Instruction: Generate impression based on findings.

Input: Female, 68 years old, with history of childhood radiation and enlarged parapharyngeal nerve sheath tumor, now with hypercalcemia, hyperparathyroidism, and memory issues. History of thyroidectomy. Brain:A lesion with bubbly central T2 hyperintensity and a rim of hemosiderin in the left anterior temporal lobe is not significantly changed. A small associated developmental venous anomaly is not as well seen on today's examination.An additional suspected developmental venous anomaly is redemonstrated in the right superior frontal gyrus showing no significant change. No new pathologic enhancement is detected. No parenchymal edema or significant mass effect is seen. A few scattered small foci of white matter T2 hyperintensity are similar to prior and nonspecific. No new intracranial hemorrhage or abnormal extra-axial fluid is detected. The ventricles are normal in size and morphology.Neck:Again seen is a lobular, well-circumscribed, T2 hyperintense enhancing mass which principally occupies the right carotid and parapharyngeal spaces. There has been no significant interval change in the size of this lesion which measures up to 41 mm in maximal dimension. As before, the lesion displaces the internal carotid artery anteriorly and medially but the flow void is preserved compatible with patency. The internal jugular vein is compressed. The right vertebral artery passes along and possibly through the medial aspect of this lesion. The lesion infiltrates the right prevertebral space with extension through the chronically widened right C1-occipital foramen. The lesion occupies the epidural space at this level but does not significantly encroach upon the spinal canal.A subcentimeter mildly enhancing nodule within the right cerebellar medullary angle is also unchanged. No new lesions are seen. No pathologic adenopathy is detected in the neck. The salivary glands are unremarkable. The thyroid is not visualized compatible with thyroidectomy.

Output: 1.No significant change in the size of a presumed nerve sheath tumor involving the right parapharyngeal, carotid, and prevertebral spaces.2.No significant change in the size of a subcentimeter additional presumed nerve sheath tumor at the right cerebello-medullary angle.3.Stable appearing left anterior temporal cavernous malformation with associated developmental venous anomaly.


Instruction: Generate impression based on findings.

Input: 43 years, Female, multiple sclerosis, evaluate for progression. Compared to 8/20/2014, no new lesions are seen within the brain to suggest disease progression. Again seen are multiple abnormal foci of increased T2/FLAIR hyperintensity involving the corpus callosum and periventricular white matter bilaterally consistent with known demyelinating disease. No appreciable change in extensive, confluent abnormal signal involving the posterior periventricular white matter, particularly the periatrial region. Several these lesions again demonstrate T1 hypointensity. There are no new lesions. No abnormal enhancement. Brain parenchymal volume appears within normal limits for age.

Output: No new lesions to suggest progression of demyelinating disease. No abnormal enhancement.


Instruction: Generate impression based on findings.

Input: Scalp melanoma. Hepatic lesion seen on prior CT. ABDOMEN:LIVER, BILIARY TRACT: Again seen is the 3.5 x 4.3 cm lesion in hepatic segment 8. This lesion demonstrates hypointensity centrally with rim hyperintensity on T2-weighted sequences. This lesion demonstrates hyperintensity throughout on T1 weighted sequences. There is peripheral rim enhancement of this lesion.SPLEEN: No significant abnormality noted.PANCREAS: Fatty atrophic of the pancreatic neck, body, and tail. No focal lesion or pancreatic ductal dilation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Partially imaged. No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: Enhancing T1 hyperintense lesion in the right hepatic lobe, with features most suggestive of melanoma metastasis.


Instruction: Generate impression based on findings.

Input: Vertebral body heights in the thoracic spine are normal. No worrisome focal marrow signal abnormality is appreciated. There is trace prominence of the central canal involving the upper thoracic cord. The spinal cord is otherwise of normal caliber and signal. Mild degenerative changes are seen in the thoracic spine including disc desiccation and height loss at multiple levels in the lower thoracic spine. There is a small left paracentral disc extrusion at the T9-T10 level with mild superior migration and associated mild deformity of the left ventral cord. There is overall no significant spinal canal stenosis at this level. There is also significant disc height loss at the T11-T12 level with associated endplate marrow signal changes and mild disc bulge. There is facet arthropathy and ligamentum flavum thickening at this level. There is also mildly exaggerated thoracic kyphosis and mild spinal canal stenosis at this level. There is mild deformity of the ventral cord without cord signal abnormality. This finding was partially imaged on recent lumbar spine MRI study. Aside from the kyphotic deformity at this level, alignment of the thoracic spine is grossly maintained.There is no significant disk bulge, herniation, spinal canal or foraminal stenosis elsewhere within the thoracic spine. Paraspinous soft tissues are unremarkable.

Output: 1. Degenerative changes in the lower thoracic spine including disc bulge at the T11-T12 level with mild spinal canal stenosis. There is also a small left paracentral disc extrusion at the T9-T10 level. There is mild associated deformity of the cord at these levels as described above without cord signal abnormality. There is no higher grade spinal canal stenosis at any level in the thoracic spine. 2. Trace prominence of the central canal in the upper thoracic cord which is of doubtful clinical significance.


Instruction: Generate impression based on findings.

Input: Female, 20 years old, with elevated prolactin and nipple discharge. A 2 mm focus of relative hypoenhancement is seen within the left aspect of the pituitary gland, best visualized on coronal image 10 series 7. Elsewhere, the pattern of pituitary glandular enhancement is homogeneous and within normal limits. The size of the gland is normal. The pituitary stalk enhances normally and sits at the midline. The posterior pituitary T1 hyperintense spot is well visualized and normal. No suprasellar abnormalities are detected. Limited views of the remainder of the brain are within normal limits.

Output: A 2 mm focus of relative hypoenhancement is seen within the left aspect of the pituitary gland. This could potentially represent a microadenoma, though a small cyst or an area of prior parenchymal injury could appear similarly.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for stenosis/occlusive disease, etiology right MCA stroke. Signs and symptoms: Left hand weakness of two days duration. Nonenhanced brain MRA:Bilateral vertebral arteries remain patent across the skull base and in the intracranial segments. Bilateral pica branches are identified.Vascular artery and bilateral superior cerebellar and posterior cerebral arteries are visualized.There is no evidence of high-grade vascular lumen compromise or stenosis however mild atherosclerotic disease of intracranial circulation is suspected.Right internal carotid artery is patent in its distal cervical, across the skull base and in its supraclinoid segment. There is atherosclerotic disease and irregularity of the cavernous carotid on the right with a tiny segmental focus of moderate posterior lumen compromise. The right anterior and middle cerebral arteries are patent. Regions of vascular lumen irregularity and moderate stenosis are noted in the anterior division of right MCA distal branches.The internal prior arteries is patent and is visualized cervical segment and across the skull base as well as its supraclinoid segment. Mild atherosclerotic disease of the cavernous carotid with resultant mild to moderate vascular lumen compromise is present.Right anterior cerebral artery demonstrate mild atherosclerotic plaque at its origin and patent otherwise. There is a short segment of absence of visualization of the proximal M2 segment of left middle cerebral artery suggestive of high-grade stenosis. Possibly two complete occlusion cannot be entirely excluded. Branches of left MCA however beyond this focus remains been visualized and with similar signal pattern and is the opposite side suggesting likelihood of antegrade filling. Mild atherosclerotic irregularity and stenosis of the proximal M1 segment of the left middle cerebral arteries also noted.

Output: 1.Patent bilateral vertebral arteries, basilar artery and their branches however within the distal atherosclerotic vascular inlet of the without significant compromise of lumen or distal occlusion.2.Examination of carotid system demonstrate a short segmental high grade stenosis or complete occlusion of the left proximal M2. Atherosclerotic irregularity and mild to moderate stenosis of the left M1 segment is also present. There is atherosclerotic disease of right cavernous carotid with high-grade stenosis. Atherosclerotic disease and high-grade vascular lumen compromise of the M2 segment of the anterior division of right MCA. Anterior cerebral arteries demonstrate mild atherosclerotic disease without high-grade stenosis or distal vessel occlusion.3.MRA often over estimate the degree of stenosis and if further assessment is clinically deemed necessary follow-up with CTA is recommended.


Instruction: Generate impression based on findings.

Input: Female, 69 years old, with blurry vision. Evaluate for left optic neuropathy Numerous scattered foci of periventricular and subcortical white matter T2 hyperintensity are seen, progressed from the prior examination. No evidence of restricted diffusion is seen. No parenchymal edema or mass effect is detected. There is no abnormal parenchymal or extra-axial enhancement. No evidence of intracranial hemorrhage or any abnormal extra-axial fluid collection is seen. The ventricular system is normal in size and morphology.The globes are round and symmetric. The extraocular muscles demonstrate normal caliber and morphology. The optic nerves and chiasm are morphologically normal and free of signal abnormality. No pathologic orbital enhancement is observed. Please note, however, that fat suppression failed in the right orbit likely due to underlying dental hardware which does limit the postcontrast evaluation of right orbital structures.

Output: 1.Interval progression of small vessel ischemic disease, with no findings to suggest acute intracranial abnormality.2.No specific orbital abnormalities are identified to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: 74-year-old female with leg weakness. Small focus of restricted diffusion in the left parietal subcortical white matter. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. Scattered foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter and brainstem, which are nonspecific, but compatible with chronic small vessel ischemic changes. Focal encephalomalacia compatible with remote right cerebellar hemisphere infarction. No abnormal parenchymal or meningeal enhancement. Major flow-voids are preservedSella and orbits are grossly within normal limits. Small amount of fluid and mucosal thickening in the left maxillary sinus. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: 1. Small focus of acute ischemia in the left parietal subcortical white matter likely related to small vessel infarction.2. Moderate chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: Female 55 years old Reason: rectal ca s/p chemo History: rectal CA PELVIS:UTERUS, ADNEXA: Stable-appearing left adnexal cystic lesion with thin septation measuring 5.6 x 4.3 cm.Partially septated uterus.BLADDER: No significant abnormality noted. LYMPH NODES: There are small mesorectal lymph nodes with the largest measuring 4 mm located at the 4:00 position approximately 1 cm from the mesorectal fascia. A second smaller lymph node is abutting the mesorectal fascia slightly more superiorly measuring 3 mm (image 34 of series 801).BOWEL, MESENTERY: Mild circumferential low rectal wall thickening measuring 8 mm at the 1:00 position. There is no postcontrast enhancement or restricted diffusion.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Stable mild circumferential low rectal wall thickening and tiny mesorectal lymph nodes without significant change.2.Unchanged left adnexal cyst.


Instruction: Generate impression based on findings.

Input: Female, 65 years old, with hereditary hemorrhagic telangiectasia, known meningioma seen several years ago on outside imaging, prior angio embolization for nosebleeds, evaluate for AVMs and for known meningioma. Scattered small foci of periventricular and subcortical T2 hyperintensity are seen, slightly increased in number from prior examinations. No evidence of restricted diffusion is seen. No edema or mass effect is detected.A 10 mm enhancing extra-axial mass is seen along the left paramedian convexity partially involving the adjacent marrow. This lesion exerts no significant mass effect on underlying brain. There has been no significant interval change in size compared to prior exams.No additional enhancing lesions are seen. No intracranial hemorrhage or any abnormal extra-axial fluid collection is seen. The ventricles are normal in size and morphology.The anterior nasal septum is deficient and the posterior nasal septum is thickened, findings which have not significantly changed from prior. The ostiomeatal units are deficient which may be postoperative. Mucosal thickening is seen along the maxillary sinus floors, left side more than right.No evidence of an arteriovenous malformation, capillary telangiectasia, or other vascular malformation is seen. No significant vascular stenosis or occlusion is detected. Early branching of the right M1 MCA is a normal variant.

Output: 1.A small left convexity meningioma is unchanged.2.No evidence of any AVM, capillary telangiectasia or other intracranial vascular malformation is seen. 3.The MRA examination is within normal limits.4.Scattered foci of white matter signal abnormalilty are nonspecific but likely represent chronic small vessel ischemic disease. 5.Deficiency of the anterior nasal septum may be post-operative or related to prior embolization. There is evidence of sinus mucosal inflammation and likely prior sinus surgery.


Instruction: Generate impression based on findings.

Input: Shoulder pain The examination is significantly limited by motion artifact.ROTATOR CUFF: There is fluid signal in the area of the supraspinatus tendon suggesting full-thickness tearing with retraction to the level of the clinoid. The infraspinatus may also be involved however this is unclear given the motion artifact. The distal fibers of the supraspinatus tendon are also poorly visualized but again this may be technical in nature.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is age-related degeneration of the labrum with mild glenohumeral osteoarthritic change.BICEPS TENDON: The intra-articular aspect of the biceps tendon is poorly visualized which may be secondary to at least partial tearing.ADDITIONAL

Output: 1. Significantly limited examination secondary to motion artifact.2. Within the limits, there is likely full-thickness tearing of the supra/infraspinatus tendons with retraction to the level of the glenoid. Evaluation of the subscapularis tendon is limited although there may be partial tearing of the distal superior fibers as well.3. Poor visualization of the intra-articular biceps tendon likely secondary to tearing.


Instruction: Generate impression based on findings.

Input: Reason: R/o stroke History: Vision changes R eye, RUE weakness There are multiple new foci of restricted diffusion both supratentorially and infratentorially, distributed bilaterally throughout the cerebellar, frontal, parietal, and occipital lobes, as well as the deep white matter, left thalamus, and right frontal corona radiata. There is corresponding FLAIR hyperintensity. There is evidence of petechial hemorrhage on SWAN images, involving the lesions in the right parietal lobe, bilateral occipital lobes, and right frontal corona radiata. No evidence of frank hematoma. There is FLAIR hyperintensity corresponding to the infarcts.No evidence of mass affect or volume loss out of proportion to patient's age. There is redemonstration of periventricular and subcortical white matter patchy hyperintensity on FLAIR images compatible with mild chronic small vessel ischemic changes. No intracranial mass or mass effect. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: Multiple acute infarcts involving the bilateral cerebral and cerebellar hemispheres. Petechial hemorrhages are evident within the infarcts in the right parietal lobe, bilateral occipital lobes, and right frontal corona radiata. No frank hematoma or significant mass effect. Dr. Altman discussed findings with Dr. Neborak at 1540 hrs on 8/4/2015.


Instruction: Generate impression based on findings.

Input: Liver lesion identified on ultrasound November 2015. ABDOMEN:LIVER, BILIARY TRACT: There is a segment 7 T2 hyperintense lesion measuring 1.9 x 1.4 cm (series 3, image 9), with peripheral nodular enhancement and gradual fill-in on delayed imaging, compatible with a hemangioma. The liver is normal in contour and morphology. There is no intra- or extra- hepatic biliary ductal dilatation. The gallbladder is unremarkable.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: Corresponding to lesion seen on prior sonography is T2 hyperintense gradually enhancing hepatic lesion in segment 7, compatible with hemangioma.


Instruction: Generate impression based on findings.

Input: Female 44 years old Reason: Evaluate for impingement vs. rotator cuff tear History: Pain refractory to injectionsx2 Some sequences are slightly limited due to patient motion artifact.ROTATOR CUFF: Mild increased signal intensity within the supraspinatus tendon and anterior fibers of the infraspinatus tendon suggesting mild tendinosis, but we see no discrete rotator cuff tear. Mild fatty atrophy along the myotendinous junction of the supraspinatus and to a lesser degree the infraspinatus otherwise the muscles appear normal. Teres minor muscle and tendon appear intact. There may be mild fraying of the superior subscapularis tendon but this is of questionable clinical significance. Coracohumeral interval appears slightly narrowed raising possibility of subcoracoid impingement, though the clinical significance of this is uncertain. SUPRASPINATUS OUTLET: There is mild osteoarthritis affecting the AC joint. In addition there is broad-based prominence of the undersurface of the acromion process that could represent source of impingement with slight narrowing of the acromiohumeral interval and a small amount of fluid in the subacromial subdeltoid bursa. GLENOHUMERAL JOINT AND GLENOID LABRUM: Fluid signal intensity in the posterior superior labrum suggesting tear. The remainder of the labrum appears normal for age given limitations of a nonarthrographic study. Glenohumeral joint alignment is normal. We see no joint effusion.BICEPS TENDON: Given the limitations of a nonarthrographic study the long head of the biceps tendon appears normal although transition from the rotator cuff interval to the intertubercular groove is not well defined on this study.ADDITIONAL

Output: 1.Broad-based prominence of the undersurface of the acromion as well as small amount of fluid in the subacromial/subdeltoid bursa could reflect subacromial impingement; there is mild tendinosis of the underlying rotator cuff, but no tear is seen.2.Narrowing of the coracohumeral interval and equivocal fraying of the superior fibers of the subscapularis raising possibility of subcoracoid impingement but the clinical significance of these findings is uncertain.3.Tear of the posterior superior labrum.4.Loss of fat signal beneath the coracohumeral ligament has been described in patients with adhesive capsulitis.


Instruction: Generate impression based on findings.

Input: 74-year-old male reported as "LEFT dorsal wrist soft tissue sarcoma now with recurrent mass" although the electronic medical record/pathology states the patient had a right soft tissue mass status post resection, now with recurrent mass. An avidly enhancing, predominantly high T2, intermediate T1 signal mass is noted along the dorsal aspect of the RIGHT wrist, within the subcutaneous tissue.Mass measures 16 x 11 x 20 mm (series 1201, image 13; series 1401, image 12) and extends along although does not appear to invade through the extensor tendon sheath. Small feeding and draining vessels are seen. The extensor and flexor tendons are normal in signal without evidence of invasion.Degenerative changes affect the radiocarpal joint, midcarpal joints, and particularly the basilar joint with multiple subchondral cysts. Abnormal edema type marrow signal within the ulnar aspect of the triquetrum. Degenerative tearing of the triangular fibrocartilage complex with a 6 x 6 mm ganglion cyst at the tip of the ulnar styloid. Small amount of enhancing synovium and fluid within the distal radioulnar joint and midcarpal joints. Scapholunate widening is present suggesting tearing of the scapholunate ligament.

Output: 1.Avidly enhancing subcutaneous mass along the dorsal aspect of the right wrist as described above. Provided the patient's history, may represent an additional soft tissue sarcoma.2.Degenerative disease affects the wrist with ganglion cyst formation along the ulnar styloid as described above.3.Mild synovitis and joint fluid of the distal radioulnar joint and midcarpal joints.


Instruction: Generate impression based on findings.

Input: 30-year-old man with history of firm material in semen. PELVIS:PROSTATE:Prostate Size: 50 x 29 mm.Peripheral Zone: There is diffusely decreased T2 signal within the peripheral zone bilaterally along with intermediate signal on ADC maps. Additionally, there are more pronounced focal areas of T2 hypointensity in the right lateral and midline peripheral zone (series 801, image 16). Within the left para midline mid prostatic peripheral zone, there is a 10 x 6 mm focus of T2 hyperintensity, T1 hypointensity, and no diffusion restriction (series 801, image 14), suggesting a cystic focus.Central Gland: No significant abnormality noted.Seminal Vesicles: There is a focus of high T1 signal and markedly low T2 signal within the right seminal vesicle (series 1201, image 85) measuring 8.5 mm.BLADDER: No significant abnormality noted.LYMPH NODES: No significant lymphadenopathy noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small amount of pelvic free fluid is noted.

Output: 1.Diffusely decreased T2 signal in the peripheral zone suspicious for prostatitis, correlate with patient's clinical history/laboratory values; findings may be followed up as clinically warranted.2.Small amount of blood products in the right seminal vesicle.


Instruction: Generate impression based on findings.

Input: POD#2 after right orbitofrontal craniotomy for tumor resection. Aphasic immediately post-op, EEG negative. There are postoperative findings related to right anterior cranial fossa extra-axial tumor resection via subfrontal osteotomy with removal of the anterior wall of the right frontal sinus with a small amount of nodular dural enhancement along the floor of the resection cavity. There is a diffuse thin rim of susceptibility effect and apparent restricted diffusion along the margins of the surgical cavity in the right orbitofrontal gyri, as well as a confluent area of high T2 signal in the right frontal lobe white matter. There is scattered high FLAIR signal in the cerebral sulci. There are scattered nonspecific foci of high T2 signal in the cerebral white matter. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The right frontal sinus and frontoethmoid recess have been obliterated. There is subgaleal fluid in the frontal region that measures up to 12 mm in width. There are secretions and mucosal thickening in the left maxillary and sphenoid sinuses.

Output: Postoperative findings related to right subfrontal osteotomy with probable small amounts of residual meningioma, residual edema surrounding the resection cavity, persistent scattered foci of subarachnoid hemorrhage, and a subgaleal fluid in the frontal region that measures up to 12 mm in width, but no evidence of territorial infarction.


Instruction: Generate impression based on findings.

Input: 66-year-old woman with history of IPMN. ABDOMEN:LIVER, BILIARY TRACT: There is an 8 x 8 mm T2 hyperintense segment 4A hepatic cyst (series 8, image 26). The liver is otherwise normal. There is no intra or extrahepatic biliary duct dilatation. The gallbladder is normal.SPLEEN: No significant abnormality noted.PANCREAS: Multiple subcentimeter areas of T2 hyperintensity are seen communicating with the pancreatic duct in the neck and body (series 5, images 66, 78, 79, and 85). No enhancing suspicious foci are identified.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: The kidneys appear normal and enhance symmetrically.RETROPERITONEUM, LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: The visualized small bowel and colon are normal.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Multiple subcentimeter sidebranch IPMNs.2.Simple liver and splenic cysts.


Instruction: Generate impression based on findings.

Input: Known numerous CCM lesions with history of 3 craniotomies for lesion resection: headaches and seizures. There are postoperative findings related to left parietal craniotomy for resection of a left parietal cavernous malformation with unchanged diffuse susceptibility effect along the surgical cavity margins and confluent surrounding T2 hyperintensity. There are also unchanged posteroparietal findings in the left posterior fossa. There are numerous remaining supratentorial and infratentorial cavernous malformations, which are unchanged. For example, the largest remaining supratentorial lesion is located in the left anterior frontal lobe, which measures up to approximately 20 mm, and the largest infratentorial lesion is in the right cerebellar hemisphere, which measures up to 8 mm. There is no evidence of acute intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are unchanged.

Output: No significant interval change in the postoperative findings and numerous remaining cerebral cavernous malformations.


Instruction: Generate impression based on findings.

Input: Right hemisphere cysts. There is a multiloculated cystic lesion in the right frontal lobe that extends to the right lateral ventricle. Overall, the lesion measures 42 x 36 mm in axial cross-section, which is unchanged since 2012. There is also unchanged minimal surrounding T2 hyperintensity. There is also a multiloculated cystic lesion along the anterior right frontal convexity, which measures 49 x 14 mm in axial cross-section, which is unchanged. There is no evidence of intracranial hemorrhage or acute infarct. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are unchanged in size and configuration. There is no cerebral or cerebellar herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are unchanged. There is mild scattered paranasal sinus mucosal thickening and retention cyst formation.

Output: The right frontal lobe porencephalic and frontal convexity arachnoid cysts are unchanged since 2012.


Instruction: Generate impression based on findings.

Input: 72 years Male (DOB:7/26/1944)Reason: Pt w/ solitary fibrous tumor of lower C spine/T1. Most recent s/p resection on 10/20/15. History: solitary fibrous tumorPROVIDER/ATTENDING NAME: RIMAS V. LUKAS RIMAS V. LUKAS The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal enhancing lesions are identified in the cervical spine.The patient status post T1 corpectomy, C7-T2 anterior fusion as well as C6-T1 laminoplasty. The patient status post posterior fossa surgery. The vertebral body height is preserved. Multilevel fatty marrow replacement most prominent at C7-T2 is consistent with prior radiation. The spinal cord is of normal caliber and signal. There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the cervical spine. There is an enhancing left C7-T1 paraspinal soft tissue lesion measuring 27 x 35 mm in axial dimensions which measured the same on the prior exam.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.Some opacities are present in the mastoid air cells were present to a lesser degree on the prior exam.

Output: 1.An enhancing left paraspinous mass involving the left C7-T1 neural foramen remains stable compared to the prior exam. The possibility that this represents recurrent neoplasm cannot be excluded.2.Status post cervical spine surgery with corpectomy,fusion and laminoplasty.


Instruction: Generate impression based on findings.

Input: 66-year-old man with history of prostate cancer status post prostatectomy in 2015, now with detectable PSA. PELVIS:PROSTATE: The patient is status post prostatectomy. Susceptibility artifact is noted in the operative bed. No local soft tissue recurrence is seen.BLADDER: No evidence of abnormal soft tissue or enhancement.LYMPH NODES: No significant lymphadenopathy noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Postoperative changes without evidence of local or nodal recurrence.


Instruction: Generate impression based on findings.

Input: Previous immediate postoperative changes have resolved. Postoperative changes from prior third ventriculostomy are not well visualized on this exam. The previous left parietal approach ventriculostomy catheter has been removed. The right ventricular catheter has been replaced, now coursing along the lateral margin of the right lateral ventricle, with tip in the right anterolateral frontal lobe parenchyma. A small amount of fluid is identified along the scalp and upper neck along the subcutaneous portion of the catheter tract, with associated enhancement. Surrounding the tip, there is prominent susceptibility with evidence of a small air-fluid level on axial T2-weighted images which may relate to recent catheter manipulation. A small amount of enhancement is noted following contrast demonstration along the proximal intracranial portion of the catheter, which likely is postprocedural. No other pathological enhancement is appreciated.The sulci are increased in prominence since the prior MRI, consistent with slight interval increased parenchymal volume loss. The cisterns remain patent. There is no midline shift or mass effect. There is no diffusion abnormality. No extra-axial fluid collection is identified. There is trace layering susceptibility in the left occipital horn, likely relating to post procedural blood products. A few other new foci are seen along the left lateral ventricular margin. A small area of FLAIR hyperintense encephalomalacia is present underlying the prior left parietal burr hole. Degree of myelination is difficult to assess secondary to relative paucity of white matter.Other previously described developmental abnormalities are unchanged. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. Fluid is noted within the mastoid air cells and middle ears bilaterally which is nonspecific.

Output: 1.Essentially stable ventricular size with continued diffuse dilatation although slight interval increased parenchymal volume loss compared to remote MRI brain.2.Interval removal of left sided ventriculostomy catheter with replacement of right, which is noted abutting the lateral wall of the right lateral ventricle with tip in the right frontal lobe parenchyma, surrounded by a small air-fluid level which may relate to recent catheter manipulation. Fluid is also identified within the subcutaneous tissues tracking along the catheter course. Please correlate with physical exam.3.No significant abnormal enhancement to suggest infection, although enhancement is noted along the portion of the catheter in the lung the proximal intracranial portion which may be postprocedural. Please correlate clinically.Dr. Yang discussed these findings over the telephone with Dr. Castanda (PICU) on 1/29/2016 6:30 AM.


Instruction: Generate impression based on findings.

Input: Intermittent visual loss. Note from the on-call resident: Per ophthalmology, patient with strong clinical concern for carotid cavernous sinus fistula. Patient has 6 weeks pregnant and therefore decision was made to proceed with MRI versus CTA. Brain MRI: There is no brain signal abnormality. Gray-white matter differentiation is preserved. There is no mass effect, midline shift or brain herniation. The ventricles and the other CSF-containing spaces are normal in size. There is no susceptibility artifact or diffusion restriction to indicate intracranial hemorrhage or acute/recent infarct, respectively. Major intracranial arterial and venous flow voids are preserved.There is no gross orbital abnormality. The mastoid air cells and middle the middle ear cavities are clear. There is polypoid mucosal thickening/retention cyst in the left maxillary sinus. The anterior nasal septum is deviated to the left, with spurring. The other paranasal sinuses are clear.There is no evidence for any skull lesion or scalp gross abnormality.Cranial MR venogram:The superior sagittal sinus is patent. The internal cerebral veins, vein of Galen and straight sinus are patent as well. The superior sagittal sinus preferentially drains into the right transverse and sigmoid sinuses which are patent. The left transverse and sigmoid sinuses are small and preferentially drained the deep venous system. This is a common variation. There is asymmetrically increased T1 and T2 signal in the included upper most segment of the left internal jugular vein just below the skull base which is probably related to slow flow, less likely thrombosis, given the congenitally smaller left transverse and sigmoid sinuses. This is associated with attenuated signal on phase contrast MR venogram.Cranial MR angiogram:There is no significant narrowing of the intracranial arteries. Of note, the right A1 segment is small but the A2 and downstream segments are symmetric. There is no or very small right posterior communicating artery. There is no sign of carotid-cavernous fistula.

Output: 1.There is no brain abnormality2.MR venogram shows no intracranial venous thrombosis. Attenuated signal on phase contrast MRV as well as increased T1 signal in the included upper most segment of the left internal jugular vein just below the skull base is probably related to slow flow rather than thrombosis. However, if there is high clinical index of suspicion for venous thrombosis, the more caudal segments of the jugular veins can be assessed with Doppler ultrasound to avoid radiation exposure. 3.MR angiogram shows no significant vessel stenosis. There is no sign of carotid-cavernous fistula.


Instruction: Generate impression based on findings.

Input: There is mild motion degradation of some sequences, limiting evaluation. There is no suspicious intracranial enhancement, acute infarct, mass, or cerebral edema. There is a single new punctate focus of susceptibility effect in the left anterior temporal lobe. There is an unchanged developmental venous anomaly in the medial superior right parietal lobe. There are nonspecific periventricular and subcortical white matter T2 signal abnormalities, likely representing chronic microvascular ischemic changes. There is progressive age-related sulcal prominence from 2010. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable.

Output: Single punctate foci of susceptibility effect in the left anterior temporal lobe which is nonspecific, probably representing remote microhemorrhage, new from the prior MRI from 2010. No evidence of intracranial metastases.


Instruction: Generate impression based on findings.

Input: Clinical question: Stroke? Signs and symptoms: Facial droop. Unenhanced CT of brain:No evidence of hemorrhage, edema, mass effect or midline shift or hydrocephalus. The gray -- white matter differentiation is well preserved. Questionable minute subcortical foci of low attenuation is noted. This finding may represent minimal small vessel disease. Patient has risk factors for stroke an MRI examination is recommended.Calvarium, paranasal sinuses and mastoid air cells are unremarkable.

Output: With the exception of possible minimal small vessel disease of indeterminate age this study is unremarkable.


Instruction: Generate impression based on findings.

Input: Male, 53 years old, status post stereotactic radiosurgery for brain metastases with increased enhancement of a cerebellar lesion on the most recent exam. A 6 mm enhancing lesion within the left anterior cerebellum has not significantly changed in size since. The lesion demonstrates internal susceptibility effect which has gradually increased over multiple prior examinations, possibly representing slow accumulation of hemosiderin. Surrounding T2 hyperintensity compatible with vasogenic edema is stable to at most minimally more extensive when compared to the immediate prior study.An oval, T2 hyperintense lesion with minimal if any rim enhancement is redemonstrated in the left frontal lobe showing no significant interval change in size. There is no edema surrounding this lesion. A punctate focus of enhancement within the left intraparietal sulcus is unchanged. No new enhancing lesions are seen. Scattered punctate foci of FLAIR hyperintensity are unchanged, for example, along the cortex in the left frontal lobe, right precentral gyrus and left occipital lobe, possibly related to prior treated lesions. No evidence of significant generalized mass effect is seen. Ventricular size and morphology are within normal limits.

Output: 1.An enhancing lesion within the left anterior cerebellum shows no significant interval change in size when compared to the immediate prior study. Edema surrounding this lesion, although clearly more extensive when compared to older exams, is stable or at most minimally more extensive when compared to the prior study. Given the interval stability of the enhancing component, and the fact that this lesion shows evidence of progressive hemosiderin accumulation over the prior several exams, the edema could be related to treatment effect and mild intralesional hemorrhage. Continued close follow-up is suggested.2.A lesion in the left frontal lobe and a punctate enhancing focus within the left intraparietal sulcus are unchanged. No new enhancing lesions are seen. The remainder of the examination is unchanged.


Instruction: Generate impression based on findings.

Input: Reason: R leg radicular pain s/p laminectomy hx of lung cancer History: R leg radicular pain s/p laminectomy hx of lung cancerAdditional history from EMR: Status post L2-L4 bilateral laminectomy with partial medial facetectomy in 2011, 2/11/2015, presenting with new onset right thigh pain. Alignment remains anatomic. There is stable multilevel degenerative disc narrowing, moderate-severe in degree at multiple levels. There is diffuse mildly heterogeneous signal of the marrow which is nonspecific. Scattered Schmorl's nodes appear similar. There is normal cord signal and caliber distally, with the conus terminating approximately at the T12-L1 level. There is thickening and redundancy of the cauda equina nerve roots.Interval postoperative changes are seen with small left laminotomy/medial facetectomy at L3 and L4. Enhancement likely relating to granulation tissue traverses the surgical tracts without significant mass effect upon the thecal sac. There is now moderate central spinal canal stenosis at L2-L3 and L3-L4. There is continued moderate left and severe right foraminal narrowing at L3-L4.Since the prior exam, there has been interval worsening of disc disease at L3-L4 where there is now a large right paracentral disc extrusion migrating cranially x 2.3 cm. It demonstrates mild intrinsic T1 hyperintensity, enhancement, and appears slightly lower signal on T2 with respect to other disc material. The axial plane, this measures up to 1.2 x 0.8 cm and results in moderate effacement of the thecal sac spanning the L3 level. There is presumed posterior displacement of the descending right L3 and L4 nerve roots.Central spinal canal stenosis at L1-L2 appears similar although the CSF is not as well visualized which may in part be technical. There is perhaps mild interval further ligamentum flavum thickening. Previously described multilevel spondylosis is otherwise unchanged.There is again atrophy of the right psoas muscle.

Output: 1.Interval worsening of disc extrusion at L3-L4 which is right paracentral in location, now extending cranially along the entire height of the L3 vertebral body resulting in moderate central spinal canal stenosis and posterior displacement of the descending right L3 and L4 nerve roots. A portion of this may be sequestered given its differential signal from parent disc.2.Interval postoperative changes following left L3 and L4 laminotomy/medial facetectomy. Presumed enhancing granulation tissue along the surgical tracts without significant mass effect. Overall, improved thecal sac caliber at these levels.3.Otherwise, stable appearance of multilevel spondylotic changes with up to moderate left and severe right foraminal narrowing at L3-L4.


Instruction: Generate impression based on findings.

Input: Family history of breast cancer. Sister with gene mutation. Bilateral nipple discharge, blood on the left. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally. There is mild motion artifact on this exam. A few high T2 cysts are present clustered in the right outer breast.There are bilateral typically benign morphology masses and foci. Many of these are highly likely to be fibroadenomas based on non-enhancing internal septations. The largest probable fibroadenoma measures up to 9 mm in the left upper outer breast at mid-depth. No abnormal axillary lymph nodes are identified in either axillary region.Recommendations below reflect a consensus opinion of 3 attending breast radiologists.

Output: Bilateral typically benign morphology masses and foci, left greater than right. As long as her nipple discharge does not demand intervention based on clinical grounds, a 6 month follow up MRI is recommended to document stability of her masses and foci. BIRADS: 3 - Probably benign finding.RECOMMENDATION: 3B - Followup at Short Interval (1-11 Months).


Instruction: Generate impression based on findings.

Input: Foot ulcer There is superficial ulceration along the lateral midfoot overlying the base of the fifth metatarsal which does not appear to extend to the level of the cortex. There is no abnormal T1 signal intensity of the fifth metatarsal base to suggest osteomyelitis and the overlying cortex appears intact however there is increased STIR signal suggesting some reactive osteitis. The marrow signal intensity of the remaining metatarsals is normal.Images of the forefoot demonstrate moderate osteoarthritis of the first MTP joint with a mild hallux valgus deformity. There is diffuse soft tissue edema, skin thickening, and inflammation, particularly along the dorsum of the foot. No discrete fluid collection is identified.

Output: Superficial ulceration along the lateral midfoot overlying the base of the fifth metatarsal without definite evidence of osteomyelitis. Abnormal signal intensity within the fifth metatarsal is thought to represent reactive osteitis.


Instruction: Generate impression based on findings.

Input: Low back pain. The vertebral body heights are within normal limits. There is straightening of the expected lumbar lordosis. The conus medullaris is normal in position, terminating at the level of L2. The right transverse process of the T12 vertebra demonstrates high T2 signal without posterior suppression indicative of possible edematous changes, although this is partially-imaged. There is multilevel degenerative spondylosis, including Schmorl nodes in the inferior portion of L5 and L3 with associated surrounding edematous changes at L5 greater than L3, and a mild disc bulge and ligamentum flavum thickening at L5-S1 with mild bilateral neural foraminal narrowing, but no significant spinal canal stenosis. The paraspinous soft tissues are unremarkable.

Output: 1. Multilevel degenerative changes, including Schmorl nodes in the inferior portion of L5 and L3 with associated surrounding edematous changes at L5 greater than L3, and a mild disc bulge at L5-S1 with mild bilateral neural foraminal narrowing, but no significant spinal canal stenosis. 2. The right transverse process of T12 demonstrates high T2 signal without posterior suppression with apparent edematous changes. Further characterization with dedicated thoracic spine is recommended if clinically warranted.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Male, 48 years old, with history of thoracic laminectomy, evaluate decompression. Postoperative changes are redemonstrated compatible with complete laminectomy at T7 with partial laminectomy at T6 and T8. The spinal canal is congenitally slender. At the operative levels, the caliber of the spinal canal is similar to or slightly wider than the remained of the thoracic spine. There is minimal T2 hyperintensity in the cord at T7/8 likely representing myelomalacia from prior stenosis. Spinal alignment is adequate. Vertebral body heights are preserved allowing for minimal degenerative loss of height at lower levels. Fatty marrow change is seen in the mid thoracic vertebral bodies compatible with endplate degeneration. At T4-5, there is a left paracentral protrusion causing mild canal stenosis and left foraminal narrowing. At T8-9, there is a bulky right anterior osteophyte.At T10-11, a disc bulge and facet arthropathy result in moderate canal stenosis and moderate bilateral foraminal narrowing. At T11-12, a disc bulge and facet arthropathy result in mild canal stenosis, moderate right and mild left foraminal narrowing.

Output: Findings are seen indicating surgical decompression of the spinal canal from T6 through T8. The caliber of the canal at these levels is at least as wide if not wider than the rest of the thoracic region. Minimal cord signal abnormality at T7/8 likely reflects myelomalacia from prior stenosis.


Instruction: Generate impression based on findings.

Input: There is bilateral, nearly symmetric, T2 hyperintensity localized to the anterior aspect of the medulla without restricted diffusion, susceptibility abnormality, or enhancement.The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain.

Output: There is bilateral, nearly symmetric, T2 hyperintensity localized to the anterior aspect of the medulla without restricted diffusion, susceptibility abnormality, or enhancement. This is nonspecific in appearance and has been described in entities such as demyelination, infectious/inflammatory processes, hypertrophic olivary degeneration (although there is no definite primary lesion as the source), and subacute combined immunodeficiency.


Instruction: Generate impression based on findings.

Input: Nausea with vomiting, unspecified [R11.2], Reason for Study: ^Reason: W contrast only, evaluate brainstem lesion History: diplopia, vertigo, vomiting There is subtle somewhat patchy enhancement on the anterior pial surface of the mid-pons which slightly extends toward left side on 3D SPGR sequence. However, there is no MR evidence of the same enhancement on conventional post enhanced MRI (series 401). Since 3D SPGR sequence was obtained slightly delayed (about 5min), this could indicate delayed enhancement of pial surface indicating low grade inflammatory lesion. However, mid-pons area on 3D sequence is a frequent site for an artifacts. Therefore, it is hard to emphasize the clinical significance of this findings. Clinical correlations including if needed CSF analysis may be helpful for further evaluation.There is no other abnormal enhancement seen on this scan. The ventricles, sulci and cisterns are symmetric and unremarkable.

Output: Subtle delayed enhancement on the anterior pial surface of mid-pons which cannot be differentiated from artifacts as described above. Clinical correlation including CSF analysis can be considered for further evaluation of the finding's clinical significance if indicated.


Instruction: Generate impression based on findings.

Input: 50 year-old female with history of multiple myeloma presents with headachesIMAGE ACQUISITIONS: Noncontrast head CT There is a large high-density extra-axial mass centered in the left frontal bone with a large intracranial component causing significant mass-effect on the left cerebral hemisphere. There is extension through the anterior aspect of the falx cerebri and into the right anterior medial frontal lobe. There is also a smaller extracranial component.Although there is no other obvious tumor or lytic calvarial lesion, there does appear to be some additional mass-effect in the posterior fossa causing rightward shift of the fourth ventricle. We recommend a brain MRI with contrast to further evaluate these findings.Findings were discussed with Dr. Mattingly at 2:30 p.m.

Output: Large left frontal extra-axial mass with destruction of the left frontal bone and significant extra- and intra-cranial components. We recommend a brain MRI with contrast.


Instruction: Generate impression based on findings.

Input: A patient submitted outside study for review. Submitted for review are breast MRI (3/16/2015) performed at silver cross. For comparison, prior MRIs dated 5/6/2014 and 10/9/2013 are available. MRI was performed as per outside protocol.Per outside report, the patient is status post bilateral mastectomies. The tissue seen is therefore all compatible with bilateral reconstructions. Multiple signal voids from surgical clips are seen bilaterally. There are bilateral areas of fat density with thin peripheral enhancement compatible with fat necrosis. The largest area is in the right upper breast measuring 6.4 x 7.9 x 6.8 cm. The largest left breast area is located medially and inferiorly, and measures 3.6 x 1.7 x 2.1 cm. A 5 mm focus of enhancement in the right lateral reconstruction near 9:00 is stable compared to priors and likely represents a small intramammary lymph node. No abnormal lymph nodes are identified in either axillary region.

Output: Benign MRI appearance is compatible with bilateral areas of fat necrosis in this patient who is status post bilateral mastectomies and reconstructions.BIRADS: 2 - Benign finding.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: 54-year-old female with pain and swelling and a negative x-ray. TENDONS: The extensor tendons appear intact. The flexor tendons appear intact. The Achilles tendon is normal in appearance. The peroneal tendons appear intact. There is circumferential fluid within the tendon sheath of the peroneus longus which may represent a mild tenosynovitis versus fluid extension from the joint space.LIGAMENTS: The lateral collateral ligament complex appears intact. The distal tibiofibular syndesmotic complex appears intact. The visualized components of the deltoid ligament appear intact.ARTICULAR SURFACES AND BONE: No bone marrow signal abnormality is identified. No articular cartilage defects are seen. ADDITIONAL

Output: Findings suggestive of a mild tenosynovitis of the peroneus longus tendon as well as subcutaneous edema most pronounced along the lateral aspect of the ankle.


Instruction: Generate impression based on findings.

Input: Cerebral infarction, unspecified [I63.9], Reason for Study: ^Reason: assess for stroke History: R lower face droop and dysarthria Brain MRIThere is a focal restricted diffusion on the left internal capsule posterior limb. There is no evidence of hemorrhagic transformation.Patch bilateral periventricular and centrum semiovale T-2/FLAIR high signal intensity lesions indicate nonspecific small vessel ischemic disease. The ventricles, sulci and cisterns are unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage. The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate focal luminal narrowing of the right MCA proximal M2 segment and left MCA distal M1 segment with luminal irregularity indicating atherosclerotic changes. Vertebrobasilar system appears to be normal.

Output: 1. Acute ischemic infarct involving left internal capsule posterior limb without evidence of hemorrhagic transformation.2. Atherosclerotic changes of intracranial arterial system. However, there is no evidence of intracranial large vessel occlusion. No evidence of intracranial arterial aneurysm.


Instruction: Generate impression based on findings.

Input: Episodes of short term memory loss. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are several scattered cerebral white matter T2 hyperintense foci. The hippocampi are grossly unremarkable. There is no abnormal intracranial enhancement. There is mild diffuse cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There are small bilateral maxillary sinus retention cysts.

Output: 1. No evidence of intracranial hemorrhage, mass, or acute infarct. 2. Nonspecific scattered cerebral white matter T2 hyperintense foci may represent chronic small vessel ischemic disease. 3. Mild diffuse cerebral volume loss, which has progressed since 2010.


Instruction: Generate impression based on findings.

Input: Female, 65 years old, with low back pain, left radicular pain, and weight loss. Evaluate for soft tissue mass at L3. A 4 x 3 x 3 cm enhancing mass is evident centered along the left aspect of the L3 vertebral body. A large portion of the mass is extra osseous and abuts or invades the adjacent psoas muscle. However there is substantial nondestructive osseous involvement as well including the posterior lateral vertebral body, pedicle, transverse process and facet complex. The left L2-3 and L3-4 neural foramina may be infiltrated to a mild degree. However, no significant intracanalicular epidural involvement is seen. There is no loss of vertebral body height.Marrow signal characteristics are generally heterogeneous with endplate degenerative changes and edema at L2-3. However, no additional enhancing lesions are seen. Vertebral body heights are preserved. Trace retrolisthesis of L2 relative to L3, and L3 relative to L4 is noted.The visualized distal spinal cord and conus are within normal limits. No convincing spinal cord or leptomeningeal enhancement is seen.L1-2: Mild facet arthropathy. Ligamentum flavum thickening. No spinal canal or foraminal stenosis. L2-3: Facet arthropathy. Ligamentum flavum thickening. Mild disc bulging. No spinal canal stenosis. Moderate left foraminal narrowing. L3-4: Facet arthropathy. Ligamentum flavum thickening. Minimal spinal canal narrowing. Severe left and moderate right foraminal narrowing.L4-5: Facet arthropathy. Ligamentum flavum thickening. Minimal disc bulging. No spinal canal stenosis. Severe right and moderate left foraminal narrowing. L5-S1: Facet arthropathy. Minimal disc bulging. Mild foraminal narrowing.

Output: An enhancing mass is evident centered along the left aspect of the L3 vertebral body. There is an extraosseous component abutting or infiltrating the psoas muscle, as well as nondestructive osseous involvement of portions of the vertebral body as detailed above. This lesion would be compatible with metastatic disease.No definite additional metastases are seen. Multilevel disc and posterior element degeneration is noted. While there is no high-grade spinal canal stenosis, severe foraminal narrowing is evident on the left at L3-4 and on the right at L4-5.


Instruction: Generate impression based on findings.

Input: Posterior triceps pain, lateral pain Please note exam is limited with absence of patient placed marker identifying the site of patient pain.LIGAMENTS: No significant abnormality noted. Specifically ligaments are intactTENDONS: No significant abnormality noted. All tendons are observed, specifically attention was placed on the triceps which is unremarkable and without evidence of intrasubstance abnormality or definite distinct tear. Please note however only the distalmost portion and insertion is observed, if patient symptoms are beyond 3 cm from the olecranon insertion, this anatomy may be outside the field of view and evaluation.ARTICULAR SURFACES AND BONE: Small elbow effusion without overt osseous abnormality or evidence to suggest erosions. Marrow signal unremarkable SURROUNDING STRUCTURES: No significant abnormality noted.ADDITIONAL

Output: Small effusion and no discrete additional focal abnormality with limitations described above. Please correlate


Instruction: Generate impression based on findings.

Input: A patient submitted outside study for review. Submitted for review are breast MRI (7/14/16) performed at outside institution. For comparison, mammograms and ultrasound (7/14/16) are available. Breast MRI was performed with a protocol outlined in the outside report.There is a large area of segmental non-mass enhancement at upper inner and lower inner quadrant of the left breast measuring 55 x 49 x 60 mm (AP x LR x CC). This non-mass enhancement likely corresponds to the proven malignancy. An enlarged lymph node (16 mm) is present at left axilla with a marker clip inside. A metallic artifact from the marker clip is present at anterior lower outer quadrant in the right breast without suspicious enhancement. The marker clip likely corresponds to the site of biopsy-proven malignant lesion. A few borderline enlarged lymph nodes are seen in the right axilla.

Output: 1. Large segmental non-mass enhancement in the right upper - lower inner quadrant. 2. A marker clip artifact in the right anterior lower outer quadrant, corresponding to the recent biopsy site.3. Biopsy proven metastatic lymph node in the left axilla with a marker clip4. A few borderline right axillary lymph nodescomments: Outside radiology report mentions that there is a separate focal non-mass enhancement in the left breast at inferolateral to the primary non-mass enhancement, I believe these two non-mass enhancements are contiguous. Also, outside radiology report mentions about an irregular region of enhancement at central inner portion in the right breast, I think this is not a real lesion.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Evaluation of brain metastases from lung cancer: stable cough and DOE. There is a peripherally-enhancing lesion that measures 7 mm in width in the anterior right frontal lobe with surrounding confluent T2 hyperintensity. There is a background of mild scattered T2 hyperintensity without enhancement in the bilateral cerebral hemisphere white matter, which may represent chronic small vessel ischemic disease. There is no evidence of intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is a left lens implant.

Output: A subcentimeter anterior right frontal lobe lesion with surrounding vasogenic edema is compatible with metastatic disease.


Instruction: Generate impression based on findings.

Input: Left lower extremity weakness. Evaluate for spinal stenosis. 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 disk desiccation and mild bulge. Mild facet arthropathy. There is minimal bilateral neural foraminal narrowing, right relatively worse than left. No significant spinal canal stenosis. Incidentally seen are multiple small perineural cysts in the lumbar spine, lower thoracic spine, as well as in the sacrum. Relatively largest of these is along the right S2 nerve root measuring approximately 2 cm. Paraspinous soft tissues are within normal limits.

Output: 1. Mild degenerative changes in the lumbar spine without significant spinal canal stenosis at any level. There is minimal narrowing of the bilateral L5-S1 neural foramina, right relatively worse than left; otherwise no significant neural foraminal narrowing in the lumbar spine. 2. Mild facet arthropathy at L4-5 and L5-S1.3. Multiple small perineural cysts are noted which are of doubtful clinical significance.


Instruction: Generate impression based on findings.

Input: Clinical question to be answered: Response. Clinical question to be answered: Rule-out intracranial process. Extensive decreased density of white matter of both cerebral hemispheres are redemonstrated. There is no evidence of effacement of cortical sulci or mass effect on the lateral ventricles. No evidence of hemorrhage, hydrocephalus or midline shift. In comparison with the prior CT examination from 11 -- 25 -- 2008 and MRI examination from 5 -- 15 -- 2009 no evidence of interval change is detected.

Output: No evidence of new finding since prior study.


Instruction: Generate impression based on findings.

Input: 62-year-old female. Multiple myeloma patient on clinical drug trial with increasing hip pain, specifically left sided lately. Evaluate for degenerative changes versus myeloma lesions. No focal myelomatous lesions are identified. Chronic appearing severe compression deformity of L4, grossly unchanged. Mild degenerative disk disease of L3-4 to L5-S1. Mild bilateral hip osteoarthritis. Patchy red marrow in the bilateral proximal femoral diaphyses and sacrum.

Output: No evidence of a focal myelomatous lesion. Mild bilateral hip osteoarthritis. Grossly unchanged L4 compression deformity.


Instruction: Generate impression based on findings.

Input: Worsening abdominal pain. History of carcinoma with unknown primary site, concerned for cholangiocarcinoma. History of HCV.3/10/2016 liver biopsy demonstrated poorly differentiated carcinoma with overall impression not favoring metastatic disease from gynecological primary, rather intrahepatic cholangiocarcinoma or metastases from pancreatic biliary or upper GI tract primary. ABDOMEN:LIVER, BILIARY TRACT: Diffuse fatty infiltration. Hepatomegaly measuring 20.5 cm in length.There are numerous mildly T2 hyperintense masses in the liver, some of which appear targetoid, with a dominant mass in the lateral segment of the left hepatic lobe measuring approximately 8.2 x 5.8 cm (series 501/14). For future reference a right hepatic dome segment 7 lesion measures 2.1 x 2.2 cm (series 501/31).The masses demonstrate peripheral nodular thick-walled enhancement and internal heterogeneous enhancement which appears to subtly progressively fill-in on delayed imaging. There is no obvious capsular retraction. There is a serosal implant anterior to the left hepatic lobe (series 501/13).There is moderate intra and extrahepatic biliary ductal dilatation to the level of the porta hepatis, likely related to bulky lymphadenopathy.The gallbladder is distended with gallbladder wall thickening/pericholecystic fluid.SPLEEN: Small amount of perisplenic ascites. Normal splenic size without a focal lesion.PANCREAS: Small amount of peripancreatic fluid. There are numerous enlarged peripancreatic lymph nodes. No pancreatic atrophy or pancreatic ductal dilatation. A bulky lymph node at the level of the pancreatic head appears to invade and/or displace (series 5 and 1/12) the pancreatic parenchyma.ADRENAL GLANDS: No significant abnormality noted. Retroperitoneal metastatic lymphadenopathy near the adrenal fossa bilaterally.KIDNEYS, URETERS: Simple appearing right renal cyst. No hydronephrosis or suspicious lesion.RETROPERITONEUM, LYMPH NODES: Extensive retroperitoneal, gastrohepatic, mesenteric and portal caval heterogeneously enhancing necrotic lymphadenopathy. The lymphadenopathy results in regional mass effect including narrowing of the portal vein at the hepatic hilum/porta hepatis and narrowing of the left renal vein.For future reference, an inferior aortocaval lymph node measures 1.9 x 1.3 cm (series 601/10).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Discoid atelectasis, similar to that seen on recent CT. Cardiophrenic lymphadenopathy.OTHER: No significant abnormality noted.

Output: Constellation of findings favoring a mass forming intrahepatic cholangiocarcinoma with dominant lesion in the left hepatic lobe with numerous satellite/metastases in the right liver lobe. Bulky heterogeneously enhancing lymphadenopathy in the upper abdomen with associated mass effect as described above. Most significantly the porta hepatis lymphadenopathy results in moderate central and extrahepatic biliary ductal dilatation and attenuation of the portal vein.Perihepatic serosal implant. Bibasilar discoid atelectasis better seen on recent CT.


Instruction: Generate impression based on findings.

Input: 87 year old man with coronary artery disease referred to evaluate for ischemia and viability.MEDICATIONS: aspirin, atorvastatin, lisinopril, metoprolol First Pass PerfusionDuring hyperemia, a perfusion defect of moderate severity was present in the basal inferoseptum, inferior, and inferolateral walls. There is additionally a very mild perfusion defect in the basal anterolateral wall.Viability/ Myocardial ScarThere was no evidence of myocardial infarction; however, there was an atypical mid-wall pattern of late gadolinium enhancement involving the basal inferolateral wall. This pattern is not consistent with myocardial infarction but suggests the presence of underlying myocardial inflammation, fibrosis, or infiltration. The pattern has been described in a variety of disorders ranging from hypertension to old myocarditis. Because there is late gadolinium enhancement in the basal inferolateral wall, it is unclear whether this segment is viable. However, the remainder of the myocardium is free of late gadolinium enhancement and is viable.Left VentricleThe left ventricle is normal in size with moderately reduced systolic function. There is global hypokinesis with regional variation. The overall LV ejection fraction is 36%, the LV end diastolic volume index is 83 ml/m2 (normal range: 74+/-15), the LVEDV is 153 ml (normal range 142+/-34), the LV end systolic volume index is 53 ml/m2 (normal range 25+/-9), the LVESV is 98 ml (normal range 47+/-19), the LV mass index is 60 g/m2, and the LV mass is 110 g. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 55%, the RV end diastolic volume index is 71 ml/m2 (normal range 82+/-16), the RVEDV is 131 ml (normal range 142+/-31), the RV end systolic volume index is 32 ml/m2 (normal range 31+/-9), and the RVESV is 58 ml (normal range 54+/-17).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 mild tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is mildly dilated.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is a small pericardial effusion.Extracardiac FindingsBilateral small to moderate pleural effusion with neighboring atelectasis is noted (L>R). This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. During hyperemia, a perfusion defect of moderate severity was present in the basal inferoseptum, inferior, and inferolateral walls. There is additionally a very mild perfusion defect in the basal anterolateral wall.2. There was no evidence of myocardial infarction; however, there was an atypical mid-wall pattern of late gadolinium enhancement involving the basal inferolateral wall. This pattern is not consistent with myocardial infarction but suggests the presence of underlying myocardial inflammation, fibrosis, or infiltration. The pattern has been described in a variety of disorders ranging from hypertension to old myocarditis. Because there is late gadolinium enhancement in the basal inferolateral wall, it is unclear whether this particular segment is viable. However, the remainder of the myocardium is free of late gadolinium enhancement and is viable.3. Normal LV size with moderately reduced systolic function (LVEF 36%).4. Normal RV size and systolic function (RVEF 55%).5. Mild dilation of the main pulmonary artery.6. Small pericardial effusion.7. See extra-cardiac findings.


Instruction: Generate impression based on findings.

Input: Reason: right shoulder arthritis History: right shoulder arthritis Patient motion artifact limits multiple sequences.ROTATOR CUFF: There is a complete tear of the supraspinatus and infraspinatus tendons with approximately 2.3 cm of retraction of the proximal tendon fragment. There is thickening and intermediate signal intensity within the proximal tendon fragment indicating tendinosis. There is fatty atrophy of the supraspinatus and infraspinatus muscles. There is partial thickness undersurface tearing of the subscapularis. The teres minor muscle and tendon appear intactSUPRASPINATUS OUTLET: There is a small amount of fluid within the subacromial subdeltoid bursa. Mild osteoarthritis affects the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is a high riding humeral head. Mild osteoarthritis affects the glenohumeral joint. There is subchondral cyst formation within the humeral head with full-thickness articular cartilage degeneration along the superior aspect of the glenoid. There is heterogeneity and increased signal intensity within the anterior, posterior and inferior labrum likely representing a combination of degeneration and degenerative tearing.BICEPS TENDON: The extra-articular portion of the tendon of the long head of the biceps is not visualized which may reflect postoperative changes from prior biceps tenodesis or tendon rupture with retraction. ADDITIONAL

Output: 1. Complete tear of the supraspinatus and infraspinatus tendons with retraction. Partial-thickness high grade tearing of the subscapularis.2. The tendon of the long head of the biceps is poorly visualized which may reflect postsurgical change from prior biceps tenodesis or tendon rupture with retraction.3. Osteoarthritis of the shoulder.


Instruction: Generate impression based on findings.

Input: 38 year old male with a history of bicuspid aortic valve, aortic pseudocoarctation and aneurysm with perforated ulcer, 24mm hemashield graft to aorta in October 2013 presenting for repeat evaluation. FIrst part of the study was done May 22, 2015 but had to be aborted because patient developed a severe headache and was unable to go back into the MRI machine. Contrast had not yet been given. Patient returned on May 29 to complete the study without incident. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 57%, the LV end diastolic volume index is 89 ml/m2 (normal range: 74+/-15), the LVEDV is 192 ml (normal range 142+/-34), the LV end systolic volume index is 38 ml/m2 (normal range 25+/-9), the LVESV is 82 ml (normal range 47+/-19), the LV mass index is 58 g/m2 (normal range 85+/-15), and the LV mass is 128 g (normal range 164+/-36). There are no regional wall motion abnormalities present. Left AtriumThe left atrium is normal in size.Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 51%, the RV end diastolic volume index is 91 ml/m2 (normal range 82+/-16), the RVEDV is 198 ml (normal range 142+/-31), the RV end systolic volume index is 45 ml/m2 (normal range 31+/-9), and the RVESV is 98 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation. Aortic valve not well seen on cine imaging.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 regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. Hemashield graft noted in the descending thoracic aorta with surrounding post-operative changes. The aortic dimensions are as follows: (Previous dimensions in parentheses) Sinus of valsalva 33x32mm (31 x 31mm)Sinotubular junction 28x27mm (30 x 27mm)Ascending aorta 32x32mm (31 x 31mm)Proximal aortic arch 30x30mm (32 x 32mm)Distal aortic arch 27x23mm (25 x 24mm)The abdominal aorta is imaged to just below the right renal artery. There is no left renal artery noted The abdominal aorta is ectatic with 4 regions of dilation. Previous measurements are in parentheses. 1. 4cm distal to the inferior border of the aortic graft measuring 35 mm (35mm) in diameter2. 10cm distal to the inferior border of the aortic graft measuring 32 mm (33mm) in diameter 3. 11cm distal to the inferior border of the aortic graft measuring 34 mm (33mm) in diameter4. 13cm distal to the inferior border of the aortic graft measuring 33 mm (33mm) in diameterPulmonary 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 FindingsA midline sternotomy with post-surgical changes is noted. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Normal LV size and systolic function (LVEF 57%) without evidence of underlying fibrosis, inflammation, or infiltration.2. Normal RV size and systolic function (RVEF 51%). 3. Aorta measurements are given above. 4. Graft noted in the descending thoracic aorta.5. Multiple ectatic areas noted in abdominal aorta. 6. No significant difference from previous study done 2014-02-04I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: The clinical question to be answered: Mental status changes. Signs and symptoms: Unresponsive. No evidence of hemorrhage, edema, mass-effect, midline shift or hydrocephalus. Cortical sulci, ventricular system and all CSF cisterns remain within normal range for patient's stated age of 77. This examination demonstrates no interval change since prior study. Calvarium, paranasal sinuses and mastoid air cells are also unremarkable. Follow-up with an MRI examination is highly recommended considering patients provided clinical data.

Output: Stable CT examination.


Instruction: Generate impression based on findings.

Input: 59-year-old woman with a history of grade 1 left breast IDC, status post lumpectomy and radiation therapy. There is heterogeneous amount of fibroglandular tissue in both breasts.Minimal parenchymal enhancement is noted bilaterally.Stable postlumpectomy changes are identified in the left upper outer breast. 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: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: 78 years, Male, vertigo, rule out brainstem lesion. History of hypertension. No restricted diffusion to suggest acute ischemia. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration for age. Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild chronic small vessel ischemic changes. There is a punctate focus of susceptibility in the left temporal subcortical white matter which is compatible with a chronic focus of microhemorrhage. Foci of susceptibility are also evident within the pons and also compatible with chronic microhemorrhages. Brain parenchyma is otherwise unremarkable for age. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: 1. Mild chronic small vessel ischemic changes as well as few small foci of chronic microhemorrhage including within the pons, which may be related to chronic hypertension.2. Brain parenchyma is otherwise unremarkable for age.


Instruction: Generate impression based on findings.

Input: Diagnosis: Benign neoplasm of cerebral meningesClinical question: Hx of suprasellar meningioma s/p RT, surveillance MRISigns and Symptoms: None The patient is status post right-sided craniotomy for removal of the anterior cranial fossa mass on the right side. There is some mild pachymeningeal enhancement present which is likely reactive in nature given the surgical history. There is redemonstration of encephalomalacia predominantly involving the right orbital gyrus and the gyrus rectus bilaterally. There is some involvement of the lateral aspect of the left orbital gyrus.There is an enhancing extra-axial mass present along the posterior aspect of the planum sphenoidale extending into the suprasellar cistern abutting the infundibulum of the pituitary gland and also abutting the distal internal carotid arteries bilaterally and the cisternal portions of the optic nerves and chiasm. It measures 14 x 10 mm sagittal dimensions on the current exam and previously measured 14 x 10 mm on 1/13/2015.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 redemonstration of a change of an extra-axial mass at the posterior aspect of the planum sphenoidale and the suprasellar cistern which abuts the distal internal carotid arteries and optic nerves. This most likely represents a meningioma.2.Status post right-sided craniotomy.3.There is encephalomalacia present along the right orbital gyrus and gyrus rectus bilaterally as well as a small portion of the left orbital gyrus.


Instruction: Generate impression based on findings.

Input: Diagnosis: Thoracic or lumbosacral neuritis or radiculitis, unspecified Other postprocedural status(V45.89)Clinical question: recurrent disc herniation?Signs and Symptoms: RLE radic s/p microdiscx 3 mos 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 some T2 hyperintense signal present along the superior and anterior aspect of the T12 vertebral body which on the accompanying plain films appears represent discogenic sclerosis.At L5-S1 there is a right lateral recess disc extrusion which appears similar in size compared to the prior exam and extends towards the right lateral recess and encroaches on the nerve root at the right lateral recess. There is loss of disc space height, disc desiccation and some mild endplate reactive changes present at this level. The exiting nerve roots within the neural foramina are surrounded by fat. The patient is status post L5-S1 surgery along the right posterior elements. There is contrast enhancement at the right laminotomy site at L5-S1. There is contrast enhancement present adjacent to the disc protrusion at the L5-S1 right lateral recess which involves the right nerve root at the right lateral recess at this level.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is mild facet and ligamentum flavum hypertrophy present at this level. There is a mild disc desiccation at this level associated with a minor disc bulge.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.Since the prior examination the patient is undergone surgery at the L5-S1 level. There is a large disc extrusion present at the right lateral recess at the L5-S1 level which affects the nerve root at the right lateral recess (most likely right S1 nerve root) associated contrast enhancement at this level could represent a small amount of scar formation adjacent to the nerve root. The disc extrusion appears similar in size when compared to the prior exam


Instruction: Generate impression based on findings.

Input: 40 year old with Cowden-like syndrome. Personal history of thyroid and renal cancers. Breast parenchyma is almost entirely fat in both breasts.Mild parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Nausea/vomiting, weakness, history of metastatic breast cancer with brain mets, new cerebellar edema on CT head. Exam is mildly limited by motion artifact, particularly on postcontrast imaging. As compared to MRI on 11/4/2016, there has been interval development of edema in the bilateral cerebellar hemispheres and vermis, right greater than left. There is associated mass effect including effacement of the fourth ventricle, anterior displacement of the brainstem, and crowding in the posterior fossa. There is mild enlargement of the ventricular system related to obstruction. There is mild increase in nodular enhancement surrounding the right cerebellar resection cavity as compared to the most recent prior MRI. Susceptibility sensitive sequence is nondiagnostic due to motion degradation.Enhancing lesions in the right anterior aspect of the pons and right occipital lobe are again seen and are not appreciably changed in size or MR characteristics since the recent study. There is additional punctate nonspecific enhancement along the right corona radiata. No new metastatic lesions are appreciated. There are unchanged postoperative findings of a posterior craniotomy and left frontal craniotomy with left frontal encephalomalacia.

Output: 1. Fairly rapid increase in nodular enhancement surrounding the cerebellar resection cavity and marked increase in cerebellar edema. Given their relatively rapid development, these findings may be related to treatment effect. Infection/encephalitis can be considered in the appropriate clinical setting. Rapid progression of metastatic disease is much less likely.2. Mass effect associated with cerebellar edema resulting in effacement of the fourth ventricle, mild interval enlargement of the ventricular system, and increased crowding in the posterior fossa.3. Right pontine lesion, right occipital lesion, and additional tiny enhancing foci are not significantly changed from the most recent prior MRI.


Instruction: Generate impression based on findings.

Input: Lower back pain and right foot drop. There are five lumbar type vertebral bodies. There is a normal lumbar lordosis. Stable 4 mm of anterolisthesis of L4 on L5. The vertebral body and disk heights are well-maintained. The conus medullaris terminates at L1/L2. The paraspinal soft tissues are unremarkable.Within the posterior aspect of L1 vertebral body there is a small focus of abnormal signal that is intermediate on T1 and bright on T2 and STIR, with peripheral T1 hyperintensity. At L3 there is ill-defined signal abnormality superiorly and posteriorly, it is hypointense on T1 and T2-weighted images with no STIR abnormality and corresponds to an ill-defined lucency on the recent CT, where it has a benign appearance. Additionally, there is a benign-appearing heterogeneous T1, T2 hyperintense lesion in the right ischium as well as a focus of sclerosis in the left ischium, similar in appearance compared to the recent CT.T12-L1: There is no significant compromise to spinal canal or neural foramina.L1-L2: There is mild to moderate facet joint hypertrophy, ligamentum flavum thickening and a very shallow left foraminal disc protrusion but no significant compromise to spinal canal or neural foramina.L2-L3: There is moderate facet joint hypertrophy and ligamentum flavum thickening. There is bilateral, right greater than left shallow disc protrusion but no significant compromise to spinal canal or neural foramina.L3-L4: There is moderate facet hypertrophy and ligamentum flavum thickening with mild narrowing of the spinal canal. There are bilateral foraminal disc protrusions resulting in mild to moderate narrowing of the left neural foramen and very mild narrowing of the right neural foramen.L4-5: There is moderate facet joint hypertrophy with facet joint effusions and ligamentum flavum thickening. There is a prominent central disc protrusion with an annular fissure. These findings result in moderate narrowing of the spinal canal as well as moderate to severe left and moderate right neural foraminal narrowing and narrowing of the lateral recesses bilaterally.L5-S1: There is moderate facet joint hypertrophy with facet joint effusions. There is a disc bulge and superimposed right foraminal disc protrusion resulting in severe neural foraminal narrowing. Disc material abuts the descending right S1 nerve root and displaces it minimally posteriorly. There is moderate narrowing of the left foramen. The lateral recesses are narrowed, greater on the right.Probable right renal cyst is similar in size compared to the.

Output: 1.Disc bulge with superimposed right foraminal protrusion at L5-S1 severely narrows the right neural foramen. The disc material abuts and posteriorly displaces the right S1 nerve root.2.Prominent central disc protrusion with annular fissure at L4-5 results in moderate central spinal stenosis, moderate to severe left and moderate right neural foraminal narrowing.3.Bone marrow signal abnormalities in the L1 and L3 vertebral bodies are nonspecific with only subtle CT correlating abnormality. The L3 lesion may represent an atypical hemangioma. These findings could be further evaluated with bone scan if there is concern for infection or metastatic disease.


Instruction: Generate impression based on findings.

Input: Status post fall. Questionable loss of consciousness. Please evaluate. Positive headache. There is no evidence of intracranial hemorrhage, mass effect, edema or midline shift. Areas of hypodensity in the left superior frontal gyrus are unlikely related to the patient's trauma and may represent volume averaging. The cerebellar tonsils are low lying and appear at the level of the foramen magnum. Further imaging, such as with an MRI, is recommended.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal without evidence of fracture. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: No intracranial hemorrhage or calvarial fracture. There is an area of hypodensity in the left superior frontal gyrus and the cerebellar tonsils are low-lying. MRI imaging is recommended as clinically indicated.These findings were discussed with Dr. Paik at the time of interpretation.


Instruction: Generate impression based on findings.

Input: 62-year-old male with mildly elevated creatinine of 1.6. Evaluate for renal abnormalities. This examination is limited by absence of oral and intravenous contrast.ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Multiple bilateral renal pelvic calcifications are nonobstructive. Bilateral renal cysts. In the left midpole region dorsally there is a 1.4-cm partially exophytic solid lesion. This may be more fully evaluated with dedicated contrast enhanced CT or MRI examination. The lesion is best seen at axial image 36 of series 3 adjacent to a large benign simple cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: Degenerative changes in the lower lumbar spine and pelvis.OTHER: No significant abnormality noted

Output: No acute abnormality to explain the elevation in creatinine. Suspicious left midpole lesion may be an occult renal mass, so contrast enhanced dedicated kidney MRI or CT exam is recommended for further evaluation.


Instruction: Generate impression based on findings.

Input: 56 years, Male, Reason: Patient with hx of right tonsil cancer treated in 2012 with CRT. Now with new onset right horner' s, right hypoglossal weakness and dysphagia Brain: Please note lack of contrast limits evaluation for small metastatic lesions. Within this limitation no intracranial mass, mass effect, or evidence of edema to suggest metastatic disease is appreciated. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. The ventricles are within normal limits in size and configuration. Few scattered foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with minimal chronic small vessel ischemic changes. Major flow-voids are preserved.There is opacification of the bilateral ethmoid air cells, right sphenoid sinus, as well as mild mucosal thickening involving the maxillary sinuses, similar to prior CT from 9/13/2013. No destructive lesions within the calvarium.Neck: There are posttreatment changes in the neck including asymmetrically increased soft tissue thickening along the right carotid sheath, which was seen on prior CT as well. There is asymmetric volume loss involving the right aspect of the tongue with rightward deviation of the extrinsic tongue muscles. There is also posterior displacement of the right posterior tongue which may also be related to denervation. There is also increased volume loss involving the right sternocleidomastoid muscle and trapezius when compared to prior study from 9/13/2013. No obvious destructive mass at the right skull base or elsewhere in the neck is appreciated within the limitations of noncontrast MRI.No discrete neck mass or significant cervical lymphadenopathy is appreciated within the limitations of noncontrast MRI.

Output: 1. Please note lack of contrast limits evaluation, especially for perineural tumor spread. There is soft tissue thickening in the right neck which is grossly similar to prior neck CT and favored to be related to posttreatment change. No discrete neck mass or significant cervical lymphadenopathy is appreciated. 2. Volume loss involving the right oral tongue, posterior displacement of the right posterior tongue, and volume loss involving the right trapezius and sternocleidomastoid muscles. These findings all appear progressed/new since prior CT from 9/13/2013 and most compatible with multiple lower cranial neuropathies. No discrete mass at the right skull base is appreciated within the limitations of noncontrast MRI. If patient is not on dialysis and GFR is greater than 30, consider postcontrast sequences with half dose gadolinium to better exclude the possibility of recurrent neoplasm.3. No intracranial mass, mass effect, or edema within the brain to suggest intracranial metastases is seen.


Instruction: Generate impression based on findings.

Input: Evaluate for Chiari. Non-enhanced CT:This examination was tailored to include the upper cervical spine to facilitate detection of Chiari malformation as clinically is questioned.There is no evidence of intracranial hemorrhage, edema, midline shift or hydrocephalus.Images through posterior fossa as well as reformatted sagittal and coronal 2-D images demonstrate 18-mm upward herniation of the dens through the foramen magnum into the posterior fossa. There is evidence of platybasia.The anatomical orientation of the articulation of occipital condyles with lateral mass of C1 are abnormal and they appear more vertical in orientation. There is suggestion of at least partial fusion of the right lateral mass of C1 with the occipital condyles. There is no fusion of the lateral mass of C1 with the occipital condyles on the left. There is fusion of the anterior arch of C1 to the anterior lip of foramen magnum. There is apparent fusion of the posterior elements of C1 with C2. There is no fusion of the articulating facets of C1 and C2. Sagittal reformatted images demonstrate mass effect and posterior displacement of medulla by the upwardly herniated dens and there is no detectable subarachnoid space at this level. There is suggestion of possible herniation of cerebellar tonsils anterior to the posterior nipple foramina magnum. Recommend further follow-up with an MRI examination for better assessment.

Output: 1.No evidence of intracranial pathology or brain parenchyma.2.Platybasia and upward herniation of dens of approximately 18 mm through the foramina magnum.3.Congenital anatomical variation of fusion of anterior arch of C1 to the anterior lip of the foramen magnum, partial fusion of the right occipital condyles and lateral mass of C1 and partial fusion of posterior elements of C1 and C2.4.Above findings were discussed with the referring clinical physician Dr. Ben Roitberg at the time of interpretation.