm of unspecified part of unspecified bronchus or lung [C34.90] / Disorder of brain, unspecified [G93.9], Reason for Study: ^Reason: Hx of brain mets, on oral chemo, pls compare to previous and measure History: eval progression Motion artifacts degraded exam quality.The small (previously measured as 3mm) left anterior temporal lobe intra axial enhancing lesion is only demonstrated on axial reconstruction scan (about 2.5mm, series 1203, image 43/100). Due to motion artifact, the lesion is not seen on post Gad T1 axial scan. Non-enhancing right frontal and parietal skull lesions are again seen, unchanged since prior scan.Multifocal bihemispheric supra and infra tentorial brain parenchymal nodular susceptibility lesions are again seen, unchanged.There is no evidence of new abnormal enhancing lesion.There is no evidence of acute ischemic or hemorrhagic lesion.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: 1. The left anterior temporal small enhancing lesion does not show any significant interval change since prior scan.2. There is no evidence of new abnormal enhancement.3. Unchanged multifocal susceptibility lesions and skull lesions since prior scan.4. No evidence of acute ischemic or hemorrhagic lesion.


Instruction: Generate impression based on findings.

Input: Diagnosis: Paresthesia of skin Cervicalgia Other chronic painClinical question: persistent L arm and neck burning x months. Neurological exam wnl. Evaluate for DDD or demyelinating disease.Signs and Symptoms: persistent L arm and neck burning x months. Neurological exam wnl. Evaluate for DDD or demyelinating disease. The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There is multilevel disc desiccation present. There is mild reversal of the normal cervical curvature.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina. There is a mild disc bulge at this levelAt C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina. There is a mild disc bulge at this levelAt C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.A small heterogeneous lesion present within the left lobe of the thyroid measuring 7 mm which is bright on T2-weighted imaging.

Output: 1.There are mild degenerative changes present in the cervical spine without significant compromise to the spinal canal or exiting nerve roots.2.A small lesion in the left thyroid gland is present. Statistically these are most likely benign. If clinically appropriate additional imaging of the thyroid may be helpful in the appropriate clinical setting.


Instruction: Generate impression based on findings.

Input: 51-year-old female with history of a right mastectomy for ILC in 2006. Patient received adjuvant chemotherapy There is scattered fibroglandular tissue in left breast.Mild parenchymal enhancement is noted in left breast. Several foci of enhancement in the left breast, mostly in the retroareolar region are unchanged from prior exam 3T exam.Status post right mastectomy with no suspicious chest wall enhancement.No abnormal enhancement is seen in 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: 61-year-old male with primary sclerosing cholangitis undergoing cholangiocarcinoma screening. ABDOMEN:LIVER, BILIARY TRACT: There is mild fissural widening and hypertrophy of the caudate lobe which may represent an early biliary pattern of cirrhosis. Subtle areas of wedge shaped T2 hyperintensity could represent fibrosis.Multifocal irregular dilatation of the intrahepatic and extrahepatic biliary ducts consistent with the history of primary sclerosing cholangitis with mild interval progression (for example, a left hepatic duct series 11, image 388). There is no dominant stricture or focal enhancing hepatic mass. Status post cholecystectomy. The hepatic vasculature appears patent.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Cardiophrenic and upper abdominal lymphadenopathy is nonspecific but unchanged and can be seen with PSC.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Multifocal intra and extrahepatic biliary structures consistent with primary sclerosing cholangitis with slight progression since the previous exam. No dominant stricture or suspicious enhancing lesion is identified.


Instruction: Generate impression based on findings.

Input: 55 year-old female with endometrial cancer. Now with supraclavicular lymph nodes and cough. Images through the skull base including cavernous sinuses, petrous bones and paranasal sinuses remain within normal limits.Images through the soft tissues of the neck demonstrate a small midline cystic structure in the nasopharynx which is believed to represent a Tornwaldt cyst with questionable clinical significance.There is suggestion of a cyst within the right tonsil suspect that of a retention cyst with no enhancement.Images the level of the left supraclavicular region demonstrate minimal soft tissue thickening immediately posterior to the left scalene muscle. There is no evidence of enhancement of this soft tissue prominence. This finding may represent a lymph node. This area is somewhat obscured by contrast material that was injected from the left side. Further evaluation with an MRI is recommended. This finding is best appreciated on axial image 66 to 71. No evidence of any additional area of suspected lymph node is present. Extensive degenerative changes of cervical spine with multilevel neuroforamina compromise is noted.

Output: Only minimal soft tissue fullness in the left supraclavicular region with no distinct lymph node or enhancement as detailed above. Further follow-up with an MRI is recommended to exclude lymphadenopathy.


Instruction: Generate impression based on findings.

Input: 57-year-old male patient with ascites in the setting of hepatitis C/cirrhosis. Evaluate common bile duct abnormality on abdominal ultrasound and for other abdominal etiology. ABDOMEN:LIVER, BILIARY TRACT: The common bile duct is mildly dilated measuring up to 10 mm in diameter but tapers distally without evidence of an obstructing mass/lesion. Mild central intrahepatic biliary ductal dilatation. Cholelithiasis without evidence of acute cholecystitis. Cirrhotic morphology of the liver. No focal hepatic lesion is identified. There is recannulization of the umbilical vein. SPLEEN: Mild splenomegaly measuring 15 cm in the craniocaudal dimension.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Gynecomastia.OTHER: There is a large right perihepatic multiseptated cystic mass occupying a majority of the right hemiabdomen; this causes mass effect on the adjacent liver and bowel. This lesion extends inferiorly outside of the field of view but measures at least 17 x 24 x 12 cm within the visualized portions. The infrahepatic IVC appears small in caliber. The azygous vein is prominent in size and there are multiple intraabdominal and body wall venous collateral vessels.

Output: 1.Large, multiseptated cystic perihepatic mass occupying the right hemiabdomen; this is favored to represent an evolving hematoma.2.Cholelithiasis without evidence of acute cholecystitis.3.Prominence of the common bile duct without evidence of an obstructing lesion. 4. Suggestion of central intrahepatic venous stenosis of the IVC with multiple intraabdominal and body wall venous collaterals.


Instruction: Generate impression based on findings.

Input: CSF FLOW: There is diminished biphasic flow at the level of the foramen magnum worse posteriorly than anteriorly. There is effacement of the CSF spaces secondary to marked crowding of the medulla and cerebellum, similar to prior exam. There is inferior herniation of the cerebellar tonsils measuring up to 11 mm below the foramen magnum with a pointed cerebellar tonsillar tip morphology. As seen on recent brain MRI, there is dilatation of the ventricular system which is in part related to periventricular leukomalacia right worse than left with superimposed mild obstructive hydrocephalus. Cerebellar aqueduct is patent.CERVICAL: There appears to be congenitally narrow cervical spinal canal. There is loss of normal cervical lordosis which may be in part positional. The osseous marrow signal is benign. Vertebral body heights are preserved. There is no cervical cord syrinx or significant signal abnormality. There are no significant disk disease or focal high-grade spinal canal or neural foraminal stenosis.There is a retention cyst in the left maxillary sinus.THORACIC: There is congenital narrowing of the upper and mid thoracic spinal canal. There is mild epidural lipomatosis. The vertebral body heights and signal are normal. There is no significant disk herniation, or focal high-grade spinal canal or neural foraminal stenosis in the thoracic spine. There is no thoracic cord syrinx or significant cord signal abnormality.LUMBAR: The vertebral body heights and marrow are within normal limits. The intervertebral disks show normal signal intensity. There are minimal disk bulges at L3-4, L4-5 and mild disk bulge at L5-S1. There is mild facet hypertrophy in the lower lumbar spine. There is no central spinal canal or significant neural foramina stenosis at any level. No spinal dysraphism. The conus terminates at mid L2 within normal limits. There is no lipoma or other masses in the lumbar spinal canal.

Output: 1. As seen on recent brain MRI, there are findings consistent with Chiari I malformation with significant crowding at the craniocervical junction and inferiorly displaced cerebellar tonsils with pointed morphology. Diminished biphasic CSF flow is noted at the level of the foramen magnum, worse posteriorly than anteriorly. Dilatation of the ventricular system is better assessed on recent brain MRI which is primarily related to periventricular leukomalacia, right worse than left, with suspected superimposed mild obstructive hydrocephalus. 2. No evidence of syrinx or signal abnormalities in the spinal cord.3. Congenital narrowing of the cervical and thoracic spinal canal. There is also mild thoracic epidural lipomatosis. No focal high-grade stenosis at any level.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Low grade glial neural tumor status post third ventriculostomy and biopsy: surveillance. There are postoperative findings related to right transfrontal biopsy of a periaqueductal lesion with persistent susceptibility effect and T2 hyperintensity along the surgical tract related to prior hemorrhage. There is no significant interval change in the subcentimeter nonenhancing, T2 hyperintense lesion within the tectum. There are a few scattered punctate foci of unchanged cerebral white matter T2 hyperintensity. There is no evidence of 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: Postoperative findings related to biopsy of a periaqueductal lesion, which has otherwise not significantly changed in size.


Instruction: Generate impression based on findings.

Input: 25-year-old male. Left elbow possible ligamentous injury secondary to dislocation. Pain and inability to extend. The study is limited due to inability to optimally position the patient. Furthermore, a flex coil was used instead of a high definition knee coil due to inability of the patient to extend his elbow. These limitations result in suboptimal image quality.LIGAMENTS: We see no full thickness tear of the ulnar collateral ligament; however, a small amount of fluid partially separates the distal fibers of the anterior bundle of the ulnar collateral ligament from the sublime tubercle of the coronoid process, which may reflect mild undersurface stripping. Furthermore increased signal intensity within the proximal and posterior fibers of the anterior bundle of the ulnar collateral ligament may represent a partial-thickness tear. The proximal attachment of the radial collateral ligament is not well defined and we cannot exclude the possibility of a partial thickness tear of this ligament either. Distally the ligament, including the lateral ulnar collateral ligament, appear intact.TENDONS: There is poorly defined increased signal intensity within the proximal fibers of the common extensor tendon at its origin suggesting a mild strain. The common flexor tendon is intact. The biceps and brachialis tendons are intact although there is edema within the distal fibers of the brachialis muscle suggesting a strain. The triceps tendon is intact.ARTICULAR SURFACES AND BONE: There is mild edema within the capitellum of the distal humerus but we see no discrete fracture line. We see no fracture of the proximal radius as questioned on recent radiographs. There is a moderate to large elbow joint effusion. We see no cartilage defects given the aforementioned limitations of the study. There is, however, an approximately 7-mm focus of ovoid low signal intensity situated within the joint between the distal humeral articular surface and the posteromedial rim of the proximal radial articular surface, suspicious for an intra-articular loose body, but we cannot determine its source. There may be a slightly smaller loose body more posteriorly in the joint but this is equivocal.

Output: 1. Limited study, as described above.2. Findings suggestive of partial thickness tearing of the ulnar collateral ligament and possibly a tear of the radial collateral ligament at its humeral attachment.3. Joint effusion with small focus/foci of low signal intensity in the joint space suspicious for loose bodies. This can be further evaluated with CT if clinically warranted.4. Strains of the brachialis and common extensor tendons.5. Edema within the capitellum may represent a bone contusion but we see no fracture line.


Instruction: Generate impression based on findings.

Input: tuberous sclerosis and history of embolization of right kidney angiomyolipoma. ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic mass. No intra or extra hepatic biliary ductaldilatation. The gallbladder is normal in appearance.SPLEEN: Heterogeneous foci scattered throughout the spleen may reflect splenic hamartomas and are unchanged from prior examination. PANCREAS: No significant abnormality noted.ADRENAL GLANDS: The adrenal glands are not well visualized.KIDNEYS, URETERS: Large heterogeneous mass occupying the majority of the upper and midpoleof the right kidney that now appears confluent with the inferior pole. The mass measures 6.1 x 7.2 cm in axial dimension (series #401, image 22). The previously described blood vessel that appeared the periphery of this mass remains present, but is significantly decreased in size when compared to prior examination.There is a slightly smaller mass occupying the inferior pole anteriorly with only a smallamount of renal parenchyma remaining. The mass measures approximately 4.2 x 5 cm (series #401, image 13). The mass effect on the inferior vena cava has significantly improved when compared to prior examination. Innumerable bilateral T2 hyperintense foci compatible with renal cysts. Additional hypointense foci bilaterally compatible with angiomyolipomas. The largest of which on the left measures 3.2 x 2.1 cm (series 401, image 17). Retroaortic left renal vein, unchanged. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Bilateral dependent atelectasis in the partially visualized lung bases.

Output: 1. Heterogeneous right renal masses with interval decrease in size when compared to prior examination. 2. Multiple renal cysts, left angiomyolipomas, and splenic hamartomas are unchanged.


Instruction: Generate impression based on findings.

Input: 71-year-old female with history of radiation for anal cancer, prior small bowel obstruction status post small bowel resection, with diarrhea and weight loss. 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: Nonenhancing T2 hyperintense focus of the right interpolar region is too small to characterize, favor cystic. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No bowel obstruction or ascites. Above average stool burden compatible with constipation.The terminal ileum demonstrates a short segment of mild wall thickening and hyperenhancement on postcontrast series (axial series 22 image 35). No upstream dilatation. No evidence for other stricture or fistulization.There is suspected just under distention of small bowel loops in the left mid hemiabdomen at the level of the umbilicus (axial series 11 image 17). Improved distention was visualized as the study progressed. On the postcontrast series, there is no significant wall thickening or hyperenhancement (axial series 22 image 27).BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Uterus is atrophic versus surgically absent.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: As above.BONES, SOFT TISSUES: Restricted diffusion of the right hemisacrum and left posterior iliac bone likely related to prior radiation change (axial series 13 images 22, 24).OTHER: No significant abnormality noted.

Output: 1.Short segment wall thickening and hyperenhancement of the terminal ileum with no upstream dilatation. Findings compatible with mild terminal ileitis, of uncertain etiology. No additional signs of Crohn's disease, i.e., no fibrofatty proliferation or locoregional adenopathy seen.2.Above average stool burden consistent with constipation.3.Restricted diffusion of the right hemisacrum and left posterior iliac bone presumably related to prior radiation change, correlation with patient's clinical history recommended.


Instruction: Generate impression based on findings.

Input: Breast cancer with dizziness, assess for brain metastasis. No intracranial mass or mass-effect. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. The ventricles are within normal limits in size and configuration. There is a linear focus of abnormal enhancement involving the undersurface of the posterior body of the corpus callosum on the left measuring up to 8x4 mm. Otherwise, there is no abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. There is an approximately 1 cm enhancing lesion involving the right frontal calvarium and a smaller one involving the left frontal calvarium which are nonspecific. There may be some T1 hyperintensity associated with the right frontal lesion. No destructive changes in the calvarium.

Output: 1. There is no definite evidence of intracranial metastatic disease. 8x4 mm linear enhancing lesion is seen involving the left posterior callosum which is nonspecific and would be atypical for metastases. Possibilities include a benign vascular lesion, subacute ischemia and demyelinating lesion, although metastasis is not exluded. Consider close follow up evaluation. 2. No evidence of acute infarct. No intracranial mass or mass-effect. 3. Nonspecific small enhancing lesions in the right and left frontal calvarium. Consider comparison with priors or correlation with bone scan.


Instruction: Generate impression based on findings.

Input: Female, 48 years old, with history of low-grade salivary gland type carcinoma of the right nasopharynx. Brain:No evidence of significant parenchymal signal abnormality, edema or mass effect is seen. No pathologic parenchymal or extra-axial enhancement is detected. The ventricular system is normal in size and morphology. No intracranial hemorrhage or abnormal fluid collections are seen. Enucleation of the left globe is redemonstrated with a prosthesis in place.Neck:A polypoid mass arising from the right nasopharynx is stable or slightly reduced in size, now measuring 15 x 14 mm (image 16 series 22), previously 18 x 14 mm. No other mucosal masses are seen. No pathologic adenopathy is detected. The salivary glands are unremarkable. A T2 hyperintense nodule in the right thyroid lobe is unchanged. No concerning marrow lesions are seen. Mucosal thickening is evident in the maxillary sinuses.

Output: 1. The right nasopharyngeal mass is stable to decreased in size with no evidence of pathologic adenopathy.2. No intracranial metastases.


Instruction: Generate impression based on findings.

Input: Paresthesia of skin [R20.2] / Weakness [R53.1], Reason for Study: ^Reason: stroke? History: L sided numbness and weakness Brain MRIThere is no evidence of acute ischemic or hemorrhagic lesion. Several susceptibility lesion seen on bilateral basal ganglia especially globus pallidi indicating mineralization.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear. Minimal mucosal thickening on bilateral ethmoid sinus are seen.Brain MR angiogram3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal.Neck MRA3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The vertebral artery origins are normal. There is normal flow enhancement through the bilateral common carotid, carotid bifurcations, internal/external carotid, and vertebral arteries.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. Normal brain MRA, normal neck MRA


Instruction: Generate impression based on findings.

Input: The brain, brainstem, and cerebellum appear unremarkable, including terminal zones of myelination in the bilateral parietal lobes. Specifically, there is no evidence of gray matter heterotopia or cortical dysplasia. The bilateral hippocampi are symmetric in size, signal characteristics, and with preserved internal architecture. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are normal in size and configuration, including mild asymmetry of the occipital horns. There is no midline shift or herniation. The major cerebral flow voids are intact. There is mild mucosal sinus thickening involving the maxillary sinuses. The orbits, skull and scalp soft tissues are grossly unremarkable.

Output: No evidence of potential seizure foci.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 20 year old woman with exertional pre-syncope referred for further evaluation of underling cardiac structure and fibrosis. Left VentricleThe left ventricle is mildly dilated with normal systolic function. The overall LV ejection fraction is 63%, the LV end diastolic volume index is 104 ml/m2 (normal range: 65+/-11), the LVEDV is 194 ml (normal range 109+/-23), the LV end systolic volume index is 39 ml/m2 (normal range 18+/-5), the LVESV is 72 ml (normal range 31+/-10), the LV mass index is 81 g/m2 (normal range 67+/-11), and the LV mass is 152 g (normal range 114+/-24). There are no regional wall motion abnormalities present. There is a subtle, small amount of epicardial late gadolinium enhancement involving the basal inferoseptum and inferior wall suggesting the presence of an underlying fibrosing, infiltrative, or inflammatory process. In the same region, there is decreased post-contrast T1 times confirming the finding using a different pulse sequence. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is mildly dilated with normal systolic function. The overall RV ejection fraction is 59%, the RV end diastolic volume index is 109 ml/m2 (normal range 69+/-14), the RVEDV is 205 ml (normal range 110+/-24), the RV end systolic volume index is 48 ml/m2 (normal range 22+/-8), and the RVESV is 84 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve is tri-leaflet, 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 trace tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size. Normal origin of the coronary arteries. 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. The left ventricle is mildly dilated with normal systolic function. The overall LV ejection fraction is 63%. There is a subtle, small amount of epicardial late gadolinium enhancement involving the basal inferoseptum and inferior wall suggesting the presence of an underlying fibrosing, infiltrative, or inflammatory process. 2. The right ventricle is mildly dilated with normal systolic function. The overall RV ejection fraction is 59%.3. Although the mechanism of late gadolinium enhancement is not evident, mild biventricular dilation and late gadolinium enhancement has previously been described in marathon runners. The differential diagnosis also includes but is not limited to prior myocarditis.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, 30 years old, with paresthesias. Assess for demyelinating disease. Redemonstrated are numerous scattered small foci of T2 hyperintensity within the cerebral white matter, particularly affecting the thalami and brain stem, to a lesser degree the cerebral hemispheres. These are unchanged and there are no definite new lesions. Numerous punctate foci of enhancement which correlated to these lesions, particularly in the brainstem and posterior fossa, are less conspicuous than on the immediate prior examination and significantly less conspicuous than on the more remote study from August of 2014.No evidence of parenchymal edema or mass effect is seen. No acute intracranial hemorrhage or any abnormal extra axial fluid collection is detected. The ventricles are stable and normal in size. A small defect in the left parietal bone likely reflects prior instrumentation.

Output: 1. Continued interval improvement in the conspicuity and number of small enhancing foci within the brainstem and posterior fossa.2. The number and size of scattered T2 hyperintense white matter lesions are unchanged.


Instruction: Generate impression based on findings.

Input: 42 year old with family history of breast cancer and personal history of benign bilateral breast biopsies. There is heterogeneous amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.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: 1 - Negative.RECOMMENDATION: NS - Routine Screening Mammogram.


Instruction: Generate impression based on findings.

Input: 47-year-old with history of BRCA1 carrier. History of benign left breast MRI guided biopsy in September 2012. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.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: 1 - Negative.RECOMMENDATION: NS - Routine Screening Mammogram.


Instruction: Generate impression based on findings.

Input: Reason: Right shoulder dislocations over the past 2 months, history of multiple myeloma tx'd at outside hospital, now with acromial mass and lesion in proximal humerus and scapula, evaluate for cause of instability History: above ROTATOR CUFF: There is a high-grade partial-thickness tear of the bursal surface fibers of the supraspinatus tendon at the level of its insertion on the greater tuberosity without significant retraction, measuring approximately 15 mm in the AP dimension. There is interstitial tearing of the infraspinatus at the level of the myotendinous junction. There is interstitial tearing of the subscapularis at the level of the myotendinous junction. The teres minor muscle and tendon appear intact. There are intramuscular cysts within the muscle belly of the subscapularis.SUPRASPINATUS OUTLET: There is no significant fluid within the subacromial subdeltoid bursa. Mild osteoarthritis affects the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is anatomic. There is heterogeneity and increased signal intensity within the superior, anterior, and inferior labrum suggesting degeneration/degenerative tearing. No fluid-filled tear is evident on this non arthrogram study.BICEPS TENDON: The tendon of the long head of the biceps appears intact. ADDITIONAL

Output: 1. Findings consistent with the stated history of multiple myeloma as described above.2. Avascular necrosis of the humeral head.3. High-grade partial-thickness tearing of the supraspinatus as well as additional interstitial tearing of the rotator cuff without significant retraction.4. Glenoid labral degeneration/degenerative tearing.


Instruction: Generate impression based on findings.

Input: 52 years Male (DOB: 6/2/1963) PROVIDER/ATTENDING NAME: SERVICES ANCILLARY SERVICES ANCILLARY The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There is T2 signal hyperintensity along the right hemicord at the C7-T1 level.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is loss of disc space height, disc desiccation and diffuse disc bulge associated with ligamentum flavum hypertrophy. There are uncovertebral osteophytes present at this level bilaterally. There is associated effacement of spinal fluid ventral and posterior the spinal cord at this level. Overall there is moderate spinal stenosis at this level. There is associated mild encroachment of the exiting nerve roots bilaterally at this level. There are mild endplate reactive changes at this level.At C4-5 there is loss of disc space height, disc desiccation and diffuse disc bulge. There are small uncovertebral osteophytes present at this level bilaterally. There is associated effacement of spinal fluid ventral and posterior the spinal cord at this level. Overall there is mild to moderate spinal stenosis at this level. There is associated moderate encroachment of the exiting nerve roots bilaterally at this level . There are mild endplate reactive changes at this level.At C5-6 there is loss of disc space height, disc desiccation and diffuse disc bulge. There are uncovertebral osteophytes present at this level associated with disc material bilaterally. There is associated partial effacement of spinal fluid ventral and posterior the spinal cord at this level. Overall there is mild spinal stenosis at this level. There is associated moderate encroachment of the exiting nerve roots bilaterally at this level .At C6-7 there is loss of disc space height, disc desiccation and diffuse disc bulge. There are uncovertebral osteophytes present at this level associated with disc material bilaterally. There is associated partial effacement of spinal fluid ventral and posterior the spinal cord at this level. Overall there is mild spinal stenosis at this level. There is associated moderate encroachment of the exiting nerve roots bilaterally at this level .At C7-T1 there is loss of disc space height, disc desiccation and diffuse disc bulge. There are uncovertebral osteophytes present at this level associated with disc material bilaterally. There is associated partial effacement of spinal fluid ventral and posterior the spinal cord at this level. Overall there is mild spinal stenosis at this level. There is associated moderate encroachment of the exiting nerve roots on the right side more than the left at this level . There are endplate reactive changes at this level which are high signal on T2 and inversion recovery imaging.The vertebral artery flow voids appear to be intact.

Output: 1.There are multilevel degenerative changes present in the cervical spine with moderate spinal stenosis at C3-4 and milder degrees of spinal stenosis at the levels below that as detailed above. There is additional encroachment of exiting nerve roots bilaterally at C4-5, C5-6, C6-7 and C7-T1.2.There is spinal cord lesion present on the right hemicord at the C7-T1 level. This could represent myelomalacia. Demyelination may have a similar appearance


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for intracranial hemorrhage. Signs and symptoms: Right arm weakness. Unenhanced CT of brain:There is no definite evidence of hemorrhage, edema, mass-effect, midline shift or hydrocephalus. Cortical sulci, ventricular system and all CSF cisterns are within normal range for patient's stated age of 77. Note should be made that very small acute cortical strokes can be missed on CT examination and for further follow-up and MRI is recommended.

Output: No definitive evidence of intracranial abnormality.


Instruction: Generate impression based on findings.

Input: Recurrent stage IV neuroblastoma status post radiation therapy. Assess for response. Redemonstration of a lobulated heterogeneous mass centered in the left masticator space and infratemporal fossa. The mass extends into the left middle cranial fossa. There is also perineural extension into the cavernous sinus through the left foramen rotundum and ovale. Overall the mass is slightly decreased in size. There is more marked interval decrease in size of the middle temporal cranial fossa component of the tumor which used to measure 12 mm in craniocaudal dimension and now only measures 2 mm. The dural based nodule adjacent to the anterolateral left frontal lobe is no longer identified compatible with resolution. No foci of abnormal enhancement within the brain parenchyma. The ventricles are normal in size and configuration. The basal cisterns are preserved. The expected intracranial vascular flow voids are present.The previously noted tumor masses along the posterior mandibular condyles has resolved. There remains poorly defined soft tissue enhancement compatible with posttreatment change. The visualized mandibular condyles have minimally decreased marrow signal and expansion also possibly reflecting treatment change. Near complete opacification of the paranasal sinuses is slightly progressed compared to prior. Persistent opacification of the left mastoid air cells compatible with eustachian tube dysfunction appears similar to prior.Orbits:The tumor extends from the infratemporal fossa into the inferolateral extraconal left orbit. The intraorbital component now measures 9 mm, previously 12 mm. There is still persistent mass effect on the optic nerve and lateral rectus muscles.

Output: Overall decrease in tumor burden in the visualized head and orbits. There has been interval resolution of the perimandibular masses and marked interval decrease in the extension of tumor into the left middle cranial fossa. More mild interval decrease in size of the main infratemporal mass and left intraorbital tumor component.