Instruction: Generate impression based on findings.

Input: Female, 38 years old, 23 weeks gestational age, with hydrocephalus detected on fetal ultrasound. Image quality is reduced by fetal motion on most sequences. Within this limitation, the following observations are made.The lateral ventricles are significantly dilated. At the level of the atria, the left lateral ventricle measures up to 23 mm, and the right measures up to 28 mm. The third ventricle is also prominent, but the fourth ventricle is not dilated. The cerebral aqueduct is not discretely visualized. The cerebral hemispheres are thinned by the expanded ventricular system, but otherwise appear to be present in their entirety. The thalami are not fused. The brainstem and cerebellum are unremarkable. The septum pellucidum is absent and may have degenerated secondary to ventriculomegaly. The corpus callosum is not well visualized, and is likely thinned. No evidence to suggest intracranial hemorrhage is seen. A two-vessel umbilical cord is noted. Limited views of the fetal abdomen are otherwise unremarkable.

Output: 1.Marked lateral ventriculomegaly is seen. The cerebral aqueduct is not discretely visualized and may therefore be stenosed or underdeveloped. However, motion artifact does compromise the assessment in this regard.2.The cerebral parenchyma is thinned due to ventriculomegaly, though the hemispheres appear to be present in their entirety. The corpus callosum is not well visualized and is likely thinned.3.No additional cerebral or cerebellar anomalies are suspected.


Instruction: Generate impression based on findings.

Input: 47-year-old female with history of appendiceal adenocarcinoma. ABDOMEN:LIVER, BILIARY TRACT: Subcentimeter T2 hyperintense focus in segment four of the liver is unchanged. Additional previously noted T2 hyperintense foci are again noted, not significantly changed.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The previously seen left lower quadrant T2 hyperintense foci and nodules are not seen on the current study.BONES, SOFT TISSUES: See below.

Output: 1.Left lower quadrant T2 hyperintense focus in nodule is not seen on the current study.2.T2 hyperintense foci in the liver are unchanged since the prior exam.3.Enhancing right sacral lesion is unchanged, nonspecific.4.Findings compatible with uterine adenomyosis.


Instruction: Generate impression based on findings.

Input: 55 year old male with arm and leg weakness with scattered abnormal findings in the brain. Evaluate for cord infarction. Note that axial images through the lower cervical spine are limited from motion and other artifact. IN addition, DWI images were inadvertently not obtained which limits evaluation for cord ischemia.Alignment is anatomic. The marrow signal is benign. The cervical and upper thoracic cord are normal in signal. Redemonstrated is diffuse abnormal signal in the pons, including the pontomedullary junction, as described previously. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable.C2/3: No significant spinal canal stenosis or neuroforaminal narrowing.C3/4: Minimal disk bulge. No significant spinal canal stenosis or neuroforaminal narrowing.C4/5: Minimal disk bulge. No significant spinal canal stenosis. Mild right uncovertebral hypertrophy and mild right neuroforaminal narrowing.C5/6: Minimal disk bulge and mild ligamentum flavum thickening. Mild bilateral neuroforaminal narrowing. No significant spinal canal stenosis. C6/7: Mild bilateral uncovertebral hypertrophy and ligamentum flavum thickening which causes mild to moderate bilateral neuroforaminal narrowing. No significant spinal canal stenosis. C7/T1: No significant spinal canal stenosis or neuroforaminal narrowing.

Output: 1.Although diffusion weighted images were inadvertently not obtained, the cervical and upper thoracic cord signal appears normal. No definite MR suspicion for cord abnormality.2.Mild degenerative changes as described above.3.Redemonstration of signal abnormalities in the pons similar to the previous exam.


Instruction: Generate impression based on findings.

Input: Clinical question: Status post ETV. Signs and symptoms: Status post ETV. Nonenhanced head CT:There is evidence of a small right recumbent AP paramedian frontal burr hole since prior study. Small punctate focus of air density immediately under the burr hole is present. Linear low attenuation traversing the right frontal lobe and terminating into the right lateral ventricle likely result of recent instrumentation. Punctate focus of air within the right frontal horn is also present.There is no radiopaque catheter in place.No convincing evidence of any change in size of ventricular system.Periventricular low attenuation of white matter is similar to prior exam corresponding to regions of small muscle ischemic strokes on prior MRI study. Possibility of underlying periventricular exudate of CSF should also be considered.

Output: 1.No convincing evidence of interval change in the size of the supratentorial enlarged ventricular system.2.Evidence of interval right frontal burr hole, minimal intracranial air, small linear low-attenuation across the frontal lobe likely along the track of instrumentation.3.No radiopaque ventricular catheter / shunt is present.


Instruction: Generate impression based on findings.

Input: 41 years Female (DOB:12/1/1975)Reason: rule out CVA History: right arm and face numbnessPROVIDER/ATTENDING NAME: JAMES X. TAO JAMES X. TAO The CSF spaces are appropriate for the patient's stated age with no midline shift. The patient is status post right temporal craniotomy. There is encephalomalacia present in the right temporal lobe. This appearance is stable compared to the previous exam.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. This appearance is stable compared to the previous exam.Small foci of T2 and FLAIR hyperintensity are also present along the gray matter in the left watershed zone predominantly involving the left frontal lobe cortex and subcortical white matter. This appearance is stable compared to the previous exam.Several punctate foci of susceptibility are present in the right middle frontal gyrus subcortical white matter. This appearance is stable compared to the previous exam.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.

Output: 1.The patient status post right middle cranial fossa surgery. There is encephalomalacia present in the right temporal lobe.2.Findings suggest prior small watershed distribution infarctions in the left frontal lobe. This appearance is unchanged since previous exams. 3.Periventricular and subcortical white matter signal changes of a mild degree are present which are nonspecific. They could be vascular related, related to demyelination, trauma, vasculitis, sarcoid. They are nonspecific.


Instruction: Generate impression based on findings.

Input: History of chordoma. Lethargy and vomiting There is a redemonstration of a large calcified mass within the right middle cranial fossa with involvement of the skull base, which remains unchanged from prior brain MRI exam. Postoperative change of the right middle cranial fossa and skull base is present.The cerebral and cerebellar hemispheres are normal in attenuation and morphology. There is no intracranial hemorrhage, edema, midline shift or abnormal extra-axial fluid collection. The ventricles are normal in volume and symmetric.Mucosal thickening is noted in the ethmoid and right frontal sinuses. Opacification of the right mastoid is noted.

Output: 1.No intracranial hemorrhage.2.A calcified mass and postoperative change at the right middle cranial fossa.3.Right mastoid and ethmoid and frontal sinus inflammatory disease.


Instruction: Generate impression based on findings.

Input: History of necrotizing pancreatitis complicated by pseudocyst formation status post internal drainage. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in size, signal intensity and enhancement. No focal suspicious lesion or biliary ductal dilatation. Fatty infiltration with focal fat sparing. Status post cholecystectomy.The common bile duct is normal in caliber.The portal vein is significantly narrowed and is slit-like just distal to the SMV splenic vein confluence, similar to that seen on the prior CT.SPLEEN: No significant abnormality noted. Splenic vein is patent.PANCREAS: In the region of the pancreatic body and proximal tail there is a fluid collection measuring 4.6 x 1.4 cm (series 5/19) with a cystogastrostomy stent in place. This is significantly decreased in size compared to the prior CT study where it measured 9.7 x 3.8 cm.There is mild decrease in intrinsic T1 weighted hyperintensity the pancreatic tail without peripancreatic inflammation, atrophy or pancreatic ductal dilatation.The pancreatic head is normal in T1-weighted signal intensity and enhancement and has a normal pancreatic duct caliber.Following secretin administration the pancreatic duct at the level of the pancreatic head demonstrates appropriate increase in caliber with increased excretion into the jejunum. The pancreatic duct in the pancreatic tail also becomes more visible on the post-secretin images, compatible with intact exocrine function. There is no evidence of obstruction, pancreas divisum, annular pancreas or choledocholithiasis. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Simple right renal superior pole 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.Interval decrease in the intrapancreatic fluid collection/pseudocyst with cystogastrostomy stent in place.2.Slit-like narrowing of the portal vein just distal to the SMV-splenic vein confluence, appearing similar to the prior study.3.Appropriate exocrine response of the pancreatic head following secretin administration. The pancreatic duct in the pancreatic tail also becomes more visible on the post-secretin administration images, compatible with intact exocrine function. 4.No specific finding to explain the etiology of the patient's pancreatitis. 5.Fatty liver with focal fat sparing.


Instruction: Generate impression based on findings.

Input: 59-year-old female with right knee pain stepping into a hole. Evaluate for medial meniscal tear. MENISCI: There is a radial tear of the posterior horn of the medial meniscus, near its root. There is also a horizontal tear of the posterior horn of the medial meniscus which extends to the body of the meniscus. The anterior horn appears intact. There is globular signal abnormality posterior horn of the lateral meniscus indicating intrasubstance degeneration. Some of the signal extends to the tibial articular surface consistent with degenerative tearing/fraying, appearing similar to the prior study.ARTICULAR CARTILAGE AND BONE: There is full-thickness articular cartilage degeneration along the lateral facet of the patella with underlying degenerative subchondral signal abnormality. There is full-thickness articular cartilage degeneration within the medial facet of the patella with portions completely devoid of articular cartilage. There is near full-thickness to full-thickness articular cartilage degeneration along the weightbearing surface of the medial femoral condyle above the body and posterior horn of the meniscus. There is also full-thickness articular cartilage degeneration along the medial aspect of the tibial plateau.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Tearing of the medial meniscus as described above, new from prior examination. 2. Intrasubstance degeneration/tearing of the lateral meniscus appearing similar to the prior study. 3. Small joint effusion and articular cartilage degeneration as described above. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Dizziness and giddiness [780.4], Reason for Study: ^Reason: c/f acute CVA, new dizziness (pre-syncope, dysequilibrium) History: see above There is no evidence of acute ischemic or hemorrhagic lesion on the scan.Multifocal scattered patchy high signal intensities on FLAIR imaging on bilateral periventricular white matter indicate nonspecific small vessel ischemic disease.There is a focal increased signal intensity on the right basal ganglia likely involving anterior limb of internal capsule and globus pallidus may indicate age-indeterminate likely chronic ischemia.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, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. Nonspecific small vessel ischemic disease.3. Chronic ischemic lesion on the right basal ganglia.


Instruction: Generate impression based on findings.

Input: Reason: Endometrial cancer compare to last MRI and measure 1) vaginal cuff mass, 2) left inguinal node and 3) r. common iliac node History: post SBRT and 4 cycles of immunotherapy PELVIS:UTERUS, ADNEXA: Status post TAH/BSO.At the vaginal cuff, a previously seen soft tissue mass measuring 4.6 x 8.0 cm (601:46) now measures 4.6 x 8.0 cm (1301:38). Again, the mass is ill-defined with numerous satellite nodules and peritoneal extension with additional peritoneal implants with reflecting carcinomatosis. There is extension throughout the parametrial fat with implants close to but not immediately associated with the sidewall (601/45). Tumor is present along the peritoneal reflection of the bladder. The mass also abuts the rectosigmoid colon (1301:39). There is enhancing tissue along the anterior surgical scar which also likely represents tumor.BLADDER: See above.LYMPH NODES: Previously enlarged left inguinal node measuring 2.3 x 1.7 cm (601/31) now measures 0.5 x 0.9 cm (1301:23). There are multiple enlarged pelvic lymph nodes with an enlarged right common iliac node measuring 2.1 x 1.4 cm (601/57), now measuring 1.2 x 1.0 cm (1301:48).BOWEL, MESENTERY: Large volume ascites causing dielectric artifact limiting evaluation. This ascites has layering low intensity on T2 images (1301:29) suggesting some proteinaceous/hemorrhagic component. BONES, SOFT TISSUES: Mild anasarca.OTHER: There is a large amount of abdominal ascites.

Output: 1.Grossly stable infiltrative soft tissue mass at the vaginal cuff with extension into the parametrial soft tissue, along the peritoneum, and with abutment of both the bladder and rectosigmoid colon. Measurements above. Grossly stable numerous peritoneal implants and extensive ascites.2. Interval decrease in size of reference lymph nodes as described above.


Instruction: Generate impression based on findings.

Input: Right-sided weakness. Motion artifact degraded image quality significantly.However, on diffusion-weighted image, there are multiple high signal intensities especially on the left precentral gyrus, posterior central gyrus as well as occipital lobe with corresponding restricted diffusion on ADC map indicating acute ischemic infarctions. Corresponding T2 weighted images do not show evidence of high signal intensity, thus the possibility of T2 shine through might be very slim.There is no evidence of acute hemorrhagic lesion.Minimal non specific small vessel ischemic disease on FLAIR images.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: Provided that the examination quality has been degraded due to motion artifacts, the possibility of acute ischemic infarctions without evidence of hemorrhagic transformation on the left frontal and parietal lobes is high as described above. Non specific small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: Female, 44 years old. History of left hamstring tear. Left buttock pain. BONE MARROW: Bone marrow signal is normal.SOFT TISSUES: The hamstring origins appear normal bilaterally, without evidence of tendinopathy or tear. Minimal edema is again noted along the greater trochanters bilaterally, which is not necessarily of any clinical significance. The gluteal tendons appear normal. The visualized musculature appears normal. JOINTS: No significant abnormality noted. Postsurgical changes of prior left labral tear are better appreciated on prior dedicated hip MRI from 05/02/2016.ADDITIONAL

Output: Normal appearance of the proximal hamstring tendons, without evidence of tendinopathy or tear. No other acute abnormality to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: Reason: eval for bile duct dilation, likely new diagnosis of panc CA History: see above ABDOMEN:LIVER, BILIARY TRACT: Again seen is diffuse infiltration of the liver with a dominant enhancing lesion centered on segments 5/8 measuring approximately 18 x 8 cm (1403/79). There are additional enhancing satellite lesions (1403/89), including a right hepatic lobe reference lesion measuring 2.2 x 3.1 cm (1401/73). In addition, there is diffuse T2 hyperintensity within the liver as well as numerous small subcentimeter hypoenhancing lesions.Portal venous system is patent. No evidence of intra or extrahepatic biliary ductal dilatation.Hepatomegaly. The gallbladder is nondistended without stones, however there is wall thickening which is nonspecific. Mild periportal edema.SPLEEN: No significant abnormality noted.PANCREAS: Hypoenhancing pancreatic tail lesion measures 2.6 x 2.5 cm. No pancreatic ductal dilatation.ADRENAL GLANDS: Bilateral adrenal nodularity. 1.7 cm left adrenal lesion containing fat likely represents a myelolipoma.KIDNEYS, URETERS: Small left lower pole cyst.RETROPERITONEUM, LYMPH NODES: Enlarged portacaval node measuring 2.3 x 1.4 cm. Additional enlarged periaortic lymph nodes, similar to prior CT. Small cardiophrenic and paraesophageal lymph nodes are present.BOWEL, MESENTERY: Small fat-containing ventral hernia.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Perihepatic ascites as well as free fluid in the pelvis.

Output: 1.No evidence of intra or extrahepatic biliary ductal dilatation.2.Pancreatic tail lesion, suspicious for neoplasm. In addition, there is a large, dominant infiltrative hepatic mass with smaller satellite lesions which are suspected to represent metastases. While the pancreatic lesion is relatively small compared to the extensive infiltrative hepatic metastases, this may represent a primary pancreatic adenocarcinoma with atypical hepatic metastases. Another consideration may be metastatic disease to both the pancreas and liver.3.Diffusely abnormal signal and subcentimeter hypoenhancing lesions may be related to a hepatitis, possibly infectious. Gallbladder wall thickening is nonspecific but likely related to chronic liver disease.4.Retroperitoneal in mediastinal lymphadenopathy.5.Left adrenal myelolipoma.


Instruction: Generate impression based on findings.

Input: Clinical question: preop for brain tumor resection. Signs and symptoms: Brain tumor. Unenhanced Stealth head CT:A standard preoperative nonenhanced stealth head CT is performed. A halo is secured to patient's head.Examination demonstrates mass in the right anterior temporal lobe with extension into the inferior right frontal lobe and right basal ganglia. Mass effect and deviation of third ventricle to the left is similar to prior MRI exam from 9 -- 6 -- 11. Ventricular system remains stable in size and unchanged. There is no detectable hemorrhage or any new foci of abnormality since prior exam. There is evidence of a small burr hole in right frontal bone likely from prior surgical approach for biopsy.

Output: Nonenhanced stealth head CT reveals stable right temporal, frontal and basal ganglia mass and its associated mass effect.


Instruction: Generate impression based on findings.

Input: Axenfeld-Rieger syndrome and fibro-osseous clival lesion status post multiple surgeries. Evaluate for Chiari malformation and CSF flow, pseudotumor cerebri, status post lumboperitoneal shunt and with continued headache. The cerebellar tonsils are minimally low-lying, perhaps to a slightly lesser degree that previously. The cerebellar tonsils also display a rounded morphology and there is essentially intact CSF flow across the foramen magnum. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues appear unchanged with postoperative alterations in the central skull base.

Output: 1. The cerebellar tonsils are minimally low-lying, perhaps to a slightly lesser degree that previously. In addition, the cerebellar tonsils display a rounded morphology and there is essentially intact CSF flow across the foramen magnum. 2. Stable postoperative alterations in the central skull base related to fibro-osseous lesion resection.


Instruction: Generate impression based on findings.

Input: Female 66 years old Reason: 66 y/o F with prior CT abd/pelvis 12/29/2014 (elsewhere) noted intra and extrahepatic biliary dilation and dilated pancreatic duct with suggestion of pancreas divisum. MRCP requested to further evaluate. The absence of intravenous contrast limits evaluation of the solid organs and of the bowels. Given these limitations, the following observations were made:ABDOMEN:LIVER, BILIARY TRACT: The common duct is somewhat tortuous and measures 7 mm in maximum transverse dimension, within normal limits in this patient who is postcholecystectomy. There is no focal liver lesion within the limitations of this noncontrast study.SPLEEN: No significant abnormality noted.PANCREAS: The pancreas demonstrates normal intrinsic T1 hyperintense signal. There is a bilobed 7 mm T2 hyperintensity within the pancreatic tail which communicates with the pancreatic duct. This is consistent with a side branch IPMN. There is a 2 mm T2 hyperintensity within the body/tail downstream from this lesion and although there is no definite communication with the pancreatic duct this likely represents a second side branch IPMN. There is no pancreatic duct dilatation which measures 3 mm in maximum dimension. There is no pancreas divisum or accessory pancreatic duct.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: T2 hyperintense lesion at the lower pole of the left kidney is consistent with a renal cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is a large duodenal diverticulum.BONES, SOFT TISSUES: No significant abnormality noted.

Output: There is no pancreas divisum or accessory pancreatic duct. Two cystic lesions within the pancreas are consistent with sidebranch IPMNs. Guideline suggestions for IPMN lesions of this category would for follow up imaging in 1 year to ensure stability.


Instruction: Generate impression based on findings.

Input: Elevated PSA. PELVIS:PROSTATE:Prostate Size: 3.2 x 5.3 x 5.3 cmPeripheral Zone: In the left mid gland peripheral zone there is a 8 mm focus of restricted diffusion with associated T2-weighted hypointensity. There is early arterial enhancement. This lesion abuts the capsule without evidence of extracapsular extension. In the right mid gland there is a 4 mm focus of restricted diffusion and associated T2-weighted hyperintensity.Central Gland: Changes of BPH.Seminal Vesicles: No evidence of seminal vesicle invasion. No extracapsular extension.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: 1.8 mm left mid gland peripheral zone lesion suspicious for prostatic adenocarcinoma.2.4 mm focus in the right mid gland may represent a site of metastatic adenocarcinoma. 3.No evidence of seminal vesicle invasion or extracapsular extension. No pelvic lymphadenopathy by size criteria.


Instruction: Generate impression based on findings.

Input: 54-year-old female with HCV and IPMN. Evaluate. ABDOMEN:LIVER, BILIARY TRACT: No biliary ductal dilatation or strictures. No suspicious hepatic lesions are identified.SPLEEN: No significant abnormality noted.PANCREAS: Again noted is a 5 mm side branch IPMN in the pancreatic uncinate process (series 3, image 27).ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Stable subcentimeter uncinate process IPMN. 2.No intra or extrahepatic biliary ductal dilatation or strictures. 3.No suspicious hepatic lesions.


Instruction: Generate impression based on findings.

Input: Evaluate for demyelinating disease: tremors; anxiety. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is focal prominence of the subarachnoid space overlying the left anterior temporal pole, which measures up to 9 mm in width. The left lateral ventricle is asymmetrically larger than the right, which can represent a developmental variant. 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. Small left middle cranial fossa arachnoid cyst overlying the left anterior temporal pole.2. The left lateral ventricle is asymmetrically larger than the right, which can represent a developmental variant.3. No evidence of intracranial demyelinating lesions.


Instruction: Generate impression based on findings.

Input: Male, 30 years old, with low back pain status post epidural injection. Evaluate for epidural abscess. Alignment is anatomic. Vertebral body height and morphology are within normal limits. No pathologic marrow replacement, enhancement, or edema is observed.The distal spinal cord, conus and nerve roots of the cauda equina are within normal limits. No pathologic intramedullary or leptomeningeal enhancement is seen. No epidural abnormalities are identified.The L5-S1 disc demonstrates loss of T2 signal. In addition, there is a small central/right paracentral disc protrusion with annular fissuring. However, there is no significant compromise of the spinal canal or neural foramina. The remaining intervertebral discs are within normal limits.

Output: 1.No evidence of any epidural abnormality is seen.2.Disc degeneration is noted at L5-S1 with a small central and right paracentral protrusion. However, there is no significant compromise of the spinal canal or neural foramina. The remaining discs are normal.


Instruction: Generate impression based on findings.

Input: High risk breast cancer screening. History of breast cancer in mother, maternal second cousin and maternal aunt. Heterogeneous fibroglandular tissue is present bilaterally. Simple and complicated cysts are present.Mild parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: NS - Routine Screening Mammogram.


Instruction: Generate impression based on findings.

Input: 63-year-old male with history of thymic carcinoma. Status post chemo/RT, please evaluate, CHEST:LUNGS AND PLEURA: Multiple small calcified micronodules are identified consistent with a previous granulomatous infection. Centrilobular emphysema is again noted. No pleural effusion can be identified.MEDIASTINUM AND HILA: There is redemonstration of an anterior mediastinal mass measuring 28 mm x 14.3 mm (image 47, series 4), previously, measuring 15 mm x 28.8 mm. Port-A-Cath with its tip in the SVC. A coronary artery and aortic calcifications. Cardiac size is normal. There is no evidence of pericardial effusion.No mediastinal or hilar lymphadenopathyCHEST WALL: Right-sided port. Degenerative changes in the thoracic spine.ABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy. Hypodense subcentimeter lesions, most likely representing cystsSPLEEN: No significant abnormality notedADRENAL GLANDS: Right adrenal nodule is stable, measuring 14.1 mm x 18.5 mm (image 92, series 4).KIDNEYS, URETERS: Redemonstration of a small exophytic mass arising from the superior pole. The left kidney. (Image 96, series 4). Dedicated CT or MRI is recommended to evaluate this lesion. Several subcentimeter hypodense lesions in the right kidney, most represent cysts. Again noted is an accessory right renal artery.PANCREAS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Atherosclerotic diseaseBOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: 1. Anterior mediastinal soft tissue mass is stable and presumably represents the residual of this patient's thymic carcinoma.2. Stable right adrenal nodule and small exophytic left renal mass that is indeterminate. Dedicated CT or MRI is recommended to evaluate these lesions.3. Centrilobular emphysema with evidence of a previous granulomatous infection.4. No evidence of metastatic disease.


Instruction: Generate impression based on findings.

Input: Ms. Jargella is a 61-year-old female status post right mastectomy in 2008 for IDC followed by radiation, chemotherapy and Arimidex. Personal history of benign left breast biopsy and left reduction mammoplasty. There is scattered fibroglandular tissue in the left breast. Minimal parenchymal enhancement is noted.Postsurgical changes consistent with right breast mastectomy and implant-based reconstruction are re-identified. There is no abnormal enhancement seen in the right chest wall.There is no abnormal enhancement seen in the left breast. No abnormal axillary lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Male, 44 years old. Left shoulder pain ROTATOR CUFF: The supraspinatus tendon and muscle appear intact. The infraspinatus tendon and muscle appear intact. The teres minor tendon and muscle appear intact. The subscapularis tendon appears slightly thickened, which may reflect tendinosis, but we see no tear.SUPRASPINATUS OUTLET: Moderate osteoarthritis affects the acromioclavicular joint with osteophytes resulting in slight impression on the superior fibers of the supraspinatus.GLENOHUMERAL JOINT AND GLENOID LABRUM: Moderate osteoarthritis affects the glenohumeral joint with near full-thickness to full-thickness cartilage loss along the glenoid posteriorly associated with subchondral cysts. There is extensive tearing of the labrum involving the superior, anterior, and posterior labrum in a near-circumferential manner. Bandlike low signal intensity extending from the inferior margin of the glenoid into the axillary recess likely represents a displaced cartilage flap with additional poorly defined intermediate signal intensity in the axillary recess likely representing a combination of debris and synovitis.BICEPS TENDON: There is mild thickening and increased signal intensity of the tendon of the long head of biceps at its transition from the rotator interval to the intertubercular groove, suggesting mild tendinosis. There is a 1.3 cm lobulated focus of intermediate signal intensity within the biceps tendon sheath that presumably represents a displaced cartilage fragment.

Output: Osteoarthritis of the glenohumeral joint with extensive tearing of the labrum and displacement of cartilaginous fragments as described above.


Instruction: Generate impression based on findings.

Input: 37 year old with known right breast cancer and metastatic right axillary lymph node presents for research MRI on the I-SPY protocol. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.A faint 4 mm focus on enhancement is seen in the posterior depth of the right breast, 11 o'clock position. On the most recent comparison, the mass at this site measured 8 x 8 x 9 mm. No new enhancing breast lesion. The reference lymph node now measures only 6 mm in long axis, previously this had a maximum diameter of 9 mm. No abnormal enhancement is seen in left breast. No abnormal axillary lymph nodes are identified in left axillary region.

Output: Near resolution of enhancement at the site of known cancer in the right breast.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Elevated LFTs. History of pancreas transplant. The study is limited by the patient's inability to hold his breath. Large volume ascites also limits the image quality.ABDOMEN:LIVER, BILIARY TRACT: Limited evaluation of the liver. No biliary ductal dilatation. Normally distended gallbladder with gallbladder wall thickening/pericholecystic fluid. No gallstone is evident.SPLEEN: No significant abnormality noted.PANCREAS: The native pancreatic parenchyma appears to be replaced by innumerable small and moderate-sized cysts. The transplanted pancreas is noted in the right hemi-abdomen without apparent ductal dilatation and unchanged tail atrophy.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Atrophic kidneys with multiple likely cysts. No hydronephrosis. Right iliac fossa transplanted kidney is only evaluated on the coronal T2 imaging without hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Large volume of abdominal pelvic ascites.BONES, SOFT TISSUES: Cardiomegaly. Diffuse bladder wall thickening is noted.OTHER: Note is made of diffuse decrease in signal intensity of the liver, spleen and axial skeleton bone marrow.

Output: 1. Suboptimal study due to patient respiration or ascites.2. No intrahepatic biliary ductal dilatation. Normally distended gallbladder with non-specific wall thickening/pericholecystic fluid without gallstones evident. 3. The native pancreatic parenchyma is replaced by numerous cysts. Stable appearance of partially evaluated transplanted pancreas.4. Abnormal low T2-weighted signal intensity of the liver, spleen and axial skeleton bone marrow. This may be seen in the setting of hemosiderosis. 5. Non-specific diffuse bladder wall thickening.


Instruction: Generate impression based on findings.

Input: 5-year-old male patient with tuberous sclerosis. Evaluate for angiomyolipomas.EXAMINATION: MR abdomen with and without IV contrast 5/1/2015 ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesion is identified.SPLEEN: The spleen is normal in appearance.PANCREAS: The pancreas is normal in appearance.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Normal enhancement of the kidneys. No renal lesion is identified. No evidence of hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY:No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No renal lesion is identified.


Instruction: Generate impression based on findings.

Input: Reason: Right knee continued anterior and medial knee pain, s/p patellar microfracture 5/15, evaluate for healing History: Right knee pain MENISCI: Again seen is branching increased signal intensity within the posterior horn of the medial meniscus indicating a complex tear involving the red and red/white zones. There is intermediate signal intensity which extends to the tibial and femoral articular surfaces, however, there is a new fluid-filled defect along the undersurface of the medial meniscus at the junction of the body and posterior horn that indicates a new tear. The anterior horn appears intact. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is thinning of the articular cartilage of the medial facet of the patella with heterogeneity of the signal intensity of the remainder of the cartilage which likely represents a combination of chondroplasty, degeneration and perhaps immature cartilage secondary to the stated history of prior microfracture. There is a more focal defect along the median eminence that likely represents prior chondroplasty at the site of a prior articular cartilage cleft seen on the prior MRI examination. There is a small focus of poorly defined low signal intensity within the femoral trochlea, centrally, that may represent a small focus of degeneration. There appears to be increased signal intensity of the articular cartilage within the medial tibial plateau underlying the aforementioned medial meniscal tear suggesting focal degeneration. There is a small adjacent osteophyte. The lateral compartment articular cartilage appears intact.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact. There is a small amount of fluid within the deep infrapatellar bursa.ADDITIONAL

Output: 1. Complex tear of the medial meniscus with new fluid-filled defect along its undersurface.2. Thinning and heterogeneity of the articular cartilage of the medial facet of the patella likely represents a combination of chondroplasty, degeneration and perhaps immature cartilage related to the stated history of prior microfracture.3. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Hydrocephalus. Evaluate ventricles. Status post shunt. There is significant ventriculomegaly of the supratentorial ventricular system is again identified with no interval change. Excessive extra-axial fluid collection within the posterior fossa remains also stable since prior study. The fourth ventricle is not enlarged and remains similar to what was noted on prior MRI. Severely compressed brain parenchyma in the supratentorial space secondary to massive hydrocephalus. No definitive interval appreciable change in comparison to MRI examination of January 29, 2009.

Output: Stable severe hydrocephalus since prior MRI examination from January 29, 2009.


Instruction: Generate impression based on findings.

Input: 9-year-old boy with history of chronic granulomatous disease, evaluate for perirectal fistula or abscess. PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Bilateral inguinal lymph nodes are stable.BOWEL, MESENTERY: A large stool burden is noted throughout the imaged colon.BONES, SOFT TISSUES: Drainage catheters are again noted both immediately to the right and left of the venous. A very small, residual collection has decreased in size from the prior exam and (series 401, image 43) measures 16 x 5 mm. There is no new fluid collection. Increased T2 signal in the surrounding subcutaneous soft tissues indicates mild surrounding edema.OTHER: No significant abnormality noted.

Output: Bilateral perianal drainage catheters in place with a small residual left perianal collection, decreased in size from the prior exam.


Instruction: Generate impression based on findings.

Input: Numbness in right lower extremity Examination is mildly motion degraded. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position.Mild degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: No significant disc disease. No spinal canal or neural foraminal stenosis.L4-L5: No significant disc disease. No spinal canal or neural foraminal stenosis. Mild facet arthropathy.L5-S1: There is disc desiccation with small right central disc extrusion. No significant spinal canal or neural foraminal stenosis. Mild facet arthropathy.Postgadolinium images demonstrate no abnormal enhancement. Paraspinous soft tissues are within normal limits.

Output: Mild degenerative changes in the lumbar spine with small disc extrusion at the L5-S1 level. There is no significant spinal canal or neural foraminal stenosis at any level.


Instruction: Generate impression based on findings.

Input: New development of difficulty in walking and history of prostate cancer. Multifocal vertebral body signal changes (lower signal intensity on T1) indicating bony metastasis on C3, T4, T5, T6, T9, and L5.Vertebral body deformity indicating compression fracture is seen on T4, T6, T7, T8, T10, T11, T12, L1, L2, L3, L4 and L5 with various degrees.Especially at the level of T6, there are anterior and posterior epidural enhancing soft tissue mass surrounding corresponding level spinal cord with subtle cord signal change indicating spinal cord compression. Enhancing soft tissue encasing right side rib including costochondral junction with evidence of adjacent pleural enhancement were seen at the level of T5, T6, and T7 (subtle) indicating metastatic involvement. There is normal cervical lordosis. The cranial-cervical junction is normal. There is normal thoracic kyphosis and lumbar lordosis. The spine alignment is anatomic. The conus medullaris terminates at the level of L1-L2 level.

Output: 1. Evidence of spinal cord compression likely due to metastasis and metastasis related compression fracture at the level of T6.2. Multifocal vertebral body signal changes indicating metastasis.3. Multifocal various degreed vertebral compression fractures as described above.4. Evidence of T5, T6 and T7 ribs and costochondral junction involvement by metastasis as described above.Above information has been discussed with Radiology resident on call Dr.Bennett and Dr.Aisch at 11:11PM.


Instruction: Generate impression based on findings.

Input: Proptosis. There appears to be a diffusely prominent amount orbital fat bilaterally, with proptosis. Otherwise, the extraocular muscles do not appear to be enlarged. The optic nerves appear to be normal is signal and caliber. The lacrimal glands are unremarkable. There is no evidence of orbital tumors or abnormal enhancement. The periorbital soft tissues and paranasal sinuses are unremarkable. There is diffuse patchy cerebral white matter T2 hyperintensity.

Output: 1. Apparent diffusely prominent amount orbital fat bilaterally, with proptosis, may be related to dysthyroid orbitopathy, but no evidence of extraocular muscle enlargement. 2. Diffuse patchy cerebral white matter T2 hyperintensity may be related to chronic small vessel ischemia.


Instruction: Generate impression based on findings.

Input: 49 years Female (DOB:3/30/1967)Reason: worsening sciatica L sided History: as abovePROVIDER/ATTENDING NAME: DEBORAH L. BURNET DEBORAH L. BURNET Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. There is mild disc desiccation present.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is a mild disc bulge at this level.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is mild bilateral facet and ligamentum flavum hypertrophy at this level. There is a small left lateral disc protrusion at this level which mildly affects the left-sided exiting nerve root as it exits the neural foramen. There is some effacement of fat adjacent to this nerve rootAt L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.There is a small cystic lesion in the right kidney measuring 13 x 14 mm axial dimensions. The renal pelvises are large bilaterally.

Output: 1.There is a small left lateral disc protrusion at L4-5 which mildly affects the left-sided exiting nerve root as it exits the neural foramen.2.There are some mild degenerative changes present in the lower lumbar spine without significant compromise to spinal canal or exiting nerve roots.


Instruction: Generate impression based on findings.

Input: There are unchanged postoperative findings related to left parietal craniotomy for resection of a left frontal lobe mass with associated susceptibility effect in and adjacent to the resection cavity compatible with chronic blood products. There is an unchanged 11-mm thick CSF signal intensity extra-axial fluid collection subjacent to the craniotomy flap. There is unchanged T2 hyperintensity without associated mass effect within the left frontal white matter. There is no thick, nodular, or measurable enhancement near the resection cavity. There is no significantly elevated relative cerebral blood volume adjacent to the resection cavity. There is no evidence of acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The paranasal sinuses are unremarkable.

Output: Unchanged postoperative findings without evidence of tumor progression. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 74 year-old woman with fall. There is no evidence of intracranial hemorrhage, mass or edema. There are atherosclerotic changes of the internal carotid and vertebral arteries. There are moderate, periventricular regions of hypoattenuation consistent with age-indeterminate, small vessel ischemic disease. If stroke remains a clinical concern, recommend MRI.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. There is mucosal thickening in the visualized portion of the maxillary sinuses bilaterally. The mastoid air cells are normally pneumatized.

Output: No CT findings of acute intracranial process. If stroke remains a clinical concern, recommend MRI.


Instruction: Generate impression based on findings.

Input: 46 years, Male, lung cancer. Please note comparison with outside MRI from 3/1/2016 is slightly limited due to limited sequences on prior study. Again seen are innumerable foci of intracranial metastatic disease with susceptibility indicating hemorrhage. There are at least 10 enhancing lesions which are evident involving the bilateral cerebral hemispheres as well as few punctate lesions involving the cerebellar hemispheres. Some of the hemorrhagic foci do not definitively demonstrate enhancement and may represent treated metastases.A relatively large right frontal lobe peripherally enhancing mass measures approximately 22 x 20 x 26 mm, previously measured approximately 21 x 15 x 22 mm. A right paramedian right parietal lesion measures 16 x 16 x 16 mm, previously 14 x 14 x 13 mm. A bilobed enhancing mass involving the left central sulcus measures approximately 18 x 13 mm in the craniocaudal and transverse dimensions in the coronal plane, previously 13 x 12 mm, measured similarly. There is decrease in central enhancement suggesting necrosis or treatment change. A punctate left lateral cerebellar enhancing lesion is not significantly changed. There is a punctate right cerebellar hemispheric lesion which was present on prior and not clearly enhancing on the current study. No new lesion is appreciated.Prior outside exam was obtained with limited sequences however there is increased FLAIR hyperintensity compatible with vasogenic edema associated with the relatively large right frontal, right parietal, and left central sulcus lesions. No evidence of midline shift or herniation. No hydrocephalus. No destructive calvarial lesions.There is a fluid collection in the left suboccipital scalp measuring approximately 11 x 10 mm, corresponding to a pin site of the prior stereotactic frame. There are surrounding inflammatory changes. There is central restricted diffusion which can be seen with pus.

Output: 1. Again seen is evidence of intracranial metastatic disease with multiple, predominantly supratentorial enhancing lesions. Compared to most recent MRI brain dated 3/1/2016 with limited sequences, there is mild enlargement of some of the lesions and, more significantly, increased surrounding vasogenic edema which may represent posttreatment change, although progression is not excluded. Suggest continued close follow-up. No new lesion is definitively appreciated. Please see details above.2. Susceptibility-weighted sequence demonstrates numerous foci of chronic hemorrhage, many of which correspond to the enhancing foci described above. The nonenhancing foci may represent treated metastases.3. 11 x 10 mm fluid collection with peripheral enhancement and surrounding edema in the left suboccipital scalp region, which appears to represent a pin site for prior stereotactic frame. Imaging features are highly suggestive of abscess, but suggest correlation with examination.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for CVA. Signs and symptoms: Aphagia. Unenhanced head CT:The examination demonstrates very subtle subcortical and periventricular low attenuation which are suspected for mild small vessel ischemic disease of indeterminate age. These findings were noted on prior MRI examination from 6 -- 23 -- 10.There is no evidence of intracranial hemorrhage, edema, mass-effect, midline shift or hydrocephalus. High density extra axial lesion measuring approximately 18 times 15 mm in transaxial dimension is noted along the superiorly surface of tentorium on the left is consistent with patient's known meningioma. There is no appreciable interval change since prior exam. There is no evidence of surrounding vasogenic edema.

Output: 1.No detectable acute intracranial findings.2.Minimal small vessel ischemic disease of indeterminate age.3.Stable left sided subtemporal meningioma.


Instruction: Generate impression based on findings.

Input: 56-year-old man with wound to the left first and second toe, history of diabetes mellitus, radiograph concerning for first phalanx subacute transverse fracture. There is abnormal signal intensity throughout the distal phalanx of the left great toe with gas density in the marrow space indicating osteomyelitis. Disruption of the cortical surface may represent a nondisplaced fracture as suggested on recent radiographs. There is abnormal signal within the subcutaneous soft tissues of the left great toe indicating edema. There is also enhancement within the subcutaneous soft tissues of the great toe. Foci of signal void dorsal to the distal and proximal phalanges indicate gas, possibly with a few additional small foci of gas density extending proximally along the flexor hallucis longus tendon. There is a small erosion of the medial aspect of the head of the proximal phalanx, although this may be chronic in etiology as we see no underlying marrow edema.Mild hallux valgus deformity affects the first MTP joint. There is a small amount of fluid within the first MTP joint .There is mild signal abnormality and enhancement within the soft tissues of the tip of the second toe, suggesting edema. There is also mild signal abnormality within the distal phalanx of the second toe and we cannot exclude the possibility of early osteomyelitis.There is edema within the dorsal subcutaneous fat as well as the musculature of the foot. The phalanges of the third, fourth and fifth toes are normal in appearance.

Output: 1.Osteomyelitis of the distal phalanx of the first toe with subcutaneous gas in the dorsal soft tissues.2.Equivocal early osteomyelitis of the distal phalanx of the second toe.


Instruction: Generate impression based on findings.

Input: Male; 66 years old. Reason: staging exam History: prostate cancer PELVIS:PROSTATE:Prostate Size: 4 x 4.8 x 6.4 cm.Peripheral Zone: Small focus of low T2 signal with restricted diffusion increased enhancement in the right posteromedial mid gland measuring up to 6 x 9 mm, compatible with prostate cancer.Central Gland: Heterogeneous.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: No extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: Small fat-containing left inguinal hernia.OTHER: No significant abnormality noted.

Output: Small focus of prostate cancer in the right mid gland without extracapsular extension.


Instruction: Generate impression based on findings.

Input: New onset seizure. Evaluate for seizure focus. The bilateral hippocampi are symmetric and display normal signal characteristics. There is no evidence of cortical dysplasia and gray matter heterotopia. There is no evidence of acute intracranial hemorrhage or mass effect. The brain parenchyma appears unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There is minimal mucosal thickening of the right maxillary sinus. The skull and extracranial soft tissues are unremarkable.

Output: 1. No evidence of seizure focus.2. No evidence of acute intracranial hemorrhage or mass effect.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 31 years, Male, Reason: Elevated liver enzymes and abnormal ultrasound. Liver protocol History: Elevated liver enzymes and abnormal ultrasound. Liver protocol. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Segment IVb lesion measuring 6 x 6 mm corresponding to echogenic focus on ultrasound is bright on T2 weighted images and shows progressive centripetal enhancement, consistent with a hemangioma.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Lesion identified on prior ultrasound is consistent with a hemangioma.


Instruction: Generate impression based on findings.

Input: 52-year-old woman with self palpated suspicious right breast mass presents for further evaluation with bilateral breast MRI. The patient is involving the Alan Penn research study. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.Right breast: In the upper inner quadrant near the 2:00 position, posterior depth, there is a homogeneously enhancing macrolobulated mass, suspicious for malignancy. The mass measures approximately 14 x 18 x 15 mm (AP x TV x CC). Portions of this mass demonstrates rapid uptake and washout on dynamic evaluation. A distinct fat plane is noted between the mass and pectoralis muscle. There is no pectoralis muscle enhancement. Few scattered subcentimeter enhancing foci are seen, likely related to background parenchymal enhancement.There are a few prominent right axillary lymph nodes, which demonstrate borderline increased cortical thickness similar to the findings on mammogram and ultrasound. The most prominent node measures up to 9 mm in maximum diameter. Left breast: Few scattered subcentimeter enhancing foci are seen in the right breast, not uniquely suspicious and likely related to bagging or parenchymal enhancement. There is no suspicious mass, morphology or focus of temporal enhancement. There are a few scattered lymph nodes in the left axilla, none uniquely suspicious.Other: There is enlargement of the cardiac silhouette, better evaluated on prior cardiac MRI and related to patient's history of sarcoid.

Output: (1) Homogeneously enhancing right upper inner breast 2:00 position mass measuring up to 18 mm, suspicious for malignancy. This mass was biopsied under ultrasound guidance later today and reported under separate accession.(2) Indeterminate prominent right axilla lymph nodes some of which demonstrate borderline increased cortical thickness measuring up to 9 mm in maximum diameter. One of these lymph nodes were biopsied under ultrasound guidance today and reported under accession.(3) No MR evidence of malignancy in the left breast or left axilla.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: X - No Letter.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Nontraumatic intracerebral hemorrhage, unspecified [I61.9], Reason for Study: ^Reason: ICH History: ICH 61.3mm (AP) x 30.2mm (RL) x 42.8mm (CC) sized right basal ganglia acute intracerebral hemorrhage with surrounding edema and midline shift toward left side.There is focal susceptibility lesion on the posterior aspect of putamen (series 10, image 50/92) without evidence of surrounding edema, thus indicate possible chronic hemorrhagic focus or calcification. In addition, there are various sized multifocal bihemispheric susceptibility lesions including right frontal, left frontal and right temporal lobes, again indicating chronic petechial hemorrhagic foci or calcifications.There is no evidence of acute ischemic lesion.There is no evidence of abnormal 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: Large right basal ganglia ICH with surrounding edema and mass effects, comparing to prior CT scan, no significant interval change in terms of ICH size and the degree of midline shift toward left.Multiple various sized susceptibility lesions as described above.No acute ischemic lesion.No abnormal enhancement.


Instruction: Generate impression based on findings.

Input: Female, 54 years old, with history of metastatic triple negative breast cancer with headache and abnormal CT findings. Pathologic leptomeningeal enhancement is demonstrated most notably in the right frontal lobe, but also along the brainstem and fissures of the cerebellum. Abnormal enhancement is seen along the cisternal segments of the fifth cranial nerves, within the IACs, and along the lower cranial nerve roots arising from the medulla.No evidence of significant parenchymal edema or generalized mass effect is seen. No acute intracranial hemorrhage or any abnormal extra axial fluid collection is detected. The ventricles remain normal in size and shape. There is evidence of widespread osseous metastatic disease.

Output: Diffuse pathologic leptomeningeal enhancement is seen which, given the clinical context, most likely represents leptomeningeal spread of disease.


Instruction: Generate impression based on findings.

Input: Ms. Chen is a 52-year-old female with history of left breast pain. Per electronic medical record, history of right breast biopsy showing DCIS in 2013. Presumed postsurgical changes are present in the right breast including relative volume loss.There is heterogeneous amount of fibroglandular tissuein both breasts.Minimal parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.

Output: Postsurgical changes in the right breast without MRI evidence for malignancy. Patient should undergo a diagnostic mammogram if not recently performed; diagnostic mammograms are recommended annually given history of DCIS.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: History of HCC, evaluate for interval change after TACE/RFA. ABDOMEN:LIVER, BILIARY TRACT: The liver demonstrates fissural widening and a nodular contour compatible with cirrhosis. Multiple subcentimeter T2 hyperintense lesions in the liver are too small to characterize and likely represent cysts. There is once again trace perihepatic ascites.On the prior examination, there was a segment 4 ablation cavity with high T1 signal intensity with a rim of enhancement immediately posterior to the area of high T1 signal intensity. On today's examination, the area of high T1 signal within segment 4 has increased in size now measuring 3.3 x 4.0 cm (series 10, image 24) corresponding to interval ablation cavity and which encompasses the previously described area of rim enhanced. Postcontrast images demonstrate mild rim enhancement surrounding the ablation cavity without washout which likely represents posttreatment change. There is a new area of abnormal signal along the posterior margin of the left hepatic lobe in continuity with the ablation cavity which demonstrates intermediate T1 and T2 signal as well as peripheral enhancement measuring approximately 2.6 x 7.5 cm (series 11, image 26) and which most likely represents a postprocedural hematoma.There is an arterially enhancing lesion along the anterior aspect of the left hepatic lobe (series 11, image 40) measuring 9 x 9 mm. This lesion demonstrates isointense signal on T1 and T2-weighted images and becomes centrally hypointense on delayed postcontrast images. Attention should be paid to this lesion on subsequent imaging. Additional scattered foci of arterial enhancement without washout are noted in the peripheral liver parenchyma, compatible with perfusional anomalies. The hepatic vasculature appears patent.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable right upper pole small wedge-shaped T2 hyperintensity.RETROPERITONEUM, LYMPH NODES: Prominent periportal lymph node (series 11, image 136) has increased in size from prior and is nonspecific.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Cirrhotic liver morphology.2.Interval ablation of suspected marginal recurrence along the posterior lateral aspect of segment 4 ablation cavity without evidence of recurrence.3.2.6 x 7.5 cm area of abnormal signal along the posterior aspect of the left lobe of the liver in continuity with the ablation cavity and which most likely represents a postprocedural hematoma.4. 9 mm arterial enhancing lesion within anterior left hepatic lobe which is indeterminant but should be monitored on subsequent examinations.


Instruction: Generate impression based on findings.

Input: Clinical question: evaluate for extension of CVA signs and symptoms: Dysphagia Nonenhanced CT of brain: Bilateral cerebellar strokes with no evidence of hemorrhagic conversion.Multiple supratentorial subcortical and periventricular white matter low attenuation consistent with patient's known prior strokes remains similar. There is a small left parietal nonhemorrhagic cortical stroke since prior exam. This may represent extension of the previously noted stroke or a new cortical stroke. Review of prior MRI examination demonstrated a small cortical stroke at this site on 8 -- 10 -- 2010.No evidence of intracranial hemorrhage, mass effect, midline shift or hydrocephalus.

Output: 1.No definitive evidence of any new stroke.2.No evidence of hemorrhagic transformation.3.Better delineation of areas of stroke secondary to further evolution of multiple strokes.


Instruction: Generate impression based on findings.

Input: 73-year-old male with history of prostate cancer. Evaluate for extracapsular extension.Per pathology report: Prostate, LLB: Prostatic adenocarcinoma, Gleason score 7 (4+3)Prostate, LB: Prostatic adenocarcinoma, Gleason score 6 (3+3)Prostate, LM: Prostatic adenocarcinoma, Gleason score 7 (3+4) PELVIS:PROSTATE:Prostate Size: 5.3 x 3.3 cmPeripheral Zone: There is a subcentimeter focus demonstrating T2 hyperintensity and low ADC signal in the left mid gland laterally and left mid gland medially. Scattered T1 hyperintensity consistent with post biopsy hemorrhage.Central Gland: Heterogeneous signal throughout the central gland consistent with changes from benign prostatic hypertrophy.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: No evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Two abnormal subcentimeter foci as above likely correspond to the known adenocarcinoma.2.No evidence of extracapsular extension or seminal vesicle invasion.


Instruction: Generate impression based on findings.

Input: 68 years Female (DOB:7/11/1948)Reason: evaluate for embolic stroke History: left face and arm weakness, slurred speech, left field cutPROVIDER/ATTENDING NAME: MICHAEL ANDREW WARD MRI of the brainThere is diffusion restriction present along the lateral aspect of the right precentral gyrus which extends to the right centrum semiovale. This measures approximately 33 x 11 mm axial dimensions.There is a mild to moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.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.Images are degraded due to patient motion artifact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the left distal vertebral artery, the basilar artery and the proximal anterior, middle and posterior cerebral arteries. The right vertebral artery is not identified. The may be some retrograde filling of the distal right vertebral artery.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. The posterior communicating arteries are intact. The vertebral arteries are similar in size.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. The left common carotid artery originates from the innominate artery.The proximal common carotid arteries and the proximal vertebral arteries are not well imaged. The right vertebral artery is not readily identified.Images are degraded due to patient motion artifact.

Output: 1.Acute infarction involving the right postcentral gyrus and adjacent centrum semiovale.2.Occlusion of the right vertebral artery.3.Periventricular and subcortical white matter lesions of a mild to moderate degree are nonspecific. At this age they are most likely vascular related. 4.The proximal common carotid arteries and the proximal vertebral arteries are not well imaged on this exam.5.Examination is somewhat compromised due to patient motion artifact.


Instruction: Generate impression based on findings.

Input: 73-year-old male with HBV and HCC status post treatment. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology. Redemonstrated are two right-sided liver lesions, segment six and segment five. There is intrinsic T1 signal within bilateral ablation cavities compatible with post ablation hemorrhage/treatment change. Segment five lesion cavity measures 4.0 x 3.8 cm (series 10010, image 346). Segment six of ablation cavity measures 6.0 x 4.7 cm (series 10010, image 346). Limited subtraction sequences due to misregistration secondary to patient breathing motion. No abnormal enhancement is present within the ablation cavities.Focus of arterial enhancement in segment 4A without definite washout is noted (series 10, image 28).Cholelithiasis and gallbladder sludge.SPLEEN: Splenic size is borderline.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: T2 hyperintense cysts and subcentimeter T2 hyperintense cysts within the left kidney. No hydronephrosis or perinephric inflammation.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.Limited examination due to motion from breathing.2.Within these limitations, no abnormal enhancement is present within the segment five and segment six ablation cavities. 3.Small focus of arterial enhancement without definite washout in hepatic segment 4A is nonspecific. Attention on subsequent imaging is recommended.


Instruction: Generate impression based on findings.

Input: 51-year-old woman with history of cervical cancer. PELVIS:UTERUS, ADNEXA: There is abnormal intermediate T2 signal involving the left lateral cervix (501/40) with corresponding diffusion abnormality (806/328). This signal abnormality extends approximately 18 mm laterally into the parametrial fat beyond the ectocervix. Additionally, there is a small area of T2 signal abnormality along the right posterior cervix with loss of the ectocervical interface (601/30).Multiple uterine fibroids are noted.BLADDER: The bladder appears normal. There is no hydronephrosis.LYMPH NODES: No significant lymphadenopathy seen.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Peritoneal dialysis catheter noted in the abdomen.

Output: 1.Cervical carcinoma with parametrial extension, left greater than right, as detailed above.2.No regional lymphadenopathy or hydroureter.


Instruction: Generate impression based on findings.

Input: Meningioma, yearly follow up: evaluate for change in size. There is no significant interval change in the dural-based mass along the superior left frontoparietal convexity mass, which measures 19 AP x 23 RL x 18 SI mm, although assessment is somewhat limited by the lack of intravenous contrast. There is mild mass effect upon the underlying brain parenchyma, but no evidence of associated vasogenic edema. The mass appears to be separated from the superior sagittal sinus. There are unchanged nonspecific mild scattered punctate foci of T2 hyperintensity within the cerebral white matter, which likely represent small vessel ischemic disease. There is no evidence of acute intracranial hemorrhage or acute infarct. The ventricles are stable in size and configuration. There is no midline shift or herniation. The extracranial soft tissues are unremarkable, including a small right maxillary sinus retention cyst.

Output: No significant interval change in the left frontoparietal convexity mass, which likely represents a meningioma.


Instruction: Generate impression based on findings.

Input: Female 71 years old Reason: Right shoulder pathology, possible rotator cuff. ROTATOR CUFF: There is intermediate signal intensity within the supraspinatus tendon indicating moderate-severe tendinosis with extension to both articular surfaces suggesting surface fraying. While we see no discrete fluid-filled full-thickness rotator cuff tear, there is a linear focus of high signal intensity within the proximal supraspinatus tendon extending to the bursal surface best seen on the sagittal oblique sequence, compatible with a bursal surface tear. Furthermore, low signal intensity undersurface fibers of the tendon appear to end abruptly approximately 1.5 cm proximal to their expected site of attachment on the greater tuberosity, suggesting delamination and retraction. Small foci of fluid signal intensity within the distal supraspinatus tendon at its insertion represent small interstitial insertional tears with possible extension to the bursal surface on the anterior cuts. There is mild fatty atrophy of the supraspinatus muscle. There is tendinosis of the infraspinatus with mild interstitial tearing along the myotendinous junction but no full-thickness tear. Mild fatty atrophy of the infraspinatus muscle. The teres minor muscle and tendon are unremarkable. There is increased signal intensity within the superior fibers of the subscapularis tendon at its insertion compatible with partial thickness undersurface tear. The subscapularis muscle is unremarkable.SUPRASPINATUS OUTLET: Mild osteoarthritis of the acromioclavicular joint. Small amount of fluid within the subacromial/subdeltoid bursa containing intermediate signal intensity, presumably representing debris/synovitis.GLENOHUMERAL JOINT AND GLENOID LABRUM: Normal alignment of the glenohumeral joint. Given the limitations of this non-arthrographic study, the labrum appears normal for age.BICEPS TENDON: Thickening and increased signal intensity within the long head of biceps tendon at its transition from rotator interval to the intertubercular sulcus, indicating mild tendinosis. The tendon is also slightly perched upon the lesser tuberosity. ADDITIONAL

Output: 1. Rotator cuff tendinosis and partial thickness tears as described above most severely affecting the supraspinatus tendon.2. Osteoarthritis of the acromioclavicular joint.3. Mild tendinosis of the biceps tendon which appears slightly perched along the lesser tuberosity.4. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Fall status post head trauma. Patchy hypodensity within the periventricular and subcortical white matter represent small vessel disease of indeterminate age. There is hypodensity of the right thalamus, possibly representing subacute ischemia.There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration. The calvaria and skull base are radiographically normal. The paranasal sinuses and mastoid air cells are normally aerated.

Output: Small vessel ischemic disease of indeterminate age. Possible acute/subacute ischemia of the right thalamus. MRI can be obtained for further evaluation if clinically indicated.


Instruction: Generate impression based on findings.

Input: Mass Evaluation of the soft tissues about the first MTP joint is limited by metallic artifact from first metatarsal screws.Two markers are placed at the plantar aspect of the foot between the distal first and second metatarsals, indicating the location of a small palpable nodular lesion. No distinct soft tissue or osseous abnormality is noted in this region on MRI. Mild osteoarthritis affects the midfoot, with small osteophytes.

Output: No distinct soft tissue or osseous abnormality to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for venous thrombosis. Signs and symptoms: 82-year-old female with history of CVA. Presenting with left-sided weakness and new CVA. Pre and post enhanced MRV:Examination demonstrates normal appearing intracranial venous sinuses. Unremarkable superior sagittal sinus, confluence of sinuses, bilateral transverse and sigmoid sinuses as well as bilateral jugular bulbs and proximal internal jugular vein. Normal visualization of bilateral internal cerebral veins, vein of Galen, inferior sagittal sinus, vein of Galen and the straight sinus. There is also normal symmetrical visualization of bilateral cerebral cortical veins.

Output: Unremarkable pre and post enhanced brain MRV.


Instruction: Generate impression based on findings.

Input: 72-year-old female with history of spinal stenosis with acute worsening of pain. The visualized calvaria and skull base are radiographically normal.Cervical spine alignment is anatomic. Vertebral body heights and density is within normal limits. The foramen magnum is unremarkable.C2-3 is unremarkable.C3-4 demonstrates neuroforaminal compromise bilaterally with mild central spinal stenosis and ventral hypertrophic changes.C4-5 demonstrates mild spinal stenosis and ventral hypertrophic changes with neuroforaminal narrowing but laterally.C5-6 demonstrates bilateral neuroforaminal narrowing, and advanced degenerative disk disease.C6-7 demonstrates bilateral neuroforaminal narrowing, and advanced degenerative disk disease.C7-T1 demonstrates bilateral neuroforaminal narrowing.T10-11 and T11-12 demonstrates severe degenerative disk disease and near complete loss of disk height.T10/11 demonstrates significant neuroforaminal compromise.T12-L1 is unremarkable.L1-2 is unremarkable.L2-3 shows degenerative disk disease with hypertrophy of the posterior elements.L3-4 demonstrates a large diffuse bulging of disk density material that extends to the ventral epidural space greater on the left which may represent diffuse disk bulge or hypertrophic changes. For further elucidation of this level an MRI may be considered. Advanced degenerative disease is noted with sclerotic end plate changes and vacuum phenomenon. Neuroforaminal compromise is noted bilaterally and a high suspicion for central spinal stenosis.L4-5 demonstrates advanced degenerative disease with vacuum phenomenon. There is complete right neuroforaminal compromise by lateral hypertrophic changes. There is a high suspicion for a tight central spinal stenosis.The L5-S1 shows advanced degenerative disease and a significant diffuse disk bulge. Neuroforaminal compromise affects the right side. The left neuroforamina remains patent.

Output: Multilevel degenerative disk disease, neuroforaminal compromise and spinal stenosis as described above.


Instruction: Generate impression based on findings.

Input: Ms. Hester is a 33-year-old female presented for ultrasound-guided biopsy of the left breast palpable mass at the 7:00 location. Left ultrasound re-identified the target lesion for biopsy. The lesion to be targeted is a isoechoic and slightly hypoechoic mass measuring 20 x 17 x 26 mm at the 7 o’clock position with increased vascularity, 1 cm from the nipple. The lesion was readily visible. In addition, in the left breast, 6:00 location, approximately 2 cm from the nipple, there is another small well defined mass with similar sonographic appearance, which measures 7 x 7 mm. This likely correlates with the MRI finding.PROCEDURE: The procedure and its risks, including bleeding, infection, and failure to diagnose, and expected benefits of ultrasound-guided core biopsy with percutaneous placement of a marking clip and post-procedure unilateral mammogram were discussed with the patient. Questions were answered. Consent was obtained both verbally and in writing. The time-out form was completed to confirm patient identity and side/type of procedure.The left breast was cleansed with chlorhexidine over the target area. Transducer was sterilely sheathed. Local anesthesia was obtained using 2% lidocaine superficially, with 1% lidocaine with 1:100,000 epinephrine at depth. A 3 mm incision was made in the skin with a #11 scalpel blade. Using aseptic technique, continuous ultrasound guidance and a inferior to superior approach, three 12-gauge core needle (Celero) specimens were obtained of the lesion. Targeting was judged very good. All specimens sank to the bottom of the prefilled container of 10% formalin. Specimen quality was judged very good.Specimens were sent to Pathology with an accompanying history sheet. Using continuous ultrasound-guidance a Bard ribbon clip was placed into the lesion in the usual manner. Pressure was held over the biopsy site until all bleeding subsided. The skin incision was closed with a Steri-Strip. Post-procedure digital left CC and ML views revealed the percutaneously placed clip to be in the expected location in the central medial aspect of the lesion. No evidence of hematoma or other complication.A pressure dressing was positioned over the biopsy site and an ice pack positioned over the pressure dressing. Post-procedure instructions were reviewed with the patient both verbally and in writing. She tolerated the procedure well with no evident complications and left the Breast Imaging Department in stable condition.The procedure was performed by Dr. Wang. Dr. Schacht was present during the procedure at all times.

Output: Successful ultrasound-guided core biopsy of the left breast lesion and clip placement. Pathology is pending at this time.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: 10-year-old female with a history of tubular sclerosis. ABDOMEN:Please note exam is limited by motion artifact and artifact from loss of signal anteriorly.LIVER, BILIARY TRACT: No focal hepatic mass. No intra or extra hepatic biliary ductal dilatation. The gallbladder is normal in appearance.SPLEEN: Heterogeneous foci scattered throughout the spleen may reflect splenic hamartomas. The largest focus measures 2.8 x 3.1 cm.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: The adrenal glands are not visualized.KIDNEYS, URETERS: Large heterogeneous mass occupying the majority of the upper and midpole of the right kidney. The mass measures 9.8 x 8.6 x 11.2 cm (series 901, image 22 and series 501, image 16). A large prominent blood vessel appears to be at the periphery of the mass and drains into the inferior vena cava. There is mass effect on the liver and multiple bowel loops.There is a slightly smaller mass occupying the inferior pole anteriorly with only a small amount of renal parenchyma remaining. The mass measures approximately 4.8 x 5.9 x 6.2 cm (series 901, image 34 and series 501, image 22). There is mass effect on the inferior vena cava at approximately the L4 level.Right-sided hydronephrosis. Innumerable bilateral T2 hyperintense foci compatible with renal cysts. Additional hypointense foci bilaterally compatible with angiomyolipomas. The largest of which on the left measures 2.9 x 2.2 cm (series 901, image 23). Note is made of a retroaortic left renal vein.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Bilateral dependent atelectasis in the partially visualized lung bases.

Output: 1. Large heterogeneous right renal masses exerting mass effect on the liver, bowel, inferior vena cava, and right renal collecting system likely angiomyolipomas. Smaller bilateral angiomyolipomas and innumerable renal cysts.2. Heterogeneous foci in the spleen are suggestive of splenic hamartomas.The above findings were communicated via telephone to Dr. Magno at 11:24 AM on 6/21/2016. The patient will be admitted to Comer Children's Hospital.


Instruction: Generate impression based on findings.

Input: MRI Brain:The exam is limited by motion artifact. There is an area of restricted diffusion involving the right middle and inferior frontal gyri compatible with an acute ischemic infarct. There is associated FLAIR signal abnormality and sulcal effacement. Additional scattered punctate foci of FLAIR hyperintensity are consistent with chronic small vessel ischemic changes. Encephalomalacia is visualized in the right occipital lobe indicating an old infarct.Bilateral prominent perivascular spaces versus lacunar infarct are visualized along the basal ganglia. There is diffuse age-related volume loss. There is no evidence of acute intracranial hemorrhage, midline shift, herniation, hydrocephalus or extra-axial fluid collection. The major cerebral flow voids are intact. Incidental note is made of bilateral exophthalmos.MRA Brain: The exam is limited by motion artifact. The intracranial internal carotid arteries demonstrate no significant stenosis. The middle and anterior cerebral arteries are also patent. The vertebral arteries and basilar artery are patent with no significant stenosis. There are fetal-like PCAs noted bilaterally which are patent. No evidence of aneurysm or flow-limiting stenosis.

Output: 1.Small acute to subacute ischemic infarct involving the right middle and inferior frontal gyri.2.Right occipital lobe chronic infarct.3.Mild underlying chronic small vessel ischemic disease.4.No evidence of aneurysm or flow-limiting stenosis involving the intracranial arteries.


Instruction: Generate impression based on findings.

Input: Female 39 years old Reason: ascites. complete liver ultrasound with dopplers to rule out liver pathology or process History: ascites, LIVER: Liver measures 16.1 cm. Normal echogenicity. No focal liver lesions. No evidence of intra or extrahepatic biliary dilatation.BILIARY TRACT: No evidence of intra or extrahepatic biliary dilatation. Mild gallbladder wall thickening. Small amount of sludge is present in the gallbladder.PANCREAS: Not well visualized due to overlying bowel gas.SPLEEN: Spleen measures 10.7 cm.RIGHT KIDNEY: No significant abnormalities noted. OTHER: Bilateral small pleural effusions and trace amount of ascites. Uterus is heterogeneous and enlarged. MRI of the liver may be helpful if further evaluation of the uterus is clinically indicated.

Output: Mild gallbladder wall thickening as small amount of sludge in the gallbladder.Bilateral small pleural effusions and ascites.Heterogeneous enlarged uterus of uncertain etiology.


Instruction: Generate impression based on findings.

Input: The patient was unable to complete the study secondary to pain thus axial thoracic spine, entire lumbar spine, and all contrast enhanced images were not obtained. The patient stated a desire to reschedule the exam at a later date.Several sequences are motion degraded, with attempts to repeat when possible.Cervical spine:There is reversal of normal upper cervical curvature. The marrow signal is benign. The cervical and upper thoracic cord is normal in signal without abnormal enhancement. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable.C2/3: UnremarkableC3/4: UnremarkableC4/5: UnremarkableC5/6: Posterior osteophyte disc complex and bilateral uncinate hypertrophy contribute to mild left neural foraminal and moderate right neural foraminal stenosis.C6/7: Posterior osteophyte disc complex and bilateral uncinate hypertrophy contribute to severe left neural foraminal and moderate right neural foraminal stenosis.C7/T1: UnremarkableThoracic spine:Abnormal T2 hyperintensity is noted within the thoracic cord spanning the levels from T2 through T4/5 as well as more inferiorly from T9/10 through the conus, with mild conus expansion. Vertebral body heights are maintained and marrow signal is benign.

Output: 1.The patient was unable to complete the study secondary to pain thus axial thoracic spine, entire lumbar spine, and all contrast enhanced images were not obtained. The patient stated a desire to reschedule the exam at a later date.2.C5/6: Mild left neural foraminal and moderate right neural foraminal stenosis.3.C6/7: Severe left neural foraminal and moderate right neural foraminal stenosis.4.Abnormal T2 hyperintensity is noted within the thoracic cord spanning the levels from T2 through T4/5 as well as more inferiorly from T9/10 through the conus, with mild conus expansion.


Instruction: Generate impression based on findings.

Input: There is a small 8 x 13 mm focal oval CSF signal intensity structure along the anterior lateral aspect of the left temporal horn. There appears to be minimal mass effect on the adjacent hippocampus with possible associated volume loss of the left hippocampus relative to the right. Additionally, there is mild prominence of the left trigone and atrium, which is of unknown clinical significance. Overall, there is mild to moderate prominence of the ventricles and sulci consistent with age related volume loss. Mild peri-ventricular and subcortical white matter T2/FLAIR signal abnormality consistent with chronic small vessel ischemic disease. No diffusion restriction to suggest ischemia. There is no midline shift. There are no extra-axial fluid collections or subdural hematomas. The cerebellar tonsils are in normal position. Flow voids are present within the major vessels indicating patency.

Output: Small focal oval CSF signal along the anterolateral aspect of left temporal horn which may relate to coaptation of ependymal surfaces forming a pseudo-lesion, versus a true ependymal cyst given slight mass effect on the adjacent hippocampus. Possible associated mild volume loss of the left hippocampus, although thin section imaging not available.


Instruction: Generate impression based on findings.

Input: A 37 year old female with palpitations, NSVT on holter, normal echocardiogram and stress echo. Referred to cardiac MRI for further evaluation. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 58%, the LV end diastolic volume index is 84 ml/m2 (normal range: 65+/-11), the LVEDV is 159 ml (normal range 109+/-23), the LV end systolic volume index is 35 ml/m2 (normal range 18+/-5), the LVESV is 67 ml (normal range 31+/-10), the LV mass index is 37 g/m2 (normal range 67+/-11), and the LV mass is 71 g (normal range 114+/-24). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is normal in size.Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 51%, the RV end diastolic volume index is 77 ml/m2 (normal range 69+/-14), the RVEDV is 147 ml (normal range 110+/-24), the RV end systolic volume index is 37 ml/m2 (normal range 22+/-8), and the RVESV is 71 ml (normal range 35+/-13). No RV wall motion abnormalities. No sacculations or aneurysms.Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with normal systolic function, the LVEF is 55%. There are no regional wall motion abnormalities present. 2. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.3. The right ventricle is normal in size with normal systolic function, the RVEF is 52%.No findings compatible with ARVD.4. The left and right atria are normal in size.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Back pain Five lumbar type vertebral bodies are presumed to be present with the most inferior well-defined disc space labeled L5-S1. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position.Axial sequences are motion degraded slightly limiting evaluation. There are multilevel degenerative changes as detailed below. There is T1 and T2 hyperintensity involving the L5-S1 disc space which may be related to calcification. There is evidence of prior laminectomies at L4-L5 and L5-S1. There is ossification along the lateral aspects of the posterior elements from L4 to S1 presumably related to prior osseous fusion. CT may better assess the bony fusion mass.Multilevel degenerative changes are seen, as described below:L1-L2: Minimal disc bulge. No spinal canal or neural foraminal stenosis. Mild bilateral facet arthropathy.L2-L3: Minimal disc bulge. No spinal canal or neural foraminal stenosis. Mild bilateral facet arthropathy.L3-L4: Minimal disc bulge. There is moderate bilateral facet arthropathy. There is also ligamentum flavum thickening. Mild narrowing of the spinal canal including partial effacement of the posterior left lateral aspect of the thecal sac related to facet arthropathy. There is also mild narrowing of the bilateral neural foramina.L4-L5: Prior laminectomy. Bilateral facet arthropathy. Bony proliferation noted lateral to the facet joints. No spinal canal stenosis. No neural foraminal stenosis.L5-S1: Prior laminectomy. Bony proliferation noted lateral to the facet joints. No spinal canal stenosis. No neural foraminal stenosis.

Output: 1. Postsurgical changes compatible with remote L4-S1 laminectomy and fusion and can be correlated with history. CT or radiographs may be helpful to better assess the degree of fusion if clinically indicated.2. Mild spinal canal and mild bilateral neural foraminal narrowing at the L3-L4 level. Otherwise no spinal canal or neural foraminal stenosis is appreciated at any level.3. Moderate facet arthropathy at L3-L4 and to a lesser degree at additional levels as above and may be contributing to low back pain.


Instruction: Generate impression based on findings.

Input: 26 years Female (DOB:8/5/1990)Reason: seizure focus? History: seizurePROVIDER/ATTENDING NAME: SHASHA WU SHASHA WU The CSF spaces are appropriate for the patient's stated age with no midline shift. There is T2 and FLAIR signal hyperintensity associated with the loss of volume along the junction of the body and the splenium of the corpus callosum. Additional T2 and FLAIR hyperintense foci are present along the colossal cingulate junction along the body of the corpus callosum.There is a 4 mm focus of signal loss associated with susceptibility effect which is a ringlike pattern on T2 imaging along the junction of the head and body of the caudate nucleus on the right side.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.

Output: 1.There is loss of volume present along the corpus callosum at the body of the corpus callosum extending to the splenium consistent with encephalomalacia. In isolation these are nonspecific. These lesions are nonspecific. Please correlate with patient's prior clinical history including possible history of prior trauma, inflammatory process and ischemic event.2.Is a hemorrhagic lesion present right caudate nucleus adjacent to the right lateral ventricle. Differential considerations include cerebral cavernous malformation though it is too small to characterize and may represent some other than the cerebral cavernous malformation. Contrast-enhanced exam may be helpful in further characterizing this lesion and exclude the possibility of associated lesions not visible on this exam. If the patient has a known history of a primary neoplasm elsewhere the possibility of metastasis cannot be excluded.


Instruction: Generate impression based on findings.

Input: 50 year-old female with change in mental status following craniotomy. Evaluate for hemorrhage. Postoperative changes status post bifrontal craniotomy, with pneumocephalus, surgical hardware, and skin staples evident. Previously described partially calcified lesions along the anterior interhemispheric fissure just right of midline and along the high left frontal convexity are unchanged. There is marked low attenuation within the frontal lobes, right greater than left, corresponding to edema seen on MRI. An area of focal low attenuation is seen in the medial left frontal lobe, concerning for ischemia. Punctate high attenuation in the medial left frontal lobe may represent calcification or hemorrhage, though thrombus within the anterior cerebral artery may have this appearance.A small curvilinear focus of high attenuation is seen in the medial right frontal lobe inferior to the partially calcified lesion, which may represent a small focus of hemorrhage. The degree of leftward midline shift has slightly increased, with ventricular volumes unchanged. The remainder of the cerebral and cerebellar hemispheres and brainstem demonstrate normal morphology and attenuation. Postoperative changes affect the frontal bones, with the remainder of the calvarium and osseous structures appearing intact. There is partial opacification of the left anterior ethmoid air cells, with the remainder the visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. Focal low attenuation in the medial left frontal lobe, suspicious for anterior cerebral artery territory or venous infarction.2. Extensive postoperative changes with residual tumor and mass effect as described.