Instruction: Generate impression based on findings.

Input: 54-year-old female with left knee pain for 6 months, assess for medial meniscus tear, patellofemoral chondromalacia MENISCI: On the coronal T1-weighted images, there is a globular increased signal intensity within the body of the medial meniscus indicating intrasubstance degeneration. This signal extends to the tibial articular surface, which may represent undersurface fraying, but we see no discrete fluid-filled meniscal tear. Intrasubstance signal in the lateral meniscus also appears degenerative, without discrete meniscal tear.ARTICULAR CARTILAGE AND BONE: Severe osteoarthritis affects the patellofemoral joint with much of the medial facet of the patella and the trochlea of the femur devoid of cartilage. There is increased signal of the underlying subchondral bone, which is likely degenerative in etiology. Loss of cartilage along the inferior aspect of the lateral facet of the patella is also noted. There is relative preservation of the articular cartilage in the medial and lateral tibiofemoral compartments. Note is made of tricompartmental osteophytes.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1. Severe osteoarthritis of the patellofemoral joint, particularly affecting the medial facet of the patella and the trochlea.2. Intrasubstance degeneration of the menisci with possible undersurface fraying of the body of the medial meniscus, but no discrete meniscal tear is evident.


Instruction: Generate impression based on findings.

Input: Medulloblastoma, status post resection and chemoradiation. Brain: There are postoperative findings related to suboccipital craniotomy for resection of a cerebellar medulloblastoma. There is unchanged mild confluent T2 hyperintensity in the medial cerebellar hemispheres along the margins of the resection site, but no evidence of tumor. There are also unchanged scattered punctate foci of susceptibility effect in the cerebral hemispheres and along a right occipital surgical tract. There is no evidence of acute intracranial hemorrhage or infarct. The ventricles and basal cisterns are stable in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unchanged. Spine: The spinal cord and cauda equina nerve roots display normal signal characteristics. There is no evidence of abnormal enhancement within the spinal canal. The vertebral bone marrow displays diffuse T1 and T2 hyperintensity, compatible with radiation effects. The vertebral column alignment is within normal limits. The vertebral body heights are preserved. The paraspinal soft tissues are unremarkable.

Output: 1. No convincing evidence of tumor recurrence in the posterior fossa. 2. No evidence of drop metastases in the spinal canal.


Instruction: Generate impression based on findings.

Input: Female, 33 years old, with chronic headache. Assess for structural lesions. A few scattered punctate foci of T2 hyperintensity within the cerebral white matter are seen, essentially unchanged from the prior examination.No evidence of restricted diffusion is seen. No parenchymal edema or mass effect is detected. There is no intracranial hemorrhage or any abnormal extra-axial fluid collection. No abnormal parenchymal or extra-axial enhancement is observed.

Output: 1.Scattered punctate foci of white matter T2 hyperintensity are again seen. These show no significant interval change and remain nonspecific.2.No structural lesions or other specific findings to account for the patient's headaches.


Instruction: Generate impression based on findings.

Input: Ms. Cathleen Neeley is a 57 years old female with left breast cancer (1:00 ID C and 11:00 and DCIS). She presents today for evaluation of imaging response to chemotherapy. On physical examination, a mass is palpated in the left upper outer breast, at the site marked by the physician.A targeted left ultrasound was performed for the left upper outer breast palpable area of concern, left axilla and left upper inner breast. --Index lesion in the left breast with a biopsy clip, 1:00 position, 12 cm from the nipple, now measuring 1.4 x 1.5 x 1.2 cm, previously 1.8 x 1 x 1.1 cm, has slightly decreased in size and appears more heterogeneous.--Satellite lesion in the left breast with a biopsy clip, 10:00 position, 4 cm from the nipple (reported as 1:00 lesion with MRI guided biopsy), measuring 0.8 x 0.7 x 1.2 cm.--There is redemonstration of the multiple prominent lymph nodes in the left axilla,, grossly unchanged in size and morphology from the prior study. For example, the largest lymph node now measures 2.8 x 0.9 x 0.8 cm, previously 2.8 x 1 x 1 cm.

Output: --Slightly decreased to stable size of the left breast index mass measuring 1.4 x 1.5 x 1.2 cm (previously 1.8 x 1 x 1.1 cm). --Stable multiple prominent left axillary lymph node. Results and recommendations were discussed with the patient.BIRADS: 6 - Known cancer.RECOMMENDATION: B - Surgical Consultation.


Instruction: Generate impression based on findings.

Input: 56 years Female (DOB:11/6/1960)Reason: 56 yo F with metastatic breast cancer s/p GTR of L temporal met, MRI for SRS planning History: nonePROVIDER/ATTENDING NAME: SEAN PITRODA SEAN PITRODA The patient is status post left-sided craniotomy for removal of a left temporal lobe mass. There are now some blood products present at the surgical site. Some adjacent signal change in the adjacent left temporal lobe white matter has regressed but not resolved.

Output: Status post removal of a left temporal lobe mass. Since the prior exam adjacent white matter signal change has regressed.


Instruction: Generate impression based on findings.

Input: Low signal to noise is present secondary to patient positioning in relation to the MRI coil. There is loss of the normal cervical lordosis with a kyphotic angle centered at C5/C6. Vertebral body heights are grossly preserved. There is a trace anterolisthesis of C4 on C5 and grade 1 anterolisthesis of C5 on C6. There is disc dessication throughout the cervical spine with severe degenerative disc disease at C5/C6. Diffuse marrow heterogeneity with increased sclerosis (hypointensity on T1 and T2) is consistent with metastatic disease as seen on previous bone scan, likely demonstrating a treatment response. The cervicomedullary junction is normal. C2/3: No significant canal or neural foraminal stenosis.C3/4: There is right greater than left uncovertebral hypertrophy with mild right neural foraminal stenosis. Minimal posterior disc-osteophyte complex with effacement of the dorsal thecal sac consistent with mild spinal canal stenosis. C4/5: There is trace uncovering of the disc without significant spinal canal stenosis. There is uncovertebral and severe left facet hypertrophy contributing to severe left neural foraminal stenosis as well as mild right neural foraminal stenosis.C5/6: There is uncovering of the disc with a superimposed disc-osteophyte complex which causes mild spinal canal stenosis. There is uncovertebral hypertrophy and minimal bilateral neural foraminal stenosis. C6/7: There is a posterior-disc osteophyte complex causing mild to moderate spinal canal stenosis and uncovertebral hypertrophy causing mild bilateral neural foraminal stenosis. C7/T1: No significant spinal canal or neural foraminal stenosis.

Output: 1. Multilevel degenerative changes of the cervical spine most prominent at C4/C5 with severe left neural foraminal stenosis and C5/C6 with grade I anterolisthesis and mild spinal canal stenosis. Additional findings as described above.2. Diffuse bone marrow heterogeneity with sclerosis is consistent with metastatic disease as seen on prior bone scan.


Instruction: Generate impression based on findings.

Input: 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 to suggest nerve sheath tumor or other lesion within the spinal canal or neural foramina.Minimal degenerative changes are present without significant disk herniation or spinal canal or neural foraminal stenosis within the cervical spine. THORACIC SPINE

Output: 1. No discrete masses to suggest schwannoma in the cervical or thoracic spine.2. Minimal residual enhancing lesion involving the right L2 neural foramen is difficult to measure due to susceptibility artifact but is grossly unchanged.3. There has been interval enlargement of the right L3 schwannoma which measures 26 x 23 mm, previously 22 x 18 mm on 12/14/2013.


Instruction: Generate impression based on findings.

Input: Clinical question coiling evaluate sella. History of pituitary adenoma. Signs and symptoms Crohn's history of pituitary adenoma. Nonenhanced head CT:Slightly prominent sella turcica and the pituitary gland appears similar to prior exam.This examination is also compared with CT of soft tissues of neck dated 2-- 9 -- 10 which also demonstrates similar findings without appreciable change.Nonenhanced head CT is not the appropriate tests for precise evaluation of pituitary gland and or sella. This finding can be better evaluated with a dedicated MRI of pituitary gland. There is no abnormality of basal cistern or any mass effect on the chiasm. Splenic sinus is within normal limits.There is no evidence of intracranial hemorrhage, edema, mass-effect, midline shift or hydrocephalus. No evidence of any new finding since prior head CT from 1 -- 27 -- 10

Output: 1.No evidence of acute new finding since prior study.2.Slight prominence of pituitary gland and sella is identical to prior study from 1 -- 27 -- 10.3.Most appropriate method of evaluation for pituitary pathology is by MRI exam.


Instruction: Generate impression based on findings.

Input: Male, 29 years old, with right-sided weakness and hyperreflexia not explained by Todd's paralysis. Alignment is anatomic. Vertebral body height and morphology are within normal limits. No pathologic marrow signal abnormality or enhancement is seen.The visualized spinal cord is normal in signal intensity and morphology. No focal cord lesions are seen. No pathologic intradural or epidural enhancement is noted.The intervertebral discs are preserved. No significant bulge or herniation is seen. No significant compromise of the spinal canal or neural foramina is noted.

Output: No specific findings to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: 27-year-old female with head injury No evidence of hemorrhage, edema, mass-effect, midline shift or hydrocephalus. Cortical sulci, ventricular system and all CSF cisterns remain within normal limits.Images at the level of common magnum demonstrates crowding of brain parenchyma at the level of the foramina magnum with effacement of subarachnoid space. This is consistent with low position of cerebellar tonsils (Chiari malformation) which requires further evaluation with a dedicated MRI exam.Calvarium, mastoid air cells and very limited view of paranasal sinuses are unremarkable.

Output: 1.No evidence of acute post traumatic findings.2.Findings consistent with Chiari malformation which requires further evaluation with an MRI.


Instruction: Generate impression based on findings.

Input: Female, 26 years old, with history of biphenotypic liver tumor, HCC/cholangiocarcinoma, with bone metastases and back pain. Assess metastatic disease at T11-12 as seen on CT. An enhancing mass is present centered on the left aspect of the T12 vertebral body and pedicle measuring up to 34 x 31 mm in the axial plane. The lesion extends into the left ventral epidural space causing mild encroachment upon the thecal sac. The lesion also extends mildly into the left lateral paraspinal soft tissues. The neural foramen is not significantly compromised. The remaining marrow space of the T12 vertebral body is edematous and enhancing which may be reactive to the tumor.No other discrete osseous lesions are seen in the thoracic spine. Spinal alignment is anatomic. Vertebral body heights are preserved. The spinal cord shows normal signal intensity and morphology. No pathologic intrathecal enhancement is noted. The intervertebral discs are normal.Numerous pulmonary nodules are partially visualized. The left lobe of the liver is enlarged and heterogeneous likely indicating tumor involvement.

Output: An osseous metastasis is seen affecting the left aspect of the T12 vertebral body and pedicle. This lesion encroaches upon the left ventral epidural space causing mild thecal sac narrowing but no significant spinal canal stenosis or compression of the spinal cord or nerve roots.


Instruction: Generate impression based on findings.

Input: Clinical question: Patient is aphasic acute the. Evaluate for CVA. Signs and symptoms: As above. Nonenhanced brain MRI:No detectable acute intracranial process and in particular no evidence of acute ischemic stroke.Degraded images due to excessive motion artifact. Within this limitation however the study demonstrate diffuse periventricular and subcortical and minimally of pontine foci of flair hyperintensity which considering patient's stated age likely representing chronic nonhemorrhagic small vessel ischemic strokes of mild degree.There is a slight prominence of cortical sulci and supratentorial ventricular system for age. Correlate with history and risk factors.Signal void of major intracranial arterial branches are identified.Unremarkable images through the orbits, paranasal sinuses and mastoid air cells.

Output: 1.No acute intracranial process.2.Findings of mild chronic nonhemorrhagic small vessel ischemic strokes as detailed.


Instruction: Generate impression based on findings.

Input: 60-year-old female recently managed for acute subdural bleed status post PEA arrest during MRI after administration. Global aphasia and generalized hyperreflexia. There is no evidence of new intracranial hemorrhage, mass or edema. The previously described epidural bleed with some adjacent mass effect appears slightly smaller than before. Within the left high convexity there is a possible subdural hygroma which exerts mass effect on the adjacent parenchyma. This may be further evaluated with MRI as clinically warranted.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Slightly smaller appearing epidural hemorrhage and a new adjacent left subdural hygroma which exerts mass effect on adjacent parenchyma and may be further evaluated with MRI as clinically warranted.


Instruction: Generate impression based on findings.

Input: Lack of coordination, hyperreflexia. The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology.At C2-3 there is no significant compromise to the spinal canal or neural foramina. There is minor disc bulge.At C3-4 there is loss of disc height and disc desiccation. There is mild disc bulge. There is posterior ligament hypertrophy. There is partial effacement of the spinal fluid anterior and posterior to the spinal cord. There is bilateral uncovertebral joint osteophytes with narrowing of the neural foramina bilaterally. There is encroachment of the exiting nerve roots within the neural foramina bilaterally.At C4-5 there is loss of disc height, disk dessication and diffuse disc bulge and mild posterior ligamental hypertrophy associated with bilateral uncovertebral osteophytes and encroachment of the exiting nerve roots within the neural foramina bilaterally.. There is partial effacement of the spinal fluid anterior and posterior to the spinal cord. At C5-6 there is loss of disc height, disk dessication and diffuse disc bulge and mild posterior ligamental hypertrophy associated with bilateral uncovertebral osteophytes and encroachment of the exiting nerve roots within the neural foramina bilaterally.. There is partial effacement of the spinal fluid anterior and posterior to the spinal cord. At C6-7 there is disc bulge and desiccation. There is posterior ligament hypertrophy. There is partial effacement of the anterior and posterior fluid space. Uncovertebral osteophytes are present bilaterally with a mild degree of encroachment of the exiting nerve roots.The left vertebral artery flow-void is not seen. There is high T2 signal present within the left vertebral artery throughout its visualized course.Note is made that the postcontrast images are degraded by the patient motion.

Output: 1. There are multilevel degenerative changes present in the cervical spine with mild degrees of spinal stenosis at C3-4 and C5-6 and multilevel neural foramen encroachment of exiting nerve roots due to uncovertebral osteophytes and disc disease.2. Findings are suspicious for occlusion of the left vertebral artery.


Instruction: Generate impression based on findings.

Input: History of MS presenting with paresthesias. Evaluate for progression. Brain:Redemonstration of multiple foci of increased T2 signal in the cerebral white matter in a predominantly periventricular distribution compatible with the history of multiple sclerosis. There is also involvement of the corpus callosum. Overall findings are not significantly changed from prior. The larger lesions are associated with a stable decrease in T1 signal. No new lesions are identified. No evidence of acute ischemia, hemorrhage, or intracranial mass effect.  The ventricles and basal cisterns are normal in size and configuration. The expected intracranial vascular flow voids are present. The paranasal sinuses are clear. The visualized mastoid air cells are clear. Lumbar Spine:Vertebral body heights are preserved. Alignment is anatomic. There is loss of signal in the intervertebral disks at L3-4 compatible with disc desiccation. Increased T2 signal in the vertebral body endplates at L4-5 level which is new from prior and associated with increased signal within the intervertebral disc. No adjacent soft tissue inflammation or epidural collection. The distal cord is grossly normal in signal. The conus medullaris terminates at the mid L1 level.Level by level findings are as follows:T12-L1: No disc bulge, spinal canal stenosis, or neuroforaminal narrowing.L1-L2: No disc bulge, spinal canal stenosis, or neuroforaminal narrowing.L2-L3: No disc bulge, spinal canal stenosis, or neuroforaminal narrowing.L3-L4: Mild disc bulge eccentric to the right which effaces the right lateral recess and extends into the right neural foramen creating mild right neural foraminal stenosis. No central canal or left neural foraminal stenosis.L4-L5: Interval decrease in size of previously noted disc extrusion. There is still effacement of the left lateral recess, however this is significantly improved. Mild left neural foraminal narrowing. No significant central canal or right neural foraminal narrowingL5-S1: Mild disc bulge eccentric to the right partially effacing the right lateral recess and abutting the descending right S1 nerve root. No significant neural foraminal or central canal stenosis.

Output: 1. Stable findings of chronic demyelinating disease in the brain. No new lesions to suggest progression.2. Multilevel degenerative changes of the lumbar spine with interval improvement in previous seen disc extrusion at the left L4-L5 level and improvement in associated effacement of the lateral recess where there was mass effect on the left L5 nerve root. Please see details of additional levels as above.3. Interval increase in T2 signal within the L4-5 vertebral body endplates and intervertebral disc is likely on a progressive degenerative basis. Early discitis-osteomyelitis may appear similar however and can be considered in the appropriate clinical setting.


Instruction: Generate impression based on findings.

Input: Three punctate foci of T2 hyperintensity in the right cerebral hemisphere are nonspecific. The ventricles and sulci are normal in size. There are no masses, mass effect or midline shift. There is no evidence for intracranial hemorrhage or abnormal extra-axial fluid collection. No diffusion-weighted abnormalities are identified. The cerebellar tonsils are in normal position. The pituitary gland is normal in size. Flow voids are present within the major vessels indicating patency. Trace mucosal thickening of the ethmoid air cells. The paranasal sinuses and mastoid air cells are otherwise clear.

Output: 1. No specific findings to account for the patient's altered mental status.2. Several punctate foci of T2 hyperintensity in the right cerebral hemisphere is a nonspecific finding.


Instruction: Generate impression based on findings.

Input: Stage IV endometrial cancer and worsening upper extremity weakness There is no evidence of cord compression or high-grade stenosis in the cervical, thoracic, or lumbar spine. Alignment is maintained.There is a mass involving the at the right spinous/paraspinous T2-T3 level with mild encroachment into the right T2-T3 and T3-T4 neural foramina.There is a destructive osseous lesion involving the left aspect of the L3 vertebral body with extension into the left pedicle. There is mild loss of height in the left aspect of the vertebral body. There is T1 hyperintensity involving the lower thoracic and lumbar vertebral bodies which may be related to prior radiation. There is more diffuse low T1 marrow signal more superiorly. There are mild degenerative changes including disk bulge at T7-T8.There is destructive lesion involving the sacrum at the right S2 level. There is a large sternal mass which is also noted.Right cerebellar lesion and edema is also partially visualized.

Output: 1. This is a limited exam specific for the exclusion of cord compression only and does not exclude more subtle lesions such as intrinsic cord abnormalities. There is no evidence of cord compression or high-grade stenosis in the cervical, thoracic, or lumbar spine2. Metastatic lesions at right T2-3, left L3, and sacrum which can be further evaluated with dedicated thoracic and lumbar spine studies as clinically indicated. There is some loss of height involving the left aspect of the L3 vertebral body which is also noted on outside CT abdomen study.3. Right cerebellar lesion as well as sternal lesion also noted.


Instruction: Generate impression based on findings.

Input: Meningioma, 6 month follow up. There is no significant interval change in size of the extra-axial enhancing left lateral skull base mass centered along the left petrous apex with extension into the cavernous sinus left prepontine cistern and along the left tentorial leaflet with associated hyperostosis and permeation of tumor into the underlying skull, as well as encasement of the left cavernous carotid artery, and mass effect with vasogenic edema in the left temporal lobe. There is also mass effect upon the left brainstem. There is no evidence of acute intracranial hemorrhage or acute infarction. The ventricles are normal in size and configuration. There is no significant midline shift. There is staphylomatous deformity of the bilateral globes. There is mild high T2 signal within the left mastoid air cells suggestive of fluid or mucosal thickening. There appears to be filler material within the bilateral nasolabial folds.

Output: No significant interval change in size of the left lateral skull base probable meningioma centered along the left petrous apex with extension into the cavernous sinus left prepontine cistern and along the left tentorial leaflet with associated hyperostosis and permeation of tumor into the underlying skull, as well as encasement of the left cavernous carotid artery, and associated vasogenic edema in the left temporal lobe.


Instruction: Generate impression based on findings.

Input: Reason: positive rotator cuff clinical exam, right shoulder instability ROTATOR CUFF: There is a diffuse increase in T2 signal of the supraspinatus and infraspinatus muscles, indicating inflammation. The supraspinatus and infraspinatus musculature appears atrophic. There is a partial tear of the articular surface of the supraspinatus tendon without retraction. No discrete tear is identified in the infraspinatus tendon. The teres minor and subscapularis muscles and tendons appear unremarkable.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: No significant abnormality noted.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: Partial tear of the articular surface of the supraspinatus tendon with atrophy and inflammation of the supraspinatus and infraspinatus musculature.


Instruction: Generate impression based on findings.

Input: There are numerous infiltrative enhancing lesions throughout the calvarium as well as in the visualized cervical spine at C1 and C2. The largest lesion is located within the frontal bone, predominantly on the left, and has a 7-mm thick component of scalp soft tissue extension along the left forehead extending posteriorly. There is also extension into the left frontal sinus as well as mild epidural extension with thickening and enhancement of the abutting dura. There is mild mass effect on the adjacent left frontal lobe.In addition, there is a relatively large right occipital enhancing lesion with scalp soft tissue and mild epidural extension. There are numerous patchy foci of T2 hyperintensity within the supratentorial and infratentorial white matter including the brainstem that are most compatible with chronic small vessel ischemic disease. There is no evidence of intraparenchymal mass or acute infarct. There is a punctate focus of susceptibility effect within the left parietal lobe which may be related to a prior chronic microhemorrhage. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is fluid within the left mastoid air cells suspected to be related to an adjacent left temporal bone lesion..

Output: 1.Numerous calvarial metastases with scalp soft tissue and intracranial epidural extension. There is enhancement of the dura particularly in the left frontal and right parieto-occipital regions which may be reactive or represent early dural invasion. There is mild mass effect on the left frontal lobe. In addition, there is invasion of the left frontal sinus. 2.There is no evidence of intraparenchymal metastases. 3.Metastatic lesions also seen at C1 and C2 in the cervical spine without mass effect on the visualized cervical cord.4.Fluid within the left mastoid air cells may be related to left temporal bone lesion.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Male 57 years old s/p OLT with elevated LFTs. ABDOMEN:LIVER, BILIARY TRACT: Status post liver transplant. There is no biliary ductal dilatation. The biliary enteric anastomosis is patent. A large amount of ascites is again seen throughout the abdomen.The portal vein and its branches are patent. The hepatic vein and IVC are patent. The anastomosis between the hepatic artery and celiac trunk is not well seen due to artifact from clips however the hepatic artery appears patent.SPLEEN: No significant abnormality noted.PANCREAS: No pancreatic lesion or pancreatic ductal dilatation is seen.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Soft tissue surrounding the head of the pancreas correlates with adenopathy that is not significantly changed compared to the prior CT.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Postoperative changes of liver transplant with patent biliary anastomosis and patent vasculature.2.Large amount of ascites.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for hemorrhage. Signs and symptoms: Left-sided weakness. Nonenhanced head CT:There is no evidence of intracranial hemorrhage, edema, mass effect, midline shift or hydrocephalus. Cortical sulci, ventricular system and all CSF cisterns remain within normal range and unchanged since prior exam. Calvarium is intact. Visualized paranasal sinuses and mastoid air cells are unremarkable. Limited images through the orbits are unremarkable. Considering provided clinical inflammation of left-sided weakness recommend follow-up with an MRI.

Output: Negative nonenhanced CT of brain and calvarium.


Instruction: Generate impression based on findings.

Input: 51-year-old female status post craniotomy for tumor resection. Presents for surveillance. Redemonstration of a right parietal craniotomy status post resection of a lesion from the right precentral gyrus. A small somewhat ill-defined focus of enhancement along the precentral gyrus appears similar to the preoperative examination. T2 hyperintensity within the gyrus is unchanged.Evidence of additional previous surgery includes a right pterional craniotomy and multiple surgical/aneurysm clips along the right sphenoid wing, multiple bilateral burr holes and placement of a posterior fossa drainage catheter. The loculated appearing subdural collection seen along the right parietal lobe on the prior examination has completely or near completely resolved. Bilateral frontal subdural collections are not significantly changed. Bilateral diffuse dural thickening and enhancement is unchanged.The previously demonstrated shunted lesion within the medial left cerebellum shows no significant interval change. As before, this lesion contains an enhancing focus which measures up to 12 mm in diameter. A nonenhancing area of T2 signal abnormality within the left middle frontal gyrus is unchanged. Scattered nonspecific foci of T2 hyperintensity are seen within the cerebral hemispheres, nonspecific but unchanged. The ventricles are stable in size and morphology.

Output: 1.Postsurgical findings are seen compatible with lesion resection from the right precentral gyrus. A small nodule of enhancement and associated T2 signal abnormality at this site appears similar to the preoperative study.2.Evidence of more remote surgical intervention is again seen including aneurysm clipping along the right sphenoid wing and placement of a drainage catheter through the left cerebellum.3.An enhancing lesion within the left medial cerebellum and a nonenhancing lesion within the left middle frontal gyrus are unchanged. No new intracranial lesions are demonstrated.4.A somewhat loculated subdural collection seen previously along the right parietal lobe has significantly improved. Bilateral frontal subdural collections are unchanged.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 66-year-old male with history of orthotopic liver transplant. Recent MRA showing patent vasculature but concern for ischemic cholangiopathy. Needs MRCP prior to proceeding with ERCP. ABDOMEN:LIVER, BILIARY TRACT: Status post hepatic transplant. No intra or extrahepatic biliary ductal dilatation. No evidence for choledocholithiasis. The biliary anastomosis is patent. The intrahepatic bile ducts are attenuated peripherally. No suspicious hepatic lesions.SPLEEN: No significant abnormality noted.PANCREAS: Parenchymal atrophy. No pancreatic ductal dilatation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral native kidneys are atrophic. Right iliac fossa renal transplant (series 1 image 50), which was not included on the prior exam are. No hydronephrosis of the transplant graft.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Trace right pleural effusion. Bibasilar patchy signal could be related to atelectasis versus infiltrates. Clinical correlation is needed.

Output: 1.No intra or extrahepatic biliary ductal dilatation. No choledocholithiasis.2.Attenuation of the intrahepatic bile ducts is nonspecific. "Pruning" of the bile ducts can be seen in chronic rejection.3.Stable bibasilar patchy infiltrates of the lung bases could represent atelectasis versus infection. Follow-up imaging is recommended.


Instruction: Generate impression based on findings.

Input: 70 year-old female with history of right lower extremity weakness. There is extensive bone marrow signal abnormality within all elements of the imaged spine and pelvis demonstrating low T1/high T2 signal and irregular enhancement after contrast administration. There are compression deformities of T12 and L5 and to a lesser extent L4 with associated increased STIR signal abnormality suggesting an acute to subacute process. There is slight retropulsion of T12, however the spinal canal and underlying cord are intact. Mild soft tissue thickening and enhancement within the ventral epidural space at L5-S1 may represent mild epidural tumor spread. There are diffuse enhancing lesions within the liver likely representing additional metastatic deposits.Multilevel degenerative changes are seen, as described below:T11-12: There is mild neuroforaminal narrowing on the right likely secondary to tumor involvement of the pedicle. No significant disc disease.T12-L1: There is mild neuroforaminal narrowing on the right likely secondary to tumor involvement of the pedicle. No significant disc disease.L1-2: No significant disc disease. The neuroforamina are patent.L2-3: There is mild annular disc bulge and facet hypertrophy. There is no significant spinal canal or neuroforaminal narrowing.L3-4: There is mild annular disc bulge and facet hypertrophy. A Schmorl's node is present within the superior endplate of L4. The spinal canal and neuroforamina are patent. L4-5: No significant disc disease. There is mild right greater than left facet hypertrophy. Mild neuroforaminal narrowing bilaterally. The spinal canal is patent.L5-S1: There is mild facet hypertrophy and annular disc bulge. There is mild neuroforaminal narrowing on the right. The spinal canal is patent.

Output: 1.Diffuse osseous metastatic disease with compression deformities at T12 and L5, and to a lesser extent, L4. There is mild retropulsion at T12 without significant spinal canal stenosis.2.Ventral epidural metastatic disease is suspected at L5-S1. There is no evidence of intrathecal metastatic disease.3.Diffuse liver metastases for which dedicated imaging is recommended.4.Relatively mild degenerative disc disease as above.


Instruction: Generate impression based on findings.

Input: Reason: new or active MS lesions? History: Worsened L-sided spasticity MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. These appear to be stable. There is subtle gyral signal hyperintensity in the left middle frontal gyrus present identified on FLAIR MRI image #27.There is redemonstration of foci of signal hyperintensity centered in the globus pallidi(5mm on the left and 3mm on the right) - image #15 of coronal T2, image #16 on axial T2 and image #17 on FLAIR with signal loss on T1 - image #17. There is no associated contrast enhancement. It is stable since 2011.No abnormal enhancing mass lesions are appreciated within the brain parenchyma. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.A cystic lesion in the high occipital scalp tissues at the junction with parietal scalp along the midline is likely a pilonidal cyst.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI orbits:The eyeballs are intact. No intraconal or extraconal space mass is identified. The extraocular muscles are intact. The lacrimal glands are symmetric and within normal limits in size and configuration. There is no optic nerve enhancement appreciated. The suprasellar cistern is intact .Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. There is multilevel disk dessication present.There is abnormal signal and loss of volume along the left posterolateral aspect of the spinal cord from the T2-3 to the T3-4 disk space levels. There is no associated contrast enhancement in the cervical spinal cord.No abnormal enhancing lesions are identified 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. There is a small centra disk protrusion at this level.At C4-5 there is no significant compromise to the spinal canal or neural foramina. There is a disk bulge at this level with associated endplate osteophytes.At C5-6 there is loss of disk space height, disk dessication and a disk bulge at this level associated with posterior ligamentous hypertrophy, bilateral uncovertebral osteophytes and endplate osteophytes. There is effacement of spinal fluid ventral and posterior to the cord. There is encroachment of the exiting nerve roots at this level.At C6-7 there is no significant compromise to the spinal canal . There is a left lateral disk protrusion at this level encroaching on the left exiting nerve roots at this level.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. The LVA is larger than the RVA.

Output: 1.Periventricular and subcortical white matter signal changes of a mild degree are present which are nonspecific. They are stable. They could be vascular related, related to demyelination, trauma, vasculitis, sarcoid. They are nonspecific. 2.The globus pallidus lesions are present but stable since the prior exam. Because the globus pallidi are vulnerable to metabolic abnormalities and many systemic or generalized disease processes and underlying metabolic or toxic (carbon monoxide fore example) process may be considered. Please correlate with the patient's clinical history.3.There is a spinal cord lesion present extending from the C2-3 disk level to the C3-4 disk level. This is compatible with demyelination.4.There are degenerative changes present in the cervical spine with moderate spinal stenosis at C5-6 and encroachment of the exiting nerve roots bilaterally at C5-6 and on the left side at C6-7.5.There is no evidence for optic neuritis identified based on this exam and no evidence for active MS in the brain, optic nerves or cervical spinal cord based on the lack of contrast enhancement.


Instruction: Generate impression based on findings.

Input: 28 year old female status post shunt internalization The intracranial catheter courses through right frontal lobe, enters the left lateral ventricle with tip terminating near the left anterior limb of the internal capsule. This catheter course is unchanged when compared to prior examination.The CSF spaces are appropriate for the patient's stated age with no midline shift or evidence of hydrocephalus.Low density change in the pons, bilateral temporal lobes, and left cerebellar folia are noted, but much better demonstrated on previous MRI.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: Unchanged position of right frontal approach ventriculostomy and unchanged ventricular sizes without evidence of hydrocephalus.


Instruction: Generate impression based on findings.

Input: 14-year-old female with history of multiple renal cysts identified on prior MRI. KIDNEYS  Cortical Echogenicity: Normal   Medullary Echogenicity: Normal   Pelvicaliceal System -- SFU Grade*  Right: 0 Left: 0  Length*** Right: 11.6 cm Left: 10.1 cm   Mean for age: 9.9 cm  Range for age: 8.6 - 11.1 cmADDITIONAL OBSERVATIONS: There is a well-defined hypoechoic lesion within the mid pole of the right kidney, which measures up to 7 mm in diameter. Multiple hypoechoic lesions are also identified within the left kidney. The largest is located in the left lower pole and measures 1.7 x 1.0 cm x 1.6.

Output: The left kidney is slightly enlarged. Multiple cystic lesions within the kidneys do not appear significantly changed from those seen on the prior MRI.*SFU grading system: Grade 0: No hydronephrosis. Grade 1: The renal pelvis is visualized. Grade 2: A few but not all of the calices are identified in addition to the renal pelvis. Grade 3: Virtually all the calices are seen. Grade 4: Grade 3 and parenchymal thinning.Fernbach SK, Maizels M, Conway JJ. Ultrasound Grading of Hydronephrosis: Introduction to the System used by the Society for Fetal Urology. Pediatric Radiology (1993) 23: 478-480.***Rosenbaum DM, Korngold E, Teele RL. Sonographic Assessment of Renal Length in Normal Children. AJR Am J. Roentgenol (1984) 142:467-469


Instruction: Generate impression based on findings.

Input: Female, 68 years old, with coma. Bilateral subdural collections are seen showing intermediate T1 signal intensity and mixed T2 signal intensity. There has been no significant interval change in size when compared to prior CT examinations. Thin subdural blood product is also evident along the interhemispheric falx and the tentorium.As on prior exams, these collections measure up to 10 mm in thickness and exerts generalized mass effect upon the brain. The sulci are effaced and the lateral ventricles are narrowed. The basilar cisterns are effaced with herniation of the medial temporal lobes across the tentorial incisure.Patchy restricted diffusion is evident within the midbrain and pons. There is some associated patchy susceptibility within the pons as well which may reflect petechial hemorrhage versus vascular engorgement. Very subtle restricted diffusion is also seen within the posterior medial left temporal lobe and to a mild degree within the left medial occipital lobe, better seen on the ADC map. The midbrain and pons are edematous resulting in crowding of the posterior fossa structures. The fourth ventricle is nearly completely effaced.On postcontrast images, there appears to be a developmental venous anomaly within the pons. No other pathologic intracranial enhancement is seen.

Output: 1.Bilateral subdural hemorrhages are stable in size.2.Generalized mass effect upon the brain is seen with crowding of the sulci and partial effacement of the lateral ventricles. The medial temporal lobe parenchyma is herniating to a mild degree across the tentorial incisure. This contributes to crowding and mass effect upon the brainstem.3.Patchy restricted diffusion is seen within the midbrain and pons compatible with ischemia. The pontine signal abnormality associated with patchy susceptibility which could represent small Duret hemorrhages or possibly just vascular engorgement.4.The pons is edematous which contributes to crowding of the posterior fossa structures. The fourth ventricle is partially effaced.5.Very mild restricted diffusion is seen within the posterior medial left temporal lobe and medial left occipital lobe compatible with developing ischemia.The finding of medial temporal lobe herniation was text-paged to Dr. Dellaria at 3:20 PM on 6/28/15.


Instruction: Generate impression based on findings.

Input: Clinical question: Remote ischemia. Signs and symptoms: Lower extremity weakness. Nonenhanced head CT:There is no evidence of intracranial hemorrhage, edema, mass effect, midline shift or hydrocephalus. CT is insensitive for early detection of acute ischemic strokes. If clinical concern persists an MRI examination is recommended.The cortical sulci, ventricular system, CSF cisterns and gray -- white matter differentiation remains within normal.Calvarium is intact.Mastoid air cells and middle ear cavities are unremarkable and well pneumatized.Extensive bilateral ethmoid sinus disease and near complete opacification of right maxillary sinus a been limited view of paranasal sinuses.

Output: 1.No evidence of acute intracranial findings. Please see above comments.2.Extensive chronic sinus disease.


Instruction: Generate impression based on findings.

Input: 59 year old female patient with persistent jaundice two weeks after ERCP for choledocholithiasis. Evaluate for etiology of hyperbilirubinemia, extrahepatic vs intrahepatic. ABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis without evidence of acute cholecystitis. There is very mild intrahepatic biliary ductal dilatation, which is best seen on the portal venous phase. No extrahepatic biliary ductal dilatation. No foci of signal void are seen within the common bile duct to suggest choledocholithiasis. No suspicious hepatic lesion is identified. The hepatic vasculature is patent. SPLEEN: No significant abnormality noted.PANCREAS: No evidence of acute pancreatitis. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: There is a T2 hyperintense exophytic lesion measuring 2.8 x 3.2 cm within the midpole of the left kidney with probable internal septations and without appreciable enhancement (image 38, series 6). An additional subcentimeter T2 hyperintense lesion in left lower pole likely represents a cyst. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Very mild intrahepatic biliary ductal dilatation without other acute abnormality to account for the patient's symptoms.2.Cholelithiasis without evidence of cholecystitis.3.Left renal cystic lesion with internal septations; this can be followed on ultrasound in 6-8 months.


Instruction: Generate impression based on findings.

Input: Reason: s/p rotator cuff repair, biceps tenodesis eval for re-rupture following fall History: s/p rotator cuff repair, biceps tenodesis eval for re-rupture following fall. Slightly limited examination due to motion artifact and metallic artifact on multiple sequences. ROTATOR CUFF: Metallic artifact within the humeral head and proximal humerus compatible with history of rotator cuff repair and biceps tenodesis.Full thickness tear of the supraspinatus tendon with retraction. The infraspinatus, subscapularis, and teres minor are grossly intact. Diffuse fatty atrophy of the rotator cuff muscles. SUPRASPINATUS OUTLET: Moderate AC joint osteoarthritis. Small amount of fluid within the subacromial/subdeltoid bursa. Small joint effusion. GLENOHUMERAL JOINT AND GLENOID LABRUM: Moderate osteoarthritis of the glenohumeral joint. Diffuse thinning of the glenohumeral joint articular cartilage. Irregularity of the anterior and posterior labrum compatible with degeneration. BICEPS TENDON: Postsurgical changes of a biceps tenodesis. The common biceps tendon is visualized at its insertion on to the radial tuberosity although cannot be followed in its entirely to the site of tenodesis. ADDITIONAL

Output: 1.Postsurgical changes of rotator cuff repair with full thickness tear of the supraspinatus with retraction. Diffuse rotator cuff muscle atrophy.2.Postsurgical changes of a biceps tenodesis. The common biceps tendon is visualized at its radial tuberosity insertion although cannot be followed in its entirely to the site of tenodesis.3.Findings compatible with adhesive capsulitis.4.Degenerative arthritic changes as described above.


Instruction: Generate impression based on findings.

Input: AMS, ischemic CVA in 2012, and atrial fibrillation. There is encephalomalacia in the left middle frontal gyrus and periventricular region and left temporo-occipital region. There is mild ex vacuo dilatation of the left lateral ventricle. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Chronic infarcts in the left middle cerebral artery watershed zones, but no evidence of acute intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: Melanoma Again seen are are small foci of signal void within the lateral soft tissues adjacent to the fibular head presumably representing artifact from prior surgical intervention. Scarring with minimal enhancement is seen within the soft tissues lateral to the fibular head appearing similar in extent to the prior exam. No enhancing masses are identified.There is a small joint effusion extending posteromedially into a Baker's cyst. There is mild nonspecific subcutaneous edema along the anterior aspect of the patellar tendon. There is prominence of the lateral head of the gastrocnemius which may reflect herniation through the deep fascia, but this appears similar to the prior study. Osteoarthritis affects the knee. The bone marrow signal intensity otherwise appears normal.

Output: Surgical scarring along the fibular head without evidence of residual or recurrent disease.


Instruction: Generate impression based on findings.

Input: 72-year-old male status post stereotactic radiosurgery for an occipital metastasis. An irregular, peripherally enhancing lesion is present in the right occipital lobe measuring 33 x 23 x 23 mm. The lesion is somewhat T2 hypointense centrally with superimposed internal susceptibility consistent with hemosiderin staining. Confluent T2 hyperintense signal is evident in the adjacent white matter compatible with edema. Single and multivoxel spectroscopy with an intermediate TE of 144 was performed on the lesion and on contralateral normal tissue. A large voxel which encompassed the enhancing rim and nonenhancing core of the right occipital lesion demonstrated a prominent lipid-lactate peak, with relative slight increased choline with respect to the normal side, as well as moderately decreased NAA. A smaller voxel which encompassed predominantly the enhancing rim showed reduction of all major metabolites. Multi voxel spectroscopy performed of the right and left occipital regions showed no worrisome choline elevation at any point within or adjacent to the lesion. rCBV mapping showed low blood volume over a majority of the enhancing portions of the lesion.No additional enhancing lesions are seen. Mass effect from the lesion induced edema results in local sulcal effacement and partial effacement of the right ventricular atrium and the right temporal horn. No midline shift or brain herniation is detected. Numerous small non specific foci of T2 hyperintensity as seen scattered throughout the brain. Mild cerebellar atrophy is suspected.

Output: Right occipital ring-enhancing lesion with spectroscopy and relative cerebral blood volume findings which favor radiation necrosis/injury over recurrent viable tissue.


Instruction: Generate impression based on findings.

Input: 85 year-old female with facial asymmetry and left hand weakness. There is redemonstration of a left temporal craniotomy with underlying extensive encephalomalacia in the left frontotemporal and ex vacuo dilatation of the left lateral ventricle, unchanged when compared to the previous study. There is no new parenchymal lesion or CT evidence of acute territorial ischemia. MRI would be more sensitive for small or acute infarctions.There is no acute intracranial hemorrhage or extraaxial collection. The ventricles and sulci are stable with ex vacuo dilation of the left lateral ventricle as noted earlier. No midline shift or basal cistern effacement.The visualized mastoid air cells and paranasal sinuses are within normal limits. Orbits unremarkable. Redemonstration of debris within the extra auditory canals bilaterally.

Output: 1. No evidence of acute intracranial hemorrhage or CT evidence of acute territorial ischemia. MRI is offered as a more sensitive test should there be a high degree of suspicion for acute infarction.2. Stable left temporal lobe encephalomalacia underlying prior craniotomy site consistent with prior left MCA infarct.


Instruction: Generate impression based on findings.

Input: 56-year-old male with syncope evaluate for hemorrhage. High attenuation, well-defined lesion within the left thalamus measuring approximately 8 mm x 8 mm without surrounding edema is suspicious for hemorrhage however cavernoma may have a similar appearance. MRI is recommended for further characterization.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and right mastoid air cells are normally pneumatized with left mastoid air cell opacification.

Output: Left thalamic high attenuation lesion is suspicious for hemorrhage, however, cavernoma may have a similar appearance and MRI is recommended for further characterization.


Instruction: Generate impression based on findings.

Input: Advanced degenerative changes are partially visualized in the cervical spine on localizer images. Thoracic vertebral column alignment is within normal limits. There is minimal anterior wedging of the T7, T8 and T9 vertebral bodies. The vertebral body heights are otherwise preserved. There is multilevel degenerative endplate bone marrow signal alteration and multilevel disc desiccation and loss of disc height throughout the upper and mid thoracic spine with vacuum disc phenomenon at multiple levels. Minimal disc-osteophyte complexes are present throughout the thoracic spine, but there is no significant spinal canal stenosis. The thoracic spinal cord displays normal signal and morphology. There is a large heterogeneous right thyroid lobe mass. There are bilateral pleural effusions and posterior pulmonary consolidations. The atrophic right kidney is partially imaged, but contains multiple probable renal cysts. There is a large staghorn calculus left renal collecting system.

Output: 1. Multilevel degenerative disc-osteophyte complexes without spinal canal compromise, but no specific findings to suggest discitis-osteomyelitis or epidural abscess.2. Large heterogeneous right thyroid lobe mass. 3. Large staghorn calculus left renal collecting system.4. Bilateral pleural effusions and posterior pulmonary consolidations.


Instruction: Generate impression based on findings.

Input: Diagnosis: Sarcoidosis of other sitesClinical question: Eval for sarcoid lesionsSigns and Symptoms: headaches The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. These are stable compared to the prior exam additional punctate T2 and FLAIR hyperintense lesions are present in the brainstem which were also present on the prior exam as well. The preferentially affecting the right pons.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. There is stable compared to the prior exam. Additional lesions in the brainstem are also thought to be vascular related and stable since the prior exam.2.There is no convincing evidence for neurosarcoid on this exam. Please note that neurosarcoid may be present in the absence of MR findings.


Instruction: Generate impression based on findings.

Input: 84-year-old male with metastatic prostate cancer Examination is limited due to motion artifact.ABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy. No focal liver lesions. No intrahepatic or extrahepatic biliary ductal dilatation. The hepatic vasculature appears patent. Hepatic steatosis. SPLEEN: Probable splenule.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple hyperintense renal cysts are noted bilaterally appearing similar to the prior exam.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Post surgical changes of the right lower quadrant ileal conduit.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Stable examination without evidence of recurrent or metastatic disease.


Instruction: Generate impression based on findings.

Input: Known left upper inner breast IDC/DCIS. Question of additional lesions at 10:00 and 11:00. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.There are multiple enhancing masses/foci in the left breast. This includes the index mass in the upper inner quadrant, which is seen as a 1.0 x 1.5 x 1.5 cm spiculated mass with artifact from the Hydromark biopsy clip. Additionally, a 0.8 cm mass in the far posterior depth of the left upper outer breast is the likely correlate to the additional finding seen on mammograms. Morphologically, this may represent a lymph node, though a clear fatty hilum is not seen. Finally, a 0.5 cm avidly enhancing focus is present in the central left breast, at the anterior aspect of fainter foci/non-mass enhancement. No abnormal enhancement is seen medial to the index lesion, and the mammographic appearance medially may have been the result of tissue overlap. In the right central breast, there is linear non-mass enhancement extending 2.2 cm AP. No abnormal axillary lymph nodes are identified in either axillary region.

Output: 1. Multiple findings in the left breast: -Biopsy proven index cancer in the upper inner quadrant measuring up to 1.5 cm.-5 mm avidly enhancing focus for which MRI directed ultrasound is recommended. If no correlate is seen, MRI guided biopsy will be necessary.-Additional mass which may be a lymph node in the posterior depth of the upper outer breast. This mass is likely the correlate for the additional mammographic finding. MRI directed ultrasound is recommended to evaluate for this mass, and to determine morphology if this is in fact a lymph node. 2. Linear non-mass enhancement in the right breast for which MRI guided biopsy is recommended. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Patient with history of pituitary macroadenoma, please evaluate for interval change History: history of visual field loss on the left. Again noted is macroadenoma of the pituitary gland, measuring minimally larger compared to prior exam of 11/22/2010. For example, on midline sagittal images, the lesion measures 23 x 24 mm in the AP and craniocaudal dimensions, as compared to 19 x 21 mm on the prior exam. The lesion demonstrates suprasellar extension and mass effect on the left aspect of the optic chiasm, similar to prior. There is abnormal T2 signal within the left optic nerve, which was previously present.Pituitary macroadenoma abuts the cavernous sinuses, right greater than the left, with no clear evidence of invasion. Flow voids for cavernous segment internal carotid arteries are present. The remodeling of the floor of the sella is unchanged. Visualized paranasal sinuses are clear.

Output: Pituitary macroadenoma measures minimally larger as compared to prior exam of 11/22/2010, with unchanged mass effect on the left aspect of the optic chiasm and unchanged signal abnormality the left optic nerve.


Instruction: Generate impression based on findings.

Input: Metastatic brain lesions. Follow-up evaluation. Again seen are postsurgical changes of left frontal and left temporal craniotomy for tumor resection. There is encephalomalacia involving the left frontal lobe with T2/FLAIR hyperintensity compatible with gliosis which is unchanged. There is extra-axial dural based thickening in the surgical bed measuring which remains unchanged and likely representing granulation tissue. Again seen is an area of increased T2/FLAIR signal in the cortex and subcortical white matter of the left anterior temporal lobe similar to prior. There is a punctate focus of enhancement along the surface of the left temporal lobe which measures up to 6 mm and not significantly changed since at least 7/29/2015 allowing for slight differences in technique. This lesion is not seen on several earlier studies although corresponds to a site of an enhancing lesion on 3/2/2011.No new mass or mass-effect. No abnormal parenchymal or abnormal meningeal enhancement elsewhere in the brain is seen. No hydrocephalus. No evidence of acute ischemia or hemorrhage. Major flow-voids are preserved. Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear.

Output: 1.Stable postoperative changes related to resection of a metastatic lesion with stable areas of encephalomalacia/gliosis in the anterior left frontal lobe. Adjacent extra-axial enhancing area remains unchanged and likely represents scarring.2.No new or enlarging lesions to suggest progression of metastatic disease.3.Again seen is T2/FLAIR hyperintensity in the anterior left temporal lobe and adjacent nodular focus of enhancement measuring up to 6 mm, which is not significantly changed since at least 7/29/2015 and corresponds to a site of prior treated/resected lesion in 2011. Recommend continued attention on follow-up.


Instruction: Generate impression based on findings.

Input: 63-year-old man with history of rising PSA and Gleason 6 prostate adenocarcinoma in the right mid gland. PELVIS:PROSTATE:Prostate Size: 40 x 33 mm.Peripheral Zone: Within the right lateral prostatic base (1201/19) there is a 9 x 6 mm area of T2 hypointense signal with diffusion restriction and enhancement. Very small foci of T1 signal noted, likely blood products from prior biopsy.Central Gland: No significant abnormality noted.Seminal Vesicles: Seminal vesicles are unremarkable.Extracapsular Extension: No evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Signal abnormality in the right lateral prostatic base suspicious for tumor.


Instruction: Generate impression based on findings.

Input: Brain: Scattered hyperattenuating foci within the left temporoparietal lobe, frontal lobe, basal ganglia, and midbrain tegmentum likely represent small intraparenchymal hematomas/contusions. Trace blood product is also seen within the interpeduncular cistern. Trace subdural blood product is suspected along the right pterion. Areas of parenchymal hemorrhage on the straight mild edema. However, no significant generalized mass effect or brain Abnormal T2 hyperintensity is present within the bilateral frontal lobes (left much greater than right), left bilateral temporal lobes (left much greater than right), anterior body of the corpus callosum, bilateral basal ganglia including prominence of the posterior limbs of the internal capsules, as well as within the midbrain. Associated susceptibility hypointensity of corresponding hemorrhage or microhemorrhage is present involving the left frontal lobe, temporal lobe, corpus callosal, basal ganglia, and midbrain abnormality consistent with grade 3 exam axonal injury. There is mild medialization of the left uncus. Otherwise basilar cisterns are maintained. Redemonstrated is trace subdural hemorrhage along the right pterion. Interpeduncular cisternal hemorrhage is less apparent.Calvarial fractures and sutural diastases are better demonstrated on previous CT.The cerebellar tonsils are in normal position. The pituitary gland is normal in size. Flow voids are present within the major vessels indicating patency. Cervical spine:Straightening of the cervical spine is likely positional. There are no fractures or subluxations. The marrow signal is benign. There is mild increased T2 signal within portions of the skin as well as the immediately underlying superficial musculature at the approximate C3 and C4 levels suggesting mild subcutaneous injury. There are no MRI findings of ligamentous injury. The cervical cord is normal in signal. There are no osseous dysplasias or stenoses.Thoracic spine:There is a normal thoracic kyphotic curve. The vertebral body heights and disc spaces are maintained. Marrow signal intensity is benign throughout. The spinal cord has a smooth contour and is without focal atrophy, edema, or myelomalacia. There is increased T2 signal within portions of the skin as well as underlying superficial musculature at the approximate T4-T7 levels. Additionally, there is more significant skin and subcutaneous T2 hyperintensity centered in the midline spanning the levels from approximately T9 though L3. There are no osseous dysplasias or stenoses.Lumbar spine:Alignment is anatomic. There are no fractures or subluxations. The marrow signal is benign. The conus is normal in signal and morphology and terminates at an appropriate level. There is mild increased T2 hyperintensity within the paraspinal musculature from approximately L2 through S2 without interspinous ligamentous injury. Note is made of partial lumbarization of S1 with a rudimentary disc at S1/2. There are no osseous dysplasias or stenoses.

Output: 1.Brain MRI findings consistent with grade 3 axonal injury as described in detail above.2.There is mild medialization of the left uncus, otherwise basilar cisterns are maintained. 3.Redemonstrated is trace subdural hemorrhage along the right pterion4.No MRI evidence of spinal cord injury.5.MRI findings consistent with skin, subcutaneous, and paraspinal muscular injury of the spine as described in detail above without definitive ligamentous injury.


Instruction: Generate impression based on findings.

Input: Dysarthria [784.51], Reason for Study: ^Reason: SINUS THROMBOSIS History: HEADACHE Brain MRI:No evidence of acute ischemic or hemorrhagic lesion.There are extensive patchy high signal intensity lesions on periventricular white matter on FLAIR images indicate nonspecific small vessel ischemic disease. In addition, there is a slitlike tissue defect on the left basal ganglia with hemosiderin deposition indicating chronic hemorrhagic infarct with encephalomalacia.Right gyrus rectus and right side lower pons also shows encephalomalacia.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. 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.MRV:3D MRV brain Phase Contrast MRV and post-gadolinium with maximum intensity projections of the superficial/deep intracranial venous drainage demonstrate normal superior sagittal sinus, right transverse sinuses, sigmoid sinuses, internal cerebral veins, vein of Galen and straight sinus. The left transverse sinus, sigmoid sinus and jugular bulb appear to be hypoplastic without evidence of intraluminal filling defect or occlusion of venous drainage pathway.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. Extensive non specific small vessel ischemic disease with multifocal encephalomalacia as described above.3. No evidence of dural sinus thrombosis.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for progression of known GBM, new cranial nerve involvement. Signs and symptoms: Fossa bulge. Pre-and post-enhanced brain MRI:Diffusion weighted images demonstrate patchy irregular foci of restricted diffusion surrounding patient's known right hemispheric tumor.This finding is nearly identical to prior exam from January of 2015.Examination demonstrates post operative changes of a right-sided frontal -- temporal craniotomy and resection of a large segment of right anterior and mid temporal lobe similar to prior exam.A CSF signal intensity surgical cavity at the site of surgical resection remains identical in size and signal intensity to prior exam.Significant flair hyperintensity posterior to the surgical cavity in the right posterior temporal lobe and with extension to the right occipital lobe and splenium of corpus callosum with extension across the midline remain grossly identical to prior exam. There is no evidence of an acute new finding since prior study.Post enhanced images demonstrate a solid thick band of enhancement along the posterior edge of surgical cavity in the right posterior temporal lobe and extending along the medial aspect of the resection cavity along the medial aspect of left temporal lobe which demonstrate no appreciable change.Post enhanced images also demonstrate extensive nodular pattern of enhancement posterior to the surgical cavity in the right posterior temporal -- occipital region. Compared to prior exam there is increased nodularity of foci of enhancement. This observation could possibly be technique related. Ill-defined patchy enhancement of corpus callosum demonstrate no convincing evidence of change. Mild to moderately enlarged lateral ventricles (right greater than left demonstrate no significant change.There is no detectable foci of parenchymal signal abnormality or enhancement.

Output: 1.No convincing evidence of an acute or definite acute new finding since prior exam.2.Stable residual enhancing tumor in the right posterior temporal lobe with extension into the splenium of corpus callosum and along the medial aspect of left temporal lobe in signal intensity, extent, size and pattern of enhancement. Please see above comments.


Instruction: Generate impression based on findings.

Input: History of lung cancer. Altered mental status. Examination demonstrates numerous enhancing lesions with surrounding vasogenic edema in the bilateral cerebral and cerebellar hemispheres and in the right cerebral peduncle. Some of the lesions appear hyperdense on the precontrast images. No significant mass effect, midline shift or abnormal extra-axial fluid collection is identified. The ventricles are normal in size and are symmetric.Incidental finding is a soft tissue lesion within the sella. After reviewing the prior MRI date dated 1/25/07, it is considered either an adenoma or cyst involving the pituitary stalk. Visualized paranasal sinuses and mastoid air cells are normally pneumatized. The calvarium is intact.

Output: 1.Multiple hemorrhagic metastatic lesions in light of the clinical history provided. 2.Likely an adenoma or cyst in the pituitary stalk.


Instruction: Generate impression based on findings.

Input: Female, 59 years old, with Horner's, dysphagia, and headaches. A few scattered small foci of T2 hyperintensity are demonstrated within the cerebral hemispheres. Small bilateral foci of T2 hyperintensity are also seen within the medulla at the level of the medullary olives which, although not mentioned on prior examinations, have been present since at least 2009.No new lesions are detected. No evidence of restricted diffusion, parenchymal edema or mass effect is seen. No intracranial hemorrhage is suspected. Ventricles remain normal in size and shape.Anterior cervical fusion instrumentation is partial visualized. The marrow signal characteristics are otherwise unremarkable. Atrophy or absence of the right parotid is a stable finding.

Output: No significant interval change is seen in several scattered nonspecific foci of T2 hyperintensity in the brain, including two foci at the level of the medullary olives which, although not mentioned on prior examinations, have been present since at least 2009.


Instruction: Generate impression based on findings.

Input: 39 years Female (DOB:1/20/1977)Reason: evaluate for cause of headache in patient with unevaluated headaches and family history of brain tumor History: headachesPROVIDER/ATTENDING NAME: NAOUM P ISSA NAOUM P ISSA MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is very small. The posterior communicating arteries are very small.. The vertebral arteries are similar in size.

Output: 1.No evidence for cerebrovascular occlusive disease.2.No evidence for intracranial aneurysm.3.No evidence for acute ischemic cerebral infarction or intracranial mass


Instruction: Generate impression based on findings.

Input: 65-year-old male with history of elevated PSA. PELVIS:PROSTATE:Prostate Size: The prostate measures 4.4 x 2.9 x 3.9 cm.Peripheral Zone: In the right midgland/base anteriorly there is a lesion measuring 15 x 8 mm demonstrating decreased T2 signal with associated restricted diffusion as well as rapid enhancement and washout following contrast administration. There is a focal area of capsular indistinctness which may represent extracapsular spread.A second wedge-shaped lesion with decreased T2 signal with no restricted diffusion measures 11 x 5 mm.Central Gland: Small hyperplastic nodules compatible with BPH.Seminal Vesicles: No significant abnormality.Extracapsular Extension: There is a focal area of capsular indistinctness which is suspicious for extracapsular spread.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Right midgland/base lesion with a focus of extracapsular spread highly suspicious for adenocarcinoma.2.Left midgland wedge-shaped lesion is indeterminant and may represent prostatitis or a low grade lesion.


Instruction: Generate impression based on findings.

Input: Low back pain with pseudoclaudication. Evaluate for spinal stenosis. There is Grade 1 anterolisthesis of L3 on L4 measuring approximately 6 mm, previously 5 mm. The vertebral body heights are preserved. There is mild loss of disc height at L3-L4. There is disc desiccation at L2-L3 and L3-L4. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The distal spinal cord and conus are within normal limits with the conus terminating at the L2 level. There are postoperative changes in the lower lumbar spine with posterior soft tissue edema at L3-L4.T12-L1: No significant disc bulge, spinal canal or foraminal stenosis. L1-L2: No significant disc bulge, spinal canal or foraminal stenosis. L2-L3: Progression of disc bulge, posterior epidural fat and bilateral facet degeneration, contributing to mild spinal canal stenosis and moderate right and mild left foraminal stenosis. L3-L4: Status post laminectomy. Grade 1 anterolisthesis of L3 on L4, pseudo disc bulge, and bilateral facet degeneration, contributing to moderate to severe bilateral foraminal stenosis. L4-L5: Status post laminectomy. Bilateral facet degeneration, contributing to unchanged mild right and mild to moderate left foraminal stenosis. No significant spinal canal stenosis.L5-S1: Mild disc bulge with superimposed new central disc protrusion, contributing to mild bilateral foraminal stenosis. No significant spinal canal stenosis.

Output: 1. Evidence of remote L3-L4 and L4-L5 laminectomies. 2. Degenerative changes of the lumbar spine with progression of disc bulge and posterior epidural fat at L2-L3, contributing to increased mild spinal canal stenosis and moderate right and mild left foraminal stenosis. 3. Grade I anterolisthesis of L3 on L4, contributing to moderate to severe bilateral foraminal stenosis. 4. Multilevel facet arthropathy which may be contributing to patient's back pain.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 40 years old Reason: pelvic mass- uterine fibroids History: mass, hydroureter. PELVIS:UTERUS, ADNEXA: The uterus is enlarged measuring 15.8 x 13.8 x 10.8 cm (series 601, image 20; series 401, image 39). There is a 12.0 x 10.5 x 12.6 cm intramural mass which is heterogeneously T2 hypointense with some small areas of T2 hyperintensity, likely reflecting cystic degeneration. There is deviation of the endometrial cavity to the left side. Postcontrast imaging demonstrates progressive enhancement of the lesion which is consistent with a large uterine fibroid. Both ovaries are unremarkable.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.There is a 12.6 cm enhancing lesion within the uterus which is consistent with an intramural fibroid.


Instruction: Generate impression based on findings.

Input: Chiari, neck and back pain. The cerebellar tonsils are minimally low-lying, up to 3 mm inferior to the foramen magnum. The cerebellar tonsils demonstrate rounded morphologies. The vertebral column alignment is within normal limits. The vertebral body heights are preserved. There are small posterior disc-osteophyte complexes at multiple levels of the cervical spine and lumbar spine, but no significant spinal canal stenosis. There are also postoperative findings at the L5-S1. The spinal cord displays normal signal and morphology. The cauda equina nerve roots are unremarkable. There is an incompletely characterized left renal lesion that measures up to 12 mm. The paravertebral soft tissues are unremarkable.

Output: 1. Minimally low-lying cerebellar tonsils with normal rounded morphology.2. No evidence of syringohydromyelia.3. Incompletely characterized left renal lesion. A renal ultrasound may be useful for further evaluation.


Instruction: Generate impression based on findings.

Input: 61-year-old female with metastatic colon cancer to liver. ABDOMEN:LIVER, BILIARY TRACT: Status post left hepatectomy. Multiple T2 hyperintense cystic lesions scattered toward the liver are not significantly changed when compared to the prior exam. There is no new focal lesion. There is trace perihepatic fluid. There is mild restricted diffusion along the liver capsule and abdominal wall peritoneum with corresponding postcontrast enhancement without definite nodule or mass.SPLEEN: There is linear focus of restricted diffusion along the peritoneum adjacent to the spleen with corresponding postcontrast enhancement.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: High T2 signal, enhancing lesion within the L1 vertebral body is unchanged.

Output: 1.Linear foci of restricted diffusion along the liver capsule and along the abdominal wall peritoneum, particularly adjacent to the spleen, with corresponding postcontrast enhancement is suspicious for carcinomatosis.2.Status post left lobectomy and unchanged T2 hyperintense cysts. No new liver lesions.


Instruction: Generate impression based on findings.

Input: The cervical spine is in normal alignment, with straightening of the normal cervical lordosis. There is mild disc narrowing at C5-C6 with disc desiccation. The vertebral body and disk heights are otherwise well-maintained. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal. There is no pathological enhancement.Very mild mid to lower cervical disc degeneration is noted with trace disc bulges from C4-C5 through C6-C7 and up to mild-moderate central spinal canal stenosis at C5-C6 and minimal right foraminal narrowing at C6-C7. There is no significant spinal canal or foraminal stenosis within the remainder of the cervical spine.

Output: No MR evidence of syringohydromyelia. Mild cervical spondylotic changes.


Instruction: Generate impression based on findings.

Input: Female, 57 years old, status post C5 corpectomy and instrumentation with arm weakness. Surgical findings are evident consistent with C5 corpectomy and interbody spacer placement as well as instrumented fusion from C4 through C6. The retropharyngeal tissues are thickened and edematous from C2 through C4. Paraspinal soft tissues are otherwise unremarkable.The remaining vertebral bodies demonstrate normal morphology and signal characteristics. Spinal alignment is grossly anatomic. No pathologic marrow enhancement is seen.The visualized spinal cord shows normal signal intensity and morphology. No pathologic intracanalicular enhancement is detected.C2-3: Unremarkable. C3-4: Mild left facet hypertrophy. Minimal posterior disk osteophyte formation. No significant spinal canal stenosis or neuroforaminal narrowing.C4-5: Corpectomy. No significant spinal canal or neuroforaminal stenosis. C5-6: Corpectomy. No significant spinal canal or neuroforaminal stenosis. C6-7: No significant spinal canal or neuroforaminal stenosis. C7-T1: Unremarkable.

Output: 1. Postoperative findings consistent with C5 corpectomy and instrumented anterior fusion from C4 through C6. The osseous structures of the cervical spine are otherwise intact and unremarkable.2. No evidence of any other findings which would account for the patient's weakness.


Instruction: Generate impression based on findings.

Input: The lower lumbar spine is congenitally narrowed on the basis of pedicle hypoplasia. There is minimal retrolisthesis of L4 on L5. There is no focal high-grade stenosis. There are no fractures or subluxations. There is a nonspecific focus of T1 hyperintensity in the T11 vertebral body. The conus is normal in signal and morphology and terminates at the L2 level. The visualized intra-abdominal and paraspinal contents are unremarkable.T12/L1: No significant spinal canal or neuroforaminal narrowing.L1/2: No significant spinal canal or neuroforaminal narrowing.L2/3: No significant spinal canal or neuroforaminal narrowing.L3/4: Mild diffuse disc bulge with minimal spinal canal narrowing and mild bilateral neuroforaminal narrowing.L4/5: There is a left paracentric disc protrusion with effacement of the left lateral recess, which may be impinging the traversing left L5 nerve root. No significant focal high-grade stenosis in the spinal canal or neuroforamina.L5/S1:There is a central disc protrusion without significant spinal canal or neuroforaminal narrowing.SI joints: There is a presumed bone island adjacent to the right SI joint in the right ileum.

Output: 1.Minimal retrolisthesis of L4 on L5 with a left paracentric disc protrusion with effacement of the left lateral recess, which may be impinging on the traversing left L5 nerve root. 2.Congenitally narrowed lower lumbar spine on the basis of pedicle hypoplasia. Otherwise no significant central canal stenosis is appreciated in the lumbar spine.3.Focus of T1 hypointensity and T2 hyperintensity in the T11 vertebral body may represent an atypical hemangioma but is nonspecific.


Instruction: Generate impression based on findings.

Input: Daily worsening migrainous headache with dizziness. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is a right parietal lobe developmental venous anomaly. The brain parenchyma otherwise appears 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 orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. No evidence of intracranial hemorrhage, mass, or acute infarct. 2. Incidental right parietal lobe developmental venous anomaly.


Instruction: Generate impression based on findings.

Input: 58 year-old woman with history of breast cancer. Now with headache Low attenuation area identified in the left parietal area (image 20, series 514) at the level of the corona radiata is identified. An additional low density lesion is identified in the deep white matter in the posterior frontal area in the region of the precentral gyrus is seen. Given patient's history, metastases does remain a possibility and follow-up MRI is recommended.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Two areas of low attenuation in the left parietal area and in the deep white matter of the precentral gyrus. Given the patient's clinical history the findings may represent metastatic disease. Follow up MRI with contrast is recommended as clincally indicated.


Instruction: Generate impression based on findings.

Input: The risks (including, but not limited to, those of bleeding, infection, allergic reaction, temporary nerve block, pain, and inability to access the joint) and benefits of the procedure were explained to the patient, and informed written consent was obtained. A pre-procedural “time-out” form was completed.The patient was placed supine on the fluoroscopy table. The right hip was localized fluoroscopically, and a spot radiograph was obtained. The course of the femoral artery was noted on the patient's skin using an ink marker. The skin was cleansed and covered with a sterile drape. The skin and subcutaneous tissues were anesthetized with 1% lidocaine using 25-gauge and 22-gauge needles.Under fluoroscopic guidance, a 20-gauge spinal needle was advanced into the joint. Attempted aspiration yielded no fluid. Next, 10 ml of a 50/50 mixture of Omnipaque 240 (to confirm the intra-articular position of the needle) and dilute Multihance (0.1 cc in a 10 cc vial of saline, for subsequent MR imaging) were injected into the joint. Contrast opacified the joint in the expected manner. A spot radiograph was obtained for documentation. The needle was withdrawn. Blood loss was negligible (<1cc), and patient tolerated the procedure well without immediate complication. An adhesive bandage was placed on the patient’s skin. Routine post procedure instructions were communicated to the patient. The patient was escorted to the MRI suite for further imaging in stable condition. Please refer to the subsequent MRI report for further information.Exposure time: 9 seconds

Output: Successful fluoroscopically guided right hip injection.


Instruction: Generate impression based on findings.

Input: Clinical question: Hemorrhage. Signs and symptoms: Seizure this a.m. Old left cerebellar stroke is again identified and no change. No new findings within the posterior fossa.Images through the supratentorial space are again demonstrates large area of vasogenic edema in the left frontal -- parietal region with a high density mass. Review of prior examination (MRI of brain from 7 -- 16 -- 2009) reveal presence of a metastatic tumor in the left occipital posterior parietal region. Direct comparison for size is not possible since no post infusion images were obtained. There is no evidence of hemorrhage with this mass. Extensive vasogenic pattern of low density in the right hemisphere is also noted which may represent postradiation edema. The ventricular system and supratentorial space are slightly prominent and may represent underlying parenchymal volume loss. This finding however remains relatively stable since prior study. Postoperative changes of left frontal -- parietal craniotomy. Further evaluation with a post infusion study is recommended. In comparison with prior non-infused CT examination from 6 -- 17 -- 2009 the mass appears to slightly larger.

Output: 1.Left parietal mass which appears a slightly larger on this non-infused study since the prior examination from 6 -- 17 Ash 2009.2.No evidence of hemorrhage.3.Extensive vasogenic edema left hemisphere. No hydrocephalus or midline shift.


Instruction: Generate impression based on findings.

Input: Seven year old male evaluate for facial fracture/ICH CT of brain.No evidence of calvarial fracture is identified. Mastoid air cells and paranasal sinuses are unremarkable. No evidence of intracranial post traumatic finding. No evidence of edema, mass effect, hemorrhage, midline shift is detected. There is however a slight prominence of the lateral ventricles which although may be within normal limits possibility of hydrocephalus cannot be entirely ruled out an MRI examination is recommended.CT of the maxillofacial region.The paranasal sinuses are well pneumatized. The regional maxillofacial demonstrate no evidence of fracture. No definitive evidence of any soft tissue abnormality is detected.

Output: 1.No evidence of maxillofacial fracture.2.No evidence of post traumatic findings on CT of brain.3.Slight prominence of lateral ventricles as detailed.


Instruction: Generate impression based on findings.

Input: Altered mental status, parkinsonian dementia. History of cirrhosis. There is no MR evidence of acute ischemic or hemorrhagic lesion on this scan.On FLAIR images, there are scattered bihemispheric white matter high signal intensity lesions indicating possible nonspecific small vessel ischemic disease.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: No evidence of acute ischemic or hemorrhagic lesion.No evidence of abnormal enhancement.Scattered high signal intensity lesions on FLAIR images possible non specific small vessel disease as described above.


Instruction: Generate impression based on findings.

Input: 58 years Male (DOB:7/30/1958)Reason: back pain History: back painPROVIDER/ATTENDING NAME: RANIER T GULOY MAGDALENA ANITESCU 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 levocurvature present to the lumbar spine which is centered at approximately L3 there is mild left lateral translation of L3 under L2..There appears to be tubing which enters between the L4 and L5 spinous processes into the thecal sac. The upper extent of the tubing is not included on this exam.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is a right paramedian disc protrusion present at this level which mildly encroaches on the nerve roots of the right lateral recess. There is bilateral facet hypertrophy at this level which is worse on the right compared to the left side. There is loss of disc space height, disc desiccation and minimal anterior subluxation of L5 on S1At L4-5 there is no significant compromise to spinal canal or neural foramina. There is loss of disc space height, disc desiccation and a disc bulge at this level. There is mild ligamentum flavum hypertrophy present.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is loss of disc space height, disc desiccation and a minor disc bulge at this level. There is a right far lateral disc protrusion present at this level which displaces the right-sided exiting nerve roots.. There is some partial effacement of the fat at the right lateral recess with mild encroachment upon nerve roots at the right lateral recess.At L2-3 there is no significant compromise to spinal canal or neural foramina. There is some loss of disc space height, disc desiccation and a right far lateral broad-based disc protrusion at this level. This right far lateral disc protrusion displaces the right-sided exiting nerve roots and is associated with some partial effacement of fat at the right lateral recess.At L1-2 there is no significant compromise to spinal canal or neural foramina.The renal pelvis and ureter are dilated bilaterally. The patient has known renal stents placed in the past.There is a large presacral mass present which is not completely evaluated on this exam.

Output: 1.There are multilevel degenerative changes present lumbar spine which is associated with a levocurvature to the lumbar spine and some mild degrees of translation and subluxation. There are far lateral disc protrusion present on the right-sided L2-3 and L3-4 with some mild nerve root displacements at these levels.2.There is a large presacral mass present which is not completely evaluated on this exam. Please refer to the patient's prior CT scans for further comments3.There is a drainage tube present within the thecal sac anteriorly at L4-5. Please correlate clinical history.4.Hydroureter and hydronephrosis. The patient is known to have renal stents please correlate with clinical history. CT of the abdomen may help further evaluate this if clinically appropriate.


Instruction: Generate impression based on findings.

Input: Chronic left shoulder pain ROTATOR CUFF: There is no rotator cuff tear or muscle atrophy/edema.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: Linear focus of contrast signal in the inferior labrum compatible with tear without evidence of labral detachment. The cartilage surfaces are intact.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: Focal inferior labral tear. Intact rotator cuff.


Instruction: Generate impression based on findings.

Input: Back and leg pain, neurogenic medication Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall height. There is grade 1 anterolisthesis at L4-5 which is not significantly changed. Alignment is otherwise maintained. There is vacuum phenomena at the L4-L5 and L5-S1 levels is stable to slightly increased since prior. Bone marrow signal is benign.Degenerative changes further described below:At L1-2 there is no significant compromise to spinal canal or neural foramina. Mild facet arthropathy. At L2-3 there is no significant compromise to spinal canal or neural foramina. Mild facet arthropathy. Minimal disc bulge.At L3-4 there is no significant compromise to spinal canal or neural foramina. Bilateral facet arthropathy. Minimal disc bulge.At L4-5 there is grade 1 anterolisthesis, disc dessication, disc uncovering as well as tiny extrusion superimposed on disc bulge similar to prior. There is also advanced facet arthropathy and evidence of prior decompressive left hemi-laminectomy. There is mild to moderate left and mild right neural foraminal stenosis minimally worse since 6/2/2015. No significant spinal canal stenosis. At L5-S1 there is mild disc bulge similar to prior along with advanced facet arthropathy, right greater than left. Previously seen distention within the right facet joint has decreased. There is moderate to severe right neural foraminal stenosis which appears slightly worse. Left neural foramen and spinal canal remain patent.18 x 17 mm T2 hyperintense lesion involving the right kidney again seen and better characterized on prior postcontrast CT studies.

Output: 1. Again seen are degenerative changes in the lumbar spine at the L4-L5 and L5-S1 levels with vacuum phenomena which are stable to minimally progressed since 6/2/2015. Grade 1 anterolisthesis at L4-L5 appears similar to prior. There is no significant spinal canal stenosis at any level. 2. There is moderate to severe right L5-S1, mild to moderate left L4-L5, and mild right L4-L5 neural foraminal stenosis. 3. There is advanced facet arthropathy at the L4-L5 and L5-S1 levels.4. Prior left L4-5 hemilaminectomy.


Instruction: Generate impression based on findings.

Input: Male, 6 years old, with seizures. EEG showed frequent right-sided discharges. The cerebral and cerebellar hemispheres and brainstem show normal signal intensity and morphology. No restricted diffusion is seen. In particular, the mesial temporal lobe structures are symmetric and free of pathologic signal abnormality.No evidence of parenchymal edema, mass, or mass effect is seen. There is no evidence of intracranial hemorrhage or abnormal extra-axial fluid. The ventricular system is normal in caliber and morphology. Signal intensity of the bone marrow is unremarkable. Diffuse paranasal sinus opacification is seen.

Output: No specific findings are seen to account for the patient's seizures.