Instruction: Generate impression based on findings.

Input: 43 year old male with history of paroxysmal atrial fibrillation now with chest pain who presents for stress cardiac MRI to evaluate for ischemiaMEDICATIONS: Flecainide,Magnesium, Aspirin First Pass PerfusionDuring hyperemia, no perfusion defects were present. A dark rim artifact is present. Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 56%, the LV end diastolic volume index is 85 ml/m2 (normal range: 74+/-15), the LVEDV is 180 ml (normal range 142+/-34), the LV end systolic volume index is 37 ml/m2 (normal range 25+/-9), the LVESV is 79 ml (normal range 47+/-19), the LV mass index is 46 g/m2, and the LV mass is 97 g. There are no regional wall motion abnormalities present. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 54%, the RV end diastolic volume index is 82 ml/m2 (normal range 82+/-16), the RVEDV is 173 ml (normal range 142+/-31), the RV end systolic volume index is 38 ml/m2 (normal range 31+/-9), and the RVESV is 80 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. No perfusion defects/ "ischemia" present during hyperemia.2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and systolic function (LVEF 56%).4. Normal RV size and systolic function (RVEF 54%).I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Female 15 years old with enlarged thyroid, irregular periods, amenorrhea. EXAMINATION: Sonogram thyroid 4/15/2016 RIGHT LOBE MEASUREMENTS: 4.9 x 1.3 x 1.6 cmLEFT LOBE MEASUREMENTS: 4.1 x 1.4 x 1.3 cmISTHMUS MEASUREMENTS: 4 mmRIGHT LOBE: Normal echogenicity, no discrete nodule.LEFT LOBE: Normal echogenicity, no discrete nodule.ISTHMUS: Normal echogenicity, no discrete nodule.PARATHYROID GLANDS: Not identified.LYMPH NODES: A few normal appearing cervical lymph nodes were present bilaterally.OTHER: No significant abnormality.

Output: Normal examination.


Instruction: Generate impression based on findings.

Input: 66-year-old male with history of hemophilia now with right flank pain ABDOMEN:LUNG BASES: Significant interval increase in the size and number of bilateral lung nodules. These are incompletely imaged with this CT of abdomen and pelvis. New small bilateral pleural effusions.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Interval increase in the size of the lytic lesion involving T8 vertebral body. There is cathodic fracture of the T 8 vertebral body secondary to this metastatic lesion. MRI may be helpful for further evaluation of the metastatic lesion and spinal canal. Small lytic lesions are also present in the lumbar vertebral bodies, suspicious for metastatic disease.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Interval increase in the size of the right iliac bone lytic lesion, best seen on image number 113, series number 3.. New left iliac bone lesion, best seen on image number 104, series number 3.OTHER: No significant abnormality noted

Output: Interval increase in the size of the T8 and right iliac bone lytic lesions and interval development of a new left iliac bone lytic lesion consistent with metastatic disease. Smaller lytic lesions are also present in the lumbar vertebral bodies. MRI of the thoracic and lumber spine may be helpful for better evaluation of these lesions.Interval increase in the size and number of lung lesions suspicious for metastatic disease.Dr. Bhatt was notified and acknowledged by the findings at the time of dictation.


Instruction: Generate impression based on findings.

Input: Syncope and collapse [R55], Reason for Study: ^Reason: eval SDH, eval ischemic cerebellar infarct History: falls Brain MRI:There are restricted diffusion lesions on the right side posterior inferior cerebellar hemisphere without evidence of hemorrhagic transformation indicating right PICA territorial acute/subacute ischemic infarction.Patchy high signal intensity lesions on mid pons, centrum semiovale and bilateral periventricular white matter indicate age indeterminate non specific ischemic lesions.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Bilateral PCAs are fetal origin.The distal right vertebral artery is faintly shown. This could represent hypoplastic or stenosis.The right PICA is not seen but the left PICA is demonstrated.Basilar artery appears to be small in diameter, however, considering bilateral fetal PCAs, the size is appropriate.There is no evidence of large vessel occlusion or significant luminal stenosis.There is no evidence of intracranial arterial aneurysm.Neck MRA3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The vertebral artery origins are normal. There is normal flow enhancement through the bilateral common carotid, carotid bifurcations, internal/external carotid, and vertebral arteries. The distal right vertebral artery is faintly visualized and the left vertebral artery appears to be dominant.

Output: 1. Right PICA territorial acute/subacute ischemic infarction without evidence of hemorrhagic transformation.2. Non specific small vessel ischemic disease.3. The right vertebral artery diameter is smaller than that of the left vertebral artery and the distal right vertebral artery is faintly visualized. The right PICA is not visualized. Subtle irregularity of basilar artery and bilateral MCAs indicate minimal to mild intracranial atherosclerosis.4. No intracranial arterial aneurysm. No intracranial arterial luminal narrowing or occlusion. Bilateral carotid bifurcation appear to be normal.


Instruction: Generate impression based on findings.

Input: Right oculomotor nerve palsy. History of brainstem astrocytoma. The well-circumscribed, mixed cystic and solid mass involving the mid brain has not significantly changed since the previous examination. It measures anteroposteriorly 2.3 cm, transversely 1.7 cm and craniocaudally 2.1 cm. The cystic foci within the mass and along the interface between the mass and the adjacent brain parenchyma remain unchanged. There continues to be no peritumoral edema and mass-effect remains mild. Following contrast injection, the mass shows no significant enhancement.There is a 5 mm focus of diffusion restriction involving the right external capsule correlating with mild T1/FLAIR hyperintensity. This probably represents a recent infarct. There is focal encephalomalacia from a prior infarct/insult in the right cerebellar hemisphere, which is unchanged. Otherwise, there are dilated perivascular spaces in the deep gray nuclei regions and brainstem. A prominent CSF intensity lesion in the left globus pallidus measuring up to 7 mm and may represent a dilated perivascular space or a chronic lacunar infarct. There are also small patches of T2 hyperintensity in the cerebral white-matter which are mildly increased since the prior examination. Mild global brain volume loss is unchanged as is associated mild ventricular and sulcal enlargement. Major intracranial vascular flow voids are preserved. There are numerous tiny foci of susceptibility effect clustered within and around the brainstem and adjacent tissues which may be related to prior radiation. There are also foci of susceptibility effect related to the encephalomalacia in the right cerebellar hemisphere.Dynamic susceptibility-weighted contrast-enhanced MR perfusion shows lack of significant hyperperfusion within the brainstem mass or adjacent tissues.

Output: 1.Tiny but acute/recent right external capsule infarct.2.The brainstem glioma is unchanged since the 2007 examination.3.Otherwise, mild cerebral white-matter signal abnormality is nonspecific but may reflect chronic microvascular ischemia in addition to unchanged focal right cerebellar encephalomalacia/gliosis.Dr. Monther Qandeel sent the above findings to Dr. Jeffrey W Nichols by email on 5/11/2016 3:40 PM.


Instruction: Generate impression based on findings.

Input: 41-year-old female patient with left knee pain. MENISCI: There is a full thickness radial tear of the posterior horn of the medial meniscus near its root. There is globular signal intensity in the body of the medial meniscus likely representing intrasubstance degeneration with fraying of the inner edge. The anterior horn is intact. The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: The superior aspect of the median eminence of the patella is devoid of articular cartilage with a near full-thickness cartilage cleft noted inferiorly. Osteoarthritis affecting the medial compartment particularly along the posterior aspect of the medial femoral condyle appears similar to the prior study, although, there appears to be new mild edema in the medial tibial plateau. There are small osteophytes.LIGAMENTS: The cruciate ligaments are intact. There is edema along the medial collateral ligament; while this could represent a sprain in the appropriate clinical context, it may reflect underlying medial compartment pathology.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1. Limited study as described above.2. Radial tear of the posterior horn of the medial meniscus.3. Osteoarthritis and loose bodies in the joint as described above.4. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Male, 47 years old, history of tonsil cancer, now with small palpable firmness on the left lateral tongue. No evidence of any masslike lesion is seen at the left lateral tongue or elsewhere along the aerodigestive mucosa. Findings related to left neck dissection are seen. No pathologic adenopathy is detected on either side of the neck by size criteria. The salivary glands and the thyroid are within normal limits. Patchy mucosal thickening is seen in the ethmoid air and the left mastoid air cells.A slight dextrocurvature of the visualized cervical spine is noted when viewed in the coronal plane. In addition, there is a rotational subluxation of C2 relative to C1. Mild marrow edema is seen within the left lateral aspect of the C3 and C4 vertebral bodies. The left C3-4 facet joint is degenerated and inflamed with evidence of facet effusion. The surrounding left paraspinal soft tissues are also mildly edematous. Of note, similar abnormalities were identified at this location on prior exams from 2012 resulting in paraspinal excision with benign results.

Output: 1.No evidence of any masslike or suspicious lesion is seen along the left lateral tongue to correlate with physical exam findings. No pathologic adenopathy is detected in the neck.2.Multiple chronic cervical spine findings are seen including a rotational subluxation of C1 relative to C2 and advanced left facet degeneration at C3-4.


Instruction: Generate impression based on findings.

Input: Reason: Evaluate for osteomyelitis vs. septic arthritis vs. Cellulitis History: left foot pain There is diffuse subcutaneous edema, particularly involving the dorsal aspect of the foot. Although the edema becomes confluent dorsally, we see no well-defined fluid collection to indicate abscess. There is perhaps mild edema of the plantar musculature of the foot, which is nonspecific. Osteoarthritic changes are noted in the interphalangeal joint of the great toe as seen on recent radiographs, but we see no bone marrow signal abnormalities to suggest osteomyelitis. There is a small amount of fluid in the first MTP joint, likely physiologic. We see no findings to suggest septic arthritis. There is a small amount of metallic susceptibility artifact in the web space of the first and second toes.

Output: Subcutaneous edema consistent with stated diagnosis of cellulitis, but we see no imaging features of septic arthritis or osteomyelitis.


Instruction: Generate impression based on findings.

Input: Chiari malformation with progression of optic neuropathy. Again noted are changes compatible with prior suboccipital craniectomy and posterior fossa decompression, with creation of a neo foramen magnum. Low-lying cerebellar tonsils extend to the inferior margin of the anterior arch of C1, not significantly changed since the prior study. Biphasic CSF flow is robust anteriorly. At the level of the neo foramen magnum, there is a paucity of CSF flow posteriorly along the cerebellar tonsils and no definite CSF flow is appreciated directly posterior to the tonsils. The ventricles and sulci are normal in size for age. There is prominent volume loss involving the superior cerebellar vermis similar to prior. There is no mass, mass effect, or midline shift. Few scattered foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild chronic small vessel ischemic changes. Brain parenchyma is otherwise unremarkable for age. The pituitary gland is normal in size. There are no foci of increased susceptibility. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. Postcontrast images are motion degraded but demonstrate no abnormal parenchymal or meningeal enhancement. Subcentimeter focus of enhancement in the left frontal calvarium is nonspecific and unchanged since 4/27/2009.No masses are seen within the orbits or abnormal enhancement. The right optic nerve is tortuous making evaluation of signal abnormality suboptimal on the coronal sequences however no abnormal optic nerve T2 signal is definitively appreciated. No mass, compression, or abnormal signal involving the optic chiasm.Small cervical syrinx and myelomalacia are partially visualized and better assessed previously.

Output: 1.Again seen are postsurgical changes following posterior fossa decompression for Chiari decompression, without significant interval change in position of low lying cerebellar tonsils. No definite CSF flow is appreciated posterior to the cerebellar tonsils at the level of the neo foramen magnum similar to prior.2.No intracranial mass or mass effect. No evidence of infarct. No masses within the orbits or signal abnormality involving the optic nerves is appreciated. 3.Partially visualized cervical syrinx and myelomalacia, better assessed on prior dedicated cervical spine studies.


Instruction: Generate impression based on findings.

Input: Cerebellar hemangioblastomatosis treated with surgery in 2002 and SRS in 2004: headache and gait difficulty. There are postoperative findings related to left suboccipital craniotomy. There has been interval increase in size of the left inferior cerebellar hemisphere enhancing lesions, which now measure up to 18 and 8 mm each, previously 15 and 5 mm, respectively. There is also increased associated vasogenic edema and susceptibility effect. There are unchanged nonspecific punctate foci of T2 hyperintensity in the supratentorial brain. There is no evidence of acute infarct. There is an enlarged partially-empty sella. The ventricles are stable in size and configuration. There is no midline shift or herniation. There is fluid within the right mastoid air cells. The extracranial soft tissues are unremarkable. There are bilateral lens implants.

Output: Interval increase in size of the left inferior cerebellar hemisphere hemangioblastomas, along with increased associated vasogenic edema.


Instruction: Generate impression based on findings.

Input: Male, 70 years old, with pineal parenchymal tumor. Postoperative findings are redemonstrated compatible with biopsy/partial resection of a bulky enhancing pineal tumor utilizing a posterior right paramedian occipital approach. Since the prior examination, the acute postoperative findings have resolved. The previously seen excavated tract within the tumor core has either collapsed or, more likely, filled via tumor ingrowth. The lesion is overall larger than on the prior examination, measuring up to 36 mm in the transaxial plane, previously 31 mm. As on prior examinations, the tumor appears to infiltrate the adjacent thalami with ill-defined T2 hyperintensity tapering laterally, particularly on the right.A right frontal approach ventricular catheter remains in stable position. Ventricular caliber has increased, more so on the right where the atrium now measures up to 18 mm in diameter, previously 11 mm. Extensive patchy white matter T2 hyperintensity is grossly unchanged. No new lesions are detected.

Output: Since the prior examination, the surgical tract into the core of the pineal tumor has filled in likely through tumor regrowth. The overall size of the lesion has also increased mildly.


Instruction: Generate impression based on findings.

Input: 5-month-old male with subdural hematoma, seizure. MRI BRAIN: Again seen are bilateral subdural collections along the bilateral cerebral convexities which are of CSF intensity within the frontal region and demonstrate high signal posteriorly. Intermediate density which is higher than of CSF is well demonstrated on recent CT in the bilateral frontal region. The collections measure up to 9 mm in greatest dimension along the frontal convexities. There is some displacement of the cortical vessels away from the inner table of the calvarium which indicates that these collections are subdural in location; however there may be a component of enlargement of the subarachnoid spaces as well. No foci of intraparenchymal hemorrhage or edema are noted. There is mildly increased vascularity/enhancement in the right parietal region which may be related to seizure as indicated in history versus congestion. There is mild enhancement of the posterior dura including along the tentorium, which is likely reactive. There is no restricted diffusion to suggest acute ischemia. No intracranial mass lesions noted. Gray-white matter differentiation is well preserved. No midline shift or herniation.The paranasal sinuses and mastoid air cells are clear. The orbits are unremarkable.MRI CERVICAL SPINE: Cervical spine is in anatomic alignment. Vertebral body heights are normal. Spinal cord is normal in signal intensity with no evidence of cord edema or hemorrhage. No epidural hematoma. No spinal canal or neural foraminal stenosis. The ligamentous structures are intact. The transverse ligament is intact. There is minimal fluid along the atlantooccipital joint bilaterally, which is nonspecific.

Output: 1. Again seen are subdural hematomas involving the bilateral cerebral convexities. Thin subdural hematoma component posteriorly with T1 hyperintensity and hyperdensity on recent CT is compatible with recent subdural hemorrhage. Larger component which is similar to CSF in intensity along the anterior frontal convexities may represent coexisting subdural hygroma (CSF) versus chronic blood products. No evidence of intraparenchymal hemorrhage or intraparenchymal edema.2. Subtly increased vascularity and possible leptomeningeal enhancement in the right parietal region may be postictal in etiology.3. No evidence of injury to the cervical spine.


Instruction: Generate impression based on findings.

Input: Reason: Right hip pain anterior x 10 years, no improvement with physical therapy, evaluate for labral tear PLEASE INJECT WITH KENALOG 40MG AT TIME OF ARTHROGRAM History: Right hip pain. ACETABULAR LABRUM: Nondisplaced tear at the base of the anterior superior labrum.ARTICULAR CARTILAGE AND BONE: No significant abnormality noted.SOFT TISSUES: No significant abnormality noted. ADDITIONAL

Output: Nondisplaced anterior superior labral tear.


Instruction: Generate impression based on findings.

Input: Spinal surgery with neck pain and history of thyroglossal duct cysts surgery. Neck: There are postoperative findings related to thyroglossal duct cyst resection with punctate linear T2 hyperintensity in the midline inferior tongue base, just superior to the hyoid bone. There is no evidence of mass lesions or significant cervical lymphadenopathy. The thyroid and major salivary glands are unremarkable. The imaged intracranial structures are unremarkable.Cervical Spine: There are postoperative findings related to anterior fusion of C6 and C7. There is multilevel degenerative spondylosis with severe trace posterior disc-osteophyte complexes and a congenitally narrow spinal canal. At C2-3, there is mild to moderate bilateral neural foraminal narrowing. At C3-C4, there is severe bilateral neuroforaminal stenosis. At C4-C5, there is mild left and severe right neuroforaminal stenosis. At C5-C6, there is moderate left and severe right neuroforaminal stenosis. At C6-C7, there is mild bilateral neural foraminal narrowing. At C7-T1, there is severe bilateral neuroforaminal stenosis. The vertebral body heights are preserved. The vertebral bone marrow signal is unremarkable. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: 1. Postoperative findings related to thyroglossal duct cyst resection with punctate linear T2 hyperintensity in the midline inferior tongue base, just superior to the hyoid bone, which may represent a residual portion of the thyroglossal duct. 2. Postoperative findings related to anterior fusion of C6 and C7. 3. Multilevel degenerative spondylosis and a congenitally narrow spinal canal and extensive neural foraminal stenoses at multiple levels, as described in the findings section.


Instruction: Generate impression based on findings.

Input: There is no evidence of acute intracranial hemorrhage, mass, or acute infarct. There is unchanged extensive confluent T2 hyperintensity within the supratentorial white matter, as well as involving the basal ganglia, thalami, brainstem, and cerebellar white matter. There are multiple unchanged punctate foci of susceptibility effect in the supratentorial and infratentorial white matter. There is no definite abnormal intracranial enhancement. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull and scalp soft tissues are unremarkable. There is fluid within left mastoid air cells and minimal paranasal sinus mucosal thickening.

Output: Unchanged treatment related effects including confluent T2 hyperintensity throughout the white matter and numerous punctate foci of susceptibility effect, which may represent treated metastases, microhemorrhages, and/or cavernous malformations. Assessment for metastatic disease is otherwise limited due to the lack of intravenous contrast.


Instruction: Generate impression based on findings.

Input: 53 old female with acute altered mental status. There is a hypodense region in the left frontal lobe which is unchanged from yesterday, but new compared to CT from 12/20/08. MRI is recommended for further evaluation of this lesion.The ventricles and basal cisterns are normal in size and configuration.There is a lytic lesion in the right parietal calvarium which was seen on the prior scan and may represent metastases. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1- Hypodense lesion in the left frontal lobe unchanged from yesterday. MRI is recommended for further evaluation.2- Right parietal calvarial lesion doesn't appear to have significantly changed from prior and likely represent metastases.


Instruction: Generate impression based on findings.

Input: Other complicated headache syndrome [G44.59] / Dizziness and giddiness [R42], Reason for Study: ^Reason: L HA/ear pain, vertigo, tinnitus History: L HA/ear pain, vertigo, tinnitus Brain MRIThere is no evidence of acute ischemic or hemorrhagic lesion on this scan.There is no evidence of abnormal enhancement.Underlying brain shows multiple bihemispheric scattered high signal intensity lesions on FLAIR/T2 images which indicate non specific small vessel ischemic disease.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal. There is no evidence of intracranial arterial aneurysm. No intracranial arterial luminal stenosis or irregularity.

Output: 1. Non specific small vessel ischemic disease. 2. No evidence of acute ischemic or hemorrhagic lesion. No abnormal enhancement.3. Normal brain MRA.


Instruction: Generate impression based on findings.

Input: 70 year old with palpable lump in the right 2 o'clock position, which had been sampled with FNA with palpation guidance and ultrasound guided core biopsy. FNA result was suspicious for malignancy, and the core biopsy result was benign; dense fibrosis with acute and chronic perivascular inflammation and focal fat necrosis. Problem solving MRI is requested. History of right lumpectomy in 2001 followed by radiation and tamoxifen. There is heterogeneous amount of fibroglandular tissue in both breasts.Minimal parenchymal enhancement is noted bilaterally.Post-surgical scar with multiple signal voids by the surgical clips is seen in the right upper inner quadrant.Hydromark clip is identified at 2 o'clock position in the right breast, at the site of recent ultrasound guided core biopsy performed on 5/5/15. No abnormal enhancement is present near the Hydromark clip, or elsewhere in the right breast. No abnormal enhancement is seen in left breast. No abnormal lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Rule out CVA. Patient with two days of left-sided weakness. Several areas of encephalomalacia, the largest in the right occipital lobe that likely represent areas of prior infarct. Multiple areas of subcortical and periventricular white matter hypodensity indicate small vessel ischemic disease of indeterminate age. An MRI is recommended if there is clinical concern for acute stroke.There is no evidence of intracranial hemorrhage, mass or midline shift. 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: Areas of encephalomalacia and evidence of small vessel ischemic disease of indeterminate age. An MRI is recommended for further evaluation if there is concern for an acute stroke.


Instruction: Generate impression based on findings.

Input: 57 years Male (DOB:10/19/1958)Reason: stroke r.o History: LUE / LLE driftPROVIDER/ATTENDING NAME: NAVNEET CHEEMA HELENE G RUBEIZ The CSF spaces are appropriate for the patient's stated age with no midline shift. There 6 or 7 periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. These are often seen at this age and nonspecific and of no clinical significance.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: There 6 or 7 periventricular and subcortical punctate punctate white matter lesions present. These are often seen at this age and nonspecific and of no established clinical significance.


Instruction: Generate impression based on findings.

Input: 74 year-old female with recurrent laryngeal cancer. Status post laryngectomy. Rule out recurrence and lung metastases. CT of the soft tissues of the neck with infusion:Images through the skull base, cavernous sinuses, paranasal sinuses and petrous bones remain negative for malignancy. Small retention cyst within the left maxillary sinus is again identified with no interval change.Images through the neck demonstrate post therapy/surgical changes. No evidence of a mass or pathologic adenopathy is present. Tracheostomy is noted. Small foci of nonenhancing tissue within the right lobe of thyroid matter present assist and remains stable since prior exam. This lesion measures approximately 4 mm in transaxial dimension. No detectable left lobe of thyroid.Limited images of mediastinum are negative for adenopathy.Limited images of the apices of the lungs are negative for metastatic lesions minimal apical scarring is noted. Please review the dictated report of CT of chest.No evidence of osseous or cartilaginous erosion. Complete laryngectomy is noted.CT of brain with infusion:No evidence of metastatic lesion to the brain, leptomeninges or the calvarium is detected. Findings of possible minimal small vessel disease of indeterminate age is again identified.Significant increased vascularity at the level of the tentorium and across the left cerebellum is highly concerning for an arteriovenous malformation/dural AVF. This finding was present on multiple prior studies and without any significant interval change. Further evaluation with a CT A4 MRA -- MRI is recommended.60 cc of Omnipaque 350 was utilized for the above studies.

Output: 1.No evidence of recurrence of disease in neck.2.No evidence of metastatic disease to the brain, leptomeninges or the calvarium.3.Arteriovenous malformation or an AVF in the left cerebellum needs further follow-up with dedicated studies of MRI / MRA or CTA examination or conventional angiogram.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for demyelinating disease. Signs and symptoms: Spasticity. Nonenhanced cervical MRI:The examination demonstrates normal signal intensity and caliber of cervical cord and without convincing evidence of a demyelinating plaque.The signal intensity of the vertebral column demonstrate changes related to mild degenerative disease and unremarkable otherwise.At C3 -- C4 mild degenerative changes results in mild right neural foraminal compromise and unremarkable otherwise.At C5 -- C6 there is mild degenerative disk disease with resultant significant right and mild left neural foraminal compromise and without central spinal stenosis.At C6 -- C7 there is moderate left neural foraminal compromise and unremarkable otherwise.Nonenhanced thoracic MRI:There is normal signal intensity and caliber thoracic cord with convincing evidence of demyelinating disease.There is normal signal intensity and alignment the vertebral column.There is no evidence of spinal canal or neural foramina compromise at any level.

Output: 1.Negative nonenhanced MRI of cervical and thoracic spine for demyelinating disease.2.Degenerative changes of cervical spine with resultant multilevel neural foraminal compromise however without central spinal stenosis as detailed above.3.No evidence of spinal canal or neural foraminal compromise of thoracic spine.


Instruction: Generate impression based on findings.

Input: 50-year-old female status post hysterectomy, concern for recurrent endometrial carcinoma status post surgery 11/16/2015 who presents for characterization of pelvic fluid collection.Additional history obtained from gynecology service, Dr. Libbe Hassenfritz, patient with hysterectomy in 2009 for endometrial carcinoma. Patient presented in October with concern of recurrent endometrial carcinoma. Patient with rectosigmoid resection with creation of Hartmann's pouch, mucocutaneous fistula; transverse loop colostomy on 11/16/2015. PELVIS:UTERUS, ADNEXA: Status post hysterectomy and bilateral salpingo-oophorectomy.BLADDER: No significant abnormality noted.LYMPH NODES: There are mildly prominent pelvic lymph nodes.BOWEL, MESENTERY: Postoperative changes of rectosigmoid resection with creation of Hartmann's pouch, mucocutaneous fistula; transverse loop colostomy.BONES, SOFT TISSUES: There is a complex appearing T1 hypointense and T2 heterogeneous collection in the left hemipelvis measuring approximately 7.1 x 3.1 cm. This collection demonstrates peripheral rim diffusion restriction. There is contrast enhancement of the peripheral rim as well as peripheral nodularity within the collection (series 1002, image 362). This complex collection/lesion is adjacent to the anastomosis. When compared across modalities, this fluid collection was present on the previous examinations.There is ill-defined soft tissue around the ostomy site and anterior abdominal wall with areas of enhancement, likely representing inflammatory changes.Additionally, there is a ventral abdominal wound with packing material, unchanged.OTHER: There is mild enhancement of the synovium of bilateral hip joints which is likely reactive versus synovitis.

Output: 1.Complex left hemipelvis collection as above concerning for necrotic tumor, postcontrast enhancement seen both peripherally and within structure.2.Inflammatory changes in the anterior abdominal wall near the ostomy again noted.3.Mild enhancement of bilateral hip joints may be reactive in etiology versus synovitis.


Instruction: Generate impression based on findings.

Input: Reason: ? Osteomyelitis, abscess History: ulceration Markers were placed along the anteromedial aspect of the lower leg. There is irregularity of the soft tissues between the markers likely representing the patient's site of ulceration. There is mild enhancement of the adjacent skin suggesting inflammation. There is edema and perhaps some fluid within the underlying subcutaneous fat, but we see no rim-enhancing collection in the surrounding soft tissues to suggest abscess formation. There is diffuse subcutaneous edema involving the leg. There is mild nonenhancing edema-type signal within the musculature of the leg which may reflect mild atrophy. The bone marrow signal intensity of the tibia and fibula is normal. We see no findings to suggest osteomyelitis. There is also subcutaneous edema involving the right leg as seen on the large field-of-view images.

Output: Soft tissue ulceration and edema without evidence of osteomyelitis or abscess.


Instruction: Generate impression based on findings.

Input: orbital lymphoma follow up Brain MRILeft temporal small craniotomy site and skull base area shows minimal smooth dural enhancement which is likely represent postoperative in nature. Comparing to prior study, there is no significant interval change in terms of enhancement pattern and characteristics.Scalp, left temporalis muscle as well as left masticator space also show no evidence of abnormal enhancement.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. Bilateral mastoid air cells show fluid collections. There is fluid collection on the left frontal sinus indicating possible localized sinusitis. No change of partial empty sellar.Orbit MRI:There is no evidence of abnormal thickening or enhancement on extra ocular muscles.In particular, the right superior rectus muscle appears to be normal in size without showing evidence of abnormal enhancement.Other orbital contents appear to be unremarkable.

Output: 1. Stable minimal smooth enhancement of left temporal lobe and skull base dura indicating postoperative change since prior exam.2. No evidence of abnormal enhancement on scalp, temporalis muscle, left masticator space and right superior rectus muscle.3. Bilateral mastoid fluid collections and left frontal sinusitis.


Instruction: Generate impression based on findings.

Input: Male, 63 years old. Status post rotator cuff repair, chondroplasty, microfracture. Right shoulder pain ROTATOR CUFF: There is a complete tear of the supraspinatus tendon with fibers retracted to the level of the glenoid. The majority of the fibers of infraspinatus also appear to be torn with retraction to the level of the glenoid. There is advanced fatty atrophy of both supraspinatus and infraspinatus muscles. The teres minor tendon is intact, and there is mild to moderate fatty atrophy of the teres minor muscle. There is marked tendinopathy of the subscapularis tendon with small areas of predominantly bursal surface tearing. The subscapularis muscle is intact. Anchors within the humeral head create artifact.SUPRASPINATUS OUTLET: Moderate osteoarthritis affects the acromioclavicular joint. There are postsurgical changes of the acromion.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is diffuse cartilage loss involving the glenohumeral articulation with subchondral cysts. The labrum is diffusely degenerated and torn. There are small loose bodies within the joint. The synovium is thickened, compatible with synovitis.BICEPS TENDON: The tendon of the long head of the biceps is normal in morphology and position. ADDITIONAL

Output: Chronic high-grade rotator cuff tear and severe osteoarthritis of the shoulder as above.


Instruction: Generate impression based on findings.

Input: Hemorrhage from cavernoma of the pons in March A T2 hypointense lesion with susceptibility effect is again seen in the posterior pons and is mildly exophytic into the fourth ventricle. Lesion measures 9 mm in diameter (image 8, series 501) and consistent with pontine cavernous reformation. This is unchanged in size when compared with the prior study dated 3/3/2015, however it has decreased in size when compared with the prior MRI dated 1/24/2015 where it measured 1.4 cm. There is decrease in T1 and T2 signal intensity when compared with the prior study dated 1/24/2015 which is compatible with evolving blood products. There is no surrounding edema. Adjacent developmental venous anomaly is seen within the left cerebellum (image 24, series 2301).Cystic areas are seen adjacent to the lateral ventricle atria most likely represent perivascular spaces and a normal variant. Remainder of the brain parenchyma is unremarkable. No diffusion restriction is seen to suggest acute ischemia. The CSF spaces are appropriate for the patient's stated age with no midline shift. Normal vascular flow voids are present in the major intracranial vasculature.Retention cyst/mucosal polyp is seen in the right sphenoid sinus. The remaining visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: Again seen is a dorsal pontine cavernous reformation with associated developmental venous anomaly. There is mild decrease in size when compared to 1/24/2015 with evolution of internal blood products. Remainder of the brain parenchyma appears unremarkable without evidence of additional cavernous reformations.


Instruction: Generate impression based on findings.

Input: Reason: please do Dr javed MS prtocol on 3 tesla History: MS, gait disorder The CSF spaces are appropriate for the patient's stated age with no midline shift. Multiple periventricular and subcortical white matter lesions present asymmetrically located to the left hemisphere some of which are perpendicularly oriented to the lateral ventricles. There total of approximately 10 or 15 lesions present. No associated enhancement following gadolinium administration is appreciated in association with these lesions.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: Periventricular and subcortical white matter lesions are suspicious for demyelination.


Instruction: Generate impression based on findings.

Input: There is redemonstration of postoperative changes including bilateral antrostomies which are both widely patent, as well as right middle turbinectomy. Right-sided ethmoidectomies are also noted. There is redemonstration of lobulated mucosal thickening predominantly along the floor of the right greater than left maxillary sinuses.There is no evidence of abnormal enhancement, mass lesion, or abnormal signal involving the face or paranasal sinuses. Grossly, Meckel's cave appears relatively symmetric without evidence of space-occupying mass. The cisternal portions of the trigeminal nerves are partially visualized and are grossly unremarkable. However, Meckel's caves and trigeminal nerves are incompletely evaluated on this nondedicated exam. A mildly enlarged left level 2A lymph node is noted in these 1.7 cm, which is nonspecific and may be reactive.

Output: 1.No evidence of facial or paranasal sinus mass. Redemonstration of postoperative changes with patent bilateral antrostomies and persistent maxillary sinus floor mucosal thickening.2.Grossly unremarkable appearance of visualized portions of Meckel's caves and trigeminal nerves, although these structures are incompletely evaluated on this exam. If there remains clinical concern for trigeminal pathology, MRI of the brain with trigeminal nerve protocol is recommended for further evaluation.


Instruction: Generate impression based on findings.

Input: 51-year-old female with history of Crohn's ileitis, status post ileocecectomy in 6/2015. Currently not on any medications. Now with right lower quadrant pain. Evaluate for Crohn's disease activity. 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: Stable right lower pole renal parenchymal cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Interval Ileocecectomy since the 2/9/2015 CT enterography exam. The neoterminal ileum is identified near the hepatic flexure and demonstrates short segment (approximately 5 cm) thickening and T2 hypointensity of the bowel wall. This region also demonstrates persistent narrowing and wall enhancement suggesting active disease.Nondilated small bowel loops within a small right Spigelian hernia also demonstrate questionable wall enhancement and could represent a skip lesion.An adjacent ileal loop near the neoterminal ileum demonstrates a 3.2 cm segment of wall thickening and suspected enhancement, which could also represent an additional skip lesion.No obvious fistulization or abscess.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Arising from or abutting the uterus is a 10.2 x 8.9 cm lesion that is hypointense on T2 and demonstrates diffuse avid contrast-enhancement.In the left adnexa, there is a T2 hypointense, T1 hyperintense focus. This could represent a hemorrhagic cyst versus endometrioma.

Output: 1.Status post ileocecectomy with findings suggesting active disease within a short segment (approximately 5 cm) of the neoterminal ileum. Additionally, two adjacent ileal segments with suspected wall enhancement are concerning for skip lesions. One of these suspected skip lesions is located within a small spigelian hernia.2.A 10.2 x 8.9 cm T2 hypointense, enhancing lesion abutting the uterus could represent an exophytic fibroid versus an adjacent ovarian Brenner tumor, but favor to be the former.3.A small T1 hyperintense, T2 hypointense lesion in the left adnexa could represent a hemorrhagic cyst versus an endometrioma. Follow-up ultrasound in 3-6 weeks is recommended.


Instruction: Generate impression based on findings.

Input: There is redemonstration of postoperative findings from multiple prior craniotomies with areas of bilateral frontal and cerebellar hemisphere encephalomalacia. There is an unchanged meningioma along the planum sphenoidale. The partially cystic lesion in the left cerebellar hemisphere with surrounding edema appears to be unchanged in size. There is no evidence of acute ischemia. The shunted ventricular system appears to be unchanged. There is an unchanged enhancing intraconal lesion within the lateral left orbit. There is a partially-imaged upper cervical spinal cord ependymoma and upper cervical spinal canal schwannomas. There are unchanged enhancing left parietal and right occipital scalp lesions. There are postoperative findings related to bilateral retrosigmoid craniotomies. The residual components of the left vestibular schwannoma have not significantly changed in size. Likewise, the residual right vestibular schwannoma has not significantly changed in size. There is no significant interval change in the left facial nerve schwannoma involving the geniculate ganglion and internal auditory canal. There are also smaller facial nerve schwannomas centered in the right geniculate ganglion, as well as in the right mastoid segment, which are unchanged. A punctate left cerebellomedullary cistern schwannoma is unchanged. There are grossly unchanged bilateral trigeminal nerve schwannomas.

Output: 1. No significant interval change in the stigmata of neurofibromatosis type 2, including the planum sphenoidale meningioma, residual bilateral vestibular schwannomas and bilateral facial nerve and trigeminal nerve schwannomas, and left cerebellomedullary cistern schwannomas, left orbit and scalp schwannomas, left cerebellar lesion with surrounding edema, partially-imaged upper cervical spinal cord ependymoma and upper cervical spinal canal schwannomas. 2. The shunted ventricular system appears to be unchanged in size.


Instruction: Generate impression based on findings.

Input: History of Crohn's disease. 3/16/2015 colonoscopy biopsies demonstrate mildly active Crohn's enteritis of the neoterminal ileum. History of ileocolonic resection with 130 cm of small bowel removed 12/12/2013. ABDOMEN:LIVER, BILIARY TRACT: The liver measures 21 cm in craniocaudal dimension, the upper limits of normal. There is diffuse fatty infiltration. No focal lesion, biliary ductal dilatation or vascular abnormality. Status post cholecystectomy.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Stable 1.4 cm left adrenal nodule with imaging characteristics consistent with a lipid rich adenoma.KIDNEYS, URETERS: Simple left renal interpolar cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There are postsurgical changes of an ileocecectomy and significant ileal resection with an overall paucity of small bowel.Oral contrast only mildly distends the jejunum. The residual ileum is adequately distended.Oral contrast is seen throughout the colon.The small bowel fold pattern is unremarkable.The residual small bowel is normal in caliber and wall thickness without abnormal wall enhancement or restricted diffusion. No adjacent inflammatory changes or fibrofatty proliferation.No fixed luminal narrowing or prestenotic/upstream dilatation to suggest a flow-limiting stricture.No specific evidence of sinus tract or fistula formation.No significant free fluid or a loculated fluid collection.No specific evidence of active colonic inflammation or flow-limiting stenosis. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Left adnexal simple cyst, within physiologic limits. Status post hysterectomy.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: See discussion above. Trace free pelvic fluid. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No specific findings of significant active small or large bowel inflammation, improved from the prior 3/10/15 MRI. No flow-limiting stricture.Fatty infiltration of the liver.


Instruction: Generate impression based on findings.

Input: 71-year-old male with history of lung cancer and lower back pain, evaluate for spinal stenosis Alignment is anatomic. There is degenerative disk disease, increased at L2-L3 and L3-L4 where there is vacuum disk phenomena. There are new endplate degenerative changes along the superior endplates of L4 and L3 and inferior endplate of L2. T1 and T2 hypointense rounded structure in the posterior aspect of L4 with mild STIR hyperintensity is unchanged and while nonspecific, may represent an atypical hemangioma. There is otherwise diffuse heterogeneous signal of the marrow. Multiple Schmorl's nodes and mild endplate depressions are unchanged. Signal within the distal cord and conus is normal, terminating at T12-L1.T10-T11: Diffuse disk bulge seen only on sagittal views is unchanged. No gross neuroforaminal or central canal narrowing.T11-T12: Central disk extrusion extending caudally 14 mm is unchanged. Mild spinal stenosis is unchanged. No neural foraminal stenosis, however there is narrowing at the left lateral recessT12-L1: Mild diffuse disk bulge. Mild facet arthropathy and ligamentum flavum thickening. Mild to moderate spinal stenosis. Narrowing at the lateral recess ease bilaterally.L1-L2: Mild diffuse disk bulge. Ligamentum flavum thickening and facet arthropathy. Mild effacement of the ventral thecal sac, unchanged. No neural foraminal stenosis.L2-L3: Moderate diffuse disk bulge and thickening of the ligamentum flavum is unchanged. Moderate bilateral neuroforaminal narrowing, right greater than left, slightly worse on the left. Moderate to severe spinal stenosis is unchanged. Prominent epidural fat.L3-L4: Broad-based disk bulge with a right paracentral disk extrusion extending cranially 8 mm appears similar to the prior exam. Ligamentum flavum thickening and facet arthropathy. Severe spinal stenosis is unchanged. Severe right and mild left neural foramina stenosis is unchanged.L4-L5: Mild diffuse disk bulge, ligamentum flavum thickening and facet arthropathy. Moderate left and mild right neural foraminal stenosis is unchanged. Mild narrowing of the left lateral recess.L5-S1: Diffuse disk bulge and facet arthropathy without spinal or neuroforaminal stenosis.There is a right adrenal nodule consistent with adenoma, grossly unchanged. There are probable tiny right renal T2 hyperintense cysts. Atrophy of the right psoas muscle.

Output: 1.Multilevel degenerative disk disease, increased at L2-L3 and L3-L4.2.Severe central spinal canal stenosis at L2-L3 and L3-L4 is unchanged.3.Prominent disk extrusions at T11-T12 and L3-L4 are unchanged.4.Multilevel neural foraminal narrowing, slightly worse at L2-L3 where it is moderate in degree.


Instruction: Generate impression based on findings.

Input: Cavernous malformation. There is no significant interval change in the T2 and T1 hyperintense lesion with extensive surrounding hemosiderin in the right anterior orbital gyrus that measures up to 15 mm. Likewise, there is an unchanged associated small developmental venous anomaly. There is no evidence of acute intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are grossly intact. There is an unchanged non-enhancing T1 and T2 hypointense lesion within the right occipital bone, which likely represents an intraosseous hemangioma. The extracranial soft tissues are unremarkable.

Output: Unchanged right frontal lobe cavernous hemangioma and associated small developmental venous anomaly.


Instruction: Generate impression based on findings.

Input: Diagnosis: Ataxia, unspecified Disease of spinal cord, unspecifiedClinical question: eval postop changesSigns and Symptoms: s/p cervical decompression The cervical vertebral bodies are appropriate in overall alignment and height. The patient status post laminectomies at C3, C4, C5 which is new since the prior exam. There is redemonstration of atrophy of the cervical spinal cord associated with signal change from the C1 level down to the C7 level. There is a fluid collection present behind the thecal sac extending throughout the laminectomy sites.At C2-3 there is no significant compromise to the spinal canal or neural foramina. There is a disc bulge present at this level. There is partial effacement of spinal fluid ventral and posterior the spinal cord at this level.At C3-4 there is loss of disc space height, disc desiccation, diffuse disc bulge, endplate and uncovertebral osteophytes and effacement of spinal fluid ventral and posterior the spinal cord. There is narrowing of the neural foramina bilaterally at this level with encroachment of exiting nerve roots. Despite laminectomy there is effacement of spinal fluid ventral and posterior the spinal cord.At C4-5 there is loss of disc space height, disc desiccation, diffuse disc bulge, endplate and uncovertebral osteophytes and effacement of spinal fluid ventral and posterior the spinal cord. There is narrowing of the neural foramina bilaterally at this level with encroachment of exiting nerve roots. Despite laminectomy there is effacement of spinal fluid ventral and posterior the spinal cord.At C5-6 there is loss of disc space height, disc desiccation, diffuse disc bulge, endplate and uncovertebral osteophytes and effacement of spinal fluid ventral and posterior the spinal cord. There is narrowing of the neural foramina bilaterally at this level with encroachment of exiting nerve roots. Despite laminectomy there is effacement of spinal fluid ventral and posterior the spinal cord.At C6-7 there is diffuse disc bulge associated with loss of disc space height and disc desiccation, endplate osteophytes and uncovertebral osteophytes with encroachment of the exiting nerve roots bilaterally within the neural foramina and effacement of spinal fluid ventral and posterior the spinal cord. At this level cord signal change appears to be relatively stableAt C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.Since the prior exam, the patient has undergone laminectomies at C3, C4 and C5. 2.There is a fluid collection present at the laminectomies site. There is multilevel spinal stenosis present from the C2-3 level down to the C6-7 level. In part it is possible that the spinal stenosis is related to the fluid collection.3.There is multilevel bilateral neural foramen encroachment of exiting nerve roots present at C3-4, C4-5, C5-6 and C6-7.


Instruction: Generate impression based on findings.

Input: Neck pain. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained. Vertebral body endplate degenerative signal changes are noted, predominantly in the lower cervical spine. Bone marrow signal is within normal limits. No evidence of traumatic injury. Ligamentous structures are intact.The cervical spinal cord has normal signal characteristics and overall morphology within the limits of motion degradation.There are mild disc osteophyte complexes throughout the cervical spine with ligamentum flavum thickening. Other degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: Mild bilateral facet arthropathy and left greater than right disc osteophyte complex resulting in mild left neural foraminal narrowing. No significant compromise to the spinal canal or right neural foramen.C4-5: Bilateral facet arthropathy resulting in mild left neural foraminal narrowing. No significant compromise to the spinal canal or right neural foramen.C5-6: Bilateral facet arthropathy with mild left neural foraminal narrowing. No significant compromise to the spinal canal.C6-7: Mild to moderate bilateral facet arthropathy with mild to moderate left neural foraminal narrowing. No significant compromise to the spinal canal or right neural foramen.C7-T1: Bilateral facet arthropathy with mild to moderate left and mild right neural foraminal narrowing. No significant compromise to the spinal canal.Images are technically degraded, which limits the ability to evaluate the vertebral artery flow voids. Paraspinous soft tissue structures appear within normal limits. The nasogastric tube is partially visualized. Scarring at the lung apices is again noted. The right cerebellar hemisphere infarct is partially visualized.

Output: 1. No evidence of traumatic injury in the cervical spine.2. Mild multilevel degenerative changes, as detailed above, without high-grade stenosis at any level.3. Normal vertebral artery flow voids are not well seen, at least in part related to the motion degradation. Dedicated vascular imaging of the neck can be considered as clinically indicated.


Instruction: Generate impression based on findings.

Input: There are two punctate foci of restricted diffusion in the right superior frontal gyrus and left inferior frontal gyrus. There is diffuse global volume loss that is more focally pronounced in the bilateral hippocampi, greater on the right. There are scattered predominantly subcortical white matter T2 signal abnormalities, with lesser degree of periventricular white matter involvement, along with symmetric involvement of the bilateral external capsules and subinsular white matter. There is no associated susceptibility abnormality. There is unchanged volume loss in the anterior temporal lobes bilaterally with ex vacuo dilatation of the temporal horns. There is a partial empty sella. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable.

Output: 1.Two punctate foci of restricted diffusion in the left inferior frontal gyrus and the right superior frontal gyrus likely representing acute nonhemorrhagic infarcts, although small metastatic lesions are in the differential diagnosis, given the history of colon cancer. Further evaluation with contrast enhanced MRI can be considered, if clinically indicated.2.Predominately peripheral subcortical white matter T2 signal abnormalities suspected to represent chronic distal small vessel infarcts, possibly secondary to vasculitis/vasculopathy, and CADASIL variant. 3.Global volume loss that is most pronounced in the hippocampi, greater on the right. The overall pattern supports the clinical suspicion of Alzheimer's disease.Findings were discussed with Dr. Mastrianni over the telephone at 2:59 p.m. today.


Instruction: Generate impression based on findings.

Input: Diagnosis: Unspecified cerebral artery occlusion with cerebral infarctionClinical question: Eval strokeSigns and Symptoms: Dysarthria MRI of the brainThere is a focus of diffusion restriction involving the left precentral gyrus lateral to the hand motor area. There is associated T2 and FLAIR signal hyperintensity.A small focus of diffusion restriction is present in the periventricular white matter adjacent to the trigone of the right lateral ventricle and the right posterior cerebral artery territory. There is associated T2 and FLAIR signal hyperintensity.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.There are 5-10 punctate subcortical foci of signal loss on susceptibility imaging in the right frontal lobe, right parietal lobe, right temporal lobe, left occipital lobe and left cerebellar hemisphere.Focus of volume loss associated with T2 and FLAIR signal hyperintensity measuring approximately 18 mm diameter and located within the anterior aspect of the left middle frontal gyrus.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and right 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 left vertebral artery flow-void is absentThe visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal right vertebral artery, the basilar artery and the proximal anterior, middle and posterior cerebral arteries. The left vertebral artery is not readily identified.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. There is fetal origin of the posterior cerebral arteries bilaterally with the small P1 segments. The vertebral arteries are similar in size.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the right vertebral artery. The left vertebral artery origin is not identified. The left vertebral artery is not small in the cervical portion, however, it is not identified at V3..The thyroid gland is markedly enlarged and associated with shift of the trachea towards the left side.

Output: 1.Left precentral gyrus focus of acute or subacute infarction located lateral to the hand motor area.2.Right periventricular white matter microinfarct in the acute or subacute stage.3.Findings are suspicious for left vertebral artery occlusion.4.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 5.There is a mild degree of subcortical microhemorrhages present in mainly in the supratentorial brain which is non-specific. Amyloid angiopathy is one possible explanation.6.A small focus of encephalomalacia is present in the left middle frontal gyrus which is most likely related to prior infarction.7.Thyromegaly.


Instruction: Generate impression based on findings.

Input: 65 years, Male, Reason: evaluate for SB lesions, also please note if any pancreatic lesions History: patient has secretory diarrhea and slightly elevated somatostatin level.. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Small left upper pole cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS: MalePROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Severely limited exam. Only a few sequences were obtained, as patient refused to continue exam. No gross abnormalities are identified on this essentially nondiagnostic exam.


Instruction: Generate impression based on findings.

Input: Female, 22 days old, ex 36 5/7 wga, with seizures. Assess for structural brain malformation. Also with metabolic acidosis. A 3 mm focus of very mildly restricted diffusion is seen adjacent to the right frontal horn associated with minimally elevated signal on T1 and FLAIR images. No associated susceptibility is detected.The remainder of the brain demonstrates normal morphology and signal characteristics. The pattern of white matter myelination is appropriate for age. The corpus callosum is fully formed and intact. The pituitary region is unremarkable. The brainstem, cerebellar vermis and cerebellar hemispheres are unremarkable.No evidence of intracranial hemorrhage or any abnormal extra-axial fluid collection is seen. The ventricular system is patent, symmetric and normal in size.Single voxel spectroscopy was performed on regions of predominantly parietal gray matter, predominantly parietal white matter, and the basal ganglia. The spectra obtained from each of these regions is within normal limits. Specifically, the pattern of relatively elevated myoinositol and choline and relatively depressed NAA is typical and expected during the neonatal period. No unusual resonances are detected. No evidence of any clinically significant lactate is seen.

Output: 1. A single small focus of mildly restricted diffusion is seen adjacent to the right frontal horn. This could represent a very tiny ischemic lesion, though the relevance of this finding to the patient's clinical presentation is uncertain. Follow-up imaging in one to two months may be considered if symptomatology does not improve.2. Spectroscopic assessment of gray matter, white matter and basal ganglia regions is within normal limits for the neonatal period. No evidence of clinically significant lactate is seen.


Instruction: Generate impression based on findings.

Input: 59 years Male (DOB:9/3/1957)Reason: Cervical radiculopathy History: arm painPROVIDER/ATTENDING NAME: DALIA H ELMOFTY YASMIN HASAN Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There is multilevel disc desiccation present.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina. There is left-sided facet hypertrophy present at this level and a disc bulge. There are small uncovertebral osteophytes present this level associated with disc material and mild narrowing of the neural foramina bilaterally.At C4-5 there is no significant compromise to the spinal canal or neural foramina. There is mild facet hypertrophy present at this level associated with minor disc bulge. There is mild narrowing of the right neural foramen at this level related to some small right-sided uncovertebral osteophytes and disc material.At C5-6 there is mild loss of disc space height, disc desiccation, diffuse disc bulge, endplate and uncovertebral osteophytes as well as encroachment of the exiting nerve roots within the neural foramina and effacement of spinal fluid ventral and posterior the spinal cord. Overall there is mild to moderate spinal stenosis at this level.At C6-7 there is no significant compromise to the spinal canal . There is a left lateral recess disc protrusion present at this level extending into the left neural foramen which is associated with some uncovertebral osteophytes. There is encroachment of the left-sided exiting nerve roots within the neural foramen 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.Lumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is loss of disc space height, disc desiccation, endplate osteophytes and a diffuse disc bulge at this level associated with mild facet hypertrophy. There is more facet hypertrophy on the left side when compared to the right. There is some mild encroachment of the left-sided exiting nerve roots within the neural foramen at this level.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is bilateral facet and ligamentum flavum hypertrophy at this level associated with a disc bulge.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.There are degenerative changes present in the cervical spine worse at C5-6 and C6-7 where there is mild to moderate spinal stenosis at C5-6 and encroachment of exiting nerve roots bilaterally at C5-6 and on the left-sided C6-7.2.There are some mild degenerative changes present in the lower lumbar spine without significant compromise to the spinal canal or exiting nerve roots.


Instruction: Generate impression based on findings.

Input: Medial knee pain MENISCI: There is vertically oriented increased signal intensity within the posterior horn of the medial meniscus at its root likely representing a focal tear with mild associated edema in the underlying tibial plateau. There is also blunting and thinning of the free edge of the posterior horn of the medial meniscus likely representing mild chronic attritional tearing. There is an additional small defect within the anterior horn of the medial meniscus at its root; this could represent a small tear or a peculiar anatomic variant. The body of the medial meniscus appears normal.The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is diffuse thinning of the articular cartilage of the patella most pronounced centrally where there is near full-thickness to full-thickness articular cartilage loss along with small underlying subchondral cysts. The articular cartilage of the femoral trochlea also appears thinned with a subchondral degenerative lesion noted beneath the medial facet of the trochlea inferiorly and heterogeneity of the overlying articular cartilage which indicates more focal degeneration. There is mild heterogeneity of the articular cartilage of the lateral tibial plateau likely representing relatively mild degeneration. There are small tricompartmental osteophytes.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: There is focal intermediate signal intensity within the distal quadriceps tendon laterally which may reflect focal tendinosis but is of questionable clinical significance, and there is no focal fluid-filled tear. There is mild subcutaneous edema anterior to the patella tendon which is nonspecific.ADDITIONAL

Output: 1. Vertically oriented increased signal intensity within the posterior horn of the medial meniscus at its root suggesting a focal tear.2. Articular cartilage loss further detailed above.3. Other findings as described above.


Instruction: Generate impression based on findings.

Input: 70 year-old male with metastatic adenocarcinoma of the appendix with new right-sided headaches and some unsteadiness. No focality on physical exam. There is no evidence of intracranial hemorrhage, mass or edema. Mild diffuse hypodensities in a periventricular and subcortical distribution consistent with small vessel disease, age indeterminate. If there is clinical concern for acute ischemia, an MRI may be considered.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: Small vessel disease, age indeterminate. If there is clinical concern for acute ischemia, an MRI may be considered.


Instruction: Generate impression based on findings.

Input: Again seen is a syrinx extending from superior C6 to the inferior T1 level and measuring up to 5 mm in maximal diameter, unchanged from prior exam. The spinal cord is otherwise normal in caliber and signal without evidence of pathological enhancement. Cervical spine alignment is anatomic, with a normal cervical lordosis. The vertebral body and disk heights are preserved. No worrisome focal marrow signal abnormality is appreciated. There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the cervical spine. THORACIC SPINE

Output: Cervical and thoracic cord syrinxes appear stable from prior exam.


Instruction: Generate impression based on findings.

Input: 65-year-old woman with a strong family history of breast cancer, including bilateral breast cancer diagnosed in her mother at age 69. Personal history of benign left breast biopsy in 1986, and bilateral breast aspirations. There is heterogeneous amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Medial joint pain MENISCI: Marked destruction of the posterior horn of the medial meniscus without extension into the body. Only portions of the medial anchor remains given extensive fragmentation. Anterior horn is otherwise intact. Lateral meniscus is significant for moderate fraying of the inner edge. A small parameniscal cyst is observed adjacent to the anterior horn of the lateral meniscus.ARTICULAR CARTILAGE AND BONE: Mild thinning with focal 1.5 cm defect involving the posterior aspect of the femoral condyle, and overlying the medial meniscal abnormality described above. Mild overlying bone edema. Otherwise moderate changes most pronounced underlying the patella, without additional focal defects. Marrow signal otherwise intact other than scattered degenerative changes with numerous cysts, otherwise observed in the tibial plateau.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Large knee effusion with associated fragmentation and destruction of the posterior horn of the medial meniscus. See description and the associated overlying adjacent cartilaginous defect.


Instruction: Generate impression based on findings.

Input: 19 year old with abnormal echocardiogram, with concern for non-compaction. MRI done for further evaluation. Left VentricleThe left ventricle is normal in size and function. The overall LV ejection fraction is 55%. The LVEDV is 226 ml (normal range 142+/-34), the LV end diastolic volume index is 121 ml/m2 (normal range: 74+/-15), the LVESV is 103 ml (normal range 47+/-19) and the LV end systolic volume index is 55 ml/m2 (normal range 25+/-9). The LV mass is 141 g (normal range 164+/-36) and the LV mass index is 75 g/m2 (normal range 85+/-15). 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. There are findings consistent with noncompaction in the left ventricle, focused in the left ventricular apical endocardium as well as the anterior mid ventricle. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and function. The overall RV ejection fraction is 50%. The RVEDV is 212 ml (normal range 142+/-31), RV end diastolic volume index is 113 ml/m2 (normal range 82+/-16), the RVESV is 107 ml (normal range 54+/-17), and the RV end systolic volume index is 57 ml/m2 (normal range 31+/-9). There are findings consistent with noncompaction, focused on the lateral right ventricular wall. Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve is trileaflet, 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 drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Left ventricle is normal in size and function. The overall LV ejection fraction is 55%.2. Right ventricle is normal in size and function. The overall RV ejection fraction is 50%.3. Presence of noncompaction in the left ventricle, focused in the left ventricular apical endocardium as well as the anterior mid ventricle. There is also presence of noncompaction in the right ventricle, focused on the free wall.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: BRAIN: There is abnormal T2 hyperintensity noted on the FLAIR sequence within the occipital horns, anterior suprasellar cistern, interpeduncular cistern and sylvian fissures compatible with subarachnoid and intraventricular hemorrhage. There is no MR evidence of tentorial subdural hematoma. The prior CT findings were likely artifactual. Additional T2 hyperintensity on the FLAIR sequence within multiple parietal and occipital sulci is most likely artifactual secondary to sedation and oxygenation.The intraventricular hemorrhage demonstrates susceptibility effect. Additional susceptibility effect is present within the fourth ventricle, secondary to additional blood products versus choroid plexus. There is unchanged mild dilatation of the temporal horns. There are abnormal patchy foci of T2 hyperintensity within the deep frontal and parietal white matter. There is no evidence of acute infarct. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull and scalp soft tissues are unremarkable. There is paranasal sinus mucosal thickening and fluid within the bilateral mastoid air cells.MRA HEAD: Images are somewhat limited by artifact likely due to patient positioning during the exam. The intracranial internal carotid arteries are normal in course and caliber. The middle and anterior cerebral arteries are unremarkable. The vertebral arteries, basilar artery, and posterior cerebral arteries are normal in course and caliber. There is no evidence of flow-limiting stenosis or aneurysm.MRV HEAD: No evidence of thrombosis within the major dural venous sinuses or major cerebral veins.

Output: 1.Scattered mild subarachnoid hemorrhage and intraventricular hemorrhage with unchanged mild ventricular dilatation. This may possibly be secondary to cyclosporine toxicity or coagulopathy.2.Patchy white matter signal abnormalities are nonspecific with the differential including infectious/inflammatory etiologies, but could also be seen with intracranial manifestation of the patient's known HLH. No evidence of corresponding enhancement.3.No evidence of intracranial aneurysm, vascular malformation or venous sinus thrombosis.4.Paranasal sinus mucosal thickening and mastoid air cell fluid may be infectious or secondary to intubation. Please correlate clinically.


Instruction: Generate impression based on findings.

Input: Female, 23 years old. Fall, pain and swelling. MENISCI: The medial and lateral menisci are intact.ARTICULAR CARTILAGE AND BONE: No significant abnormality noted.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Normal MRI appearance of the knee without specific findings to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: 25-year-old female with multiple liver lesions, deemed to be FNH. Please do FNH protocol. Previous Ewing's sarcoma. ABDOMEN:LIVER, BILIARY TRACT: The liver measures 20 cm in craniocaudal dimension. There is diffuse loss of signal on out of phase imaging indicating hepatic steatosis.Multiple T2 hyperintense lesions are again seen throughout the liver parenchyma. In the posterior right hepatic dome a T2 hyperintense, arterially enhancing lesion measures 3.2 x 1.8 cm (series 1403, image 292), previously 1.9 x 1.2 cm. This lesion does not retain contrast on the delayed hepatobiliary phase images.Numerous additional T2 hyperintense, arterially enhancing hepatic lesions retain contrast on hepatobiliary phase imaging compatible with focal nodular hyperplasia and appear similar in size and appearance when compared to the previous exam.A nonenhancing lesion anteriorly in the left lobe the liver measures 1.3 x 1.0 6 cm, it is T2 hyperintense and T1 hypointense compatible with a simple cyst.No intra or extrahepatic biliary ductal dilatation. No cholelithiasis. The hepatic vasculature appears patent.SPLEEN: The spleen measures 9.8 cm in craniocaudal dimension.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Right lower lobe peribronchial vascular soft tissue thickening was better evaluated on prior chest CTs.

Output: 1.Hepatic steatosis. 2.Interval increase in size of posterior right hepatic dome lesion. Given the lack of persistent enhancement this is favored to represent an adenoma, particularly the inflammatory subtype (given avid enhancement particularly in arterial phase and background of diffuse hepatic steatosis), although an atypical FNH is not entirely excluded.3.Additional lesions throughout the liver parenchyma are stable and have imaging features compatible with FNH.


Instruction: Generate impression based on findings.

Input: Left submandibular lymphadenopathy: tender left lymphadenopathy. MDS progressed to AML, admitted for initiation of chemotherapy. There is an enlarged and hyperenhancing left level 1B lymph node that measures up to 20 mm, with inflammatory changes in the surrounding fat planes. There is no evidence of abscess or hematoma. There is no significant lymphadenopathy in the rest of the neck. The salivary glands and thyroid are unremarkable. The bone marrow appears to be diffusely heterogeneous. The imaged intracranial structures and orbits are unremarkable. There is a retention cyst in the left maxillary sinus.

Output: 1. Findings suggestive of left submandibular lymphadenitis and associated cellulitis, but no evidence of abscess or hematoma.2. The diffusely heterogeneous bone marrow appearance may be related to the hematological malignancy.


Instruction: Generate impression based on findings.

Input: Shoulder instability ROTATOR CUFF: No significant abnormality noted.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is mild fraying of the posterior labrum but no full-thickness detachment is identified. There is mild flattening of the anterior aspect of the humeral head likely the result of remote dislocation.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: Mild fraying of the posterior labrum without full-thickness detachment and mild flattening of the anterior humeral head, which is likely posttraumatic. This findings are not significantly changed from the prior exam and no additional abnormality is identified.


Instruction: Generate impression based on findings.

Input: CNS lymphoma and lymphoplasmacytic lymphoma/Waldenstrom macroglobulinemia status post 4 cycles of MTR chemotherapy, now with new blindness. There has been interval progression of infiltrative abnormal enhancement involving the optic apparatus. In particular, there is now swelling and enhancement involving the intraorbital, canalicular, and prechiasmatic segments of the left optic nerve, as well as the canalicular and prechiasmatic segments of the right optic nerve and optic chiasm, right greater than left, with extension into the adjacent optic pathway. There is persistent swelling, but decreased enhancement of the left trigeminal nerve and persistent T2 hyperintensity in the left lateral pons along the course of the trigeminal nerve fibers, also without residual enhancement. There are also new subcentimeter areas of leptomeningeal enhancement along the right cerebellar tonsil and left cerebellomedullary junction region, as well as ependymal and subependymal enhancement in the right frontal horn. There are unchanged nonspecific foci of T2 hyperintensity without corresponding enhancement in the cerebral white matter. There is no evidence of acute infarction or intracranial hemorrhage. There is no significant interval change in the size of the ventricular system. There is no midline shift or herniation. The skull and scalp soft tissues are unremarkable. There is diffuse moderate paranasal sinus mucosal thickening. There is mild fluid signal within the mastoid air cells.

Output: 1. Interval progression of infiltrative abnormal enhancement involving the optic apparatus likely related to involvement by lymphoplasmacytic lymphoma. 2. New areas of leptomeningeal enhancement along the right cerebellar tonsil and left cerebellomedullary junction region, as well as ependymal and subependymal enhancement in the right frontal horn also likely represent involvement by lymphoplasmacytic lymphoma. 3. Persistent swelling, but decreased enhancement of the left trigeminal nerve also likely related to lymphoplasmacytic lymphoma. 4. Findings suggestive of sinusitis.


Instruction: Generate impression based on findings.

Input: Recurrent nasopharyngeal carcinoma treated with CRT completed July 2016 with worsening left mandible pain, left parotid swelling, and skull base findings of nasolaryngoscopy concerning for ORN and/or osteomyelitis. There is a heterogeneously enhancing mass in the left in the upper left post-styloid parapharyngeal space and extending into the hypoglossal canal and jugular foramen, measuring up to approximately 23 mm in axial section, which is not significantly changed. There is no significant intracranial component or tumor and the left pterygopalatine fossa region appears unchanged. There are persistently diminished adjacent sigmoid and internal jugular venous flow voids. There are denervation changes involving the left masticator and tongue muscles, with associated diffuse edema and enhancement. There is unchanged asymmetric effacement of the left lateral nasopharyngeal recess with diffuse mucosal enhancement and surrounding inflammatory changes, but otherwise no evidence of gross tumor in this particular location. There is diffuse central skull base enhancement and diffuse right sphenoid sinus mucosal thickening. There is also abnormal bone marrow signal in the left mandible with an apparent defect in the left mandibular ramus, with surrounding reticular subcutaneous fat enhancement. There also appears to be mild inflammation of the anterior portion of the left parotid gland and what may represent focal dilatation of the left parotid duct near the ampulla, with a punctate central focus of low signal. There is fluid within the left mastoid air cells and middle ear. There is no significant cervical lymphadenopathy. The orbits and imaged brain parenchyma are grossly unremarkable.

Output: 1. The treated recurrent tumor in the left in the upper left post-styloid parapharyngeal space and extending into the hypoglossal canal and jugular foramen has not significantly changed, along with denervation effects in the left masticator and tongue muscles.2. Diffuse central skull base bone marrow abnormality may represent treatment effects, including osteonecrosis, and/or osteomyelitis, perhaps related to sphenoid sinusitis.3. Findings compatible with left mandible osteonecrosis, perhaps with superimposed osteomyelitis and cellulitis and an apparent pathological fracture, for which a maxillofacial CT may aid in further delineation.4. Apparent mild inflammatory changes in the anterior left parotid gland, which may be related to extension from adjacent inflammatory process or perhaps related to ductal obstruction from a calculus. CT may be useful for further evaluation of this as well.5. Fluid within the left mastoid air cells and middle ear may be secondary to Eustachian tube obstruction, perhaps with superimposed otomastoiditis.


Instruction: Generate impression based on findings.

Input: History of hepatocellular carcinoma status post TACE/RFA. History of HBV cirrhosis. ABDOMEN:LIVER, BILIARY TRACT: The left hepatic lobe ablation cavity measures 1.9 x 1.4 cm (series 8/228), unchanged. Adjacent to the dorsal aspect of this ablation cavity is a 2.7 x 2.8 cm poorly enhancing mass with associated intermediate T2 weighted signal hyperintensity and restricted diffusion, not definitively seen on the prior study. There is associated poorly enhancing suspected tumor thrombus in the left portal vein and possible involvement of the bile duct.Right hepatic lobe superior peripheral ablation cavity measures 2.8 x 1.8 cm (series 8/222), compared to 2.6 x 1.8 cm previously containing proteinaceous/hemorrhagic debris, unchanged.The right hepatic lobe inferior peripheral ablation cavity measures approximately 2.8 x 1.4 cm (series 8/226), compared to 3.4 x 1.9 cm previously containing proteinaceous/hemorrhagic debris.The more medial right hepatic lobe ablation cavity measures 2.8 x 1.3 cm (series 8/226), compared to 2.5 x 1.8 cm previously, not significantly changed.Stable punctate hypervascular lesion in the left lateral segment of liver compatible with a portal to hepatic venous shunt. The right and main portal vein is patent. The visualized hepatic artery is patent. No stigmata of portal hypertension.Cirrhotic liver morphology including hypertrophy of the left hepatic and caudate lobes. Significant atrophy of the right hepatic lobe. Status post cholecystectomy.Demonstrated again is common bile duct dilatation up to 13 mm which tapers smoothly to the level of the ampulla, unchanged and likely related to age and postcholecystectomy state. No filling defect to suggest a mass or stone. The cystic duct remnant is noted.SPLEEN: No significant abnormality noted.PANCREAS: Stable 4 mm pancreatic head sidebranch IPMN.ADRENAL GLANDS: Punctate renal cysts are noted bilaterally, unchanged.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Stable nonspecific mild elevation of the left hemidiaphragm.OTHER: No significant abnormality noted.

Output: 1.New 2.8 cm segment 3 lesion just dorsal to the left hepatic lobe ablation cavity demonstrating poor enhancement and suspected tumor thrombus of the left portal vein. This does not meet imaging criteria for hepatocellular carcinoma. Differential considerations include atypical hepatocellular carcinoma, cholangiocarcinoma and cholangiohepatoma.2.Stable postablation changes of the right hepatic lobe without evidence of marginal recurrence.


Instruction: Generate impression based on findings.

Input: Reason: hx of elevated PSA, evaluate for disease, Fusion biopsy to follow History: see above PELVIS:PROSTATE:Prostate Size: 5.3 x 4.0 x 4.6 cmPeripheral Zone: No suspicious lesions are evident.Central Gland: Multiple BPH 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: 1.No suspicious lesions are evident.2.No pelvic lymphadenopathy.


Instruction: Generate impression based on findings.

Input: 78-year-old female, follow for sarcoma Again seen is a large mass situated along the posterior compartment of the left mid thigh. The mass is decreased in transverse dimensions and slightly elongated and CC dimension, now measuring 15 cm in CC dimension and 5.2 x 5.6 cm in transverse dimensions (previously 11.2 x 9 x 7 cm). There has been interval cystic degeneration of the mass with multiple fluid fluid levels and no significant internal enhancement. The mass displaces the adjacent musculature. Mild edema and enhancement of the surrounding tissues particularly along the cranial most aspect of the mass may in part represent treatment effect. The underlying osseous structures appear normal, without evidence of disease involvement.

Output: Interval cystic degeneration of the large posterior thigh mass consistent with treatment effect as described above.


Instruction: Generate impression based on findings.

Input: NF-2, bilateral vestibular schwannomas who presents with acute on chronic gait worsening with extramedullary lesions observed on MRI causing thoracic spinal cord compression, status post thoracic spinal cord lesion removal. There are interval postoperative findings related to resection of an intradural extramedullary meningioma at the T4 level via bilateral T3, T4, and T5 laminectomy. There is fluid within the paraspinal space and epidural space along the surgical approach with associated narrowing of the thecal sac, such that there is minimal cerebrospinal fluid surrounding the spinal cord at the T3 though T5 levels. However, there is no measurable residual meningioma at this level. There are otherwise unchanged multiple enhancing tumors within the spinal canal, including an intradural extramedullary tumor that measures 5 mm in thickness within the left anterolateral aspect of the spinal canal at C4 and numerous subcentimeter nodules along the conus and nerve roots of the cauda equina. There are also multiple unchanged enhancing lesions within the cervical and upper thoracic spinal cord. The previously demonstrated bilateral internal auditory canal lesions are only partially-imaged. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable.

Output: 1. Interval postoperative findings related to resection of an intradural extramedullary meningioma at the T4 level via bilateral T3, T4, and T5 laminectomy. There is fluid within the paraspinal space and epidural space along the surgical approach with associated narrowing of the thecal sac, such that there is minimal cerebrospinal fluid surrounding the spinal cord at the T3 though T5 levels. However, there is no measurable residual meningioma at this level. 2. An intradural extramedullary tumor that measures 5 mm in thickness within the left anterolateral aspect of the spinal canal at C4 likely represents a meningioma.3. Numerous subcentimeter nodules along the conus and nerve roots of the cauda equina likely represent peripheral nerve sheath tumors. 4. Multiple lesions within the cervical and upper thoracic spinal cord likely represent ependymomas.5. The previously demonstrated bilateral internal auditory canal lesions are only partially-imaged.