Instruction: Generate impression based on findings.

Input: Male 38 years old Reason: hx of urethral cancer eval for mets History: hx of urethral cancer eval for mets 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: Postsurgical changes of right lower quadrant ileal conduit. No abnormally enhancing renal lesion or filling defect within the collecting system. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: Status post cystoprostatectomy.BLADDER: Status post cystoprostatectomy.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.Status post cystoprostatectomy for urethral cancer. No evidence of tumor recurrence within the abdomen or pelvis.


Instruction: Generate impression based on findings.

Input: The study is severely limited due to artifact.Focal kyphosis is noted at T10-T11, new from the prior MRI dated 10/9/2014, however likely unchanged from the recent MRI dated 6/5/2015. Disc protrusion at this level again indents on the ventral spinal cord, however no cord signal abnormality is identified. Severe loss of disc height and wedge deformity of the T11 vertebral body are again noted. The T10 vertebral body is only partially visualized and there may be compression deformity of the T10 vertebral body as well. Increased T1/T2 signal is seen along the depressed superior endplate of T11. Paraspinal edema seen at the T10-T11 level, right greater than left, on the STIR images which raises concern for inflammation/infection.Subcutaneous edema is seen in the soft tissues superficial to the lumbar spine. There are no fractures or subluxations. Multiple T1/T2 hyperintense lesions seen throughout the vertebral bodies are favored to represent hemangiomas. The conus is normal in signal and morphology and terminates at an appropriate level.Multilevel degenerative disc disease is seen predominantly in the lower lumbar spine with diffuse disc bulges at L4-L5 and L5-S1. While there is no central canal stenosis, moderate bilateral neural foraminal stenosis is seen at these levels.

Output: 1.Severely limited study due to artifact.2.Focal kyphosis at T10-11 is again seen with severe loss of disc height and compression fractures. This area is incompletely imaged, however given the paraspinal edema at this level, the possibility for an underlying osteomyelitis/discitis must be raised. These findings can be correlated with CT imaging if desired as the patient may better tolerate CT than MRI.


Instruction: Generate impression based on findings.

Input: 40-year-old male with pain and history of previous meniscal repair. MENISCI: There is branching linear increased signal abnormality within the posterior horn of the medial meniscus which extends to the tibial and femoral articular surfaces, consistent with a complex tear with both a horizontal and longitudinal component. There are subcentimeter foci of fluid signal abnormality along the posterior horn of the meniscus consistent with parameniscal cyst formation. There is globular increased signal abnormality within the body of the meniscus consistent with intrasubstance degeneration. Some of this signal abnormality extends to the femoral articular surface suggesting fraying/degenerative tearing. No fluid-filled tear is identified. The anterior horn appears intact. The lateral meniscus appears intact. ARTICULAR CARTILAGE AND BONE: There is subjective thickening of the articular cartilage along the weightbearing surface of the lateral femoral condyle. There is partial-thickness articular cartilage degeneration along the weightbearing surface of the medial femoral condyle, above the posterior horn of the meniscus. There is fraying of the articular cartilage along the lateral facet of the patella. There is partial-thickness articular cartilage degeneration along the lateral facet of the patella.LIGAMENTS: The cruciate and collateral ligaments appear intact EXTENSOR MECHANISM: The extensor mechanism appears intact. There is enthesophyte formation along the inferior and lateral aspect of the patella. There is also associated increased signal abnormality within the lateral aspect of the proximal patellar tendon indicating mild patellar tendinosis.ADDITIONAL

Output: 1. Branching linear increased signal abnormality within the medial meniscus which extends to the tibial and femoral articular surfaces, consistent with a complex tear. It is uncertain if these findings represent a re-tear or prior tearing/postsurgical changes without the availability of prior examinations for comparison. No fluid-filled meniscal tear is evident. There are associated parameniscal cysts.2. Findings consistent with mild patellar tendinosis.


Instruction: Generate impression based on findings.

Input: Worsening right leg sciatica and pain with new numbness/tingling in the bilateral feet. There is degenerative spondylosis in the lower lumbar spine. In particular, there is 5 mm of anterolisthesis of L4 on L5, a disc bulge with loss of disc space height and fluid content, as well as endplate degenerative signal alterations, bilateral ligamentum flavum hypertrophy, and facet hypertrophy, which result in severe spinal canal stenosis with compression of the cauda equina nerve roots, as well as mild right and moderate left neural foraminal stenosis. At L5-S1, there is exuberant bilateral facet joint arthropathy and mild disc bulging, which results in moderate-to-severe bilateral neural foraminal narrowing. There is a slight disc bulge at L3-4, without significant spinal canal or neural foraminal stenosis. There is no significant spinal canal or neural foraminal stenosis at T12 through L3 either. The vertebral body and disc space heights are preserved. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: Degenerative spondylosis in the lower lumbar spine. In particular, there is 5 mm of anterolisthesis of L4 on L5, a disc bulge with loss of disc space height and fluid content, as well as endplate degenerative signal alterations, bilateral ligamentum flavum hypertrophy, and facet hypertrophy, which result in severe spinal canal stenosis with compression of the cauda equina nerve roots, as well as mild right and moderate left neural foraminal stenosis. At L5-S1, there is exuberant bilateral facet joint arthropathy and mild disc bulging, which results in moderate-to-severe bilateral neural foraminal narrowing.


Instruction: Generate impression based on findings.

Input: Clinical question: Rule out cord compression. Signs and symptoms: T7 lesion, back pain. Complete spine MRI:Examination is performed utilizing cord compression protocol which is a limited exam.Within this limitation examination demonstrates postoperative changes of posterior fusion and placement of transpedicular screws extending from T4 inferiorly to T11. Although images are degraded due to metallic hardware artifact there is no definitive evidence of cord compression however this possibility cannot be entirely excluded due to limited visibility of the cord at the level of surgery. There is evidence of marrow signal changes of T6 and T7 with suggestion of subtle extraosseous extension of signal abnormality which is concerning for tumor. Correlate with history and comparison made prior exams if available. Beyond the region of surgery there is normal signal intensity and caliber of the cord and without mass effect.Advanced degenerative changes at L4-L5 and L5-S1 levels are noted.Follow-up with pre- and post enhanced dedicated imaging is recommended.

Output: 1.There are postoperative changes of posterior fusion with multilevel transpedicular screws placement from T4 through T8 and with highly suspected mass of T6 and T7 with extraosseous spread of tumor.2.Within the limitation of metallic hardware artifact there is no definitive detectable mass effect on the cord however this possibility cannot be entirely excluded due to limitation of the exam.3.Beyond the region of surgery no evidence of mass effect on the cord is detected.4.Advanced degenerative disc disease at L4-L5 and L5-S1 levels are noted.5.Follow-up imaging for better assessment of tumor and cord compression of thoracic spine is recommended.6.If there are outside studies available and provided to radiology department and addendum to this report will be submitted after comparison.


Instruction: Generate impression based on findings.

Input: Reason: please do dr jave d ms protocol compare to prior History: progression MS MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. There is a moderate degree of periventricular and subcortical punctate and confluent hyperintense white matter lesions present identified on the FLAIR and T2 images. These are stable compared to last years exam.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. There is redemonstration of small foci of signal hyperintensity within the posterior aspect of the spinal cord along its midline at the C2, C3 -4 and C5-6 vertebral levels. These were also present on the prior exam from March of last year and is not display any interval change. No abnormal enhancing lesions are identified in the cervical spine.There is multilevel disk desiccation present cervical spine and mild reversal of the normal cervical curvature which is stable compared to the prior exam.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina. There is a mild disk bulge present at this level.At C5-6 there is no significant compromise to the spinal canal or neural foramina. There is a mild disk bulge present at this level.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.A single hyperintense lesion measuring 12 mm in diameter is present which is bright on T2 and isointense on T1. It was not included on imaging on the prior exam it is associated with some enhancement following gadolinium administration.

Output: 1.There are periventricular white matter lesions present which are stable since the prior exam and compatible with patient's clinical history of demyelinating disorder.2.There are several lesions present in the spinal cord which are compatible with a diagnosis of demyelination and stable since the prior exam. 3.There are mild degenerative changes present in the cervical spine without significant compromise of spinal canal or neural foramina.


Instruction: Generate impression based on findings.

Input: 30-year-old male patient with PSC-IBD. Evaluate for cholangiocarcinoma. ABDOMEN:LIVER, BILIARY TRACT: Again seen are alternating areas of intrahepatic biliary narrowing and dilation, particularly centrally and in the left hepatic lobe. These findings appear similar compared to comparison examination. No suspicious enhancing lesions seen. Hepatic vasculature is patent. Prominent lymph nodes are noted at the porta hepatis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Subcentimeter T2 hyperintense lesion in the inferior pole of the right kidney is too small to characterize and likely represents a cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Alternating intrahepatic biliary narrowing and dilatation compatible with known history of PSC, not significantly changed compared to prior.2.No evidence of cholangiocarcinoma.


Instruction: Generate impression based on findings.

Input: 75 years, Female, Reason: Tremor, worse with action (such as finger to nose, where tremor becomes coarse). Difficulty with tandem gait (falls/steps rightward). Evaluate for cerebellar disease. There is mild volume loss involving the cerebellar hemispheres. There is also a tiny linear focus of T2 hyperintensity in the right cerebellar hemisphere suggestive of a small chronic infarct. Otherwise no significant abnormality in the cerebellum is appreciated. There is also mild supratentorial parenchymal volume loss, which is appropriate for age. No intracranial mass or mass effect. No midline shift or herniation. No hydrocephalus. Calvarium and extracranial soft tissues are grossly unremarkable.Degenerative changes in the cervical spine with spinal canal stenosis better assessed on recent MRI from 8/11/2016.

Output: 1. No evidence of acute infarct, hemorrhage, or mass.2. Mild cerebellar and supratentorial parenchymal volume loss, which appears within normal limits for age. There is also a suggestion of a tiny chronic right cerebellar infarct. Brain MRI is otherwise unremarkable for age.


Instruction: Generate impression based on findings.

Input: History of pancreatic tail cyst. Evaluate for any interval change. ABDOMEN:LIVER, BILIARY TRACT: Stable bilobar simple cysts. Normally distended gallbladder. No focal suspicious lesion. No biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: Stable pancreatic tail unilocular cyst measuring 1.1 x 1.1 cm (series 901/28), unchanged. No suspicious enhancement. The main pancreatic duct is normal in caliber. Pancreas divisum.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No significant change in the is unilocular cystic pancreatic tail lesion.


Instruction: Generate impression based on findings.

Input: 49-year-old female with abnormal uterine bleeding. Evaluate for adenomyosis. PELVIS: Motion artifact limits evaluation.UTERUS, ADNEXA: The junctional zone is ill-defined and diffusely thickened measuring up to 13 mm. There are multiple subserosal T2 heterogeneous lesions with the largest measuring approximately 3.7 mm; these lesions demonstrate heterogeneous enhancement and most compatible with leiomyomata.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: Right iliac fossa kidney is noted.

Output: 1.Uterine leiomyomata.2.Within the limitations of motion artifact, findings suggestive of diffuse adenomyosis.


Instruction: Generate impression based on findings.

Input: Female 49 years old; Reason: chronic tendinitis History: pain and swelling TENDONS: The flexor and extensor tendons are normal in appearance. The Achilles tendon is normal in appearance. No significant abnormality is noted.LIGAMENTS: The medial and lateral ligaments of the ankle are intact. No significant abnormality is noted.ARTICULAR SURFACES AND BONE: The bone marrow signal is within normal limits. No osteochondral defect is seen. No significant abnormality is otherwise noted. ADDITIONAL

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


Instruction: Generate impression based on findings.

Input: Orbital cellulitis possible orbital abscess: left orbital pain and blurry vision. There are secretions and moderate mucosal thickening diffusely throughout the left frontal anterior ethmoid, and maxillary sinuses. There is a defect in the left lamina papyracea with mild protrusion of the orbital contents, which is more conspicuous on the recent CT. There is high T2 signal and enhancement within the medial left orbital fat, mainly confined to the extraconal space. There is no evidence of intraorbital fluid collection. The left superior opthalmic vein demonstrates normal enhancement and the left globe and optic nerve appear to be intact. The right orbit appears unremarkable. The right maxillary and ethmoid sinuses and bilateral sphenoid sinuses appear unremarkable. There are several subcentimeter retention cysts in the adenoids. The imaged intracranial contents appear unremarkable.

Output: Left osteomeatal unit pattern of sinusitis and medial left orbit cellulitis associated with a lamina papyracea defect, but no evidence of orbital abscess.


Instruction: Generate impression based on findings.

Input: 60 year-old female with history of pain. There is narrowing along the superior aspect of the hip joint compatible with mild to moderate osteoarthritis. We see no fracture line, however there is periosteal bone formation along the medial aspect of the femoral neck which may represent a stress fracture in the correct clinical context. An MRI is recommended for further evaluation.

Output: 1.Periosteal bone formation along the medial aspect of the femoral neck which may represent a stress fracture. An MRI is recommended for further evaluation.2.Osteoarthritis as above.Findings and plan discussed with Dr. Welch at 1030 on 2/4/15.


Instruction: Generate impression based on findings.

Input: 81-year-old female with a history of a lung mass presents with back pain, concern for bony metastases; evaluate for spinal cord compression. This is a limited exam specific for the exclusion of cord compression only and does not exclude more subtle lesions such as intrinsic cord abnormalities or dural based metastases. There is diffuse patchy marrow replacement throughout the visualized spine.There are T2 hyperintense lesions corresponding to lytic lesions on recent chest CT and lumbar spine CT present. One is located on the right aspect of T5 and extends into the posterior elements of T5. There is soft tissue extension outside of the bony elements into the epidural space and into the adjacent T4-5 and T5-6 neural foramina. There is encroachment of exiting nerve roots at T4-5 and T5-6. There is no associated cord compression.There is a mild compression fracture present at T12 associated with a lytic lesion at T12 also visualized on the recent CT of the lumbar spine. There is no associated cord compression.There is a lytic lesion present along the anterior aspect of L2 which is hyperintense on T2 imaging and also identified on the recent CT of the lumbar spine. There is no associated cauda equina compressionThere are degenerative changes present in the cervical spine without evidence of associated spinal canal stenosis. This appears to be worse at C4-5, C5-6 and C6-7 where there are uncovertebral osteophytes and disc material narrowing neural foramina.There are degenerative changes present in the lumbar spine which appear worse at L5-S1 where there is a disc bulge present and loss of disc space heightA left lung mass lateral to the aorta and left-sided pleural thickening is partially imaged and better appreciated on the prior CT.

Output: 1.No evidence of spinal cord compression. Please note that this is a limited exam specific for the exclusion of cord compression only and does not exclude more subtle lesions such as intrinsic cord abnormalities, nerve root involvement or dural based metastases. 2.There is a lytic lesion present at T5 which extends into the surrounding tissues including the right neural foramina of T4-5 and T5-6 and the epidural space. There is encroachment of the right-sided exiting nerve roots at T5-6 as a result. There is no spinal cord compression appreciated.3.There is a lytic lesion present at T12 associated with a mild compression fracture which is been also identified in the recent lumbar spine CT. There is no associated cord compression.4.There is a lytic lesion present within the L2 vertebral body which was also identified on the recent lumbar spine CT.5.There is a left-sided long the mass present which is associated pleural-based lesion. Please refer to the recent chest CT for further comments.6.There are degenerative changes present in the cervical spine and lumbar spine without evidence of spinal cord compression or cauda equina compression.


Instruction: Generate impression based on findings.

Input: Benign neoplasm of pituitary gland [D35.2] / Benign neoplasm of craniopharyngeal duct [D35.3], Reason for Study: ^Reason: hx of pituitary adenoma s/p RT, surveillance MRI History: HA Postsurgical changes with a defect along the right sella related to prior pituitary tumor resections are again demonstrated. The pituitary stalk remains mildly deviated to the right. No abnormal enhancing lesion is identified within the pituitary. Non pneumatization of the sphenoid sinus is again noted. Mild cerebellar tonsillar ectopia appears similar to prior examination. Scattered foci of T2/FLAIR hyperintensity involving the subcortical and periventricular white matter are again seen. The visualized brain parenchyma is otherwise grossly unremarkable.

Output: Stable postoperative changes in the sella without new or enlarging lesions.


Instruction: Generate impression based on findings.

Input: 58 years Female (DOB:4/12/1958)Reason: Left arm radicular pain with history of cervical fusion in 2002 History: AbovePROVIDER/ATTENDING NAME: THOMAS J. KELLY THOMAS J. KELLY The cervical vertebral bodies are appropriate in overall alignment and height. The patient status post anterior fusion from C3 through C6. There is also osseous bridging across the C6-7 disc space. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal enhancing lesions are identified in the cervical spine.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is loss of disc space height, disc desiccation and diffuse disc bulge associated with ligamentum flavum hypertrophy. There is effacement of spinal fluid ventral and posterior the spinal cord and overall a moderate degree of spinal stenosis at this level. There is also narrowing of the neural foramina bilaterally at this level with encroachment of exiting nerve roots. There is facet hypertrophy at this level.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: The patient is status post anterior fusion from C3 through C7. There is a moderate degree of spinal stenosis present at C7-T1 associated with encroachment of exiting nerve roots within the neural foramina at C7-T1.


Instruction: Generate impression based on findings.

Input: Left sided weakness initially, followed by incontinence and LOC. Many of the images are degraded by patient motion.MRI: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are subcentimeter defects in the bilateral thalami. There is mild supratentorial and infratentorial white matter T2 hyperintensity. There is no definite abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There are secretions in the right posterior ethmoid sinus. There is a defect in the right medial orbital wall with herniation of the orbital fat and deformity of the medial rectus muscle. There is a subcentimeter right frontal scalp lipoma.MRA: There is mild stenosis of the right middle cerebral artery. The other major cerebral arteries appear to be patent. There is no evidence of cerebral aneurysms.

Output: 1. Chronic lacunar infarcts in the thalami and mild small vessel ischemic disease, but no evidence of intracranial hemorrhage, mass, or cerebral edema.2. Mild stenosis of the right middle cerebral artery.3. Chronic right medial orbital wall fracture.


Instruction: Generate impression based on findings.

Input: Patient used prophylactic antibiotics before and after the procedure as prescribed. The patient received antibiotic prophylaxis with oral Ciprofloxacin 500mg and Keflex 500 mg. The patient took 1 tablet of Ciprofloxacin 500mg the night before and morning of the procedure. The patient also took 2 tablets of Keflex 500 mg the morning of the procedure. After the procedures, the patient will take 2 tablets of Ciprofloxacin 500mg and 2 tablets of Keflex 500 mg.Following the discussion of the risks, benefits, and alternatives of the procedure, informed consent was obtained.  Dynatrim was used to localize the left mid gland peripheral zone of the prostate at the site of the T2 hypointense lesion. Using the Dynatrim guidance system an 18-gauge MR- compatible needle was inserted into the left side of the prostate. Upon confirmation of the tip of the needles close to the suspected lesion, MR guided biopsy using an 18 gauge biopsy needle was performed and 3 cores were obtained.The cores were hand delivered to the pathology lab.The patient tolerated the procedure well and was discharged without any immediate complications.ESTIMATED BLOOD LOSS: Less than 5 cc.

Output: Successful core-biopsies of the left mid gland peripheral zone.


Instruction: Generate impression based on findings.

Input: Female 85 years old with inflammation and severe pain in low back and left hip, evaluate for osteoarthritis Please note that the patient aborted the study before all pre-contrast sequences could be completed. No post-contrast sequences were performed.BONE MARROW: Bandlike signal abnormalities within the left sacral wing adjacent to the SI joint noted. There is similar but less extensive signal abnormality in the left superior iliac wing adjacent to the SI joint. There is also edema within the body and the superior ramus of the left pubic bone with edema in the adjacent adductor musculature of the hip. Based on location and morphology of these foci of signal abnormalities, we suspect they represent fractures, perhaps insufficiency fractures if there is no history of trauma. The bone marrow signal intensity is otherwise within normal limits.JOINTS: Trace fluid in in the left hip without frank effusion. There is a small amount of fluid in the right hip joint likely within normal limits.SOFT TISSUES: Other than the aforementioned edema of the left hip from a suspected stress fracture, the remaining visualized musculature is normal for age. ADDITIONAL

Output: Limited study showing edema within the sacral ala bilaterally as well as the right pubic bone. Given the location and morphology of edema we suspect these represent fractures, perhaps stress fractures if there is no history of trauma.


Instruction: Generate impression based on findings.

Input: 60-year-old female with past medical history of Crohn's status post colectomy with elevated bilirubin ABDOMEN:LIVER, BILIARY TRACT: Trace perihepatic fluid. The gallbladder is absent. No intrahepatic ductal dilation. The proximal common bile duct is difficult to visualize although the distal CBD is normal in caliber.SPLEEN: No significant abnormality noted.PANCREAS: The pancreatic duct is normal in caliber.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: 7 mm T2 hyperintense cyst in the right kidney. The right kidney is ptotic. No hydronephrosis or perinephric inflammation.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Status post colectomy. Ileus type bowel pattern. Small amount pelvic ascites is present.BONES, SOFT TISSUES: There is edema type signal in the subcutaneous tissue along the back.OTHER: Foley catheter is present.

Output: 1.Limited examination due to the lack of IV contrast. The proximal common bile duct is difficult to visualize although the distal CBD appears normal in caliber. No intrahepatic ductal dilation. 2.The gallbladder is absent.3.Small volume abdominopelvic ascites and ileus type pattern.


Instruction: Generate impression based on findings.

Input: Migraine, left sided numbness, and blurriness of vision. There is a punctate focus of high T2 signal and perhaps mild restricted diffusion in the medial right occipital lobe. There is no evidence of intracranial hemorrhage or acute infarct. There is a 20 mm wide arachnoid cyst in the middle cranial fossa with flattening of the anterior left temporal lobe. 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, mastoid air cells, and scalp soft tissues are grossly unremarkable. There is minimal mucosal thickening in a posterior left ethmoid air cell.

Output: 1. A punctate focus of high T2 signal and perhaps mild restricted diffusion in the medial right occipital lobe may represent a recent "migrainous stroke" or embolic infarct or perhaps an atypical focus of demyelinating disease or incipient neoplasm, for example. Follow up via a brain MRI with contrast may be useful.2. Left middle cranial fossa arachnoid cyst.


Instruction: Generate impression based on findings.

Input: Female, 51 years old. Pain MENISCI: The medial and lateral menisci are intact, without evidence of tear.ARTICULAR CARTILAGE AND BONE: There is a bone contusion along the posterior aspect of the medial femoral condyle. There is diffuse patellar chondral thinning, without focal defects.LIGAMENTS: The cruciate and collateral ligaments are unremarkable. EXTENSOR MECHANISM: Mild edema within the suprapatellar fat pad is nonspecific. The quadriceps and patellar tendons are unremarkable.ADDITIONAL

Output: 1.Bone contusion along the posterior aspect of the medial femoral condyle. 2.Diffuse patellar chondral thinning, without focal cartilage defects.


Instruction: Generate impression based on findings.

Input: 56 years Female (DOB:12/25/1959)Reason: please assess for atrophy History: MoCA score is 16, psychosisPROVIDER/ATTENDING NAME: KAMALA GULLAPALLI COTTS The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild to moderate degree of centrum semiovale, periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.On susceptibility weighted imaging there are punctate foci of signal loss present within the pons and left thalamus.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 demonstrate mild 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 lesions of a mild to moderate degree are nonspecific. They are most likely vascular related. Please note that this degree of periventricular white matter lesion accumulation is more than expected at this age.2.Several microhemorrhages are noted in the brainstem and left thalamus. There are location suggests that these could be related to hypertension but they are nonspecific3.The degree of brain atrophy is commensurate with the patient's stated age.


Instruction: Generate impression based on findings.

Input: 73 year old female with a left ear infection and pain with left face weakness, dysarthria, and stuttering. Evaluate the left ear and facial nerve for infection or mass. MRI Brain:Several sequences, including the axial thin section T2 and post-contrast sequences, are severely limited by motion. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mild-to-moderate periventricular and subcortical white matter T2/FLAIR hyperintensity, which is nonspecific but likely related to chronic small vessel ischemic disease. 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.MRI IACs:Redemonstrated is left sided middle ear and mastoid air cell opacification. The bony erosion of the left lateral mastoid air cells is better appreciated on the recent head CT. There is extensive soft tissue edema and enhancement involving the left external auditory canal, peri-auricular soft tissues and extending inferiorly within the infratemporal space below the provided images. There is restricted diffusion involving this region as well. There is no loculated fluid or evidence of a drainable abscess. The left external auditory canal is narrowed from the edema compared to the right side but remains patent. No abnormal mass or abnormal enhancement is seen within the cerebellopontine angle, cisterns bilaterally or within the internal auditory canals.

Output: Significant left sided otomastoiditis with extensive soft tissue edema and enhancement involving the external auditory canal, peri-auricular soft tissues and extending inferiorly along the infra-temporal soft tissues. At this point, there is no evidence of intracranial extension and no evidence of a drainable abscess.


Instruction: Generate impression based on findings.

Input: Right upper quadrant fullness, known PBC, evaluate for change in mass, known hemangioma ABDOMEN:LIVER, BILIARY TRACT: Stable hepatic segment 6 T2 hyperintense focus demonstrating progressive enhancement, consistent with a hemangioma, measures 1 x 0.9 cm, image 17 series 3.Anteriorly located 0.9 x 0.5 cm subcapsular focus, T2 hyperintense with retention of contrast seen on delayed sequences, likely a hemangioma, image 7 series 3 and image 19 series 11. Additional subcentimeter focus previously seen more superiorly at level of hepatic dome not well visualized on current exam.Another T2 hyperintense focus measuring up to 4 mm and located in hepatic segment 8/7 on image 23 series 11 demonstrates no definite enhancement and is most likely a punctate cyst. Additional punctate cyst formation also seen.No biliary duct dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Right-sided juxtaphrenic lymph nodes, stable to mildly decreased in size. Reference right anterior cardiophrenic lymph node measuring 1.6 x 1.1 cm, image 9 series 3, previously measured 1.9 x 1.1 cm. Right paracardiac lymph node near hepatic dome and measures 1.2 x 0.7 cm, image 5 series 3, previously measured 1.2 x 0.8 cm. Stable prominent gastrohepatic, periportal and retroperitoneal lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Stable scattered cysts and hemangiomas.Unchanged lymphadenopathy.


Instruction: Generate impression based on findings.

Input: Reason: h/o lung ca, r/o mets History: none The CSF spaces are appropriate for the patient's stated age with no midline shift. There are subtle subtle T1 signal hyperintense small lesions located in the right thalamus, left putamen, left caudate nucleus, right posterior insular cortex and two at the right precentral gyrus (one at the hand motor area and another leg area). These are not associated with contrast enhancement. These were not clearly identified on the prior exam.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. There are additional T2 and flair signal hyperintensities within the pons - left more than right - and right thalamus which are not readily identified on the prior exam.Punctate foci of low signal on susceptibility-weighted imaging are present in the globus pallidi. Another one is present in the left hippocampus. These are stable and likely of little clinical relevance.Cortical T1 and FLAIR signal hyperintensities identifiable on the prior exam along the fusiform gyri just above the petrous bones are not identified on the current exam. They are located in an area where artifact may occur depending on the image acquisition. Please refer to comments from the prior report as these may be artifactual. The significance is thus uncertain.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells demonstrate minor opacities in the right mastoid air cells. The visualized portions of the orbits are intact. The eyeball lenses are thin.

Output: 1.There is small lesions present in the right thalamus, left putamen, left caudate nucleus, right posterior insular cortex and two at the right precentral gyrus which are not identified on the prior exam. These are not typical for metastases, though it is conceivable in the appropriate clinical setting that they are related to partially treated metastases or atypical non-enhancing metastases. The possibility that these are benign cannot be excluded.2.Small lesions in the left pons and right thalamus are also new. These may be vascular related.3.Periventricular and subcortical white matter changes of a mild degree are nonspecific but stable. At this age they are most likely vascular related. 4.Cortical T1 and FLAIR signal hyperintensities identifiable on the prior exam along the fusiform gyri just above the petrous bones are not identified on the current exam. They are located in an area where artifact may occur depending on the image acquisition. Please refer to comments from the prior report as these may be artifactual. The significance is thus uncertain.


Instruction: Generate impression based on findings.

Input: Brain tumor. Status post resection. Evaluate extent of resection. The dural based, parasagittal right parietal mass has been near completely resected. There is small residual contrast enhancing tissue within the involved posterior segment of the superior sagittal sinus. There is also minimal, nodular contrast enhancing tissue is questioned in the adjacent dura over the right parietal convexity laterally and along the falx posteriorly. A small filling defect has developed in the superior sagittal sinus just anterior to the invaded segment and likely represents a small thrombus. Heterogeneous T1 shortening in the surgical bed reflects the blood products. Mild diffusion restriction along the resection cavity margin is consistent with cytotoxic edema with additional areas corresponding to blood products. The T2 hyperintensity surrounding the treatment surgical bed (vasogenic edema) has not significantly changed compared to the preoperative examination. The associated mass effect is stable or minimally improved with mild midline shift and mass effect on the right lateral ventricle but no uncal herniation.An extra-axial collection underlying the craniotomy flap has a maximum thickness of 11 mm (on sagittal images) causes mild mass effect on the underlying right perirolandic area. A small, thin right frontal subdural collection has a maximum thickness of 4 mm (on axial images) and causes no significant mass effect.The mastoid air cells and the paranasal sinuses are clear. The orbits are normal.

Output: Expected postsurgical changes of right parietal parasagittal meningioma resection. There has been near total tumor resection with small residual enhancement within the invaded posterior superior sagittal sinus compatible with residual tumor. Minimal nodularity along the right parietal convexity dura and along the posterior falx may represent minimal residual tumor as well and can be assessed on follow-up studies.


Instruction: Generate impression based on findings.

Input: Male 24 years old; Reason: injury History: pain, and decrease ROM LIGAMENTS: There is abnormal morphology and signal of the anterior bundle of the ulnar collateral ligament suggestive of a high-grade partial-thickness tear, if not a full thickness tear. Edema is seen in the adjacent soft tissues. The lateral collateral ligament appears intact.TENDONS: Mild edema is seen at the myotendinous junction of the flexor digitorum superficialis, suggestive of strain. The biceps, brachialis, and triceps tendons appear normal.ARTICULAR SURFACES AND BONE: No significant abnormality noted. No osteochondral defect is seen.ADDITIONAL

Output: 1. Findings suggestive of a tear of the anterior bundle of the ulnar collateral ligament.2. Strain of the flexor digitorum superficialis.3. Slight prominence of the radiohumeral plica, which can be seen in patients with synovial fringe syndrome, though is of questionable clinical significance in this patient.


Instruction: Generate impression based on findings.

Input: Right parotid mass. There is a well-defined, bosselated, T2 hyperintense, heterogeneously enhancing mass in the superficial portion of the right parotid gland that measures 19 AP x 14 RL x 31 SI mm. The mass appears to be situated inferior to the main trunk of the right intraparotid facial nerve. The other major salivary glands are unremarkable. There is no evidence of significant lymphadenopathy in the neck. There are left thyroid nodules that measure up to 12 mm. The osseous structures are unremarkable. The imaged intracranial structures are unremarkable.

Output: 1. A right parotid gland tumor that measures up to 31 mm likely represents a pleomorphic adenoma.2. Nonspecific left thyroid nodules measuring up to 12 mm. Follow up via thyroid ultrasound may be useful.


Instruction: Generate impression based on findings.

Input: knee pain MENISCI: There is a bucket-handle type tear of the medial meniscus with the fragment displaced anteriorly towards the anterior horn of the meniscus. There is no evidence of lateral meniscal tear.ARTICULAR CARTILAGE AND BONE: No significant abnormality noted.LIGAMENTS: There are surgical changes of ACL reconstruction. The ACL graft is intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Bucket-handle type tear of the medial meniscus with anterior displacement of the meniscal fragment. There is no evidence of a lateral meniscus tear.2. Intact ACL graft.


Instruction: Generate impression based on findings.

Input: Female 85 years old Reason: evaluate for malignancy History: Eval abdomen and abnormal bladder wall thickening unintentional wt loss LIVER: 11.7 cm in length.Two septated cysts seen: 2.8 x 2.3 x 2.8 cm. The second measures 1.8 x 1.6 x 2.1 cm. These correspond to lesions seen on the MRI.Hemangioma along the posterior cortex of the liver is seen measuring 2.1 x 1.6 cm. Other smaller hemangioma seen on the MR is not visualized by ultrasound.Prominent diaphragmatic slips noted,should not be confused focal lesions. Flow in the portal vein is patent with a peak velocity .2 m/sec.GALLBLADDER, BILIARY TRACT: No evidence of gallstones. No intra-or extrahepatic biliary dilatation. Common bile duct .4 cm neither.PANCREAS: Small peripancreatic focal lesion 1.9 x 1.4 x 0.8 may represent a lymph node.RIGHT KIDNEY: 10.8 cm in length. Simple cysts. Upper pole cyst 2.6 x 2.2 x 2.2 cm.Large lower pole cyst 6.7 x 7.2 x 5.5 cm. No hydronephrosis.OTHER: Left kidney measures 10.4 cm in length. Left renal cyst 5.6 x 6.9 x 5.9 cm.No hydronephrosisSpleen 6.4 cm in length.

Output: Hepatic cysts. Renal cysts. Peripancreatic lymph node.


Instruction: Generate impression based on findings.

Input: 35-year-old male experiencing headache, history of AML status post stem cell transplant, recently hit in the face. There is no evidence of intracranial hemorrhage, mass, or acute infarct. Redemonstrated is encephalomalacia in the right occipital lobe with predominantly gyriform areas of susceptibility effect, and ex vacuo dilatation of the right occipital horn. Also redemonstrated is mild encephalomalacia in the left occipital lobe. There are also a few scattered foci of susceptibility effect within the cerebral hemispheres and left cerebellar hemisphere, which are nonspecific, but may represent chronic microhemorrhages. There is no evidence of abnormal intracranial enhancement or acute infarction. There is no midline shift or herniation. The orbits, skull, and scalp soft tissues are unremarkable.

Output: Stable bilateral occipital lobe encephalomalacia, right greater than left, but no evidence of intracranial mass or leptomeningeal disease.


Instruction: Generate impression based on findings.

Input: Status post orthotopic liver transplant. Evaluate for HCC. ABDOMEN:LIVER, BILIARY TRACT: Postsurgical changes from orthotopic liver transplant. The gallbladder has been surgically removed.No suspicious liver lesion. There is mild biliary ductal wall thickening and enhancement with mild central ductal dilatation without a focal lesion. The hepaticojejunostomy appears patent.The portal and hepatic veins are patent. Susceptibility artifact at the hepatic hilum limits evaluation of the hepatic artery.SPLEEN: Multiple punctate splenic siderotic nodules. The spleen is normal in size.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Simple appearing renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Postsurgical changes of the anterior abdominal wall.OTHER: No significant abnormality noted.

Output: No suspicious liver lesion.There is mild biliary ductal wall thickening and enhancement with mild central ductal dilatation without a focal lesion. The hepaticojejunostomy appears patent.


Instruction: Generate impression based on findings.

Input: A 38 year old female with hypertension and hyperlipidemia. Hospitalized now with a clinical diagnosis of myo-pericarditis. Referred to cardiac MRI for further evaluation. Left VentricleThe left ventricle is normal size with overall normal systolic function. There is mild hypokinesia and the basal to mid inferolateral wall. The overall LV ejection fraction is 59%, the LV end diastolic volume index is 76 ml/m2 (normal range: 65+/-11), the LVEDV is 122 ml (normal range 109+/-23), the LV end systolic volume index is 31 ml/m2 (normal range 18+/-5), the LVESV is 51 ml (normal range 31+/-10), the LV mass index is 43 g/m2 (normal range 67+/-11), and the LV mass is 69 g (normal range 114+/-24). There is late gadolinium enhancement in the subendocardium and mid myocardium of the infralateral wall at the basal and mid segments. This corresponds to the area of mild wall motion abnormality. While this can be seen with myocardial infarct, based on the clinical history, the finding is most suggestive of myocarditis. No thrombus is present.Left AtriumThe left atrium is normal size. Right VentricleThe right ventricle is normal size and normal systolic function. The overall RV ejection fraction is 50%, the RV end diastolic volume index is 78 ml/m2 (normal range 69+/-14), the RVEDV is 126 ml (normal range 110+/-24), the RV end systolic volume index is 39 ml/m2 (normal range 22+/-8), and the RVESV is 63 ml (normal range 35+/-13). Right AtriumThe right atrium is normal size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no pericardial enhancement or effusion.

Output: 1. The left ventricle is normal size with normal systolic function, the LVEF is 59%. There is mild hypokinesia at the area of enhancementdemonstrated by the infero-lateral wall base to midchamber. Given the clinical history, this is suggestive of myocarditis. No associated pericardial effusion or enhancement.2. The right ventricle is normal size and normal systolic function, the RVEF is 50%. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Reason: 59M with gleason 6 PrCa on active surveillance History: as above. PELVIS:PROSTATE:Prostate Size: 2.8 x 4.8 x 4 cm.Peripheral Zone: In the left posterior mid/base peripheral zone there is a 0.7 x 0.9 x 0.8 cm tumor (series 501 image 80, series 601 image 21). Central Gland: Heterogeneous with probable hyperplastic nodules. Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Findings suspicious for subcentimeter tumor in the left posterior mid/base peripheral zone.


Instruction: Generate impression based on findings.

Input: Numerous FLAIR hyperintense foci are seen in the subcortical and periventricular white matter. Similar foci are seen in the centrum semiovale bilaterally, in the midbrain, pons and medulla. These foci are nonspecific but likely relate to chronic ischemic microvascular disease.Apparent punctate enhancement is suggested in the right aspect of the medulla (1501/32) and in the right aspect of the pons with no definite enhancement on the earlier obtained fat saturation post-contrast images. There is no corresponding abnormalities on T2 images, and therefore these are felt to be artifactual.Ventricular size is normal with no evidence of midline shift. No acute hemorrhage or edema. There are no diffusion abnormalities.There is a prominent area of intrinsic T1 hyperintensity in the suprasellar region posteriorly without significant superimposed enhancement and without drop out of signal on fat saturated images, consistent with an incidental ectopic posterior pituitary gland.There is leftward deviation of the nasal septum. There are mucous retention cysts in the posterior nasopharyngeal soft tissue. Scattered mucosal thickening is seen in the paranasal sinuses.

Output: 1. No definite evidence of metastatic brain disease. 2. Incidental ectopic posterior pituitary.3. Moderate chronic small vessel ischemic changes.


Instruction: Generate impression based on findings.

Input: Female, 63 years old, history of brain lesion, planning for resection. A rim-enhancing lesion centered in the right frontal corona radiata has increased in size compared to the prior examination, now measuring 45 x 41 mm, previously no more than 31 x 23 mm. The degree of surrounding parenchymal T2 signal abnormality and local mass effect is also increased.A second rim-enhancing lesion centered on the right paracentral lobule has also increased in size now measuring 28 x 19 mm, previously 14 x 11 mm.As above, there is some increase in local and regional mass effect related to these lesions with more sulcal effacement and a greater degree of midline shift to the left now up to 7 mm. The right lateral ventricle is minimally effaced if at all.No new enhancing lesions are seen. Sequela of prior right parietal vertex craniotomy are again seen.

Output: Interval growth of both rim-enhancing right cerebral masses.


Instruction: Generate impression based on findings.

Input: A patient submitted outside study for review. Submitted for review are 2 view mammograms of the bilateral breasts, 2 spot compression views of the right breast, and right grayscale ultrasonographic images dated 7/14/2016 and bilateral breast MRI dated 8/9/2016 performed at Saint Alexius Medical Center. Mammogram 7/14/16:Focal lobulated asymmetry is visualized within the retroareolar region of the right breast measuring approximately 5.2 x 4.9 cm extending towards the nipple that persists on spot compression views. No significant associated calcification is visualized. This asymmetry likely corresponds to patient's area of palpable abnormality.Ultrasound 7/14/16:Targeted grayscale ultrasound of the right breast at 12:00 about 3 cm from the nipple demonstrates a largely hypoechoic heterogeneous appearing lesion without significant posterior shadowing measuring 3.4 x 2.1 cm. Further, questionable satellite lesions are also visualized. No color images were obtained, as such vascularity was not assessed.In the interim between Ultrasound and Breast MRI FNA was performed for lack of correlate ultrasound findings when compared to the mammogram.Breast MRI 8/9/2016:There is abnormal non-mass contrast enhancement with many lateral and inferior satellite lesions within the central and superior right breast that reaches anteriorly to the nipple. The total extent of the pathologic enhancement measures 6.0 cm in the medial to lateral dimension, 7.7 cm in the AP dimension, and 5.5 cm in the superior to inferior dimension. Further, two axillary lymph nodes are pathologically enlarged, the largest of which measures 18 x 9 mm.

Output: Abnormal non-mass enhancement on breast MRI dated 8/9/2016 as specifically outlined above (more disease seen on MRI than mammogram) dated 7/14/2016 and is compatible with malignancy. Further, two pathologically enlarged right axillary lymph nodes are visualized. Ultrasound of the right axilla can be performed.Kindly submit the pathology report of the right breast biopsy. BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Male, 44 years old, history of metastatic melanoma status post two cycles of Temodar. Assess response to therapy. Numerous enhancing parenchymal lesions are again seen, most of which have substantially decreased in size compared to the prior examination. Some of the larger lesions also show reduced edema. For example, a lesion along the left posterior insula now measures 6 x 3 mm, previously 10 x 7 mm. Likewise, a lesion along the right superior temporal sulcus measures 4 x 4 mm, previously 9 x 6 mm.A few lesions have not significantly changed in size but these represent the minority. No definite growing or new lesions are seen. As before, some of the lesions demonstrate hemosiderin staining compatible with blood product, particularly one along the left precentral gyrus, while others show intrinsic T1 hyperintensity which may reflect either blood product or melanin.No acute intracranial hemorrhage is suspected. No abnormal extra axial fluid collections are detected. The ventricles are stable and normal in size.

Output: Interval response to treatment with a majority of the previously seen enhancing lesions showing a substantial reduction in size.


Instruction: Generate impression based on findings.

Input: Male, 74 years old. Pain, swelling TENDONS: The Achilles tendon is thickened with areas of internal abnormal signal, compatible with mild to moderate tendinopathy. A 6-7 mm cystic structure is noted within the tendon posteriorly approximately 2 cm from its insertion. A focus of fluid signal along the middle third of the Achilles tendon insertion on the calcaneus indicates a partial tear. There is moderate edema in the soft tissues surrounding the Achilles tendon. The other visualized tendons of the ankle had normal appearance.LIGAMENTS: The ligaments of the ankle are intact.ARTICULAR SURFACES AND BONE: There is marked bone marrow edema of the calcaneus centered on the Achilles tendon insertion, likely related to the tendon injury as described above. No discrete fracture line is identified. There is a small osteochondral defect at the medial talar dome. Additional degenerative changes are noted particularly involving the cuneiform-metatarsal articulations. There is a small tibiotalar joint effusion.ADDITIONAL

Output: 1.Partial tear of the Achilles tendon insertion is likely subacute in nature on a background of mild to moderate tendinopathy. Bone marrow edema in the calcaneus is likely secondary to the Achilles tendon insertion injury.2.Medial talar dome osteochondral defect and additional degenerative changes throughout the forefoot and midfoot.


Instruction: Generate impression based on findings.

Input: Nontraumatic intracranial hemorrhage, unspecified, evaluate for microbleeds. The exam is degraded by patient motion. Within this limitation, there is an unchanged hematoma in the right thalamus with intrinsic T1 signal and surrounding T2 hyperintensity, measuring up to approximately 20 mm. There is no evidence of acute infarct. There is unchanged extensive T2 hyperintensity involving the bilateral cerebral white matter, bilateral basal ganglia, thalami, and brainstem. The ventricles and basal cisterns are unchanged. There is no midline shift or herniation. The major cerebral flow voids are intact. There is a right lens implant. The skull, paranasal sinuses, and scalp soft tissues are unchanged.

Output: 1. Unchanged small subacute right thalamic hematoma.2. No evidence of acute ischemic cerebral infarction.3. Extensive white matter abnormality may represent chronic small vessel ischemic disease.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 65-year-old female with altered mental status. Evaluate for CVA. Patient is status post right parietal craniotomy with region of encephalomalacia seen in the right precentral gyrus, involving the right centrum semi-ovale as well. Patchy hypoattenuation areas are also seen in bilateral corona radiata. These findings appear relatively unchanged on comparison to previous MRI from 2006. There is no evidence of acute intracranial hemorrhage, mass or edema. Hyperdense lesion seen in the medial right temporal lobe (series 4, image 9) also appears similar to prior studies. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Postsurgical changes appearing similar to prior MRI from 2006. Please note that lack of IV contrast limits evaluation for tumor, and CT is insensitive to early detection of CVA. Consider contrast-enhanced CT or MRI to evaluate for tumor recurrence or stroke if clinically needed.


Instruction: Generate impression based on findings.

Input: External impingement right shoulder ROTATOR CUFF: The supraspinatus and infraspinatus tendons are intact. There is a small articular sided partial tear of the subscapularis.SUPRASPINATUS OUTLET: Mild degenerative changes are seen at the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: Note is made of degenerative subchondral cysts in the humeral head.BICEPS TENDON: No significant abnormality noted.

Output: Small articular sided partial tear of the subscapularis tendon.


Instruction: Generate impression based on findings.

Input: Reason: r/o lose body fragment History: pain and locking of knee MENISCI: There is a oblique tear of the posterior horn of the medial meniscus which extends to the free edge of the meniscus as well as the tibial and femoral articular surface. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: No full-thickness or near full-thickness articular cartilage defects are identifiedLIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Oblique tear of the posterior horn of the medial meniscus.2. Edema within the quadriceps fat pad is nonspecific but can be seen in fat pad impingement syndrome.


Instruction: Generate impression based on findings.

Input: 64-year-old woman with history of HCC status post TACE/RFA in April 2015. ABDOMEN:LIVER, BILIARY TRACT: Ablation cavity in segment 5 (1011/172) appears similar to the prior examinations without evidence of arterial enhancing lesion. The liver is cirrhotic in morphology.No intra or extrahepatic biliary ductal dilatation. The patient is status post cholecystectomy.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Bilateral breast prostheses noted. Mild degenerative changes in the lumbar spine noted.OTHER: No significant abnormality noted.

Output: Segment five ablation zone without evidence of local recurrent or new disease.


Instruction: Generate impression based on findings.

Input: 26-year-old male with recurrent dislocation of the patella. Evaluate for loose ligaments of the patella or internal derangement. MENISCI: There is linear signal abnormality which extends to the femoral articular surface within the posterior horn of the lateral meniscus which may reflect a small vertical tear. The anterior horn appears intact. There is linear increased signal abnormality within the blunted posterior horn of the medial meniscus which extends to the femoral articular surface consistent with a complex tear. The anterior horn appears intact.ARTICULAR CARTILAGE AND BONE: Note is made of full-thickness articular cartilage defects along the lateral aspect of the weightbearing portion of the medial femoral condyle. There are also full-thickness articular cartilage defects along the weightbearing surface of the lateral femoral condyle above the anterior horn of the meniscus with underlying subchondral signal abnormality. There is a suggestion of mild dysplasia of the medial facet of the femoral trochlea.LIGAMENTS: There is complete rupture of the ACL. There is a curvilinear focus of low signal intensity along the anterior aspect of the expected location of the ACL which may represent ligamentous fragments. The PCL appears intact. The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact. The Insall-Salvati ratio measures 1.5 consistent with patella alta. The medial retinaculum appears intact. ADDITIONAL

Output: 1. Complete rupture of the ACL.2. Tearing of the medial and lateral meniscus.3. Findings consistent with patellofemoral instability with a probable loose body within the joint space.4. Full-thickness articular cartilage defects as described above.


Instruction: Generate impression based on findings.

Input: Osteomyelitis of the pubic symphysis. Evaluate for pelvic abscess. Extensive pelvic wall edema. Dependent body wall edema. Extensive edema signal of the adductor musculature bilaterally. Osteomyelitis affects the body of the pubic symphysis with extensive reactive osteitis extending along the pubic rami and inferiorly. There is air in the pubic symphysis and extending just superior to the pubic symphysis. This communicates with the fluid collection in the medial proximal aspect of the right thigh, better characterized on the dedicated MRI of the femur. There is extensive adjacent inflammatory/phlegmonous soft tissue changes about the pubic symphysis. The bladder is presumably collapsed and is not well seen. Involvement with the bladder cannot be excluded.No loculated drainable fluid collection is evident within the pelvis. Bilateral hip prostheses.

Output: No loculated drainable fluid collection is evident in the pelvis. See the dedicated MRI of the femur report. Acute on chronic pubic symphysis osteomyelitis and inflammatory/phlegmonous soft tissue changes about the pubic symphysis, involvement with a collapsed non-visualized bladder cannot be excluded.


Instruction: Generate impression based on findings.

Input: Multiple sclerosis with head and fatigue. There are several cerebral white matter lesions. A lesion in the left frontal centrum semiovale has slightly increased in size, although the associated enhancement has essential resolved. On the other hand, an anterior right frontal lobe lesion has decreased in size. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable.

Output: Multiple demyelinating lesions related to multiple myeloma, including decrease in size of a right anterior frontal lobe and slight increase in size of a left frontal centrum semiovale lesion.


Instruction: Generate impression based on findings.

Input: 38-year-old male with tenderness, fever. Evaluate for epidural abscess. Alignment and bone density are within normal limits. Vertebral body heights and disk spaces are maintained. Hypertrophy of the facet joints at L3-4, L4-5, and L5-S1. The dorsal epidural fat pads are intact. There is no definite dural thickening along the ventral aspect of the spinal canal. No evidence of effacement on the thecal sac to suggest an epidural process. The paraspinous muscles are normal. No evidence of central spinal stenosis or neuroforaminal compromise at any level.

Output: Limited study in evaluating for an epidural abscess. However, within the limitations, there are no findings to suggest an epidural process. No other specific findings on this study to explain the patient's symptoms.


Instruction: Generate impression based on findings.

Input: 57 years, Female, Reason: H/o HCV; CT scan on admit showing 1.6 cm indeterminate lesion; stable from previous imaging in 11/2014; evaluate for HCC versus other etiology History: as above. ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: 1.6-cm lesion in the left hepatic lobe is hyperintense on T2 weighted images with concentric enhancement which fills in on delayed phases. No washout.SPLEEN: Small splenule's. Subcentimeter splenic lesion which is hyperintense on T2, likely a lymphangioma.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right upper pole renal 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.Enhancing left hepatic lobe lesion. There is a lack of nodular enhancement and an atypical hemangioma is considered most likely. 12-month follow-up is recommended.


Instruction: Generate impression based on findings.

Input: Knee pain. Malignant neoplasm of the breast. Due to the patient's body habitus, the high-resolution knee coil could not be used. An alternative coil was used instead which results in slightly suboptimal image quality.MENISCI: The menisci appear normal.ARTICULAR CARTILAGE AND BONE: There is perhaps mild superficial degeneration of the articular cartilage along the lateral facet of the patella, but otherwise the articular cartilage appears normal for age. There is a 4 mm rounded focus of low signal intensity within the distal femoral metaphysis surrounded by a thin irregular rim of high signal intensity on the fat-suppressed T2-weighted images. This corresponds to a small sclerotic focus on recent radiographs. It is nonspecific. Bone marrow signal intensity otherwise is unremarkable.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact. There is mild signal heterogeneity of the quadriceps fat pad which is of questionable clinical significance.

Output: 1.Minimal degeneration of the articular cartilage of the patella.2.Small focus of low signal intensity within the distal femoral metaphysis is nonspecific. While I suspect that it is benign in etiology, given the patient's history of breast cancer, follow-up radiographs are recommended to assess for interval change in size.3.Mild signal heterogeneity of the quadriceps fat pad may reflect chronic inflammation but is of questionable current clinical significance.


Instruction: Generate impression based on findings.

Input: Female 79 years old with abdominal pain. A 1.5 cm cystic lesion in the uncinate process of the pancreas was seen on EUS done in August of 2016. Patient was also noted to have multiple other cystic type lesions. Please evaluate for interval changes. Additional history from the electronic medical record indicates a right nephrectomy for renal cell carcinoma. ABDOMEN:LIVER, BILIARY TRACT: There are multiple T1 isointense to muscle, T2 bright, enhancing lesions within the right lobe of the liver. Corresponding restricted diffusion suggested. The largest lesion is in segment 6 and measures 1 x 1 cm (series 4, image 24). The hepatic vasculature is patent. There is no ascites.SPLEEN: No significant abnormality noted.PANCREAS: A 2.2 x 1.0 cm cystic, ovoid lesion in the uncinate process is favored to represent a side branch IPMN (series 4, image 14). An additional subcentimeter cystic lesion at the pancreatic head/uncinate process junction is likely an additional sidebranch PMN. No definite associated wall thickening or enhancement seen.There are multiple additional solid, avidly enhancing lesions along involving the length of the pancreas, i.e., the head, body and tail, at least one lesion shows central necrosis. The largest measures 3.5 x 3.4 cm (series 11, image 37) and insinuates between the pancreatic tail and stomach (versus a separate metastatic deposit separate from pancreas).ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: The right kidney is surgically absent. There is a subcentimeter T1 bright lesion within the left kidney which most likely represents a proteinaceous or hemorrhagic cyst, evaluation suboptimal due to small size and lesion is not well delineated on postcontrast sequences. Additional small foci within the left kidney are too small to reliably evaluate.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. Solid enhancing lesions along the length of the pancreas are most suspicious for metastatic renal cell carcinoma given multiplicity and the patient's remote history of RCC. 2. Neuroendocrine tumor another differential consideration.3. Findings concerning for hepatic metastatic disease.4. Probable sidebranch IPMNs in uncinate process.5. Please refer to details above.


Instruction: Generate impression based on findings.

Input: The exam is markedly degraded by dental brace artifact. The ventricles and sulci are normal in size. There are no masses, mass effect or midline shift. There is no evidence for intracranial hemorrhage or acute infarction in the areas that are not degraded by artifact. The paranasal sinuses and mastoid air cells are grossly unremarkable, within the limitations of artifact.

Output: The exam is markedly degraded by dental brace artifact, but there is no gross intracranial mass. 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; 75 years old. Reason: eval PSC for dominant stricture, eval for HCC, f/u pancreatic cyst History: cirrhosis, PSC, pancreatic cyst ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic morphology of the liver again seen. No focal, enhancing hepatic lesions. Portal venous system is patent. Gallbladder sludge and/or small stones.Stable appearance of the biliary tree with stable mild narrowing of the common hepatic duct and proximal common bile duct. No dominant biliary stricture.SPLEEN: Splenomegaly, similar to prior study.PANCREAS: Limited examination of the pancreas on M.R.C.P. images due to ascites. Within this limitation, uncinate process cystic lesion, likely due to side branch IPMN, appears grossly stable measuring up to 1.1 x 1.5 cm on coronal image 20, series 7.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: New moderate upper abdominal retroperitoneal lymphadenopathy. For future reference, the largest lymph node measures 3.9 x 1.5 cm (series 3/16).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.New moderate retroperitoneal lymphadenopathy.2.No focal, enhancing hepatic lesions.3.Stable appearance of the biliary tree, likely secondary to sclerosing cholangitis, with no new dominant stricture evident.4.No gross change in multiseptated uncinate pancreatic IPMN.


Instruction: Generate impression based on findings.

Input: History of urothelial cancer with new onset pain to scrotum, pain worsening, please evaluate PELVIS:PROSTATE/SEMINAL VESICLES: Prostatomegaly, evidence of BPH, gland measures up to 6.1 cm (please note that prostate is suboptimally assessed on this nondedicated study).BLADDER: No significant abnormality noted.LYMPH NODES: Pelvic lymphadenopathy. Enlarged right iliac chain lymph node measuring 2.7 x 1.5 cm on image 57 series 801, seen on prior CT imaging as well, please note that comparative measurements difficult due to differences in technique and modality. Additional prominent lymph nodes also seen (see key images) including more superiorly located enlarged right pelvic lymph node located just anterior to sacrum on image 61 series 801, measuring 1.6 x 1.5 cm and in retrospect also present on earlier CT imaging. BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Partially imaged right-sided nephroureteral stent, seen curled just beyond the level of the UVJ, mild focal wall thickening seen in this region and mild ureteral wall thickening also seen.

Output: Pelvic lymphadenopathy as above.


Instruction: Generate impression based on findings.

Input: Male, 41 days old, ex 28 weeker with history of presumed meningitis, now with poor head growth. Hemosiderin staining is evident along the germinal matrices bilaterally. Hemosiderin staining is also evident within the occipital horn of the left lateral ventricle. A small focus of susceptibility effect is demonstrated in the left cerebellar hemisphere.The corpus callosum is fully formed and intact. The pituitary region is within normal limits. The brainstem, cerebellar vermis and cerebellar hemispheres are normally formed and unremarkable.No restricted diffusion is seen. The ventricular margins are smooth and symmetric. Ventricular size is within normal limits. No areas of parenchymal signal abnormality, edema or mass effect are observed.  The degree of cerebral gyration is appropriate for the corrected gestational age. White matter myelination is slightly delayed for the corrected gestational age.

Output: 1.Sequelae of mild bilateral germinal matrix hemorrhages are seen. In addition, there is evidence of hemosiderin staining within the left lateral ventricle which would imply some degree of intraventricular hemorrhagic extension. Ventricular size, however, remains within normal limits.2.A small focus of susceptibility effect within the left cerebellum is nonspecific. This could be artifactual or could represent a small area of chronic microscopic hemorrhage.3.No evidence of any large acute or chronic ischemic injury.4.The degree of gyral development is appropriate for the corrected gestational age. White matter myelination is slightly delayed for corrected gestational age.


Instruction: Generate impression based on findings.

Input: T4N2cM0 p16+ left BOT/oral tongue squamous cell carcinoma 1month post TFHX. There are post-treatment findings in the upper neck. There is no measurable residual oropharyngeal tumor. There is also no evidence of residual significant cervical lymphadenopathy. For example, a right level 2A lymph node measures 4 x 10 mm in axial section, previously 11 x 20 mm. There appears to be thrombosis of the catheterized right internal jugular vein. The salivary glands and thyroid appear unchanged. The osseous structures appear to be intact. The orbits are unremarkable. There is an unchanged left cerebellopontine angle cisterna and internal auditory canal mass that measures up to 24 mm.

Output: 1. No measurable residual oropharyngeal tumor or residual significant cervical lymphadenopathy.2. Apparent thrombosis of the catheterized right internal jugular vein. Doppler ultrasound may be useful for further evaluation.3. Unchanged left vestibular schwannoma.


Instruction: Generate impression based on findings.

Input: 37 year old with history of right mastectomy for IDC and DCIS. There is heterogeneous amount of fibroglandular tissue in the left breast. The patient is status post right mastectomy. Mild parenchymal enhancement is noted in the left breast.No abnormal enhancement is seen in the left breast or right chest wall. No abnormal lymph nodes are identified in either axillary region. Post-surgical changes are seen in the right axilla.

Output: No MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: 61-year-old female with poor PO intake. Evaluate for any small bowel abnormalities. ABDOMEN: Mild dependent right basilar atelectasis.LIVER, BILIARY TRACT: There is a mildly lobulated T2 hyperintense non- focus in the hepatic dome measuring 3.9 x 2.5 cm. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: There is a T2 hyperintense, T1 hypointense, nonenhancing 9 mm focus in the left mid pole compatible with a cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The stomach is severely distended. The small bowel is diffusely distended measuring up to 3.2 cm. There is increased ileal folds. A decrease in the number of jejunal folds is equivocal in this case. Large stool burden is noted.BONES, SOFT TISSUES: Scoliosis.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: As above.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Gastric and diffuse small bowel distention, consistent with diffuse adynamic ileus. The dilated ileum has a "hidebound appearance" with narrowed separation of the valvulae conniventes (despite the degree of bowel lumen dilatation) with normal-appearing thickness of the folds. Somewhat more than expected intraluminal fluid may reflect hypersecretion. Constellation of findings is especially suspicious for scleroderma (also given patient's history of interstitial lung disease), although other differential considerations such as celiac sprue cannot be entirely excluded. In the latter case there is classically jejunization of the ileum with increased folds seen; a decrease in the number of jejunal folds is equivocal in this case. Correlation with patient's clinical history and laboratory values recommended.2.Hepatic dome cystic lesion. Differential considerations include a simple cyst versus biliary cystic neoplasm. Hemangioma is considered much less likely.


Instruction: Generate impression based on findings.

Input: 65 year old male with new diagnosis of heart failure with reduced ejection fraction, atrial fibrillation referred for cardiac MRI for further evaluation. Left VentricleThe left ventricle is normal in size with mildly reduced systolic function. The overall LV ejection fraction is 51%, the LV end diastolic volume index is 63 ml/m2 (normal range: 74+/-15), the LVEDV is 135 ml (normal range 142+/-34), the LV end systolic volume index is 31 ml/m2 (normal range 25+/-9), the LVESV is 66 ml (normal range 47+/-19), the LV mass index is 63 g/m2 (normal range 85+/-15), and the LV mass is 134 g (normal range 164+/-36). There is mild-moderate left ventricular hypertrophy (mid septum 16-17mm, lateral wall 15 mm). There is global hypokinesis. There is diffuse predominantly mid to based subendocardial late gadolinium enhancement. The pre-contrast native myocardial T1 relaxation time is upper limits of normal 1080 ms. Left AtriumThe left atrium is mildly dilated with suggestion of diffuse late gadolinium enhancement. Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 48%, the RV end diastolic volume index is 64 ml/m2 (normal range 82+/-16), the RVEDV is 137 ml (normal range 142+/-31), the RV end systolic volume index is 33 ml/m2 (normal range 31+/-9), and the RVESV is 71 ml (normal range 54+/-17). There is mild right ventricular hypertrophy. Right AtriumThe right atrium is mildly dilated with suggestion of diffuse late gadolinium enhancement.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is trace mitral regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumSmall circumferential pericardial effusion.Extracardiac FindingsLarge bilateral pleural effusions (right greater than left) with associated passive atelectasis. 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. The left ventricle is normal in size with mildly reduced systolic function (LVEF 51%) with global hypokinesis. 2. The right ventricle is normal in size with mildly reduced systolic function (RVEF 48%). 3. Mild-moderate left ventricular hypertrophy and mild right ventricular hypertrophy with diffuse predominantly mid to basilar subendocardial late enhancement. Overall these findings highly suggest cardiac amyloid. 6. See extracardiac findings as above.


Instruction: Generate impression based on findings.

Input: 29 year old with BRCA 1 mutation. History of benign left breast MR guided biopsy in 2015. There is heterogeneous amount of fibroglandular tissue in both breasts.Minimal parenchymal enhancement is noted bilaterally.Metallic artifact from prior benign biopsy is present in the upper inner quadrant in the left breast.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Female, 81 years old, with memory decline, history of pituitary macroadenoma. A chronic lacunar infarct of the right basal ganglia is unchanged. No diffusion restricting lesions are seen. No evidence of parenchymal edema or mass effect is detected. No acute intracranial hemorrhage or any abnormal extra axial fluid collection is seen. Ventricular size and morphology are unchanged. There is mild generalized parenchymal volume loss, not out of proportion to age, and not significantly changed. On postcontrast images, no pathologic parenchymal or extra-axial enhancement is observed. The pituitary gland remains enlarged, similar to that seen on the prior examination.

Output: 1.A chronic right lacunar infarct is redemonstrated. No new or acute findings are seen.2.Stable enlargement of the pituitary gland.


Instruction: Generate impression based on findings.

Input: Reason: Evaluate for cervical myelopathy History: LE weakness, hyperreflexia, LE numbness Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology.No abnormal enhancing lesions are appreciated in the cervical spine. There is multilevel disk desiccation present.At C2-3 there is no significant compromise to the spinal canal or neural foramina. There is a small central broad-based disk protrusion present at this levelAt C3-4 there is no significant compromise to the spinal canal or neural foramina. There is a minor disk bulge present at this levelAt C4-5 there is no significant compromise to the spinal canal or neural foramina. There is a minor disk bulge present at this levelAt C5-6 there is no significant compromise to the spinal canal or neural foramina. There is a minor disk bulge present at this levelAt C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.MRI thoracic spine:The thoracic vertebral bodies are appropriate in the overall alignment and height. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots. No abnormal enhancing lesions are appreciated in the thoracic spine.

Output: 1.No spinal cord lesions are appreciated.2.There are mild degenerative changes present in the cervical spine.


Instruction: Generate impression based on findings.

Input: Right knee pain. MENISCI: The apical portion of the body of the medial meniscus is not visualized. Additionally, there is abnormal signal adjacent to the anterior horn of the medial meniscus which may represent the displaced meniscal fragment. There is also blunting of the posterior horn of the medial meniscus. The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: The articular cartilage of all three compartments is intact. Bone marrow signal is within normal limits.LIGAMENTS: The collateral and cruciate ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1. Tear of the body of the medial meniscus with possible displacement as described above. 2. Intact cruciate ligaments.


Instruction: Generate impression based on findings.

Input: Dizziness and giddiness [780.4], Reason for Study: ^Reason: HA, vertigo, possible neurosyphilis? History: HA, vertigo No evidence of acute ischemic or hemorrhagic lesion on the scan.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear.There are opacification with retention cysts on bilateral maxillary sinus indicating sinusitis.

Output: Maxillary sinusitis, otherwise unremarkable brain MRI.


Instruction: Generate impression based on findings.

Input: There is mild narrowing of the distal cavernous right internal carotid artery. The intracranial internal carotid arteries are otherwise normal in course and caliber. There is a mildly hypoplastic right A1 segment. There is mild irregularity of the proximal left M1 segment. There is also mild irregularity of the proximal right M2 segments. The middle and anterior cerebral arteries are otherwise unremarkable.There is a fetal right posterior cerebral artery with absent right P1 segment. There is a hypoplastic left P1 segment with fetal type supply to the left posterior cerebral artery. There is mild-moderate focal narrowing of the proximal left P2 segment. There is additional mild focal irregularity and narrowing of the proximal posterior and anterior P2 sub-segments. The post-PICA right V4 segment is developmentally diminutive. The vertebral arteries, basilar artery, and posterior cerebral arteries are otherwise normal in course and caliber. There is no evidence of flow-limiting stenosis or aneurysm. There is a duplicated left superior cerebellar artery.

Output: No flow-limiting stenosis or intracranial aneurysm. However, mild scattered posterior greater than anterior circulation atherosclerotic disease as detailed above. Of note, there is fetal right inferior type left supply to the PCAs.


Instruction: Generate impression based on findings.

Input: 31-year-old female with left knee pain. MENISCI: There is a bucket-handle tear of the posterior horn of the medial meniscus. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: No significant thinning of the articular cartilage. There is bone marrow edema of the medial femoral condyle and medial tibial plateau.LIGAMENTS: The ACL is not visualized secondary to a tear. The PCL, LCL, and MCL are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1. Large joint effusion with bucket handle tear of the posterior horn of the medial meniscus.2. ACL tear.3. Bone marrow edema within the medial femoral condyle and medial tibial plateau.


Instruction: Generate impression based on findings.

Input: Headaches, acoustic neuroma, preoperative planning. Examination is obtained for operative planning and intraoperative navigation. Fiducial markers are in place. Again seen is an enhancing mass at the right cerebellopontine angle cistern measuring approximately 3.0 x 2.9 x 2.7 cm in the AP, transverse, and craniocaudal dimensions similar to prior. There is mass effect on the right lateral aspect of the pons as well as on the right middle cerebellar peduncle and right cerebellar hemispheres. There is also mass effect on the cisternal segment of the right trigeminal nerve which is anteromedially displaced. Enhancing mass extends through the porus acusticus into the right internal auditory canal. No extension into the cochlea seen, but can be correlated with prior dedicated IAC MRI.Unchanged diffuse prominence of the ventricular system without evidence of obstruction relating to the cerebellopontine angle neoplasm. Again noted is aneurysm involving the right MCA bifurcation as well as the left M1 segment as seen on recent CTA.

Output: 1. Heterogeneously enhancing right cerebellopontine angle mass measuring 3.0 x 2.9 x 2.7 cm extending into the right internal auditory canal consistent with known vestibular schwannoma.2. Mass-effect on the right pons, middle cerebellar peduncle, cerebellum, as well as the cisternal segment of the right trigeminal nerve.3. Communicating hydrocephalus, possibly related to the schwannoma (associated with elevated CSF protein concentration). No direct mass effect on the ventricular system. 4. Middle cerebral artery aneurysms better demonstrated on recent CT angiogram.


Instruction: Generate impression based on findings.

Input: Fatty filum, scoliosis, symptom changes. Please do on 3T. Urinary changes For the purposes of numbering, there are 5 lumbar type vertebral bodies. Conus appears to terminate at the L2-L3 level. Fatty infiltration of the filum terminale is noted below the upper L4 level and measuring up to 2.5 mm in the AP dimension. There is severe levoscoliosis with apex near the thoracolumbar junction which has progressed since remote study from 10/29/2008. There is trace prominence of the central canal at the conus. Prone images demonstrate no definite anterior motion of the conus although scoliosis makes evaluation difficult. No significant spinal canal stenosis or neural foraminal narrowing in the lumbar spine is appreciated.

Output: 1. Conus appears to terminate at the lower L2/L2-L3 level which is borderline low. There is a fatty filum terminale measuring up to 2.5 mm in thickness at the L4 level. Overall findings are somewhat suggestive of tethered cord and can be correlated with clinical exam.2. Trace prominence of the central canal at the conus without discrete syrinx.


Instruction: Generate impression based on findings.

Input: 58 year old man with history of HTN, AF, referred for cardiac MRI prior to planned AF ablation. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 51%, the LV end diastolic volume index is 62 ml/m2 (normal range: 74+/-15), the LVEDV is 142 ml (normal range 142+/-34), the LV end systolic volume index is 30 ml/m2 (normal range 25+/-9), the LVESV is 70 ml (normal range 47+/-19), the LV mass index is 44 g/m2 (normal range 85+/-15), and the LV mass is 103 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.No intracardiac thrombus.Left AtriumThe left atrial volume is 190.7ml. The left atrial volume index is 82.5ml/m2, which is severely increased. There is artifact on the dedicated 3-dimensional delayed viability sequences. No reliable evidence of left atrial enhancement.Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 51%, the RV end diastolic volume index is 65 ml/m2 (normal range 82+/-16), the RVEDV is 151 ml (normal range 142+/-31), the RV end systolic volume index is 32 ml/m2 (normal range 31+/-9), and the RVESV is 75 ml (normal range 54+/-17).Right AtriumThe right atrium is severely dilated.Aortic ValveThe aortic valve is tri-leaflet and opens widely. There is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation. The mitral valve leaflets appear thickened.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is trace tricuspid regurgitation.AortaThere is a left sided aortic arch with a common origin of the innominate and left common carotid arteries (normal variant). The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium. Individual dimensions are:RUPV:16x17mm. There is either early branching or common origin of right middle lobe branches.RLPV: 21X26mm. There is early branching.LUPV: 14x16mmLLPV: 16x8mmPulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no pericardial effusion effusion.

Output: 1. The left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 51%. There is no late gadolinium enhancement in the left ventricle to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.2. The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 51%.3. The left atrial volume index is 82.5ml/m2, which is severely increased. 4. Early branching of the right superior and inferior pulmonary veins. Two left pulmonary veins drain normally into the left atrium, dimensions as above. 5. Severe bi-atrial enlargement. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 14-year-old male with history of syncope and new right-sided limp. The cerebellar tonsils extend down to the level of the foramen magnum, raising the question of tonsillar herniation. This could be better evaluated on MRI.There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Question of low lying cerebellar tonsils which could be better evaluated on MRI. Otherwise, unremarkable examination.