Instruction: Generate impression based on findings.

Input: 72-year-old woman with history of right radicular leg pain. Five lumbar type vertebral bodies are present on this study. The vertebral body heights are within normal limits. There is slight exaggeration of the lumbar lordosis which may be positional. Lumbar spinal alignment is otherwise normal. Small, scattered foci of T1 and T2 hyperintensity may represent hemangiomata or areas of focal fat. The bone marrow signal is benign. The conus medullaris is normal in position.There is mildly increased signal in all of the intervertebral discs suggesting desiccation. Multilevel degenerative changes are seen, as described below:L1-L2: There is no significant disc disease. There is no spinal canal or neural foraminal stenosis.L2-L3: There is no significant disc disease. There is no spinal canal or neural foraminal stenosis.L3-L4: There is minimal disc bulge, eccentric to the right. Additionally, there is mild ligamentum flavum thickening. Minimal right neural foraminal narrowing. There is no spinal canal or left neural foraminal stenosis.L4-L5: There is a mild bulge, eccentric to the right. A small focus of increased T2 signal suggests a mild posterior annular fissure on the right. Additionally, there is mild bilateral facet arthropathy with ligamentum flavum thickening. There is mild effacement of the right lateral recess with minimal contact with the L5 descending nerve but no evidence of impingement. Minimal right neural foraminal narrowing also without clear evidence of impingement. There is no spinal canal or left neural foraminal stenosis.L5-S1: There is a mild bulge, eccentric to the right. Additionally, there is mild bilateral facet arthropathy with ligamentum flavum thickening. There is no spinal canal or neural foraminal stenosis.Small bilateral cystic lesions at the S1 level are compatible with perineural cysts.The paraspinous soft tissues are within normal limits.

Output: Mild multilevel degenerative changes without spinal canal stenosis or clear evidence of nerve root impingement. Please see comments above.


Instruction: Generate impression based on findings.

Input: Soft tissue enlargement on the dorsum of foot and near calcaneus, tender to palpation. There is soft tissue density overlying the dorsal aspect of the ankle joint, nonspecific, suggestive of a mass. Consider MRI for further evaluation as clinically indicated. Mild degenerative changes at the first MTP joint. Small plantar and Achilles tendon spurs.

Output: Nonspecific soft tissue density overlying the dorsal aspect of ankle joint is incompletely evaluated on radiograph. Consider MRI for further evaluation as clinically indicated.


Instruction: Generate impression based on findings.

Input: 63-year-old man with history of prostate cancer. PELVIS:PROSTATE:Prostate Size: 47 x 37 mmPeripheral Zone: There is an 12 x 8 mm area of T2 hypointensity, diffusion restriction, and enhancement in the right paramedian prostatic base (series 1001, image 17). Additionally, there is a well encapsulated focus of benign prostatic hyperplasia in the mid peripheral zone of the base (series 1001, image 13).Central Gland: The central gland appears normal.Seminal Vesicles: Seminal vesicles appear normal.Extracapsular Extension: There is no evidence of extracapsular tumor extension.BLADDER: The bladder is normal.LYMPH NODES: There is no significant lymphadenopathy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Focus of adenocarcinoma in the right prostatic base without evidence of extracapsular extension or nodal spread.


Instruction: Generate impression based on findings.

Input: 59-year-old female with knee pain MENISCI: There may be some degenerative fraying along the undersurface of the posterior horn root junction of the medial meniscus, however no discrete tear is identified. The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is diffuse thinning along the lateral facet of the patella with areas of partial thickness cartilage loss. There is full-thickness cartilage loss along the medial patellar facet with a small amount of edema in the underlying bone. The trochlear cartilage is intact. There is mild thinning of the articular cartilage along the lateral femoral condyle. The articular cartilage of the medial compartment is intact.LIGAMENTS: The ACL and PCL are intact. The MCL and lateral collateral ligament complex is intact. EXTENSOR MECHANISM: The extensor mechanism is intact. There is a small amount of prepatellar edemaADDITIONAL

Output: 1.No discrete meniscal tear is identified.2.Full-thickness cartilage loss along the medial patellar facet.3.Small joint effusion.


Instruction: Generate impression based on findings.

Input: 60-year-old female with splenic abnormality who presents for MRI evaluation. ABDOMEN:LIVER, BILIARY TRACT: T2 hyperintense subcentimeter lesions compatible with cysts. Again noted is atrophy of the right hepatic lobe.Postoperative changes of cholecystectomy. No intra or extrahepatic biliary ductal dilatation. Chronic portal venous thrombosis with cavernous transformation and splenorenal shunting.SPLEEN: Unchanged marked splenomegaly with the spleen measuring approximately 24 cm in the cranial caudal dimension and 17 x 11 cm in the transverse dimension. The spleen demonstrates T1 and T2 heterogeneity with evidence of T2 intermediate signal lesions which don't demonstrate contrast enhancement. Additionally, there is evidence of iron deposition. This is not significantly changed compared to the prior exam.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple subcentimeter T1 hypointense, T2 hyperintense, nonenhancing lesions compatible with cysts. Additionally, there are subcentimeter T1 hyperintense, nonenhancing lesions compatible with proteinaceous cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Unchanged splenomegaly and appearance of the spleen. 2.Chronic portal venous thrombosis with splenorenal shunting.


Instruction: Generate impression based on findings.

Input: Chiari I malformation: headache, presyncope, and blurred vision. Brain: The cerebellar tonsils extend up to approximately 6 mm inferior to the foramen magnum and display slightly pointed morphologies, which is similar to 2006. However, there appears to be grossly intact cerebrospinal fluid flow across the foramen magnum. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Cervical Spine: The spinal cord displays normal signal and morphology. There is paucity of the usual lordosis of the cervical vertebral column, but no spondylolisthesis. The cervical vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The paravertebral soft tissues are unremarkable.

Output: 1. The cerebellar tonsils extend up to approximately 6 mm inferior to the foramen magnum, which is similar to 2006. However, cerebrospinal fluid flow across the foramen magnum appears to be grossly intact.2. No evidence of syringohydromyelia.


Instruction: Generate impression based on findings.

Input: Complex atypical endometrial hyperplasia with foci of squamous differentiation. Evaluate extent of endometrial disease. PELVIS:UTERUS, ADNEXA: The uterus is anteverted and measures 8.6 x 10.7 x 10.8 cm (AP x ML x CC).The endometrium measures 19 mm in thickness, which is increased. It is mildly T2 hyperintense. It is homogeneous in signal intensity without a discernable lesion on pre-contrast or post-contrast imaging. It demonstrates mild somewhat heterogeneous post-contrast enhancement. The endometrial myometrial junction is relatively preserved. The inner myometrium/junctional zone is normal in signal intensity and thickness, measuring 8 to 9 mm.In the left uterine body extending to the fundus is an intramural/subserosal well-defined mass measuring 8.7 x 7.8 cm demonstrating T1 weighted isointensity to the myometrium with regions of mild T1 hyperintensity and T2 weighted mild hyperintensity with smaller regions of hypointensity. The lesion demonstrates gradual heterogeneous enhancement similar in intensity to the remainder of the myometrium. Findings suggest a fibroid with myxoid degeneration. The cervical mucosal is normal in signal intensity. There is minimal cervical luminal fluid and small nabothian cysts.The ovaries are normal in morphology and size. The left ovary measures 3.7 x 2.3 cm. The right ovary measures 3.0 x 2.8 cm. They contain numerous follicles. The para-ovarian soft tissues are unremarkable.BLADDER: No significant abnormality noted.LYMPH NODES: Nonspecific prominent external iliac and inguinal lymph nodes. A left external iliac lymph node measures 2.2 x 0.9 cm.Small subcentimeter nonspecific mesorectal lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.The endometrium is thickened up to 19 mm, upper limits of normal, correlate with the phase of the patient's menstrual cycle. The endometrium is mildly T2-hyperintense and demonstrates mild somewhat heterogeneous enhancement, without a discernable mass lesion or myometrial invasion. 2.8.7 cm left uterine body/fundus intramural/subserosal probable fibroid with suspected myxoid degeneration.3.Normal adnexa. 4.Non-specific mildly prominent external iliac and inguinal lymph nodes.


Instruction: Generate impression based on findings.

Input: Nasopharyngeal carcinoma, status post treatment. Neck: There has been marked interval decrease in size of the left nasopharyngeal mass, which now measures up to approximately 7 mm, previously approximately 40 mm. The remaining tumor also appears necrotic. There is no evidence of intracranial extension or skull base erosion. There are secretions in the right lateral nasopharyngeal recess. A cystic or necrotic right level 2B lymph node measures 5 x 10 mm in axial cross-section, previously 20 x 30 mm. Other cervical lymph nodes are unchanged. The salivary glands and thyroid are unremarkable. There is no evidence of acute infarction. The orbits are unremarkable. The cervical spine is intact. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation.

Output: Marked interval decrease in size necrosis of the left nasopharyngeal tumor right level 2B lymphadenopathy with necrosis, consistent with treatment response.


Instruction: Generate impression based on findings.

Input: 65-year-old female with FIGO IIb cervical cancer status post chemotherapy/radiation PELVIS:UTERUS, ADNEXA: There is a lesion predominantly in the posterior aspect of the cervix measuring up to 2.0 x 1.5 cm (series 901, image 7) and 1.5 cm in coronal dimension (series 601, image 26) compatible with known cervical cancer, slightly smaller when compared to the prior exam. Lesion extends beyond the posterior margin of the cervix into the posterior parametrial tissues appearing similar to the prior exam. There is no evidence of rectal, bladder, or pelvic sidewall invasion. There are cystic appearing T2 hyperintense lesions along the superior margin of the lesion.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Slight interval decrease in size of known cervical malignancy.2.No significant lymphadenopathy.


Instruction: Generate impression based on findings.

Input: NF1 with impairment of acuity and macrocephaly with mental retardation. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is a small left medial orbitofrontal gyrus developmental venous anomaly. The brain parenchyma otherwise appears unremarkable. The lateral ventricles are perhaps mildly prominent, particularly on the right side. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Orbits: The bilateral intraorbital optic nerves are somewhat tortuous, but do not appear to be thickened or display abnormal signal or enhancement. The bilateral globes and ocular adnexa are unremarkable. There is no evidence of abnormal intraorbital enhancement or mass lesions.

Output: 1. The bilateral intraorbital optic nerves are somewhat tortuous, but no definite evidence of optic nerve glioma.2. No intracranial stigmata of neurofibromatosis type 1 other than perhaps mildly prominent lateral ventricles.


Instruction: Generate impression based on findings.

Input: Female, 70 years old, with history of breast cancer, triple negative, with possible brain metastases on head CT. Corresponding to the abnormality detected on CT, a 5 mm enhancing lesion is evident within the mid vermis with mild local edema.Although postcontrast imaging is somewhat limited due to motion, up to five additional small enhancing lesions are also suspected within the cerebellum, and a small enhancing focus is also seen within the right frontal lobe. These small lesions are associated with no significant parenchymal edema.A developmental venous anomaly is present in the right operculum. Patchy periventricular and brainstem T2 hyperintensity is seen in the background, a nonspecific finding which likely reflects chronic microvascular ischemic disease. No convincing evidence of restricted diffusion is evident. No acute intracranial hemorrhage or any abnormal extra-axial fluid collection is observed. The ventricles are normal in size and morphology.

Output: Up to seven small enhancing lesions are evident, primarily within the posterior fossa, suspicious for metastatic disease. The largest lesion is in the cerebellar vermis and is associated with mild local edema.


Instruction: Generate impression based on findings.

Input: There is an extra-axial mass in the left posterior frontal convexity that measures 5.2 x 4.5 cm in anteroposterior and transverse dimensions and 4.5 cm in craniocaudal dimension. The tumor infiltrates the overlying calvarium with associated hyperostosis. There is mass effect upon the left superior frontal gyrus and approximately 3 mm of midline shift to the right. There is infiltration of tumor into the superior sagittal sinus and compression of underlying cortical vein. This are areas of susceptibility effect within the mass related to calcifications and hemorrhage. In addition, there is susceptibility effect within adjacent sulci, which is suggestive of prior subarachnoid hemorrhage or superficial siderosis. There is no evidence of intraparenchymal edema or acute infarct. The ventricles are normal in size and configuration. However, there is a partially-empty sella. The adenoids are prominent and contain several retention cysts.

Output: 1. An extra-axial parasagittal mass that measures up to 5.2 cm along the left frontal convexity with invasion of the superior sagittal sinus and infiltration of the overlying calvarium likely represents a meningioma. 2. Susceptibility effect within left frontal lobe sulci is suggestive of prior subarachnoid hemorrhage or superficial siderosis associated with the tumor. 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, 60 years old, with likely metastatic cancer, assess for metastases. Most sequences are degraded by motion artifact. Within this limitation, the following observations are made.Patchy areas of high T2/low T1 signal are evident throughout the visualized marrow space including the vertebral bodies and the posterior elements. Vertebral body morphology is otherwise unremarkable. No loss of vertebral body height is seen.A grade 1 anterolisthesis of L4 relative to L5 is demonstrated. Elsewhere, spinal alignment is anatomic.No definite abnormalities of the spinal cord, conus or cauda equina are seen, though again, the examination is limited. No definite evidence of any significant epidural or paraspinal soft tissue encroachment is seen.At T11-12, there is mild disc bulging but no significant spinal canal or foraminal stenosis.At L4-5, there is loss of disc height, disc uncovering and disc bulging which results in a mild narrowing of the spinal canal and moderate bilateral foraminal narrowing.At L5-S1, there is mild disc bulging but no significant spinal canal stenosis. Mild foraminal narrowing is evident bilaterally.Facet hypertrophy is present particularly at lower lumbar levels.Volume loss is evident in the left thorax.

Output: 1.Limited examination due to lack of IV contrast and substantial motion artifact.2.Diffuse patchy areas of marrow replacement are seen involving the vertebral bodies and posterior elements of the thoracic and lumbar spine. These findings are compatible with widespread metastatic involvement.3.Accounting for the exam limitations, no definite evidence of any significant epidural or paraspinal disease extension is seen


Instruction: Generate impression based on findings.

Input: Stroke: left side weakness. MRI: There are cortical and subcortical areas of high T2 signal and mildly restricted diffusion in the right frontal and parietal lobes, including the precentral and postcentral gyri. The largest area in the right middle frontal gyrus measures up to at least 25 mm, where there are small areas of susceptibility effect. There is a large area of encephalomalacia in the left occipital and medial temporal lobes with ex vacuo dilatation of the left lateral ventricle, superimposed upon diffuse cerebral volume loss. There is a background of scattered cerebral and pontine white matter T2 hyperintensity. There is no midline shift or herniation. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.MRA: There is an apparent focal deficit of flow related enhancement in the insular branch and distal left middle cerebral artery M1 segment. There also appears to be focal steno-occlusive disease of the distal left middle cerebral artery M1 segment. There are multiple focal areas of markedly diminished flow related enhancement in the left vertebral artery. There is paucity of flow related enhancement of the right posterior cerebral artery beyond the very proximal segment arising from the posterior communicating artery. There is loss of flow related enhancement in the left posterior cerebral artery P2 segment. The basilar artery appears to be intact. There appears to be intact flow related enhancement in the proximal anterior cerebral arteries, aside from an apparently hypoplastic left A1 segment. The bilateral intracranial interval carotid arteries appear to be intact. There is no evidence of aneurysms.

Output: 1. Subacute infarcts in the right frontal and parietal lobes, with evidence of petechial hemorrhages in the right frontal lobe.2. Chronic left posterior cerebral artery territory infarct.3. A background of scattered cerebral and pontine white matter T2 hyperintensity likely represents chronic small vessel ischemic disease. 4. Apparent focal steno-occlusive disease of a proximal right middle cerebral artery and insular branch and distal left middle cerebral artery M1 segment.3. Significant steno-occlusive lesions involving the bilateral posterior cerebral arteries and left vertebral artery.


Instruction: Generate impression based on findings.

Input: Images are moderately limited by patient motion. Axial T1-weighted images images are not available to the lumbar spine.There is stable mild concavity of the superior endplate of T12, with redemonstration of associated T2/STIR hyperintensity and T1 hypointensity. Mild STIR hyperintensity persists within the interspinous ligament posteriorly which may indicate ligamentous strain. More anteriorly in the interspinous space, there is no significant abnormal signal. Small area of linear T1 hypointensity is again seen just along the superior aspect of the spinous process, consistent with the minimally displaced spinous process cortical fragment.The known superior articulating process fracture fragment is not well delineated on this MRI. Edema is also noted in the minimally displaced smaller anterior superior vertebral body fracture fragment. There is only trace convexity of the dorsal cortex of the vertebral body without significant retropulsion of fracture fragments. There is perhaps mild right foraminal narrowing secondary to the displaced superior articular process fragment. There is also mild prevertebral soft tissue edema and effusion at this level. STIR hyperintensity within the paraspinal musculature extending down to the L3 level bilaterally. There is also fluid signal within the deep subcutaneous fat of the lower back.The spine is in normal alignment. There is mild disc desiccation from C3-C4 through C5-C6. The vertebral body and disk heights are otherwise well-maintained. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal, although axial T2-weighted images through the cervical spine are limited by artifact. Apparent increased signal along the left aspect of the cord at the lower T11 level does not demonstrate corresponding abnormality on sagittal images and likely artifactual.At C4-C5, there is a right paramedian central disc protrusion which indents the ventral thecal sac.At C5-C6, there is a mild disc bulge without stenosis.There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the remainder of the spine. There is mild fluid opacification of visualized left mastoid air cells.

Output: 1. Redemonstration of mild acute compression deformity of T12 superiorly with a few associated displaced fracture fragments as detailed above, including a small bone fragment along the inferior aspect of the right foramen resulting in perhaps mild foraminal narrowing. No significant retropulsion of fracture fragments. Mild interspinous ligament strain at T11-T12.2. No MR evidence of cord compression.3. Motion limited exam, especially through the cervical spine.


Instruction: Generate impression based on findings.

Input: Family history of Crohn's disease presents with diarrhea and abdominal pain. ABDOMEN:LIVER, BILIARY TRACT: Punctate right hepatic lobe hypointensities, compatible with benign hepatic cysts. No suspicious liver lesion, biliary ductal dilatation or vascular abnormality.SPLEEN: Punctate splenic cysts or hemangiomata.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The small bowel is adequately distended with oral contrast.The small bowel fold pattern is unremarkable.Note is made of lipomatosis infiltration of the ileocecal valve, a benign incidental normal variant.The small bowel is normal in caliber. No wall thickening, abnormal wall signal intensity, hyperenhancement, restricted diffusion, fibrofatty proliferation or other specific findings of active small bowel inflammation.No fixed luminal narrowing or prestenotic/upstream dilatation to suggest a flow-limiting stricture.No evidence of sinus tract or fistula formation.No significant free fluid or loculated fluid collection.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No specific evidence of active bowel inflammation or stigmata of inflammatory bowel disease.


Instruction: Generate impression based on findings.

Input: History of tuberous sclerosis, evaluate kidneys for angiomyolipomas and cysts. Note that this examination is protocoled for evaluation of the kidneys and as such portions of the upper abdomen are excluded from the field-of-view.ABDOMEN:LUNG BASES: Trace basilar atelectasis.LIVER, BILIARY TRACT: The visualized portion of the liver demonstrates normal parenchymal signal intensity without focal lesions.SPLEEN: The visualized portions of the spleen appears normal.PANCREAS: The pancreatic parenchyma demonstrates normal signal intensity and enhancement without focal lesions.ADRENAL GLANDS: The adrenal glands appear normal.KIDNEYS, URETERS: There are scattered 1-2 mm cystic lesions throughout both kidneys which are too small to characterize but do not demonstrate suspicious features. It is estimated that approximately 20 of these cysts are present in each kidney. A representative lesion in the right lower pole (series 501, image 8) measures 2 mm. No evidence of angiomyolipoma. There is no evidence of hydronephrosis. The kidneys demonstrate normal parenchymal enhancement and excretion of contrast.RETROPERITONEUM, LYMPH NODES: No retroperitoneal lymphadenopathy is identified.BOWEL, MESENTERY: The visualized bowel is not significantly dilated.BONES, SOFT TISSUES: The visualized osseous structures appear normal.OTHER: A trace amount of free fluid is present within the pelvis.

Output: Numerous 1-2 mm cystic lesions within both kidneys which are too small to characterize.


Instruction: Generate impression based on findings.

Input: 63 years Female (DOB:10/13/1952)Reason: right parietal stroke History: left face, arm weakness, left gaze/neglectPROVIDER/ATTENDING NAME: JAMES J WALTER RICHARD A KRAIG MRI of the brainThere is a focus of diffusion restriction present measuring approximately 34 x 18 mm axial dimensions which involves the precentral gyrus and some of the postcentral gyrus extending down to the level of the subcentral lobule in superiorly to the level of the hand motor area. It is of high signal on T2 and FLAIR MR imaging. It measures approximately 51 x 27 mm in coronal dimensions.There is a focus of encephalomalacia present along the left superior frontal gyrus posteriorly extending to the left middle frontal gyrus. Another focus of encephalomalacia is present in the left occipital lobe involving the left cuneus. Another focus of encephalomalacia is present along the right cerebellar hemisphere.There are punctate foci of signal loss on susceptibility imaging predominantly involving basal ganglia and midbrain .There is a moderate to marked degree of periventricular and subcortical confluent hyperintense white matter lesions present identified on the FLAIR and T2 images.The patchy foci of signal hyperintensity on T2 and FLAIR MRI in the brainstem.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.Exam is degraded by patient motion which may obscure more subtle abnormalities.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries. There is 60% stenosis present along the ophthalmic segment of the left internal carotid artery measuring approximately 12 mm in length.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. The posterior communicating arteries are intact. The right posterior communicating artery is larger than the left posterior communicating artery. The right posterior communicating artery is medium-sized whereas the left posterior communicating arteries there are small. Anterior communicating artery is small. The left vertebral artery is larger than the right vertebral artery.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis appreciated along the course of the vertebral arteries. However, the proximal vertebral arteries are not imaged adequately.There are nodular lesions present in the thyroid gland which are not adequately evaluated on this exam.

Output: 1.Findings are compatible with acute ischemic cerebral infarction involving right pre and postcentral gyri.2.There is a 60% stenosis present at the left internal carotid artery ophthalmic segment.3.There are multiple foci of encephalomalacia present which include left frontal lobe, left occipital lobe, and right cerebellar hemisphere. In general these are suspected to be of ischemic origin.4.There are microhemorrhages predominantly involving basal ganglia and upper midbrain. This pattern is suggestive of hypertension.5.Periventricular and subcortical white matter lesions of a moderate to marked degree are nonspecific. At this age they are most likely vascular related. 6.Patchy lesions in the brainstem are also likely vascular related.7.The proximal vertebral arteries are not imaged adequately. No obvious stenosis is appreciated in the proximal vertebral arteries.8.Exam is degraded by patient motion which may obscure more subtle abnormalities.9.There are nodular lesions present in the thyroid gland which are not adequately evaluated on this exam.


Instruction: Generate impression based on findings.

Input: Male, 68 years old, with multiple myeloma. Evaluate for new myelomatous lesions. Grade 1 anterolisthesis of L4 relative to L5 is unchanged. Spinal alignment is otherwise anatomic. Vertebral body height and morphology are within normal limits. Mild degenerative endplate edema is seen at C5-6, slightly progressed from prior. Scattered focal fatty lesions within the thoracic spine may represent hemangiomas and are unchanged. Heterogeneous mildly enhancing, STIR hyperintense marrow signal within the sacrum and iliac wings is probably unchanged when compared to the prior MRI. The pattern of this abnormality is symmetric bilaterally. Of note, there is no corresponding hypermetabolism on a recent PET/CT and no abnormalities on the CT portion of the exam.Marrow signal is diffusely low on T1 and T2-weighted images compatible with marrow reconversion, similar to the prior exam. No evidence of pathologic marrow replacement or any focal marrow lesion is seen.The visualized spinal cord shows normal signal intensity throughout. No pathologic parenchymal or leptomeningeal enhancement is identified.C2-3: Left facet hypertrophy. Minimal posterior disc-osteophyte complex formation. No spinal canal stenosis. Mild left foraminal narrowing. C3-4: Bilateral facet hypertrophy. Minimal posterior disc-osteophyte complex formation. No spinal canal stenosis. Moderate left foraminal narrowing. C4-5: Bilateral facet hypertrophy right greater than left. Posterior disc-osteophyte complex formation asymmetric to the right. Mild generalized spinal canal stenosis particularly affecting the right lateral aspect of the spinal canal. Moderate to severe right foraminal narrowing. C5-6: Bilateral facet hypertrophy. Posterior disc-osteophyte complex formation. Moderate generalized spinal canal stenosis. Moderate left foraminal narrowing. C6-7: Facet hypertrophy. Minimal posterior disc-osteophyte complex formation. No spinal canal stenosis. Mild left foraminal narrowing. C7-T1: Unremarkable. In the thoracic spine, scattered small disc protrusions are seen most notably at T11-12 without significant interval change. No spinal canal or foraminal stenosis is observed.L1-2: Facet arthropathy and ligamentum flavum thickening. Mild disc bulging. Minimal spinal canal stenosis and mild bilateral foraminal narrowing. L2-3: Facet arthropathy and ligamentum flavum thickening. Mild disc bulging. Mild spinal canal narrowing. Moderate bilateral foraminal narrowing. L3-4: Facet arthropathy and ligamentum flavum thickening. No significant spinal canal stenosis. Mild bilateral foraminal narrowing. L4-5: Marked facet arthropathy, worsened on the right with evidence of surrounding inflammation. Disc uncovering and disc bulging. Mild spinal canal narrowing. Moderate to severe left and moderate right foraminal narrowing. L5-S1: Marked facet arthropathy. No significant spinal canal or foraminal stenosis. Multiple bilateral renal cystic lesions are partially visualized.

Output: 1.No evidence of any discrete myelomatous lesions in the spine.2.Diffuse marrow reconversion appears similar to prior.3.Bilateral symmetric ill-defined signal abnormality and enhancement within the sacral ala and iliac wings is most likely benign and may represent subacute to chronic bone infarction.4.Scattered relatively mild degenerative findings are redemonstrated as above. Facet arthropathy has progressed on the right at L4-5.


Instruction: Generate impression based on findings.

Input: 45-year-old male with pain. Evaluate for medial meniscus tear. MENISCI: There is relatively linear increased signal abnormality within the posterior horn of the medial meniscus which extends to the free edge of the meniscus along the tibial articular surface consistent with an oblique tear. The tear extends into the body of the meniscus. The anterior horn appears intact. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: No bone marrow signal abnormalities identified. No full-thickness or near full-thickness articular cartilage defects are seen.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: Oblique tear of the posterior horn of the medial meniscus as described above.


Instruction: Generate impression based on findings.

Input: Intermittent headache for 5 months. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is mild mucosal thickening in the right sphenoid sinus.

Output: No evidence of acute intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: 66 year old male with lower extremity weakness. Rule out cord compression. MRI T-Spine: Note the contrast portion of the exam is motion degraded. The thoracic spine is in normal alignment. There is an expansile enhancing tumor involving the vertebral body of T5 with prominent posterior extension into the epidural space. This causes severe narrowing of the spinal canal with compression of the spinal cord and cord signal abnormality. There is up to 50% loss of height of the T5 vertebral body. The bilateral T5-6 neural foramina are narrowed secondary to tumor. There is thin superior and inferior extension of tumor within the anterior epidural space to the levels above and below the T5 tumor. There is thickening and enhancement involving the anterior paraspinal soft tissues at T5. Findings appear similar to those evident on prior CT.MRI Cord Compression Protocol.There is severe spinal cord compression in the thoracic spine T5 level as described above. The vertebral bodies within the cervical and lumbar spine are appropriate in the overall alignment and height. Multi-level degenerative changes involve the cervical spine with reversal of the lordotic curvature but no evidence of cord compression or visible cord signal abnormality. There are also multilevel degenerative changes involving the lumbar spine. Although there is no significant central spinal canal stenosis in the lumbar spine, there is a disc protrusion at L4-5 which causes left lateral recess and foraminal stenosis. The cervical and lumbar spinal cord have normal signal characteristics and overall morphology.

Output: 1.Expansile enhancing tumor involving the vertebral body of T5 with prominent posterior extension into the epidural space with severe spinal cord compression. 2.The T5 vertebral body tumor also contributes to bilateral T5-6 foraminal narrowing. 3.Loss of height of the T5 vertebral body of up to 50% may reflect a pathologic fracture.4.Evaluation of the cervical and lumbar spine was performed specifically for exclusion of cord compression only and does not exclude more subtle lesions such as intrinsic cord abnormalities. No cord compression is identified in the cervical or lumbar spine. Additional degenerative changes are as described above at these levels which and evaluated only on sagittal imaging.


Instruction: Generate impression based on findings.

Input: Cervical stenosis. Neck pain, upper extremity weakness. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. There is loss of cervical lordosis with minimal retrolisthesis of C5 on C6 and C6 on C7. Alignment is otherwise maintained. Bone marrow signal is benign. No definite cord signal abnormality is appreciated within the limits of motion degradation.There is mild developmental narrowing of the cervical spinal canal with superimposed degenerative changes as described below: C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: There is mild to moderate degree of spinal canal stenosis related to developmental narrowing and small central disc protrusion. Mild facet arthropathy. There is mild bilateral neural foraminal stenosis.C4-5: No significant compromise to the spinal canal or right neural foramen. Mild left neural foraminal stenosis related to uncovertebral hypertrophy and mild facet arthropathy.C5-6: There is a small disc osteophyte complex, eccentric to the right, with associated effacement of the ventral thecal sac and mild impression on the ventral cord, particularly on the right. There is overall mild spinal canal stenosis at this level. There is moderate left and mild right neural foraminal stenosis related to uncovertebral hypertrophy and mild facet arthropathy.C6-7: Small disc osteophyte complex which is eccentric to the right. There is effacement of the ventral thecal sac and mild impression on the right ventral aspect of the cord. There is overall mild spinal canal stenosis at this level. There is mild narrowing of the bilateral neural foramina, left worse than right. C7-T1: No significant compromise to the spinal canal or right neural foramen. There is mild left neural foraminal stenosis related to facet arthropathy. The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: Mild developmental narrowing of the cervical spinal canal with superimposed mild degenerative changes as described above. No high-grade spinal canal stenosis at any level or cord signal abnormality is evident. There is up to mild to moderate degree of spinal canal stenosis at the C3-C4 level as well as mild stenosis involving the right aspect of the spinal canal at the C5-C6 and C6-C7 levels. Multilevel neural foraminal narrowing as detailed above.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for nerve root compression and acuity of the L4 compression fracture. Signs and symptoms: Extremely L4 compression fracture, right lower extremity pain. Pre and post enhanced lumbar MRI:There is normal anatomical alignment of vertebral column.There is mild compression deformity of the superior endplate of L4 without associated marrow signal edema or abnormal enhancement. Finding is consistent with a chronic compressive deformity. The signal intensity of vertebral column is unremarkable on sagittal T2 STIR series.T12-L1 through L3-L4 levels demonstrate minimal degenerative changes without spinal stenosis or neural foraminal compromise.L4-L5 demonstrate moderate disc disease and loss of disc height, moderate bilateral ligamentum flavum and to a lesser degree facet hypertrophic changes. There is a right lateral and far lateral broad-based disc protrusion with resultant significant compromise of right neural foraminal. No spinal stenosis and patent left neural foraminal.L5-S1 demonstrate mild degenerative disc, moderate right lateral (right greater than left) facet hypertrophic changes however without spinal stenosis or neural foraminal compromise.Normal signal intensity and caliber of the lower most visualized thoracic cord, conus and the cauda equina without abnormal enhancement.

Output: 1.Mild chronic compression deformity of the superior endplate of L4.2.Normal signal intensity and anatomic alignment of vertebral column.3.At L4-L5 there is a large right lateral and far lateral broad-based disc protrusion with significant right neural foraminal compromise and no central spinal stenosis.4.No spinal stenosis or neural foraminal compromise at any level otherwise. No abnormal enhancement. Please review detailed report per level above.


Instruction: Generate impression based on findings.

Input: Patient presenting with new hypoattenuation in right side of the brain on recent CT, evaluate for acute vs subacute stroke. There are areas of mild diffusion abnormality along the peripheral right frontal lobe involving the right frontal operculum and insula. These areas correspond to foci of high ADC signal or isointense ADC signal, suggestive of chronic and subacute components of infarction. Mild areas of associated volume loss is compatible with encephalomalacia. Punctate focus of subacute infarcts are also noted in the right precentral gyrus as well as right superior parietal lobule. Additionally, there are areas of cortical T1 hyperintensity along the right frontal lobe and parietal lobe, consistent with cortical laminar necrosis related to prior ischemic injury. There are also areas of minimal punctate foci of periventricular T2/FLAIR hyperintensities which are nonspecific but are suggestive of very mild chronic microvascular ischemic changes. There is no evidence of acute intracranial hemorrhage, mass, or mass effect. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is minimal opacification of the left sphenoid sinus and right mastoid air cells

Output: Multiple infarcts in the right middle cerebral artery territory with signal features compatible with areas of subacute as well as chronic infarcts. No clear evidence of an acute infarct.


Instruction: Generate impression based on findings.

Input: MRI brain:Redemonstrated are diffuse small foci of susceptibility throughout the brain, likely representing post radiation changes. There has been interval appearance of a T2/FLAIR and T1 hyperintense lesion in the left paracentral parietal region which demonstrates prominent susceptibility and measures 13 x 17 mm (series 4, image 9) indicating a focal area of blood products. There is no significant surrounding FLAIR signal abnormality or hemosiderin rim and there is associated diffusion restriction from the blood products. There is a background of scattered foci of susceptibility abnormality. Note however that a focus of susceptibility was not definitively located in the location of the above described lesion on the prior MRI exam.The ventricles and sulci are within normal limits. The cisterns remain patent. There is no midline shift or mass effect. A few nonspecific scattered punctate foci of FLAIR hyperintensity are again seen. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. MRI spine:Diffuse postradiation marrow changes are again noted. A 12 mm STIR hyperintense enhancing lesion in the posterior-superior aspect of C7 vertebral body is unchanged. There is a stable region of irregular marrow enhancement and STIR hyperintensity in the left posterior T6 vertebral body minimally extending into the left pedicle, again appearing similar to prior.Previous tiny foci of nodular enhancement along the ventral medulla on the left at the level of the clivus tip is not well seen on today's exam. The left ventral C1 level enhancing punctate lesion along the surface of the cord is stable. Scattered punctate foci of enhancement along the dorsal and lateral surface of the distal thoracic cord appear overall decreased in conspicuity. There is also slight decreased irregular enhancement along the surface of the conus. No abnormal cord signal is seen. Redemonstrated is a stable punctate focus of enhancement along the right ventral cauda equina at L1-L2. A small rounded enhancing lesion along the left cauda equina at the L2 level measuring 7 x 4 mm is also stable. There has been significant interval decrease in the plaque-like enhancement along the distal thecal sac. There is also decrease in the diffuse enhancement of the cauda equina nerve roots and CSF is now visualized in between the nerve roots.Postoperative changes relating to lower lumbar laminectomies are redemonstrated. Mid thoracic and mid lumbar spondylotic changes appear similar. There remains moderate-severe central spinal canal stenosis at L3-L4.

Output: MRI brain:On a background of previously noted innumerable punctate foci of susceptibility throughout the brain, interval development of a larger left T2/FLAIR and T1 hyperintense lesion in the left paracentral parietal region which demonstrates avid susceptibility abnormality indicating a focal area of blood products. There is no significant surrounding FLAIR signal abnormality to suggest significant vasogenic edema. Given history of prior radiation treatment, these findings may represent an underlying postradiation cavernoma that has bled versus some other hemorrhagic lesion with the possibility of metastases not entirely excluded. Note however that a focus of susceptibility was not definitively located in this region on the prior exam.MRI Spine:1.Overall, stable appearance of the upper spine with improvement of the multiple regions of enhancement in the lower thecal sac.2.Stable postsurgical changes in the lower lumbar spine with persistent moderate-severe central spinal canal stenosis at L3-L4.


Instruction: Generate impression based on findings.

Input: Low back pain The sacroiliac joints appear normal for the patient's age with no findings to account for the patient's low back pain.

Output: Normal appearance of the sacroiliac joints with no findings to account for the patient's pain.


Instruction: Generate impression based on findings.

Input: 50 year old man referred for evaluation of thoracic aortic dissection. Patient not a candidate for CTA or urgent TEE. Decision made to perform "rapid" CMR protocol to rule out thoracic aortic dissection. Left VentricleThe left ventricle appears grossly normal in size. There is moderate concentric LVH. Visually, the LV function appears preserved.Left AtriumThe left atrium appears mild ot moderately dilated. Right VentricleThe right ventricle appears grossly normal in size. Visually, the RV function appears preserved.Right AtriumThe right atrium is grossly normal in size.AortaThere is a left sided aortic arch with a"psuedo-bovine" brachiocephalic branching pattern (normal variant). The aortic root is normal in size. There is no evidence of thoracic aortic dissection. There is a small area of aneurysmal dilation in the descending thoracic aorta measuring 33mm.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is mildly dilated.Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsGroundglass opacities predominantly in right lung field. 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. No evidence of thoracic aortic dissection2. Small area of aneurysmal dilation in descending thoracic aorta measuring 33mm (unchanged from prior study when measured on a side-by-side basis). 3. Lung abnormalities more localized to just the right lung now. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Female, 23 years old, with di-di twin pregnancy, 32 week 6 day GA, midline brain cyst seen on twin A on ultrasound. Imaging was tailored for assessment of twin A which lies more caudally and more toward the maternal left. Brain parenchymal morphology and signal characteristics of twin A are within normal limits for gestational age. A normal cavum septum pellucidum is identified. More posteriorly, a slightly prominent cystic space is seen situated at midline, just below the splenium of the corpus callosum and above the internal cerebral veins. No other definite abnormal fluid collections are seen. Twin B is inadequately assessed due to excessive fetal motion, but the limited images obtained show no significant abormality. Maternal pelvicaliectasis is seen on the left, likely physiologic.

Output: A slightly prominent cystic space is seen in twin A situated between the splenium of the corpus callosum and the internal cerebral veins. This is a typical location for a cavum vellum interpositum, sometimes referred to as a cyst of the cavum vellum interpositum. The brain is otherwise within normal limits for gestational age. Please note that this exam was interpreted without the benefit of review of the prior US images. These will be obtained and reviewed, and if any change to the interpretation is warranted, an addendum to this report will be made.


Instruction: Generate impression based on findings.

Input: Clinical question: Incidental finding on head CT. Sclerotic changes of right parietal calvarium, MRI follow up for further evaluation was commented. Signs and symptoms: Patient is a status post fall on ice, hit head on the left side. Incidental finding of a sclerotic bony changes head CT. Pre-and post brain MRI:No acute intracranial process.Examination demonstrates a irregular focus of T1, T2 and T2 flair hypointensity without enhancement arising from the inner table of the right parietal bone corresponding to region of sclerotic bony change on head CT. This finding measures approximately at 19 x 21 mm in transaxial dimensions.Findings results in very subtle flattening deformity of the descending cerebral cortex however is without causing edema or abnormal enhancement.Findings to represent a calvarial osteoma. Possibility of a totally calcified/burned out meningioma cannot be entirely excluded.Examination otherwise demonstrate normal anatomical morphology and signal intensity brain parenchyma on all MRI sequences.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and myelination of brain.No detectable abnormal parenchymal, leptomeningeal enhancement. No evidence of calvarial or soft tissues of the scalp enhancement.Unremarkable images through the orbits and including axial fat sat post enhanced series.All paranasal sinuses and bilateral mastoid air cells and middle ear cavities demonstrate normal sacrum intensity.

Output: 1.A benign calvarial osteoma in the right parietal region as detailed. The less likely totally calcified/burned out meningioma cannot be entirely excluded.2.Unremarkable pre-and post enhanced brain MRI otherwise.


Instruction: Generate impression based on findings.

Input: Fat saturation is slightly inhomogeneous. There is redemonstration of postoperative changes related to thyroid isthmusectomy and neck dissection with susceptibility artifact from surgical clips. There is no evidence of recurrent mass in the thyroid bed. No nasopharyngeal mass is identified. There is no diffusion abnormality.PHARYNX/LARYNX: The nasopharynx, oropharynx, and hypopharynx are unremarkable. The larynx is unremarkable. The upper trachea and esophagus are unremarkable. There is no abnormal soft tissue mass or pathological enhancement.GLANDS: The contrast-enhanced appearance of the submandibular, sublingual, and parotid glands bilaterally is unremarkable. The remaining thyroid gland is unremarkable. ORAL CAVITY: The oral tongue and the floor of mouth are unremarkable.CERVICAL SOFT TISSUES: Scattered small cervical lymph nodes are identified.OTHER: The previously described right anterior frontal lobe intrinsic T1 hyperintensity adjacent curvilinear developmental venous anomaly, as well as the left midbrain cavernoma are again visualized. Please see separately dictated report for MRI brain of the prior day for further details. An area of pulmonary opacity is seen in the left upper lung field, slightly less confluent than on the prior exam.

Output: Stable appearance of postoperative and posttreatment changes, without mass recurrence or lymphadenopathy.


Instruction: Generate impression based on findings.

Input: A patient submitted outside study for review. Submitted for review are images from stereotactic biopsy of right breast with specimen radiograph (1/14/15), ultrasound images of right breast including biopsy procedure (1/14/15), digital mammographic images of right breast (1/14/15), breast MRI (2/5/15), images from stereotactic biopsy of right breast with specimen radiograph and post-procedural digital mammographic images (2/18/15) performed at Midwest Center for Advanced Imaging. IMAGES FROM STEREOTACTIC BIOPSY OF RIGHT BREAST WITH SPECIMEN RADIOGRAPH (1/14/15):No prior standard mammographic images are provided.Stereotactic biopsy was performed for the right breast at 12:00 position, middle depth. A cluster of pleomorphic calcifications are confirmed with specimen radiograph. Per outside radiology report, the pathology result was malignant; DCIS.ULTRASOUND IMAGES OF RIGHT BREAST INCLUDING BIOPSY PROCEDURE (1/14/15):Ultrasound images of right subareolar region are obtained. There is a hypo-/anechoic mass measuring 5 x 3 mm at the right subareolar region. Ultrasound guided needle biopsy is performed for this hypo-/anechoic mass, and complete resolution of the mass is obtained after the biopsy. Per outside radiology report, the biopsy result was benign.DIGITAL MAMMOGRAPHIC IMAGES OF RIGHT BREAST (1/14/15):This study was done as a post-procedural imaging. Two marker clips are identified in the right breast, one at 12:00 position, middle depth, at the site of proven DCIS, and the other at the retroareolar region for the benign ultrasound-guided biopsy. Amorphus calcifications are seen anterior to the marker clip of the DCIS site, extending approximately 13 mm. A cluster of coarse calcifications is seen at the central aspect in the right breast.BREAST MRI (2/5/15):Breast MRI was performed with a protocol outline in the outside radiology report. There is a linear non-mass enhancement at 12:00 position, middle to anterior measuring 19 x 10 x 8 mm (AP x LR x CC) in the right breast, corresponding to the biopsy-proven DCIS. The marker clip is present at the posterior aspect of this linear enhancement. There is a focal non-mass enhancement measuring 18 x 10 x 11 mm at the central aspect of the right breast.No abnormal enhancement is seen in left breast. No abnormal lymph nodes are identified in either axillary region.IMAGES FROM STEREOTACTIC BIOPSY OF RIGHT BREAST WITH SPECIMEN RADIOGRAPH AND POST-PROCEDURAL DIGITAL MAMMOGRAPHIC IMAGES (2/18/15):Stereotactic biopsy was performed for the cluster of calcifications seen in the central aspect of the right breast. Specimen radiographs show multiple coarse calcifications within the specimens. Postprocedural right mammographic images show the marker clip at the central aspect in the right breast, corresponding to the area of focal non-mass enhancement seen on the MRI. Per outside radiology report, the pathology result was benign; sclerosing intraductal papilloma without atypia. The pathology result is concordant with imaging findings.

Output: 1. Biopsy-proven DCIS in the right breast at 12:00 position. 2. MR detected focal non-mass enhancement at central right breast, correlating to a cluster of coarse calcifications on mammogram, and the stereotactic biopsy of these calcifications revealed benign papilloma. If breast conservation surgery is performed for the right breast DCIS, follow-up MRI is recommended in 6 months.3. No MR evidence for malignancy in the left breast.4. No abnormal lymph nodes in either axillary region.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: 51 years Female (DOB:3/19/1965)Reason: 51F with recurrent lung cancer, OSH transfer for Strep pneumo bacteremia and respiratory failure requiring intubation, now with left-sided paralysis and right MCA CVA, ?embolic, ?ischemic, ?other lesions History: 51F with recurrent lung cancer, OSH transfer for Strep pneumo bacteremia and respiratory failure requiring intubation, now with left-sided paralysis and right MCA CVA, ?embolic, PROVIDER/ATTENDING NAME: BRYAN A CAMPBELL ANSHU A VERMA MRI of the brainThere is cortically based diffusion restriction present along the right middle frontal gyrus as well as the medial lateral aspect of the right superior frontal gyrus and along the left middle frontal gyrus as well as the precentral gyri bilaterally and the right postcentral gyrus. This associated with it T2 signal hyperintensity in the underlying white matter. These findings are new when compared to the prior examThe CSF spaces are appropriate for the patient's stated age with no midline shift. On susceptibility imaging there is vascular or dilation along the high convexities of the right frontal lobe.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.The anterior communicating artery and the posterior communicating arteries are identified and are intact.There is extracranial origin of the left posterior inferior cerebellar artery.. There is extracranial origin of the right posterior inferior cerebellar artery. There is effectively an azygos A2 segment left anterior cerebral arteries smaller than the right anterior cerebral artery at the level of the A1 segments. The anterior communicating artery is present. The left frontopolar artery originates from the left A1-ACOMA junction.The superior division of the right middle cerebral artery is dominant whereas the inferior division of the left middle cerebral artery is dominant.

Output: 1.Findings suggest a cortically based infarction associated with underlying edema which is new since the prior exam explanations may include RCVS, vasculitis as well as encephalitis and ischemia. This is new since the MRI from 8/27/2016.2.There is a vascular microdilation along the high convexities of the right hemisphere. One possible explanation is that this represents a collateral recruitment with associated distal branch occlusions. A conventional angiogram would help differentiate.3.Please note that there is an azygos A2 segment predominately supplied from the right internal carotid artery.4.At the time of this dictation we attempted to contact the clinical service to discuss the findings (pager 3658) We are awaiting a callback


Instruction: Generate impression based on findings.

Input: 64-year-old male with metastatic brain tumor with bleeding in the right frontal. Follow-up Multiple foci of vasogenic edema are consistent with peritumoral edema from patient's known metastatic lesions. A small hemorrhagic and necrotic tumor superficially within the high convexity left frontal lobe measuring 9.6-mm times 9-mm on axial image 22 is noted. A second solid hemorrhagic tumor in the right frontal lobe measures 12.2-mm x 9.7-mm on axial image 18. Both of these lesions were present on the prior MRI exam and demonstrates no definitive interval change.

Output: Multiple foci of vasogenic edema with two hemorrhagic METs as detailed above.


Instruction: Generate impression based on findings.

Input: Follow-up brain metastases. History of non-small cell lung cancer. There are prominent essentially confluent areas of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, which are likely posttreatment related. There is no residual contrast enhancement. There is no diffusion abnormality or extra-axial fluid collection. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, paranasal sinuses, and scalp soft tissues are grossly unremarkable. The clivus, left frontal bone and C3 vertebral body lesions are unchanged, probable related to metastasis.

Output: Posttreatment effects within the brain parenchyma, with no new or enlarging parenchymal metastases. Unchanged osseous metastases.


Instruction: Generate impression based on findings.

Input: 22-year-old female with a history of neuroblastoma. Baseline pre-stem cell transplant. CHEST:LUNGS AND PLEURA: The innumerable bilateral pulmonary nodules have increased in size and number. No significant pleural effusion is identified. Many of the metastatic nodules are pleural based.MEDIASTINUM AND HILA: The heart size is normal. The pre-vascular, subcarinal and right hilar lymphadenopathy has increased in size in the interval. The lymph nodes are in a conglomeration are not amenable to reproducible measurement.CHEST WALL: The previously described right axillary lymph node now measures 4.4 x 2 cm (image 13/2 a one). On the most recent exam this measured 3.6 x 2 centimeters.There is new sclerosis of the T5 and T6 vertebral bodies. The T6 vertebral body shows a loss of height of approximately 50%. While no involvement of the spinal canal is identified on this examination, if there is clinical concern for involvement, an MRI may be obtained. Multiple sclerotic metastatic lesions are seen in the ribs.ABDOMEN:LIVER, BILIARY TRACT: There are multiple hypodense lesions in both lobes of the liver. The phase of enhancement is different on today's examination and therefore reproducible measurement is not possible. However, it appears to these lesions have all increased in size. No biliary ductal dilatation is present.SPLEEN: No significant abnormality noted.PANCREAS: Multiple hypodense lesions are identified within the body and tail of the pancreas. Lesions in the tail of pancreas have increased slightly in size. Lesions in the body of the pancreas are not as clearly seen on this examination. This may be due to phase of contrast enhancement rather than actual decrease in size.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: The right kidney is atrophic. No abnormalities are identified within the left kidney itself. However multiple nodules are identified surrounding the left kidney which likely represent metastatic nodules.RETROPERITONEUM, LYMPH NODES: Multiple retroperitoneal lymph nodes are increased in number but not enlarged by CT criteria.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Subtle sclerotic lesions are identified within the thoracic and lumbar spine. These correlate with the areas of increased uptake on recent bone scan likely represent metastatic disease.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: The uterus is small for age.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: See discussion of bones in the abdomen above.OTHER: No significant abnormality noted.

Output: Interval worsening of metastatic disease in the chest, abdomen and pelvis as described above. Specifically new collapse of the T6 vertebral body is identified.


Instruction: Generate impression based on findings.

Input: 64-year-old female with right hip pain, evaluate for osteonecrosis The bone marrow signal intensity is within normal limits, and we see no fracture or osteonecrosis. There is no hip joint effusion. Mild osteoarthritic changes affect the hip, which are better seen on recent CT. The pubic symphysis and sacroiliac joints are within normal limits.There is a mass along the medial surface of the right iliac wing that appears to be centered in the iliacus muscle and displaces the psoas muscle medially. There are no signs of bony invasion. The mass is approximately 56 x 33 mm in the transverse dimension, and approximately 88 mm in the oblique craniocaudal dimension. On T2-weighted images, it is of heterogeneous signal intensity with regions that are hypointense, isointense, and hyperintense relative to the skeletal muscles. The mass is also of heterogeneous signal on T1-weighted images, and is predominantly isointense with some regions of hyperintensity relative to the skeletal muscles. Mild edema-type signal extends distally from the mass along the course of the iliopsoas muscles and tendon to the lesser trochanter.

Output: 1. No evidence of osteonecrosis.2. Soft tissue mass along the medial aspect of the right iliac wing centered in the iliacus muscle as described above. Please note that this mass is not included in its entirety on many of the sequences of this hip MRI study. Its signal characteristics suggest the possibility of hematoma. However, it is impossible to exclude a malignancy on this study. We would recommend MRI of the pelvis with and without contrast for further evaluation.


Instruction: Generate impression based on findings.

Input: History of ulcerative colitis with mild IBD symptoms. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Shotty retroperitoneal lymph nodes.BOWEL, MESENTERY: Shotty mesenteric lymph nodes. The stomach appears very distended during the course of the examination without an associated duodenal abnormality.The small bowel is adequately distended. It is normal in caliber. There is no abnormal wall thickening, enhancement, restricted diffusion or adjacent inflammatory changes. No fibrofatty proliferation. No focal fluid collection. The colon is also unremarkable in appearance.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. No evidence of acute or chronic inflammatory changes of the bowel.2. The stomach remains very distended during the course of the examination without an obstructive mass or stricture evident. This may reflect delayed transit. Clinical correlation and follow-up is recommended.


Instruction: Generate impression based on findings.

Input: 74 years Male (DOB:2/5/1942)Reason: recent memory loss problems History: memory lossPROVIDER/ATTENDING NAME: SERVICES ANCILLARY SERVICES ANCILLARY The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.There are several subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin.

Output: Several subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related. They are likely of little clinical significance.


Instruction: Generate impression based on findings.

Input: Bilateral cerebellar tonsils extend below the level of the foramen magnum approximately 10-11 mm, demonstrating a peglike appearance, partially effacing the posterior CSF space. CSF flow analysis demonstrates a small amount of biphasic CSF flow at the level of the cerebellar tonsils.There are no fractures. The marrow signal is benign. The cervical and upper thoracic cord are normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable.C1/2: Ligament thickening posterior to the odontoid tip narrows the anterior CSF space without cervicomedullary abutment.C2/3: Trace anterolisthesis C2 on C3, osteophyte disc complex, bilateral uncinate hypertrophy, mild left facet hypertrophy, and moderate right facet hypertrophy. There is mild to moderate bilateral neural foraminal stenosis. Posterior to the hypertrophic right facet joint, there is a 2 cm transverse x 1.3 cm AP x 1.0 cm craniocaudal mass which abuts the adjacent osseous structures and follows fat intensity on all sequences including inversion technique.C3/4: Osteophyte disc complex, left uncinate hypertrophy, and moderate left facet hypertrophy with partial facet fusion. There is severe left neural foraminal stenosis.C4/5: Osteophyte disc complex, left uncinate hypertrophy, moderate left facet hypertrophy, and ligamentum flavum thickening. There is mild central and moderate to severe left neural foraminal stenosis.C5/6: Posterior osteophyte disc complex, bilateral uncinate hypertrophy, mild left facet appear to be, and ligament flavum thickening. There is mild central, moderate to severe left neural foraminal, and severe right neural foraminal stenosis.C6/7: Trace anterolisthesis C6 on C7, minimal disc bulge, and moderate right facet hypertrophy. There is mild right neural foraminal stenosis.C7/T1: Minimal disc bulge and mild bilateral facet hypertrophy. There is mild bilateral neural foraminal stenosis.

Output: 1.Bilateral cerebellar tonsils extend below the level of the foramen magnum approximately 10-11 mm, demonstrating a peglike appearance, partially effacing the posterior CSF space, consistent with Chiari I malformation. CSF flow analysis demonstrates a small amount of biphasic CSF flow at the level of the cerebellar tonsils.2.C2/3: There is mild to moderate bilateral neural foraminal stenosis. Posterior to the hypertrophic right facet joint, there is a 2 cm transverse x 1.3 cm AP x 1.0 cm craniocaudal mass which abuts the adjacent osseous structures and follows fat intensity on all sequences including inversion technique. This is of uncertain etiology or significance, and CT could better define the association with the adjacent facet if deemed clinically beneficial.3.C3/4: Severe left neural foraminal stenosis.4.C4/5: Mild central and moderate to severe left neural foraminal stenosis.5.C5/6: Mild central, moderate to severe left neural foraminal, and severe right neural foraminal stenosis.6.C6/7: Mild right neural foraminal stenosis.7.C7/T1: Mild bilateral neural foraminal stenosis.


Instruction: Generate impression based on findings.

Input: Reason: eval for septic wrist vs osteomyelitis History: right wrist pain x 1 week. No wrist joint effusion is identified. Osseous structures within the wrist are normal in appearance, without osteolysis or abnormal enhancement to suggest osteomyelitis. Minimal soft tissue thickening in the volar aspect of the wrist demonstrating minimal enhancement is nonspecific and may be suggestive of cellulitis.

Output: 1.No evidence of septic joint or osteomyelitis as clinically inquired.2.Minimal soft tissue thickening of the volar aspect of the wrist demonstrating minimal enhancement, which may be suggestive of cellulitis.


Instruction: Generate impression based on findings.

Input: 53-year-old man with new diagnosis of prostate cancer. Additional history as per chart: PSA of 7 in August 2016, right-sided prostate biopsy revealing Gleason 3+4 disease. PELVIS:PROSTATE:Prostate Size: 52 x 38 mm.Peripheral Zone: Within the medial right base (401/16) there is a 9 x 5 mm area of decreased T2 signal. There is questionable diffusion abnormality corresponding to this area and there is no early enhancement seen on perfusion series. A small focus of T1 hyperintensity/hemorrhage is seen lateral to this region.The remainder of the peripheral zone appears heterogeneous without discrete focus of signal abnormality. Central Gland: Heterogeneous in appearance with BPH nodules.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: The right medial base lesion abuts the capsule, however there does not appear to be extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant lymphadenopathy noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Signal abnormality in the right medial prostatic base which likely corresponds to focus of adenocarcinoma.


Instruction: Generate impression based on findings.

Input: Male, 35 years old, with history of ependymoma and suspicious brain lesions. Surveillance exam. Brain:A punctate focus of enhancement along the left precentral sulcus has not significantly changed from the prior examination, accounting for some mild imaging artifact and differences in technique (see image 26 series 63). T2 hyperintensity spreading mildly from this lesion into the surrounding white matter seems to have lessened compared to prior.Previously seen small foci of enhancement, one each in the right and left occipital lobes, are not reliably detected on this study. No associated parenchymal signal abnormality is observed.No new areas of pathologic parenchymal signal abnormality or enhancement are detected. No restricted diffusion is seen. There is no evidence of edema or mass effect.Sequelae of prior chronic ischemia are seen in the bilateral cerebral hemispheres. Otherwise the brain morphology is within normal limits. No abnormal fluid collections are detected. The ventricles are stable and normal in size.Spine:Again seen is evidence of laminectomy from C6 through T2. The soft tissues of the paraspinal operative bed again show evidence of scarring, but no fluid collections are detected.Sequelae of tumor resection from the low cervical/upper thoracic spinal cord are again demonstrated. The cord remains thinned from C7 through T2, and also shows diffuse enhancement through this region, all similar to prior.Syringohydromyelia of the cord above the level of the lesion is stable to slightly improved. Mild syringohydromyelia below the level of the lesion, extending down to approximately T7, is probably not significantly changed, although the prior examination was motion degraded which complicates comparison.Within the limitations of mild imaging artifact, no evidence of any new pathologic intraspinal or paraspinal enhancement is seen. No new abnormalities of the spinal cord, conus or cauda equina are detected.Spinal alignment is anatomic. Vertebral body morphology is within normal limits allowing for a Schmorl's node at L1. No significant degenerative disc disease, spinal canal stenosis or neuroforaminal narrowing is detected.

Output: 1.A small focus of enhancement along the left precentral sulcus shows no significant interval change. Surrounding T2 hyperintensity does, however, seem to have improved relative to the prior examination.2.Two small foci of enhancement seen previously within the occipital lobes are no longer visualized on this study. No new intracranial lesions are detected.3.Redemonstration of postoperative findings in the spine compatible with ependymoma resection from the low cervical/upper thoracic spinal cord. The cord remains thinned and diffusely enhancing in the operative region, similar to the prior exam. No new intraspinal lesions are detected.


Instruction: Generate impression based on findings.

Input: Lumbar radiculopathy. There is 7 mm of anterolisthesis of L4 on L5. There is a superimposed disc bulge, bilateral facet hypertrophy with slight effusions, and ligamentum flavum thickening, which results in severe left and moderate right neural foraminal narrowing and mild to moderate spinal canal stenosis, with a greater degree of lateral recess effacement on the left. There is also a small synovial cyst along the inferior aspect of the right L4-L5 facet joint. There is a mild disc bulge, facet hypertrophy, and ligamentum flavum thickening at L5-S1, with mild bilateral neural foraminal narrowing, but no significant spinal canal narrowing. There is also a punctate synovial cyst along the inferior aspect of the right L5-S1 facet joint. There is a mild disc bulge, facet hypertrophy, and ligamentum flavum thickening at L3-L4, with mild left and slight right neural foraminal narrowing, but no significant spinal canal narrowing. There are also a small synovial cysts along the inferior aspect of the right L3-L4 facet joints bilaterally. The imaged portions of the spinal cord are unremarkable. There is trace disc bulging at L2-3, without significant neural foraminal or spinal canal narrowing. T12 through L2 are unremarkable. The conus medullaris is located at the L2-3 level. The bone marrow is unremarkable, including scattered foci of focal fat. The paraspinal soft tissues are unremarkable, aside from dependent edema in the posterior subcutaneous tissues. There is a small right renal probable cyst.

Output: Multilevel degenerative lower lumbar spondylosis, which is most pronounced at L4-5, which is conjunction with grade 1 anterolisthesis, results in severe left and moderate right neural foraminal narrowing and mild mild to moderate spinal canal stenosis.


Instruction: Generate impression based on findings.

Input: Female 51 years old Reason: thigh pain History: thigh pain PELVIS: The femoral heads are well formed and seated within well formed acetabula. No evidence of avascular necrosis or fracture.Postsurgical changes in the lower lumbar spine.No muscle atrophy or edema. The tendinous origins of the gluteal, hamstring and iliopsoas tendons are intact.The left sciatic nerve is intact.Cystic lesion along the superior aspect of the bladder likely represents a urachal remnant.Nonspecific T2 hyperintense focus adjacent to the rectum.LEFT THIGH: Left femur cortex is intact. Marrow signal is normal.No muscle atrophy or edema. No evident soft tissue mass.

Output: No acute fracture or dislocation.Etiology for the patient's left thigh pain is not evident.Cystic lesion along the dome of the bladder likely represents a urachal remnant and further evaluation is recommended.


Instruction: Generate impression based on findings.

Input: Pilocytic astrocytoma treated with laser ablation. There has been interval evolution of postoperative findings related to left transfrontal laser ablation of a hypothalamic region tumor, which has decreased in size, now measuring up to 10 mm, previously 12 mm. The ventricles are essentially unchanged is size and configuration. The optic apparatus appears grossly intact. There is no evidence of territorial infarction or acute intracranial hemorrhage. There is no midline shift or herniation. The skull and extracranial soft tissues are unchanged.

Output: Postoperative findings related to laser ablation of a hypothalamic region pilocytic astrocytoma, which has further decreased in size.


Instruction: Generate impression based on findings.

Input: Laser ablation of the corpus callosum. There has been interval laser ablution of the corpus callosum via right transparietal and bilateral transfrontal approaches. There is expected peripheral enhancement of the ablation zones. There is no evidence of gross intracranial hemorrhage. There is no midline shift.

Output: Expected findings related to interval laser ablation of the corpus callosum.


Instruction: Generate impression based on findings.

Input: Persistent headache for 3 weeks. Hx SS-b thalassemia. Brain MRI: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Brain MRA: There is no evidence of significant steno-occlusive lesions or aneurysms.Brain MRV: There is no evidence of venous sinus thrombosis. There is hypoplasia of the transverse sinuses, which can represent an anatomic variant.

Output: 1. No evidence of acute intracranial hemorrhage, mass, or acute infarct.2. No evidence of significant steno-occlusive lesions in the cerebral arteries.3. No evidence of venous sinus thrombosis.


Instruction: Generate impression based on findings.

Input: Colitis, evaluate small bowel for inflammation to differentiate Crohn's and UC. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No evidence of small bowel inflammation. The terminal ileum is normal.BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Multiple prominent perirectal lymph nodes, which can be seen in colonic inflammation.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1. No evidence of small bowel inflammation.2. Multiple prominent perirectal lymph nodes, which can be seen in colitis.


Instruction: Generate impression based on findings.

Input: 39 year old female with neurosarcoidosis. Interval change of the fourth ventricle. Shunt placement left frontal. Rest of provided clinical data is not legible. Transient alteration of awareness. Nonenhanced CT of brain:Images through posterior fossa demonstrate an enlarged fourth ventricle and no appreciable interval change since prior MRI exam.Images through supratentorial space demonstrate collapsed left lateral ventricle. This is similar to what was noted on prior MRI exam. Normal appearing right lateral ventricle and similar in size to prior MRI study.Third ventricle is small and in midline and with no interval change. Left-sided ventricular catheter traverses the left frontal lobe, enters the left frontal horn, traverses the midline and with the tip at the level of foramina of Monroe on the right. Small area of encephalomalacia in bilateral frontal lobes (right greater than left) shows no interval change since prior MRI. There is no evidence of hemorrhage, edema mass-effect or midline shift.

Output: 1.No evidence of new findings since prior MRI examination of brain.2.Dilated fourth ventricle and a small supratentorial ventricular system remains stable since prior study.


Instruction: Generate impression based on findings.

Input: 15-year-old male with hematochezia. Assess for Crohn's disease.EXAMINATION: MR enterography without and with IV contrast 11/23/2015, 1106. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Symmetric in size and normal enhancement.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY:Moderate fecal burden without evidence of dilatation or bowel wall thickening.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Moderate fecal burden without evidence of dilatation or bowel wall thickening.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Moderate fecal burden without evidence of inflammatory bowel disease.


Instruction: Generate impression based on findings.

Input: 71-year-old male presents with right shoulder pain, evaluate for rotator cuff tear. ROTATOR CUFF: There is a complete tear of the subscapularis tendon from its insertion on the lesser tuberosity. Portions of the tendon are retracted to the level of the glenoid. The subscapularis muscle appears normal. There is generalized thinning of the supraspinatus tendon likely reflecting chronic attritional tearing, but no full-thickness tear is identified. The anterior fibers of the infraspinatus tendon likewise appears thin, but without a full-thickness tear. The supraspinatus and infraspinatus muscles appear normal. The teres minor muscle and tendon are normal.SUPRASPINATUS OUTLET: Mild osteoarthritis affects the acromioclavicular joint. A small amount of fluid is noted within the subdeltoid bursa anteriorly.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is a glenohumeral joint effusion with fluid concentrated anteriorly. Intermediate signal intensity within the superior labrum may reflect degeneration. There is also enlargement of the anterior inferior labrum which may reflect degeneration or prior trauma.BICEPS TENDON: The tendon of the long head of the biceps appears intact, although edema anterior to the tendon at its transition from the rotator interval to the intertubercular groove may indicate injury to the pulley.

Output: Complete tear of the subscapularis tendon and other findings as described above.


Instruction: Generate impression based on findings.

Input: Squamous cell vocal cord cancer with possible recurrence to cervical esophagus region. There are post-treatment findings in the upper neck, including diffuse pharyngeal and supraglottic edema and fatty signal alteration in the cervical spine bone marrow related to radiation therapy. There is an ill-defined mass in the left tracheoesophageal groove that measures approximately 30 mm in width. There is otherwise no evidence of significant lymphadenopathy elsewhere in the neck. However, there is a T1 hypointense and T2 hyperintense submucosal nodule deep to the right palatine tonsil that measures approximately 10 mm in diameter.

Output: 1. An incompletely characterized mass in the left tracheoesophageal groove that measures up to approximately 30 mm with corresponding hypermetabolism on the prior PET likely represents locoregionally recurrent squamous cell carcinoma. Aside from post-treatment edema, no measurable tumor is identified within the larynx, although the assessment is limited by the lack of intravenous contrast.2. An incompletely characterized submucosal nodule deep to the right palatine tonsil that measures approximately 10 mm in diameter may represent a minor salivary gland neoplasm for example.


Instruction: Generate impression based on findings.

Input: 53 year-old woman with altered mental status. Unsure of baseline. Otherwise stable. There are diffuse regions of hypoattenuation consistent with prior infarct throughout the cerebral cortex. There are diffuse areas of encephalomalacia most pronounced in the left occipital lobe. Extensive periventricular hypoattenuating regions consistent with age indeterminate, small vessel ischemic disease. These findings are unchanged from the prior study dated 5/1/2008. If acute stroke is a clinical concern, recommend MRI. The ventricles are unchanged in size from the prior study. The basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. Stable head CT with extensive ischemic changes. If acute stroke is a clinical concern, recommend MRI.


Instruction: Generate impression based on findings.

Input: Reason: gait disorder, tremor, concern for ischemia vs NPH vs idiopathic History: tremor, gait disorder The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate minor mucosal thickening. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 2.No intracranial mass lesions are appreciated. There is no evidence for ventriculomegaly appreciated.


Instruction: Generate impression based on findings.

Input: History of multiple sclerosis, new Lhermitte's sign Again seen are multiple foci of T2 hyperintensity throughout the cervical cord consistent with known demyelinating disease. Relatively more prominent discrete lesion is seen at the right dorsal C3-C4 level and is unchanged. There is mild associated volume loss. Some of the lesions appear slightly more prominent than on the prior study which is favored to be related to subtle differences in technique. For example right paracentral C5-C6 lesion appears more prominent but present previously. No new lesion is definitively appreciated. No lesion with enhancement is seen to suggest active demyelination.Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained. Bone marrow signal is within normal limits. Mild degenerative changes are again seen in the cervical spine including multilevel disc desiccation and minimal disc bulges. There is no significant spinal canal or neural foraminal stenosis at any level.

Output: Multiple T2 hyperintense lesions throughout the cervical cord consistent with chronic demyelinating disease. Allowing for slight differences in technique, no new lesion is definitively appreciated. There is no abnormal enhancement to suggest active demyelination.


Instruction: Generate impression based on findings.

Input: 60-year-old male with history of resected uveal melanoma, evaluate for recurrence. ABDOMEN:LIVER, BILIARY TRACT: There are two T2 hyperintense subcentimeter foci in segment four that likely representing benign cysts. No abnormal enhancement is present. Additional subcentimeter T2 hyperintensities in hepatic segment five and six are too small to further characterize although are likely benign. No intrinsically T1 weighted hyperintense lesion or rim-enhancing lesion is appreciated to suggest a metastatic lesion. These lesions are unchanged compared to the prior exam.No intra or extrahepatic biliary ductal dilatation. The gallbladder is within normal limits.SPLEEN: Normal splenic size without a focal lesion.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Partially imaged probable intramuscular lipoma in the right lateral chest wall, unchanged.OTHER: No significant abnormality noted.

Output: Unchanged T2 hyperintense lesions as described above are favored to be benign. No specific evidence of metastatic disease.


Instruction: Generate impression based on findings.

Input: Diagnosis: Vomiting, unspecifiedClinical question: cyclical vomiting, R/O lesion area postremaSigns and Symptoms: Cyclical vomiting The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are underdeveloped. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: MRI of the brain is within normal limits. No intracranial mass lesion or other explanation for the patient's symptoms is appreciated


Instruction: Generate impression based on findings.

Input: 60-year-old man with history of prostate cancer PELVIS:PROSTATE:Prostate Size: 64 x 58 mmPeripheral Zone: The peripheral zone is markedly thickened. In the peripheral zone of the right apex (series 8, image 11) there is a very small, approximately 5 x 2 mm focus of decreased T2 signal and diffusion restriction without extracapsular extension. Enhancement of this focus is difficult to evaluate given its size.Central Gland: The central gland is markedly hypertrophic and nodular.Seminal Vesicles: The seminal vesicles appear normal.Extracapsular Extension: No evidence of extracapsular extension.BLADDER: There is mass effect from the adjacent enlarged central gland, otherwise the bladder appears normal.LYMPH NODES: No significant lymphadenopathy identified.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Very small focus of signal abnormality in the peripheral right apex of the prostate suspicious for a small focus of adenocarcinoma.


Instruction: Generate impression based on findings.

Input: Crohn's disease, evaluate bowel wall thickening, exclude ileal stenosis and fistula ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There are chronic changes involving 14 cm of distal and terminal ileum. There is mild wall enhancement in this region suggestive of acute on chronic disease. Just proximal to this segment, there is a focally narrowed segment of small bowel measuring 2 cm in length with mild wall thickening and enhancement compatible with active disease. No evidence of fistula.BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Focally narrowed ileal segment with wall enhancement and thickening compatible with active inflammatory bowel disease. No evidence of fistula.2.Acute on chronic disease affects the distal and terminal ileum.


Instruction: Generate impression based on findings.

Input: 53-year-old female with metastatic PNET with liver metastasis and pancreatic primary intact ABDOMEN:LIVER, BILIARY TRACT: Interval increase in multiple right liver lobe T2 hyperintense metastatic lesions. The largest lesion in segment seven measures 3.0 x 3.1 cm, previously 2.3 x 2.4 cm (series 6, image 16). New hepatic segment four and segment six lesions.Status post cholecystectomy. No intrahepatic or extrahepatic biliary ductal dilatation. Hepatic steatosis.SPLEEN: Splenule.PANCREAS: Redemonstrated is an enhancing pancreatic head masslesion with central necrosis measuring 2.7 x 2.1 cm, previously 2.2 x 1.5 cm (series 11, image 303). Abrupt cessation of the main pancreatic duct at the level of the mass. Upstream from the lesion, the pancreatic duct measures 4 mm. There is a small side branch can been in the distal body/tail. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Horseshoe kidney. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Findings compatible with disease progression. Increased size of pancreatic head masslesion. Interval increase in size and number of liver metastasis.


Instruction: Generate impression based on findings.

Input: 51 year-old female with left shoulder pain of unknown origin. ROTATOR CUFF: There is thickening and increased signal within the supraspinatus tendon suggesting tendinosis with undersurface fraying but no discrete tear or significant tendon retraction. There is also abnormal signal intensity in the supraspinatus tendon suggesting tendinosis and possibly mild interstitial tearing without discrete full thickness tear. The infraspinatus and teres minor muscles and tendons appear unremarkable.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: No discrete labral tear. Glenohumeral alignment is within normal limits.BICEPS TENDON: There is again suggestion of abnormal signal intensity within the biceps anchor suggesting tendinosis/incomplete tearing, however evaluation is somewhat limited by patient motion artifact.ADDITIONAL

Output: 1.Supraspinatus and subscapularis tendinosis without evidence of full thickness tear or significant tendon retraction. 2.No evidence of labral tear.3.Redemonstration of mild abnormal signal in the biceps anchor suggesting tendinosis/incomplete tearing.